ROUNDUP MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- ROUNDUP MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0245848)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-15
- IRS object ID
- 201931359349312033
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-15T16:30:22-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 EAST FRONT STREET 301 | AddressLine1Txt |
| City | MISSOULA | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59802 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810245848 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROUNDUP MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | ROUN | BusinessNameControlTxt |
| Phone | 4063232301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 40 | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59072 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | HOLLY WOLFF | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4063232301 | PhoneNum |
| Signature | 2019-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PHILIP L YASENAK CPA | PreparerPersonNm |
| PTIN | P01248379 | PTIN |
| Phone | 4067281800 | PhoneNum |
| Preparation | 2019-05-15 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 65.158.74.97 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-05-15 | IPDt |
| IP Tm | 14:58:27 | IPTm |
| IP Timezone | MD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BE7A92E7B0152C1C6812F3C99C620D56F411D8FD | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | HOLLY WOLFF | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 40 | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59072 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,199,329 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RMHMT.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE HEALTHCARE SERVICES | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 107 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $311,495 | PYContributionsGrantsAmt |
| CY Contributions Grants | $388,317 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $7,041,387 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,539,636 | CYProgramServiceRevenueAmt |
| PY Investment Income | $678 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,885 | CYInvestmentIncomeAmt |
| PY Other Revenue | $378,170 | PYOtherRevenueAmt |
| CY Other Revenue | $269,491 | CYOtherRevenueAmt |
| PY Total Revenue | $7,731,730 | PYTotalRevenueAmt |
| CY Total Revenue | $9,199,329 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,017,567 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,203,747 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $225 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $3,475,142 | PYOtherExpensesAmt |
| CY Other Expenses | $4,438,337 | CYOtherExpensesAmt |
| PY Total Expenses | $7,492,709 | PYTotalExpensesAmt |
| CY Total Expenses | $8,642,084 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $239,021 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $557,245 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,877,633 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,196,278 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,037,178 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,798,578 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $2,840,455 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,397,700 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | IT IS THE MISSION OF THE ROUNDUP MEMORIAL HOSPITAL TO ACCEPT THE ONGOING CHALLENGE OF PROVIDING FOR THE HEALTHCARE NEEDS OF ALL OF OUR CITIZENS. IT IS OUR SINCERE DESIRE TO HEAL THE SICK AND COMFORT THE SUFFERING WITH ALL THE RESOURCES WE HAVE AVAILABLE. AS GOOD STEWARDS OF THESE INSTITUTIONS, EMPLOYEES WILL HELP ENSURE THE SURVIVAL OF THE HOSPITAL BY BEING COMMITTED TO THE CARE AND WELL-BEING OF THOSE THEY SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $6,750,539 | ExpenseAmt |
| Revenue | $8,809,127 | RevenueAmt |
| Desc | CRITICAL ACCESS HOSPITAL - ROUTINE SERVICE FOR ADULTS, PEDIATRICS, AND SWING BED. RURAL HEALTH CLINIC WITH FOUR PROVIDERS. OTHER SERVICES INCLUDE BUT ARE NOT LIMITED TO ANCILLARIES; CT SCANS; LABORATORY; PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES; PHARMACY; EMERGENCY ROOM; X-RAY; CENTRAL SUPPLY; INTRAVENOUS SOLUTIONS; ULTRASOUND; ELECTROCARDIOGRAPHY; OBSERVATION; BLOOD BANK; AND PATHOLOGY. | Desc |
| Total Program Service Expenses | $6,750,539 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (1) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 107 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (1) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROUNDUP MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4063232301 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1202 THIRD STREET WEST | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59702 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JOHN PFISTER | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK ROSEBUSH DMD | |||||||
| VICE PRESIDENT | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KEN MOSDAL | |||||||
| TREASURER | 0.50 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRYAN ADOLPH | |||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| THERESA DOUMITT | |||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| MARSHALL WHITE MD | |||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| LEONARD WALL | |||||||
| DIRECTOR | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| BRADLEY C HOWELL | |||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| KYLE GEE | |||||||
| CFO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| KEVIN CRISWELL | |||||||
| PHYSICAL THERAPIST | 40.00 | $162,293 | $0 | $6,120 | Yes (X) | ||
| BRYNN BIXBY | |||||||
| PA | 40.00 | $128,424 | $0 | $0 | Yes (X) | ||
| DEB SHIELDS | |||||||
| PA | 40.00 | $121,183 | $0 | $12,246 | Yes (X) | ||
| VALERI RUSSELL | |||||||
| PA | 40.00 | $112,306 | $0 | $16,536 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $524,206 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $34,902 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BILLINGS CLINIC | |||||
| PO BOX 37000 | BILLINGS | MT | 59107 | MANAGEMENT SERVICES | $910,371 |
| FISHER CONSTRUCTION | |||||
| 235 MOORE LN | BILLINGS | MT | 59101 | CLINIC REMODEL | $106,816 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $222,619 | GovernmentGrantsAmt |
| All Other Contributions | $165,698 | AllOtherContributionsAmt |
| Total Contributions | $388,317 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| INPATIENT/OUTPATIENT R | 621110 | $8,242,186 | $8,242,186 |
| 340B REVENUE | 446110 | $163,574 | $163,574 |
| OTHER OPERATING REVENU | 900099 | $133,876 | $133,876 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,539,636 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,885 | TotalRevenueColumnAmt |
| Exclusion | $1,885 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,840 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,840 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,840 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $1,840 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| TAX REVENUE | 900099 | $217,221 | $217,221 |
| REBATES/REFUNDS | 900099 | $50,430 | $50,430 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $267,651 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,199,329 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,809,127 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,885 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,411,621 | TotalAmt |
| Program Services | $2,966,243 | ProgramServicesAmt |
| Management And General | $445,378 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,362 | TotalAmt |
| Management And General | $42,362 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450,353 | TotalAmt |
| Program Services | $340,124 | ProgramServicesAmt |
| Management And General | $110,229 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,411 | TotalAmt |
| Program Services | $212,237 | ProgramServicesAmt |
| Management And General | $87,174 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $666,949 | TotalAmt |
| Program Services | $369,654 | ProgramServicesAmt |
| Management And General | $297,295 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,571 | TotalAmt |
| Management And General | $105,571 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,249 | TotalAmt |
| Program Services | $10,004 | ProgramServicesAmt |
| Management And General | $32,245 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,231,678 | TotalAmt |
| Program Services | $1,011,098 | ProgramServicesAmt |
| Management And General | $220,580 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,489 | TotalAmt |
| Management And General | $49,489 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,268 | TotalAmt |
| Program Services | $9,330 | ProgramServicesAmt |
| Management And General | $24,938 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $237,316 | TotalAmt |
| Management And General | $237,316 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $146,023 | TotalAmt |
| Program Services | $146,023 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $57,318 | TotalAmt |
| Program Services | $44,569 | ProgramServicesAmt |
| Management And General | $12,749 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,865 | TotalAmt |
| Program Services | $14,583 | ProgramServicesAmt |
| Management And General | $5,282 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,121 | TotalAmt |
| Management And General | $18,121 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $290,790 | TotalAmt |
| Program Services | $269,928 | ProgramServicesAmt |
| Management And General | $20,862 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,995 | TotalAmt |
| Management And General | $82,995 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $648,488 | $648,488 | |
| BAD DEBT EXPENSE | $475,273 | $475,273 | |
| REPAIRS & MAINTENANCE | $114,167 | $111,627 | $2,540 |
| OTHER SUPPLIES | $95,497 | $64,578 | $30,919 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,280 | TotalAmt |
| Program Services | $56,780 | ProgramServicesAmt |
| Management And General | $65,275 | ManagementAndGeneralAmt |
| Fundraising | $225 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,642,084 | TotalAmt |
| Program Services | $6,750,539 | ProgramServicesAmt |
| Management And General | $1,891,320 | ManagementAndGeneralAmt |
| Fundraising | $225 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $868,557 | BOYAmt |
| EOY | $176,015 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $951,634 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,855,048 | BOYAmt |
| EOY | $1,599,801 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $131,233 | BOYAmt |
| EOY | $154,807 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $42,856 | BOYAmt |
| EOY | $58,260 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $10,369,327 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $8,196,878 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,979,939 | BOYAmt |
| EOY | $2,172,449 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $83,312 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,877,633 | BOYAmt |
| EOY | $5,196,278 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $505,431 | BOYAmt |
| EOY | $614,715 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,259,853 | BOYAmt |
| EOY | $1,183,863 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $271,894 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,037,178 | BOYAmt |
| EOY | $1,798,578 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,824,578 | BOYAmt |
| EOY | $3,381,823 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,877 | BOYAmt |
| EOY | $15,877 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,840,455 | BOYAmt |
| EOY | $3,397,700 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,877,633 | BOYAmt |
| EOY | $5,196,278 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $557,245 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | 0 | FSAuditedInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,725,661 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,950,357 | DepreciationAmt |
| Book Value | $775,304 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,604,846 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,246,521 | DepreciationAmt |
| Book Value | $1,358,325 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $38,820 | OtherCostOrOtherBasisAmt |
| Book Value | $38,820 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,172,449 | TotalBookValueLandBuildingsAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $79,103 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $79,103 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00920 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,914,239 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,816,574 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $97,665 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,993,342 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,816,574 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $176,768 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02050 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,603 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,356 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,247 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $21,603 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,356 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $13,247 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,014,945 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,824,930 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $190,015 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02200 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,080 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,080 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,080 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $475,273 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $191,110 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,618,251 | ReimbursedByMedicareAmt |
| Medicare Surplus Or Shortfall | $4,618,251 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROUNDUP MEMORIAL HOSPITAL ASSOCIATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1202 3RD STREET WEST | AddressLine1Txt |
| City | ROUNDUP | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59072 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | RURAL HEALTH CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROUNDUP MEMORIAL HOSPITAL ASSOC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.RMHMT.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.RMHMT.ORG | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.RMHMT.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.RMHMT.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| None Made | Yes (X) | NoneMadeInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | ROUNDUP MEMORIAL HOSPITAL ASSOC | FormAndLineReferenceDesc |
| Explanation | PART V, SECTION B, LINE 6B: THE MONTANA OFFICE OF RURAL HEALTHTHE NATIONAL RURAL HEALTH RESOURCE CENTER | ExplanationTxt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART III, LINE 3: | APPROXIMATELY 40% OF TOTAL BAD DEBT EXPENSE IS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. |
| PART III, LINE 9B: | POLICY STATES UP FRONT THAT ADMISSIONS REPRESENTATIVE IS TO GIVE FINANCIAL ASSISTANCE PAPERWORK WITH INFORMAION ON CHARITY CARE AT THE TIME OF ADMISSION. FOLLOW UP CONSULTATION IS DONE LATER TO INCLUDE FINANCIAL ASSISTANCE DISCUSSIONS WITH PATIENT. |
| PART VI, LINE 2: | IN 2018, THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT. THE STEERING COMMITTEE INCLUDED REPRESENTATIVES FROM THE LOCAL MEDIA, EMS, PUBLIC HEALTH, THE SCHOOL SYSTEM, AGENCY ON AGING, AND MENTAL HEALTH IN ADDITION TO THE HOSPITAL CLINICAL AND ADMINISTRATIVE STAFF. ONE FOCUS GROUP AND FIVE KEY INFORMANT MEETINGS WERE HELD TO GATHER INFORMATION ON HEALTHCARE NEEDS AND DESIRES. |
| PART VI, LINE 3: | WHEN A PATIENT INDICATES THAT A FINANCIAL HARDSHIP EXISTS, THE HOSPITAL PROVIDES INFORMATION ON THE HOSPITAL CHARITY PLAN AND OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS. |
| PART VI, LINE 4: | ROUNDUP MEMORIAL HEALTHCARE (RMH) IS THE SOLE COMMUNITY HEALTHCARE PROVIDER FOR MUSSELSHELL COUNTY, A RURAL AREA WITH A POPULATION DENSITY OF 2.4 PER SQUARE MILE. NO OTHER HOSPITALS SERVE THE COMMUNITY AND THE NEAREST HEALTHCARE FACILITY IS LOCATED IN BILLINGS, 45 MILES TO THE SOUTH. PER THE 2010 FEDERAL CENSUS, THE COUNTY POPULATION WAS 4,538; THE PER CAPITA INCOME IN THE COUNTY IS $19,164 AND THE PERCENTAGE OF PERSONS BELOW THE POVERTY LINE WAS 20.5 PERCENT. IN 2006, 26.4 PERCENT OF MUSSELSHELL COUNTY WAS UNINSURED. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION HAS DESIGNATED MUSSELSHELL COUNTY AS AN UNDERSERVED AREA WITH A SCORE OF 16. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KEVIN CRISWELL | PersonNm |
| Title | PHYSICAL THERAPIST | TitleTxt |
| Base Compensation Filing Org | $162,293 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $6,120 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $168,413 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|
| BRAD HOWELL | ||
| MR. HOWELL IS ROUNDUP MEMORIAL HOSPITAL ASSOCIATION'S CEO. | MR. HOWELL IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CEO FROM BILLINGS CLINIC, INC. | 0 |
| KYLE GEE | ||
| MR. GEE IS ROUNDUP MEMORIAL HOSPITAL ASSOCIATION'S CFO. | MR. GEE IS AN EMPLOYEE OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR HIS SERVICES AS CEO FROM BILLINGS CLINIC, INC. | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | LEONARD WALL AND BRYAN ADOLPH - FAMILY RELATIONSHIP |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS CONTRACTED WITH BILLINGS CLINIC TO PROVIDE MANAGEMENT SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERS OF HOSPITAL ASSOCIATION 501 (C)(3) |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS REVIEWED BY THE CEO, CFO, AND CONTROLLER AND IS DISTRIBUTED TO THE BOARD BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE COMPLIANCE OFFICER MONITORS AND EVALUATES CONFLICT OF INTEREST ISSUES. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CEO IS COMPENSATED ACCORDING TO ARRANGEMENTS WITH THE MANAGEMENT AGREEMENT WITH BILLINGS CLINIC, WHO RECOMMENDS THE CEO SALARY TO THE BOARD FOR APPROVAL. THE HOSPITAL UTILIZES THE MONTANA HOSPITAL ASSOCIATION AND ASSOCIATED EMPLOYEES SALARY SURVEY TO DETERMINE SALARIES OF KEY EMPLOYEES. |
| FORM 990, PART VI, SECTION C, LINE 19 | AVAILABLE UPON REQUSET TO THE CEO. |
| FORM 990, PART IX, LINE 11G | OTHER FEES & CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,011,098. MANAGEMENT AND GENERAL EXPENSES 220,580. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,231,678. |