2018-05-15T11:13:08-05:00 2017-06-30 390758449 Wipfli LLP PO Box 1699 Helena MT 59624 990 2016-07-01 816016920 Daniels Memorial Hospital dba Daniels Memorial Healthcare Center DANI 4064875331 P O Box 400 Scobey MT 59263 Dave Ryerse CEO 4064875331 2018-05-14 1 Nathan D McCarthy CPA P00368408 4064425520 2018-05-14 2016 2022-09-23 18:48:47Z Dave Ryerse P O Box 400 Scobey MT 59263 7333336 0 X www.danielsmemorialhealthcare.org X 1956 MT TO PROMOTE THE GENERAL HEALTH CARE OF THE COMMUNITY THROUGH PROVIDING HIGH QUALITY HEALTH CARE AND A HOME FOR THE AGED AND INFIRM. 10 10 121 6 0 0 343011 197892 6444336 6703050 635 354 479486 432040 7267468 7333336 0 0 0 0 4173463 4540326 0 0 0 3568543 3184512 7742006 7724838 -474538 -391502 3119674 2810135 1302993 1384956 1816681 1425179 X To provide a health care system with clinic, acute inpatient, emergency, outpatient, and long-term care services to all patients regardless of their ability to pay. 0 1 4365017 5808898 PROFESSIONAL CARE - PRIMARY, ACUTE AND LONG TERM CARE. 1066179 1270640 CLINIC SERVICES FOR OUTPATIENT CLIENTS. 555939 HOUSEKEEPING, LAUNDRY, LINEN & PLANT SERVICES - PROVIDE FOR THE HOUSEKEEPING AND BUILDING MAINTENANCE OF THE FACILTIY. 444415 55552 DIETARY SERVICES FOR ACUTE AND LONG TERM CARE PATIENTS. Other Unrestricted 444415 55552 6431550 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 4 0 1 121 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 1 1 1 0 0 X DANIELS MEMORIAL HOSPITAL 4064872296 105 5TH AVENUE EAST Scobey MT 59263 X Paul Kanning Chair 2.00 X X 0 0 0 Susan Ferestad Vice Chair 2.00 X X 0 0 0 Jedda Barron Secretary 2.00 X X 0 0 0 Jack Pittenger Treasurer 2.00 X X 0 0 0 Mike BJARKO Director 2.00 X 0 0 0 Perry Wolfe Director 2.00 X 0 0 0 Kristin Bekker Director 2.00 X 0 0 0 Jamie Zumbuhl Director 2.00 X 0 0 0 Corey Lindsay Director 2.00 X 0 0 0 JR Maldonado Director 2.00 X 0 0 0 Dave Ryerse CEO 40.00 X 0 0 0 Dr Donald Sawdey DO 40.00 X 183932 0 3865 Zoe McCarty Fugere FNP 40.00 X 162193 0 24467 Shirley Reller PT 40.00 X 131243 0 23958 Linda Wolford Lab/Radiology Manager 40.00 X 109149 0 9822 Kimberly Wolfe Director of Nursing 40.00 X 102672 0 9822 689189 0 71934 5 0 1 0 Billings Clinic 2800 10th Ave North Billings MT 59107 Management Services 174588 1 197892 197892 Professional Care Reve 623000 5498740 5498740 Clinic Revenue 623000 1204310 1204310 6703050 354 354 450 0 450 450 450 Hosplital Tax district 623000 260000 260000 Income/Loss from Insur 623000 -14295 -14295 185885 185885 431590 7333336 7135090 0 354 3393414 3092391 301023 885152 803640 81512 261760 243704 18056 22541 743 21798 34868 22142 12726 50404 45224 5180 43740 24743 18997 2486 2486 258382 258382 116190 3589 112601 Contractual Services 1045575 704522 341053 Professional Fees 548201 252474 295727 MEDICAL SUPPLIES AND PH 381867 381867 Supplies 224767 203813 20954 455491 394316 61175 7724838 6431550 1293288 0 651524 168516 32000 32000 884276 888833 364081 207406 189378 50261 78992 5870381 4976282 1085869 894099 208338 194236 3119674 2810135 1302673 1384443 320 513 1302993 1384956 X 1812681 1401852 4000 23327 1816681 1425179 3119674 2810135 -391502 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 13500 13500 3635217 3168658 466559 2182483 1783257 399226 39181 24367 14814 894099 Resident Cash 513 Subscribers equity in insurance cap 193723 194236 Resident Trust Fund 513 513 X 7333336 0 7333336 0 7333336 7724838 0 7724838 0 7724838 Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Hospital is also exempt from state income taxes on related income. Federal and state income taxes are paid on nonexempt unrelated business income in accordance with the Code. Current accounting guidelines require an organization to determine whether it is more likely than not that a tax position will be sustained upon examination of the technical merits of the position, assuming the taxing authority has full knowledge of all information. If the tax position does not meet the more-likely-than-not recognition threshold, the benefit of that position is not recognized in the financial statements. The Hospital recorded no assets or liabilities related to uncertain tax positions. Federal returns for tax years 2014 and beyond remain subject to examination by the Internal Revenue Service. 1 1 1 X 1 X 1 1 0 1 1 28065 28065 0.00360 28591 28591 0.00370 56656 56656 0.00730 119562 3750 115812 0.01500 37672 3385 34287 0.00440 157234 7135 150099 0.01940 213890 7135 206755 0.02670 1050 1441 1441 0.00020 140 140 0.00000 1050 1581 1581 0.00020 0 189438 142078 2714593 2875340 -160747 X 1 1 1 1 Daniels Memorial Hospital PO Box 400 Scobey MT 59263 www.danielsmemorialhealthcare.org X X X X Rural health clinic Daniels Memorial Healthcare Center 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X www.danielsmemorialhealthcare.org X X 1 16 1 www.danielsmemorialhealthcare.org 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X www.danielsmemorialhealthcare.org X www.danielsmemorialhealthcare.org X www.danielsmemorialhealthcare.org X X X X X X 1 X X 1 X X X X 1 0 0 Daniels Memorial Healthcare Center Part V, Section B, Line 5: A FEW OF THE SURVEY QUESTIONS WERE MODIFIED AND ADDITIONAL QUESTIONS WERE ADDED TO THE COMMUNITY ASSESSMENT THAT PERTAINED TO PUBLIC HEALTH, ISSUES RELATED TO SMOKING, ALCOHOL CONUSMPTION, HEALTHY LIFESTYLES AND CANCER SCREENING. Daniels Memorial Healthcare Center Part V, Section B, Line 7d: Publicized in local newspaper. Daniels Memorial Healthcare Center Part V, Section B, Line 11: The hospital is still in the process of addressing all of the needs identified in its most recently conducted needs assessment. Part II, Community Building Activities: These are items where we are trying to improve the health of the community by advocating for better healthy habits and hopefully healthier outcomes for members of the community. Part III, Line 2: Total write-offs adjusted for estimated uncollectible amounts on existing accounts receivable. Part III, Line 3: Estimate based on the knowledge of the community and the patient population. Part III, Line 4: See Note 1 starting on page 7 of the attached financial statements. Part III, Line 8: Amounts is taken from the cost report. Part III, Line 9b: Notification about the DMHC charity availability form, which shall include a contact number, shall be disseminated by DMHC by various means, which may include, but are not limited to, the publication of notices in patient bills and by posting notices in emergency rooms, admitting and registration departments. Information shall also be included on the facility websites and in the Conditions of Admission form. Such information shall be provided in the primary languages spoken by the population serviced by DMHC. Referral of patients for charity may be made by any member of the DMHC staff or medical staff, including physicians, nurses, financial workers, social workers, etc. A request for charity may be made by the patient or a family member, close friend, or associate for the patient, subject to applicable privacy laws. Part VI, Line 2: Public Health Nursing service requests all participants: business, civic, religious, healthcare, public and we identify issues that may assist the community. i.e. healthcare, housing, roads, infrastructure. Part VI, Line 3: We inform the public about programs, i.e. Medicare/Medicaid. Advertisement in print and radio, phamplets in the waiting room, and social service visits with patients. Part VI, Line 4: We are designated a frontier CAH, >6 people per sq mile, town has 960 people, county has 1406 people, we are 5 hours away from a tertiary hospital, and 3 hours away from a secondary hospital. Part VI, Line 5: Through the Telemedicine Network, patients can see specialists 5 hours away right here. Several free telemedicine network services are offered: cardiology, diabetes, baby sitting classes with dipolma, mental health, chemical dependency are all free to the public and groups. X X 0 0 0 0 0 0 0 0 0 Dr Donald Sawdey DO 183932 0 0 0 0 0 0 0 3865 0 187797 0 0 0 Zoe McCarty Fugere FNP 162193 0 0 0 0 0 0 0 24467 0 186660 0 0 0 Shirley Reller PT 131243 0 0 0 0 0 0 0 23958 0 155201 0 0 0 Dave Ryerse Mr. Ryerse is the CEO of Daniels Memorial Hospital 0 Mr. Ryerse is an employee of Billings Clinic, the independent contractor hired to manage the hospital, and received all compensation for his services as CEO from Billings Clinic. 0 Form 990, Part III, line 3 Facility converted to a 25 bed CAH and delicensed its Nursing Home on 4/1/17. Form 990, Part VI, Section A, line 3 Daniels Memorial Hospital contracts with the Billings Clinic for management, IT, and accounting services. Form 990, Part VI, Section B, line 11b The 990 is available for review by the Board after approval by the CEO. Form 990, Part VI, Section B, line 12c At the annual meeting, conflict of interest statements are reviewed and signed by all trustees and the CEO. The board and the CEO monitor the status of all trustees throughout the year for changes that could lead to a new situation requiring disclosure. Form 990, Part VI, Section B, line 15a The board of trustees reviews and makes decisions on the compensation package for the CEO. The CEO compensation is part of the management contract paid to the outside management company. All managers report to the CEO and the CEO reviews and makes decisions on the managers compensation. Form 990, Part VI, Section C, line 19 All governing documents, including the conflict of interest statements and the financial statements, are available to the public upon request. Form 1023 and 990 are available upon request. Form 990 Line 2C The board reviews the financial statements.