STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

FRANCES MAHON DEACONESS HOSPITAL: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
FRANCES MAHON DEACONESS HOSPITAL (EIN 81-0231786)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-14
IRS object ID
201811349349307126
Schema version
2016v3.1
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

FieldValueIRS element (for citing)
Return2018-05-14T12:59:52-06:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1GREEN HEALTH GROUP PCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1110 5TH ST S SUITE 106AddressLine1Txt
CityGLASGOWCityNm
State AbbreviationMTStateAbbreviationCd
ZIP592302338ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN810231786EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FRANCES MAHON DEACONESS HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlFRANBusinessNameControlTxt
Phone4062283500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 3RD STREET SOUTHAddressLine1Txt
CityGLASGOWCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59230ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonCAMI KALINSKIPersonNm
Person TitleDIRECTOR OF FINANCEPersonTitleTxt
Phone4062283660PhoneNum
Signature2018-05-09SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonDANIEL GREENPreparerPersonNm
PTINP01311679PTIN
Phone4062632615PhoneNum
Preparation2018-05-14PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCAMI KALINSKIPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 3RD STREET SOUTHAddressLine1Txt
CityGLASGOWCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59230ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$27,011,615GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.FMDH.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1914FormationYr
Legal Domicile StateMTLegalDomicileStateCd
Activity Or MissionTO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent9VotingMembersIndependentCnt
Total Employee294TotalEmployeeCnt
Total Volunteers8TotalVolunteersCnt
Total Gross UBI$344,283TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm-$234,331NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$172,481PYContributionsGrantsAmt
CY Contributions Grants$39,801CYContributionsGrantsAmt
PY Program Service Revenue$23,774,422PYProgramServiceRevenueAmt
CY Program Service Revenue$26,186,293CYProgramServiceRevenueAmt
PY Investment Income$575,527PYInvestmentIncomeAmt
CY Investment Income$535,838CYInvestmentIncomeAmt
PY Other Revenue$724,798PYOtherRevenueAmt
CY Other Revenue$249,683CYOtherRevenueAmt
PY Total Revenue$25,247,228PYTotalRevenueAmt
CY Total Revenue$27,011,615CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,807,130PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$13,150,040CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$45,660CYTotalFundraisingExpenseAmt
PY Other Expenses$9,535,125PYOtherExpensesAmt
CY Other Expenses$9,342,021CYOtherExpensesAmt
PY Total Expenses$22,342,255PYTotalExpensesAmt
CY Total Expenses$22,492,061CYTotalExpensesAmt
PY Revenues Less Expenses$2,904,973PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$4,519,554CYRevenuesLessExpensesAmt
Total Assets BOY$60,728,898TotalAssetsBOYAmt
Total Assets EOY$65,058,013TotalAssetsEOYAmt
Total Liabilities BOY$3,306,496TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,402,162TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$57,422,402NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$61,655,851NetAssetsOrFundBalancesEOYAmt
MissionTO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$16,410,077ExpenseAmt
Revenue$26,186,293RevenueAmt
DescPROVIDE QUALITY MEDICAL CARE TO PATIENTS.Desc
Total Program Service Expenses$16,410,077TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsfalseTempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstYes (true)ReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntYes (true)BusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document16IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee294EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitYes (true)UnrelatedBusIncmOverLimitInd
Form990 T FiledYes (true)Form990TFiledInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member9IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCAMI KALINSKIPersonNm
Phone4062283660PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 3RD ST SAddressLine1Txt
CityGLASGOWCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59230ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtHighest Compensated EmployeeHighestCompensatedEmployeeInd
KAREN BREIGENZER
PRESIDENT2.00Yes (X)$0$0$0
KEVIN MILLER
VICE PRESIDE1.00Yes (X)$0$0$0
KRIS SIMENSEN
SECRETARY/TR1.00Yes (X)$0$0$0
CAROL BUCHHEIT
DIRECTOR1.00Yes (X)$0$0$0
TERRY COLBRESE
DIRECTOR1.00Yes (X)$0$0$0
KERRY KINGSLEY
DIRECTOR1.00Yes (X)$0$0$0
AMY CAPDEVILLE
DIRECTOR1.00Yes (X)$0$0$0
DON FAST
DIRECTOR1.00Yes (X)$0$0$0
BUTCH TEWELL
DIRECTOR1.00Yes (X)$0$0$0
RANDALL HOLOM
CEO40.00$257,634$0$19,651Yes (X)
ELLEN GUTTENBERG
COO40.00$153,014$0$18,675Yes (X)
CAMI KALINSKI
DIRECTOR OF40.00$123,475$0$4,596Yes (X)
KEVIN ROSS
MD12.00$414,793$0$22,26428.00Yes (X)
DAVID KNIERIM
MD12.00$366,068$0$15,31028.00Yes (X)
ROBERT CROCHELT
MD2.00$350,027$0$9,28638.00Yes (X)
DONNA SMITH
MD6.00$345,792$0$17,38334.00Yes (X)
ANNE MILLARD BRADLEY
MD15.00$329,882$0$17,59125.00Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,340,685TotalReportableCompFromOrgAmt
Total Other Compensation$124,756TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K32IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
MCKINSTRY ESSENTION LLC
PO BOX 3895SEATTLEWA98124CONSTRUCTION$1,662,667
MEDPRO HEALTHCARE STAFFING
1580 SAWGRASS CORPORATE PKWY 100SUNRISEFL33323MEDICAL STAFF$468,678
GE HEALTHCARE
PO BOX 96483CHICAGOIL60693SERV CONTRACTS$226,354
MEDICAL INFORMATION TECHNOLOGY INC
PO BOX 74569CHICAGOIL60696DATA PROCESSING$144,603
COMPHEALTH INC
PO BOX 972651DALLASTX75397MEDICAL STAFF$108,934
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K5CntrctRcvdGreaterThan100KCnt
Related Organizations$10,278RelatedOrganizationsAmt
Government Grants$21,838GovernmentGrantsAmt
All Other Contributions$7,685AllOtherContributionsAmt
Total Contributions$39,801TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT REVENUE621500$25,234,317$25,234,317
PROFESSIONAL RADIOLOGY621110$716,579$557,129$159,450
HI-LINE MEDICAL SRVCS RENT531120$93,633$93,633
GLASGOW CLINIC RENT531120$91,200$91,200
OTHER RENTAL INCOME531120$50,564$50,564
FieldValueIRS element (for citing)
Total Program Service Revenue$26,186,293TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$535,838TotalRevenueColumnAmt
Related Or Exempt Func Income$535,838RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PARTNERSHIP INCOME900099$201,137$201,137
COUNTY CONTRIBUTION900099$26,195$26,195
GAIN ON DISPOSAL OF ASSETS900099$22,351$22,351
FieldValueIRS element (for citing)
Other Revenue Total$249,683OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$27,011,615TotalRevenueColumnAmt
Related Or Exempt Func Income$26,627,531RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$344,283UnrelatedBusinessRevenueAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$563,437TotalAmt
Management And General$563,437ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$10,139,905TotalAmt
Program Services$8,524,223ProgramServicesAmt
Management And General$1,583,431ManagementAndGeneralAmt
Fundraising$32,251FundraisingAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$265,227TotalAmt
Program Services$201,294ProgramServicesAmt
Management And General$62,954ManagementAndGeneralAmt
Fundraising$979FundraisingAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,340,570TotalAmt
Program Services$1,029,602ProgramServicesAmt
Management And General$300,735ManagementAndGeneralAmt
Fundraising$10,233FundraisingAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$840,901TotalAmt
Program Services$683,008ProgramServicesAmt
Management And General$155,716ManagementAndGeneralAmt
Fundraising$2,177FundraisingAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$85,423TotalAmt
Management And General$85,423ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$50,900TotalAmt
Management And General$50,900ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,178,517TotalAmt
Program Services$938,682ProgramServicesAmt
Management And General$239,835ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$117,137TotalAmt
Management And General$117,137ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$600,849TotalAmt
Program Services$274,525ProgramServicesAmt
Management And General$326,304ManagementAndGeneralAmt
Fundraising$20FundraisingAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$289,145TotalAmt
Program Services$289,145ProgramServicesAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$131,255TotalAmt
Program Services$99,698ProgramServicesAmt
Management And General$31,557ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$129,856TotalAmt
Program Services$101,138ProgramServicesAmt
Management And General$28,718ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,789,667TotalAmt
Management And General$1,789,667ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$266,093TotalAmt
Program Services$46,435ProgramServicesAmt
Management And General$219,658ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES$3,448,358$3,448,358
REPAIRS & MAINTENANCE$900,846$481,283$419,563
FOOD & DIETARY SUPPLIES$212,118$212,118
BED TAXES$68,250$68,250

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$73,607TotalAmt
Program Services$12,318ProgramServicesAmt
Management And General$61,289ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$22,492,061TotalAmt
Program Services$16,410,077ProgramServicesAmt
Management And General$6,036,324ManagementAndGeneralAmt
Fundraising$45,660FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$2,239,818BOYAmt
EOY$4,386,594EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$6,883,452BOYAmt
EOY$3,858,367EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$3,325,827BOYAmt
EOY$2,978,574EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$3,808,583BOYAmt
EOY$3,696,274EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$788,163BOYAmt
EOY$767,263EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$274,847BOYAmt
EOY$643,389EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$38,697,562LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$25,288,069LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,058,314BOYAmt
EOY$13,409,493EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$16,684,641BOYAmt
EOY$18,962,748EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$14,665,253BOYAmt
EOY$16,355,311EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$60,728,898BOYAmt
EOY$65,058,013EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$2,297,068BOYAmt
EOY$2,495,428EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$169,041BOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$840,387BOYAmt
EOY$906,734EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$3,306,496BOYAmt
EOY$3,402,162EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$57,422,402BOYAmt
EOY$61,655,851EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$57,422,402BOYAmt
EOY$61,655,851EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$60,728,898BOYAmt
EOY$65,058,013EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$4,519,554ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$286,105NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementYes (true)PaidStaffOrManagementInd
Media AdvertisementsYes (true)MediaAdvertisementsInd
Media Advertisements$4MediaAdvertisementsAmt
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastYes (true)PublicationsOrBroadcastInd
Publications Or Broadcast$1,270PublicationsOrBroadcastAmt
Grants Other OrganizationsfalseGrantsOtherOrganizationsInd
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsYes (true)RalliesDemonstrationsInd
Rallies Demonstrations$1,878RalliesDemonstrationsAmt
Other ActivitiesYes (true)OtherActivitiesInd
Other Activities$3,009OtherActivitiesAmt
Total Lobbying Expenditures$6,161TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FormAndLineReferenceDesc
ExplanationB. 1,998 OF EMPLOYEE COMPENSATION FOR TIME SPENT ADVOCATING FOR THE VALLEY COUNTY SPECIAL ASSESSMENT TO SUPPORT THE LOCAL NURSING HOME IS INCLUDED IN CATEGORIES C, E, AND H. C. USED FACEBOOK AS A SOCIAL MEDIA ADVERTISING PLATFORM TO ADVOCATE FOR THE VALLEY COUNTY SPECIAL ASSESSMENT WHICH WOULD PROVIDE SUPPORT FOR THE LOCAL NURSING HOME. E. CREATED TASK FORCE LOGO AND PURCHASED MARKETING MATERIALS TO SUPPORT THE VOTE YES CAMPAIGN EFFORTS FOR THE VALLEY COUNTY SPECIAL ASSESSMENT WHICH WOULD PROVIDE SUPPORT FOR THE LOCAL NURSING HOME. H. EMPLOYEE COMPENSATION FOR PARTICIPATING IN A WEEKLY VOLUNTEER TASK FORCE MEETING TO GET THE VOTE YES CAMPAIGN GOING AND DEVELOP A POWER POINT PRESENTATION TO EDUCATE THE PUBLIC REGARDING THE VALLEY COUNTY SPECIAL ASSESSMENT WHICH WOULD PROVIDE SUPPORT FOR THE LOCAL NURSING HOME. I. 0.33 PERCENT OF MHA DUES PAID TO MHA, WHICH WAS 86, AND 21.78 PERCENT OF DUES PAID TO MHA FOR AHA, WHICH WAS 2,923, WERE USED FOR LOBBYING EXPENSES BY MHA AND AHA.ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$88,748OtherCostOrOtherBasisAmt
Book Value$88,748BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$24,213,720OtherCostOrOtherBasisAmt
Depreciation$14,576,742DepreciationAmt
Book Value$9,636,978BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,395,094OtherCostOrOtherBasisAmt
Depreciation$10,711,327DepreciationAmt
Book Value$3,683,767BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$13,409,493TotalBookValueLandBuildingsAmt

Invst Program Related Org InvstProgramRelatedOrgGrp (7 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
US GOVERNMENT & AGENCY SECURITIES$9,646,201F
BANK CERTIFICATES OF DEPOSIT$3,582,400C
BROKERED CERTIFICATES OF DEPOSIT$2,006,612F
MUTUAL FUNDS - BOND$998,942F
MUTUAL FUNDS - EQUITY GROWTH$992,735F
MUTUAL FUNDS - EQUITY VALUE$990,413F
CORPORATE DEBT SECURITIES$745,445F
FieldValueIRS element (for citing)
Total Book Value Program Rltd$18,962,748TotalBookValueProgramRltdAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
INTERCOMPANY AND OTHER RECEIVABLES$11,901,789
NE MT STAT AIR AMBULANCE INVESTMENT$3,076,674
INTEREST IN FMDH FOUNDATION$957,134
MEDICARE/MEDICAID RECEIVABLES$419,714
FieldValueIRS element (for citing)
Total Book Value Other Assets$16,355,311TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
MEDICARE & MEDICAID PAYABLES$707,089
NET INVESTMENT IN PRAIRIE RIDGE VILL$199,645
FieldValueIRS element (for citing)
Total Liability$906,734TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$26,725,510TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$286,105NetUnrealizedGainsInvstAmt
Revenue Not Reported-$286,105RevenueNotReportedAmt
Revenue Subtotal$27,011,615RevenueSubtotalAmt
Total Revenue Per Form990$27,011,615TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$22,492,061TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$22,492,061ExpensesSubtotalAmt
Total Expenses Per Form990$22,492,061TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PAGE 3, PART XFormAndLineReferenceDesc
ExplanationIT IS THE JUDGMENT OF MANAGEMENT THAT THE COMPANY HAS NO SIGIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THIS FOOTNOTE IS ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other1.400000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other2.400000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetfalseExpensesExceedBudgetInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$248,738TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$248,738NetCommunityBenefitExpnsAmt
Total Expense0.01030TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$248,738TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$248,738NetCommunityBenefitExpnsAmt
Total Expense0.01030TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,461,582TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,554,685DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,906,897NetCommunityBenefitExpnsAmt
Total Expense0.07870TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$28,075TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$28,075NetCommunityBenefitExpnsAmt
Total Expense0.00120TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,489,657TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,554,685DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,934,972NetCommunityBenefitExpnsAmt
Total Expense0.07990TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,738,395TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,554,685DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,183,710NetCommunityBenefitExpnsAmt
Total Expense0.09020TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$609,573BadDebtExpenseAmt
Reimbursed By Medicare$9,020,629ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,140,866CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$120,237MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FRANCES MAHON DEACONESS HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 3RD ST SAddressLine1Txt
CityGLASGOWCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59230ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.FMDH.ORGWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1FRANCES MAHON DEACONESS HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLWWW.FMDH.ORGOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLWWW.FMDH.ORGStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care140.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care240.000000000000FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLWWW.FMDH.ORGFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLWWW.FMDH.ORGFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLWWW.FMDH.ORGFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesYes (true)GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 5TO SOLICIT INPUT FROM INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS IMPLEMENTED AS PART OF THE CHNA PROCESS AND SENT TO A LIST OF RECOMMENDED PARTICIPANTS INCLUDING PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS AND A VARIETY OF OTHER COMMUNITY LEADERS. ALSO, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. THE PARTICIPANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE. IN ALL, 63 COMMUNITY STAKEHODLERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. THE INPUT WAS GATHERED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. ON BEHALF OF FRANCES MAHON DEACONESS HOSPITAL IN THE SPRING OF 2016.
FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 6BVALLEY COUNTY PUBLIC HEALTH DEPARTMENT
FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 11AS REQUIRED BY THE IRS IMPLEMENTING REGULATIONS, FMDH PRIORITIZED THE IDENTIFIED NEEDS TO IDENTIFY THOSE NEEDS THAT IT COULD EFFICACIOUSLY ADDRESS GIVEN THE RESOURCE LIMITATIONS INHERENT IN A SMALL RURAL HOSPITAL OPERATION. THE ONLINE KEY INFORMANT SURVEY PRESENTED THE STAKEHOLDERS WITH 20 HEALTH TOPICS AND WERE ASKED TO RATE EACH AS A MAJOR PROBLEM, MODERATE PROBLEM, MINOR PROBLEM, OR NOT A PROBLEM AT ALL IN THEIR OWN COMMUNITY. FOR MAJOR PROBLEM RESPONSES, THE FOLLOWING WERE RANKED AS TOP CONCERNS FOR THE FRANCES MAHON DEACONESS HOSPITAL SERVICE AREA: MENTAL HEALTH, TOBACCO USE, SUBSTANCE ABUSE, AND CANCER. THROUGH A MEETING WITH INTERNAL AND EXTERNAL STAKEHOLDERS, PRIORITIZATION WAS ACCOMPLISHED USING A PRIORITIZATION EXERCISE THAT SCORED THE SCOPE & SEVERITY OF THE PROBLEM BY CONSIDERATION OF THREE FACTORS AND ABILITY TO IMPACT, BOTH RATED ON A SCALE OF 1 TO 10 FROM LEAST SEVERE TO MOST SEVERE. BASED ON THE SEVERITY OF THE RATINGS, FRANCES MAHON DEACONESS HOSPITAL CHOSE TO PRIORITIZE THE FOLLOWING TOP HEALTH NEEDS OF THE COMMUNITY TO ADDRESS IN ITS IMPLEMENTATION STRATEGY IN THE COMING YEARS: HEART DISEASE & STROKE, NUTRITION, PHYSICAL ACTIVITY & WEIGHT, AND MENTAL HEALTH. FMDH IS ADDRESSING THE PRIORITIZED HEALTH NEEDS BY THREE OVERALL GOALS: THE FIRST GOAL IS TO IMPROVE CARDIOVASCULAR HEALTH BY IMPLEMENTING AND SUPPORTING EVIDENCE BASED APPROACHES TO IMPACT BEHAVIORS AFFECTING CARDIOVASCULAR HEALTH. ONE STRATEGY FOR ADDRESSING THIS GOAL IS TO BUILD AWARENESS OF OPPORTUNITIES IN THE COUNTY TO PARTICIPATE IN COMMUNITY FITNESS PROGRAMS BY DEVELOPING AND PROMOTING A COMMUNITY FITNESS RESOURCES LIST. THE SECOND GOAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY IMPLEMENTING AND SUPPORTING EVIDENCE BASED APPROACHES TO IMPACT BEHAVIORS RELATED TO NUTRITION, WEIGHT AND PHYSICAL ACTIVITY THEREBY HAVING A POSITIVE IMPACT ON A MUILTITUDE OF HEALTH CONDITIONS. A STRATEGY FOR ADDRESSING THIS GOAL IS TO HAVE A FOCUSED PUBLIC AWARENESS CAMPAIGN ON FITNESS AND EXERCISE SUCH AS COMMUNICATING EXCLUSIVELY ABOUT EXERCISE AND FITNESS IN AT LEAST 75% OF ALL COMMUNICATION FOR 12 MONTHS. THE THIRD GOAL IS TO UTILIZE EVIDENCE BASED TACTICS TO ADDRESS BARRIERS TO ACCESSING MENTAL HEALTH SERVICES BY AUGMENTING THE RANGE AND ACCESSIBILITY OF MENTAL/BEHAVIORAL HEALTH SERVICES. A STRATEGY FOR ADDRESSING THIS GOAL IS TO ADVOCATE FOR MENTAL HEALTH LEGISLATION BY FOCUSING ADVOCACY EFFORTS ON LEGISLATION THAT INCREASES FUNDING FOR AND AVAILABILITY OF MENTAL/BEHAVIORAL HEALTH SERVICES. ADDITIONAL STRATEGIES TO ACCOMPLISH THE THREE GOALS ARE IDENTIFIED IN THE IMPLEMENTATION STRATEGY. NINE ADDITIONAL SIGNFICANT HEALTH NEEDS THAT EMERGED FROM THIS COMMUNITY HEALTH NEEDS ASSESSMENT ARE OUTLINED BELOW. THESE NEEDS WILL NOT BE SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY, ALTHOUGH SOME MAY BE ADDRESSED IN SOME WAY THROUGH PROGRAMS TARGETING THE TOP HEALTH NEEDS WHICH WILL BE ADDRESSED. 1. SUBSTANCE ABUSE - FMDH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE MENTAL HEALTH WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S SUBSTANCE ABUSE, AND THAT A SEPARATE SET OF SUBSTANCE ABUSE INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 2. TOBACCO USE - FMDH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE CARDIOVASCULAR HEALTH WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S TOBACCO USE, AND THAT A SEPARATE SET OF TOBACCO INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. WHILE THIS NEED WAS NOT SCHEDULED TO BE ADDRESSED, IN 2017, FMDH IMPLEMENTED AND EXECUTED A TOBACCO CESSATION MASS MARKETING PLAN TO RAISE AWARENESS OF THE RISKS ASSOCIATED WITH TOBACCO AS WELL AS OPPORTUNITIES WITHIN OUR COMMUNITY TO QUIT. WE RAN WEEKLY AND MONTHLY ADS IN OUR LOCAL PUBLICATIONS, SPONSORED A 'SMOKE FREE' MOVIE NIGHT TARGETING HIGH SCHOOL YOUTH, SPONSORED ANTI-TOBACCO T-SHIRTS FOR HIGH SCHOOL YOUTH, AND RAN A RADIO MEDIA CAMPAIGN, AS WELL AS SOCIAL MEDIA AND BILLBOARD CAMPAIGNS. 3. CANCER - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 4. IMMUNIZATION & INFECTIOUS DISEASES - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 5. INJURY & VIOLENCE PREVENTION - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 6. INFANT HEALTH & FAMILY PLANNING - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 7. STD HIV/AIDS - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 8. DIABETES - FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE NUTRITION, WEIGHT AND PHYSICAL ACTIVITY WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S DIABETIC POPULATION, AND THAT A SEPARATE SET OF DIABETIC- SPECIFIC INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 9. ACCESS TO HEALTH CARE SERVICES - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. IN 2017, FMDH ALSO CO-FOUNDED AN INTERAGENCY COALITION WHOSE PURPOSE IS TO COORDINATE THE EFFORTS OF VARIOUS COMMUNITY HEALTH ORGANIZATIONS. KNOWN AS THE VALLEY CARE COALITION, THE ORGANIZATION EXISTS TO IMPROVE THE HEALTH OF VALLEY COUNTY RESIDENTS BY USING EVIDENCE-BASED TACTICS TO IMPROVE IDENTIFIED NEEDS. THE COALITION FOCUSES ON THREE AREAS: PHYSICAL ACTIVITY AND NUTRITION, SUBSTANCE ABUSE AND MENTAL HEALTH. IN THE PAST YEAR, THE COALITION HAS CONDUCTED SUICIDE PREVENTION TRAINING FOR THE COMMUNITY AND COUNTY EDUCATORS AND PRODUCED A SERIES OF PSAS ON LOCAL RADIO TO REDUCE THE STIGMA SURROUNDING MENTAL HEALTH SERVICES. IN THE AREA OF SUBSTANCE ABUSE, THE COALITION HAS PROMOTED TOBACCO CESSATION, SECURED GRANT FUNDING TO PROVIDE A WASTE DRUG INCINERATOR FOR LOCAL LAW ENFORCEMENT, AND PROVIDED COMMUNITY EDUCATION SURROUNDING THE SAFE DISPOSAL OF SURPLUS PRESCRIPTION NARCOTICS. IN THE AREA OF PHYSICAL ACTIVITY AND NUTRITION, THE COALITION HAS WORKED WITH THE LOCAL FOOD BANK TO RAISE FUNDS AND AWARENESS FOR THEIR EFFORTS AND PROVIDED A COOKING CLASS TO LOW INCOME PARENTS THAT FOCUSED ON USING WHOLE FOODS, FOOD PREP AND CROCK POTS TO CREATE HEALTHY WEEKNIGHT MEALS. THE ATTENDEES WENT HOME WITH A CROCK POT AND THREE FOUR-SERVING MEALS. THE COALITION AND ITS ACTIVITIES SERVED TO ADDRESS THE THREE GOALS SCHEDULED TO BE IMPLEMENTED AS WELL AS ADDRESSED MANY OF THE NEEDS PREVIOUSLY DESIGNATED AS UNABLE TO BE ADDRESSED.
FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 24SOME SERVICES PROVIDED BY THE HOSPITAL ARE CONSIDERED ELECTIVE. ELECTIVE SERVICES ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE THUS A PERSON QUALIFYING FOR A DISCOUNT FOR MEDICALLY NECESSARY SERVICES MAY NEED TO PAY FULL PRICE FOR ELECTIVE SERVICES. THE FAP ADDRESSES WHAT SERVICES ARE DEEMED ELECTIVE.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1GLASGOW CLINIC PCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1621 THIRD STREET SOUTHAddressLine1Txt
CityGLASGOWCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59230ZIPCd
FieldValueIRS element (for citing)
FacilityRURAL HEALTH CLINICFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATIONPHYSICIAN PROFESSIONAL SERVICES MAKE UP 1,734,786 OF COLUMN C, 826,301 OF COLUMN D, AND 908,485 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 128,050. FRANCES MAHON DEACONESS HOSPITAL'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONUSED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND FINANCIAL ASSISTANCE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYTHE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, FINANCIAL ASSISTANCE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF BAD DEBT WHICH REDUCE BAD DEBT EXPENSE. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NON PROFIT HOSPITAL.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSTHE BAD DEBT EXPENSE FOOTNOTE IS ON PAGES 7 & 8 OF THE AUDITED FINANCIAL STATEMENTS.
PART III, LINE 8 - MEDICARE EXPLANATIONTHERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE, BUT THIS IS THEN REDUCED BY THE 2 PERCENT SEQUESTRATION ADJUSTMENT. THIS MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT SINCE THE HOSPITAL IS PROVIDING MEDICARE PATIENT CARE SERVICES AT LESS THAN THE COST. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT. THE ELECTRONIC HEALTH RECORD CAPITAL COSTS AND RELATED INCENTIVE PAYMENTS ARE EXCLUDED FROM THIS CALCULATION.
PART III, LINE 9B - COLLECTION PRACTICES EXPLANATIONTHE ORGANIZATION USES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES, COMBINED WITH AN ASSET TEST AND A MEDICALLY INDIGENT TEST REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. THE ORGANIZATION DOES NOT ATTEMPT TO COLLECT CHARGES APPROVED AS FINANCIAL ASSISTANCE. FOR PATIENTS THAT HAVE HAD A PORTION OF THEIR ACCOUNT WRITTEN OFF AS FINANCIAL ASSISTANCE AND THAT LATER DEFAULT ON THE PORTION THAT WAS DETERMINED TO BE THEIR RESPONSIBILITY, AND THEREFORE IS NOT CONSIDERED FINANACIAL ASSISTANCE, THE ORGAINIZATION DOES ATTEMPT TO COLLECT THIS BALANCE.
PART VI, LINE 2 - NEEDS ASSESSMENTPURSUANT TO THE PROVISIONS OF THE AFFORDABLE CARE ACT, FRANCES MAHON DEACONESS HOSPITAL COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DURING FISCAL YEARS 2013 & 2016 (TAX YEARS 2012 & 2015). BOTH ASSESSMENTS ARE LOCATED ON THE ENTITY'S WEBSITE. HOWEVER, FRANCES MAHON DEACONESS HOSPITAL (FMDH) HAS TRADITIONALLY INCLUDED COMMUNITY NEEDS ASSESSMENTS IN ITS PLANNING FOR MANY YEARS AND UTILIZES MANY METHODS OF ASSESSING THE PATIENT SERVICES NEEDS FOR OUR SERVICE AREA. THESE INCLUDE BUT ARE NOT LIMITED TO: ANALYSIS OF OUTMIGRATION STATISTICS OBTAINED THROUGH ACCESS TO THE COMPDATA DATABASE PROVIDED THROUGH THE MONTANA HOSPITAL ASSOCIATION AND MODELING OF PATIENT TO POPULATION RATIOS TO IDENTIFY AND PLAN FOR THE APPROPRIATE PROVIDER MIX TO SERVE THE COMMUNITY. IN ADDITION, FMDH PARTICIPATED IN AN AREA HEALTH EDUCATION CENTER LEAD COMMUNITY HEALTH SERVICES DEVELOPMENT ASSESSMENT. IDEAS GENERATED OUT OF EACH OF THESE EFFORTS ARE THEN EVALUATED AS TO THE CAPABILITIES OF OUR ORGANIZATION TO DEVELOP IDENTIFIED SERVICES. MINIMUM CRITERIA FOR DEVELOPMENT OF NEW OR MODIFICATION OF EXISTING SERVICES ARE: THE NEW OR MODIFIED SERVICE CAN REASONABLY FINANCIALLY SUPPORT ITS OPERATION; WE HAVE OR CAN ACQUIRE THE NECESSARY PERSONNEL WITH THE CREDENTIALS TO DELIVER THE SERVICE AND RETAIN ENOUGH PERSONNEL WITH THE REQUIRED SKILL SETS TO AVOID INTERRUPTION OF SERVICE DELIVERY IF SAID PERSONNEL TURN OVER; THE SERVICES CAN BE DELIVERED IN A MANNER THAT ACHIEVES APPROPRIATELY HIGH LEVELS OF PATIENT SATISFACTION.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEFRANCES MAHON DEACONESS HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO HAS THE SOLE RESPONSIBILITY TO WORK WITH PATIENTS TO NAVIGATE OUR FINANCIAL ASSISTANCE PROGRAM. ALL PATIENTS ARE SENT INFORMATION AT THE INITIAL BILLING FOR DELIVERED PATIENT SERVICES THAT DESCRIBES OUR FINANCIAL ASSISTANCE PROGRAM. OUR WEBSITE HAS INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM ALONG WITH ACCESS TO THE APPLICATION. FRANCES MAHON DEACONESS HOSPITAL ALSO EMPLOYS TWO STAFF MEMBERS THAT ARE CERTIFIED APPLICATION COUNSELORS THAT HELP COMMUNITY MEMBERS WITH APPLYING FOR INSURANCE AND MEDICAID ON THE MARKETPLACE.
PART VI, LINE 4 - COMMUNITY INFORMATIONFRANCES MAHON DEACONESS HOSPITAL IS LOCATED IN GLASGOW MONTANA WHICH IS OVER FOUR HOURS HIGHWAY TRAVEL TIME AWAY FROM ANY TERTIARY MEDICAL CENTER. WHILE OUR PRIMARY SERVICE AREA CONSISTS OF GLASGOW MONTANA AND VALLEY COUNTY, OUR FACILITY AND SPECIALTY SERVICES ALSO DRAW FROM PORTIONS OF THE SURROUNDING COUNTIES OF DANIELS, ROOSEVELT, AND PHILLIPS. THE AREA IS PRIMARILY AGRICULTURAL BASED WITH LOW POPULATION DENSITIES WHICH HOUSES A TOTAL POPULATION OF 24,113 RESIDENTS OVER 13,843.20 SQUARE MILES. THE DIFFERENT AGE GROUPS OF THE SERVICE AREA ARE AS FOLLOWS: 26.2% ARE INFANTS, CHILDREN OR ADOLESCENTS AGES 0-17; ANOTHER 57.1% ARE AGES 18 TO 64, WHILE 16.7% ARE AGES 65 AND OLDER. THE POPULATION IS MOSTLY WHITE, BUT PORTIONS OF OUR EXTENDED SERVICE AREA HAVE HIGH POPULATIONS OF NATIVE AMERICAN ANCESTRY (29.8% IN THE TOTAL SERVICE AREA) TO WHICH WE PROVIDE SERVICES. THE STATISTICS PROVIDED ABOVE ARE BASED ON THE US CENSUS BUREAU AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2009-2013).
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHFRANCES MAHON DEACONESS HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. WE ARE GOVERNED BY A VOLUNTARY BOARD OF COMMUNITY PERSONS REPRESENTING MOST OF THE INDIVIDUAL TOWNS OR GEOGRAPHICAL AREAS OF OUR PRIMARY SERVICE AREA. FOR NONELECTIVE SERVICES, WE TREAT PATIENTS WITHOUT REGARD TO ABILITY TO PAY, CONSISTENT WITH OUR ORIGINS AS A HILL BURTON FUNDED FACILITY. ALTHOUGH OUR HILL BURTON OBLIGATION WAS SATISFIED MANY YEARS AGO, WE STILL ADHERE TO THE PRINCIPLES INHERENT IN THAT OBLIGATION. SURPLUS FUNDS ARE RETAINED WITHIN THE ORGANIZATION TO ASSURE FULFILLMENT OF OUR CHARITABLE MISSION BOTH IN THE PRESENT AND IN THE FUTURE.
PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEMFRANCES MAHON DEACONESS HOSPITAL PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. GLASGOW CLINIC PC PROVIDES PROFESSIONAL PRIMARY CARE PHYSICIAN AND MIDLEVEL PROVIDER SERVICES. HI-LINE MEDICAL SERVICES INC PROVIDES SPECIALTY PHYSICIAN AND RETAIL PHARMACY SERVICES.
ADDITIONAL INFORMATIONPART I, LINE 6A: THE FORM 990 SCHEDULE H IS CONSIDERED AN ANNUAL COMMUNITY BENEFIT REPORT AND IT IS AVAILABLE TO THE PUBLIC ON OUR WEBSITE. PART I, LINE 7I: FMDH CONTRIBUTED TO THE SCHOOLS IN VALLEY COUNTY FOR THE HEALTHY SCHOOL SNACK PROGRAM. PART V: GLASGOW CLINIC PC IS A SEPARATE ORGANIZATION THAT IS A RURAL HEALTH CLINIC AND IS WHOLLY OWNED AND OPERATED BY FRANCES MAHON DEACONESS HOSPITAL (FMDH). THEIR REVENUES AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990. HI-LINE MEDICAL SERVICES, INC IS A SEPARATE ORGANIZATION THAT INCLUDES SPECIALTY PHYSICIAN PRACTICES AND A RETAIL PHARMACY. FMDH WHOLLY OWNS AND MANAGES THIS ENTITY AND SUBSIDIZES THE PHYSICIAN PRACTICES AS NEEDED TO ASSURE ACCESS TO AS FULL OF A SCOPE OF SERVICES AS IS APPROPRIATE GIVEN THE NEEDS OF THE COMMUNITY WE SERVE. HI-LINE MEDICAL SERVICES' REVENUES AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990, EXCEPT THAT THE SUBSIDIZED PHYSICIAN ACTIVITY IS SHOWN ON SCHEDULE H, PART I, LINE 7G. PART V, SECTION B, 1I: THE MOST RECENT CHNA WAS CONDUCTED IN TAX YEAR 2015 IN COMPLIANCE WITH THE 501(R) REGULATIONS THAT WERE EFFECTIVE AT THAT TIME. THE REQUIREMENT TO INCLUDE IN THE CHNA THE IMPACT OF ANY ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL'S PRIOR CHNA WAS NOT EFFECTIVE UNTIL THE FOLLOLWING YEAR, WHICH WAS TAX YEAR 2016. THEREFORE THIS WAS NOT INCLUDED IN THE CHNA CONDUCTED IN TAX YEAR 2015, BUT WILL BE INCLUDED IN THE NEXT CHNA.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmt
RANDALL HOLOM
CEO$257,634$9,275$10,376$277,285
ELLEN GUTTENBERG
COO$153,014$5,686$12,989$171,689
KEVIN ROSS
MD$414,793$9,275$12,989$437,057
DAVID KNIERIM
MD$366,068$8,924$6,386$381,378
ROBERT CROCHELT
MD$350,027$9,275$11$359,313
DONNA SMITH
MD$345,792$9,275$8,108$363,175
ANNE MILLARD BRADLEY
MD$329,882$7,431$10,160$347,473

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 1AGOLF CLUB MEMBERSHIP FOR THE CEO IS PAID BY THE ORGANIZATION. THIS IS NOT TREATED AS TAXABLE COMPENSATION SINCE IT IS CONSIDERED PUBLIC RELATIONS WHICH IS PART OF THE CEO'S JOB RESPONSIBILITY.
SCHEDULE J, PART IIIA PERCENTAGE OF THE COMPENSATION PAID TO KEVIN ROSS, M.D. (70%), DAVID KNIERIM, M.D. (70%), DONNA SMITH, M.D. (85%), AND ANNE MILLARD BRADLEY, M.D. (62%) IS AN EXPENSE OF GLASGOW CLINIC PC, A RELATED COMPANY, AND A PERCENTAGE OF THE COMPENSATION PAID TO ROBERT CROCHELT, M.D. (95%) IS AN EXPENSE OF HI-LINE MEDICAL SERVICES, INC, A RELATED COMPANY. THE COMPENSATION WAS PAID TROUGH FRANCES MAHON DEACONESS HOSPITAL AS A CENTRAL PAYMASTER.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1FIRST COMMUNITY BANKBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship DescriptionBOARD MEMBERSRelationshipDescriptionTxt
Transaction$1,044,568TransactionAmt
TransactionBANKING & INVESTINGTransactionDesc
Sharing Of RevenuesfalseSharingOfRevenuesInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART VFormAndLineReferenceDesc
ExplanationTHE HOSPITAL CEO AND ONE BOARD MEMBER ARE BOTH BOARD MEMBERS OF FIRST COMMUNITY BANK, PLUS THE BOARD MEMBER IS ALSO AN OFFICER OF THE BANK. THE HOSPITAL HAS BANK ACCOUNTS AND INVESTMENTS WITH FIRST COMMUNITY BANK. THE BUSINESS RELATIONSHIP WITH THE BANK IS MANAGED BY THE DIRECTOR OF FINANCIAL SERVICES OF THE HOSPITAL AND SHE HAS A DIRECT REPORTING RELATIONSHIP TO THE BOARD FINANCE COMMITTEE IN THIS REGARD. FURTHER, ANY DECISION MADE BY THE DIRECTOR OF FINANCIAL SERVICES IS GOVERNED BY POLICIES AND PROCEDURES APPROVED BY THE ENTIRE BOARD OF TRUSTEES ON THE RECOMMENDATION OF THE FINANCE COMMITTEE. ADDITIONALLY, FOR ANY PARTICULAR BUSINESS TRANSACTION OR DECISION THAT DIRECTLY INVOLVES FIRST COMMUNITY BANK, THE CEO AND THE BOARD MEMBER WITH A CONFLICT OF INTEREST LEAVE THE BOARD MEETING WHILE THE REMAINING BOARD MEMBERS DELIBERATE OR ACT ON THE MATTER. THE TRANSACTION DOLLAR AMOUNT SHOWN ABOVE IS THE NET INCREASE IN THE HOSPITAL'S BANK ACCOUNT AND INVESTMENT BALANCES WITH FIRST COMMUNITY BANK AND AFFILIATED COMPANIES FOR THE FISCAL YEAR.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 6MEMBERSHIP IN THE FRANCES MAHON DEACONESS HOSPITAL CORPORATION (FMDH) IS ACHIEVED BY VIRTUE OF DONATING AT LEAST 100 TO FMDH, TO THE FRANCES MAHON DEACONESS HOSPITAL FOUNDATION (ALTHOUGH THE FOUNDATION IS A SEPARATE CHARITABLE ENTITY AND NOT CONTROLLED BY THE FMDH CORPORATION, ITS STATED PURPOSE IS TO SUPPORT FMDH AND THE DELIVERY OF HEALTHCARE SERVICES IN VALLEY COUNTY, MONTANA, THROUGH CHARITABLE DONATIONS SUPPORTING SERVICES DEVELOPMENT AND EQUIPMENT PURCHASES), AND LUKE'S 100 (ANOTHER LOCAL CHARITABLE ORGANIZATION SEPARATE FROM FMDH BUT WHICH SUPPORTS FMDH THROUGH ANNUAL DONATIONS). THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE CONTROL OVER FMDH.
FORM 990, PAGE 6, PART VI, LINE 7ATHERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE OR CONTROL OVER FMDH.
FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 IS REVIEWED BY THE CEO AND DIRECTOR OF FINANCIAL SERVICES AND IS MADE AVAILABLE FOR THE BOARD'S REVIEW PRIOR TO BEING FILED.
FORM 990, PAGE 6, PART VI, LINE 12CCONFLICTS OF INTEREST ARE REQUIRED TO BE REPORTED AT THE FIRST MEETING OF EACH CALENDAR YEAR. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE REQUIRED TO LEAVE THE BOARD MEETING WHILE THE BUSINESS IS BEING DISCUSSED OR ACTED UPON.
FORM 990, PAGE 6, PART VI, LINE 15ATHE BOARD OF TRUSTEES APPROVES THE CEO'S COMPENSATION.
FORM 990, PAGE 6, PART VI, LINE 15BTHE BOARD OF TRUSTEES APPROVES THE COMPENSATION FOR ALL PHYSICIANS EMPLOYED BY FMDH. THE CEO APPROVES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES.
FORM 990, PAGE 6, PART VI, LINE 19ALL WRITTEN POLICIES ARE KEPT IN THE OFFICE OF THE DIRECTOR OF FINANCIAL SERVICES AND ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
FMDH FOUNDATION
621 3RD STREET SOUTHGLASGOWMT59230810406872SUPPORTMT501C37NAfalse
PRAIRIE RIDGE VILLAGE LLP
521 4TH AVE SGLASGOWMT59230810515202ASSTLIVINGMT501C310NAfalse
NE MT STAT AIR AMBULANCE COOPERATIV
519 PLEASANT STREETMILES CITYMT59301204748673AIR AMBULAMT501C312BNAfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdDirect Controlling NADirectControllingNACdControlled OrganizationControlledOrganizationInd
HI-LINE MEDICAL SERVICES INC
621 THIRD STREET SOUTHGLASGOWMT59230208393201PHYSICIANSMTN/Afalse
GLASGOW CLINIC PC
621 THIRD STREET SOUTHGLASGOWMT59230810341714CLINICMTN/Afalse
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (true)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgYes (true)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (9 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
FMDH FOUNDATION
O$45,660STAFF & OTHER ITEMS
GLASGOW CLINIC PC
J$91,200RENTAL INCOME
GLASGOW CLINIC PC
R$411,757CHANGE IN RECEIVABLE
HI-LINE MEDICAL SERVICES INC
J$93,633RENTAL INCOME
HI-LINE MEDICAL SERVICES INC
R$472,362CHANGE IN RECEIVABLE
NORTHEAST MT STAT AIR AMBULANCE
Q$41,220CONTRACT STAFF
PRAIRIE RIDGE VILLAGE LLP
D$3,665,796LOAN BALANCE
PRAIRIE RIDGE VILLAGE LLP
A$192,868INTEREST RECEIVED ON LOAN
FMDH FOUNDATION
C$10,278SUPPORT