CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- CULBERTSON FROID BAINVILLE HEALTH CARE CORPORATION (EIN 81-0373589)
- Tax period
- 2016-05-01 to 2017-04-30
- Filed
- 2018-03-07
- IRS object ID
- 201830669349301003
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-03-07T13:13:33-07:00 | ReturnTs |
| Tax Period End | 2017-04-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREEN HEALTH GROUP PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 5TH ST S SUITE 106 | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 592302338 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-05-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810373589 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CULBERTSON FROID BAINVILLE | BusinessNameLine1Txt |
| Business Name Line2 | HEALTHCARE CORPORATION | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CULB | BusinessNameControlTxt |
| Phone | 4067876401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AUDREY STROMBERG | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 4067876401 | PhoneNum |
| Signature | 2018-03-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DANIEL GREEN | PreparerPersonNm |
| PTIN | P01311679 | PTIN |
| Phone | 4062632615 | PhoneNum |
| Preparation | 2018-03-07 | PreparationDt |
Filing Security Information FilingSecurityInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| At Submission Creation Device Id | 77D71ED6ADEA0495973AF0BFF4723F6679972267 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BB858BA31F04699E906BF4765556342F31FF276D | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | AUDREY STROMBERG | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,327,787 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | ROOSEVELTMEDICAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 110 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $265,035 | PYContributionsGrantsAmt |
| CY Contributions Grants | $122,760 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,928,374 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,911,319 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,663 | PYInvestmentIncomeAmt |
| CY Investment Income | $55,153 | CYInvestmentIncomeAmt |
| PY Other Revenue | $255,161 | PYOtherRevenueAmt |
| CY Other Revenue | $238,555 | CYOtherRevenueAmt |
| PY Total Revenue | $5,450,233 | PYTotalRevenueAmt |
| CY Total Revenue | $5,327,787 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,507,263 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,529,000 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $39,389 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,098,397 | PYOtherExpensesAmt |
| CY Other Expenses | $1,947,657 | CYOtherExpensesAmt |
| PY Total Expenses | $5,605,660 | PYTotalExpensesAmt |
| CY Total Expenses | $5,476,657 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$155,427 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$148,870 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $2,576,159 | TotalAssetsBOYAmt |
| Total Assets EOY | $2,736,687 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $822,370 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,131,768 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,753,789 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,604,919 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,049,609 | ExpenseAmt |
| Revenue | $4,911,319 | RevenueAmt |
| Desc | ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. | Desc |
| Total Program Service Expenses | $4,049,609 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 18 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 110 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JENNIFER KESSNER | PersonNm |
| Phone | 4067876401 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| PAULA SCHLEDEWITZ | |||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LANA ENGELKE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK COLVIN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| GRANT SALVEVOLD | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| BOB BEERY | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DUANE LARSEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KEVIN MILLER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SHARON SCHMITZ | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| JO NELSON | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| AUDREY STROMBERG | |||||||
| ADMINISTRATO | 40.00 | $91,814 | $0 | $5 | Yes (X) | ||
| JENNIFER KESSNER | |||||||
| CFO | 41.00 | $79,080 | $0 | $5,341 | Yes (X) | ||
| DON HELLAND | |||||||
| MD | 40.00 | $193,032 | $0 | $5,799 | Yes (X) | ||
| ELIZABETH KLEPPEN | |||||||
| PA-C | 22.00 | $173,547 | $0 | $305 | Yes (X) | ||
| BLAINE WHITE | |||||||
| PA-C | 33.00 | $120,379 | $0 | $305 | Yes (X) | ||
| DANIELLE CHRISTENSEN | |||||||
| RN | 56.00 | $114,817 | $0 | $5 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $772,669 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $11,760 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| HEALTHCARE SERVICES GROUP INC | |||||
| 3220 TILLMAN DRIVE SUITE 300 | BENSALEM | PA | 19020 | DIETARY SVCS | $289,568 |
| MONTANA HEALTH NETWORK | |||||
| 519 PLEASANT STREET | MILES CITY | MT | 59301 | LOCUM NURSE, PA | $171,416 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $34,298 | RelatedOrganizationsAmt |
| Government Grants | $34,609 | GovernmentGrantsAmt |
| All Other Contributions | $53,853 | AllOtherContributionsAmt |
| Total Contributions | $122,760 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT REVENUE | 621500 | $4,809,446 | $4,809,446 |
| MISC REVENUE | 900099 | $101,873 | $101,873 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,911,319 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $55,153 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $55,153 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| HOSPITAL DISTRICT SUBSIDY | 900099 | $238,260 | $238,260 |
| GAIN ON DISPOSAL OF ASSETS | 900099 | $295 | $295 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $238,555 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,327,787 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,205,027 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $180,703 | TotalAmt |
| Management And General | $180,703 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,915,815 | TotalAmt |
| Program Services | $2,524,346 | ProgramServicesAmt |
| Management And General | $357,008 | ManagementAndGeneralAmt |
| Fundraising | $34,461 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,202 | TotalAmt |
| Program Services | $11,578 | ProgramServicesAmt |
| Management And General | $2,466 | ManagementAndGeneralAmt |
| Fundraising | $158 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,923 | TotalAmt |
| Program Services | $123,097 | ProgramServicesAmt |
| Management And General | $29,158 | ManagementAndGeneralAmt |
| Fundraising | $1,668 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,357 | TotalAmt |
| Program Services | $209,452 | ProgramServicesAmt |
| Management And General | $51,803 | ManagementAndGeneralAmt |
| Fundraising | $3,102 | FundraisingAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $821,378 | TotalAmt |
| Program Services | $752,723 | ProgramServicesAmt |
| Management And General | $68,655 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,221 | TotalAmt |
| Management And General | $18,221 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $241,887 | TotalAmt |
| Program Services | $39,903 | ProgramServicesAmt |
| Management And General | $201,984 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,215 | TotalAmt |
| Program Services | $1,215 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,638 | TotalAmt |
| Program Services | $39,831 | ProgramServicesAmt |
| Management And General | $14,807 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,241 | TotalAmt |
| Management And General | $1,241 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $222,687 | TotalAmt |
| Management And General | $222,687 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,251 | TotalAmt |
| Management And General | $108,251 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $233,982 | $233,982 | |
| REPAIRS & MAINTENANCE | $209,690 | $81,833 | $127,857 |
| MISC | $15,332 | $15,332 | |
| FOOD & DIETARY SUPPLIES | $12,417 | $12,417 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,718 | TotalAmt |
| Program Services | $3,900 | ProgramServicesAmt |
| Management And General | $2,818 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,476,657 | TotalAmt |
| Program Services | $4,049,609 | ProgramServicesAmt |
| Management And General | $1,387,659 | ManagementAndGeneralAmt |
| Fundraising | $39,389 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,702 | BOYAmt |
| EOY | $3,122 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $843,497 | BOYAmt |
| EOY | $958,187 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $92,488 | BOYAmt |
| EOY | $65,748 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $722,344 | BOYAmt |
| EOY | $893,486 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $118,226 | BOYAmt |
| EOY | $121,041 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,261 | BOYAmt |
| EOY | $69,333 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,396,258 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,888,426 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $670,641 | BOYAmt |
| EOY | $507,832 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $65,000 | BOYAmt |
| EOY | $117,938 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,576,159 | BOYAmt |
| EOY | $2,736,687 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $486,062 | BOYAmt |
| EOY | $510,770 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $202,691 | BOYAmt |
| EOY | $159,782 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $133,617 | BOYAmt |
| EOY | $461,216 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $822,370 | BOYAmt |
| EOY | $1,131,768 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,719,176 | BOYAmt |
| EOY | $1,589,683 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,613 | BOYAmt |
| EOY | $15,236 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,753,789 | BOYAmt |
| EOY | $1,604,919 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,576,159 | BOYAmt |
| EOY | $2,736,687 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$148,870 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $257 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $257 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART IV | FormAndLineReferenceDesc |
| Explanation | 0.33 PERCENT OF DUES PAID TO MHA AND 21.78 PERCENT OF DUES PAID TO AHA, WHICH TOTALED 257, WERE USED FOR LOBBYING EXPENSES BY MHA. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,055,439 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,880,450 | DepreciationAmt |
| Book Value | $174,989 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,340,819 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,007,976 | DepreciationAmt |
| Book Value | $332,843 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $507,832 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| MEDICARE/MEDICAID ESTIMATED PAYABLE | $394,611 |
| RESIDENT DEPOSITS PAYABLE | $66,605 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $461,216 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $5,327,787 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $5,327,787 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $5,327,787 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $5,476,657 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $5,476,657 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $5,476,657 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | IT IS THE JUDGEMENT OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,977 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,434 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $44,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,977 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $28,434 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $157,870 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,428 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $144,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $505,452 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $314,895 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $190,557 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03480 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $663,322 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $328,323 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $334,999 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06120 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $707,733 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $344,300 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $363,433 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06640 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $114,929 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $1,847,201 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $1,879,450 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$32,249 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 419 | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | ROOSEVELTMEDICAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | ROOSEVELTMEDICAL.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | 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 |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.ROOSEVELTMEDICAL.ORG | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 5 | IN OCTOBER 2014, A STEERING COMMITTEE WAS CONVENED TO ASSIST ROOSEVELT MEDICAL CENTER IN CONDUCTING THE CHNA. THE COMMITTEE WAS A DIVERSE GROUP OF MEMBERS WHICH REPRESENTED VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY SUCH AS PUBLIC HEALTH, MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY CITIZENS, SENIORS, YOUTH, AND TRIBAL/AMERICAN INDIANS. ALSO, IN NOVEMBER 2014, A SURVEY WAS MAILED TO 880 RANDOMLY SELECTED RESIDENTS IN THE HOSPITAL'S SERVICE AREA TO SOLICIT THEIR INPUT. THERE WAS A 22 PERCENT RESPONSE. |
| FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 11 | THE FIRST STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO UTILIZE A VARIETY OF COMMUNICATION STRATEGIES TO BETTER INFORM THE RMC SERVICE AREA OF HOSPITAL SERVICES, AS WELL AS INCREASE AND DIVERSIFY OUTREACH EFFORTS REGARDING SERVICES AVAILABLE AT RMC SUCH AS PUBLISHING A QUARTERLY HOSPITAL NEWSLETTER. DURING FISCAL YEAR 2017, A HOSPITAL NEWSLETTER WENT OUT TWICE DURING THE YEAR. IT WENT TO EVERY DOOR DIRECT VIA THE POST OFFICE. MARKETING ALSO SENT OUT OTHER MAILINGS THAT COMMUNICATED INFORMATION SUCH AS THAT THE HOSPITAL HAD ROOM FOR LONG TERM CARE PATIENTS, ETC. THE SECOND STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO EXPAND EXISTING COMMUNITY EDUCATION PROGRAMS AND EXPLORE OPPORTUNITIES TO START NEW PROGRAMS SUCH AS EXPLORING THE FEASIBILTY OF HOSTING A HEALTH FAIR AND PROMOTING THE EXISTING DIABETES EDUCATION PROGRAM. IN FISCAL YEAR 2017, BOTH A HEALTH FAIR AND BLOOD SCREENINGS WERE HELD. THE THIRD STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO INCREASE AWARENESS OF LOCAL OPPORTUNITIES FOR PHYSICAL ACTIVITY SUCH AS PUBLISHING A SCHEDULE OF LOCAL CLASSES AND PHYSICAL ACTIVITY EVENTS IN HOSPITAL NEWSLETTERS AND EMAIL UPDATES. DURING FISCAL YEAR 2017, AN IN-HOUSE HOSPITAL NEWSLETTER WENT OUT MONTHLY WHICH INCLUDED HEALTH TIPS. THERE WERE NO PHYSICAL ACTIVITY EVENTS TO ADVERTISE. THE FOURTH STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO EXPAND CURRENT PRIMARY CARE SERVICES AT RMC AND INCREASE PRIMARY CARE AND EMERGENCY ROOM COVERAGE SUCH AS RECRUITING AND HIRING AN ADDITIONAL PRIMARY CARE PROVIDER AND PROVIDING EDUCATION REIMBURSEMENT FOR HOSPITAL STAFF WHO WANT TO ADVANCE IN A HEALTH-RELATED FIELD. DURING FISCAL YEAR 2017, A NURSE PRACTITIONER WAS HIRED TO REPLACE A PROVIDER WHO WAS LEAVING, BUT NO ADDITIONAL PROVIDERS WERE HIRED. ONE PROVIDER WAS TRAINING TO WORK IN THE ER, BUT SHE THEN DECIDED TO LEAVE. THE AVERA EEMERGENCY SYSTEM WAS USED IN THE ER TO HELP WITH ADDITIONAL COVERAGE. ANOTHER IDENTIFIED HEALTH NEED WAS THAT PEOPLE INDICATED BEING UNAWARE OF PROGRAMS THAT WOULD HELP THEM PAY FOR THEIR HEALTHCARE BILLS. IN ADDITION TO MAKING THE FAP WIDELY AVAILABLE AS DOCUMENTED IN PART V, ITEM 16, WE ALSO HAD A CERTIFIED NAVIGATOR AND HELD PUBLIC MEETINGS IN THE PAST YEAR TO EDUCATE THE PUBLIC ABOUT THE HEALTH INSURANCE MARKETPLACE/EXCHANGE. THE NAVIGATOR CERTIFICATION ENDED SEPTEMBER 1, 2017. ADDITIONALLY, WE WILL CONTINUE TO PROVIDE INFORMATION ABOUT FINANCIAL ASSISTANCE IN NEWSLETTERS, ON OUR WEBSITE, AND ON OUR FACEBOOK PAGE IN ORDER TO INCREASE PUBLIC AWARENESS OF FINANCIAL ASSISTANCE OPTIONS FOR HEALTHCARE BILLS. ONE OF THE IDENTIFIED HEALTH NEEDS WHICH WAS NOT ADDRESSED IS AFFORDABLE HOUSING. THIS IS A BROAD ISSUE THAT CANNOT BE ADDRESSED THROUGH THE HOSPITAL ALONE. THE COMMUNITY ALREADY HAS THE GREAT NORTHERN DEVELOPMENT ORGANIZATION THAT WAS CREATED TO ADDRESS THIS ISSUE. WITH A LULL IN THE LOCAL OIL FIELD BOOM, HOUSING COSTS HAVE DECREASED SOME ON THEIR OWN, BUT THIS WAS NOT DUE TO A SPECIFIC PROGRAM IN PLACE. ANOTHER IDENTIFIED HEALTH NEED WHICH WAS NOT ADDRESSED WAS PROVIDING FULL- TIME SPECIALISTS. AT THIS TIME IT IS BEYOND THE RESOURCE CAPACITY OF ROOSEVELT MEDICAL CENTER. RMC OFFERS CONSULTS WITH SOME SPECIALISTS VIA TELEMEDICINE AND WORKS WITH BILLINGS CLINIC TO ADD MORE SPECIALITIES AS THE SPECIALISTS ARE WILLING TO PROVIDE TELEHEALTH SERVICES. RMC DOES NOT HAVE ENOUGH VOLUME OF PATIENTS IN ANY ONE SPECIALITY AREA TO GET SPECIALISTS TO TRAVEL HERE FOR ONSITE CONSULTATIONS. THIS DID NOT CHANGE DURING FISCAL YEAR 2017. TRANSPORTATION ASSISTANCE, DENTAL CLINIC, FITNESS CENTER, AND MASSAGE THERAPY ARE MORE IDENTIFIED HEALTH NEEDS WANTED BY THE COMMUNITY BUT PROVIDING THESE SERVICES IS BEYOND THE RESOURCE AND FINANCIAL CAPACITY OF RMC AT THE TIME OF THE IMPLEMENTATION PLAN. HOWEVER, RMC DID HAVE AN INDEPENDENT MASSAGE THERAPIST AVAILABLE ON CAMPUS FROM 7/20/2015-8/31/2016. NO ADDITIONAL SERVICES WERE ADDED DURING FISCAL YEAR 2017. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ROOSEVELT MEDICAL CENTER CLINIC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 818 2ND AVE E | AddressLine1Txt |
| City | CULBERTSON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59218 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION | PHYSICIAN PROFESSIONAL SERVICES MAKE UP 187,299 OF COLUMN C, 115,589 OF COLUMN D, AND 71,710 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 10,510. ROOSEVELT MEDICAL CENTER'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 EXPLANATION | USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND CHARITY CARE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, CHARITY CARE, 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 STATEMENTS | THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 8 OF THE AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8 - MEDICARE EXPLANATION | THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE FOR MOST SERVICES, LESS THE 2% SEQUESTRATION ADJUSTMENT, AND SOME SERVICES LIKE AMBULANCE ARE PAID BASED ON FEE SCHEDULES. 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 AND THE MEDICARE PROVIDER SUMMARY REPORT. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | IF APPROVED FOR FINANCIAL ASSISTANCE UNDER THE PROVISIONS OF THE FINANCIAL ASSISTANCE POLICY (FAP), THE PATIENT WILL RECEIVE NOTIFICATIONS THAT INCLUDE: A. THE DISCOUNT OF GROSS CHARGES TO THE AGB. THEN FINANCIAL ASSISTANCE DISCOUNTS WILL BE APPLIED TO THE AGB IN ACCORDANCE WITH THE DISCOUNT OF AGB CHARGES SCHEDULE DESCRIBED IN THE "DISCOUNT" SECTION OF THE FAP. B. PROVIDING THE PATIENT WITH A BILLING STATEMENT THAT INDICATES THE AMOUNT THE PATIENT OWES, IF THEY ARE NOT ELIGIBLE FOR FREE CARE. C. REFUNDING ANY EXCESS PAYMENTS MADE BY THE INDIVIDUAL BEYOND THE AGB ON ELIGIBLE ACCOUNTS IF NECESSARY. D. TAKING ALL REASONABLY AVAILABLE MEASURES TO REVERSE EXTRAORDINARY COLLECTION ACTIONS THAT OCCURRED. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | WE SEND OUT PATIENT SATISFACTION SURVEYS TO OUR PATIENTS. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | RMC WILL MAKE ALL REASONABLE EFFORTS TO NOTIFY A PATIENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY BY: 1.ATTEMPTING TO DETERMINE WHETHER A PATIENT HAS THIRD-PARTY COVERAGE FOR ANY PART OF THE EMERGENCY OR MEDICALLY NECESSARY HEALTH CARE SERVICE PROVIDED. IF A PATIENT DOES NOT HAVE OR QUALIFY FOR THIRD-PARTY FUNDING, THE BUSINESS OFFICE STAFF WILL EXPLAIN THE FINANCIAL ASSISTANCE POLICY, PROVIDE AN APPLICATION FOR FINANCIAL ASSISTANCE AND PROVIDE ASSISTANCE WITH COMPLETING THE APPLICATION, IF DESIRED. 2.OFFERING THE PATIENT A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE AVAILABLE UNDER THIS POLICY AT THE TIME OF ADMISSION OR BEFORE DISCHARGE FROM RMC. 3.PROVIDING THE INFORMATION DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ON AT LEAST THREE (3) BILLING STATEMENTS AND IN ALL OTHER WRITTEN COMMUNICATIONS IN REFERENCE TO FINANCIAL RECORDS TO THE PATIENT; 4.INFORMING PATIENTS DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE CARE THAT OCCURRED; 5.PROVIDING THE PATIENT WITH AT LEAST ONE WRITTEN NOTICE INFORMING THE PATIENT ABOUT THE EXTRAORDINARY COLLECTION ACTIONS THAT RMC MAY TAKE IF THE PATIENT DOES NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR PAY THE AMOUNT DUE BY AT LEAST THIRTY DAYS FOLLOWING THE DATE OF THE NOTICE. THE NOTICE WILL NOT BE MAILED OR DELIVERED TO A PATIENT EARLIER THAN 30 DAYS PRIOR TO THE END OF THE NOTIFICATION PERIOD; AND 6.RMC WILL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST A PATIENT UNTIL SUCH TIME AS IT DETERMINES THE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY DURING THE 120 DAY NOTIFICATION PERIOD AND HAS PROVIDED THE PATIENT WITH THE NOTICE AS DESCRIBED ABOVE. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | WE PROVIDE SERVICE TO THE POPULATION IN EASTERN ROOSEVELT COUNTY, SOUTHERN SHERIDAN COUNTY, AND NORTHERN RICHLAND COUNTY. |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | THE ADMINISTRATOR OF ROOSEVELT MEDICAL CENTER PARTICIPATES IN THE LOCAL CHAMBER OF COMMERCE. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| DON HELLAND | ||||
| MD | $193,032 | $300 | $5,499 | $198,831 |
| ELIZABETH KLEPPEN | ||||
| PA-C | $173,547 | $300 | $5 | $173,852 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 2 | PAULA SCHLEDEWITZ GRANT SALVEVOLD CHAIRMAN DIRECTOR FAMILY RELATIONSHIP |
| FORM 990, PAGE 6, PART VI, LINE 11B | FORM 990 IS REVIEWED AT A REGULAR BOARD MEETING. |
| FORM 990, PAGE 6, PART VI, LINE 12C | COMPLIANCE IS REVIEWED ANNUALLY. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS WHICH IS USUALLY BASED ON THE AMOUNT/PERCENTAGE OF RAISE THE REST OF THE EMPLOYEES ARE GOING TO RECEIVE. |
| FORM 990, PAGE 6, PART VI, LINE 15B | CFO COMPILES INFORMATION FROM ANNUAL MHA SALARY SURVEY REGARDING AVERAGE WAGE BEING PAID FOR EACH JOB DESCRIPTION BASED ON PEER GROUP, CAH'S, OR MHA REGION. CFO AND CEO COMPARE AVERAGES BEING PAID TO CURRENT ROOSEVELT MEDICAL CENTER SALARY SCALE TO SEE IF ADJUSTMENTS NEED TO BE MADE TO KEEP JOB COMPETITIVE WITHIN INDUSTRY. RECOMMENDATIONS FOR SALARY INCREASES ARE MADE TO THE BOARD OF DIRECTORS FOR APPROVAL OR DISAPPROVAL WHICH IS RECORDED IN THE BOARD MINUTES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | DOCUMENTS RELATING TO ROOSEVELT MEDICAL CENTER ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | ADMIN PROF FEES 0 40,080 0 ADMIN PURCHASED SERVICES 0 3,589 0 CLINIC PROF FEES 1,566 0 0 DIETARY PURCHASED SERVICES 274,454 0 0 LAB PROF FEES 88,669 0 0 LAB PURCHASED SERVICES 34,547 0 0 MAINT PURCHASED SERVICES 0 135 0 MEDICAL & SURGICAL PROF FEES 95,199 0 0 MEDICAL & SURGICAL PURCH SVCS 17,824 0 0 MEDICAL RECORDS PURCH SRVCS 11,503 0 0 OT PURCHASED SERVICES 19,934 0 0 PT PURCHASED SERVICES 69,014 0 0 AMBULANCE PURCHASED SERVICE 317 0 0 RADIOLOLGY PURCHASED SERVICES 10,460 0 0 SWING BED PROF FEES 94,671 0 0 ER PROF FEES 10,273 0 0 SPEECH THERAPY PURCHASED SVCS 24,225 0 0 BUSINESS OFFICE PROF FEES 0 24,851 0 CLINIC PURCHASED SVCS 67 0 0 TOTAL 752,723 68,655 0 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Business Name Line2DirectControllingEntityName/BusinessNameLine2Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||||||||||||
| PO BOX 419 | CULBERTSON | MT | 59218 | 810529284 | SUPPORT OR | MT | 501C3 | 7 | N/A | false | ||
| NE MT STAT AIR AMB COOP | ||||||||||||
| 519 PLEASANT STREET | MILES CITY | MT | 59301 | 204748673 | AIR AMBUL | MT | 501C3 | 12B | false | NA | N/A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| C | $34,298 | SUPPORT |
| ROOSEVELT MEMORIAL HEALTHCARE FOUND | ||
| O | $31,509 | WAGES FOR RMHF DIRECTOR |