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STILLWATER HOSPITAL ASSOCIATION INC: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
STILLWATER HOSPITAL ASSOCIATION INC (EIN 81-0286525)
Tax period
2015-07-01 to 2016-06-30
Filed
2017-05-15
IRS object ID
201721359349312417
Schema version
2015v3.0
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)
Return2017-05-15T16:53:33-05:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1111 South Tejon Suite 800AddressLine1Txt
CityColorado SpringsCityNm
State AbbreviationCOStateAbbreviationCd
ZIP809039848ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN810286525EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Stillwater Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% KELLEY HARMONInCareOfNm
Business Name ControlSTILBusinessNameControlTxt
Phone4063225316PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1710 N 11th StAddressLine1Txt
CityColumbusCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59019ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonKELLEY EVANSPersonNm
Person TitleCAOPersonTitleTxt
Phone4063225316PhoneNum
Signature2017-05-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonAdam R Smith CPAPreparerPersonNm
PTINP00958966PTIN
Phone7194714290PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerDR DEBORAH AGNEW MDPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1710 N 11th StAddressLine1Txt
CityColumbusCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59019ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$9,964,195GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.stillwaterbillingsclinic.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1914FormationYr
Legal Domicile StateMTLegalDomicileStateCd
Activity Or MissionStillwater Hospital Association is a rural integrated health care organization bringing together a physician clinic & hospital svcs to deliver quality coordinated care.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent5VotingMembersIndependentCnt
Total Employee65TotalEmployeeCnt
Total Volunteers5TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$420,175PYContributionsGrantsAmt
CY Contributions Grants$138,527CYContributionsGrantsAmt
PY Program Service Revenue$9,049,799PYProgramServiceRevenueAmt
CY Program Service Revenue$9,777,223CYProgramServiceRevenueAmt
PY Investment Income$43,527PYInvestmentIncomeAmt
CY Investment Income$31,744CYInvestmentIncomeAmt
PY Other Revenue$47,272PYOtherRevenueAmt
CY Other Revenue-$2,223CYOtherRevenueAmt
PY Total Revenue$9,560,773PYTotalRevenueAmt
CY Total Revenue$9,945,271CYTotalRevenueAmt
PY Grants And Similar Paid$5,385PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$4,929CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$2,691,464PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$3,257,627CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,096,947PYOtherExpensesAmt
CY Other Expenses$6,299,721CYOtherExpensesAmt
PY Total Expenses$8,793,796PYTotalExpensesAmt
CY Total Expenses$9,562,277CYTotalExpensesAmt
PY Revenues Less Expenses$766,977PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$382,994CYRevenuesLessExpensesAmt
Total Assets BOY$17,570,478TotalAssetsBOYAmt
Total Assets EOY$17,610,146TotalAssetsEOYAmt
Total Liabilities BOY$14,374,429TotalLiabilitiesBOYAmt
Total Liabilities EOY$14,072,199TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$3,196,049NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,537,947NetAssetsOrFundBalancesEOYAmt
MissionSTILLWATER HOSPITAL ASSOCIATION IS A RURAL INTEGRATED HEALTH CARE ORGANIZATION BRINGING TOGETHER A PHYSICIAN CLINIC & HOSPITAL SERVICES TO DELIVER QUALITY COORDINATED CARE.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$7,558,948ExpenseAmt
Grant$4,929GrantAmt
Revenue$9,768,192RevenueAmt
DescACUTE CARE HOSPITAL AND RURAL HEALTH CLINICDesc
Total Program Service Expenses$7,558,948TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
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 ActivitiesYes (true)FundraisingActivitiesInd
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 EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document6IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee65EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsYes (true)QuidProQuoContributionsInd
Quid Pro Quo Contri DisclYes (true)QuidProQuoContriDisclInd
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 Member5IndependentVotingMemberCnt
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 ApprovaYes (true)DecisionsSubjectToApprovaInd
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 CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonKELLEY HARMONPersonNm
Phone9706574612PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12800 TENTH AVENUE NAddressLine1Txt
CityBillingsCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59107ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Michael Matovich
President3.00.0Yes (X)Yes (X)$0$0$0
Luke Kobold
Vice President3.040.0Yes (X)Yes (X)$0$154,913$33,674
Ron Martinez
Secretary/Treasurer3.00.0Yes (X)Yes (X)$0$0$0
John Hungerford
Past President3.00.0Yes (X)$0$0$0
Dr Camilla Reese
Director3.040.0Yes (X)$0$295,708$35,932
Dr Richard Klee
Director/physician40.01.0Yes (X)$0$312,994$38,314
Mike Follett
Director3.040.0Yes (X)$0$184,254$20,317
Bharat Acharya
Director3.00.0Yes (X)$0$0$0
Dan Vesbach
Director3.00.0Yes (X)$0$0$0
Dr Deborah Agnew
CEO18.04.0Yes (X)$0$261,358$37,205
Kelley Evans
CAO20.00.0Yes (X)$0$162,795$27,061
Kyle Gee
CFO10.030.0Yes (X)$0$329,496$38,425
Dr David Kane
Physician40.00.0$0$253,635$49,085Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$0TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,955,153TotReportableCompRltdOrgAmt
Total Other Compensation$280,013TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K0IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (2 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
BILLINGS CLINIC
2800 Tenth Avenue NorthBILLINGSMT59101management services$2,524,445
WILDERNESS MEDICAL STAFFING
PO BOX 616HOMERAK99603MEDICAL STAFFING$179,575
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K2CntrctRcvdGreaterThan100KCnt
Fundraising$33,074FundraisingAmt
All Other Contributions$105,453AllOtherContributionsAmt
Total Contributions$138,527TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtExclusionExclusionAmt
PATIENT SERVICE REVENUE621300$9,766,491$9,766,491
MEALS900099$10,732$10,732
FieldValueIRS element (for citing)
Total Program Service Revenue$9,777,223TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$31,744TotalRevenueColumnAmt
Exclusion$31,744ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$15,000FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$33,074ContriRptFundraisingEventAmt
Fundraising Direct Expenses$18,924FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column-$3,924TotalRevenueColumnAmt
Exclusion-$3,924ExclusionAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescMISCELLANEOUS INCOMEDesc
Business900099BusinessCd
Total Revenue Column$1,701TotalRevenueColumnAmt
Related Or Exempt Func Income$1,701RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$1,701OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$9,945,271TotalRevenueColumnAmt
Related Or Exempt Func Income$9,768,192RelatedOrExemptFuncIncomeAmt
Exclusion$38,552ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$4,929TotalAmt
Program Services$4,929ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$537,681TotalAmt
Program Services$486,292ProgramServicesAmt
Management And General$51,389ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$2,316,423TotalAmt
Program Services$1,720,159ProgramServicesAmt
Management And General$596,264ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$24,234TotalAmt
Program Services$18,085ProgramServicesAmt
Management And General$6,149ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$210,560TotalAmt
Program Services$156,657ProgramServicesAmt
Management And General$53,903ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$168,729TotalAmt
Program Services$124,025ProgramServicesAmt
Management And General$44,704ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$1,747,334TotalAmt
Program Services$1,424,181ProgramServicesAmt
Management And General$323,153ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,180TotalAmt
Management And General$4,180ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,540TotalAmt
Management And General$7,540ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$872,891TotalAmt
Program Services$756,521ProgramServicesAmt
Management And General$116,370ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$52,896TotalAmt
Program Services$29,397ProgramServicesAmt
Management And General$23,499ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$303,825TotalAmt
Program Services$128,244ProgramServicesAmt
Management And General$175,581ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$217,967TotalAmt
Program Services$172,194ProgramServicesAmt
Management And General$45,773ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$71,608TotalAmt
Program Services$54,537ProgramServicesAmt
Management And General$17,071ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$800,305TotalAmt
Program Services$631,955ProgramServicesAmt
Management And General$168,350ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$959,969TotalAmt
Program Services$688,452ProgramServicesAmt
Management And General$271,517ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$104,738TotalAmt
Program Services$21,075ProgramServicesAmt
Management And General$83,663ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
PROVISION FOR BAD DEBT$620,931$620,931
MEDICAL SUPPLIES$455,436$455,436
DIETARY$50,619$50,504$115
REPAIRS & MAINTENANCE$18,103$9,448$8,655

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$11,379TotalAmt
Program Services$5,926ProgramServicesAmt
Management And General$5,453ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$9,562,277TotalAmt
Program Services$7,558,948ProgramServicesAmt
Management And General$2,003,329ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,768,459BOYAmt
EOY$2,444,965EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$821,380BOYAmt
EOY$1,048,700EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,259,998BOYAmt
EOY$1,256,484EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$166,162BOYAmt
EOY$184,089EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$158,943BOYAmt
EOY$176,688EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$16,175,532LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$4,167,628LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,890,972BOYAmt
EOY$12,007,904EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$466,691BOYAmt
EOY$458,976EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$37,873BOYAmt
EOY$32,340EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$17,570,478BOYAmt
EOY$17,610,146EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$312,024BOYAmt
EOY$507,320EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$13,654,273BOYAmt
EOY$13,301,067EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$408,132BOYAmt
EOY$263,812EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,374,429BOYAmt
EOY$14,072,199EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,977,018BOYAmt
EOY$3,406,178EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$199,031BOYAmt
EOY$111,769EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$20,000BOYAmt
EOY$20,000EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,196,049BOYAmt
EOY$3,537,947EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$17,570,478BOYAmt
EOY$17,610,146EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$382,994ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$41,096NetUnrlzdGainsLossesInvstAmt
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 RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

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 D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$29,088BeginningYearBalanceAmt
Investment Earnings Or Losses$88InvestmentEarningsOrLossesAmt
End Year Balance$29,176EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$29,001BeginningYearBalanceAmt
Investment Earnings Or Losses$87InvestmentEarningsOrLossesAmt
End Year Balance$29,088EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$28,914BeginningYearBalanceAmt
Investment Earnings Or Losses$87InvestmentEarningsOrLossesAmt
End Year Balance$29,001EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$28,813BeginningYearBalanceAmt
Investment Earnings Or Losses$101InvestmentEarningsOrLossesAmt
End Year Balance$28,914EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
Contributions$28,813ContributionsAmt
End Year Balance$28,813EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.31450BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.68550PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$558,194OtherCostOrOtherBasisAmt
Book Value$558,194BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,088,220OtherCostOrOtherBasisAmt
Depreciation$2,140,745DepreciationAmt
Book Value$9,947,475BookValueAmt
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovementsGrp

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$2,616,384OtherCostOrOtherBasisAmt
Depreciation$1,678,652DepreciationAmt
Book Value$937,732BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$912,734OtherCostOrOtherBasisAmt
Depreciation$348,231DepreciationAmt
Book Value$564,503BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$12,007,904TotalBookValueLandBuildingsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE TO RELATED ORGANIZATIONDesc
Amt$263,812Amt
FieldValueIRS element (for citing)
Total Liability$263,812TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$9,308,213TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$41,096NetUnrealizedGainsInvstAmt
Other Revenue$24,969OtherRevenueAmt
Revenue Not Reported-$16,127RevenueNotReportedAmt
Revenue Subtotal$9,324,340RevenueSubtotalAmt
Other Revenues Not Included$620,931OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$620,931RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$9,945,271TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$8,962,293TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$20,947OtherExpensesIncludedAmt
Expenses Not Reported$20,947ExpensesNotReportedAmt
Expenses Subtotal$8,941,346ExpensesSubtotalAmt
Other Expenses Not Included$620,931OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$620,931ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$9,562,277TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule D, Part V, line 4DESCRIBE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS: The endowment includes both donor-restricted endowment funds and funds designated by the governing body to function as endowments (board-designated endowment funds). As required by accounting principles generally accepted in the United States of America GAAP), net assets associated with endowment funds, including board-designated endowment funds, are classified and reported based on the existence or absence of donor-imposed restrictions.
Schedule D, PART X, LINE 2UNCERTAIN TAX POSITIONS: Management has evaluated their income tax positions under the guidance included in asc 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.
SCHEDULE D, PART XI, LINE 2DREVENUE ON BOOKS, NOT ON RETURN: ACTIVITY OF STILLWATER FOUNDATION CONSOLIDATED IN FINANCIALS, EXCLUDED FOR TAX RETURN 6,045 SPECIAL EVENT EXPENSE 18,924 TOTAL 24,969
SCHEDULE D, PART XI, LINE 4BREVENUE ON RETURN, NOT ON BOOKS: BAD DEBT NET WITH REVENUE ON FINANCIALS, TREATED AS EXPENSE ON TAX RETURN 620,931
SCHEDULE D, PART XII, LINE 2DEXPENSE ON BOOKS, NOT ON RETURN: ACTIVITY OF STILLWATER FOUNDATION CONSOLIDATED IN FINANCIALS, EXCLUDED FOR TAX RETURN 2,023 SPECIAL EVENT EXPENSE 18,924 TOTAL 20,947
SCHEDULE D, PART XII, LINE 4BEXPENSE ON RETURN, NOT ON BOOKS: BAD DEBT NET WITH REVENUE ON FINANCIALS, TREATED AS EXPENSE ON TAX RETURN 620,931

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1JEWELEvent1Nm
Gross Receipts Event1$48,074GrossReceiptsEvent1Amt
Charitable Contri Event1$33,074CharitableContriEvent1Amt
Gross Revenue Event1$15,000GrossRevenueEvent1Amt
Rent Facility Costs Event1$675RentFacilityCostsEvent1Amt
Food And Beverage Event1$7,625FoodAndBeverageEvent1Amt
Entertainment Event1$4,013EntertainmentEvent1Amt
Other Direct Expenses Event1$6,611OtherDirectExpensesEvent1Amt
Other Events Total0OtherEventsTotalCnt
Gross Receipts Total$48,074GrossReceiptsTotalAmt
Charitable Contributions Tot$33,074CharitableContributionsTotAmt
Gross Revenue Total Events$15,000GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$675RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$7,625FoodAndBeverageTotalEventsAmt
Entertainment Total Events$4,013EntertainmentTotalEventsAmt
Oth Direct Expnss Total Events$6,611OthDirectExpnssTotalEventsAmt
Direct Expense Summary Events$18,924DirectExpenseSummaryEventsAmt
Net Income Summary-$3,924NetIncomeSummaryAmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent100Yes (X)Percent100Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
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$85,311TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$85,311NetCommunityBenefitExpnsAmt
Total Expense0.00950TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$478,504TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$408,456DirectOffsettingRevenueAmt
Net Community Benefit Expns$70,048NetCommunityBenefitExpnsAmt
Total Expense0.00780TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$563,815TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$408,456DirectOffsettingRevenueAmt
Net Community Benefit Expns$155,359NetCommunityBenefitExpnsAmt
Total Expense0.01730TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,929TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,929NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,929TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,929NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$568,744TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$408,456DirectOffsettingRevenueAmt
Net Community Benefit Expns$160,288NetCommunityBenefitExpnsAmt
Total Expense0.01790TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$620,931BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$2,842,404ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$2,719,593CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$122,811MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
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 Line1Stillwater Hospital AssociationBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1710 N 11th StAddressLine1Txt
CityColumbusCityNm
State AbbreviationMTStateAbbreviationCd
ZIP59019ZIPCd
FieldValueIRS element (for citing)
Website Addressstillwaterbillingsclinic.comWebsiteAddressTxt
State License13418StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Emergency Room OtherYes (X)EmergencyRoomOtherInd
OtherPHYSICIAN CLINICOtherDesc
Facility Reporting Group1FacilityReportingGroupCd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Stillwater Hospital AssociationBusinessNameLine1Txt
FieldValueIRS element (for citing)
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedfalseCHNAConductedInd
Organization Incur Excise TaxYes (true)OrganizationIncurExciseTaxInd
Form4720 FiledYes (true)Form4720FiledInd
Excise Report Form4720 For All$50,000ExciseReportForm4720ForAllAmt
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care100FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
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 App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLsee part v section cFAPAppAvailableOnWebsiteURLTxt
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
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
None MadeYes (X)NoneMadeInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Average Negotiated RatesYes (X)AverageNegotiatedRatesInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 16bwebsite URL for FAP application form: http://stillwaterbillingsclinic.com/wp-content/uploads/Charity-care.pdf
SCHEDULE H, PART V, SECTION B, LINE 16a & 16cStillwater Hospital Associations (Stillwater) financial assistance policy (FAP) and plain language summary were not made widely available on a website during its fiscal year ended 6/30/2016. The hospital is currently in the process of making adjustments to their FAP, which will be effective in October 2017. Billings Clinic, the sole member of Stillwater, will be taking over Stillwaters revenue cycle to provide a more streamlined approach, which will enable both organizations to serve patients better. Stillwater will then be included in the Billings Clinics FAP.

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7, column fBad debt expense included on Form 990, part IX, line 25 but excluded for purposes of calculating percentages in this column equal $620,931.
SCHEDULE H, PART I, LINE 7THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS.
SCHEDULE H, PART III, Section A, LINE 2Bad debt is estimated by actual write offs plus a reserve calculated using different percentages based on aging category of receivables.
SCHEDULE H, PART III, Section A, LINE 4See page 12 of the attached audited financial statements for the footnote that describes bad debt expense.
SCHEDULE H, PART III, Section C, LINE 9bPatients are screened by the organization's financial counselors to see if they qualify for financial assistance. If they qualify, their account balances are adjusted accordingly. If there is a balance after the adjustment, the organization follows the normal debt collection practice. In unusual situations where the patient's circumstances have changed, the CEO has the authority to grant exceptions to the policy.
SCHEDULE H, PART VI, LINE 2NEEDS ASSESSMENT: The organization assesses the health care needs of the communities it serves through day to day patient care and the work of the community health services department.
SCHEDULE H, PART VI, LINE 3PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: The Organization employs a Business office lead who is responsible for administering the Financial Assistance Program, assuring the determination for financial assistance meets the requirements of the policy, and notifying the patient and/or responsible party of the final determination of amounts approved under the policy. Patient representatives work with the patients in completing applications that determine eligibility for financial assistance under the hospital's financial assistance policy. Information is also in printed form on patient bills.
SCHEDULE H, PART VI, LINE 4COMMUNITY INFORMATION: Stillwater County stretches 75 miles of two lane roads from north to south connecting mountain ranges to the lake basins, coulees, and rolling plains. Interstate 90 passes through the County at Columbus. County has population of 9,185 with 6 unincorporated communities and 1 incorporated community of Columbus where the hospital resides. County has a vast array of outdoor recreational opportunities.
SCHEDULE H, PART VI, LINE 5Promotion of community health: Stillwater Hospital Association's Community health services department strives to provide broad-based community health information and services to the residents, facilities and guests of Stillwater County. The board has community members serving.
SCHEDULE H, PART VI, LINE 6Affiliated health care system: Stillwater Billings Clinic is managed by Billings Clinic and works closely with Billings Clinic and other hospitals also managed by Billings Clinic to provide high quality patient care.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Luke Kobold
Vice President$0$144,084$0$10,829$0$0$0$13,757$0$19,917$0$188,587$0$0
Dr Camilla Reese
Director$245,708$0$50,000$23,275$12,657$331,640$0
Dr Richard Klee
Director/physician$0$138,497$0$50,847$0$123,650$0$21,740$0$16,574$0$351,308$0$0
Mike Follett
Director$0$160,419$0$23,835$0$0$0$16,425$0$3,892$0$204,571$0$0
Dr David Kane
Physician$0$124,093$0$10,000$0$119,542$0$21,780$0$27,305$0$302,720$0$0
Dr Deborah Agnew
CEO$0$258,503$0$0$0$2,855$0$22,453$0$14,752$0$298,563$0$0
Kelley Evans
CAO$0$141,178$0$20,000$0$1,617$0$13,504$0$13,557$0$189,856$0$0
Kyle Gee
CFO$0$233,483$0$46,890$0$49,123$0$20,303$0$18,122$0$367,921$0$49,123

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PART I, LINE 3DESCRIBE HOW CEO COMPENSATION IS DETERMINED: COMPENSATION FOR THE CEO IS PAID BY BILLINGS CLINIC, A RELATED ORGANIZATION. PLEASE SEE SCHEDULE O, PART VI, LINE 15A NARRATIVE FOR HOW CEO COMPENSATION IS DETERMINED.
SCHEDULE J, PART I, LINE 4B457(F) PLAN: The Billings Clinic supplemental retirement agreement for senior executives (SERP) is a non-elective 457(f) agreement and provides for annual deferrals, which become vested and payable after 4 years. Vesting will occur on January 1, 2017. Kyle Gee participated in the plan and a payment of $49,123 was made during 2015 and is included in other reportable compensation on Schedule J, Part II, column B (III).

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, Line 6DESCRIBE CIRCUMSTANCES FOR HAVING MEMBERS: Billings Clinic is the sole member of Stillwater Hospital Association.
Form 990, Part VI, Section A, Line 7aMembers who can elect members of the governing body: The sole member has authority to recommend, approve and reject nominations of board members.
Form 990, Part VI, Section A, Line 7bDecisions of governing body subject to approval by members: The following are Governance decisions of the organization which are subject to approval by the sole member: - Amendments to the organization's articles of incorporation, bylaws, or name; - Dissolution, mergers, or consolidations with or into another entity; - Sale, lease, exchange or dispositions of property of the organization; - Approval of budgets; - Incurrence or debt and purchases made by the organization in amounts exceeding $100,000; - Selection, hiring, primary supervision, discipline and termination of the organization's Chief Executive Officer; - Addition or discontinuance of any service offered to by the organization.
Form 990, Part VI, Section B, line 11bProcess to Review the Form 990: The form 990 is prepared by a third party and review is performed by the board of directors. Any changes and comments are provided back to the preparer and the final form 990 is provided to the full board prior to filing. The organization was provided an e-file submission form with the completed return which was signed and submitted for ERO processing.
Form 990, Part VI, Section B, line 12cProcess for Monitoring Compliance with Conflict of Interest Policy: All directors, officers, employees, and members of a committee with board delegated powers are covered by the conflict of interest policy and must provide an annual statement indicating they have reviewed and are in compliance with the policy. The board is charged with periodically reviewing and monitoring the policy to ensure the organization acts in a manner consistent with its charitable purpose. If a potential conflict is identified, the board will investigate any alternatives and determinations as to whether the transaction or arrangement is in the organizations best interest and will establish procedures for violations of the policy.
Form 990, Part VI, Section B, line 15aDescribe process for determining CEO/Executive compensation: Compensation is paid through Billings Clinic, the sole member. Compensation is determined by an annual review of external market data for similar size organizations through use of survey data with MHA and Yaffee & Company, and Rural Critical Access Hospital facilities. Compensation is reviewed and approved by the Board of Directors as recommended by the VP of Regional Services. The review is done at the time of the CEO's annual performance review.
Form 990, Part VI, Section B, line 15bDESCRIBE PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS: Other officer Compensation is paid through Billings Clinic, the sole member. Salaries for the other key officers/leaders in the organization are reviewed for comparison to other similar size organizations through use of external salary survey sources such as MHA and Associated Employers. This review is conducted by Stillwater's HR Generalist and the CEO. Budget recommendations are formulated for review and approval by the VP of Regional Services and for final approval by the Board of Directors/Finance Committee.
Form 990, Part VI, Section C, line 19DESCRIBE HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC: The organizations governing documents, conflict of interest policy, and financials statementS 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
Billings Clinic (BC)
2800 Tenth Avenue NorthBillingsMT59101810231784HOSPITALMT501(c)(3)LINE 3NAfalse
Billing Clinic Foundation
2917 Tenth Avenue NorthBillingsMT59101810407289FUNDRAISINGMT501(c)(3)LINE 7BCfalse
STILLWATER COMMUNITY HEALTHCARE FDN
710 N 11TH STCOLUMBUSMT59019200748325fundraisingMT501(c)(3)Line 7stillwaterYes (true)

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxt
New West Health Services
130 Neill AvenueHelenaMT59601841418136Insurance SalesMTBillings ClinicC-Corporation
Billings Clinic Express Care LLC
2800 10th Avenue northBilingsMT59101463355499Outpatient ClinicMTBillings ClinicC-Corporation
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (true)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd