MARCUS DALY MEMORIAL HOSPITAL CORPORATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- MARCUS DALY MEMORIAL HOSPITAL CORPORATION (EIN 81-0240726)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-04-05
- IRS object ID
- 201730959349300428
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-04-05T14:18:34-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 410746749 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLIFTONLARSONALLEN LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 220 SOUTH SIXTH STREET SUITE 300 | AddressLine1Txt |
| City | MINNEAPOLIS | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55402 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810240726 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCUS DALY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | MARC | BusinessNameControlTxt |
| Phone | 4063632211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN M BARTOS | PersonNm |
| Person Title | CEO, SECRETARY AND TREASURER | PersonTitleTxt |
| Phone | 4063632211 | PhoneNum |
| Signature | 2017-03-31 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DARRYN MCGARVEY | PreparerPersonNm |
| PTIN | P00958683 | PTIN |
| Phone | 6123764500 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN M BARTOS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $62,451,641 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MDMH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1929 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 622 | TotalEmployeeCnt |
| Total Volunteers | 75 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,609,705 | PYContributionsGrantsAmt |
| CY Contributions Grants | $522,820 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $57,609,506 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $61,202,601 | CYProgramServiceRevenueAmt |
| PY Investment Income | $38,637 | PYInvestmentIncomeAmt |
| CY Investment Income | $57,681 | CYInvestmentIncomeAmt |
| PY Other Revenue | $813,728 | PYOtherRevenueAmt |
| CY Other Revenue | $320,492 | CYOtherRevenueAmt |
| PY Total Revenue | $60,071,576 | PYTotalRevenueAmt |
| CY Total Revenue | $62,103,594 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $72,240 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $89,558 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $34,802,931 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $37,720,263 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $160,810 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,133,990 | PYOtherExpensesAmt |
| CY Other Expenses | $24,151,964 | CYOtherExpensesAmt |
| PY Total Expenses | $58,009,161 | PYTotalExpensesAmt |
| CY Total Expenses | $61,961,785 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,062,415 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $141,809 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $60,236,732 | TotalAssetsBOYAmt |
| Total Assets EOY | $57,938,753 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $31,861,353 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $29,679,846 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $28,375,379 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $28,258,907 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $52,432,380 | ExpenseAmt |
| Grant | $89,558 | GrantAmt |
| Revenue | $61,201,809 | RevenueAmt |
| Desc | MARCUS DALY MEMORIAL HOSPITAL CORPORATION OWNS AND OPERATES A 25 LICENSED BED ACUTE CARE CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES ACUTE CARE SERVICES TO PATIENTS IN RAVALLI COUNTY. THE SERVICES PROVIDED INCLUDE ACUTE CARE HOSPITAL, RELATED ANCILLARY SERVICES SUCH AS LABORATORY, RADIOLOGY, THERAPY, INPATIENT AND OUTPATIENT SURGERY, EMERGENCY CARE, AMBULANCE, HOME HEALTH, CLINIC, INPATIENT AND OUTPATIENT HOSPICE CARE. THE HOSPITAL PROVIDES EMS SERVICES WITH 3 CREWS PROVIDING 911 SERVICE TO THE COUNTY. THE GOAL IS TO RESPOND WITHIN 20 MINUTES OR LESS TO ANY CALL WITHIN THE COUNTY. THE HOSPITAL IS A PEDIATRIC REHABILITATION PROVIDER OF PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY USING CERTIFIED THERAPISTS. THE HOSPITAL CLINICS SEE ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY AND ENABLE THE COMMUNITY ACCESS TO PRIMARY CARE. | Desc |
| Total Program Service Expenses | $52,432,380 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 76 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 622 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
| Other | Yes (X) | OtherInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DONJA ERDMAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4063754609 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DON LODMELL PHD | ||||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BILL BEAN | ||||||||
| VICE CHAIR | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| BARBARA ACKERMAN | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| TOM ANDERSON | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| SUSAN BENJAMIN | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| LOIS HEDG-PETH | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| FREDERICK ILGENFRITZ MD | ||||||||
| BOARD MEMBER/PHYSICIAN THRU APRIL 2016 | 40.00 | Yes (X) | $302,453 | $0 | $63,996 | |||
| ALLEN W JONES MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | Yes (X) | $303,114 | $0 | $44,730 | |||
| BRIAN KELLEHER MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | Yes (X) | $176,744 | $0 | $0 | |||
| JOHN ORMISTON | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| JAMES OWINGS CPA | ||||||||
| BOARD MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| TIMOTHY WOODS MD | ||||||||
| BOARD MEMBER/PHYSICIAN | 40.00 | Yes (X) | $525,649 | $0 | $54,333 | |||
| JOHN M BARTOS | ||||||||
| CEO/SECRETARY/TREASURER | 39.00 | Yes (X) | $322,741 | $0 | $33,374 | 1.00 | ||
| DONJA C ERDMAN | ||||||||
| CFO | 39.00 | Yes (X) | $138,037 | $0 | $30,809 | 1.00 | ||
| JOHN MORELAND MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.00 | Yes (X) | $299,881 | $0 | $39,544 | |||
| TROY HANSON | ||||||||
| ASSISTANT ADMINISTRATOR | 40.00 | Yes (X) | $164,564 | $0 | $14,599 | |||
| SUSAN HILL RN | ||||||||
| DIRECTOR OF NURSING THRU APRIL 2016 | 40.00 | Yes (X) | $127,109 | $0 | $5,849 | |||
| KATHRYN PADILLA RN | ||||||||
| DIRECTOR OF NURSING | 40.00 | Yes (X) | $108,739 | $0 | $14,189 | |||
| MARY CAMDEN MD | ||||||||
| PHYSICIAN | 40.00 | $318,726 | $0 | $16,938 | Yes (X) | |||
| RICHARD DAY MD | ||||||||
| PHYSICIAN | 40.00 | $923,146 | $0 | $43,049 | Yes (X) | |||
| JEREMIAH CLINTON MD | ||||||||
| PHYSICIAN | 40.00 | $397,244 | $0 | $39,767 | Yes (X) | |||
| JENNIFER FEIGHNER MD | ||||||||
| PHYSICIAN | 40.00 | $296,448 | $0 | $21,464 | Yes (X) | |||
| MARK CALDERWOOD MD | ||||||||
| PHYSICIAN | 40.00 | $396,557 | $0 | $30,818 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,801,152 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $453,459 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 50 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| JACKSON CONTRACTOR GROUP INC | |||||
| PO BOX 967 | MISSOULA | MT | 59806 | GENERAL CONTRACTOR | $1,163,728 |
| CERNER CORPORATION | |||||
| PO BOX 959156 | ST LOUIS | MO | 63195 | EHR SERVICES | $763,776 |
| BECK BUILDERS INC | |||||
| 231 BLODGETT WAY | HAMILTON | MT | 59840 | CONSTRUCTION SERVICES | $443,291 |
| HEALHCARE OUTSOURCING NETWORK | |||||
| 617 17TH ST 1800 | DENVER | CO | 80293 | BILLING SERVICES | $399,077 |
| OZ ARCHITECTS | |||||
| 531 NORTH HIGGINS AVE A | MISSOULA | MT | 59802 | ARCHITECTUAL FEES | $250,542 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 14 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $333,914 | RelatedOrganizationsAmt |
| All Other Contributions | $188,906 | AllOtherContributionsAmt |
| Total Contributions | $522,820 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $59,744,165 | $59,744,165 |
| OTHER OPERATING INCOME | 621400 | $785,125 | $785,125 |
| HOSPITAL UTILZTN. REV. | 621400 | $673,311 | $673,311 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $61,202,601 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,835 | TotalRevenueColumnAmt |
| Exclusion | $22,835 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,910 | TotalRevenueColumnAmt |
| Exclusion | $1,910 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $235,842 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $128,057 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $107,785 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $107,785 | TotalRevenueColumnAmt |
| Exclusion | $107,785 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $50,770 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $17,834 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $32,936 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $32,936 | TotalRevenueColumnAmt |
| Exclusion | $32,936 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $111,125 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $202,156 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$91,031 | TotalRevenueColumnAmt |
| Exclusion | -$91,031 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CONSTRUCTION SETTLEMENT | 900099 | $180,726 | $180,726 |
| MISCELLANEOUS | 900099 | $106,326 | $106,326 |
| EDUCATION | 900099 | $8,838 | $8,838 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,848 | TotalRevenueColumnAmt |
| Exclusion | $7,848 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $303,738 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $62,103,594 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $61,202,601 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $378,173 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,558 | TotalAmt |
| Program Services | $89,558 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,666,629 | TotalAmt |
| Program Services | $1,955,270 | ProgramServicesAmt |
| Management And General | $711,359 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,217,923 | TotalAmt |
| Program Services | $23,688,725 | ProgramServicesAmt |
| Management And General | $4,449,116 | ManagementAndGeneralAmt |
| Fundraising | $80,082 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,054,559 | TotalAmt |
| Program Services | $890,245 | ProgramServicesAmt |
| Management And General | $161,327 | ManagementAndGeneralAmt |
| Fundraising | $2,987 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,940,698 | TotalAmt |
| Program Services | $3,288,547 | ProgramServicesAmt |
| Management And General | $641,710 | ManagementAndGeneralAmt |
| Fundraising | $10,441 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,840,454 | TotalAmt |
| Program Services | $1,552,905 | ProgramServicesAmt |
| Management And General | $282,565 | ManagementAndGeneralAmt |
| Fundraising | $4,984 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,905 | TotalAmt |
| Management And General | $122,905 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,373 | TotalAmt |
| Management And General | $62,373 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,443,727 | TotalAmt |
| Program Services | $1,705,797 | ProgramServicesAmt |
| Management And General | $1,734,609 | ManagementAndGeneralAmt |
| Fundraising | $3,321 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,007 | TotalAmt |
| Program Services | $81,007 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $548,709 | TotalAmt |
| Program Services | $224,837 | ProgramServicesAmt |
| Management And General | $323,239 | ManagementAndGeneralAmt |
| Fundraising | $633 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $958,725 | TotalAmt |
| Program Services | $851,468 | ProgramServicesAmt |
| Management And General | $107,257 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,654 | TotalAmt |
| Program Services | $277,071 | ProgramServicesAmt |
| Management And General | $18,583 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $193,146 | TotalAmt |
| Program Services | $157,389 | ProgramServicesAmt |
| Management And General | $35,757 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,166,899 | TotalAmt |
| Program Services | $996,929 | ProgramServicesAmt |
| Management And General | $135,976 | ManagementAndGeneralAmt |
| Fundraising | $33,994 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,175,104 | TotalAmt |
| Program Services | $3,953,502 | ProgramServicesAmt |
| Management And General | $202,558 | ManagementAndGeneralAmt |
| Fundraising | $19,044 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $963,080 | TotalAmt |
| Program Services | $963,080 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR BAD DEBTS | $5,813,595 | $5,813,595 | |
| MEDICAL EXPENSES | $3,736,200 | $3,736,200 | |
| PHARMACY/ LAB EXPENSES | $1,230,899 | $1,230,899 | |
| MAINTENANCE AND REPAIRS | $909,107 | $765,852 | $143,255 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $450,834 | TotalAmt |
| Program Services | $209,504 | ProgramServicesAmt |
| Management And General | $236,006 | ManagementAndGeneralAmt |
| Fundraising | $5,324 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,961,785 | TotalAmt |
| Program Services | $52,432,380 | ProgramServicesAmt |
| Management And General | $9,368,595 | ManagementAndGeneralAmt |
| Fundraising | $160,810 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,796,587 | BOYAmt |
| EOY | $8,250,264 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,076,859 | BOYAmt |
| EOY | $3,494,400 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,534,975 | BOYAmt |
| EOY | $8,811,539 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,000 | BOYAmt |
| EOY | $239,166 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,151,464 | BOYAmt |
| EOY | $2,009,194 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $430,819 | BOYAmt |
| EOY | $391,756 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $67,208,920 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $34,062,520 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,325,571 | BOYAmt |
| EOY | $33,146,400 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,444,609 | BOYAmt |
| EOY | $1,181,917 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $450,848 | BOYAmt |
| EOY | $414,117 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,236,732 | BOYAmt |
| EOY | $57,938,753 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,163,771 | BOYAmt |
| EOY | $6,509,367 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $269,181 | BOYAmt |
| EOY | $93,744 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,675,000 | BOYAmt |
| EOY | $6,155,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,158,822 | BOYAmt |
| EOY | $14,092,451 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $287,758 | BOYAmt |
| EOY | $847,592 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,306,821 | BOYAmt |
| EOY | $1,981,692 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,861,353 | BOYAmt |
| EOY | $29,679,846 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,296,467 | BOYAmt |
| EOY | $26,367,443 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,385,095 | BOYAmt |
| EOY | $1,193,193 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $693,817 | BOYAmt |
| EOY | $698,271 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,375,379 | BOYAmt |
| EOY | $28,258,907 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $60,236,732 | BOYAmt |
| EOY | $57,938,753 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $141,809 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$258,281 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | 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 D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $984 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $984 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,019 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,019 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,806 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,806 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $2,665 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $2,665 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $313,190 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $1,997 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $1,997 | OtherExpendituresAmt |
| End Year Balance | $313,190 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | 0 | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,637,827 | OtherCostOrOtherBasisAmt |
| Book Value | $1,637,827 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $45,697,357 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,371,320 | DepreciationAmt |
| Book Value | $26,326,037 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,090,651 | OtherCostOrOtherBasisAmt |
| Depreciation | $686,293 | DepreciationAmt |
| Book Value | $404,358 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,629,811 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,004,907 | DepreciationAmt |
| Book Value | $4,624,904 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $153,274 | OtherCostOrOtherBasisAmt |
| Book Value | $153,274 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $33,146,400 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | THIRD PARTY SETTLEMENT | Desc |
| Amt | $1,981,692 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,981,692 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $55,626,761 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$5,813,595 | OtherRevenueAmt |
| Revenue Not Reported | -$5,813,595 | RevenueNotReportedAmt |
| Revenue Subtotal | $61,440,356 | RevenueSubtotalAmt |
| Other Revenues Not Included | $663,238 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $663,238 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $62,103,594 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $56,289,002 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $106,568 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $106,568 | ExpensesNotReportedAmt |
| Expenses Subtotal | $56,182,434 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $5,779,351 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $5,779,351 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $61,961,785 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUND IS DESIGNATED FOR THE PURPOSE OF BUILDING AND CARRYING ON A HOSPITAL IN HAMILTON, MONTANA. THE EVANS ENDOWMENT IS TO BE USED FOR THE CARE AND TREATMENT OF CRIPPLED CHILDREN. |
| PART X, LINE 2: | PER THE AUDITED FINANCIAL STATEMENTS, NOTE 1: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT MARCUS DALY MEMORIAL HOSPITAL IS A TAX-EXEMPT, NOT-FOR-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE HOSPITAL FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HOSPITAL'S FINANCIAL STATEMENTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS -5,813,595. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | TEMPORARILY RESTRICTED CONTRIBUTIONS 488,054. OTHER OPERATING REVENUES 222,241. RENTAL EXPENSE -106,568. INTEREST REVENUE 24,745. GRANTS AND CONTRIBUTIONS 34,766. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | RENTAL EXPENSES 106,568. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 5,813,595. EMPLOYEE BENEFIT PLAN EXPENSES REFUNDED -34,244. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 150 | PersonsServedCnt |
| Total Community Benefit Expns | $434,561 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $434,561 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,560,297 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,722,727 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,837,570 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02970 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 150 | PersonsServedCnt |
| Total Community Benefit Expns | $7,994,858 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $5,722,727 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,272,131 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03670 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $354,686 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $354,686 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00570 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $93,830 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $93,830 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,225,930 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,994,946 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,230,984 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03600 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $95,437 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $95,437 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,769,883 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,994,946 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,774,937 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04470 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 150 | PersonsServedCnt |
| Total Community Benefit Expns | $15,764,741 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,717,673 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,047,068 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08140 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,319 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,319 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $853 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $853 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,731 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,731 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,903 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $70,903 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,813,595 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $16,303,620 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $16,671,355 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$367,735 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MARCUS DALY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MDMH.ORG | WebsiteAddressTxt |
| State License | 12911 | StateLicenseNum |
| 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 | MARCUS DALY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.MDMH.ORG/DOCS/2015_COMMUNITY_HEALTH_NEEDS_ASSESSMENT_REVISED_5.2 | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.MDMH.ORG/DOCS/2015_COMMUNITY_HEALTH_NEEDS_ASSESSMENT_REVISED_5.2 | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.MDMH.ORG/DOCS/CHARITY_CARE_POLICY_REVISED_062816FINAL.PDF | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTP://WWW.MDMH.ORG/DOCS/FINANCIAL_ASSISTANCE_APPLICATION_8.1.16.PDF | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTP://WWW.MDMH.ORG/DOCS/PATIENT_FINANCIAL_ASSISTANCE_PLAIN_LANGUAGE_SUMMAR | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| MARCUS DALY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 3J: PART V, SECTION B, LINE 3F:THIS BOX WAS LEFT UNCHECKED BECAUSE MDMH'S CHNA DIDN'T DIRECTLY INCLUDE A STATEMENT ADDRESSING THE PRIMARY AND CHRONIC DISEASE NEEDS AND OTHER HEALTH ISSUES OF UNINSURED PERSONS, LOW INCOME PERSONS, AND MINORITY GROUPS, HOWEVER, THE HOSPITAL IS TAKING STEPS TO ADDRESS THESE ISSUES. MDMH HAS RECENTLY JOINED TOGETHER WITH 10 OTHER HOSPITALS FROM RURAL MONTANA, IDAHO, AND WYOMING TO FORM THE MOUNTAIN WEST ACCOUNTABLE CARE ORGANIZATION (ACO). ONE OF THE MAIN OBJECTIVES OF THE ACO IS TO IMPROVE OVERALL COMMUNITY HEALTH BY FOCUSING ON THOSE WITH CHRONIC HEALTH NEEDS. AS PART OF THE ACO PROGRAM, MDMH HAS SPECIFICALLY HIRED A SECOND CLINIC RN TO HELP MANAGE THOSE PATIENTS IDENTIFIED WITH CHRONIC HEALTH CONDITIONS AND CONCERNS. |
| MARCUS DALY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 5: MR. VETO J. "SONNY" LASALLE SERVED AS THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROGRAM COORDINATOR. ALMOST 70 ORGANIZATIONS WERE IDENTIFIED WITH IN THE COUNTY , INCLUDING BUT NOT LIMITED TO COUNTY AND CITY ELECTED OFFICERS, SCHOOL BOARDS, SCHOOL STAFF, SERVICE CLUBS, RETIREMENT HOMES, POLITICAL GROUPS, FEDERAL AND STATE OFFICES, AND OTHERS. MR. LASALLE WOULD MEET WITH THE GROUP AT A SCHEDULED MEETING PRESENT THE PURPOSE OF THE CHNA, ANSWER QUESTIONS AND DISTRIBUTE SURVEYS. NOTICE OF THE SURVEY WAS ALSO MADE BY NEWSPAPER, TELEVISION, AND THE HOSPITAL NEWSLETTER, HEALTHLINES, WHICH IS MAILED TO COUNTY RESIDENTS. THIS SURVEY WAS ALSO POSTED ON THE HOSPITAL'S WEBSITE. |
| MARCUS DALY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 11: THE HIGHEST PRIORITY HEALTH NEEDS AS SUGGESTED BY THE COMMUNITY SERVED BY MDMH BASED UPON THE RESULT OF THE 2015 SURVEY ARE:1. EXPAND SERVICES TO INCLUDE A HEALTH CARE CINIC IN DARBY AND EXPANDED CHEMOTHERAPY SERVICES. 2. EXPAND PHYSICIAN SERVICES TO INCLUDE A PEDIATRITION, UROLOGIST, EAR, NOSE, AND THROAT SPECIALIST, PULMONOLOGY AND DERMATOLOGY. THE HOSPITAL BOARD OF DIRECTORS HAS DECIDED NOT TO PURSUE A PEDIATRICIAN AT THIS TIME. 3. EXPAND EDUCATIONAL OPPORTUNITIES ESPECIALLY RELATED TO DIABETES, NUTRITION, OBESITY AND DEMENTIA. 4. EXPANDED MENTAL HEALTH COVERAGE WAS ALSO REQUESTED. MDMH RECOGNIZES THAT THIS IS A STATE AND NATIONAL CONCERN BUT UNFORTUNATELY AT THIS TIME MDMH IS NOT STAFFED TO DEAL WITH MENTAL HEALTH PATIENTS OUTSIDE OF THE EMERGENCY DEPARTMENT. |
| MARCUS DALY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 13B: ELIGIBILITY FOR PATIENT ASSISTANCE SHALL BE MADE REGARDLESS OF RACE, GENDER, AGE, SEXUAL ORIENTATION, RELIGIOUS AFFILIATION, AND SOCIAL OR IMMIGRANT STATUS. MAJOR AREAS OF CONSIDERATIONS 1) RELATIONSHIP TO FEDERAL INCOME POVERTY GUIDELINES ADJUSTED FOR FAMILY SIZE 2) FAMILY NET ASSETS 3) DEMONSTRATION OF INABILITY TO WORK 4) COMPLETED APPLICATION AND 5) RESIDENT OF RAVALLI COUNTY MONTANA WITH EXCEPTIONS. |
| MARCUS DALY MEMORIAL HOSPITAL | PART V, SECTION B, LINE 22D: FOR FIRST SIX MONTHS OF FY16, MDMH DETERMINED AMOUNTS GENERALLY BILLED ("AGB") BASED ON COMMERCIAL PAYOR PERCENTAGE FROM LARGEST COMMERCIAL PAYOR DISCOUNT OF 19% AS OF YEAR ENDED JUNE 30, 2015. FOR THE SECOND SIX MONTHS, MDMH IMPLETMENTED THE NEW 501R GUIDELINES AND DETERMINED AMOUNTS GENERALLY BILLED ("AGB") BASED ON MEDICAID, MEDICARE FEE-FOR-SERVICE, AND ALL PRIVATE HEALTH INSURERS. THE AVERAGE PAYOR DISCOUNT WAS 47.66% FOR THE TWELVE MONTHS ENDED JUNE 30, 2015. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - CORVALLIS FAMILY MEDICINE CLINIC | ||||
| 1037 MAIN STREET | CORVALLIS | MT | 59828 | FAMILY PRACTICE CLINIC |
| 2 - BITTERROOT VALLEY EYE ASSOCIATES | ||||
| 300 N 10TH STREET | HAMILTON | MT | 59840 | OPTICAL SPECIALTY CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON MULTIPLE FACTORS, INCLUDING THE NATURE OF THE CONDITION AND CARE REQUIRED, INSURANCE COVERAGE OR OTHER SOURCES OF PAYMENT, INCOME (FEDERAL POVERTY LEVEL GUIDELINES ARE USED TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE OFFERED), FAMILY SIZE, ASSETS, AND RESIDENCY IN RAVALLI COUNTY UNLESS SERVICES WERE FOR EMERGENCY CARE.FULL FINANCIAL ASSISTANCE WILL BE GRANTED BASED ON INCOME EQUAL TO OR LESS THAN 100% OF FEDERAL POVERTY LEVEL GUIDELINES. PARTIAL ASSISTANCE MAY BE GRANTED BASED ON INCOME BETWEEN 100% AND 200% OF FEDERAL POVERTY LEVEL GUIDELINES. VALUE OF ASSETS MAY BE CONSIDERED IN DETERMINING THE LEVEL OF ASSISTANCE. |
| PART I, LINE 7: | EXPLANATION OF COSTING METHOD:FINANCIAL ASSISTANCE AT COST AND MEDICAID AMOUNTS REPORTED IN PART I, LINE 7 ARE COMPUTED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. COMMUNITY HEALTH IMPROVEMENTS SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONAL EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE REPORTED AT COST. GENERAL SUBSIDIZED SERVICES ARE COMPUTED USING THE IRS GUIDELINES OF COST ADJUSTED NET PAYMENTS RECEIVED. THE MEDICARE COST REPORT WAS USED TO DETERMINE THE TOTAL SUBSIDY FOR THE HOME HEALTH / HOSPICE DEPARTMENTS. |
| PART I, LINE 7G: | INCLUDED IN THE SUBSIDIZED HEALTH SERVICES ARE THE FOLLOWING DEPARTMENTS: HOME HEALTH, HOSPICE CENTER AND HOSPICE OUTPATIENT, BITTERROOT GENERAL VASCULAR SURGERY CENTER, BITTERROOT VALLEY EYE ASSOCIATES, BITTERROOT ORTHOPEDIC & SPORTS MEDICINE, HAMILTON GENERAL SURGERY CENTER, HAMILTON OB/GYN, AND ROCKY MOUNTAIN NEUROSURGERY. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSES THAT WAS EXCLUDED FROM THE CALCULATION TO DETERMINE THE NET COMMUNITY BENEFIT EXPENSES AS A PERCENT OF TOTAL EXPENSES WAS $5,813,595. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY PARTICIPATION IN BOTH ECONOMIC AND COALITION BUILDING EVENTS. THE HOSPITAL PARTNERS WITH LOCAL HIGH SCHOOLS WITH A "JOB SHADOW" PROGRAM. THE GOAL IS TO EXPOSE AND PROMOTE THE HEALTH CARE PROFESSION TO AREA YOUTH. THE HOSPITAL IS ALSO ACTIVELY INVOLVED IN NUMEROUS COMMUNITY SUPPORT ORGANIZATIONS. |
| PART III, LINE 2: | BAD DEBT EXPENSE IS CALCULATED BY REVIEWING PAYMENT ARRANGEMENTS WHICH INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. |
| PART III, LINE 4: | THE FOLLOWING IS FROM THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTIBILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS." |
| PART III, LINE 8: | MDMH HAS A MEDICARE SHORTFALL IN EXCESS OF APPROXIMATELY $367,735. THE HOSPITAL HAS CRITICAL ACCESS HOSPITAL STATUS AND IS REIMBURSED BY MEDICARE FOR INPATIENT AND OUTPATIENT SERVICES ON A COST BASIS AS DEFINED AND LIMITED BY THE MEDICARE PROGRAM. MDMH PROVIDES A SIGNIFICANT RURAL LINK FOR BOTH THE HEALTH AND WELL-BEING OF RAVALLI COUNTY RESIDENTS. WE ARE COMMITTED TO LOCAL HEALTHCARE CLOSE TO HOME AND WORK HARD TO EARN AND KEEP THE TRUST OF THE LOCAL COMMUNITY. TO ENSURE THAT A VARIETY OF CLINIC, HOSPITAL AND EMERGENCY SERVICES ARE OPEN AND AVAILABLE TO ALL THOSE WITHIN OUR SERVICE AREA WE STRIVE TO OPERATE AT THE HIGHEST LEVEL OF FISCAL RESPONSIBILITY AND TO BE A GOOD STEWARD OF OUR RESOURCES. THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WAS DERIVED USING THE 2016 FILED MEDICARE COST REPORT. |
| PART III, LINE 9B: | IF A PATIENT IS PRESUMED TO BE FINANCIALLY INDIGENT, THE PATIENT REPRESENTATIVE WILL OFFER A PERSONAL FINANCIAL STATEMENT (PFS) TO BE FILLED OUT. THE PFS WILL BE FORWARDED TO THE PATIENT FINANCIAL ASSISTANCE COMMITTEE FOR REVIEW AND DETERMINATION OF PATIENT FINANCIAL ASSISTANCE STATUS. A PATIENT MAY REQUEST A MONTHLY PAYMENT ARRANGMENT. A MINIMUM PAYMENT OF $50 MUST BE PAID MONTHLY, WITH THE GOAL OF THE BALANCE PAID IN FULL WITHIN 5 YEARS. ACCOUNTS THAT CANNOT BE COLLECTED AFTER NORMAL IN-HOUSE COLLECTION PROCEDURES MAY BE REFERRED TO A COLLECTION AGENCY, MAGISTRATE OR ATTORNEY FOR FURTHER COLLECTION ACTION. |
| PART VI, LINE 2: | IN ADDITION TO CONDUCTING A COMMUNITY HEALTH NEEDS ASSESSMENT EVERY THREE YEARS, MDMH ASSESSES THE HEALTH NEEDS OF THE COMMUNITY BY LISTENING TO OUR PATIENTS, FRIENDS, FAMILY AND NEIGHBORS AS WE INTERACT WITH THEM DAILY WE HEAR THEIR CARES AND CONCERNS. WE ALWAYS ARE LOOKING FOR NEW WAY TO RESPOND TO, AND PROVIDE BETTER CARE FOR THE LOCAL COMMUNITY. |
| PART VI, LINE 3: | AS OF JANUARY 1, 2014, THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS POSTED ON THEIR WEBSITE AT HTTP://WWW.MDMH.ORG/GETPAGE.PHP?NAME=FINANCIAL_ASSISTANCE_POLICY_SUMMARY. IN ADDITION THE HOSPITAL INFORMS PATIENTS UNABLE TO PAY THEIR BILLS ABOUT THEIR FINANCIAL ASSISTANCE WHILE TALKING TO THEM OVER THE PHONE AND SENDS THEM A FINANCIAL ASSISTANCE PACKET. |
| PART VI, LINE 4: | THE HOSPITAL SERVES A RURAL POPULATION WHERE THE AVERAGE ANNUAL WAGE IS $40,065. THE PAYER MIX IS 53% MEDICARE, 14% MEDICAID, 6% SELF PAY, NO INSURANCE, WITH THE BALANCE AT OTHER COMMERCIAL PAYORS. THE UNEMPLOYMENT RATE IN RAVALLI COUNTY IS CURRENTLY AT 4.1% ACCORDING TO THE MONTANTA DEPARTMENT OF LABOR AND INDUSTRY. |
| PART VI, LINE 5: | THE HOSPITAL IS PROUD OF ITS EFFORTS TO PROMOTE COMMUNITY HEALTH AND WELLNESS. "SPRINKLE PINK" PROGRAM IS A COMMUNITY WIDE PROGRAM THAT PROMOTES MAMMOGRAPHY SCREENING AND RAISES FUNDS TO PROVIDE NO-COST MAMMOGRAMS TO QUALIFIED LOW INCOME AREA RESIDENTS. THE HOSPITAL COORDINATES AND SPONSORS THE ANNUAL SPORTS PHYSICAL CLINIC TO SUPPORT AND ENCOURAGE AREA YOUTH TO PARTICIPATE IN PHYSICIAL ACTIVITIES. OTHER COMMUNITY CLINICS OR SCREENINGS INCLUDED BLOOD PRESSURE TESTING AT AREA SENIOR CENTERS, AND LIPID PROFILES AND CHOLESTEROL TESTS PROVIDED TO THE COMMUNITY FREE OF CHARGE. A VARIETY OF HEALTH EDUCATION CLASSES ARE OFFERED TO THE COMMUNITY FREE OF CHARGE THROUGH OUT THE YEAR. |
| PART VI, LINE 6: | THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | MT |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| HAMILTON SCHOOL DISTRICT | |||||||
| 217 DALY AVENUE | HAMILTON | MT | 59840 | 816000830 | GOVERNMENTAL | $9,525 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS. |
| CORVALLIS SCHOOL DISTRICT | |||||||
| PO BOX 700 1045 MAIN STREET | CORVALLIS | MT | 59828 | 816000828 | GOVERNMENTAL | $9,450 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS. |
| STEVENSVILLE SCHOOL DISTRICT | |||||||
| 300 PARK STREET | STEVENSVILLE | MT | 59870 | 816000829 | GOVERNMENTAL | $6,625 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS |
| DARBY SCHOOL DISTRICT | |||||||
| 209 SCHOOL DRIVE | DARBY | MT | 59829 | 816000834 | GOVERNMENTAL | $7,250 | SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 4 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS COMMITTED TO SUPPORT THE HEALTH AND WELL-BEING OF AREA SCHOOL AGED CHILDREN BY PROVIDING FUNDING GRANTS RESTRICTED TO THE DISTRICT'S SCHOOL NURSE PROGRAM. THE HOSPITAL HAS ALSO COMMITTED TO SUPPORT STUDENT ATHLETICS BY PROVIDING A VOLUNTEER BASED, LOW-COST SPORTS PHYSICAL CLINIC DURING THE SUMMER. THE PROCEEDS ARE GIVEN TO THE PARTICIPATING STUDENTS' HOME DISTRICT TO SUPPORT THE DISTRICT'S ATHLETIC PROGRAMS. OTHER COMMUNITY ORGANIZATIONS MAY SUBMIT A GRANT PROPOSAL DIRECTLY TO THE HOSPITAL CEO FOR CONSIDERATION. THE REQUESTS ARE EVALUATED BASED UPON BROAD BASED COMMUNITY SUPPORT AND THE URGENCY OF NEED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Idemnification Gross Up Pmts | Yes (X) | IdemnificationGrossUpPmtsInd |
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| FREDERICK ILGENFRITZ MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN THRU APRIL 20 | $298,976 | $0 | $3,477 | $0 | $0 | $0 | $54,000 | $0 | $9,996 | $0 | $366,449 | $0 | $0 | $0 |
| ALLEN W JONES MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $213,456 | $0 | $89,658 | $0 | $0 | $0 | $36,000 | $0 | $8,730 | $0 | $347,844 | $0 | $0 | $0 |
| BRIAN KELLEHER MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $176,744 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $176,744 | $0 | $0 | $0 |
| TIMOTHY WOODS MD | ||||||||||||||
| BOARD MEMBER/PHYSICIAN | $457,906 | $0 | $67,743 | $0 | $0 | $0 | $42,000 | $0 | $12,333 | $0 | $579,982 | $0 | $0 | $0 |
| JOHN M BARTOS | ||||||||||||||
| CEO/SECRETARY/TREASURER | $253,806 | $0 | $68,935 | $0 | $0 | $0 | $24,000 | $0 | $9,374 | $0 | $356,115 | $0 | $0 | $0 |
| DONJA C ERDMAN | ||||||||||||||
| CFO | $137,256 | $0 | $781 | $0 | $0 | $0 | $28,600 | $0 | $2,209 | $0 | $168,846 | $0 | $0 | $0 |
| JOHN MORELAND MD | ||||||||||||||
| CHIEF MEDICAL OFFICER | $228,854 | $0 | $71,027 | $0 | $0 | $0 | $39,012 | $0 | $532 | $0 | $339,425 | $0 | $0 | $0 |
| TROY HANSON | ||||||||||||||
| ASSISTANT ADMINISTRATOR | $157,276 | $0 | $7,288 | $0 | $0 | $0 | $2,025 | $0 | $12,574 | $0 | $179,163 | $0 | $0 | $0 |
| MARY CAMDEN MD | ||||||||||||||
| PHYSICIAN | $311,040 | $0 | $7,686 | $0 | $0 | $0 | $7,200 | $0 | $9,738 | $0 | $335,664 | $0 | $0 | $0 |
| RICHARD DAY MD | ||||||||||||||
| PHYSICIAN | $824,551 | $0 | $98,595 | $0 | $0 | $0 | $42,000 | $0 | $1,049 | $0 | $966,195 | $0 | $0 | $0 |
| JEREMIAH CLINTON MD | ||||||||||||||
| PHYSICIAN | $392,146 | $0 | $5,098 | $0 | $0 | $0 | $31,500 | $0 | $8,267 | $0 | $437,011 | $0 | $0 | $0 |
| JENNIFER FEIGHNER MD | ||||||||||||||
| PHYSICIAN | $270,747 | $0 | $25,701 | $0 | $0 | $0 | $7,898 | $0 | $13,566 | $0 | $317,912 | $0 | $0 | $0 |
| MARK CALDERWOOD MD | ||||||||||||||
| PHYSICIAN | $292,029 | $0 | $104,528 | $0 | $0 | $0 | $24,000 | $0 | $6,818 | $0 | $427,375 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | DR RICHARD DAY RECEIVES A HOUSING ALLOWANCE OF $7,200 THAT IS NOT INCLUDED IN HIS TAXABLE INCOME. THE HOUSE IS PROVIDED TO DR DAY AS A CONVENIENCE TO MARCUS DALY MEMORIAL HOSPITAL. |
| PART I, LINE 1B | THE CEO HAS BEEN APPROVED BY THE BOARD OF DIRECTORS TO RECEIVE A MONTHLY $400 VEHICLE ALLOWANCE. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MT HEALTH FACILITY AUTHORITY | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 810302406 | BondIssuerEIN |
| CUSIP | 612043ED7 | CUSIPNum |
| Bond Issued | 2007-01-31 | BondIssuedDt |
| Issue Price | $7,068,924 | IssuePriceAmt |
| Purpose | CONSTRUCTION OF A NEW EMERGENCY DEPARTMENT | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $2,230,000 | RetiredAmt |
| Total Proceeds | $7,135,000 | TotalProceedsAmt |
| In Reserve Fund | $534,379 | InReserveFundAmt |
| Issuance Costs From Proceeds | $155,264 | IssuanceCostsFromProceedsAmt |
| Capital Expenditures | $5,973,474 | CapitalExpendituresAmt |
| Substantial Completion | 2008 | SubstantialCompletionYr |
| Current Refunding | 0 | CurrentRefundingInd |
| Advance Refunding | 0 | AdvanceRefundingInd |
| Final Allocation Made | Yes (1) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | 0 | MgmtContractBondFincdPropInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | 0 | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | 0 | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | Yes (1) | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | 0 | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| DATE REBATE COMPUTATION PERFORMED | ISSUER NAME: MT HEALTH FACILITY AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 08/01/2014 |
| PART II, LINE 3, PROCEEDS OF ISSUE | THE ISSUE PRICE OF $7,068,924 (PART I, COLUMN E) DOES NOT EQUAL THE TOTAL PROCEEDS OF ISSUE OF $7,135,000 (PART II, LINE 3) BECAUSE OF A $66,076 ORIGINAL ISSUE DISCOUNT. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KATHLEEN OWINGS | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SPOUSE OF BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $148,651 | TransactionAmt |
| Transaction | EMPLOYMENT | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | A REPRESENTATIVE FROM CLIFTONLARSONALLEN WILL BE RESPONSIBLE TO PRESENT THE FORM 990 TO THE HOSPITAL FINANCE COMMITTEE. UPON APPROVAL THE FORM 990 WILL BE PRESENTED TO THE BOARD OF DIRECTORS FOR ACCEPTANCE AND APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 12C | ANY DIRECTOR, CORPORATE OFFICER, SENIOR MANAGER, TRUSTEE OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS AN INTERESTED PERSON. IF A PERSON IS AN INTERESTED PERSON WITH RESPECT TO ANY ENTITY IN THE HEALTH CARE SYSTEM OF WHICH THE HOSPITAL IS A PART, HE OR SHE IS AN INTERESTED PERSON WITH RESPECT TO ALL ENTITIES IN THE HEALTH CARE SYSTEM. UPON APPOINTMENT, HIRE OR TRANSFER AND ANNUALLY THEREAFTER, EACH INTERESTED PERSON SHALL EXECUTE AND SUBMIT TO THE HOSPITAL'S CEO A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; B. HAS READ AND UNDERSTANDS THE POLICY; C. HAS AGREED TO COMPLY WITH THE POLICY; AND D. UNDERSTANDS THAT THE HOSPITAL IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL AND STATE TAX EXEMPTIONS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE CONFLICTING FINANCIAL INTEREST AND MUST BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. ANY OTHER MEMBER OF THE BOARD OR COMMITTEE MAY RAISE THE QUESTION OF WHETHER A CONFLICT EXISTS, DISCLOSE FACTS RELATING TO THE CONFLICT AND REQUEST THE INTERESTED PERSON TO PROVIDE FURTHER DETAILS. THE BOARD CHAIR (OR VICE CHAIR ACTING IN THE PLACE OF THE CHAIR) OR THE HOSPITAL'S LEGAL COUNSEL MAY, BASED ON THEIR INFORMATION ABOUT THE CONFLICT, DISCLOSE THE CONFLICT AND REQUEST THE INTERESTED PERSON TO WITHDRAW FROM DISCUSSION OF THE TRANSACTION AND/OR NOT VOTE. THE INTERESTED PERSON SHALL LEAVE THE MEETING OR REQUEST A DETERMINATION BY THE BOARD OR COMMITTEE OF WHETHER A CONFLICT OF INTEREST EXISTS. AFTER DISCLOSURE OF THE CONFLICTING INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING, DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS BEFORE CONSIDERING OR ACTING UPON ANY OTHER BUSINESS. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE HOSPITAL CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15A | ON AN ANNUAL BASIS, THE NON-CONFLICTED HOSPITAL BOARD MEMBERS (COMPENSATION COMMITTEE) RECEIVES THE ANNUAL COMPENSATION AND BENEFIT SURVEY PREPARED BY THE MONTANA HOSPITAL ASSOCIATION (MHA). THE COMMITTEE ALSO RECEIVES A REPORT FROM THE HOSPITAL THAT INCLUDES RESEARCH OF ALL CRITICAL ACCESS HOSPITALS IN THE STATES OF MONTANA, IDAHO, AND WYOMING. USING THIS INFORMATION THE COMPENSATION COMMITTEE THEN PROVIDES A RECOMMENDATION FOR CEO COMPENSATION TO THE FULL HOSPITAL BOARD. THE CEO HAS THE AUTHORITY TO SET THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE HOSPITAL. FOR PHYSICIAN COMPENSATION, THE HOSPITAL USES A THIRD PARTY CPA FIRM TO GATHER COMPENSATION DATA FROM MGMA AND NON-PHYSICAN COMPENSATION INFORMATION IS FROM THE MHA COMPENSATION SURVEY. |
| FORM 990, PART VI, SECTION C, LINE 18 | IN ADDITION TO BEING AVAILABLE UPON REQUEST, A COPY OF THE FORM 990 IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG. |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF DALY HOSPITAL FOUNDATION -262,692. AUXILIARY 4,411. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DALY HOSPITAL FOUNDATIONINC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 WESTWOOD DRIVE | AddressLine1Txt |
| City | HAMILTON | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59840 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 363766000 | EIN |
| Primary Activities | CHARITABLE SERVICES | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |