FRANCES MAHON DEACONESS HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- FRANCES MAHON DEACONESS HOSPITAL (EIN 81-0231786)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-10
- IRS object ID
- 201731309349302088
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-10T11:30:57-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREEN HEALTH GROUP PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 110 5TH ST S SUITE 106 | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 592302338 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810231786 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRANCES MAHON DEACONESS HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | FRAN | BusinessNameControlTxt |
| Phone | 4062283500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 3RD STREET SOUTH | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59230 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAMI KALINSKI | PersonNm |
| Person Title | DIRECTOR OF FINANCE | PersonTitleTxt |
| Phone | 4062283660 | PhoneNum |
| Signature | 2017-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DANIEL GREEN | PreparerPersonNm |
| PTIN | P01311679 | PTIN |
| Phone | 4062632615 | PhoneNum |
| Preparation | 2017-05-10 | PreparationDt |
| 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 | CAMI KALINSKI | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 3RD STREET SOUTH | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $25,247,228 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FMDH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1914 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | TO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 286 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $481,503 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$291,655 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $87,387 | PYContributionsGrantsAmt |
| CY Contributions Grants | $172,481 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,252,363 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,774,422 | CYProgramServiceRevenueAmt |
| PY Investment Income | $499,071 | PYInvestmentIncomeAmt |
| CY Investment Income | $575,527 | CYInvestmentIncomeAmt |
| PY Other Revenue | $936,050 | PYOtherRevenueAmt |
| CY Other Revenue | $724,798 | CYOtherRevenueAmt |
| PY Total Revenue | $25,774,871 | PYTotalRevenueAmt |
| CY Total Revenue | $25,247,228 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $12,586,920 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,807,130 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $41,455 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,549,034 | PYOtherExpensesAmt |
| CY Other Expenses | $9,535,125 | CYOtherExpensesAmt |
| PY Total Expenses | $22,135,954 | PYTotalExpensesAmt |
| CY Total Expenses | $22,342,255 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,638,917 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,904,973 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $58,087,704 | TotalAssetsBOYAmt |
| Total Assets EOY | $60,728,898 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,748,035 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,306,496 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $54,339,669 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $57,422,402 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $16,063,368 | ExpenseAmt |
| Revenue | $23,774,422 | RevenueAmt |
| Desc | PROVIDE QUALITY MEDICAL CARE TO PATIENTS. | Desc |
| Total Program Service Expenses | $16,063,368 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (true) | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | Yes (true) | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 286 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CAMI KALINSKI | PersonNm |
| Phone | 4062283500 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 3RD ST S | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59230 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt |
|---|---|---|---|---|---|---|---|---|
| KAREN BREIGENZER | ||||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | |||
| KEVIN MILLER | ||||||||
| VICE PRESIDE | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KRIS SIMENSEN | ||||||||
| SECRETARY/TR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| CAROL BUCHHEIT | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| TERRY COLBRESE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| KERRY KINGSLEY | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| AMY CAPDEVILLE | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| DON FAST | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| BUTCH TEWELL | ||||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | |||
| RANDALL G HOLOM | ||||||||
| CEO | 40.00 | $257,396 | $0 | $18,058 | Yes (X) | |||
| ELLEN GUTTENBERG | ||||||||
| COO | 40.00 | $150,053 | $0 | $17,090 | Yes (X) | |||
| CAMI KALINSKI | ||||||||
| DIRECTOR OF | 40.00 | $118,626 | $0 | $4,425 | Yes (X) | |||
| WALTER SMITH | ||||||||
| DO | 40.00 | $508,476 | $0 | $11,537 | Yes (X) | |||
| KEVIN ROSS | ||||||||
| MD | 14.00 | $452,966 | $0 | $20,812 | Yes (X) | 26.00 | ||
| ANNE MILLARD BRADLEY | ||||||||
| MD | 15.00 | $370,121 | $0 | $16,198 | Yes (X) | 25.00 | ||
| ROBERT CROCHELT | ||||||||
| MD | 2.00 | $300,194 | $0 | $5,333 | Yes (X) | 32.00 | ||
| DONNA SMITH | ||||||||
| MD | 5.00 | $299,575 | $0 | $11,664 | Yes (X) | 30.00 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,457,407 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $105,117 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 20 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MCKINSTRY ESSENTION LLC | |||||
| PO BOX 3895 | SEATTLE | WA | 98124 | CONSTRUCTION | $881,625 |
| GE HEALTHCARE | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | SERV CONTRACTS | $470,108 |
| HAYES LOCUMS LLC | |||||
| 6700 N ANDREWS AVE SUITE 600 | FT LAUDERDALE | FL | 33309 | TEMP PROVIDERS | $432,768 |
| MEDICAL INFORMATION TECHNOLOGY INC | |||||
| PO BOX 74569 | CHICAGO | IL | 60696 | DATA PROCESSING | $152,652 |
| MEDICUS HOSPITALISTS WEST LLC | |||||
| 22 ROULSTON RD | WINDHAM | NH | 03087 | TEMPORARY SERVI | $108,775 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $50,015 | GovernmentGrantsAmt |
| All Other Contributions | $122,466 | AllOtherContributionsAmt |
| Noncash Contributions | $30,000 | NoncashContributionsAmt |
| Total Contributions | $172,481 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT REVENUE | 621500 | $22,864,322 | $22,864,322 | |
| PROFESSIONAL RADIOLOGY | 621110 | $686,736 | $390,066 | $296,670 |
| HI-LINE MEDICAL SRVCS RENT | 531120 | $93,633 | $93,633 | |
| GLASGOW CLINIC RENT | 531120 | $91,200 | $91,200 | |
| OTHER RENTAL INCOME | 531120 | $38,531 | $38,531 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,774,422 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $575,527 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $575,527 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PARTNERSHIP INCOME | 900099 | $698,603 | $698,603 |
| COUNTY CONTRIBUTION | 900099 | $26,195 | $26,195 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $724,798 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $25,247,228 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $24,593,244 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $481,503 | UnrelatedBusinessRevenueAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,971 | TotalAmt |
| Management And General | $569,971 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,961,350 | TotalAmt |
| Program Services | $8,413,576 | ProgramServicesAmt |
| Management And General | $1,519,232 | ManagementAndGeneralAmt |
| Fundraising | $28,542 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,625 | TotalAmt |
| Program Services | $200,970 | ProgramServicesAmt |
| Management And General | $62,722 | ManagementAndGeneralAmt |
| Fundraising | $933 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,173,251 | TotalAmt |
| Program Services | $891,258 | ProgramServicesAmt |
| Management And General | $272,422 | ManagementAndGeneralAmt |
| Fundraising | $9,571 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $837,933 | TotalAmt |
| Program Services | $678,909 | ProgramServicesAmt |
| Management And General | $156,966 | ManagementAndGeneralAmt |
| Fundraising | $2,058 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $156,181 | TotalAmt |
| Management And General | $156,181 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,900 | TotalAmt |
| Management And General | $49,900 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,292,367 | TotalAmt |
| Program Services | $1,083,415 | ProgramServicesAmt |
| Management And General | $208,952 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $121,480 | TotalAmt |
| Management And General | $121,480 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $668,195 | TotalAmt |
| Program Services | $306,546 | ProgramServicesAmt |
| Management And General | $361,629 | ManagementAndGeneralAmt |
| Fundraising | $20 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $326,099 | TotalAmt |
| Program Services | $326,099 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,135 | TotalAmt |
| Program Services | $107,461 | ProgramServicesAmt |
| Management And General | $36,343 | ManagementAndGeneralAmt |
| Fundraising | $331 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,062 | TotalAmt |
| Program Services | $113,427 | ProgramServicesAmt |
| Management And General | $13,635 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,910,290 | TotalAmt |
| Management And General | $1,910,290 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $215,941 | TotalAmt |
| Program Services | $9,497 | ProgramServicesAmt |
| Management And General | $206,444 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,038,802 | $3,038,802 | |
| REPAIRS & MAINTENANCE | $1,037,308 | $569,246 | $468,062 |
| FOOD & DIETARY SUPPLIES | $210,342 | $210,342 | |
| MISCELLANEOUS | $85,734 | $30,770 | $54,964 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $151,289 | TotalAmt |
| Program Services | $83,050 | ProgramServicesAmt |
| Management And General | $68,239 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,342,255 | TotalAmt |
| Program Services | $16,063,368 | ProgramServicesAmt |
| Management And General | $6,237,432 | ManagementAndGeneralAmt |
| Fundraising | $41,455 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,793,996 | BOYAmt |
| EOY | $2,239,818 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,845,484 | BOYAmt |
| EOY | $6,883,452 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,227,707 | BOYAmt |
| EOY | $3,325,827 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,912,758 | BOYAmt |
| EOY | $3,808,583 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $733,081 | BOYAmt |
| EOY | $788,163 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $258,790 | BOYAmt |
| EOY | $274,847 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $35,802,053 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $23,743,739 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,223,814 | BOYAmt |
| EOY | $12,058,314 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,685,661 | BOYAmt |
| EOY | $16,684,641 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,406,413 | BOYAmt |
| EOY | $14,665,253 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,087,704 | BOYAmt |
| EOY | $60,728,898 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,179,456 | BOYAmt |
| EOY | $2,297,068 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $218,302 | BOYAmt |
| EOY | $169,041 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,350,277 | BOYAmt |
| EOY | $840,387 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,748,035 | BOYAmt |
| EOY | $3,306,496 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,339,669 | BOYAmt |
| EOY | $57,422,402 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $54,339,669 | BOYAmt |
| EOY | $57,422,402 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $58,087,704 | BOYAmt |
| EOY | $60,728,898 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $2,904,973 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $177,760 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $3,524 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,524 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | 2.44 PERCENT OF MHA DUES PAID TO MHA, WHICH WAS 614, AND 22.12 PERCENT OF DUES PAID TO MHA FOR AHA, WHICH WAS 2,910, WERE USED FOR LOBBYING EXPENSES BY MHA. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $88,748 | OtherCostOrOtherBasisAmt |
| Book Value | $88,748 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $22,575,884 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,718,979 | DepreciationAmt |
| Book Value | $8,856,905 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,137,421 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,024,760 | DepreciationAmt |
| Book Value | $3,112,661 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,058,314 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| US GOVERNMENT & AGENCY SECURITIES | $10,599,966 | F |
| CORPORATE DEBT SECURITIES | $3,077,448 | F |
| BROKERED CERTIFICATES OF DEPOSIT | $2,817,056 | F |
| BANK CERTIFICATES OF DEPOSIT | $190,171 | C |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $16,684,641 | TotalBookValueProgramRltdAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| INTERCOMPANY AND OTHER RECEIVABLES | $10,203,787 |
| NE MT STAT AIR AMBULANCE INVESTMENT | $2,833,783 |
| INTEREST IN FMDH FOUNDATION | $957,134 |
| MEDICARE/MEDICAID RECEIVABLE | $670,549 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $14,665,253 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| MEDICARE & MEDICAID PAYABLE | $682,497 |
| NET INVESTMENT IN PRAIRIE RIDGE VILL | $157,890 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $840,387 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $25,424,988 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $177,760 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $177,760 | RevenueNotReportedAmt |
| Revenue Subtotal | $25,247,228 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $25,247,228 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,342,255 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $22,342,255 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $22,342,255 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | IT IS THE JUDGMENT OF MANAGEMENT THAT THE COMPANY HAS NO SIGIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THIS FOOTNOTE IS ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $499,442 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $499,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $499,442 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $499,442 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02130 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,153,892 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,958,332 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,195,560 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09350 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,286 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,286 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,203,178 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,958,332 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,244,846 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09560 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,702,620 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,958,332 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,744,288 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11690 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $409,895 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $8,198,304 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,253,388 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$55,084 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp (2 entries)
| Primary ActivitiesPrimaryActivitiesTxt | Org Profit Or OwnershipOrgProfitOrOwnershipPct |
|---|---|
| PRAIRIE RIDGE VILLAG | |
| ASSISTED LIVING | 0.50000 |
| NE MT STAT AIR AMBUL | |
| AIR AMBULANCE | 0.33000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | FRANCES MAHON DEACONESS HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 3RD ST S | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FMDH.ORG | WebsiteAddressTxt |
| 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 | FRANCES MAHON DEACONESS HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.FMDH.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.FMDH.ORG | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWWFMDHORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWWFMDHORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWWFMDHORG | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | Yes (true) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 5 | TO SOLICIT INPUT FROM INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS IMPLEMENTED AS PART OF THE CHNA PROCESS AND SENT TO A LIST OF RECOMMENDED PARTICIPANTS INCLUDING PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS AND A VARIETY OF OTHER COMMUNITY LEADERS. ALSO, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. THE PARTICIPANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE. IN ALL, 63 COMMUNITY STAKEHODLERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. THE INPUT WAS GATHERED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. ON BEHALF OF FRANCES MAHON DEACONESS HOSPITAL IN THE SPRING OF 2016. |
| FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 11 | AS REQUIRED BY THE IRS IMPLEMENTING REGULATIONS, FMDH PRIORITIZED THE IDENTIFIED NEEDS TO IDENTIFY THOSE NEEDS THAT IT COULD EFFICACIOUSLY ADDRESS GIVEN THE RESOURCE LIMITATIONS INHERENT IN A SMALL RURAL HOSPITAL OPERATION. THE ONLINE KEY INFORMANT SURVEY PRESENTED THE STAKEHOLDERS WITH 20 HEALTH TOPICS AND WERE ASKED TO RATE EACH AS A MAJOR PROBLEM, MODERATE PROBLEM, MINOR PROBLEM, OR NOT A PROBLEM AT ALL IN THEIR OWN COMMUNITY. FOR MAJOR PROBLEM RESPONSES, THE FOLLOWING WERE RANKED AS TOP CONCERNS FOR THE FRANCES MAHON DEACONESS HOSPITAL SERVICE AREA: MENTAL HEALTH, TOBACCO USE, SUBSTANCE ABUSE, AND CANCER. THROUGH A MEETING WITH INTERNAL AND EXTERNAL STAKEHOLDERS, PRIORITIZATION WAS ACCOMPLISHED USING A PRIORITIZATION EXERCISE THAT SCORED THE SCOPE & SEVERITY OF THE PROBLEM BY CONSIDERATION OF THREE FACTORS AND ABILITY TO IMPACT, BOTH RATED ON A SCALE OF 1 TO 10 FROM LEAST SEVERE TO MOST SEVERE. BASED ON THE SEVERITY OF THE RATINGS, FRANCES MAHON DEACONESS HOSPITAL CHOSE TO PRIORITIZE THE FOLLOWING TOP HEALTH NEEDS OF THE COMMUNITY TO ADDRESS IN ITS IMPLEMENTATION STRATEGY IN THE COMING YEARS: HEART DISEASE & STROKE, NUTRITION, PHYSICAL ACTIVITY & WEIGHT, AND MENTAL HEALTH. FMDH IS ADDRESSING THE PRIORITIZED HEALTH NEEDS BY THREE OVERALL GOALS: THE FIRST GOAL IS TO IMPROVE CARDIOVASCULAR HEALTH BY IMPLEMENTING AND SUPPORTING EVIDENCE BASED APPROACHES TO IMPACT BEHAVIORS AFFECTING CARDIOVASCULAR HEALTH. ONE STRATEGY FOR ADDRESSING THIS GOAL IS TO BUILD AWARENESS OF OPPORTUNITIES IN THE COUNTY TO PARTICIPATE IN COMMUNITY FITNESS PROGRAMS BY DEVELOPING AND PROMOTING A COMMUNITY FITNESS RESOURCES LIST. THE SECOND GOAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY IMPLEMENTING AND SUPPORTING EVIDENCE BASED APPROACHES TO IMPACT BEHAVIORS RELATED TO NUTRITION, WEIGHT AND PHYSICAL ACTIVITY THEREBY HAVING A POSITIVE IMPACT ON A MUILTITUDE OF HEALTH CONDITIONS. A STRATEGY FOR ADDRESSING THIS GOAL IS TO HAVE A FOCUSED PUBLIC AWARENESS CAMPAIGN ON FITNESS AND EXERCISE SUCH AS COMMUNICATING EXCLUSIVELY ABOUT EXERCISE AND FITNESS IN AT LEAST 75% OF ALL COMMUNICATION FOR 12 MONTHS. THE THIRD GOAL IS TO UTILIZE EVIDENCE BASED TACTICS TO ADDRESS BARRIERS TO ACCESSING MENTAL HEALTH SERVICES BY AUGMENTING THE RANGE AND ACCESSIBILITY OF MENTAL/BEHAVIORAL HEALTH SERVICES. A STRATEGY FOR ADDRESSING THIS GOAL IS TO ADVOCATE FOR MENTAL HEALTH LEGISLATION BY FOCUSING ADVOCACY EFFORTS ON LEGISLATION THAT INCREASES FUNDING FOR AND AVAILABILITY OF MENTAL/BEHAVIORAL HEALTH SERVICES. ADDITIONAL STRATEGIES TO ACCOMPLISH THE THREE GOALS ARE IDENTIFIED IN THE IMPLEMENTATION STRATEGY. NINE ADDITIONAL SIGNFICANT HEALTH NEEDS THAT EMERGED FROM THIS COMMUNITY HEALTH NEEDS ASSESSMENT ARE OUTLINED BELOW. THESE NEEDS WILL NOT BE SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY, ALTHOUGH SOME MAY BE ADDRESSED IN SOME WAY THROUGH PROGRAMS TARGETING THE TOP HEALTH NEEDS WHICH WILL BE ADDRESSED. 1. SUBSTANCE ABUSE - FMDH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE MENTAL HEALTH WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S SUBSTANCE ABUSE, AND THAT A SEPARATE SET OF SUBSTANCE ABUSE INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 2. TOBACCO USE - FMDH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE CARDIOVASCULAR HEALTH WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S TOBACCO USE, AND THAT A SEPARATE SET OF TOBACCO INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 3. CANCER - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 4. IMMUNIZATION & INFECTIOUS DISEASES - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 5. INJURY & VIOLENCE PREVENTION - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 6. INFANT HEALTH & FAMILY PLANNING - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 7. STD HIV/AIDS - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 8. DIABETES - FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE NUTRITION, WEIGHT AND PHYSICAL ACTIVITY WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S DIABETIC POPULATION, AND THAT A SEPARATE SET OF DIABETIC- SPECIFIC INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 9. ACCESS TO HEALTH CARE SERVICES - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. |
| FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 16I | THE OTHER WAYS FMDH PUBLICIZES THE FINANCIAL ASSISTANCE POLICY ARE AS FOLLOWS: 1. THE APPLICATION FOR FINANCIAL ASSISTANCE FORM IS OFFERED IN THE FMDH PATIENT OPTION LETTER AND OTHER MAILINGS. 2. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS OFFERED TO ALL PATIENTS UPON ADMISSION OR DISCHARGE FROM FMDH, AND IT IS INCLUDED WITH PATIENT BILLING STATEMENTS. 3. FMDH WILL PUBLISH THE PLAIN LANGUAGE SUMMARY OF THE POLICY IN THE FMDH HEALTH AND WELLNESS SECTION OF THE LOCAL NEWSPAPER ON AT LEAST AN ANNUAL BASIS. 4. FMDH WILL DISCUSS FINANCIAL ASSISTANCE WITH PATIENTS WHEN THEY CALL ABOUT THEIR BILL. 5. FMDH EMPLOYS A FINANCIAL COUNSELOR WHO HELPS PATIENTS NAVIGATE THROUGH THEIR FINANCIAL OPTIONS AND HER CONTACT INFORMATION IS MADE AVAILABLE IN THE LOCAL NEWSPAPER IN THE QUARTERLY WELLNESS SECTION AS WELL AS ON OUR WEBSITE. |
| FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 22D | AGB PERCENTAGE IS DETERMINED ANNUALLY BY USING A 12 MONTH MEASUREMENT PERIOD UTILIZING THE LOOK BACK METHOD. THE AGB PERCENTAGE IS ALL CLAIMS ALLOWED BY MEDICARE AND ALL PRIVATE HEALTH INSURERS DIVIDED BY GROSS CHARGES FOR THOSE CLAIMS. ALL CLAIMS INCLUDED ARE THOSE FOR THE HOSPITAL AND GLASGOW CLINIC AS WELL AS FOR HI-LINE MEDICAL SERVICES, AS IT IS A SIGNIFICANTLY RELATED ENTITY. THE MEASUREMENT PERIOD IS 7/1 THROUGH 6/30 OF EACH YEAR AND THE START DATE FOR THE NEW CALCULATION WILL BE 10/1 OF EACH YEAR WHICH IS WITHIN THE 120 DAY REQUIREMENT. |
| FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 24 | SOME SERVICES PROVIDED BY THE HOSPITAL ARE CONSIDERED ELECTIVE. ELECTIVE SERVICES ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE THUS A PERSON QUALIFYING FOR A DISCOUNT FOR MEDICALLY NECESSARY SERVICES MAY NEED TO PAY FULL PRICE FOR ELECTIVE SERVICES. THE FAP ADDRESSES WHAT SERVICES ARE DEEMED ELECTIVE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GLASGOW CLINIC PC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 621 THIRD STREET SOUTH | AddressLine1Txt |
| City | GLASGOW | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59230 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION | PHYSICIAN PROFESSIONAL SERVICES MAKE UP 1,201,044 OF COLUMN C, 274,214 OF COLUMN D, AND 926,830 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 87,332. FRANCES MAHON DEACONESS HOSPITAL'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION. |
| PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION | USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND CHARITY CARE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. |
| PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY | THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, CHARITY CARE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF BAD DEBT WHICH REDUCE BAD DEBT EXPENSE. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NON PROFIT HOSPITAL. |
| BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS | THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGES 7 & 8 OF THE AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8 - MEDICARE EXPLANATION | THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE, BUT THIS IS THEN REDUCED BY THE 2 PERCENT SEQUESTRATION ADJUSTMENT. THIS MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT SINCE THE HOSPITAL IS PROVIDING MEDICARE PATIENT CARE SERVICES AT LESS THAN THE COST. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT. THE ELECTRONIC HEALTH RECORD CAPITAL COSTS AND RELATED INCENTIVE PAYMENTS ARE EXCLUDED FROM THIS CALCULATION. |
| PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION | THE ORGANIZATION USES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES, COMBINED WITH AN ASSET TEST AND A MEDICALLY INDIGENT TEST REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. THE ORGANIZATION DOES NOT ATTEMPT TO COLLECT CHARGES APPROVED AS CHARITY OR FINANCIAL ASSISTANCE. FOR PATIENTS THAT HAVE HAD A PORTION OF THEIR ACCOUNT WRITTEN OFF AS FINANCIAL ASSISTANCE AND THAT LATER DEFAULT ON THE PORTION THAT WAS DETERMINED TO BE THEIR RESPONSIBILITY, AND THEREFORE IS NOT CONSIDERED CHARITY CARE OR FINANACIAL ASSISTANCE, THE ORGAINIZATION DOES ATTEMPT TO COLLECT THIS BALANCE. |
| PART VI, LINE 2 - NEEDS ASSESSMENT | PURSUANT TO THE PROVISIONS OF THE AFFORDABLE CARE ACT, FRANCES MAHON DEACONESS HOSPITAL COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DURING FISCAL YEARS 2013 & 2016 (TAX YEARS 2012 & 2015). BOTH ASSESSMENTS ARE LOCATED ON THE ENTITY'S WEBSITE. HOWEVER, FRANCES MAHON DEACONESS HOSPITAL (FMDH) HAS TRADITIONALLY INCLUDED COMMUNITY NEEDS ASSESSMENTS IN ITS PLANNING FOR MANY YEARS AND UTILIZES MANY METHODS OF ASSESSING THE PATIENT SERVICES NEEDS FOR OUR SERVICE AREA. THESE INCLUDE BUT ARE NOT LIMITED TO: ANALYSIS OF OUTMIGRATION STATISTICS OBTAINED THROUGH ACCESS TO THE COMPDATA DATABASE PROVIDED THROUGH THE MONTANA HOSPITAL ASSOCIATION AND MODELING OF PATIENT TO POPULATION RATIOS TO IDENTIFY AND PLAN FOR THE APPROPRIATE PROVIDER MIX TO SERVE THE COMMUNITY. IN ADDITION, FMDH PARTICIPATED IN AN AREA HEALTH EDUCATION CENTER LEAD COMMUNITY HEALTH SERVICES DEVELOPMENT ASSESSMENT. IDEAS GENERATED OUT OF EACH OF THESE EFFORTS ARE THEN EVALUATED AS TO THE CAPABILITIES OF OUR ORGANIZATION TO DEVELOP IDENTIFIED SERVICES. MINIMUM CRITERIA FOR DEVELOPMENT OF NEW OR MODIFICATION OF EXISTING SERVICES ARE: THE NEW OR MODIFIED SERVICE CAN REASONABLY FINANCIALLY SUPPORT ITS OPERATION; WE HAVE OR CAN ACQUIRE THE NECESSARY PERSONNEL WITH THE CREDENTIALS TO DELIVER THE SERVICE AND RETAIN ENOUGH PERSONNEL WITH THE REQUIRED SKILL SETS TO AVOID INTERRUPTION OF SERVICE DELIVERY IF SAID PERSONNEL TURN OVER; THE SERVICES CAN BE DELIVERED IN A MANNER THAT ACHIEVES APPROPRIATELY HIGH LEVELS OF PATIENT SATISFACTION. |
| PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | FRANCES MAHON DEACONESS HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO HAS THE SOLE RESPONSIBILITY TO WORK WITH PATIENTS TO NAVIGATE OUR FINANCIAL ASSISTANCE PROGRAM. ALL PATIENTS ARE SENT INFORMATION AT THE INITIAL BILLING FOR DELIVERED PATIENT SERVICES THAT DESCRIBES OUR FINANCIAL ASSISTANCE PROGRAM. OUR WEBSITE HAS INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM ALONG WITH ACCESS TO THE APPLICATION. FRANCES MAHON DEACONESS HOSPITAL ALSO EMPLOYS TWO STAFF MEMBERS THAT ARE CERTIFIED APPLICATION COUNSELORS THAT HELP COMMUNITY MEMBERS WITH APPLYING FOR INSURANCE AND MEDICAID ON THE MARKETPLACE. |
| PART VI, LINE 4 - COMMUNITY INFORMATION | FRANCES MAHON DEACONESS HOSPITAL IS LOCATED IN GLASGOW MONTANA WHICH IS OVER FOUR HOURS HIGHWAY TRAVEL TIME AWAY FROM ANY TERTIARY MEDICAL CENTER. WHILE OUR PRIMARY SERVICE AREA CONSISTS OF GLASGOW MONTANA AND VALLEY COUNTY, OUR FACILITY AND SPECIALTY SERVICES ALSO DRAW FROM PORTIONS OF THE SURROUNDING COUNTIES OF DANIELS, ROOSEVELT, AND PHILLIPS. THE AREA IS PRIMARILY AGRICULTURAL BASED WITH LOW POPULATION DENSITIES WHICH HOUSES A TOTAL POPULATION OF 24,113 RESIDENTS OVER 13,843.20 SQUARE MILES. THE DIFFERENT AGE GROUPS OF THE SERVICE AREA ARE AS FOLLOWS: 26.2% ARE INFANTS, CHILDREN OR ADOLESCENTS AGES 0-17; ANOTHER 57.1% ARE AGES 18 TO 64, WHILE 16.7% ARE AGES 65 AND OLDER. THE POPULATION IS MOSTLY WHITE, BUT PORTIONS OF OUR EXTENDED SERVICE AREA HAVE HIGH POPULATIONS OF NATIVE AMERICAN ANCESTRY (29.8% IN THE TOTAL SERVICE AREA) TO WHICH WE PROVIDE SERVICES. THE STATISTICS PROVIDED ABOVE ARE BASED ON THE US CENSUS BUREAU AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2009-2013). |
| PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH | FRANCES MAHON DEACONESS HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. WE ARE GOVERNED BY A VOLUNTARY BOARD OF COMMUNITY PERSONS REPRESENTING MOST OF THE INDIVIDUAL TOWNS OR GEOGRAPHICAL AREAS OF OUR PRIMARY SERVICE AREA. FOR NONELECTIVE SERVICES, WE TREAT PATIENTS WITHOUT REGARD TO ABILITY TO PAY, CONSISTENT WITH OUR ORIGINS AS A HILL BURTON FUNDED FACILITY. ALTHOUGH OUR HILL BURTON OBLIGATION WAS SATISFIED MANY YEARS AGO, WE STILL ADHERE TO THE PRINCIPLES INHERENT IN THAT OBLIGATION. SURPLUS FUNDS ARE RETAINED WITHIN THE ORGANIZATION TO ASSURE FULFILLMENT OF OUR CHARITABLE MISSION BOTH IN THE PRESENT AND IN THE FUTURE. |
| PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM | FRANCES MAHON DEACONESS HOSPITAL PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. GLASGOW CLINIC PC PROVIDES PROFESSIONAL PRIMARY CARE PHYSICIAN AND MIDLEVEL PROVIDER SERVICES. HI-LINE MEDICAL SERVICES INC PROVIDES SPECIALTY PHYSICIAN AND RETAIL PHARMACY SERVICES. |
| ADDITIONAL INFORMATION | PART I, LINE 6A: THE FORM 990 SCHEDULE H IS CONSIDERED AN ANNUAL COMMUNITY BENEFIT REPORT AND IT IS AVAILABLE TO THE PUBLIC ON OUR WEBSITE. PART I, LINE 7E: FMDH CONTRACTED WITH AN OUTSIDE COMPANY TO COMPILE THE COMMUNITY HEALTH NEEDS ASSESSMENT INFORMATION. PART I, LINE 7I: FMDH CONTRIBUTED TO THE SCHOOLS IN VALLEY COUNTY FOR THE HEALTHY SCHOOL SNACK PROGRAM. PART V: GLASGOW CLINIC PC IS A SEPARATE ORGANIZATION THAT IS A RURAL HEALTH CLINIC AND IS WHOLLY OWNED AND OPERATED BY FRANCES MAHON DEACONESS HOSPITAL (FMDH). THEIR REVENUES AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990. HI-LINE MEDICAL SERVICES, INC IS A SEPARATE ORGANIZATION THAT INCLUDES SPECIALTY PHYSICIAN PRACTICES AND A RETAIL PHARMACY. FMDH WHOLLY OWNS AND MANAGES THIS ENTITY AND SUBSIDIZES THE PHYSICIAN PRACTICES AS NEEDED TO ASSURE ACCESS TO AS FULL OF A SCOPE OF SERVICES AS IS APPROPRIATE GIVEN THE NEEDS OF THE COMMUNITY WE SERVE. HI-LINE MEDICAL SERVICES' REVENUES AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990, EXCEPT THAT THE SUBSIDIZED PHYSICIAN ACTIVITY IS SHOWN ON SCHEDULE H, PART I, LINE 7G. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|---|
| RANDALL G HOLOM | ||||
| CEO | $257,396 | $9,275 | $8,783 | $275,454 |
| ELLEN GUTTENBERG | ||||
| COO | $150,053 | $5,553 | $11,537 | $167,143 |
| WALTER SMITH | ||||
| DO | $508,476 | $11,537 | $520,013 | |
| KEVIN ROSS | ||||
| MD | $452,966 | $9,275 | $11,537 | $473,778 |
| ANNE MILLARD BRADLEY | ||||
| MD | $370,121 | $7,215 | $8,983 | $386,319 |
| ROBERT CROCHELT | ||||
| MD | $300,194 | $5,324 | $9 | $305,527 |
| DONNA SMITH | ||||
| MD | $299,575 | $5,418 | $6,246 | $311,239 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PAGE 1, PART I, LINE 1A | GOLF CLUB MEMBERSHIP FOR THE CEO IS PAID BY THE ORGANIZATION. THIS IS NOT TREATED AS TAXABLE COMPENSATION SINCE IT IS CONSIDERED PUBLIC RELATIONS WHICH IS PART OF THE CEO'S JOB RESPONSIBILITY. |
| SCHEDULE J, PART III | A PERCENTAGE OF THE COMPENSATION PAID TO KEVIN ROSS M.D. (66%), ANNE MILLARD BRADLEY M.D. (63%), DONNA SMITH M.D. (85%), AND ROBERT CROCHELT, M.D. (95%) IS AN EXPENSE OF GLASGOW CLINIC PC, A RELATED COMPANY, BUT WAS PAID THROUGH FRANCESS MAHON DEACONESS HOSPITAL AS A CENTRAL PAYMASTER. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FIRST COMMUNITY BANK | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | BOARD MEMBERS | RelationshipDescriptionTxt |
| Transaction | $761,441 | TransactionAmt |
| Transaction | BANKING & INVESTING | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL CEO AND ONE BOARD MEMBER ARE BOTH BOARD MEMBERS OF FIRST COMMUNITY BANK, PLUS THE BOARD MEMBER IS ALSO AN OFFICER OF THE BANK. THE HOSPITAL HAS BANK ACCOUNTS AND INVESTMENTS WITH FIRST COMMUNITY BANK. THE BUSINESS RELATIONSHIP WITH THE BANK IS MANAGED BY THE DIRECTOR OF FINANCIAL SERVICES OF THE HOSPITAL AND SHE HAS A DIRECT REPORTING RELATIONSHIP TO THE BOARD FINANCE COMMITTEE IN THIS REGARD. FURTHER, ANY DECISION MADE BY THE DIRECTOR OF FINANCIAL SERVICES IS GOVERNED BY POLICIES AND PROCEDURES APPROVED BY THE ENTIRE BOARD OF TRUSTEES ON THE RECOMMENDATION OF THE FINANCE COMMITTEE. ADDITIONALLY, FOR ANY PARTICULAR BUSINESS TRANSACTION OR DECISION THAT DIRECTLY INVOLVES FIRST COMMUNITY BANK, THE CEO AND THE BOARD MEMBER WITH A CONFLICT OF INTEREST LEAVE THE BOARD MEETING WHILE THE REMAINING BOARD MEMBERS DELIBERATE OR ACT ON THE MATTER. THE TRANSACTION DOLLAR AMOUNT SHOWN ABOVE IS THE NET INCREASE IN THE HOSPITAL'S BANK ACCOUNT AND INVESTMENT BALANCES WITH FIRST COMMUNITY BANK AND AFFILIATED COMPANIES FOR THE FISCAL YEAR. | ExplanationTxt |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | LUCAS DEVICE | Desc |
| Contribution | 2 | ContributionCnt |
| Noncash Contributions Rpt F990 | $30,000 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 6 | MEMBERSHIP IN THE FRANCES MAHON DEACONESS HOSPITAL CORPORATION (FMDH) IS ACHIEVED BY VIRTUE OF DONATING AT LEAST 100 TO FMDH, TO THE FRANCES MAHON DEACONESS HOSPITAL FOUNDATION (ALTHOUGH THE FOUNDATION IS A SEPARATE CHARITABLE ENTITY AND NOT CONTROLLED BY THE FMDH CORPORATION, ITS STATED PURPOSE IS TO SUPPORT FMDH AND THE DELIVERY OF HEALTHCARE SERVICES IN VALLEY COUNTY, MONTANA, THROUGH CHARITABLE DONATIONS SUPPORTING SERVICES DEVELOPMENT AND EQUIPMENT PURCHASES), AND LUKE'S 100 (ANOTHER LOCAL CHARITABLE ORGANIZATION SEPARATE FROM FMDH BUT WHICH SUPPORTS FMDH THROUGH ANNUAL DONATIONS). THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE CONTROL OVER FMDH. |
| FORM 990, PAGE 6, PART VI, LINE 7A | THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE OR CONTROL OVER FMDH. |
| FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE CEO AND DIRECTOR OF FINANCIAL SERVICES AND IS MADE AVAILABLE FOR THE BOARD'S REVIEW PRIOR TO BEING FILED. |
| FORM 990, PAGE 6, PART VI, LINE 12C | CONFLICTS OF INTEREST ARE REQUIRED TO BE REPORTED AT THE FIRST MEETING OF EACH CALENDAR YEAR. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE REQUIRED TO LEAVE THE BOARD MEETING WHILE THE BUSINESS IS BEING DISCUSSED OR ACTED UPON. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE BOARD OF TRUSTEES APPROVES THE CEO'S COMPENSATION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | THE BOARD OF TRUSTEES APPROVES THE COMPENSATION FOR ALL PHYSICIANS EMPLOYED BY FMDH. THE CEO APPROVES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. |
| FORM 990, PAGE 6, PART VI, LINE 19 | ALL WRITTEN POLICIES ARE KEPT IN THE OFFICE OF THE DIRECTOR OF FINANCIAL SERVICES AND ARE AVAILABLE UPON REQUEST. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| FMDH FOUNDATION | ||||||||||
| 621 3RD STREET SOUTH | GLASGOW | MT | 59230 | 810406872 | SUPPORT | MT | 501C3 | 7 | NA | false |
| PRAIRIE RIDGE VILLAGE LLP | ||||||||||
| 521 4TH AVE S | GLASGOW | MT | 59230 | 810515202 | ASSTLIVING | MT | 501C3 | 9 | NA | false |
| NE MT STAT AIR AMBULANCE COOPERATIV | ||||||||||
| 519 PLEASANT STREET | MILES CITY | MT | 59301 | 204748673 | AIR AMBULA | MT | 501C3 | 11B | NA | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|
| HI-LINE MEDICAL SERVICES INC | ||||||||
| 621 THIRD STREET SOUTH | GLASGOW | MT | 59230 | 208393201 | PHYSICIANS | MT | N/A | false |
| GLASGOW CLINIC PC | ||||||||
| 621 THIRD STREET SOUTH | GLASGOW | MT | 59230 | 810341714 | CLINIC | MT | N/A | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (true) | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | Yes (true) | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (9 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| FMDH FOUNDATION | ||
| O | $41,455 | STAFF & OTHER ITEMS |
| GLASGOW CLINIC PC | ||
| J | $91,200 | RENTAL INCOME |
| GLASGOW CLINIC PC | ||
| R | $505,208 | CHANGE IN RECEIVABLE |
| HI-LINE MEDICAL SERVICES INC | ||
| J | $93,633 | RENTAL INCOME |
| HI-LINE MEDICAL SERVICES INC | ||
| R | $487,489 | CHANGE IN RECEIVABLE |
| NORTHEAST MT STAT AIR AMBULANCE | ||
| Q | $33,623 | CONTRACT STAFF |
| NORTHEAST MT STAT AIR AMBULANCE | ||
| P | $30,135 | CONTRACT STAFF |
| PRAIRIE RIDGE VILLAGE LLP | ||
| D | $3,722,936 | LOAN BALANCE |
| PRAIRIE RIDGE VILLAGE LLP | ||
| A | $198,124 | INTEREST RECEIVED ON LOAN |