SIDNEY HEALTH CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SIDNEY HEALTH CENTER (EIN 81-0233499)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-12
- IRS object ID
- 201731329349305838
- 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 K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-12T15:19:35-05:00 | 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 | 810233499 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SIDNEY HEALTH CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SIDN | BusinessNameControlTxt |
| Phone | 4064882100 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 14TH AVENUE SW | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59270 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TINA MONTGOMERY | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4064882100 | PhoneNum |
| Signature | 2017-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KURT BENNION | PreparerPersonNm |
| PTIN | P01469618 | 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 | TINA MONTGOMERY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 14TH AVENUE SW | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59270 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $64,659,375 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SIDNEYHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH BY PROVIDING QUALITY MEDICAL CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 541 | TotalEmployeeCnt |
| Total Volunteers | 112 | TotalVolunteersCnt |
| Total Gross UBI | $1,621,835 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $302,664 | PYContributionsGrantsAmt |
| CY Contributions Grants | $352,942 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $54,170,348 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $57,417,667 | CYProgramServiceRevenueAmt |
| PY Investment Income | $885,455 | PYInvestmentIncomeAmt |
| CY Investment Income | $507,510 | CYInvestmentIncomeAmt |
| PY Other Revenue | $3,637,822 | PYOtherRevenueAmt |
| CY Other Revenue | $2,770,181 | CYOtherRevenueAmt |
| PY Total Revenue | $58,996,289 | PYTotalRevenueAmt |
| CY Total Revenue | $61,048,300 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $100 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $400 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $23,786,401 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $25,967,546 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $289,809 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,192,602 | PYOtherExpensesAmt |
| CY Other Expenses | $38,332,808 | CYOtherExpensesAmt |
| PY Total Expenses | $57,979,103 | PYTotalExpensesAmt |
| CY Total Expenses | $64,300,754 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,017,186 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,252,454 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $66,633,712 | TotalAssetsBOYAmt |
| Total Assets EOY | $62,027,876 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $33,337,312 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,985,635 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $33,296,400 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $30,042,241 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH AND WELL-BEING. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $58,659,237 | ExpenseAmt |
| Grant | $400 | GrantAmt |
| Revenue | $57,417,667 | RevenueAmt |
| Desc | SIDNEY HEALTH CENTER IS A NOT-FOR-PROFIT COMMUNITY BASED MEDICAL CENTER THAT HAS BEEN SERVING PEOPLE IN THE MONDAK REGION FOR MORE THAN 100 YEARS. OUR PASSION FOR CARING IS SHARED BY THE DOCTORS, NURSES, AND SEVERAL HUNDRED EMPLOYEES AND VOLUNTEERS. THIS COMMITMENT TO CARING IS OUR ALLEGIANCE TO THE COMMUNITY AS WE STRIVE TO PROVIDE "EXCEPTIONAL CARE FOR LIFE."LOCATED IN THE HEART OF RICHLAND COUNTY, THE ATTRACTIVE EASTERN MONTANA CAMPUS INCLUDES AN ACUTE CARE HOSPITAL, CLINIC AREA, RETAIL PHARMACY AND A 93-BED EXTENDED CARE FACILITY OFFERING A COMPLETE RANGE OF SERVICES FROM BIRTH THROUGH END-OF-LIFE, WHICH IS COMPLEMENTED BY AN ARRAY OF OUTREACH SERVICES. THIS CONTINUUM OR SUCCESSION OF SERVICES IS NOT TYPICAL OF RURAL HEALTHCARE ORGANIZATIONS, BUT SIDNEY HEALTH CENTER IS NOT TYPICAL. A STRONG COMPLEMENT OF PRIMARY CARE PHYSICIANS AND A UNIQUE SELECTION OF SURGICAL SPECIALISTS COMBINED WITH A MODERN FACILITY, AND UP-TO-DATE MEDICAL EQUIPMENT, MAKES SIDNEY HEALTH CENTER A SPECIAL PLACE TO WORK, RECEIVE CARE AND PRACTICE MEDICINE. SIDNEY HEALTH CENTER ALSO PROVIDES VARIOUS COMMUNITY BENEFIT PROGRAMS FOR THE INDIVIDUALS IN THEIR SERVICE REGION.RICHLAND COUNTY TRANSPORTATION - THIS PROGRAM GIVES OPPORTUNITIES FOR THOSE WHO CANNOT DRIVE THE OPTION OF A RIDE. SIDNEY HEALTH CENTER PROVIDES A DRIVER AND HELPS PAY FOR BUSSES. SINCE IT'S CONCEPTION WE HAVE GONE FROM ONE BUS AND ONE DRIVER FOR THE FULL PROGRAM TO 5 BUSSES AND 8 DRIVERS. WE WORK WITH THE HEALTH DEPARTMENT, RICHLAND COUNTY AND THE LODGE.MILES CITY NURSING PROGRAM - WE PROVIDE THE FACILITY AND PROGRAM COSTS TO HAVE MILES CITY COMMUNITY COLLEGE RUN A SATELLITE SCHOOL HERE IN SIDNEY. THIS PROMOTES NURSING AS A PROFESSION AND KEEPS THOSE WHO ARE INTERESTED IN OUR COMMUNITY AS POSSIBLE EMPLOYEES LATER.OUTREACH CLINIC - SOME OF THE OUTLYING COMMUNITIES DO NOT HAVE ACCESS TO AN ENT PHYSICIAN. SIDNEY HEALTH CENTER PROVIDES THE TRAVEL FOR OUR ENT TO GO TO THOSE OUTREACH AREAS.HEALTH FAIR - WORKING WITH RICHLAND COUNTY HEALTH DEPARTMENT, COALITION ON AGING, FIRE, POLICE AND MENTAL HEALTH PROFESSIONS, JUST TO NAME A FEW, SIDNEY HEALTH CENTER HOLDS A HEALTH FAIR WHERE PEOPLE CAN COME AND LEARN ABOUT DIFFERENT HEALTHCARE NEEDS OF OUR COMMUNITY. SIDNEY HEALTH CENTER PROMOTES PREVENTATIVE CARE, DIABETES EDUCATION, LAB SCREENINGS AND MANY OTHER TOPICS.LIVE-IT-UP - THIS IS A PROGRAM THAT SIDNEY HEALTH CENTER DOES TO MAKE WOMEN OF RICHLAND COUNTY AWARE OF HOW HEART DISEASE AFFECTS THEM. RICHLAND COUNTY FAIR & RODEO - SIDNEY HEALTH CENTER PROVIDES A BOOTH WHERE PEOPLE CAN GET THEIR BLOOD PRESSURE TAKEN, DO A FINGER STICK BLOOD TEST FOR DIABETS AND GET A BOTTLE OF WATER FOR FREE IN THE EXTREME HOT AUGUST DAYS OF THE FAIR.GRIEF RECOVERY SUPPORT GROUPS - SIDNEY HEALTH CENTER'S HOSPICE PROGRAMS PUT ON TWO DIFFERENT CAMPS FOR PEOPLE WHO HAVE LOST LOVED ONES. ONE IS FOR ADULTS, THE OTHER FOR KIDS. THERE ARE ALSO MEMORIAL SERVICES AND NUMEROUS GRIEF SUPPORT GROUPS THROUGHOUT THE YEAR.BIRTHDAY HEALTH FAIR - PATIENTS WHO SIGN UP CAN GET LABS DURING THEIR BIRTHDAY MONTH.VISITING NURSE SERVICE - INITIAL NURSE VISIT.MEDICATION ASSISTANCE - PROVIDES MEDS TO THOSE WHO HAVE NO INSURANCE. ALSO HELPS GET PATIENTS SIGNED UP WITH DRUG COMPANIES FOR FREE MEDICATIONSRX BOXES - PHARMACY SETS UP PILLS IN MEDICATION BOXES SO THAT GROUP HOME RESIDENTS GET THE CORRECT PILLS FOR EACH ADMINISTRATION TIME.SCHOOL AGE BASED EDUCATION ACTIVITIES - CENTRAL SCHOOL BLOOD TYPING. INTERACTIVE TOUR FOR 2ND GRADERS.AARP DRIVING - DRIVING COURSE FOR THOSE OVER 55 THROUGH AARP.CHAMBER OF COMMERCE - VARIOUS DONATIONS FOR COMMUNITY AND CHAMBER FUNCTIONS.CHILDBIRTH CLASSES - CLASSES OFFERED TO THE COMMUNITY. | Desc |
| Total Program Service Expenses | $58,659,237 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | 0 | 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 | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 82 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 541 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | 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 | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | 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 | 0 | 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 | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TINA MONTGOMERY CFO | PersonNm |
| Phone | 4064882117 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 14TH AVE SW | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59270 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| RANDY JOHNSON | ||||||||
| PRESIDENT | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRIAN MCGINNIS | ||||||||
| VICE PRESIDENT | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| MARK MARTIN | ||||||||
| SECRETARY/TREASURER | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| BRYCE BAKER | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| REBECCA BRADLEY | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT BURNISON | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SANDY CHRISTENSEN | ||||||||
| TRUSTEE (THROUGH NOVEMBER 2015) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LYLE HARRISON MD | ||||||||
| TRUSTEE | 39.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| LESZEK JASZCZAK MD | ||||||||
| TRUSTEE | 39.00 | 1.00 | Yes (X) | $221,388 | $0 | $7,782 | ||
| SANDRA JEPSEN | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DICK VANDE BOSSCHE | ||||||||
| TRUSTEE | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CINDY WAGNER | ||||||||
| TRUSTEE (THROUGH NOVEMBER 2015) | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD HARALDSON | ||||||||
| CEO | 39.00 | 1.00 | Yes (X) | $273,414 | $0 | $10,571 | ||
| TINA MONTGOMERY | ||||||||
| CFO | 39.00 | 1.00 | Yes (X) | $136,886 | $0 | $10,850 | ||
| JEROME KESSLER | ||||||||
| PHYSICIAN | 40.00 | $369,459 | $0 | $11,805 | Yes (X) | |||
| KELLY O'NEAL | ||||||||
| GENERAL SURGEON | 40.00 | $314,856 | $0 | $12,030 | Yes (X) | |||
| GEORGE SCORDALAKES MD | ||||||||
| PHYSICIAN | 40.00 | $422,117 | $0 | $11,967 | Yes (X) | |||
| BRADLEY STRUPP | ||||||||
| CRNA | 40.00 | $313,153 | $0 | $11,130 | Yes (X) | |||
| SHARI TWIGG MD | ||||||||
| PHYSICIAN | 40.00 | $384,293 | $0 | $9,158 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,435,566 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $85,293 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 27 | 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 |
|---|---|---|---|---|---|
| WEATHERBY LOCUMS INC | |||||
| PO BOX 972633 | DALLAS | TX | 75397 | PHYSICIAN SERVICES | $983,740 |
| BRETT BENNION MD | |||||
| 214 14TH AVE SW | SIDNEY | MT | 59270 | PHYSICIAN SERVICES | $774,700 |
| EDWARD P BERGIN MD | |||||
| PO BOX 1529 | SIDNEY | MT | 59270 | PHYSICIAN SERVICES | $606,000 |
| SANFORD HEALTH | |||||
| 1305 W 18TH ST | SOUIX FALLS | SD | 57105 | IT SUPPORT | $531,618 |
| MEDIKAR PC | |||||
| 214 14TH AVE SUITE 110 | SIDNEY | MT | 59270 | PHYSICIAN SERVICES | $500,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 19 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $15,844 | GovernmentGrantsAmt |
| All Other Contributions | $337,098 | AllOtherContributionsAmt |
| Total Contributions | $352,942 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| PATIENT REVENUES | 621500 | $50,778,350 | $50,778,350 | |
| CLINIC PHARMACY | 446110 | $5,752,636 | $4,130,801 | $1,621,835 |
| OTHER PATIENT CARE | 621500 | $886,681 | $886,681 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $57,417,667 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $485,423 | TotalRevenueColumnAmt |
| Exclusion | $485,423 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,500 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $6,500 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $6,500 | TotalRevenueColumnAmt |
| Exclusion | $6,500 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,385,186 | SecuritiesAmt |
| Other | $41,859 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,404,958 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$19,772 | SecuritiesAmt |
| Other | $41,859 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,087 | TotalRevenueColumnAmt |
| Exclusion | $22,087 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $325,674 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $206,117 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $119,557 | TotalRevenueColumnAmt |
| Exclusion | $119,557 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| OTHER PHARMACY REVENUE | 900099 | $1,678,543 | $1,678,543 |
| MISCELLANEOUS REVENUE | 900099 | $505,248 | $505,248 |
| MEAL INCOME | 900099 | $370,900 | $370,900 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $89,433 | TotalRevenueColumnAmt |
| Exclusion | $89,433 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,644,124 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,048,300 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $55,795,832 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $1,621,835 | UnrelatedBusinessRevenueAmt |
| Exclusion | $3,277,691 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $400 | TotalAmt |
| Program Services | $400 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $420,804 | TotalAmt |
| Program Services | $155,587 | ProgramServicesAmt |
| Management And General | $230,473 | ManagementAndGeneralAmt |
| Fundraising | $34,744 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,920,049 | TotalAmt |
| Program Services | $19,299,581 | ProgramServicesAmt |
| Management And General | $1,480,044 | ManagementAndGeneralAmt |
| Fundraising | $140,424 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $395,911 | TotalAmt |
| Program Services | $356,948 | ProgramServicesAmt |
| Management And General | $36,435 | ManagementAndGeneralAmt |
| Fundraising | $2,528 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,802,947 | TotalAmt |
| Program Services | $2,553,223 | ProgramServicesAmt |
| Management And General | $225,519 | ManagementAndGeneralAmt |
| Fundraising | $24,205 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,427,835 | TotalAmt |
| Program Services | $1,291,341 | ProgramServicesAmt |
| Management And General | $123,584 | ManagementAndGeneralAmt |
| Fundraising | $12,910 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,367 | TotalAmt |
| Management And General | $31,367 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,706 | TotalAmt |
| Management And General | $106,026 | ManagementAndGeneralAmt |
| Fundraising | $680 | FundraisingAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $93,344 | TotalAmt |
| Management And General | $93,344 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,558,269 | TotalAmt |
| Program Services | $9,854,772 | ProgramServicesAmt |
| Management And General | $683,189 | ManagementAndGeneralAmt |
| Fundraising | $20,308 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,526 | TotalAmt |
| Program Services | $13,770 | ProgramServicesAmt |
| Management And General | $145,165 | ManagementAndGeneralAmt |
| Fundraising | $10,591 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,983,858 | TotalAmt |
| Program Services | $2,070,335 | ProgramServicesAmt |
| Management And General | $885,384 | ManagementAndGeneralAmt |
| Fundraising | $28,139 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $535,340 | TotalAmt |
| Program Services | $535,340 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,008,819 | TotalAmt |
| Program Services | $1,000,248 | ProgramServicesAmt |
| Management And General | $3,657 | ManagementAndGeneralAmt |
| Fundraising | $4,914 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | -$21,281 | TotalAmt |
| Program Services | $392,417 | ProgramServicesAmt |
| Management And General | -$420,473 | ManagementAndGeneralAmt |
| Fundraising | $6,775 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,236,894 | TotalAmt |
| Management And General | $1,236,894 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,119,035 | TotalAmt |
| Program Services | $4,119,035 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $670,079 | TotalAmt |
| Program Services | $670,079 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| PHARMACY/LAB EXPENSE | $9,538,276 | $9,537,909 | $367 | |
| BAD DEBT | $5,770,243 | $5,770,243 | ||
| RECRUITING | $400,588 | $391,012 | $9,404 | $172 |
| GOOD CENTS STORE | $318,624 | $56,787 | $261,837 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $813,121 | TotalAmt |
| Program Services | $590,210 | ProgramServicesAmt |
| Management And General | $219,492 | ManagementAndGeneralAmt |
| Fundraising | $3,419 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,300,754 | TotalAmt |
| Program Services | $58,659,237 | ProgramServicesAmt |
| Management And General | $5,351,708 | ManagementAndGeneralAmt |
| Fundraising | $289,809 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,305,692 | BOYAmt |
| EOY | $5,103,095 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,454,565 | BOYAmt |
| EOY | $13,828,196 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $61,158 | BOYAmt |
| EOY | $41,158 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,519,520 | BOYAmt |
| EOY | $1,675,187 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $909,359 | BOYAmt |
| EOY | $996,417 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $67,455,518 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $44,327,672 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $26,107,200 | BOYAmt |
| EOY | $23,127,846 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,200,479 | BOYAmt |
| EOY | $11,733,529 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,499,791 | BOYAmt |
| EOY | $2,304,918 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $642,222 | BOYAmt |
| EOY | $672,456 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $398,469 | BOYAmt |
| EOY | $269,864 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,535,257 | BOYAmt |
| EOY | $2,275,210 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,633,712 | BOYAmt |
| EOY | $62,027,876 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,577,981 | BOYAmt |
| EOY | $5,716,354 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,391,936 | BOYAmt |
| EOY | $21,155,070 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,112 | BOYAmt |
| EOY | $8,927 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,092,735 | BOYAmt |
| EOY | $2,688,153 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,261,548 | BOYAmt |
| EOY | $2,417,131 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,337,312 | BOYAmt |
| EOY | $31,985,635 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,654,178 | BOYAmt |
| EOY | $29,369,785 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $642,222 | BOYAmt |
| EOY | $672,456 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,296,400 | BOYAmt |
| EOY | $30,042,241 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,633,712 | BOYAmt |
| EOY | $62,027,876 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,252,454 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$57,062 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $55,357 | 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $4,784 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $4,784 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE MEMBERSHIP DUES PAID TO THE MONTANA HOSPITAL ASSOCIATION, THE AMERICAN HOSPITAL ASSOCIATION AND LEADINGAGE ARE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $198,261 | OtherCostOrOtherBasisAmt |
| Book Value | $198,261 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $42,323,495 | OtherCostOrOtherBasisAmt |
| Depreciation | $25,510,118 | DepreciationAmt |
| Book Value | $16,813,377 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $24,831,042 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,817,554 | DepreciationAmt |
| Book Value | $6,013,488 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $102,720 | OtherCostOrOtherBasisAmt |
| Book Value | $102,720 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $23,127,846 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| THIRD PARTY PAYABLE | $198,306 |
| SWAP CONTRACT LIABILITY | $2,218,825 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $2,417,131 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $54,623,722 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $206,117 | OtherRevenueAmt |
| Revenue Not Reported | $206,117 | RevenueNotReportedAmt |
| Revenue Subtotal | $54,417,605 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $93,344 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $6,537,351 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $6,630,695 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $61,048,300 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $58,643,285 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $206,117 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $206,117 | ExpensesNotReportedAmt |
| Expenses Subtotal | $58,437,168 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $93,344 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $5,770,243 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $5,863,587 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $64,300,755 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 2B: | RESIDENT TRUST ACCOUNT: THIS IS THE EXTENDED CARE RESIDENT TRUST ACCOUNT, WHICH IS MADE UP OF THE RESIDENTS' MONEY THAT SIDNEY HEALTH CENTER HOLDS ON THEIR BEHALF. THESE MONIES ARE KEPT IN A SEPARATE BANK ACCOUNT FROM THE ORGANIZATION'S FUNDS AND ARE DUE BACK TO THE RESIDENTS UPON LEAVING THE FACILITY. |
| PART X, LINE 2: | THE IRS HAS DETERMINED THAT THE HEALTH CENTER IS A TAX-EXEMPT, NOT-FOR-PROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE IRC. THE HEALTH CENTER 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 HEALTH CENTER'S FINANCIAL STATEMENTS. THE HEALTH CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD 206,117. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | INVESTMENT INCOME 372,307. GRANTS AND CONTRIBUTIONS 352,942. GAIN ON DISPOSAL OF FIXED ASSETS 41,859. BAD DEBT EXPENSE 5,770,243. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | COST OF GOODS SOLD 206,117. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 5,770,243. |
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 |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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) |
|---|---|---|
| Total Community Benefit Expns | $317,024 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $317,024 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $317,024 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $317,024 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $88,116 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $88,116 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,841 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $19,841 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,392,898 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,582,425 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,810,473 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07480 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $107,957 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $107,957 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00170 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,608,812 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,582,425 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,026,387 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07820 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,925,836 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,582,425 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,343,411 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08310 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,770,243 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,074,429 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,139,143 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$64,714 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | SIDNEY HEALTH CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 216 14TH AVENUE SW | AddressLine1Txt |
| City | SIDNEY | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59270 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SIDNEYHEALTH.ORG | WebsiteAddressTxt |
| State License | 12709 | 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 | SIDNEY HEALTH CENTER | 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 |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SCHEDULE H, PART VI, LINE 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 | SEE SCHEDULE H, PART VI, LINE 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 | 175.000000000000 | 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 |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.SIDNEYHEALTH.ORG/BILLING | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| 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 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 (1) | NondisEmergencyCarePolicyInd |
| Average Negotiated Rates | Yes (X) | AverageNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SIDNEY HEALTH CENTER | PART V, SECTION B, LINE 5: PUBLIC INPUT WAS COLLECTED USING THE "COMMUNITY ASSESSMENT USING A PUBLIC HEALTH EMERGENCY RESPONSE" (CASPER) PROCESS. OVER A TWO-DAY PERIOD, 42 VOLUNTEERS WENT DOOR-TO-DOOR ACROSS OUR COMMUNITY AND COMPLETED 204 INTERVIEWS. IN ADDITION, SEVEN TOWN HALL MEETINGS WERE HELD IN APRIL 2016 IN VARIOUS LOCATIONS OF RICHLAND COUNTY. THESE MEETINGS WERE ADVERTISED IN LOCAL NEW MEDIA AND WERE OPEN TO THE PUBLIC. |
| SIDNEY HEALTH CENTER | PART V, SECTION B, LINE 6B: THE JUNE 30, 2016 COMMUNITY HEALTH NEEDS ASSESSMENT WAS OVERSEEN BY SIDNEY HEALTH CENTER, RICHLAND COUNTY HEALTH DEPARTMENT, AND THE PUBLIC HEALTH AND SAFETY DIVISION. |
| SIDNEY HEALTH CENTER | PART V, SECTION B, LINE 11: SIDNEY HEALTH CENTER IS NOT RESPONDING TO ALL IDENTIFIED COMMUNITY HEALTH NEEDS BECAUSE THE HOSPITAL HAS LIMITED HOSPITAL STAFF AND FINANCIAL RESOURCES, OTHER COMMUNITY RESOURCES ARE ALREADY AVAILABLE, AND SIDNEY HEALTH CENTER WANTS TO FOCUS ON HIGHER PRIORITIES THAT WE BELIEVE CAN HAVE A GREATER IMPACT ON THE LIVES OF OUR COMMUNITY MEMBERS. |
| 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 - SIDNEY HEALTH CENTER EXTENDED CARE | ||||
| 216 14TH AVE SW | SIDNEY | MT | 59270 | NURSING HOME |
| 2 - THE LODGE AT LONE TREE | ||||
| 1015 7TH AVE SW | SIDNEY | MT | 59270 | ASSISTED LIVING COMPLEX |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | ELIGIBILITY CRITERIA: 1. FINANCIAL ASSISTANCE IS SECONDARY TO ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT. THIS INCLUDES BUT IS NOT LIMITED TO:A. GROUP OR INDIVIDUAL MEDICAL INSURANCE PLANSB. WORKERS COMPENSATION PLANSC. MEDICAID, STATE, OR COUNTY MEDICAL PROGRAMSD. OTHER STATE, FEDERAL, OR MILITARY PROGRAMSE. THIRD PARTY LIABILITY SITUATIONS (E.G., AUTO ACCIDENTS OR PERSONAL INJURY CLAIMS)F. ANY OTHER PERSONS OR ENTITIES WHO MAY HAVE A LEGAL RESPONSIBILITY TO PAY FOR THE MEDICAL SERVICESG. CRIME VICTIMS2. DETERMINATION OF ELIGIBILITY OF A PATIENT FOR ASSISTANCE SHALL BE APPLIED REGARDLESS OF THE SOURCE OF REFERRAL AND WITHOUT DISCRIMINATION AS TO RACE, COLOR, CREED, NATIONAL ORIGIN, AGE, HANDICAP STATUS, OR MARITAL STATUS.3. PATIENT CARE WHICH IS ELECTIVE (NON-EMERGENT), COSMETIC, AND/OR EXPERIMENTAL SHALL NOT BE CONSIDERED ELIGIBLE FOR ASSISTANCE. FOR EMERGENCY ROOM SERVICES, IF THE VISIT IS DEEMED NON-EMERGENT AND THE PATIENT COULD HAVE BEEN SEEN IN A PHYSICIAN'S OFFICE, THE CHARITY CARE WRITE OFF WILL BE SUBJECT TO A 50% LIMITATION.4. PATIENT SPEND DOWNS AS DETERMINED BY MEDICAID, STATE OR COUNTY MEDICAL PROGRAMS ARE NOT ELIGIBLE FOR ASSISTANCE. (THE PATIENT ACCOUNTS MANAGER CAN MAKE EXCEPTIONS ON A CASE-BY-CASE BASIS.)5. TO THE EXTENT THE HOSPITAL CHARGES RELATED TO APPROPRIATE HOSPITAL BASED MEDICAL SERVICES ARE NOT COVERED BY THIRD-PARTY COVERAGE, A 100% WRITE-OFF MAY BE PROVIDED TO PATIENTS IF THE NET AVAILABLE ASSETS ARE NO GREATER THAN TWO TIMES THE FEDERAL INCOME POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE AND THE FAMILY'S GROSS INCOME IS BELOW %100 OF THE FEDERAL INCOME POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE. 6. PARTIAL ASSISTANCE MAY BE PROVIDED TO PATIENTS IF NET AVAILABLE ASSETS ARE NO GREATER THAN TWO TIMES THE FEDERAL INCOME POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE AND THE GROSS FAMILY INCOME IS BETWEEN 100% AND 175% OF THE FEDERAL INCOME POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE. THE UNPAID BALANCE AFTER THIRD-PARTY PAYMENTS FOR PATIENTS MEETING THIS CRITERIA WILL BE DISCOUNTED ACCORDING TO THE FOLLOWING SLIDING FEE SCALE CONSIDERING INDIVIDUAL CIRCUMSTANCES SUCH AS EXTRAORDINARY NONDISCRETIONARY EXPENSES RELATIVE TO THE AMOUNT OF MEDICAL EXPENSES, THE EXISTENCE AND AVAILABILITY OF FAMILY ASSETS, THE RESPONSIBLE PARTY'S FUTURE INCOME EARNING CAPACITY, AND ABILITY TO MAKE PAYMENTS OVER AND EXTENDED PERIOD OF TIME. THE FINANCIAL OBLIGATIONS WHICH REMAIN AFTER THE APPLICATION OF THIS SLIDING SCALE MAY BE PAYABLE IN MONTHLY INSTALLMENTS OVER A REASONABLE PERIOD OF TIME WHICH SHOULD BE CONSISTENT WITH THE ESTABLISHED MONTHLY PAYMENT PLAN GUIDELINES.7. FULL FINANCIAL ASSISTANCE (LESS CO-PAY) MAY BE PROVIDED TO PATIENTS THAT DO NOT HAVE AVAILABLE ASSETS AND WITH GROSS FAMILY INCOME BETWEEN 100%-175% OF THE FEDERAL POVERTY GUIDELINES AS ADJUSTED FOR FAMILY SIZE WHEN CIRCUMSTANCES AS DETERMINED BY THE PATIENT ACCOUNTS MANAGER INDICATE THAT FULL PAYMENT MAY CAUSE SOCIAL AND FINANCIAL HARDSHIP SO AS TO SIGNIFICANTLY HARM THE PATIENT OR THE FAMILY UNIT. CO-PAY PROVISION: A PATIENT CO-PAY AMOUNT WILL BE ASSIGNED TO THOSE PATIENTS QUALIFYING FOR 100% ASSISTANCE AS FOLLOWS: A.INPATIENT SERVICES 10% OR $500, WHICHEVER IS THE LESSER AMOUNTB.OUTPATIENT SURGERY 10% OR $250, WHICHEVER IS THE LESSER AMOUNTC.OUTPATIENT ANCILLARY 10% OF BILL8. FULL OR PARTIAL ASSISTANCE MAY BE PROVIDED TO PATIENTS WITH GROSS FAMILY INCOME ABOVE 175% OF THE POVERTY GUIDELINES WHEN CIRCUMSTANCES DETERMINED BY THE PATIENT ACCOUNTS MANAGER INDICATE THAT FULL PAYMENT MAY CAUSE SOCIAL AND FINANCIAL HARDSHIPS SO AS TO SIGNIFICANTLY HARM THE PATIENT OR THE FAMILY UNIT. SHC WILL DETERMINE IF ASSETS CAN BE LIQUEFIED TO MEET THE OUTSTANDING MEDICAL EXPENSES AND/OR WHAT MONTHLY PAYMENT AMOUNT COULD BE MADE FOR A PERIOD OF UP TO 36 MONTHS AND THE REMAINING BALANCE WRITTEN OFF AS FINANCIAL ASSISTANCE. |
| PART I, LINE 7: | IN ORDER TO CALCULATE THE OVERALL HOSPITAL'S COST TO CHARGE RATIO USED FOR PART I, LINE 7, THE HOSPITAL FIRST DETERMINED A COST TO CHARGE RATIO BASED ON THE 2016 FILED MEDICARE COST REPORT SEPARATELY FOR INPATIENT SERVICES, OUTPATIENT SERVICES, AND TOTAL SERVICES. TO CALCULATE THE COST OF CHARITY CARE INCLUDED ON LINE 7A, THE HOSPITAL TOOK EACH OF THE SEPARATE COST TO CHARGE RATIOS DESCRIBED IN THE PRECEEDING PARAGRAPH AND APPLIED THEM ONLY TO THE RELATED CHARGES BY SERVICE TYPE TO COME UP WITH A WEIGHTED AVERAGE COST TO CHARGE RATIO. |
| PART I, LINE 7G: | THE FOLLOWING SUBSIDIZED HEALTH SERVICES WERE INCLUDED IN PART I, LINE 7G:OBSERVATION, NURSERY, IMPLANTS, AUDIOLOGY, CARDIAC REHAB, CLINIC FACILITY, EMERGENCY ROOM, AMBULANCE SERVICES, AND ENT/RADIOLOGY/ONCOLOGY CLINIC AND PROVIDER-BASED CLINIC |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN A, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $5,770,243. |
| PART III, LINE 2: | IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE HEALTH CENTER 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 UNCOLLECTIBLE ACCOUNTS. 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 HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY. 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 HEALTH CENTER RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. |
| PART III, LINE 3: | THE HEALTH CENTER IS UNABLE TO ESTIMATE THE AMOUNT OF ITS BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF THEY WERE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. |
| PART III, LINE 4: | SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, NET" PARAGRAPH IN NOTE 1 (PAGE 9) OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 ARE DERIVED FROM USING THE 2016 FILED MEDICARE COST REPORT. THE SHORTFALL OCCURS DUE TO VARIOUS EXPENSES INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. |
| PART III, LINE 9B: | IF THE PATIENT INDICATES THEIR INABILITY TO PAY ACCORDING TO THE HOSPITAL CREDIT TERMS THEY WILL BE ASKED TO FILL OUT A FINANCIAL STATEMENT. THE HOSPITAL MAY PULL A CREDIT REPORT TO CONFIRM OR SUPPLEMENT INFORMATION PROVIDED TO THE HOSPITAL ON THE FINANCIAL STATEMENT. THE PATIENT CAN THEN BE EVALUATED TO DETERMINE WHETHER THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE OR AN EXTENDED PAYMENT PROGRAM.IF THE FINANCIAL STATEMENT SHOWS THAT THE PATIENT HAS ASSETS OR POTENTIAL SOURCES OF INCOME THAT WOULD ENABLE THEM TO PAY THE HOSPITAL BILL WITHIN A YEAR, THEY WILL BE DENIED THE EXTENDED PAYMENT WAIVER. IF A PATIENT REFUSES TO FURNISH A COMPLETED FINANCIAL STATEMENT, THEIR ACCOUNT WILL BE DEEMED DELINQUENT AND FURTHER COLLECTION ACTION WILL BE TAKEN. PRIOR TO ADMISSION, AT THE TIME OF ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, THE HOSPITAL WILL MAKE AN INITIAL ASSESSMENT OF POTENTIAL ELIGIBILITY BASED ON THE VERBAL APPLICATION FOR FINANCIAL ASSISTANCE. IF POTENTIAL ASSISTANCE IS INDICATED WITH INITIAL ASSESSMENT, THE HOSPITAL WILL NOT INITIATE COLLECTION EFFORTS OR REQUESTS FOR DEPOSITS PENDING THE RECEIPT OF THE COMPLETED APPLICATION AND FINAL ELIGIBILITY DETERMINATION. THE RESPONSIBLE PARTY MUST BE COOPERATIVE WITH THE HOSPITAL'S EFFORTS TO REACH A DETERMINATION OF ELIGIBILITY WITH OTHER ASSISTANCE PROGRAMS AND TO VALIDATE THE INFORMATION NEEDED.SIDNEY HEALTH CENTER WILL MAKE A CONCERTED EFFORT TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE. EDUCATIONAL MATERIALS ABOUT THE PROGRAM WILL BE AVAILABLE TO PATIENTS THROUGH THE ADMISSIONS PROCESS. AS SOON AS A PATIENT EVIDENCES INABILITY TO PAY HE OR SHE WILL BE REFERRED TO THE PATIENT FINANCIAL SERVICES COUNSELOR FOR AN APPLICATION. APPLICATIONS ARE ALSO AVAILABLE AT THE ADMISSIONS AREA, AND THROUGH SOCIAL SERVICES. |
| PART VI, LINE 2: | THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN THE YEAR ENDED JUNE 30, 2016. THE REPORT AND PLANNED RESPONSES ARE AVAILABLE ONLINE AT HTTP://WWW.SIDNEYHEALTH.ORG/ABOUTUS/COMMUNITY-HEALTH-ASSESSMENT-IMPLEMENTATION-PLAN. |
| PART VI, LINE 3: | SIDNEY HEALTH CENTER HAS NOTICES LOCATED AT THE ADMISSIONS OFFICE INFORMING PATIENTS ABOUT THEIR FINANCIAL ASSISTANCE POLICY. THE PROGRAM IS ALSO STATED ON THE ORGANIZATION'S WEBSITE AND INCLUDED IN THE PATIENT'S PACKET UPON DISCHARGE FROM THE FACILITY. |
| PART VI, LINE 4: | LOCATED IN THE HEART OF RICHLAND COUNTY, SIDNEY HEALTH CENTER SERVES PEOPLE IN ALL OF THE MONDAK REGION. |
| PART VI, LINE 5: | THE HEALTH CENTER DEFINES AND MEASURES THEIR INVESTMENT IN AND PARTNERSHIP WITH THE COMMUNITY PRIMARILY THROUGH VARIOUS COMMUNITY BASED SERVICES PROGRAMS, PROVIDING HEALTH EQUIPMENT IN AREA SCHOOLS, AND COMMUNITY PROGRAMS AND EDUCATION. A NUMBER OF HEALTH RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| 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 | Yes (1) | 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LESZEK JASZCZAK MD | ||||||||||||||
| TRUSTEE | $221,388 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,782 | $0 | $229,170 | $0 | $0 | $0 |
| RICHARD HARALDSON | ||||||||||||||
| CEO | $273,414 | $0 | $0 | $0 | $0 | $0 | $7,841 | $0 | $2,730 | $0 | $283,985 | $0 | $0 | $0 |
| JEROME KESSLER | ||||||||||||||
| PHYSICIAN | $369,459 | $0 | $0 | $0 | $0 | $0 | $7,950 | $0 | $3,855 | $0 | $381,264 | $0 | $0 | $0 |
| KELLY O'NEAL | ||||||||||||||
| GENERAL SURGEON | $314,856 | $0 | $0 | $0 | $0 | $0 | $7,950 | $0 | $4,080 | $0 | $326,886 | $0 | $0 | $0 |
| GEORGE SCORDALAKES MD | ||||||||||||||
| PHYSICIAN | $422,117 | $0 | $0 | $0 | $0 | $0 | $7,950 | $0 | $4,017 | $0 | $434,084 | $0 | $0 | $0 |
| BRADLEY STRUPP | ||||||||||||||
| CRNA | $313,153 | $0 | $0 | $0 | $0 | $0 | $7,950 | $0 | $3,180 | $0 | $324,283 | $0 | $0 | $0 |
| SHARI TWIGG MD | ||||||||||||||
| PHYSICIAN | $384,293 | $0 | $0 | $0 | $0 | $0 | $5,528 | $0 | $3,630 | $0 | $393,451 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | RICHARD HARALDSON - HEALTH OR SOCIAL CLUB DUES OF $1,805 - NOT INCLUDED IN TAXABLE INCOME. |
| PART I, LINE 5 | PHYSICIANS RECEIVE BONUSES BASED ON PRODUCTIVITY, AMONG OTHER FACTORS. PRODUCTIVITY IS CLOSELY CONNECTED WITH REVENUES. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp (2 entries)
| Bond ReferenceBondReferenceCd | Bond Issuer EINBondIssuerEIN | Bond IssuedBondIssuedDt | Issue PriceIssuePriceAmt | PurposePurposeDesc | DefeasedDefeasedInd | On Behalf Of IssuerOnBehalfOfIssuerInd | Pool FinancingPoolFinancingInd |
|---|---|---|---|---|---|---|---|
| RICHLAND COUNTY MT | |||||||
| A | 816001419 | 2010-12-01 | $2,350,000 | MEDICAL EQUIPMENT REVENUE BOND FOR TOMOTHERAPY RADIATION ONCOLOGY UNIT | 0 | 0 | 0 |
| RICHLAND COUNTY MT | |||||||
| B | 816001419 | 2011-09-15 | $24,370,000 | REDEEMING AND RETIRING PREVIOUSLY ISSUED DEBT (2006, 2007A AND 2007B) | 0 | 0 | 0 |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp (2 entries)
| Bond ReferenceBondReferenceCd | RetiredRetiredAmt | Total ProceedsTotalProceedsAmt | Issuance Costs From ProceedsIssuanceCostsFromProceedsAmt | Capital ExpendituresCapitalExpendituresAmt | Substantial CompletionSubstantialCompletionYr | Current RefundingCurrentRefundingInd | Advance RefundingAdvanceRefundingInd | Final Allocation MadeFinalAllocationMadeInd | Adequate Books And Rec MaintAdequateBooksAndRecMaintInd | Credit EnhancementCreditEnhancementAmt |
|---|---|---|---|---|---|---|---|---|---|---|
| A | $1,784,930 | $2,350,000 | $20,059 | $2,329,941 | 2011 | 0 | 0 | Yes (1) | Yes (1) | |
| B | $3,780,000 | $24,370,000 | $233,683 | 2012 | Yes (1) | 0 | Yes (1) | Yes (1) | $137,747 |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp (2 entries)
| Bond ReferenceBondReferenceCd | Owning Bond Financed PropertyOwningBondFinancedPropertyInd | Any Lease ArrangementsAnyLeaseArrangementsInd | Mgmt Contract Bond Fincd PropMgmtContractBondFincdPropInd | Any Research AgreementsAnyResearchAgreementsInd | Bond Iss Meet Prvt Sec Pymt TestBondIssMeetPrvtSecPymtTestInd | Change In Use Bond Financed PropChangeInUseBondFinancedPropInd | Procs Nonqualified Bond RemdtdProcsNonqualifiedBondRemdtdInd |
|---|---|---|---|---|---|---|---|
| A | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 |
| B | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp (2 entries)
| Bond ReferenceBondReferenceCd | Form8038 T FiledForm8038TFiledInd | Rebate Not Due YetRebateNotDueYetInd | Exception To RebateExceptionToRebateInd | No Rebate DueNoRebateDueInd | Variable Rate IssueVariableRateIssueInd | Hedge Identified In Bks And RecHedgeIdentifiedInBksAndRecInd | Gross Proceeds Invested In GICGrossProceedsInvestedInGICInd | Gross Proceeds InvestedGrossProceedsInvestedInd | Written Proc To Monitor ReqsWrittenProcToMonitorReqsInd | Term Of HedgeTermOfHedgePct | Superintegrated HedgeSuperintegratedHedgeInd | Hedge TerminatedHedgeTerminatedInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (no name) | ||||||||||||
| A | 0 | Yes (1) | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |||
| US BANK | ||||||||||||
| B | 0 | Yes (1) | 0 | 0 | Yes (1) | Yes (1) | 0 | 0 | 0 | 7.900000000000 | 0 | 0 |
Procedures Corrective Action ProceduresCorrectiveActionGrp (2 entries)
| Bond ReferenceBondReferenceCd | Procedures Corrective ActionProceduresCorrectiveActionInd |
|---|---|
| A | 0 |
| B | 0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT MONTGOMERY | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SPOUSE OF TINA MONTGOMERY, CFO | RelationshipDescriptionTxt |
| Transaction | $64,435 | TransactionAmt |
| Transaction | EMPLOYEE COMPENSATION | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS AND ONE OTHER MEMEBER OF THE BOARD APPOINTED BY THE PRESIDENT. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, BYLAWS AND STATE POLICIES. ANY OFFICIAL ACTION TAKEN BY THE EXECUTIVE COMMITTEE IS SUBMITTED TO THE BOARD FOR RATIFICATION AT THE NEXT BOARD MEETING. |
| FORM 990, PART VI, SECTION A, LINE 6 | NATURAL PERSONS, CORPORATIONS, OR UNINCORPORATED ASSOCIATIONS MAY BECOME MEMBERS OF SIDNEY HEALTH CENTER BY: A. PAYMENT TO SIDNEY HEALTH CENTER A SUM OF NOT LESS THAN $100 CASH OR BY AN EQUIVALENT CONTRIBUTION OR METHOD AS APPROVED BY THE BOARD; B. RESIDING IN OR HAVING ITS PRINCIPAL PLACES OF BUSINESS IN THE SERVICE AREA OF SIDNEY HEALTH CENTER; AND C. AGREEING TO BE BOUND BY THE BYLAWS OF SIDNEY HEALTH CENTER. |
| FORM 990, PART VI, SECTION A, LINE 7A | ELECTION OF DIRECTORS IS HELD AT THE ANNUAL MEETING OF THE MEMBERS BY WRITTEN BALLOT LISTING THE CANDIDATES NOMINATED BY THE NOMINATING COMMITTEE OF THE MEMBERS. EACH MEMBER OF SIDNEY HEALTH CENTER, PRESENT IN PERSON OR BY PROXY, IS ENTITLED TO VOTE FOR ONE CANDIDATE FOR EACH DIRECTOR VACANCY TO BE FILLED. THE CANDIDATES RECEIVING THE HIGHEST NUMBER OF VOTES AT THE MEETING ARE CONSIDERED ELECTED AS DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | ANY PROPOSED AMENDMENTS APPROVED BY THE BOARD OR BY VERIFIED PETITION TO THE ARTICLES OF INCORPORATION OR BYLAWS SHALL BE SUBMITTED FOR VOTE BY THE MEMBERS AT THE NEXT SPECIAL OR ANNUAL MEMBERSHIP MEETING. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE CEO AND CFO WILL REVIEW THE COMPLETED 990 WITH THE BOARD OF DIRECTORS AT THEIR NEXT SCHEDULED MEETING AFTER THE 990 IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE POLICY OF THE CORPORATION IS TO REQUIRE THAT EACH INDIVIDUAL SUBJECT TO THIS POLICY STATEMENT PROMPTLY AND FULLY DISCLOSE ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST, AND THAT THE CORPORATION WILL NOT ENGAGE IN ANY CONTRACT, TRANSACTION, OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST UNLESS THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS (ACTING AT A DULY CONSTITUTED MEETING THEREOF) DETERMINE BY A MAJORITY VOTE THAT APPROPRIATE SAFEGUARDS TO PROTECT THE CHARITABLE MISSION OF THE CORPORATION HAVE BEEN IMPLEMENTED. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED ANNUALLY TO ALL INTERESTED PERSONS (BOARD MEMBERS, OFFICERS, AND COMMITTEE MEMBERS). AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST HE/SHE MAY HAVE. "DISCLOSURE" MEANS PROMPTLY PROVIDING A WRITTEN DESCRIPTION OF THE MATERIAL FACTS OF THE ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST TO THE EXECUTIVE COMMITTEE ON THE CONFLICTS-OF-INTEREST QUESTIONNAIRE. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. AT ANY TIME THAT AN ACTUAL, APPARENT, OR A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED TO THE BOARD OF DIRECTORS, WHETHER THROUGH THE VOLUNTARY SUBMISSION OF A DISCLOSURE STATEMENT BY AN INTERESTED PERSON, OR BY A DISCLOSURE BY A PERSON OTHER THAN THE SUBJECT INTERESTED PERSON, THE EXECUTIVE COMMITTEE SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON SHALL NOT BE PRESENT DURING ANY MEETING IN WHICH THE EXECUTIVE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. THE EXECUTIVE COMMITTEE MAY REQUEST ADDITIONAL INFORMATION FROM ALL REASONABLE SOURCES AND MAY INVOLVE THE GENERAL COUNSEL IN ITS DELIBERATIONS. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, EXECUTIVE COMMITTEE SHALL MAKE A FINDING AS TO WHETHER A CONFLICT OF INTEREST INDEED EXISTS, AND SHALL FORWARD THAT FINDING TO THE BOARD OF DIRECTORS FOR DISCUSSION AND VOTE. ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON MAY NOT BE PRESENT WHEN THIS VOTE IS TAKEN. ONCE THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS HAVE DETERMINED THAT AN ACTUAL CONFLICT OF INTEREST EXISTS WITH RESPECT TO A PARTICULAR TRANSACTION OR ARRANGEMENT: (I) THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS SHALL EXERCISE DUE DILIGENCE TO DETERMINE WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES AND, IF APPROPRIATE, SHALL APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT. (II) IN CONSIDERING WHETHER TO ENTER INTO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT, THE BOARD OF DIRECTORS MAY APPROVE SUCH A CONTRACT, TRANSACTION, OR ARRANGEMENT ONLY IF THE DISINTERESTED DIRECTORS DETERMINE BY A MAJORITY VOTE THAT: (A) THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTERESTS AND FOR THE CORPORATION'S OWN BENEFIT; AND (B) THE PROPOSED TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, TAKING INTO ACCOUNT, AMONG OTHER RELEVANT FACTORS, WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. (III) THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS MAY, IN THEIR DISCRETION, REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM WHILE THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT IS DISCUSSED. THE INTERESTED PERSON SHALL LEAVE THE ROOM WHILE THE MATTER IS VOTED ON AND ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER TO APPROVE THE TRANSACTION OR ARRANGEMENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE BOARD OF DIRECTORS DETERMINES SALARIES USING THE MHA SALARY SURVEY FOR MARKET INFORMATION AND ALSO PERFORMS A WRITTEN EVALUATION ANNUALLY. ADDITIONALLY, THE CEO USES MHA MANAGEMENT SURVEY, AS WELL AS OTHER COMPENSATION SURVEYS, TO DETERMINE ANNUAL PAY INCREASES FOR ADMINISTRATION. A WRITTEN EVALUATION IS PERFORMED. ALL ESTIMATED ANNUAL INCREASES ARE INCLUDED IN THE BUDGET, WHICH IS APPROVED BY THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 9,854,772. MANAGEMENT AND GENERAL EXPENSES 683,189. FUNDRAISING EXPENSES 20,308. TOTAL EXPENSES 10,558,269. |
| FORM 990, PART XI, LINE 9: | CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 30,230. CHANGE IN VALUE OF FAIR VALUE SWAP 25,127. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| LONE TREE SENIOR LIVING | ||||||||||
| 1015 7TH AVENUE SW | SIDNEY | MT | 59270 | 810518821 | ASSISTED LIVING | MT | 501(C)(3) | LINE 9 | SIDNEY HEALTH CENTER | Yes (1) |
| FOUNDATION FOR COMMUNITY CARE OF RICHLAND COUNTY | ||||||||||
| 221 2ND ST NW | SIDNEY | MT | 59270 | 810417465 | FUNDRAISING | MT | 501(C)(3) | LINE 11A, I | SIDNEY HEALTH CENTER | Yes (1) |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| LONE TREE SENIOR LIVING | ||
| A | $104,365 | CONTRACTED INTEREST RATE |
| LONE TREE SENIOR LIVING | ||
| L | $97,930 | FAIR MARKET VALUE |