NORTHERN MONTANA HOSPITAL: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN MONTANA HOSPITAL (EIN 81-0231787)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-12
- IRS object ID
- 201741329349305669
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-12T15:00:08-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 401 N 31st St Ste 1120 PO Box 7112 | AddressLine1Txt |
| City | Billings | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 591037112 | 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 | 810231787 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Montana Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 4062652211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1231 | AddressLine1Txt |
| City | Havre | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 595011231 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | David Henry | PersonNm |
| Person Title | President/CEO | PersonTitleTxt |
| Phone | 4062652211 | PhoneNum |
| Signature | 2017-05-12 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim C Hunwardsen | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 4068962400 | PhoneNum |
| Preparation | 2017-05-12 | 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 | David Henry | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1231 | AddressLine1Txt |
| City | Havre | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 595011231 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $68,771,434 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nmhcare.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1921 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | Provision of healthcare services. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 797 | TotalEmployeeCnt |
| Total Volunteers | 113 | TotalVolunteersCnt |
| Total Gross UBI | $122,037 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $24,745 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $22,314 | PYContributionsGrantsAmt |
| CY Contributions Grants | $107,120 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $66,007,442 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $67,038,664 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,036,502 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,608,690 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,488 | PYOtherRevenueAmt |
| CY Other Revenue | $7,598 | CYOtherRevenueAmt |
| PY Total Revenue | $67,072,746 | PYTotalRevenueAmt |
| CY Total Revenue | $68,762,072 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $47,505 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $112,796 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $32,938,113 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $33,945,662 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $28,359,309 | PYOtherExpensesAmt |
| CY Other Expenses | $31,132,010 | CYOtherExpensesAmt |
| PY Total Expenses | $61,344,927 | PYTotalExpensesAmt |
| CY Total Expenses | $65,190,468 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,727,819 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,571,604 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $68,515,477 | TotalAssetsBOYAmt |
| Total Assets EOY | $69,832,391 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,434,863 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,173,680 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $56,080,614 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $56,658,711 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To deliver high quality comprehensive healthcare services to the Hi-Line communities. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $51,350,363 | ExpenseAmt |
| Grant | $112,796 | GrantAmt |
| Revenue | $67,038,664 | RevenueAmt |
| Desc | Northern Montana Hospital (Hospital) includes 49 acute care hospital beds, 135 skilled nursing beds, 10 assisted living beds and two medical clinics located in Havre, Montana. The Hospital provides quality healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of the Hospital, it is recognized that not all individuals possess the ability to purchase these essential services. It is the Hospital's mission to serve the surrounding area by providing healthcare services and healthcare education to all community members. During the year ended June 30, 2016, the Hospital provided $1,152,327 of medical services, based on charges, to individuals who were determined unable to purchase such services under the Hospital's charity care policy and guidelines. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients was $39,208,931 for the year ended June 30, 2016. During the fiscal year ended June 30, 2016 the Hospital provided over 4,000 days of hospital services. The nursing home provided over 33,700 resident days during the year.The Hospital also provides community care and services through many healthcare activities and programs provided to support the community. These activities include: wellness programs, community education programs, senior services, healthcare screening, special programs for specific groups, published articles, radio programs, and a variety of community supported activities. The Hospital also received many hours of volunteer help from the community residents. | Desc |
| Total Program Service Expenses | $51,350,363 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 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 | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| 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 | 0 | 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 |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 160 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 797 | 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 | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kim Lucke VP of Finance | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4062652211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1231 | AddressLine1Txt |
| City | Havre | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59501 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 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 |
|---|---|---|---|---|---|---|---|---|
| David C Henry | ||||||||
| President/CEO | 42.00 | 3.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Miles Hamilton | ||||||||
| Chair | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Tom Patrick | ||||||||
| Vice Chair | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| David Leeds | ||||||||
| Treasurer | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Judy Greenwood | ||||||||
| Secretary | 1.00 | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Paul Tuss | ||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Debbie Healy | ||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Andrew Carlson | ||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Rick Stevens | ||||||||
| Trustee | 1.00 | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| Karrie Lien MD | ||||||||
| Trustee - IPD Member | 40.00 | 1.00 | Yes (X) | $460,879 | $0 | $39,227 | ||
| Kevin Harada MD | ||||||||
| Trusteee - IPD Member | 40.00 | 1.00 | Yes (X) | $344,382 | $0 | $56,215 | ||
| Gary Grow PhD | ||||||||
| Trustee - IPD Member | 40.00 | 1.00 | Yes (X) | $189,893 | $0 | $17,698 | ||
| Marc Whitacre | ||||||||
| Chief of Medical Staff | 40.00 | 1.00 | Yes (X) | $283,060 | $0 | $36,132 | ||
| Steven Liston MDChief of | ||||||||
| Medical Staff (thru Feb 2016) | 40.00 | 1.00 | Yes (X) | $606,000 | $0 | $0 | ||
| Kim Lucke | ||||||||
| VP of Finance | 43.00 | 2.00 | Yes (X) | $80,422 | $0 | $24,828 | ||
| Julie Mariani | ||||||||
| Vice President | 40.00 | 1.00 | Yes (X) | $137,777 | $0 | $27,517 | ||
| Wilburt Pino MD | ||||||||
| Orthopedic Surgeon | 40.00 | $606,495 | $0 | $38,963 | Yes (X) | |||
| Michelle Cameron-Donaldson MD | ||||||||
| Orthopedic Surgeon | 40.00 | $508,428 | $0 | $33,452 | Yes (X) | |||
| Damian Ymzon MD | ||||||||
| General Surgeon | 40.00 | $340,542 | $0 | $33,732 | Yes (X) | |||
| Allen Rebchook MD | ||||||||
| General Surgeon | 40.00 | $344,739 | $0 | $20,932 | Yes (X) | |||
| Margo J Hein-Muniz MD | ||||||||
| Obstetrics & Gynecology | 40.00 | $319,026 | $0 | $27,062 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,221,643 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $355,758 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 34 | 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 |
|---|---|---|---|---|---|
| Nurses Professional Services LLC | |||||
| 1616 S Voss Ste 350 | Houston | TX | 77057 | Contract Employees | $1,203,350 |
| Sletten Construction | |||||
| 1000 25th St North | Great Falls | MT | 59405 | Construction | $917,467 |
| Benefis Healthcare | |||||
| 1101 26th Street S | Great Falls | MT | 59405 | IT Services, Contract Physician | $667,774 |
| C & A Industries | |||||
| 11825 Q Street | Omaha | NE | 68137 | Contract Employees | $446,716 |
| Pete Clausen and Sons | |||||
| 2480 2nd Street West | Havre | MT | 59501 | Construction | $316,465 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 18 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $107,120 | AllOtherContributionsAmt |
| Total Contributions | $107,120 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Net Patient Service Revenue | 622110 | $53,861,776 | $53,861,776 | |
| Pharmacy | 446110 | $11,634,686 | $11,512,649 | $122,037 |
| Supporting Revenue | 900099 | $826,800 | $826,800 | |
| Healthcare Consulting | 900099 | $385,105 | $385,105 | |
| Cafeteria Revenue | 722210 | $330,297 | $330,297 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $67,038,664 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $715,352 | TotalRevenueColumnAmt |
| Exclusion | $715,352 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,960 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,362 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,598 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,598 | TotalRevenueColumnAmt |
| Exclusion | $7,598 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $228,935 | SecuritiesAmt |
| Other | $664,403 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $228,935 | SecuritiesAmt |
| Other | $664,403 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $893,338 | TotalRevenueColumnAmt |
| Exclusion | $893,338 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $68,762,072 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $66,916,627 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $122,037 | UnrelatedBusinessRevenueAmt |
| Exclusion | $1,616,288 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,796 | TotalAmt |
| Program Services | $112,796 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,497,134 | TotalAmt |
| Program Services | $2,048,272 | ProgramServicesAmt |
| Management And General | $448,862 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,608,753 | TotalAmt |
| Program Services | $18,753,061 | ProgramServicesAmt |
| Management And General | $7,855,692 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $592,212 | TotalAmt |
| Program Services | $414,548 | ProgramServicesAmt |
| Management And General | $177,664 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,828,421 | TotalAmt |
| Program Services | $1,005,632 | ProgramServicesAmt |
| Management And General | $822,789 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,419,142 | TotalAmt |
| Program Services | $1,693,399 | ProgramServicesAmt |
| Management And General | $725,743 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $306,000 | TotalAmt |
| Program Services | $61,200 | ProgramServicesAmt |
| Management And General | $244,800 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,039 | TotalAmt |
| Management And General | $18,039 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $78,364 | TotalAmt |
| Management And General | $78,364 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,062,699 | TotalAmt |
| Program Services | $5,799,172 | ProgramServicesAmt |
| Management And General | $263,527 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,098 | TotalAmt |
| Management And General | $315,098 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,809,965 | TotalAmt |
| Program Services | $2,353,096 | ProgramServicesAmt |
| Management And General | $456,869 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $720,345 | TotalAmt |
| Program Services | $576,276 | ProgramServicesAmt |
| Management And General | $144,069 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,854,859 | TotalAmt |
| Program Services | $1,295,593 | ProgramServicesAmt |
| Management And General | $559,266 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $220,974 | TotalAmt |
| Program Services | $77,341 | ProgramServicesAmt |
| Management And General | $143,633 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,036 | TotalAmt |
| Management And General | $25,036 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,374,560 | TotalAmt |
| Program Services | $1,662,192 | ProgramServicesAmt |
| Management And General | $712,368 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,212,870 | TotalAmt |
| Program Services | $970,296 | ProgramServicesAmt |
| Management And General | $242,574 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $8,704,077 | $8,704,077 | |
| Bad Debt Expense | $3,885,801 | $3,885,801 | |
| Equipment Rental and Ma | $984,567 | $541,512 | $443,055 |
| Bed Tax | $499,329 | $499,329 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,059,427 | TotalAmt |
| Program Services | $896,770 | ProgramServicesAmt |
| Management And General | $162,657 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,190,468 | TotalAmt |
| Program Services | $51,350,363 | ProgramServicesAmt |
| Management And General | $13,840,105 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,924,817 | BOYAmt |
| EOY | $9,164,953 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,290,971 | BOYAmt |
| EOY | $15,417,233 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,069,180 | BOYAmt |
| EOY | $2,127,745 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $673,748 | BOYAmt |
| EOY | $719,370 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $55,292,596 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $42,813,887 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,628,677 | BOYAmt |
| EOY | $12,478,709 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,235,541 | BOYAmt |
| EOY | $27,107,972 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $101,129 | BOYAmt |
| EOY | $87,463 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,591,414 | BOYAmt |
| EOY | $2,728,946 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,515,477 | BOYAmt |
| EOY | $69,832,391 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,587,937 | BOYAmt |
| EOY | $5,220,195 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,186,216 | BOYAmt |
| EOY | $698,540 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,660,710 | BOYAmt |
| EOY | $7,254,945 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,434,863 | BOYAmt |
| EOY | $13,173,680 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,080,614 | BOYAmt |
| EOY | $56,658,711 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,080,614 | BOYAmt |
| EOY | $56,658,711 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,515,477 | BOYAmt |
| EOY | $69,832,391 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,571,604 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $50,003 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | -$3,043,510 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $28,743 | BeginningBalanceAmt |
| Additions During Year | $86,967 | AdditionsDuringYearAmt |
| Distributions During Year | $88,851 | DistributionsDuringYearAmt |
| Ending Balance | $26,859 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $75,272 | OtherCostOrOtherBasisAmt |
| Book Value | $75,272 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,428,613 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,302,660 | DepreciationAmt |
| Book Value | $5,125,953 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $28,890,515 | OtherCostOrOtherBasisAmt |
| Depreciation | $23,607,319 | DepreciationAmt |
| Book Value | $5,283,196 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,898,196 | OtherCostOrOtherBasisAmt |
| Depreciation | $903,908 | DepreciationAmt |
| Book Value | $1,994,288 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $12,478,709 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| Liability for pension benefits | $7,244,221 |
| Due to Affiliates | $10,724 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $7,254,945 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $65,121,462 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$3,885,801 | OtherRevenueAmt |
| Revenue Not Reported | -$3,885,801 | RevenueNotReportedAmt |
| Revenue Subtotal | $69,007,263 | RevenueSubtotalAmt |
| Other Revenues Not Included | -$245,191 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | -$245,191 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $68,762,072 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $61,549,858 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $245,191 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $245,191 | ExpensesNotReportedAmt |
| Expenses Subtotal | $61,304,667 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,885,801 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,885,801 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $65,190,468 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 1b: | The custodial funds are not reported on the balance sheet of NMH as they are the personal resource funds of the residents to be used only for their personal needs. If the resident passes, the funds either go to the family or back to the state. They are in no way an asset of the organization. |
| Part X, Line 2: | The Organization is organized as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for bad debts included in expenses on Form 990 -3,885,801. |
| Part XI, Line 4b - Other Adjustments: | Rental expenses included in expenses on financial statements -9,362. Cost of goods sold included in expenses on financial statements -235,829. |
| Part XII, Line 2d - Other Adjustments: | Rental expenses included in revenue on Form 990 9,362. Cost of goods sold included in revenue on Form 990 235,829. |
| Part XII, Line 4b - Other Adjustments: | Provision for bad debts included in revenue on financial statements 3,885,801. |
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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | 225.000000000000 | 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 | $576,587 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $576,587 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00940 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,400,412 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,271,898 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,128,514 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06730 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,976,999 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $9,271,898 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,705,101 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07670 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $33,263 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $33,263 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,238,256 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,729,988 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,508,268 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02460 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $15,876 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $15,876 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,287,395 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,729,988 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,557,407 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02540 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,264,394 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,001,886 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $6,262,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.10210 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $148,697 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $102,495 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $46,202 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $148,697 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $102,495 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $46,202 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,885,801 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $37,065 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,627,199 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $13,456,178 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$828,979 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Montana Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 13th Street | AddressLine1Txt |
| City | Havre | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.nmhcare.org | WebsiteAddressTxt |
| State License | 12835 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 2 provider based rural health clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Northern Montana Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | 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 | www.nmhcare.org/documents/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | www.bullhook.com and www.hillcountyhealth.com | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.nmhcare.org/documents/ | 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 | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 225.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.nmhcare.org/documents/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://www.nmhcare.org/documents/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Northern Montana Hospital | Part V, Section B, Line 5: NMH is a member of the Hill County Health Consortium and conducted the Needs Assessment in collaboration with them. Members of the Consortium include the Hill County Health Department, The Board of Health, Rocky Boy Health Department, Salvation Army, United Way, HRDC, Havre Public Schools and MSU-Northern College, County Extension Office, County Commissioners, Office of Public Assistance, 12th Judicial District Youth Court and several other community organizations and forums. |
| Northern Montana Hospital | Part V, Section B, Line 6a: Benefis Health System, Marias Medical Center, Liberty Medical Center, Northern Rockies Medical Center, Phillips County Hospital, Big Sandy Medical Center, Missouri River Medical Center, Mountainview Medical Center, Central Montana Medical Center, Teton Medical Center, Pondera Medical Center |
| Northern Montana Hospital | Part V, Section B, Line 6b: See Schedule H, Part V, Section B, Line 5 |
| Northern Montana Hospital | Part V, Section B, Line 7d: The CHNA is electronically delivered to every member of the Consortium and NMH. Bullhook Community Health Center and the Hill County Health Department all received hard copies available for distribution. |
| Northern Montana Hospital | Part V, Section B, Line 11: In the most recent CHNA four needs were identified. As of fiscal year end June 30, 2016 the following is the progress made on addressing each need:1) Alcohol Abuse: Hill County community health survey respondents chose alcohol abuse as their most serious health concern in the most recent Community Health Needs Assessment report. Behavioral Risk factors support this concern as an area on which the county needs to focus. Both binge drinking and heavy drinking are self-reported higher in Hill County than Montana overall.Northern Montana Hospital engages in routine alcohol screening, intervention and referral as part of the Rural Health Clinic annual visit with the patient Family Social History update process.In FY16, Northern Montana Hospital opened a Chemical Dependency Treatment and Addiction Counseling Services program. The outpatient program is designed to treat substance use disorders while allowing individuals to remain in the community living at home and continuing with their employment. Treatment plans are individualized and include individual and group therapy. The Northern Montana Hospital Chemical Dependency Treatment Services program is also "Prime for Life Certified". Prime for Life is an evidence-based prevention and intervention program that helps people learn to reduce their risks of alcohol and drug related problems. This program is a requirement for individuals who have received some DUI Citations.2) Mental Health Awareness: Social and Mental Health Indicators for Hill County led stakeholders to choose mental health as an area of concern to be addressed in the current planning cycle. Hill County residents who responded to the community health survey indicated the three most important mental health issues that impacted them included workrelated stress, depression, and alcohol use.Northern Montana Hospital uses evidence based screening tools in the primary care setting. Using the Patient Health Questionnaire-2 (PHQ-2), inquiries are made about the frequency of depressed mood and anhedonia over the past two weeks. The purpose of the PHQ-2 is not to establish a final diagnosis or to monitor depression severity, but rather to screen for depression in a "first step" approach.The Northern Montana Chemical Dependency Treatment Services program offers individuals the opportunity to address their alcohol use in an outpatient program.3) Teen Pregnancy: The Hill County Health Needs Assessment completed in Summer 2013 indicated the rate of births to teens was significantly higher in Hill County when compared with Montana overall. Births to adolescents is defined as the number of live births to mothers 15-17 years of age, divided by the estimated population of females 15-17 years of age. The rate for Hill County is 39.1 per 1000 compared to the State of Montana at 29.2 per 1000.Northern Montana Hospital provides reproductive health care services to teens during their pregnancy and delivery at the Northern Montana Family Medical Center. Northern Montana Hospital supports the Consortium through in-kind donations such as meeting rooms, copies, and web-site postings. Financial support was provided to the Consortium for the CHNA/CHIP. The activities identified in Initiative 1-3 have been incorporated by existing programs and providers, no additional resources or programs were required.In FY 16, some Northern Montana Family Medical Center providers began discussing reproductive health needs with teens during the teen's pre-participation physical examination (Sports Physical). Northern Montana Family Medical Center also offers free condoms. The teen pregnancy rate of females 15-17 years of age decrease twenty percent (20%) from FY 15 to FY16.4) Patient Centered Medical Home (PCMH): Northern Montana Hospital PCMH efforts focus on population health needs identified in the health caresystem. The top three diagnoses are Diabetes, Hypertension and Depression. Data metrics are being collected on Asthma, Coronary Artery Disease (CAD), Chronic Obstructive Pulmonary Disease (COPD), Diabetes, Hyperlipidemia, Hypertension, Ischemic Vascular Disease (IVD), and Depression.In FY 16, the providers at Northern Montana Family Medical Center and Northern Montana Specialty Medical Center continued to focus on clinical effectiveness in clinical quality measures and population health measures. The identified quality measures continue to be monitored through the QAPI Program and reported individually in a report card format to the providers. |
| Northern Montana Hospital | Part V, Section B, Line 16i: In addition, a summary of the financial assistance policy is posted in the facility's emergency room and waiting rooms as well as admissions offices. The hospital's "Conditions of Treatment" also includes information regarding the financial assistance policy. |
| Northern Montana Hospital | Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
| 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 | 1 - Northern Montana Care Center | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 24 13th Street | AddressLine1Txt |
| City | Havre | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Nursing Home | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 6a: | The Organization's community benefit report was published as a 1/2 page ad in the local newspaper. In addition, a statement about the amount of community benefit the organization provided can be found on our web-site at www.nmhcare.org. |
| Part I, Line 7: | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid, line 7b, was calculated using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, line 7e, and cash and in-kind donations, line 7i, are actual costs reported in the general ledger. The cost for subsidized health services reported on line 7g was determined using the cost-to-charge ratio derived from worksheet 2. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculation was $3,885,801. |
| Part II, Community Building Activities: | Reported under community building activities is the maintenance of our fitness park which is open to the public and has both a softball field and soccer field, as well as a paved walking path. It also includes an employee's time for being a member of the Hill County Health Consortium, which collaboratively conducted a Community Health Needs Assessment with several other local public health entities and works to implement the identified unmet needs of the community. |
| Part III, Line 2: | Bad debt expense is reported as charges net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. |
| Part III, Line 3: | The estimated amount of bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated by using charity care as a percentage of gross patient service revenue. As a portion of revenue is considered charity care, it is assumed that a percentage of bad debt expense would also be considered charity care. |
| Part III, Line 4: | The footnote to the Organization's financial statements can be found on page 7 of the attached audited financial statements. |
| Part III, Line 8: | Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall is considered a community benefit.Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | The Organization's financial assistance policy provides information on collection practices for those known to qualify for financial assistance. The policy states "During the patient registration or collection process, the Hospital will make an initial determination of eligibility based on verbal or written application for charity care. Pending final eligibility determination, the Hospital will not initiate collection efforts or requests for deposits, provided that the responsible party is cooperative with the Hospital's efforts to reach a determination of status." The collection policy currently sends all patient accounts with a private pay balance to a billing services after 120 days. The billing service works directly with the patients to make payment arrangements. If they default on the payment plan the billing service recommends to the hospital to send the account to collections; however if the patient applies for financial assistance within 240 days of the date of the first invoice the pulls the account back from collections and the billing service to review and complete the application process. |
| Part VI, Line 2: | Northern Montana Hospital (NMH) continues to partner, as a member, with the Hill County Health Consortium to identify and prioritize the health needs of the community. The Consortium consists of community members andorganizations, including those with special knowledge and expertise in public health.Out of the Community Health Needs Assessment (CHNA) the Community Health Improvement Plan (CHIP) was developed. The plan identifies several health related issues that adversely impact the health of the community. Thisplan not only provides the Consortium with a deeper look into the current health status of the community, it leads us into providing solutions for improving the health status of our community. These improvements are spearheaded by subcommittees chosen through the Hill County Consortium and other local agencies.To develop the strategic direction for 2014-2017, multiple assessments were used along with county and facility statistical data. The collaborative assessments relied upon included:* The Hill County Community Health Needs Assessment Report, a collaborative development of the regional North Central Montana Healthy Communities group. This health needs assessment identified the "ten most serious health concerns" in the County.* The Early Childhood Investment Team (ECIT) needs assessment; which looked at issues specifically facing young children in Hill County* A review of the previous CHIP completed in 2011 which identified obesity, awareness of Health Care resources and unsafe sex.* Facility statistical data which indicates the top diagnosis in the population are consistently Diabetes, Hypertension and Depression.As a result of the assessments, the areas of focus are: Alcohol abuse, Mental Health and Teen Pregnancy.Northern Montana Hospital Board of trustees were apprised of the priority areas chosen by the Hill County Health Consortium and endorsed participation with implementation. NMH has developed, a hospital specific CHNA/CHIP that outlines our responses and actions to each of the initiatives developed. The Northern Montana Hospital Community Health Needs Assessment and Implementation Strategy can be accessed at http://www.nmhcare.org/wpcontent/uploads/2015/05/Northern-Montana-Hospital-Community-Health-Needs-Assessment.pdf. |
| Part VI, Line 3: | Northern Montana Hospital informs and educates patients about their eligibility for assistance through a sign posted at our admissions desk, notes in the brochure we give patients at our clinics, and signs posted at our clinic registration desks. In addition, our collection staff offers charity care as an option when they are discussing the patient's balance as well as the availability of various government benefits, such as Medicaid or state programs. As of Oct 2010, NMH has contracted with a company to assist the patient with qualification for programs such as Medicaid and disability determination.We also publish a community benefit report annually which states how much financial assistance we have given away, and we post our community benefit report on our website noting that we provide financial assistance. |
| Part VI, Line 4: | The Hospital's service area consists of Hill, Blaine, Liberty, Philips and the Big Sandy census district of Choteau counties. The population of this service area is approximately 30,000. The median household income is about $47,000. Approximately 45% of the population has a household income below 200% of the federal poverty guidelines. Approximately 25% of the population is covered by Medicaid, 34% by Medicare, 2.5% by CHIP and about 14% uninsured. Additionally, another 4% of the population is covered by Indian Health Services. The entire service area is considered rural and has been designated a health professional shortage area for all primary medical care, mental health and dental. In addition, the entire service area is designated as a medically underserved area. Northern Montana Hospital is the only local hospital in its service area; however there are 3 critical access hospitals, 4 rural health clinics, 3 community health clinics and 3 IHS-Tribal clinics within its service area. The nearest hospital is a critical access hospital and is 35 miles away. |
| Part VI, Line 5: | More than 50% of Northern Montana Hospital's governing board consists of various local business people who reside within our service area and are not employed or contracted by the organization. Northern Montana Hospital extends medical staff privileges to all qualified physicians in its community. The organization applies surplus funds to improvements in patient care by keeping its medical equipment up to date, sending its employed physicians for further continuing education, supporting nursing education through a loan repayment assistance program and supporting health care education through an education assistance program. In addition, the hospital subsidizes its emergency department by offering 24/7 emergent care coverage to all, regardless of their ability to pay. Northern Montana Hospital offers Dialysis services to patients in our service area, despite the fact that this service is provided at a loss to NMH. Without this service, patients would have to travel well over 100 miles each way, 3 times per week to receive this service. Northern Montana Hospital has Sole Community Designation. The nearest PPS hospital is located 110 miles from Havre. Northern Montana Hospital also participates in all government sponsored health programs, such as CHIP, Healthy Montana Kids and the Montana Cervical and Breast Cancer Program, where it accepts payments for services at greatly discounted rates. Several members of Northern Montana Hospital's leadership team serve on other community boards, such as: Havre Chamber of Commerce, Hill County Health Consortium, Local Emergency Planning, Fetal/Infant/Child Mortality Review Board, Havre/Hill County Planning Board, Hill and Blaine County Adult Protective Services Committee, Hill County United Way, HRDC Medical Advisory Board, MSU-N Nursing Advisory Board and the Safe Kids Safe Communities Committee. |
| Part VI, Line 7, Reports Filed With States | MT |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (3 entries)
| Grant TypeGrantTypeTxt | RecipientRecipientCnt | Cash GrantCashGrantAmt |
|---|---|---|
| Education Assistance | 3 | $1,801 |
| Nursing Scholarships | 6 | $30,000 |
| Nurse Loan Repayment | 9 | $80,995 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 2: | The organization provides education assistance to qualified employees. The organization monitors the use of the assistance by disbursing the funds directly to the institution. |
| Schedule I, Part III: | For our education assistance program, we will pay up to $5,250 per person per year; however, not all recipients request the total amount. We anticipate 3-6 recipients per year. For the nursing scholarships, we pay $5,000 per recipient. We anticipate 6-8 per year. For loan repayment, we pay up to $7,500 per nurse recipient per year. We anticipate 4-6 per year. We also match that state loan repayment program for physician assistant loan repayment. The amounts for this vary due per recipient. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Karrie Lien MD | ||||||||||||||
| Trustee - IPD Member | $460,561 | $0 | $0 | $0 | $318 | $0 | $9,429 | $0 | $33,446 | $0 | $503,754 | $0 | $0 | $0 |
| Kevin Harada MD | ||||||||||||||
| Trusteee - IPD Member | $344,238 | $0 | $0 | $0 | $144 | $0 | $7,236 | $0 | $51,782 | $0 | $403,400 | $0 | $0 | $0 |
| Gary Grow PhD | ||||||||||||||
| Trustee - IPD Member | $189,085 | $0 | $0 | $0 | $808 | $0 | $3,913 | $0 | $15,310 | $0 | $209,116 | $0 | $0 | $0 |
| Marc Whitacre | ||||||||||||||
| Chief of Medical Staff | $281,872 | $0 | $0 | $0 | $1,188 | $0 | $6,000 | $0 | $32,460 | $0 | $321,520 | $0 | $0 | $0 |
| Steven Liston MDChief of | ||||||||||||||
| Medical Staff (thru Feb 2016) | $606,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $606,000 | $0 | $0 | $0 |
| Julie Mariani | ||||||||||||||
| Vice President | $137,132 | $0 | $0 | $0 | $645 | $0 | $3,000 | $0 | $25,685 | $0 | $166,462 | $0 | $0 | $0 |
| Wilburt Pino MD | ||||||||||||||
| Orthopedic Surgeon | $606,081 | $0 | $0 | $0 | $414 | $0 | $12,400 | $0 | $31,355 | $0 | $650,250 | $0 | $0 | $0 |
| Michelle Cameron-Donaldson MD | ||||||||||||||
| Orthopedic Surgeon | $508,158 | $0 | $0 | $0 | $270 | $0 | $10,400 | $0 | $27,074 | $0 | $545,902 | $0 | $0 | $0 |
| Damian Ymzon MD | ||||||||||||||
| General Surgeon | $340,372 | $0 | $0 | $0 | $170 | $0 | $7,100 | $0 | $29,383 | $0 | $377,025 | $0 | $0 | $0 |
| Allen Rebchook MD | ||||||||||||||
| General Surgeon | $343,965 | $0 | $0 | $0 | $774 | $0 | $7,000 | $0 | $16,645 | $0 | $368,384 | $0 | $0 | $0 |
| Margo J Hein-Muniz MD | ||||||||||||||
| Obstetrics & Gynecology | $318,708 | $0 | $0 | $0 | $318 | $0 | $6,560 | $0 | $23,045 | $0 | $348,631 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | President/CEO is compensated by an unrelated management company. A related organization and the management company have a process in place to determine the CEO's compensation using the Form 990 of other organizations, a written employment contract, a compensation survey or study, and the approval by the board or compensation committee. |
| Part I, Line 5 | Karrie Lien, Kevin Harada, and Gary Grow are compensated as a percentage of the prior three months' average gross revenue earned for the hospital by the physician, with the percentage being based on their specialty. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | David C. Henry, President/CEO is employed by Fundamental Financial Group, an unrelated management company. Northern Montana Hospital (NMH), pays the unrelated management company for David's services provided to the Hospital, Northern Montana Health Care, Inc. and Northern Montana Health Care Foundation. The President/CEO's responsibilities include implementing decisions and supervising the management, administration and operation of the Hospital and the related exempt organizations. The amount compensation paid during fiscal year 2016 was $423,500. The amount of compensation paid during the calendar year 2015 was $408,000. |
| Form 990, Part VI, Section A, line 6 | The sole member of the organization is Northern Montana Health Care, Inc. |
| Form 990, Part VI, Section A, line 7b | The sole member of the organization shall have such rights and powers as are provided for in the Articles of Incorporation, the Bylaws of the organization and the laws of the State of Montana, including but not limited to, the exclusive power: (a) to remove any trustee from any office at any time, with or without cause; (b) to propose and approve (i) a plan of dissolution or liquidation of the organization or (ii) a plan of merger or consolidation of the organization with another corporation; (c) to propose and approve amendments to the articles of incorporation and or the bylaws;(d) to adopt any annual or long-term capital or operational budget or any changes therein exceeding $75,000;(e) to authorize the organization to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operational budget approved by the sole member of the organization where the amount involved exceeds $50,000;(f) to adopt substantive changes to existing long-term or master institutional plans of the organization; (g) to authorize the organization to engage in, or enter into, any transaction providing for the sale, mortgage or other disposition of all or substantially all of the assets of the organization; (h) to organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the organization; (i) to authorize the organization to enter into any shared service agreement; (j) to approve long-term borrowing of money by the organization or authorize the organization to incur indebtedness involving a mortgage or lien on assets; or (k) to approve the trustees or the President of the organization from a slate prepared by the Nominating Committee of the organization. |
| Form 990, Part VI, Section A, line 8b | No committee has the authority to act on behalf of the board. |
| Form 990, Part VI, Section B, line 11 | The VP of Finance reviews the form. The Board of Directors receives a copy of the reviewed Form 990 via e-mail before it is filed. |
| Form 990, Part VI, Section B, line 12c | The conflict of interest policy covers all trustees, directors, officers, and key employees. The board identifies potential conflicts from annual disclosures. Disclosures are reviewed by administration after all are gathered. A second conflict disclosure letter is sent out annually to all current and former officers, directors, trustees, and key employees to ensure all potential conflicts are identified. The results of this disclosure form are reviewed by the VP of Finance. The board discusses the potential conflicts and determines if voting on related items would be a conflict of interest. If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item. |
| Form 990, Part VI, Section B, line 15a | The President/CEO is compensated by an unrelated management company. The unrelated management company receives a fee for service from a related organization for the CEO's service provided to this organization and related organizations, Northern Montana Hospital (NMH) and Northern Montana Health Care Foundation, Inc. (NMHCF). In determining the CEO's compensation, the Executive Committee of the board meets and reviews NMH/Northern Montana Health Care, Inc. (NMHC) financial results, CEO's current year priorities, discusses evaluation tools to be used for the CEO's evaluation, how comparative salaries will be obtained and discusses the history of compensation to the CEO. At a second Executive Committee meeting they review non-financial activity of NMH/NMHC and the results of the CEO evaluations completed by the board members. Then they review and discuss a compensation comparative summary of Montana CEO's compensation. They agree upon a list of the coming year's priorities for the CEO and proposed compensation, with the compensation set by board vote. This annual process was completed during fiscal year 2016. |
| 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. The financial statements are attached to the Form 990 per the IRS instructions. |
| Form 990, Part XI, line 9: | Minimum Pension Liability Adjustment: -2,543,510. Equity Transfer to Related Organization: -500,000. |
| Form 990, Part XII, Line 2c: | The controlling organization, Northern Montana Health Care, Inc.'s Board has a committee that assumes responsibility for oversight of the audit of the financial statements and selection of an independent auditor. |
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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| North Care Corporation | |||||||||||
| 30 13th Street | Havre | MT | 59501 | 810447638 | Health Care Services | MT | 501(c)(3) | Line 3 | Northern Montana Health Care Inc | 0 | |
| Northern Montana Health Care Inc | |||||||||||
| PO Box 1231 | Havre | MT | 59501 | 810428854 | Supporting Organization | MT | 501(c)(3) | Line 11b, II | 0 | N/A | |
| Northern Montana Health Care Foundation Inc | |||||||||||
| PO Box 1231 | Havre | MT | 59501 | 363464641 | Fundraising | MT | 501(c)(3) | Line 7 | Northern Montana Health Care Inc | 0 | |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Paramount Health Care Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1231 | AddressLine1Txt |
| City | Havre | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59501 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810393353 | EIN |
| Primary Activities | Health Care Services | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Entity Type | C | EntityTypeTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | 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 | Yes (1) | TransferFromOtherOrgInd |