2017-05-12T15:00:08-05:00 2016-06-30 450250958 Eide Bailly LLP 401 N 31st St Ste 1120 PO Box 7112 Billings MT 591037112 990 2015-07-01 810231787 Northern Montana Hospital NORT 4062652211 PO Box 1231 Havre MT 595011231 David Henry President/CEO 4062652211 2017-05-12 1 Kim C Hunwardsen P00484560 4068962400 2017-05-12 2015 2021-01-29 14:40:06Z David Henry PO Box 1231 Havre MT 595011231 68771434 0 X www.nmhcare.org X 1921 MT Provision of healthcare services. 13 9 797 113 122037 24745 22314 107120 66007442 67038664 1036502 1608690 6488 7598 67072746 68762072 47505 112796 0 0 32938113 33945662 0 0 0 28359309 31132010 61344927 65190468 5727819 3571604 68515477 69832391 12434863 13173680 56080614 56658711 X To deliver high quality comprehensive healthcare services to the Hi-Line communities. 0 0 51350363 112796 67038664 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. 51350363 1 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 160 0 1 797 1 1 1 0 0 0 0 0 0 0 0 0 X 13 9 0 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Kim Lucke VP of Finance 4062652211 PO Box 1231 Havre MT 59501 David C Henry President/CEO 42.00 3.00 X X 0 0 0 Miles Hamilton Chair 1.00 1.00 X X 0 0 0 Tom Patrick Vice Chair 1.00 1.00 X X 0 0 0 David Leeds Treasurer 1.00 1.00 X X 0 0 0 Judy Greenwood Secretary 1.00 1.00 X X 0 0 0 Paul Tuss Trustee 1.00 1.00 X 0 0 0 Debbie Healy Trustee 1.00 1.00 X 0 0 0 Andrew Carlson Trustee 1.00 1.00 X 0 0 0 Rick Stevens Trustee 1.00 1.00 X 0 0 0 Karrie Lien MD Trustee - IPD Member 40.00 1.00 X 460879 0 39227 Kevin Harada MD Trusteee - IPD Member 40.00 1.00 X 344382 0 56215 Gary Grow PhD Trustee - IPD Member 40.00 1.00 X 189893 0 17698 Marc Whitacre Chief of Medical Staff 40.00 1.00 X 283060 0 36132 Steven Liston MDChief of Medical Staff (thru Feb 2016) 40.00 1.00 X 606000 0 0 Kim Lucke VP of Finance 43.00 2.00 X 80422 0 24828 Julie Mariani Vice President 40.00 1.00 X 137777 0 27517 Wilburt Pino MD Orthopedic Surgeon 40.00 X 606495 0 38963 Michelle Cameron-Donaldson MD Orthopedic Surgeon 40.00 X 508428 0 33452 Damian Ymzon MD General Surgeon 40.00 X 340542 0 33732 Allen Rebchook MD General Surgeon 40.00 X 344739 0 20932 Margo J Hein-Muniz MD Obstetrics & Gynecology 40.00 X 319026 0 27062 4221643 0 355758 34 0 1 0 Nurses Professional Services LLC 1616 S Voss Ste 350 Houston TX 77057 Contract Employees 1203350 Sletten Construction 1000 25th St North Great Falls MT 59405 Construction 917467 Benefis Healthcare 1101 26th Street S Great Falls MT 59405 IT Services, Contract Physician 667774 C & A Industries 11825 Q Street Omaha NE 68137 Contract Employees 446716 Pete Clausen and Sons 2480 2nd Street West Havre MT 59501 Construction 316465 18 107120 107120 Net Patient Service Revenue 622110 53861776 53861776 Pharmacy 446110 11634686 11512649 122037 Supporting Revenue 900099 826800 826800 Healthcare Consulting 900099 385105 385105 Cafeteria Revenue 722210 330297 330297 67038664 715352 715352 16960 9362 7598 7598 7598 228935 664403 0 0 228935 664403 893338 893338 68762072 66916627 122037 1616288 112796 112796 2497134 2048272 448862 26608753 18753061 7855692 592212 414548 177664 1828421 1005632 822789 2419142 1693399 725743 306000 61200 244800 18039 18039 78364 78364 6062699 5799172 263527 315098 315098 2809965 2353096 456869 720345 576276 144069 1854859 1295593 559266 220974 77341 143633 25036 25036 2374560 1662192 712368 1212870 970296 242574 Medical Supplies 8704077 8704077 Bad Debt Expense 3885801 3885801 Equipment Rental and Ma 984567 541512 443055 Bed Tax 499329 499329 1059427 896770 162657 65190468 51350363 13840105 0 6924817 9164953 15290971 15417233 2069180 2127745 673748 719370 55292596 42813887 11628677 12478709 27235541 27107972 101129 87463 4591414 2728946 68515477 69832391 5587937 5220195 1186216 698540 5660710 7254945 12434863 13173680 X 56080614 56658711 56080614 56658711 68515477 69832391 X 3571604 50003 -3043510 X X 0 1 X 1 0 X 1 28743 86967 88851 26859 0 75272 75272 23428613 18302660 5125953 28890515 23607319 5283196 2898196 903908 1994288 12478709 Liability for pension benefits 7244221 Due to Affiliates 10724 7254945 X 65121462 -3885801 -3885801 69007263 -245191 -245191 68762072 61549858 245191 245191 61304667 3885801 3885801 65190468 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. 1 1 X 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 576587 576587 0.00940 13400412 9271898 4128514 0.06730 13976999 9271898 4705101 0.07670 33263 33263 0.00050 5238256 3729988 1508268 0.02460 15876 15876 0.00030 5287395 3729988 1557407 0.02540 19264394 13001886 6262508 0.10210 148697 102495 46202 0.00080 148697 102495 46202 0.00080 0 3885801 37065 12627199 13456178 -828979 X 1 1 1 1 Northern Montana Hospital 30 13th Street Havre MT 59501 www.nmhcare.org 12835 X X X 2 provider based rural health clinics Northern Montana Hospital 1 0 0 1 X X X X X X X X 14 1 1 1 1 X www.nmhcare.org/documents/ X www.bullhook.com and www.hillcountyhealth.com X X 1 14 1 www.nmhcare.org/documents/ 0 0 1 X 125.000000000000 225.000000000000 X 1 1 X X X 1 X http://www.nmhcare.org/documents/ X http://www.nmhcare.org/documents/ X X X X 1 X 0 X X X X 1 X 0 1 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. 1 1 - Northern Montana Care Center 24 13th Street Havre MT 59501 Nursing Home 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 1 Education Assistance 3 1801 Nursing Scholarships 6 30000 Nurse Loan Repayment 9 80995 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. 0 0 0 1 0 0 0 0 0 Karrie Lien MD Trustee - IPD Member 460561 0 0 0 318 0 9429 0 33446 0 503754 0 0 0 Kevin Harada MD Trusteee - IPD Member 344238 0 0 0 144 0 7236 0 51782 0 403400 0 0 0 Gary Grow PhD Trustee - IPD Member 189085 0 0 0 808 0 3913 0 15310 0 209116 0 0 0 Marc Whitacre Chief of Medical Staff 281872 0 0 0 1188 0 6000 0 32460 0 321520 0 0 0 Steven Liston MDChief of Medical Staff (thru Feb 2016) 606000 0 0 0 0 0 0 0 0 0 606000 0 0 0 Julie Mariani Vice President 137132 0 0 0 645 0 3000 0 25685 0 166462 0 0 0 Wilburt Pino MD Orthopedic Surgeon 606081 0 0 0 414 0 12400 0 31355 0 650250 0 0 0 Michelle Cameron-Donaldson MD Orthopedic Surgeon 508158 0 0 0 270 0 10400 0 27074 0 545902 0 0 0 Damian Ymzon MD General Surgeon 340372 0 0 0 170 0 7100 0 29383 0 377025 0 0 0 Allen Rebchook MD General Surgeon 343965 0 0 0 774 0 7000 0 16645 0 368384 0 0 0 Margo J Hein-Muniz MD Obstetrics & Gynecology 318708 0 0 0 318 0 6560 0 23045 0 348631 0 0 0 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. 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. 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 N/A 0 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 Paramount Health Care Inc PO Box 1231 Havre MT 59501 810393353 Health Care Services MT N/A C 0 0 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 1