VISTA PLAINS HEALTH: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- VISTA PLAINS HEALTH (EIN 81-0392231)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201603199349307905
- Schema version
- 2015v2.1
- 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 | 2016-11-14T14:29:51-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | 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 | 1545 Associates Dr Ste 101 | AddressLine1Txt |
| City | Dubuque | CityNm |
| State Abbreviation | IA | StateAbbreviationCd |
| ZIP | 520022299 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810392231 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wheatland Memorial Healthcare | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WHEA | BusinessNameControlTxt |
| Phone | 4066324351 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 287 | AddressLine1Txt |
| City | Harlowton | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59036 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Kyle Gee | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 4066324351 | PhoneNum |
| Signature | 2016-11-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Carmen Krantz | PreparerPersonNm |
| PTIN | P00031958 | PTIN |
| Phone | 5635561790 | PhoneNum |
| Preparation | 2016-11-09 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Brad Howell | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 287 | AddressLine1Txt |
| City | Harlowton | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59036 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,972,154 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wheatlandmemorial.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1951 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | To provide healthcare services to the surrounding community | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 100 | TotalEmployeeCnt |
| Total Volunteers | 12 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $185,738 | PYContributionsGrantsAmt |
| CY Contributions Grants | $164,323 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $5,207,888 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $5,715,235 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$48,684 | PYInvestmentIncomeAmt |
| CY Investment Income | $76,699 | CYInvestmentIncomeAmt |
| PY Other Revenue | $27,912 | PYOtherRevenueAmt |
| CY Other Revenue | $15,897 | CYOtherRevenueAmt |
| PY Total Revenue | $5,372,854 | PYTotalRevenueAmt |
| CY Total Revenue | $5,972,154 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,500 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $125 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,288,162 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $3,601,661 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,710,879 | PYOtherExpensesAmt |
| CY Other Expenses | $2,873,933 | CYOtherExpensesAmt |
| PY Total Expenses | $6,000,541 | PYTotalExpensesAmt |
| CY Total Expenses | $6,475,719 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$627,687 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$503,565 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,543,383 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,882,151 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,511,087 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,428,860 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,032,296 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,453,291 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Responsive to the communities we serve, Wheatland Memorial Healthcare is dedicated to providing sustainable quality care with respect, compassion and teamwork. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $4,967,541 | ExpenseAmt |
| Grant | $125 | GrantAmt |
| Revenue | $5,715,235 | RevenueAmt |
| Desc | As a Critical Access Hospital, Wheatland Memorial Healthcare provides a broad range of primary care services to the local community. The objective for operating the Hospital and its various departments is to meet the mission of being responsive to the communities we serve and providing sustainable quality health care with respect, compassion and teamwork.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. Continued on Schedule O.The amounts of charges foregone were $22,790 for the year ended December 31, 2015. Total direct and indirect costs related to these foregone charges were approximately $24,000 at December 31, 2015, based on an average ratio of cost to gross charges. | Desc |
| Total Program Service Expenses | $4,967,541 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 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 | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 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 |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 100 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | 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 | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | 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 | Kyle Gee | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4066573821 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 37000 | AddressLine1Txt |
| City | Billings | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59107 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 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 |
|---|---|---|---|---|---|---|---|---|
| Aubrey Miller | ||||||||
| Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| June Voldseth | ||||||||
| Vice Chairperson | 0.50 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Don Amundson | ||||||||
| Secretary/Treasurer | 0.20 | 0.20 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jenny Peters | ||||||||
| Trustee | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Tom Bennett | ||||||||
| Trustee | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Sarah Mauws | ||||||||
| Trustee | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Leta Nash | ||||||||
| Trustee until 01/15/2015 | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Lorraine Peterson | ||||||||
| Trustee until 12/31/2015 | 0.20 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Brad Howell | ||||||||
| CEO commencing Dec. 2015 | 30.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Kyle Gee | ||||||||
| CFO | 10.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Mike Zwicker | ||||||||
| CEO until May 2015 | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Larry Putnam | ||||||||
| Interim CEO - June - Aug 2015 | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Tim Russell | ||||||||
| Interim CEO - Sept - Oct 2015 | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Charlotte Jutila MD | ||||||||
| Cardiologist | 33.00 | 0.00 | $195,124 | $0 | $15,493 | Yes (X) | ||
| Taylor Lies PA-C | ||||||||
| Physician Assistant | 40.00 | 0.00 | $126,366 | $0 | $7,667 | Yes (X) | ||
| Hannah Sexton MPA-C | ||||||||
| Certified Physician Assistant | 40.00 | 0.00 | $102,665 | $0 | $0 | Yes (X) | ||
| Rebecca Sturdevant FNP | ||||||||
| Family Nurse Practitioner | 40.00 | 0.00 | $134,576 | $0 | $2,969 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $558,731 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $26,129 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Billings Clinic | |||||
| PO Box 37000 | Billings | MT | 59107 | Management, accounting and IT services | $1,260,764 |
| Eide Bailly LLP | |||||
| PO Box 2545 | Fargo | ND | 58108 | Accounting and IT services | $155,596 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $12,268 | RelatedOrganizationsAmt |
| Government Grants | $63,139 | GovernmentGrantsAmt |
| All Other Contributions | $88,916 | AllOtherContributionsAmt |
| Total Contributions | $164,323 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenu | 622110 | $5,264,963 | $5,264,963 |
| Electronic health reco | 900099 | $425,917 | $425,917 |
| Supporting revenue | 900099 | $24,355 | $24,355 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $5,715,235 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,046 | TotalRevenueColumnAmt |
| Exclusion | $61,046 | ExclusionAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $13,697 | TotalRevenueColumnAmt |
| Exclusion | $13,697 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,200 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,200 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,200 | TotalRevenueColumnAmt |
| Exclusion | $2,200 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,653 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $15,653 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,653 | TotalRevenueColumnAmt |
| Exclusion | $15,653 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,972,154 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $5,715,235 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $92,596 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125 | TotalAmt |
| Program Services | $125 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,075,102 | TotalAmt |
| Program Services | $2,644,979 | ProgramServicesAmt |
| Management And General | $430,123 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,141 | TotalAmt |
| Program Services | $58,044 | ProgramServicesAmt |
| Management And General | $16,097 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $203,883 | TotalAmt |
| Program Services | $176,509 | ProgramServicesAmt |
| Management And General | $27,374 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $248,535 | TotalAmt |
| Program Services | $213,930 | ProgramServicesAmt |
| Management And General | $34,605 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,821 | TotalAmt |
| Management And General | $288,821 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,932 | TotalAmt |
| Management And General | $17,932 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,038 | TotalAmt |
| Management And General | $41,038 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,240 | TotalAmt |
| Management And General | $9,240 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $534,176 | TotalAmt |
| Program Services | $279,069 | ProgramServicesAmt |
| Management And General | $255,107 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,174 | TotalAmt |
| Program Services | $9,349 | ProgramServicesAmt |
| Management And General | $3,825 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,999 | TotalAmt |
| Program Services | $119,839 | ProgramServicesAmt |
| Management And General | $60,160 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,538 | TotalAmt |
| Management And General | $202,538 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $122,249 | TotalAmt |
| Program Services | $122,249 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,995 | TotalAmt |
| Program Services | $109,786 | ProgramServicesAmt |
| Management And General | $23,209 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,101 | TotalAmt |
| Program Services | $19,586 | ProgramServicesAmt |
| Management And General | $15,515 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,946 | TotalAmt |
| Program Services | $29,946 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $472,486 | TotalAmt |
| Program Services | $472,486 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,433 | TotalAmt |
| Management And General | $54,433 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad debt expense | $340,833 | $340,833 | |
| Medical supplies | $293,554 | $293,554 | |
| Equipment rent/lease | $102,447 | $77,257 | $25,190 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,971 | TotalAmt |
| Management And General | $2,971 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,475,719 | TotalAmt |
| Program Services | $4,967,541 | ProgramServicesAmt |
| Management And General | $1,508,178 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $544 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $266,749 | BOYAmt |
| EOY | $507,112 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,117,162 | BOYAmt |
| EOY | $884,290 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $119,631 | BOYAmt |
| EOY | $131,103 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,728 | BOYAmt |
| EOY | $26,771 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,317,220 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $4,537,596 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,158,491 | BOYAmt |
| EOY | $1,779,624 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,020,732 | BOYAmt |
| EOY | $1,631,615 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $295,777 | BOYAmt |
| EOY | $290,490 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,673 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $519,440 | BOYAmt |
| EOY | $630,602 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,543,383 | BOYAmt |
| EOY | $5,882,151 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $777,817 | BOYAmt |
| EOY | $597,929 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,665 | BOYAmt |
| EOY | $3,588 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $716,605 | BOYAmt |
| EOY | $713,008 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $114,335 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,511,087 | BOYAmt |
| EOY | $1,428,860 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,496,818 | BOYAmt |
| EOY | $4,010,849 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $535,478 | BOYAmt |
| EOY | $442,442 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,032,296 | BOYAmt |
| EOY | $4,453,291 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,543,383 | BOYAmt |
| EOY | $5,882,151 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$503,565 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$75,440 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | 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 | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 0 | AgentTrusteeEtcInd |
| Incl Escrow Custodial Acct Liab | Yes (1) | InclEscrowCustodialAcctLiabInd |
| Explanation Provided | Yes (X) | ExplanationProvidedInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $83,558 | OtherCostOrOtherBasisAmt |
| Book Value | $83,558 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,963,822 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,284,606 | DepreciationAmt |
| Book Value | $679,216 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,212,569 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,252,990 | DepreciationAmt |
| Book Value | $959,579 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $57,271 | OtherCostOrOtherBasisAmt |
| Book Value | $57,271 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,779,624 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Other receivables | $68,611 |
| Electronic health record incentive | $555,005 |
| Due from Wheatland Memorial Healthcare Foundation | $6,986 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $630,602 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $114,335 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $114,335 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part IV, Line 2b: | The Hospital acts as custodian for funds of certain swing bed patients. These funds are included in assets limited as to use and accounts payable in the financial statements. Swing bed patient trust funds totaled $3,588 at December 31, 2015. |
| Part X, Line 2: | The Hospital is organized as a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital 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, if applicable. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization business Income Tax Return (Form 990-T) with the IRS. The Hospital 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 Hospital 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 175.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00390 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,558,914 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,048,789 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $510,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08320 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,558,914 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,048,789 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $510,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08320 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,582,914 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,048,789 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $534,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08710 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $340,833 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $35,106 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $1,829,259 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $1,844,519 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$15,260 | 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 | Wheatland Memorial Healthcare | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 287 | AddressLine1Txt |
| City | Harlowton | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59036 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.wheatlandmemorial.org | WebsiteAddressTxt |
| State License | 13546 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Provider based RHC - Bair Memorial Clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wheatland Memorial Healthcare | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.wheatlandmemorial.org | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.wheatlandmemorial.org | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 175.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.wheatlandmemorial.org/resources/compassionate-care/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.wheatlandmemorial.org/resources/compassionate-care/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.wheatlandmemorial.org/resources/compassionate-care/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| 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 |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Wheatland Memorial Healthcare | Part V, Section B, Line 5: A Steering Committee was convened to assist Wheatland Memorial Healthcare in conducting its CHNA. A diverse group of community members representing various organizations and populations within the community (ex. Public health, elderly, uninsured) came together in April 2013.Steering Committee 1. Foundation/Marketing Director, Wheatland Memorial Healthcare 2. Martinsdale Community Member and Business Owner 3. Director of Nursing, Wheatland Memorial Healthcare 4. CEO, Wheatland Memorial Healthcare 5. Hospital Guild Volunteer 6. Human Resources, Wheatland Memorial Healthcare 7. County Commissioner and Rancher 8. Harlowton Community Member and Business Owner 9. Board Member, Wheatland Memorial Healthcare |
| Wheatland Memorial Healthcare | Part V, Section B, Line 11: Access to Healthcare ServicesWheatland Memorial Healthcare (WMH) finalized contracts and credentialed a Pulmonologist and a Certified Sleep Doctor for a Sleep Lab in 2013. We designated a space, finalized a fee structure, and marketed the sleep lab. We successfully did a number of sleep studies locally in 2014. Unfortunately, WMH had challenges with the Certified Sleep Doctors schedule. He was struggling to keep his commitment with Rocky Mountain Sleep Disorders. After many failed attempts to find a new Certified Sleep Doctor and keep the lab going it closed in early 2015. Wheatland Memorial Healthcare has been creative when it has come to offering pulmonary services. We recently established pulmonary function testing in-house. Patients must be referred by a medical provider. We are currently marketing capabilities in the community. Wheatland Memorial Healthcare nurses did a Lifestyle Balance accountability group open to community members and employees in June 2015. The program had 11 participants and was deemed successful. We have plans to do another winter/spring course depending on clinic staffing. Plan for ExpansionIn 2014, Wheatland Memorial Healthcare purchased a large piece of property in front of the hospital. Currently WMH owns all the property in front of the hospital on the main highway through town. A committee along with some board members is doing a cost analysis on space, needs and outcomes. WMH has explored moving the Physical Therapy department off campus to provide more space for more equipment and private provider space while working with patients. We are weighing out all options and doing a cost analysis.Wheatland Memorial Healthcare is building relationships with donors and Grantors that give for bricks and mortar. Education and OutreachThe Hospital advertised counseling services that were available in the community, especially for substance abuse counseling and metal health. These services were added to our newly launched website in 2015. We also ran a full page feature on the local NAMI group and awareness on mental health on our website and in our newsletter annually and numerous articles have been written for the local newspaper regarding mental health issues. NAMI groups were invited to set up informal booths at local health fairs free of charge. |
| Wheatland Memorial Healthcare | Part V, Section B, Line 16i: A summary of the financial assistance policy and information on how to obtain an application or view the entire policy is posted in the emergency room, waiting rooms, and admission areas of the Hospital. A summary is also available on the Hospital's website. The financial assistance policy was also provided with the initial collection effort notices. |
| Wheatland Memorial Healthcare | 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. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | At 101%-125% of FPG patients receive a 75% write-offAt 126%-150% of FPG patients receive a 50% write-offAt 151%-175% of FPG patients receive a 25% write-offOver 175% of FPG patients do not receive a write-off |
| Part I, Line 6a: | Wheatland Memorial's annual community benefit report can be found on their website. |
| Part I, Line 7: | Charity care was recorded at cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services on line 7g was determined using the Medicare Cost Report. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from total expenses to determine the percentage was $340,833. |
| Part III, Line 2: | Patient accounts are not classified as bad debt until every effort is made to collect on the account. Insurance is filed and all payments are applied including contractual allowances and discounts. Any payment on an account that was written off to bad debt reduces bad debt expense in the current year. Bad debt expense on line 2 is reported at charges as presented on the financial statements. |
| Part III, Line 3: | The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated by using the percentage of individuals within the community who are below the federal poverty level at 10.3%. |
| 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: | Wheatland Memorial Healthcare is a critical access hospital and in prior years has not shown a Medicare shortfall. There was a shortfall for 2013 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Total revenue received from Medicare is the gross reimbursement plus settlement. Both 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 the Centers for Medicare and Medicaid Services. |
| Part III, Line 9b: | The Hospital is aware of patients who are in the process of applying for financial assistance and these accounts are not sent to collections. If a patient does not cooperate or is not in compliance with their payment arrangement the account is turned over to a collection agency. Collection efforts cease while a patient is under review for charity care or while a patient is in compliance with a payment arrangement. After financial assistance is awarded, any personal portion due follows the same collection procedure as other accounts. |
| Part VI, Line 2: | Wheatland Memorial Healthcare assessed the needs of the community through patient surveys, general public surveys, and community meetings. After review of these, the Hospital created a plan of action to address the needs of the community and monitored the implementation. The needs assessment and implementation strategy was posted to the Hospital's website by 12/31/2013. The next CHNA is in process and will be completed by 12/31/2016. |
| Part VI, Line 3: | Wheatland Memorial Healthcare tries to determine if patients qualify or possibly qualify for any financial assistance either at registration or discharge. We notify patients of our programs by making available financial assistance brochures in waiting rooms, emergency room areas, and other patient access areas and local newspaper ads. Financial assistance information is provided in all correspondence regarding patient bills. We also have staff available to assist in applications for state aid. |
| Part VI, Line 4: | Wheatland Memorial Healthcare (WMH) is a 25 bed critical access hospital and rural health clinic located in Harlowton, Montana. Harlowton is a ranching community in central Montana with approximately 1.6 people per square mile. The 2013 population of Harlowton was estimated at 991, with WMH serving residents of Wheatland, Golden Valley, Judith Basin and portions of Sweet Grass and Meagher counties. The nearest tertiary care facility is 93 miles south east of Harlowton, in Billings, MT. The next closest tertiary care facility is 130 miles north west of Harlowton, in Great Falls, MT. Lewistown which is 60 miles north from WMH, has a secondary care facility. The median household income in Harlowton was $23,636, compared to $41,994 for the state of Montana. Individuals below the federal poverty level in Wheatland County was 10.3%, compared to above 14% for the state of Montana. |
| Part VI, Line 5: | Our Board is comprised of members within our local and outlying service area. These Members are not employees or contractors of the organization. At this time the Organization has lacked excess funds from operations but has pursued grants aggressively in order to replace aging equipment and establish community health programs that will allow us to continue serving the health care needs of our community during these challenging economic times. Our emergency room is available 24/7 and serves all individuals regardless of ability to pay. We extend privileges to medical staff that are licensed and qualified. The Hospital provides space for immunization clinics to ensure children in the community receive recommended immunizations. We also provide space for the regional WIC (Women, Infants and Children) clinic to promote the services offered by that organization. The Hospital has established a strong working relationship with the chaplains of several churches who provide support to patients and families of the facility and participate in care planning and regular meetings. The CEO regularly attends county commissioner meetings to provide the community with an update of the events going on at the Hospital. Board members also frequently attend these commissioner meetings. The Hospital and its attached rural health clinic is the sole provider of health care services within the community. |
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 | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Charlotte Jutila MD | PersonNm |
| Title | Cardiologist | TitleTxt |
| Base Compensation Filing Org | $195,124 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $0 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $0 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $7,962 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $7,542 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $210,628 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Question 3: | FormAndLineReferenceDesc |
| Explanation | Wheatland Memorial Healthcare does not pay compensation to the CEO directly. The CEO is a common law employee and compensated by Billings Clinic. Billings Clinic determines compensation based on the processes described in Part I, Question 3 and other methods they have established. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 3 | The CEO and CFO positions at Wheatland Memorial Healthcare are considered common law employees of Billings Clinic. Billings Clinic may, in its discretion at any time, remove and replace the CEO and CFO. The CEO has the responsibility of supervising management, administration the operation of Wheatland Memorial Healthcare. The CFO has the responsibility of managing the Organization's finances. Mike Zwicker - CEO through May 2015 Salary $88,229 (this includes a $50,000 severance) Pension 2,258 Other benefits 4,382 Larry Putnam - Interim CEO June - August 2015 Consultant fee of $36,750 Tim Russell - Interim CEO September - October 2015 Salary $ 5,400 Pension 350 No additional benefits Brad Howell - Current CEO hired December 2015 Salary $ 4,204 Pension 420 Other benefits 375 Kyle Gee, CFO Salary $44,790 |
| Form 990, Part VI, Section A, line 8b | The Organization does not have committees with authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11 | A copy of the completed Form 990 is provided to the Board Members before it is filed. The CEO and CFO review the Form 990. |
| Form 990, Part VI, Section B, line 12c | All officers, trustees, and key employees are required upon hire and at least annually thereafter to disclose any conflicts or potential conflicts and sign a conflict of interest policy. A conflict of interest can be considered to exist in any instance where the actions or activities of an individual on behalf of Wheatland Memorial also involve the obtaining of an improper gain or advantage, or adverse effect on the interests of Wheatland Memorial. The CEO reviews the statements and investigates all disclosures of possible conflicts of interest. The CEO prepares a report for the Executive Committee. The Executive Committee is responsible for final review and investigation of potential conflicts of interest and presentation of its findings to the Wheatland Memorial Board of Directors on an annual basis. Upon disclosure of a possible conflict of interest, Board Members will refrain from deliberating on the matter until all relevant and pertinent facts and circumstances have been disclosed and any potential conflict has been avoided or resolved. The individual with a conflict is not allowed to be present when the matter is discussed or voted upon. All matters of discussion are documented. |
| Form 990, Part VI, Section B, line 15 | The CEO is a common law employee of Billings Clinic. Billings Clinic determines compensation based on methods they have established. The Board of Directors approves the management relationship with Billings Clinic. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. The financial statements are also attached to the Form 990. |
| Form 990, Part XII, line 2c: | The CEO of Wheatland Memorial Healthcare is responsible for oversight of the audit of its financial statements and selection of an independent accountant. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wheatland Memorial Healthcare Foundation | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 287 | AddressLine1Txt |
| City | Harlowton | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59036 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 454035841 | EIN |
| Primary Activities | Support Wheatland Memorial Healthcare | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 11a, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wheatland Memorial Healthcare | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 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 | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |