2015-05-14T09:30:24-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 810247705 COMMUNITY MEDICAL CENTER INC COMM 4067284100 2827 FORT MISSOULA ROAD MISSOULA MT 59804 JAN K PARKS VICE CHAIR 4067284100 2015-05-13 1 KACIE MCEWEN P01599614 6123764500 2013 2016-02-25 16:41:14Z STAN MOSER 2827 FORT MISSOULA ROAD MISSOULA MT 59804 178904372 0 X WWW.COMMUNITYMED.ORG X 1948 MT YOUR HEALTH - OUR COMMITEMENT TO YOU, FROM DAY ONE. 13 12 1413 200 2898306 -476829 1075030 374123 156421696 168838381 715839 368603 8780714 9309659 166993279 178890766 193440 196710 0 0 76495493 76688327 0 0 253873 83990426 91489792 160679359 168374829 6313920 10515937 153399701 170824687 60360743 65947687 93038958 104877000 YOUR HEALTH - OUR COMMITMENT TO YOU, FROM DAY ONE. 0 0 135084288 196710 168838381 CMC PROVIDES DAILY PATIENT SERVICES, PROFESSIONAL AND TECHNICAL SERVICES, AND REHABILITATION SERVICES FOR PATIENT CARE. 5,080 INPATIENTS WERE ADMITTED TO CMC, 139,766 OUTPATIENT SERVICES WERE PROVIDED, AND 107,144 VISITS WERE MADE TO OUR PHYSICIANS DURING FISCAL YEAR 2014. THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY POLICY AGGREGATED APPROXIMATELY $4,742,143 FOR THE YEAR ENDED JUNE 30, 2014. 135084288 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 157 0 1413 1 1 1 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X DAVID RICHHART 4063274004 2827 FORT MISSOULA ROAD MISSOULA MT 59804 SCOTT STEARNS BOARD CHAIR 1.50 X X 0 0 0 SCOTT HACKER 1ST VICE CHAIR 1.50 X X 0 0 0 JAN PARKS 2ND VICE CHAIR 1.50 X X 0 0 0 JOHN VANSTRYDONCK SECRETARY/TREASURER 1.50 X X 0 0 0 TANYA ASK BOARD MEMBER 1.50 X 0 0 0 FRANK D'ANGELO BOARD MEMBER 1.50 X 0 0 0 MARK GARNAAS MD BOARD MEMBER 1.50 X 0 0 0 BILL JOHNSTON BOARD MEMBER 1.50 X 0 0 0 BARRY KENFIELD BOARD MEMBER 1.50 3.00 X 0 0 0 SUZANNE PETERSON BOARD MEMBER 1.50 X 0 0 0 ROBERT PHILLIPS BOARD MEMBER 1.50 X 0 0 0 THOMAS LOWDER MD BOARD MEMBER/EMPLOYED PHYSICIAN 40.00 X 185216 0 33393 MICHAEL STEWART MD BOARD MEMBER 1.50 X 0 0 0 STEPHEN CARLSON PRESIDENT & CEO 40.00 X 420928 0 37086 STAN MOSER EXECUTIVE VICE PRESIDENT 40.00 X 261343 0 17264 DAVID LECHNER PRESIDENT, CPG 40.00 X 244015 0 25918 DAVID RICHHART VP - FISCAL SERVICES/CFO 40.00 X 196918 0 22120 JONATHAN WEISUL CHEIF MEDICAL OFFICER 40.00 X 302955 0 31850 DAVID JINICH MD CARDIOLOGY PHYSICIAN 40.00 X 659208 0 47227 KARA ARVIN MD NEONATOLOGY PHYSICIAN 40.00 X 363168 0 17762 ERIC STERN MD PULMONOLOGY PHYSICIAN 40.00 X 343772 0 27820 BONNIE STEPHENS MD NEONATOLOGY PHYSICIAN 40.00 X 449227 0 41981 BRUCE MORGAN MD VASCULAR SURGURY PHYSICIAN 40.00 X 281394 0 12006 3708144 0 314427 84 0 1 0 MT CANCER SPECIALISTS 1821 SOUTH AVE W SUITE 5 MISSOULA MT 59801 ONCOLOGY SERVICES 1735733 MT HEART ANGIO LAB LLC 2827 FORT MISSOULA ROAD MISSOULA MT 59804 CATH SERVICES 1176240 SOUND INPATIENT PO BOX 742936 LOS ANGELES CA 90074 HOSPITALIST 1125998 BILLINGS CLINIC PO BOX 30977 BILLINGS MT 59107 MEDICAL SERVICES 755790 MAYO COLLABORATIVE PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 527755 27 86645 218000 69478 374123 NET PATIENT REVENUE 621500 165533973 162635667 2898306 JV ANCILLARY REVENUE 621500 3487488 3487488 HEART LAB REVENUE 621500 -183080 -183080 168838381 345551 345551 542664 0 542664 542664 542664 36658 13606 23052 23052 23052 MISCELLANEOUS REVENUE 900099 6037184 6037184 340B REVENUE 900099 1378049 1378049 MEANINGFUL USE REVENUE 900099 1351762 1351762 8766995 178890766 165940075 2898306 9678262 X 196710 196710 1685159 1685159 61631362 49624519 11853606 153237 2386720 1995688 384655 6377 6566485 5703397 844863 18225 4418601 3449678 957900 11023 402798 402121 677 112706 97226 15480 24563852 19149376 5404354 10122 3014698 1458430 1548462 7806 2596895 1084707 1509213 2975 784198 459780 323629 789 1719950 1719950 9333425 9259310 74115 1407359 1407359 MEDICAL SUPPLIES/DRUGS 26427542 26427542 BAD DEBT 9980510 9980510 REPAIRS & MAINTENANCE 6682384 895282 5787102 LICENSE & FEES 1740261 1228422 511839 2723214 1043628 1652424 27162 168374829 135084288 33036668 253873 14906384 22551021 10937099 11452513 25960108 31452860 3877121 3895029 3414286 3703276 1084495 1011224 151576216 78631066 69200136 72945150 15101689 13891761 3773064 2059414 827029 807816 4318290 7054623 153399701 170824687 20570213 22001046 31932 24447509 24466486 10321822 15941305 355034 161573 4634233 3377277 60360743 65947687 X 88813900 99940596 1125361 1812037 3099697 3124367 93038958 104877000 153399701 170824687 X 10515937 -2036 1324141 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 9500 0 0 1 7110 16610 0 PART II-B, LINE 1: COMMUNITY MEDICAL CENTER PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND MONTANA HOSPITAL ASSOCIATION. THESE ORGANIZATIONS PARTICIPATE IN LOBBYING ACTIVITIES. COMMUNITY MEDICAL CENTER ALSO PROVIDED GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING TO SUPPORT THE EXPANSION OF MEDICAID AND THE LOCAL BUS SERVICE. 3092824 27233 288751 256011 3152797 3822091 11831 202604 943702 3092824 3756462 41273 24356 3822091 3054980 49499 651983 3756462 2356624 38678 659678 3054980 0.00000 0.99100 0.00900 0 1 1 209682 209682 70888156 29646156 41242000 1463965 449144 1014821 70423433 48535766 21887667 8590980 8590980 72945150 MORTGAGE BACKED GOVERNMENT SECURITIES 13891761 F 13891761 THIRD PARTY PAYABLE 3377277 3377277 X PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE CMC FOUNDATION AND THE INCOME EARNED ON THESE FUNDS ARE DISTRIBUTED TO THE HOSPITAL TO COMPLY WITH THE PURPOSES SPECIFIED BY THE DONOR. PART X, LINE 2: THE HOSPITAL IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOSPITAL IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS ENDED 2011 TO 2013 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 1 X 1 X 1 X 1 1 1 0 1 1 2228807 73439 2155368 0.01280 23534264 20574474 2959790 0.01760 25763071 20647913 5115158 0.03040 996658 996658 0.00590 744476 744476 0.00440 33165244 25027311 8137933 0.04830 246441 246441 0.00150 35152819 25027311 10125508 0.06010 60915890 45675224 15240666 0.09050 20000 20000 0.00010 3000 3000 0.00000 43240 43240 0.00030 66240 66240 0.00040 1 9980509 35000 28122098 30803216 -2681118 X 1 1 1 1 COMMUNITY MEDICAL CENTER 2827 FORT MISSOULA ROAD MISSOULA MT 59804 X X X COMMUNITY MEDICAL CENTER 1 1 X X X X X X X X X 11 1 1 1 X HTTP://COMMUNITYMED.ORG/UPLOADS/DOCS/CHNA X HTTP://WWW.CO.MISSOULA.MT.US/MEASURES/PDF/COMM X X X X X X X X X X 1 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X X X X 1 0 X X X X X 1 X X 0 0 COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 3: NUMEROUS STAKEHOLDERS FROM THE LARGER COMMUNITY WERE INVOLVED IN THE CREATION OF THE CHNA, INCLUDING; MISSOULA AGING SERVICES, INDIAN HEALTH SERVICE, UNIVERSITY OF MONTANA, MISSOULA YMCA, MISSOULA UNITED WAY, AND MISSOULA COUNTY PARKS & RECREATION. COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 4: MISSOULA CITY-COUNTY HEALTH DEPARTMENTPARTNERSHIP HEALTH CENTERPROVIDENCE ST. PATRICK HOSPITAL COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 6I: COMMUNITY MEDICAL CENTER INCORPORATED INDICATERS FROM THE CHNA INTO THEIR STRATEGIC PLAN. COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 14G: CUSTOMER SERVICE PHONE, CASHIER'S WINDOW, DURING SCREENING FOR OTHER SOURCES OF PAYMENT, COLLECTION AGENCIES, CMC REPRESENTATIVES. COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 18E: NOTIFY PATIENTS OF AVAILABILITY OF CHARITY WHEN MAKING PAYMENT ARRANGEMENTS. COMMUNITY MEDICAL CENTER PART V, SECTION B, LINE 20D: THE MINIMUM DISCOUNT ALLOWED FOR INDIVIDUALS ELIGBLE UNDER THIS POLICY WILL MEET OR EXCEED THE AVERAGE DISCOUNT RATE (CALCULATED ANNUALLY) BY COMMERCIAL PAYORS. IN THE CASE OF CATASTROPHIC EVENTS, CMC USES MEDICARE RATES TO DETERMINE THE MAXIMUM AMOUNTS TO BE CHARGED TO FAP ELIGIBLE PATIENTS. 24 CPG MISSOULA VALLEY PEDIATRICS (MVP) 2835 FORT MISSOULA ROAD SUITE 201 205 MISSOULA MT 59804 PEDIATRICS CMC REHABILITATION PHYSICIANS 2827 FORT MISSOULA ROAD MISSOULA MT 59804 PHYSIATRISTS, FAMILY NURSE PRACTIONER, PY CPG PARKSIDE COMMUNITY FAMILY CARE 2831 FORT MISSOULA ROAD SUITE 146 MISSOULA MT 59804 FAMILY PRACTICE ROCKY MOUNTAIN NEONATOLOGY (RMN) 2827 FORT MISSOULA ROAD MISSOULA MT 59804 NEONATOLOGY ROCKY MOUNTAIN PERINATAL ASSOCIATES 2825 FORT MISSOULA ROAD SUITE 217 MISSOULA MT 59804 PERINATOLOGY CPG STEVENSVILLE CMC (SCMC) 3800 EASTSIDE HIGHWAY STEVENSVILLE MT 59870 INTERNAL MEDICINE, FAMILY PRACTICE WELLCARE 2825 FORT MISSOULA ROAD SUITE 203 MISSOULA MT 59804 INDEPENDENT MEDICAL EXAMS FOR WORKERS' COMP CPG DIABETES & ENDOCRINOLOGY ASSOCIATES 1211 S RESERVE ST STE 201 MISSOULA MT 59801 ENDOCRINOLOGY CPG DIABETES & NUTRITION CENTER 1211 S RESERVE ST STE 202 MISSOULA MT 59804 PUMP EDUCATOR, DIETITIAN, DIABETES EDUCATION MOUNTAIN VIEW FAMILY MEDICINE 2835 FORT MISSOULA ROAD SUITE 101 MISSOULA MT 59804 FAMILY PRACTICE CPG ON NORTH RESERVE 2230 NORTH RESERVE STREET MISSOULA MT 59801 FAMILY PRACTICE/OPEN ACCESS WALK-IN CARE CPG ON SOUTH RESERVE 1211 RESERVE ST SOUTH SUITE 101 MISSOULA MT 59801 FAMILY PRACTICE/RHEUMATOLOGY CPG COUMADIN CLINIC 2825 FORT MISSOULA ROAD STE 115 MISSOULA MT 59804 COUMADIN CPG CARDIOLOGYGENERAL & VASCULAR SURGER 2831 FORT MISSOULA RD STE 102 MISSOULA MT 59804 CARDIOLOGY, GENERAL & VASCULAR SURGERY CPG NORTH PRIMARY CARE 2230 NORTH RESERVE STREET MISSOULA MT 59808 INTERNAL MEDICINE MONTANA BREAST HEALTH CENTER 2827 FORT MISSOULA ROAD MISSOULA MT 59804 BREAST HEALTH CPG OBGYN 2825 FORT MISSOULA ROAD STE 217 MISSOULA MT 59804 OB/GYN CPG NEUROSURGERY & CPG NEUROBEHAIVORAL 2825 FORT MISSOULA ROAD STE 317 MISSOULA MT 59804 NEUROLOGY CPG THORACIC SURGERY 2835 FORT MISSOULA ROAD STE 204 MISSOULA MT 59804 THORACIC SURGERY COMMUNITY BRIDGES & WORCCENTER 2685 PALMER ST SUITE D MISSOULA MT 59801 BRAIN INJURY REHABILITATION CPG DERMATOLOGY 2835 FORT MISSOULA ROAD STE 302 MISSOULA MT 59804 DERMATOLOGY CPG MT NEUROBEHAVIORAL SPECIALISTS SOUTH 1622 SOUTH AVENUE WEST MISSOULA MT 59801 NEUROLOGY CPG PSYCHIATRY 2827 FORT MISSOULA ROAD MISSOULA MT 59804 PSYCHIATRY CPG PULMONOLOGY 2825 FORT MISSOULA ROAD STE 115 MISSOULA MT 59804 PULMONOLOGY PART I, LINE 7: THE COSTING METHOD USED WAS THE COST TO CHARGE RATIO DERIVED FROM USING WORKSHEET 2. PART I, LINE 7G: $6,248,049 OF SUBSIDIZED HEALTH SERVICES IS ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, LN 7 COL(F): WHEN CALCULATING CHARITY-CARE PERCENTAGE OF TOTAL EXPENSES (SCHEDULE H, PART I, LINE 7, COLUMN F), THE HOSPITAL ELIMINATED $9,980,509 OF BAD DEBT EXPENSE. PART II, COMMUNITY BUILDING ACTIVITIES: CMC INVESTS IN MISSOULA AND THE SURROUNDING AREA THROUGH MULTIPLE AVENUES. AS A KEY PARTNER OF THE MISSOULA ECONOMIC PROJECT (MEP), CMC HELPS MEP CREATE A PROGRESSIVE BUSINESS DEVELOPMENT AND RECRUITMENT PROGRAM FOR THE CITY OF MISSOULA. WE BELIEVE THAT A STRONG BUSINESS COMMUNITY CREATES A VIBRANT CITY THAT CAN BE SUPPORTED BY NON-PROFIT HEALTHCARE ORGANIZATIONS, SUCH AS CMC. IN ADDITION, OUR PARTICIPATION IN EMERGENCY PREPAREDNESS IN PARTNERSHIP WITH OTHER HOSPITALS, FIRE, POLICE, AND THE CITY/COUNTY GOVERNMENT STRENGTHENS OUR ABILITY TO RESPOND EFFICIENTLY AND QUICKLY TO ANY EMERGENCY WITHIN THE AREA. AS MISSOULA CHAMBER OF COMMERCE MEMBERS, WE SUPPORT OUR BUSINESS COMMUNITY BY SPONSORING AT LEAST ONE PARTICIPANT FROM CMC IN THE LEADERSHIP MISSOULA PROGRAM ANNUALLY. THIS PROGRAM CREATES AMBASSADORS OF CMC EMPLOYEES FOR THE LARGER COMMUNITY. PART III, LINE 3: THE AMOUNT OF BAD DEBT EXPENSE THAT IS ESTIMATED TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE IS BASED ON HISTORY AND THE JUDGMENT OF THE DIRECTOR OF PATIENT ACCOUNTS. PART III, LINE 4: FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: ONE HUNDRED PERCENT OF THIS SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THIS AMOUNT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: IN OUR COMMUNITY MEDICARE HAS THE LOWEST REIMBURSEMENT RATE OF ALL PAYERS. WE DO NOT BELIEVE OUR MEDICARE SHORTFALL TO BE FROM ANY SORT OF DEFICIENCIES IN THE EFFICIENCY OF OPERATIONS OR LOW PATIENT VOLUMES. THE AMOUNTS SHOWN ARE CALCULATED BY UTILIZING THE INCOME AND EXPENSES AS CALCULATED BY THE MEDICARE COST REPORT LESS ANY AMOUNTS THAT ARE ALREADY INCLUDED IN THE SUBSIDIZED HEALTH EXPENSES. PART III, LINE 9B: PATIENTS RECEIVE INFORMATION AT THE TIME OF REGISTRATION REGARDING FINANCIAL ASSISTANCE BOTH FOR SELF PAY AND BALANCE AFTER INSURANCE. ALL SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PROGRAMS BY THE MASH PROGRAMS, AND IF NO ELIGIBILITY EXISTS, PATIENTS ARE FURTHER SCREENED FOR HOSPITAL FINANCIAL ASSISTANCE. ADDITIONALLY, PATIENTS RECEIVE INFORMATION REGARDING FINANCIAL ASSISTANCE IN THEIR BILLING STATEMENTS AS WELL AS VERBALLY WHEN FOLLOW UP CALLS ARE MADE ON ANY PATIENT BALANCE. PATIENTS WHO QUALIFY FOR CHARITY CARE RECEIVE AN ADJUSTMENT ON THE BALANCE OF THEIR ACCOUNT CORRESPONDING WITH THE APPROPRIATE REDUCTION ACCORDING TO POLICY. REMAINING BALANCES, IF ANY, ARE COLLECTED EITHER IN FULL OR BY PAYMENT PLAN, OR IN THE CASE OF NON-PAYMENT MAY HAVE THE ADJUSTED BALANCE ASSIGNED TO AN OUTSIDE AGENCY FOR RESOLUTION. PART VI, LINE 2: CMC, ALONG WITH OUR PARTNER ORGANIZATIONS, ASSESSES THE NEEDS OF THE COMMUNITY AND THEN CRAFTS A RESPONSE TO THE NEEDS ASSESSMENT TO FULFILL ANY GAPS THAT ARE IDENTIFIED. COMMUNITY MEDICAL CENTER WORKS WITH SAINT PATRICK HOSPITAL AND THE MISSOULA CITY-COUNTY HEALTH DEPARTMENT TO ASSESS THE NEEDS OF THE COMMUNITY, AS WELL AS WITH OTHER NON-PROFIT ORGANIZATIONS, I.E., MISSOULA AGING SERVICES, YWCA, YMCA, POVERELLO HOMELESS SHELTER, AND UNITED WAY. PART VI, LINE 3: PATIENTS RECEIVE INFORMATION AT THE TIME OF REGISTRATION REGARDING FINANCIAL ASSISTANCE BOTH FOR SELF PAY AND BALANCE AFTER INSURANCE. ALL SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PROGRAMS BY THE MASH PROGRAMS, AND IF NO ELIGIBILITY EXISTS, PATIENTS ARE FURTHER SCREENED FOR HOSPITAL FINANCIAL ASSISTANCE. ADDITIONALLY, PATIENTS RECEIVE INFORMATION REGARDING FINANCIAL ASSISTANCE IN THEIR BILLING STATEMENTS AS WELL AS VERBALLY WHEN FOLLOW UP CALLS ARE MADE ON ANY PATIENT BALANCE. PART VI, LINE 4: CMC SERVES THE COMMUNITY OF MISSOULA, MT AND THE SURROUNDING COUNTIES. MONTANA IS A RURAL STATE AND THEREFORE, THERE ARE LIMITED HOSPITALS IN THE REGION. THERE ARE TWO HOSPITALS IN MISSOULA. CMC SERVES A DISPROPORTIONATE NUMBER OF LOWER INCOME INDIVIDUAL AND THEREFORE RECEIVES DSH PAYMENTS. 1 PARTNERSHIP HEALTH CENTER 323 W ALDER ST MISSOULA MT 59802 363843543 501(C)(3) 25000 SUPPORT OF MISSION MISSOULA ECONOMIC PARTNERSHIP PO BOX 7457 MISSOULA MT 59807 273994460 501(C)(6) 20200 SUPPORT OF MISSION MISSOULA FAMILY YMCA 3000 S RUSSELL ST MISSOULA MT 59801 810300829 501(C)(3) 14000 SUPPORT OF MISSION LIVING ART PO BOX 17303 MISSOULA MT 59808 810518819 501(C)(3) 10000 SUPPORT OF MISSION MISSOULA CHAMBER COMMERCE PO BOX 7577 MISSOULA MT 59807 810167990 501(C)(6) 8975 SUPPORT OF MISSION MISSOULA DOWNTOWN ASSOCIATION 218 EAST MAIN STREET MISSOULA MT 59802 810403474 501(C)(6) 8100 SUPPORT OF MISSION MARCH OF DIMES 807 GRAND AVE BILLINGS MT 59101 131846366 501(C)(3) 8000 SUPPORT OF MISSION CHICKS N CHAPS 2785 MERIWETHER ST MISSOULA MT 59803 272760144 501(C)(3) 7500 SUPPORT OF MISSION AMERICAN HEART ASSOCIATION 320 B EAST MAIN ST MISSOULA MT 59802 135613797 501(C)(3) 6500 SUPPORT OF MISSION UNIVERSITY OF MONTANA 600 CONNELL AVE MISSOULA MT 59812 810362989 501(C)(3) 6339 SUPPORT OF MISSION 7 3 PART I, LINE 2: ONLY NONPROFIT ORGANIZATIONS ARE ELIGIBLE FOR DONATIONS FROM CMC. THEY HAVE TO IDENTIFY HOW THEIR MISSION LINKS TO CMC'S AND OUR CORE COMPETENCIES IN WOMEN'S HEALTH, PEDIATRICS, ONCOLOGY, AND REHABILITATION. ALL COMMUNITY BENEFIT APPLICATIONS AND SUPPORTING MATERIALS ARE KEPT FOR EACH GRANT GIVEN. ONCE FUNDING IS GRANTED, NO ADDITIONAL MONITORING IS PERFORMED BY CMC. X 0 0 X X X X 0 0 0 0 0 0 0 0 0 THOMAS LOWDER MD BOARD MEMBER/EMPLOYED PHYSICIAN 182885 0 1750 0 581 0 9305 0 24088 0 218609 0 0 0 STEPHEN CARLSON PRESIDENT & CEO 392763 0 15000 0 13165 0 19685 0 17401 0 458014 0 0 0 STAN MOSER EXECUTIVE VICE PRESIDENT 261343 0 0 0 0 0 4215 0 13049 0 278607 0 0 0 DAVID LECHNER PRESIDENT, CPG 242773 0 0 0 1242 0 10345 0 15573 0 269933 0 0 0 DAVID RICHHART VP - FISCAL SERVICES/CFO 190202 0 0 0 6716 0 9491 0 12629 0 219038 0 0 0 JONATHAN WEISUL CHEIF MEDICAL OFFICER 297669 0 0 0 5286 0 13635 0 18215 0 334805 0 0 0 DAVID JINICH MD CARDIOLOGY PHYSICIAN 582891 0 75075 0 1242 0 26618 0 20609 0 706435 0 0 0 KARA ARVIN MD NEONATOLOGY PHYSICIAN 348507 0 14000 0 661 0 2770 0 14992 0 380930 0 0 0 ERIC STERN MD PULMONOLOGY PHYSICIAN 343232 0 0 0 540 0 6640 0 21180 0 371592 0 0 0 BONNIE STEPHENS MD NEONATOLOGY PHYSICIAN 431087 0 17600 0 540 0 18671 0 23310 0 491208 0 0 0 BRUCE MORGAN MD VASCULAR SURGURY PHYSICIAN 281394 0 0 0 0 0 9145 0 2861 0 293400 0 0 0 PART I, LINE 1A CMC PAID COUNTRY CLUB DUES ON BEHALF OF STEVE CARLSON, CEO IN THE AMOUNT OF $15,393. THIS AMOUNT WAS NOT INCLUDED IN STEVE'S TAXABLE COMPENSATION. A MONTANA FACILITY FINANCE AUTHORITY 364615155 612043JA3 2010-12-29 24400067 CONSTRUCTION/FACILITY EXPANSION OF WOMEN'S, NEWBORN CARE, & ONCOLOGY CENTER 0 0 0 B MONTANA FACILITY FINANCE AUTHORITY 364615155 2010-06-29 14525000 REFINANCE 1988, 1996, AND 2001 BONDS 0 0 0 C MONTANA FACILITY FINANCE AUTHORITY 364615155 2013-07-30 8500000 CONSTRUCTION OF RADIATION AND ONCOLOGY FACILITIES 0 0 0 A 24146299 2141709 2341766 565765 19169250 4 0 0 0 1 B 6220000 14345948 178052 2001 0 1 1 1 C 1049292 8500000 6040124 2459876 0 0 0 1 A 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 SCHEDULE K, PART II, LINE 3 TOTAL PROCEEDS OF $24,146,299 ON PART II, LINE 3 DOES NOT EQUAL THE ISSUE PRICE OF $24,400,061 INCLUDED IN PART I, LINE A, COLUMN E. THE DIFFERENCE OF $253,768 IS EQUAL TO THE UNDERWRITERS' DISCOUNTS. TOTAL PROCEEDS OF $14,345,948 ON PART II, LINE 3 DOES NOT EQUAL THE ISSUE PRICE OF $14,524,000 INCLUDED IN PART I, LINE A, COLUMN E. THE DIFFERENCE OF $178,052 IS EQUAL TO THE BOND ISSUANCE COSTS. FORM 990, PART VI, SECTION A, LINE 1 THE ROLE OF THE EXECUTIVE COMMITTEE IS TO TRANSACT THE BUSINESS OF THE COMMUNITY MEDICAL CENTER BOARD OF DIRECTORS IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD, WHEN A MEETING OF THE FULL BOARD IS NOT FEASIBLE. THEIR RESPONSIBILITIES INCLUDE: - ACT ON MATTERS THAT CANNOT REASONABLY WAIT ACTION BY THE FULL BOARD. - ACT ON OTHER MATTERS DELEGATED TO THE EXECUTIVE COMMITTEE BY THE BOARD. - REPORT ACTIONS AT THE NEXT MEETING OF THE BOARD FOR RATIFICATION. - FUNCTION AS AN ADVISOR TO THE PRESIDENT/CEO ON SENSITIVE TOPICS. - PROVIDE INPUT INTO THE CONTENT AND STRUCTURING OF THE BOARD AGENDA. - CONDUCT THE EVALUATION AND SET THE SALARY OF THE PRESIDENT/CEO. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD AND ONE ADDITIONAL BOARD MEMBER AT LARGE. THE PRESIDENT/CEO SHALL BE AN EX OFFICIO MEMBER WITHOUT VOTE. THE CHAIR OF THE BOARD APPOINTS THE COMMITTEE MEMBERS ANNUALLY, TO COINCIDE WITH THE ELECTION OF OFFICERS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND RELATED SCHEDULES WILL BE GIVEN TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C IN THE BEGINNING OF EACH CALENDAR YEAR, THE BOARD IS REQUIRED TO COMPLETE AND SIGN A CONFLICT OF INTEREST FORM THAT SPECIFICALLY ASKS ABOUT OUTSIDE INTERESTS, OUTSIDE ACTIVITIES, GIFTS, GRATUITIES, AND ENTERTAINMENT, AND INSIDE INFORMATION AND OTHER INTEREST. ON THIS SAME FORM, BOARD MEMBERS MUST ALSO CERTIFY THAT THEY HAVE A CONTINUING RESPONSIBILITY TO OBSERVE AND APPLY THE PROVISIONS OF THE POLICY. THIS CERTIFICATION REQUIRES THAT THEY UPDATE THEIR CONFLICT OF INTEREST FORM SHOULD ANY NEW CONFLICTS DEVELOP. ANY BOARD MEMBER WITH A CONFLICT OF INTEREST MAY NOT VOTE, INFLUENCE, OR PARTICIPATE IN ANY WAY ON ANY MATTER THAT THEY, OR THEIR RELATIVES, HAVE A SUBSTANTIAL INTEREST. THE ANNUAL CONFLICT OF INTEREST FORMS ARE MONITORED BY THE CEO'S ASSISTANT. FORM 990, PART VI, SECTION B, LINE 15 WE HIRED AN INDEPENDENT SERVICE (INTEGRATED HEALTHCARE STRATEGIES) TO DO AN EXECUTIVE COMPENSATION SURVEY. THIS SURVEY WAS CONDUCTED FOR THE TOP 12 COMPENSATED EMPLOYEES OF THE HOSPITAL. THE DATA WAS PRESENTED TO THE BOARD OF DIRECTORS, AND SALARY ADJUSTMENTS (IF ANY) WERE DETERMINED. THE SURVEY INCLUDED REGIONAL AND NATIONAL COMPARISONS TO INSTITUTIONS OF A SIMILAR SIZE AND REVENUE GENERATION TO MAKE THE RESULTS COMPARABLE. AS MENTIONED ABOVE, THE SAME PROCESS THAT WAS USED FOR THE CEO, WAS USED TO COMPARE THE SALARIES OF OTHER KEY EXECUTIVES. THE LAST COMPENSATION ANALYSIS WAS PERFORMED IN 2011. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION TO BEING AVAILABLE UPON REQUEST, CMC'S FORM 990 IS ALSO AVAILABLE ONLINE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 18,660,792. MANAGEMENT AND GENERAL EXPENSES 5,404,354. FUNDRAISING EXPENSES 10,122. TOTAL EXPENSES 24,075,268. PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 488,584. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 488,584. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST OF CMC FOUNDATION 709,025. CHANGE IN BENEFICIAL INTEREST OF PIHC 615,116. COMMUNITY MEDICAL CENTER FOUNDATION 2825 FORT MISSOULA ROAD MISSOULA MT 59804 363627205 TO PROVIDE FUNDING TO COMMUNITY MEDICAL CENTER HOSPITAL MT 501(C)(3) 7 COMMUNITY MEDICAL CENTER 1 MONTANA HEART ANGIO LAB LLC 2827 FORT MISSOULA ROAD MISSOULA MT 59804 810542065 CATH LAB MT COMMUNITY MEDICAL CENTER RELATED 1853244 2192708 0 0 0.92900 1 0 1 1 0 0 0 0 0 1 1 1 1 1 1 0 1 0 0 CMC FOUNDATION C 86645 FMV MONTANA HEART ANGIO LAB LLC A 94428 FMV MONTANA HEART ANGIO LAB LLC D 161573 FMV MONTANA HEART ANGIO LAB LLC J 97428 FMV MONTANA HEART ANGIO LAB LLC K 56070 FMV MONTANA HEART ANGIO LAB LLC L 117616 FMV MONTANA HEART ANGIO LAB LLC M 1684218 FMV MONTANA HEART ANGIO LAB LLC O 847775 FMV MONTANA HEART ANGIO LAB LLC Q 1867133 FMV