2015-11-05T16:24:57-06:00 2014-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1200 PORTLAND OR 97205 990 2014-01-01 810232122 BENEFIS HOSPITALS INC BENE 4064552563 1101 26TH STREET SOUTH GREAT FALLS MT 59405 TERRY OLINGER ACUTE CARE GROUP PRESIDENT 4064552563 2015-10-30 1 WENDY CAMPOS P00448102 5032421447 2014 2016-04-25 22:37:26Z TERRY OLINGER 1101 26TH STREET SOUTH GREAT FALLS MT 59405 767208158 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 530 BED HOSPITAL, PROVIDING INPATIENT AND OUTPATIENT SERVICES. 11 8 2843 685 330313 -47974 57089 1877047 764550230 762191606 6666822 456650 1901606 2031898 773175747 766557201 0 0 0 0 114195163 120491402 0 0 0 647079904 635749406 761275067 756240808 11900680 10316393 290921273 290629182 269945002 259332930 20976271 31296252 X WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 0 0 293647915 360206349 BENEFIS HOSPITALS, INC. OPERATES A 530 BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 355251838 360740325 BENEFIS HOSPITALS, INC. PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE HOSPITAL ALSO PROVIDES PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH A FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. ALSO PROVIDES SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY AND INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS AND RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART AND VASCULAR, SPORTS MEDICINE, MED SPA AND VEIN CENTER. 39070961 39321496 BENEFIS HOSPITALS, INC. PROVIDES HOSPICE AND SKILLED NURSING SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 687970714 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 138 0 1 2843 1 1 1 0 0 0 0 0 0 0 0 0 X 11 8 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X FORREST EHLINGER 4064555479 1101 26TH STREET SOUTH GREAT FALLS MT 59405 MARILYN ROSE CHAIR 2.00 X X 0 0 0 BILL FERRIN VICE CHAIR 2.00 X X 0 0 0 JUDY BORLAND MD DIRECTOR 2.00 X 0 0 0 CAL EKLUND DIRECTOR 2.00 X 0 0 0 DAVID ENGBRECHT MD DIRECTOR 2.00 X 0 0 0 BRYCE GRAFT DIRECTOR 2.00 4.00 X 0 0 0 SUSAN HUMBLE DIRECTOR 2.00 4.00 X 0 0 0 BRIAN LOUCKS DIRECTOR 2.00 X 0 0 0 LYLE J ONSTAD MD DIRECTOR 2.00 X 0 0 0 SENATOR EDWARD BUTTREY DIRECTOR 2.00 X 0 0 0 GREGORY S TIERNEY MD DIRECTOR 25.00 25.00 X 44317 294790 9011 CARI YTURRI 12014-32014 DIRECTOR 2.00 X 0 0 0 LAURA GOLDHAHN 12014-122014 HOSPITAL PRESIDENT 58.00 2.00 X X 801682 0 24410 PAUL DOLAN MD 12014-122014 CHIEF MEDICAL INFORMATION 58.00 2.00 X 403736 0 71643 JULIE HICKETHIER 12014-122014 CHIEF CLINICAL AND NURSING 60.00 X 336142 0 59386 DEBORAH STRATMAN 12014-122014 MEDICAL PHYSICIST 50.00 X 186218 0 17259 RAYN GINNATY VICE PRESIDENT, NURSING 50.00 X 181408 0 9681 CARL BRUESCH DIRECTOR OF BMG FINANCE 25.00 25.00 X 167601 0 14621 KATHY HILL DIRECTOR, BMG 25.00 25.00 X 166250 0 18574 ADAM ELLIOT MEDICAL PHYSICIST 50.00 X 163049 0 18446 2450403 294790 243031 61 0 1 0 ARAMARK 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 HEALTHCARE FACILITIES SERVICES 3335530 PRECYSE SOLUTIONS LLC DEPT 1736 BOX 11407 BIRMINGHAM AL 35246 MEDICAL RECORDS MANAGEMENT 3272232 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 FOOD SERVICES 2846635 ANESTHESIA ASSOCIATES 401 15TH AVE S STE 109 GREAT FALLS MT 59405 PHYSICIAN SERVICES 2273030 COGENT HEALTHCARE OF MONTANA PO BOX 645037 CINCINNATI OH 45264 PHYSICIAN SERVICES 2168479 49 76813 1800234 1877047 PATIENT SERVICES 621990 751099994 751099994 OTHER OPERATIONS 621990 9171110 9171110 CAFETERIA 722210 1920502 1920502 762191606 456906 456906 5000 0 5000 5000 5000 11043 11299 -256 -256 -256 1271996 639658 632338 330313 302025 VENDOR REBATES/DISCOUN 900099 1009763 1009763 JOINT VENTURE 621110 -2934 -2934 387731 387731 1394560 766557201 760268170 330313 4081671 2000798 1726555 274243 96599525 83362332 13237193 14878088 12832915 2045173 7012991 6124777 888214 11878 11878 56499754 43708147 12791607 28506 28506 65009422 63389148 1620274 11908888 6717940 5190948 875088 723729 151359 5352443 5352443 12169145 9751109 2418036 611772 611772 CONTRACTUAL ADJ/CHARITY 405215027 405215027 OTHER EXPENSES 54637022 30336418 24300604 BAD DEBT EXPENSE 23430461 23430461 756240808 687970714 68270094 0 -1201482 -2360699 196567569 188312856 50354 7130979 7680336 1093660 1804851 190087717 111816202 70179381 78271515 14807404 14706292 2343762 2163677 290921273 290629182 154277872 142921535 82100 113806280 110454047 1860850 5875248 269945002 259332930 X 20976271 31296252 20976271 31296252 290921273 290629182 X 10316393 654 2934 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 23705 55544 59467 19782 0 45491495 4433775 41057720 5978505 582688 5395817 137624232 106109594 31514638 993485 690145 303340 78271515 2007 BONDS D/S RESERVE FUND 8715007 F 2007 BONDS INTEREST RESERVE 2635441 F 2007 BONDS PRINCIPAL RESERVE 3355844 F 14706292 THIRD-PARTY SETTLEMENTS 5722224 OTHER LIABILITIES 153024 5875248 X PART IV, LINE 1B: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. EFFECTIVE JANUARY 1, 2009, THE ORGANIZATION ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2014 OR 2013. THE ORGANIZATION IS NO LONGER SUBJECT TO EXAMINATION BY U.S. FEDERAL AUTHORITIES FOR YEARS BEFORE 2011. 1 1 X 1 X 1 X 1 1 0 1 1 5521441 5521441 0.00750 5521441 5521441 0.00750 528877 528877 0.00070 94320 94320 0.00010 8075999 8075999 0.01100 128108 128108 0.00020 924672 924672 0.00130 9751976 9751976 0.01330 15273417 15273417 0.02080 5631 5631 0.00000 2700 2700 0.00000 95 95 0.00000 6000 6000 0.00000 28161 28161 0.00000 42587 42587 1 23430461 121229680 151105739 -29876059 X 1 1 1 TREASURE STATE HEALTHCARE NETWORK PREFERRED PROVIDER ORGANIZATION SERVING GREAT FALLS AND SURROUNDING AREAS 0.50000 0.00000 0.50000 2 1 BENEFIS HOSPITALS INC EAST CAMPUS 1101 26TH STREET SOUTH GREAT FALLS MT 59405 X X X A 2 BENEFIS HOSPITALS INC WEST CAMPUS 500 15TH AVENUE SOUTH GREAT FALLS MT 59405 X X A BENEFIS HOSPITALS INC 1 0 1 X X X X X X X X X 13 1 1 1 1 X HTTP://WWW.BENEFIS.ORG/MAIN/HEALTHSYSTEM.ASPX X 1 14 0 1 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X X X X X 1 X 0 X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: BENEFIS HOSPITALS, INC. EAST CAMPUS, - FACILITY 2: BENEFIS HOSPITALS, INC. WEST CAMPUS BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 5: BENEFIS HOSPITALS OBTAINED INPUT FROM COMMUNITY MEMBERS WHO REPRESENT A BROAD INTEREST OF THE COMMUNITY THROUGH THREE PRIMARY INITIATIVES: (1) BENEFIS HOSPITALS PROVIDED LEADERSHIP, IN CONJUNCTION WITH THE CASCADE COUNTY CITY-COUNTY HEALTH DEPARTMENT, TO A COMMUNITY-WIDE COALITION THAT PLANNED AND DESIGNED THE CHNA. THE COALITION WORKED TOGETHER FOR OVER 18 MONTHS TO DESIGN AND IMPLEMENT A COMMUNITY HEALTH SURVEY AND DEVELOP BOTH CHNA AND CHIP REPORTS. THE COALITION INCLUDED THE CENTER FOR MENTAL HEALTH; THE GREAT FALLS PUBLIC SCHOOL SYSTEM; GATEWAY SERVICES (FOR ALCOHOL AND DRUG ABUSE TREATMENT); THE INDIAN FAMILY HEALTH CLINIC; NORTHCENTRAL MONTANA HEALTHCARE ALLIANCE; PLANNED PARENTHOOD; AND UNITED WAY AMONG OTHER COMMUNITY GROUPS WITH A COMMITMENT TO PUBLIC HEALTH AND HEALTHY COMMUNITIES. (2) A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WHICH WAS DESIGNED AND SENT TO 664 HOUSEHOLDS WITH A RESPONSE FROM 122 HOUSEHOLDS IN AN EFFORT TO OBTAIN BROAD COMMUNITY RESIDENTS' INPUT. (3) IN MAY 17, 2013 A COMMUNITY TOWN HALL WAS CONDUCTED FOR 6 HOURS AND HAD 67 INDIVIDUALS REPRESENTING THE GENERAL COMMUNITY, BUT PRIMARILY COMMUNITY HEALTH-CONCERNED AGENCIES. THE INFORMATION FROM THE CHNA WAS PRESENTED AT THE MEETING AND DISCUSSED AND THE COMMUNITY GROUP CAME TO A CONSENSUS ON THE THREE HIGHEST COMMUNITY HEALTH PRIORITIES. THESE HEALTH PRIORITIES PROVIDED DIRECTION TO DEVELOP THE COMMUNITY HEALTH IMPROVEMENT PLAN AND RELATED STEERING COMMITTEES WHICH CONTINUE TO INVOLVE COMMUNITY AGENCIES IN ACCOMPLISHING PROGRESS IN THE THREE HEALTH PRIORITY AREAS: HEALTHY WEIGHT, SUBSTANCE ABUSE, AND ACCESS TO HEALTH CARE. BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 6A: LIBERTY MEDICAL CENTERNORTHERN MONTANA HEALTHCAREPHILLIPS COUNTY HOSPITALMARIAS MEDICAL CENTERNORTHERN ROCKIES MEDICAL CENTERBIG SANDY MEDICAL CENTERMISSOURI RIVER MEDICAL CENTERMOUNTAINVIEW MEDICAL CENTERTETON MEDICAL CENTERPONDERA MEDICAL CENTER BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 6B: LIBERTY MEDICAL CENTERNORTHERN MONTANA HEALTHCAREPHILLIPS COUNTY HOSPITALMARIAS MEDICAL CENTERNORTHERN ROCKIES MEDICAL CENTERBIG SANDY MEDICAL CENTERMISSOURI RIVER MEDICAL CENTERMOUNTAINVIEW MEDICAL CENTERTETON MEDICAL CENTERPONDERA MEDICAL CENTER BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 11: STEERING COMMITTEES FOR EACH OF THE THREE PRIORITY CHNA HEALTH PRIORITY AREAS WERE ESTABLISHED AND MET SEVERAL TIMES STARTING IN JUNE OF 2013. THE COMMITTEES INCLUDE: THE ACCESS TO CARE STEERING COMMITTEE; THE SUBSTANCE ABUSE STREEING COMMITTEE AND THE HEALTHY WEIGHT STEERING COMMITTEE. EACH COMMITTEE DEVELOPED GOALS AND OBJECTIVES FOR EACH OF THEIR AREAS AND ARE INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN. BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 22D: THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR CARE IS BASED ON 100% OF TOTAL PATIENT CHARGES BEFORE ANY ADJUSTMENTS OR WRITE-OFFS. 1 BENEFIS SLETTEN HI-LINE CANCER CENTER 40 13TH STREET WEST HAVRE MT 59501 CANCER TREATMENT CENTER PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 23,430,461. PART I, LINE 6A: AS REQUIRED BY MONTANA LAW, THE ORGANIZATION ANNUALLY SUBMITS A COMMUNITY BENEFIT REPORT TO THE MONTANA ATTORNEY GENERAL'S OFFICE, WHICH OVERSEES NONPROFIT CORPORATIONS IN THE STATE. IN 2013, THE ATTORNEY GENERAL'S OFFICE RELEASED TO THE PUBLIC ITS SIXTH ANNUAL REPORT ON THE CHARITABLE ACTIVITIES OF MONTANA HOSPITALS, INCLUDING THE TEN LARGEST HOSPITALS IN THE STATE (WITH THE ORGANIZATION AMONG THEM). THE ORGANIZATION ITSELF ALSO ANNUALLY PREPARES A SUMMARY COMMUNITY BENEFIT REPORT FOR PURPOSES OF EXPLANATION TO THE LOCAL PUBLIC, WHICH IS PUBLISHED IN THE FORM OF A POSTING IN THE LOCAL NEWSPAPER.PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED. PART III, LINE 4: THE ORGANIZATION'S FINANICAL STATEMENTS INCLUDE THE FOLLOWING NOTE REGARDING BAD DEBT EXPENSE: "THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS OR RESIDENTS DUE TO BAD DEBTS AND CHARITY CARE. MANAGEMENT CONSIDERS HISTORICAL WRITE-OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION." THE COSTING METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO. PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID SUBSTANTIALLY LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. PART III, LINE 9B: PERSONS DETERMINED TO BE ELIGIBLE FOR 100 % CHARITY CARE SHALL NOT RECEIVE A BILL FOR SERVICES OR BE SUBJECT TO COLLECTION PROCEDURES. PERSONS DETERMINED TO BE ELIGIBLE FOR A REDUCTION OF A PERCENTAGE OF CHARGES UNDER THE CHARITY CARE PROGRAM LESS THAN 100% SHALL NOT BE BILLED OR SUBJECT TO COLLECTION PROCEDURES FOR THE PORTION OF THE BILL THAT IS REDUCED UNDER THE SLIDING FEE SCALE, ONLY THE OUT OF POCKET RESPONSIBILITY. PART VI, LINE 2: BENEFIS HOSPITALS, INC. HISTORICALLY HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. THE HOSPITAL HAS ASSEMBLED A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO CONDUCTED A COMMUNITY NEEDS ASSESSMENT IN 2013, AS CONTEMPLATED BY NEWLY ENACTED IRC SECTION 501(R). PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND IS MAILED TO EACH PATIENT ALONG WITH THEIR BILLING STATEMENT. PART VI, LINE 4: THE ORGANIZATION'S SERVICE AREA IS APPROXIMATELY 45,000 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 225,000 PEOPLE. THE SERVICE AREA IS APPROXIMATELY 49.5% FEMALE AND 50.5% MALE. APPROXIMATELY 6.6% OF THE POPULATION IS UNDER 5 YEARS OF AGE, APPROXIMATELY 74% BETWEEN THE AGE OF 18 AND 65 YEARS OF AGE, AND APPROXIMATELY 14% OF THE POPULATION IS OVER THE AGE OF 65. THE SERVICE AREA IS 90.7% WHITE WITH THE NEXT LARGEST COMBINED POPULATION APPROXIMATELY 5.8% NATIVE AMERICAN AND THE REMAINDER AFRICAN-AMERICAN OR MULTIPLE RACES. THE AVERAGE HOUSEHOLD SIZE IS 2.4 PEOPLE, WITH APPROXIMATELY 92.4% OF ALL HOUSING UNITS BEING OWNER OCCUPIED. THE AVERAGE PER CAPITA INCOME IS $17,566 WITH THE MEDIAN HOUSEHOLD INCOME BEING $32,971. (US CENSUS BUREAU, 2000 DEMOGRAPHIC PROFILE) PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. PART VI, LINE 7, REPORTS FILED WITH STATES MT X X X X X 1 1 0 0 0 0 0 1 0 GREGORY S TIERNEY MD DIRECTOR 44317 189280 0 103070 0 2440 0 3520 0 5491 44317 303801 0 0 LAURA GOLDHAHN 12014-122014 HOSPITAL PRESIDENT 319577 0 81223 0 400882 0 18200 0 6210 0 826092 0 393176 0 PAUL DOLAN MD 12014-122014 CHIEF MEDICAL INFORMATION 274476 0 62252 0 67008 0 63704 0 7939 0 475379 0 67008 0 JULIE HICKETHIER 12014-122014 CHIEF CLINICAL AND NURSING 250779 0 29713 0 55650 0 53481 0 5905 0 395528 0 54350 0 DEBORAH STRATMAN 12014-122014 MEDICAL PHYSICIST 172100 0 0 0 14118 0 9388 0 7871 0 203477 0 0 0 RAYN GINNATY VICE PRESIDENT, NURSING 153245 0 28163 0 0 0 9221 0 460 0 191089 0 0 0 CARL BRUESCH DIRECTOR OF BMG FINANCE 131847 0 35754 0 0 0 6779 0 7842 0 182222 0 0 0 KATHY HILL DIRECTOR, BMG 137425 0 28825 0 0 0 8775 0 9799 0 184824 0 0 0 ADAM ELLIOT MEDICAL PHYSICIST 163049 0 0 0 0 0 8615 0 9831 0 181495 0 0 0 PART I, LINES 4A-B DEBORAH STRATMAN WAS PAID A SEVERANCE PAYMENT IN 2014 OF $14,118. BENEFIS HEALTH SYSTEM, INC PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR MS. GOLDHAHN, DR. DOLAN AND MS. HICKETHIER. PART I, LINE 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM (INCLUDING MS. GOLDHAHN, MS. HICKETHIER, AND DR. DOLAN), AND IS SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. IN 2010, THE SYSTEM ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, FINANCE/OPERATIONS, AND COMMUNITY BENEFIT. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED IN 2010 ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY INDIVIDUAL PERFORMANCE. IN ADDITION, THE SYSTEM MUST HAVE MAINTAINED SATISFACTORY OVERALL PERFORMANCE, BASED ON BOTH FINANCIAL CRITERIA AND SATISFACTION OF EMPLOYEES, PATIENTS AND PHYSICIANS. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. A MONTANA FACILITY FINANCE AUTHORITY 810302402 2007-04-10 129048928 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 A 16375000 129048928 8633769 4169 2500000 2395619 96568150 18947222 2009 0 1 0 0 A 0 0 1 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 1 A 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MONTANA FACILITY FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 JAIMEE GREGOIRE FAMILY MEMBER OF BOARD MEMBER 35636 COMPENSATION 0 DANIELLE TIERNEY FAMILY MEMBER OF BOARD MEMBER 40999 COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1B: THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NONPROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO APPROVE THE ELECTION OF INDIVIDUALS TO ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS'S OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS PROVIDES THESE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT OPERATING ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES - INFORMATION SYSTEMS COORDINATION - OVERSEES QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGES REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT THE BOARD OF DIRECTORS OF BHS ALSO OVERSEES ALL OF THE ORGANIZATION'S BOARD ACTIVITIES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NON-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE ORGANIZATION IS ELECTED BY BENEFIS HEALTH SYSTEM, INC. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 INCLUDING SCHEDULE B WAS DISTRIBUTED TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS, WITH A PRESENTATION TO SUCH BOARD BY THE ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE PRESIDENT, THE CHIEF CLINICAL AND NURSING OFFICER, AND THE CHIEF MEDICAL INFORMATION AND MEDICAL OFFICER WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILARLY-SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 BENEFIS HOSPITALS, INC. PROVIDES COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. FORM 990, PART XI, LINE 9: TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA PHYSICIANS 2,934. 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