BILLINGS CLINIC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: BILLINGS CLINIC (EIN 81-0231784)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-05-12
IRS object ID: 201401339349300445
Schema version: 2012v2.0
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-05-12T12:36:38-07:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	810231784	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	BILLINGS CLINIC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	BILL	NameControl
Phone	4062382500	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2800 Tenth Avenue North	AddressLine1
City	Billings	City
State	MT	State
ZIP Code	59101	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	Connie F Prewitt	Name
Title	CFO	Title
Phone	4062382134	Phone
Date Signed	2014-05-15	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Nicholas Wolter MD	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	2800 Tenth Avenue North	AddressLine1
City	Billings	City
State	MT	State
ZIP Code	59101	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	1344358616	GrossReceipts
Group Return For Affiliates	0	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	billingsclinic.com	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1907	YearFormation
State Legal Domicile	MT	StateLegalDomicile
Activity Or Mission Description	Billings Clinic will be a national leader in providing the best clinical quality, patient safety, service and value.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	4100	TotalNbrEmployees
Total Nbr Volunteers	296	TotalNbrVolunteers
Total Gross UBI	8920410	TotalGrossUBI
Net Unrelated Business Txbl Income	1303592	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	3948921	ContributionsGrantsPriorYear
Contributions Grants Current Year	6635189	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	534476077	ProgramServiceRevenuePriorYear
Program Service Revenue CY	543532933	ProgramServiceRevenueCY
Investment Income Prior Year	9447693	InvestmentIncomePriorYear
Investment Income Current Year	6855638	InvestmentIncomeCurrentYear
Other Revenue Prior Year	11282122	OtherRevenuePriorYear
Other Revenue Current Year	3171645	OtherRevenueCurrentYear
Total Revenue Prior Year	559154813	TotalRevenuePriorYear
Total Revenue Current Year	560195405	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	0	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	281545875	SalariesEtcPriorYear
Salaries Etc Current Year	299067297	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	238719332	OtherExpensePriorYear
Other Expenses Current Year	246649815	OtherExpensesCurrentYear
Total Expenses Prior Year	520265207	TotalExpensesPriorYear
Total Expenses Current Year	545717112	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	38889606	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	14478293	RevenuesLessExpensesCY
Total Assets BOY	589973650	TotalAssetsBOY
Total Assets EOY	614621362	TotalAssetsEOY
Total Liabilities BOY	264809291	TotalLiabilitiesBOY
Total Liabilities EOY	260318573	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	325164359	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	354302789	NetAssetsOrFundBalancesEOY
Mission Description	Billings Clinic is a not-for-profit, physician-led, multispecialty medical group practice integrated with a hospital and long term care faciltiy, serving the communities of Montana, northern Wyoming and the western Dakotas. Our mission is health care, education and research.	MissionDescription
Significant New Program Services	0	SignificantNewProgramServices
Significant Change	0	SignificantChange
Expense	201132016	Expense
Grants	0	Grants
Revenue	313539193	Revenue
Description	Hospital patient care Inpatient days 68,894	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	191662660	Expense
Grants	0	Grants
Revenue	203683575	Revenue
Description	Clinic patient care Encounters 896,635	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	8785088	Expense
Grants	0	Grants
Revenue	7571224	Revenue
Description	Nursing home patient care Skilled and assisted days 38,011	Description

Activity Other ActivityOther

Field	Value	IRS element (for citing)
Expense	7166922	Expense
Grants	0	Grants
Revenue	18738941	Revenue
Description	See Schedule O, statement 1	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	7166922	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	0	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	18738941	TotalOfOtherProgramServiceRev
Total Program Service Expense	408746686	TotalProgramServiceExpense
Described In501 C3	1	DescribedIn501C3
Schedule B Required	1	ScheduleBRequired
Political Activities	0	PoliticalActivities
Lobbying Activities	1	LobbyingActivities
Subject To Proxy Tax	0	SubjectToProxyTax
Donor Advised Funds	0	DonorAdvisedFunds
Conservation Easements	0	ConservationEasements
Collections Of Art	0	CollectionsOfArt
Credit Counseling	0	CreditCounseling
Term Or Permanent Endowments	1	TermOrPermanentEndowments
Report Land Bldg Equip	1	ReportLandBldgEquip
Report Invest Oth Securities	0	ReportInvestOthSecurities
Report Prog Rel Invest	0	ReportProgRelInvest
Report Other Assets	1	ReportOtherAssets
Report Other Liabilities	1	ReportOtherLiabilities
Report Fin48 Footnote	0	ReportFin48Footnote
Independent Audit Financial Stmt	1	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	1	ConsolidatedAuditFinancialStmt
School	0	School
Foreign Office	0	ForeignOffice
Foreign Activities	0	ForeignActivities
More Than5000 K To Organizations	0	MoreThan5000KToOrganizations
More Than5000 K To Individuals	0	MoreThan5000KToIndividuals
Professional Fundraising	0	ProfessionalFundraising
Fundraising Activities	0	FundraisingActivities
Gaming	0	Gaming
Hospital	1	Hospital
Financial Stmt Attached	1	FinancialStmtAttached
Grants To Organizations	0	GrantsToOrganizations
Grants To Individuals	0	GrantsToIndividuals
Schedule J Required	1	ScheduleJRequired
Tax Exempt Bonds	1	TaxExemptBonds
Invest Tax Exempt Bonds	0	InvestTaxExemptBonds
Escrow Account	0	EscrowAccount
On Behalf Of Issuer	0	OnBehalfOfIssuer
Excess Benefit Transaction	0	ExcessBenefitTransaction
Prior Excess Benefit Transaction	0	PriorExcessBenefitTransaction
Loan To Officer Or DQP	0	LoanToOfficerOrDQP
Grant To Related Person	0	GrantToRelatedPerson
Bsnss Rltnshp With Organization	0	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	0	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	0	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	0	DeductibleNonCashContributions
Deductible Contributions Of Art	0	DeductibleContributionsOfArt
Terminated	0	Terminated
Partial Liquidation	0	PartialLiquidation
Disregarded Entity	1	DisregardedEntity
Related Entity	1	RelatedEntity
Related Org Controlled Entity	1	RelatedOrgControlledEntity
Transaction Related Entity	1	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	0	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	0	ActivitiesConductedPartnership
Schedule O Required	1	ScheduleORequired
Number Forms Transmitted With1096	238	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	1	ComplianceWithBackupWitholding
Number Of Employees	4100	NumberOfEmployees
Employment Tax Returns Filed	1	EmploymentTaxReturnsFiled
Unrelated Business Income	1	UnrelatedBusinessIncome
Form990-T Filed	1	Form990-TFiled
Foreign Financial Account	0	ForeignFinancialAccount
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTrans
Taxable Party Notification	0	TaxablePartyNotification
Non Deductible Contributions	0	NonDeductibleContributions
Quid Pro Quo Contributions	0	QuidProQuoContributions
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOf
Funds To Pay Premiums	0	FundsToPayPremiums
Premiums Paid	0	PremiumsPaid
Indoor Tanning Services	0	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	0	FamilyOrBusinessRelationship
Delegation Of Management Duties	0	DelegationOfManagementDuties
Changes To Organizing Docs	0	ChangesToOrganizingDocs
Material Diversion Or Misuse	0	MaterialDiversionOrMisuse
Members Or Stockholders	0	MembersOrStockholders
Election Of Board Members	0	ElectionOfBoardMembers
Decisions Subject To Approval	0	DecisionsSubjectToApproval
Minutes Of Governing Body	1	MinutesOfGoverningBody
Minutes Of Committees	1	MinutesOfCommittees
Officer Mailing Address	0	OfficerMailingAddress
Local Chapters	0	LocalChapters
Form990 Provided To Governing Body	1	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	1	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	1	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	1	RegularMonitoringEnforcement
Whistleblower Policy	1	WhistleblowerPolicy
Document Retention Policy	1	DocumentRetentionPolicy
Compensation Process CEO	1	CompensationProcessCEO
Compensation Process Other	1	CompensationProcessOther
Investment In Joint Venture	0	InvestmentInJointVenture
States Where Copy Of Return Is Filed	CA	StatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is Filed	MT	StatesWhereCopyOfReturnIsFiled
States Where Copy Of Return Is Filed	NC	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	Connie F Prewitt	NamePerson
Telephone Number	4062382134	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2800 Tenth Avenue North	AddressLine1
City	Billings	City
State	MT	State
ZIP Code	59101	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
D Brown
Board member	5	X	0	0	6923
D Ehrlick
Board member	3	X	0	0	9458
E Fulton
Board member	8	X	0	0	6342
T Hathaway
Board member	2	X	0	0	4860
L Knight
Board member	5	X	21958	0	10143
P Nance
Board member	30	X	6000	0	0
J Ott
Board member	3	X	0	0	6713
A Sparboe
Board member	8	X	0	0	3011
M Valandra
Board member	3	X	0	0	3011
Dr C McCracken
Board member/physician	72	X	332834	0	36950
Dr J Millikan
Board member/physician	70	X	605508	0	42973
Dr N Wolter
CEO	75		1091626	0	36775	X
C Prewitt
CFO	70		405315	0	60862	X
Dr Sample
Interventional cardiologist	110		1089184	0	36754		X
Dr Gibb
Gynecologic oncologist	85		899740	0	35122		X
Dr Santala
Oncologist/hemotologist	64.00		836135	0	34574		X
Dr Jones
Dermatologic surgeon	50		776740	0	34062		X
Dr Goulet
Radiation oncologist	65		774759	0	34045		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	6839799	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	0	TotalReportableCompFrmRltdOrgs
Total Other Compensation	402578	TotalOtherCompensation
Number Individuals GT100 K	367	NumberIndividualsGT100K
Formers Listed	0	FormersListed
Total Comp GT150 K	1	TotalCompGT150K
Compensation From Other Sources	0	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation	Address Line2AddressOfContractor/AddressUS/AddressLine2
Sodexo
C/O Billings Clinic	Billings	MT	59101	Patient food service	5382550
Weatherby Locums Inc
PO Box 972633	Dallas	TX	75397	Professional staffing	2650717
Command Health
Box 844797	Dallas	TX	75284	Transcription services	1936593
Healthcare Resource Group
12610 E Mirabeau Parkway	Spokane Valley	WA	99216	AR staffing and collection	1598499
Healthcare Outsourcing Network
621 17th St	Denver	CO	80293	Early out vendor	1272929	Suite 1800

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	50	NumberOfContractorsGT100K
Federated Campaigns	0	FederatedCampaigns
Membership Dues	0	MembershipDues
Fundraising Events	0	FundraisingEvents
Related Organizations	6635189	RelatedOrganizations
Government Grants	0	GovernmentGrants
All Other Contributions	0	AllOtherContributions
Noncash Contributions	0	NoncashContributions
Total Contributions	6635189	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue	ExclusionExclusionAmount
Patient service revenue	622000	533902537	533902537	0	$0
Optical shop/cosmetics	446130	725706	0	725706	$0
Reference lab	621500	3564694	0	3564694	$0
IT services to other hospitals	541519	4553963	0	4553963	$0
Partnership Income related to Group Purchasing Program Services	541900	786033	763131	22902	$0

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	543532933	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	6335632	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	53145	UnrelatedBusinessRevenue
Exclusion	$6,282,487	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	65609	Real
Personal	0	Personal

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	52112	Real
Personal	0	Personal

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	13497	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	13497	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$13,497	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	784260486	Securities
Other	11446	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Securities	783460769	Securities
Other	291157	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	799717	Securities
Other	-279711	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	520006	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$520,006	ExclusionAmount

Field	Value	IRS element (for citing)
Cntrbtns Rprtd Fundraising Events	0	CntrbtnsRprtdFundraisingEvents
Gross Sales Of Inventory	494310	GrossSalesOfInventory
Cost Of Goods Sold	359173	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	135137	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$135,137	ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	ExclusionExclusionAmount
Insurance premiums	524298	4605504	4605504	$0
Meaningful use	922190	4329500	4329500	$0
Share of joint ventures	621300	-6553748	-6553748	$0

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	641755	TotalRevenueColumn
Related Or Exempt Function Income	641755	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	3023011	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	560195405	TotalRevenueColumn
Related Or Exempt Function Income	537688679	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	8920410	UnrelatedBusinessRevenue
Exclusion	$6,951,127	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	2616066	Total
Program Services	0	ProgramServices
Management And General	2616066	ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	245720362	Total
Program Services	197871716	ProgramServices
Management And General	47848646	ManagementAndGeneral
Fundraising	0	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	11319179	Total
Program Services	9331533	ProgramServices
Management And General	1987646	ManagementAndGeneral
Fundraising	0	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	24125584	Total
Program Services	17215872	ProgramServices
Management And General	6909712	ManagementAndGeneral
Fundraising	0	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	15286106	Total
Program Services	11909263	ProgramServices
Management And General	3376843	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1056663	Total
Program Services	0	ProgramServices
Management And General	1056663	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	183885	Total
Program Services	0	ProgramServices
Management And General	183885	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	219228	Total
Program Services	0	ProgramServices
Management And General	219228	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	925033	Total
Program Services	0	ProgramServices
Management And General	925033	ManagementAndGeneral
Fundraising	0	Fundraising

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	38510684	Total
Program Services	10441544	ProgramServices
Management And General	28069140	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1171837	Total
Program Services	87413	ProgramServices
Management And General	1084424	ManagementAndGeneral
Fundraising	0	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	96313971	Total
Program Services	91737287	ProgramServices
Management And General	4576684	ManagementAndGeneral
Fundraising	0	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	10470656	Total
Program Services	1147938	ProgramServices
Management And General	9322718	ManagementAndGeneral
Fundraising	0	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	6152862	Total
Program Services	2533768	ProgramServices
Management And General	3619094	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	2762854	Total
Program Services	1791956	ProgramServices
Management And General	970898	ManagementAndGeneral
Fundraising	0	Fundraising

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	433768	Total
Program Services	141755	ProgramServices
Management And General	292013	ManagementAndGeneral
Fundraising	0	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	6958268	Total
Program Services	7693	ProgramServices
Management And General	6950575	ManagementAndGeneral
Fundraising	0	Fundraising

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	17491870	Total
Program Services	14378004	ProgramServices
Management And General	3113866	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	10110816	Total
Program Services	4916452	ProgramServices
Management And General	5194364	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
Recruitment	1918192	4478	1913714
Repairs	6768785	5443110	1325675
Bad debts	37166854	37051759	115095
Bed tax	3601180	285130	3316050

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4432409	Total
Program Services	2450015	ProgramServices
Management And General	1982394	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	545717112	Total
Program Services	408746686	ProgramServices
Management And General	136970426	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	7002784	BOY
EOY	8945209	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	73859885	BOY
EOY	29900621	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	74742299	BOY
EOY	80362618	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	8517044	BOY
EOY	197650	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	6952922	BOY
EOY	7647986	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	4750002	BOY
EOY	5580587	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	424018696	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	220611405	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	189709750	BOY
EOY	203407291	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	180956748	BOY
EOY	231541353	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	7943998	BOY
EOY	8156365	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	2406842	BOY
EOY	2251431	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	33131376	BOY
EOY	36630251	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	589973650	BOY
EOY	614621362	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	44511964	BOY
EOY	48609875	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	168955000	BOY
EOY	165690000	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	3986222	BOY
EOY	3221006	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	47356105	BOY
EOY	42797692	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	264809291	BOY
EOY	260318573	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	297619748	BOY
EOY	322877269	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	7891423	BOY
EOY	10853070	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	19653188	BOY
EOY	20572450	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	325164359	BOY
EOY	354302789	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	589973650	BOY
EOY	614621362	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	14478293	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	14618721	ReconciliationUnrealizedInvest
Reconcilation Donated Services	0	ReconcilationDonatedServices
Reconcilation Invest Expenses	0	ReconcilationInvestExpenses
Reconcilation Prior Adjustment	0	ReconcilationPriorAdjustment
Reconcilation Other Changes	41416	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	0	AccountantCompileOrReview
FS Audited	1	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Both	X	FinancialStatementBoth

Field	Value	IRS element (for citing)
Audit Committee	1	AuditCommittee
Federal Grant Audit Required	0	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Total Grassroots Lobbying TotalGrassrootsLobbying

Field	Value	IRS element (for citing)
Filing Organizations Totals	0	FilingOrganizationsTotals

Total Direct Lobbying TotalDirectLobbying

Field	Value	IRS element (for citing)
Filing Organizations Totals	219228	FilingOrganizationsTotals

Total Lobbying Expenditures TotalLobbyingExpenditures

Field	Value	IRS element (for citing)
Filing Organizations Totals	219228	FilingOrganizationsTotals

Other Exempt Purpose Expenditures OtherExemptPurposeExpenditures

Field	Value	IRS element (for citing)
Filing Organizations Totals	545497888	FilingOrganizationsTotals

Total Exempt Purpose Expenditures TotalExemptPurposeExpenditures

Field	Value	IRS element (for citing)
Filing Organizations Totals	545717116	FilingOrganizationsTotals

Lobbying Nontaxable LobbyingNontaxableAmount

Field	Value	IRS element (for citing)
Filing Organizations Totals	1000000	FilingOrganizationsTotals

Grassroots Nontaxable GrassrootsNontaxableAmount

Field	Value	IRS element (for citing)
Filing Organizations Totals	250000	FilingOrganizationsTotals

Tot Lobbying Grassroot Minus Non Tx TotLobbyingGrassrootMinusNonTx

Field	Value	IRS element (for citing)
Filing Organizations Totals	0	FilingOrganizationsTotals

Tot Lobby Expend Mns Lobbying Nontx TotLobbyExpendMnsLobbyingNontx

Field	Value	IRS element (for citing)
Filing Organizations Totals	0	FilingOrganizationsTotals

Lobbying Nontaxable Amount2 LobbyingNontaxableAmount2

Field	Value	IRS element (for citing)
Current Year Minus3	1000000	CurrentYearMinus3
Current Year Minus2	1000000	CurrentYearMinus2
Current Year Minus1	1000000	CurrentYearMinus1
Current Year	1000000	CurrentYear
Total	4000000	Total

Field	Value	IRS element (for citing)
Lobbying Ceiling	$6,000,000	LobbyingCeilingAmount

Total Lobbying Expenditures2 TotalLobbyingExpenditures2

Field	Value	IRS element (for citing)
Current Year Minus3	21245	CurrentYearMinus3
Current Year Minus2	37524	CurrentYearMinus2
Current Year Minus1	82631	CurrentYearMinus1
Current Year	219228	CurrentYear
Total	360628	Total

Grassroots Nontaxable Amount2 GrassrootsNontaxableAmount2

Field	Value	IRS element (for citing)
Current Year Minus3	250000	CurrentYearMinus3
Current Year Minus2	250000	CurrentYearMinus2
Current Year Minus1	250000	CurrentYearMinus1
Current Year	250000	CurrentYear
Total	1000000	Total

Field	Value	IRS element (for citing)
Grassroots Ceiling	$1,500,000	GrassrootsCeilingAmount

Grassroots Lobbying Expenditures GrassrootsLobbyingExpenditures

Field	Value	IRS element (for citing)
Current Year Minus3	0	CurrentYearMinus3
Current Year Minus2	0	CurrentYearMinus2
Current Year Minus1	0	CurrentYearMinus1
Current Year	0	CurrentYear
Total	0	Total

Schedule D IRS990ScheduleD

Current Year CurrentYear

Field	Value	IRS element (for citing)
Beginning Of Year Balance	21981852	BeginningOfYearBalance
Contributions	415028	Contributions
Investment Earnings Or Losses	1054443	InvestmentEarningsOrLosses
Grants Or Scholarships	204010	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	-12633	AdministrativeExpenses
End Of Year Balance	23259946	EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

Field	Value	IRS element (for citing)
Beginning Of Year Balance	21026911	BeginningOfYearBalance
Contributions	246728	Contributions
Investment Earnings Or Losses	724344	InvestmentEarningsOrLosses
Grants Or Scholarships	44349	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	-28218	AdministrativeExpenses
End Of Year Balance	21981852	EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	19640069	BeginningOfYearBalance
Contributions	605720	Contributions
Investment Earnings Or Losses	781122	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	21026911	EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	18575246	BeginningOfYearBalance
Contributions	665198	Contributions
Investment Earnings Or Losses	399625	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	19640069	EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

Field	Value	IRS element (for citing)
Beginning Of Year Balance	1781249	BeginningOfYearBalance
Contributions	1048699	Contributions
Investment Earnings Or Losses	-197238	InvestmentEarningsOrLosses
Grants Or Scholarships	0	GrantsOrScholarships
Other Expenditures	0	OtherExpenditures
Administrative Expenses	0	AdministrativeExpenses
End Of Year Balance	2632710	EndOfYearBalance

Field	Value	IRS element (for citing)
Board Designated EOY Balance	0.02	BoardDesignatedEOYBalance
Permanent Endowment EOY Balance	0.88	PermanentEndowmentEOYBalance
Term Endowment EOY Balance	0.1	TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs	0	EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs	1	EndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule R	1	AreRelatedOrgsListedScheduleR

Land Land

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	17998001	OtherCostOrOtherBasis
Book Value	17998001	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	152501853	OtherCostOrOtherBasis
Depreciation	66788330	Depreciation
Book Value	85713523	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	1726153	OtherCostOrOtherBasis
Depreciation	1268803	Depreciation
Book Value	457350	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	206852299	OtherCostOrOtherBasis
Depreciation	144078461	Depreciation
Book Value	62773838	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Investment Cost Or Other Basis	0	InvestmentCostOrOtherBasis
Other Cost Or Other Basis	44940390	OtherCostOrOtherBasis
Depreciation	8475811	Depreciation
Book Value	36464579	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	203407291	TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescription	Book ValueBookValue
Note receivable New West	18653742
Interest in assets of New West	-21799882
Interest in assets of Billings Clinic Foundation	39776391

Field	Value	IRS element (for citing)
Total Book Value Other Assets	36630251	TotalBookValueOtherAssets
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
Swap valuation	$24,283,307
Provision for unpaid claims	$11,367,934
Estimated claims	$7,146,451

Field	Value	IRS element (for citing)
Total Of Amounts	42797692	TotalOfAmounts
Footnote In Part XIII	X	FootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt	529936691	TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments	14618722	NetUnrealizedGainsInvestments
Donated Srvc And Use Of Facilities	0	DonatedSrvcAndUseOfFacilities
Recoveries Of Prior Year Grants	0	RecoveriesOfPriorYearGrants
Other Revenues	0	OtherRevenues
Revenue Not Rptd F990	14618722	RevenueNotRptdF990
Revenue Subtotal	515317969	RevenueSubtotal
Investment Expenses Not Included	925033	InvestmentExpensesNotIncluded
Other Revenues Not Included	43952403	OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt	44877436	RevenueNotRptdOnFinStmt
Total Revenue Per Form990	560195405	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	500277744	TotExpensesEtcAuditedFinclStmt
Donated Services Use Of Facilities	0	DonatedServicesUseOfFacilities
Prior Year Adjustments	0	PriorYearAdjustments
Losses Reported	0	LossesReported
Other Expenses Included	0	OtherExpensesIncluded
Expenses Not Rptd F990	0	ExpensesNotRptdF990
Expenses Subtotal	500277744	ExpensesSubtotal
Investment Expenses Not Included2	925033	InvestmentExpensesNotIncluded2
Other Expenses Not Included	44514335	OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt	45439368	ExpensesNotRptdOnFinStmt
Total Expenses Per Form990	545717112	TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchD_P05_S00_L04	Schedule D, Part V, Line 4	Endowment funds are invested and held in perpetuity to provide a source of income for Billings Clinic programs and needs.
SchD_P10_S00_L02	Schedule D, Part X, Line 2	Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosd in the financials statements.
SchD_P11_S00_L04b	Schedule D, Part XI, Line 4b	Bad debt, MHI, Auxiliary, Elimination entries, Rounding
SchD_P12_S00_L04b	Schedule D, Part XII, Line 4b	Bad debts, MHI, Auxiliary, Elimination entries, Rounding

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	1	CharityCarePolicy
Written Policy	1	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	1	FPGReferenceFreeCare

Other Percentage OtherPercentage

Field	Value	IRS element (for citing)
Other	X	Other
Free Other Percentage	1.20	FreeOtherPercentage

Field	Value	IRS element (for citing)
FPG Reference Discounted Care	1	FPGReferenceDiscountedCare
Pcent300	X	Pcent300
Free Disc Care Medically Indigent	1	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	1	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	1	ExpensesExceededBudget
Unable To Provide Care	0	UnableToProvideCare
Annual Community Benefit Report	1	AnnualCommunityBenefitReport
Report Publically Available	1	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	40388	PersonsServed
Total Community Benefit Expense	15819027	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	15819027	NetCommunityBenefitExpense
Percent Of Total Expense	0.0311	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	100341	PersonsServed
Total Community Benefit Expense	42724248	TotalCommunityBenefitExpense
Direct Offsetting Revenue	39738305	DirectOffsettingRevenue
Net Community Benefit Expense	2985943	NetCommunityBenefitExpense
Percent Of Total Expense	0.0059	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	140729	PersonsServed
Total Community Benefit Expense	58543275	TotalCommunityBenefitExpense
Direct Offsetting Revenue	39738305	DirectOffsettingRevenue
Net Community Benefit Expense	18804970	NetCommunityBenefitExpense
Percent Of Total Expense	0.0370	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Persons Served	122087	PersonsServed
Total Community Benefit Expense	2900529	TotalCommunityBenefitExpense
Direct Offsetting Revenue	500637	DirectOffsettingRevenue
Net Community Benefit Expense	2399892	NetCommunityBenefitExpense
Percent Of Total Expense	0.0047	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Persons Served	1843	PersonsServed
Total Community Benefit Expense	3953134	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1172640	DirectOffsettingRevenue
Net Community Benefit Expense	2780494	NetCommunityBenefitExpense
Percent Of Total Expense	0.0055	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Persons Served	158133	PersonsServed
Total Community Benefit Expense	42699568	TotalCommunityBenefitExpense
Direct Offsetting Revenue	32951096	DirectOffsettingRevenue
Net Community Benefit Expense	9748472	NetCommunityBenefitExpense
Percent Of Total Expense	0.019	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Persons Served	11974	PersonsServed
Total Community Benefit Expense	1698011	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1364	DirectOffsettingRevenue
Net Community Benefit Expense	1696647	NetCommunityBenefitExpense
Percent Of Total Expense	0.0033	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Persons Served	200	PersonsServed
Total Community Benefit Expense	439080	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	439080	NetCommunityBenefitExpense
Percent Of Total Expense	0.0009	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	294237	PersonsServed
Total Community Benefit Expense	51690322	TotalCommunityBenefitExpense
Direct Offsetting Revenue	34625737	DirectOffsettingRevenue
Net Community Benefit Expense	17064585	NetCommunityBenefitExpense
Percent Of Total Expense	0.0334	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	434966	PersonsServed
Total Community Benefit Expense	110233597	TotalCommunityBenefitExpense
Direct Offsetting Revenue	74364042	DirectOffsettingRevenue
Net Community Benefit Expense	35869555	NetCommunityBenefitExpense
Percent Of Total Expense	0.0704	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Total Community Building Expense	23022	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	23022	NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Persons Served	100	PersonsServed
Total Community Building Expense	12470	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	12470	NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Persons Served	380	PersonsServed
Total Community Building Expense	55457	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	55457	NetCommunityBuildingExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	480	PersonsServed
Total Community Building Expense	90949	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	90949	NetCommunityBuildingExpense
Percent Of Total Expense	0	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	0	BadDebtExpenseReported
Bad Debt Expense	$37,166,854	BadDebtExpenseAmount
Amount Attributable To	22309836	AmountAttributableTo
Amount Reimbursed By Medicare	157742850	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	182832600	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-25089750	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	1	WrittenDebtCollectionPolicy
Provision For Charity Care	1	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Billings Clinic (Billings Clinic Hospital)	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	2800 Tenth Avenue North	AddressLine1
City	Billings	City
State	MT	State
ZIP Code	59101	ZIPCode

Field	Value	IRS element (for citing)
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Teaching Hospital	X	TeachingHospital
Research Facility	X	ResearchFacility
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Billings Clinic (Billings Clinic Hospital)	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	1	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Needs Assessment Conducted	11	NeedsAssessmentConducted
Take Into Account	1	TakeIntoAccount
Other Facilities	1	OtherFacilities
CHNA Widely Available	1	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Other Method	X	OtherMethod
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Participate Community Plan	X	ParticipateCommunityPlan
Include Operational Plans	X	IncludeOperationalPlans
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	0	AllNeedsAddressed
Organization Incur Excise Tax	0	OrganizationIncurExciseTax
Eligibility Criteria Explained	1	EligibilityCriteriaExplained
Uses FPG Free	1	UsesFPGFree
FPG Free Percent	120	FPGFreePercent
Uses FPG Discounted	1	UsesFPGDiscounted
FPG Discount Percent	300	FPGDiscountPercent
Explains Basis	1	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Uninsured Discount	X	UninsuredDiscount
Medicaid Medicare	X	MedicaidMedicare
Explains Application Method	1	ExplainsApplicationMethod
Includes Publicity Measures	1	IncludesPublicityMeasures
Available On Request	X	AvailableOnRequest
Other Publicity	X	OtherPublicity
Actions On Nonpayment	1	ActionsOnNonpayment
Collection Activities	0	CollectionActivities
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	1	NondiscrimEmergencyCarePolicy
Average Negotiated Rates	X	AverageNegotiatedRates
Amounts Generally Billed	0	AmountsGenerallyBilled
Gross Charges	0	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	4	NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
Billings Clinic (Billings Clinic)
2800 Tenth Avenue North	Billings	MT	59101	Multispeciality physician outpatient clinics
Billings Clinic (Aspen Meadows)
3155 Avenue C	Billings	MT	59102	Long term care facility
Livingston Imaging
504 S 13th St	Livingston	MT	59047	Medical imaging
Billings Clinic Sheridan Dialysis
1401 West 5th St	Sheridan	WY	82801	Dialysis unit

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchH_P01_S00_L03c	Schedule H, Part I, Line 3c	The Federal Poverty Guidelines (FPG) are utilized to determine eligibility. In addition to FPG, Billings Clinic utilizes a calculator that has built-in formulas for the FPG and the cost of living within our area to help determine the patient's ability to pay. Our application requires submitting bank statement and investment account information to consider assets as part of the process. The application includes: o Completed and signed application and financial assistance checklist completed. o Letter of need completed. o Complete copies of previous years federal and state tax returns, all pages, all schedules, all W-2's. o Debt to income ratio o Type of employment (part/time, seasonal, etc.) o Copies of earnings for last three months for each person in the household, i.e., paystubs, social security, pensions, unemployment benefits, etc. Profit and Loss statement for self employed applicants. o Copies of last three months bank statements, savings statements, investment account statements. o Letters of support from assisting party if household is receiving assistance from family and/or friends. o Award letters from SNAP, LIEAP, TANF, college loans, general assistance, etc. o If currently unemployed, when was last day of work? o How they spend their income (Information from bank statements). In April of 2013, Billings Clinic implemented a new Financial Assistance Form that was created to incorporate the guidelines for presumptive eligibility (New Policy approved in FY12) and improve readability for persons needing assistance. Presumptive eligibility means that if a person (or household) proves currently qualified for a means-tested (income-based) program, we presume they are eligible for our financial assistance program. Patient shows proof and signs our form but does not fill out detailed financial information. The following programs have income criteria for eligibility that are similar to our criteria for financial assistance and will help qualify a patient for financial assistance (with proof of eligibility): * Supplemental Nutrition Assistance Program (SNAP) * Women, Infants and Children programs * Subsidized/low income housing * Low income energy assistance program * State-funded low income prescription programs * Homeless, or receiving care from a homeless clinic
SchH_P01_S00_L07	Schedule H, Part I, Line 7	Billings Clinic calculated the approval rate of financial applications by taking the value of accounts successfully qualified for charity (including presumptive eligibility) divided by the total applications for financial assistance received. That approval rate was then applied to the total value of accounts that did not complete financial assistance applications and were assigned to bad debt. Billings Clinic used the same cost to charge ratio as applied throughout the entire schedule to determine the cost of those accounts.
SchH_P01_S00_L07g	Schedule H, Part I, Line 7g	Billings Clinic included in subsidized services physician clinics that offered primary care or specialty care in medical underserved or health professional underserved areas. Primary care clinics were only included if they were in a rural, underserved county outside our primary service area. Oncology services were included only where they were located in a rural, underserved area (Cody, Wyoming). Pediatric specialty care (pediatric GI, oncology, hematology, pulmonology, cardiology) was included in our primary service area (Billings, Montana) because those subspecialties were not offered to patients in our region/state when the physicians were recruited or there were not enough pediatric subspecialists to meet the need in our tertiary service area. Billings Clinic also included the costs of specialty outreach services where physicians traveled to provide specialty care to underserved populations in counties that are medically underserved. The community benefit of physician clinics that was included in total subsidized health services was $4,992,924.
SchH_P02_S00_L00	Schedule H, Part II	Billings Clinic's community building activities includes support for the Alliance, a partnership between city-county public health department, St. Vincent Healthcare and Billings Clinic for community health improvement efforts, advocacy for community health, a chronic pain control collaborative, community influenza vaccinations and disaster readiness/response planning. The community health needs assessment (CHNA) and implementation planning began in FY13 and during FY13 we approved two new positions to coordinate all this work -- a Community Health Improvement Coordinator and a part-time Administrative Assistant, both whom are paid by all three Alliance organizations. (These positions will be included in the FY14 Schedule H.) Under Workforce Development, Billings Clinic coordinates and sponsors a regional Science Expo to encourage young scientists to become future nurses, physicians or health care professionals, as well as providing classroom space on campus for the Billings Public Schools' Medical Careers Class for high school students interested in learning more about health care and health care professions.
SchH_P03_S0A_L04	Schedule H, Part III, Section A, Line 4	See attached audit pages 9 and 10
SchH_P03_S0B_L08	Schedule H, Part III, Section B, Line 8	We believe that 46 percent of Billings Clinic's Medicare shortfalls should be counted as a community benefit. Our rationale is that 46 percent is the best estimate of the percentage of Montana's Medicare population (65 and older) who are at or below 300% of Federal Poverty Level, based on U.S. Census data. The upper limit of our financial assistance policy is 300%. For the calculation of the unreimbursed cost of Medicare a ratio of patient care cost to charges using worksheet 2 was utilized and applied to gross Medicare charges. We do not use the Cost Report for this number. The Cost Report only captures revenue related to the facility and does not capture revenue/losses related to clinical professional services, which are a substantial portion of Billings Clinic Medicare shortfalls.
SchH_P03_S0C_L09b	Schedule H, Part III, Section C, Line 9b	Yes, we did have a formal, written policy in tax year 2011, effective as of 10/5/11 (OHA-205 "Patient Financial Services"). We did have a collection process, which was used to screen patients for financial assistance prior to making payment arrangements for care. The policy applies equally to all patients - insured, under-insured or uninsured. Once a determination has been made and adjustments applied to the account balance, any remaining balance would fall into the regular guidelines of collection, giving patients financing options that will work within their monthly budget. Patients who cannot meet the requirements of a payment arrangement should be offered the loan program and/or financial assistance as options. If the patient agrees to financial assistance, the application should be requested. Agency will print and mail financial assistance applications. This will be completed by the end of each business day. After a patient completes the application, the patient will send it back to Billings Clinic for financial assistance determination.
SchH_P05_S0B_L04	Schedule H, Part V, Section B, Line 4	Key Informant Focus Groups were held in the community, including five different groups with 8-12 participants in each. The groups represented local social services providers, legislators, physicians and other health professionals, employers and educators. The survey itself included a random sample of 400 individuals 18 and older living in Yellowstone County. The entire CHNA was conducted by Professional Research Consultants (PRC). Billings Clinic's Community Health Needs Assessment was conducted in a pre-existing community health partnership called "The Alliance" with St. Vincent Healthcare (hospital organization) and RiverStone Health (public health department for city and county). The Alliance had conducted a CHNA in 2005-6 as well.
SchH_P05_S0B_L05	Schedule H, Part V, Section B, Line 5	Other public communications about our CHNA included a press conference with the CEOs of all three health care organizations resulting in local media coverage on local TV and in newspaper, as well as a meeting with more than 25 community leaders at Montana State University-Billings, where we discussed the major identified needs, available assets and worked in groups to prioritize the needs for our community plan.
SchH_P05_S0B_L06	Schedule H, Part V, Section B, Line 6	Billings Clinic has participated in a Community Health Needs Assessment (CHNA) process in collaboration with St. Vincent Healthcare and RiverStone Health (The Alliance) to better identify medical/health needs of Yellowstone County in 1994, 2006 and 2011. We will complete and release a new CHNA in January of 2014. The Alliance determined in 2008 that it would engage stakeholders to pursue population-based and public policy initiatives to improve community health. The 2011 Community Health Assessment was a systematic, data driven approach to determining the health status, behaviors and needs of residents in Yellowstone County. It serves as a tool to improve the health status and improve the quality of life overall of Yellowstone County residents. The 2011 Community Health Survey consisted of 400 randomized telephone contacts representing the diverse socioeconomic and geographic characteristics of Yellowstone County. Existing vital statistics and other health-related data are incorporated into the assessment as secondary sources. In addition, focus groups were conducted among physicians, legislators, social services, educators and employers. Results of the 2011 Community Health Assessment were reviewed by the Alliance, a Healthy By Design sponsored community forum, and the Billings Clinic Community Health Improvement Committee. Positive trends were in:Dental care Overweight kids Tobacco use Physical activity Chronic depression Sexually transmitted diseases Violent crimes Infant health indicatiors Negative trends were in:Overall health status Suicide rate Hypertension Cancer screenings Overweight adults Cirrhosis/liver disease Unwed mothers. The Alliance Community Health Needs Assessment implementation plan (also called the Community Health Improvement Plan) will focus on:Improve Access to Health Care Goal: Increase percentage of people who have a specific source of ongoing health care. Improve Healthy Weight Status Improve Mental Health. As we move forward into the future, we will organize our community health efforts around Billings Clinic's current clinical strengths and programs as they align with the assessment results. We also hope to focus and guide program performance utilizing the guiding principles outlined in the national Advancing the State of the Art in Community Benefit (ASACB) - disporportionate unmet health-related needs; primary and secondary prevention, seamless continuum of care, building a healthy communityespecially related to capacity, and collaborative governance-and the institue for Healthcare Improvement (IHI) Triple Aims-better care for individuals, better health for populations, and lower per capita costs. Programs to Address Identified Community Needs - Program Categories Priorities for Billings Clinic:Pediatric health and injury preventionChronic disease management: Hypertension and cardiovascular risk screening and cancer screening Healthy weight (employees and patients). Program Description - 1. Primary Care Access Billings Clinic has multiple initiatives in design and implementation to improve primary care access using the model of a patient-centered medical home, including: addition of family medicine services to the downtown campus Primary Care Medical Home-one nurse practitioner or physician assistant per physician, incorporation of care navigators, data exchange and pilot project with Blue Cross Blue Shield Outreach to assisted living facilities "patient Partners" councils to provide operational feedback from patients Start an Internal Medicine Residency Program, achieve accreditation (completed in 2013) and start first class of residents in July 2014. Goal: Achieve and maintain NCQA certification. Status: Yes, approved by NCQA as an Accountable Care Organization in January of 2013. 2. Chronic Disease Management a) Hypertension and Cardiovascular Screening - Goal: Increase proportion of patients whose hypertension, diabetes and heart failure is identified and controlled. Objective: The primary care team will complete disease registries for hypertension, diabetes and heart failure by January 2014 that are functional in identifying gaps in care. Indicators:Increase proportion of patients whose hypertension is controlled. Increase proportion of patients whose diabetes is controlled. Increase proportion of patients whose heart failure is controlled. b) Cancer Screening -Goal: Development of integrated and comprehensive treatment models to increase access and timely cancer treatment to all populations Objective: Complete objectives for National Cancer Institute Community Cancer Centers Program (NCCCP) research contract by May 2014, and find ways to sustain activities into the future. Indicators:Increase screening rates for all cancers to NCI guidelines, with a focus on low income and health disparities, especially among the American Indian population. 4. Pediatric Health and Injury Prevention - Goal: Prevention of avoidable injury and vaccine-preventable diseases in children. Objectives:Expand injury prevention program, including through School District #2 and club sports, about traumatic brain injury and concussion, using IMPACT testing, Think First education program with third graders in the local schools, free and low-cost helmet program offered to third graders and available at special events and in the Emergency Department. Implement new developmental screening tool in pediatrics and family medicine by 2014. Educate parents about benefits of immunization for their children. Create an interface between the Cerner electronic medical record and the imMTrax state immunization database, to increase accurate reporting and data for patient care, recalls and reminders. Indicators: Decrease numbers of injuries in children, especially brain injury and concussion. Increased immunization rates among Billings Clinic patients and decreased numbers of children with vaccine-preventable diseases. Increase numbers of children screened for developmental delays. 5. Healthy Weight - Billings Clinic has multiple initiatives in design and implementation to improve weight management and physical activity among our patient population, including:Worksite nutrition and physical activity policy development. Evaluation:The Alliance completed the Community Health Needs Assessment (CHNA) in 2011 (will complete a new CHNA and revise the CHIP in 2014) and measured the impact on known population health risks. Billings Clinic's Community Benefit Inventory was utilized to complete the schedule H in the IRS Form 990, as well as the Montana's Attorney General Report, Montana's Hospitals, Issues and facts related to the charitable purposes of our hospitals and the protection of Montana consumers. VI. Conclusion: The objective of Billings Clinic's community benefit plan for the next several years is to align, enhance and/or develop programs based on a set of criteria established by our Community Health Improvement Committee, including Billings Clinic's mission, vision and values Billings Clinic's strategic operating plan Date obtained through the 2005-6, 2010-11, and 2013-14 Community Health Needs Assessments The Alliance Yellowstone County Community Health Improvement Plan, IRS 990 Schedule H requirements, and *The Institute for Healthcare Improvement's Triple Aim(Improve the health of the population; enhance the patient experience of care (including quality, access and reliability); and reduce, or at least control, the per capital cost of care.) We will, as appropriate and possible, design methods to measure program effectiveness in the short and longer terms and at the organizational and population levels. To view the Yellowstyone County Community Health Improvement Plan, go to www.healthbydesignyellowstone.org/aboutus/
SchH_P05_S0B_L07	Schedule H, Part V, Section B, Line 7	Billings Clinic has started to address the needs that we have the assets and resources to address. The objective of Billings Clinic's community benefit plan for the next several years is to align, enhance and/or develop programs based on a set of criteria established by our Community Health Improvement Committee, including: * Billings Clinic's mission, vision and values, * Billings Clinic's strategic operating plan, * Data obtained through the 2005 and 2011 Community Health Needs Assessments, * The Alliance Plan to Improve the Community's Health, * IRS 990 Schedule H requirements, and * The Institute for Healthcare Improvement's Triple Aim (Improve the health of the population; enhance the patient experience of care (including quality, access and reliability); and reduce, or at least control, the per capita cost of care.) We will, as appropriate and possible, design methods to measure program effectiveness in the short and longer terms and at the organizational and population levels. If any community health needs do not meet the above criteria, we will not be able to address that particular need in the next few years. In 2013-14 we will finish a new assessment of both community health needs and the resources we have available to meet those needs.
SchH_P05_S0B_L14	Schedule H, Part V, Section B, Line 14	Billings Clinic has an easy-to-read plain language brochure that describes the Financial Assistance Policy, presumptive eligibility guidelines and contact information to apply. This is given to patients in pre-visit hospital admission packets, emergency department, registration desks and is on the website at billingsclinic.com.
SchH_P06_S00_L02	Schedule H, Part VI, Line 2	The 2011 Community Health Needs Assessment (CHNA) was a systematic, data driven approach to determining the health status, behaviors and needs of residents in Yellowstone County. Billings Clinic partnered with the local health care Alliance, including another local hospital, St. Vincent Healthcare, and city/county health department, RiverStone Health, to coordinate and pay for the CHNA. It serves as a tool to improve the health status and improve the quality of life overall of Yellowstone County residents. In the winter of 2010-2011, the Yellowstone County Community Health Survey consisted of 400 randomized telephone contacts representing the diverse socioeconomic and geographic characteristics of Yellowstone County. Existing vital statistics and other health-related data are incorporated into the assessment as secondary sources. In addition, focus groups were conducted among physicians, legislators, social services, educators and employers. Results of the 2010 Community Health Assessment were reviewed by the Alliance, a community forum sponsored by the Alliance's community health coalition (called Healthy By Design), and the Billings Clinic Community Health Improvement Committee (a Board committee). Findings were compared between 2011 and the 2006 assessment results. An Implementation Plan has been completed, both for the Alliance (community-wide) and for Billings Clinic (organization-wide). Implementation of many of the objectives has begun, with community workgroups, using measures and evaluation. The URL for the CHNA is located at http://www.billingsclinic.com/BillingsClinicGivesBacktotheCommunity
SchH_P06_S00_L03	Schedule H, Part VI, Line 3	Patient Education of Eligibility for Assistance: * All patients may apply for financial assistance - informational brochures with a one-page summary, and application forms are available at registration desks in the clinic and hospital, the Emergency Department discharge desk, care management staff and on our website at billingsclinic.com. * Information about financial assistance is printed on the back of patient bills. * Patients hospitalized without identifying a third party payer source are screened for coverage/assistance - SSI (Social Security Supplemental income, if approved will qualify for Medicaid), SSDI (Social Security Disability Income), Veterans' Administration, Indian Health Services, Workers Compensation, Medicaid, Crime Victims, and health insurance coverage. * A Financial Assistance brochure is mailed to new patients (Clinic and Hospital) in their pre-admission packets. These packets are mailed to all patients, even if they cannot be reached by phone in advance. * An application is mailed to patients whose payment pattern indicates that they may need assistance. * Patient Financials Services staff is available to help any patient needing assistance to complete an application. * According to our existing Financial Application policy, a patient is not eligible for financial assistance if the account has been sent to bad debt. We do bring accounts back in-house for charity assistance on a case-by-case basis. * An account is sent to bad debt at least 158 days after they are considered "self-pay," including at least three statements, letter and phone call attempts to contact the patient.
SchH_P06_S00_L04	Schedule H, Part VI, Line 4	Community Information: Billings Clinic is based in Billings, Montana, the largest city in Montana, with more than 150,000 people in Yellowstone County. In Billings there are two not-for-profit hospitals of similar size. Billings Clinic is an integrated, not for profit, community-governed health care organization providing services to a forty-three county area in eastern Montana and northern Wyoming. Billings Clinic defines its broad geographic service area as 43 counties in eastern Montana and northern Wyoming, encompassing nearly 128,000 square miles with a population of 595,000 people. Today, Billings Clinic employs more than 3,750 employees, including 259 physicians, and 90 mid-level practitioners, and operates a multi-specialty physician clinic; 285-bed acute care hospital; level II trauma center; a 90-bed long-term care facility; a clinical research center; and a variety of ambulatory, diagnostic and treatment services. Thirty-eight of those 43 counties are either wholly or partly designated as Health Professional Shortage Areas (HPSA) by the US Department of Health and Human Services, Health Resources and Services Administration under the Primary Medical Care discipline. The area includes five American Indian Reservations and an American Indian population of 38,882, or 6.9% of the service area's population. The US Census Bureau 2008 estimates show that 27.3% of Montana families are below 200% of the Federal Poverty level, compared to 26.6% for the nation and Montana is ranked 13th lowest of 50 states in Median Family Income. According to the 2010 US Census, Montana had 17.3% of the population without health insurance coverage in 2010, including all ages of the civilian, non-institutionalized population.
SchH_P06_S00_L05	Schedule H, Part VI, Line 5	Billings Clinic is an integrated health care organization, combining a not-for-profit multi-specialty medical group practice with a hospital and long term care facility. Our organization promoted community health in many ways in Fiscal Year 2013, including: * Substantial financial assistance and charity care was provided to patients in need. Billings Clinic provides more charity care than another other hospital or health care organization in Montana. * Care was provided to Medicare and Medicaid patients, as well as SCHIP for children. * Our Board's governance and nominating committee reviewed the entire 990, including Schedule H, which was then discussed with the entire Board of Directors. The Community Benefit Report, including Schedule H data, is also reviewed by the Board committee for Community Health Improvement. * Billings Clinic is a teaching hospital and supports, along with Riverstone Health and St. Vincent Healthcare, the only post-graduate medical education in Montana - the Montana Family Medicine Residency Program. Nearly 90 percent of the graduates establish a practice in rural, medically underserved settings in Montana. In addition we provide ongoing preceptorships for medical, nursing and pharmacy students so that they can obtain real-life experience during college and graduate school. In 2013, we also created and were approved for a new Internal Medicine Residency program. Residents will start the program in July of 2014. * Billings Clinic is a Medicaid disproportionate share hospital serving a significantly disproportionate number of low-income patients. * Our full-time emergency department is maintained where no one is denied care, within our capacity to provide care. * Our board of directors is composed of community members who reside in the primary service area. Only three out of 12 board members are employees - two are employed physicians and one is our CEO. * Medical staff privileges are open to all qualified physicians in our community. Operating surpluses are directed solely toward meeting our charitable purposes, including education, research, capital expenses, debt amortization, patient care improvements and medical education. * Billings Clinic has the only inpatient psychiatric services for youth and adults available in our region of central and eastern Montana and northern Wyoming, despite significant financial loss. We are committed to mental health care and continually work to find ways to reach those in need in the region, such as through telemedicine programs and education for primary care providers.
SchH_P06_S00_L07	Schedule H, Part VI, Line 7	Billings Clinic files a community benefit report to the state of Montana's Attorney General's office, with different values than requested by Schedule H.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
First Class Or Charter Travel	X	FirstClassOrCharterTravel
Travel For Companions	X	TravelForCompanions
Written Policy Re T And E Expenses	1	WrittenPolicyReTAndEExpenses
Substantiation Required	1	SubstantiationRequired
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Form990 Of Other Organizations	X	Form990OfOtherOrganizations
Written Employment Contract	X	WrittenEmploymentContract
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	0	SeverancePayment
Supplemental Nonqual Retire Plan	1	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	0	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	0	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	0	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	0	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	0	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	1	AnyNonFixedPayments
Initial Contract Exception	0	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg
Dr C McCracken
Board member/physician	332833	0	0	0	0	0	6713	0	30238	0	369784	0
Dr J Millikan
Board member/physician	605508	0	0	0	0	0	10386	0	32587	0	648481	0
Dr N Wolter
CEO	669604	0	172022	0	250000	0	0	0	36775	0	1128401	0
C Prewitt
CFO	365880	0	39435	0	0	0	30000	0	30862	0	466177	0
Dr Sample
Interventional cardiologist	1089185	0	0	0	0	0	0	0	36754	0	1125939	0
Dr Gibb
Gynecologic oncologist	899740	0	0	0	0	0	0	0	35122	0	934862	0
Dr Santala
Oncologist/hemotologist	638815	0	0	0	197320	0	0	0	34574	0	870709	0	197320
Dr Jones
Dermatologic surgeon	776740	0	0	0	0	0	0	0	34062	0	810802	0
Dr Goulet
Radiation oncologist	604807	0	0	0	169952	0	0	0	34045	0	808804	0	169952

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
SchJ_P01_S00_L01a	Schedule J, Part I, Line 1a	Billings Clinic periodically arranges and pays for charter travel for management and/or Board members attending governance eduation, State legislative hearings and association meetings. There were 28 of these flights in FY13. Billings Clinic also pays for the travel expense of spouses of Board members attending organizationally approved/arranged goverance education. This reimbursement is reported as income consistent with the Board travel reimbursement policy.
SchJ_P01_S00_L04	Schedule J, Part I, Line 4	The Billings Clinic Board Deferred Compensation Plan provides that all amounts earned are deferred until age 65 when payments are made over 5 years. Interest is accrued and credited each quarter and account balances are always 100% vested. The Billings Clinic Supplemental Retirement Agreement for Senior Executives (SERP) is a nonelective 457(f) agreement and provides for annual deferrals, which become vested and payable after 4 years. There was a separate 457(f) retirement plan designed specifically for Billings Clinic physicians which is closed. Under the 457(f) Dr Santala - Other reportable compensation $197,320 due to withdrawal from a 457(f) plan. Dr Goulet - Other reportable compensation $169,952 due to a SERP withdrawal.
SchJ_P01_S00_L07	Schedule J, Part I, Line 7	The Board of Directors annually determines the incentive plan amount for the CEO and the Senior Executive Team based on an external compensation study. The availability of the incentive is triggered by the organizational operating margin performance targets. The incentive is awarded based on financial performance as well as organizational performance measurements in quality, service satisfaction, both patient and employee satisfaction and then individual goals set each year if the the target is triggered. The incentive is paid only if triggered following the financial audit presentation.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Bond ReferenceBondReferenceCd	Issuer EINIssuerEIN	CUSIP NumberCUSIPNumber	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	Pool FinancingPoolFinancing
Montana Facility Finance Authority
A	810302402	612043FL8	2008-05-30	60000000	Property, plant and equipment	1	0	0
Montana Facility Finance Authority
B	810302402	61204MAA5	2011-08-24	140000000	Property, plant and equipment, Refund prior issue	0	0	0

Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)

Bond ReferenceBondReferenceCd	Amount RetiredAmountRetired	Amount Bond DefeasedAmountBondDefeased	Total ProceedsTotalProceeds	Amount In Reserve FundAmountInReserveFund	Capitalized InterestCapitalizedInterest	Refunding EscrowRefundingEscrow	Issuance Costs From ProceedsIssuanceCostsFromProceeds	Credit EnhancementCreditEnhancement	Working Capital ExpendituresWorkingCapitalExpenditures	Capital ExpendituresCapitalExpenditures	Other Spent ProceedsOtherSpentProceeds	Amount UnspentAmountUnspent	Year Of Subst CompletionYearOfSubstCompletion	Current RefundingCurrentRefunding	Advance RefundingAdvanceRefunding	Final Allocation MadeFinalAllocationMade	Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
A	7010000	23000000	60000000	3567467	0	0	1200000	0	0	49976092	0	0	2009	0	0	1	1
B	4300000	0	140000000	0	0	0	858750	0	0	15114094	84553156	40925679		0	1	1	1

Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)

Bond ReferenceBondReferenceCd	Owning Bond Financed PropertyOwningBondFinancedProperty	Any Lease ArrangementsAnyLeaseArrangements	Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty	Any Research AgreementsAnyResearchAgreements	Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers	Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI	Total Private Business UseTotalPrivateBusinessUse	Bond Iss Meet Prvt Security Pay TestBondIssMeetPrvtSecurityPayTest	Change In Use Bond Financed PropChangeInUseBondFinancedProp	Non Qualified Bond Remed ProcdrsNonQualifiedBondRemedProcdrs
A	0	0	0	0	0	0	0	0	0	1
B	0	0	0	0	0	0	0	0	0	1

Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)

Bond ReferenceBondReferenceCd	Form8038 T FiledForm8038TFiled	Rebate Not Due YetRebateNotDueYet	Exception To RebateExceptionToRebate	No Rebate DueNoRebateDue	Variable Rate IssueVariableRateIssue	Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds	Gross Proceeds Invested In GICGrossProceedsInvestedInGIC	Gross Proceeds InvestedGrossProceedsInvested	Written Proc To Monitor ReqsWrittenProcToMonitorReqs
A	0	0	0	1	0	0	0	0	1
B	0	1	0	0	1	0	0	0	1

Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)

Bond ReferenceBondReferenceCd	Proc To Undertk Corrective ActionProcToUndertkCorrectiveAction
A	1
B	1

Form990 Schedule K Part VI Form990ScheduleKPartVI

Field	Value	IRS element (for citing)
Identifier	SchK_P04_S00_L02c	Identifier
Return Reference	Schedule K, Part IV, Line 2c	ReturnReference
Explanation	Rebate calculation completed 2/25/13	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
F990_P06_S0B_L11b	Form 990, Part VI, Section B, Line 11b	The 990 review is completed before the return is filed. It is reviewed by the CFO, the executive group, the Governance & Nominating Committee of the board and finally by the Board of Directors.
F990_P06_S0B_L12c	Form 990, Part VI, Section B, Line 12c	The Governance and Nominating Committee of the Board of Directors, according to their charter, review annually the disclosure statements of the Board of Directors and senior executives and takes action to resolve conflicts. A Conflict of Interest Review Panel, chaired by the Compliance Officer, as outlined in organizational policy, is responsible for reviewing disclosed conflicts and approving necessary conflict management plans of all other interested persons at Billings Clinic.
F990_P06_S0B_L15	Form 990, Part VI, Section B, Line 15	Billings Clinic has as executive compensation program administered by independent trustees following best practices and the highest regulatory standards expected of a not-for-profit organization. They follow a board approved charter and overall executive compensation philosophy which defines the market as a comparable set of not-for-profit health care delivery systems. They look at relevant market data of similar roles in similar organizations. Annual disclosure of the committee's actions and decisions to the full Board is required.
F990_P06_S0C_L19	Form 990, Part VI, Section C, Line 19	Billings Clinic makes it governing documents, conflict of interest policy and financial statements available to the public on an as needed basis.
F990_P11_S00_L09	Form 990, Part XI, Line 9	Transfer of donated equipment from Billings Clinic Foundation

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	Montana Healthcare Indemnity LLC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2800 Tenth Avenue North	AddressLine1
City	Billings	City
State	MT	State
ZIP Code	59101	ZIPCode

Field	Value	IRS element (for citing)
EIN	810231784	EIN
Primary Activities	Insurance captive	PrimaryActivities
Legal Domicile State	MT	LegalDomicileState
Total Income	5013854	TotalIncome
EOY Assets	12063637	EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	Billings Clinic	BusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
Billings Clinic Foundation
2917 Tenth Avenue North	Billings	MT	59101	810407289	Fund raising	MT	501(c)(3)	7	Billings Clinic	1
Stillwater Hospital Association
710 N 11th St	Columbus	MT	59019	810286525	Healthcare	MT	501(c)(3)	3	Billings Clinic	1

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	New West Health Services	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	130 Neill Avenue	AddressLine1
City	Helena	City
State	MT	State
ZIP Code	59601	ZIPCode

Field	Value	IRS element (for citing)
EIN	841418136	EIN
Primary Activity	Insurance sales	PrimaryActivity
Legal Domicile State	MT	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	Billings Clinic	BusinessNameLine1

Field	Value	IRS element (for citing)
Type Of Entity	C	TypeOfEntity
Share Of Total Income	95090204	ShareOfTotalIncome
Share Of EOY Assets	23573870	ShareOfEOYAssets
Percentage Ownership	1	PercentageOwnership
Controlled Org	1	ControlledOrg

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	1	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	1	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	1	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	1	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	0	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	0	DividendsRelatedOrganization
Sale Of Assets To Other Org	0	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	0	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	0	ExchangeOfAssets
Rental Of Facilities To Other Orgs	0	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	1	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	1	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	1	PerformOfServicesByOtherOrgs
Sharing Of Facilities	1	SharingOfFacilities
Sharing Of Paid Employees	1	SharingOfPaidEmployees
Reimbursement Paid To Other Org	1	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	1	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	0	OtherTransferToOtherOrg
Other Transfer From Other Org	1	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved
New West Health Services
a-i	171237
Billings Clinic Foundation
c	6635189
Billings Clinic Foundation
d	94791
Stillwater Hospital Association
d	1133871
New West Health Services
d	18653742