2014-03-17T14:00:41-05:00 2013-06-30 810272932 GALUSHA HIGGINS AND GALUSHA PC P O BOX 1530 HAVRE MT 59501 990 2012-07-01 816016920 DANIELS MEMORIAL HOSPITAL ASSOCIATION DANI 4064875331 P O BOX 400 SCOBEY MT 59263 DAVE HUBBARD 4064875331 2014-03-10 1 P00647883 4062653201 2012 2015-11-30 17:44:51Z DAVE HUBBARD P O BOX 400 SCOBEY MT 59263 7438223 0 X N/A X 1956 MT TO PROMOTE THE GENERAL HEALTH CARE OF THE COMMUNITY THROUGH PROVIDING HIGH QUALITY HEALTH CARE AND A HOME FOR THE AGED AND INFIRM. 10 10 119 10 0 0 196001 391858 6025450 7043006 0 0 68323 3359 6289774 7438223 0 0 0 0 4006871 4082653 0 0 0 2307084 2736777 6313955 6819430 -24181 618793 3467917 3818775 932796 664861 2535121 3153914 X TO PROVIDE A HEALTH CARE SYSTEM WITH CLINIC, ACUTE INPATIENT, EMERGENCY, OUTPATIENT, AND LONG-TERM CARE SERVICES 0 0 3782792 6201590 PROFESSIONAL CARE - PRIMARY, ACUTE AND LONG TERM CARE. 838510 844775 CLINIC SERVICES FOR OUTPATIENT CLIENTS. 476814 HOUSEKEEPING, LAUNDRY, LINEN & PLANT SERVICES - PROVIDE FOR THE HOUSEKEEPING AND BUILDING MAINTENANCE OF THE FACILTIY. 495577 DIETARY SERVICES FOR ACUTE AND LONG TERM CARE PATIENTS. MEDICAL RECORDS 495577 5593693 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 4 0 1 119 0 0 0 0 0 0 0 0 0 X 10 10 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 0 1 1 0 0 MT X DANIELS MEMORIAL HOSPITAL ASSOCIATI 4064872296 105 5TH AVENUE EAST SCOBEY MT 59263 TOM HAGAN 3.00 X 0 0 0 BEV LINDSEY 2.00 X 0 0 0 PERRY WOLFE 2.00 X 0 0 0 CARTER JENSEN 2.00 X 0 0 0 SCOTT SUSAG 1.50 X 0 0 0 DERRICK MOTTERN 2.00 X 0 0 0 MIKE BJARKO 1.50 X 0 0 0 KATHY WICOXON 2.00 X 0 0 0 KAREN TANDE 2.00 X 0 0 0 ANA BRENDEN 1.50 X 0 0 0 DR DONALD SAWDEY 40.00 X 380084 0 0 380084 0 0 3 0 1 0 BILLINGS CLINIC 2800 10TH AVE NORTH BILLINGS MT 59107 MANAGEMENT SERVICES 469356 1 391858 391858 PATIENT SERVICE REVENU 623000 6790470 6790470 OTHER OPERATING REVENU 623000 252536 252536 7043006 OTHER UNRESTRICTED INC 623000 5378 5378 REAILIZED/UNREALIZED I 623000 -2019 -2019 3359 7438223 7046365 0 0 380084 380084 2816232 2557999 258233 34038 34562 -524 615505 517782 97723 236794 201283 35511 83038 17043 65995 20000 20000 34966 4431 30535 11143 4399 6744 44952 37812 7140 59600 22548 37052 8338 8338 297003 297003 123091 3004 120087 CONTRACTUAL SERVICES 811470 505247 306223 SUPPLIES 330323 303765 26558 MEDICAL SUPPLIES AND PH 308455 308455 REPAIRS AND MAINTENANCE 172683 168727 3956 431715 229549 202166 6819430 5593693 1225737 0 768400 801078 311171 311911 624557 1012256 45000 50000 175397 206875 40509 46740 5325638 3935764 1501816 1389874 1067 41 3467917 3818775 673118 541385 258611 123435 1067 41 932796 664861 X 2535121 3153914 2535121 3153914 3467917 3818775 618793 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 34837 34837 3622664 2836998 785666 1668137 1098766 569371 1389874 RESIDENT TRUST FUND 41 41 6903676 -139330 -139330 7043006 395217 395217 7438223 6680100 0 6680100 139330 139330 6819430 PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT PART XI, LINE 4B - OTHER ADJUSTMENTS: OTHER REVENUES PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBT THE RECONCILIATION FOR REVENUES AND EXPENSES PER AUDITED FINANCIAL STATMENTS COMPARED TO THE TAX RETURN CONTAINS ADJUSTMENTS DO TO A PROVISION FOR BAD DEBT EXPENSE AND OTHER REVENUES INCLUDING CONTRIBUTION INCOME AND HOSPITAL DISTRICT TAX REVENUES. 1 1 1 X 1 X 1 1 1 0 0 51584 51584 0.00770 51584 51584 0.00770 21106 2000 19106 0.00290 104680 76391 28289 0.00420 125786 78391 47395 0.00710 177370 78391 98979 0.01480 12737 3920 8817 0.00130 12737 3920 8817 0.00130 0 139330 41799 1223188 1223188 X 1 1 1 1 DANIELS MEMORIAL HOSPITAL ASSOCIATION

PO BOX 400 SCOBEY MT 59263

X X X X LONG-TERM CARE FACILITY; RURAL HEALTH CLINIC; HOME CARE & HOSPICE DANIELS MEMORIAL HEALTH CARE CENTER 1 1 X X X X X X X X X 11 1 0 1 X X X X X 1 0 1 1 100.000000000000 1 150.000000000000 1 X X X X X X X 1 0 1 X X 1 X X X X 1 0 0 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 $ 139330. DANIELS MEMORIAL HEALTH CARE CENTER PART V, SECTION B, LINE 3: THE DANIELS COUNTY PUBLIC NURSE MARY NYPHUS IS THE PERSON WHO REPRESENTED THE COMMUNITY AND WHOM WHICH THE HOSPITAL CONSULTED WITH. A FEW OF THE SURVEY QUESTIONS WERE MODIFIED AND ADDITIONAL QUESTIONS WERE ADDED TO THE COMMUNITY ASSESSMENT THAT PERTAINED TO PUBLIC HEALTH, ISSUES RELATED TO SMOKING, ALCOHOL CONUSMPTION, HEALTHY LIFESTYLES AND CANCER SCREENING. DANIELS MEMORIAL HEALTH CARE CENTER PART V, SECTION B, LINE 5C: PUBLICIZED IN LOCAL NEWSPAPER. DANIELS MEMORIAL HEALTH CARE CENTER PART V, SECTION B, LINE 7: THE HOSPITAL IS STILL IN THE PROCESS OF ADDRESSING ALL OF THE NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED NEEDS ASSESSMENT. PART VI, LINE 2: PUBLIC HEALTH NURSING SERVICE REQUESTS ALL PARTICIPANTS: BUSINESS, CIVIC, RELIGIOUS, HEALTHCARE, PUBLIC AND WE IDENTIFY ISSUES THAT MAY ASSIST THE COMMUNITY. I.E. HEALTHCARE, HOUSING, ROADS, INFRASTRUCTURE. PART VI, LINE 3: WE INFORM THE PUBLIC ABOUT PROGRAMS, I.E. MEDICARE/MEDICAID. ADVERTISEMENT IN PRINT AND RADIO, PHAMPLETS IN THE WAITING ROOM, AND SOCIAL SERVICE VISITS WITH PATIENTS. PART VI, LINE 4: WE ARE DESIGNATED A FRONTIER CAH, >6 PEOPLE PER SQ MILE, TOWN HAS 960 PEOPLE, COUNTY HAS 1406 PEOPLE, WE ARE 5 HOURS AWAY FROM A TERTIARY HOSPITAL, AND 3 HOURS AWAY FROM A SECONDARY HOSPITAL. PART VI, LINE 5: THROUGH THE TELEMEDICINE NETWORK, PATIENTS CAN SEE SPECIALISTS 5 HOURS AWAY RIGHT HERE. SEVERAL FREE TELEMEDICINE NETWORK SERVICES ARE OFFERED: CARDIOLOGY, DIABETES, BABY SITTING CLASSES WITH DIPOLMA, MENTAL HEALTH, CHEMICAL DEPENDENCY ARE ALL FREE TO THE PUBLIC AND GROUPS. X X 0 0 0 0 0 0 0 0 0 DR DONALD SAWDEY 380084 0 0 0 0 0 0 0 0 0 380084 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 DANIELS MEMORIAL HOSPITAL CONTRACTS WITH THE BILLINGS CLINIC FOR MANAGEMENT, IT, AND ACCOUNTING SERVICES. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS AVAILABLE FOR REVIEW BY THE BOARD AFTER APPROVAL BY THE CEO. FORM 990, PART VI, SECTION B, LINE 12C AT THE ANNUAL MEETING, CONFLICT OF INTEREST STATEMENTS ARE REVIEWED AND SIGNED BY ALL TRUSTEES AND THE CEO. THE BOARD CHAIR AND CEO MONITOR THE STATUS OF ALL TRUSTEES THROUGHOUT THE YEAR FOR CHANGES THAT COULD LEAD TO A NEW SITUATION REQUIRING DISCLOSURE. FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF TRUSTEES REVIEW AND MAKE DECISIONS ON THE COMPENSATION PACKAGE FOR THE CEO. THE CEO COMPENSATION IS PART OF THE MANAGEMENT CONTRACT PAID TO THE OUTSIDE MANAGEMENT COMPANY. ALL MANAGERS REPORT TO THE CEO AND THE CEO REVIEWS AND MAKES DECISIONS ON THE MANAGERS COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS, INCLUDING THE CONFLICT OF INTEREST STATEMENT AND THE FINANCIAL STATEMENTS, ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE REVIEWED BY THE FINANCE COMMITTEE AND THEN REFERRED TO THE OVERALL BOARD. THE BOARD VOTES TO ACCEPT THE AUDITED FINANCIAL STATEMENTS.