2013-05-15T09:43:33-05:00 2012-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1200 PORTLAND OR 97205 990 2012-01-01 810232122 BENEFIS HOSPITALS INC BENE 4064552563 1101 26TH STREET SOUTH GREAT FALLS MT 59405 LAURA GOLDHAHN 4064552563 2013-05-10 1 WENDY CAMPOS P00448102 5032421447 2012 2016-02-25 16:41:14Z LAURA GOLDHAHN 1101 26TH STREET SOUTH GREAT FALLS MT 59405 686966282 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 513 BED HOSPITAL, PROVIDING INPATIENT AND OUTPATIENT SERVICES. 9 7 2304 765 227075 -115999 0 251591 527070506 683893703 442682 375515 1686999 1668693 529200187 686189502 0 0 0 0 97607918 134812103 0 0 0 403467625 542727599 501075543 677539702 28124644 8649800 190480324 208647760 189618145 199309690 862179 9338070 X WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 1 0 249898242 292699109 BENEFIS HOSPITALS, INC. OPERATES A 513 BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 267219565 312987111 BENEFIS HOSPITALS, INC. PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE HOSPITAL ALSO PROVIDES PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH A FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. ALSO PROVIDES SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY & INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS & RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART & VASCULAR, SPORTS MEDICINE, MED SPA & VEIN CENTER. 68391915 77942230 BENEFIS HOSPITALS, INC. PROVIDES HOSPICE, DIALYSIS, AND SKILLED NURSING SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 585509722 1 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 221 0 1 2304 1 1 1 0 0 0 0 0 0 0 0 0 X 9 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X DALE BIMLER 4064552565 500 15TH AVENUE SOUTH GREAT FALLS MT 59405 SUSAN RAPH 2.00 X X 0 0 0 MARILYN ROSE 2.00 X X 0 0 0 JUDY BORLAND MD 2.00 X 0 0 0 CAL EKLUND 2.00 X 0 0 0 BILL FERRIN 2.00 X 0 0 0 SUSAN HUMBLE 2.00 4.00 X 0 0 0 DALE MORTENSON MD 2.00 X 0 0 0 TERRY OLINGER 2.00 58.00 X 0 335004 69862 LYLE J ONSTAD MD 2.00 X 0 0 0 COLONEL BRUCE ROEHM 2.00 X 0 0 0 JERRY W SPEER MD 2.00 48.00 X 0 269321 8552 GREGORY S TIERNEY MD 2.00 X 4025 0 0 CARI YTURRI 2.00 X 0 0 0 LAURA GOLDHAHN 58.00 2.00 X X 405509 0 85041 PAUL DOLAN MD 58.00 2.00 X 344955 0 71802 JULIE HICKETHIER 60.00 X 448354 0 64199 KATHY HILL 50.00 X 150263 0 16390 JOSEPH LODUCA JR 50.00 X 145285 0 15014 CHRISTINE LUDLUM 50.00 X 140021 0 6687 DAVE RUNKEL 50.00 X 141613 0 15250 FRANK SOLTYS 50.00 X 141716 0 8029 1921741 604325 360826 84 0 1 0 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 606731252 FOOD SERVICES 3119411 PRECYSE SOLUTIONS LLC PO BOX 11407 BIRMINGHAM AL 352461736 MEDICAL RECORDS MANAGEMENT 2813080 METRO AVIATION INC PO BOX 7008 SHREVEPORT LA 71137 AIR AMBULANCE 2436024 ANESTHESIA ASSOCIATES OF GREAT FALLS 401 15TH AVENUE SOUTH GREAT FALLS MT 59405 ANESTHESIA SERVICES 2087753 AMERICAN RED CROSS PO BOX 73013 CHICAGO IL 606737013 BLOOD SERVICES 1720813 56 251591 251591 PATIENT SERVICES 621990 680394975 680394975 OTHER OPERATIONS 621990 3498728 3232247 266481 683893703 384163 384163 3061 11709 -8648 -8648 -8648 827265 765071 62194 -39406 101600 CAFETERIA 722210 1605271 1605271 JOINT VENTURES 621110 1228 1228 1606499 686189502 683628450 227075 2082386 1423884 1281762 142122 114302940 102894067 11408873 13278955 11953548 1325407 5806324 5226780 579544 48431077 48431077 61789289 60190582 1598707 11320394 4443209 6877185 362621 290981 71640 5637123 5637123 10809019 7245228 3563791 16691 15521 1170 CONTRACTUAL ADJ/CHARITY 351106367 351106367 OTHER EXPENSES 26667633 14274292 12393341 BAD DEBT EXPENSE 26587385 26587385 677539702 585509722 92029980 0 3967690 -1818688 106820419 134135705 7303703 7361389 841872 558864 146249102 95521745 53647463 50727357 15179579 15153981 2719598 2529152 190480324 208647760 64818489 77568505 120088990 117012998 4710666 4728187 189618145 199309690 X 862179 9338070 862179 9338070 190480324 208647760 X 8649800 -123667 -11097 -39145 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 17538 26417 21005 22950 0 14973967 1278454 13695513 1052820 99327 953493 128612725 93414169 35198556 1609590 729795 879795 50727357 2007 BONDS D/S RESERVE FUND 9306788 F 2007 BONDS INTEREST RESERVE 2792428 F 2007 BONDS PRINCIPAL RESERVE 3054765 F 15153981 THIRD-PARTY SETTLEMENTS 4728187 4728187 X PART IV, LINE 1B: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. EFFECTIVE JANUARY 1, 2009, THE ORGANIZATION ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2012 OR 2011. 1 1 X 1 X 1 X 1 1 0 1 1 5822503 5822503 0.01940 12752 12752 0.00000 5835255 5835255 0.01940 117175 701095 6772 694323 0.00230 1299 253159 253159 0.00080 16832995 16832995 0.05610 326675 326675 0.00110 824204 824204 0.00270 118474 18938128 6772 18931356 0.06300 118474 24773383 6772 24766611 0.08240 11742 11742 0.00000 203030 203030 0.00070 2829 2829 0.00000 70000 70000 0.00020 287601 287601 0.00090 1 26587386 0 132080703 146883134 -14802431 X 1 1 1 TREASURE STATE HEALTHCARE NETWORK PREFERRED PROVIDER ORGANIZATION SERVING GREAT FALLS AND SURROUNDING AREAS 0.50000 0.00000 0.50000 2 1 BENEFIS HOSPITALS INC EAST CAMPUS

1101 26TH STREET SOUTH GREAT FALLS MT 59405

X X X 2 BENEFIS HOSPITALS INC WEST CAMPUS

500 15TH AVENUE SOUTH GREAT FALLS MT 59405

X X BENEFIS HOSPITALS INC EAST CAMPUS 1 0 1 1 200.000000000000 1 400.000000000000 0 1 1 X X X X 1 0 1 X 0 0 BENEFIS HOSPITALS INC WEST CAMPUS 2 0 1 1 200.000000000000 1 400.000000000000 0 1 1 X X X X 1 0 1 X 0 0 1 BENEFIS SLETTEN HI-LINE CANCER CENTER

40 13TH STREET WEST HAVRE MT 59501

CANCER TREATMENT CENTER PART I, L7 COL(F): THE ORGANIZATION ESTIMATES THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS CHARITY CARE POLICY BY ANALYZING PAST ACTIVITY FOR ACCOUNTS CLASSIFIED AS BAD DEBT THAT SUBSEQUENTLY QUALIFIED FOR CHARITY CARE WHEN ADDITIONAL ELIGIBILITY INFORMATION WAS OBTAINED. ALL PATIENTS ARE PRESENTED WITH A COPY OF THE CHARITY CARE POLICY AND ENCOURAGED TO APPLY REGARDLESS OF ABILITY TO PAY. BY INCLUDING A PORTION OF BAD DEBT EXPENSE AS A COMMUNITY BENEFIT, THE ORGANIZATION CAN DIRECTLY ASSOCIATE THE DOLLAR VALUE OF FREE MEDICAL CARE AS PROVIDED TO THE RESIDENTS OF THE COMMUNITY. OUR MISSION IS TO PROVIDE EXCELLENT CARE FOR ALL, HEALING, BODY, MIND AND SPIRIT. PART I, LINE 6A: AS REQUIRED BY MONTANA LAW, THE ORGANIZATION ANNUALLY SUBMITS A COMMUNITY BENEFIT REPORT TO THE MONTANA ATTORNEY GENERAL'S OFFICE, WHICH OVERSEES NONPROFIT CORPORATIONS IN THE STATE. IN 2011, THE ATTORNEY GENERAL'S OFFICE RELEASED TO THE PUBLIC ITS FOURTH ANNUAL REPORT ON THE CHARITABLE ACTIVITIES OF MONTANA HOSPITALS, INCLUDING THE TEN LARGEST HOSPITALS IN THE STATE (WITH THE ORGANIZATION AMONG THEM). THE ORGANIZATION ITSELF ALSO ANNUALLY PREPARES A SUMMARY COMMUNITY BENEFIT REPORT FOR PURPOSES OF EXPLANATION TO THE LOCAL PUBLIC, WHICH IS PUBLISHED IN THE FORM OF A POSTING IN THE LOCAL NEWSPAPER.PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED. PART III, LINE 4: THE ORGANIZATION'S FINANICAL STATEMENTS INCLUDE THE FOLLOWING NOTE REGARDING BAD DEBT EXPENSE: "THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS OR RESIDENTS DUE TO BAD DEBTS AND CHARITY CARE. MANAGEMENT CONSIDERS HISTORICAL WRITE-OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION." THE COSTING METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO. PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID SUBSTANTIALLY LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. PART III, LINE 9B: PERSONS DETERMINED TO BE ELIGIBLE FOR 100 % CHARITY CARE SHALL NOT RECEIVE A BILL FOR SERVICES OR BE SUBJECT TO COLLECTION PROCEDURES. PERSONS DETERMINED TO BE ELIGIBLE FOR A REDUCTION OF A PERCENTAGE OF CHARGES UNDER THE CHARITY CARE PROGRAM LESS THAN 100% SHALL NOT BE BILLED OR SUBJECT TO COLLECTION PROCEDURES FOR THE PORTION OF THE BILL THAT IS REDUCED UNDER THE SLIDING FEE SCALE, ONLY THE OUT OF POCKET RESPONSIBILITY. BENEFIS HOSPITALS, INC. EAST CAMPUS PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR CARE IS BASED ON 100% OF TOTAL PATIENT CHARGES BEFORE ANY ADJUSTMENTS OR WRITE-OFFS. BENEFIS HOSPITALS, INC. WEST CAMPUS PART V, SECTION B, LINE 20D: THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR CARE IS BASED ON 100% OF TOTAL PATIENT CHARGES BEFORE AN ADJUSTMENTS OR WRITE-OFFS. PART VI, LINE 2: BENEFIS HOSPITALS, INC. HISTORICALLY HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. THE HOSPITAL IS CURRENTLY ASSEMBLING A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO WILL CONDUCT A COMMUNITY NEEDS ASSESSMENT IN THE FUTURE, AS CONTEMPLATED BY NEWLY ENACTED IRC SECTION 501(R). PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND IS MAILED TO EACH PATIENT ALONG WITH THEIR BILLING STATEMENT. PART VI, LINE 4: THE ORGANIZATION'S SERVICE AREA IS APPROXIMATELY 45,000 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 225,000 PEOPLE. THE SERVICE AREA IS APPROXIMATELY 49.5% FEMALE AND 50.5% MALE. APPROXIMATELY 6.6% OF THE POPULATION IS UNDER 5 YEARS OF AGE, APPROXIMATELY 74% BETWEEN THE AGE OF 18 AND 65 YEARS OF AGE, AND APPROXIMATELY 14% OF THE POPULATION IS OVER THE AGE OF 65. THE SERVICE AREA IS 90.7% WHITE WITH THE NEXT LARGEST COMBINED POPULATION APPROXIMATELY 5.8% NATIVE AMERICAN AND THE REMAINDER AFRICAN-AMERICAN OR MULTIPLE RACES. THE AVERAGE HOUSEHOLD SIZE IS 2.4 PEOPLE, WITH APPROXIMATELY 92.4% OF ALL HOUSING UNITS BEING OWNER OCCUPIED. THE AVERAGE PER CAPITA INCOME IS $17,566 WITH THE MEDIAN HOUSEHOLD INCOME BEING $32,971. (US CENSUS BUREAU, 2000 DEMOGRAPHIC PROFILE) PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE RGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PRUPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. REPORTS FILED WITH STATES PART VI, LINE 7 MT X X X X 1 1 0 0 0 0 0 1 0 TERRY OLINGER 0 250137 0 41378 0 43489 0 61540 0 8322 0 404866 0 0 JERRY W SPEER MD 0 119658 0 14526 0 135137 0 5134 0 3418 0 277873 0 0 LAURA GOLDHAHN 307238 0 91004 0 7267 0 79564 0 5477 0 490550 0 0 0 PAUL DOLAN MD 265727 0 73438 0 5790 0 64670 0 7132 0 416757 0 0 0 JULIE HICKETHIER 239620 0 65653 0 143081 0 58768 0 5431 0 512553 0 139502 0 KATHY HILL 132126 0 18137 0 0 0 8356 0 8034 0 166653 0 0 0 JOSEPH LODUCA JR 132120 0 13165 0 0 0 6980 0 8034 0 160299 0 0 0 DAVE RUNKEL 137978 0 0 0 3635 0 7210 0 8040 0 156863 0 0 0 PART I, LINES 4A-B THE FOLLOWING EMPLOYEE REPORTED ON FORM 990 PART VII RECEIVED SEVERANCE PAYMENTS: JERRY SPEER, MD = $135,137 THE ORGANIZATION PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EMPLOYEES. PART I, LINE 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM (INCLUDING MS. GOLDHAHN, MS. HICKETHIER, AND DR. DOLAN), AND IS SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. IN 2010, THE SYSTEM ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, FINANCE/OPERATIONS, AND COMMUNITY BENEFIT. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED IN 2010 ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY INDIVIDUAL PERFORMANCE. IN ADDITION, THE SYSTEM MUST HAVE MAINTAINED SATISFACTORY OVERALL PERFORMANCE, BASED ON BOTH FINANCIAL CRITERIA AND SATISFACTION OF EMPLOYEES, PATIENTS AND PHYSICIANS. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. 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DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. DATE THE REBATE COMPUTATION WAS PERFORMED: 05/01/2012 ISSUER NAME: BENEFIS HOSPITALS, INC. 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0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 B 0 0 0 1 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 C 0 0 0 1 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 A 1 B 1 C 1 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 PROVIDE PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH A FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. ALSO PROVIDE SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY & INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS & RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART & VASCULAR, SPORTS MEDICINE, MED SPA & VEIN CENTER. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN OF THE OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS PROVIDES THESE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT OPERATING ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES - INFORMATION SYSTEMS COORDINATION - OVERSEES QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGES REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT THE BOARD OF DIRECTORS OF BHS ALSO OVERSEES ALL OF THE ORGANIZATION'S BOARD ACTIVITIES. THE FOLLOWING PERSONS LISTED IN PART VII WERE COMPENSATED BY BHS: TERRY OLINGER - $335,004 (COMPENSATION FOR SERVICES AS OFFICER OF BHS AND AS OFFICER OF BMG) JERRY W. SPEER - $269,321 (COMPENSATION FOR SERVICES AS OFFICER OF BMG) FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NON-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE ORGANIZATION IS ELECTED BY BENEFIS HEALTH SYSTEM, INC. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS DISTRIBUTED TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS, WITH A PRESENTATION TO SUCH BOARD BY THE ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE PRESIDENT, THE CHIEF CLINICAL AND NURSING OFFICER, AND THE CHIEF MEDICAL INFORMATION AND MEDICAL OFFICER WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILARLY-SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 BENEFIS HOSPITALS, INC. PROVIDES COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: INTERAFFILIATE TRANSFERS -37,917. TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA PHYSICIANS -1,228. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S FINANCIAL RESULTS ARE REPORTED AS PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF BENEFIS HEALTH SYSTEM, INC. AND AFFILIATES. THE AUDIT COMMITTEE OF BENEFIS HEALTH SYSTEM, INC. IS RESPONSIBLE FOR SELECTION OF THE INDEPENDENT AUDIT FIRM AND OVERSEEING THE AUDIT. 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