HEALTHSHARE MONTANAINC: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- HEALTHSHARE MONTANAINC (EIN 26-0593833)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-08-12
- IRS object ID
- 201302249349301420
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-08-12T10:37:00-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810385940 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ANDERSON ZURMUEHLEN & CO PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1040 | AddressLine1 |
| City | HELENA | City |
| State | MT | State |
| ZIP Code | 596241040 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 260593833 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEALTHSHARE MONTANAINC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | HEAL | NameControl |
| Phone | 4067940170 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2475 VILLAGE LANE NO 302 | AddressLine1 |
| City | BILLINGS | City |
| State | MT | State |
| ZIP Code | 59102 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BRAD PUTNAM | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 4067940170 | Phone |
| Date Signed | 2013-08-09 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JACQUELYN M FRANK | Name |
| PTIN | P00254610 | PTIN |
| Phone | 4064421040 | Phone |
| Date Prepared | 2013-08-08 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | BRAD PUTNAM | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2475 VILLAGE LANE SUITE 302 | AddressLine1 |
| City | BILLINGS | City |
| State | MT | State |
| ZIP Code | 59102 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 1922232 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.HEALTHSHAREMONTANA.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2007 | YearFormation |
| State Legal Domicile | MT | StateLegalDomicile |
| Activity Or Mission Description | TO SUPPORT, PROMOTE, AND ENCOURAGE THE EXCHANGE OF SECURE AND RELIABLE HEALTH INFORMATION AMONG STAKEHOLDERS AND REGIONAL NETWORKS TO IMPROVE THE SAFETY, QUALITY, AND EFFICIENCY OF HEALTHCARE THROUGH THE ADOPTION OF ELECTRONIC HEALTH RECORDS ALONG WITH OTHER FORMS OF HEALTH INFORMATION TECHNOLOGY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 19 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 19 | NbrIndependentVotingMembers |
| Total Nbr Employees | 6 | TotalNbrEmployees |
| Total Nbr Volunteers | 22 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 4077378 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1869832 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 52400 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 4077378 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1922232 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 339201 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 466686 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 618766 | 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 | 2328692 | OtherExpensePriorYear |
| Other Expenses Current Year | 1266140 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 2795378 | TotalExpensesPriorYear |
| Total Expenses Current Year | 2224107 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1282000 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -301875 | RevenuesLessExpensesCY |
| Total Assets BOY | 1567312 | TotalAssetsBOY |
| Total Assets EOY | 1259717 | TotalAssetsEOY |
| Total Liabilities BOY | 37385 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 31666 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 1529927 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 1228051 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO SUPPORT, PROMOTE, AND ENCOURAGE THE EXCHANGE OF SECURE AND RELIABLE HEALTH INFORMATION AMONG STAKEHOLDERS AND REGIONAL NETWORKS TO IMPROVE THE SAFETY, QUALITY, AND EFFICIENCY OF HEALTHCARE THROUGH THE ADOPTION OF ELECTRONIC HEALTH RECORDS ALONG WITH OTHER FORMS OF HEALTH INFORMATION TECHNOLOGY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2086710 | Expense |
| Grants | 339201 | Grants |
| Revenue | 52400 | Revenue |
| Description | HEALTHSHARE MONTANA IS THE STATE DESIGNATED HEALTH INFORMATION EXCHANGE (HIE) ORGANIZATION FOCUSED ON THE SECURE EXCHANGE OF HEALTHCARE INFORMATION TO HELP IMPROVE HEALTHCARE QUALITY AND REDUCE COSTS. THE HIE IS DEVELOPING A SECURE ELECTRONIC NETWORK THAT USES HIGHLY SECURED TECHNOLOGY TO ENSURE MEDICAL PROFESSIONALS WILL HAVE A THOROUGH VIEW OF THEIR PATIENT'S MEDICAL STATUS WITH ACCESS TO ANALYTICS, REPORTING, AND A NEW LOOK AT ENTIRE PATIENT POPULATIONS. THE THEME 5 CHALLENGE GRANT IS A COLLABORATION WITH THE INSTITUTE FOR TRANSLATIONAL HEALTH SCIENCES AT THE UNIVERSITY OF WASHINGTON AND COVISINT CORPORATION, TO USE OPEN-SOURCE INFORMATICS FOR INTEGRATING BIOLOGY AND THE BESIDE ARCHITECTURE TO BUILD A TECHNICAL PLATFORM THAT WILL INTERFACE WITH HSM'S CONTINUITY OF CARE DOCUMENT STANDARD CLINICAL DATA REPOSITORY TO ENABLE SECURE ACCESS TO DE-IDENTIFIED CLINICAL DATA IN SUPPORT OF A RANGE OF SECONDARY RESEARCH USES. | Description |
| Total Program Service Expense | 2086710 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | 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 | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 0 | Hospital |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 0 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| 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 | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 18 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 6 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 19 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 19 | 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 | 0 | 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 | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SANDRA RANDALL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4067940170 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2475 VILLAGE LANE SUITE 302 | AddressLine1 |
| City | BILLINGS | City |
| State | MT | State |
| ZIP Code | 59102 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer |
|---|---|---|---|---|---|---|
| KRISTIN JULIAR | ||||||
| DIRECTOR | 4.00 | X | 0 | 0 | 0 | |
| CHRIS STEVENS | ||||||
| BOARD CHAIR | 4.00 | X | 0 | 0 | 0 | X |
| RAJEEV PILLAI | ||||||
| TREASURER | 2.00 | X | 0 | 0 | 0 | X |
| DANIEL HILLMAN | ||||||
| VICE-CHAIR | 2.50 | X | 0 | 0 | 0 | X |
| CHERIE TAYLOR | ||||||
| SECRETARY | 2.00 | X | 0 | 0 | 0 | X |
| JOHN MIDDLETON MD | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| GREG DRAPES | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| CHELSEA CULPON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| RICK HARALDSON | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| DAVID KIBBE MD | ||||||
| DIRECTOR | 0.70 | X | 0 | 0 | 0 | |
| JACK KING | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| PATRICK LAW | ||||||
| DIRECTOR (RESIGNED LATE 2012) | 1.00 | X | 0 | 0 | 0 | |
| BOB OLSEN | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| KRISTIN PAGE NEI | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| KIP SMITH | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| LEIGH THURSTON | ||||||
| DIRECTOR | 0.50 | X | 0 | 0 | 0 | |
| STARLA BLANK | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| JEAN BRANSCUM | ||||||
| DIRECTOR | 1.30 | X | 0 | 0 | 0 | |
| BOB MARSALLI | ||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | |
| BRAD PUTNAM | ||||||
| EXECUTIVE DIRECTOR | 50.00 | 70000 | 0 | 4226 | X | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 70000 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 4226 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 0 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| NORTHWEST EHR COLLABORATIVE INC | |||||
| 1102 EAST COMMERCIAL AVENUE | ANACONDA | MT | 59711 | SERVICES RELATED TO GRANT | 368811 |
| REITER FOUNDATION INC | |||||
| 1102 EAST COMMERCIAL AVENUE | ANACONDA | MT | 59711 | SERVICES RELATED TO GRANT | 120106 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Government Grants | 1863716 | GovernmentGrants |
| All Other Contributions | 6116 | AllOtherContributions |
| Total Contributions | 1869832 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PCMH SETUP FEE REVENUE | 621300 | 50000 | 50000 |
| REGISTRATION FEE INCOM | 621300 | 2400 | 2400 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 52400 | TotalProgramServiceRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1922232 | TotalRevenueColumn |
| Related Or Exempt Function Income | 52400 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 339201 | Total |
| Program Services | 339201 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 70000 | Total |
| Program Services | 63000 | ProgramServices |
| Management And General | 7000 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 439958 | Total |
| Program Services | 396263 | ProgramServices |
| Management And General | 43695 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21916 | Total |
| Program Services | 19738 | ProgramServices |
| Management And General | 2178 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 51798 | Total |
| Program Services | 46662 | ProgramServices |
| Management And General | 5136 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35094 | Total |
| Program Services | 31602 | ProgramServices |
| Management And General | 3492 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13619 | Total |
| Program Services | 12257 | ProgramServices |
| Management And General | 1362 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19745 | Total |
| Program Services | 17770 | ProgramServices |
| Management And General | 1975 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 385954 | Total |
| Program Services | 389255 | ProgramServices |
| Management And General | -3301 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 56214 | Total |
| Program Services | 50562 | ProgramServices |
| Management And General | 5652 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17217 | Total |
| Program Services | 14180 | ProgramServices |
| Management And General | 3037 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 94969 | Total |
| Program Services | 85542 | ProgramServices |
| Management And General | 9427 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 48290 | Total |
| Program Services | 43525 | ProgramServices |
| Management And General | 4765 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 54629 | Total |
| Program Services | 46089 | ProgramServices |
| Management And General | 8540 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8508 | Total |
| Program Services | 5428 | ProgramServices |
| Management And General | 3080 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 562746 | Total |
| Program Services | 521905 | ProgramServices |
| Management And General | 40841 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 3154 | 2799 | 355 |
| DUES AND SUBSCRIPTIONS | 960 | 864 | 96 |
| LICENSE AND REGISTRATIO | 76 | 68 | 8 |
| BANK FEES | 59 | 59 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2224107 | Total |
| Program Services | 2086710 | ProgramServices |
| Management And General | 137397 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 366903 | BOY |
| EOY | 129863 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 134486 | BOY |
| EOY | 19365 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13781 | BOY |
| EOY | 360332 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 1191863 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 442006 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1051842 | BOY |
| EOY | 749857 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 300 | BOY |
| EOY | 300 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1567312 | BOY |
| EOY | 1259717 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37385 | BOY |
| EOY | 31666 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 37385 | BOY |
| EOY | 31666 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1475515 | BOY |
| EOY | 1178680 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 54412 | BOY |
| EOY | 49371 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1529927 | BOY |
| EOY | 1228051 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1567312 | BOY |
| EOY | 1259717 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -301875 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -1 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| 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 Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org170b1 Avi | X | PubliclySupportedOrg170b1Avi |
Gifts Grants Contrib Received170 GiftsGrantsContribReceived170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 9000 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 545878 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4022217 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1869832 | CurrentTaxYear |
| Total | 6446927 | Total |
Total170 Total170
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 9000 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 545878 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 4022217 | CurrentTaxYearMinus1Year |
| Current Tax Year | 1869832 | CurrentTaxYear |
| Total | 6446927 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total170 | 6446927 | PublicSupportTotal170 |
| Total Support | 6446927 | TotalSupport |
| Public Support Pertcentage170 | 1.00000 | PublicSupportPertcentage170 |
| Thirty Three Percnt Tests CY170 | X | ThirtyThreePercntTestsCY170 |
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 D IRS990ScheduleD
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1191863 | OtherCostOrOtherBasis |
| Depreciation | 442006 | Depreciation |
| Book Value | 749857 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 749857 | TotalOfBookValueLandBuildings |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 2168915 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 246683 | DonatedSrvcAndUseOfFacilities |
| Revenue Not Rptd F990 | 246683 | RevenueNotRptdF990 |
| Revenue Subtotal | 1922232 | RevenueSubtotal |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 1922232 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 2470790 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 246683 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 246683 | ExpensesNotRptdF990 |
| Expenses Subtotal | 2224107 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 2224107 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X, LINE 2: | ReturnReference |
| Explanation | HEALTHSHARE MONTANA IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS INCLUDED IN THE ACCOMPANYING FINANCIAL STATEMENTS. HSM'S POLICY IS TO EVALUATE THE LIKELIHOOD THAT ITS UNCERTAIN TAX POSITIONS WILL PREVAIL UPON EXAMINATION BASED ON THE EXTENT TO WHICH THOSE POSITIONS HAVE SUBSTANTIAL SUPPORT WITHIN THE INTERNAL REVENUE CODE AND REGULATIONS, REVENUE RULINGS, COURT DECISIONS AND OTHER EVIDENCE. IT IS THE OPINION OF MANAGEMENT THAT THE ASSOCIATION HAS NO UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO THE INTERPRETATION. THE YEARS OF DECEMBER 31, 2011 THROUGH DECEMBER 31, 2012 REMAIN OPEN AND SUBJECT TO EXAMINATION BY FEDERAL AND STATE TAXING AUTHORITIES. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 0 | RecordsMaintained |
Recipient Table RecipientTable (17 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant |
|---|---|---|---|---|---|---|---|
| BARRETT HOSPITAL & HEALTHCARE | |||||||
| 600 MT HWY 91 S | DILLON | MT | 597257379 | 810357909 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| BIG HORN COUNTY MEMORIAL HOSPITAL | |||||||
| 17 N MILES AVENUE | HARDIN | MT | 590340430 | 810384618 | 501(C)3 | 7881 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| CENTRAL MONTANA MEDICAL CENTER | |||||||
| 408 WENDELL AVENUE | LEWISTOWN | MT | 59457 | 237169043 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| CLARK FORK VALLEY HOSPITAL | |||||||
| PO BOX 768 | PLAINS | MT | 59859 | 810475376 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| DANIELS MEMORIAL HEALTHCARE CENTER | |||||||
| 105 5TH AVE EAST | SCOBEY | MT | 59263 | 816016920 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| LIVINGSTON HEALTHCARE | |||||||
| 504 SOUTH 13TH STREET | LIVINGSTON | MT | 59047 | 810621997 | 501(C)3 | 12341 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| MARCUS DALY MEMORIAL HOSPITAL | |||||||
| 1200 WESTWOOD | HAMILTON | MT | 59840 | 810240726 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| MCCONE COUNTY HEALTH CENTER | |||||||
| BOX 48 | CIRCLE | MT | 59215 | 810269223 | 501(C)3 | 13070 | MONTANA HEALTHSHARE INFORMATION EXCHANGE INFRASTRUCTURE. |
| MINERAL COMMUNITY HOSPITAL | |||||||
| PO BOX 66 | SUPERIOR | MT | 598720066 | 810421823 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| NORTHERN ROCKIES MEDICAL CENTER | |||||||
| 802 2ND STREET SE | CUT BANK | MT | 59427 | 810530457 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| PONDERA MEDICAL CENTER | |||||||
| 805 SUNSET BLVD | CONRAD | MT | 59425 | 810232406 | 501(C)3 | 12069 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| ROOSEVELT MEDICAL CENTER | |||||||
| 818 2ND AVENUE EAST | CULBERTSON | MT | 59218 | 810373589 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| ROSEBUD HEALTH CARE CENTER | |||||||
| 383 17TH AVENUE N | FORSYTH | MT | 59327 | 810405434 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| ROUNDUP MEMORIAL HEALTHCARE | |||||||
| PO BOX 40 | ROUNDUP | MT | 590720040 | 810245848 | 501(C)3 | 12852 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| SIDNEY HEALTH CENTER | |||||||
| 216 14TH AVE SW | SIDNEY | MT | 59270 | 810233499 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| WHEATLAND MEMORIAL HEALTHCARE | |||||||
| 530 3RD STREET NW | HARLOWTON | MT | 59036 | 810392231 | 501(C)3 | 15000 | MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE |
| UNIVERSITY OF WASHINGTON | |||||||
| 4333 BROOKLYN AVE NE | SEATTLE | WA | 981950001 | 916001537 | WA UNIVERISTY SY | 115988 | RESEARCH AND HEALTH CARE MANAGEMENT. |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE I PART II LINE 1(A) | PURPOSE OF CAH GRANTS | AS HEALTHSHARE MONTANA CAREFULLY CRAFTED THE BUDGET FOR MONTANA'S HEALTH INFORMATION EXCHANGE ORGANIZATION AND INFRASTRUCTURE, WE WERE WELL AWARE THAT CRITICAL ACCESS HOSPITALS MIGHT HAVE A DIFFICULT TIME FINDING THE FUNDING AND, IN SOME CASES, THE QUALIFIED PERSONNEL TO TAKE ON YET ANOTHER HIT PROJECT. WITH THAT THOUGHT IN MIND, FUNDING WAS INCLUDED IN THE BUDGET TO HELP SMALLER HOSPITALS CONNECT TO THE STATEWIDE ELECTRONIC HEALTH INFORMATION EXCHANGE. AS PART OF THE ACCEPTANCE OF THESE FUNDS, CRITICAL ACCESS HOSPTIAL ORGANIZATION SIGNED A LETTER OF INTENT TO PARTICIPATE WITH HEALTHSHARE MONTANA. |
| SCHEDULE I PART II LINE 1(A) | PURPOSE OF GRANT PAID TO UNIVERSITY OF WASHINGTON | THE INSTITUTE FOR TRANSLATIONAL HEALTH SCIENCES AT THE UNIVERSITY OF WASHINGTON IS WORKING IN COLLABORATION WITH HEALTHSHARE MONTANA ON THE CHALLENGE THEME 5 GRANT. TOGETHER, THEY WILL USE OPEN-SOURCE INFORMATICS FOR INTEGRATING BIOLOGY AND BESIDE (I2B2) ARCHITECTURE TO BUILD A TECHNICAL PLATFORM THAT WILL INTERFACE WITH HSM'S CONTINUITY OF CARE DOCUMENT-BASED (CCD) CLINICAL DATA REPOSITORY (CDR) TO ENABLE SECURE ACCESS TO BOTH IDENTIFIED AND DE-IDENTIFIED STATEWIDE CLINICAL, CLAIMS AND PHARMACY BENEFIT DATA IN SUPPORT OF A RANGE OF SECONDARY RESEARCH AND HEALTHCARE MANAGEMENT USES. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WILLIAM REITER MD | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | THE REITER FOUNDATION, INC. | Relationship |
| Amount Of Transaction | 120106 | AmountOfTransaction |
| Description Of Transaction | SEE BELOW.HSM HAS CONTRACTED WITH THE REITER FOUNDATION, INC., WHOSE FOUNDER AND EXECUTIVE DIRECTOR SERVES AS THE CHIEF MEDICAL INFORMATION OFFICER (CMIO) FOR THE ONC-COOP AGREEMENT AND THE PRINCIPAL INVESTIGATOR FOR THE ONC THEME 5 CHALLENGE GRANT. PRIOR TO THE CONTRACT, THE CMIO SERVED ON HSM'S BOARD OF DIRECTORS BUT RESIGNED WHEN THE CONTRACT WAS EXECUTED. DURING THE YEAR ENDED DECEMBER 31, 2012, HSM PAID THE REITER FOUNDATION $120,106. SUBSEQUENT TO DECEMBER 31, 2012, THE SERVICE AGREEMENT WAS TERMINATED IN ADVANCE OF THE SCHEDULED TERMINATION DATE BY MUTUAL AGREEMENT OF BOTH PARTIES AND OTHER CONSIDERATION. | DescriptionOfTransaction |
| Sharing Of Revenues | 0 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 WILL BE REVIEWED BY THE EXECUTIVE DIRECTOR, FINANCE CHAIR AND THE BOARD CHAIR BEFORE IT IS FILED. | |
| FORM 990, PART VI, SECTION B, LINE 12C | IN ACCORDANCE WITH ITS BYLAWS, THE ORGANIZATION ADOPTED A CONFLICT OF INTEREST POLICY WHICH COMPLIES WITH THE MONTANA NONPROFIT CORPORATION ACT. THE POLICY COVERS ANY OFFICER, BOARD DIRECTOR, OR COMMITTEE MEMBER. IT DEFINES THE PROCEDURES FOR DETERMINING WHETHER THERE IS A CONFLICT OF INTEREST IN A TRANSACTION. ALL MEMBERS OF ITS GOVERNING BODY ARE REQUIRED TO PROVIDE AN ANNUAL STATEMENT WHICH STATES THEY UNDERSTAND AND ARE IN COMPLIANCE WITH THE POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE EXECUTIVE DIRECTOR'S SALARY WAS DETERMINED BASED ON A BOARD REVIEW OF EXECUTIVE DIRECTOR SALARIES IN THE STATE AS WELL AS A REVIEW OF SALARIES FOR SIMILAR POSITIONS OF OTHER STATE HEALTH INFORMATION EXCHANGES. THE SALARY WAS VOTED ON BY HEALTHSHARE MONTANA'S EXECUTIVE COMMITTEE. | |
| FORM 990, PART VI, SECTION C, LINE 19 | INFORMATION AVAILABLE UPON REQUEST | |
| FORM 990, PART IX, LINE 11G | OUTSIDE CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 389,255. MANAGEMENT AND GENERAL EXPENSES -3,301. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 385,954. | OTHER FEES |
| FORM 990, PART XI, LINE 9: | ROUNDING ADJUSTMENT -1. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| PART XII, LINE 2C | THE PROCESS FOR THE FINANCIAL OVERSIGHT HAS NOT CHANGED. | PROCESS FOR FINANCIAL OVERSIGHT |
| FORM 990, PG 1 LINE 3 | HEALTHSHARE MONTANA HOLDS 21 VOTING SEATS ON THEIR GOVERNING BOARD. FOR THE CURRENT TAX YEAR ONLY 19 OF THESE SEATS WERE FILLED ALONG WITH THREE EX-OFFICIOS. THE EX-OFFICIOS DO NOT HAVE VOTING AUTHORITY. | BOARD MEMBERS |