2013-05-15T09:42:58-05:00 2012-06-30 810272932 GALUSHA HIGGINS AND GALUSHA PC P O BOX 1530 HAVRE MT 59501 990 2011-07-01 810245848 ROUNDUP MEMORIAL HOSPITAL ASSOC ROUN 4062322301 PO BOX 40 ROUNDUP MT 59072 BRAD HOWELL 4062322301 2013-05-14 1 DARCY DEE REUM CPA P00647883 4062653201 2011 2016-02-24 21:20:13Z BRAD HOWELL PO BOX 40 ROUNDUP MT 59072 6784484 0 X WWW.RMHMT.ORG X 1979 MT PROVIDE HEALTH CARE SERVICES 7 7 110 0 0 0 998700 558068 4291217 5815741 266 0 0 410675 5290183 6784484 0 0 0 0 1941960 2913391 0 0 0 5207420 3269789 7149380 6183180 -1859197 601304 2766674 2629486 2811835 2073343 -45161 556143 X IT IS THE MISSION OF THE ROUNDUP MEMORIAL HOSPITAL AND MUSSELLSHELL COUNTY MEDICAL CENTER TO ACCEPT THE ONGOING CHALLENGE OF PROVIDING FOR THE HEALTHCRE NEEDS OF ALL OF OUR CITIZENS. IT IS OUR SINCERE DESIRE TO HEAL THE SICK AND COMFORT THE SUFFERING WITH ALL THE RESOURCES WE HAVE AVAILABLE. AS GOOD STEWARDS OF THESE INSTITUTIONS, EMPLOYEES WILL HELP INSURE THE SURVIVAL OF THE HOSPITAL AND CLINIC BY BEING COMMITTED TO THE CARE AND WELL BEING OF THOSE THEY SERVE. 0 0 2597683 2828429 CRITICAL ACCESS HOSPITAL - ROUTINE SERVICE FOR ADULTS, PEDRIATRICS, AND SWINGBED. 803466 569558 RURAL HEALTH CLINIC - 4 PROVIDERS 2597683 2828429 OTHER SERVICES INCLUDE BUT ARE NOT LIMITED TO ANCILLARIES, CT SCANS, LABRATORY, PHYSICAL, SPEECH, AND OCCUPATIONAL THERAPIES, PHARMACY, EMERGENCY ROOM, X-RAY, CENTRAL SUPPLY, INTRAVENOUS SOLUTIONS, ULTRASOUND, ELECTROCARDIOGRAPHY, OBSERVATION, BLOOD BANK, AND PATHOLOGY. 5998832 1 1 0 0 0 0 0 0 0 1 1 0 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 0 1 16 0 1 110 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 0 0 1 1 0 0 0 1 0 1 1 0 1 0 0 MT X THE ORGANIZATION 4062322301 PO BOX 40 ROUNDUP MT 59072 JOHN PHISTER 0.50 X 0 0 0 MARK ROSEBUSH 0.50 X 0 0 0 KEN MOSDAL 0.50 X 0 0 0 OLIVER ODDEN 0.50 X 0 0 0 TERRI RUSTAD 0.50 X 0 0 0 LEONARD WALL 0.50 X 0 0 0 MARSHALL WHITE MD 0.50 X 0 0 0 GARY BOSTROM 40.00 X 0 0 0 TERRY JONES MD 45.00 X 186164 0 0 186164 0 0 1 0 1 0 BILLINGS CLINIC PO BOX 37000 BILLINGS MT 59107 MANAGEMENT SERVICES 640464 1 558068 558068 INPATIENT/OUTPATIENT R 621110 5765237 5765237 50504 50504 5815741 OTHER NON OPERATING RE 621110 410675 410675 410675 6784484 6226416 0 0 X 2331211 2226718 104493 27805 26554 1251 281737 269059 12678 272638 260369 12269 53657 53657 302662 302662 61300 61300 DISCOUNTS AND ALLOWANCE 607306 607306 CONTRACT LABOR 594117 594117 SUPPLIES 505127 505127 BAD DEBT EXPENSE 418061 418061 727559 727559 6183180 5998832 184348 0 60118 147777 795087 649142 33089 33089 119394 107757 7740 33713 7935116 6291160 1737194 1643956 14052 14052 2766674 2629486 1222902 917197 1370849 945062 218084 211084 2811835 2073343 X -45161 556143 -45161 556143 2766674 2629486 601304 0 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 52279 141459 199 104341 89596 15912 41345 22 5000 52279 1.00000 1 0 4054478 3425934 628544 3880638 2865226 1015412 1643956 3RD PARTY PAYERS 211084 211084 1 1 1 X 1 X 1 1 1 0 0 128706 128706 0.02080 982070 853356 128714 0.02080 1110776 853356 257420 0.04160 9291 9291 0.00150 9291 9291 0.00150 1120067 853356 266711 0.04310 418061 1080894 1080894 X 1 1 2 1 ROUNDUP MEMORIAL HOSPITAL - HOSPITAL

1202 3RD STREET WEST ROUNDUP MT 59072

X X X X 2 ROUNDUP MEMORIAL HOSPITAL - CLINIC

1207 3RD STREET WEST ROUNDUP MT 59072

RURAL HEALTH CLINIC ROUNDUP MEMORIAL HOSPITAL ASSOC 1 1 1 100.000000000000 1 200.000000000000 1 X X X X X X X 1 1 1 X X 1 X X X X 1 0 0 PART III, LINE 9B: POLICY STATES UP FRONT THAT ADMISSIONS REPRESENTATIVE IS TO GIVE FINANCIAL ASSISTANCE PAPERWORK WITH INFORMAION ON CHARITY CARE AT THE TIME OF ADMISSION. FOLLOW UP CONSULTATION IS DONE LATER TO INCLUDE FINANCIAL ASSISTANCE.DISCUSSIONS WITH PATIENT ROUNDUP MEMORIAL HOSPITAL ASSOC PART V, SECTION B, LINE 13G: WHEN A PATIENT INDICATES THAT A FINANCIAL HARDSHIP EXISTS, THE HOSPITAL PROVIDES INFORMATION ON THE HOSPITAL CHARITY PLAN AND OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS. ROUNDUP MEMORIAL HOSPITAL ASSOC PART V, SECTION B, LINE 18C: THE FACILITY CHARGES THE SAME TO ALL INDIVIDUALS. PART VI, LINE 2: IN 2010, THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT IN CONJUNCTION WITH A COMMUNITY MILL LEVY ELECTION. STAKEHOLDERS INVOLVED INCLUDED COUNTY COMMISSIONERS, COMMUNITY SERVICE ORGANIZATIONS, SUCH AS ROTARY AND THE LION'S CLUB, AND AREA STATE AGENCIES. IN ADDITION, THE HOSPITAL HELD TWO COMMUNITY MEETINGS AND LED DISCUSSIONS OF HEALTHCARE NEEDS AND DESIRES. PART VI, LINE 3: WHEN A PATIENT INDICATES THAT A FINANCIAL HARDSHIP EXISTS, THE HOSPITAL PROVIDES INFORMATION ON THE HOSPITAL CHARITY PLAN AND OTHER STATE AND DEFERAL ASSISTANCE PROGRAMS. PART VI, LINE 4: ROUNDUP MEMORIAL HEALTHCARE (RMH) IS THE SOLE COMMUNITY HEALTHCARE PROVIDER FOR MUSSELSHELL COUNTY, A RURAL AREA WITH A POPULATION DENSITY OF 2.4 PER SQUARE MILE. NO OTHER HOSPITALS SERVE THE COMMUNITY AND THE NEAREST HEALTHCARE FACILITY IS LOCATED IN BILLINGS, 45 MILES TO THE SOUTH. PER THE 2010 FEDERAL CENSUS, THE COUNTY POPULATION WAS 4,538; THE PER CAPITA INCOME IN THE COUNTY IS $19,164 AND THE PERCENTAGE OF PERSONS BELOW THE POVERTY LINE WAS 20.5 PERCENT. IN 2006, 26.4 PERCENT OF MUSSELSHELL COUNTY WAS UNINSURED. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION HAS DESIGNATED MUSSELSHELL COUNTY AS AN UNDERSERVED AREA WITH A SCORE OF 16. X X 0 0 0 0 0 0 0 0 0 TERRY JONES MD 186164 0 0 0 0 0 0 0 0 0 186164 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH A LARGER HOSPITAL FACILITY TO PROVIDE MANAGEMENT DUTIES. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF HOSPITAL ASSOCIATION 501 (C)3 FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS REVIEWED BY THE CEO AND ACCOUNTING CLERK BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER MONITORS AND EVALUATES CONFLICT OF INTEREST ISSUES. FORM 990, PART VI, SECTION B, LINE 15A CEO COMPENSATED ACCORDING TO ARRANGEMENTS WITH THE MANAGEMETN AGREEMENT WITH BILLINGS CLINIC, WHO RECOMMENDS THE CEO SALARY TO THE BOARD FOR APPROVAL. THE HOSPITAL UTILIZES THE MONTANA HOSPITAL ASSOCIATION AND ASSOCIATED EMPLOYEES SALARY SURVEY TO DETERMINE SALARIES OF KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUSET TO THE CEO. THE ORGANIZATION WILL PROVIDE A COPY OF FORM 990 TO THE GOVERNING BODY. ALL OTHER FUNCTIONAL EXPENSES FORM 990, PART X, LINE 24E PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 402,523. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 402,523. OTHER OPERATING EXPENSES: PROGRAM SERVICE EXPENSES 187,253. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 187,253. UTILITIES: PROGRAM SERVICE EXPENSES 133,574. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 133,574. CHARITY CARE: PROGRAM SERVICE EXPENSES 129,450. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 129,450. REPAIRS AND MAINTENANCE: PROGRAM SERVICE EXPENSES 20,518. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 20,518. LEASES AND RENTALS: PROGRAM SERVICE EXPENSES 9,408. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,408. PRIOR YEAR SETTLEMENTS: PROGRAM SERVICE EXPENSES -155,167. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES -155,167.