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MARCUS DALY MEMORIAL HOSPITAL CORPORATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
MARCUS DALY MEMORIAL HOSPITAL CORPORATION (EIN 81-0240726)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-03
IRS object ID
201201259349300440
Schema version
2010v3.4
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

FieldValueIRS element (for citing)
Timestamp2012-05-03T11:20:54-05:00Timestamp
Tax Period End Date2011-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CLIFTONLARSONALLEN LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1220 SOUTH SIXTH STREET SUITE 300AddressLine1
CityMINNEAPOLISCity
StateMNState
ZIP Code55402ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810240726EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1MARCUS DALY MEMORIAL HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlMARCNameControl
Phone4063754609Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11200 WESTWOOD DRIVEAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJOHN M BARTOSName
TitleCEO, SECRETARY AND TREASURERTitle
Phone4063754609Phone
Date Signed2012-05-03DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone6123764500Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJOHN M BARTOSNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11200 WESTWOOD DRIVEAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode
FieldValueIRS element (for citing)
Gross Receipts47476583GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.MDMH.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1938YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionOUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees546TotalNbrEmployees
Total Nbr Volunteers169TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year163036ContributionsGrantsPriorYear
Contributions Grants Current Year225104ContributionsGrantsCurrentYear
Program Service Revenue Prior Year47076333ProgramServiceRevenuePriorYear
Program Service Revenue CY46893051ProgramServiceRevenueCY
Investment Income Prior Year67705InvestmentIncomePriorYear
Investment Income Current Year60140InvestmentIncomeCurrentYear
Other Revenue Prior Year-80797OtherRevenuePriorYear
Other Revenue Current Year-23951OtherRevenueCurrentYear
Total Revenue Prior Year47226277TotalRevenuePriorYear
Total Revenue Current Year47154344TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2644GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year23335366SalariesEtcPriorYear
Salaries Etc Current Year25424585SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year187663TotalFundrsngExpCurrentYear
Other Expense Prior Year20904864OtherExpensePriorYear
Other Expenses Current Year20627165OtherExpensesCurrentYear
Total Expenses Prior Year44240230TotalExpensesPriorYear
Total Expenses Current Year46054394TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2986047RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1099950RevenuesLessExpensesCY
Total Assets BOY45412010TotalAssetsBOY
Total Assets EOY47137440TotalAssetsEOY
Total Liabilities BOY20273003TotalLiabilitiesBOY
Total Liabilities EOY20687420TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY25139007NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY26450020NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense38228340Expense
Grants2644Grants
Revenue46893051Revenue
DescriptionMARCUS DALY MEMORIAL HOSPITAL CORPORATION OWNS AND OPERATES A 48 LICENSED BED ACUTE CARE CRITICAL ACCESS HOSPITAL WITH 25 BEDS SETUP. THE HOSPITAL PROVIDES ACUTE CARE SERVICES TO PATIENTS IN RAVALLI COUNTY. THE SERVICES PROVIDED INCLUDE ACUTE CARE HOSPITAL, RELATED ANCILLARY SERVICES SUCH AS LABORATORY, RADIOLOGY AND THERAPY INPATIENT AND OUTPATIENT SURGERY, EMERGENCY CARE, AMBULANCE, HOME HEALTH, CLINIC, TRANSITIONAL CARE, INPATIENT AND OUTPATIENT HOSPICE CARE. THE HOSPITAL PROVIDES EMS SERVICES WITH 3 CREWS PROVIDING 911 SERVICE TO THE COUNTY. THE GOAL IS TO RESPOND WITHIN 20 MINUTES OR LESS TO ANY CALL WITHIN THE COUNTY. THE HOSPITAL IS THE ONLY PEDIATRIC REHABILITATION PROVIDER OF PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY IN WESTERN MONTANA USING CERTIFIED THERAPISTS. THE HOSPITAL CLINICS SEE ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY AND ENABLE THE COMMUNITY ACCESS TO PRIMARY CARE. IN 2010, THE HOSPITAL OPERATED FOUR RURAL HEALTH CLINICS.Description
Total Program Service Expense38228340TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109667NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees546NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DONJA C ERDMANBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4063754609TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11200 WESTWOOD DRIVEAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
SONNY LASALLE
CHAIR4.00XX000
DON LODMELL PHD
VICE CHAIR4.00XX000
DONNA COONEY
BOARD MEMBER4.00X000
STEVEN ELLIS MD
BOARD MEMBER4.00X000
BARBARA ACKERMAN
BOARD MEMBER4.00X000
BILL BEAN
BOARD MEMBER4.00X000
JAMES OWINGS CPA
BOARD MEMBER4.00X000
MICHAEL COWAN
BOARD MEMBER4.00X000
RANDY STEWART MD
BOARD MEMBER4.00X000
JOHN M BARTOS
CEO/SECRETARY/TREASURER40.00XX277485029233
WALKER ASHCRAFT MD
PHYSICIAN/BOARD MEMBER40.00X152724022698
FREDERIK ILGENFRITZ MD
PHYSICIAN/BOARD MEMBER40.00X21900209400
DONJA C ERDMAN
CFO40.00X120169019581
JOHN COURCHESNE MD
PHYSICIAN40.00351250037206X
JEREMIAH CLINTON MD
PHYSICIAN40.0036635405185X
JOHN MORELAND MD
PHYSICIAN40.00317493038500X
YVONNE COURCHESNE MD
PHYSICIAN40.00322413031492X
LUKE CHANNER MD
PHYSICIAN40.00285895028188X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2412785TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation221483TotalOtherCompensation
Number Individuals GT100 K30NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HEALTHCARE OUTSOURCING NETWORK LLC
621 17TH ST 1800DENVERCO80293BUSINESS SERVICES PROVIDER450281
ALLIANCE HEALTHCARE SERVICES
FILE 55826LOS ANGELESCA90074MRI IMAGING443682
E-PARTNERS
75 REMITTANCE DR 8617CHICAGOIL60675IT PROFESSIONAL FEES358282
CLINTON R ADKINS DO
387 WOMBATCORVALLISMT59828EMERGENCY ROOM PHYSICIAN254107
CERNER CORPORATION
PO BOX 412072KANSAS CITYMO64141IT SUPPORT226331
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K
Related Organizations36500RelatedOrganizations
All Other Contributions188604AllOtherContributions
Total Contributions225104TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE INCOME6214004523973645239736
HOSPITAL UTILZTN. REV.62140015364651536465
OTHER OPERATING INCOME621400116850116850
FieldValueIRS element (for citing)
Total Program Service Revenue46893051TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column109850TotalRevenueColumn
Exclusion$109,850ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real171919Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real261309Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-89390Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-89390TotalRevenueColumn
Exclusion-$89,390ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other11220Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other60930Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-49710Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-49710TotalRevenueColumn
Exclusion-$49,710ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionMISCELLANEOUSDescription
Business Code900099BusinessCode
Total Revenue Column65439TotalRevenueColumn
Exclusion$65,439ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue65439TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column47154344TotalRevenueColumn
Related Or Exempt Function Income46893051RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$36,189ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total2644Total
Program Services2644ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total818861Total
Program Services400351ProgramServices
Management And General418510ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total19402817Total
Program Services15854546ProgramServices
Management And General3444007ManagementAndGeneral
Fundraising104264Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total105002Total
Program Services95418ProgramServices
Management And General8849ManagementAndGeneral
Fundraising735Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3786359Total
Program Services3045660ProgramServices
Management And General721140ManagementAndGeneral
Fundraising19559Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1311546Total
Program Services1048855ProgramServices
Management And General255166ManagementAndGeneral
Fundraising7525Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total64578Total
Management And General64578ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total49150Total
Management And General49150ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total4334091Total
Program Services2827351ProgramServices
Management And General1494341ManagementAndGeneral
Fundraising12399Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total175919Total
Program Services175919ProgramServices

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total4366369Total
Program Services4041137ProgramServices
Management And General322710ManagementAndGeneral
Fundraising2522Fundraising

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total529456Total
Program Services465937ProgramServices
Management And General63519ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total323507Total
Program Services316812ProgramServices
Management And General6695ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total105554Total
Program Services73593ProgramServices
Management And General31918ManagementAndGeneral
Fundraising43Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total795689Total
Program Services635161ProgramServices
Management And General128422ManagementAndGeneral
Fundraising32106Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2897824Total
Program Services2605460ProgramServices
Management And General285653ManagementAndGeneral
Fundraising6711Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total959619Total
Program Services959619ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
PROVISION FOR BAD DEBTS48727424872742
MAINTENANCE AND REPAIRS7187705640901529651715
MISCELLANEOUS EXPENSES2505536627018419984
PHARMACY/ LAB EXPENSES149276149276
TRAINING & DEVELOPMENT34068274996569

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total46054394Total
Program Services38228340ProgramServices
Management And General7638391ManagementAndGeneral
Fundraising187663Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY6104400BOY
EOY3127975EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY3604899BOY
EOY2592286EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8661625BOY
EOY11265092EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY163929BOY
EOY108523EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY967188BOY
EOY1079757EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY453245BOY
EOY370554EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis48289511LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec21509276LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY23527354BOY
EOY26780235EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY1157713BOY
EOY1368776EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY771657BOY
EOY444242EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY45412010BOY
EOY47137440EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4077061BOY
EOY5201791EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9265000BOY
EOY8685000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY5811840BOY
EOY5381512EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
EOY600007EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1119102BOY
EOY819110EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY20273003BOY
EOY20687420EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23631082BOY
EOY24723132EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY524562BOY
EOY743245EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY983363BOY
EOY983643EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY25139007BOY
EOY26450020EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY45412010BOY
EOY47137440EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1099950ReconcilationRevenueExpenses
Reconcilation Other Changes211063ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance313190BeginningOfYearBalance
Investment Earnings Or Losses3160InvestmentEarningsOrLosses
Other Expenditures3160OtherExpenditures
End Of Year Balance313190EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance313190BeginningOfYearBalance
Investment Earnings Or Losses4071InvestmentEarningsOrLosses
Other Expenditures4071OtherExpenditures
End Of Year Balance313190EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance313190BeginningOfYearBalance
End Of Year Balance313190EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis1415098OtherCostOrOtherBasis
Book Value1415098BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis29431724OtherCostOrOtherBasis
Depreciation11392672Depreciation
Book Value18039052BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis695752OtherCostOrOtherBasis
Depreciation606282Depreciation
Book Value89470BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis16428793OtherCostOrOtherBasis
Depreciation9510322Depreciation
Book Value6918471BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis318144OtherCostOrOtherBasis
Book Value318144BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings26780235TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionTHIRD PARTY SETTLEMENTDescription
Amount$819,110Amount
FieldValueIRS element (for citing)
Total Of Amounts819110TotalOfAmounts
Total Revenue47154344TotalRevenue
Total Expenses46054394TotalExpenses
Excess Or Deficit For Year1099950ExcessOrDeficitForYear
Other$211,063OtherAmount
Total Adjustments211063TotalAdjustments
Excess Or Deficit Per FS1311013ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt46881091TotRevenueEtcAuditedFinclStmt
Other Revenues261309OtherRevenues
Revenue Not Rptd F990261309RevenueNotRptdF990
Revenue Subtotal46619782RevenueSubtotal
Other Revenues Not Included534562OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt534562RevenueNotRptdOnFinStmt
Total Revenue Per Form99047154344TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt46315703TotExpensesEtcAuditedFinclStmt
Other Expenses Included261309OtherExpensesIncluded
Expenses Not Rptd F990261309ExpensesNotRptdF990
Expenses Subtotal46054394ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99046054394TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:PART V, LINE 4:ENDOWMENT FUNDS ARE DESIGNATED FOR THE PURPOSE OF BUILDING AND CARRYING ON A HOSPITAL IN HAMILTON, MONTANA, AND FOR THE CARE AND TREATMENT OF CRIPPLED CHILDREN.
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:PART X:PER THE AUDITED FINANCIAL STATEMENTS, NOTE 1: THE HOSPITAL FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HOSPITAL'S FINANCIAL STATEMENTS. THE HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE INFORMATION TAX RETURNS FOR THE YEARS ENDED 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage100.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served313PersonsServed
Total Community Benefit Expense343132TotalCommunityBenefitExpense
Net Community Benefit Expense343132NetCommunityBenefitExpense
Percent Of Total Expense0.00750PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense3665461TotalCommunityBenefitExpense
Direct Offsetting Revenue4094448DirectOffsettingRevenue
Net Community Benefit Expense-428987NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served313PersonsServed
Total Community Benefit Expense4008593TotalCommunityBenefitExpense
Direct Offsetting Revenue4094448DirectOffsettingRevenue
Net Community Benefit Expense-85855NetCommunityBenefitExpense
Percent Of Total Expense0.00750PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense243403TotalCommunityBenefitExpense
Net Community Benefit Expense243403NetCommunityBenefitExpense
Percent Of Total Expense0.00530PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense2000TotalCommunityBenefitExpense
Net Community Benefit Expense2000NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense6406754TotalCommunityBenefitExpense
Direct Offsetting Revenue5059809DirectOffsettingRevenue
Net Community Benefit Expense1346945NetCommunityBenefitExpense
Percent Of Total Expense0.02920PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense33444TotalCommunityBenefitExpense
Net Community Benefit Expense33444NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense6685601TotalCommunityBenefitExpense
Direct Offsetting Revenue5059809DirectOffsettingRevenue
Net Community Benefit Expense1625792NetCommunityBenefitExpense
Percent Of Total Expense0.03520PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Persons Served313PersonsServed
Total Community Benefit Expense10694194TotalCommunityBenefitExpense
Direct Offsetting Revenue9154257DirectOffsettingRevenue
Net Community Benefit Expense1539937NetCommunityBenefitExpense
Percent Of Total Expense0.04270PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense2644TotalCommunityBuildingExpense
Net Community Building Expense2644NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense721TotalCommunityBuildingExpense
Net Community Building Expense721NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense77866TotalCommunityBuildingExpense
Net Community Building Expense77866NetCommunityBuildingExpense
Percent Of Total Expense0.00170PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Total Community Building Expense81231TotalCommunityBuildingExpense
Net Community Building Expense81231NetCommunityBuildingExpense
Percent Of Total Expense0.00180PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$2,534,533BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare6359311AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare12053268CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-5693957MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1MARCUS DALY MEMORIAL HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11200 WESTWOOD DRIVEAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIREDBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities4NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
CORVALLIS FAMILY MEDICINE CLINIC
1037 MAIN STREETCORVALLISMT59828CLINIC
BITTERROOT VALLEY EYE ASSOCIATES
300 N 10TH STREETHAMILTONMT59840CLINIC
BITTERROOT CLINIC
1224 MAIN STREETHAMILTONMT59840CLINIC
RAVALLI UROLOGY
1224 MAIN STREETHAMILTONMT59840CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
PART I, LINE 3C: FULL TO PARTIAL ASSISTANCE MAY BE GRANTED TO PATIENTS WITH GROSS FAMILY INCOME BELOW 100% OF THE FPG, AS ADJUSTED FOR FAMILY SIZE. A FAMILY MAY NOT OWN NET ASSETS IN EXCESS OF $10,000 CURRENT VALUE.
PART I, LINE 6A: A COMMUNITY BENEFIT REPORT FOR FISCAL YEAR 2010 WAS IN THE WINTER 2011 EDITION OF HEALTHLINES, THE NEWSLETTER OF MARCUS DALY MEMORIAL HOSPITAL. THE NEWSLETTER WAS DELIVERED TO EVERY MAILING ADDRESS IN RAVALLI COUNTY COVERING APPROXIMATELY 14,300 HOUSEHOLDS. AN ADDITIONAL 1,000 COPIES OF THE NEWSLETTER WERE PRINTED FOR GENERAL CIRCULATION.
PART I, LINE 7: EXPLANATION OF COSTING METHOD:FOR FINANCIAL ASSISTANCE, MEDICAID, COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS,THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COSTS TO CHARGES (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, MEDICAID PROVIDER TAXES, TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING). THIS METHODOLOGY ALSO APPLIES TO EMERGENCY SERVICES, THE BITTERROOT GENERAL VASCULAR SURGERY CLINIC, THE RAVALLI UROLOGY GLINIC, AND BITTERROOT ORTHOPEDICS & SPORTS, ALL INCLUDED IN SUBSIDIZED HEALTH SERVICES. ALSO INCLUDED IN THE SUBSIDIZED HEALTH SERVICES LINE IS HOME HEALTH AND HOSPICE. FOR HOME HEALTH AND HOSPICE, THE MEDICARE COST REPORT WAS USED TO DETERMINE TOTAL COSTS AND REVENUES.
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 $ 4872742.
PART II: THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY PARTICIPATION IN BOTH ECONOMIC AND COALITION BUILDING EVENTS. THE HOSPITAL PARTNERS WITH LOCAL HIGH SCHOOLS WITH A "JOB SHADOW" PROGRAM. THE GOAL IS TO EXPOSE AND PROMOTE THE HEALTH CARE PROFESSION TO AREA YOUTH. THE HOSPITAL IS ALSO REPRESENTED ON THE BITTERROOT COLLEGE STEERING TEAM AND THE JOB SERVICE ECONOMIC COUNCIL. THE HOSPITAL PARTNERS WITH THE ROCKY MOUNTAIN LAB, A LEVEL 4 BIOHAZARD LAB, TO HELP ENSURE COMMUNITY SAFETY AND IS REPRESENTED AT ADULT PROTECTION SERVICES AND OTHER COMMUNITY SUPPORT ORGANIZATIONS.
PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT RECEIVABLES" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"THE HOSPITAL MAINTAINS AN ALLOWANCE FOR UNCOLLECTIBLE SELF-PAY ACCOUNTS. PATIENTS ARE NOT REQUIRED TO PROVIDE COLLATERAL FOR SERVICES RENDERED. PAYMENT FOR SERVICES IS REQUIRED AT THE TIME OF SERVICE WHEN THE AMOUNT DUE IS KNOWN OR UPON RECEIPT OF AN INVOICE, AFTER PAYMENT BY INSURANCE, IF ANY. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED TO AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENTS' FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. WHEN ALL COLLECTION EFFORTS HAVE BEEN EXHAUSTED, THE ACCOUNT IS WRITTEN OFF AGAINST THE RELATED ALLOWANCE."THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS.
PART III, LINE 8: MDMH HAS A MEDICARE SHORTFALL IN EXCESS OF $5 MILLION. THE HOSPITAL HAS CRITICAL ACCESS HOSPITAL STATUS AND IS REIMBURSED BY MEDICARE FOR INPATIENT AND OUTPATIENT SERVICES ON A COST BASIS AS DEFINED AND LIMITED BY THE MEDICARE PROGRAM. MDMH PROVIDES A SIGNIFICANT RURAL LINK FOR BOTH THE HEALTH AND WELL-BEING OF RAVALLI COUNTY RESIDENTS. WE ARE COMMITTED TO LOCAL HEALTHCARE CLOSE TO HOME AND WORK HARD TO EARN AND KEEP THE TRUST OF THE LOCAL COMMUNITY. TO ENSURE THAT A VARIETY OF CLINIC, HOSPITAL AND EMERGENCY SERVICES ARE OPEN AND AVAILABLE TO ALL THOSE WITHIN OUR SERVICE AREA WE STRIVE TO OPERATE AT THE HIGHEST LEVEL OF FISCAL RESPONSIBILITY AND TO BE A GOOD STEWARD OF OUR RESOURCES. IRS AND CLIFTONLARSONALLEN METHODOLOGY WAS USED TO COMPUTE THE MEDICARE SHORTFALL.
PART III, LINE 9B: IF A PATIENT IS PRESUMED TO BE FINANCIALLY INDIGENT, THE PATIENT REPRESENTATIVE WILL OFFER A PATIENT FINANCIAL STATEMENT (PFS) TO BE FILLED OUT. THE PFS WILL BE FORWARDED TO THE CHARITY CARE COMMITTEE FOR REVIEW AND DETERMINATION OF CHARITY CARE STATUS. A PATIENT MAY REQUEST A MONTHLY PAYMENT ARRANGMENT. A MINIMUM PAYMENT OF $30 MUST BE PAID MONTHLY, WITH THE BALANCE PAID IN FULL WITHIN 3 YEARS. ACCOUNTS THAT CANNOT BE COLLECTED AFTER NORMAL IN-HOUSE COLLECTION PROCEDURES MAY BE REFERRED TO A COLLECTION AGENCY, MAGISTRATE OR ATTORNEY FOR FURTHER COLLECTION ACTION.
PART VI, LINE 2: PLANNING IS IN PLACE TO DEVELOP CRITERIA FOR ASSESSING THE NEEDS OF THE COMMUNITY IN WHICH THE HOSPITAL SERVES. NEEDS ASSESSMENT CRITERIA WILL BE IN USE FOR FISCAL YEAR 2013.
PART VI, LINE 3: BILLING AND COLLECTION INFORMATION IS LOCATED ON THE BACK OF STATEMENTS SENT TO PATIENTS. ON A MONTHLY BASIS, WE CONTACT BY PHONE REQUESTING PAYMENT AND MAY EXPLAIN POLICIES AT THAT TIME. WE UTITLIZE THE MASH PROGRAM TO SCREEN PRIVATE PAY PATIENTS TO QUALIFY FOR OTHER PROGRAMS SUCH AS MEDICAID AND DISABILITY.
PART VI, LINE 4: WE SERVE A RURAL POPULATION WHERE THE HOUSEHOLD MEDIAN INCOME IS ABOUT $28,000. OUR PAYER MIX IS 50% MEDICARE, 9% MEDICAID, 11% SELF PAY, NO INSURANCE, WITH THE BALANCE AS OTHER COMMERCIAL PAYERS. THE PERIOD UNEMPLOYMENT RATE IN RAVALLI COUNTY IS BETWEEN 9 AND 10.2%.
PART VI, LINE 6: THE HOSPITAL IS PROUD OF IT'S EFFORTS TO PROMOTE COMMUNITY HEALTH AND WELLNESS THROUGH PROMOTING WOMEN'S HEART HEALTH AND BREAST CANCER AWARENESS. THE HOSPITAL SPONSORS AN ANNUAL SPORTS PHYSICAL CLINIC TO SUPPORT AND ENCOURAGE AREA YOUTH TO PARTICIPATE IN PHYSICAL ACTIVITIES. OTHER COMMUNITY CLINICS OR SCREENINGS INCLUDED BLOOD PRESSURE TESTING AT AREA SENIOR CENTERS, AND LIPID PROFILES AND CHOLESTEROL TESTS PROVIDED TO THE COMMUNITY FREE OF CHARGE. THE HOSPITAL WAS PROUD TO CONDUCT AN EDUCATIONAL SERIES DEDICATED TO DIABETES WHICH WAS WELL RECEIVED BY THE COMMUNITY.
PART VI, LINE 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM.
MTREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
JOHN M BARTOS
23341200044073020520087130306718000
WALKER ASHCRAFT MD
13200102072300015984067140175422000
FREDERIK ILGENFRITZ MD
219002000008400010000228402000
JOHN COURCHESNE MD
184452016679800030492067140388456000
JEREMIAH CLINTON MD
366354000000051850371539000
JOHN MORELAND MD
27184404564900038500000355993000
YVONNE COURCHESNE MD
163708015870500030492010000353905000
LUKE CHANNER MD
24999903589600018500096880314083000

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1MT HEALTH FACILITY AUTHORITYBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN810302402IssuerEIN
CUSIP Number612043ED7CUSIPNumber
Date Issued2007-01-31DateIssued
Issue Price7068924IssuePrice
Description Of PurposeCONSTRUCTION OF A NEW EMERGENCY DEPARTMENTDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired750000AmountRetired
Total Proceeds7135000TotalProceeds
Amount In Reserve Fund538116AmountInReserveFund
Issuance Costs From Proceeds261801IssuanceCostsFromProceeds
Capital Expenditures5973474CapitalExpenditures
Year Of Subst Completion2008YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonKATHLEEN OWINGSNamePerson
FieldValueIRS element (for citing)
RelationshipSPOUSE OF BOARD MEMBERRelationship
Amount Of Transaction104607AmountOfTransaction
Description Of TransactionEMPLOYMENTDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 WAS REVIEWED, IN DETAIL, BY THE CFO AND CEO. THE FORM 990 WAS THEN REVIEWED BY THE BOARD OF DIRECTORS AND HOSPITAL FINANCE COMMITTEE AT A BOARD MEETING BEFORE IT WAS FILED.
THE HOSPITAL ATTORNEY ATTENDS ALL BOARD MEETINGS AND HE IS GIVEN THE AUTHORITY TO QUESTION, PRIOR TO DISCUSSION, A POTENTIAL CONFLICT OF INTEREST FOR ANY DIRECTOR. THE CEO RAISES A QUESTION REGARDING CONFLICT OF INTEREST. THE HOSPITAL BOARD ASKS THE DIRECTOR TO STEP OUT OF THE ROOM DURING DISCUSSION OF CONFLICT. THE DIRECTOR IS EXCUSED FOR THE DISCUSSION ONCE A CONFLICT HAS BEEN DETERMINED OR IS INVITED BACK INTO THE ROOM IF NO CONFLICT IS DETERMINED TO EXIST.FORM 990, PART VI, SECTION B, LINE 12C
CEO - OCCURS ANNUALLY WITH ANNUAL COMPENSATION COMMITTEE OF THE BOARD. THE COMMITTEE REVIEWS SURVEYS FOR COMPARABLE PAY AND BENEFITS. THIS COMMITTEE ALSO CONDUCTS THE ANNUAL EVALUATION OF THE CFO.FORM 990, PART VI, SECTION B, LINE 15
GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST.FORM 990, PART VI, SECTION C, LINE 19
CHANGES IN NET ASSETS OR FUND BALANCES:CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF DALY HOSPITAL FOUNDATION 211,063. TOTAL TO FORM 990, PART XI, LINE 5: 211,063.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1DALY HOSPITAL FOUNDATIONINCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11200 WESTWOOD DRIVEAddressLine1
CityHAMILTONCity
StateMTState
ZIP Code59840ZIPCode
FieldValueIRS element (for citing)
EIN363766000EIN
Primary ActivitiesCHARITABLE SERVICESPrimaryActivities
Legal Domicile StateMTLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity Status11-TYPE 2PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
Controlled Org1ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1DALY HOSPITAL FOUNDATION INCBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeKTransactionType
Amount Involved145953AmountInvolved
Method Of Amt DeterminationFAIR MARKET VALUEMethodOfAmtDetermination