2012-05-01T15:25:24-05:00 2011-06-30 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2010-07-01 810247705 COMMUNITY MEDICAL CENTER INC COMM 4067284100 2827 FORT MISSOULA ROAD MISSOULA MT 59804 DAVID RICHHART CFO 4067284100 2012-05-01 1 6123764500 2010 2016-02-24 21:20:13Z STEVE CARLSON 2827 FORT MISSOULA ROAD MISSOULA MT 59804 150559442 0 X WWW.COMMUNITYMED.ORG X 1948 MT PROVIDE EXCEPTIONAL HEALTHCARE SERVICES TO THE PEOPLE OF WESTERN MONTANA. 13 13 1352 200 1461101 -270364 2332902 897895 139150066 146279301 541556 356059 2575042 2875966 144599566 150409221 136634 155521 0 0 67111393 70700892 0 0 42811 67532215 70438410 134780242 141294823 9819324 9114398 111286834 150377522 40688024 69729886 70598810 80647636 COMMUNITY MEDICAL CENTER (CMC) WILL IMPROVE THE HEALTH OF THE PEOPLE IN OUR REGION THROUGH EXCEPTIONAL CARE AND SERVICES. 0 0 108199075 155521 146279301 CMC PROVIDES DAILY PATIENT SERVICES, PROFESSIONAL AND TECHNICAL SERVICES, AND REHABILITATION SERVICES FOR PATIENT CARE. 5,463 INPATIENTS ARE ADMITTED TO CMC EACH YEAR. 129,988 OUTPATIENT SERVICES ARE PROVIDED ANNUALLY. 94,586 VISITS ARE MADE TO OUR PHYSICIANS. THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY POLICY AGGREGATED APPROXIMATELY $4,517,620 FOR THE YEAR ENDED JUNE 30, 2011. 108199075 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 184 0 1352 1 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 MT X DAVID RICHHART 4063274004 2827 FORT MISSOULA ROAD MISSOULA MT 59804 ROGER MUNRO 1.50 X X 0 0 0 SCOTT STEARNS 1.50 X X 0 0 0 GEORGE MANLOVE 1.50 X X 0 0 0 JOHN VAN STRYDONCK 1.50 X X 0 0 0 TANYA ASK 1.50 X 0 0 0 MARK GARNAAS 1.50 X 0 0 0 SCOTT HACKER 1.50 X 0 0 0 SHAREN PETERS 1.50 X 0 0 0 MICHAEL STEWART 1.50 X 0 0 0 RICH ZINS 1.50 X 0 0 0 FRANK D'ANGELO 1.50 X 0 0 0 JAN PARKS 1.50 X 0 0 0 STEVE CARLSON 55.00 X X 339674 0 23473 BILL JOHNSTON 1.50 X 0 0 0 DAVID RICHHART 60.00 X 185011 0 16691 GREG UTTER 40.00 X 373406 0 28303 FRANK REED MD 50.00 X 229620 0 16661 JONATHAN WEISUL MD 55.00 X 327790 0 19076 MARK KANETA MD 40.00 X 338746 0 21286 JANET HILLER MD 40.00 X 332398 0 23304 NEWTON COUTINHO 40.00 X 310757 0 16884 DAVID JINICH 40.00 X 287897 0 4760 PHILIP HOLMAN 40.00 X 274200 0 10282 2999499 0 180720 55 0 1 0 MT HEART ANGIO LAB LLC 2827 FORT MISSOULA ROAD MISSOULA MT 59804 HEART CATH SERVICES 1828649 MT CANCER SPECIALISTS PO BOX 7877 MISSOULA MT 59807 PHYSICIAN SERVICES 1630340 GE MEDICAL SYSTEMS PO BOX 843553 DALLAS TX 75284 SUPPLIES & SERVICES 1083980 MTN STATES HEALTHCARE RISK RET PO BOX 410067 SALT LAKE CITY UT 84141 CONSULTING 1079485 ELLERBE BECKET INC NW 8400 MINNEAPOLIS MT 55485 ARCHITECTURE/ENGINEERING 1041952 59 465841 431184 870 897895 NET PATIENT REVENUE 621500 144626212 143165111 1461101 JV ANCILLARY REVENUE 621500 2098769 2098769 HEART LAB REVENUE 621500 -445680 -445680 146279301 394141 394141 377436 377436 377436 377436 112139 150221 -38082 -38082 -38082 MISCELLANEOUS REVENUE 900099 2498530 2498530 2498530 150409221 144818200 1461101 3232025 155521 155521 1651991 1651991 54276692 44464618 9812074 2041711 1626444 415267 8841856 7132141 1709715 3888642 3097725 790917 157758 157758 75681 75681 17337862 10971532 6366330 33558193 25915499 7642694 2740131 1217158 1480162 42811 928287 366319 561968 7601 95 7506 703930 703930 4732388 4687833 44555 1277126 772829 504297 BAD DEBT 6890807 6890807 LICENSE & FEES 1156912 14572 1142340 DUES & SUBSCRIPTIONS 518082 161255 356827 MISCELLANEOUS EXPENSES 290310 20797 269513 EDUCATION AND TRAINING 63342 63342 141294823 108199075 33052937 42811 11748642 22001552 19318079 33315767 20745002 20323744 5154301 5154301 3145847 3336757 974189 803489 103722751 55617272 35646148 48105479 9355710 10601745 202111 952862 4996805 5781826 111286834 150377522 17072127 21238533 26511 24409555 15703927 13701378 2036970 1505784 5875000 8848125 40688024 69729886 X 64062730 74863568 3532702 2731191 3003378 3052877 70598810 80647636 111286834 150377522 X 9114398 934429 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7686 7686 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: COMMUNITY MEDICAL CENTER PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND MONTANA HOSPITAL ASSOCIATION. THESE ORGANIZATION PARTICIPATE IN LOBBYING ACTIVITIES. 3054980 49499 651983 3756462 2356624 38678 659678 3054980 2952845 11855 -608076 2356624 0.19000 0.81000 0 1 1 209682 209682 44504431 22502714 22001717 897737 187526 710211 48823072 32927032 15896040 9287829 9287829 48105479 INVESTMENT IN JOINT VENTURES 3474241 F MORTAGE BACKED GOVERNMENT SECURITIES 7127504 F 10601745 THIRD PARTY PAYABLE 8848125 8848125 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE FOUNDATION AND THE INCOME EARNED ON THESE FUNDS ARE DISTRIBUTED TO THE HOSPITAL TO COMPLY WITH THE PURPOSES SPECIFIED BY THE DONOR. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: 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 HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOSPITAL IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS ENDED 2008 TO 2010 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. THE HOSPITAL'S MAJORITY OWNED LIMITED LIABILITY COMPANY, MONTANA HEART ANGIO LAB, LLC IS TREATED AS A PARTNERSHIP FOR FEDERAL INCOME TAX PURPOSES. CONSEQUENTLY, FEDERAL INCOME TAXES ARE NOT PAYABLE BY, OR PROVIDED FOR, BY MONTANA HEART ANGIO LAB, LLC. 1 1 X 1 X 1 X 1 1 1 0 1 1 2317707 2317707 0.01720 20667340 18512585 2154755 0.01600 22985047 18512585 4472462 0.03320 199203 199203 0.00150 585596 585596 0.00440 16748591 9318333 7430258 0.05530 190919 190919 0.00140 17724309 9318333 8405976 0.06260 40709356 27830918 12878438 0.09580 20000 20000 0.00010 8000 8000 0.00010 1500 1500 0.00000 29500 29500 0.00020 1 3534983 35000 24514505 30174437 -5659932 X 1 1 1 1 COMMUNITY MEDICAL CENTER

2827 FORT MISSOULA ROAD MISSOULA MT 59804

X X X NA 1 18 MISSOULA VALLEY PEDIATRICS (MVP)

2835 FORT MISSOULA ROAD SUITE 205 MISSOULA MT 59804

PEDIATRICS CMC REHABILITATION PHYSICIANS

2827 FORT MISSOULA ROAD MISSOULA MT 59804

PHYSIATRISTS PARKSIDE COMMUNITY FAMILY CARE (PCFC)

2831 FORT MISSOULA ROAD SUITE 146 MISSOULA MT 59804

FAMILY PRACTICE, OFFICE-BASED PSYCHIATRY ROCKY MOUNTAIN NEONATOLOGY (RMN)

2825 FORT MISSOULA ROAD SUITE 121 MISSOULA MT 59804

NEONATOLOGY ROCKY MOUNTAIN PERINATAL ASSOCIATES

2835 FORT MISSOULA ROAD SUITE 304 MISSOULA MT 59804

PERINATOLOGY STEVENSVILLE CMC (SCMC)

3800 EASTSIDE HIGHWAY STEVENSVILLE MT 59870

INTERNAL MEDICINE, FAMILY PRACTICE WELLCARE

2825 FORT MISSOULA ROAD SUITE 203 MISSOULA MT 59804

INDEPENDENT MEDICAL EXAMS FOR WORKERS' COMP MANAGEMENT DIABETES & ENDOCRINOLOGY ASSOCIATES

1211 S RESERVE ST STE 202 MISSOULA MT 59804

ENDOCRINOLOGY DIABETES & NUTRITION CENTER

1211 S RESERVE ST STE 202 MISSOULA MT 59804

PUMP EDUCATOR, DIETITIAN, DIABETES EDUCATION MOUNTAIN VIEW FAMILY MEDICINE & OB

2835 FORT MISSOULA ROAD SUITE 101 MISSOULA MT 59804

FAMILY PRACTICE, FAMILY PRACTICE WITH OBSTETRICS COMMUNITY PEDIATRIC HOSPITALISTS

2827 FORT MISSOULA ROAD MISSOULA MT 59804

HOSPITALIST/PEDIATRICIAN CPG ON NORTH RESERVE

2230 NORTH RESERVE STREET MISSOULA MT 59801

FAMILY PRACTICE/OPEN ACCESS WALK-IN CARE CPG ON SOUTH RESERVE

1211 RESERVE ST SOUTH SUITE 101 MISSOULA MT 59801

FAMILY PRACTICE/OPEN ACCESS WALK-IN CARE CPG COUMADIN CLINIC

2831 FORT MISSOULA ROAD STE 103 MISSOULA MT 59804

COUMADIN CPG CARDIOLOGY

2831 FORT MISSOULA RD STE 102 MISSOULA MT 59804

CARDIOLOGY CPG THORACIC AND VASCULAR

2831 FORT MISSOULA RD STE 102 MISSOULA MT 59804

THORACIC AND VASCULAR CPG NORTH PRIMARY

2230 NORTH RESERVE STREET MISSOULA MT 59801

INTERNAL MEDICINE FORT MISSOULA MEDICAL ASSOCIATES (FMMA)

1211 S RESERVE ST STE 101 MISSOULA MT 59801

INTERNAL MEDICINE, FAMILY PRACTICE, RHEUMATOLOGY PART I, LINE 3C: SLIDING SCALE BETWEEN 200% AND 300% PART I, LINE 7: THE COSTING METHOD USED WAS THE COST TO CHARGE RATIO DERIVED FROM USING WORKSHEET 2. PART I, LINE 7G: ALL CLINICS ARE PHYSICIAN CLINICS. THEREFORE ALL SUBSIDIZED HEATH COST ARE ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, L7 COL(F): WHEN CALCULATING CHARITY-CARE PERCENTAGE OF TOTAL EXPENSES (SCHEDULE H, PART I, LINE 7, COLUMN F), THE HOSPITAL ELIMINATED $6,890,807 OF BAD DEBT EXPENSE. PART II: CMC INVESTS IN THE MISSOULA AND THE SURROUNDING AREA THROUGH MULTIPLE AVENUES. AS A KEY PARTNER OF THE MISSOULA ECONOMIC PROJECT(MEP), CMC HELPS MEP CREATE A PROGRESSIVE BUSINESS DEVELOPMENT AND RECRUITMENT PROGRAM FOR THE CITY OF MISSOULA. WE BELIEVE THAT A STRONG BUSINESS COMMUNITY CREATES A VIBRANT CITY THAT CAN BE SUPPORTED BY NON-PROFIT HEALTHCARE ORGANIZATIONS, SUCH AS CMC. IN ADDITION, OUR PARTICIPATION IN EMERGENCY PREPAREDNESS IN PARTNERSHIP WITH OTHER HOSPITALS, FIRE, POLICE, AND THE CITY/COUNTY GOVERNMENT STRENGTHENS OUR ABILITY TO RESPOND EFFICIENTLY AND QUICKLY TO ANY EMERGENCY WITHIN THE AREA. AS MISSOULA CHAMBER OF COMMERCE MEMBERS, WE SUPPORT OUR BUSINESS COMMUNITY BY SPONSORING AT LEAST ONE PARTICIPANT FROM CMC IN THE LEADERSHIP MISSOULA PROGRAM ANNUALLY. THIS PROGRAM CREATES AMBASSADORS OF CMC EMPLOYEES FOR THE LARGER COMMUNITY. PART III, LINE 4: BAD DEBT IS AN ESTIMATE USING HISTORICAL DATA ON PAYMENTS RECEIVED AND AMOUNTS THAT WERE ACTUALLY NEVER COLLECTED. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS AN ESTIMATE BASED ON TOTAL CHARITY CARE. PART III, LINE 8: COST ARE ALLOCATED BASED ON ACTUAL COST OF INDIVIDUAL CLINICS OR HOSPITAL DEPARTMENTS. THE AMOUNT SHOWN HERE AS THE MEDICARE SHORTFALL DOES NOT INCLUDED ALL COSTS AND REVENUES FOR MEDICARE. THE COSTS AND REVENUES SHOWN HERE INCLUDE ONLY THE AMOUNTS ALLOWED IN THE MEDICARE COST REPORT. TO DETERMINE THE ACTUAL MEDICARE SHORTFALL ALL REVENUES AND COST MUST BE INCLUDED IN THE CALCULATION. WHEN ALL COSTS ARE INCLUDED OUR SHORTFALL FOR MEDICARE WAS $10,238,836 RATHER THAN $5,659,933. THIS IS A DIFFERENCE OF $4,578,903. OUR BENEFIT TO THE COMMUNITY FOR TREATING MEDICARE PATIENTS IS $4,578,903 HIGHER THAN WHAT IS SHOWN IN PART III SECTION B OF THE SCHEDULE H. OUR ACTUAL NET MEDICARE REVENUES WERE $33,092,944. OUR ACTUAL NET MEDICARE EXPENSES WERE $43,331,780. THESE NUMBERS DO NOT INCLUDE ANY REVENUES OR EXPENSES FROM SUBSIDIZED HEALTH SERVICES. ONE HUNDRED PERCENT OF THIS SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THIS AMOUNT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: IN OUR COMMUNITY MEDICARE HAS THE LOWEST REIMBURSEMENT RATE OF ALL PAYERS. WE DO NOT BELIEVE OUR MEDICARE SHORTFALL TO BE FROM ANY SORT OF DEFICIENCIES IN THE EFFICIENCY OF OPERATIONS OR LOW PATIENT VOLUMES. PART III, LINE 9B: PATIENTS RECEIVE INFORMATION AT THE TIME OF REGISTRATION REGARDING FINANCIAL ASSISTANCE BOTH FOR SELF PAY AND BALANCE AFTER INSURANCE. ALL SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PROGRAMS BY THE MASH PROGRAMS, AND IF NO ELIGIBILITY EXISTS ARE FURTHER SCREENED FOR HOSPITAL FINANCIAL ASSISTANCE. ADDITIONALLY, PATIENTS RECEIVE INFORMATION REGARDING FINANCIAL ASSISTANCE IN THEIR STATEMENTS AS WELL AS VERBALLY WHEN FOLLOW UP CALLS ARE MADE ON ANY PATIENT BALANCE. PATIENTS WHO QUALIFY FOR CHARITY CARE RECEIVE AN ADJUSTMENT ON THE BALANCE OF THEIR ACCOUNT CORRESPONDING WITH THE APPROPRIATE REDUCTION ACCORDING TO POLICY. REMAINING BALANCES, IF ANY, ARE COLLECTED EITHER IN FULL OR BY PAYMENT PLAN, OR IN THE CASE OF NON-PAYMENT MAY HAVE THE ADJUSTED BALANCE ASSIGNED TO AN OUTSIDE AGENCY FOR RESOLUTION. PART VI, LINE 2: COMMUNITY MEDICAL CENTER WORKS WITH SAINT PATRICK HOSPITAL AND THE MISSOULA CITY-COUNTY HEALTH DEPARTMENT TO ASSESS THE NEEDS OF THE COMMUNITY, AS WELL AS WITH OTHER NON-PROFIT ORGANIZATIONS, I.E., MISSOULA AGING SERVICES, YWCA, YMCA, POVERELLO HOMELESS SHELTER, AND UNITED WAY. COMMUNITY ASSESSES THE NEEDS OF THE COMMUNITY ALONG WITH OUR PARTNER ORGANIZATIONS AND THEN CRAFTS A RESPONSE TO THE NEEDS ASSESSMENT TO FULFILL ANY GAPS THAT ARE IDENTIFIED. PART VI, LINE 3: PATIENTS RECEIVE INFORMATION AT THE TIME OF REGISTRATION REGARDING FINANCIAL ASSISTANCE BOTH FOR SELF PAY AND BALANCE AFTER INSURANCE. ALL SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PROGRAMS BY THE MASH PROGRAMS, AND IF NO ELIGIBILITY EXISTS ARE FURTHER SCREENED FOR HOSPITAL FINANCIAL ASSISTANCE. ADDITIONALLY, PATIENTS RECEIVE INFORMATION REGARDING FINANCIAL ASSISTANCE IN THEIR STATEMENTS AS WELL AS VERBALLY WHEN FOLLOW UP CALLS ARE MADE ON ANY PATIENT BALANCE. PART VI, LINE 4: CMC SERVES THE COMMUNITY OF MISSOULA, MT AND THE SURROUNDING COUNTIES. MONTANA IS A RURAL STATE AND THERE ARE THEREFORE LIMITED HOSPITALS IN THE REGION. THERE ARE TWO HOSPITALS IN MISSOULA. CMC SERVES A DISPROPORTIONATE NUMBER OF LOWER INCOME INDIVIDUAL AND THEREFORE RECEIVES DSH PAYMENTS. 0 MISSOULA CHAMBER OF COMMERCE PO BOX 7577 MISSOULA MT 59807 810167990 501(C)(6) 11940 TO SUPPORT GENERAL OPERATIONS. MISSOULA FAMILY YMCA 3000 SOUTH RUSSEL STREET MISSOULA MT 59801 810300829 501(C)(3) 16500 TO SUPPORT GENERAL OPERATIONS. UNITED WAY PO BOX 7395 MISSOULA MT 59806 810287854 501(C)(3) 20100 TO SUPPORT GENERAL OPERATIONS. AMERICAN HEART ASSOCIATION 710 2ND AVENUE SUITE 900 SEATTLE WA 98104 135613797 501(C)(3) 21071 TO SUPPORT GENERAL OPERATIONS. MISSOULA DOWNTOWN ASSOCIATION 218 E MAIN STREET MISSOULA MT 59802 810403474 501(C)(6) 5450 TO SUPPORT GENERAL OPERATIONS. MISSOULA THE BEST PLACE PROJECT PO BOX 7457 MISSOULA MT 59802 273994460 501(C)(6) 20000 TO SUPPORT GENERAL OPERATIONS. 3 3 X X X X 0 0 0 0 0 1 0 0 0 STEVE CARLSON 295932 0 39500 0 4242 0 14701 0 8772 0 363147 0 0 0 DAVID RICHHART 165888 0 16637 0 2486 0 8561 0 8130 0 201702 0 0 0 GREG UTTER 350853 0 17311 0 5242 0 17634 0 10669 0 401709 0 0 0 FRANK REED MD 202408 0 20000 0 7212 0 10061 0 6600 0 246281 0 0 0 JONATHAN WEISUL MD 277003 0 28500 0 22287 0 11204 0 7872 0 346866 0 0 0 MARK KANETA MD 211242 0 125561 0 1943 0 13250 0 8036 0 360032 0 0 0 JANET HILLER MD 217117 0 111757 0 3524 0 14021 0 9283 0 355702 0 0 0 NEWTON COUTINHO 310757 0 0 0 0 0 11417 0 5467 0 327641 0 0 0 DAVID JINICH 201420 0 79250 0 7227 0 0 0 4760 0 292657 0 0 0 PHILIP HOLMAN 179320 0 92425 0 2455 0 1203 0 9079 0 284482 0 0 0 PART I, LINE 6 CMC PAYS OUT LEADERSHIP COUNCIL BONUSES IF THE NET EARNINGS OF CMC MEET OR EXCEED THE BUDGETED AMOUNTS. BASED ON THE FISCAL YEAR 2011 FINANCIAL RESULTS, A PERCENTAGE OF THEIR BASE SALARY WAS PAID OUT AS A BONUS. MONTANA FACILITY FINANCE AUTHORITY 364615155 612043JA3 2010-12-29 24400067 CONSTRUCTION AND FACILITY EXPANSION OF WOMEN'S AND NEWBORN CARE CENTER 0 0 0 24146299 2142813 1993174 220565 3669258 11693129 0 0 0 1 0 0 0 0 1 SCHEDULE K, PART II, LINE 3 TOTAL PROCEEDS OF ISSUE TOTAL PROCEEDS OF $24,146,299 ON PART II, LINE 3 DOES NOT EQUAL THE ISSUE PRICE OF $24,400,061 INCLUDED IN PART I, LINE A, COLUMN E. THE DIFFERENCE OF $253,768 IS EQUAL TO THE UNDERWRITERS' DISCOUNTS. FORM 990, PART VI, SECTION A, LINE 1 THE ROLE OF THE EXECUTIVE COMMITTEE IS TO TRANSACT THE BUSINESS OF THE COMMUNITY MEDICAL CENTER BOARD OF DIRECTORS IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD, WHEN A MEETING OF THE FULL BOARD IS NOT FEASIBLE. THEIR RESPONSIBILITIES INCLUDE: - ACT ON MATTERS THAT CANNOT REASONABLY WAIT ACTION BY THE FULL BOARD. - ACT ON OTHER MATTERS DELEGATED TO THE EXECUTIVE COMMITTEE BY THE BOARD. - REPORT ACTIONS AT THE NEXT MEETING OF THE BOARD FOR RATIFICATION. - FUNCTION AS AN ADVISOR TO THE PRESIDENT/CEO ON SENSITIVE TOPICS. - PROVIDE INPUT INTO THE CONTENT AND STRUCTURING OF THE BOARD AGENDA. - CONDUCT THE EVALUATION AND SET THE SALARY OF THE PRESIDENT/CEO. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD AND ONE ADDITIONAL BOARD MEMBER AT LARGE. THE PRESIDENT/CEO SHALL BE AN EX OFFICIO MEMBER WITHOUT VOTE. THE CHAIR OF THE BOARD APPOINTS THE COMMITTEE MEMBERS ANNUALLY, TO COINCIDE WITH THE ELECTION OF OFFICERS. FORM 990, PART VI, SECTION B, LINE 11 SUBSEQUENT TO FILING THE FORM 990 WITH THE IRS, THE FORM 990 AND RELATED SCHEDULES WILL BE PROVIDED OF THE BOARD OF DIRECTORS FOR A COMPLETE REVIEW. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS SHALL BY RESOLUTION APPROVE A CONFLICT OF INTEREST POLICY FOR CMC THAT IS CONSISTENT WITH AND AT LEAST HAS PROTECTIVE AS THE APPLICABLE CONFLICT OF INTEREST PROVISIONS UNDER THE MONTANA NONPROFIT CORPORATION ACT. THE PURPOSE OF THE POLICY IS TO PROTECT CMC'S INTEREST WHEN IT IS CONTEMPLATING ENTRY INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF A DIRECTOR, OFFICER OF THE BOARD, OFFICER OF THE ORGANIZATION, OR MEMBER OF A COMMITTEE ("INTERESTED PERSON"). THE POLICY SHALL CONTAIN AT LEAST THE FOLLOWING PROVISIONS: (A) A DEFINITION OR DESCRIPTION OF WHAT CONSTITUTES A "CONFLICT OF INTEREST TRANSACTION," (B) A DEFINITION OR DESCRIPTION OF AN "INTERSTED PERSON," (C) A DEFINITION OR DESCRIPTION OF WHEN A PERSON HAS A "FINANCIAL INTERST" IN A TRANSACTION OR ARRANGEMENT, (D) DISCLOSURE PROCEDURES, (E) PROCEDURES FOR DETERMINING WHETHER THE FINANCIAL INTEREST OF AN INTERESTED PERSON MAY RESULT IN A CONFLICT OF INTEREST, (F) PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST AFTER DETERMINING THAT THERE IS A CONFLICT, INCLUDING VOTING REQUIREMENTS AND PROCEDURES, (G) PROCEDURES FOR ADEQUATE RECORD KEEPING, AND (H) PROCEDURES FOR ENSURING THAT ALL DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF COMMITTEES, UNDERSTAND AND COMPLY WITH THE CONFLICT OF INTEREST POLICY. ALL REAL OR POTENTIAL CONFLICT OF INTEREST MUST BE IMMEDIATELY REFERRED TO THE INTEGRITY OFFICER FOR RESOLUTION. CMC'S EMPLOYEE HANDBOOK AND STANDARDS OF CONDUCT IS GIVEN TO EACH NEW HIRE UPON EMPLOYMENT, UNDER THE STANDARDS OF CONDUCT THERE IS A SECTION ON CONFLICTS OF INTEREST AND HOW TO HANDLE THE CONFLICT. CONFLICTS ARE TO BE REPORTED DIRECTLY TO THE IMMEDIATE SUPERVISOR AND CMC ALSO OFFERS AN ANONYMOUS HOTLINE SERVCES. ONCE A YEAR THE CONFLICT OF INTEREST POLICY IS REVIEWED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15 WE HIRED AN INDEPENDENT SERVICE (INTEGRATED HEALTHCARE STRATEGIES) TO DO AN EXECUTIVE COMPENSATION SURVEY. THIS SURVEY WAS CONDUCTED FOR THE TOP 12 COMPENSATED EMPLOYEES OF THE HOSPITAL. THE DATA WAS PRESENTED TO A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, AND SALARY ADJUSTMENTS (IF ANY) WERE DETERMINED. THE SURVEY INCLUDED REGIONAL AND NATIONAL COMPARISONS TO INSTITUTIONS OF A SIMILAR SIZE AND REVENUE GENERATION TO MAKE THE RESULTS COMPARABLE. AS MENTIONED ABOVE, THE SAME PROCESS THAT WAS USED FOR THE CEO, WAS USED TO COMPARE THE SALARIES OF OTHER KEY EXECUTIVES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -79,191. PRIOR PERIOD ADJUSTMENTS: 158,388. CHANGE IN BENEFICIAL INTEREST OF CMC FOUNDATION 855,232. TOTAL TO FORM 990, PART XI, LINE 5: 934,429. COMMUNITY MEDICAL CENTER FOUNDATION 2827 FORT MISSOULA ROAD MISSOULA MT 59804 363627205 TO PROVIDE FUNDING TO COMMUNITY MEDICAL CENTER HOSPITAL MT 501(C)(3) 7 N/A 0 MONTANA HEART ANGIO LAB LLC 2827 FORT MISSOULA ROAD MISSOULA MT 58904 810542065 CATH LAB MT COMMUNITY MEDICAL CENTER RELATED -445680 2651244 0 0 0.92900 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 0 COMMUNITY MEDICAL CENTER FOUNDATION C 465841 CASH COMMUNITY MEDICAL CENTER FOUNDATION P 437552 EXPENSE