STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

BIG HORN HOSPITAL ASSOCIATION: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BIG HORN HOSPITAL ASSOCIATION (EIN 81-0384618)
Tax period
2010-07-01 to 2011-06-30
Filed
2012-05-14
IRS object ID
201241359349306074
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)
Timestamp2012-05-14T16:49:04-05:00Timestamp
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)
EIN810384618EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1BIG HORN HOSPITAL ASSOCIATIONBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBIGHNameControl
Phone4066652310Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line117 NORTH MILES AVENUEAddressLine1
CityHARDINCity
StateMTState
ZIP Code59034ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameROXIE CAINName
TitleCONTROLLERTitle
Phone4066652310Phone
Date Signed2012-05-14DateSigned
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 PersonTERRY BULLISNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line117 NORTH MILES AVENUEAddressLine1
CityHARDINCity
StateMTState
ZIP Code59034ZIPCode
FieldValueIRS element (for citing)
Gross Receipts13011574GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BIGHORNHOSPITAL.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionTO PROVIDE QUALITY MEDICAL AND HEALTH SERVICES IN BIG HORN COUNTY AND SURROUNDING AREAS.ActivityOrMissionDescription
Nbr Voting Members Governing Body7NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees218TotalNbrEmployees
Total Nbr Volunteers15TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year299394ContributionsGrantsPriorYear
Contributions Grants Current Year968104ContributionsGrantsCurrentYear
Program Service Revenue Prior Year10850331ProgramServiceRevenuePriorYear
Program Service Revenue CY11815681ProgramServiceRevenueCY
Investment Income Prior Year11229InvestmentIncomePriorYear
Investment Income Current Year46771InvestmentIncomeCurrentYear
Other Revenue Prior Year17439OtherRevenuePriorYear
Other Revenue Current Year8411OtherRevenueCurrentYear
Total Revenue Prior Year11178393TotalRevenuePriorYear
Total Revenue Current Year12838967TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY32333GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year6335983SalariesEtcPriorYear
Salaries Etc Current Year6756927SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year4488399OtherExpensePriorYear
Other Expenses Current Year4862707OtherExpensesCurrentYear
Total Expenses Prior Year10824382TotalExpensesPriorYear
Total Expenses Current Year11651967TotalExpensesCurrentYear
Revenues Less Expenses Prior Year354011RevenuesLessExpensesPriorYear
Revenues Less Expenses CY1187000RevenuesLessExpensesCY
Total Assets BOY9305775TotalAssetsBOY
Total Assets EOY11962446TotalAssetsEOY
Total Liabilities BOY2288607TotalLiabilitiesBOY
Total Liabilities EOY3586940TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7017168NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY8375506NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionBIG HORN HOSPITAL ASSOCIATION, ALONG WITH ITS AFFILIATED STAFF, WILL WORK TOGETHER TO PROVIDE CARING, ECONOMICAL, QUALITY MEDICAL AND HEALTH SERVICES IN BIG HORN COUNTY AND SURROUNDING AREAS.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense10403163Expense
Grants32333Grants
Revenue11815681Revenue
DescriptionBIG HORN HOSPITAL ASSOCIATION IS COMPRISED OF BIG HORN HOSPITAL AND HERITAGE ACRES. BIG HORN HOSPITAL IS A 25-BED ACUTE CARE HOSPITAL. HERITAGE ACRES IS A 36-BED NURSING CARE FACILITY AND A 10-UNIT ASSISTED LIVING AND 10-UNIT INDEPENDENT LIVING. DURING THE YEAR ENDED JUNE 30, 2011, BIG HORN HOSPITAL PROVIDED 683 DAYS OF PATIENT SERVICES, 7,550 OUTPATIENT VISITS (INCLUDING 4,280 ER VISITS) AND 4,557 DAYS OF RESIDENT SERVICES; HERITAGE ACRES PROVIDED 12,649 DAYS OF RESIDENT SERVICES. THE HOSPITAL ALSO ADDED NEW MRI AND MAMMOGRAPHY MACHINES. BIG HORN HOSPITAL ASSOCIATION PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDED CARE TO THESE PATIENTS WAS $88,066 FOR THE YEAR ENDED JUNE 30, 2011.Description
Total Program Service Expense10403163TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
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 Organizations1GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required0ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109627NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees218NumberOfEmployees
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 Members7NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
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 Body0Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy0WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1ROXIE CAIN CONTROLLERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4066659222TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line117 N MILES AVENUEAddressLine1
CityHARDINCity
StateMTState
ZIP Code59034ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (9 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensation
TERRY BULLIS
CHAIRMAN0.40XX000
C WILLIAM FISHER
VICE CHAIRMAN0.40XX000
JAMES SEYKORA
SECRETARY0.40XX000
SUE MURPHY
TREASURER0.40XX000
GARY OSTAHOWSKI MD
MEMBER0.40X000
CHAD FENNER
MEMBER0.40X000
ROCKY EGGART
MEMBER0.40X000
GARY ROBERTSON
CEO40.00X130698012990
ROXIE CAIN
CONTROLLER40.00X78358014412
FieldValueIRS element (for citing)
Total Reportable Comp From Org209056TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation27402TotalOtherCompensation
Number Individuals GT100 K1NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K0TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation

Name Of Contractor NameOfContractor

FieldValueIRS element (for citing)
Name PersonDIANE FISCHER - CRNA PCNamePerson

Address Of Contractor AddressOfContractor

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14395 HIGHWAY 87 NAddressLine1
CityBILLINGSCity
StateMTState
ZIP Code59105ZIPCode
FieldValueIRS element (for citing)
Description Of ServicesCRNADescriptionOfServices
Compensation147320Compensation
FieldValueIRS element (for citing)
Number Of Contractors GT100 K1NumberOfContractorsGT100K
Related Organizations744634RelatedOrganizations
Government Grants159118GovernmentGrants
All Other Contributions64352AllOtherContributions
Total Contributions968104TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeExclusionExclusionAmount
PATIENT REVENUE6211101174519611745196
CAFETERIA90009938277$38,277
OTHER PATIENT REVENUE90009932208$32,208
FieldValueIRS element (for citing)
Total Program Service Revenue11815681TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column36416TotalRevenueColumn
Exclusion$36,416ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real167018Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real158607Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real8411Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column8411TotalRevenueColumn
Exclusion$8,411ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities13822Securities
Other10533Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other14000Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities13822Securities
Other-3467Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column10355TotalRevenueColumn
Exclusion$10,355ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column12838967TotalRevenueColumn
Related Or Exempt Function Income11745196RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$125,667ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total32333Total
Program Services32333ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total233249Total
Program Services46650ProgramServices
Management And General186599ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total5506623Total
Program Services5121602ProgramServices
Management And General385021ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total85182Total
Program Services74388ProgramServices
Management And General10794ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total519396Total
Program Services447820ProgramServices
Management And General71576ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total412477Total
Program Services378516ProgramServices
Management And General33961ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total62824Total
Management And General62824ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total971998Total
Program Services884243ProgramServices
Management And General87755ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total19000Total
Program Services969ProgramServices
Management And General18031ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total813442Total
Program Services757498ProgramServices
Management And General55944ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total27815Total
Program Services7560ProgramServices
Management And General20255ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total213462Total
Program Services213462ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total68709Total
Program Services53883ProgramServices
Management And General14826ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total25630Total
Management And General25630ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total637178Total
Program Services632055ProgramServices
Management And General5123ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total144164Total
Management And General144164ManagementAndGeneral

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT777226777226
EQUIPMENT RENT & MAINT2696842652614423
FOOD255599255599
MINOR EQUIPMENT17984014298136859
BED TAXES139737139737

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total256399Total
Program Services171380ProgramServices
Management And General85019ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total11651967Total
Program Services10403163ProgramServices
Management And General1248804ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY1270594BOY
EOY674348EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY961333BOY
EOY1997351EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY1402498BOY
EOY1689210EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY78559BOY
EOY122945EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY173522BOY
EOY142225EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY99957BOY
EOY73306EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis17043308LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec9911447LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY5213783BOY
EOY7131861EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY105529BOY
EOY131200EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY9305775BOY
EOY11962446EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY1253226BOY
EOY1530447EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY136000BOY
EOY120000EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY730000BOY
EOY655000EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY28894BOY
EOY32439EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY140487BOY
EOY1249054EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY2288607BOY
EOY3586940EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY6840034BOY
EOY8197768EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY177134BOY
EOY177738EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7017168BOY
EOY8375506EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY9305775BOY
EOY11962446EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses1187000ReconcilationRevenueExpenses
Reconcilation Other Changes171338ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$945OtherActivitiesAmount
Total Lobbying Expenditures IIB945TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierEXPLANATION OF OTHER LOBBYING ACTIVITIES:Identifier
Return ReferencePART II-B, LINE 1I:ReturnReference
ExplanationA PORTION OF THE DUES PAID TO THE MONTANA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION ARE USED FOR LOBBYING PURPOSES.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis434616OtherCostOrOtherBasis
Book Value434616BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis12545942OtherCostOrOtherBasis
Depreciation7747887Depreciation
Book Value4798055BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4045583OtherCostOrOtherBasis
Depreciation2163560Depreciation
Book Value1882023BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17167OtherCostOrOtherBasis
Book Value17167BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings7131861TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
Return ReferencePART IV, LINE 2B:ReturnReference
ExplanationTHE HOSPITAL ACTS AS A CUSTODIAN FOR THE FUNDS OF THE NURSING HOME RESIDENTS. THOSE FUNDS APPEAR AS RESTRICTED CASH AND ACCOUNT PAYABLE IN THE BALANCE SHEET.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report0AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense203178TotalCommunityBenefitExpense
Net Community Benefit Expense203178NetCommunityBenefitExpense
Percent Of Total Expense0.01870PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense1370089TotalCommunityBenefitExpense
Direct Offsetting Revenue1606689DirectOffsettingRevenue
Net Community Benefit Expense-236600NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1573267TotalCommunityBenefitExpense
Direct Offsetting Revenue1606689DirectOffsettingRevenue
Net Community Benefit Expense-33422NetCommunityBenefitExpense
Percent Of Total Expense0.01870PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense260TotalCommunityBenefitExpense
Net Community Benefit Expense260NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense260TotalCommunityBenefitExpense
Net Community Benefit Expense260NetCommunityBenefitExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1573527TotalCommunityBenefitExpense
Direct Offsetting Revenue1606689DirectOffsettingRevenue
Net Community Benefit Expense-33162NetCommunityBenefitExpense
Percent Of Total Expense0.01870PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$562,506BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare3364804AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare3376941CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-12137MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care0ProvisionForCharityCare
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 Line1BIG HORN HOSPITAL ASSOCIATIONBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line117 N MILESAddressLine1
CityHARDINCity
StateMTState
ZIP Code59034ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1HERITAGE ACRESBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1200 NORTH MITCHELLAddressLine1
CityHARDINCity
StateMTState
ZIP Code59034ZIPCode
FieldValueIRS element (for citing)
Facility TypeEXTENDED CARE FACILITY (SNF, ASSISTED LIVING, INDEPENDENT LIVING)FacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)

ExplanationExplanation
PART I, LINE 3C: THE "TEST" FOR COMMUNITY CARE IS IN THE FORM OF INCOME, WHICH IS VERIFIED WITH THE TAX RETURNS. IF A PERSON MEETS THE 150% OF FEDERAL POVERTY GUIDELINES THEIR ENTIRE BILL IS WRITTEN OFF. THE ORGANIZATION THEN PROVIDES A SLIDING FEE SCALE FOR DISCOUNTED CARE UP TO 300% OF THE FEDERAL POVERTY GUILDLINES. THE ORGANIZATION PROVIDES CUSTOMERS WITH AN APPLICATION UPON REQUEST, IF THE CUSTOMER IS STRICTLY PRIVATE PAY OR IF WE HAVE KNOWLEDGE OF A FINANCIAL HARDSHIP. THE ORGANIZATION KEEPS A LOG OF COMMUNITY CARE APPLICATIONS GIVEN TO CUSTOMERS AS WELL AS FOR COMMUNITY CARE AWARDED AND DENIED.
PART I, LINE 7: A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2 FROM THE IRS WAS USED TO CALCULATE THE AMOUNTS IN PART I, LINE 7.
PART I, LINE 7G: PHYSICIAN'S FEES BILLED FROM BHHA ARE WRITTEN OFF IF A CUSTOMER IS ELIGIBLE FOR COMMUNITY CARE.
PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE EQUAL TO $777,226 INCLUDED IN FORM 990, PART IX, LINE 25 WAS EXCLUDED IN CALCULATING THE PERCENT OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F.
PART II: BHHA USES THE LOCAL PAPERS AS AN OUTLET FOR GIVING THE PUBLIC INFORMATION ON DIFFERENT TYPE OF HEALTH CONCERNS, SUCH AS DIABETES, WEIGHT LOSS ETC. THEIR PUBLIC HEALTH EDUCATOR IS DEVELOPING A HEALTH COUNCIL TO HELP EDUCATE AND SHARE IDEAS WITH OTHER HEALTH PROVIDERS IN THE COMMUNITY AS TO THE TYPE OF SERVICES NEEDED IN THE AREA AND HOW TO GET THOSE SERVICES TO THE POPULATION.
PART III, LINE 4: PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"THE HOSPITAL REPORTS PATIENT AND RESIDENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS, RESIDENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT AND RESIDENT, THE HOSPITAL BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENTS AND RESIDENT WHEN THE PATIENT AND RESIDENT'S LIABILITY IS DETERMINED. PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE ORDINARILY DUE IN FULL WHEN BILLED. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND RESIDENT OR THIRD-PARTY PAYOR."THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTS 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-PART PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS.
PART III, LINE 8: SHORTFALL OF $12,137 IS REPRESENTATIVE OF PATIENT DEDUCTABLES AND COINSURANCE. FROM PART III, LINE 6 THE TOTAL ALLOWABLE COST REPORTS TO MEDICARE WAS BASED ON THE 2011 FILED MEDICARE COST REPORT.
PART VI, LINE 2: THE HOSPITAL HAS DONE A MAIL SURVEY TO HELP ASSESS THE NEEDS OF THE COMMUNITY. BHHA ALSO USES COMMUNICATION WITH THE PHYSICIAN PRACTICE AS TO WHAT WOULD BE USEFUL AND NEEDED BY THEIR PAITIENT POPULATION.
PART VI, LINE 3: THE FACILITY KEEPS FORMS ON HAND THAT ARE AVAILABLE (ON IN PLAIN SITE) FOR DIFFERENT GOV'T PROGRAMS SUCH AS HEALTH MT KIDS. THE PATIENT ACCOUNTS REPRESENTATIVE WILL INFORM ANY PRIVATE PAY PATIENT OF OUR COMMUNITY CARE AND WILL ALSO RELAY THIS INFORMATION TO CUSTOMERS WHEN DISCUSSING PAYMENT OPTIONS FOR OUTSTANDING BILLS.
PART VI, LINE 4: BHHA SERVERS A HIGH POVERTY LEVEL. THEY ARE ON THE EDGE OF THE CROW INDIAN RESERVATION AND HAVE A LOT OF CUSTOMERS WHO UTILIZE INDIAN HEALTH SERVICES AS A PAYOR SOURCE FOR HEALTH CARE. THEIR POPULATION HAS A LARGE POPULATION OF MEDICARE AND MEDICAID CUSTOMERS. AS THEY SERVE A SMALL TOWN IN MONTANA, THE POPULATION CONSISTS OF A LOT OF CHILDREN AS WELL AS ELDERLY, BOTH OF WHICH UTILIZE OUR HEALTHCARE SYSTEM.
PART VI, LINE 6: BHHA DOES HAVE A COMMUNITY BOARD TO HELP NOT ONLY "RUN" THE FACILITY WITH POLICIES AND PROCEDURES, BUT TO GIVE INPUT TO THE MANAGEMENT TEAM ABOUT THE NEEDS THEY SEE FOR THE COMMUNITY IN WHICH THEY LIVE. BHHA IS DEVELOPING MORE EDUCATIONAL PROGRAMS FOR ITEMS SUCH AS WOMEN'S HEALTH, DIABETES MANAGMENT AND SMOKING CESASTION.BHHA USES THE LOCAL PAPERS AS AN OUTLET FOR GIVING THE PUBLIC INFORMATION ON DIFFERENT TYPE OF HEALTH CONCERNS, SUCH AS DIABETES, WEIGHT LOSS ETC. THEIR PUBLIC HEALTH EDUCATOR IS DEVELOPING A HEALTH COUNCIL TO HELP EDUCATE AND SHARE IDEAS WITH OTHER HEALTH PROVIDERS IN THE COMMUNITY AS TO THE TYPE OF SERVICES NEEDED IN THE AREA AND HOW TO GET THOSE SERVICES TO THE POPULATION.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1BIG HORN COUNTY HOSPITAL AND HEALTH CARE FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line117 NORTH MILES AVENUEAddressLine1
CityHARDINCity
StateMTState
ZIP Code59034ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient810504410EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant32333AmountOfCashGrant
Purpose Of GrantTO SUPPORT GENERAL OPERATIONSPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPROCEDURE FOR MONITORING GRANTS IN THE U.S.:Identifier
Return ReferencePART I, LINE 2:ReturnReference
ExplanationSCHEDULE I, PART I, LINE 2: THE GRANT MADE WAS AN EQUITY TRANSFER TO A RELATED ORGANIZATION. THESE FUNDS ARE TRACKED THROUGH THE ORGANIZATION'S INTERNAL FINANCIAL REPORTING PROCESS.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, PART VI, SECTION A, LINE 1THE EXECUTIVE COMMITTEE SHALL HAVE ALL OF THE POWERS OF THE BOARD OF DIRECTORS WHEN THE BOARD IS NOT IN SESSION AND SHALL GENERALLY PERFORM SUCH DUTIES AND EXERCISE SUCH POWERS AS MAY BE PERFORMED AND EXERCISED BY THE BOARD OF DIRECTORS FROM TIME TO TIME. THE FACT THAT THE EXECUTIVE COMMITTEE HAS ACTED SHALL BE CONCLUSIVE EVIDENCE THAT THE BOARD OF DIRECTORS WAS NOT IN SESSION AT THAT TIME.
FORM 990, PART VI, SECTION B, LINE 11THE FORM 990 IS REVIEWED IN DETAIL BY THE CONTROLLER AND CEO, A COPY IS NOT PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING.
REGULAR COMPLIANCE MEETINGS DISCUSS ANY ACTUAL CONFLICTS OR POTENTIAL CONFLICTS. THERE IS ALSO A HOTLINE NUMBER TO CALL FOR COMPLIANCE OR HIPAA ISSUES THAT IS OPERATED BY MONTANA HOSPITAL ASSOCIATION, NOT BIG HORN HOSPITAL ASSOCIATION. BOARD MEMBERS SIGN YEARLY CONFLICT OF INTEREST STATEMENTS AND IF A CONFLICT OCCURS ON A SPECIFIC ITEM, THEY ABSTAIN FROM THE VOTE ON THAT ITEM.FORM 990, PART VI, SECTION B, LINE 12C
ALL POSITIONS - MONTANA HOSPITAL ASSOCIATION SALARY SURVEY IS COMPLETED AND REVIEWED EVERY YEAR TO ALLOW FAIR PAY FOR ALL POSITIONS. THE BOARD ALSO REVIEWS AND APPROVES THE CEO'S COMPENSATION AND WAS LAST DONE IN 2011.FORM 990, PART VI, SECTION B, LINE 15A
GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABE TO THE PUBLIC UPON REQUEST TO THE BUSINESS OFFICE.FORM 990, PART VI, SECTION C, LINE 19
ALLOCATION OF HOURSTERRY BULLIS, JAMES SEYKORA, AND WILLIAM FISHER, BOARD MEMBERS OF BIG HORN HOSPITAL ASSOCIATION, ALSO SERVE ON THE BOARD OF DIRECTORS FOR THE BIG HORN COUNTY HOSPITAL AND HEALTH CARE FOUNDATION, A RELATED ORGANIZATION. ROXIE CAIN, CONTROLLER OF BIG HORN HOSPITAL ASSOCIATION, ALSO SERVES THE BIG HORN COUNTY HOSPITAL AND HEALTH CARE FOUNDATION, A RELATED ORGANIZATION.FORM 990, PART VII, SECTION A
CHANGES IN NET ASSETS OR FUND BALANCES:NET UNREALIZED GAINS ON INVESTMENTS: 78,595. PRIOR PERIOD ADJUSTMENTS: -504. RESTRICTED GRANTS INCLUDED ON FOUNDATION BOOKS 93,247. TOTAL TO FORM 990, PART XI, LINE 5: 171,338.FORM 990, PART XI, LINE 5:

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrg
BIG HORN COUNTY MEMORIAL HOSPITAL AND HEALTHCARE FOUNDATION
17 N MILES AVENUEHARDINMT59034810504410HOSPITAL FUNDRAISINGMT501(C)(3)11 TYPE 1N/A0
BIG HORN COUNTY MEMORIAL HOSPITAL AUXILIARY
HC 36 BOX 2065HARDINMT59034810428249FUNDS TO BENEFIT BIG HORN COUNTY MEMORIAL HOSPITALMT501(C)(3)11 TYPE 2N/A0
HERITAGE ACRES AUXILIARY LIMITED
PO BOX 474HARDINMT59034810444017FUNDS TO BENEFIT HERITAGE ACRES NURSING HOMEMT501(C)(3)11 TYPE 2N/A0
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
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 Orgs1PerformOfServicesByOtherOrgs
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