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BENEFIS HOSPITALS INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
BENEFIS HOSPITALS INC (EIN 81-0232122)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-10
IRS object ID
201123149349303122
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)
Timestamp2011-11-10T16:53:44-06:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1805 SW BROADWAY SUITE 1200AddressLine1
CityPORTLANDCity
StateORState
ZIP Code97205ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810232122EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HOSPITALS INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBENENameControl
Phone4064552563Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameLAURA GOLDHAHNName
TitlePRESIDENTTitle
Phone4064552563Phone
Date Signed2011-10-25DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWENDY CAMPOSName
Phone5032421447Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLAURA GOLDHAHNNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
Gross Receipts501801061GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BENEFIS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1897YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionBENEFIS HOSPITALS, INC. IS A 513 BED HOSPITAL, PROVIDING INPATIENT AND OUTPATIENT SERVICES.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees2389TotalNbrEmployees
Total Nbr Volunteers545TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year2053770ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year242223015ProgramServiceRevenuePriorYear
Program Service Revenue CY498946250ProgramServiceRevenueCY
Investment Income Prior Year-350692InvestmentIncomePriorYear
Investment Income Current Year790935InvestmentIncomeCurrentYear
Other Revenue Prior Year2038521OtherRevenuePriorYear
Other Revenue Current Year1541270OtherRevenueCurrentYear
Total Revenue Prior Year245964614TotalRevenuePriorYear
Total Revenue Current Year501278455TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year98128700SalariesEtcPriorYear
Salaries Etc Current Year95693909SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year130163330OtherExpensePriorYear
Other Expenses Current Year383491409OtherExpensesCurrentYear
Total Expenses Prior Year228292030TotalExpensesPriorYear
Total Expenses Current Year479185318TotalExpensesCurrentYear
Revenues Less Expenses Prior Year17672584RevenuesLessExpensesPriorYear
Revenues Less Expenses CY22093137RevenuesLessExpensesCY
Total Assets BOY401952006TotalAssetsBOY
Total Assets EOY132767947TotalAssetsEOY
Total Liabilities BOY162857953TotalLiabilitiesBOY
Total Liabilities EOY151999870TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY239094053NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-19231923NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionBENEFIS HOSPITALS, INC. IS DEDICATED TO OUR CHRISTIAN TRADITION AS A HEALING MINISTRY TO PROVIDE EXCELLENT PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE TO ALL IN NEED.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change1SignificantChange
Expense235843754Expense
Revenue293080291Revenue
DescriptionBENEFIS HOSPITALS, INC. OPERATES A 513 BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense133679115Expense
Revenue166121483Revenue
DescriptionBENEFIS HOSPITALS, INC. PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense31982659Expense
Revenue39744476Revenue
DescriptionBENEFIS HOSPITALS, INC. PROVIDES HOSPICE, DIALYSIS, AND SKILLED NURSING SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY.Description
FieldValueIRS element (for citing)
Total Program Service Expense401505528TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments1TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
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 Attached0FinancialStmtAttached
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 Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp1OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation1PartialLiquidation
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 With1096198NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees2389NumberOfEmployees
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 Members7NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
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 Policy1WhistleblowerPolicy
Document Retention Policy0DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture1InvestmentInJointVenture
Written Policy Or Procedure1WrittenPolicyOrProcedure
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DALE BIMLERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4064552565TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekHighest Compensated EmployeeHighestCompensatedEmployeeReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficer
DOMINIC CASELNOVA III
PHARMACY DIRECTOR60.00X175699015039
COLONEL LESLIE L DIXON
DIRECTOR3.00000X
PAUL DOLAN MD
CMQO59.00655373075181X
CHRIS EBELING
CHAIR6.00000XX
BILL FERRIN
DIRECTOR3.00000X
LAURA GOLDHAHN
PRESIDENT39.00070744689549X
PETER GRAY
EXECUTIVE DIRECTOR60.00X14878006787
JULIE HICKETHIER
COO60.00580616066112X
KATHY HILL
CAO60.00X149294014372
JEFF JARACZESKI
DIRECTOR3.00000X
JOE LODUCA
CAO60.00X150850013378
KEVIN A MCCAFFERTY MD
DIRECTOR3.00000X
LYLE J ONSTAD MD
DIRECTOR3.00000X
SUSAN WALLACE RAPH MN
DIRECTOR3.00000X
DAVID A ROHRER MD
DIRECTOR3.00000X
MAYILYN K ROSE
DIRECTOR3.00000X
JERRY W SPEER MD
DIRECTOR3.0003021676252X
FRANK SOLTYS
EXECUTIVE DIRECTOR60.00X14181106787
GREGORY S TIERNEY MD
DIRECTOR3.00000X
BILL WEBER
DIRECTOR3.00000X
DAVID WILSEY
DIRECTOR3.00000X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2002423TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1009613TotalReportableCompFrmRltdOrgs
Total Other Compensation293457TotalOtherCompensation
Number Individuals GT100 K36NumberIndividualsGT100K
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
ARAMARK HEALTHCARE FOOD
25271 NETWORK PLACECHICAGOIL60673CAFETERIA1997801
ANESTHESIA ASSOCIATES
401 15TH AVENUE SOUTH 109GREAT FALLSMT59405MEDICAL1877132
METRO AVIATION INC
PO BOX 7008SHREVEPORTLA71137AMBULANCE1512523
COGENT HEALTHCARE
PO BOX 645037CINCINNATIOH45264HOSPITALISTS1066483
CITY OF GREAT FALLS
PO BOX 5021GREAT FALLSMT59403UTILITIES960774
FieldValueIRS element (for citing)
Number Of Contractors GT100 K113NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICES621990494118472494118472
OTHER OPERATIONS62199048277784827778
FieldValueIRS element (for citing)
Total Program Service Revenue498946250TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column589958TotalRevenueColumn
Exclusion$589,958ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other200977Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other200977Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column200977TotalRevenueColumn
Exclusion$200,977ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory513511GrossSalesOfInventory
Cost Of Goods Sold522606CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-9095TotalRevenueColumn
Exclusion-$9,095ExclusionAmount

Other Revenue Misc OtherRevenueMisc

FieldValueIRS element (for citing)
DescriptionCAFETERIADescription
Business Code722210BusinessCode
Total Revenue Column1550365TotalRevenueColumn
Exclusion$1,550,365ExclusionAmount
FieldValueIRS element (for citing)
Total Other Revenue1550365TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column501278455TotalRevenueColumn
Related Or Exempt Function Income498946250RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$2,332,205ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1377282Total
Program Services1186558ProgramServices
Management And General190724ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total79451050Total
Program Services68448758ProgramServices
Management And General11002292ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total9043010Total
Program Services158615ProgramServices
Management And General8884395ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total5822567Total
Management And General5822567ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total31006602Total
Management And General31006602ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total47663422Total
Program Services46246185ProgramServices
Management And General1417237ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total12967062Total
Program Services6434933ProgramServices
Management And General6532129ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total537775Total
Program Services389282ProgramServices
Management And General148493ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total5922439Total
Management And General5922439ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total7936071Total
Program Services6435185ProgramServices
Management And General1500886ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total18437Total
Program Services18437ProgramServices

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CONTRACTUAL ADJ/CHARITY241174476241174476
OTHER EXPENSES21908200166561745252026
BAD DEBT EXPENSE1435692514356925

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total479185318Total
Program Services401505528ProgramServices
Management And General77679790ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY13447360BOY
EOY23198521EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY42557563BOY
EOY41563391EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY7392737BOY
EOY7642738EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2294774BOY
EOY822048EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis117804947LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec75728713LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY233279295BOY
EOY42076234EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY76838291BOY
EOY14550138EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY26141986BOY
EOY2914877EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY401952006BOY
EOY132767947EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY22937658BOY
EOY26653080EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY131518076BOY
EOY123059068EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY8402219BOY
EOY2287722EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY162857953BOY
EOY151999870EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY230445277BOY
EOY-19231923EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY2422346BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY6226430BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY239094053BOY
EOY-19231923EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY401952006BOY
EOY132767947EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses22093137ReconcilationRevenueExpenses
Reconcilation Other Changes-280419113ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required1FederalGrantAuditRequired
Federal Grant Audit Performed1FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc1AgentTrusteeEtc
Beginning Balance11091BeginningBalance
Distributions During Year3273DistributionsDuringYear
Ending Balance7818EndingBalance
Included On FS0IncludedOnFS

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance8650429BeginningOfYearBalance
Other Expenditures8650429OtherExpenditures

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance6708274BeginningOfYearBalance
Contributions1547349Contributions
Investment Earnings Or Losses772024InvestmentEarningsOrLosses
Other Expenditures377218OtherExpenditures
End Of Year Balance8650429EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance7442737BeginningOfYearBalance
Contributions1828005Contributions
Investment Earnings Or Losses-963297InvestmentEarningsOrLosses
Other Expenditures1599171OtherExpenditures
End Of Year Balance6708274EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.00000BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.00000PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.00000TermEndowmentEOYBalance
Endowments Held By Unrelated Orgs0EndowmentsHeldByUnrelatedOrgs
Endowments Held By Related Orgs0EndowmentsHeldByRelatedOrgs

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis117804947OtherCostOrOtherBasis
Depreciation75728713Depreciation
Book Value42076234BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings42076234TotalOfBookValueLandBuildings

Other Securities OtherSecurities (3 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
2007 BONDS D/S RESERVE FUND8830620F
2007 BONDS INTEREST RESERVE2914458F
2007 BONDS PRINCIPAL RESERVE2805060F
FieldValueIRS element (for citing)
Total Of Book Value Securities14550138TotalOfBookValueSecurities

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionTHIRD-PARTY SETTLEMENTSDescription
Amount$2,287,722Amount
FieldValueIRS element (for citing)
Total Of Amounts2287722TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART IV, LINE 1B:THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME.
PART V, LINE 4:ENDOWMENT FUNDS ARE RELATED TO BENEFIS HEALTHCARE FOUNDATION. THESE ACCOUNTS WERE TRANSFERRED TO BENEFIS HEALTH SYSTEM, INC., A RELATED EXEMPT ORGANIZATION, DURING 2010.DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS:
PART X:THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. EFFECTIVE JANUARY 1, 2009, THE ORGANIZATION ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2010 OR 2009.DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage180.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage220.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense8136269TotalCommunityBenefitExpense
Net Community Benefit Expense8136269NetCommunityBenefitExpense
Percent Of Total Expense0.01750PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense8136269TotalCommunityBenefitExpense
Net Community Benefit Expense8136269NetCommunityBenefitExpense
Percent Of Total Expense0.01750PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense318093TotalCommunityBenefitExpense
Net Community Benefit Expense318093NetCommunityBenefitExpense
Percent Of Total Expense0.00070PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense289290TotalCommunityBenefitExpense
Net Community Benefit Expense289290NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense5988921TotalCommunityBenefitExpense
Net Community Benefit Expense5988921NetCommunityBenefitExpense
Percent Of Total Expense0.01290PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense199302TotalCommunityBenefitExpense
Net Community Benefit Expense199302NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense1418903TotalCommunityBenefitExpense
Net Community Benefit Expense1418903NetCommunityBenefitExpense
Percent Of Total Expense0.00310PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8214509TotalCommunityBenefitExpense
Net Community Benefit Expense8214509NetCommunityBenefitExpense
Percent Of Total Expense0.01770PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense16350778TotalCommunityBenefitExpense
Net Community Benefit Expense16350778NetCommunityBenefitExpense
Percent Of Total Expense0.03520PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense16800TotalCommunityBuildingExpense
Net Community Building Expense16800NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense15940TotalCommunityBuildingExpense
Net Community Building Expense15940NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense11543TotalCommunityBuildingExpense
Net Community Building Expense11543NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense2432TotalCommunityBuildingExpense
Net Community Building Expense2432NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense27528TotalCommunityBuildingExpense
Net Community Building Expense27528NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense681TotalCommunityBuildingExpense
Net Community Building Expense681NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense74924TotalCommunityBuildingExpense
Net Community Building Expense74924NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$6,940,138BadDebtExpenseAmount
Amount Attributable To337985AmountAttributableTo
Amount Reimbursed By Medicare85421261AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare106425033CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-21003772MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (4 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
1 TREASURE STATE
PREFERRED PROVIDER
2 HEALTHCARE NETWORK
ORGANIZATION SERVING0.500000.000000.50000
3
GREAT FALLS AND
4
SURROUNDING AREAS
FieldValueIRS element (for citing)
Number Of Hospital Facilities2NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumberAddress Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgicalEr24 HoursEr24Hours
BENEFIS HOSPITALS INC EAST CAMPUS
11101 26TH STREET SOUTHGREAT FALLSMT59405XXX
BENEFIS HOSPITALS INC WEST CAMPUS
2500 15TH AVENUE SOUTHGREAT FALLSMT59405XX

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1NOT REQUIRED FOR 2010BusinessNameLine1
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 Line1BENEFIS SLETTEN HI-LINE CANCER CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line140 13TH STREET WESTAddressLine1
CityHAVRECity
StateMTState
ZIP Code59501ZIPCode
FieldValueIRS element (for citing)
Facility TypeCANCER TREATMENT CENTERFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (6 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
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 $ 14357000.
PART I, LINE 6A: AS REQUIRED BY MONTANA LAW, THE ORGANIZATION ANNUALLY SUBMITS A COMMUNITY BENEFIT REPORT TO THE MONTANA ATTORNEY GENERAL'S OFFICE, WHICH OVERSEES NONPROFIT CORPORATIONS IN THE STATE. IN 2011, THE ATTORNEY GENERAL'S OFFICE RELEASED TO THE PUBLIC ITS FOURTH ANNUAL REPORT ON THE CHARITABLE ACTIVITIES OF MONTANA HOSPITALS, INCLUDING THE TEN LARGEST HOSPITALS IN THE STATE (WITH THE ORGANIZATION AMONG THEM). THE ORGANIZATION ITSELF ALSO ANNUALLY PREPARES A SUMMARY COMMUNITY BENEFIT REPORT FOR PURPOSES OF EXPLANATION TO THE LOCAL PUBLIC, WHICH IS PUBLISHED IN THE FORM OF A POSTING IN THE LOCAL NEWSPAPER.PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED.PART III, LINE 3: THE ORGANIZATION ESTIMATES THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS CHARITY CARE POLICY BY ANALYZING PAST ACTIVITY FOR ACCOUNTS CLASSIFIED AS BAD DEBT THAT SUBSEQUENTLY QUALIFIED FOR CHARITY CARE WHEN ADDITIONAL ELIGIBILITY INFORMATION WAS OBTAINED.PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS INCLUDE THE FOLLOWING NOTE REGARDING BAD DEBT EXPENSE: "THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS OR RESIDENTS DUE TO BAD DEBTS AND CHARITY CARE. MANAGEMENT CONSIDERS HISTORICAL WRITE-OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION." THE COSTING METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO.PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID SUBSTANTIALLY LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE.
PART VI, LINE 2: BENEFIS HOSPITALS, INC. HISTORICALLY HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. THE HOSPITAL IS CURRENTLY ASSEMBLING A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO WILL CONDUCT A COMMUNITY NEEDS ASSESSMENT IN THE FUTURE, AS CONTEMPLATED BY NEWLY ENACTED IRC SECTION 501(R).PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND IS MAILED TO EACH PATIENT ALONG WITH THEIR BILLING STATEMENT.PART VI, LINE 4: THE ORGANIZATION'S SERVICE AREA IS APPROXIMATELY 45,000 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 225,000 PEOPLE. THE SERVICE AREA IS APPROXIMATELY 49.5% FEMALE AND 50.5% MALE. APPROXIMATELY 6.6% OF THE POPULATION IS UNDER 5 YEARS OF AGE, APPROXIMATELY 74% BETWEEN THE AGE OF 18 AND 65 YEARS OF AGE, AND APPROXIMATELY 14% OF THE POPULATION IS OVER THE AGE OF 65.THE SERVICE AREA IS 90.7% WHITE WITH THE NEXT LARGEST COMBINED POPULATION APPROXIMATELY 5.8% NATIVE AMERICAN AND THE REMAINDER AFRICAN-AMERICAN OR MULTIPLE RACES.
THE AVERAGE HOUSHOLD SIZE IS 2.4 PEOPLE, WITH APPROXIMATELY 92.4% OF ALL HOUSING UNITS BEING OWNER OCCUPIED.THE AVERAGE PER CAPITA INCOME IS $17,566 WITH THE MEDIAN HOUSEHOLD INCOME BEING $32,971.(US CENSUS BUREAU, 2000 DEMOGRAPHIC PROFILE)PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES.BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS, THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PRUPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3).
PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES.
MTREPORTS FILED WITH STATESPART VI, LINE 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses0WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
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 Payments1AnyNonFixedPayments
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
DOMINIC CASELNOVA III
160493014966024008223068160190738000
PAUL DOLAN MD
255750075207032441606819906982073055403180560
LAURA GOLDHAHN
029050608608603308540837670578207969950328611
PETER GRAY
148780000000067870155567000
JULIE HICKETHIER
22319706372402936950656700442064672802902140
KATHY HILL
149294000007585067870163666000
JOE LODUCA
134798015812024006591067870164228000
JERRY W SPEER MD
029267909488000006252030841900

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 1ATHE HEALTH CLUB WHERE OFFICERS ARE MEMBERS IS A SUBSIDIARY OF BENEFIS HEALTH SYSTEM, INC. (BHS). THE HEALTH CLUB DUES THAT BHS PAYS FOR ITS OFFICERS ARE TREATED AS TAXABLE INCOME TO THE INDIVIDUAL ACCORDINGLY. OFFICERS AND DEPARTMENT HEADS ARE ELIGIBLE FOR HEALTH CLUB DUES. SUBSTANTIATION IS REQUIRED BEFORE ANY REIMBURSEMENTS ARE PAID.
PART I, LINE 4BBENEFIS HEALTH SYSTEM, INC. HISTORICALLY PERMITTED EXECUTIVES OF ITS AFFILIATED ENTITIES (INCLUDING THE ORGANIZATION) TO PARTICIPATE IN A NONQUALIFIED 457(F) RETIREMENT PLAN, WITH ANNUAL CONTRIBUTIONS BASED ON A PERCENT OF SALARY. IN 2010, THE SYSTEM SOUGHT THE ASSISTANCE OF AN INDEPENDENT COMPENSATION CONSULTING FIRM TO CONDUCT A COMPREHENSIVE REVIEW OF THE SYSTEM'S EXECUTIVE BENEFITS. BASED ON THE CONSULTANT'S RECOMMENDATIONS, BENEFIS HEALTH SYSTEM, INC. ADOPTED A MODIFIED VESTING SCHEDULE PURSUANT TO WHICH (I) ALL PARTICIPANTS IN THE PLANS WOULD BECOME FULLY VESTED IN SUPPLEMENTAL CONTRIBUTIONS MADE PRIOR TO 2010, WITH ALL PROCEEDS DISTRIBUTED CURRENTLY, AND (II) A NEW VESTING SCHEDULE WOULD APPLY TO FUTURE ACCRUALS UNDER CERTAIN OF THE PLANS. AS A RESULT OF THESE CHANGES, CERTAIN EXECUTIVES PARTICIPATING IN THE PLANS INCURRED SUBSTANTIAL ADDITIONAL TAXABLE INCOME IN 2010, AS SHOWN IN PART II, COLUMN B(III).
PART I, LINE 7BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM (INCLUDING MS. GOLDHAHN, MS. HICKETHIER, AND DR. DOLAN), AND IS SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. IN 2010, THE SYSTEM ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, FINANCE/OPERATIONS, AND COMMUNITY BENEFIT. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED IN 2010 ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY INDIVIDUAL PERFORMANCE. IN ADDITION, THE SYSTEM MUST HAVE MAINTAINED SATISFACTORY OVERALL PERFORMANCE, BASED ON BOTH FINANCIAL CRITERIA AND SATISFACTION OF EMPLOYEES, PATIENTS AND PHYSICIANS. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS.

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BENEFIS HOSPITALS INC
81023212261204KGH82007-04-012455000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGJ42007-04-01350000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGK12007-04-011035000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGL92007-04-011880000CONSTRUCTION OF NEW MEDICAL FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
251610816956737212377737619428189668020090000
3587122417553052110838831027040220090000
1060763714881568833277326114479961920090000
192679612985228496659530474348145244820090000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BENEFIS HOSPITALS INC
81023212261204KGM72007-04-01415000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGN52007-04-012635000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGP02007-04-01155000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGQ82007-04-013045000CONSTRUCTION OF NEW MEDICAL FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
42533028664629051314110471032062020090000
27005891820003994078343766484420357420090000
158858107062349549083910811975020090000
312079421031946155496420768293235250220090000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BENEFIS HOSPITALS INC
81023212261204KGR62007-04-01940000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGS42007-04-012415000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGT22007-04-011100000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGU92007-04-012420000CONSTRUCTION OF NEW MEDICAL FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
963398649261424832976523717472622420090000
247511316680436606076471609336186577720090000
1127381759771667363483127754484983620090000
248023716715036681876629610597186964020090000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BENEFIS HOSPITALS INC
81023212261204KGV72007-04-011365000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGW52007-04-012320000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGX32007-04-013850000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KGY12007-04-014045000CONSTRUCTION OF NEW MEDICAL FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
13989772428120690443223344407105457020090000
237774816024335166073463585366179238220090000
3945832265920583574121910971405297442720090000
41456862793896131321280851020606312508020090000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BENEFIS HOSPITALS INC
81023212261204KGZ82007-04-014245000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KHA22007-04-014460000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KHB02007-04-014680000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KHC82007-04-014920000CONSTRUCTION OF NEW MEDICAL FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
43506642932036434481344181071068327959620090000
45710163080536760371412261125315344570020090000
47964923232487093841481921180824361566820090000
50424663398257457631557921241379380108620090000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (4 entries)

Issuer EINIssuerEINCUSIP NumberCUSIPNumberDate IssuedDateIssuedIssue PriceIssuePriceDescription Of PurposeDescriptionOfPurposeDefeasedDefeasedOn Behalf Of IssuerOnBehalfOfIssuerPool FinancingPoolFinancing
BENEFIS HOSPITALS INC
81023212261204KHD62007-04-015160000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KHE42007-04-015410000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KHF12007-04-017985000CONSTRUCTION OF NEW MEDICAL FACILITIES000
BENEFIS HOSPITALS INC
81023212261204KHG92007-04-0143310000CONSTRUCTION OF NEW MEDICAL FACILITIES000

Form990 Schedule K Part II Form990ScheduleKPartII (4 entries)

Total ProceedsTotalProceedsAmount In Reserve FundAmountInReserveFundRefunding EscrowRefundingEscrowIssuance Costs From ProceedsIssuanceCostsFromProceedsWorking Capital ExpendituresWorkingCapitalExpendituresCapital ExpendituresCapitalExpendituresYear Of Subst CompletionYearOfSubstCompletionCurrent RefundingCurrentRefundingAdvance RefundingAdvanceRefundingFinal Allocation MadeFinalAllocationMadeAdequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind
52884403564027821411633911301934398650520090000
5544662373669820036820036417965020090000
818375855152512103482528452014718616904020090000
44388047299142865648331371409109276713346037720090000

Form990 Schedule K Part III Form990ScheduleKPartIII (4 entries)

Owning Bond Financed PropertyOwningBondFinancedPropertyAny Lease ArrangementsAnyLeaseArrangementsMngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprtyAny Research AgreementsAnyResearchAgreementsBond Counsel Routinely EngagedBondCounselRoutinelyEngagedPrcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthersPercentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBITotal Private Business UseTotalPrivateBusinessUsePost Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001
001010.000000.000000.000001

Form990 Schedule K Part IV Form990ScheduleKPartIV (4 entries)

Form8038 T FiledForm8038TFiledVariable Rate IssueVariableRateIssueHedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecdsGross Proceeds Invested In GICGrossProceedsInvestedInGICBusiness Name Line2NameOfGICProvider/BusinessNameLine2Term Of GICTermOfGICRegulatory Safe Harbor SatisfiedRegulatorySafeHarborSatisfiedGross Proceeds InvestedGrossProceedsInvestedException To RebateExceptionToRebate
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100
BAYERISCHE
0001LANDESBANK2.500000000000100

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HOSPITALS INCBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN810232122IssuerEIN
CUSIP Number61204KHH7CUSIPNumber
Date Issued2007-04-01DateIssued
Issue Price10000000IssuePrice
Description Of PurposeCONSTRUCTION OF NEW MEDICAL FACILITIESDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds10248914TotalProceeds
Amount In Reserve Fund690702AmountInReserveFund
Refunding Escrow1515778RefundingEscrow
Issuance Costs From Proceeds316649IssuanceCostsFromProceeds
Working Capital Expenditures2523129WorkingCapitalExpenditures
Capital Expenditures7725785CapitalExpenditures
Year Of Subst Completion2009YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind0AdequateBooksAndRecdsMaintaind

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
Bond Counsel Routinely Engaged1BondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
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 GIC1GrossProceedsInvestedInGIC

Name Of GIC Provider NameOfGICProvider

FieldValueIRS element (for citing)
Business Name Line1BAYERISCHEBusinessNameLine1
Business Name Line2LANDESBANKBusinessNameLine2
FieldValueIRS element (for citing)
Term Of GIC2.500000000000TermOfGIC
Regulatory Safe Harbor Satisfied1RegulatorySafeHarborSatisfied
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 PersonKEVIN A MCCAFFERTY MDNamePerson
FieldValueIRS element (for citing)
RelationshipDIRECTORRelationship
Amount Of Transaction180599AmountOfTransaction
Description Of TransactionKEVIN MCCAFFERTY IS A PARTNER IN EMERGENCY PHYSICIANS PC, AN ENTITY THAT HAS AN AGREEMENT TO PROVIDE MEDICAL SERVICES TO THE ORGANIZATION.DescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule N IRS990ScheduleN

Disposition Table DispositionTable

FieldValueIRS element (for citing)
Description Of AssetLAND AND BUILDING OWNED BY BENEFIS HOSPITALS TRANSFERRED TO BENEFIS HEALTH SYSTEM, INC., THE PARENT EXEMPT ORGANIZATION.DescriptionOfAsset
Date Of Distribution2010-04-30DateOfDistribution
FMV Of Asset272007831FMVOfAsset
Method Of FMV DeterminationASSETS TRANSFERRED AT NET BOOK VALUE, APPROXIMATING FMVMethodOfFMVDetermination
EIN263538104EIN

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HEALTH SYSTEM INCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
IRC Section501(C)(3)IRCSection
FieldValueIRS element (for citing)
Director Of Successor21DirectorOfSuccessor2
Employee Of Successor20EmployeeOfSuccessor2
Owner Of Successor20OwnerOfSuccessor2
Receive Compensation20ReceiveCompensation2

Form990 Schedule N Part III Form990ScheduleNPartIII (2 entries)

ExplanationExplanation
PART II, LINE 2E: CHRIS EBELING
PART II, LINE 2E: CHRIS EBELING IS A DIRECTOR IN BENEFIS HOSPITALS, INC. AND BENEFIS HEALTH SYSTEM, INC.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (14 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
CHANGES IN PROGRAM SERVICESFORM 990, PART III, LINE 3IN EARLY 2010, AS PART OF A ONE-TIME REORGANIZATION, THE ORGANIZATION TRANSFERRED TO ITS TAX-EXEMPT PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC., TITLE TO THE REAL ESTATE PREVIOUSLY OWNED BY THE ORGANIZATION. ON A GOING-FORWARD BASIS, BENEFIS HEALTH SYSTEM, INC. WILL OWN AND OVERSEE SUCH REAL ESTATE ASSETS FOR THE BENEFIT OF THE SYSTEM AS A WHOLE, LEASING THEM TO THE ORGANIZATION AND ITS AFFILIATES AS APPROPRIATE FOR THEIR RESPECTIVE OPERATIONS.
FORM 990, PART VI, SECTION A, LINE 2CERTAIN OF THE OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER.
FORM 990, PART VI, SECTION A, LINE 3PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS PROVIDES THESE SERVICES TO ITS SUBSIDARY TAX EXEMPT OPERATING ENTITIES ON A CENTRALIZED BASIS.
FORM 990, PART VI, SECTION A, LINE 6THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NON-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3).
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD OF DIRECTORS OF THE ORGANIZATION IS ELECTED BY BENEFIS HEALTH SYSTEM, INC. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER.
FORM 990, PART VI, SECTION A, LINE 7BAS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS OUTSTANDING ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS DISTRIBUTED TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS, WITH A PRESENTATION TO SUCH BOARD BY THE CHIEF FINANCIAL OFFICER OF BENEFIS HEALTH SYSTEM, INC.
FORM 990, PART VI, SECTION B, LINE 12CBOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT.
FORM 990, PART VI, SECTION B, LINE 15THE COMPENSATION OF THE PRESIDENT, THE COO, AND THE CMQO WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER DISQUALIFIED PERSONS, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILARLY-SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES.
FORM 990, PART VI, SECTION C, LINE 19BENEFIS HOSPITALS, INC. PROVIDES COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS.
AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS:FORM 990, PART VII, SECTION A, COLUMN BPAUL DOLAN - 1 HOUR LAURA GOLDHAHN - 21 HOURS JERRY SPEER - 57 HOURS
CHANGES IN NET ASSETS OR FUND BALANCES:FORM 990, PART XI, LINE 5:NET UNREALIZED GAINS ON INVESTMENTS: 237,494. INTERAFFILIATE TRANSFERS -280,656,607. TOTAL TO FORM 990, PART XI, LINE 5: -280,419,113.
FORM 990, PART XII, LINE 2CTHE ORGANIZATION'S FINANCIAL RESULTS ARE REPORTED AS PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF BENEFIS HEALTH SYSTEM, INC. AND AFFILIATES. THE AUDIT COMMITTEE OF BENEFIS HEALTH SYSTEM, INC. IS RESPONSIBLE FOR SELECTION OF THE INDEPENDENT AUDIT FIRM AND OVERSEEING THE AUDIT.
FORM 990, PART XI, LINE 5:IN EARLY 2010, AS PART OF A ONE-TIME REORGANIZATION, THE ORGANIZATION TRANSFERRED TO ITS SOLE MEMBER, BENEFIS HEALTH SYSTEM, INC., TITLE TO ITS REAL ESTATE, RESULTING IN A SIGNIFICANT CHANGE IN THE ORGANIZATION'S NET ASSETS. ON A GOING-FORWARD BASIS, BENEFIS HEALTH SYSTEM, INC. WILL OWN AND OVERSEE SUCH REAL ESTATE ASSETS, LEASING THEM TO THE ORGANIZATION AND ITS AFFILIATES AS APPROPRIATE IN LIGHT OF THEIR RESPECTIVE OPERATIONS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1BENEFIS SLETTEN HI-LINE CANCER CENTER LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
EIN263144419EIN
Primary ActivitiesMEDICAL CAREPrimaryActivities
Legal Domicile StateMTLegalDomicileState
Total Income-291584TotalIncome
EOY Assets1840955EOYAssets

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HEALTH SYSTEM INCBusinessNameLine1

Form990 Schedule R Part II Form990ScheduleRPartII (4 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
BENEFIS MEDICAL GROUP INC
1101 26TH STREET SOUTHGREAT FALLSMT59405263538192PHYSICIAN SERVICESMT501(C)(3)SCHEDULE A, LINE 3BENEFIS HEALTH SYSTEM INC0
BENEFIS SPECTRUM MEDICAL INC
1101 26TH STREET SOUTHGREAT FALLSMT59405810431871HOME HEALTH AND RELATED PRODUCTSMT501(C)(3)SCHEDULE A, LINE 9BENEFIS HEALTH SYSTEM INC0
BENEFIS HEALTH SYSTEM INC
1101 26TH STREET SOUTHGREAT FALLSMT59405263538104MANAGEMENT AND SUPPORT SERVICESMT501(C)(3)SCHEDULE A, LINE 11BENEFIS HEALTH SYSTEM INC0
BENEFIS HEALTHCARE EES HEALTH PLAN AND TRUST
1101 26TH STREET SOUTHGREAT FALLSMT59405363386166BENEFIT PLANMT501(C)(9)BENEFIS HEALTH SYSTEM INC0

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
SPECTRUM HOME SOLUTIONS
2509 7TH AVE SOUTHGREAT FALLSMT59405810431871IV THERAPYMTBENEFIS SPECTRUM MEDICAL INCRELATED337068257484010.50670
BBB LLC
1101 26TH STREET SOUTHGREAT FALLSMT59405263652926MEDICAL BUILDINGMTBENEFIS HEALTH SYSTEM INCRELATED935059686166010.60000
GREAT FALLS ATHLETIC CLUB LLC
1800 BENEFIS COURTGREAT FALLSMT59405912081505FITNESS CLUBMTBENEFIS HEALTH SYSTEM INCUNRELATED2175382478270010.51000

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HEALTHCARE PRACTITIONERS PCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
EIN201383362EIN
Primary ActivityHEALTHCARE SERVICESPrimaryActivity
Legal Domicile StateMTLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HEALTH SYSTEM INCBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Percentage Ownership1.00000PercentageOwnership
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org1GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org1SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org1PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org1OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg