2011-11-10T16:53:44-06:00 2010-12-31 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1200 PORTLAND OR 97205 990 2010-01-01 810232122 BENEFIS HOSPITALS INC BENE 4064552563 1101 26TH STREET SOUTH GREAT FALLS MT 59405 LAURA GOLDHAHN 4064552563 2011-10-25 1 WENDY CAMPOS 5032421447 2010 2016-03-07 17:11:31Z LAURA GOLDHAHN 1101 26TH STREET SOUTH GREAT FALLS MT 59405 501801061 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 513 BED HOSPITAL, PROVIDING INPATIENT AND OUTPATIENT SERVICES. 11 7 2389 545 0 0 2053770 0 242223015 498946250 -350692 790935 2038521 1541270 245964614 501278455 0 0 0 0 98128700 95693909 0 0 0 130163330 383491409 228292030 479185318 17672584 22093137 401952006 132767947 162857953 151999870 239094053 -19231923 X BENEFIS HOSPITALS, INC. IS DEDICATED TO OUR CHRISTIAN TRADITION AS A HEALING MINISTRY TO PROVIDE EXCELLENT PHYSICAL, EMOTIONAL, AND SPIRITUAL CARE TO ALL IN NEED. 0 1 235843754 293080291 BENEFIS 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. 133679115 166121483 BENEFIS HOSPITALS, INC. PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 31982659 39744476 BENEFIS HOSPITALS, INC. PROVIDES HOSPICE, DIALYSIS, AND SKILLED NURSING SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 401505528 1 0 0 0 0 0 0 0 1 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 1 198 0 2389 1 0 0 0 0 0 0 0 0 0 0 X 11 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 1 1 X DALE BIMLER 4064552565 1101 26TH STREET SOUTH GREAT FALLS MT 59405 X DOMINIC CASELNOVA III 60.00 X 175699 0 15039 COLONEL LESLIE L DIXON 3.00 X 0 0 0 PAUL DOLAN MD 59.00 X 655373 0 75181 CHRIS EBELING 6.00 X X 0 0 0 BILL FERRIN 3.00 X 0 0 0 LAURA GOLDHAHN 39.00 X 0 707446 89549 PETER GRAY 60.00 X 148780 0 6787 JULIE HICKETHIER 60.00 X 580616 0 66112 KATHY HILL 60.00 X 149294 0 14372 JEFF JARACZESKI 3.00 X 0 0 0 JOE LODUCA 60.00 X 150850 0 13378 KEVIN A MCCAFFERTY MD 3.00 X 0 0 0 LYLE J ONSTAD MD 3.00 X 0 0 0 SUSAN WALLACE RAPH MN 3.00 X 0 0 0 DAVID A ROHRER MD 3.00 X 0 0 0 MAYILYN K ROSE 3.00 X 0 0 0 JERRY W SPEER MD 3.00 X 0 302167 6252 FRANK SOLTYS 60.00 X 141811 0 6787 GREGORY S TIERNEY MD 3.00 X 0 0 0 BILL WEBER 3.00 X 0 0 0 DAVID WILSEY 3.00 X 0 0 0 2002423 1009613 293457 36 0 1 0 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 CAFETERIA 1997801 ANESTHESIA ASSOCIATES 401 15TH AVENUE SOUTH 109 GREAT FALLS MT 59405 MEDICAL 1877132 METRO AVIATION INC PO BOX 7008 SHREVEPORT LA 71137 AMBULANCE 1512523 COGENT HEALTHCARE PO BOX 645037 CINCINNATI OH 45264 HOSPITALISTS 1066483 CITY OF GREAT FALLS PO BOX 5021 GREAT FALLS MT 59403 UTILITIES 960774 113 PATIENT SERVICES 621990 494118472 494118472 OTHER OPERATIONS 621990 4827778 4827778 498946250 589958 589958 200977 200977 200977 200977 513511 522606 -9095 -9095 CAFETERIA 722210 1550365 1550365 1550365 501278455 498946250 0 2332205 1377282 1186558 190724 79451050 68448758 11002292 9043010 158615 8884395 5822567 5822567 31006602 31006602 47663422 46246185 1417237 12967062 6434933 6532129 537775 389282 148493 5922439 5922439 7936071 6435185 1500886 18437 18437 CONTRACTUAL ADJ/CHARITY 241174476 241174476 OTHER EXPENSES 21908200 16656174 5252026 BAD DEBT EXPENSE 14356925 14356925 479185318 401505528 77679790 0 13447360 23198521 42557563 41563391 7392737 7642738 2294774 822048 117804947 75728713 233279295 42076234 76838291 14550138 26141986 2914877 401952006 132767947 22937658 26653080 131518076 123059068 8402219 2287722 162857953 151999870 X 230445277 -19231923 2422346 0 6226430 0 239094053 -19231923 401952006 132767947 X 22093137 -280419113 X X 0 1 1 X 1 1 X 1 11091 3273 7818 0 8650429 8650429 6708274 1547349 772024 377218 8650429 7442737 1828005 -963297 1599171 6708274 0.00000 0.00000 0.00000 0 0 117804947 75728713 42076234 42076234 2007 BONDS D/S RESERVE FUND 8830620 F 2007 BONDS INTEREST RESERVE 2914458 F 2007 BONDS PRINCIPAL RESERVE 2805060 F 14550138 THIRD-PARTY SETTLEMENTS 2287722 2287722 PART IV, LINE 1B: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: 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 UNCERTAIN TAX POSITIONS UNDER FIN 48: 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. 1 1 X 1 X 180.000000000000 1 X 220.000000000000 1 1 1 0 1 1 8136269 8136269 0.01750 8136269 8136269 0.01750 318093 318093 0.00070 289290 289290 0.00060 5988921 5988921 0.01290 199302 199302 0.00040 1418903 1418903 0.00310 8214509 8214509 0.01770 16350778 16350778 0.03520 16800 16800 0.00000 15940 15940 0.00000 11543 11543 0.00000 2432 2432 0.00000 27528 27528 0.00010 681 681 0.00000 74924 74924 0.00010 1 6940138 337985 85421261 106425033 -21003772 X 1 1 1 TREASURE STATE PREFERRED PROVIDER 2 HEALTHCARE NETWORK ORGANIZATION SERVING 0.50000 0.00000 0.50000 3 GREAT FALLS AND 4 SURROUNDING AREAS 2 1 BENEFIS HOSPITALS INC EAST CAMPUS

1101 26TH STREET SOUTH GREAT FALLS MT 59405

X X X 2 BENEFIS HOSPITALS INC WEST CAMPUS

500 15TH AVENUE SOUTH GREAT FALLS MT 59405

X X NOT REQUIRED FOR 2010 1 1 BENEFIS SLETTEN HI-LINE CANCER CENTER

40 13TH STREET WEST HAVRE MT 59501

CANCER TREATMENT CENTER 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. REPORTS FILED WITH STATES PART VI, LINE 7 MT X 0 1 X X X X 0 1 0 0 0 0 0 1 0 DOMINIC CASELNOVA III 160493 0 14966 0 240 0 8223 0 6816 0 190738 0 0 0 PAUL DOLAN MD 255750 0 75207 0 324416 0 68199 0 6982 0 730554 0 318056 0 LAURA GOLDHAHN 0 290506 0 86086 0 330854 0 83767 0 5782 0 796995 0 328611 PETER GRAY 148780 0 0 0 0 0 0 0 6787 0 155567 0 0 0 JULIE HICKETHIER 223197 0 63724 0 293695 0 65670 0 442 0 646728 0 290214 0 KATHY HILL 149294 0 0 0 0 0 7585 0 6787 0 163666 0 0 0 JOE LODUCA 134798 0 15812 0 240 0 6591 0 6787 0 164228 0 0 0 JERRY W SPEER MD 0 292679 0 9488 0 0 0 0 0 6252 0 308419 0 0 PART I, LINE 1A THE 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 4B BENEFIS 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 7 BENEFIS 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. BENEFIS HOSPITALS INC 810232122 61204KGH8 2007-04-01 2455000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGJ4 2007-04-01 350000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGK1 2007-04-01 1035000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGL9 2007-04-01 1880000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 2516108 169567 372123 77737 619428 1896680 2009 0 0 0 0 358712 24175 53052 11083 88310 270402 2009 0 0 0 0 1060763 71488 156883 32773 261144 799619 2009 0 0 0 0 1926796 129852 284966 59530 474348 1452448 2009 0 0 0 0 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KGM7 2007-04-01 415000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGN5 2007-04-01 2635000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGP0 2007-04-01 155000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGQ8 2007-04-01 3045000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 425330 28664 62905 13141 104710 320620 2009 0 0 0 0 2700589 182000 399407 83437 664844 203574 2009 0 0 0 0 158858 10706 23495 4908 39108 119750 2009 0 0 0 0 3120794 210319 461554 96420 768293 2352502 2009 0 0 0 0 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KGR6 2007-04-01 940000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGS4 2007-04-01 2415000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGT2 2007-04-01 1100000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGU9 2007-04-01 2420000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 963398 64926 142483 29765 237174 726224 2009 0 0 0 0 2475113 166804 366060 76471 609336 1865777 2009 0 0 0 0 1127381 75977 166736 34831 277544 849836 2009 0 0 0 0 2480237 167150 366818 76629 610597 1869640 2009 0 0 0 0 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KGV7 2007-04-01 1365000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGW5 2007-04-01 2320000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGX3 2007-04-01 3850000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KGY1 2007-04-01 4045000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 1398977 24281 206904 43223 344407 1054570 2009 0 0 0 0 2377748 160243 351660 73463 585366 1792382 2009 0 0 0 0 3945832 265920 583574 121910 971405 2974427 2009 0 0 0 0 4145686 279389 613132 128085 1020606 3125080 2009 0 0 0 0 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KGZ8 2007-04-01 4245000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHA2 2007-04-01 4460000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHB0 2007-04-01 4680000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHC8 2007-04-01 4920000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 4350664 293203 643448 134418 1071068 3279596 2009 0 0 0 0 4571016 308053 676037 141226 1125315 3445700 2009 0 0 0 0 4796492 323248 709384 148192 1180824 3615668 2009 0 0 0 0 5042466 339825 745763 155792 1241379 3801086 2009 0 0 0 0 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KHD6 2007-04-01 5160000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHE4 2007-04-01 5410000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHF1 2007-04-01 7985000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHG9 2007-04-01 43310000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 5288440 356402 782141 163391 1301934 3986505 2009 0 0 0 0 5544662 373669 820036 820036 4179650 2009 0 0 0 0 8183758 551525 1210348 252845 2014718 6169040 2009 0 0 0 0 44388047 2991428 6564833 1371409 10927671 33460377 2009 0 0 0 0 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KHH7 2007-04-01 10000000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 10248914 690702 1515778 316649 2523129 7725785 2009 0 0 0 0 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 KEVIN A MCCAFFERTY MD DIRECTOR 180599 KEVIN MCCAFFERTY IS A PARTNER IN EMERGENCY PHYSICIANS PC, AN ENTITY THAT HAS AN AGREEMENT TO PROVIDE MEDICAL SERVICES TO THE ORGANIZATION. 0 LAND AND BUILDING OWNED BY BENEFIS HOSPITALS TRANSFERRED TO BENEFIS HEALTH SYSTEM, INC., THE PARENT EXEMPT ORGANIZATION. 2010-04-30 272007831 ASSETS TRANSFERRED AT NET BOOK VALUE, APPROXIMATING FMV 263538104 BENEFIS HEALTH SYSTEM INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 501(C)(3) 1 0 0 0 PART II, LINE 2E: CHRIS EBELING PART II, LINE 2E: CHRIS EBELING IS A DIRECTOR IN BENEFIS HOSPITALS, INC. AND BENEFIS HEALTH SYSTEM, INC. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 IN 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 2 CERTAIN 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 3 PURSUANT 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 6 THE 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 7A THE 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 7B AS 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 11 THIS 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 12C BOARD 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 15 THE 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 19 BENEFIS 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 B PAUL 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 2C THE 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. BENEFIS SLETTEN HI-LINE CANCER CENTER LLC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263144419 MEDICAL CARE MT -291584 1840955 BENEFIS HEALTH SYSTEM INC BENEFIS MEDICAL GROUP INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263538192 PHYSICIAN SERVICES MT 501(C)(3) SCHEDULE A, LINE 3 BENEFIS HEALTH SYSTEM INC 0 BENEFIS SPECTRUM MEDICAL INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 810431871 HOME HEALTH AND RELATED PRODUCTS MT 501(C)(3) SCHEDULE A, LINE 9 BENEFIS HEALTH SYSTEM INC 0 BENEFIS HEALTH SYSTEM INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263538104 MANAGEMENT AND SUPPORT SERVICES MT 501(C)(3) SCHEDULE A, LINE 11 BENEFIS HEALTH SYSTEM INC 0 BENEFIS HEALTHCARE EES HEALTH PLAN AND TRUST 1101 26TH STREET SOUTH GREAT FALLS MT 59405 363386166 BENEFIT PLAN MT 501(C)(9) BENEFIS HEALTH SYSTEM INC 0 SPECTRUM HOME SOLUTIONS 2509 7TH AVE SOUTH GREAT FALLS MT 59405 810431871 IV THERAPY MT BENEFIS SPECTRUM MEDICAL INC RELATED 337068 257484 0 1 0.50670 BBB LLC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263652926 MEDICAL BUILDING MT BENEFIS HEALTH SYSTEM INC RELATED 93505 9686166 0 1 0.60000 GREAT FALLS ATHLETIC CLUB LLC 1800 BENEFIS COURT GREAT FALLS MT 59405 912081505 FITNESS CLUB MT BENEFIS HEALTH SYSTEM INC UNRELATED 217538 2478270 0 1 0.51000 BENEFIS HEALTHCARE PRACTITIONERS PC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 201383362 HEALTHCARE SERVICES MT BENEFIS HEALTH SYSTEM INC C 1.00000 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1