2011-04-12T11:44:05-05:00 2010-06-30 LARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2009-07-01 810240726 Marcus Daly Memorial Hospital MARC 4063754609 1200 Westwood Drive Hamilton MT 59840 John M Bartos 4063754609 2011-04-12 1 6123764500 2009 2016-02-24 21:20:13Z John M Bartos 1200 Westwood Drive Hamilton MT 59840 47607835 0 X www.mdmh.org X 1938 MT OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. 11 6 522 169 0 0 434839 163036 43742019 47076333 58820 67705 224445 -80797 44460123 47226277 0 0 23362220 23335366 0 104183 20719373 20904864 44081593 44240230 378530 2986047 41830875 45412010 19727155 20273003 22103720 25139007 Our commitment to the Bitterroot Valley is quality, accessible, personalized healthcare. 0 0 38282354 47076333 Marcus Daly Memorial Hospital Corporation owns and operates a 48 licensed bed acute care critical access hospital with 25 beds setup. The hospital provides acute care services to patients in Ravalli County. The services provided include acute care hospital, related ancillary services such as laboratory, radiology and therapy inpatient and outpatient surgery, emergency care, ambulance, home health, clinic, transitional care, inpatient and outpatient hospice care. The hospital provides EMS services with 3 crews providing 911 service to the county. The goal is to respond within 20 minutes or less to any call within the county. The hospital is the only pediatric rehabilitation provider of physical therapy, occupational therapy and speech therapy in Western Montana using certified therapists. The hospital clinics see all patients regardless of insurance or ability to pay and enable the community access to primary care. 38282354 1 1 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 58 0 1 522 1 0 0 0 0 0 0 0 0 0 11 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Donja c Erdman 4063754609 1200 westwood Drive HAMILTON MT 59840 SONNY LASALLE 1.00 X X 0 0 0 DON LODMELL PHD 1.00 X X 0 0 0 DONNA COONEY 1.00 X 0 0 0 STEVE ELLIS MD 1.00 X 0 0 0 BARBARA ACKERMAN 1.00 X 0 0 0 BILL BEAN 1.00 X 0 0 0 JAMES OWINGS CPA 1.00 X 0 0 0 MICHAEL COWAN 1.00 X 0 0 0 ROGER LOOYSEN 1.00 X 0 0 0 RANDY STEWART MD 1.00 X 0 0 0 JOHN M BARTOS 40.00 X X 283650 0 28823 WALKER ASHCRAFT MD 40.00 X 158131 0 39172 FREDERIK ILGENFRITZ 40.00 X 220002 0 9400 DONJA C ERDMAN 40.00 X 96892 0 0 GARY L SMITH MD 40.00 X 338277 0 47967 Yvonne Courchesne MD 40.00 X 322369 0 16367 Luke T Channer MD 40.00 X 316544 0 25788 JOHN LARAWAY MD 40.00 X 310876 0 16188 John Moreland MD 40.00 X 305613 0 38500 2352354 0 222205 20 0 1 0 WESTERN INTERSTATE INC 7590 DESMET RD MISSOULA MT 59808 Construction 739894 HEALTHCARE OUTSOURCING NETWORK 621 17TH ST SUITE 1800 DENVER CO 80293 buiness services 726602 ALLIANCE HEALTHCARE SERVICES FILE 55826 LOS ANGELES CA 90074 MRI IMAGING 348870 CERNER CORPORATION PO BOX 412072 KANSAS CITY MO 64141 IT Construction 347032 CLINTON R ADKINS 387 WOMBAT CORVALLIS MT 59828 EMERGENCY ROOM PHYSICIAN 261363 20 106272 56764 163036 Patient ServICE INCOME 621400 45808668 45808668 HOSPITAL Utilztn. REV. 621400 1150428 1150428 Other Operating INCOME 621400 117237 117237 47076333 99709 99709 139345 276081 -136736 -136736 -136736 73473 105477 -32004 -32004 -32004 Miscellaneous 900099 55939 55939 55939 47226277 47076333 0 -13092 836070 426705 409365 17668181 15217227 2377623 73331 755987 662681 90070 3236 2778834 2388220 379274 11340 1296294 1112289 178774 5231 100606 90818 9788 62962 56836 6126 4873124 4007353 859876 5895 185995 129180 56425 390 4388767 4139476 247462 1829 260702 181067 79089 546 66948 46498 20310 140 838348 838348 2764123 1990169 773954 991664 991664 Provision for Bad Debts 5188082 5188082 MAINTENANCE AND REPAIRS 796473 546908 248131 1434 MISCELLANEOUS EXPENSES 260262 180761 78956 545 PHARMACY/ LAB EXPENSES 98609 68487 29915 207 TRAINING & development 28199 19585 8555 59 44240230 38282354 5853693 104183 3214264 6104400 3550774 3604899 8506135 8661625 244655 163929 1018763 967188 348466 453245 42667540 19140186 22314426 23527354 1102150 1157713 950514 771657 580728 0 41830875 45412010 4015525 4077061 9815000 9265000 5291545 5811840 505085 100000 1119102 19727155 20273003 X 20667019 23631082 454503 524562 982198 983363 22103720 25139007 41830875 45412010 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 313190 85732 85732 313190 313190 313190 1.00000 0 0 1252628 1252628 27011729 9987966 17023763 695752 478643 217109 12353417 8673577 3679840 1354014 1354014 23527354 THIRD PARTY SETTLEMENT 1119102 1119102 47226277 44240230 2986047 -6323 55563 49240 3035287 47076333 276081 276081 46800252 426025 426025 47226277 44516310 276080 276080 44240230 0 44240230 Part V, Line 4: Description of Intended Use of Endowment Funds: Endowment funds are designated for the purpose of building and carrying on a hospital in Hamilton, Montana, and for the care and treatment of crippled children. Part XI, Line 8 - Other Adjustments: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF DALY HOSPITAL FOUNDATION: 55563. Part XII, Line 2d - Other Adjustments: Rental Expenses: 276081. Part XII, Line 4b - Other Adjustments: NONOPERATING REVENUE: 319046. CONTRIBUTIONS AND GRANTS: 91317. AUXILLIARY GAIN: 15662. Part XIII, Line 2d - Other Adjustments: Rental Expenses: 276080. 1 1 1 X 1 X 100.000000000000 1 1 0 1 1 1 131 379251 379251 0.00960 3545072 3756182 -211110 0.00000 1 131 3924323 3756182 168141 0.00960 39 238964 238964 0.00610 13 32 53445 53445 0.00140 2 1185514 905236 280278 0.00710 20 41077 41077 0.00100 74 32 1519000 905236 613764 0.01560 75 163 5443323 4661418 781905 0.02520 4 9305 9305 0.00020 2 1003 1003 0.00000 3 75559 75559 0.00190 9 85867 85867 0.00210 1 2666310 0 8118479 10149320 -2030841 X 1 1 Marcus Daly Memorial Hospital

1200 WESTWOOD DRIVE HAMILTON MT 59840

X X X X CORVALLIS FAMILY MEDICINE CLINIC

1037 MAIN STREET CORVALLIS MT 59828

CLINIC BITTERROOT VALLEY EYE ASSOCIATES

300 N 10TH STREET HAMILTON MT 59840

CLINIC BITTERROOT CLINIC

1224 MAIN STREET HAMILTON MT 59840

CLINIC BITTERROOT VALLEY EYE ASSOCIATES

401 MAIN STREET SUITE A STEVENSVILLE MT 59870

CLINIC Part I, Line 3c: Full to partial assistance may be granted to patients with gross family income below 100% of the FPG, as adjusted for family size. A family may not own net assets in excess of $10,000 current value. Part I, Line 6a: A Community Benefit report for fiscal year 2009 was in the Summer 2010 edition of HealthLines, the newsletter of Marcus Daly Memorial Hospital. The newletter was delivered to every mailing address in Ravalli County covering approximately 14,300 households. An additional 1,000 copies of the newsletter were printed for general circulation. Part I, Line 7: EXPLANATION OF COSTING METHOD: THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COSTS TO CHARGES (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, MEDICAID PROVIDER TAXES, TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING).THE ORGANIZATION INCLUDED SUBSIDIZED HEALTH SERVICES OF $1,104,210 ATTRIBUTABLE TO PHYSICIAN CLINICS. Part I, Line 7f: The Hospital maintains an allowance for uncollectible self-pay accounts. Patients are not required to provide collateral for services rendered. Payment for services is required at the time of service when the amount due is known or upon receipt of an invoice, after payment by insurance, if any. Management determines the allowance for doubtful accounts by identifying troubled accounts, by historical experience applied to an aging of accounts and by considering the patients' financial history, credit history and current economic conditions. When all collection efforts have been exhausted, the account is written off against the related allowance. Part III, Line 4: THE FOLLOWING IS FROM THE "PATIENT RECEIVABLES" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"The Hospital maintains an allowance for uncollectible self-pay accounts. Patients are not required to provide collateral for services rendered. Payment for services is required at the time of service when the amount due is known or upon receipt of an invoice, after payment by insurance, if any. Management determines the allowance for doubtful accounts by identifying troubled accounts, by historical experience applied to an aging of accounts and by considering the patients' financial history, credit history and current economic conditions. When all collection efforts have been exhausted, the account is written off against the related allowance."THE AMOUNT OF BAD DEBT EXPENSE (AT COST) REPORTED IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. Part III, Line 8: MDMH has a Medicare shortfall in excess of $2 million. MDMH provides a significant rural link for both the health and well-being of Ravalli County residents. We are committed to local healthcare close to home and work hard to earn and keep the trust of the local community. To ensure that a variety of Clinic, Hospital and Emergency Services are open and available to all those within our service area we strive to operate at the highest level of fiscal responsibility and to be a good steward of our resources. Latest demographics list 31.6% of the service population over the age of 45 with 16% over 64 yet Medicare accounts for 48% of the total facility revenue. IRS / Larson Allen methodology was used to compute the Medicare shortfall. Part III, Line 9b: In order for patients to qualify for charity care, they must fill out an application. After receipt of application, it is reviewed by a committee who determines charity care eligibility. If balances are determined to qualify for charity care and are written off, then no collections are pursued on the patient. Part VI, Line 2: We Hire consultants to conduct focus groups within the community. We Conducted Community Benefit report sessions within 5 communities in the county we serve. Also, we Conducted telephone surveys of residents within the county. Part VI, Line 3: Billing and collection information is located on the back of statements sent to patients. On a monthly basis, we contact by phone requesting payment and may explain policies at that time. We utitlize the MASH Program to screen private pay patients to qualifiy for other programs such as Medicaid and Disability. Part VI, Line 4: We serve a rural population where the household median income is about $28,000. Our Payer mix is 48% Medicare, 8% Medicaid, 11% Self Pay, no insurance, with the balance at other Commercial payers. The period unemployment rate in Ravalli County is between 9 and 10.2%. Part VI, Line 5: The Hospital promotes the health of the community by participation in both economic and coalition building events. The Hospital partners with local high schools with a "job shadow" program. The goal is to expose and promote the health care profession to area youth. The Hospital is also represented on the Bitterroot College Steering Team and the Job Service Economic Council. The Hospital partners with the Rocky Mountain Lab, a level 5 biohazard lab, to help ensure community safety and is represented at Adult Protection Services and other community support organizations. Part VI, Line 6: The Hospital is proud of its efforts to promote community health and wellness with the launching of a Tobacco Free Campaign. The Hospital sponsors an annual Sports Physical clinic to support and encourage area youth to participate in physicial activities. Other community clinics or screenings included blood pressure testing at area senior centers, and lipid profiles and cholesterol tests provided to the community free of charge. A variety of health education classes were conducted including, but not limited to, hand washing, eye health, Parkinson's disease, AED and DUI education. Part VI, Line 7: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. MT X X X 0 0 0 0 0 0 0 0 0 JOHN M BARTOS 224511 0 0 0 59139 0 20520 0 8303 0 312473 0 0 0 WALKER ASHCRAFT MD 132001 0 26130 0 0 0 16984 0 22188 0 197303 0 0 0 FREDERIK ILGENFRITZ 220002 0 0 0 0 0 8400 0 1000 0 229402 0 0 0 GARY L SMITH MD 166958 0 171319 0 0 0 38484 0 9483 0 386244 0 0 0 Yvonne Courchesne MD 145114 0 174343 0 2912 0 15367 0 1000 0 338736 0 0 0 Luke T Channer MD 250000 0 66544 0 0 0 16500 0 9288 0 342332 0 0 0 JOHN LARAWAY MD 310876 0 0 0 0 0 8400 0 7788 0 327064 0 0 0 John Moreland MD 273988 0 31325 0 300 0 38500 0 0 0 344113 0 0 0 MT Health Facility Authority 810302402 612043ED7 2007-01-31 7068924 Construction of a new Emergency Department 0 0 7135000 533494 261801 5973474 2008 1 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 Form 990, Part VI, Section B, line 11 The form 990 was reviewed, in detail, by the CFO and CEO. The form 990 was then reviewed by the Board of Directors and hospital finance committee at a Board meeting before it was filed. Form 990, Part VI, Section B, line 12c The hospital attorney attends all board meetings and he is given the authority to question, prior to discussion, a potential conflict of interest for any director. The CEO raises a question regarding conflict of interest. The hospital board asks the Director to step out of the room during discussion of conflict. The Director is excused for the discussion once a conflict has been determined or is invited back into the room. Form 990, Part VI, Section B, line 15a CEO - occurs annually with annual compensation committee of the board. The committee reviews surveys for comparable pay and benefits. This committee also conducts the annual evaluation of the CFO. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. DALY HOSPITAL FOUNDATIONINC 1200 WESTWOOD DRIVE HAMILTON MT 59840 363766000 charitable services MT 501(C)(3) 11-TYPE 2 N/A 0 0 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 DALY HOSPITAL FOUNDATION INC C 106272 DALY HOSPITAL FOUNDATION INC K 154819