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SIDNEY HEALTH CENTER: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
SIDNEY HEALTH CENTER (EIN 81-0233499)
Tax period
2009-07-01 to 2010-06-30
Filed
2011-05-16
IRS object ID
201131409349300603
Schema version
2009v1.7
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)
Timestamp2011-05-16T09:42:03-05:00Timestamp
Tax Period End Date2010-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHMS PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1741 3rd Ave SAddressLine1
CityGlasgowCity
StateMTState
ZIP Code59230ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810233499EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1SIDNEY HEALTH CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlSIDNNameControl
Phone4064882100Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1216 14TH AVE SWAddressLine1
CitySIDNEYCity
StateMTState
ZIP Code59270ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTINA MONTGOMERYName
TitleCFOTitle
Phone4064882100Phone
Date Signed2011-05-20DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameRichard A Wiens CPAName
Phone4062289391Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonTINA MONTGOMERYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1216 14TH AVE SWAddressLine1
CitySIDNEYCity
StateMTState
ZIP Code59270ZIPCode
FieldValueIRS element (for citing)
Gross Receipts40731224GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501cXOrganization501c
Web Sitewww.sidneyhealth.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1946YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionTO HELP THOSE WE SERVE ACHIEVE THIER HIGHEST LEVEL OF HEALTH BY PROVIDING QUALITY MEDICAL CARE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees643TotalNbrEmployees
Total Nbr Volunteers150TotalNbrVolunteers
Total Gross UBI5487494TotalGrossUBI
Net Unrelated Business Txbl Income-2148040NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year586372ContributionsGrantsPriorYear
Contributions Grants Current Year157967ContributionsGrantsCurrentYear
Program Service Revenue Prior Year36988993ProgramServiceRevenuePriorYear
Program Service Revenue CY39217237ProgramServiceRevenueCY
Investment Income Prior Year108225InvestmentIncomePriorYear
Investment Income Current Year277911InvestmentIncomeCurrentYear
Other Revenue Prior Year81184OtherRevenuePriorYear
Other Revenue Current Year61626OtherRevenueCurrentYear
Total Revenue Prior Year37764774TotalRevenuePriorYear
Total Revenue Current Year39714741TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year20541382SalariesEtcPriorYear
Salaries Etc Current Year20508024SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year232423TotalFundrsngExpCurrentYear
Other Expense Prior Year19067388OtherExpensePriorYear
Other Expenses Current Year20035933OtherExpensesCurrentYear
Total Expenses Prior Year39608770TotalExpensesPriorYear
Total Expenses Current Year40543957TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-1843996RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-829216RevenuesLessExpensesCY
Total Assets BOY61507011TotalAssetsBOY
Total Assets EOY62129772TotalAssetsEOY
Total Liabilities BOY31080103TotalLiabilitiesBOY
Total Liabilities EOY32532080TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY30426908NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY29597692NetAssetsOrFundBalancesEOY
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense29424196Expense
Revenue33729743Revenue
DescriptionREVENUE AND EXPENSES DIRECTLY RELATED TO PATIENT CARE.Description
Total Program Service Expense29424196TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Balance Sheet Amounts Reported1BalanceSheetAmountsReported
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
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 Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109631NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees643NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters1LocalChapters
Policies Reference Chapters1PoliciesReferenceChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1TINA MONTGOMERYBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4064882117TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12816 4TH STREET NWAddressLine1
CitySIDNEYCity
StateMTState
ZIP Code59270ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (16 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployeeOfficerOfficer
PAM BURMAN
Vice President1.00X000
MIKE MOHL
SeCRETARY/TREASURER1.00X000
TAMI CHRISTENSEN
PRESIDENT2.00X000
RANDY JOHNSON
Director1.00X000
LAURA SCHIEBER
DIrector1.00X000
Janice Norby
Director1.00X000
Gale Frank
Director1.00X000
STEVE SING
Director1.00X000
Rajohn Karanjai MD
PHYSICIAN (Chief of Staff)40.00X000
CARLOS TREVINOS
PHYSICIAN (Vice Chief)40.00X278986019230X
RICK HARALDSON
CEO40.00187974015929XX
TINA MONTGOMERY
CFO40.0099999018960X
Lotfi Ben-youssef
Physician40.0045727209887X
C Scordalakes
Physician40.00368484025703X
Brad Struupp
CRNA40.00306013022499X
Bard Lundemo
CRNA40.00298460024615X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1997188TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation136823TotalOtherCompensation
Number Individuals GT100 K6NumberIndividualsGT100K
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
Brett Bennion MD
214 14TH AVE SWSIDNEYMT59270PHYSICIAN SERVICES392244
EDWARD L PIERCE MD PC
214 14TH AVE SWSIDNEYMT59270PHYSICIAN SERVICES349408
PETE COUNCIL MD
214 14TH AVE SW SUITE 104SIDNEYMT59270PHYSICIAN SERVICES239053
SODEXO OPERATIONS LLC
4880 PAYSPHERE CIRCLEPITTSBURGPA15262Food Services214705
RAJOHN KARANJAI MD PC
214 14TH AVE SW SUITE 110SIDNEYMT59270PHYSICIAN SERVICES157170
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
All Other Contributions157967AllOtherContributions
Total Contributions157967TotalContributions

Program Service Revenue ProgramServiceRevenue (4 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PatIENT REVENUE9000993372974333729743
CLINIC PHARMACY44611036838423683842
PHYSICIAN OFFICES62111013467641346764
MONDAK PHARMACY446110456888456888
FieldValueIRS element (for citing)
Total Program Service Revenue39217237TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column264093TotalRevenueColumn
Related Or Exempt Function Income264093RelatedOrExemptFunctionIncome

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real60493Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real60493Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column60493TotalRevenueColumn
Related Or Exempt Function Income60493RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities1030301Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities1016483Securities

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities13818Securities

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column13818TotalRevenueColumn
Related Or Exempt Function Income13818RelatedOrExemptFunctionIncome

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column1133TotalRevenueColumn
Related Or Exempt Function Income1133RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue1133TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column39714741TotalRevenueColumn
Related Or Exempt Function Income34069280RelatedOrExemptFunctionIncome
Unrelated Business Revenue5487494UnrelatedBusinessRevenue
Exclusion$0ExclusionAmount

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16547790Total
Program Services10528359ProgramServices
Management And General5888123ManagementAndGeneral
Fundraising131308Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total348585Total
Program Services290216ProgramServices
Management And General55324ManagementAndGeneral
Fundraising3045Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2515869Total
Program Services2209698ProgramServices
Management And General283564ManagementAndGeneral
Fundraising22607Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1095780Total
Program Services941123ProgramServices
Management And General145981ManagementAndGeneral
Fundraising8676Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total755842Total
Program Services493313ProgramServices
Management And General234556ManagementAndGeneral
Fundraising27973Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total8102Total
Management And General8102ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total53723Total
Management And General53723ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total110704Total
Management And General110704ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2154944Total
Program Services1790555ProgramServices
Management And General364389ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total135850Total
Program Services9976ProgramServices
Management And General119714ManagementAndGeneral
Fundraising6160Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total7899167Total
Program Services7493246ProgramServices
Management And General403005ManagementAndGeneral
Fundraising2916Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1904564Total
Program Services1184068ProgramServices
Management And General712682ManagementAndGeneral
Fundraising7814Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total181074Total
Program Services125042ProgramServices
Management And General51832ManagementAndGeneral
Fundraising4200Fundraising

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total90017Total
Program Services59317ProgramServices
Management And General27238ManagementAndGeneral
Fundraising3462Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total1326378Total
Management And General1326378ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2697522Total
Program Services2697522ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total511309Total
Program Services495711ProgramServices
Management And General15598ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalManagement And GeneralManagementAndGeneralProgram ServicesProgramServicesFundraisingFundraising
BAD DEBT EXPENSE921434921434
TAXES43168214577416146959
RECRUITING77356106775404012639
DONATIONS622037552465

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total770045Total
Program Services633399ProgramServices
Management And General135982ManagementAndGeneral
Fundraising664Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total40543957Total
Program Services29424196ProgramServices
Management And General10887338ManagementAndGeneral
Fundraising232423Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY11218886BOY
EOY9088068EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY5530235BOY
EOY6675912EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY3095307BOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
EOY2995580EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1260955BOY
EOY1298473EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY643267BOY
EOY717011EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis56944977LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27976815LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY22788454BOY
EOY28968162EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3097720BOY
EOY3380231EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY4372888BOY
EOY1294927EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY5509535BOY
EOY5935148EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY3989764BOY
EOY1776260EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY61507011BOY
EOY62129772EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3404742BOY
EOY3428190EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY9515000BOY
EOY9425000EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY16375000BOY
EOY17222219EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY1785361BOY
EOY2456671EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY31080103BOY
EOY32532080EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY29713497BOY
EOY29597692EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY713411BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY30426908BOY
EOY29597692EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY61507011BOY
EOY62129772EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee0AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Political Expenditures32500PoliticalExpenditures
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities0OtherActivities

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart I-A, Line 1:Identifier
Return ReferenceOrganizations Direct and Indirect Political Campaign Activities:ReturnReference
ExplanationHIRED A LOBBYIST TO ENGAGE IN POLITICAL ACTIVITY.Explanation

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Investment Cost Or Other Basis198261InvestmentCostOrOtherBasis
Book Value198261BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis36511638InvestmentCostOrOtherBasis
Depreciation15336856Depreciation
Book Value21174782BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Investment Cost Or Other Basis18499247InvestmentCostOrOtherBasis
Depreciation12639959Depreciation
Book Value5859288BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis1735831InvestmentCostOrOtherBasis
Book Value1735831BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings28968162TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
DescriptionFUNDED DEPRECIATIONDescription
Book Value5935148BookValue
Method Of ValuationFMethodOfValuation
FieldValueIRS element (for citing)
Total Of Book Value Program Related5935148TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
INTEREST RATE SWAP LIABILITY$2,413,419
Medicare/Medicaid, Est. Payable$43,252
FieldValueIRS element (for citing)
Total Of Amounts2456671TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt39714741TotRevenueEtcAuditedFinclStmt
Tot Expenses Etc Audited Fincl Stmt40543957TotExpensesEtcAuditedFinclStmt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget1ExpensesExceededBudget
Unable To Provide Care0UnableToProvideCare

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense90553TotalCommunityBenefitExpense
Net Community Benefit Expense90553NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4581605TotalCommunityBenefitExpense
Direct Offsetting Revenue5554709DirectOffsettingRevenue
Net Community Benefit Expense-973104NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense4672158TotalCommunityBenefitExpense
Direct Offsetting Revenue5554709DirectOffsettingRevenue
Net Community Benefit Expense-882551NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense4672158TotalCommunityBenefitExpense
Direct Offsetting Revenue5554709DirectOffsettingRevenue
Net Community Benefit Expense-882551NetCommunityBenefitExpense
Percent Of Total Expense0.00230PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$707,769BadDebtExpenseAmount
Amount Attributable To100920AmountAttributableTo
Amount Reimbursed By Medicare6360533AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare4885627CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall1474906MedicareSurplusOrShortfall

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 V Form990ScheduleHPartV

Name Name

FieldValueIRS element (for citing)
Business Name Line1SIDNEY HEALTH CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1216 14TH AVENUE SWAddressLine1
CitySIDNEYCity
StateMTState
ZIP Code59270ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Income Based CriteriaPart I, Line 3c: Individual Applying for Charity care must provide pay stubs, thier most recent tax return, forms approving or denying eligibility for medicaid and or state or county funded medical assistance, forms approving or denying unemployment compensation and current bank statements. The items listed above will be used to determine family income. Family income and family size are then used to determine what the poverty threshold is for the applicant and to determine if free or discounted care will be approved.IncomeBasedCriteria
Percent Of Total Expense ExplnPart I, Line 7f: Accounts Receivable are carried net of an estimate for uncollectibles and allowances. Accounts which are not considered collectible are written off against the allowance account. Allowances for uncollectible accounts are set based on historical loss rates applied to aged accounts receivable. Bad debts are classified as an operating expense.PercentOfTotalExpenseExpln
Bad Debt FootnotePart III, Line 4: Accounts Receivable are carried net of an estimate for uncollectibles and allowances. Accounts which are not considered collectible are written off against the allowance account. Allowances for uncollectible accounts are set based on historical loss rates applied to aged accounts receivable. Bad debts are classified as an operating expense.BadDebtFootnote
Shortfall As Community BenefitPart III, Line 8: THE COST TO CHARGE RATIO IS USED TO DETERMINE COMMUNITY BENEFIT. THIS IS DONE BY APPLYING THE RATIO TO THE TOTAL MEDICARE REVENUE. THE SHORTFALL OCCURRS DUE TO VARIOUS EXPENSES INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY.ShortfallAsCommunityBenefit
Debt Collection PolicyPart III, Line 9b: A PATIENT ACCOUNTS REP MAINTAINS A CURRENT AGING REPORT MONTHLY. AN ACCOUNT IS CONSIDERED DELINQUENT IF IT IS NOT PAID WITHIN THIRTY DAYS OF THE MAILING OF THE FIRST STATEMENT. IF PAYMENT IS NOT RECEIVED IN THE FOLLOWING BILLING CYCLE, THE PATIENT IS IS ISSUED A "PAYMENT MISSED" STICKER,ENCOURAGING PATIENTS TO MAKE PAYMENT. ALL BILLS ARE CONSIDERED PAST DUE IF NOT PAID BY THE THIRD BILLING CYCLE. A FINAL NOTICE WILL BE ISSUED IF PAYMENT IS NOT RECEIVED BY THE FOURTH BILLING CYCLE. IF PAYMENT IS NOT MADE WITHIN 5 BUSINESS DAYS AFTER THE FOURTH BILLING CYCLE THE PATIENT'S ACCOUNT WILL BE SENT TO COLLECTION.DebtCollectionPolicy

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
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 Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 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
CARLOS TREVINOS
278986000003510015720029821602369240
RICK HARALDSON
18797400000209015720020390301836340
Lotfi Ben-youssef
457272000009887000467159000
C Scordalakes
368484000009983015720039418703677300
Brad Struupp
306013000006779015720032851202867510
Bard Lundemo
298460000008895015720032307502901790

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Richland CountyBusinessNameLine1
FieldValueIRS element (for citing)
Date Issued2008-07-03DateIssued
Issue Price9685000IssuePrice
Description Of PurposeContructionDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Total Proceeds3829796TotalProceeds
Amount In Reserve Fund967947AmountInReserveFund
Issuance Costs From Proceeds670457IssuanceCostsFromProceeds
Capital Expenditures2710046CapitalExpenditures
Year Of Subst Completion2010YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding1AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind0AdequateBooksAndRecdsMaintaind

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (4 entries)

IdentifierIdentifierExplanationExplanation
Form 990, Part VI, Section B, line 11A COPY OF THE 990 WAS GIVEN TO THE CFO AND MADE AVAILABLE TO THE BOARD FOR APPROVAL.
Form 990, Part VI, Section B, line 12cA CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED TO THE BOARD ANNUALLY AND IS REQUIRED TO BE FILLED OUT BY EACH MEMBER.
Form 990, Part VI, Section B, line 15THE BOARD REVIEWS THE MONTANA HOSPITAL COMPENSATION SALARIES FOR COMPARABLE HOSPITALS ANNUALLY AND COMPARE TO THE SALARIES BEING PAID BY THE FACILITY.
Form 990, Part VI, Section C, line 19POLICIES ARE KEPT AT THE HOSPITAL AND ARE AVAILABLE UPON REQUEST.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Lone Tree Senior LivingBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1216 14th Avenue SWAddressLine1
CitySidneyCity
StateMTState
ZIP Code59270ZIPCode
FieldValueIRS element (for citing)
EIN810518821EIN
Primary ActivitiesOperation of an Assisted LivingPrimaryActivities
Legal Domicile StateMTLegalDomicileState
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties1ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org0GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org1LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other 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 Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
Lone Tree Senior Living
K74722
Lone Tree Senior Living
A141740
Lone Tree Senior Living
D2963502

Form990 Schedule R Part VI Form990ScheduleRPartVI

Name Of Business NameOfBusiness

FieldValueIRS element (for citing)
Business Name Line1Health Net LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111 South 7th Suite 241AddressLine1
CityMiles CityCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
EIN810506005EIN
Primary ActivityData ProcessingPrimaryActivity
Legal Domicile StateMTLegalDomicileState
All Partners C3 S1AllPartnersC3S
Share Of EOY Assets218117ShareOfEOYAssets
Disproportionate Allocations0DisproportionateAllocations
General Or Managing Partner0GeneralOrManagingPartner