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HOLY ROSARY HEALTHCARE: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
HOLY ROSARY HEALTHCARE (EIN 81-0231792)
Tax period
2010-01-01 to 2010-12-31
Filed
2011-11-15
IRS object ID
201143199349305304
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)
Timestamp2011-11-15T12:11:33-05:00Timestamp
Tax Period End Date2010-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1190 CARONDELET PLAZA SUITE 1300AddressLine1
CityCLAYTONCity
StateMOState
ZIP Code63105ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810231792EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY HEALTHCAREBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHOLYNameControl
Phone4062373318Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 WILSON STREETAddressLine1
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NamePAUL LEWISName
TitleINTERIM CEOTitle
Date Signed2011-11-09DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone3142901000Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-03-07 17:11:31ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonRON WEBBNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12600 WILSON STREETAddressLine1
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts37103118GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.HRH-MT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionWE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees438TotalNbrEmployees
Total Nbr Volunteers59TotalNbrVolunteers
Total Gross UBI123043TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year137357ContributionsGrantsPriorYear
Contributions Grants Current Year472754ContributionsGrantsCurrentYear
Program Service Revenue Prior Year32464440ProgramServiceRevenuePriorYear
Program Service Revenue CY36138027ProgramServiceRevenueCY
Investment Income Prior Year365InvestmentIncomePriorYear
Investment Income Current Year-46267InvestmentIncomeCurrentYear
Other Revenue Prior Year407413OtherRevenuePriorYear
Other Revenue Current Year487877OtherRevenueCurrentYear
Total Revenue Prior Year33009575TotalRevenuePriorYear
Total Revenue Current Year37052391TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year73797GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY46119GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year19156356SalariesEtcPriorYear
Salaries Etc Current Year20682130SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year17025454OtherExpensePriorYear
Other Expenses Current Year17921156OtherExpensesCurrentYear
Total Expenses Prior Year36255607TotalExpensesPriorYear
Total Expenses Current Year38649405TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3246032RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1597014RevenuesLessExpensesCY
Total Assets BOY24038596TotalAssetsBOY
Total Assets EOY21970302TotalAssetsEOY
Total Liabilities BOY12018061TotalLiabilitiesBOY
Total Liabilities EOY3029198TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12020535NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY18941104NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense22745297Expense
Revenue30120201Revenue
DescriptionHOLY ROSARY HEALTHCARE PROVIDES INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO THE POPULATIONS OF EASTERN MONTANA. THESE SERVICES INCLUDE SURGICAL, ONCOLOGY, AND MATERNITY SERVICES, AS WELL AS 24- HOUR EMERGENCY ROOM AND DIAGNOSTIC AND THERAPUTIC SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5473151Expense
Revenue3616771Revenue
DescriptionHOLY ROSARY HEALTHCARE'S EXTENDED CARE UNIT PROVIDES SHORT-TERM TRANSITIONAL CARE AFTER ILLNESS, INJURY, OR SURGERY, AS WELL AS, LONG-TERM CARE FOR THOSE UNABLE TO LIVE INDEPENDENTLY.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3871592Expense
Revenue2285178Revenue
DescriptionHOLY ROSARY HEALTHCARE CLINIC PROVIDES PRIMARY CARE SERVICES. THE CLINIC ALSO MAKES AVAILABLE VARIOUS SPECIALTY SERVICES OFFERED BY VISITING PROVIDERS.Description

Activity Other ActivityOther (4 entries)

ExpenseExpenseRevenueRevenueDescriptionDescriptionGrantsGrants
118002115877PROGRAM SERVICE RENTAL INCOME
321019NON-PATIENT FOOD SERVICE
142593DEPARTMENT OTHER OPERATING REVENUE
4611918451ALL OTHER REVENUE46119
FieldValueIRS element (for citing)
Total Of Other Program Service Exp164121TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt46119TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev597940TotalOfOtherProgramServiceRev
Total Program Service Expense32254161TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedfalseFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109696NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees438NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMARK PETESCH DIR OF FINANCENamePerson
Telephone Number4062373318TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO BOX 35200AddressLine1
CityBILLINGSCity
StateMTState
ZIP Code591075200ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployeeFormerFormer
MONTY LESH
BOARD CHAIR2.0X000
SISTER MARY LOU MENDEL
BOARD MEMBER2.0X000
SISTER MARIE DAMIAN GLATT
BOARD MEMBER2.0X000
DR J R GRIERSON
BOARD VICE CHAIR2.0X000
JANETTE JONES
BOARD SECRETARY2.0X000
JAMES T PAQUETTE
REGIONAL CEO40.0X076890997940X
SISTER JUDITH JACKSON
BOARD MEMBER2.0X000
RHONDA VERBECK
BOARD MEMBER2.0X000
TRACI SCHELL
BOARD MEMBER2.0X000
TAD TORGERSON
BOARD MEMBER2.0X000
RON WEBB
CEO40.0X021120430448X
JEFF HARDING
BOARD MEMBER2.0X000
SYLVIA DANFORTH
BOARD MEMBER2.0X000
BILL OFTEDAL
BOARD MEMBER2.0X000
STEVE BALLOCK
REGIONAL CFO40.0026490133739X
PAUL LEWIS
VP FINANCE/ADMIN40.0010638316871X
DANIEL G TAILEUR
PHYSICIAN40.0301448037299X
CHRISTINE DRIVDAHL-SMITH
PHYSICIAN40.0222568030947X
EARL BENNETT
PHARMACIST40.0139237027656X
JAMES MACMILLAN
PHYSICIAN40.0314431011639X
JEFFERY WILLIAMS
PHYSICIAN40.0212188012229X
RICHARD LOPES
FORMER CHIEF TRANSFORMA OFFIC40.0058827617185X
PAMELA NICHOLS
FORMER CHIEF NURSING OFFICER40.0010601562X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1189872TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs2045688TotalReportableCompFrmRltdOrgs
Total Other Compensation316015TotalOtherCompensation
Number Individuals GT100 K17NumberIndividualsGT100K
Formers ListedtrueFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
ARAMARK CORPORATION
PO BOX 651009CHARLOTTENC282651009FOOD SERVICES803356
B E SMITH INC
9777 RIDGE DRIVELENEXAKS66219MANAGEMENT LOCUMS245540
CONIFER HEALTH SOLUTIONS
1500 SOUTH DOUGLASS ROADANAHEIMCA92806PATIENT BILLING SERV1585739
PRAIRIE TRAVELERS INC
130 3RD STREET SOUTHGLASCOWMT59230NURSING LOCUMS209584
HILL FARRER BURRILL LLP
300 SOUTH GRAND STREET 37TH FLRLOS ANGELESCA900713147LEGAL SERVICES148323
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
Related Organizations472754RelatedOrganizations
Total Contributions472754TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE9000993602215036022150
PROGRAM SERVICE RENTAL INCOME532000115877115877
FieldValueIRS element (for citing)
Total Program Service Revenue36138027TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column-66870TotalRevenueColumn
Exclusion-$66,870ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real1400Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real2752Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-1352Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-1352TotalRevenueColumn
Exclusion-$1,352ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other68578Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2792Securities
Other45183Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities-2792Securities
Other23395Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column20603TotalRevenueColumn
Exclusion$20,603ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NON-PATIENT FOOD SERVICES7223203281853210197166
DEPARTMENT OTHER OPERATING REVENUE900099142593142593
ALL OTHER REVENUE9000991845118451
FieldValueIRS element (for citing)
Total Other Revenue489229TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column37052391TotalRevenueColumn
Related Or Exempt Function Income36504213RelatedOrExemptFunctionIncome
Unrelated Business Revenue123043UnrelatedBusinessRevenue
Exclusion-$47,619ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total46119Total
Program Services46119ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total367154Total
Management And General367154ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total16347568Total
Program Services14588582ProgramServices
Management And General1758986ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total731995Total
Program Services668183ProgramServices
Management And General63812ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2194394Total
Program Services2193948ProgramServices
Management And General446ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1041019Total
Program Services944395ProgramServices
Management And General96623ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total2291830Total
Program Services153339ProgramServices
Management And General2138491ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total73251Total
Management And General73251ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total21794Total
Management And General21794ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total682Total
Management And General682ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total1770Total
Management And General1770ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3490307Total
Program Services2801359ProgramServices
Management And General688947ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total139953Total
Management And General139953ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5516906Total
Program Services5301647ProgramServices
Management And General215259ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total117880Total
Management And General117880ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total665812Total
Program Services654654ProgramServices
Management And General11158ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total147246Total
Program Services70341ProgramServices
Management And General76904ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2386713Total
Program Services2386713ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total299713Total
Program Services299713ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS17969111796911
MEDICAID PROVIDER TAXES414080414080
RECRUITING EXPENSES331047191611139436
DUES & MEMBERSHIPS958822992465958
EDUCATION & SEMINARS32774301142660

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total96606Total
Program Services96606ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total38649404Total
Program Services32254161ProgramServices
Management And General6395243ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY162117BOY
EOY-1603867EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY215057BOY
EOY217457EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4308962BOY
EOY5578927EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY857392BOY
EOY816603EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY183508BOY
EOY376160EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis39613396LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec24646310LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY16756896BOY
EOY14967086EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY896857BOY
EOY780897EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY657807BOY
EOY837039EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY24038596BOY
EOY21970302EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4113061BOY
EOY3029198EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY7905000BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY12018061BOY
EOY3029198EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY12020535BOY
EOY18941104EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12020535BOY
EOY18941104EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY24038596BOY
EOY21970302EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-1597013ReconcilationRevenueExpenses
Reconcilation Other Changes8517582ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

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)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$682DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB682TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierSchedule C, Part II-BIdentifier
Return ReferenceLobbying Activity ExplanationReturnReference
ExplanationHoly Rosary Healthcare pays dues to the Montana Hospital Association, of which $682 is charged for lobbying.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance170256BeginningOfYearBalance
Investment Earnings Or Losses-15721InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
Administrative Expenses3AdministrativeExpenses
End Of Year Balance152032EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance126507BeginningOfYearBalance
Investment Earnings Or Losses46785InvestmentEarningsOrLosses
Grants Or Scholarships3000GrantsOrScholarships
Administrative Expenses36AdministrativeExpenses
End Of Year Balance170256EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance152571BeginningOfYearBalance
Investment Earnings Or Losses-23564InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
End Of Year Balance126507EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis135511OtherCostOrOtherBasis
Book Value135511BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis13548598OtherCostOrOtherBasis
Depreciation6042011Depreciation
Book Value7506587BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis24213604OtherCostOrOtherBasis
Depreciation17321588Depreciation
Book Value6892016BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1715683OtherCostOrOtherBasis
Depreciation1282711Depreciation
Book Value432972BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings14967086TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierSCH. D, PART V, LINE 4Identifier
Return ReferenceENDOWMENT FUNDSReturnReference
ExplanationTHE INTENDED USE FOR THE KENNETH HOM TRUST ENDOWMENT FUND IS TO PROVIDE NURSING SCHOLARSHIPS. EACH YEAR A $2,500 SCHOLARSHIP IS AWARDED TO AN INDIVIDUAL WITH EASTERN MONTANA TIES WHO IS PURSUING HIS OR HER NURSING EDUCATION. IN 2010, ONE SCHOLARSHIP WAS AWARDED. Endowment funds are held by the Holy Rosary Healthcare Foundation.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served480PersonsServed
Total Community Benefit Expense1840650TotalCommunityBenefitExpense
Net Community Benefit Expense1840650NetCommunityBenefitExpense
Percent Of Total Expense0.04990PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense4314732TotalCommunityBenefitExpense
Direct Offsetting Revenue3785606DirectOffsettingRevenue
Net Community Benefit Expense529126NetCommunityBenefitExpense
Percent Of Total Expense0.01440PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served480PersonsServed
Total Community Benefit Expense6155382TotalCommunityBenefitExpense
Direct Offsetting Revenue3785606DirectOffsettingRevenue
Net Community Benefit Expense2369776NetCommunityBenefitExpense
Percent Of Total Expense0.06430PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs29NumberOfActivitiesOrPrograms
Persons Served4705PersonsServed
Total Community Benefit Expense261627TotalCommunityBenefitExpense
Direct Offsetting Revenue8303DirectOffsettingRevenue
Net Community Benefit Expense253324NetCommunityBenefitExpense
Percent Of Total Expense0.00690PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs16NumberOfActivitiesOrPrograms
Persons Served422PersonsServed
Total Community Benefit Expense133951TotalCommunityBenefitExpense
Net Community Benefit Expense133951NetCommunityBenefitExpense
Percent Of Total Expense0.00360PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Benefit Expense47623TotalCommunityBenefitExpense
Net Community Benefit Expense47623NetCommunityBenefitExpense
Percent Of Total Expense0.00130PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs10NumberOfActivitiesOrPrograms
Persons Served3427PersonsServed
Total Community Benefit Expense21505TotalCommunityBenefitExpense
Direct Offsetting Revenue800DirectOffsettingRevenue
Net Community Benefit Expense20705NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs57NumberOfActivitiesOrPrograms
Persons Served8554PersonsServed
Total Community Benefit Expense464706TotalCommunityBenefitExpense
Direct Offsetting Revenue9103DirectOffsettingRevenue
Net Community Benefit Expense455603NetCommunityBenefitExpense
Percent Of Total Expense0.01240PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs57NumberOfActivitiesOrPrograms
Persons Served9034PersonsServed
Total Community Benefit Expense6620088TotalCommunityBenefitExpense
Direct Offsetting Revenue3794709DirectOffsettingRevenue
Net Community Benefit Expense2825379NetCommunityBenefitExpense
Percent Of Total Expense0.07670PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Total Community Building Expense1199TotalCommunityBuildingExpense
Net Community Building Expense1199NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served57PersonsServed
Total Community Building Expense2917TotalCommunityBuildingExpense
Net Community Building Expense2917NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense8328TotalCommunityBuildingExpense
Net Community Building Expense8328NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense782TotalCommunityBuildingExpense
Net Community Building Expense782NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense205939TotalCommunityBuildingExpense
Net Community Building Expense205939NetCommunityBuildingExpense
Percent Of Total Expense0.00560PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served539PersonsServed
Total Community Building Expense7541TotalCommunityBuildingExpense
Net Community Building Expense7541NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs10NumberOfActivitiesOrPrograms
Persons Served596PersonsServed
Total Community Building Expense226706TotalCommunityBuildingExpense
Net Community Building Expense226706NetCommunityBuildingExpense
Percent Of Total Expense0.00610PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$1,138,471BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare13347387AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16294191CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-2946804MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Holy Rosary HealthcareBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12600 Wilson StreetAddressLine1
CityMiles CityCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Holy Rosary HealthcareBusinessNameLine1
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 Line1POWDER RIVER MEDICAL CLINICBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1507 NORTH LINCOLN AVENUEAddressLine1
CityBROADUSCity
StateMTState
ZIP Code59317ZIPCode
FieldValueIRS element (for citing)
Facility TypeAMBULATORY CARE CLINICFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
SCHEDULE H, PART VISUPPLEMENTAL INFORMATIONPART I, LINE 3C ELIGIBILITY IS BASED ON FEDERAL POVERTY GUIDELINES. PART I, LINE 6A THE ANNUAL COMMUNITY BENEFIT REPORT IS INCLUDED IN THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM REPORT TO THE COMMUNITY. WE SUBMIT COMMUNITY BENEFIT ACTIVITIES AS NEWS TO LOCAL MEDIA AND REPORT THEM ON OUR WEBSITE AS THEY OCCUR. A SEPARATE PUBLICATION SPECIFICALLY DEDICATED TO COMMUNITY BENEFIT WAS NOT RELEASED IN 2010. PART I, LINE 7G PHYSICIAN CLINICS ACCOUNT FOR $31,649 OF TOTAL SUBSIDIZED SERVICE EXPENSE; THIS IS A CLINIC IN A REMOTE RURAL AREA WITH NO OTHER ACCESS TO HEALTHCARE WITHIN AN 80 MILE RADIUS. PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE DELETED FROM THE DENOMINATOR BEFORE CALCULATING PERCENTAGES IN COLUMN (F) IS $1,796,911. PART I, LINE 7 COST TO CHARGE RATIO IS USED FOR ALL REMAINING CATEGORIES OF COMMUNITY BENEFIT. THE COST TO CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. PART II THE MOST SIGNIFICANT EXPENSE IN COMMUNITY BUILDING ACTIVITIES IS THE COST OF PHYSICIAN RECRUITMENT TO OUR MEDICALLY UNDERSERVED AREA. PART III, LINE 4 DISCOUNTS AND PAYMENTS APPLIED TO ACCOUNTS REDUCE BAD DEBT EXPENSE. NO METHOD IS USED TO DETERMINE THE AMOUNT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE, HOWEVER, THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ALLOWS FINANCIAL ASSISTANCE AWARDS TO BE MADE PRESUMPTIVELY TO INDIVIDUALS WHO HAVE NOT ADEQUATELY COMPLETED THE APPLICATION PROCESS IF THE INDIVIDUAL IS HOMELESS OR IF THE INDIVIDUAL IS NON-RESPONSIVE AND HAS A CREDIT SCORE LESS THAN 600. BAD DEBT EXPENSES INCLUDE ACTUAL WRITE OFFS AND ANY ASSOCIATED ACCRUAL BASED ON ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF BAD DEBT INCLUDED ON PART III LINE 2 WAS THE COST TO CHARGE RATIO DERIVED USING THE METHODOLOGY FROM WORKSHEET 2. PART III, LINE 8 THE ORGANIZATION DOES NOT BELIEVE THAT MEDICARE SHORTFALLS SHOULD BE INCLUDED AS COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT'S SCHEDULE D PART V, PART VI AND SCHEDULE D-1. PART III, 9B AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WE MAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TO THOSE WHO NEED IT MOST, AND TO ENSURE THAT WE MANAGE OUR RESOURCES SO THAT WE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. HOLY ROSARY HEALTHCARE NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. NEEDS ASSESSMENT: AS PART OF OUR CORE VALUE OF RESPONSE TO NEED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. HOLY ROSARY HEALTHCARE HAS REGULARLY PARTICIPATED IN NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2006, AND ONE IS CURRENTLY BEING CONDUCTED FOR 2011. THIS ASSESSMENT STUDIES MILES CITY, MONTANA, AND THE IMMEDIATE SURROUNDING AREA SERVED BY HOLY ROSARY HEALTHCARE, AND IS COMPLETED BY PARTNERING WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; AND CONDUCTING SURVEYS, FOCUS GROUPS, AND ASSESSMENTS WITH THE ASSISTANCE OF THE OFFICE OF RURAL HEALTH. COMMUNITY EDUCATION WAS COMPLETED UTILIZING THE MEDIA, INTERNET, AND MAILINGS TO BUILD AWARENESS AND ENCOURAGE PARTICIPATION IN THIS PROJECT. IN 2011, WE ADDED A NEW APPROACH TO IDENTIFY COMMUNITY HEALTH NEEDS BY CREATING THE CONSENSUS BUILDING FORUM: IDENTIFYING PRIORITIES IN HEALTHCARE DELIVERY IN EASTERN MONTANA. THIS IS PROVING TO BE AN INFORMATIVE APPROACH TO IDENTIFYING ISSUES AND PRIORITIZING SOLUTIONS. WE ALSO CONTINUOUSLY ASSESS THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY, AND BY EVALUATING STATE AND COUNTY HEALTH STATISTICS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: HOLY ROSARY HEALTHCARE TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. HOLY ROSARY HEALTHCARE HAS A WRITTEN FINANCIAL ASSISTANCE POLICY THAT EXPLAINS ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE AT VARIOUS LEVELS, INCLUDING A 100% DISCOUNT, AND IS BASED ON FEDERAL POVERTY GUIDELINES. WE WORK WITH PATIENTS TO HELP THEM UNDERSTAND THEIR FINANCIAL RESPONSIBILITY FOR CARE RECEIVED, FINANCIAL ASSISTANCE AVAILABLE TO THEM, AND TO ESTABLISH PAYMENT PROGRAMS IN DEMONSTRATION OF OUR CORE VALUE OF RESPECT. AS PART OF OUR RESPONSIBILITY TO EDUCATE, WE INFORM OUR PATIENTS AND THEIR FAMILIES OF THE AVAILABILITY OF ASSISTANCE, INCLUDING GOVERNMENT PROGRAMS. WE COMMUNICATE THIS IN A VARIETY OF WAYS TO ENSURE THAT MESSAGES REACH MULTIPLE AUDIENCES. BEFORE, DURING AND/OR AFTER ADMISSION, WE ENCOURAGE OUR SELF PAY PATIENTS TO VISIT WITH A FINANCIAL COUNSELOR TO DISCUSS QUALIFICATIONS FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WORKS WITH THE PATIENT TO COMPLETE A FINANCIAL ASSISTANCE FORM TO DETERMINE THE LEVEL OF DISCOUNT FOR WHICH THE PATIENT MAY BE ELIGIBLE. WE POST FINANCIAL ASSISTANCE INFORMATION IN EMERGENCY AND ADMISSIONS AREAS, ON BILLING INVOICES, IN VARIOUS AREAS AROUND THE HOSPITAL AND CLINIC SITES AND ON THE HOSPITAL WEBSITE. WE PROVIDE WRITTEN MATERIALS TO PATIENTS THAT DETAIL OUR FINANCIAL ASSISTANCE POLICY AND HOW IT IS ADMINISTERED. THIS COVERS ELIGIBILITY, STEPS TO FOLLOW TO DETERMINE IF A PATIENT QUALIFIES FOR ASSISTANCE, TYPICAL CHARGES A PATIENT MAY EXPECT FOR ROUTINE PROCEDURES, AND ASSISTANCE AVAILABLE BASED ON A PATIENT'S INCOME LEVEL. WE PROVIDE MATERIALS AND EDUCATION WHEN PATIENTS ARE DISCHARGED, AND INCLUDE INFORMATION IN BILLING STATEMENTS, INCLUDING PHONE NUMBERS AND OTHER METHODS TO CONTACT US WITH QUESTIONS. WE ENSURE THAT OUR FINANCIAL COUNSELORS, ADMISSION EMPLOYEES, SOCIAL WORKERS AND OTHER EMPLOYEES UNDERSTAND OUR POLICIES TO BE ABLE TO ASSIST PATIENTS IN THE MOST APPROPRIATE WAY. WE HAVE A PARTNERSHIP WITH STOCKMAN BANK OF MONTANA TO PROVIDE PAYMENT PLANS AND MEDICAL CREDIT LINES. THIS HELPS PATIENTS MEET THEIR FINANCIAL OBLIGATIONS IN A REASONABLE AND DIGNIFIED MANNER BASED ON THEIR ABILITY TO PAY, AND ALLOWS THEM TO CONTINUE TO ENSURE THE ONGOING WELFARE OF THEIR FAMILIES. THIS IS DONE IN ACCORDANCE WITH OUR CORE VALUE OF RESPECT. COMMUNITY INFORMATION: HOLY ROSARY HEALTHCARE - THE LARGEST HEALTHCARE FACILITY BETWEEN BILLINGS, MONTANA, AND BISMARCK, NORTH DAKOTA - PROVIDES A COMPLETE CONTINUUM OF CARE THROUGH OUR 25-BED ACUTE CARE HOSPITAL, 87-BED EXTENDED CARE LIVING COMMUNITY, OUTPATIENT MEDICAL ARTS CENTER, AND HOSPICE AND PALLIATIVE CARE PROGRAMS. WHILE THE ORGANIZATION DRAWS PATIENTS FROM A 13-COUNTY REGION IN THE STRONGEST SERVICE-LINES, HOLY ROSARY HEALTHCARE'S PRIMARY AND SECONDARY SERVICE AREAS INCLUDE A NINE-COUNTY CORE REGION WITH APPROXIMATELY 45,000 PEOPLE. THE DEMOGRAPHIC MAKE-UP OF OUR PRIMARY AND SECONDARY SERVICE AREAS INCLUDES: - OVERALL DECLINING POPULATION OF 3% IN MOST COUNTIES WIH THE EXCEPTION OF TWO, ROSEBUD AND FALLON COUNTIES. - LARGE GEOGRAPHIC AREA WITH SPARSE POPULATION, AVERAGING 1.4 PEOPLE/SQUARE MILE. - AGING POPULATION WITH AVERAGE AGE OF 43 AND AVERAGE LIFE EXPECTANCY OF 79; EXCEPTION IS ROSEBUD COUNTY WITH AVERAGE AGE OF 36. - PRIMARY INDUSTRIES ARE AGRICULTURE, STATE/LOCAL GOVERNMENT, AND RETAIL. AVERAGE HOUSEHOLD INCOME IS $49,000, $20,000 BELOW THE NATIONAL AVERAGE. PROMOTION OF COMMUNITY HEALTH: WE EXTEND OUR CARE BEYOND OUR HOSPITAL'S WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR COMMUNITY BUILDING ACTIVITIES DEMONSTRATE THIS COMMITMENT. IN 2010, THE MOST SIGNIFICANT EXPENSE IN COMMUNITY BUILDING ACTIVITIES IS THE COST OF PHYSICIAN RECRUITMENT TO OUR MEDICALLY UNDERSERVED AREA. WE ARE ALSO INVOLVED IN MANY COMMUNITY ORGANIZATIONS THAT VARY IN SCOPE INCLUDING CRITICAL INCIDENT STRESS MANAGEMENT, COMMUNITY HEALTH ALLIANCE (WHICH PARTNERS WITH ALL LOCAL HEALTH ORGANIZATION TO CREATE COMMUNITY HEALTH IMPROVEMENT), AND OTHER CIVIC MINDED ORGANIZATIONS. WE ARE AN IMPORTANT PART OF OUR COMMUNITY AND SERVE IN MANY WAYS, FROM DELIVERING CORE HEALTH CARE TO PREVENTIVE CARE TO SUPPORT OF OTHER CIVIC GROUPS. IN 2010, WE PROVIDED COMMUNITY BENEFIT TOTALING $3,659,134, INCLUDING TRADITIONAL CHARITY CARE AND THE UNPAID COST OF MEDICAID. OUR BOARD OF DIRECTORS REPRESENTS MEDICAL AND BUSINESS PROFESSIONALS, AND ALL PROVIDE HOURS OF SERVICE IN SUPPORT OF OUR HOSPITAL. THEY ARE DEEPLY INVOLVED IN OUR NEEDS ASSESSMENT PROCESS, BUILDING PROGRAMS AND SERVICES, AND COMMUNITY OUTREACH TO ENSURE THAT PEOPLE KNOW ABOUT SERVICES AVAILABLE TO THEM THROUGH OUR H
STATE FILING OF COMMUNITY BENEFIT REPORT990 SCHEDULE H, PART VICA, KS, MT,

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12600 WILSONAddressLine1
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient202270238EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant38329AmountOfCashGrant
Purpose Of GrantASSIST IN CHARITABLE EXEMPT PURPOSEPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierDescription of Organization's Procedures for Monitoring the Use of GrantsIdentifier
Return ReferenceForm 990, Schedule I, Part I, Line 2ReturnReference
ExplanationGRANTS ARE MONITORED THROUGH THE HOLY ROSARY HEALTHCARE FOUNDATION. THE FOUNDATION FOLLOWS A TWO-STEP PROCESS IN PREPARING THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA). THE GRANT PROJECT DIRECTOR IS RESPONSIBLE TO SUBMIT THE INVOICES FOR EACH MONTH'S ACTIVITY TO THE FOUNDATION DIRECTOR. THESE ARE THEN REVIEWED FOR COMPLIANCE WITH FEDERAL STANDARDS AND GUIDELINES AND ARE SUBMITTED TO THE FEDERAL GOVERNMENT FOR REIMBURSEMENT OR APPLIED TO GRANT IF AWARDED UPFRONT. THE AMOUNTS ARE THEN DRAWN DOWN BY THE FOUNDATION ADMINISTRATOR AND THE MONEY IS WIRED TO THE FOUNDATION'S BANK ACCOUNT OR REIMBURSED TO THE HOSPITAL IF THE EXPENDITURES WERE PAID BY THE HOSPITAL AND THE FUNDS MADE AVAILABLE TO THE FOUNDATION IN ADVANCE. THIS INFORMATION IS COMPILED QUARTERLY BY THE DIRECTOR OF FINANCE AND IS TRACKED BY GRANT NAME AND CEDA NUMBER. THE FOUNDATION DIRECTOR ALSO PROVIDES THE FINANCE DIRECTOR WITH THE AWARD LETTER AND ANY COMMUNICATIONS RELATED TO THE GRANT AS WELL AS SUPPORTING INVOICES AND EXPENDITURES. AT THE END OF THE YEAR, QUARTERLY WORKSHEETS ARE USED TO PREPARE THE SEFA. THE SEFA IS PREPARED BY THE DIRECTOR OF FINANCE, REVIEWED BY THE GRANTS ADMINISTRATOR AND FORWARDED TO THE SYSTEM OFFICE AND ERNST AND YOUNG CPA FIRM.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymenttrueSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 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
JAMES T PAQUETTE
07689090000087072010868086684900
DANIEL G TAILEUR
30144800000122500250490338747000
CHRISTINE DRIVDAHL-SMITH
22256800000111910197560253515000
EARL BENNETT
13923700000114000162570166894000
STEVE BALLOCK
02649010000018700015039029864000
RICHARD LOPES
0588276000001467302512060546100
RON WEBB
02112040000019610010838024165200
JAMES MACMILLAN
3144310000000116390326070000
JEFFERY WILLIAMS
2121880000000122290224417000
PAMELA NICHOLS
000001060150006201060770106015

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, SCHEDULE J, PART I, LINE 3PROCESS FOR DETERMINING COMPENSATION SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHARE SYSTEMS AND HOSPITALS.
FORM 990, SCHEDULE J, PART I, LINE 4ASEVERANCE WAS PAID IN 2010 TO PAMELA J. NICHOLS, CHIEF NURSING OFFICER , IN THE AMOUNT OF $106,015.SEVERANCE PAYMENTS
FORM 990, SCHEDULE J, PART I, LINE 4BOTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR IRS IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2010 WERE: JAMES T. PAQUETTE $108,797 STEVEN A. BALLOCK $9,198 RICHARD T. LOPES $10,148 IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE AMOUNTS WITHDRAWN FOR THIS TYPE OF PAYMENT IN 2010 WERE FOR RICHARD T. LOPES $152,565.PAYMENTS FROM NONQUALIFIED RETIREMENT PLAN
FORM 990 SCHEDULE J, PART II AND FORM 990 PART VIITHE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING HOLY ROSARY HEALTHCARE (HOLY ROSARY) IN MILES CITY, MONTANA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. JAMES T. PAQUETTE IS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR ST. VINCENT HEALTHCARE (ST. VINCENT) IN BILLINGS, MT. HE ALSO SERVES AS A MEMBER OF HOLY ROSARY'S BOARD. STEVEN A. BALLOCK IS VICE PRESIDENT, CHIEF FINANCIAL OFFICER FOR ST. VINCENT. HE ALSO SERVES AS A MEMBER OF HOLY ROSARY'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S AND MR. BALLOCK'S POSITIONS AS ST. VINCENT EXECUTIVES AND NOT AS MEMBERS OF HOLY ROSARY'S BOARD. RICHARD T. LOPES WAS SENIOR VICE PRESIDENT AND CHIEF TRANSFORMATION OFFICER AT SCLHS. AS A FORMER OFFICER OF HOLY ROSARY, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. LOPES' POSITION AS AN SCLHS EXECUTIVE AND IS NOT RELATED TO HOLY ROSARY. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierDISCLOSURESIdentifier
ExplanationPART I, LINE 18 - THE PRIOR YEAR TOTAL EXPENSE AMOUNT HAS BEEN REVISED DUE TO A MATHMATICAL ERROR. FORM 990, PART III, LINE 4D PROGRAM SERVICE ACCOMPLISHEMENTS HOLY ROSARY HEALTHCARE (HOSPITAL) PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO INDIVIDUALS COVERED BY GOVERNMENTAL PROGRAMS, OTHER BENEFITS, AND ACCOMPLISHMENTS INCLUDE: -ASSISTING EDUCATORS BY WORKING WITH HEALTHCARE INTERNS. -PRESENT SPEAKING ENGAGEMENTS TO THE COMMUNITY COVERING HEALTHCARE ISSUES SUCH AS TELEMEDICINE, ARTHRITIS, HOSPICE PROGRAM, SLEEP DISORDERS, ETHICS, JOINT SEMINARS, EAR, NOSE, AND THROAT ISSUES, PSYCHOLOGY, AND DIABETES. -PARTICIPATED IN HEALTH FAIRS TO PROMOTE HEALTH EDUCATION AND FOSTER PREVENTION TECHNIQUES. -PROVIDE HOSPICE PROGRAM TO COMMUNITY. -PROVIDE DENTAL CARE FOR CHILDREN THROUGH SMILE SAVERS. -PROVIDE HEALTH RELATED ARTICLES TO LOCAL PRESS TO EDUCATE PUBLIC ON VARIOUS TOPICS. -PROVIDE WELLNESS SCREENS TO SCHOOL DISTRICT AT DISCOUNTED RATE. -PROVIDE FREE TOURS TO AREA SCHOOL CHILDREN AND OTHER COMMUNITY GROUPS TO TEACH THEM ABOUT THE HOSPITAL. -PROVIDE MEDICAL EXPLORERS PROGRAM TO PROMOTE CAREERS IN HEALTHCARE. -SPONSOR AFFORDABLE ACCESS ADVANTAGE FOR OUR EMPLOYEES. -SPONSOR BLOOD DRIVES, CHARITY WALKS, 55 ALIVE, SCHOOL NURSE PROGRAM, AND OTHER GROUPS. FORM 990 PART VI, SEC A, LINE 3 MANAGEMENT COMPANIES MANAGEMENT DUTIES DELEGATED BY HOLY ROSARY HEALTHCARE TO MANAGEMENT COMPANIES WERE IN THE FOLLOWING AREAS: (1) CONIFER HEALTH SOLUTIONS: REVENUE CYCLE SERVICES THAT INCLUDES PATIENT ACCESS, CHARGE CAPTURE AND ACCOUNTS RECEIVABLE MANAGEMENT (2) ARAMARK CORPORATION: FOOD SERVICES (3) BROADLANE: SUPPLY CHAIN MANAGEMENT FORM 990 PART VI, SEC A, LINES 6, 7A & 7B CLASS OF MEMBER, NATURE OF RIGHTS, ELECTION OF BOARD MEMBERS, DECISIONS SUBJECT TO APPROVAL THE SOLE MEMBER AND CONTROLLING MEMBER OF THE HOLY ROSARY HEALTHCARE (HRH) CORPORATION IS THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC (SCLHS), A KANSAS NON-FOR-PROFIT CORPORATION. SOME OF THE EXCLUSIVE POWERS OF SCLHS INCLUDE: - TO APPOINT, AFTER CONSULTATION WITH THE HRH CORPORATE BOARD, THE BOARD OF DIRECTORS OF HRH AND APPOINT MEMBERS OF SCLHS TO THE HRH BOARD OF DIRECTORS; - TO REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE HRH CORPORATE BOARD, ANY MEMBER OF THE HRH BOARD OF DIRECTORS; - TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER AND THE CHIEF ADMINISTRATIVE OFFICER OF HRH; - TO IMPLEMENT CORPORATE GOALS, POLICIES, AND PROCEDURES OF HRH; - TO APPROVE FOR HRH THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS, OR THE LEASE, SALE, TRANSFER, ASSUMPTION, OR ENCUMBERING OF HRH ASSETS; - TO APPROVE THE MERGER, DISSOLUTION, OR CORPORATE RESTRUCTURING OF HRH; AND - TO APPROVE HRH ANNUAL STRATEGIC PLANS AND OPERATING AND CAPITAL BUDGETS. THE HRH BOARD OF DIRECTORS HAVE THE POWERS TO EXERCISE GENERAL MANAGEMENT AND CONTROL OF THE BUSINESS AFFAIRS OF HRH WITH DUE REGARD FOR THE POWERS RESERVED BY SCLHS. THE POWERS OF THE HRH BOARD OF DIRECTORS INCLUDE NOMINATION OF BOARD MEMBERS FOR APPOINTMENT BY SCLHS. FORM 990 PART VI, SEC B, LINE 11B PROCESS THE ORGANIZATION USES TO REVIEW FORM 990 THE 990 FOR HOLY ROSARY HEALTHCARE WILL BE REVIEWED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND THE HOLY ROSARY HEALTHCARE BOARD MEETINGS BEFORE THE RETURN IS FILED WITH THE IRS. THE 990 TAX RETURN IS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PART VI, SEC B, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST ALL HOLY ROSARY HEALTHCARE EXECUTIVES, DIRECTORS, AND MANAGERS, BOARD MEMBERS AND BOARD COMMITTEE MEMBERS, MEDICAL EXECUTIVE COMMITTEE (MEC) MEMBERS AND OTHER PHYSICIANS IN DECISION MAKING ROLES OR SERVING ON HRH COMMITTEES, COMPLETE A NEW CONFLICT OF INTEREST (COI) DISCLOSURE FORM ANNUALLY. A COPY OF THE POLICY IS DISTRIBUTED ALONG WITH THE COI FORMS. IN THE EVENT OF A CHANGE OF CIRCUMSTANCE, EACH INDIVIDUAL WHO HAS ALREADY SIGNED A COI IS EXPECTED TO NOTIFY THE ORGANIZATION OF THE CHANGE AND UPDATE THE CONFLICT OF INTEREST INFORMATION. THE STATEMENTS ARE REVIEWED AND COI ISSUES ARE ADDRESSED BY THE ORGANIZATION RESPONSIBILITY OFFICER (ORO) AND LEADERSHIP AT THE APPROPRIATE LEVEL: - BOARD BY BOARD CHAIR - PHYSICIANS BY THE MEC PRESIDENT - HRH DIRECTORS AND MANAGERS BY THE HRH ADMINISTRATION - HRH EXECUTIVES BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM THE SIGNED COI FORMS ARE MAINTAINED IN HRH ADMISTRATION. THE CONFLICT OF INTEREST DISCLOSURE STATEMENTS FOR HRH EXECUTIVES ARE MAINTAINED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AT THE BEGINNING OF BOARD AND BOARD COMMITTEE MEETINGS, THE QUESTION OF COI IS ASKED OF THOSE IN ATTENDANCE. WHEN AN ACTUAL CONFLICT IS IDENTIFIED, THE INDIVIDUAL ASKS TO BE EXCUSED FROM PARTICIPATING IN THE DISCUSSIONS AND DECISION-MAKING. FORM 990 PART VI, SEC C, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE AT HOSPITAL ADMINISTRATION UPON REQUEST. THE SISTERS OF CHARITY CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON THE SISTERS OF CHARITY WEBSITE WWW.SCLHEALTHSYSTEM.ORG. FORM 990, PART VII AND SCHEDULE J, PART II OFFICERS, DIRECTORS, TRUSTEE, KEY EMPLOYEES ADDITIONAL INFORMATION THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) IS THE SOLE CORPORATE MEMBER OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING HOLY ROSARY HEALTHCARE (HOLY ROSARY) IN MILES CITY, MONTANA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. JAMES T. PAQUETTE IS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR ST. VINCENT HEALTHCARE (ST. VINCENT) IN BILLINGS, MT. HE ALSO SERVES AS A MEMBER OF HOLY ROSARY'S BOARD. STEVEN A. BALLOCK IS VICE PRESIDENT, CHIEF FINANCIAL OFFICER FOR ST. VINCENT. HE ALSO SERVES AS AN OFFICER OF HOLY ROSARY. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S AND MR. BALLOCK'S POSITIONS AS ST. VINCENT EXECUTIVES AND NOT AS MEMBERS OF HOLY ROSARY'S BOARD OR OFFICERS. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. RICHARD T. LOPES IS SENIOR VICE PRESIDENT AND CHIEF TRANSFORMATION OFFICER AT SCLHS. AS A FORMER OFFICER OF HOLY ROSARY, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. LOPES' POSITION AS AN SCLHS EXECUTIVE AND IS NOT RELATED TO HOLY ROSARY. FORM 990, PART VII AND SCHEDULE J, PART II AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS ESTIMATE OF AVERAGE HOURS PER WEEK, IF ANY, DEVOTED TO RELATED ORGANIZATIONS FOR WHICH COMPENSATION WAS REPORTED IN COLUMNS (E) OR (F) OF PART VII: - JAMES PAQUETTE 36 HOURS/WEEK ON RELATED ORGANIZATIONS - STEVE BALLOCK 35 HOURS/WEEK ON RELATED ORGANIZATIONS - RON WEBB 1 HOUR/WEEK ON WORK FOR HRH FOUNDATION - RICHARD LOPES 1 HOUR/WEEK ON WORK FOR HRH FOUNDATION - PAUL LEWIS 1 HOUR/WEEK ON WORK FOR HRH FOUNDATION FORM 990, PART XI, LINE 5 RECONCILIATION OF NET ASSETS THE CHANGES IN NET ASSETS SHOWN ON LINE 5 OF PART XI ($8,517,582) STEM FROM THE FOLLOWING: (1) THE AMOUNT OF $-233,208 OPERATING EXPENSES OF THE HRH FOUNDATION PAID BY HRH (2) WRITEOFF OF HRH NOTE PAYABLE TO ST VINCENT HEALTHCARE FOR $8,925,000 (3) TRANSFER OF $-291,795 TO SCLHS FOR INFORMATION TECHNOLOGY (4) TRANSFER FROM SCLHS OF $64,511 FOR HRH VIDEO EQUIPMENT (5) UNREALIZED GAIN ON INVESTMENTS NOT RECORDED IN THE TAX RETURN $53,074Explanation

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
SISTERS OF CHARITY LEAVENWORTH HLTH SYST
9801 RENNER BLVD STE 100LENEXAKS66219237379161SUPPORT MMBRSKS501(C)(3)11B-TYPE IINA
CARITAS CLINICS INC
818 NORTH 7TH STREETLEAVENWORTHKS66048481009910CLINIC SVCSKS501(C)(3)3NA
MARIAN CLINIC INC
1001 SW GARFIELDTOPEKAKS66604481046905CLINIC SVCSKS501(C)(3)3NA
MARILLAC CLINIC INC
2333 N 6TH STREETGRAND JUNCTIONCO81501841085822CLINIC SVCSCO501(C)(3)3NA
PROVIDENCE MEDICAL CENTER
8929 PARALLEL PARKWAYKANSAS CITYKS66112480784446HEALTHCAREKS501(C)(3)3NA
ST JOHN HOSPITAL INC
3500 SOUTH FOURTH STREETLEAVENWORTHKS66048480543768HEALTHCAREKS501(C)(3)3NA
BETHANY COMMUNITY PLAZA INC
15 NORTH 12TH STREETKANSAS CITYKS66102481207407HEALTHCAREKS501(C)(3)3NA
PROVIDENCEST JOHN FOUNDATION INC
8929 PARALLEL PARKWAYKANSAS CITYKS661121689480925688SUPPORT 501C3KS501(C)(3)7NA
ST FRANCIS HEALTH CENTER INC
1700 SW 7TH STREETTOPEKAKS66606480547719HEALTHCAREKS501(C)(3)3NA
ST FRANCIS HEALTH CENTER FOUNDATION
1700 SW 7TH STREETTOPEKAKS66606481092520SUPPORT 501C3KS501(C)(3)11A-TYPE INA
ST MARYS HOSPITAL & MEDICAL CENTER INC
2635 N 7TH STREETGRAND JUNCTIONCO81502840425720HEALTHCARECO501(C)(3)3NA
ST MARYS HOSPITAL FOUNDATION
2635 N 7TH STREETGRAND JUNCTIONCO81502237001007SUPPORT 501C3CO501(C)(3)11A-TYPE INA
SAINT JOSEPH HOSPITAL FOUNDATION
1835 FRANKLIN STREETDENVERCO80218840735096SUPPORT 501C3CO501(C)(3)11A-TYPE INA
HOLY ROSARY HEALTHCARE FOUNDATION INC
2600 WILSONMILES CITYMT59301202270238SUPPORT 501C3MT501(C)(3)11A-TYPE INA
ST VINCENT HEALTHCARE
1233 NORTH 30THBILLINGSMT59101810232124HEALTHCAREMT501(C)(3)3NA
ST VINCENT HEALTHCARE FOUNDATION
PO BOX 35200BILLINGSMT591075200810468034SUPPORT 501C3MT501(C)(3)7NA
NORTHWEST RESEARCH & EDUCATION INSTITUTE
315 NORTH 25TH STREETBILLINGSMT59101201343024COMM HLTH RESMT501(C)(3)9NA
ST JAMES HEALTHCARE
400 SOUTH CLARK STREETBUTTEMT597012328810231785HEALTHCAREMT501(C)(3)3NA
ST JAMES HEALTHCARE FOUNDATION
400 SOUTH CLARK STREETBUTTEMT59701651202190SUPPORT 501C3MT501(C)(3)11A-TYPE INA
SAINT JOHN'S HEALTH CENTER
1328 22ND STREETSANTA MONICACA90404951684082HEALTHCARECA501(C)(3)3NA
JOHN WAYNE CANCER INSTITUTE
2000 SANTA MONICA BLVDSANTA MONICACA90404954291515CANCER R&DCA501(C)(3)4NA
SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN
1328 22ND STREETSANTA MONICACA904042091956100079SUPPORT 501C3CA501(C)(3)11A-TYPE INA
EXEMPLA INC FKA LUTHERAN HOSPITAL
2420 W 26TH AVE SUITE 100DDENVERCO80211841103606HEALTHCARECO501(C)(3)3NA
EXEMPLA LUTHERAN MEDICAL CENTER FNDTN
2480 W 26TH AVESUITE 360BDENVERCO80211208846152SUPPORT 501C3CO501(C)(3)7NA
EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN
200 EXEMPLA CIRCLELAFAYETTECO80026841649162SUPPORT 501C3CO501(C)(3)7NA
LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST
2480 W 26TH AVESUITE 360BDENVERCO80211742571584INSURANCECO501(C)(3)11A-TYPE INA
MEDPARK INC
2480 W 26TH AVESUITE 360BDENVERCO80211841490379PARKINGCO501(C)(3)7NA
SAINT JOSEPH HOSPITAL
1835 FRANKLIN STREETDENVERCO80218840417134HEALTHCARECO501(C)(3)3NA

Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeType
PAVILION IMAGING LLC
750 WELLINGTONGRAND JUNCTIONCO81501030516198RADIOLOGYCONAN/A
GRAND VALLEY SURGICAL CENTER LLC
710 WELLINGTONGRAND JUNCTIONCO81501841505075OP SURGERYCONAN/A
SAN JUAN CANCER CENTER LLC
600 SOUTH 5TH STREETMONTROSECO81401202856331OP CANCERCONAN/A
BILLINGS MRI CENTER LLC
1041 NORTH 29TH STREETBILLINGSMT59101810450943MRI-PET SCANMTNAN/A
LUTHERAN CAMPUS ASC LLC
3455 LUTHRN PKW SUITE 150WHEATRIDGECO800336028020749532OP SURGERYCONAN/A
COLORADO SURGICAL VENTURES LLC
30 S WACKER DR SUITE 2302CHICAGOIL60605208038915OP SURGERYCONAN/A
COLORADO SURGICAL HOSPITAL LLC
30 S WACKER DR SUITE 2302CHICAGOIL60605208038977OP SURGERYCONAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
CARITAS INC AND SUBSIDIARIES
9801 RENNER BOULEVARD SUITE 100LENEXAKS66219480941069OTHER MEDICALKSN/AC CORP
LEAVEN INSURANCE COMPANY LTD
980370522INSURANCEN/A23 LIME TREE BAY AVE PO BOX 1051GEORGETOWNGRAND CAYMANCJKY1-1102CJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
ST VINCENT HEALTHCARE
Q8925000
ST VINCENT HEALTHCARE
O149125
HOLY ROSARY HEALTHCARE FOUNDATION
B38329
HOLY ROSARY HEALTHCARE FOUNDATION
C472754