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            <StateAbbreviationCd>MT</StateAbbreviationCd>
            <ZIPCd>59107</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>MANAGEMENT, ACCOUNTING, IT AND PROVIDER</ServicesDesc>
        <CompensationAmt>1144111</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>FOREFRONT HEALTHCARE</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 33661</AddressLine1Txt>
            <CityNm>DETROIT</CityNm>
            <StateAbbreviationCd>MI</StateAbbreviationCd>
            <ZIPCd>48232</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT DIETARY STAFF AND SERVICES</ServicesDesc>
        <CompensationAmt>597613</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>WILDERNESS MEDICAL STAFFING</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>PO BOX 30729</AddressLine1Txt>
            <CityNm>SPOKANE</CityNm>
            <StateAbbreviationCd>WA</StateAbbreviationCd>
            <ZIPCd>99223</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>CONTRACT PROVIDERS</ServicesDesc>
        <CompensationAmt>462595</CompensationAmt>
      </ContractorCompensationGrp>
      <ContractorCompensationGrp>
        <ContractorName>
          <BusinessName>
            <BusinessNameLine1Txt>AVEL ECARE</BusinessNameLine1Txt>
          </BusinessName>
        </ContractorName>
        <ContractorAddress>
          <USAddress>
            <AddressLine1Txt>4500 N LEWIS AVENUE</AddressLine1Txt>
            <CityNm>SIOUX FALLS</CityNm>
            <StateAbbreviationCd>SD</StateAbbreviationCd>
            <ZIPCd>57104</ZIPCd>
          </USAddress>
        </ContractorAddress>
        <ServicesDesc>EMERGENCY CONSULTING SERVICES</ServicesDesc>
        <CompensationAmt>112593</CompensationAmt>
      </ContractorCompensationGrp>
      <CntrctRcvdGreaterThan100KCnt>5</CntrctRcvdGreaterThan100KCnt>
      <GovernmentGrantsAmt>11500</GovernmentGrantsAmt>
      <AllOtherContributionsAmt>190802</AllOtherContributionsAmt>
      <TotalContributionsAmt>202302</TotalContributionsAmt>
      <ProgramServiceRevenueGrp>
        <Desc>PATIENT SERVICE REVENUE</Desc>
        <BusinessCd>621110</BusinessCd>
        <TotalRevenueColumnAmt>15363947</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>15363947</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>340B REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>382687</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>382687</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <ProgramServiceRevenueGrp>
        <Desc>OTHER OPERATING REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>113162</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>113162</RelatedOrExemptFuncIncomeAmt>
      </ProgramServiceRevenueGrp>
      <TotalProgramServiceRevenueAmt>15859796</TotalProgramServiceRevenueAmt>
      <InvestmentIncomeGrp>
        <TotalRevenueColumnAmt>366588</TotalRevenueColumnAmt>
        <ExclusionAmt>366588</ExclusionAmt>
      </InvestmentIncomeGrp>
      <GrossRentsGrp>
        <RealAmt>42607</RealAmt>
      </GrossRentsGrp>
      <LessRentalExpensesGrp>
        <RealAmt>0</RealAmt>
      </LessRentalExpensesGrp>
      <RentalIncomeOrLossGrp>
        <RealAmt>42607</RealAmt>
      </RentalIncomeOrLossGrp>
      <NetRentalIncomeOrLossGrp>
        <TotalRevenueColumnAmt>42607</TotalRevenueColumnAmt>
        <ExclusionAmt>42607</ExclusionAmt>
      </NetRentalIncomeOrLossGrp>
      <GrossAmountSalesAssetsGrp>
        <OtherAmt>8000</OtherAmt>
      </GrossAmountSalesAssetsGrp>
      <LessCostOthBasisSalesExpnssGrp>
        <OtherAmt>6018</OtherAmt>
      </LessCostOthBasisSalesExpnssGrp>
      <GainOrLossGrp>
        <OtherAmt>1982</OtherAmt>
      </GainOrLossGrp>
      <NetGainOrLossInvestmentsGrp>
        <TotalRevenueColumnAmt>1982</TotalRevenueColumnAmt>
        <ExclusionAmt>1982</ExclusionAmt>
      </NetGainOrLossInvestmentsGrp>
      <OtherRevenueMiscGrp>
        <Desc>TAX REVENUE</Desc>
        <BusinessCd>900099</BusinessCd>
        <TotalRevenueColumnAmt>1081842</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>1081842</RelatedOrExemptFuncIncomeAmt>
      </OtherRevenueMiscGrp>
      <OtherRevenueTotalAmt>1081842</OtherRevenueTotalAmt>
      <TotalRevenueGrp>
        <TotalRevenueColumnAmt>17555117</TotalRevenueColumnAmt>
        <RelatedOrExemptFuncIncomeAmt>16941638</RelatedOrExemptFuncIncomeAmt>
        <UnrelatedBusinessRevenueAmt>0</UnrelatedBusinessRevenueAmt>
        <ExclusionAmt>411177</ExclusionAmt>
      </TotalRevenueGrp>
      <InfoInScheduleOPartIXInd>X</InfoInScheduleOPartIXInd>
      <OtherSalariesAndWagesGrp>
        <TotalAmt>5131383</TotalAmt>
        <ProgramServicesAmt>4885659</ProgramServicesAmt>
        <ManagementAndGeneralAmt>207239</ManagementAndGeneralAmt>
        <FundraisingAmt>38485</FundraisingAmt>
      </OtherSalariesAndWagesGrp>
      <PensionPlanContributionsGrp>
        <TotalAmt>75980</TotalAmt>
        <ProgramServicesAmt>66292</ProgramServicesAmt>
        <ManagementAndGeneralAmt>9118</ManagementAndGeneralAmt>
        <FundraisingAmt>570</FundraisingAmt>
      </PensionPlanContributionsGrp>
      <OtherEmployeeBenefitsGrp>
        <TotalAmt>435306</TotalAmt>
        <ProgramServicesAmt>379804</ProgramServicesAmt>
        <ManagementAndGeneralAmt>52237</ManagementAndGeneralAmt>
        <FundraisingAmt>3265</FundraisingAmt>
      </OtherEmployeeBenefitsGrp>
      <PayrollTaxesGrp>
        <TotalAmt>427288</TotalAmt>
        <ProgramServicesAmt>372808</ProgramServicesAmt>
        <ManagementAndGeneralAmt>51275</ManagementAndGeneralAmt>
        <FundraisingAmt>3205</FundraisingAmt>
      </PayrollTaxesGrp>
      <FeesForServicesManagementGrp>
        <TotalAmt>162135</TotalAmt>
        <ProgramServicesAmt>31583</ProgramServicesAmt>
        <ManagementAndGeneralAmt>130552</ManagementAndGeneralAmt>
      </FeesForServicesManagementGrp>
      <FeesForServicesLegalGrp>
        <TotalAmt>20283</TotalAmt>
        <ProgramServicesAmt>3951</ProgramServicesAmt>
        <ManagementAndGeneralAmt>16332</ManagementAndGeneralAmt>
      </FeesForServicesLegalGrp>
      <FeesForServicesAccountingGrp>
        <TotalAmt>106954</TotalAmt>
        <ProgramServicesAmt>20834</ProgramServicesAmt>
        <ManagementAndGeneralAmt>86120</ManagementAndGeneralAmt>
      </FeesForServicesAccountingGrp>
      <FeesForServicesOtherGrp>
        <TotalAmt>4445233</TotalAmt>
        <ProgramServicesAmt>3816329</ProgramServicesAmt>
        <ManagementAndGeneralAmt>628904</ManagementAndGeneralAmt>
      </FeesForServicesOtherGrp>
      <AdvertisingGrp>
        <TotalAmt>8290</TotalAmt>
        <ProgramServicesAmt>3534</ProgramServicesAmt>
        <ManagementAndGeneralAmt>626</ManagementAndGeneralAmt>
        <FundraisingAmt>4130</FundraisingAmt>
      </AdvertisingGrp>
      <OfficeExpensesGrp>
        <TotalAmt>149438</TotalAmt>
        <ProgramServicesAmt>106165</ProgramServicesAmt>
        <ManagementAndGeneralAmt>43273</ManagementAndGeneralAmt>
      </OfficeExpensesGrp>
      <InformationTechnologyGrp>
        <TotalAmt>421690</TotalAmt>
        <ProgramServicesAmt>326697</ProgramServicesAmt>
        <ManagementAndGeneralAmt>94993</ManagementAndGeneralAmt>
      </InformationTechnologyGrp>
      <OccupancyGrp>
        <TotalAmt>238733</TotalAmt>
        <ProgramServicesAmt>161350</ProgramServicesAmt>
        <ManagementAndGeneralAmt>77383</ManagementAndGeneralAmt>
      </OccupancyGrp>
      <TravelGrp>
        <TotalAmt>62237</TotalAmt>
        <ProgramServicesAmt>32543</ProgramServicesAmt>
        <ManagementAndGeneralAmt>29694</ManagementAndGeneralAmt>
      </TravelGrp>
      <ConferencesMeetingsGrp>
        <TotalAmt>33053</TotalAmt>
        <ProgramServicesAmt>6660</ProgramServicesAmt>
        <ManagementAndGeneralAmt>26393</ManagementAndGeneralAmt>
      </ConferencesMeetingsGrp>
      <InterestGrp>
        <TotalAmt>5140</TotalAmt>
        <ManagementAndGeneralAmt>5140</ManagementAndGeneralAmt>
      </InterestGrp>
      <DepreciationDepletionGrp>
        <TotalAmt>828921</TotalAmt>
        <ProgramServicesAmt>825644</ProgramServicesAmt>
        <ManagementAndGeneralAmt>3277</ManagementAndGeneralAmt>
      </DepreciationDepletionGrp>
      <InsuranceGrp>
        <TotalAmt>115376</TotalAmt>
        <ProgramServicesAmt>15777</ProgramServicesAmt>
        <ManagementAndGeneralAmt>99599</ManagementAndGeneralAmt>
      </InsuranceGrp>
      <OtherExpensesGrp>
        <Desc>MEDICAL SUPPLIES</Desc>
        <TotalAmt>930564</TotalAmt>
        <ProgramServicesAmt>930564</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>BAD DEBT EXPENSE</Desc>
        <TotalAmt>344783</TotalAmt>
        <ProgramServicesAmt>344783</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>REPAIRS &amp; MAINTENANCE</Desc>
        <TotalAmt>303055</TotalAmt>
        <ProgramServicesAmt>303055</ProgramServicesAmt>
      </OtherExpensesGrp>
      <OtherExpensesGrp>
        <Desc>OTHER OPERATING EXPENSE</Desc>
        <TotalAmt>152812</TotalAmt>
        <ProgramServicesAmt>88765</ProgramServicesAmt>
        <ManagementAndGeneralAmt>64047</ManagementAndGeneralAmt>
      </OtherExpensesGrp>
      <AllOtherExpensesGrp>
        <TotalAmt>245754</TotalAmt>
        <ProgramServicesAmt>226863</ProgramServicesAmt>
        <ManagementAndGeneralAmt>18891</ManagementAndGeneralAmt>
      </AllOtherExpensesGrp>
      <TotalFunctionalExpensesGrp>
        <TotalAmt>14644408</TotalAmt>
        <ProgramServicesAmt>12949660</ProgramServicesAmt>
        <ManagementAndGeneralAmt>1645093</ManagementAndGeneralAmt>
        <FundraisingAmt>49655</FundraisingAmt>
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      <CashNonInterestBearingGrp>
        <BOYAmt>28995</BOYAmt>
        <EOYAmt>50534</EOYAmt>
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      <SavingsAndTempCashInvstGrp>
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        <EOYAmt>10976064</EOYAmt>
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      <AccountsReceivableGrp>
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        <EOYAmt>2921406</EOYAmt>
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      <InventoriesForSaleOrUseGrp>
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        <EOYAmt>253675</EOYAmt>
      </InventoriesForSaleOrUseGrp>
      <PrepaidExpensesDefrdChargesGrp>
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        <EOYAmt>221393</EOYAmt>
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      <LandBldgEquipCostOrOtherBssAmt>17306277</LandBldgEquipCostOrOtherBssAmt>
      <LandBldgEquipAccumDeprecAmt>12342955</LandBldgEquipAccumDeprecAmt>
      <LandBldgEquipBasisNetGrp>
        <BOYAmt>5505228</BOYAmt>
        <EOYAmt>4963322</EOYAmt>
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      <InvestmentsPubTradedSecGrp>
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        <EOYAmt>121283</EOYAmt>
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        <BOYAmt>246067</BOYAmt>
        <EOYAmt>248186</EOYAmt>
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      <TotalAssetsGrp>
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        <EOYAmt>19755863</EOYAmt>
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      <AccountsPayableAccrExpnssGrp>
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        <EOYAmt>198755</EOYAmt>
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      <OtherLiabilitiesGrp>
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        <EOYAmt>0</EOYAmt>
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      <TotalLiabilitiesGrp>
        <BOYAmt>1089353</BOYAmt>
        <EOYAmt>873639</EOYAmt>
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      <OrganizationFollowsFASB117Ind>X</OrganizationFollowsFASB117Ind>
      <NoDonorRestrictionNetAssetsGrp>
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        <EOYAmt>18756046</EOYAmt>
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      <DonorRestrictionNetAssetsGrp>
        <BOYAmt>248630</BOYAmt>
        <EOYAmt>126178</EOYAmt>
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      <TotalNetAssetsFundBalanceGrp>
        <BOYAmt>15971515</BOYAmt>
        <EOYAmt>18882224</EOYAmt>
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      <TotLiabNetAssetsFundBalanceGrp>
        <BOYAmt>17060868</BOYAmt>
        <EOYAmt>19755863</EOYAmt>
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      <ReconcilationRevenueExpnssAmt>2910709</ReconcilationRevenueExpnssAmt>
      <OtherChangesInNetAssetsAmt>0</OtherChangesInNetAssetsAmt>
      <InfoInScheduleOPartXIIInd>X</InfoInScheduleOPartXIIInd>
      <MethodOfAccountingAccrualInd>X</MethodOfAccountingAccrualInd>
      <AccountantCompileOrReviewInd>0</AccountantCompileOrReviewInd>
      <FSAuditedInd>1</FSAuditedInd>
      <FSAuditedBasisGrp>
        <SeparateBasisFinclStmtInd>X</SeparateBasisFinclStmtInd>
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      <AuditCommitteeInd>1</AuditCommitteeInd>
      <FederalGrantAuditRequiredInd>0</FederalGrantAuditRequiredInd>
    </IRS990>
    <IRS990ScheduleA documentId="RetDoc1039100001">
      <HospitalInd>X</HospitalInd>
    </IRS990ScheduleA>
    <IRS990ScheduleB documentId="RetDoc1234500001">
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        <ContributorNum>RESTRICTED</ContributorNum>
        <ContributorBusinessName>
          <BusinessNameLine1>RESTRICTED</BusinessNameLine1>
        </ContributorBusinessName>
        <ContributorUSAddress>
          <AddressLine1>RESTRICTED</AddressLine1>
          <AddressLine2>RESTRICTED</AddressLine2>
          <City>RESTRICTED</City>
          <State>RESTRICTED</State>
          <ZIPCode>RESTRICTED</ZIPCode>
        </ContributorUSAddress>
        <TotalContributionsAmt>RESTRICTED</TotalContributionsAmt>
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    <IRS990ScheduleD documentId="RetDoc1040000001">
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      <RevenueSubtotalAmt>17205194</RevenueSubtotalAmt>
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      <RevenueNotReportedFinclStmtAmt>349923</RevenueNotReportedFinclStmtAmt>
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      <ExpensesNotRptFinclStmtAmt>349923</ExpensesNotRptFinclStmtAmt>
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      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART XI, LINE 4B - OTHER ADJUSTMENTS:</FormAndLineReferenceDesc>
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      <SupplementalInformationDetail>
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      <WrittenPolicyInd>1</WrittenPolicyInd>
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      <FPGReferenceDiscountedCareInd>1</FPGReferenceDiscountedCareInd>
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      <FinancialAssistanceAtCostTyp>
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        <NetCommunityBenefitExpnsAmt>557886</NetCommunityBenefitExpnsAmt>
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      <UnreimbursedMedicaidGrp>
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      <CommunityHealthServicesGrp>
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        <CriticalAccessHospitalInd>X</CriticalAccessHospitalInd>
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      <HospitalFcltyPoliciesPrctcGrp>
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        <TaxExemptHospitalCYOrPYInd>0</TaxExemptHospitalCYOrPYInd>
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        <CommunityDefinitionInd>X</CommunityDefinitionInd>
        <CommunityDemographicsInd>X</CommunityDemographicsInd>
        <ExistingResourcesInd>X</ExistingResourcesInd>
        <HowDataObtainedInd>X</HowDataObtainedInd>
        <CommunityHealthNeedsInd>X</CommunityHealthNeedsInd>
        <OtherHealthIssuesInd>X</OtherHealthIssuesInd>
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        <ConsultingProcessInd>X</ConsultingProcessInd>
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        <CHNAConductedWithNonFcltsInd>1</CHNAConductedWithNonFcltsInd>
        <CHNAReportWidelyAvailableInd>1</CHNAReportWidelyAvailableInd>
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        <FPGFamilyIncmLmtDscntCarePct>400.000000000000</FPGFamilyIncmLmtDscntCarePct>
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        <ProvidedNonprofitContactInd>X</ProvidedNonprofitContactInd>
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        <FAPAppAvailableOnWebsiteURLTxt>WWW.RMHMT.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/</FAPAppAvailableOnWebsiteURLTxt>
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        <FAPSummaryOnWebsiteURLTxt>WWW.RMHMT.ORG/PATIENT-RESOURCES/FINANCIAL-ASSISTANCE/</FAPSummaryOnWebsiteURLTxt>
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        <FAPActionsOnNonpaymentInd>1</FAPActionsOnNonpaymentInd>
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        <ProvidedWrittenNoticeInd>X</ProvidedWrittenNoticeInd>
        <MadeEffortOrallyNotifyInd>X</MadeEffortOrallyNotifyInd>
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        <MadePresumptiveEligDetermInd>X</MadePresumptiveEligDetermInd>
        <NondisEmergencyCarePolicyInd>1</NondisEmergencyCarePolicyInd>
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      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>ROUNDUP MEMORIAL HOSPITAL ASSOC</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 5: THE STEERING COMMITTEE CREATED TO ASSIST ROUNDUP MEMORIAL HEALTHCARE IN CONDUCTING CHSD WAS SELECTED TO REPRESENT A BROAD GROUP ACROSS THE COMMUNITY, BUT DIFFERENTIATE FROM THE PAST CHNA. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN MARCH 2024. THE STEERING COMMITTEE MET TWICE DURING THE CHSD PROCESS; FIRST TO DISCUSS HEALTH CONCERNS IN THE COMMUNITY AND OFFER THEIR PERSPECTIVE IN DESIGNING THE SURVEY INSTRUMENT, CONSIDERING APPROPRIATE CANDIDATES FOR TARGETED KEY INTERVIEWS (DUE TO INABILITY TO CONDUCT FOCUS GROUPS) AND MEETING AGAIN TO REVIEW RESULTS OF THE SURVEY AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS WHEN CREATING THE IMPLEMENTATION PLAN.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>ROUNDUP MEMORIAL HOSPITAL ASSOC</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 6B: THE MONTANA OFFICE OF RURAL HEALTHTHE NATIONAL RURAL HEALTH RESOURCE CENTER</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationGrp>
        <FormAndLineReferenceDesc>ROUNDUP MEMORIAL HOSPITAL ASSOC</FormAndLineReferenceDesc>
        <ExplanationTxt>PART V, SECTION B, LINE 11: THE FOLLOWING SUMMARY BRIEFLY REPRESENTS THE GOALS AND CORRESPONDING STRATEGIES AND ACTIVITIES WHICH THE FACILITY WILL EXECUTE TO ADDRESS THE PRIORITIZED HEALTH NEEDS.GOAL 1: IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH RESOURCES IN MUSSELSHELL COUNTY.STRATEGY 1.1: ENHANCE COLLABORATION WITH LOCAL LCSW TO INCREASE AWARENESS OF AND AMOUNT OF SERVICES PROVIDED. - SUPPORT LCSW TO VISIT LOCAL MEETINGS (E.G. COMMUNITY CENTER, LEPC) TO INCREASE PRESENCE AND VISIBILITY IN THE COMMUNITY.- WORK TO DETERMINE LCSW'S ROLE IN ORGANIZING, FACILITATING, AND MAINTAINING LOCAL SUPPORT GROUPS.- DETERMINE FEASIBILITY OF STARTING GRANDPARENTS RAISING GRANDCHILDREN SUPPORT GROUP.- EXPLORE FEASIBILITY OF COOPERATING WITH LOCAL CHURCHES TO ENABLE AND SUSTAIN SUPPORT GROUPS FOR THE COMMUNITY (E.G. GRIEF SUPPORT). STRATEGY 1.2: CONTINUE TO SUPPORT OTHER MENTAL AND BEHAVIORAL HEALTH RESOURCES IN THE COMMUNITY.- CONTINUE TO COORDINATE WITH AND SUPPORT LOCAL SCHOOL COUNSELORS AND LCSWS.- CONTINUE TO EXPLORE WAYS TO BOLSTER IN-PATIENT MENTAL HEALTH RESOURCES. GOAL 2: ENHANCE COMMUNITY AWARENESS OF HEALTH RESOURCES AND SERVICES OFFERED THROUGH RMH.STRATEGY 2.1: ENHANCE MARKETING AND PUBLICITY EFFORTS TO INCREASE VISIBILITY OF RMH IN THE COMMUNITY.- INQUIRE ABOUT PUTTING HOSPITAL ADVERTISING MATERIALS IN NEW KIOSK DOWNTOWN. - EXPLORE RE-STARTING RMH PRESENCE ON LOCAL RADIO STATION.- CONTINUE TO ENGAGE WITH LEPC MEETINGS AND UTILIZE THIS FORUM TO ADVERTISE RMH SERVICES AND RESOURCES.- CONTINUE TO ATTEND COMMUNITY EVENTS (E.G. MARKET ON MAIN, COMMUNITY JOB FAIR) TO INCREASE HOSPITAL PRESENCE IN THE COMMUNITY. STRATEGY 2.2: REINVIGORATE PARTNERSHIPS AND RELATIONSHIPS WITH VARIOUS COMMUNITY ENTITIES.- CONTINUE COMMUNITY EDUCATION EFFORTS.- DEFINE THE ROLE OF THE HOSPITAL FOUNDATION AND ITS RELATIONSHIP WITH RMH.- CONTINUE TO SUPPORT AND COLLABORATE WITH THE HOSPITAL FOUNDATION.- EXPLORE METHODS OF INCREASING AWARENESS OF CHW PRESENCE AND SERVICES THROUGH THE CLINIC.- ENHANCE CLINICAL STAFF AWARENESS OF PATIENT ASSISTANCE PROGRAM THROUGH INCREASED COMMUNICATION.- MONITOR NEWLY-INTRODUCED RMH PASSENGER VAN TO EVALUATE SUCCESSES AND ROOM FOR IMPROVEMENT. GOAL 3: BOLSTER ACCESS TO SPECIALTY CARE SERVICES AVAILABLE THROUGH RMH.STRATEGY 3.1: EXPLORE INTRODUCTION OF NEW SPECIALTY SERVICES OFFERED THROUGH RMH.- EXPLORE RE-INTRODUCING AUDIOLOGY AND PODIATRY VISITING SPECIALISTS.- EXPLORE FEASIBILITY OF BRINGING VISITING DERMATOLOGY SPECIALTY SERVICES TO RMH.- DETERMINE IF PATIENT LOAD IS SUFFICIENT TO WARRANT AN ORTHO PA AT RMH.</ExplanationTxt>
      </SupplementalInformationGrp>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LINE 7:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE FIGURES IN THE TABLE. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART I, LN 7 COL(F):</FormAndLineReferenceDesc>
        <ExplanationTxt>THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 HAS BEEN SUBTRACTED FROM TOTAL OPERATING EXPENSES IN THE CALCULATION OF THE COST-TO-CHARGE RATIO FROM WORKSHEET 2.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>NET BAD DEBT EXPENSE RECORDED IN THE GENERAL LEDGER (EXPENSE LESS RECOVERIES).</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>WE IMPLEMENTED PRESUMPTIVE BAD DEBT PROCEDURES SO WE STIMATE ONLY ABOUT 5% OF THE BAD DEBT WRITE OFFS MIGHT BE ELIGIBLE FOR THE FINANCIAL ASSISTANCE POLICY BUT MISSED BY OUR PROCESSES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FOOTNOTE DESCRIBING BAD DEBT IS ON PAGE 14 OF THE ATTACHED FINANCIAL STATEMENTS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 8:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ENTIRE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. MEDICARE RATES DO NOT ALWAYS ALIGN WITH THE ACTUAL COSTS OF TREATMENT. BY CONTINUING TO TREAT PATIENTS ELIGIBLE UNDER MEDICARE, THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE ORGANIZATION USED AMOUNTS FROM THEIR MEDICARE COST REPORT TO DETERMINE LINE 6.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART III, LINE 9B:</FormAndLineReferenceDesc>
        <ExplanationTxt>POLICY STATES UP FRONT THAT ADMISSIONS REPRESENTATIVE IS TO GIVE FINANCIAL ASSISTANCE PAPERWORK WITH INFORMAION ON CHARITY CARE AT THE TIME OF ADMISSION. FOLLOW UP CONSULTATION IS DONE LATER TO INCLUDE FINANCIAL ASSISTANCE DISCUSSIONS WITH PATIENT.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 2:</FormAndLineReferenceDesc>
        <ExplanationTxt>IN 2024, THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT. THE STEERING COMMITTEE INCLUDED REPRESENTATIVES FROM THE LOCAL BUSINESSES, EMS, PUBLIC HEALTH, THE SCHOOL SYSTEM, AGENCY ON AGING, AND LOCAL GOVERNMENT IN ADDITION TO THE HOSPITAL CLINICAL AND ADMINISTRATIVE STAFF. KEY INTERVIEWS AND INFORMANT MEETINGS WERE HELD TO GATHER INFORMATION ON HEALTHCARE NEEDS AND GAPS IN SERVICES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 3:</FormAndLineReferenceDesc>
        <ExplanationTxt>WHEN A PATIENT INDICATES THAT A FINANCIAL HARDSHIP EXISTS, THE HOSPITAL PROVIDES INFORMATION ON THE HOSPITAL CHARITY PLAN AND OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 4:</FormAndLineReferenceDesc>
        <ExplanationTxt>ROUNDUP MEMORIAL HEALTHCARE (RMH) IS THE SOLE COMMUNITY HEALTHCARE PROVIDER FOR MUSSELSHELL COUNTY, A RURAL AREA WITH A POPULATION DENSITY OF 2.4 PER SQUARE MILE. NO OTHER HOSPITALS SERVE THE COMMUNITY, AND THE NEAREST HEALTHCARE FACILITY IS LOCATED IN BILLINGS, 45 MILES TO THE SOUTH. PER THE 2020 FEDERAL CENSUS, THE COUNTY POPULATION WAS 4,730; THE PER CAPITA INCOME IN THE COUNTY IS $24,979 AND THE PERCENTAGE OF PERSONS BELOW THE POVERTY LINE WAS 15.4 PERCENT. IN 2010, 13.4 PERCENT OF MUSSELSHELL COUNTY WAS UNINSURED. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION HAS DESIGNATED MUSSELSHELL COUNTY AS AN UNDERSERVED AREA WITH A SCORE OF 16.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>PART VI, LINE 5:</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CEO HAS ATTENDED THE ROUNDUP COMMUNITY PARTNERS COMMITTEE TO WORK ON COMMUNITY EFFORTS IN PROMOTING HOSPITAL-LED PARTICIPATION. THE HOSPITAL MAINTAINS A WORKING RELATIONSHIP WITH THIS GROUP. THE HOSPITAL COMMITTEE, PATIENTS AND FAMILY ADVISORY COMMITTEE (PFAC) HAS RECRUITED A COMMUNITY MEMBER TO ACT AS AN ADVISORY ROLE IN PROVIDING INPUT AND INSIGHT FROM THE COMMUNITY PERSPECTIVE.</ExplanationTxt>
      </SupplementalInformationDetail>
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        <PersonNm>VALERI RUSSELL</PersonNm>
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        <PersonNm>BRYNN BIXBY</PersonNm>
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    <IRS990ScheduleO documentId="RetDoc1044400001">
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 2</FormAndLineReferenceDesc>
        <ExplanationTxt>BRYAN ADOLPH AND VAL RUSSELL HAVE A FAMILY RELATIONSHIP.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 3</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION HAS CONTRACTED WITH BILLINGS CLINIC TO PROVIDE MANAGEMENT SERVICES. THE ORGANIZATION'S CEO DURING FY25, TRACY ANDERSON FOR PART OF THE YEAR AND RICK SCHROEDER FOR PART OF THE YEAR, WAS AN EMPLOYEE OF BILLINGS CLINIC AND COMPENSATION FOR SERVICES PROVIDED TO THE HOSPITAL INCLUDE THE FOLLOWING: TRACY ANDERSON: BASE SALARY - $137,421 EMPLOYER CONTRIBUTION TO MEDICAL AND DENTAL - $6,634 EMPLOYER CONTRIBUTION TO LIFE INSURANCE AND LONG-TERM DISABILITY - $293 RICK SCHROEDER: BASE SALARY - $42,300 EMPLOYER CONTRIBUTION TO 403B PLAN - $5,499</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION A, LINE 8B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION DOES NOT HAVE HAVE ANY COMMITTEES AUTHORIZED TO ACT ON BEHALF OF GOVERNING BODY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 11B</FormAndLineReferenceDesc>
        <ExplanationTxt>THE FORM 990 IS REVIEWED BY THE CEO, CFO, AND CONTROLLER AND IS DISTRIBUTED TO THE BOARD BEFORE FILING.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 12C</FormAndLineReferenceDesc>
        <ExplanationTxt>THE POLICY APPLIES TO EMPLOYEES, VOLUNTEERS, MEDICAL STAFF, AND CONTRACTED WORKERS. ALL INTERESTED PERSONS SHOULD REPORT AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST AS SOON AS THEY BECOME AWARE OF IT. DISCLOSURE OF CONFLICTS OF INTEREST INVOLVING EMPLOYEES WILL BE REVIEWED BY SENIOR LEADERSHIP. DISCLOSURES INVOLVING SENIOR LEADERSHIP WILL BE REVIEWED BY THE BOARD OF DIRECTORS. IF THE MATTER IS DEEMED A CONFLICT OF INTEREST, THE INTERESTED PERSON SHALL DISCONTINUE THE RELATIONSHIP/ACTIVITY OR MANAGEMENT SHALL ESTABLISH A PLAN TO MONITOR THE ACTIVITY.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION B, LINE 15</FormAndLineReferenceDesc>
        <ExplanationTxt>THE CEO IS COMPENSATED ACCORDING TO ARRANGEMENTS WITH THE MANAGEMENT AGREEMENT WITH BILLINGS CLINIC, WHO RECOMMENDS THE CEO SALARY TO THE BOARD FOR APPROVAL. THE HOSPITAL UTILIZES THE MONTANA HOSPITAL ASSOCIATION AND ASSOCIATED EMPLOYEES SALARY SURVEY TO DETERMINE SALARIES OF KEY EMPLOYEES.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART VI, SECTION C, LINE 19</FormAndLineReferenceDesc>
        <ExplanationTxt>THE ORGANIZATION MAKES IT GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST TO THE CEO.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART IX, LINE 11G</FormAndLineReferenceDesc>
        <ExplanationTxt>CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 3,578,350. MANAGEMENT AND GENERAL EXPENSES 519,302. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,097,652. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 227,465. MANAGEMENT AND GENERAL EXPENSES 66,139. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 293,604. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 10,514. MANAGEMENT AND GENERAL EXPENSES 43,463. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 53,977.</ExplanationTxt>
      </SupplementalInformationDetail>
      <SupplementalInformationDetail>
        <FormAndLineReferenceDesc>FORM 990, PART XII, LINE 2C:</FormAndLineReferenceDesc>
        <ExplanationTxt>THERE IS NO SEPARATE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. THE BOARD OF DIRECTORS ASSUMES THIS OVERSIGHT RESPONSIBILITY. THE BOARD HIRES THE AUDIT FIRM AND MEETS WITH THE AUDIT TEAM AT THE CONCLUSION OF THE AUDIT. THE BOARD IS ALSO AVAILABLE FOR ANY QUESTIONS THAT ARISE THROUGHOUT THE AUDIT.</ExplanationTxt>
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