2026-05-12T11:46:16-05:00 2025-06-30 393647910 WIPFLI ADVISORY LLC 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2024-07-01 810469886 POWELL COUNTY MEMORIAL HOSPITAL ASSOC POWE 4068462212 1100 HOLLENBACK LANE DEER LODGE MT 59722 JAENA RICHARDS CEO 4068462212 2026-04-03 1 1 SAM BRUNSON CPA P01696998 4067281800 2026-04-03 2024 2025-03-06 01:10:19Z DEER LODGE MEDICAL CENTER JAENA RICHARDS 1100 HOLLENBACK LANE DEER LODGE MT 59722 31425494 0 X DLMED.ORG X 1991 MT TO PROVIDE PATIENT FOCUSED HEALTHCARE. 7 7 161 7 0 0 66207 13500 25762684 31024933 372730 338030 542353 36716 26743974 31413179 0 0 0 0 13430435 14617643 0 0 0 11610389 12030249 25040824 26647892 1703150 4765287 42409090 46974200 18403858 17645869 24005232 29328331 TO PROVIDE PATIENT FOCUSED HEALTHCARE. 0 0 22527749 0 31024933 THE HOSPITAL PROVIDES DAILY PATIENT CARE SERVICES AND IS THE ONLY SOURCE OF THESE SERVICES IN THE AREA. THE HOSPITAL NOW ALSO HAS AN AMBULANCE SERVICE. 22527749 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 1 0 1 0 0 0 0 1 1 0 0 0 1 45 0 161 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X JENNIFER SPRING 4068462212 1100 HOLLENBACK LANE DEER LODGE MT 59722 JACK ANDERSON PRESIDENT 1.00 X X 0 0 0 TERRY MOSIER VICE PRESIDENT 1.00 X X 0 0 0 JIM DECKER SECRETARY/TREASURER 1.00 X X 0 0 0 HOWARD NECKELS DIRECTOR 1.00 X 0 0 0 CARLEE HANSEN DIRECTOR 1.00 X 0 0 0 COLTER CUMIN DIRECTOR 1.00 X 0 0 0 ED MCCARTHY DIRECTOR 1.00 X 0 0 0 JENNIFER SPRING CFO 40.00 X 180667 0 9393 TONY PFAFF PRESIDENT 40.00 X 0 0 0 ANDREW BECK CHIEF CLINICAL OFFICER 40.00 X 198173 0 27816 JAENA RICHARDS CEO 40.00 X 266409 0 44242 PATRICK WABER MD 32.00 X 266427 0 20808 VAUGHN JOHNSON MD 40.00 X 485172 0 39670 LORI DRUMM DO 32.00 X 277221 0 16046 PATRICK KRACH COO 32.00 X 262042 0 27480 JUDITH WILSON MD 24.00 X 243764 0 15107 SUMERA QAMAR MD 32.00 X 287512 0 17707 SCOT MURRAY MD 32.00 X 556493 0 55910 3023880 0 274179 27 0 1 0 SCOTT RIGDON CRNA MPHTRANSCENDENT A 330 TRIPLE TREE RD BOZEMAN MT 59715 ANESTHESIA AND PAIN MGMT. SERVICES 695713 CYPRESS HEALTHCARE LLC 791 EASTSIDE ROAD DEER LODGE MT 59722 MANAGEMENT, CEO AND TRAVEL 583127 MAYO CLINIC LABORATORIES 200 FIRST ST SW ROCHESTER MN 55905 REFERENCE LAB 303375 MONIDA SHARED IMAGING LLC 1200 S RESERVE STE H MISSOULA MN 59801 MRI SERVICES 244608 CHAD COLVIN DBA HIGH MTN CRITIAL CA 926 W SHERASON DR EAGLE ID 836167156 EMERGENCY ROOM PHYSICIAN 194842 10 2000 11500 13500 NET PATIENT SERVICE REVENUE 621110 26851802 26851802 UTILIZATION FEE REVENUE 621110 1770019 1770019 340B PHARMACY REVENUE 456110 1634293 1634293 OTHER OPERATING REVENUE 621110 768819 768819 31024933 334401 334401 40964 4248 36716 36716 36716 11696 8067 3629 3629 3629 31413179 31024933 0 374746 X 1671487 1093066 578421 10493559 9393040 1100519 305502 286695 18807 1335010 1177115 157895 812085 706514 105571 11368 11368 3807025 3118860 688165 110612 110612 196787 176511 20276 408693 114722 293971 292234 207721 84513 118387 55253 63134 467017 415649 51368 1227694 1092648 135046 373035 358114 14921 SUPPLIES 2736228 2641531 94697 PHARMACEUTICALS 771138 771138 LICENSES & TAXES 476700 241642 235058 BAD DEBT EXPENSE 451233 451233 582098 226297 355801 26647892 22527749 4120143 0 1004251 900084 7821267 11195111 3660408 4472529 24571 31517 518231 581332 289123 335563 32104581 11629938 20693766 20474643 6002802 6673487 35698 35698 2352027 2281182 42409090 46974200 2871036 3148649 10650000 9885000 4882822 4612220 18403858 17645869 X 24005232 29328331 24005232 29328331 42409090 46974200 4765287 557812 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 695642 695642 23008602 6217572 16791030 8224670 5412366 2812304 175667 175667 20474643 30752868 557812 4248 562060 30190808 1222371 1222371 31413179 25429769 4248 4248 25425521 1222371 1222371 26647892 PART XI, LINE 2D - OTHER ADJUSTMENTS: DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 4,248. PART XI, LINE 4B - OTHER ADJUSTMENTS: 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 771,138. BAD DEBT EXPENSE NETTED W/ REVENUE ON FINANCIAL STATEMENTS 451,233. PART XII, LINE 2D - OTHER ADJUSTMENTS: DIRECT RENT EXPENSE DEDUCTED FROM GROSS RENTS FOR 990 REVENUE 4,248. PART XII, LINE 4B - OTHER ADJUSTMENTS: 340B PHARMACEUTICAL EXPENSES NETTED W/ REVENUE ON FINANCIAL STATEMENTS 771,138. BAD DEBT EXPENSE NETTED W/ REVENUE ON FINANCIAL STATEMENTS 451,233. 1 1 1 X 250.000000000000 0 1 1 1 0 0 227496 227496 0.00850 5980607 8081058 0 0.00000 6208103 8081058 227496 0.00850 205132 2010 203122 0.00760 2500 2500 0.00010 4958742 3858292 1100450 0.04130 12888 12888 0.00050 5179262 3860302 1318960 0.04950 11387365 11941360 1546456 0.05800 1753 1753 0.00010 24562 24562 0.00090 26315 26315 0.00100 0 1441462 9042235 9183944 -141709 X 1 1 1 CYPRESS HEALTHCARE LLC MANAGEMENT SERVICES 0.00000 1.00000 0.00000 1 1 POWELL COUNTY MEMORIAL HOSPITAL 1100 HOLLENBACK LANE DEER LODGE MT 59722 WWW.DLMED.ORG 12992 X X X X POWELL COUNTY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 24 1 0 1 1 X WWW.DLMED.ORG X 1 25 1 WWW.DLMED.ORG 0 1 X 250.000000000000 X X 1 1 X X X 1 X WWW.DLMED.ORG X WWW.DLMED.ORG X WWW.DLMED.ORG X X X X X X 1 X 0 X X X X 1 X 0 0 POWELL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST DEER LODGE MEDICAL CENTER IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN JANUARY 2025. FOR A LIST OF ALL STEERING COMMITTEE MEMBERS AND THEIR AFFILIATIONS, SEE APPENDIX A. 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, AND AGAIN TO REVIEW RESULTS OF THE CHNA AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS. POWELL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: THE MONTANA STATE UNIVERSITY OFFICE OF RURAL HEALTH, AREA HEALTH EDUCATION CENTER, FACILITATED THE PREPARATION OF OUR COMMUNITY HEALTH NEEDS ASSESSMENT. POWELL COUNTY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: GOAL 1: INCREASE COMMUNITY AWARENESS OF SERVICES OFFERED AT DEER LODGE MEDICAL CENTER. STRATEGY 1.1: CONTINUE TO DEVELOP AND SUSTAIN DLMC'S USE OF ONLINE TOOLS AND TECHNOLOGY TO PROMOTE AWARENESS OF DLMC SERVICES. 1.1.1 SUSTAIN SOCIAL MEDIA STRATEGY AND PRESENCE THAT INCLUDES POSTING PROVIDER AND COMMUNITY HIGHLIGHTS. 1.1.2 IMPROVE DLMC WEBSITE TO EASE USER INTERFACE, MAKING IT EASIER FOR THE COMMUNITY TO SEE WHAT SERVICES ARE OFFERED, HOW TO ACCESS THOSE SERVICES, WHICH SERVICES THEY MIGHT NEED TO UTILIZE, AND ACCESS TO PRESENTATION ARCHIVES, AMONG ADDITIONAL OFFERINGS. 1.1.3 CONDUCT MARKETING CAMPAIGN TO PROMOTE NEW WEBSITE AND ITS CAPABILITIES. 1.1.4 INCREASE EDUCATION ABOUT LOW APPOINTMENT WAIT TIME TO ADDRESS COMMUNITY DESIRE FOR URGENT CARE. 1.1.5 CONTINUE TO SHARE OUTREACH FLYERS, HANDOUTS, AND MESSAGES ON SCREEN IN DLMC LOBBY DETAILING LOCAL RESOURCES, SUCH AS SENIOR SERVICES, MENTAL HEALTH RESOURCES, NEW SERVICES, FINANCIAL ASSISTANCE, ETC. STRATEGY 1.2: CONTINUE TO PROVIDE MENTAL HEALTH CARE FOR POWELL COUNTY. 1.2.1 EXPLORE HOW BEST TO ADVERTISE AVAILABLE TELE-MENTAL HEALTH SERVICES (E.G., TELEPSYCHIATRY AND MEDICATION ASSISTANCE) AVAILABLE THROUGH DLMC. 1.2.2 EXPLORE OPPORTUNITIES TO EXPAND AND SHARE PLANETREE MINDFULNESS AND WELLNESS PROGRAMS WITH THE COMMUNITY. 1.2.3 CONTINUE TO IMPLEMENT TELEHEALTH CRISIS PROTOCOLS WHEN PATIENTS IN CRISIS PRESENT IN THE EMERGENCY DEPARTMENT. GOAL 2: ENHANCE COMMUNITY ENGAGEMENT AND OUTREACH WITHIN DEER LODGE MEDICAL CENTER'S SERVICE AREASTRATEGY 2.1: CONTINUE AND SUPPORT AND PROVIDE COMMUNITY PROGRAMMING FOR HEALTH AND HEALTH-RELATED NEEDS.2.1.1 REACH OUT TO THOSE WHO PUT ON THE GRIEF SUPPORT GROUP AND DETERMINE HOW DLMC CAN BEST SUPPORT THE GROUP. 2.1.2 CONTINUE TO DISTRIBUTE COMMUNITY RESOURCE LIST AND UPDATE AS NEEDED 2.1.3 CONTINUE TO FACILITATE CAREGIVER SUPPORT GROUP AND ADVERTISE AS NEEDED. 2.1.4 CONTINUE DIABETES EDUCATION AND SERVICES, INCLUDING MONITORING AND PREVENTION. 2.1.5 CONTINUE TO CONVENE A DLMC WORKGROUP/ADMINISTRATIVE TEAM TO DISCUSS CURRENT OUTREACH EFFORTS, GAPS, AND NEW OPPORTUNITIES STRATEGY 2.2: BOLSTER THE ALREADY-POPULAR HIPPOCRATES CAF TO PROVIDE MORE EDUCATION TO THE COMMUNITY AND ENHANCE COMMUNITY ENGAGEMENT WITH DLMC AND THEIR OWN HEALTH. 2.2.1 CONTINUE TO BRING SPEAKERS IN FOR HC ACCORDING TO COMMUNITY WANTS AND NEEDS. 2.2.2 EXPLORE INCREASING THE FREQUENCY OF HIPPOCRATES CAFS TO EVERY OTHER MONTH TO EXPAND TOPICS DISCUSSED WITH THE COMMUNITY. 2.2.3 CONSIDER FURTHER TOPICS OF CONVERSATION, SUCH AS INSURANCE, HEALTH EDUCATION, HOSPICE, OPEN ENROLLMENT, PAIN MANAGEMENT, PT/OT, CARDIO REHAB. 2.2.4 EXPLORE CONDUCTING HC SESSIONS WITH NEW DLMC PROVIDERS. 2.2.5 EXPLORE HOW TO BEST PROMOTE AND SHARE DLMC'S SERVICES THROUGH HC. STRATEGY 2.3: ENHANCE REACH AND AWARENESS OF DLMC'S HEALTH AND WELLNESS PROGRAMS. 2.3.1 SUSTAIN NUTRITIONAL OUTREACH CAMPAIGN TO PROMOTE DISEASE PREVENTION AND HEALTHY DIETS. 2.3.2 SUSTAIN PROGRAM THAT FITS CHILD CAR SEATS FOR LOCAL FAMILIES. 2.3.3 CONTINUE TO PROVIDE AND ADVERTISE HEALTH EDUCATION OPPORTUNITIES THAT PROMOTE HEALTH AND WELLNESS, SUCH AS PRE-DIABETES SUPPORT GROUP, TRIM THE TOWN, WOMEN'S NIGHT OUT, STOP THE BLOOD, ANNUAL HEALTH FAIR, ETC. 2.3.4 CONTINUE TO HOST COMMUNITY EVENTS THAT PROMOTE PHYSICAL ACTIVITY, SUCH AS GOLF TOURNAMENT, ANNUAL HEALTH WALK, ETC. 2.3.5 SPONSOR LOCAL ADULT AND YOUTH RECREATIONAL SPORTS LEAGUES. 2.3.6 CONTINUE TO PROVIDE YOUTH SPORTS PHYSICALS, CONCUSSION SCREENINGS, AND HELMET PROTECTION PROGRAM. GOAL 3: IMPROVE ACCESS TO HEALTHCARE SERVICES IN POWELL COUNTY. STRATEGY 3.1: SUSTAIN AND IMPROVE ACCESS TO HEALTHCARE SERVICES AVAILABLE THROUGH DLMC. 3.1.1 CONTINUE TO IMPLEMENT CARDIAC PULMONARY REHABILITATION PHASE TWO (I.E., MONITOR/TRACK PHYSICAL ACTIVITY AND NUTRITION AMONG IDENTIFIED ELIGIBLE PATIENTS THROUGH QUALIFYING EVENTS). CONTINUE TO REFER PROGRAM "GRADUATES" TO PHASE THREE (I.E., COMPLIMENTARY PASSES TO FITNESS CENTER TO REDUCE BARRIERS TO CONTINUING PHYSICAL ACTIVITY). 3.1.2 PARTNER WITH ENTITIES IN THE AREA TO SUSTAIN AMBULANCE SERVICES IN POWELL COUNTY. CONTINUE TO SUSTAIN THE PEDIATRIC PREPAREDNESS GOLD STANDARD AND CONTINUE PROVIDING REGULAR TRAINING AND SUPPLIES TO THE LOCAL QUICK RESPONSE UNITS. 3.1.3 CONTINUE TO OFFER ANNUAL LOW-COST LABS AND MONTHLY FOOT CARE CLINICS. 3.1.4 CONTINUE SPONSORING MONTHLY HEALTH OUTREACH OPPORTUNITIES THROUGH THE LOCAL SENIOR CENTER (E.G. BLOOD PRESSURE CHECKS, MEDICATION MANAGEMENT, ETC.). 3.1.5 MAINTAIN PRIMARY CARE PROVIDERS AND EXPLORE FURTHER RECRUITMENT IF NECESSARY. 3.1.6 SUSTAIN PATIENT NAVIGATOR SERVICES LINKING PATIENTS TO COMMUNITY RESOURCES. FACILITATE PRESUMPTIVE ELIGIBILITY STATUS FOR PROGRAMS LIKE MEDICAID, MEDICARE, 340B PROGRAM, ETC. IMPLEMENT METHODOLOGY AND PROTOCOLS TO SHARE FINANCIAL ASSISTANCE RESOURCES WITH THE COMMUNITY (E.G., CLINIC, EMERGENCY ROOM, DLMC WEBSITE, ETC.) 3.1.7 CONTINUE TO OFFER TELE-ONCOLOGY SERVICES. PART I, LINE 7: PCMH USED COST-TO-CHARGE RATIOS FROM ITS MOST RECENT MEDICARE COST REPORT TO DETERMINE THE COST OF FINANCIAL ASSISTANCE, MEDICAID, PROVIDING REDUCED COST SPORTS PHYSICALS, AND PROVIDING REDUCED COST LABS. COST ACCOUNTING, WHICH INCLUDED ALL SEGMENTS (INPATIENT, OUTPATIENT, ER, ET AL) WAS USED TO DETERMINE ALL OTHER AMOUNTS REPORTED IN THE TABLE.BAD DEBT EXPENSE WAS NOT A FACTOR IN CALCULATING THE PERCENTAGES FOR COLUMN F. FORM 990, SCH H, PART I LINE C: WE ONLY OFFER A 100% WRITE OFF AT 250% OF FPG, OR IF OUT-OF-POCKET OBLIGATIONS RESULTING FROM MEDICAL SERVICES PROVIDED BY DLMC OVER THE LAST 12 MONTHS EXCEED 30% OF FAMILY INCOME. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY SUPPORT: PMCH CFO SERVED ON LOCAL PUBLIC HEALTH BOARD, AND OTHER PCMH REPRESENTATIVES ATTENDED/PRESENTED THE PUBLIC HEALTH BOARD MEETINGS. WORKFORCE DEVELOPMENT: PROVIDED INTERNSHIPS FOR LOCAL HIGH SCHOOL STUDENTS INTERESTED IN PURSUING A CAREER IN HEALTHCARE. SPONSORED A STUDENT FOR THE MEDSTART PROGRAM. PART III, LINE 2: DUE TO REV PROC 606, ALL OF OUR BAD DEBT IS RECLASSIFIED AS PRICE CONCESSIONS. WE DO TRACK ACTUAL WRITE-OFFS, RECOVERIES, AND CHANGES IN THE ALLOWANCE FOR BAD DEBT ON CURRENT SELF-PAY RECEIVABLES IN OUR GENERAL LEDGER. THAT AMOUNT IS PRESENTED HERE. PART III, LINE 3: NONE OF THE ABOVE BAD DEBT IS INCLUDED AS COMMUNITY BENEFIT. PART III, LINE 4: SEE PAGE 13 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: BY CONTINUING TO TREAT PATIENTS ELIGIBLE FOR MEDICARE, THE HOSPITAL ALLEVIATES THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING MEDICAL SERVICES. COST ACCOUNTING (VIA THE MEDICARE COST REPORT) WAS USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS. PART III, LINE 9B: PER OUR POLICY DLMC (PCMH) WILL NOT ENGAGE IN ECAS, EITHER DIRECTLY OR BY ANY DEBT COLLECTION AGENCY OR OTHER PARTY TO WHICH DLMC HAS REFERRED THE PATIENT'S DEBT, BEFORE REASONABLE EFFORTS ARE MADE TO DETERMINE WHETHER A RESPONSIBLE INDIVIDUAL(S) IS ELIGIBLE FOR ASSISTANCE UNDER THE FAP. PART VI, LINE 2: PCMH CONTINUES TO WORK THE LOCAL SCHOOLS, THE POWELL COUNTY PUBLIC HEALTH DEPARTMENT, POWELL COUNTY LOCAL EMERGENCY PREPAREDNESS COMMITTEE, MAJOR EMPLOYERS (SUN MOUNTAIN LUMBER, MONTANA STATE PRISON), LOCAL NURSING HOMES, POWELL COUNTY SENIOR CITIZEN CENTER, AND POWELL COUNTY COUNCIL ON AGING TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY WE SERVE. WE STRONGLY ENCOURAGE EMPLOYEES TO VOLUNTEER, ON PCMH TIME, FOR ORGANIZATIONS THAT STRIVE TO IMPROVE THE WELL-BEING OF OUR COMMUNITY MEMBERS. PART VI, LINE 3: PCMH STRIVES TO MEET WITH EVERY SELF-PAY PATIENT TO DETERMINE THEIR ABILITY TO PAY, AND OFFER FINANCIAL ASSISTANCE, MEDICAID PRESUMPTIVE ELIGIBILITY SCREENING, OR MONTHLY PAYMENT PLANS AS NEEDED. BEFORE TURNING AN ACCOUNT OVER TO 3RD PARTY COLLECTORS, WE PERFORM A REVIEW TO SEE IF THEY MEET THE PRESUMPTIVE ELIGIBILITY CRITERIA OF OUR FINANCIAL ASSISTANCE POLICY. SIGNS ARE POSTED THROUGHOUT THE FACILITY, ESPECIALLY AT PATIENT INTAKE AREAS, THAT NOTIFY PATIENTS OF THE AVAILABILITY OF FINANCIAL ASSISTANCE. NOTICES ARE ALSO INCLUDED WITH BILLING STATEMENTS. WITH OUR 2022 REMODELING PROJECT, WE MADE SURE TO INCORPORATE A SEPARATE OFFICE THAT IS EASILY ACCESSIBLE FOR PATIENTS TO DISCUSS THEIR ACCOUNTS IN PRIVATE WITH OUR PATIENT ACCESS MANAGER. PART VI, LINE 4: PCMH SERVES THE COUNTIES OF POWELL, GRANITE, DEER LODGE, AND SILVER BOW, AND ALSO PROVIDES SERVICES TO INMATES AT THE MONTANA STATE PRISON. PART VI, LINE 5: THE GOVERNING BOARD OF PCMH CONSISTS OF RESIDENTS OF THE HOSPITAL'S PRIMARY SERVICE AREA. EMPLOYEES NOR INDEPENDENT CONTRACTORS (OTHER THAN DISCLOSED ON THIS FORM) OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF, ARE ALLOWED TO BE BOARD MEMBERS.PCMH EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PROVIDERS IN THE COMMUNITY. WE'VE ALSO CONTRACTED WITH SEVERAL VISITING SPECIALISTS TO OFFER SERVICES NOT OTHERWISE AVAILABLE IN OUR COMMUNITY (CARDIOLOGY, PAIN MANAGEMENT, UROLOGY, PODIATRY, TELEPSYCHIATRY).PCMH CONTINUALLY REINVESTS SURPLUS FUNDS BY UPDATING OUR FACILITIES AND EQUIPMENT AND EMPLOYING ADDITIONAL STAFF TO EXPAND THE SERVICES OFFERED TO THE COMMUNITY OR IMPROVE CURRENTLY OFFERED SERVICES. THE HOSPITAL CONTINUES TO OPERATE POWELL EMERGENCY MEDICAL SERVICE, WHICH BOUGHT OUT THE FLAILING LOCAL VOLUNTEER AMBULANCE COMPANY IN 2020, TO ENSURE THAT THE COMMUNITY WOULD CONTINUE TO HAVE AMBULANCE SERVICES. ALTHOUGH PEMS RECEIVES A LARGE AMOUNT OF LEVY MONEY TO OPERATE THE SERVICE, IT REALIZED A NET LOSS FOR FISCAL YEAR 2025. SURPLUS FUNDS ARE ALSO USED TO OFFER PROGRAMS AT FREE OR REDUCED CHARGES TO THE COMMUNITY, SUCH AS THE FOLLOWING:- FREE FOOT CARE CLINIC FOR THE AGING, DISABLED, AND DIABETIC COMMUNITY - FREE BASELINE CONCUSSION TESTING FOR LOCAL STUDENT ATHLETES- LOW COST SPORTS PHYSICALS TO LOCAL STUDENT ATHLETES- SCHOLARSHIPS TO HIGH SCHOOL STUDENTS PURSUING DEGREES IN HEALTH CARE- OFFERING LOW COST LAB WORK TWO DAYS A YEAR AND DURING A PATIENT'S BIRTH MONTH.- OFFERING INTERNSHIP OPPORTUNITIES TO LOCAL HIGH SCHOOL STUDENTS INTERESTED IN CAREERS IN HEALTHCARE, AND MENTORING COLLEGE STUDENTS INTERNING IN HOSPITAL LEAN PROJECTS.- WE PROVIDE FREE TRAINING AND SUPPLIES TO LOCAL QUICK RESPONSE UNITS, VOLUNTTER FIRE DEPARTMENTS, AND VOLUNTEER AMBULANCE SERVICES.- MAINTAIN A COMMUNITY PLAYGROUND THAT PROVIDES A SAFE AREA FOR THE LOCAL YOUTH TO ENJOY HEALTHY OUTDOOR PLAY. X 1 1 X X X X X 0 0 0 0 0 0 0 0 0 SCOT MURRAY MD 555243 0 1250 0 0 0 17250 0 38660 0 612403 0 0 0 VAUGHN JOHNSON MD 480922 0 4250 0 0 0 0 0 39670 0 524842 0 0 0 JAENA RICHARDS CEO 262159 0 4250 0 0 0 13631 0 30611 0 310651 0 0 0 SUMERA QAMAR MD 283262 0 4250 0 0 0 2897 0 14810 0 305219 0 0 0 LORI DRUMM DO 272971 0 4250 0 0 0 13963 0 2083 0 293267 0 0 0 PATRICK KRACH COO 257792 0 4250 0 0 0 12670 0 14810 0 289522 0 0 0 PATRICK WABER MD 222177 0 44250 0 0 0 0 0 20808 0 287235 0 0 0 JUDITH WILSON MD 239514 0 4250 0 0 0 0 0 15107 0 258871 0 0 0 ANDREW BECK CHIEF CLINICAL OFFICER 193923 0 4250 0 0 0 10110 0 17706 0 225989 0 0 0 JENNIFER SPRING CFO 176417 0 4250 0 0 0 9033 0 360 0 190060 0 0 0 PART I, LINE 1A THE ORGANIZATION PAYS CEO, TONY PFAFF'S DUES TO ROCK CREEK CATTLE COMPANY AS THE ORGANIZATION USES THE FACILITY FOR DINING AND LODGING WHEN RECRUITING PHYSICIANS AND OTHER KEY EMPLOYEES. THIS IS NOT INCLUDED IN TONY'S TAXABLE INCOME. A MONTANA FACILITY FINANCE AUTHORITY 364615115 612043GQ6 2010-08-01 15000000 TO FINANCE THE CONSTRUCTION AND EQUIPPING OF A NEW HEALTH CARE FACILITY 0 0 0 A 4350000 15000000 1184142 13557042 258697 2011 0 0 1 1 A 0 0 0 0 0 0 1 A 0 0 0 0 0 0 0 0 0 A 0 DR VAUGHN JOHNSON KEY EMPLOYEE PERSONAL LOAN X 49000 24571 0 1 1 24571 CYPRESS HEALTHCARE LLC THE HOSPITAL'S CURRENT CEO, TONY PFAFF, OWES CYPRESS HEALTHCARE, LLC 504507 MR. PFAFF IS THE OWNER OF CYPRESS HEALTHCARE, LLC, THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL. HE RECEIVES ALL COMPENSATION FOR HIS SERVICES AS CEO FROM CYPRESS HEALTHCARE, LLC. 0 JACK ANDERSON MR. ANDERSEN IS A MEMBER OF PCMC'S BOARD OF DIRECTORS. 42000 MR. ANDERSEN SERVES AS THE HOSPITAL'S PHARMACIST. 0 CARLEE HANSEN MS. HANSEN IS A MEMBER OF PCMH'S BOARD OF DIRECTORS 17850 THE HOSPITAL RENTS AN APARTMENT FROM MS. HANSEN. 0 FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH CYPRESS HEALTHCARE, LLC WHICH COVERS ADMINISTRATOR COMPENSATION, MANAGEMENT FEES, AND MISCELLANEOUS EXPENSES SUCH AS TRAVEL. TONY PFAFF, PRESDIENT OF THE HOSPITAL, IS THE OWNER OF CYPRESS HEALTHCARE, LLC. OF THE FEES PAID TO CYPRESS HEALTHCARE, $311,720 WERE FOR PRESIDENT SERVICES. FORM 990, PART VI, SECTION A, LINE 4 THE ORGANIZATION AMENDED THEIR BYLAWS DURING THE YEAR. THE SIGNIFICANT CHANGES ARE AS FOLLOWS: - REMOVED THE REQUIREMENT TO HAVE A COUNTY COMMISSIONER ON THE BOARD - ADDED STRUCTURE AND CLARIFICATION REGARDING COMMITTEES (INCLUDING THE AUDIT COMMITTEE) - ADDITION TO NOT ALLOW VOTING BY PROXY - ADDITIONAL CLARIFICATION ADDED REGARDING THE ROLE OF THE CEO FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO REVIEW THE 990 PRIOR TO ITS FILING. THE BOARD IS THEN INFORMED THE 990 IS AVAILABLE TO BE REVIEWED AT THEIR REQUEST. FORM 990, PART VI, SECTION B, LINE 12C IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. AFTER DISCLOSURE OF THE FINANCIAL INTEREST AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD OR COMMITTEE MEETING WHILE THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON. THE REMAINING BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. AN INTERESTED PERSON MAY MAKE A PRESENTATION AT THE GOVERNING BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE/SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND THE VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POSSIBLE CONFLICT OF INTEREST. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN, WITH REASONABLE EFFORTS, A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION DETERMINATION IS A JOINT EFFORT BY THE MANAGEMENT COMPANY AND THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES IT'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,435,323. MANAGEMENT AND GENERAL EXPENSES 153,684. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,589,007. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 683,537. MANAGEMENT AND GENERAL EXPENSES 534,481. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,218,018. FORM 990, PART XII, LINE 2C: THE ORGANIZATION HAS A COMMITTEE WHICH ASSUMES OVERSIGHT OF THE AUDIT/REVIEW OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT. THERE HAVE BEEN NO CHANGES TO THE POLICY IN THE CURRENT YEAR. POWELL EMERGENCY MEDICAL SERVICES LLC 1100 HOLLENBACK LANE DEER LODGE MT 59722 843599616 AMBULANCE SERVICE MT 907307 262826 POWELL COUNTY MEMORIAL HOSPITAL ASSOC POWELL COUNTY MEDICAL FOUNDATION 1100 HOLLENBACK LANE DEER LODGE MT 59722 810438377 RAISE FUNDS FOR POWELL COUNTY MEMORIAL HOSPITAL. MT 501(C)(3) LINE 12C, III-FI 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 POWELL COUNTY MEDICAL FOUNDATION C 2765