2023-05-08T09:34:41-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2021-07-01 810233499 SIDNEY HEALTH CENTER SIDN 4064882100 216 14TH AVENUE SW SIDNEY MT 59270 TINA MONTGOMERY CFO 4064882100 2023-05-04 1 TINA MONTGOMERY XXX-XX-XXXX KURT BENNION CPA P01469618 4252506100 2023-05-04 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JEN DOTY 216 14TH AVENUE SW SIDNEY MT 59270 104336517 0 X WWW.SIDNEYHEALTH.ORG X 1946 MT TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH BY PROVIDING QUALITY MEDICAL CARE. 9 8 648 135 1541234 25791 11978788 5578804 83785111 92316930 1089815 1451731 963124 892134 97816838 100239599 27600 161801 0 0 39044753 41441124 0 0 287857 47133592 55329536 86205945 96932461 11610893 3307138 99470484 98812336 35829557 33906830 63640927 64905506 X TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH AND WELL-BEING. 1 0 86638813 161801 90255073 SIDNEY HEALTH CENTER IS A NOT-FOR-PROFIT COMMUNITY-BASED MEDICAL CENTER THAT HAS BEEN SERVING PEOPLE IN THE MONDAK REGION FOR MORE THAN 100 YEARS. OUR PASSION FOR CARING IS SHARED BY THE DOCTORS, NURSES, AND SEVERAL HUNDRED EMPLOYEES AND VOLUNTEERS. THIS COMMITMENT TO CARING IS OUR ALLEGIANCE TO THE COMMUNITY AS WE STRIVE TO PROVIDE "EXCEPTIONAL CARE FOR LIFE."LOCATED IN THE HEART OF RICHLAND COUNTY, THE ATTRACTIVE EASTERN MONTANA CAMPUS INCLUDES AN ACUTE CARE HOSPITAL, CLINIC, CANCER CARE, RETAIL PHARMACY AND AN EXTENDED CARE FACILITY OFFERING A COMPLETE RANGE OF SERVICES FROM BIRTH THROUGH END-OF-LIFE, WHICH IS COMPLEMENTED BY AN ARRAY OF OUTREACH SERVICES. THIS CONTINUUM OR SUCCESSION OF SERVICES IS NOT TYPICAL OF RURAL HEALTHCARE ORGANIZATIONS, BUT SIDNEY HEALTH CENTER IS NOT TYPICAL. A STRONG COMPLEMENT OF PRIMARY CARE PHYSICIANS AND A UNIQUE SELECTION OF SURGICAL SPECIALISTS, COMBINED WITH A MODERN FACILITY AND UP-TO-DATE MEDICAL EQUIPMENT, MAKES SIDNEY HEALTH CENTER A SPECIAL PLACE TO WORK, RECEIVE CARE AND PRACTICE MEDICINE.SIDNEY HEALTH CENTER ALSO PROVIDES VARIOUS COMMUNITY BENEFIT PROGRAMS FOR THE INDIVIDUALS IN OUR SERVICE REGION.RICHLAND COUNTY TRANSPORTATION - THIS PROGRAM GIVES OPPORTUNITIES FOR THOSE WHO CANNOT DRIVE THE OPTION OF A RIDE. SIDNEY HEALTH CENTER PROVIDES A DRIVER AND HELPS PAY FOR BUSSES. SINCE ITS CONCEPTION, WE HAVE GONE FROM ONE BUS AND ONE DRIVER FOR THE FULL PROGRAM TO MULTIPLE BUSSES AND DRIVERS. WE WORK WITH THE HEALTH DEPARTMENT, RICHLAND COUNTY AND THE LODGE.MILES CITY NURSING PROGRAM - WE PROVIDE THE FACILITY AND PROGRAM COSTS TO HAVE MILES CITY COMMUNITY COLLEGE RUN A SATELLITE SCHOOL HERE IN SIDNEY. THIS PROMOTES NURSING AS A PROFESSION AND KEEPS THOSE WHO ARE INTERESTED IN OUR COMMUNITY AS POSSIBLE EMPLOYEES LATER.OUTREACH CLINIC - SOME OF THE OUTLYING COMMUNITIES DO NOT HAVE ACCESS TO SPECIALTY SERVICES. SIDNEY HEALTH CENTER SENDS PROVIDERS TO THESE NEIGHBORING COMMUNITIES SO PATIENTS DO NOT HAVE TO TRAVEL. SHC ALSO HOSTS SPECIALISTS FROM LARGER FACILITIES TO OFFER QUALITY AND CONVENIENT CARE WE ARE UNABLE TO PROVIDE TO PATIENTS IN AND AROUND RICHLAND COUNTY.HEALTH SCREENINGS, EDUCATION AND MAINTENANCE SIDNEY HEALTH CENTER SUPPORTS A VARIETY OF EVENTS WHERE OUR COMMUNITY CAN BE EDUCATION ON HEALTH ISSUES. OUR CANCER CENTER SPONSORS THE "TOUGH ENOUGH TO WEAR PINK" DAY THE COUNTY FAIR; SUPPORTS "PINK NIGHTS" AT AREA SCHOOLS FOR VOLLEYBALL AND FOOTBALL DURING THE MONTH OF OCTOBER; AND HOLDS ANNUAL MENS HEALTH SCREENINGS. THE MENS SCREENING PROVIDES FREE PSA TESTS AND DRE EXAMS. IN OCTOBER, THE RADIOLOGY DEPARTMENT EXTENDS ITS HOURS TO OFFER MAMMOGRAMS A FEW EVENINGS DURING THE MONTH. SIDNEY HEALTH CENTER PROMOTES PREVENTATIVE CARE, DIABETES EDUCATION, LAB SCREENINGS AND MANY OTHER TOPICS. SIDNEY HEALTH CENTER OFTEN PARTNERS WITH THE RICHLAND COUNTY HEALTH DEPARTMENT, COALITION ON AGING, FIRE, POLICE AND MENTAL HEALTH PROFESSIONS, JUST TO NAME A FEW. SIDNEY HEALTH CENTER ALSO PARTICIPATES IN SUPPORTIVE HEALTH MAINTENANCE GROUPS, INCLUDING COMMUNITIES IN ACTION GROUPS.RICHLAND COUNTY FAIR & RODEO - SIDNEY HEALTH CENTER IS THE DAY SPONSOR AT THE COUNTY FAIR (DAILY ATTENDANCE OF AROUND 5,000), WHERE PEOPLE CAN HAVE THEIR BLOOD PRESSURE CHECKED AND RECEIVE A FREE COLD LEMONADE OR WATER DURING THE HOT AUGUST FAIR.GRIEF RECOVERY SUPPORT GROUPS - SIDNEY HEALTH CENTER ASSISTS INDIVIDUALS IN CONNECTING WITH LOCAL BEREAVEMENT SUPPORT GROUPS AND INDIVIDUAL COUNSELING AS REQUESTED OR WHEN A NEED IS IDENTIFIED. IN ADDITION, THE HOSPITAL'S BEREAVEMENT PROGRAM PROVIDES FAMILIES WITH MATERIALS AND RESOURCES FOLLOWING THE LOSS OF A LOVED ONE WHO RECEIVED CARE IN OUR FACILITY. BIRTHDAY HEALTH FAIR - PATIENTS WHO SIGN UP CAN GET AN ANNUAL HEALTH SCREEN AT A DISCOUNTED RATE DURING THEIR BIRTHDAY MONTH. THE LAB SCREENING INCLUDES A CHEMISTRY PANEL THAT EVALUATES KIDNEY AND LIVER FUNCTION, BLOOD SUGAR AND ELECTROLYES, A BLOOD COUNT WITH IDENTIFIES ANEMIA OR INFECTION AS WELL AS LIPIS (CHOLESTROL) PANEL.VISITING NURSE SERVICE - INITIAL NURSE VISIT AND POST DISCHARGE MEDICATION RECONCILIATION ALONG WITH ONGOING MEDICATION SETUPS TO THOSE IN NEED.MEDICATION ASSISTANCE THE MEDICATION ASSISTANCE PROGRAM OFFERS A 30-DAY SUPPLY OF SOME MEDICATIONS PRESCRIBED BY SIDNEY HEALTH CENTER PHYSICIANS AND ADVANCED PRACTICE PROVIDERS FREE OF CHARGE TO THOSE WHO QUALIFY. THIS PROGRAM WORKS WITH PATIENTS WHO ARE UNINSURED OR UNDERINSURED TO SECURE ONGOING COVERAGE FOR MEDICATIONS. THE PROGRAM WAS EXPANDED IN 2020 TO INCLUDE THE LIFELINE SERVICES FOR THOSE WHO FIT WITHIN THE 200% FPG. RX BOXES - PHARMACY SETS UP PILLS IN MEDICATION BOXES SO THAT GROUP HOME RESIDENTS GET THE CORRECT PILLS FOR EACH ADMINISTRATION TIME.CHAMBER OF COMMERCE - VARIOUS DONATIONS FOR COMMUNITY AND CHAMBER FUNCTIONS.CHILDBIRTH CLASSES - CLASSES OFFERED ON A QUARTERLY BASIS TO THE COMMUNITY.INTERACTIVE TOUR FOR ELEMENTARY STUDENTS - AS REQUESTED, LOCAL ELEMENTARY CLASSES PARTICIPATE IN INTERACTIVE STATIONS THAT ARE HOSTED BY VARIOUS SIDNEY HEALTH CENTER DEPARTMENTS.REACH TOUR - EVERY OTHER YEAR, SIDNEY HEALTH CENTER HOSTS R.E.A.C.H. (RESEARCH AND EXPLORE AWESOME CAREERS IN HEALTHCARE) TOUR THROUGH AHEC FOR HIGH SCHOOL STUDENTS INTERESTED IN HEALTHCARE CAREERS. STUDENTS SPEND THE DAY AT SIDNEY HEALTH CENTER PARTICIPATING IN INTERACTIVE DEMONSTRATIONS, VISITING WITH HEALTHCARE PROFESSIONALS AND MORE.FITNESS CENTER - SIDNEY HEALTH CENTER PARTNERED WITH HEALTHWORKS FITNESS CENTER TO SUBSIDIZE MEMBERSHIPS TO LOW INCOME INDIVIDUALS WITH DOCTOR ORDERED FITNESS REGIMENS.COVID-19 VACCINATION CLINICS SIDNEY HEALTH CENTER PARTNERS WITH THE RICHLAND COUNTY HEALTH DEPARTMENT TO VACCINATE INDIVIDUALS AGAINST COVID-19 ACCORDING THE STATE DISTRIBUTION PLAN. COVID-19 DRIVE-THRU TESTING SIDNEY HEALTH CENTER OFFERS FREE COVID-19 TESTS TO SYMPTOMATIC INDIVIDUALS MONDAY THROUGH FRIDAY BY APPOINTMENT. TEST RESULTS ARE SHARED VIA MY CHART WITHIN A FEW HOURS. 691408 0 583123 SIDNEY HEALTH CENTER CARE FLIGHT OFFERS HIGH QUALITY, AFFORDABLE, AIR MEDICAL TRANSPORTATION FOR PATIENTS REQUIRING EMERGENT OR URGENT MEDICAL CARE THAT IS NOT PROVIDED LOCALLY. APPROXIMATELY 24 PATIENTS ARE FLOWN OUT EACH MONTH FOR CRITICAL MEDICAL CONDITIONS INCLUDING HEART, STROKE, TRAUMA, AND PEDIATRIC NEEDS. 87330221 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 1 0 0 1 127 0 1 648 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 X TINA MONTGOMERY CFO 4064882117 216 14TH AVENUE SW SIDNEY MT 59270 RAJOHN KARANJAI MD TRUSTEE/CMO 39.00 1.00 X 1090745 0 0 LESZEK JASZCZAK MD TRUSTEE/CMO (THROUGH JUNE 2022) 39.00 1.00 X 795330 0 36717 ERIC SIGMOND MD PHYSICIAN 35.00 0.00 X 612797 0 43178 JEROME KESSLER MD PHYSICIAN 40.00 0.00 X 567858 0 34925 MALUA TAMBI MD PHYSICIAN 40.00 0.00 X 512543 0 41957 JOHN CAREY MD VICE-CHIEF OF MEDICAL STAFF 39.00 1.00 X 509285 0 41957 CHAD PEDERSEN MD PHYSICIAN 40.00 0.00 X 524039 0 14361 RALF KIEHL MD CHIEF OF MEDICAL STAFF 39.00 1.00 X X 449031 0 23066 JEN DOTY CEO 39.00 1.00 X 271494 0 30741 TINA MONTGOMERY CFO 39.00 1.00 X 172691 0 23629 LANCE AVERETT PRESIDENT 1.00 1.00 X X 0 0 0 RANDY JOHNSON VICE PRESIDENT 1.00 1.00 X X 0 0 0 REBECCA BRADLEY SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 ERIC BEENKEN TRUSTEE 1.00 1.00 X 0 0 0 ROBERT BURNISON TRUSTEE 1.00 1.00 X 0 0 0 STEPHANIE CARROLL TRUSTEE 1.00 1.00 X 0 0 0 KEVIN MAYER TRUSTEE 1.00 1.00 X 0 0 0 TERRY SILVERTSON TRUSTEE (THROUGH NOVEMBER 2021) 1.00 1.00 X 0 0 0 CHERYL VAN EVERY TRUSTEE 1.00 1.00 X 0 0 0 5505813 0 290531 55 0 1 1 BRETT BENNION MD 214 14TH AVENUE SW SUITE 110 SIDNEY MT 59270 PHYSICIAN SERVICES 1680899 MEDIKAR PC 214 14TH AVENUE SW SIDNEY MT 59270 PHYSICIAN SERVICES 1090745 BADLAND MEDICAL STAFFING 214 14TH AVENUE SW SUITE 108 SIDNEY MT 59270 CONTRACT LABOR 438298 JUSTIN SHAFER MD 214 14TH AVENUE SW SUITE 105 SIDNEY MT 59270 PHYSICIAN SERVICES 415024 O PETE COUNCIL MD 214 14TH AVENUE SW SUITE 104 SIDNEY MT 59270 PHYSICIAN SERVICES 368926 26 295915 4761453 521436 104000 5578804 PATIENT REVENUES 621500 82833830 82833830 CLINIC PHARMACY 446110 7891664 6379259 1512405 OTHER PATIENT CARE 621500 1641688 1641688 JOINT VENTURE LOSS 901101 -50252 -16581 -33671 92316930 662728 662728 3600 62500 0 0 3600 62500 66100 62500 3600 4599772 35000 3828918 16851 770854 18149 789003 789003 412633 251149 161484 161484 MEAL INCOME 900099 382271 382271 MISCELLANEOUS REVENUE 900099 282279 282279 664550 100239599 90838196 1541234 2281365 X 161801 161801 3376784 2784837 551543 40404 29523785 26998078 2394097 131610 639276 567513 67807 3956 5748744 4881952 828561 38231 2152535 1963287 177424 11824 20066 20066 107259 106284 975 132290 132290 18974307 17735012 1214321 24974 321959 19268 300984 1707 3640985 2197931 1419447 23607 883187 883187 2293584 1623405 663140 7039 769272 740753 26474 2045 700394 700394 4255476 4243431 12045 1146543 1123541 23002 PHARMACY/LAB EXPENSE 17770536 17770279 257 BAD DEBT 1749133 1749133 GOOD CENTS STORE 351937 55329 296608 UBI TAXES 9034 9034 2203574 1831484 370605 1485 96932461 87330221 9314383 287857 29974427 23858936 34025 24386 12436851 14159158 2235329 2188895 869064 1118209 85302607 55664699 25423746 29637908 24406400 22987807 2176814 1262285 594724 1449631 1319104 2125121 99470484 98812336 6576269 8288918 3688546 1100000 19974823 18437171 34025 24386 2367099 1777073 482623 331767 2706172 3947515 35829557 33906830 X 61146203 63951934 2494724 953572 63640927 64905506 99470484 98812336 X 3307138 -3578501 1535942 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 5623 5623 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE MONTANA HOSPITAL ASSOCIATION, THE AMERICAN HOSPITAL ASSOCIATION AND LEADINGAGE ARE USED FOR LOBBYING. THESE ARE ALLOCATED ON A PERCENTAGE BASIS TO LOBBYING ACTIVITIES. 0 1 X 198261 198261 50486110 34765347 15720763 1901737 1003688 898049 29049205 19895664 9153541 3667294 3667294 29637908 ESTIMATED THIRD-PARTY PAYOR PAYABLES 3947515 3947515 X 97448404 -3578501 2969911 -608590 98056994 132290 2050315 2182605 100239599 96581318 1727462 1727462 94853856 132290 1946315 2078605 96932461 PART IV, LINE 2B: RESIDENT TRUST ACCOUNT: THIS IS THE EXTENDED CARE RESIDENT TRUST ACCOUNT, WHICH IS MADE UP OF THE RESIDENTS' MONEY THAT SIDNEY HEALTH CENTER HOLDS ON THEIR BEHALF. THESE MONIES ARE KEPT IN A SEPARATE BANK ACCOUNT FROM THE ORGANIZATION'S FUNDS AND ARE DUE BACK TO THE RESIDENTS UPON LEAVING THE FACILITY. PART X, LINE 2: THE IRS HAS DETERMINED THAT THE HEALTH CENTER IS A TAX-EXEMPT, NONPROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE IRC. THE HEALTH CENTER FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HEALTH CENTER'S FINANCIAL STATEMENTS. THE HEALTH CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 251,149. CHANGE IN VALUE OF FAIR VALUE SWAP 1,278,783. LONE TREE REVENUE PER CONSOLIDATED AFS 1,439,979. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,749,133. REAL ESTATE RESTRICTED CONTRIBUTION INCLUDED IN REVENUE 104,000. LONE TREE ELIMINATIONS PER CONSOLIDATED AFS 197,182. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 251,149. LONE TREE EXPENSES PER CONSOLIDATED AFS 1,476,313. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,749,133. LONE TREE ELIMINATIONS PER CONSOLIDATED AFS 197,182. 1 1 X 1 X 1 X 1 1 0 1 1 629627 629627 0.00660 12156524 8453104 3703420 0.03890 12786151 8453104 4333047 0.04550 177104 177104 0.00190 23500 23500 0.00020 26285538 13398057 12887481 0.13540 26486142 13398057 13088085 0.13750 39272293 21851161 17421132 0.18300 0 1749133 0 20953318 20784518 168800 X 1 1 1 1 SIDNEY HEALTH CENTER 216 14TH AVENUE SW SIDNEY MT 59270 WWW.SIDNEYHEALTH.ORG 12709 X X X X SIDNEY HEALTH CENTER 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE LINE 7D X X 1 22 1 SEE LINE 7D 0 1 X 200.000000000000 400.000000000000 1 1 X X X X 1 X WWW.SIDNEYHEALTH.ORG/BILLING X WWW.SIDNEYHEALTH.ORG/BILLING X WWW.SIDNEYHEALTH.ORG/BILLING X X X X X X 1 X 0 X X X X 1 X 0 0 SIDNEY HEALTH CENTER PART V, SECTION B, LINE 5: IN APRIL 2022, SURVEYS WERE MAILED OUT TO A RANDOM SAMPLE OF 800 RESIDENTS OF RICHLAND COUNTY, MONTANA, THE HOSPITAL'S COMMUNITY. 65 COMPLETED SURVEYS WERE RETURNED. IN ADDITION, 3 FOCUS GROUP INTERVIEWS WERE CONDUCTED. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH THE MONTANA OFFICE OF RURAL HEALTH. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.SIDNEYHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-ASSESSMENT-IMPLEMENTATION-PLAN. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 11: SIDNEY HEALTH CENTER ("SHC") IS RESPONDING TO ALL THE IDENTIFIED COMMUNITY HEALTH NEEDS, WITH THE EXCEPTION OF ONE THAT IS NOT WITHIN OUR SCOPE. SIDNEY HEALTH CENTER ADDRESSES THE NEEDS IDENTIFIED BY THE CHNA THAT ARE IN ALIGNMENT WITH OUR STRATEGIC GOALS. ONCE THESE NEEDS ARE IDENTIFIED, SHC CREATES A COMMUNITY HEALTH NEEDS IMPLEMENTATION PLAN.SHC IS ADDRESSING CHRONIC ILLNESS BY PROMOTING HEALTHY LIFESTYLES THROUGH COMMUNITY ENGAGEMENT ACTIVITIES, PROVIDING EDUCATIONAL RESOURCES AND SERVICES TO THE COMMUNITY, AND PROVIDING EDUCATIONAL SUPPORT TO THE COMMUNITY. OVERALL AWARENESS OF THE CANCER SERVICES PROVIDED BY SHC ARE BEING ADDRESSED BY IMPROVING ACCESS TO CANCER CARE SERVICES, IMPROVING QUALITY OF CARE FOR INDIVIDUALS WITH CANCER, AND PARTICIPATING IN COMMUNITY EVENTS SPECIFIC TO CANCER. SHC IS TRYING TO BETTER SERVE THE MENTAL AND BEHAVIORAL HEALTH NEEDS BY PARTICIPATING IN COMMUNITY GROUPS CONCERNED WITH MENTAL HEALTH, PROVIDING RESOURCES AND SUPPORT TO THE COMMUNITY TO ADDRESS MENTAL HEALTH, AND INCREASING ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES AND RESOURCES. 2 1 - SIDNEY HEALTH CENTER EXTENDED CARE 216 14TH AVE SW SIDNEY MT 59270 NURSING HOME 2 - THE LODGE AT LONE TREE 1015 7TH AVE SW SIDNEY MT 59270 ASSISTED LIVING COMPLEX PART I, LINE 3C: FINANCIAL ASSISTANCE IS BASED ON INCOME AND FAMILY SIZE ONLY. PRIOR TO QUALIFYING FOR FINANCIAL ASSISTANCE, AN INDIVIDUAL MUST (A) RECEIVE QUALIFYING MEDICAL SERVICES FROM SIDNEY HEALTH CENTER; (B) EXHAUST ALL ALTERNATIE PAYMENT RESOURCES INCLUDING THIRD-PARTY AND FEDERAL AND STATE PROGRAMS; AND (C) SUBMIT A COMPLETED APPLICATION WITH THE REQUIRED SUPPORTING DOCUMENTATION. PART I, LINE 7: IN ORDER TO CALCULATE THE OVERALL HOSPITAL'S COST TO CHARGE RATIO USED FOR PART I, LINE 7, THE HOSPITAL FIRST DETERMINED A COST-TO-CHARGE RATIO BASED ON THE JUNE 30, 2022 FILED MEDICARE COST REPORT SEPARATELY FOR INPATIENT SERVICES, OUTPATIENT SERVICES, AND TOTAL SERVICES. TO CALCULATE THE COSTS INCLUDED ON LINES 7A AND 7B, THE HOSPITAL TOOK EACH OF THE SEPARATE COST-TO-CHARGE RATIOS DESCRIBED IN THE PRECEEDING PARAGRAPH AND APPLIED THEM ONLY TO THE RELATED CHARGES BY SERVICE TYPE. THE AMOUNTS IN LINES 7E-7I ARE BASED ON ACTUAL COST. PART I, LINE 7G: THE FOLLOWING SUBSIDIZED HEALTH SERVICES WERE INCLUDED IN PART I, LINE 7G:OBSERVATION, NURSERY, AUDIOLOGY, CARDIAC REHAB, MEDICAL ONCOLOGY, CLINIC FACILITY, EMERGENCY ROOM, AMBULANCE SERVICES, ENT/RADIOLOGY/ONCOLOGY CLINIC, AND PROVIDER-BASED CLINIC. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 1,749,133. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH CENTER RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. PART III, LINE 3: THE HEALTH CENTER IS UNABLE TO ESTIMATE THE AMOUNT OF ITS BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF THEY WERE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. PART III, LINE 4: SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, NET" PARAGRAPH IN NOTE 1 (PAGE 12) OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 IS DERIVED FROM USING THE JUNE 30, 2022 FILED MEDICARE COST REPORT. THE SHORTFALL OCCURS DUE TO VARIOUS EXPENSES INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED, IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. PART III, LINE 9B: IF THE PATIENT INDICATES THEIR INABILITY TO PAY ACCORDING TO THE HOSPITAL CREDIT TERMS THEY WILL BE ASKED TO FILL OUT A FINANCIAL STATEMENT. THE HOSPITAL MAY PULL A CREDIT REPORT TO CONFIRM OR SUPPLEMENT INFORMATION PROVIDED TO THE HOSPITAL ON THE FINANCIAL STATEMENT. THE PATIENT CAN THEN BE EVALUATED TO DETERMINE WHETHER THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE OR AN EXTENDED PAYMENT PROGRAM.IF THE FINANCIAL STATEMENT SHOWS THAT THE PATIENT HAS ASSETS OR POTENTIAL SOURCES OF INCOME THAT WOULD ENABLE THEM TO PAY THE HOSPITAL BILL WITHIN A YEAR, THEY WILL BE DENIED THE EXTENDED PAYMENT WAIVER. IF A PATIENT REFUSES TO FURNISH A COMPLETED FINANCIAL STATEMENT, THEIR ACCOUNT WILL BE DEEMED DELINQUENT AND FURTHER COLLECTION ACTION WILL BE TAKEN. PRIOR TO ADMISSION, AT THE TIME OF ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, THE HOSPITAL WILL MAKE AN INITIAL ASSESSMENT OF POTENTIAL ELIGIBILITY BASED ON THE VERBAL APPLICATION FOR FINANCIAL ASSISTANCE. IF POTENTIAL ASSISTANCE IS INDICATED WITH INITIAL ASSESSMENT, THE HOSPITAL WILL NOT INITIATE COLLECTION EFFORTS OR REQUESTS FOR DEPOSITS PENDING THE RECEIPT OF THE COMPLETED APPLICATION AND FINAL ELIGIBILITY DETERMINATION. THE RESPONSIBLE PARTY MUST BE COOPERATIVE WITH THE HOSPITAL'S EFFORTS TO REACH A DETERMINATION OF ELIGIBILITY WITH OTHER ASSISTANCE PROGRAMS AND TO VALIDATE THE INFORMATION NEEDED.SIDNEY HEALTH CENTER WILL MAKE A CONCERTED EFFORT TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE. EDUCATIONAL MATERIALS ABOUT THE PROGRAM WILL BE AVAILABLE TO PATIENTS THROUGH THE ADMISSIONS PROCESS. AS SOON AS A PATIENT EVIDENCES INABILITY TO PAY HE OR SHE WILL BE REFERRED TO THE PATIENT FINANCIAL SERVICES COUNSELOR FOR AN APPLICATION. APPLICATIONS ARE ALSO AVAILABLE AT THE ADMISSIONS AREA, AND THROUGH SOCIAL SERVICES. PART VI, LINE 2: THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN THE YEAR ENDED JUNE 30, 2022. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.SIDNEYHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-ASSESSMENTIMPLEMENTATION-PLAN. PART VI, LINE 3: SIDNEY HEALTH CENTER HAS NOTICES LOCATED AT THE ADMISSIONS OFFICE INFORMING PATIENTS ABOUT THEIR FINANCIAL ASSISTANCE POLICY. THE PROGRAM IS ALSO STATED ON THE ORGANIZATION'S WEBSITE AND INCLUDED IN THE PATIENT'S PACKET UPON DISCHARGE FROM THE FACILITY. PART VI, LINE 4: LOCATED IN THE HEART OF RICHLAND COUNTY, SIDNEY HEALTH CENTER SERVES PEOPLE IN ALL OF THE MONDAK REGION. PART VI, LINE 5: THE HEALTH CENTER DEFINES AND MEASURES THEIR INVESTMENT IN AND PARTNERSHIP WITH THE COMMUNITY PRIMARILY THROUGH VARIOUS COMMUNITY-BASED SERVICES PROGRAMS, PROVIDING HEALTH EQUIPMENT IN AREA SCHOOLS, AND COMMUNITY PROGRAMS AND EDUCATION. A NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. 1 ST JOHNS LUTHERAN MINISTRIES INC 3940 RIMROCK RD BILLINGS MT 59102 810288768 501(C)(3) 90000 0 N/A N/A AT-HOME SENIOR SERVICE PROGRAM NEXT 3 YEARS 1 0 PART I, LINE 2: SIDNEY HEALTH CENTER CONFIRMS THAT EACH RECIPIENT ORGANIZATION IS A QUALIFIED GOVERNMENT OR CHARITY ORGANIZATION. CONTRIBUTED FUNDS ARE INTENDED FOR GENERAL OPERATING SUPPORT, SO SIDNEY HEALTH CENTER DOES NOT CONDUCT ANY FOLLOW-UP MONITORING ACTIVITIES. X 1 1 X X 0 0 0 1 0 1 0 0 0 RAJOHN KARANJAI MD TRUSTEE/CMO 1090745 0 0 0 0 0 0 0 0 0 1090745 0 0 0 LESZEK JASZCZAK MD TRUSTEE/CMO (THROUGH JUNE 2022) 794330 0 1000 0 0 0 6683 0 30034 0 832047 0 0 0 ERIC SIGMOND MD PHYSICIAN 611797 0 1000 0 0 0 8700 0 34478 0 655975 0 0 0 JEROME KESSLER MD PHYSICIAN 566858 0 1000 0 0 0 8700 0 26225 0 602783 0 0 0 MALUA TAMBI MD PHYSICIAN 511543 0 1000 0 0 0 8700 0 33257 0 554500 0 0 0 JOHN CAREY MD VICE-CHIEF OF MEDICAL STAFF 508285 0 1000 0 0 0 8700 0 33257 0 551242 0 0 0 CHAD PEDERSEN MD PHYSICIAN 523039 0 1000 0 0 0 0 0 14361 0 538400 0 0 0 RALF KIEHL MD CHIEF OF MEDICAL STAFF 448031 0 1000 0 0 0 8528 0 14538 0 472097 0 0 0 JEN DOTY CEO 269494 0 2000 0 0 0 8300 0 22441 0 302235 0 0 0 TINA MONTGOMERY CFO 170691 0 2000 0 0 0 5282 0 18347 0 196320 0 0 0 PART I, LINE 1A RALF KIEHL RECEIVED A HOUSING ALLOWANCE OF $16,350. THIS AMOUNT WAS INCLUDED IN HIS TAXABLE COMPENSATION. PART I, LINE 5 PHYSICIANS RECEIVE BONUSES BASED ON PRODUCTIVITY, AMONG OTHER FACTORS. PRODUCTIVITY IS CLOSELY CONNECTED WITH REVENUES. PART I, LINE 6 FOR THE EXECUTIVES, ANNUAL RAISES ARE BASED ON MEETING ORGANIZATIONAL GOALS RELATED TO VARIOUS FACTORS INCLUDING EMPLOYEE RETENTION, PATIENT SATISFACTION, QUALITY METRICS, AND OPERATING MARGIN. FORM 990, PART VII, LINE 5 DR. RAJON KARANJAI IS COMPESATED BY MEDIKAR PC, AN UNRELATED ORGANIZATION. A RICHLAND COUNTY MT 816001419 2011-09-15 24370000 REDEEMING AND RETIRING PREVIOUSLY ISSUED DEBT (2006, 2007A AND 2007B) 0 0 0 B RICHLAND COUNTY MT 816001419 2018-01-09 5700000 HOSPITAL CAPITAL IMPROVEMENTS 0 0 0 A 10075000 24370000 233683 137747 23998570 2012 1 0 1 1 B 1510000 5700000 5700000 2018 0 0 1 1 A 1 0 0 0 0 0 0 B 1 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 B 0 1 0 0 1 1 US BANK 3.800000000000 0 0 0 0 0 A 0 B 0 ROBERT MONTGOMERY SPOUSE OF TINA MONTGOMERY, CFO 57265 EMPLOYEE COMPENSATION 0 SEAN MONTGOMERY CHILD OF TINA MONTGOMERY, CFO 40749 EMPLOYEE COMPENSATION 0 SCOTT DOTY SPOUSE OF JEN DOTY, CEO 89423 EMPLOYEE COMPENSATION 0 NANCY STEFFAN MOTHER OF JEN DOTY, CEO 41018 EMPLOYEE COMPENSATION 0 TARYN MCMILLEN DAUGHTER OF TERRY SILVERTSON, BOARD MEMBER 73830 EMPLOYEE COMPENSATION 0 X 1 104000 APPRAISAL 0 0 0 0 PART I, COLUMN (B): THE NUMBER OF CONTRIBUTIONS WAS USED IN PART I. FORM 990, PART III, LINE 2 DURING THE FISCAL YEAR, SIDNEY HEALTH CENTER BEGAN PROVIDING AIR AMBULANCE SERVICES. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS AND ONE OTHER MEMEBER OF THE BOARD APPOINTED BY THE PRESIDENT. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, BYLAWS AND STATE POLICIES. ANY OFFICIAL ACTION TAKEN BY THE EXECUTIVE COMMITTEE IS SUBMITTED TO THE BOARD FOR RATIFICATION AT THE NEXT BOARD MEETING. FORM 990, PART VI, SECTION A, LINE 6 NATURAL PERSONS, CORPORATIONS, OR UNINCORPORATED ASSOCIATIONS MAY BECOME MEMBERS OF SIDNEY HEALTH CENTER BY: A. PAYMENT TO SIDNEY HEALTH CENTER A SUM OF NOT LESS THAN $100 CASH OR BY AN EQUIVALENT CONTRIBUTION OR METHOD AS APPROVED BY THE BOARD; B. RESIDING IN OR HAVING ITS PRINCIPAL PLACES OF BUSINESS IN THE SERVICE AREA OF SIDNEY HEALTH CENTER; AND C. AGREEING TO BE BOUND BY THE BYLAWS OF SIDNEY HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF DIRECTORS IS HELD AT THE ANNUAL MEETING OF THE MEMBERS BY WRITTEN BALLOT LISTING THE CANDIDATES NOMINATED BY THE NOMINATING COMMITTEE OF THE MEMBERS. EACH MEMBER OF SIDNEY HEALTH CENTER, PRESENT IN PERSON OR BY PROXY, IS ENTITLED TO VOTE FOR ONE CANDIDATE FOR EACH DIRECTOR VACANCY TO BE FILLED. THE CANDIDATES RECEIVING THE HIGHEST NUMBER OF VOTES AT THE MEETING ARE CONSIDERED ELECTED AS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B ANY PROPOSED AMENDMENTS APPROVED BY THE BOARD OR BY VERIFIED PETITION TO THE ARTICLES OF INCORPORATION OR BYLAWS SHALL BE SUBMITTED FOR VOTE BY THE MEMBERS AT THE NEXT SPECIAL OR ANNUAL MEMBERSHIP MEETING. FORM 990, PART VI, SECTION B, LINE 11B BEFORE IT WAS FILED, THE FORM 990 WAS REVIEWED BY THE FINANCE DIRECTOR, CFO AND CEO. THE CEO AND CFO WILL REVIEW THE COMPLETED FORM 990 WITH THE BOARD OF DIRECTORS AT THEIR NEXT SCHEDULED MEETING AFTER THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY OF THE CORPORATION IS TO REQUIRE THAT EACH INDIVIDUAL SUBJECT TO THIS POLICY STATEMENT PROMPTLY AND FULLY DISCLOSE ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST, AND THAT THE CORPORATION WILL NOT ENGAGE IN ANY CONTRACT, TRANSACTION, OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST UNLESS THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS (ACTING AT A DULY CONSTITUTED MEETING THEREOF) DETERMINE BY A MAJORITY VOTE THAT APPROPRIATE SAFEGUARDS TO PROTECT THE CHARITABLE MISSION OF THE CORPORATION HAVE BEEN IMPLEMENTED. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED ANNUALLY TO ALL INTERESTED PERSONS (BOARD MEMBERS, OFFICERS, AND COMMITTEE MEMBERS). AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST HE/SHE MAY HAVE. "DISCLOSURE" MEANS PROMPTLY PROVIDING A WRITTEN DESCRIPTION OF THE MATERIAL FACTS OF THE ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST TO THE EXECUTIVE COMMITTEE ON THE CONFLICTS-OF-INTEREST QUESTIONNAIRE. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. AT ANY TIME THAT AN ACTUAL, APPARENT, OR A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED TO THE BOARD OF DIRECTORS, WHETHER THROUGH THE VOLUNTARY SUBMISSION OF A DISCLOSURE STATEMENT BY AN INTERESTED PERSON, OR BY A DISCLOSURE BY A PERSON OTHER THAN THE SUBJECT INTERESTED PERSON, THE EXECUTIVE COMMITTEE SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON SHALL NOT BE PRESENT DURING ANY MEETING IN WHICH THE EXECUTIVE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. THE EXECUTIVE COMMITTEE MAY REQUEST ADDITIONAL INFORMATION FROM ALL REASONABLE SOURCES AND MAY INVOLVE THE GENERAL COUNSEL IN ITS DELIBERATIONS. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, EXECUTIVE COMMITTEE SHALL MAKE A FINDING AS TO WHETHER A CONFLICT OF INTEREST INDEED EXISTS, AND SHALL FORWARD THAT FINDING TO THE BOARD OF DIRECTORS FOR DISCUSSION AND VOTE. ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON MAY NOT BE PRESENT WHEN THIS VOTE IS TAKEN. ONCE THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS HAVE DETERMINED THAT AN ACTUAL CONFLICT OF INTEREST EXISTS WITH RESPECT TO A PARTICULAR TRANSACTION OR ARRANGEMENT: (I) THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS SHALL EXERCISE DUE DILIGENCE TO DETERMINE WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES AND, IF APPROPRIATE, SHALL APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT. (II) IN CONSIDERING WHETHER TO ENTER INTO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT, THE BOARD OF DIRECTORS MAY APPROVE SUCH A CONTRACT, TRANSACTION, OR ARRANGEMENT ONLY IF THE DISINTERESTED DIRECTORS DETERMINE BY A MAJORITY VOTE THAT: (A) THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTERESTS AND FOR THE CORPORATION'S OWN BENEFIT; AND (B) THE PROPOSED TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, TAKING INTO ACCOUNT, AMONG OTHER RELEVANT FACTORS, WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. (III) THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS MAY, IN THEIR DISCRETION, REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM WHILE THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT IS DISCUSSED. THE INTERESTED PERSON SHALL LEAVE THE ROOM WHILE THE MATTER IS VOTED ON AND ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER TO APPROVE THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES SALARIES USING THE MHA SALARY SURVEY FOR MARKET INFORMATION AND ALSO PERFORMS A WRITTEN EVALUATION ANNUALLY. ADDITIONALLY, THE CEO USES MHA MANAGEMENT SURVEY, AS WELL AS OTHER COMPENSATION SURVEYS, TO DETERMINE ANNUAL PAY INCREASES FOR ADMINISTRATION. A WRITTEN EVALUATION IS PERFORMED. ALL ESTIMATED ANNUAL INCREASES ARE INCLUDED IN THE BUDGET, WHICH IS APPROVED BY THE BOARD OF DIRECTORS. THIS PROCEDURE WAS LAST PERFORMED IN JUNE OF 2022. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 17,735,012. MANAGEMENT AND GENERAL EXPENSES 1,214,321. FUNDRAISING EXPENSES 24,974. TOTAL EXPENSES 18,974,307. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 257,159. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 1,278,783. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. LONE TREE SENIOR LIVING 216 14TH AVENUE SW SIDNEY MT 59270 810518821 ASSISTED LIVING MT 501(C)(3) LINE 10 SIDNEY HEALTH CENTER 1 FOUNDATION FOR COMMUNITY CARE OF RICHLAND COUNTY 221 2ND STREET NW SIDNEY MT 59270 810417465 FUNDRAISING MT 501(C)(3) LINE 12A, I SIDNEY HEALTH CENTER 1 SHC 2021 LLC 1429 KINGS VIEW DRIVE GRAND FORKS ND 58201 863920806 AIR AMBULANCE ND N/A RELATED -93767 667000 0 -33671 1 0.49000 1 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 LONE TREE SENIOR LIVING A 54841 CONTRACTED INTEREST RATE FOUNDATION FOR COMMUNITY CARE OF RICHLAND COUNTY C 295915 CASH LONE TREE SENIOR LIVING L 142341 FAIR MARKET VALUE