2023-05-14T13:42:18-05:00 2022-06-30 410746749 CLIFTONLARSONALLEN LLP 220 S 6TH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2021-07-01 810240726 MARCUS DALY MEMORIAL HOSPITAL MARC 4063632211 1200 WESTWOOD DRIVE HAMILTON MT 59840 JOHN BISHOP CEO, SECRETARY AND TREASURER 4063632211 2023-05-12 1 JOHN BISHOP 999009999 TYLER JOHNSON P01604007 6123764500 2023-05-11 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z JOHN BISHOP 1200 WESTWOOD DRIVE HAMILTON MT 59840 110766019 0 X WWW.MDMH.ORG X 1929 MT OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. 11 9 788 120 0 0 2867314 726204 89237487 106820601 241636 457026 90449 53088 92436886 108056919 29000 29200 0 0 54850724 62100885 0 0 564112 28175576 39440414 83055300 101570499 9381586 6486420 106424756 114826297 46402973 50929892 60021783 63896405 X OUR COMMITMENT TO THE BITTERROOT VALLEY IS QUALITY, ACCESSIBLE, PERSONALIZED HEALTHCARE. 0 0 82830458 29200 106820601 MARCUS DALY MEMORIAL HOSPITAL OWNS AND OPERATES A 25 LICENSED BED ACUTE CARE CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES ACUTE CARE SERVICES TO PATIENTS IN RAVALLI COUNTY. THE SERVICES PROVIDED INCLUDE ACUTE CARE HOSPITAL, RELATED ANCILLARY SERVICES SUCH AS LABORATORY, RADIOLOGY, THERAPY, INPATIENT AND OUTPATIENT SURGERY, EMERGENCY CARE, AMBULANCE, CLINIC, OUTPATIENT HOSPICE CARE. THE HOSPITAL PROVIDES EMS SERVICES WITH 3 CREWS PROVIDING 911 SERVICE TO THE COUNTY. THE GOAL IS TO RESPOND WITHIN 20 MINUTES OR LESS TO ANY CALL WITHIN THE COUNTY. THE HOSPITAL IS A PEDIATRIC REHABILITATION PROVIDER OF PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH THERAPY USING CERTIFIED THERAPISTS. THE HOSPITAL CLINICS SEE ALL PATIENTS REGARDLESS OF INSURANCE OR ABILITY TO PAY AND ENABLE THE COMMUNITY ACCESS TO PRIMARY CARE. THE HOSPITAL STRIVES TO PROVIDE ACCESS TO NECESSARY SPECIALTY SERVICES WITHIN OUR COMMUNITY AND CURRENTLY PROVIDES SEVERAL SERVICES SUCH AS PRIMARY CARE, ORTHOPEDICS, OBSTETRICS AND GYNECOLOGY, UROLOGY, GENERAL SURGERY, EAR NOSE AND THROAT, GASTROENTEROLOGY, OPHTHALMOLOGY, DERMATOLOGY, NEPHROLOGY, SLEEP MEDICINE, CARDIOLOGY, NEUROSURGERY, INTERVENTIONAL PAIN, AND PAIN MEDICINE SERVICES. 82830458 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 110 0 1 788 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X JOHN BISHOP 4063632211 1200 WESTWOOD DRIVE HAMILTON MT 59840 LOIS HEDG-PETH CHAIRMAN 1.00 0.00 X X 0 0 0 TOM ANDERSON VICE CHAIR 1.00 0.00 X X 0 0 0 SUSANNAH BENJAMIN BOARD MEMBER (END 11/21) 1.00 0.00 X 0 0 0 LAWRENCE BROUWER MD BOARD MEMBER/PHYSICIAN 10.00 0.00 X 192913 0 11316 JIM CORDLE BOARD MEMBER 1.00 0.00 X 0 0 0 JAIME DEVLIN BOARD MEMBER 1.00 0.00 X 0 0 0 LINDA DODDS BOARD MEMBER 1.00 0.00 X 0 0 0 MARK JERGENS MD BOARD MEMBER 1.00 0.00 X 0 0 0 TOM KORST BOARD MEMBER (END 11/21) 1.00 0.00 X 0 0 0 CHRISTINE LEWANSKI BOARD MEMBER 1.00 0.00 X 0 0 0 ROBERT WHALEN BOARD MEMBER 1.00 0.00 X 0 0 0 TIMOTHY WOODS MD BOARD MEMBER/PHYSICIAN 40.00 0.00 X 487824 0 37596 BRET YOUNG BOARD MEMBER 1.00 0.00 X 0 0 0 JOHN BISHOP CEO/SECRETARY/ TREASURER 39.00 1.00 X 427999 0 41641 TREVOR LEWIS CFO CFO 40.00 1.00 X 180799 0 25527 DR RICHARD DAY PHYSICIAN 40.00 0.00 X 1121080 0 32290 DAVID BOHLER PHYSICIAN 40.00 0.00 X 544535 0 27917 BRET PEARCE PHYSICIAN 40.00 0.00 X 470040 0 40155 ANGELA COVINGTON PHYSICIAN 40.00 0.00 X 494249 0 52214 BRISTOL SCHMITZ PHYSICIAN 40.00 0.00 X 479498 0 39247 4398937 0 307903 69 0 1 0 HEALTHCARE OUTSOURCING 1597 COLE BLVD 150 LAKEWOOD CO 80401 PATIENT PAYMENT ASSISTANCE 539360 INLAND IMAGING BUSINESS ASSOCIATES 801 S STEVENS ST SPOKANE WA 99204 RADIOLOGY SERVICES 231306 PROVIDENCE HEALTH & SERVICES PO BOX 4669 PORTLAND OR 97208 LAB SERVICES 138071 ROLF HOLLE MD 4691 HONEYMOON BAY RD FREELAND WA 98249 MEDICAL SERVICES 124035 FUSION MEDICAL STAFFING PO BOX 82674 LINCOLN NE 68501 LAB STAFFING 123498 8 520715 205489 726204 NET PATIENT SERVICE REVENUE 621400 98259823 98259823 HOSPITAL UTILZTN. REV. 621400 7714323 7714323 OTHER OPERATING INCOME 621400 846455 846455 106820601 451331 451331 370 370 225038 188441 36597 36597 36597 2525798 186 2520659 0 5139 186 5325 5325 EDUCATION 900099 6006 6006 CAFETERIA/VENDING 900099 5640 5640 MISCELLANEOUS 900099 4845 4845 16491 108056919 106820601 0 510114 29200 29200 1463702 1425281 33664 4757 48811229 40973331 7720447 117451 2394300 2011306 377252 5742 6478420 5452778 1009965 15677 2953234 2390244 553432 9558 192622 192622 54357 54357 5270058 3133754 2142171 -5867 196645 196645 8664503 7859893 797383 7227 2007105 2007105 1253704 529292 724412 136022 121763 12815 1444 1442467 1153974 288493 4702929 4105352 478062 119515 1046341 750997 295344 PROVISION FOR BAD DEBTS 9054077 9054077 PHARMACY/ LAB EXPENSES 2106301 2091216 15085 MISCELLANEOUS EXPENSES 1639052 1516064 122873 115 MAINTENANCE AND REPAIRS 1451900 1257184 194716 222331 128726 93605 101570499 82830458 18175929 564112 18051197 11808457 19496535 20876303 14098633 17893272 241592 141028 2955633 3320052 602938 546124 108896519 56319670 43268837 52576849 3515522 3131314 4193869 4532898 106424756 114826297 12984144 9021462 20940424 35084011 9066227 3816363 3412178 3008056 46402973 50929892 X 55771930 60078341 4249853 3818064 60021783 63896405 106424756 114826297 X 6486420 -1896168 -715630 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 313190 2089 2089 313190 313190 1065 1065 313190 313190 2089 2089 313190 313190 1833 1833 313190 313190 1416 1416 313190 0.00000 1.00000 0.00000 0 0 4029690 4029690 66737513 34971695 31765818 513170 496615 16555 27339665 20851360 6488305 10276481 10276481 52576849 EMPLOYEE BENEFIT OBLIGATION 3008056 3008056 X 96552426 -1896168 -554248 -2450416 99002842 9054077 9054077 108056919 92677804 161382 161382 92516422 9054077 9054077 101570499 PART V, LINE 4: THE ENDOWMENT FUND IS DESIGNATED FOR THE PURPOSE OF BUILDING AND CARRYING ON A HOSPITAL IN HAMILTON, MONTANA. THE EVANS ENDOWMENT IS TO BE USED FOR THE CARE AND TREATMENT OF CRIPPLED CHILDREN. PART X, LINE 2: PER THE AUDITED FINANCIAL STATEMENTS, NOTE 1: THE INTERNAL REVENUE SERVICE (IRS) HAS DETERMINED THAT MARCUS DALY MEMORIAL HOSPITAL IS A TAX-EXEMPT, NONPROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE HOSPITAL 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 HOSPITAL'S FINANCIAL STATEMENTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 188,441. RENT REVENUE INCLUDED IN EXPENSES -27,059. LOSS ON DEBT REFINANCING -331,422. CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF DALY HOSPITAL -384,208. PART XI, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 9,054,077. INVESTMENT INCOME UNRESTRICTED GRANTS AND CONTRIBUTIONS OTHER NONOPERATING REVENUES TEMPORARILY RESTRICTED CONTRIBUTIONS AND GRANTS AUXILIARY INCOME PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES 188,441. RENT REVENUE INCLUDED IN EXPENSES -27,059. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR UNCOLLECTIBLE ACCOUNTS 9,054,077. 1 1 X 1 X 1 X 1 1 0 1 1 130006 130006 0.00140 15724155 13657968 2066187 0.02230 15854161 13657968 2196193 0.02370 73071 73071 0.00080 184943 184943 0.00200 9860855 5777555 4083300 0.04410 29000 29000 0.00030 10147869 5777555 4370314 0.04720 26002030 19435523 6566507 0.07090 1 9054077 0 15594327 24028620 -8434293 X 1 1 1 1 MARCUS DALY MEMORIAL HOSPITAL 1200 WESTWOOD DRIVE HAMILTON MT 59840 WWW.MDMH.ORG 12911 X X X X MARCUS DALY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 0 0 1 X SEE LINE 7D X X 1 20 1 SEE LINE 7D 0 1 X 100.000000000000 200.000000000000 X X X X X X 1 1 X X X X 1 X SEE LINE 16J X SEE LINE 16J X SEE LINE 16J X X X X X X X 1 X 0 X X 1 X 0 0 MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: MDMH GATHERED QUALITATIVE INFORMATION AND PERSPECTIVES ON COMMUNITY HEALTH NEEDS THROUGH SIXTEEN ONE-ON-ONE INTERVIEWS WITH KEY COMMUNITY STAKEHOLDERS IN JANUARY 2021. THE FOLLOWING AGENCIES, ORGANIZATIONS AND BUSINESSES, LISTED IN ALPHABETICAL ORDER, PARTICIPATED IN MDMH'S COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS BY CONTRIBUTING THEIR PERSPECTIVES, OPINIONS AND OBSERVATIONS.- CORVALLIS SCHOOL DISTRICT- DARBY SCHOOL DISTRICT- HAMILTON POLICE DEPARTMENT- HAMILTON SCHOOL DISTRICT- MARCUS DALY MEMORIAL HOSPITAL- MONTANA STATE UNIVERSITY COLLEGE OF NURSING- RAVALLI COUNTY COUNCIL ON AGING- RAVALLI COUNTY PUBLIC HEALTH DEPARTMENT- RAVALLI COUNTY SHERIFFS OFFICE- WESTERN MONTANA MENTAL HEALTH (RIVERFRONT) MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: CHNA REPORT AND IMPLEMENTATION STRATEGY: HTTPS://WWW.BITTERROOTHEALTH.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS/WHEN COPYING AND PASTING THIS URL, FORMAT THE URL WITH UNDERCASE LETTERS OR THE LINK WILL BE BROKEN. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: BITTERROOT HEALTH CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2021 THAT HELPED TO OUTLINE OUR TOP 3 PRIORITY GOALS FOR THE NEXT THREE YEARS. THE GOALS AND SOME OF THE EFFORTS THAT HAVE TAKEN PLACE TOWARD MEETING THEM ARE OUTLINED BELOW: GOAL 1: ENHANCE ACCESS TO BEHAVIORAL AND MENTAL HEALTH SERVICES IN RAVALLI COUNTY.BITTERROOT HEALTH HAS IMPLEMENTED AN INTEGRATED BEHAVIORAL HEALTH PROGRAM WHERE MENTAL HEALTH AND MEDICAL CARE PROVIDERS WORK TOGETHER IN A TEAM CARE APPROACH TO MEET THE MEDICAL, SOCIAL AND BEHAVIORAL NEEDS OF IDENTIFIED PATIENTS. THIS PROGRAM HAS BEEN IMPLEMENTED IN OUR PRIMARY CARE SERVICE LINE AND WILL CONTINUE TO GROW AS WE IMPLEMENT THE SERVICE INTO OTHER AREAS SUCH AS OBSTETRICS AND GYNECOLOGY. GOAL 2: IMPROVE ACCESS TO HEALTHCARE AND RESOURCES IN RAVALLI COUNTY.BITTERROOT HEALTH HAS ADDED SEVERAL NEW SERVICES INCLUDING UROLOGY, ENT, DERMATOLOGY AND PAIN MANAGEMENT TO IMPROVE ACCESS TO A WIDE VARIETY OF HEALTHCARE RESOURCES. ADDITIONALLY, WE ARE WORKING TO OPEN A NEW MULTI-DISCIPLINARY CLINIC IN STEVENSVILLE AND ENHANCE OUR CURRENT SERVICE OFFERINGS IN DARBY TO MAKE SURE THAT CARE IS READILY AVAILABLE AT BOTH ENDS OF OUR VALLEY. ALSO, BITTERROOT HEALTH IS IMPLEMENTING A DIGITAL FRONT DOOR PLATFORM TO IMPROVE DIGITAL ACCESS OPTIONS FOR CARE. THE NEW PLATFORM WILL ALLOW FOR PATIENT SELF-SCHEDULING, INCREASED TELEHEALTH SERVICES AND POSSIBLY REMOTE PATIENT MONITORING. LASTLY, BITTERROOT HEALTH IS CURRENTLY CONSTRUCTING A CANCER & INFUSION CENTER THAT WILL GIVE PATIENTS LOCAL ACCESS FOR CHEMOTHERAPY AND INFUSION NEEDS. GOAL 3: ADVANCE POPULATION HEALTH INITIATIVES IN RAVALLI COUNTY.BITTERROOT HEALTH HAS A POPULATION HEALTH CARE TEAM THAT IS WORKING TO FIND WAYS TO ADDRESS SOCIAL DETERMINANTS OF HEALTH WITHIN OUR COMMUNITY AND IMPLEMENT EVIDENCE-BASED INTERVENTIONS THAT ALLOW PROVIDERS TO SCREEN FOR DETERMINANT AND FIND WAYS TO CONNECT THOSE PATIENTS TO CARE AND RESOURCES. WE ALSO CONTINUE TO PARTNER WITH STAKEHOLDERS SUCH AS PUBLIC HEALTH, LOCAL SCHOOLS AND LOCAL CIVIC GROUPS TO PROVIDER EDUCATION AND RESOURCES NECESSARY TO IMPROVE THE OVERALL HEALTH OF OUR COMMUNITY. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: ELIGIBILITY FOR PATIENT ASSISTANCE SHALL BE MADE REGARDLESS OF RACE, GENDER, AGE, SEXUAL ORIENTATION, RELIGIOUS AFFILIATION, AND SOCIAL OR IMMIGRANT STATUS. MAJOR AREAS OF CONSIDERATIONS 1) RELATIONSHIP TO FEDERAL INCOME POVERTY GUIDELINES ADJUSTED FOR FAMILY SIZE 2) FAMILY NET ASSETS 3) DEMONSTRATION OF INABILITY TO WORK 4) COMPLETED APPLICATION AND 5) RESIDENT OF RAVALLI COUNTY MONTANA WITH EXCEPTIONS. MARCUS DALY MEMORIAL HOSPITAL PART V, SECTION B, LINE 16J: FAP: HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/MARCUS-DALY-SITE-390/MEDIA/B2003D5AC7C84190BF948928A05388B4/BH-CHARITY-CARE-POLICY-REVISED-032320-JULY-2021.PDFWHEN COPYING AND PASTING THIS URL, FORMAT THE URL WITH UNDERCASE LETTERS, OR THE LINK WILL BE BROKEN.FAP PLAIN LANGUAGE SUMMARY: HTTPS://BITTERROOTHEALTH.MYMEDICALACCOUNT.COM/FINANCIALASSISTANCEWHEN COPYING AND PASTING THIS URL, FORMAT THE URL WITH UNDERCASE LETTERS, OR THE LINK WILL BE BROKEN. 13 1 - BITTERROOT HEALTH CONVENIENT CARE 1200 WESTWOOD DR STE J HAMILTON MT 59840 RURAL HEALTH CLINIC 2 - BITTERROOT HEALTH CORVALLIS 1037 MAIN STREET CORVALLIS MT 59828 RURAL HEALTH CLINIC 3 - BITTERROOT HEALTH DARBY 3334 DVN LANE DARBY MT 59829 RURAL HEALTH CLINIC 4 - BITTERROOT HEALTH DERMATOLOGY 1103 WESTWOOD DR STE A HAMILTON MT 59840 DERMATOLOGY CLINIC 5 - BITTERROOT HEALTH EYE CLINIC 300 N 10TH ST STE A HAMILTON MT 59840 OPHTHALMOLOGY CLINIC 6 - BITTERROOT HEALTH HAMILTON 1200 WESTWOOD DR STE I HAMILTON MT 59840 RURAL HEALTH CLINIC 7 - BITTERROOT HEALTH HOSPICE 1200 WESTWOOD DR HAMILTON MT 59840 HOSPICE SERVICES 8 - BITTERROOT HEALTH NEUROSURGERY 1200 WESTWOOD DR STE A HAMILTON MT 59840 NEUROSURGERY CLINIC 9 - BITTERROOT HEALTH OBGYN 1200 WESTWOOD DR STE G HAMILTON MT 59840 OB/GYN CLINIC 10 - BITTERROOT HEALTH ORTHO & SPORTS MED 1200 WESTWOOD DR STE H HAMILTON MT 59840 ORTHOPEDIC CLINIC 11 - BITTERROOT HEALTH PAIN MANAGEMENT 1103 WESTWOOD DR STE B HAMILTON MT 59840 PAIN MEDICINE CLINIC 12 - BITTERROOT HEALTH SURGICAL ASSOCIATES 1200 WESTWOOD DR STE F HAMILTON MT 59840 SURGICAL CLINIC 13 - BITTERROOT HEALTH VICTOR 2386 US HIGHWAY 93 N VICTOR MT 59875 RURAL HEALTH CLINIC PART I, LINE 3C: ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON MULTIPLE FACTORS, INCLUDING THE NATURE OF THE CONDITION AND CARE REQUIRED, INSURANCE COVERAGE OR OTHER SOURCES OF PAYMENT, INCOME (FEDERAL POVERTY LEVEL GUIDELINES ARE USED TO DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE OFFERED), FAMILY SIZE, ASSETS, AND RESIDENCY IN RAVALLI COUNTY UNLESS SERVICES WERE FOR EMERGENCY CARE.FULL FINANCIAL ASSISTANCE WILL BE GRANTED BASED ON INCOME EQUAL TO OR LESS THAN 100% OF FEDERAL POVERTY LEVEL GUIDELINES. PARTIAL ASSISTANCE MAY BE GRANTED BASED ON INCOME BETWEEN 100% AND 200% OF FEDERAL POVERTY LEVEL GUIDELINES. VALUE OF ASSETS MAY BE CONSIDERED IN DETERMINING THE LEVEL OF ASSISTANCE. PART I, LINE 7: EXPLANATION OF COSTING METHOD:FINANCIAL ASSISTANCE AT COST AND MEDICAID AMOUNTS REPORTED IN PART I, LINE 7 ARE COMPUTED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2 OF THE IRS INSTRUCTIONS. COMMUNITY HEALTH IMPROVEMENTS SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONAL EDUCATION, AND CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS ARE REPORTED AT COST GENERAL SUBSIDIZED SERVICES ARE COMPUTED USING THE IRS GUIDELINES OF COST ADJUSTED NET PAYMENTS RECEIVED. THE MEDICARE COST REPORT AND DIRECT IDENTIFIABLE OFFSETTING REVENUES WERE USED TO DETERMINE THE TOTAL SUBSIDY FOR THE HOSPICE AND PALLATIVE CARE, IN-PATIENT OBSTETRICS, AMBULANCE SERVICES, SCHOOL BASED THERAPY PROGRAMS, POPULATION HEALTH SERVICES, OB/GYN CLINIC, AND IN-PATIENT HOSPITALIST PROGRAM. PART I, LINE 7G: INCLUDED IN THE SUBSIDIZED HEALTH SERVICES ARE THE FOLLOWING DEPARTMENTS: HOSPICE AND PALLATIVE CARE, IN-PATIENT OBSTETRICS, AMBULANCE SERVICES, SCHOOL BASED THERAPY PROGRAMS, POPULATION HEALTH SERVICES, OB/GYN CLINIC, AND IN-PATIENT HOSPITALIST PROGRAM PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSES THAT WAS EXCLUDED FROM THE CALCULATION TO DETERMINE THE NET COMMUNITY BENEFIT EXPENSES AS A PERCENT OF TOTAL EXPENSES WAS $9,054,077 PART II, COMMUNITY BUILDING ACTIVITIES: THE HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY PARTICIPATION IN BOTH ECONOMIC AND COALITION BUILDING EVENTS. THE HOSPITAL PARTNERS WITH LOCAL HIGH SCHOOLS, WITH A "JOB SHADOW" PROGRAM. THE GOAL IS TO EXPOSE THOSE AREA YOUTH WHO MAY BE INTERESTED IN PURSUING A CAREER IN HEALTHCARE. WE HAVE ADDED RESIDENCY TRAINING OPPORTUNITIES TO THOSE NEW PHYSICIANS WHO ARE INTERESTED IN EXPERIANCING MEDICAL PRACTICE IN A RUAL SETTING. THE HOSPITAL CONTINUES TO RECRUIT NEW PHYSICIANS TO THE AREA TO PROVIDE BASIC AND EXPANDED SERVICES TO BETTER SERVE THE NEEDS OF THE LOCAL COMMUNITY. PART III, LINE 2: BAD DEBT EXPENSE IS CALCULATED BY REVIEWING PAYMENT ARRANGEMENTS WHICH INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 3: THE HOSPITAL HAS NOT IDENTIFIED A METHOD FOR REASONABLY CALCULATING THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE HAD THEY APPLIED. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH ON PAGE 10 OF THE HOSPITAL'S ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF THE ORGANIZATION'S BAD DEBT EXPENSE. PART III, LINE 8: MDMH HAS A MEDICARE SHORTFALL IN EXCESS OF APPROXIMATELY $7.9 MILLION. THE HOSPITAL HAS CRITICAL ACCESS HOSPITAL STATUS AND IS REIMBURSED BY MEDICARE FOR INPATIENT AND OUTPATIENT SERVICES ON A COST BASIS AS DEFINED AND LIMITED BY THE MEDICARE PROGRAM. MDMH PROVIDES A SIGNIFICANT RURAL LINK FOR BOTH THE HEALTH AND WELL-BEING OF RAVALLI COUNTY RESIDENTS. WE ARE COMMITTED TO LOCAL HEALTHCARE CLOSE TO HOME AND WORK HARD TO EARN AND KEEP THE TRUST OF THE LOCAL COMMUNITY. TO ENSURE THAT A VARIETY OF CLINIC, HOSPITAL AND EMERGENCY SERVICES ARE OPEN AND AVAILABLE TO ALL THOSE WITHIN OUR SERVICE AREA WE STRIVE TO OPERATE AT THE HIGHEST LEVEL OF FISCAL RESPONSIBILITY AND TO BE A GOOD STEWARD OF OUR RESOURCES. THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 WAS DERIVED USING THE 2019 FILED MEDICARE COST REPORT. PART III, LINE 9B: IF A PATIENT IS PRESUMED TO BE FINANCIALLY INDIGENT, THE PATIENT REPRESENTATIVE WILL OFFER A PERSONAL FINANCIAL STATEMENT (PFS) TO BE FILLED OUT. THE PFS WILL BE FORWARDED TO THE PATIENT FINANCIAL ASSISTANCE COMMITTEE FOR REVIEW AND DETERMINATION OF PATIENT FINANCIAL ASSISTANCE STATUS. A PATIENT MAY REQUEST A MONTHLY PAYMENT ARRANGMENT. A MINIMUM PAYMENT OF $50 MUST BE PAID MONTHLY, WITH THE GOAL OF THE BALANCE BEING PAID IN FULL WITHIN 5 YEARS. ACCOUNTS THAT CANNOT BE COLLECTED AFTER NORMAL IN-HOUSE COLLECTION PROCEDURES MAY BE REFERRED TO A COLLECTION AGENCY, MAGISTRATE OR ATTORNEY FOR FURTHER COLLECTION ACTION. PART VI, LINE 2: BY LISTENING TO OUR PATIENTS, FRIENDS, FAMILY AND NEIGHBORS AS WE INTERACT WITH THEM DAILY WE HEAR THEIR CARES AND CONCERNS. WE ALWAYS ARE LOOKING FOR NEW WAY TO RESPOND TO, AND PROVIDE BETTER CARE FOR, THE LOCAL COMMUNITY. PART VI, LINE 3: THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS POSTED ON THEIR WEBSITE AT HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/MARCUS-DALY-SITE-390/MEDIA/B2003D5AC7C84190BF948928A05388B4/BH-CHARITY-CARE-POLICY-REVISED-032320-JULY-2021.PDFWHEN COPYING AND PASTING THIS URL, FORMAT THE URL WITH UNDERCASE LETTERS, OR THE LINK WILL BE BROKEN.IN ADDITION THE HOSPITAL INFORMS PATIENTS UNABLE TO PAY THEIR BILLS ABOUT THEIR FINANCIAL ASSISTANCE WHILE TALKING TO THEM OVER THE PHONE AND SENDS THEM A FINANCIAL ASSISTANCE PACKET. PART VI, LINE 4: THE HOSPITAL SERVES A RURAL POPULATION WHERE THE AVERAGE ANNUAL WAGE IS $48,427. THE PAYER MIX IS 53% MEDICARE, 17% MEDICAID, 2% SELF PAY, NO INSURANCE, WITH THE BALANCE AT OTHER COMMERCIAL PAYORS. THE UNEMPLOYMENT RATE IN RAVALLI COUNTY IS CURRENTLY AT 6.3% ACCORDING TO THE MONTANTA DEPARTMENT OF LABOR AND INDUSTRY. PART VI, LINE 5: THE HOSPITAL IS PROUD OF ITS EFFORTS TO PROMOTE COMMUNITY HEALTH AND WELLNESS. THE COLORS OF CANCER PROGRAM IS A COMMUNITY-WIDE PROGRAM TO RAISE AWARENESS FOR ALL TYPES OF CANCER. THE HOSPITAL CONTINUES TO PROVIDE NO-COST MAMMOGRAMS TO QUALIFIED LOW-INCOME AREA RESIDENTS. THE HOSPITAL COORDINATES AND SPONSORS THE ANNUAL SPORTS PHYSICAL CLINIC TO SUPPORT AND ENCOURAGE AREA YOUTH TO PARTICIPATE IN PHYSICAL ACTIVITIES. IN 2021 OUR CONVENIENT CARE CLINIC EXPANDED IT SERVICES TO INCLUDE A VIRAL CLINIC TO SUPPORT TESTING AND MITIGATION EFFORTS OF COVID AND FLU RELATED CASES PART VI, LINE 6: THE ORGANIZATION IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES MT 1 HAMILTON SCHOOL DISTRICT 217 DALY AVENUE HAMILTON MT 59840 816000830 GOVERNMENTAL 7600 0 SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS CORVALLIS SCHOOL DISTRICT PO BOX 700 1045 MAIN STREET CORVALLIS MT 59828 816000828 GOVERNMENTAL 7600 0 SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS STEVENSVILLE SCHOOL DISTRICT 300 PARK STREET STEVENSVILLE MT 59870 816000829 GOVERNMENTAL 7500 0 SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS FLORENCE CARTON SCHOOL DISTRICT 5602 OLD HWY 93 FLORENCE MT 59833 816000836 GOVERNMENTAL 6500 0 SUPPORT FOR SCHOOL RN PROGRAM AND STUDENT ATHLETICS 4 0 PART I, LINE 2: THE HOSPITAL IS COMMITTED TO SUPPORT THE HEALTH AND WELL-BEING OF AREA SCHOOL AGED CHILDREN BY PROVIDING FUNDING GRANTS RESTRICTED TO THE DISTRICT'S SCHOOL NURSE PROGRAM. THE HOSPITAL HAS ALSO COMMITTED TO SUPPORT STUDENT ATHLETICS BY PROVIDING A VOLUNTEER BASED, LOW-COST SPORTS PHYSICAL CLINIC DURING THE SUMMER. THE PROCEEDS ARE GIVEN TO THE PARTICIPATING STUDENTS' HOME DISTRICT TO SUPPORT THE DISTRICT'S ATHLETIC PROGRAMS. OTHER COMMUNITY ORGANIZATIONS MAY SUBMIT A GRANT PROPOSAL DIRECTLY TO THE HOSPITAL CEO FOR CONSIDERATION. THE REQUESTS ARE EVALUATED BASED UPON BROAD BASED COMMUNITY SUPPORT AND THE URGENCY OF NEED. X 0 0 X X X X X X 0 0 0 0 0 0 0 0 0 DR RICHARD DAY PHYSICIAN 1061080 0 15000 0 45000 0 21550 0 10740 0 1153370 0 0 0 DAVID BOHLER PHYSICIAN 536814 0 0 0 7721 0 5851 0 22066 0 572452 0 0 0 ANGELA COVINGTON PHYSICIAN 395339 0 87375 0 11535 0 26792 0 25422 0 546463 0 0 0 TIMOTHY WOODS MD BOARD MEMBER/PHYSICIAN 438324 0 4500 0 45000 0 18539 0 19057 0 525420 0 0 0 BRISTOL SCHMITZ PHYSICIAN 429895 0 10603 0 39000 0 28981 0 10266 0 518745 0 0 0 BRET PEARCE PHYSICIAN 442040 0 8500 0 19500 0 19841 0 20314 0 510195 0 0 0 JOHN BISHOP CEO/SECRETARY/ TREASURER 304499 0 85000 0 38500 0 20413 0 21228 0 469640 0 0 0 TREVOR LEWIS CFO CFO 178093 0 0 0 2706 0 3636 0 21891 0 206326 0 0 0 LAWRENCE BROUWER MD BOARD MEMBER/PHYSICIAN 152537 0 14376 0 26000 0 11316 0 0 0 204229 0 0 0 PART I, LINE 1A THE EMPLOYEES REPORTED IN FORM 990, PART VII, SECTION A RECEIVED TAX GROSS-UP PAYMENTS FOR THEIR TAXABLE COMPENSATION RELATED TO LONG-TERM DISABILITY INSURANCE PROVIDED BY MARCUS DALY MEMORIAL HOSPITAL. THE TOTAL VALUE OF THE PAYMENTS DURING CALENDAR YEAR 2021 WAS $10,704. A MT FACILITY FINANCE AUTHORITY 364615155 2017-12-15 15000000 FINANCE CONSTRUCTION OF A NEW SURGERY CENTER 0 0 0 B MT FACILITY FINANCE AUTHORITY 364615155 2021-10-01 27000000 REFINANCE TO CONSTRUCT NEW PROCEDURE ROOMS, CANCER CENTER, AND CLINICS 0 0 0 C MT FACILITY FINANCE AUTHORITY 364615155 2021-10-01 10000000 REFINANCE TO CONSTRUCT NEW PROCEDURE ROOMS, CANCER CENTER, AND CLINICS 0 0 0 A 2845000 15000000 1040407 300000 13659593 2019 0 0 0 1 B 27000000 540000 13502240 0 0 0 0 C 245000 10000000 623794 200000 0 0 0 0 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 1 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 C 0 1 0 0 0 0 0 0 0 A 1 B 1 C 1 FORM 990, PART VI, SECTION B, LINE 11B A REPRESENTATIVE FROM CLIFTONLARSONALLEN, THE PAID PREPARER, PRESENTED THE FORM 990 TO THE HOSPITAL FINANCE COMMITTEE. UPON APPROVAL, THE FORM 990 WAS PRESENTED TO THE BOARD OF DIRECTORS FOR ACCEPTANCE AND APPROVAL PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR, CORPORATE OFFICER, SENIOR MANAGER, TRUSTEE OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST, IS AN INTERESTED PERSON. IF A PERSON IS AN INTERESTED PERSON WITH RESPECT TO ANY ENTITY IN THE HEALTH CARE SYSTEM OF WHICH THE HOSPITAL IS A PART, HE OR SHE IS AN INTERESTED PERSON WITH RESPECT TO ALL ENTITIES IN THE HEALTH CARE SYSTEM. UPON APPOINTMENT, HIRE OR TRANSFER AND ANNUALLY THEREAFTER, EACH INTERESTED PERSON SHALL EXECUTE AND SUBMIT TO THE HOSPITAL'S CEO A STATEMENT WHICH AFFIRMS SUCH PERSON: A. HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY; B. HAS READ AND UNDERSTANDS THE POLICY; C. HAS AGREED TO COMPLY WITH THE POLICY; AND D. UNDERSTANDS THAT THE HOSPITAL IS A CHARITABLE ORGANIZATION AND IN ORDER TO MAINTAIN ITS FEDERAL AND STATE TAX EXEMPTIONS IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ONE OR MORE OF ITS TAX-EXEMPT PURPOSES. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF THE CONFLICTING FINANCIAL INTEREST AND MUST 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. ANY OTHER MEMBER OF THE BOARD OR COMMITTEE MAY RAISE THE QUESTION OF WHETHER A CONFLICT EXISTS, DISCLOSE FACTS RELATING TO THE CONFLICT AND REQUEST THE INTERESTED PERSON TO PROVIDE FURTHER DETAILS. THE BOARD CHAIR (OR VICE CHAIR ACTING IN THE PLACE OF THE CHAIR) OR THE HOSPITAL'S LEGAL COUNSEL MAY, BASED ON THEIR INFORMATION ABOUT THE CONFLICT, DISCLOSE THE CONFLICT AND REQUEST THE INTERESTED PERSON TO WITHDRAW FROM DISCUSSION OF THE TRANSACTION AND/OR NOT VOTE. THE INTERESTED PERSON SHALL LEAVE THE MEETING OR REQUEST A DETERMINATION BY THE BOARD OR COMMITTEE OF WHETHER A CONFLICT OF INTEREST EXISTS. AFTER DISCLOSURE OF THE CONFLICTING 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, DISINTERESTED BOARD OR COMMITTEE MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS BEFORE CONSIDERING OR ACTING UPON ANY OTHER BUSINESS. AFTER EXERCISING DUE DILIGENCE, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE HOSPITAL CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT WITH REASONABLE EFFORTS FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY ATTAINABLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE GOVERNING BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS FAIR AND REASONABLE. IN CONFORMITY WITH THE ABOVE DETERMINATION, THE GOVERNING BOARD OR COMMITTEE SHALL MAKE ITS DECISION AS TO WHETHER TO ENTER INTO THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15A AT THE DISCRETION OF THE BOARD OF DIRECTORS BUT NO LESS THAN EVERY TWO YEARS, THE NON-CONFLICTED HOSPITAL BOARD MEMBERS (COMPENSATION COMMITTEE) MEET TO REVIEW THE ANNUAL COMPENSATION AND BENEFITS PACKAGE OF THE CEO. THE BOARD USES APPLICABLE COMPENSATION SURVEY DATA PROVIDED BY SEVERAL SOURCES INCLUDING OTHER HOSPITAL 990'S, MHA SURVEY, AND THIRD-PARTY CONSULTANTS. USING THIS INFORMATION, THE COMPENSATION COMMITTEE THEN PROVIDES A RECOMMENDATION FOR CEO COMPENSATION TO THE FULL HOSPITAL BOARD. THE CEO HAS THE AUTHORITY TO SET THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES OF THE HOSPITAL. FOR PHYSICIAN COMPENSATION, THE HOSPITAL USES A THIRD-PARTY CPA FIRM TO GATHER COMPENSATION DATA FROM MGMA AND NON-PHYSICAN COMPENSATION INFORMATION IS FROM THE MHA COMPENSATION SURVEY. THIS PROCESS WAS LAST CONDUCTED IN 2022. FORM 990, PART VI, SECTION C, LINE 18 IN ADDITION TO BEING AVAILABLE UPON REQUEST, A COPY OF THE FORM 990 IS ALSO AVAILABLE AT WWW.GUIDESTAR.ORG. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF DALY HOSPITAL FOUNDATION -384,208. LOSS ON DEBT REFINANCING -331,422. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. DALY HOSPITAL FOUNDATIONINC 1200 WESTWOOD DRIVE HAMILTON MT 59840 363766000 CHARITABLE SERVICES MT 501(C)(3) LINE 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 1 DALY HOSPITAL FOUNDATION C 520715 FMV