BIG SANDY MEDICAL CENTER INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization: BIG SANDY MEDICAL CENTER INC (EIN 81-0291695)
Tax period: 2019-07-01 to 2020-06-30
Filed: 2021-05-13
IRS object ID: 202101339349304070
Schema version: 2019v5.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule D
Schedule H
Schedule J
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2021-05-13T14:25:54-05:00	ReturnTs
Tax Period End	2020-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	390758449	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	WIPFLI LLP	BusinessNameLine1Txt

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	101 EAST FRONT STREET 301	AddressLine1Txt
City	MISSOULA	CityNm
State Abbreviation	MT	StateAbbreviationCd
ZIP	59802	ZIPCd

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2019-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	810291695	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BIG SANDY MEDICAL CENTER INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Business Name Control	BIGS	BusinessNameControlTxt
Phone	4063782188	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 530	AddressLine1Txt
City	BIG SANDY	CityNm
State Abbreviation	MT	StateAbbreviationCd
ZIP	59520	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	LEAH GRIFFITH	PersonNm
Person Title	CEO	PersonTitleTxt
Phone	4063782188	PhoneNum
Signature	2021-05-11	SignatureDt
Discuss With Paid Preparer	Yes (1)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	WAYNE R HIETT CPA	PreparerPersonNm
PTIN	P00159424	PTIN
Phone	4067281800	PhoneNum
Preparation	2021-05-11	PreparationDt

Field	Value	IRS element (for citing)
Tax	2019	TaxYr
Build TS	2022-09-23 18:48:47Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Principal Officer	LEAH GRIFFITH	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 530	AddressLine1Txt
City	BIG SANDY	CityNm
State Abbreviation	MT	StateAbbreviationCd
ZIP	59520	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$4,077,051	GrossReceiptsAmt
Group Return For Affiliates	0	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	BSMC.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1963	FormationYr
Legal Domicile State	MT	LegalDomicileStateCd
Activity Or Mission	TO PROVIDE THE BEST POSSIBLE CARE FOR PATIENTS AT THE MOST REASONABLE COST IN A COMPETENT, PROFESSIONAL MANNER.	ActivityOrMissionDesc
Voting Members Governing Body	5	VotingMembersGoverningBodyCnt
Voting Members Independent	5	VotingMembersIndependentCnt
Total Employee	67	TotalEmployeeCnt
Total Volunteers	6	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$311,884	PYContributionsGrantsAmt
CY Contributions Grants	$542,820	CYContributionsGrantsAmt
PY Program Service Revenue	$3,218,838	PYProgramServiceRevenueAmt
CY Program Service Revenue	$3,457,559	CYProgramServiceRevenueAmt
PY Investment Income	$35,358	PYInvestmentIncomeAmt
CY Investment Income	$41,472	CYInvestmentIncomeAmt
PY Other Revenue	$1,221	PYOtherRevenueAmt
CY Other Revenue	$35,200	CYOtherRevenueAmt
PY Total Revenue	$3,567,301	PYTotalRevenueAmt
CY Total Revenue	$4,077,051	CYTotalRevenueAmt
PY Grants And Similar Paid	$0	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$0	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$2,377,623	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$2,078,133	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$1,146,223	PYOtherExpensesAmt
CY Other Expenses	$1,654,654	CYOtherExpensesAmt
PY Total Expenses	$3,523,846	PYTotalExpensesAmt
CY Total Expenses	$3,732,787	CYTotalExpensesAmt
PY Revenues Less Expenses	$43,455	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$344,264	CYRevenuesLessExpensesAmt
Total Assets BOY	$4,275,919	TotalAssetsBOYAmt
Total Assets EOY	$6,275,980	TotalAssetsEOYAmt
Total Liabilities BOY	$321,632	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$1,977,429	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$3,954,287	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$4,298,551	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	TO PROVIDE THE BEST POSSIBLE CARE FOR PATIENTS AT THE MOST REASONABLE COST IN A COMPETENT, PROFESSIONAL MANNER.	MissionDesc
Significant New Program Srvc	Yes (1)	SignificantNewProgramSrvcInd
Significant Change	Yes (1)	SignificantChangeInd
Expense	$2,965,479	ExpenseAmt
Revenue	$3,491,559	RevenueAmt
Desc	BIG SANDY MEDICAL CENTER PROVIDES HOSPITAL AND LONG-TERM MEDICAL CARE FOR THE TOWN OF BIG SANDY AND NORTHERN CHOUTEAU COUNTY, MONTANA.	Desc
Total Program Service Expenses	$2,965,479	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (1)	DescribedInSection501c3Ind
Schedule B Required	Yes (1)	ScheduleBRequiredInd
Political Campaign Acty	0	PoliticalCampaignActyInd
Lobbying Activities	0	LobbyingActivitiesInd
Subject To Proxy Tax	0	SubjectToProxyTaxInd
Donor Advised Fund	0	DonorAdvisedFundInd
Conservation Easements	0	ConservationEasementsInd
Collections Of Art	0	CollectionsOfArtInd
Credit Counseling	0	CreditCounselingInd
Donor Rstr Or Quasi Endowments	0	DonorRstrOrQuasiEndowmentsInd
Report Land Building Equipment	Yes (1)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	0	ReportInvestmentsOtherSecInd
Report Program Related Invst	0	ReportProgramRelatedInvstInd
Report Other Assets	0	ReportOtherAssetsInd
Report Other Liabilities	0	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (1)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	Yes (1)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	0	ConsolidatedAuditFinclStmtInd
School Operating	0	SchoolOperatingInd
Foreign Office	0	ForeignOfficeInd
Foreign Activities	0	ForeignActivitiesInd
More Than5000 K To Org	0	MoreThan5000KToOrgInd
More Than5000 K To Individuals	0	MoreThan5000KToIndividualsInd
Professional Fundraising	0	ProfessionalFundraisingInd
Fundraising Activities	0	FundraisingActivitiesInd
Gaming Activities	0	GamingActivitiesInd
Operate Hospital	Yes (1)	OperateHospitalInd
Audited Financial Stmt Att	Yes (1)	AuditedFinancialStmtAttInd
Grants To Organizations	0	GrantsToOrganizationsInd
Grants To Individuals	0	GrantsToIndividualsInd
Schedule J Required	Yes (1)	ScheduleJRequiredInd
Tax Exempt Bonds	0	TaxExemptBondsInd
Engaged In Excess Benefit Trans	0	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	0	PYExcessBenefitTransInd
Loan Outstanding	0	LoanOutstandingInd
Grant To Related Person	0	GrantToRelatedPersonInd
Business Rln With Org Mem	0	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	0	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	0	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	0	DeductibleNonCashContriInd
Deductible Art Contribution	0	DeductibleArtContributionInd
Terminate Operations	0	TerminateOperationsInd
Partial Liquidation	0	PartialLiquidationInd
Disregarded Entity	0	DisregardedEntityInd
Related Entity	0	RelatedEntityInd
Related Organization Ctrl Ent	0	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	0	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	0	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (1)	ScheduleORequiredInd
IRP Document	3	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (1)	BackupWthldComplianceInd
Employee	67	EmployeeCnt
Employment Tax Returns Filed	Yes (1)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	0	UnrelatedBusIncmOverLimitInd
Foreign Financial Account	0	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	0	ProhibitedTaxShelterTransInd
Taxable Party Notification	0	TaxablePartyNotificationInd
Nondeductible Contributions	0	NondeductibleContributionsInd
Quid Pro Quo Contributions	0	QuidProQuoContributionsInd
Form8282 Property Disposed Of	0	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	0	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	0	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	0	IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt	0	SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc	0	SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	5	GoverningBodyVotingMembersCnt
Independent Voting Member	5	IndependentVotingMemberCnt
Family Or Business Rln	0	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	0	DelegationOfMgmtDutiesInd
Change To Org Documents	0	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	0	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (1)	MembersOrStockholdersInd
Election Of Board Members	0	ElectionOfBoardMembersInd
Decisions Subject To Approva	0	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (1)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (1)	MinutesOfCommitteesInd
Officer Mailing Address	0	OfficerMailingAddressInd
Local Chapters	0	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (1)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (1)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (1)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (1)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (1)	WhistleblowerPolicyInd
Document Retention Policy	Yes (1)	DocumentRetentionPolicyInd
Compensation Process CEO	Yes (1)	CompensationProcessCEOInd
Compensation Process Other	Yes (1)	CompensationProcessOtherInd
Investment In Joint Venture	0	InvestmentInJointVentureInd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	LEAH GRIFFITH	PersonNm
Phone	4063782188	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 530	AddressLine1Txt
City	BIG SANDY	CityNm
State Abbreviation	MT	StateAbbreviationCd
ZIP	59520	ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (8 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Highest Compensated EmployeeHighestCompensatedEmployeeInd
HARVEY KELLER
CHAIR	1.00	Yes (X)	Yes (X)	$0	$0	$0
ROBERT NELSON
VICE CHAIR	1.00	Yes (X)	Yes (X)	$0	$0	$0
NICOLE ALLDERDICE
SECRETARY/TREASURER	1.00	Yes (X)	Yes (X)	$0	$0	$0
ANNA BOLD
DIRECTOR	1.00	Yes (X)		$0	$0	$0
ANN QUINN
DIRECTOR	1.00	Yes (X)		$0	$0	$0
LEAH GRIFFITH
CEO	40.00		Yes (X)	$79,101	$0	$25,791
COLETTE TERRY
CFO	40.00		Yes (X)	$58,452	$0	$7,289
KRYSTYL KULBECK
PA-C	40.00			$149,660	$0	$26,570	Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$287,213	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$59,650	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	1	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	0	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (1)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	0	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	KC CORPORATION	BusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 1246	AddressLine1Txt
City	BIG SANDY	CityNm
State Abbreviation	MT	StateAbbreviationCd
ZIP	59520	ZIPCd

Field	Value	IRS element (for citing)
Services	PHYSICAL THERAPY	ServicesDesc
Compensation	$108,888	CompensationAmt

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	1	CntrctRcvdGreaterThan100KCnt
Government Grants	$396,400	GovernmentGrantsAmt
All Other Contributions	$146,420	AllOtherContributionsAmt
Total Contributions	$542,820	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
PATIENT SERVICE REVENU	621110	$2,888,186	$2,888,186
OTHER OPERATING REVENU	621110	$419,959	$419,959
340B REVENUE	621110	$130,577	$130,577
DIETARY REVENUE	621110	$18,837	$18,837

Field	Value	IRS element (for citing)
Total Program Service Revenue	$3,457,559	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$39,972	TotalRevenueColumnAmt
Exclusion	$39,972	ExclusionAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$1,200	RealAmt

Less Rental Expenses LessRentalExpensesGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$1,200	RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,200	TotalRevenueColumnAmt
Exclusion	$1,200	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$1,500	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$0	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$1,500	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$1,500	TotalRevenueColumnAmt
Exclusion	$1,500	ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

Field	Value	IRS element (for citing)
Desc	HOSPITAL TAX DISTRICT	Desc
Business	621110	BusinessCd
Total Revenue Column	$34,000	TotalRevenueColumnAmt
Related Or Exempt Func Income	$34,000	RelatedOrExemptFuncIncomeAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$34,000	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$4,077,051	TotalRevenueColumnAmt
Related Or Exempt Func Income	$3,491,559	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$0	UnrelatedBusinessRevenueAmt
Exclusion	$42,672	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$187,670	TotalAmt
Management And General	$187,670	ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$1,631,938	TotalAmt
Program Services	$1,530,193	ProgramServicesAmt
Management And General	$101,745	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$8,580	TotalAmt
Management And General	$8,580	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$120,899	TotalAmt
Management And General	$120,899	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$129,046	TotalAmt
Management And General	$129,046	ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$1,625	TotalAmt
Management And General	$1,625	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$5,600	TotalAmt
Management And General	$5,600	ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$483,685	TotalAmt
Program Services	$447,045	ProgramServicesAmt
Management And General	$36,640	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$6,209	TotalAmt
Management And General	$6,209	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$19,219	TotalAmt
Program Services	$18,606	ProgramServicesAmt
Management And General	$613	ManagementAndGeneralAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$60,193	TotalAmt
Program Services	$55,139	ProgramServicesAmt
Management And General	$5,054	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$11,464	TotalAmt
Management And General	$11,464	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$2,717	TotalAmt
Management And General	$2,717	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$102,000	TotalAmt
Program Services	$102,000	ProgramServicesAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$54,390	TotalAmt
Program Services	$54,390	ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
SUPPLIES	$671,798	$654,617	$17,181
BAD DEBT EXPENSE	$45,440	$45,440
REPAIRS	$42,643	$36,331	$6,312
DUES & SUBSCRIPTIONS	$42,260		$42,260

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$105,411	TotalAmt
Program Services	$21,718	ProgramServicesAmt
Management And General	$83,693	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,732,787	TotalAmt
Program Services	$2,965,479	ProgramServicesAmt
Management And General	$767,308	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$309,807	BOYAmt
EOY	$630,219	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,994,779	BOYAmt
EOY	$3,291,123	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$923,838	BOYAmt
EOY	$1,385,513	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$8,683	BOYAmt
EOY	$0	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$27,482	BOYAmt
EOY	$28,396	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$3,948,087	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$3,201,632	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$832,215	BOYAmt
EOY	$746,455	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$179,115	BOYAmt
EOY	$194,274	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$4,275,919	BOYAmt
EOY	$6,275,980	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$275,240	BOYAmt
EOY	$158,971	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$1,768,629	EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

Field	Value	IRS element (for citing)
BOY	$46,392	BOYAmt
EOY	$49,829	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$321,632	BOYAmt
EOY	$1,977,429	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows FASB117	Yes (X)	OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$3,954,287	BOYAmt
EOY	$4,298,551	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$3,954,287	BOYAmt
EOY	$4,298,551	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$4,275,919	BOYAmt
EOY	$6,275,980	EOYAmt

Field	Value	IRS element (for citing)
Reconcilation Revenue Expnss	$344,264	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$0	OtherChangesInNetAssetsAmt
Info In Schedule O Part XII	Yes (X)	InfoInScheduleOPartXIIInd
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	0	AccountantCompileOrReviewInd
FS Audited	Yes (1)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (1)	AuditCommitteeInd
Federal Grant Audit Required	0	FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$22,544	OtherCostOrOtherBasisAmt
Book Value	$22,544	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$2,448,076	OtherCostOrOtherBasisAmt
Depreciation	$2,397,581	DepreciationAmt
Book Value	$50,495	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$1,008,382	OtherCostOrOtherBasisAmt
Depreciation	$804,051	DepreciationAmt
Book Value	$204,331	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$469,085	OtherCostOrOtherBasisAmt
Book Value	$469,085	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$746,455	TotalBookValueLandBuildingsAmt
Footnote Text	Yes (X)	FootnoteTextInd
Total Rev Etc Audited Fincl Stmt	$4,009,893	TotalRevEtcAuditedFinclStmtAmt
Revenue Not Reported	$0	RevenueNotReportedAmt
Revenue Subtotal	$4,009,893	RevenueSubtotalAmt
Other Revenues Not Included	$67,158	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$67,158	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$4,077,051	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$3,665,629	TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported	$0	ExpensesNotReportedAmt
Expenses Subtotal	$3,665,629	ExpensesSubtotalAmt
Other Expenses Not Included	$67,158	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$67,158	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$3,732,787	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART X, LINE 2:	THE MEDICAL CENTER, AS A NOT-FOR-PROFIT ORGANIZATION OPERATING UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, IS EXEMPT FROM FEDERAL AND STATE INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS INCLUDED IN THESE FINANCIAL STATEMENTS.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 45,440. 340B EXPENSES 21,718.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	BAD DEBT EXPENSE 45,440. 340B EXPENSES 21,718.

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (1)	FinancialAssistancePolicyInd
Written Policy	Yes (1)	WrittenPolicyInd
FPG Reference Free Care	Yes (1)	FPGReferenceFreeCareInd
Percent100	Yes (X)	Percent100Ind
FPG Reference Discounted Care	Yes (1)	FPGReferenceDiscountedCareInd
Percent200 D	Yes (X)	Percent200DInd
Free Care Medically Indigent	Yes (1)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	0	FinancialAssistanceBudgetInd
Annual Community Bnft Report	0	AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$26,291	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$26,291	NetCommunityBenefitExpnsAmt
Total Expense	0.00700	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$216,560	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$128,592	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$87,968	NetCommunityBenefitExpnsAmt
Total Expense	0.02360	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$8,855	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$5,202	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$3,653	NetCommunityBenefitExpnsAmt
Total Expense	0.00100	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$251,706	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$133,794	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$117,912	NetCommunityBenefitExpnsAmt
Total Expense	0.03160	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$251,706	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$133,794	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$117,912	NetCommunityBenefitExpnsAmt
Total Expense	0.03160	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (1)	BadDebtExpenseReportedInd
Bad Debt Expense	$45,440	BadDebtExpenseAmt
Reimbursed By Medicare	$1,294,257	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$1,310,586	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$16,329	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost Accounting System	Yes (X)	CostAccountingSystemInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (1)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (1)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	BIG SANDY MEDICAL CENTER	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO BOX 530	AddressLine1Txt
City	BIG SANDY	CityNm
State Abbreviation	MT	StateAbbreviationCd
ZIP	59520	ZIPCd

Field	Value	IRS element (for citing)
Website Address	BSMC.ORG	WebsiteAddressTxt
State License	12767	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
Critical Access Hospital	Yes (X)	CriticalAccessHospitalInd
Emergency Room24 Hrs	Yes (X)	EmergencyRoom24HrsInd
Other	RURAL HEALTH CLINIC	OtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	BIG SANDY MEDICAL CENTER	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
First Licensed CY Or PY	0	FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY	0	TaxExemptHospitalCYOrPYInd
CHNA Conducted	Yes (1)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Prior CHNA Impact	Yes (X)	PriorCHNAImpactInd
CHNA Conducted	17	CHNAConductedYr
Take Into Account Others Input	Yes (1)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	0	CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts	0	CHNAConductedWithNonFcltsInd
CHNA Report Widely Available	Yes (1)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	WWW.BSMC.ORG/COMMUNITYHEALTHNEEDS.HTML	OwnWebsiteURLTxt
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Implementation Strategy Adopt	Yes (1)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	17	ImplementationStrategyAdptYr
Strategy Posted Website	Yes (1)	StrategyPostedWebsiteInd
Strategy Website URL	HTTP://WWW.BSMC.ORG/COMMUNITYHEALTHNEEDS.HTML	StrategyWebsiteURLTxt
Organization Incur Excise Tax	0	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (1)	EligCriteriaExplainedInd
FPG Family Incm Lmt Free Dscnt	Yes (X)	FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care	100.000000000000	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	200.000000000000	FPGFamilyIncmLmtDscntCarePct
Explained Basis	Yes (1)	ExplainedBasisInd
App Financial Asst Expln	Yes (1)	AppFinancialAsstExplnInd
Described Info	Yes (X)	DescribedInfoInd
Described Suprt Doc	Yes (X)	DescribedSuprtDocInd
Provided Hospital Contact	Yes (X)	ProvidedHospitalContactInd
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
Includes Publicity Measures	Yes (1)	IncludesPublicityMeasuresInd
FAP Available On Website	Yes (X)	FAPAvailableOnWebsiteInd
FAP Available On Website URL	WWW.BSMC.ORG	FAPAvailableOnWebsiteURLTxt
FAP App Available On Website	Yes (X)	FAPAppAvailableOnWebsiteInd
FAP App Available On Website URL	WWW.BSMC.ORG	FAPAppAvailableOnWebsiteURLTxt
FAP Summary On Website	Yes (X)	FAPSummaryOnWebsiteInd
FAP Summary On Website URL	WWW.BSMC.ORG	FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No Charge	Yes (X)	FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No Chrg	Yes (X)	FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No Chrg	Yes (X)	FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill Display	Yes (X)	NotifiedFAPCopyBillDisplayInd
Communtity Notified FAP	Yes (X)	CommuntityNotifiedFAPInd
FAP Translated	Yes (X)	FAPTranslatedInd
FAP Actions On Nonpayment	Yes (1)	FAPActionsOnNonpaymentInd
Permit No Actions	Yes (X)	PermitNoActionsInd
Collection Activities	0	CollectionActivitiesInd
Provided Written Notice	Yes (X)	ProvidedWrittenNoticeInd
Nondis Emergency Care Policy	Yes (1)	NondisEmergencyCarePolicyInd
Prospective Medicare Medicaid	Yes (X)	ProspectiveMedicareMedicaidInd
Amounts Generally Billed	0	AmountsGenerallyBilledInd
Gross Charges	0	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
BIG SANDY MEDICAL CENTER	PART V, SECTION B, LINE 5: A WRITTEN, COMMUNITY SURVEY WAS THE CHOSEN METHOD OF DATA COLLECTION FOR THE MOST RECENT CHNA. THE PRIMARY REASON FOR CHOOSING THIS METHOD AS OPPOSED TO OTHER METHODS, SUCH AS FOCUS GROUPS, ONLINE SURVEYS, AND INTERVIEWS, IS IT ACCOMMODATED THE BIG SANDY POPULATION AND WAS A FAIRLY COST-EFFECTIVE PROCESS. THE WRITTEN SURVEY WAS DISTRIBUTED BY MAIL TO 520 HOUSEHOLDS IN THE BSMC SERVICE AREA.
BIG SANDY MEDICAL CENTER	PART V, SECTION B, LINE 11: OBJECTIVE 1: IMPROVE PATIENT CARE AND SATISFACTION STRATEGIES: - INCREASED, ADDITIONAL SERVICES (I.E. SPECIALIST VISITS, PROCEDURES)- DEVELOP A PATIENT ADVISORY COMMITTEE- CONDUCT CONSISTENT, REAL-TIME SATISFACTION SURVEYS TAILORED TO THIS POPULATIONOBJECTIVE 2: COLLABORATE WITH OTHER COMMUNITY STAKEHOLDERS ON PROJECTS STRATEGIES:- COLLABORATE ON FUTURE CHNAS AND OTHER ASSESSMENTS (I.E. CRA, CHI, RALA)- COORDINATE GRANT WORK, INCLUDING SEARCHING, APPLYING, AND WRITING OF GRANTS- EDUCATE THE COMMUNITY ON HEALTH-RELATED ISSUES AND TOPICS- ACTIVELY SUPPORT HEALTHY LIFESTYLE ACTIVITIES WITHIN THE COMMUNITYSOME OF THE NEEDS ARE NOT FINANCIALLY OR GEOGRAPHICALLY FEASIBLE FOR A FACILITY THIS SIZE (I.E. MORE SPECIALISTS). WITH LARGER FACILITIES WITHIN 35 MILES, IT IS SOMETIMES MORE PRACTICAL TO REFER PATIENTS TO THE LARGER FACILITY.
PART V, SECTION B, LINE 20B	IN GENERAL, NO ORAL ATTEMPTS TO NOTIFY INDIVIDUALS WERE MADE BEFORE SENDING ACCOUNTS TO A THIRD-PARTY DURING THE FISCAL YEAR DUE TO STAFFING LIMITATIONS. HOWEVER, IF PATIENTS CALLED TO INQUIRE ABOUT THEIR ACCOUNT, THE OPTIONS WERE DISCUSSED VERBALLY. OTHERWISE ONLY WRITTEN ATTEMPTS TO NOTIFY INDIVIDUALS WERE MADE. THE ORGANIZATION HAS SINCE HIRED ADDITIONAL PERSONNEL SO THAT MORE ORAL ATTEMPTS TO NOTIFY INDIVIDUALS CAN BE MADE GOING FORWARD.
PART V, SECTION B, LINE 20C	WE DO NOT PROCESS INCOMPLETE APPLICATIONS. APPLICANT IS NOTIFIED IN WRITING OF WHAT DOCUMENTATION IS REQUIRED IF THE APPLICATION IS CONSIDERED INCOMPLETE.
PART V, SECTION B, LINE 20D	NO PRESUMPTIVE ELIGIBILITY DETERMINATIONS WERE MADE.

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, LINE 7:	THE ORGANIZATION USES THE COST-TO-CHARGE RATIO TO CALCULATE AMOUNTS ON PART I, LINE 7.
PART III, LINE 2:	BAD DEBTS ARE DETERMINED WHEN AN ACCOUNT IS SENT TO COLLECTIONS BASED ON THE POLICIES OF THE ORGANIZATION.
PART III, LINE 4:	THE FOOTNOTE THAT DESCRIBES THE BAD DEBT EXPENSE BEGINS ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS.
PART III, LINE 8:	NONE OF THE SHORTFALL REPORTED IS TREATED AS COMMUNITY BENEFIT. BSMC USES THE AMOUNTS FROM MEDICARE PROVIDER STATISTICAL REIMBURSEMENT (PS&R) TO DETERMINE THE MEDICARE ALLOWABLE COSTS.
PART III, LINE 9B:	WHEN A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, THE DISCOUNT AMOUNT IS APPLIED TO THE GROSS CHARGES BILLABLE TO THE PATIENT. THE PATIENT IS THEN NOTIFIED IN WRITING THE REMAINING BALANCE. IN THE EVENT THAT A PATIENT THAT QUALIFIES FOR FINANCIAL ASSISTANCE BUT FAILS TO TIMELY PAY THE REMAINING BALANCE DUE, THE FACILITY MAY TAKEN ANY ACTIONS DEFINED IN THE BILLING AND COLLECTIONS POLICY.
PART VI, LINE 2:	BSMC SENDS OUT SATISFACTION SURVEYS AND ASKS FOR INPUT ON ANY CHANGES PATIENTS WOULD LIKE TO SEE. ALSO, ONCE A YEAR, AN ANNUAL PUBLIC MEETING IS HELD AND INPUT IS SOLICITED AS WELL AS A REPORT ON HOSPITAL ACTIVITIES GIVEN. THIS PUBLIC MEETING IS WELL ADVERTISED IN THE LOCAL PRESS.
PART VI, LINE 3:	A NOTICE OF PATIENT ELIGIBILITY IS POSTED IN ALL WAITING AREA AND ON THE WEBSITE - BSMC.ORG. NOTICE OF FINANCIAL ASSISTANCE IS ALSO SENT OUT WITH ALL PRE-COLLECTION CORRESPONDENCE.
PART VI, LINE 4:	THE COMMUNITY IS MOSTLY AGRICULTURAL WITH LARGE WHEAT FARMS AND LARGE CATTLE RANCHES. THOSE WHO DO NOT WORK AT THESE AGRICULTURAL BUSINESS SITES USUALLY WORK IN A BUSINESS THAT SUPPORTS THE WHEAT AND CATTLE OPERATIONS. UNEMPLOYMENT IS THE COUNTY AND AREA IS VERY LOW, USUALLY IN THE 2-3% RANGE. MOST PATIENTS HAVE AVERAGE TO NORMAL PAYING JOBS WITH AVERAGE BENEFITS.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	0	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	0	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	0	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	0	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	0	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	0	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	0	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	0	AnyNonFixedPaymentsInd
Initial Contract Exception	0	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp

Field	Value	IRS element (for citing)
Person	KRYSTYL KULBECK	PersonNm
Title	PA-C	TitleTxt
Base Compensation Filing Org	$149,660	BaseCompensationFilingOrgAmt
Compensation Based On Rltd Orgs	$0	CompensationBasedOnRltdOrgsAmt
Bonus Filing Organization	$0	BonusFilingOrganizationAmount
Bonus Related Organizations	$0	BonusRelatedOrganizationsAmt
Other Compensation Filing Org	$0	OtherCompensationFilingOrgAmt
Other Compensation Rltd Orgs	$0	OtherCompensationRltdOrgsAmt
Deferred Compensation Flng Org	$2,882	DeferredCompensationFlngOrgAmt
Deferred Comp Rltd Orgs	$0	DeferredCompRltdOrgsAmt
Nontaxable Benefits Filing Org	$23,688	NontaxableBenefitsFilingOrgAmt
Nontaxable Benefits Rltd Orgs	$0	NontaxableBenefitsRltdOrgsAmt
Total Compensation Filing Org	$176,230	TotalCompensationFilingOrgAmt
Total Compensation Rltd Orgs	$0	TotalCompensationRltdOrgsAmt
Comp Report Prior990 Filing Org	$0	CompReportPrior990FilingOrgAmt
Comp Report Prior990 Rltd Orgs	$0	CompReportPrior990RltdOrgsAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 2	THE 22-BED NURSING HOME WAS DELICENSED ON 10/01/2019 AND WAS CONVERTED TO A 25-BED CAH.
FORM 990, PART III, LINE 3	THE 22-BED NURSING HOME WAS DELICENSED ON 10/01/2019 AND WAS CONVERTED TO A 25-BED CAH.
FORM 990, PART VI, SECTION A, LINE 6	ANY RESIDENT AND/OR TAXPAYER OF CHOUTEAU COUNTY HOSPITAL DISTRICT II IS ELIGIBLE TO BECOME A MEMBER. MEMBERS ELECT THE GOVERNING BODY AT AN ANNUAL MEETING.
FORM 990, PART VI, SECTION B, LINE 11B	FORM 990 IS EMAILED TO AND REVIEWED BY MANAGEMENT AND THE BOARD OF DIRECTORS BEFORE BEING FILED.
FORM 990, PART VI, SECTION B, LINE 12C	MEMBERS OF THE BOARD ARE MADE AWARE OF THE CONFLICT OF INTEREST POLICY OF THE ORGANIZATION AND DISCUSS SUCH ONCE A YEAR AT A REGULAR BOARD MEETING.
FORM 990, PART VI, SECTION B, LINE 15	THE BOARD OF DIRECTORS WILL REFER TO THE MONTANA HOSPITAL ASSOCIATION ANNUAL SALARY SURVEY.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST
FORM 990, PART IX, LINE 11G	CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 447,045. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 447,045. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 36,640. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 36,640.
FORM 990, PART IX, LINE 24E	MISCELLANEOUS: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 31,411. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 31,411. TRAINING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 29,149. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 29,149. 340B EXPENSE: PROGRAM SERVICE EXPENSES 21,718. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 21,718. BED TAX: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 19,982. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,982. LICENSES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 3,151. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,151.
FORM 990, PART XII, LINE 2C:	THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.