2020-07-10T16:03:41-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 810231787 Northern Montana Hospital NORT 4062652211 PO Box 1231 Havre MT 595011231 David Henry President/CEO 4062652211 2020-07-10 1 Kim Hunwardsen CPA P00484560 6122536500 2020-07-10 63.233.88.226 2020-07-10 15:38:05 CD P EE7B44BF798B4EF79D5DDE03D0EF16CE53CA0C32 BA05F834D2B7B20DF6AEA96E90D793C812197CFC 2018 2021-01-29 14:40:06Z David Henry PO Box 1231 Havre MT 595011231 73619546 0 X www.nmhcare.org X 1921 MT Provision of healthcare services. 14 10 797 75 369470 59613 75370 95781 62656629 72472105 684530 1029572 9880 7294 63426409 73604752 57238 79472 0 0 35425921 34347478 0 0 16908 30114471 32064235 65597630 66491185 -2171221 7113567 68331804 74922452 9462838 10584368 58868966 64338084 X To deliver high quality comprehensive healthcare services to the Hi-Line communities. 0 0 53616685 79472 72102635 Northern Montana Hospital (Hospital) includes 49 acute care hospital beds, 135 skilled nursing beds, 10 assisted living beds and two medical clinics located in Havre, Montana. The Hospital provides quality healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of the Hospital, it is recognized that not all individuals possess the ability to purchase these essential services. It is the Hospital's mission to serve the surrounding area by providing healthcare services and healthcare education to all community members. During the year ended June 30, 2019, the Hospital provided $283,118 of medical services, based on charges, to individuals who were determined unable to purchase such services under the Hospital's charity care policy and guidelines. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients was $53,363,474 for the year ended June 30, 2019. During the fiscal year ended June 30, 2019 the Hospital provided over 3,100 days of hospital services. The nursing home provided over 31,000 resident days during the year.The Hospital also provides community care and services through many healthcare activities and programs provided to support the community. These activities include: wellness programs, community education programs, senior services, healthcare screening, special programs for specific groups, published articles, radio programs, and a variety of community supported activities. The Hospital also received many hours of volunteer help from the community residents. 53616685 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 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 68 0 1 797 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 10 0 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Kim Lucke VP of Finance 4062652211 PO Box 1231 Havre MT 59501 David C Henry President/CEO 52.00 3.00 X X 0 0 0 Miles Hamilton Chair 1.00 1.00 X X 0 0 0 David Leeds - Treasurer Treas(Jul-Sep)/Vice Chair(Oct-Jun) 1.00 1.00 X X 0 0 0 Tom Patrick - Vice Chair Vice Chair(Jul-Sep)/Trustee(Oct-Jun) 1.00 1.00 X X 0 0 0 Rick Stevens - Trustee Trustee(Jul-Sep)/Treasurer(Oct-Jun) 1.00 1.00 X X 0 0 0 Karrie Lien MD Secretary 41.00 1.00 X X 467705 0 41105 Paul Tuss Trustee 1.00 1.00 X 0 0 0 Debbie Healy Trustee 1.00 1.00 X 0 0 0 Andrew Carlson Trustee 1.00 1.00 X 0 0 0 Kirsten Kammerzell Trustee 1.00 1.00 X 0 0 0 Fr Daniel Wathen Trustee 1.00 1.00 X 0 0 0 Kevin Harada MD Trustee-IPD Jul-Jan/Chief Medical Staff(Feb-Jun) 40.00 1.00 X 478069 0 40771 Gary Grow PhD Trustee - IPD Member 40.00 1.00 X 187210 0 19613 Cameron Acor DPM Trustee - IPD Member (Feb-Jun) 40.00 1.00 X 202479 0 40368 Marc Whitacre Chief of Medical Staff (Jul-Jan) 40.00 1.00 X 294047 0 34505 Kim Lucke VP of Finance 50.00 3.00 X 101438 0 27384 Christen Obresley Vice President 40.00 14.00 X 134521 0 19745 Walter Smith MD Radiologist 40.00 0.00 X 602495 0 42405 Michelle Cameron-Donaldson MD Orthopedic Surgeon 40.00 0.00 X 635784 0 33801 Damian Ymzon MD General Surgeon 40.00 0.00 X 409289 0 41355 Mohammed Kanaan MD Oncology/Hematology 40.00 0.00 X 339349 0 40576 Margo J Hein-Muniz MD Obstetrics & Gynecology 40.00 0.00 X 320758 0 25924 4173144 0 407552 40 0 1 0 Nurses Professional Services LLC Eight Greenway Plaza Ste 400 Houston TX 77046 Staffing 1165408 University of Women's Health LLC 59 Bend Park Rd Great Falls MT 59404 Staffing 503139 Fundamental Financial Group Inc 2552 South Lima Street Aurora CO 80014 Staffing 451500 Park Place International LLC 8401 Chagrin Rd Ghagrin Falls OH 44023 IT Services 405373 Ernest V Smith MD 807 Second Ave Havre MT 59501 Staffing 400710 16 83676 12105 95781 Net Patient Service Revenue 622110 52594947 52594947 Pharmacy 446110 18087566 17718096 369470 Healthcare Consulting 900099 373011 373011 Cafeteria Revenue 722210 333127 333127 1083454 1083454 72472105 809677 809677 16582 9288 7294 7294 7294 216651 8750 0 5506 216651 3244 219895 219895 73604752 72102635 369470 1036866 79472 79472 2356913 1900823 456090 27003085 21977288 5013214 12583 605143 492514 112347 282 1995844 1624379 370535 930 2386493 1942320 443061 1112 456000 91200 364800 161702 161702 82414 82414 3800689 2821766 978923 229550 229550 2737233 1701018 1034796 1419 1480740 1184592 296148 1829163 1335675 493488 217514 166610 50904 3120275 1114247 2005446 582 913686 730949 182737 Medical Supplies 8953179 8873996 79183 Bad Debt Expense 3304386 3304386 Contract Labor 2097370 1862284 235086 Equipment Rental and Ma 996630 940319 56311 1683704 1472847 210857 66491185 53616685 12857592 16908 7775479 12976227 14476555 13778292 2220059 2312462 1189222 1186033 61392494 51017696 12152589 10374798 27852726 32232745 82424 100214 2582750 1961681 68331804 74922452 4935134 5480388 4527704 5103980 9462838 10584368 X 58868966 64338084 58868966 64338084 68331804 74922452 X 7113567 695375 -2339824 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 72056 72056 0 Part II-B, Line 1: Lobbying portion of association dues: $7,056 Montana I85 Project: $65,000 1 21369 66944 60863 27450 0 75272 75272 25294858 19895845 5399013 34630484 30058173 4572311 1391880 1063678 328202 10374798 Liability for Pension Benefits 4873621 Due to Affiliates 24036 Estimated Third Party Payables 206323 5103980 X 70309654 -3304386 -3304386 73614040 -9288 -9288 73604752 63196087 9288 9288 63186799 3304386 3304386 66491185 Part IV, Line 1b: The custodial funds are not reported on the balance sheet of NMH as they are the personal resource funds of the residents to be used only for their personal needs. If the resident passes, the funds either go to the family or back to the state. They are in no way an asset of the organization. Part X, Line 2: The Organization is organized as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Provision for bad debts included in expenses on Form 990 -3,304,386. Part XI, Line 4b - Other Adjustments: Rental expenses included in expenses on financial statements -9,288. Part XII, Line 2d - Other Adjustments: Rental expenses included in revenue on Form 990 9,288. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in revenue on financial statements 3,304,386. 1 1 X 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 4051 126000 126000 0.00200 27101 15261530 13887020 1374510 0.02180 31152 15387530 13887020 1500510 0.02380 804 804 0.00000 12 105 105 0.00000 17101 8184972 5991081 2193891 0.03470 3546 37207 37207 0.00060 20659 8223088 5991081 2232007 0.03530 51811 23610618 19878101 3732517 0.05910 4250 17039 17039 0.00030 4250 17039 17039 0.00030 0 3304386 538615 15505958 14611992 893966 X 1 1 1 1 Northern Montana Hospital 30 13th Street Havre MT 59501 www.nmhcare.org 12835 X X X 2 provider based rural health clinics Northern Montana Hospital 1 0 0 1 X X X X X X X X 17 1 0 1 1 X See Section C Supplemental Information X www.bullhook.com and www.hillcountyhealth.com X X 1 17 1 See Section C Supplemental Information 0 1 X 125.000000000000 225.000000000000 X 1 1 X X X 1 X See Supplemental Info X See Supplemental Info X See Supplemental Info X X X X X X 1 X 0 X X X X 1 X 0 1 Northern Montana Hospital Part V, Section B, Line 5: The 2018-2020 Community Health Needs Assessment includes a large collaborative effort between the hospital and the Hill County Health Consortium. Northern Montana Hospital partnered with the Hill County Health Consortium to engage multiple segments of the community to provide an assessment and plan for the health needs of Hill County. Community Assessment for Public Health Emergency Response (CASPER) was the technique used to quickly, accurately and reliably provide household-based information about our community's needs. Volunteers from Northern Montana Hospital and other community agencies hit the ground running, canvasing the community to help the Hill County Health Consortium collect data. To further gain insight on the health status of our community, the CASPER results along with county and facility statistical data were utilized in identifying the priority issues for Northern Montana Hospital. The Hill County Health Consortium consists of many important stakeholders in our community who put in a great deal of time, effort, and resources. Those who participated included the following: 1. Boys and Girls club of the Hi-Line2. Bullhook Community Health Center3. Havre Daily News4. Havre Public Schools5. Hill County Board of Health6. Hill County Commissioners7. Hill County Extension Office8. Hill County Health Department9. Human Resource Development Council (HRDC)10. Local Emergency Preparedness Committee11. Montana State University - Northern12. New Media Broadcasters, Inc.13. Northern Montana Hospital14. Office of Public Assistance15. Opportunity Link16. Rocky Boy Health Department17. Salvation Army18. Sanitarian/Planner19. United Way20. Youth Dynamics Northern Montana Hospital Part V, Section B, Line 6b: See Schedule H, Part V, Section B, Line 5 Northern Montana Hospital Part V, Section B, Line 7d: The CHNA is electronically delivered to every member of the Consortium and NMH. Bullhook Community Health Center and the Hill County Health Department all received hard copies available for distribution. Northern Montana Hospital Part V, Section B, Line 11: Priority Issue One: Opioid Abuse NMH Health leaders identified opioid abuse as their most serious health concern. While not specifically identified during the data collection process, there is a national focus on combatting the opioid epidemic. The opioid addiction crisis is now declared a public health emergency. During FY 2019 Northern Montana Hospital joined with the Northcentral Montana Hospital Alliance (NMHA) in applying for the Health Resources and Services Administration (HRSA) Planning grant to support prevention of and treatment for substance use disorders (SUD) including opioid use disorder (OUD). The grant was awarded to address prevention, treatment and recovery in rural and remote areas which include the Northern Montana Hospital Service area. Shane Jenson, APRN, Pain Management Provider, and Susan Morgan, RN, Clinic Director, have participated in training in Lewistown to develop opioid use treatment at NMHA facilities. This training allows participating facilities an opportunity to bring providers and resources together so they can help develop an OUD treatment implementation plan. NMH has established a multi-disciplinary team to address Medication Assisted Treatment (MAT). MAT includes the use of specific medications in combination with counseling and behavioral therapies to provide a "whole-patient" approach to treatment. NMH has two MAT-waived providers. A MedSafe was installed in the foyer of the second floor of Northern Montana Hospital. MedSafe is a disposal system for unused and expired medication. This system accepts controlled (Schedules II-V), non-controlled and over-the-counter medicines and meets the requirements of the DEA Controlled Substances Act. Our promotion of MedSafe through press releases, website and Facebook postings increases public awareness about the dangers of prescription misuse and the importance of proper storage and disposal of unused medications. Susan Morgan, RN, Clinic Director, and Sarah Spangler, RN, Med Surg/Sletten Clinical Director, attended the Chinook Mental Health Fair as representatives of Northern Montana Hospital. Materials presented included information on the Substance Abuse Counseling, Mental Health/Behavioral Health Providers and Pain Management available through NMH.Priority Issue 2: Substance Abuse Substance abuse statistics for Hill County led group health leaders to choose substance abuse, specifically illegal drug and alcohol abuse, as an area of concern that will also be addressed in the current planning cycle. Hill County residents who responded to the community health survey also indicated that addressing illegal drug abuse and alcohol abuse was of high importance. Based on the County Health Rankings of 2017, alcohol-impaired driving deaths in Hill County ranked 12% higher than the state of Montana. During FY 2019 NMH approached substance abuse through focused efforts which included community events, sponsorships and educational outreach opportunities. NMH participated in sponsoring the third annual Veteran's Stand Down event in November. This event afforded the opportunity to reach out to the veteran population with information on our available programs including Chemical Dependency Treatment Services. NMH's participating sponsorship in the Havre High School Senior Weekend event allows us to aid in offering alternative events to local youth. Graduation weekend is typically known for underaged alcohol consumption. Through this event, seniors participate in multiple drug-free activities to promote a safe and fun graduation weekend. Parenting Montana provides easy-to-use parenting tools to support children's success from kindergarten through the teen years. NMH participates in this program by displaying signage, providing handouts and advertising on our flat screen televisions and Facebook. Two areas of special significance discussed in this program are "Establishing Rules for Alcohol and "Mixed Messages About Alcohol." These programs are especially beneficial in helping to de-glamorize alcohol consumption. Pam Olson, RN, represented NMH at the First Annual Rocky Boy Men's Health Fair held at the Northern Winz Casino. Materials presented included Chemical Dependency Treatments Services, Prime for Life Classes, Pain Management and Behavioral Health Providers.Priority Issue 3: Tobacco Use Tobacco abuse is also considered a top priority issue among the hospital's group health leaders. The CDC reported in 2013 a Hill County tobacco use rate of 30%; the state-wide rate at that time was 18%. 78.5% of the Hill County community health survey respondents ranked tobacco use as an issue within our community. Primary Care Providers at the Rural Health Clinics conduct tobacco use screening assessments routinely as part of the office visit. Patients aged 12 and older are screened; if tobacco use is present, they are offered assistance from the Montana Quitline by nursing staff. And smoking cessation is recommended by the provider. The CDC has concluded that tobacco use screening and intervention is one of the most cost-effective clinical preventive services and is an important component of a comprehensive strategy for increasing tobacco use cessation and reducing tobacco use. Christen Obresley, VP, Regulatory and Community Services, has been appointed to the Board of Directors of the Boys & Girls Club of the Hi-Line and HELP Committee. In this role she serves on the Tobacco Use Prevention Committee providing the health care perspective. The major component of the Committee's philosophy is that we must concentrate our efforts on the younger generations in order to instill values that do not condone the use of tobacco, alcohol and other illegal substances. NMH is an active participant in the summer HELP Camp. Christen Obresley represents NMH at the North Montana Tobacco-Free Coalition. The North Montana Tobacco-Free Coalition works to promote healthier and safer communities by promoting tobacco-free lifestyles and smoke-free environments. The most recent focus of the Coalition is to change the "norms" regarding tobacco use and public health. The committee is working specifically to address the "national epidemic" of e-cigarettes (vaping) locally. The "Thumbs-up" campaign focuses on catching kids "doing things right", promoting self-esteem among today's youth. The National Institute of Health has reported that improved self-esteem in adolescents is useful in combating the onset of tobacco use. NMH promotes this campaign in-house, on Facebook, and through partnerships with the local City Recreation Department. Northern Montana Hospital acknowledges the wide range of significant health issues that emerged from the CHNA process and determined that it could effectively focus on only those health needs which it deemed to be most urgent and essential to the community as well as within its ability to influence. These health priorities are being addressed within the organization through other methods and programs throughout the community. NMH will not take new or specific, additional actions on the following health needs: obesity, cancer, depression/anxiety. Northern Montana Hospital Part V, Section B, Line 16j: In addition, a summary of the financial assistance policy is posted in the facility's emergency room and waiting rooms as well as admissions offices. The hospital's "Conditions of Treatment" also includes information regarding the financial assistance policy. Northern Montana Hospital Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Schedule H, Part V, Line 7a and 10a: nmhcare.org/wp-content/uploads/2019/10/FY19-Community-Health-Needs-Assessment-Evaluation.pdf Schedule H, Part V, Line 16a-c: Financial Assistance Policy:nmhcare.org/wp-content/uploads/2018/05/NMH-Financial-Assistance.pdf Financial Assistance Application:https://nmhcare.org/wp-content/uploads/2015/06/NMHC-Financial-Assistance-Application.pdfFinancial Assistance Plain Language Summary:https://nmhcare.org/about-us/financial-assistance-policy/ 1 1 - Northern Montana Care Center 24 13th Street Havre MT 59501 Nursing Home Part I, Line 6a: The Organization's community benefit report was published as a 1/2 page ad in the local newspaper. In addition, a statement about the amount of community benefit the organization provided can be found on our web-site at www.nmhcare.org. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid, line 7b, was calculated using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, line 7e, health professional education, line 7f, and cash and in-kind donations, line 7i, are actual costs reported in the general ledger. The cost for subsidized health services reported on line 7g was determined using the cost-to-charge ratio derived from worksheet 2. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $3,304,386. Part II, Community Building Activities: Reported under community building activities is the maintenance of our fitness park which is open to the public and has both a softball field and soccer field, as well as a paved walking path. It also includes an employee's time for being a member of the Hill County Health Consortium, which collaboratively conducted a Community Health Needs Assessment with several other local public health entities and works to implement the identified unmet needs of the community. Part III, Line 2: Bad debt expense is reported as charges net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated by using the percent of population in the Organization's service area below the FPG. The Organization feels it is reasonable to assume that at least that same percentage of bad debt is attributable to those patients that would have qualified for charity care, had the organization had the information available to determine eligibility. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 8 of the attached audited financial statements. Part III, Line 9b: The Organization's financial assistance policy provides information on collection practices for those known to qualify for financial assistance. The policy states "During the patient registration or collection process, the Hospital will make an initial determination of eligibility based on verbal or written application for charity care. Pending final eligibility determination, the Hospital will not initiate collection efforts or requests for deposits, provided that the responsible party is cooperative with the Hospital's efforts to reach a determination of status." The collection policy currently sends all patient accounts with a private pay balance to a billing services after 120 days. The billing service works directly with the patients to make payment arrangements. If they default on the payment plan the billing service recommends to the hospital to send the account to collections; however if the patient applies for financial assistance within 240 days of the date of the first invoice the hospital pulls the account back from collections and the billing service to review and complete the application process. Part VI, Line 2: In addition to conducting Community Health Needs Assessments, Northern Montana Hospital assesses the needs of the communities it serves in several ways. NMH reviews the top ten diagnosis in it's two Rural Health Clinics at least quarterly. We also monitor "left without being seen" patients in the Emergency Department. We monitor blood pressure and tobacco and alcohol status with every patient visit. We also have a Diabetes Prevention program that meets at least monthly with enrolled patients. In addition, we have a Chronic Care Management program in which our two Care Coordinators monitor high risk patients via phone calls and a software program called Chronic Care IQ that patients in the program interact with and record their vital signs back to NMH regularly. Part VI, Line 3: Northern Montana Hospital informs and educates patients about their eligibility for assistance through a sign posted at our admissions desk, notes in the brochure we give patients at our clinics, and signs posted at our clinic registration desks. In addition, our collection staff offers charity care as an option when they are discussing the patient's balance as well as the availability of various government benefits, such as Medicaid or state programs. As of Oct 2010, NMH has contracted with a company to assist the patient with qualification for programs such as Medicaid and disability determination.We also publish a community benefit report annually which states how much financial assistance we have given away, and we post our community benefit report on our website noting that we provide financial assistance. Part VI, Line 4: The Hospital's service area consists of Hill, Blaine, Liberty, Philips and the Big Sandy census district of Choteau counties. The population of this service area is approximately 30,300. The median household income is about $42,000. Approximately 45% of the population has a household income below 200% of the federal poverty guidelines. Approximately 29% of the population is covered by Medicaid, 35% by Medicare, 2.5% by CHIP and about 14% uninsured. Additionally, another 3% of the population is covered by Indian Health Services. The entire service area is considered rural and has been designated a health professional shortage area for all primary medical care, mental health and dental. In addition, the entire service area is designated as a medically underserved area. Northern Montana Hospital is the only local hospital in its service area; however there are 3 critical access hospitals, 4 rural health clinics, 3 community health clinics and 3 IHS-Tribal clinics within its service area. The nearest hospital is a critical access hospital and is 35 miles away. Part VI, Line 5: More than 50% of Northern Montana Hospital's governing board consists of various local business people who reside within our service area and are not employed or contracted by the organization. Northern Montana Hospital extends medical staff privileges to all qualified physicians in its community. The organization applies surplus funds to improvements in patient care by keeping its medical equipment up to date, sending its employed physicians for further continuing education, supporting nursing education through loan repayment assistance and scholarship programs and supporting health care education through an education assistance program. In addition, the hospital subsidizes its emergency department by offering 24/7 emergent care coverage to all, regardless of their ability to pay. Northern Montana Hospital offers Dialysis services to patients in our service area, despite the fact that this service is provided at a loss to NMH. Without this service, patients would have to travel well over 100 miles each way, 3 times per week to receive this service. Northern Montana Hospital has Sole Community Designation. The nearest PPS hospital is located 110 miles from Havre. Northern Montana Hospital also participates in all government sponsored health programs, such as CHIP, Healthy Montana Kids and the Montana Cervical and Breast Cancer Program, where it accepts payments for services at greatly discounted rates. Several members of Northern Montana Hospital's leadership team serve on other community boards, such as: Havre Chamber of Commerce, Hill County Health Consortium, Local Emergency Planning, Fetal/Infant/Child Mortality Review Board, Havre/Hill County Planning Board, Hill and Blaine County Adult Protective Services Committee, Hill County United Way, HRDC Medical Advisory Board, MSU-N Nursing Advisory Board and the Safe Kids Safe Communities Committee. Part VI, Line 7, Reports Filed With States MT 1 Education Assistance 6 14437 Nursing Scholarships 5 10000 Nurse Loan Repayment 9 54273 Part I, Line 2: The organization provides education assistance to qualified employees. The organization monitors the use of the assistance by disbursing the funds directly to the institution. Schedule I, Part III: The Organization will pay up to $5,250 per person per year for education assistance in a healthcare related field. Not all recipients request the total amount. The Organization anticipates 3-8 recipients per year. The Organization will pay up to $5,000 per person for nursing scholarships. The Organization anticipates 3-6 per year. The Organization will be up to $7,500 per person for Nurse Loan re-payments. The Organization anticipates 2-4 per year. 0 0 0 1 0 0 0 0 0 Karrie Lien MD Secretary 467291 0 0 0 414 0 5500 0 37806 0 511011 0 0 0 Kevin Harada MD Trustee-IPD Jul-Jan/Chief Medical Staff(Feb-Jun) 477910 0 0 0 159 0 5500 0 37543 0 521112 0 0 0 Gary Grow PhD Trustee - IPD Member 186022 0 0 0 1188 0 3875 0 16643 0 207728 0 0 0 Cameron Acor DPM Trustee - IPD Member (Feb-Jun) 202209 0 0 0 270 0 4463 0 36944 0 243886 0 0 0 Marc Whitacre Chief of Medical Staff (Jul-Jan) 291944 0 0 0 2103 0 5500 0 30417 0 329964 0 0 0 Christen Obresley Vice President 134079 0 0 0 442 0 2815 0 17587 0 154923 0 0 0 Walter Smith MD Radiologist 601721 0 0 0 774 0 5500 0 39741 0 647736 0 0 0 Michelle Cameron-Donaldson MD Orthopedic Surgeon 635394 0 0 0 390 0 5500 0 31261 0 672545 0 0 0 Damian Ymzon MD General Surgeon 409094 0 0 0 195 0 5500 0 37825 0 452614 0 0 0 Mohammed Kanaan MD Oncology/Hematology 339187 0 0 0 162 0 5500 0 36709 0 381558 0 0 0 Margo J Hein-Muniz MD Obstetrics & Gynecology 320344 0 0 0 414 0 5500 0 21935 0 348193 0 0 0 Part I, Line 3 President/CEO is compensated by an unrelated management company. A related organization and the management company have a process in place to determine the CEO's compensation a compensation committee, using the Form 990 of other organizations, and the approval by the board or compensation committee. Part I, Line 5 Karrie Lien, Kevin Harada, and Gary Grow are compensated as a percentage of the prior three months' average gross revenue earned for the hospital by the physician, with the percentage being based on their specialty. Form 990, Part VI, Section A, line 3 David C. Henry, President/CEO is employed by Fundamental Financial Group, an unrelated management company. Northern Montana Hospital (NMH), pays the unrelated management company for David's services provided to the Hospital, Northern Montana Health Care, Inc. and Northern Montana Health Care Foundation. The President/CEO's responsibilities include implementing decisions and supervising the management, administration and operation of the Hospital and the related, exempt organizations. The amount of compensation paid during fiscal year 2019 was $456,000. The amount of compensation paid during the calendar year 2018 was $451,500. Form 990, Part VI, Section A, line 6 The sole member of the organization is Northern Montana Health Care, Inc. Form 990, Part VI, Section A, line 7b The sole member of the organization shall have such rights and powers as are provided for in the Articles of Incorporation, the Bylaws of the organization and the laws of the State of Montana, including but not limited to, the exclusive power: (a) to remove any trustee from any office at any time, with or without cause; (b) to propose and approve (i) a plan of dissolution or liquidation of the organization or (ii) a plan of merger or consolidation of the organization with another corporation; (c) to propose and approve amendments to the articles of incorporation and or the bylaws;(d) to adopt any annual or long-term capital or operational budget or any changes therein exceeding $75,000;(e) to authorize the organization to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operational budget approved by the sole member of the organization where the amount involved exceeds $50,000;(f) to adopt substantive changes to existing long-term or master institutional plans of the organization; (g) to authorize the organization to engage in, or enter into, any transaction providing for the sale, mortgage or other disposition of all or substantially all of the assets of the organization; (h) to organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the organization; (i) to authorize the organization to enter into any shared service agreement; (j) to approve long-term borrowing of money by the organization or authorize the organization to incur indebtedness involving a mortgage or lien on assets; or (k) to approve the trustees or the President of the organization from a slate prepared by the Nominating Committee of the organization. Form 990, Part VI, Section A, line 8b No committee has the authority to act on behalf of the board. Form 990, Part VI, Section B, line 11b The VP of Finance reviews the form. The Board of Directors receives a copy of the reviewed Form 990 via e-mail before it is filed. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers all trustees, directors, officers, and key employees. The board identifies potential conflicts from annual disclosures. Disclosures are reviewed by administration after all are gathered. A second conflict disclosure letter is sent out annually to all current and former officers, directors, trustees, and key employees to ensure all potential conflicts are identified. The results of this disclosure form are reviewed by the VP of Finance. The board discusses the potential conflicts and determines if voting on related items would be a conflict of interest. If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item. Form 990, Part VI, Section B, line 15a The President/CEO is compensated by an unrelated management company. The unrelated management company receives a fee for service for the CEO's service provided to this organization and related organizations, Northern Montana Health Care, Inc (NMHC) and Northern Montana Health Care Foundation, Inc. (NMHCF). In determining the CEO's compensation, the governing board, with the exception of the CEO, meets and reviews NMH and NMHC financial results, CEO's current year priorities, discusses evaluation tools to be used for the CEO's evaluation, how comparative salaries will be obtained and discusses the history of compensation to the CEO. At a second meeting the Board reviews non-financial activity of NMH and NMHC and the results of the CEO evaluations completed by the board members. Then they review and discuss a compensation comparative summary of Montana CEO's compensation. They agree upon a list of the coming year's priorities for the CEO and proposed compensation, with the compensation set by board vote. This annual process was completed during fiscal year 2019. The CEO reviews and approves the compensation for all other officers and physicians. 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. The financial statements are attached to the Form 990 per the IRS instructions. Form 990, Part XI, line 9: Minimum Pension Liability Adjustment: -1,839,824. Equity Transfer to Affiliate - Northern Montana Health Care, Inc. -500,000. Form 990, Part XII, Line 2c: The controlling organization, Northern Montana Health Care, Inc.'s Board has a committee that assumes responsibility for oversight of the audit of the financial statements and selection of an independent auditor. North Care Corporation 30 13th Street Havre MT 59501 810447638 Health Care Services MT 501(c)(3) Line 3 Northern Montana Health Care Inc 0 Northern Montana Health Care Inc PO Box 1231 Havre MT 59501 810428854 Supporting Organization MT 501(c)(3) Line 12b, II N/A 0 Northern Montana Health Care Foundation Inc PO Box 1231 Havre MT 59501 363464641 Fundraising MT 501(c)(3) Line 7 Northern Montana Health Care Inc 0 Paramount Health Care Inc PO Box 1231 Havre MT 59501 810393353 Health Care Services MT N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 1 Northern Montana Health Care Foundation Inc C 83676