2019-11-12T14:42:04-06:00 2018-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1200 PORTLAND OR 98205 990 2018-01-01 473448483 BENEFIS COMMUNITY HOSPITALS INC BENE 4064552544 1101 26TH STREET SOUTH GREAT FALLS MT 59405 LOUIE KING PRESIDENT 4064552544 2019-11-11 1 WENDY CAMPOS P00448102 5032421447 2019-11-04 50.35.116.250 2019-11-11 02:06:54 PS P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 21D6D88AA253EBC443F9931C9F869B6318C08854 2018 2020-03-31 21:24:44Z LOUIE KING 1101 26TH STREET SOUTH GREAT FALLS MT 59405 6639170 0 X HTTPS://BENEFIS.ORG/TETON-MEDICAL-CENTER X 2015 MT WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 7 5 102 71 0 0 58889 116149 6830386 6457334 341 1297 16445 64390 6906061 6639170 15172 29632 0 0 4261928 3919325 0 0 0 4407297 3365839 8684397 7314796 -1778336 -675626 2298859 2527323 4057194 4966073 -1758335 -2438750 BENEFIS COMMUNITY HOSPITALS, INC. (BCH) WAS ORGANIZED IN 2015 FOR THE PURPOSE OF PROVIDING MEDICAL CARE AND TO SERVE AS AN ECONOMIC PILLAR IN RURAL MONTANA COMMUNITIES BY SUPPORTING THE ROLE OF CRITICAL ACCESS HOSPITALS. 0 0 5558715 29632 6436451 PROVIDE EMERGENCY SERVICES, OPERATE AN OUTPATIENT CLINIC, ACUTE CARE SERVICES AND ANCILLARY SERVICES INCLUDING: PHYSICAL THERAPY, LABORATORY, RADIOLOGY, ECHOCARDIOGRAPHY, CAROTID ULTRASOUND, MAMMOGRAM, DIABETIC FOOT CARE, BONE DENSITY (DEXA SCAN), TELE-DERMATOLOGY, CAT SCAN AND OCCUPATIONAL THERAPY. 5558715 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 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 0 1 0 1 0 0 1 102 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 5 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X FORREST EHLINGER 4254555479 1101 26TH STREET SOUTH GREAT FALLS MT 59405 RON DAUWALDER CHAIR 2.00 X X 0 0 0 DALE HANSON VICE CHAIR 2.00 X X 0 0 0 DAN LINDSETH DIRECTOR 2.00 X 0 0 0 JUDY BORLAND MD DIRECTOR 2.00 48.00 X 0 107133 28733 MARCIE MANGOLD DIRECTOR (THRU 10/18) 2.00 X 0 0 0 BRIAN MCCOLLOM DIRECTOR 2.00 X 0 0 0 WARD FIFIELD DIRECTOR (THRU 5/18) 2.00 X 0 0 0 JERE LONG DIRECTOR (FROM 12/18) 2.00 X 0 0 0 LOUIE KING PRESIDENT 50.00 X X 198221 0 21637 198221 107133 50370 1 0 1 0 0 116149 116149 PATIENT SERVICES 621990 6301333 6301333 OTHER PROGRAM REVENUE 621990 130329 130329 CAFETERIA 722210 20883 20883 NORTHCENTRAL MONTANA H 621990 4789 4789 6457334 1297 1297 6574 0 6574 6574 6574 OTHER INCOME 621990 57816 57816 57816 6639170 6436451 0 86570 X 1081 1081 28551 28551 219858 219858 3005360 2505963 499397 94150 70216 23934 386520 292974 93546 213437 180881 32556 731325 731325 19900 19900 735295 735295 25454 13624 11830 78621 5717 72904 187276 187276 183579 182958 621 21385 15343 6042 9 9 155791 155791 CONTRACTUAL ALLOWANCES 416407 416407 MEDICAL SUPPLIES 278733 274603 4130 PURCHASED SERVICES 226798 200653 26145 305266 291382 13884 7314796 5558715 1756081 0 159188 -36529 773368 1201927 55240 53884 63590 41527 2722319 1455805 1247473 1266514 2298859 2527323 4057194 4966073 4057194 4966073 X -1758335 -2438750 -1758335 -2438750 2298859 2527323 X -675626 -4789 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14585 14585 932698 167617 765081 1775036 1288188 486848 1266514 X PART X, LINE 2: THE ORGANIZATION IS COMPRISED OF SEVERAL CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515, AND SEVERAL LIMITED LIABILITY COMPANIES. THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS, WHICH IS AN ACCOUNTING STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2018 OR 2017. 1 1 X 1 X 1 X 1 1 0 0 28551 28551 0.00420 1319438 1519648 0 0.00000 1347989 1519648 28551 0.00420 21795 16350 5445 0.00080 25106 25106 0.00370 1081 1081 0.00020 47982 16350 31632 0.00470 1395971 1535998 60183 0.00890 7860 7860 0.00110 10835 10835 0.00160 18695 18695 0.00270 1 2436 0 2881499 2928733 -47234 X 1 1 1 1 BENEFIS TETON MEDICAL CENTER 915 FOURTH ST NW CHOTEAU MT 59422 HTTP://TETONMEDICALCENTER.NET 12766 X X X X INCLUDING EXTENDED CARE LIVING & RURAL HEALTH CLINIC BENEFIS TETON MEDICAL CENTER 0 0 1 X X X X X X X X X 17 1 0 1 1 X WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS X WWW.TETONCOMT.ORG X 1 17 1 WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES X HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES X HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES X X X X X 1 X X X 0 X X 1 X 0 0 BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 5: BCH, INC COLLABORATED WITH TETON COUNTY HEALTH DEPARTMENT AND TETON COUNTY MENTAL HEALTH LOCAL ADVISORY COUNCIL TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT. A SERIES OF SEVEN FOCUS GROUP DISCUSSIONS WERE HELD IN THREE COMMUNITIES WITHIN THE COUNTY. EACH MEETING TARGETED UNIQUE POPULATION GROUPS, INCLUDING: HIGH SCHOOL STUDENTS, PEOPLE WITH CHRONIC HEALTH CONDITIONS, MENTAL HEALTH PATIENTS AND ADVOCATES, LOW INCOME FAMILIES, FAITH COMMUNITY LEADERS AND SENIOR CITIZENS. A TOTAL OF 65 COMMUNITY MEMBERS PARTICIPATED IN THESE DISCUSSION GROUPS. EACH GROUP WAS ASKED THE SAME 7 QUESTIONS.IN ADDITION, A STAKEHOLDER ADVISORY GROUP (SAG), CONSISTING OF 23 COMMUNITY MEMBERS WITH KNOWLEDGE OF AND A BROAD CONNECTION TO THE COMMUNITY GROUPS AND SPECIAL POPULATIONS, WAS DEVELOPED. THE SAG ATTENDED 7 WEEKLY MEETINGS WITH THE FOLLOWING AGENDA:- DRAFT A VISIONS STATEMENT AND A LIST OF VALUES- REVIEW RESULTS OF FOCUS GROUP MEETINGS- IDENTIFY AND PRIORITIZE IMPORTANT LOCAL HEALTH ISSUES.- DRAFT GOALS, OBJECTIVES AND STRATEGIES FOR ADDRESSING THE TOP 3 MOST IMPORTANT LOCAL HEALTH ISSUES. BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 6B: TETON COUNTY HEALTH DEPARTMENTTETON COUNTY MENTAL HEALTH LOCAL ADVISORY COUNCIL BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 11: AN IMPLEMENTATION PLANNING COMMITTEE (IPC) PARTICIPATED IN AN PROCESS TO SYSTEMATICALLY RESPOND TO ALL ISSUES IDENTIFIED IN THE CHNA PROCESS. THE IPC REVIEWED THE PRIORITIES SET BY THE SAG, THEY IDENTIFIED THE AVAILABLE COMMUNITY PARTNERS AND IDENTIFIED THE NEEDS THAT BCH, INC WOULD BE UNABLE TO ADDRESS. THE IPC SELECTED 3 GOALS AND SET STRATEGIES FOR EACH GOAL, INCLUDING ACTIVITIES TO COMPLETE THOSE STRATEGIES. STAFF RESPONSIBLE AND A TIMELINE WERE SET TO ACCOMPLISH THE 3 GOALS. BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 13H: - HOMELESS- DECEASED WITH NO ESTATE- MENTALLY INCAPACITATED WITH NO ONE TO ACT ON HIS OR HER BEHALF- MEDICAID ELIGIBLE, BUT NOT ON THE DATE OF SERVICE OR FOR NON-COVERED SERVICES- ENROLLED IN ONE OR MORE GOVERNMENTAL PROGRAMS FOR LOW-INCOME INDIVIDUALS HAVING ELIGIBILITY CRITERIA AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES - INCARCERATION IN A PENAL INSTITUTION PART I, LINE 7: THE COST TO CHARGE RATIO IS USED TO CALCULATE THE TOTAL COMMUNITY BENEFIT EXPENSE. PART I, LINE 7, COLUMN (F) THE BAD DEBT AND CONTRACTUAL ALLOWANCES ARE INCLUDED ON FORM 990 PART IX, LINE 24(D) AND 24(A), BUT ARE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $2,436 AND $416,407 RESPECTIVELY. PART III, LINE 4: SEE NOTE 2 ON PAGE 13 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT.THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE.RECONCILIATION OF MEDICARE COST REPORT TO TOTAL MEDICARE REVENUE & EXPENSES:$2,881,499 MEDICARE NET REVENUE AS REPORTED ON PART III, SECTION B, LINE 5 $84,513 MEDICARE CLAIMS PAID BUT EXCLUDED FROM COST REPORT (OUTPATIENT FEE SCHEDULE, PHYSICIANS & OTHER MISCELLANEOUS)$2,966,012 TOTAL MEDICARE NET REVENUE$2,928,733 MEDICARE ALLOWABLE COSTS AS REPORTED ON PART III, SECTION B, LINE 6($198,117) MEDICARE COST DEPARTMENTS EXCLUDED FROM COST REPORT (OUTPATIENT FEE SCHEDULE, PHYSICIANS & OTHER MISCELLANEOUS) $135,211 MEDICARE COST REPORT REVENUE AND EXPENSE ADJUSTMENTS$2,865,827 TOTAL MEDICARE COSTS $100,185 TOTAL NET ON MEDICARE PART III, LINE 9B: PERSONS DETERMINED TO BE ELIGIBLE FOR 100 % CHARITY CARE SHALL NOT RECEIVEA BILL FOR SERVICES OR BE SUBJECT TO COLLECTION PROCEDURES. PERSONS DETERMINED TO BE ELIGIBLE FOR A REDUCTION OF A PERCENTAGE OF CHARGES UNDER THE CHARITY CARE PROGRAM LESS THAN 100% SHALL NOT BE BILLEDOR SUBJECT TO COLLECTION PROCEDURES FOR THE PORTION OF THE BILL THAT ISREDUCED UNDER THE SLIDING FEE SCALE, ONLY THE OUT OF POCKET RESPONSIBILITY. PART VI, LINE 2: HISTORICALLY, BENEFIS COMMUNITY HOSPITALS, INC. HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. IN 2017, BENEFIS COMMUNITY HOSPITALS, INC. CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR ITS SERVICE AREA IN TETON COUNTY, MONTANA, AS CONTEMPLATED BY IRC SECTION 501(R). THE ORGANIZATION WORKED COLLABORATIVELY WITH TETON COUNTY MENTAL HEALTH LOCAL ADVISORY COUNCIL (LAC) AND TETON COUNTY HEALTH DEPARTMENT TO IDENTIFY THE NEEDS OF ITS COMMUNITY THROUGH STAKEHOLDER SURVEYS, COMMUNITY FOCUS GROUPS, AND RESEARCH USING REGIONAL AND STATE HEALTH DATA. SIGNIFICANT HEALTH NEEDS OF TETON COUNTY AREA RESIDENTS WERE IDENTIFIED AND PRIORITIZED THROUGH THE SURVEY PROCESS AND DATA ANALYSIS. ALL COLLECTED INFORMATION HAS BEEN COMPILED INTO A CHNA REPORT. AFTER THE REPORT'S PUBLIC PRESENTATION, THE ORGANIZATION DEVELOPED AN IMPLEMENTATION STRATEGY FOR EACH OF THE HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT REPORT. BOTH THE ORGANIZATION'S CHNA REPORT AND ITS IMPLEMENTATION PLAN ARE AVAILABLE FREE OF CHARGE TO THE PUBLIC AS WELL AS DIGITALLY ON ITS WEBSITE AT THE FOLLOWING ADDRESS HTTPS://WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS. PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AT HTTP://TETONMEDICALCENTER.NET/DEPARTMENTS/BUSINESS-PAYMENT-SERVICES AND IS MAILED TO EACH PATIENT ALONG WITH THEIR BILLING STATEMENT. PART VI, LINE 4: THE HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL LOCATED IN CHOTEAU, TETON COUNTY, MT. THE HOSPITAL'S SERVICE AREA IS 2,293 SQUARE MILES. TETON COUNTY IS A FRONTIER COMMUNITY LOCATED ALONG THE ROCKY MOUNTAIN FRONT WITH A POPULATION DENSITY OF 3/SQUARE MILE. THE POPULATION IN CHOTEAU, MT IS 1,714 WITH TETON COUNTY'S POPULATION BEING 6,085. 14.1% OF THE RESIDENTS ARE AT OR BELOW 200% FEDERAL POVERTY LEVEL. TETON COUNTY IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA AND A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA. PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. 1 CHARITY HEALTH CARE SERVICES 44 28551 PART I, LINE 2: THE ORGANIZATION HAS A FINANCIAL ASSISTANCE POLICY IN PLACE THAT LINES OUT WHO MAY BE ELIGIBLE FOR FREE OR DISCOUNTED CARE. IN ORDER TO QUALIFY A PATIENT MUST COMPLETE AND SUBMIT A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION ACQUIRES DOCUMENTS WITH THE APPLICATION TO VERIFY CLAIMS THE APPLICANT'S QUALIFICATIONS FOR ASSISTANCE. 0 1 0 0 0 0 0 1 0 LOUIE KING PRESIDENT 132384 0 27460 0 38377 0 10143 0 11494 0 219858 0 31227 0 PART I, LINE 4B BENEFIS HEALTH SYSTEM, INC. PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR MR. KING WHO MET THE REQUIREMENTS. MR. KING RECEIVED A PAYOUT FROM THE PLAN IN 2018. PART I, LINE 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE AND MANAGEMENT LEADERSHIP TEAM. PAYMENTS PURSUANT TO THE INCENTIVE PLAN ARE SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. THE SYSTEM HAS ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, AND FINANCE/OPERATIONS. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S AND MANAGER'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM INCENTIVE PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY OVERALL PERFORMANCE. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. FORM 990, PART VI, SECTION A, LINE 1 THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NONPROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO APPROVE THE ELECTION OF INDIVIDUALS TO ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS' OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. SUCH BUSINESS RELATIONSHIPS ARE UNDERTAKEN IN THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS, AS THE PARENT AND SYSTEM ENTITY, PROVIDES THE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT NON-PROFIT CORPORATE ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES AND FUNCTIONS - MANAGEMENT OF INFORMATION TECHNOLOGY SERVICES - OVERSIGHT OF QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGEMENT OF REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. (ACTING THROUGH ITS OWN GOVERNING BODY) ELECTS THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS PRESENTED TO THE BENEFIS HEALTH SYSTEM, INC. BOARD BY THE ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND VOTING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM, INC.'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILAR SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 BENEFIS COMMUNITY HOSPITALS, INC. PROVIDES COPIES OF AUDITED FINANCIALS STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. FORM 990, PART IX, LINE 11G PROVIDER CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 735,295. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 735,295. FORM 990, PART XI, LINE 9: TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA HOSPITALS -4,789. BBB LLC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263652926 MEDICAL BUILDING MT BENEFIS HEALTH SYSTEM INC BENEFIS CASCADE RIDGE LLC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 274602798 REAL ESTATE MT BENEFIS HEALTH SYSTEM INC BENEFIS HEALTH SYSTEM FOUNDATION PROPERTIES LLC PO BOX 7008 GREAT FALLS MT 59406 272514629 HOLDS REAL ESTATE PROPERTY DONATED TO THE FOUNDATION MT BENEFIS HEALTH SYSTEM FOUNDATION BENEFIS SLETTEN HI-LINE CANCER CENTER LLC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263144419 MEDICAL CARE MT BENEFIS HEALTH SYSTEM INC WALK IN EXPRESS LLC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 320481028 OUTPATIENT CLINIC MT BENEFIS HEALTH SYSTEM INC BENEFIS SPECTRUM MEDICAL INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 810431871 HOME HEALTH AND RELATED PRODUCTS MT 501(C)(3) LINE 10 BENEFIS HEALTH SYSTEM INC 0 BENEFIS HEALTH SYSTEM FOUNDATION INC PO BOX 7008 GREAT FALLS MT 59406 810480587 FOUNDATION MT 501(C)(3) LINE 7 BENEFIS HEALTH SYSTEM INC 0 BENEFIS HEALTH SYSTEM INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263538104 MANAGEMENT AND SUPPORT SERVICES MT 501(C)(3) LINE 12C, III-FI 0 BENEFIS HEALTHCARE EES HEALTH PLAN AND TRUST 1101 26TH STREET SOUTH GREAT FALLS MT 59405 363386166 BENEFIT PLAN MT 501(C)(9) BENEFIS HEALTH SYSTEM INC 0 BENEFIS MEDICAL GROUP INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 263538192 PHYSICIAN SERVICES MT 501(C)(3) LINE 3 BENEFIS HEALTH SYSTEM INC 0 BENEFIS SENIOR SERVICES INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 461344408 SENIOR SERVICES/CCRC MT 501(C)(3) LINE 10 BENEFIS HEALTH SYSTEM INC 0 BENEFIS HOSPITALS INC 1101 26TH STREET SOUTH GREAT FALLS MT 59405 810232122 HOSPITAL MT 501(C)(3) LINE 3 BENEFIS HEALTH SYSTEM INC 0 GREAT FALLS ATHLETIC CLUB LLC 1800 BENEFIS COURT GREAT FALLS MT 59405 912081505 FITNESS CLUB MT N/A N/A 0 0 SPECTRUM HOME SOLUTIONS 2509 7TH AVE SOUTH GREAT FALLS MT 59405 810431871 IV THERAPY MT N/A N/A 0 0 TREASURE STATE HEALTHCARE NETWORK LLC 500 15TH AVENUE SOUTH GREAT FALLS MT 59405 810534714 HEALTHCARE SERVICES MT N/A N/A 0 0 BHS 2017 TRUST 400 HOWARD STREET SAN FRANCISCO CA 94105 306559361 INVESTMENT TRUST CA N/A T 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 BENEFIS HEALTHCARE EES HEALTH PLAN AND TRUST M 375909 PLAN CONTRIBUTION