2019-05-13T13:06:04-05:00 2018-06-30 450250958 Eide Bailly LLP 401 N 31st St Ste 1120 PO Box 7112 Billings MT 591037112 990 2017-07-01 810231787 Northern Montana Hospital NORT 4062652211 PO Box 1231 Havre MT 595011231 David Henry President/CEO 4062652211 2019-05-10 1 Kim C Hunwardsen P00484560 4068962400 2019-05-10 72.175.213.18 2019-05-10 14:05:35 MD P B1517DAAED479AA3B0236E79C14EA2E11B9BE589 B1517DAAED479AA3B0236E79C14EA2E11B9BE589 2017 2019-02-21 02:37:17Z David Henry PO Box 1231 Havre MT 595011231 63469712 0 X www.nmhcare.org X 1921 MT Provision of healthcare services. 14 10 797 108 137322 53860 34859 75370 67072151 62656629 1084134 684530 7206 9880 68198350 63426409 142729 57238 0 0 35058102 35425921 0 0 0 29866360 30114471 65067191 65597630 3131159 -2171221 71145505 68331804 11168882 9462838 59976623 58868966 X To deliver high quality comprehensive healthcare services to the Hi-Line communities. 0 0 50559161 57238 62656629 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, 2018, the Hospital provided $263,240 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 $51,359,829 for the year ended June 30, 2018. During the fiscal year ended June 30, 2018 the Hospital provided over 3,200 days of hospital services. The nursing home provided over 30,000 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. 50559161 1 1 0 0 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 1 102 0 1 797 1 1 1 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 41.00 2.00 X X 0 0 0 Miles Hamilton Chair 1.00 1.00 X X 0 0 0 Tom Patrick Vice Chair 1.00 1.00 X X 0 0 0 David Leeds Treasurer 1.00 1.00 X X 0 0 0 Karrie Lien MD Secretary 41.00 1.00 X X 496430 0 36814 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 Rick Stevens 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 Trusteee - IPD Member 40.00 1.00 X 400165 0 42230 Gary Grow PhD Trustee - IPD Member 40.00 1.00 X 184382 0 20484 Marc Whitacre Chief of Medical Staff 40.00 1.00 X 293181 0 36214 Kim Lucke VP of Finance 43.00 2.00 X 99660 0 28735 Christen Obresley Vice President 40.00 1.00 X 129059 0 20555 Walter Smith MD Radiologist 40.00 0.00 X 593690 0 43964 Michelle Cameron-Donaldson MD Orthopedic Surgeon 40.00 0.00 X 636072 0 33975 Damian Ymzon MD General Surgeon 40.00 0.00 X 355587 0 38214 Mohammed Kanaan MD Oncology/Hematology 40.00 0.00 X 334428 0 42330 Margo J Hein-Muniz MD Obstetrics & Gynecology 40.00 0.00 X 319420 0 28771 3842074 0 372286 43 0 1 0 Nurses Professional Svcs LLC 1616 S Voss Ste 350 Houston MT 77057 Staffing 950797 Cornerstone Advisors Group LLC PO Box 419695 Boston TX 02241 IT Consulting Services 609106 Benefis Healthcare 1101 26th Street S Great Falls MT 59405 IT Services & Staffing 554926 University Women's Health LLC 59 Bend Park Rd Great Falls MT 59405 Staffing 443780 Fundamental Financial Group Inc 2552 South Lima Street Aurora CO 80014 CEO Services 439000 20 51315 24055 75370 Net Patient Service Revenue 622110 46019920 46019920 Pharmacy 446110 15002585 14865263 137322 Healthcare Consulting 900099 357640 357640 Cafeteria Revenue 722210 340837 340837 935647 935647 62656629 716388 716388 19325 9445 9880 9880 9880 2000 33263 595 -33263 1405 -31858 -31858 63426409 62519307 137322 694410 57238 57238 2041790 1621784 420006 28015776 19611043 8404733 950687 665481 285206 1953046 1367132 585914 2464622 1725235 739387 332000 66400 265600 269896 269896 80122 80122 3181022 2873691 307331 282106 282106 2830802 2382533 448269 1368886 1095109 273777 1844691 1288450 556241 218938 76628 142310 1318 1318 3552152 2486506 1065646 1043602 834882 208720 Medical Supplies 8356292 8322867 33425 Bad Debt Expense 3390687 3390687 Equipment Rental and Ma 992097 545653 446444 Contract Labor 845552 845552 1524308 1302290 222018 65597630 50559161 15038469 0 5966764 7775479 15156938 14476555 2294632 2220059 735196 1189222 60602184 48449595 14613251 12152589 28466580 27852726 88018 82424 3824126 2582750 71145505 68331804 5243040 4935134 198275 5727567 4527704 11168882 9462838 X 59976623 58868966 59976623 58868966 71145505 68331804 X -2171221 -83948 1147512 X X 0 1 X 1 0 X 1 21575 65753 65959 21369 0 75272 75272 24997279 19294948 5702331 33998178 28142827 5855351 1531455 1011820 519635 12152589 Liability for Pension Benefits 4244430 Due to Affiliates 17030 Estimated Third Party Payables 266244 4527704 X 60202826 -3390687 -3390687 63593513 -167104 -167104 63426409 62374047 167104 167104 62206943 3390687 3390687 65597630 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 -3,390,687. Part XI, Line 4b - Other Adjustments: Rental expenses included in expenses on financial statements -9,445. UBI COGS and bad debt included in expenses on financial statements -157,659. Part XII, Line 2d - Other Adjustments: Rental expenses included in revenue on Form 990 9,445. UBI COGS and bad debt included in revenue on Form 990 157,659. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in revenue on financial statements 3,390,687. 1 1 X 1 X 125.000000000000 1 X 225.000000000000 1 1 0 1 1 2609 126000 126000 0.00200 27406 16209699 10685195 5524504 0.08880 30015 16335699 10685195 5650504 0.09080 426 3887 3887 0.00010 9817 6284184 4355517 1928667 0.03100 3265 25435 25435 0.00040 13508 6313506 4355517 1957989 0.03150 43523 22649205 15040712 7608493 0.12230 4440 14916 14916 0.00020 4440 14916 14916 0.00020 0 3390687 605577 13102089 13588809 -486720 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 nmhcare.org/documents X www.bullhook.com and www.hillcountyhealth.com X X 1 17 1 nmhcare.org/documents 0 1 X 125.000000000000 225.000000000000 X 1 1 X X X 1 X nmhcare.org/documents X nmhcare.org/documents X https://nmhcare.org/about-us/financial-assistance-policy/ 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: In the most recent CHNA conducted for the period of FY2018 through FY2020 the NMH health leaders have identified the following priorities: -Opioids-Illegal Drug Use/ Alcohol-Tobacco UsePriority Issue One: Opioid AbuseNMH 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 as a public health emergency. Behavioral Risk Factors also support this concern as an area on which the hospital needs to focus. Prescription drug use (including opioids) is 6% higher in Hill County than in Montana State. Prescription opioid related drug overdose deaths make-up 43.7% of Montana Residents; based on death certificates from 2000-2015 (Office of Epidemiology and Scientific Support, Montana DPHHS). During an 11 month period 36 patients presented to NMH with opioid dependency or opioid overdose as their primary diagnosis. Another 18 patients participated in the NMCDTS program for treatment of their opioid addiction. Initiative - Create a specific multi-disciplinary opioid abuse prevention team to develop a unified approach for policy review, education, intervention and treatment. Actions: 1. Create an inventory of current opioid related programs, policies and procedures.2. Create a public awareness campaign about prescription opioid misuse and opioid use disorder and treatment.3. Develop a strategic plan to reduce opioid abuse using Northern Montana Hospital's current Chemical Dependency Treatment Services Program and Pain Management program.Northern Montana Hospital does have the existing infrastructure, organizational competencies and established protocols to deal with implementing most of the actions identified in Initiative. Priority Issue 2: Substance AbuseSubstance Abuse statistics for Hill County led group health leaders to choose substance abuse, specifically; illegal drug and alcohol abuse as an area of concern 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. Initiative - Partner with community stakeholders to secure a regional hub for prevention. Actions: 1. Create a public awareness campaign about substance abuse, specifically illegal drug abuse and alcohol abuse. 2. Utilize current pain management program to reduce addiction and self-medication.3. Conduct screening assessments at annual wellness exams and provide educational materials.NMH has a great foundation of chemical dependency programs that can be further built upon to include the surrounding community and implement prevention courses and treatments offered at the hospital. Priority Issue 3: Tobacco UseTobacco abuse is also considered a top priority issue amongst 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. Initiative - Identify and implement strategies to reduce tobacco use among NMH patients. Actions:1. Conduct screening assessments at annual wellness exams.2. Create communication strategies about detecting early warning signs of tobacco use.3. Collaborate with Hill & Blaine County Tobacco Coalition to develop a strategic plan to reduce tobacco use. 4. Collaborate with other stakeholders to promote smoking cessation. During the collaborative Community Health Needs Assessment. The following top six health issues were drawn from a written survey, asking the community, "Using the following list, for each potential problem, please tell us if this is not a problem, a problem, a big problem, or don't know." The community sees the following as the top five health concerns in Hill County based on the perception of "a problem and "a big problem":-Obesity (79.8%)-Illegal Drug Abuse (78.8%)-Alcohol Abuse (78.8%)-Tobacco Use (78.5%)-Cancer (73.1%)-Depression/Anxiety (72.8%)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 l will not take new or specific, additional actions on the following health needs: Obesity: Obesity continues to be addressed indirectly through assessment, education and awareness. BMI is evaluated during the patients' visits to their primary care providers. Additionally, focusing on health indicators such as blood pressure, glucose and cholesterol levels gives primary care providers another avenue to discuss and motivate their patients to lose weight. Northern Montana Hospital built and maintains the Community Fitness Park. Area residents enjoy the outdoor destination for walking, soccer, softball/baseball, kite flying, pet walking and family picnics. The Community Fitness Park is featured on the community walking map. Three laps equal one mile.Cancer: The Northern Montana Sletten Cancer Center provides compassionate care for cancer patients and their families. Upon diagnosis patients are supported by a team of medical professionals working together to determine the best course of treatment for them. The Northern Montana Sletten Cancer Center is celebrating a "Decade of Caring" in August of 2018. Both chemotherapy and radiation therapy services are provided at the center. Cancer is not being addressed as a priority issue in this assessment as the hospital already provides treatment services to the community.Depression/Anxiety: Northern Montana Hospital provides local services in the community to address Depression/Anxiety; therefore, it is not being identified as a priority issue in this report. During the patient's annual examination, the PHQ-2 is utilized to screen for depression. Patients who screen positive on the PHQ-2 may require further testing and may be evaluated with the PHQ-9. The PHQ-9 is a more detailed test with a scoring system based on duration/severity of symptoms. Northern Montana Hospital employs three Psychologists and one Psychiatric Nurse Practitioner who provide mental health services to the community. Additionally, we stabilize vulnerable patients with mental health issues on our Medical Surgical floor. In FY18 the following actions were taken to address the needs identified in the FY15 CHNA:Alcohol Abuse: NMH continued to engage in routine alcohol screening, intervention and referral as part of the Rural Health Clinic annual visit with the patient Family Social History update process. Northern Montana Hospital Chemical Dependency Treatment and Addiction Counseling Services program began its third year, treating substance abuse disorders with individualized treatment plans, as well as individual and group therapy.Mental Health Awareness: NMH continued to screen for depression in a "first step approach" using the Patient Health Questionnaire in the primary care setting which inquired on the frequency of depressed mood and anhedonia in the patient's past two weeks. Teen Pregnancy: NMH continued to provide reproductive health care services to teens during their pregnancy and delivery at the Northern Montana Family Medical Center (NMFMC). NMH supported the Consortium through in-kind donations such as meeting rooms, copies, and web-site postings, as well as financial support for the CHNA/CHIP. Providers continued to discuss reproductive health needs with teens during regularly scheduled visits, including pre-participation examinations (sports physicals). NMFMC continued to offer free condoms.Patient Centered Medical Home (PCMH): In FY18 providers at NMFMC and Northern Montana Specialty Medical Center continued to focus on clinical effectiveness in clinical quality measures and population health measures. The identified quality measures continue to be monitored through the QAPI Program and reported individually in a report card format to the providers. 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: https://nmhcare.org/about-us/community-health-needs-assessment/ Schedule H, Part V, Line 10a: https://nmhcare.org/about-us/community-health-needs-assessment/ 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 $3,390,687. 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 7 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: Through the Hill County Health Consortium, Northern Montana Hospital partnered with the Hill County Health Department, Bullhook Community Health Center, Montana State University - Northern, District 4 Human Resources Development Council, and the Boys & Girls Club of the Hi-Line. These partnerships brought multiple sections of the community together for a collaborative assessment of Hill County's health needs. To further grasp the health status of our community and to facilitate good prioritization, multiple assessments were utilized to create the survey tool. The survey tool along with county and facility statistical data directed the selection of the health priorities. The Community Assessment for Public Health Emergency Response (CASPER) is an epidemiologic technique designed to provide quickly and at a low-cost household-based information about a community. The CASPER toolkit was used to collect primary data as part of a collaborative Community Health Needs Assessment. CASPER involves conducting door-to-door surveys using a random sample of households. Community partners recruited 37 volunteers from 7 different agencies. Volunteers had just-in-time training led by the State of Montana one week prior to the data collection. This training covered an overview of the CASPER method, the survey tool, safety guidelines and volunteer roles and responsibilities. Volunteers were deployed to 18 different clusters located throughout Hill County to conduct surveys. A return rate of 80% was needed for the sample to be valid, and a return rate of 86% (121 surveys out of 140) was achieved. 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 3 8171 Nursing Scholarships 3 15000 Nurse Loan Repayment 8 34067 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 pay up to $7,500 per person for Nurse loan re-payment. The organization anticipates 3-6 per year. The organization also does a State match for up to $25,000 per person for PA and NP loan re-payment. The Organization anticipates 2-4 per year. 0 0 0 1 0 0 0 0 0 Karrie Lien MD Secretary 496016 0 0 0 414 0 5400 0 33718 0 535548 0 0 0 Kevin Harada MD Trusteee - IPD Member 400021 0 0 0 144 0 5400 0 38753 0 444318 0 0 0 Gary Grow PhD Trustee - IPD Member 183194 0 0 0 1188 0 3829 0 17549 0 205760 0 0 0 Marc Whitacre Chief of Medical Staff 291993 0 0 0 1188 0 5400 0 32224 0 330805 0 0 0 Christen Obresley Vice President 128636 0 0 0 423 0 2715 0 18473 0 150247 0 0 0 Walter Smith MD Radiologist 592916 0 0 0 774 0 5400 0 41363 0 640453 0 0 0 Michelle Cameron-Donaldson MD Orthopedic Surgeon 635802 0 0 0 270 0 5400 0 31533 0 673005 0 0 0 Damian Ymzon MD General Surgeon 355407 0 0 0 180 0 5400 0 34523 0 395510 0 0 0 Mohammed Kanaan MD Oncology/Hematology 334266 0 0 0 162 0 5400 0 38538 0 378366 0 0 0 Margo J Hein-Muniz MD Obstetrics & Gynecology 319006 0 0 0 414 0 5400 0 24880 0 349700 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 using the Form 990 of other organizations, a written employment contract, a compensation survey or study, 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 2018 was $446,000. The amount of compensation paid during the calendar year 2017 was $439,000. 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 2018. 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: 1,647,512. 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 51315