STILLWATER HOSPITAL ASSOCIATION INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- STILLWATER HOSPITAL ASSOCIATION INC (EIN 81-0286525)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-05-08
- IRS object ID
- 201811289349302646
- Schema version
- 2016v3.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-05-08T16:09:44-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 South Tejon Suite 800 | AddressLine1Txt |
| City | Colorado Springs | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 809039848 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810286525 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stillwater Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % KELLEY HARMON | InCareOfNm |
| Business Name Control | STIL | BusinessNameControlTxt |
| Phone | 4063225316 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 N 11th St | AddressLine1Txt |
| City | Columbus | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59019 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MIKE FOLLETT | PersonNm |
| Person Title | Interim CEO | PersonTitleTxt |
| Phone | 4063225316 | PhoneNum |
| Signature | 2018-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Adam R Smith CPA | PreparerPersonNm |
| PTIN | P00958966 | PTIN |
| Phone | 7194714290 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Mike Follett | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 N 11th St | AddressLine1Txt |
| City | Columbus | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59019 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,266,852 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.stillwaterbillingsclinic.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1914 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | Stillwater Hospital Association is a rural integrated health care organization bringing together a physician clinic & hospital svcs to deliver quality coordinated care. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 79 | TotalEmployeeCnt |
| Total Volunteers | 5 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $138,527 | PYContributionsGrantsAmt |
| CY Contributions Grants | $487,491 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,777,223 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,189,255 | CYProgramServiceRevenueAmt |
| PY Investment Income | $31,744 | PYInvestmentIncomeAmt |
| CY Investment Income | $55,968 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$2,223 | PYOtherRevenueAmt |
| CY Other Revenue | $2,902 | CYOtherRevenueAmt |
| PY Total Revenue | $9,945,271 | PYTotalRevenueAmt |
| CY Total Revenue | $10,735,616 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $4,929 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,088 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $3,257,627 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,892,661 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,299,721 | PYOtherExpensesAmt |
| CY Other Expenses | $5,829,754 | CYOtherExpensesAmt |
| PY Total Expenses | $9,562,277 | PYTotalExpensesAmt |
| CY Total Expenses | $10,728,503 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $382,994 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,113 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $17,610,146 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,273,240 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $14,072,199 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $13,710,728 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,537,947 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $3,562,512 | NetAssetsOrFundBalancesEOYAmt |
| Mission | STILLWATER HOSPITAL ASSOCIATION IS A RURAL INTEGRATED HEALTH CARE ORGANIZATION BRINGING TOGETHER A PHYSICIAN CLINIC & HOSPITAL SERVICES TO DELIVER QUALITY COORDINATED CARE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $7,985,459 | ExpenseAmt |
| Grant | $6,088 | GrantAmt |
| Revenue | $10,183,041 | RevenueAmt |
| Desc | ACUTE CARE HOSPITAL AND RURAL HEALTH CLINIC | Desc |
| Total Program Service Expenses | $7,985,459 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 4 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 79 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KELLEY HARMON | PersonNm |
| Phone | 9706574612 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2800 TENTH AVENUE N | AddressLine1Txt |
| City | Billings | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Michael Matovich | ||||||||
| President | 3.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Luke Kobold | ||||||||
| Vice President | 3.0 | 40.0 | Yes (X) | Yes (X) | $0 | $151,316 | $33,794 | |
| Ron Martinez | ||||||||
| Secretary/Treasurer | 3.0 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Dr Camilla Reese | ||||||||
| Director | 3.0 | 40.0 | Yes (X) | $0 | $305,748 | $29,781 | ||
| Dr Richard Klee | ||||||||
| Director/physician | 40.0 | 1.0 | Yes (X) | $0 | $311,123 | $34,411 | ||
| Mike Follett | ||||||||
| Interim CEO | 40.0 | 3.0 | Yes (X) | Yes (X) | $0 | $184,960 | $19,381 | |
| Bharat Acharya | ||||||||
| Director | 3.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Dr Dan Vesbach | ||||||||
| Director | 3.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Tom Chamberlain | ||||||||
| Director | 3.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Dr Deborah Agnew | ||||||||
| CEO | 14.0 | 12.0 | Yes (X) | $90,864 | $77,884 | $26,329 | ||
| Kelley Evans | ||||||||
| CAO | 20.0 | 0.0 | Yes (X) | $75,208 | $0 | $19,468 | ||
| Dr David Kane | ||||||||
| Physician | 40.0 | 0.0 | $0 | $281,430 | $43,748 | Yes (X) | ||
| Susan Ivankovich | ||||||||
| Physician Assistant | 40.0 | 0.0 | $0 | $145,330 | $32,495 | Yes (X) | ||
| Quinten Lundby | ||||||||
| Laboratory Supervisor | 40.0 | 0.0 | $114,745 | $0 | $20,703 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $280,817 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,457,791 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $260,110 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| BILLINGS CLINIC | |||||
| 2800 Tenth Avenue North | BILLINGS | MT | 59101 | mgmt/staff services | $2,733,225 |
| WILDERNESS MEDICAL STAFFING | |||||
| PO BOX 616 | HOMER | AK | 99603 | MEDICAL STAFFING | $133,336 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $487,491 | AllOtherContributionsAmt |
| Total Contributions | $487,491 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 621300 | $10,173,157 | $10,173,157 | |
| MEALS | 900099 | $9,116 | $9,116 | |
| MEANINGFUL USE REVENUE | 621110 | $6,982 | $6,982 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,189,255 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,645 | TotalRevenueColumnAmt |
| Exclusion | $7,645 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $579,559 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $531,236 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $48,323 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $48,323 | TotalRevenueColumnAmt |
| Exclusion | $48,323 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | MISCELLANEOUS INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $2,902 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,902 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $2,902 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,735,616 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,183,041 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $65,084 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,088 | TotalAmt |
| Program Services | $6,088 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,943 | TotalAmt |
| Program Services | $306,114 | ProgramServicesAmt |
| Management And General | $51,829 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,774,464 | TotalAmt |
| Program Services | $2,737,757 | ProgramServicesAmt |
| Management And General | $1,036,707 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $114,640 | TotalAmt |
| Program Services | $86,618 | ProgramServicesAmt |
| Management And General | $28,022 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $363,792 | TotalAmt |
| Program Services | $242,332 | ProgramServicesAmt |
| Management And General | $121,460 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $281,822 | TotalAmt |
| Program Services | $195,357 | ProgramServicesAmt |
| Management And General | $86,465 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,184,969 | TotalAmt |
| Program Services | $983,896 | ProgramServicesAmt |
| Management And General | $201,073 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $755 | TotalAmt |
| Management And General | $755 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,540 | TotalAmt |
| Management And General | $7,540 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $859,808 | TotalAmt |
| Program Services | $591,269 | ProgramServicesAmt |
| Management And General | $268,539 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,332 | TotalAmt |
| Program Services | $18,348 | ProgramServicesAmt |
| Management And General | $21,984 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,930 | TotalAmt |
| Program Services | $94,481 | ProgramServicesAmt |
| Management And General | $217,449 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,749 | TotalAmt |
| Program Services | $11,739 | ProgramServicesAmt |
| Management And General | $1,010 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $202,475 | TotalAmt |
| Program Services | $159,955 | ProgramServicesAmt |
| Management And General | $42,520 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,415 | TotalAmt |
| Program Services | $50,777 | ProgramServicesAmt |
| Management And General | $30,638 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $780,894 | TotalAmt |
| Program Services | $616,906 | ProgramServicesAmt |
| Management And General | $163,988 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $959,620 | TotalAmt |
| Program Services | $692,107 | ProgramServicesAmt |
| Management And General | $267,513 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $160,772 | TotalAmt |
| Program Services | $20,585 | ProgramServicesAmt |
| Management And General | $140,187 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR BAD DEBT | $613,933 | $613,933 | |
| MEDICAL SUPPLIES | $540,554 | $514,442 | $26,112 |
| DIETARY | $33,254 | $31,824 | $1,430 |
| REPAIRS & MAINTENANCE | $26,129 | $6,778 | $19,351 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,625 | TotalAmt |
| Program Services | $4,153 | ProgramServicesAmt |
| Management And General | $8,472 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,728,503 | TotalAmt |
| Program Services | $7,985,459 | ProgramServicesAmt |
| Management And General | $2,743,044 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,444,965 | BOYAmt |
| EOY | $2,365,749 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,048,700 | BOYAmt |
| EOY | $1,501,606 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,256,484 | BOYAmt |
| EOY | $1,668,242 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $184,089 | BOYAmt |
| EOY | $218,038 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $176,688 | BOYAmt |
| EOY | $182,046 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $16,412,797 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,127,247 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,007,904 | BOYAmt |
| EOY | $11,285,550 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $458,976 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,340 | BOYAmt |
| EOY | $52,009 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,610,146 | BOYAmt |
| EOY | $17,273,240 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $507,320 | BOYAmt |
| EOY | $467,802 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,301,067 | BOYAmt |
| EOY | $12,961,992 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $263,812 | BOYAmt |
| EOY | $280,934 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,072,199 | BOYAmt |
| EOY | $13,710,728 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,406,178 | BOYAmt |
| EOY | $3,521,112 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $111,769 | BOYAmt |
| EOY | $21,400 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,000 | BOYAmt |
| EOY | $20,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,537,947 | BOYAmt |
| EOY | $3,562,512 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,610,146 | BOYAmt |
| EOY | $17,273,240 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $7,113 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $17,452 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $29,176 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $50 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $9,226 | OtherExpendituresAmt |
| End Year Balance | $20,000 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $29,088 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $88 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $29,176 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $29,001 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $87 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $29,088 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $28,914 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $87 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $29,001 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $28,813 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $101 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $28,914 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $558,194 | OtherCostOrOtherBasisAmt |
| Book Value | $558,194 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,088,220 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,663,638 | DepreciationAmt |
| Book Value | $9,424,582 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,853,649 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,024,288 | DepreciationAmt |
| Book Value | $829,361 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $912,734 | OtherCostOrOtherBasisAmt |
| Depreciation | $439,321 | DepreciationAmt |
| Book Value | $473,413 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,285,550 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO RELATED ORGANIZATION | Desc |
| Amt | $280,934 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $280,934 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $10,145,409 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $17,452 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $6,274 | OtherRevenueAmt |
| Revenue Not Reported | $23,726 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,121,683 | RevenueSubtotalAmt |
| Other Revenues Not Included | $613,933 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $613,933 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $10,735,616 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $10,134,239 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $19,669 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $19,669 | ExpensesNotReportedAmt |
| Expenses Subtotal | $10,114,570 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $613,933 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $613,933 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $10,728,503 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part V, line 4 | DESCRIBE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS: The endowment includes donor-restricted endowment funds. As required by accounting principles generally accepted in the United States of America GAAP), net assets associated with endowment funds are classified and reported based on the existence or absence of donor-imposed restrictions. |
| Schedule D, PART X, LINE 2 | UNCERTAIN TAX POSITIONS: Management has evaluated their income tax positions under the guidance included in asc 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. |
| SCHEDULE D, PART XI, LINE 2D | REVENUE ON BOOKS, NOT ON RETURN: ACTIVITY OF STILLWATER FOUNDATION CONSOLIDATED IN FINANCIALS, EXCLUDED FOR TAX RETURN 6,274 |
| SCHEDULE D, PART XI, LINE 4B | REVENUE ON RETURN, NOT ON BOOKS: BAD DEBT NET WITH REVENUE ON FINANCIALS, TREATED AS EXPENSE ON TAX RETURN 613,933 |
| SCHEDULE D, PART XII, LINE 2D | EXPENSE ON BOOKS, NOT ON RETURN: ACTIVITY OF STILLWATER FOUNDATION CONSOLIDATED IN FINANCIALS, EXCLUDED FOR TAX RETURN 19,669 |
| SCHEDULE D, PART XII, LINE 4B | EXPENSE ON RETURN, NOT ON BOOKS: BAD DEBT NET WITH REVENUE ON FINANCIALS, TREATED AS EXPENSE ON TAX RETURN 613,933 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,496 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,496 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $790,356 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $795,845 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $819,852 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $795,845 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $29,496 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $226,023 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $147,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $78,301 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00770 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,088 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,088 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $238,861 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $147,722 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $91,139 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00900 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,058,713 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $943,567 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $120,635 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01190 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $613,933 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $2,281,494 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,752,298 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$470,804 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stillwater Hospital Association | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 N 11th St | AddressLine1Txt |
| City | Columbus | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59019 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | stillwaterbillingsclinic.com | WebsiteAddressTxt |
| State License | 13418 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Emergency Room Other | Yes (X) | EmergencyRoomOtherInd |
| Other | PHYSICIAN CLINIC | OtherDesc |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Stillwater Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See part V, Section C for URL | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | See part V, Section C for URL | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | Yes (true) | OrganizationIncurExciseTaxInd |
| Form4720 Filed | Yes (true) | Form4720FiledInd |
| Excise Report Form4720 For All | $50,000 | ExciseReportForm4720ForAllAmt |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See PArt V Section C for URL | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | see part v section c for URL | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See part V Section C for URL | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 5 | Describe how the Hospital took into account persons who represent the community: A STEERING COMMITTEE WAS FORMED WHICH INCLUDED A DIVERSE GROUP OF COMMUNITY MEMBERS (public health, elderly, uninsured, business owners and hospital staff) INCLUDING: 1. STILLWATER COUNTY PUBLIC HEALTH NURSE 2. STILLWATER BILLINGS CLINIC DIRECTOR OF QUALITY 3. STILLWATER COUNTY BUSINESS OWNER 4. STILLWATER COUNTY ECONOMIC DEVELOPMENT 5. PARAMEDIC STILLWATER EMS 6. RETIRED CITIZEN COLUMBUS 7. COUNTY CITIZEN 8. REED POINT COUNTY CITIZEN 9. STILLWATER COUNTY SHERIFFS OFFICE 10. ABSAROKEE ST. VINCENTS CLINIC 11. STILLWATER BILLINGS CLINIC CEO The Steering Committee determined the most important health needs to be addressed by reviewing the Community Health Needs Assessment (CHNA), secondary data, community demographics, and input from representatives representing the broad interest of the community, including those with public health expertise. The Steering Committee met twice between March 2017 and November 2017 during the Community Health Services Development (CHSD) process, first to discuss health concerns in the community and again to review the results of the survey and focus groups and to assist in the prioritization of health needs to address. |
| Schedule H, part V, Section B, Line 7a | Direct URL where CHNA report is made widely available on the Organization's website: HTTP://STILLWATERBILLINGSCLINIC.COM/WP-CONTENT/UPLOADS/COMMUNITY-HEALTH-NE EDS_2017.PDF |
| Schedule H, part V, section B, Line 10a | Direct URL where implementation plan is made widely available: The implemenation plan is included with the 2017 CHNA the URL is HTTP://STILLWATERBILLINGSCLINIC.COM/WP-CONTENT/UPLOADS/COMMUNITY-HEALTH-NE EDS_2017.PDF |
| Schedule H, Part V, Section B, Line 11 | STILLWATER COMMUNITY HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN THE CHNA BY IDENTIFYING THE TOP 5 GOALS ALONG WITH CORRESPONDING STRATEGIES AND ACTIVITIES, PERSONS RESPONSIBLE AND TIMELINE FOR ADAPTATION. The top five goals and corresponding strategies are as follows: 1)Goal - Improve awareness of services through enhanced community outreach and education Strategies - Explore opportunities to enhance SBC community engagement and partnership in community events by partnering with the local athletic department to co-sponsor events, developing community outreach materials to market services, sponsor community dinners before football games, booster club participation, and patient experience stories in newspaper and on social media; Enhance website features and develop social media marketing presence by developing a social media campaign, designating staff to be responsible for marketing and outreach, determining feasibility of adding online clinic scheduling to website, and adding current events scrolling banner to website; and Improve community knowledge of available health services in Stillwater County by researching community events, programs and resources, developing list of community resources and marketing campaign, meet and partner with schools to develop health and wellness resource page, and hosting an open house. 2)Goal - Improve communitys access to transportation in and around Stillwater County Strategy Collaborate with community partners on transportation needs in Stillwater County by determining a community stakeholder group, identifying transportation needs and opportunities, researching community models and best practices, exploring grant opportunities and developing patient transportation protocol for staff if/when assisting patients. 3)Goal Enhance health and wellness opportunities in Stillwater County Strategy Explore creating a Stillwater County Recreation Coalition by determining a community stakeholder group to discuss resources and needs for potential projects, explore developing a walking trail around hospital campus and engage with MT BACI program to explore feasibility of BACI program in Stillwater County. 4)Goal Improve access to mental health services in Stillwater County Strategy Improve access and education of mental health resources for community and SBC staff by exploring available training and education for mental health and substance abuse, determining staff responsible to deliver mental health education for staff and community, developing suicide risk assessment protocol for all staff at Stillwater Billings Clinic, adopting and modifying education for community members as appropriate and meeting with local schools to develop mental health, suicide risk, and substance abuse resource page for teachers and counselors. 5)Goal Improve access to specialty services at Stillwater Billings Clinic Strategy - Explore opportunities to expand specialty services at SBC by exploring feasibility of offering dermatology and optometry visiting specialists and expanding telemedicine at SBC (i.e. tele-phsychiatry) and create marketing campaign for new services and providers. Stillwater Billings Clinic will determine which needs or opportunities could be addressed considering SBCs parameters of resources and limitations. The committee will prioritize the needs/opportunities using the additional parameters of the organizational vision, mission, and/or values, as well as existing and potential community partners. The participants will create goals to achieve through strategies and activities, as well as the general approach to meeting the stated goal (i.e. staff member responsibilities, timeline, potential community partners, anticipated impact(s), and performance/evaluation measures). This plan will be documented and posted along with the CHSD assessment report. THERE WERE THREE NEEDS THAT HAVE BEEN IDENTIFIED AS UNABLE TO ADDRESS: 1) One need Identified during the process was for more physicians MORE PRIMARY PROVIDERS-A PA-C AND A PHYSICIAN WERE added while the survey was still being performed the survey indicates that this is still a need but was meet during the process; 2) DESIRE FOR SPECIALISTS INCLUDING CARDIOLOGIST, OB/GYN AND SLEEP STUDIES - FINANCIALLY UNMANAGEABLE AND LACKS PATIENT VOLUME NEEDED TO SUPPORT THESE SERVICES; 3) ADDITIONAL SENIOR SERVICES-MANY SERVICES ALREADY EXIST IN THE COMMUNITY AND OTHER SERVICES ARE BEYOND THE SCOPE OF WHAT THE HOSPITAL CAN PROVIDE (I.E. SWIMMING POOL). |
| SCHEDULE H, PART V, SECTION B, LINE 16a | Direct URL for Financial assistance policy: In 2017 Stillwaters Hospital Association who is related to Billings Clinic adopted Billings Clinic Financial policies. There is a link on Stillwaters hospital website that is a direct link to billings Clinic Financial policy. TO Navigate there start at Stillwaters website: http://stillwaterbillingsclinic.com/ Click on Patient Info, then Financial Assistance. The direct link is: https://www.billingsclinic.com/app/files/public/2227/Financial-Assistance- Policy.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16b | Direct URl for Financial assistance policy: In 2017 Stillwaters Hospital Association who is related to Billings Clinic adopted Billings Clinic Financial policies. There is a link on Stillwaters hospital website that is a direct link to billings Clinic Financial policy. TO Navigate there start at Stillwaters website: http://stillwaterbillingsclinic.com/ Click on Patient Info, then Financial Assistance. The direct link is: https://www.billingsclinic.com/app/files/public/114/Financial-Assistance-A pplication.pdf |
| Schedule H, part V, Section B, Line 16c | Direct URl for Financial assistance policy: In 2017 Stillwaters Hospital Association who is related to Billings Clinic adopted Billings Clinic Financial policies. There is a link on Stillwaters hospital website that is a direct link to billings Clinic Financial policy. TO Navigate there start at Stillwaters website: http://stillwaterbillingsclinic.com/ Click on Patient Info, then Financial Assistance. The direct link is: https://www.billingsclinic.com/app/files/public/113/Financial-Assistance.p df |
| Schedule H, Part V, Line 16G | Patient notification of the FAP: For the tax year of the return Stillwater Hospiptal association was not able to mark the box for part V, Line 16G. However, Stillwater has taken corrective actions to be able to comply with this question. they have posted the FAP in visible areas near the reception desk and have started to provide copies of the FAP policy at check in. Stillwater was already providing a conspicous written notive about the FAp on the billing statements. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS. |
| SCHEDULE H, PART I, LINE 7, Column (f) | Bad debt expense included on Form 990, part IX, line 25 but excluded for purposes of calculating percentages in this column equal $613,933. |
| SCHEDULE H, PART III, Section A, LINE 2 | Bad debt is estimated by actual write offs plus a reserve calculated using different percentages based on aging category of receivables. |
| SCHEDULE H, PART III, Section A, LINE 3 | THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. |
| SCHEDULE H, PART III, Section A, LINE 4 | See page 12 of the attached audited financial statements for the footnote that describes bad debt expense. |
| SCHEDULE H, PART III, Section B, Line 8 | ALLOWABLE MEDICARE COSTING METHODOLOGY: STILLWATER BILLINGS CLINIC ESTIMATES THAT 45 PERCENT OF STILLWATER BILLINGS CLINIC'S MEDICARE SHORTFALLS SHOULD BE COUNTED AS COMMUNITY BENEFIT. OUR RATIONALE IS THAT 45 PERCENT IS THE BEST ESTIMATE OF THE PERCENTAGE OF MONTANA'S MEDICARE POPULATION (65 AND OLDER) WHO ARE AT OR BELOW 100% OF FEDERAL POVERTY LEVEL, BASED ON MEDICARE AND U.S. CENSUS DATA, AND THOSE PATIENTS WOULD QUALIFY FOR FULL FINANCIAL ASSISTANCE. A HIGHER PERCENTAGE WOULD QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE WITH INCOMES FROM 100-300 PERCENT OF FEDERAL POVERTY LEVEL. |
| SCHEDULE H, PART III, Section C, LINE 9b | Patients are screened by the organization's financial counselors to see if they qualify for financial assistance. If they qualify, their account balances are adjusted accordingly. If there is a balance after the adjustment, the organization follows the normal debt collection practice. In unusual situations where the patient's circumstances have changed, the CEO has the authority to grant exceptions to the policy. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT: The organization assesses the health care needs of the communities it serves through day to day patient care and the work of the community health services department. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: The Organization employs a Business office lead who is responsible for administering the Financial Assistance Program, assuring the determination for financial assistance meets the requirements of the policy, and notifying the patient and/or responsible party of the final determination of amounts approved under the policy. Patient representatives work with the patients in completing applications that determine eligibility for financial assistance under the hospital's financial assistance policy. Information is also in printed form on patient bills. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: Stillwater County stretches 75 miles of two lane roads from north to south connecting mountain ranges to the lake basins, coulees, and rolling plains. Interstate 90 passes through the County at Columbus. County has population of 9,185 with 6 unincorporated communities and 1 incorporated community of Columbus where the hospital resides. County has a vast array of outdoor recreational opportunities. |
| SCHEDULE H, PART VI, LINE 5 | Promotion of community health: Stillwater Hospital Association's Community health services department strives to provide broad-based community health information and services to the residents, facilities and guests of Stillwater County. The board has community members serving. |
| SCHEDULE H, PART VI, LINE 6 | Affiliated health care system: Stillwater Billings Clinic is managed by Billings Clinic and works closely with Billings Clinic and other hospitals also managed by Billings Clinic to provide high quality patient care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Luke Kobold | ||||||||||||||
| Vice President | $0 | $141,510 | $0 | $9,806 | $0 | $0 | $0 | $14,031 | $0 | $19,763 | $0 | $185,110 | $0 | $0 |
| Dr Camilla Reese | ||||||||||||||
| Director | $0 | $255,748 | $0 | $0 | $0 | $50,000 | $0 | $23,275 | $0 | $6,506 | $0 | $335,529 | $0 | $0 |
| Dr Richard Klee | ||||||||||||||
| Director/physician | $0 | $192,872 | $0 | $2,563 | $0 | $115,688 | $0 | $23,027 | $0 | $11,384 | $0 | $345,534 | $0 | $0 |
| Mike Follett | ||||||||||||||
| Interim CEO | $0 | $161,390 | $0 | $23,570 | $0 | $0 | $0 | $16,489 | $0 | $2,892 | $0 | $204,341 | $0 | $0 |
| Dr David Kane | ||||||||||||||
| Physician | $165,339 | $116,091 | $23,275 | $20,473 | $325,178 | |||||||||
| Dr Deborah Agnew | ||||||||||||||
| CEO | $86,657 | $74,278 | $4,207 | $3,606 | $7,849 | $6,728 | $6,328 | $5,424 | $105,041 | $90,036 | ||||
| Susan Ivankovich | ||||||||||||||
| Physician Assistant | $145,130 | $200 | $9,800 | $22,695 | $177,825 | |||||||||
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | DESCRIBE HOW CEO COMPENSATION IS DETERMINED: COMPENSATION FOR THE CEO IS PAID BY BILLINGS CLINIC, A RELATED ORGANIZATION. PLEASE SEE SCHEDULE O, PART VI, LINE 15A NARRATIVE FOR HOW CEO COMPENSATION IS DETERMINED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, Line 6 | DESCRIBE CIRCUMSTANCES FOR HAVING MEMBERS: Billings Clinic is the sole member of Stillwater Hospital Association. |
| Form 990, Part VI, Section A, Line 7a | Members who can elect members of the governing body: The sole member has authority to recommend, approve and reject nominations of board members. |
| Form 990, Part VI, Section A, Line 7b | Decisions of governing body subject to approval by members: The following are Governance decisions of the organization which are subject to approval by the sole member: - Amendments to the organization's articles of incorporation, bylaws, or name; - Dissolution, mergers, or consolidations with or into another entity; - Sale, lease, exchange or dispositions of property of the organization; - Approval of budgets; - Incurrence orf debt and purchases made by the organization in amounts exceeding $100,000; - Selection, hiring, primary supervision, discipline and termination of the organization's Chief Executive Officer; - Addition or discontinuance of any service offered to by the organization. |
| Form 990, Part VI, Section B, line 11b | Process to Review the Form 990: The form 990 is prepared by a third party and review is performed by the board of directors. Any changes and comments are provided back to the preparer and the final form 990 is provided to the full board prior to filing. The organization was provided an e-file submission form with the completed return which was signed and submitted for ERO processing. |
| Form 990, Part VI, Section B, line 12c | Process for Monitoring Compliance with Conflict of Interest Policy: All directors, officers, employees, and members of a committee with board delegated powers are covered by the conflict of interest policy and must provide an annual statement indicating they have reviewed and are in compliance with the policy. The board is charged with periodically reviewing and monitoring the policy to ensure the organization acts in a manner consistent with its charitable purpose. If a potential conflict is identified, the board will investigate any alternatives and determinations as to whether the transaction or arrangement is in the organizations best interest and will establish procedures for violations of the policy. |
| Form 990, Part VI, Section B, line 15a | Describe process for determining CEO/Executive compensation: Compensation is paid through Billings Clinic, the sole member. Compensation is determined by an annual review of external market data for similar size organizations through use of survey data with MHA and Yaffee & Company, and Rural Critical Access Hospital facilities. Compensation is reviewed and approved by the Board of Directors as recommended by the VP of Regional Services. The review is done at the time of the CEO's annual performance review. |
| Form 990, Part VI, Section B, line 15b | DESCRIBE PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS: Other officer Compensation is paid through Billings Clinic, the sole member. Salaries for the other key officers/leaders in the organization are reviewed for comparison to other similar size organizations through use of external salary survey sources such as MHA and Associated Employers. This review is conducted by Stillwater's HR Generalist and the CEO. Budget recommendations are formulated for review and approval by the VP of Regional Services and for final approval by the Board of Directors/Finance Committee. |
| Form 990, Part VI, Section C, line 19 | DESCRIBE HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC: The organizations governing documents, conflict of interest policy, and financials statementS are available upon request. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Billings Clinic (BC) | ||||||||||
| 2800 Tenth Avenue North | Billings | MT | 59101 | 810231784 | HOSPITAL | MT | 501(c)(3) | LINE 3 | NA | false |
| Billing Clinic Foundation | ||||||||||
| 2917 Tenth Avenue North | Billings | MT | 59101 | 810407289 | FUNDRAISING | MT | 501(c)(3) | LINE 7 | BC | false |
| STILLWATER COMMUNITY HEALTHCARE FDN | ||||||||||
| 710 N 11TH ST | COLUMBUS | MT | 59019 | 200748325 | fundraising | MT | 501(c)(3) | Line 7 | stillwater | Yes (true) |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt |
|---|---|---|---|---|---|---|---|---|
| New West Health Services | ||||||||
| 130 Neill Avenue | Helena | MT | 59601 | 841418136 | Insurance Sal | MT | Billings Clinic | C-Corporation |
| Billings Clinic Express Care LLC | ||||||||
| 2800 10th Avenue north | Bilings | MT | 59101 | 463355499 | Outpatient Cl | MT | Billings Clinic | C-Corporation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | stillwater community healthcare FDN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | d | TransactionTypeTxt |
| Involved | $52,009 | InvolvedAmt |
| Method Of Amount Determination | Interco Amount | MethodOfAmountDeterminationTxt |
Comments