2016-05-12T10:34:13-05:00 2015-06-30 GREEN HEALTH GROUP PC 110 5TH ST S SUITE 106 GLASGOW MT 592302338 990 2014-07-01 810231786 FRANCES MAHON DEACONESS HOSPITAL FRAN 4062283500 621 3RD STREET SOUTH GLASGOW MT 59230 CAMI KALINSKI DIRECTOR OF FINANCIAL SERVICES 4062283500 2016-05-11 true DANIEL GREEN P01311679 4062632615 2016-05-12 2014 2016-08-17 19:52:53Z CAMI KALINSKI 621 3RD ST S GLASGOW MT 59230 25774871 false X WWW.FMDH.ORG X 1914 MT TO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY. 9 9 277 6 484843 -184802 115486 87387 24850934 24252363 466454 499071 174148 936050 25607022 25774871 0 0 12289318 12586920 0 41599 8515177 9549034 20804495 22135954 4802527 3638917 54291228 58087704 3611256 3748035 50679972 54339669 TO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY. false false 16027860 24252363 PROVIDE QUALITY MEDICAL CARE TO PATIENTS. 16027860 true true false true false false false false false false true false true true true true false true false false false false false false false false true true false false true false false false false false false false true false false false false false true true true false false true 11 0 true 277 true true true false false false false false false false false false X 9 9 false false false false true true false true true false false true true true true true true true true false X CAMI KALINSKI 4062283500 621 3RD ST S GLASGOW MT 59230 KAREN BREIGENZER PRESIDENT 2.00 X 0 0 0 KEVIN MILLER VICE PRESIDE 1.00 X 0 0 0 TIM NEWTON SECRETARY/TR 1.00 X 0 0 0 PAT GUNDERSON DIRECTOR 1.00 X 0 0 0 KERRY KINGSLEY DIRECTOR 1.00 X 0 0 0 CAROL BUCHHEIT DIRECTOR 1.00 X 0 0 0 TRACY MELAND DIRECTOR 1.00 X 0 0 0 KRIS SIMENSEN DIRECTOR 1.00 X 0 0 0 AMY CAPDEVILLE DIRECTOR 1.00 X 0 0 0 RANDALL G HOLOM CEO 40.00 X 246552 0 17377 ELLEN GUTTENBERG COO 40.00 X 144992 0 16530 DELBERT GIENGER DIRECTOR OF 40.00 X 120735 0 13168 CAMI KALINSKI DIRECTOR OF 40.00 X 0 0 0 WALTER SMITH DO 40.00 X 483392 0 11216 ANNE MILLARD BRADLEY MD 15.00 25.00 X 410031 0 16149 KEVIN ROSS MD 13.00 27.00 X 400085 0 20316 BRIAN BELL MD 1.00 43.00 X 223649 0 14537 THOMAS SCHULTZ CRNA 40.00 X 192104 0 18233 2221540 127526 28 false true false MCKINSTRY ESSENTION LLC PO BOX 3895 SEATTLE WA 98124 CONSTRUCTION 882716 MEDICAL INFORMATION TECHNOLOGY INC PO BOX 74569 CHICAGO IL 60696 DATA PROCESSING 281997 HAYES LOCUMS LLC 6700 N ANDREWS AVE SUITE 600 FT LAUDERDALE FL 33309 TEMP PROVIDERS 271297 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 SERV CONTRACTS 163493 COMPHEALTH INC PO BOX 972651 DALLAS TX 753972651 RECRUITMENT 151360 5 87117 270 87387 PATIENT REVENUE 621500 23302408 23302408 PROFESSIONAL RADIOLOGY 621110 731375 431365 300010 HI-LINE MEDICAL SRVCS RENT 531120 93633 93633 GLASGOW CLINIC RENT 531120 91200 91200 OTHER RENTAL INCOME 531120 33747 33747 24252363 499071 499071 PARTNERSHIP INCOME 900099 907672 907672 COUNTY CONTRIBUTION 900099 28378 28378 936050 25774871 25202641 484843 529006 529006 9861053 8178598 1651664 30791 263520 197134 65545 841 1103357 846367 249188 7802 829984 652607 175477 1900 74399 74399 47145 47145 1582050 1489940 92110 89419 89419 626136 287719 338417 10339 10339 299139 299139 155612 108937 46675 81923 59950 21708 265 1966630 1966630 239649 13699 225950 MEDICAL SUPPLIES 3066704 3066704 REPAIRS & MAINTENANCE 927405 509909 417496 FOOD & DIETARY SUPPLIES 214567 214567 BED TAXES 88350 88350 79567 14240 65327 22135954 16027860 6066495 41599 2787612 1793996 7873457 7845484 2772908 3227707 4012087 3912758 768022 733081 308251 258790 34952270 23728456 11190360 11223814 12503035 16685661 12075496 12406413 54291228 58087704 2205224 2179456 223103 218302 1182929 1350277 3611256 3748035 X 50679972 54339669 50679972 54339669 54291228 58087704 3638917 20780 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3457 3457 false SCHEDULE C, PART II-B, LINE 1 2.44 PERCENT OF MHA DUES PAID TO MHA, WHICH WAS 597, AND 22.12 PERCENT OF DUES PAID TO MHA FOR AHA, WHICH WAS 2,860, WERE USED FOR LOBBYING EXPENSES BY MHA. 88748 88748 21079030 13023854 8055176 13784492 10704602 3079890 11223814 US GOVERNMENT & AGENCY SECURITIES 10977916 F BROKERED CERTIFICATES OF DEPOSIT 2741281 F CORPORATE DEBT SECURITIES 2473138 F BANK CERTIFICATES OF DEPOSIT 493326 C 16685661 INTERCOMPANY AND OTHER RECEIVABLES 8905931 NE MT STAT AIR AMBULANCE INVESTMENT 2157173 INTEREST IN FMDH FOUNDATION 957134 MEDICARE/MEDICAID RECEIVABLE 386175 12406413 MEDICAID & MEDICARE PAYABLE 1170395 NET INVESTMENT IN PRAIRIE RIDGE VILL 179882 1350277 X 25795651 20780 20780 25774871 25774871 22135954 22135954 22135954 SCHEDULE D, PAGE 3, PART X IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THIS FOOTNOTE IS ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. true true true X true X true true true false true true 503562 503562 0.02090 503562 503562 0.02090 4689785 2104226 2585559 0.10730 4689785 2104226 2585559 0.10730 5193347 2104226 3089121 0.12820 true 579954 8247823 8303064 -55241 X true true PRAIRIE RIDGE VILLAG ASSISTED LIVING 0.50000 NE MT STAT AIR AMBUL AIR AMBULANCE 0.35000 1 1 FRANCES MAHON DEACONESS HOSPITAL 621 3RD ST S GLASGOW MT 59230 WWW.FMDH.ORG X X X X FRANCES MAHON DEACONESS HOSPITAL 1 false false true X X X X X X X X X X 12 true false false true X WWW.FMDH.ORG X true 12 true WWW.FMDH.ORG false false true X 100.000000000000 200.000000000000 X X X X true true X X X X true X WWWFMDHORG X WWWFMDHORG X WWWFMDHORG X X X X X X true X true X X X X true X false true FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 5 A SURVEY WAS MAILED TO A RANDOMLY CHOSEN SAMPLE OF 800 RESIDENTS IN OUR PRIMARY SERVICE AREA TO SOLICIT THEIR INPUT. ALSO, FOCUS GROUPS WERE HELD IN GLASGOW AND SURROUNDING COMMUNITIES WHICH REPRESENTED VARIOUS CONSUMER GROUPS OF HEALTH CARE INCLUDING SENIOR CITIZENS, MENTAL HEALTH REPRESENTATIVES, AND LOCAL COMMUNITY MEMBERS. ADDITIONALLY, FMDH SOUGHT INPUT FROM VARIOUS GROUPS THROUGHOUT THE COMMUNITY THAT HAVE SPECIAL KNOWLEDGE REGARDING THE NEEDS OF VARIOUS GROUPS WITHIN THE SERVICE AREA. THESE GROUPS WERE IDENTIFIED THROUGH INPUT FROM FMDH LEADERSHIP AS WELL AS THE FMDH BOARD OF TRUSTEES BASED ON DISCUSSION OF POPULATION DEMOGRAPHICS FROM THE US CENSUS AS WELL AS INTERNAL SOURCES. THE IDENTIFIED GROUPS WERE CONTACTED AND MEETINGS WERE ESTABLISHED WITH APPROPRIATE MEMBERS OF FMDH LEADERSHIP. THE FOLLOWING CONSTITUTES A LIST OF PARTIES CONSULTED WHICH INCLUDED MENTAL HEALTH PROFESSIONALS, INDIAN HEALTH SERVICES, SECONDARY MARKET AREA REPRESENTATIVES, PUBLIC HEALTH SERVICES, AND EDUCATIONAL PROFESSIONALS. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 11 AS REQUIRED BY THE IRS IMPLEMENTING REGULATIONS, FMDH PRIORITIZED THE IDENTIFIED NEEDS TO IDENTIFY THOSE NEEDS THAT IT COULD EFFICACIOUSLY ADDRESS GIVEN THE RESOURCE LIMITATIONS INHERENT IN A SMALL RURAL HOSPITAL OPERATION. PRIORITIZATION WAS ACCOMPLISHED USING A PRIORITIZATION TOOL THAT SCORED EIGHT VARIABLES FOR EACH DISEASE CATERGORY RELATED TO THE IDENTIFIED NEEDS. A RELATIVE NEED PERCENTAGE WAS ASSIGNED TO EACH DISEASE CATEGORY BASED ON THE SCORING. A RELATIVE NEED PERCENTAGE OF 30 OR MORE WAS IDENTIFIED AS A NATURAL BREAK IN THE AGGREGATE SCORE, SO THOSE NEEDS WITH A RELATIVE NEED PERCENTAGE OF LESS THAN 30 WERE NOT ADDRESSED. FMDH PRIORITIZED DEVELOPING IMPLEMENTATION STRATEGIES THAT ADDRESS THE NEEDS ASSOCIATED WITH SEVEN DISEASE GROUPS. THESE GROUPS INCLUDE RESPIRATORY DISEASE, HYPERLIPIDEMIA, HYPERTENSION, CARDIOVASCULAR DISEASE, CANCER, OB/GYN/PRENATAL, AND MENTAL HEALTH & SUBSTANCE ABUSE. COMMUNITY AWARENESS STRATEGIES WERE DEVELOPED FOR ALL DISEASE CATEGORIES AND INCLUDE THE TOPICS TO BE COVERED IN THE COMMUNITY AWARENESS CAMPAIGN. ADDITIONALLY, DISEASE SPECIFIC STRATEGIES WERE DEVELOPED THAT ARE RELEVANT TO EACH IDENTIFIED HIGH-NEED DISEASE, AS DOCUMENTED IN THE IMPLEMENTATION PLAN. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 16I THE FINANCIAL ASSISTANCE POLICY DOES ADDRESS HOW THE PATIENT IS NOTIFIED. INFORMATION ABOUT OUR POLICY CAN BE FOUND ON THE HOSPITAL WEBSITE, REFERENCED IN A BILLING STUFFER, AND REFERENCED IN VARIOUS LETTERS BEFORE AN ACCOUNT IS OUTSOURCED TO A THIRD PARTY COLLECTION AGENCY. THE FINAL LETTER NOTIFYING THE PATIENT THAT WE ARE FORWARDING THEIR ACCOUNT TO A COLLECTION AGENCY IF WE DO NOT HEAR FROM THEM INCLUDES THE ACTUAL APPLICATION. THE APPLICATION ALSO INFORMS THE PATIENT OF THE POLICY AND IS AVAILABLE ON THE WEBSITE AND AT REGISTRATION AREAS. WE EMPLOY A FINANCIAL COUNSELOR (PATIENT ADVOCATE) THAT HELPS A PATIENT NAVIGATE THROUGH THEIR FINANCIAL OPTIONS AND HER CONTACT INFORMATION IS MADE AVAILABLE IN OUR LOCAL NEWSPAPER AS WELL AS ON OUR WEBSITE. OUR FINANCIAL COUNSELOR ALSO ACTIVELY COMMUNICATES WITH VARIOUS ORGANIZATIONS IN OUR COMMUNITY FOR THEM TO COUNSEL PATIENTS ON FINANCIAL OPTIONS (I.E. MENTAL HEALTH FACILITY, STATE HEALTH AND INSURANCE ASSISTANCE PROGRAM, MEDICAID OFFICE, WOMEN'S RESOURCE CENTER). BECAUSE THIS POSITION IS A PATIENT ADVOCATE, SHE ALSO KEEPS UP TO DATE ON OTHER FINANCIAL RESOURCES THAT MAY BE AVAILABLE TO OUR PATIENTS. THE HOSPITAL BOARD OF TRUSTEES HAS ALSO PROVIDED COMMUNITY EDUCATION AT VARIOUS ORGANIZATIONS. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 24 SOME SERVICES PROVIDED BY THE HOSPITAL ARE CONSIDERED ELECTIVE. ELECTIVE SERVICES ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE THUS A PERSON QUALIFYING FOR A DISCOUNT FOR MEDICALLY NECESSARY SERVICES MAY NEED TO PAY FULL PRICE FOR ELECTIVE SERVICES. THE FAP ADDRESSES WHAT SERVICES ARE DEEMED ELECTIVE. 1 GLASGOW CLINIC PC 621 THIRD STREET SOUTH GLASGOW MT 59230 RURAL HEALTH CLINIC PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION PHYSICIAN PROFESSIONAL SERVICES MAKE UP 1,958,381 OF COLUMN C, 634,531 OF COLUMN D, AND 1,323,850 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 111,223. FRANCES MAHON DEACONESS HOSPITAL'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND CHARITY CARE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, CHARITY CARE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF BAD DEBT WHICH REDUCE BAD DEBT EXPENSE. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NON PROFIT HOSPITAL. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGES 7 & 8 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE, BUT THIS IS THEN REDUCED BY THE 2 PERCENT SEQUESTRATION ADJUSTMENT. THIS MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT SINCE THE HOSPITAL IS PROVIDING MEDICARE PATIENT CARE SERVICES AT LESS THAN THE COST. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT. THE ELECTRONIC HEALTH RECORD CAPITAL COSTS AND RELATED INCENTIVE PAYMENTS ARE EXCLUDED FROM THIS CALCULATION. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE ORGANIZATION USES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES, COMBINED WITH AN ASSET TEST AND A MEDICALLY INDIGENT TEST REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. THE ORGANIZATION DOES NOT ATTEMPT TO COLLECT CHARGES APPROVED AS CHARITY OR FINANCIAL ASSISTANCE. FOR PATIENTS THAT HAVE HAD A PORTION OF THEIR ACCOUNT WRITTEN OFF AS FINANCIAL ASSISTANCE AND THAT LATER DEFAULT ON THE PORTION THAT WAS DETERMINED TO BE THEIR RESPONSIBILITY, AND THEREFORE IS NOT CONSIDERED CHARITY CARE OR FINANACIAL ASSISTANCE, THE ORGAINIZATION DOES ATTEMPT TO COLLECT THIS BALANCE. PART VI, LINE 2 - NEEDS ASSESSMENT PURSUANT TO THE PROVISIONS OF THE AFFORDABLE CARE ACT, FRANCES MAHON DEACONESS HOSPITAL COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DURING FISCAL YEAR 2013 (TAX YEAR 2012). HOWEVER, FRANCES MAHON DEACONESS HOSPITAL (FMDH) HAS TRADITIONALLY INCLUDED COMMUNITY NEEDS ASSESSMENTS IN ITS PLANNING FOR MANY YEARS AND UTILIZES MANY METHODS OF ASSESSING THE PATIENT SERVICES NEEDS FOR OUR SERVICE AREA. THESE INCLUDE BUT ARE NOT LIMITED TO: ANALYSIS OF OUTMIGRATION STATISTICS OBTAINED THROUGH ACCESS TO THE COMPDATA DATABASE PROVIDED THROUGH THE MONTANA HOSPITAL ASSOCIATION AND MODELING OF PATIENT TO POPULATION RATIOS TO IDENTIFY AND PLAN FOR THE APPROPRIATE PROVIDER MIX TO SERVE THE COMMUNITY. IN ADDITION, FMDH PARTICIPATED IN AN AREA HEALTH EDUCATION CENTER LEAD COMMUNITY HEALTH SERVICES DEVELOPMENT ASSESSMENT. IDEAS GENERATED OUT OF EACH OF THESE EFFORTS ARE THEN EVALUATED AS TO THE CAPABILITIES OF OUR ORGANIZATION TO DEVELOP IDENTIFIED SERVICES. MINIMUM CRITERIA FOR DEVELOPMENT OF NEW OR MODIFICATION OF EXISTING SERVICES ARE: THE NEW OR MODIFIED SERVICE CAN REASONABLY FINANCIALLY SUPPORT ITS OPERATION; WE HAVE OR CAN ACQUIRE THE NECESSARY PERSONNEL WITH THE CREDENTIALS TO DELIVER THE SERVICE AND RETAIN ENOUGH PERSONNEL WITH THE REQUIRED SKILL SETS TO AVOID INTERRUPTION OF SERVICE DELIVERY IF SAID PERSONNEL TURN OVER; THE SERVICES CAN BE DELIVERED IN A MANNER THAT ACHIEVES APPROPRIATELY HIGH LEVELS OF PATIENT SATISFACTION. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FRANCES MAHON DEACONESS HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO HAS THE SOLE RESPONSIBILITY TO WORK WITH PATIENTS TO NAVIGATE OUR FINANCIAL ASSISTANCE PROGRAM. ALL PATIENTS ARE SENT INFORMATION AT THE INITIAL BILLING FOR DELIVERED PATIENT SERVICES THAT DESCRIBES OUR FINANCIAL ASSISTANCE PROGRAM. OUR WEBSITE HAS INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM ALONG WITH ACCESS TO THE APPLICATION. PART VI, LINE 4 - COMMUNITY INFORMATION FRANCES MAHON DEACONESS HOSPITAL IS LOCATED IN GLASGOW MONTANA WHICH IS OVER FOUR HOURS HIGHWAY TRAVEL TIME AWAY FROM ANY TERTIARY MEDICAL CENTER. OUR PRIMARY SERVICE AREA CONSISTS OF GLASGOW MONTANA AND VALLEY COUNTY, POPULATIONS OF 3250 AND 7659, RESPECTIVELY (BASED ON 2010 CENSUS DATA AND THE 2015 CENSUS BUREAU ESTIMATES, RESPECTFULLY). OUR SPECIALTY SERVICES DRAW FROM PORTIONS OF THE SURROUNDING COUNTIES OF DANIELS, ROOSEVELT, AND PHILLIPS COUNTY. THE AREA IS PRIMARILY AGRICULTURAL BASED WITH LOW POPULATION DENSITIES. OUR POPULATION IS AN OLDER POPULATION WITH 20.8% OF THE POPULATION OVER THE AGE OF 65 (BASED ON THE 2014 CENSUS BUREAU ESTIMATES). THE POPULATION IS MOSTLY WHITE, BUT PORTIONS OF OUR EXTENDED SERVICE AREA HAVE HIGH POPULATIONS OF NATIVE AMERICAN ANCESTRY (58.0% IN ROOSEVELT COUNTY BASED ON THE 2014 CENSUS BUREAU ESTIMATES) TO WHICH WE PROVIDE SERVICES. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH FRANCES MAHON DEACONESS HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. WE ARE GOVERNED BY A VOLUNTARY BOARD OF COMMUNITY PERSONS REPRESENTING MOST OF THE INDIVIDUAL TOWNS OR GEOGRAPHICAL AREAS OF OUR PRIMARY SERVICE AREA. FOR NONELECTIVE SERVICES, WE TREAT PATIENTS WITHOUT REGARD TO ABILITY TO PAY, CONSISTENT WITH OUR ORIGINS AS A HILL BURTON FUNDED FACILITY. ALTHOUGH OUR HILL BURTON OBLIGATION WAS SATISFIED MANY YEARS AGO, WE STILL ADHERE TO THE PRINCIPLES INHERENT IN THAT OBLIGATION. SURPLUS FUNDS ARE RETAINED WITHIN THE ORGANIZATION TO ASSURE FULFILLMENT OF OUR CHARITABLE MISSION BOTH IN THE PRESENT AND IN THE FUTURE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM FRANCES MAHON DEACONESS HOSPITAL PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. GLASGOW CLINIC PC PROVIDES PROFESSIONAL PRIMARY CARE PHYSICIAN AND MIDLEVEL PROVIDER SERVICES. HI-LINE MEDICAL SERVICES INC PROVIDES SPECIALTY PHYSICIAN AND RETAIL PHARMACY SERVICES. ADDITIONAL INFORMATION PART I, LINE 6A: THE FORM 990 SCHEDULE H IS CONSIDERED AN ANNUAL COMMUNITY BENEFIT REPORT AND IT IS AVAILABLE TO THE PUBLIC. PART V: GLASGOW CLINIC PC IS A SEPARATE ORGANIZATION THAT IS A RURAL HEALTH CLINIC AND IS OPERATED BY FRANCES MAHON DEACONESS HOSPITAL (FMDH). THEIR REVENUE AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990. HI-LINE MEDICAL SERVICES, INC IS A SEPARATE ORGANIZATION THAT INCLUDES SPECIALTY PHYSICIAN PRACTICES AND A RETAIL PHARMACY. FMDH MANAGES THIS ENTITY AND SUBSIDIZES THE PHYSICIAN PRACTICES AS NEEDED. THEIR REVENUE AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990, EXCEPT THAT THE SUBSIDIZED PHYSICIAN ACTIVITY IS SHOWN ON SCHEDULE H, PART I, LINE 7G. X true true X X X false false false false false false false false false RANDALL G HOLOM CEO 246552 8821 8556 263929 ELLEN GUTTENBERG COO 144992 5314 11216 161522 WALTER SMITH DO 483392 11216 494608 ANNE MILLARD BRADLEY MD 410031 7431 8718 426180 KEVIN ROSS MD 400085 9100 11216 420401 BRIAN BELL MD 223649 7989 6548 238186 THOMAS SCHULTZ CRNA 192104 7017 11216 210337 SCHEDULE J, PAGE 1, PART I, LINE 1A GOLF CLUB MEMBERSHIP FOR THE CEO IS PAID BY THE ORGANIZATION. THIS IS NOT TREATED AS TAXABLE COMPENSATION SINCE IT IS CONSIDERED PUBLIC RELATIONS WHICH IS PART OF THE CEO'S JOB RESPONSIBILITY. SCHEDULE J, PART III A PERCENTAGE OF THE COMPENSATION PAID TO KEVIN ROSS M.D. (67%), ANNE MILLARD BRADLEY M.D. (63%), AND BRIAN BELL M.D. (97%) IS AN EXPENSE OF GLASGOW CLINIC PC, A RELATED COMPANY, BUT WAS PAID THROUGH FRANCESS MAHON DEACONESS HOSPITAL AS A CENTRAL PAYMASTER. FIRST COMMUNITY BANK BOARD MEMBERS 3286583 BANKING & INVESTING false SCHEDULE L, PART V THE HOSPITAL CEO AND ONE BOARD MEMBER ARE BOTH BOARD MEMBERS OF FIRST COMMUNITY BANK. THE HOSPITAL HAS BANK ACCOUNTS AND INVESTMENTS WITH FIRST COMMUNITY BANK. THE BUSINESS RELATIONSHIP WITH THE BANK IS MANAGED BY THE DIRECTOR OF FINANCIAL SERVICES OF THE HOSPITAL AND SHE HAS A DIRECT REPORTING RELATIONSHIP TO THE BOARD FINANCE COMMITTEE IN THIS REGARD. FURTHER, ANY DECISION MADE BY THE DIRECTOR OF FINANCIAL SERVICES IS GOVERNED BY POLICIES AND PROCEDURES APPROVED BY THE ENTIRE BOARD OF TRUSTEES ON THE RECOMMENDATION OF THE FINANCE COMMITTEE. ADDITIONALLY, FOR ANY PARTICULAR BUSINESS TRANSACTION OR DECISION THAT DIRECTLY INVOLVES FIRST COMMUNITY BANK, THE CEO AND THE BOARD MEMBER WITH A CONFLICT OF INTEREST LEAVE THE BOARD MEETING WHILE THE REMAINING BOARD MEMBERS DELIBERATE OR ACT ON THE MATTER. THE TRANSACTION DOLLAR AMOUNT SHOWN ABOVE IS THE NET INCREASE IN THE HOSPITAL'S BANK ACCOUNT AND INVESTMENT BALANCES WITH FIRST COMMUNITY BANK AND AFFILIATED COMPANIES FOR THE FISCAL YEAR. FORM 990, PAGE 6, PART VI, LINE 6 MEMBERSHIP IN THE FRANCES MAHON DEACONESS HOSPITAL CORPORATION (FMDH) IS ACHIEVED BY VIRTUE OF DONATING AT LEAST 100 TO FMDH, TO THE FRANCES MAHON DEACONESS HOSPITAL FOUNDATION (ALTHOUGH THE FOUNDATION IS A SEPARATE CHARITABLE ENTITY AND NOT CONTROLLED BY THE FMDH CORPORATION, ITS STATED PURPOSE IS TO SUPPORT FMDH AND THE DELIVERY OF HEALTHCARE SERVICES IN VALLEY COUNTY, MONTANA, THROUGH CHARITABLE DONATIONS SUPPORTING SERVICES DEVELOPMENT AND EQUIPMENT PURCHASES), AND LUKE'S 100 (ANOTHER LOCAL CHARITABLE ORGANIZATION SEPARATE FROM FMDH BUT WHICH SUPPORTS FMDH THROUGH ANNUAL DONATIONS). THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE CONTROL OVER FMDH. FORM 990, PAGE 6, PART VI, LINE 7A THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE CONTROL OVER FMDH. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO AND DIRECTOR OF FINANCIAL SERVICES AND IS MADE AVAILABLE FOR THE BOARD'S REVIEW PRIOR TO BEING FILED. FORM 990, PAGE 6, PART VI, LINE 12C CONFLICTS OF INTEREST ARE REQUIRED TO BE REPORTED AT THE FIRST MEETING OF EACH CALENDAR YEAR. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE REQUIRED TO LEAVE THE BOARD MEETING WHILE THE BUSINESS IS BEING DISCUSSED OR ACTED UPON. FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD OF TRUSTEES APPROVES THE CEO'S COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 15B THE BOARD OF TRUSTEES APPROVES THE COMPENSATION FOR ALL PHYSICIANS EMPLOYED BY FMDH. THE CEO APPROVES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PAGE 6, PART VI, LINE 19 ALL WRITTEN POLICIES ARE KEPT IN THE OFFICE OF THE DIRECTOR OF FINANCIAL SERVICES AND ARE AVAILABLE UPON REQUEST. FMDH FOUNDATION 621 3RD STREET SOUTH GLASGOW MT 59230 810406872 SUPPORT MT 501C3 7 NA false PRAIRIE RIDGE VILLAGE LLP 521 4TH AVE S GLASGOW MT 59230 810515202 ASSTLIVING MT 501C3 9 NA false NE MT STAT AIR AMBULANCE COOPERATIV 11 SOUTH 7TH ST SUITE 241 MILES CITY MT 59301 204748673 AIR AMBULA MT 501C3 11B NA false HI-LINE MEDICAL SERVICES INC 621 THIRD STREET SOUTH GLASGOW MT 59230 208393201 PHYSICIANS MT N/A false GLASGOW CLINIC PC 621 THIRD STREET SOUTH GLASGOW MT 59230 810341714 CLINIC MT N/A false true false false true false false false false false true false false false false true false false true false FMDH FOUNDATION O 41599 STAFF & OTHER ITEMS GLASGOW CLINIC PC J 91200 RENTAL INCOME GLASGOW CLINIC PC R 283848 CHANGE IN RECEIVABLE HI-LINE MEDICAL SERVICES INC J 93633 RENTAL INCOME HI-LINE MEDICAL SERVICES INC R 721088 CHANGE IN RECEIVABLE NORTHEAST MT STAT AIR AMBULANCE O 17640 CONTRACT STAFF NORTHEAST MT STAT AIR AMBULANCE O 58832 CONTRACT STAFF PRAIRIE RIDGE VILLAGE LLP D 3871820 LOAN BALANCE PRAIRIE RIDGE VILLAGE LLP A 203102 INTEREST RECEIVED ON LOAN