SHERIDAN MEMORIAL HOSPITAL ASSOCIATION: Form 990, tax year 2014
View the entire original 990 at ProPublica ↗
- Organization
- SHERIDAN MEMORIAL HOSPITAL ASSOCIATION (EIN 81-0243720)
- Tax period
- 2014-07-01 to 2015-06-30
- Filed
- 2016-05-16
- IRS object ID
- 201611379349307176
- Schema version
- 2014v6.0
- 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 | 2016-05-16T14:43:52-05:00 | ReturnTs |
| Tax Period End | 2015-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2014-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810243720 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sheridan Memorial Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | SHER | BusinessNameControlTxt |
| Phone | 4067653700 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W Laurel Avenue | AddressLine1Txt |
| City | Plentywood | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Greg Maurer | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4067653700 | PhoneNum |
| Signature | 2016-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Lisa Chaffee CPA | PreparerPersonNm |
| PTIN | P00193453 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2016-05-16 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2014 | TaxYr |
| Build TS | 2016-08-17 19:52:53Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Greg Maurer | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W Laurel Avenue | AddressLine1Txt |
| City | Plentywood | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $11,404,197 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.sheridanmemorial.net | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1920 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | Provide quality care to improve the health and well-being of the people and community we serve. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 248 | TotalEmployeeCnt |
| Total Volunteers | 52 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $868,839 | PYContributionsGrantsAmt |
| CY Contributions Grants | $235,246 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,372,482 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,147,842 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$26,537 | PYInvestmentIncomeAmt |
| CY Investment Income | $4,098 | CYInvestmentIncomeAmt |
| PY Other Revenue | $20,844 | PYOtherRevenueAmt |
| CY Other Revenue | $17,011 | CYOtherRevenueAmt |
| PY Total Revenue | $13,235,628 | PYTotalRevenueAmt |
| CY Total Revenue | $11,404,197 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,155 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,167,540 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,134,981 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $62,612 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,390,525 | PYOtherExpensesAmt |
| CY Other Expenses | $5,957,306 | CYOtherExpensesAmt |
| PY Total Expenses | $12,558,065 | PYTotalExpensesAmt |
| CY Total Expenses | $13,093,442 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $677,563 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,689,245 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $10,773,220 | TotalAssetsBOYAmt |
| Total Assets EOY | $8,277,335 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,497,078 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,748,440 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,276,142 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,528,895 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Providing quality care to improve the health and well-being of the people and community we serve. We are committed to the future healthcare needs of our community. We endeavor to be a leader and innovator in providing reliable, compassionate, comprehensive, high quality, cost effective healthcare services. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,124,647 | ExpenseAmt |
| Grant | $1,155 | GrantAmt |
| Revenue | $11,147,842 | RevenueAmt |
| Desc | The Organization operates a 19-bed critical access hospital, a 78-bed long term care facility and a Provider Based Rural Health Clinic that benefits the people in the surrounding area. | Desc |
| Total Program Service Expenses | $11,124,647 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | Yes (1) | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 8 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 248 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Greg Maurer | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 4067653702 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 West Laurel Avenue | AddressLine1Txt |
| City | Plentywood | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (15 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 |
|---|---|---|---|---|---|---|---|---|
| Jake Fladager | ||||||||
| Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Linda Nelson | ||||||||
| Vice Chairperson | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Jessica Schackelford | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Robert Michels | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Bill McCoy | ||||||||
| Director | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| Mike O'Toole | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Myrnette Miller | ||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Greg Maurer | ||||||||
| CEO (as of Mar 2015) | 40.00 | 0.10 | Yes (X) | $0 | $0 | $0 | ||
| Rob Brandt | ||||||||
| Interim CEO (thru Feb 2015) | 40.00 | 0.10 | Yes (X) | $0 | $0 | $0 | ||
| Sandra Christensen | ||||||||
| CEO (thru July 2014) | 40.00 | 0.10 | Yes (X) | $0 | $0 | $0 | ||
| Kyle Gee | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Adam Graham | ||||||||
| PA | 40.00 | 0.00 | $156,026 | $0 | $15,089 | Yes (X) | ||
| Jennifer Hoversland | ||||||||
| FNP | 40.00 | 0.00 | $101,415 | $0 | $0 | Yes (X) | ||
| Lynne Graham | ||||||||
| PA | 40.00 | 0.00 | $136,609 | $0 | $6,132 | Yes (X) | ||
| Kristin McColly | ||||||||
| FNP | 37.00 | 0.00 | $128,612 | $0 | $12,352 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $522,662 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $33,573 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Billings Clinic | |||||
| 801 North 29th Street | Billings | MT | 591077000 | Management Services | $655,109 |
| Cerner Corporation | |||||
| PO Box 959156 | St Louis | MO | 63195 | Software Support/Implementation | $366,012 |
| MHN | |||||
| 11 South 7th Street | Miles City | MT | 59301 | eEmergency/ePharmacy Services | $276,805 |
| Avera Health | |||||
| 3900 West Avera Drive | Sioux Falls | SD | 57108 | Rural Hospital Support | $190,334 |
| Prairie Travelers | |||||
| 130 3rd St S 2 | Glasgow | MT | 59230 | Temporary Staffing | $107,361 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $206,415 | RelatedOrganizationsAmt |
| Government Grants | $28,831 | GovernmentGrantsAmt |
| Total Contributions | $235,246 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621990 | $10,743,680 | $10,743,680 |
| Other Revenue | 900099 | $404,162 | $404,162 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,147,842 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,098 | TotalRevenueColumnAmt |
| Exclusion | $4,098 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,011 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $17,011 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,011 | TotalRevenueColumnAmt |
| Exclusion | $17,011 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,404,197 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,147,842 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $21,109 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,155 | TotalAmt |
| Program Services | $1,155 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,505,649 | TotalAmt |
| Program Services | $5,075,528 | ProgramServicesAmt |
| Management And General | $403,000 | ManagementAndGeneralAmt |
| Fundraising | $27,121 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,182,247 | TotalAmt |
| Program Services | $933,148 | ProgramServicesAmt |
| Management And General | $238,146 | ManagementAndGeneralAmt |
| Fundraising | $10,953 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $447,085 | TotalAmt |
| Program Services | $410,865 | ProgramServicesAmt |
| Management And General | $33,615 | ManagementAndGeneralAmt |
| Fundraising | $2,605 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $693,777 | TotalAmt |
| Program Services | $73,787 | ProgramServicesAmt |
| Management And General | $619,990 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,197 | TotalAmt |
| Management And General | $27,197 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,072,096 | TotalAmt |
| Program Services | $922,725 | ProgramServicesAmt |
| Management And General | $149,371 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,847 | TotalAmt |
| Program Services | $24,958 | ProgramServicesAmt |
| Management And General | $4,603 | ManagementAndGeneralAmt |
| Fundraising | $5,286 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $224,984 | TotalAmt |
| Program Services | $131,821 | ProgramServicesAmt |
| Management And General | $91,562 | ManagementAndGeneralAmt |
| Fundraising | $1,601 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $317,719 | TotalAmt |
| Program Services | $216,733 | ProgramServicesAmt |
| Management And General | $100,986 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,682 | TotalAmt |
| Program Services | $54,703 | ProgramServicesAmt |
| Management And General | $16,979 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,553 | TotalAmt |
| Program Services | $16,780 | ProgramServicesAmt |
| Management And General | $25,646 | ManagementAndGeneralAmt |
| Fundraising | $127 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,935 | TotalAmt |
| Program Services | $14,009 | ProgramServicesAmt |
| Management And General | $8,876 | ManagementAndGeneralAmt |
| Fundraising | $1,050 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,089,098 | TotalAmt |
| Program Services | $1,047,494 | ProgramServicesAmt |
| Management And General | $41,604 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,056 | TotalAmt |
| Program Services | $4,700 | ProgramServicesAmt |
| Management And General | $81,356 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $862,683 | $862,683 | |
| Bad Debt | $846,534 | $846,534 | |
| Repairs and Maintenance | $329,225 | $316,855 | $12,370 |
| Bed Tax | $167,456 | $159,662 | $7,794 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,464 | TotalAmt |
| Program Services | $10,507 | ProgramServicesAmt |
| Management And General | $43,088 | ManagementAndGeneralAmt |
| Fundraising | $13,869 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,093,442 | TotalAmt |
| Program Services | $11,124,647 | ProgramServicesAmt |
| Management And General | $1,906,183 | ManagementAndGeneralAmt |
| Fundraising | $62,612 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,392,094 | BOYAmt |
| EOY | $422,745 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $607,564 | BOYAmt |
| EOY | $164,942 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,035,483 | BOYAmt |
| EOY | $1,360,999 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $182,867 | BOYAmt |
| EOY | $222,100 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $151,105 | BOYAmt |
| EOY | $135,424 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $17,513,860 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,094,761 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,886,974 | BOYAmt |
| EOY | $4,419,099 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,120 | BOYAmt |
| EOY | $57,166 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,246,631 | BOYAmt |
| EOY | $1,188,629 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $213,382 | BOYAmt |
| EOY | $306,231 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,773,220 | BOYAmt |
| EOY | $8,277,335 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,421,679 | BOYAmt |
| EOY | $1,056,311 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $500,399 | BOYAmt |
| EOY | $383,726 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $575,000 | BOYAmt |
| EOY | $308,403 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,497,078 | BOYAmt |
| EOY | $1,748,440 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,349,394 | BOYAmt |
| EOY | $6,036,726 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $812,832 | BOYAmt |
| EOY | $378,253 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $113,916 | BOYAmt |
| EOY | $113,916 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,276,142 | BOYAmt |
| EOY | $6,528,895 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,773,220 | BOYAmt |
| EOY | $8,277,335 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,689,245 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$58,002 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
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
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,916 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $64 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $64 | OtherExpendituresAmt |
| End Year Balance | $113,916 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $113,916 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $72 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $72 | OtherExpendituresAmt |
| End Year Balance | $113,916 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $37,530 | BeginningYearBalanceAmt |
| Contributions | $76,386 | ContributionsAmt |
| Investment Earnings Or Losses | $27 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $27 | OtherExpendituresAmt |
| End Year Balance | $113,916 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $27,195 | BeginningYearBalanceAmt |
| Contributions | $10,335 | ContributionsAmt |
| End Year Balance | $37,530 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $27,075 | BeginningYearBalanceAmt |
| Contributions | $120 | ContributionsAmt |
| End Year Balance | $27,195 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $384,756 | OtherCostOrOtherBasisAmt |
| Book Value | $384,756 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,394,557 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,333,066 | DepreciationAmt |
| Book Value | $2,061,491 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,734,547 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,761,695 | DepreciationAmt |
| Book Value | $1,972,852 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,419,099 | TotalBookValueLandBuildingsAmt |
Invst Program Related Org InvstProgramRelatedOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Interest in Net Assets of Foundation | Desc |
| Book Value | $1,188,629 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Program Rltd | $1,188,629 | TotalBookValueProgramRltdAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Related Party Note Payable | Desc |
| Amt | $308,403 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $308,403 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $10,731,694 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$643,672 | OtherRevenueAmt |
| Revenue Not Reported | -$643,672 | RevenueNotReportedAmt |
| Revenue Subtotal | $11,375,366 | RevenueSubtotalAmt |
| Other Revenues Not Included | $28,831 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $28,831 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,404,197 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,246,908 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $12,246,908 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $846,534 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $846,534 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $13,093,442 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 4: | The endowment, held by the Sherdian Health Care Foundation, Inc., consists of individual funds established by donors to provide annual funding for specific activities and general operations of the Hospital. |
| Part X, Line 2: | The Hospital is organized as a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from Federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Provision for Bad Debts reported as Revenue offset on the Financials -846,534. Equity in Income of Foundation reported as Other Revenue on the Financials -58,002. Net Assets Released from Restrictions reported as Revenue on the Financials 260,864. |
| Part XI, Line 4b - Other Adjustments: | Contributions included in Fund Balance on the Financials 28,831. |
| Part XII, Line 4b - Other Adjustments: | Provision for Bad Debts reported as Revenue offset on the Financials 846,534. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $113,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $113,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00920 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,370,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,162,287 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $208,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01700 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,483,824 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,162,287 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $321,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02620 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,555 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,555 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $143,101 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $54,820 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $88,281 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,972 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,972 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $154,628 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $54,820 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $99,808 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,638,452 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,217,107 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $421,345 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03430 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $846,534 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,876,164 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,837,786 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $38,378 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | Sheridan Memorial Hospital Association | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W Laurel Ave | AddressLine1Txt |
| City | Plentywood | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.sheridanmemorial.net | WebsiteAddressTxt |
| State License | 13547 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Rural Health Clinic, Long-term Care Facility | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sheridan Memorial Hospital Association | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.sheridanmemorial.net | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 13 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Lowest Negotiated Rates | Yes (X) | LowestNegotiatedRatesInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | Yes (1) | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Sheridan Memorial Hospital Association | Part V, Section B, Line 5: Through the process of the Community Health Needs Assessment, the Hospital worked with focus groups and a committee including public health employees, retirement center representatives, and special needs and mental health counselors. |
| Sheridan Memorial Hospital Association | Part V, Section B, Line 6b: Pioneer Manor, Retirement FacilityLaCasa, Assisted Living FacilitySheridan County HealthGlenwood, Assisted Living |
| Sheridan Memorial Hospital Association | Part V, Section B, Line 7d: The full CHNA is available upon request. It is also posted in a couple places in the hospital. |
| Sheridan Memorial Hospital Association | Part V, Section B, Line 11: Alcohol and substance abuse was one need identified in the Community Health Needs Assessment that is not being addressed. The organization does not have the space, staff or funding to start a program addressing this at this time. The organization will also not be addressing the need for Cancer related services. Space and financial constraints limit the organization's ability to start offering services such as chemo and radiation.Other needs identified by the CHNA that are being addressed by Sheridan Memorial is access to specialists/healthcare and need for another doctor within the community. To address those Sheridan Memorial began marketing the telemedicine services available at Sheridan Memorial to allow patients to see specialists from around the country via ITV. Sheridan Memorial providers have also been versed in the services offered over telemed which then allows them to relay on to their patients that such services are available. Any additional specialized healthcare services cannot be offered locally due to space and lack of need the expense could not be justified. Since 2013 CHNA Sheridan Memorial has continued to do provider recruiting, currently has a staff of 5 providers and looking to hire another. |
| Sheridan Memorial Hospital Association | Part V, Section B, Line 20e: Every statement the patient receives notes that financial assistance may be applied for within 30 days. |
| Sheridan Memorial Hospital Association | Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c: | Individuals applying for charity care must provide pay stubs, their most recent tax return, forms approving or denying eligibility for Medicaid and/or state or county funded medical assistance, forms approving or denying unemployment compensation and current bank statements. The items listed above will be used to determine family income. Family income and family size are then used to determine what the poverty threshold is for the applicant and to determine if free or discounted care will be approved. |
| Part I, Line 7: | Line 7a: Charity care was calculated by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients.Line 7b: The Medicaid calculation is based on Worksheet 2, Ratio of Patient Care Cost to Charges.Line 7e, g, and i: Actual costs were used to report community health improvement services, subsidized health services, and cash and in-kind contributions. |
| Part I, Ln 7 Col(f): | The amount of bad debt expense removed from the denominator of the calculation was $846,534. |
| Part III, Line 2: | The Organization relies on Financial management Association Statement 15 to determine bad debt expense and financial assistance in their audited financial statements. |
| Part III, Line 4: | Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 8 and 9 of the attached audit report. |
| Part III, Line 8: | The cost to charge ratio is used to determine community benefit. This is done by applying the ratio to the total Medicare revenue. A shortfall or overage in any given year is a result of the timing of payments from Medicare on an interim basis and when final settlement is made. Management uses estimates to calculate such settlements but actual results vary from those estimates. Additionally, shortfalls can result from various expenses that are incurred by the facility which are considered non-reimbursable by Medicare. Since part of the costs are not reimbursed it is only prudent to consider this shortfall to be a benefit to the community. |
| Part III, Line 9b: | Once a financial assistance application is submitted, collection actions are suspended until it is determined if the patient is eligible for financial assistance. All applications for financial assistance are reviewed and approved by the board. If an individual submits an incomplete FAP application, a patient account representative provides a notice requesting additional information and lets the individual know what additional information is needed. In certain cases, where deemed appropriate, collection actions are reversed if an individual is determined to be eligible for financial assistance. |
| Part VI, Line 2: | In order to assess the healthcare needs of the community, the facility did a community health needs assessment which consisted of focus groups and mail in surveys. The facility also does satisfaction surveys and has a complaint policy for the public. |
| Part VI, Line 3: | The facility tries to make sure patients are aware of the financial assistance policy by giving it to them upon admission and with invoices. The facility also has it posted on the web site. All patients who call about their bill are educated on payment options. |
| Part VI, Line 4: | Sheridan Memorial Hospital is a private not-for-profit organization which is the only medical facility in Sheridan County with a population of approximately 4,105 residents. The facility provides acute, emergency, clinical and long term care for residents in the county and surrounding areas. Established in 1922 as primarily a hospital, Sheridan Memorial Hospital Association continued expanding throughout the years with first a relocation from our small main street location to our current location. In 2008 Sheridan Memorial Hospital added a Rehab suite including exam rooms, prep area, work out area and a hydrotherapy pool. The hospital has an active medical staff of one physician, three family nurse practitioners and two physician assistants as well as consulting medical doctors in the fields of radiology and surgery. Services provided at the hospital include: xray technology, physical, occupational and speech therapy, laboratory testing, visiting nurse and hospice care, durable medical equipment and home oxygen sales, social services and emergency services. In 2010 Sheridan Memorial became the first contracted tele-health VA clinic in the country offering area veterans' primary health care via tele-video equipment. |
| Part VI, Line 5: | Sheridan Memorial's governing body is comprised of all residents of Sheridan Memorial's primary service area who are not employed by the facility. Sheridan Memorial has expanded medical staff privileges to an MD who has his own private Clinic in the area. Medical privileges are also extended to qualfied physicians in the community and providers willing to see Sheridan Memorial patient's via telemed/video conference. The Board of Directors is made up of volunteers from the community. We try to have representation of the board from individuals throughout the county and not just of those living in Plentywood. Surplus funds are applied back to patient care and education. We offer many services which are a community benefit to the communities we serve which include the following:* Alzheimer's support group offered free of charge* Grief counselor does counseling free of charge* Use of telemedicine equipment is open to the community for use such as mental health visits, behavioral health classes, MIP classes, Lunch and Learns community educational telemeds when available, Lifestyle balance classes for community members as well as continuing education courses for employees, other medical personnel outside of Sheridan Memorial such as Pharmacists etc. all free of charge* ER open 24 hours regardless of ability to pay* Participates in education of healthcare professionals* Participates in government sponsored health programs* Sheridan Memorial is involved in community outreach through the Sheridan County Chamber, Council on Aging, a working relationship with County Health among other involvements. -* Through a grant received, offers free Marketplace Health insurance assistance to help educate and enroll residents in health insurance. The Navigator does promotions throughout the enrollment period and works with community members from start to finish.* Assist community members in applying for State Medicaid assistance and SSDI. Applications can be confusing and the process frustrating thus Sheridan Memorial offers any help to get patients the help they need* Sole community provider of most service lines* Offers volunteer opportunities to community through Hospice, EMS, Activities, Beauty Shop, Pink Lady Program as well as gift shop staffing. * Has a foundation that serves as a vehicle for attracting and effectively using donated funds * Has the support of an Auxiliary that hosts events throughout the year to raise funds for the health care facility. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | 0 | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | 0 | SubstantiationRequiredInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Adam Graham | PersonNm |
| Title | PA | TitleTxt |
| Base Compensation Filing Org | $126,968 | BaseCompensationFilingOrgAmt |
| Compensation Based On Rltd Orgs | $0 | CompensationBasedOnRltdOrgsAmt |
| Bonus Filing Organization | $16,821 | BonusFilingOrganizationAmount |
| Bonus Related Organizations | $0 | BonusRelatedOrganizationsAmt |
| Other Compensation Filing Org | $12,237 | OtherCompensationFilingOrgAmt |
| Other Compensation Rltd Orgs | $0 | OtherCompensationRltdOrgsAmt |
| Deferred Compensation Flng Org | $0 | DeferredCompensationFlngOrgAmt |
| Deferred Comp Rltd Orgs | $0 | DeferredCompRltdOrgsAmt |
| Nontaxable Benefits Filing Org | $15,089 | NontaxableBenefitsFilingOrgAmt |
| Nontaxable Benefits Rltd Orgs | $0 | NontaxableBenefitsRltdOrgsAmt |
| Total Compensation Filing Org | $171,115 | TotalCompensationFilingOrgAmt |
| Total Compensation Rltd Orgs | $0 | TotalCompensationRltdOrgsAmt |
| Comp Report Prior990 Filing Org | $0 | CompReportPrior990FilingOrgAmt |
| Comp Report Prior990 Rltd Orgs | $0 | CompReportPrior990RltdOrgsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a | FormAndLineReferenceDesc |
| Explanation | An apartment was made available to the CEO which was approved by the Board of Directors. A housing allowance was provided for highest compensated employees Adam and Lynne Graham. This was included as compensation on Adam's Form W-2. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 1 | The Executive Committee shall consist of the President, as Chairman, the Secretary/Treasurer. The Executive Committee shall have the power to transact all regular business of the hospital during the period between the meetings of the Board of Directors subject to any prior limitations imposed by the Board of Directors. |
| Form 990, Part VI, Section A, line 3 | The hospital has a management agreement with Billings Clinic. They provide general accounting, HR, and business support services. Greg Maurer, CEO, became an employee of Billings Clinic in March 2015 and is compensated by Billings Clinic. Prior to Greg's arrival Billings Clinic employed Rob Brandt and Sandra Christensen. Sandra, Rob and Greg's compensation through the management company was $147,160 for fiscal year 2015. Kyle Gee's, Regional CFO, compensation from the management company for Sheridan's portion of his compensation was $19,048 for fiscal year 2015. |
| Form 990, Part VI, Section A, line 6 | Sheridan Memorial Hospital Association has 772 lifetime voting members. These members are granted voting privileges in electing/re-electing association board members. |
| Form 990, Part VI, Section A, line 7a | Sheridan Memorial Hospital Association has 772 lifetime voting members. These members are granted voting privileges in electing/re-electing association board members during the Annual Meeting held the third Tuesday of February every year. |
| Form 990, Part VI, Section B, line 11 | The board reviews an electronic copy of the Form 990 before the final copy is filed with the IRS. |
| Form 990, Part VI, Section B, line 12c | The Board of Directors, CEO, and meeting secretary are annually required to sign the conflict of interest policy. The board members review any potential conflicts to determine if a conflict exists. If there is a conflict of interest, the conflicted board member is not included in the vote on the particular matter. If the transaction is relating to a particularly sensitive topic, the conflicted board member may be asked to excuse themselves from both the discussion and the vote. |
| Form 990, Part VI, Section B, line 15 | Billings Clinic, along with input from the SMH Board of Directors, determines compensation for the CEO. |
| Form 990, Part VI, Section C, line 19 | The Organization's governing documents, conflict of interest policy, and financial statements are available upon request. |
| Form 990, Part XI, line 9: | Net Change in Interest in Net Assets of Foundation -58,002. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Sheridan Health Care Foundation Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 440 W Laurel Avenue | AddressLine1Txt |
| City | Plentywood | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810496987 | EIN |
| Primary Activities | Support activities of Sheridan Memorial Hospital Association | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(c)(3) | ExemptCodeSectionTxt |
| Public Charity Status | Line 7 | PublicCharityStatusTxt |
| Direct Controlling NA | N/A | DirectControllingNACd |
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |