2015-05-14T10:13:05-05:00 2014-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-07-01 810231787 Northern Montana Hospital NORT 4062652211 PO Box 1231 Havre MT 595011231 David Henry President/CEO 4062652211 2015-05-14 1 Kim C Hunwardsen P00484560 6122536500 2015-05-12 2013 2016-02-25 16:41:14Z David Henry PO Box 1231 Havre MT 595011231 62062585 0 X www.nmhcare.org X 1921 MT Provision of healthcare services. 13 8 724 135 145628 14020 92137 172875 55155647 60851380 867779 1028293 7056 1033 56122619 62053581 14711 27810 0 0 30961654 31989382 0 0 0 20872733 25300390 51849098 57317582 4273521 4735999 60313312 65371501 13670900 12472270 46642412 52899231 X To deliver high quality comprehensive healthcare services to the Hi-Line communities. 1 0 43354949 27810 60851380 Northern Montana Hospital (Hospital) provides quality healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of the Hospital, it is recognized that not all individuals possess the ability to purchase these essential services. It is the Hospital's mission to serve the surrounding area by providing healthcare services and healthcare education to all community members. During the year ended June 30, 2014, the Hospital provided $1,411,381 of medical services, based on charges, to individuals who were determined unable to purchase such services under the Hospital's charity care policy and guidelines. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients was $28,737,428 for the year ended June 30, 2014. During the fiscal year ended June 30, 2014 the Hospital provided almost 4,000 days of hospital services. The nursing home provided over 38,800 resident days during the year.The Hospital also provides community care and services through many healthcare activities and programs provided to support the community. These activities include: wellness programs, community education programs, senior services, healthcare screening, special programs for specific groups, published articles, radio programs, and a variety of community supported activities. The Hospital also received many hours of volunteer help from the community residents. 43354949 1 1 0 0 0 0 0 0 1 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 102 0 1 724 1 1 1 0 0 0 0 0 0 0 0 0 X 13 8 1 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 0 0 X Kim Lucke VP of Finance 4062652211 PO Box 1231 Havre MT 59501 David C Henry President/CEO 40.00 5.00 X X 0 0 0 Miles Hamilton Chairman 1.00 1.00 X X 0 0 0 Tom Patrick Vice Chair (Nov-June) 1.00 1.00 X X 0 0 0 Bruce Richardson MD Vice Chair (thru Oct 2013) 1.00 1.00 X X 245426 0 8366 David Leeds Treasurer 1.00 1.00 X X 0 0 0 Judy Greenwood Secretary 1.00 1.00 X X 0 0 0 Paul Tuss Trustee 1.00 1.00 X 0 0 0 Stephen Bechdolt MD Medical Director of IPD 1.00 1.00 X 303320 0 15835 Julie Holt Trustee 1.00 1.00 X 0 0 0 Andrew Carlson Trustee 1.00 1.00 X 0 0 0 Rick Stevens Trustee 1.00 1.00 X 0 0 0 Michael Nolan MD Trustee - IPD Member 1.00 1.00 X 309139 0 8687 Karrie Lien MD Trustee - IPD Member 1.00 1.00 X 396010 0 31650 Steven Liston MD Chief of Medical Staff 40.00 1.00 X 605500 0 0 Kim Lucke VP of Finance 40.00 5.00 X 79873 0 20746 Julie Mariani Vice President 40.00 1.00 X 109336 0 25639 Michelle Donaldson MD Orthopedic Surgeon 40.00 0.00 X 489831 0 14069 Damian Ymzon MD General Surgeon 40.00 0.00 X 335739 0 31682 Allen Rebchook MD General Surgeon 40.00 0.00 X 345376 0 18244 Marc Whitacre MD Opthamalogist 40.00 0.00 X 300824 0 34222 Terence Hankins MD Internal Medicine 40.00 0.00 X 215708 0 17310 Karen Pollington Former Vice President 40.00 0.00 X 109633 0 17883 3845715 0 244333 12 1 1 0 Clausen & Sons Inc 2480 2nd St West Havre MT 59501 Construction 5082435 Fundamental Financial Groups PO Box 1231 Havre MT 59501 Management Services 396000 A&E Architects PC 608 N 29th St Billings MT 59101 Architect Services 262967 Med Assets Inc PO Box 405652 Atlanta GA 303845652 Revenue Cycle Re-Engineering 252725 PAML PO Box 2720 Spokane WA 992204002 Reference Lab Testing 202015 14 112360 60515 172875 Net Patient Service Revenue 622110 52160546 52160546 Pharmacy 446110 6896060 6750432 145628 Supporting Revenue 900099 1057003 1057003 Healthcare Consulting 900099 448427 448427 Cafeteria Revenue 722210 289344 289344 60851380 698271 698271 10037 9004 1033 1033 1033 328712 1310 0 0 328712 1310 330022 330022 62053581 60705752 145628 1029326 16650 16650 11160 11160 2251308 2036202 215106 80962 80962 24748303 17323812 7424491 561784 393249 168535 1903005 1046653 856352 2444020 1710814 733206 396000 79200 316800 95009 95009 74360 74360 3416426 3076130 340296 253584 253584 2025738 780674 1245064 606970 485576 121394 1790193 1250434 539759 210469 73664 136805 47229 47229 2167596 1517317 650279 1053627 842902 210725 Medical Supplies 6033368 6033368 Bad Debt Expense 4835339 4835339 Equipment Rental and Ma 817366 449551 367815 Bed Tax 555056 555056 922060 756236 165824 57317582 43354949 13962633 0 64652 7037642 6037894 12167524 13138861 1551648 1738728 503985 765443 49386512 39285072 10769738 10101440 26284073 27731143 79781 104721 1854269 5753271 60313312 65371501 4860951 6495595 2107553 1661618 6702396 4315057 13670900 12472270 X 46642412 52899231 46642412 52899231 60313312 65371501 X 4735999 469918 1050902 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 32418 113358 112608 33168 0 75272 75272 21191367 17379373 3811994 26794289 21112175 5682114 1325584 793524 532060 10101440 Due from Affiliates 5679566 Accrued interest receivable 73705 5753271 Liability for pension benefits 3702512 Third-party payor settlements 600000 Due to Affiliates 12545 4315057 X 57468566 -4835339 -4835339 62303905 -250324 -250324 62053581 52732567 250324 250324 52482243 4835339 4835339 57317582 Part IV, Line 1b: The custodial funds are not reported on the balance sheet of NMH as they are the personal resource funds of the residents to be used only for their personal needs. If the resident passes, the funds either go to the family or back to the state. They are in no way an asset of the organization. Part X, Line 2: The Organization is organized as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Provision for bad debts included in revenue on financial statements -4,835,339. Part XI, Line 4b - Other Adjustments: Rental expenses included in expenses on financial statements -9,004. Cost of goods sold included in expenses on financial statements -241,320. Part XII, Line 2d - Other Adjustments: Rental expenses included in expenses on financial statements 9,004. Cost of goods sold included in expenses on financial statements 241,320. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in revenue on financial statements 4,835,339. 1 1 X 1 X 125.000000000000 1 X 225.000000000000 1 1 1 0 1 1 729000 729000 0.01390 9018602 8276455 742147 0.01410 9747602 8276455 1471147 0.02800 4423 4423 0.00010 7574286 6283346 1290940 0.02460 21189 21189 0.00040 7599898 6283346 1316552 0.02510 17347500 14559801 2787699 0.05310 163479 99391 64088 0.00120 9290 1725 7565 0.00010 230 230 0.00000 172999 101116 71883 0.00130 0 4835339 68200 9685834 10590255 -904421 X 1 1 1 1 Northern Montana Hospital 30 13th Street Havre MT 59501 www.nmhcare.org 12835 X X X 2 provider based rural health clinics Northern Montana Hospital 1 1 X X X X X X X X 13 1 1 1 X www.nmhcare.org X www.bullhook.com and www.hillcountyhealth.com X X X X X X X X X X X 1 0 1 1 125.000000000000 1 225.000000000000 1 X X 1 1 X X X 1 0 X X X 1 X 0 1 Northern Montana Hospital Part V, Section B, Line 3: NMH is a member of the Hill County Health Consortium and conducted the Needs Assessment in collaboration with them. Members of the Consortium include the Hill County Health Department, The Board of Health, Rocky Boy Health Department, Salvation Army, United Way, HRDC, Havre Public Schools and MSU-Northern College, County Extension Office, County Commissioners, Office of Public Assistance, 12th Judicial District Youth Court and several other community organizations and forums. Northern Montana Hospital Part V, Section B, Line 4: Benefis Health System, Marias Medical Center, Liberty Medical Center, Northern Rockies Medical Center, Phillips County Hospital, Big Sandy Medical Center, Missouri River Medical Center, Mountainview Medical Center, Central Montana Medical Center, Teton Medical Center, Pondera Medical Center Northern Montana Hospital Part V, Section B, Line 5d: The CHNA is electronically delivered to every member of the Consortium and NMH. Bullhook Community Health Center and the Hill County Health Department all received hard copies available for distribution. Northern Montana Hospital Part V, Section B, Line 6i: MH hosts Consortium meetings and provide lunch free of charge. NMH also paid half of the consulting fee for the development of initiative, action objective and strategy language. The implementation strategy may be found at: www.nmhcare.org. Northern Montana Hospital Part V, Section B, Line 14g: In addition, a summary of the financial assistance policy is posted in the facility's emergency room and waiting rooms as well as admissions offices. The hospital's "Conditions of Treatment" also includes information regarding the financial assistance policy. Northern Montana Hospital Part V, Section B, Line 22: 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. 1 Northern Montana Care Center 24 13th Street Havre MT 59501 Nursing Home Part I, Line 6a: The Organization's community benefit report was published as a 1/2 page ad in the local newspaper. In addition, a statement about the amount of community benefit the organization provided can be found on our web-site at www.nmhcare.org. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid, line 7b, was calculated using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, line 7e, and cash and in-kind donations, line 7i, are actual costs reported in the general ledger. The cost for subsidized health services reported on line 7g was determined using the cost-to-charge ratio derived from worksheet 2. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $4,835,339. Part II, Community Building Activities: Reported under community building activities is the maintenance of our fitness park which is open to the public and has both a softball field and soccer field, as well as a paved walking path. It also includes an employee's time for being a member of the Hill County Health Consortium, which collaboratively conducted a Community Health Needs Assessment with several other local public health entities and works to implement the identified unmet needs of the community. Another community building activity is community forums at which employed physicians give educational presentations to the community on various health topics. Part III, Line 2: Bad debt expense is reported as charges net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated by using charity care as a percentage of gross patient service revenue. As a portion of revenue is considered charity care, it is assumed that a percentage of bad debt expense would also be considered charity care. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 7 of the attached audited financial statements. Part III, Line 8: The expenses represent an overall shortfall of the Medicare patient population. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The Organization's financial assistance policy provides information on collection practices for those known to qualify for financial assistance. The policy states "During the patient registration or collection process, the Hospital will make an initial determination of eligibility based on verbal or written application for charity care. Pending final eligibility determination, the Hospital will not initiate collection efforts or requests for deposits, provided that the responsible party is cooperative with the Hospital's efforts to reach a determination of status, including return of applications and documentation required by the Hospital within fourteen (14) days of receipt." Part VI, Line 2: In FY 2011 Northern Montana Hospital became a member of the Hill County Health Consortium. The Consortium is composed of many important stakeholders in the community who have joined together to identify the current health needs impacting the community. Partnerships were formed by members of the Consortium to help gather the data needed in the discussions. The CHANGE (Community Health Assessment and Group Evaluation) tool from the CDC website was chosen to help us through the process of our community health assessment mainly because it would walk us through each step in the process. CHANGE can be used to gain a picture of the policy, systems, and environmental change strategies currently in place throughout the community; develop a community action plan for improving policies, systems, and the environment to support healthy lifestyles; and assist with prioritizing community needs and allocating available resources. The CHANGE tool involves dividing our community into 5 different sectors and choosing a few sites within those sectors to collect responses from. The 5 Sectors include:(1) Community-At-Large(2) Community-Institutions-Organizations(3) Worksite(4) Health Care(5) SchoolsAlong with the CHANGE tool, a written survey was created using an example from Wilkes Healthy Carolinians Council (wilkeshealth.com). This survey seemed to fit closely with our needs, with only minor adjustments being made to fit Hill County. This written survey was available throughout Hill County at various waiting areas so people would have adequate time to complete them.Out of the Community Health Needs Assessment (CHNA) the Community Health Improvement Plan (CHIP) was developed. The plan identifies several health related issues that adversely impact the health of the community. This plan not only provides us with a deeper look into the current health status of the community, it leads us into providing solutions for improving the health status of our community. These improvements are spearheaded by subcommittees chosen through the Hill County Consortium and other local agencies.The Community Health Improvement Plan is an ongoing process. The Community Health Assessment will be repeated in 2014 and will form the basis by which improvement will be measured. Northern Montana Hospital takes an active role in the Hill County Health Consortium.In FY 2014, NMH again partnered with the Hill County Health Consortium to engage multiple segments of the community in collaboration, assessment and planning of the health needs of Hill County. Multiple assessments were used along with county and facility statistical data. The collaborative assessments relied upon included:* The Hill County Community Health Needs Assessment Report, a collaborative development of the regional North Central Montana Healthy Communities group. This health needs assessment identified the "ten most serious health concerns" in the County.* The Early Childhood Investment Team (ECIT) needs assessment; which looked at issues specifically facing young children in Hill County* A review of the previous CHIP completed in 2011 which identified obesity, awareness of Health Care resources and unsafe sex.* Facility statistical data which indicates the top diagnosis in the population are consistently Diabetes, Hypertension and Depression.As a result of the assessments, the new areas of focus chosen for 2014-2017 are: Alcohol abuse, Mental Health and Teen Pregnancy. Part VI, Line 3: Northern Montana Hospital informs and educates patients about their eligibility for assistance through a sign posted at our admissions desk, noted in the brochure we give patients at our clinics, and signs posted at our clinic registration desks. In addition, our collection staff offers charity care as an option when they are discussing the patient's balance as well as the availability of various government benefits, such as Medicaid or state programs. As of Oct 2010, NMH has contracted with a company to assist the patient with qualification for programs such as Medicaid and disability determination.We also publish a community benefit report annually which states how much financial assistance we have given away, and we post our community benefit report on our website noting that we provide financial assistance. Part VI, Line 4: Northern Montana Hospital is a 49 bed hospital including 5 swing beds, a 5 bed intensive care unit, 24-hour staffed emergency room, same day surgery, and a 6 chair dialysis unit. Northern Montana Care Center is a 136 bed skilled and intermediate care facility of which 20 beds are designated for residents with Alzheimer's disease and other related dementias. Northern Montana Assisted Living is a 10 bed facility. Northern Montana Medical Group - East and Northern Montana Medical Group - West are both provider based rural health clinics. Other services include: Northern Montana Vision Center, an ophthalmology office; Bear Paw Hospice; and the Hi-Line Sleep Center. The Hospital's service area consists of Hill, Blaine, Liberty, Philips and the Big Sandy census district of Choteau counties. The population of this service area is approximately 30,000. The median household income is about $42,000. Approximately 45% of the population has a household income below 200% of the federal poverty guidelines. Approximately 24% of the population is covered by Medicaid, 30% by Medicare, 2.5% by CHIP and about 27% uninsured. Additionally, another 6% of the population is covered by Indian Health Services. The entire service area is considered rural and has been designated a health professional shortage area for all primary medical care, mental health and dental. In addition, the entire service area is designated as a medically underserved area. Northern Montana Hospital is the only local hospital in its service area; however there are 3 critical access hospitals, 4 rural health clinics, 3 community health clinics and 3 IHS-Tribal clinics within its service area. The nearest hospital is a critical access hospital and is 35 miles away. Part VI, Line 5: More than 50% of Northern Montana Hospital's governing board consists of various local business people who reside within our service area and are not employed or contracted by the organization. Northern Montana Hospital extends medical staff privileges to all qualified physicians in its community. The organization applies surplus funds to improvements in patient care by keeping its medical equipment up to date, sending its employed physicians for further continuing education, supporting nursing education through a loan re-payment assistance program and supporting health care education through an education assistance program. In addition, the hospital subsidizes its emergency department by offering 24/7 emergent care coverage to all, regardless of their ability to pay. Northern Montana Hospital offers Dialysis services to patients in our service area, despite the fact that this service is provided at a loss to NMH. Without this service, patients would have to travel well over 100 miles each way, 3 times per week to receive this service. Northern Montana Hospital has Sole Community Designation. The nearest PPS hospital is located 110 miles from Havre. Northern Montana Hospital also participates in all government sponsored health programs, such as CHIP, Healthy Montana Kids and the Montana Cervical and Breast Cancer Program, where it accepts payments for services at greatly discounted rates. Several members of Northern Montana Hospital's leadership team serve on other community boards, such as: Havre Chamber of Commerce, Hill County Health Consortium, Local Emergency Planning, Fetal/Infant/Child Mortality Review Board, Havre/Hill County Planning Board, Hill and Blaine County Adult Protective Services Committee, Hill County United Way, HRDC Medical Advisory Board, MSU-N Nursing Advisory Board and the Safe Kids Safe Communities Committee. Part VI, Line 7, Reports Filed With States MT 1 Education Assistance 5 11160 Part I, Line 2: The organization provides education assistance to qualified employees. The organization monitors the use of the assistance by disbursing the funds directly to the institution. Schedule I, Part III: Per our education assistance policy, we will only assist for degrees that will fulfill our staffing needs. We will pay up to $5,250 per employee per year, however not every applicant requests the full amount. Therefore, we anticipate 3-6 recipients per year. 0 0 0 1 0 0 0 0 0 Bruce Richardson MD Vice Chair (thru Oct 2013) 243711 0 0 0 1715 0 0 0 10289 0 255715 0 0 0 Stephen Bechdolt MD Medical Director of IPD 302132 0 0 0 1188 0 6120 0 12089 0 321529 0 0 0 Michael Nolan MD Trustee - IPD Member 306853 0 0 0 2286 0 6187 0 4900 0 320226 0 0 0 Karrie Lien MD Trustee - IPD Member 395740 0 0 0 270 0 8101 0 26686 0 430797 0 0 0 Steven Liston MD Chief of Medical Staff 605500 0 0 0 0 0 0 0 0 0 605500 0 0 0 Michelle Donaldson MD Orthopedic Surgeon 489628 0 0 0 203 0 0 0 17898 0 507729 0 0 0 Damian Ymzon MD General Surgeon 335577 0 0 0 162 0 7000 0 27395 0 370134 0 0 0 Allen Rebchook MD General Surgeon 344602 0 0 0 774 0 7000 0 13957 0 366333 0 0 0 Marc Whitacre MD Opthamalogist 299739 0 0 0 1085 0 6333 0 30345 0 337502 0 0 0 Terence Hankins MD Internal Medicine 215354 0 0 0 354 0 4400 0 14622 0 234730 0 0 0 Karen Pollington Former Vice President 108823 0 0 0 810 0 0 0 18804 0 128437 0 0 0 Part I, Line 3 President/CEO is compensated by an unrelated management company. A related organization and the management company have a process in place to determine the CEO's compensation using the Form 990 of other organizations, a written employment contract, a compensation survey or study, and the approval by the board or compensation committee. Part I, Line 5 Karrie Lien and Michael Nolan are compensated as a percentage of the prior three months' average gross revenue earned for the hospital by the physician, with the percentage being based on their specialty. Form 990, Part III, line 2 Cancer care services became available May 1, 2014, through a joint venture with Benefis Healthcare, Inc. The cancer center in Havre was re-opened and residents of Havre and the surrounding hi-line can now get cancer treatment in Havre. Form 990, Part VI, Section A, line 2 Kim Lucke, Julie Mariani, Bruce Richardson, David C. Henry, David Leeds, Judy Greenwood, Miles Hamilton, Paul Tuss, Julie Holt, Andrew Carlson, Tom Patrick, Michael Nolan, Steven Liston, Karrie Lien and Stephen Bechdolt have business relationships with each other. Form 990, Part VI, Section A, line 3 David C. Henry, President/CEO is employed by Fundamental Financial Group, an unrelated management company. Northern Montana Hospital (NMH), pays the unrelated management company for David's services provided to the Hospital, Northern Montana Health Care, Inc. and Northern Montana Health Care Foundation. The President/CEO's responsibilities include implemeting decisions and supervising the management, administration and operation of the Hospital and the related, exempt organizations. The amount of compensation paid during fiscal year 2014 was $396,000. Form 990, Part VI, Section A, line 6 The sole member of the organization is Northern Montana Health Care, Inc. Form 990, Part VI, Section A, line 7b The sole member of the organization shall have such rights and powers as are provided for in the Articles of Incorporation, the Bylaws of the organization and the laws of the State of Montana, including but not limited to, the exclusive power: (a) to remove any trustee from any office at any time, with or without cause; (b) to propose and approve (i) a plan of dissolution or liquidation of the organization or (ii) a plan of merger or consolidation of the organization with another corporation; (c) to propose and approve amendments to the articles of incorporation and or the bylaws;(d) to adopt any annual or long-term capital or operational budget or any changes therein exceeding $75,000;(e) to authorize the organization to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operational budget approved by the sole member of the organization where the amount involved exceeds $50,000;(f) to adopt substantive changes to existing long-term or master institutional plans of the organization; (g) to authorize the organization to engage in, or enter into, any transaction providing for the sale, mortgage or other disposition of all or substantially all of the assets of the organization; (h) to organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the organization; (i) to authorize the organization to enter into any shared service agreement; (j) to approve long-term borrowing of money by the organization or authorize the organization to incur indebtedness involving a mortgage or lien on assets; or (k) to approve the trustees or the President of the organization from a slate prepared by the Nominating Committee of the organization. Form 990, Part VI, Section A, line 8b No committee has the authority to act on behalf of the board. Form 990, Part VI, Section B, line 11 The Board of Directors receives a copy of the Form 990 via e-mail before it is filed. The VP of Finance reviews the form. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers all trustees, directors, officers, and key employees. The board identifies potential conflicts from annual disclosures. Disclosures are reviewed by administration after all are gathered. A second conflict disclosure letter is sent out annually to all current and former officers, directors, trustees, and key employees to ensure all potential conflicts are identified. The results of this disclosure form are reviewed by the VP of Finance. The board discusses the potential conflicts and determines if voting on related items would be a conflict of interest. If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item. Form 990, Part VI, Section B, line 15a The President/CEO is compensated by an unrelated management company. The Executive Committee of the board meets and reviews Northern Montana Hospital(NMH)/Northern Montana Health Care, Inc.(NMHC) financial results, the CEO's current year priorities, discusses evaluation tools to be used for CEO evaluation, how comparative salaries will be obtained and discusses the history of compensation to the CEO. At a second Executive Committee meeting they review non-financial activity of NMH/NMHC and the results of the CEO evaluations completed by the board members. Then they review and discuss a compensation comparative summary of Montana CEO's compensation and a Guidestar CEO Compensation Checkpoint that is prepared specifically for NMH. They agree upon a list of the coming year's priorities for the CEO and proposed compensation, with the compensation set by board vote. This annual process was last completed during fiscal year 2014. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The financial statements are attached to the Form 990 per the IRS instructions. Form 990, Part XI, line 9: Minimum Pension Liability Adjustment: 1,550,902. Equity Transfer to Related Organization: -500,000. Form 990, Part XII, Line 2c: The controlling organization, Northern Montana Health Care, Inc.'s Board has a committee that assumes responsibility for oversight of the audit of the financial statements and selection of an independent auditor. North Care Corporation 30 13th Street Havre MT 59501 810447638 Health Care Services MT 501(c)(3) Line 3 Northern Montana Health Care Inc 0 Northern Montana Health Care Inc PO Box 1231 Havre MT 59501 810428854 Supporting Organization MT 501(c)(3) Line 11b, II N/A 0 Northern Montana Health Care Foundation Inc PO Box 1231 Havre MT 59501 363464641 Fundraising MT 501(c)(3) Line 7 Northern Montana Health Care Inc 0 Paramount Health Care Inc PO Box 1231 Havre MT 59501 810393353 Health Care Services MT N/A C 0 0 0 1 0 0 0 0 0 0 0 1 1 0 1 1 0 1 0 1 Northern Montana Healthcare Foundation Inc O 65784 Actual Cost Northern Montana Healthcare Foundation Inc C 112360 Actual Cost