FURP.ORG / PUBLIC DATA EXPLORER

CENTRAL MONTANA MEDICAL FACILITIES INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
CENTRAL MONTANA MEDICAL FACILITIES INC (EIN 23-7169043)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-13
IRS object ID
201411339349303221
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-05-13T12:37:57-05:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN450250958EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1800 Nicollet Mall Ste 1300AddressLine1
CityMinneapolisCity
StateMNState
ZIP Code554027033ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN237169043EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Central Montana Medical Facilities IncBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCENTNameControl
Phone4065387711Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1408 Wendell AvenueAddressLine1
CityLewistownCity
StateMTState
ZIP Code59457ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameAlan R AldrichName
TitleCFOTitle
Phone4065386243Phone
Date Signed2014-05-09DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKim C HunwardsenName
PTINP00484560PTIN
Phone6122536500Phone
Date Prepared2014-05-09DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

Doing Business As DoingBusinessAs

FieldValueIRS element (for citing)
Business Name Line1Central Montana Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name Of Principal Officer PersonLee RhodesNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1408 Wendell AvenueAddressLine1
CityLewistownCity
StateMTState
ZIP Code59457ZIPCode
FieldValueIRS element (for citing)
Gross Receipts28959727GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.cmmccares.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1971YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionThe mission of CMMC is to be the leader in assuring community based quality healthcare.ActivityOrMissionDescription
Nbr Voting Members Governing Body14NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees443TotalNbrEmployees
Total Nbr Volunteers240TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year180603ContributionsGrantsPriorYear
Contributions Grants Current Year148718ContributionsGrantsCurrentYear
Program Service Revenue Prior Year26032781ProgramServiceRevenuePriorYear
Program Service Revenue CY27678308ProgramServiceRevenueCY
Investment Income Prior Year101698InvestmentIncomePriorYear
Investment Income Current Year240160InvestmentIncomeCurrentYear
Other Revenue Prior Year-13978OtherRevenuePriorYear
Other Revenue Current Year-13448OtherRevenueCurrentYear
Total Revenue Prior Year26301104TotalRevenuePriorYear
Total Revenue Current Year28053738TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year15813633SalariesEtcPriorYear
Salaries Etc Current Year16907595SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year67662TotalFundrsngExpCurrentYear
Other Expense Prior Year10491129OtherExpensePriorYear
Other Expenses Current Year11110163OtherExpensesCurrentYear
Total Expenses Prior Year26304762TotalExpensesPriorYear
Total Expenses Current Year28017758TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-3658RevenuesLessExpensesPriorYear
Revenues Less Expenses CY35980RevenuesLessExpensesCY
Total Assets BOY20497551TotalAssetsBOY
Total Assets EOY21345794TotalAssetsEOY
Total Liabilities BOY4926941TotalLiabilitiesBOY
Total Liabilities EOY4944209TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15570610NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY16401585NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionThe mission of Central Montana Medical Center is to be the leader in assuring community based quality healthcare.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense2502329Expense
Revenue2531466Revenue
DescriptionHospital Inpatient Services:Number of beds: 25Provided 1,767 acute days of care and 735 swing bed days of care for 27.4% occupancy rate.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense3809107Expense
Revenue3853594Revenue
DescriptionSkilled Nursing Care/Long-Term Care Rehabilitation or Long-Term Nursing Services:Provided 17,308 days of care for a 55.79% occupancy rate.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense1801545Expense
Revenue2921195Revenue
DescriptionEmergency Services:Provided for 5,188 Emergency visits.24 hour Physician coverage available.Description

Activity Other ActivityOther

FieldValueIRS element (for citing)
Expense14659248Expense
Revenue18372053Revenue
DescriptionCommunity care and services are also provided through the many reduced price services and free clinics, fairs, and programs offered throughout the year. These include but are not limited to the following (all costs are estimates):1. Twenty-five foot clinics were held in 2012-2013 in Denton, Hobson and Lewistown, MT. A total of 359 people were served, all received discounted health care. Total community benefits expense of $5,499.2. One health fair was held in 2012-2013, serving 1,800 people in Fergus and surrounding counties. All received discounted health care. Total community benefits expense of $4,725.3. Diabetes Education held Support Groups throughout 2012-2013, serving 46 people and totaling a community benefit expense of $609.4. CMMC educated locals with a babysitting class (24 people served, 1 class offered, total community benefit $966), and several community boards were served on in 2012-2013 for a total of $2,566.5. EMS educated local community and surrounding counties throughout 2012-2013, serving 243 people and totaling a community benefit expense of $11,242.The facilities maintain records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. The amount of charges foregone for services provided under the Facilities charity care policy were approximately $1,067,000 for the fiscal year. Total direct and indirect costs related to these foregone charges were $731,000, based on an average ratio of cost to gross charges.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp14659248TotalOfOtherProgramServiceExp
Total Of Other Program Service Rev18372053TotalOfOtherProgramServiceRev
Total Program Service Expense22772229TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling1CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt1IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt0ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities1FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity0RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109640NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees443NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions1QuidProQuoContributions
Quid Pro Quo Disclosure1QuidProQuoDisclosure
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members14NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO0CompensationProcessCEO
Compensation Process Other0CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1Alan R AldrichBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4065357711TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1408 Wendell AveAddressLine1
CityLewistownCity
StateMTState
ZIP Code59457ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Mike Zacher
President2.00XX000
Dave Phillips
Vice President2.00XX000
Nancy Wilson
Secretary/Treasurer2.00XX000
Doug Flament
Member1.00X000
Alta Pallett
Member (July)1.00X000
Russel Spika CPA
Member1.00X000
Mike Delaney
Member1.00X000
Francis Weinheimer
Member1.00X000
Laura Bennett MD
Member1.00X177711011053
Christine Volf
Member (July-September)1.00X000
Roy Kohler MD
Member1.00X1373100
Josh Webber
Member1.00X000
Carl Seilstad
Member1.00X000
Greg Smith
Member (September-June)1.00X000
Ann Econom
Member (October-June)1.00X000
Susan Miller
Member (September-June)1.00X000
Lee Rhodes
CEO40.00X000
Alan R Aldrich
CFO40.00X129488015265
Dianne Scotten
CCO40.00X12498503774
Aaron Humphreys
Orthopedic Surgeon40.00527133016546X
James Fox
CRNA40.0021370006429X
Joan McMahon
Emergency Medicine40.0020983708341X
Danny Harbour
Emergency Medicine40.00201493017993X
Michael Sura
Family Medicine40.00195493016977X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1793571TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation96378TotalOtherCompensation
Number Individuals GT100 K15NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (2 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Quorum Health Resources LLC
105 Continential PlaceBrentwoodTN37027Facility Management & CEO services509885
L'Heureux Page Werner PC
15 5th Ave SGreat FallsMT59401Architect for Hospice House & ER/Lab Pro136040
FieldValueIRS element (for citing)
Number Of Contractors GT100 K2NumberOfContractorsGT100K
Fundraising Events42367FundraisingEvents
Government Grants30176GovernmentGrants
All Other Contributions76175AllOtherContributions
Total Contributions148718TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Revenue6221102648736326487363
Special Programs900099929681929681
Cafeteria722210127726127726

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column133538TotalRevenueColumn
Related Or Exempt Function Income133538RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue27678308TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column114243TotalRevenueColumn
Exclusion$114,243ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real286485Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real299933Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real-13448Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-13448TotalRevenueColumn
Exclusion-$13,448ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities715185Securities
Other3458Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities592726Securities
Other0Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities122459Securities
Other3458Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column125917TotalRevenueColumn
Exclusion$125,917ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events13330GrossIncomeFundraisingEvents
Cntrbtns Rprtd Fundraising Events42367CntrbtnsRprtdFundraisingEvents
Fundraising Direct Expenses13330FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column28053738TotalRevenueColumn
Related Or Exempt Function Income27678308RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$226,712ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total528026Total
Program Services375719ProgramServices
Management And General152307ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total53981Total
Program Services53981ProgramServices

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total13395204Total
Program Services10716163ProgramServices
Management And General2650486ManagementAndGeneral
Fundraising28555Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total292564Total
Program Services230277ProgramServices
Management And General61145ManagementAndGeneral
Fundraising1142Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1687106Total
Program Services1327660ProgramServices
Management And General348759ManagementAndGeneral
Fundraising10687Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total950714Total
Program Services760571ProgramServices
Management And General188355ManagementAndGeneral
Fundraising1788Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total478108Total
Program Services286865ProgramServices
Management And General191243ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total19926Total
Management And General19926ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total34200Total
Management And General34200ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total808759Total
Program Services560248ProgramServices
Management And General246104ManagementAndGeneral
Fundraising2407Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total77869Total
Program Services38935ProgramServices
Management And General20349ManagementAndGeneral
Fundraising18585Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1447856Total
Program Services1141184ProgramServices
Management And General304277ManagementAndGeneral
Fundraising2395Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total965533Total
Program Services752632ProgramServices
Management And General211101ManagementAndGeneral
Fundraising1800Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total32452Total
Program Services32452ProgramServices

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total87770Total
Program Services58354ProgramServices
Management And General29416ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total85278Total
Program Services58687ProgramServices
Management And General26591ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1183084Total
Program Services893502ProgramServices
Management And General289279ManagementAndGeneral
Fundraising303Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total559332Total
Program Services532037ProgramServices
Management And General27295ManagementAndGeneral

Other Expenses OtherExpenses (3 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies23178822317882
Bad Debt Allowance10180821018082
Equipment Rental and Ma28083121966861163

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total1713201Total
Program Services1397330ProgramServices
Management And General315871ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total28017758Total
Program Services22772229ProgramServices
Management And General5177867ManagementAndGeneral
Fundraising67662Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1065863BOY
EOY764982EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3710400BOY
EOY4159417EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY151572BOY
EOY81286EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY505418BOY
EOY575316EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY166265BOY
EOY222147EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis30851923LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec22468364LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY8908694BOY
EOY8383559EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY3056929BOY
EOY3586263EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2932410BOY
EOY3572824EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY20497551BOY
EOY21345794EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2004705BOY
EOY2370903EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
EOY233974EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY488458BOY
EOY216827EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY2433778BOY
EOY1958650EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY163855EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4926941BOY
EOY4944209EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY13322780BOY
EOY13646285EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1341503BOY
EOY1854960EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY906327BOY
EOY900340EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15570610BOY
EOY16401585EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY20497551BOY
EOY21345794EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses35980ReconcilationRevenueExpenses
Reconciliation Unrealized Invest287525ReconciliationUnrealizedInvest
Reconcilation Other Changes507470ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement SeparateXFinancialStatementSeparate
FieldValueIRS element (for citing)
Audit Committee1AuditCommittee
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc1AgentTrusteeEtc
Beginning Balance5452BeginningBalance
Additions During Year10788AdditionsDuringYear
Distributions During Year11371DistributionsDuringYear
Ending Balance4869EndingBalance
Included On FS0IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis103009OtherCostOrOtherBasis
Book Value103009BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis17373765OtherCostOrOtherBasis
Depreciation12050434Depreciation
Book Value5323331BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis12175861OtherCostOrOtherBasis
Depreciation9745535Depreciation
Book Value2430326BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1199288OtherCostOrOtherBasis
Depreciation672395Depreciation
Book Value526893BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings8383559TotalOfBookValueLandBuildings

Other Assets OtherAssets (3 entries)

DescriptionDescriptionBook ValueBookValue
Long-Term Prepaid Expenses402973
Due from Foundation2755300
Other Receivables414551
FieldValueIRS element (for citing)
Total Book Value Other Assets3572824TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionEstimated Third-Party Payor SettlementsDescription
Amount$163,855Amount
FieldValueIRS element (for citing)
Total Of Amounts163855TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII
Tot Revenue Etc Audited Fincl Stmt27546939TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments287525NetUnrealizedGainsInvestments
Other Revenues-1018082OtherRevenues
Revenue Not Rptd F990-730557RevenueNotRptdF990
Revenue Subtotal28277496RevenueSubtotal
Other Revenues Not Included-223758OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt-223758RevenueNotRptdOnFinStmt
Total Revenue Per Form99028053738TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt27299609TotExpensesEtcAuditedFinclStmt
Other Expenses Included299933OtherExpensesIncluded
Expenses Not Rptd F990299933ExpensesNotRptdF990
Expenses Subtotal26999676ExpensesSubtotal
Other Expenses Not Included1018082OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt1018082ExpensesNotRptdOnFinStmt
Total Expenses Per Form99028017758TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (6 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Line 1b:The Organization is a custodian for resident trust funds. A sub-register is used and listed by resident. The SNC Biller makes fund distribution as residents request funds be paid.
Part X, Line 2:The Facilities 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 Facilities is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Facilities are 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 990-T) with the IRS to report its unrelated business taxable income. The Facilities 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 Facilities 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 Facilities' Federal Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2010.Description of Uncertain Tax Positions Under FIN 48:
Provision for Bad Debts recorded in Revenue for F/S -1,018,082.Part XI, Line 2d - Other Adjustments:
Contributions for Specific Purposes recorded in Fund Balance for F/S 76,175. Rental Expenses recorded in Expenses for F/S -299,933.Part XI, Line 4b - Other Adjustments:
Rental Expenses recorded in Expenses for F/S 299,933.Part XII, Line 2d - Other Adjustments:
Provision for Bad Debts recorded in Revenue for F/S 1,018,082.Part XII, Line 4b - Other Adjustments:

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1Hospice Home TourNameOfEvent1
Gross Receipts Event120715GrossReceiptsEvent1
Charitable Contributions Event115591CharitableContributionsEvent1
Gross Revenue Event15124GrossRevenueEvent1
Rent Facility Costs Event13256RentFacilityCostsEvent1
Other Direct Expenses Event11868OtherDirectExpensesEvent1
Name Of Event2Golf TourneyNameOfEvent2
Gross Receipts Event213957GrossReceiptsEvent2
Charitable Contributions Event29095CharitableContributionsEvent2
Gross Revenue Event24862GrossRevenueEvent2
Cash Prizes Event2900CashPrizesEvent2
Non Cash Prizes Event2797NonCashPrizesEvent2
Rent Facility Costs Event21944RentFacilityCostsEvent2
Other Direct Expenses Event21221OtherDirectExpensesEvent2
Total Number Of Other Events3TotalNumberOfOtherEvents
Gross Receipts Other Events21025GrossReceiptsOtherEvents
Charitable Contrib Other Events17681CharitableContribOtherEvents
Gross Revenue Other Events3344GrossRevenueOtherEvents
Non Cash Prizes Other Events2000NonCashPrizesOtherEvents
Other Direct Expenses Other Events1344OtherDirectExpensesOtherEvents
Gross Receipts Total55697GrossReceiptsTotal
Charitable Contributions Total42367CharitableContributionsTotal
Gross Revenue Total Events13330GrossRevenueTotalEvents
Cash Prizes Total Events900CashPrizesTotalEvents
Non Cash Prizes Total Events2797NonCashPrizesTotalEvents
Rent Facility Costs Total Events5200RentFacilityCostsTotalEvents
Other Direct Expenses Total Events4433OtherDirectExpensesTotalEvents
Direct Expense Summary Events13330DirectExpenseSummaryEvents
Net Income Summary0NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent300XPcent300
Free Disc Care Medically Indigent1FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care1AmountsBudgetedForCharityCare
Expenses Exceeded Budget0ExpensesExceededBudget
Annual Community Benefit Report1AnnualCommunityBenefitReport
Report Publically Available1ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served478PersonsServed
Total Community Benefit Expense731000TotalCommunityBenefitExpense
Net Community Benefit Expense731000NetCommunityBenefitExpense
Percent Of Total Expense0.02710PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served478PersonsServed
Total Community Benefit Expense731000TotalCommunityBenefitExpense
Net Community Benefit Expense731000NetCommunityBenefitExpense
Percent Of Total Expense0.02710PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs11NumberOfActivitiesOrPrograms
Persons Served5589PersonsServed
Total Community Benefit Expense30947TotalCommunityBenefitExpense
Direct Offsetting Revenue3500DirectOffsettingRevenue
Net Community Benefit Expense27447NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served60PersonsServed
Total Community Benefit Expense792TotalCommunityBenefitExpense
Net Community Benefit Expense792NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Total Community Benefit Expense3980991TotalCommunityBenefitExpense
Direct Offsetting Revenue3122701DirectOffsettingRevenue
Net Community Benefit Expense858290NetCommunityBenefitExpense
Percent Of Total Expense0.03180PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs4NumberOfActivitiesOrPrograms
Persons Served1359PersonsServed
Total Community Benefit Expense2840TotalCommunityBenefitExpense
Net Community Benefit Expense2840NetCommunityBenefitExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs20NumberOfActivitiesOrPrograms
Persons Served7008PersonsServed
Total Community Benefit Expense4015570TotalCommunityBenefitExpense
Direct Offsetting Revenue3126201DirectOffsettingRevenue
Net Community Benefit Expense889369NetCommunityBenefitExpense
Percent Of Total Expense0.03290PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs20NumberOfActivitiesOrPrograms
Persons Served7486PersonsServed
Total Community Benefit Expense4746570TotalCommunityBenefitExpense
Direct Offsetting Revenue3126201DirectOffsettingRevenue
Net Community Benefit Expense1620369NetCommunityBenefitExpense
Percent Of Total Expense0.06000PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served1478PersonsServed
Total Community Building Expense5348TotalCommunityBuildingExpense
Net Community Building Expense5348NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served1478PersonsServed
Total Community Building Expense5348TotalCommunityBuildingExpense
Net Community Building Expense5348NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$1,018,082BadDebtExpenseAmount
Amount Attributable To28778AmountAttributableTo
Amount Reimbursed By Medicare5816449AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare5810382CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall6067MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection Policy1WrittenDebtCollectionPolicy
Provision For Charity Care1ProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Central Montana Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1408 Wendall AvenueAddressLine1
CityLewistownCity
StateMTState
ZIP Code59457ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours
OtherHome Health / HospiceOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Central Montana Medical Facilities IncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
OtherXOther
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs Addressed0AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent150.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent300.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges0GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities2NumberOfOtherFacilities

Other Facilities OtherFacilities (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Central Montana Medical Center - DME
202 4th Avenue SouthLewistownMT59457HME/DME Services
Central Montana Medical Center
Nursing Center 408 Wendell AvenueLewistownMT59457Skilled Nursing Facility

Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 3c: Eligibility is based on patient's family size, family gross income, personal assets, and other medical debts.
Part I, Line 6a: The Organization's community benefit report can be found on its website at: www.cmmccares.com.
Part I, Line 7: The Organization used an average overall ratio of costs to gross charges which addresses all patient segments in order to calculate charity care. Community health improvement services, health professions education, and cash and in-kind contributions were based on expenses recorded in the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare cost report.
Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $1,018,082.
Part II: Community Building activities promoted the health of the communities served by providing service and donations for a healthy, active, and educated public. Central Montana Medical Center staff donated time to community boards, such as LEPC (Lewistown Emergency Preparedness Community), Kiwanis, Central Montana Youth Challenge, and the DUI Task Force. By being a part of these community meetings CMMC staff provides a range of knowledge to the community members with a foundation on health and medical needs. CMMC was a sponsor of MT Island Challenge, a walk/run/bike competition put on by the Boys & Girls Club of Lewistown. CMMC provided EMS Coverage and 100 first aid kits for participants. CMMC donated 100 Band-Aid kits for R.S.V.P Annual Meeting (Community Volunteer Program) and a box of first aid supplies to the Red Bird Baseball District Tourney. All of these programs benefit central Montana area and promote health and wellness.
Part III, Line 4: Bad debt expense is reported at charges as recorded by the organization.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 % of gross patient services 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.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 7 of the attached audit report.
Part III, Line 8: Medicare allowable costs of care are based on 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: Patients deemed by CMMC to be unable to pay at any time during the revenue cycle may be eligible to receive available financial assistance. Patients must complete an application. Our collection practice is to refrain from collection efforts until financial assistance is determined. Normal collection efforts would resume if the application is not returned timely or after the write-off is complete and the patient owes a balance.
Part V, Section B, Line 1j: Secondary Data: County Profile, Demographic Trends and Economic ImpactsCentral Montana Medical Facilities, Inc.
Part V, Section B, Line 3: The hospital formed a steering committee, consulting with community members from various organizations including: Fergus County Council on Aging, School District #1, Lewistown City Office, Snowy Mountain Development Corporation, Central MT Health District, Central MT Family Planning, News Argus, KXLO/KLCM Radio, and the Community Health Clinic.Central Montana Medical Facilities, Inc.
Part V, Section B, Line 5c: The Needs Assessment is available at the Community Relations Office at Central Montana Medical Center and is available on their website at: www.cmmccares.com.Central Montana Medical Facilities, Inc.
Part V, Section B, Line 7: Respondents indicated a need for more specialists, and more primary care providers. CMMC already offers a number of primary care and specialty services to the community, and continues to recruit/retain providers. Respondents indicated a need for a walk-in clinic. Providing a walk-in clinic is outside of CMMC's capacity and financial resources. A need for dialysis was also indicated. Dialysis services are beyond CMMC's capacity due to investment required in equipment and specialized staff. One of the top three concerns was alcohol abuse. This is beyond CMMC's scope of work. Other resources are available in the community to meet this community need.Central Montana Medical Facilities, Inc.
Part V, Section B, Line 14g: A summary of the financial assistance policy is also posted in the hospital facility's emergency room, waiting rooms, and admissions offices.Central Montana Medical Facilities, Inc.
Part VI, Line 2: Currently, CMMC assesses the health care needs of the community by the number of responses to ads and articles released through the local media. CMMC monitors the attendance at annual events such as health fairs. Also tracked were the kinds of support requested of CMMC such as children's safety, wellness initiatives and healthcare assessments. In the past, CMMC completed an official Community Needs Assessment with the help of Montana State University. Mail and phone surveys were completed and "town hall" type meetings were held in Lewistown as well as most of the surrounding smaller communities.
Part VI, Line 3: CMMC has financial assistance signage posted in the admissions areas and the ER waiting area. A pamphlet explaining our financial assistance program, the application process and contact information is available at all hospital registration areas. The Charity Care policy and application along with a checklist and contact information is posted on our website on the internet. Prior to discharge someone from discharge planning discusses with the patient the availability of various government benefits, such as Medicaid, and assists the patient with qualifications for such programs, where applicable. Assistance with filling out the Charity Care application is also provided at this time. Private Pay in-patients are informed of Charity Care either prior to scheduled admission by physician referral or prior to discharge from the facility. We also send out information with first time statements. All other patients are informed upon inquiry.
Part VI, Line 4: Lewistown is an agricultural community and the county seat for Fergus County Montana. Lewistown is located in the center of Montana and is surrounded by five mountain ranges: the Snowies, the Judiths, the Moccasins, the Belts and the Highwoods. The city of Lewistown and the surrounding rural towns are supported by one hospital, Central Montana Medical Center. Fergus County has a Primary Care Low Income HPSA Designation with a score of 17. Fergus County is located in a federally designated medically underserved area. As of the census of 2010, there were 5,901 people, 2,761 households, and 1,512 families residing in the city. The population density was 1,109.2 inhabitants per square mile. There were 3,007 housing units at an average density of 565.2 per square mile. The racial makeup of the city was 95.4% White, 0.3% African American, 1.7% Native American, 0.4% Asian, 0.3% from other races, and 2.0% from two or more races. Hispanic or Latino of any race was 2.1% of the population.There were 2,761 households of which 23.7% had children under the age of 18 living with them, 42.7% were married couples living together, 8.3% had a female householder with no husband present, 3.7% had a male householder with no wife present, and 45.2% were non-families. 39.8% of all households were made up of individuals and 18.8% had someone living alone who was 65 years of age or older. The average household size was 2.07 and the average family size was 2.78.The median age in the city was 45.4 years. 20.4% of residents were under the age of 18: 6.5% were between the ages of 18 and 24; 22.6% were from 25 to 44; 28.9% were from 45 to 64; and 21.7% were 65 years of age or older. The gender makeup of the city was 49.2% male and 50.8% female.
Part VI, Line 5: The CMMC Governing Board consists of 14 volunteer community members including residents from Grass Range, Stanford, Denton and Judith Gap. CMMC extends medical staff privileges to qualified physicians based upon community needs.Surplus funds, when available, are applied to patient care needs, equipment and building maintenance and medical education requirements. The expenditure of these funds is approved by the Governing Board which meets on a monthly basis.As stated above, Lewistown is an agricultural community and the county seat for Fergus County Montana. Lewistown is located in the center of Montana and is surrounded by five mountain ranges: the Snowies, the Judiths, the Moccasins, the Belts and the Highwoods. The city of Lewistown and the surrounding rural towns are supported by one hospital, Central Montana Medical Center. Fergus County has a Primary Care Low Income HPSA Designation with a score of 17. Fergus County is located in a federally designated medically underserved area.
Part VI, Line 6: N/A
MTReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceXHousingAllowanceOrResidence
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E Expenses1WrittenPolicyReTAndEExpenses
Substantiation Required1SubstantiationRequired
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments0AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (6 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Laura Bennett MD
Member1777110000000110530188764000
Aaron Humphreys
Orthopedic Surgeon5271330000000178930545026000
James Fox
CRNA213700000006429013840221513000
Joan McMahon
Emergency Medicine209837000002381073070219525000
Danny Harbour
Emergency Medicine2014930000061540131860220833000
Michael Sura
Family Medicine1954930000000176500213143000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part I, Line 1aHousing allowance was paid to an Orthopedic Surgeon, as part of a recruiting package. The annual dues for membership in local service organizations are paid for the CEO and the CCO.
Part IIIPart I, Question 3: The Organization does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, Quorum Health Resources LLC. He is compensated for services provided to Central Montana Medical Facilities, Inc. The management company bases the CEO's salary on compensation surveys for the area. The Board of Directors approves the contract with the management company.Supplemental Information

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Fergus County MontanaBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN816001358IssuerEIN
Date Issued2003-07-31DateIssued
Issue Price1980000IssuePrice
Description Of PurposeTo refinance bonds issued July 6, 1992DescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Amount Retired1763173AmountRetired
Total Proceeds1980000TotalProceeds
Other Spent Proceeds1980000OtherSpentProceeds
Year Of Subst Completion2003YearOfSubstCompletion
Current Refunding1CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made1FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Bond Iss Meet Prvt Security Pay Test0BondIssMeetPrvtSecurityPayTest
Change In Use Bond Financed Prop0ChangeInUseBondFinancedProp
Non Qualified Bond Remed Procdrs1NonQualifiedBondRemedProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Form8038 T Filed0Form8038TFiled
Rebate Not Due Yet0RebateNotDueYet
Exception To Rebate1ExceptionToRebate
No Rebate Due0NoRebateDue
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Written Proc To Monitor Reqs1WrittenProcToMonitorReqs

Form990 Schedule K Part V Form990ScheduleKPartV

FieldValueIRS element (for citing)
Bond ReferenceABondReferenceCd
Proc To Undertk Corrective Action0ProcToUndertkCorrectiveAction

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Relationship With OrganizationRelationshipWithOrganizationPurpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
Aaron G Humphreys MD
Highest compensated employeeRecruitingX$220,00077484011
Michael Sura
Highest compensated employeeRecruitingX$111,1843802000
FieldValueIRS element (for citing)
Total Balance Due81286TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonAnnie DavisNamePerson
FieldValueIRS element (for citing)
RelationshipFamily Member of Board MemberRelationship
Amount Of Transaction53981AmountOfTransaction
Description Of TransactionPayment of CompensationDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 1The Executive Committee includes the President or Chair, Vice President or Vice Chair, Secretary and Treasurer and 2 memebers-at-large and their authority is similar to that of the full governing board.
Form 990, Part VI, Section A, line 2Russell Spika and Alan R. Aldrich have a business relationship.
Form 990, Part VI, Section A, line 3The organization delegated control over management duties customarily performed by or under direct supervision of officers, directors, trustees, or key employees to the CEO who is employed by a management company, Quorum Health Resources LLC (QHR). QHR assists with the management and supervision of the organization under the policies and direction of the governing board. Compensation paid to QHR for Lee Rhodes services as CEO was $163,000.
Form 990, Part VI, Section A, line 6The organization's members consist of residents of the Central Montana area who are at least 18 years of age and who have or shall indicate their interest in the maintenance of adequate medical facilities and high standards of medical care in the area. Members of the organization must attend and sign the register at the organization's annual meeting.
Form 990, Part VI, Section A, line 7aMembers of the organization may vote on matters being addressed at the annual meetings. Each member is entitled to one vote on any question or action with the exception of the election of Directors of the corporation. For the election of Directors, the members shall vote for one nominee for each vacant board position.
Form 990, Part VI, Section B, line 11Draft copy of Form 990 is reviewed by the CFO and Board of Directors prior to its filing.
Form 990, Part VI, Section B, line 12cThe organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by discussing at the Board of Director Meetings and obtaining signed statements from members. All officers, board members, and key employees are covered by the policy. The board determines whether conflicts exist and all potential conflicts are reviewed by the board. Any persons with a conflict are not allowed to vote on conflicted issues.
The CEO is employed by Quorum Health Resources LLC (QHR), a hospital management corporation. QHR determines the CEO's compensation based on independent data and comparisons. The information is then presented to the Board of Directors for review and approval. This process is completed on an annual basis and was completed in fiscal year ending 6/30/13. Compensation of the CFO is determined by the CEO.
Form 990, Part VI, Section C, line 19The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. A copy may be requested by calling, emailing, walk-in or via mail.
Form 990, Part XI, line 9:Interest in Central Montana Foundation 507,470.Changes in Net Assets or Fund Balances: