2014-05-02T11:10:02-05:00 2013-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2012-07-01 810428854 Northern Montana Health Care Inc NORT 4062652211 PO Box 1231 Havre MT 59501 David Henry 4062652211 2014-05-01 1 Kim C Hunwardsen P00484560 6122536500 2014-05-01 2012 2015-11-30 17:44:51Z David Henry PO Box 1231 Havre MT 59501 11333110 0 X www.nmhcare.org X 1985 MT Provision of healthcare services. 12 7 0 130 0 0 8398 8439 1397670 6878652 132225 896052 0 1347618 1538293 9130761 0 0 0 0 0 0 0 0 0 6763826 1654097 6763826 1654097 -5225533 7476664 61425889 68302269 9004427 8355648 52421462 59946621 X To deliver high quality comprehensive health care services to the hi-line communities. 0 0 1275006 6878652 Northern Montana Health Care, Inc. (NMHC) supports and encourages health care services by providing financial and managerial consulting assistance to the following controlled health care organizations:1) Northern Montana Hospital, ID# 81-02317872) North Care Corporation, ID# 81-04476383) Northern Montana Health Care Foundation, ID# 36-3464641NMHC provides overall direction and coordinates the policy making and long-range planning for its subsidiaries. It is organized solely to carry out the purposes of its tax-exempt subsidiaries. Some of the services NMHC furnishes to its subsidiaries are: accounting services, negotiation assistance with rental agreements, management and healthcare consulting, and other miscellaneous services. 1275006 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 7 1 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X Kim Lucke VP of Finance 4062652211 PO Box 1231 Havre MT 59501 David C Henry 1.00 42.00 X X 0 0 0 Miles Hamilton 1.00 1.00 X X 0 0 0 Bruce Richardson MD 1.00 40.00 X X 0 326849 20318 David Leeds 1.00 1.00 X X 0 0 0 Judy Greenwood 1.00 1.00 X X 0 0 0 Paul Tuss 1.00 1.00 X 0 0 0 Julie Holt 1.00 1.00 X 0 0 0 Andrew Carlson 1.00 1.00 X 0 0 0 Tom Patrick 1.00 1.00 X 0 0 0 Margaret Dow MD 1.00 40.00 X 0 277425 23738 Michael Nolan MD 1.00 40.00 X 0 276158 5000 Stephen Bechdolt MD 1.00 40.00 X 0 291119 9430 Karen Pollington 1.00 40.00 X 0 92341 19282 Kim Lucke 1.00 48.00 X 0 73289 18143 Julie Mariani 1.00 40.00 X 0 94014 23234 0 1431195 119145 0 0 1 0 Northern Montana Hospital PO Box 1231 Havre MT 59501 Contract Labor 387075 1 8439 8439 Income from affiliates 900099 6870252 6870252 Supporting revenue 900099 8400 8400 6878652 152548 152548 1347618 0 1347618 1347618 1347618 2945853 2202349 743504 743504 743504 9130761 6878652 0 2243670 310080 232560 77520 6671 6671 12410 12410 93891 61947 31944 4794 3596 1198 22175 13659 8516 137165 72839 64326 763 587 176 316832 316832 690709 557405 133304 34841 1929 32912 23766 13652 10114 1654097 1275006 379091 0 1065852 1298997 85207 67670 1952893 28285 25595 18854657 9507928 9934940 9346729 6958626 7170236 43198657 48329037 154322 111112 61425889 68302269 386283 352654 6156442 5335001 1233465 887970 1228237 1780023 9004427 8355648 X 52421462 59946621 52421462 59946621 61425889 68302269 7476664 48495 0 X 0 1 X 1 0 X X X 0 0 0 Northern Montana Hospital 810231787 3 1 1184882 North Care Corporation 810447638 3 1 0 Northern Montana Health Care Foundation Inc 363464641 7 0 90124 3 1275006 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100000 100000 18058874 9196202 8862672 129528 127437 2091 566255 184289 381966 9346729 Investment in Affiliates 48329037 F 48329037 Due from Affiliates 1780023 1780023 X Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Organization and its three nonprofit affiliates are entities organized as described in Section 501(c)(3) of the Internal Revenue Code and are exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Organization also has a taxable affiliate, which is inactive and had no taxable income in 2013 and 2012. The Organization and its affiliates are 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 2010. 0 0 0 0 1 0 0 0 0 Bruce Richardson MD 0 324837 0 0 0 2012 0 0 0 22923 0 349772 0 0 Margaret Dow MD 0 277245 0 0 0 180 0 0 0 26005 0 303430 0 0 Michael Nolan MD 0 274695 0 0 0 1463 0 0 0 7172 0 283330 0 0 Stephen Bechdolt MD 0 289931 0 0 0 1188 0 0 0 11708 0 302827 0 0 Part I, Line 5 Margaret Dow 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. Supplemental Information Part III Part I, Line 3: CEO/President 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 II: Individuals listed on Schedule J, Part II, other than the CEO, are compensated by a related organization for their services provided to that organization. They are not compensated for their services as board members. The related organization has procedures in place to determine their compensation. A Montana Facility Finance Authority 810302402 612043DM8 2006-03-01 6843295 Refund bonds issued 11/9/1995 and 12/15/1995. 0 0 0 B City of Havre Montana 816001274 2007-11-30 3186968 Fund new medical building 0 0 0 A 4495000 6843295 667000 136846 6039449 2006 1 0 1 1 B 3186968 181856 61698 2943162 2008 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 Schedule K Part IV, Arbitrage, Line 2c Date Rebate Computation Performed Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 10/01/2010 Form 990, Part VI, Section A, line 2 Kim Lucke, Karen Pollington, Bruce Richardson, David C. Henry, David Leeds, Judy Greenwood, Miles Hamilton, Paul Tuss, Julie Holt, Andrew Carlson, Tom Patrick, Margaret Dow, Michael Nolan, Julie Mariani 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 compensation paid during 2012 was $378,500. Form 990, Part VI, Section A, line 6 Those persons who reside in the area served by Northern Montana Hospital and who have been members of or given money to Northern Montana Hospital at any time from the founding of the hospital to May 1, 1984 shall be invited to become members of the corporation (Northern Montana Health Care, Inc.). The corporation shall only be required to act in good faith and use its best efforts to identify all persons qualifying for such invitation. The initial members shall be those persons invited to be members who agreed in writing to become a member of the corporation. These members shall meet at a place and time designated by the board to take the following action: (1) if their number is less than fifty (50), to elect as many additional members as necessary to bring their total number to fifty (50) and (2) to select the terms of service of each of the members. The terms of one-third (1/3) of the initial members shall expire on the second Tuesday of March of each year, beginning in 1986. Form 990, Part VI, Section A, line 7b The members of the corporation shall have the following powers: (i) to approve, or disapprove amendments to the Articles of Incorporation that affect the identity, power and/or duties of the members of the corporation, or mergers or consolidations with another corporation, or sales of all or substantially all of the corporation's assets, (ii) to approve, or disapprove, liquidations of the corporation's mergers or consolidations of the corporation with another corporation, or sales of all or substantially all of the corporation's assets, (iii) to elect the members of the corporation, and (iv) to approve, or disapprove, amendments to the bylaws which affect the identity, power and/or duties of the members of the corporation. The members shall have no other powers with regard to the corporation. Form 990, Part VI, Section A, line 8b No subcommittee had the authority to act on behalf of the board during the fiscal year ended June 30, 2013. Form 990, Part VI, Section B, line 11 The Board of Directors receive 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. The President/CEO is compensated by an unrelated management company. The unrelated management company receives a fee for service from a related organization for the CEO's service provided to this organization and related organizations, Northern Montana Hospital (NMH) and Northern Montana Health Care Foundation, Inc. (NMHCF). In determining the CEO's compensation, the Executive Committee of the board meets and reviews NMH/Northern Montana Health Care, Inc. (NMHC) financial results, CEO's current year priorities, discusses evaluation tools to be used for the CEO's 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 completed during fiscal year 2013. 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. Northern Montana Hospital PO Box 1231 Havre MT 59501 810231787 Health Care Services MT 501(c)(3) Line 3 Northern Montana Health Care Inc 1 Northern Montana Health Care Foundation Inc PO Box 1231 Havre MT 59501 363464641 Support of Northern Montana Hospital MT 501(c)(3) Line 7 Northern Montana Health Care Inc 1 North Care Corporation 30 13th Street Havre MT 59501 810447638 Health Care Services MT 501(c)(3) Line 3 Northern Montana Health Care Inc 1 Paramount Health Care Inc PO Box 1231 Havre MT 59501 810393353 Health Care Services MT Northern Montana Health Care Inc C 1.00000 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 1 1 1 Northern Montana Hospital J 867360 FMV Northern Montana Hospital M 310080 Cost Northern Montana Hospital O 73335 Cost Northern Montana Hospital Q 1548210 Cost Northern Montana Health Care Foundation Inc R 90123 Cost Northern Montana Hospital S 500000 Cost