2014-02-15T16:07:35-06:00 2013-03-31 810497523 JORDAHL & SLITER PLLC PO BOX 8600 KALISPELL MT 599041600 990 2012-04-01 237293874 KALISPELL REGIONAL MEDICAL CENTER KALI 4067525111 310 SUNNYVIEW LANE KALISPELL MT 59901 CHARLES PEARCE 4067521724 2014-02-18 1 JUSTIN P SLITER P00188996 4067521040 2014-02-18 2012 2015-11-30 17:44:51Z CHARLES PEARCE 310 SUNNYVIEW LANE KALISPELL MT 59901 251979140 0 X WWW.NWHC.ORG/KRMC X 1973 MT PROVIDE ACUTE HOSPITAL CARE 16 7 2152 143 2151381 -437055 800578 757987 217873275 245746315 2052850 1389958 2979782 2870325 223706485 250764585 0 0 0 0 114428534 126802858 0 0 0 101681994 108797148 216110528 235600006 7595957 15164579 215953130 234662297 107327768 107550726 108625362 127111571 PROVIDE ACUTE HOSPITAL CARE 0 0 209818364 243594934 OPERATION OF REGIONAL ACUTE CARE HOSPITAL. 209818364 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 239 0 1 2152 1 1 1 0 0 0 0 0 0 0 0 0 X 16 7 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHARLES PEARCE 4067521724 310 SUNNYVIEW LANE KALISPELL MT 59901 CHARLES GRENIER 1.00 X 1200 0 0 WILSON HIGGS MD 1.00 X 1818 0 0 JON JOHNSON MD 1.00 X 282339 0 19782 GWEN JONAS MD 1.00 X 37780 0 0 PETER L LARSON 1.00 X 1818 0 0 JEANNIE LUCKEY 1.00 X 1200 0 0 ROGER BARTH MD 1.00 X 28343 0 0 CURTIS LUND 1.00 X 2130 0 0 DENNIS SABO 1.00 X 2130 0 0 CAL SWEET 1.00 X 2130 0 0 MUFFIE THOMSON 1.00 X 1200 0 0 WILLIAM BENEDETTO MD 1.00 X 2400 0 0 VELINDA STEVENS 12.50 X X 0 664643 34748 LOUISE SWANBERG MD 1.00 X 223654 0 18082 JAMES STRAINER 1.00 X 0 0 0 PETE FISHER MD 1.00 X 0 0 0 JANE KARAS 1.00 X 2074 0 0 DAVID WALKER MD 1.00 X 900 0 0 CHARLES PEARCE 30.00 X 0 455915 31474 KAREN LEE 40.00 X 311137 0 46198 DEB WILSON 38.00 X 293772 0 50520 AC EDDY 30.00 X 477875 0 52926 TONY PATTERSON 22.00 X 486504 0 46557 TATE KREITINGER 25.00 X 355290 0 29943 ROBERT YACAVONE MD 50.00 X 933552 0 24368 ALAN WILLIAMS MD 50.00 X 650062 0 3066 DREW KIRSHNER MD 50.00 X 603756 0 24361 HOWARD TICE MD 50.00 X 636246 0 21869 CRAIG HARRISON MD 50.00 X 626037 0 3066 5965347 1120558 406960 138 0 1 0 SILVER TIP EMERGENCY PHYSICIANS 310 SUNNYVIEW LANE KALISPELL MT 59901 EMERGENCY ROOM PHYSICIANS 3575575 GLACIER REGIONAL PATHOLOGY 495 NORTH MAIN STREET KALISPELL MT 59901 PATHOLOGY SERVICES 850039 NORTHWEST IMAGING PC PO BOX 9110 KALISPELL MT 59904 IMAGING SERVICES 792172 MAYO MEDICAL LAB PO BOX 9146 MINNEAPOLIS MN 554809146 LAB SERVICES 591773 NORTHERN ROCKIES ANESTHESA CONSULTANTS 1075 MARTIN CREEK LANE WHITEFISH MT 59937 ANESTHESIA SERVICES 586423 24 720286 37701 291013 757987 MEDICAL SERVICE REVENUE 621990 234039635 231888254 2151381 PARTNERSHIP INCOME 621990 3980992 3980992 MEANINGFUL USE REVENUE 900099 2949790 2949790 OUTREACH PROGRAMS 621990 840324 840324 RESEARCH 621990 725044 725044 3210530 3210530 245746315 1212960 1212960 281490 0 281490 281490 281490 1302969 88584 1004844 209711 298125 -121127 176998 176998 CAFETERIA 722210 1549521 1549521 CHILD CARE 624410 760541 760541 MISC. REVENUE 900099 278773 278773 2588835 250764585 243594934 2151381 4260283 1771752 1771752 102678311 92936214 9742097 3473440 3246249 227191 12404496 11028517 1375979 6474859 5773230 701629 537976 28564 509412 79028 79028 9123752 6811284 2312468 1067799 428798 639001 2480297 1679564 800733 10758168 9141172 1616996 1423524 1028548 394976 1044474 1044474 9341191 7366114 1975077 1859283 1857703 1580 SUPPLIES 43246794 42691120 555674 PURCHASED SERVICES 12223651 10587501 1636150 BAD DEBTS 12190808 12190808 3420403 1978504 1441899 235600006 209818364 25781642 0 6446029 23510082 50883925 57190239 3055068 31893429 27068234 3882976 3046367 6171367 6231727 4651135 2557126 204044292 100537959 81883654 103506333 2409569 2138779 966101 909944 26764945 5448398 215953130 234662297 35649155 36413500 566357 58964540 57953266 4648937 2758017 8065136 9859586 107327768 107550726 X 104640846 120097375 2097510 4928115 1887006 2086081 108625362 127111571 215953130 234662297 X 15164579 4653479 -1331849 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 9767 1 24321 1 1 34088 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING EXPENDITURES WERE INCURRED IN AN ATTEMPT TO ENSURE MEDICARE AND MEDICAID PAID COST OF SERVICES AND IN RELATION TO FUNDING FOR ADVANCE OF OUR ELECTRONIC HEALTH RECORD PROJECT. EXPENDITURES INCLUDED CONSULTANT, STAFF TIME AND A PORTION OF HOSPITAL ASSOCIATION MEMBERSHIP DUES. 3984516 2988068 41612 7014196 1917545 2059932 7039 3984516 1480454 280808 156283 1917545 1250610 53165 176679 1480454 1225468 224116 -198974 1250610 0.29740 0.70260 0 1 1 282845 282845 96129258 62576062 33553196 55420501 37961897 17458604 52211688 52211688 103506333 PAYABLE TO CONTRACTUAL AGENCIES 1889946 ACCOUNTS PAYABLE TO AFFILIATES 3000188 LEASES PAYABLE 1401609 OTHER LIABILITIES 3567843 9859586 X 243299142 4653479 792172 5445651 237853491 12911094 12911094 250764585 224116080 706882 706882 223409198 12190808 12190808 235600006 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: KALISPELL REGIONAL HEALTHCARE FOUNDATION'S ENDOWMENT FUNDS WILL BE DISBURSED ACCORDING TO THE FUND'S DESIGNATED PURPOSE CONSIDERING ANY RESTRICTIONS AND/OR CONDITIONS ON THE FUND. WHERE THERE IS AN UNDESIGNATED ENDOWMENT FUND WITHOUT RESTRICTIONS AND/OR CONDITIONS, THE ORGANIZATION WILL REVIEW REQUESTS FOR FUNDING FROM KALISPELL REGIONAL MEDICAL CENTER, THE SUPPORTED ORGANIZATION, ON A PERIODIC BASIS. HISTORICALLY, ENDOWMENT FUND DISBURSEMENTS HAVE FUNDED EQUIPMENT REQUESTS FROM KALISPELL REGIONAL MEDICAL CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL ADOPTED THE PROVISIONS OF ACCOUNTING STANDARDS CODIFICATION 740, INCOME TAXES. ASC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE ASC AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT STANDARD FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE HOSPITAL HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED NO RESERVES ARE REQUIRED. PART XI, LINE 2D - OTHER ADJUSTMENTS: FASB FAS 136 INVESTMENT IN NET ASSETS OF FOUNDATION 44,125. FOUNDATION INCOME RECORDED ON CONSOLIDATED BASIS 706,882. ACTIVITY OF KRMC VOLUNTEERS (EIN 27-3866474) 41,165. PART XI, LINE 4B - OTHER ADJUSTMENTS: SUPPORT FROM AFFILIATED FOUNDATION 720,286. BAD DEBT EXPENSE INCLUDED IN NET REVENUES 12,190,808. PART XII, LINE 2D - OTHER ADJUSTMENTS: FOUNDATION EXPENSES RECORDED ON CONSOLIDATED BASIS 706,882. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE INCLUDED IN NET REVENUES 12,190,808. 1 1 1 X 1 X 1 1 1 0 1 1 7499394 7499394 0.03360 25206344 17198071 8008273 0.03580 32705738 17198071 15507667 0.06940 145518 145518 0.00070 236323 236323 0.00110 57860526 44619295 13241231 0.05930 58242367 44619295 13623072 0.06110 90948105 61817366 29130739 0.13050 8940 8940 0.00000 47830 47830 0.00020 3268 3268 0.00000 60038 60038 0.00020 1 5890411 1086780 82285816 100253916 -17968100 X 1 0 1 MRI - CT IMAGING 0.51000 0.00850 0.18740 1 1 KALISPELL REGIONAL MEDICAL CENTER

310 SUNNYVIEW LANE KALISPELL MT 59901

X X X KALISPELL REGIONAL MEDICAL CENTER 1 1 X X X X X X X X 12 1 1 1 X X X X X X X X 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X 1 X X 1 X X X X X X 1 X 0 1 PART I, LINE 7: COST ACCOUNTING WAS UTILIZED FOR THE ENTIRE TABLE. COST ACCOUNTING COVERS ALL PATIENT SEGMENTS. PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE INCLUDED ON FORM 990, PART VIII, LINE 2, BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN COLUMN (F) IS $12,190,808. PART II: KRMC PROVIDES FUNDING TO VARIOUS NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. IN ADDITION, KRMC IS ACTIVELY INVOLVED IN THE KALISPELL CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS FOR THE PURPOSES OF ECONOMIC DEVELOPMENT. KRMC PROVIDES FURTHER DONATIONS TO BENEFIT THE BROADER COMMUNITY. PART III, LINE 4: COST ACCOUNTING WAS UTILIZED TO DETERMINE BAD DEBT EXPENSE.PROVISION FOR BAD DEBTS: THE HOSPITAL PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AN AMOUNT THAT COULD BECOME UNCOLLECTIBLE, WHEREBY SUCH RECEIVABLES ARE REDUCED TO THEIR ESTIMATED NET REALIZABLE VALUE. THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON THE UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN ON COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE, AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND HAVE AN IMPACT ON THE ESTIMATION PROCESS.THE FOOTNOTE REGARDING BAD DEBT EXPENSE IS INCLUDED ON PAGES 15 AND 16 OF THE ORGANIZATIONS'S FINANCIAL STATEMENTS. PART III, LINE 8: COST TO CHARGE RATIO WAS UTILIZED TO PREPARE THE FY 2013 COST REPORT. MEDICARE TOTALS PROVIDED EXCLUDE AMOUNTS REPORTED UNDER COMMUNITY BENEFIT PROGRAMS. THE ORGANIZATION PROVIDES CARE TO THE ELDERLY AND DISABLED AT A REDUCED REIMBURSEMENT TO ENSURE ALL OF THE COMMUNITY MEMBERS IN NORTHWEST MONTANA RECEIVE GOOD QUALITY HEALTHCARE REGARDLESS OF AGE, DISABILITY, OR MEANS. KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 3: KALISPELL REGIONAL HEALTHCARE SERVICES, THE FLATHEAD CITY-COUNTY HEALTH DEPARTMENT, AND NORTH VALLEY HOSPITAL COLLABORATED TO ARRANGE QUALITATIVE DATA COLLECTION DESIGNED TO ADDRESS HEALTHCARE ISSUES IN THE COMMUNITY. FOUR FOCUS GROUPS AND TWO SURVEYS WERE CONDUCTED IN AN EFFORT TO OBTAIN THE BEST INFORMATION REGARDING THE HEALTH NEEDS OF ALL INDIVIDUALS IN THE COMMUNITY. THE FOCUS GROUPS CONSISTED OF INDIVIDUALS SELECTED TO PARTICIPATE BASED ON THEIR AREA OF EXPERTISE WITHIN HEALTHCARE.FOCUS GROUP PARTICIPANTS INCLUDED PERSONS WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH; LOCAL HEALTH OR OTHER DEPARTMENTS OR AGENCIES WITH CURRENT DATA OR OTHER INFORMATION RELEVANT TO THE HEALTH NEEDS OF THE COMMUNITY SERVED; REPRESENTATIVES MEDICALLY UNDERSERVED, LOW-INCOME AND MINORITY POPULATIONS AND POPULATIONS WITH CHRONIC DISEASE NEEDS IN THE COMMUNITY SERVED; HEALTHCARE CONSUMER ADVOCATES; REPRESENTATIVES OF NONPROFIT ORGANIZATIONS; ACADEMIC EXPERTS; LOCAL GOVERNMENT OFFICIALS; REPRESENTATIVES FROM COMMUNITY-BASED ORGANIZATIONS; HEALTHCARE PROVIDERS, AND PRIVATE BUSINESS LEADERS.ORGANIZATIONS REPRESENTED INCLUDED: BRENDAN HOUSE (SKILLED NURSING FACILITY), HOME OPTIONS (HOME HEALTH AND HOSPICE), A PLUS HEALTH CARE (HOME HEALTH), PATHWAYS TREATMENT CENTER (MENTAL HEALTH AND SUBSTANCE ABUSE), IMMANUEL LUTHERAN HOME (SKILLED NURSING FACILITY), AGENCY ON AGING, NORTH VALLEY EMBRACE HEALTH (SENIOR MENTAL HEALTH), AMERICAN ASSOCIATION OF RETIRED PEOPLE, ADULT PROTECTIVE SERVICES, SUNBURST MENTAL HEALTH CENTER, SCHOOL DISTRICT #44, NORTH VALLEY PROFESSIONAL CENTER, NORTH VALLEY HOSPITAL EMERGENCY ROOM, SCHOOL DISTRICT #6, SHEPARDS HAND, FREE HEALTH CLINIC, NORTHWEST IMAGING, COURT APPOINTED SPECIAL ADVOCATES, FLATHEAD COMMUNITY HEALTH CENTER, NORTHWEST MONTANA HEAD START, COMMUNITY ACTION PARTNERSHIP, CHILD DEVELOPMENT CENTER, CHILDREN MENTAL HEALTH BUREAU, ABBIE SHELTER, BODY BALANCE DISORDERED EATING PROGRAM, BIG SKY FAMILY MEDICINE, WOODLAND CLINIC, KALISPELL REGIONAL MEDICAL CENTER EMERGENCY DEPARTMENT, MATERNAL CHILD HEALTH HOME VISITING PROGRAM.IN ADDITION TO THE FOCUS GROUPS, THE COLLABORATORS CONDUCTED TWO PUBLIC SURVEYS. THE FIRST SURVEY WAS CONDUCTED ON JUNE 7 AND 8, 2012 AT PROJECT HOMELESS CONNECT. IT CONSISTED OF FIVE QUESTIONS AND 40 INDIVIDUALS PARTICIPATED IN THE SURVEY. THE SECOND SURVEY WAS CONDUCTED FROM JUNE 26, 2012 TO JUNE 29, 2102 AT FLATHEAD JOB SERVICE. IT CONSISTED OF SIX QUESTIONS AND 60 INDIVIDUALS WHO WERE SEARCHING OR HELPING OTHERS SEARCH FOR JOBS PARTICIPATED IN THE SURVEY. KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 4: NORTH VALLEY HOSPITAL, WHITEFISH, MT KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 6I: USE FINANCIAL ASSISTANCE TO FREE DENTAL CLINIC; EXPANSION OF DIABETES EDUCATION AND ASSESSMENT FUNCTIONS; EXPANSION OF MENTAL HEALTH SERVICES; PARTICIPATION IN FORMATION AND COLLABORTION OF PATIENT ADVOCACY EFFORTS; EXPANDING PRIMARY CARE PRACTITIONERS. KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 20D: KALISPELL REGIONAL MEDICAL CENTER CHARGES THE SAME FOR SERVICES REGARDLESS OF AN INDIVIDUAL'S INSURANCE OR NON-INSURED STATUS. AN ADJUSTMENT IS THEN MADE TO THE CHARGE FOR PATIENTS WHO ARE FAP-ELIGIBLE INDIVIDUALS. KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 22: KALISPELL REGIONAL MEDICAL CENTER CHARGES THE SAME FOR SERVICES REGARDLESS OF AN INDIVIDUAL'S INSURANCE OR NON-INSURED STATUS. AN ADJUSTMENT IS THEN MADE TO THE CHARGE FOR PATIENTS WHO ARE FAP-ELIGIBLE INDIVIDUALS. PART VI, LINE 2: KRMC IDENTIFIES NEEDS THROUGHOUT THE COMMUNITY BY UTILIZING COMMUNITY REPRESENTATIVES ON KRMC GOVERNANCE BOARDS, SOLICITATION OF IDEAS FROM COMMUNITY LEADERS AND OTHER MEMBERS VIA THE MEDIA AND OTHER FORMS OF COMMUNICATION, AND KEY STAFF AIDING IN IDENTIFYING HEALTH CARE SERVICE AREA SHORTAGES. KRMC MAINTAINS A CLOSE RELATIONSHIP TO THE COMMUNITY BY PROVIDING INFORMATION AND EDUCATION ABOUT UPCOMING HEALTH CARE ISSUES OR CHANGES AT KRMC AND SOLICITS FEEDBACK FROM THE COMMUNITY. ONCE NEEDS ARE IDENTIFIED, THE KRMC BOARD AND ADMINISTRATION WORK TO PRIORITIZE NEEDS BASED UPON THE MISSION AND VALUES OF KRMC. PART VI, LINE 3: KRMC DISPLAYS OUR CHARITY POLICY ON OUR WEBSITE. CHARITY CARE IS DISCUSSED WITH ALL PATIENTS AT THE TIME OF THEIR ADMIT. THROUGH THE MEDIA, KRMC NOTIFIED THE COMMUNITY OF OUR CHARITY CARE POLICY AND ELIGIBILITY REQUIREMENTS. PART VI, LINE 4: KRMC IS A SOLE COMMUNITY MEDICARE HOSPITAL IN NORTHWEST MONTANA. KRMC SERVES PATIENTS IN A LARGE GEOGRAPHIC AREA, THAT COVERS ALL OF NORTHWESTERN MONTANA, PARTS OF NORTHEASTERN IDAHO AND AREAS OF CENTRAL MONTANA. KRMC SERVES ALL PATIENTS REGARDLESS OF THEIR INCOME AND REGARDLESS OF THEIR PAYER. IN FLATHEAD COUNTY, 12.5% OF THE RESIDENTS LIVE AT OR BELOW 100% OF FEDERAL POVERTY LEVELS AND ACCORDING TO THE MONTANA MEDICAL ASSOCIATION APPROXIMATELY 22.3% OF THE COUNTY RESIDENTS UNDER THE AGE OF 65 ARE UNINSURED. PART VI, LINE 5: THIS WAS ANSWERED BY QUESTION 2 INFORMATION. X X X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 JON JOHNSON MD 135096 0 30000 0 117243 0 3000 0 16782 0 302121 0 0 0 VELINDA STEVENS 0 419245 0 117388 0 128010 0 15000 0 19748 0 699391 0 0 LOUISE SWANBERG MD 155106 0 24728 0 43820 0 3000 0 15082 0 241736 0 0 0 CHARLES PEARCE 0 280217 0 78461 0 97237 0 10403 0 21071 0 487389 0 0 KAREN LEE 199472 0 55852 0 55813 0 36721 0 9477 0 357335 0 0 0 DEB WILSON 194166 0 51444 0 48162 0 33277 0 17243 0 344292 0 0 0 AC EDDY 323149 0 90482 0 64244 0 35252 0 17674 0 530801 0 0 0 TONY PATTERSON 327434 0 91681 0 67389 0 31978 0 14579 0 533061 0 0 0 TATE KREITINGER 219024 0 61327 0 74939 0 12257 0 17686 0 385233 0 0 0 ROBERT YACAVONE MD 476187 0 449567 0 7798 0 3000 0 21368 0 957920 0 0 0 ALAN WILLIAMS MD 507562 0 60000 0 82500 0 3000 0 66 0 653128 0 0 0 DREW KIRSHNER MD 553756 0 50000 0 0 0 3000 0 21361 0 628117 0 0 0 HOWARD TICE MD 447252 0 188994 0 0 0 3000 0 18869 0 658115 0 0 0 CRAIG HARRISON MD 500011 0 126026 0 0 0 3000 0 66 0 629103 0 0 0 PART I, LINE 1A FIRST CLASS OR CHARTER TRAVEL - KRMC DOES NOT PROVIDE FIRST CLASS TRAVEL. CHARTER TRAVEL IS UTILIZED FOR THESE INDIVIDUALS WHEN A GROUP IS FLYING TOGETHER TO A CONFERENCE OR MEETING AND IT IS LESS EXPENSIVE THAN FLYING COMMERCIAL OR NO COMMERCIAL FLIGHT IS AVAILABLE. THIS WAS NOT INCLUDED AS TAXABLE COMPENSATION AS IT WAS BUSINESS RELATED. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - THE MEMBERS OF THE EXECUTIVE TEAM RECEIVED A 457 PLAN CONTRIBUTION OF $22,500 FOR 2012. THIS AMOUNT IS GROSSED-UP TO TAKE CARE OF THE APPLICABLE TAXES. THE EXECUTIVE TEAM INCLUDES: PRESIDENT, CFIO, CNO, CMO, COO, CAO, AND THE HEALTHCENTER CEO. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - ALL EXECUTIVE TEAM MEMBERS RECEIVE A FREE MEMBERSHIP TO THE SUMMIT. PART I, LINE 4B MEMBERS OF THE EXECUTIVE TEAM RECEIVED A 457 PLAN CONTRIBUTION OF $22,500 FOR 2012. THE EXECUTIVE TEAM INCLUDES: PRESIDENT, CFIO, CNO, CMO, COO, CAO, AND THE HEALTHCENTER CEO. PART I, LINE 7 BONUS PLANS ADMIN AND MGMT-BASED ON A NUMBER OF FACTORS INCLUDING BUT NOT LIMITED TO: QUALITY AND FINANCIAL INDICATORS INCLUDING DEPARTMENT SPECIFIC GOALS AND INITIATIVES, PATIENT SATISFACTION, PRODUCTIVITY, EMPLOYEE SATISFACTION, AND EMPLOYEE EVALUATION TIMELINESS. SUCCESSFUL IMPLEMENTATION OF COMPANY FISCAL YEAR ACTION PLANS AND THE OVERALL FINANCIAL HEALTH AND STABILITY OF THE ORGANIZATION. A MONTANA FACILITY FINANCE AUTHORITY 364615155 612043XXX 2010-11-01 57115000 REFUND 1998 AND 2001 SERIES BONDS AND FUND NEW SURGERY BUILDING PROJECT 0 0 0 B MONTANA FACILITY FINANCE AUTHORITY 364615155 2011-08-03 4174486 CAPITAL EXPENDITURES 0 0 0 A 1545000 57308306 3641233 891005 42004808 10771260 2013 1 0 1 1 B 958844 4174486 12486 4162000 2012 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 1 B 0 0 1 0 0 0 0 0 1 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: 07/01/2013 PART II, LINE 3 DIFFERENCE IN PROCEEDS: THE PROCEEDS OF THE BOND ISSUANCE EXCEED THE ISSUE PRICE OF $57,115,000 BY $193,306. THIS AMOUNT IS THE NET ORIGINAL ISSUE PREMIUM. PART II, LINE 11 OTHER SPENDING: OF THE TOTAL PROCEEDS, $10,771,260 WAS USED TO REDEEM BONDS ISSUED IN 1998 AND 2001. GLACIER REGIONAL PATHOLOGY DR. FISHER, A CURRENT TRUSTEE, IS A GREATER THAN 5% OWNER. 838039 PATHOLOGY & LAB SERVICES 0 ROCKY MOUNTAIN SUB-SPECIALTY ASSOC DR. JOHNSON, A CURRENT TRUSTEE, IS A GREATER THAN 5% PARTNER. 679889 RENT AND JANITORIAL SERVICES 0 NORTHWEST IMAGING INC DR. BENEDETTO, A CURRENT TRUSTEE, IS A GREATER THAN 5% OWNER. 710151 RADIOLOGY SERVICES 0 KEN JONAS MD SPOUSE OF CURRENT TRUSTEE 286639 SALARY 0 SWANBERG BUILDING INC DR. SWANBERG, A CURRENT TRUSTEE, IS A GREATER THAN 5% OWNER. 117290 RENT 0 X EQUIPMENT 1 291013 COST 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 KALISPELL REGIONAL MEDICAL CENTER HAS ONE MEMBER, KALISPELL REGIONAL HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A KALISPELL REGIONAL MEDICAL CENTER HAS THE SAME BOARD OF DIRECTORS AS ITS SOLE MEMBER, KALISPELL REGIONAL HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B KALISPELL REGIONAL MEDICAL CENTER HAS THE SAME BOARD OF DIRECTORS AS ITS SOLE MEMBER, KALISPELL REGIONAL HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS MAILED TO ALL BOARD MEMBERS WITH THE FEBRUARY BOARD PACKET. THE BOARD MEMBERS HAVE A CHANCE TO REVIEW THE FORM BEFORE THE FINANCE COMMITTEE MEETING WHERE A PRESENATION ON THE FORM 990 IS DONE. QUESTION AND ANSWER SESSIONS ARE HELD AT BOTH THE FINANCE COMMITTEE MEETING AND THE BOARD MEETING CONCERNING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES. THE COMPLIANCE OFFICE REVIEWS THEM, IDENTIFIES POTENTIAL CONFLICTS, AND FORWARDS TO THE ADMINISTRATIVE TEAM IF A POTENTIAL CONFLICT EXISTS, AS OUTLINED IN THE ORGANIZATIONAL POLICY. FORM 990, PART VI, SECTION B, LINE 15 KALISPELL REGIONAL HEALTHCARE SYSTEM HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL ITS EMPLOYEES, INCLUDING THE SENIOR EXECUTIVES. SALARY AND BENEFITS FOR THE PRESIDENT/CHIEF EXECUTIVE OFFICER ARE DETERMINED BY THE KALISPELL REGIONAL HEALTHCARE SYSTEM BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE AND REPORTED TO THE KALISPELL REGIONAL HEALTHCARE SYSTEM BOARD. THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWS BASE AND TOTAL COMPENSATION DATA FROM AN ARRAY OF COMPENSATION SURVEYS OF HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO KALISPELL REGIONAL HEALTHCARE SYSTEM. THESE REPORTS ARE CONSIDERED BY THE COMMITTEE, AND A DETERMINATION IS MADE AS TO THE STATUS OF THE BASE SALARY, BENEFITS, AND TOTAL COMPENSATION FOR THE PRESIDENT/CEO. THE BOARD AND EXECUTIVE COMPENSATION COMMITTEE EMBRACE THE PHILOSOPHY OF MAINTAINING A COMPENSATION LEVEL WHICH WILL FAVOR RETENTION OF KEY LEADERSHIP IN ORDER TO MAINTAIN STABILITY IN KEY INITIATIVES. ADDITIONALLY, THE PRESIDENT/CEO UTILIZES THE PERIODIC RETENTION OF A COMPENSATION CONSULTANT AND MARKET INFORMATION PROVIDED TO DETERMINE RECOMMENDATIONS FOR OTHER SENIOR EXECUTIVES AND ENGAGES IN AN ANALYSIS THROUGH USE OF INDEPENDENT SURVEY RESULTS. THE BOARD COMMITTEE ALSO INCLUDES A REVIEW OF PERFORMANCE TARGETS WHICH ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION. THESE MEASURES INCLUDE ORGANIZATIONAL AND INDIVIDUAL GOALS, EFFORTS TO FURTHER THE MISSION AND VISION OF KALISPELL REGIONAL HEALTHCARE SYSTEM, QUALITY INDICATORS, CUSTOMER/PATIENT SATISFACTION, AND FINANCIAL PERFORMANCE OBJECTIVES. THE BOARD COMMITTEE REVIEWS BENEFIT LEVELS AND TOTAL COMPENSATION TO ENSURE APPROPRIATENESS IN THE NOT-FOR-PROFIT HEALTH CARE SECTOR. THE BOARD EXECUTIVE COMPENSATION COMMITTEE MAKES ITS REPORT TO THE KALISPELL REGIONAL HEALTHCARE SYSTEM BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 ONLY FORM 990 IS AVAILABLE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: FUND BALANCE TRANSFERRED TO AFFILIATES -4,017,546. ADJUSTMENT FOR FOUNDATION ACTIVITY -385,148. NET CHANGE IN RESTRICTED ASSETS 3,029,680. ADJUSTMENT FOR KRMC VOLUNTEERS ACTIVITY 41,165. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, COLUMN (B) THE OFFICERS OF KALISPELL REGIONAL MEDICAL CENTER DIVIDE THEIR TIME AMONG THE OTHER RELATED ENTITIES FOR WHICH THEY ARE ALSO OFFICERS. THEIR TOTAL AVERAGE WEEKLY HOURS DEVOTED TO ALL OF THE ENTITIES IS IN EXCESS OF 50 HOURS. SEVERAL OF THE TRUSTEES WHO ARE PHYSICIANS RECEIVE COMPENSATION FOR MEDICAL SERVICES RENDERED TO THE HOSPITAL. THEIR AVERAGE WEEKLY HOURS DEVOTED TO THE HOSPITAL VARIES. TATE KREITINGER DEVOTES APPROXIMATELY 50% OF HIS TIME TO KALISPELL REGIONAL MEDICAL CENTER AND 50% OF HIS TIME TO HEALTHCENTER NORTHWEST, A RELATED ENTITY. 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