NORTHERN MONTANA HOSPITAL: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
NORTHERN MONTANA HOSPITAL (EIN 81-0231787)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-05-02
IRS object ID
201441229349300624
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)
Timestamp2014-05-02T11:09:49-05:00Timestamp
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)
EIN810231787EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northern Montana HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlNORTNameControl
Phone4062652211Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 1231AddressLine1
CityHavreCity
StateMTState
ZIP Code595011231ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameDavid HenryName
TitlePresident/CEOTitle
Phone4062652211Phone
Date Signed2014-05-01DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKim C HunwardsenName
PTINP00484560PTIN
Phone6122536500Phone
Date Prepared2014-04-27DatePrepared
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonDavid HenryNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1PO Box 1231AddressLine1
CityHavreCity
StateMTState
ZIP Code595011231ZIPCode
FieldValueIRS element (for citing)
Gross Receipts62379906GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.nmhcare.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1921YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionProvision of healthcare services.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members7NbrIndependentVotingMembers
Total Nbr Employees726TotalNbrEmployees
Total Nbr Volunteers130TotalNbrVolunteers
Total Gross UBI285330TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year182176ContributionsGrantsPriorYear
Contributions Grants Current Year92137ContributionsGrantsCurrentYear
Program Service Revenue Prior Year51574936ProgramServiceRevenuePriorYear
Program Service Revenue CY55155647ProgramServiceRevenueCY
Investment Income Prior Year738446InvestmentIncomePriorYear
Investment Income Current Year867779InvestmentIncomeCurrentYear
Other Revenue Prior Year2308OtherRevenuePriorYear
Other Revenue Current Year7056OtherRevenueCurrentYear
Total Revenue Prior Year52497866TotalRevenuePriorYear
Total Revenue Current Year56122619TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year12105GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY14711GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year28582383SalariesEtcPriorYear
Salaries Etc Current Year30961654SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year21633370OtherExpensePriorYear
Other Expenses Current Year20872733OtherExpensesCurrentYear
Total Expenses Prior Year50227858TotalExpensesPriorYear
Total Expenses Current Year51849098TotalExpensesCurrentYear
Revenues Less Expenses Prior Year2270008RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4273521RevenuesLessExpensesCY
Total Assets BOY55588753TotalAssetsBOY
Total Assets EOY60313312TotalAssetsEOY
Total Liabilities BOY15352296TotalLiabilitiesBOY
Total Liabilities EOY13670900TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY40236457NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY46642412NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTo deliver high quality comprehensive health care services to the Hi-Line communities.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense38662831Expense
Grants14711Grants
Revenue55155647Revenue
DescriptionNorthern Montana Hospital (hospital) provides quality health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of the hospital, it is recognized that not all individuals possess the ability to purchase these essential services. It is the hospital's mission to serve the surrounding area by providing healthcare services and healthcare education to all community members. During the year ended June 30, 2013, the hospital provided $1,200,243 of medical services, based on charges, to individuals who were determined unable to purchase such services under the hospital's charity care policy and guidelines. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients was $27,424,700 for the year ended June 30, 2013. During the fiscal year ended June 30, 2013 the hospital provided over 3,800 days of hospital services. The nursing home provided over 36,300 resident days during the year.The hospital also provides community care and services through many health care activities and programs provided to support the community. These activities include: wellness programs, community education programs, senior services, health care screening, special programs for specific groups, published articles, radio programs, and a variety of community supported activities. The hospital also received many hours of volunteer help from the community residents.Description
Total Program Service Expense38662831TotalProgramServiceExpense
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 Assets0ReportOtherAssets
Report Other Liabilities1ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital1Hospital
Financial Stmt Attached1FinancialStmtAttached
Grants To Organizations0GrantsToOrganizations
Grants To Individuals1GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP0LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member0BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity1RelatedOrgControlledEntity
Transaction Related Entity1TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109689NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees726NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members7NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees0MinutesOfCommittees
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 CEO1CompensationProcessCEO
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 Line1Kim Lucke VP of FinanceBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4062652211TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 1231AddressLine1
CityHavreCity
StateMTState
ZIP Code59501ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
David C Henry
President/CEO40.003.00XX000
Miles Hamilton
Chairman1.001.00XX000
Bruce Richardson MD
Vice Chair40.001.00XX326849020318
David Leeds
Treasurer1.001.00XX000
Judy Greenwood
Secretary1.001.00XX000
Paul Tuss
Trustee1.001.00X000
Stephen Bechdolt MD
Trustee - Chief of Medical Staff40.001.00X29111909430
Tom Patrick
Trustee1.001.00X000
Andrew Carlson
Trustee1.001.00X000
Margaret Dow MD
Trustee - IPD Member40.001.00X277425023738
Michael Nolan MD
Trustee - IPD Member40.001.00X27615805000
Julie Holt
Trustee1.001.00X000
Karen Pollington
Vice President retired May 201340.001.00X92341019282
Kim Lucke
VP of Finance40.009.00X73289018143
Julie Mariani
Vice President commenced June 201340.001.00X94014023234
Karen E Lien MD
Physician40.000.00364322022211X
John True MD
Physician40.000.0035370800X
Damian Ymzon MD
Physician40.000.00342324016782X
Allen Rebchook MD
Physician40.000.00345299011110X
Marc Whitacre MD
Physician40.000.00309974025455X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3146822TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation194703TotalOtherCompensation
Number Individuals GT100 K33NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
Steven Liston
1562 Rialto LaneDavisCA956186401Contract Radiologist Services604813
Fundamental Financial Group
PO Box 1231HavreMT59501Management Services378500
Comphealth Medical Staffing Inc
PO Box 972651DallasTX753972670Locums Physicians356001
Sletten Construction Company
1000 25th Street NGreat FallsMT59405Construction263228
PAML
PO Box 2720SpokaneWA992204002Reference Lab Services200919
FieldValueIRS element (for citing)
Number Of Contractors GT100 K10NumberOfContractorsGT100K
Related Organizations52222RelatedOrganizations
All Other Contributions39915AllOtherContributions
Total Contributions92137TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
Net Patient Service Revenue6221104648688946486889
Pharmacy44611062509025965572285330
Supporting revenue90009917211481721148
Healthcare Consulting900099439088439088
Cafeteria Revenue722210257620257620
FieldValueIRS element (for citing)
Total Program Service Revenue55155647TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column666501TotalRevenueColumn
Exclusion$666,501ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real14993Real
Personal1048Personal

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real7025Real
Personal1960Personal

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real7968Real
Personal-912Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column7056TotalRevenueColumn
Exclusion$7,056ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6449580Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities6248248Securities
Other54Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities201332Securities
Other-54Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column201278TotalRevenueColumn
Exclusion$201,278ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column56122619TotalRevenueColumn
Related Or Exempt Function Income54870317RelatedOrExemptFunctionIncome
Unrelated Business Revenue285330UnrelatedBusinessRevenue
Exclusion$874,835ExclusionAmount

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total14711Total
Program Services14711ProgramServices

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1815756Total
Program Services1452982ProgramServices
Management And General362774ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total23635824Total
Program Services16545077ProgramServices
Management And General7090747ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total1181791Total
Program Services827254ProgramServices
Management And General354537ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2229670Total
Program Services1560769ProgramServices
Management And General668901ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total2098613Total
Program Services1469029ProgramServices
Management And General629584ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total381500Total
Program Services76300ProgramServices
Management And General305200ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total39207Total
Management And General39207ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total71627Total
Management And General71627ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3433192Total
Program Services2803564ProgramServices
Management And General629628ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total224233Total
Management And General224233ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total2061874Total
Program Services1034550ProgramServices
Management And General1027324ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total517084Total
Program Services413667ProgramServices
Management And General103417ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1760108Total
Program Services1229380ProgramServices
Management And General530728ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total240215Total
Program Services84075ProgramServices
Management And General156140ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total37721Total
Management And General37721ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2024567Total
Program Services1417196ProgramServices
Management And General607371ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1236179Total
Program Services988943ProgramServices
Management And General247236ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
Medical Supplies44310824431082
Bad Debt Expense37630473763047
Bed Tax526232526232
Dues and subscriptions1015102030281208

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total23355Total
Program Services4671ProgramServices
Management And General18684ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total51849098Total
Program Services38662831ProgramServices
Management And General13186267ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY24109BOY
EOY64652EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4964034BOY
EOY7037642EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY13860295BOY
EOY12167524EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1299343BOY
EOY1551648EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY433168BOY
EOY503985EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis48261703LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec37491965LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY7920155BOY
EOY10769738EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY25671006BOY
EOY26284073EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY93637BOY
EOY79781EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1323006BOY
EOY1854269EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY55588753BOY
EOY60313312EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3579713BOY
EOY4860951EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY2107553EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY11772583BOY
EOY6702396EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY15352296BOY
EOY13670900EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY40236457BOY
EOY46642412EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY40236457BOY
EOY46642412EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY55588753BOY
EOY60313312EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4273521ReconcilationRevenueExpenses
Reconciliation Unrealized Invest-168362ReconciliationUnrealizedInvest
Reconcilation Other Changes2300796ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 Balance34936BeginningBalance
Additions During Year155258AdditionsDuringYear
Distributions During Year157776DistributionsDuringYear
Ending Balance32418EndingBalance
Included On FS0IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis75272OtherCostOrOtherBasis
Book Value75272BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis21167541OtherCostOrOtherBasis
Depreciation16912003Depreciation
Book Value4255538BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis25737352OtherCostOrOtherBasis
Depreciation19832392Depreciation
Book Value5904960BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1281538OtherCostOrOtherBasis
Depreciation747570Depreciation
Book Value533968BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings10769738TotalOfBookValueLandBuildings

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescriptionAmountAmount
Liability for pension benefits$5,975,190
Third-party payor settlements$720,000
Due to Affiliates$7,206
FieldValueIRS element (for citing)
Total Of Amounts6702396TotalOfAmounts
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Line 1b:The custodial funds are not reported on the balance sheet of NMH as they are the personal resource funds of the residents to be used only for their personal needs. If the resident passes, the funds either go to the family or back to the state. They are in no way an asset of the organization.
Part X, Line 2:The Organization 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.Description of Uncertain Tax Positions Under FIN 48:

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare

Other Percentage OtherPercentage

FieldValueIRS element (for citing)
OtherXOther
Free Other Percentage125.000000000000FreeOtherPercentage
FieldValueIRS element (for citing)
FPG Reference Discounted Care1FPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage225.000000000000DiscountedOtherPercentage
FieldValueIRS element (for citing)
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)
Total Community Benefit Expense627000TotalCommunityBenefitExpense
Net Community Benefit Expense627000NetCommunityBenefitExpense
Percent Of Total Expense0.01300PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense10208408TotalCommunityBenefitExpense
Direct Offsetting Revenue8540864DirectOffsettingRevenue
Net Community Benefit Expense1667544NetCommunityBenefitExpense
Percent Of Total Expense0.03470PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense10835408TotalCommunityBenefitExpense
Direct Offsetting Revenue8540864DirectOffsettingRevenue
Net Community Benefit Expense2294544NetCommunityBenefitExpense
Percent Of Total Expense0.04770PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense28446TotalCommunityBenefitExpense
Net Community Benefit Expense28446NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense26830TotalCommunityBenefitExpense
Net Community Benefit Expense26830NetCommunityBenefitExpense
Percent Of Total Expense0.00060PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense8097705TotalCommunityBenefitExpense
Direct Offsetting Revenue6774884DirectOffsettingRevenue
Net Community Benefit Expense1322821NetCommunityBenefitExpense
Percent Of Total Expense0.02750PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense41336TotalCommunityBenefitExpense
Net Community Benefit Expense41336NetCommunityBenefitExpense
Percent Of Total Expense0.00090PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense8194317TotalCommunityBenefitExpense
Direct Offsetting Revenue6774884DirectOffsettingRevenue
Net Community Benefit Expense1419433NetCommunityBenefitExpense
Percent Of Total Expense0.02960PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense19029725TotalCommunityBenefitExpense
Direct Offsetting Revenue15315748DirectOffsettingRevenue
Net Community Benefit Expense3713977NetCommunityBenefitExpense
Percent Of Total Expense0.07730PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense140795TotalCommunityBuildingExpense
Direct Offsetting Revenue100925DirectOffsettingRevenue
Net Community Building Expense39870NetCommunityBuildingExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense8465TotalCommunityBuildingExpense
Net Community Building Expense8465NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense1190TotalCommunityBuildingExpense
Net Community Building Expense1190NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense63TotalCommunityBuildingExpense
Net Community Building Expense63NetCommunityBuildingExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense150513TotalCommunityBuildingExpense
Direct Offsetting Revenue100925DirectOffsettingRevenue
Net Community Building Expense49588NetCommunityBuildingExpense
Percent Of Total Expense0.00100PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReported
Bad Debt Expense$3,763,047BadDebtExpenseAmount
Amount Attributable To50989AmountAttributableTo
Amount Reimbursed By Medicare9099018AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare9565749CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-466731MedicareSurplusOrShortfall

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 Line1Northern Montana HospitalBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line130 13th StreetAddressLine1
CityHavreCity
StateMTState
ZIP Code59501ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
Other2 provider based rural health clinicsOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Northern Montana HospitalBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted1CHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Needs Assessment Conducted10NeedsAssessmentConducted
Take Into Account1TakeIntoAccount
Other Facilities0OtherFacilities
CHNA Widely Available1CHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Other MethodXOtherMethod
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Other Needs AddressedXOtherNeedsAddressed
All Needs Addressed1AllNeedsAddressed
Organization Incur Excise Tax0OrganizationIncurExciseTax
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent125.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent225.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1Northern Montana Care CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line124 13th StreetAddressLine1
CityHavreCity
StateMTState
ZIP Code59501ZIPCode
FieldValueIRS element (for citing)
Facility TypeNursing HomeFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI (18 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 6a: The Organization's community benefit report was published as a 1/2 page ad in the local newspaper. In addition, a statement about the amount of community benefit the organization provided can be found on our web-site at www.nmhcare.org.
Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid, line 7b, was calculated using the cost-to-charge ratio derived from Worksheet 2. Community health improvement services, line 7e, health professions education, line 7f, and cash and in-kind donations, line 7i, are actual costs reported in the general ledger. The cost for subsidized health services reported on line 7g was determined using the cost-to-charge ratio derived from worksheet 2.
Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $3,763,047.
Part II: Reported under community building activities is the maintenance of our fitness park which is open to the public and has both a softball field and soccer field, as well as a paved walking path. It also includes an employee's time for being a member of the Hill County Health Consortium, which collaboratively conducted a Community Health Needs Assessment with several other local public health entities and works to implement the identified unmet needs of the community. Another community building activity is community forums at which employed physicians give educational presentations to the community on various health topics.
Part III, Line 4: The estimated amount of bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated by using charity care as a percentage of gross patient service revenue. As a portion of revenue is considered charity care, it is assumed that a percentage of bad debt expense would also be considered charity care.Bad debt expense is reported as charges net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. The footnote to the Organization's financial statements can be found on page 7 of the attached audited financial statements.
Part III, Line 8: The expenses represent an overall shortfall of the Medicare patient population. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.
Part III, Line 9b: The Organization's financial assistance policy provides information on collection practices for those known to qualify for financial assistance. The policy states "During the patient registration or collection process, the Hospital will make an initial determination of eligibility based on verbal or written application for charity care. Pending final eligibility determination, the Hospital will not initiate collection efforts or requests for deposits, provided that the responsible party is cooperative with the Hospital's efforts to reach a determination of status, including return of applications and documentation required by the Hospital within fourteen (14) days of receipt."
Part V, Section B, Line 3: NMH is a member of the Hill County Health Consortium and conducted the Needs Assessment in collaboration with them. Members of the Consortium include the Hill County Health Department, The Board of Health, Rocky Boy Health Department, Salvation Army, United Way, HRDC, Havre Public Schools and MSU-Northern College, County Extension Office, County Commissioners, Office of Public Assistance, 12th Judicial District Youth Court and several other community organizations and forums.Northern Montana Hospital
Part V, Section B, Line 5c: The CHNA is made widely available to the public via its website www.nmhcare.org. It is also posted on the web-sites of Bullhook Community Health Center and the Hill County Health Department. The CHNA is electronically delivered to every member of the Consortium and NMH. Bullhook Community Health Center and the Hill County Health Department all received hard copies available for distribution.Northern Montana Hospital
Part V, Section B, Line 6i: NMH hosts Consortium meetings and provide lunch free of charge, we sponsored "Open Swim", which was part of the CHIP plan for obesity. We printed the community resource pamphlets free of charge and we participated in the "unsafe sex" campaign. The implementation strategy may be found at: www.nmhcare.org.Northern Montana Hospital
Part V, Section B, Line 14g: The financial assistance policy is available on the Hospital's website at www.nmhcare.org. In addition, a summary of the financial assistance policy is posted in the facility's emergency room and waiting rooms as well as admissions offices. The hospital's "Conditions of Treatment" also includes information regarding the financial assistance policy.Northern Montana Hospital
Part V, Section B, Line 22: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures.Northern Montana Hospital
Part VI, Line 2: Community needs assessments are conducted throughout the community by organizations such as HRDC, the Boys & Girls Club and the Montana Economic Development Council. These assessments are shared with the community. Through these assessments, Northern Montana Hospital is able to identify the needs they can help meet. The current needs are: transportation, mental health and youth in need. Northern Montana Hospital has key employees that are working with a collective community group on the transportation coalition. We also participate in a community program, 'Healthy Youth, Healthy Community' in coalition with the Boys & Girls Club and other community organizations. Northern Montana Hospital is helping to meet the mental health needs of the community by offering and subsidizing mental health services. We also subsidize the Bullhook Community Health Center which was formed to meet the needs of the uninsured and underinsured.In FY 2011 Northern Montana Hospital became a member of the Hill County Health Consortium. The Consortium is composed of many important stakeholders in the community who have joined together to identify the current health needs impacting the community. Partnerships were formed by members of the Consortium to help gather the data needed in the discussions. The CHANGE (Community Health Assessment and Group Evaluation) tool from the CDC website was chosen to help us through the process of our community health assessment mainly because it would walk us through each step in the process. CHANGE can be used to gain a picture of the policy, systems, and environmental change strategies currently in place throughout the community; develop a community action plan for improving policies, systems, and the environment to support healthy lifestyles; and assist with prioritizing community needs and allocating available resources. The CHANGE tool involves dividing our community into 5 different sectors and choosing a few sites within those sectors to collect responses from. The 5 Sectors include:(1) Community-At-Large(2) Community-Institutions-Organizations(3) Worksite(4) Health Care(5) SchoolsAlong with the CHANGE tool, a written survey was created using an example from Wilkes Healthy Carolinians Council (wilkeshealth.com). This survey seemed to fit closely with our needs, with only minor adjustments being made to fit Hill County. This written survey was available throughout Hill County at various waiting areas so people would have adequate time to complete them.Out of the Community Health Needs Assessment (CHNA) the Community Health Improvement Plan (CHIP) was developed. The plan identifies several health related issues that adversely impact the health of the community. This plan not only provides us with a deeper look into the current health status of the community, it leads us into providing solutions for improving the health status of our community. These improvements are spearheaded by subcommittees chosen through the Hill County Consortium and other local agencies.The Community Health Improvement Plan is an ongoing process. The Community Health Assessment will be repeated in 2014 and will form the basis by which improvement will be measured. Northern Montana Hospital takes an active role in the Hill County Health Consortium.
Part VI, Line 3: Northern Montana Hospital informs and educates patients about their eligibility for assistance through a sign posted at our admissions desk, noted in the brochure we give patients at our clinics, and signs posted at our clinic registration desks. In addition, our collection staff offer charity care as an option when they are discussing the patient's balance as well as the availability of various government benefits, such as Medicaid or state programs. As of Oct 2010, NMH has contracted with a company to assist the patient with qualification for programs such as Medicaid and disability determination.We also publish a community benefit report annually which states how much financial assistance we have given away, and we post our community benefit report on our website noting that we provide financial assistance.
Part VI, Line 4: Northern Montana Hospital is a 49 bed hospital including 5 swing beds, a 5 bed intensive care unit, 24-hour staffed emergency room, same day surgery, and a 6 chair dialysis unit. Northern Montana Care Center is a 136 bed skilled and intermediate care facility of which 20 beds are designated for residents with Alzheimer's disease and other related dementias. Northern Montana Assisted Living is a 10 bed facility. Northern Montana Medical Group - East and Northern Montana Medical Group - West are both provider based rural health clinics. Other services include: Northern Montana Vision Center, an ophthalmology office; Bear Paw Hospice; and the Hi-Line Sleep Center. The Hospital's service area consists of Hill, Blaine, Liberty, Philips and the Big Sandy census district of Choteau counties. The population of this service area is approximately 30,000. The median household income is about $42,000. Approximately 45% of the population has a household income below 200% of the federal poverty guidelines. Approximately 22% of the population is covered by Medicaid, 30% by Medicare, 2.5% by CHIP and about 24% uninsured. Additionally, another 7% of the population is covered by Indian Health Services. The entire service area is considered rural and has been designated a health professional shortage area for all primary medical care, mental health and dental. In addition, the entire service area is designated as a medically underserved area. Northern Montana Hospital is the only local hospital in its service area; however there are 3 critical access hospitals, 4 rural health clinics, 3 community health clinics and 3 IHS-Tribal clinics within its service area. The nearest hospital is a critical access hospital and is 35 miles away.
Part VI, Line 5: More than 50% of Northern Montana Hospital's governing board consists of various local business people who reside within our service area and are not employed or contracted by the organization.Northern Montana Hospital extends medical staff privileges to all qualified physicians in its community. The organization applies surplus funds to improvements in patient care by keeping its medical equipment up to date, sending its employed physicians for further continuing education, supporting nursing education through a loan re-payment assistance program and supporting health care education through an education assistance program. In addition, the hospital subsidizes its emergency department by offering 24/7 emergent care coverage to all, regardless of their ability to pay. Northern Montana Hospital offers Dialysis services to patients in our service area, despite the fact that this service is provided at a loss to NMH. Without this service, patients would have to travel well over 100 miles each way, 3 times per week to receive this service. Northern Montana Hospital has Sole Community Designation. The nearest PPS hospital is located 110 miles from Havre. Northern Montana Hospital also participates in all government sponsored health programs, such as CHIP, Healthy Montana Kids and the Montana Cervical and Breast Cancer Program, where it accepts payments for services at greatly discounted rates. Several members of Northern Montana Hospital's leadership team serve on other community boards, such as: Havre Chamber of Commerce, Hill County Health Consortium, Local Emergency Planning, Fetal/Infant/Child Mortality Review Board, Havre/Hill County Planning Board, Hill and Blaine County Adult Protective Services Committee, Hill County United Way, HRDC Medical Advisory Board, MSU-N Nursing Advisory Board and the Safe Kids Safe Communities Committee.
Part VI, Line 6: N/A
MTReports Filed With StatesPart VI, Line 7

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records Maintained1RecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantEducation AssistanceTypeOfGrant
Number Of Recipients4NumberOfRecipients
Amount Of Cash Grant14711AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Procedure for Monitoring Grants in the U.S.:Part I, Line 2:Schedule I, Part I, Line 2: The organization provides education assistance to qualified employees. The organization monitors the use of the assistance by disbursing the funds directly to the institution.
Per our education assistance policy, we will only assist for degrees that will fulfill our staffing needs. We will pay up to $5,250 per employee per year, however not every applicant requests the full amount. Therefore, we antipate 3-6 recipients per year.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan0SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org1CompBasedOnRevenueOfFilingOrg
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 (9 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
Bruce Richardson MD
Vice Chair3248370002012000229230349772000
Stephen Bechdolt MD
Trustee - Chief of Medical Staff2899310001188000117080302827000
Margaret Dow MD
Trustee - IPD Member277245000180000260050303430000
Michael Nolan MD
Trustee - IPD Member274695000146300071720283330000
Karen E Lien MD
Physician364052000270000251060389428000
John True MD
Physician350000000370800027130356421000
Damian Ymzon MD
Physician342162000162000194950361819000
Allen Rebchook MD
Physician344525000774000138230359122000
Marc Whitacre MD
Physician309200000774000279750337949000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
Part I, Line 3The CEO/President of Northern Montana Hospital is compensated by an unrelated management company, Fundamental Financial Group, for services provided to Northern Montana Hospital, Northern Montana Health Care Foundation, Inc., and Northern Montana Health Care, Inc. The board works with the unrelated management company to determine the CEO/President's compensation using the methods checked in line 3.
Part I, Line 5Margaret Dow, Michael Nolan, and Karen Lien 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.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (10 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Form 990, Part VI, Section A, line 3David 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 6The sole member of the organization is Northern Montana Health Care, Inc.
Form 990, Part VI, Section A, line 7bThe sole member of the organization shall have such rights and powers as are provided for in the Articles of Incorporation, the Bylaws of the organization and the laws of the State of Montana, including but not limited to, the exclusive power: (a) to remove any trustee from any office at any time, with or without cause; (b) to propose and approve (i) a plan of dissolution or liquidation of the organization or (ii) a plan of merger or consolidation of the organization with another corporation; (c) to propose and approve amendments to the articles of incorporation and or the bylaws;(d) to adopt any annual or long-term capital or operational budget or any changes therein exceeding $75,000;(e) to authorize the organization to enter into any contract or engage in any transaction which is not provided for in an annual or long-term capital or operational budget approved by the sole member of the organization where the amount involved exceeds $50,000;(f) to adopt substantive changes to existing long-term or master institutional plans of the organization; (g) to authorize the organization to engage in, or enter into, any transaction providing for the sale, mortgage or other disposition of all or substantially all of the assets of the organization; (h) to organize or acquire, or authorize the organization or acquisition of, any subsidiary or affiliate of the organization; (i) to authorize the organization to enter into any shared service agreement; (j) to approve long-term borrowing of money by the organization or authorize the organization to incur indebtedness involving a mortgage or lien on assets; or (k) to approve the trustees or the President of the organization from a slate prepared by the Nominating Committee of the organization.
Form 990, Part VI, Section A, line 8bNo committee has the authority to act on behalf of the board.
Form 990, Part VI, Section B, line 11The 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 12cThe conflict of interest policy covers all trustees, directors, officers, and key employees. The board identifies potential conflicts from annual disclosures. Disclosures are reviewed by administration after all are gathered. A second conflict disclosure letter is sent out annually to all current and former officers, directors, trustees, and key employees to ensure all potential conflicts are identified. The results of this disclosure form are reviewed by the VP of Finance. The board discusses the potential conflicts and determines if voting on related items would be a conflict of interest. If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item.
Form 990, Part VI, Section B, line 15aThe CEO/President is compensated by an unrelated management company. The Executive Committee of the board meets and reviews Northern Montana Hospital(NMH)/Northern Montana Health Care, Inc.(NMHC) financial results, the CEO's current year priorities, discusses evaluation tools to be used for CEO evaluation, how comparative salaries will be obtained and discusses the history of compensation to the CEO. At a second Executive Committee meeting they review non-financial activity of NMH/NMHC and the results of the CEO evaluations completed by the board members. Then they review and discuss a compensation comparative summary of Montana CEO's compensation and a Guidestar CEO Compensation Checkpoint that is prepared specifically for NMH. They agree upon a list of the coming year's priorities for the CEO and proposed compensation, with the compensation set by board vote. This annual process was last completed during fiscal year 2013.
Form 990, Part VI, Section C, line 19The organization's governing documents, conflict of interest policy, and financial statements are made available to the public upon request. The financial statements are attached to the Form 990 per the IRS instructions.
Form 990, Part XI, line 9:Equity Transfer to Related Organization: -500,000. Minimum Pension Liability Adjustment: 2,800,796.Changes in Net Assets or Fund Balances:
Form 990, Part XII, Line 2c:The controlling organization, Northern Montana Health Care, Inc.'s Board has a committee that assumes responsibility for oversight of the audit of the financial statements and selection of an independent auditor.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrgDirect Controlling Entity NADirectControllingEntityNA
North Care Corporation
30 13th StreetHavreMT59501810447638Health Care ServicesMT501(c)(3)Line 3Northern Montana Health Care Inc0
Northern Montana Health Care Inc
PO Box 1231HavreMT59501810428854Supporting OrganizationMT501(c)(3)Line 11b, II0N/A
Northern Montana Health Care Foundation Inc
PO Box 1231HavreMT59501363464641FundraisingMT501(c)(3)Line 7Northern Montana Health Care Inc0

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Paramount Health Care IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1PO Box 1231AddressLine1
CityHavreCity
StateMTState
ZIP Code59501ZIPCode
FieldValueIRS element (for citing)
EIN810393353EIN
Primary ActivityHealth Care ServicesPrimaryActivity
Legal Domicile StateMTLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
Controlled Org0ControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Dividends Related Organization0DividendsRelatedOrganization
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs1PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities1SharingOfFacilities
Sharing Of Paid Employees1SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org1OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Northern Montana Healthcare Foundation
C52222Actual Cost
Northern Montana Healthcare Foundation
O55674Fair Market Value

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