2013-02-15T15:34:01-06:00 2012-05-31 810272932 GALUSHA HIGGINS & GALUSHA PC PO BOX 1699 HELENA MT 596241699 990 2011-06-01 810231789 MONTANA CHILDREN'S HOME AND HOSPITAL MONT 4064447500 PO BOX 5539 HELENA MT 59604 JOHN P CASEY 4064447500 2013-02-06 1 NATHAN D MCCARTHY CPA P00368408 4064425520 2013-02-06 2011 2016-03-07 17:11:31Z JOHN P CASEY PO BOX 5539 HELENA MT 59604 21376340 0 X WWW.SHODAIRHOSPITAL.ORG X 1942 MT PSYCHIATRIC, GENETIC AND OTHER SERVICES FOR CHILDREN IN A HOSPITAL SETTING AT COST, BELOW COST, OR NO CHARGE. 14 14 376 0 0 0 2908272 2915290 19930919 18411092 27662 21760 0 28198 22866853 21376340 0 0 0 0 13359567 13967754 0 0 0 9745472 6473039 23105039 20440793 -238186 935547 20266964 21032806 9297035 9127330 10969929 11905476 X SHODAIR CHILDREN'S HOSPITAL IS A NON-PROFIT, MONTANA CORPORATION WHOSE PURPOSES SHALL BE:TO ESTABLISH AND MAINTAIN A HOSPITAL AND OTHER APPROPRIATE FACILITIES FOR CARE AND TREATMENT OF CHILDREN SUFFERING FROM ILLNESSES, DISEASES, DEFECTS AND OTHER PHYSICAL, MENTAL, AND EMOTIONAL ABNORMALITIES WHICH IMPAIR THE HEALTH AND WELL-BEING OF CHILDREN WHICH MAY BE JUSTIFIED BY THE FACILITY'S PERSONNEL, FUNCTIONS, OR OTHER REQUIREMENTS THAT ARE OR CAN BE MADE AVAILABLE. TO PROMOTE AND CARRY ON SCIENTIFIC RESEARCH RELATED TO THE CARE OF THE SICK AND INJURED. TO PARTICIPATE SO FAR AS CIRCUMSTANCES MAY WARRANT IN ANY ACTIVITY DESIGNATED AND CARRIED ON TO PROMOTE THE GENERAL HEALTH OF THE COMMUNITY. 0 0 3583097 8060220 THE ACUTE CARE UNIT ACCOMMODATES UP TO 20 CHILDREN FROM AGES 3 TO 18. THE ACUTE PSYCHIATRIC INPATIENT PROGRAM WAS DESIGNATED IN 2008 AS A MODEL PROGRAM USING DR. GREENE'S APPROACH TO SOLVING PROBLEMS COLLABORATIVELY AS DESCRIBED IN HIS BOOKS "THE EXPLOSIVE CHILD" AND "LOST AT SCHOOL". THE PROGRAM OFFERS INTENSIVE SERVICES FOR EMOTIONALLY AND BEHAVIORALLY IMPAIRED CHILDREN AND THEIR FAMILIES WHO ARE IN CRISIS. AT SHODAIR, CHILDREN AND FAMILIES INTERACT WITH A TEAM OF SPECIALISTS, INCLUDING NURSES, DOCTORS, THERAPISTS, AND TEACHERS. 6866521 7488462 SHODAIR CHILDREN'S HOSPITAL PROVIDES THREE DEVELOPMENTALLY SPECIFIC RESIDENTIAL TREATMENT PROGRAMS FOR CHILDREN OF ALL AGES. EACH PROGRAM PROVIDES A THERAPEUTIC AND NURTURING ENVIRONMENT TO PROMOTE POSITIVE CHANGE.THE CHILDREN'S RESIDENTIAL PROGRAM USES DR. GREENE'S APPROACH TO SOLVING PROBLEMS COLLABORATIVELY AS DESCRIBED IN HIS BOOKS AND PROVIDES DEVELOPMENTALLY APPROPRIATE RESIDENTIAL PSYCHIATRIC CARE FOR UP TO 20 CHILDREN (AGES 4 TO 9). THE 20 BED MIDDLE SCHOOL RESIDENTIAL PROGRAM PROVIDES PSYCHIATRIC TREATMENT FOR MIDDLE SCHOOL-AGED YOUTH (AGES 10 TO 13) THE ADOLESCENT UNIT (AGES 14 TO 18) HAS A CAPACITY TO PROVIDE CARE FOR UP TO 24 ADOLESCENTS. 2911531 1280338 THE MISSION OF SHODAIR CHILDREN'S HOSPITAL'S DEPARTMENT OF MEDICAL GENETICS IS TO MEET GENETIC NEEDS OF MONTANANS THROUGH DIAGNOSIS, CONSULTATION, AND SUPPORT FOR FAMILIES, OUTREACH, SCHOLARSHIP, AND EDUCATION. THIS PROGRAM IS MEDICALLY ORIENTED AND OFFERS A BROAD RANGE OF SERVICES TO INDIVIDUALS AND FAMILIES WITH BIRTH DEFECTS, GENETIC AND HEREDITARY CONDITIONS WITH OR WITHOUT MENTAL RETARDATION. SERVICES INCLUDE PATIENT EVALUATIONS, GENETIC COUNSELING, AND EDUCATION. SERVICE MAY BE FOR DIAGNOSIS, PROGNOSIS, NATURAL HISTORY, RECURRENCE RISK INFORMATION, PSYCHOLOGICAL SUPPORT, PRENATAL DIAGNOSIS, FETAL DEATH EVALUATION, MOLECULAR GENETIC AND OTHER SPECIAL TESTING OR FOR A VARIETY OF OTHER REASONS. AN IMPORTANT PART OF THE SERVICE MANDATE IS TO EDUCATE LAY AND PROFESSIONAL MONTANANS ABOUT GENETICS AND GENETIC CONDITIONS SO THEY ARE AWARE OF WHAT SERVICES MAY BENEFIT THEM. THE PROGRAM IS DIVIDED INTO TWO PRIMARY SERVICE UNITS: CLINICAL AND LABORATORY. AN ADMINISTRATIVE DIRECTOR IS RESPONSIBLE FOR MANAGEMENT OF PROGRAM FUNCTIONS. 2181603 1582072 OTHER PROGRAM SERVICES INCLUDE PHARMACY, MEDICAL RECORDS, AND MEDICAL LIBRARY. 2181603 1582072 15542752 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 81 0 1 376 1 0 0 0 0 0 0 0 0 X 14 14 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 MT X X JOHN P CASEY 4064447500 2755 COLONIAL DRIVE HELENA MT 59601 RED MENAHAN 1.00 X X 0 0 0 BOB LEMM 1.00 X X 0 0 0 CYNTHIA MELTON 1.00 X X 0 0 0 RITA GOWEN 1.00 X X 0 0 0 JOE SHEVLIN 1.00 X 0 0 0 ED TINSLEY 1.00 X 0 0 0 MOE WOSEPKA 1.00 X 0 0 0 DAVID LEMM 1.00 X 0 0 0 DR BILL HASQUET 1.00 X 0 0 0 JANET HEDGES 1.00 X 0 0 0 GALEN HOLLENBAUGH 1.00 X 0 0 0 JOEL MAES 1.00 X 0 0 0 DAN SHEA 1.00 X 0 0 0 EDWARD SURBRUGG 1.00 X 0 0 0 JOHN JACK CASEY 40.00 X 287286 0 48443 RONALD J WIENS 40.00 X 127315 0 30879 KEITH FOSTER 40.00 X 249463 0 38425 HEATHER ZALUSKI 40.00 X 203671 0 35235 KATHERINE RAPPAPORT 40.00 X 218347 0 22216 JOHN JOHNSON 40.00 X 204725 0 45675 JAMES REYNOLDS 40.00 X 187784 0 34810 1478591 0 255683 14 0 1 0 LOCUMTENENSCOM 2655 NORTHWINDS PARKWAY ALPHARETTA GA 30009 PHYSICIAN RECRUITMENT 368491 1 1468044 1447246 2915290 ACUTE SERVICES 623990 8060220 8060220 RESIDENTIAL TREATMENT 623990 7488462 7488462 PHARMACY 623990 1514409 1514409 GENETICS SERVICES 621500 1280338 1280338 67663 67663 18411092 21760 21760 CAFETERIA SALES 623990 28198 28198 28198 21376340 18411092 0 49958 492434 492434 11398053 9525164 1872889 541117 448968 92149 556395 434925 121470 979755 795683 184072 51636 185 51451 72379 72379 546097 394474 151623 129355 26922 102433 481380 89984 391396 175472 127331 48141 9201 9201 367884 367884 913084 761612 151472 421934 384938 36996 MEDICAID UTILIZATION FE 862800 862800 SUPPLIES - OTHER 470018 470018 GENERAL SERVICES SUPPLI 390814 390814 SUPPLIES - GENETICS 332804 332804 1248181 886944 361237 20440793 15542752 4898041 0 3205593 3803959 1155966 1149085 4356304 4835118 195039 194864 255205 291341 18074664 7837103 10509623 10237561 60747 900 528487 519978 20266964 21032806 2490812 2327330 6800000 6800000 6223 0 9297035 9127330 X 10909929 11375183 60000 530293 10969929 11905476 20266964 21032806 935547 0 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 858 858 20439092 20439950 1000000 250000 0 0 999523 1000000 1000000 2999523 4499285 23470 43660 858 67988 249881 250000 250000 749881 1124822 1944065 1944065 12914792 5446139 7468653 3215807 2390964 824843 10237561 21376340 20440793 935547 935547 21376340 0 21376340 0 21376340 20440793 0 20440793 0 20440793 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 EXPLANATION OF DOCUMENT RETENTION SCHEDULE E, PART I, LINE 4 THE PART 4 QUESTIONS ANSWERED NO ARE NOT APPLICABLE TO THIS ORGANIZATION. EXPLANATION OF GOVERNMENT FINANCIAL ASSISTANCE SCHEDULE E, PART I, LINE 6 THE ORGANIZATION RECEIVED ASSISTANCE FROM THE OFFICE OF PUBLIC INSTRUCTION. 1 1 1 X 1 X 1 1 0 1 1 49633 59292 -9659 0.00000 13155377 11692650 1462727 0.07240 13205010 11751942 1453068 0.07240 7113 7113 0.00040 25795 25795 0.00130 1692721 1146031 546690 0.02710 3300 3300 0.00020 1728929 1146031 582898 0.02900 14933939 12897973 2035966 0.10140 3711 3711 0.00020 3711 3711 0.00020 1 148119 88900 50928 149431 -98503 X 1 1 1 1 SHODAIR CHILDREN'S HOSPITAL

PO BOX 5539 HELENA MT 59604

X X SHODAIR CHILDREN'S HOSPITAL 1 1 1 100.000000000000 1 200.000000000000 1 X X X X X 1 1 X X X 1 X X 1 X X X X X 1 X 0 0 PART I, LINE 7: THE HOSPITAL USES THE COST TO CHARGE RATIO METHOD. PART I, LINE 7G: THE HOSPITAL SUBSIDIZES THE STATEWIDE GENETICS PROGRAM. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 242760. PART II: THE HOSPITAL'S DOCTORS ARE ON THE BOARDS OF SEVERAL ORGANIZATIONS WHICH PROMOTE THE HEALTH OF THE COMMUNITY. PART III, LINE 4: ACCOUNTS RECEIVABLE ARE STATED AT UNPAID BALANCES, LESS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE HOSPITAL PROVIDES FOR LOSSES ON ACCOUNTS RECEIVABLE USING THE ALLOWANCE METHOD. THE ALLOWANCE IS BASED ON EXPERIENCE, THIRD-PARTY CONTRACTS, AND OTHER CIRCUMSTANCES, WHICH MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS. RECEIVABLES ARE CONSIDERED IMPAIRED IF FULL PRINCIPAL PAYMENTS ARE NOT RECEIVED IN ACCORDANCE WITH THE CONTRACTUAL TERMS. IT IS THE HOSPITAL'S POLICY TO CHARGE OFF UNCOLLECTIBLE ACCOUNTS RECEIVABLE WHEN MANAGEMENT DETERMINES THE RECEIVABLE WILL NOT BE COLLECTED. THE HOSPITAL USES A COST TO CHARGE RATIO. PART III, LINE 9B: FOR THE ACCOUNTS RECEIVABLE POLICY, SEE SUPPLEMENTAL INFORMATION PROVIDED FOR PART III, LINE 4. ADDITIONAL INFORMATION: CHARITY DISCOUNT IS APPROVED AND GRANTED PRIOR TO A PATIENT BEING ADMITTED TO SHODAIR CHILDREN'S HOSPITAL. THE CHARITY DISCOUNT MAY BE FOR THE ENTIRE ACCOUNT OR A PORTION OF AN INSURED ACCOUNT WHERE THE PAYMENT OF THE CO-PAY INSURANCE AND OR DEDUCTIBLE WOULD CREATE A FINANCIAL HARDSHIP FOR THE FAMILY OR THE CHILD OR ADOLESCENT PATIENT. THE GRANTING OF A CHARITY DISCOUNT IS DEPENDENT ON APPLICATION AND MEETING THE INCOME TEST OF THE CHARITY DISCOUNT POLICY AS ESTABLISHED. SHODAIR CHILDREN'S HOSPITAL PART V, SECTION B, LINE 19D: 10% DISCOUNT, WHICH IS SIMILAR TO DISCOUNTS NEGOTIATED WITH COMMERICIAL INSURANCE CARRIERS. PART VI, LINE 2: SHODAIR CHILDREN'S HOSPITAL IS LOCATED IN HELENA, MONTANA. ITS FACILITY TOTALS 90,000 SQUARE FEET AND INCLUDES THE RESIDENTIAL AND ACUTE PSYCHIATRIC TREATMENT CENTERS FOR CHILDREN AND ADOLESCENTS, THE MEDICAL GENETICS PROGRAM, ADMINISTRATIVE OFFICES, AND THE MARKETING/COMMUNITY RELATIONS AND FOUNDATION OFFICES. SHODAIR CHILDREN'S HOSPITAL IS THE ONLY FACILITY IN THE STATE OF MONTANA TO OFFER BOTH ACUTE AND RESIDENTIAL TREATMENT SERVICES FOR CHILDREN AND ADOLESCENTS. SHODAIR CHILDREN'S HOSPITAL PROVIDES THREE DEVELOPMENTALLY SPECIFIC RESIDENTIAL TREATMENT PROGRAMS FOR CHILDREN OF ALL AGES. EACH PROGRAM PROVIDES A THERAPEUTIC AND NURTURING ENVIRONMENT TO PROMOTE POSITIVE CHANGE. THE SCHOOL AT SHODAIR IS ACCREDITED BY THE NORTHWEST ASSOCIATION OF ACCREDITED SCHOOLS AND IS SCHEDULED YEAR-ROUND. THIS ALLOWS STUDENTS AN OPPORTUNITY TO WORK IN ACADEMIC AREAS AS NEEDED OR TO MAKE UP MISSED CREDITS. THE MISSION OF SHODAIR CHILDREN'S HOSPITAL'S DEPARTMENT OF MEDICAL GENETICS IS TO MEET GENETIC NEEDS OF MONTANANS THROUGH DIAGNOSIS, CONSULTATION, AND SUPPORT FOR FAMILIES, OUTREACH, SCHOLARSHIP, AND EDUCATION. PART VI, LINE 3: FINANCIAL ASSISTANCE WILL BE PROVIDED TO THE HOSPITAL'S PATIENTS WHO MEET SPECIFIED FINANCIAL CRITERA AND REQUEST SUCH ASSISTANCE. PART VI, LINE 4: SHODAIR CHILDREN'S HOSPITAL BEGAN ITS OPERATIONS IN HELENA, MONTANA. THE HOSPITAL SERVES PATIENTS FROM ACROSS THE COUNTRY, AS IT PROVIDES SPECIALIZED SERVICES. X X 1 1 X X X X 0 0 0 0 0 0 0 0 0 JOHN JACK CASEY 287286 0 0 0 0 0 16908 0 31535 0 335729 0 0 0 RONALD J WIENS 127315 0 0 0 0 0 7729 0 23150 0 158194 0 0 0 KEITH FOSTER 249463 0 0 0 0 0 15037 0 23388 0 287888 0 0 0 HEATHER ZALUSKI 203671 0 0 0 0 0 12498 0 22737 0 238906 0 0 0 KATHERINE RAPPAPORT 218347 0 0 0 0 0 13070 0 9146 0 240563 0 0 0 JOHN JOHNSON 204725 0 0 0 0 0 12181 0 33494 0 250400 0 0 0 JAMES REYNOLDS 187784 0 0 0 0 0 11268 0 23542 0 222594 0 0 0 US BANK NATIONAL ASSOCIATION 2005-04-01 9720000 TO FINANCE COSTS OF IMPROVEMENTS TO THE HOSPITAL 0 0 0 2006 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 BOB LEMM, 1ST VICE CHAIR, IS THE FATHER OF DAVID LEMM, TRUSTEE FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE FORM 990 IS PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL BEFORE IT IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS SIGN A CONFLICT OF INTEREST POLICY ANNUALLY. THE HOSPITAL ATTORNEY ATTENDS EACH BOARD MEETING AND MONITORS ADHERENCE TO THE POLICY. FORM 990, PART VI, SECTION B, LINE 15 DUE TO THE NATURE OF THE SPECIALTY OF THIS HOSPITAL, A COMPANY SPECIALIZING IN COMPENSATION PACKAGES IS CONTRACTED TO REVIEW THE ADMINISTRATOR'S COMPENSATION. OTHER KEY EMPLOYEES' COMPENSATION IS DETERMINED UTILIZING THE MONTANA HOSPITAL ASSOCIATION'S ANNUAL COMPENSATION SURVEY. IF THE SPECIALTY HAS A LIMITED NUMBER OF PROFESSIONALS IN MONTANA THE REGIONAL OR NATIONAL COMPENSATION DATA IS UTILIZED. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS ARE ON FILE WITH THE STATE OF MONTANA AND AVAILABLE TO THE PUBLIC IF REQUESTED FROM THE STATE. CONFLICT OF INTEREST AND FINANCIAL STATEMENTS ARE NOT MADE READILY AVAILABLE TO THE GENERAL PUBLIC BUT ARE DISTRIBUTED TO THE BOARD OF TRUSTEES WHO ARE REPRESENTATION OF THE PUBLIC. THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR IN THE OVERSIGHT OF THE AUDIT OR THE SELECTION OF AN INDEPENDENT ACCOUNTANT. MONTANA CHILDREN'S FOUNDATION PO BOX 5539 HELENA MT 59604 810365625 TO PROMOTE AND FURTHER OPERATIONS OF MONTANA CHILDREN'S HOME AND HOSPITAL MT 501(C)(3) 509(A)(3) 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 MONTANA CHILDREN'S FOUNDATION C 915528 CASH RECEIVED