2013-05-10T14:04:28-05:00 2012-06-30 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2011-07-01 237169043 CENTRAL MONTANA MEDICAL FACILITIES INC CENT 4065387711 408 WENDELL AVENUE LEWISTOWN MT 59457 ALAN R ALDRICH 4065386243 2013-05-09 1 KIM C HUNWARDSEN P00484560 6122536500 2013-05-09 2011 2016-02-24 21:20:13Z CENTRAL MONTANA MEDICAL CENTER LEE RHODES 408 WENDELL AVENUE LEWISTOWN MT 59457 26809703 0 X WWW.CMMCCARES.COM X 1971 MT THE MISSION OF CMMC IS TO BE THE LEADER IN ASSURING COMMUNITY BASED QUALITY HEALTHCARE. 13 10 441 250 0 0 140928 180603 24480464 26032781 21398 101698 4660 -13978 24647450 26301104 0 0 0 0 14754925 15813633 0 0 58505 10552851 10491129 25307776 26304762 -660326 -3658 20642912 20497551 5536887 4926941 15106025 15570610 X THE MISSION OF CENTRAL MONTANA MEDICAL CENTER IS TO BE THE LEADER IN ASSURING COMMUNITY BASED QUALITY HEALTHCARE. 1 1 2472063 2264925 HOSPITAL INPATIENT SERVICES:NUMBER OF BEDS: 25PROVIDED 1,892 ACUTE DAYS OF CARE AND 846 SWING BED DAYS OF CARE FOR 30% OCCUPANCY RATE. 3690715 3912028 SKILLED NURSING CARE/LONG-TERM CARE REHABILITATION OR LONG-TERM NURSING SERVICES:PROVIDED 18,670 DAYS OF CARE FOR A 60.01% OCCUPANCY RATE. 1693788 2607585 EMERGENCY SERVICES:PROVIDED FOR 5,040 EMERGENCY VISITS.24 HOUR PHYSICIAN COVERAGE AVAILABLE. 13487431 17248243 COMMUNITY CARE AND SERVICES ARE ALSO PROVIDED THROUGH THE MANY REDUCED PRICE SERVICES AND FREE CLINICS, FAIRS, AND PROGRAMS OFFERED THROUGHOUT THE YEAR. THESE INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING (ALL COSTS ARE ESTIMATES):1.THIRTY-TWO FOOT CLINICS WERE HELD IN 2011-2012 IN DENTON, HOBSON AND LEWISTOWN MT. A TOTAL OF 410 PEOPLE WERE SERVED, ALL RECEIVED DISCOUNTED HEALTH CARE. TOTAL COMMUNITY BENEFITS EXPENSE OF $4,111.2.ONE HEALTH FAIR WAS HELD IN 2011-2012, SERVING 2,290 PEOPLE IN FERGUS AND SURROUNDING COUNTIES. ALL RECEIVED DISCOUNTED HEALTH CARE. TOTAL COMMUNITY BENEFITS EXPENSE OF $4,350.3.DIABETES EDUCATION HELD SUPPORT GROUPS THROUGHOUT 2011-2012, SERVING 28 PEOPLE AND TOTALING A COMMUNITY BENEFIT EXPENSE OF $449.4.CMMC EDUCATED LOCALS WITH A BABYSITTING CLASS (24 PEOPLE SERVED, 1 CLASS OFFERED, TOTAL COMMUNITY BENEFIT $1,144), AND SEVERAL COMMUNITY BOARDS WERE SERVED ON IN 2011-2012 FOR A TOTAL OF $4,565.5.EMS EDUCATED LOCAL COMMUNITY AND SURROUNDING COUNTIES THROUGHOUT 2011-2012, SERVING 145 PEOPLE AND TOTALING A COMMUNITY BENEFIT EXPENSE OF $5,307.THE FACILITIES MAINTAIN RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. THESE RECORDS INCLUDE THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER ITS CHARITY CARE POLICY. THE AMOUNT OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, WAS $660,355 FOR THE CURRENT YEAR. 13487431 17248243 21343997 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 42 0 1 441 1 0 0 0 0 0 0 0 0 0 0 X 13 10 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X ALAN R ALDRICH 4065357711 408 WENDELL AVE LEWISTOWN MT 59457 X WAYNE EDWARDS 2.00 X X 0 0 0 MIKE ZACHER 2.00 X X 0 0 0 NANCY WILSON 2.00 X X 0 0 0 JOHN JENSEN 1.00 X 0 0 0 DOUG FLAMENT 1.00 X 0 0 0 ALTA PALLETT 1.00 X 0 0 0 DAVE PHILLIPS 2.00 X X 0 0 0 RUSSELL SPIKA CPA 1.00 X 0 0 0 MIKE DELANEY 1.00 X 0 0 0 FRANCIS WEINHEIMER 1.00 X 0 0 0 LAURA BENNETT MD 1.00 X 35900 0 0 CHRISTINE VOLF 1.00 X 0 0 0 ROY KOHLER MD 1.00 X 7581 0 0 JOSH WEBBER 1.00 X 0 0 0 CARL SEILSTAD 1.00 X 0 0 0 LEE RHODES 40.00 X 0 0 0 ALAN R ALDRICH 40.00 X 125321 0 33302 DIANNE SCOTTEN 40.00 X 119973 0 15107 AARON HUMPHREYS 40.00 X 242907 0 11948 JAMES FOX 40.00 X 207423 0 18746 RENE DEGUZMAN 40.00 X 183471 0 27498 RONALD SKIPPER 40.00 X 304389 0 43955 RICHARD TAYLOR JR 40.00 X 195596 0 12763 1422561 0 163319 12 0 1 0 QUORUM HEALTH RESOURCES LLC 105 CONTINENTIAL PLACE BRENTWOOD TN 37027 FACILITY MANAGEMENT & CEO SERVICES 423890 CPSI PO BOX 850309 MOBILE AL 366850309 COMPUTER TECHNOLOGY 106760 2 126659 35237 18707 180603 NET PATIENT REVENUE 622110 25031811 25031811 SPECIAL PROGRAMS 900099 869179 869179 CAFETERIA 722210 130538 130538 1253 1253 26032781 107682 107682 275463 289441 -13978 -13978 -13978 180279 5538 185052 6749 -4773 -1211 -5984 -5984 27357 126659 27357 0 26301104 26032781 0 87720 245281 119973 125308 12836251 10269001 2547894 19356 251170 200936 49653 581 1576789 1261431 309406 5952 904142 723314 179583 1245 369705 221823 147882 43090 43090 34200 34200 988216 747889 236927 3400 64525 32263 8898 23364 1512370 1187620 322246 2504 792946 576469 214677 1800 38065 38065 71028 55746 15282 133470 104107 29363 1369396 1068129 300964 303 665120 634677 30443 MEDICAL SUPPLIES 2192499 2192499 BAD DEBT ALLOWANCE 578610 578610 EQUIPMENT RENTAL AND MA 272874 240734 32140 1365015 1090711 274304 26304762 21343997 4902260 58505 576615 1065863 3339910 3710400 151572 476943 505418 144684 166265 30351689 21442995 9474307 8908694 4011332 3056929 251996 68428 2367125 2863982 20642912 20497551 2052036 2004705 916227 488458 2056795 2433778 443500 0 68329 0 5536887 4926941 X 13325124 13322780 980947 1341503 799954 906327 15106025 15570610 20642912 20497551 X -3658 468243 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 5434 20766 20748 5452 0 103009 103009 17176108 11546867 5629241 12159591 9254192 2905399 912981 641936 271045 8908694 LONG-TERM PREPAID EXPENSES 278751 DUE FROM FOUNDATION 2247830 OTHER RECEIVABLES 269389 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 68012 2863982 26301104 26304762 -3658 1314 466929 468243 464585 26570227 -1611 -1611 26571838 -270734 -270734 26301104 26592592 289441 289441 26303151 1611 1611 26304762 PART IV, LINE 1B: THE RESIDENT TRUST FUNDS ARE LISTED ON THE BALANCE SHEET AS AN ESCROW ACCOUNT LIABILITY. A SUB-REGISTER IS USED AND LISTED BY RESIDENT. THE SNC BILLER MAKES FUND DISTRIBUTION AS RESIDENT REQUESTS. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE FACILITIES IS ORGANIZED AS A MONTANA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE FACILITIES IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE FACILITIES ARE SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE FACILITIES BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE FACILITIES WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE FACILITIES' FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. PART XI, LINE 8 - OTHER ADJUSTMENTS: INTEREST IN CENTRAL MONTANA FOUNDATION 466,929. PART XII, LINE 2D - OTHER ADJUSTMENTS: FEES RECORDED IN REVENUE FOR FINANCIAL STATEMENTS -1,611. PART XII, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTIONS FOR SPECIFIC PURPOSES RECORDED IN FUND BALANCE FOR F/S 18,707. RENTAL EXPENSES RECORDED IN EXPENSES FOR FINANCIAL STATEMENTS -289,441. PART XIII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES RECORDED IN EXPENSES FOR FINANCIAL STATEMENTS 289,441. PART XIII, LINE 4B - OTHER ADJUSTMENTS: FEES RECORDED IN REVENUE FOR FINANCIAL STATEMENTS 1,611. EMERGENCY DEPT. GALA 116185 100439 15746 863 10563 748 3572 CHRISTMAS MEMORIES 17126 12535 4591 3120 1471 2 20705 13685 7020 800 2144 830 3246 154016 126659 27357 800 6127 11393 748 8289 27357 0 1 1 X 1 X 1 X 1 1 0 0 604 660355 660355 0.02570 604 660355 660355 0.02570 15 5677 26847 4232 22615 0.00090 2 246 170 170 0.00000 1 85 3935699 3189655 746044 0.02900 5 1550 13511 13511 0.00050 23 7558 3976227 3193887 782340 0.03040 23 8162 4636582 3193887 1442695 0.05610 0 578610 15539 6192838 6125496 67342 X 1 1 1 1 CENTRAL MONTANA MEDICAL CENTER

408 WENDALL AVENUE LEWISTOWN MT 59457

X X X X HOME HEALTH / HOSPICE CENTRAL MONTANA MEDICAL FACILITIES INC 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 2 CENTRAL MONTANA MEDICAL CENTER - DME

202 4TH AVENUE SOUTH LEWISTOWN MT 59457

HME/DME SERVICES CENTRAL MONTANA MEDICAL CENTER

NURSING CENTER 408 WENDELL AVENUE LEWISTOWN MT 59457

SKILLED NURSING FACILITY PART I, LINE 3C: ELIGIBILITY IS BASED ON PATIENT'S FAMILY SIZE, FAMILY GROSS INCOME, PERSONAL ASSETS, AND OTHER MEDICAL DEBTS. PART I, LINE 7: CHARITY CARE WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. UNREIMBURSED MEDICAID WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS WERE BASED ON EXPENSES RECORDED IN THE GENERAL LEDGER. SUBSIDIZED HEALTH SERVICES ARE REPORTED ACCORDING TO COSTS ALLOCATED TO THE RELEVANT COST CENTERS ON THE MEDICARE COST REPORT. PART I, LINE 7G: $7,316 OF COSTS ARE ATTRIBUTABLE TO A PROVIDER BASED CLINIC. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION WAS $578,610. PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BY USING CHARITY CARE AS A % OF GROSS PATIENT SERVICES REVENUE. AS A PORTION OF REVENUE IS CONSIDERED CHARITY CARE, IT IS ASSUMED THAT A PERCENTAGE OF BAD DEBT EXPENSE WOULD ALSO BE CONSIDERED CHARITY CARE.BAD DEBT EXPENSE IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.FINANCIAL STATEMENT NOTE: THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS AND THIRD PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE BAD DEBT PROVISION. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. PART III, LINE 9B: PATIENTS DEEMED BY CMMC TO BE UNABLE TO PAY AT ANY TIME DURING THE REVENUE CYCLE MAY BE ELIGIBLE TO RECEIVE AVAILABLE FINANCIAL ASSISTANCE. PATIENTS MUST COMPLETE AN APPLICATION. OUR COLLECTION PRACTICE IS TO REFRAIN FROM COLLECTION EFFORTS UNTIL FINANCIAL ASSISTANCE IS DETERMINED. NORMAL COLLECTION EFFORTS WOULD RESUME IF THE APPLICATION IS NOT RETURNED TIMELY OR AFTER THE WRITE-OFF IS COMPLETE AND THE PATIENT OWES A BALANCE. CENTRAL MONTANA MEDICAL FACILITIES, INC. PART V, SECTION B, LINE 13G: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS ALSO POSTED IN THE HOSPITAL FACILITY'S EMERGENCY ROOM, WAITING ROOMS, AND ADMISSIONS OFFICES. PART VI, LINE 2: CURRENTLY, CMMC ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY BY THE NUMBER OF RESPONSES TO ADS AND ARTICLES RELEASED THROUGH THE LOCAL MEDIA. CMMC MONITORS THE ATTENDANCE AT ANNUAL EVENTS SUCH AS HEALTH FAIRS. ALSO TRACKED WERE THE KINDS OF SUPPORT REQUESTED OF CMMC SUCH AS CHILDREN'S SAFETY, WELLNESS INITIATIVES AND HEALTHCARE ASSESSMENTS. IN THE PAST, CMMC COMPLETED AN OFFICIAL COMMUNITY NEEDS ASSESSMENT WITH THE HELP OF MONTANA STATE UNIVERSITY. MAIL AND PHONE SURVEYS WERE COMPLETED AND "TOWN HALL" TYPE MEETINGS WERE HELD IN LEWISTOWN AS WELL AS MOST OF THE SURROUNDING SMALLER COMMUNITIES. CMMC WILL BE DOING ANOTHER COMMUNITY NEEDS ASSESSMENT IN THE NEXT YEAR. PART VI, LINE 3: CMMC HAS FINANCIAL ASSISTANCE SIGNAGE POSTED IN THE ADMISSIONS AREAS AND THE ER WAITING AREA. A PAMPHLET EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM, THE APPLICATION PROCESS AND CONTACT INFORMATION IS AVAILABLE AT ALL HOSPITAL REGISTRATION AREAS. THE CHARITY CARE POLICY AND APPLICATION ALONG WITH A CHECKLIST AND CONTACT INFORMATION IS POSTED ON OUR WEBSITE ON THE INTERNET. PRIOR TO DISCHARGE SOMEONE FROM DISCHARGE PLANNING DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID, AND ASSISTS THE PATIENT WITH QUALIFICATIONS FOR SUCH PROGRAMS, WHERE APPLICABLE. ASSISTANCE WITH FILLING OUT THE CHARITY CARE APPLICATION IS ALSO PROVIDED AT THIS TIME. PRIVATE PAY IN-PATIENTS ARE INFORMED OF CHARITY CARE EITHER PRIOR TO SCHEDULED ADMISSION BY PHYSICIAN REFERRAL OR PRIOR TO DISCHARGE FROM THE FACILITY. WE ALSO SEND OUT INFORMATION WITH FIRST TIME STATEMENTS. ALL OTHER PATIENTS ARE INFORMED UPON INQUIRY. PART VI, LINE 4: LEWISTOWN IS AN AGRICULTURAL COMMUNITY AND THE COUNTY SEAT FOR FERGUS COUNTY MONTANA. LEWISTOWN IS LOCATED IN THE CENTER OF MONTANA AND IS SURROUNDED BY FIVE MOUNTAIN RANGES: THE SNOWIES, THE JUDITHS, THE MOCCASINS, THE BELTS AND THE HIGHWOODS. THE CITY OF LEWISTOWN AND THE SURROUNDING RURAL TOWNS ARE SUPPORTED BY ONE HOSPITAL, CENTRAL MONTANA MEDICAL CENTER. FERGUS COUNTY HAS A PRIMARY CARE LOW INCOME HPSA DESIGNATION WITH A SCORE OF 17. FERGUS COUNTY IS LOCATED IN A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. AS OF 2012, THERE WERE 5,901 PEOPLE RESIDING IN THE CITY. THE POPULATION DENSITY WAS 1,109.4 PEOPLE PER SQUARE MILE. ALSO 10.6% OF THE RESIDENTS WERE BELOW THE POVERTY LEVEL.THERE WERE 2,761 HOUSEHOLDS OUT OF WHICH 66.9% OWNED THEIR HOME. THE MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS WAS $99,100 WITH A 2.16 AVERAGE PERSONS PER HOUSEHOLD. IN THE CITY, THE POPULATION SPREAD WAS 20.4% UNDER THE AGE OF 18, 5.9% UNDER THE AGE OF 5, AND 21.7% OF THE POPULATION IS 65 YEARS AND OVER. THE FEMALE POPULATION CONSISTED OF 50.8%.THE MEDIAN INCOME FOR A HOUSEHOLD IN THE CITY WAS $34,089 COMPARED TO THE STATE MEDIAN INCOME AT $45,324. PART VI, LINE 5: THE CMMC GOVERNING BOARD CONSISTS OF 13 VOLUNTEER COMMUNITY MEMBERS INCLUDING RESIDENTS FROM GRASS RANGE, STANFORD, DENTON AND JUDITH GAP. CMMC EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS BASED UPON COMMUNITY NEEDS.SURPLUS FUNDS, WHEN AVAILABLE, ARE APPLIED TO PATIENT CARE NEEDS, EQUIPMENT AND BUILDING MAINTENANCE AND MEDICAL EDUCATION REQUIREMENTS. THE EXPENDITURE OF THESE FUNDS IS APPROVED BY THE GOVERNING BOARD WHICH MEETS ON A MONTHLY BASIS. PART VI, LINE 6: N/A X X 1 1 X X 0 0 0 0 0 0 0 0 0 ALAN R ALDRICH 125321 0 0 0 0 0 17516 0 16857 0 159694 0 0 0 AARON HUMPHREYS 242907 0 0 0 0 0 0 0 12193 0 255100 0 0 0 JAMES FOX 207423 0 0 0 0 0 18746 0 1369 0 227538 0 0 0 RENE DEGUZMAN 183471 0 0 0 0 0 11711 0 16949 0 212131 0 0 0 RONALD SKIPPER 304389 0 0 0 0 0 28168 0 15885 0 348442 0 0 0 RICHARD TAYLOR JR 195596 0 0 0 0 0 0 0 12763 0 208359 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE WAS PAID TO AN ORTHOPEDIC SURGEON, AS PART OF A RECRUITING PACKAGE. THE ANNUAL DUES FOR MEMBERSHIP IN LOCAL SERVICE ORGANIZATIONS ARE PAID FOR THE CEO AND THE CCO. SUPPLEMENTAL INFORMATION PART III PART I, QUESTION 3: THE ORGANIZATION DOES NOT PAY COMPENSATION TO THE CEO DIRECTLY. THE CEO IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. THE BOARD OF DIRECTORS APPROVES THE CONTRACT WITH THE MANAGEMENT COMPANY. PART II: THE CEO, LEE RHODES, IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY, QUORUM HEALTH RESOURCES LLC. HE IS COMPENSATED FOR SERVICES PROVIDED TO C.M. MEDICAL FACILITIES, INC. THE MANAGEMENT COMPANY BASES THE CEO'S SALARY ON COMPENSATION SURVEYS FOR THE AREA. THE BOARD OF DIRECTORS APPROVES THE SALARY OR MAKES RECOMMENDATIONS BACK TO THE MANAGEMENT COMPANY. FERGUS COUNTY MONTANA 816001358 2003-07-31 1980000 TO REFINANCE BONDS ISSUED JULY 6, 1993 0 0 0 1554724 1980000 1980000 2003 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 SCHEDULE K, PART II, LINE 11: THE AMOUNT REPORTED ON LINE 11 REPRESENTS THE AMOUNT USED TO REFUND THE PRIOR BONDS. AARON G HUMPHREYS MD RECRUITING X 220000 151572 0 1 1 151572 ANNIE DAVIS FAMILY MEMBER OF BOARD MEMBER 48646 PAYMENT OF COMPENSATION 0 YELLOWSTONE INSURANCE CEO OF ORGANIZATION IS ALSO A DIRECTOR FOR YELLOWSTONE INSURANCE 540490 PAYMENT FOR SERVICES 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 THE ORGANIZATION BEGAN OFFERING PULMONARY REHABILITATION SERVICES IN MARCH 2012. CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 SERVICES AT THE BASIN MEDICAL CLINIC WERE DISCONTINUES AS OF 6/30/11. FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE INCLUDES THE PRESIDENT, VICE PRESIDENT, SECRETARY AND TREASURER AND THEIR AUTHORITY IS SIMILAR TO THAT OF THE FULL GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 2 RUSSELL SPIKA AND ALAN R. ALDRICH HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO THE CEO WHO IS EMPLOYED BY A MANAGEMENT COMPANY, QUORUM HEALTH RESOURCES LLC (QHR). QHR ASSISTS WITH THE MANAGEMENT AND SUPERVISION OF THE ORGANIZATION UNDER THE POLICIES AND DIRECTION OF THE GOVERNING BOARD. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S MEMBERS CONSIST OF RESIDENTS OF THE CENTRAL MONTANA AREA WHO ARE AT LEAST 18 YEARS OF AGE AND WHO HAVE OR SHALL INDICATE THEIR INTEREST IN THE MAINTENANCE OF ADEQUATE MEDICAL FACILITIES AND HIGH STANDARDS OF MEDICAL CARE IN THE AREA. MEMBERS OF THE ORGANIZATION MUST ATTEND AND SIGN THE REGISTER AT THE ORGANIZATION'S ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7A MEMBERS OF THE ORGANIZATION MAY VOTE ON MATTERS BEING ADDRESSED AT THE ANNUAL MEETINGS. EACH MEMBER IS ENTITLED TO ONE VOTE ON ANY QUESTION OR ACTION WITH THE EXCEPTION OF THE ELECTION OF DIRECTORS OF THE CORPORATION. FOR THE ELECTION OF DIRECTORS, THE MEMBERS SHALL VOTE FOR ONE NOMINEE FOR EACH VACANT BOARD POSITION. FORM 990, PART VI, SECTION B, LINE 11 DRAFT COPY OF FORM 990 IS REVIEWED BY THE CFO AND BOARD OF DIRECTORS PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY DISCUSSING AT THE BOARD OF DIRECTOR MEETINGS AND OBTAINING SIGNED STATEMENTS FROM MEMBERS. ALL OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE COVERED BY THE POLICY. THE BOARD DETERMINES WHETHER CONFLICTS EXIST AND ALL POTENTIAL CONFLICTS ARE REVIEWED BY THE BOARD. ANY PERSONS WITH A CONFLICT ARE NOT ALLOWED TO VOTE ON CONFLICTED ISSUES. THE CEO IS EMPLOYED BY QUORUM HEALTH RESOURCES LLC (QHR), A HOSPITAL MANAGEMENT CORPORATION. QHR DETERMINES THE CEO'S COMPENSATION BASED ON INDEPENDENT DATA AND COMPARISONS. THE INFORMATION IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS AND WAS COMPLETED IN FISCAL YEAR ENDING 6/30/12. COMPENSATION OF THE CFO IS DETERMINED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. A COPY MAY BE REQUESTED BY CALLING, EMAILING, WALK-IN OR VIA MAIL. FORM 990, PART VII AND PART IX LINE 5 AND LINE 11A THE CEO IS PAID BY A MANAGEMENT COMPANY FOR SERVICES PROVIDED TO THE ORGANIZATION. THE COMPENSATION PAID TO THE MANAGEMENT COMPANY FOR HIS SERVICES IS DISCLOSED ON PART VII, SECTION A AND ALSO INCLUDED IN THE AMOUNT PAID TO THE MANAGEMENT COMPANY IN PART VII SECTION B. PART IX LINE 11A INCLUDES COMPENSATION PAID TO THE MANAGEMENT COMPANY FOR MANAGEMENT AND CEO SERVICES. LINE 5 INCLUDES COMPENSATION PAID TO THE CFO AND THE CCO FOR SERVICES AS AN EMPLOYEE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 1,314. INTEREST IN CENTRAL MONTANA FOUNDATION 466,929. TOTAL TO FORM 990, PART XI, LINE 5: 468,243.