GLENDIVE MEDICAL CENTER INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
GLENDIVE MEDICAL CENTER INC (EIN 81-6016016)
Tax period
2011-07-01 to 2012-06-30
Filed
2013-05-14
IRS object ID
201311349349306601
Schema version
2011v1.5
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)
Timestamp2013-05-14T15:38:07-05:00Timestamp
Tax Period End Date2012-06-30TaxPeriodEndDate

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 Date2011-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN816016016EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Glendive Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlGLENNameControl
Phone4063653306Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1202 Prospect DriveAddressLine1
CityGlendiveCity
StateMTState
ZIP Code593301999ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameBarbara MarkhamName
TitleCFOTitle
Phone4063653306Phone
Date Signed2013-05-14DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameKim Hunwardsen CPAName
PTINP00484560PTIN
Phone6122536500Phone
Date Prepared2013-05-14DatePrepared
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonScott DukeNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1202 Prospect DriveAddressLine1
CityGlendiveCity
StateMTState
ZIP Code593301999ZIPCode
FieldValueIRS element (for citing)
Gross Receipts34563963GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.gmc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1964YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionCommitted to caring, healing and a healthier community through the procurement of health services.ActivityOrMissionDescription
Nbr Voting Members Governing Body10NbrVotingMembersGoverningBody
Nbr Independent Voting Members8NbrIndependentVotingMembers
Total Nbr Employees565TotalNbrEmployees
Total Nbr Volunteers327TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year77432ContributionsGrantsPriorYear
Contributions Grants Current Year578737ContributionsGrantsCurrentYear
Program Service Revenue Prior Year34213352ProgramServiceRevenuePriorYear
Program Service Revenue CY33733025ProgramServiceRevenueCY
Investment Income Prior Year440603InvestmentIncomePriorYear
Investment Income Current Year168559InvestmentIncomeCurrentYear
Other Revenue Prior Year78070OtherRevenuePriorYear
Other Revenue Current Year77210OtherRevenueCurrentYear
Total Revenue Prior Year34809457TotalRevenuePriorYear
Total Revenue Current Year34557531TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year19513534SalariesEtcPriorYear
Salaries Etc Current Year18976309SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year15924427OtherExpensePriorYear
Other Expenses Current Year16603239OtherExpensesCurrentYear
Total Expenses Prior Year35437961TotalExpensesPriorYear
Total Expenses Current Year35579548TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-628504RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1022017RevenuesLessExpensesCY
Total Assets BOY58364600TotalAssetsBOY
Total Assets EOY55908463TotalAssetsEOY
Total Liabilities BOY34882121TotalLiabilitiesBOY
Total Liabilities EOY33448001TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY23482479NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY22460462NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWe are committed to caring, healing and a healthier community.MissionDescription
Significant New Program Services1SignificantNewProgramServices
Significant Change0SignificantChange
Expense27956247Expense
Revenue34006423Revenue
DescriptionGlendive Medical Center, Inc. (GMC) is a totally integrated medical center with a 25-bed Critical Access Hospital providing all primary care services to the community of Glendive and the surrounding rural service area. The Medical Center also is comprised of 151 nursing home beds, 13-suite Assisted Living Facility, Home Health, Durable Medical Equipment and Hospice services. A clinic with Rural Health Clinic designation and pharmacy services is attached. GMC is very committed to meeting the needs of the service area they serve. IRS requirements of the community benefit standard for tax-exempt organizations are integral to GMC's charitable mission of being committed to caring, healing and a healthier community. GMC is governed by an independent board with a representative composition by gender, rural/urban, professional/non-professional and geography. The Board has a history of acting with the highest integrity and proactively adopting governance best practices to ensure the organization operates with the highest of integrity for the benefit of the community they serve. During this year, the Board continued to actively oversee critical functions of the organization. During the past year:1. The annual compliance reports and education was provided to the Board as part of their mandatory education.2. Board members reviewed and signed the required annual conflict of interest statement.GMC makes medical care accessible to the entire area it serves. They operate a 24 hour emergency room, providing care regardless of the ability to pay. GMC had over 4,500 emergency room visits during the past year. GMC provides clinical services including onsite providers needed to operate the Emergency Department.In addition, GMC, through its integrated group of providers and visiting specialists, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare, Medicaid, Veterans Administration and by offering financial assistance in various ways to those who are unable to pay.GMC's Uncompensated Care policy provides discounted and free services to patients who do not have the resources to be fully responsible for the medical care they receive. GMC's policy is structured to provide various options of financial assistance depending upon the patient's needs. The applications and policies for the various financial assistance options and uncompensated care are available on the organization's website, gmc.org. GMC maintains records to identify and monitor the care provided under the uncompensated care policies. During the past year, GMC's costs for charity care, based on the amount of charges foregone, was $1,166,000 serving 312 members in their service area.GMC through the annual board approved strategic plan strives to meet the community needs. Some of the objectives in this plan that were completed during the past year were:1. Quality Reporting - GMC has replaced the "dashboard": reporting tool, emphasizing the areas for quality/safety, patient experience and financial information which is being made available to the public through various media. 2. Efficiency Projects - GMC is working with various committees on an ongoing basis to improve consistency in care processes and reducing costs to patients.3. Patient Representation - Patient representatives were invited for the first time in 2012 to be part of a committee to enhance the patient's experience. The first project of navigating through GMC was completed and successful. Further information about the services provided by GMC to the community it serves including their annual Community Benefit Report is available on their official website, gmc.org.Description
Total Program Service Expense27956247TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required1ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities1LobbyingActivities
Subject To Proxy Tax0SubjectToProxyTax
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities1ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets1ReportOtherAssets
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 Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds1TaxExemptBonds
Invest Tax Exempt Bonds0InvestTaxExemptBonds
Escrow Account0EscrowAccount
On Behalf Of Issuer0OnBehalfOfIssuer
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 With109631NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup Witholding1ComplianceWithBackupWitholding
Number Of Employees565NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income0UnrelatedBusinessIncome
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 Members10NbrVotingGoverningBodyMembers
Number Independent Voting Members8NumberIndependentVotingMembers
Family Or Business Relationship0FamilyOrBusinessRelationship
Delegation Of Management Duties0DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders0MembersOrStockholders
Election Of Board Members0ElectionOfBoardMembers
Decisions Subject To Approval0DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
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 Line1Barbara MarkhamBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4063453301TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1608 RegalAddressLine1
CityGlendiveCity
StateMTState
ZIP Code59330ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
David Linn
Chairperson2.00XX000
Laura Glueckert
Vice Chairperson1.00XX000
Sandra Cargill
Secretary1.00XX000
Kevin Maxwell MD
Treasurer; Chief of Staff40.00XX547500070344
Charles Deisher
Director1.00X000
Steve Scheitlin
Director1.00X000
Troy Myers OD
Director1.00X000
Jackie Schultz
Director1.00X000
Kyle Voss DVM
Director1.00X000
Arthur K Fink DO
Director40.00X260083038357
Scott Duke
CEO50.00X258671052266
Barbara Markham
CFO50.00X107926021614
Judy Courtney
VP Patient Care Services50.00177257016642X
Dale Adishian MD
Physician40.00573923075171X
Joseph Leal MD
Physician40.0024903808921X
Sonja Samsoondar Labrie MD
Physician40.00300148023819X
Mark Nichols MD
Physician40.00288462013654X
Mechelle Lewis MD
Physician40.00247400014247X
FieldValueIRS element (for citing)
Total Reportable Comp From Org3010408TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation335035TotalOtherCompensation
Number Individuals GT100 K28NumberIndividualsGT100K
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
High Tech Construction
PO Box 31511BillingsMT59107Construction Services1212434
Sodexo Inc & Affiliates
10 Earhart DriveWilliamvilleNY14221Dietary Management Services865438
MT Health Network Inc
11 S 7th St 160Miles CityMT59301Contract Nursing Labor521909
Imaging Solutions Inc
2829 S University DriveFargoND58103MRI Equipment Leasing178775
RPH on the Go
5510 W Howard StreetSkokieIL60077Contract Clinical Labor142306
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
Related Organizations305339RelatedOrganizations
Government Grants8398GovernmentGrants
All Other Contributions265000AllOtherContributions
Total Contributions578737TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Patient Service Revenu6211103212332532123325
Other Revenue90009916097001609700
FieldValueIRS element (for citing)
Total Program Service Revenue33733025TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column161891TotalRevenueColumn
Exclusion$161,891ExclusionAmount

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real77210Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real0Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real77210Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column77210TotalRevenueColumn
Exclusion$77,210ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other13100Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other6432Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other6668Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column6668TotalRevenueColumn
Exclusion$6,668ExclusionAmount

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column34557531TotalRevenueColumn
Related Or Exempt Function Income33733025RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$245,769ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1662159Total
Program Services837265ProgramServices
Management And General824894ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total14273824Total
Program Services11953264ProgramServices
Management And General2320560ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total226484Total
Program Services165785ProgramServices
Management And General60699ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1804853Total
Program Services1250545ProgramServices
Management And General554308ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1008989Total
Program Services826664ProgramServices
Management And General182325ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total6255Total
Management And General6255ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total51582Total
Management And General51582ManagementAndGeneral

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total1479537Total
Program Services891347ProgramServices
Management And General588190ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total55509Total
Program Services2392ProgramServices
Management And General53117ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1652408Total
Program Services1378824ProgramServices
Management And General273584ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total264095Total
Management And General264095ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total664136Total
Program Services173141ProgramServices
Management And General490995ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total124414Total
Program Services99389ProgramServices
Management And General25025ManagementAndGeneral

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total39Total
Program Services39ProgramServices

Interest Interest

FieldValueIRS element (for citing)
Total1415136Total
Management And General1415136ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total3272845Total
Program Services3210672ProgramServices
Management And General62173ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total443276Total
Program Services326875ProgramServices
Management And General116401ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
Bad Debt Expense33167863316786
Medical Supplies22549992254999
Food571940571940
Bed Tax429536429536

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total600746Total
Program Services266784ProgramServices
Management And General333962ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total35579548Total
Program Services27956247ProgramServices
Management And General7623301ManagementAndGeneral
Fundraising0Fundraising

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1259474BOY
EOY609362EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY9337063BOY
EOY8586239EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY206087BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY35766EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1420591BOY
EOY1402659EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY117538BOY
EOY154376EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis60072274LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec28876577LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY32001440BOY
EOY31195697EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY6604398BOY
EOY6084649EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY2763735BOY
EOY2268193EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY4654274BOY
EOY5571522EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY58364600BOY
EOY55908463EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4290732BOY
EOY3768031EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY839832BOY
EOY898197EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY29081300BOY
EOY28368540EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY96930BOY
EOY103938EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY500000BOY
EOY300000EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY73327BOY
EOY9295EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY34882121BOY
EOY33448001EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY23482479BOY
EOY22460462EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY23482479BOY
EOY22460462EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY58364600BOY
EOY55908463EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses-1022017ReconcilationRevenueExpenses
Reconcilation Other Changes0ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
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 C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0Volunteers
Paid Staff Or Management0PaidStaffOrManagement
Media Advertisements0MediaAdvertisements
Mailings Members0MailingsMembers
Publications Or Broadcast0PublicationsOrBroadcast
Grants Other Organizations0GrantsOtherOrganizations
Direct Contact Legislators0DirectContactLegislators
Rallies Demonstrations0RalliesDemonstrations
Other Activities1OtherActivities
Other Activities$2,814OtherActivitiesAmount
Total Lobbying Expenditures IIB2814TotalLobbyingExpendituresIIB
Not Described In501c30NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierExplanation of Lobbying Activities:Identifier
Return ReferencePart II-B, Line 1:ReturnReference
ExplanationIncluded in dues paid to Montana Hospital Association, American Hospital Association and Leading Age was a portion for lobbying purposes totaling $2,814.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Agent Trustee Etc0AgentTrusteeEtc
Included On FS1IncludedOnFS

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis139683OtherCostOrOtherBasis
Book Value139683BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Investment Cost Or Other Basis824891InvestmentCostOrOtherBasis
Other Cost Or Other Basis42115629OtherCostOrOtherBasis
Depreciation17871970Depreciation
Book Value25068550BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis13666130OtherCostOrOtherBasis
Depreciation9962187Depreciation
Book Value3703943BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis3325941OtherCostOrOtherBasis
Depreciation1042420Depreciation
Book Value2283521BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings31195697TotalOfBookValueLandBuildings

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
Estimated Third Party Payor Receivable665090
Deferred Financing Costs, Net884588
Accrued Interest Receivable32392
Physician and Clinic Receivables3989452
FieldValueIRS element (for citing)
Total Book Value Other Assets5571522TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCapitalized Lease ObligationsDescription
Amount$9,295Amount
FieldValueIRS element (for citing)
Total Of Amounts9295TotalOfAmounts
Total Revenue34557531TotalRevenue
Total Expenses35579548TotalExpenses
Excess Or Deficit For Year-1022017ExcessOrDeficitForYear
Excess Or Deficit Per FS-1022017ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt34977644TotRevenueEtcAuditedFinclStmt
Other Revenues420113OtherRevenues
Revenue Not Rptd F990420113RevenueNotRptdF990
Revenue Subtotal34557531RevenueSubtotal
Revenue Not Rptd On Fin Stmt0RevenueNotRptdOnFinStmt
Total Revenue Per Form99034557531TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt35999661TotExpensesEtcAuditedFinclStmt
Other Expenses Included420113OtherExpensesIncluded
Expenses Not Rptd F990420113ExpensesNotRptdF990
Expenses Subtotal35579548ExpensesSubtotal
Expenses Not Rptd On Fin Stmt0ExpensesNotRptdOnFinStmt
Total Expenses Per Form99035579548TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
Part IV, Line 2b:Upon written authorization of residents of GMC Extended Care and EMVH Extended Care, the Organization holds, safeguards, manages and accounts for the personal funds of those residents that have been deposited in the two trust accounts.
Part X:Glendive Medical Center, Glendive Medical Center Auxiliary, and Glendive Medical Center Foundation are organized and have been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Glendive Medical Center, (combined with Glendive Medical Center Auxiliary), and the Glendive Medical Center Foundation are annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. 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.Description of Uncertain Tax Positions Under FIN 48:
Eliminating Journal Entries- GMC Revenue Received from Auxiliary per Audited Financial Statements 281,323. Eliminating Journal Entries- GMC Revenue Received from EMVH per Audited Financial Statements 138,790.Part XII, Line 2d - Other Adjustments:
Eliminating Journal Entries- GMC with Auxiliary 281,323. Eliminating Journal Entries- GMC with EMVH 138,790.Part XIII, Line 2d - Other Adjustments:

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care Policy1CharityCarePolicy
Written Policy1WrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free Care1FPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted Care1FPGReferenceDiscountedCare
Pcent200 DXPcent200D
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)
Persons Served312PersonsServed
Total Community Benefit Expense719861TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense719861NetCommunityBenefitExpense
Percent Of Total Expense0.02230PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served543PersonsServed
Total Community Benefit Expense3393227TotalCommunityBenefitExpense
Direct Offsetting Revenue4026103DirectOffsettingRevenue
Net Community Benefit Expense-632876NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Persons Served141PersonsServed
Total Community Benefit Expense115796TotalCommunityBenefitExpense
Direct Offsetting Revenue128651DirectOffsettingRevenue
Net Community Benefit Expense-12855NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served996PersonsServed
Total Community Benefit Expense4228884TotalCommunityBenefitExpense
Direct Offsetting Revenue4154754DirectOffsettingRevenue
Net Community Benefit Expense74130NetCommunityBenefitExpense
Percent Of Total Expense0.02230PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs5NumberOfActivitiesOrPrograms
Persons Served12695PersonsServed
Total Community Benefit Expense135561TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense135561NetCommunityBenefitExpense
Percent Of Total Expense0.00420PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served28PersonsServed
Total Community Benefit Expense16866TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense16866NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs7NumberOfActivitiesOrPrograms
Persons Served3276PersonsServed
Total Community Benefit Expense8764857TotalCommunityBenefitExpense
Direct Offsetting Revenue7099900DirectOffsettingRevenue
Net Community Benefit Expense1664957NetCommunityBenefitExpense
Percent Of Total Expense0.05160PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Number Of Activities Or Programs0NumberOfActivitiesOrPrograms
Persons Served0PersonsServed
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served3681PersonsServed
Total Community Benefit Expense119145TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense119145NetCommunityBenefitExpense
Percent Of Total Expense0.00370PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs17NumberOfActivitiesOrPrograms
Persons Served19680PersonsServed
Total Community Benefit Expense9036429TotalCommunityBenefitExpense
Direct Offsetting Revenue7099900DirectOffsettingRevenue
Net Community Benefit Expense1936529NetCommunityBenefitExpense
Percent Of Total Expense0.06000PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs17NumberOfActivitiesOrPrograms
Persons Served20676PersonsServed
Total Community Benefit Expense13265313TotalCommunityBenefitExpense
Direct Offsetting Revenue11254654DirectOffsettingRevenue
Net Community Benefit Expense2010659NetCommunityBenefitExpense
Percent Of Total Expense0.08230PercentOfTotalExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served22PersonsServed
Total Community Building Expense5748TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense5748NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served22PersonsServed
Total Community Building Expense5748TotalCommunityBuildingExpense
Net Community Building Expense5748NetCommunityBuildingExpense
Percent Of Total Expense0.00020PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense Reported1BadDebtExpenseReported
Bad Debt Expense$3,316,786BadDebtExpenseAmount
Amount Attributable To137614AmountAttributableTo
Amount Reimbursed By Medicare6207946AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare6018057CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall189889MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
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 Line1Glendive Medical CenterBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1202 Prospect DriveAddressLine1
CityGlendiveCity
StateMTState
ZIP Code59330ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Glendive Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA Conducted0CHNAConducted
Eligibility Criteria Explained1EligibilityCriteriaExplained
Uses FPG Free1UsesFPGFree
FPG Free Percent100.000000000000FPGFreePercent
Uses FPG Discounted1UsesFPGDiscounted
FPG Discount Percent200.000000000000FPGDiscountPercent
Explains Basis1ExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Uninsured DiscountXUninsuredDiscount
Explains Application Method1ExplainsApplicationMethod
Includes Publicity Measures1IncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Other PublicityXOtherPublicity
Actions On Nonpayment1ActionsOnNonpayment
Collection Activities0CollectionActivities
Nondiscrim Emergency Care Policy1NondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally Billed0AmountsGenerallyBilled
Gross Charges1GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Glendive Medical Center Nursing Home
202 Prospect DriveGlendiveMT5933071 bed skilled nursing home
Glendive Medical Center Home Health
202 Prospect DriveGlendiveMT59330Home health for Dawson, Wibaux, McCone and Prairie Counties
Eastern Montana Veterans Home
2000 Montana AvenueGlendiveMT5933080 bed veterans skilled nursing home
The Heritage on Merrill Avenue
1313 North Merrill AvenueGlendiveMT5933013 suite assisted living center
Glendive Medical Center Hospice
202 Prospect DriveGlendiveMT59330Hospice for Dawson and Wibaux Counties

Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)

ExplanationExplanationIdentifierIdentifierReturn ReferenceReturnReference
Part I, Line 6a: Currently, GMC is filing a community benefit report with the State of Montana, in conjunction with other requested information for the State of Montana's report on issues and facts related to the charitable purposes of hospitals and the protection of Montana's consumers.GMC mails to all service area households either a community benefit report or a post card detailing where to go on the gmc.org website to access the community report. GMC's community benefit reports are available at all times on the gmc.org website.
Part I, Line 7: The cost to charge ratio from Worksheet 2 was utilized for charity care. Unreimbursed Medicaid and other means-tested government programs was calculated using actual amounts captured from internal logs for charges and receipts. Subsidized health services was calculated using actual direct costs and receipts of each department. A step down allocation of the 2012 annual cost report was applied to correctly allocate overhead to each department. These allocations are necessary, as they directly affect the Medicare and Medicaid reimbursement. All others were based off of actual expenses.
Part I, Line 7g: Subsidized health services does not include any costs attributable to a physician clinic.
Part I, L7 Col(f): Bad debt expense of $3,316,786 was included on Form 990, Part IX, line 25, column (a) and has been subtracted for purposes of calculating the percentage in this column.
Part II: The amount reported in Part II for Community Building Activities represents assistance provided by GMC leaders to develop and maintain an active Economic Development Committee (EDC) formed to assist in projects to enhance the health, safety and well being of the community of Glendive.The initial activity of the EDC during the past several years was obtaining funds and building low income housing for seniors in the community which has been completed. This was a community benefit providing safe housing for those seniors in an area of housing shortages.EDC is made up of community leaders and has the support of the community. It is currently working to bring new businesses to the area, which will create additional employment opportunities for the area's population. Also, these new businesses will provide additional services helping enhance the ability to recruit healthcare providers and professionals. Due to Glendive's remote rural location, this is always a challenge as shown by the Dawson County's designation as a HSPA area which was discussed in Item 4.
Part III, Line 4: Bad debt expense is reported at charges as recorded by the organization.The amount of bad debt shown to be attributable to patients eligible for charity care was based on applications submitted without the necessary information or paperwork to enable the completion of the application. The information was not obtained even though the the collection department aggressively worked with the parties through letters, telephone calls, and meetings. Therefore, as shown in Schedule H, Part III, Line 3, with the education and assistance provided, the amount reported is appropriate and should be considered a community benefit.Footnote from Financial Statements: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 cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. In addition to hospital services, Home Health, Hospice and Skilled Nursing Facility are also included in the Organization's cost report. All of these activities are subsidized health services shown on line 7 of Part I. Therefore, the Medicare piece related to these activities is shown on Part I, Line 7. As noted in the Schedule H instructions, the cost report does not reflect certain programs which GMC provides - Durable Medical Equipment, Medicare Part C, Medicare Part D and Provider Based Services - Emergency Room Providers, Certified Nurse Anesthetists and Radiologists. Since GMC is in a very rural area, to have 24 hour coverage avaialble by these providers in the area is definitely a quality and safety issue, and therefore, a community benefit.Due to utilizing the allowable Medicare cost from the cost report, Part III does not reflect the fact that there is a Medicare shortfall to this facility, due to a number of factors such as the following:1. Any non-patient revenue received for reimbursable departments must be offset against expenses. At the same time, it is not allowed to offset revenue against expenses of non-reimbursable departments. This results in shifting a substantial amount of administrative expenses to the non-reimbursable areas due to the allocation of administrative costs being based on total expense without the offset of revenue to the non-reimbursable departments.2. Allocating administrative expenses based on the percent of total expenses also shifts excess costs to areas such as GMC's retail pharmacy due to the high cost of drugs; again resulting in overstating administrative expenses in a non-reimbursable department resulting in lower reimbursement to Medicare reimbursable departments.3. Medicare Advantage (Part C) plans are creating additional costs and shortfalls not currently reported in Part III.4. Medicare Part D - With two nursing homes, located in a very rural area with no other area pharmacies providing Unit Dose Dispensing, which is required for the safety of our residents, GMC again is seeing a shortfall that is not being reported for providing the necessary services to local residents which is definitely a benefit to the resident and their families.
Part III, Line 9b: The following are excerpts from GMC's financial assistance policy and bad debt policy:Bad Debt Policy:For those that are known to qualify for financial assistance, the portion that is identified as charity care is written off to charity care. The Hospital policy states if there is a portion of the patient account that does not qualify for free care the remaining unpaid portion falls under the same collection policy as the accounts that do not qualify for financial assistance.
Part V, Section B, Line 13g: GMC's Credit Department sends the policy and application to patients/guarantors who have made no effort to complete and application or make arrangements for payments at the time the account becomes past due. In addition to providing the fill policy unpon request, a summary of the policy is posted in the emergency rooms, waiting rooms, admissions office and provided up admission.Glendive Medical Center
Part V, Section B, Line 19d: All uninsured patients are given a 5% discount, which is the average discount provided to patients with insurance companies that contract with GMC.Glendive Medical Center
Part V, Section B, Line 21: Even though the identified FAP eligible patients received an average of 89% discount to charges, this facility can not state that all eligible FAP patients was not charged gross charges. This facility does everything possible to provide patients with the education, information, applications, etc. so we can determine their eligibility. In the upcoming months, with the person being in place in our ED and our Patient Advocacy Liaison with patients throughout the organization, this organization will work to meet the requirements for continued tax exemption.Currently Gross Charges are charged to all patients and adjustments made according to contracts. Therefore, there are certain insurance companies not under contract and thus full charges are collected. The large majority of GMC's contracts are a discount on charges. Beginning in July 2012 GMC began providing a discount to all patients. The only result from providing this discount in a rural isolated area is it will require an increase in all patient charges in order to cover expenses to provide quality care to our patients. Since GMC receives no tax monies, etc. the patients pay for the care they receive. Therefore, the monies received from our patients must cover expenses including Medicare short falls, bad debt and charity care. In a very rural area such as Glendive, discounting insurance companies and uninsured patients does not result in helping lower charges since it does not result in an increase is volume of patients/visits. GMC is in a very rural area and is not near any heavily populated area. Discounting only increases charges so the discounted charges will cover the facility's expenses. For Fiscal year the total revenue for uninsured services was $3,424,000, the amount collected from patients was $235,000. The balances of these accounts were either charity care with an average discount of 89% or transferred to a collection agency after all efforts by our credit department were exhausted. The patients that were transferred to a collection agency did not return charity care applications or make any effort to set up a payment plan.Glendive Medical Center
Part VI, Line 2: 1. Over the past years, GMC has identified and prioritized community needs through a variety of community surveys in collaboration with various organizations including the City of Glendive and Dawson County.2. Public meetings were held by GMC at various times to receive community input.3. Strategic Planning sessions are held by GMC to plan and prioritize the needs of the community on an annual basis. These sessions include the Board of Directors, the Foundation's Board of Directors, Physicians and other Medical Providers and the Administration of GMC. Areas identified and services implemented from the prior community surveys included the need for Hospice, Assisted Living and Behavior Health Services.4. Planning for a Community Assessment survey began in June of 2012 and will be completed in conjuction with the Dawson County Public Health Department by April 2013.
Part VI, Line 3: GMC provides information and education concerning assistance through various programs and the organization's charity care policy in a variety of ways including:1. Through the social services department, patient financial services and other areas, assistance is offered and given to all patients and their families about available programs. Beginning in fiscal year 2012, a Patient Advocate Liaison (PAL) was added to assist patients throughout the organization. The PAL's role is to assist all patients and provide them with information on available programs, etc.2. GMC's website, www.gmc.org, provides charity care and other financial assistance policies and procedures, including applications.3. Signage is posted throughout the facilities in admissions areas, the emergency room and waiting rooms. The signage provides information concerning charity care and other financial assistance available throughout GMC.4. A Guest Information Book for the patient and their family's use is in each patient's room and other areas providing various information including financial assistance information that is available and the appropriate personnel to contact if they have not been contacted. Contact information for the social services department is included in the information bookk if the patient needs assistance or has questions about various government and other programs available in the area. 5. GMC's monthly statement provides information for the person(s) to contact if financial assistance is needed. The credit and collection department includes financial assistance information including an application and the contact person at GMC who can assist them with all collection letters.6. GMC employees are aware of the financial assistance programs and are able to provide direction to patients or their families in their departments concerning charity care. Quarterly, at the CEO forums, the employees are provided with the amount of charity care provided by the facility while expressing the importance of providing the free care for people that are in need.
Part VI, Line 4: GMC's primary service area is Dawson County on the eastern edge of Montana. GMC's secondary service areas are surrounding counties, McCone, Richland, Fallon, Prairie and Wibaux.Projections by the National Planning Association Data Services, Inc. show that Dawson County will experience a decrease in population from the 2000 Census until after 2020 when a slow and steady growth pattern is projected. The population age 65 and over in Dawson County decreased by 4.4% from the 2000 census to 2006 but was projected to increase approximately 10% by 2010 and an additional 20% by 2020. The population of Dawson County was estimated to be 8,520 in 2010. Approximately 12,000 persons are in the total area GMC serves. The projected increase in population and area health care services is related to the increase in the senior population and energy-related services taking place in the area.Glendive is a medical, retail and agricultural trade center for the county and the surrounding communities within a 30-60 mile radius. Glendive's economic base is closely tied to agriculture and the transportation industry, particularly rail services. GMC is the largest employer in Glendive. Other significant employers in the GMC's service area are state, county and city governments, Burlington Northern Santa Fe Railway, Glendive Public Schools, Dawson County Community College and Williston Basin Interstate Pipeline.Dawson County is designated as a Health Professional Shortage Area (HPSA) with shortages of primary medical care and mental health providers. Beginning in July of 2010 GMC has a psychiatrist on staff, the only one east of Billings, MT, 200 miles to the west. The Behavior Care Unit opened in July, 2010 as part of the Critical Access Hospital to provide a needed service throughout Eastern Montana and Western North Dakota.The service area residents, see GMC and its providers as a place to come to receive treatment, without regard to whether they have insurance or are uninsured, knowing they will be treated and cared for in a respectful and caring manner.GMC also provides outreach in various ways to the very small critical access frontier facilities as small as one bed facilities in neighboring counties and to four counties in the service area for home care services in sparsely populated areas.There are no other providers in GMC's primary service area. Sidney Health Center, a critical access hospital located 50 miles north of Glendive, and Holy Rosary Medical Center, a critical access hospital located 70 miles south of Glendive, are the closest facilities.
Part VI, Line 5: GMC Board of Directors:The governing body of GMC is its Board of Directors (the "Board"), which consists of ten members. The Board includes the Chief of Medical Staff and one member of GMC's active medical staff. Other members are selected to promote a representative composition of the Board by gender, rural/urban, professional/non-professional and geography. Board members are selected from GMC's service area by the Board's nominating committee and approved by the existing Board members. The members of the Board serve in a voluntary capacity and receive no compensation for their services. Members of the Board have various relationships with services or products, who may, from time to time, have dealings with the GMC, but these relationships are not considered to be material. The Chief of Staff and member of the medical staff are employed by the GMC as physicians and medical advisors. The Board has an established conflict of interest policy to detect and manage such relationships.GMC Medical Staff:The active medical staff of GMC is comprised of eleven (11) physicians and thirteen (13) allied health professionals. These providers are all employed by GMC and provide services at all of GMC facilities, including the attached for profit clinic, Gabert Medical Services, and two of the frontier critical access hospitals in McCone and Prairie County. Ten (10) of the eleven (11) physicians are board certified.A Specialty Clinic at GMC is utilized by physicians from Billings, MT and Bismarck, ND to provide services that are not available by the GMC Medical Staff. The patients are able to stay at home in Glendive and have the services provided by out of town physicians locally without traveling great distances.Tele Health is also utilized by GMC providers and providers in Billings and other locations. This allows the patients to have follow up visits with providers via video conferencing instead of traveling great distances to see the providers.GMC extends medical staff privileges to all qualified physicians in the area. GMC also extends those privileges to the qualified specialty physicians who provide services through the Specialty Clinic.GMC Surplus Funds:All funds in excess of expenses are utilized in the following ways:1. The facilities' debt service payments on the 2008 $30,000,000 bond issue obtained to provide a much needed expansion and renovation of the Surgery Suite, an additional nursing home wing and expansion and renovation of the emergency department.2. A substantial amount of funds are needed each year and utilized for the ongoing capital needs of the facility to ensure the appropriate equipment is available to meet the needs of the community. All departments have a three to five year plan in place to forecast these needs.3. Continued assistance to providers and professional staff for education to maintain GMC's standards to provide the care needed in the community.4. To increase reserve funds to insure the ability to continue meeting the above obligations in future years when surplus funds are not available.
Part VI, Line 6: GMC is currently evaluating collaboration/affiliation with Billings Clinic. An agreement is planned to be in place by the end of fiscal year 2013.
MTReports Filed With StatesPart VI, Line 7

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
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)

Base 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
Kevin Maxwell MD
54750000000551830158170618500000
Arthur K Fink DO
235083025000000228050163080299196000
Scott Duke
2012150100000474560338100191620311643000
Judy Courtney
176507075000010171071570194585000
Dale Adishian MD
57392300000541590216690649751000
Joseph Leal MD
249038000002450071280258616000
Sonja Samsoondar Labrie MD
27723102291700065630180330324744000
Mark Nichols MD
288462000004846092590302567000
Mechelle Lewis MD
22240002500000049000101030262403000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
Return ReferencePart I, Line 4bReturnReference
ExplanationScott Duke participates in a nonqualified retirement plan under 457(f). Amounts from his base wages was deferred into the plan at his discretion. The organization contributed $46,000 into the plan on behalf of Scott.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1Montana Facility Finance AuthorityBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN364615155IssuerEIN
CUSIP Number612043GD5CUSIPNumber
Date Issued2008-07-01DateIssued
Issue Price29716927IssuePrice
Description Of PurposeVarious Capital ProjectsDescriptionOfPurpose
Defeased0Defeased
On Behalf Of Issuer0OnBehalfOfIssuer
Pool Financing0PoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired1410000AmountRetired
Total Proceeds30693884TotalProceeds
Amount In Reserve Fund2098390AmountInReserveFund
Capitalized Interest1887501CapitalizedInterest
Issuance Costs From Proceeds594338IssuanceCostsFromProceeds
Capital Expenditures23222376CapitalExpenditures
Other Spent Proceeds2891299OtherSpentProceeds
Year Of Subst Completion2011YearOfSubstCompletion
Current Refunding0CurrentRefunding
Advance Refunding0AdvanceRefunding
Final Allocation Made0FinalAllocationMade
Adequate Books And Recds Maintaind1AdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed Property0OwningBondFinancedProperty
Any Lease Arrangements0AnyLeaseArrangements
Mngment Cntrct Bond Financd Prprty0MngmentCntrctBondFinancdPrprty
Any Research Agreements0AnyResearchAgreements
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance Procdrs1PostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T Filed0Form8038TFiled
Variable Rate Issue0VariableRateIssue
Hedge Identified In Books And Recds0HedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GIC0GrossProceedsInvestedInGIC
Gross Proceeds Invested0GrossProceedsInvested
Exception To Rebate0ExceptionToRebate

Form990 Schedule K Part VI Form990ScheduleKPartVI

FieldValueIRS element (for citing)
IdentifierPart II, Line 3:Identifier
ExplanationThe difference between the issue price (Part I, Column (e)) and the total proceeds of the issue (Part II, Line 3, Column (B)) is investment interest during construction.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (7 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
New Program ServicesForm 990, Part III, line 2With the addition of the 128 slice CT Scanner the imaging department has added cardiac angiography exams as a new service beginning in November 2011. A single study is able to rule out pulmonary embolism, coronary artery disease and aortic dissection. At the same time, the new scanner has reduced the average radiation dose per study by 80%. This activity furthers the tax exempt purpose of GMC in providing health care services to the community.
Form 990, Part VI, Section A, line 1The Executive Committee is comprised of the Board President, Vice-President, Secretary, Treasurer and the immediate Past Chair. The Executive Committee will, in the interim between meetings of the Board of Directors, exercise the powers of that body necessary for efficient operation of the Hospital in accordance with the general policy of the Hospital and the Board of Directors. The committee shall be empowered to act in only those areas of responsibility as the Board of Directors authorizes. It shall not have the power to amend the bylaws nor adopt or amend the Hospital's annual budget or long range plan and with the understanding that all matters of major importance will be referred to the governing board.
Form 990, Part VI, Section B, line 11A copy of the 990 was reviewed by the CFO and distributed to the Board before filing with the IRS.
Form 990, Part VI, Section B, line 12cAny director, officer, key employee or committee member having an interest in a contract or other transaction presented to the Board of Directors or a committee thereof for authorization, approval or ratification shall make a prompt, full and frank disclosure of his interest to the board or committee prior to its acting on such contract or transaction. The body to which such disclosure is made shall thereupon determine, by majority vote, whether the disclosure shows that a conflict of interest exists or can reasonably be construed to exist. If a conflict is deemed to exist, such person shall not vote on, nor use his personal influence on, nor participate in the discussions or deliberations with respect to, such contract or transaction. Such person may be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted up. The minutes of the meeting shall reflect the disclosure made, the vote thereon and where applicable, the abstention from voting and participation, and whether a quorum was present. A statement from directors and officers and key members of the medical staff is completed and signed annually. Conflict of Interest is normally handled at the executive or board level. In the majority of the cases, no vote is necessary since the Board member or GMC staff voluntarily excuse themselves. But, the Board Chair and the CEO monitors proposed or ongoing transactions of the organization for conflicts of interest and discloses them to the Board and staff, as appropriate.
Form 990, Part VI, Section B, line 15aCompensation for all positions is reviewed annually utilizing the MHA survey and other information such as the 990 and MGMA information during the budget process. This includes all officers and key personnel. The CEO compensation is reviewed biannually prior to the contract renewal. This is normally done by the Executive Committee utilizing various market surveys. The last review was in May - July, 2012. For the 2012 review, the Board appointed board members to a compensation committee. They utilized area market surveys and Form 990 information to complete their review of the CEO and the other four members of the leadership team. This information was used for reviewing the compensation adjustment for the CEO for the 2012-13 contract based on the 2011-2012 contract requirements and the wage adjustments for the other leadership members for budget year 2012-13.
Form 990, Part VI, Section C, line 19Governing documents, conflict of interest policy and financial statements are kept at the Hospital and are available upon request. The annual Community Benefit report includes annual audited consolidated income statements and is mailed to all service area households. It is also posted on the GMC website.
Form 990, Part XII, Line 2c:The Finance Committee was reactivated in January 2012. The committee has the oversight of the financial statements, selection of independent accountants, audit and other financial aspects of the board. The committtee brings recommendations as a seconded motion to the full board of directors for final approval on any required decisions.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1Glendive Medical Center FoundationBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1202 Prospect DriveAddressLine1
CityGlendiveCity
StateMTState
ZIP Code59330ZIPCode
FieldValueIRS element (for citing)
EIN810440518EIN
Primary ActivitiesRaising Funds for Glendive Medical Center and Community Medical NeedsPrimaryActivities
Legal Domicile StateMTLegalDomicileState
Exempt Code Section501(c)(3)ExemptCodeSection
Public Charity StatusLine 7PublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Glendive Medical Center IncBusinessNameLine1
FieldValueIRS element (for citing)
Controlled Org0ControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1HealthNet LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line111 South 7th Street Suite 241AddressLine1
CityMiles CityCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
EIN810506005EIN
Primary ActivityOperating intergrated computer and software packages for use in the facilityPrimaryActivity
Legal Domicile StateMTLegalDomicileState
Predominant Income TypeRelatedPredominantIncomeType
Share Of Total Income-39027ShareOfTotalIncome
Share Of EOY Assets132841ShareOfEOYAssets
Disproportionate Allocations1DisproportionateAllocations
General Or Managing Partner1GeneralOrManagingPartner
Percentage Ownership0.43869PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1Gabert Medical Clinic IncBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1107 DilworthAddressLine1
CityGlendiveCity
StateMTState
ZIP Code59330ZIPCode
FieldValueIRS element (for citing)
EIN810477745EIN
Primary ActivityProvides Comprehensive Medical Care and Related ServicesPrimaryActivity
Legal Domicile StateMTLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1Glendive Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
Type Of EntityCTypeOfEntity
Share Of Total Income4158405ShareOfTotalIncome
Share Of EOY Assets2145620ShareOfEOYAssets
Percentage Ownership1.00000PercentageOwnership
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
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 Orgs0RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs0PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1Glendive Medical Center FoundationBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved305339AmountInvolved
Method Of Amt DeterminationActualMethodOfAmtDetermination

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