2013-05-15T09:56:05-05:00 2012-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2011-07-01 810247705 COMMUNITY MEDICAL CENTER INC COMM 4067284100 2827 FORT MISSOULA ROAD MISSOULA MT 59804 DAVID RICHHART 4067284100 2013-05-13 1 ROBERT E SCHILE P00369682 6123764500 2011 2016-02-24 21:20:13Z STEVE CARLSON 2827 FORT MISSOULA ROAD MISSOULA MT 59804 152780784 0 X WWW.COMMUNITYMED.ORG X 1948 MT YOUR HEALTH - OUR COMMITMENT TO YOU, FROM DAY ONE. 12 12 1371 150 2253970 -380924 897895 1504029 146279301 148440839 356059 498118 2875966 2292684 150409221 152735670 155521 147928 0 0 70700892 71932249 0 0 2106 70438410 72330762 141294823 144410939 9114398 8324731 150377522 149194755 69729886 61708913 80647636 87485842 YOUR HEALTH - OUR COMMITMENT TO YOU, FROM DAY ONE. 0 0 109656104 147928 148440839 CMC PROVIDES DAILY PATIENT SERVICES, PROFESSIONAL AND TECHNICAL SERVICES, AND REHABILITATION SERVICES FOR PATIENT CARE. 5,061 INPATIENTS ARE ADMITTED TO CMC EACH YEAR. 127,695 OUTPATIENT SERVICES ARE PROVIDED ANNUALLY. 92,816 VISITS ARE MADE TO OUR PHYSICIANS. THE AMOUNT OF CHARGES FORGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THE HOSPITAL'S CHARITY POLICY AGGREGATED APPROXIMATELY $4,167,171 FOR THE YEAR ENDED JUNE 30, 2012. 109656104 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 184 0 1371 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X DAVID RICHHART 4063274004 2827 FORT MISSOULA ROAD MISSOULA MT 59804 X SCOTT STEARNS 1.50 X X 0 0 0 SCOTT HACKER 1.50 X X 0 0 0 JAN PARKS 1.50 X X 0 0 0 JOHN VANSTRYDONCK 1.50 X X 0 0 0 TANYA ASK 1.50 X 0 0 0 FRANK D'ANGELO 1.50 X 0 0 0 MARK GARNAAS MD 1.50 X 0 0 0 BILL JOHNSTON 1.50 X 0 0 0 ROBERT PHILLIPS 1.50 X 0 0 0 RON PREMUROSO 1.50 X 0 0 0 ROGER MUNRO MD 1.50 X X 0 0 0 MICHAEL STEWART MD 1.50 X 0 0 0 GEORGE MANLOVE 1.50 X X 0 0 0 SHARON PETERS 1.50 X 0 0 0 RICH ZINS 1.50 X 0 0 0 STEVE CARLSON 40.00 X 451949 0 29281 DAVID RICHHART 40.00 X 216688 0 18871 FRANK REED 40.00 X 171629 0 18775 JONATHAN WEISUL 40.00 X 329303 0 30771 DAVID JINICH MD 35.00 X 735464 0 32720 PAULA GUINNIP MD 35.00 X 459555 0 11661 GREGORY UTTER MD 35.00 X 422693 0 32708 BRUCE MORGAN MD 35.00 X 358174 0 4269 JANET HILLER MD 35.00 X 371775 0 17709 3517230 0 196765 79 0 1 0 MT CANCER SPECIALISTS PO BOX 7877 MISSOULA MT 59807 ONCOLOGY SERVICES 1648340 MT HEART ANGIO LAB LLC 2827 FORT MISSOULA ROAD MISSOULA MT 59804 CARDIOLOGY SERVICES 1631454 SOUND INPATIENT PO BOX 742936 LOS ANGELES CA 90074 HOSPITALIST 970312 MAYO COLLABORATIVE PO BOX 9146 MINNEAPOLIS MN 55480 LAB SERVICES 482844 SEATTLE CHILDREN'S PO BOX 24728 SEATTLE WA 98124 PHYSICIAN SERVICES 414387 24 959802 145500 398727 1504029 NET PATIENT REVENUE 621500 145910558 143656588 2253970 JV ANCILLARY REVENUE 621500 2909480 2909480 HEART LAB REVENUE 621500 -379199 -379199 148440839 510064 510064 593162 0 593162 593162 593162 33168 45114 -11946 -11946 -11946 MISCELLANEOUS REVENUE 900099 3245889 3245889 LOSS ON JOINT VENTURE 900099 -1546367 -1546367 1699522 152735670 146186869 2253970 2790802 147928 147928 1392219 1392219 57281474 45361247 11920227 2181086 1688649 492437 7015377 5496799 1518578 4062093 3144969 917124 351011 351011 48882 48882 18127190 12962273 5164917 4152211 1579213 2572998 2699878 1242750 1455022 2106 705131 338983 366148 6864 6864 825784 623003 202781 6742317 6715657 26660 1345332 821074 524258 MEDICAL SUPPLIES/DRUGS 21721242 20881433 839809 BAD DEBT 7247920 7247920 REPAIRS & MAINTENANCE 4774337 697740 4076597 LICENSE & FEES 1092312 20088 1072224 2490351 686378 1803973 144410939 109656104 34752729 2106 22001552 17084983 33315767 21681565 20323744 20999168 5154301 3855003 3336757 3097534 803489 1114186 123928615 61621357 48105479 62307258 7127504 10026066 3474241 3423001 952862 889946 5781826 4716045 150377522 149194755 21238533 17349578 26511 30812 24409555 24428532 13701378 11858882 1505784 945429 8848125 7095680 69729886 61708913 X 74863568 82901610 2731191 1490082 3052877 3094150 80647636 87485842 150377522 149194755 X 8324731 -1486525 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 10056 10056 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: COMMUNITY MEDICAL CENTER PAYS DUES TO THE AMERICAN HOSPITAL ASSOCIATION AND MONTANA HOSPITAL ASSOCIATION. THESE ORGANIZATION PARTICIPATE IN LOBBYING ACTIVITIES. 3756462 41273 24356 3822091 3054980 49499 651983 3756462 2356624 38678 659678 3054980 2952845 11855 -608076 2356624 0.19000 0.00000 0.81000 0 1 1 209682 209682 54482859 24643940 29838919 1115362 252387 862975 53555698 36725030 16830668 14565014 14565014 62307258 MORTGAGE BACKED GOVERNMENT SECURITIES 10026066 F 10026066 THIRD PARTY PAYABLE 7095680 7095680 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE ENDOWMENT FUNDS ARE HELD BY THE CMC FOUNDATION AND THE INCOME EARNED ON THESE FUNDS ARE DISTRIBUTED TO THE HOSPITAL TO COMPLY WITH THE PURPOSES SPECIFIED BY THE DONOR. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE HOSPITAL'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. THE HOSPITAL IS NOT AWARE OF ANY ACTIVITIES THAT WOULD JEOPARDIZE ITS TAX-EXEMPT STATUS. THE TAX RETURNS FOR THE YEARS ENDED 2009 TO 2011 ARE OPEN TO EXAMINATION BY FEDERAL, LOCAL, AND STATE AUTHORITIES. 1 1 X 1 X 1 X 1 1 1 0 1 1 2137759 2137759 0.01480 20003571 16281097 3722474 0.02580 22141330 16281097 5860233 0.04060 613551 613551 0.00420 721967 721967 0.00500 18942426 11898844 7043582 0.04880 237839 237839 0.00160 20515783 11898844 8616939 0.05960 42657113 28179941 14477172 0.10020 15000 15000 0.00010 8000 8000 0.00010 1500 1500 0.00000 24500 24500 0.00020 1 7249754 35000 24290891 31570664 -7279773 X 1 1 1 1 COMMUNITY MEDICAL CENTER

2827 FORT MISSOULA ROAD MISSOULA MT 59804

X X X COMMUNITY MEDICAL CENTER 1 1 1 200.000000000000 1 300.000000000000 1 X X X X X 1 1 X X 1 0 1 X 0 0 18 MISSOULA VALLEY PEDIATRICS (MVP)

2835 FORT MISSOULA ROAD SUITE 205 MISSOULA MT 59804

PEDIATRICS CMC REHABILITATION PHYSICIANS

2827 FORT MISSOULA ROAD MISSOULA MT 59804

PHYSIATRISTS PARKSIDE COMMUNITY FAMILY CARE (PCFC)

2831 FORT MISSOULA ROAD SUITE 146 MISSOULA MT 59804

FAMILY PRACTICE, OFFICE-BASED PSYCHIATRY ROCKY MOUNTAIN NEONATOLOGY (RMN)

2825 FORT MISSOULA ROAD SUITE 121 MISSOULA MT 59804

NEONATOLOGY ROCKY MOUNTAIN PERINATAL ASSOCIATES

2835 FORT MISSOULA ROAD SUITE 304 MISSOULA MT 59804

PERINATOLOGY STEVENSVILLE CMC (SCMC)

3800 EASTSIDE HIGHWAY STEVENSVILLE MT 59870

INTERNAL MEDICINE, FAMILY PRACTICE WELLCARE

2825 FORT MISSOULA ROAD SUITE 203 MISSOULA MT 59804

INDEPENDENT MEDICAL EXAMS FOR WORKERS' COMP MANAGEMENT DIABETES & ENDOCRINOLOGY ASSOCIATES

1211 S RESERVE ST STE 202 MISSOULA MT 59804

ENDOCRINOLOGY DIABETES & NUTRITION CENTER

1211 S RESERVE ST STE 202 MISSOULA MT 59804

PUMP EDUCATOR, DIETITIAN, DIABETES EDUCATION MOUNTAIN VIEW FAMILY MEDICINE & OB

2835 FORT MISSOULA ROAD SUITE 101 MISSOULA MT 59804

FAMILY PRACTICE, FAMILY PRACTICE WITH OBSTETRICS COMMUNITY PEDIATRIC HOSPITALISTS

2827 FORT MISSOULA ROAD MISSOULA MT 59804

HOSPITALIST/PEDIATRICIAN CPG ON NORTH RESERVE

2230 NORTH RESERVE STREET MISSOULA MT 59801

FAMILY PRACTICE/OPEN ACCESS WALK-IN CARE CPG ON SOUTH RESERVE

1211 RESERVE ST SOUTH SUITE 101 MISSOULA MT 59801

FAMILY PRACTICE/OPEN ACCESS WALK-IN CARE CPG COUMADIN CLINIC

2831 FORT MISSOULA ROAD STE 103 MISSOULA MT 59804

COUMADIN CPG CARDIOLOGY

2831 FORT MISSOULA RD STE 102 MISSOULA MT 59804

CARDIOLOGY CPG THORACIC AND VASCULAR

2831 FORT MISSOULA RD STE 102 MISSOULA MT 59804

THORACIC AND VASCULAR CPG NORTH PRIMARY

2230 NORTH RESERVE STREET MISSOULA MT 59801

INTERNAL MEDICINE MONTANA BREAST HEALTH CENTER

2827 FORT MISSOULA ROAD MISSOULA MT 59804

BREAST HEALTH PART I, LINE 7: THE COSTING METHOD USED WAS THE COST TO CHARGE RATIO DERIVED FROM USING WORKSHEET 2. PART I, LINE 7G: ALL SUBSIDIZED HEALTH COSTS ARE ATTRIBUTABLE TO PHYSICIAN CLINICS. PART I, L7 COL(F): WHEN CALCULATING CHARITY-CARE PERCENTAGE OF TOTAL EXPENSES (SCHEDULE H, PART I, LINE 7, COLUMN F), THE HOSPITAL ELIMINATED $7,249,754 OF BAD DEBT EXPENSE. PART II: CMC INVESTS IN MISSOULA AND THE SURROUNDING AREA THROUGH MULTIPLE AVENUES. AS A KEY PARTNER OF THE MISSOULA ECONOMIC PROJECT (MEP), CMC HELPS MEP CREATE A PROGRESSIVE BUSINESS DEVELOPMENT AND RECRUITMENT PROGRAM FOR THE CITY OF MISSOULA. WE BELIEVE THAT A STRONG BUSINESS COMMUNITY CREATES A VIBRANT CITY THAT CAN BE SUPPORTED BY NON-PROFIT HEALTHCARE ORGANIZATIONS, SUCH AS CMC. IN ADDITION, OUR PARTICIPATION IN EMERGENCY PREPAREDNESS IN PARTNERSHIP WITH OTHER HOSPITALS, FIRE, POLICE, AND THE CITY/COUNTY GOVERNMENT STRENGTHENS OUR ABILITY TO RESPOND EFFICIENTLY AND QUICKLY TO ANY EMERGENCY WITHIN THE AREA. AS MISSOULA CHAMBER OF COMMERCE MEMBERS, WE SUPPORT OUR BUSINESS COMMUNITY BY SPONSORING AT LEAST ONE PARTICIPANT FROM CMC IN THE LEADERSHIP MISSOULA PROGRAM ANNUALLY. THIS PROGRAM CREATES AMBASSADORS OF CMC EMPLOYEES FOR THE LARGER COMMUNITY. PART III, LINE 4: BAD DEBT IS AN ESTIMATE USING HISTORICAL DATA ON PAYMENTS RECEIVED AND AMOUNTS THAT WERE ACTUALLY NEVER COLLECTED. THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS AN ESTIMATE BASED ON TOTAL CHARITY CARE. PART III, LINE 8: COST ARE ALLOCATED BASED ON ACTUAL COST OF INDIVIDUAL CLINICS OR HOSPITAL DEPARTMENTS. THE AMOUNT SHOWN HERE AS THE MEDICARE SHORTFALL DOES NOT INCLUDED ALL COSTS AND REVENUES FOR MEDICARE. THE COSTS AND REVENUES SHOWN HERE INCLUDE ONLY THE AMOUNTS ALLOWED IN THE MEDICARE COST REPORT. TO DETERMINE THE ACTUAL MEDICARE SHORTFALL ALL REVENUES AND COST MUST BE INCLUDED IN THE CALCULATION. WHEN ALL COSTS ARE INCLUDED OUR SHORTFALL FOR MEDICARE OUR SHORTFALL IS SIGNIFICANTLY HIGHER. ONE HUNDRED PERCENT OF THIS SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THIS AMOUNT IS CONSIDERED TO BE COMMUNITY BENEFIT FOR THE FOLLOWING REASONS: IN OUR COMMUNITY MEDICARE HAS THE LOWEST REIMBURSEMENT RATE OF ALL PAYERS. WE DO NOT BELIEVE OUR MEDICARE SHORTFALL TO BE FROM ANY SORT OF DEFICIENCIES IN THE EFFICIENCY OF OPERATIONS OR LOW PATIENT VOLUMES. PART III, LINE 9B: PATIENTS RECEIVE INFORMATION AT THE TIME OF REGISTRATION REGARDING FINANCIAL ASSISTANCE BOTH FOR SELF PAY AND BALANCE AFTER INSURANCE. ALL SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PROGRAMS BY THE MASH PROGRAMS, AND IF NO ELIGIBILITY EXISTS ARE FURTHER SCREENED FOR HOSPITAL FINANCIAL ASSISTANCE. ADDITIONALLY, PATIENTS RECEIVE INFORMATION REGARDING FINANCIAL ASSISTANCE IN THEIR STATEMENTS AS WELL AS VERBALLY WHEN FOLLOW UP CALLS ARE MADE ON ANY PATIENT BALANCE. PATIENTS WHO QUALIFY FOR CHARITY CARE RECEIVE AN ADJUSTMENT ON THE BALANCE OF THEIR ACCOUNT CORRESPONDING WITH THE APPROPRIATE REDUCTION ACCORDING TO POLICY. REMAINING BALANCES, IF ANY, ARE COLLECTED EITHER IN FULL OR BY PAYMENT PLAN, OR IN THE CASE OF NON-PAYMENT MAY HAVE THE ADJUSTED BALANCE ASSIGNED TO AN OUTSIDE AGENCY FOR RESOLUTION. PART VI, LINE 2: COMMUNITY MEDICAL CENTER WORKS WITH SAINT PATRICK HOSPITAL AND THE MISSOULA CITY-COUNTY HEALTH DEPARTMENT TO ASSESS THE NEEDS OF THE COMMUNITY, AS WELL AS WITH OTHER NON-PROFIT ORGANIZATIONS, I.E., MISSOULA AGING SERVICES, YWCA, YMCA, POVERELLO HOMELESS SHELTER, AND UNITED WAY. COMMUNITY ASSESSES THE NEEDS OF THE COMMUNITY ALONG WITH OUR PARTNER ORGANIZATIONS AND THEN CRAFTS A RESPONSE TO THE NEEDS ASSESSMENT TO FULFILL ANY GAPS THAT ARE IDENTIFIED. PART VI, LINE 3: PATIENTS RECEIVE INFORMATION AT THE TIME OF REGISTRATION REGARDING FINANCIAL ASSISTANCE BOTH FOR SELF PAY AND BALANCE AFTER INSURANCE. ALL SELF PAY PATIENTS ARE SCREENED FOR ELIGIBILITY FOR FEDERAL, STATE AND LOCAL PROGRAMS BY THE MASH PROGRAMS, AND IF NO ELIGIBILITY EXISTS ARE FURTHER SCREENED FOR HOSPITAL FINANCIAL ASSISTANCE. ADDITIONALLY, PATIENTS RECEIVE INFORMATION REGARDING FINANCIAL ASSISTANCE IN THEIR STATEMENTS AS WELL AS VERBALLY WHEN FOLLOW UP CALLS ARE MADE ON ANY PATIENT BALANCE. PART VI, LINE 4: CMC SERVES THE COMMUNITY OF MISSOULA, MT AND THE SURROUNDING COUNTIES. MONTANA IS A RURAL STATE AND THERE ARE THEREFORE LIMITED HOSPITALS IN THE REGION. THERE ARE TWO HOSPITALS IN MISSOULA. CMC SERVES A DISPROPORTIONATE NUMBER OF LOWER INCOME INDIVIDUAL AND THEREFORE RECEIVES DSH PAYMENTS. 0 MISSOULA CHAMBER OF COMMERCE PO BOX 7577 MISSOULA MT 59807 810167990 501(C)(6) 10070 TO SUPPORT GENERAL OPERATIONS. UNITED WAY OF MISSOULA COUNTY PO BOX 7395 MISSOULA MT 59806 810287854 501(C)(3) 20820 TO SUPPORT GENERAL OPERATIONS. AMERICAN HEART ASSOCIATION 700 SOUTH AVENUE WEST MISSOULA MT 59801 135613797 501(C)(3) 15000 TO SUPPORT GENERAL OPERATIONS. MISSOULA DOWNTOWN ASSOCIATION 218 EAST MAIN STREET MISSOULA MT 59802 810403474 501(C)(6) 5500 TO SUPPORT GENERAL OPERATIONS. MISSOULA ECONOMIC PARTNERSHIP PO BOX 7457 MISSOULA MT 59807 273994460 501(C)(6) 20000 TO SUPPORT GENERAL OPERATIONS. 2 3 X 0 0 X X X X 0 0 0 0 0 1 0 0 0 STEVE CARLSON 372394 0 78313 0 1242 0 19981 0 9300 0 481230 0 0 0 DAVID RICHHART 182714 0 31500 0 2474 0 9721 0 9150 0 235559 0 0 0 FRANK REED 100909 0 36750 0 33970 0 7260 0 11515 0 190404 0 0 0 JONATHAN WEISUL 277932 0 51371 0 0 0 13809 0 16962 0 360074 0 0 0 DAVID JINICH MD 561661 0 172561 0 1242 0 12588 0 20132 0 768184 0 0 0 PAULA GUINNIP MD 283714 0 0 0 175841 0 0 0 11661 0 471216 0 0 0 GREGORY UTTER MD 388712 0 31239 0 2742 0 9721 0 22987 0 455401 0 0 0 BRUCE MORGAN MD 338250 0 19924 0 0 0 2989 0 1280 0 362443 0 0 0 JANET HILLER MD 209483 0 159842 0 2450 0 15156 0 2553 0 389484 0 0 0 PART I, LINE 1A CMC PAID COUNTRY CLUB DUES ON BEHALF OF STEVE CARLSON, CEO IN THE AMOUNT OF $14,438. THIS AMOUNT WAS NOT INCLUDED IN STEVE'S TAXABLE COMPENSATION. PART I, LINE 6 CMC PAYS OUT LEADERSHIP COUNCIL BONUSES IF THE NET EARNINGS OF CMC MEETS OR EXCEED THE BUDGETED AMOUNTS. BASED ON THE FISCAL YEAR 2012 FINANCIAL RESULTS, A PERCENTAGE OF THEIR BASE SALARY WAS PAID OUT AS A BONUS. MONTANA FACILITY FINANCE AUTHORITY 364615155 612043JA3 2010-12-29 24400067 CONSTRUCTION AND FACILITY EXPANSION OF WOMEN'S AND NEWBORN CARE CENTER 0 0 0 24146299 2139736 1944776 220565 10606964 8539525 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 SCHEDULE K, PART II, LINE 3 TOTAL PROCEEDS OF ISSUE TOTAL PROCEEDS OF $24,146,299 ON PART II, LINE 3 DOES NOT EQUAL THE ISSUE PRICE OF $24,400,061 INCLUDED IN PART I, LINE A, COLUMN E. THE DIFFERENCE OF $253,768 IS EQUAL TO THE UNDERWRITERS' DISCOUNTS. FORM 990, PART VI, SECTION A, LINE 1 THE ROLE OF THE EXECUTIVE COMMITTEE IS TO TRANSACT THE BUSINESS OF THE COMMUNITY MEDICAL CENTER BOARD OF DIRECTORS IN THE INTERIM BETWEEN MEETINGS OF THE FULL BOARD, WHEN A MEETING OF THE FULL BOARD IS NOT FEASIBLE. THEIR RESPONSIBILITIES INCLUDE: - ACT ON MATTERS THAT CANNOT REASONABLY WAIT ACTION BY THE FULL BOARD. - ACT ON OTHER MATTERS DELEGATED TO THE EXECUTIVE COMMITTEE BY THE BOARD. - REPORT ACTIONS AT THE NEXT MEETING OF THE BOARD FOR RATIFICATION. - FUNCTION AS AN ADVISOR TO THE PRESIDENT/CEO ON SENSITIVE TOPICS. - PROVIDE INPUT INTO THE CONTENT AND STRUCTURING OF THE BOARD AGENDA. - CONDUCT THE EVALUATION AND SET THE SALARY OF THE PRESIDENT/CEO. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE OFFICERS OF THE BOARD AND ONE ADDITIONAL BOARD MEMBER AT LARGE. THE PRESIDENT/CEO SHALL BE AN EX OFFICIO MEMBER WITHOUT VOTE. THE CHAIR OF THE BOARD APPOINTS THE COMMITTEE MEMBERS ANNUALLY, TO COINCIDE WITH THE ELECTION OF OFFICERS. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 AND RELATED SCHEDULES WILL BE GIVEN TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS SHALL BY RESOLUTION APPROVE A CONFLICT OF INTEREST POLICY FOR CMC THAT IS CONSISTENT WITH AND AT LEAST AS PROTECTIVE AS THE APPLICABLE CONFLICT OF INTEREST PROVISIONS UNDER THE MONTANA NONPROFIT CORPORATION ACT. THE PURPOSE OF THE POLICY IS TO PROTECT CMC'S INTEREST WHEN IT IS CONTEMPLATING ENTRY INTO A TRANSACTION OR ARRANGEMENT THAT MIGHT BENEFIT THE PRIVATE INTEREST OF A DIRECTOR, OFFICER OF THE BOARD, OFFICER OF THE ORGANIZATION, OR MEMBER OF A COMMITTEE ("INTERESTED PERSON"). THE POLICY SHALL CONTAIN AT LEAST THE FOLLOWING PROVISIONS: (A) A DEFINITION OR DESCRIPTION OF WHAT CONSTITUTES A "CONFLICT OF INTEREST TRANSACTION," (B) A DEFINITION OR DESCRIPTION OF AN "INTERSTED PERSON," (C) A DEFINITION OR DESCRIPTION OF WHEN A PERSON HAS A "FINANCIAL INTERST" IN A TRANSACTION OR ARRANGEMENT, (D) DISCLOSURE PROCEDURES, (E) PROCEDURES FOR DETERMINING WHETHER THE FINANCIAL INTEREST OF AN INTERESTED PERSON MAY RESULT IN A CONFLICT OF INTEREST, (F) PROCEDURES FOR ADDRESSING THE CONFLICT OF INTEREST AFTER DETERMINING THAT THERE IS A CONFLICT, INCLUDING VOTING REQUIREMENTS AND PROCEDURES, (G) PROCEDURES FOR ADEQUATE RECORD KEEPING, AND (H) PROCEDURES FOR ENSURING THAT ALL DIRECTORS, PRINCIPAL OFFICERS, AND MEMBERS OF COMMITTEES, UNDERSTAND AND COMPLY WITH THE CONFLICT OF INTEREST POLICY. ALL REAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE IMMEDIATELY REFERRED TO THE INTEGRITY OFFICER FOR RESOLUTION. CMC'S EMPLOYEE HANDBOOK AND STANDARDS OF CONDUCT IS GIVEN TO EACH NEW HIRE UPON EMPLOYMENT, UNDER THE STANDARDS OF CONDUCT THERE IS A SECTION ON CONFLICTS OF INTEREST AND HOW TO HANDLE THE CONFLICT. CONFLICTS ARE TO BE REPORTED DIRECTLY TO THE IMMEDIATE SUPERVISOR AND CMC ALSO OFFERS AN ANONYMOUS HOTLINE SERVCES. ONCE A YEAR THE CONFLICT OF INTEREST POLICY IS REVIEWED AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15 WE HIRED AN INDEPENDENT SERVICE (INTEGRATED HEALTHCARE STRATEGIES) TO DO AN EXECUTIVE COMPENSATION SURVEY. THIS SURVEY WAS CONDUCTED FOR THE TOP 12 COMPENSATED EMPLOYEES OF THE HOSPITAL. THE DATA WAS PRESENTED TO A COMPENSATION COMMITTEE OF THE BOARD OF DIRECTORS, AND SALARY ADJUSTMENTS (IF ANY) WERE DETERMINED. THE SURVEY INCLUDED REGIONAL AND NATIONAL COMPARISONS TO INSTITUTIONS OF A SIMILAR SIZE AND REVENUE GENERATION TO MAKE THE RESULTS COMPARABLE. AS MENTIONED ABOVE, THE SAME PROCESS THAT WAS USED FOR THE CEO, WAS USED TO COMPARE THE SALARIES OF OTHER KEY EXECUTIVES. THE LAST COMPENSATION ANALYSIS WAS PERFORMED IN 2011. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE UPON REQUEST. ALLOCATION OF HOURS FORM 990, PART VII, SECTION A STEVE CARLSON, MEMBER OF THE GOVERNING BODY OF CMC FOUNDATION, ALSO SERVES AS THE CEO OF COMMUNITY MEDICAL CENTER, A RELATED NON-PROFIT. ON AVERAGE HE SERVES BOTH ORGANIZATIONS WORKING AN AVERAGE OF 43 HOURS PER WEEK AS FOLLOWS: COMMUNITY MEDICAL CENTER - 40 HOURS PER WEEK CMC FOUNDATION - 3 HOURS PER WEEK JANET HILLER, MD, MEMBER OF THE GOVERNING BODY OF CMC FOUNDATION, ALSO SERVES AS A PHYSICIAN OF COMMUNITY MEDICAL CENTER, A RELATED NON-PROFIT. ON AVERAGE SHE SERVES BOTH ORGANIZATIONS WORKING AN AVERAGE OF 41 HOURS PER WEEK AS FOLLOWS: COMMUNITY MEDICAL CENTER - 40 HOURS PER WEEK CMC FOUNDATION - 1 HOUR PER WEEK ROBERT PHILLIPS, MEMBER OF THE GOVERNING BODY OF CMC FOUNDATION, ALSO SERVES AS A MEMBER OF THE GOVERNING BODY OF COMMUNITY MEDICAL CENTER, A RELATED NON-PROFIT. ON AVERAGE HE SERVES BOTH ORGANIZATIONS WORKING AN AVERAGE OF 2.5 HOURS PER WEEK AS FOLLOWS: COMMUNITY MEDICAL CENTER - 1.5 HOURS PER WEEK CMC FOUNDATION - 1 HOUR PER WEEK CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -276,301. CHANGE IN BENEFICIAL INTEREST OF CMC FOUNDATION -1,210,224. TOTAL TO FORM 990, PART XI, LINE 5: -1,486,525. COMMUNITY MEDICAL CENTER FOUNDATION 2827 FORT MISSOULA ROAD MISSOULA MT 59804 363627205 TO PROVIDE FUNDING TO COMMUNITY MEDICAL CENTER HOSPITAL MT 501(C)(3) 7 N/A 0 MONTANA HEART ANGIO LAB LLC 2827 FORT MISSOULA ROAD MISSOULA MT 59804 810542065 CATH LAB MT COMMUNITY MEDICAL CENTER RELATED 1773160 1912370 0 0 0.92900 0 0 1 1 0 0 0 0 1 0 1 1 1 1 0 1 0 0 MONTANA HEART ANGIO LAB LLC I 93644 FMV MONTANA HEART ANGIO LAB LLC L 1478088 FMV MONTANA HEART ANGIO LAB LLC K 117616 FMV