2013-02-15T11:41:59-06:00 2012-03-31 810497523 JORDAHL & SLITER PLLC PO BOX 8600 KALISPELL MT 599041600 990 2011-04-01 237293874 KALISPELL REGIONAL MEDICAL CENTER KALI 4067525111 310 SUNNYVIEW LANE KALISPELL MT 59901 TONY PATTERSON 4067521724 2013-02-14 1 JUSTIN P SLITER P00188996 4067521040 2013-02-14 2011 2016-03-07 17:11:31Z TONY PATTERSON 310 SUNNYVIEW LANE KALISPELL MT 59901 231571641 0 X WWW.NWHC.ORG/KRMC X 1973 MT PROVIDE ACUTE HOSPITAL CARE 16 7 1990 138 1595606 -311782 529235 800578 179599470 217873275 1750874 2052850 2246864 2979782 184126443 223706485 0 0 0 0 93692552 114428534 0 0 0 85114297 101681994 178806849 216110528 5319594 7595957 200870659 215953130 95828119 107327768 105042540 108625362 PROVIDE ACUTE HOSPITAL CARE 0 0 191889147 216277669 OPERATION OF REGIONAL ACUTE CARE HOSPITAL. 191889147 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 302 0 1 1990 1 1 1 0 0 0 0 0 0 0 0 0 X 16 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHARLES PEARCE 4067521724 310 SUNNYVIEW LANE KALISPELL MT 59901 CHARLES GRENIER 1.00 X 1200 0 0 WILSON HIGGS MD 1.00 X 1818 0 0 JON JOHNSON MD 1.00 X 205016 0 16191 GWEN JONAS MD 1.00 X 40130 0 0 JANE KARAS 1.00 X 2274 0 0 PETER L LARSON 1.00 X 1313 0 0 JEANNIE LUCKEY 1.00 X 1200 0 0 ROGER BARTH MD 1.00 X 15000 0 0 CURTIS LUND 1.00 X 600 0 0 DENNIS SABO 1.00 X 300 0 0 CAL SWEET 1.00 X 2130 0 0 MUFFIE THOMSON 1.00 X 1252 0 0 DAVID WALKER MD 1.00 X 1200 0 0 WILLIAM BENEDETTO MD 1.00 X 2400 0 0 VELINDA STEVENS 17.50 X X 0 672012 31177 LOUISE SWANBERG MD 1.00 X 6291 0 0 TOM MCELWAIN 1.00 X 1830 0 0 DAVE MEREDITH 1.00 X 1730 0 0 BERNADETTE VANBELOIS MD 1.00 X 0 0 0 CHARLES PEARCE 30.00 X 0 437707 25850 KAREN LEE 40.00 X 332473 0 43517 DEB WILSON 35.00 X 320341 0 52161 AC EDDY 29.00 X 395925 0 50343 TONY PATTERSON 50.00 X 239655 0 9270 TATE KREITINGER 25.00 X 339638 0 31099 ALAN WILLIAMS MD 50.00 X 640262 0 3125 DREW KIRSHNER MD 50.00 X 612680 0 47524 DAVID SHELDON MD 50.00 X 508206 0 48702 THOMAS AMIDON MD 50.00 X 470705 0 46200 DAVID ROTH MD 50.00 X 452013 0 16221 4597582 1109719 421380 121 0 1 0 SWANK ENTERPRISES PO BOX 10007 KALISPELL MT 59901 CONSTRUCTION 14546857 SILVER TIP EMERGENCY PHYSICIANS 310 SUNNYVIEW LANE KALISPELL MT 59901 EMERGENCY ROOM PHYSICIANS 3503249 MEREDITH CONSTRUCTION PO BOX 7128 KALISPELL MT 59901 CONSTRUCTION 882791 GLACIER REGIONAL PATHOLOGY 495 NORTH MAIN STREET KALISPELL MT 59901 PATHOLOGY SERVICES 832222 A&E ARCHITECTS 608 NORTH 29TH STREET BILLINGS MT 59101 ARCHITECH SERVICES 818476 33 770062 30516 91506 800578 MEDICAL SERVICE REVENU 621990 209593563 207997957 1595606 OTHER OPERATING INCOME 900099 4673924 4673924 PARTNERSHIP INCOME 621990 3418417 3418417 MGMT CONTRACT SERVICES 900099 109591 109591 EDUCATION INCOME 621990 75348 75348 2432 2432 217873275 1060204 1060204 267064 0 267064 267064 267064 8718594 139208 7676726 188430 1041868 -49222 992646 992646 CAFETERIA 722210 1453009 1453009 CHILD CARE 624410 659564 659564 MISC. REVENUE 900099 600145 600145 2712718 223706485 216277669 1595606 5032632 1995916 1995916 90669669 81985499 8684170 3330611 3093891 236720 12500642 11156136 1344506 5931696 5261350 670346 98296 98296 79091 79091 9694307 7003944 2690363 1207164 545576 661588 2236769 1481603 755166 9433198 8295256 1137942 1318579 878358 440221 1074324 1074324 9153385 7579053 1574332 2658590 2657569 1021 SUPPLIES 38714070 38106802 607268 BAD DEBTS 12185992 12185992 PURCHASED SERVICES 10054347 8553512 1500835 OTHER EXPENSES 3773882 2030282 1743600 216110528 191889147 24221381 0 6203380 6446029 47698479 50883925 25266388 31893429 4246715 3882976 5541756 6171367 2616203 4651135 178051244 96167590 59203167 81883654 6498505 2409569 1009145 966101 42586921 26764945 200870659 215953130 30825974 35649155 56864697 58964540 3232507 4648937 4904941 8065136 95828119 107327768 X 103124995 104640846 122795 2097510 1794750 1887006 105042540 108625362 200870659 215953130 X 7595957 -4013135 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 12630 1 15432 1 1 28062 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LOBBYING EXPENDITURES WERE INCURRED IN AN ATTEMPT TO ENSURE MEDICARE AND MEDICAID PAID COST OF SERVICES AND IN RELATION TO FUNDING FOR ADVANCE OF OUR ELECTRONIC HEALTH RECORD PROJECT. EXPENDITURES INCLUDED CONSULTANT, STAFF TIME AND A PORTION OF HOSPITAL ASSOCIATION MEMBERSHIP DUES. 1917545 2059932 7039 3984516 1480454 280808 156283 1917545 1250610 53165 176679 1480454 1225468 224116 -198974 1250610 0.47360 0.52640 0 1 1 282845 282845 95095306 58187496 36907810 56377436 37980094 18397342 26295657 26295657 81883654 TRUSTEE FUNDS - RESERVE FUND 21036294 DEPOSITS 74197 OTHER 5654454 26764945 PAYABLE TO CONTRACTUAL AGENCIES 866181 ACCOUNTS PAYABLE TO AFFILIATES 1768542 LEASES PAYABLE 643554 OTHER LIABILITIES 4786859 8065136 223706485 216110528 7595957 291289 -6371395 -6080106 1515851 224106047 291289 878335 1169624 222936423 770062 770062 223706485 216858911 748383 748383 216110528 0 216110528 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: NORTHWEST HEALTHCARE FOUNDATION'S ENDOWMENT FUNDS WILL BE DISBURSED ACCORDING TO THE FUND'S DESIGNATED PURPOSE CONSIDERING ANY RESTRICTIONS AND/OR CONDITIONS ON THE FUND. WHERE THERE IS AN UNDESIGNATED ENDOWMENT FUND WITHOUT RESTRICTIONS AND/OR CONDITIONS, THE ORGANIZATION WILL REVIEW REQUESTS FOR FUNDING FROM KALISPELL REGIONAL MEDICAL CENTER, THE SUPPORTED ORGANIZATION, ON A PERIODIC BASIS. HISTORICALLY, ENDOWMENT FUND DISBURSEMENTS HAVE FUNDED EQUIPMENT REQUESTS FROM KALISPELL REGIONAL MEDICAL CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ADOPTED THE PROVISIONS OF ASC 740, INCOME TAXES. ASC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE ASC AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT STANDARD FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE HOSPITAL HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED NO RESERVES ARE REQUIRED. PART XI, LINE 8 - OTHER ADJUSTMENTS: FUND BALANCE TRANSFERRED TO AFFILIATES -5,972,791. ADJUSTMENT FOR FOUNDATION ACTIVITY -548,604. CONSOLIDATION ENTRY FOR PRIOR YEAR TRANSFER 150,000. TOTAL TO SCHEDULE D, PART XI, LINE 8: -6,371,395. PART XII, LINE 2D - OTHER ADJUSTMENTS: FASB FAS 136 INVESTMENT IN NET ASSETS OF FOUNDATION 129,952. FOUNDATION INCOME RECORDED ON CONSOLIDATED BASIS 748,383. PART XII, LINE 4B - OTHER ADJUSTMENTS: SUPPORT FROM AFFILIATED FOUNDATION 770,062. PART XIII, LINE 2D - OTHER ADJUSTMENTS: FOUNDATION EXPENSES RECORDED ON CONSOLIDATED BASIS 748,383. 1 1 1 X 1 X 1 1 1 0 1 1 7836441 7836441 0.03630 25506779 18779582 6727197 0.03110 33343220 18779582 14563638 0.06740 354741 354741 0.00160 178233 178233 0.00080 50164244 36338834 13825410 0.06400 5715 5715 0.00000 50702933 36338834 14364099 0.06640 84046153 55118416 28927737 0.13380 17723 17723 0.00010 45476 45476 0.00020 952 952 0.00000 400 400 0.00000 64551 64551 0.00030 1 6155145 1135624 79310401 89733193 -10422792 X 1 0 1 MRI - CT IMAGING 0.51000 0.00009 0.18740 1 1 KALISPELL REGIONAL MEDICAL CENTER

310 SUNNYVIEW LANE KALISPELL MT 59901

X X X KALISPELL REGIONAL MEDICAL CENTER 1 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X X 1 1 X X X X 1 X X 1 X X X X X X 1 X 0 1 PART I, LINE 7: COST ACCOUNTING WAS UTILIZED FOR THE ENTIRE TABLE. COST ACCOUNTING COVERS ALL PATIENT SEGMENTS. PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN COLUMN (F) IS $10,555,948. PART II: KRMC PROVIDES FUNDING TO VARIOUS NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. IN ADDITION, KRMC IS ACTIVELY INVOLVED IN THE KALISPELL CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS FOR THE PURPOSES OF ECONOMIC DEVELOPMENT. KRMC PROVIDES FURTHER DONATIONS TO BENEFIT THE BROADER COMMUNITY. PART III, LINE 4: COST ACCOUNTING WAS UTILIZED TO DETERMINE BAD DEBT EXPENSE.PROVISION FOR BAD DEBTS: THE HOSPITAL PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AN AMOUNT THAT COULD BECOME UNCOLLECTIBLE, WHEREBY SUCH RECEIVABLES ARE REDUCED TO THEIR ESTIMATED NET REALIZABLE VALUE. THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON THE UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN ON COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE, AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND HAVE AN IMPACT ON THE ESTIMATION PROCESS. PART III, LINE 8: COST TO CHARGE RATIO WAS UTILIZED TO PREPARE THE FY 2012 COST REPORT. MEDICARE TOTALS PROVIDED EXCLUDE AMOUNTS REPORTED UNDER COMMUNITY BENEFIT PROFRAMS. THE ORGANIZATION PROVIDES CARE TO THE ELDERLY AND DISABLED AT A REDUCED REIMBURSEMENT TO ENSURE ALL OF THE COMMUNITY MEMBERS IN NORTHWEST MONTANA RECEIVE GOOD QUALITY HEALTHCARE REGARDLESS OF AGE, DISABILITY, OR MEANS. KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: KALISPELL REGIONAL MEDICAL CENTER CHARGES THE SAME FOR SERVICES REGARDLESS OF AN INDIVIDUAL'S INSURANCE STATUS. PART VI, LINE 2: KRMC IDENTIFIES NEEDS THROUGHOUT THE COMMUNITY BY UTILIZING COMMUNITY REPRESENTATIVES ON KRMC GOVERNANCE BOARDS, SOLICITATION OF IDEAS FROM COMMUNITY LEADERS AND OTHER MEMBERS VIA THE MEDIA AND OTHER FORMS OF COMMUNICATION, AND KEY STAFF AIDING IN IDENTIFYING HEALTH CARE SERVICE AREA SHORTAGES. KRMC MAINTAINS A CLOSE RELATIONSHIP TO THE COMMUNITY BY PROVIDING INFORMATION AND EDUCATION ABOUT UPCOMING HEALTH CARE ISSUES OR CHANGES AT KRMC AND SOLICITS FEEDBACK FROM THE COMMUNITY. ONCE NEEDS ARE IDENTIFIED, THE KRMC BOARD AND ADMINISTRATION WORK TO PRIORITIZE NEEDS BASED UPON THE MISSION AND VALUES OF KRMC. PART VI, LINE 3: KRMC DISPLAYS OUR CHARITY POLICY ON OUR WEBSITE. CHARITY CARE IS DISCUSSED WITH ALL PATIENTS AT THE TIME OF THEIR ADMIT. THROUGH THE MEDIA, KRMC NOTIFIED THE COMMUNITY OF OUR CHARITY CARE POLICY AND ELIGIBILITY REQUIREMENTS. PART VI, LINE 4: KRMC IS A SOLE COMMUNITY HOSPITAL IN NORTHWEST MONTANA. KRMC SERVES PATIENTS IN A LARGE GEOGRAPHIC AREA, THAT COVERS ALL OF NORTHWESTERN MONTANA, PARTS OF NORTHEASTERN IDAHO AND AREAS OF CENTRAL MONTANA. KRMC SERVES ALL PATIENTS REGARDLESS OF THEIR INCOME AND REGARDLESS OF THEIR PAYER. IN FLATHEAD COUNTY, 11.7% OF THE RESIDENTS LIVE AT OR BELOW 100% OF FEDERAL POVERTY LEVELS AND ACCORDING TO COUNTY HEALTH RANKINGS AND ROAD MAPS APPROXIMATELY 22% OF THE COUNTY RESIDENTS UNDER THE AGE OF 65 ARE UNINSURED. PART VI, LINE 5: THIS WAS ANSWERED BY QUESTION 2 INFORMATION. 1 KALISPELL REGIONAL HEALTHCARE FOUNDATION 310 SUNNYVIEW LANE KALISPELL MT 59901 311703013 501(C)(3) 169000 GENERAL USE 1 1 X X X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 JON JOHNSON MD 170016 0 30000 0 5000 0 3000 0 13191 0 221207 0 0 0 VELINDA STEVENS 0 400771 0 92836 0 178405 0 14700 0 16477 0 703189 0 0 CHARLES PEARCE 0 262460 0 67787 0 107460 0 9912 0 15938 0 463557 0 0 KAREN LEE 190565 0 49197 0 92711 0 36700 0 6817 0 375990 0 0 0 DEB WILSON 168765 0 44315 0 107261 0 38542 0 13619 0 372502 0 0 0 AC EDDY 310688 0 78468 0 6769 0 33951 0 16392 0 446268 0 0 0 TONY PATTERSON 203082 0 30000 0 6573 0 0 0 9270 0 248925 0 0 0 TATE KREITINGER 204693 0 52609 0 82336 0 14902 0 16197 0 370737 0 0 0 ALAN WILLIAMS MD 580262 0 60000 0 0 0 3000 0 125 0 643387 0 0 0 DREW KIRSHNER MD 526114 0 50000 0 36566 0 31808 0 15716 0 660204 0 0 0 DAVID SHELDON MD 395706 0 112500 0 0 0 33000 0 15702 0 556908 0 0 0 THOMAS AMIDON MD 415705 0 55000 0 0 0 30500 0 15700 0 516905 0 0 0 DAVID ROTH MD 447013 0 5000 0 0 0 3000 0 13221 0 468234 0 0 0 PART I, LINE 1A FIRST CLASS OR CHARTER TRAVEL - KRMC DOES NOT PROVIDE FIRST CLASS TRAVEL. CHARTER TRAVEL IS UTILIZED FOR THESE INDIVIDUALS WHEN A GROUP IS FLYING TOGETHER TO A CONFERENCE OR MEETING AND IT IS LESS EXPENSIVE THAN FLYING COMMERCIAL OR NO COMMERCIAL FLIGHT IS AVAILABLE. THIS WAS NOT INCLUDED AS TAXABLE COMPENSATION AS IT WAS BUSINESS RELATED. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - THE MEMBERS OF THE ADMINISTRATIVE TEAM RECEIVE A 457 PLAN CONTRIBUTION OF $22,000 FOR 2011. THIS AMOUNT IS GROSSED-UP TO TAKE CARE OF THE APPLICABLE TAXES. THE MEMBERS INCLUDE: PRESIDENT, CFIO, CNO, CMO, COO, AND THE HEALTHCENTER CEO. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - ALL ADMINISTRATIVE TEAM MEMBERS RECEIVE A FREE MEMBERSHIP TO THE SUMMIT. PART I, LINE 4B MEMBERS OF THE ADMINISTRATIVE TEAM RECEIVE A 457 PLAN CONTRIBUTION OF $22,000 FOR 2011. THE MEMBERS INCLUDE: PRESIDENT, CFIO, CNO, CMO, COO, AND THE HEALTHCENTER CEO. PART I, LINE 7 BONUS PLANS ADMIN AND MGMT-BASED ON A NUMBER OF FACTORS INCLUDING BUT NOT LIMITED TO: QUALITY AND FINANCIAL INDICATORS INCLUDING DEPARTMENT SPECIFIC GOALS AND INITIATIVES, PATIENT SATISFACTION, PRODUCTIVITY, EMPLOYEE SATISFACTION, AND EMPLOYEE EVALUATION TIMELINESS. SUCCESSFUL IMPLEMENTATION OF COMPANY FISCAL YEAR ACTION PLANS AND THE OVERALL FINANCIAL HEALTH AND STABILITY OF THE ORGANIZATION. MONTANA FACILITY FINANCE AUTHORITY 364615155 612043XXX 2010-11-01 57115000 REFUND 1998 AND 2001 SERIES BONDS AND FUND NEW SURGERY BUILDING PROJECT 0 0 0 MONTANA FACILITY FINANCE AUTHORITY 364615155 2011-08-03 4174486 CAPITAL EXPENDITURES 0 0 0 440000 57308306 3304842 891005 22829174 10771260 19512025 0 1 1 1 216067 4174486 12486 3874257 287743 2012 0 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 PART II, LINE 3 DIFFERENCE IN PROCEEDS: THE PROCEEDS OF THE BOND ISSUANCE EXCEED THE ISSUE PRICE OF $57,115,000 BY $193,306. THIS AMOUNT IS THE NET ORIGINAL ISSUE PREMIUM. PART II, LINE 11 OTHER SPENDING: OF THE TOTAL PROCEEDS, $10,771,260 WAS USED TO REDEEM BONDS ISSUED IN 1998 AND 2001. GLACIER REGIONAL PATHOLOGY DR. WALKER, A CURRENT TRUSTEE, WAS THE PRESIDENT AND 1/3 OWNER OF GRP. 147986 PATHOLOGY & LAB SERVICES 0 ROCKY MOUNTAIN SUB-SPECIALTY ASSOC DR. JOHNSON, A CURRENT TRUSTEE, IS A GREATER THAN 5% PARTNER. 659704 RENT AND JANITORIAL SERVICES 0 NORTHWEST IMAGING INC DR. BENEDETTO, A CURRENT TRUSTEE, IS A GREATER THAN 5% OWNER. 811178 RADIOLOGY SERVICES 0 KEN JONAS MD SPOUSE OF CURRENT TRUSTEE 227239 SALARY 0 0 SWANBERG BUILDING INC DR. SWANBERG, A CURRENT TRUSTEE, IS A 5% OR GREATER OWNER. 108000 RENT 0 X EQUIPMENT 1 91506 COST 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 PETER LARSON AND DAVE MEREDITH HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 KALISPELL REGIONAL MEDICAL CENTER HAS ONE MEMBER, KALISPELL REGIONAL HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7A KALISPELL REGIONAL MEDICAL CENTER HAS THE SAME BOARD OF DIRECTORS AS ITS SOLE MEMBER, KALISPELL REGIONAL HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION A, LINE 7B KALISPELL REGIONAL MEDICAL CENTER HAS THE SAME BOARD OF DIRECTORS AS ITS SOLE MEMBER, KALISPELL REGIONAL HEALTHCARE SYSTEM. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS MAILED TO ALL BOARD MEMBERS WITH THE FEBRUARY BOARD PACKET. THE BOARD MEMBERS HAVE A CHANCE TO REVIEW THE FORM BEFORE THE FINANCE COMMITTEE MEETING WHERE A PRESENATION ON THE FORM 990 IS DONE. QUESTION AND ANSWER SESSIONS ARE HELD AT BOTH THE FINANCE COMMITTEE MEETING AND THE BOARD MEETING CONCERNING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES. THE COMPLIANCE OFFICE REVIEWS THEM, IDENTIFIES POTENTIAL CONFLICTS, AND FORWARDS TO THE ADMINISTRATIVE TEAM IF A POTENTIAL CONFLICT EXISTS, AS OUTLINED IN THE ORGANIZATIONAL POLICY. FORM 990, PART VI, SECTION B, LINE 15 KALISPELL REGIONAL HEALTHCARE SYSTEM HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL ITS EMPLOYEES, INCLUDING THE SENIOR EXECUTIVES. SALARY AND BENEFITS FOR THE PRESIDENT/CHIEF EXECUTIVE OFFICER ARE DETERMINED BY THE KALISPELL REGIONAL HEALTHCARE SYSTEM BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE AND REPORTED TO THE KALISPELL REGIONAL HEALTHCARE SYSTEM BOARD. THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWS BASE AND TOTAL COMPENSATION DATA FROM AN ARRAY OF COMPENSATION SURVEYS OF HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO KALISPELL REGIONAL HEALTHCARE SYSTEM. THESE REPORTS ARE CONSIDERED BY THE COMMITTEE, AND A DETERMINATION IS MADE AS TO THE STATUS OF THE BASE SALARY, BENEFITS, AND TOTAL COMPENSATION FOR THE PRESIDENT/CEO. THE BOARD AND EXECUTIVE COMPENSATION COMMITTEE EMBRACE THE PHILOSOPHY OF MAINTAINING A COMPENSATION LEVEL WHICH WILL FAVOR RETENTION OF KEY LEADERSHIP IN ORDER TO MAINTAIN STABILITY IN KEY INITIATIVES. ADDITIONALLY, THE PRESIDENT/CEO UTILIZES THE PERIODIC RETENTION OF A COMPENSATION CONSULTANT AND MARKET INFORMATION PROVIDED TO DETERMINE RECOMMENDATIONS FOR OTHER SENIOR EXECUTIVES AND ENGAGES IN AN ANALYSIS THROUGH USE OF INDEPENDENT SURVEY RESULTS. THE BOARD COMMITTEE ALSO INCLUDES A REVIEW OF PERFORMANCE TARGETS WHICH ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION. THESE MEASURES INCLUDE ORGANIZATIONAL AND INDIVIDUAL GOALS, EFFORTS TO FURTHER THE MISSION AND VISION OF KALISPELL REGIONAL HEALTHCARE SYSTEM, QUALITY INDICATORS, CUSTOMER/PATIENT SATISFACTION, AND FINANCIAL PERFORMANCE OBJECTIVES. THE BOARD COMMITTEE REVIEWS BENEFIT LEVELS AND TOTAL COMPENSATION TO ENSURE APPROPRIATENESS IN THE NOT-FOR-PROFIT HEALTH CARE SECTOR. THE BOARD EXECUTIVE COMPENSATION COMMITTEE MAKES ITS REPORT TO THE KALISPELL REGIONAL HEALTHCARE SYSTEM BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 ONLY FORM 990 IS AVAILABLE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 291,289. FUND BALANCE TRANSFERRED TO AFFILIATES -5,972,791. ADJUSTMENT FOR FOUNDATION ACTIVITY -548,604. NET CHANGE IN RESTRICTED ASSETS 2,066,971. CONSOLIDATION ENTRY FOR PRIOR YEAR TRANSFER 150,000. TOTAL TO FORM 990, PART XI, LINE 5: -4,013,135. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, COLUMN (B) THE OFFICERS OF KALISPELL REGIONAL MEDICAL CENTER DIVIDE THEIR TIME AMONG THE OTHER RELATED ENTITIES FOR WHICH THEY ARE ALSO OFFICERS. THEIR TOTAL AVERAGE WEEKLY HOURS DEVOTED TO ALL OF THE ENTITIES IS IN EXCESS OF 50 HOURS. SEVERAL OF THE TRUSTEES WHO ARE PHYSICIANS RECEIVE COMPENSATION FOR MEDICAL SERVICES RENDERED TO THE HOSPITAL. THEIR AVERAGE WEEKLY HOURS DEVOTED TO THE HOSPITAL VARIES. TATE KREITINGER DEVOTES APPROXIMATELY 50% OF HIS TIME TO KALISPELL REGIONAL MEDICAL CENTER AND 50% OF HIS TIME TO HEALTHCENTER NORTHWEST, A RELATED ENTITY. KALISPELL REGIONAL HEALTHCARE SYSTEM 310 SUNNYVIEW LANE KALISPELL MT 59901 810406485 SUPPORT SUBSIDIARY TAX EXEMPT ORGANIZATIONS MT 501(C)(3) 11, TYPE II N/A 0 KALISPELL REGIONAL HEALTHCARE FOUNDATION 310 SUNNYVIEW LANE KALISPELL MT 59901 311703013 SUPPORTING ORGANIZATION MT 501(C)(3) 11, TYPE I KALISPELL REGIONAL MEDICAL CENTER 1 NORTHWEST HORIZONS INC 310 SUNNYVIEW LANE KALISPELL MT 59901 810420653 OPERATE LONG TERM AMBULATORY FACILITY MT 501(C)(3) 9 KALISPELL REGIONAL HEALTHCARE SYSTEM 1 THE SUMMIT MEDICAL FITNESS CENTER 310 SUNNYVIEW LANE KALISPELL MT 59901 203752312 COMMUNITY HEALTH & WELLNESS CENTER MT 501(C)(3) 9 KALISPELL REGIONAL HEALTHCARE SYSTEM 1 KALISPELL REGIONAL MEDICAL CENTER VOLUNTEERS 310 SUNNYVIEW LANE KALISPELL MT 59901 273866474 SUPPORTING ORGANIZATION MT 501(C)(3) APPLIED FOR KALISPELL REGIONAL MEDICAL CENTER 1 MRICT JOINT OPERATING AGREEMENT 310 SUNNYVIEW LANE KALISPELL MT 59901 205010390 DIAGNOSTIC SCREENING MT KALISPELL REGIONAL MEDICAL CENTER RELATED 3572906 1861040 1 1 HEALTHCENTER NORTHWEST LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 810540517 ACUTE CARE HOSPITAL MT N/A N/A 0 0 FLATHEAD HOSPITAL DEVELOPMENT COMPANY LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 810541707 COMMERICAL BUILDING RENTAL MT N/A N/A 0 0 NORTHWEST ORTHOPEDICS & SPORTS MEDICINE LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 371518772 ORTHOPEDIC MEDICINE MT N/A N/A 0 0 ORTHOPEDICS ONE LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 800346984 ORTHOPEDIC MEDICINE MT N/A N/A 0 0 APPLIED HEALTH SERVICES INC 310 SUNNYVIEW LANE KALISPELL MT 59901 810413632 HEALTH RELATED MT N/A C 1 1 1 1 1 0 1 0 1 1 1 1 1 1 1 1 1 1 FLATHEAD HOSPITAL DEVELOPMENT COMPANY LLC A 29543 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC A 175549 ACTUAL PAYMENT KALISPELL REGIONAL HEALTHCARE FOUNDATION B 169000 ACTUAL PAYMENT KALISPELL REGIONAL HEALTHCARE SYSTEM A 27804 ACTUAL PAYMENT NORTHWEST HORIZON INC A 103 ACTUAL PAYMENT KALISPELL REGIONAL HEALTHCARE SYSTEM B 5822791 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC J 491330 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC J 150904 ACTUAL PAYMENT KALISPELL REGIONAL HEALTHCARE SYSTEM J 1129821 ACTUAL PAYMENT THE SUMMIT MEDICAL FITNESS CENTER INC J 253196 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC K 503255 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC K 211158 ACTUAL PAYMENT NORTHWEST HORIZON INC K 280926 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC L 3726427 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC L 3005958 ACTUAL PAYMENT NORTHWEST ORTHOPEDIC & SPORTS MEDICINE LLC L 183000 ACTUAL PAYMENT THE SUMMIT MEDICAL FITNESS CENTER INC L 512409 ACTUAL PAYMENT NORTHWEST HORIZON INC L 378687 ACTUAL PAYMENT FLATHEAD HOSPITAL DEVELOPMENT COMPANY LLC J 131896 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC G 60432 ACTUAL PAYMENT