NORTHERN MONTANA HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN MONTANA HOSPITAL (EIN 81-0231787)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-13
- IRS object ID
- 201321339349303967
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-13T15:09:36-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 450250958 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 NICOLLET MALL STE 1300 | AddressLine1 |
| City | MINNEAPOLIS | City |
| State | MN | State |
| ZIP Code | 554027033 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810231787 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | NORT | NameControl |
| Phone | 4062652211 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1231 | AddressLine1 |
| City | HAVRE | City |
| State | MT | State |
| ZIP Code | 595011231 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID HENRY | Name |
| Title | PRESIDENT/CEO | Title |
| Phone | 4062652211 | Phone |
| Date Signed | 2013-05-10 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KIM C HUNWARDSEN | Name |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | Phone |
| Date Prepared | 2013-05-10 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID HENRY | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1231 | AddressLine1 |
| City | HAVRE | City |
| State | MT | State |
| ZIP Code | 595011231 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 59742293 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NMHCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1921 | YearFormation |
| State Legal Domicile | MT | StateLegalDomicile |
| Activity Or Mission Description | PROVISION OF HEALTHCARE SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 726 | TotalNbrEmployees |
| Total Nbr Volunteers | 135 | TotalNbrVolunteers |
| Total Gross UBI | 324645 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 237879 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 182176 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 52974508 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 51574936 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 922805 | InvestmentIncomePriorYear |
| Investment Income Current Year | 738446 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 11540 | OtherRevenuePriorYear |
| Other Revenue Current Year | 2308 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 54146732 | TotalRevenuePriorYear |
| Total Revenue Current Year | 52497866 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 9152 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 12105 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 28598427 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 28582383 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 22385565 | OtherExpensePriorYear |
| Other Expenses Current Year | 21633370 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 50993144 | TotalExpensesPriorYear |
| Total Expenses Current Year | 50227858 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3153588 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2270008 | RevenuesLessExpensesCY |
| Total Assets BOY | 53915880 | TotalAssetsBOY |
| Total Assets EOY | 55588753 | TotalAssetsEOY |
| Total Liabilities BOY | 9021711 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 15352296 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 44894169 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 40236457 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO DELIVER HIGH QUALITY COMPREHENSIVE HEALTH CARE SERVICES TO THE HI-LINE COMMUNITIES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 37792055 | Expense |
| Grants | 12105 | Grants |
| Revenue | 51250291 | Revenue |
| Description | NORTHERN MONTANA HOSPITAL (HOSPITAL) PROVIDES QUALITY HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE THESE ESSENTIAL SERVICES. IT IS THE HOSPITAL'S MISSION TO SERVE THE SURROUNDING AREA BY PROVIDING HEALTHCARE SERVICES AND HEALTHCARE EDUCATION TO ALL COMMUNITY MEMBERS. DURING THE YEAR ENDED JUNE 30, 2012, THE HOSPITAL PROVIDED $1,047,714 OF MEDICAL SERVICES, BASED ON CHARGES, TO INDIVIDUALS WHO WERE DETERMINED UNABLE TO PURCHASE SUCH SERVICES UNDER THE HOSPITAL'S CHARITY CARE POLICY AND GUIDELINES. IN ADDITION TO FREE CARE AND/OR SUBSIDIZED CARE, CARE IS ALSO PROVIDED AT BELOW COST RATES TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS $29,879,652 FOR THE YEAR ENDED JUNE 30, 2012. DURING THE FISCAL YEAR ENDED JUNE 30, 2012 THE HOSPITAL PROVIDED OVER 4,300 DAYS OF HOSPITAL SERVICES. THE NURSING HOME PROVIDED OVER 36,500 DAYS OF RESIDENT SERVICES DURING THE YEAR.THE HOSPITAL ALSO PROVIDES COMMUNITY CARE AND SERVICES THROUGH MANY HEALTH CARE ACTIVITIES AND PROGRAMS PROVIDED TO SUPPORT THE COMMUNITY. THESE ACTIVITIES INCLUDE: WELLNESS PROGRAMS, COMMUNITY EDUCATION PROGRAMS, SENIOR SERVICES, HEALTH CARE SCREENING, SPECIAL PROGRAMS FOR SPECIFIC GROUPS, PUBLISHED ARTICLES, RADIO PROGRAMS, AND A VARIETY OF COMMUNITY SUPPORTED ACTIVITIES. THE HOSPITAL ALSO RECEIVED MANY HOURS OF VOLUNTEER HELP FROM THE COMMUNITY RESIDENTS. | Description |
| Total Program Service Expense | 37792055 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 1 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 1 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 1 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 106 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 726 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 0 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KIM LUCKE VP OF FINANCE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4062652211 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1231 | AddressLine1 |
| City | HAVRE | City |
| State | MT | State |
| ZIP Code | 59501 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| DAVID C HENRY | |||||||
| PRESIDENT/CEO | 40.00 | X | X | 378000 | 0 | 0 | |
| MILES HAMILTON | |||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 | |
| BRUCE RICHARDSON MD | |||||||
| VICE-CHAIRMAN | 40.00 | X | X | 326996 | 0 | 19765 | |
| DAVID LEEDS | |||||||
| TREASURER | 1.00 | X | X | 0 | 0 | 0 | |
| JUDY GREENWOOD | |||||||
| SECRETARY | 1.00 | X | X | 0 | 0 | 0 | |
| PAUL TUSS | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| STEPHEN BECHDOLT MD | |||||||
| TRUSTEE - CHIEF OF MEDICAL STAFF | 40.00 | X | 286923 | 0 | 10291 | ||
| TOM PATRICK | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| ANDREW CARLSON | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| MARGARET DOW MD | |||||||
| TRUSTEE - IPD MEMBER | 40.00 | X | 272528 | 0 | 23427 | ||
| MICHAEL NOLAN MD | |||||||
| TRUSTEE - IPD MEMBER | 40.00 | X | 272513 | 0 | 2548 | ||
| JULIE HOLT | |||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | ||
| KAREN POLLINGTON | |||||||
| VICE PRESIDENT | 40.00 | X | 89640 | 0 | 18971 | ||
| KIM LUCKE | |||||||
| VP OF FINANCE | 40.00 | X | 69989 | 0 | 17180 | ||
| KAREN E LIEN MD | |||||||
| DOCTOR | 40.00 | 323833 | 0 | 20808 | X | ||
| JOHN TRUE MD | |||||||
| DOCTOR | 40.00 | 353116 | 0 | 0 | X | ||
| DAMIAN YMZON MD | |||||||
| DOCTOR | 40.00 | 342564 | 0 | 16471 | X | ||
| ALLEN REBCHOOK MD | |||||||
| DOCTOR | 40.00 | 347976 | 0 | 7733 | X | ||
| SUZANNE SWIETNICKI MD | |||||||
| DOCTOR | 40.00 | 238088 | 0 | 21259 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 3302166 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 158453 | TotalOtherCompensation |
| Number Individuals GT100 K | 33 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| LISTON RADIOLOGY CONSULTING | |||||
| 1562 RIALTO LANE | DAVIS | CA | 95618 | CONTRACT RADIOLOGY SERVICES | 600000 |
| DANIEL ABBOTT | |||||
| 1715 13TH STREET WEST | HAVRE | MT | 59501 | ANESTHESIA SERVICES | 247777 |
| D & Y LOCUM TENENS | |||||
| 86 JUNIPER BEND DRIVE | KALISPELL | MT | 59901 | LOCUMS PHYSICIANS | 203107 |
| DAVID WIDDEKIND | |||||
| 1624 PINE DRIVE | HAVRE | MT | 59501 | ANESTHESIA SERVICES | 177600 |
| PAML | |||||
| PO BOX 2720 | SPOKANE | WA | 99220 | REFERENCE LAB SERVICES | 146311 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 12 | NumberOfContractorsGT100K |
| Related Organizations | 154941 | RelatedOrganizations |
| Government Grants | 15430 | GovernmentGrants |
| All Other Contributions | 11805 | AllOtherContributions |
| Total Contributions | 182176 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| NET PATIENT SERVICE RE | 622110 | 44737193 | 44737193 | |
| PHARMACY | 446110 | 6050276 | 5725631 | 324645 |
| HEALTHCARE CONSULTING | 541900 | 448568 | 448568 | |
| CAFETERIA REVENUE | 722210 | 230587 | 230587 | |
| OTHER PROGRAM REVENUE | 900099 | 108312 | 108312 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 51574936 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 746849 | TotalRevenueColumn |
| Exclusion | $746,849 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 9365 | Real |
| Personal | 1650 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 6810 | Real |
| Personal | 1897 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2555 | Real |
| Personal | -247 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2308 | TotalRevenueColumn |
| Exclusion | $2,308 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7227317 | Securities |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 7235720 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -8403 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -8403 | TotalRevenueColumn |
| Exclusion | -$8,403 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 52497866 | TotalRevenueColumn |
| Related Or Exempt Function Income | 51250291 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 324645 | UnrelatedBusinessRevenue |
| Exclusion | $740,754 | ExclusionAmount |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12105 | Total |
| Program Services | 12105 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2002815 | Total |
| Program Services | 1385316 | ProgramServices |
| Management And General | 617499 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22277399 | Total |
| Program Services | 15932572 | ProgramServices |
| Management And General | 6344827 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 477243 | Total |
| Program Services | 334070 | ProgramServices |
| Management And General | 143173 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1768302 | Total |
| Program Services | 972566 | ProgramServices |
| Management And General | 795736 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2056624 | Total |
| Program Services | 1439637 | ProgramServices |
| Management And General | 616987 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 300000 | Total |
| Program Services | 60000 | ProgramServices |
| Management And General | 240000 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 64969 | Total |
| Management And General | 64969 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 69890 | Total |
| Management And General | 69890 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4415066 | Total |
| Program Services | 4152745 | ProgramServices |
| Management And General | 262321 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 240848 | Total |
| Management And General | 240848 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2164115 | Total |
| Program Services | 1221348 | ProgramServices |
| Management And General | 942767 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 474464 | Total |
| Program Services | 379571 | ProgramServices |
| Management And General | 94893 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1723077 | Total |
| Program Services | 1203542 | ProgramServices |
| Management And General | 519535 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 188686 | Total |
| Program Services | 66040 | ProgramServices |
| Management And General | 122646 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1869354 | Total |
| Program Services | 1308548 | ProgramServices |
| Management And General | 560806 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1402769 | Total |
| Program Services | 1122215 | ProgramServices |
| Management And General | 280554 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 4120998 | 4120998 | |
| BAD DEBT EXPENSE | 3012420 | 3012420 | |
| EQUIPMENT RENTAL AND MA | 897456 | 493601 | 403855 |
| BED TAX | 546130 | 546130 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 143128 | Total |
| Program Services | 28631 | ProgramServices |
| Management And General | 114497 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50227858 | Total |
| Program Services | 37792055 | ProgramServices |
| Management And General | 12435803 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5390345 | BOY |
| EOY | 24109 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 287849 | BOY |
| EOY | 4964034 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11385437 | BOY |
| EOY | 13860295 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1319273 | BOY |
| EOY | 1299343 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 713310 | BOY |
| EOY | 433168 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 47280950 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 39360795 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8629178 | BOY |
| EOY | 7920155 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 25350329 | BOY |
| EOY | 25671006 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 90226 | BOY |
| EOY | 93637 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 749933 | BOY |
| EOY | 1323006 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53915880 | BOY |
| EOY | 55588753 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3759420 | BOY |
| EOY | 3579713 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5262291 | BOY |
| EOY | 11772583 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9021711 | BOY |
| EOY | 15352296 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44894169 | BOY |
| EOY | 40236457 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 44894169 | BOY |
| EOY | 40236457 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53915880 | BOY |
| EOY | 55588753 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 2270008 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -6927720 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | 1 | AgentTrusteeEtc |
| Beginning Balance | 32409 | BeginningBalance |
| Additions During Year | 125157 | AdditionsDuringYear |
| Distributions During Year | 122630 | DistributionsDuringYear |
| Ending Balance | 34936 | EndingBalance |
| Included On FS | 0 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 75272 | OtherCostOrOtherBasis |
| Book Value | 75272 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 20062756 | OtherCostOrOtherBasis |
| Depreciation | 16379023 | Depreciation |
| Book Value | 3683733 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 972249 | OtherCostOrOtherBasis |
| Depreciation | 709204 | Depreciation |
| Book Value | 263045 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 26007441 | OtherCostOrOtherBasis |
| Depreciation | 22272568 | Depreciation |
| Book Value | 3734873 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 163232 | OtherCostOrOtherBasis |
| Book Value | 163232 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 7920155 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| LIABILITY FOR PENSION BENEFITS | $10,885,957 |
| THIRD-PARTY PAYOR SETTLEMENTS | $882,698 |
| DUE TO RELATED PARTIES | $3,928 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 11772583 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 1B: | THE CUSTODIAL FUNDS ARE NOT REPORTED ON THE BALANCE SHEET OF NMH AS THEY ARE THE PERSONAL RESOURCE FUNDS OF THE RESIDENTS TO BE USED ONLY FOR THEIR PERSONAL NEEDS. IF THE RESIDENT PASSES, THE FUNDS EITHER GO TO THE FAMILY OR BACK TO THE STATE. THEY ARE IN NO WAY AN ASSET OF THE ORGANIZATION. | |
| PART X: | THE ORGANIZATION AND ITS THREE NONPROFIT AFFILIATES ARE ENTITIES ORGANIZED AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION ALSO HAS A TAXABLE AFFILIATE, WHICH IS INACTIVE AND HAD NO TAXABLE INCOME IN 2012 AND 2011. THE ORGANIZATION AND ITS AFFILIATES ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE 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. THE ORGANIZATION'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2009. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 1 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 594000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 594000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01260 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10125666 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 8978833 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1146833 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02430 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 371494 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 490718 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -119224 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 11091160 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 9469551 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1621609 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03690 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15634 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 15634 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3169 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 3169 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9361006 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7064345 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2296661 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04860 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 32279 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 32279 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9412088 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 7064345 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2347743 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04970 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 20503248 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 16533896 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3969352 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08660 | PercentOfTotalExpense |
Physical Improvements And Housing PhysicalImprovementsAndHousing
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 10753 | PersonsServed |
| Total Community Building Expense | 137953 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 99996 | DirectOffsettingRevenue |
| Net Community Building Expense | 37957 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 460 | PersonsServed |
| Total Community Building Expense | 3385 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3385 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Coalition Building CoalitionBuilding
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 521 | PersonsServed |
| Total Community Building Expense | 71 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 71 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 11734 | PersonsServed |
| Total Community Building Expense | 141409 | TotalCommunityBuildingExpense |
| Direct Offsetting Revenue | 99996 | DirectOffsettingRevenue |
| Net Community Building Expense | 41413 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $3,012,420 | BadDebtExpenseAmount |
| Amount Attributable To | 38697 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 8492370 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 8970104 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -477734 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 0 | WrittenDebtCollectionPolicy |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 30 13TH STREET | AddressLine1 |
| City | HAVRE | City |
| State | MT | State |
| ZIP Code | 59501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 0 | CHNAConducted |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 100.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| NORTHERN MONTANA MEDICAL GROUP WEST | ||||
| 20 13TH STREET WEST | HAVRE | MT | 59501 | CLINIC |
| NORTHERN MONTANA MEDICAL GROUP EAST | ||||
| 124 13TH STREET | HAVRE | MT | 59501 | CLINIC |
| NORTHERN MONTANA CARE CENTER | ||||
| 24 13TH STREET | HAVRE | MT | 59501 | NURSING HOME |
Form990 Schedule H Part VI Form990ScheduleHPartVI (16 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT WAS PUBLISHED AS A 1/2 PAGE AD IN THE LOCAL NEWSPAPER. IN ADDITION, A STATEMENT ABOUT THE AMOUNT OF COMMUNITY BENEFIT THE ORGANIZATION PROVIDED CAN BE FOUND ON OUR WEB-SITE AT WWW.NMHCARE.ORG. | ||
| PART I, LINE 7: CHARITY CARE EXPENSE ON LINE 7A WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. UNREIMBURSED MEDICAID, LINE 7B, AND UNREIMBURSED COSTS - OTHER MEANS-TESTED GOVERNMENT PROGRAMS, LINE 7C, WERE CALCULATED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, AND CASH AND IN-KIND DONATIONS, LINE 7I, ARE ACTUAL COSTS REPORTED IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. | ||
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION WAS $3,012,420. | ||
| PART II: REPORTED UNDER COMMUNITY BUILDING ACTIVITIES IS THE MAINTENANCE OF OUR FITNESS PARK WHICH IS OPEN TO THE PUBLIC AND HAS BOTH A SOFTBALL FIELD AND SOCCER FIELD, AS WELL AS A PAVED WALKING PATH. IT ALSO INCLUDES AN EMPLOYEE'S TIME FOR BEING A MEMBER OF THE HILL COUNTY HEALTH CONSORTIUM, WHICH COLLABORATIVELY CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT WITH SEVERAL OTHER LOCAL PUBLIC HEALTH ENTITIES AND WORKS TO IMPLEMENT THE IDENTIFIED UNMET NEEDS OF THE COMMUNITY. ANOTHER COMMUNITY BUILDING ACTIVITY IS COMMUNITY FORUMS AT WHICH EMPLOYED PHYSICIANS GIVE EDUCATIONAL PRESENTATIONS TO THE COMMUNITY ON VARIOUS HEALTH TOPICS. | ||
| PART III, LINE 4: THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BY USING CHARITY CARE AS A PERCENTAGE OF GROSS PATIENT SERVICE REVENUE. AS A PORTION OF REVENUE IS CONSIDERED CHARITY CARE, IT IS ASSUMED THAT A PERCENTAGE OF BAD DEBT EXPENSE WOULD ALSO BE CONSIDERED CHARITY CARE.BAD DEBT EXPENSE IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR. THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. | ||
| PART III, LINE 8: THESE EXPENSES REPRESENT AN OVERALL SHORTFALL OF THE MEDICARE PATIENT POPULATION. THE COSTS THEMSELVES ARE THEREFORE A COMMUNITY BENEFIT AS THE COMMUNITY WOULD NOT RECEIVE THESE SERVICES IF WE DID NOT PROVIDE THEM. MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. | ||
| PART III, LINE 9B: THE ORGANIZATION DOES NOT HAVE A WRITTEN DEBT COLLECTION POLICY, BUT HAVE WRITTEN PROCEDURES THAT THEY FOLLOW. THE ORGANIZATION IS WORKING ON DEVELOPING A WRITTEN DEBT COLLECTION POLICY. THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY PROVIDES HOW THEY WILL COLLECT FROM THOSE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. THE POLICY STATES "DURING THE PATIENT REGISTRATION OR COLLECTION PROCESS, THE HOSPITAL WILL MAKE AN INITIAL DETERMINATION OF ELIGIBILITY BASED ON VERBAL OR WRITTEN APPLICATION FOR CHARITY CARE. PENDING FINAL ELIGIBILITY DETERMINATION, THE HOSPITAL WILL NOT INITIATE COLLECTION EFFORTS OR REQUESTS FOR DEPOSITS, PROVIDED THAT THE RESPONSIBLE PARTY IS COOPERATIVE WITH THE HOSPITAL'S EFFORTS TO REACH A DETERMINATION OF STATUS, INCLUDING RETURN OF APPLICATIONS AND DOCUMENTATION REQUIRED BY THE HOSPITAL WITHIN FOURTEEN (14) DAYS OF RECEIPT." | ||
| PART V, SECTION B, LINE 13G: THE FINANCIAL ASSISTANCE POLICY IS AVAILABLE ON THE HOSPITAL'S WEBSITE AT WWW.NMHCARE.ORG. IN ADDITION A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE FACILITY'S EMERGENCY ROOM AND WAITING ROOMS AS WELL AS ADMISSIONS OFFICES. THE HOSPITAL'S "CONDITIONS OF TREATMENT" ALSO INCLUDES INFORMATION REGARDING THE FINANCIAL ASSISTANCE POLICY. | NORTHERN MONTANA HOSPITAL | |
| PART V, SECTION B, LINE 19D: THE MAXIMUM AMOUNT CHARGED TO A PATIENT UNDER THE FINANCIAL ASSISTANCE POLICY FOR EMERGENCY AND MEDICALLY NECESSARY CARE IS 80% OF THE GROSS CHARGES. THIS IS BASED ON THE LOWEST DISCOUNT UNDER THE CHARITY CARE POLICY OF 20%. THE HOSPITAL WILL REVIEW THE PROPOSED METHODS TO DETERMINE AMOUNTS GENERALLY BILLED TO DETERMINE ITS DISCOUNT UNDER THE FINANCIAL ASSISTANCE POLICY MEETS THE REQUIREMENTS OF 501(R). | NORTHERN MONTANA HOSPITAL | |
| PART V, SECTION B, LINE 21: ALL INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY ARE PROVIDED A DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO ELECTIVE PROCEDURES. THEREFORE, FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE CHARGED GROSS CHARGES ON ELECTIVE PROCEDURES. | NORTHERN MONTANA HOSPITAL | |
| PART VI, LINE 2: COMMUNITY NEEDS ASSESSMENTS ARE CONDUCTED THROUGHOUT THE COMMUNITY BY ORGANIZATIONS SUCH AS HRDC, THE BOYS & GIRLS CLUB AND THE MONTANA ECONOMIC DEVELOPMENT COUNCIL. THESE ASSESSMENTS ARE SHARED WITH THE COMMUNITY. THROUGH THESE ASSESSMENTS, NORTHERN MONTANA HOSPITAL IS ABLE TO IDENTIFY THE NEEDS WE CAN HELP MEET. THE CURRENT NEEDS ARE: TRANSPORTATION, MENTAL HEALTH AND YOUTH IN NEED. NORTHERN MONTANA HOSPITAL HAS KEY EMPLOYEES THAT ARE WORKING WITH A COLLECTIVE COMMUNITY GROUP ON THE TRANSPORTATION COALITION. WE ALSO PARTICIPATE IN A COMMUNITY PROGRAM, 'HEALTHY YOUTH, HEALTHY COMMUNITY' IN COALITION WITH THE BOYS & GIRLS CLUB AND OTHER COMMUNITY ORGANIZATIONS. NORTHERN MONTANA HOSPITAL IS HELPING TO MEET THE MENTAL HEALTH NEEDS OF THE COMMUNITY BY OFFERING AND SUBSIDIZING MENTAL HEALTH SERVICES. WE ALSO SUBSIDIZE THE BULLHOOK COMMUNITY HEALTH CENTER WHICH WAS FORMED TO MEET THE NEEDS OF THE UNINSURED AND UNDERINSURED.IN FY 2011 NORTHERN MONTANA HOSPITAL BECAME A MEMBER OF THE HILL COUNTY HEALTH CONSORTIUM. THE CONSORTIUM IS COMPOSED OF MANY IMPORTANT STAKEHOLDERS IN THE COMMUNITY WHO HAVE JOINED TOGETHER TO IDENTIFY THE CURRENT HEALTH NEEDS IMPACTING THE COMMUNITY. PARTNERSHIPS WERE FORMED BY MEMBERS OF THE CONSORTIUM TO HELP GATHER THE DATA NEEDED IN THE DISCUSSIONS. THE CHANGE (COMMUNITY HEALTH ASSESSMENT AND GROUP EVALUATION) TOOL FROM THE CDC WEBSITE WAS CHOSEN TO HELP US THROUGH THE PROCESS OF OUR COMMUNITY HEALTH ASSESSMENT MAINLY BECAUSE IT WOULD WALK US THROUGH EACH STEP IN THE PROCESS. CHANGE CAN BE USED TO GAIN A PICTURE OF THE POLICY, SYSTEMS, AND ENVIRONMENTAL CHANGE STRATEGIES CURRENTLY IN PLACE THROUGHOUT THE COMMUNITY; DEVELOP A COMMUNITY ACTION PLAN FOR IMPROVING POLICIES, SYSTEMS, AND THE ENVIRONMENT TO SUPPORT HEALTHY LIFESTYLES; AND ASSIST WITH PRIORITIZING COMMUNITY NEEDS AND ALLOCATING AVAILABLE RESOURCES. THE CHANGE TOOL INVOLVES DIVIDING OUR COMMUNITY INTO 5 DIFFERENT SECTORS AND CHOOSING A FEW SITES WITHIN THOSE SECTORS TO COLLECT RESPONSES FROM. THE 5 SECTORS INCLUDE:(1) COMMUNITY-AT-LARGE(2) COMMUNITY-INSTITUTIONS-ORGANIZATIONS(3) WORKSITE(4) HEALTH CARE(5) SCHOOLSALONG WITH THE CHANGE TOOL, A WRITTEN SURVEY WAS CREATED USING AN EXAMPLE FROM WILKES HEALTHY CAROLINIANS COUNCIL (WILKESHEALTH.COM). THIS SURVEY SEEMED TO FIT CLOSELY WITH OUR NEEDS, WITH ONLY MINOR ADJUSTMENTS BEING MADE TO FIT HILL COUNTY. THIS WRITTEN SURVEY WAS AVAILABLE THROUGHOUT HILL COUNTY AT VARIOUS WAITING AREAS SO PEOPLE WOULD HAVE ADEQUATE TIME TO COMPLETE THEM.OUT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) THE COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) WAS DEVELOPED. THE PLAN IDENTIFIES SEVERAL HEALTH RELATED ISSUES THAT ADVERSELY IMPACT THE HEALTH OF THE COMMUNITY. THIS PLAN NOT ONLY PROVIDES US WITH A DEEPER LOOK INTO THE CURRENT HEALTH STATUS OF THE COMMUNITY, IT LEADS US INTO PROVIDING SOLUTIONS FOR IMPROVING THE HEALTH STATUS OF OUR COMMUNITY. THESE IMPROVEMENTS ARE SPEARHEADED BY SUBCOMMITTEES CHOSEN THROUGH THE HILL COUNTY CONSORTIUM AND OTHER LOCAL AGENCIES.THE COMMUNITY HEALTH IMPROVEMENT PLAN IS AN ONGOING PROCESS. THE COMMUNITY HEALTH ASSESSMENT WILL BE REPEATED IN 2014 AND WILL FORM THE BASIS BY WHICH IMPROVEMENT WILL BE MEASURED. NORTHERN MONTANA HOSPITAL TAKES AN ACTIVE ROLE IN THE HILL COUNTY HEALTH CONSORTIUM. | ||
| PART VI, LINE 3: NORTHERN MONTANA HOSPITAL INFORMS AND EDUCATES PATIENTS ABOUT THEIR ELIGIBILITY FOR ASSISTANCE THROUGH A SIGN POSTED AT OUR ADMISSIONS DESK, NOTED IN THE BROCHURE WE GIVE PATIENTS AT OUR CLINICS, AND SIGNS POSTED AT OUR CLINIC REGISTRATION DESKS. IN ADDITION, OUR COLLECTION STAFF OFFER CHARITY CARE AS AN OPTION WHEN THEY ARE DISCUSSING THE PATIENT'S BALANCE AS WELL AS THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS. AS OF OCT 2010, NMH HAS CONTRACTED WITH A COMPANY TO ASSIST THE PATIENT WITH QUALIFICATION FOR PROGRAMS SUCH AS MEDICAID AND DISABILITY DETERMINATION.WE ALSO PUBLISH A COMMUNITY BENEFIT REPORT ANNUALLY WHICH STATES HOW MUCH FINANCIAL ASSISTANCE WE HAVE GIVEN AWAY, AND WE POST OUR COMMUNITY BENEFIT REPORT ON OUR WEBSITE NOTING THAT WE PROVIDE FINANCIAL ASSISTANCE. | ||
| PART VI, LINE 4: NORTHERN MONTANA HOSPITAL IS A 49 BED HOSPITAL INCLUDING 5 SWING BEDS, A 5 BED INTENSIVE CARE UNIT, 24-HOUR STAFFED EMERGENCY ROOM, SAME DAY SURGERY, AND A 6 CHAIR DIALYSIS UNIT; NORTHERN MONTANA CARE CENTER, A 136 BED SKILLED AND INTERMEDIATE CARE FACILITY OF WHICH 20 BEDS ARE DESIGNATED FOR RESIDENT'S WITH ALZHEIMER'S DISEASE AND OTHER RELATED DEMENTIAS; NORTHERN MONTANA ASSISTED LIVING, A 10 BED FACILITY; NORTHERN MONTANA MEDICAL GROUP - EAST, A RURAL HEALTH CLINIC; NORTHERN MONTANA MEDICAL GROUP - WEST, A RURAL HEALTH CLINIC; NORTHERN MONTANA VISION CENTER, AN OPHTHALMOLOGY OFFICE; BEAR PAW HOSPICE, AND THE HI-LINE SLEEP CENTER. THE HOSPITAL'S SERVICE AREA CONSISTS OF HILL, BLAINE, LIBERTY, PHILIPS AND THE BIG SANDY CENSUS DISTRICT OF CHOTEAU COUNTIES. THE POPULATION OF THIS SERVICE AREA IS APPROXIMATELY 30,000. THE MEDIAN HOUSEHOLD INCOME IS ABOUT $42,000. APPROXIMATELY 45% OF THE POPULATION HAS A HOUSEHOLD INCOME BELOW 200% OF THE FEDERAL POVERTY GUIDELINES. APPROXIMATELY 22% OF THE POPULATION IS COVERED BY MEDICAID, 30% BY MEDICARE, 2.5% BY CHIP AND ABOUT 24% UNINSURED. ADDITIONALLY, ANOTHER 8% OF THE POPULATION IS COVERED BY INDIAN HEALTH SERVICES. THE ENTIRE SERVICE AREA IS CONSIDERED RURAL AND HAS BEEN DESIGNATED A HEALTH PROFESSIONAL SHORTAGE AREA FOR ALL PRIMARY MEDICAL CARE, MENTAL HEALTH AND DENTAL. IN ADDITION, THE ENTIRE SERVICE AREA IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA. NORTHERN MONTANA HOSPITAL IS THE ONLY LOCAL HOSPITAL IN ITS SERVICE AREA; HOWEVER THERE ARE 3 CRITICAL ACCESS HOSPITALS, 4 RURAL HEALTH CLINICS, 3 COMMUNITY HEALTH CLINICS AND 3 IHS-TRIBAL CLINICS WITHIN ITS SERVICE AREA. THE NEAREST HOSPITAL IS A CRITICAL ACCESS HOSPITAL AND IS 35 MILES AWAY. | ||
| PART VI, LINE 5: NORTHERN MONTANA HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. THE ORGANIZATION APPLIES SURPLUS FUNDS TO IMPROVEMENTS IN PATIENT CARE BY KEEPING ITS MEDICAL EQUIPMENT UP TO DATE, SENDING ITS EMPLOYED PHYSICIANS FOR FURTHER CONTINUING EDUCATION, SUPPORTING NURSING EDUCATION THROUGH A LOAN RE-PAYMENT ASSISTANCE PROGRAM AND SUPPORTING HEALTH CARE EDUCATION THROUGH AN EDUCATION ASSISTANCE PROGRAM. IN ADDITION, THE HOSPITAL SUBSIDIZES ITS EMERGENCY DEPARTMENT BY OFFERING 24/7 EMERGENT CARE COVERAGE TO ALL, REGARDLESS OF THEIR ABILITY TO PAY. NORTHERN MONTANA HOSPITAL OFFERS DIALYSIS SERVICES TO PATIENTS IN OUR SERVICE AREA, DESPITE THE FACT THAT THIS SERVICE IS PROVIDED AT A LOSS TO NMH. WITHOUT THIS SERVICE, PATIENTS WOULD HAVE TO TRAVEL WELL OVER 100 MILES EACH WAY, 3 TIMES PER WEEK TO RECEIVE THIS SERVICE. NORTHERN MONTANA HOSPITAL HAS SOLE COMMUNITY DESIGNATION. THE NEAREST PPS HOSPITAL IS LOCATED 110 MILES FROM HAVRE. NORTHERN MONTANA HOSPITAL ALSO PARTICIPATES IN ALL GOVERNMENT SPONSORED HEALTH PROGRAMS, SUCH AS CHIP, HEALTHY MONTANA KIDS AND THE MONTANA CERVICAL AND BREAST CANCER PROGRAM, WHERE IT ACCEPTS PAYMENTS FOR SERVICES AT GREATLY DISCOUNTED RATES. SEVERAL MEMBERS OF NORTHERN MONTANA HOSPITAL'S LEADERSHIP TEAM SERVE ON OTHER COMMUNITY BOARDS, SUCH AS: HAVRE CHAMBER OF COMMERCE, HILL COUNTY HEALTH CONSORTIUM, LOCAL EMERGENCY PLANNING, FETAL/INFANT/CHILD MORTALITY REVIEW BOARD, HAVRE/HILL COUNTY PLANNING BOARD, HILL AND BLAINE COUNTY ADULT PROTECTIVE SERVICES COMMITTEE, HILL COUNTY UNITED WAY, HRDC MEDICAL ADVISORY BOARD, MSU-N NURSING ADVISORY BOARD AND THE SAFE KIDS SAFE COMMUNITIES COMMITTEE. | ||
| PART VI, LINE 6: N/A | ||
| MT | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | EDUCATION ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 2 | NumberOfRecipients |
| Amount Of Cash Grant | 12105 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | PART I, LINE 2: | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION PROVIDES EDUCATION ASSISTANCE TO QUALIFIED EMPLOYEES. THE ORGANIZATION MONITORS THE USE OF THE ASSISTANCE BY DISBURSING THE FUNDS DIRECTLY TO THE INSTITUTION. |
| PER OUR EDUCATION ASSISTANCE POLICY, WE WILL ONLY ASSIST FOR DEGREES THAT WILL FULFILL OUR STAFFING NEEDS. WE WILL PAY UP TO $5,250 PER EMPLOYEE PER YEAR, HOWEVER NOT EVERY APPLICANT REQUESTS THE FULL AMOUNT. THEREFORE, WE ANTIPATE 3-6 RECIPIENTS PER YEAR. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 1 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVID C HENRY | |||||||||||||
| 300000 | 0 | 78000 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 378000 | 0 | 0 | 0 |
| BRUCE RICHARDSON MD | |||||||||||||
| 325808 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 22710 | 0 | 349706 | 0 | 0 | 0 |
| STEPHEN BECHDOLT MD | |||||||||||||
| 285735 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 12842 | 0 | 299765 | 0 | 0 | 0 |
| MARGARET DOW MD | |||||||||||||
| 272333 | 0 | 0 | 0 | 195 | 0 | 0 | 0 | 25942 | 0 | 298470 | 0 | 0 | 0 |
| MICHAEL NOLAN MD | |||||||||||||
| 271325 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 4949 | 0 | 277462 | 0 | 0 | 0 |
| KAREN E LIEN MD | |||||||||||||
| 323563 | 0 | 0 | 0 | 270 | 0 | 0 | 0 | 23727 | 0 | 347560 | 0 | 0 | 0 |
| JOHN TRUE MD | |||||||||||||
| 350000 | 0 | 0 | 0 | 3116 | 0 | 0 | 0 | 3068 | 0 | 356184 | 0 | 0 | 0 |
| DAMIAN YMZON MD | |||||||||||||
| 342402 | 0 | 0 | 0 | 162 | 0 | 0 | 0 | 19539 | 0 | 362103 | 0 | 0 | 0 |
| ALLEN REBCHOOK MD | |||||||||||||
| 347292 | 0 | 0 | 0 | 684 | 0 | 0 | 0 | 10802 | 0 | 358778 | 0 | 0 | 0 |
| SUZANNE SWIETNICKI MD | |||||||||||||
| 237614 | 0 | 0 | 0 | 474 | 0 | 0 | 0 | 23450 | 0 | 261538 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART I, LINE 5 | TWO PHYSICIANS LISTED IN PART VII OF THE FORM 990 ARE COMPENSATED AS A PERCENTAGE OF THE PRIOR THREE MONTHS' AVERAGE GROSS REVENUE EARNED FOR THE HOSPITAL BY THE PHYSICIAN, WITH THE PERCENTAGE BEING BASED ON THEIR SPECIALTY. | |
| PART III | SCHEDULE J, PART I, LINE 3: THE CEO/PRESIDENT OF NORTHERN MONTANA HOSPITAL IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY, FUNDAMENTAL FINANCIAL GROUP, FOR HIS SERVICES PROVIDED TO NORTHERN MONTANA HOSPITAL, NORTHERN MONTANA HEALTH CARE FOUNDATION, INC., AND NORTHERN MONTANA HEALTH CARE, INC. HE SERVES 40 HOURS PER WEEK AT THE HOSPITAL, TWO (2) HOURS PER WEEK AT THE FOUNDATION, AND ONE (1) HOUR PER WEEK AT NORTHERN MONTANA HEALTH CARE, INC. THE BOARD WORKS WITH THE UNRELATED MANAGEMENT COMPANY TO DETERMINE THE CEO/PRESIDENT'S COMPENSATION USING THE METHODS CHECKED IN LINE 3. | SUPPLEMENTAL INFORMATION |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE PRESIDENT/CEO OF THE HOSPITAL IS EMPLOYED BY AN UNRELATED MANAGEMENT COMPANY. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS NORTHERN MONTANA HEALTH CARE, INC. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE SOLE MEMBER OF THE ORGANIZATION SHALL HAVE SUCH RIGHTS AND POWERS AS ARE PROVIDED FOR IN THE ARTICLES OF INCORPORATION, THE BYLAWS OF THE ORGANIZATION AND THE LAWS OF THE STATE OF MONTANA, INCLUDING BUT NOT LIMITED TO, THE EXCLUSIVE POWER: (A) TO REMOVE ANY TRUSTEE FROM ANY OFFICE AT ANY TIME, WITH OR WITHOUT CAUSE; (B) TO PROPOSE AND APPROVE (I) A PLAN OF DISSOLUTION OR LIQUIDATION OF THE ORGANIZATION OR (II) A PLAN OF MERGER OR CONSOLIDATION OF THE ORGANIZATION WITH ANOTHER CORPORATION; (C) TO PROPOSE AND APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION AND OR THE BYLAWS;(D) TO ADOPT ANY ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET OR ANY CHANGES THEREIN EXCEEDING $75,000;(E) TO AUTHORIZE THE ORGANIZATION TO ENTER INTO ANY CONTRACT OR ENGAGE IN ANY TRANSACTION WHICH IS NOT PROVIDED FOR IN AN ANNUAL OR LONG-TERM CAPITAL OR OPERATIONAL BUDGET APPROVED BY THE SOLE MEMBER OF THE ORGANIZATION WHERE THE AMOUNT INVOLVED EXCEEDS $50,000;(F) TO ADOPT SUBSTANTIVE CHANGES TO EXISTING LONG-TERM OR MASTER INSTITUTIONAL PLANS OF THE ORGANIZATION; (G) TO AUTHORIZE THE ORGANIZATION TO ENGAGE IN, OR ENTER INTO, ANY TRANSACTION PROVIDING FOR THE SALE, MORTGAGE OR OTHER DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (H) TO ORGANIZE OR ACQUIRE, OR AUTHORIZE THE ORGANIZATION OR ACQUISITION OF, ANY SUBSIDIARY OR AFFILIATE OF THE ORGANIZATION; (I) TO AUTHORIZE THE ORGANIZATION TO ENTER INTO ANY SHARED SERVICE AGREEMENT; (J) TO APPROVE LONG-TERM BORROWING OF MONEY BY THE ORGANIZATION OR AUTHORIZE THE ORGANIZATION TO INCUR INDEBTEDNESS INVOLVING A MORTGAGE OR LIEN ON ASSETS; OR (K) TO APPROVE THE TRUSTEES OR THE PRESIDENT OF THE ORGANIZATION FROM A SLATE PREPARED BY THE NOMINATING COMMITTEE OF THE ORGANIZATION. | |
| FORM 990, PART VI, SECTION A, LINE 8B | NO COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 WILL BE REVIEWED BY THE VP OF FINANCE, AND THEN SUBMITTED VIA E-MAIL TO THE BOARD OF DIRECTORS TO VIEW BEFORE FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY COVERS ALL TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES. THE BOARD IDENTIFIES POTENTIAL CONFLICTS FROM ANNUAL DISCLOSURES. DISCLOSURES ARE REVIEWED BY ADMINISTRATION AFTER ALL ARE GATHERED. A SECOND CONFLICT DISCLOSURE LETTER IS SENT OUT ANNUALLY TO ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO ENSURE ALL POTENTIAL CONFLICTS ARE IDENTIFIED. THE RESULTS OF THIS DISCLOSURE FORM ARE REVIEWED BY THE VP OF FINANCE. THE BOARD DISCUSSES THE POTENTIAL CONFLICTS AND DETERMINES IF VOTING ON RELATED ITEMS WOULD BE A CONFLICT OF INTEREST. IF A CONFLICT IS DETERMINED TO EXIST, THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE CONFLICTED ITEM. | |
| FORM 990, PART VI, SECTION B, LINE 15A | THE CEO/PRESIDENT IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. THE EXECUTIVE COMMITTEE OF THE BOARD MEETS AND REVIEWS NORTHERN MONTANA HOSPITAL(NMH)/NORTHERN MONTANA HEALTH CARE, INC.(NMHC) FINANCIAL RESULTS, THE CEO'S CURRENT YEAR PRIORITIES, DISCUSSES EVALUATION TOOLS TO BE USED FOR CEO EVALUATION, HOW COMPARATIVE SALARIES WILL BE OBTAINED AND DISCUSSES THE HISTORY OF COMPENSATION TO THE CEO. AT A SECOND EXECUTIVE COMMITTEE MEETING THEY REVIEW NON-FINANCIAL ACTIVITY OF NMH/NMHC AND THE RESULTS OF THE CEO EVALUATIONS COMPLETED BY THE BOARD MEMBERS. THEN THEY REVIEW AND DISCUSS A COMPENSATION COMPARATIVE SUMMARY OF MONTANA CEO'S COMPENSATION AND A GUIDESTAR CEO COMPENSATION CHECKPOINT THAT IS PREPARED SPECIFICALLY FOR NMH. THEY AGREE UPON A LIST OF THE COMING YEAR'S PRIORITIES FOR THE CEO AND PROPOSED COMPENSATION, WITH THE COMPENSATION SET BY BOARD VOTE. THIS ANNUAL PROCESS WAS LAST COMPLETED DURING 2012. | |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ATTACHED TO THE FORM 990 PER THE IRS INSTRUCTIONS. | |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 300,991. EQUITY TRANSFER TO RELATED ORGANIZATION: -500,000. MINIMUM PENSION LIABILITY ADJUSTMENT: -6,728,711. TOTAL TO FORM 990, PART XI, LINE 5: -6,927,720. | CHANGES IN NET ASSETS OR FUND BALANCES: |
| FORM 990, PART XII, LINE 2C: | THE CONTROLLING ORGANIZATION, NORTHERN MONTANA HEALTH CARE, INC.'S BOARD HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT AUDITOR. | |
| FORM 990, PART VII, SECTION A, PERCENTAGE OF TIME SPENT BETWEEN RELATED | NO INDIVIDUALS ARE COMPENSATED FOR THEIR BOARD SERVICE TO EITHER ORGANIZATION, ONLY FOR THEIR SERVICE AS EMPLOYEES OF THE HOSPITAL. THE FOLLOWING INDIVIDUALS SPEND 2% OF THEIR TIME ON NMHC BUSINESS AND 98% OF THEIR TIME ON NMH BUSINESS: -VICE PRESIDENT OF NMHC ALSO SERVES AS THE VP OF NMH. -THE VICE CHAIR OF NMHC ALSO SERVES AS THE VICE CHAIR AND AN EMPLOYED PHYSICIAN OF NMH. -THREE TRUSTEES OF NMHC ALSO SERVE AS TRUSTEES AND EMPLOYED PHYSICIANS (INCLUDING THE MEDICAL DIRECTOR AND CHIEF OF STAFF) OF NMH. THE FOLLOWING INDIVIDUALS SPEND 2% OF THEIR TIME ON NMHC BUSINESS AND 2% OF THEIR TIME ON NMHCF BUSINESS AND 96% OF THEIR TIME ON NMH BUSINESS: -CEO/PRESIDENT OF NMHC ALSO SERVES AS THE CEO/PRESIDENT OF NMH AND NMHCF. -VP OF FINANCE OF NMHC ALSO SERVES AS THE VP OF FINANCE OF NMH AND NMHCF. THE REMAINING MEMBERS OF THE BOARD OF TRUSTEES SPEND 50% OF THEIR TIME ON NMHC BUSINESS AND 50% OF THEIR TIME ON NMH BUSINESS. NONE OF THEM ARE EMPLOYED BY EITHER ORGANIZATION. | ORGANIZATIONS: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg | Direct Controlling Entity NADirectControllingEntityNA |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTH CARE CORPORATION | |||||||||||
| 30 13TH STREET | HAVRE | MT | 59501 | 810447638 | HEALTH CARE SERVICES | MT | 501(C)(3) | LINE 3 | NORTHERN MONTANA HEALTH CARE INC | 0 | |
| NORTHERN MONTANA HEALTH CARE INC | |||||||||||
| PO BOX 1231 | HAVRE | MT | 59501 | 810428854 | SUPPORTING ORGANIZATION | MT | 501(C)(3) | LINE 11B, II | 0 | N/A | |
| NORTHERN MONTANA HEALTH CARE FOUNDATION INC | |||||||||||
| PO BOX 1231 | HAVRE | MT | 59501 | 363464641 | FUNDRAISING | MT | 501(C)(3) | LINE 7 | NORTHERN MONTANA HEALTH CARE INC | 0 | |
Form990 Schedule R Part IV Form990ScheduleRPartIV
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PARAMOUNT HEALTH CARE INC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 1231 | AddressLine1 |
| City | HAVRE | City |
| State | MT | State |
| ZIP Code | 59501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activity | HEALTH CARE SERVICES | PrimaryActivity |
| Legal Domicile State | MT | LegalDomicileState |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Type Of Entity | C | TypeOfEntity |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 1 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 1 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 0 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HEALTHCARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 154941 | AmountInvolved |
| Method Of Amt Determination | ACTUAL | MethodOfAmtDetermination |
Comments