2013-12-09T14:10:05-06:00 2013-06-30 810446334 DOUGLAS WILSON & COMPANY PC 1000 FIRST AVENUE SOUTH GREAT FALLS MT 59401 990 2012-07-01 810291695 BIG SANDY MEDICAL CENTER INC BIGS 4063782188 PO BOX 530 BIG SANDY MT 59520 HARRY BOLD 4063782188 2013-12-03 1 RANDAL J BOYSUN P00039907 4067614645 2012 2015-11-30 17:44:51Z HARRY BOLD PO BOX 530 BIG SANDY MT 59520 3822237 0 X BSMC.ORG X 1963 MT TO PROVIDE THE BEST POSSIBLE CARE FOR PATIENTS AT THE MOST REASONABLE COST IN A COMPETENT, PROFESSIONAL MANNER. 6 6 74 0 0 0 93583 919146 2944479 2759787 26193 23234 104535 120070 3168790 3822237 0 0 0 0 2178832 2364647 0 0 0 931078 862495 3109910 3227142 58880 595095 4035258 4652280 489360 247135 3545898 4405145 TO PROVIDE THE BEST POSSIBLE CARE FOR PATIENTS AT THE MOST REASONABLE COST IN A COMPETENT, PROFESSIONAL MANNER. 0 0 2932296 BIG SANDY MEDICAL CENTER PROVIDES HOSPITAL AND LONG-TERM MEDICAL CARE FOR THE TOWN OF BIG SANDY AND NORTHERN CHOUTEAU COUNTY, MONTANA. 2932296 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 2 0 1 74 1 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X NORA GRUBB 4063782188 PO BOX 530 BIG SANDY MT 59520 GORDON MOES 1.00 X 0 0 0 ROBERT NELSON 1.00 X 0 0 0 DIANNA WEBSTER 1.00 X 0 0 0 SHARON ROBERTSON 1.00 X 0 0 0 HARVEY KELLER 1.00 X 0 0 0 HARRY BOLD 40.00 X 76072 0 21545 76072 0 21545 0 0 0 0 0 696281 222865 919146 PATIENT SERVICES 622110 2759787 2759787 2759787 23234 23234 1200 0 1200 1200 1200 MISCELLANEOUS INCOME 622110 109198 109198 CAPITAL CREDITS 622110 9672 9672 118870 3822237 2901891 0 1200 89743 89743 1821527 1758291 63236 17932 16318 1614 226889 206469 20420 208556 189786 18770 11689 11689 12173 12173 25201 25201 11121 11121 200446 200446 58401 58401 REPAIRS & SUPPLIES 336075 336075 UTILITIES 66227 66227 NURSING FACILITY BED TA 51975 51975 OTHER 34287 34287 54900 37187 17713 3227142 2932296 294846 0 476618 2315988 1581233 408476 1183913 865 865 35423 34055 3605504 2324524 1274506 1280980 0 94616 4035258 4652280 211068 247135 278292 0 489360 247135 X 3545898 4405145 0 3545898 4405145 4035258 4652280 595095 264152 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 22544 22544 1268684 912604 356080 1578385 841594 736791 701276 560967 140309 34615 9359 25256 1280980 3822237 0 3822237 0 3822237 3227142 0 3227142 0 3227142 1 1 0 1 X 1 0 0 2012 0 2012 0.00350 26377 6714 19663 0.03400 27861 13359 14502 0.02510 56250 20073 36177 0.06260 56250 20073 36177 0.06260 0 2012 303759 322316 -18557 X 1 0 1 1 BIG SANDY MEDICAL CENTER

PO BOX 530 BIG SANDY MT 59520

BSMC.ORG X X 8 BED CRITICAL ACCESS HOSPITAL WITH 24 HOUR ER BIG SANDY MEDICAL CENTER 1 0 0 0 0 0 0 0 0 0 1 0 0 PART I, LINE 7: BSMC TRACKS REVENUES AND EXPENSES BY PAYER AND DEPARTMENT. THIS INFORMATION ALLOWS THE HOSPITAL TO REPORT THE AMOUNT OF HOSPITAL SERVICES PROVIDED FOR MEDICAID, HEALTHY MONTANA KIDS, CHIP & INDIAN HEALTH SERVICES DURING THE FISCAL YEAR. PART III, LINE 8: BSMC USES THE AMOUNTS FROM MEDICARE PROVIDER STATISTICAL REIMBURSEMENT (PS&R) TO DETERMINE THE MEDICARE ALLOWABLE COSTS. PART VI - 2 NEEDS ASSESSMENT BSMC SENDS OUT SATISFACTION SURVEYS AND ASKS FOR INPUT ON ANY CHANGES PATIENTS WOULD LIKE TO SEE. ALSO, ONCE A YEAR, AN ANNUAL PUBLIC MEETING IS HELD AND INPUT IS SOLICITED AS WELL AS A REPORT ON HOSPITAL ACTIVITIES GIVEN. THIS PUBLIC MEETING IS WELL ADVERTISED IN THE LOCAL PRESS. PART VI - 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE A NOTICE OF PATIENT ELIGIBILITY IS POSTED IN ALL WAITING AREAS AND ON THE WEBSITE. PART VI - 4 COMMUNITY INFORMATION THE COMMUNITY IS MOSTLY AGRICULTURAL WITH LARGE WHEAT FARMS AND LARGE CATTLE RANCHES. THOSE WHO DO NOT WORK AT THESE AGRICULTURAL BUSINESS SITES USUALLY WORK IN A BUSINESS THAT SUPPORTS THE WHEAT AND CATTLE OPERATIONS. UNEMPLOYMENT IN THE COUNTY AND AREA IS VERY LOW, USUALLY IN THE 2-3% RANGE. MOST PATIENTS HAVE AVERAGE TO NORMAL PAYING JOBS WITH AVERAGE BENEFITS. PART VI - 7 STATE FILING OF COMMUNITY BENEFIT REPORT MONTANA DR MIKESELL EXCESS INS. LOAN X 14965 865 0 1 1 865 FORM 990, PART VI, SECTION B, LINE 11 FORM 990 IS REVIEWED BY MANAGEMENT AND THE BOARD OF DIRECTORS BEFORE BEING FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ARE MADE AWARE OF THE CONFLICT OF INTEREST POLICY OF THE ORGANIZATION AND DISCUSSES SUCH ONCE A YEAR AT A REGULAR BOARD MEETING FORM 990, PART VI, SECTION B, LINE 15A THE BOARD OF DIRECTORS WILL REFER TO THE ANNUAL MONTANA HOSPITAL ASSOCIATION ANNUAL SALARY SURVEY FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST.