NORTHERN MONTANA HEALTH CARE INC: Form 990, tax year 2011
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- Organization
- NORTHERN MONTANA HEALTH CARE INC (EIN 81-0428854)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-05-13
- IRS object ID
- 201331339349304013
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-13T15:10:10-05:00 | 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 | 810428854 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HEALTH CARE INC | 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 | 3663626 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.NMHCARE.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1985 | 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 | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 135 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 8374 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 8398 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 7051845 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 1397670 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 207171 | InvestmentIncomePriorYear |
| Investment Income Current Year | 132225 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 7267390 | TotalRevenuePriorYear |
| Total Revenue Current Year | 1538293 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | 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 | 1768414 | OtherExpensePriorYear |
| Other Expenses Current Year | 6763826 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 1768414 | TotalExpensesPriorYear |
| Total Expenses Current Year | 6763826 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 5498976 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -5225533 | RevenuesLessExpensesCY |
| Total Assets BOY | 67108502 | TotalAssetsBOY |
| Total Assets EOY | 61425889 | TotalAssetsEOY |
| Total Liabilities BOY | 9544982 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9004427 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 57563520 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 52421462 | 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 | 6370673 | Expense |
| Revenue | 1397670 | Revenue |
| Description | NORTHERN MONTANA HEALTH CARE, INC. (NMHC) SUPPORTS AND ENCOURAGES HEALTH CARE SERVICES BY PROVIDING FINANCIAL AND MANAGERIAL CONSULTING ASSISTANCE TO THE FOLLOWING CONTROLLED HEALTH CARE ORGANIZATIONS:1) NORTHERN MONTANA HOSPITAL, ID# 81-02317872) NORTH CARE CORPORATION, ID# 81-04476383) NORTHERN MONTANA HEALTH CARE FOUNDATION, ID# 36-3464641NMHC PROVIDES OVERALL DIRECTION AND COORDINATES THE POLICY MAKING AND LONG-RANGE PLANNING FOR ITS SUBSIDIARIES. IT IS ORGANIZED SOLELY TO CARRY OUT THE PURPOSES OF ITS TAX-EXEMPT SUBSIDIARIES. SOME OF THE SERVICES NMHC FURNISHES TO ITS SUBSIDIARIES ARE: ACCOUNTING SERVICES, NEGOTIATION ASSISTANCE WITH RENTAL AGREEMENTS, MANAGEMENT AND HEALTHCARE CONSULTING, AND OTHER MISCELLANEOUS SERVICES. | Description |
| Total Program Service Expense | 6370673 | 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 | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | 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 | 0 | Hospital |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| 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 | 1 | 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 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| 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 | 1 | 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 | 0 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (14 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| DAVID C HENRY | ||||||
| PRESIDENT/CEO | 1.00 | X | X | 0 | 378000 | 0 |
| MILES HAMILTON | ||||||
| CHAIRMAN | 1.00 | X | X | 0 | 0 | 0 |
| BRUCE RICHARDSON MD | ||||||
| VICE CHAIRMAN | 1.00 | X | X | 0 | 326996 | 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 | |
| JULIE HOLT | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| ANDREW CARLSON | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| TOM PATRICK | ||||||
| TRUSTEE | 1.00 | X | 0 | 0 | 0 | |
| MARGARET DOW MD | ||||||
| TRUSTEE - IPD MEMBER | 1.00 | X | 0 | 272528 | 23427 | |
| MICHAEL NOLAN MD | ||||||
| TRUSTEE - IPD MEMBER | 1.00 | X | 0 | 272513 | 2548 | |
| STEPHEN BECHDOLT MD | ||||||
| CHIEF OF MEDICAL STAFF | 1.00 | X | 0 | 286923 | 10291 | |
| KAREN POLLINGTON | ||||||
| VICE PRESIDENT | 1.00 | X | 0 | 89640 | 18971 | |
| KIM LUCKE | ||||||
| VP OF FINANCE | 1.00 | X | 0 | 69989 | 17180 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 1696589 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 92182 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HOSPITAL | BusinessNameLine1 |
Address Of Contractor AddressOfContractor
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) |
|---|---|---|
| Description Of Services | CONTRACT LABOR | DescriptionOfServices |
| Compensation | 381013 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| All Other Contributions | 8398 | AllOtherContributions |
| Total Contributions | 8398 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | RENTAL INC.-AFFILIATES | Description |
| Business Code | 532000 | BusinessCode |
| Total Revenue Column | 1397670 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1397670 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 1397670 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 152862 | TotalRevenueColumn |
| Exclusion | $152,862 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2104696 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2125333 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -20637 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -20637 | TotalRevenueColumn |
| Exclusion | -$20,637 | ExclusionAmount |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1538293 | TotalRevenueColumn |
| Related Or Exempt Function Income | 1397670 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $132,225 | ExclusionAmount |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 294525 | Total |
| Program Services | 220894 | ProgramServices |
| Management And General | 73631 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15285 | Total |
| Management And General | 15285 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12122 | Total |
| Management And General | 12122 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118828 | Total |
| Program Services | 72714 | ProgramServices |
| Management And General | 46114 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8147 | Total |
| Program Services | 2520 | ProgramServices |
| Management And General | 5627 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 23405 | Total |
| Program Services | 12916 | ProgramServices |
| Management And General | 10489 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135863 | Total |
| Program Services | 67743 | ProgramServices |
| Management And General | 68120 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1134 | Total |
| Program Services | 178 | ProgramServices |
| Management And General | 956 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 382695 | Total |
| Program Services | 382695 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 687813 | Total |
| Program Services | 554938 | ProgramServices |
| Management And General | 132875 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33857 | Total |
| Program Services | 16284 | ProgramServices |
| Management And General | 17573 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | LOSS FROM AFFILIATES | Description |
| Total | 5025336 | Total |
| Program Services | 5025336 | ProgramServices |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 24816 | Total |
| Program Services | 14455 | ProgramServices |
| Management And General | 10361 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6763826 | Total |
| Program Services | 6370673 | ProgramServices |
| Management And General | 393153 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 688949 | BOY |
| EOY | 1065852 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 59595 | BOY |
| EOY | 85207 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23995 | BOY |
| EOY | 28285 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18776346 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8841406 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10494485 | BOY |
| EOY | 9934940 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6941983 | BOY |
| EOY | 6958626 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 48698493 | BOY |
| EOY | 43198657 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 201002 | BOY |
| EOY | 154322 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67108502 | BOY |
| EOY | 61425889 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 384571 | BOY |
| EOY | 386283 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6932107 | BOY |
| EOY | 6156442 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1557481 | BOY |
| EOY | 1233465 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 670823 | BOY |
| EOY | 1228237 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9544982 | BOY |
| EOY | 9004427 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57563520 | BOY |
| EOY | 52421462 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 57563520 | BOY |
| EOY | 52421462 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67108502 | BOY |
| EOY | 61425889 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -5225533 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 83475 | ReconcilationOtherChanges |
| 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) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type2 | X | SupportingOrg509a3Type2 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | 0 | ContribByControllingIndividual |
| Contribution By Related Party | 0 | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | 0 | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation (3 entries)
| EINEIN | Type Of OrganizationTypeOfOrganization | Listed In Governing DocListedInGoverningDoc | AmountAmount |
|---|---|---|---|
| NORTHERN MONTANA HOSPITAL | |||
| 810231787 | 3 | 1 | $1,232,774 |
| NORTH CARE CORPORATION | |||
| 810447638 | 3 | 1 | $0 |
| NORTHERN MONTANA HEALTH CARE FOUNDATION INC | |||
| 363464641 | 7 | 1 | $112,563 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 3 | TotalNumberOfSupportedOrgs |
| Sum Of Amounts | 1345337 | SumOfAmounts |
| General Explanation | SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: FORM 990, SCHEDULE A, PART I, LINE 11I, COLUMN VII: NORTHERN MONTANA HEALTH CARE, INC. PROVIDED NON-MONETARY SUPPORT TO NORTHERN MONTANA HOSPITAL, NORTH CARE CORPORATION, AND NORTHERN MONTANA HEALTH CARE FOUNDATION IN THE FORM OF DIRECTION AND GUIDANCE. IN ADDITION NORTHERN MONTANA HEALTH CARE, INC PROVIDED MONETARY SUPPORT, ACCOUNTING SERVICES, NEGOTIATION ASSISTANCE, MANAGEMENT AND HEALTH CARE CONSULTING AND OTHER MISCELLANEOUS SERVICES TO NORTHERN MONTANA HOSPITAL AND NOTHERN MONTANA HEALTH CARE FOUNDATION. | GeneralExplanation |
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
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 100000 | OtherCostOrOtherBasis |
| Book Value | 100000 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18058874 | OtherCostOrOtherBasis |
| Depreciation | 8535602 | Depreciation |
| Book Value | 9523272 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 210898 | OtherCostOrOtherBasis |
| Depreciation | 179003 | Depreciation |
| Book Value | 31895 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 129528 | OtherCostOrOtherBasis |
| Depreciation | 126801 | Depreciation |
| Book Value | 2727 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 277046 | OtherCostOrOtherBasis |
| Book Value | 277046 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9934940 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities (2 entries)
| DescriptionDescription | Book ValueBookValue | Method Of ValuationMethodOfValuation |
|---|---|---|
| INVESTMENT IN MUTUAL BENEFIT CORPORATION | 1330000 | C |
| INVESTMENT IN AFFILIATES | 41868657 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 43198657 | TotalOfBookValueSecurities |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM AFFILIATES | Description |
| Amount | $1,228,237 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1228237 | TotalOfAmounts |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | 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. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 1 | 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 (5 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 | |||||||||||||
| 0 | 300000 | 0 | 78000 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 378000 | 0 | 0 |
| BRUCE RICHARDSON MD | |||||||||||||
| 0 | 325808 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 22710 | 0 | 349706 | 0 | 0 |
| MARGARET DOW MD | |||||||||||||
| 0 | 272333 | 0 | 0 | 0 | 195 | 0 | 0 | 0 | 25942 | 0 | 298470 | 0 | 0 |
| MICHAEL NOLAN MD | |||||||||||||
| 0 | 271325 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 4949 | 0 | 277462 | 0 | 0 |
| STEPHEN BECHDOLT MD | |||||||||||||
| 0 | 285735 | 0 | 0 | 0 | 1188 | 0 | 0 | 0 | 12842 | 0 | 299765 | 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: CEO/PRESIDENT IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. A RELATED ORGANIZATION AND THE MANAGEMENT COMPANY HAVE A PROCESS IN PLACE TO DETERMINE THE CEO'S COMPENSATION USING THE FORM 990 OF OTHER ORGANIZATIONS, A WRITTEN EMPLOYMENT CONTRACT, A COMPENSATION SURVEY OR STUDY, AND THE APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SCHEDULE J, PART II: INDIVIDUALS LISTED ON SCHEDULE J, PART II, OTHER THAN THE CEO, ARE COMPENSATED BY A RELATED ORGANIZATION FOR THEIR SERVICES PROVIDED TO THAT ORGANIZATION. THEY ARE NOT COMPENSATED FOR THEIR SERVICES AS BOARD MEMBERS. THE RELATED ORGANIZATION HAS PROCEDURES IN PLACE TO DETERMINE THEIR COMPENSATION. | SUPPLEMENTAL INFORMATION |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)
| Issuer EINIssuerEIN | CUSIP NumberCUSIPNumber | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|---|
| MONTANA FACILITY FINANCE AUTHORITY | |||||||
| 810302402 | 612043DM8 | 2006-03-01 | 6843295 | REFUND BONDS ISSUED 11/9/1995 AND 12/15/1995. | 0 | 0 | 0 |
| CITY OF HAVRE MONTANA | |||||||
| 816001274 | 2007-11-30 | 3186968 | FUND NEW MEDICAL BUILDING | 0 | 0 | 0 | |
Form990 Schedule K Part II Form990ScheduleKPartII (2 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Amount In Reserve FundAmountInReserveFund | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Capital ExpendituresCapitalExpenditures |
|---|---|---|---|---|---|---|---|---|---|---|
| 3415000 | 6843295 | 667000 | 136846 | 6039449 | 2006 | 1 | 0 | 1 | 1 | |
| 3186968 | 181856 | 61698 | 2008 | 0 | 0 | 0 | 1 | 2943162 |
Form990 Schedule K Part III Form990ScheduleKPartIII (2 entries)
| Owning Bond Financed PropertyOwningBondFinancedProperty | Any Lease ArrangementsAnyLeaseArrangements | Mngment Cntrct Bond Financd PrprtyMngmentCntrctBondFinancdPrprty | Any Research AgreementsAnyResearchAgreements | Prcntge Prvt Business Use By OthersPrcntgePrvtBusinessUseByOthers | Percentage Of Prvt Business Re UBIPercentageOfPrvtBusinessReUBI | Total Private Business UseTotalPrivateBusinessUse | Post Issuance Compliance ProcdrsPostIssuanceComplianceProcdrs |
|---|---|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
| 0 | 0 | 0 | 0 | 0.00000 | 0.00000 | 0.00000 | 1 |
Form990 Schedule K Part IV Form990ScheduleKPartIV (2 entries)
| Form8038 T FiledForm8038TFiled | Variable Rate IssueVariableRateIssue | Hedge Identified In Books And RecdsHedgeIdentifiedInBooksAndRecds | Gross Proceeds Invested In GICGrossProceedsInvestedInGIC | Gross Proceeds InvestedGrossProceedsInvested | Exception To RebateExceptionToRebate |
|---|---|---|---|---|---|
| 0 | 0 | 0 | 0 | 0 | 0 |
| 0 | 0 | 0 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (11 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | KIM LUCKE, KAREN POLLINGTON, BRUCE RICHARDSON, DAVID C. HENRY, DAVID LEEDS, JUDY GREENWOOD, MILES HAMILTON, PAUL TUSS, JULIE HOLT, ANDREW CARLSON, TOM PATRICK, MARGARET DOW, MICHAEL NOLAN, AND STEPHEN BECHDOLT HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE PRESIDENT/CEO OF THE HOSPITAL IS EMPLOYED BY AN UNRELATED MANAGEMENT COMPANY. RELATED ORGANIZATION, NORTHERN MONTANA HOSPITAL (NMH), PAYS THE UNRELATED MANAGEMENT COMPANY FOR HIS SERVICES PROVIDED TO NMH, NORTHERN MONTANA HEALTH CARE, INC. AND NORTHERN MONTANA HEALTH CARE FOUNDATION. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THOSE PERSONS WHO RESIDE IN THE AREA SERVED BY NORTHERN MONTANA HOSPITAL AND WHO HAVE BEEN MEMBERS OF OR GIVEN MONEY TO NORTHERN MONTANA HOSPITAL AT ANY TIME FROM THE FOUNDING OF THE HOSPITAL TO MAY 1, 1984 SHALL BE INVITED TO BECOME MEMBERS OF THE CORPORATION (NORTHERN MONTANA HEALTH CARE, INC.). THE CORPORATION SHALL ONLY BE REQUIRED TO ACT IN GOOD FAITH AND USE ITS BEST EFFORTS TO IDENTIFY ALL PERSONS QUALIFYING FOR SUCH INVITATION. THE INITIAL MEMBERS SHALL BE THOSE PERSONS INVITED TO BE MEMBERS WHO AGREED IN WRITING TO BECOME A MEMBER OF THE CORPORATION. THESE MEMBERS SHALL MEET AT A PLACE AND TIME DESIGNATED BY THE BOARD TO TAKE THE FOLLOWING ACTION: (1) IF THEIR NUMBER IS LESS THAN FIFTY (50), TO ELECT AS MANY ADDITIONAL MEMBERS AS NECESSARY TO BRING THEIR TOTAL NUMBER TO FIFTY (50) AND (2) TO SELECT THE TERMS OF SERVICE OF EACH OF THE MEMBERS. THE TERMS OF ONE-THIRD (1/3) OF THE INITIAL MEMBERS SHALL EXPIRE ON THE SECOND TUESDAY OF MARCH OF EACH YEAR, BEGINNING IN 1986. | |
| FORM 990, PART VI, SECTION A, LINE 7B | THE MEMBERS OF THE CORPORATION SHALL HAVE THE FOLLOWING POWERS: (I) TO APPROVE, OR DISAPPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION THAT AFFECT THE IDENTITY, POWER AND/OR DUTIES OF THE MEMBERS OF THE CORPORATION, OR MERGERS OR CONSOLIDATIONS WITH ANOTHER CORPORATION, OR SALES OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS, (II) TO APPROVE, OR DISAPPROVE, LIQUIDATIONS OF THE CORPORATION'S MERGERS OR CONSOLIDATIONS OF THE CORPORATION WITH ANOTHER CORPORATION, OR SALES OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS, (III) TO ELECT THE MEMBERS OF THE CORPORATION, AND (IV) TO APPROVE, OR DISAPPROVE, AMENDMENTS TO THE BYLAWS WHICH AFFECT THE IDENTITY, POWER AND/OR DUTIES OF THE MEMBERS OF THE CORPORATION. THE MEMBERS SHALL HAVE NO OTHER POWERS WITH REGARD TO THE CORPORATION. | |
| FORM 990, PART VI, SECTION A, LINE 8B | NO SUBCOMMITTEE HAD THE AUTHORITY TO ACT ON BEHALF OF THE BOARD DURING THE FISCAL YEAR ENDED JUNE 30, 2012. | |
| FORM 990, PART VI, SECTION B, LINE 11 | A COPY OF THE FORM 990 WILL BE REVIEWED BY THE VP OF FINANCE, 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. | |
| THE PRESIDENT/CEO IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. THE UNRELATED MANAGEMENT COMPANY RECEIVES A FEE FOR SERVICE FROM A RELATED ORGANIZATION FOR THE CEO'S SERVICE PROVIDED TO THIS ORGANIZATION AND RELATED ORGANIZATIONS, NORTHERN MONTANA HOSPITAL (NMH) AND NORTHERN MONTANA HEALTH CARE FOUNDATION, INC. (NMHCF). IN DETERMINING THE CEO'S COMPENSATION, THE EXECUTIVE COMMITTEE OF THE BOARD MEETS AND REVIEWS NMH/NORTHERN MONTANA HEALTH CARE, INC. (NMHC) FINANCIAL RESULTS, 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 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. | |
| 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: |
| FORM 990, PART XI, LINE 5: | NET UNREALIZED GAINS ON INVESTMENTS: 83,475. | CHANGES IN NET ASSETS OR FUND BALANCES: |
Schedule R IRS990ScheduleR
Form990 Schedule R Part I Form990ScheduleRPartI
Name Of Disregarded Entity NameOfDisregardedEntity
| 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) |
|---|---|---|
| EIN | 810393353 | EIN |
| Primary Activities | PROVISION OF HEALTH SERVICES | PrimaryActivities |
| Legal Domicile State | MT | LegalDomicileState |
| Total Income | 0 | TotalIncome |
| EOY Assets | 528 | EOYAssets |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
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 |
|---|---|---|---|---|---|---|---|---|---|---|
| NORTHERN MONTANA HOSPITAL | ||||||||||
| PO BOX 1231 | HAVRE | MT | 59501 | 810231787 | HEALTH CARE SERVICES | MT | 501(C)(3) | LINE 3 | NORTHERN MONTANA HEALTH CARE INC | 1 |
| NORTHERN MONTANA HEALTH CARE FOUNDATION INC | ||||||||||
| PO BOX 1231 | HAVRE | MT | 59501 | 363464641 | SUPPORTING ORGANIZATION | MT | 501(C)(3) | LINE 7 | NORTHERN MONTANA HEALTH CARE INC | 1 |
| NORTH CARE CORPORATION | ||||||||||
| 30 13TH STREET | HAVRE | MT | 59501 | 810447638 | HEALTH CARE SERVICES | MT | 501(C)(3) | LINE 3 | NORTHERN MONTANA HEALTH CARE INC | 1 |
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 Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN MONTANA HEALTH CARE INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Entity | C | TypeOfEntity |
| Percentage Ownership | 1.00000 | PercentageOwnership |
| 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 | 0 | 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 | 1 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 1 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 1 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 1 | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (7 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| NORTHERN MONTANA HOSPITAL | ||
| I | 867360 | FMV |
| NORTHERN MONTANA HOSPITAL | ||
| L | 294525 | COST |
| NORTHERN MONTANA HOSPITAL | ||
| N | 86488 | COST |
| NORTHERN MONTANA HOSPITAL | ||
| P | 1586435 | COST |
| NORTHERN MONTANA HEALTH CARE FOUNDATION INC | ||
| Q | 112563 | COST |
| NORTHERN MONTANA HOSPITAL | ||
| R | 500000 | COST |
| NORTH CARE CORPORATION | ||
| 0 | ||
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