LOGAN HEALTH - CONRAD: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LOGAN HEALTH - CONRAD (EIN 81-0232406)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201333199349303203
- Schema version
- 2012v2.1
- 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 | 2013-11-15T09:53:00-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | 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 | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810232406 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pondera Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | POND | NameControl |
| Phone | 4062713211 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sunset Blvd | AddressLine1 |
| City | Conrad | City |
| State | MT | State |
| ZIP Code | 59425 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Wayne Ogburn | Name |
| Title | CEO | Title |
| Phone | 4062713211 | Phone |
| Date Signed | 2013-11-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Kim Hunwardsen CPA | Name |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | Phone |
| Date Prepared | 2013-11-14 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Wayne Ogburn | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sunset Blvd | AddressLine1 |
| City | Conrad | City |
| State | MT | State |
| ZIP Code | 59425 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 14168683 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.ponderamedical.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1975 | YearFormation |
| State Legal Domicile | MT | StateLegalDomicile |
| Activity Or Mission Description | Provide access to quality health care through all life's stages | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 7 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 291 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 545298 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 928120 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 12205765 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 13203666 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 40255 | InvestmentIncomePriorYear |
| Investment Income Current Year | 28089 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 8808 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12791318 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14168683 | 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 | 7859666 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8206499 | 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 | 4859192 | OtherExpensePriorYear |
| Other Expenses Current Year | 5168154 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12718858 | TotalExpensesPriorYear |
| Total Expenses Current Year | 13374653 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 72460 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 794030 | RevenuesLessExpensesCY |
| Total Assets BOY | 6596738 | TotalAssetsBOY |
| Total Assets EOY | 6666200 | TotalAssetsEOY |
| Total Liabilities BOY | 3159488 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2873767 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3437250 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3792433 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | As an essential member of our regional community, PMC strives to be a progressive healthcare business devoted to providing access to quality healthcare and exceeding the expectations of those we serve through all of life's stages. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8308608 | Expense |
| Revenue | 7997864 | Revenue |
| Description | Pondera Medical Center is a 25-bed critical access hospital. The Medical Center provided 408 patient days and 70 newborn days along with a 24-hour emergency room that accounted for 2,113 visits for the year. Outpatient services such as lab, x-ray, physical and occupational therapy, wellness center, surgery, ambulance, cardiac rehab, DME, home health and respiratory therapy were provided to members of our rural community so they could receive the services they needed close to home. The services are essential for the survival of our community.The Medical Center maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amounts of charges foregone for services provided under the Medical Center's charity care policy was $85,632. Total direct and indirect costs related to these foregone charges were approximately $76,000 at December 31, 2012, based on average ratios of cost to gross charges.The Medical Center provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient and resident service revenue. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1554205 | Expense |
| Revenue | 3439340 | Revenue |
| Description | Pondera Medical Center's Extended Care Facility is a 59-bed nursing home offering 24-hour care and nursing services provided by licensed, certified and compassionate staff members. The facility had 19,351 total patient days. Staff-to-resident ratio is 1 to 4. Specialized services are also available including those offered by a physical therapist, occupational therapist, registered dietitian, and medical social worker. We have a remarkable activity program directed by a Certified Eden Alternative Associate Manager and a Certified Activity Manager. Activities are offered 7 days a week and include exercise, socials, games, theme parties, pets, gardening, cooking, live music, crafts and outings. We have a 14-bed Special Care Unit designated for residents with pervasive memory loss and confusion, providing an extra touch of attention and supervision. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1490374 | Expense |
| Revenue | 1766462 | Revenue |
| Description | Pondera Medical Center Clinic is a Family Practice Rural Health Clinic dedicated to providing and coordinating comprehensive services to the entire family. Our physicians are Board Certified Family Practitioners, with experience in Obstetrics. Boarded Family Practice Physicians must complete an additional three years of specialized training above and beyond that of medical school. Family Practitioners are trained in all avenues of medicine, so they can provide a full range of care. PMCC Physician Assistants are licensed by the State of Montana and specialize in Family Medicine and Urgent Care. Our Providers promote healthy lifestyles and continually strengthen the relationship between the clinic and community, with excellent, timely, and compassionate patient care. The Clinic has 3 physicians and 2 physician assistants and provided 12,201 total clinic visits, 397 extended care visits and 123 swing bed visits. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expense | 11353187 | 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 | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 1 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 0 | 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 | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 40 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 291 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| 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 | 7 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 1 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 1 | 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 | Brenda Ries | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4062713211 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sunset Blvd | AddressLine1 |
| City | Conrad | City |
| State | MT | State |
| ZIP Code | 59425 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|
| Brent Gaylord | |||||||
| Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Jayne Gollehon | |||||||
| Vice Chair | 1.00 | X | X | 0 | 0 | 0 | |
| Karla Styren | |||||||
| Secretary | 1.00 | X | X | 0 | 0 | 0 | |
| Bernard Ries | |||||||
| Treasurer | 1.00 | X | X | 0 | 0 | 0 | |
| Ted Kronebusch | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Cheryl Bakken | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Joe Christiaens | |||||||
| Trustee | 1.00 | X | 0 | 0 | 0 | ||
| Betty Cooper | |||||||
| Trustee - partial year | 1.00 | X | 0 | 0 | 0 | ||
| Mark Jones | |||||||
| CEO | 1.00 | X | 102426 | 0 | 12177 | ||
| Dave Doran | |||||||
| CFO until Sept. 2012 | 1.00 | X | 73112 | 0 | 6198 | ||
| Brenda Ries | |||||||
| Interim CFO | 40.00 | X | 65637 | 0 | 5556 | ||
| Clifford Davis | |||||||
| Physician Assistant | 40.00 | 136432 | 0 | 10302 | X | ||
| Ilene Hawkinson | |||||||
| Physician Assistant | 40.00 | 141043 | 0 | 6766 | X | ||
| Patricia Grena | |||||||
| Physician | 40.00 | 151847 | 0 | 24362 | X | ||
| Peter Barran | |||||||
| Physician | 40.00 | 210276 | 0 | 10164 | X | ||
| Jay Taylor | |||||||
| Physician | 40.00 | 226630 | 0 | 33953 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1107403 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 109478 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Kalispell Medical Center | |||||
| 310 Sunny View Lane | Kalispell | MT | 59901 | Lab management fees | 479743 |
| Hill Anesthesia PC | |||||
| PO Box 1006 | Conrad | MT | 59425 | Anesthesia services | 256500 |
| CPSI | |||||
| 6600 Wall St | Mobile | AL | 36695 | Software support services | 228381 |
| GE Healthcare Financial Services | |||||
| PO Box 641419 | Pittsburgh | PA | 15264 | CT maintenance | 115079 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Fundraising Events | 9895 | FundraisingEvents |
| Government Grants | 834919 | GovernmentGrants |
| All Other Contributions | 83306 | AllOtherContributions |
| Total Contributions | 928120 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| Patient service revenue | 622110 | 8703403 | 8703403 |
| Nursing Home | 623000 | 3439340 | 3439340 |
| EHR Incentive | 900099 | 838658 | 838658 |
| Bed tax revenue | 900099 | 128348 | 128348 |
| Supporting revenue | 900099 | 93917 | 93917 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 13203666 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28089 | TotalRevenueColumn |
| Exclusion | $28,089 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6400 | TotalRevenueColumn |
| Exclusion | $6,400 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2408 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 2408 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2408 | TotalRevenueColumn |
| Exclusion | $2,408 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 0 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 9895 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 0 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14168683 | TotalRevenueColumn |
| Related Or Exempt Function Income | 13203666 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $36,897 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 265106 | Total |
| Management And General | 265106 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6734145 | Total |
| Program Services | 6069331 | ProgramServices |
| Management And General | 664814 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 682714 | Total |
| Program Services | 614823 | ProgramServices |
| Management And General | 67891 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 524534 | Total |
| Program Services | 464304 | ProgramServices |
| Management And General | 60230 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 216141 | Total |
| Program Services | 216141 | ProgramServices |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 77166 | Total |
| Management And General | 77166 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30400 | Total |
| Management And General | 30400 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1247432 | Total |
| Program Services | 996755 | ProgramServices |
| Management And General | 250677 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38778 | Total |
| Program Services | 3244 | ProgramServices |
| Management And General | 35534 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 898595 | Total |
| Program Services | 736646 | ProgramServices |
| Management And General | 161949 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 180654 | Total |
| Program Services | 30758 | ProgramServices |
| Management And General | 149896 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 271921 | Total |
| Program Services | 263403 | ProgramServices |
| Management And General | 8518 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20661 | Total |
| Program Services | 20395 | ProgramServices |
| Management And General | 266 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 79364 | Total |
| Program Services | 51666 | ProgramServices |
| Management And General | 27698 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 63989 | Total |
| Program Services | 63989 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 643016 | Total |
| Program Services | 643016 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 200956 | Total |
| Management And General | 200956 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| Medical supplies | 384774 | 384774 |
| Bad debt expense | 379508 | 379508 |
| Food | 229921 | 229921 |
| MT bed tax | 184513 | 184513 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20365 | Total |
| Management And General | 20365 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13374653 | Total |
| Program Services | 11353187 | ProgramServices |
| Management And General | 2021466 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 945953 | BOY |
| EOY | 967673 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1360050 | BOY |
| EOY | 1165565 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 162147 | BOY |
| EOY | 135653 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 70255 | BOY |
| EOY | 67765 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 12767549 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9640177 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3175876 | BOY |
| EOY | 3127372 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 436601 | BOY |
| EOY | 447590 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11696 | BOY |
| EOY | 6836 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 434160 | BOY |
| EOY | 747746 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6596738 | BOY |
| EOY | 6666200 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1688302 | BOY |
| EOY | 1601933 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1247481 | BOY |
| EOY | 1081322 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 89367 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 223705 | BOY |
| EOY | 101145 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3159488 | BOY |
| EOY | 2873767 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 979300 | BOY |
| EOY | 1224869 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2457950 | BOY |
| EOY | 2567564 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3437250 | BOY |
| EOY | 3792433 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6596738 | BOY |
| EOY | 6666200 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 794030 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -438847 | 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 |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommittee |
| 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 | 3341 | BeginningBalance |
| Additions During Year | 5377 | AdditionsDuringYear |
| Distributions During Year | 3218 | DistributionsDuringYear |
| Ending Balance | 5500 | EndingBalance |
| Included On FS | 0 | IncludedOnFS |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 48854 | OtherCostOrOtherBasis |
| Book Value | 48854 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 7183132 | OtherCostOrOtherBasis |
| Depreciation | 5551237 | Depreciation |
| Book Value | 1631895 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5258271 | OtherCostOrOtherBasis |
| Depreciation | 3940865 | Depreciation |
| Book Value | 1317406 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 277292 | OtherCostOrOtherBasis |
| Depreciation | 148075 | Depreciation |
| Book Value | 129217 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3127372 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Investment in perpetual trust | Description |
| Book Value | 447590 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 447590 | TotalOfBookValueSecurities |
Other Assets OtherAssets (4 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other assets | 39752 |
| Estimated third-party payor settlements | 285403 |
| Worker's compensation deposit | 97069 |
| Other accounts receivable | 325522 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 747746 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Compensated absences | Description |
| Amount | $101,145 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 101145 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 13187938 | TotRevenueEtcAuditedFinclStmt |
| Donated Srvc And Use Of Facilities | 1200 | DonatedSrvcAndUseOfFacilities |
| Other Revenues | -882344 | OtherRevenues |
| Revenue Not Rptd F990 | -881144 | RevenueNotRptdF990 |
| Revenue Subtotal | 14069082 | RevenueSubtotal |
| Other Revenues Not Included | 99601 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 99601 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 14168683 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 12932356 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 1200 | DonatedServicesUseOfFacilities |
| Expenses Not Rptd F990 | 1200 | ExpensesNotRptdF990 |
| Expenses Subtotal | 12931156 | ExpensesSubtotal |
| Other Expenses Not Included | 443497 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 443497 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 13374653 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part IV, Line 1b: | The funds are the personal funds of the nursing home residents and are to be used only for specific personal expenditures as requested by the residents. | |
| Part X, Line 2: | The Medical Center is organized as a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. The Medical Center 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 Medical Center 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. | Description of Uncertain Tax Positions Under FIN 48: |
| Bad debt expense recorded in revenue for financial statements -379,508. Interest expense recorded in non-operating revenue for financial statements -63,989. Gain on perpetual trust recorded in non-operating revenue for financial stmt 10,989. Intergovernment transfer recorded in revenue for financial statements -449,836. | Part XI, Line 2d - Other Adjustments: | |
| Capital grants and restricted contributions recorded in revenue for Form 990 99,601. | Part XI, Line 4b - Other Adjustments: | |
| Bad debt expense recorded in total expenses for Form 990 379,508. Interest expense recorded in total expenses for Form 990 63,989. | Part XII, Line 4b - Other Adjustments: |
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 |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 175.000000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | 0 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 76000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 76000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 76000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 76000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 171013 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 80688 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 90325 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00700 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6480439 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4866052 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1614387 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12420 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4703 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 4703 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6656155 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4946740 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1709415 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13160 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6732155 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4946740 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1785415 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.13740 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $379,508 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 2359431 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 2330852 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 28579 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| 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 | Pondera Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 805 Sunset Blvd | AddressLine1 |
| City | Conrad | City |
| State | MT | State |
| ZIP Code | 59425 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.ponderamedical.com | WebsiteAddress |
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | Provider based rural health clinic | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pondera Medical Center | 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 | 175.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medicaid Medicare | X | MedicaidMedicare |
| Other Factors | X | OtherFactors |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Collection Activities | 0 | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| 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 | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Pondera Med Ctr Extended Care Facility | ||||
| 805 Sunset Blvd | Conrad | MT | 59425 | Long term care |
| Pondera Medical Center Eye Clinic PLLC | ||||
| 403 S Delaware St | Conrad | MT | 59425 | Eye care and optical |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation | IdentifierIdentifier |
|---|---|
| Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services and cash and in-kind contributions to community groups were reported based on actual expenses incurred. The cost for subsidized health services was determined using the Medicare Cost Report. | |
| Part I, L7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $379,508. | |
| Part III, Line 4: Bad debt expense is reported net of discounts and contractual allowances. We are using the bad debt expense as reported on the financial statements. Payments on accounts previously written off to bad debt expense reduce bad debt expense in the current year. In determining the amount of bad debt attributable to patients eligible under our charity care policy, we used management's best estimate of bad debt expense based on demographic and financial factors of the community. The footnote to the Organization's financial statements can be found on page 8 of the attached audited financial statements. | |
| Part III, Line 8: Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. | |
| Part III, Line 9b: Patients must complete a financial assistance application to be considered for charity care. Those patients known to qualify for financial assistance or that have contacted the business office and are in the process of completing an application or setting up a payment schedule will not receive additional collection notices. | |
| Part V, Section B, Line 12h: Pondera Medical Center utilizes the federal poverty guidelines (FPG) as the primary financial measurement tool. Financial determination is based on family size and income. All forms of income are considered, including but not limited to: workman's compensation payments, social security benefits, unemployment wages, child support payments, etc. | Pondera Medical Center |
| Part V, Section B, Line 14g: Patients are informed about their eligibility for financial assistance during conversations at registration and during follow-up on outstanding account balances. Information regarding financial assistance and applications are available at our business office. The financial assistance application is also available on our website. | Pondera Medical Center |
| Part V, Section B, Line 20d: The maximum amount charged to a patient under the financial assistance policy for emergency and medically necessary care is 75% of the gross charges. This is based on the lowest discount under the charity care policy of 25%. 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). | Pondera Medical Center |
| Part V, Section B, Line 22: 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. | Pondera Medical Center |
| Part VI, Line 2: A community survey was prepared and administered by an independent third party. We also obtained health fair requests and results, physician studies of trends and patient satisfaction surveys. Our community health needs assessment is due December 31, 2013 and will be made widely available before that time. An implementation strategy addressing the needs will also be completed and board approved. | |
| Part VI, Line 3: Patients are informed about their eligibility for financial assistance during conversations at registration and during follow-up on outstanding account balances. Financial assistance is offered if a patient is unable to make a payment. | |
| Part VI, Line 4: Pondera Medical Center serves the population of Pondera County, Montana. The population of Pondera County in 2012 was 6,165 and is considered rural. The median household income for 2007 - 2011 was $38,852 in which 18.4% of the population was below the poverty guidelines. The racial makeup consists of 83% white, 15% American Indian or Alaska Native with the remainder being other races. The largest income producing segment of Pondera County is agriculture and while there are a couple large employers in the county including Pondera Medical Center, small business, and oil and natural gas producers make up the majority of employers. The nearest hospital is Marias Medical Center, a 20-bed acute care hospital located in Shelby, MT. Marias Medical Center is located approximately 27 miles north of Conrad, MT. | |
| Part VI, Line 5: The Board of Directors is comprised of community members throughout Pondera County and all board meetings are open to the public. Surpluses of cash, when available, are invested back into the Hospital for equipment purchases and wage considerations.Pondera Medical Center operates an emergency room available to all regardless of ability to pay, 20 acute care beds for hospital stays, obstetric services and rooms, surgery center, 59 bed extended care center, special care unit, rural health clinic, wellness center, cardiac rehab, home health agency, physical therapy and numerous other services to meet your daily and long-term health care needs. Pondera Medical Center seeks and encourages community members to become involved and volunteer in our Extended Care facility. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 1 | 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 (3 entries)
| TitleTitle | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Patricia Grena | ||||||||||||||
| Physician | 151655 | 0 | 192 | 0 | 0 | 0 | 0 | 0 | 24362 | 0 | 176209 | 0 | 0 | 0 |
| Peter Barran | ||||||||||||||
| Physician | 175276 | 0 | 35000 | 0 | 0 | 0 | 0 | 0 | 10164 | 0 | 220440 | 0 | 0 | 0 |
| Jay Taylor | ||||||||||||||
| Physician | 166710 | 0 | 59920 | 0 | 0 | 0 | 0 | 0 | 33953 | 0 | 260583 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| Part I, Line 4a | Dave Doran, CFO, received $18,846.10 in a severance payment for termination of employment on September 14, 2012. Dave received six month's salary, with the final payment being made on March 22, 2013. |
| Part I, Line 5 | The physicians are paid bonuses based on their revenue. Revenue tiers are set and if met a specified bonus is paid to that physician. The revenue tiers and bonus amounts are set up on the physician's employment contract therefore the board does not have authority to deny or change an amount. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (8 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part VI, Section A, line 4 | The Organization's Bylaws were amended on January 26, 2012 and September 27, 2012. The role of the CEO/Administrator has the authority to make necessary purchases with limits of $10,000 per purchase. Previously there was no limit stated. The role of the Board of Directors now includes performing other activities permitted by the Articles of Incorporation or state law. The CEO/Administrator shall be hired by and be accountable to the Board. Wording was removed stating the CEO/Administrator be employed by the Board. The Medical Staff is responsible and accountable to the CEO/Administrator for the quality of the medical practice rendered. It was previously stated that the Medical Staff was responsible and accountable to the Board. The composition of the Board of Directors was updated. The January amendment stated the Board of Directors consist of nine persons, seven of whom were appointed by the Pondera Medical Center Board of Directors from an approved candidate or list of approved candidates submitted by the Pondera County Commissioners. The eighth Director shall be a Pondera County Commissioner selected by them from their board. This was amended in September to the Board of Directors shall consist of not fewer than seven or more than eleven member who are appointed by the Board of Directors. One Board Director shall be a member of the Board of Commissioners of Pondera County, and one Board Director shall be the Corporation's Chief of Medical Staff. The Chief of Medical Staff will be a non-voting member of the Board. The January amendment stated each of the eight members shall be appointed to a three-year term, with no more than three director terms ending in any given year. The September amendment stated each member shall be appointed to a three-year term with no more than four directors' terms ending in any given year. Vacancies on the Board were to be filled by the Board of County Commissioners. This has been amended to state vacancies are filled following the process outlined in Article III, Section A of the Bylaws. The September amendment added term limitations for any Board member to be nine consecutive years. For members on December 17, 2009, term limits began at their last appointment prior to that date. The September amendment added a super majority of the Board, which is defined as three quarters of the voting Board of Directors in office immediately before a meeting begins, may remove a Board member. The Organization no longer needs to notify the County Commissioner. A super majority defined as six was removed. The January amendment states a majority of the Directors shall constitute a quorum at any meeting. A majority is defined a five voting members. The September amendment states a majority of the voting Board of Directors in office immediately before a meeting begins shall constitute a quorum at any meeting. If a quorum is present at a meeting when a vote is taken, an affirmative vote of a majority of the voting Board of Directors present is the act of the entire Board unless state law, the Articles of Incorporation or these Bylaws require the vote of a greater number of Board of Directors. The Chairman of the Board of Directors has the principal duties of providing leadership to the Board and to assure effective communication between the Board, Administrator, and Medical Staff. Also providing this to the Members of the Senior Staff was added. It was clarified in the September amendment that management matters are the primary responsibility of the CEO/Administrator. The term limitations for any Board member to serve as an officer of the Board shall be three consecutive years in each officer position was added. | |
| Form 990, Part VI, Section A, line 8b | The Organization does not have committees with authority to act on behalf of the governing body. | |
| Form 990, Part VI, Section B, line 11 | The Form 990 is reviewed by the CEO and CFO. After their review a draft copy of the 990 is provided by e-mail to the board members for review. The final copy of the Form 990 is e-mailed to the board prior to filing. | |
| Form 990, Part VI, Section B, line 12c | Officers and Trustees annually disclose potential conflicts, which are discussed at a Board of Trustees meeting. Segregation of duties is strictly enforced for any potential family or business conflicts of interest. If there is a potential conflict at a board meeting, the board member is not allowed to vote on the conflicting issue. | |
| Form 990, Part VI, Section B, line 15 | Compensation is determined on an annual basis by the Board of Trustees by using the Montana Hospital Salary Survey for like hospitals in the state and adjusted for budget limitations. | |
| Form 990, Part VI, Section C, line 19 | Governing documents, conflict of interest policy and financial statements are available to the public upon request. | |
| Form 990, Part XI, line 9: | Gain on perpetual trust 10,989. County pymt to be paid to State of Montana for intergovernmental transfer -449,836. | Changes in Net Assets or Fund Balances: |
| Form 990, Part XII, Line 2c: | The Board of Directors is responsible for oversight of the audit of its financial statements and selection of an independent accountant. |