CENTRAL MONTANA MEDICAL FACILITIES INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- CENTRAL MONTANA MEDICAL FACILITIES INC (EIN 23-7169043)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-04-22
- IRS object ID
- 201201139349300700
- Schema version
- 2010v3.4
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-04-22T12:56:55-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
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 | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237169043 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL MONTANA MEDICAL FACILITIES INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CENT | NameControl |
| Phone | 4065387711 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 408 WENDELL AVENUE | AddressLine1 |
| City | LEWISTOWN | City |
| State | MT | State |
| ZIP Code | 59457 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ALAN R ALDRICH | Name |
| Title | CFO | Title |
| Phone | 4065386243 | Phone |
| Date Signed | 2012-04-16 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | KIM C HUNWARDSEN | Name |
| Phone | 6122536500 | Phone |
| Date Prepared | 2012-04-17 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CENTRAL MONTANA MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | DAVID FAULKNER | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 408 WENDELL AVENUE | AddressLine1 |
| City | LEWISTOWN | City |
| State | MT | State |
| ZIP Code | 59457 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 26768915 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CMMCCARES.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1971 | YearFormation |
| State Legal Domicile | MT | StateLegalDomicile |
| Activity Or Mission Description | THE MISSION OF CMMC IS TO BE THE LEADER IN ASSURING COMMUNITY BASED QUALITY HEALTHCARE. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 443 | TotalNbrEmployees |
| Total Nbr Volunteers | 350 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 62928 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 140928 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 25012193 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 24480464 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 103817 | InvestmentIncomePriorYear |
| Investment Income Current Year | 21398 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 5130 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4660 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 25184068 | TotalRevenuePriorYear |
| Total Revenue Current Year | 24647450 | 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 | 14740308 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 14754925 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 42909 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10360013 | OtherExpensePriorYear |
| Other Expenses Current Year | 10552851 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 25100321 | TotalExpensesPriorYear |
| Total Expenses Current Year | 25307776 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 83747 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -660326 | RevenuesLessExpensesCY |
| Total Assets BOY | 19912767 | TotalAssetsBOY |
| Total Assets EOY | 20642912 | TotalAssetsEOY |
| Total Liabilities BOY | 4917200 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 5536887 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 14995567 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 15106025 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF CENTRAL MONTANA MEDICAL CENTER IS TO BE THE LEADER IN ASSURING COMMUNITY BASED QUALITY HEALTHCARE. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 2492223 | Expense |
| Revenue | 4164143 | Revenue |
| Description | SKILLED NURSING CARE/LONG TERM CARE REHAB OR LONG TERM NURSING SERVICES:NUMBER OF BEDS: 85PROVIDED 20,929 DAYS OF CARE FOR A 67.46% OCCUPANCY RATE. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 2437280 | Expense |
| Revenue | 1427472 | Revenue |
| Description | EMERGENCY SERVICES:PROVIDED FOR 5,199 EMERGENCY VISITS.24 HOUR PHYSICIAN COVERAGE AVAILABLE. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 1507223 | Expense |
| Revenue | 2527296 | Revenue |
| Description | HOSPITAL INPATIENT SERVICES:NUMBER OF BEDS: 25PROVIDED 2,274 ACUTE DAYS OF CARE AND 923 SWING BED DAYS OF CARE FOR A 25% OCCUPANCY RATE. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 14089493 | Expense |
| Revenue | 16361553 | Revenue |
| Description | CMMC ALSO PROVIDES OTHER PATIENT CARE SERVICES INCLUDING CLINIC, INTENSIVE AND CORONARY CARE AND NURSERY CARE. SOME OF THE LARGER ANCILLARY SERVICES INCLUDE LABORATORY, PHARMACY, OPERATING ROOM, CT SCAN AND RADIOLOGY, THERAPY SERVICES, SURGERY CLINIC, AND HOME OXYGEN CARE. COMMUNITY CARE AND SERVICES ARE ALSO PROVIDED THROUGH THE MANY REDUCED PRICE SERVICES AND FREE CLINICS, FAIRS, AND PROGRAMS OFFERED THROUGHOUT THE YEAR. THESE INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING (ALL COSTS ARE ESTIMATES): 1. TWENTY-NINE FOOT CLINICS WERE HELD IN 2010-2011 IN DENTON, HOBSON AND LEWISTOWN, MT. A TOTAL OF 393 PEOPLE WERE SERVED, ALL RECEIVED DISCOUNTED HEALTH CARE. TOTAL COMMUNITY BENEFIT EXPENSE OF $3,825.2. TWO HEALTH FAIRS WERE HELD IN 2010-2011, SERVING 4,306 PEOPLE IN FERGUS AND BASIN COUNTIES. ALL RECEIVED DISCOUNTED HEALTH CARE. TOTAL COMMUNITY BENEFIT EXPENSE OF $7,817.3. TWO SUPPORT GROUPS MET IN 2010-2011, SERVING 56 PEOPLE. SUPPORT GROUPS INCLUDED CANCER AND DIABETES EDUCATION. TOTAL COMMUNITY BENEFIT EXPENSE OF $1,076.4. CMMC EDUCATED LOCALS WITH A BABY SITTING CLASS (25 PEOPLE SERVED, 1 CLASS OFFERED, TOTAL COMMUNITY BENEFIT $751), AND SEVERAL COMMUNITY BOARDS WERE SERVED ON IN 2010-2011 FOR A TOTAL OF $5,722. THE FACILITY 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. THE AMOUNT OF CHARGES FOREGONE, BASED ON ESTABLISHED RATES, WAS $739,596 FOR THE CURRENT YEAR. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 14089493 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 16361553 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 20526219 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| 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 | 0 | 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 | 1 | 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 | 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 | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 32 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 443 | 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 | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | 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 | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | 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 | ALAN R ALDRICH CFO | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 4065357711 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 408 WENDELL AVENUE | AddressLine1 |
| City | LEWISTOWN | City |
| State | MT | State |
| ZIP Code | 59457 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (22 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 |
|---|---|---|---|---|---|---|---|
| WAYNE EDWARDS | |||||||
| PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| MIKE ZACHER | |||||||
| VICE PRESIDENT | 2.00 | X | X | 0 | 0 | 0 | |
| NANCY WILSON | |||||||
| SECRETARY/TREASURER | 2.00 | X | X | 0 | 0 | 0 | |
| JOHN JENSEN | |||||||
| MEMBER (THRU NOV 2010) | 1.00 | X | 0 | 0 | 0 | ||
| DOUG FLAMENT | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ALTA PALLETT | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVE PHILLIPS | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| RUSSELL SPIKA CPA | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| MIKE DELANEY | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| FRANCIS WEINHEIMER | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| LAURA BENNETT MD | |||||||
| MEMBER | 1.00 | X | 20000 | 0 | 0 | ||
| CHRISTINE VOLF | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| ROY KOHLER MD | |||||||
| MEMBER | 1.00 | X | 6912 | 0 | 0 | ||
| CARL SEILSTAD | |||||||
| MEMBER | 1.00 | X | 0 | 0 | 0 | ||
| DAVID FAULKNER | |||||||
| CEO | 40.00 | X | 155087 | 0 | 48792 | ||
| ALAN R ALDRICH | |||||||
| CFO | 40.00 | X | 102482 | 0 | 29600 | ||
| DIANNE SCOTTEN | |||||||
| CCO | 40.00 | X | 96283 | 0 | 12672 | ||
| DANNY HARBOUR | |||||||
| ER PHYSICIAN | 40.00 | 175499 | 0 | 36172 | X | ||
| JAMES FOX | |||||||
| CRNA | 40.00 | 203046 | 0 | 18344 | X | ||
| BRIAN PRIEST | |||||||
| ER PHYSICIAN | 40.00 | 176880 | 0 | 25786 | X | ||
| RONALD SKIPPER | |||||||
| PHYSICIAN | 40.00 | 296840 | 0 | 39924 | X | ||
| RENE DEGUZMAN | |||||||
| CRNA | 40.00 | 177867 | 0 | 26838 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1410896 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 238128 | TotalOtherCompensation |
| Number Individuals GT100 K | 8 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (2 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| QUORUM HEALTH RESOURCES LLC | |||||
| 105 CONTINENTIAL PLACE | BRENTWOOD | TN | 37027 | FACILITY MANAGEMENT & CEO SERVICES | 506743 |
| GE MEDICAL SYSTEMS | |||||
| PO BOX 843553 | DALLAS | TX | 75284 | MRI CONTRACT SERVICES | 140041 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 2 | NumberOfContractorsGT100K |
| Fundraising Events | 29108 | FundraisingEvents |
| Government Grants | 24150 | GovernmentGrants |
| All Other Contributions | 87670 | AllOtherContributions |
| Total Contributions | 140928 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 622110 | 23455816 | 23455816 |
| SPECIAL PROGRAMS | 900099 | 901603 | 901603 |
| CAFETERIA | 722210 | 124396 | 124396 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -1351 | TotalRevenueColumn |
| Related Or Exempt Function Income | -1351 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 24480464 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 131477 | TotalRevenueColumn |
| Exclusion | $131,477 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 287656 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 295929 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -8273 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -8273 | TotalRevenueColumn |
| Exclusion | -$8,273 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1690425 | Securities |
| Other | 13747 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 1808177 | Securities |
| Other | 6074 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -117752 | Securities |
| Other | 7673 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -110079 | TotalRevenueColumn |
| Exclusion | -$110,079 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 11285 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 29108 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 11285 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INTEREST INCOME | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 12933 | TotalRevenueColumn |
| Exclusion | $12,933 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 12933 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24647450 | TotalRevenueColumn |
| Related Or Exempt Function Income | 24480464 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $26,058 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 258721 | Total |
| Program Services | 134489 | ProgramServices |
| Management And General | 124232 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11831844 | Total |
| Program Services | 9465475 | ProgramServices |
| Management And General | 2347089 | ManagementAndGeneral |
| Fundraising | 19280 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 239283 | Total |
| Program Services | 188513 | ProgramServices |
| Management And General | 50192 | ManagementAndGeneral |
| Fundraising | 578 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1578129 | Total |
| Program Services | 1254122 | ProgramServices |
| Management And General | 318131 | ManagementAndGeneral |
| Fundraising | 5876 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 846948 | Total |
| Program Services | 677558 | ProgramServices |
| Management And General | 168158 | ManagementAndGeneral |
| Fundraising | 1232 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 461751 | Total |
| Program Services | 277051 | ProgramServices |
| Management And General | 184700 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58745 | Total |
| Management And General | 58745 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 32500 | Total |
| Management And General | 32500 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 746083 | Total |
| Program Services | 746083 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 57894 | Total |
| Program Services | 28947 | ProgramServices |
| Management And General | 19011 | ManagementAndGeneral |
| Fundraising | 9936 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3162479 | Total |
| Program Services | 2824612 | ProgramServices |
| Management And General | 335427 | ManagementAndGeneral |
| Fundraising | 2440 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 973591 | Total |
| Program Services | 749041 | ProgramServices |
| Management And General | 222750 | ManagementAndGeneral |
| Fundraising | 1800 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47820 | Total |
| Program Services | 47820 | ProgramServices |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93740 | Total |
| Program Services | 62012 | ProgramServices |
| Management And General | 31728 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140848 | Total |
| Program Services | 109861 | ProgramServices |
| Management And General | 30987 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1180190 | Total |
| Program Services | 888258 | ProgramServices |
| Management And General | 291623 | ManagementAndGeneral |
| Fundraising | 309 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 621141 | Total |
| Program Services | 585934 | ProgramServices |
| Management And General | 35207 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| BAD DEBT ALLOWANCE | 898816 | 898816 | ||
| SERVICE CONTRACTS | 582430 | 383660 | 197590 | 1180 |
| EQUIPMENT RENTAL AND MA | 251685 | 209457 | 42228 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1243138 | Total |
| Program Services | 994510 | ProgramServices |
| Management And General | 248350 | ManagementAndGeneral |
| Fundraising | 278 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25307776 | Total |
| Program Services | 20526219 | ProgramServices |
| Management And General | 4738648 | ManagementAndGeneral |
| Fundraising | 42909 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1570599 | BOY |
| EOY | 576615 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3479999 | BOY |
| EOY | 3339910 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 50238 | BOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 442033 | BOY |
| EOY | 476943 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 144993 | BOY |
| EOY | 144684 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 29767038 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 20292731 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8095441 | BOY |
| EOY | 9474307 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3616602 | BOY |
| EOY | 4011332 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 251996 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2512862 | BOY |
| EOY | 2367125 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19912767 | BOY |
| EOY | 20642912 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2125546 | BOY |
| EOY | 2052036 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1147968 | BOY |
| EOY | 916227 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1643686 | BOY |
| EOY | 2056795 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 443500 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 68329 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4917200 | BOY |
| EOY | 5536887 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13271811 | BOY |
| EOY | 13325124 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 931428 | BOY |
| EOY | 980947 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 792328 | BOY |
| EOY | 799954 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14995567 | BOY |
| EOY | 15106025 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19912767 | BOY |
| EOY | 20642912 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -660326 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 770784 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 | 6260 | BeginningBalance |
| Additions During Year | 10833 | AdditionsDuringYear |
| Distributions During Year | 11659 | DistributionsDuringYear |
| Ending Balance | 5434 | EndingBalance |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 103009 | OtherCostOrOtherBasis |
| Book Value | 103009 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 16934704 | OtherCostOrOtherBasis |
| Depreciation | 11056508 | Depreciation |
| Book Value | 5878196 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11513383 | OtherCostOrOtherBasis |
| Depreciation | 8626610 | Depreciation |
| Book Value | 2886773 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1215942 | OtherCostOrOtherBasis |
| Depreciation | 609613 | Depreciation |
| Book Value | 606329 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 9474307 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| LONG-TERM PREPAID EXPENSES | 283501 |
| DUE FROM FOUNDATION | 1780901 |
| OTHER RECEIVABLES | 302723 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 2367125 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS | Description |
| Amount | $68,329 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 68329 | TotalOfAmounts |
| Total Revenue | 24647450 | TotalRevenue |
| Total Expenses | 25307776 | TotalExpenses |
| Excess Or Deficit For Year | -660326 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 713639 | NetUnrealizedGLOnInvestments |
| Other | $57,145 | OtherAmount |
| Total Adjustments | 770784 | TotalAdjustments |
| Excess Or Deficit Per FS | 110458 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 24831559 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 24831559 | RevenueSubtotal |
| Other Revenues Not Included | -184109 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -184109 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 24647450 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 25603705 | TotExpensesEtcAuditedFinclStmt |
| Expenses Not Rptd F990 | 0 | ExpensesNotRptdF990 |
| Expenses Subtotal | 25603705 | ExpensesSubtotal |
| Other Expenses Not Included | -295929 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | -295929 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 25307776 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| PART IV, LINE 1B: | NURSING HOME TRUST ACCOUNT. THESE FUNDS BELONG TO OUR RESIDENTS. WE HAVE DEPOSITED THEM IN TRUST FOR VARIOUS SMALL EXPENSES INCURRED BY THE INDIVIDUALS. | |
| PART X: | THE FACILITIES UNDERGO AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THOSE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES. AS OF JUNE 30, 2011 AND 2010, THE UNRECOGNIZED TAX BENEFIT ACCRUAL IS ZERO. THE FACILITIES WILL RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO TAX BENEFITS IN INCOME TAX EXPENSE, IF INCURRED. THE FACILITIES ARE NO LONGER SUBJECT TO FEDERAL OR STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR THE YEARS BEFORE 2007. | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: |
| INTEREST IN CENTRAL MONTANA FOUNDATION 57,145. | PART XI, LINE 8 - OTHER ADJUSTMENTS: | |
| CONTRIBUTIONS FOR SPECIFIC PURPOSES RECORDED IN FUND BALANCE FOR F/S 111,820. RENTAL EXPENSES RECORDED IN EXPENSES FOR FINANCIAL STATEMENTS -295,929. | PART XII, LINE 4B - OTHER ADJUSTMENTS: | |
| RENTAL EXPENSES RECORDED IN EXPENSES FOR FINANCIAL STATEMENTS -295,929. | PART XIII, LINE 4B - OTHER ADJUSTMENTS: |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | HOSPICE AUCTION & HOME TOURS | NameOfEvent1 |
| Gross Receipts Event1 | 18493 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 12146 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 6347 | GrossRevenueEvent1 |
| Rent Facility Costs Event1 | 4500 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 1847 | OtherDirectExpensesEvent1 |
| Name Of Event2 | GOLF TOURNEY | NameOfEvent2 |
| Gross Receipts Event2 | 12001 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 7919 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 4082 | GrossRevenueEvent2 |
| Non Cash Prizes Event2 | 449 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 3213 | RentFacilityCostsEvent2 |
| Other Direct Expenses Event2 | 420 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 9899 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 9043 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 856 | GrossRevenueOtherEvents |
| Other Direct Expenses Other Events | 856 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 40393 | GrossReceiptsTotal |
| Charitable Contributions Total | 29108 | CharitableContributionsTotal |
| Gross Revenue Total Events | 11285 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 449 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 7713 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 3123 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 11285 | DirectExpenseSummaryEvents |
| Net Income Summary | 0 | NetIncomeSummary |
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 |
| Pcent150 | X | Pcent150 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 468 | PersonsServed |
| Total Community Benefit Expense | 479247 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 479247 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2434515 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2615931 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -181416 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 468 | PersonsServed |
| Total Community Benefit Expense | 2913762 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2615931 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 297831 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01960 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 11 | NumberOfActivitiesOrPrograms |
| Persons Served | 8760 | PersonsServed |
| Total Community Benefit Expense | 18794 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 3991 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 14803 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00060 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3683298 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2829173 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 854125 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03500 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 1408 | PersonsServed |
| Total Community Benefit Expense | 10665 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 10665 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 10168 | PersonsServed |
| Total Community Benefit Expense | 3712757 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2833164 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 879593 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03600 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 10636 | PersonsServed |
| Total Community Benefit Expense | 6626519 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5449095 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1177424 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05560 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 8641 | PersonsServed |
| Total Community Building Expense | 12423 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 12423 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 3 | NumberOfActivitiesOrPrograms |
| Persons Served | 8641 | PersonsServed |
| Total Community Building Expense | 12423 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 12423 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReported |
| Bad Debt Expense | $582,420 | BadDebtExpenseAmount |
| Amount Attributable To | 13197 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5955760 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5861153 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 94607 | 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 | CENTRAL MONTANA MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 408 WENDALL AVENUE | AddressLine1 |
| City | LEWISTOWN | City |
| State | MT | State |
| ZIP Code | 59457 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | HOME HEALTH / HOSPICE | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NOT REQUIRED | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| CENTRAL MONTANA MEDICAL CENTER - DME | ||||
| 202 4TH AVENUE SOUTH | LEWISTOWN | MT | 59457 | HME/DME SERVICES |
| BASIN MEDICAL CENTER | ||||
| 76 CENTRAL AVENUE | STANFORD | MT | 59479 | RURAL HEALTH CLINIC |
| CENTRAL MT MEDICAL CENTER SKILLED | ||||
| NURSING CENTER 408 WENDELL AVENUE | LEWISTOWN | MT | 59457 | SKILLED NURSING FACILITY |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: ELIGIBILITY IS BASED ON PATIENT'S FAMILY SIZE, FAMILY GROSS INCOME, PERSONAL ASSETS, AND OTHER MEDICAL DEBTS. |
| PART I, LINE 7: CHARITY CARE WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. UNREIMBURSED MEDICAID WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS WERE BASED ON EXPENSES RECORDED IN THE GENERAL LEDGER. SUBSIDIZED HEALTH SERVICES ARE REPORTED ACCORDING TO COSTS ALLOCATED TO THE RELEVANT COST CENTERS ON THE MEDICARE COST REPORT. |
| PART I, LINE 7G: $317,978 OF COSTS ARE ATTRIBUTABLE TO A PROVIDER BASED CLINIC. |
| PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION WAS $898,816. |
| PART II: CMMC PROMOTES THE HEALTH OF THE COMMUNITY BY SERVING ON SEVERAL DIFFERENT COMMUNITY BOARDS AND THROUGH SEVERAL COMMUNITY EVENTS. SEVERAL OF THE ORGANIZATION'S DEPARTMENT MANAGERS SERVE ON COMMUNITY BOARDS SUCH AS RELAY FOR LIFE, KIWANIS, TRANSPORTATION ADVISORY BOARD, COMMUNITY HEALTH STEERING COMMITTEE, AND THE LOCAL EMERGENCY PLANNING COMMITTEE. BY BEING INVOLVED IN COMMUNITY GROUPS, THE ORGANIZATION HAS THE OPPORTUNITY TO ADDRESS UNDERLYING CAUSES OF HEALTH ISSUES. |
| PART III, LINE 4: BAD DEBT EXPENSE WAS CONVERTED TO COST USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BY USING CHARITY CARE AS A % OF GROSS PATIENT SERVICES REVENUE. AS A PORTION OF REVENUE IS CONSIDERED CHARITY CARE, IT IS ASSUMED THAT A PERCENTAGE OF BAD DEBT EXPENSE WOULD ALSO BE CONSIDERED CHARITY CARE.BAD DEBT EXPENSE IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.FINANCIAL STATEMENT NOTE: THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS AND THIRD PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE BAD DEBT PROVISION. |
| PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CMS. |
| PART III, LINE 9B: PATIENTS DEEMED UNABLE TO PAY BY CMMC AT ANY TIME DURING THE REVENUE CYCLE MAY BE ELIGIBLE TO RECEIVE AVAILABLE FINANCIAL ASSISTANCE. PATIENTS MUST COMPLETE AN APPLICATION. OUR COLLECTION PRACTICE IS TO REFRAIN FROM COLLECTION EFFORTS UNTIL FINANCIAL ASSISTANCE IS DETERMINED. NORMAL COLLECTION EFFORTS WOULD RESUME IF THE APPLICATION IS NOT RETURNED TIMELY OR AFTER THE WRITE-OFF IS COMPLETE AND THE PATIENT OWES A BALANCE. |
| PART VI, LINE 2: CURRENTLY, CMMC ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY BY THE NUMBER OF RESPONSES TO ADS AND ARTICLES RELEASED THROUGH THE LOCAL MEDIA. CMMC MONITORS THE ATTENDANCE AT ANNUAL EVENTS SUCH AS HEALTH FAIRS. IN ADDITION, CMMC TRACKS THE TYPES OF SUPPORT REQUESTED TO PROVIDE SUCH AS CHILDREN'S SAFETY, WELLNESS INITIATIVES AND HEALTHCARE ASSESSMENTS. IN THE PAST, CMMC COMPLETED AN OFFICIAL COMMUNITY NEEDS ASSESSMENT WITH THE HELP OF MONTANA STATE UNIVERSITY. MAIL AND PHONE SURVEYS WERE COMPLETED AND "TOWN HALL" TYPE MEETINGS WERE HELD IN LEWISTOWN AS WELL AS MOST OF THE SURROUNDING SMALLER COMMUNITIES. CMMC WILL BE DOING ANOTHER COMMUNITY NEEDS ASSESSMENT IN THE NEAR FUTURE TO MEET 501(R) REQUIREMENTS. |
| PART VI, LINE 3: CMMC HAS FINANCIAL ASSISTANCE SIGNAGE POSTED IN THE ADMISSIONS AREAS AND THE ER WAITING AREA. A PAMPHLET EXPLAINING OUR FINANCIAL ASSISTANCE PROGRAM, THE APPLICATION PROCESS AND CONTACT INFORMATION IS AVAILABLE AT ALL HOSPITAL REGISTRATION AREAS. THE CHARITY CARE POLICY AND APPLICATION ALONG WITH A CHECKLIST AND CONTACT INFORMATION IS POSTED ON OUR WEBSITE ON THE INTERNET. PRIOR TO DISCHARGE, SOMEONE FROM DISCHARGE PLANNING DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID, AND ASSISTS THE PATIENT WITH QUALIFICATIONS FOR SUCH PROGRAMS, WHERE APPLICABLE. ASSISTANCE WITH FILLING OUT THE CHARITY CARE APPLICATION IS ALSO PROVIDED AT THIS TIME. PRIVATE PAY IN-PATIENTS ARE INFORMED OF CHARITY CARE EITHER PRIOR TO SCHEDULED ADMISSION BY PHYSICIAN REFERRAL OR PRIOR TO DISCHARGE FROM THE FACILITY. WE ALSO SEND OUT INFORMATION WITH FIRST TIME STATEMENTS. ALL OTHER PATIENTS ARE INFORMED UPON INQUIRY. |
| PART VI, LINE 4: LEWISTOWN IS AN AGRICULTURAL COMMUNITY AND THE COUNTY SEAT FOR FERGUS COUNTY MONTANA. LEWISTOWN IS LOCATED IN THE CENTER OF MONTANA AND IS SURROUNDED BY FIVE MOUNTAIN RANGES: THE SNOWIES, THE JUDITHS, THE MOCCASINS, THE BELTS AND THE HIGHWOODS. THE CITY OF LEWISTOWN AND THE SURROUNDING RURAL TOWNS ARE SUPPORTED BY ONE HOSPITAL, CENTRAL MONTANA MEDICAL CENTER. FERGUS COUNTY HAS A PRIMARY CARE LOW INCOME HPSA DESIGNATION WITH A SCORE OF 16. FERGUS COUNTY IS LOCATED IN A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. AS OF 2010, THERE WERE 5,901 PEOPLE RESIDING IN THE CITY. THE POPULATION DENSITY WAS 1,109.4 PEOPLE PER SQUARE MILE. ALSO 11.5% OF THE RESIDENTS WERE BELOW THE POVERTY LEVEL.THE RACIAL MAKEUP OF THE CITY WAS 95.40% WHITE, 0.30% AFRICAN AMERICAN, 1.7% NATIVE AMERICAN, 0.40% ASIAN, AND 2.0% FROM TWO OR MORE RACES. HISPANIC OR LANTINO OF ANY RACE WERE 2.1% OF THE POPULATION.THERE WERE 2,808 HOUSEHOLDS OUT OF WHICH 87.3% HAVE LIVED IN THE SAME HOUSE FOR 1 YEAR & OVER. LANGUAGES OTHER THAN ENGLISH SPOKEN AT HOME WERE 1.9%. THE AVERAGE HOUSEHOLD SIZE WAS 2.08. MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS WAS $96,900 WITH A PER CAPITA INCOME IN THE PAST 12 MONTHS OF $22,664. 84.4% OF THE RESIDENTS ARE HIGH SCHOOL GRADUATES WITH 20.0% HAVING RECEIVED A BACHELOR'S DEGREE OR HIGHER. IN THE CITY, THE POPULATION SPREAD WAS 5.9% PERSONS UNDER 5 YEARS OF AGE, 20.4% UNDER THE AGE OF 18, 21.7% PERSONS 65 YEARS AND OVER WITH 50.8% BEING OF FEMALE SEX. |
| PART VI, LINE 6: THE CMMC GOVERNING BOARD CONSISTS OF 13 VOLUNTEER COMMUNITY MEMBERS INCLUDING RESIDENTS FROM GRASS RANGE, STANFORD, DENTON AND JUDITH GAP. CMMC EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS BASED UPON COMMUNITY NEEDS.SURPLUS FUNDS, WHEN AVAILABLE, ARE APPLIED TO PATIENT CARE NEEDS, EQUIPMENT AND BUILDING MAINTENANCE AND MEDICAL EDUCATION REQUIREMENTS. THE EXPENDITURE OF THESE FUNDS ARE APPROVED BY THE GOVERNING BOARD WHICH MEETS ON A MONTHLY BASIS. |
| PART VI, LINE 7: N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | 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 (6 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 FAULKNER | |||||||||||||
| 155087 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 155087 | 0 | 0 | 0 |
| DANNY HARBOUR | |||||||||||||
| 175499 | 0 | 0 | 0 | 0 | 0 | 23546 | 0 | 13699 | 0 | 212744 | 0 | 0 | 0 |
| JAMES FOX | |||||||||||||
| 203046 | 0 | 0 | 0 | 0 | 0 | 18344 | 0 | 1073 | 0 | 222463 | 0 | 0 | 0 |
| BRIAN PRIEST | |||||||||||||
| 176880 | 0 | 0 | 0 | 0 | 0 | 14830 | 0 | 10956 | 0 | 202666 | 0 | 0 | 0 |
| RONALD SKIPPER | |||||||||||||
| 296840 | 0 | 0 | 0 | 0 | 0 | 24353 | 0 | 16644 | 0 | 337837 | 0 | 0 | 0 |
| RENE DEGUZMAN | |||||||||||||
| 177867 | 0 | 0 | 0 | 0 | 0 | 11267 | 0 | 16608 | 0 | 205742 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | SUPPLEMENTAL INFORMATION | Identifier |
| Return Reference | PART III | ReturnReference |
| Explanation | PART I, QUESTION 3: THE ORGANIZATION DOES NOT PAY COMPENSATION TO THE CEO DIRECTLY. THE CEO IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. THE BOARD OF DIRECTORS APPROVES THE CONTRACT WITH THE MANAGEMENT COMPANY. PART II: THE CEO, DAVID FAULKNER, IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY, QUORUM HEALTH RESOURCES LLC. HE IS COMPENSATED FOR SERVICES PROVIDED TO C.M. MEDICAL FACILITIES, INC. THE MANAGEMENT COMPANY BASES THE CEO'S SALARY ON COMPENSATION SURVEYS FOR THE AREA. THE BOARD OF DIRECTORS APPROVES THE CONTRACT WITH QUORUM OR MAKES RECOMMENDATIONS BACK TO THE MANAGEMENT COMPANY. | Explanation |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI (3 entries)
| Issuer EINIssuerEIN | Date IssuedDateIssued | Issue PriceIssuePrice | Description Of PurposeDescriptionOfPurpose | DefeasedDefeased | On Behalf Of IssuerOnBehalfOfIssuer | Pool FinancingPoolFinancing |
|---|---|---|---|---|---|---|
| FERGUS COUNTY MONTANA | ||||||
| 816001358 | 2003-07-31 | 1980000 | REFUND OLD BONDS | 0 | 0 | 0 |
| FERGUS COUNTY MONTANA | ||||||
| 816001358 | 2006-08-25 | 1529611 | MRI SYSTEM PROJECT | 0 | 0 | 0 |
| FERGUS COUNTY MONTANA | ||||||
| 816001358 | 2003-04-30 | 525000 | CONSTRUCT/EQUIPMENT ADDITION | 0 | 0 | 0 |
Form990 Schedule K Part II Form990ScheduleKPartII (3 entries)
| Amount RetiredAmountRetired | Total ProceedsTotalProceeds | Other Spent ProceedsOtherSpentProceeds | Year Of Subst CompletionYearOfSubstCompletion | Current RefundingCurrentRefunding | Advance RefundingAdvanceRefunding | Final Allocation MadeFinalAllocationMade | Adequate Books And Recds MaintaindAdequateBooksAndRecdsMaintaind | Issuance Costs From ProceedsIssuanceCostsFromProceeds | Capital ExpendituresCapitalExpenditures |
|---|---|---|---|---|---|---|---|---|---|
| 1354331 | 1980000 | 1980000 | 2003 | 1 | 0 | 1 | 1 | ||
| 1362768 | 1529611 | 2006 | 0 | 0 | 1 | 1 | 29611 | 1500000 | |
| 525000 | 2003 | 0 | 0 | 1 | 1 | 2800 | 522200 |
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 (3 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 | 1 |
| 0 | 0 | 0 | 0 | 0 | 1 |
| 0 | 0 | 0 | 0 | 0 | 1 |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| ANNIE DAVIS | |||
| FAMILY OF BOARD MEMBER | 47926 | PAYMENT OF COMPENSATION | 0 |
| YELLOWSTONE INSTURANCE | |||
| CEO OF ORGANIZATION IS ALSO A DIRECTOR FOR YELLOWSTONE INSURANCE | 530000 | PAYMENT FOR SERVICES | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE INCLUDES THE PRESIDENT, VICE PRESIDENT, SECRETARY, AND TREASURER. THEIR AUTHORITY IS SIMILAR TO THAT OF THE FULL GOVERNING BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 2 | RUSSELL SPIKA AND ALAN R. ALDRICH HAVE A BUSINESS RELATIONSHIP. | |
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION DELEGATED CONTROL OVER MANAGEMENT DUTIES CUSTOMARILY PERFORMED BY OR UNDER DIRECT SUPERVISION OF OFFICERS, DIRECTORS, TRUSTEES, OR KEY EMPLOYEES TO THE CEO WHO IS EMPLOYED BY A MANAGEMENT COMPANY, QUORUM HEALTH RESOURCES LLC (QHR). QHR ASSISTS WITH THE MANAGEMENT AND SUPERVISION OF THE ORGANIZATION UNDER THE POLICIES AND DIRECTION OF THE GOVERNING BOARD. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION MEMBERS CONSIST OF RESIDENTS OF THE CENTRAL MONTANA AREA WHO ARE AT LEAST 18 YEARS OF AGE AND WHO HAVE OR SHALL INDICATE THEIR INTEREST IN THE MAINTENANCE OF ADEQUATE MEDICAL FACILITIES AND HIGH STANDARDS OF MEDICAL CARE IN THE AREA. MEMBERS OF THE ORGANIZATION MUST ATTEND AND SIGN THE REGISTER AT THE ORGANIZATION'S ANNUAL MEETING. | |
| FORM 990, PART VI, SECTION A, LINE 7A | MEMBERS OF THE ORGANIZATION MAY VOTE ON MATTERS BEING ADDRESSED AT THE ANNUAL MEETINGS. EACH MEMBER IS ENTITLED TO ONE VOTE ON ANY QUESTION OR ACTION WITH THE EXCEPTION OF THE ELECTION OF DIRECTORS OF THE CORPORATION. FOR THE ELECTION OF DIRECTORS, THE MEMBERS SHALL VOTE FOR ONE NOMINEE FOR EACH VACANT BOARD POSITION. | |
| FORM 990, PART VI, SECTION B, LINE 11 | DRAFT COPY OF FORM 990 IS REVIEWED BY THE CFO AND BOARD OF DIRECTORS PRIOR TO ITS FILING. | |
| THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY BY DISCUSSING AT THE BOARD OF DIRECTOR MEETINGS AND OBTAINING SIGNED STATEMENTS FROM MEMBERS. ALL OFFICERS, BOARD MEMBERS, AND KEY EMPLOYEES ARE COVERED BY THE POLICY. THE BOARD DETERMINES WHETHER CONFLICTS EXIST AND ALL POTENTIAL CONFLICTS ARE REVIEWED BY THE BOARD. ANY PERSONS WITH A CONFLICT ARE NOT ALLOWED TO VOTE ON CONFLICTED ISSUES. | FORM 990, PART VI, SECTION B, LINE 12C | |
| FORM 990, PART VI, LINE 15: THE CEO IS EMPLOYED BY QUORUM HEALTH RESOURCES LLC (QHR), A HOSPITAL MANAGEMENT CORPORATION. QHR DETERMINES THE CEO'S COMPENSATION BASED ON INDEPENDENT DATA AND COMPARISONS. THE INFORMATION IS THEN PRESENTED TO THE BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS AND WAS COMPLETED IN FISCAL YEAR ENDING 6/30/11. COMPENSATION OF THE CFO IS DETERMINED BY THE CEO. | ||
| THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. A COPY MAY BE REQUESTED BY CALLING, EMAILING, WALK-IN OR VIA MAIL. | FORM 990, PART VI, SECTION C, LINE 19 | |
| THE CEO IS PAID BY A MANAGEMENT COMPANY FOR SERVICES PROVIDED TO THE ORGANIZATION. THE COMPENSATION PAID TO THE MANAGEMENT COMPANY FOR HIS SERVICES IS DISCLOSED ON PART VII, SECTION A AND ALSO INCLUDED IN THE AMOUNT PAID TO THE MANAGEMENT COMPANY IN PART VII SECTION B. PART IX LINE 11A INCLUDES COMPENSATION PAID TO THE MANAGEMENT COMPANY FOR MANAGEMENT AND CEO SERVICES. LINE 5 INCLUDES COMPENSATION PAID TO THE CFO AND THE CCO FOR SERVICES AS AN EMPLOYEE. | FORM 990, PART VII AND PART IX LINE 5 AND LINE 11A | |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 713,639. INTEREST IN CENTRAL MONTANA FOUNDATION 57,145. TOTAL TO FORM 990, PART XI, LINE 5: 770,784. | FORM 990, PART XI, LINE 5: |
| ORGANIZATION VISION STATEMENT | OUR VISION IS TO BE THE HEALTHCARE PROVIDER FOR OUR REGION; DEDICATE OURSELVES TO INNOVATIVE EXCELLENCE IN CARE; COLLABORATE CARE FOR ECONOMICAL SERVICES WITH OTHER AGENCIES; BE THE LEADER IN PROVIDING HEALTH EDUCATION, PREVENTION, AND WELLNESS SERVICES TO PROMOTE INDIVIDUAL RESPONSIBILITY FOR HEALTH OUTCOMES; PROVIDE FINANCIAL STEWARDSHIP FOR ECONOMIC HEALTH CARE; CREATE AN ENVIRONMENT IN WHICH ALL PARTICIPANTS FEEL VALUED AND RESPECTED; EMBRACE CHANGE WHILE EXPLORING TOMORROWS NEEDS TODAY. OUR VALUES ARE THE INTRINSIC FORCES BEHIND OUR MISSION AND VISION, AND DESCRIBE HOW OUR ACTIONS WILL BE GUIDED. WE BELIEVE IN COMPASSION: WE WILL BE AWARE AND RESPECTFUL OF THE LIFE SITUATION OF OTHERS AND TREAT THEM WITH COMPASSION AND CONSIDERATION, ACCOUNTABILITY: WITH INTEGRITY, KNOWLEDGE, ACTION AND TRUST, RESPECT: FOR DIGNITY, CARE, AND CONCERN FOR ALL, EXCELLENCE: AS A TEAM IN ALL WE DO. | FORM 990, PART III, LINE 1 |