2012-05-03T17:16:26-05:00 2011-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1200 PORTLAND OR 97205 990 2011-01-01 810232122 BENEFIS HOSPITALS INC BENE 4064552563 1101 26TH STREET SOUTH GREAT FALLS MT 59405 LAURA GOLDHAHN 4064552563 2012-04-30 1 WENDY CAMPOS P00448102 5032421447 2011 2016-02-24 21:20:13Z LAURA GOLDHAHN 1101 26TH STREET SOUTH GREAT FALLS MT 59405 529835976 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 513 BED HOSPITAL, PROVIDING INPATIENT AND OUTPATIENT SERVICES. 9 5 2308 589 0 0 0 0 498946250 527070506 790935 442682 1541270 1686999 501278455 529200187 0 0 0 0 95693909 97607918 0 0 0 383491409 403467625 479185318 501075543 22093137 28124644 132767947 190480324 151999870 189618145 -19231923 862179 X WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 0 1 224901898 275572554 BENEFIS HOSPITALS, INC. OPERATES A 513 BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 149934599 189269724 BENEFIS HOSPITALS, INC. PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 58436173 62229321 BENEFIS HOSPITALS, INC. PROVIDES HOSPICE, DIALYSIS, AND SKILLED NURSING SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 433272670 1 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 171 0 2308 1 0 0 0 0 0 0 0 0 0 0 X 9 5 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 1 1 X DALE BIMLER 4064552565 1101 26TH STREET SOUTH GREAT FALLS MT 59405 X COLONEL LESLIE L DIXON 3.00 X 0 0 0 CHRIS EBELING 3.00 X 0 0 0 BILL FERRIN 3.00 X 0 0 0 LAURA GOLDHAHN 56.00 X 0 383185 79882 SUSAN HUMBLE 3.00 X 0 0 0 JEFF JARACZESKI 3.00 X 0 0 0 KEVIN A MCCAFFERTY MD 3.00 X 0 0 0 DALE MORTENSON MD 3.00 X 0 0 0 LYLE J ONSTAD MD 3.00 X 0 0 0 SUSAN RAPH 6.00 X X 0 0 0 COLONEL BRUCE ROEHM 3.00 X 0 0 0 DAVID A ROHRER MD 3.00 X 0 0 0 MARILYN K ROSE 3.00 X X 0 0 0 JERRY W SPEER MD 3.00 X 0 300365 43717 GREGORY S TIERNEY MD 3.00 X 0 0 0 BILL WEBER 3.00 X 0 0 0 DAVID WILSEY 3.00 X 0 0 0 KEVIN BROOKS 60.00 X 112830 0 2456 PAUL DOLAN MD 59.00 X 339356 0 63595 JULIE HICKETHIER 60.00 X 294467 0 59364 PETER GRAY 60.00 X 128801 26734 24870 KATHY HILL 60.00 X 154072 0 14515 RANDY KUIPER 60.00 X 129988 0 15442 JOE LODUCA 60.00 X 151955 0 13084 FRANK SOLTYS 60.00 X 145681 0 7417 1457150 710284 324342 45 0 1 0 PRECYSE SOLUTIONS LLC PO BOX 11407 BIRMINGHAM AL 352461736 CONSULTING 3242052 ANESTHESIA ASSOCIATES OF GREAT FALLS 401 15TH AVENUE SOUTH GREAT FALLS MT 59405 ANESTHESIA SERVICES 3088956 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 606731252 FOOD SERVICES 3064612 METRO AVIATION INC PO BOX 7008 SHREVEPORT LA 71137 AIR AMBULANCE 2897630 AMERICAN RED CROSS PO BOX 73013 CHICAGO IL 606737013 BLOOD SERVICES 1702048 40 PATIENT SERVICES 621990 520255374 520255374 OTHER OPERATIONS 621990 6815132 6815132 527070506 441827 441827 855 855 855 855 664955 635789 29166 29166 CAFETERIA 722210 1656740 1656740 JOINT VENTURES 621110 1093 1093 1657833 529200187 527071599 0 2128588 872069 764089 107980 80658845 70671598 9987247 10335789 9056003 1279786 5741215 5030333 710882 29822025 29822025 50697090 49239550 1457540 11398940 4499114 6899826 476629 378316 98313 5778618 318 5778300 8837770 7157551 1680219 16254 15809 445 CONTRACTUAL ADJ/CHARITY 252868041 252868041 OTHER EXPENSES 29356987 19376677 9980310 BAD DEBT EXPENSE 14215271 14215271 501075543 433272670 67802873 0 23198521 3967690 41563391 106820419 7642738 7303703 822048 841872 137954978 84307515 42076234 53647463 14550138 15179579 2914877 2719598 132767947 190480324 26653080 64818489 123059068 120088990 2287722 4710666 151999870 189618145 X -19231923 862179 -19231923 862179 132767947 190480324 X 28124644 -8030542 X X 0 1 1 X 1 1 X 1 7818 9720 17538 0 137954978 84307515 53647463 53647463 2007 BONDS D/S RESERVE FUND 9392262 F 2007 BONDS INTEREST RESERVE 2858494 F 2007 BONDS PRINCIPAL RESERVE 2917726 F INVESTMENT IN NORTH CENTRAL MONTANA PHYSICANS LLP 11097 C 15179579 THIRD-PARTY SETTLEMENTS 4710666 4710666 PART IV, LINE 1B: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION IS A NOT-FOR-PROFIT CORPORATION AND HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (IRC). THE ORGANIZATION IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515. EFFECTIVE JANUARY 1, 2009, THE ORGANIZATION ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS. THE ACCOUNTING STANDARD PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2011 OR 2010. 1 1 X 1 X 180.000000000000 1 X 220.000000000000 1 1 0 1 1 5538 8391932 8391932 0.01670 345144 345144 0.00070 5538 8737076 8737076 0.01740 3872 252120 252120 0.00050 24 163425 163425 0.00030 9376992 9376992 0.01870 301279 301279 0.00060 1184492 1184492 0.00240 3896 11278308 11278308 0.02250 9434 20015384 20015384 0.03990 14093 14093 0.00000 15100 15100 0.00000 14100 14100 0.00000 43293 43293 1 14215271 0 111076800 143529241 -32452441 X 1 1 1 TREASURE STATE PREFERRED PROVIDER 2 HEALTHCARE NETWORK ORGANIZATION SERVING 0.50000 0.00000 0.50000 3 GREAT FALLS AND 4 SURROUNDING AREAS 2 1 BENEFIS HOSPITALS INC EAST CAMPUS

1101 26TH STREET SOUTH GREAT FALLS MT 59405

X X X 2 BENEFIS HOSPITALS INC WEST CAMPUS

500 15TH AVENUE SOUTH GREAT FALLS MT 59405

X X BENEFIS HOSPITALS INC 1 0 1 1 180.000000000000 1 220.000000000000 0 1 1 X X X X 1 0 1 X 0 0 1 BENEFIS SLETTEN HI-LINE CANCER CENTER

40 13TH STREET WEST HAVRE MT 59501

CANCER TREATMENT CENTER PART I, LINE 6A: AS REQUIRED BY MONTANA LAW, THE ORGANIZATION ANNUALLY SUBMITS A COMMUNITY BENEFIT REPORT TO THE MONTANA ATTORNEY GENERAL'S OFFICE, WHICH OVERSEES NONPROFIT CORPORATIONS IN THE STATE. IN 2011, THE ATTORNEY GENERAL'S OFFICE RELEASED TO THE PUBLIC ITS FOURTH ANNUAL REPORT ON THE CHARITABLE ACTIVITIES OF MONTANA HOSPITALS, INCLUDING THE TEN LARGEST HOSPITALS IN THE STATE (WITH THE ORGANIZATION AMONG THEM). THE ORGANIZATION ITSELF ALSO ANNUALLY PREPARES A SUMMARY COMMUNITY BENEFIT REPORT FOR PURPOSES OF EXPLANATION TO THE LOCAL PUBLIC, WHICH IS PUBLISHED IN THE FORM OF A POSTING IN THE LOCAL NEWSPAPER.PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED. PART III, LINE 3: THE ORGANIZATION ESTIMATES THE AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER ITS CHARITY CARE POLICY BY ANALYZING PAST ACTIVITY FOR ACCOUNTS CLASSIFIED AS BAD DEBT THAT SUBSEQUENTLY QUALIFIED FOR CHARITY CARE WHEN ADDITIONAL ELIGIBILITY INFORMATION WAS OBTAINED. ALL PATIENTS ARE PRESENTED WITH A COPY OF THE CHARITY CARE POLICY AND ENCOURAGED TO APPLY REGARDLESS OF ABILITY TO PAY. BY INCLUDING A PORTION OF BAD DEBT EXPENSE AS A COMMUNITY BENEFIT, THE ORGANIZATION CAN DIRECTLY ASSOCIATE THE DOLLAR VALUE OF FREE MEDICAL CARE AS PROVIDED TO THE RESIDENTS OF THE COMMUNITY. OUR MISSION IS TO PROVIDE EXCELLENT CARE FOR ALL, HEALING, BODY, MIND AND SPIRIT.PART III, LINE 4: THE ORGANIZATION'S FINANCIAL STATEMENTS INCLUDE THE FOLLOWING NOTE REGARDING BAD DEBT EXPENSE: "THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S 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 OR RESIDENTS DUE TO BAD DEBTS AND CHARITY CARE. MANAGEMENT CONSIDERS HISTORICAL WRITE-OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION." THE COSTING METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO.PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID SUBSTANTIALLY LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. PART V, SECTION B, LINE 19D: THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR CARE IS BASED ON 100% OF TOTAL PATIENT CHARGES BEFORE ANY ADJUSTMENTS OR WRITE-OFFS. PART VI, LINE 2: BENEFIS HOSPITALS, INC. HISTORICALLY HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. THE HOSPITAL IS CURRENTLY ASSEMBLING A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO WILL CONDUCT A COMMUNITY NEEDS ASSESSMENT IN THE FUTURE, AS CONTEMPLATED BY NEWLY ENACTED IRC SECTION 501(R).PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND IS MAILED TO EACH PATIENT ALONG WITH THEIR BILLING STATEMENT.PART VI, LINE 4: THE ORGANIZATION'S SERVICE AREA IS APPROXIMATELY 45,000 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 225,000 PEOPLE. THE SERVICE AREA IS APPROXIMATELY 49.5% FEMALE AND 50.5% MALE. APPROXIMATELY 6.6% OF THE POPULATION IS UNDER 5 YEARS OF AGE, APPROXIMATELY 74% BETWEEN THE AGE OF 18 AND 65 YEARS OF AGE, AND APPROXIMATELY 14% OF THE POPULATION IS OVER THE AGE OF 65.THE SERVICE AREA IS 90.7% WHITE WITH THE NEXT LARGEST COMBINED POPULATION APPROXIMATELY 5.8% NATIVE AMERICAN AND THE REMAINDER AFRICAN-AMERICAN OR MULTIPLE RACES. THE AVERAGE HOUSHOLD SIZE IS 2.4 PEOPLE, WITH APPROXIMATELY 92.4% OF ALL HOUSING UNITS BEING OWNER OCCUPIED.THE AVERAGE PER CAPITA INCOME IS $17,566 WITH THE MEDIAN HOUSEHOLD INCOME BEING $32,971.(US CENSUS BUREAU, 2000 DEMOGRAPHIC PROFILE)PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES.BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS, THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PRUPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES.PART VI, LINE 7, LIST OF STATES RECEIVING COMMUNITY BENEFIT REPORT: MT X 0 1 X X X X 0 1 0 0 0 0 0 1 0 LAURA GOLDHAHN 0 303153 0 71185 0 8847 0 75653 0 4229 0 463067 0 0 JERRY W SPEER MD 0 260323 0 40042 0 0 0 38376 0 5341 0 344082 0 0 PAUL DOLAN MD 262034 0 69952 0 7370 0 57867 0 5728 0 402951 0 0 0 JULIE HICKETHIER 233670 0 57219 0 3578 0 55181 0 4183 0 353831 0 0 0 PETER GRAY 104615 26734 24186 0 0 0 17450 0 7420 0 153671 26734 0 0 KATHY HILL 130273 0 23719 0 80 0 8212 0 6303 0 168587 0 0 0 JOE LODUCA 128883 0 22992 0 80 0 6781 0 6303 0 165039 0 0 0 FRANK SOLTYS 126180 0 19421 0 80 0 0 0 7417 0 153098 0 0 0 PART I, LINE 1A THE HEALTH CLUB WHERE OFFICERS ARE MEMBERS IS A SUBSIDIARY OF BENEFIS HEALTH SYSTEM, INC. (BHS). THROUGH APRIL 2011, HEALTH CLUB DUES THAT BHS PAID FOR ITS OFFICERS WERE TREATED AS TAXABLE INCOME TO THE INDIVIDUAL ACCORDINGLY. OFFICERS AND DEPARTMENT HEADS WERE ELIGIBLE FOR HEALTH CLUB DUES. SUBSTANTIATION WAS REQUIRED BEFORE ANY REIMBURSEMENTS WERE PAID. SUBSEQUENT TO APRIL 2011, DISCOUNTS ONLY ARE OFFERED TO ALL EMPLOYEES OF BENEFIS. PART I, LINE 4B THE ORGANIZATION PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EMPLOYEES. PART I, LINE 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM (INCLUDING MS. GOLDHAHN, MS. HICKETHIER, AND DR. DOLAN), AND IS SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. IN 2010, THE SYSTEM ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, FINANCE/OPERATIONS, AND COMMUNITY BENEFIT. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED IN 2010 ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY INDIVIDUAL PERFORMANCE. IN ADDITION, THE SYSTEM MUST HAVE MAINTAINED SATISFACTORY OVERALL PERFORMANCE, BASED ON BOTH FINANCIAL CRITERIA AND SATISFACTION OF EMPLOYEES, PATIENTS AND PHYSICIANS. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. 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HOSPITALS INC 810232122 61204KHD6 2007-04-01 5160000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHE4 2007-04-01 5410000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHF1 2007-04-01 7985000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 BENEFIS HOSPITALS INC 810232122 61204KHG9 2007-04-01 43310000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 5288440 356402 782141 163391 1301934 3986505 2009 0 0 0 0 5544662 373669 820036 820036 4179650 2009 0 0 0 0 10248914 690702 1515778 316649 2523129 7725785 2009 0 0 0 0 44388047 2991428 6564833 1371409 10927671 33460377 2009 0 0 0 0 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 1 1 0 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 BENEFIS HOSPITALS INC 810232122 61204KHH7 2007-04-01 10000000 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 10248914 690702 1515778 316649 2523129 7725785 2009 0 0 0 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 0 CHANGES IN PROGRAM SERVICES FORM 990, PART III, LINE 3 IN LATTER 2011, BENEFIS HOSPITALS BEGAN OPERATING PROVIDER BASED BILLING DEPARTMENTS IN THE NEW BENEFIS MEDICAL GROUP PROFESSIONAL CENTER LOCATED AT 1401 25TH ST S, GREAT FALLS, MT. THE PROFESSIONAL CENTER IS PART OF OUR MAIN EAST CAMPUS AND CONNECTED TO THE MAIN HOSPITAL'S SOUTH TOWER VIA A SKYWALK. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN OF THE OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS PROVIDES THESE SERVICES TO ITS SUBSIDARY TAX EXEMPT OPERATING ENTITIES ON A CENTRALIZED BASIS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NON-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A THE BOARD OF DIRECTORS OF THE ORGANIZATION IS ELECTED BY BENEFIS HEALTH SYSTEM, INC. AS THE ORGANIZATION'S SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11 THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS OUTSTANDING ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS DISTRIBUTED TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS, WITH A PRESENTATION TO SUCH BOARD BY THE CHIEF FINANCIAL OFFICER OF BENEFIS HEALTH SYSTEM, INC. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE PRESIDENT, THE COO, AND THE CMQO WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILARLY-SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 BENEFIS HOSPITALS, INC. PROVIDES COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, AND FINANCIAL STATEMENTS TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, COLUMN B PAUL DOLAN - 1 HOUR CHRIS EBELING - 4 HOURS LAURA GOLDHAHN - 4 HOURS JERRY SPEER - 57 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 325,938. INTERAFFILIATE TRANSFERS -8,366,485. BOOK/TAX DIFFERENCE IN SUBSIDIARY AND JOINT VENTURE INCOME 10,005. TOTAL TO FORM 990, PART XI, LINE 5: -8,030,542. FORM 990, PART XII, LINE 2C THE ORGANIZATION'S FINANCIAL RESULTS ARE REPORTED AS PART OF THE CONSOLIDATED FINANCIAL STATEMENTS OF BENEFIS HEALTH SYSTEM, INC. AND AFFILIATES. THE AUDIT COMMITTEE OF BENEFIS HEALTH SYSTEM, INC. IS RESPONSIBLE FOR SELECTION OF THE INDEPENDENT AUDIT FIRM AND OVERSEEING THE AUDIT. 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