2012-11-15T12:45:24-06:00 2011-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2011-01-01 810232121 BOZEMAN DEACONESS HEALTH SERVICES BOZE 4065855000 915 HIGHLAND BOULEVARD BOZEMAN MT 59715 GORDON DAVIDSON 4065855000 2012-11-08 1 KIM C HUNWARDSEN P00484560 6122536500 2012-11-08 2011 2016-02-24 21:20:13Z JOHN NORDWICK 915 HIGHLAND BOULEVARD BOZEMAN MT 59715 217192431 0 X WWW.BOZEMANDEACONESS.ORG X 1911 MT TO IMPROVE COMMUNITY HEALTH AND QUALITY OF LIFE FOR RESIDENTS AND VISITORS OF THE BOZEMAN, MT AREA. 11 10 1674 250 3813935 -592894 589263 1506716 167836517 184227479 4150938 3706737 -328130 -887204 172248588 188553728 628328 916074 0 0 71680409 80728682 0 0 0 85825379 89819043 158134116 171463799 14114472 17089929 276617016 309285614 68712966 88857449 207904050 220428165 X TO IMPROVE COMMUNITY HEALTH AND QUALITY OF LIFE. 1 0 42618809 39456604 BOZEMAN DEACONESS HEALTH GROUP IS OUR DEPARTMENT THAT PROVIDES PHYSICIAN SERVICES TO OUTPATIENTS. THE NUMBER OF MEDICARE AND MEDICAID PATIENTS SEEN IN 2011 INCREASED FROM 2010 BY 21% ON EXISTING SERVICE LINES AND 52% IN TOTAL AFTER TAKING INTO ACCOUNT THE ADDITION OF NEW PROVIDERS. REVENUE FOR THESE PATIENTS AND UNINSURED PATIENTS TOTALED 51% ($30,214,234) OF THE $58,850,935 TOTAL GROSS CLINIC REVENUE. WRITE-OFFS OF $19,394,331 ALONG WITH OPERATING EXPENSES OF $42,618,809 RESULTED IN A LOSS OF $3,162,205. THIS LOSS IS REFLECTIVE OF OUR COMMITMENT TO PROVIDE ACCESS TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 18513313 29979902 BOZEMAN DEACONESS SURGICAL SERVICES STRIVES TO OFFER A WIDE ARRAY OF SURGICAL SERVICES USING STATE OF THE ART TECHNOLOGY. APPROXIMATELY ONE THIRD OF THE 5,345 INPATIENT AND OUTPATIENT SURGERIES PERFORMED IN 2011 WERE PROVIDED TO PATIENTS COVERED BY MEDICARE AND MEDICAID, WHICH COMPRISED 39% ($17,205,963) OF TOTAL REVENUE FROM THESE SERVICES ($44,413,398). OVER HALF OF THE MEDICARE/MEDICAID REVENUES ($9,607,235) WERE UNREIMBURSED AND WRITTEN OFF, ALONG WITH ANOTHER $4,826,261 FROM OTHER PAYORS. OUR OPERATING ROOM ALSO RECORDED $18,513,313 IN COMBINED DIRECT AND INDIRECT OPERATING EXPENSES. 7415089 8107710 THE EMERGENCY ROOM AT BOZEMAN DEACONESS HOSPITAL IS ONE OF THE BUSIEST DEPARTMENTS IN OUR ORGANIZATION, WITH JUST UNDER 23,000 VISITS IN 2011. APPROXIMATELY 31% OF THE PATIENTS SEEN IN THE DEPARTMENT WERE COVERED BY MEDICARE AND MEDICAID. THE GROSS REVENUE FOR THOSE SERVICES ACCOUNTED FOR $5,033,367 OF THE $14,793,014 TOTAL GROSS REVENUE. OVER HALF OF THE MEDICARE/MEDICAID REVENUE IS UNREIMBURSED (56%) AND WRITTEN OFF, ALONG WITH ALMOST 40% OF THE REMAINING REVENUE (TOTAL WRITE-OFFS OF $6,685,304). DIRECT AND INDIRECT EXPENSES INCURRED IN SUPPORTING THESE EMERGENCY OPERATIONS ACCUMULATED TO $7,415,089. 74291009 916074 106683263 BOZEMAN DEACONESS HEALTH SERVICES OPERATES AN 86 BED HOSPITAL FACILITY (HOSPITAL), ALONG WITH A 43 UNIT ASSISTED LIVING HOME AND A 115 UNIT INDEPENDENT LIVING HOME (HILLCREST SENIOR LIVING OR HSL). ALL PATIENT AND RESIDENT SERVICE REVENUE IS USED TO PROVIDE HEALTH CARE SERVICES, HEALTH CARE PROMOTION, AND HEALTH CARE EDUCATION TO BOZEMAN AND THE SURROUNDING COMMUNITIES. 74291009 916074 106683263 142838220 1 1 0 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 163 0 1 1674 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X GORDON DAVIDSON 4065851036 915 HIGHLAND BLVD BOZEMAN MT 59715 TERRY CUNNINGHAM 1.00 X X 0 0 0 JULIE JACKSON 1.00 X X 0 0 0 KIRK MILLER 1.00 X X 0 0 0 JOHN MURDOCH 1.00 X X 0 0 0 JOHN ROBBINS MD 50.00 X X 151978 0 40543 TOM MILLESON 1.00 X 0 0 0 REV DAVE MCCONNELL 1.00 X 0 0 0 BRIAN BROWN 1.00 X 0 0 0 JAYNEE GROSETH 1.00 X 0 0 0 LEN LUTZ 1.00 X 0 0 0 KERRY PETITT 1.00 X 0 0 0 JOHN NORDWICK 50.00 X 667863 0 45525 STAN MOSER 50.00 X 288784 0 29811 GORDON DAVIDSON 50.00 X 350870 0 49579 ELIZABETH LEWIS 50.00 X 330730 0 51458 ANNE CASTILLO MD 50.00 X 660276 0 14700 JACK HENSOLD MD 50.00 X 545821 0 48075 J BRUCE ROBERTSON MD 50.00 X 432234 0 51145 BLAIR ERB MD 50.00 X 505732 0 15959 DANE SOBEK MD 50.00 X 542067 0 29721 4476355 0 376516 90 0 1 0 MC BUILDERS JV 1203 S CHURCH BOZEMAN MT 59715 CONSTRUCTION 6203086 ABSAROKA EMERGENCY PHYSICIANS 1184 N 15TH STREET SUITE 1 BOZEMAN MT 59715 ER PHYSICIANS FEE 3380766 ARBOR MEDIC PO BOX 10305 BOZEMAN MT 59715 LANDSCAPING/LAWN/SNOW REMOVAL 973912 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 REFERENCE LAB 578528 GALLATIN VALLEY ANESTHESIA 10150 S CENTENNIAL PKWY SUITE 230 SANDY UT 84070 ANESTHESIOLOGY 563128 35 1506716 1506716 PATIENT SERVICE REVENU 622110 166488821 166218858 269963 RESIDENT SERVICE REVEN 623000 5621071 5621071 INCOME FROM SUBSIDIARI 900099 4823387 4823387 PHARMACY REVENUE 446110 3203986 635502 2568484 SUPPORTING REVENUE 900099 1880433 1508059 372374 2209781 1608339 601442 184227479 2230466 2230466 1307463 2194667 -887204 -887204 -887204 25572773 2347534 24391167 2052869 1181606 294665 1476271 1672 1474599 188553728 180415216 3813935 2817861 916074 916074 2043993 193154 1850839 64422892 54964154 9458738 3200571 2740283 460288 6340240 5303418 1036822 4720986 3908190 812796 220146 220146 85854 85854 49945 49945 385096 385096 13784007 7334331 6449676 946853 212797 734056 3369355 2691231 678124 1716840 489314 1227526 413659 241432 172227 275773 160955 114818 1766906 1766906 12566643 12566643 2114934 842855 1272079 MEDICAL SUPPLIES 32181071 32082279 98792 PROVISION FOR BAD DEBTS 11759382 11759382 EQUIPMENT RENT & MAINTE 6259387 4174191 2085196 TAXES & LICENSES 1292657 193375 1099282 630535 297256 333279 171463799 142838220 28625579 0 32758275 25543416 19695581 20584585 393600 406123 4955740 5227112 1555426 2064705 220943740 103021079 113413177 117922661 46045379 48051003 18168044 44678793 16338434 17671871 8721359 9678992 14572001 17456353 276617016 309285614 16032568 19066668 795670 628404 31766186 51463674 8005388 7044537 12113154 10654166 68712966 88857449 X 197960821 210501099 8352216 8334508 1591013 1592558 207904050 220428165 276617016 309285614 X 17089929 -4565814 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 7952 1 0 0 1 42000 49952 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: HIRED CONSULTANT TO PROVIDE LOBBYING SERVICES IN CONNECTION WITH GOVERNMENTAL AFFAIRS REPRESENTATION TO ENSURE HOSPITAL, COMMUNITY, AND EMPLOYEE INTERESTS AND NEEDS ARE REPRESENTED. 9735942 398579 -284159 84676 9765686 8337197 383010 1071551 55816 9735942 7225497 36288 1087324 11912 8337197 9844389 75363 -1797068 897187 7225497 0.74750 0.20780 0.04470 0 1 1 7104910 2502319 9607229 142205090 59949194 82255896 69131421 43071885 26059536 117922661 ALTERNATIVE INVESTMENTS 3789846 F SHORT TERM INVESTMENTS - CDS 40888947 F 44678793 INVESTMENT IN JOINT VENTURES 17671871 F 17671871 DEFERRED FINANCING COSTS, NET 971399 ACCRUED INT RECEIVABLE & OTHER RECEIVABLES 4341616 DUE FROM AFFILIATES 75180 OTHER ASSETS 234978 INTEREST IN NET ASSETS OF FOUNDATION 11833180 17456353 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 220000 DEPOSITS 10434166 10654166 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: EACH ENDOWMENT FUND IS PRIVY TO A SEPARATE AGREEMENT. DONATIONS MADE FOR EACH PURPOSE SHALL BE RECEIVED, HELD, AND INVESTED BY THE BOZEMAN DEACONESS FOUNDATION ACCORDING TO ESTABLISHED POLICIES GOVERNING GIFT ACCEPTANCE, INVESTMENT, AND DISTRIBUTION. THE PRINCIPAL OF THE FUND SHALL BE RETAINED IN PERPETUITY. THE INTEREST INCOME IS UTILIZED FOR THE GREATEST NEEDS OF THE DESIGNATED DEPARTMENT. POLICY SAYS THE ORGANIZATION CAN USE A PORTION OF INTEREST FOR OPERATIONS. THE ENDOWMENT FUNDS REPORTED INCLUDE ALL ENDOWMENT FUNDS HELD BY BOZEMAN DEACONESS FOUNDATION. WITH THE EXCEPTION OF THE EMPLOYEE EMERGENCY FUND AND THE BOZEMAN DEACONESS FOUNDATION GENERAL FUND, ALL ENDOWMENT FUNDS HELD BY THE FOUNDATION ARE FOR USE BY BOZEMAN DEACONESS HEALTH SERVICES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE ORGANIZATION CONSISTS OF MONTANA NONPROFIT CORPORATIONS 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 FOUNDATION OPERATES PURSUANT TO SECTION 509 (A)(1) AND 170(B)(L)(A)(VI) OF THE INTERNAL REVENUE CODE. THE ORGANIZATION AND THE FOUNDATION ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE ORGANIZATION BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE ORGANIZATION WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE ORGANIZATION'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2008. 1 1 X 1 X 1 X 1 1 1 0 1 1 6375061 425248 5949813 0.03730 8622944 6087137 2535807 0.01590 442640 642151 -199511 0.00000 15440645 7154536 8286109 0.05320 581767 185556 396211 0.00250 166204 0 166204 0.00100 28881846 21893460 6988386 0.04380 0 0 532346 0 532346 0.00330 30162163 22079016 8083147 0.05060 45602808 29233552 16369256 0.10380 11003 11003 0.00010 625 625 0.00000 9429 9429 0.00010 1787 1787 0.00000 22844 22844 0.00020 0 11973781 1693351 30007151 33661401 -3654250 X 1 0 1 1 BOZEMAN DEACONESS HOSPITAL

915 HIGHLAND BLVD BOZEMAN MT 59107

X X X BOZEMAN DEACONESS HOSPITAL 1 1 1 150.000000000000 1 250.000000000000 1 X X X 1 1 X 1 1 X X X X 1 X 0 0 6 DEACONESS INTERCITY IMAGING LLC

915 HIGHLAND BLVD BOZEMAN MT 59715

OUTPATIENT IMAGING CENTER ROCKY MOUNTAIN SURGERY CENTER LLC

1450 ELLIS ST SUITE 101 BOZEMAN MT 59715

OUTPATIENT SURGICAL CENTER BOZEMAN DIALYSIS CENTER

931 HIGHLAND BLVD SUITE 3105 BOZEMAN MT 59715

OUTPATIENT DIALYSIS CENTER HILLCREST SENIOR LIVING

1201 HIGHLAND BLVD BOZEMAN MT 59715

INDEPENDENT AND ASSISTED LIVING FACILITY HOSPICE OF SOUTHWEST MONTANA LLC

1600 ELLIS STREET SUITE 3A BOZEMAN MT 59715

HOSPICE SERVICES FAMILY DOCTORS URGENT CARE LLC

120 N 18TH AVENUE BOZEMAN MT 59715

OUTPATIENT HEALTH CARE PART I, LINE 3C: ANY INDIVIDUAL AND THEIR DEPENDENTS WHO ARE AT 150% OF THE FEDERAL POVERTY INCOME LEVEL OR BELOW WILL BE ELIGIBLE TO RECEIVE A 100% WRITE-OFF OF THE SELF-PAY PORTION OF INCURRED CHARGES, UPON COMPLETION OF AN APPLICATION. ANY UNINSURED INDIVIDUAL WITH INCOME UNDER 250% OF THE FEDERAL POVERTY GUIDELINES (FPG) WILL BE ELIGIBLE TO RECEIVE A DISCOUNT FROM CHARGES BASED ON CERTAIN GUIDELINES. COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATION WILL BE REQUIRED. IN SOME CASES, FULL OR PARTIAL ASSISTANCE MAY BE PROVIDED TO INSURED INDIVIDUALS WITH GROSS FAMILY INCOMES ABOVE 250% OF THE FPG ADJUSTED FOR FAMILY SIZE. CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE TO INDIVIDUALS WHO HAVE A LARGE BALANCE REMAINING AFTER ALL THIRD PARTY PAYMENTS HAVE BEEN TAKEN INTO ACCOUNT. THE BALANCE UNDER CONSIDERATION IS THAT AMOUNT WHICH IS DEEMED TO BE THE PATIENT'S FINANCIAL RESPONSIBILITY. IF SUCH RESPONSIBILITY IS GREATER THAN 50% OF THE FAMILY'S ANNUAL HOUSEHOLD INCOME, THE EXCESS AMOUNT WILL BE TREATED AS CATASTROPHIC FINANCIAL ASSISTANCE AND WRITTEN OFF OF THE PATIENT'S ACCOUNT. THIS ASSISTANCE IS AVAILABLE WITHOUT RESPECT TO THE FPG, BUT THEY MUST FOLLOW THE SAME PROCESS AS ALL OTHER PATIENTS SEEKING FINANCIAL ASSISTANCE BASED UPON FPG. ASSET TESTS ARE NOT USED FOR DETERMINING ANY LEVEL OF FINANCIAL ASSISTANCE. ALL DECISIONS REGARDING FINANCIAL ASSISTANCE ARE IN THE SOLE DISCRETION OF BDH. PRIOR TO PROVIDING SERVICES, BDH WILL MAKE AN EFFORT TO NOTIFY THE PATIENT REGARDING THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 7: THE COST TO CHARGE RATIO FROM WORKSHEET 2 WAS USED TO OBTAIN THE COSTS RELATED TO CHARITY CARE, MEDICAID, AND OTHER MEANS-TESTED PROGRAMS. ALL OTHER BENEFITS WERE CALCULATED USING OUR INTERNAL COSTING SYSTEM. THIS SYSTEM ASSIGNS ALL DIRECT EXPENSES TO SEPARATE COST CENTERS (DEPARTMENTS) AND ACCOUNTS. INDIRECT COSTS ARE THEN ALLOCATED TO APPLICABLE DEPARTMENTS BASED ON APPROPRIATE STATISTICS. FOR EXAMPLE, ENGINEERING AND ENVIRONMENTAL SERVICES WOULD BE ALLOCATED BASED ON SQUARE FOOTAGE WHEREAS INFORMATION SYSTEMS AND BENEFITS ARE ALLOCATED BASED ON AN ACCUMULATED COST PERCENTAGE AS DETERMINED BY THE MEDICARE COST REPORT. OUR INTERNAL SYSTEM DOES RECORD PATIENT REVENUES BASED ON TYPE (INPATIENT VS. OUTPATIENT VS. EMERGENCY) AND PAYOR (MEDICAID, MEDICARE, COMMERCIAL, SELF-PAY, ETC.). RELATED COSTS ARE THEN DETERMINED BASED ON THE PRO-RATED SHARE AS A PERCENTAGE OF THE TOTAL. FOR EXAMPLE, IF MEDICAID COMPRISES 7% OF A DEPARTMENTS REVENUE, MEDICAID EXPENSES ARE CALCULATED AT 7% OF THE TOTAL AS WELL. PART I, LINE 7G: AMOUNT OF COST ATTRIBUTABLE TO A PHYSICIAN CLINIC IS $27,582,718. ALL COSTS ASSOCIATED WITH A PROVIDER-BASED CLINIC OPERATIONAL DEPARTMENT WERE CONSIDERED PART OF THIS TOTAL. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR IS $11,759,382. PART II: BOZEMAN DEACONESS HEALTH SERVICES PROVIDED LEADERSHIP DEVELOPMENT TO ASPIRING HEALTHCARE PROFESSIONALS THROUGH THE JUNIOR ACHIEVEMENT PROGRAM. BDHS EMPLOYEES SPOKE WITH HIGH SCHOOL STUDENTS ABOUT A CAREER AS A NURSE AND PROVIDED THEM WITH REAL LIFE EXAMPLES OF WHAT THE PROFESSION ENTAILS. THESE ACTIVITIES PROMOTE HEALTHCARE BECAUSE THE INDIVIDUALS ARE DIRECTED TOWARD LEARNING ABOUT HEALTH CARE PROFESSIONS AND WILL HOPEFULLY ENCOURAGE FUTURE INTEREST IN THESE TYPES OF POSITIONS THAT PROMOTE HEALTHCARE.ONE OF OUR ADMINISTRATORS PARTICIPATED IN ECONOMIC AND BUSINESS DEVELOPMENT THROUGH INVOLVEMENT IN SEVERAL ADVISORY BOARDS AND TASK FORCE PROJECTS AND INITIATIVES. THE INVOLVEMENT IN THESE COMMUNITY INITIATIVES PROVIDES AWARENESS OF HEALTH ISSUES AND EDUCATION ON HOW TO ACCESS HEALTH SERVICES. PART III, LINE 4: THE ORGANIZATION USES WORKSHEET 2 TO CALCULATE BAD DEBT EXPENSE AT CHARGES. BAD DEBT IS REPORTED BASED UPON ACTUAL BAD DEBT EXPENSE NET OF DISCOUNTS AND CONTRACTUAL ADJUSTMENTS, LESS RECOVERIES.IN DETERMINING THE AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR CHARITY CARE POLICY, WE OBTAINED STATISTICAL INFORMATION DIRECTLY FROM OUR CREDIT AGENCIES. FROM THIS INFORMATION WE WERE ABLE TO CALCULATE AN AVERAGE PERCENTAGE (14.4%) OF ACCOUNTS TURNED OVER FOR COLLECTIONS THAT WOULD HAVE BEEN SUBSEQUENTLY DEEMED UNCOLLECTIBLE OR RETURNED FOR CHARITY. THIS PERCENTAGE WAS APPLIED TO BAD DEBT EXPENSE AT CHARGES TO DETERMINE THE ESTIMATE. NONE OF THE BAD DEBT IS INCLUDED AS COMMUNITY BENEFIT.NOTE IN AUDITED FINANCIAL STATEMENTS: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 ESTIMATED BAD DEBT PROVISION. PART III, LINE 8: THE ENTIRE AMOUNT OF SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT.THE MEDICARE SHORTFALL REPRESENTS A COST ABSORBED BY THE HOSPITAL AS A RESULT OF PROVIDING CARE TO MEDICARE PATIENTS. THE CONTRACT DRIVING THIS LOSS IS A NONDISCRETIONARY CONTRACT, AS IS PROVIDING THE SERVICES TO THIS POPULATION OF INDIVIDUALS. THE COST OF PROVIDING THIS BENEFIT TO THE COMMUNITY SHOULD BE REPORTABLE AS SUCH. 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.FOR THE JOINT VENTURES, NET MEDICARE REVENUE WAS USED AS THE REVENUE RECEIVED, AND THAT % OF TOTAL REVENUES WAS APPLIED AGAINST OPERATING EXPENSES TO DETERMINE RELATED COSTS. THE JOINT VENTURE PORTION OF THE SHORTFALL IS $767,517. PART III, LINE 9B: THE COLLECTION POLICY DOES NOT SPECIFICALLY ADDRESS THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 13G: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED ON THE HOSPITAL FACILITY WEBSITE, ATTACHED TO BILLING INVOICES, PROVIDED TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY AND IS AVAILABLE UPON REQUEST. INFORMATION ABOUT FINANCIAL ASSISTANCE IS ALSO INCLUDED IN OUR PATIENT FINANCIAL SERVICES BROCHURE. BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 19D: FOR ALL SELF-PAY PATIENTS, AN AUTOMATIC 5% DISCOUNT IS APPLIED TO CHARGES UPON BILLING. THIS IS COMPARABLE TO WHAT OUR MOST FAVORABLE INSURANCE CONTRACT RATE WOULD BE. PART VI, LINE 2: IN ADDITION TO CONDUCTING A FOLLOW-UP TO OUR INDEPENDENTLY CONDUCTED COMMUNITY HEALTH NEEDS ASSESSMENT, BDHS PARTNERED WITH GALLATIN CITY-COUNTY HEALTH DEPARTMENT (GCCHD) TO CONDUCT A LARGER AND COMPREHENSIVE GRANT-FUNDED COMMUNITY HEALTH ASSESSMENT AND HEALTH IMPROVEMENT PLAN FOCUSING ON GALLATIN COUNTY CALLED THE "HEALTHY GALLATIN" INITIATIVE. THE HEALTHY GALLATIN INITIATIVE IS A RESULT OF COLLABORATION BETWEEN GCCHD, CHP, MONTANA STATE UNIVERSITY'S LOCAL GOVERNMENT CENTER AND MANY OTHER ORGANIZATIONS, ALL OF WHOM SHARE THE COMMITMENT TO HAVE A ROLE IN THE COMMUNITY'S HEALTH AND OVERALL WELL-BEING. THIS INITIATIVE CALLS FOR CONDUCTING 4 ASSESSMENTS AND IS INTENDED TO RESULT IN THE DEVELOPMENT OF A COMMUNITY-WIDE STRATEGIC PLAN FOR COMMUNITY HEALTH IMPROVEMENT. TOGETHER, THESE 4 ASSESSMENTS CALL FOR COMMUNITY INVOLVEMENT WHICH HELPS ENSURE APPROPRIATE COMMUNITY OWNERSHIP OF THE HEALTHY GALLATIN INITIATIVE. 1. COMMUNITY HEALTH STATUS ASSESSMENT (CHSA) IDENTIFIED PRIORITY COMMUNITY HEALTH AND QUALITY OF LIFE ISSUES THROUGH THE 3-COUNTY JOINT CHNA CONDUCTED VIA TELEPHONE SURVEY IN THE SUMMER OF 2011 (SEE PREVIOUS SECTION FOR MORE DETAILS.)2. COMMUNITY THEMES AND STRENGTHS ASSESSMENT (CTSA) PROVIDES A DEEP UNDERSTANDING OF THE ISSUES RESIDENTS FEEL ARE IMPORTANT. THIS IS BEING CONDUCTED THROUGH A SERIES OF IN-DEPTH COMMUNITY CONVERSATIONS CALLED "STUDY CIRCLES" IN SEVEN DIFFERENT COMMUNITIES THROUGHOUT GALLATIN COUNTY. THESE FACILITATED SMALL GROUP, DEMOCRATIC, HIGHLY PARTICIPATORY CONVERSATIONS/DISCUSSIONS OCCUR ONCE A WEEK OVER A PERIOD OF THREE WEEKS. THESE CONVERSATIONS ARE MEANT TO EMPOWER PEOPLE NOT ONLY TO FIGURE OUT THE MOST IMPORTANT HEALTH ISSUES, BUT TO ALSO PRODUCE IDEAS AND IDENTIFY SOLUTIONS THAT WILL WORK BEST FOR THEIR INDIVIDUAL COMMUNITY, AND GALLATIN COUNTY AS A WHOLE.3. LOCAL PUBLIC HEALTH SYSTEM ASSESSMENT (LPHSA) FOCUSES ON THE LOCAL PUBLIC HEALTH SYSTEM - ALL OF THE ORGANIZATIONS AND ENTITIES, WHETHER PUBLIC, PRIVATE, OR VOLUNTARY, THAT CONTRIBUTES TO THE DELIVERY OF PUBLIC HEALTH SERVICES WITHIN A COMMUNITY. THE PURPOSE OF THE ASSESSMENT WAS TO EVALUATE THE ACTIVITIES, COMPONENTS AND CAPACITIES OF OUR LOCAL PUBLIC HEALTH SYSTEM IN PROVIDING THE ESSENTIAL PUBLIC HEALTH SERVICES IN GALLATIN COUNTY. THE DIALOGUE THAT OCCURS IN ANSWERING THESE QUESTIONS HELPED IDENTIFY AREAS OF STRENGTH AND WEAKNESS AND DETERMINE OPPORTUNITIES FOR IMPROVEMENT. THE ASSESSMENT INSTRUMENT USED WAS DEVELOPED BY THE NATIONAL PUBLIC HEALTH PERFORMANCE STANDARDS PROGRAM WHICH IS A COLLABORATIVE EFFORT OF SEVEN NATIONAL PARTNERS, WHICH INCLUDES CDC AND THE AMERICAN PUBLIC HEALTH ASSOCIATION.4. FORCES OF CHANGE ASSESSMENT (FCA) IS AIMED AT IDENTIFYING FORCES - SUCH AS TRENDS, FACTORS, OR EVENTS - THAT ARE OR WILL BE INFLUENCING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITY AND THE WORK OF THE LOCAL PUBLIC HEALTH SYSTEM. THIS ASSESSMENT IS BEING PLANNED FOR JULY. PART VI, LINE 3: BOZEMAN DEACONESS HOSPITAL IS DEEPLY COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS NEEDING, BUT UNABLE TO AFFORD, MEDICALLY NECESSARY HEALTH CARE SERVICES. BDH POSTS NOTICE OF ITS FINANCIAL ASSISTANCE POLICY IN ALL ADMITTING AREAS, AS WELL AS ON THE WEBSITE. AT THE EARLIEST FEASIBLE TIME, BDH WILL ATTEMPT TO DETERMINE WHETHER A PATIENT HAS THIRD PARTY COVERAGE FOR ANY PART OF THE HOSPITAL SERVICES PROVIDED. IF A PATIENT DOES NOT HAVE THIRD PARTY COVERAGE, A PATIENT ADVOCATE FROM THE MASH PROGRAM WILL SCREEN ALL INPATIENT CASES AND ANY OUTPATIENT CASES EXCEEDING $1,000 IN TOTAL CHARGES TO DETERMINE IF THE PATIENT QUALIFIES FOR THIRD PARTY FUNDING. IF NOT, THE PATIENT ADVOCATE WILL EXPLAIN THE FINANCIAL ASSISTANCE POLICY AND GIVE THE PATIENT AN APPLICATION IF DESIRED. IN CIRCUMSTANCES WHERE PAYMENT IN FULL WILL CAUSE FINANCIAL HARDSHIP THAT WILL SIGNIFICANTLY HARM THE PATIENT OR PATIENT'S FAMILY, THE APPLICANT MAY BE ASKED TO VISIT WITH CONSUMER CREDIT COUNSELING SERVICES TO FURTHER REVIEW THEIR FINANCIAL SITUATIONS. UPON REQUEST, PATIENTS MAY BE ASKED TO COMPLETE AN APPLICATION FOR MEDICAID PARTICIPATION OR FOR COVERAGE BY OTHER GOVERNMENTAL PAYMENT PROGRAMS. PATIENT BILLS ALSO CONTAIN BILLING INFORMATION EXPLAINING FINANCIAL OPTIONS AND PROVIDE CONTACT INFORMATION TO THE APPROPRIATE RESOURCES. ADDITIONALLY BDHS HAS AN UNWRITTEN POLICY WHEREBY SPECIFIC OUTPATIENT PROCEDURES ALLOW PATIENTS OF COMMUNITY HEALTH PARTNERS (CHP) TO FOLLOW THE FINANCIAL ASSISTANCE POLICY ESTABLISHED BY CHP. PART VI, LINE 4: BEING THE ONLY HOSPITAL FACILITY IN GALLATIN COUNTY, BDHS SERVES PRIMARILY THE 89,500 (PER CENSUS 2010) RESIDENTS OF GALLATIN COUNTY. WHILE PARK AND MADISON COUNTIES EACH HAVE A CRITICAL ACCESS HOSPITAL, ROUGHLY 8% OF BDHS' INPATIENT POPULATION STILL COME FROM THESE OUTLYING COMMUNITIES. GALLATIN COUNTY INCLUDES 2 INCORPORATED PLACES - BOZEMAN, A CITY OF 37,000 RESIDENTS AND BELGRADE, A CITY OF 7,400 RESIDENTS AND A NUMBER OF SMALL TOWNS/COMMUNITIES WHERE 13,000 RESIDENTS LIVE (FOUR CORNERS, THREE FORKS, MANHATTAN, CHURCHILL, AMSTERDAM, KING ARTHUR'S, BIG SKY, WILLOW CREEK, AND WEST YELLOWSTONE). ALL TOGETHER THESE RESIDENTS REPRESENT 65% OF GALLATIN COUNTY'S POPULATION; THE REST (31,800) LIVE OUTSIDE THESE TOWN/CITY BOUNDRIES AND IN MORE RURAL AREAS. OVER THE PAST DECADE, GALLATIN COUNTY GREW AT A RATE 3 TIMES THAT OF MONTANA OR THE UNITED STATES, GROWING 32% FROM 67,831 IN 2000 TO 89,513 IN 2010, AND ADDING ABOUT 22,000 RESIDENTS IN THE VALLEY.THE MEDIAN HOUSEHOLD INCOME (HHI) HAS ALSO CHANGED DRAMATICALLY OVER THE PAST DECADE FROM $38,000 TO $50,000, AN INCREASE OF ABOUT 32%. HOWEVER, THE PROPORTION OF PERSONS LIVING BELOW POVERTY HAS NOT CHANGED AND REMAINED AROUND 12.9%. THIS RATE JUMPS TO 30% IF PERSONS LIVING BETWEEN 100% TO 199% OF FEDERAL POVERTY LEVEL (FPL) ARE INCLUDED. TOGETHER, THESE RESIDENTS BELOW 200% OF FPL COMPRISE THE LOW-INCOME SEGMENT OF THE POPULATION. PART VI, LINE 5: AS A SOLE COMMUNITY HOSPITAL, BOZEMAN DEACONESS HEALTH SERVICES IS COMMITTED TO PROVIDING QUALITY CARE AND PROMOTING HEALTH TO THE VERY COMMUNITY THAT SUPPORTS US. OUR GOVERNING BODY IS REPRESENTED BY INDIVIDUALS OF OUR COMMUNITY, WITH ALL BUT ONE BEING INDEPENDENT TO OUR ORGANIZATION. TO ENSURE IMMEDIATE ACCESS TO CARE, BDHS HAS AN OPEN MEDICAL STAFF AND REQUIRES EACH MEDICAL STAFF MEMBER TO CARE FOR ANYONE PRESENTING A NEED FOR CARE IN THE EMERGENCY DEPARTMENT. WE ALSO DEVOTE A SIGNIFICANT AMOUNT OF SURPLUS FUNDS TO MAINTAINING A HIGH LEVEL OF PATIENT CARE THROUGH QUALITY INITIATIVES AND TECHNOLOGY INVESTMENTS.BDHS GIVES BACK TO ITS COMMUNITY THROUGH COMMUNITY BENEFIT OPPORTUNITIES, WHICH AT OVER $16 MILLION COMPRISED 10% OF OUR TOTAL OPERATING EXPENSES (EXCLUDING BAD DEBT) IN 2011.VARIOUS EMPLOYEES, PHYSICIANS, ADMINISTRATORS, AND BOARD MEMBERS OF THE HOSPITAL ARE ACTIVELY INVOLVED IN VOLUNTEER ROLES INCLUDING COMMUNITY BOARD POSITIONS IN NUMEROUS OTHER ACTIVITIES, GROUPS, AND ORGANIZATIONS THAT ACTIVELY PROMOTE THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: BOZEMAN DEACONESS HEALTH SERVICES OWNS A MAJORITY INTEREST IN ADVANCED MEDICAL IMAGING, ROCKY MOUNTAIN SURGERY CENTER, AND BOZEMAN DIALYSIS CENTER. ALL THREE OF THESE ORGANIZATIONS HOLD SIMILAR POLICIES REGARDING PROVIDING CARE TO ALL MEMBERS OF THE COMMUNITY AND OFFERING FINANCIAL ASSISTANCE AS DETERMINED BY ABILITY TO PAY. 1 GREATER GALLATIN UNITED WAY 945 TECHNOLOGY BLVD 101F BOZEMAN MT 59718 810384820 501(C)(3) 100000 SUPPORT COMMUNITY HEALTH PROGRAMS WITHIN OUR SERVICE AREA CANCER SUPPORT COMMUNITY MONTANA 102 S 11TH AVE BOZEMAN MT 59715 810542266 501(C)(3) 49500 SUPPORT COMMUNITY HEALTH PROGRAMS WITHIN OUR SERVICE AREA WESTERN MONTANA MENTAL HEALTH CENTER BLDG T-9 FORT MISSOULA RD MISSOULA MT 59804 810307814 501(C)(3) 169500 SUPPORT COMMUNITY HEALTH CRISIS PROGRAMS WITHIN OUR SERVICE AREA BOZEMAN DEACONESS FOUNDATION 931 HIGHLAND BLVD SUITE 3200 BOZEMAN MT 59715 811407943 501(C)(3) 500000 FUND ENDOWMENTS COMMUNITY HEALTH PARTNERS 126 S MAIN STREET LIVINGSTON MT 59047 841420492 501(C)(3) 54000 SUPPORT COMMUNITY HEALTH PROGRAMS WITHIN OUR SERVICE AREA 5 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: RECIPIENTS OF GRANTS AND ASSISTANCE PREPARE INFORMATIONAL REPORTS SUBSTANTIATING THE USE OF THE FUNDS THAT WERE EARMARKED TO SUPPORT COMMUNITY HEALTH PROGRAMS. INVOLVEMENT OF BOZEMAN DEACONESS HEALTH SERVICES STAFF AND/OR ADMINISTRATION AS VOLUNTEERS IN THE ACTIVITIES BEING SUPPORTED ALSO ENSURES PROPER USAGE OF FUNDS. X 1 1 X X X X 0 0 0 0 0 1 0 1 0 JOHN ROBBINS MD 136826 0 14688 0 464 0 28435 0 12741 0 193154 0 0 0 JOHN NORDWICK 329027 0 326632 0 12204 0 31404 0 16084 0 715351 0 251693 0 STAN MOSER 267566 0 20000 0 1218 0 16612 0 15153 0 320549 0 0 0 GORDON DAVIDSON 208105 0 125012 0 17753 0 34879 0 16718 0 402467 0 0 0 ELIZABETH LEWIS 203238 0 121701 0 5791 0 32634 0 20839 0 384203 0 0 0 ANNE CASTILLO MD 626018 0 3333 0 30925 0 14700 0 1133 0 676109 0 0 0 JACK HENSOLD MD 517351 0 0 0 28470 0 32415 0 16777 0 595013 0 0 0 J BRUCE ROBERTSON MD 397704 0 32982 0 1548 0 32640 0 19599 0 484473 0 0 0 BLAIR ERB MD 504904 0 0 0 828 0 0 0 16988 0 522720 0 0 0 DANE SOBEK MD 491207 0 50500 0 360 0 14662 0 16088 0 572817 0 0 0 PART I, LINE 1A PER JOHN NORDWICK'S CONTRACT, HE IS REIMBURSED FOR TWO BUSINESS TRIPS PER YEAR WHERE HIS WIFE ACCOMPANIES HIM. THESE ARE REPORTED AS TAXABLE COMPENSATION. PART I, LINE 6 A PHYSICIAN LISTED IN PART VII, SECTION A, RECEIVES INCENTIVE COMPENSATION BASED ON ACTUAL RELATIVE VALUE UNIT'S (RVU'S) PRODUCED IN EXCESS OF TARGETS. THE TOTAL OF THE INCENTIVE IS CALCULATED BY TAKING THE EXCESS RVU'S TIMES A RVU CONVERTER. THE RVU CONVERTER IS BASED UPON NET EARNINGS FROM SERVICES PROVIDED BY THE PHYSICIAN. PART I, LINE 7 THE BOARD ESTABLISHES GOALS EACH YEAR AND IF MET, THERE IS COMPENSATION TIED TO THEM. ALL SUCH COMPENSATION IS REVIEWED BY THE INDEPENDENT COMPENSATION SPECIALISTS. INCENTIVE COMPENSATION IS DETERMINED BY ACHIEVING FINANCIAL PERFORMANCE IN EXCESS OF BUDGETED PERFORMANCE, AND ACHIEVING PRE-DETERMINDED GOALS DEALING WITH PATIENT QUALITY, PATIENT SATISFACTION AND EMPLOYEE SATISFACTION. THIS APPLIES TO ALL SENIOR ADMINISTRATION AND ALL PHYSICIANS (WITH ONE EXCEPTION DESCRIBED IN SCHEDULE J, PART I LINE 6A) THAT RECEIVES COMPENSATION AND INCLUDES INCENTIVE COMPENSATION REFLECTED IN PART II, COLUMN B(II). MONTANA FACILITY FINANCE AUTHORITY 810302402 61204JAW4 2004-03-04 12591558 TO FUND NEW MEDICAL OFFICE BUILDING AND TO REFUND BONDS ISSUED 6/10/93 0 0 0 MONTANA FACILITY FINANCE AUTHORITY 810302402 621043CZ0 2005-09-21 28001371 TO FUND ADDITION OF HILLCREST & ADVANCE REFUND REVENUE BONDS ISSUED 3/28/00 0 0 0 MONTANA FACILITY FINANCE AUTHORITY 364615155 61204EAH8 2010-04-22 6645000 REFINANCING OF 1998 BOND DEBT 0 0 0 MONTANA FACILITY FINANCE AUTHORITY 810302402 61204MAS6 2011-09-28 20680164 TO FUND NEW ER & ACQUIRE LEGACY CONDOS & RENOVATE EXISTING FACILITY 0 0 0 5905000 12591558 835776 251831 6985411 4518540 2005 1 0 1 1 3970000 28001371 408114 459960 8526661 18606636 2006 0 1 1 1 775000 6645000 132900 6512100 2010 1 0 1 1 20680164 401295 20278809 2011 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 SCHEDULE K, PART II, LINE 11, COLUMN A THE AMOUNT REPORTED ON PART I, LINE 11 IS THE AMOUNT OF BOND PROCEEDS USED TO REFUND THE BONDS ISSUED IN 1993. SCHEDULE K, PART II, LINE 11, COLUMN B THE AMOUNT REPORTED ON PART I, LINE 11 IS THE AMOUNT OF BOND PROCEEDS USED TO REFUND THE BONDS ISSUED IN 2000. SCHEDULE K, PART II, LINE 11, COLUMN C THE AMOUNT REPORTED ON PART I, LINE 11 IS THE AMOUNT OF BOND PROCEEDS USED TO CURRENTLY REFUND THE 1998 BONDS. NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 EFFECTIVE 2/1/2011, BOZEMAN DEACONESS HEALTH SERVICES ADDED CARDIOLOGY; EAR, NOSE, & THROAT; AUDIOLOGY; AND COSMETIC SURGERY SERVICES TO OUR OPERATIONS. FORM 990, PART VI, SECTION A, LINE 7A THE YELLOWSTONE CONFERENCE OF THE METHODIST CHURCH CONFIRMS THE BOARD MEMBERS AND HAS AUTHORITY TO APPOINT THE CLERGY MEMBER OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B CHANGING THE ARTICLES OF INCORPORATION IN RELATIONSHIP TO THE PROCESS OF SELECTING BOARD MEMBERSHIP MUST BE APPROVED BY THE YELLOWSTONE CONFERENCE OF THE UNITED METHODIST CHURCH. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE WILL REVIEW FORM 990 IN DETAIL AND WILL MAKE A RECOMMENDATION TO THE FULL BOARD FOR APPROVAL BEFORE FILING OF THE FORM 990. THE CFO REVIEWS THE FORM 990 AT A HIGHER LEVEL WITH THE BOARD BEFORE APPROVAL IS GRANTED. FORM 990, PART VI, SECTION B, LINE 12C IN-HOUSE COUNSEL IDENTIFIES POTENTIAL CONFLICTS FROM ANNUAL DISCLOSURES AND INFORMS THE BOARD CHAIR. THE BOARD CHAIR DISCUSSES THE CONFLICT AND DECIDES WHETHER THE CONFLICT IS OF SUCH A NATURE TO EXCLUDE THE CONFLICTED PARTY FROM DISCUSSION AND/OR VOTE. THIS POLICY COVERS ALL BOARD MEMBERS, OFFICERS, SENIOR ADMINISTRATION, AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE RECEIVES A FORMAL PRESENTATION BY AN INDEPENDENT COMPENSATION CONSULTANT (AS SELECTED BY THE BOARD) QUALIFIED TO PERFORM COMPENSATION REVIEWS INCLUDING USAGE OF COMPARABILITY DATA. THIS PERSON PRESENTS RECOMMENDATIONS TO THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD ON AN ANNUAL BASIS FOR OFFICERS AND SENIOR ADMINISTRATION. THIS ANNUAL PROCESS WAS PERFORMED DURING 2011. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ALL TAX RELATED INFORMATION REQUIRED TO BE AVAILABLE FOR PUBLIC INSPECTION ARE AVAILABLE VIA WALK-IN, TELEPHONE CALL, E-MAIL, AND/OR MAIL-IN REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE REQUIRED TO BE ATTACHED TO THE FORM 990 AND PROVIDED TO THE MUNICIPAL SECURITIES RULEMAKING BOARD, WHICH IS OUR TAX-EXEMPT BONDS TRUSTEE, VIA AN ON-LINE, CENTRAL FILING LOCATION CALLED ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA). THE FINANCIAL STATEMENTS CAN BE OBTAINED BY THE GENERAL PUBLIC AT THE EMMA WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -3,682,221. TRANSFERS TO RELATED PARTIES -883,593. TOTAL TO FORM 990, PART XI, LINE 5: -4,565,814. LISTING OF ALL CUSIP#'S ASSOCIATED WITH BOND ISSUANCE SCHEDULE K, PART I, BOND A, CUSIP#'S FOR SERIES 2004 BOND $ 1,255,000 61204J AA 2 1,275,000 61204J AB 0 1,300,000 61204J AC 8 1,335,000 61204J AD 6 240,000 61204J AE 4 245,000 61204J AF 1 255,000 61204J AG 9 260,000 61204J AH 7 270,000 61204J AJ 3 280,000 61204J AK 0 290,000 61204J AL 8 305,000 61204J AM 6 315,000 61204J AN 4 330,000 61204J AP 9 340,000 61204J AQ 7 1,955,000 61204J AV 6 2,445,000 61204J AW 4 LISTING OF ALL CUSIP#'S ASSOCIATED WITH BOND ISSUANCE SCHEDULE K, PART I, BOND B, CUSIP#'S FOR SERIES 2005 BOND $ 455,000 612043 CE 7 655,000 612043 CF 4 675,000 612043 CG 2 700,000 612043 CH 0 730,000 612043 CJ 6 755,000 612043 CK 3 785,000 612043 CL 1 820,000 612043 CM 9 845,000 612043 CN 7 885,000 612043 CP 2 920,000 612043 CQ 0 960,000 612043 CR 8 1,000,000 612043 CS 6 1,040,000 612043 CT 4 1,085,000 612043 CU 1 1,125,000 612043 CV 9 1,175,000 612043 CW 7 1,220,000 612043 CX 5 1,270,000 612043 CY 3 1,325,000 612043 CZ 0 7,555,000 612043 DA 4 2,565,000 612043 DB 2 LISTING OF ALL CUSIP#'S ASSOCIATED WITH BOND ISSUANCE SCHEDULE K, PART I, BOND B, CUSIP#'S FOR SERIES 2011 BOND $ 635,000 61204M AB 3 780,000 61204M AC 1 795,000 61204M AD 9 815,000 61204M AE 7 840,000 61204M AF 4 865,000 61204M AG 2 890,000 61204M AH 0 915,000 61204M AJ 6 945,000 61204M AK 3 980,000 61204M AL 1 1,010,000 61204M AM 9 1,050,000 61204M AN 7 1,090,000 61204M AP 2 1,135,000 61204M AQ 0 1,180,000 61204M AR 8 6,775,000 61204M AS 6 HILLCREST SENIOR LIVING LIMITED LIABILITY COMPANY 1201 HIGHLAND BLVD BOZEMAN MT 59715 810232121 INDEPENDENT AND ASSISTED LIVING HOME MT 6166718 35939890 N/A BOZEMAN DEACONESS FOUNDATION 931 HIGHLAND BLVD SUITE 3200 BOZEMAN MT 59715 841407943 RAISE FUNDS TO SUPPORT BOZEMAN DEACONESS HEALTH SERVICES MT 501(C)(3) 7 N/A 1 DEACONESS INTERCITY IMAGING LLC 915 HIGHLAND BLVD BOZEMAN MT 59715 810666871 HEALTHCARE - IMAGING SERVICES MT N/A RELATED 1778443 2919089 0 1 0.77500 ROCKY MOUNTAIN SURGICAL CENTER LLC 1450 ELLIS ST SUITE 101 BOZEMAN MT 59715 364462300 HEALTHCARE - SURGICAL SERVICES MT N/A RELATED 2626470 2814441 1 0 0.51010 BOZEMAN DIALYSIS CENTER PO BOX 37000 BILLINGS MT 59107 810519879 HEALTHCARE - DIALYSIS SERVICES MT N/A RELATED -16705 -125090 0 1 0.60000 BOZEMAN DEACONESS REAL ESTATE DEVELOPMENT CORP PO BOX 10490 BOZEMAN MT 59719 205496567 SALE OF REAL ESTATE PROPERTY AND RESIDENCES TO SENIORS MT N/A C 537503 9135364 1.00000 0 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 DEACONESS INTERCITY IMAGING LLC I 296520 GENERAL LEDGER AND CORP. 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