2012-03-28T12:11:28-05:00 2011-03-31 JORDAHL & SLITER PLLC PO BOX 8600 KALISPELL MT 599041600 990 2010-04-01 237293874 KALISPELL REGIONAL MEDICAL CENTER KALI 4067525111 310 SUNNYVIEW LANE KALISPELL MT 59901 CHARLES PEARCE 4067521724 2012-03-27 1 JUSTIN P SLITER 4067521040 2012-03-27 2010 2016-02-24 21:20:13Z CHARLES PEARCE 310 SUNNYVIEW LANE KALISPELL MT 59901 196742285 0 X WWW.NWHC.ORG/KRMC X 1973 MT PROVIDE ACUTE HOSPITAL CARE 15 6 1893 155 1877095 -186616 1160279 529235 170185380 179599470 1154809 1750874 2067569 2246864 174568037 184126443 0 0 0 0 81151708 93692552 0 0 0 82931200 85114297 164082908 178806849 10485129 5319594 155492366 200870659 53296854 95828119 102195512 105042540 PROVIDE ACUTE HOSPITAL CARE 0 0 158800261 177722375 OPERATION OF REGIONAL ACUTE CARE HOSPITAL. 158800261 1 1 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 1 1 1 0 0 1 213 0 1 1893 1 1 1 0 0 0 0 0 0 0 0 0 X 15 6 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X CHARLES PEARCE 4067521724 310 SUNNYVIEW LANE KALISPELL MT 59901 CHARLES GRENIER 1.00 X 1000 0 0 WILSON HIGGS MD 1.00 X 1100 0 0 JON JOHNSON MD 1.00 X 204123 0 15501 GWEN JONAS MD 1.00 X 41800 0 0 JANE KARAS 1.00 X 1100 0 0 PETER L LARSON 1.00 X 1100 0 0 JEANNIE LUCKEY 1.00 X 1100 0 0 TOM MCELWAIN 1.00 X 1100 0 0 DAVE MEREDITH 1.00 X 1100 0 0 ANDY PALCHAK MD 1.00 X 800 0 0 CAL SWEET 1.00 X 1200 0 0 MUFFIE THOMSON 1.00 X 1200 0 0 DAVID WALKER MD 1.00 X 1200 0 0 WILLIAM BENEDETTO MD 1.00 X 300 0 0 CARL TINLIN MD 1.00 X 30000 0 0 VELINDA STEVENS 17.50 X X 0 580833 41022 BERNADETTE VANBELOIS MD 1.00 X 15000 0 0 LOUISE SWANBERG MD 1.00 X 26930 0 0 CHARLES PEARCE 30.00 X 0 380705 24330 FRANCES LAUKAITIS 40.00 X 298179 0 12104 KAREN LEE 40.00 X 252101 0 33820 DEB WILSON 35.00 X 207932 0 39776 AC EDDY 29.00 X 199610 0 420 TATE KREITINGER 25.00 X 312638 0 29477 RICHARD PALAGI 5.00 X 349258 0 27856 ALAN WILLIAMS MD 50.00 X 640262 0 3084 DAVID SHELDON MD 50.00 X 558205 0 44184 DAVID ROTH MD 50.00 X 457508 0 15501 TIM OBERMILLER MD 50.00 X 426568 0 47859 EVE GILLESPIE MD 50.00 X 414202 0 45501 4446616 961538 380435 80 0 1 0 SILVERTIP EMERGENCY PHYSICIANS 310 SUNNYVIEW LANE KALISPELL MT 59901 EMERGENCY ROOM PHYSICIANS 3441766 SWANK ENTERPRISES PO BOX 10007 KALISPELL MT 59901 CONSTRUCTION 991262 GLACIER REGIONAL PATHOLOGY 495 N MAIN STREET KALISPELL MT 59901 PATHOLOGY SERVICES 742621 NORTHERN ROCKIES ANESTHESIA CONSULTANTS 1075 MARTIN CREEK LANE WHITEFISH MT 59937 ANESTHESIA SERVICES 550679 MAYO MEDICAL LAB PO BOX 9146 MINNEAPOLIS MN 554809146 LAB SERVICES 546548 24 498835 30400 47261 529235 MEDICAL SERVICE REVENU 621990 174521346 172644251 1877095 PARTNERSHIP INCOME 621990 2846418 2846418 OTHER OPERATING INCOME 900099 2077800 2077800 MGMT CONTRACT SERVICES 900099 95493 95493 EDUCATION INCOME 621990 57265 57265 1148 1148 179599470 1098389 1098389 343532 343532 343532 343532 12766487 501840 12172697 443145 593790 58695 652485 652485 CAFETERIA 722210 1269752 1269752 CHILD CARE 624410 612179 612179 MISC. REVENUE 900099 393071 393071 -371670 -371670 1903332 184126443 177722375 1877095 3997738 1460634 1460634 72999329 65619519 7379810 2692497 2469439 223058 11527888 10238628 1289260 5012204 4427067 585137 732102 732102 87119 87119 9377993 7609957 1768036 967393 463199 504194 1864753 1125204 739549 8170153 7147302 1022851 1127618 760611 367007 1006128 1006128 8639587 7377239 1262348 1952155 1952155 SUPPLIES 29928340 29100634 827706 BAD DEBTS 10555948 10555948 0 PURCHASED SERVICES 7810602 7204547 606055 OTHER EXPENSES 2894406 1742684 1151722 178806849 158800261 20006588 0 12110394 6203380 42636597 47698479 21894648 25266388 3566405 4246715 3919464 5541756 1305042 2616203 147105770 87902603 57346324 59203167 5364999 6498505 425390 1009145 6923103 42586921 155492366 200870659 28720233 30825974 18282477 56864697 2232584 3232507 4061560 4904941 53296854 95828119 X 100715058 103124995 37144 122795 1443310 1794750 102195512 105042540 155492366 200870659 X 5319594 -2472566 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 10355 1 74380 1 1 84735 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LOBBYING EXPENDITURES WERE INCURRED IN AN ATTEMPT TO ENSURE MEDICARE AND MEDICAID PAID COST OF SERVICES AND IN RELATION TO FUNDING FOR ADVANCE OF OUR ELECTRONIC HEALTH RECORD PROJECT. EXPENDITURES INCLUDED CONSULTANT, STAFF TIME AND A PORTION OF HOSPITAL ASSOCIATION MEMBERSHIP DUES. 1480454 280808 156283 1917545 1250610 53165 176679 1480454 1225468 224116 -198974 1250610 0.06400 0.93600 0 1 1 282845 282845 94460824 53953758 40507066 46644471 33948845 12695626 5717630 5717630 59203167 TRUSTEE FUNDS - RESERVE FUND 42440510 DEPOSITS 21234 OTHER 125177 42586921 PAYABLE TO CONTRACTUAL AGENCIES 2667169 ACCOUNTS PAYABLE TO AFFILIATES 1896745 LEASES PAYABLE 341027 4904941 184126443 178806849 5319594 3575322 -6484979 -2909657 2409937 187502678 3575322 299748 3875070 183627608 498835 498835 184126443 178806849 0 178806849 0 178806849 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: NORTHWEST HEALTHCARE FOUNDATION'S ENDOWMENT FUNDS WILL BE DISBURSED ACCORDING TO THE FUND'S DESIGNATED PURPOSE CONSIDERING ANY RESTRICTIONS AND/OR CONDITIONS ON THE FUND. WHERE THERE IS AN UNDESIGNATED ENDOWMENT FUND WITHOUT RESTRICTIONS AND/OR CONDITIONS, THE ORGANIZATION WILL REVIEW REQUESTS FOR FUNDING FROM KALISPELL REGIONAL MEDICAL CENTER, THE SUPPORTED ORGANIZATION, ON A PERIODIC BASIS. HISTORICALLY, ENDOWMENT FUND DISBURSEMENTS HAVE FUNDED EQUIPMENT REQUESTS FROM KALISPELL REGIONAL MEDICAL CENTER. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ADOPTED THE PROVISIONS OF ASC 740, INCOME TAXES. ASC 740 CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ORGANIZATION'S FINANCIAL STATEMENTS IN ACCORDANCE WITH THE ASC AND PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT STANDARD FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF AN INCOME TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE HOSPITAL HAS REVIEWED ITS TAX POSITIONS FOR ALL OPEN TAX YEARS AND HAS CONCLUDED NO RESERVES ARE REQUIRED. PART XI, LINE 8 - OTHER ADJUSTMENTS: FUND BALANCE TRANSFERRED TO AFFILIATES ADJUSTMENT FOR FOUNDATION ACTIVITY PART XII, LINE 2D - OTHER ADJUSTMENTS: FASB FAS 136 INVESTMENT IN NET ASSETS OF FOUNDATION 299,748. PART XII, LINE 4B - OTHER ADJUSTMENTS: SUPPORT FROM AFFILIATED FOUNDATION 451,574. CONTRIBUTION OF FIXED ASSETS BOOKED TO EQUITY 47,261. 1 1 1 X 1 X 1 1 1 0 1 1 5822111 5822111 0.03260 18702745 14606969 4095776 0.02290 24524856 14606969 9917887 0.05550 173396 173396 0.00100 216646 216646 0.00120 39741467 31828967 7912500 0.04430 19278 19278 0.00010 40150787 31828967 8321820 0.04660 64675643 46435936 18239707 0.10210 0 16931 16931 0.00010 57826 57826 0.00030 0 1966 1966 0.00000 4331 4331 0.00000 81054 81054 0.00040 1 5331809 983719 54403578 75063392 -20659814 X 1 0 1 MRI - CT IMAGING 0.51000 0.01100 0.18500 1 1 KALISPELL REGIONAL MEDICAL CENTER

310 SUNNYVIEW LANE KALISPELL MT 59901

X X X KALISPELL REGIONAL MEDICAL CENTER 1 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X 1 X X 1 X X X X X X 1 X 0 1 PART I, LINE 7: COST ACCOUNTING WAS UTILIZED FOR THE ENTIRE TABLE. COST ACCOUNTING COVERS ALL PATIENT SEGMENTS. PART I, L7 COL(F): TOTAL BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGES IN COLUMN (F) IS $10,555,948. PART II: KRMC PROVIDES FUNDING TO VARIOUS NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. IN ADDITION, KRMC IS ACTIVELY INVOLVED IN THE KALISPELL CHAMBER OF COMMERCE AND OTHER ORGANIZATIONS FOR THE PURPOSES OF ECONOMIC DEVELOPMENT. KRMC PROVIDES FURTHER DONATIONS TO BENEFIT THE BROADER COMMUNITY. PART III, LINE 4: COST ACCOUNTING WAS UTILIZED TO DETERMINE BAD DEBT EXPENSE.PROVISION FOR BAD DEBTS: THE HOSPITAL PROVIDES FOR AN ALLOWANCE AGAINST PATIENT ACCOUNTS RECEIVABLE FOR AN AMOUNT THAT COULD BECOME UNCOLLECTIBLE, WHEREBY SUCH RECEIVABLES ARE REDUCED TO THEIR ESTIMATED NET REALIZABLE VALUE. THE HOSPITAL ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ACCOUNTS RECEIVABLE, HISTORICAL COLLECTION EXPERIENCE AND OTHER RELEVANT FACTORS. THERE ARE VARIOUS FACTORS THAT CAN IMPACT THE COLLECTION TRENDS, SUCH AS CHANGES IN THE ECONOMY, WHICH IN TURN HAVE AN IMPACT ON THE UNEMPLOYMENT RATES AND THE NUMBER OF UNINSURED AND UNDERINSURED PATIENTS, THE INCREASED BURDEN ON COPAYMENTS TO BE MADE BY PATIENTS WITH INSURANCE, AND BUSINESS PRACTICES RELATED TO COLLECTION EFFORTS. THESE FACTORS CONTINUOUSLY CHANGE AND HAVE AN IMPACT ON THE ESTIMATION PROCESS. PART III, LINE 8: COST TO CHARGE RATIO WAS UTILIZED TO PREPARE THE FY 2010 COST REPORT. ALL OF THE MEDICARE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. THE ORGANIZATION PROVIDES CARE TO THE ELDERLY AND DISABLED AT A REDUCED REIMBURSEMENT TO ENSURE ALL OF THE COMMUNITY MEMBERS IN NORTHWEST MONTANA RECEIVE GOOD QUALITY HEALTHCARE REGARDLESS OF AGE, DISABILITY, OR MEANS. KALISPELL REGIONAL MEDICAL CENTER PART V, SECTION B, LINE 19D: KALISPELL REGIONAL MEDICAL CENTER CHARGES THE SAME FOR SERVICES REGARDLESS OF AN INDIVIDUAL'S INSURANCE STATUS. PART VI, LINE 2: KRMC IDENTIFIES NEEDS THROUGHOUT THE COMMUNITY BY UTILIZING COMMUNITY REPRESENTATIVES ON KRMC GOVERNANCE BOARDS, SOLICITATION OF IDEAS FROM COMMUNITY LEADERS AND OTHER MEMBERS VIA THE MEDIA AND OTHER FORMS OF COMMUNICATION, AND KEY STAFF AIDING IN IDENTIFYING HEALTH CARE SERVICE AREA SHORTAGES. KRMC MAINTAINS A CLOSE RELATIONSHIP TO THE COMMUNITY BY PROVIDING INFORMATION AND EDUCATION ABOUT UPCOMING HEALTH CARE ISSUES OR CHANGES AT KRMC AND SOLICITS FEEDBACK FROM THE COMMUNITY. ONCE NEEDS ARE IDENTIFIED, THE KRMC BOARD AND ADMINISTRATION WORK TO PRIORITIZE NEEDS BASED UPON THE MISSION AND VALUES OF KRMC. PART VI, LINE 3: KRMC ESTABLISHED A NEW WEBSITE THAT DISPLAYS OUR CHARITY POLICY. CHARITY CARE IS DISCUSSED WITH ALL PATIENTS AT THE TIME OF THEIR ADMIT. THROUGH THE MEDIA, KRMC NOTIFIED THE COMMUNITY OF OUR CHARITY CARE POLICY AND ELIGIBILITY REQUIREMENTS. PART VI, LINE 4: KRMC IS A SOLE COMMUNITY HOSPITAL IN NORTHWEST MONTANA. KRMC SERVES PATIENTS IN A LARGE GEOGRAPHIC AREA, THAT COVERS ALL OF NORTHWESTERN MONTANA, PARTS OF NORTHEASTERN IDAHO AND AREAS OF CENTRAL MONTANA. KRMC SERVES ALL PATIENTS REGARDLESS OF THEIR INCOME AND REGARDLESS OF THEIR PAYER. APPROXIMATELY 19% OF THE COUNTY IS UNINSURED AND 12.5% IS BELOW THE FEDERAL POVERTY LEVEL ACCORDING TO DATA FROM THE STATE HEALTH DEPARTMENT. PART VI, LINE 6: THIS WAS ANSWERED BY QUESTION 2 INFORMATION. 1 NORTHWEST HEALTHCARE FOUNDATION 310 SUNNYVIEW LANE KALISPELL MT 59901 311703013 501(C)(3) 150000 GENERAL USE 1 1 X X X 1 1 X X X X X X 0 1 0 0 0 0 0 1 0 JON JOHNSON MD 131167 0 11600 0 61356 0 3000 0 12501 0 219624 0 0 0 VELINDA STEVENS 0 458638 0 87542 0 34653 0 25407 0 15615 0 621855 0 0 CHARLES PEARCE 0 287042 0 60789 0 32874 0 8761 0 15569 0 405035 0 0 FRANCES LAUKAITIS 145895 0 52615 0 99669 0 4457 0 7647 0 310283 0 0 0 KAREN LEE 204544 0 43426 0 4131 0 26781 0 7039 0 285921 0 0 0 DEB WILSON 168178 0 37503 0 2251 0 26831 0 12945 0 247708 0 0 0 AC EDDY 181242 0 15000 0 3368 0 0 0 420 0 200030 0 0 0 TATE KREITINGER 234770 0 46005 0 31863 0 14064 0 15413 0 342115 0 0 0 RICHARD PALAGI 282998 0 52504 0 13756 0 14700 0 13156 0 377114 0 0 0 ALAN WILLIAMS MD 546062 0 60000 0 34200 0 3000 0 84 0 643346 0 0 0 DAVID SHELDON MD 406682 0 121023 0 30500 0 29325 0 14859 0 602389 0 0 0 DAVID ROTH MD 450008 0 0 0 7500 0 3000 0 12501 0 473009 0 0 0 TIM OBERMILLER MD 328219 0 60000 0 38349 0 33000 0 14859 0 474427 0 0 0 EVE GILLESPIE MD 309302 0 75000 0 29900 0 33000 0 12501 0 459703 0 0 0 PART I, LINE 1A FIRST CLASS OR CHARTER TRAVEL - KRMC DOES NOT PROVIDE FIRST CLASS TRAVEL. CHARTER TRAVEL IS UTILIZED FOR THESE INDIVIDUALS WHEN A GROUP IS FLYING TOGETHER TO A CONFERENCE OR MEETING AND IT IS LESS EXPENSIVE THAN FLYING COMMERCIAL OR NO COMMERCIAL FLIGHT IS AVAILABLE. THIS WAS NOT INCLUDED AS TAXABLE COMPENSATION AS IT WAS BUSINESS RELATED. TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - THE MEMBERS OF THE ADMINISTRATIVE TEAM RECEIVE A 457 PLAN CONTRIBUTION OF $16,500 FOR 2010. THIS AMOUNT IS GROSSED-UP TO TAKE CARE OF THE APPLICABLE TAXES. THE MEMBERS INCLUDE: PRESIDENT, CFO, CEO, COO, CMO, VICE PRESIDENT OF HUMAN RESOURCES, SUMMIT ADMINISTRATOR, VICE PRESIDENT OF COMMUNITY RELATIONS, TREASURER, ADMINISTRATOR REGIONAL OUTREACH, AND THE FOUNDATION EXECUTIVE VICE PRESIDENT. HEALTH OR SOCIAL CLUB DUES OR INITIATION FEES - ALL ADMINISTRATIVE TEAM MEMBERS RECEIVE A FREE MEMBERSHIP TO THE SUMMIT. PART I, LINE 4B MEMBERS OF THE ADMINISTRATIVE TEAM RECEIVE A 457 PLAN CONTRIBUTION OF $16,500 FOR 2010. THE MEMBERS INCLUDE: PRESIDENT, CFO, CEO, COO, CMO, VICE PRESIDENT OF HUMAN RESOURCES, SUMMIT ADMINISTRATOR, VICE PREDIENT OF COMMUNITY RELATIONS, AND THE FOUNDATION EXECUTIVE VICE PRESIDENT. PART I, LINE 7 BONUS PLANS ADMIN AND MGMT-BASED ON A NUMBER OF FACTORS INCLUDING BUT NOT LIMITED TO: QUALITY AND FINANCIAL INDICATORS INCLUDING DEPARTMENT SPECIFIC GOALS AND INITIATIVES, PATIENT SATISFACTION, PRODUCTIVITY, EMPLOYEE SATISFACTION, AND EMPLOYEE EVALUATION TIMELINESS. SUCCESSFUL IMPLEMENTATION OF COMPANY FISCAL YEAR ACTION PLANS AND THE OVERALL FINANCIAL HEALTH AND STABILITY OF THE ORGANIZATION. MONTANA FACILITY FINANCE AUTHORITY 612043XXX 2010-11-01 57115000 REFUND 1998 AND 2001 SERIES BONDS AND FUND NEW SURGERY BUILDING PROJECT 0 0 0 10771260 57308306 807398 891005 3506992 41331651 0 0 1 1 0 0 0 0 1 1 0 0 0 0 0 GWEN PALCHAK WIFE OF CURRENT TRUSTEE 70773 SALARY 0 GLACIER REGIONAL PATHOLOGY DR. WALKER, A CURRENT TRUSTEE, IS THE PRESIDENT AND 1/3 OWNER OF GRP. 786308 PATHOLOGY & LAB SERVICES 0 ROCKY MOUNTAIN SUB-SPECIALTY ASSOC DR. JOHNSON, A CURRENT TRUSTEE, IS A GREATER THAN 5% PARTNER. 530832 RENT AND JANITORIAL SERVICES 0 NORTHWEST IMAGING INC DR. BENEDETTO, A CURRENT TRUSTEE, IS A GREATER THAN 5% OWNER. 564809 RADIOLOGY SERVICES 0 NORTHERN ROCKIES ANESTHESIA CONSULTANTS DR. TINLIN, A CURRENT TRUSTEE, IS A GREATER THAN 5% OWNER. 556665 ANESTHESIA SERVICES 0 MICHAEL LAUKAITIS SPOUSE OF PAST OFFICER 12695 SALARY 0 PETER LARSON CURRENT TRUSTEE AND ALSO ON THE BOARD OF DIRECTORS OF GLACIER BANK. 163560 KALISPELL REGIONAL MEDICAL CENTER PAID INTEREST EXPENSE ON LOANS FROM GLACIER BANK. 0 X EQUIPMENT 1 47261 COST 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 PETER LARSON AND DAVE MEREDITH HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 KALISPELL REGIONAL MEDICAL CENTER HAS ONE MEMBER, NORTHWEST HEALTHCARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A KALISPELL REGIONAL MEDICAL CENTER HAS THE SAME BOARD OF DIRECTORS AS ITS SOLE MEMBER, NORTHWEST HEALTHCARE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B KALISPELL REGIONAL MEDICAL CENTER HAS THE SAME BOARD OF DIRECTORS AS ITS SOLE MEMBER, NORTHWEST HEALTHCARE CORPORATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS MAILED TO ALL BOARD MEMBERS WITH THE FEBRUARY BOARD PACKET. THE BOARD MEMBERS HAVE A CHANCE TO REVIEW THE FORM BEFORE THE FINANCE COMMITTEE MEETING WHERE A PRESENATION ON THE FORM 990 IS DONE. QUESTION AND ANSWER SESSIONS ARE HELD AT BOTH THE FINANCE COMMITTEE MEETING AND THE BOARD MEETING CONCERNING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES. THE COMPLIANCE OFFICE REVIEWS THEM, IDENTIFIES POTENTIAL CONFLICTS, AND FORWARDS TO THE ADMINISTRATIVE TEAM IF A POTENTIAL CONFLICT EXISTS, AS OUTLINED IN THE ORGANIZATIONAL POLICY. FORM 990, PART VI, SECTION B, LINE 15 NORTHWEST HEALTHCARE HAS A CONSISTENT COMPENSATION PHILOSOPHY FOR ALL ITS EMPLOYEES, INCLUDING THE SENIOR EXECUTIVES. SALARY AND BENEFITS FOR THE PRESIDENT/CHIEF EXECUTIVE OFFICER ARE DETERMINED BY THE NORTHWEST HEALTHCARE BOARD OF DIRECTORS EXECUTIVE COMPENSATION COMMITTEE AND REPORTED TO THE NORTHWEST HEALTHCARE BOARD. THE EXECUTIVE COMPENSATION COMMITTEE OF THE BOARD REVIEWS BASE AND TOTAL COMPENSATION DATA FROM AN ARRAY OF COMPENSATION SURVEYS OF HOSPITALS THAT ARE SIMILAR IN SIZE AND COMPLEXITY TO NORTHWEST HEALTHCARE. THESE REPORTS ARE CONSIDERED BY THE COMMITTEE, AND A DETERMINATION IS MADE AS TO THE STATUS OF THE BASE SALARY, BENEFITS, AND TOTAL COMPENSATION FOR THE PRESIDENT/CEO. THE BOARD AND EXECUTIVE COMPENSATION COMMITTEE EMBRACE THE PHILOSOPHY OF MAINTAINING A COMPENSATION LEVEL WHICH WILL FAVOR RETENTION OF KEY LEADERSHIP IN ORDER TO MAINTAIN STABILITY IN KEY INITIATIVES. ADDITIONALLY, THE PRESIDENT/CEO UTILIZES THE PERIODIC RETENTION OF A COMPENSATION CONSULTANT AND MARKET INFORMATION PROVIDED TO DETERMINE RECOMMENDATIONS FOR OTHER SENIOR EXECUTIVES AND ENGAGES IN AN ANALYSIS THROUGH USE OF INDEPENDENT SURVEY RESULTS. THE BOARD COMMITTEE ALSO INCLUDES A REVIEW OF PERFORMANCE TARGETS WHICH ALLOW EXECUTIVES TO EARN ADDITIONAL COMPENSATION. THESE MEASURES INCLUDE ORGANIZATIONAL AND INDIVIDUAL GOALS, EFFORTS TO FURTHER THE MISSION AND VISION OF NORTHWEST HEALTHCARE, QUALITY INDICATORS, CUSTOMER/PATIENT SATISFACTION, AND FINANCIAL PERFORMANCE OBJECTIVES. THE BOARD COMMITTEE REVIEWS BENEFIT LEVELS AND TOTAL COMPENSATION TO ENSURE APPROPRIATENESS IN THE NOT-FOR-PROFIT HEALTH CARE SECTOR. THE BOARD EXECUTIVE COMPENSATION COMMITTEE MAKES ITS REPORT TO THE NORTHWEST HEALTHCARE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 ONLY FORM 990 IS AVAILABLE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 3,575,322. FUND BALANCE TRANSFERRED TO AFFILIATE -6,333,153. NET INCREASE IN TEMPORARILY RESTRICTED NET ASSETS 85,651. NET INCREASE IN PERMANENTLY RESTRICTED ASSETS 351,440. ADJUSTMENT FOR ACTIVITY OF AFFILIATED FOUNDATION -151,826. TOTAL TO FORM 990, PART XI, LINE 5: -2,472,566. AVERAGE HOURS PER WEEK FORM 990, PART VII, SECTION A, COLUMN (B) THE OFFICERS OF KALISPELL REGIONAL MEDICAL CENTER DIVIDE THEIR TIME AMONG THE OTHER RELATED ENTITIES FOR WHICH THEY ARE ALSO OFFICERS. THEIR TOTAL AVERAGE WEEKLY HOURS DEVOTED TO ALL OF THE ENTITIES IS IN EXCESS OF 50 HOURS. SEVERAL OF THE TRUSTEES WHO ARE PHYSICIANS RECEIVE COMPENSATION FOR MEDICAL SERVICES RENDERED TO THE HOSPITAL. THEIR AVERAGE WEEKLY HOURS DEVOTED TO THE HOSPITAL VARIES. TATE KREITINGER DEVOTES APPROXIMATELY 50% OF HIS TIME TO KALISPELL REGIONAL MEDICAL CENTER AND 50% OF HIS TIME TO HEALTHCENTER NORTHWEST, A RELATED ENTITY. NORTHWEST HEALTHCARE CORPORATION 310 SUNNYVIEW LANE KALISPELL MT 59901 810406485 SUPPORT SUBSIDIARY TAX EXEMPT ORGANIZATIONS MT 501(C)(3) 11, TYPE II N/A 0 NORTHWEST HEALTHCARE FOUNDATION INC 310 SUNNYVIEW LANE KALISPELL MT 59901 311703013 SUPPORTING ORGANIZATION MT 501(C)(3) 11, TYPE I KALISPELL REGIONAL MEDICAL CENTER 1 NORTHWEST HORIZONS INC 310 SUNNYVIEW LANE KALISPELL MT 59901 810420653 OPERATE LONG TERM AMBULATORY FACILITY MT 501(C)(3) 9 NORTHWEST HEALTHCARE CORPORATION 1 THE SUMMIT MEDICAL FITNESS CENTER 310 SUNNYVIEW LANE KALISPELL MT 59901 203752312 COMMUNITY HEALTH & WELLNESS CENTER MT 501(C)(3) 9 NORTHWEST HEALTHCARE CORPORATION 1 KALISPELL REGIONAL MEDICAL CENTER VOLUNTEERS 310 SUNNYVIEW LANE KALISPELL MT 59901 273866474 SUPPORTING ORGANIZATION MT 501(C)(3) APPLIED FOR KALISPELL REGIONAL MEDICAL CENTER 1 MRICT JOINT OPERATING AGREEMENT 310 SUNNYVIEW LANE KALISPELL MT 59901 205010390 DIAGNOSTIC SCREENING MT KALISPELL REGIONAL MEDICAL CENTER RELATED 2960538 8417200 1 1 HEALTHCENTER NORTHWEST LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 810540517 ACUTE CARE MT N/A N/A 0 0 FLATHEAD HOSPITAL DEVELOPMENT COMPANY LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 810541707 COMMERICAL BUILDING RENTAL MT N/A N/A 0 0 NORTHWEST ORTHOPEDICS & SPORTS MEDICINE LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 371518772 ORTHOPEDIC MEDICINE MT N/A N/A 0 0 ORTHOPEDICS ONE LLC 310 SUNNYVIEW LANE KALISPELL MT 59901 800346984 ORTHOPEDIC MEDICINE MT N/A N/A 0 0 APPLIED HEALTH SERVICES INC 310 SUNNYVIEW LANE KALISPELL MT 59901 810413632 HEALTH RELATED MT N/A C 1 1 0 1 0 0 0 0 1 1 1 1 1 1 1 1 1 1 FLATHEAD HOSPITAL DEVELOPMENT COMPANY LLC A 28897 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC A 267194 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC A 16301 ACTUAL PAYMENT NORTHWEST HEALTHCARE CORPORATION A 27804 ACTUAL PAYMENT NORTHWEST HORIZON INC A 31166 ACTUAL PAYMENT NORTHWEST HEALTHCARE CORPORATION B 6333153 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC J 513590 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC J 405125 ACTUAL PAYMENT NORTHWEST HEALTHCARE CORPORATION J 728546 ACTUAL PAYMENT THE SUMMIT MEDICAL FITNESS CENTER INC J 250092 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC K 504619 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC K 227993 ACTUAL PAYMENT NORTHWEST HORIZON INC K 210231 ACTUAL PAYMENT HEALTHCENTER NORTHWEST LLC L 3498692 ACTUAL PAYMENT APPLIED HEALTH SERVICES INC L 2162817 ACTUAL PAYMENT NORTHWEST ORTHOPEDIC & SPORTS MEDICINE LLC L 182500 ACTUAL PAYMENT THE SUMMIT MEDICAL FITNESS CENTER INC L 453724 ACTUAL PAYMENT NORTHWEST HORIZON INC L 152047 ACTUAL PAYMENT THIS RETURN IS BEING FILED BETWEEN MARCH 1, 2012 AND MARCH 30, 2012, AS DIRECTED BY THE IRS IN NOTICE 2012-4, BECAUSE ELECTRONIC FILING WAS NOT AVAILABLE JANUARY 1, 2012 THROUGH FEBRUARY 29, 2012. WE REQUEST THAT PENALTIES BE WAIVED BECAUSE IT WOULD BE INEQUITABLE TO IMPOSE A PENALTY ON US DUE TO THE UNUSUAL CIRCUMSTANCES REQUIRING US TO DELAY THE FILING OF THE RETURN.