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BENEFIS MEDICAL GROUP INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
BENEFIS MEDICAL GROUP INC (EIN 26-3538192)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-05-03
IRS object ID
201241259349300909
Schema version
2011v1.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-05-03T17:16:26-05:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

FieldValueIRS element (for citing)
EIN910189318EIN

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1MOSS ADAMS LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1805 SW BROADWAY 1200AddressLine1
CityPORTLANDCity
StateORState
ZIP Code97205ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN263538192EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1BENEFIS MEDICAL GROUP INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlBENENameControl
Phone4064552563Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11401 25TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJERRY SPEER MDName
TitlePRESIDENTTitle
Phone4064552563Phone
Date Signed2012-04-26DateSigned
Authorize Third Party1AuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameWENDY CAMPOSName
PTINP00448102PTIN
Phone5032421447Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Address ChangeXAddressChange
Name Of Principal Officer PersonJERRY SPEER MDNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11401 25TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
Gross Receipts69484726GrossReceipts
Group Return For Affiliates0GroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.BENEFIS.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation2009YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionMULTI-SPECIALTY PHYSICIAN GROUP.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members1NbrIndependentVotingMembers
Total Nbr Employees373TotalNbrEmployees
Total Nbr Volunteers0TotalNbrVolunteers
Total Gross UBI216216TotalGrossUBI
Net Unrelated Business Txbl Income-163711NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year0ContributionsGrantsPriorYear
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year57470198ProgramServiceRevenuePriorYear
Program Service Revenue CY69418946ProgramServiceRevenueCY
Investment Income Prior Year105InvestmentIncomePriorYear
Investment Income Current Year338InvestmentIncomeCurrentYear
Other Revenue Prior Year-11328OtherRevenuePriorYear
Other Revenue Current Year-56805OtherRevenueCurrentYear
Total Revenue Prior Year57458975TotalRevenuePriorYear
Total Revenue Current Year69362479TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year25176486SalariesEtcPriorYear
Salaries Etc Current Year31890909SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year45708022OtherExpensePriorYear
Other Expenses Current Year53736052OtherExpensesCurrentYear
Total Expenses Prior Year70884508TotalExpensesPriorYear
Total Expenses Current Year85626961TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-13425533RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-16264482RevenuesLessExpensesCY
Total Assets BOY11239030TotalAssetsBOY
Total Assets EOY20250721TotalAssetsEOY
Total Liabilities BOY4048761TotalLiabilitiesBOY
Total Liabilities EOY20274933TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY7190269NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY-24212NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. WE OPERATE PROFESSIONAL MEDICAL SERVICES IN COLLABORATION WITH BENEFIS HEALTH SYSTEM, INC. AND BENEFIS HOSPITALS, INC. AS PART OF A COLLECTIVE EFFORT TO MEET THE HEALTHCARE NEEDS OF RESIDENTS OF NORTH CENTRAL MONTANA.MissionDescription
Significant New Program Services0SignificantNewProgramServices
Significant Change0SignificantChange
Expense76572798Expense
Revenue69023678Revenue
DescriptionBENEFIS MEDICAL GROUP, INC. PROVIDES PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. BENEFIS MEDICAL GROUP, INC. ALSO PROVIDES SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY & INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS & RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART & VASCULAR, SPORTS MEDICINE, MED SPA & VEIN CENTER.Description
Total Program Service Expense76572798TotalProgramServiceExpense
Described In501 C31DescribedIn501C3
Schedule B Required0ScheduleBRequired
Political Activities0PoliticalActivities
Lobbying Activities0LobbyingActivities
Donor Advised Funds0DonorAdvisedFunds
Conservation Easements0ConservationEasements
Collections Of Art0CollectionsOfArt
Credit Counseling0CreditCounseling
Term Or Permanent Endowments0TermOrPermanentEndowments
Report Land Bldg Equip1ReportLandBldgEquip
Report Invest Oth Securities0ReportInvestOthSecurities
Report Prog Rel Invest0ReportProgRelInvest
Report Other Assets0ReportOtherAssets
Report Other Liabilities0ReportOtherLiabilities
Report Fin48 Footnote1ReportFin48Footnote
Independent Audit Financial Stmt0IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt1ConsolidatedAuditFinancialStmt
School0School
Foreign Office0ForeignOffice
Foreign Activities0ForeignActivities
More Than5000 K To Organizations0MoreThan5000KToOrganizations
More Than5000 K To Individuals0MoreThan5000KToIndividuals
Professional Fundraising0ProfessionalFundraising
Fundraising Activities0FundraisingActivities
Gaming0Gaming
Hospital0Hospital
Grants To Organizations0GrantsToOrganizations
Grants To Individuals0GrantsToIndividuals
Schedule J Required1ScheduleJRequired
Tax Exempt Bonds0TaxExemptBonds
Excess Benefit Transaction0ExcessBenefitTransaction
Prior Excess Benefit Transaction0PriorExcessBenefitTransaction
Loan To Officer Or DQP1LoanToOfficerOrDQP
Grant To Related Person0GrantToRelatedPerson
Bsnss Rltnshp With Organization0BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member1BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp0OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions0DeductibleNonCashContributions
Deductible Contributions Of Art0DeductibleContributionsOfArt
Terminated0Terminated
Partial Liquidation0PartialLiquidation
Disregarded Entity0DisregardedEntity
Related Entity1RelatedEntity
Related Org Controlled Entity0RelatedOrgControlledEntity
Transaction Related Entity0TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org0TransfersToExemptNonChrtblOrg
Activities Conducted Partnership0ActivitiesConductedPartnership
Schedule O Required1ScheduleORequired
Number Forms Transmitted With109658NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees373NumberOfEmployees
Employment Tax Returns Filed1EmploymentTaxReturnsFiled
Unrelated Business Income1UnrelatedBusinessIncome
Form990-T Filed1Form990-TFiled
Foreign Financial Account0ForeignFinancialAccount
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTrans
Taxable Party Notification0TaxablePartyNotification
Non Deductible Contributions0NonDeductibleContributions
Quid Pro Quo Contributions0QuidProQuoContributions
Form8282 Property Disposed Of0Form8282PropertyDisposedOf
Funds To Pay Premiums0FundsToPayPremiums
Premiums Paid0PremiumsPaid
Indoor Tanning Services0IndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members1NumberIndependentVotingMembers
Family Or Business Relationship1FamilyOrBusinessRelationship
Delegation Of Management Duties1DelegationOfManagementDuties
Changes To Organizing Docs0ChangesToOrganizingDocs
Material Diversion Or Misuse0MaterialDiversionOrMisuse
Members Or Stockholders1MembersOrStockholders
Election Of Board Members1ElectionOfBoardMembers
Decisions Subject To Approval1DecisionsSubjectToApproval
Minutes Of Governing Body1MinutesOfGoverningBody
Minutes Of Committees1MinutesOfCommittees
Officer Mailing Address0OfficerMailingAddress
Local Chapters0LocalChapters
Form990 Provided To Governing Body1Form990ProvidedToGoverningBody
Conflict Of Interest Policy1ConflictOfInterestPolicy
Annual Disclosure Covered Persons1AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement1RegularMonitoringEnforcement
Whistleblower Policy1WhistleblowerPolicy
Document Retention Policy1DocumentRetentionPolicy
Compensation Process CEO1CompensationProcessCEO
Compensation Process Other1CompensationProcessOther
Investment In Joint Venture0InvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1DALE BIMLERBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number4064552565TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
T BRICE ADDISON MD
DIRECTOR60.00X51182406424
RICHARD BLEVINS MD
VICE CHAIR59.00X29946606240X
DAREN BRAGET MD
DIRECTOR60.00X69852906430
DOUGLAS DAVENPORT
FORMER DIRECTOR1.00X025222917688
PAUL DOLAN MD
DIRECTOR1.00X033935663595
WAYNE DUNN
DIRECTOR1.00X02275314132
LAURA GOLDHAHN
DIRECTOR1.00X038318579882
GREG HATLEY
DIRECTOR1.00X000
BRIAN MALLOY MD
DIRECTOR60.00X46671606537
TIMOTHY ROUX MD
DIRECTOR60.00X30179606235
JAMES WHITTLE MD
DIRECTOR60.00X53345807180
JERRY SPEER MD
PRESIDENT BENEFIS MEDICAL50.00030036543717X
JULIE WALL
COO60.00185248014059X
ROLLIN BEARSS MD
PHYSICIAN60.0056541205108X
DONALD H BERDEAUX MD
PHYSICIAN60.008114860857X
BRYAN MARTIN MD
PHYSICIAN60.00115446407769X
JEFFREY STEPHENSON MD
PHYSICIAN60.0073422206661X
KELLY J UNDERHILL MD
PHYSICIAN60.0055354906571X
FieldValueIRS element (for citing)
Total Reportable Comp From Org6816170TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs1502666TotalReportableCompFrmRltdOrgs
Total Other Compensation289085TotalOtherCompensation
Number Individuals GT100 K75NumberIndividualsGT100K
Formers Listed0FormersListed
Total Comp GT150 K1TotalCompGT150K
Compensation From Other Sources0CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
PRECYSE SOLUTIONS LLC
DEPT 1736 BOX 11407BIRGMINGHAMAL352461736CONTRACT LABOR583665
XTEND HEALTHCARE LLC
BOX 1709HENDERSONVILLETN37077CONTRACT LABOR500593
GREAT FALLS CLINIC LLP
BOX 5012GREAT FALLSMT59403LOCUM PHYSICIANS438702
DURITZ MEDICAL GROUP INC
36 EL CAMINOBERKELEYCA94705NICU MEDICAL SERVICES164049
HOLLY STRONG
401 15TH AVE SOUTH SUITE 202GREAT FALLSMT59405PHYSICIAN SERVICES150505
FieldValueIRS element (for citing)
Number Of Contractors GT100 K9NumberOfContractorsGT100K

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICE REVENU6211106867040668670406
OTHER OPERATING REVENU621110748540475519273021
FieldValueIRS element (for citing)
Total Program Service Revenue69418946TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column338TotalRevenueColumn
Exclusion$338ExclusionAmount
FieldValueIRS element (for citing)
Gross Sales Of Inventory65442GrossSalesOfInventory
Cost Of Goods Sold122247CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-56805TotalRevenueColumn
Unrelated Business Revenue-56805UnrelatedBusinessRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column69362479TotalRevenueColumn
Related Or Exempt Function Income69145925RelatedOrExemptFunctionIncome
Unrelated Business Revenue216216UnrelatedBusinessRevenue
Exclusion$338ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3050142Total
Program Services2865063ProgramServices
Management And General185079ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total25746321Total
Program Services24211806ProgramServices
Management And General1534515ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total229956Total
Program Services200374ProgramServices
Management And General29582ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total1435277Total
Program Services1260920ProgramServices
Management And General174357ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1429213Total
Program Services1423421ProgramServices
Management And General5792ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total4816301Total
Management And General4816301ManagementAndGeneral

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total4056662Total
Program Services3056042ProgramServices
Management And General1000620ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total9356649Total
Program Services9104985ProgramServices
Management And General251664ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total241108Total
Program Services5280ProgramServices
Management And General235828ManagementAndGeneral

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1789718Total
Program Services1729686ProgramServices
Management And General60032ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total310265Total
Program Services271982ProgramServices
Management And General38283ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total567729Total
Program Services200510ProgramServices
Management And General367219ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total1259229Total
Program Services1201400ProgramServices
Management And General57829ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
CONTRACTUAL ADJ/CHARITY2915560829155608
BAD DEBT12680031268003
TRANSCRIPTION FEES6212466177183528
OTHER EXPENSES293534293534

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total85626961Total
Program Services76572798ProgramServices
Management And General9054163ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY36117BOY
EOY-54808EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8761089BOY
EOY16332175EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY30096BOY
EOY33838EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY843380BOY
EOY1071585EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY12263BOY
EOY-10100EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis4426879LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec1548848LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY1556085BOY
EOY2878031EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY11239030BOY
EOY20250721EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY4048761BOY
EOY20274933EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4048761BOY
EOY20274933EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY7190269BOY
EOY-24212EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY7190269BOY
EOY-24212EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY11239030BOY
EOY20250721EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-16264482ReconcilationRevenueExpenses
Reconcilation Other Changes9050000ReconcilationOtherChanges
Info In Schedule O Part XIIXInfoInScheduleOPartXII
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or Review0AccountantCompileOrReview
FS Audited1FSAudited
Audit Committee1AuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit Required0FederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule D IRS990ScheduleD

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis4426879OtherCostOrOtherBasis
Depreciation1548848Depreciation
Book Value2878031BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings2878031TotalOfBookValueLandBuildings

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

FieldValueIRS element (for citing)
IdentifierDESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:Identifier
Return ReferencePART X:ReturnReference
ExplanationTHE 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance Payment0SeverancePayment
Supplemental Nonqual Retire Plan1SupplementalNonqualRetirePlan
Equity Based Comp Arrangement0EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org0CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs0CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org0CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs0CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments1AnyNonFixedPayments
Initial Contract Exception0InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (17 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
T BRICE ADDISON MD
282945020697502190400064240518248000
RICHARD BLEVINS MD
2946110477508000062400305706000
DAREN BRAGET MD
301132038700901038800064300704959000
DOUGLAS DAVENPORT
0241272079120304501225005438026991700
PAUL DOLAN MD
02620340699520737005786705728040295100
WAYNE DUNN
0944820113411019638031790953023166300
LAURA GOLDHAHN
03031530711850884707565304229046306700
BRIAN MALLOY MD
4567160001000000065370473253000
TIMOTHY ROUX MD
2795340929401296800062350308031000
JAMES WHITTLE MD
498145035000031300071800540638000
JERRY SPEER MD
02603230400420003837605341034408200
JULIE WALL
1566540285940007920061390199307000
ROLLIN BEARSS MD
35101002144020000051080570520000
DONALD H BERDEAUX MD
68302501283810800008570812343000
BRYAN MARTIN MD
630448052401600000776901162233000
JEFFREY STEPHENSON MD
63063308506301852600066610740883000
KELLY J UNDERHILL MD
515209037840050000065710560120000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

Return ReferenceReturnReferenceExplanationExplanation
PART I, LINE 4BTHE ORGANIZATION PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR CERTAIN EMPLOYEES.
PART I, LINE 7BENEFIS 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 MR. DAVENPORT, MS. GOLDHAHN, 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.

Schedule L IRS990ScheduleL

Loan Table LoanTable (2 entries)

Purpose Of LoanPurposeOfLoanLoan From OrganizationLoanFromOrganizationOriginal PrincipalOriginalPrincipalAmountBalance DueBalanceDueDefaultDefaultApproved By BoardApprovedByBoardWritten AgreementWrittenAgreement
DAREN BRAGET
RETENTION INCENTIVEX$25,0008921011
JEFFREY STEPHENSON
RETENTION INCENTIVEX$50,00024917011
FieldValueIRS element (for citing)
Total Balance Due33838TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonELIZABETH ADDISON O'CONNORNamePerson
FieldValueIRS element (for citing)
RelationshipFAMILY MEMBER OF BOARD MEMBERRelationship
Amount Of Transaction110606AmountOfTransaction
Description Of TransactionCOMPENSATIONDescriptionOfTransaction
Sharing Of Revenues0SharingOfRevenues

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

Return ReferenceReturnReferenceExplanationExplanationIdentifierIdentifier
PART VI, SECTION A, LINE 1B:THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NONPROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO APPROVE THE ELECTION OF INDIVIDUALS TO ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO THUS MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS'S OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF.
FORM 990, PART VI, SECTION A, LINE 2CERTAIN 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 3PURSUANT 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 SUBSIDIARY TAX-EXEMPT OPERATING ENTITIES ON A CENTRALIZED BASIS.
FORM 990, PART VI, SECTION A, LINE 6THE 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 7AAS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. (ACTING THROUGH ITS OWN GOVERNING BODY) HAS THE AUTHORITY TO APPROVE INDIVIDUALS PROPOSED TO SERVE ON THE ORGANIZATION'S BOARD OF DIRECTORS, AS ELECTED BY THE PHYSICIAN EMPLOYEES OF THE ORGANIZATION.
FORM 990, PART VI, SECTION A, LINE 7BAS 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, APPROVAL OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, PHYSICIAN COMPENSATION ARRANGEMENTS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS.
FORM 990, PART VI, SECTION B, LINE 11THIS 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 12CBOARD 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 15THE COMPENSATION OF THE PRESIDENT 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 COO WAS SET BY EXECUTIVE LEADERSHIP OF BENEFIS HEALTH SYSTEM, INC. IN CONSULTATION WITH ITS HUMAN RESOURCES DEPARTMENT, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILARLY-SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. THE COMPENSATION OF THE ORGANIZATION'S OTHER OFFICERS AND KEY EMPLOYEES IS ESTABLISHED BY THE PHYSICIAN COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH CONSISTS SOLELY OF EXECUTIVE LEADERS (WITHOUT PARTICIPATION OF ANY PRACTICING PHYSICIANS). THE COMPENSATION COMMITTEE USES VARIOUS EXTERNAL PHYSICIAN COMPENSATION REPORTING SOURCES, AND FROM TIME TO TIME MAY ENGAGE AN INDEPENDENT COMPENSATION CONSULTING FIRM, TO DETERMINE AMOUNTS PAID BY COMPARABLE PHYSICIAN ORGANIZATIONS OF SIMILAR SIZE AND MARKET. BASED THEREON, THE COMMITTEE DETERMINES COMPENSATION AND BENEFIT AMOUNTS TO BE PAID TO THE ORGANIZATION'S EMPLOYED PHYSICIANS. THE COMMITTEE'S DECISIONS ARE THOROUGHLY AND TIMELY DOCUMENTED.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION PROVIDES COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, AND THE FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS.
FORM 990, PART VII, SECTION A, COLUMN BRICHARD BLEVINS - 1 HOUR DOUGLAS DAVENPORT - 59 HOURS PAUL DOLAN - 59 HOURS WAYNE DUNN - 59 HOURS LAURA GOLDHAHN - 59 HOURS GREG HATLEY - 3 HOURS JERRY SPEER - 10 HOURSAVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS:
FORM 990, PART XI, LINE 5:INTERAFFILIATE TRANSFERS 9,050,000. TOTAL TO FORM 990, PART XI, LINE 5: 9,050,000.CHANGES IN NET ASSETS OR FUND BALANCES:
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.

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BENEFIS SLETTEN HI-LINE CANCER CENTER LLC
1101 26TH STREET SOUTHGREAT FALLSMT59405263144419MEDICAL CAREMTBENEFIS HEALTH SYSTEM INC
BENEFIS CASCADE RIDGE LLC
1101 26TH STREET SOUTHGREAT FALLSMT59405274602798REAL ESTATEMTBENEFIS HEALTH SYSTEM INC
BENEFIS HEALTH SYSTEM FOUNDATION PROPERTIES LLC
PO BOX 7008GREAT FALLSMT59406272514629HOLDS REAL PROPERTY DONATED TO FOUNDATIONMTBENEFIS HEALTH SYSTEM FOUNDATION INC

Form990 Schedule R Part II Form990ScheduleRPartII (5 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusDirect Controlling Entity NADirectControllingEntityNAControlled OrgControlledOrgBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
BENEFIS HEALTH SYSTEM INC
1101 26TH STREET SOUTHGREAT FALLSMT59405263538104MANAGEMENT AND SUPPORT SERVICESMT501(C)(3)SCHEDULE A LINE 11N/A0
BENEFIS HOSPITALS INC
1101 26TH STREET SOUTHGREAT FALLSMT59405810232122HOSPITALMT501(C)(3)SCHEDULE A LINE 30BENEFIS HEALTH SYSTEM INC
BENEFIS SPECTRUM MEDICAL INC
1101 26TH STREET SOUTHGREAT FALLSMT59405810431871HOME HEALTH SERVICES AND RELATED PRODUCTSMT501(C)(3)SCHEDULE A LINE 90BENEFIS HEALTH SYSTEM INC
BENEFIS HEALTHCARE EES HEALTH PLAN AND TRUST
1101 26TH STREET SOUTHGREAT FALLSMT59405363386166BENEFIT PLANMT501(C)(9)0BENEFIS HEALTH SYSTEM INC
BENEFIS HEALTH SYSTEM FOUNDATION INC
PO BOX 7008GREAT FALLSMT59406810480587FOUNDATIONMT501(C)(3)SCHEDULE A LINE 70BENEFIS HEALTH SYSTEM INC

Form990 Schedule R Part III Form990ScheduleRPartIII (3 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateDirect Controlling Entity NADirectControllingEntityNAPredominant Income TypePredominantIncomeTypeDisproportionate AllocationsDisproportionateAllocationsGeneral Or Managing PartnerGeneralOrManagingPartner
BBB LLC
1101 26TH STREET SOUTHGREAT FALLSMT59405263652926MEDICAL BUILDINGMTN/AN/A00
GREAT FALLS ATHLETIC CLUB LLC
1800 BENEFIS COURTGREAT FALLSMT59405912081505FITNESS CLUBMTN/AN/A00
SPECTRUM HOME SOLUTIONS
2509 7TH AVE SOUTHGREAT FALLSMT59405810431871IV THERAPYMTN/AN/A00

Form990 Schedule R Part IV Form990ScheduleRPartIV

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1BENEFIS HEALTHCARE PRACTITIONERS PCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11101 26TH STREET SOUTHAddressLine1
CityGREAT FALLSCity
StateMTState
ZIP Code59405ZIPCode
FieldValueIRS element (for citing)
EIN201383362EIN
Primary ActivityHEALTHCARE SERVICESPrimaryActivity
Legal Domicile StateMTLegalDomicileState
Direct Controlling Entity NAN/ADirectControllingEntityNA
Type Of EntityCTypeOfEntity
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents Royalties0ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org0GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org1GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org0LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org0SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org0PurchaseOfAssetsFromOtherOrg
Exchange Of Assets0ExchangeOfAssets
Rental Of Facilities To Other Orgs0RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs1RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs0PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs1PerformOfServicesByOtherOrgs
Sharing Of Facilities0SharingOfFacilities
Sharing Of Paid Employees0SharingOfPaidEmployees
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org1ReimbursementPaidByOtherOrg
Other Transfer To Other Org0OtherTransferToOtherOrg
Other Transfer From Other Org0OtherTransferFromOtherOrg

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