2012-05-15T13:56:05-05:00 2011-06-30 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2010-07-01 810428854 NORTHERN MONTANA HEALTH CARE INC NORT 4062652211 PO BOX 1231 HAVRE MT 59501 DAVID HENRY 4062652211 2012-05-15 1 KIM C HUNWARDSEN 6122536500 2012-05-14 2010 2016-02-24 21:20:13Z DAVID HENRY PO BOX 1231 HAVRE MT 59501 10436660 0 X WWW.NMHCARE.ORG X 1985 MT PROVISION OF HEALTHCARE SERVICES. 12 7 0 115 0 0 8576 8374 3074563 7051845 80758 207171 0 0 3163897 7267390 0 0 0 0 0 0 0 0 0 1762365 1768414 1762365 1768414 1401532 5498976 61580656 67108502 10118731 9544982 51461925 57563520 X TO DELIVER HIGH QUALITY COMPREHENSIVE HEALTH CARE SERVICES TO THE HI-LINE COMMUNITIES. 0 0 1404111 7051845 NORTHERN MONTANA HEALTH CARE, INC. (NMHC) SUPPORTS AND ENCOURAGES HEALTH CARE SERVICES BY PROVIDING FINANCIAL AND MANAGERIAL CONSULTING ASSISTANCE TO THE FOLLOWING CONTROLLED HEALTH CARE ORGANIZATIONS:1) NORTHERN MONTANA HOSPITAL, ID# 81-02317872) NORTH CARE CORPORATION, ID# 81-04476383) NORTHERN MONTANA HEALTH CARE FOUNDATION, ID# 36-3464641NMHC PROVIDES OVERALL DIRECTION AND COORDINATES THE POLICY MAKING AND LONG-RANGE PLANNING FOR ITS SUBSIDIARIES. IT IS ORGANIZED SOLELY TO CARRY OUT THE PURPOSES OF ITS TAX-EXEMPT SUBSIDIARIES. SOME OF THE SERVICES NMHC FURNISHES TO ITS SUBSIDIARIES ARE: ACCOUNTING SERVICES, NEGOTIATION ASSISTANCE WITH RENTAL AGREEMENTS, MANAGEMENT AND HEALTHCARE CONSULTING, AND OTHER MISCELLANEOUS SERVICES. 1404111 1 1 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 12 7 1 1 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0 0 0 X KIM LUCKE VP OF FINANCE 4062652211 PO BOX 1231 HAVRE MT 59501 DAVID C HENRY 1.00 X X 0 347250 0 DAVID LEEDS 1.00 X X 0 0 0 JUDY GREENWOOD 1.00 X X 0 0 0 MILES HAMILTON 1.00 X X 0 0 0 BRUCE RICHARDSON MD 1.00 X X 0 322727 18229 PAUL TUSS 1.00 X 0 0 0 JULIE HOLT 1.00 X 0 0 0 ANDREW CARLSON 1.00 X 0 0 0 TOM PATRICK 1.00 X 0 0 0 MARGARET DOW MD 1.00 X 0 206109 22828 MICHAEL NOLAN MD 1.00 X 0 256158 3048 STEPHEN BECHDOLT MD 1.00 X 0 277266 11019 KAREN POLLINGTON 1.00 X 0 91011 18417 KIM LUCKE 1.00 X 0 70551 15318 0 1571072 88859 0 0 1 0 NORTHERN MONTANA HOSPITAL PO BOX 1231 HAVRE MT 59501 CONTRACT LABOR 278460 1 8374 8374 INCOME FROM AFFILIATES 900099 5666145 5666145 RENTAL INCOME - AFFILI 532000 1385700 1385700 7051845 150437 150437 3226004 3169270 56734 56734 56734 7267390 7051845 0 207171 278460 208845 69615 12003 12003 112805 76910 35895 3143 2357 786 23202 13166 10036 149576 80211 69365 1332 985 347 440366 440366 682884 550721 132163 34263 16087 18176 30380 14463 15917 1768414 1404111 364303 0 592864 688949 76410 59595 24280 23995 18671517 8177032 11044309 10494485 6460431 6941983 43137471 48698493 244891 201002 61580656 67108502 378961 384571 7676351 6932107 1861602 1557481 201817 670823 10118731 9544982 X 51461925 57563520 51461925 57563520 61580656 67108502 X 5498976 602619 X 0 1 1 X 0 X X X 0 0 0 NORTHERN MONTANA HOSPITAL 810231787 3 1 867360 NORTH CARE CORPORATION 810447638 3 1 0 NORTHERN MONTANA HEALTH CARE FOUNDATION INC 363464641 7 1 107147 3 974507 SCHEDULE A, PART IV, SUPPLEMENTAL INFORMATION: FORM 990, SCHEDULE A, PART I, LINE 11I, COLUMN VII: NORTHERN MONTANA HEALTH CARE, INC. PROVIDED NON-MONETARY SUPPORT TO NORTHERN MONTANA HOSPITAL, NORTH CARE CORPORATION, AND NORTHERN MONTANA HEALTH CARE FOUNDATION IN THE FORM OF DIRECTION AND GUIDANCE. IN ADDITION NORTHERN MONTANA HEALTH CARE, INC PROVIDED MONETARY SUPPORT, ACCOUNTING SERVICES, NEGOTIATION ASSISTANCE, MANAGEMENT AND HEALTH CARE CONSULTING AND OTHER MISCELLANEOUS SERVICES TO NORTHERN MONTANA HOSPITAL AND NOTHERN MONTANA HEALTH CARE FOUNDATION. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100000 100000 17513559 7886556 9627003 129528 125221 4307 928430 165255 763175 10494485 INVESTMENT IN MUTUAL BENEFIT CORPORATION 2170000 C INVESTMENT IN AFFILIATES 46528493 F 48698493 DUE FROM AFFILIATES 670823 670823 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE COMPANY UNDERGOES AN ANNUAL ANALYSIS OF ITS VARIOUS TAX POSITIONS, ASSESSING THE LIKELIHOOD OF THOSE POSITIONS BEING UPHELD UPON EXAMINATION WITH RELEVANT TAX AUTHORITIES. AS OF JUNE 30, 2011 AND 2010, THE UNRECOGNIZED TAX BENEFIT ACCRUAL IS ZERO. 0 0 0 0 1 0 0 0 0 DAVID C HENRY 0 275250 0 72000 0 0 0 0 0 0 0 347250 0 0 BRUCE RICHARDSON MD 0 321539 0 0 0 1188 0 0 0 21131 0 343858 0 0 MARGARET DOW MD 0 205941 0 0 0 168 0 0 0 24756 0 230865 0 0 MICHAEL NOLAN MD 0 254970 0 0 0 1188 0 0 0 5310 0 261468 0 0 STEPHEN BECHDOLT MD 0 276078 0 0 0 1188 0 0 0 13474 0 290740 0 0 PART I, LINE 5 ONE PHYSICIAN LISTED IN PART VII OF THE FORM 990 IS COMPENSATED AS A PERCENTAGE OF THE PRIOR THREE MONTHS' AVERAGE GROSS REVENUE EARNED FOR THE HOSPITAL BY THE PHYSICIAN, WITH THE PERCENTAGE BEING BASED ON THEIR SPECIALTY. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART I, LINE 3: CEO/PRESIDENT IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. A RELATED ORGANIZATION AND THE MANAGEMENT COMPANY HAVE A PROCESS IN PLACE TO DETERMINE THE CEO'S COMPENSATION USING PROCEDURES NOTED IN SCHEDULE J, LINE 3. SCHEDULE J, PART II: INDIVIDUALS LISTED ON SCHEDULE J, PART II, OTHER THAN THE CEO, ARE COMPENSATED BY A RELATED ORGANIZATION FOR THEIR SERVICES PROVIDED TO THAT ORGANIZATION. THEY ARE NOT COMPENSATED FOR THEIR SERVICES AS BOARD MEMBERS. THE RELATED ORGANIZATION HAS PROCEDURES IN PLACE TO DETERMINE THEIR COMPENSATION. MONTANA FACILITY FINANCE AUTHORITY 810302402 612043DM8 2006-03-01 6843295 REFUND BONDS ISSUED 11/9/1995 AND 12/15/1995. 0 0 0 CITY OF HAVRE MONTANA 816001274 2007-11-30 3186968 FUND NEW MEDICAL BUILDING 0 0 0 2640000 6843295 667000 136846 6039449 2006 1 0 1 1 3186968 181856 61698 2943162 2008 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 FORM 990, PART VI, SECTION A, LINE 2 KIM LUCKE, KAREN POLLINGTON, BRUCE RICHARDSON, DAVID C. HENRY, DAVID LEEDS, JUDY GREENWOOD, MILES HAMILTON, BRUCE RICHARDSON, PAUL TUSS, JULIE HOLT, ANDREW CARLSON, TOM PATRICK, MARGARET DOW, MICHAEL NOLAN, AND STEPHEN BECHDOLT HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. FORM 990, PART VI, SECTION A, LINE 3 THE PRESIDENT/CEO OF THE HOSPITAL IS EMPLOYED BY AN UNRELATED MANAGEMENT COMPANY. RELATED ORGANIZATION, NORTHERN MONTANA HOSPITAL (NMH), PAYS THE UNRELATED MANAGEMENT COMPANY FOR HIS SERVICES PROVIDED TO NMH, NORTHERN MONTANA HEALTH CARE, INC. AND NORTHERN MONTANA HEALTH CARE FOUNDATION. FORM 990, PART VI, SECTION A, LINE 6 THOSE PERSONS WHO RESIDE IN THE AREA SERVED BY NORTHERN MONTANA HOSPITAL AND WHO HAVE BEEN MEMBERS OF OR GIVEN MONEY TO NORTHERN MONTANA HOSPITAL AT ANY TIME FROM THE FOUNDING OF THE HOSPITAL TO MAY 1, 1984 SHALL BE INVITED TO BECOME MEMBERS OF THE CORPORATION (NORTHERN MONTANA HEALTH CARE, INC.). THE CORPORATION SHALL ONLY BE REQUIRED TO ACT IN GOOD FAITH AND USE ITS BEST EFFORTS TO IDENTIFY ALL PERSONS QUALIFYING FOR SUCH INVITATION. THE INITIAL MEMBERS SHALL BE THOSE PERSONS INVITED TO BE MEMBERS WHO AGREED IN WRITING TO BECOME A MEMBER OF THE CORPORATION. THESE MEMBERS SHALL MEET AT A PLACE AND TIME DESIGNATED BY THE BOARD TO TAKE THE FOLLOWING ACTION: (1) IF THEIR NUMBER IS LESS THAN FIFTY (50), TO ELECT AS MANY ADDITIONAL MEMBERS AS NECESSARY TO BRING THEIR TOTAL NUMBER TO FIFTY (50) AND (2) TO SELECT THE TERMS OF SERVICE OF EACH OF THE MEMBERS. THE TERMS OF ONE-THIRD (1/3) OF THE INITIAL MEMBERS SHALL EXPIRE ON THE SECOND TUESDAY OF MARCH OF EACH YEAR, BEGINNING IN 1986. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS OF THE CORPORATION SHALL HAVE THE FOLLOWING POWERS: (I) TO APPROVE, OR DISAPPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION THAT AFFECT THE IDENTITY, POWER AND/OR DUTIES OF THE MEMBERS OF THE CORPORATION, OR MERGERS OR CONSOLIDATIONS WITH ANOTHER CORPORATION, OR SALES OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS, (II) TO APPROVE, OR DISAPPROVE, LIQUIDATIONS OF THE CORPORATION'S MERGERS OR CONSOLIDATIONS OF THE CORPORATION WITH ANOTHER CORPORATION, OR SALES OF ALL OR SUBSTANTIALLY ALL OF THE CORPORATION'S ASSETS, (III) TO ELECT THE MEMBERS OF THE CORPORATION, AND (IV) TO APPROVE, OR DISAPPROVE, AMENDMENTS TO THE BYLAWS WHICH AFFECT THE IDENTITY, POWER AND/OR DUTIES OF THE MEMBERS OF THE CORPORATION. THE MEMBERS SHALL HAVE NO OTHER POWERS WITH REGARD TO THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 8B NO SUBCOMMITTEE HAD THE AUTHORITY TO ACT ON BEHALF OF THE BOARD DURING THE FISCAL YEAR ENDED JUNE 30, 2011. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE FORM 990 WILL BE REVIEWED BY THE VP OF FINANCE, THEN SUBMITTED VIA E-MAIL TO THE BOARD OF DIRECTORS TO VIEW BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL TRUSTEES, DIRECTORS, OFFICERS, AND KEY EMPLOYEES. THE BOARD IDENTIFIES POTENTIAL CONFLICTS FROM ANNUAL DISCLOSURES. DISCLOSURES ARE REVIEWED BY ADMINISTRATION AFTER ALL ARE GATHERED. A SECOND CONFLICT DISCLOSURE LETTER IS SENT OUT ANNUALLY TO ALL CURRENT AND FORMER OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TO ENSURE ALL POTENTIAL CONFLICTS ARE IDENTIFIED. THE RESULTS OF THIS DISCLOSURE FORM ARE REVIEWED BY THE VP OF FINANCE. THE BOARD DISCUSSES THE POTENTIAL CONFLICTS AND DETERMINES IF VOTING ON RELATED ITEMS WOULD BE A CONFLICT OF INTEREST. IF A CONFLICT IS DETERMINED TO EXIST, THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE CONFLICTED ITEM. FORM 990, PART VI, LINE 15: THE PRESIDENT/CEO IS COMPENSATED BY AN UNRELATED MANAGEMENT COMPANY. THE UNRELATED MANAGEMENT COMPANY RECEIVES A FEE FOR SERVICE FROM A RELATED ORGANIZATION FOR THE CEO'S SERVICE PROVIDED TO THIS ORGANIZATION AND RELATED ORGANIZATIONS, NORTHERN MONTANA HOSPITAL (NMH) AND NORTHERN MONTANA HEALTH CARE FOUNDATION, INC. (NMHCF). IN DETERMINING THE CEO'S COMPENSATION, THE EXECUTIVE COMMITTEE OF THE BOARD MEETS AND REVIEWS NMH/NORTHERN MONTANA HEALTH CARE, INC. (NMHC) FINANCIAL RESULTS, CEO'S CURRENT YEAR PRIORITIES, DISCUSSES EVALUATION TOOLS TO BE USED FOR CEO EVALUATION, HOW COMPARATIVE SALARIES WILL BE OBTAINED AND DISCUSSES THE HISTORY OF COMPENSATION TO THE CEO. AT A SECOND EXECUTIVE COMMITTEE MEETING THEY REVIEW NON-FINANCIAL ACTIVITY OF NMH/NMHC AND THE RESULTS OF THE CEO EVALUATIONS COMPLETED BY THE BOARD MEMBERS. THEN THEY REVIEW AND DISCUSS A COMPENSATION COMPARATIVE SUMMARY OF MONTANA CEO'S COMPENSATION AND A GUIDESTAR CEO COMPENSATION CHECKPOINT THAT IS PREPARED SPECIFICALLY FOR NMH. THEY AGREE UPON A LIST OF THE COMING YEAR'S PRIORITIES FOR THE CEO AND PROPOSED COMPENSATION, WITH THE COMPENSATION SET BY BOARD VOTE. THIS ANNUAL PROCESS WAS COMPLETED DURING 2011. FORM 990, PART VI, SECTION C, LINE 19 FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 209,239. CHANGE IN NET ASSETS NOT INCLUDED FOR TAX RETURN IN PRIOR YEAR: 527. NET TRANSFERS WITH RELATED ORGANIZATIONS: 392,853. TOTAL TO FORM 990, PART XI, LINE 5: 602,619. ORGANIZATIONS: FORM 990, PART VII, SECTION A, PERCENTAGE OF TIME SPENT BETWEEN RELATED NO INDIVIDUALS ARE COMPENSATED FOR THEIR BOARD SERVICE TO EITHER ORGANIZATION, ONLY FOR THEIR SERVICE AS EMPLOYEES OF THE HOSPITAL. THE FOLLOWING INDIVIDUALS SPEND 2% OF THEIR TIME ON NMHC BUSINESS AND 98% OF THEIR TIME ON NMH BUSINESS: -VICE PRESIDENT OF NMHC ALSO SERVES AS THE VP OF NMH. -THE VICE CHAIR OF NMHC ALSO SERVES AS THE VICE CHAIR AND AN EMPLOYED PHYSICIAN OF NMH. -THREE TRUSTEES OF NMHC ALSO SERVE AS TRUSTEES AND EMPLOYED PHYSICIANS (INCLUDING THE MEDICAL DIRECTOR AND CHIEF OF STAFF) OF NMH. THE FOLLOWING INDIVIDUALS SPEND 2% OF THEIR TIME ON NMHC BUSINESS AND 2% OF THEIR TIME ON NMHCF BUSINESS AND 96% OF THEIR TIME ON NMH BUSINESS: -CEO/PRESIDENT OF NMHC ALSO SERVES AS THE CEO/PRESIDENT OF NMH AND NMHCF. -VP OF FINANCE OF NMHC ALSO SERVES AS THE VP OF FINANCE OF NMH AND NMHCF. THE REMAINING MEMBERS OF THE BOARD OF TRUSTEES SPEND 50% OF THEIR TIME ON NMHC BUSINESS AND 50% OF THEIR TIME ON NMH BUSINESS. NONE OF THEM ARE EMPLOYED BY EITHER ORGANIZATION. PARAMOUNT HEALTH CARE INC PO BOX 1231 HAVRE MT 59501 810393353 PROVISION OF HEALTH SERVICES MT 0 0 N/A NORTHERN MONTANA HOSPITAL PO BOX 1231 HAVRE MT 59501 810231787 HEALTH CARE SERVICES MT 501(C)(3) LINE 3 NORTHERN MONTANA HEALTH CARE INC 1 NORTHERN MONTANA HEALTH CARE FOUNDATION INC PO BOX 1231 HAVRE MT 59501 363464641 SUPPORTING ORGANIZATION MT 501(C)(3) LINE 7 NORTHERN MONTANA HEALTH CARE INC 1 NORTH CARE CORPORATION 30 13TH STREET HAVRE MT 59501 810447638 SUPPORTING ORGANIZATION MT 501(C)(3) LINE 3 NORTHERN MONTANA HEALTH CARE INC 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 1 1 NORTHERN MONTANA HOSPITAL I 867360 FMV NORTHERN MONTANA HOSPITAL L 278460 COST NORTHERN MONTANA HOSPITAL N 81850 COST NORTHERN MONTANA HOSPITAL Q 1693869 COST NORTHERN MONTANA HEALTH CARE FOUNDATION INC Q 107147 COST NORTHERN MONTANA HOSPITAL R 500000 COST NORTH CARE CORPORATION