2011-01-11T13:28:49-06:00 2010-05-31 Galusha Higgins and Galusha PO Box 1699 Helena MT 596241699 990 2009-06-01 810231789 MONTANA CHILDREN'S HOME & HOSPITAL INC MONT 4064447500 PO BOX 5539 HELENA MT 59604 John P Casey 4064447500 2011-01-10 1 Nathan D McCarthy CPA 4064425520 2011-01-09 2009 2016-02-24 21:20:13Z John P Casey PO BOX 5539 HELENA MT 59604 22618460 0 X WWW.SHODAIRHOSPITAL.ORG X 1942 MT PSYCHIATRIC, GENETIC AND OTHER SERVICES FOR CHILDREN IN A HOSPITAL SETTING AT COST, BELOW COST, OR NO CHARGE. 9 9 320 0 0 0 2188700 2410822 16114677 20163508 31671 30309 13086 13821 18348134 22618460 0 0 11683705 12249016 0 0 5306757 5997845 16990462 18246861 1357672 4371599 18500604 21004238 11670186 9796123 6830418 11208115 Shodair Children's Hospital is a non-profit, Montana corporation whose purposes shall be:To establish and maintain a hospital and other appropriate facilities for care and treatment of children suffering from illnesses, diseases, defects and other physical, mental, and emotional abnormalities which impair the health and well-being of children which may be justified by the facility's personnel, functions, or other requirements that are or can be made available. To promote and carry on scientific research related to the care of the sick and injured. To participate so far as circumstances may warrant in any activity designated and carried on to promote the general health of the community. 0 0 4084653 9273870 The Acute Care Unit accommodates up to 20 children from ages 3 to 18. The Acute Psychiatric Inpatient program was designated in 2008 as a model program for Collaborative Problem Solving. The program offers intensive services for emotionally and behaviorally impaired children and their families who are in crisis. At Shodair, children and families interact with a team of specialists, including nurses, doctors, therapists, and teachers. 7372635 9774441 Shodair Children's Hospital provides three developmentally specific residential treatment programs for children of all ages. Each program provides a safe, therapeutic, and nurturing environment to promote positive change.The children's residential program is a Model Program for Collaborative Problem Solving and provides developmentally appropriate residential psychiatric care for up to 20 children (ages 4 to 9). The 20 bed middle school residential program provides psychiatric treatment for middle school-aged youth (ages 10 to 13) The adolescent unit (ages 14 to 18) has a capacity to provide care for up to 24 adolescents. 2374764 1102302 The mission of Shodair Children's Hospital's Department of Medical Genetics is to provide excellence in meeting genetic needs of Montanans through diagnosis, consultation, and support for families, outreach, scholarship, and education. This program is medically oriented and offers a broad range of services to individuals and families with birth defects, genetic and hereditary conditions with or without mental retardation. Services include patient evaluations, genetic counseling, and education. Service may be for diagnosis, prognosis, natural history, recurrence risk information, psychological support, prenatal diagnosis, fetal death evaluation, molecular genetic and other special testing or for a variety of other reasons. An important part of the service mandate is to educate lay and professional Montanans about genetics and genetic conditions so they are aware of what services may benefit them. The program is divided into two primary service units: clinical and laboratory. An administrative director is responsible for management of program functions. 13832052 1 1 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 63 0 1 320 1 0 0 0 0 0 0 0 0 0 0 0 9 9 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 MT X X John P Casey 4064447500 2755 COLONIAL DRIVE Helena MT 59601 REd MENAHAN X X 0 0 0 BOB LEMM X X 0 0 0 Virginia Thompson X X 0 0 0 Cynthia Melton X X 0 0 0 Rita Gowen X X 0 0 0 Joe Shevlin X 0 0 0 ED TINSLEY X 0 0 0 MOE WOSEPKA X 0 0 0 David Lemm X 0 0 0 John JACK CASEY 40.00 X 261654 0 44433 Ron Wiens 40.00 X 98360 0 24997 KEITH FOSTER 40.00 X 220636 0 32558 Celeste SINTON 40.00 X 201205 0 19465 Heather Zaluski 40.00 X 179026 0 34679 kATHERINE rAPPAPORT 40.00 X 191420 0 22840 JOHN JOHNSON 40.00 X 195704 0 41209 1348005 0 220181 6 0 1 0 St Peter's Hospital 2475 Broadway Street Helena MT 59601 Medical Services 133931 1 1652038 758784 2410822 Residential treatment 623990 9720025 9720025 Acute Services 623990 9206606 9206606 Genetics Services 621500 1068564 1068564 CAFETERIA SALES 623990 26716 26716 141597 141597 20163508 30309 30309 13821 13821 13821 13821 22618460 20150613 0 57025 10182934 8149761 2033173 415213 339236 75977 611676 433839 177837 1039193 826766 212427 28900 28900 25847 2049 23798 395496 269510 125986 133825 27268 106557 406582 79954 326628 142053 110357 31696 10048 10048 390492 390492 730612 631737 98875 418690 383252 35438 MEDICAID UTILIZATION FE 733152 733152 Supplies - Other 395918 395918 General Services Suppli 293201 293201 MEDICAID UTILIZATION FE 291072 291072 BAD DEBTS 287055 287055 1314902 871126 443776 18246861 13832052 4414809 0 2634195 3676745 1161773 1138361 3965972 4675967 199518 224141 255033 198115 17161753 6751476 9784102 10410277 177405 119076 322606 561556 18500604 21004238 2095963 2562882 5000 3000 8065000 7225000 1504223 5241 11670186 9796123 X 6764418 11162615 66000 45500 6830418 11208115 18500604 21004238 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1707003 1707003 12432502 4433719 7998783 3022248 2317757 704491 10410277 Due to Montana Children's Foundation 5241 5241 22618460 18246861 4371599 6098 6098 4377697 22615086 0 22615086 3374 3374 22618460 18237389 -9472 -9472 18246861 0 18246861 Part XI, Line 8 - Other Adjustments: Adjustment due to gain on sale of assets: 6098. Part XII, Line 4b - Other Adjustments: Other Revenue: 3374. Part XIII, Line 2d - Other Adjustments: Other Revenue: -3374. Gain on Sale of asset: -6098. 1 0 0 1 0 0 0 THE PART 4 QUESTIONS ANSWERED NO ARE NOT APPLICABLE TO THIS ORGANIZATION. 0 0 0 0 0 0 0 0 1 0 THE ORGANIZATION RECEIVED ASSISTANCE FROM THE OFFICE OF PUBLIC INSTRUCTION. 1 1 1 1 X 1 X 1 0 0 0 90077 0 90077 0.00500 9359783 11762725 -2402942 0.00000 9449860 11762725 -2312865 0.00500 5762 5762 0.00030 47518 47518 0.00260 14756 14756 0.00080 68036 68036 0.00370 9517896 11762725 -2244829 0.00870 1 207270 145089 23115 23146 -31 X 1 1 Shodair Children's Hospital

PO BOX 5539 HELENA MT 59604

X X Part I, Line 7: The Hospital uses the cost to charge ratio method. Part I, Line 7f: Administrative write-off is one that is granted at the sole disgression of the COO for reasons that do not fit any of the other designations, but are granted in the best interests of Shodair Children's Hospital. A bad debt is business when accepted; the expectation was that the full account or the patient's portion of the account, co-insurance and or deductible would have been paid in full. However, over time, collectibility of the account or the patient's portion has proven to be uncollectible according to the policy. Any write down of an accounts receivable must be documented properly and have the approval of the CFO. Part III, Line 4: Accounts receivable are stated at unpaid balances, less an allowance for doubtful accounts. The Hospital provides for losses on accounts receivable using the allowance method. The allowance is based on experience, third-party contracts, and other circumstances, which may affect the ability of patients to meet their obligations. Receivables are considered impaired if full principal payments are not received in accordance with the contractual terms. It is the Hospital's policy to charge off uncollectible accounts receivable when management determines the receivable will not be collected. The Hospital uses a cost to charge ratio. Part III, Line 8: Part III, Line 9b: For the accounts receivable policy, see supplemental information provided for PART III, Line 4. Additional information: Charity Discount is approved and granted prior to a patient being admitted to Shodair Children's Hospital. The Charity Discount may be for the entire account or a portion of an insured account where the payment of the co-pay insurance and or deductible would create a financial hardship for the family or the child or adolescent patient. The granting of a Charity Discount is dependent on application and meeting the income test of the Charity Discount policy as established. Part VI, Line 2: Shodair Children's Hospital is located in Helena, Montana. Its facility totals 90,000 square feet and includes the residential and acute psychiatric treatment centers for children and adolescents, the medical genetics program, administrative offices, and the marketing/community relations and foundation offices. Shodair Children's Hospital is the only facility in the state of Montana to offer both acute and residential treatment services for children and adolescents. Shodair Children's Hospital provides three developmentally specific residential treatment programs for children of all ages. Each program provides a safe, therapeutic, and nurturing environment to promote positive change. The School at Shodair is accredited by the Northwest Association of Accredited Schools and is scheduled year-round. This allows students an opportunity to work in academic areas as needed or to make up missed credits. The mission of Shodair Children's Hospital's Department of Medical Genetics is to provide excellence in meeting genetic needs of Montanans through diagnosis, consultation, and support for families, outreach, scholarship, and education. Part VI, Line 3: Financial Assistance will be provided to the Hospital's patients who meet specified financial critera and request such assistance. Part VI, Line 4: Shodair Children's Hospital began its operations in Helena, Montana. The Hospital serves patients from across the country, as it provides specialized services. Part VI, Line 5: Community Building Activities - NA X X 1 1 X X X X 0 0 0 0 0 0 0 0 0 John JACK CASEY 261654 0 0 0 0 0 14651 0 29782 0 306087 0 296887 0 KEITH FOSTER 220636 0 0 0 0 0 13091 0 19467 0 253194 0 253557 0 Celeste SINTON 201205 0 0 0 0 0 12031 0 7434 0 220670 0 223190 0 Heather Zaluski 179026 0 0 0 0 0 11049 0 23630 0 213705 0 0 0 kATHERINE rAPPAPORT 191420 0 0 0 0 0 11444 0 11396 0 214260 0 226100 0 JOHN JOHNSON 195704 0 0 0 0 0 11682 0 29527 0 236913 0 203454 0 US Bank National Association 2005-04-01 9720000 To finance costs of improvements to the Hospital. 0 0 9524336 805033 6018470 75833 2625000 2006 0 0 1 1 Form 990, Part VI, Section A, line 2 Bob Lemm, 1st Vice Chair, is the father of David Lemm, Trustee Form 990, Part VI, Section B, line 11 A DRAFT OF THE FORM 990 IS PRESENTED TO THE BOARD FOR REVIEW AND APPROVAL BEFORE IT IS FILED. Form 990, Part VI, Section B, line 12c BOARD MEMBERS SIGN A CONFLICT OF INTEREST POLICY ANNUALLY. THE HOSPITAL ATTORNEY ATTENDS EACH BOARD MEETING AND MONITORS ADHERENCE TO THE POLICY. Form 990, Part VI, Section B, line 15 DUE TO THE NATURE OF THE SPECIALTY OF THIS HOSPITAL, A COMPANY SPECIALIZING IN COMPENSATION PACKAGES IS CONTRACTED TO REVIEW THE ADMINISTRATOR'S COMPENSATION. OTHER KEY EMPLOYEES COMPENSATION IS DETERMINED UTILIZING THE MONTANA HOSPITAL ASSOCIATION'S ANNUAL COMPENSATION SURVEY. IF THE SPECIALTY HAS A LIMITED NUMBER OF PROFESSIONALS IN MONTANA THE REGIONAL OR NATIONAL COMPENSATION DATA IS UTILIZED. Form 990, Part VI, Section C, line 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. THERE HAS BEEN NO CHANGE FROM THE PRIOR YEAR IN THE OVERSIGHT OF THE AUDIT OR THE SELECTION OF AN INDEPENDENT ACCOUNTANT. MONTANA CHILDREN'S FOUNDATION PO BOX 5539 HELENA MT 59604 810365625 TO PROMOTE AND FURTHER OPERATIONS OF MONTANA CHILDRENS HOME AND HOSPITAL MT 501(C)(3) 509(A)(3) 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0