2011-02-14T17:30:46-06:00 2010-03-31 JORDAHL & SLITER PLLC PO BOX 8600 KALISPELL MT 599041600 990 2009-04-01 237293874 KALISPELL REGIONAL MEDICAL CENTER KALI 4067525111 310 SUNNYVIEW LANE KALISPELL MT 59901 CHARLES PEARCE 4067521724 2011-02-12 1 JUSTIN P SLITER 4067521040 2011-02-12 2009 2016-02-24 21:20:13Z CHARLES PEARCE 310 SUNNYVIEW LANe Kalispell MT 59901 175727598 0 X WWW.NWHC.ORG/KRMC X 1973 MT PROVIDE ACUTE HOSPITAL CARE 15 7 1641 146 0 0 1349472 1160279 154473194 170185380 818760 1154809 2123495 2067569 158764921 174568037 0 0 72704478 81151708 0 0 77422752 82931200 150127230 164082908 8637691 10485129 142239708 155492366 54391508 53296854 87848200 102195512 Provide Acute Hospital Care 0 0 145576976 170185380 OPERATION OF REGIONAL ACUTE CARE HOSPITAL. 145576976 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 1 186 0 1641 0 0 0 0 0 0 0 0 15 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X CHARLES PEARCE 4067521724 310 SUNNYVIEW LANE KALISPELL MT 59901 Charles grenier 1.00 X 1200 0 0 Wilson Higgs MD 1.00 X 1918 0 0 Jon Johnson MD 1.00 X 275128 0 14770 Gwen Jonas MD 1.00 X 61430 0 0 Jane Karas 1.00 X 2374 0 0 Peter L Larson 1.00 X 1300 0 0 Jeannie Luckey 1.00 X 1300 0 0 Tom McElwain 1.00 X 2257 0 0 Dave Meredith 1.00 X 2230 0 0 Andrew Palchak MD 1.00 X 1300 0 0 Cal Sweet 1.00 X 2130 0 0 Muffie Thomas 1.00 X 1818 0 0 David Walker MD 1.00 X 2400 0 0 William Benedetto MD 1.00 X 2400 0 0 Carl Tinlin MD 1.00 X 2500 0 0 Velinda Stevens 17.50 X X 0 542191 29454 Charles Pearce 35.00 X 0 343092 22907 Frances Laukaitis 50.00 X 325001 0 21478 Karen Lee 40.00 X 249304 0 35285 Deb Wilson 40.00 X 121702 36884 19460 Patricia Wilson 50.00 X 180488 0 39736 Tate Kreitinger 30.00 X 326355 0 25351 Richard Palagi 5.00 X 298896 0 42605 Alan Williams MD 50.00 X 620762 0 3084 David Roth MD 50.00 X 536008 0 14770 Tim Obermiller MD 50.00 X 440125 0 16998 Eve Gillespie MD 50.00 X 415437 0 14770 Brent Pistorese MD 50.00 X 383294 0 16998 4259057 922167 317666 62 0 1 0 SilvERTIP EMERGENCY PHYSICIANS 310 SUNNYVIEW LANE KALISPELL MT 59901 EMERGENCY ROOM PHYSICIANS 3573603 Swank Enterprises PO Box 10007 KALISPELL MT 59901 Construction 2304520 Fulbright & Jaworski 2200 Ross Avenue Suite 2800 Dallas TX 75201 Legal Services 1177052 Glacier REgional Pathology 495 N main Street KalispelL MT 59901 Pathology Services 724361 Northwest Imaging PC PO Box 9110 Kalispell MT 59901 Imaging Services 574214 24 1092568 67711 1160279 MEDICAL SERVICE REVENU 621990 165537072 165537072 Partnership Income 621990 2900866 2900866 OTHER OPERATING INCOME 900099 1591521 1591521 MGMT CONTRACT SERVICES 900099 86980 86980 EDUCATION INCOME 621990 63685 63685 5256 5256 170185380 1431098 1431098 203995 203995 203995 203995 870718 12554 1115326 44235 -244608 -31681 -276289 -276289 CAFETERIA 722210 1145888 1145888 chilD CARE 624410 541499 541499 misc. revenue 900099 176187 176187 1863574 174568037 170185380 0 3222378 1738329 54250 1684079 62042783 55362884 6679899 2373934 2249304 124630 10652888 9373975 1278913 4343774 3790994 552780 879206 879206 72774 72774 9414709 7757024 1657685 914877 461090 453787 1698638 976998 721640 7585319 6784545 800774 953459 554483 398976 1133643 1133643 8497586 7422800 1074786 1929067 1929067 SUPPLIES 25164213 24653080 511133 Bad debts 14619524 14619524 Purchased Services 7225595 6723261 502334 Other Expenses 2842590 1730054 1112536 164082908 145576976 18505932 0 8152088 12110394 32112813 42636597 20340637 21894648 2641624 3566405 3383574 3919464 2146827 1305042 138319079 80972755 60812593 57346324 5040941 5364999 519307 425390 7089304 6923103 142239708 155492366 25547939 28720233 21099028 18282477 3695033 2232584 4049508 4061560 54391508 53296854 X 86415288 100715058 182300 37144 1250612 1443310 87848200 102195512 142239708 155492366 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 13723 1 42637 0 0 56360 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: 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. 1250610 53165 176679 1480454 1225468 224116 -198974 1250610 0.97490 0.02510 0 1 1 282845 282845 93919973 49817877 44102096 44115309 31154878 12960431 952 952 57346324 PAYABLE TO CONTRACTUAL AGENCIES 2470710 ACCOUNTS PAYABLE TO AFFILIATES 986829 Leases Payable 604021 4061560 174568037 164082908 10485129 9338950 -5291377 4047573 14532702 182927865 9338950 113446 9452396 173475469 1092568 1092568 174568037 164082908 0 164082908 0 164082908 Part V, Line 4: Description of Intended Use of Endowment Funds: 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. Part X: Description of Uncertain Tax Positions Under FIN 48: 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 Affiliate Part XII, Line 2d - Other Adjustments: FASB FAS 136 INVESTMENT IN NET ASSETS OF FOUNDATION: 113446. Part XII, Line 4b - Other Adjustments: Support from Affiliated Foundation: 1092568. 1 1 1 X 1 X 1 1 1 0 1 1 3294444 3294444 0.02200 17530439 13523511 4006928 0.02680 20824883 13523511 7301372 0.04880 131371 0 131371 0.00090 249884 0 249884 0.00170 22415228 15224622 7190606 0.04810 6856 0 6856 0.00000 22803339 15224622 7578717 0.05070 43628222 28748133 14880089 0.09950 9893 0 9893 0.00010 55734 0 55734 0.00040 10076 0 10076 0.00010 1140 0 1140 0.00000 76843 76843 0.00060 1 7307587 1348250 50260964 72125371 -21864407 X 1 0 MRI - CT Imaging 0.51000 0.00007 0.18910 Kalispell Regional Medical Center

310 Sunnyview Lane Kalispell MT 59901

X X X Part I, Line 7: Cost Accounting was utilized for the entire table. Cost Accounting covers all patient segments. Part I, Line 7f: 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 $14,619,524. 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. 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 5: 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. In addition, KRMC provides leadership training to volunteers to serve the community in various leadership roles. Part VI, Line 6: This was answered by Question 2 information. X X X 1 1 X X X X X 0 1 0 0 0 0 0 1 0 Jon Johnson MD 124392 0 0 0 150736 0 3000 0 11770 0 289898 0 0 0 Velinda Stevens 0 414670 0 84271 0 43250 0 14700 0 14754 0 571645 0 0 Charles Pearce 0 257651 0 53539 0 31902 0 8272 0 14635 0 365999 0 0 Frances Laukaitis 241232 0 50003 0 33766 0 7354 0 14124 0 346479 0 0 0 Karen Lee 204467 0 41252 0 3585 0 28643 0 6642 0 284589 0 0 0 Deb Wilson 100042 36884 17626 0 4034 0 7315 0 12145 0 141162 36884 0 0 Patricia Wilson 146559 0 31252 0 2677 0 25400 0 14336 0 220224 0 0 0 Tate Kreitinger 180349 0 42203 0 103803 0 10869 0 14482 0 351706 0 0 0 Richard Palagi 232822 0 52504 0 13570 0 30212 0 12393 0 341501 0 0 0 Alan Williams MD 507562 0 0 0 113200 0 3000 0 84 0 623846 0 0 0 David Roth MD 445008 0 0 0 91000 0 3000 0 11770 0 550778 0 0 0 Tim Obermiller MD 299322 0 0 0 140803 0 3000 0 13998 0 457123 0 0 0 Eve Gillespie MD 267937 0 15000 0 132500 0 3000 0 11770 0 430207 0 0 0 Brent Pistorese MD 223174 0 0 0 160120 0 3000 0 13998 0 400292 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 2009. This amount is grossed-up to take care of the applicable taxes. The members include: President, CFO, CEO, COO, 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 1b Part I, Line 4a Members of the Administrative Team receive a 457 Plan Contribution of $16,500 for 2009. The members include: President, CFO, CEO, COO, 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: one of which is the financial health and stability of the organization. Gwen Palchak Wife of Current Trustee 67174 salary 0 Glacier Regional Pathology Dr. Walker, a current trustee, is the President and 1/3 owner of GRP. 686991 pathology & lab services 0 Rocky Mountain Sub-Specialty Assoc Dr. Johnson, a current trustee, is a greater than 5% partner. 438966 rent and Janitorial service 0 Northwest Imaging Inc Dr. Benedetto, a current trustee, is a greater than 5% owner. 763618 Radiology services 0 Northern Rockies Anesthesia Consultants Dr. Tinlin, a current trustee, is a greater than 5% owner. 546737 Anesthesia Services 0 Michael Laukaitis Spouse of current officer 35881 salary 0 Form 990, Part VI, Section B, line 11 The Form 990 is mailed to all board members with the January 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 market information provided to determine recommendations for other senior executives and engages in a rigorous 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. Form 990, Part VII, section A, Column (B) Average Hours Per Week 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 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 60% of his time to Kalispell Regional Medical Center and 40% 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) 3 N/A Northwest Healthcare Foundation Inc 310 Sunnyview Lane kalispell MT 59901 311703013 Supporting Organization MT 501(c)(3) II, Type I Northwest Healthcare Corporation Northwest Horizons Inc 310 Sunnyview Lane Kalispell MT 59901 810420653 Operate Long Term Ambulatory Facility MT 501(c)(3) 3 Northwest Healthcare Corporation The Summit Medical Fitness Center 310 Sunnyview Lane Kalispell MT 59901 203752312 Community Health & Wellness Center MT 501(c)(3) 9 Northwest Healthcare Corporation MriCT Joint Operating Agreement 310 Sunnyview Lane Kalispell MT 59901 205010390 Diagnostic Screening MT Kalispell Regional Medical Center Related 3359823 7227033 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 1 0 1 0 0 0 1 1 1 1 1 1 1 1 1 1 Flathead Hospital Development Company LLC A 28763 HealthCenter Northwest LLC A 150000 Applied Health Services Inc A 16301 Northwest Healthcare Corporation A 27804 Northwest horizon inc A 16338 Northwest Healthcare Corporation B 5291377 Healthcenter Northwest LLC J 483582 Applied Health Services Inc J 373845 Northwest healthcare Corporation J 686914 The Summit Medical Fitness center Inc J 240929 Healthcenter Northwest LLC K 525145 Applied Health Services Inc K 188042 Northwest Horizon inc K 126559 HealthCenter Northwest LLC L 3928597 Applied Health Services Inc L 1357901 Northwest orthopedic & Sports Medicine LLC L 182500 The Summit Medical Fitness center Inc L 341711