2011-05-16T09:45:19-05:00 2010-06-30 EIDE BAILLY LLP 401N 31ST ST SUITE 1120 PO BOX 7112 BILLINGS MT 591037112 990 2009-07-01 810428854 Northern Montana Health Care Inc NORT 4062652211 PO Box 1231 Havre MT 59501 David Henry 4062652211 2011-05-13 1 Steve Markovich 4068962400 2009 2016-02-24 21:20:13Z David Henry PO Box 1231 Havre MT 59501 3948656 0 X www.nmhcare.org X 1985 MT Provision of Healthcare Services 11 5 0 150 0 0 508325 8576 58580 3074563 140802 80758 0 707707 3163897 2500 0 0 0 0 0 1833185 1762365 1835685 1762365 -1127978 1401532 60498953 61580656 11058147 10118731 49440806 51461925 To deliver high quality comprehensive health care services to the hi-line communities. 0 0 1426104 3480070 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 directions 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. 1426104 1 1 0 0 0 0 0 0 0 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 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 11 5 0 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 X DAVID C HENRY 1.00 X X 0 354000 0 ALAN PEARSON 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 323253 14671 Paul Tuss 1.00 X 0 0 0 MIKE INMAN 1.00 X 0 0 0 DAVID LEEDS 1.00 X 0 0 0 TOM PATRICK 1.00 X 0 0 0 SUZANNE SWIETNICKI MD 1.00 X 0 244919 19755 Michael Nolan MD 1.00 X 0 259844 3748 JOSEPH P MARINO DPM 1.00 X 0 170808 16908 KAREN POLLINGTON 1.00 X 0 87786 16960 KIM LUCKE 1.00 X 0 69499 12838 0 1510109 84880 0 0 1 0 NORTHERN MONTANA HOSPITAL PO BOX 1231 HAVRE MT 59501 CONTRACT LABOR 278460 1 8576 8576 Income from affiliates 900099 1799173 1799173 Rental income from exe 532000 1275390 1275390 3074563 133138 133138 732379 784759 -52380 -52380 -52380 3163897 3074563 0 80758 278460 208845 69615 11319 11319 76503 57377 19126 3272 2454 818 7421 1606 5815 129043 72759 56284 1530 1206 324 489381 489381 683546 551150 132396 34112 15646 18466 Miscellaneous 30120 14593 15527 Pest control and mainte 11582 6530 5052 Bank charges 6076 4557 1519 1762365 1426104 336261 0 2559222 592864 545621 76410 25089 24280 18560523 7516214 11311924 11044309 4319881 6460431 41455963 43137471 281253 244891 60498953 61580656 521121 580778 8390079 7676351 2146947 1861602 11058147 10118731 X 49440806 51461925 49440806 51461925 60498953 61580656 X 0 1 1 X 0 X X X 0 0 0 Northern Montana Hospital 810231787 3 1 1 1 867360 North Care Corporation 810447638 3 1 1 1 0 Northern Montana Health Care Foundation Inc 363464641 7 0 1 1 94493 3 961853 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 100000 100000 17513559 7241065 10272494 129528 123642 5886 817436 151507 665929 11044309 Investment in Mutual Benefit Corporation 2250000 C Investment in affiliates 40887471 F 43137471 3163897 1762365 1401532 214607 404980 619587 2021119 3784011 214607 405507 620114 3163897 0 3163897 1762365 0 1762365 0 1762365 Part X: Description of Uncertain Tax Positions Under FIN 48: 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, 2010 and 2009, the unrecognized tax benefit accrual is zero. Part XI, Line 8 - Other Adjustments: Change in net assets not included for tax return in prior year: -527. Net Transfers with related organizations: 405507. Part XII, Line 2d - Other Adjustments: Net Transfers with related organizations netted with revenue for f/s: 405507. 0 0 0 0 0 0 0 0 0 DAVID C HENRY 0 273000 0 81000 0 0 0 0 0 0 0 354000 0 0 Bruce Richardson MD 0 322065 0 0 0 1188 0 0 0 17564 0 340817 0 0 SUZANNE SWIETNICKI MD 0 244505 0 0 0 414 0 0 0 22000 0 266919 0 0 Michael Nolan MD 0 258656 0 0 0 1188 0 0 0 6042 0 265886 0 0 JOSEPH P MARINO DPM 0 170359 0 0 0 449 0 0 0 18477 0 189285 0 0 Part I, Line 5 Four physicians listed in Part VII of the Form 990 are 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 Refinance outstanding bonds 0 0 City of Havre Montana 816001274 NoneAvail 2007-11-30 3186968 Fund new medical building 0 0 6843295 667000 136846 2006 1 0 1 1 3186968 181838 61968 2943162 2008 0 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 1 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 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, 2010. 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 officer, 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 organization does not compensate board members for their board service and does not have any paid employees. 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 2010. 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. Form 990, Schedule R, Part V, Line 2 Method for Determining Value of Transactions Between Related Entities: The method used by Northern Montana Health Care, Inc. for determining the value of transactions being reported between related entities is either the FMV of the property or actual cost. Form 990, Part VII, Section A Percentage of time spent between related organizations 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 -575 N/A Northern Montana Hospital PO Box 1231 Havre MT 59501 810231787 Health Care Services MT 501(c)(3) Line 3 N/A Northern Montana Health Care Foundation Inc pO Box 1231 havre MT 59501 363464641 Supporting Organization MT 501(c)(3) Line 7 N/A North Care Corporation 30 13th Street Havre MT 59501 810447638 Supporting Organization MT 501(c)(3) Line 3 N/A 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 1 0 Northern Montana Hospital I 867360 Northern Montana Hospital L 278460 Northern Montana Hospital N 76503 Northern Montana Hospital Q 2223721 Northern Montana Health Care Foundation Inc Q 94493 Northern Montana Hospital R 500000