TY 2012 Form 990 Schedule O

efile Public Visual Render ObjectId: 201441359349304094 - Submission: 2014-05-15 TIN: 81-6016016

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2012

Open to Public
Inspection

Name of the organization

Glendive Medical Center

Employer identification number

81-6016016

Identifier	Return Reference	Explanation
Changes in Program Services	Form 990, Part III, line 3	Effective January 1, 2013, the Nuclear Medicine department was closed due to the decision not to purchase the needed equipment at this time in order to provide the quality of procedures performed for this department.
	Form 990, Part VI, Section A, line 1	The Executive Committee is comprised of the Board President, Vice-President, Secretary, Treasurer and the immediate Past Chair. The Executive Committee will, in the interim between meetings of the Board of Directors, exercise the powers of that body necessary for efficient operation of the Hospital in accordance with the general policy of the Hospital and the Board of Directors. The committee shall be empowered to act in only those areas of responsibility as the Board of Directors authorizes. It shall not have the power to amend the bylaws nor adopt or amend the Hospital's annual budget or long range plan and with the understanding that all matters of major importance will be referred to the governing board.
	Form 990, Part VI, Section B, line 11	A copy of the 990 was reviewed by the CFO and distributed to the Board prior to filing with the IRS.
	Form 990, Part VI, Section B, line 12c	Any director, officer, key employee or committee member having an interest in a contract or other transaction presented to the Board of Directors or a committee thereof for authorization, approval or ratification shall make a prompt, full and frank disclosure of his interest to the board or committee prior to its acting on such contract or transaction. The body to which such disclosure is made shall thereupon determine, by majority vote, whether the disclosure shows that a conflict of interest exists or can reasonably be construed to exist. If a conflict is deemed to exist, such person shall not vote on, nor use his personal influence on, nor participate in the discussions or deliberations with respect to, such contract or transaction. Such person may be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted up. The minutes of the meeting shall reflect the disclosure made, the vote thereon and where applicable, the abstention from voting and participation, and whether a quorum was present. A statement from directors and officers and key members of the medical staff is completed and signed annually. Conflict of Interest is normally handled at the executive or board level. In the majority of the cases, no vote is necessary since the Board member or GMC staff voluntarily excuses themselves. But, the Board Chair and the CEO monitors proposed or ongoing transactions of the organization for conflicts of interest and discloses them to the Board and staff, as appropriate.
	Form 990, Part VI, Section B, line 15a	Compensation for all positions is reviewed annually utilizing the MHA survey and other information such as the 990 and MGMA information during the budget process. This includes all officers and key personnel. The CEO compensation is reviewed biannually prior to the contract renewal. This is normally done by the Executive Committee utilizing various market surveys. The last review was in May - July, 2012. For the 2012 review, the Board appointed board members to a compensation committee. They utilized area market surveys and Form 990 information to complete their review of the CEO and the other four members of the leadership team. This information was used for reviewing the compensation adjustment for the CEO for the 2012-13 contract based on the 2011-2012 contract requirements and the wage adjustments for the other leadership members for budget year 2012-13. The CFO compensation is reviewed and approved by the CEO.
	Form 990, Part VI, Section C, line 19	Governing documents, conflict of interest policy and financial statements are kept at the Hospital and are available upon request. The annual Community Benefit report includes a consolidated financial statement for Glendive Medical Center and its Affiliates and is mailed to all service area households. It is also posted on the Hospital website.
Changes in Net Assets or Fund Balances:	Form 990, Part XI, line 9:	Book/Tax Difference - HealthNet, LLC 952.

Identifier

Return Reference

Explanation

Changes in Program Services

Form 990, Part III, line 3

Effective January 1, 2013, the Nuclear Medicine department was closed due to the decision not to purchase the needed equipment at this time in order to provide the quality of procedures performed for this department.

Form 990, Part VI, Section A, line 1

The Executive Committee is comprised of the Board President, Vice-President, Secretary, Treasurer and the immediate Past Chair. The Executive Committee will, in the interim between meetings of the Board of Directors, exercise the powers of that body necessary for efficient operation of the Hospital in accordance with the general policy of the Hospital and the Board of Directors. The committee shall be empowered to act in only those areas of responsibility as the Board of Directors authorizes. It shall not have the power to amend the bylaws nor adopt or amend the Hospital's annual budget or long range plan and with the understanding that all matters of major importance will be referred to the governing board.

Form 990, Part VI, Section B, line 11

A copy of the 990 was reviewed by the CFO and distributed to the Board prior to filing with the IRS.

Form 990, Part VI, Section B, line 12c

Any director, officer, key employee or committee member having an interest in a contract or other transaction presented to the Board of Directors or a committee thereof for authorization, approval or ratification shall make a prompt, full and frank disclosure of his interest to the board or committee prior to its acting on such contract or transaction. The body to which such disclosure is made shall thereupon determine, by majority vote, whether the disclosure shows that a conflict of interest exists or can reasonably be construed to exist. If a conflict is deemed to exist, such person shall not vote on, nor use his personal influence on, nor participate in the discussions or deliberations with respect to, such contract or transaction. Such person may be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted up. The minutes of the meeting shall reflect the disclosure made, the vote thereon and where applicable, the abstention from voting and participation, and whether a quorum was present. A statement from directors and officers and key members of the medical staff is completed and signed annually. Conflict of Interest is normally handled at the executive or board level. In the majority of the cases, no vote is necessary since the Board member or GMC staff voluntarily excuses themselves. But, the Board Chair and the CEO monitors proposed or ongoing transactions of the organization for conflicts of interest and discloses them to the Board and staff, as appropriate.

Form 990, Part VI, Section B, line 15a

Compensation for all positions is reviewed annually utilizing the MHA survey and other information such as the 990 and MGMA information during the budget process. This includes all officers and key personnel. The CEO compensation is reviewed biannually prior to the contract renewal. This is normally done by the Executive Committee utilizing various market surveys. The last review was in May - July, 2012. For the 2012 review, the Board appointed board members to a compensation committee. They utilized area market surveys and Form 990 information to complete their review of the CEO and the other four members of the leadership team. This information was used for reviewing the compensation adjustment for the CEO for the 2012-13 contract based on the 2011-2012 contract requirements and the wage adjustments for the other leadership members for budget year 2012-13. The CFO compensation is reviewed and approved by the CEO.

Form 990, Part VI, Section C, line 19

Governing documents, conflict of interest policy and financial statements are kept at the Hospital and are available upon request. The annual Community Benefit report includes a consolidated financial statement for Glendive Medical Center and its Affiliates and is mailed to all service area households. It is also posted on the Hospital website.

Changes in Net Assets or Fund Balances:

Form 990, Part XI, line 9:

Book/Tax Difference - HealthNet, LLC 952.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2012

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