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 990-EZ or to provide any additional information.
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OMB No. 1545-0047
2017
Open to Public
Inspection
Name of the organization
Montrose Memorial Hospital Inc
 
Employer identification number

84-6002707
Return Reference Explanation
Part III, Line 1 Continued: IN IMPLEMENTING THE MISSION AND VISION OF MONTROSE MEMORIAL HOSPITAL, WE HOLD AND RESPECT THE FOLLOWING VALUES: INTEGRITY AND HONESTY IN EVERYTHING WE DO; SERVICE WITH CARING AND COMPASSION; EXCELLENCE... ALWAYS PURSUING THE BEST OUTCOME; AND LEADERSHIP WITH INNOVATION AND CREATIVITY.
PART VI, SECTION A, LINE 3 The organization contracts with Quorum Health Resources, a healthcare management company. The CEO, COO, and CFO are Employees of the healthcare management company. The Board of directors works in conjunction with QHR and the Board has ultimate authority and responsibility for the organization.
PART VI, SECTION A, LINE 8B There are no committees with authority to act on behalf of the governing body.
PART VI, SECTION B, LINE 11B THE FORM 990 WAS DISTRIBUTED TO ALL MEMBERS OF THE BOARD OF DIRECTORS via E-MAIL FOR THEIR REVIEW. A REGULARLY SCHEDULED FINANCE COMMITTEE MEETING WAS HELD AT WHICH TIME THE CPA FIRM WHICH PREPARED THE FORM 990 EXPLAINED THE DOCUMENT AND ANSWERED QUESTIONS FROM THE BOARD.
PART VI, SECTION B, LINE 12C COMPLIANCE IS MONITORED on an annual basis through individual acknowledgement of the conflict of interest policy and written self-disclosure, and through a 24/7 hotline complaint report.
PART VI, SECTION B, LINE 15A&15B Compensation for the CEO, COO, and CFO is based on market salaries paid to CEO's, COO's and CFO's in hospitals with similar net revenue totals. Compensation for the CEO includes a bonus calculation which is paid based on pre-established target criteria and performances set before the start of the salary period. The Montrose Memorial Hospital, Inc. Board of Directors is uncompensated for their services. The compensation for other key employees is based on market salaries paid to individuals performing similar jobs in similar markets to ours.
PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE POSTED ON THE WEBSITE. OTHER GOVERNING DOCUMENTS AND THE ORGANIZATION'S CONFLICT OF INTEREST POLICY ARE AVAILABLE BY REQUEST FROM THE ADMINISTRATION.
PART IX, LINE 13 Line 13 column B represents patient care supplies. PART XI, LINE 9 THE OTHER CHANGE TO NET ASSETS -$43,952 Change in restricted Net Assets
PART XII, LINE 2C NO CHANGE TO SELECTION PROCESS FOR AUDITORS.
FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:7860184
FORM 990 PART IX LINE 11G DESCRIPTION:OTHER TOTAL FEES:6531545
FORM 990 PART IX LINE 11G DESCRIPTION:COLORADO HOSPITAL TRUST TOTAL FEES:137288
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2017


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