TY 2011 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) PETER SORINI MD PHYSICIAN/TR	40.00	X			1,021,616	0
(2) WILLIAM REITER MD FACP TRUSTEE	1.00	X			423,018	0
(3) JOHN S MCNEECE CEO/TRUSTEE	40.00	X	X		338,851	25,917
(4) SHAWNA BAKER MD PHYSICIAN/TR	40.00	X			204,433	66,515
(5) BOB FRANCISCO CHAIR	1.00	X	X		0	0
(6) LEE ANN BARTOLETTI VICE CHAIR	1.00	X	X		0	0
(7) BILL FINNEGAN SECRETARY-TR	1.00	X	X		0	0
(8) GENE VUCKOVICH TRUSTEE	1.00	X			0	0
(9) JACK HAFFEY TRUSTEE	1.00	X			0	0
(10) CHARLENE GALLE TRUSTEE	1.00	X			0	0
(11) STAN BLAZ TRUSTEE	1.00	X			0	0
(12) LAURA AUSTIN V.P. OF FINA	40.00		X		172,463	14,179
(13) PETER WENDT PHYSICIAN	40.00			X	350,000	17,410
(14) FREDRICK BARTOLETTI MD ER PHYSICIAN	38.00			X	324,915	54,620
(15) JENNIFER AUSTIN PHYSICIAN	40.00			X	296,499	37,721
(16) RISHONA CORSON ER PHYSICIAN	32.00			X	225,110	25,837
(17) DANIEL HARTMAN ER PHYSICIAN	38.00			X	206,706	32,501

(A) Name and business address	(B) Description of services	(C) Compensation
DR PETER SORINI 22 BITTERSWEET BUTTE,MT59701	SURGEON	1,021,616
JBP ORTHOPEDICS PLLC PO BOX 1486 ANACONDA,MT59711	SURGEON	519,625
THE LOST CREEK COMPANY 1102 E COMMERCIAL ANACONDA,MT59711	PHYSICIAN SRVCS	423,018
ST PATRICK HOSPITAL PO BOX 4587 MISSOULA,MT59806	CEO SERVICES	375,441
DR THOMAS MCMAHON 401 W PENN AVE ANACONDA,MT59711	SURGEON	337,748
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 8

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the United States. See Part IV, line 21	26,024	26,024
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	186,642		186,642
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	12,467,668	10,991,200	1,476,468
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	315,353	279,107	36,246
9	Other employee benefits .......	1,343,036	1,175,272	167,764
10	Payroll taxes ...........	1,204,078	1,047,004	157,074
11	Fees for services (non-employees):
a	Management ......	376,841		376,841
b	Legal .........	73,523		73,523
c	Accounting ...........	58,704		58,704
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......
g	Other ..........	5,090,145	4,791,226	298,919
12	Advertising and promotion ....	167,710	1,556	166,154
13	Office expenses .......	2,263,652	2,091,888	171,764
14	Information technology ......	201,710	201,710
15	Royalties ..
16	Occupancy ...........	976,434	530,764	445,670
17	Travel ............	13,227	7,176	6,051
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	82,258	67,215	15,043
20	Interest ...........	242,615	222,336	20,279
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	807,524	738,111	69,413
23	Insurance ..............	754,813	750,307	4,506
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	3,434,218	3,434,218
b	BAD DEBT EXPENSE	1,696,576	1,696,576
c	OTHER EXPENSES	636,677	387,876	248,801
d	COGS	48,690	48,690
e
f	All other expenses		814,827	-814,827
25	Total functional expenses. Add lines 1 through 24f	32,468,118	29,303,083	3,165,035	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	1,894,901	1	574,158
2	Savings and temporary cash investments .......	3,995,381	2	3,607,866
3	Pledges and grants receivable, net .........	69,852	3	1,086,500
4	Accounts receivable, net .........	4,573,767	4	6,790,901
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........	3,452	5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............	112,416	7	71,983
8	Inventories for sale or use ..............	422,319	8	627,543
9	Prepaid expenses and deferred charges ............	129,224	9	149,045
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	16,444,364
b	Less: accumulated depreciation. .....	10b	9,812,175	5,269,882	10c	6,632,189
11	Investments—publicly traded securities ..........	1,719,019	11	2,058,912
12	Investments—other securities. See Part IV, line 11 ......	510,692	12	259,531
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	1,268,621	15	173,196
16	Total assets. Add lines 1 through 15 (must equal line 34)...	19,969,526	16	22,031,824
	17	Accounts payable and accrued expenses .	2,359,317	17	2,880,985
18	Grants payable ..........		18
19	Deferred revenue ..........	511,967	19	318,945
20	Tax-exempt bond liabilities ..........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	3,161,753	23	4,197,116
24	Unsecured notes and loans payable to unrelated third parties ....	108,308	24	95,471
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....	680,648	25	435,612
26	Total liabilities. Add lines 17 through 25.....	6,821,993	26	7,928,129
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	13,147,533	27	14,103,695
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	13,147,533	33	14,103,695
34	Total liabilities and net assets/fund balances .....	19,969,526	34	22,031,824

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2010. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2011. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) 2011	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2010 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2010 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2011. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2010. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2011

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2011

Name of organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not total to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

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

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2

Name of organization COMMUNITY HOSPITAL OF ANACONDA
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part I	Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3

Name of organization COMMUNITY HOSPITAL OF ANACONDA
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Part II	Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions).	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Name of organization
COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

$
Use duplicate copies of Part III if additional space is needed

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2011

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance (line 1g) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of property		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	783,022		783,022
b	Buildings ................	5,952,462	3,278,857	2,673,605
c	Leasehold improvements ............
d	Equipment ................	8,689,640	6,168,302	2,521,338
e	Other .................	1,019,240	365,016	654,224
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				6,632,189

Schedule D (Form 990) 2011

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Book value
Federal Income Taxes
ESTIMATED MEDICAID SETTLEMENT		435,612








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		435,612
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2011

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3
4	Net unrealized gains (losses) on investments ..........................	4
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV.) .................................	8
9	Total adjustments (net). Add lines 4 through 8 .........................	9
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......		1
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d .....................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV.) ...........	4b
c	Add lines 4a and 4b.......................		4c
5	Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......		5

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............		1
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV.) ............	2d
e	Add lines 2a through 2d......................		2e
3	Subtract line 2e from line 1.....................		3
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV.) ............	4b
c	Add lines 4a and 4b.......................		4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......		5

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
LIABILITY UNDER FIN 48 FOOTNOTE	SCHEDULE D, PAGE 3, PART X	THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE HOSPITAL EVALUATES UNCERTAIN TAX PROVISIONS WHEREBY THE EFFECT OF UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WERE CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2011 AND 2010, THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL.

Schedule D (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 130.000 %

Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the

following was the family income limit for eligibility for discounted care: ............

Yes

200% 250% 300% 350% 400% Other 220.000 %

If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......

Yes

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............

Did the organization prepare a community benefit report during the tax year?...........

Yes

If "Yes," did the organization make it available to the public? ...............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Financial Assistance at cost (from Worksheet 1) ..	331,881	209,760	122,121	0.400 %
b Medicaid (from Worksheet 3, column a) .....	3,555,581	3,555,581
c Costs of other means-tested government programs (from Worksheet 3, column b) .
dTotal Financial Assistance and Means-Tested Government Programs .....	3,887,462	3,765,341	122,121	0.400 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	149,214		149,214	0.480 %
f Health professions education (from Worksheet 5) ..	1,257		1,257
g Subsidized health services (from Worksheet 6) ..	9,809,406	6,784,071	3,025,335	9.830 %
h Research (from Worksheet 7)
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....	10,385		10,385	0.030 %
jTotal Other Benefits ...	9,970,262	6,784,071	3,186,191	10.340 %
kTotal. Add lines 7d and 7j. ..	13,857,724	10,549,412	3,308,312	10.740 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011

Schedule H (Form 990) 2011

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(c) Total community building expense	(e) Net community building expense
1	Physical improvements and housing
2	Economic development	62	62
3	Community support
4	Environmental improvements	1,088	1,088
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total	1,150	1,150

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense........

882,220

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

8,748,698

Enter Medicare allowable costs of care relating to payments on line 5.....

8,808,845

Subtract line 6 from line 5. This is the surplus or (shortfall)........

-60,147

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures

(see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1NA
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2011

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	COMMUNITY HOSPITAL OF ANACONDA 401 W PENNSYLVANIA ANACONDA,MT59711	X	X	X	X	HOSPITAL

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

COMMUNITY HOSPITAL OF ANACONDA

Name of Hospital Facility:

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1	Yes
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet the community health needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20 08
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3	Yes
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4		No
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5	Yes
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Participation in the development of a community-wide community benefit plan
	d	Participation in the execution of a community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. ....		7	Yes
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8	Yes
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care?...........		9	Yes
	If "Yes," indicate the FPG family income limit for eligibility for free care: 130.0% If "No," explain in Part VI the criteria the hospital facility used.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care?.................		10	Yes
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 220.0% If "No," explain in Part VI the criteria the hospital facility used.
11	Explained the basis for calculating amounts charged to patients?.................		11	Yes
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12	Yes
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13	Yes
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?.......		14	Yes
15	Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
16	Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?..........		16	Yes
	If “Yes,” check all actions in which the hospital facility or a third party engaged:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other similar actions (describe in Part VI)
17	Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
	e	Other (describe in Part VI)

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18	Yes
	If “No,” indicate why:
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility’s policy was not in writing
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19	Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
	a	The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
	b	The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
	c	The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?...............................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2011

Page

Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?2
Name and address		Type of Facility (describe)
1	COMMUNITY NURSING HOME OF ANACONDA 600 MAIN ANACONDA,MT59711	NURSING HOME
2	PINTLER HOME OPTIONS 305 W PENNSYLVANIA ANACONDA,MT59711	HOME HEALTH AGENCY
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2011

Page

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
SUBSIDIZED HEALTH SERVICES EXPLANATION	PART I LINE 7G	THE HOSPITAL HAS INCLUDED COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES IN PART I LINE 7G IN THE AMOUNT OF 5481711 IN COLUMN C AND 2505469 IN COLUMN D
EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE	PART I LINE 7 COLUMN F	BAD DEBT EXPENSE INCLUDED ON FORM 990 PART IX LINE 25 COLUMN A OF 1696576 WAS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN PART I LINE 7 COLUMN F
COSTING METHODOLOGY EXPLANATION	PART I LINE 7	THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COSTTOCHARGES FOR FIGURES REPORTED IN THE TABLE TOTAL OPERATING EXPENSES LESS BAD DEBT NONPATIENT CARE ACTIVITIES MEDICAID PROVIDER TAXES TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING EXPENSES
COMMUNITY BUILDING ACTIVITIES	PART II	COMMUNITY HOSPITAL OF ANACONDA CHA IS A LEADING SUPPORTER OF SOCIAL SERVICE PROGRAMS THAT BENEFIT LOCAL RESIDENTS HOSPITAL EMPLOYEES ARE ENCOURAGED TO VOLUNTEER IN THE COMMUNITY EMPLOYEES VOLUNTEER AT THE LOCAL FOOD BANK AND VOLUNTEER THEIR TIME TO TEACHING BASIC LIFE SUPPORT COURSES AT LOCAL BUSINESSES THE HOSPITAL SUPPORTS THE LOCAL SCHOOLS MOUTHRINSE AND HEALTHY SNACK PROGRAMS AND OFFERS FINANCIAL SUPPORT TO AFTER SCHOOL AND SUMMER PROGRAMS FOR AT RISK YOUTH IN ADDITION CHA OFFERS A SCHOLARSHIP FOR A HIGH SCHOOL SENIOR PURSUING ADVANCED EDUCATION IN A HEALTHCARE FIELD THE HOSPITAL ALSO PROMOTES PROGRAMS THAT BENEFIT THE ELDERLY SUCH AS THE DEMENTIA SUPPORT GROUP AND THE SIT AND BE FIT EXERCISE PROGRAMS WHICH ARE BOTH OFFERED AT THE LOCAL SENIOR CENTER THE HOSPITALS ANNUAL HEALTH FAIR OFFERS NOT ONLY A VARIETY OF INFORMATION ABOUT HEALTH PREVENTION AND MAINTENANCE BUT OFFERS A SPECTRUM OF LAB WORK FOR 3550 SERVICES THAT WOULD NORMALLY COST IN EXCESS OF 300 CHA ALSO SUPPORTS LOCAL ARTS AND ENTERTAINMENT INCLUDING SHAKESPEARE IN THE PARK ALIVE AFTER FIVE AND ART IN THE PARK CHA ALSO OFFERS FINANCIAL SUPPORT TO THE FOLLOWING COMMUNITY ACTIVITIES COPPER VILLAGE ARTS CENTERART EXPERIENCES FOR YOUNG PEOPLE ANACONDA COMMUNITY INTERVENTIONPOSITIVE LIFESTYLESUBSTANCE ABUSE EDUCATION FOR YOUTH ANACONDA RELAY FOR LIFECANCER RESEARCH FUNDRAISINGSURVIVOR RECOGNITIONAWARENESS EVENT HEARST FREE LIBRARYSUMMER READING PROGRAM FOR ANACONDA YOUTH SHAKESPEARE IN THE PARK FREE THEATRICAL PERFORMANCE FOR THE COMMUNITY FREE PRENATAL CLASSES FIVE SESSIONS FOR EXPECTANT PARENTS NEED NOT BE DELIVERING AT CHA COMMUNITY FOOD BANK UNITED WAY COMMUNITY HEALTH FAIR LOW COST BLOOD WORK RESULTS COUNSELING PREVENTATIVE HEALTH EDUCATION FINANCIAL COUNSELING FOR THE UNINSURED ANACONDA HIGH SCHOOL ATHLETIC SPONSORSHIPINCLUDES SPORTS PHYSICALS EQUIPMENT SPONSORSHIP OF LOCAL REGIONAL AND DIVISIONAL SPORTING EVENTS SPONSORSHIP OF LOCAL SCHOOL DISTRICT PROGRAMS SUCH AS NATIONAL HONOR SOCIETY ALCOHOL FREE GRADUATION PARTY CAREER FAIRS BLOOD DRIVES AND NONATHLETIC CLUBS AND ACTIVITIES NUTRITIONAL COUNSELING BY A REGISTERED DIETITIAN TO VARIOUS COMMUNITY GROUPS AND ORGANIZATIONS CPR CLASSES FOR LOCAL ORGANIZATIONS FIRE AND POLICE DEPARTMENTS AS WELL AS EMERGENCY MEDICAL TECHNICIAN SPECIAL OLYMPICS OF ANACONDA AND MONTANA UNITED VETERANS OF ANACONDA WASHOE PARK FOUNDATION AND ANNUAL BIKE FESTIVAL GRACE CAMP FOR ATRISK YOUTH CROSSROADS YOUTH PROGRAM KIDZ CLUB ANACONDA CAR SEAT SAFETY PROGRAM CARING IS SHARING PROGRAM ANACONDA LITTLE LEAGUE EDUCATIONAL CAMPS FOR YOUTH INTERESTED IN EXPLORING HEALTHCARE RELATED CAREERS
BAD DEBT EXPENSE EXPLANATION	PART III LINE 4	THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNTS REPORTED ON SCHEDULE H PART III LINE 2 INCLUDES THE COST TO CHARGE RATIO OF PATIENT CARE THE HOSPITAL DID NOT TRACK THE AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITALS CHARITY CARE POLICY BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING 2011 THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS READS AS FOLLOWS RECEIVABLES ARISING FROM REVENUES FROM SERVICES TO PATIENTS ARE REDUCED BY ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS AND CONTRACTUAL ADJUSTMENTS BASED ON EXPERIENCE THIRDPARTY CONTRACTUAL REIMBURSEMENT ARRANGEMENTS AND ANY UNUSUAL CIRCUMSTANCES WHICH MAY AFFECT THE ABILITY OF PATIENTS TO MEET THEIR OBLIGATIONS ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED AGAINST THESE ALLOWANCES ACCOUNTS ARE DEEMED UNCOLLECTIBLE WHEN THE HOSPITAL HAS FOLLOWED ITS COLLECTION PROCEDURES FOR 120 DAYS AFTER INITIALLY BILLING THE PATIENT AND NO PAYMENT ACTIVITY HAS OCCURRED
MEDICARE EXPLANATION	PART III LINE 8	ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR
COLLECTION PRACTICES EXPLANATION	PART III LINE 9B	IF A PATIENT CANNOT PAY THE ENTIRE BILL WITHIN THE TIMELINE SPECIFIED IN THE BILLINGCOLLECTION POLICY AN INTERVIEW WITH THE PATIENT IS CONDUCTED WE SCREEN THE PATIENT TO DETERMINE THEIR FINANCIAL STATUS IF THEY ARE TRUE SELF PAY WITHOUT INSURANCE WE MAKE A REFERRAL TO THE MASH PROGRAM TO SEE IF THEY QUALIFY FOR ANY GOVERNMENT PROGRAMS SUCH AS MEDICAID MEDICARE SSI ETC IF THEY HAVE BEEN SCREENED AND DO NOT QUALIFY FOR ANY PROGRAMS WE DETERMINE IF THEY ARE ELIGIBLE FOR OUR FINANCIAL ASSISTANCE PROGRAM PART OF THE FINANCIAL ASSISTANCE PROGRAM IS A REDUCED PAYMENT PLAN THAT CAN BE APPROVED EVEN IF THE PATIENT DOES NOT QUALIFY FOR FULL FINANCIAL ASSISTANCE IF THE PATIENT HAS INSURANCE THE SAME PROCEDURE IS COMPLETED WITHOUT THE PATIENT BEING SCREENED BY THE MASH PROGRAM ANOTHER PROVISION IN THE CREDIT AND COLLECTIONS POLICY ALLOWS THE PATIENT ACCOUNT REPRESENTATIVE TO APPROVE A LESSER PAYMENT ARRANGEMENT IF THE ARRANGEMENT IS IN THE BEST INTEREST OF THE HOSPITAL AND THE PATIENT AN EXAMPLE OF THIS WOULD BE IF A PATIENT IS IN A TEMPORARY SITUATION THAT PREVENTS MEETING A HIGHER PAYMENT WE WILL APPROVE THE LOWER PAYMENT PLAN WITH A DATE TO REEVALUATE WHEN THAT SITUATION IS RESOLVED CHA WORKS WITH PATIENTS TO ACCOMMODATE THEIR FINANCIAL SITUATION THE FACT THAT THEY CANNOT MEET THE GUIDELINES UNDER THE FINANCIAL POLICY DOES NOT MEAN THAT THEY ARE SENT DIRECTLY TO COLLECTIONS PARTIAL OR FULL PAYMENT MAY BE REQUIRED PRIOR TO SERVICE IN SOME SITUATIONS ALL NONEMERGENT PATIENTS REQUIRING A SURGICAL PROCEDURE THAT DO NOT HAVE INSURANCE COVERAGE MUST MEET WITH A PATIENT ACCOUNT REPRESENTATIVE PRIOR TO HAVING THE SERVICE PROVIDED WE INTERVIEW THE PATIENT TO DETERMINE THEIR FINANCIAL STATUS BASED ON THE PROCEDURE BEING PERFORMED AND THE FINANCIAL STATUS OF THE PATIENT A PARTIAL OR FULL PAYMENT MAY BE REQUIRED IF THE PATIENT IS UNABLE TO MAKE THE PARTIAL OR FULL PAYMENT A REFERRAL IS MADE WITH THE MASH PROGRAM TO DETERMINE IF THE PATIENT QUALIFIES FOR ANY GOVERNMENT PROGRAMS ONCE SCREENED BY MASH FOR ANY PATIENT THAT DOES NOT QUALIFY FOR ANY GOVERNMENT PROGRAM AN APPLICATION FOR FINANCIAL ASSISTANCE IS OFFERED PRIOR TO THE SERVICE BEING PERFORMED BASED ON THE RESULTS OF THE FINANCIAL ASSISTANCE APPLICATION THE BALANCE OF THE ACCOUNT AND THE PATIENTS ABILITY TO PAY ARE EVALUATED IF THE PATIENT HAS THE ABILITY TO PAY A PARTIAL OR FULL PAYMENT IS REQUIRED IF THE PATIENT DOES NOT HAVE THE ABILITY TO PAY THE ACCOUNT IS RELIEVED UNDER THE PATIENT FINANCIAL ASSISTANCE PROGRAM
NEEDS ASSESSMENT	PART VI	IN MID 2008 CHA COMPLETED A COMMUNITY NEEDS ASSESSMENT WITH ASSISTANCE FROM THE MONTANA OFFICE OF RURAL HEALTH TO DETERMINE THE QUALITY OF CARE AT CHA AS WELL AS TO DETERMINE NEEDED HEALTHCARE AND COMMUNITY SERVICES THE PROCESS INCLUDED A RANDOM SURVEY OF ANACONDA HOUSEHOLDS AND A NUMBER OF FOCUS GROUPS THE FOLLOWING WERE IDENTIFIED AS THE TOP COMMUNITY HEALTH CARE NEEDS ADDITIONAL PROFESSIONALS TO ADDRESS THE ISSUES OF DRUG AND ALCOHOL ABUSE INCREASED COMMUNITY HEALTH EDUCATION REGARDING PREVENTION AND WELLNESS ADDITIONAL SPECIALISTS TO ALLEVIATE THE NEED TO TRAVEL OUT OF THE COMMUNITY IN RESPONSE CHA HAS INCREASED OUR COMMUNITY OUTREACH EFFORTS OFFERING PREVENTATIVE HEALTH EDUCATION TO LOCAL BUSINESSES COUNTY EMPLOYERS AND LOCAL SCHOOLS IN ADDITION WE HOST AN ANNUAL HEALTH FAIR WITH LOWCOST LAB WORK AND EDUCATION REGARDING NUTRITION AND RISK PREVENTION CHA HAS ALSO WORKED TO DEVELOP ADDITIONAL REFERRAL SOURCES FOR DRUG AND ALCOHOL INTERVENTIONEDUCATION TO ALLEVIATE THE NEED FOR PATIENTS TO TRAVEL GREAT DISTANCES TO SEEK SPECIALIZED CARE CHA HAS ADDED THE FOLLOWING SPECIALISTS WHO VISIT CHA ON A REGULAR BASIS CARDIOLOGY GASTROENTEROLOGY PODIATRY GENERAL SURGERY NEUROLOGY NEUROSURGERY OBSTETRICSGYNECOLOGY ORTHOPEDICS IN ADDITION CHA HAS ADDED ADDITIONAL FULLTIME PROVIDERS IN THE AREAS OF INTERNAL AND FAMILY MEDICINE AND HAS STAFFED OUR EMERGENCY DEPARTMENT TWENTY FOUR HOURS PER DAY WITH BOARD ELIGIBLE EMERGENCY PHYSICIANS CHA WILL CONTINUE TO ASSESS THE NEED FOR ADDITIONAL SPECIALISTS AND WILL CONTINUE TO WORK WITH COMMUNITY GROUPS TO OFFER ADDITIONAL COMMUNITY OUTREACH AND EDUCATION CHA WILL CONDUCT ANOTHER COMMUNITY NEEDS ASSESSMENT IN 2012
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI	IN COMPLIANCE WITH THE COLLECTION POLICIES OF CHA AN ANNUAL REVIEW IS PERFORMED OF ALL CREDITCOLLECTION AND FINANCIAL ASSISTANCE POLICIES ONCE REVIEWED AND REVISED THE INFORMATION IS DISTRIBUTED TO THE COMMUNITY IN A VARIETY OF WAYS THE FACILITY PUBLISHED A BROCHURE THAT IS PLACED IN PUBLIC AREAS OF ALL THE CHA FACILITIES AS WELL AS INCLUDED IN ALL FORMAL ADMISSION PACKETS TO PATIENTS THE PATIENT ACCOUNT REPRESENTATIVES HAND OUT THE INFORMATION DURING PATIENT CONSULTS AS WELL THE INFORMATION IS ALSO AVAILABLE ON THE CHA WEBSITE ANNUALLY THE PATIENT ACCOUNTS LEADER DISTRIBUTES THE NEW INFORMATION TO LOCAL AGENCIES THAT ASSIST LOW INCOME POPULATIONS DISCUSSIONS OCCUR WITH THE AGENCIES REGARDING THE FINANCIAL ASSISTANCE PROGRAMS AND CHAS ABILITY TO ASSIST PATIENTS WITH THE BURDEN OF APPLYING FOR GOVERNMENT PROGRAMS SUCH AS DISABILITY ETC
COMMUNITY INFORMATION	PART VI	ANACONDADEER LODGE COUNTY ADLC COVERS 737 SQUARE MILES OF SOUTHWESTERN MONTANA WITH 126 PERSONS PER SQUARE MILE MAKING IT A RURAL COUNTY WITH RURAL URBAN CONTINUUM CODE OF 7 RUCC 1 MOST URBAN 10 MOST RURAL ANACONDA DEER LODGE COUNTY IS A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA HPSA ID1309993042 THE 2010 POPULATION WAS 9298 COMPARED TO A 2000 POPULATION OF 9417 REPRESENTING A POPULATION LOSS OF 13 SINCE 2000 THE MAJOR COMMUNITY IN ANACONDADEER LODGE COUNTY IS ANACONDA WITH A MEDIAN AGE OF 46 YEARS 212 OF THE PEOPLE IN THE COUNTY LIVE BELOW THE POVERTY LINE WITH AN AVERAGE UNEMPLOYMENT RATE OF 78 COMPARED TO THE STATE RATE OF 68 COMMUNITY HOSPITAL OF ANACONDA CHA HAS BEEN SERVING THE HEALTHCARE NEEDS OF ANACONDADEER LODGE COUNTY ADLC SINCE 1889 THE HOSPITAL IS A PRIVATELY OWNED NONPROFIT TWENTYFIVE BED CRITICAL ACCESS FACILITY BUILT IN 1981 CHA OFFERS A FULL CONTINUUM OF CARE INCLUDING INPATIENT HOSPITAL SERVICES OUTPATIENT SERVICES FIVE AMBULATORY CARE CLINICS INCLUDING INTERNAL MEDICINE FAMILY MEDICINE SURGICAL PEDIATRICS AND CONVENIENT CARE AN EDEN REGISTERED LONGTERM CARE FACILITY AND HOSPICEHOME HEALTH SERVICES CHA EMPLOYS OVER 300 INDIVIDUALS WITH AN ANNUAL PAYROLL IN EXCESS OF 15 MILLION IN 2011 GROSS PATIENT SERVICE REVENUE WAS APPROXIMATELY 46000000 AS THE COMMUNITYS ONLY SOURCE OF HOSPITAL CARE CHA PROVIDED NEARLY 640000 OF UNCOMPENSATEDCHARITY CARE FOR UNINSURED AND UNDERINSURED PEOPLE
HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE	PART VI	COMMUNITY HOSPITAL OF ANACONDAS BOARD OF TRUSTEES IS COMPRISED OF COMMUNITY MEMBERS REPRESENTING MULTIPLE FACETS OF OUR COMMUNITY FROM THE FINANCIAL SECTOR TO SMALL BUSINESS OWNERS TO RETIREES AND SCHOOL DISTRICT EMPLOYEES THIS VOLUNTEER BOARD HAS DEDICATED THEIR TIME TO ENSURING THEY UNDERSTAND THE HEALTH AND WELFARE NEEDS OF OUR COMMUNITY MEDICAL STAFF PRIVILEGES AT CHA ARE OPEN TO ALL MEDICAL PROVIDERS WITH ACTIVE LICENSURE WHILE WE HAVE INSTITUTED AN ARDUOUS CREDENTIALING PROCESS TO ENSURE PRACTITIONERS OF THE HIGHEST CALIBER ARE PRIVILEGED WE ENCOURAGE PRACTITIONERS FROM NUMEROUS SPECIALTIES TO MEET THE EVER EXPANDING HEALTHCARE NEEDS OF THE COMMUNITY AS A NONPROFIT CORPORATION WE DO NOT HAVE SHAREHOLDERS THEREFORE SURPLUS FUNDS ARE REINVESTED INTO OUR FACILITIES EQUIPMENT AND EMPLOYEE EDUCATION THE ABSENCE OF SHAREHOLDERS ELIMINATES THE POTENTIAL FOR CONFLICTS OF INTEREST RELATED TO ATTAINING INFLATED PROFIT MARGINS AND ALLOWS COMMUNITY HOSPITAL OF ANACONDA TO FOCUS ON WHAT IS IMPORTANT MEETING THE HEALTH AND WELFARE NEEDS OF OUR COMMUNITY
AFFILIATED HEALTH CARE INFORMATION	PART VI	NA
LIST OF STATES WHERE COMMUNITY BENEFIT REPORT IS FILED	PART VI	MONTANA
COMMUNITY HOSPITAL OF ANACONDA LINE NUMBER 1 PART V LINE 3	PART V LINE 3	THE PROCESS INCLUDED A RANDOM WRITTEN SURVEY MAILED TO OVER 600 RESIDENTS OF ANACONDADEER LODGE COUNTY HOUSEHOLDS FOLLOWED BY THREE FOCUS GROUPS IN ADDITION A STEERING COMMITTEE OF VARIOUS COMMUNITY MEMBERS WAS FORMED TO ASSIST IN THE DEVELOPMENT OF THE SURVEY INSTRUMENT AND TO PROVIDE A FORUM TO DISCUSS THE COMMUNITYS ISSUES WITH RESPECT TO HEALTHCARE

Schedule H (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990

OMB No. 1545-0047

2011

Open to Public
Inspection

Name of the organization
COMMUNITY HOSPITAL OF ANACONDA

Employer identification number
81-0303913

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet

(a) Name and address of organization or government	(b) EIN	(c) IRC Code section if applicable	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of non-cash assistance	(h) Purpose of grant or assistance

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2011

Page 2

Part III

Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.

(a)Type of grant or assistance	(b)Number of recipients	(c)Amount of cash grant	(d)Amount of non-cash assistance	(e)Method of valuation (book, FMV, appraisal, other)	(f)Description of non-cash assistance

Part IV

Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.

Identifier	Return Reference	Explanation
PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS INSIDE THE UNITED STATES	SCHEDULE I, PAGE 1, PART I, LINE 2	A REQUEST IS PRESENTED TO THE ADMINISTRATIVE TEAM BY THE HUMAN RESOURCES/MARKETING DIRECTOR. THE TEAM APPROVES OR DISAPPROVES THE REQUEST. A VOUCHER IS PREPARED FOR ACCOUNTS PAYABLE TO CUT A CHECK. FOLLOW UP IS DONE WITH THE RECIPIENT AFTER THE USE OF THE FUNDS.

Schedule I (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2011

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported as deferred in prior Form 990
(1) PETER SORINI MD	(i) (ii)	1,021,616					1,021,616
(2) WILLIAM REITER MD FACP	(i) (ii)	423,018					423,018
(3) JOHN S MCNEECE	(i) (ii)	338,851				25,917	364,768
(4) SHAWNA BAKER MD	(i) (ii)	204,433				66,515	270,948
(5) LAURA AUSTIN	(i) (ii)	172,463				14,179	186,642
(6) PETER WENDT	(i) (ii)	350,000				17,410	367,410
(7) FREDRICK BARTOLETTI MD	(i) (ii)	324,915				54,620	379,535
(8) JENNIFER AUSTIN	(i) (ii)	296,499				37,721	334,220
(9) RISHONA CORSON	(i) (ii)	225,110				25,837	250,947
(10) DANIEL HARTMAN	(i) (ii)	206,706				32,501	239,207

Schedule J (Form 990) 2011

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation

Schedule J (Form 990) 2011

Additional Data

Software ID:
Software Version:

- TIN:

Schedule L
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Transactions with Interested Persons

Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet

Attach to Form 990 or Form 990-EZ. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part I

Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.

1(a) Name of disqualified person	(b) Description of transaction	(c) Corrected?
1(a) Name of disqualified person	(b) Description of transaction	Yes	No

Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image

Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image

Part II

Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.

(a) Name of interested person and purpose	(b) Loan to or from the organization?		(c)Original principal amount	(d)Balance due	(e) In default?		(f) Approved by board or committee?		(g)Written agreement?
(a) Name of interested person and purpose	To	From	(c)Original principal amount	(d)Balance due	Yes	No	Yes	No	Yes	No






Total ............... $

Part III

Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.

(a) Name of interested person	(b)Relationship between interested person and the organization	(c)Amount of grant or type of assistance

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

Cat. No. 50056A

Schedule L (Form 990 or 990-EZ) 2011

Page 2

Part IV

Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.

(a) Name of interested person	(b) Relationship between interested person and the organization	(c) Amount of transaction	(d) Description of transaction	(e) Sharing of organization's revenues?
(a) Name of interested person		(c) Amount of transaction	(d) Description of transaction	Yes	No
(1) FREDRICK BARTOLETTI MD	TRUSTEE FAMILY	379,535	EMPLOYMENT		No
(2) WILLIAM REITER MD	TRUSTEE	423,018	OWNER OF PHY SERV CO		No
(3) PETER SORINI MD	TRUSTEE	1,021,616	CONTRACTED SERVICES		No
(4) JOHN S MCNEECE CEO	TRUSTEE	368,393	CONTRACTED SERVICES		No
(5) SHAWNA BAKER MD	TRUSTEE	270,948	EMPLOYMENT		No

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule L (see instructions).

Identifier	Return Reference	Explanation

Schedule L (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

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

2011

Open to Public
Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Identifier	Return Reference	Explanation
RELATED PARTY INFORMATION AMONG OFFICERS	FORM 990, PAGE 6, PART VI, LINE 2	LEE ANN BARTOLETTI FREDRICK BARTOLETTI, MD TRUSTEE ER PHYSICIAN FAMILY RELATIONSHIP
MANAGEMENT DELEGATED	FORM 990, PAGE 6, PART VI, LINE 3	THE HOSPITAL UTILIZES AN EMPLOYEE OF ST. PATRICK HOSPITAL AS IT'S CHIEF EXECUTIVE OFFICER.
CLASSES OF MEMBERS OR STOCKHOLDERS	FORM 990, PAGE 6, PART VI, LINE 6	WHEN THE HOSPITAL WAS FORMED IN 1969, SOME COMMUNITY MEMBERS PURCHASED THE HOSPITAL FROM SISTERS OF CHARITY. AS THESE ORIGINAL MEMBERS DECEASE, THEIR MEMBERSHIP IS LOST. AN ANNUAL MEETING IS SCHEDULED IN SEPTEMBER OF EACH YEAR WITH A PUBLIC NOTICE POSTED IN THE LOCAL PAPER. THE REMAINING ORIGINAL MEMBERS MAY ATTEND THE MEETING; HOWEVER, THEY ARE NOT ACTIVE MEMBERS AND DO NOT HAVE VOTING RIGHTS.
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990	FORM 990, PAGE 6, PART VI, LINE 11B	A COPY OF THE 990 IS PROVIDED TO THE V.P. OF FINANCE, WHO REVIEWS THE FORM, SCHEDULES, AND RELATED ATTACHMENTS. THE FINANCE COMMITTEE IS DESIGNATED BY THE BOARD OF TRUSTEES TO ASSUME RESPONSIBILITY FOR OVERSIGHT OF THE 990 AND IS ALSO PART OF THE REVIEW PROCESS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL APPROVAL IS GIVEN TO THE PREPARER BEFORE FINALIZING. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE V.P. OF FINANCE SIGNS OFF ON THE FORM 8879-EO BEFORE THE RETURN IS E-FILED BY THE PREPARER.
ENFORCEMENT OF CONFLICTS POLICY	FORM 990, PAGE 6, PART VI, LINE 12C	ARTICLE II OF THE BYLAWS STATES THAT, AT A MINIMUM, EACH MEMBER OF THE BOARD WILL EXECUTE THE CONFLICT OF INTEREST FORM AT THE COMMENCEMENT OF THE TERM OR IN THE EVENT OF ANY CHANGE THAT MAY DEVELOP. THE CONFLICT OF INTEREST GUIDELINES ARE MONITORED BY THE CHA CORPORATE COMPLIANCE OFFICER. THE COMPLIANCE OFFICER ATTENDS NEW EMPLOYEE ORIENTATION AND PRESENTS THE POLICY AS PART OF THE OVERALL CORPORATE LEGAL COMPLIANCE PROGRAM. EACH EMPLOYEE IS PRESENTED WITH A CONFLICT OF INTEREST STATEMENT. ALL POTENTIAL CONFLICTS ARE DISCLOSED. IF ANY POTENTIAL CONFLICTS ARE IDENTIFIED, THE COMPLIANCE OFFICER WILL MEET WITH THE EMPLOYEE'S SUPERVISOR AND ADMINISTRATION TO DETERMINE IF A CONFLICT EXISTS. ON AN ANNUAL BASIS, ALL EMPLOYEES AND THE BOARD OF DIRECTORS ARE REQUIRED TO READ AND SIGN THE CONFLICT OF INTEREST STATEMENT. THE CORPORATE COMPLIANCE OFFICER TRACKS THE RECEIPT AND COMPLETION OF THE CONFLICT OF INTEREST STATEMENTS. THE PROCESS IS A PART OF THE ANNUAL EMPLOYEE REQUIREMENTS MANDATED FOR CONTINUED EMPLOYMENT.
COMPENSATION PROCESS FOR TOP OFFICIAL	FORM 990, PAGE 6, PART VI, LINE 15A	THE SOURCES UTILIZED BY CHA IN REGARD TO FAIR MARKET VALUE IN SALARIES ARE AN EXECUTIVE COMPENSATION SURVEY, PUBLISHED BY CRITICAL DATA, INC., AND THE MONTANA HOSPITAL ASSOCIATION (MHA) ANNUAL SALARY SURVEY. THESE SURVEYS ARE UTILIZED FOR SETTING THE SALARY LEVELS OF EMPLOYEES AT CHA. THE MHA SURVEY ITEMIZES ALL HOSPITALS AS A GROUP, CAH HOSPITALS, AND HOSPITALS BY REGION. CHALLENGES EXIST WHEN CHA JOB DESCRIPTIONS ARE UNIQUE AND, THEREFORE, MAY NOT BE LISTED AS A JOB CATEGORY IN THE MHA SURVEY. IN REGARD TO SETTING THE SALARY LEVELS OF PHYSICIANS, CHA UTILIZES THE MGMA PHYSICIAN COMPENSATION AND PRODUCTION SURVEY. THIS SURVEY ITEMIZES SALARIES AND PRODUCTIVITY BY PHYSICIAN SPECIALTY, YEARS IN PRACTICE, GEOGRAPHIC REGION, AND OTHER CATEGORIES. CHA STRIVES TO PAY MARKET LEVEL SALARIES TO ALL EMPLOYEES OF THE ORGANIZATION. IT IS OUR GOAL TO RECRUIT AND RETAIN TOP TALENT IN EVERY VENUE, WHILE CONTROLLING SALARY AND BENEFIT COSTS WITHIN ESTABLISHED TARGETS. IN 2008 AND 2010, CHA HIRED AN INDEPENDENT CONSULTANT TO EVALUATE THE SALARY LEVELS OF THE SENIOR MANAGEMENT. THIS SALARY SURVEY REVIEWED SALARIES FOR HOSPITALS IN CHA'S REVENUE RANGE IN OUR REGION, AS WELL AS SALARY LEVELS ACROSS THE COUNTRY. ALL JOBS REVIEWED WERE WELL WITHIN THE PUBLISHED RANGES, AS DETERMINED BY CRITICAL DATA, INC.
COMPENSATION PROCESS FOR OFFICERS	FORM 990, PAGE 6, PART VI, LINE 15B	SEE FORM 990, PART VI, LINE 15A.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATION	FORM 990, PAGE 6, PART VI, LINE 19	COMMUNITY HOSPITAL OF ANACONDA MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO INCLUDED IN THE COMMUNITY BENEFIT REPORT.
OTHER CHANGES IN NET ASSETS EXPLANATION	FORM 990, PART XI, LINE 5	THE HOSPITAL RECOGNIZED 233,983 NET UNREALIZED LOSS ON INVESTMENT IN 2011.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2011

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2011

Open to Public Inspection

Name of the organization

COMMUNITY HOSPITAL OF ANACONDA

Employer identification number

81-0303913

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) CHANHA FOUNDATION PO BOX 1245 ANACONDA,MT59711 81-0504127	SUPPORT	MT	501C3	11B	COMMUNITY HOSPITAL OF ANACONDA		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2011

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership

Schedule R (Form 990) 2011

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .

n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) CHANHA FOUNDATION	J	78,180	FAIR MARKET VALUE
(2) CHANHA FOUNDATION	C	51,400	FAIR MARKET VALUE
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2011

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(e) Are all partners section 501(c)(3) organizations?		(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2011

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE A CARING ENVIRONMENT, RESPONDING WITH EXCELLENCE TO THE HEALTH CARE NEEDS OF THOSE WE SERVE. RESPECTING THE DIGNITY AND RECOGNIZING THE WORTH OF EACH PERSON IS THE FOUNDATION OF OUR COMMITMENT TO CARE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a).....	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	6
5	Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...	5	355
6	Total number of volunteers (estimate if necessary) ....	6	22
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	55,609
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-6,588

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	322,614	624,338
9	Program service revenue (Part VIII, line 2g) .........	28,644,889	32,865,774
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	70,524	121,046
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	68,838	47,105
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	29,106,865	33,658,263
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	26,518	26,024
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	13,528,808	15,516,777
16a	Professional fundraising fees (Part IX, column (A), line 11e).....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	14,645,228	16,925,317
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	28,200,554	32,468,118
19	Revenue less expenses. Subtract line 18 from line 12.......	906,311	1,190,145
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	19,969,526	22,031,824
21	Total liabilities (Part X, line 26).............	6,821,993	7,928,129
22	Net assets or fund balances. Subtract line 21 from line 20.....	13,147,533	14,103,695

Sign Here

	Signature of officer	Date

	Type or print name and title.


4a	(Code: ) (Expenses $ 29,277,059 including grants of $ ) (Revenue $ 32,797,456 )
	COMMUNITY HOSPITAL OF ANACONDA IS COMPRISED OF A 25-BED CRITICAL ACCESS HOSPITAL AND A 62-BED NURSING HOME FACILITY WHICH PROVIDES HEALTH CARE SERVICES. THE HOSPITAL PROVIDED 4,657 DAYS OF INPATIENT ACUTE CARE SERVICES, 45,088 OUTPATIENT VISITS, 7,970 EMERGENCY ROOM/CONVENIENT CARE VISITS, AND 1,052 SURGERIES. THE NURSING HOME PROVIDED 19,722 DAYS OF RESIDENT SERVICES FOR THE YEAR ENDED DECEMBER 31, 2011. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED CHARGES OF PROVIDING CARE TO THESE PATIENTS WAS 638,232 FOR CHARITY CARE, 7,266,652 FOR MEDICARE, 1,149,339 FOR MEDICAID, AND 4,105,142 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR ENDED DECEMBER 31, 2011.

4b	(Code: ) (Expenses $ 26,024 including grants of $ 26,024 ) (Revenue $ )
	COMMUNITY HOSPITAL OF ANACONDA ALSO SPONSORS NUMEROUS YOUTH GROUPS AND ACTIVITIES WITHIN ITS COMMUNITY.

4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 29,303,083

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,563,611	274,700

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d		51,400
e	Government grants (contributions)1e		492,709

f	All other contributions, gifts, grants, and similar amounts not included above1f		80,229
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			624,338
			Business Code
2a	PATIENT SERVICE REVENUE, NET		624,100	32,797,456	32,797,456
b	PHARMACY SALES		446,110	44,589		44,589
c	RENTAL INCOME		621,110	12,709			12,709
d	CATERING		722,320	11,020		11,020
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			32,865,774
3	Investment income (including dividends, interest
	and other similar amounts).....			121,046			121,046
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross rents
b	Less: rental expenses
c	Rental income or (loss)
d	Net rental income or (loss).......
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a	CAFETERIA REVENUE		722,210	26,612			26,612
b	OTHER		900,099	16,070			16,070
c	MEDICAL RECORDS & TRANSCRIPTI		900,099	4,423			4,423
d	All other revenue ....
e	Total. Add lines 11a–11d ......			47,105
12	Total revenue. See Instructions....			33,658,263	32,797,456	55,609	180,860


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			1,894,901	1	574,158
2	Savings and temporary cash investments .......			3,995,381	2	3,607,866
3	Pledges and grants receivable, net .........			69,852	3	1,086,500
4	Accounts receivable, net .........			4,573,767	4	6,790,901
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........			3,452	5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............			112,416	7	71,983
8	Inventories for sale or use ..............			422,319	8	627,543
9	Prepaid expenses and deferred charges ............			129,224	9	149,045
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	16,444,364
b	Less: accumulated depreciation. .....	10b	9,812,175	5,269,882	10c	6,632,189
11	Investments—publicly traded securities ..........			1,719,019	11	2,058,912
12	Investments—other securities. See Part IV, line 11 ......			510,692	12	259,531
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			1,268,621	15	173,196
16	Total assets. Add lines 1 through 15 (must equal line 34)...			19,969,526	16	22,031,824
17	Accounts payable and accrued expenses .			2,359,317	17	2,880,985
18	Grants payable ..........				18
19	Deferred revenue ..........			511,967	19	318,945
20	Tax-exempt bond liabilities ..........				20
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			3,161,753	23	4,197,116
24	Unsecured notes and loans payable to unrelated third parties ....			108,308	24	95,471
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.....			680,648	25	435,612
26	Total liabilities. Add lines 17 through 25.....			6,821,993	26	7,928,129
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			13,147,533	27	14,103,695
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			13,147,533	33	14,103,695
34	Total liabilities and net assets/fund balances .....			19,969,526	34	22,031,824