Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
Do not enter social security numbers on this form as it may be made public.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
A For the 2023 calendar year, or tax year beginning 07-01-2023 , and ending 12-31-2023
BCheck if applicable:
CName of organization
Billings Clinic
 
 
Doing business as
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2800 Tenth Avenue North
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Billings, MT59101
D Employer identification number

81-0231784
E Telephone number

G Gross receipts $ 983,590,332
F Name and address of principal officer:
CLINT SEGER MD
2800 Tenth Avenue North
Billings,MT59101
I
Tax-exempt status: (   ) (insert no.) or
J
Website:
WWW.BILLINGSCLINIC.COM
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number  
K Form of organization:  
L Year of formation: 1917
M State of legal domicile: MT
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: BILLINGS CLINIC IS MONTANA'S LARGEST HEALTHCARE ORGANIZATION CONSISTING OF A 336 BED HOSPITAL AND LEVEL 1 TRAUMA CENTER, PRIMARY CARE AND OVER 80 SPECIALTIES.
2 Check this box
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 9
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 7
5 Total number of individuals employed in calendar year 2023 (Part V, line 2a) ...... 5 6,074
6 Total number of volunteers (estimate if necessary) ............. 6 86
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 13,916,593
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 5,494,840
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 11,112,553 1,642,869
9 Program service revenue (Part VIII, line 2g) ......... 971,557,398 508,769,420
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 81,683,280 17,671,483
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 27,642,818 12,322,725
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 1,091,996,049 540,406,497
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 277,725 128,328
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 504,893,175 250,032,826
16a Professional fundraising fees (Part IX, column (A), line 11e) ..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) 0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 596,454,984 303,035,118
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 1,101,625,884 553,196,272
19 Revenue less expenses. Subtract line 18 from line 12....... -9,629,835 -12,789,775
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 1,374,741,411 1,396,449,787
21 Total liabilities (Part X, line 26)............. 488,326,129 496,385,928
22 Net assets or fund balances. Subtract line 21 from line 20..... 886,415,282 900,063,859
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
Signature of officer Date
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name

Firm's EIN
Firm's address



Phone no.
May the IRS discuss this return with the preparer shown above? See Instructions. ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2023)
Form 990 (2023)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: BILLINGS CLINIC MISSION IS HEALTH CARE, EDUCATION AND RESEARCH. BILLINGS CLINIC WILL PROVIDE THE BEST IN NATION CLINICAL QUALITY, PATIENT SAFETY, SERVICE AND VALUE.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 216,481,428 including grants of $ 60,151 ) (Revenue $ 283,640,168 )
BILLINGS CLINIC IS A 336 BED HOSPITAL PROVIDING SURGICAL, LABOR AND DELIVERY, PSYCHIATRIC, CANCER CARE, NEONATAL SERVICES AND ACUTE CARE. BILLINGS CLINIC HAD APPROXIMATELY 15,000 ADMISSIONS IN 2023.
4b (Code:   ) (Expenses $ 198,835,157 including grants of $ 55,247 ) (Revenue $ 172,385,061 )
BILLINGS CLINIC HAS NEARLY 600 PHYSICIANS AND ADVANCED PRACTITIONERS OFFERING MORE THAN 80 SPECIALTIES. PRIMARY CARE IS AVAILABLE AT MULTIPLE LOCATIONS INCLUDING BILLINGS CLINIC DOWNTOWN, HEIGHTS, WEST END, CODY WY, MILES CITY AND A BOZEMAN LOCATION WITH ADDITIONAL SPECIALTIES. IN ADDITION, BILLINGS CLINIC CONDUCTS SPECIALTY CARE CLINICS FOR MORE THAN 20 REGIONAL LOCATIONS IN MONTANA, WYOMING AND NORTH DAKOTA. BILLINGS CLINIC HAD OVER 880,000 PATIENT VISITS IN 2023.
4c (Code:   ) (Expenses $ 46,536,247 including grants of $ 12,930 ) (Revenue $ 51,199,364 )
BILLINGS CLINIC SPECIALTY PHARMACY FOCUSES ON THE PHARMACY CARE OF CHRONIC, RARE OR COMPLEX CONDITIONS THAT REQUIRE SPECIALTY MEDICATIONS. SPECIALTY MEDICATIONS TYPICALLY REQUIRE SPECIAL HANDLING, ADMINISTRATION OR MONITORING BEYOND THAT WHICH A TRADITIONAL RETAIL PHARMACY CAN PROVIDE. WE WORK TO ENSURE APPROPRIATE MEDICATION USE AND PROMOTE ADHERENCE. BILLINGS CLINIC SPECIALTY PHARMACY IS PART OF THE LARGEST HEALTH CARE SYSTEM IN THE REGION. OUR STAFF WORKS WITH YOU, YOUR PROVIDER AND YOUR INSURANCE COMPANY TO MAKE SURE YOUR NEEDS ARE MET. OUR GOAL IS TO MAKE BILLINGS CLINIC A ONE-STOP SOLUTION.
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expenses461,852,832
Form 990 (2023)
Form 990 (2023)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment
List of Attached Documents:
// Content
.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment
List of Attached Documents:
// Content
...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment
List of Attached Documents:
// Content
.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II....
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part III..............
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part VClick to see attachment
List of Attached Documents:
// Content
......
10
Yes
 
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment
List of Attached Documents:
// Content
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment
List of Attached Documents:
// Content
............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
List of Attached Documents:
// Content
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
List of Attached Documents:
// Content
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
List of Attached Documents:
// Content
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
List of Attached Documents:
// Content
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
List of Attached Documents:
// Content
21
Yes
 
Form 990 (2023)
Form 990 (2023)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........Click to see attachment
List of Attached Documents:
// Content
22
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
List of Attached Documents:
// Content
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
List of Attached Documents:
// Content
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................Click to see attachment
List of Attached Documents:
// Content
28a
Yes
 
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
List of Attached Documents:
// Content
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
List of Attached Documents:
// Content
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...Click to see attachment
List of Attached Documents:
// Content
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
234
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2023)
Form 990 (2023)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
6,074
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country:
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, or any disqualified or other person engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2023)
Form 990 (2023)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
9
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
7
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
Yes
 
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
 
No
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filed
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
KATHLEEN QUINONES2800 TENTH AVENUE NORTH   BILLINGS,MT59101 (406) 435-6445
Form 990 (2023)
Form 990 (2023)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, box 6 of Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) KEITH COOK
 
BOARD CHAIR
 5.0
.................
2.0 		X   X       7,500 0 9,000
(2) WAYNE HIRSCH
 
BOARD TREASURER
 5.0
.................
0 		X   X       0 0 6,000
(3) ALICE GORDON
 
BOARD MEMBER
 5.0
.................
1.0 		X           4,500 0 6,000
(4) AMY CEBULL
 
BOARD MEMBER
 5.0
.................
2.0 		X           0 0 3,015
(5) CRAIG BARTHOLOMEW
 
BOARD MEMBER
 5.0
.................
1.0 		X           0 0 10,995
(6) EILEEN MCDONALD
 
BOARD MEMBER
 5.0
.................
3.0 		X           0 0 6,447
(7) HEIDI DUNCAN MD
 
PHYSICIAN BOARD MEMBER
 60.0
.................
1.0 		X           233,914 0 61,250
(8) JOHN EDWARDS
 
BOARD MEMBER
 5.0
.................
1.0 		X           0 0 3,015
(9) KENDRICK TROSTEL MD
 
PHYSICIAN BOARD MEMBER
 5.0
.................
0 		X           666,254 0 55,471
(10) CLINTON SEGER MD
 
CEO
 60.0
.................
4.0 		    X       830,292 0 132,500
(11) KATHLEEN QUINONES
 
CFO
 60.0
.................
3.0 		    X       448,591 0 102,141
(12) ANTHONY ROCCISANO DO
 
PHYSICIAN
 60.0
.................
0 		        X   1,612,546 0 61,354
(13) CHRISTOPHER STEWART DO
 
PHYSICIAN
 60.0
.................
0 		        X   1,295,248 0 48,388
(14) MARLIN RICHARDSON MD
 
PHYSICIAN
 60.0
.................
0 		        X   1,474,845 0 59,472
(15) MICHAEL MORONE MD
 
PHYSICIAN
 60.0
.................
0 		        X   1,504,067 0 56,622
(16) VANCE FREDRICKSON MD
 
PHYSICIAN
 60.0
.................
0 		        X   2,068,644 0 36,971
(17) SCOTT ELLNER DO
 
FORMER CEO
 60.0
.................
2.0 		          X 982,800 0 1,002
Form 990 (2023)
Form 990 (2023)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;


























1b Sub-Total..............
c Total from continuation sheets to Part VII, Section A..
d Total (add lines 1b and 1c)......... 11,129,201 0 659,643
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization 1,008
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
HAYES LOCUMS LLC

PO BOX 5068
NEW YORK,NY10087 		CONTRACT PHYSICIANS 38,669,086
VAYA WORKFORCE SOUTIONS LLC

PO BOX 9416
MINNEAPOLIS,MN55480 		CONTRACT LABOR 33,262,059
BILLINGS ANESTHESIOLOGY PC

2800 10th Ave N
BILLINGS,MT59101 		ANESTHESIOLOGIST SERVICES 21,468,730
ORACLE AMERICA INC

2300 ORACLE WAY
AUSTIN,TX78741 		IT SERVICES 10,554,844
AVANT HEALTHCARE PROFESSION

PO BOX 744554
ATLANTA,GA303744554 		CONTRACT NURSING 5,516,945
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 52
Form 990 (2023)
Form 990 (2023)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 1,642,869
e Government grants (contributions)1e  
f All other contributions, gifts, grants, and similar amounts not included above1f  
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f....... 1,642,869
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 621110 462,376,727 462,376,727    
b RETAIL PHARMACY 621110 38,014,858 38,014,858    
c REFERENCE LAB 621500 3,523,889   3,523,889  
d INCOME ON EQUITY INVESTEES 900099 4,634,114 4,634,114    
e CLINICAL TRIAL REVENUE 541900 219,832 219,832    
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f ..... 508,769,420
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ...... 8,544,290     8,544,290
4 Income from investment of tax-exempt bond proceeds        
5 Royalties...........        
(i) Real (ii) Personal
6a Gross rents 6a 108,491  
b Less: rental expenses 6b 213,952  
c Rental income or (loss) 6c -105,461 0
d Net rental income or (loss)....... -105,461     -105,461
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 7a 452,017,007  
b Less: cost or other basis and sales expenses 7b 442,889,814  
c Gain or (loss) 7c 9,127,193 0
d Net gain or (loss)......... 9,127,193     9,127,193
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..        
10a Gross sales of inventory, less
returns and allowances ..
10a 258,531
b Less: cost of goods sold .. 10b 80,069
c Net income or (loss) from sales of inventory.. 178,462 166,237 12,225  
OtherRevenueMiscAmt
Business Code
11a REGIONAL PAHRMACY SALES 621110 7,987,220   7,987,220  
b SERVICE TO OTHER HOSPITALS 541519 1,870,041   1,870,041  
c IT CMC 541519 523,218   523,218  
d All other revenue .... 1,869,245 1,812,825 0 56,420
e Total. Add lines 11a–11d ...... 12,249,724
12 Total revenue. See instructions..... 540,406,497 507,224,593 13,916,593 17,622,442
Form 990 (2023)
Form 990 (2023)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
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 domestic organizations and domestic governments. See Part IV, line 21 .... 120,507 120,507
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ........... 7,821 7,821
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members ....... 0 0
5 Compensation of current officers, directors, trustees, and key employees ........... 1,548,992 1,162,209 386,783  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ......... 2,617,603   2,617,603  
7 Other salaries and wages........ 208,393,942 170,870,653 37,523,289  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 6,627,458 5,686,927 940,531  
9 Other employee benefits ....... 18,972,993 11,276,440 7,696,553  
10 Payroll taxes ........... 11,871,838 9,237,477 2,634,361  
11 Fees for services (non-employees):        
a Management ...... 27,500   27,500  
b Legal ......... 1,080,683 3,674 1,077,009  
c Accounting ........... 337,263   337,263  
d Lobbying ........... 74,218   74,218  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ...... 710,621   710,621  
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 81,128,784 70,080,236 11,048,548 0
12 Advertising and promotion .... 1,784,591 15,704 1,768,887  
13 Office expenses ....... 6,621,978 2,946,118 3,675,860  
14 Information technology ...... 15,153,410 11,652,972 3,500,438  
15 Royalties ..        
16 Occupancy ........... 3,831,622 3,340,408 491,214  
17 Travel ............ 2,554,110 1,826,444 727,666  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 48,873   48,873  
20 Interest ........... 6,034,096 4,527,382 1,506,714  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 16,590,622 13,838,238 2,752,384  
23 Insurance ... 3,416,058 1,467,880 1,948,178  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 140,637,741 140,356,466 281,275  
b REPAIRS AND MAINTENANCE 6,256,803 6,256,803    
c BED TAX 4,941,473 3,833,595 1,107,878  
d DUES 1,871,015 741,296 1,129,719  
e All other expenses 9,933,657 2,603,582 7,330,075 0
25 Total functional expenses. Add lines 1 through 24e 553,196,272 461,852,832 91,343,440 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).        
Form 990 (2023)
Form 990 (2023)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 16,079,651 1 31,289,949
2 Savings and temporary cash investments ......... 240,857,717 2 136,439,358
3 Pledges and grants receivable, net ......   3  
4 Accounts receivable, net ............. 147,576,315 4 207,581,779
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
  5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
  6 0
7 Notes and loans receivable, net ........... 1,077,350 7 1,194,984
8 Inventories for sale or use ............ 23,262,216 8 24,152,113
9 Prepaid expenses and deferred charges ...... 12,022,494 9 13,846,413
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 773,472,922
b Less: accumulated depreciation 10b 413,148,507 360,824,889 10c 360,324,415
11 Investments—publicly traded securities . 393,528,818 11 436,077,688
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 .. 38,197,490 13 30,922,198
14 Intangible assets ............... 2,595,143 14 2,424,034
15 Other assets. See Part IV, line 11 ........... 138,719,328 15 152,196,856
16 Total assets. Add lines 1 through 15 (must equal line 33)... 1,374,741,411 16 1,396,449,787
Liabilities 17 Accounts payable and accrued expenses ..... 86,164,548 17 98,154,128
18 Grants payable ...   18  
19 Deferred revenue ......... 688,976 19 444,976
20 Tax-exempt bond liabilities ......... 172,378,620 20 168,864,918
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 190,130,457 23 187,181,126
24 Unsecured notes and loans payable to unrelated third parties ..   24  
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 38,963,528 25 41,740,780
26 Total liabilities. Add lines 17 through 25.. 488,326,129 26 496,385,928
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 814,969,320 27 818,532,058
28 Net assets with donor restrictions ........... 71,445,962 28 81,531,801
Organizations that do not follow FASB ASC 958, check here right arrow and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 886,415,282 32 900,063,859
33 Total liabilities and net assets/fund balances ........ 1,374,741,411 33 1,396,449,787
Form 990 (2023)
Form 990 (2023)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
540,406,497
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
553,196,272
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
-12,789,775
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
886,415,282
5
Net unrealized gains (losses) on investments ...............
5
10,763,358
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
15,674,994
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
900,063,859
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Uniform Guidance, 2 C.F.R. Part 200, Subpart F?
3a
 
No
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
 
 
Form 990 (2023)
Form 990 (2023)
Additional Data


Software ID: 23017437
Software Version: 2023v5.1
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

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.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
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 12, check only one box.)
1
A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).
2
A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990).)
3
A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).
4
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:

5
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.)
6
A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).
7
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.)
8
A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)
9
An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:
10
An organization that normally receives: (1) more than 33 1/3% 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 33 1/3% 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.)
11
12
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 on lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.
a
Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.
b
Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.
c
Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.
d
Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.
e
Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 2
Part II
Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
33 1/3% support test—2023. 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
b
33 1/3% support test—2022. If the organization did not check a 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—2023. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow
b
10%-facts-and-circumstances test—2022. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ............ right arrow
18
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) 2023

Schedule A (Form 990) 2023
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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) right arrow (a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) 2023 (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 on 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 VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here................................................. right arrow
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
33 1/3% support tests-2023. 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
b
33 1/3 % support tests—2022. 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
20
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) 2023

Schedule A (Form 990) 2023
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)
Schedule A (Form 990) 2023

Schedule A (Form 990) 2023
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2023 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2023 		(iii)
Distributable
Amount for 2023
1 Distributable amount for 2023 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2023:
a From 2018.......  
b From 2019.......  
c From 2020.......  
d From 2021.......  
e From 2022.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2023 distributable amount  
i Carryover from 2018 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2023 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2023 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2023, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2023. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2024. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2019.....  
b Excess from 2020.....  
c Excess from 2021.....  
d Excess from 2022.....  
e Excess from 2023.....  
Schedule A (Form 990) (2023)

Schedule A (Form 990) 2023
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 


Return Reference Explanation
Schedule A (Form 990) 2023


Additional Data


Software ID: 23017437
Software Version: 2023v5.1
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




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
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
Billings Clinic
  		Employer identification number
81-0231784
Part I
Contributors
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


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 3
Name of organization
Billings Clinic
  		Employer identification number

81-0231784
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) (2023)
Schedule B (Form 990) (2023)
Page 4
Name of organization
Billings Clinic
  		Employer identification number

81-0231784
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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 (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2023)
Additional Data


Software ID: 23017437
Software Version: 2023v5.1
SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

right arrow Complete if the organization is described below. right arrow Attach to Form 990 or Form 990-EZ.
right arrowGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................right arrow
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................right arrow
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................right arrow
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... right arrow
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................right arrow

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........right arrow

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2022

Schedule C (Form 990) 2022
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check right arrowexpenses, and share of excess lobbying expenditures).
B Check right arrow
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................ 124,457  
c Total lobbying expenditures (add lines 1a and 1b) ............................................................ 124,457  
d Other exempt purpose expenditures ............................................................................... 553,071,937  
e Total exempt purpose expenditures (add lines 1c and 1d) .................................................. 553,196,394  
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 1,000,000 0
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) ................................................. 250,000  
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................ 0  
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................ 0  
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2019 (b) 2020 (c) 2021 (d) 2022 (e) Total
2a Lobbying nontaxable amount 1,000,000 1,000,000 1,000,000 1,000,000 4,000,000
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		6,000,000
c Total lobbying expenditures 165,280 264,515 278,299 124,457 832,551
d Grassroots nontaxable amount 250,000 250,000 250,000 250,000 1,000,000
e Grassroots ceiling amount
(150% of line 2d, column (e))		 1,500,000
f Grassroots lobbying expenditures       0 0
Schedule C (Form 990) 2022


Schedule C (Form 990) 2022
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
 
c
Media advertisements? ...................................................................................................
 
 
 
d
Mailings to members, legislators, or the public? .............................................................................
 
 
 
e
Publications, or published or broadcast statements? ...........................................................
 
 
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
 
 
i
Other activities? ...................................................................................................................
 
 
 
j
Total. Add lines 1c through 1i ....................................................................................................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C (Form 990) 2022


Additional Data


Software ID: 23017437
Software Version: 2023v5.1

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
right arrow Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
right arrow Attach to Form 990.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
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? ............
6
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? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
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.
Held at the End of the 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 July 25, 2006, and not on a historic structure listed in the National Register ... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year right arrow  
4
Number of states where property subject to conservation easement is located right arrow  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow  
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
right arrow $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, 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" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB 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 XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB 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)
Revenue included on Form 990, Part VIII, line 1 .........................right arrow $  
(ii)
Assets included in Form 990, Part X ...............................right arrow $  
2
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 FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................right arrow $  
b
Assets included in Form 990, Part X ...............................right arrow $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
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?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on 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 .... 73,095,797 73,071,314 70,534,237 63,959,649 59,205,624
b Contributions ... 429,886 1,346,174 1,143,430 427,564 2,802,581
c Net investment earnings, gains, and losses 1,995,033 414,941 3,769,220 6,900,818 2,753,070
d Grants or scholarships ... 78,183 1,736,632 2,375,573 753,794 801,626
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ...... 75,442,533 73,095,797 73,071,314 70,534,237 63,959,649
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment right arrow37.05 %
b
Permanent endowment right arrow47.83 %
c
Term endowment right arrow15.12 %
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
No
(ii) Related organizations .................
3a(ii)
Yes
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ..... 9,206,385 30,671,395 39,877,780
b Buildings ....   287,894,811 123,491,535 164,403,276
c Leasehold improvements   2,017,777 1,150,073 867,704
d Equipment ....   404,172,894 274,377,367 129,795,527
e Other .....   39,509,660 14,129,532 25,380,128
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..right arrow 360,324,415
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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........    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)right arrow  
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)right arrow  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)DUE FROM RELATED PARTY 4,863,654
(2)DUE FROM JV  
(3)INTEREST IN FOUNDATION 139,180,004
(4)RIGHT-OF-USE-ASSETS OPERATING LEASE 8,153,198
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........right arrow 152,196,856
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
DUE TO MDOR 359,954
DEPOSITS  
INTEREST RATE SWAP AGREEMENT 3,751,740
ESTIMATED CLAIMS LIABILITY 11,043,547
ACCRUED INTEREST 4,126,484
UNEARNED PREMIUMS 14,238,359
RIGHT-OF-USE LEASE LIABILITIES 8,220,696


Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)right arrow 41,740,780
2. Liability for uncertain tax positions. In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2022

Schedule D (Form 990) 2022
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ........... 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 XIII.) ........... 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 XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 XIII.) ........... 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 XIII.) ........... 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 XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS.
Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE GOVERNING BODY TO FUNCTION AS ENDOWMENTS. ENDOWMENT FUNDS ARE INVESTED AND HELD TO PROVIDE GROWTH OVER THE LONG-TERM.
Schedule D (Form 990) 2022


Additional Data


Software ID: 23017437
Software Version: 2023v5.1




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
Medium right arrow Complete if the organization answered "Yes" on Form 990, Part IV, question 20a.
Medium right arrow Attach to Form 990.
Medium right arrow Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
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.
3
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.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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, as a factor in determining eligibility for free or discounted care.
4
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"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
Yes
 
c
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? . . . . . . . . . . . . .
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (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) . . . 		    8,814,970   8,814,970 1.58 %
b Medicaid (from Worksheet 3, column a) . . . . .     67,206,805 42,281,942 24,924,863 4.46 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .         0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 76,021,775 42,281,942 33,739,833 6.04 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     2,734,982 943,058 1,791,924 0.32 %
f Health professions education (from Worksheet 5) . . .     8,808,847 4,301,325 4,507,522 0.81 %
g Subsidized health services (from Worksheet 6) . . . .     26,643,380 17,325,973 9,317,407 1.67 %
h Research (from Worksheet 7) .     2,063,588   2,063,588 0.37 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     7,271,828   7,271,828 1.30 %
j Total. Other Benefits . . 0 0 47,522,625 22,570,356 24,952,269 4.47 %
k Total. Add lines 7d and 7j . 0 0 123,544,400 64,852,298 58,692,102 10.51 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
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.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support     4,410   4,410 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy     147,685   147,685 0.03 %
8 Workforce development         0 0 %
9 Other         0 0 %
10 Total 0 0 152,095 0 152,095 0.03 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
 
No
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
15,207,016
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
146,740,250
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
225,915,950
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-79,175,700
8
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:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
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 .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General Medical and Surgical Children's Hospital Teaching Hospital Critical Access Hospital Research Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 BILLINGS CLINIC
2800 TENTH AVE N
BILLINGS,MT59101
WWW.BILLINGSCLINIC.COM
13345 		X X   X   X X     1
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
1
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 22
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): https://www.billingsclinic.com/app/files/public/5d8a9fb2-7968-4e91-9405-d6caa64f123c/CHIP-Community-
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
1
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
WWW.BILLINGSCLINIC.COM/FINASSIST
b
WWW.BILLINGSCLINIC.COM/FINASSIST
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 6
Part VFacility Information (continued)

Billing and Collections
1
Name of hospital facility or letter of facility reporting group  
Yes No
17 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 all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
1
Name of hospital facility or letter of facility reporting group  
Yes No
22 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
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 5 Facility 1, 1 Facility 1, 1 - BILLINGS CLINIC. Billings Clinic conducted the 2020-23 CHNA in collaboration with the city-county health department, Riverstone Health and St. Vincent Healthcare, a hospital located in Billings MT. In 2020, Billings Clinic, RiverStone Health and St. Vincent Healthcare released Yellowstone County's most recent Community Health Needs Assessment with primary, secondary and qualitative research into the health needs in the community. The 2020 CHNA was a follow-up to similar surveys conducted in 2011, 2014, and 2017 which allowed for historical data in addition to solicited input from key informants and community stakeholders. Community stakeholders and key informants are members of organizations from government, education, health care and public health. Underserved and underrepresented populations were represented by key informants including individuals from various populations comprised of various racial and socio-economic backgrounds.
Schedule H, Part V, Section B, Line 6a Facility 1, 1 Facility 1, 1 - BILLINGS CLINIC. BILLINGS CLINIC'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN A PRE-EXISTING COMMUNITY HEALTH PARTNERSHIP, THE HEALTHY BY DESIGN ALLIANCE, WITH ST. VINCENT HEALTHCARE (HOSPITAL ORGANIZATION) AND RIVERSTONE HEALTH (PUBLIC HEALTH DEPARTMENT FOR CITY AND COUNTY). THE ALLIANCE ALSO CONDUCTED A CHNA IN 2006, 2011, 2014, 2017 AND 2020.
Schedule H, Part V, Section B, Line 11 Facility 1, 1 Facility 1, 1 - BILLINGS CLINIC. The CHNA identified 11 areas of opportunity after consideration of various criteria, including a comparison with benchmark data and historical trends, analysis of the number of persons affected and significance of findings. These areas of opportunity identified included access to health care, cancer, diabetes, heart disease and stroke, injury and violence, mental health, nutrition and physical activity, potentially disabling conditions, respiratory diseases, sexual health and substance abuse. Prioritization ranked four priorities as the top needs: 1) mental health; 2) substance abuse; 3) access to health care and 4) nutrition, physical activity and weight. Billings Clinic addresses these CHNA-identified needs at the organizational level with efforts to improve awareness and education, as well as to remove barriers to care. Work is done with clinical departments, service lines, nursing and medical education, community relations, population health, care management, city/county health department, and the state and federal government. Billings Clinic is part of several community-wide coalitions to address community health needs in a collaborative way. Access to health care - Billings Clinic participated in improving access to health care through appointment availability, transportation from appointments, cost of prescriptions and increased telemedicine offerings in rural communities. This year, more than 100 Billings Clinic physicians in 28 specialties traveled in excess of 260,000 miles to provide specialty care for residents of rural Montana, Wyoming, and North Dakota. Billings Clinic is the home office of the Eastern Montana Telemedicine Network, which provided thousands of telemedicine appointments with medical specialists, as well as administrative and operational support to people attending education and meetings through 40 partner sites in Montana, western North Dakota, and northern Wyoming. Billings Clinic supports medical careers classes in local high schools, clinical rotations for nursing students, dietary students and pharmacy students each year to help increase students in the healthcare rural workforce pipeline. Billings Clinic provides free transportation for patients who are financially unable to get home from outpatient and inpatient stays, for a total, unreimbursed cost of $38,000. For the last 19 years, Billings Clinic has offered HealthLine, which is a free service available to all community members to ask health-related questions to medical professionals, twenty-four hours a day, seven days a week. From July to December of 2023, Billings Clinic spent $221,000 on HealthLine-related costs to ensure that this service is available to the community. Billings Clinic Medication Assistance Program served thousands of uninsured and underinsured patients with tens of thousands of prescriptions processed in 2023, including financial assistance for necessary medications. The total value of the donated medications was over $1 million. Cancer - Billings Clinic provides financial and in-kind support for the American Cancer Society, Montana Women's Run, cancer research and screenings. Free or low-cost screenings for cancer are coordinated and reported on through the Cancer Committee's community outreach task group. Cancer Care Navigators help with non-clinical needs to impact patient care. Diabetes - Billings Clinic provides financial and in-kind support for Diabetes Camp for Kids in addition to diabetes prevention and self-management education at no or low charge (subsidized). Heart disease and stroke - Billings Clinic makes annual financial donations and provides in-kind leadership, health policy advocacy, special event and committee support for organizations supporting prevention, research and advocacy for many chronic diseases, including the American Heart Association. Billings Clinic also partners with the Alliance for Healthy Montanans to advocate for health policies that benefit persons with chronic diseases, including support for Medicaid expansion. In addition, Billings Clinic offers free community education during Heart Month and throughout the year including awareness for the signs and symptoms of heart attack and through our cardiac rehabilitation program. Infant health - Billings Clinic provides parental education resources and free lactation education and consultations for new moms. Injury and violence - Trauma and Injury Prevention is subsidized at a 0.5 (half time) position in the Emergency and Trauma Center by a registered nurse who provided education for safe driving, falls prevention, brain and spinal cord injury prevention, helmet safety and more. The Sexual Assault Nursing Exam (SANE) program provides subsidized medical treatment and emotional support to children, teens and adults annually who were victims of sexual assault at a cost of more than $121,000. Billings Clinic also subsidized the hours for a physician to serve as the medical director of the SANE program and to provide free follow-up care for children under 18. The SANE staff and volunteers also provide training in the region. Billings Clinic also provides in-kind time support for local organizations and the city to address public safety. Mental health - Billings Clinic is a founding member of the Community Crisis Center which is a point of access for people in our community seeking crisis stabilization services for mental health, substance abuse and/or social service needs regardless of their ability to pay. We support the Community Crisis Center for people with co-occurring disorders of mental health and substance use through financial support, leadership and staffing of mental health workers and social workers, as well as board membership by our Director of Psychiatric Services. The Community Crisis Center serves thousands of individuals with assessments, case management, group therapy, addiction counseling, referrals and stabilization services to people in need 24/7. Billings Clinic provides psychiatric hospital admissions at the only inpatient psychiatric hospital for children, teens and adults in central/eastern Montana and northern Wyoming. Psychiatric services are subsidized at a multi-million-dollar shortfall each year. Over the last six months of 2023, the shortfall totaled $2.3M. Our latest project to increase access to mental health care is Billings Clinic's Psychiatric Residency Program, which started in July 2019 and is the only one of its kind in the surrounding region. In addition, we provide financial donations to several mental health organizations, including the Out of the Darkness Walk for suicide prevention and Rimrock Foundation. Nutrition and weight - Billings Clinic is a founding member of the Healthy By Design Coalition which aims to address issues of underinsured and underserved community members. Billings Clinic in partnership with Healthy By Design, provided access to low-cost fresh fruits and vegetables at the Healthy By Design Gardeners' Market by accepting WIC and SNAP for payment. Billings Clinic provided financial support for major events to encourage thousands of individuals and families to exercise together, including Big Sky State Games, Big Sky Fit Kids, Saturday Live Fun Run, Run Turkey Run, Montana Marathon, Montana Women's Run, and many other run/walk fundraisers for local nonprofit organizations. Billings Clinic also supports local schools in the promotion of physical activity and wellness through the "Superstar Awards" $100 grant awards for 10 teachers per year to encourage physical activity and wellness in their classrooms, for all grades, in partnership with the YMCA. Disabling conditions - Billings Clinic offers support groups for caregivers of persons with disabilities and provides financial support to local nonprofits in advancing health equity for individuals with disabilities. Respiratory diseases - Clinic provides education for adults and teens about the dangers of vaping and tools/information for cessation. In coordination with community health partners, Billings Clinic provides ongoing community education for the prevention and treatment of respiratory illness. Sexual health - Billings Clinic conducts numerous outreach clinics for underserved populations in rural regions in addition to free education focused on sexual health.
Schedule H, Part V, Section B, Line 11 Facility 1, 2 Facility 1, 2 - BILLINGS CLINIC. Substance abuse - Billings Clinic is a member of the Substance Abuse Connect Coalition which focuses its work on prevention, education, and diversion to increase access to resources. Billings Clinic's participation in the coalition allows for coordinated efforts and increased impact. In addition, Project ECHO provided training and support to mental health professionals, nurses and physicians across the region throughout the year in educational sessions for the Department of Corrections, Integrated Addictions and Psychiatry and Pediatric Mental Health at an unreimbursed cost of $5,000. Tobacco use - Billings Clinic provides free education for adults and teens about the dangers of vaping, tobacco cessation screening and reduction in insurance premiums for Billings Clinic employees who don't use tobacco, as well as a free tobacco cessation course. Billings Clinic addresses the social determinants of health through advocacy, in-kind leadership and financial support of a variety of organizations doing work on important issues that affect health, including housing/homelessness, substance abuse, transportation and education. Billings Clinic is a member of several coalitions in Yellowstone County working on social determinants of health, including healthy neighborhoods, built environment and social connections (Healthy By Design Coalition and Age Friendly Billings); transportation (led by Met Transit); and housing (Continuum of Care Coalition, led by United Way and Tumbleweed). Billings Clinic provides board leadership, in-kind and financial support for economic development and security for residents of Yellowstone County and our surrounding region through Big Sky Economic Development and the Chamber of Commerce (Billings and Montana state Chambers of Commerce).
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 9
Part VFacility Information (continued)

Section D. 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?17
Name and address Type of Facility (describe)
1 BILLINGS CLINIC
1045 N 30TH ST
BILLINGS,MT59101 		OUTPATIENT CLINIC
2 BILLINGS CLINIC MILES CITY
620 S HAYNES AVE
MILES CITY,MT59301 		OUTPATIENT CLINIC
3 BILLINGS CLINIC HEIGHTS
760 WICKS LN
BILLINGS,MT59105 		OUTPATIENT CLINIC
4 BILLINGS CLINIC OBGYN
925 HIGHLAND BLVD
BOZEMAN,MT59715 		OBSTETRICS AND GYNECOLOGY CLINIC
5 BILLINGS CLINIC SURGERY CENTER
2929 TENTH AVE N
BILLINGS,MT59101 		OUTPATIENT SURGERY CENTER
6 BILLINGS CLINIC WEST
2675 CENTRAL AVE
BILLINGS,MT59102 		OUTPATIENT CLINIC
7 BEHAVIORAL HEALTH CENTER
2800 10TH AVE N
BILLINGS,MT591010703 		OUTPATIENT MENTAL HEALTH CENTER
8 BILLINGS CLINIC CODY
201 YELLOWSTONE AVE
CODY,WY92414 		OUTPATIENT CLINIC
9 BILLINGS CLINIC CANCER CENTER
801 N 29TH ST
BILLINGS,MT59101 		CANCER CARE, INFUSION
10 PSYCHIATRIC CENTER
1020 N 27TH ST
BILLINGS,MT59101 		INPATIENT PSYCHIATRIC CENTER
11 HOME OXYGEN
1050 S 25TH ST W
BILLINGS,MT59102 		DURABLE MEDICAL EQUIPMENT
12 BOZEMAN PEDIATRICS
1819 S 22ND ST
BOZEMAN,MT59715 		PEDIATRIC OUTPATIENT CENTER
13 BILLINGS CLINIC ORTHOPEDICS
2702 8TH AVE N
BILLINGS,MT59101 		ORTHOPEDICS AND SPORTS MEDICINE
14 BILLINGS CLINIC BOZEMAN
3905 WELLNESS WAY
BOZEMAN,MT59718 		OUTPATIENT CLINIC
15 BILLINGS CLINIC CODY ORTHOPEDICS
3030 BIG HORN AVE
CODY,MT82414 		ORTHOPEDICS
16 BILLINGS CLINIC CODY MRI & CT IMAGING
613 YELLOWSTONE AVE
CODY,WY82414 		MRI & CT IMAGING
17 BILLINGS CLINIC WEST YELLOWSTONE
236 YELLOWSTONE AVE
WEST YELLOWSTONE,WY59758 		OUTPATIENT CLINIC
Schedule H (Form 990) 2023
Schedule H (Form 990) 2023
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
Schedule H, Part I, Line 3c DESCRIPTION OF ADDITIONAL CRITERIA TO DETERMINE FINANCIAL ASSISTANCE IN ADDITION TO THE FEDERAL POVERTY GUIDELINES BILLINGS CLINIC ALSO USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, UNDERINSURANCE STATUS AND RESIDENCY IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE.
Schedule H, Part I, Line 6a RELATED ORGANIZATION ANNUAL COMMUNITY BENEFIT REPORT STILLWATER COMMUNITY HOSPITAL, A RELATED CRITICAL ACCESS HOSPITAL, PREPARES THEIR OWN INDEPENDENT COMMUNITY BENEFIT REPORT.
Schedule H, Part V, Section B, Line 16c DIRECT URL FOR FINANICAL POLICY: HTTPS://WWW.BILLINGSCLINIC.COM/APP/FILES/PUBLIC/7C016AF9-3E3F-4FA1-A20DB85669557B4C/BCL_FINANCIALASSISTANCEBROCHUREMAY23.PDF
Schedule H, Part I, Line 7g Subsidized Health Services SUBSIDIZED HEALTH SERVICES INCLUDES VARIOUS PHYSICIAN CLINICS IN ORDER TO BETTER SERVE THE MONTANA AREAS. MANY CRITICAL SERVICES WERE NOT FULLY REIMBURSED SUCH AS BEHAVIORAL HEALTH, PEDIATRIC SPECIALTIES, SEXUAL ASSAULT NURSE EXAMINATION AND RURAL OUTREACH CLINICS. PRIMARY CARE CLINICS WERE ONLY INCLUDED IF THEY WERE IN RURAL, UNDERSERVED AREAS OUTSIDE OUR PRIMARY SERVICE AREA. TOTAL COSTS FOR THE SUBSIDIZED SERVICES WERE $26,643,380 AND NET COMMUNITY BENEFIT OF THOSE SERVICES WAS DETERMINED TO BE $9,317,408.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 0
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. BILLINGS CLINIC USED THE SAME COST-TO-CHARGE RATIO THROUGHOUT THE ENTIRE SCHEDULE TO DETERMINE THE COST OF THOSE ACTIVITIES.
Schedule H, Part II Community Building Activities COMMUNITY BUILDING ACTIVITIES: BILLINGS CLINIC'S COMMUNITY BUILDING ACTIVITIES INCLUDE COMMUNITY SUPPORT AND ADVOACY FOR PATIENT CARE.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs IS THE BEST ESTIMATE OF THE PERCENTAGE OF MONTANA'S MEDICARE POPULATION (65 AND OLDER) WHO ARE AT OR BELOW 200% OF FEDERAL POVERTY LEVEL, BASED ON MEDICARE AND U.S. CENSUS DATA, AND THOSE PATIENTS WOULD QUALIFY FOR FULL FINANCIAL ASSISTANCE. A HIGHER PERCENTAGE WOULD QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE WITH INCOMES FROM 200- 400 PERCENT OF FEDERAL POVERTY LEVEL. FOR THE CALCULATION OF THE UNREIMBURSED COST OF MEDICARE A RATIO OF PATIENT COST-TO CHARGES USING WORKSHEET 2 WAS UTILIZED AND APPLIED TO GROSS MEDICARE CHARGES. WE DO NOT USE THE MEDICARE COST REPORT FOR THIS NUMBER. THE COST REPORT ONLY CAPTURES REVENUE RELATED TO THE FACILITY AND DOES NOT CAPTURE REVENUE/LOSSES RELATED TO CLINICAL PROFESSIONAL SERVICES, WHICH ARE A SUBSTANTIAL PORTION OF MEDICARE SHORTFALLS.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance ACCOUNTS ARE BILLED WITH INSURANCE INFORMATION SUPPLIED BY THE PATIENT AND WHEN AVAILABLE, VERIFIED BY BILLINGS CLINIC. BILLINGS CLINIC SENDS PATIENT BILLING STATEMENTS THAT INCLUDE THE SUMMARY OF SERVICES PROVIDED, AMOUNTS PENDING INSURANCE AND AMOUNTS OWED BY THE PATIENT. FINANCIAL ASSISTANCE IS OFFERED TO PATIENTS WHO ARE UNINSURED OR UNDERINSURED. BILLINGS CLINIC ASSISTS PATIENTS APPLYING FOR FINANCIAL ASSISTANCE, AND PUBLIC PROGRAMS SUCH AS MEDICAID. BILLINGS CLINIC ALSO ASSISTS PATIENTS WITH PAYMENT PLANS INTEREST FREE FOR 12 MONTHS OR THROUGH AN EXTENDED LOAN OPTION UP TO 60 MONTHS. BILLINGS CLINIC WILL NOT REFER A PATIENT TO COLLECTIONS UNTIL AFTER 120 DAYS OF THE INDIVIDUAL BEING AWARE OF THEIR OPTIONS.
Schedule H, Part V, Section B, Line 16a FAP website 1 - BILLINGS CLINIC: Line 16a URL: WWW.BILLINGSCLINIC.COM/FINASSIST;
Schedule H, Part V, Section B, Line 16b FAP Application website 1 - BILLINGS CLINIC: Line 16b URL: WWW.BILLINGSCLINIC.COM/FINASSIST;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website 1 - BILLINGS CLINIC: Line 16c URL: WWW.BILLINGSCLINIC.COM/FINASSIST;
Schedule H, Part VI, Line 2 Needs assessment SINCE 1994, BILLINGS CLINIC, RIVERSTONE HEALTH AND ST. VINCENT HEALTHCARE HAVE BEEN WORKING TOGETHER AS THE ALLIANCE, CREATING AND SUSTAINING INNOVATIVE PROGRAMS THAT ADDRESS COMPLEX COMMUNITY-WIDE HEALTH ISSUES. RIVERSTONE HEALTH IS THE PUBLIC HEALTH DEPARTMENT FOR THE YELLOWSTONE COUNTY AND ST. VINCENT HEALTHCARE IS A 501(C)(3) HEALTHCARE ENTITY ALSO SERVING THE BILLINGS AREA.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance ALL PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE. INFORMATIONAL BROCHURES WITH ONE-PAGE PLAIN LANGUAGE SUMMARY AND APPLICATION FORMS ARE AVAILABLE AT REGISTRATION DESKS IN THE CLINIC AND THE HOSPITAL, THE EMERGENCY DEPARTMENT DISCHARGE DESK, AND ON OUR WEBSITE AT WWW.BILLINGSCLINIC.COM/FINASSIST. OUR WEBPAGE INCLUDES THE FULL FINANCIAL ASSISTANCE POLICY. PATIENTS CAN ALSO CALL A DIRECT LINE TO TALK TO A PATIENT FINANCIAL REPRESENTATIVE. INFORMATION ABOUT FINANCIAL ASSISTANCE IS PRINTED ON THE BACK OF PATIENT BILLS. PATIENTS HOSPITALIZED WITHOUT IDENTIFIYING A THIRD PARTY PAYER SOURCE ARE SCREENED FOR COVERAGE/ASSISTANCE (DISABILITY, MEDICAID, VETERANS ADMINSTRATION, INDIAN HEALTH SERVICES AND WORKERS COMPENSATIONS). APPLICATIONS ARE MAILED TO PATIENTS WHOSE PAYMENT PATTERN INDICATES THAT THEY MAY NEED ASSISTANCE. PATIENT FINANCIAL SERVICES STAFF IS AVAILABLE TO HELP ANY PATIENT NEEDING ASSISTANCE COMPLETING AN APPLICATION. LANGUAGE TRANSLATION SERVICES ARE ALSO AVAILABLE.
Schedule H, Part VI, Line 4 Community information BILLINGS CLINIC IS BASED IN BILLINGS, MONTANA AND IS MONTANA'S LARGEST HEALTH CARE ORGANIZATION SERVING A VAST REGION COVERING MUCH OF MONTANA, WYOMING AND NORTH DAKOTA. BILLINGS CLINIC IS ONE OF MONTANA'S LARGEST EMPLOYERS WITH APPROXIATELY 4,500 EMPLOYEES INCLUDING MORE THAN 600 PHYSICIANS AND ADVANCED PRACTITIONERS OFFERING MORE THAN 80 SPECIALTIES. COMMUNITY BENEFIT INCLUDES HEALTH CARE SERVICES PROVIDED AT BILLINGS CLINIC LOCATIONS, INCLUDING THE HOSPITAL, MAIN CLINIC, BRANCH CLINICS AND OUTREACH CLINICS. BILLINGS CLINIC SPECIALISTS PROVIDE 110 OUTREACH CLINICS PER MONTH AT 21 DIFFERENT REGIONAL LOCATIONS FOR THE RESIDENTS OF MONTANA, WYOMING AND NORTH DAKOTA.
Schedule H, Part VI, Line 5 Promotion of community health AS A NOT-FOR PROFIT COMMUNITY-GOVERNED ORGANIZATION, WORKING WITH OTHER ORGANIZATIONS IN THE COMMUNITY TO ADDRESS THE HEALTH CARE NEEDS IS AN IMPORTANT PART OF OUR MISSION. BILLINGS CLINIC HAS BEEN INVOLVED IN MEETING THE NEEDS OF INDIVIDUALS AND COMMUNITIES THROUGH COOPERATIVE EFFORTS WITH OTHER ORGANIZATIONS IN YELLOWSTONE COUNTY AND IN OUR REGION. COMMUNITY HEALTH COLLABORATION SINCE 1994, BILLINGS CLINIC, RIVERSTONE HEALTH AND ST. VINCENT HEALTHCARE HAVE BEEN WORKING TOGETHER, CREATING AND SUSTAINING INNOVATIVE PROGRAMS THAT ADDRESS COMPLEX COMMUNITY-WIDE HEALTH ISSUES. THEIR PURPOSE IS TO CREATE SUSTAINED CHANGE IN HOW OUR COMMUNITY RESPONDS TO THE CHALLENGE OF THE HIGH COST OF PRESCRIPTION DRUGS FOR THE UNINSURED AND THE POPULATION LIFESTYLE ISSUES OF OBESITY, POOR NUTRITION AND PHYSICAL ACTIVITY HABITS. THESE ARE EXAMPLES OF THE PAST AND FUTURE SUCCESSES OF THE ALLIANCE'S EFFORTS. COMMUNITY CRISIS CENTER - THE COMMUNITY CRISIS CENTER (CCC), ENHANCES\ACCESS TO BEHAVIORAL HEALTH CARE IN BILLINGS. THE CCC HAS SUCCESSFULLY REDUCED INAPPROPRIATE UTILIZATION OF LOCAL EMERGENCY DEPARTMENTS, DECREASED THE NUMBER OF SHORT-TERM INPATIENT HOSPITAL ADMISSIONS, AND HAS BEEN A DRIVING FORCE IN REDUCING THE INMATE POPULATION AT THE YELLOWSTONE COUNTY DETENTION FACILITY. MEDICATION ASSISTANCE PROGRAM (MAP) - MAP HELPS PATIENTS AFFORD THE PRESCRIPTION DRUGS THEY NEED BY CONNECTING INDIVIDUALS WITH AVAILABLE PATIENT ASSISTANCE PROGRAMS OFFERING DISCOUNTED OR FREE PRESCRIPTION MEDICATION. MAP ASSISTS LOW INCOME, UNINSURED OR UNDER INSURED PEOPLE IN GETTING THE MEDICATIONS THEY NEED, BUT CAN'T AFFORD. HEALTHY BY DESIGN - TO HELP RECOGNIZE ORGANIZATIONS IN YELLOWSTONE COUNTY COMMITTED TO IMPROVING OUR COMMUNITY'S HEALTH, BILLINGS CLINIC, RIVERSTONE HEALTH, AND ST. VINCENT HEALTHCARE LAUNCHED A COMMUNITY HEALTH COALITION CALLED HEALTHY BY DESIGN. HEALTHY BY DESIGN ENCOURAGES, RECOGNIZES, EDUCATES AND CREATES A STANDARD OF EXCELLENCE FOR PROMOTING HEALTHY LIFESTYLES BY ENCOURAGING ACTIVE LIVING AND HEALTHY CHOICES THAT SHAPE THE FUTURE OF THE COMMUNITY. FOR PROMOTING HEALTHY LIFESTYLES BY ENCOURAGING ACTIVE LIVING AND HEALTHY CHOICES THAT SHAPE THE FUTURE OF THE COMMUNITY.
Schedule H, Part VI, Line 6 Affiliated health care system AFFILIATED HEALTH CARE SYSTEM: BILLINGS CLINIC HAS AN AFFILIATED RELATIONSHIP WITH BEARTOOTH BILLINGS CLINIC, STILLWATER HOSPITAL ASSOCIATION AND BROADWATER HEALTHCARE. EACH HOSPITAL IS A MONTANA NON-PROFIT CORPORATION. BEARTOOTH AND STILLWATER HAVE BEEN AFFILIATES OF BILLINGS CLINIC SINCE 2002 WITH A SHARED MANAGEMENT AGREEMENT. BROADWATER HEALTHCARE BEGAN THEIR AFFILIATION IN 2019. WITHIN THE AGREEMENT BILLINGS CLINIC PROVIDES MANAGEMENT, DIGITAL INFORMATION SYSTEMS, AND ANCILLARY SUPPORT SERVICES TO AREA HOSPITALS AND CLINICS. THE AFFILIATION BRINGS A STRONGER ALIGNMENT WITHIN THE GROUP DUE TO A DESIRE TO STABILIZE AND ENHANCE THE LEVEL AND SCOPE OF HEALTH CARE SERVICES AVAILABLE IN EACH COMMUNITY. THE AFFILIATION ALLOWED THEM TOSTRENGTHEN THEIR COMMITMENT TO QUALITY, PATIENT SAFETY AND SERVICE VALUES.
Schedule H (Form 990) 2023
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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," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Billings Clinic
 
Employer identification number
81-0231784
Part I
General Information on Grants and Assistance
1
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? ........................
2
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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC 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
noncash assistance		 (h) Purpose of grant
or assistance
(1) COMMUNITY CRISIS CENTER
704 NORTH 30TH STREET
BILLINGS,MT59101 		20-3231164 501(C)(3) 40,595       SUPPORT OPERATIONS
(2) BILLINGS COMMUNITY FOUNDATION
404 N 30TH ST BILLINGS MT 59101
BILLINGS,MT59101 		20-4286919 501(C)(3) 10,000       SUBSTANCE ABUSE PROGRAMS
(3) Rocky Mountain College
1511 Poly Dr
Billings,MT59102 		81-0235407 501(C)(3) 5,500       EDUCATION PROGRAMS
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2023

Schedule I (Form 990) 2023
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1) SCHOLARSHIPS 9 7,821      
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. BILLINGS CLINIC AWARDS SCHOLARSHIPS TO INDIVIDUALS WHO EXHIBIT A STRONG DESIRE AND POTENTIAL TO EXCEL IN THE HEALTHCARE FIELD. BILLINGS CLINIC ALSO PROVIDES GRANTS TO OTHER HEALTH RELATED ORGANIZATIONS. MONTHLY FINANCIAL REPORTS ARE REVIEWED AND SIGNED BY THE GRANT MANAGER, AND THEN SUBMITTED FOR APPROVAL OF THE DRAWING OF FUNDS FOR GRANTS.
Schedule I (Form 990) 2023



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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
medium right arrow graphic Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
medium right arrow graphic Attach to Form 990.
medium right arrow graphic Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used 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.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on 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 ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
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 on 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 (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1HEIDI DUNCAN MD
 
PHYSICIAN BOARD MEMBER 		(i)

(ii)		 231,799
-------------
0 		0
-------------
0 		2,115
-------------
0 		23,387
-------------
0 		37,863
-------------
0 		295,164
-------------
0 		0
-------------
0
2KENDRICK TROSTEL MD
 
PHYSICIAN BOARD MEMBER 		(i)

(ii)		 660,998
-------------
0 		0
-------------
0 		5,256
-------------
0 		30,017
-------------
0 		25,454
-------------
0 		721,725
-------------
0 		0
-------------
0
3SCOTT ELLNER DO
 
FORMER CEO 		(i)

(ii)		 18,900
-------------
0 		0
-------------
0 		963,900
-------------
0 		1,002
-------------
0 		0
-------------
0 		983,802
-------------
0 		0
-------------
0
4KATHLEEN QUINONES
 
CFO 		(i)

(ii)		 445,263
-------------
0 		0
-------------
0 		3,328
-------------
0 		89,147
-------------
0 		12,994
-------------
0 		550,732
-------------
0 		0
-------------
0
5CLINTON SEGER MD
 
CEO 		(i)

(ii)		 770,581
-------------
0 		0
-------------
0 		59,711
-------------
0 		114,630
-------------
0 		17,870
-------------
0 		962,792
-------------
0 		56,104
-------------
0
6MICHAEL MORONE MD
 
PHYSICIAN 		(i)

(ii)		 1,500,503
-------------
0 		0
-------------
0 		3,564
-------------
0 		28,150
-------------
0 		28,472
-------------
0 		1,560,689
-------------
0 		0
-------------
0
7VANCE FREDRICKSON MD
 
PHYSICIAN 		(i)

(ii)		 2,046,757
-------------
0 		20,000
-------------
0 		1,887
-------------
0 		27,482
-------------
0 		9,489
-------------
0 		2,105,615
-------------
0 		0
-------------
0
8MARLIN RICHARDSON MD
 
PHYSICIAN 		(i)

(ii)		 1,472,913
-------------
0 		0
-------------
0 		1,932
-------------
0 		28,150
-------------
0 		31,322
-------------
0 		1,534,317
-------------
0 		0
-------------
0
9ANTHONY ROCCISANO DO
 
PHYSICIAN 		(i)

(ii)		 1,610,326
-------------
0 		0
-------------
0 		2,220
-------------
0 		28,150
-------------
0 		33,204
-------------
0 		1,673,900
-------------
0 		0
-------------
0
10CHRISTOPHER STEWART DO
 
PHYSICIAN 		(i)

(ii)		 1,273,724
-------------
0 		20,000
-------------
0 		1,524
-------------
0 		19,900
-------------
0 		28,488
-------------
0 		1,343,636
-------------
0 		0
-------------
0
Schedule J (Form 990) 2023

Schedule J (Form 990) 2023
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 4a Severance or change-of-control payment SCOTT ELLNER, FORMER BILLINGS CLINIC CEO. THESE PAYMENTS ARE INCLUDED IN THE AMOUNT OF OTHER REPORTABLE COMPENSATION REPORTED ON FORM 990, PART VII AND SCHEDULE J, PART II.
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan THE BILLINGS CLINIC SUPPLEMENTAL RETIREMENT AGREEMENT FOR SENIOR EXECUTIVES (SERP) IS A NON-ELECTIVE 457(F) AGREEMENT AND PROVIDES FOR ANNUAL DEFERRALS, WHICH BECOME VESTED AND PAYABLE AFTER 4 YEARS. THE FOLLOWING INDIVIDUALS ARE PARTICIPANTS IN THE PLAN DURING THE 2023 CALENDAR YEAR WHICH IS INCLUDED IN DEFERRED COMPENSATION ON SCHEDULE J, PART II, COLUMN C: CLINTON SEGER - 90,002 KATHLEEN QUINONES - 67,367 THE FOLLOWING INDIVIDUAL PARTICIPATED IN THE 457(F) PLAN AND RECEIVED A PAYMENT REPORTED IN PART II, COLUMN (F) THAT WAS REPORTED AS DEFERRED COMPENSATION BY BILLINGS CLINIC IN A PRIOR YEAR: CLINTON SEGER - 56,104
Schedule J, Part I, Line 7 Non-fixed payments THE BOARD OF DIRECTORS ANNUALLY DETERMINES THE INCENTIVE PLAN AMOUNT FOR THE CEO AND THE SENIOR EXECUTIVE TEAM BASED ON AN EXTERNAL COMPENSATION STUDY. THE AVAILABILITY OF THE INCENTIVE IS AWARDED BASED ON FINANCIAL PERFORMANCE AS WELL AS ORGANIZATIONAL PERFORMANCE MEASUREMENTS IN QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND THE INDIVIDUAL GOALS SET EACH YEAR IF THE TARGET IS TRIGGERED. THE INCENTIVE IS PAID ONLY IF TRIGGERED FOLLOWING THE FINANCIAL AUDIT PRESENTATION. NO INCENTIVES WERE PAID IN THE PERIOD.
Schedule J (Form 990) 2023

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Billings Clinic
 
Employer identification number
81-0231784
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A MONTANA FACILITY FINANCE AUTHORITY
  		36-4615155 61204KLQ2 10-01-2018 125,786,085 SEE PART VI X     X   X
B MONTANA FACILITY FINANCE AUTHORITY
  		36-4615155   10-01-2018 56,580,000 SEE PART VI   X   X   X
C MONTANA FACILITY FINANCE AUTHORITY
  		36-4615155 61204KNX5 05-17-2022 59,605,571 SEE PART VI   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 73,795,000   1,440,000  
2 Amount of bonds legally defeased ..............        
3 Total proceeds of issue .................. 128,688,498 56,585,037 59,736,796  
4 Gross proceeds in reserve funds .............        
5 Capitalized interest from proceeds ............. 51,823 91    
6 Proceeds in refunding escrows ...............        
7 Issuance costs from proceeds ...............     194,301  
8 Credit enhancement from proceeds .............        
9 Working capital expenditures from proceeds .............        
10 Capital expenditures from proceeds ............. 43,367,802 75,828    
11 Other spent proceeds ............. 85,247,023 56,509,118 59,542,495  
12 Other unspent proceeds .............        
13 Year of substantial completion ............. 2022 2022
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		X   X   X      
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X   X    
16 Has the final allocation of proceeds been made? .......... X   X     X    
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X   X      
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2023

Schedule K (Form 990) 2023
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X   X    
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X   X    
3a Are there any management or service contracts that may result in private business use of bond-financed property? ............. X   X   X      
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? X   X   X      
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X   X    
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government .... 0.2 % 0.3 % 0.2 %  
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .........        
6 Total of lines 4 and 5 ............. 0.2 % 0.3 % 0.2 %  
7 Does the bond issue meet the private security or payment test? ...   X   X   X    
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X   X    
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		X   X   X      
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X   X    
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X   X   X    
b Exception to rebate? ........ X   X   X      
c No rebate due? ......... X   X     X    
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? ..... X   X   X      
Schedule K (Form 990) 2023

Schedule K (Form 990) 2023
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of hedge .........        
d Was the hedge superintegrated? ......                
e Was the hedge terminated? ........                
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X   X    
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period? X   X   X      
7 Has the organization established written procedures to monitor the requirements of section 148? ... X   X   X      
Part Ⅴ
Procedures To Undertake Corrective Action
A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? X   X   X      
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K, Part I, Column (f) Column A THE BONDS WERE ISSUED TO FINANCE CAPITAL PROJECTS, TO REISSUE SERIES 2011A BONDS (ISSUED ON OCTOBER 6, 2014) AND TO CURRENT REFUND SERIES 2008 BONDS (ISSUED ON MAY, 30, 2008).
Schedule K, Part II, Line 3 Column A The total proceeds shown in Part II, Line 3 differs from the Issue Price shown in Part I, (e) due to interest earnings on invested proceeds.
Schedule K, Part III, Line 7 Column A As provided in Treasury Regulation Section 1.141-4(c)(2)(i)(B), the amount of private payments taken into account under the private security or payment test may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount stated in Part III, Line 6. The organization has not undertaken an analysis of the private security or payment test with respect to the bonds, as the level of private business use and/or unrelated trade or business use reported in Part III, Line 6 is not in excess of amounts permitted under Section 145 of the Code.
Schedule K, Part IV, Line 2b Column A THE REFUNDING PORTION OF THE BONDS HAS MET AN EXCEPTION TO THE REBATE REQUIREMENT.
Schedule K, Part I, Column (f) Column B THE BONDS WERE ISSUED TO FINANCE CAPITAL PROJECTS AND TO REISSUE SERIES 2011B BONDS (ISSUED ON JUNE 28, 2016).
Schedule K, Part II, Line 3 Column B The total proceeds shown in Part II, Line 3 differs from the Issue Price shown in Part I, (e) due to interest earnings on invested proceeds.
Schedule K, Part III, Line 7 Column B AS PROVIDED IN TREASURY REGULATION SECTION 1.141-4(C)(2)(I)(B), THE AMOUNT OF PRIVATE PAYMENTS TAKEN INTO ACCOUNT UNDER THE PRIVATE SECURITY OR PAYMENT TEST MAY NOT EXCEED THE AMOUNT OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE. ACCORDINGLY, THE AMOUNT OF PRIVATE PAYMENTS FOR THE REPORTING PERIOD DOES NOT EXCEED THE AMOUNT STATED IN PART III, LINE 6. THE ORGANIZATION HAS NOT UNDERTAKEN AN ANALYSIS OF THE PRIVATE SECURITY OR PAYMENT TEST WITH RESPECT TO THE BONDS, AS THE LEVEL OF PRIVATE BUSINESS USE AND/OR UNRELATED TRADE OR BUSINESS USE REPORTED IN PART III, LINE 6 IS NOT IN EXCESS OF AMOUNTS PERMITTED UNDER SECTION 145 OF THE CODE.
Schedule K, Part IV, Line 2b Column B The refunding and new money portions of the Bonds have met exceptions to the rebate requirement.
Schedule K, Part IV, Line 2c Column B The most recent 5th year rebate report was prepared on October 11, 2023.
Schedule K, Part I, Column (f) Column C THE BONDS WERE ISSUED TO CURRENT REFUND THE SERIES 2018C BONDS (ISSUED ON OCTOBER 1, 2018).
Schedule K, Part II, Line 3 Column C The total proceeds shown in Part II, Line 3 differs from the Issue Price shown in Part I, (e) due to interest earnings on invested proceeds.
Schedule K, Part III, Line 7 Column C As provided in Treasury Regulation Section 1.141-4(c)(2)(i)(B), the amount of private payments taken into account under the private security or payment test may not exceed the amount of private business use and/or unrelated trade or business use. Accordingly, the amount of private payments for the reporting period does not exceed the amount stated in Part III, Line 6. The organization has not undertaken an analysis of the private security or payment test with respect to the bonds, as the level of private business use and/or unrelated trade or business use reported in Part III, Line 6 is not in excess of amounts permitted under Section 145 of the Code.
Schedule K, Part IV, Line 2b Column C Bond proceeds have met an exception to the rebate requirement.
Schedule K, Part IV, Line 2c Column A The most recent 5th year rebate report was prepared on October 25, 2023.
Schedule K (Form 990) 2023

Additional Data


Software ID: 23017437
Software Version: 2023v5.1

Schedule L
(Form 990)
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, line 38a or 40b.
Attach to Form 990 or Form 990-EZ.
Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Part I
Excess Benefit Transactions (section 501(c)(3), section 501(c)(4), and section 501(c)(29) 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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No
2
Enter the amount of tax incurred by the organization managers or disqualified persons during the year under section 4958. ........................... $
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ........ $
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e) Original principal amount (f) Balance due (g) In default? (h) Approved by board or committee? (i) Written agreement?
To From Yes No Yes No Yes No
Total ............... $  
Part III
Grants or Assistance Benefiting 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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990) 2023
Schedule L (Form 990) 2023
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?
Yes No
(1) E JAMES DUNCAN
  		E. JAMES DUNCAN HAS A FAMILY RELATIONSHIP WITH BOARD MEMBER HEIDI DUNCAN. 403,760 EMPLOYEE COMPENSATION   No
(2) NADINE SEGER
  		NADINE SEGER HAS A FAMILY RELATIONSHIP WITH CEO CLINT SEGER. 206,534 EMPLOYEE COMPENSATION   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
Schedule L (Form 990) 2023


Additional Data


Software ID: 23017437
Software Version: 2023v5.1




SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
Attach to Form 990 or 990-EZ.
 Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Open to Public
Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Return Reference Explanation
Form 990, Part VI, Line 4 Significant changes to organizational documents Description of Significant Changes to Bylaws: Billings Clinic added a sole member, MTWY Health Inc. and explains the role of MTWY Health INC as the sole member.
Form 990, Part VI, Line 6 Classes of members or stockholders Description of Members: MTWY Health Inc is Sole member of Billings Clinic. With rights to approve governance decisions.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Description of Governance Decision by Member: MTWY Health INC as the Sole Member approves Amendments to the bylaws, Dissolution, Change in Name, Approval of budgets and strategic plans, Action or inaction in material variance to the Member and any matters required by to be submitted to Member.
Form 990, Part VI, Line 11b Review of form 990 by governing body THE 990 REVIEW IS COMPLETED BEFORE THE RETURN IS FILED. IT IS REVIEWED BY THE CONTROLLER, CFO AND THEN THE BOARD OF DIRECTORS.
Form 990, Part VI, Line 12c Conflict of interest policy THE COMPLIANCE OFFICER ALONG WITH THE GOVERNANCE AND NOMINATING COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR MONITORING THE EFFECTIVENESS OF THE CONFLICT OF INTEREST REPORTING AND MANAGEMENT FOR BILLINGS CLINIC. IN ADDITION, BILLINGS CLINIC VICE PRESIDENTS ARE RESPONSIBLE FOR ENSURING THAT THEIR DIRECT REPORTS ARE COMPLYING WITH THIS POLICY.
Form 990, Part VI, Line 15a Process to establish compensation of top management official BILLINGS CLINIC HAS AN EXECUTIVE COMPENSATION PROGRAM ADMINISTERED ANNUALLY BY INDEPENDENT TRUSTEES FOLLOWING BEST PRACTICES AND THE HIGHEST REGULATORY STANDARDS EXPECTED OF A NOT-FOR PROFIT ORGANIZATION. THEY FOLLOW BOARD APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY WHICH DEFINES THE MARKET AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. THEY LOOK AT RELEVANT MARKET DATA OF SIMILAR ROLES IN SIMILAR ORGANIZATIONS. ANNUAL DISCLOSURE OF THE COMMITTEE'S ACTIONS AND DECISIONS TO THE FULL BOARD IS REQUIRED. BILLINGS CLINIC ENGAGES SULLIVAN COTTER TO PERFORM REGULAR COMPENSATION REVIEWS FOR EXECUTIVES, MANAGER AND DIRECTORS. SULLIVAN COTTER PERFORMED EXECUTIVE COMPENSATION REVIEWS IN 2023 AND ON AN AD HOC BASIS AS NEEDED.
Form 990, Part VI, Line 15b Process to establish compensation of other employees BILLINGS CLINIC HAS AN EXECUTIVE COMPENSATION PROGRAM ADMINISTERED ANNUALLY BY INDEPENDENT TRUSTEES FOLLOWING BEST PRACTICES AND THE HIGHEST REGULATORY STANDARDS EXPECTED OF A NOT-FOR PROFIT ORGANIZATION. THEY FOLLOW BOARD APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY WHICH DEFINES THE MARKET AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. THEY LOOK AT RELEVANT MARKET DATA OF SIMILAR ROLES IN SIMILAR ORGANIZATIONS. ANNUAL DISCLOSURE OF THE COMMITTEE'S ACTIONS AND DECISIONS TO THE FULL BOARD IS REQUIRED. BILLINGS CLINIC ENGAGES SULLIVAN COTTER TO PERFORM REGULAR COMPENSATION REVIEWS FOR EXECUTIVES, MANAGER AND DIRECTORS. SULLIVAN COTTER PERFORMED EXECUTIVE COMPENSATION REVIEWS IN 2023 AND ON AN AD HOC BASIS AS NEEDED.
Form 990, Part VI, Line 19 Required documents available to the public BILLINGS CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON AN AS NEEDED BASIS.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: 1869245, Related or Exempt Function Revenue: 1812825, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 56420;
Form 990, Part IX, Line 11g Other Fees AMBULANCE SERVICES - Total Expense: 103766, Program Service Expense: 103766, Management and General Expenses: , Fundraising Expenses: ; CONTRACT LABOR - Total Expense: 1124286, Program Service Expense: 635671, Management and General Expenses: 488615, Fundraising Expenses: ; COLLECTIONS - Total Expense: 647143, Program Service Expense: 365895, Management and General Expenses: 281248, Fundraising Expenses: ; CONSULTING - Total Expense: 743686, Program Service Expense: 420480, Management and General Expenses: 323206, Fundraising Expenses: ; CONTRACT MANAGEMENT - Total Expense: 26717, Program Service Expense: 15106, Management and General Expenses: 11611, Fundraising Expenses: ; CONTRACT SERVICES - Total Expense: 20886186, Program Service Expense: 11809050, Management and General Expenses: 9077136, Fundraising Expenses: ; HEALTH CARE TECH SERVICES - Total Expense: 3834506, Program Service Expense: 3834506, Management and General Expenses: , Fundraising Expenses: ; MEDICAL TEST SERVICES - Total Expense: 3453159, Program Service Expense: 3453159, Management and General Expenses: , Fundraising Expenses: ; PHYSICIAN FEES - Total Expense: 32761255, Program Service Expense: 32761255, Management and General Expenses: , Fundraising Expenses: ; PATIENT CARE SERVICES - Total Expense: 1743475, Program Service Expense: 1743475, Management and General Expenses: , Fundraising Expenses: ; NURSING - Total Expense: 13810283, Program Service Expense: 13810283, Management and General Expenses: , Fundraising Expenses: ; OTHER PURCHASED SERVICES - Total Expense: 1994322, Program Service Expense: 1127590, Management and General Expenses: 866732, Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances CHANGE IN FAIR VALUE OF INTEREST RATE SWAP - -299253; CHANGE IN INTEREST OF FOUNDATION - 15974247;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2023


Additional Data


Software ID: 23017437
Software Version: 2023v5.1
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
Attach to Form 990.
Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2023
Open to Public Inspection
Name of the organization
Billings Clinic
 
Employer identification number

81-0231784
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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
(1) MONTANA HEALTHCARE INDEMNITY LLC
2800 TENTH AVENUE NORTH
BILLINGS,MT59101
 INSUR CAPTIVE MT 4,537,699 30,383,407 BILLINGS CLINIC
 
(2) SPECIALTY SUPPLIES AND SERVICES LLC
2800 TENTH AVENUE NORTH
BILLINGS,MT59101
36-4871868 		SPEC SUPPLY MT 44,475,326 17,261,379 BILLINGS CLINIC
 
(3) BILLINGS CLINIC ONCALL LLC
2800 TENTH AVENUE NORTH
BILLINGS,MT59101
87-3543333 		TELEHEALTH MT 3,705 9,258 BILLINGS CLINIC
 






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 entity?
Yes No
(1)BILLINGS CLINIC FOUNDATION
2917 TENTH AVENUE NORTH

BILLINGS,MT59101
81-0407289 		FUNDRAISING MT 501(c)(3) 7 BILLINGS CLINIC
 
Yes
 
(2)STILLWATER HOSPITAL ASSOCIATION
710 N 11TH STREET

COLUMBUS,MT59019
81-0286525 		HOSPITAL MT 501(c)(3) 3 BILLINGS CLINIC
 
Yes
 
(3)TOWNSEND HEALTH SYSTEMS INC
110 NORTH OAK STREET

TOWNSEND,MT59644
81-0398400 		HEALTHCARE MT 501(c)(3) 3 BILLINGS CLINIC
 
Yes
 
(4)Billincs Clinic Employee Benefit Trust
2800 10th Ave

North Billings,MT59107
81-0391600 		Employee Benefits MT 501(c)(9)   Billings Clinic
 
Yes
 
(5)MTWY HEALTH INC
310 Sunnyview Ln

KALISPELL,MT59901
93-2584380 		Support MT 501(c)(3) Type II NA
 
 
No
(6)KALISPELL REGIONAL MEDICAL CENTER
310 SUNNYVIEW LANE

KALISPELL,MT59901
23-7293874 		ACUTE CARE HOSPITAL MT 501(c)(3) 3 LOGAN HEALTH
 
 
No
(7)KALISPELL REGIONAL HEALTHCARE FOUNDATION
310 SUNNYVIEW LANE

KALISPELL,MT59901
31-1703013 		SUPPORTING ORGANIZATION MT 501(c)(3) Type I KALISPELL REGIONAL MEDICAL CENTER
 
 
No
(8)ASSIST-FLATHEAD VALLEY
310 SUNNYVIEW LANE

KALISPELL,MT59901
46-2669324 		WELLNESS RESOURCE PROVIDER MT 501(c)(3) 10 KALISPELL REGIONAL MEDICAL CENTER
 
 
No
(9)KALISPELL REGIONAL MEDICAL CENTER VOLUNTEERS
310 SUNNYVIEW LANE

KALISPELL,MT59901
27-3866474 		SUPPORTING ORGANIZATION MT 501(c)(3) 10 KALISPELL REGIONAL MEDICAL CENTER
 
 
No
(10)LIBERTY COUNTY HOSPITAL AND NURSING HOME INC
315 W MADISON AVE

CHESTER,MT59522
81-0515463 		PROVIDE ACUTE HOSPITAL CARE MT 501(c)(3) 3 LOGAN HEALTH
 
 
No
(11)LOGAN HEALTH - CONRAD
805 SUNSET BLVD

CONRAD,MT59425
81-0232406 		PROVIDE ACUTE HOSPITAL CARE MT 501(c)(3) 3 LOGAN HEALTH
 
 
No
(12)LOGAN HEALTH - CUT BANK
226 9TH AVE SE

CUT BANK,MT59427
81-0530457 		PROVIDE ACUTE HOSPITAL CARE MT 501(c)(3) 3 LOGAN HEALTH
 
 
No
(13)LOGAN HEALTH - SHELBY
640 PARK AVE

SHELBY,MT59474
86-2327525 		PROVIDE ACUTE HOSPITAL CARE MT 501(c)(3) 3 LOGAN HEALTH
 
 
No
(14)LOGAN HEALTH - WHITEFISH
1600 HOSPITAL WAY

WHITEFISH,MT59937
81-0247969 		PROVIDE ACUTE HOSPITAL CARE MT 501(c)(3) 3 LOGAN HEALTH
 
 
No
(15)LOGAN HEALTH EMERGENCY MEDICAL SERVICES
310 SUNNYVIEW LANE

KALISPELL,MT59901
88-0538346 		EMERGENCY SERVICES MT 501(c)(3) 7 LOGAN HEALTH
 
 
No
(16)MONTANA PEDIATRICS
259 W FRONT ST STE B

MISSOULA,MT59802
85-4133807 		AMBULATORY CARE MT 501(c)(3) 7 LOGAN HEALTH
 
 
No
(17)NORTHWEST HORIZONS INC
310 SUNNYVIEW LANE

KALISPELL,MT59901
81-0420653 		LONG-TERM AMBULATORY CARE MT 501(c)(3) 10 LOGAN HEALTH
 
 
No
(18)SUMMIT MEDICAL FITNESS CENTER
310 SUNNYVIEW LANE

KALISPELL,MT59901
20-3752312 		COMMUNITY HEALTH & WELLNESS CENTER MT 501(c)(3) 10 LOGAN HEALTH
 
 
No
(19)NORTH VALLEY HOSPITAL FOUNDATION
1600 HOSPITAL WAY

WHITEFISH,MT59937
81-0526541 		SUPPORTING ORGANIZATION MT 501(c)(3) Type III-FI LOGAN HEALTH - WHITEFISH
 
 
No
(20)LOGAN HEALTH ASSISTED LIVING - SHELBY
111 2ND ST S

SHELBY,MT59474
86-2394240 		RETIREMENT & ASSISTED LIVING MT 501(c)(3) 10 NORTHWEST HORIZONS INC
 
 
No
(21)LOGAN HEALTH CARE CENTER - SHELBY
630 PARK DRIVE

SHELBY,MT59474
86-2346458 		LONG-TERM CARE & SKILLED NURSING MT 501(c)(3) 10 NORTHWEST HORIZONS INC
 
 
No
(22)LOGAN HEALTH
310 Sunnyview Ln

Kalispell,MT59901
81-0406485 		SUPPORT SUBSIARY HEALTH ORGANIZATIONS MT 501(c)(3) 3 MTWY Health
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
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



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) BILLINGS CLINIC INNOVATION FERTILITY

399 KNOLLWOOD ROAD SUITE 303
WHITE PLAINS,NY10603
88-1032699 		FERTILITY CLINIC NY NA
  		N/A             No 49.00 %












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
 		(i)
Section 512(b)(13) controlled entity?
Yes No












Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
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, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
Yes
 
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
 
No
q Reimbursement paid by related organization(s) for expenses ............................
1q
Yes
 
r Other transfer of cash or property to related organization(s) ............................
1r
 
No
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) BILLINGS CLINIC FOUNDATION

 C 1,642,869 INTERCOMPANY AMOUNT
(2) BILLINGS CLINIC FOUNDATION

 D 451,797 INTERCOMPANY AMOUNT
(3) STILLWATER HOSPITAL ASSOCIATION

 D 855,019 INTERCOMPANY AMOUNT
(4) TOWNSEND HEALTH SYSTEMS INC

 D 3,641,569 INTERCOMPANY AMOUNT
(5) STILLWATER HOSPITAL ASSOCIATION

 Q 7,417,250 INTERCOMPANY AMOUNT
(6) TOWNSEND HEALTH SYSTEMS INC

 Q 2,218,939 INTERCOMPANY AMOUNT
(7) BILLINGS CLINIC SPECIALTY SUPPLIES AND SERVICES LLC

 S 3,000,000 INTERCOMPANY AMOUNT
(8) STILLWATER HOSPITAL ASSOCIATION

 O 3,735,289 INTERCOMPANY AMOUNT
(9) TOWNSEND HEALTH SYSTEMS INC

 O 2,484,929 INTERCOMPANY AMOUNT
Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
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) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(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 V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2023
Schedule R (Form 990) 2023
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2023

Additional Data


Software ID: 23017437
Software Version: 2023v5.1