Those who scored high on a report ranking charity care at Montana's major hospitals called it an affirmation of their commitment to providing care for those unable to pay for it.

"It's something that we as an organization are very proud of," said Kristianne Wilson, vice president of strategic development for Billings Clinic. "We've been through a variety of processes and changes to ensure that all those who receive services at our organization and do not have the ability to pay are identified early, and offered the benefit of financial assistance."

The Clinic, which is Montana's largest hospital, provided $12 million in charity care in 2006, more than its estimated tax-exempt value.

But those who didn't rank as well said the report omitted key data and sometimes made "distorted" comparisons.

"Unfortunately, the attorney general did not use all of St. Peter's community benefit report, which shows that (we) provide about four times as much community benefit, compared to the net value of (our) tax exemption," said Peggy Stebbins, spokeswoman for St. Peter's Hospital in Helena.

Yet even those who had critical comments praised Attorney General Mike McGrath for the report, which they said was a "healthy contribution" to the state and national debate over what community benefits should be provided by tax-exempt hospitals.

The report, released Wednesday, looked at 2006 financial data from Montana's 11 largest hospitals, compiled their charity care and other costs for serving the needy, and compared it to hospital profits and the value of taxes they would pay if they weren't nonprofits.

The profit or "surplus" of these hospitals is plowed back into the organization, rather than paid out to shareholders, as they would in a for-profit company.

In Missoula, St. Patrick Hospital ranked high, with charity care well above its tax-exempt value and more than two-thirds its annual profit for 2006.

"Our faring well is more a reflection of our commitment to our mission than trying to justify our tax-exempt status," said Mary Anne Sladich-Lantz, vice president of mission leadership for St. Patrick.

The hospital has a "robust" charity-care policy because it doesn't want recovering patients worrying about paying their bills, she said. It provides financial aid to people earning up to 400 percent of the federal poverty level.

Missoula's other hospital, Community Medical Center, scored in the middle of the pack.

Community's spokeswoman, Karen Sullivan, echoed the concerns of several hospitals listed in the report, saying it didn't include all of the "community benefits" provided by the hospital.

Stebbins, of St. Peter's, said community benefits should include the cost of care that hospitals provide at a loss, such as emergency rooms, preventive care and ambulances. At St. Peter's, this "subsidized care" totaled $8.6 million in 2006, which is almost double the value of its tax exemption, she said.

The Internal Revenue Service is working on a proposal that will standardize reporting of community benefits for all nonprofit hospitals.

Jim Paquette, president of St. Vincent Healthcare in Billings, said the report also didn't include bad debt when measuring charity care against a hospital's profit or tax-exemption.

Including bad debt would provide a more accurate value of a hospital's care for which it's not paid, he said.

Also, by comparing a hospital's charity care against profits and ranking lower those with a low percentage, the report penalizes hospitals that have a strong balance sheet for that year, Paquette added.

"I don't think running a financially stable hospital is anything anyone ought to be ashamed of," he said.

At the Billings Clinic, officials said the report shows that much work needs to be done on reforming health care and making it more affordable for many.

"The way health-care financing is in place, it's unsustainable," Wilson said.

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