2024-04-29T17:12:37-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 363808993 Fallon Medical Complex Inc FALL 4067783331 PO Box 820 Baker MT 59313 David Espeland CEO 4067783331 2024-04-26 1 David Espeland 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2024-04-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z See Schedule O David Espeland PO Box 820 Baker MT 59313 10552803 0 X www.fallonmedical.org X 1991 MT Providing healthcare services 7 7 115 51 0 0 293091 404763 11482504 10084582 -9088 31778 2016 2681 11768523 10523804 40630 59617 0 0 4985867 4877869 0 0 0 6222151 7373480 11248648 12310966 519875 -1787162 24617884 21940603 2008474 962346 22609410 20978257 X Fallon Medical Complex, in its innovative pursuit of Friends Healing Friends, provides comfort, compassion, and excellence in the promotion of quality of life to all individuals. 0 0 9464691 59617 9139754 Fallon Medical Complex (FMC) provides quality health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of FMC, it is recognized that not all individuals possess the ability to purchase these essential services. It is FMC's mission to serve the surrounding area by providing health care services to all community members.FMC provides medical services to individuals who are determined unable to purchase such services through FMC's Financial Assistance policy and guidelines. In addition to free and/or subsidized care, services are also provided at below cost rates to persons covered by government programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients, based on established rates is $14,000 for the year ended June 30, 2023. FMC's Critical Access Hospital provides 24 hour x 7 days a week Emergency Room services, observation, Acute Care, Swing Bed services and onsite ancillary lab and diagnostic imaging services. During fiscal year ended June 30, 2023, FMC provided over 175 days of hospital services, 5,597 days of swing bed care, 889 ER visits, and over 8,088 outpatient visits. 1132759 0 944828 FMC Community Clinic (Rural Health Clinic) operates under the same mission as FMC by providing family health care to over 4,925 patient visits per year. The three providers (one physician and two mid-levels) also provide ER coverage 24 hours, 7 days a week. 18007 0 0 One of FMC's operating philosophies states that education programs are necessary to enhance the competence of personnel in the healthcare system as well as to assist in the attainment of both personal and organizational goals. To this end, not only does the organization routinely budget $30,000 or more in continuing education for its employees, it also provides job shadowing to area students (typically 3-5 students per year) who may be interested in a healthcare career, in addition to offering routine Certified Nursing Assistant training programs (to about 5-10 prospective aides per year).FMC also hosts numerous college students seeking careers as doctors, physician assistants, and various other disciplines, such as nursing, radiology, laboratory technology, and physical therapy. FMC further believes that it is its responsibility to take a leadership role in informing the public about healthcare subjects of relevance or interest through community education. This objective is supported through a number of channels, which includes routine "Lunch and Learn" sessions provided by medical professionals (about 6 times per year), weekly public service announcements on the local radio station, and an annual health fair which is attended by people from all over the service area. 10615457 1 1 0 0 0 0 0 0 1 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 0 0 0 1 23 0 1 115 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Marjorie Losing 4067785303 PO Box 820 Baker MT 593130820 Betty Mueller President (Jul-Dec)/Trusee (Jan-Feb) 0.50 0.00 X X 0 0 0 Doug Varner V.P.(Jul-Dec)/President starting Jan 0.50 0.50 X X 0 0 0 Curt Arnell Trustee (Jul-Dec)/V.P. starting Jan 0.50 0.00 X X 0 0 0 Richard Menger Secretary (Jul-Dec) 0.50 0.00 X X 0 0 0 Evelyn Neary Secretary starting January 0.50 0.50 X X 0 0 0 Bryant Steen Trustee (Jul-Dec) 0.50 0.00 X 0 0 0 Erin Lutts Trustee starting June 0.50 0.00 X 0 0 0 David Kirschten Trustee starting January 0.50 0.00 X 0 0 0 Elaine Stanhope Trustee staring September 0.50 0.00 X 0 0 0 Alice Kay Schweigert Trustee 0.50 0.00 X 0 0 0 David Espeland Chief Executive Officer 40.00 0.00 X 164884 0 29990 Marjorie Losing Chief Financial Officer 40.00 0.00 X 96283 0 27369 Deb Wiman RN 40.00 0.00 X 108317 0 18097 Eldon King ADON 40.00 0.00 X 100876 0 11570 Caleb Bettenhausen PA-C PA-C 40.00 0.00 X 122701 0 1841 593061 0 88867 4 0 1 0 Rural Medical Partners 4956 Curran Court Grand Forks ND 58201 Locum Physicians 737626 Priorcare Staffing Solutions 4755 E Colorado Blvd Spearfish SD 57783 Contract Nursing 245223 Medical Solutions LLC PO Box 310737 Des Moines IA 50331 Contracted Nursing and Xray 238329 MT Health Network 111 S 7th St Ste 241 Miles City MT 59301 Contracted Nursing and Xray 223129 Wilderness Medical Staffing 1124 W Riverside Ave Spokane WA 99223 Locum Midlevels 212726 8 236067 168696 45405 404763 Net Patient Service Revenue 621110 9568030 9568030 County Subsidy 900099 419496 419496 Meals on Wheels 900099 71924 71924 Cafeteria 722514 23252 23252 1880 1880 10084582 31778 31778 31680 28999 2681 2681 2681 10523804 10084582 0 34459 X 59617 59617 332120 332120 10287 10287 3620154 3067914 552240 91427 83003 8424 533865 447920 85945 290016 233044 56972 5270 5270 4060811 3772590 288221 26586 11070 15516 487729 419495 68234 173210 173210 108486 108486 14462 14462 8845 8845 962232 810815 151417 191981 191981 Medical Supplies 577624 577624 Repairs and Maintenance 519955 415707 104248 Food 132788 132788 Bed Taxes 58674 58674 44827 17925 26902 12310966 10615457 1695509 0 10463534 7203725 4279069 3008839 251345 215054 68399 198435 22573175 15598506 7830268 6974669 64438 1853689 1660831 1759375 0 726817 24617884 21940603 868597 615132 233842 5595 7176 460440 331459 440000 8579 2008474 962346 X 22173977 20522602 435433 455655 22609410 20978257 24617884 21940603 X -1787162 51905 104104 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 260014 781 260795 259707 307 260014 258575 1132 259707 255821 2754 258575 244418 10000 1403 255821 0.16120 0.74020 0.09860 0 1 1 96522 96522 18164774 12505220 5659554 3888095 2843121 1044974 423784 250165 173619 6974669 Investment in Foundation 1631560 F Investment in Cooperative 127815 F 1759375 Opearting Lease Liability 8579 8579 X 10703542 51905 104104 156009 10547533 5270 -28999 -23729 10523804 12334695 28999 28999 12305696 5270 5270 12310966 Part IV, Line 2b: The organization acts as a custodian for the funds of some nursing home residents and for the auxiliary. Part V, Line 4: Friends of FMC Foundation, Inc. holds the permanently restricted funds to provide a source of income to be used for Long Term Care, and/or equipment purchases on behalf of Fallon Medical Complex, and for scholarships. The principal has been invested and the generated income (temporarily restricted) is used for said purpose. Part X, Line 2: The Hospital believes it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Equity in Earnings of Affiliate recorded in revenue for financial statements 104,104. Part XI, Line 4b - Other Adjustments: Rental Expenses recorded in revenue for Form 990 -28,999. Part XII, Line 2d - Other Adjustments: Rental Expenses recorded in revenue for Form 990 28,999. 1 1 X 1 X 1 X 1 1 0 0 14000 14000 0.00110 1705446 1259202 446244 0.03620 15371 8178 7193 0.00060 1734817 1267380 467437 0.03790 99226 39860 59366 0.00480 2899260 1630873 1268387 0.10300 837 837 0.00010 2999323 1670733 1328590 0.10790 4734140 2938113 1796027 0.14580 1193 1193 0.00010 996 996 0.00010 165880 71924 93956 0.00760 2168 2168 0.00020 170237 71924 98313 0.00800 1 466506 59713 3765025 3796619 -31594 X 1 1 1 1 Fallon Medical Complex Inc 202 South 4th Street West Baker MT 59313 www.fallonmedical.org 13128 X X X Outpatient Clinic - RHC Fallon Medical Complex Inc 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X http://www.fallonmedical.org/ X X 1 21 1 http://www.fallonmedical.org/ 0 1 X 150.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X https://www.fallonmedical.org/financial-assistance X https://www.fallonmedical.org/financial-assistance X https://www.fallonmedical.org/financial-assistance X X X X X X X 1 X 0 X X X X X 1 X 0 1 Fallon Medical Complex, Inc. Part V, Section B, Line 5: During the Community Health Needs Assessment process, Fallon Medical Complex conducted a third-party random survey of 600 people in our service area, in addition to two focus group meetings that were open to the public, and three key-informant interviews. All activities were conducted from February 2022 through May 2022 with guidance and assistance from the State Office of Rural Health (SORH). Steering committee participants were selected based on their familiarity with social conditions and healthcare needs in the community, including those who work with young children, behavioral health issues, seniors, patients with disabilities and those who are recovering from surgeries, home bound patients and those with occupational therapy needs. The steering community members were local community advocates, Fallon County Health Department personnel, and FMC personnel, including a social worker. The SORH provided demographic information and expertise regarding low-income and minority populations, as well as a compilation and an interpretation of the data derived from all of the sources. Fallon Medical Complex, Inc. Part V, Section B, Line 7d: Available in FMC's Quality Improvement Department Fallon Medical Complex, Inc. Part V, Section B, Line 11: Our Board of Trustees passed a resolution on September 7, 2022 to approve our most recent Implementation Plan, based on collective needs identified on our CHNA plan, which was completed June 29, 2022. This plan identified three goals, to be supported with a number of strategic initiatives:Goal #1: Enhance behavioral health services (mental/behavioral/SUD) in the Fallon Medical Complex service area by fostering the development and coordination of behavioral health resources.Enhance behavioral health services (mental/behavioral/SUD) in the Fallon Medical Complex service area: This is an ongoing goal from our previous Implementation Plan, wherein we are continuing to foster the development and coordination of behavioral health assistance and resources. We have sustained participation in an established integrated behavioral health grant through the Montana Health Network (MHN). Our Clinic Manager has been attending monthly steering committee meetings and leading our internal program. We are actively using our screening and intake forms to determine which patients may benefit from a visit with a behavior health specialist. MHN recently announced that they have received a second grant to find solutions for access to specialists, of which we will be a part. We are consistently looking for cost-effective training opportunities that may enhance our IBH program, and partner with other entities that may have solutions that are beneficial to our patients. For example, we agreed to support an online tool called "Credible Minds" that is offered by the county to its residents. This app allows an individual to explore behavior health topics, do self-assessments, and seek out assistance from various sources. We have not been able to research Charlie Health yet and determine how it might be of benefit to address youth crises services. We have, however, continued to provide and promote medication and needle disposal at our facility to the community.Goal #2: Improve access to health care services and the continuity of care through Fallon Medical Complex by enhancing access to primary care services and enhancing education and outreach related to available local services.Improve access to health care services and the continuity of care through Fallon Medical Complex: We have continued to partner with Intermountain Holy Rosary Healthcare to offer a regular OB/GYN outreach clinic at our facility. We also added a Podiatry outreach clinic in cooperation with Sidney Health Center, and an Orthopedic outreach clinic in cooperation with Glendive Medical Center. We have continued to seek out opportunities to expand both onsite and telemedicine specialty services. This includes maintaining and expanding our list of specialists available from Billings Clinic, as well as frequently using Avel's eEmergency and ePharmacy telemedicine systems in our hospital. We are still implementing an upgrade in our Electronic Health Record (EHR) which has proven to be challenging. We are hoping to leverage functionality within that program to develop protocols for patient appointment reminders and follow-up clinic appointments, but we are not quite there yet. We do call all patients after discharge from our Emergency Department to check on their recovery and to look for opportunities to offer enhanced care coordination. We discontinued the pursuit of offering Platelet Rich Plasma (PRP) injections, since the provider who had an interest in developing this service is no longer working for us. We take every opportunity to direct patients toward the use of telemedicine, where it makes sense. Referrals largely come from the providers on the other end, although we do put a plug in for the service when the opportunity presents itself. Billings Clinic recently upgraded their telemedicine equipment, condensing it into a smaller cabinet, so we were able to place it in one of our clinic exam rooms. It is more accessible by patients who may want a more expedient specialty visit following their primary care appointment in our clinic. And it is far closer to our check-in counter and clinic nurses, who typically accompany the patients during their visits. Our "We are Fallon Medical Complex" campaign has languished a bit on Facebook, so we are planning to roll out a new campaign called, "Do you know" to increase outreach and awareness of local providers and resources. Our third-party vendor has maintained and enhanced our redesigned website to continue making it user-friendly and patient-focused. One employee is our liaison with the website developer, constantly feeding them content and making sure that everything is up to date. We have been reluctant to actively promote our occupational and physical therapy services, since they have traditionally had a backlog of patients. One of our PT's has been trained in the use of "dry needling and is beginning to ramp up that service. In addition, our OT has built a strong practice in pediatrics. Both of these services are building their patient base largely via word of mouth, but they could benefit from the development of a local awareness plan.Goal #3: Support chronic disease prevention and management efforts throughout Fallon Medical Complex's service area by sustaining chronic disease prevention and management outreach through FMC.Support chronic disease prevention and management efforts throughout Fallon Medical Complex's service area: We have continued participation in the Chronic Care Management (CCM) HRSA grant offered by the Montana Health Network (MHN). As the grant winds down, we have agreed to continue participating in the program by purchasing services from MHN. We have not been a part of implementing Community Health Workers to assist with patient management, since there are duplicative services offered in our community. Furthermore, we continue to offer Lunch & Learns on relevant topics, most recently "the anti-inflammatory approach to heart health and other chronic conditions" by our dietician. We continue to offer outreach materials for patient distribution on chronic care management as developed by the MHN HRSA grant, and we are beginning to explore the development of video clips that endorse the service and provide patient testimonials. Our primary annual community wellness program is offered through a collaboration with Intermountain Holy Rosary Healthcare, called "Healthy Lifestyles." They also provide a dietician to support our dietary department, who is also available to individually consult with patients upon request or referral. We offer wellness programs for our employees, but have not been able to develop a community-wide event, such as a 5k run, yet. We hoping to do something along that line in collaboration with our foundation.FMC chose not to address the following needs identified during the CHNA process:1) 10.6% of survey respondents indicated they had difficulty getting a prescription or taking their medication regularly due to cost in the last year. We do not own a retail pharmacy or have an ownership interest in the local store, so it cannot set rates or provide medications under our financial assistance program. Nevertheless, we can recommend qualified patients for significantly discounted medications in collaboration with Baker Rexall Drug through the federal HRSA 340(b) program. This government program requires drug manufacturers to provide outpatient drugs to eligible patients at significantly reduced prices. We act as a gatekeeper for access to the program which is based on a patient's financial ability to pay for healthcare services. While this program provides financial assistance with many routine medications, drug manufacturers can choose which ones they are willing to offer to program participants. For this reason, not all prescriptions are offered at discount prices.2) Focus group and key informant interview participants shared challenges among community members in accessing resources such as Medicaid and Supplemental Nutrition Assistance Program (SNAP) benefits. We do provide assistance in helping our long-term care residents pull together the information they need to qualify for Medicaid in an institutional setting. However, we do not have staff trained, and certified by the state, to provide assistance to people seeking community Medicaid or SNAP benefits. Those types of workers are required to be state employees. Fallon County Council on Aging assists seniors with Medicare, including Part D, and Social Security. Our county hosted a public assistance office for many years, but the State of Montana consolidated offices to save money, shutting down our local office. Fallon Medical Complex, Inc. Part V, Section B, Line 13h: All applicants are required to pursue alternative sources of payment, such as government health care benefit programs, and provide proof of being ineligible for any assistance. Fallon Medical Complex, Inc. Part V, Section B, Line 16j: FMC provides a summary of the financial assistance policy to patients upon admission. FMC also attaches a summary of the policy to billing invoices and posts a plain language summary in the facility's emergency and waiting rooms, admissions offices, public health, courthouse, and senior citizen center. Fallon Medical Complex, Inc. Part V, Section B, Line 20e: Offered an appeals process with respect to FAP determinations. Fallon Medical Complex, Inc. Part V, Section B, Line 24: Services excluded under the FAP include cosmetic procedures, DOT/ICC/FAA physical exams, marijuana eligibility exams, and any FMC Long Term or Intermediate Swing Bed care. 2 1 - Community Clinic 202 South 4th Street West Baker MT 59313 Outpatient Clinic - RHC 2 - Wibaux Clinic 710 Drake Street Wibaux MT 59353 Outpatient Clinic Part I, Line 3c: We do not include an asset test to determine eligibility for applicants who have family income up to 200% of FPG; those with family income that exceeds 200% of FPG but not more than 250% may be asked to complete a net asset test. All applicants are required to pursue alternative sources of payment, such as government health care benefit programs, and provide proof of being ineligible for any other assistance.Anyone at or below 150% qualifies for free care. Anyone with family income above 150% and below 200% qualifies for a discount of 50% of their account balance. Those with family income that exceeds 200% of FPG but not more than 250% are eligible to receive a discount of 15%. Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Cost of other means tested government programs, community health improvement services and community benefit operations, and cash and in-kind contributions to community groups are based on costs recorded in the general ledger and estimated costs. Medicaid and Subsidized health services are determined based on costing methods used to prepare the cost report. Part II, Community Building Activities: FMC participates in community building activities to improve our community. Our Foundation Coordinator has been a member of the local housing board, searching for ways to address our community's chronic housing shortage by facilitating the construction of new housing and the renovation of existing housing. She is also actively involved with a local group that is working to develop a community daycare facility.From an economic development standpoint, our Foundation Director has also been a board member of our local Southeastern Montana Revitalization Team which is dedicated to revitalizing the economic climate in the area. They are focused on building community infrastructure, as well as attracting new businesses and finding ways to provide housing for incoming workers and their families. In addition, in an effort to help keep local commerce alive, our Foundation Coordinator actively participates in Baker Chamber of Commerce meetings and events, including hosting their monthly meeting on a rotating basis. One of the Chamber's primary events, the Fall Festival, is coordinated by FMC staff, who also participate in the Chili Cook-off event every year.To further support the community, a number of FMC employees frequently participate in disaster preparedness meetings and events through the Fallon County Local Emergency Preparedness Committee (LEPC). This group meets regularly to discuss disaster preparedness activities, to review the response of similar groups to disasters across the nation, to determine ways to enhance the effectiveness of disaster response in our area and to conduct table top exercises that simulate potential local disasters. We have also dedicated staff time and resources to acquiring knowledge in the Hospital Emergency Incident Command System (HEICS), a nationally recognized and practice program in incident management.In an effort to assist with leadership development, a number of staff members routinely provide assistance with youth leadership programs. For instance, one of our Physical Therapists has acted as a 4H leader for a number of years, participating in youth developmental programs that provide hands-on learning activities to youth. In addition, our CEO, and other employees, provide judging for our local Business Professionals of America (BPA) chapter, which teaches basic and advanced business skills to high school students. Our CEO, and other employees, have also acted as judges for local Speech and Drama events, which helps high school students gain valuable skills in public speaking and performing.FMC participates in coalition building by contributing to collaborative efforts that address health and safety issues, including LEPC and HEICS mentioned earlier, with other healthcare entities and emergency service providers. To further provide continuity across our service area, our Chief of the Medical Staff is the County Health Officer and County Ambulance Medical Director, routinely attending their meeting and providing medical control and guidance on relevant issues.One of our larger efforts to assist with community health improvement is to take an active role in offering, serving and significantly subsidizing noon meals to seniors. FMC collaborates with our local Council on Aging to serve 2,884 meals each year to seniors in our facility dining room as well as an additional 3,061 meals through Meals on Wheels. This program promotes health and well-being of our seniors by providing nutritious meals to those who might otherwise not receive them, especially those who are home bound.FMC's workforce development support is largely focused on healthcare careers. We annually work with the local school system to offer "Medical Explorers," which allows students to ask medical professionals questions about their job and learn about the myriad of healthcare careers. Some years we are able to secure a patient simulator to give students a real-life experience. Additionally, we allow students of all levels to request an opportunity to job shadow a healthcare professional. In the past, students have observed lab techs, radiology techs, physical and occupational therapists, nurses, doctors and mid-levels in their daily activities of providing care for patients. Our CEO and Foundation Director serve on two Montana healthcare-related scholarship committees. Their participation on these committees promotes healthcare-related careers by helping to fund college educations. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of implicit price concessions attributable to patients eligible under the organization's charity care policy is 12.8% (based upon US Census Bureau Quickfacts for percent of citizens below the poverty level in Fallon County). Fallon Medical Complex is estimating the amount of implicit price concessions to be charity care based on the percentage of demographics below charity care income/asset levels. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 13-14 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.All of the Medicare shortfall should be treated as a community benefit. The Organization treats individuals regardless of the ability to pay. It is a community benefit to be able to treat all individuals at the local hospital and clinic. Part III, Line 9b: Once a patient has been determined by FMC to be eligible for financial assistance, that patient shall not receive any future bills based upon undiscounted gross charges on approved account balances. Requests for financial assistance shall be processed promptly. FMC shall notify the patient in writing within 30 days of receipt of a completed application. Collection activity will be suspended while a financial assistance application is under review. Normal collection efforts will resume if the application is not returned in a timely fashion or after the write-off is complete and the patient owes a balance. Part VI, Line 2: We have traditionally received input about unmet community health care needs from a number of sources: a) citizens, board members, patients, and residents expressing an idea or a concern, b) suggestions from consultants who were hired to provide a study of our operations, c) the county or state health department providing observations or data regarding the health status of our specific population, d) staff members gleaning information from an education program or from reviewing professional journals and periodicals regarding the latest equipment or trends in patient and resident care, e) suggestions from the public posted on our website, etc. We have completed a formal Community Health Services Development assessment through Montana State University, the result of which is available on our website, www.fallonmedical.org. Subsequent to the CHNA, we developed a 3 year implementation plan to address the most important health needs in our community. This plan is also published on our website. Information from all of these sources is analyzed on a case by case basis by the department manager who would be responsible for implementing the program. The manager determines the program's merit relative to our stated mission as well as what resources would be necessary to implement the program. The manager submits the analysis to our internal Operational Review Committee, which looks at its impact facility-wide and its feasibility. If it progresses past this committee, it is then evaluated by our management team, who analyzes the finer details. Ultimately, it is discussed at the Board of Trustees level to seek their input and approval, if necessary. Part VI, Line 3: We notify our patients of our financial assistance program through a number of methods; (1) we post the charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, facility website, other areas of our facility in which eligible patients are likely to be present, public health department, senior citizen center and courthouse; (2) we make available a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) we provide a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials; (4) we include the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) we discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable. Part VI, Line 4: Fallon Medical Complex (FMC) is a sole community health care provider for a rural population in excess of 7,200 people spread over seven counties. In addition to serving Fallon County, located in southeastern Montana, FMC also provides health care for three bordering Montana counties (Carter, Wibaux, and part of Custer) and three adjacent North Dakota counties (Slope, Golden Valley, and part of Bowman). Considered "frontier" by the Montana Department of Public Health and Human Services, this region boasts less than two residents per square mile. FMC operates a Critical Access Hospital, a Rural Health Clinic, and a home care and personal care services agency.Although Carter County operates a Critical Access Hospital and a Rural Health Clinic in Ekalaka, MT (35 miles to the south), facilities offering the next highest level of care are over 80 miles from Baker, necessitating a drive of nearly two hours in inclement weather. Two mid-levels (physician assistants and/or family nurse practitioners) practice full time in Baker and see patients one day a week in our satellite clinic in Wibaux, MT. FMC also utilizes three primary care locum physicians to work in the clinic and see patients in our Emergency Room. We also employ one part-time DO who provides DOT and FAA physicals. These physicians supervise mid-level providers at FMC. All in all, the DHHS Bureau of Primary Health Care has designated FMC's service area as a Health Professional Shortage Area (HPSA) due to: a) a high population-to-physician ratio (greater than 3,500:1), b) the extreme remoteness of this facility, c) sparseness of our service area, and d) excessive distances to alternative providers.The majority of patients in FMC's service area are Caucasian (95%), with a median age of 35.1, and have graduated from high school (96.5%). The median income is $61,855 per year (compared to $66,341 for all of Montana), the median household income is $83,750 (compared to $72,980) and the unemployment rate is 1.4% (compared to 3.0%). About 12.8% of the population is below the Federal Poverty Level (compared to the national average of 12.6%) and roughly 8.2% of the population does not have health insurance. Of those with health insurance, 12.1% are covered by Medicare, 16.5% are covered by Medicaid, and 50.9% are covered by their employer. In all, according to a Robert Wood Johnson Foundation study, Fallon County is ranked 10 out of 47 (1 is best) for "health factors," based on health behaviors, clinical care, social and economic factors, and physical environment.FMC's service area economy is largely based on oil and gas exploration and extraction, as well as construction services that accompany that industry. Many residents are employed by large energy exploration and drilling companies or smaller energy-related service companies. The other major contributor is agriculture. Wheat and barley are major farm crops and cattle and sheep dominate the local livestock production. The area has been delving into the alternative energy arena with wind farms and solar farms cropping up across the wind-swept prairie. Part VI, Line 5: All members of the FMC Board of Trustees reside in our primary service area and are not employees or contractors of FMC. None have family members who are employed by FMC. They are not compensated for their participation on the board and must be interested in, and willing to work towards, the best interests of healthcare in our service area. The board strives to find trustee candidates from all corners of FMC's service area, as well as do their best to embrace diversity in gender and occupations. The Board is comprised of individuals who work as educators, ranchers, small business employees or owners, retirees, and oil company managers.One of the board's responsibilities is to maintain and oversee FMC's Medical Staff. As such, they are responsible for granting privileges to qualified physicians and mid-level providers based on education and skills confirmed through a structured credentialing process. The board extends medical staff privileges to all qualified providers that have an interest in providing services to our patients and who complete our formal application process. This process includes conducting due diligence through background checks, verification of education and credentials, and personal and professional reference checks. Providers may offer their services directly in our community or remotely via telemedicine systems.Given the isolated rural location of FMC as well as its limited-service area population, the facility typically does not generate surplus funds from operations. A delicate balance exists between forecasting an anticipated revenue stream and attempting to match up operational expenses. Given that no revenue is guaranteed, adjustments must be made throughout each fiscal year to ensure the facility's ongoing solvency. Accordingly, FMC has not realized a net profit from operations for over 30 years. Most "surplus" funds are derived from gifts, grants, and fundraising efforts, all of which are generally focused on acquiring capital for the acquisition of patient care equipment. Some of these purchases are meant to upgrade equipment that has reached the end of its useful life cycle, in which case we strive to leverage design or technology improvements to provide greater comfort and effectiveness for the benefit of our patients. And in some cases, we use the funding to start a new service which was identified through our various needs assessments.FMC is predominantly a sole community "primary care" provider for its service area. Its system, or complex, of health care services was created out of necessity due to its remoteness. FMC lacks the resources and service area population to offer specialized medical services and/or conduct formal medical education and medical research. For the most part, we have striven to incrementally improve and enhance our core service offerings in an effort to increase the overall health status of our patients and residents. Accordingly, we strive to excel at primary care, offering family practice and preventative health outpatient services, routine hospital and fully digital diagnostic services, 24-hour emergency care (available to all regardless of ability to pay), long-term care, home-based skilled and personal care, and physical and occupational therapy. Our ER includes a telemedicine connection to the Avel eCare network which offers on-demand board certified physicians on call 24-hours a day and pharmacy consultation services.In an effort to provide comprehensive medical care to the community, various providers from neighboring communities routinely offer services to patients at FMC. For instance, chiropractic, dental, and hearing aid clinics are held regularly in Baker. In addition, FMC's primary medical care is augmented by visiting physicians such as an Obstetrician, a Podiatrist, and an Orthopedic Surgeon. Our telemedicine system is routinely used by participants in Healthy Lifestyles classes in conjunction with Intermountain Holy Rosary Healthcare, allowing participants to interact with others in neighboring communities without having to drive more than an hour each way multiple times each month. Telemedicine is also used to connect our patients with specialists located at Billings Clinic.Although we are not a formal teaching facility, we have hosted multiple students annually who are seeking careers in healthcare-related disciplines. This includes high school students who would like to job shadow, and medical students who are completing a primary care rural rotation. We have a number of cooperative agreements with colleges and universities across the nation that allow students a variety of clinical experiences, from observation of care by a trained professional to providing limited patient services under direct supervision. In the past few years, we have hosted students pursuing careers as nurses, lab techs, radiology techs, physician assistants, occupational therapists, physical therapists and physicians coming from Pennsylvania, Washington State, Florida, Utah and Montana.In addition, FMC's Hospital Helpers organization has 15 members who volunteer their time by fundraising for various projects, while working in our long term care area -- operating a beauty shop, visiting with residents, and providing assistance with activities -- and managing a small gift shop in the hospital. All of the money raised by this group is gifted to the facility for the purchase of essential furniture, fixtures, and equipment, and for providing scholarships to students being educated in a healthcare-related field. The community also provides 36 specialty volunteers who offer their talents to our facility. For example, various music groups provide events throughout the year and clergy from surrounding churches hold regular church services and help with special needs. Volunteers also read newspapers and books, hold bible study classes, and decorate rooms and hallways for our residents.FMC is the sole beneficiary of a foundation that exists to attract and manage funds from donors who would like to provide financial support in the furtherance of FMC's mission. This separate charitable non-profit entity is governed by its own Board of Directors, which raises the funds, manages the investments, and determines how the funds should be spent. One of their most actively managed efforts is the awarding of scholarships to students from our service area seeking healthcare careers.We also encourage our staff to be involved in community-related boards and programs. For instance, our Foundation Coordinator has been a member of a local housing board, searching for ways to address our community's chronic housing shortage, as well as a county-supported economic revitalization team, and the local chamber of commerce. Furthermore, a number of employees participate in disaster preparedness meetings through the Local Emergency Preparedness Committee and provide leadership roles in Boy Scouts, 4H, Business Professionals of America, Medical Explorers and Speech and Drama.Lastly, FMC participates in many government-sponsored health care programs, including Medicare, Medicaid, Champus/Tricare, CHIP, VA Choice, and the expanded Medicaid program (HELP) offered in Montana. We have also embraced participation in a number of voluntary government-sponsored programs that focus on quality assurance and process improvement, both independently as well as through collaborative efforts with other Montana hospitals and associations (such as the Montana Health Network, the Montana Hospital Association, the Mountain-Pacific Quality Health Foundation and the Hospital Improvement Innovation Network). 1 Friends of FMC Foundation Inc PO BOX 820 Baker MT 59313 431975486 501(c)(3) 0 59617 Cost In kind donation of wages and supplies 1 0 Part I, Line 2: The organization pays for the salaries and wages of the Foundation Director for Friends of FMC Foundation, a related organization, as well as small amounts of supplies. X X 0 0 0 0 0 0 0 0 0 David Espeland Chief Executive Officer 164884 0 0 0 0 0 7047 0 22955 0 194886 0 0 0 Darryl Espeland Employee and brother of CEO 10287 Compensation 0 X Genexpert Cepheid Molecular Analyzer 1 26430 Cost X Unitrends backup unit for IT 1 18975 Replacement Cost 0 0 0 0 Form 990, Part VI, Section A, line 6 The members of the Corporation shall consist of all trustees and those individuals who apply for membership and fulfill the qualifications for membership which are established by the Board of Trustees. Form 990, Part VI, Section A, line 7a Elections for Trustees shall be held at the annual membership meeting, or by written ballot if authorized by the Board of Trustees. Form 990, Part VI, Section A, line 8b The organization does not have a committee that acts on behalf of the governing board. Form 990, Part VI, Section B, line 11b The Form 990 is emailed to the Board of Trustees for their review and they are allowed to comment prior to filing. Form 990, Part VI, Section B, line 12c The organization's policy requires a duty to disclose any conflicts annually as well as during discussions. The conflict of interest policy covers all members of the board, officers and employees. Board Members, officers and employees complete a questionnaire annually addressing potential areas of conflicts. Conflicts are determined by each individual. Conflicts are determined by each individual, but reviewed at the board level. If a conflict arises, the board member abstains from voting on matters that gave rise to the conflict. Form 990, Part VI, Section B, line 15 The Montana Hospital Association (MHA) publishes its compensation data for all classifications of healthcare workers annually. The data pertaining to facilities comparable in size is used to determine executive and officer compensation. The Board may also choose to call their peers in other facilities to substantiate the MHA data and to confirm the appropriateness of any proposed compensation. The board votes and approves the compensation for officers such as the CEO and CFO. The decisions are documented on an annual basis when salaries are approved. The process last took place at the end of fiscal year 06/30/23 and the board approval of the budget for FY2024 was at the 06/07/2023 board meeting. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy and financial statements are available for inspection at the corporation's place of business upon request. Form 990, Part IX, line 11g Contract Labor: Program service expenses 2,090,813. Management and general expenses 155,468. Fundraising expenses 0. Total expenses 2,246,281. Professional Services: Program service expenses 1,652,580. Management and general expenses 114,587. Fundraising expenses 0. Total expenses 1,767,167. Other Fees: Program service expenses 29,197. Management and general expenses 18,166. Fundraising expenses 0. Total expenses 47,363. Form 990, Part XI, line 9: Equity in Earnings of Affiliate recorded in Revenue for Financial Statement 104,104. Form 990, Page 1, Line C: Fallon Medical Complex, Inc. is doing business under the following names: Community Clinic, Home Care Services, Fallon Memorial Hospital, and Wibaux Clinic. Friends of FMC Foundation PO Box 820 Baker MT 59313 431975486 Foundation/Fundraising MT 501(c)(3) Line 7 N/A 0 0 1 0 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0