2022-09-21T12:09:05-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 237169043 Central Montana Medical Facilities Inc CENT 4065387711 408 Wendell Avenue Lewistown MT 59457 Scott Merkle CFO 4065387711 2022-09-21 1 Scott Merkle 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-09-20 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Central Montana Medical Center Cody Langbehn 408 Wendell Avenue Lewistown MT 59457 57323705 0 X www.cmmc.health X 1971 MT The mission of CMMC is to be the leader in assuring community based quality healthcare. 15 14 394 120 0 0 627180 15311849 36641852 40267064 270818 464122 545997 302194 38085847 56345229 0 0 0 0 23287930 22870876 0 0 116745 18081915 20484154 41369845 43355030 -3283998 12990199 43203325 47226831 23170560 13155913 20032765 34070918 X The mission of Central Montana Medical Center is to be the leader in assuring community based quality healthcare. 1 0 35574347 40267064 Central Montana Medical Facilities, Inc. operates a 25-bed critical access hospital located in Lewistown, Montana.Hospital Inpatient Services for FY 2021:Number of beds: 25Provided 1,878 acute days of care and 1,004 swing bed days of care for 31.58% occupancy rate. Emergency Services for FY 2021:Provided for 4,448 Emergency visits.24-hour Physician coverage available.OB Services for FY 2021:Provided for 95 births in Central MontanaCommunity care and services are also provided through the many reduced-price services and free clinics, fairs, and programs offered throughout the year. Due to the Covid-19 Pandemic many of our services were not held to keep community members and employees safe. What we were able to complete includes but is not limited to the following (all costs are estimates):Services provided for fiscal year 20-21:*Concussion Testing: -429 students tested-Established baseline cognitive functioning for all area schools' athletic programs (Lewistown High School and Junior High, Winifred, Roy, Hobson, and Moore)-Educated on importance of brain health and injury prevention-Estimated Cost: $3,000.00*Sports Physical Clinics:-Provided 224 sports physical exams to area students that included a musculoskeletal exam by CMMC Rehab department: Donated proceeds back to individual school athletic programs-Estimated cost: $6,160.00*CPR / First Aid:-107 students taught at Fergus High School: 7 day class / 6 class periods per day-Educated on 9-1-1 emergency calls; basic adult / infant CPR; AED training; seizure care; allergic reactions and training in use of an Epi-pen; Stop the Bleed training; diabetic s/sx and response to abnormal issues -Estimated cost: $5,055.00*Rural EMS volunteer services:-11 volunteer EMTs served.-Respirator fit testing, TB testing & immunization assessment completed-Estimated cost: $1,100.00*Respirator Fit Testing:-117 individuals served-Respirators fit testing for Roundup Memorial Hospital and Wheatland Memorial Hospital -Estimated cost: $5,026.00*Community Wellness Screenings: -281 clients served-Lab testing, vital signs and body metrics provided-5 staff and supplies used -Estimated cost to provide: $31,000*Hospice Annual Volunteer Training: -13 volunteers served-Educated on immunizations; appropriate PPE, and Covid precautions / symptoms for Covid-Estimated cost: $90.00The facilities maintain records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. The amount of charges foregone for services provided under the Facilities charity care policy were approximately $344,934 for the fiscal year. Total direct and indirect costs related to these foregone charges were $515,000 based on an average ratio of cost to gross charges.Awards received for FY 2021 were:* Top 100 Critical Access Hospital 2021 iVantange Health Analytics (7 years in a row)* NOSORH Performance Leadership Award (4 years in a row)* MHA PIN- Performance Improvement Network (4 years in a row) * MHA PIN Quality Program of the Year * Dr. Michael Sura received the Dr. Frank Newman Rural Health award for Rural Health Education in Montana. 35574347 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 27 0 1 394 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 15 14 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Scott Merkle 4065357711 408 Wendell Ave Lewistown MT 59457 Dr Gardner Smith Surgeon 40.00 X 433876 0 21630 Dr Amy A LePage ER Physician 40.00 X 380820 0 27700 Felipe Vile Martignoni Physician 32.00 X 379480 0 28067 Dr Michael Sura Physician/Member 40.00 X 354291 0 32446 Kimberly Schaaf ER Physician 48.00 X 281741 0 21295 Dr Tamara Welsh Physician/Member 40.00 X 277256 0 11219 Alan R Aldrich Co-CEO-Aug 2020, CFO-Dec 2020 40.00 X 249545 0 20511 Dr Laura Bennett Co-CEO-Aug 2020, Dir Clinical Ops 40.00 X 217159 0 21786 Melanie Hardy ER Physician 48.00 X 170765 0 8624 Scott Merkle CFO starting April 2021 40.00 X 0 0 0 Cody Langbehn CEO starting Aug 2020 40.00 X 0 0 0 Bret Carpenter Chair 1.00 X X 0 0 0 Dave Phillips Vice Chair until 10/5/20 1.00 X X 0 0 0 Corry Arntzen - Member until 10/4/20/Vice Chair starting 10/5/20 1.00 X X 0 0 0 Jennifer Saunders Secretary/Treasurer 1.00 X X 0 0 0 Mary Albers Member starting 9/2/20 1.00 X 0 0 0 Brandon Bantz Member 1.00 X 0 0 0 Keith Cook Member 1.00 X 0 0 0 Ryan d'Autremont Member starting 10/5/20 1.00 X 0 0 0 Karen Durbin Member 1.00 X 0 0 0 Nick Econom Member 1.00 X 0 0 0 Marvin Mauws Member 1.00 X 0 0 0 Melody Montgomery Member starting 1/5/21 1.00 X 0 0 0 Ashley Morris Member 1.00 X 0 0 0 Carl Seilstad Member 1.00 X 0 0 0 Kimberly Vincent Member until 10/5/20 1.00 X 0 0 0 Erik Wood Member 1.00 X 0 0 0 2744933 0 193278 15 0 1 0 Billings Clinic PO Box 37000 Billings MT 59107 Mgmt & Radiology Med Dir Fees 1189768 Crist Krogh Alke & Nord PLLC 2708 1st Ave N Suite 300 Billings MT 59457 Legal Services 315000 Hall Render Killian Heath & Lyman P 999 17th Street Suite 800 Denver CO 80202 Legal Services 287342 Fusion Medical Staffing PO Box 82674 Lincoln NE 685012674 Medical Staffing 167652 Oaas Law Firm 618 W Main Lewistown MT 59457 Legal Services 145000 6 2880 8901007 6407962 15311849 Net Patient Revenue 621110 38088934 38088934 Special Programs 900099 1648405 1648405 Pharmacy Revenue 446110 493933 493933 Cafeteria 722210 35792 35792 40267064 146156 146156 573461 254467 318994 318994 318994 675000 265000 622034 0 52966 265000 317966 317966 85175 2880 101975 -16800 -16800 56345229 40267064 0 766316 X 1045926 763714 282212 100871 100871 17462338 13940210 3446194 75934 690503 462702 226251 1550 2325875 1860700 453853 11322 1245363 996291 244426 4646 300000 300000 140338 140338 60189 60189 6133528 6133328 200 295123 221342 59686 14095 3283397 2090762 1182108 10527 877626 692812 183014 1800 73637 73637 38538 38488 50 164645 124522 40123 1700863 1286372 414491 524982 524982 Medical Supplies 4640219 4640193 26 Equipment Rental and Ma 1392275 1395680 -3405 Taxes and Licenses 224929 82141 142788 633865 246471 387394 43355030 35574347 7663938 116745 12998243 10331104 4065167 7442282 7957547 700672 930284 440143 560372 46281657 33076259 13187319 13205398 3964696 5281382 4469970 4895577 43203325 47226831 4672375 4403769 8339770 3343436 3486772 3367238 2419272 1977349 3772500 479871 64121 23170560 13155913 X 16862898 30747153 3169867 3323765 20032765 34070918 43203325 47226831 X 12990199 894056 153898 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 123009 123009 24987016 17229516 7757500 18294298 14676022 3618276 2877334 1170721 1706613 13205398 Long-Term Prepaid Expenses 603272 Due from Foundation 3323765 Other Receivables 968540 4895577 Estimated Third-Party Payor Settlements 64121 64121 Oak Ridge Boys Concert 88055 2880 85175 1000 28500 72475 88055 2880 85175 1000 28500 72475 101975 -16800 1 1 X 1 X 1 X 1 1 1 0 0 515000 515000 0.01190 3654527 2901111 753416 0.01740 4169527 2901111 1268416 0.02930 7 815 9316 1680 7636 0.00020 1 10 62 62 0.00000 11151304 4692625 6458679 0.14900 1 42 500 500 0.00000 9 867 11161182 4694305 6466877 0.14920 9 867 15330709 7595416 7735293 0.17850 2 32 993 993 0.00000 2 32 993 993 0.00000 1 0 0 9116828 9026562 90266 X 1 1 1 1 Central Montana Medical Center 408 Wendall Avenue Lewistown MT 59457 www.cmmc.health 12894 X X X X Home Health / Hospice Central Montana Medical Facilities Inc 1 0 0 1 X X X X X X X X X X 18 1 0 1 1 X https://www.cmmc.health/resources/reports/ X X 1 18 1 https://www.cmmc.health/resources/reports/ 0 1 X 150.000000000000 300.000000000000 X 1 1 X X X 1 X See Part V X See Part V X See Part V X X X X X X 1 X 0 X X X X 1 X 0 0 Central Montana Medical Facilities, Inc. Part V, Section B, Line 3j: Secondary Data: County Profile, Demographic Trends and Economic Impacts Central Montana Medical Facilities, Inc. Part V, Section B, Line 5: A Steering Committee was convened to assist Central Montana Medical Center in conducting a Communtiy Health Services Development (CHSD) Project administered by the Montana Office of Rural Health. A diverse group of community members representing various organizations and populations within the community (ex. public health, elderly, uninsured) came together. The Steering Committee met twice during the CHSD process; first to discuss health concerns in the community and offer their perspective in designing the survey instrument and again to review results of the survey and focus groups and to assist in the prioritization of health needs to address. Central Montana Medical Facilities, Inc. Part V, Section B, Line 6b: The Needs Assessment was formed by a committee. Central Montana Community Health Center in Lewiston was included as part of this. Central Montana Medical Facilities, Inc. Part V, Section B, Line 7d: The Needs Assessment is available at the Foundation Office, Administration Assistant Office and at Central Montana Medical Center hospital website. Central Montana Medical Facilities, Inc. Part V, Section B, Line 11: The Organization completed a new CHNA during the 6/30/19 FYE. Survey respondents identified the community's top health concerns as: Alcohol abuse/substance abuse; Cancer; Overweight/obesity.The following summary briefly represents the goals and corresponding strategies which the facility will execute to address the prioritized health needs:Goal 1: Expand access to behavioral health services at Central Montana Medical CenterStrategy 1.1: Develop a workforce and processes to support CMMC's behavioral health activities1. Explore feasibility of adding staff positions (social worker, licensed addiction counselor, other);**The Organization hired a behavioral health specialist.2. Expand number of M.A.T. trained providers in clinic and ED.**Not accomplishedStrategy 1.2: Support local community efforts that address behavioral health needs in the CMMC service area1. Continued to participate in the Lewistown Dementia Friendly Community Workgroup;2. Continued to assist local support groups (e.g., dementia support, care givers support, cancer, etc.);3. Explore opportunities to expand health educational offerings in the CMMC area (at CMMC or with community partners); **This goal was delayed due to COVID.Strategy 1.3: Ensure sustainability of collaborative care efforts at CMMC which help screen and provide resources for behavioral health needs1. Explore feasibility of expanding behavioral health medicine services at CMMC; *All patients now are provided a mental health questionnaire prior to seeing a provider.2. Explore best practices/models to address behavioral health needs/population health metrics: *Implemented suicide screenings in clinic and ED; domestic violence; OUD/SUD resources.Goal 2: Increase access to healthcare services at Central Montana Medical Center.Strategy 2.1: Increase access to primary care services at CMMC1. Conducted a feasibility study of expanded clinic hours, urgent care, or walk-in clinic models; **Expanded clinic hours from 5-7 pm for same day appointments three days a week2. Expand primary care workforce at CMMC (hire new providers); **Hired several new providers3. Develop educational/marketing materials for community related to capabilities and skills to promote role of NP/PA as a part of the primary care team and services; **Some marketing has been done however no brochures were created yet.4. Explore hosting a facility open house to introduce community to CMMC NP providers. **This goal was delayed due to COVID.Strategy 2.2: Increase access to specialty care services at CMMC1. Created community education and outreach on available CMMC specialty services, schedule, and how to make an appointment; 2. Explore feasibility of specialty care service expansion (ortho, cariology, radiology); **Hired for specialty services within ortho and continue to explore other organizations to bring in cardiology and other specialty services3. Created community education and outreach on telemedicine (technology/uses). 4. Explore hosting a telemedicine open house to introduce community to CMMC telemedicine services. **This was not done due to COVID.Goal 3: Enhance patient understanding of healthcare billing, insurance, and navigation of patient financial programs.Strategy 3.1: Improve CMMC education and outreach efforts related to billing, insurance and financial health 1. Create outreach to assist community in understanding changes in patient billing and transition to Cerner; **This is in process2. Explore development of a "how to Interpret My Bill" tab/resource on CMMC website; **This has been done and is on our website.3. Created education and marketing on how to access new website resource for CMMC community and staff; 4. Convene community partners (e.g., insurance, Council on Aging etc.) to develop and support community financial education (topics may include health insurance education, personal finance, estate planning, financial assistance programs, etc.). **This has not been done yet due to COVID.Goal 4: Enhance population health education and outreach in the CMMC service area. Strategy 4.1: Continue population health related outreach through CMMC1. Assessed and promoted current CMMC classes and programs that promote health and wellness; 2. Explore offering health additional education classes and programs that promote prevention, health, and chronic disease management (e.g., diabetes management, COPD, parenting, financial education, stress management, cancer support, etc.); **Began addressing this, and will continue to work on it.3. Continued to support physical health and healthy behaviors in the CMMC service area (community fun runs, sponsoring various events, etc.). Strategy 4.2: Develop community resource to increase knowledge of available health and wellness opportunities1. Convene community partners to assess and catalogue available resources; **This is not done yet, but is in process.2. Collaborate with community partners to develop ad promote health and wellness resources. **A health fair was scheduled to help address this, but was cancelled due to COVID.The following needs were identified in our most recent CHNA and will not be addressed:1. Secondary data shows Fergus County has a higher unintentional injury death rate (per 100,000 population) compared to state and nation. Additionally, significantly more 2019 survey respondents felt that "Work/farm/ranch related accidents/injuries" were a serious health concern.2. 12.5% of survey respondents indicated cost had prohibited them from getting or taking their prescription medication regularly.3. Top reason identified for survey respondents who delayed or not receive needed care was cost (33.3%).Rationale of needs that were unable to address were as follows:* We live in an ag community where farm accidents are prevalent.* CMMC offers programs/charity care to assist with paying for healthcare costs/medicine at healthcare priced services that are based on current market conditions. CMMC provides Navigator services to the community. CMMC has affiliated with Billings Clinic (as of June 2017) to provide additional healthcare services and physicians. Central Montana Medical Facilities, Inc. Part V, Section B, Line 13h: Eligibility is based on patient's family size, family gross income, personal assets, and other medical debts. Central Montana Medical Facilities, Inc. Part V, Section B, Line 16j: A summary of the financial assistance policy is also posted in the hospital facility's emergency room, waiting rooms, and admissions offices. Part V, Line 16a, FAP Website: https://www.cmmc.health/for-patients/billing-and-financial-assistance/ Part V, Line 16b, FAP Application Website: https://www.cmmc.health/for-patients/billing-and-financial-assistance/ Part V, Line 16c, FAP Plain Language Summary Website: https://www.cmmc.health/for-patients/billing-and-financial-assistance/ 2 1 - Central Montana Medical Center - DME 202 4th Avenue South Lewistown MT 59457 HME/DME Services 2 - Central Montana Medical Center - Clinic 410 Wendell Ave Lewistown MT 59457 Physician Clinic Part I, Line 3c: Eligibility is based on patient's family size, family gross income, personal assets, and other medical debts. Part I, Line 7: The Organization used an average overall ratio of costs to gross charges which addresses all patient segments in order to calculate charity care. Community health improvement services, health professions education and cash and in kind contributions were based on expenses recorded in the general ledger. Medicaid and subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare cost report. Part II, Community Building Activities: Community Building activities promoted the health of the communities served by providing service and donations for a healthy, active, and educated public. Central Montana Medical Center staff donated time to community boards, such as LEPC (Lewistown Emergency Preparedness Community), Central Montana Youth Challenge, EPI Committing Meeting, and the DUI Task Force. By being a part of these community meetings CMMC staff provides a range of knowledge to the community members with a foundation on health and medical needs. All of these programs benefit central Montana area and promote health and wellness. 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. Part III, Line 9b: On every patient statement it states that the Hospital assistance application is available upon request. Applications received prior to 120 days are not referred to a collection agency to be processed accordingly. Any application received from day 120-240 are immediately returned from any collection agency for the application to be processed. Applications are available upon request and on the website for clients to access. Part VI, Line 2: Currently, CMMC assesses the health care needs of the community by the number of responses to ads and articles released through the local media. Also tracked were the kinds of support requested of CMMC such as children's safety, wellness initiatives and healthcare assessments. In FYE 2019 CMMC completed a Community Health Needs Assessment with the help of Montana State University. Mail and phone surveys were completed and "town hall" type meetings were held in Lewistown, as well as some smaller surrounding communities. Part VI, Line 3: CMMC has financial assistance signage posted in the admissions areas and the ER waiting area. A pamphlet explaining our financial assistance program, the application process and contact information is available at all hospital registration areas. The Charity Care policy and application along with a checklist and contact information is posted on our website on the internet. Prior to discharge someone from discharge planning discusses with the patient the availability of various government benefits, such as Medicaid, and assists the patient with qualifications for such programs, where applicable. Assistance with filling out the Charity Care application is also provided at this time. Private Pay in-patients are informed of Charity Care either prior to scheduled admission by physician referral or prior to discharge from the facility. We also send out information with first time statements. All other patients are informed upon inquiry. Part VI, Line 4: Lewistown is an agricultural community and the county seat for Fergus County Montana. Lewistown is located in the center of Montana and is surrounded by five mountain ranges: the Snowies, the Judiths, the Moccasins, the Belts and the Highwoods. Lewistown's elevation is 3,963 feet with 3,102 people per square mile (average).The city of Lewistown and the surrounding rural towns are supported by one hospital, Central Montana Medical Center. Fergus County is located in a federally designated medically underserved area. As of the census of 2020, the population of Lewistown MT is 5,952 (2,988 female and 2,964 male). The county's population was 11,096 and there are 13.38 persons per square mile. March 2016 cost of living index in our zip code (59457) is 83.1%, U.S. average is 100.Real estate property taxes paid for housing units with mortgages in 2015 was $1,326. Renter-occupied apartments were 31% compared to the state average of 33%.The median resident age for this zip code is 45.8 years old with an average household size of 2.2 people.The population 25 years and over in 59457 shows High school or higher: 94.0%, Bachelor's degree or higher: 29.1%, Graduate or professional degree: 6.9%, Unemployed: 2.8%, Mean travel time to work (commute): 10.8 minutesInformation obtained from www.city-data.com/city/Lewistown-Montana.html Part VI, Line 5: The CMMC Governing Board consisted of 16 volunteer community members including residents from Grass Range, Winifred, Hobson and 2 members from our affiliate, Billings Clinic. CMMC extends medical staff privileges to qualified physicians based upon community needs.Surplus funds, when available, are applied to patient care needs, equipment and building maintenance and medical education requirements. The expenditure of these funds is approved by the Governing Board which meets on a monthly basis. Part VI, Line 6: CMMC is part of an affiliated health care system with Billings Clinic. Central Montana Medical Center is involved in promoting community health by participating in Population Health programs offered by Medicare and other third party insurers. Billings Clinic and CMMC collaborate on Population Health and Care Coordination initiatives that are provided to the community. CMMC has an independent Care Coordination department focused on promoting the health of the individuals in our community. X 0 0 0 0 0 0 0 0 0 Dr Gardner Smith Surgeon 433876 0 0 0 0 0 585 0 22381 0 456842 0 0 0 Dr Amy A LePage ER Physician 380820 0 0 0 0 0 6654 0 21046 0 408520 0 0 0 Felipe Vile Martignoni Physician 379480 0 0 0 0 0 7021 0 21046 0 407547 0 0 0 Dr Michael Sura Physician/Member 354291 0 0 0 0 0 11400 0 22381 0 388072 0 0 0 Kimberly Schaaf ER Physician 281741 0 0 0 0 0 249 0 21046 0 303036 0 0 0 Dr Tamara Welsh Physician/Member 277256 0 0 0 0 0 11219 0 1277 0 289752 0 0 0 Alan R Aldrich Co-CEO-Aug 2020, CFO-Dec 2020 249545 0 0 0 0 0 10203 0 11625 0 271373 0 0 0 Dr Laura Bennett Co-CEO-Aug 2020, Dir Clinical Ops 217159 0 0 0 0 0 8971 0 12815 0 238945 0 0 0 Melanie Hardy ER Physician 170765 0 0 0 0 0 0 0 8624 0 179389 0 0 0 A Fergus County Montana 816001358 000000000 2014-05-01 4500000 Emergency and laboratory expansion and remodel of existing facility 0 0 0 A 1132762 4500000 4500000 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 Annie Davis Family Member of Board Member Dave Phillips 100871 Payment of Compensation 0 Form 990, Part III, line 2 Orthopedic services began in 2021. Form 990, Part IV, line 20b: The organization is in the process of completing an audit for the tax year ended June 30, 2021. As such, the most recent financial statement issued for June 30, 2020 has been attached. An amended return will be completed when the audit is complete to make any adjustments and attach the audited financial statements for the year ended June 30, 2021. Form 990, Part VI, Section A, line 1 The Executive Committee includes the President or Chair, Vice President or Vice Chair, Secretary and Treasurer and 2 members-at-large and their authority is similar to that of the full governing board. Form 990, Part VI, Section A, line 3 Cody Langbehn is a contract employee of Billings Clinic as of August 31, 2020. Central Montana Medical Center became affiliated with Billings Clinic and Cody serves as the CEO. Billings Clinic was paid $262,322 for Cody's services during fiscal year 2021. The organization pays Billings Clinic a Management Fee of $30,738 per month for our affiliation. Form 990, Part VI, Section A, line 6 The organization has two classes of membership: Class A general membership and Class B membership, with the sole member of the Class B Membership being Billings Clinic. Class A Membership in the Corporation shall consist of residents of Central Montana residing within the counties of Fergus, Judith Basin and Petroleum who are at least eighteen (18) years of age and who have or shall indicate their interest in the maintenance of adequate medical facilities and high standards of medical care in the area, served by CMMC, and who indicate a willingness and desire to be a member of the Corporation by attending and signing the register at the Corporation's annual meeting. Form 990, Part VI, Section A, line 7a The board has two classes of directors. Class A Directors are elected by the Class A Members and Class B Directors are appointed by the Billings Clinic. There shall be at last nine but no more than thirteen Class A Directors. There shall be at least one but no more than two Billings Clinic Directors, as determined by Billings Clinic from time to time. Each Class A Director must reside within the counties of Fergus, Judith Basin or Petroleum. Two Class A Directors must be physicians holding privileges on CMMC's active Medical Staff. Further, so long as the Corporation remains obligated for the repayment of any long-term tax-exempt financing, underwritten through Fergus County, Montana, one Class A Director shall be selected from the Fergus County Commissioners. The Board and Billings Clinic shall communicate concerning the appointment of Billings Clinic Directors with the objective of selecting individuals who will work cooperatively with the Class A Directors for the benefit of CMMC. Form 990, Part VI, Section A, line 7b Any amendment to the bylaws affecting the voting rights and powers of membership, must be approved by both a two-thirds majority of the board present at any regular or special meeting of the board and Billings Clinic. Additionally, Billings Clinic must consent to any amendment of the bylaws relating to CMMC's purpose, the membership, the members of the board, including but not limited to the number of directors, the composition of the board, the term of office of directors or the method or way in which directors are elected or selected. Form 990, Part VI, Section B, line 11b A draft copy of the Form 990 is reviewed by the CFO and Board of Directors prior to its filing. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by discussing at the Board of Director Meetings and obtaining signed statements from members. All officers, board members, and key employees are covered by the policy. The board determines whether conflicts exist and all potential conflicts are reviewed by the board. Any person with a conflict is not allowed to vote on conflicted issues. Form 990, Part VI, Section B, line 15a The Board of Directors established the compensation for Interim Co-CEO's Alan Aldrich and Dr. Laura Bennett. Cody Langbehn took over as CEO on August 31, 2020 and is employed by Billings Clinic. Billings Clinic provided market data to the Board and the Board takes action annually to set his compensation level. CFO compensation was determined by the CEO after looking at market data from MHA and consulting with a recruitment company about market data for the CFO pay range. The specific pay rate was then set based on the market range and relevant experience. These processes take place on an annual basis. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. A copy may be requested by calling, emailing, walk-in or via mail. Form 990, Part IX, line 11g Medical/Professional Fees: Program service expenses 671,963. Management and general expenses 0. Fundraising expenses 0. Total expenses 671,963. Service Contracts: Program service expenses 802,540. Management and general expenses 0. Fundraising expenses 0. Total expenses 802,540. Purchased Services: Program service expenses 4,658,825. Management and general expenses 0. Fundraising expenses 200. Total expenses 4,659,025. Form 990, Part XI, line 9: Change in Interest in Central Montana Foundation 153,898.