2022-11-11T16:28:30-06:00 2021-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1200 PORTLAND OR 98205 990 2021-01-01 473448483 BENEFIS COMMUNITY HOSPITALS INC BENE 4064552544 1101 26TH STREET SOUTH GREAT FALLS MT 59405 LOUIE KING PRESIDENT 4064552544 2022-11-10 1 LOUIE KING 999009999 WENDY CAMPOS P00448102 5032421447 2022-11-10 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z LOUIE KING 1101 26TH STREET SOUTH GREAT FALLS MT 59405 9559244 0 X HTTPS://BENEFIS.ORG/TETON-MEDICAL-CENTER X 2015 MT WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 7 6 90 40 0 0 172407 349929 6731496 9197987 15471 320 8093 11008 6927467 9559244 29529 29766 0 0 4025026 4442633 0 0 0 2890220 3733052 6944775 8205451 -17308 1353793 7529288 10772274 10342162 12231355 -2812874 -1459081 BENEFIS COMMUNITY HOSPITALS, INC. (BCH) PROVIDES MEDICAL CARE AND SERVES AS AN ECONOMIC PILLAR IN RURAL MONTANA COMMUNITIES BY SUPPORTING THE ROLE OF CRITICAL ACCESS HOSPITALS. 0 0 6263562 29766 9176459 OPERATED AS A 25-BED CRITICAL ACCESS HOSPITAL, PROVIDE EMERGENCY SERVICES, OPERATE AN OUTPATIENT CLINIC, ACUTE CARE SERVICES AND ANCILLARY SERVICES INCLUDING: PHYSICAL THERAPY, LABORATORY, RADIOLOGY, ECHOCARDIOGRAPHY, CAROTID ULTRASOUND, MAMMOGRAM, DIABETIC FOOT CARE, BONE DENSITY (DEXA SCAN), TELE-DERMATOLOGY, CAT SCAN AND OCCUPATIONAL THERAPY. 6263562 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 90 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X FORREST EHLINGER 4254555479 1101 26TH STREET SOUTH GREAT FALLS MT 59405 LOUIE KING PRESIDENT 25.00 25.00 X X 223620 0 32431 RON DAUWALDER CHAIR 2.00 X X 0 0 0 DALE HANSON VICE CHAIR 2.00 X X 0 0 0 DAN LINDSETH DIRECTOR 2.00 X 0 0 0 DAN LANNEN DIRECTOR 2.00 X 0 0 0 BRIAN MCCOLLOM DIRECTOR 2.00 X 0 0 0 JERE LONG DIRECTOR 2.00 X 0 0 0 SUSAN MURPHY CHIEF OPERATING OFFICER 50.00 X 115074 0 21463 PENNY SMOOT DIRECTOR OF NURSING, BTMC 50.00 X 103568 0 25688 442262 0 79582 3 0 1 0 NUWEST GROUP HOLDINGS LLC PO BOX 940 ROSEVILLE CA 95661 CONTRACT NURSING 286992 1 344549 5380 349929 PATIENT SERVICES 621990 9065591 9065591 OTHER PROGRAM REVENUE 621990 110868 110868 CAFETERIA 722210 21528 21528 9197987 320 320 11008 0 11008 11008 11008 9559244 9176459 0 32856 2147 2147 27619 27619 256051 256051 3371484 2935984 435500 112034 88022 24012 459617 380317 79300 243447 213896 29551 794707 794707 27276 27276 89148 15272 73876 171611 171611 219219 213876 5343 21428 19278 2150 8 8 194236 194236 PROVIDER CONTRACT SERVI 755632 755632 PURCHASED SERVICES 661922 642546 19376 MEDICAL SUPPLIES 347084 341984 5100 BAD DEBT EXPENSE 63975 63975 386806 368778 18028 8205451 6263562 1941889 0 900662 1916127 4793047 7069024 66439 39630 28264 86767 3587227 1926501 1740876 1660726 7529288 10772274 10342162 12231355 10342162 12231355 X -2812874 -1459081 -2812874 -1459081 7529288 10772274 1353793 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 14585 14585 1438744 311738 1127006 2133898 1614763 519135 1660726 X PART X, LINE 2: THE ORGANIZATION COMPRISES SEVERAL CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515, AND SEVERAL LIMITED LIABILITY COMPANIES. THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS, WHICH IS AN ACCOUNTING STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2021 OR 2020. 1 1 X 1 X 1 X 1 1 0 0 26781 26781 0.00330 1636438 1912559 0 0.00000 1663219 1912559 26781 0.00330 13815 13815 0.00170 4000 4000 0.00050 0 17815 17815 0.00220 1681034 1912559 44596 0.00550 1 63975 0 4528065 4535485 -7420 X 1 1 1 1 BENEFIS TETON MEDICAL CENTER 915 FOURTH ST NW CHOTEAU MT 59422 BENEFIS.ORG/TETON-MEDICAL-CENTER 12766 X X X X INCLUDING EXTENDED CARE LIVING & RURAL HEALTH CLINIC BENEFIS TETON MEDICAL CENTER 0 0 1 X X X X X X X X X 20 1 0 1 1 X SEE PART V, PAGE 8 X HTTPS://TETONCOMT.ORG/HEALTH-DEPARTMENT/ X 1 20 1 SEE PART V, PAGE 8 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X SEE PART V, PAGE 8 X X X X X 1 0 X X X X 1 X 0 0 BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 5: BCH, INC COLLABORATED WITH TETON COUNTY HEALTH DEPARTMENT AND TETON COUNTY LOCAL MENTAL HEALTH ADVISORY COUNCIL TO CONDUCT A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2020. A SERIES OF SEVEN FOCUS GROUP DISCUSSIONS WERE CONDUCTED IN FOUR COUNTY COMMUNITIES. EACH MEETING TARGETED UNIQUE COUNTY POPULATION GROUPS, INCLUDING: HIGH SCHOOL STUDENTS, PEOPLE WITH CHRONIC HEALTH CONDITIONS, A BEHAVIORAL HEALTH COHORT, MEMBERS OF A HUTTERITE COLONY, LOW INCOME FAMILIES, A COMMUNITY SEWING CIRCLE, AND SENIOR CITIZENS. FORTY-FIVE COMMUNITY MEMBERS PARTICIPATED IN DISCUSSION GROUPS RANGING IN SIZE FROM FOUR TO FOURTEEN. EACH GROUP WAS ASKED THE SAME 8 QUESTIONS, AND DATA WAS COMPILED FROM THEIR DISCUSSIONS AND ANSWERS.THE KEY INFORMANT SURVEY INCLUDED 266 "KEY INFORMANTS," MEMBERS OF THE COUNTY WITH KNOWLEDGE OF AND BROAD CONNECTION TO COMMUNITY GROUPS AND SPECIAL POPULATIONS, WERE IDENTIFIED AND SENT ELECTRONIC SURVEYS. THE ELECTRONIC SURVEY CONSISTED OF 22 QUESTIONS. REPRESENTED IN THE CONTACT LIST WERE HEALTH PROVIDERS, EDUCATORS, NONPROFIT LEADERS, RETAIL BUSINESS OWNERS, PUBLIC AGENCY LEADERS, LOCAL GOVERNMENT, SENIOR SERVICES ADMINISTRATORS, FAITH LEADERS, AND COMMUNITY VOLUNTEERS. OF THE 266 SURVEYS DISTRIBUTED, 14 SURVEYS WERE SENT BACK UNCOMPLETED DUE TO EMAIL ERROR, FIVE INDIVIDUALS DECLINED TO ANSWER, AND 79 (40%) SURVEYS WERE COMPLETED AND RETURNED.THE FOLLOWING COMMUNITY PARTNERS AND STAKEHOLDERS PROVIDED VALUABLE INPUT TOWARDS UNDERSTANDING THE HEALTH STATUS OF TETON COUNTY: CHOTEAU CHAMBER OF COMMERCE CHOTEAU LIONS CLUB CHOTEAU PUBLIC SCHOOL CHOTEAU UNITED METHODIST CHURCH CHOTEAU SOROPTIMISTS DUTTON/BRADY PUBLIC SCHOOL DISTRICT HEAD START EARLY CHILDHOOD CENTERS FAIRFIELD CHAMBER OF COMMERCE FAIRFIELD FIRE FAIRFIELD PUBLIC SCHOOLS FAMILY CONNECTIONS U.S. FOREST SERVICE FRONT RANGE ASSISTED LIVING POWER SENIOR CENTER CITY OF CHOTEAU LIONS CLUB MONTANA STATE UNIVERSITY EXTENSION NEW LIFE COMMUNITY CHURCH OLD TRAIL MUSEUM ST. JOSEPH CATHOLIC CHURCH TETON COUNTY CONSERVATION DISTRICT TETON COUNTY EMERGENCY MEDICAL SERVICES TETON COUNTY FOOD PANTRY TETON COUNTY PLANNING DEPARTMENT TETON COUNTY BOARD OF HEALTH TETON COUNTY HEALTH DEPARTMENT CHOTEAU AREA PORT AUTHORITY TETON PASS SKI AREA TRINITY LUTHERAN CHURCH MILLER HUTTERITE COLONY BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 6B: TETON COUNTY HEALTH DEPARTMENTTETON COUNTY LOCAL MENTAL HEALTH ADVISORY COUNCIL BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 11: THE 2020 COMMUNITY HEALTH NEEDS ASSESSMENT THAT DROVE THE MOST RECENT COMMUNITY HEALTH IMPROVEMENT PLAN FOR TETON COUNTY IDENTIFIED THREE PRIORITIES. THOSE PRIORITIES INCLUDE THE FOLLOWING:- SUPPORT ACCESS TO & IMPROVE UTILIZATION OF MENTAL HEALTH RESOURCES AMOUNT RESIDENTS OF TETON COUNTY.- PROVIDE COMMUNITY-WIDE SUPPORT FOR DECREASING ACES AND INCREASING RESILIENCY AMONG FAMILIES & YOUTH SO THEY CAN THRIVE MENTALLY, PHYSICALLY, & EMOTIONALLY. - EMPOWER COMMUNITY MEMBERS TO ENGAGE WITH THEIR HEALTH THROUGH CLEAR, CONSISTENT, COLLABORATIVE, AND CULTURALLY APPROPRIATE HEALTH MESSAGING.IN ADDRESSING MENTAL HEALTH OUR OBJECTIVES INCLUDE:- INCREASE THE NUMBER OF MENTAL HEALTH SCREENINGS- FOLLOW UP WITH PATIENTS IDENTIFIED AS NEEDING MENTAL HEALTH SERVICESIN ADDRESSING THE PRIORITY AREA OF THRIVING FAMILIES OUR OBJECTIVE INCLUDE: - CREATE A SAFE AND PRIVATE SPACE FOR PROVIDERS TO SPEAK WITH EMERGENCY ROOM PATIENTS WITHIN 20 MINUTES OF PATIENT PRESENTING TO ER- INCREASE PATIENT FAMILY ENGAGEMENTIN ADDRESSING OUR HEALTH COMMUNICATIONS OUR OBJECTIVE ARE THE FOLLOWING:- ACTIVELY PARTICIPATE IN ESTABLISHMENT OF HEALTH INFORMATION COMMITTEE BENEFIS TETON MEDICAL CENTER PART V, SECTION B, LINE 13H: - HOMELESS- DECEASED WITH NO ESTATE- MENTALLY INCAPACITATED WITH NO ONE TO ACT ON HIS OR HER BEHALF- MEDICAID ELIGIBLE, BUT NOT ON THE DATE OF SERVICE OR FOR NON-COVERED SERVICES- ENROLLED IN ONE OR MORE GOVERNMENTAL PROGRAMS FOR LOW-INCOME INDIVIDUALS HAVING ELIGIBILITY CRITERIA AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES - INCARCERATION IN A PENAL INSTITUTION PART V, LINE 7A, CHNA ON HOSPITAL FACILITY WEBSITE: HTTPS://WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS PART V, LINE 10A, IMPLEMENTATION PLAN WEBSITE: HTTPS://WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS PART V, LINE 16A, FAP WEBSITE: HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES PART V, LINE 16B, FAP APPLICATION WEBSITE: HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES PART V, LINE 16I, EXPLANATION: THERE IS NO LIMITED ENGLISH PROFICIENCY POPULATIONS THAT MAKE UP 10% OR MORE OF THE COMMUNITY SERVED BY THE ORGANIZATION. PART I, LINE 7: THE COST TO CHARGE RATIO IS USED TO CALCULATE THE TOTAL COMMUNITY BENEFIT EXPENSE. PART I, LINE 7, COLUMN (F) THE BAD DEBT OF $63,975 IS INCLUDED ON FORM 990 PART IX, LINE 24(D), BUT IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART III, LINE 2: THE METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO. PART III, LINE 4: SEE NOTE 2 ON PAGE 11 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT.THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID 94% OF COSTS TO PROVIDE SERVICES TO MEDICARE PATIENTS. RECONCILIATION OF MEDICARE COST REPORT TO TOTAL MEDICARE REVENUE & EXPENSES:$4,528,065 MEDICARE NET REVENUE AS REPORTED ON PART III, SECTION B, LINE 5 $127,004 MEDICARE CLAIMS PAID BUT EXCLUDED FROM COST REPORT (OUTPATIENT FEE SCHEDULE, PHYSICIANS & OTHER MISCELLANEOUS)$4,655,069 TOTAL MEDICARE NET REVENUE$4,535,485 MEDICARE ALLOWABLE COSTS AS REPORTED ON PART III, SECTION B, LINE 6($929,586) MEDICARE COST DEPARTMENTS EXCLUDED FROM COST REPORT (OUTPATIENT FEE SCHEDULE, PHYSICIANS & OTHER MISCELLANEOUS) $100,085 MEDICARE COST REPORT REVENUE AND EXPENSE ADJUSTMENTS$3,705,984 TOTAL MEDICARE COSTS $949,085 TOTAL NET ON MEDICARE PART III, LINE 9B: PERSONS DETERMINED TO BE ELIGIBLE FOR 100% CHARITY CARE SHALL NOT RECEIVEA BILL FOR SERVICES OR BE SUBJECT TO COLLECTION PROCEDURES. PERSONS DETERMINED TO BE ELIGIBLE FOR A REDUCTION OF A PERCENTAGE OF CHARGES UNDER THE CHARITY CARE PROGRAM LESS THAN 100% SHALL NOT BE BILLEDOR SUBJECT TO COLLECTION PROCEDURES FOR THE PORTION OF THE BILL THAT ISREDUCED UNDER THE SLIDING FEE SCALE, ONLY THE OUT OF POCKET RESPONSIBILITY. PART VI, LINE 2: HISTORICALLY, BENEFIS COMMUNITY HOSPITALS, INC. HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. IN 2020, BENEFIS COMMUNITY HOSPITALS, INC. CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) FOR ITS SERVICE AREA IN TETON COUNTY, MONTANA, AS CONTEMPLATED BY IRC SECTION 501(R). THE ORGANIZATION WORKED COLLABORATIVELY WITH TETON COUNTY LOCAL MENTAL HEALTH ADVISORY COUNCIL AND TETON COUNTY HEALTH DEPARTMENT TO IDENTIFY THE NEEDS OF ITS COMMUNITY THROUGH STAKEHOLDER SURVEYS, COMMUNITY FOCUS GROUPS, AND RESEARCH USING REGIONAL AND STATE HEALTH DATA. SIGNIFICANT HEALTH NEEDS OF TETON COUNTY AREA RESIDENTS WERE IDENTIFIED AND PRIORITIZED THROUGH THE SURVEY PROCESS AND DATA ANALYSIS. ALL COLLECTED INFORMATION HAS BEEN COMPILED INTO A CHNA REPORT. AFTER THE REPORT'S PUBLIC PRESENTATION, THE ORGANIZATION DEVELOPED AN IMPLEMENTATION STRATEGY FOR EACH OF THE HEALTH NEEDS IDENTIFIED IN THE ASSESSMENT REPORT. BOTH THE ORGANIZATION'S CHNA REPORT AND ITS IMPLEMENTATION PLAN ARE AVAILABLE FREE OF CHARGE TO THE PUBLIC AS WELL AS DIGITALLY ON ITS WEBSITE AT THE FOLLOWING ADDRESS HTTPS://WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS. PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AT HTTPS://WWW.BENEFIS.ORG/TETON-MEDICAL-CENTER/PATIENT-RESOURCES AND IS MAILED TO EACH PATIENT ALONG WITH THEIR BILLING STATEMENT. PART VI, LINE 4: THE HOSPITAL IS A 25 BED CRITICAL ACCESS HOSPITAL LOCATED IN CHOTEAU, TETON COUNTY, MT. THE HOSPITAL'S SERVICE AREA IS 2,293 SQUARE MILES. TETON COUNTY IS A FRONTIER COMMUNITY LOCATED ALONG THE ROCKY MOUNTAIN FRONT WITH A POPULATION DENSITY OF 3/SQUARE MILE. THE POPULATION IN CHOTEAU, MT IS 1,730 WITH TETON COUNTY'S POPULATION BEING 6,073. 14.1% OF THE RESIDENTS ARE AT OR BELOW 200% FEDERAL POVERTY LEVEL. TETON COUNTY IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA AND A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA. PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES AND PROVIDE EDUCATION. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. 1 CHARITY HEALTH CARE SERVICES 28 27619 PART I, LINE 2: THE ORGANIZATION HAS A FINANCIAL ASSISTANCE POLICY IN PLACE THAT LINES OUT WHO MAY BE ELIGIBLE FOR FREE OR DISCOUNTED CARE. IN ORDER TO QUALIFY A PATIENT MUST COMPLETE AND SUBMIT A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION ACQUIRES DOCUMENTS WITH THE APPLICATION TO VERIFY CLAIMS OF THE APPLICANT'S QUALIFICATIONS FOR ASSISTANCE. 0 1 0 0 0 0 0 1 0 LOUIE KING PRESIDENT 162749 0 37833 0 23038 0 13303 0 19128 0 256051 0 16038 0 PART I, LINE 4B BENEFIS HEALTH SYSTEM, INC. PROVIDES A SECTION 457F NONQUALIFIED DEFERRED COMPENSATION PLAN FOR MR. KING WHO MET THE REQUIREMENTS. MR. KING RECEIVED A PAYOUT FROM THE PLAN IN 2021. PART I, LINE 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE AND MANAGEMENT LEADERSHIP TEAMS. PAYMENTS PURSUANT TO THE INCENTIVE PLAN ARE SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. THE SYSTEM HAS ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, AND FINANCE/OPERATIONS. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S AND MANAGER'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. FORM 990, PART VI, SECTION A, LINE 1A THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NONPROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO APPROVE THE ELECTION OF INDIVIDUALS TO ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS' OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS, AS THE PARENT AND SYSTEM ENTITY, PROVIDES THE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT NON-PROFIT CORPORATE ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES AND BENEFITS - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES AND FUNCTIONS - MANAGEMENT OF INFORMATION TECHNOLOGY SERVICES - OVERSIGHT OF QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGEMENT OF REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. (ACTING THROUGH ITS OWN GOVERNING BODY) ELECTS THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS PRESENTED TO THE BENEFIS HEALTH SYSTEM, INC. BOARD BY THE ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND VOTING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM, INC.'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILAR SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 BENEFIS COMMUNITY HOSPITALS, INC. PROVIDES COPIES OF AUDITED FINANCIALS STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. 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