2021-05-06T14:17:54-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 237169043 Central Montana Medical Facilities Inc CENT 4065387711 408 Wendell Avenue Lewistown MT 59457 Cody Langehn CEO 4065387711 2021-05-06 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-06 2019 2022-09-23 18:48:47Z Central Montana Medical Center Cody Langehn 408 Wendell Avenue Lewistown MT 59457 38465804 0 X www.cmmc.health X 1971 MT The mission of CMMC is to be the leader in assuring community based quality healthcare. 14 11 310 120 0 0 1084512 627180 36891543 36641852 253820 270818 600587 545997 38830462 38085847 0 0 0 0 20886396 23287930 0 0 119935 15744678 18081915 36631074 41369845 2199388 -3283998 32154222 43203325 9101647 23170560 23052575 20032765 X The mission of Central Montana Medical Center is to be the leader in assuring community based quality healthcare. 1 0 32101957 36641852 Central Montana Medical Facilities, Inc. operates a 25-bed critical access hospital located in Lewistown, Montana.Hospital Inpatient Services for FY 2020:Number of beds: 25Provided 1,606 acute days of care and 1,054 swing bed days of care for 29.1% occupancy rate. Emergency Services for FY 2020:Provided for 4,797 Emergency visits.24-hour Physician coverage available.OB Services for FY 2020:Provided for 86 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 include but are not limited to the following (all costs are estimates):1. Sixteen foot clinics were held in 2019-2020 in Denton, Stanford, and the Hobson communities. A total of 178 people were served, all received discounted health care. Total community benefits expense of $1,488.2. Due to Covid Pandemic CMMC was unable to hold our Safe Sitter Course (babysitting class).3. Instead of a Health Fair, CMMC offered lab draws during your birth month at discounted prices. A total of 260 persons participated, with expenses such as staff time and supplies were $5,564.4. CMMC served our community in a multitude of ways throughout 2019-2020 fiscal year. Staff were involved in several community boards, staff helped serve luncheons at our local Council on Aging, we did hold CPR/First Aid Classes, an impact concussion testing sessions which 107 community members took advantage of, we did hold our annual REACH Camp for 24 individuals and we held several support groups including dementia and diabetes.The 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 $722,122 for the fiscal year. Total direct and indirect costs related to these foregone charges were $467,000 based on an average ratio of cost to gross charges.Awards received for FY 2020 were:* Top 100 Critical Access Hospital iVantange Health Analytics (6 years in a row)* NOSORH Performance Leadership Award (3 years in a row)* MHA PIN- Performance Improvement Network (3 years in a row)* Dr. Christina Marchion received the Dr. Frank Newman Rural Health award for Rural Health Education in Montana. 32101957 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 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 52 0 1 310 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Alan R Aldrich 4065357711 408 Wendell Ave Lewistown MT 59457 Dr Gardner Smith Surgeon 40.00 X 447998 0 20096 Dr Amy A LePage ER Physician 40.00 X 353035 0 20713 Dr Michael Sura Member 40.00 X 337644 0 29454 Dr Christina Marchion Physician 40.00 X 320051 0 31431 Dr Tamara Welsh Member 40.00 X 273655 0 11497 James Fox CRNA 40.00 X 244165 0 10156 Rene DeGuzman Anesthetist 40.00 X 218339 0 27314 Alan R Aldrich CFO/Co-CEO 40.00 X 213148 0 24263 Dr Laura Bennett Co-CEO 40.00 X 212346 0 23631 Karin White CNO until February 40.00 X 123081 0 12082 Dave Phillips - Chair until Oct/Vice Chair starting Nov 2.00 X X 0 0 0 Bret Carpenter - Member until Oct/Chair starting Nov 1.00 X X 0 0 0 Carl Seilstad Vice Chair until October 2.00 X X 0 0 0 Jennifer Saunders Secretary/Treasurer 2.00 X X 0 0 0 Josh Webber Member until October 1.00 X 0 0 0 Marvin Mauws Member 1.00 X 0 0 0 Corry Arntzen Member 1.00 X 0 0 0 Brandon Bantz Member 1.00 X 0 0 0 Keith Cook Member 1.00 X 0 0 0 Erik Wood Member 1.00 X 0 0 0 Nick Econom Member 1.00 X 0 0 0 Kim Vincent Member 1.00 X 0 0 0 Karin Durbin Member 1.00 X 0 0 0 Ashley Morris Member starting October 1.00 X 0 0 0 2743462 0 210637 24 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 532788 94392 627180 Net Patient Revenue 621110 33601940 33601940 Special Programs 900099 2024747 2024747 Pharmacy Revenue 446110 879648 879648 Cafeteria 722210 135517 135517 36641852 211146 211146 643840 97843 545997 545997 545997 341786 282114 59672 59672 59672 38085847 36641852 0 816815 X 1317103 835191 481912 94162 94162 18154011 14458013 3624310 71688 430932 285373 145559 2080253 1693091 376601 10561 1211469 969175 238335 3959 300000 300000 513670 513670 42785 42785 4363637 2934186 1429451 117681 88260 1717 27704 2858564 1830407 1024026 4131 1137348 903517 232031 1800 127163 93300 33863 186948 112928 73970 50 219829 168209 51620 1517802 1173575 344227 604333 604333 Medical Supplies 3415604 3415604 Bad Debt Allowance 2045368 2045368 Equipment Rental and Ma 373048 373006 42 Taxes and Licenses 112374 23676 88698 145761 94745 51016 41369845 32101957 9147953 119935 2137505 12998243 7367797 7442282 780241 700672 264546 440143 44724239 31536920 12469961 13187319 4158582 3964696 4975590 4469970 32154222 43203325 3847192 4672375 8339770 3602829 3486772 1651626 2419272 3772500 0 479871 9101647 23170560 X 20348829 16862898 2703746 3169867 23052575 20032765 32154222 43203325 X -3283998 -201933 466121 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 123009 123009 24306087 16645707 7660380 17530033 13775121 3754912 2765110 1116092 1649018 13187319 Long-Term Prepaid Expenses 647619 Due from Foundation 3169867 Other Receivables 652484 4469970 Estimated Third-Party Payor Settlements 479871 479871 X 35903793 -201933 -2045368 -2247301 38151094 -65247 -65247 38085847 39422320 97843 97843 39324477 2045368 2045368 41369845 Part X, Line 2: The Facilities believes that 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 Facilities 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: Provision for Bad Debts Reported in Expenses for Tax Purposes -2,045,368. Part XI, Line 4b - Other Adjustments: Contributions for Specific Purposes Recorded in Fund Balance for F/S 32,596. Rental Expenses Reported in Revenue for Tax Purposes -97,843. Part XII, Line 2d - Other Adjustments: Rental Expenses Reported in Revenue for Tax Purposes 97,843. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Reported in Expenses for Tax Purposes 2,045,368. 1 1 X 1 X 1 X 1 1 1 0 0 467000 467000 0.01190 3256526 2514105 742421 0.01890 3723526 2514105 1209421 0.03080 12 1486 36448 5006 31442 0.00080 13099116 7933131 5165985 0.13140 12 1486 13135564 7938137 5197427 0.13220 12 1486 16859090 10452242 6406848 0.16300 3 548 4042 30 4012 0.00010 3 548 4042 30 4012 0.00010 1 2045368 0 7763936 7778203 -14267 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 CHSD. 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. Have developed and continued Behavioral Health services with CMMC LCSW;2. Expanded Psychiatric outreach with Dr. Davis and Shelly Andrus3. CMMC hired a full time, onsite Psychiatric NP to start 12/1/2021.Strategy 1.2: Support local community efforts that address behavioral health needs in the CMMC service area1. With the addition of the onsite Psychiatric NP, we will be able to service our community & surrounding areas with improved and expanded accessStrategy 1.3: Ensure sustainability of collaborative care efforts at CMMC which help screen and provide resources for behavioral health needs1. Ongoing effort to continually perform real time screening. Goal 2: Increase access to healthcare services at Central Montana Medical Center.Strategy 2.1: Increase access to primary care services at CMMC1. Extended evening hours found to be successful and used regularly. Expanded to 3 days a week. 2. Hired additional primary care IM, Dr. Amaral. Strategy 2.2: Increase access to specialty care services at CMMC1. Expanded telemedicine with Rheumatology and Endocrinology. Future of PM & R (Physician Medicine & Rehab) specialist onsite. 2. Continue to look at service gaps with specialists. 3. Hired full time, onsite Interventional Radiologist. 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. With EMR conversion, the statements are clearer and easier to understand and both clinic & hospital bills are on the same statement. Future community education still needed. Goal 4: Enhance population health education and outreach in the CMMC service area. This goal is still of importance, however with Covid, many of the population health initiatives did not occur. However, unified efforts for public health were of importance and successful during 2020 Covid.Strategy 4.1: Continue population health related outreach through CMMCStrategy 4.2: Develop community resource to increase knowledge of available health and wellness opportunitiesThe 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 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 I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $2,045,368. 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 2: Bad debt expense is reported at charges as recorded by the organization.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 10 of the attached audit report. 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. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. 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 2015, the population of Lewistown MT is 9,200 with a 2010 estimate of 9,105 people. There is an estimate of 4,615 males compared to 4,585 females. March 2016 cost of living index in our zip code (59457) is 83.1%, U.S. average is 100. Lewistown Montana has an estimate of 11,096 people per square mile with our land area at an estimated 829.1 square miles.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 447998 0 0 0 0 0 0 0 21100 0 469098 0 0 0 Dr Amy A LePage ER Physician 353035 0 0 0 0 0 617 0 20096 0 373748 0 0 0 Dr Michael Sura Member 337644 0 0 0 0 0 9358 0 21188 0 368190 0 0 0 Dr Christina Marchion Physician 320051 0 0 0 0 0 11338 0 20383 0 351772 0 0 0 Dr Tamara Welsh Member 273655 0 0 0 0 0 11497 0 1097 0 286249 0 0 0 James Fox CRNA 244165 0 0 0 0 0 10156 0 1115 0 255436 0 0 0 Rene DeGuzman Anesthetist 218339 0 0 0 0 0 7219 0 21193 0 246751 0 0 0 Alan R Aldrich CFO/Co-CEO 213148 0 0 0 0 0 8859 0 16538 0 238545 0 0 0 Dr Laura Bennett Co-CEO 212346 0 0 0 0 0 7166 0 16757 0 236269 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 1013226 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 94162 Payment of Compensation 0 Form 990, Part III, line 2 Dr. Smith and Dr. Church did outreach to Harlow Clinic for surgery and podiatry. As of July 1, 2019 Dr. Martignoni came on staff and is our new Internal Medicine Physician. 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 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. This process 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 1,153,182. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,153,182. Service Contracts: Program service expenses 719,037. Management and general expenses 323,614. Fundraising expenses 0. Total expenses 1,042,651. Purchased Services: Program service expenses 1,061,967. Management and general expenses 1,105,837. Fundraising expenses 0. Total expenses 2,167,804. Form 990, Part XI, line 9: Change in Interest in Central Montana Foundation 466,121.