2021-05-07T13:56:32-05:00 2020-06-30 810446334 DOUGLAS WILSON & COMPANY PC 1000 FIRST AVENUE SOUTH GREAT FALLS MT 59401 990 2019-07-01 810515463 LIBERTY COUNTY HOSPITAL & NURSING HOME LIBE 4067595181 BOX 705 315 WEST MADISON AVENUE CHESTER MT 59522 SHARI DOLAN CHIEF FINANCIAL OFFICER 4067595181 2021-05-04 1 KAYCEE LEWIS P01361310 4067614645 2019 2022-09-23 18:48:47Z LIBERTY MEDICAL CENTER SHARI DOLAN BOX 705 315 WEST MADISON AVENUE CHESTER MT 59522 9375203 0 X HTTP://WWW.LIBERTYMEDICALCENTER.ORG X 1998 MT HEALTHCARE 5 5 148 0 0 0 800183 438500 7808514 8224088 140865 19461 94811 139724 8844373 8821773 0 0 0 0 4830491 5481680 0 0 18803 3251970 3702494 8082461 9184174 761912 -362401 7946740 11100374 846438 4421009 7100302 6679365 LIBERTY MEDICAL CENTER IS IN BUSINESS TO IMPROVE THE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITY. 0 0 7653300 8298663 LCHNH PROVIDED HEALTHCARE IN THE FORM OF HOSPITAL IN-PATIENT DAYS, EMERGENCY ROOM VISITS, HOSPITAL OUTPATIENT VISITS, SURGERIES, ASSISTED LIVING DAYS, LONG-TERM SWING BED DAYS, OBSERVATION VISITS, CLINIC VISITS, ETC. 7653300 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 23 0 1 148 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X X SHARI DOLAN 4067595181 BOX 705 315 WEST MADISON AVENUE CHESTER MT 595220705 LARRY HENDRICKSON PRESIDENT 2.00 X X 0 0 0 MAUREEN WICKS VICE-PRESIDENT 2.00 X X 0 0 0 BRITNEY TEMPEL SECRETARY/TREASURER 2.00 X X 0 0 0 TIM BRONK DIRECTOR 2.00 X 0 0 0 KIRK SKARI DIRECTOR 2.00 X 0 0 0 MATTHEW WALLER CEO BY MGMT AGREEMENT 40.00 X 0 0 0 LAURA MERCHANT CEO BY MGMT AGREEMENT 40.00 X 0 0 0 LACEE L LALUM DIRECTOR OF FINANCE 40.00 X 26972 0 0 SHARI DOLAN CHIEF FINANCIAL OFFICER 40.00 X 67429 0 0 GLADYS E YOUNG PHYSICIAN 20.00 X 106291 0 0 WYNAND NEL PHYSICIAN 40.00 X 246847 0 0 PATRICK ARMSTRONG PHYSICIAN ASSISTANT 40.00 X 162601 0 0 TIMOTHY BLAIR NURSE PRACTITIONER 40.00 X 164084 0 0 DARREN YOUNG PHYSICIAN ASSISTANT 40.00 X 150172 0 0 924396 0 0 5 0 1 0 PRAIRIE TRAVELERS 130 3RD STREET SOUTH GLASGOW MT 59230 TRAVELING STAFF 224438 SANFORD USD MEDICAL CENTER P O BOX 5074 SIOUX FALLS SD 571175074 MANAGEMENT SERVICES 187447 KALISPELL REGIONAL MEDICAL CENTER 310 SUNNYVIEW LANE KALISPELL MT 59901 MAMMOGRAPHY & MRI SERVICES 107499 3 438500 438500 GROSS PATIENT REVENUE 623000 7806954 7806954 CONTRACTUAL ADJUSTMENT 623000 417134 417134 8224088 84610 84610 16909 2565 14344 14344 14344 483366 2350 507831 43034 -24465 -40684 -65149 -65149 EMPLOYEE/OTHER MEALS 623000 58437 58437 OTHER 623000 40934 40934 BAD DEBT RECOVERIES 623000 14421 14421 11588 11588 125380 8821773 8298663 0 84610 94401 94401 4221102 3606811 598927 15364 1166177 1031667 131491 3019 15625 15625 190082 159794 30288 8030 6769 1261 366768 258557 108211 81540 6548 74992 PURCHASED SERVICES/PROF 1421278 1162296 258982 SUPPLIES 912699 883185 29441 73 REPAIRS AND MAINTENANCE 393349 380285 13064 OTHER 298737 143002 155388 347 14386 14386 9184174 7653300 1512071 18803 1000 1000 1388548 4124842 1182154 1186530 148178 155028 305 9051 6531359 4421553 2094499 2109806 2794999 2788730 337057 725387 7946740 11100374 549026 914624 11588 0 285824 246181 0 3260204 846438 4421009 X 7025672 6645415 74630 33950 7100302 6679365 7946740 11100374 X -362401 -17856 -40680 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED PART I-A, LINE 1: THROUGH DUES-MONTANA HOSPITAL ASSOCIATION-1.61%, AMERICAN HOSPITAL ASSOCIATION-23.32%, LEADING AG-3.0% PART II-B, LINE 1: NONE 61138 61138 2539593 1564404 975189 84988 72843 12145 3845640 2784306 1061334 2109806 OTHER RECEIVABLES 154371 TAXES RECEIVABLE 110340 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 460676 725387 REFUNDABLE ADVANCE - PROVIDER RELIEF FUNDS 3260204 3260204 8790857 -17856 2565 -15291 8806148 15625 15625 8821773 9171114 2565 2565 9168549 15625 15625 9184174 PART XI, LINE 2D - OTHER ADJUSTMENTS: EXPENSES AGAINST RENTAL INCOME 2565. PART XII, LINE 2D - OTHER ADJUSTMENTS: EXPENSES AGAINST RENTAL INCOME 2565. 1 1 1 X 1 X 1 1 0 1 1 22048 0 22048 0.00240 135360 0 135360 0.01470 157408 157408 0.01710 157408 157408 0.01710 1 57519 17599 2527491 2896543 -369052 X 1 1 1 1 LIBERTY MEDICAL CENTER 315 WEST MADISON CHESTER MT 59522 X X X LEVEL 4 TRAUMA CENTER LIBERTY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X WWW.LIBERTYMEDICALCENTER.ORG 1 18 1 WWW.LIBERTYMEDICALCENTER.ORG 0 1 X 100.000000000000 101.000000000000 X X X X 1 1 1 X HTTP://WWW.LIBERTYMEDICALCENTER.ORG/ X X 1 X X 1 X X X X X 0 0 0 LIBERTY MEDICAL CENTER PART V, SECTION B, LINE 5: THE HOSPITAL PARTICIPATES IN A COMMUNITY NEEDS ASSESSMENT, IN COOPERATION WITH MONTANA OFFICE OF RURAL HEALTH. A RANDOM LIST OF PATIENTS WERE MAILED SURVEYS. IT WAS DETERMINED THAT AREAS WHERE PATIENTS RESIDE WOULD BE REPRESENTED IN PROPORTION. THE SURVEY WAS BASED ON: DEMOGRAPHICS; HOSPITALS, PRIMARY CARE PROVIDERS AND SPECIALISTS USED AND THE REASON FOR A PATIENT'S SELECTION OF THAT PROVIDER; LOCAL HEALTH CARE PROVIDER USAGE; SERVICES PREFERRED LOCALLY; AND PERCEPTION AND SATISFACTION OF LOCAL HEALTH CARE. TWO FOCUS GROUP MEETINGS WERE HELD TO IDENTIFY THE MOTIVES OF LOCAL RESIDENTS WHEN SELECTING LOCAL HEALTH CARE AND DISCOVER REASONS WHY PEOPLE MAY LEAVE THE AREA TO SEEK HEALTH CARE SERVICES. THIS REPORT HAS BEEN REVIEWED BY LIBERTY MEDICAL CENTER'S ADMINISTRATIVE TEAM, MANAGERS, SHARED WITH EMPLOYEES AT THE MONTHLY EMPLOYEE ASSEMBLIES, AND THE BOARD OF DIRECTORS. THIS REPORT HAS BEEN USED BY THE BOARD TO ASSIST WITH THEIR STRATEGIC PLANNING. LIBERTY MEDICAL CENTER PART V, SECTION B, LINE 11: -REVIEWED THE FACILITY'S PRESENCE IN THE COMMUNITY-CONSIDERED ORGANIZATIONS OUTSIDE THE FACILITY WHICH MAY SERVE AS COLLABORATORS IN EXECUTING THE FACILITY'S IMPLEMENTATION PLAN-ASSESSED THE HEALTH INDICATORS OF THE COMMUNITY THROUGH SECONDARY DATE-EVALUATED THE FEEDBACK RECEIVED FROM CONSULTATIONS WITH THOSE REPRESENTING THE COMMUNITY'S INTERESTS INCLUDING PUBLIC HEALTH LIBERTY MEDICAL CENTER PART V, SECTION B, LINE 16J: DURING REVIEW OF AGED ACCOUNTS, A PATIENT CAN BE CONTACTED BY PHONE AND THEN INFORMATION IS SENT TO THE PATIENT TO APPLY. THEY CAN ALSO GET THE FORMS ONLINE OR AT ANY RECEPTION DESK. LIBERTY MEDICAL CENTER PART V, SECTION B, LINE 18E: JUDGEMENTS LIBERTY MEDICAL CENTER PART V, SECTION B, LINE 19E: JUDGEMENTS LIBERTY MEDICAL CENTER PART V, SECTION B, LINE 20E: SETUP PAYMENT AGREEMENTS ON PATIENT BALANCES DUE 1 1 - WHEAT COUNTRY ESTATES 111 6 W CHESTER MT 59522 ASSISTED LIVING PART I, LINE 3C: USE FPL, AS ADJUSTED FOR FAMILY UNIT AND GROSS FAMILY INCOME BETWEEN 100% AND 199% FPL0-100%=100% DISCOUNT101%-125%=80% DISCOUNT126%-150%=60% DISCOUNT151%-175%=40% DISCOUNT176%-199%=20% DISCOUNT PART I, LINE 6A: LINE 42-FINANCIAL ASSISTANCE APPLICATION REQUESTS ALL MEDICAL EXPENSES INCURRED BY THE INDIVIDUAL FAMILY AT ANY FACILITY. FOR THOSE WITH EXCESSIVE MEDICAL BILLS WE MAY INCREASE THE DISCOUNT WE PROVIDE. PART I, LINE 7: COST BASED PART I, LINE 7G: N/A PART I, LN 7 COL(F): N/A PART II, COMMUNITY BUILDING ACTIVITIES: HOSPITAL WORKED TO PROVIDE MENTAL AND EMOTIONAL HEALTH SUPPORT TO THE COMMUNITY DUE TO THE COVID-19 PANDEMIC. HOSPITAL WORKED WITH OPEN DOOR WELLNESS CENTER TO PROVIDE ONSITE PRIVATE SESSIONS, TELEHEALTH PRIVATE SESSIONS AND THREE PUBLIC PRESENTATIONS TO OUR COMMUNITY. SPECIFIC TOPICS INCLUDED LIVING IN THE PRESENT, SUICIDE PREVENTION AND ANXIETY. OPEN DOOR WELLNESS CENTER FOCUSES ON FAMILY, TRAUMA AND RELATIONSHIPS.HOSPITAL COORDINATED WITH THE MONTANA TOBACCO PREVENTION PROGRAM AND THE LIBERTY COUNTY CHAMBER OF COMMERCE FOR A COMMUNITY WALK WITH EASE SELF DIRECTED PROGRAM. THE PROGRAM WAS OFFERED TO HOSPITAL EMPLOYEES AS WELL AS THE COMMUNITY FOR A SIX WEEK PROGRAM. THE GOAL OF THE COLLABORATION WAS TO INCREASE PHYSICAL ACTIVITY WHILE PROVIDING EDUCATION ON TOBACCO/VAPING CESSATION, MOST IMPORTANTLY DURING THE COVID-19 PANDEMIC. PARTICIPANTS RECEIVED A POSITIVE AND ENCOURAGING WEEKLY EMAIL. TOBACCO QUIT KITS WERE ALSO AVAILABLE TO PARTICIPANTS. PART III, LINE 4: THE CARRYING AMOUNT OF PATIENT AND RESIDENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS, RESIDENTS, AND THIRD PARTY PAYORS. MANAGEMENT REVIEWS PATIENT AND RESIDENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND RESIDENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF RECOVERY INFORMATION IN DETERMINING BAD DEBT PROVISION. COMMUNITY BENEFIT IS NOT A FACTOR IN BAD DEBT EXPENSE AS THE HOSPITAL HAS GUIDELINES IN PLACE TO DETERMINE ELIGIBILITY. PART III, LINE 8: 5 DEPARTMENTS ARE ABOVE 1:1 COST RATIO:MEDICAL SUPPLIES 2.983480; BLOOD STORING 1.101089; OUTPATIENT SERVICES 1.724743; ER 1.48243; OBSERVATION 2.968409PUBLIC HEALTH CONTRACT WITH COUNTY TO PROVIDE SERVICES:IN KIND-OFFICE/TELEPHONE/UTILITY/ADMIN SUPPORT(+OR-)$15,000 PER YEAR PART III, LINE 9B: THERE IS A SEPARATE FINANCIAL ASSISTANCE POLICY PART VI, LINE 2: HOSPITAL PARTICIPATES IN COMMUNITY NEEDS ASSESSMENT IN COOPERATION WITH MT OFFICE OF RURAL HEALTH. THE OFFICE WILL BE DOING THESE EVERY 3 YEARS. THE LAST ONE WE PARTICIPATED IN WAS IN 2018. THE ORGANIZATION WILL BEGIN A NEW ASSESSMENT IN 2021. PART VI, LINE 3: HOSPITAL'S FINANCIAL COUNCELOR MAILS INFORMATION TO THE PATIENTS. SHE IS ALSO AVAILABLE BY APPOINTMENT TO HELP WITH ANY PAPERWORK TO DETERMINE IF THE PATIENT IS ELIGIBLE BY FEDERAL POVERTY GUIDELINES TO QUALIFY FOR FINANCIAL ASSISTANCE. THE CLINIC'S RECEPTIONIST MEETS FACE TO FACE WITH PATIENTS AND ASSISTS THEM WITH THE PROPER PAPERWORK TO OBTAIN DRUGS AT NO COST FROM PHARMACEUTICAL COMPANIES. ONE EMPLOYEE ASSISTS WITH APPLICATIONS OF PATIENTS TO THE HEALTHY MT KIDS PROGRAM PART VI, LINE 4: HOSPITAL IS A 25 BED CAH BASED IN CHESTER, LIBERTY COUNTY, MT. SERVICE AREA IS 1,430 SQUARE MILES. COUNTY IS A FRONTIER COMMUNITY LOCATED IN NORTHCENTRAL MT WITH A POPULATION DENSITY OF 1.21/SQUARE MILE. POPULATION IS 1,099 BUT HOSPITAL SERVES APPROXIMATELY 2,500 PEOPLE. LIBERTY COUNTY IS DESIGNATED AS A MEDICALLY UNDERSERVED AREA AS WELL AS A PRIMARY CARE HEALTH PROFESSIONAL SHORTAGE AREA. 39.3% OF RESIDENTS ARE AT OR BELOW 200% FPL AND 26.1% ARE AT OR BELOW 100% FPL. PART VI, LINE 5: HOSPITAL PROVIDES ALL HEALTHCARE TO THE COMMUNITYALL PHYSICIAN SERVICES, LONG TERM CARE, ASSISTED LIVING IS PROVIDED TO THE HOSPITAL.HOSPITAL PROVIDES CARE TO ANYONE WHO REQUESTS IT. PART VI, LINE 6: NOT APPLICABLE X X X 0 0 0 0 0 0 0 0 0 WYNAND NEL PHYSICIAN 246847 0 0 0 0 0 0 0 0 0 246847 0 0 0 PATRICK ARMSTRONG PHYSICIAN ASSISTANT 162601 0 0 0 0 0 0 0 0 0 162601 0 0 0 TIMOTHY BLAIR NURSE PRACTITIONER 164084 0 0 0 0 0 0 0 0 0 164084 0 0 0 DARREN YOUNG PHYSICIAN ASSISTANT 150172 0 0 0 0 0 0 0 0 0 150172 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION RENEWED A MANAGEMENT AGREEMENT WITH SANFORD HEALTH SYSTEM. CEO IS PROVIDED THROUGH AGREEMENT. LMC BOARD OF DIRECTORS RETAINS FULL CONTROL. THE AGREEMENT EXPIRES IN MARCH 2022. FORM 990, PART VI, SECTION B, LINE 11B NOTIFICATION HAS BEEN SENT BY EMAIL TO BOARD MEMBERS THAT RETURN MAY BE REVIEWED FORM 990, PART VI, SECTION B, LINE 12C OFFICERS, DIRECTORS OR TRUSTEES REVIEW CONFLICT OF INTEREST POLICY ANNUALLY AND SIGN NOTICE FORM 990, PART VI, SECTION B, LINE 15 PARTICIPATE IN MT HOSPITAL ASSOC ANNUAL WAGE SURVEY. REPORT PROVIDED TO FACILITY SHOWING COMPARISONS OF OTHER PEER CAHS. INFORMATION IS THEN USED IN SALARY NEGOTIATIONS. FORM 990, PART VI, SECTION C, LINE 18 GUIDESTAR FORM 990, PART VI, SECTION C, LINE 19 COMMUNITY IS ENCOURAGED TO VIEW ALL DOCUMENTS AT THE HOSPITAL ADMINISTRATIVE OFFICES. ANY COMMUNITY MEMBER WHO REQUESTS TO SEE INFORMATION IS PROVIDED WHAT THEY REQUEST TO SEE ASIDE FROM INDIVIDUAL EMPLOYEE WAGES. MONTHLY BOARD MEETINGS ARE OPEN TO THE PUBLIC AS ALL OF OUR ASSETS ARE OWNED BY THE COUNTY AND THEREFORE REQUIRED TO HOLD OPEN MEETINGS. THE MONTHLY BOARD AGENDA ALLOWS TIME FOR PUBLIC COMMENT. FORM 990, PART XI, LINE 9: NET ASSETS RELEASED FROM RESTRICTIONS -40680. CONTRIBUTIONS WITH DONOR RESTRICTIONS 0. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR