2020-04-10T14:45:15-05:00 2019-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2018-07-01 810378200 Livingston Healthcare LIVI 4062223541 320 Alpenglow Lane Livingston MT 59047 Deb Anczak CEO 4062223541 2020-04-08 1 Kim Hunwardsen CPA P00484560 6122536500 2020-04-08 63.233.88.226 2020-04-08 12:50:40 CD P EE7B44BF798B4EF79D5DDE03D0EF16CE53CA0C32 910E667CAF9535F6E07908141D928A1E2DABEDFE 2018 2021-01-29 14:40:06Z Deb Anczak 320 Alpenglow Lane Livingston MT 59047 58444434 0 X www.livingstonhealthcare.org X 1955 MT A 25-bed critical access hospital, a multispecialty physician practice, rehabilitation services, and home-based services. 12 9 489 6 0 0 1534445 432481 51485726 57629777 63449 288581 61837 87012 53145457 58437851 9504 13740 0 0 24880299 27410660 0 0 229987 26333320 27387406 51223123 54811806 1922334 3626045 69173547 72583735 39460871 39085239 29712676 33498496 X Excellence in patient-centered care. 0 0 45355099 13740 57629777 Livingston HealthCare (LHC) is a 25-bed acute care hospital located in Livingston, Montana, providing inpatient, outpatient, and emergency services primarily for the residents of Livingston Montana and the surrounding area. It is a multispecialty physician practice that also provides rehabilitation services and home-based services such as home care and hospice care.LHC provides medical treatment of the sick and injured patients regardless of ability to pay. This includes private payers, insured payers, Medicare, Medicaid and Charity Care.LHC provided funding for Windrider Transit in the amount of $10K in FY 2019. Windrider provides a free, efficient fixed-route transportation system to citizens and disabled persons in Park County, Montana; it operates Monday through Friday from 6:15 AM-6:15 PM. All vehicles are ADA accessible and equipped with lifts. The Windrider bus makes seven stops each day at Livingston HealthCare, and includes multiple daily stops at 14 other locations in Livingston, including to the public library and a local grocery store. In FY 2019, the Windrider bus picked up 3,637 passengers and was driven 248.5 days, with an average of 14.636 passengers each day. 510 passengers received a ride from Livingston HealthCare via the Windrider bus in FY 2019. LHC provided funding for school nurse for the Livingston School District in the amount of $11K. The school nurse ensures the health and safety of all students, preparing them to be consistently present at school and ready to learn to the best of their ability. The school nurse manages chronic and acute health problems, screens students for various health impairments, connects students and families to community resources and identifies school-wide health initiatives and health education needs. In FY 2019, the Livingston School District school nurse provided 618 student vision screenings, 743 hearing screenings and 308 scoliosis screens. Medications were administered to 171 students, as needed, with 18 students receiving daily medications. 15 students with asthma/inhalers were monitored and 27 students with life-threatening allergies were monitored and had care plans in place. 45355099 1 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 1 46 0 1 489 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Kris Kester 4062223541 320 Alpenglow Lane Livinston MT 59047 Denis Prager President 15.00 1.00 X X 0 0 0 Shiell Anderson Vice President 2.00 0.00 X X 0 0 0 Kristen Galbraith Secretary 2.00 0.00 X X 0 0 0 Dan Kaul Treasurer 2.00 0.00 X X 0 0 0 D Scott Coleman MD Director, Family Medicine 40.00 1.00 X 284823 0 17300 David Stanley Director 2.00 0.00 X 0 0 0 Douglas P Wadle MD Director, Internal Medicine 40.00 0.00 X 255717 0 21912 Joseph Swindlehurst Director 2.00 0.00 X 0 0 0 Michael Schaer Director 2.00 0.00 X 0 0 0 Jeffry Lindenbaum MD Director 2.00 0.00 X 0 0 0 Michelle Becker Director 2.00 1.00 X 0 0 0 Laurie Smith Director 2.00 0.00 X 0 0 0 Deb Anczak CEO 40.00 1.00 X 182766 0 8429 Ryan Speas CFO 40.00 1.00 X 146888 0 4676 Raymond Wright MD ER Physician 40.00 0.00 X 329425 0 21639 Michael Briggs MD ER Physician 40.00 0.00 X 320240 0 16820 Krista Arnett MD ER Physician 40.00 0.00 X 320019 0 10400 Warren Liebers MD ER Physician 40.00 0.00 X 251656 0 23961 Ted Scofield MD Internal Medicine 40.00 0.00 X 245412 0 19181 2336946 0 144318 34 0 1 0 Billings Clinic Laboratory PO Box 30977 Billings MT 59107 Lab Services 1728410 Medical Solutions PO Box 310737 Des Moines IA 50331 Contract Staffing 599003 Billings Clinic Telrad PO Box 30977 Billings MT 59107 Tele-radiology Services 533955 Crowley Fleck PO Box 30441 Billings MT 59107 Legal Services 342623 Hayes Locums 6700 N Andrews Avenue Ste 600 Fort Lauderdale FL 33309 Locums coverage 332030 6 432481 432481 Net Patient Service Revenue 621110 55781531 55781531 Supporting Revenue 621110 1081357 1081357 Pharmacy Revenue 446110 766889 766889 57629777 285929 285929 87012 0 87012 87012 87012 9235 6583 2652 2652 2652 58437851 57629777 0 375593 X 13740 13740 1088768 567960 520808 171385 51503 119882 21917239 18081127 3788686 47426 653447 532928 115643 4876 1938903 1584607 351286 3010 1640918 1328776 299627 12515 137268 137268 215555 3110 211400 1045 48544 45404 3140 6605817 4957457 1646499 1861 151791 19859 125015 6917 1320707 1037223 279566 3918 882134 148940 721177 12017 428751 420912 7839 271921 227994 43799 128 134234 86329 45768 2137 1094260 1094260 3246029 3246029 702298 447763 254535 Medical Supplies 6999253 6988080 11173 Bad Debt 3381957 3381957 Repairs and Maintenance 655149 639152 15815 182 Food 372867 367054 5813 738871 128339 599599 10933 54811806 45355099 9226720 229987 1132505 3222722 2842246 2554464 9668253 11262943 1484863 1576548 101500 171140 52118194 13299246 40974756 38818948 10535510 14027583 667754 681050 1766160 268337 69173547 72583735 3608867 3686014 34492467 33869071 1359537 1530154 39460871 39085239 X 29712676 33498496 29712676 33498496 69173547 72583735 X 3626045 159772 3 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1503731 1545780 264106 833584 2480033 1432806 101575 30650 1503731 436740 907288 88778 1432806 350332 86408 436740 350332 350332 0.48230 0.51770 0.00000 0 1 1 951320 951320 37087896 6274498 30813398 14054472 7024748 7029724 24506 24506 38818948 Professional Liability Claims 111010 Deferred Compensation Liability 1120129 Estimated Third-Party Payor Settlements 299015 1530154 X 55582260 159772 -2582882 -2423110 58005370 432481 432481 58437851 51458823 28974 28974 51429849 3381957 3381957 54811806 Part V, Line 4: The organization has adopted investment and spending policies for endowment assets that attempt to provide a predictable stream of funding to programs supported by its endowment while seeking to maintain the purchasing power of the endowment assets. Endowment assets include those assets of donor-restricted funds that the organization must hold in perpetuity or for a donor-specified period(s) as well as board-designated funds. A portion of the endowment fund is held by the Ough Charitable Trust, a trust established to make charitable contributions to Livingston HealthCare Foundation, which further benefits Livingston Healthcare. The Foundation is the sole trustee of The Ough Charitable Trust. A separate portion of the endowment fund relates to the Stafford Hospice endowment held directly by the Foundation. Part X, Line 2: The Hospital is organized as a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. Management has determined that the Hospital is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Hospital 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 consolidated 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: Livingston Foundation Revenue Reported on a Separate Form 990 799,075. Provision for Bad Debts Reported in Expense on Form 990 -3,381,957. Part XI, Line 4b - Other Adjustments: Foundation Contribution to Hospital that is Eliminated on Audited Financials 432,481. Part XII, Line 2d - Other Adjustments: Livingston Foundation Expenses Reported on a Separate Form 990 28,974. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts reported in expense on Form 990 3,381,957. 1 1 X 0 1 X 1 1 0 0 426000 426000 0.00830 426000 426000 0.00830 25058 3820 21238 0.00040 1520523 952802 567721 0.01100 39470 39470 0.00080 1585051 956622 628429 0.01220 2011051 956622 1054429 0.02050 5000 5000 0.00010 7500 7500 0.00010 53443 53443 0.00100 65943 65943 0.00120 1 3381957 0 21345123 21764470 -419347 X 1 1 1 1 Livingston Healthcare 320 Alpenglow Ln Livingston MT 59047 www.livingstonhealthcare.org 12556 X X X Livingston Healthcare 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Supplement Information X 1 16 1 See Part V, Supplement Information 0 1 X 0.000000000000 200.000000000000 X X X X 1 1 X X X 1 X See Part V, Supplement Information X See Part V, Supplement Information X See Part V, Supplement Information X X X X X X 1 X 0 X X X X 1 X 0 1 Livingston Healthcare Part V, Section B, Line 5: The hospital facility consulted a steering committee that was made up of a diverse group of community members representing various organizations and populations within the community. The various organizations follow: child and family services, clinics, community health partners, health department, special ed co-op and school nurses, chemical dependency program, mental health center, health and nutrition coordinator, community foundation, agency on aging, environmental health, and from the hospital itself. The steering committee met to discuss health concerns in the community and offer their perspective in designing the survey and they met again to review the results of the survey and the focus groups interviews. Livingston Healthcare Part V, Section B, Line 11: In the most recent CHNA LHC identified the following needs LHC would address: the need to improve access to mental and behavioral health services in Park County, improve the community's access to transportation in and around Park County, and enhance health and wellness education opportunities in Park County. The needs that were identified, but were not addressed are: 1) more affordable healthcare, 2) more specialists, and 3) aging services. These needs are not addressed due to limited staff time and resources. They will be addressed at a future date.In FY19 Livingston HealthCare hired a psychiatric physician assistant to provide support to the organization's on-staff psychiatrist. In addition, the hospital continued to play an integral role in the implementation of the Connect Referral Program, which is designed to seamlessly connect patients in need with applicable community resources. In FY18 Livingston HealthCare hired two social workers that continued to improve services in FY19. One social worker serves patients who are in the Emergency Department, on the Medical/Surgical floor, and also at Shields Valley Clinic. In addition, another social worker was hired to work with Home Health and Hospice patients. In addition, the hospital played an integral role in the implementation of the Connect Referral Program, which is designed to seamlessly connect patients in need with applicable community resources. This program went live in June 2018. The hospital continues to be the largest financial sponsor of Park County's free community transit system. In FY19, LHC donated another $10,000 to the system, in addition to utilizing in-house hospital resources to create all communication pieces associated with the transit system (branding, brochures, flyers, maps). The hospital continued to work closely with Park County Transit Board to increase community awareness of this free public transit system. Livingston HealthCare continued to enhance health and wellness education opportunities in Park County by mailing out a community newsletter "Living Well" to all Park County residents twice in FY19. The newsletter contains information for the community on available health and wellness programs and resources in Park County. LHC also actively informed the community of health education opportunities and health services through the local newspaper and social media. An incentive program was established for LHC employee health insurance, which is anticipated to improve health outcomes for LHC employees. In FY19 Livingston HealthCare continued the employee incentive program to improve health outcomes for LHC employees on the health plan, as well as continued focus on community health and wellness programs including Lifestyle Balance classes, Health Steps Program, Livingston Trails RX Race, Community Health Day at the local farmers market and the Fall Health Festival held at Livingston HealthCare. Livingston Healthcare Part V, Section B, Line 13h: Presumptive eligibility is used. If a patient is a Medicaid patient, the Hospital writes off to charity care any portion of charges that is denied by Medicaid. Livingston Healthcare Part V, Section B, Line 24: The Hospital does not provide elective services under the financial assistance policy. Schedule H, Part V, Section B, Line 16a-c: The FAP, FAP application, and plain language summary of the FAP can be found at:https://www.livingstonhealthcare.org/Patients-Visitors/Patient-Financial-Services.aspx Schedule H, Part V, Section B, Line 7a and 10a: https://www.livingstonhealthcare.org/About-Us/Community-Health-Needs-Assessment.asp 4 1 - LHC Clinic 320 Aplenglow Ln Livingston MT 59047 Clinic 2 - Livingston Healthcare Home CareHospice 320 Aplenglow Ln Livingston MT 59047 Home Care 3 - Livingston Urgent Care 104 Centennial Dr 103 Livingston MT 59047 Clinic 4 - Livingston Clinic Shields Valley 309 Elliot St N Wilsall MT 59086 Clinic Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community Health Improvement Services on line 7e and Cash and In-Kind Contributions on Line 7i were determined using actual costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 3,381,957. Part II, Community Building Activities: Livingston HealthCare identified the need to improve access to mental and behavioral health services in Park County, improve the community's access to transportation in and around Park County and enhance health and wellness education opportunities in Park County. To that end, in FY19 Livingston HealthCare hired a psychiatric physician assistant to provide support to the organization's on-staff psychiatrist. In addition, the hospital continues to play an integral role in the implementation of the Connect Referral Program, which is designed to seamlessly connect patients in need with applicable community resources. The hospital continues to be the largest financial sponsor of Park County's free community transit system. In FY19, LHC donated $10,000 to the system, in addition to utilizing in-house hospital resources to update and create communication pieces associated with the transit system (branding, brochures, flyers, maps). The hospital worked closely with Park County Transit Board to increase community awareness of this free public transit system. Livingston HealthCare continued to enhance health and wellness education opportunities in Park County by mailing out a community newsletter "Living Well" to all Park County residents in FY 2019. The newsletter contains information for the community on available health and wellness programs and resources in Park County. LHC also actively informed the community of health education opportunities and health services through the local newspaper and social media. An incentive program was established for LHC employee health insurance, which is anticipated to improve health outcomes for LHC employees. Part III, Line 2: Bad debt is based on charges. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 9 of the attached audited financial statements. Part III, Line 8: LHC provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services.Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall is considered a community benefit. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare cost report for the year.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare Services. Part III, Line 9b: Once a patient is approved for financial assistance, it is expected that the patient continue to meet his/her financial commitments to Livingston Healthcare. If a patient is approved for a percentage allowance due to financial hardship and the patient does not make the required initial payment within 60 days toward their part of the bill, the financial assistance allowance will be reversed and the patient will owe the entire amount. The organization recommends that the patient make a good faith payment at the beginning of the financial assistance period.LHC sends notification to the patients 30 days prior to sending to collections. LHC does not send patient accounts to collections until 180 days from the date of the invoice. If the patient applies for financial assistance within 240 days of the date of the invoice, LHC will cease extraordinary collection actions and process the application. Part VI, Line 2: The hospital Leadership meets often with city, county, and school leadership to discuss and plan shared needs within Livingston/Park County boundaries. Most recently these shared need discussions have been around building a new community pool/community center, expansion of medical services within the school (Park Clinic) system, and joint efforts toward bringing additional mental health services to students in the Park County school district. Part VI, Line 3: Financial assistance will be provided to Livingston Healthcare patients who meet specified financial criteria and request such assistance. A notice of availability of financial assistance program will be posted at patient registration sites within each facility and presented to patients upon request. Schedule H, Part V, Section B, line 16a-16i list other ways the organization informs and educates patients and person who may be eligible for financial assistance. Part VI, Line 4: Livingston is a city in and the county seat of Park County, Montana, United States. The population was approximately 7,784 people in 2018. Livingston is located in southwestern Montana, on the Yellowstone River, north of Yellowstone National Park. The median income for a household in Livingston in 2018 was about $42,635. Part VI, Line 5: Livingston HealthCare's governing body is comprised of persons who reside in the organization's primary service area who are neither employees nor contractors of the organization, nor family members thereof.Livingston HealthCare extends medical staff privileges to all qualified physicians in its community for some or all of its departments.Livingston HealthCare applies surplus funds to improvements in patient care, medical education, and expansion of needed services.In FY 2019, the hospital continued programs and events that focus on community health and wellness, including family-centered prenatal education classes, Strong People, Strong Bones classes, Dine with a Dietician Lunch and Learns, the Livingston Trails Rx 5K Race, Community Health Day at the local farmers market and Fall Health Festival at the hospital. 1 0 0 0 0 0 0 0 0 D Scott Coleman MD Director, Family Medicine 284823 0 0 0 0 0 16000 0 1300 0 302123 0 0 0 Douglas P Wadle MD Director, Internal Medicine 255717 0 0 0 0 0 16000 0 5912 0 277629 0 0 0 Deb Anczak CEO 182766 0 0 0 0 0 0 0 8429 0 191195 0 0 0 Ryan Speas CFO 146888 0 0 0 0 0 0 0 4676 0 151564 0 0 0 Raymond Wright MD ER Physician 329425 0 0 0 0 0 12812 0 8826 0 351063 0 0 0 Michael Briggs MD ER Physician 320240 0 0 0 0 0 14400 0 2420 0 337060 0 0 0 Krista Arnett MD ER Physician 320019 0 0 0 0 0 10400 0 0 0 330419 0 0 0 Warren Liebers MD ER Physician 251656 0 0 0 0 0 12800 0 11161 0 275617 0 0 0 Ted Scofield MD Internal Medicine 245412 0 0 0 0 0 16581 0 2600 0 264593 0 0 0 Part I, Line 3 LHC employed the CEO from July 1, 2018 through January 3, 2019. The compensation paid directly by LHC is reported in Part VII, Part IX, and Schedule J of the Form 990. The remaining of the fiscal year the CEO was paid by an unrelated management company, Billings Clinic. LHC paid Billings Clinic $137,268 for CEO services. LHC relied on Billings Clinic to establish compensation from January 4, 2019 through June 30, 2019. Part I, Line 4a Ryan Speas received a severance payment in the amount of $150,409 for Fiscal year ending June 30, 2019. This payment was received during the 2019 calendar year and thus is not reported in Part II. Babs Brandfass Spouse of Board Member 119882 Employee Compensation 0 Paula Coleman Spouse of Board Member 51503 Employee Compensation 0 Form 990, Part VI, Section A, line 1 The Board shall have as a standing committee an Executive Committee. The Executive Committee shall consist of at least four members of the Board, which shall include the Chairperson, Vice Chairperson, Secretary, and Treasurer. If none of the officers named in the previous sentence is a Class B Director, a Class B Director shall be the fifth member of the Executive Committee. The Executive Committee may consist of additional members of the Board at the discretion of the Board. Action of the Executive Committee shall be subject to approval by the Board, except to the extent provided otherwise in a resolution of the Board pertaining to a particular matter, transaction, or undertaking. The Executive Committee did not meet in the fiscal year. Form 990, Part VI, Section A, line 3 LHC employed the CEO from July 1, 2018 through January 3, 2019. The compensation paid directly by LHC is reported in Part VII, Part IX, and Schedule J of the Form 990. The remaining of the fiscal year the CEO was paid by an unrelated management company, Billings Clinic. LHC paid Billings Clinic $137,268 for CEO services. Form 990, Part VI, Section B, line 11b The finance committee reviews the 990 prior to its issuing. The governing board is provided a copy prior to filing. Form 990, Part VI, Section B, line 12c This policy applies to all employees of Livingston HealthCare (LHC), volunteers, medical staff, contracted workforce, or other individuals that have a financial interest and are authorized to conduct business on behalf of LHC. Conflicts are reviewed by the Conflict of Interest Review Panel, chaired by the Compliance Officer. Communication will direct the interested person to discontinue the outside relationship/activity, discontinue relationship with outside organization, or establish management plan to monitor relationship/activities. Policy is monitored through open communication and review of the policy. Form 990, Part VI, Section B, line 15a LHC employed the CEO from July 1, 2018 through January 3, 2019. The independent board used comparability data to determine reasonable compensation, and documented the process. The remaining of the fiscal year the CEO was paid by an unrelated management company, Billings Clinic. The CFO compensation is reviewed and approved by the CEO. Form 990, Part VI, Section C, line 19 The organization made its governing documents, conflict of interest policy, and financial statements available to the public upon request. The organization also has an annual report available on its website. Form 990, Part IX, line 11g Contracted Services: Program service expenses 4,079,110. Management and general expenses 1,471,411. Fundraising expenses 1,861. Total expenses 5,552,382. Licenses, Fees, and Taxes: Program service expenses 51,701. Management and general expenses 45. Fundraising expenses 0. Total expenses 51,746. Other Fees: Program service expenses 826,646. Management and general expenses 175,043. Fundraising expenses 0. Total expenses 1,001,689. Form 990, Part XI, line 9: Rounding 3. Livingston Healthcare Foundation 320 Alpenglow Ln Livingston MT 59047 810621997 To Support Livingston Healthcare Programs MT 501(c)(3) Line 7 N/A 0 The Ough Charitable Trust 320 Alpenglow Ln Livingston MT 59047 816080844 To Support Livingston Healthcare Programs MT 501(c)(3) Line 12c, III-FI Livingston Healthcare Foundation 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0