2020-04-30T13:28:01-05:00 2019-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2018-07-01 810233499 SIDNEY HEALTH CENTER SIDN 4064882100 216 14TH AVENUE SW SIDNEY MT 59270 TINA MONTGOMERY CFO 4064882100 2020-04-29 1 KURT BENNION P01469618 4252506100 2020-04-29 67.137.57.251 2020-04-29 10:40:39 PD P 1B5C3D789EA1CAB95545BA7E5C79790E16AB9CAF CD21A1384DEE20FA4DD3B5E13B3ACB8006081540 2018 2020-11-19 02:30:22Z JEN DOTY 216 14TH AVENUE SW SIDNEY MT 59270 80880426 0 X WWW.SIDNEYHEALTH.ORG X 1946 MT TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH BY PROVIDING QUALITY MEDICAL CARE. 9 8 567 164 1154778 214571 334032 316168 69056189 73164721 857046 1013614 1008589 1009334 71255856 75503837 450 65967 0 0 30184552 33086728 0 0 326248 36468148 38904418 66653150 72057113 4602706 3446724 72374320 77101782 33597470 34857022 38776850 42244760 X TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH AND WELL-BEING. 0 0 64011000 65967 73164721 SIDNEY HEALTH CENTER IS A NOT-FOR-PROFIT COMMUNITY-BASED MEDICAL CENTER THAT HAS BEEN SERVING PEOPLE IN THE MONDAK REGION FOR MORE THAN 100 YEARS. OUR PASSION FOR CARING IS SHARED BY THE DOCTORS, NURSES, AND SEVERAL HUNDRED EMPLOYEES AND VOLUNTEERS. THIS COMMITMENT TO CARING IS OUR ALLEGIANCE TO THE COMMUNITY AS WE STRIVE TO PROVIDE "EXCEPTIONAL CARE FOR LIFE." LOCATED IN THE HEART OF RICHLAND COUNTY, THE ATTRACTIVE EASTERN MONTANA CAMPUS INCLUDES AN ACUTE CARE HOSPITAL, CLINIC, CANCER CARE, RETAIL PHARMACY AND AN EXTENDED CARE FACILITY OFFERING A COMPLETE RANGE OF SERVICES FROM BIRTH THROUGH END-OF-LIFE, WHICH IS COMPLEMENTED BY AN ARRAY OF OUTREACH SERVICES. THIS CONTINUUM OR SUCCESSION OF SERVICES IS NOT TYPICAL OF RURAL HEALTHCARE ORGANIZATIONS, BUT SIDNEY HEALTH CENTER IS NOT TYPICAL. A STRONG COMPLEMENT OF PRIMARY CARE PHYSICIANS AND A UNIQUE SELECTION OF SURGICAL SPECIALISTS, COMBINED WITH A MODERN FACILITY AND UP-TO-DATE MEDICAL EQUIPMENT, MAKES SIDNEY HEALTH CENTER A SPECIAL PLACE TO WORK, RECEIVE CARE AND PRACTICE MEDICINE. SIDNEY HEALTH CENTER ALSO PROVIDES VARIOUS COMMUNITY BENEFIT PROGRAMS FOR THE INDIVIDUALS IN OUR SERVICE REGION. RICHLAND COUNTY TRANSPORTATION - THIS PROGRAM GIVES OPPORTUNITIES FOR THOSE WHO CANNOT DRIVE THE OPTION OF A RIDE. SIDNEY HEALTH CENTER PROVIDES A DRIVER AND HELPS PAY FOR BUSSES. SINCE ITS CONCEPTION, WE HAVE GONE FROM ONE BUS AND ONE DRIVER FOR THE FULL PROGRAM TO MULTIPLE BUSSES AND DRIVERS. WE WORK WITH THE HEALTH DEPARTMENT, RICHLAND COUNTY AND THE LODGE. MILES CITY NURSING PROGRAM - WE PROVIDE THE FACILITY AND PROGRAM COSTS TO HAVE MILES CITY COMMUNITY COLLEGE RUN A SATELLITE SCHOOL HERE IN SIDNEY. THIS PROMOTES NURSING AS A PROFESSION AND KEEPS THOSE WHO ARE INTERESTED IN OUR COMMUNITY AS POSSIBLE EMPLOYEES LATER. OUTREACH CLINIC - SOME OF THE OUTLYING COMMUNITIES DO NOT HAVE ACCESS TO SPECIALTY SERVICES. SIDNEY HEALTH CENTER SENDS PROVIDERS TO THESE NEIGHBORING COMMUNITIES SO PATIENTS DO NOT HAVE TO TRAVEL. SHC ALSO HOSTS SPECIALISTS FROM LARGER FACILITIES TO OFFER QUALITY AND CONVENIENT CARE WE ARE UNABLE TO PROVIDE TO PATIENTS IN AND AROUND RICHLAND COUNTY.HEALTH SCREENINGS, EDUCATION AND MAINTENANCE - SIDNEY HEALTH CENTER SUPPORTS A VARIETY OF EVENTS WHERE OUR COMMUNITY CAN BE EDUCATED ON HEALTH ISSUES. OUR CANCER CENTER SPONSORS THE "TOUGH ENOUGH TO WEAR PINK" DAY AT THE COUNTY FAIR; SUPPORTING "PACK IT IN PINK" VOLLEYBALL NIGHTS IN SAVAGE, FAIRVIEW AND SIDNEY; AND HOLDING ANNUAL MEN'S AND WOMEN'S HEALTH SCREENINGS. THE MEN'S SCREENING PROVIDED PSA TESTS AND RECTAL EXAMS AND THE WOMEN'S PROVIDED BLOOD PRESSURE TESTS AND BREAST EXAMS. SIDNEY HEALTH CENTER PROMOTES PREVENTATIVE CARE, DIABETES EDUCATION, LAB SCREENINGS AND MANY OTHER TOPICS. SIDNEY HEALTH CENTER OFTEN PARTNERS WITH THE RICHLAND COUNTY HEALTH DEPARTMENT, COALITION ON AGING, FIRE, POLICE AND MENTAL HEALTH PROFESSIONS, JUST TO NAME A FEW. SIDNEY HEALTH CENTER ALSO PARTICIPATES IN SUPPORTIVE HEALTH MAINTENANCE GROUPS, INCLUDING COMMUNITIES IN ACTION GROUPS. RICHLAND COUNTY FAIR & RODEO - SIDNEY HEALTH CENTER IS THE DAY SPONSOR AT THE COUNTY FAIR (DAILY ATTENDANCE OF AROUND 5,000), WHERE PEOPLE CAN HAVE THEIR BLOOD PRESSURE CHECKED AND RECEIVE A FREE COLD LEMONADE OR WATER DURING THE HOT AUGUST FAIR. GRIEF RECOVERY SUPPORT GROUPS - SIDNEY HEALTH CENTER'S HOSPICE PROGRAMS PUT ON TWO DIFFERENT CAMPS FOR PEOPLE WHO HAVE LOST LOVED ONES. ONE IS FOR ADULTS, AND THE OTHER FOR KIDS. THERE ARE ALSO MEMORIAL SERVICES AND NUMEROUS GRIEF SUPPORT GROUPS THROUGHOUT THE YEAR. BIRTHDAY HEALTH FAIR - PATIENTS WHO SIGN UP CAN GET LABS DURING THEIR BIRTHDAY MONTH. VISITING NURSE SERVICE - INITIAL NURSE VISIT AND POST DISCHARGE MEDICATION RECONCILIATION ALONG WITH ONGOING MEDICATION SETUPS TO THOSE IN NEED. MEDICATION ASSISTANCE - PROVIDES MEDS TO THOSE WHO HAVE NO INSURANCE. ALSO HELPS GET PATIENTS SIGNED UP WITH DRUG COMPANIES FOR FREE MEDICATIONS. IN 2020, THIS PROGRAM WILL BE EXPANDING TO INCLUDE SUPPORT FOR LIFELINE SERVICES TO THOSE IN NEED. RX BOXES - PHARMACY SETS UP PILLS IN MEDICATION BOXES SO THAT GROUP HOME RESIDENTS GET THE CORRECT PILLS FOR EACH ADMINISTRATION TIME. CHAMBER OF COMMERCE - VARIOUS DONATIONS FOR COMMUNITY AND CHAMBER FUNCTIONS. CHILDBIRTH CLASSES - CLASSES OFFERED ON A QUARTERLY BASIS TO THE COMMUNITY. INTERACTIVE TOUR FOR ELEMENTARY STUDENTS - AS REQUESTED, LOCAL ELEMENTARY CLASSES PARTICIPATE IN INTERACTIVE STATIONS THAT ARE HOSTED BY VARIOUS SIDNEY HEALTH CENTER DEPARTMENTS. REACH TOUR - EVERY OTHER YEAR, SIDNEY HEALTH CENTER HOSTS R.E.A.C.H. (RESEARCH AND EXPLORE AWESOME CAREERS IN HEALTHCARE) TOUR THROUGH AHEC FOR HIGH SCHOOL STUDENTS INTERESTED IN HEALTHCARE CAREERS. STUDENTS SPEND THE DAY AT SIDNEY HEALTH CENTER PARTICIPATING IN INTERACTIVE DEMONSTRATIONS, VISITING WITH HEALTHCARE PROFESSIONALS AND MORE.FITNESS CENTER - SIDNEY HEALTH CENTER PARTNERED WITH HEALTHWORKS FITNESS CENTER TO SUBSIDIZE MEMBERSHIPS TO LOW INCOME INDIVIDUALS WITH DOCTOR ORDERED FITNESS REGIMENS. 64011000 1 1 0 1 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 72 0 567 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 1 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 X TINA MONTGOMERY CFO 4064882117 216 14TH AVENUE SW SIDNEY MT 59270 LANCE AVERETT PRESIDENT 1.00 1.00 X X 0 0 0 RANDY JOHNSON VICE PRESIDENT 1.00 1.00 X X 0 0 0 REBECCA BRADLEY SECRETARY/TREASURER 1.00 1.00 X X 0 0 0 BRYCE BAKER TRUSTEE (THROUGH MARCH 2019) 1.00 1.00 X 0 0 0 ROBERT BURNISON TRUSTEE 1.00 1.00 X 0 0 0 STEPHANIE CARROLL TRUSTEE 1.00 1.00 X 0 0 0 LESZEK JASZCZAK MD TRUSTEE 39.00 1.00 X 600033 0 4337 SANDRA JEPSEN TRUSTEE (THROUGH NOVEMBER 2018) 1.00 1.00 X 0 0 0 KEVIN MAYER TRUSTEE 1.00 1.00 X 0 0 0 TERRY SILVERTSON TRUSTEE 1.00 1.00 X 0 0 0 CHERYL VAN EVERY TRUSTEE 1.00 1.00 X 0 0 0 DICK VANDE BOSSCHE TRUSTEE (THROUGH FEBRUARY 2019) 1.00 1.00 X 0 0 0 JEN DOTY CEO 39.00 1.00 X 175891 0 8853 TINA MONTGOMERY CFO 39.00 1.00 X 158272 0 12102 JEROME KESSLER MD PHYSICIAN 40.00 0.00 X 486741 0 9652 CHAD PEDERSEN MD PHYSICIAN 40.00 0.00 X 468419 0 1232 GEORGE SCORDALAKES MD PHYSICIAN 40.00 0.00 X 477173 0 9040 MALUA TAMBI IYA MD PHYSICIAN 40.00 0.00 X 448346 0 9652 KELLY O'NEAL MD PHYSICIAN 40.00 0.00 X 387116 0 9652 3201991 0 64520 37 0 1 0 MEDIKAR PC 214 14TH AVE SW STE 110 SIDNEY MT 59270 PHYSICIAN SERVICES 998085 BRETT BENNION MD 214 14TH AVE SW STE 101 SIDNEY MT 59270 PHYSICIAN SERVICES 847750 EDWARD BERGIN MD 214 14TH AVE SW STE 105 SIDNEY MT 59270 PHYSICIAN SERVICES 480000 O PETE COUNCIL MD 214 14TH AVE SW STE 104 SIDNEY MT 59270 PHYSICIAN SERVICES 438916 JAMES SCOTT MD 214 14TH AVE SW STE 108 SIDNEY MT 59270 PHYSICIAN SERVICES 350000 16 287134 18343 10691 316168 PATIENT REVENUES 621500 66235944 66235944 CLINIC PHARMACY 446110 6193029 5038251 1154778 OTHER PATIENT CARE 621500 735748 735748 73164721 705286 705286 6000 0 6000 6000 6000 5479742 1500 5146351 26563 333391 -25063 308328 308328 400778 203675 197103 197103 MEAL INCOME 900099 377089 377089 MISCELLANEOUS REVENUE 900099 343564 343564 RELATED PARTY REIMBURSEMENTS 900099 85578 85578 806231 75503837 72009943 1154778 2022948 X 65967 65967 1040629 732564 277024 31041 25806250 23975506 1700971 129773 543507 490543 48928 4036 3894942 3566987 294556 33399 1801400 1643500 145513 12387 200877 200877 116641 115716 925 152097 152097 11840672 10484762 1336530 19380 176714 7941 153423 15350 3033245 1893326 1092036 47883 606633 606633 1560561 1294282 261106 5173 520500 454803 59528 6169 1120429 1120429 3535491 3523446 12045 814098 804326 9772 UBI TAXES 60664 60664 PHARMACY/LAB EXPENSE 10832038 10829545 2493 BAD DEBT 1928002 1928002 MISCELLANEOUS EXPENSE 636229 400745 235484 1769527 1308122 440673 20732 72057113 64011000 7719865 326248 12174910 14316332 5577 10221 10129143 11430781 1757594 1918776 649394 745582 76410095 50987820 21556083 25422275 18041912 19204740 5603189 1761147 610184 630242 1846334 1661686 72374320 77101782 6166917 7307649 23804499 22607762 5577 10221 564331 1616436 757277 757277 2298869 2557677 33597470 34857022 X 38166666 41614518 610184 630242 38776850 42244760 72374320 77101782 X 3446724 111936 -90750 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4260 4260 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE MONTANA HOSPITAL ASSOCIATION, THE AMERICAN HOSPITAL ASSOCIATION AND LEADINGAGE ARE USED FOR LOBBYING. 0 1 X 198261 198261 47573196 29593690 17979506 1177858 686588 491270 26853164 20707542 6145622 607616 607616 25422275 ESTIMATED THIRD-PARTY PAYOR PAYABLES 1786000 SWAP CONTRACT LIABILITIES 771677 2557677 X 72449728 228738 228738 72220990 152097 3130750 3282847 75503837 70180689 203675 203675 69977014 152097 1928002 2080099 72057113 PART IV, LINE 2B: RESIDENT TRUST ACCOUNT: THIS IS THE EXTENDED CARE RESIDENT TRUST ACCOUNT, WHICH IS MADE UP OF THE RESIDENTS' MONEY THAT SIDNEY HEALTH CENTER HOLDS ON THEIR BEHALF. THESE MONIES ARE KEPT IN A SEPARATE BANK ACCOUNT FROM THE ORGANIZATION'S FUNDS AND ARE DUE BACK TO THE RESIDENTS UPON LEAVING THE FACILITY. PART X, LINE 2: THE IRS HAS DETERMINED THAT THE HEALTH CENTER IS A TAX-EXEMPT, NONPROFIT CORPORATION UNDER SECTION 501(C)(3) OF THE IRC. THE HEALTH CENTER FOLLOWS THE GUIDANCE IN THE ACCOUNTING STANDARDS REGARDING THE RECOGNITION AND MEASUREMENT OF UNCERTAIN TAX POSITIONS. THE GUIDANCE CLARIFIES THE ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES RECOGNIZED IN AN ENTITY'S FINANCIAL STATEMENTS. THE GUIDANCE FURTHER PRESCRIBES RECOGNITION AND MEASUREMENT OF TAX PROVISIONS TAKEN OR EXPECTED TO BE TAKEN ON A TAX RETURN THAT ARE NOT CERTAIN TO BE REALIZED. THE APPLICATION OF THIS STANDARD HAS NO IMPACT ON THE HEALTH CENTER'S FINANCIAL STATEMENTS. THE HEALTH CENTER'S INCOME TAX RETURNS ARE SUBJECT TO REVIEW AND EXAMINATION BY FEDERAL, STATE, AND LOCAL AUTHORITIES. PART XI, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 203,675. LOSS ON DISPOSAL OF PROPERTY AND EQUIPMENT 25,063. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 886,580. GRANTS AND CONTRIBUTIONS 316,168. BAD DEBT EXPENSE 1,928,002. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 203,675. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,928,002. 1 1 X 1 X 1 X 1 1 0 1 1 443403 443403 0.00630 443403 443403 0.00630 86767 86767 0.00120 30573 30573 0.00040 17752685 10892966 6859719 0.09780 17870025 10892966 6977059 0.09940 18313428 10892966 7420462 0.10570 1 1928002 0 16169226 16241726 -72500 X 1 1 1 1 SIDNEY HEALTH CENTER 216 14TH AVENUE SW SIDNEY MT 59270 WWW.SIDNEYHEALTH.ORG 12709 X X X X SIDNEY HEALTH CENTER 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X SEE LINE 7D X X 1 18 1 SEE LINE 7D 0 1 X 100.000000000000 200.000000000000 1 1 X X X X 1 X WWW.SIDNEYHEALTH.ORG/BILLING X WWW.SIDNEYHEALTH.ORG/BILLING X WWW.SIDNEYHEALTH.ORG/BILLING X X X X X X 1 X 0 X X X X 1 X 0 0 SIDNEY HEALTH CENTER PART V, SECTION B, LINE 5: IN MARCH 2019, SURVEYS WERE MAILED OUT TO A RANDOM SAMPLE OF 800 RESIDENTS OF RICHLAND COUNTY, MONTANA, THE HOSPITAL'S COMMUNITY. 137 COMPLETED SURVEYS WERE RETURNED. IN ADDITION, 3 FOCUS GROUP INTERVIEWS WERE CONDUCTED. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 6B: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN COLLABORATION WITH THE MONTANA OFFICE OF RURAL HEALTH. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 7D: THE ORGANIZATION'S COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.SIDNEYHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENT- IMPLEMENTATION-PLAN. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 11: SIDNEY HEALTH CENTER ("SHC") IS RESPONDING TO ALL THE IDENTIFIED COMMUNITY HEALTH NEEDS, WITH THE EXCEPTION OF ONE THAT IS NOT WITHIN OUR SCOPE. SIDNEY HEALTH CENTER ADDRESSES THE NEEDS IDENTIFIED BY THE CHNA THAT ARE IN ALIGNMENT WITH OUR STRATEGIC GOALS. ONCE THESE NEEDS ARE IDENTIFIED, SHC CREATES A COMMUNITY HEALTH NEEDS IMPLEMENTATION PLAN.SHC IS ADDRESSING CHRONIC ILLNESS BY PROMOTING HEALTHY LIFESTYLES THROUGH COMMUNITY ENGAGEMENT ACTIVITIES, PROVIDING EDUCATIONAL RESOURCES AND SERVICES TO THE COMMUNITY, AND PROVIDING EDUCATIONAL SUPPORT TO THE COMMUNITY. OVERALL AWARENESS OF THE CANCER SERVICES PROVIDED BY SHC ARE BEING ADDRESSED BY IMPROVING ACCESS TO CANCER CARE SERVICES, IMPROVING QUALITY OF CARE FOR INDIVIDUALS WITH CANCER, AND PARTICIPATING IN COMMUNITY EVENTS SPECIFIC TO CANCER. SHC IS TRYING TO BETTER SERVE THE MENTAL AND BEHAVIORAL HEALTH NEEDS BY PARTICIPATING IN COMMUNITY GROUPS CONCERNED WITH MENTAL HEALTH, PROVIDING RESOURCES AND SUPPORT TO THE COMMUNITY TO ADDRESS MENTAL HEALTH, AND INCREASING ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES AND RESOURCES. 2 1 - SIDNEY HEALTH CENTER EXTENDED CARE 216 14TH AVE SW SIDNEY MT 59270 NURSING HOME 2 - THE LODGE AT LONE TREE 1015 7TH AVE SW SIDNEY MT 59270 ASSISTED LIVING COMPLEX PART I, LINE 3C: FINANCIAL ASSISTANCE IS BASED ON INCOME AND FAMILY SIZE ONLY. PRIOR TO QUALIFYING FOR FINANCIAL ASSISTANCE, AN INDIVIDUAL MUST (A) RECEIVE QUALIFYING MEDICAL SERVICES FROM SIDNEY HEALTH CENTER; (B) EXHAUST ALL ALTERNATIE PAYMENT RESOURCES INCLUDING THIRD-PARTY AND FEDERAL AND STATE PROGRAMS; AND (C) SUBMIT A COMPLETED APPLICATION WITH THE REQUIRED SUPPORTING DOCUMENTATION. PART I, LINE 7: IN ORDER TO CALCULATE THE OVERALL HOSPITAL'S COST TO CHARGE RATIO USED FOR PART I, LINE 7, THE HOSPITAL FIRST DETERMINED A COST-TO-CHARGE RATIO BASED ON THE JUNE 30, 2019 FILED MEDICARE COST REPORT SEPARATELY FOR INPATIENT SERVICES, OUTPATIENT SERVICES, AND TOTAL SERVICES. TO CALCULATE THE COST OF CHARITY CARE INCLUDED ON LINE 7A, THE HOSPITAL TOOK EACH OF THE SEPARATE COST-TO-CHARGE RATIOS DESCRIBED IN THE PRECEEDING PARAGRAPH AND APPLIED THEM ONLY TO THE RELATED CHARGES BY SERVICE TYPE TO COME UP WITH A WEIGHTED AVERAGE COST-TO-CHARGE RATIO. PART I, LINE 7G: THE FOLLOWING SUBSIDIZED HEALTH SERVICES WERE INCLUDED IN PART I, LINE 7G:OBSERVATION, NURSERY, AUDIOLOGY, CARDIAC REHAB, CLINIC FACILITY, EMERGENCY ROOM, AMBULANCE SERVICES, ENT/RADIOLOGY/ONCOLOGY CLINIC, AND PROVIDER-BASED CLINIC. 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 $ 1,928,002. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, THE HEALTH CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HEALTH CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HEALTH CENTER RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE. PART III, LINE 3: THE HEALTH CENTER IS UNABLE TO ESTIMATE THE AMOUNT OF ITS BAD DEBT EXPENSE THAT IS ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE IF THEY WERE TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION. PART III, LINE 4: SEE THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE, NET" PARAGRAPH IN NOTE 1 (PAGE 10) OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS INCLUDED IN PART III, LINE 6 IS DERIVED FROM USING THE JUNE 30, 2019 FILED MEDICARE COST REPORT. THE SHORTFALL OCCURS DUE TO VARIOUS EXPENSES INCURRED BY THE FACILITY WHICH ARE CONSIDERED NON-REIMBURSABLE BY MEDICARE. SINCE PART OF THE COSTS ARE NOT REIMBURSED, IT IS ONLY PRUDENT TO CONSIDER THIS SHORTFALL TO BE A BENEFIT TO THE COMMUNITY. PART III, LINE 9B: IF THE PATIENT INDICATES THEIR INABILITY TO PAY ACCORDING TO THE HOSPITAL CREDIT TERMS THEY WILL BE ASKED TO FILL OUT A FINANCIAL STATEMENT. THE HOSPITAL MAY PULL A CREDIT REPORT TO CONFIRM OR SUPPLEMENT INFORMATION PROVIDED TO THE HOSPITAL ON THE FINANCIAL STATEMENT. THE PATIENT CAN THEN BE EVALUATED TO DETERMINE WHETHER THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE OR AN EXTENDED PAYMENT PROGRAM.IF THE FINANCIAL STATEMENT SHOWS THAT THE PATIENT HAS ASSETS OR POTENTIAL SOURCES OF INCOME THAT WOULD ENABLE THEM TO PAY THE HOSPITAL BILL WITHIN A YEAR, THEY WILL BE DENIED THE EXTENDED PAYMENT WAIVER. IF A PATIENT REFUSES TO FURNISH A COMPLETED FINANCIAL STATEMENT, THEIR ACCOUNT WILL BE DEEMED DELINQUENT AND FURTHER COLLECTION ACTION WILL BE TAKEN. PRIOR TO ADMISSION, AT THE TIME OF ADMISSION, OR AS SOON AS POSSIBLE THEREAFTER, THE HOSPITAL WILL MAKE AN INITIAL ASSESSMENT OF POTENTIAL ELIGIBILITY BASED ON THE VERBAL APPLICATION FOR FINANCIAL ASSISTANCE. IF POTENTIAL ASSISTANCE IS INDICATED WITH INITIAL ASSESSMENT, THE HOSPITAL WILL NOT INITIATE COLLECTION EFFORTS OR REQUESTS FOR DEPOSITS PENDING THE RECEIPT OF THE COMPLETED APPLICATION AND FINAL ELIGIBILITY DETERMINATION. THE RESPONSIBLE PARTY MUST BE COOPERATIVE WITH THE HOSPITAL'S EFFORTS TO REACH A DETERMINATION OF ELIGIBILITY WITH OTHER ASSISTANCE PROGRAMS AND TO VALIDATE THE INFORMATION NEEDED.SIDNEY HEALTH CENTER WILL MAKE A CONCERTED EFFORT TO COMMUNICATE THE AVAILABILITY OF CHARITY CARE. EDUCATIONAL MATERIALS ABOUT THE PROGRAM WILL BE AVAILABLE TO PATIENTS THROUGH THE ADMISSIONS PROCESS. AS SOON AS A PATIENT EVIDENCES INABILITY TO PAY HE OR SHE WILL BE REFERRED TO THE PATIENT FINANCIAL SERVICES COUNSELOR FOR AN APPLICATION. APPLICATIONS ARE ALSO AVAILABLE AT THE ADMISSIONS AREA, AND THROUGH SOCIAL SERVICES. PART VI, LINE 2: THE HOSPITAL CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT IN THE YEAR ENDED JUNE 30, 2019. THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT HTTPS://WWW.SIDNEYHEALTH.ORG/ABOUT/COMMUNITY-HEALTH-ASSESSMENT- IMPLEMENTATION-PLAN. PART VI, LINE 3: SIDNEY HEALTH CENTER HAS NOTICES LOCATED AT THE ADMISSIONS OFFICE INFORMING PATIENTS ABOUT THEIR FINANCIAL ASSISTANCE POLICY. THE PROGRAM IS ALSO STATED ON THE ORGANIZATION'S WEBSITE AND INCLUDED IN THE PATIENT'S PACKET UPON DISCHARGE FROM THE FACILITY. PART VI, LINE 4: LOCATED IN THE HEART OF RICHLAND COUNTY, SIDNEY HEALTH CENTER SERVES PEOPLE IN ALL OF THE MONDAK REGION. PART VI, LINE 5: THE HEALTH CENTER DEFINES AND MEASURES THEIR INVESTMENT IN AND PARTNERSHIP WITH THE COMMUNITY PRIMARILY THROUGH VARIOUS COMMUNITY-BASED SERVICES PROGRAMS, PROVIDING HEALTH EQUIPMENT IN AREA SCHOOLS, AND COMMUNITY PROGRAMS AND EDUCATION. A NUMBER OF HEALTH-RELATED EDUCATIONAL PROGRAMS ARE PROVIDED FOR THE BENEFIT OF THE COMMUNITY, INCLUDING HEALTH ENHANCEMENTS AND WELLNESS, CLASSES ON SPECIFIC CONDITIONS, AND PROGRAMS DESIGNED TO IMPROVE THE GENERAL STANDARDS OF THE HEALTH OF THE COMMUNITY. 1 COMMUNITY HEALTH FITNESS CENTER 216 14TH AVENUE SW SIDNEY MT 59270 810460658 501(C)(3) 45000 TO PURCHASE EQUIPMENT 1 0 PART I, LINE 2: GRANTS TO LONE TREE SENIOR LIVING ARE MONITORED THROUGH COMMON MANAGEMENT AND BOARD OVERSIGHT. SIDNEY HEALTH CENTER CONFIRMS THAT EACH RECIPIENT ORGANIZATION IS A QUALIFIED GOVERNMENT OR CHARITY ORGANIZATION. CONTRIBUTED FUNDS ARE INTENDED FOR GENERAL OPERATING SUPPORT, SO SIDNEY HEALTH CENTER DOES NOT CONDUCT ANY FOLLOW-UP MONITORING ACTIVITIES. X 1 1 X X 0 0 0 1 0 0 0 0 0 LESZEK JASZCZAK MD TRUSTEE 600033 0 0 0 0 0 2935 0 1402 0 604370 0 0 0 JEN DOTY CEO 175891 0 0 0 0 0 5272 0 3581 0 184744 0 0 0 TINA MONTGOMERY CFO 158272 0 0 0 0 0 4748 0 7354 0 170374 0 0 0 JEROME KESSLER MD PHYSICIAN 486741 0 0 0 0 0 8250 0 1402 0 496393 0 0 0 CHAD PEDERSEN MD PHYSICIAN 468419 0 0 0 0 0 0 0 1232 0 469651 0 0 0 GEORGE SCORDALAKES MD PHYSICIAN 477173 0 0 0 0 0 8250 0 790 0 486213 0 0 0 MALUA TAMBI IYA MD PHYSICIAN 448346 0 0 0 0 0 8250 0 1402 0 457998 0 0 0 KELLY O'NEAL MD PHYSICIAN 387116 0 0 0 0 0 8250 0 1402 0 396768 0 0 0 PART I, LINE 1A DR. MALUA TAMBI IYA RECEIVED A HOUSING STIPEND OF $4,800 DURING CALENDAR YEAR 2018. THIS AMOUNT WAS INCLUDED IN HER TAXABLE COMPENSATION. DR. CHAD PEDERSEN RECEIVED A HOUSING STIPEND OF $18,000 DURING CALENDAR YEAR 2018. THIS AMOUNT WAS INCLUDED IN HIS TAXABLE COMPENSATION. DR. KELLY O'NEAL RECEIVED A HOUSING STIPEND OF $7,200 DURING CALENDAR YEAR 2018. THIS AMOUNT WAS INCLUDED IN HER TAXABLE COMPENSATION. PART I, LINE 5 PHYSICIANS RECEIVE BONUSES BASED ON PRODUCTIVITY, AMONG OTHER FACTORS. PRODUCTIVITY IS CLOSELY CONNECTED WITH REVENUES. A RICHLAND COUNTY MT 816001419 2011-09-15 24370000 REDEEMING AND RETIRING PREVIOUSLY ISSUED DEBT (2006, 2007A AND 2007B) 0 0 0 B RICHLAND COUNTY MT 816001419 2018-01-09 5700000 HOSPITAL CAPITAL IMPROVEMENTS 0 0 0 A 6685000 24370000 233683 137747 23998570 2012 1 0 1 1 B 456000 5700000 5700000 2018 0 0 1 1 A 1 0 0 0 0 0 0 B 1 0 0 0 0 0 0 A 0 0 1 0 1 1 US BANK 7.900000000000 0 0 0 0 0 B 0 1 0 0 1 1 US BANK 3.800000000000 0 0 0 0 0 A 0 B 0 ROBERT MONTGOMERY SPOUSE OF TINA MONTGOMERY, CFO 56220 EMPLOYEE COMPENSATION 0 SEAN MONTGOMERY CHILD OF TINA MONTGOMERY, CFO 13942 EMPLOYEE COMPENSATION 0 SCOTT DOTY SPOUSE OF JEN DOTY, CEO 78680 EMPLOYEE COMPENSATION 0 NANCY STEFFAN MOTHER OF JEN DOTY, CEO 35821 EMPLOYEE COMPENSATION 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS AND ONE OTHER MEMEBER OF THE BOARD APPOINTED BY THE PRESIDENT. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN THE MEETINGS OF THE BOARD, PROVIDED ANY ACTION TAKEN SHALL NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, BYLAWS AND STATE POLICIES. ANY OFFICIAL ACTION TAKEN BY THE EXECUTIVE COMMITTEE IS SUBMITTED TO THE BOARD FOR RATIFICATION AT THE NEXT BOARD MEETING. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN NOVEMBER 2018 TO MAKE THE CHIEF OF SIDNEY HEALTH CENTER'S MEDICAL STAFF A VOTING MEMBER OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 NATURAL PERSONS, CORPORATIONS, OR UNINCORPORATED ASSOCIATIONS MAY BECOME MEMBERS OF SIDNEY HEALTH CENTER BY: A. PAYMENT TO SIDNEY HEALTH CENTER A SUM OF NOT LESS THAN $100 CASH OR BY AN EQUIVALENT CONTRIBUTION OR METHOD AS APPROVED BY THE BOARD; B. RESIDING IN OR HAVING ITS PRINCIPAL PLACES OF BUSINESS IN THE SERVICE AREA OF SIDNEY HEALTH CENTER; AND C. AGREEING TO BE BOUND BY THE BYLAWS OF SIDNEY HEALTH CENTER. FORM 990, PART VI, SECTION A, LINE 7A ELECTION OF DIRECTORS IS HELD AT THE ANNUAL MEETING OF THE MEMBERS BY WRITTEN BALLOT LISTING THE CANDIDATES NOMINATED BY THE NOMINATING COMMITTEE OF THE MEMBERS. EACH MEMBER OF SIDNEY HEALTH CENTER, PRESENT IN PERSON OR BY PROXY, IS ENTITLED TO VOTE FOR ONE CANDIDATE FOR EACH DIRECTOR VACANCY TO BE FILLED. THE CANDIDATES RECEIVING THE HIGHEST NUMBER OF VOTES AT THE MEETING ARE CONSIDERED ELECTED AS DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B ANY PROPOSED AMENDMENTS APPROVED BY THE BOARD OR BY VERIFIED PETITION TO THE ARTICLES OF INCORPORATION OR BYLAWS SHALL BE SUBMITTED FOR VOTE BY THE MEMBERS AT THE NEXT SPECIAL OR ANNUAL MEMBERSHIP MEETING. FORM 990, PART VI, SECTION B, LINE 11B THE CEO AND CFO WILL REVIEW THE COMPLETED FORM 990 WITH THE BOARD OF DIRECTORS AT THEIR NEXT SCHEDULED MEETING AFTER THE FORM 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE POLICY OF THE CORPORATION IS TO REQUIRE THAT EACH INDIVIDUAL SUBJECT TO THIS POLICY STATEMENT PROMPTLY AND FULLY DISCLOSE ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST, AND THAT THE CORPORATION WILL NOT ENGAGE IN ANY CONTRACT, TRANSACTION, OR ARRANGEMENT INVOLVING A CONFLICT OF INTEREST UNLESS THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS (ACTING AT A DULY CONSTITUTED MEETING THEREOF) DETERMINE BY A MAJORITY VOTE THAT APPROPRIATE SAFEGUARDS TO PROTECT THE CHARITABLE MISSION OF THE CORPORATION HAVE BEEN IMPLEMENTED. A CONFLICT OF INTEREST QUESTIONNAIRE IS DISTRIBUTED ANNUALLY TO ALL INTERESTED PERSONS (BOARD MEMBERS, OFFICERS, AND COMMITTEE MEMBERS). AN INTERESTED PERSON HAS A CONTINUING OBLIGATION TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST HE/SHE MAY HAVE. "DISCLOSURE" MEANS PROMPTLY PROVIDING A WRITTEN DESCRIPTION OF THE MATERIAL FACTS OF THE ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST TO THE EXECUTIVE COMMITTEE ON THE CONFLICTS-OF-INTEREST QUESTIONNAIRE. SUCH DISCLOSURE SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT, OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF THE CONTRACT, TRANSACTION, OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. AT ANY TIME THAT AN ACTUAL, APPARENT, OR A POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED TO THE BOARD OF DIRECTORS, WHETHER THROUGH THE VOLUNTARY SUBMISSION OF A DISCLOSURE STATEMENT BY AN INTERESTED PERSON, OR BY A DISCLOSURE BY A PERSON OTHER THAN THE SUBJECT INTERESTED PERSON, THE EXECUTIVE COMMITTEE SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON SHALL NOT BE PRESENT DURING ANY MEETING IN WHICH THE EXECUTIVE COMMITTEE CONDUCTS ITS EVALUATION, EXCEPT TO ANSWER QUESTIONS AS MAY BE NECESSARY. THE EXECUTIVE COMMITTEE MAY REQUEST ADDITIONAL INFORMATION FROM ALL REASONABLE SOURCES AND MAY INVOLVE THE GENERAL COUNSEL IN ITS DELIBERATIONS. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, EXECUTIVE COMMITTEE SHALL MAKE A FINDING AS TO WHETHER A CONFLICT OF INTEREST INDEED EXISTS, AND SHALL FORWARD THAT FINDING TO THE BOARD OF DIRECTORS FOR DISCUSSION AND VOTE. ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE SUBJECT INTERESTED PERSON MAY NOT BE PRESENT WHEN THIS VOTE IS TAKEN. ONCE THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS HAVE DETERMINED THAT AN ACTUAL CONFLICT OF INTEREST EXISTS WITH RESPECT TO A PARTICULAR TRANSACTION OR ARRANGEMENT: (I) THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS SHALL EXERCISE DUE DILIGENCE TO DETERMINE WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES AND, IF APPROPRIATE, SHALL APPOINT A NON-INTERESTED PERSON OR COMMITTEE TO INVESTIGATE ALTERNATIVES TO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT. (II) IN CONSIDERING WHETHER TO ENTER INTO THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT, THE BOARD OF DIRECTORS MAY APPROVE SUCH A CONTRACT, TRANSACTION, OR ARRANGEMENT ONLY IF THE DISINTERESTED DIRECTORS DETERMINE BY A MAJORITY VOTE THAT: (A) THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT IS IN THE CORPORATION'S BEST INTERESTS AND FOR THE CORPORATION'S OWN BENEFIT; AND (B) THE PROPOSED TRANSACTION IS FAIR AND REASONABLE TO THE CORPORATION, TAKING INTO ACCOUNT, AMONG OTHER RELEVANT FACTORS, WHETHER THE CORPORATION COULD OBTAIN A MORE ADVANTAGEOUS CONTRACT, TRANSACTION, OR ARRANGEMENT WITH REASONABLE EFFORTS UNDER THE CIRCUMSTANCES. (III) THE DISINTERESTED MEMBERS OF THE BOARD OF DIRECTORS MAY, IN THEIR DISCRETION, REQUIRE THE INTERESTED PERSON TO LEAVE THE ROOM WHILE THE PROPOSED CONTRACT, TRANSACTION, OR ARRANGEMENT IS DISCUSSED. THE INTERESTED PERSON SHALL LEAVE THE ROOM WHILE THE MATTER IS VOTED ON AND ONLY DISINTERESTED DIRECTORS MAY VOTE TO DETERMINE WHETHER TO APPROVE THE TRANSACTION OR ARRANGEMENT. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD OF DIRECTORS DETERMINES SALARIES USING THE MHA SALARY SURVEY FOR MARKET INFORMATION AND ALSO PERFORMS A WRITTEN EVALUATION ANNUALLY. ADDITIONALLY, THE CEO USES MHA MANAGEMENT SURVEY, AS WELL AS OTHER COMPENSATION SURVEYS, TO DETERMINE ANNUAL PAY INCREASES FOR ADMINISTRATION. A WRITTEN EVALUATION IS PERFORMED. ALL ESTIMATED ANNUAL INCREASES ARE INCLUDED IN THE BUDGET, WHICH IS APPROVED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 10,484,762. MANAGEMENT AND GENERAL EXPENSES 1,336,530. FUNDRAISING EXPENSES 19,380. TOTAL EXPENSES 11,840,672. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 20,058. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS -110,808. LONE TREE SENIOR LIVING 216 14TH AVENUE SW SIDNEY MT 59270 810518821 ASSISTED LIVING MT 501(C)(3) LINE 10 SIDNEY HEALTH CENTER 1 FOUNDATION FOR COMMUNITY CARE OF RICHLAND COUNTY 221 2ND STREET NW SIDNEY MT 59270 810417465 FUNDRAISING MT 501(C)(3) LINE 12A, I SIDNEY HEALTH CENTER 1 1 0 1 1 0 0 0 0 0 0 0 1 1 1 1 0 1 0 0 LONE TREE SENIOR LIVING A 81342 CONTRACTED INTEREST RATE FOUNDATION FOR COMMUNITY CARE OF RICHLAND COUNTY C 287134 CASH LONE TREE SENIOR LIVING L 109970 FAIR MARKET VALUE