2019-05-13T08:56:52-05:00 2018-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2017-07-01 810233499 SIDNEY HEALTH CENTER SIDN 4064882100 216 14TH AVENUE SW SIDNEY MT 59270 TINA MONTGOMERY CFO 4064882100 2019-05-10 1 KURT BENNION P01469618 4252506100 2019-05-10 67.137.57.251 2019-05-10 16:44:58 PD P 29E0587BA93A6A199F773AE5AB92E6D01B4A8886 FC22DA715B55187DFB022ABBE867634B2E01E370 2017 2019-02-21 02:37:17Z JEN DOTY 216 14TH AVENUE SW SIDNEY MT 59270 74506464 0 X WWW.SIDNEYHEALTH.ORG X 1946 MT TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH BY PROVIDING QUALITY MEDICAL CARE. 10 8 574 154 778135 168673 400457 334032 61358944 69056189 871763 857046 2284589 1008589 64915753 71255856 43854 450 0 0 27797641 30184552 0 0 358216 35146992 36468148 62988487 66653150 1927266 4602706 61740167 72374320 28620615 33597470 33119552 38776850 X TO HELP THOSE WE SERVE ACHIEVE THEIR HIGHEST LEVEL OF HEALTH AND WELL-BEING. 0 0 59355818 450 69056189 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 AREA, RETAIL PHARMACY AND A 93-BED 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 THEIR 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 IT'S CONCEPTION WE HAVE GONE FROM ONE BUS AND ONE DRIVER FOR THE FULL PROGRAM TO 5 BUSSES AND 8 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 AN ENT PHYSICIAN. SIDNEY HEALTH CENTER PROVIDES THE TRAVEL FOR OUR ENT TO GO TO THOSE OUTREACH AREAS.HEALTH FAIR - WORKING WITH RICHLAND COUNTY HEALTH DEPARTMENT, COALITION ON AGING, FIRE, POLICE AND MENTAL HEALTH PROFESSIONS, JUST TO NAME A FEW, SIDNEY HEALTH CENTER HOLDS A HEALTH FAIR WHERE PEOPLE CAN COME AND LEARN ABOUT DIFFERENT HEALTHCARE NEEDS OF OUR COMMUNITY. SIDNEY HEALTH CENTER PROMOTES PREVENTATIVE CARE, DIABETES EDUCATION, LAB SCREENINGS AND MANY OTHER TOPICS.RICHLAND COUNTY FAIR & RODEO - SIDNEY HEALTH CENTER PROVIDES A BOOTH ONE DAY AT THE FAIR WHERE PEOPLE CAN HAVE THEIR BLOOD PRESSURE CHECKED AND RECEIVE A COLD WATER OR DRINK FOR FREE 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; 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.MEDICATION ASSISTANCE - PROVIDES MEDS TO THOSE WHO HAVE NO INSURANCE. ALSO HELPS GET PATIENTS SIGNED UP WITH DRUG COMPANIES FOR FREE MEDICATIONS.RX BOXES - PHARMACY SETS UP PILLS IN MEDICATION BOXES SO THAT GROUP HOME RESIDENTS GET THE CORRECT PILLS FOR EACH ADMINISTRATION TIME.SCHOOL AGE BASED EDUCATION ACTIVITIES - CENTRAL SCHOOL BLOOD TYPING. AARP DRIVING - DRIVING COURSE FOR THOSE OVER 55 THROUGH AARP.CHAMBER OF COMMERCE - VARIOUS DONATIONS FOR COMMUNITY AND CHAMBER FUNCTIONS.CHILDBIRTH CLASSES - CLASSES OFFERED TO THE COMMUNITY.INTERACTIVE TOUR FOR 2ND GRADERS - LOCAL 2ND GRADE 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.OUR CANCER CENTER IS VERY INVOLVED PROVIDING ACTIVITIES THROUGH OUT THE YEAR - TOUGH ENOUGH TO WEAR PINK AT THE COUNTY FAIR. PACK IT PINK VOLLEYBALL NIGHTS IN SAVAGE, FAIRVIEW AND SIDNEY. THEY HELD A MEN'S HEALTH SCREENING WHERE THEY PROVIDED PSA TESTS AND RECTAL EXAMS AND A WOMEN'S HEALTH SCREENING WHERE THEY PROVIDED BLOOD PRESSURE TESTS AND BREAST EXAMS. THEY ALSO HELD A ROCK PAINTING PARTY AND CANCER SURVIVOR DAY OPEN HOUSE. 59355818 1 1 0 1 0 0 0 0 1 0 1 1 0 0 1 1 0 1 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 1 1 1 0 0 1 100 0 574 1 1 1 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 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 RANDY JOHNSON PRESIDENT & VICE PRESIDENT 1.00 1.00 X X 0 0 0 LANCE AVERETT TRUSTEE & PRESIDENT 1.00 1.00 X X 0 0 0 DICK VANDE BOSSCHE VICE PRESIDENT & TRUSTEE 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 1.00 1.00 X 0 0 0 BRETT BENNION MD TRUSTEE 39.00 1.00 X 827303 0 0 ROBERT BURNISON TRUSTEE 1.00 1.00 X 0 0 0 LYLE HARRISON MD TRUSTEE (THROUGH JANUARY 2018) 39.00 1.00 X 0 0 0 LESZEK JASZCZAK MD TRUSTEE 39.00 1.00 X 507120 0 1028 SANDRA JEPSEN TRUSTEE 1.00 1.00 X 0 0 0 CHERYL VAN EVERY TRUSTEE 1.00 1.00 X 0 0 0 RICHARD HARALDSON CEO (THROUGH DECEMBER 2017) 39.00 1.00 X 334622 0 8966 THERESA LIVERS INTERIM CEO (DEC '17 - MARCH '18) 39.00 1.00 X 93250 0 15137 NANCY DYNNESON INTERIM CEO (MARCH '18 - MAY '18) 39.00 1.00 X 140558 0 7617 JEN DOTY CEO (AS OF JUNE 2018) 39.00 1.00 X 0 0 0 TINA MONTGOMERY CFO 39.00 1.00 X 148949 0 11137 JEROME KESSLER MD PHYSICIAN 40.00 0.00 X 493207 0 9128 KELLY O'NEAL MD GENERAL SURGEON 40.00 0.00 X 442008 0 9128 GEORGE SCORDALAKES MD PHYSICIAN 40.00 0.00 X 468716 0 8840 JEFFREY GILES MD ORTHOPEDIC SURGEON 40.00 0.00 X 621852 0 1028 MALUA TAMBI MD PHYSICIAN 40.00 0.00 X 440346 0 9128 4517931 0 81137 30 0 1 0 MEDIKAR PC 214 14TH AVE SW STE 110 SIDNEY MT 59270 PHYSICIAN SERVICES 1240635 BRETT BENNION MD 214 14TH AVE SW SIDNEY MT 59270 PHYSICIAN SERVICES 827303 GUARDIAN MEDICAL 105 WEST PARK DRIVE SUITE 100 BRENTWOOD TN 370275062 PHYSICIAN SERVICES 695972 EDWARD BERGIN MD 214 14TH AVE SW STE 105 SIDNEY MT 59270 PHYSICIAN SERVICES 484800 O PETE COUNCIL MD 214 14TH AVE SW STE 104 SIDNEY MT 59270 PHYSICIAN SERVICES 428123 20 14750 319282 334032 PATIENT REVENUES 621500 62510736 62510736 CLINIC PHARMACY 446110 5760575 4982440 778135 OTHER PATIENT CARE 621500 784878 784878 69056189 568289 568289 5800 0 5800 5800 5800 3341516 34468 3080052 7175 261464 27293 288757 288757 316375 163381 152994 152994 MISCELLANEOUS REVENUE 900099 407849 407849 MEAL INCOME 900099 338865 338865 RELATED PARTY REIMBURSEMENTS 900099 103081 103081 849795 71255856 68278054 778135 1865635 X 450 450 707052 246187 398678 62187 23964439 22346832 1475156 142451 478151 440733 33476 3942 3380214 3099504 240526 40184 1654696 1510629 129195 14872 133683 133683 91301 90601 700 133823 133823 11538837 9993975 1524123 20739 138521 13032 121868 3621 2761224 1728209 982816 50199 521226 521226 1170725 1159661 5240 5824 450714 448085 -4353 6982 1033958 1033958 3686465 3679173 7292 772369 760232 12137 UBI TAXES 55882 55882 PHARMACY/LAB EXPENSE 8903412 8903336 76 BAD DEBT 2793013 2793013 MISCELLANEOUS EXPENSE 667139 627620 39519 0 1615856 1083921 525420 6515 66653150 59355818 6939116 358216 7501309 12174910 9825 5577 10988295 10129143 41158 0 1701733 1757594 972557 649394 72228747 50672664 20715194 21556083 13547232 18041912 3571410 5603189 573085 610184 2118369 1846334 61740167 72374320 5122161 6166917 19395087 23804499 9883 5577 1079047 564331 999427 757277 2015010 2298869 28620615 33597470 X 32546467 38166666 573085 610184 33119552 38776850 61740167 72374320 X 4602706 302416 -65 752241 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4752 4752 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 43608122 28201854 15406268 1042533 603576 438957 25868631 21867234 4001397 1511200 1511200 21556083 MONEY MARKET FUNDS 4208782 F CDS AND REPURCHASE AGREEMENTS 1394407 F 5603189 ESTIMATED THIRD-PARTY PAYOR PAYABLES 1638000 SWAP CONTRACT LIABILITIES 660869 2298869 X 67435146 163381 163381 67271765 133823 3850268 3984091 71255856 63889695 163381 163381 63726314 133823 2793013 2926836 66653150 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 163,381. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT INCOME 695,930. GRANTS AND CONTRIBUTIONS 334,032. GAIN ON DISPOSAL OF FIXED ASSETS 27,293. BAD DEBT EXPENSE 2,793,013. PART XII, LINE 2D - OTHER ADJUSTMENTS: COST OF GOODS SOLD 163,381. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,793,013. 1 1 X 1 X 1 X 1 1 0 1 1 264682 264682 0.00410 264682 264682 0.00410 136056 136056 0.00210 25873 25873 0.00040 15852950 10217169 5635781 0.08830 16014879 10217169 5797710 0.09080 16279561 10217169 6062392 0.09490 1 2793013 0 14312268 14380171 -67903 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 15 1 0 1 1 X SEE SCHEDULE H, PART VI, LINE 2 X 1 15 1 SEE SCHEDULE H, PART VI, LINE 2 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: PUBLIC INPUT WAS COLLECTED USING THE "COMMUNITY ASSESSMENT USING A PUBLIC HEALTH EMERGENCY RESPONSE" (CASPER) PROCESS. OVER A TWO-DAY PERIOD, 42 VOLUNTEERS WENT DOOR-TO-DOOR ACROSS OUR COMMUNITY AND COMPLETED 204 INTERVIEWS. IN ADDITION, SEVEN TOWN HALL MEETINGS WERE HELD IN APRIL 2016 IN VARIOUS LOCATIONS OF RICHLAND COUNTY. THESE MEETINGS WERE ADVERTISED IN LOCAL NEW MEDIA AND WERE OPEN TO THE PUBLIC. SIDNEY HEALTH CENTER PART V, SECTION B, LINE 6B: THE JUNE 30, 2016 COMMUNITY HEALTH NEEDS ASSESSMENT WAS OVERSEEN BY SIDNEY HEALTH CENTER, RICHLAND COUNTY HEALTH DEPARTMENT, AND THE PUBLIC HEALTH AND SAFETY DIVISION. 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, 2018 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, IMPLANTS, 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 $ 2,793,013. 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 9) 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, 2018 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, 2016. THE REPORT AND PLANNED RESPONSES ARE AVAILABLE ONLINE AT HTTP://WWW.SIDNEYHEALTH.ORG/ABOUTUS/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. X 1 1 X X 0 0 0 1 0 0 0 0 0 BRETT BENNION MD TRUSTEE 827303 0 0 0 0 0 0 0 0 0 827303 0 0 0 LESZEK JASZCZAK MD TRUSTEE 507120 0 0 0 0 0 0 0 1028 0 508148 0 0 0 RICHARD HARALDSON CEO (THROUGH DECEMBER 2017) 334622 0 0 0 0 0 7938 0 1028 0 343588 0 0 0 TINA MONTGOMERY CFO 148949 0 0 0 0 0 4468 0 6669 0 160086 0 0 0 JEROME KESSLER MD PHYSICIAN 493207 0 0 0 0 0 8100 0 1028 0 502335 0 0 0 KELLY O'NEAL MD GENERAL SURGEON 442008 0 0 0 0 0 8100 0 1028 0 451136 0 0 0 GEORGE SCORDALAKES MD PHYSICIAN 468716 0 0 0 0 0 8100 0 740 0 477556 0 0 0 JEFFREY GILES MD ORTHOPEDIC SURGEON 621852 0 0 0 0 0 0 0 1028 0 622880 0 0 0 MALUA TAMBI MD PHYSICIAN 440346 0 0 0 0 0 8100 0 1028 0 449474 0 0 0 PART I, LINE 1A DR. MALUA TAMBI RECEIVED A HOUSING STIPEND OF $14,800 DURING CALENDAR YEAR 2017. 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 5665000 24370000 233683 137747 2012 1 0 1 1 B 131000 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 69629 EMPLOYEE COMPENSATION 0 SEAN MONTGOMERY CHILD OF TINA MONTGOMERY, CFO 11089 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 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 9,993,975. MANAGEMENT AND GENERAL EXPENSES 1,524,123. FUNDRAISING EXPENSES 20,739. TOTAL EXPENSES 11,538,837. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 37,099. CHANGE IN FAIR VALUE OF INTEREST RATE SWAPS 715,142. 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 89379 CONTRACTED INTEREST RATE FOUNDATION FOR COMMUNITY CARE OF RICHLAND COUNTY C 310823 CASH LONE TREE SENIOR LIVING L 107856 FAIR MARKET VALUE