2018-05-15T11:20:24-05:00 2017-06-30 390758449 Wipfli LLP PO Box 1699 Helena MT 59624 990 2016-07-01 810243720 Sheridan Memorial Hospital Association SHER 4067653700 440 W Laurel Avenue Plentywood MT 59254 Greg Maurer CEO 4067653700 2018-05-14 1 Nathan D McCarthy CPA P00368408 4064425520 2018-05-14 2016 2022-09-23 18:48:47Z Greg Maurer 440 W Laurel Avenue Plentywood MT 59254 11840679 0 X www.sheridanmemorial.net X 1920 MT Provide quality care to improve the health and well-being of the people and community we serve. 7 7 217 68 0 0 406825 306016 11414356 11440978 34406 4853 19442 88832 11875029 11840679 0 0 0 0 7037972 6735048 0 0 51782 5235785 4984587 12273757 11719635 -398728 121044 7896749 6165298 1766582 1215120 6130167 4950178 X Providing quality care to improve the health and well-being of the people and community we serve, regardless of their ability to pay. 0 0 9224988 11494496 Sheridan Memorial Hospital Association operates a 19-bed critical access hospital, a 45-bed long-term care facility, and a Rural Health Clinic that benefit the people in the surrounding area. SMHA is the only medical facility in Sheridan County, which has a population of approximately 4,105 residents. Highlights of the organization's accomplishments during FY17 are included below:In FY16, EMS purchased a Zoll 12-lead monitor to assist in the care of patients during transport. In addition, they received a Lucas 2 device that allows for automated chest compressions for CPR. During FY17, Critical Access Hospital employees completed training for both the Zoll Monitor and Lucas 2 device and the equipment was placed into service. The Critical Access Hospital added a Patient/Resident Care & Quality Control coordinator position. The Laboratory Department purchased new equipment called Sysmex XN-100R for Hematology. Installation took place in April and a correlation study is in process. The equipment will interface with the Cerner system and is expected to go live in FY18. The Immunization Clinic, which opened at the end of FY16, registered 140 patients and had 288 appointments. The Hospital also received training from Billings Clinic regarding scheduling and documentation. Sheridan Memorial Rural Health Clinic added a new FNP, participated in numerous Emergency Preparedness drills, and improved workflow for Pre-Op and CPAP. EMS purchased 4 new Zoll AEDs and 2 new Lucas 3 devices that will be placed in service in the Westby and Med Lake QRUs. EMS was also awarded a MT DOT grant to purchase a new ambulance - delivery will occur in FY18. EMS also started offering Baby Sitter CPR 1st Aid Classes to local youth. The Nursing Home increased the number of Air Overlay Mattress devices and gel wheelchair cushions to provide pressure relief for patients. 9224988 1 1 0 0 0 0 0 0 0 1 1 0 0 1 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 8 0 1 217 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Greg Maurer 4067653702 440 West Laurel Avenue Plentywood MT 59254 X Jake Fladager Chairperson 1.00 0.00 X X 0 0 0 Linda Nelson Vice Chairperson 1.00 0.00 X X 0 0 0 Jessica Schackelford Secretary/Treasurer 1.00 0.00 X X 0 0 0 Robert Michael Director 1.00 0.00 X 0 0 0 Mike O'Toole Director 1.00 0.00 X 0 0 0 Myrnette Miller Director 1.00 0.00 X 0 0 0 Don Benson Director 1.00 0.00 X 0 0 0 Greg Maurer CEO 40.00 1.00 X 0 0 0 Kyle Gee CFO 10.00 0.00 X 0 0 0 Carlos Trevino MD 40.00 0.00 X 277565 0 6687 Adam Graham PA 40.00 0.00 X 150110 0 6400 Lynne Graham PA 40.00 0.00 X 124219 0 6400 Kristin McColly FNP 37.00 0.00 X 116106 0 6400 668000 0 25887 4 0 1 0 Montana Health Network 11 South 7th Street Miles City MT 59301 Rural Hospital Support 628673 Billings Clinic PO Box 30977 Billings MT 59107 Management Company 607001 Toshiba American Medical System 1 Marconi Ste A Irvine CA 92618 Radiology 471500 Dakota Drug 1101 Lund Boulevard Anoka MN 55303 Health Care Products 239506 Cerner Corporation PO Box 959156 St Louis MO 63195 Computer Program 145975 6 237328 24515 44173 306016 Patient Service Revenue 621990 10651150 10651150 Other Operating Revenue 900099 371146 371146 Contract Revenue 621990 211086 211086 340B Revenue 621990 207596 207596 11440978 505 505 35314 0 35314 35314 35314 4348 0 4348 4348 4348 Bad Debt Recovery 621990 48143 48143 Gift Shop Revenue 900099 5375 5375 53518 11840679 11494496 0 40167 X 5239874 4448253 773151 18470 1541 1541 1079676 872473 205166 2037 413957 357959 54606 1392 334887 334887 17694 17694 30805 28605 2200 1371749 973031 396317 2401 29588 495 23554 5539 262428 14429 247999 10009 3116 6749 144 45870 33548 12322 14877 10305 3522 1050 818550 814613 3937 137603 250 135991 1362 Supplies 948995 895794 52200 1001 Bad Debt 410750 410750 Repairs and Maintenance 217903 176187 41716 Bed Tax 157034 142528 14506 175845 71257 88402 16186 11719635 9224988 2442865 51782 851603 712193 174852 48812 5000 1379614 1210575 203863 223594 136659 78823 17033054 13789368 3917575 3243686 59854 59884 1301033 0 137146 317281 7896749 6165298 1333741 884677 261868 137606 170973 192837 1766582 1215120 X 5683778 4941687 332405 8491 113984 0 6130167 4950178 7896749 6165298 X 121044 -1301033 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 113984 237 10225 103996 113916 68 145 145 113984 113916 64 64 113916 113916 72 72 113916 37530 76386 27 27 113916 1.00000 0 1 1 384756 384756 9417031 8212304 1204727 7228884 5577064 1651820 2383 2383 3243686 Cost Report Receivable 180701 Guarantee of Patient Loan 126080 Bed Tax Receivable 10500 317281 Related Party Note Payable 30053 Guarantee of Patient Loan 126080 Bed Taxes Payable 36355 Other Payables 349 192837 X Part V, Line 4: The endowment, held by the Sheridan Health Care Foundation, Inc., consists of individual funds established by donors to provide annual funding for specific activities and general operations of the Hospital. Gifts given to the Endowment Fund at Sheridan Health Care Foundation are invested and carefully managed to protect the principal; they are intended to be a part of the permanent investment reserve which will remain for perpetuity. Interest from endowments will go towards Sheridan Health Care Foundation's unrestricted fund to allow for additonal revenue to ensure the future of the Foundation and Sheridan Memorial Hospital Association unless otherwise stipulated by the donor. Part X, Line 2: The Hospital is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code (the "Code") and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. The Hospital is also exempt from state income taxes on related income. Federal and state income taxes are paid on nonexempt unrelated business income in accordance with the Code. Current accounting guidelines require an organization to determine whether it is more likely than not that a tax position will be sustained upon examination of the technical merits of the position, assuming the taxing authority has full knowledge of all information. If the tax position does not meet the more-likely-than-not recognition threshold, the benefit of that position is not recognized on the financial statements. The Hospital recorded no assets or liabilities related to uncertain tax positions. Federal returns for tax years 2014 and beyond remain subject to examination by the Internal Revenue Service. Part V, Line 1(e) The Foundation identified that the endowment fund balance was incorrect. $10,225 of "administrative expenses" were recorded this year to correct the balance of the endowment fund. 1 1 X 1 X 1 X 1 1 1 0 0 161421 161421 0.01380 1045166 1045166 0.08920 1206587 1206587 0.10300 49642 49642 0.00420 125932 75999 49933 0.00430 1585 1585 0.00010 177159 75999 101160 0.00860 1383746 75999 1307747 0.11160 9935 9935 0.00080 890 890 0.00010 10825 10825 0.00090 1 344168 3555541 3822529 -266988 X 1 1 1 1 Sheridan Memorial Hospital Association 440 W Laurel Ave Plentywood MT 59254 www.sheridanmemorial.net 13547 X X X General Medical, Rural Health Clinic, Long-Term Care Facility Sheridan Memorial Hospital Association 1 0 0 1 X X X X X X X X 15 1 0 1 1 X www.sheridanmemorial.net X X 1 15 1 www.sheridanmemorial.net 0 1 X 100.000000000000 400.000000000000 X 1 1 X X X 1 X www.sheridanmemorial.net X www.sheridanmemorial.net X www.sheridanmemorial.net X X X X X 1 X 0 X 1 X 0 1 Sheridan Memorial Hospital Association Part V, Section B, Line 5: Three focus groups were held in May 2016. The meetings were held in Plentywood, Westby and Medicine Lake, Montana. Focus group participants were identified as people living in Sheridan Memorial Hospital's service area. Additionally, four key informant interviews were conducted with the assistance from the Montana Office of Rural Health. Sheridan Memorial Hospital Association Part V, Section B, Line 6b: Sheridan County Sheriff's OfficeSheridan County Office of Public HealthSheridan County Mental Health CounselorPioneer Manor Retirement HomeSheridan County Child and Family Services Sheridan Memorial Hospital Association Part V, Section B, Line 7d: The full CHNA is available upon request. It is also posted in a couple places in the hospital. Sheridan Memorial Hospital Association Part V, Section B, Line 11: The following needs were identified in the most recently conducted Community Health Needs Assessment:1. Improving local access to wellness opportunities and health care services by optimizing facility space and recruiting/retaining staff to support community health needs.2. Improving local access to wellness opportunities by providing health education and community outreach activities.A community health outreach program is tentatively planned for the town of Westby. Administration has met with residents of Westby to assess health needs and develop a plan. Westby will be our "pilot program" for starting a Community Health Needs Program. Currently, the facility is working on a plan and will be seeking grant funding to bring the plan to fruition. Sheridan Memorial Hospital Association Part V, Section B, Line 13h: In addition to family size and federal poverty guidelines, the hospital facility will consider special hardships or unusual circumstances in determining financial assistance. Sheridan Memorial Hospital Association Part V, Section B, Line 20e: The patient receives up to 240 days to properly submit a financial assistance application. Sheridan Memorial Hospital Association Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part I, Line 3c: In addition to family size and federal poverty guidelines, the hospital facility will consider special hardships or unusual circumstances in determining financial assistance. Part I, Line 7: Line 7a: Charity care was calculated by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to patients.Line 7b: The Medicaid calculation is based on the ratio of patient care cost to charges.Line 7e and 7i: Actual costs were used to report community health improvement services and cash and in-kind contributions. Part I, Line 7g: A combination of actual costs and costs based on the Cost Report were used to report Subsidized Health Services. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $344,168. Part II, Community Building Activities: Sheridan Memorial's activities listed in Part II promote the health and wellbeing of our community in several ways. We offer free telemed services to those who need to see a specialist. Being in a rural community we find that our patients have to travel for specialists and follow-up appointments. By making telemed services readily available we are saving our patients and community money and time as well as promoting health by making these services easily accessible. We performed a community health needs assessment in prior years and are diligently working towards goals set by that assessment. Our current work is focusing on creating a Community Health Worker program that will be piloted in a community 20 miles from Plentywood. Our program will focus on those who do not have support systems of family and friends as well as anyone who may need assistance in coordinating their health care. The CHW program will promote health care by ensuring patients are able to understand and follow their providers medical instructions, ensure patients have transport to and from medical appointments and ensure patients can maintain the needed care on their own through evaluations and monitoring. Marketplace Navigator Assistance is free to all residents in Sheridan County. This is a service Sheridan Memorial offers to help consumers understand health care insurance and the benefits received. There are many who do not see a medical provider or don't continue with their providers care instructions because they do not have and/or cannot afford health insurance; thus cannot afford the visit and/or follow-up care. Through education of insurance programs and assisting patients to enroll in an insurance plan, patients are more informed and have the opportunity for more affordable or free health care coverage. Sheridan Memorial staff attended the annual Sheridan County Safety fair and held a booth for youth and young adults. Attendees were educated on the importance of hand hygiene and while being educated on safety, they decorated and filled first aid kits for them to take home. Sheridan Memorial participated in a County-wide Disaster Preparedness Exercise that enabled our staff to have hands-on experience and utilize the training that we've learned through NIMS. Sheridan Memorial incident command was activated as well as our trauma team. Our facility also practiced the process of lock-down and evacuation. All these mock-practices keeps staff educated and up-to-date on patient and staff safety practices. From this hands-on, live training event we were able to identify our strengths and found areas where we could improve. In the event that an actual disaster happens within our community, our staff will be better prepared to handle the situation.Sheridan Memorial staff are involved in different community events and meetings to include Sheridan County Chamber and Sheridan County Council on Aging. By being involved with these events our staff are able to communicate with our community on services offered locally as well as get a pulse on issues or concerns that the community may have about our medical community. This is one of many ways that Sheridan Memorial communicates with the community. Part III, Line 2: Accounts are written off as determined. The allowance is adjusted up or down based on the change in Self Pay aged outstanding balance. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 9 of the attached audit report. Part III, Line 8: The cost to charge ratio is used to determine community benefit. This is done by applying the ratio to the total Medicare revenue. A shortfall or overage in any given year is a result of the timing of payments from Medicare on an interim basis and when final settlement is made. Management uses estimates to calculate such settlements but actual results vary from those estimates. Additionally, shortfalls can result from various expenses that are 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. Also Medicare recipients are part of a charitable class and so the provision of medical care furthers this charitable class. Part III, Line 9b: Sheridan Memorial follows the collection and financial assistance practices mandated in 501r. Once a financial assistance application is received it is reviewed to ensure all areas are completed and all requested documents are provided. At this time all collection action is suspended until a decision can be made on the applicant's financial assistance request. If the patient qualifies for assistance in accordance to the sliding fee schedule and the federal poverty guidelines, a patient financial representative then looks back 240 days from the date the application was received and applies that percentage of discount to all accounts. Some accounts at this point may have already been turned over to a Collection Agency. Those accounts are pulled back from the collection agency and the same discount is applied. Once all discounts are applied, collection action is proceeded as normal. Part VI, Line 2: Sheridan Memorial Hospital conducted a thorough secondary data analysis to identify health concerns in Plentywood and Sheridan County. Additionally, a diverse group of community memebers representing various organizations and populations within the community (ex. public health, elderly, uninsured) came together for key informant interviews and focus groups to better understand the community's perception of health and health concerns in the area. The interviews and focus groups were conducted in May 2016. Part VI, Line 3: Sheridan Memorial ensures all patients are notified of the availability of financial assistance at every admission. At admission, the patient signs a Condition of Admission which states that assistance is available. In addition, financial assistance packets are handed out by the Admission's Clerk to those who are underinsured/uninsured or express need for assistance. This packet includes all payment options, Medicaid information and Financial Assistance application. In addition the Financial Assistance policy and application are posted on the Sheridan Memorial website www.sheridanmemorial.net and posters are placed around the facility explaining payment options and financial assistance availability. Each statement sent out to the patient states that Financial Assistance is available. In addition, when making collection or payment plan calls, the self-pay collection clerk informs all of assistance availability. Part VI, Line 4: Sheridan Memorial Hospital is a private not-for-profit organization which is the only medical facility in Sheridan County with a population of approximately 4,105 residents. The facility provides acute, emergency, clinical and long term care for residents in the county and surrounding areas. Established in 1922 as primarily a hospital, Sheridan Memorial Hospital Association continued expanding throughout the years with first a relocation from our small main street location to our current location. In 2008 Sheridan Memorial Hospital added a Rehab suite including exam rooms, prep area, work out area and a hydrotherapy pool. The hospital has an active medical staff of one physician, three family nurse practitioners and two physician assistants as well as consulting medical doctors in the fields of radiology and surgery. Services provided at the hospital include: x-ray technology, physical, occupational and speech therapy, laboratory testing, visiting nurse and hospice care, durable medical equipment and home oxygen sales, social services and emergency services. In 2010 Sheridan Memorial became the first contracted tele-health VA clinic in the country offering area veterans' primary health care via tele-video equipment. Part VI, Line 5: Sheridan Memorial has expanded medical staff privileges to an MD who has his own private clinic in the area. Medical privileges are also extended to qualified physicians in the community and providers willing to see Sheridan Memorial patient's via tele-med/video conference. The Board of Directors is made up of volunteers from the community. We try to have representation of the board from individuals throughout the country and not just of those living in Plentywood. Surplus funds are applied back to patient care and education. We offer many services which are a community benefit to the communities we serve which include the following: * Alzheimer's support group offered free of charge* Grief counselor does counseling free of charge* Use of telemedicine equipment is open to the community for use such as mental health visits, behavioral health classes, MIP classes, Lunch and Learns community educational tele-meds when available, Lifestyle balance classes for community members as well as continuing education courses for employees, other medical personnel outside of Sheridan Memorial such as Pharmacists etc. all free of charge* ER open 24 hours regardless of ability to pay* Participates in education of healthcare professionals* Participates in government sponsored health programs* Sheridan Memorial is involved in community outreach through the Sheridan County Chamber, Council on Aging, a working relationship with County Health among other involvements* Assist community members in applying for State Medicaid assistance and SSDI. Applications can be confusing and the process frusterating thus Sheridan Memorial offers any help to get patients the help they need* Sole community provider of most service lines* Offers volunteer opportunities to community through Hospice, EMS, Activities, Beauty Shop, Pink Lady Program as well as gift shop staffing* Has a foundation that serves as a vehicle for attracting and effectively using donated funds* Has the support of an Auxiliary that hosts events throughout the year to raise funds for the health care facility.* Emergency standby coverage for community events at no cost to the community. X 0 0 0 0 0 0 0 0 0 0 0 Carlos Trevino MD 270927 0 6638 0 0 0 0 0 6687 0 284252 0 0 0 Adam Graham PA 150110 0 0 0 0 0 0 0 6400 0 156510 0 0 0 Part I, Line 1a A housing allowance was provided for the highest compensated employees Adam and Lynne Graham. This was included as compensation on Adam's Form W-2. Greg Maurer Mr. Maurer is Sheridan Memorial Hospital Association's CEO. 0 MR. Maurer is an employee of the Billings Clinic, Inc., the independent contractor hired to manage the hospital, and received all compensation for his services as CEO from Billings Clinic, Inc. 0 Kyle Gee Mr. Gee is Sheridan Memorial Hospital Association's CFO. 0 MR. Gee is an employee of the Billings Clinic, Inc., the independent contractor hired to manage the hospital, and received all compensation for his services as CEO from Billings Clinic, Inc. 0 Form 990, Part VI, Section A, line 1 The Executive Committee shall consist of the President, as Chairman, the Vice Chairperson and the Secretary/Treasurer. The Executive Committee shall have the power to transact all regular business of the hospital during the period between the meetings of the Board of Directors subject to any prior limitations imposed by the Board of Directors. Form 990, Part VI, Section A, line 3 The hospital has a management agreement with Billings Clinic. They provide general accounting, HR, and business support services. Greg Maurer, CEO, is an employee of Billings Clinic and is compensated by Billing Clinic. Kyle Gee, CFO, is also compensated by Billings Clinic. Form 990, Part VI, Section A, line 6 Sheridan Memorial Hospital Association has 763 lifetime voting members. These members are granted voting privileges in electing/re-electing association board members. Form 990, Part VI, Section A, line 7a Sheridan Memorial Hospital Association has 763 lifetime voting members. These members are granted voting privileges in electing/re-electing association board members during the Annual Meeting held the third Tuesday of February every year. Form 990, Part VI, Section B, line 11b The board reviews an electronic copy of the Form 990 before the final copy is filed with the IRS. Form 990, Part VI, Section B, line 12c The Board of Directors, CEO, and meeting secretary are annually required to sign the conflict of interest policy. The board members review any potential conflicts to determine if a conflict exists. If there is a conflict of interest, the conflicted board member is not included in the vote on the particular matter. If the transaction is relating to a particularly sensitive topic, the conflicted board memeber may be asked to excuse themselves from both the discussion and the vote. Form 990, Part VI, Section B, line 15a Billings Clinic, along with the input from the SMH Board of Directors, determines compensation for the CEO. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 973,031. Management and general expenses 396,317. Fundraising expenses 2,401. Total expenses 1,371,749. Form 990, Part XI, line 9: Assets reported in prior year reported on related entity. -1,301,033. Part XII, Line 2c This process has not changed from the prior year. Sheridan Health Care Foundation Inc 440 W Laurel Avenue Plentywood MT 59254 810496987 Support activities of Sheridan Memorial Hospital Association MT 501(c)(3) Line 7 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 Sheridan Health Care Foundation Inc C 237328 Sheridan Health Care Foundation Inc O 60046