2018-05-04T16:27:40-05:00 2017-06-30 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2016-07-01 810231784 Billings Clinic % CONNIE PREWITT BILL 4062382500 2800 Tenth Avenue South Billings MT 59101 CONNIE PREWITT CFO 4062382500 2018-05-15 true Adam R Smith CPA P00958966 7194714290 2016 2022-09-23 18:48:47Z Randall Gibb 2800 Tenth Avenue South Billings MT 59101 1357539184 false X WWW.BILLINGSCLINIC.ORG X 1907 MT BILLINGS CLINIC IS A NOT-FOR PROFIT MULTI-SPECIALTY Physician GROUP PRACTICE which provides Healthcare, Research and Education. 13 10 4803 275 10832324 2024396 6882544 8616665 644159429 709548648 2653118 19474531 11330945 15274456 665026036 752914300 520930 422167 0 0 351210024 365871574 0 0 0 288444620 312900780 640175574 679194521 24850462 73719779 711015080 776435285 276052936 259698478 434962144 516736807 X BILLINGS CLINIC MISSION IS HEALTH CARE, EDUCATON AND RESEARCH. BILLINGS CLINIC WILL PROVIDE BEST IN NATION CLINICAL QUALITY, PATIENT SAFETY, SERVICE AND VALUE. false true 268063136 211084 436443917 BILLINGS CLINIC IS A 304 BED HOSPITAL PROVIDING SURGICAL, LABOR AND DELIVERY, PSYCHIATRIC, CANCER CARE, NEONATAL SERVICES AND ACUTE CARE. BILLINGS CLINIC HAD OVER 15,700 ADMISSIONS. 257340610 202640 271883096 BILLINGS CLINIC HAS OVER 400 PHYSICIANS AND ADVANCED PRACTITIONERS OFFERING MORE THAN 50 SPECIALTIES. PRIMARY CARE IS AVAILABLE AT MULTIPLE LOCATIONS INCLUDING BILLINGS CLINIC DOWNTOWN, HEIGHTS, WEST END, CODY WY, MILES CITY AND BOZEMAN. IN ADDITION, BILLINGS CLINIC CONDUCTS SPECIALTY CARE CLINICS FOR MORE THAN 20 REGIONAL LOCATIONS IN MONTANA, WYOMING AND NORTH DAKOTA. BILLINGS CLINIC HAD OVER 800,000 VISITS. 10722526 8443 7154818 ASPEN MEADOWS IS A 90 BED SKILLED NURSING HOME AND 35 BED ASSISTED LIVING FACILITY. ASPEN MEADOWS HAD OVER 34,000 PATIENT DAYS. Aspen Meadows closed during the year. 536126272 true true false true false false false false false true true false false true true false true true false false false false false false false false true true true true true true false false false false false false false true false false false false false false true true true true false false true 154 0 true 4803 true true true false false false false false false false false false X 13 10 true false false false false false false true true false false true true true true true true true true true false X CONNIE PREWITT 4062382500 2800 TENTH AVENUE SOUTH BILLINGS MT 59101 NICHOLAS J WOLTER CEO - Thru January 2017 60.0 5.0 X X 1219538 0 31901 DAVID BROWN Board Member 5.0 0.0 X 0 0 10850 JOY OTT Board Chair 5.0 5.0 X X 0 0 10368 ELIZABETH FULTON TREASURER 5.0 0.0 X X 0 0 6993 LIL ANDERSON SECRETARY 5.0 0.0 X X 6000 0 0 PENNI NANCE Vice Chair 3.0 0.0 X X 6000 0 0 CLAYTON H MCCRACKEN III MD PHYSICIAN BOARD MEMBER 60.0 0.0 X 349721 0 55151 CRAIG BARTHOLOMEW BOARD MEMBER 5.0 0.0 X 0 0 6139 ROBERT PUERINGER MD PHYSICIAN BOARD MEMBER 60.0 0.0 X 408298 0 52127 Bill Ebzery Board Member 5.0 0.0 X 1500 0 0 Frank Reed Board Member 5.0 0.0 X 6000 0 0 Keith Cook Board member 5.0 0.0 X 3000 0 0 Randall Gibb Interim CEO 60.0 5.0 X X 694417 0 73764 Wayne Hirsch Board Member 5.0 0.0 X 0 0 0 CONNIE PREWITT CHIEF FINANCIAL OFFICER 60.0 5.0 X 638464 0 73520 Scott A Sample Physician 70.0 0.0 X 941641 0 50955 Mark P Piedra Physician 70.0 0.0 X 869893 0 33004 Barry N Smith Physician 70.0 0.0 X 837235 0 49647 Jeffry O Lindenbaum Physician 70.0 0.0 X 821937 0 50267 Jared J Lund Physician 70.0 0.0 X 795415 0 51521 Darrell Ehrlick Former Board Member 0.0 0.0 X 29344 0 0 Linda Overstreet Former Board Member 0.0 0.0 X 13129 0 0 7641532 0 556207 462 true true false HAyes Locums 6700 N Andrews Ave STE 600 FORT LAUDERDALE FL 33309 Physicians Services 5170226 Sodexo PO BOX 360170 PITTSBURGH PA 15251 Food Service 4270665 Healthcare OUtsourcing Network 621 17th street ste 1800 DENVER CO 80293 Early out vendor 1972496 Command health PO Box 844797 DALLAS TX 75284 Transcription 1835292 Healtcare Resource Group 12610 East Mirabeau Parkway SPOKANE WASHINGTON WA 99216 Denial Resolution 1614137 92 8616665 8616665 PATIENT SERVICE REVENUE 621110 699875405 699875405 REFERENCE LAB 621500 4110286 4110286 INCOME ON EQUITY INVESTEES 900099 4281045 2399380 1881665 CLINICAL TRIAL REVENUE 541900 415778 415778 MEANINGFUL USE PAYMENTS 621110 866134 866134 709548648 5747323 95722 5651601 0 0 500435 257801 242634 0 242634 242634 616873031 1153892 603828907 470808 13044124 683084 13727208 13727208 0 0 0 0 0 0 243676 67368 176308 176308 REGIONAL IT SERVICES 541519 3005464 3005464 IT CMC 541519 1102858 1102858 OPTICAL SHOP 446199 574039 574039 10173153 9867161 62290 243702 14855514 752914300 713600166 10832324 19865145 384987 384987 37180 37180 0 0 5423945 4069586 1354359 0 298782267 242323939 56458328 13761343 11632661 2128682 29130510 17251072 11879438 18773509 14607667 4165842 40000 40000 1395436 4744 1390692 284253 284253 161509 161509 0 1105350 1105350 58713153 33196417 25516736 2410774 20827 2389947 5574500 2480095 3094405 14109344 10850086 3259258 0 7744110 6751315 992795 4091218 2925630 1165588 0 117788 117788 6687675 5017763 1669912 0 24946165 20807596 4138569 5643607 128836 5514771 MEDICAL SUPPLIES 123808478 123560861 247617 BAD DEBT EXPENSE 23958950 23958950 REPAIRS AND MAINTENANCE 8647915 6709052 1938863 BED TAX 3963688 3963688 19496867 5443320 14053547 679194521 536126272 143068249 0 16701241 17873039 6411982 48393488 0 0 90707342 119635287 0 0 0 0 194177 87408 9544802 8459783 9222003 5101151 542886144 297563745 231690027 245322399 245865238 231840570 0 0 18397884 21935675 0 0 82280384 77786485 711015080 776435285 59230375 68984857 0 0 29008 1835612 152171468 147820075 0 0 0 0 722468 0 0 0 63899617 41057934 276052936 259698478 X 395690325 479607300 15144652 11770866 24127167 25358641 434962144 516736807 711015080 776435285 X 73719779 4025475 4029409 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 161509 161509 679033012 679194521 1000000 250000 false 1000000 1000000 1500000 161509 161509 250000 250000 375000 0 0 46940725 1430705 1962519 449773 49884176 45241517 808522 1194556 303870 46940725 25855937 17610002 1990724 215146 45241517 23259946 551706 2064279 19994 25855937 21981852 415028 1054443 201010 -12633 23262946 0.39800 0.50800 0.09400 false true true 9897742 23916839 33814581 198030826 85704322 112326504 2380430 1704039 676391 290042714 199915602 90127112 18617593 10239782 8377811 245322399 NOTES RECEIVABLE FROM NEW WEST 42367660 DUE FROM RELATED PARTY 4584885 DUE FROM JV 8706 DEPOSIT 27400 INTEREST IN FOUNDATION 70257800 INTEREST IN NEW WEST -44616927 INTEREST IN STILLWATER 3845126 INTEREST IN EXPRESSCARE -3288805 INTEREST IN MHI 4002493 ACCRUED INTEREST 598147 77786485 0 DUE TO MDOR 572324 DEPOSITS 23640 INTEREST RATE SWAP AGREEMENT 21478827 ESTIMATED CLAIMS LIABILITY 8803060 ACCRUED INTEREST 846518 PROVISION FOR UNPAID CLAIMS 9048065 UNEARNED PREMIUMS 285500 41057934 X 734437594 4025475 4019411 8044886 726392708 1105350 25416242 26521592 752914300 652314410 652314410 1105350 25774761 26880111 679194521 SCHEDULE D, PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT CONSISTS OF APPROXIMATELY 80 INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE GOVERNING BODY TO FUNCTION AS ENDOWMENTS. ENDOWMENT FUNDS ARE INVESTED AND HELD TO PROVIDE GROWTH OVER THE LONG-TERM. Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. Schedule D, Part XI, Line 2d Revenue on books, not on return: Change in fair value of interest rate swap 8,335,437 Change in interest in foundation 2,428,981 Change in interest of Affiliates (6,745,007) Total 4,019,411 Schedule D, Part XI, Line 4b Revenue on Return, Not on Books: Bad Debt reclassed to expense 23,958,950 MHI Revenue 1,457,292 Total 25,416,242 Schedule D, Part XII, Line 4b Expense on Return, Not on Books: Bad Debt reclassed to expense 23,958,950 MHI Expenses 1,815,811 Total 25,774,761 true true X true X true X true true false true true 6210582 0 6210582 0.00940 81439399 87537999 87649981 87537999 6210582 0.00940 3307948 164460 3143488 0.00480 8899133 2738905 6160227 0.00940 40689695 31537877 9151817 0.01390 1946725 812305 1134420 0.00170 3566555 784763 2781792 0.00420 58410056 36038310 22371744 0.03400 146060037 123576309 28582326 0.04340 5151 5151 243708 243708 45 45 835000 835000 1083904 1083904 false 23958950 220872589 235545273 -14672684 X true true 1 1 BILLINGS CLINIC 2800 TENTH AVENUE NORTH Billings MT 59101 WWW.BILLINGSCLINIC.COM 13345 X X X X X 1 BILLINGS CLINIC false false true X X X X X X X X X 17 true true true true X WWW.HEALTHYBYDESIGNYELLOWSTONE.ORG true 17 true www.healthybydesignyellowstone.org false true X 200. 400. X X X X X true true X X X X true X WWW.BILLINGSCLINIC.COM/FINASSIST X WWW.BILLINGSCLINIC.COM/FINASSIST X See Part V for URL X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 THE 2016-17 COMMUNITY HEALTH NEEDS ASSESSMENT FOR YELLOWSTONE COUNTY IS A SYSTEMATIC, DATA-DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS, BEHAVIORS AND NEEDS OF OUR POPULATION. SUBSEQUENTLY, THIS INFORMATION MAY BE USED TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS. THERE ARE THREE COMPONENTS THAT ARE ESSENTIAL IN RENDERING A COMPLETE PICTURE OF THE HEALTH OF YELLOWSTONE COUNTY: (1) THE COMMUNITY HEALTH SURVEY [PRIMARY QUANTITATIVE DATA]; (2) EXISTING DATA [SECONDARY QUANTITATIVE DATA]; AND (3) ONLINE KEY INFORMANT DATA [PRIMARY QUALITATIVE DATA]. THE COMMUNITY HEALTH SURVEY DEVELOPED FOR THIS STUDY GIVES US A COMPLETE AND TIMELY VIEW OF THE HEALTH STATUS AND BEHAVIORS OF AREA RESIDENTS THROUGH A RANDOMIZED TELEPHONE SURVEY OF 400 YELLOWSTONE COUNTY ADULTS. ALL ADMINISTRATION OF THE SURVEYS, DATA COLLECTION AND DATA ANALYSIS WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). THE SAMPLE DRAWN FOR THIS SURVEY IS REPRESENTATIVE OF THE ADULT YELLOWSTONE COUNTY POPULATION IN TERMS OF DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, AS WELL AS GEOGRAPHICAL LOCATION. THE MAXIMUM ERROR RATE ASSOCIATED WITH THE TOTAL SAMPLE OF 400 IS 4.9% AT THE 95 PERCENT LEVEL OF CONFIDENCE. EXISTING VITAL STATISTICS AND OTHER DATA ARE INCORPORATED INTO THIS ASSESSMENT FOR YELLOWSTONE COUNTY. COMPARISONS ARE ALSO MADE, WHERE AVAILABLE, TO STATE AND NATIONAL BENCHMARKS. FURTHERMORE, WHEREVER POSSIBLE, HEALTH PROMOTION GOALS OUTLINED IN HEALTHY PEOPLE 2020 ARE INCLUDED. TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED AS PART OF THIS PROCESS. 194 PARTICIPANTS INCLUDED HEALTHCARE PROVIDERS, PUBLIC HEALTH REPRESENTATIVES, GOVERNMENT REPRESENTATIVES, EDUCATORS, BUSINESS LEADERS, AND A VARIETY OF OTHER COMMUNITY LEADERS AND COMMUNITY MEMBERS. Schedule H, Part V, Section B, Line 6a THE MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN 2016-2017 WITH THE FINAL REPORT RELEASED IN 2017. THE ENTIRE CHNA WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS (PRC). BILLINGS CLINIC'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN A PRE-EXISTING COMMUNITY HEALTH PARTNERSHIP CALLED "THE ALLIANCE" WITH ST. VINCENT HEALTHCARE (HOSPITAL ORGANIZATION) AND RIVERSTONE HEALTH (PUBLIC HEALTH DEPARTMENT FOR CITY AND COUNTY). THE ALLIANCE ALSO CONDUCTED A CHNA IN 2006, 2011 AND 2014. Schedule H, Part V, Line 11 BILLINGS CLINIC HAS STARTED TO ADDRESS THE NEEDS THAT WE HAVE THE RESOURCES TO ADDRESS. THE OBJECTIVE OF BILLINGS CLINIC'S COMMUNITY BENEFIT PLAN FOR THE NEXT SEVERAL YEARS IS TO ALIGN, ENHANCE AND DEVELOP PROGRAMS BASED ON A SET OF CRITERIA ESTABLISHED BY OUR COMMUNITY HEALTH IMPROVEMENT COMMITTEE. AT THIS TIME, BILLINGS CLINIC DOES NOT HAVE THE RESOURCES NECESSARY TO ADDRESS ALL NEEDS, INCLUDING LACK OF TRANSPORTATION (ONLY AVAILABLE DURING WEEKDAYS ON A LIMITED BASIS); ACCESS TO DENTAL CARE (WE DO NOT OFFER DENTAL SERVICES); AVAILABILTY OF SUBSTANCE ABUSE TREATMENT (LIMITED).IN SOME AREAS WE DON'T OFFER ANY SERVICES BUT DO ADVOCATE ON POLICY SUCH AS SEAT BELT USAGE, FIREARM SAFETY, AND LACK OF HEALTHCARE COVERAGE. Overview: Strategy 1 - Healthy Food Retail and Healthy Food Procurement Current Situation: While an individual can avoid physical activity by simply not doing it, daily consumption of food is a necessary part of survival. However, Yellowstone County residents experience several barriers to consuming healthy foods, including affordability and availability. What if your morning latte came with a side of fresh fruit or a simple salad? One key strategy for increasing access to healthy foods, such as fruits and vegetables, is to encourage our local food retailers and institutions to stock and promote these items. Activities selected below aim to increase the prevalence of healthy foods throughout our daily lives, so that the healthy choice is the easy choice. Strategy Description: There is strong evidence that a strategy focused on healthy food retail and healthy food procurement methods is an effective approach to improve healthy weight and increased consumption of nutritional foods. Retail environments and institutional meal offerings, including schools, workplaces, neighborhood convenience stores, and coffee shops, can each play a significant role in consumer food choices, for better or worse. This is especially true for residents of neighborhoods that lack access to full service grocery stores, who otherwise may find it easier to find junk food than fruits and vegetables. Examples of proven activities related to this strategy include increasing retail offerings to include nutritious options, intentional product placement and marketing of these foods, while de-emphasizing unhealthy products such as tobacco, alcohol, sugary drinks and other junk foods. Sources: ChangeLab Solutions, US Surgeon General, CDC Winnable Battles, Procurement - City Health Overview: Strategy 2 - Creating and Improving Access to Places, Parks, and Playgrounds for Physical Activity and Creating and Maintaining Safe Neighborhoods Current Situation: Yellowstone County and Billings have several beautiful parks and places for recreation. However, the ability to access these destinations without a car, and safety concerns related to some of these destinations are barriers to their enjoyment. One key strategy for promoting use of existing facilities, including parks and bikeways, is to normalize their use. Activities selected below promote the normalization of active transportation and parks to increase physical activity. The more this infrastructure is utilized, the safer and popular it becomes. Strategy Description: There is strong evidence that a strategy focused on creating and improving access to places for physical activity, maintaining safe neighborhoods, and improving access to parks and playgrounds is an effective approach to improve healthy weight and physical activity. Examples of proven activities related to this strategy include increased access to facilities such as walking trails and exercise spaces, joint and shared use agreements, Complete Streets policies, Complete Parks, safe routes to school and parks, and zoning that promotes accessibility and activity. Overview: Strategy 3 - Provide Space for Organized Activities that Encourage Social Participation and Inclusion Current Situation: Overweight and obese adults are more likely to report a number of adverse health conditions, including fair/poor overall health and fair/poor mental health. Yellowstone County residents are increasingly active, however, disparities persist among lower-income residents and seniors. Key informants noted a lack of supportive built environment that does not always support healthy living as a significant concern. Local senior service and mental health representatives believe identification and development of community gathering places would be beneficial to their respective clients as social isolation and inactivity are often interwoven. A key strategy to promote activity and social engagement is to enhance or create spaces that are welcoming and accessible to all, with organized activities and opportunities for social engagement. Strategy Description: The evidence states this is an effective strategy for improved weight and increased physical activity by creating safe, attractive opportunities for all residents to be active and engaged. Research shows that perceptions of poor safety, unwelcoming spaces, and inaccessibility are all barriers to activity and that social engagement is associated with better health outcomes. Schedule H, Part V, Section B, Line 16c Direct URL for Plain Language Summary: WWW.BILLINGSCLINIC.COM/FINASSIST Schedule H, Part V, Section B, Line 16i Translation of FAP for LEP Populations: Billings Clinic has considered the need for a plain language summary for those with limited english proficiency. We have translation of most languages available to patients through our MARTTI translation services, online or by phone translation for discussing and translating financial assistance materials. 15 BILLINGS CLINIC 1045 N 30TH STREET Billings MT 59101 Outpatient Clinic BILLINGS CLINIC MILES CITY 620 SOUTH HAYNES AVENUE MILES CITY MT 59301 Outpatient Clinic BILLINGS CLINIC HEIGHTS 760 WICKS LANE Billings MT 59105 Outpatient Clinic BOZEMAN OBGYN 925 HIGHLAND BLVD BOZEMAN MT 59715 OBSTETRICS & GYNECOLOGY Clinic BILLINGS CLINIC SURGERY CENTER 2929 TENTH AVENUE NORTH Billings MT 59101 OUTPATIENT SURGERY Center BILLINGS CLINIC WEST 2675 CENTRAL AVENUE Billings MT 59102 Outpatient Clinic BEHAVIORAL HEALTH CENTER 1020 NORTH 27TH STREET 4TH FL Billings MT 59101 OUTPATIENT MENTAL HEALTH Center ASPEN MEADOWS 3155 AVENUE C Billings MT 59102 LONG TERM CARE FACILITY And Assisted living BILLINGS CLINIC CODY 201 YELLOWSTONE AVENUE CODY WY 92414 Outpatient Clinic BILLINGS CLINIC CANCER CENTER 801 NORTH 29TH STREET Billings MT 59101 CANCER CARE, INFUSION, Radiation Oncology Psychiatric Center 1020 North 27th Street Billings MT 59101 Inpatient Psychiatric Center Home Oxygen 801 N 27th Street Billings MT 59101 Durable Medical Equipment Livingston Home Oxygen 1201 US HWY 10 West Livingston MT 59047 Durable Medical Equipment Bozeman Pediatrics 1819 S 22nd Street Bozeman MT 59715 Pediatric Outpatient Center Billings Clinic Orthopedics 2702 8th Avenue North Billings MT 59101 Orthopedics and Sports Medicine Schedule H, part I, Line 6a Related Organization annual Community benefit report: STILLWATER COMMUNITY HOSPITAL, A RELATED CRITICAL ACCESS HOSPITAL, PREPARES THIER OWN INDEPENDENT COMMUNITY BENEFIT REPORT. Schedule H, Part I, Line 7 Costing methodology: THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. BILLINGS CLINIC USED THE SAME COST-TO-CHARGE RATIO THROUGHOUT THE ENTIRE SCHEDULE TO DETERMINE THE COST OF THOSE ACTIVITIES. Schedule H, Part I, Line 7, Column (F) Bad Debt Expense: BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25 BUT EXCLUDED FOR PURPOSES OF CALCULATING PERCENTAGES IN THIS COLUMN EQUAL $23,958,950. Schedule H, Part I, Line 7g Subsidized health service costs: SUBSIDIZED HEALTH SERVICES INCLUDES VARIOUS PHYSICIAN CLINICS IN ORDER TO BETTER SERVE THE MONTANA AREAS. MANY CRITICAL SERVICES WERE NOT FULLY REIMBURSED SUCH AS BEHAVIORAL HEALTH, PEDIATRIC SPECIALTIES, SEXUAL ASSAULT NURSE EXAMINATION AND RURAL OUTREACH CLINICS. PRIMARY CARE CLINICS WERE ONLY INCLUDED IF THEY WERE IN RURAL, UNDERSERVED AREAS OUTSIDE OUR PRIMARY SERVICE AREA. TOTAL COSTS FOR THE SUBSIDIZED SERVICES WERE $40,689,695 AND NET COMMUNITY BENEFIT OF THOSE SERVICES WAS DETERMINED TO BE $9,151,817. Schedule H, Part II Community Building Activities: BILLINGS CLINICS COMMUNITY BUILDING ACTIVITIES INCLUDE DISASTER PLANNING, ADVOCACY FOR PATIENT CARE, HEALTH CARE AND COMMUNITY HEALTH; SCIENCE EXPO FOR WORKFORCE DEVELOPMENT; AND THE RECENT STATE OF MONTANA COMMUNITY BENEFIT ASSESSMENT. THE ASSESSMENT FUNDS WERE USED TO IMPLEMENT EARLY CHILDHOOD (PRE-KINDERGARTEN) EDUCATION PROGRAMS FOR UNDERSERVED FAMILIES AROUND THE STATE. Schedule H, Part III, Section A, Line 2 Bad Debt Expense Methodology: THE ORGANIZATION 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 BAD DEBTS. Schedule H, Part III, Section A, Line 3 Bad Debt as community benefit: THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. Schedule H, Part III, Section A, Line 4 Bad debt expense in Financial statements: See page 12 of the attached audited financial statements for the footnote describing bad debt expense. Schedule H, Part III, Section B, Line 8 Allowable Medicare Costing Methodology: BILLINGS CLINIC ESTIMATES THAT 45 PERCENT OF BILLINGS CLINIC'S MEDICARE SHORTFALLS SHOULD BE COUNTED AS COMMUNITY BENEFIT. OUR RATIONALE IS THAT 45 PERCENT IS THE BEST ESTIMATE OF THE PERCENTAGE OF MONTANA'S MEDICARE POPULATION (65 AND OLDER) WHO ARE AT OR BELOW 200% OF FEDERAL POVERTY LEVEL, BASED ON MEDICARE AND U.S. CENSUS DATA, AND THOSE PATIENTS WOULD QUALIFY FOR FULL FINANCIAL ASSISTANCE. A HIGHER PERCENTAGE WOULD QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE WITH INCOMES FROM 200-400 PERCENT OF FEDERAL POVERTY LEVEL. FOR THE CALCULATION OF THE UNREIMBURESED COST OF MEDICARE A RATIO OF PATIENT COST-TO-CHARGES USING WORKSHEET 2 WAS UTILIZED AND APPLIED TO GROSS MEDICARE CHARGES. WE DO NOT USE THE MEDICARE COST REPORT FOR THIS NUMBER. THE COST REPORT ONLY CAPTURES REVENUE RELATED TO THE FACILITY AND DOES NOT CAPTURE REVENUE/LOSSES RELATED TO CLINICAL PROFESSIONAL SERVICES, WHICH ARE A SUBSTANTIAL PORTION OF MEDICARE SHORTFALLS. Schedule H, Part III, Section B, Line 9b Collection Practices: BILLINGS CLINIC HAD A FORMAL, WRITTEN POLICY IN TAX YEAR 2016, (OHA-205 "PATIENT FINANCIAL SERVICES"). WE DID HAVE A COLLECTION PROCESS, WHICH WAS USED TO SCREEN PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO MAKING PAYMENT ARRANGEMENTS FOR CARE. THE POLICY APPILES EQUALLY TO ALL PATIENTS - INSURED, UNDER-INSURED AND UNINSURED. ONCE A DETERMINATION HAS BEEN MADE AND ADJUSTMENTS APPLIED TO THE ACCOUNT BALANCE, ANY REMAINING BALANCE WOULD FALL INTO THE REGULAR GUIDELINES OF COLLECTION, GIVING PATIENTS FINANCING OPTIONS THAT WILL WORK WITHIN THEIR MONTHLY BUDGET. PATIENTS WHO CANNOT MEET THE REQUIREMENTS OF A PAYMENT ARRANGEMENT SHOULD APPLY FOR FINANCIAL ASSISTANCE. IF THEY DONT QUALIFY FOR FINANCIAL ASSISTANCE, THEY WILL BE OFFERED INTEREST-FREE PAYMENT PLANS FOR 12 MONTHS AND THEN A LOAN. Schedule H, Part VI, Line 2 Needs Assessment: SINCE 1994, BILLINGS CLINIC, RIVERSTONE HEALTH AND ST. VINCENT HEALTHCARE HAVE BEEN WORKING TOGETHER AS THE ALLIANCE, CREATING AND SUSTAINING INNOVATIVE PROGRAMS THAT ADDRESS COMPLEX COMMUNITY-WIDE HEALTH ISSUES. RIVERSTONE HEALTH IS THE PUBLIC HEALTH DEPARTMENT FOR THE YELLOWSTONE COUNTY AND ST. VINCENT HEALTHCARE IS A 501(C)(3) HEALTHCARE ENTITY ALSO SERVING THE BILLINGS AREA. Schedule H, Part VI, Line 3 Patient Education of eligibility assistance: ALL PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE. INFORMATIONAL BROCHURES WITH ONE-PAGE PLAIN LANGUAGE SUMMARY AND APPLICATION FORMS ARE AVAILABLE AT REGISTRATION DESKS IN THE CLINIC AND THE HOSPITAL, THE EMERGENCY DEPARTMENT DISCHARGE DESK, AND ON OUR WEBSITE AT WWW.BILLINGSCLINIC.COM/FINASSIST. OUR WEBPAGE INCLUDES THE FULL FINANCIAL ASSISTANCE POLICY. PATIENTS CAN ALSO CALL A DIRECT LINE TO TALK TO A PATIENT FINANCIAL REPRESENTATIVE. INFORMATION ABOUT FINANCIAL ASSISTANCE IS PRINTED ON THE BACK OF PATIENT BILLS. PATIENTS HOSPITALIZED WITHOUT IDENTIFIYING A THIRD PARTY PAYER SOURCE ARE SCREENED FOR COVERAGE/ASSISTANCE (DISABILITY, MEDICAID, VETERANS ADMINSTRATION, INDIAN HEALTH SERVICES AND WORKERS COMPENSATIONS). APPLICATIONS ARE MAILED TO PATIENTS WHOSE PAYMENT PATTERN INDICATES THAT THEY MAY NEED ASSISTANCE. PATIENT FINANCIAL SERVICES STAFF IS AVAILABLE TO HELP ANY PATIENT NEEDING ASSISTANCE COMPLETING AN APPLICATION. LANGUAGE TRANSLATION SERVICES ARE ALSO AVAILABLE. Schedule H, part VI, Line 4 Community Information: BILLINGS CLINIC IS BASED IN BILLINGS, MONTANA AND IS MONTANA'S LARGEST HEALTH CARE ORGANIZATION SERVING A VAST REGION COVERING MUCH OF MONTANA, WYOMING AND NORTH DAKOTA. BILLINGS CLINIC IS ONE OF MONTANA'S LARGEST EMPLOYERS WITH APPROXIATELY 4,300 EMPLOYEES INCLUDING MORE THAN 450 PHYSICIANCS AND ADVANCED PRACTITIONERS OFFERING MORE THAN 50 SPECIALTIES. COMMUNITY BENEFIT INCLUDES HEALTH CARE SERVICES PROVIDED AT BILLINGS CLINIC LOCATIONS, INCLUDING THE HOSPITAL, MAIN CLINIC, BRANCH CLINICS AND OUTREACH CLINICS. BILLINGS CLINIC SPECIALISTS PROVIDE 122 OUTREACH CLINICS PER MONTH AT 20 DIFFERENT REGIONAL LOCATIONS FOR THE RESIDENTS OF MONTANA, WYOMING AND NORTH DAKOTA. Schedule H, Part Vi, Line 5 Promotion of community health: As a not-for-profit community-governed organization, working with other organizations in the community to address the health care needs is an important part of our mission. Billings Clinic has been involved in meeting the needs of individuals and communities through cooperative efforts with other organizations in Yellowstone County and in our region. Community Health Collaboration Since 1994, Billings Clinic, RiverStone Health and St. Vincent Healthcare have been working together, creating and sustaining innovative programs that address complex community-wide health issues. Their purpose is to create sustained change in how our community responds to the challenge of the high cost of prescription drugs for the uninsured and the population lifestyle issues of obesity, poor nutrition and physical activity habits. These are examples of the past and future successes of the Alliance's efforts. Community Crisis Center - The Community Crisis Center (CCC), enhances access to behavioral health care in Billings.The CCC has successfully reduced inappropriate utilization of local emergency departments, decreased the number of short-term inpatient hospital admissions, and has been a driving force in reducing the inmate population at the Yellowstone County Detention Facility. Medication Assistance Program (MAP) - MAP helps patients afford the prescription drugs they need by connecting individuals with available patient assistance programs offering discounted or free prescription medication. MAP assists low income, uninsured or under insured people in getting the medications they need, but can't afford. Healthy by Design - To help recognize organizations in Yellowstone County committed to improving our community's health, Billings Clinic, RiverStone Health, and St. Vincent Healthcare launched a community health coalition called Healthy by Design. Healthy by Design encourages, recognizes, educates and creates a standard of excellence for promoting healthy lifestyles by encouraging active living and healthy choices that shape the future of the community. Schedule H, Part VI, Line 6 Affiliated Health Care System: Billings Clinic has an affiliated relationship with Beartooth Billings Clinic and Stillwater Hospital Association. Each Hospital is a Montana non-profit corporation. Beartooth and Stillwater have been affiliates of Billings Clinic since 2002 with a shared management agreement. Within the agreement Billings Clinic provides management, Digital information systems, and ancillary support services to area hospitals and clinics. The affiliation brings a stronger alignment within the group due to a desire to stabilize and enhance the level and scope of health care services available in each community. The affiliation allowed them to strengthen their commitment to quality, patient safety and service values. true Billings Clinic Foundation 2917 Tenth Avenue North Billings MT 59101 810407289 501(c)(3) 664355 Book Provide Employees To Support Operations Community Crisis Center 704 North 30th Street Billings MT 59101 203231164 501(c)(3) 67659 To Support Operations 2 Scholarships 90 37180 SCHEDULE I, PART I, LINE 2 Description of monitoring process for Scholarships and grants: BILLINGS CLINIC AWARDS SCHOLARSHIPS TO INDIVIDUALS WHO EXHIBIT A STRONG DESIRE AND POTENTIAL TO EXCEL IN THE HEALTHCARE FIELD. BILLINGS CLINIC ALSO PROVIDES GRANTS TO OTHER HEALTH RELATED ORGANIZATIONS. MONTHLY FINANCIAL REPORTS ARE REVIEWED AND SIGNED BY THE GRANT MANAGER, AND THEN SUBMITTED FOR APPROVAL OF THE DRAWING OF FUNDS FOR GRANTS X true true X X X X X false true false false false false false true false NICHOLAS J WOLTER CEO - Thru January 2017 731103 0 452763 0 35672 0 23275 0 8626 0 1251439 0 0 0 CLAYTON H MCCRACKEN III MD PHYSICIAN BOARD MEMBER 344539 0 0 0 5182 0 30632 0 24519 0 404872 0 0 0 ROBERT PUERINGER MD PHYSICIAN BOARD MEMBER 405735 0 0 0 2563 0 29414 0 22713 0 460425 0 0 0 CONNIE PREWITT CHIEF FINANCIAL OFFICER 477494 0 113003 0 47967 0 53275 0 20245 0 711984 0 0 0 Randall Gibb Interim CEO 552188 0 128644 0 13585 0 53275 0 20489 0 768181 0 0 0 Scott A Sample Physician 937039 0 0 0 4602 0 23275 0 27680 0 992596 0 0 0 Mark P Piedra Physician 869145 0 0 0 748 0 21910 0 11094 0 902897 0 0 0 Barry N Smith Physician 803193 0 29440 0 4602 0 23275 0 26372 0 886882 0 0 0 Jeffry O Lindenbaum Physician 800060 0 16278 0 5599 0 23275 0 26992 0 872204 0 0 0 Jared J Lund Physician 771461 0 20000 0 3954 0 23275 0 28246 0 846936 0 0 0 Darrell Ehrlick Former Board Member 29344 29344 29344 Linda Overstreet Former Board Member 13129 13129 13129 Schedule J, part i, Line 1a Description of Charter Travel and travel for COmpanions: Charter travel were provided for Nicholas Wolter, Randall Gibb, Connie Prewitt & Frank Reed. The travel was for board meetings and state legislation related travels. The travel for this purpose was treated as a business expense. Travel for companions was provided for the board members. Any travel for companions was included in a 1099 to the board memeber. Schedule J, Part I, Line 4b Description of Non-qualified retirement plan: The billings clinic supplemental retirement agreement for senior executives (SERP) is a non-elective 457(f) agreement and provides for annual deferrals, which become vested and payable after 4 years. the following individuals are participants in the plan during the 2016 calendar year which is included in deferred compensation on Schedule J, part II, Column C: Connie Prewitt - 30,000 Randall Gibb - 30,000 The Following Individuals received a payment during the 2016 calendar year which is included in other reportable compensation on Schedule J, Part II, Column B: Connie Prewitt - 39,741 Schedule J, Part I, Line 7 Description of non-fixed payments: The board of directors annually determines the incentive plan amount for the CEO and the Senior executive team based on an external compensation study. The availability of the incentive is awarded based on financial performance as well as organizational performance measurements in qualtiy, patient satisfaction, employee satisfaction and the individual goals set each year if the target is triggered. The incentive is paid only if triggered following the financial audit presentation. A MONTANA FACiLITY FINANCE AUTHority 364615155 612043FL8 2008-05-30 60000000 CAPITAL PROJECTS true false false B Montana Facility Finance Authority 364615155 61204MAA5 2011-08-24 140000000 CAPITAL PROJECTS, REFUND 2008 BOND false false false A 35480000 0 60000000 3605872 0 0 1200000 0 0 55194128 0 0 2009 false false true true B 15345000 0 140124100 0 0 0 858750 0 0 54703676 84561674 0 2014 true false false true A false false false 0 false false false true B false false false 0 false false false true A false false false true false false 0 false 0 false true B false true false false true false 0 false 0 false true A true B true AARON SPARBOE See Part V 679208 RENT false Schedule L, Part IV Relationship Between Interested Person & the Organization: Line 1, Column B - Aaron Sparboe, is a former board member of billings clinic within the last five years and rents two clinics to the organization. From 990, Part III, Line 3 Discontinued Program Service: BILLINGS CLINIC SOLD ASPEN MEADOWS SKILLED NURSING AND ASSISTED LIVING CENTER ON JUNE 30, 2017. Form 990, Part VI, Section A, Line 2 Business or Family Transaction: NICHOLAS WOLTER, CONNIE PREWITT, JOY OTT, AND Randall Gibb HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE DIRECTORS OR OFFICERS OF THE SUBSIDIARY New West DISCLOSED ON SCHEDULE R, PART IV. Form 990, Part VI, Section B, line 11b Process to review 990: THE 990 REVIEW IS COMPLETED BEFORE THE RETURN IS FILED. IT IS REVIEWED BY THE CFO AND THEN THE BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 12c Process to monitor conflict of interest: THE GOVERNANCE AND NOMINATING COMMITTEE OF THE BOARD OF DIRECTORS, ACCORDING TO THEIR CHARTER, REVIEW ANNUALLY THE DISCLOSURE STATEMENTS OF THE BOARD OF DIRECTORS AND SENIOR EXECUTIVES AND TAKE ACTIONS TO RESOLVE CONFLICTS. A CONFLICT OF INTEREST REVIEW PANEL, CHAIRED BY THE COMPLIANCE OFFICER, AS OUTLINED IN THE ORGANIZATIONAL POLICY, IS RESPONSIBLE FOR REVIEWING DISCLOSED CONFLICTS AND APPROVING NECESSARY CONFLICT MANAGEMENT PLANS OF ALL OTHER INTERESTED PERSONS AT BILLINGS CLINIC. Form 990, Part VI, Section B, line 15a & 15b Process to Determine CEO Compensation: BILLINGS CLINIC HAS AN EXECUTIVE COMPENSATION PROGRAM ADMINISTERED Annualy BY INDEPENDENT TRUSTEES FOLLOWING BEST PRACTICES AND THE HIGHEST REGULATORY STANDARDS EXPECTED OF A NOT-FOR-PROFIT ORGANIZATION. THEY FOLLOW BOARD APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY WHICH DEFINES THE MARKET AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. THEY LOOK AT RELEVANT MARKET DATA OF SIMILAR ROLES IN SIMILAR ORGANIZATIONS. ANNUAL DISCLOSURE OF THE COMMITTEE'S ACTIONS AND DECISIONS TO THE FULL BOARD IS REQUIRED. Form 990, Part VI, Section C, line 19 Describe how Governing documents are made available to the public: Billings Clinic makes its governing documents, conflict of interest policy and financial statements available to the public on an as needed basis. Form 990, Part XI, Line 9 Other Changes in Net Assets: Change in Fair Value of INterest Rate Swap 8,335,437 Change in Interest of Affiliates (4,306,028) Total 4,029,409 MONTANA HEALTHCARE INDEMNITY LLC 2800 TENTH AVENUE NORTH Billings MT 59101 810231784 INSUR CAPTIVE MT 5018500 13343940 BILLINGS CLI BILLINGS CLINIC FOUNDATION 2917 TENTH AVENUE NORTH BILLINGS MT 59101 810407289 FUNDRAISING MT 501(C)(3) 7 BILLINGS CLI true STILLWATER HOSPITAL ASSOCIATION 710 N 11TH STREET Columbus MT 59019 810286525 HOSPITAL MT 501(C)(3) 3 BILLINGS CLI true NEW WEST HEALTH SERVICES 130 NEILL AVENUE Helena MT 59601 841418136 INSURANCE SALES MT BILLINGS CLINIC C Corp 20897549 2712750 0.35000 true BILLINGS CLINIC EXPRESS CARE 2800 TENTH AVENUE NORTH BILLINGS MT 59101 463355499 OUTPATIENT CLINIC MT BILLINGS CLINIC C CORP -762421 561556 1.00000 true false false true true true false false false false false false true true true true true true true true Billings Clinic Foundation C 8616665 INTERCO AMOUNT New West Health Services D 42367660 INTERCO AMOUNT Billings Clinic FOundation D 364628 Interco Amount Stillwater Hospital Association D 280934 Interco Amount Billings Clinic Express Care D 3831342 Interco Amount Stillwater Hospital Association E 108081 Interco Amount Stillwater Hospital Association L 1780398 InterCo Amount New West Health Services M 9374558 INterCo Amount New West Health Services M 10303337 Interco Amount