2018-11-12T15:30:45-06:00 2017-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-01-01 474717998 Bozeman Health Deaconess Hospital BOZE 4064145000 915 Highland Blvd Bozeman MT 59715 Brad Ludford Current CFO 4064145000 2018-11-06 1 Kim Hunwardsen CPA P00484560 6122536500 2018-11-06 72.175.213.18 2018-11-06 15:02:06 MS P B1517DAAED479AA3B0236E79C14EA2E11B9BE589 B602D594AFD2B0B327E07A06F36CA6A7E42546D0 2017 2019-02-21 02:37:17Z John Hill 915 Highland Blvd Bozeman MT 59715 304825749 0 X www.bozemanhealth.org X 2015 MT To improve community health and quality of life for residents and visitors of Southwest Montana. 12 11 2055 281 996551 -151754 1292727 1547864 261374289 292255233 1049017 9463267 465897 676233 264181930 303942597 60000 0 0 0 81429704 87968965 0 0 0 173581261 193566443 255070965 281535408 9110965 22407189 342535998 364510562 91037890 84511597 251498108 279998965 X To improve community health and quality of life. 0 0 80690496 72907325 The Bozeman Health Deaconess Hospital clinics consists of our departments that provide physician services to outpatients. The number of Medicare and Medicaid patients seen increased by about 15% from 2016 to 2017. Revenue for these patients totaled 53% of all clinic revenue. Total net operating revenues were $73,033,392 with associated operating expenses of $80,690,496. The loss of $7,657,104 is reflective of our commitment to provide access to all patients regardless of their ability to pay. 30241834 93132976 Bozeman Health Deaconess Hospital's Surgical Services strives to offer a wide array of surgical options using state of the art technology. Of the 8,956 inpatient and outpatient surgeries, about 48% were Medicare and Medicaid patients, which comprised 52% ($48,183,530) of total revenue from these services ($93,132,976). Over 60% of the Medicare/Medicaid revenues were unreimbursed ($29,187,625) and written off, along with another $7,305,644 from other payors. Our surgical services also recorded $25,514,734 in operating expenses plus another $4,727,100 of indirect overhead. 12199707 22794581 The Emergency Room at Bozeman Health Deaconess Hospital is one of the busiest departments in our organization, with just over 31,000 visits in 2017. Approximately 42% of these visits were from Medicare and Medicaid patients, comprising $10,421,395 of the $22,794,581 gross revenue. Over 62% of the Medicare/Medicaid revenue were unreimbursed ($6,500,713) and written off, along with 61% of the remaining revenue ($7,622,901). Direct and indirect expenses incurred in supporting the operation of this emergency room accumulated to $12,199,707. 118734891 103293613 Bozeman Health Deaconess Hospital operates an 86 bed hospital facility (Hospital), along with a 43 unit assisted living home and a 115 unit independent living home (Hillcrest Senior Living or HSL). All patient and resident service revenue from these operations are used to provide health care services, health care promotion, and health care education to Bozeman and the surrounding communities. 118734891 103293613 241866928 1 1 0 0 0 0 0 0 1 1 1 0 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 0 0 0 0 0 0 0 1 0 0 0 1 248 0 1 2055 1 1 1 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 X Carrie Morasko 4064141036 915 Highland Blvd Bozeman MT 59715 Brian Brown - 1st Vice Chair (Jan-June)/Chair (July-Dec) 1.00 1.00 X X 0 0 0 Julie Jackson Chair (Jan-June) 1.00 1.00 X X 0 0 0 Katie Daughenbaugh - 2nd Vice Chair (Jan-Jun)/1st V.C. (July-Dec) 1.00 1.00 X X 0 0 0 Dr Dane Sobek - Cardiologist Sec. (Jan-June)/2nd V.C. (July-Dec) 1.00 50.00 X X 0 629591 66871 Robert Watson - Director (Jan-June)/Secretary (July-Dec) 1.00 1.00 X X 0 0 0 Dennis Munson Treasurer 1.00 1.00 X X 0 0 0 Kerri Brown Director 1.00 1.00 X 0 0 0 Peter Buerhaus Director (July-Dec) 1.00 1.00 X 0 0 0 Jerry Cashman Director 1.00 1.00 X 0 0 0 Rev Dave McConnell Director 1.00 1.00 X 0 0 0 Kerry Petitt Director 1.00 1.00 X 0 0 0 Walt Sales Director 1.00 1.00 X 0 0 0 John Hill CEO 15.00 35.00 X 0 573117 40442 Gordon Davidson CFO 35.00 15.00 X 0 418121 66485 LeRoy Wilson VP Senior Services 50.00 0.00 X 164919 0 39622 Mike Bertagnolli Pharmacy Director 50.00 0.00 X 184689 0 36629 Alan Brayton Pharmacy Supervisor 50.00 0.00 X 165528 0 32294 Rebecca Miller Pharmacy Informatics Specialist 50.00 0.00 X 142582 0 35333 James Wiley Physician Assistant 50.00 0.00 X 145087 0 34041 802805 1620829 351717 54 0 1 0 Montana Linen Supply LLC 20900 E Frontage Rd Ste A Belgrade MT 59730 Linen Cleaning 948409 Montana Surgical Clinic PLLC 905 Highland Blvd Ste 4450 Bozeman MT 59715 Physician Services 883144 Microsoft Licensing One Microsoft Way Redmond WA 98052 Software Licensing 678093 Sequoia Construction 2976 Oliver St Bozeman MT 59718 Construction Contractor Services 393233 Bridger Orthopedic & Sports 1450 Ellis St Ste 201 Bozeman MT 59715 Physician Services 347667 10 1547864 1547864 Net Patient Revenue 622110 284575424 284575424 Pharmacy Revenue 446110 2246744 1966367 280377 Cafeteria Revenue 722210 1854475 1848613 5862 3578590 2868278 710312 292255233 5491135 5491135 1456250 780017 676233 676233 676233 4075267 0 103135 4075267 -103135 3972132 3972132 303942597 291258682 996551 10139500 X 69580903 62380706 7200197 3065594 2747188 318406 10093539 9045179 1048360 5228929 4685829 543100 672913 672913 96812795 74812975 21999820 451826 179226 272600 3719647 1334806 2384841 2584994 476196 2108798 324421 304922 19499 216280 203281 12999 2365951 2365951 12718661 12718661 903112 800791 102321 Medical Supplies 55979565 55940038 39527 Provision for Bad Debts 9059871 9059871 Equipment Rental and Ma 5813547 4426272 1387275 Taxes and Licenses 1640157 113222 1526935 302703 271814 30889 281535408 241866928 39668480 0 28014308 36142258 39900089 42857721 7533366 7323283 775520 842448 275659518 146842400 133776806 128817118 118710946 131112638 12993 2915 2209240 1798133 1798133 12013837 13404808 342535998 364510562 20404748 17390809 728461 915904 36772878 34242024 7591059 7724537 20950000 20491721 4590744 3746602 91037890 84511597 X 242488292 269469271 7001740 8298537 2008076 2231157 251498108 279998965 342535998 364510562 X 22407189 5677939 415729 X 0 1 X 1 0 X 0 1 X 14747913 223082 2235283 377878 16828400 13928221 122889 843418 146615 14747913 0.73000 0.14530 0.12470 0 1 1 2972690 2972690 191004530 96429862 94574668 54078 44060 10018 78288746 49880019 28408727 3339474 488459 2851015 128817118 Estimated Payments to Third Party Payors 240000 Due to Affiliates 3506602 3746602 X Part IV, Line 2b: The organization holds resident funds on behalf of its residents, as well as security deposits. Part V, Line 4: Each endowment fund is privy to a separate agreement. Donations made for each purpose shall be received, held, and invested by Bozeman Health Foundation according to established policies governing gift acceptance, investment, and distribution. The principal of the fund shall be retained in perpetuity. The interest income is utilized for the greatest needs of the designated department. Policy says the organization can use a portion of interest for operations. The endowment fund reported in Line 1 is currently being held by a related organization, Bozeman Health Foundation, and benefits Bozeman Health and related system entities listed on Schedule R. Due to this relationship the endowment fund is being reported all the Form 990, Schedule D, Part V for all three related entities. Part X, Line 2: The Organization is a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Organization is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 1 1 0 1 1 3996375 2007867 1988508 0.00730 27393004 20349694 7043310 0.02580 31389379 22357561 9031818 0.03310 251292 139340 111952 0.00040 28539 28539 0.00010 41736159 28502838 13233321 0.04860 130476 130476 0.00050 42146466 28642178 13504288 0.04960 73535845 50999739 22536106 0.08270 1842 1842 0.00000 1842 1842 0.00000 1 9059871 0 42805055 52432629 -9627574 X 1 1 1 1 Bozeman Health Deaconess Hospital 915 Highland Blvd Bozeman MT 59715 www.bozemanhealth.org 12933 X X X Bozeman Health Deaconess Hospital 1 1 1 1 X X X X X X X X X 17 1 1 1 1 X See Part V, Section B, Line 7d X 1 17 1 See Part V, Section B, Line 7d 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X https://www.bozemanhealth.org/For-Patients-Visitors/Financial-Services X https://www.bozemanhealth.org/For-Patients-Visitors/Financial-Services X https://www.bozemanhealth.org/For-Patients-Visitors/Financial-Services X X X X X X X 1 X 0 X X X X 1 X 0 1 Bozeman Health Deaconess Hospital Part V, Section B, Line 5: To solicit feedback from key community stakeholders, we utilized an Online Key Informant Survey and collected responses in March and April of 2017. We asked the Key Informants to rate the degree to which various health issues are a problem in their community. Follow-up questions asked them to describe why they identify problem areas as such, and how theses might be better addressed. In total, we invited 284 Key Informants via email including physicians and advanced practice clinicians, public and community health representatives, health professionals, social service providers, and community leaders to participate. Of the 284 invited, 114 participated. The following is a full list of participating organizations:o Alcohol and Drug Services of Gallatin County o American Indian Student Support Services o AWARE o Belgrade School District o Big Sky Community Food Bank o Big Sky Fire Department o Big Sky Medical Center o Big Sky School District o Big Sky Youth Empowerment o Billings Clinic Acorn Pediatrics o Bozeman Health o Bozeman Health Clinic o Bozeman Health Deaconess Hospital o Bozeman Health Internal Medicine o Bozeman Health Urgent Care o Bozeman Parks and Recreation Department o Bozeman Police Department o Bozeman School District o Bridgercare o Brookdale Springmeadows o Cancer Support Community Montana o City of Belgrade o City of Bozeman o City of Three Forks o Community Health Partners o Community West Outreach o Cottonwood Case Management o Ennis School District o Gallatin City-County Health Department o Gallatin County Commission o Gallatin County Detention Center o Gallatin County Government o Gallatin Early Childhood Community Council o Gallatin Valley Farm to School COMMUNITY HEALTH NEEDS ASSESSMENT 16 o Gallatin Valley Land Trust o Greater Gallatin United Way o HAVEN o Headwaters Area Food Bank o Help Center 211 o Highgate Senior Living o Hospice of Bozeman Health Frontier Home Health o Human Resource Development Council o LaMotte School District o Livingston Food Resource Center o Madison County o Madison County Public Health Department o Madison County Senior Care o Madison Valley Medical Center o Manhattan School District o Mint Dental Studio o Monforton School District o Montana Independent Living Project o Montana Nutrition and Physical Activity Program o Montana State University o NAMI o Park County o Park County Community Foundation o Park County Government o Park County Public Health Department o Park County Sheriff's Office o Park County Superintendent of Schools o Shields Valley School District o SNAP-Education Program o Sprout Oral Health o The Community Cafe o Thrive o Town of West Yellowstone o West Yellowstone Police Department o West Yellowstone School o West Yellowstone Social Services o Willing Workers Ladies Aid o YMCA o Youth Dynamics o ZoeCareInput was gathered from several individuals whose organizations work with low-income, minority populations, or other medically underserved populations. These populations include: abused children, African-Americans, Arabs, children, construction laborers, crime victims, disabled, domestic violence victims, elderly, English as a second language, geographic barriers, Head Start participants, high school dropouts, Hispanics, HIV patients, HMK (Healthy Montana Kids) patients, homeless, immigrants, international students and families, LGBT, low-income, Medicare/Medicaid, mentally ill, migrant workers, minority students, Native Americans, non-English speaking, nursing home residents, pre-release clients, recent arrivals to the community, rural population, seasonal workers, service workers, students, substance abusers, teenagers, undocumented immigrants, uneducated, unemployed, uninsured/underinsured, veterans, women Bozeman Health Deaconess Hospital Part V, Section B, Line 6a: Bozeman Health Big Sky Medical Center, LLC Bozeman Health Deaconess Hospital Part V, Section B, Line 6b: Community Health Partners (CHP)Gallatin City-County Health Department Bozeman Health Deaconess Hospital Part V, Section B, Line 7d: CHNA:https://www.bozemanhealth.org/documents/Reports/2017_PRC_CHNA_Report_BHDH.pdfImplementation Strategy:https://www.bozemanhealth.org/documents/Content/2018.2020_BHDH_CBSP_FINAL.pdf Bozeman Health Deaconess Hospital Part V, Section B, Line 2: Bozeman Health Deaconess Hospital is a new tax-exempt corporation with operations beginning 1/1/16. It is formed under the Bozeman Health system umbrella. Bozeman Health Deaconess Hospital Part V, Section B, Line 11: Based on the CHNA and community / stakeholder input, BHDH adopted the following priority areas:1. Behavioral Health (Mental Health + Substance Abuse)2. Access to Health Services 3. Healthy Lifestyles (Nutrition, Physical Activity & Weight + Heart Disease & Stroke)4. Injury & Violence Although the CHNA was conducted and approved in 2017, the resulting implantation strategy will not be approved and implemented until early 2018. Within the above priority areas, BHDH plans to actively work to achieve the following over the next few years:1.1 Develop, refine and implement a system-wide Bozeman Health BehavioralHealth Strategic Plan1.2 Increase community education initiatives1.3 Strengthen community capacity and collaboration1.4 Implement evidence-based suicide prevention strategies targeting youth1.5 Reduce use and exposure of tobacco among youth and adults2.1 Grow the HealthCare Connections mobile outreach program2.2 Increase the number of people reached through community health events2.3 Collaborate with community to provide access to health related resources, expand health literacy efforts, and increase health education opportunities2.4 Explore and address barriers faced by minority and medically underserved populations2.5 Grow the Telehealth program3.1 Expand nutrition and physical activity opportunities and access to educational programs for children, youth, and families3.2 Continue to foster, promote and support community and workplace initiatives3.3 Increase stroke education initiatives targeting adults, youth, and community4.1 Promote personal - protective behaviors, including safe motor vehicle practices4.2 Explore and implement evidence-based fall prevention programs4.3 Work with community organizations and coalitions to shift social norms about the acceptability and experience of violence, including domestic and sexual violenceRationale for Unaddressed Needs: Several of the community-prioritized needs were not selected as BHDH priority areas. In order to best impact health outcomes, BHDH focused on prioritizing health issues for which there are existing internal and/or external resources and feasibility to affect change. Additionally, in recognition of comorbidities, and in a strategic effort to consolidate, many of the community-prioritized needs will be addressed thorough BHDH priority area strategies, programs, and efforts: Diabetes: decreasing both incidence and prevalence will be addressed under the area of Healthy Lifestyles Cancer: screenings for certain cancers will remain a key strategy under the area of Access to Health ServicesTobacco Use: decreasing tobacco use will be a focus under the area of Behavioral Health Potentially Disabling Conditions: many disabling conditions occur with other chronic conditions such as diabetes, heart disease, and obesity. As such, strategies addressing these conditions will appear under the area of Healthy Lifestyles. Respiratory Disease: BHDH providers are currently engaged in providing care in this area. We will continually assess and be responsive to opportunities to expand programming and/or outreach. Bozeman Health Deaconess Hospital Part V, Section B, Line 13h: Any individual and their dependents who are at 150% of the Federal Poverty income level or below will be eligible to receive a 100% write-off of the self-pay portion of incurred charges, upon completion of an application. Completion of the Financial Assistance application will be required. Catastrophic Financial Assistance is available to individuals who have a large balance remaining after all third party payments have been taken into account. The balance under consideration is that amount which is deemed to be the patient's financial responsibility. If such responsibility is greater than 50% of the family's annual household income, the excess amount will be treated as Catastrophic Financial Assistance and written off of the patient's account. This assistance is available without respect to the FPG, but they must follow the same process as all other patients seeking financial assistance based upon FPG. Asset tests are not used for determining any level of financial assistance. Prior to providing services, BH will make an effort to notify the patient regarding their eligibility for financial assistance. Bozeman Health Deaconess Hospital Part V, Section B, Line 16j: Medical Advocacy Services in Healthcare (MASH) will give out our financial application after determining patient is ineligible for federal and state programs.A summary of the financial assistance policy is attached to billing invoices, posted in patient admissions area, and provided to patient on admission to the hospital facility. Bozeman Health Deaconess Hospital 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 billed gross charges on elective procedures. 3 1 - Hillcrest Senior Living 1201 Highland Blvd Bozeman MT 59715 Independent and assisted living facility 2 - Bozeman Health Belgrade Clinic 206 Alaska Frontage Rd Belgrade MT 59714 Ambulatory healthcare services 3 - Bozeman Health Clinical Research 950 Stoneridge Dr 1 Bozeman MT 59715 Outpatient healthcare research Part I, Line 3c: Any individual and their dependents who are at 150% of the Federal Poverty income level or below will be eligible to receive a 100% write-off of the self-pay portion of incurred charges, upon completion of an application. Completion of the Financial Assistance application will be required. Catastrophic Financial Assistance is available to individuals who have a large balance remaining after all third party payments have been taken into account. The balance under consideration is that amount which is deemed to be the patient's financial responsibility. If such responsibility is greater than 50% of the family's annual household income, the excess amount will be treated as Catastrophic Financial Assistance and written off of the patient's account. This assistance is available without respect to the FPG, but they must follow the same process as all other patients seeking financial assistance based upon FPG. Asset tests are not used for determining any level of financial assistance. Prior to providing services, BH will make an effort to notify the patient regarding their eligibility for financial assistance. Part I, Line 6a: The organization's community benefit report can be found on its website at https://www.bozemanhealth.org/About-Us/Community-Benefit.aspx Part I, Line 7: The cost to charge ratio from Worksheet 2 was used to obtain the costs related to Charity Care, Medicaid, and Other Means-Tested Programs. All net benefit expenses were calculated using direct costs and revenue with reasonable indirect overhead allocation methods. Benefits are allocated at 23% of payroll dollars. For Subsidized Services, other indirect overhead costs are allocated based on historical reasonableness of 15% of total expenses. Our internal system does record patient revenues based on type (inpatient vs. outpatient vs. emergency) and payor (Medicaid, Medicare, Commercial, Self-Pay, etc.). Related costs are then determined based on the pro-rated share as a percentage of the total. For example, if Medicaid comprises 7% of a department's revenue, Medicaid expenses are calculated at 7% of the total as well. Part I, Line 7g: Amount of cost attributable to a physician clinic is $40,181,220. All costs associated with a provider-based clinic operational department were considered part of this total. 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 $ 9,059,871. Part II, Community Building Activities: BHDH is represented through participation in the Bozeman Kiwanis Club, an organization dedicated to community service and improving the holistic health of children. Part III, Line 2: Bad debt is reported at charges as recorded by the organization.Bad debt is reported based upon actual bad debt expense net of discounts and contractual adjustments, less recoveries. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expense is located in Footnote 1 on page 9 of the attached financial statements. Part III, Line 8: The entire amount of shortfall should be considered a community benefit.The Medicare shortfall represents a cost absorbed by the Hospital as a result of providing care to Medicare patients. The contract driving this loss is a nondiscretionary contract, as is providing the services to this population of individuals. The cost of providing this benefit to the community should be reportable as such. Part III, Line 9b: Bozeman Health's Financial Assistance Policy explains the patient notification practice that includes providing the patient, either directly or through its contracted collection agency with at least one written notice informing the patient about the Extraordinary Collection Actions that we intend to take if the patient does not submit an Application for Financial Assistance or pay the amount due by at least thirty days following the date of the notice. The notice will include a copy of the plain language summary and will not be mailed or delivered to a patient earlier than 30 days prior to the end of the Notification Period. No Extraordinary Collection Actions will be undertaken during the 120 day Notification Period, during which time we will take reasonable efforts to determine whether the patient is eligible for Financial Assistance. After the 120 day Notification Period, an Extraordinary Collection Action will be undertaken only if the patient has received the 30 day written notice described above. Extraordinary Collection Actions are defined as those actions that may be taken in the event of non-payment following the expiration of the notification period. These may include the reporting of adverse information about the individual to consumer credit reporting agencies or credit bureaus, garnishment of an individual's wages, and/or commencement of a legal civil action against an individual. As part of Bozeman Health collection practices, any patient account placed in collections will be pulled back from collections should that patient apply for financial assistance within 240 days of receiving their initial patient statement. Part VI, Line 2: In addition to the CHNA, Bozeman Health Deaconess Hospital (BHDH) assesses community health care needs in a number of ways. The Hospital sends representatives to community meetings and conversations related to health and heath care to hear directly from community members - patients, clients, stakeholders, etc. - about their needs. In a related fashion, the Hospital also convenes community members - patients, clients, stakeholders, etc. - to solicit feedback about health and health care needs. Finally, the Hospital looks at and considers 3rd party projections about health care needs and available local and national trend data when making health care delivery and health improvement decisions. Part VI, Line 3: Bozeman Health Deaconess Hospital (BHDH) is deeply committed to providing financial assistance to patients needing, but unable to afford, medically necessary health care services. BHDH posts notice of its Financial Assistance Policy in all admitting areas, as well as on the website. At the earliest feasible time, BHDH will attempt to determine whether a patient has third party coverage for any part of the hospital services provided. If a patient does not have third party coverage, a patient advocate from the Medical Advocacy Services in Healthcare (MASH) program will screen all inpatient cases and any outpatient cases exceeding $1,000 in total charges to determine if the patient qualifies for third party funding. If not, the patient advocate will explain the Financial Assistance Policy and give the patient an application if desired. In circumstances where payment in full will cause financial hardship that will significantly harm the patient or patient's family, the applicant may be asked to visit with Consumer Credit Counseling Services to further review their financial situations. Upon request, patients may be asked to complete an application for Medicaid participation or for coverage by other governmental payment programs. Patient bills also contain billing information explaining financial options and provide contact information to the appropriate resources. Part VI, Line 4: Bozeman Health Deaconess Hospital (BHDH) primarily serves Gallatin, Park, and Madison Counties. 86.6% of 2017 inpatient admissions were of patients originating from these three counties (Gallatin: 78.6%, Park 4.7%, and Madison 3.4%). The population of the tri-county region was an estimated 129,049 in 2017 (Truven Health Analytics). Bozeman (in Gallatin County) was listed in the 2016 ACS as a Micropolitan area whereas Belgrade (Gallatin County), Four Corners (Gallatin County), and Livingston (Park County) were listed as Urban Clusters in the 2010 Census. As of 2016, 5.9% of the families were below the poverty level in the tri-county region-ranging from 6.0% in Gallatin County to 4.7% in Park County and 7.0% in Madison County (2016 ACS 5yr estimates). Average per capita income was an estimated $30,924 in Gallatin County followed by Madison ($27,346) and Park ($27,346) (2016 ACS 5 Year Estimates). Estimates suggest that about 14.2% of residents in the tri-county area were insured by Medicaid, roughly 13.5% were insured by Medicare, and about 5.82% were uninsured in 2017 (Truven Health Analytics 2017). About 16.8% of BHDH inpatients were insured under Medicaid in 2017.BHDH's tri-county service area houses five hospitals-of which, three are critical access hospitals (CAH): Bozeman Health Deaconess Hospital (Bozeman, MT), Bozeman Health Big Sky Medical Center (Big Sky, MT), Livingston HealthCare-CAH (Livingston, MT), Madison Valley Medical Center-CAH (Ennis, MT), and Ruby Valley Hospital-CAH (Sheridan, MT).As listed on the MT DPPHS webpage, low income populations in Gallatin and Park Counties and total geographic populations in Madison County are designated Mental Health Care Health Professional Shortage Areas (HPSAs). Additionally, low income populations in Park and Madison Counties are designated Primary Care HPSAs (note Gallatin County is under review). (https://dphhs.mt.gov/publichealth/primarycare/-shortage-area-designations). Part VI, Line 5: As a sole community hospital, Bozeman Health Deaconess Hospital (BHDH) Services is committed to providing quality care and promoting health to the very community that supports us. Our governing body is represented by individuals of our community, with all but one being independent to our organization. To ensure immediate access to care, BHDH has an open medical staff and requires each medical staff member to care for anyone presenting a need for care in the Emergency Department. We also devote a significant amount of surplus funds to maintaining a high level of patient care through quality initiatives and technology investments.Various employees, physicians, administrators, and board members of the Hospital are actively involved in volunteer roles including community board positions in numerous other activities, groups, and organizations that actively promote the health of the community.In 2017, Bozeman Health hired a FTE dedicated to community involvement. The System Program Manager for Community Health Improvement and Partnerships works to align Bozeman Health Deaconess Hospital health improvement initiatives with the needs and desires of the communities served by BHDH. This includes, among other things, representing BHDH at community meetings, and planning and implementing programs with community partners to address needs highlighted in the CHNA. Part VI, Line 6: Bozeman Health Deaconess Hospital is a nonprofit public benefit corporation with a sole corporate member, Bozeman Deaconess Health Services d/b/a Bozeman Health. X X X 0 0 0 0 0 0 0 0 0 Dr Dane Sobek - Cardiologist Sec. (Jan-June)/2nd V.C. (July-Dec) 0 573370 0 55300 0 921 0 44676 0 23170 0 697437 0 0 John Hill CEO 0 510667 0 52083 0 10367 0 17993 0 23829 0 614939 0 0 Gordon Davidson CFO 0 317472 0 59071 0 41578 0 51190 0 16270 0 485581 0 0 LeRoy Wilson VP Senior Services 129660 0 25106 0 10153 0 21897 0 18345 0 205161 0 0 0 Mike Bertagnolli Pharmacy Director 167563 0 0 0 17126 0 11533 0 25824 0 222046 0 0 0 Alan Brayton Pharmacy Supervisor 151098 0 0 0 14430 0 10390 0 22477 0 198395 0 0 0 Rebecca Miller Pharmacy Informatics Specialist 139471 0 0 0 3111 0 9303 0 26502 0 178387 0 0 0 James Wiley Physician Assistant 137185 0 0 0 7902 0 9145 0 25331 0 179563 0 0 0 Part I, Line 3 The CEO is paid by Bozeman Deaconess Health Services, a related organization. The board of directors is the same for both organizations and they use the methods selected in Line 3 to determine the CEO compensation. A Montana Facility Finance Authority 364615155 61204EAH8 2010-04-22 6645000 Refinancing of 1998 bond debt issued 9/2/1998 0 0 0 B Montana Facility Finance Authority 810302402 61204MAS6 2011-09-28 20680164 To fund structure and equipment of new ER, acquisition of Legacy condos 0 0 0 C Montana Facility Finance Authority 364615155 2015-09-10 19522471 Refinance 2005 bond issued 12/1/2015 0 0 0 D Montana Facility Finance Authority 364615155 2015-01-09 15700000 Portion for MOB V addition 0 0 0 A 5735000 6645000 132900 6512100 2010 1 0 1 1 B 4723801 20693206 11797 401295 20278869 1246 2013 0 0 1 1 C 1659028 19522471 243567 19278904 2015 1 0 1 1 D 323765 15700000 37689 15662311 2016 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 0 0 0 0 0 1 D 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 06/30/2014 Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 06/01/2014 Form 990, Part VI, Section A, line 6 Bozeman Deaconess Health Services, dba Bozeman Health, is the sole member of the organization. Form 990, Part VI, Section A, line 7a Bozeman Deaconess Health Services, dba Bozeman Health, is the sole member of BHDH. Bozeman Health appoints the board members. The Bozeman Health Board Chair, Vice Chair and CEO serve as the board members of BHDH. The Yellowstone Conference of the Methodist Church confirms the Board Members for Bozeman Health and has authority to appoint the clergy member of the board. Form 990, Part VI, Section A, line 7b Bozeman Health has the authority over the following items: 1) approval of mission, vision and values 2) approval of the strategic plans 3) adoption of annual capital and operating budgets 4) oversight of financial operations, including the consolidated audit 5) incurrance of any long-term debt 6) establishment of policies specifying the level of internal authority 7) approval of annual quality plan and aoption of policies and procedures regarding healthcare services and law and regulation 8) appointment and removal of board members and officers 9) approval of any affiliations, mergers, and dissolutions 10) approval of closures of medical staffs and services 11) approval of any amendment of the Articles or Bylaws Due to Bozeman Health governing documents any changes in the Articles of Incorporation in relationship to the process of selecting board membership must be approved by the Yellowstone Conference of the United Methodist Church. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Planning and Finance Committee will review Form 990 in detail, as well as the CFO. The full Board will be provided a copy of the Form 990 before filing with the IRS. Form 990, Part VI, Section B, line 12c Annual Disclosure Statement is obtained from the Board, Operating Committee, and Executive Team Members. Disclosures are reviewed with the Conflict of Interest (COI) Panel (Compliance Officer, Board Compliance Committee Chair, Chief Executive Officer, & Chief Legal Officer). The COI Panel assesses the disclosure, develops an acknowledgement and management plan. The management plan is reviewed with the affected member, if the COI Panel and the member are unable to resolve the disclosure, the disclosure is reported to the Board Compliance Committee for further review. Conflicts are addressed annually in writing and verbally during meetings. If a COI exists, the member shall not participate in any deliberations or vote regarding the transaction or arrangement at issues, and shall not be present in the meeting room for any part of the deliberations or vote relating to the transaction or arrangement. Form 990, Part VI, Section B, line 15 Bozeman Deaconess Health Services, parent company and sole member of the BHDH, compensates the CEO and CFO. The board of directors and executive committee consist of the same individuals for both organizations. The Executive Compensation Committee receives a formal presentation by an independent compensation consultant (as selected by the Board) qualified to perform compensation reviews including usage of comparability data. This person presents recommendations to the Compensation Committee of the Board. The Compensation Committee makes recommendations to the full Board on an annual basis for Officers and Senior Administration. This annual process was performed in fall 2016 to determine 2017 compensation. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and all tax related information required to be available for public inspection are available via walk-in, telephone call, e-mail, and/or mail-in request. The audited financial statements are required to be attached to the Form 990 and provided to the Municipal Securities Rulemaking Board, which is our tax-exempt bonds trustee, via an on-line, central filing location called Electronic Municipal Market Access (EMMA). The financial statements can be obtained by the general public at the EMMA website. Form 990, Part IX, line 11g Other Fees: Program service expenses 12,168,495. Management and general expenses 5,386,104. Fundraising expenses 0. Total expenses 17,554,599. Bozeman Health Shared Services: Program service expenses 29,652,357. Management and general expenses 16,613,716. Fundraising expenses 0. Total expenses 46,266,073. Physician Salary Allocation: Program service expenses 32,992,123. Management and general expenses 0. Fundraising expenses 0. Total expenses 32,992,123. Form 990, Part XI, line 9: Transfer of Net Assets From Related Party -1,104,149. Change in Temp & Perm Restricted Investment of Foundation 1,519,878. Bozeman Deaconess Health Services 915 Highland Blvd Bozeman MT 59715 810232121 Hospital and Healthcare Services MT 501(c)(3) Line 3 N/A 0 Bozeman Deaconess Foundation dba Bozeman Health Foundation 931 Highland Blvd Suite 3200 Bozeman MT 59715 841407943 Raise Funds to Support Bozeman Deaconess Health Services MT 501(c)(3) Line 7 Bozeman Deaconess Health Services 0 Deaconess Intercity Imagining LLC 915 Highland Blvd Bozeman MT 59715 810666871 Healthcare - Imaging Services MT N/A Rocky Mountain Surgical Center LLC 1450 Ellis St Suite 101 Bozeman MT 59715 364462300 Healthcare - Surgical Services MT N/A Spanish Peaks Plaza LLC 120 N 15th Ave Suite A Bozeman MT 59718 810539803 Rental Real Estate for VA Med Clinic & Chiro MT N/A Bozeman Deaconess Real Estate Development PO Box 10490 Bozeman MT 59719 205496567 Sale of Real Estate Property and Residences to Seniors MT N/A C 0 0 0 1 0 0 0 0 0 0 1 0 1 1 1 1 1 1 1 1