2017-01-16T00:00:00-06:00 2015-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-07-01 816016016 Glendive Medical Center GLEN 4063653306 202 Prospect Drive Glendive MT 593301999 Angela Bryhn Interim CFO 4063653306 2017-01-13 1 Kim Hunwardsen CPA P00484560 6122536500 2017-01-13 2014 2021-01-29 14:40:06Z Parker Powell 202 Prospect Drive Glendive MT 593301999 39396431 0 X www.gmc.org X 1964 MT Committed to caring, healing, and a healthier community through the procurement of health services. 11 9 530 192 -40282 -40282 398622 74200 36484189 38539727 230495 194994 353916 256795 37467222 39065716 0 0 0 0 20275103 21308723 0 0 0 16598747 18094292 36873850 39403015 593372 -337299 55463798 59013629 32483935 36371065 22979863 22642564 X We are committed to caring, healing, and a healthier community. 0 0 31332120 38539727 Glendive Medical Center, Inc. (GMC) is a totally integrated medical center with a 25-bed Critical Access Hospital providing all primary care services to the community of Glendive and the surrounding rural service area. The Medical Center also is comprised of 151 nursing home beds, 13-suite Assisted Living Facility, Home Health, Durable Medical Equipment and Hospice services. A clinic with Rural Health Clinic designation and pharmacy services is attached. GMC is very committed to meeting the needs of the service area they serve. IRS requirements of the community benefit standard for tax-exempt organizations are integral to GMC's charitable mission of being committed to caring, healing and a healthier community. GMC is governed by an independent board with a representative composition by gender, rural/urban, professional/non-professional and geography. The Board has a history of acting with the highest integrity and proactively adopting governance best practices to ensure the organization operates with the highest of integrity for the benefit of the community they serve. During this year, the Board continued to actively oversee critical functions of the organization. During the past year:1. The annual compliance reports and education was provided to the Board as part of their mandatory education.2. Board members reviewed and signed the required annual conflict of interest statement.GMC makes medical care accessible to the entire area it serves. They operate a 24 hour emergency room, providing care regardless of the ability to pay. GMC had 4,030 emergency room visits during the past year. GMC provides clinical services including onsite providers needed to operate the Emergency Department.In addition, GMC, through its integrated group of providers and visiting specialists, provides non-emergency services to the community it serves. It makes these services accessible to the community through participation in government programs like Medicare, Medicaid, and Veterans Administration and by offering financial assistance in various ways to those who are unable to pay.GMC's Uncompensated Care policy provides discounted and free services to patients who do not have the resources to be fully responsible for the medical care they receive. GMC's policy is structured to provide various options of financial assistance depending upon the patient's needs. The applications and policies for the various financial assistance options and uncompensated care are available on the organization's website, gmc.org. GMC maintains records to identify and monitor the care provided under the uncompensated care policies. During the past year, GMC's costs for charity care, based on the amount of charges foregone, was $420,004 serving 48 members in their service area.GMC through the annual board approved strategic plan strives to meet the community needs. Further information about the services provided by GMC to the community it serves including their annual Community Benefit Report is available on their official website, gmc.org. 31332120 1 1 0 1 0 0 0 0 0 0 1 1 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 1 0 0 1 24 0 1 530 1 1 1 0 0 0 0 0 0 0 0 0 X 11 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Angela Bryhn 4063453351 202 Prospect Glendive MT 59330 Laura Glueckert Chairperson 2.00 0.00 X X 0 0 0 Troy Myers OD Vice Chairperson 1.00 0.00 X X 0 0 0 Jim Hicks Secretary 1.00 0.00 X X 0 0 0 Jackie Schultz Treasurer 1.00 0.00 X X 0 0 0 Holly Micheletto Director 1.00 0.00 X 0 0 0 Steve Scheitlin Director 1.00 0.00 X 0 0 0 Bruce Swarny MD Director/Physician 40.00 0.00 X 203340 0 0 Joseph Leal MD Director/Chief of Staff 40.00 0.00 X 237000 0 10305 Chris Stevens Director 1.00 0.00 X 0 0 0 John Schallenkamp MD Director 40.00 0.00 X 0 0 0 David Linn Director 1.00 0.00 X 0 0 0 Parker Powell CEO 49.00 1.00 X 0 0 0 Angela Bryhn Interim CFO (Feb-Jun) 49.00 1.00 X 9240 0 0 Barbara Markham CFO (Jul-Feb) 49.00 1.00 X 149760 0 0 Jill Domek VP Patient Care Services 50.00 0.00 X 124800 0 9376 Chrystal Potter MD Physician 40.00 0.00 X 147865 0 6595 Clifford Reske MD Physician 40.00 0.00 X 225000 0 4515 Richard Lewis Physician 40.00 0.00 X 325000 0 19920 J Kevin Maxwell Physician 40.00 1.00 X 550000 0 19293 1972005 0 70004 21 0 1 0 Primetime Healthcare LLC 14811 Shepard Street Omaha NE 68138 Traveling Clinical Staff 975179 Sodexo Inc & Affiliates 120 North Ave NW Atlanta GA 303132527 Dietary Mgmt Services 872737 Billings Clinic 2800 10th Avenue North Billings MT 59107 Mgmt, Staffing, & IT Services 646928 Prairie Travelers 130 3rd Street South Suite 2 Glasgow MT 59230 Traveling Clinical Staff 443092 Cucanic Construction 7310 Entryway Drive Billings MT 59101 Construction 302634 12 1738 47396 25066 74200 Patient Service Revenue 621110 37002146 37002146 Other Revenue 900099 1540437 1540437 HealthNet, LLC K-1 Income 900099 -2856 -2856 38539727 129155 129155 141842 167573 -25731 -25731 -40282 14551 219121 153282 65839 65839 65839 292386 9860 282526 282526 39065716 38539727 -40282 492071 662931 410524 252407 38420 38420 17690696 14888960 2801736 196938 160967 35971 1676169 1153482 522687 1043569 850362 193207 213167 213167 6542 6542 38983 38983 2259233 1340373 918860 52184 2017 50167 1515595 1275121 240474 52064 12640 39424 666344 148020 518324 81250 63051 18199 1322558 1322558 3239948 3157199 82749 348217 208314 139903 Bad Debt Expense 3520662 3520662 Medical supplies 2821090 2821090 Food 634874 634874 Bed Tax 434003 434003 887578 212041 675537 39403015 31332120 8070895 0 333932 151200 8814374 11413924 93376 1739372 1726477 101403 25372 64248433 38214496 27932440 26033937 5730948 4547960 8025488 8022632 2785841 6998751 55463798 59013629 5256620 8971524 44931 66779 26831743 26007630 100641 68865 250000 1256267 32483935 36371065 X 22692394 22355095 287469 287469 22979863 22642564 55463798 59013629 -337299 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2087 2087 0 Part II-B, Line 1: Included in dues paid to Montana Hospital Association, American Hospital Association and Leading Age was a portion for lobbying purposes. 0 1 X 139683 139683 668785 43242857 23297395 20614247 16362538 12941081 3421457 3834570 1976020 1858550 26033937 64178 F GMC Other Investments - Clinic 7958454 F 8022632 Deferred Financing Costs, Net 763963 Physician and Clinic Receivables 5471448 Related Party Receivable 28716 Estimated Third Party Payor Settlements 734624 6998751 X Part IV, Line 2b: Upon written authorization of residents of GMC Extended Care and EMVH Extended Care, the organization holds, safeguards, manages and accounts for the personal funds of those residents that have been deposited in the two trust accounts. As of June 30, 2015, the balance in these accounts were $53,952 and $14,914 respectively. Part X, Line 2: Glendive Medical Center, the Auxiliary, and Properties LLC are organized and have been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). Glendive Medical Center (combined with the Auxiliary and Properties LLC) is annually required to file a Return of Organization Exempt fromm Income Tax (Form 990) with the IRS. The Organization has determined it is subject to unrelated business income tax and has filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. 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 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 315000 315000 0.00880 315000 315000 0.00880 6260582 3990780 2269802 0.06330 6260582 3990780 2269802 0.06330 6575582 3990780 2584802 0.07210 1 3520662 0 8921527 8907070 14457 X 1 1 1 1 Glendive Medical Center 202 Prospect Drive Glendive MT 59330 13226 X X X X Glendive Medical Center 1 0 0 1 X X X X X X X X X 12 1 0 0 1 X See Part V, Line 7d X See Part V, Line 7d X X 1 12 1 See Part V, Line 7d 0 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X 1 X www.gmc.org/docs/Financial_Assistance.doc X www.gmc.org/docs/Financial_Assistance.doc X www.gmc.org/getpage.php?name=poverty_income_levels X X X X X 1 X 0 X X X X X 1 X 0 0 Glendive Medical Center Part V, Section B, Line 5: A. Needs Assessment Steering Committee Members - 1. Dawson County Health Department Director - Public Health Focus 2. Dawson County Superintendent of Schools 3. Glendive Economic Development Executive Director 4. Dawson County Commissioner - Population Consultation Focus 5. Glendive Police Department Officers (2) - Population Consultation Focus 6. Glendive Medical Center - CEO, DFO, Community Relations coordinator, Marketing Coordinator, GMC Foundation Director, Executive AssistantB. Focus Groups - Population: Seniors 1. Richey MT Senior Center 2. Glendive MT Senior Center 3. Wibaux MT Senior CenterC. Survey - Mailing to Service Area Glendive Medical Center Part V, Section B, Line 7d: http://www.gmc.org/getpage.php?name=community_reports&sub=About%20Ushttp://www.dawsoncountymontana.com/departments/publichealth/docs/GMC_Implementation%20Plan%20Report_2016.pdfIt is also available at Glendive's Public Library. Glendive Medical Center Part V, Section B, Line 11: Improving resident's access to health through better recruiting and retention of providers, improving health outcomes for chronic diseases and behavioral health, and expanding health education opportunities.Identified health needs unable to be addressed by Glendive Medical Center Rationale 1. "Cancer" (55%) was chosen as the second-most serious health concern by survey respondents. GMC currently provides Oncology/Chemotherapy Infusion services. Offering additional cancer services would not be feasible from a staffing and financial standpoint. 2. "Dermatology" (27.7%) was chosen as the most desired local healthcare service not currently available. At this time, GMC currently offers dermatology services through visiting physicians, approximately once a month. GMC is working with the provider to expand offerings/and or determine if telemedicine is a feasible option. 3. "Women's health" (27.7%) was the third-most desired educational class/program. GMC currently offers OB/GYN services and will look to the future to expand Women's Health services for women in Dawson County and the surrounding region. Glendive Medical Center Part V, Section B, Line 16i: GMC's Credit Department sends the policy and application to patients/guarantors who have made no effort to complete an application or make arrangements for payments at the time the account becomes past due. In addition to providing the full policy upon request, a summary of the policy is posted in the emergency rooms, waiting rooms, admissions office and provided upon admission. Glendive Medical Center Part V, Section B, Line 20e: At the time the patient/guarantor receives their final notice of nonpayment, the financial assistance application is again sent to them and contact persons are provided who can assist them in completing their application. Glendive Medical Center Part V, Section B, Line 22d: GMC calculates the amount based on the average of all negotiated commercial insurance rates. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Glendive Medical Center Part V, Section B, line 16a website: www.gmc.org/docs/Financial_Assistance.doc Glendive Medical Center Part V, Section B, line 16b website: www.gmc.org/docs/Financial_Assistance.doc Glendive Medical Center Part V, Section B, line 16c website: www.gmc.org/getpage.php?name=poverty_income_levels 5 Glendive Medical Center Nursing Home 202 Prospect Drive Glendive MT 59330 71 bed skilled nursing home Glendive Medical Center Home Health 202 Prospect Drive Glendive MT 59330 Home health for Dawson, Wibaux, McCone and Prairie Counties Eastern Montana Veterans Home 2000 Montana Avenue Glendive MT 59330 80 bed Veterans skilled nursing home The Heritage on Merrill Avenue 1313 North Merrill Avenue Glendive MT 59330 13 suite assisted living center Glendive Medical Center Hospice 202 Prospect Drive Glendive MT 59330 Hospice for Dawson and Wibaux Counties Part I, Line 6a: Currently, GMC is filing a community benefit report with the State of Montana, in conjunction with other requested information for the State of Montana's report on issues and facts related to the charitable purposes of hospitals and the protection of Montana's consumers.GMC mails to all service area households either a community benefit report or a post card detailing where to go on the gmc.org website to access the community report. GMC's community benefit reports are available at all times on the gmc.org website. Part I, Line 7: The cost to charge ratio for charity care was calculated by multiplying the ratio of cost to gross charges by the uncompensated care policy without charge or at amounts less than established rates. Subsidized health services was determined using the Medicare cost report and applying the Medicare ratio of cost to charge for the respective cost centers. Part I, Ln 7 Col(f): Bad debt expense of $3,520,662 included on Form 990, Part IX, line 25, column (a) has been subtracted for purposes of calculating the percentage in this column. Part III, Line 2: Bad debt is reported at charges. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page eight and nine of the attached audit report. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. In addition to hospital services, Home Health, Hospice, and Skilled Nursing Facility are also included in the Organization's cost report. All of these activities are subsidized health services shown on line 7 or Part I. Therefore, the Medicare piece related to these activities is shown on Part I, Line 7. As noted in the Schedule H instructions, the cost report does not reflect certain programs which GMC provides - Durable Medical Equipment, Medicare Part C, Medicare Part D, and Provider Based Services - Emergency Room Providers, Certified Nurse Anesthetists, and Radiologists. Since GMC is in a very rural area, to have 24 hour coverage by these providers for our service area is definitely a quality and safety issue, and therefore, a community benefit.Due to utilizing the allowable Medicare cost from the cost report, Part III does not reflect the fact that there is Medicare shortfall to this facility, due to a number of factors such as the following:1. Any non patient revenue received for reimbursable departments must be offset against expenses. But at the same time, it is not allowed to offset revenue against expenses of non-reimbursable departments. This results in substantial shifting of a substantial amount of administrative expenses to the non-reimbursable areas due to allocation of the administrative costs being based on total expense without the offset of revenue on the non-reimbursable departments.2. Allocating administrative expense based on the percent of total expense also shifts an excess of costs to areas such as GMC's retail pharmacy due to high cost of drugs again resulting in overstating administrative expenses in a non-reimbursable department which in turn lowers reimbursement to Medicare reimbursable departments.3. Medicare Advantage (Part C) plans are creating additional cost and shortfall and are not currently reported in Part III.4. Medicare Part D - With two nursing homes, being in a very rural area with no other area pharmacies providing Unit Dose dispensing which is required for the safety of our residents, GMC again is seeing a shortfall which is not being reported while providing the necessary services to our local residents and is definitely a benefit to the resident and their families. Part III, Line 9b: For those that are known to qualify for financial assistance, the portion that is identified as charity care is written off to charity care. The Hospital policy states if there is a portion of the patient account that does not qualify for free care the remaining unpaid portion falls under the same collection policy as the accounts that do not qualify for financial assistance.The organization does not send balances to collections until 120 days after the date of the first invoice. If at any time in the next 120 days an individual begins the application process for financial assistance the Hospital removes them from the collection process. Part VI, Line 2: 1. Over the past years, GMC has identified and prioritized community needs through a variety of community surveys in collaboration with various organizations including the City of Glendive and Dawson County.2. Public meetings were held by GMC at various times to receive community input.3. Strategic Planning sessions are held by GMC to plan and prioritize the needs of the community on an annual basis. These sessions include the Board of Directors, the Foundation's Board of Directors, Physicians and other Medical Providers and the Administration of GMC. Areas identified and services implemented from the prior community surveys included the need for Hospice, Assisted Living and Behavior Health Services.4. Planning for a Community Assessment survey was completed with the Dawson County Public Health Department in April 2013.A review and the implementation plan based on the results of the survey were completed in June 2013. Monthly meetings to review the progress and update the plan are in place and will continue during the upcoming months. Part VI, Line 3: GMC provides information and education concerning assistance through various programs and the organization's charity care policy in a variety of ways including:1. Through the social services department, patient financial services and other areas, assistance is offered and information is given to all patients and their families about available programs. Beginning in fiscal year 2012, a Patient Advocate Liaison (PAL) was added to assist patients throughout the organization. The PAL's role is to assist all patients and provide them with information on available programs, etc. Beginning in January 2014 Emergency Department Specialists are available seven days a week after the patient has been treated to assist patients and their families to provide the financial assistance information including the charity care program and assist them with applying for these programs if appropriate.2. GMC's website, www.gmc.org, provides charity care and other financial assistance policies and procedures, including applications.3. Signage is posted throughout the facilities in admissions areas, the emergency room and waiting rooms. The signage provides information concerning charity care and other financial assistance available throughout GMC.4. A Guest Information Book for the patient and their family's use is in each patient's room and other areas providing various information including financial assistance information that is available and the appropriate personnel to contact if they have not been contacted. Contact information for the social services department is included in the information book if the patient needs assistance or has questions about various government and other programs available in the area. 5. GMC's monthly statement provides information for the person(s) to contact if financial assistance is needed. The credit and collection department includes financial assistance information including an application and the contact person at GMC who can assist them with all collection letters.6. GMC employees are aware of the financial assistance programs and are able to provide direction to patients or their families in their departments concerning charity care. Quarterly, at the CEO forums, the employees are provided with the amount of charity care provided by the facility while expressing the importance of providing the free care for people that are in need. Part VI, Line 4: GMC's primary service area is Dawson County on the eastern edge of Montana. GMC's secondary service areas are surrounding counties, McCone, Richland, Fallon, Prairie and Wibaux.Projections by the National Planning Association Data Services, Inc. projected that Dawson County would experience a decrease in population from the 2000 Census until after 2020 when a slow and steady growth pattern was projected. Instead, the population of Dawson County based on the 2010 census increased to 8,966, compared to the projected population of 8,520. By 2014 Dawson County population has grown to 9,518, an increase of 6.2% since 2010. At the same time the State of Montana as a whole showed an increase of 3.5%. Approximately 23,000 persons are now in the area GMC serves. The increase in population and area's health care services is related to the increase in the senior population and the energy-related services which continue to show strong growth. Based on the current trends, Dawson County will continue to see growth due to the outlying energy related services.Glendive is a medical, retail and agricultural trade center for the county and the surrounding communities within a 30-60 mile radius. Glendive's economic base continues to be closely tied to agriculture and the transportation industry, particularly rail services. GMC is the largest employer in Glendive. Other significant employers in the GMC's service area are state, county and city governments, Burlington Northern Santa Fe Railway, Glendive Public Schools, Dawson County Community College and Williston Basin Interstate Pipeline.Dawson County is designated as a Health Professional Shortage Area (HPSA) with shortages of mental health providers. Beginning in July of 2010 GMC has a psychiatrist on staff, the only one east of Billings, MT, 200 miles to the west. The Behavior Care Unit opened in July, 2010 as part of the Critical Access Hospital to provide a needed service throughout Eastern Montana and Western North Dakota.The service area residents see GMC and its providers as a place to come to receive treatment, without regard to whether they have insurance or are uninsured, knowing they will be treated and cared for in a respectful and caring manner.GMC also provides outreach in various ways to the very small critical access frontier facilities as small as one bed facilities in neighboring counties and to four counties in the service area for home care services in sparsely populated areas.There are no other providers in GMC's primary service area. Sidney Health Center, a critical access hospital located 50 miles north of Glendive, and Holy Rosary Medical Center, a critical access hospital located 70 miles south of Glendive, are the closest facilities. Part VI, Line 5: GMC Board of Directors:The governing body of GMC is its Board of Directors (the "Board"), which consists of eleven members. The Board includes the Chief of Medical Staff and one member of GMC's active medical staff. Other members are selected to promote a representative composition of the Board by gender, rural/urban, professional/non-professional and geography. Board members are selected from GMC's service area by the Board's nominating committee and approved by the existing Board members. The members of the Board serve in a voluntary capacity and receive no compensation for their services. Members of the Board have various relationships with services or products, which may, from time to time, have dealings with the GMC, but these relationships are not considered to be material. The Chief of Staff and member of the medical staff are employed by the GMC as physicians and medical advisors. The Board has an established conflict of interest policy to detect and manage such relationships.GMC Medical Staff:The active medical staff of GMC currently is comprised of seven (7) physicians and thirteen (13) allied health professionals. These providers are all employed by GMC and provide services at all of GMC facilities, including the attached for profit clinic, Gabert Medical Services, outreach clinic in Wibaux, MT. and two of the frontier critical access hospitals in McCone and Prairie County. Six (6) of the seven (7) physicians are board certified. A full time orthopedic surgeon began providing services at the medical center beginning in August 2014. An internist/pediatrician will begin providing services at GMC in August. Another internist and FP are actively being recruited.A Specialty Clinic at GMC is utilized by physicians from Billings, MT and Bismarck, ND to provide services that are not available by the GMC Medical Staff. The patients are able to stay at home in Glendive and have the services provided by out of town physicians locally without traveling great distances.Tele Health is also utilized by GMC providers and providers in Billings and other locations. This allows the patients to have follow up visits with providers via video conferencing instead of traveling great distances to see the providers.GMC extends medical staff privileges to all qualified physicians in the area. GMC also extends those privileges to the qualified specialty physicians who provide services through the Specialty Clinic.GMC Surplus Funds:All funds in excess of expenses are utilized in the following ways:1. The facilities' debt service payments on the 2008 $30,000,000 bond issue obtained to provide a much needed expansion and renovation of the Surgery Suite, an additional nursing home wing and expansion and renovation of the emergency department.2. A substantial amount of funds are needed each year and utilized for the ongoing capital needs of the facility to ensure the appropriate equipment is available to meet the needs of the community. All departments have a three to five year plan in place to forecast these needs.3. Continued assistance to providers and professional staff for education to maintain GMC's standards to provide the care needed in the community.4. To increase reserve funds to ensure the ability to continue meeting the above obligations in future years when surplus funds are not available. Part VI, Line 6: GMC in September, 2013 began an affiliation with Billings Clinic. This affiliation provides resources to Glendive Medical Center which should assist in retaining providers and staff which will assist us to continue to provide quality care to our community. 0 1 0 0 0 0 0 0 0 Bruce Swarny MD Director/Physician 200000 0 1000 0 2340 0 0 0 0 0 203340 0 0 0 Joseph Leal MD Director/Chief of Staff 225000 0 0 0 12000 0 2962 0 7990 0 247952 0 0 0 Barbara Markham CFO (Jul-Feb) 149760 0 0 0 0 0 0 0 648 0 150408 0 0 0 Chrystal Potter MD Physician 122304 0 25000 0 561 0 1631 0 5112 0 154608 0 0 0 Clifford Reske MD Physician 225000 0 0 0 0 0 4500 0 663 0 230163 0 0 0 Richard Lewis Physician 325000 0 0 0 0 0 5000 0 15715 0 345715 0 0 0 J Kevin Maxwell Physician 550000 0 0 0 0 0 5000 0 15528 0 570528 0 0 0 Part I, Line 3 The CEO's compensation is set by Billings Clinic, an affiliated management company. Glendive Medical Center employs all of the methods indicated above to determine that the CEO compensation is reasonable and appropriate given the size and complexity of the organization. Part I, Line 4b J. Kevin Maxwell and Joseph Leal participated in a nonqualified retirement plan under 457(f). Amounts from their base wages were deferred into the plan at their discretion. For the fiscal year 2015 and calendar year 2014, there were no current year contributions for either J. Kevin Maxwell or Joseph Leal. A Montana Facility Finance Authority 364615155 612043GD5 2008-07-01 29716927 Various Capital Projects 0 0 0 A 3820000 30745739 2150826 1887501 594338 23222376 22890698 2011 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 1 GE Funding Capital Market Services 25.000000000000 1 0 0 A 0 Date Rebate Computation Performed Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 07/01/2013 Part II, Line 3: The difference between the issue price (Part I, Column (e)) and the total proceeds of the issue (Part II, Line 3, Column (B)) is investment interest during construction and on reserve funds. Ashley Powell Wife of CEO 38420 Employee Compensation 0 Form 990, Part VI, Section A, line 1 The Executive Committee is comprised of the Board President, Vice-President, Secretary, Treasurer and the immediate Past Chair. The Executive Committee will, in the interim between meetings of the Board of Directors, exercise the powers of that body necessary for efficient operation of the Hospital in accordance with the general policy of the Hospital and the Board of Directors. The committee shall be empowered to act in only those areas of responsibility as the Board of Directors authorizes. It shall not have the power to amend the bylaws nor adopt or amend the Hospital's annual budget or long range plan and with the understanding that all matters of major importance will be referred to the governing board. Form 990, Part VI, Section A, line 3 Glendive Medical Center, paid a management company, Billings Clinic, for CEO services for Parker Powell. Glendive Medical Center paid Billings Clinic $213,167 for the services of the CEO for fiscal year ending June 30, 2015. In addition, Billings Clinic received a management fee totaling $120,800 for the fiscal year ending June 30, 2015. Form 990, Part VI, Section B, line 11 A copy of the 990 was reviewed by the CFO and distributed to the board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Any director, officer, key employee or committee member having an interest in a contract or other transaction presented to the Board of Directors or a committee thereof for authorization, approval or ratification shall make a prompt, full and frank disclosure of his interest to the board or committee prior to its acting on such contract or transaction. The body to which such disclosure is made shall thereupon determine, by majority vote, whether the disclosure shows that a conflict of interest exists or can reasonably be construed to exist. If a conflict is deemed to exist, such person shall not vote on, nor use his personal influence on, nor participate in the discussions or deliberations with respect to, such contract or transaction. Such person may be counted in determining the existence of a quorum at any meeting where the contract or transaction is under discussion or is being voted up. The minutes of the meeting shall reflect the disclosure made, the vote thereon and where applicable, the abstention from voting and participation, and whether a quorum was present. A statement from directors and officers and key members of the medical staff is completed and signed annually. Conflict of Interest is normally handled at the executive or board level. In the majority of the cases, no vote is necessary since the Board member or GMC staff voluntarily excuses themselves. But, the Board Chair and the CEO monitors proposed or ongoing transactions of the organization for conflicts of interest and discloses them to the Board and staff, as appropriate. Form 990, Part VI, Section B, line 15 Staring in September 2013, the CEO was compensated by Billings Clinic, an unrelated management company. The Organization paid Billings Clinic for his services as CEO. The CFO compensation is reviewed and approved by the CEO. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy and financial statements are kept at the Hospital and are available upon request. The annual Community Benefit report includes a consolidated financial statement for Glendive Medical Center and its Affiliates and is mailed to all service area households. It is also posted on the Hospital website. GMC Properties LLC 202 Prospect Drive Glendive MT 593301999 Apartment Rental Management MT 58462 26136 Glendive Medical Center Glendive Medical Center Foundation 202 Prospect Drive Glendive MT 59330 810440518 Raising Funds for Glendive Medical Center and Community Medical Needs MT 501(c)(3) Line 7 Glendive Medical Center Inc 1 HealthNet LLC 11 South 7th Street Suite 241 Miles City MT 59301 810506005 Operating integrated computer and software MT Glendive Medical Center Related -2856 64179 1 1 0.50000 Gabert Medical Services Inc 107 Dilworth Glendive MT 59330 810477745 Provides Comprehensive Medical Care and Related Services MT Glendive Medical Center C 3466433 2931373 1.00000 1 1 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 1 0 0 Gabert Medical Services Inc A 83380 Actual Gabert Medical Services Inc Q 3531830 Actual The audited financials and information needed to file a complete and accurate Form 990 was not available by May 15, 2016.