2017-05-10T11:49:34-05:00 2016-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-07-01 810243720 Sheridan Memorial Hospital Association SHER 4067653700 440 W Laurel Avenue Plentywood MT 59254 Kyle Gee CFO 4067653700 2017-05-10 1 Kim Hunwardsen CPA P00484560 6122536500 2017-05-10 2015 2021-01-29 14:40:06Z Greg Maurer 440 W Laurel Avenue Plentywood MT 59254 11875029 0 X www.sheridanmemorial.net X 1920 MT Provide quality care to improve the health and well-being of the people and community we serve. 7 7 248 71 0 0 235246 406825 11147842 11414356 4098 34406 17011 19442 11404197 11875029 1155 0 0 0 7134981 7037972 0 0 55881 5957306 5235785 13093442 12273757 -1689245 -398728 8277335 7896749 1748440 1766582 6528895 6130167 X Providing quality care to improve the health and well-being of the people and community we serve. 0 0 11455628 11414356 The Organization operates a 19-bed critical access hospital, a 78-bed long term care facility and a Provider Based Rural Health Clinic that benefits the people in the surrounding area.Some of the organization's accomplishments during FY2016 include:Implemented the SunRX 340B Pharmacy Discount program facility wide. EMS purchased a Zoll 12-lead monitor to assist in the care of patients during transport. Sheridan Memorial EMS/Trauma received LUCAS 2 device that allows for automated chest compressions for CPR. Sheridan Memorial saw a need for an Immunization Clinic in our community to provide immunizations from infant to age 18. In FY16 the IZ clinic was set up, surveyed and saw its first patient June 15th. Sheridan Memorial Rural Health Clinic began providing Micronutrient testing.Sheridan Memorial Radiology installed a new, 80 slice CT scanner in June. The 80 slice was an upgrade from the 16 slice. Physical Therapy installed a rail to assist with pulleys and Thera band/Thera tubing exercises. 6 people were trained in the Instructor CPR course, allowing for convenience of staff and community training. Sheridan Memorial Nursing Home consolidated their service area from 2 "wings" to 1 wing. Currently all residents are housed in the East Wing of the Nursing with 45 beds. This allowed for cost savings for space, staffing and other expenses. In addition, the residents have enjoyed the remodeled Resident Living Room. 11455628 1 1 0 0 0 0 0 0 0 1 1 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 8 0 1 248 1 0 0 0 0 0 0 0 0 0 0 X 7 7 0 1 1 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Greg Maurer 4067653702 440 West Laurel Avenue Plentywood MT 59254 X Jake Fladager Chairperson 1.00 0.00 X X 0 0 0 Linda Nelson Vice Chairperson 1.00 0.00 X X 0 0 0 Jessica Schackelford Secretary/Treasurer 1.00 0.00 X X 0 0 0 Robert Michels Director 1.00 0.00 X 0 0 0 Bill McCoy Director 1.00 0.50 X 0 0 0 Mike O'Toole Director 1.00 0.00 X 0 0 0 Myrnette Miller Director 1.00 0.00 X 0 0 0 Greg Maurer CEO 40.00 0.10 X 0 0 0 Kyle Gee CFO 10.00 0.00 X 0 0 0 Adam Graham PA 40.00 0.00 X 160216 0 16114 Jennifer Hoversland FNP 40.00 0.00 X 100227 0 0 Lynne Graham PA 40.00 0.00 X 125619 0 5808 Kristin McColly FNP 37.00 0.00 X 111631 0 13079 Carlos Trevino MD 40.00 0.00 X 267954 0 16433 765647 0 51434 5 0 1 0 Billings Clinic PO Box 30977 Billings MT 59107 Management Company 670999 MHN 11 South 7th Street Miles City MT 59301 Rural Hospital Support 623619 Cerner Corporation PO Box 959156 St Louis MO 63195 Computer Program 237310 NXC Imaging 2118 4th Ave South Minneapolis MN 554042642 Radiology 189942 Avera Health 3900 West Avera Drive Sioux Falls SD 57108 eEmergency/ePharmacy Services 152287 6 32417 8344 366064 406825 Patient Service Revenue 621990 10956376 10956376 Intergovernmental Transfers 900099 266345 266345 Net Change in Interest in Net Ass 900099 112404 112404 Other Revenue 900099 65381 65381 EHRI 900099 13850 13850 11414356 1406 1406 19442 0 19442 19442 19442 33000 0 33000 33000 33000 11875029 11414356 0 53848 5610938 5550400 40804 19734 4950 4950 996506 918104 71842 6560 425578 421628 2262 1688 372429 372429 11039 11039 27876 27876 1011232 980504 26551 4177 34458 28625 5833 152523 131861 18589 2073 286665 206503 80162 44563 39245 5043 275 14530 11024 3349 157 17434 12211 4173 1050 1067529 1062394 5135 96116 643 94189 1284 Medical Supplies 878692 878692 Bad Debt 712797 712797 Repairs and Maintenance 332014 327067 4947 Bed Tax 154198 153075 1123 21690 15905 -7265 13050 12273757 11455628 762248 55881 422745 712193 164942 48812 1360999 1379614 222100 203863 135424 136659 16900441 12982866 4419099 3917575 57166 59854 1188629 1301033 306231 137146 8277335 7896749 1056311 1333741 383726 261868 308403 170973 1748440 1766582 X 6036726 5683778 378253 332405 113916 113984 6528895 6130167 8277335 7896749 -398728 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 113916 68 145 145 113984 113916 64 64 113916 113916 72 72 113916 37530 76386 27 27 113916 27195 10335 37530 1.00000 0 1 1 384756 384756 9394557 7879381 1515176 7104455 5103485 2000970 16673 16673 3917575 Interest in Net Assets of Foundation 1301033 C 1301033 Related Party Note Payable 170973 170973 X 10941637 -558984 -558984 11500621 374408 374408 11875029 11560960 0 11560960 712797 712797 12273757 Part V, Line 4: The endowment, held by the Sherdian Health Care Foundation, Inc., consists of individual funds established by donors to provide annual funding for specific activities and general operations of the Hospital. Gifts given to the Endowment Fund at Sheridan Health Care Foundation are invested and carefully managed to protect the principal; they are intended to be a part of the permanent investment reserve which will remain for perpetuity. Interest from endowments will go towards Sheridan Health Care Foundation's unrestricted fund to allow for additional revenue to ensure the future of the Foundation and Sheridan Memorial Hospital Association unless otherwise stipulated by the donor. Part X, Line 2: The Hospital is organized as 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 Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS. The Hospital 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 Hospital 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. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts reported as Revenue offset on the Financials -712,797. Net Assets Released from Restrictions reported as Revenue on the Financials 153,813. Part XI, Line 4b - Other Adjustments: Contributions included in Fund Balance on the Financials 374,408. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts reported as Revenue offset on the Financials 712,797. 1 1 X 1 X 1 X 1 1 0 0 55000 55000 0.00480 1583348 1497564 85784 0.00740 1638348 1497564 140784 0.01220 20086 20086 0.00170 889722 619534 270188 0.02340 730 730 0.00010 910538 619534 291004 0.02520 2548886 2117098 431788 0.03740 1 712797 0 3388845 3423076 -34231 X 1 1 1 1 Sheridan Memorial Hospital Association 440 W Laurel Ave Plentywood MT 59254 www.sheridanmemorial.net 13547 X X X Rural Health Clinic, Long-term Care Facility Sheridan Memorial Hospital Association 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X www.sheridanmemorial.net X X 1 15 1 www.sheridanmemorial.net 0 0 1 X 100.000000000000 400.000000000000 X X 1 1 X X X 1 X X X X X 1 X 0 X X X 1 X 0 1 Sheridan Memorial Hospital Association Part V, Section B, Line 5: Three focus groups were held in May of 2016. The meetings were held in Plentywood, Westby and Medicine Lake, Montana. Focus group participants were identified as people living in Sheridan Memorial Hospital's service area. Additionally, four key informant interviews were conducted with the assistance from the Montana Office of Rural Health. Sheridan Memorial Hospital Association Part V, Section B, Line 6b: Sheridan County Sheriff's OfficeSheridan County Office of Public HealthSheridan County Mental Health CounselorPioneer Manor Retirement HomeSheridan County Child and Family Services Sheridan Memorial Hospital Association Part V, Section B, Line 7d: The full CHNA is available upon request. It is also posted in a couple places in the hospital. Sheridan Memorial Hospital Association Part V, Section B, Line 11: The following needs were identified in the most recently conducted Community Health Needs Assessment:1. Improving local access to wellness opportunities and health care services by optimizing facility space and recruiting/retaining staff to support community health needs.2. Improving local access to wellness opportunities by providing health education and community outreach activities.The aforementioned needs have not been addressed yet due to the timing of when the CHNA was completed and when the implementation plan was adopted. Sheridan Memorial Hospital Association Part V, Section B, Line 13h: In addition to family size and federal poverty guidelines, the hospital facility will consider special hardships or unusual circumstatnces in determining financial assistance. Sheridan Memorial Hospital Association Part V, Section B, Line 20e: The patient receives up to 240 days to properly submit a financial assistance application. Sheridan Memorial Hospital Association Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part V, Section B, Line 16a-c: During the current tax year, these documents were not available on the website but were made available to the public in hospital locations. All documents have been placed on the website and are available in the hospital facility. Part I, Line 3c: In addition to family size and federal poverty guidelines, the hospital facility will consider special hardships or unusual circumstatnces in determining financial assistance. Part I, Line 7: Line 7a: Charity care was calculated by multiplying the ratio of cost to gross charges by the gross uncompensated charges associated with providing charity care to its patients.Line 7b: The Medicaid calculation is based on Worksheet 2, Ratio of Patient Care Cost to Charges.Line 7e and 7i: Actual costs were used to report community health improvement services, and cash and in-kind contributions.Line 7g: A combination of actual costs and costs based on the Cost report were used to report Subsidized Health Services. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $712,797. Part III, Line 2: The Organization relies on Healthcare Financial Management Association Statement 15 to determine bad debt expense and financial assistance in their audited financial statements. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 8 of the attached audit report. Part III, Line 8: The cost to charge ratio is used to determine community benefit. This is done by applying the ratio to the total Medicare revenue. A shortfall or overage in any given year is a result of the timing of payments from Medicare on an interim basis and when final settlement is made. Management uses estimates to calculate such settlements but actual results vary from those estimates. Additionally, shortfalls can result from various expenses that are incurred by the facility which are considered non-reimbursable by Medicare. Since part of the costs are not reimbursed it is only prudent to consider this shortfall to be a benefit to the community. Also Medicare recipients are part of a charitable class and so the provision of medical care furthers this charitable class. Part III, Line 9b: Once a financial assistance application is submitted, collection actions are suspended until it is determined if the patient is eligible for financial assistance. If an individual submits an incomplete FAP application, a patient account representative provides a notice requesting additional information and lets the individual know what additional information is needed. In certain cases, where deemed appropriate, collection actions are reversed if an individual is determined to be eligible for financial assistance. Part VI, Line 2: Sheridan Memorial Hospital conducted a thorough secondary data analysis to identify health concerns in Plentywood and Sheridan County. Additionally, a diverse group of community members representing various organizations and populations within the community (ex. public health, elderly, uninsured) came together for key informant interviews and focus groups to better understand the community's perception of health and health concerns in the area. The interviews and focus groups were conducted in May 2016. Part VI, Line 3: Sheridan Memorial ensures all patients are notified of the availability of financial assistance at every admission. At admission the patient signs a Condition of Admission which states that assistance is available. In addition, financial assistance packets are handed out by the Admission's Clerk to those you are underinsured/uninsured or express need for assistance. This packet includes all payment options, Medicaid information and Financial Assistance application. In addition the Financial Assistance policy and application are posted on the Sheridan Memorial website www.SheridanMemorial.net and posters are placed around the facility explaining payment options and financial assistance availability. Each statement sent out to the patient states that Financial Assistance is available. In addition, when making collection or payment plan calls, the self-pay collection clerk informs all of assistance availability. Part VI, Line 4: Sheridan Memorial Hospital is a private not-for-profit organization which is the only medical facility in Sheridan County with a population of approximately 4,105 residents. The facility provides acute, emergency, clinical and long term care for residents in the county and surrounding areas. Established in 1922 as primarily a hospital, Sheridan Memorial Hospital Association continued expanding throughout the years with first a relocation from our small main street location to our current location. In 2008 Sheridan Memorial Hospital added a Rehab suite including exam rooms, prep area, work out area and a hydrotherapy pool. The hospital has an active medical staff of one physician, two family nurse practitioners and two physician assistants as well as consulting medical doctors in the fields of radiology and surgery. Services provided at the hospital include: x-ray technology, physical, occupational and speech therapy, laboratory testing, visiting nurse and hospice care, durable medical equipment and home oxygen sales, social services and emergency services. In 2010 Sheridan Memorial became the first contracted tele-health VA clinic in the country offering area veterans' primary health care via tele-video equipment. Part VI, Line 5: Sheridan Memorial's governing body is comprised of all residents of Sheridan Memorial's primary service area who are not employed by the facility. Sheridan Memorial has expanded medical staff privileges to an MD who has his own private Clinic in the area. Medical privileges are also extended to qualified physicians in the community and providers willing to see Sheridan Memorial patient's via tele-med/video conference. The Board of Directors is made up of volunteers from the community. We try to have representation of the board from individuals throughout the county and not just of those living in Plentywood. Surplus funds are applied back to patient care and education. We offer many services which are a community benefit to the communities we serve which include the following:* Alzheimer's support group offered free of charge* Grief counselor does counseling free of charge* Use of telemedicine equipment is open to the community for use such as mental health visits, behavioral health classes, MIP classes, Lunch and Learns community educational tele-meds when available, Lifestyle balance classes for community members as well as continuing education courses for employees, other medical personnel outside of Sheridan Memorial such as Pharmacists etc. all free of charge* ER open 24 hours regardless of ability to pay* Participates in education of healthcare professionals* Participates in government sponsored health programs* Sheridan Memorial is involved in community outreach through the Sheridan County Chamber, Council on Aging, a working relationship with County Health among other involvements. * Through a grant received, offers free Marketplace Health insurance assistance to help educate and enroll residents in health insurance. The Navigator does promotions throughout the enrollment period and works with community members from start to finish.* Assist community members in applying for State Medicaid assistance and SSDI. Applications can be confusing and the process frustrating thus Sheridan Memorial offers any help to get patients the help they need* Sole community provider of most service lines* Offers volunteer opportunities to community through Hospice, EMS, Activities, Beauty Shop, Pink Lady Program as well as gift shop staffing. * Has a foundation that serves as a vehicle for attracting and effectively using donated funds * Has the support of an Auxiliary that hosts events throughout the year to raise funds for the health care facility. X 0 0 X X X 0 0 0 0 0 0 0 0 0 Adam Graham PA 136264 0 14323 0 9629 0 0 0 16114 0 176330 0 0 0 Carlos Trevino MD 257954 0 10000 0 0 0 0 0 16720 0 284674 0 0 0 Part I, Line 1a A housing allowance was provided for highest compensated employees Adam and Lynne Graham. This was included as compensation on Adam's Form W-2. Form 990, Part VI, Section A, line 1 The Executive Committee shall consist of the President, as Chairman, the Vice Chairperson and the Secretary/Treasurer. The Executive Committee shall have the power to transact all regular business of the hospital during the period between the meetings of the Board of Directors subject to any prior limitations imposed by the Board of Directors. Form 990, Part VI, Section A, line 3 The hospital has a management agreement with Billings Clinic. They provide general accounting, HR, and business support services. Greg Maurer, CEO, is an employee of Billings Clinic and is compensated by Billings Clinic. Wages and benefits for fiscal year 2016 were $153,032 Kyle Gee's, Regional CFO, compensation from the management company for Sheridan's portion of his compensation was $12,090 for fiscal year 2016. Form 990, Part VI, Section A, line 4 Bylaws were updated in February 2016 to indicate that a quorum for the transaction of business at the annual meeting shall consist of not less than five percent of the members of the corporation, present, in person or duly certified proxy. Form 990, Part VI, Section A, line 6 Sheridan Memorial Hospital Association has 778 lifetime voting members. These members are granted voting privileges in electing/re-electing association board members. Form 990, Part VI, Section A, line 7a Sheridan Memorial Hospital Association has 778 lifetime voting members. These members are granted voting privileges in electing/re-electing association board members during the Annual Meeting held the third Tuesday of February every year. Form 990, Part VI, Section B, line 11 The board reviews an electronic copy of the Form 990 before the final copy is filed with the IRS. Form 990, Part VI, Section B, line 12c The Board of Directors, CEO, and meeting secretary are annually required to sign the conflict of interest policy. The board members review any potential conflicts to determine if a conflict exists. If there is a conflict of interest, the conflicted board member is not included in the vote on the particular matter. If the transaction is relating to a particularly sensitive topic, the conflicted board member may be asked to excuse themselves from both the discussion and the vote. Form 990, Part VI, Section B, line 15 Billings Clinic, along with input from the SMH Board of Directors, determines compensation for the CEO. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available upon request. Sheridan Health Care Foundation Inc 440 W Laurel Avenue Plentywood MT 59254 810496987 Support activities of Sheridan Memorial Hospital Association MT 501(c)(3) Line 7 N/A 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 1