2017-02-14T15:43:49-06:00 2016-03-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-04-01 810241755 St John's Lutheran Hospital Inc STJO 4062837000 209 Health Park Drive Libby MT 59923 Brigid Burke CFO 4062837000 2017-02-14 1 Kim Hunwardsen CPA P00484560 6122536500 2017-02-14 2015 2021-01-29 14:40:06Z Cabinet Peaks Medical Center Bruce Whitfield 209 Health Park Drive Libby MT 59923 33842057 0 X www.cabinetpeaks.org X 1952 MT Healthcare services. 8 6 264 58 0 0 327607 199304 29848669 31447750 1412 -138195 11074 -59056 30188762 31449803 5692 2822 0 0 16075404 15469629 0 0 78879 14153096 14568439 30234192 30040890 -45430 1408913 48898801 49241777 28271946 27229819 20626855 22011958 X Committed to quality, compassionate care. 1 1 23695121 2822 31297569 Cabinet Peaks Medical Center operates a 25 bed critical access hospital providing medical services to the residents of Lincoln County. Due to the remote location of Lincoln County, Cabinet Peaks serves a critical role in caring for the medical needs of its community, as the next closest emergency room is over 50 miles away and the nearest regional hospital is 90 miles away. As such Cabinet Peaks makes it a priority to provide an Intensive Care Unit, 24/7 Emergency Services, Birthing Services, and extensive Surgery Services. Cabinet Peaks also offers a complement of outpatient services, including a variety of rehab and therapy services, infusion and chemotherapy, imaging, and lab. Continued on Schedule O.Patients often do not have the luxury of time or money or the physical strength necessary to make the 90 mile trip to Kalispell to receive these services, which is why Cabinet Peaks recognizes the value of providing these services close to home. In fiscal year 2016, Cabinet Peaks Medical Center provided services to 9,453 unique patients amounting to a total of 12,596 adjusted patient days. Just over 1,000 surgeries (1,043) were performed. CPMC provided 2,283 patient encounters for rehab services. As Lincoln County consistently has one of the top unemployment rates in the State and is an economically depressed area, many of Cabinet Peaks' patients are uninsured or underinsured, meaning Cabinet Peaks provides a significant amount of uncompensated care.The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. The amounts of charges forgone, based on established rates, were $1,526,203 during the year ended March 31, 2016. The estimated cost of providing these services was approximately $955,000 for the year ended March 31, 2016, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. 23695121 1 1 0 0 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 80 0 1 264 1 0 0 0 0 0 0 0 0 0 0 X 8 6 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Gayl Smith Controller 4062837139 209 Health Park Drive Libby MT 59923 Steve Sorenson OD Chair 1.00 0.00 X X 0 0 0 John Konzen Vice Chair 1.00 0.00 X X 0 0 0 Sarah Sorensen Secretary/Treasurer 1.00 0.00 X X 0 0 0 Russ Barnes Trustee 1.00 0.00 X 0 0 0 Kerry Beasley Trustee 1.00 0.00 X 0 0 0 Kathy Nelson Trustee 1.00 0.00 X 0 0 0 Manuel Castaneda Trustee 1.00 0.00 X 0 0 0 Joseph Nicoletto MD Trustee 31.00 0.00 X 197100 0 46878 Bruce Whitfield CEO 40.00 1.00 X 264282 0 101195 Brigid Burke CFO 40.00 0.00 X 115396 0 63837 Anita Ivankovig CNO 40.00 0.00 X 139752 0 30666 Kathryn Cockerham MD ER Physician 39.00 0.00 X 275505 0 37952 Mark Serra DO ER Physician 50.00 0.00 X 350325 0 33405 Raymond Zurcher MD ER Physician 33.00 0.00 X 225178 0 37184 Jay Maloney MD ER Physician 40.00 0.00 X 294458 0 43734 Judy Marshall HR Manager (thru July 2015) 40.00 0.00 X 183372 0 21508 2045368 0 416359 18 0 1 0 Kalispell Regional Medical Center 310 Sunnyview Lane Kalispell MT 59901 Software maintenance & support, lab & di 1430480 Cardinal Health 21377 Network Place Chicago IL 60673 Pharmacy management services 394962 GE Healthcare PO Box 96483 Chicago IL 60693 Diagnostic imaging equipment maintenance 216535 Thomas Cuisine Management 700 E Franklin Rd Meridian ID 83642 Cafeteria and diabetes and nutrition man 144547 Comphealth PO Box 972651 Dallas TX 75397 Staffing services 122849 5 5450 68804 125050 199304 Net Patient Service Revenue 622110 30407978 30407978 Other Revenue 900099 597614 597614 Cafeteria 722210 279252 279252 Change in Interest in Foundation 900099 150181 150181 Auxiliary Revenue 900099 12725 12725 31447750 26277 26277 122894 181950 -59056 -59056 -59056 2045832 2032304 178000 13528 -178000 -164472 -164472 31449803 31447750 0 -197251 2822 2822 950421 396512 553909 64822 64822 11333219 9001963 2292016 39240 355466 319650 34409 1407 1952904 1583505 362475 6924 812797 626194 183885 2718 44575 44575 2981207 2450366 524089 6752 86046 7768 78188 90 807639 616814 187060 3765 270337 232753 37584 163911 121737 42174 3450 3450 945086 945086 2980943 2980943 454604 454604 Medical Supplies 2863849 2857012 6837 Bad Debts 1637206 1637206 Repairs and Maintenance 1006551 709808 296743 Licenses and taxes 151641 14296 137345 171394 70950 82461 17983 30040890 23695121 6266890 78879 3472718 6750477 5349931 5281195 659076 654268 501224 519180 50999099 20003854 34009953 30995245 3029465 3082873 1539230 1689411 337204 269128 48898801 49241777 2882982 2651329 175351 36859 25213613 24541631 28271946 27229819 X 19537990 20800324 198094 363606 890771 848028 20626855 22011958 48898801 49241777 X 1408913 -28402 4592 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 14097 12725 17317 9505 0 194000 867280 1061280 30067122 7260434 22806688 16477560 11644672 4832888 3393137 1098748 2294389 30995245 X 29813288 -1637206 -1637206 31450494 -691 -691 31449803 28565607 179240 179240 28386367 1654523 1654523 30040890 Part IV, Line 1b: The assets of St. John's Hospital Auxiliary are held by Cabinet Peaks Medical Center. The auxiliary account balances were not included in the balance sheet as they are not recorded for audit purposes. Part X, Line 2: The Hospital is a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under 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 Oraganization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. 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 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. The Hospital's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2012. Part XI, Line 2d - Other Adjustments: Provision for bad debts included in revenue on financial statements -1,637,206. Part XI, Line 4b - Other Adjustments: Contribution from Foundation recorded in fund balance on financial statement 15,643. Auxiliary revenue not included in financial statements 12,725. Rent expenses recorded in expenses on financial statements -179,240. Change in interest in net assets of Foundation in fund balance on financials 150,181. Part XII, Line 2d - Other Adjustments: Rent expenses included in revenue on financial statements 179,240. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in revenue on financial statements 1,637,206. Auxiliary expenses not included in financial statements 17,317. 1 1 X 1 X 1 X 280.000000000000 1 1 1 0 1 1 955000 955000 0.03360 3749265 3203885 545380 0.01920 4704265 3203885 1500380 0.05280 9 1002 35786 35786 0.00130 4550349 4142670 407679 0.01440 2 542 542 0.00000 11 1002 4586677 4142670 444007 0.01570 11 1002 9290942 7346555 1944387 0.06850 1 153 153 0.00000 1 153 153 1 1637206 0 7826944 7866923 -39979 X 1 1 1 1 Cabinet Peaks Medical Center 209 Health Park Drive Libby MT 59923 www.cabinetpeaks.org 13545 X X X X 1 provider based clinic Cabinet Peaks Medical Center 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X www.cabinetpeaks.org X 1 14 1 www.cabinetpeaks.org 0 0 1 X 100.000000000000 280.000000000000 X X X 1 1 X X X 1 X www.cabinetpeaks.org X www.cabinetpeaks.org X www.cabinetpeaks.org X X X X X 1 X 0 X X X X 1 X 0 1 Cabinet Peaks Medical Center Part V, Section B, Line 5: In September 2014, surveys were mailed out to the residents in Cabinet Peak Medical Center's service area. Additionally, two focus groups were held to identify the motives of local residents when selecting healthcare providers and to discover reasons why people may leave the Libby area to seek healthcare services. A Steering Committee was convened to assist Cabinet Peaks Medical Center in conducting the CHSD assessment process. A diverse group of community members representing various organizations and populations within the community (ex. public health, elderly, uninsured) came together in August 2014. The Steering Committee met twice during the CHSD process; first to discuss health concerns in the community and offer their perspective in designing the survey instrument and again to review results of the survey and focus groups.The Steering Committee was comprised of public leaders including members of other healthcare organizations, law enforcement, school system, athletic clubs, local politicians, governmental organizations, community service organizations, etcAn Implementation Planning Committee was comprised of Cabinet Peaks Medical Center's leadership team. Cabinet Peaks Medical Center Part V, Section B, Line 11: Goal 1: Improve access to healthcare in the Cabinet Peaks Medical Center service area. In April of 2015, CPMC staff attended a 3RNet seminar and have begun utilizing their recruitment tools for physician recruitment. In March 2016, CPMC hired two primary care providers. CPMC continues to support family medicine residencies and remains a NHSC certified location. Additionally, CPMC researched and began the process of applying for Rural Health Clinic designation for primary care services.Goal 2: Continually improve the quality of care provided at Cabinet Peaks Medical Center. PEAK Team staff Education & Reward Program for PROMISE standards formally started in June 2014 and ended in October of 2015. Inservices were completed in Aug 2015 & recorded inservices were made available for all new employees. CPMC completed 1x1 education of a majority of the nursing staff on HCAHPS in May 2015. As of September 2015, all future managers and providers will receive HCAHPS education as part of their orientation.CPMC continues to track and improve upon our HCAHPS scores. CPMC completed Code Blue Training of Charge nurses in September 2015. Evac Chair training was offered November and December 2015. Dosage Calculation Competency for RNs was completed January 2016. CPMC continues to offer CMEs. CPMC coordinated with KRMC for CEU education via telemed January 2016 for Peds update. CPMC continued its training for new hires on Team STEPPS. Core staff have also been trained. CPMC continues to participate in LEAN projects. CPMC held its first PFAC Focus Group on July 28, 2015 and the second PFAC Focus Group on Feb. 16, 2016.Goal 3: Improve access to healthcare services through increased awareness of hospital services available. CPMC developed scripts for a letter to the editor, patient satisfaction survey, and referrals to friends and family. In September of 2015, CPMC ran a page ad to share highlights from community benefit report. CPMC continued its sponsorship of community initiatives and activities. CPMC started a high school medical mentorship program. 5 Libby senior students participated in the Mentorship for Fall Semester (started 9/2/15). 5 Libby students and 1 Troy student participated in the Mentorship for Spring Semester (started 1/28/16).Goal 4: Improve access to mental health services in the Libby community. In April 2015, CPMC began meeting with MHP, law enforcement, county judge, county officials to work towards developing a crisis center for our community. CPMC worked with local organizations for grant writing assistance. MHP was awarded a grant for mental health services.Goal 5: Raise awareness of alcohol and substance abuse in Lincoln County. CPMC has a staff member on the Board for Unite for Youth, working with the organization to provide ongoing alcohol and substance abuse education to our youth. In January 2015 CPMC hosted a presentation for the community's providers on "An Evidence Based, Systematic Approach to Treating Chronic Pain." Cabinet Peaks Medical Center Part V, Section B, Line 16i: A summary of the financial assistance policy is provided with billing invoices and is posted in the facility's emergency room and waiting rooms and a summary brochure is also posted on the Hospital's website. Cabinet Peaks Medical Center Part V, Section B, Line 22d: Amounts generally billed for emergency or other medically necessary care to individuals who have insurance covering that same care. In determining AGB, CPMC has chosen to use the "Look Back Method", in which AGB is based on Medicare fee for service payment amounts and the amounts paid by private health insurers, as outlined in Internal Revenue Code regulations. Cabinet Peaks Medical Center 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. FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part I, Line 6a: The Organization's community benefit report can be found on its website at www.cabinetpeaks.org. Part I, Line 7: Charity care expense was converted to cost using an overall cost-to-charge ratio addressing all patient segments. Community health improvement services, line 7e, and cash and in-kind contributions, line 7i, are reported based on actual expenses. The cost for subsidized health services on line 7g was determined using the Medicare cost report. Part I, Ln 7 Col(f): The amount of bad debt expense backed out of total expenses to determine the percentage was $1,637,206. Part II, Community Building Activities: Cabinet Peaks Medical Center is officially designated as a Health Professions Shortage Area. Members of the facility work with local groups to enhance economic development. Additionally, employees are committed to environmental improvements. Part III, Line 2: Bad debt is the unpaid obligation for care provided to patients who may be unable or unwilling to pay or who do not qualify for charity care. Prior to any account being classified as bad debt, all payments are applied including contractual allowances and discounts from Medicare, Medicaid, and insurance companies. Accounts from patients qualifying for charity care or the SharePay sliding scale financial assistance program are not written off to bad debt. Every effort is made with the patient in an attempt to collect the outstanding balance. Payments on accounts that were written off as bad debt reduces bad debt expense.The Organization's bad debt is reported as charges incurred during the year. Part III, Line 3: Cabinet Peaks Medical Center budgets for and monitors the level of charity care it provides. The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy cannot be estimated due to the expectation that all eligible individuals would apply for financial assistance. Part III, Line 4: The footnote to the Organization's financial statements that describes bad debt expenses is located in Footnote 1 on page 8 of the attached financial statements. Part III, Line 8: The expenses represent an overall shortfall for the Medicare patient population. The costs themselves are a community benefit as the community would not receive these services if we did not provide them.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: There are no collection efforts for patients who are known to qualify for charity care or who qualify for SharePay, a sliding scale financial assistance program designed to meet the medical financial obligations of the uninsured and underinsured. Part VI, Line 2: A complete community health needs assessment was conducted and completed during the 2015 fiscal year. Cabinet Peaks Medical Center participated in the Community Health Services Development (CHSD) process, a Community Health Needs Assessment (CHNA), conducted by the Montana Office of Rural Health and the National Rural Health Resource Center (NRHRC) in Duluth, Minnesota. The CHNA was funded by the Frontier Medicine Better Health Partnership (FMBHP) Project. Community involvement in steering committee meetings and focus groups enhanced the community's engagement in the assessment process. The hospital also completed and the Board approved our implementation plan with NRHRC for the CHNA in FY15. Throughout FY16, CPMC worked on its implementation plan. Part VI, Line 3: Brochures are available at the hospital in waiting areas. The Financial Assistance information is also available on the Hospital's website and in patient registration materials. Statements regarding the availability of financial assistance are also included in various billing materials. In addition, the hospital employs a full-time trained patient financial services counselor, who is also a certified Navigator, to assist patients in determining if they qualify for Medicaid as well as free or discounted care and to assist patients in signing up for insurance coverage on the exchange. The counselor also provides hands-on assistance to patients applying for other financial assistance such as CHIP's, heating assistance, Medicaid, and WIC. Applications for charity care are also discussed at registration and discharge and with patients who have bills that are past due. Part VI, Line 4: Cabinet Peaks Medical Center is located in Libby in northwestern Montana, 72 miles south of the Canadian border, 89 miles northwest of Kalispell, Montana, and 35 miles east of the Idaho border. Libby became the county seat for Lincoln County in 1909, the county being named after President Abraham Lincoln.Helicopter transport services are available to patients requiring specialized care in a larger hospital in Spokane, Kalispell, or Missoula. The closest hospital is Bonner General Hospital about 47 miles from Libby in Sandpoint, ID. The next largest hospital with additional services is Kalispell Regional Medical Center 90 miles from Libby.CPMC has been designated a Medically Underserved Population and a Health Professional Shortage Area due to our economic challenges, lack of resources and remote location. We are a relatively poor county, with 22.8% of Libby population being at or below the poverty level, compared to a state average of 15.2%. Part VI, Line 5: Cabinet Peaks Medical Center operates a 25 bed critical access hospital providing medical services to the residents of Lincoln County. Due to the remote location of Lincoln County, Cabinet Peaks serves a critical role in caring for the medical needs of its community, as the next closest emergency room is over 50 miles away and the nearest regional hospital is 90 miles away. As such Cabinet Peaks makes it a priority to provide an Intensive Care Unit, 24/7 Emergency Services, Birthing Services, and extensive Surgery Services. Cabinet Peaks also offers a complement of outpatient services, including a variety of rehab and therapy services, infusion and chemotherapy, imaging, and lab. Patients often do not have the luxury of time or money or the physical strength necessary to make the 90 mile trip to Kalispell to receive these services, which is why Cabinet Peaks recognizes the value of providing these services close to home. As Lincoln County consistently has one of the top unemployment rates in the State and is an economically depressed area, many of Cabinet Peaks' patients are uninsured or underinsured, meaning Cabinet Peaks provides a significant amount of uncompensated care. Emergency and other medically necessary services are provided to all persons, regardless of their ability to pay.In addition to the services provided within the Hospital campus, Cabinet Peaks also does a considerable amount of outreach to promote the health of the community. Organizing and funding a community health fair, providing discounted services for mammography, laboratory tests, and x-rays, providing speakers for health lectures, promoting hospital tours for the schools, providing internship opportunities for the schools, and providing support for the recruitment of physicians are just a few ways Cabinet Peaks partners to promote the health of the community. Cabinet Peaks' mission is to provide quality, compassionate, care to its community. Cabinet Peaks' Board of Directors is comprised entirely of residents of Lincoln County, all of whom are considered leaders in the community. With the exception of the Medical Staff representative on the Board, none of the Board members are Cabinet Peak's contractors or employees, meaning they truly do serve the needs of the community. In order to ensure the appropriate medical staff and services are available for patients, Cabinet Peak's medical staff privileges are open to all qualified, licensed physicians in the community and are also extended to physicians who visit Lincoln County in order to offer additional services to our residents. Additionally, in order to ensure the future success of Cabinet Peaks, any and all surplus funds generated by the Hospital are reinvested into operations, capital equipment and infrastructure, including facility upkeep. X 1 1 X X X 1 0 0 0 0 0 0 1 0 Joseph Nicoletto MD Trustee 197100 0 0 0 0 0 13250 0 33628 0 243978 0 0 0 Bruce Whitfield CEO 195282 0 39000 0 30000 0 41076 0 60119 0 365477 0 0 0 Brigid Burke CFO 103395 0 12001 0 0 0 20066 0 43770 0 179232 0 0 0 Anita Ivankovig CNO 119352 0 14160 0 6240 0 3904 0 26762 0 170418 0 0 0 Kathryn Cockerham MD ER Physician 266851 0 0 0 8654 0 2580 0 35372 0 313457 0 0 0 Mark Serra DO ER Physician 350325 0 0 0 0 0 13250 0 20155 0 383730 0 0 0 Raymond Zurcher MD ER Physician 219473 0 0 0 5705 0 11550 0 25635 0 262363 0 0 0 Jay Maloney MD ER Physician 294418 0 0 0 40 0 13250 0 30484 0 338192 0 0 0 Judy Marshall HR Manager (thru July 2015) 61217 0 0 0 122155 0 4079 0 17428 0 204879 0 0 0 Part I, Line 1a Anita Ivankovig also received $240 in gym membership dues. Jay Maloney also received $40 in gym membership dues. Part I, Line 4a Judy Marshall received a separation settlement in the amount of $106,000. Part I, Line 7 Bruce Whitfield, Brigid Burke, and Anita Ivankovig have "compensation at risk" that is provided based on performance metrics. Melanie Courteau Daughter of Trustee 64822 Salary and benefits as an employee 0 Form 990, Part III, line 2 Cabinet Peaks Family Medicine began offering scheduled and same day appointments in addition to walk in services in March 2016. Form 990, Part III, line 3 The CPMC Walk In Clinic moved to its new location and merged with Cabinet Peaks Family Medicine at 350 Louisiana Avenue. Cabinet Peaks Family Medicine began offering scheduled and same day appointments. Form 990, Part VI, Section A, line 1 The Executive Committee has the delegated authority to act on behalf of the Board of Directors. The Executive Committee consists of the Chair, Vice Chair, Secretary/Treasurer, Chief of Staff, Past Chair and one Member at Large. All members of the Executive Committee are also members of the governing body. Form 990, Part VI, Section A, line 2 Steve Sorensen and Sarah Sorensen have a family relationship. Form 990, Part VI, Section B, line 11 A draft copy of the Form 990 will be reviewed in detail by the CFO. The entire board is then provided a copy for review prior to filing of the Form 990 return. Form 990, Part VI, Section B, line 12c The organization reviews the policies for conflict of interest annually for all officers, directors, and key employees along with an annual submission of a conflict of interest form. The board oversees the process and any potential conflicts are discussed by the board. Should a conflict be determined, the conflicted individual abstains from voting on the conflicted issue. Form 990, Part VI, Section B, line 15 Kalispell Regional Medical Center is the management company for the CEO and CFO however, compensation and benefits are directly passed through to Cabinet Peaks Medical Center. The CEO and CFO are considered common law employees of Cabinet Peaks Medical Center. Administration reviews independent salary surveys and other comparability data to determine fair market compensation amounts and also takes into account local economic factors and specific job responsibilities. This is done on an annual basis as part of the budgeting process, The Board reviews Administration's recommendations for rate adjustments annually during the budget process. The Board also determines compensation for the CEO, CFO and CNO. Form 990, Part VI, Section C, line 19 Our Mission and Vision statement, conflict of interest policy, and annual financial statements are available to the public upon request. Requests may be in person, by e-mail, in writing, or by telephone. Form 990, Part XI, line 9: Change in St. John's Hospital Auxiliary assets 4,592. Cabinet Peaks Medical Center Foundation 350 Louisiana Avenue Libby MT 59923 810425832 Support the development of Cabinet Peaks Medical Center MT 501(c)(3) Line 11b, II N/A 0 St John's Real Estate Corporation 350 Louisiana Avenue Libby MT 59923 201538952 Support the development of Cabinet Peaks Medical Center MT 501(c)(2) N/A Cabinet Peaks Medical Center 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0