2017-05-15T16:53:33-05:00 2016-06-30 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2015-07-01 810286525 Stillwater Hospital Association % KELLEY HARMON STIL 4063225316 710 N 11th St Columbus MT 59019 KELLEY EVANS CAO 4063225316 2017-05-15 true Adam R Smith CPA P00958966 7194714290 2015 2021-01-29 14:40:06Z DR DEBORAH AGNEW MD 710 N 11th St Columbus MT 59019 9964195 false X www.stillwaterbillingsclinic.com X 1914 MT Stillwater Hospital Association is a rural integrated health care organization bringing together a physician clinic & hospital svcs to deliver quality coordinated care. 9 5 65 5 0 420175 138527 9049799 9777223 43527 31744 47272 -2223 9560773 9945271 5385 4929 0 0 2691464 3257627 0 0 0 6096947 6299721 8793796 9562277 766977 382994 17570478 17610146 14374429 14072199 3196049 3537947 STILLWATER HOSPITAL ASSOCIATION IS A RURAL INTEGRATED HEALTH CARE ORGANIZATION BRINGING TOGETHER A PHYSICIAN CLINIC & HOSPITAL SERVICES TO DELIVER QUALITY COORDINATED CARE. false false 7558948 4929 9768192 ACUTE CARE HOSPITAL AND RURAL HEALTH CLINIC 7558948 true true false false false false false false false true true false false false true false false true false false false false false false true false true true false false true false false false false false false false false false false false false false true false false true 6 0 true 65 true false false false false false true true false false false false X 9 5 false false false false true true true true true false false true true true true true true false false false X KELLEY HARMON 9706574612 2800 TENTH AVENUE N Billings MT 59107 X Michael Matovich President 3.0 0.0 X X 0 0 0 Luke Kobold Vice President 3.0 40.0 X X 0 154913 33674 Ron Martinez Secretary/Treasurer 3.0 0.0 X X 0 0 0 John Hungerford Past President 3.0 0.0 X 0 0 0 Dr Camilla Reese Director 3.0 40.0 X 0 295708 35932 Dr Richard Klee Director/physician 40.0 1.0 X 0 312994 38314 Mike Follett Director 3.0 40.0 X 0 184254 20317 Bharat Acharya Director 3.0 0.0 X 0 0 0 Dan Vesbach Director 3.0 0.0 X 0 0 0 Dr Deborah Agnew CEO 18.0 4.0 X 0 261358 37205 Kelley Evans CAO 20.0 0.0 X 0 162795 27061 Kyle Gee CFO 10.0 30.0 X 0 329496 38425 Dr David Kane Physician 40.0 0.0 X 0 253635 49085 0 1955153 280013 0 false true false BILLINGS CLINIC 2800 Tenth Avenue North BILLINGS MT 59101 management services 2524445 WILDERNESS MEDICAL STAFFING PO BOX 616 HOMER AK 99603 MEDICAL STAFFING 179575 2 33074 105453 138527 PATIENT SERVICE REVENUE 621300 9766491 9766491 MEALS 900099 10732 10732 9777223 31744 31744 0 0 0 0 0 0 15000 33074 18924 -3924 -3924 0 0 MISCELLANEOUS INCOME 900099 1701 1701 1701 9945271 9768192 38552 4929 4929 0 0 0 537681 486292 51389 0 0 2316423 1720159 596264 24234 18085 6149 210560 156657 53903 168729 124025 44704 1747334 1424181 323153 4180 4180 7540 7540 0 0 0 872891 756521 116370 52896 29397 23499 303825 128244 175581 0 0 217967 172194 45773 71608 54537 17071 0 0 800305 631955 168350 0 959969 688452 271517 104738 21075 83663 PROVISION FOR BAD DEBT 620931 620931 MEDICAL SUPPLIES 455436 455436 DIETARY 50619 50504 115 REPAIRS & MAINTENANCE 18103 9448 8655 11379 5926 5453 9562277 7558948 2003329 0 1768459 2444965 821380 1048700 0 0 1259998 1256484 0 0 0 0 0 0 166162 184089 158943 176688 16175532 4167628 12890972 12007904 466691 458976 0 0 0 0 0 0 37873 32340 17570478 17610146 312024 507320 0 0 0 0 0 0 0 0 0 0 13654273 13301067 0 0 408132 263812 14374429 14072199 X 2977018 3406178 199031 111769 20000 20000 3196049 3537947 17570478 17610146 382994 -41096 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 29088 88 29176 29001 87 29088 28914 87 29001 28813 101 28914 0 28813 28813 0.31450 0.68550 0.00000 false false 558194 558194 12088220 2140745 9947475 2616384 1678652 937732 912734 348231 564503 12007904 0 DUE TO RELATED ORGANIZATION 263812 263812 9308213 -41096 24969 -16127 9324340 620931 620931 9945271 8962293 20947 20947 8941346 620931 620931 9562277 Schedule D, Part V, line 4 DESCRIBE INTENDED USE OF THE ORGANIZATION'S ENDOWMENT FUNDS: The endowment includes both donor-restricted endowment funds and funds designated by the governing body to function as endowments (board-designated endowment funds). As required by accounting principles generally accepted in the United States of America GAAP), net assets associated with endowment funds, including board-designated endowment funds, are classified and reported based on the existence or absence of donor-imposed restrictions. Schedule D, PART X, LINE 2 UNCERTAIN TAX POSITIONS: Management has evaluated their income tax positions under the guidance included in asc 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. SCHEDULE D, PART XI, LINE 2D REVENUE ON BOOKS, NOT ON RETURN: ACTIVITY OF STILLWATER FOUNDATION CONSOLIDATED IN FINANCIALS, EXCLUDED FOR TAX RETURN 6,045 SPECIAL EVENT EXPENSE 18,924 TOTAL 24,969 SCHEDULE D, PART XI, LINE 4B REVENUE ON RETURN, NOT ON BOOKS: BAD DEBT NET WITH REVENUE ON FINANCIALS, TREATED AS EXPENSE ON TAX RETURN 620,931 SCHEDULE D, PART XII, LINE 2D EXPENSE ON BOOKS, NOT ON RETURN: ACTIVITY OF STILLWATER FOUNDATION CONSOLIDATED IN FINANCIALS, EXCLUDED FOR TAX RETURN 2,023 SPECIAL EVENT EXPENSE 18,924 TOTAL 20,947 SCHEDULE D, PART XII, LINE 4B EXPENSE ON RETURN, NOT ON BOOKS: BAD DEBT NET WITH REVENUE ON FINANCIALS, TREATED AS EXPENSE ON TAX RETURN 620,931 JEWEL 48074 33074 15000 675 7625 4013 6611 0 48074 33074 15000 675 7625 4013 6611 18924 -3924 true true X true X true X true true true false true true 85311 85311 0.00950 478504 408456 70048 0.00780 563815 408456 155359 0.01730 4929 4929 0.00060 4929 4929 0.00060 568744 408456 160288 0.01790 true 620931 0 2842404 2719593 122811 X true true 1 1 Stillwater Hospital Association 710 N 11th St Columbus MT 59019 stillwaterbillingsclinic.com 13418 X X X X X PHYSICIAN CLINIC 1 Stillwater Hospital Association false false false true true 50000 true X 100 300. X X X X true true X X X X true X see part v section c X X X X true X false X true X false false SCHEDULE H, PART V, SECTION B, LINE 16b website URL for FAP application form: http://stillwaterbillingsclinic.com/wp-content/uploads/Charity-care.pdf SCHEDULE H, PART V, SECTION B, LINE 16a & 16c Stillwater Hospital Associations (Stillwater) financial assistance policy (FAP) and plain language summary were not made widely available on a website during its fiscal year ended 6/30/2016. The hospital is currently in the process of making adjustments to their FAP, which will be effective in October 2017. Billings Clinic, the sole member of Stillwater, will be taking over Stillwaters revenue cycle to provide a more streamlined approach, which will enable both organizations to serve patients better. Stillwater will then be included in the Billings Clinics FAP. SCHEDULE H, PART I, LINE 7, column f Bad debt expense included on Form 990, part IX, line 25 but excluded for purposes of calculating percentages in this column equal $620,931. SCHEDULE H, PART I, LINE 7 THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS. SCHEDULE H, PART III, Section A, LINE 2 Bad debt is estimated by actual write offs plus a reserve calculated using different percentages based on aging category of receivables. SCHEDULE H, PART III, Section A, LINE 4 See page 12 of the attached audited financial statements for the footnote that describes bad debt expense. SCHEDULE H, PART III, Section C, LINE 9b Patients are screened by the organization's financial counselors to see if they qualify for financial assistance. If they qualify, their account balances are adjusted accordingly. If there is a balance after the adjustment, the organization follows the normal debt collection practice. In unusual situations where the patient's circumstances have changed, the CEO has the authority to grant exceptions to the policy. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: The organization assesses the health care needs of the communities it serves through day to day patient care and the work of the community health services department. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: The Organization employs a Business office lead who is responsible for administering the Financial Assistance Program, assuring the determination for financial assistance meets the requirements of the policy, and notifying the patient and/or responsible party of the final determination of amounts approved under the policy. Patient representatives work with the patients in completing applications that determine eligibility for financial assistance under the hospital's financial assistance policy. Information is also in printed form on patient bills. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: Stillwater County stretches 75 miles of two lane roads from north to south connecting mountain ranges to the lake basins, coulees, and rolling plains. Interstate 90 passes through the County at Columbus. County has population of 9,185 with 6 unincorporated communities and 1 incorporated community of Columbus where the hospital resides. County has a vast array of outdoor recreational opportunities. SCHEDULE H, PART VI, LINE 5 Promotion of community health: Stillwater Hospital Association's Community health services department strives to provide broad-based community health information and services to the residents, facilities and guests of Stillwater County. The board has community members serving. SCHEDULE H, PART VI, LINE 6 Affiliated health care system: Stillwater Billings Clinic is managed by Billings Clinic and works closely with Billings Clinic and other hospitals also managed by Billings Clinic to provide high quality patient care. false true false false false false false Luke Kobold Vice President 0 144084 0 10829 0 0 0 13757 0 19917 0 188587 0 0 Dr Camilla Reese Director 245708 0 50000 23275 12657 331640 0 Dr Richard Klee Director/physician 0 138497 0 50847 0 123650 0 21740 0 16574 0 351308 0 0 Mike Follett Director 0 160419 0 23835 0 0 0 16425 0 3892 0 204571 0 0 Dr David Kane Physician 0 124093 0 10000 0 119542 0 21780 0 27305 0 302720 0 0 Dr Deborah Agnew CEO 0 258503 0 0 0 2855 0 22453 0 14752 0 298563 0 0 Kelley Evans CAO 0 141178 0 20000 0 1617 0 13504 0 13557 0 189856 0 0 Kyle Gee CFO 0 233483 0 46890 0 49123 0 20303 0 18122 0 367921 0 49123 SCHEDULE J, PART I, LINE 3 DESCRIBE HOW CEO COMPENSATION IS DETERMINED: COMPENSATION FOR THE CEO IS PAID BY BILLINGS CLINIC, A RELATED ORGANIZATION. PLEASE SEE SCHEDULE O, PART VI, LINE 15A NARRATIVE FOR HOW CEO COMPENSATION IS DETERMINED. SCHEDULE J, PART I, LINE 4B 457(F) PLAN: The Billings Clinic supplemental retirement agreement for senior executives (SERP) is a non-elective 457(f) agreement and provides for annual deferrals, which become vested and payable after 4 years. Vesting will occur on January 1, 2017. Kyle Gee participated in the plan and a payment of $49,123 was made during 2015 and is included in other reportable compensation on Schedule J, Part II, column B (III). Form 990, Part VI, Section A, Line 6 DESCRIBE CIRCUMSTANCES FOR HAVING MEMBERS: Billings Clinic is the sole member of Stillwater Hospital Association. Form 990, Part VI, Section A, Line 7a Members who can elect members of the governing body: The sole member has authority to recommend, approve and reject nominations of board members. Form 990, Part VI, Section A, Line 7b Decisions of governing body subject to approval by members: The following are Governance decisions of the organization which are subject to approval by the sole member: - Amendments to the organization's articles of incorporation, bylaws, or name; - Dissolution, mergers, or consolidations with or into another entity; - Sale, lease, exchange or dispositions of property of the organization; - Approval of budgets; - Incurrence or debt and purchases made by the organization in amounts exceeding $100,000; - Selection, hiring, primary supervision, discipline and termination of the organization's Chief Executive Officer; - Addition or discontinuance of any service offered to by the organization. Form 990, Part VI, Section B, line 11b Process to Review the Form 990: The form 990 is prepared by a third party and review is performed by the board of directors. Any changes and comments are provided back to the preparer and the final form 990 is provided to the full board prior to filing. The organization was provided an e-file submission form with the completed return which was signed and submitted for ERO processing. Form 990, Part VI, Section B, line 12c Process for Monitoring Compliance with Conflict of Interest Policy: All directors, officers, employees, and members of a committee with board delegated powers are covered by the conflict of interest policy and must provide an annual statement indicating they have reviewed and are in compliance with the policy. The board is charged with periodically reviewing and monitoring the policy to ensure the organization acts in a manner consistent with its charitable purpose. If a potential conflict is identified, the board will investigate any alternatives and determinations as to whether the transaction or arrangement is in the organizations best interest and will establish procedures for violations of the policy. Form 990, Part VI, Section B, line 15a Describe process for determining CEO/Executive compensation: Compensation is paid through Billings Clinic, the sole member. Compensation is determined by an annual review of external market data for similar size organizations through use of survey data with MHA and Yaffee & Company, and Rural Critical Access Hospital facilities. Compensation is reviewed and approved by the Board of Directors as recommended by the VP of Regional Services. The review is done at the time of the CEO's annual performance review. Form 990, Part VI, Section B, line 15b DESCRIBE PROCESS FOR DETERMINING COMPENSATION OF OTHER OFFICERS: Other officer Compensation is paid through Billings Clinic, the sole member. Salaries for the other key officers/leaders in the organization are reviewed for comparison to other similar size organizations through use of external salary survey sources such as MHA and Associated Employers. This review is conducted by Stillwater's HR Generalist and the CEO. Budget recommendations are formulated for review and approval by the VP of Regional Services and for final approval by the Board of Directors/Finance Committee. Form 990, Part VI, Section C, line 19 DESCRIBE HOW DOCUMENTS ARE MADE AVAILABLE TO THE PUBLIC: The organizations governing documents, conflict of interest policy, and financials statementS are available upon request. Billings Clinic (BC) 2800 Tenth Avenue North Billings MT 59101 810231784 HOSPITAL MT 501(c)(3) LINE 3 NA false Billing Clinic Foundation 2917 Tenth Avenue North Billings MT 59101 810407289 FUNDRAISING MT 501(c)(3) LINE 7 BC false STILLWATER COMMUNITY HEALTHCARE FDN 710 N 11TH ST COLUMBUS MT 59019 200748325 fundraising MT 501(c)(3) Line 7 stillwater true New West Health Services 130 Neill Avenue Helena MT 59601 841418136 Insurance Sales MT Billings Clinic C-Corporation Billings Clinic Express Care LLC 2800 10th Avenue north Bilings MT 59101 463355499 Outpatient Clinic MT Billings Clinic C-Corporation false false false true true false false false false false false false true true true true false false false