2016-02-15T07:46:23-06:00 2015-03-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-04-01 810241755 St John's Lutheran Hospital Inc STJO 4062837000 209 Health Park Drive Libby MT 59923 Brigid Burke CFO 4062837000 2016-02-12 1 Kim Hunwardsen CPA P00484560 6122536500 2016-02-12 2014 2016-08-17 19:52:53Z Cabinet Peaks Medical Center Bruce Whitfield 209 Health Park Drive Libby MT 59923 31336973 0 X www.cabinetpeaks.org X 1952 MT Healthcare services. 8 7 270 58 0 0 194423 327607 28616476 29848669 49437 1412 33486 11074 28893822 30188762 5261 5692 0 0 17055912 16075404 0 0 91372 12559865 14153096 29621038 30234192 -727216 -45430 51281741 48898801 30689484 28271946 20592257 20626855 X Committed to quality, compassionate care. 0 1 23449765 5692 29848669 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. In fiscal year 2015, Cabinet Peaks Medical Center provided services to 10,052 patients amounting to a total of 12,645 adjusted patient days. Just over 1,000 surgeries (1,019) were performed and 2,224 patients received 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 $1,280,635 during the year ended March 31, 2015. The estimated cost of providing these services was approximately $824,000 for the year ended March 31, 2015, 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. 23449765 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 68 0 1 270 1 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 1 0 0 0 0 1 0 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 Dinning 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 Chari Lucas Trustee until April 2014 1.00 0.00 X 0 0 0 Bob Castaneda Trustee 1.00 0.00 X 0 0 0 Anne Camber MD Trustee until Dec. 2014 40.00 0.00 X 256132 0 56284 Charles LaGoy MD Trustee 1.00 0.00 X 0 0 0 Bruce Whitfield CEO 40.00 1.00 X 226758 0 106931 Brigid Burke CFO 40.00 0.00 X 76635 0 24217 Anita Ivankovig CNO 40.00 0.00 X 79149 0 16316 Joshua Urvater Physician 40.00 0.00 X 306376 0 48741 Mark Serra Physician 40.00 0.00 X 278720 0 46563 Raymond Zurcher Physician 40.00 0.00 X 231700 0 50759 Jay Maloney Physician 40.00 0.00 X 267816 0 48951 Nicolle Benz Physician 40.00 0.00 X 244324 0 52565 1967610 0 451327 18 0 1 0 Kalispell Regional Medical Center 310 Sunnyview Lane Kalispell MT 59901 Software maintenance & support, lab & di 978184 Pathology Associates Medical Laboratory PO Box 2720 Spokane WA 99220 Reference Laboratory Services 129614 2 146425 180732 450 327607 Net Patient Service Revenue 622110 29148166 29148166 Other Revenue 900099 534620 534620 Cafeteria 722210 153224 153224 Auxiliary Revenue 900099 12659 12659 29848669 61926 61926 108148 97074 11074 11074 11074 973106 17517 946204 104933 26902 -87416 -60514 -60514 30188762 29848669 0 12486 4388 4388 1304 1304 866526 312416 554110 331012 331012 11767549 9283690 2438893 44966 392395 348300 42454 1641 1819759 1491487 321449 6823 898163 669402 225658 3103 86408 86408 132905 132905 39258 39258 2279171 1881192 397979 84805 297 84508 468062 375974 81420 10668 505831 364995 140836 177804 114163 63599 42 3626 3626 966749 966749 3194011 3194011 512492 37 512455 Medical Supplies 2395730 2388855 6875 Bad Debts 1542703 1542703 Repairs and Maintenance 817198 560632 250980 5586 Licenses and taxes 132112 18968 113144 814231 479531 316157 18543 30234192 23449765 6693055 91372 1996725 3472718 4393908 5349931 12917 531282 659076 478684 501224 51272847 17262894 36977081 34009953 2811125 3029465 1429398 1539230 9597 2641024 337204 51281741 48898801 3485281 2882982 241051 175351 26963152 25213613 30689484 28271946 X 19537107 19537990 154839 198094 900311 890771 20592257 20626855 51281741 48898801 X -45430 -23519 103547 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 7812 12660 6375 14097 0 372000 867280 1239280 30225933 5893618 24332315 16454150 10505658 5948492 3353484 863618 2489866 34009953 X 28569595 -1542703 -1542703 30112298 76464 76464 30188762 28767735 82621 82621 28685114 1549078 1549078 30234192 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 2011. Part XI, Line 2d - Other Adjustments: Provision for bad debts included in revenue on financial statements -1,542,703. Part XI, Line 4b - Other Adjustments: Contributions from related organizations in fund balance on financial stmt 146,425. Auxiliary revenue not included in financial statements 12,660. Rental expenses recorded in expense on the financial statements -82,621. Part XII, Line 2d - Other Adjustments: Rental expenses recorded in expense on the financial statements 82,621. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in revenue on financial statements 1,542,703. Auxiliary expenses not included in financial statements 6,375. 1 1 X 1 X 1 X 280.000000000000 1 1 0 1 1 824000 824000 0.02870 824000 824000 0.02870 11 1937 26126 664 25462 0.00090 4832714 4152993 679721 0.02370 3 720 720 0.00000 14 1937 4859560 4153657 705903 0.02460 14 1937 5683560 4153657 1529903 0.05330 1 230 594 594 0.00000 1 608 608 0.00000 2 230 1202 1202 1 1542703 0 7686047 7723819 -37772 X 1 1 1 1 Cabinet Peaks Medical Center 209 Health Park Drive Libby MT 59923 www.cabinetpeaks.org 13545 X X X X 2 provider based clinics 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 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: Cabinet Peaks Medical Center is responding to the need to "improve access to healthcare in Cabinet Peaks Medical Center service area" through our commitment to increase access to primary care providers. CPMC is actively recruiting primary care providers and determining the feasibility of a provider-based rural health clinic. Cabinet Peaks Medical Center is responding to the need to "continually improve the quality of care provided at CPMC" through our commitment to educate staff on quality of care standards and work towards becoming eligible for the Quality Improvement Organization award.Cabinet Peaks Medical Center is responding to the need to "improve access to healthcare services through increased awareness of hospital services available" by working towards improving community perception of the Hospital.Cabinet Peaks Medical Center is responding to the need to "improve access to mental health services in Libby community" by exploring the potential development of a crisis stabilization center in Lincoln County and exploring the additional of other mental health services. Cabinet Peaks Medical Center is responding to the need to "raise awareness of alcohol and substance abuse in Lincoln County" by partnering with other community organizations to raise awareness about local community resources. The following needs identified by the Health Needs Assessment were not specifically addressed by CPMC in its Implementation Plan for the following reasons:1. Asbestos related disease was selected by 64.4% of respondents as a serious health concern. * Another organization, the Center for Asbestos Related Disease, is working to address asbestos concerns and issues in Lincoln County. 2. Overweight/obesity was selected by 33.1% of respondents as a serious health concern. * Although this need is not being addressed directly, the facility is focusing on increasing its community education efforts. The facility currently holds a weight loss and diabetes prevention class that is open to the public, as well as a quarterly Health 411 educational series which often speaks to this topic. 3. 44.8% of respondents indicated that more specialists would improve access to healthcare services in the area. * Cabinet Peaks Medical Center offers a variety of specialty services, including 13 visiting specialists. At this time the facility does not have the resources to add more. 4. 54.9% of respondents reported delaying or not receiving healthcare because it costs too much. Similarly, focus group participants expressed concern about the high cost of services at the hospital. * The cost of services at Cabinet Peaks Medical Center are comparable to other hospitals in the region. 5. 16.6% of respondents indicated a need for local rheumatology services. * At this time the hospital does not have the resources to recruit or support a rheumatologist. 6. 14.1% of respondents indicated a need for a county health nurse. * The state is responsible for county health nurse services. 7. Focus group participants indicated a need for pediatric services in Lincoln County. * At this time the hospital does not have the resources to recruit or support a pediatrician. 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: All self pay patients receive a 30% discount. If the eligible individual is a self pay patient, we charge a rate lower than our lowest negotiated commercial insurance rate. If the eligible individual has insurance, then we charge in accordance with the applicable insurance contract. The maximum charge for a self-pay patient who qualifies for Financial Assistance is 60%, as all self pay receive at least a 30% discount, which is a rate lower than our lowest negotiated commercial insurance rate. If the eligible individual has insurance and is still eligible for Financial Assistance, then we charge in accordance with the applicable insurance contract, and the patient's remaining balance may be eligible for an additional 10% discount. (Note: this is determined by subtracting the lowest discount rate in the policy from 100%.) 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 V, Section B, Line 16 Financial Assistance Policy Website Availability Cabinet Peaks Medical Center Part V, Section B, line 16b website: www.cabinetpeaks.org Cabinet Peaks Medical Center Part V, Section B, line 16c website: www.cabinetpeaks.org 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 $1,542,703. 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. 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. In addition, the hospital employs a full-time trained patient financial services counselor to assist patients in determining if they qualify for Medicaid as well as free or discounted care. 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, 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 Peaks 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 Peaks 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 X 1 1 X X X 0 0 0 0 0 0 0 1 0 Anne Camber MD Trustee until Dec. 2014 179055 0 19655 0 57422 0 13010 0 43274 0 312416 0 0 0 Bruce Whitfield CEO 194258 0 32500 0 0 0 30533 0 76398 0 333689 0 0 0 Joshua Urvater Physician 239470 0 10000 0 56906 0 12850 0 35891 0 355117 0 0 0 Mark Serra Physician 250720 0 0 0 28000 0 12850 0 33713 0 325283 0 0 0 Raymond Zurcher Physician 198902 0 0 0 32798 0 12478 0 38281 0 282459 0 0 0 Jay Maloney Physician 217816 0 0 0 50000 0 12850 0 36101 0 316767 0 0 0 Nicolle Benz Physician 226757 0 0 0 17567 0 12800 0 39765 0 296889 0 0 0 Part I, Line 1a As part of Anita Ivankovig (CNOs) relocation, CPMC housing was provided to Anita. She had an allowance of up to 3 months per terms of the Housing Benefit Usage Policy. A Housing Benefit of $1,800 was added to her 2014 W2. Anita Ivankovig also received $140 in gym membership dues that was added to her 2014 W-2. Part I, Line 7 Dr Camber and Dr. Urvater had potential for quarterly bonuses based on volumes. Bruce Whitfield, Brigid Burke, and Anita Ivankovig have "compensation at risk" that is provided based on performance metrics. Frank Lucas Spouse of Trustee 71778 Salary and benefits as an employee 0 Joshua Urvater Spouse of Trustee 204320 Salary and benefits as an employee 0 Julie Hopfer Sister of Trustee 21112 Salary and benefits as an employee 0 Melanie Courteau Daughter of Trustee 33802 Salary and benefits as an employee 0 Form 990, Part III, line 3 CPMC had previously employed an Orthopedic Surgeon and OB-GYN. During Fiscal Year 2015, the couple moved out of the Libby community. An independent Orthopedic Surgeon group still operates in Libby and performs surgeries at CPMC. CPMC began to recruit for another OB-GYN after Dr. Camber left in December 2014. The community's Family Medicine with OB providers continued to provide birthing services at CPMC. Form 990, Part VI, Section A, line 4 The Bylaws were amended in August 2014 to remove language regarding the Executive Committee. The Board of Directors shall operate as a committee of the whole. A special committee may be appointed by the Board of Directors from time to time, including a Finance Committee or a Nominating Committee, to undertake any funsction or task. Form 990, Part VI, Section A, line 8b No committee has the authority to act on behalf of the governing body. 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 on an annual basis, and also takes into account local economic factors and specific job responsibilities. The Board reviews Administration's recommendations annually and determines compensation for the CEO, CFO and CNO. The process is documented and the last review was performed in 2014. 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 unrestricted investment in net assets of Foundation 76,117. Change in temporarily restricted investment in Foundation 43,255. Change in permanently restriced investment in Foundation -9,540. Change in St. John's Hospital Auxiliary assets -6,285. 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 0 0 0 0