2016-07-27T16:39:19-05:00 2015-12-31 910189318 Moss Adams LLP 805 SW Broadway Suite 1200 Portland OR 97205 990 2015-01-01 810232122 Benefis Hospitals Inc BENE 4064552563 1101 26th Street South Great Falls MT 59405 TERRY OLINGER ACUTE CARE GROUP PRESIDENT 4064552563 2016-07-06 1 Wendy Campos P00448102 5032421447 2016-07-06 2015 2016-12-15 16:53:06Z TERRY OLINGER 1101 26th Street South Great Falls MT 59405 861445752 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 530 BED HOSPITAL, PROVIDING INPATIENT AND OUTPATIENT SERVICES. 12 7 2954 743 337855 -460444 1877047 206203 762191606 858395675 456650 441875 2031898 1636771 766557201 860680524 0 10512 0 0 120491402 139395265 0 0 0 635749406 700759906 756240808 840165683 10316393 20514841 290629182 402310610 259332930 350528453 31296252 51782157 X WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 0 0 338967537 10512 377293131 BENEFIS HOSPITALS, INC. OPERATES A 530 BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 400868385 0 438189803 BENEFIS HOSPITALS, INC. PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE HOSPITAL ALSO PROVIDES PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH A FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. ALSO PROVIDES SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY and INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS and RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART and VASCULAR, SPORTS MEDICINE, MED SPA and VEIN CENTER. 42338248 0 41000934 BENEFIS HOSPITALS, INC. PROVIDES HOSPICE AND senior care SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 782174170 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 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 1 1 0 0 0 1 0 1 0 1 131 0 1 2954 1 1 1 0 0 0 0 0 0 0 0 0 X 12 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Forrest Ehlinger 4064555479 1101 26th Street South GREAT FALLS MT 59405 Marilyn K Rose Chair 2.00 X X 0 0 0 Bill Ferrin Vice Chair 2.00 X X 0 0 0 Elton J Adams MD Director 2.00 48.00 X 0 316993 8341 Judy E Borland MD Director 2.00 48.00 X 0 150588 2503 Robert M Grasseschi MD Director 2.00 48.00 X 0 442691 10136 Brian Loucks Director 2.00 X 0 0 0 Melchisedek Margaris MD Director 2.00 X 0 0 0 David Richards Director & System Board Liaison 2.00 4.00 X 0 1221 0 Gregory Tierney MD Director 25.00 25.00 X 0 664051 8374 Cal Eklund Director 2.00 X 0 0 0 Senator Edward Buttrey Director 2.00 X 0 0 0 LAURA GOLDHAHN DIRECTOR (1/15) 2.00 X 73563 0 5916 Terry Olinger President Benefis Acute Care Group 26.00 34.00 X X 0 502670 90059 Paul Dolan MD Chief Medical Information Officer 25.00 25.00 X 376249 0 24958 Rayn Ginnaty Vice President of Nursing 50.00 X 209717 0 11361 Kathy Hill Chief Operating Officer Benefis Medical Group 25.00 25.00 X 170357 0 18109 Amy Beames System Senior Vice President 2.00 48.00 X 0 234882 16038 PETER GRAY DIRECTOR SENIOR SERVICES 50.00 X 204108 0 17488 Joseph Loduca Director of Cancer, Heart & Resp. 45.00 5.00 X 179983 0 18971 David Runkel Director of Pharmacy 50.00 X 173172 0 17837 Adam Elliott Medical Physicist 40.00 X 169245 0 18927 Greg Hilpert Director Radiology and Lab 50.00 X 173978 0 16182 Julie Hickethier System VP (Former Key Employee) 0.00 X 547337 0 9866 2277709 2313096 295066 67 1 1 0 PRECYSE SOLUTIONS LLC DEPT 1736 BOX 11407 birmingham AL 35246 MEDICAL RECORDS MANAGEMENT 3503115 Sound Physicians PO Box 742936 Los Angeles CA 90074 Physician Services 2818170 ARAMARK HEALTHCARE FOOD 25271 NETWORK PLACE CHICAGO IL 60673 Food Services 2636213 ARAMARK 12483 COLLECTIONS CENTER DR CHICAGO IL 60693 Clinical Engineering Services 2607986 Aero Air LLC 2050 NE 25th Ave Hillsboro Hillsboro OR 97124 Flight Med Services 2451013 45 167731 38472 115000 206203 PATIENT SERVICES 621990 850943941 850943941 OTHER OPERATIONS 621990 4815742 4815742 CAFETERIA 722210 1911807 1911807 Meaningful Use Funds 621990 726752 726752 joint venture 621110 -2567 -2567 858395675 432652 432652 3662 0 3662 3662 3662 9487 264 9223 9223 9223 1290345 764964 525381 337855 187526 VENDOR REBATES/DISCOUN 900099 989693 989693 Other Income 900099 118035 118035 1107728 860680524 856483868 337855 3652598 10512 10512 890230 890230 124922 124922 115073547 115073547 3479899 3479899 13729040 13729040 6097627 6097627 57741472 57741472 406089 406089 250041 250041 2182063 2182063 14492 14492 13234586 13234586 864074 864074 5139510 5139510 11420571 11420571 881730 881730 contractual adj/charity 446081868 446081868 Purchased Services 51646080 51646080 bad debt expense 37111394 37111394 Medical Supplies 35457122 35457122 38328814 38328814 840165683 782174170 57991513 0 -2360699 -3608498 188312856 307303682 50354 154 7680336 9141362 1804851 548809 194274511 122248347 78271515 72026164 14706292 14901164 8619 2163677 1989154 290629182 402310610 142921535 239492400 82100 111732 110454047 106951516 5875248 3972805 259332930 350528453 X 31296252 51782157 31296252 51782157 290629182 402310610 X 20514841 -31503 2567 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 115000 115000 X 1 1 19782 53706 54115 19373 0 45491495 6635103 38856392 5978505 871987 5106518 141294612 114003429 27291183 1509899 737828 772071 72026164 THIRD-PARTY SETTLEMENTS 3972805 3972805 X Part III, Line 4: THE ORGANIZATION'S COLLECTION IS ARTWORK THAT IS DISPLAYED IN ITS SLETTEN CANCER CENTER AND PROVIDES AN ENVIRONMENT THAT IS HELPFUL FOR PATIENTS. Part IV, Line 1b: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. Part X, Line 2: The Organization is a notforprofit corporation and has been recognized as tax exempt pursuant to Section 501(c)(3) of the IRC. The Organization is exempt from federal income tax under Section 501(c)(3) of the IRC except to the extent of unrelated business taxable income as defined under IRC Sections 511 through 515. Effective January 1, 2009, the Organization adopted accounting for uncertain tax positions. The accounting standard prescribes a recognition threshold and measurement process for uncertain tax positions. The Organization had no uncertain tax positions as of December 31, 2015 or 2014. 1 1 X 1 X 1 X 1 1 0 1 1 4728015 4728015 0.00590 4728015 4728015 0.00590 721888 721888 0.00090 247579 247579 0.00030 10321406 10321406 0.01290 90666 90666 0.00010 1519673 1519673 0.00190 12901212 12901212 0.01610 17629227 17629227 0.02200 17957 17957 0.00000 27116 27116 0.00000 45073 45073 1 37111394 147694067 164963977 -17269910 X 1 1 1 TREASURE STATE HEALTHCARE NETWORK PREFERRED PROVIDER ORGANIZATION SERVING GREAT FALLS AND SURROUNDING AREAS 0.50000 0.00000 0.50000 2 1 BENEFIS HOSPITALS INC EAST CAMPUS 1101 26TH STREET SOUTH GREAT FALLS MT 59405 X X X A 2 BENEFIS HOSPITALS INC WEST CAMPUS 500 15TH AVENUE SOUTH GREAT FALLS MT 59405 X X A BENEFIS HOSPITALS INC 1 0 1 X X X X X X X X X 13 1 1 1 1 X http://www.benefis.org/Main/healthsystem.aspx X 1 14 1 http://www.benefis.org/Main/healthsystem.aspx 0 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X 1 X http://www.benefis.org/Main/billing.aspx X HTTP://WWW.BENEFIS.ORG/MAIN/BILLING.ASPX X HTTP://WWW.BENEFIS.ORG/MAIN/BILLING.ASPX X X X X 1 X 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: BENEFIS HOSPITALS, INC. EAST CAMPUS, - Facility 2: BENEFIS HOSPITALS, INC. WEST CAMPUS BENEFIS HOSPITALS, INC. Part V, Section B, line 5: BENEFIS HOSPITALS OBTAINED INPUT FROM COMMUNITY MEMBERS WHO REPRESENT A BROAD INTEREST OF THE COMMUNITY THROUGH THREE PRIMARY INITIATIVES: (1) BENEFIS HOSPITALS PROVIDED LEADERSHIP, IN CONJUNCTION WITH THE CASCADE COUNTY CITY-COUNTY HEALTH DEPARTMENT, TO A COMMUNITY-WIDE COALITION THAT PLANNED AND DESIGNED THE CHNA. THE COALITION WORKED TOGETHER FOR OVER 18 MONTHS TO DESIGN AND IMPLEMENT A COMMUNITY HEALTH SURVEY AND DEVELOP BOTH CHNA AND CHIP REPORTS. THE COALITION INCLUDED THE CENTER FOR MENTAL HEALTH; THE GREAT FALLS PUBLIC SCHOOL SYSTEM; GATEWAY SERVICES (FOR ALCOHOL AND DRUG ABUSE TREATMENT); THE BENEFIS HOSPITALS, INC. 81-0232122 INDIAN FAMILY HEALTH CLINIC; NORTHCENTRAL MONTANA HEALTHCARE ALLIANCE; PLANNED PARENTHOOD; AND UNITED WAY AMONG OTHER COMMUNITY GROUPS WITH A COMMITMENT TO PUBLIC HEALTH AND HEALTHY COMMUNITIES. (2) A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT SURVEY WHICH WAS DESIGNED AND SENT OUT TO 1,500 HOUSEHOLDS WITH A RESPONSE FROM 1,042 IN AN EFFORT TO OBTAIN BROAD COMMUNITY RESIDENTS' INPUT. (3) ON MAY 17, 2013 A COMMUNITY TOWN HALL WAS CONDUCTED AND HAD 67 INDIVIDUALS REPRESENTING THE GENERAL COMMUNITY, BUT PRIMARILY COMMUNITY HEALTH-CONCERNED AGENCIES. THE INFORMATION FROM THE CHNA WAS PRESENTED AT THE MEETING AND DISCUSSED. THE COMMUNITY GROUP CAME TO A CONSENSUS REGARDING THE HEALTH PRIORITIES FOR OUR COMMUNITY ON THE THREE COMMUNITY HEALTH PRIORITIES THAT HAVE BEEN IN PLACE AND ADDING A FOURTH PRIORITY AREA OF CHILD ABUSE AND NEGLECT. THESE HEALTH PRIORITIES PROVIDED DIRECTION TO DEVELOP THE COMMUNITY HEALTH IMPROVEMENT PLAN AND RELATED STEERING COMMITTEES WHICH CONTINUE TO INVOLVE COMMUNITY AGENCIES IN MAKING PROGRESS IN THE THREE HEALTH PRIORITY AREAS: HEALTHY WEIGHT, SUBSTANCE ABUSE, AND ACCESS TO HEALTH CARE. BENEFIS HOSPITALS, INC. Part V, Section B, line 6a: LIBERTY MEDICAL CENTERNORTHERN MONTANA HEALTHCAREPHILLIPS COUNTY HOSPITALMARIAS MEDICAL CENTERNORTHERN ROCKIES MEDICAL CENTERBIG SANDY MEDICAL CENTERMISSOURI RIVER MEDICAL CENTERMOUNTAINVIEW MEDICAL CENTERTETON MEDICAL CENTERPONDERA MEDICAL CENTER BENEFIS HOSPITALS, INC. Part V, Section B, line 6b: LIBERTY MEDICAL CENTERNORTHERN MONTANA HEALTHCAREPHILLIPS COUNTY HOSPITALMARIAS MEDICAL CENTERNORTHERN ROCKIES MEDICAL CENTERBIG SANDY MEDICAL CENTERMISSOURI RIVER MEDICAL CENTERMOUNTAINVIEW MEDICAL CENTERTETON MEDICAL CENTERPONDERA MEDICAL CENTER BENEFIS HOSPITALS, INC. Part V, Section B, line 11: THE STEERING COMMITTEES FOR EACH OF THE PRIORITY CHNA HEALTH PRIORITY AREAS CONTINUE TO MEET MET SEVERAL TIMES DURING THE YEAR. THIS HAS CONTINUED SINCE STARTING IN JUNE OF 2013. THE COMMITTEES INCLUDE: THE ACCESS TO CARE STEERING COMMITTEE; THE SUBSTANCE ABUSE STREEING COMMITTEE AND THE HEALTHY WEIGHT STEERING COMMITTEE. EACH COMMITTEE DEVELOPED GOALS AND OBJECTIVES FOR EACH OF THEIR AREAS AND ARE INCLUDED IN THE COMMUNITY HEALTH IMPROVEMENT PLAN. THE CHILD ABUSE AND NEGLECT COMMITTEE IS NOW IN THE FORMULATIVE STAGE AND WILL BE ADDRESSED OVER THE NEXT THREE YEARS. BENEFIS HOSPITALS, INC. Part V, Section B, line 22d: THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR CARE IS BASED ON 100% OF TOTAL PATIENT CHARGES BEFORE ANY ADJUSTMENTS OR WRITE-OFFS. 1 1 - BENEFIS SLETTEN HI-LINE CANCER CENTER 40 13TH STREET WEST HAVRE MT 59501 CANCER TREATMENT CENTER Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 37,111,394. PART I, LINE 6A: AS REQUIRED BY MONTANA LAW, THE ORGANIZATION ANNUALLY SUBMITS A COMMUNITY BENEFIT REPORT TO THE MONTANA ATTORNEY GENERAL'S OFFICE, WHICH OVERSEES NONPROFIT CORPORATIONS IN THE STATE. IN 2013, THE ATTORNEY GENERAL'S OFFICE RELEASED TO THE PUBLIC ITS SIXTH ANNUAL REPORT ON THE CHARITABLE ACTIVITIES OF MONTANA HOSPITALS, INCLUDING THE TEN LARGEST HOSPITALS IN THE STATE (WITH THE ORGANIZATION AMONG THEM). THE ORGANIZATION ITSELF ALSO ANNUALLY PREPARES A SUMMARY COMMUNITY BENEFIT REPORT FOR PURPOSES OF EXPLANATION TO THE LOCAL PUBLIC, WHICH IS PUBLISHED IN THE FORM OF A POSTING IN THE LOCAL NEWSPAPER.PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED. Part III, Line 2: THE COSTING METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO. Part III, Line 4: SEE NOTE 2 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. Part III, Line 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID SUBSTANTIALLY LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. Part III, Line 9b: Persons determined to be eligible for 100 % charity care shall not receive a bill for services or be subject to collection procedures. Persons determined to be eligible for a reduction of a percentage of charges under the charity care program less than 100% shall not be billed or subject to collection procedures for the portion of the bill that is reduced under the sliding fee scale, only the out of pocket responsibility. Part VI, Line 2: BENEFIS HOSPITALS, INC. HISTORICALLY HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. THE HOSPITAL HAS ASSEMBLED A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO CONDUCTED A COMMUNITY NEEDS ASSESSMENT IN 2013, AS CONTEMPLATED BY NEWLY ENACTED IRC SECTION 501(R). Part VI, Line 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND A COMMUNICATION OF FINANCIAL ASSISTANCE IS STATED ON EACH BILLING STATEMENT. Part VI, Line 4: THE ORGANIZATION'S SERVICE AREA IS 41,234 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 230,394, WITH AN AVERAGE POPULATION DENSITY OF 5.5 PER SQUARE MILE. THE SERVICE AREA IS APPROXIMATELY 50.1% FEMALE AND 49.9% MALE. APPROXIMATELY 6.6% OF THE POPULATION IS UNDER 5 YEARS OF AGE, APPROXIMATELY 59.9% BETWEEN THE AGE OF 18 AND 65 YEARS OF AGE, AND APPROXIMATELY 16.8% OF THE POPULATION IS OVER THE AGE OF 65. THE SERVICE AREA IS 85.1% WHITE 10.4% NATIVE AMERICAN, WITH THE REMAINDER AFRICAN-AMERICAN OR MULTIPLE RACES. THE AVERAGE HOUSEHOLD SIZE IS 2.4 PEOPLE, WITH APPROXIMATELY 67.6% OF ALL HOUSING UNITS BEING OWNER OCCUPIED. THE AVERAGE PER CAPITA INCOME IS $24,912 WITH THE MEDIAN HOUSEHOLD INCOME BEING $46,938; 15.7% OF THE POPULATION LIVES IN POVERTY. (DATA SOURCE: WWW.CENSUS.GOV). Part VI, Line 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS AND PROVIDES ECONOMIC FUNDING FOR COMMUNITY HEALTH CLINICS TO PROVIDE LOCUM DOCTORS TO COME DURING PLANNED AND UNPLANNED ABSENCES. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). Part VI, Line 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. Part VI, Line 7, Reports Filed With States MT X X X X X 1 1 0 0 0 0 0 1 0 Elton J Adams MD Director 0 204653 0 100340 0 12000 0 0 0 8341 0 325334 0 0 Judy E Borland MD Director 0 140588 0 0 0 10000 0 0 0 2503 0 153091 0 0 Robert M Grasseschi MD Director 0 292039 0 82614 0 68038 0 0 0 10136 0 452827 0 0 Gregory Tierney MD Director 0 261163 0 168339 0 234549 0 0 0 8374 0 672425 0 0 Terry Olinger President Benefis Acute Care Group 0 354993 0 89774 0 57903 0 89465 0 594 0 592729 0 50023 Paul Dolan MD Chief Medical Information Officer 267297 0 43549 0 65403 0 16558 0 8400 0 401207 0 0 65403 Rayn Ginnaty Vice President of Nursing 181803 0 27914 0 0 0 10940 0 421 0 221078 0 0 0 Kathy Hill Chief Operating Officer Benefis Medi 140250 0 30107 0 0 0 8937 0 9172 0 188466 0 0 0 Amy Beames System Senior Vice President 0 181861 0 42021 0 11000 0 9879 0 6159 0 250920 0 0 PETER GRAY DIRECTOR SENIOR SERVICES 174213 0 29895 0 0 0 7456 0 10032 0 221596 0 0 0 Joseph Loduca Director of Cancer, Heart & Resp. 138549 0 41434 0 0 0 8935 0 10036 0 198954 0 0 0 David Runkel Director of Pharmacy 151493 0 21679 0 0 0 7798 0 10039 0 191009 0 0 0 Adam Elliott Medical Physicist 168045 0 1200 0 0 0 8874 0 10053 0 188172 0 0 0 Greg Hilpert Director Radiology and Lab 127391 0 46587 0 0 0 7885 0 8297 0 190160 0 0 0 Julie Hickethier System VP (Former Key Employee) 37137 0 0 0 510200 0 0 0 9866 0 557203 0 0 0 Part I, Lines 4a-b Julie Hickethier WAS PAID A SEVERANCE PAYMENT IN 2015 OF $510,200. BENEFIS HEALTH SYSTEM, INC PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR Dr. Dolan, Dr. Tierney, Mr. Olinger, Ms. Beames and Ms. Ginnaty, who meet the requirements of the plan. DR. DOLAN and Mr. Olinger received a payout from the plan in 2015. Part I, Line 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM (INCLUDING DR. DOLAN, DR. TIERNEY AND MR. OLINGER). PAYMENTS PURSUANT TO THE INCENTIVE PLAN ARE SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. THE SYSTEM HAS ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, FINANCE/OPERATIONS, AND COMMUNITY BENEFIT. THE INDIVIDUAL PERFORMANCE OBJECTIVES ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM INCENTIVE PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY OVERALL PERFORMANCE. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. A MONTANA FACILITY FINANCE AUTHORITY 810302402 2007-04-10 129048928 CONSTRUCTION OF NEW MEDICAL FACILITIES 0 0 0 A 19730000 131258007 8633769 4169 2500000 2395619 96568150 18947222 2009 0 1 0 0 A 0 0 1 1 0 0.00000 0.00000 0 0 0 A 0 0 0 1 0 0 1 BAYERISCHE LANDESBANK 2.500000000000 1 0 1 A 1 Date Rebate Computation Performed Issuer Name: MONTANA FACILITY FINANCE AUTHORITY Date the Rebate Computation was Performed: 04/10/2012 Part II, Line 2 GROSS PROCEEDS INCLUDE INVESTMENT INCOME OF $2,209,079. JAIMEE GREGOIRE FAMILY MEMBER OF Gregory Tierney, MD, director 21454 COMPENSATION 0 Danielle Tierney FAMILY MEMBER OF Gregory Tierney, MD, director 37969 COMPENSATION 0 Paula Olinger FAMILY MEMBER OF Terry Olinger, officer 65499 compensation 0 X 1 115000 Cost 0 1 0 FORM 990, PART VI, SECTION A, LINE 1B THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NON-PROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO ELECT ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS'S OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. Form 990, Part VI, Section A, line 2 CERTAIN OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. Such business relationships are undertaken in the ordinary course of business. Form 990, Part VI, Section A, line 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS, AS THE PARENT AND SYSTEM ENTITY, PROVIDES THE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT NON-PROFIT CORPORATE ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES AND FUNCTIONS - INFORMATION SYSTEMS COORDINATION - OVERSIGHT OF QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGEMENT OF REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT THE FOLLOWING PERSONS LISTED IN PART VII WERE COMPENSATED BY BHS: TERRY OLINGER - $592,729 (COMPENSATION FOR SERVICES AS OFFICER OF BHS) Form 990, Part VI, Section A, line 6 The sole corporate member of the organization is Benefis Health System, inc., a Montana non-profit public benefit corporation that has been recognized by the IRS as described in IRC Section 501(c)(3). Form 990, Part VI, Section A, line 7a AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. (ACTING THROUGH ITS OWN GOVERNING BODY) ELECTS THE BOARD OF DIRECTORS OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7b AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. Form 990, Part VI, Section B, line 11 THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS DISTRIBUTED TO ALL MEMBERS OF THE ORGANIZATION'S BOARD OF DIRECTORS, AND WAS PRESENTED TO THE BENEFIS HEALTH SYSTEM, INC. BOARD BY THE ACCOUNTING FIRM. Form 990, Part VI, Section B, line 12c BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND VOTING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. Form 990, Part VI, Section B, line 15 THE COMPENSATION OF THE PRESIDENT, CHIEF MEDICAL INFORMATION OFFICER, VICE PRESIDENT OF NURSING AND CHIEF OPERATING OFFICER WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILARLY-SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. Form 990, Part VI, Section C, line 19 BENEFIS HOSPITALS, INC. PROVIDES COPIES OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. Form 990, Part XI, line 9: TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA PHYSICIANS 2,567. 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