2016-03-07T14:38:53-06:00 2015-04-30 GREEN HEALTH GROUP PC 110 5TH ST S SUITE 106 GLASGOW MT 592302338 990 2014-05-01 810373589 CULBERTSON FROID BAINVILLE HEALTHCARE CORPORATION CULB 4067876401 PO BOX 419 CULBERTSON MT 59218 AUDREY STROMBERG ADMINISTRATOR 4067876401 2016-03-07 true DANIEL GREEN P01311679 4062632615 2016-03-07 2014 2016-08-17 19:52:53Z ROOSEVELT MEDICAL CENTER AUDREY STROMBERG PO BOX 419 CULBERTSON MT 59218 5404638 false X ROOSEVELTMEDICAL.ORG X 1976 MT ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. 11 11 132 50 0 274350 151662 4622872 4960228 1216 1766 256326 290982 5154764 5404638 0 0 3135516 3416098 0 8359 2005910 2088536 5141426 5504634 13338 -99996 2905670 2813273 896458 904057 2009212 1909216 ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. false false 3832378 4960228 ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. 3832378 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 22 0 132 true false false false false false false X 11 11 true false false false false false false true true false false true true true true true true true true false X JENNIFER KESSNER 4067876401 PO BOX 419 CULBERTSON MT 59218 PAULA SCHLEDEWITZ CHAIR 1.00 X 0 0 0 CHRIS HANSEN VICE CHAIR 1.00 X 0 0 0 MIKE WEEKS DIRECTOR 1.00 X 0 0 0 GRANT SALVEVOLD DIRECTOR 1.00 X 0 0 0 LANA ENGELKE DIRECTOR 1.00 X 0 0 0 MARK COLVIN DIRECTOR 1.00 X 0 0 0 KEVIN MILLER DIRECTOR 1.00 X 0 0 0 DUANE LARSEN DIRECTOR 1.00 X 0 0 0 DUSTIN HARMON DIRECTOR 1.00 X 0 0 0 BOB BEERY DIRECTOR 1.00 X 0 0 0 LAURA BERGUM DIRECTOR 1.00 X 0 0 0 AUDREY STROMBERG ADMINISTRATO 40.00 X 84507 0 5 JENNIFER KESSNER CFO 42.00 X 79770 0 305 DON HELLAND MD 40.00 X 196556 0 5045 ELIZABETH KLEPPEN PA-C 21.00 X 138860 0 305 JAY LAMBERT PA-C 40.00 X 105761 0 5045 605454 10705 3 false true false MONTANA HEALTH NETWORK 11 SOUTH 7TH STREET SUITE 241 MILES CITY MT 59301 LOCUM NURSE 401873 AVERA HEALTH 3900 WEST AVERA DRIVE SIOUX FALLS SD 57108 TELE-ER SERVICE 154769 2 7771 968 142923 151662 PATIENT REVENUE 621500 4693232 4693232 MISC REVENUE 900099 266996 266996 4960228 1766 1766 HOSPITAL DISTRICT SUBSIDY 900099 290982 290982 290982 5404638 5252976 X 172883 172883 2800113 2352695 440128 7290 14502 11476 2990 36 170153 127440 42320 393 258447 198743 59064 640 685433 639724 45709 27318 27318 274435 49778 224657 2160 2160 1150 1150 57888 24702 33186 2482 41 2441 376181 376181 105033 105033 MEDICAL SUPPLIES 241373 241373 REPAIRS & MAINTENANCE 181178 51708 129470 FOOD & DIETARY SUPPLIES 114664 114664 MISC 15784 15784 3457 3100 357 5504634 3832378 1663897 8359 2239 2838 637609 999720 85345 116327 916103 718074 115060 111568 61611 62939 5154995 4418188 1035703 736807 52000 65000 2905670 2813273 575932 550980 252336 245396 68190 107681 896458 904057 X 1947038 1862861 62174 46355 2009212 1909216 2905670 2813273 -99996 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 305 305 false SCHEDULE C, PART IV 0.65 PERCENT OF DUES PAID TO MHA AND 22.80 PERCENT OF DUES PAID TO AHA, WHICH TOTALED 305, WERE USED FOR LOBBYING EXPENSES BY MHA. 3017963 2725402 292561 2137032 1692786 444246 736807 RESIDENT DEPOSITS PAYABLE 74578 MEDICARE/MEDICAID ESTIMATED PAYABLE 33103 107681 X SCHEDULE D, PAGE 3, PART X IT IS THE OPINION OF MANAGEMENT THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. true true true X true X true true true false true true 36033 7085 28948 0.00530 612144 545649 66495 0.01210 648177 552734 95443 0.01730 117204 11818 105386 0.01910 960292 800494 159798 0.02900 1077496 812312 265184 0.04820 1725673 1365046 360627 0.06550 true 235154 1743158 1777113 -33955 X true true 1 1 ROOSEVELT MEDICAL CENTER PO BOX 419 CULBERTSON MT 59218 X X X X ROOSEVELT MEDICAL CENTER 1 false false true X X X X X X 14 true false false true X ROOSEVELTMEDICAL.ORG X true 14 true ROOSEVELTMEDICAL.ORG false false true X 200.000000000000 200.000000000000 X X true true X X X X true X X X X true X true X X true X false true FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 5 A RANDOM MAIL OUT SURVEY WAS DONE. A DEMOGRAPHIC BREAKDOWN WAS DONE FOR OUR DEFINED SERVICE AREA. THERE WAS A 22% RESPONSE. FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 11 THE FIRST STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO UTILIZE A VARIETY OF COMMUNICATION STRATEGIES TO BETTER INFORM THE RMC SERVICE AREA OF HOSPITAL SERVICES, AS WELL AS INCREASE AND DIVERSIFY OUTREACH EFFORTS REGARDING SERVICES AVAILABLE AT RMC SUCH AS PUBLISHING A QUARTERLY HOSPITAL NEWSLETTER. THE SECOND STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO EXPAND EXISTING COMMUNITY EDUCATION PROGRAMS AND EXPLORE OPPORTUNITIES TO START NEW PROGRAMS SUCH AS EXPLORING THE FEASIBILTY OF HOSTING A HEALTH FAIR AND PROMOTING THE EXISTING DIABETES EDUCATION PROGRAM. THE THIRD STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO INCREASE AWARENESS OF LOCAL OPPORTUNITIES FOR PHYSICAL ACTIVITY SUCH AS PUBLISHING A SCHEDULE OF LOCAL CLASSES AND PHYSICAL ACTIVITY EVENTS IN HOSPITAL NEWSLETTERS AND EMAIL UPDATES. THE FOURTH STRATEGY FOR ADDRESSING THE SIGNIFICANT NEEDS IS TO EXPAND CURRENT PRIMARY CARE SERVICES AT RMC AND INCREASE PRIMARY CARE AND EMERGENCY ROOM COVERAGE SUCH AS RECRUITING AND HIRING AN ADDITIONAL PRIMARY CARE PROVIDER AND PROVIDING EDUCATION REIMBURSEMENT FOR HOSPITAL STAFF WHO WANT TO ADVANCE IN A HEALTH-RELATED FIELD. ONE OF THE IDENTIFIED HEALTH NEEDS WHICH WAS NOT ADDRESSED IS AFFORDABLE HOUSING. THIS IS A BROAD ISSUE THAT CANNOT BE ADDRESSED THROUGH THE HOSPITAL ALONE. THE COMMUNITY ALREADY HAS THE GREAT NORTHERN DEVELOPMENT ORGANIZATION THAT WAS CREATED TO ADDRESS THIS ISSUE. ANOTHER IDENTIFIED HEALTH NEED WHICH WAS NOT ADDRESSED WAS PROVIDING FULL- TIME SPECIALISTS. AT THIS TIME IT IS BEYOND THE RESOURCE CAPACITY OF ROOSEVELT MEDICAL CENTER. RMC OFFERS CONSULTS WITH SOME SPECIALISTS VIA TELEMEDICINE AND WORKS WITH BILLINGS CLINIC TO ADD MORE SPECIALITIES AS THE SPECIALISTS ARE WILLING TO PROVIDE TELEHEALTH SERVICES. RMC DOES NOT HAVE ENOUGH VOLUME OF PATIENTS IN ANY ONE SPECIALITY AREA TO GET SPECIALISTS TO TRAVEL HERE FOR ONSITE CONSULTS. TRANSPORTATION ASSISTANCE, DENTAL CLINIC, FITNESS CENTER, AND MASSAGE THERAPY ARE MORE IDENTIFIED HEALTH NEEDS WANTED BY THE COMMUNITY BUT PROVIDING THESE SERVICES IS BEYOND THE RESOURCE AND FINANCIAL CAPACITY OF RMC AT THIS TIME. THE LAST IDENTIFIED HEALTH NEED WHICH WAS NOT ADDRESSED WAS PEOPLE INDICATED BEING UNAWARE OF PROGRAMS THAT WOULD HELP THEM PAY FOR THEIR HEALTHCARE BILLS. RMC HAS PAMPHLETS ABOUT FINANCIAL ASSISTANCE AVAILABLE IN THE CLINIC AND ER AND MAILS THEM OUT WHEN FINAL NOTICES ARE SENT FROM BILLING. WE HAVE HAD A CERTIFIED NAVIGATOR AND HELD PUBLIC MEETINGS THE PAST TWO YEARS TO EDUCATE THE PUBLIC ABOUT THE STATE HEALTH INSURANCE EXCHANGE. WE WILL CONTINUE TO PROVIDE INFORMATION ABOUT FINANCIAL ASSISTANCE IN NEWSLETTERS, OUR WEBSITE, AND OUR FACEBOOK PAGE TO INCREASE PUBLIC AWARENESS OF FINANCIAL ASSISTANCE OPTIONS FOR HEALTHCARE BILLS. FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 16I WE MAIL THE GUIDE TO FINANCIAL ASSISTANCE LETTER AND APPLICATION TO PATIENTS. OUR WEBSITE HAS A SECTION ON PATIENT FINANCIAL SERVICES THAT SAYS TO INQUIRE AT THE BUSINESS OFFICE FOR IMPORTANT INFORMATION ON PAYMENT OPTIONS, DISCOUNTS, INSURANCE PROCESSING, REFUNDS AND QUESTIONS ABOUT THEIR BILL. FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 22D OUR FACILITY INITIALLY CHARGES ONE RATE TO ALL PATIENTS WHETHER THEY ARE UNINSURED OR INSURED PER CMS GUIDELINES. THAT CHARGE MAY THEN BE DISCOUNTED BASED ON INSURANCE CONTRACTS, PREFERRED PROVIDER NETWORK AGREEMENTS, AND/OR QUALIFICATION FOR FINANCIAL ASSISTANCE. FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 24 OUR FACILITY INITIALLY CHARGES ONE RATE TO ALL PATIENTS WHETHER THEY ARE UNINSURED OR INSURED PER CMS GUIDELINES. THAT CHARGE MAY THEN BE DISCOUNTED BASED ON INSURANCE CONTRACTS, PREFERRED PROVIDER NETWORK AGREEMENTS, AND/OR QUALIFICATION FOR FINANCIAL ASSISTANCE. PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION PHYSICIAN PROFESSIONAL SERVICES MAKE UP 219,724 OF COLUMN C, 133,949 OF COLUMN D, AND 85,774 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 125,791. ROOSEVELT MEDICAL CENTER'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND CHARITY CARE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, CHARITY CARE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF BAD DEBT WHICH REDUCE BAD DEBT EXPENSE. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NON PROFIT HOSPITAL. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGE 7 & 8 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE FOR MOST SERVICES, LESS THE 2% SEQUESTRATION ADJUSTMENT, AND SOME SERVICES LIKE AMBULANCE ARE PAID BASED ON FEE SCHEDULES. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT AND THE MEDICARE PROVIDER SUMMARY REPORT. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION ROOSEVELT MEDICAL CENTER HAS GUIDELINES TO FOLLOW IN THEIR COLLECTION POLICY FOR PATIENTS THAT LACK FUNDS TO PAY THE BILL. A LETTER IS ENCLOSED WITH THE FINAL NOTICE STATEMENT TO ANY ACCOUNT HOLDER THAT HAS NOT MADE ANY PAYMENTS FOR TWO BILLING CYCLES THAT EXPLAINS PAYMENT OPTIONS AND OUR FINANCIAL ASSISTANCE GUIDELINES. IT ALSO GIVES CONTACT INFORMATION FOR PREMIUM ASSISTANCE PROGRAMS OFFERED BY GOVERNMENT PROGRAMS. PART VI, LINE 2 - NEEDS ASSESSMENT WE SEND OUT PATIENT SATISFACTION SURVEYS TO OUR PATIENTS. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE ROOSEVELT MEDICAL CENTER HAS GUIDELINES TO FOLLOW IN THEIR COLLECTION POLICY FOR PATIENTS THAT LACK FUNDS TO PAY THE BILL. A LETTER IS ENCLOSED WITH THE FINAL NOTICE STATEMENT TO ANY ACCOUNT HOLDER THAT HAS NOT MADE ANY PAYMENTS FOR TWO BILLING CYCLES THAT EXPLAINS PAYMENT OPTIONS AND OUR FINANCIAL ASSISTANCE GUIDELINES. IT ALSO GIVES CONTACT INFORMATION FOR PREMIUM ASSISTANCE PROGRAMS OFFERED BY GOVERNMENT PROGRAMS. PART VI, LINE 4 - COMMUNITY INFORMATION WE PROVIDE SERVICE TO A FAST GROWING POPULATION IN EASTERN ROOSEVELT COUNTY, SOUTHERN SHERIDAN COUNTY, AND NORTHERN RICHLAND COUNTY. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE ADMINISTRATOR OF ROOSEVELT MEDICAL CENTER PARTICIPATES IN THE LOCAL CHAMBER OF COMMERCE. X X X false false false false false false false false false DON HELLAND MD 196556 5040 5 201601 FORM 990, PAGE 6, PART VI, LINE 2 PAULA SCHLEDEWITZ GRANT SALVEVOLD CHAIR DIRECTOR PAULA IS HIS AUNT BY MARRIAGE. FORM 990, PAGE 6, PART VI, LINE 11B FORM 990 IS REVIEWED AT A REGULAR BOARD MEETING. FORM 990, PAGE 6, PART VI, LINE 12C COMPLIANCE IS REVIEWED ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS WHICH IS USUALLY BASED ON THE AMOUNT/PERCENTAGE OF RAISE THE REST OF THE EMPLOYEES ARE GOING TO RECEIVE. FORM 990, PAGE 6, PART VI, LINE 15B CFO COMPILES INFORMATION FROM ANNUAL MHA SALARY SURVEY REGARDING AVERAGE WAGE BEING PAID FOR EACH JOB DESCRIPTION BASED ON PEER GROUP, CAH'S, OR MHA REGION. CFO AND CEO COMPARE AVERAGES BEING PAID TO CURRENT ROOSEVELT MEDICAL CENTER SALARY SCALE TO SEE IF ADJUSTMENTS NEED TO BE MADE TO KEEP JOB COMPETITIVE WITHIN INDUSTRY. RECOMMENDATIONS FOR SALARY INCREASES ARE MADE TO THE BOARD OF DIRECTORS FOR APPROVAL OR DISAPPROVAL WHICH IS RECORDED IN THE BOARD MINUTES. FORM 990, PAGE 6, PART VI, LINE 19 DOCUMENTS RELATING TO ROOSEVELT MEDICAL CENTER ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G ADMIN PROF FEES 0 41,647 0 ADMIN PURCHASED SERVICES 0 4,019 0 CLINIC PROF FEES 12,933 0 0 DIETARY PURCHASED SERVICES 27,086 0 0 LAB PROF FEES 37,636 0 0 LAB PURCHASED SERVICES 30,740 0 0 MAINT PURCHASED SERVICES 0 43 0 MEDICAL & SURGICAL PROF FEES 163,310 0 0 MEDICAL & SURGICAL PURCH SVCS 13,864 0 0 MEDICAL RECORDS PURCH SRVCS 6,099 0 0 OT PURCHASED SERVICES 6,225 0 0 PT PURCHASED SERVICES 66,945 0 0 RADIOLOGY PROF FEES 9,166 0 0 RADIOLOLGY PURCHASED SERVICES 13,054 0 0 ST PURCHASED SERVICES 879 0 0 SWING BED PROF FEES 251,787 0 0 ROOSEVELT MEMORIAL HEALTHCARE FOUND PO BOX 419 CULBERTSON MT 59218 810529284 SUPPORT OR MT 501C3 7 N/A false false false true false false false false false false false false false false true true false false false false ROOSEVELT MEMORIAL HEALTHCARE FOUND C 7771 SUPPORT ROOSEVELT MEMORIAL HEALTHCARE FOUND O 22090 WAGES FOR RMHF DIRECTOR