2015-11-09T13:20:24-06:00 2014-12-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2014-01-01 810232121 BOZEMAN DEACONESS HEALTH SERVICES BOZE 4065855000 915 HIGHLAND BOULEVARD BOZEMAN MT 59715 GORDON DAVIDSON CFO/VP OF FINANCE 4065855000 2015-11-04 1 KIM HUNWARDSEN CPA P00484560 6122536500 2015-11-04 2014 2016-02-25 16:41:14Z GORDON DAVIDSON 915 HIGHLAND BOULEVARD BOZEMAN MT 59715 235646893 0 X WWW.BOZEMANDEACONESS.ORG X 1911 MT TO IMPROVE COMMUNITY HEALTH AND QUALITY OF LIFE FOR RESIDENTS AND VISITORS OF THE BOZEMAN, MT AREA. 11 10 1971 271 1365362 -543570 5517925 2067539 204688052 226325372 4805775 5704523 414407 541594 215426159 234639028 358000 1610001 0 0 90896957 101786134 0 0 0 100008076 110123291 191263033 213519426 24163126 21119602 347818522 396406654 86474925 117155952 261343597 279250702 X TO IMPROVE COMMUNITY HEALTH AND QUALITY OF LIFE. 0 0 55160581 53839716 BOZEMAN DEACONESS HEALTH GROUP CONSISTS OF OUR DEPARTMENTS THAT PROVIDE PHYSICIAN SERVICES TO OUTPATIENTS. THE NUMBER OF MEDICARE AND MEDICAID PATIENTS SEEN IN 2014 REMAINED FAIRLY CONSISTENT AT ABOUT 44% OF TOTAL VISITS. REVENUE FOR THESE PATIENTS AND UNINSURED PATIENTS TOTALED 47% OF ALL CLINIC REVENUE. TOTAL OPERATING REVENUES WERE $53,839,716 WITH ASSOCIATED OPERATING EXPENSES OF $55,160,581. THE LOSS OF $1,320,865 IS REFLECTIVE OF OUR COMMITMENT TO PROVIDE ACCESS TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. 21534716 52695007 BOZEMAN DEACONESS SURGICAL SERVICES STRIVES TO OFFER A WIDE ARRAY OF SURGICAL OPTIONS USING STATE OF THE ART TECHNOLOGY. OF THE 5,927 INPATIENT AND OUTPATIENT SURGERIES, ABOUT ONE THIRD WERE MEDICARE AND MEDICAID PATIENTS, WHICH COMPRISED 41% ($21,800,206) OF TOTAL REVENUE FROM THESE SERVICES ($52,695,007). OVER 59% OF THE MEDICARE/MEDICAID REVENUES WERE UNREIMBURSED ($12,954,791) AND WRITTEN OFF, ALONG WITH ANOTHER $5,409,045 FROM OTHER PAYORS. OUR OPERATING ROOM ALSO RECORDED $15,199,223 IN OPERATING EXPENSES PLUS ANOTHER $6,335,493 OF INDIRECT OVERHEAD. 11889764 21056267 THE EMERGENCY ROOM AT BOZEMAN DEACONESS HOSPITAL IS ONE OF THE BUSIEST DEPARTMENTS IN OUR ORGANIZATION, WITH JUST OVER 27,000 VISITS IN 2014. APPROXIMATELY 34% OF THESE VISITS WERE FROM MEDICARE AND MEDICAID PATIENTS, COMPRISING $7,593,438 OF THE $21,056,267 OF THE GROSS REVENUE. OVER 60% OF THE MEDICARE/MEDICAID REVENUE WERE UNREIMBURSED ($4,580,757) AND WRITTEN OFF, ALONG WITH ALMOST 38% OF THE REMAINING REVENUE ($5,060,839). DIRECT AND INDIRECT EXPENSES INCURRED IN SUPPORTING THE OPERATION OF THIS EMERGENCY ROOM ACCUMULATED TO $11,889,764. 81416334 1610001 98734382 BOZEMAN DEACONESS HEALTH SERVICES OPERATES AN 86 BED HOSPITAL FACILITY (HOSPITAL), ALONG WITH A 43 UNIT ASSISTED LIVING HOME AND A 115 UNIT INDEPENDENT LIVING HOME (HILLCREST SENIOR LIVING OR HSL). ALL PATIENT AND RESIDENT SERVICE REVENUE IS USED TO PROVIDE HEALTH CARE SERVICES, HEALTH CARE PROMOTION, AND HEALTH CARE EDUCATION TO BOZEMAN AND THE SURROUNDING COMMUNITIES. 81416334 1610001 98734382 170001395 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 175 0 1 1971 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 X GORDON DAVIDSON 4065851036 915 HIGHLAND BLVD BOZEMAN MT 59715 TERRY CUNNINGHAM CHAIR 1.00 X X 0 0 0 JULIE JACKSON 1ST VICE CHAIR 1.00 X X 0 0 0 BRIAN BROWN 2ND VICE CHAIR 1.00 X X 0 0 0 JOHN MURDOCH SECRETARY 1.00 X X 0 0 0 KATIE DAUGHENBAUGH TREASURER 1.00 X X 0 0 0 JOHN ROBBINS MD TREASURER (THRU 6/30/14) 50.00 X X 159291 0 57075 KERRI BROWN TRUSTEE 1.00 X 0 0 0 REV DAVE MCCONNELL TRUSTEE 1.00 X 0 0 0 DENNIS MUNSON TRUSTEE 1.00 X 0 0 0 KERRY PETITT TRUSTEE 1.00 X 0 0 0 DANE SOBEK MD TRUSTEE (AS OF 7/1/14) 50.00 X 586439 0 59604 ROBERT WATSON TRUSTEE 1.00 X 0 0 0 KEVIN PITZER CEO/PRESIDENT 50.00 X 478246 0 52633 GORDON DAVIDSON CFO/VP FINANCE 50.00 X 308004 0 63597 ELIZABETH LEWIS SENIOR VP OPERATIONS/LEGAL 50.00 X 272042 0 57522 HUGH HETHERINGTON MD DOCTOR 50.00 X 594673 0 61105 ANNIE CASTILLO MD DOCTOR 50.00 X 511386 0 15600 JACK HENSOLD MD DOCTOR 50.00 X 484419 0 57942 KEN MAY MD DOCTOR 50.00 X 443336 0 25878 BLAIR ERB MD DOCTOR 50.00 X 622487 0 39228 4460323 0 490184 107 0 1 0 LANGLAS & ASSOCIATES - BOZEMAN 1019 E MAIN ST STE 101 BOZEMAN MT 59715 CONSTRUCTION-GENERAL CONTRACTOR 5315941 ABSAROKA EMERGENCY PHYSICIANS 1184 N 15TH STREET SUITE 1 BOZEMAN MT 59715 ER PHYSICIANS FEE 4859694 MARTEL CONSTRUCTION INC 1203 S CHURCH BOZEMAN MT 59715 CONSTRUCTION-GENERAL CONTRACTOR 4773789 SANFORD HEALTH PO BOX 5074 SIOUX FALLS SD 57117 SOFTWARE HOSTING 1676988 ARBOR MEDIC PO BOX 10305 BOZEMAN MT 59715 LANDSCAPING/LAWN/SNOW REMOVAL 1215843 42 2067539 2067539 PATIENT SERVICE REVENU 622110 206612971 206231130 381841 RESIDENT SERVICE REVEN 623000 5991160 5991160 OTHER JOINT VENTURE RE 423000 3677205 3677205 PHARMACY REVENUE 446110 3489276 3124638 364638 CAFETERIA REVENUE 722210 1464545 1464545 5090215 4565576 524639 226325372 3486664 3486664 1271342 729748 541594 541594 94244 447350 2495976 0 278117 2495976 -278117 2217859 2217859 234639028 225054254 1365362 6151873 1610001 1610001 2100999 863784 1237215 80432867 65077132 15355735 3384603 2778358 606245 10153180 8126638 2026542 5714485 4549422 1165063 331269 331269 85941 85941 48868 48868 608548 608548 20489250 11410097 9079153 1203453 317488 885965 3780498 1146283 2634215 2784647 535082 2249565 465292 280131 185161 310195 186754 123441 2139943 2139943 14899858 14899858 2535714 503559 2032155 MEDICAL SUPPLIES 40347048 40265734 81314 PROVISION FOR BAD DEBTS 10535179 10535179 EQUIPMENT RENT & MAINTE 7524469 4431768 3092701 TAXES & LICENSES 1440217 103377 1336840 592902 240807 352095 213519426 170001395 43518031 0 46722702 29015934 27284960 33007908 212160 450218 5924431 6355209 2039452 2322930 269847789 132242347 125456868 137605442 95319096 142419529 3297355 1488754 16441997 16719795 10713626 10891838 14405875 16129097 347818522 396406654 24690316 32026166 365123 52254809 66621214 522909 179507 9006891 17963942 86474925 117155952 X 254995499 273114036 4739605 4496434 1608493 1640232 261343597 279250702 347818522 396406654 X 21119602 -961703 -2250794 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 44400 0 1 4468 48868 0 PART II-B, LINE 1: HIRED CONSULTANT TO PROVIDE LOBBYING SERVICES IN CONNECTION WITH GOVERNMENTAL AFFAIRS REPRESENTATION TO ENSURE HOSPITAL, COMMUNITY, AND EMPLOYEE INTERESTS AND NEEDS ARE REPRESENTED. BOZEMAN DEACONESS HEALTH SERVICES REIMBURSES CERTAIN PROFESSIONAL MEMBERSHIP DUES OF EMPLOYEES. A PORTION OF SUCH MEMBERSHIP DUES ARE USED BY THE PROFESSIONAL ASSOCIATIONS FOR LOBBYING ACTIVITIES. 12396438 785403 619492 12783 13788550 10913019 15645 1686800 219026 12396438 9765686 385183 873051 110901 10913019 9735942 398579 -284159 84676 9765686 8337197 383010 1071551 55816 9735942 0.75600 0.14800 0.09600 0 1 1 8561480 610686 9172166 155293540 77130872 78162668 86746943 53373609 33373334 18635140 1737866 16897274 137605442 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 301783 DEPOSITS 7811159 CAPITALIZED LEASE OBLIGATION 9851000 17963942 X PART V, LINE 4: EACH ENDOWMENT FUND IS PRIVY TO A SEPARATE AGREEMENT. DONATIONS MADE FOR EACH PURPOSE SHALL BE RECEIVED, HELD, AND INVESTED BY THE BOZEMAN DEACONESS FOUNDATION ACCORDING TO ESTABLISHED POLICIES GOVERNING GIFT ACCEPTANCE, INVESTMENT, AND DISTRIBUTION. THE PRINCIPAL OF THE FUND SHALL BE RETAINED IN PERPETUITY. THE INTEREST INCOME IS UTILIZED FOR THE GREATEST NEEDS OF THE DESIGNATED DEPARTMENT. POLICY SAYS THE ORGANIZATION CAN USE A PORTION OF INTEREST FOR OPERATIONS. PART X, LINE 2: THE ORGANIZATION, WHICH INCLUDES THE HOSPITAL, CONSISTS OF MONTANA NONPROFIT CORPORATIONS AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE ORGANIZATION IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE ORGANIZATION IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. BOZEMAN DEACONESS REAL ESTATE DEVELOPMENT CORP. IS A FOR PROFIT ENTITY FOR WHICH INCOME TAXES ARE PROVIDED FOR THE TAX EFFECTS OF TRANSACTIONS REPORTED IN THE FINANCIAL STATEMENTS AND CONSIST OF TAXES CURRENTLY DUE PLUS DEFERRED TAXES. THERE WAS NO TAXABLE INCOME IN 2014 AND 2013. THE ORGANIZATION 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 ORGANIZATION 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 ORGANIZATION'S FEDERAL FORM 990T AND BOZEMAN DEACONESS REAL ESTATE DEVELOPMENT CORP.'S TAX FILINGS ARE NO LONGER SUBJECT TO FEDERAL AND STATE TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. 1 1 X 1 X 1 X 1 1 0 1 1 8123130 453130 7670000 0.03780 12839278 8334290 4504988 0.02220 693726 1018354 -324628 0.00000 21656134 9805774 11850360 0.06000 712910 168339 544571 0.00270 25618 25618 0.00010 31196008 24315688 6880320 0.03390 766571 766571 0.00380 32701107 24484027 8217080 0.04050 54357241 34289801 20067440 0.10050 20000 20000 0.00010 2054 2054 0.00000 22054 22054 0.00010 1 11135124 0 37339440 39277847 -1938407 X 1 0 1 1 BOZEMAN DEACONESS HOSPITAL 915 HIGHLAND BLVD BOZEMAN MT 59107 WWW.BOZEMANDEACONESS.ORG 12933 X X X BOZEMAN DEACONESS HOSPITAL 1 0 0 1 X X X X X X X X 12 1 0 1 1 X HTTP://WWW.BOZEMANDEACONESS.ORG/FOR-COMMUNITY/NEWS-REPORTS.ASPX X HTTP://HEALTHYGALLATIN.ORG/WP-CONTENT/UPLOADS/2013/04/HEALTHYGALLATIN_ANNUA 1 12 1 HTTP://WWW.BOZEMANDEACONESS.ORG/DOCUMENTS/BDHS-2012-2014-COMMUNITY-BENEFIT- 0 0 1 X 150.000000000000 250.000000000000 X X X 1 1 X X 1 X X X X X X X 1 X 0 X X X X 1 X 0 1 BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 5: BDHS PARTNERED WITH GALLATIN CITY-COUNTY HEALTH DEPARTMENT AND COMMUNITY HEALTH PARTNERS, A FEDERALLY QUALIFIED HEALTH CENTER IN GALLATIN AND PARK COUNTY. FOR MORE DETAILS, PLEASE REFER TO BDHS 2012-2014 COMMUNITY BENEFIT PLAN PAGES 6-10 AND APPENDIX C-1,2,4,6,7,9. BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 11: ALL FOUR IDENTIFIED PRIORITY NEEDS LISTED AS STRATEGIC ISSUES IN OUR COMMUNITY BENEFIT PLAN ARE BEING ADDRESSED AND WE CONTINUE TO ACTIVELY COLLABORATE WITH THE COMMUNITY IN ADDRESSING THESE NEEDS. BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 16I: MASH-WILL GIVE OUT OUR FINANCIAL APPLICATION AFTER DETERMINING PATIENT IS INELIGIBLE FOR FEDERAL AND STATE PROGRAMS.A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS ATTACHED TO BILLING INVOICES, POSTED IN PATIENT ADMISSIONS AREAS, AND PROVIDED TO PATIENTS ON ADMISSION TO THE HOSPITAL FACILITY. BOZEMAN DEACONESS HOSPITAL 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. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO ELECTIVE PROCEDURES. THEREFORE, FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE BILLED GROSS CHARGES ON ELECTIVE PROCEDURES. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 16B WEBSITE: HTTP://WWW.BOZEMANDEACONESS.ORG/OUR-SERVICES/FINANCIAL-SERVICES.ASPX BOZEMAN DEACONESS HOSPITAL PART V, SECTION B, LINE 16C WEBSITE: HTTP://WWW.BOZEMANDEACONESS.ORG/OUR-SERVICES/FINANCIAL-SERVICES.ASPX 7 DEACONESS INTERCITY IMAGING LLC 915 HIGHLAND BLVD BOZEMAN MT 59715 OUTPATIENT IMAGING CENTER ROCKY MOUNTAIN SURGERY CENTER LLC 1450 ELLIS ST SUITE 101 BOZEMAN MT 59715 OUTPATIENT SURGICAL CENTER HILLCREST SENIOR LIVING 1201 HIGHLAND BLVD BOZEMAN MT 59715 INDEPENDENT AND ASSISTED LIVING FACILITY HOSPICE OF SOUTHWEST MONTANA LLC 3810 VALLEY COMMONS DR STE 1 BOZEMAN MT 59715 HOSPICE SERVICES FAMILY DOCTORS URGENT CARE LLC 120 N 19TH AVENUE BOZEMAN MT 59715 OUTPATIENT HEALTH CARE BOZEMAN HEALTH URGENT CARES LLC 106 W MAIN BOZEMAN MT 59715 OUTPATIENT HEALTH CARE BOZEMAN HEALTH CLINICAL RESEARCH LLC 950 STONERIDGE DR 1 BOZEMAN MT 59718 OUTPATIENT HEALTH CARE CLINICAL TRIALS PART I, LINE 3C: ANY INDIVIDUAL AND THEIR DEPENDENTS WHO ARE AT 150% OF THE FEDERAL POVERTY INCOME LEVEL OR BELOW WILL BE ELIGIBLE TO RECEIVE A 100% WRITE-OFF OF THE SELF-PAY PORTION OF INCURRED CHARGES, UPON COMPLETION OF AN APPLICATION. ANY UNINSURED INDIVIDUAL WITH INCOME UNDER 250% OF THE FEDERAL POVERTY GUIDELINES (FPG) WILL BE ELIGIBLE TO RECEIVE A DISCOUNT FROM CHARGES BASED ON CERTAIN GUIDELINES. COMPLETION OF THE FINANCIAL ASSISTANCE APPLICATION WILL BE REQUIRED. IN SOME CASES, FULL OR PARTIAL ASSISTANCE MAY BE PROVIDED TO INSURED INDIVIDUALS WITH GROSS FAMILY INCOMES ABOVE 250% OF THE FPG ADJUSTED FOR FAMILY SIZE. CATASTROPHIC FINANCIAL ASSISTANCE IS AVAILABLE TO INDIVIDUALS WHO HAVE A LARGE BALANCE REMAINING AFTER ALL THIRD PARTY PAYMENTS HAVE BEEN TAKEN INTO ACCOUNT. THE BALANCE UNDER CONSIDERATION IS THAT AMOUNT WHICH IS DEEMED TO BE THE PATIENT'S FINANCIAL RESPONSIBILITY. IF SUCH RESPONSIBILITY IS GREATER THAN 50% OF THE FAMILY'S ANNUAL HOUSEHOLD INCOME, THE EXCESS AMOUNT WILL BE TREATED AS CATASTROPHIC FINANCIAL ASSISTANCE AND WRITTEN OFF OF THE PATIENT'S ACCOUNT. THIS ASSISTANCE IS AVAILABLE WITHOUT RESPECT TO THE FPG, BUT THEY MUST FOLLOW THE SAME PROCESS AS ALL OTHER PATIENTS SEEKING FINANCIAL ASSISTANCE BASED UPON FPG. ASSET TESTS ARE NOT USED FOR DETERMINING ANY LEVEL OF FINANCIAL ASSISTANCE. ALL DECISIONS REGARDING FINANCIAL ASSISTANCE ARE IN THE SOLE DISCRETION OF BDH. PRIOR TO PROVIDING SERVICES, BDH WILL MAKE AN EFFORT TO NOTIFY THE PATIENT REGARDING THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE FOUND ON ITS WEBSITE AT HTTP://WWW.BOZEMANDEACONESS.ORG/FOR-COMMUNITY/NEWS-REPORTS.ASPX. PART I, LINE 7: THE COST TO CHARGE RATIO FROM WORKSHEET 2 WAS USED TO OBTAIN THE COSTS RELATED TO CHARITY CARE, MEDICAID, AND OTHER MEANS-TESTED PROGRAMS. ALL OTHER BENEFITS WERE CALCULATED USING OUR INTERNAL COSTING SYSTEM. THIS SYSTEM ASSIGNS ALL DIRECT EXPENSES TO SEPARATE COST CENTERS (DEPARTMENTS) AND ACCOUNTS. INDIRECT COSTS ARE THEN ALLOCATED TO APPLICABLE DEPARTMENTS BASED ON APPROPRIATE STATISTICS. FOR EXAMPLE, ENGINEERING AND ENVIRONMENTAL SERVICES WOULD BE ALLOCATED BASED ON SQUARE FOOTAGE WHEREAS INFORMATION SYSTEMS AND BENEFITS ARE ALLOCATED BASED ON AN ACCUMULATED COST PERCENTAGE AS DETERMINED BY THE MEDICARE COST REPORT. OUR INTERNAL SYSTEM DOES RECORD PATIENT REVENUES BASED ON TYPE (INPATIENT VS. OUTPATIENT VS. EMERGENCY) AND PAYOR (MEDICAID, MEDICARE, COMMERCIAL, SELF-PAY, ETC.). RELATED COSTS ARE THEN DETERMINED BASED ON THE PRO-RATED SHARE AS A PERCENTAGE OF THE TOTAL. FOR EXAMPLE, IF MEDICAID COMPRISES 7% OF A DEPARTMENT'S REVENUE, MEDICAID EXPENSES ARE CALCULATED AT 7% OF THE TOTAL AS WELL. PART I, LINE 7G: AMOUNT OF COST ATTRIBUTABLE TO A PHYSICIAN CLINIC IS $30,266,081. ALL COSTS ASSOCIATED WITH A PROVIDER-BASED CLINIC OPERATIONAL DEPARTMENT WERE CONSIDERED PART OF THIS TOTAL. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR IS $10,535,179. PART II, COMMUNITY BUILDING ACTIVITIES: BOZEMAN DEACONESS HEALTH SERVICES PROVIDED A CASH CONTRIBUTION TO THE CITY OF BOZEMAN FOR THE BOZEMAN BROADBAND INITIATIVE AND ITS DEVELOPMENT OF A COMMUNITY BROADBAND MASTER PLAN. BDHS IS ALSO REPRESENTED THROUGH PARTICIPATION IN THE BOZEMAN KIWANIS CLUB, AN ORGANIZATION DEDICATED TO COMMUNITY SERVICE AND IMPROVING THE HOLISTIC HEALTH OF CHILDREN. PART III, LINE 4: BAD DEBT IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION AND INCLUDED JOINT VENTURES. BAD DEBT IS REPORTED BASED UPON ACTUAL BAD DEBT EXPENSE NET OF DISCOUNTS AND CONTRACTUAL ADJUSTMENTS, LESS RECOVERIES.THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE AMOUNT OF SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT.THE MEDICARE SHORTFALL REPRESENTS A COST ABSORBED BY THE HOSPITAL AS A RESULT OF PROVIDING CARE TO MEDICARE PATIENTS. THE CONTRACT DRIVING THIS LOSS IS A NONDISCRETIONARY CONTRACT, AS IS PROVIDING THE SERVICES TO THIS POPULATION OF INDIVIDUALS. THE COST OF PROVIDING THIS BENEFIT TO THE COMMUNITY SHOULD BE REPORTABLE AS SUCH. MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON 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.FOR THE JOINT VENTURES, NET MEDICARE REVENUE WAS USED AS THE REVENUE RECEIVED, AND THAT PERCENTAGE OF TOTAL REVENUES WAS APPLIED AGAINST OPERATING EXPENSES TO DETERMINE RELATED COSTS. THE JOINT VENTURE PORTION OF THE SHORTFALL IS $916,268. PART III, LINE 9B: THE COLLECTION POLICY DOES NOT SPECIFICALLY ADDRESS THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. PART VI, LINE 2: A. UPDATES RELATED TO 2012 CHNATHE FOLLOWING UPDATES RELATE TO INITIATIVES/STRATEGIES TO ADDRESS NEEDS IDENTIFIED BASED ON THE 2012 CHNA CONDUCTED JOINTLY BY BOZEMAN DEACONESS HEALTH SERVICES (BDHS), GALLATIN CITY AND COUNTY HEALTH DEPARTMENT (GCCHD) AND COMMUNITY HEALTH PARTNERS (CHP).STRATEGIC ISSUE #1: IMPROVING ACCESS TO HEALTHCARE SERVICES PREVENTIVE HEALTH SERVICES:* THE HEALTHCARE CONNECTIONS-MOBILE HEALTH SCREENINGS (HCC) EXCEEDED 2014 TARGETS OF 10% INCREASE FROM PRIOR YEAR: * CLIENTS SERVED AND HEALTH SCREENINGS UP BY NEARLY 30% * NUMBER OF VACCINATIONS GIVEN INCREASED 188% * HCC PARTICIPATED IN THE GALLATIN COUNTY IMMUNIZATION AND ADULT WELLNESS DAY, GOODWILL & LATINO EVENT, PROJECT HOMELESS AND VETERANS STAND DOWN. * THE MOBILE HEALTH SCREENING VAN PROVIDES FREE SCREENINGS FOR BREAST AND COLON CANCER, HEART DISEASE, STROKE, DIABETES, OSTEOPOROSIS AND OBESITY SCREENINGS AS WELL AS FREE VACCINATIONS-TDAP - TETANUS & PERTUSSIS (WHOOPING COUGH), FLU (SEASONAL) AND PNEUMONIA VACCINATIONS. * BDHS HEALTH SCREENING DAY, ANNUAL EVENT; 60 EMPLOYEES HELPED, OVER 658 ADULTS AND 125 CHILDREN ATTENDED THE FAIR. OFFERED ACCESS TO REDUCED PRICE BLOOD DRAWS AND FOBT'S AS WELL AS FREE PREVENTIVE SCREENINGS (BONE DENSITY, HEART MONITORING FACIAL SKIN CHECKS, GLUCOSE STICKS, OXIMETRY, BLOOD PRESSURE, VISION, HEARING, AND DEPRESSION).* BIG SKY HEALTH SCREENING DAY, ANNUAL EVENT; 5 EMPLOYEES HELPED, 35 ATTENDED THE FAIR. OFFERED ACCESS TO REDUCED PRICE BLOOD DRAWS AND FOBT'S AS WELL AS FREE PREVENTIVE SCREENINGS (BONE DENSITY, GLUCOSE STICKS, BLOOD PRESSURE, AND BMI).HEALTHY GALLATIN ACCESS COMMITTEE BDHS CONTINUES TO PROVIDE LEADERSHIP AND SUPPORT TO THIS COMMITTEE. FOR 2014, THE COMMITTEE HAS MET TWICE.STRATEGIC ISSUE #2: INCREASING COLLABORATION AND STRATEGIC PARTNERSHIPSEXPAND UTILITY OF BDHS HEALTH INFORMATION CENTER (BDHS HIC)* BDHS HIC ARRANGED 14 HEALTH FORUMS TALKING ABOUT HYPERTENSION GUIDELINES, CONTROLLING GLUCOSE LEVELS, AUTOIMMUNE DISEASE, BRAIN INJURIES AND ADVANCE CARE PLANNING.* AS MEMBER OF THE CANCER COMMITTEE, REPORTING TO THE COMMITTEE THE TYPES OF CANCER SCREENINGS HELD BY BDHS, THE HCC AND CANCER EDUCATION PRESENTATIONS, LIKE THE FORUMS* PARTICIPANT IN QUARTERLY MEETINGS AND CONTRIBUTOR OF THE MT COMPREHENSIVE CANCER COALITION, REPORTING ON THE MAMMOGRAM PROJECT AND HCC MAMMOGRAM VOUCHERS * BDHS CONTINUES TO ATTEND QUARTERLY MEETINGS FOR THE IMMUNIZATION COALITION. HEALTHY GALLATIN COLLABORATION COMMITTEEBDHS CONTINUES TO PROVIDE LEADERSHIP, SUPPORT AND WORK ON THE HEALTHY GALLATIN COLLABORATION COMMITTEE. IN JANUARY, TOGETHER WITH CORE MEMBERS, THE COMMITTEE PROVIDED THE COMMUNITY UPDATES REGARDING PROGRESS OF THE HEALTHY GALLATIN COMMUNITY HEALTH IMPROVEMENT PLAN.STRATEGIC ISSUE #3: ENCOURAGING HEALTHY BEHAVIORS ACROSS LIFE SPANMAKING HEALTH LITERACY CURRICULUM/TOOLS AVAILABLE IN SCHOOLS* ABOUT HEALTHTEACHER* BDHS SPONSORS HEALTHTEACHER IN SCHOOLS ACROSS GALLATIN COUNTY. * IS A COMPREHENSIVE ONLINE K-12 HEALTH EDUCATION CURRICULUM, INCLUDING AGE-APPROPRIATE LESSONS, INTERACTIVE PRESENTATIONS AND ADDITIONAL RESOURCES THAT FOCUS ON HEALTHY BEHAVIORS AND INTEGRATE HEALTH LITERACY INTO CLASSROOMS.* LESSONS ARE RELEVANT AND SPAN THE HARD-HITTING ISSUES KIDS FACE (E.G. BULLYING, OBESITY, DEPRESSION).* FAMILY NEWSLETTERS AND AT-HOME CHALLENGES REINFORCE HEALTHY HABITS AT HOME.* EXPANDING ACCESS TO COMMUNITY* BDHS HAS RENEWED ITS SUBSCRIPTION TO HEALTH TEACHER FOR ANOTHER 3 YEARS FOR ALL OF GALLATIN COUNTY.* IN ADDITION TO DISTRICT SCHOOLS, BDHS HAS REACHED OUT TO HOME SCHOOLING GROUPS AND HEAD START* ALSO INTRODUCED HEALTHTEACHER TO KIDSLINK, AN AFTER-SCHOOL PROGRAM AND PROVIDED TRAINING SESSION FOR 25 TEACHERS.* LESSONS ACCESSED ON MENTAL AND EMOTIONAL HEALTH MODULEFOR THE SY 2014-2015, THERE WERE 260 LESSONS ACCESSED.ENCOURAGING/INCREASING PHYSICAL ACTIVITY OF SCHOOL-AGE KIDS THROUGH GO NOODLE PROGRAM* ABOUT GO NOODLE* GO NOODLE IS A PROGRAM OFFERED AS PART OF HEALTH TEACHER PROMOTING PHYSICAL ACTIVITY FOR KIDS, HELPING THEM REACH 60 MINUTES OF MOVEMENT DAILY AS RECOMMENDED BY THE CENTERS FOR DISEASE CONTROL AND PREVENTION. * IMPLEMENTED IN 2013, GO NOODLE CHANNELS K-5 CLASSROOM ENERGY WITH SHORT, INTERACTIVE PHYSICAL ACTIVITY BREAKS OR "BRAIN BREAKS" TO IMPROVE STUDENT HEALTH, ENGAGEMENT, BEHAVIOR AND PERFORMANCE. * GO NOODLE GAMES INTEGRATE MATH AND LANGUAGE ARTS, ALSO HELPING TEACHERS MEET CORE-SUBJECT STANDARDS* OUR COMMUNITY SCHOOLS HAVE ACCESS TO OVER 120 INTERACTIVE GAMES AND VIDEOS TO GET KIDS MOVING AND LEARNING IN THE CLASSROOM. IS ALSO ACCESSIBLE AT HOME.* THESE ACTIVITIES POSITIVELY IMPACT PHYSICAL ACTIVITY AND ACADEMIC PERFORMANCE. * GO NOODLE REACH AND IMPACT (SCHOOL YEAR 2014-2015)* NUMBER OF KIDS ENGAGED NOW AT 3,689, UP BY 44%* NUMBER OF PHYSICAL ACTIVITY BREAKS PLAYED NOW NEARLY 17,000, UP BY 135%* NUMBER OF STUDENT MINUTES OF PHYSICAL ACTIVITY JUMPED TO 788,594, UP BY 113%* BDHS-SPONSORED SCHOOL DISTRICTS HAD THE HIGHEST PERCENTAGE OF ACTIVE HEALTHTEACHER USERS NATIONWIDE, AMONG 30,000 TEACHERS AT 11,000 SCHOOLS IN THE PROGRAM.* BOZEMAN AREA TEACHERS REPORTED IMPROVEMENT IN THE FOLLOWING THROUGH USING GO NOODLE* 36% IMPROVEMENT IN VOCABULARY SCORES* 24% IMPROVEMENT IN MATH SCORESHEALTHY BEHAVIORS COMMITTEETHE HEALTHY GALLATIN HEALTHY BEHAVIORS COMMITTEE HAS MET TWICE IN 2014.* BEGINNING OF THE YEAR, REVIEWED THE PROGRESS AND WORK PLAN. DISCUSSION CENTERED AROUND WHAT THE GROUP DID WELL, HOW TO SET REALISTIC LONG TERM GOALS, AND DEFINE THE PURPOSE OF THE GROUP* AT END OF YEAR, THE GROUP IS WEIGHING ON A PROPOSAL TO DEVELOP A STRATEGIC COMMITTEE TO HELP DEVISE A NEW WORK PLAN FOR THE HB GROUP.STRATEGIC ISSUE #4: SOCIAL & ECONOMIC DISPARITIESSUPPORTING GALLATIN VALLEY FOOD BANK* TURKEY DONATIONS AMOUNTING TO OVER $10,000.BOARD SERVICE* BDHS VICE PRESIDENT OF SENIOR SERVICES (LEROY WILSON) SERVES AS A BOARD MEMBER TO HUMAN RESOURCE DEVELOPMENT COUNCIL (HRDC)NEXT STEPS: 2015 CHNA PLANNINGPLANNING FOR THE 2015 HAS STARTED AND THE GROUP (GCCHD, CHP AND BDHS) HAS AGAIN CONTRACTED WITH PROFESSIONAL RESEARCH CONSULTANTS (PRC) TO CONDUCT OUR NEEDS ASSESSMENT CONDUCTED LATE 2014. RESULTS WILL BE AVAILABLE IN EARLY 2015. PART VI, LINE 3: BOZEMAN DEACONESS HOSPITAL IS DEEPLY COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PATIENTS NEEDING, BUT UNABLE TO AFFORD, MEDICALLY NECESSARY HEALTH CARE SERVICES. BDH POSTS NOTICE OF ITS FINANCIAL ASSISTANCE POLICY IN ALL ADMITTING AREAS, AS WELL AS ON THE WEBSITE. AT THE EARLIEST FEASIBLE TIME, BDH WILL ATTEMPT TO DETERMINE WHETHER A PATIENT HAS THIRD PARTY COVERAGE FOR ANY PART OF THE HOSPITAL SERVICES PROVIDED. IF A PATIENT DOES NOT HAVE THIRD PARTY COVERAGE, A PATIENT ADVOCATE FROM THE MASH PROGRAM WILL SCREEN ALL INPATIENT CASES AND ANY OUTPATIENT CASES EXCEEDING $1,000 IN TOTAL CHARGES TO DETERMINE IF THE PATIENT QUALIFIES FOR THIRD PARTY FUNDING. IF NOT, THE PATIENT ADVOCATE WILL EXPLAIN THE FINANCIAL ASSISTANCE POLICY AND GIVE THE PATIENT AN APPLICATION IF DESIRED. IN CIRCUMSTANCES WHERE PAYMENT IN FULL WILL CAUSE FINANCIAL HARDSHIP THAT WILL SIGNIFICANTLY HARM THE PATIENT OR PATIENT'S FAMILY, THE APPLICANT MAY BE ASKED TO VISIT WITH CONSUMER CREDIT COUNSELING SERVICES TO FURTHER REVIEW THEIR FINANCIAL SITUATIONS. UPON REQUEST, PATIENTS MAY BE ASKED TO COMPLETE AN APPLICATION FOR MEDICAID PARTICIPATION OR FOR COVERAGE BY OTHER GOVERNMENTAL PAYMENT PROGRAMS. PATIENT BILLS ALSO CONTAIN BILLING INFORMATION EXPLAINING FINANCIAL OPTIONS AND PROVIDE CONTACT INFORMATION TO THE APPROPRIATE RESOURCES. PART VI, LINE 4: BOZEMAN DEACONESS HEALTH SERVICES CONTINUES TO PRIMARILY SERVE A 3-COUNTY AREA OF GALLATIN, PARK AND MADISON COUNTIES COVERING A TOTAL AREA OF 9,048 SQUARE MILES, WITH GALLATIN BEING MOST DENSELY POPULATED AT 37 PEOPLE PER SQUARE MILE COMPARED TO PARK (5.6/SQ MI) AND MADISON (2.1/SQ MI). THE 3-COUNTY AREA REPRESENTS A POPULATION OF APPROXIMATELY 121,000 BASED ON THE MOST RECENT (2014) POPULATION ESTIMATES FROM THE US CENSUS BUREAU. IN 2014, RESIDENTS FROM THE 3-COUNTY AREA ACCOUNTED FOR 87.2% OF TOTAL INPATIENT ADMISSIONS AT BOZEMAN DEACONESS HOSPITAL (GALLATIN = 77.63%, PARK = 5.64%, MADISON = 3.93%). PART VI, LINE 5: AS A SOLE COMMUNITY HOSPITAL, BOZEMAN DEACONESS HEALTH SERVICES IS COMMITTED TO PROVIDING QUALITY CARE AND PROMOTING HEALTH TO THE VERY COMMUNITY THAT SUPPORTS US. OUR GOVERNING BODY IS REPRESENTED BY INDIVIDUALS OF OUR COMMUNITY, WITH ALL BUT ONE BEING INDEPENDENT TO OUR ORGANIZATION. TO ENSURE IMMEDIATE ACCESS TO CARE, BDHS HAS AN OPEN MEDICAL STAFF AND REQUIRES EACH MEDICAL STAFF MEMBER TO CARE FOR ANYONE PRESENTING A NEED FOR CARE IN THE EMERGENCY DEPARTMENT. WE ALSO DEVOTE A SIGNIFICANT AMOUNT OF SURPLUS FUNDS TO MAINTAINING A HIGH LEVEL OF PATIENT CARE THROUGH QUALITY INITIATIVES AND TECHNOLOGY INVESTMENTS.BDHS GIVES BACK TO ITS COMMUNITY THROUGH COMMUNITY BENEFIT OPPORTUNITIES, WHICH AT JUST OVER $20 MILLION COMPRISED 9.9% OF OUR TOTAL OPERATING EXPENSES IN 2014.VARIOUS EMPLOYEES, PHYSICIANS, ADMINISTRATORS, AND BOARD MEMBERS OF THE HOSPITAL ARE ACTIVELY INVOLVED IN VOLUNTEER ROLES INCLUDING COMMUNITY BOARD POSITIONS IN NUMEROUS OTHER ACTIVITIES, GROUPS, AND ORGANIZATIONS THAT ACTIVELY PROMOTE THE HEALTH OF THE COMMUNITY. PART VI, LINE 6: BOZEMAN DEACONESS HEALTH SERVICES OWNED A MAJORITY INTEREST IN ADVANCED MEDICAL IMAGING, ROCKY MOUNTAIN SURGERY CENTER AND FAMILY DOCTORS URGENT CARE IN 2014, IN ADDITION TO ACQUIRING SOLE OWNERSHIP OF BOZEMAN HEALTH URGENT CARES. THESE ORGANIZATIONS HOLD SIMILAR POLICIES REGARDING PROVIDING CARE TO ALL MEMBERS OF THE COMMUNITY AND OFFERING FINANCIAL ASSISTANCE AS DETERMINED BY ABILITY TO PAY. 1 WESTERN MONTANA MENTAL HEALTH CENTER BLDG T-9 FORT MISSOULA RD MISSOULA MT 59804 810307814 501(C)(3) 419500 SUPPORT COMMUNITY HEALTH CRISIS PROGRAMS WITHIN OUR SERVICE AREA GREATER GALLATIN UNITED WAY 945 TECHNOLOGY BLVD 101F BOZEMAN MT 59718 810384820 501(C)(3) 50000 SUPPORT HUMAN SERVICE NEEDS WITHIN OUR SERVICE AREA COMMUNITY HEALTH PARTNERS 126 S MAIN STREET LIVINGSTON MT 59047 841420492 501(C)(3) 62000 SUPPORT COMMUNITY HEALTH PROGRAMS WITHIN OUR SERVICE AREA CANCER SUPPORT COMMUNITY 102 S 11TH AVE BOZEMAN MT 59715 810542266 501(C)(3) 60880 SUPPORT COMMUNITY HEALTH PROGRAMS WITHIN OUR SERVICE AREA BOZEMAN DEACONESS FOUNDATION 931 HIGHLAND BLVD STE 3200 BOZEMAN MT 59715 811407943 501(C)(3) 1000000 FUND ENDOWMENTS 5 0 PART I, LINE 2: RECIPIENTS OF GRANTS AND ASSISTANCE PREPARE INFORMATIONAL REPORTS SUBSTANTIATING THE USE OF THE FUNDS THAT WERE EARMARKED TO SUPPORT COMMUNITY HEALTH PROGRAMS. INVOLVEMENT OF BOZEMAN DEACONESS HEALTH SERVICES STAFF AND/OR ADMINISTRATION AS VOLUNTEERS IN THE ACTIVITIES BEING SUPPORTED ALSO ENSURES PROPER USAGE OF FUNDS. X 1 1 X X X X 0 0 0 0 0 1 0 1 0 JOHN ROBBINS MD TREASURER (THRU 6/30/14) 120182 0 38357 0 752 0 40988 0 16580 0 216859 0 0 0 DANE SOBEK MD TRUSTEE (AS OF 7/1/14) 556079 0 30000 0 360 0 38616 0 21869 0 646924 0 0 0 KEVIN PITZER CEO/PRESIDENT 411738 0 50920 0 15588 0 33770 0 20943 0 532959 0 0 0 GORDON DAVIDSON CFO/VP FINANCE 250024 0 30726 0 27254 0 47010 0 18133 0 373147 0 0 0 ELIZABETH LEWIS SENIOR VP OPERATIONS/LEGAL 227550 0 30097 0 14395 0 41935 0 17133 0 331110 0 0 0 HUGH HETHERINGTON MD DOCTOR 484827 0 109018 0 828 0 34260 0 27726 0 656659 0 0 0 ANNIE CASTILLO MD DOCTOR 493519 0 16319 0 1548 0 15600 0 881 0 527867 0 0 0 JACK HENSOLD MD DOCTOR 465724 0 16319 0 2376 0 38230 0 20593 0 543242 0 0 0 KEN MAY MD DOCTOR 319049 0 124017 0 270 0 15600 0 11102 0 470038 0 0 0 BLAIR ERB MD DOCTOR 570939 0 50000 0 1548 0 15600 0 24509 0 662596 0 0 0 PART I, LINE 1A PER CONTRACT, THE CEO IS REIMBURSED FOR TWO BUSINESS TRIPS PER YEAR WHERE HIS SPOUSE ACCOMPANIES HIM. THESE ARE REPORTED AS TAXABLE COMPENSATION. PART I, LINE 6 A PHYSICIAN LISTED IN PART VII, SECTION A, RECEIVES INCENTIVE COMPENSATION BASED ON ACTUAL RELATIVE VALUE UNIT'S (RVU'S) PRODUCED IN EXCESS OF TARGETS. THE TOTAL OF THE INCENTIVE IS CALCULATED BY TAKING THE EXCESS RVU'S TIMES A RVU CONVERTER. THE RVU CONVERTER IS BASED UPON NET EARNINGS FROM SERVICES PROVIDED BY THE PHYSICIAN. PART I, LINE 7 THE BOARD ESTABLISHES GOALS EACH YEAR AND IF MET, THERE IS COMPENSATION TIED TO THEM. ALL SUCH COMPENSATION IS REVIEWED BY THE INDEPENDENT COMPENSATION SPECIALISTS. INCENTIVE COMPENSATION IS DETERMINED BY ACHIEVING FINANCIAL PERFORMANCE IN EXCESS OF BUDGETED PERFORMANCE, AND ACHIEVING PRE-DETERMINDED GOALS DEALING WITH PATIENT QUALITY, PATIENT SATISFACTION AND EMPLOYEE SATISFACTION. THIS APPLIES TO ALL SENIOR ADMINISTRATION AND ALL PHYSICIANS (WITH ONE EXCEPTION DESCRIBED IN SCHEDULE J, PART I LINE 6A) WHO RECEIVE COMPENSATION AND INCLUDES INCENTIVE COMPENSATION REFLECTED IN PART II, COLUMN B(II). A MONTANA FACILITY FINANCE AUTHORITY 364615155 61240MBM8 2014-11-05 23005852 REFINANCE 2004 BOND ISSUED 3/4/2004 & FUND ADD'N OF BIG SKY MEDICAL FACILITY 0 0 0 B MONTANA FACILITY FINANCE AUTHORITY 810302402 621043CZ0 2005-09-21 28001371 FUND ADDTN TO HILLCREST & DEFEASE 3/28/00 HILLCREST CONSTRUCTION BONDS 0 0 0 C MONTANA FACILITY FINANCE AUTHORITY 364615155 61204EAH8 2010-04-22 6645000 REFINANCING OF 1998 BOND DEBT ISSUED 9/2/1998 0 0 0 D MONTANA FACILITY FINANCE AUTHORITY 810302402 61204MAS6 2011-09-28 20680164 TO FUND STRUCTURE AND EQUIPMENT OF NEW ER, ACQUISITION OF LEGACY CONDOS 0 0 0 A 23005972 377976 5127876 17500120 1 0 0 1 B 6420000 28220708 1896340 213865 345010 7153385 18612108 2006 0 1 1 1 C 3175000 6645000 132900 6512100 2010 1 0 1 1 D 2210000 20693206 11797 401295 20278869 1246 2013 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 1 0 0 0 0 1 A 1 B 1 C 1 D 1 DATE REBATE COMPUTATION PERFORMED ISSUER NAME: MONTANA FACILITY FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2010 ISSUER NAME: MONTANA FACILITY FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/30/2014 ISSUER NAME: MONTANA FACILITY FINANCE AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 06/01/2014 SCHEDULE K, PART I, LINE A(E): PART I ISSUE PRICE AND PART II LINE 3 BOND PROCEEDS DIFFER DUE TO INTEREST EARNED ON THE PROCEEDS. SCHEDULE K, PART I, LINE B(E): PART I ISSUE PRICE AND PART II LINE 3 BOND PROCEEDS DIFFER DUE TO INTEREST EARNED ON THE PROCEEDS. SCHEDULE K, PART I, LINE C(E): PART I ISSUE PRICE AND PART II LINE 3 BOND PROCEEDS DIFFER DUE TO INTEREST EARNED ON THE PROCEEDS. FORM 990, PART VI, SECTION A, LINE 7A THE YELLOWSTONE CONFERENCE OF THE METHODIST CHURCH CONFIRMS THE BOARD MEMBERS AND HAS AUTHORITY TO APPOINT THE CLERGY MEMBER OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 7B CHANGING THE ARTICLES OF INCORPORATION IN RELATIONSHIP TO THE PROCESS OF SELECTING BOARD MEMBERSHIP MUST BE APPROVED BY THE YELLOWSTONE CONFERENCE OF THE UNITED METHODIST CHURCH. FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE ANY COMMITTEES WITH THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 THE FINANCE COMMITTEE WILL REVIEW FORM 990 IN DETAIL AND WILL MAKE A RECOMMENDATION TO THE FULL BOARD FOR APPROVAL BEFORE FILING OF THE FORM 990. THE CFO REVIEWS THE FORM 990 AT A HIGHER LEVEL WITH THE BOARD BEFORE APPROVAL IS GRANTED. FORM 990, PART VI, SECTION B, LINE 12C IN-HOUSE COUNSEL IDENTIFIES POTENTIAL CONFLICTS FROM ANNUAL DISCLOSURES AND INFORMS THE BOARD CHAIR. THE BOARD CHAIR DISCUSSES THE CONFLICT AND DECIDES WHETHER THE CONFLICT IS OF SUCH A NATURE TO EXCLUDE THE CONFLICTED PARTY FROM DISCUSSION AND/OR VOTE. THIS POLICY COVERS ALL BOARD MEMBERS, OFFICERS, SENIOR ADMINISTRATION, AND KEY EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMMITTEE RECEIVES A FORMAL PRESENTATION BY AN INDEPENDENT COMPENSATION CONSULTANT (AS SELECTED BY THE BOARD) QUALIFIED TO PERFORM COMPENSATION REVIEWS INCLUDING USAGE OF COMPARABILITY DATA. THIS PERSON PRESENTS RECOMMENDATIONS TO THE COMPENSATION COMMITTEE OF THE BOARD. THE COMPENSATION COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD ON AN ANNUAL BASIS FOR OFFICERS AND SENIOR ADMINISTRATION. THIS ANNUAL PROCESS WAS PERFORMED IN FALL 2014 TO DETERMINE 2015 COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ALL TAX RELATED INFORMATION REQUIRED TO BE AVAILABLE FOR PUBLIC INSPECTION ARE AVAILABLE VIA WALK-IN, TELEPHONE CALL, E-MAIL, AND/OR MAIL-IN REQUEST. THE AUDITED FINANCIAL STATEMENTS ARE REQUIRED TO BE ATTACHED TO THE FORM 990 AND PROVIDED TO THE MUNICIPAL SECURITIES RULEMAKING BOARD, WHICH IS OUR TAX-EXEMPT BONDS TRUSTEE, VIA AN ON-LINE, CENTRAL FILING LOCATION CALLED ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA). THE FINANCIAL STATEMENTS CAN BE OBTAINED BY THE GENERAL PUBLIC AT THE EMMA WEBSITE. FORM 990, PART XI, LINE 9: TRANSFERS TO RELATED PARTIES -2,250,794. HILLCREST SENIOR LIVING LIMITED LIABILITY COMPANY 1201 HIGHLAND BLVD BOZEMAN MT 59715 810232121 INDEPENDENT AND ASSISTED LIVING HOME MT 6493493 30439879 BOZEMAN DEACONESS HEALTH SERVICES BOZEMAN HEALTH CLINICAL RESEARCH LLC 950 STONERIDGE DR 1 BOZEMAN MT 59715 471323951 HEALTHCARE CLINICAL RESEARCH MT 67462 404718 BOZEMAN DEACONESS HEALTH SERVICES BOZEMAN DEACONESS FOUNDATION 931 HIGHLAND BLVD SUITE 3200 BOZEMAN MT 59715 841407943 RAISE FUNDS TO SUPPORT BOZEMAN DEACONESS HEALTH SERVICES MT 501(C)(3) LINE 7 N/A 1 DEACONESS INTERCITY IMAGING LLC 915 HIGHLAND BLVD BOZEMAN MT 59715 810666871 HEALTHCARE - IMAGING SERVICES MT N/A RELATED 1349296 2415762 0 1 0.77500 ROCKY MOUNTAIN SURGICAL CENTER LLC 1450 ELLIS ST SUITE 101 BOZEMAN MT 59715 364462300 HEALTHCARE - SURGICAL SERVICES MT N/A RELATED 2456814 3011607 0 0 0.51010 FAMILY DOCTORS URGENT CARE LLC 120 N 19TH AVE SUITE A BOZEMAN MT 59715 810532877 HEALTHCARE - PHYSICIAN OUTPATIENT CARE MT N/A RELATED 33345 416603 0 0 0.83760 BOZEMAN HEALTH URGENT CARES LLC 1006 W MAIN BOZEMAN MT 59715 465318746 HEALTHCARE - PHYSICIAN OUTPATIENT CARE MT BOZEMAN DEACONESS HEALTH SERVICES RELATED -86761 1661622 0 1 1.00000 BOZEMAN DEACONESS REAL ESTATE DEVELOPMENT CORP PO BOX 10490 BOZEMAN MT 59719 205496567 SALE OF REAL ESTATE PROPERTY AND RESIDENCES TO SENIORS MT N/A C 5079258 9494200 1.00000 1 0 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 DEACONESS INTERCITY IMAGING LLC J 314664 GENERAL LEDGER AND CORP. RECORDS DEACONESS INTERCITY IMAGING LLC L 126489 GENERAL LEDGER AND CORP. RECORDS DEACONESS INTERCITY IMAGING LLC M 55544 GENERAL LEDGER AND CORP. RECORDS DEACONESS INTERCITY IMAGING LLC Q 2303988 GENERAL LEDGER AND CORP. RECORDS DEACONESS INTERCITY IMAGING LLC S 1483660 GENERAL LEDGER AND CORP. RECORDS BOZEMAN DEACONESS FOUNDATION B 1000000 GENERAL LEDGER AND CORP. RECORDS BOZEMAN DEACONESS FOUNDATION C 2067539 GENERAL LEDGER AND CORP. RECORDS BOZEMAN DEACONESS FOUNDATION R 587149 GENERAL LEDGER AND CORP. RECORDS ROCKY MOUNTAIN SURGICAL CENTER LLC S 2273989 GENERAL LEDGER AND CORP. RECORDS BOZEMAN HEALTH URGENT CARES LLC D 2200000 GENERAL LEDGER AND CORP. RECORDS BOZEMAN DEACONESS REAL ESTATE DEVELOPMENT CORP Q 190639 EXPENSE REIMBURSEMENTS