2015-11-16T15:09:59-06:00 2014-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-01-01 810232406 Pondera Medical Center POND 4062713211 805 Sunset Blvd Conrad MT 59425 Bill O'Leary CEO 4062713211 2015-11-12 1 Kim Hunwardsen CPA P00484560 6122536500 2014 2016-03-07 17:11:31Z Bill O'Leary 805 Sunset Blvd Conrad MT 59425 12883051 0 X www.ponderamedical.com X 1975 MT Providing access to quality healthcare through all life's stages 9 9 282 160 0 0 460050 465914 12010409 12374168 37442 27680 3009 15289 12510910 12883051 0 0 0 0 8158011 7697289 0 0 0 4592164 4984442 12750175 12681731 -239265 201320 6126065 6015723 2553657 2246285 3572408 3769438 X As an essential member of our regional community, PMC strives to be a progressive healthcare business devoted to providing access to quality healthcare and exceeding the expectations of those we serve through all life's stages. 0 0 8215813 8290693 Pondera Medical Center is a 25-bed critical access hospital. The Medical Center provided 223 inpatient days and 622 swing bed patient days along with a 24-hour emergency room that accounted for 1,690 visits for the year. Outpatient services such as lab, x-ray, physical and occupational therapy, wellness center, surgery, ambulance, cardiac rehab, DME, home health and respiratory therapy were provided to members of our rural community so they could receive the services they needed close to home. The services are essential for the survival of our community.The Medical Center maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy and equivalent service statistics. The amounts of charges foregone for services provided under the Medical Center's charity care policy was $94,612. Total direct and indirect costs related to these foregone charges were approximately $83,000 at December 31, 2014, based on average ratios of cost to gross charges.The Medical Center provides care to patients and residents who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Medical Center does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient and resident service revenue. 1405336 2969800 Pondera Medical Center's Extended Care Facility is a 59-bed nursing home offering 24-hour care and nursing services provided by licensed, certified and compassionate staff members. The facility had 18,275 total patient days. Specialized services are also available including those offered by a physical therapist, occupational therapist, registered dietitian, and medical social worker. We have a remarkable life enrichment program that offers activities 7 days a week to include exercise, socials, games, theme parties, pets, gardening, cooking, live music, crafts and outings.We have a 14-bed Special Care Unit designated for residents with pervasive memory loss and confusion, providing an extra touch of attention and supervision. 1189131 1113675 Pondera Medical Center Clinic is a Family Practice Rural Health Clinic dedicated to providing and coordinating comprehensive services to the entire family. Our physicians are Board Certified Family Practitioners. Boarded Family Practice Physicians must complete an additional three years of specialized training above and beyond that of medical school. Family Practitioners are trained in all avenues of medicine, so they can provide a full range of care. PMCC Physician Assistants are licensed by the State of Montana and specialize in Family Medicine and Urgent Care. Our Providers promote healthy lifestyles and continually strengthen the relationship between the clinic and community, with excellent, timely, and compassionate patient care. The Clinic has 2 physicians and 2 physician assistants and provided 9,347 total clinic visits, 466 extended care visits and 163 swing bed visits. 10810280 1 1 0 0 0 0 0 0 1 0 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 35 0 1 282 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Brenda Ries 4062713211 805 Sunset Blvd Conrad MT 59425 X Brent Gaylord Chair 1.00 X X 0 0 0 Bernard Ries Vice Chair 1.00 X X 0 0 0 Janice Hoppoes Treasurer 1.00 X X 0 0 0 Kelly Greer Secretary 1.00 X X 0 0 0 Jaynie Gollehon Trustee 1.00 X 0 0 0 Karla Styren Trustee 1.00 X 0 0 0 Ted Kronebusch Trustee 1.00 X 0 0 0 Gena Morris-Ries Trustee 1.00 X 0 0 0 Gene Hauer Trustee (partial year) 1.00 X 0 0 0 Bill O'Leary CEO 40.00 X 0 0 0 Randy Nightengale CFO 40.00 X 0 0 0 Jay Taylor Physician 40.00 X 205401 0 20615 Patricia Grena PA 40.00 X 144670 0 9336 Michael Hewett PA-ER 36.00 X 129519 0 0 Ilene Hawkinson PA-ER 40.00 X 117814 0 279 Laura Erickson CNO 40.00 X 102753 0 12120 700157 0 42350 5 0 1 0 Kalispell Regional Medical Center 310 Sunny View Lane Kalispell MT 59901 Professional Fees 590304 Evident 6600 Wall Street Mobile AL 36685 Professional Fees 496293 2 295134 170780 465914 Patient Service Revenue 622110 8490149 8490149 Nursing Home 623000 3292711 3292711 Supporting Revenue 900099 275180 275180 Bed Tax Revenue 900099 196212 196212 EHR Incentive 900099 119916 119916 12374168 27680 27680 15289 0 15289 15289 15289 12883051 12374168 0 42969 X 6464144 5741407 722737 712304 632663 79641 520841 462607 58234 158138 143138 15000 8783 8783 37350 37350 1613108 1114222 498886 24854 4193 20661 836605 702381 134224 153946 24310 129636 268944 260531 8413 23886 23745 141 35825 23024 12801 41291 41291 573570 573570 144841 144841 Bad Debt Expense 389750 389750 Medical Supplies 281329 281329 Food 229437 229437 MT Bed Tax 162682 162682 103 103 12681731 10810280 1871451 0 774934 1352771 1195616 1100778 124054 137881 49305 45339 12688311 10316668 2605411 2371643 466830 462540 909915 544771 6126065 6015723 1713352 1473835 716385 647035 123920 125415 2553657 2246285 X 1135080 1468710 2437328 2300728 3572408 3769438 6126065 6015723 X 201320 -4290 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 4803 10859 9126 6536 0 48854 48854 9495092 7407830 2087262 2922996 2754034 168962 221369 154804 66565 2371643 Investment in Perpertual Trust 462540 F 462540 Other Assets 69153 Workers Compensation Deposit 123159 Other Accounts Receivable 352459 544771 Compensated Absences 116542 Estimated Third-Party Payor Settlements 8873 125415 X 12298964 -435331 -435331 12734295 148756 148756 12883051 12250690 0 12250690 431041 431041 12681731 Part IV, Line 1b: The funds are the personal funds of the nursing home residents anad are to be used only for specific personal expenditures as requested by the residents. Part X, Line 2: The Medical Center is organized as a Montana nonprofit corporation 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 Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. The Medical Center 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 Medical Center 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 Medical Center is no longer subject to federal or state tax examinations by tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Interest expense reported in non-operating revenue for financial statements -41,291. Bad debt expense recorded in revenue for financial statements -389,750. Loss on perpetual trust recorded in non-operating revenue for financial stmt -4,290. Part XI, Line 4b - Other Adjustments: Capital grants and restricted contributions recorded in revenue for Form 990 148,756. Part XII, Line 4b - Other Adjustments: Interest expense recorded in total expenses for Form 990 41,291. Bad debt expense recorded in total expenses for Form 990 389,750. 1 1 X 1 X 1 X 0 1 0 0 83000 83000 0.00680 83000 83000 0.00680 6286719 4446147 1840572 0.14970 6286719 4446147 1840572 0.14970 6369719 4446147 1923572 0.15650 1 389750 0 2521996 2538159 -16163 X 1 1 1 1 Pondera Medical Center 805 Sunset Blvd Conrad MT 59425 www.ponderamedical.com 13510 X X X X Provider Based Rural Health Clinic Pondera Medical Center 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X www.ponderamedical.com X 1 14 1 www.ponderamedical.com 0 0 1 X 100.000000000000 250.000000000000 X 1 1 X X X 1 X X X X 1 X 0 X X X 1 X 0 1 Pondera Medical Center Part V, Section B, Line 5: Pondera Medical Center set up a community steering committee to help gather information and prioritize specific healthcare needs for our Needs Assessment survey. During the data collection period, we also set up focus groups with various individuals and groups throughout the community, to assist in gathering additional healthcare interests and needs information. These groups also had opportunity to see and understand our data results. Pondera Medical Center Part V, Section B, Line 11: The implementation planning committee identified the most important health needs to be addressed by reviewing the CHNA, secondary data, community demographics, and input from representatives representing the broad interest of the community, including those with public health expertise (see page 8 of the Implementation Strategy for additional information regarding input received from community representatives). The implementation planning committee determined which needs or opportunities could be addressed considering Pondera Medical Center's parameters of resources and limitations. The committee then prioritized the needs/opportunities using the additional parameters of the organization's vision, mission, and/or values, as well as existing and potential community partners. Participants then created a goal to achieve using strategies and activities, as well as the general approach to meeting the stated goal (i.e. staff member responsibilities, timeline, potential community partners, anticipated impact(s), and performance/evaluation measures). The prioritized health needs as determined through the assessment process and which the facility will be addressing relates to the following:1. Access to Healthcare2. Healthy Behaviors and Lifestyles3. Quality of CarePondera Medical Center continues to work on the Needs Assessment Survey Implementation Plan, created from our Community Health Needs Assessment from 2014. The goals, strategies, and activities are compiled in a progress tracker that is updated every quarter. Details of our plan are also updated to show our progress and the impact on the community. Updated details are available on our website. Pondera Medical Center Part V, Section B, Line 13h: Pondera Medical Center utilizes the federal poverty guidelines (FPG) as the primary financial measurement tool. Financial determination is based on family size and income. All forms of income are considered, including but not limited to: workman's compensation payments, social security benefits, unemployment wages, child support payments, etc. Pondera Medical Center Part V, Section B, Line 16i: Patients are informed about their eligibility for financial assistance during conversations at registration and during follow-up on outstanding account balances. Information regarding financial assistance and applications are available at our business office. The financial assistance application is also available on our website. We also have partnered with the MASH program, they contact our private pay patients to see if they might qualify for state funded programs and help them complete FAP if they don't qualify for state programs. Pondera 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. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Pondera Medical Center Part V, Section B, line 16b website: www.ponderamedical.com 4 Pondera Med Ctr Extended Care Facility 805 Sunset Blvd Conrad MT 59425 Long Term Care Pondera Medical Center Eye Clinic PLL 403 S Delaware St Conrad MT 59425 Eye Care and Optical Pondera Med Ctr Durable Medical Equip 809 Sunset Blvd Conrad MT 59425 Durable Medical Equipment Pondera Medical Center Home Health 809 Sunset Blvd Conrad MT 59425 Home Health Care Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services was determined using the Medicare Cost Report. Part I, Ln 7 Col(f): Bad debt expense of $389,750 removed from the denominator calculation. Part III, Line 2: Bad debt expense is reported net of discounts and contractual allowances. We are using the bad debt expense as reported on the financial statements. Payments on accounts previously written off to bad debt expense reduce bad debt expense in the current year. Part III, Line 4: The footnote to the organization's financial statements can be found on pages 10 and 11 of the attached audited financial statements. Part III, Line 8: 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 the Centers for Medicare and Medicaid Services.The Medicare shortfall represents a cost absorbed by the hospital as a result of providing care to Medicare patients. The cost of providing this benefit to the community should be reported as such. Part III, Line 9b: Patients must complete a financial assistance application to be considered for charity care. Those patients known to qualify for financial assistance or that have contacted the business office and are in the process of completing an application or setting up a payment schedule will not receive additional collection notices. Part VI, Line 2: A community survey was prepared and administered by an independent third party. We also obtained health fair requests and results, physician studies of trends and patient satisfaction surveys. The final report and an implementation strategy were approved by the board in 2014. Part VI, Line 3: Patients are informed about their eligibility for financial assistance during conversations at registration and during follow-up on outstanding account balances. Financial assistance is offered if a patient is unable to make a payment. Part VI, Line 4: Pondera Medical Center serves the population of Pondera County, Montana. The population of Pondera County in 2014 was 6,219 and is considered rural. The median household income for 2009 - 2013 was $41,277 in which 17.5% of the population was below the poverty guidelines. The racial makeup consists of 82% white, 15% American Indian or Alaska Native with the remainder being other races. The largest income producing segment of Pondera County is agriculture and while there are a couple large employers in the county including Pondera Medical Center, small business, and oil and natural gas producers make up the majority of employers. The nearest hospital is Marias Medical Center, a 20-bed acute care hospital located in Shelby, MT. Marias Medical Center is located approximately 27 miles north of Conrad, MT. Part VI, Line 5: The Board of Directors is comprised of community members throughout Pondera County and all board meetings are open to the public. Surpluses of cash, when available, are invested back into the Hospital for equipment purchases and wage considerations.Pondera Medical Center operates an emergency room available to all regardless of ability to pay, 20 acute care beds for hospital stays, surgery center, 59 bed extended care center, special care unit, rural health clinic, wellness center, cardiac rehab, home health agency, physical therapy and numerous other services to meet your daily and long-term health care needs. Pondera Medical Center seeks and encourages community members to become involved and volunteer in our Extended Care facility. 0 0 0 0 0 0 0 0 0 Jay Taylor Physician 205281 0 0 0 120 0 0 0 20615 0 226016 0 0 0 Patricia Grena PA 144313 0 0 0 357 0 0 0 9336 0 154006 0 0 0 Schedule J, Part I, Line 3: The CEO and CFO compensation is set by Kalispell Regional Medical Center. Form 990, Part VI, Section A, line 3 Pondera Medical Center contracts with Kalispell Regional Healthcare System for Chief Executive Officer and Chief Financial Officer services. Compensation of $97,792 and $7,073 was paid to Kalispell Regional Healthcare System for the Chief Executive Officer and Chief Financial Officer, respectively. Form 990, Part VI, Section A, line 8b The organization does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The Form 990 is reviewed by the CEO and CFO. After their review a draft copy of the 990 is provided by e-mail to the board members for review. The final copy of the Form 990 is e-mailed to the board prior to filing. Form 990, Part VI, Section B, line 12c Officers and Trustees annually disclose potential conflicts, which are discussed at a Board of Trustees meeting. Segregation of duties is strictly enforced for any potential family or business conflicts of interest. If there is a potential conflict at a board meeting, the board member is not allowed to vote on the conflicting issue. Form 990, Part VI, Section B, line 15 The CEO and CFO compensation is set by Kalispell Regional Medical Center. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, line 11g Professional fees: Program service expenses 624,363. Management and general expenses 128,611. Fundraising expenses 0. Total expenses 752,974. Recruitment: Program service expenses 33,292. Management and general expenses 1,550. Fundraising expenses 0. Total expenses 34,842. Repairs and maintenance: Program service expenses 174,470. Management and general expenses 4,815. Fundraising expenses 0. Total expenses 179,285. Purchased services: Program service expenses 268,872. Management and general expenses 322,343. Fundraising expenses 0. Total expenses 591,215. Collection expense: Program service expenses 13,225. Management and general expenses 41,567. Fundraising expenses 0. Total expenses 54,792. Form 990, Part XI, line 9: Loss on perpetual trust -4,290.