2015-05-11T13:24:01-05:00 2014-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-07-01 237169043 Central Montana Medical Facilities Inc CENT 4065387711 408 Wendell Avenue Lewistown MT 59457 Alan R Aldrich CFO 4065386243 2015-05-08 1 Kim C Hunwardsen P00484560 6122536500 2015-05-08 2013 2016-02-25 16:41:14Z Central Montana Medical Center Christopher Noland 408 Wendell Avenue Lewistown MT 59457 31259574 0 X www.cmmccares.com X 1971 MT The mission of CMMC is to be the leader in assuring community based quality healthcare. 14 11 418 193 0 0 148718 1557044 27678308 27768741 240160 390573 -13448 -11159 28053738 29705199 0 0 0 0 16907595 17680805 0 0 57061 11110163 11287313 28017758 28968118 35980 737081 21345794 25851619 4944209 9384973 16401585 16466646 X The mission of Central Montana Medical Center is to be the leader in assuring community based quality healthcare. 1 0 2513222 2354901 Hospital Inpatient Services:Number of beds: 25Provided 1,738 acute days of care and 763 swing bed days of care for 27.41% occupancy rate. 3719387 3994621 Skilled Nursing Care/Long-Term Care Rehabilitation or Long-Term Nursing Services:Provided 16,901 days of care for a 54.48% occupancy rate. 1922886 3272767 Emergency Services:Provided for 5,124 Emergency visits.24 hour Physician coverage available. 15032827 18146452 Community care and services are also provided through the many reduced price services and free clinics, fairs, and programs offered throughout the year. These include but are not limited to the following (all costs are estimates):1. Twenty-seven foot clinics were held in 2013-2014 in Denton and Hobson communities. A total of 336 people were served, all received discounted health care. Total community benefits expense of $4,792.2. One health fair was held in 2013-2014, serving 2,447 people in Fergus and surrounding counties. All received discounted health care. Total community benefits expense of $3,877.3. Diabetes Education held Support Groups throughout 2013-2014, serving 40 people and totaling a community benefit expense of $619.4. CMMC educated locals with a babysitting class (24 people served, 1 class offered, total community benefit $619), and several community boards were served on in 2013-2014 for a total of $1,890.5. The facilities maintain 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. The amount of charges foregone for services provided under the Facilities charity care policy were approximately $966,000 for the fiscal year. Total direct and indirect costs related to these foregone charges were $639,000 based on an average ratio of cost to gross charges. 15032827 18146452 23188322 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 35 0 1 418 1 0 0 0 0 0 1 1 0 0 0 0 X 14 11 1 1 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Alan R Aldrich 4065357711 408 Wendell Ave Lewistown MT 59457 Mike Zacher President (July-September) 2.00 X X 0 0 0 Dave Phillips V.P.(July-Sept)/President (Oct-June) 2.00 X X 0 0 0 Doug Flament Member (July-Sept)/V.P. (Oct-June) 2.00 X X 0 0 0 Nancy Wilson Secretary/Treasurer 2.00 X X 0 0 0 Mike Delaney Member (July-September) 2.00 X 0 0 0 Carl Seilstad Member 1.00 X 0 0 0 Francis Weinheimer Member 1.00 X 0 0 0 Russel Spika CPA Member 1.00 X 0 0 0 Josh Webber Member 1.00 X 0 0 0 Greg Smith Member 1.00 X 0 0 0 Ann Econom Member 1.00 X 0 0 0 Susan Miller Member 1.00 X 0 0 0 Kevin Taylor Member (January-June) 1.00 X 0 0 0 Jennifer Saunders Member (October-June) 1.00 X 0 0 0 Roy Kohler MD Member 1.00 X 15167 0 0 Laura Bennett MD Member 40.00 X 189994 0 6640 Lee Rhodes CEO (July-March) 40.00 X 0 0 0 Christopher Noland Interim CEO (March-June) 40.00 X 0 0 0 Alan R Aldrich CFO 40.00 X 112563 0 19426 Dianne Scotten CCO 40.00 X 107382 0 4326 Aaron Humphreys Orthopedic Surgeon 40.00 X 527122 0 26841 James Fox CRNA 40.00 X 224809 0 9014 Amy A LePage Emergency Medicine 40.00 X 261466 0 16498 Barbara K Miller General Surgery 40.00 X 271624 0 9226 Keith Hopkins Internal Medicine 40.00 X 234379 0 9359 1944506 0 101330 20 0 1 0 Birdwell Builders PO Box 592 Lewistown MT 59457 Building new ER/Lab 886408 Quorum Health Resources LLC 105 Continential Place Brentwood TN 37027 Facility Management & CEO services 491247 L'Heureux Page Werner PC 15 5th Ave S Great Falls MT 59401 Architect for Hospice House & ER/Lab Pro 263348 3 61220 31700 1464124 1557044 Net Patient Revenue 622110 26442791 26442791 Special Programs 900099 1015096 1015096 Cafeteria 722210 132348 132348 178506 178506 27768741 147845 147845 282476 293635 -11159 -11159 -11159 1480000 1234602 2670 245398 -2670 242728 242728 23468 61220 23468 0 29705199 27768741 0 379414 471098 331522 139576 62482 62482 14115200 10949542 3152396 13262 372096 297677 73889 530 1693077 1354462 334681 3934 966852 773482 192551 819 515828 309497 206331 63909 63909 34550 34550 736604 485236 250514 854 87069 43535 12907 30627 1242373 960786 276655 4932 931880 729064 201016 1800 24828 24828 88057 71525 16532 62255 41627 20628 1148183 865650 282230 303 589740 560949 28791 Medical Supplies 2345184 2345184 Bad Debt Allowance 1268757 1268757 Equipment Rental and Ma 310333 242307 68026 1837763 1470210 367553 28968118 23188322 5722735 57061 764982 4276392 4159417 4376130 81286 14565 575316 558128 222147 395379 32982021 23667834 8383559 9314187 3586263 3962232 35175 28140 3537649 2926466 21345794 25851619 2370903 2924596 233974 175481 216827 4486959 1958650 1797937 163855 0 4944209 9384973 X 13646285 14596875 1854960 882116 900340 987655 16401585 16466646 21345794 25851619 X 737081 213509 -885529 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 4869 12281 12705 4445 0 103009 103009 17995459 12571647 5423812 12562280 10388686 2173594 2321273 707501 1613772 9314187 Long-Term Prepaid Expenses 564871 Due from Foundation 1869771 Other Receivables 395476 Estimated Third-Party Payor Settlements 96348 2926466 X 27476015 213509 -1268757 -1055248 28531263 1173936 1173936 29705199 27992996 293635 293635 27699361 1268757 1268757 28968118 Part IV, Line 1b: The Organization is a custodian for resident trust funds. A sub-register is used and listed by resident. The SNC Biller makes fund distribution as residents request funds be paid. Part X, Line 2: The Facilities 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 Facilities is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Facilities are 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 990-T) with the IRS to report its unrelated business taxable income. The Facilities 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 Facilities 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 Facilities' Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts recorded in Revenue for F/S -1,268,757. Part XI, Line 4b - Other Adjustments: Contributions for Specific Purposes recorded in Fund Balance for F/S 1,467,571. Rental Expenses recorded in Expenses for F/S -293,635. Part XII, Line 2d - Other Adjustments: Rental Expenses recorded in Expenses for F/S 293,635. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts recorded in Revenue for F/S 1,268,757. Hospice Home Tour 17749 11569 6180 3751 2429 Golf Tourney 12849 8258 4591 900 214 2082 750 645 5 54090 41393 12697 2414 1000 9283 84688 61220 23468 900 214 2082 6915 1000 12357 23468 0 1 1 X 1 X 1 X 1 1 0 1 1 365 639000 639000 0.02310 365 639000 639000 0.02310 15 10007 19801 2980 16821 0.00060 1 2414 2414 0.00010 4358236 3336103 1022133 0.03690 4 1250 2312 2312 0.00010 20 11257 4382763 3339083 1043680 0.03770 20 11622 5021763 3339083 1682680 0.06080 1 1890 1890 0.00010 1 1890 1890 0.00010 0 1268757 30634 5975720 6013348 -37628 X 1 1 1 1 Central Montana Medical Center 408 Wendall Avenue Lewistown MT 59457 www.cmmccares.com 12894 X X X X Home Health / Hospice Central Montana Medical Facilities Inc 1 1 X X X X X X X X 12 1 0 1 X www.cmmccares.com X X X X X X X 0 0 1 1 150.000000000000 1 300.000000000000 1 X X X 1 1 X X X 1 0 X X X X 1 X 0 0 Central Montana Medical Facilities, Inc. Part V, Section B, Line 1j: Secondary Data: County Profile, Demographic Trends and Economic Impacts Central Montana Medical Facilities, Inc. Part V, Section B, Line 3: The hospital formed a steering committee, consulting with community members from various organizations. Central Montana Medical Facilities, Inc. Part V, Section B, Line 5d: The Needs Assessment is available at the Community Relations Office at Central Montana Medical Center as well as on the hospital website. Central Montana Medical Facilities, Inc. Part V, Section B, Line 6i: The implementation strategy can be found at: www.cmmccares.com. Central Montana Medical Facilities, Inc. Part V, Section B, Line 7: Respondents indicated a need for more specialists, and more primary care providers. CMMC already offers a number of primary care and specialty services to the community, and continues to recruit/retain providers. Respondents indicated a need for a walk-in clinic. Providing a walk-in clinic is outside of CMMC's capacity and financial resources. A need for dialysis was also indicated. Dialysis services are beyond CMMC's capacity due to investment required in equipment and specialized staff. One of the top three concerns was alcohol abuse. This is beyond CMMC's scope of work. Other resources are available in the community to meet this community need. Central Montana Medical Facilities, Inc. Part V, Section B, Line 14g: A summary of the financial assistance policy is also posted in the hospital facility's emergency room, waiting rooms, and admissions offices. 2 Central Montana Medical Center - DME 202 4th Avenue South Lewistown MT 59457 HME/DME Services Central Montana Medical Center Nursing Center 408 Wendell Avenue Lewistown MT 59457 Skilled Nursing Facility Part I, Line 3c: Eligibility is based on patient's family size, family gross income, personal assets, and other medical debts. Part I, Line 6a: The Organization's community benefit report can be found on its website at: www.cmmccares.com. Part I, Line 7: The Organization used an average overall ratio of costs to gross charges which addresses all patient segments in order to calculate charity care. Community health improvement services, health professions education, and cash and in-kind contributions were based on expenses recorded in the general ledger. Subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare cost report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $1,268,757. Part II, Community Building Activities: Community Building activities promoted the health of the communities served by providing service and donations for a healthy, active, and educated public. Central Montana Medical Center staff donated time to community boards, such as LEPC (Lewistown Emergency Preparedness Community), Kiwanis, Central Montana Youth Challenge, and the DUI Task Force. By being a part of these community meetings CMMC staff provides a range of knowledge to the community members with a foundation on health and medical needs. CMMC was a sponsor of MT Island Challenge, a walk/run/bike competition put on by the Boys & Girls Club of Lewistown. CMMC provided EMS Coverage and 100 first aid kits for participants. CMMC donated 100 Band-Aid kits for R.S.V.P Annual Meeting (Community Volunteer Program) and a box of first aid supplies to the Red Bird Baseball District Tourney. All of these programs benefit central Montana area and promote health and wellness. Part III, Line 2: Bad debt expense is reported at charges as recorded by the organization.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is calculated by using charity care as a % of gross patient services revenue. As a portion of revenue is considered charity care, it is assumed that a percentage of bad debt expense would also be considered charity care. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 8 of the attached audit report. Part III, Line 8: 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.All of the Medicare shortfall should be treated as a community benefit. The Organization treats individuals regardless of the ability to pay. Providing Medicare services promotes access to healthcare services which are vitally needed by our community. Part III, Line 9b: Patients deemed by CMMC to be unable to pay at any time during the revenue cycle may be eligible to receive available financial assistance. Patients must complete an application. Our collection practice is to refrain from collection efforts until financial assistance is determined. Normal collection efforts would resume if the application is not returned timely or after the write-off is complete and the patient owes a balance. Part VI, Line 2: Currently, CMMC assesses the health care needs of the community by the number of responses to ads and articles released through the local media. CMMC monitors the attendance at annual events such as health fairs. Also tracked were the kinds of support requested of CMMC such as children's safety, wellness initiatives and healthcare assessments. In the past, CMMC completed an official Community Needs Assessment with the help of Montana State University. Mail and phone surveys were completed and "town hall" type meetings were held in Lewistown as well as most of the surrounding smaller communities. Part VI, Line 3: CMMC has financial assistance signage posted in the admissions areas and the ER waiting area. A pamphlet explaining our financial assistance program, the application process and contact information is available at all hospital registration areas. The Charity Care policy and application along with a checklist and contact information is posted on our website on the internet. Prior to discharge someone from discharge planning discusses with the patient the availability of various government benefits, such as Medicaid, and assists the patient with qualifications for such programs, where applicable. Assistance with filling out the Charity Care application is also provided at this time. Private Pay in-patients are informed of Charity Care either prior to scheduled admission by physician referral or prior to discharge from the facility. We also send out information with first time statements. All other patients are informed upon inquiry. Part VI, Line 4: Lewistown is an agricultural community and the county seat for Fergus County Montana. Lewistown is located in the center of Montana and is surrounded by five mountain ranges: the Snowies, the Judiths, the Moccasins, the Belts and the Highwoods. The city of Lewistown and the surrounding rural towns are supported by one hospital, Central Montana Medical Center. Fergus County has a Primary Care Low Income HPSA Designation with a score of 17. Fergus County is located in a federally designated medically underserved area. As of the census of 2010, there were 5,901 people, 2,761 households, and 1,512 families residing in the city. The population density was 1,109.2 inhabitants per square mile. There were 3,007 housing units at an average density of 565.2 per square mile. The racial makeup of the city was 95.4% White, 0.3% African American, 1.7% Native American, 0.4% Asian, 0.3% from other races, and 2.0% from two or more races. Hispanic or Latino of any race was 2.1% of the population.There were 2,761 households of which 23.7% had children under the age of 18 living with them, 42.7% were married couples living together, 8.3% had a female householder with no husband present, 3.7% had a male householder with no wife present, and 45.2% were non-families. 39.8% of all households were made up of individuals and 18.8% had someone living alone who was 65 years of age or older. The average household size was 2.07 and the average family size was 2.78.The median age in the city was 45.4 years. 20.4% of residents were under the age of 18: 6.5% were between the ages of 18 and 24; 22.6% were from 25 to 44; 28.9% were from 45 to 64; and 21.7% were 65 years of age or older. The gender makeup of the city was 49.2% male and 50.8% female. Part VI, Line 5: The CMMC Governing Board consists of 14 volunteer community members including residents from Grass Range, Stanford, Denton and Judith Gap. CMMC extends medical staff privileges to qualified physicians based upon community needs.Surplus funds, when available, are applied to patient care needs, equipment and building maintenance and medical education requirements. The expenditure of these funds is approved by the Governing Board which meets on a monthly basis. Part VI, Line 6: N/A Part VI, Line 7, Reports Filed With States MT X X 1 1 X X 0 0 0 0 0 0 0 0 0 Laura Bennett MD Member 189994 0 0 0 0 0 2948 0 3692 0 196634 0 0 0 Aaron Humphreys Orthopedic Surgeon 527122 0 0 0 0 0 12198 0 16051 0 555371 0 0 0 James Fox CRNA 224809 0 0 0 0 0 9014 0 1438 0 235261 0 0 0 Amy A LePage Emergency Medicine 261466 0 0 0 0 0 1855 0 14644 0 277965 0 0 0 Barbara K Miller General Surgery 271624 0 0 0 0 0 3946 0 6687 0 282257 0 0 0 Keith Hopkins Internal Medicine 234379 0 0 0 0 0 0 0 10155 0 244534 0 0 0 Part I, Line 1a Housing was provided to the interim CEO. The annual dues for membership in local service organizations are paid for the CEO and the CCO. Part I, Line 3 The Organization does not pay compensation to the CEO directly. The CEO is compensated by an unrelated management company, Quorum Health Resources LLC. He is compensated for services provided to Central Montana Medical Facilities, Inc. The management company bases the CEO's salary on compensation surveys for the area. The Board of Directors approves the contract with the management company. A Fergus County Montana 816001358 2014-05-01 4500000 Emergency and laboratory expansion and remodel of existing facility 0 0 0 A 13041 4500000 448824 4051176 2015 0 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 0 Amy LePage MD Employee Recruiting X 31000 14565 0 1 1 14565 Annie Davis Family Member of Board Member 62482 Payment of Compensation 0 Form 990, Part III, line 2 Starting 7/1/13 the Organization began offering an Occupational Health Program. Form 990, Part VI, Section A, line 1 The Executive Committee includes the President or Chair, Vice President or Vice Chair, Secretary and Treasurer and 2 members-at-large and their authority is similar to that of the full governing board. Form 990, Part VI, Section A, line 2 Russel Spika, CPA, Greg Smith, and Alan R. Aldrich have a business relationship. Form 990, Part VI, Section A, line 3 The organization delegated control over management duties customarily performed by or under direct supervision of officers, directors, trustees, or key employees to the CEO who is employed by a management company, Quorum Health Resources LLC (QHR). QHR assists with the management and supervision of the organization under the policies and direction of the governing board. Compensation paid to QHR for Lee Rhodes, CEO and Christopher Noland services as Interim CEO was $193,026. Form 990, Part VI, Section A, line 6 The organization's members consist of residents of the Central Montana area who are at least 18 years of age and who have or shall indicate their interest in the maintenance of adequate medical facilities and high standards of medical care in the area. Members of the organization must attend and sign the register at the organization's annual meeting. Form 990, Part VI, Section A, line 7a Members of the organization may vote on matters being addressed at the annual meetings. Each member is entitled to one vote on any question or action with the exception of the election of Directors of the corporation. For the election of Directors, the members shall vote for one nominee for each vacant board position. Form 990, Part VI, Section B, line 11 Draft copy of Form 990 is reviewed by the CFO and Board of Directors prior to its filing. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy by discussing at the Board of Director Meetings and obtaining signed statements from members. All officers, board members, and key employees are covered by the policy. The board determines whether conflicts exist and all potential conflicts are reviewed by the board. Any person with a conflict is not allowed to vote on conflicted issues. Form 990, Part VI, Section B, line 15 The CEO is employed by Quorum Health Resources LLC (QHR), a hospital management corporation. QHR determines the CEO's compensation based on independent data and comparisons. The information is then presented to the Board of Directors for review and approval. This process is completed on an annual basis and was completed in fiscal year ending 6/30/14. Compensation of the CFO is determined by the CEO. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request. A copy may be requested by calling, emailing, walk-in or via mail. Form 990, Part XI, line 9: Interest in Central Montana Foundation -885,529.