2013-05-14T10:04:42-07:00 2012-06-30 990 2011-07-01 810231784 BILLINGS CLINIC BILL 4062382500 2800 Tenth Avenue North Billings MT 59101 Connie F Prewitt 4062382134 2013-05-15 2011 2016-02-24 21:20:13Z Nicholas Wolter MD 2800 Tenth Avenue North Billings MT 59101 1198205972 0 X billingsclinic.com X 1907 MT Billings Clinic will be a national leader in providing the best clinical quality, patient safety, service and value. 12 9 3892 255 6388420 792016 3799079 3948921 501834997 534476077 11022251 9447693 16685027 11282122 533341354 559154813 0 0 0 0 269671198 281545875 0 0 0 235125312 238719332 504796510 520265207 28544844 38889606 534176825 589973650 227968706 264809291 306208119 325164359 Billings Clinic is a not-for-profit, physician-led, multispecialty medical group practice integrated with a hospital and long term care faciltiy, serving the communities of Montana, northern Wyoming and the western Dakotas. Our mission is health care, education and research. 0 0 190516168 0 305336596 Hospital patient care 184446796 0 201825835 Clinic patient care 8544059 0 7866452 Nursing home patient care 7008781 0 22823041 See Schedule O, statement 1 7008781 0 22823041 390515804 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 202 0 1 3892 1 1 1 0 0 0 0 0 0 0 0 1 1 0 X 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Connie F Prewitt 4062382134 2800 Tenth Avenue North Billings MT 59101 D Brown 6 X 0 0 6878 D Ehrlick 4 X 0 0 6956 E Fulton 8 X 0 0 6184 T Hathaway 2 X 0 0 8011 L Knight 10 X 27551 0 13914 P Nance 15 X 6000 0 0 J Ott 4 X 0 0 6627 M Schaer 6 X 6000 0 0 A Sparboe 10 X 0 0 0 Dr J Millikan 70 X 554264 0 38259 Dr C McCracken 75 X 285490 0 35341 Dr N Wolter 60 X 1536067 0 38611 C Prewitt 70 X 360898 0 59311 Dr Sample 100 X 855105 0 33222 Dr Schallenkamp 60 X 796647 0 32760 Dr Santala 72 X 786927 0 32683 Dr Gibb 85 X 774841 0 32587 Dr Lindenbaum 55 X 772878 0 32572 Dr Knostman 0 X 12195 0 0 6774863 0 383916 338 1 1 0 Sodexo C/O Billings Clinic Billings MT 59101 Patient food service 4956821 Command Health Box 844797 Dallas TX 75284 Transcription services 1982508 Healthcare Outsourcing Network 621 17th St Suite 1800 Denver CO 80293 Early out vendor 1635879 Weatherby Locums Inc PO Box 972633 Dallas TX 75397 Professional staffing 2047043 Bauer Construction 148 Hallowell Lane Billings MT 59101 Building contractor 1722687 51 0 0 0 3948921 0 0 0 3948921 Patient service revenue 622000 528087657 528087657 0 0 Reference lab 621500 3706841 0 3706841 0 IT services to other hospitals 541519 2046132 0 2046132 0 Optical shop 446130 626373 0 626373 0 Partnership related to programs servcies 541900 9074 0 9074 0 0 0 0 0 534476077 4134766 0 0 4134766 0 0 0 0 0 0 0 0 54725 0 197193 0 -142468 0 -142468 0 0 -142468 643808838 6187 638198544 303554 5610294 -297367 5312927 0 0 5312927 0 496626 351868 144758 0 0 144758 Insurance premiums 524298 4720195 4720195 0 0 Share of Joint Ventures 621300 -3443690 -3443690 0 0 Meaningful use 921190 3132131 3132131 0 0 6871196 6871196 0 0 11279832 559154813 539367489 6388420 9449983 234733503 187640169 47093334 0 10974273 8895221 2079052 0 21434696 15295463 6139233 0 14403403 11209927 3193476 0 0 0 0 0 1485413 4842 1480571 0 154615 0 154615 0 82631 0 82631 0 0 0 886119 0 886119 0 32726589 9563295 23163294 0 1306840 130475 1176365 0 92107332 87783534 4323798 0 9083144 1178673 7904471 0 0 0 0 0 6041067 2551909 3489158 0 2805242 1793210 1012032 0 0 0 0 0 392349 135482 256867 0 8294731 38573 8256158 0 0 0 0 0 18545544 14296727 4248817 0 10291591 4628624 5662967 0 Recrutiment 1764349 5534 1758815 0 Repairs 5912157 4758802 1153355 0 Bad debt 39890252 39463252 427000 0 Bed tax 3338027 281477 3056550 0 3611340 860615 2750725 0 520265207 390515804 129749403 0 10559381 7002784 21303735 73859885 0 0 67931288 74742299 0 0 0 0 8704883 8517044 6505363 6952922 5380977 4750002 403779108 214069358 195262297 189709750 171354595 180956748 0 0 11657517 7943998 3222544 2406842 32294245 33131376 534176825 589973650 48962844 44511964 0 0 0 0 137531015 168955000 0 0 0 0 6327042 3986222 0 0 35147805 47356105 227968706 264809291 X 279868321 297619748 7316156 7891423 19023642 19653188 306208119 325164359 534176825 589973650 X 38889606 -19933366 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 82631 82631 520182576 520265207 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 105276 21245 37524 82631 246676 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 21026911 246728 724344 44349 0 0 21953634 19640069 605720 781122 0 0 0 21026911 18575246 665198 399625 0 0 0 19640069 1781249 1048699 -197238 0 0 0 2632710 0.015 0.895 0.09 0 1 1 0 17998001 17998001 0 151368779 63029955 88338824 0 1393325 1178800 214525 0 198098045 141730224 56367821 0 34920958 8130379 26790579 189709750 Beneficial interest in Billings Clinic Foundation 33131376 33131376 Swap valuation 30136424 Provision for unpaid claims 10051762 Estimated claims 7167919 47356105 559154813 520265207 38889606 -19955748 0 0 0 22382 -19933366 18956240 530750948 -19955748 22382 0 102 -19933264 550684212 886119 7584482 8470601 559154813 512704140 0 0 0 91 91 512704049 886119 6675039 7561158 520265207 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Endowment funds are to be invested and held in perpetuity to provide a source of income for Billings Clinic programs and needs. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Transfer of donated equipment from Billings Clinic Foundation SchD_P12_S00_L02d Schedule D, Part XII, Line 2d Rounding SchD_P12_S00_L04b Schedule D, Part XII, Line 4b MHI, Auxiliary, Eliminations and Reclass SchD_P13_S00_L02d Schedule D, Part XIII, Line 2d Rounding SchD_P13_S00_L04b Schedule D, Part XIII, Line 4b MHI, Auxiliary, Eliminations, Reclasses 1 1 1 X 1.20 1 X 1 1 0 1 1 36679 14756429 0 14756429 0.0284 100042 2994437 0 2994437 0.0058 0 0 0 0 0 0 136721 17750866 0 17750866 0.0342 28 84094 3185285 413111 2772174 0.0053 10 3882 2819786 837762 1982024 0.0038 13 232041 44002005 34276904 9725101 0.0187 1 11993 3388074 0 3388074 0.0065 4 1411 515137 0 515137 0.001 56 333421 53910287 35527777 18382510 0.0353 56 470142 71661153 35527777 36133376 0.0695 0 0 0 0 0 0 0 0 0 0 0 0 2 1022 6235 0 6235 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3 0 167050 0 167050 0.0003 1 340 58119 50652 7467 0 0 0 0 0 0 0 6 1362 231404 50652 180752 0.0003 0 17132684 11497442 155945925 174837411 -18891486 X 1 1 1 1 Billings Clinic (Billings Clinic Hospital)

2800 Tenth Avenue North Billings MT 59101

X X X X X Billings Clinic (Billings Clinic Hospital) 1 1 1 120 1 300 1 X X X X X X 1 1 X X X 1 1 X X X X X X 1 X 0 0 4 Billings Clinic (Billings Clinic)

2800 Tenth Avenue North Billings MT 59101

Multispeciality physician outpatient clinics Billings Clinic (Aspen Meadows)

3155 Avenue C Billings MT 59102

Long term care facility Livingston Imaging

504 S 13th St Livingston MT 59047

Medical imaging Billings Clinic Sheridan Dialysis

1401 West 5th St Sheridan WY 82801

Dialysis unit SchH_P01_S00_L07 Schedule H, Part I, Line 7 * Billings Clinic calculated the approval rate of financial applications by taking the value of accounts successfully qualified for charity (including presumptive eligibility) divided by the total applications for financial assistance received. That approval rate was then applied to the total value of accounts that did not complete financial assistance applications and assigned to bad debt. Billings Clinic used the same cost to charge ratio as applied throughout the entire schedule to determine the cost of those accounts. SchH_P01_S00_L072f Schedule H, Part I, Line 7, Column f Bad debt expense included in Form 990, Part IX, line 25, column (A) but subtracted for purposes of calculating the percentage in Schedule H, Part I, Line 7, column (f) was $39,890,252 SchH_P01_S00_L07g Schedule H, Part I, Line 7g * Billings Clinic included in subsidized services only physician clinics that offer primary care in medically underserved or health professional underserved areas that were located outside our primary service area. Billings Clinic also included the costs of any outreach services where physicians traveled to provide specialized care to underserved populations. The total of cost that was included in total subsidized health services for these types of services was $3,226,637 in FY12. SchH_P02_S00_L00 Schedule H, Part II * Part II. Billings Clinic's community building activities includes support for the Alliance, a partnership between city-county public health department, St. Vincent Healthcare and Billings Clinic for community health improvement efforts, community influenza vaccinations and disaster response planning. This includes advocacy for community health at the local and state government level. Under Workforce Development, Billings Clinic coordinates and sponsors a regional Science Expo to encourage young scientists to become future nurses, physicians or health care professionals. SchH_P03_S0A_L04 Schedule H, Part III, Section A, Line 4 For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverges exists for part of the bill), the Organization records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhaousted is charged off against the allowance for doubtful accounts. SchH_P03_S0B_L08 Schedule H, Part III, Section B, Line 8 * Part III, line 8 - We believe that 46 percent of Billings Clinic's Medicare shortfalls should be counted as a community benefit. Our rationale is that 46 percent is the best estimate of the percentage of Montana's Medicare population (65 and older) who are at or below 300% of Federal Poverty Level, based on U.S. Census data. The upper limit of our financial assistance policy is 300%. For the calculation of the unreimbursed cost of Medicare a ratio of patient care cost to charges using worksheet 2 was utilized and applied to gross Medicare charges. We do not use the Cost Report for this number. The Cost Report only captures revenue related to the facility and does not capture revenue/losses related to clinical professional services, which are a substantial portion of Billings Clinic Medicare shortfalls. SchH_P03_S0C_L09b Schedule H, Part III, Section C, Line 9b * Part III, line 9b - Yes, we did have a formal, written policy in tax year 2011, effective as of 10/5/11 (OHA-205 "Patient Financial Services"). We did have a collection process, which was used to screen patients for financial assistance prior to making payment arrangements for care. The policy applies equally to all patients - insured, under-insured or uninsured. Once a determination has been made and adjustments applied to the account balance, any remaining balance would fall into the regular guidelines of collection, giving patients financing options that will work within their monthly budget. Patients who cannot meet the requirements of a payment arrangement should be offered the loan program and/or financial assistance as options. If the patient agrees to financial assistance, the application should be requested. Agency will print and mail financial assistance applications. This will be completed by the end of each business day. After a patient completes the application, the patient will send it back to Billings Clinic for financial assistance determination. SchH_P06_S00_L02 Schedule H, Part VI, Line 2 Needs Assessment The 2011 Community Health Needs Assessment (CHNA) was a systematic, data driven approach to determining the health status, behaviors and needs of residents in Yellowstone County. Billings Clinic partnered with the local health care Alliance, including another local hospital, St. Vincent Healthcare, and city/county health department, RiverStone Health, to coordinate and pay for the CHNA. It serves as a tool to improve the health status and improve the quality of life overall of Yellowstone County residents. The 2010 Community Health Survey consisted of 400 randomized telephone contacts representing the diverse socioeconomic and geographic characteristics of Yellowstone County. Existing vital statistics and other health-related data are incorporated into the assessment as secondary sources. In addition, focus groups were conducted among physicians, legislators, social services, educators and employers. Results of the 2010 Community Health Assessment were reviewed by the Alliance, a community forum sponsored by the Alliance's community health coalition (called Healthy By Design), and the Billings Clinic Community Health Improvement Committee (a Board committee). Findings were compared between 2011 and the 2006 assessment results. An Implementation Plan has been completed, both for the Alliance (community-wide) and for Billings Clinic (organization-wide). Implementation of some of the objectives has begun, with measures and evaluation. SchH_P06_S00_L03 Schedule H, Part VI, Line 3 Patient Education of Eligibility for Assistance: * All patients may apply for financial assistance - informational brochures with a one-page summary, and application forms are available at registration desks in the clinic and hospital, the Emergency Department discharge desk, care management staff and on our website at billingsclinic.com. * Information about financial assistance is printed on the back of patient bills. * Patients hospitalized without identifying a third party payer source are screened for coverage/assistance - SSI (Social Security Supplemental income, if approved will qualify for Medicaid), SSDI (Social Security Disability Income), Veterans' Administration, Indian Health Services, Workers Compensation, Medicaid, Crime Victims, and health insurance coverage. * A Financial Assistance brochure is mailed to new patients (Clinic and Hospital) in their pre-admission packets. These packets are mailed to all patients, even if they cannot be reached by phone in advance. * An application is mailed to patients whose payment pattern indicates that they may need assistance. * Patient Financials Services staff is available to help any patient needing assistance to complete an application. * According to our existing Financial Application policy, a patient is not eligible for financial assistance if the account has been sent to bad debt. We do bring accounts back in-house for charity assistance on a case-by-case basis. * An account is sent to bad debt at least 158 days after they are considered "self-pay," including at least three statements, letter and phone call attempts to contact the patient. SchH_P06_S00_L04 Schedule H, Part VI, Line 4 Community Information: Billings Clinic is based in Billings, Montana, the largest city in Montana, with more than 150,000 people in Yellowstone County. In Billings there are two not-for-profit hospitals of similar size. Billings Clinic is an integrated, not for profit, community-governed health care organization providing services to a forty-three county area in eastern Montana and northern Wyoming. Billings Clinic defines its broad geographic service area as 43 counties in eastern Montana and northern Wyoming, encompassing nearly 128,000 square miles with a population of 595,000 people. Today, Billings Clinic employs more than 3,600 employees, including 240 physicians, and 81 mid-level practitioners, and operates a multi-specialty physician clinic; 272-bed acute care hospital; level II trauma center; a 90-bed long-term care facility; a clinical research center; and a variety of ambulatory, diagnostic and treatment services. Thirty-eight of those 43 counties are either wholly or partly designated as Health Professional Shortage Areas (HPSA) by the US Department of Health and Human Services, Health Resources and Services Administration under the Primary Medical Care discipline. The area includes five American Indian Reservations and an American Indian population of 38,882, or 6.9% of the service area's population. The US Census Bureau 2008 estimates show that 27.3% of Montana families are below 200% of the Federal Poverty level, compared to 26.6% for the nation and Montana is ranked 13th lowest of 50 states in Median Family Income. According to the 2010 US Census, Montana had 17.3% of the population without health insurance coverage in 2010, including all ages of the civilian, non-institutionalized population. SchH_P06_S00_L05 Schedule H, Part VI, Line 5 Billings Clinic is an integrated health care organization, combining a not-for-profit multi-specialty medical group practice with a hospital and long term care facility. Our organization promoted community health in many ways in Fiscal Year 2012, including: * Substantial financial assistance and charity care was provided to patients in need. Billings Clinic provides more charity care than another other hospital or health care organization in Montana. * Care was provided to Medicare and Medicaid patients, as well as SCHIP for children. * Our Board's governance and nominating committee reviewed the entire 990, including Schedule H, which was then discussed with the entire Board of Directors. The Community Benefit Report, including Schedule H data, is also reviewed by the Board committee for Community Health Improvement. * Billings Clinic is a teaching hospital and supports, along with Riverstone Health and St. Vincent Healthcare, the only post-graduate medical education in Montana - the Montana Family Medicine Residency Program. Nearly 90 percent of the graduates establish a practice in rural, medically underserved settings in Montana. In addition we provide ongoing preceptorships for medical, nursing and pharmacy students so that they can obtain real-life experience during college and graduate school. * Billings Clinic is a Medicaid disproportionate share hospital serving a significantly disproportionate number of low-income patients. * Our full-time emergency department is maintained where no one is denied care, within our capacity to provide care. * Our board of directors is composed of community members who reside in the primary service area. Only three out of 12 board members are employees - two are employed physicians and one is our CEO. * Medical staff privileges are open to all qualified physicians in our community. Operating surpluses are directed solely toward meeting our charitable purposes, including education, research, capital expenses, debt amortization, patient care improvements and medical education. * Billings Clinic has the only inpatient psychiatric services available in our region of central and eastern Montana and northern Wyoming, despite significant financial loss. We are committed to mental health care and continually work to find ways to reach those in need in the region, such as through telemedicine programs and education for primary care providers. SchH_P06_S00_L07 Schedule H, Part VI, Line 7 Billings Clinic files a community benefit report to the state of Montana's Attorney General's office, with different values than requested by Schedule H. X X 1 1 X X X X X X 0 1 0 0 0 1 0 0 0 Dr J Millikan 554265 0 0 0 0 0 7418 0 30841 0 592524 0 0 0 Dr C McCracken 285490 0 0 0 0 0 6627 0 28714 0 320831 0 0 0 Dr N Wolter 600024 0 0 0 936044 0 0 0 38611 0 1574679 0 686044 0 C Prewitt 318081 0 42818 0 0 0 30000 0 29311 0 420210 0 0 0 Dr Sample 855105 0 0 0 0 0 0 0 33222 0 888327 0 0 0 Dr Schallenkamp 652158 0 0 0 144489 0 0 0 32760 0 829407 0 144489 0 Dr Santala 605841 0 0 0 181086 0 0 0 32683 0 819610 0 181086 0 Dr Gibb 774841 0 0 0 0 0 0 0 32587 0 807428 0 0 0 Dr Lindenbaum 772878 0 0 0 0 0 0 0 32572 0 805450 0 0 0 Dr Knostman 0 0 0 0 11842 0 353 0 0 0 12195 0 11842 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Billings Clinic periodically arranges and pays for charter travel for management, State legislative hearings and association meetings. There were 16 of these flights in FY12. Billings Clinic also pays for the travel expense of spouses of Board members attending organizationally approved/arranged goverance education. This reimbursement is reported as income consistent with the Board travel reimbursement policy. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Dr N Wolter - Included in other reportable compensation is $686,044 which is due to termination of a retirement agreement which caused a taxable distribution during 2011. These dollars were earned as deferred compensation in multiple tax years prior to 2011 and were also reported on those years IRS From 990s. Dr Schallenkamp - Other reportable compensation of $144,489 is due to a SERP withdrawal. Dr Santala - Other reportable compensation of $181,086 is due to a withdrawal from a 457(f) plan. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Board of Directors annually determines the incentive plan amount for the CEO and the Senior Executive Team based on an external compensation study. The availability of the incentive is triggered by the organizational operating margin performance target. The incentive is awarded based on financial performance as well as organizational performance measurements in quality, service satisfaction, both patient and employee satisfaction and then individual goals set each year if the target is triggered. The incentive is paid only if triggered following the financial audit presentation. Montana Facility Finance Authority 810302402 2008-05-30 60000000 Property, plant and equipment 1 0 0 Montana Facility Finance Authority 810302402 2010-08-24 140000000 Property, plant and equipment, Refund prior issue 0 0 0 5755000 23000000 60000000 3614608 3288173 0 1200000 0 0 49976092 0 0 2009 0 0 1 1 2290000 0 140000000 0 0 0 770829 0 0 7736788 0 54507985 0 1 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 F990_P06_S0B_L11b Form 990, Part VI, Section B, Line 11b The 990 review is completed before the return is filed. It is reviewed by the CFO, the executive group, the Governance and Nominating Committee of the board, and finally by the Board of Directors. F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Governance and Nominating Committee of the Board of Directors, according to their charter, reviews annually the disclosure statements of the Board of Directors and senior executives and takes action to resolve conflicts. A Conflict of Interest Review Panel, chaired by the Compliance Officer, as outlined in organizational policy, is responsible for reviewing disclosed conflicts and approving necessary conflict management plans of all other interested persons at Billing Clinic. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Billings Clinic has an executive compensation program administered by independent trustees following best practices and the highest regulatory standards expected of a not-for-profit organization. They follow a board approved charter and overall executive compensation philosopy which defines the market as a comparable set of not-for-profit health carte delivery systems. They look at relevant market data of similar roles in similar organizations. Annual disclosure of the committee's actions and decisions to the full Board is required. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Billings Clinic makes its governing documents, conflict of interest policy and financial statements available to the public on an as needed basis. F990_P11_S00_L05 Form 990, Part XI, Line 5 Unrealized losses, transfer of donated equipment from Billings Clinic Foundation Montana Healthcare Indemnity LLC 2800 Tenth Avenue North Billings MT 59101 810231784 Insurance captive MT 4720195 11267679 Billings Clinic Billings Clinic Foundation 2917 Tenth Avenue North Billings MT 59101 810407289 Fund raising MT 501(c)(3) 7 Billings Clinic 0 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 Billings Clinic Foundation c 3948921