2024-03-06T08:03:58-06:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 810378200 Livingston Healthcare LIVI 4062223541 320 Alpenglow Ln Livingston MT 59047 Bruce Whitfield CEO 4062223541 2024-03-05 1 Bruce Whitfield 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2024-03-04 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Bruce Whitfield 320 Alpenglow Ln Livingston MT 59047 77646185 0 X www.livingstonhealthcare.org X 1955 MT A 25-bed critical access hospital, a multispecialty physician practice, rehabilitation services, and home-based services. 12 11 503 19 0 0 1971221 819808 66790402 76403542 365575 67994 60340 71700 69187538 77363044 18346 32766 0 0 34995731 39141627 0 0 110789 30870924 38629451 65885001 77803844 3302537 -440800 90264553 89398714 43219384 42724541 47045169 46674173 X Excellence in patient-centered care. 1 0 66076458 32766 76403542 Livingston HealthCare (LHC) is a 25-bed critical access hospital located in Livingston, Montana, providing inpatient, outpatient, and emergency services primarily for the residents of Livingston Montana and the surrounding area. It is a multispecialty physician practice that also provides rehabilitation services and home-based services such as home care and hospice care.LHC provides medical treatment of the sick and injured patients regardless of ability to pay. This includes private payers, insured payers, Medicare, Medicaid and Charity Care.Continued on Schedule O...Livingston HealthCare is proud to support Windrider Transit, a vital service that enhances the well-being of our community. In the fiscal year 2023, we contributed $10,000 to sustain and expand this free, efficient fixed-route transportation system benefiting citizens and disabled individuals in Park County, Montana.Windrider has made significant strides, extending its operations from Monday through Friday to now include half-day Saturdays. Moreover, the service has expanded to offer free rides for medical appointments within Livingston city limits and to and from Bozeman, MT. All vehicles are ADA accessible and equipped with lifts, ensuring accessibility for everyone.What sets Windrider apart is its commitment to fostering connections within our community. Recognizing the crucial role drivers play in being a touch point for some of the most vulnerable in the community, plans are underway to train them in QPR suicide prevention. This initiative aims to not only provide transportation but also create a supportive environment. The buses will soon be equipped with a list of resources, offering valuable assistance to those in need.Livingston HealthCare's Fall Health Festival is a cornerstone in our ongoing commitment to community health and public well-being in Park County. Held annually on a Saturday from 7-11 am, this event serves as a crucial platform for various organizations, including the Park County Health Department, LiveWell49, the Recreation Department, The Cancer Alliance, The Phoenix, and ASPEN, to disseminate information about available resources and services.At the heart of the festival are Livingston HealthCare providers, volunteering their expertise to address critical health topics, from diabetes prevention and behavioral health to combating loneliness. In FY2023, the event served 500 individuals, incurring direct expenses of $16,245 and staff costs totaling $25,000, amounting to a total expenditure of $41,245. This financial commitment reflects our dedication to community benefit and underscores the importance of providing accessible health information and services to our residents.The anticoagulation clinic is where LHC pharmacists manage and monitor warfarin dosing for patients under a collaborative practice agreement with the LHC clinic physicians. Warfarin is used to treat patients who have had a blood clot or have certain conditions that put them at risk of developing a clot. It has a narrow therapeutic window, meaning that there is just a small range between too little and too much drug. Warfarin must be closely monitored and titrated to keep it in range. Adding to the complication is the fact that warfarin has many drug interactions and food interactions that can impact the levels. This clinic served 1,114 patients in FY2023. 66076458 1 1 0 0 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 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 52 0 1 503 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Kris Kester 4062223541 320 Alpenglow Lane Livingston MT 59047 X Michael McCormick Chair 15.00 0.00 X X 0 0 0 Kristen Galbraith Vice Chair 2.00 0.00 X X 0 0 0 Jeffry Lindenbaum MD Treasurer 2.00 0.00 X X 0 0 0 Liz Lewis Secretary 2.00 0.00 X X 0 0 0 Lee Kinsey Director 2.00 0.00 X 0 0 0 Kyra Pinango MD Director, Family Medicine 36.00 0.00 X 182139 0 29534 Justin Roberts MD Director, Surgery 40.00 0.00 X 0 0 0 Mike Shaer Director 2.00 0.00 X 0 0 0 Russ Smith Director 2.00 0.00 X 0 0 0 Abbie Bandstra Director 2.00 0.00 X 0 0 0 Clair Kennamore MD Director 2.00 0.00 X 0 0 0 Stefanie Lange MD Director 2.00 0.00 X 0 0 0 Deb Anczak CEO until Sept 2022 40.00 0.00 X 0 0 0 Angela Linden Interim CEO from Sept thru Feb 40.00 0.00 X 0 0 0 Bruce Whitfield CEO starting March 2023 40.00 0.00 X 0 0 0 Kris Kester CFO 40.00 0.00 X 240920 0 24995 Stacy Kohler Chief Nursing Officer 40.00 0.00 X 185504 0 46296 Vickie Axtell VP of HR/People until Sept 2022 40.00 0.00 X 439640 0 32795 Kyle Arnet MD ER Physician 40.00 0.00 X 412762 0 47185 Brian Guercio ER Physician 40.00 0.00 X 381810 0 52612 Benjamin Wilkinson ER Physician 40.00 0.00 X 380383 0 55663 Raymond Wright ER Physician 40.00 0.00 X 367606 0 54863 2590764 0 343943 61 0 1 0 Billings Clinic PO Box 30977 Billings MT 591070977 IS & Administration Fees 1437439 Billings Clinic Teleradiology PO Box 30977 Billings MT 591070977 Telerad Services 687046 DPHHS PO Box 4369 Helena MT 596044369 Laboratory Services 383604 Medical Solutions PO Box 310737 Des Moines IA 503310737 Staffing Services 270169 PPR LLC PO Box 310852 Des Moines IA 503310852 Staffing Services 233515 10 502557 97723 219528 819808 Net Patient Service Revenue 621110 74533565 74533565 340B Pharmacy Revenue 456110 1005742 1005742 Supporting Revenue 621110 864235 864235 76403542 351135 351135 71700 0 71700 71700 71700 283141 -283141 -283141 -283141 77363044 76403542 0 139694 X 32766 32766 756916 423675 333241 367038 367038 29436008 24088735 5300305 46968 1628814 1330763 295491 2560 4832092 3938022 886554 7516 2120759 1708799 408559 3401 411704 411704 387081 38098 347725 1258 99448 96938 2510 13341438 12265830 1067424 8184 224720 52371 149302 23047 1916292 1586597 326119 3576 1273035 226253 1043577 3205 870093 662969 207124 303786 239002 64523 261 224089 133224 86880 3985 1306401 1306401 3462102 3462102 780574 439619 340955 Medical Supplies 12285815 12274422 11385 8 Repairs and Maintenance 938472 908094 30378 Food 413779 411197 2582 390622 180481 205831 4310 77803844 66076458 11616597 110789 2163784 2326980 2288434 1053460 14166320 14542826 1586918 1822216 437782 670976 69055697 26753787 40795901 42301910 26935155 24446904 1890259 2233442 90264553 89398714 6944289 5446226 34180923 34213451 2094172 3064864 43219384 42724541 X 47045169 46674173 47045169 46674173 90264553 89398714 -440800 69804 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4631565 35258 384615 5051438 5150614 3750 -522799 4631565 3021307 1357828 771479 5150614 2480033 570837 154145 183708 3021307 1503731 1545780 264106 833584 2480033 0.58380 0.41620 0.00000 0 1 1 5951320 5951320 36694829 11520177 25174652 24444116 14092804 10351312 1965432 1140806 824626 42301910 Professional Liability Claims 66000 Deferred Compensation Liability 2515492 Operating Lease Liability 483372 3064864 X 77649423 69804 719132 788936 76860487 502557 502557 77363044 77803844 0 77803844 0 77803844 Part V, Line 4: The organization has adopted investment and spending policies for endowment assets that attempt to provide a predictable stream of funding to programs supported by its endowment while seeking to maintain the purchasing power of the endowment assets. Endowment assets include those assets of donor-restricted funds that the organization must hold in perpetuity or for a donor-specified period(s) as well as board-designated funds. Part X, Line 2: The Hospital 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 consolidated financial statements. The Hospital 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. Part XI, Line 2d - Other Adjustments: Foundation Revenue Reported on a Separate Form 990 719,132. Part XI, Line 4b - Other Adjustments: Foundation Contribution to Hospital that is Eliminated on Audited Financials 502,557. 1 1 X 0 1 X 1 1 0 0 436000 436000 0.00560 436000 436000 0.00560 20 1412 90466 90466 0.00120 8 35 105039 105039 0.00140 15803990 10098725 5705265 0.07330 39640 1810 37830 0.00050 28 1447 16039135 10100535 5938600 0.07640 28 1447 16475135 10100535 6374600 0.08200 150 70514 102194 102194 0.00130 4 17426 18198 18198 0.00020 20 1412 35505 35505 0.00050 8 35 105455 105455 0.00140 182 89387 261352 261352 0.00340 1 3730587 205182 21703982 21640408 63574 X 1 1 1 1 Livingston Healthcare 320 Alpenglow Ln Livingston MT 59047 www.livingstonhealthcare.org 12556 X X X X Livingston Healthcare 0 0 1 X X X X X X X X X 22 1 0 1 1 X See Part V, Supplement Information X 1 22 1 See Part V, Supplement Information 0 1 X 0.000000000000 200.000000000000 X X X X 1 1 X X X 1 X See Part V, Page 8 X See Part V, Page 8 X See Part V, Page 8 X X X X X X 1 X 0 X X X X 1 X 0 1 Livingston Healthcare Part V, Section B, Line 5: During the latest Community Health Needs Assessment (CHNA), conducted in collaboration with the Park County Health Department, input from a diverse range of community partners was not just collected but actively integrated into the report using the CASPER system. CASPER, carried out through face-to-face interviews in the field during the summer of 2022, proved invaluable. Conducting interviews in person offered several advantages, including a high response rate and the opportunity to disseminate health information and resource lists directly to the community. Following the collection of surveys, a collaborative effort ensued, involving 22 stakeholders from the community. This group, which included representatives serving the most vulnerable populations, came together to provide crucial feedback on priority areas. This inclusive approach ensures that the insights of various stakeholders, including low-income residents and public health professionals, are woven into the fabric of our community health initiatives. Livingston Healthcare Part V, Section B, Line 6b: Park County, Park County Health Department, and Community Health Partners Livingston Healthcare Part V, Section B, Line 11: In response to findings from the 2022 Community Health Needs Assessment, the CHIP leadership team identified three priority areas, all of which they will address:1) Behavioral Health,2) Community Wellness: Children and Families, Housing and Income Inequality3) Access to CareWhile our current implementation plan may not explicitly target income inequality, at Livingston HealthCare, we are fully committed to mitigating its impact. We do this by providing competitive wages and comprehensive benefits to our team, recognizing our substantial role as one of Park County's major employers. Moving forward, Livingston HealthCare will persist in collaborating with community partners to address this intricate community challenge.Livingston HealthCare, in partnership with the Park County Health Department and other stakeholders, facilitated a CHNA in the Summer/Fall of 2022. Since then, LHC has been able to address the needs of the community in the following ways a. Improved patient access to behavioral health services for students through onsite services at the Park County Ranger Clinic, thereby expanding availability for adolescents in Park County.b. Implemented School-Based Outpatient Treatment (SBOT) for behavioral health services, addressing the specific needs of students.c. Applied and secured a position on the Park County Housing Coalition to proactively tackle the increasing housing needs and challenges faced by Park County residents.d. Enhanced collaboration with community partners through a signed charter for the Park County Behavioral Health Crisis Response Coalition, emphasizing a unified approach to addressing behavioral health challenges.e. Improved access to preventative services and enhanced self-management by introducing virtual fitness and Diabetes Prevention Programs, open to all community members.f. Incorporated Adverse Childhood Experiences (ACEs) presentations into the bi-monthly new employee orientation, emphasizing the importance of understanding and addressing childhood traumag. Actively supported and participated in the LiveWell49 Coalition, aligning efforts to improve overall health and wellbeing in the county, particularly in mental health and suicide prevention. h. Increased awareness of suicide prevention resources and tools through LiveWell49 Coalition initiatives. LiveWell49 employees were trained in QPR to offer these vital trainings county-wide.i. Strengthened collaboration with community partners focused on early childhood, including Community Health Partner, Park County Early Childhood Education, and Childcare Connections, to address the unique needs of young children and their families. j. Hospital leadership team joined multiple community boards that work towards addressing needs of the community including children and families through serving on the LINK advisory board. Livingston Healthcare Part V, Section B, Line 13h: Presumptive eligibility is used. If a patient is a Medicaid patient, the Hospital writes off to charity care any portion of charges that is denied by Medicaid. Livingston Healthcare Part V, Section B, Line 24: The Hospital does not provide elective services under the financial assistance policy. Schedule H, Part V, Section B, Line 16a-c: The FAP, FAP application, and plain language summary of the FAP can be found at:https://www.livingstonhealthcare.org/Patients-Visitors/Patient-Financial-Services.aspx Schedule H, Part V, Section B, Line 7a and 10a: CHNA and Implementation Strategy:https://www.livingstonhealthcare.org/About-Us/Community-Health-Needs-Assessment.aspx 4 1 - LHC Clinic 320 Aplenglow Ln Livingston MT 59047 Rural Health Clinic 2 - Livingston Healthcare Urgent Care 104 Centennial Dr 103 Livingston MT 59047 Clinic 3 - Livingston Healthcare Home CareHospice 320 Aplenglow Ln Livingston MT 59047 Home Care 4 - Livingston Clinic Shields Valley 309 Elliot St N Livingston MT 59047 Rural Health Clinic Part I, Line 3c: Presumptive eligibility is used. If a patient is a Medicaid patient, the Hospital writes off to charity care any portion of charges that is denied by Medicaid. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community health improvement services on line 7e, health professions education on line 7f, and cash and in-kind contributions on Line 7i were determined using actual costs. Subsidized health services on line 7g are determined based on costing methods used to prepare the cost report. Part II, Community Building Activities: Livingston HealthCare is a key player in community health through strategic initiatives and collaboration. Our critical access hospital takes a central role in county-level crisis care coordination by funding the crucial crisis care coordinator position. This effort directly impacts our most vulnerable populations. Additionally, our community health coordinator ensures alignment with partners to address pressing needs in Park County.Our community-building activities include virtual fitness classes and a complimentary diabetes prevention program, enhancing accessibility to preventive healthcare. Recognizing the early childhood crisis, we've partnered with organizations to address challenges faced by the youngest community members. Addressing housing challenges aligns with priorities identified in the recent community health needs assessment. Livingston HealthCare's proactive involvement underscores our commitment to fostering a resilient, healthier community where our patients live. Part III, Line 2: The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concession based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of implicit price concessions attributable to patients that would be eligible under the Organization's charity care policy was calculated by applying the 11% of the Park County population noted to be below the Federal Poverty Guidelines (FPG) to the total implicit price concessions for the year. It is estimated that half the individuals under the FPG would be eligible for charity care. In the fiscal year it was estimated that 5.5% of the implicit price concessions would be charity care if applications were completed. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 14-15 of the attached audited financial statements. Part III, Line 8: LHC provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services.Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall, if any, is considered a community benefit. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare cost report for the year.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 Centers for Medicare Services. Part III, Line 9b: Once a patient is approved for financial assistance, it is expected the patient continue to meet his/her financial commitments to Livingston Healthcare. If a patient is approved for a percentage allowance due to financial hardship and the patient does not make the required initial payment within 60 days toward their part of the bill, the financial assistance allowance will be reversed and the patient will owe the entire amount. The organization recommends that the patient make a good faith payment at the beginning of the financial assistance period.LHC sends notification to the patients 30 days prior to sending to collections. LHC does not send patient accounts to collections until 180 days from the date of the invoice. If the patient applies for financial assistance within 240 days of the date of the invoice, LHC will cease extraordinary collection actions and process the application. Part VI, Line 2: The hospital Leadership meets often with city, county, and school leadership to discuss and plan shared needs within Livingston/Park County boundaries. Most recently these shared need discussions have been around building a new community pool/community center, expansion of medical services within the school (Park Clinic) system, and joint efforts toward bringing additional mental health services to students in the Park County school district. Part VI, Line 3: Financial assistance will be provided to Livingston Healthcare patients who meet specified financial criteria and request such assistance. A notice of availability of financial assistance program will be posted at patient registration sites within each facility and presented to patients upon request. Schedule H, Part V, Section B, line 16a-16i list other ways the organization informs and educates patients and person who may be eligible for financial assistance. Part VI, Line 4: Livingston is a city in and the county seat of Park County, Montana, United States. The population was approximately 7,784 people in 2018. Livingston is located in southwestern Montana, on the Yellowstone River, north of Yellowstone National Park. The median income for a household in Livingston in 2018 was about $42,635. Part VI, Line 5: Livingston HealthCare's governing body is comprised of persons who reside in the organization's primary service area. The majority of the governing body are neither employees nor contractors of the organization, nor family members thereof.Livingston HealthCare extends medical staff privileges to all qualified physicians in its community for some or all of its departments.Livingston HealthCare applies surplus funds to improvements in patient care, medical education, and expansion of needed services. Part VI, Line 6: Livingston HealthCare is an affiliate of the Billings Clinic health system. Livingston HealthCare provides healthcare coverage to patients within its geographic area, while the Billings Clinic provides resources and expertise, as well as a higher level of care when appropriate. 1 Livingston Roundup Association PO Box 800 Livingston MT 59047 810421528 501(c)(4) 5250 0 Sponsorship Park County Community Foundation PO Box 2199 Livingston MT 59047 205581763 501(c)(3) 16250 0 Give a Hoot donation campaign to Park Cty nonprofit org 1 1 Part I, Line 2: Any donation made by LHC is to another non-profit organization. The majority of LHC donations exceeding $5,000 are made through Park County Community Foundation, through their Give a Hoot annual campaign. All monies dispursed through Give a Hoot are given to other local non-profit organizations. 1 0 0 0 0 0 0 0 0 Vickie Axtell VP of HR/People until Sept 2022 155026 0 0 0 284614 0 19489 0 15177 0 474306 0 0 0 Kyle Arnet MD ER Physician 412762 0 0 0 0 0 33189 0 17330 0 463281 0 0 0 Benjamin Wilkinson ER Physician 380383 0 0 0 0 0 30999 0 27998 0 439380 0 0 0 Brian Guercio ER Physician 381810 0 0 0 0 0 32154 0 23792 0 437756 0 0 0 Raymond Wright ER Physician 367606 0 0 0 0 0 33170 0 25026 0 425802 0 0 0 Kris Kester CFO 240920 0 0 0 0 0 16000 0 11551 0 268471 0 0 0 Stacy Kohler Chief Nursing Officer 185504 0 0 0 0 0 24847 0 23988 0 234339 0 0 0 Kyra Pinango MD Director, Family Medicine 182139 0 0 0 0 0 14400 0 17781 0 214320 0 0 0 Part I, Line 3 The CEO is paid by an unrelated management company, Billings Clinic. LHC paid Billings Clinic a total of $368,112 for all CEO services for calendar year 2022. LHC paid for for services of Deb Anczak $285,538 in compensation, $23,207 retirement benefits and $20,317 other health benefits. LHC paid for for services of Angela Linden $39,050 for compensation, retirement and health benefits. Billings Clinic uses methods in Part I, line 3 to establish reasonable compensation. The LHC Board of Directors reviews and approves the contract annually. Part I, Line 4a Vicki Axtell - Severance amount $284,614 Henry Pinango Spouse of Board Member 367038 Employee Compensation 0 Form 990, Part III, line 2 LHC started a Spine Orthopedic program in fiscal year 2023. This activity furthers their exempt purpose. Form 990, Part VI, Section A, line 1a The Board shall have as a standing committee an Executive Committee. The Executive Committee shall consist of up to four members of the Board, which shall include the Chairperson, Vice Chairperson, Secretary, and Treasurer. The Executive Committee may consist of additional members of the Board at the discretion of the Board. Action of the Executive Committee shall be subject to approval by the Board, except to the extent provided otherwise in a resolution of the Board pertaining to a particular matter, transaction, or undertaking. Form 990, Part VI, Section A, line 3 The CEO was paid by an unrelated management company, Billings Clinic. LHC paid Billings Clinic $411,704 for CEO services for the June 30, 2023 year end, and $368,112 for the calendar year 2022. Form 990, Part VI, Section A, line 7a Through an affiliations agreement Billings Clinic has the authority to approve up to 25% of the total number of board members. Form 990, Part VI, Section B, line 11b The finance committee reviews the 990 prior to its issuing. The governing board is provided a copy prior to filing. Form 990, Part VI, Section B, line 12c This policy applies to all employees of Livingston HealthCare (LHC), volunteers, medical staff, contracted workforce, or other individuals that have a financial interest and are authorized to conduct business on behalf of LHC. Conflicts are reviewed by the Conflict of Interest Review Panel, chaired by the Compliance Officer. Communication will direct the interested person to discontinue the outside relationship/activity, discontinue relationship with outside organization, or establish management plan to monitor relationship/activities. Policy is monitored through open communication and review of the policy. Form 990, Part VI, Section B, line 15 The CEO was paid by an unrelated management company, Billings Clinic. Billings Clinic reviews and establishes the compensation package for the CEO, and the full governing board of Livingston Healthcare then must approve the CEO compensation initially, as well as annually as a part of the budget process. The governing board of Livingston Healthcare has final authority on employment of the CEO through Billings Clinic. Executive compensation is reviewed by the board of directors, as well as an external third party. Form 990, Part VI, Section C, line 19 The organization made its governing documents, conflict of interest policy, and financial statements available to the public upon request. The organization also has an annual report available on its website. Form 990, Part VII, Physicians Serving on Board of Directors: Four board members are physicians that are paid by unrelated management companies for their phsyician services. They are not paid for their service on the Board of Directors, and thus, no compensation is reported on Part VII for the following indidviduals: Jeffry Lindenbaum, MD, Justin Roberts, MD, Claire Kennamore, MD, or Stefanie Lange, MD. Form 990, Part IX, line 11g Contracted Services: Program service expenses 10,003,739. Management and general expenses 971,727. Fundraising expenses 6,454. Total expenses 10,981,920. Licenses, Fees, and Taxes: Program service expenses 1,028,188. Management and general expenses 431. Fundraising expenses 20. Total expenses 1,028,639. Other Fees: Program service expenses 1,233,903. Management and general expenses 95,266. Fundraising expenses 1,710. Total expenses 1,330,879. Livingston Healthcare Foundation 320 Alpenglow Ln Livingston MT 59047 810621997 To Support Livingston Healthcare Programs MT 501(c)(3) Line 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0