2023-10-05T15:13:54-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 237169043 Central Montana Medical Facilities Inc CENT 4065387711 408 Wendell Avenue Lewistown MT 59457 Perry Howell CFO 4065387711 2023-09-28 1 Perry Howell 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-09-21 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Central Montana Medical Center Cody Langbehn 408 Wendell Avenue Lewistown MT 59457 50881832 0 X www.cmmc.health X 1971 MT The mission of CMMC is to be the leader in assuring community based quality healthcare. 14 11 365 146 0 0 15296326 154656 40282587 45596702 464122 1560723 302194 352074 56345229 47664155 0 0 0 0 23979123 24899576 0 0 174125 19375907 21050886 43355030 45950462 12990199 1713693 47226831 46445765 13155913 12390919 34070918 34054846 X The mission of Central Montana Medical Center is to be the leader in assuring community based quality healthcare. 0 0 38702178 0 45596702 Central Montana Medical Facilities, Inc. operates a 25-bed critical access hospital located in Lewistown, Montana.Hospital Inpatient Services for FY 2022:Number of beds: 25Provided 1,789 acute days of care and 618 swing bed days of care for 26.38% occupancy rate. Emergency Services for FY 2022:Provided for 5,400 Emergency visits.24-hour Physician coverage available.OB Services for FY 2022:Provided for 82 births in Central MontanaCommunity care and services are also provided through the many reduced-price services and free clinics, fairs, and programs offered throughout the year. Due to the Covid-19 Pandemic many of our services were not held to keep community members and employees safe. What we were able to complete includes but is not limited to the following (all costs are estimates):Services provided for fiscal year 21-22:*Concussion Testing: -501 students tested-Established baseline cognitive functioning for all area schools' athletic programs (Lewistown High School and Junior High, Winifred, Roy, Hobson, and Moore)-Educated on importance of brain health and injury prevention-Estimated Cost: $5,318*Sports Physical Clinics:-Provided 185 sports physical exams to area students that included a musculoskeletal exam by CMMC Rehab department: Donated proceeds back to individual school athletic programs-Estimated cost: $6,347*CPR / First Aid:-152 students taught at Fergus High School: 7 day class / 6 class periods per day-Educated on 9-1-1 emergency calls; basic adult / infant CPR; AED training; seizure care; allergic reactions and training in use of an Epi-pen; Stop the Bleed training; diabetic s/sx and response to abnormal issues; total of 560 staff hours-Estimated cost: $3,932*Rural EMS volunteer services:-60 volunteer EMTs served.-Respirator fit testing, TB testing & immunization assessment completed-Estimated cost: $6,000*Respirator Fit Testing:-167 individuals served-Respirators fit testing for Roundup Memorial Hospital and Wheatland Memorial Hospital -Estimated cost: $5,805*Volunteer Services: -104 volunteers served-Lab testing, COVID and flu vaccines, TB testing-5 staff and supplies used -Estimated cost: $1,920*Darci's Gift In-Kind:-90 students served-CPR and emergency response first aid instruction-5 staff used and supplies used-Estimated cost: $1,920*Hospice Annual Volunteer Training: -13 volunteers served-Educated on immunizations; appropriate PPE, and Covid precautions / symptoms for Covid-Estimated cost: $90The 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 $844,492 for the fiscal year. Total direct and indirect costs related to these foregone charges were $458,000 based on an average ratio of cost to gross charges.Awards received for FY 2022 were:*MHA PIN- Performance Improvement Network (6 years in a row) 38702178 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 46 0 1 365 1 0 0 0 0 0 1 1 0 0 0 0 0 0 X 14 11 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X Perry Howell 4065357711 408 Wendell Ave Lewistown MT 59457 Bret Carpenter Chair (Jul-Oct)/Director (Oct-Mar) 1.00 X X 0 0 0 Corry Arntzen - Vice Chair (Jul-Oct)/Chair starting Oct 1.00 X X 0 0 0 Carl Seilstad - Member (Jul-Oct)/Vice Chair starting Oct 1.00 X X 0 0 0 Jennifer Saunders Secretary/Treasurer 1.00 X X 0 0 0 Megan Bartel Member starting June 2022 1.00 X 0 0 0 Keith Cook Member 1.00 X 0 0 0 Ryan d'Autremont Member 1.00 X 0 0 0 Karen Durbin Member 1.00 X 0 0 0 Marvin Mauws Member 1.00 X 0 0 0 Melody Montgomery Member 1.00 X 0 0 0 Ashley Morris Member 1.00 X 0 0 0 Dr Michael Sura Physician/Member 40.00 X 308876 0 32490 Dr Tamara Welsh Physician/Member 40.00 X 287221 0 7091 Mary Albers Member 1.00 X 0 0 0 Brandon Bantz Member 1.00 X 0 0 0 Nick Econom Member (Jul-Oct) 1.00 X 0 0 0 Cody Langbehn CEO 40.00 X 0 0 0 Scott Merkle CFO 40.00 X 114033 0 5520 Dr Gardner Smith Surgeon 40.00 X 498814 0 32490 Dr Felipe Vile Martignoni Physician 40.00 X 478821 0 29240 Dr Raymond Lee Radiologist 40.00 X 462844 0 23418 Dr Augusto Amaral Neto Family Practice Doctor 40.00 X 358867 0 24368 Dr Amy A LePage ER Physician 40.00 X 347164 0 27339 2856640 0 181956 25 0 1 0 Synergy Surgicalist 12396 World Trade Dr 303 San Diego CA 92128 Physician Staffing 1227013 Billings Clinic PO Box 30357 Billings MT 59107 Mgmt Fees, advisory fees, CEO services 963885 Coronis Health LLC PO Box 66936 St Louis MO 63166 Contracted AR Services 740152 Cushing Terrell PO Box 30071 Billings MT 59107 Architecture-Building Services 260804 ASD Healthcare PO Box 978526 Dallas TX 75397 Medical Staffing 258518 9 125281 29375 154656 Net Patient Revenue 621110 42894603 42894603 Special Programs 900099 1727719 1727719 Pharmacy Revenue 446110 973188 973188 Cafeteria 722514 1192 1192 45596702 92351 92351 488388 136314 352074 352074 352074 4549735 3081363 1468372 1468372 1468372 47664155 45596702 0 1912797 X 857054 675713 181341 147605 147605 19013575 15190137 3695734 127704 477217 437250 36919 3048 3079985 2468418 602332 9235 1324140 1059312 255873 8955 273627 273627 107512 107512 87265 87265 6642395 6633532 8863 111910 83933 16460 11517 2497589 1588697 906450 2442 1096772 867537 227435 1800 76736 76435 301 115232 115104 128 149119 112781 36338 1832038 1420193 411845 286743 286743 Medical Supplies 6425369 6425357 12 Equipment Rental and Ma 597820 597820 Taxes and Licenses 95368 89607 5641 120 655391 426004 229387 45950462 38702178 7074159 174125 10331104 8217869 4065167 4065167 7957547 11055451 930284 996694 560372 210140 46860308 34948096 13205398 11912212 5281382 4686638 4895577 5301594 47226831 46445765 4403769 5274876 3343436 1921316 3367238 3236672 1977349 1547300 64121 410755 13155913 12390919 X 24841986 24460383 9228932 9594463 34070918 34054846 47226831 46445765 X 1713693 -2095296 365531 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 123009 123009 25617645 18039695 7577950 18854675 15682475 3172200 2264979 1225926 1039053 11912212 Long-Term Prepaid Expenses 570159 Due from Foundation 3689296 Other Receivables 1042139 5301594 Estimated Third-Party Payor Settlements 410755 410755 X 45705173 -2095296 -2095296 47800469 -136314 -136314 47664155 46086776 136314 136314 45950462 0 45950462 Part X, Line 2: 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. Part XI, Line 4b - Other Adjustments: Rental Expenses Reported in Revenue for Tax Purposes -136,314. Part XII, Line 2d - Other Adjustments: Rental Expenses Reported in Revenue for Tax Purposes 136,314. 1 1 X 1 X 1 X 1 1 1 0 0 458000 458000 0.01000 4181817 3464959 716858 0.01560 4639817 3464959 1174858 0.02560 11 9221 32693 1550 31143 0.00070 2 45 197 197 0.00000 12489917 5685741 6804176 0.14810 1 100 4809 4809 0.00010 14 9366 12527616 5687291 6840325 0.14890 14 9366 17167433 9152250 8015183 0.17450 4 35362 12939 12939 0.00030 4 35362 12939 12939 0.00030 1 2483848 0 10036589 9953478 83111 X 1 1 1 1 Central Montana Medical Center 408 Wendall Avenue Lewistown MT 59457 www.cmmc.health 12894 X X X X Home Health / Hospice Central Montana Medical Facilities Inc 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X https://www.cmmc.health/resources/reports/ X 1 21 1 https://www.cmmc.health/resources/reports/ 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X See Part V X See Part V X See Part V X X X X X X 1 X 0 X X X X 1 X 0 0 Central Montana Medical Facilities, Inc. Part V, Section B, Line 5: In January 2022, surveys were mailed out to the residents in Fergus County, Montana. Survey respondents had the ability to complete the survey mailed to them, or via an online survey hosted at Montana State University's HELPS Lab web portal. The survey was based on a design that has been used extensively in the states of Washington, Wyoming, Alaska, Montana, and Idaho. The survey was designed to provide each facility with information from local residents regarding: Demographics of respondents Hospitals, primary care providers and specialists used, plus reasons for selection Local healthcare provider usage Services preferred locally Perception and satisfaction of local healthcare Key informant interviews and focus groups were conducted to identify important local healthcare issues, how to improve the health of the community, and gaps in health services. It was intended that this research would help determine the awareness of local programs and services, as well as the level of satisfaction with local services, providers, and facilities. Central Montana Medical Facilities, Inc. Part V, Section B, Line 11: The Organization completed their latest CHNA during FY 2022. The following needs were identified in the latest CHNA which will be addressed: health concerns including expanding access to mental and behavioral health services through CMMC, increasing access to healthcare services at CMMC and improving the health and wellness of Central Montana.The organization did not complete anything additional during FY 2022 to address the needs from the latest CHNA due to the timing of when the CHNA was completed. In addition, the organization will not address affordable housing, as this is a challenging issue to tackle alone. As time allows in the future, CMMC would be open to engaging with community partners for discussions related to housing affordability and accessibility. The organization did take the following actions to address the needs from the previous CHNA during the fiscal year. To address the need of developing a workforce to support CMMC's behavioral health activities, a Psychiatric Mental Health Nurse Practitioner was hired. To address the need of increasing access to healthcare services, a financial navigator was hired. In addition, CMMC continued support for population health related outreach for physical health and healthy behaviors in the CMMC service area through community fun runs and by sponsoring various events. Central Montana Medical Facilities, Inc. Part V, Section B, Line 13h: Eligibility is based on patient's family size, family gross income, personal assets, and other medical debts. Central Montana Medical Facilities, Inc. Part V, Section B, Line 16j: A summary of the financial assistance policy is also posted in the hospital facility's emergency room, waiting rooms, and admissions offices. Part V, Line 16a, FAP Website: https://www.cmmc.health/for-patients/billing-and-financial-assistance/ Part V, Line 16b, FAP Application Website: https://www.cmmc.health/for-patients/billing-and-financial-assistance/ Part V, Line 16c, FAP Plain Language Summary Website: https://www.cmmc.health/for-patients/billing-and-financial-assistance/ 2 1 - Central Montana Medical Center - DME 202 4th Avenue South Lewistown MT 59457 HME/DME Services 2 - Central Montana Medical Center-Clinic 410 Wendell Ave Lewistown MT 59457 Physician Clinic Part I, Line 3c: Eligibility is based on patient's family size, family gross income, personal assets, and other medical debts. 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. Medicaid and subsidized health services are reported according to costs allocated to the relevant cost centers on the Medicare cost report. 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), Central Montana Youth Challenge, EPI Committing Meeting, 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. All of these programs benefit central Montana area and promote health and wellness. 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 4: The footnote to the Organization's financial statements can be found on pages 12-13 of the attached audited financial statements. 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. Part III, Line 9b: On every patient statement it states that the Hospital financial assistance application is available upon request. Applications received prior to 120 days are reivewed and accounts are not referred to a collection agency. Any application received from day 120-240 will have the account immediately returned from any collection agency for the application to be processed. Applications are available upon request and on the website for clients to access. 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. Also tracked were the kinds of support requested of CMMC such as children's safety, wellness initiatives and healthcare assessments. In FYE 2022 CMMC completed a Community Health Needs Assessment with the help of Montana State University. Mail and phone surveys were completed and "town hall" type meetings were held in Lewistown. 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. Lewistown's elevation is 3,963 feet with 3,102 people per square mile (average).The city of Lewistown and the surrounding rural towns are supported by one hospital, Central Montana Medical Center. Fergus County is located in a federally designated medically underserved area. As of the census of 2020, the population of Lewistown MT is 5,952 (2,988 female and 2,964 male). The county's population was 11,096 and there are 13.38 persons per square mile. March 2016 cost of living index in our zip code (59457) is 83.1%, U.S. average is 100.Real estate property taxes paid for housing units with mortgages in 2015 was $1,326. Renter-occupied apartments were 31% compared to the state average of 33%.The median resident age for this zip code is 45.8 years old with an average household size of 2.2 people.The population 25 years and over in 59457 shows High school or higher: 94.0%, Bachelor's degree or higher: 29.1%, Graduate or professional degree: 6.9%, Unemployed: 2.8%, Mean travel time to work (commute): 10.8 minutesInformation obtained from www.city-data.com/city/Lewistown-Montana.html Part VI, Line 5: The CMMC Governing Board consisted of 13 volunteer community members including members from surrounding communities and 2 members from our affiliate, Billings Clinic.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: CMMC is part of an affiliated health care system with Billings Clinic. Central Montana Medical Center is involved in promoting community health by participating in Population Health programs offered by Medicare and other third party insurers. Billings Clinic and CMMC collaborate on Population Health and Care Coordination initiatives that are provided to the community. CMMC has an independent Care Coordination department focused on promoting the health of the individuals in our community. X 0 0 0 0 0 0 0 0 0 Dr Gardner Smith Surgeon 498814 0 0 0 0 0 9750 0 24134 0 532698 0 0 0 Dr Felipe Vile Martignoni Physician 478821 0 0 0 0 0 6500 0 22740 0 508061 0 0 0 Dr Raymond Lee Radiologist 462844 0 0 0 0 0 17208 0 6210 0 486262 0 0 0 Dr Augusto Amaral Neto Family Practice Doctor 358867 0 0 0 0 0 2229 0 22139 0 383235 0 0 0 Dr Amy A LePage ER Physician 347164 0 0 0 0 0 5200 0 22139 0 374503 0 0 0 Dr Michael Sura Physician/Member 308876 0 0 0 0 0 9750 0 22740 0 341366 0 0 0 Dr Tamara Welsh Physician/Member 287221 0 0 0 0 0 7091 0 1393 0 295705 0 0 0 A Fergus County Montana 816001358 000000000 2014-05-01 4500000 Emergency and laboratory expansion and remodel of existing facility 0 0 0 A 1263328 4500000 4500000 2015 0 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 1 0 0 0 0 0 1 A 1 Amie D'Autremont Sister of board member, Ryan D'Autremont 50185 Employee compensation 0 Amy D'Autremont Wife of board member, Ryan D'Autremont 97420 Employee compensation 0 Form 990, Part VI, Section A, line 1a 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 3 Cody Langbehn is a contract employee of Billings Clinic as of August 31, 2020. Central Montana Medical Center became affiliated with Billings Clinic and Cody serves as the CEO. Billings Clinic was paid $386,090.10 for Cody's services during fiscal year 2022. The organization pays Billings Clinic a management fee of $29,826.50 per month for our affiliation. Form 990, Part VI, Section A, line 6 The organization has two classes of membership: Class A general membership and Class B membership, with the sole member of the Class B Membership being Billings Clinic. Class A Membership in the Corporation shall consist of residents of Central Montana residing within the counties of Fergus, Judith Basin and Petroleum who are at least eighteen (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, served by CMMC, and who indicate a willingness and desire to be a member of the Corporation by attending and signing the register at the Corporation's annual meeting. Form 990, Part VI, Section A, line 7a The board has two classes of directors. Class A Directors are elected by the Class A Members and Class B Directors are appointed by the Billings Clinic. There shall be at last nine but no more than thirteen Class A Directors. There shall be at least one but no more than two Billings Clinic Directors, as determined by Billings Clinic from time to time. Each Class A Director must reside within the counties of Fergus, Judith Basin or Petroleum. Two Class A Directors must be physicians holding privileges on CMMC's active Medical Staff. Further, so long as the Corporation remains obligated for the repayment of any long-term tax-exempt financing, underwritten through Fergus County, Montana, one Class A Director shall be selected from the Fergus County Commissioners. The Board and Billings Clinic shall communicate concerning the appointment of Billings Clinic Directors with the objective of selecting individuals who will work cooperatively with the Class A Directors for the benefit of CMMC. Form 990, Part VI, Section A, line 7b Any amendment to the bylaws affecting the voting rights and powers of membership, must be approved by both a two-thirds majority of the board present at any regular or special meeting of the board and Billings Clinic. Additionally, Billings Clinic must consent to any amendment of the bylaws relating to CMMC's purpose, the membership, the members of the board, including but not limited to the number of directors, the composition of the board, the term of office of directors or the method or way in which directors are elected or selected. Form 990, Part VI, Section B, line 11b A draft copy of the 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 15a Cody Langbehn, CEO, is employed by Billings Clinic. Billings Clinic provided market data to the Board and the Board takes action annually to set his compensation level. CFO compensation was determined by the CEO after looking at market data from MHA and consulting with a recruitment company about market data for the CFO pay range. The specific pay rate was then set based on the market range and relevant experience. These processes take place on an annual basis. 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 IX, line 11g Medical/Professional Fees: Program service expenses 1,024,019. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,024,019. Service Contracts: Program service expenses 801,087. Management and general expenses 0. Fundraising expenses 8,863. Total expenses 809,950. Purchased Services: Program service expenses 4,808,426. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,808,426. Form 990, Part XI, line 9: Change in Interest in Central Montana Foundation 365,531.