2023-11-14T16:08:35-06:00 2022-12-31 390758449 WIPFLI LLP 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2022-01-01 810392231 WHEATLAND MEMORIAL HEALTHCARE WHEA 4066324351 PO BOX 287 HARLOWTON MT 59036 DONNA NESTE CEO 4066324351 2023-11-08 1 DONNA NESTE XXX-XX-XXXX 1 SAM BRUNSON CPA P01696998 4067281800 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DONNA NESTE PO BOX 287 HARLOWTON MT 59036 11710040 0 X WWW.WHEATLANDMEMORIAL.ORG X 1951 MT TO PROVIDE HEALTHCARE SERVICES TO THE SURROUNDING COMMUNITY. 6 6 87 6 0 0 3617666 384119 6968980 10772030 66021 21044 19644 28515 10672311 11205708 2025 2735 0 0 4611287 4039795 0 0 0 3975162 5861734 8588474 9904264 2083837 1301444 9522176 10160673 1658303 1203473 7863873 8957200 X RESPONSIVE TO THE COMMUNITIES WE SERVE, WHEATLAND MEMORIAL HEALTHCARE IS DEDICATED TO PROVIDING SUSTAINABLE QUALITY CARE WITH RESPECT, COMPASSION, AND TEAMWORK. 0 0 8016901 2735 10772030 AS A CRITICAL ACCESS HOSPITAL, WHEATLAND MEMORIAL HEALTHCARE PROVIDES A BROAD RANGE OF PRIMARY CARE SERVICES TO THE LOCAL COMMUNITY REGARDLESS OF ABILITY TO PAY. THE OBJECTIVE FOR OPERATING THE HOSPITAL AND ITS VARIOUS DEPARTMENTS IS TO MEET THE MISSION OF BEING RESPONSIVE TO THE COMMUNITIES WE SERVE AND PROVIDING SUSTAINABLE QUALITY HEALTH CARE WITH RESPECT, COMPASSION, AND TEAMWORK.THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNTS OF CHARGES FOREGONE WERE $24,768, FOR THE YEAR ENDED DECEMBER 31, 2022. THE ESTIMATED COST OF PROVIDING THESE SERVICES WAS APPROXIMATELY $18,827 FOR THE YEAR ENDED DECEMBER 31, 2022, CALCULATED BY MULTIPLYING THE RATIO OF COST TO GROSS CHARGES FOR THE HOSPITAL BY THE GROSS UNCOMPENSATED CHARGES ASSOCIATED WITH PROVIDING CHARITY CARE TO ITS PATIENTS. 8016901 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 13 0 87 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X PATRICK MCCONNELL 4066573821 PO BOX 37000 BILLINGS MT 59701 X RICHARD MOE CHAIR 1.00 0.00 X X 0 0 0 JULIE BERG VICE CHAIR 0.50 0.50 X X 0 0 0 DON AMUNDSON SECRETARY/TREASURER 0.20 0.50 X X 0 0 0 PAXTON WOJTOWICK DIRECTOR 0.20 0.00 X 0 0 0 ADAM JONES DIRECTOR 0.20 0.00 X 0 0 0 BECKY SIEBENALER DIRECTOR 0.20 0.00 X 0 0 0 KELLEY EVANS CEO 40.00 0.00 X 0 0 0 PATRICK MCCONNELL CFO 10.00 0.00 X 0 0 0 PATRICIA MORRIS RADIOLOGIST 40.00 0.00 X 120947 0 4849 JOAN MCMAHON MD 40.00 0.00 X 111314 0 4774 SAMMI WIDDICOMBE RN 40.00 0.00 X 111119 0 11569 KELLEY OLSON PT 40.00 0.00 X 110534 0 12667 LORNA THERIAULT RN 40.00 0.00 X 110090 0 12650 564004 0 46509 6 0 0 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MANAGEMENT, PROVIDERS, ACCOUNTING, INFOR 815820 WAPITI MEDICAL STAFFING 107 FLYNN DRIVE SUITE 600 MILBANK SD 57252 PROVIDER COVERAGE 750773 XTEND HEALTHCARE 90 VOLUNTEER DRIVE SUITE 200 HENDERSONVILLE TN 37075 BILLING AND CODING SERVICES 452127 MONTANA HEALTH NETWORK 519 PLEASANT STREET MILES CITY MT 59301 CONTRACT LABOR COVERAGE 226247 CONNECTED HEALTH CARE LLC PO BOX 9487 TYLER TX 75711 CONTRACT LABOR COVERAGE 193896 5 116412 267707 384119 PATIENT SERVICE REVENUE 621110 10644436 10644436 OTHER PROGRAM INCOME 900099 127594 127594 10772030 37498 37498 28570 55 28515 28515 28515 487823 504277 -16454 -16454 -16454 11205708 10772030 0 49559 X 1235 1235 1500 1500 3299193 3205471 93722 92627 86945 5682 383100 314962 68138 264875 254237 10638 14525 14525 107439 107439 9612 9612 3368787 2128972 1239815 8521 4572 3949 159759 78376 81383 31970 21418 10552 184077 172756 11321 25465 15791 9674 21377 9849 11528 21863 21863 472650 472650 56484 643 55841 SUPPLIES 508051 453750 54301 BAD DEBT EXPENSE 318719 318719 REPAIRS AND MAINTENANCE 150611 143891 6720 FOOD 129767 129708 59 272057 179593 92464 9904264 8016901 1887363 0 181 230 3234601 3455011 1692100 2632042 302697 266058 6085 6003 8691535 7030028 2061948 1661507 1936975 1678178 280549 306480 7040 155164 9522176 10160673 619137 641457 313561 2026 2170 383179 173471 340400 386375 1658303 1203473 X 7478493 8661855 385380 295345 7863873 8957200 9522176 10160673 1301444 -236193 28076 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 315128 -59653 255475 240638 74490 315128 237185 3453 240638 123788 100000 13397 237185 129503 700 -6415 123788 0.84255 0.15745 0 1 1 60308 60308 3313682 4171852 -858170 5277307 2858176 2419131 40238 40238 1661507 COST REPORT PAYABLE 386375 386375 X PART IV, LINE 2B: THE HOSPITAL ACTS AS CUSTODIAN FOR FUNDS OF CERTAIN SWING BED PATIENTS. THESE FUNDS ARE INCLUDED IN ASSETS LIMITED AS TO USE AND ACCOUNTS PAYABLE IN THE FINANCIAL STATEMENTS. SWING BED PATIENT TRUST FUNDS TOTALED $2,570 AND $2,426 AT DECEMBER 31, 2022 AND 2021, RESPECTIVELY. PART V, LINE 4: GROW THE PRINCIPLE OF THE FUND SO EARNINGS CAN BE USED TO SUPPORT THE MISSION OF WHEATLAND MEMORIAL HEALTHCARE. PART X, LINE 2: THE HOSPITAL IS ORGANIZED AS A MONTANA NON-PROFIT 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 HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE, IF APPLICABLE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. THE HOSPITAL BELIEVES IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE 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. 1 1 1 X 125.000000000000 1 X 1 1 1 0 0 82893 82893 0.00860 2372521 2058089 314432 0.03280 2455414 2058089 397325 0.04140 8776 8776 0.00090 1500 1500 0.00020 10276 10276 0.00110 2465690 2058089 407601 0.04250 1 318719 3531228 3583381 -52153 X 1 1 1 1 WHEATLAND MEMORIAL HEALTHCARE PO BOX 287 HARLOWTON MT 59036 WWW.WHEATLANDMEMORIAL.ORG 13546 X X X X RURAL HEALTH CLINIC WHEATLAND MEMORIAL HEALTHCARE 1 0 0 0 1 0 1 X 125.000000000000 200.000000000000 X X X 1 1 X X X X 1 X WWW.WHEATLANDMEMORIAL.ORG/RESOURCES/COMPASSIONATE-CARE/ X WWW.WHEATLANDMEMORIAL.ORG/RESOURCES/COMPASSIONATE-CARE/ X WWW.WHEATLANDMEMORIAL.ORG/RESOURCES/COMPASSIONATE-CARE/ X X X X X X X 1 X 0 X X X X 1 X 0 1 WHEATLAND MEMORIAL HEALTHCARE PART V, SECTION B, LINE 16J: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY AND INFORMATION ON HOW TO OBTAIN AN APPLICATION OR VIEW THE ENTIRE POLICY IS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, AND ADMISSION AREAS OF THE HOSPITAL. A SUMMARY IS ALSO AVAILABLE ON THE HOSPITAL'S WEBSITE. THE FINANCIAL ASSISTANCE POLICY IS ALSO PROVIDED WITH THE INITIAL COLLECTION EFFORT NOTICES. WHEATLAND MEMORIAL HEALTHCARE PART V, SECTION B, LINE 24: ALL INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY ARE PROVIDED A DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. THE FINANCIAL ASSISTANCE POLICY DOES NOT APPLY TO ELECTIVE PROCEDURES. THEREFORE, FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE CHARGED GROSS CHARGES ON ELECTIVE PROCEDURES. HOWEVER, PATIENT PAYMENTS ARE ELIGIBLE FOR OTHER DISCOUNTS FROM GROSS CHARGES. PART V, LINE 12A, FAILURE TO CONDUCT CHNA: WHEATLAND MEMORIAL HEALTHCARE'S HOSPITAL FACILITY IN HARLOWTON, MONTANA FAILED TO MEET THE REQUIREMENTS OF IRC SECTION 501(R)(3) REGARDING A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) AND IMPLEMENTATION STRATEGY FOR REASONS THAT ARE EXPLAINED BELOW. THE FAILURE WAS NEITHER WILLFUL NOR EGREGIOUS, WAS THE ONLY OCCURRENCE OF SUCH A FAILURE, AND THE HOSPITAL FACILITY IS IN THE PROCESS OF CORRECTING THE FAILURE. AT THE TIME OF FILING THIS RETURN, THE PREVIOUS CHNA WAS CONDUCTED IN 2019 AND THE IMPLEMENTATION STRATEGY WAS APPROVED AND ADOPTED BY THE BOARD OF DIRECTORS IN DECEMBER 2019. THE NEXT CHNA SHOULD HAVE BEEN CONDUCTED BY THE END OF 2022 WITH THE IMPLEMENTATION STRATEGY APPROVED AND ADOPTED BY MAY 15, 2023. HOWEVER, MANAGEMENT REALIZED HALFWAY THROUGH THE TAX YEAR THAT UNFORESEEN CIRCUMSTANCES WERE PREVENTING WHEATLAND MEMORIAL HEALTHCARE FROM MEETING THESE DEADLINES. ONE SIGNIFICANT OBSTACLE WAS THE HIGH TURNOVER OF KEY LEADERSHIP ROLES WITHIN THE FACILITY. A NEW INTERIM CEO STARTED THE END OF 2021 AND SPENT THEIR FIRST SIX MONTHS TRYING TO STABILIZE THE FACILITY POST-COVID. ALSO, THERE WERE THREE DIFFERENT DIRECTORS OF NURSING IN 2022, A CHANGE IN THE CHIEF OF STAFF, AND THE DIRECTOR OF FACILITIES WAS OUT ON LONG-TERM EXTENDED LEAVE. THE LEADERSHIP TEAM ALSO SPENT A LOT OF RESOURCES AND TIME STABILIZING THE PROVIDER BASE. THE TURNOVER OF KEY LEADERSHIP ROLES DIRECTLY IMPACTED THE ASSESSMENT PROCESS. NEW LEADERS NEEDED TIME TO FAMILIARIZE THEMSELVES WITH THE ORGANIZATION AND UNDERSTAND THE INTRICACIES OF CONDUCTING A COMPREHENSIVE CHNA. EXISTING LEADERS COVERED ADDITIONAL RESPONSIBILITIES AND ASSISTED WITH THE ONBOARDING OF NEW LEADERSHIP TEAM MEMBERS. CONSEQUENTLY, THERE WAS A DELAY IN COMPLETING THE ASSESSMENT. ADDITIONALLY, THE OFFICE OF RURAL HEALTH, THE ENTITY CONTRACTED TO CONDUCT THE ASSESSMENT, ALSO EXPERIENCED TURNOVER WITHIN ITS OFFICE STAFF, WHICH FURTHER CONTRIBUTED TO DELAYS IN THE ASSESSMENT. THE INEXPERIENCED STAFF MEMBERS REQUIRED TIME TO ACCLIMATE TO THEIR ROLES AND RESPONSIBILITIES, AFFECTING THE OVERALL EFFICIENCY OF THE ASSESSMENT PROCESS. THESE KEY POSITIONS ALSO LEFT THEIR POSITIONS BEFORE THE ASSESSMENT WAS COMPLETED. FURTHERMORE, THE FACILITY ENCOUNTERED MULTIPLE SEWAGE AND PLUMBING ISSUES IN FISCAL YEAR 2022. THESE UNEXPECTED PROBLEMS DEMANDED IMMEDIATE ATTENTION AND RESOURCES TO ENSURE THE SAFETY AND WELL-BEING OF PATIENTS AND STAFF. CONSEQUENTLY, THE HOSPITAL HAD TO REDIRECT ITS FOCUS AND RESOURCES TOWARD ADDRESSING THESE PRESSING INFRASTRUCTURE CONCERNS, CAUSING A DIVERSION OF RESOURCES FROM THE CHNA.DESPITE THE CHALLENGES FACED, WHEATLAND MEMORIAL HEALTHCARE CONTINUED THEIR ACTION PLAN RELATED TO THE 2019 CHNA DURING THIS PERIOD AND DID NOT STOP STRIVING TO IMPROVE THE COMMUNITY'S ACCESS TO CARE AND HEALTH STATUS. AS PART OF THESE EFFORTS, MANAGEMENT WORKED TO STAY CONNECTED WITH THE COMMUNITY THROUGH ONGOING COMMUNICATION. THE CEO AND COMMUNITY RELATIONS MANAGER HOSTED NUMEROUS COMMUNITY FORUMS TO REMAIN IN TOUCH WITH COMMUNITY CONCERNS AND NEEDS. PART OF THE PURPOSE OF THESE COMMUNITY FORUMS WAS TO GET THE COMMUNITY'S FEEDBACK ON WHAT SERVICES THEY WANT AND NEED LOOKING INTO THE FUTURE. MANAGEMENT DOES NOT BELIEVE ANYONE IN THE COMMUNITY WAS HARMED BY THIS DELAY IN THE CHNA AS THE FACILITY WAS ACTIVELY ENGAGED IN GETTING FEEDBACK FROM THE COMMUNITY DURING THIS TIME. WHILE THIS DOES NOT SERVE AS AN OFFICIAL CHNA, THE LEADERSHIP TEAM WAS FOCUSED ON THE COMMUNITY'S NEEDS LOOKING WELL INTO THE FUTURE. GIVEN THESE CHALLENGES, COMPLETING THE CHNA BY THE DEADLINE WAS NOT FEASIBLE FOR WHEATLAND MEMORIAL HEALTHCARE, BUT THE LEADERSHIP TEAM WORKED DILIGENTLY TO COMPLETE THE CHNA AS SOON AS POSSIBLE. THE CHNA WAS COMPLETED ON OCTOBER 15, 2023. THE IMPLEMENTATION STRATEGY WILL BE REVIEWED AT THE NEXT BOARD OF DIRECTORS MEETING WHICH IS SCHEDULED FOR NOVEMBER 16, 2023. THE HOSPITAL ANTICIPATES THE BOARD WILL APPROVE AND ADOPT THE IMPLEMENTATION STRATEGY AT THIS MEETING. THE HOSPITAL RECOGNIZES THE IMPORTANCE OF CONDUCTING THIS ASSESSMENT TO MEET THE NEEDS OF THE COMMUNITY AND IS COMMITTED TO MAKING IT A PRIORITY. GOING FORWARD, THE CHNA WILL BE A STANDING AGENDA ITEM ON THE WEEKLY LEADERSHIP MEETINGS HELD BY THE FACILITY. THIS WILL ENSURE THE CHNA IS ALWAYS IN THE FOREFRONT OF THE CONVERSATION AND WILL HELP MITIGATE THE LIKELIHOOD OF THIS TYPE OF FAILURE OCCURRING IN THE FUTURE. IT WILL ALSO HELP FACILITATE THE PROMPT IDENTIFICATION AND CORRECTION OF ANY SUCH FUTURE FAILURE THAT COULD OCCUR. IN ADDITION, A FORMAL POLICY AROUND THE COMPLETION OF THE CHNA AS REQUIRED IS BEING DRAFTED AND SHOULD BE APPROVED BY THE BOARD OF DIRECTORS AT THE NOVEMBER 2023 MEETING. PART I, LINE 7: CHARITY CARE WAS RECORDED AT COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. PART I, LINE 7G: THE COST FOR SUBSIDIZED HEALTH SERVICES ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $318,719. PART III, LINE 2: PATIENT ACCOUNTS ARE NOT CLASSIFIED AS BAD DEBT UNTIL EVERY EFFORT IS MADE TO COLLECT ON THE ACCOUNT, INSURANCE IS FILED, AND ALL PAYMENTS ARE APPLIED INCLUDING CONTRACTUAL ALLOWANCES AND DISCOUNTS. ANY PAYMENT ON AN ACCOUNT THAT WAS WRITTEN OFF TO BAD DEBT REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR. BAD DEBT EXPENSE ON LINE 2 IS REPORTED AT CHARGES AS PRESENTED ON THE FINANCIAL STATEMENTS. PART III, LINE 4: BAD DEBT EXPENSE IS DESCRIBED IN FOOTNOTE 1 BEGINNING ON PAGE 10 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: WHEATLAND MEMORIAL HEALTHCARE IS A CRITICAL ACCESS HOSPITAL. THE HOSPITAL PROVIDES SERVICES TO PATIENTS BECAUSE ACCESS TO HEALTHCARE AND INDIVIDUAL'S HEALTH IS IMPORTANT TO THE HOSPITAL. THEREFORE, THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT.TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: THE HOSPITAL IS AWARE OF PATIENTS WHO ARE IN THE PROCESS OF APPLYING FOR FINANCIAL ASSISTANCE AND THESE ACCOUNTS ARE NOT SENT TO COLLECTIONS. IF A PATIENT DOES NOT COOPERATE OR IS NOT IN COMPLIANCE WITH THEIR PAYMENT ARRANGEMENT THE ACCOUNT IS TURNED OVER TO A COLLECTION AGENCY.COLLECTION EFFORTS CEASE WHILE A PATIENT IS UNDER REVIEW FOR CHARITY CARE OR WHILE A PATIENT IS IN COMPLIANCE WITH A PAYMENT ARRANGEMENT. AFTER FINANCIAL ASSISTANCE IS AWARDED, ANY PERSONAL PORTION DUE FOLLOWS THE SAME COLLECTION PROCEDURE AS OTHER ACCOUNTS. PART VI, LINE 2: WHEATLAND MEMORIAL HEALTHCARE ASSESSES THE NEEDS OF THE COMMUNITY THROUGH PATIENT SURVEYS, GENERAL PUBLIC SURVEYS, AND COMMUNITY MEETINGS.A STEERING COMMITTEE WAS CONVENED TO ASSIST WHEATLAND MEMORIAL HEALTHCARE IN CONDUCTING ITS CHNA. THE HOSPITAL USED A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY. THE 12/31/2019 NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY IS POSTED TO THE HOSPITAL WEBSITE. PART VI, LINE 3: WHEATLAND MEMORIAL HEALTHCARE TRIES TO DETERMINE IF PATIENTS QUALIFY OR POSSIBLY QUALIFY FOR ANY FINANCIAL ASSISTANCE EITHER AT REGISTRATION OR DISCHARGE. WE NOTIFY PATIENTS OF OUR PROGRAMS BY MAKING AVAILABLE FINANCIAL ASSISTANCE BROCHURES IN WAITING ROOMS, EMERGENCY ROOM AREAS, AND OTHER PATIENT ACCESS AREAS AND LOCAL NEWSPAPER ADS. FINANCIAL ASSISTANCE INFORMATION IS PROVIDED IN ALL CORRESPONDENCE REGARDING PATIENT BILLS. WE ALSO HAVE STAFF AVAILABLE TO ASSIST IN APPLICATIONS FOR STATE AID. PART VI, LINE 4: WHEATLAND MEMORIAL HEALTHCARE (WMH) IS A 25-BED CRITICAL ACCESS HOSPITAL AND RURAL HEALTH CLINIC LOCATED IN HARLOWTON, MONTANA. HARLOWTON IS A RANCHING COMMUNITY IN CENTRAL MONTANA WITH APPROXIMATELY 1.6 PEOPLE PER SQUARE MILE. THE POPULATION OF HARLOWTON WAS 992 AND WHEATLAND COUNTY WAS 2,108. WMH SERVES RESIDENTS OF WHEATLAND, GOLDEN VALLEY, JUDITH BASIN AND PORTIONS OF SWEET GRASS AND MEAGHER COUNTIES. THE MOST COMMON INDUSTRIES ARE MANAGEMENT, FARMING, FISHING, AND CONSTRUCTION. THE NEAREST TERTIARY CARE FACILITY IS 93 MILES SOUTH EAST OF HARLOWTON, IN BILLINGS, MT. THE NEXT CLOSEST TERTIARY CARE FACILITY IS 130 MILES NORTH WEST OF HARLOWTON, IN GREAT FALLS, MT. LEWISTOWN WHICH IS 60 MILES NORTH FROM WMH, HAS A SECONDARY CARE FACILITY.THE MEDIAN HOUSEHOLD INCOME IN WHEATLAND COUNTY WAS $37,222, AND INDIVIDUALS LIVING BELOW THE FEDERAL POVERTY LEVEL IN WAS 19.8%. PART VI, LINE 5: OUR BOARD IS COMPRISED OF MEMBERS WITHIN OUR LOCAL AND OUTLYING SERVICE AREA. THESE MEMBERS ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. AT THIS TIME THE ORGANIZATION HAS LACKED EXCESS FUNDS FROM OPERATIONS BUT HAS PURSUED GRANTS AGGRESSIVELY IN ORDER TO REPLACE AGING EQUIPMENT AND ESTABLISH COMMUNITY HEALTH PROGRAMS THAT WILL ALLOW US TO CONTINUE SERVING THE HEALTH CARE NEEDS OF OUR COMMUNITY DURING THESE CHALLENGING ECONOMIC TIMES. OUR EMERGENCY ROOM IS AVAILABLE 24/7 AND SERVES ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. WE EXTEND PRIVILEGES TO MEDICAL STAFF THAT ARE LICENSED AND QUALIFIED.THE HOSPITAL PROVIDES SPACE FOR IMMUNIZATION CLINICS TO ENSURE CHILDREN IN THE COMMUNITY RECEIVE RECOMMENDED IMMUNIZATIONS. WE ALSO PROVIDE SPACE FOR THE REGIONAL WIC (WOMEN, INFANTS AND CHILDREN) CLINIC TO PROMOTE THE SERVICES OFFERED BY THAT ORGANIZATION. THE HOSPITAL HAS ESTABLISHED A STRONG WORKING RELATIONSHIP WITH THE CHAPLAINS OF SEVERAL CHURCHES WHO PROVIDE SUPPORT TO PATIENTS AND FAMILIES OF THE FACILITY AND PARTICIPATE IN CARE PLANNING AND REGULAR MEETINGS. THE CEO REGULARLY ATTENDS COUNTY COMMISSIONER MEETINGS TO PROVIDE THE COMMUNITY WITH AN UPDATE OF THE EVENTS GOING ON AT THE HOSPITAL. BOARD MEMBERS ALSO FREQUENTLY ATTEND THESE COMMISSIONER MEETINGS. THE HOSPITAL AND ITS ATTACHED RURAL HEALTH CLINIC IS THE SOLE PROVIDER OF HEALTH CARE SERVICES WITHIN THE COMMUNITY. FORM 990, PART VI, SECTION A, LINE 3 WHEATLAND MEMORIAL HEALTHCARE HAS CONTRACTED WITH BILLINGS CLINIC TO PROVIDE MANAGEMENT SERVICES. THE CEO AND CFO POSITIONS AT WHEATLAND MEMORIAL HEALTHCARE ARE CONSIDERED COMMON LAW EMPLOYEES OF BILLINGS CLINIC. BILLINGS CLINIC MAY, IN ITS DISCRETION AT ANY TIME, REMOVE AND REPLACE THE CEO AND CFO. THE CEO HAS THE RESPONSIBILITY OF SUPERVISING MANAGEMENT AND ADMINISTRATING THE OPERATION OF WHEATLAND MEMORIAL HEALTHCARE. THE CFO HAS THE RESPONSIBILITY OF MANAGING THE ORGANIZATION'S FINANCES. THE AMOUNTS BELOW WERE PAID TO EACH INDIVIDUAL BASED ON AN HOURLY RATE. KELLEY EVANS, CEO SALARY $167,347 PATRICK MCCONNELL, CFO SALARY $16,731 FORM 990, PART VI, SECTION A, LINE 8B THE ORGANIZATION DOES NOT HAVE COMMITTEES WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE COMPLETED FORM 990 IS PROVIDED TO THE BOARD MEMBERS BEFORE IT IS FILED. THE CEO, CFO AND ACCOUNTING MANAGER REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C ALL OFFICERS, TRUSTEES, AND KEY EMPLOYEES ARE REQUIRED UPON HIRE AND AT LEAST ANNUALLY THEREAFTER, TO DISCLOSE ANY CONFLICTS OR POTENTIAL CONFLICTS AND SIGN A CONFLICT OF INTEREST POLICY. A CONFLICT OF INTEREST CAN BE CONSIDERED TO EXIST IN ANY INSTANCE WHERE THE ACTIONS OR ACTIVITIES OF AN INDIVIDUAL ON BEHALF OF WHEATLAND MEMORIAL ALSO INVOLVE THE OBTAINING OF AN IMPROPER GAIN OR ADVANTAGE, OR ADVERSE EFFECT ON THE INTERESTS OF WHEATLAND MEMORIAL. THE CEO REVIEWS THE STATEMENTS AND INVESTIGATES ALL DISCLOSURES OF POSSIBLE CONFLICTS OF INTEREST. THE CEO PREPARES A REPORT FOR THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE IS RESPONSIBLE FOR FINAL REVIEW AND INVESTIGATION OF POTENTIAL CONFLICTS OF INTEREST AND PRESENTATION OF ITS FINDINGS TO THE WHEATLAND MEMORIAL BOARD OF DIRECTORS ON AN ANNUAL BASIS. UPON DISCLOSURE OF A POSSIBLE CONFLICT OF INTEREST, BOARD MEMBERS WILL REFRAIN FROM DELIBERATING ON THE MATTER UNTIL ALL RELEVANT AND PERTINENT FACTS AND CIRCUMSTANCES HAVE BEEN DISCLOSED AND ANY POTENTIAL CONFLICT HAS BEEN AVOIDED OR RESOLVED. THE INDIVIDUAL WITH A CONFLICT IS NOT ALLOWED TO BE PRESENT WHEN THE MATTER IS DISCUSSED OR VOTED UPON. ALL MATTERS OF DISCUSSION ARE DOCUMENTED. FORM 990, PART VI, SECTION B, LINE 15A THE CEO AND CFO ARE COMMON LAW EMPLOYEES OF BILLINGS CLINIC. BILLINGS CLINIC DETERMINES COMPENSATION BASED ON METHODS THEY HAVE ESTABLISHED. THE BOARD OF DIRECTORS APPROVES THE MANAGEMENT RELATIONSHIP WITH BILLINGS CLINIC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990. FORM 990, PART IX, LINE 11G CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 1,993,180. MANAGEMENT AND GENERAL EXPENSES 1,038,023. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,031,203. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 98,216. MANAGEMENT AND GENERAL EXPENSES 158,417. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 256,633. RECRUITMENT: PROGRAM SERVICE EXPENSES 37,576. MANAGEMENT AND GENERAL EXPENSES 43,375. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,951. WHEATLAND MEMORIAL HEALTHCARE FOUNDATION PO BOX 287 HARLOWTON MT 59036 454035841 SUPPORT WHEATLAND MEMORIAL HEALTHCARE MT 501(C)(3) LINE 12A, I WHEATLAND MEMORIAL HEALTHCARE 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0