2025-05-13T14:46:39-05:00 2024-06-30 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2023-07-01 810378200 Livingston Healthcare LIVI 4062223541 320 Alpenglow Ln Livingston MT 59047 Bruce Whitfield CEO 4062223541 2025-05-08 1 1 Lisa Chaffee CPA P00193453 7012551091 2025-05-08 2023 2025-03-06 01:10:19Z Bruce Whitfield 320 Alpenglow Ln Livingston MT 59047 91630753 0 X www.livingstonhealthcare.org X 1955 MT A 25-bed critical access hospital, a multispecialty physician practice, rehabilitation services, and home-based services. 10 9 549 22 0 0 819808 373954 76403542 90799646 67994 371925 71700 63046 77363044 91608571 32766 23968 0 0 39141627 44292054 0 0 251285 38629451 46224958 77803844 90540980 -440800 1067591 89398714 90391456 42724541 41918602 46674173 48472854 X Excellence in patient-centered care. 0 0 77476476 23968 90799646 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 2024, we contributed $10,000 to sustain and expand this free, efficient fixed-route transportation system benefiting citizens and disabled individuals in Park County, Montana. This was a grant passed through the Park County Community Foundation to Windrider Transit.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 FY2024, the event served 250 individuals, incurring direct expenses of $14,084 and staff costs totaling $33,123, amounting to a total expenditure of $47,207. This financial commitment reflects our dedication to community benefit and underscores the importance of providing accessible health information and services to our residents.Suicide prevention emerged as an urgent community need this year, prompting Livingston HealthCare to make it a priority within our CHIP initiatives. In partnership with LiveWell49, we provided Suicide Prevention Training to over 100 individuals, including 50% of our clinical staff, marking a significant step in creating a safer, more responsive environment for those at risk. This initiative reflects our commitment to fostering resilience and offering compassionate, effective support to address mental health needs across Park County 77476476 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 1 1 0 0 1 60 0 1 549 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Deborah Evans-Small 4062223541 320 Alpenglow Lane Livingston MT 59047 X Michael McCormick Chair 15.00 X X 0 0 0 Lee Kinsey Vice Chair 2.00 X X 0 0 0 Liz Lewis Secretary 2.00 X X 0 0 0 Steve Caldwell Treasurer 2.00 X X 0 0 0 Kyra Pinango MD Director, Family Medicine 36.00 X 207368 0 19636 Justin Roberts MD Director, Surgery 2.00 X 0 0 0 Abbie Bandstra Director 2.00 X 0 0 0 Clair Kenamore MD Director 2.00 X 0 0 0 Stefanie Lange MD Director 2.00 X 0 0 0 JJ Carmody Director 2.00 X 0 0 0 Bruce Whitfield CEO 40.00 X 0 0 0 Kris Kester CFO 40.00 X 255274 0 18695 Stacy Kohler Chief Nursing Officer 40.00 X 209664 0 32469 Kyle Arnet MD ER Physician 40.00 X 453569 0 32297 Brian Guercio ER Physician 40.00 X 400009 0 38171 Benjamin Wilkinson ER Physician 40.00 X 437771 0 42124 Raymond Wright ER Physician 40.00 X 391550 0 39530 Douglas Wadle MD Hospital Provider 40.00 X 371051 0 32289 2726256 0 255211 59 0 1 0 Billings Clinic PO Box 30977 Billings MT 591070977 IS & Administration Fees 2721237 Billings Clinic Teleradiology PO Box 30977 Billings MT 591070977 Telerad Services 699087 Aya Healthcare PO Box 674907 Dallas TX 752674907 Staffing Services 578731 Soliant PO Box 934411 Atlanta GA 311934411 Staffing Services 488852 Travel Nurse PO Box 660919 Dallas TX 752660919 Staffing Services 362580 12 297259 63703 12992 373954 Net Patient Service Revenue 621110 88582442 88582442 340B Pharmacy Revenue 456110 1159898 1159898 Supporting Revenue 621110 1057306 1057306 90799646 394107 394107 63046 0 63046 63046 63046 22182 -22182 -22182 -22182 91608571 90799646 0 434971 X 23968 23968 849043 266189 582854 400281 400281 33439900 27927287 5374397 138216 1741389 1470653 263469 7267 5457503 4518007 917519 21977 2403938 1948301 446237 9400 635608 635608 199954 55828 144126 118317 115317 3000 11980270 10076059 1897077 7134 193381 21701 144112 27568 2014049 1667223 338964 7862 1260101 239861 1019167 1073 914724 656701 258023 221797 188878 32698 221 189675 126045 62946 684 1239392 1239392 3846962 3846962 879148 495310 383838 Medical Supplies 20396297 20390311 5980 6 Repairs and Maintenance 1331993 1303507 28486 Food 445797 444696 1101 357493 169316 161300 26877 90540980 77476476 12813219 251285 2326980 2862904 1053460 47126 14542826 17500518 1822216 1724514 670976 759354 72432986 30600749 42301910 41832237 24446904 22254500 2233442 3410303 89398714 90391456 5446226 5990822 34213451 32336141 3064864 3591639 42724541 41918602 X 46674173 48472854 46674173 48472854 89398714 90391456 X 1067591 761487 -30397 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5051438 55277 849704 5956419 4631565 35258 384615 5051438 5150614 3750 -522799 4631565 3021307 1357828 771479 5150614 2480033 570837 154145 183708 3021307 0.57000 0.43000 0.00000 0 1 1 5951320 5951320 36700750 12990045 23710705 25970909 16384464 9586445 3810007 1226240 2583767 41832237 Professional Liability Claims 46000 Deferred Compensation Liability 3212300 Operating Lease Liability 333339 3591639 X 93169282 761487 1096483 1857970 91311312 297259 297259 91608571 90545502 4522 4522 90540980 0 90540980 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 1,096,483. Part XI, Line 4b - Other Adjustments: Foundation Contribution to Hospital that is Eliminated on Audited Financials 297,259. Part XII, Line 2d - Other Adjustments: Foundation Expense Reported on a Separate Form 990 4,522. 1 1 X 0 1 X 1 1 1 0 0 662000 662000 0.00730 662000 662000 0.00730 63 140974 140974 0.00160 16 290150 290150 0.00320 17910532 12148448 5762084 0.06360 11 19850 19850 0.00020 90 18361506 12148448 6213058 0.06860 90 19023506 12148448 6875058 0.07590 1 25 130 130 0.00000 126 84539 137224 137224 0.00150 10 34 2368 2368 0.00000 1 17000 12136 12136 0.00010 17 1645 105474 105474 0.00120 27 2696 290150 290150 0.00320 182 105939 547482 547482 0.00600 1 5444281 299436 27460024 27426600 33424 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 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. Suicide Prevention Training: Partnered with LiveWell49 to deliver Suicide Prevention Training to over 100 employees, enhancing awareness and equipping staff with essential skills to support individuals in crisis.b. The Ranger Clinic: Expanded services and dedicated FTE of Community Health Coordinator to enhance and expand services of The Ranger Clinic, our school-based health center that provides behavioral and primary care services. c. Human Trafficking and Domestic Violence Education: Collaborated with ASPEN to provide Livingston HealthCare staff with training on recognizing and responding to human trafficking and domestic violence, fostering a safer, more informed environment for patient care. d. Addressed Housing Insecurity: Partnered with the Park County Housing Coalition to explore the Coordinated Entry Program, streamlining housing support for residents facing homelessness and housing instability.e. Stress and Anxiety Management Workshops: Offered a free six-week workshop series led by Dr. Chris Spromberg, Clinical Psychologist, empowering participants with tools to manage stress and anxiety effectively.f. Strengthened Crisis Response Efforts: Our Population Health Specialist served as a part-time Crisis Coalition Coordinator for Park County, securing essential funding from the Department of Health to enhance mental health crisis services.g. Invested Over $15,000 in Local Nonprofits: Supported community resilience and growth through the Give-A-Hoot campaign, contributing vital funds to nonprofits addressing key needs in Park County.h. Supported Youth Career Development: Collaborated with the Community School Collaborative to provide nearly 300 SGMS students with hands-on career exploration in Livingston and Bozeman, connecting students with mentors and local leaders.i. Early Childhood: Expanded collaboration with community partners to address the childcare crisis, including dedicating staff to the Park County Early Childhood Coalition and engaging with regional partners to explore a childcare cooperative model. Continued partnership with Community Health Partners, Park County Early Childhood Education, and Childcare Connections to support the unique needs of young children and their families.j. Access to Care: Leverage data tools like the Billings Clinic dashboards to track health equity and improve patient outcomes while expanding preventive screenings and chronic disease management. 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/our-community/community-health-needs-assessment-implantation-p/ 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 13-14 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.Hospital services rendered on a fee schedule are not included in the Medicare calculations per the 990 instructions. Had this been reported the Hospital would have had a greater loss from Medicare services of $888,173.Medicare fee schedule revenue $838,230Medicare estimated costs of care relating to payments $1,726,402Net (shortage) $(888,173) 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 8,908 people in 2023. Livingston is located in southwestern Montana, on the Yellowstone River, north of Yellowstone National Park. The median income for a household in Livingston in 2023 was about $65,187. 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 Park County Community Foundation 414 E Callender Livingston MT 59047 205581763 501(c)(3) 17250 0 Give a Hoot donation campaign to Park Cty nonprofit org 1 0 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 Kyle Arnet MD ER Physician 453326 0 0 0 243 0 16500 0 19131 0 489200 0 0 0 Benjamin Wilkinson ER Physician 437501 0 0 0 270 0 15295 0 30162 0 483228 0 0 0 Brian Guercio ER Physician 399604 0 0 0 405 0 16500 0 25005 0 441514 0 0 0 Raymond Wright ER Physician 390929 0 0 0 621 0 16500 0 26363 0 434413 0 0 0 Douglas Wadle MD Hospital Provider 370430 0 0 0 621 0 16500 0 19122 0 406673 0 0 0 Kris Kester CFO 226402 0 28386 0 486 0 9128 0 12452 0 276854 0 0 0 Stacy Kohler Chief Nursing Officer 197755 0 11423 0 486 0 10051 0 25183 0 244898 0 0 0 Kyra Pinango MD Director, Family Medicine 206882 0 0 0 486 0 3577 0 18923 0 229868 0 0 0 Part I, Line 4a LHC paid Billings Clinic, an unrelated management company, $275,679 of severance pay for Deb Anczak, Former CEO, for calendar year 2023. Henry Pinango Spouse of Board Member 400281 Employee Compensation 0 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 $251,004 for CEO services for Bruce Whitefield for the calendar year 2023. LHC paid Billings Clinic, an unrelated management company, $275,679 of severance pay for Deb Anczak, Former CEO, for calendar year 2023. 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: Justin Roberts, MD, Claire Kennamore, MD, or Stefanie Lange, MD. Form 990, Part IX, line 11g Contracted Services: Program service expenses 7,440,840. Management and general expenses 1,777,043. Fundraising expenses 7,134. Total expenses 9,225,017. Licenses, Fees, and Taxes: Program service expenses 1,102,069. Management and general expenses 796. Fundraising expenses 0. Total expenses 1,102,865. Other Fees: Program service expenses 1,533,150. Management and general expenses 119,238. Fundraising expenses 0. Total expenses 1,652,388. Form 990, Part XI, line 9: Audit Adjustment to Net Assets -30,397. Livingston Healthcare Foundation 320 Alpenglow Ln Livingston MT 59047 810621997 To Support Livingston Healthcare Programs MT 501(c)(3) Line 7 Livingston Healthcare 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 Livingston Healthcare Foundation B 297259