2022-03-08T12:17:46-06:00 2021-04-30 GREEN HEALTH GROUP PC 405 FOURTH AVENUE NORTH GLASGOW MT 59230 990 2020-05-01 810373589 CULBERTSON FROID BAINVILLE HEALTHCARE CORPORATION CULB 4067876401 PO BOX 419 CULBERTSON MT 59218 AUDREY STROMBERG ADMINISTRATOR 4067876401 2022-03-03 true AUDREY STROMBERG XXX-XX-XXXX DANIEL GREEN P01311679 4062632615 2022-03-08 2020 2022-09-23 18:48:47Z ROOSEVELT MEDICAL CENTER AUDREY STROMBERG PO BOX 419 CULBERTSON MT 59218 10313562 false X ROOSEVELTMEDICAL.ORG X 1976 MT ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. 7 7 87 7 0 142719 3241147 5699367 6769269 14317 62950 272753 240196 6129156 10313562 0 0 3606097 3274488 0 35734 2562027 3481997 6168124 6756485 -38968 3557077 5414285 8695613 3170343 2894594 2243942 5801019 ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. false false 5579521 6769269 ROOSEVELT MEDICAL CENTER IS DEDICATED TO PROVIDING PATIENTS WITH APPROPRIATE, PERSONALIZED, AND QUALITY HEALTH CARE. 5579521 true true false true false false false false false false true false false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 23 0 87 true false false false false false false false false false false false false X 7 7 true false false false false false false true true false false true true true true true true true true false X JENNIFER KESSNER 4067876401 PO BOX 419 CULBERTSON MT 59218 DON HELLAND MD 31.00 X 169133 0 5618 ZOE FUGERE FNP-C 40.00 X 151687 0 7065 ELIZABETH KLEPPEN PA-C 24.00 X 153317 0 302 DANIELLE CHRISTENSEN RN 59.00 X 137674 0 6765 JENNIFER KESSNER CFO 48.00 X 120930 0 7065 AUDREY STROMBERG ADMINISTRATO 40.00 X 98201 0 6 ROBBIE DENT-SAVELKOUL DIRECTOR 1.00 X 0 0 0 KEN FORBREGD VICE CHAIRMA 1.00 X 0 0 0 AMBER FOX DIRECTOR 1.00 X 0 0 0 GRANT SALVEVOLD DIRECTOR 1.00 X 0 0 0 PAULA SCHLEDEWITZ CHAIRMAN 1.00 X 0 0 0 SHARON SCHMITZ DIRECTOR 1.00 X 0 0 0 KATHY MCCABE THOMPSON DIRECTOR 1.00 X 0 0 0 830942 26821 5 false true false HEALTHCARE SERVICES GROUP INC 3220 TILLMAN DRIVE SUITE 300 BENSALEM PA 19020 DIETARY SVCS 425477 MONTANA HEALTH NETWORK INC 519 PLEASANT STREET MILES CITY MT 59301 NURSING STAFF 402850 GENERAL HEALTHCARE RESOURCES LLC 2250 HICKORY ROAD SUITE 240 PLYMOUTH MEETING PA 19462 NURSING STAFF 115609 3 34538 3108824 97785 3241147 PATIENT REVENUE 621500 6386423 6386423 MISC REVENUE 900099 382846 382846 6769269 62950 62950 HOSPITAL DISTRICT SUBSIDY 900099 240196 240196 240196 10313562 7072415 X 219821 219821 2608864 2233724 346415 28725 10857 8572 2174 111 185267 140785 42667 1815 249679 196182 50778 2719 2022854 1874250 148602 2 37975 37975 288631 194079 93801 751 228 228 39937 21823 18102 12 24391 20004 4297 90 183095 150120 32298 677 117990 96740 20813 437 MEDICAL SUPPLIES 347435 347435 REPAIRS & MAINTENANCE 331159 238212 92603 344 MISC 57576 53200 4325 51 BED TAX 22663 22663 8063 4167 3896 6756485 5579521 1141230 35734 1647 2854126 4200981 130276 122472 1056407 1511068 167648 199885 73515 112186 7588628 5281704 947896 2306924 182770 242097 5414285 8695613 859850 959298 44435 1149366 653900 150000 1612158 635930 3170343 2894594 X 2214309 5770596 29633 30423 2243942 5801019 5414285 8695613 3557077 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 307 307 false SCHEDULE C, PART IV 0.01 PERCENT OF DUES PAID TO MHA AND 25.56 PERCENT OF DUES PAID TO AHA, WHICH TOTALED 307, WERE USED FOR LOBBYING EXPENSES BY MHA. 18500 18500 4729638 3039552 1690086 2840490 2242152 598338 2306924 REFUND ADVANCE-PROVIDER RELIEF FUNDS 578992 RESIDENT DEPOSITS PAYABLE 56938 635930 X 10313562 10313562 10313562 6756485 6756485 6756485 SCHEDULE D, PAGE 3, PART X THE COMPANY BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. true true true X true X true true true false false 50990 50990 0.00750 50990 50990 0.00750 88200 11006 77194 0.01140 1345749 988714 357035 0.05280 1433949 999720 434229 0.06430 1484939 999720 485219 0.07180 true 130871 3142496 3138256 4240 X true true 1 1 ROOSEVELT MEDICAL CENTER PO BOX 419 CULBERTSON MT 59218 X X X X ROOSEVELT MEDICAL CENTER 1 false false true X X X X X X X X X X 20 true false false true X ROOSEVELTMEDICAL.ORG X true 20 true ROOSEVELTMEDICAL.ORG false false true X 100.000000000000 200.000000000000 X X X true true X X X X true X WWW.ROOSEVELTMEDICAL.ORG X WWW.ROOSEVELTMEDICAL.ORG X WWW.ROOSEVELTMEDICAL.ORG X X X X true X false X X X X true X X false false FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 3E THE SIGNIFICENT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND ARE IDENTIFIED THROUGH THE CHNA. FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 5 A STEERING COMMITTEE WAS CONVENED IN SEPTEMBER 2020 TO ASSIST ROOSEVELT MEDICAL CENTER IN CONDUCTING THE CHNA. IN OCTOBER AND NOVEMBER 2020, TEN KEY INFORMANT INTERVIEWS WERE FACILITATED BY A REPRESENTATIVE WITH THE MONTANA OFFICE OF RURAL HEALTH. THE STEERING COMMITTEE AND KEY INFORMANTS INCLUDED A DIVERSE GROUP OF MEMBERS WHICH REPRESENTED VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY SUCH AS PUBLIC HEALTH, MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY CITIZENS, SENIORS, YOUTH, AND TRIBAL/AMERICAN INDIANS. ALSO, IN OCTOBER 2020, A SURVEY WAS MAILED TO 800 RANDOMLY SELECTED RESIDENTS IN THE HOSPITAL'S SERVICE AREA TO SOLICIT THEIR INPUT. THERE WAS A 20.6 PERCENT RESPONSE. FACILITY 1, ROOSEVELT MEDICAL CENTER - PART V, LINE 11 THE PRIORITIZED HEALTH NEEDS AS DETERMINED THROUGH THE ASSESSMENT PROCESS AND WHICH THE FACILITY WILL BE ADDRESSING RELATES TO THE FOLLOWING HEALTHCARE ISSUES: 1. SENIOR SERVICES 2. HEALTH AND WELLNESS 3. MENTAL AND BEHAVIORAL HEALTH THE FIRST HEALTHCARE ISSUE IS TO ENHANCE SENIOR SERVICES AVAILABLE IN EASTERN ROOSEVELT COUNTY. ONE STRATEGY FOR ADDRESSING THIS ISSUE IS TO EXPAND SERVICES THAT HELP THE LOCAL SENIOR POPULATION TO AGE IN PLACE SUCH AS EXPLORING OFFERING A FOOT CARE CLINIC AND CHECKING IMMUNIZATION STATUS FOR AREA SENIORS, DETERMINING FEASIBILITY OF IMPLEMENTING A COMMUNITY HEALTH WORKER SERVICE OR COMMUNITY PARAMEDICINE MODEL TO ASSIST SENIORS AND COMMUNITY MEMBERS IN THEIR HOMES, CONTINUING PARTNERSHIP WITH MONTANA HEALTH NETWORK TO DISCUSS THEIR NEW GRANT WORKING TO OFFER IN-HOME SERVICES TO SENIORS AT A SIGNIFICANTLY REDUCED COST, AND RMC WILL PROVIDE/SPONSOR LUNCH AND LEARNS IN COLLABORATION WITH AREA SENIOR CENTERS REGARDING VARIOUS HEALTH TOPICS. THE SECOND STRATEGY IS TO IMPROVE AWARENESS AND REACH OF THE CHRONIC CARE MANAGEMENT PROGRAM BY EXPANDING CURRENT EFFORTS BY CONNECTING WITH THE NEW MONTANA HEALTH NETWORK REGIONAL COORDINATOR AND REACHING OUT TO THE LOCAL SENIOR CENTER TO CONDUCT OUTREACH AND EDUCATION RELATED TO THE CHRONIC CARE MANAGEMENT PROGRAM. THE SECOND HEALTHCARE ISSUE IS TO ENHANCE HEALTH, WELLNESS, AND PREVENTION OUTREACH IN EASTERN ROOSEVELT COUNTY. ONE STRATEGY FOR ADDRESSING THIS ISSUE IS TO CONTINUE RMC'S PROMOTION OF HEALTH AND WELLNESS EFFORTS IN CULBERTSON AND THE SURROUNDING AREA BY OFFERING A COMMUNITY HEALTH FAIR, CONTINUING ANNUAL HEALTH SCREENING LABS, AND CONTINUING TO PROMOTE AND SPONSOR COMMUNITY HEALTH AND WELLNESS ACTIVITIES. THE SECOND STRATEGY IS TO GROW RMC'S PRESENCE IN THE COMMUNITY AS A SOURCE FOR HEALTH EDUCATION, OUTREACH, AND RESOURCES BY ENHANCING EDUCATIONAL RESOURCES AND OUTREACH TO THE COMMUNITY REGARDING HEALTH, WELLNESS, AND PREVENTION SUCH AS PROMOTING MONTHLY WELLNESS TOPICS, PROVIDING EDUCATION MATERIALS AT SCHOOL FUNCTIONS AND COMMUNITY EVENTS, AND SPONSORSHIP OF THE K-12 HEALTH BAGS. ANOTHER ACTIVITY FOR THE SECOND STRATEGY MAY INCLUDE PUBLISHING AN ANNUAL HEALTH AND WELLNESS NEWSLETTER. THE THIRD HEALTHCARE ISSUE IS TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IN EASTERN ROOSEVELT COUNTY. THE FIRST STRATEGY FOR ADDRESSING THIS ISSUE IS TO INCREASE COMMUNITY AWARENESS OF NEW AND ENHANCED MENTAL AND BEHAVIORAL HEALTH SERVICES IN THE AREA BY PROVIDING OUTREACH TO THE COMMUNITY ON THE NEW FRONTIER PSYCHIATRY PARTNERSHIP AND AVAILABILITY OF THE NEW TELE-MENTAL HEALTH CAPABILITIES AT RMC AND PROMOTING MENTAL HEALTH AND ADDICTION SPECIALTY SERVICES OFFERED THROUGH THE NEW LICENSED CLINICAL SOCIAL WORKER AT RMC. THE SECOND STRATEGY IS TO EXPLORE NEW TRAINING OPPORTUNITIES AND PARTNERSHIPS TO ENHANCE THE COMMUNITY'S ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES BY PROMOTING MORH/AHEC'S BEHAVIORAL HEALTH TRAININGS TO RMC STAFF AND AREA PROVIDERS TO ENHANCE MENTAL AND BEHAVIORAL HEALTH SKILLS, KNOWLEDGE, AND TRAINING AND EXPLORING OPPORTUNITIES TO PARTNER WITH LOCAL SCHOOLS, EMS, POLICE, ETC. TO DELIVER SUBSTANCE ABUSE PREVENTION EDUCATION AND PROGRAMMING/EVENTS. OTHER ACTIVITIES FOR THE THIRD STRATEGY MAY INCLUDE MEETING WITH AREA MENTAL HEALTH STAKEHOLDERS TO EXPLORE THE DEVELOPMENT OF A LOCAL MENTAL HEALTH ADVISORY COMMITTEE AND CONNECTING WITH THE NEW LOCAL TOBACCO PREVENTION SPECIALIST TO DEVELOP AND ENHANCE PARTNERSHIP AND EDUCATIONAL OPPORTUNITIES/RESOURCES. FIVE HEALTH NEEDS ARE IDENTIFIED THAT ARE UNABLE TO BE ADDRESSED BY RMC. FIRST, RESPONDENTS INDICATED THEY WOULD UTILIZE A FITNESS CENTER IF AVAILABLE LOCALLY. THE SCHOOL HAS TWO GYMS FOR WALKING AS WELL AS A FITNESS ROOM WITH EQUIPMENT FOR EXERCISING. THERE IS ALSO A NEWLY CONSTRUCTED IKE'S FISH POND TO PROVIDE ANOTHER OPTION FOR WALKING. SECOND, RESPONDENTS REPORTED THAT TRANSPORTATION ASSISTANCE WOULD IMPROVE COMMUNITY ACCESS TO HEALTHCARE. RMC DOES NOT HAVE THE CAPACITY TO TAKE ON TRANSPORTATION AT THIS TIME, BUT WILL CONTINUE TO REASSESS/RESEARCH OPPORTUNITIES TO PARTNER WITH OTHER COMMUNITY ORGANIZATIONS TO ADDRESS THIS NEED. THIRD, RESPONDENTS WERE WORRIED ABOUT HAVING ENOUGH FOOD TO EAT DURING THE LAST YEAR. THE LOCAL FOOD BANKS, SCHOOL PROGRAMS, MEALS ON WHEELS, AND SENIOR SERVICES WORK TO ADDRESS FOOD INSECURITY. RMC WILL ASSIST AND PARTNER WHENEVER POSSIBLE. FOURTH, KEY INFORMANT INTERVIEW PARTICIPANTS EXPRESSED A NEED FOR IMPROVED ACCESS TO HEALTHIER FOODS, SPECIFICALLY BETTER PRODUCE. RMC WILL CONTINUE TO PROVIDE EDUCATIONAL MATERIALS AT LOCAL FARMER'S MARKETS AND COLLABORATE WITH COMMUNITY PARTNERS WHEN FEASIBLE. FIFTH, RESPONDENTS FEEL THAT THERE IS NOT ADEQUATE OR AFFORDABLE HOUSING AVAILABLE IN THE COMMUNITY. DURING THE OIL BOOM, WE DID LOOK AT A PARTNERSHIP WITH THE SCHOOL TO BUILD HOUSING FOR INCOMING STAFF BUT IT WAS NOT AFFORDABLE. WE DO ALWAYS WORK TO PROVIDE ASSISTANCE TO NEW COMMUNITY MEMBERS THROUGH WORD- OF-MOUTH ABOUT POTENTIAL PLACES THAT ARE AVAILABLE FOR RENT OR PURCHASE. HOWEVER, WE DO NOT FEEL THIS IS AN AREA OF NEED WE CAN TRULY MAKE ANY INROADS WITH THAT WOULD BE SUCCESSFUL. 1 ROOSEVELT MEDICAL CENTER CLINIC 818 2ND AVE E CULBERTSON MT 59218 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7G PHYSICIAN PROFESSIONAL SERVICES MAKE UP 116,065 OF COLUMN C, 76,178 OF COLUMN D, AND 39,887 OF COLUMN E. THE COST OF IMPLICIT PRICE CONCESSIONS REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 80,783. ROOSEVELT MEDICAL CENTER'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION. SCHEDULE H, PART I, LINE 7 USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. IMPLICIT PRICE CONCESSIONS, BAD DEBT, AND FINANCIAL ASSISTANCE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. SCHEDULE H, PART III, LINE 2 THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING IMPLICIT PRICE CONCESSIONS, BAD DEBT, FINANCIAL ASSISTANCE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO IMPLICIT PRICE CONCESSION CHARGES & BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT, WHICH INCLUDES THE COST OF IMPLICIT PRICE CONCESSIONS. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF IMPLICIT PRICE CONCESSIONS OR BAD DEBT, WHICH REDUCE THE COST OF BAD DEBT. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. IMPLICIT PRICE CONCESSIONS OR BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NONPROFIT HOSPITAL. SCHEDULE H, PART III, LINE 4 THE BAD DEBT AND IMPLICIT PRICE CONCESSIONS FOOTNOTE IS ON PAGE 19 OF THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 THERE IS A MEDICARE SURPLUS SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE FOR MOST SERVICES, AND THE 2% SEQUESTRATION ADJUSTMENT WAS SUSPENDED DURING THE CORONAVIRUS PANDEMIC. SOME SERVICES LIKE AMBULANCE ARE PAID BASED ON FEE SCHEDULES. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT AND THE MEDICARE PROVIDER SUMMARY REPORT. SCHEDULE H, PART III, LINE 9B IF APPROVED FOR FINANCIAL ASSISTANCE UNDER THE PROVISIONS OF THE FINANCIAL ASSISTANCE POLICY (FAP), THE PATIENT WILL RECEIVE NOTIFICATIONS THAT INCLUDE: A. THE DISCOUNT OF GROSS CHARGES TO THE AGB. THEN FINANCIAL ASSISTANCE DISCOUNTS WILL BE APPLIED TO THE AGB IN ACCORDANCE WITH THE DISCOUNT OF AGB CHARGES SCHEDULE DESCRIBED IN THE "DISCOUNT" SECTION OF THE FAP. B. PROVIDING THE PATIENT WITH A BILLING STATEMENT THAT INDICATES THE AMOUNT THE PATIENT OWES, IF THEY ARE NOT ELIGIBLE FOR FREE CARE. C. REFUNDING ANY EXCESS PAYMENTS MADE BY THE INDIVIDUAL BEYOND THE AGB ON ELIGIBLE ACCOUNTS IF NECESSARY. D. TAKING ALL REASONABLY AVAILABLE MEASURES TO REVERSE EXTRAORDINARY COLLECTION ACTIONS THAT OCCURRED. SCHEDULE H, PART VI, LINE 2 WE SEND OUT PATIENT SATISFACTION SURVEYS TO OUR PATIENTS. SCHEDULE H, PART VI, LINE 3 RMC WILL MAKE ALL REASONABLE EFFORTS TO NOTIFY A PATIENT REGARDING THE AVAILABILITY OF FINANCIAL ASSISTANCE UNDER THIS POLICY BY: 1. ATTEMPTING TO DETERMINE WHETHER A PATIENT HAS THIRD-PARTY COVERAGE FOR ANY PART OF THE EMERGENCY OR MEDICALLY NECESSARY HEALTH CARE SERVICE PROVIDED. IF A PATIENT DOES NOT HAVE OR QUALIFY FOR THIRD-PARTY FUNDING, THE BUSINESS OFFICE STAFF WILL EXPLAIN THE FINANCIAL ASSISTANCE POLICY, PROVIDE AN APPLICATION FOR FINANCIAL ASSISTANCE AND PROVIDE ASSISTANCE WITH COMPLETING THE APPLICATION, IF DESIRED. 2. OFFERING THE PATIENT A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE AVAILABLE UNDER THIS POLICY AT THE TIME OF ADMISSION OR BEFORE DISCHARGE FROM RMC. 3. PROVIDING THE INFORMATION DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE ON AT LEAST THREE (3) BILLING STATEMENTS AND IN ALL OTHER WRITTEN COMMUNICATIONS IN REFERENCE TO FINANCIAL RECORDS TO THE PATIENT; 4. INFORMING PATIENTS DURING THE NOTIFICATION PERIOD ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE DURING ORAL COMMUNICATIONS REGARDING THE AMOUNT DUE FOR THE CARE THAT OCCURRED; 5. PROVIDING THE PATIENT WITH AT LEAST ONE WRITTEN NOTICE INFORMING THE PATIENT ABOUT THE EXTRAORDINARY COLLECTION ACTIONS THAT RMC MAY TAKE IF THE PATIENT DOES NOT SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE OR PAY THE AMOUNT DUE BY AT LEAST THIRTY DAYS FOLLOWING THE DATE OF THE NOTICE. THE NOTICE WILL NOT BE MAILED OR DELIVERED TO A PATIENT EARLIER THAN 30 DAYS PRIOR TO THE END OF THE NOTIFICATION PERIOD; AND 6. RMC WILL NOT ENGAGE IN ANY EXTRAORDINARY COLLECTION ACTIONS AGAINST A PATIENT UNTIL SUCH TIME AS IT DETERMINES THE PATIENT'S ELIGIBILITY FOR FINANCIAL ASSISTANCE UNDER THIS POLICY DURING THE 120 DAY NOTIFICATION PERIOD AND HAS PROVIDED THE PATIENT WITH THE NOTICE AS DESCRIBED ABOVE. SCHEDULE H, PART VI, LINE 4 WE PROVIDE SERVICE TO THE POPULATION IN EASTERN ROOSEVELT COUNTY, SOUTHERN SHERIDAN COUNTY, AND NORTHERN RICHLAND COUNTY. SCHEDULE H, PART VI, LINE 5 THE ADMINISTRATOR AND MARKETING DIRECTOR OF ROOSEVELT MEDICAL CENTER PARTICIPATE IN THE LOCAL CHAMBER OF COMMERCE. THE MARKETING DIRECTOR WRITES ARTICLES FOR THE LOCAL NEWSPAPER TO PROMOTE THE FACILITY AND DOES PUBLIC SERVICE ANNOUNCEMENTS THROUGH PRINTED MEDIA AND SOCIAL MEDIA (FACEBOOK). X X X false false false false false false false false false DON HELLAND MD 169133 300 5318 174751 ZOE FUGERE FNP-C 151687 300 6765 158752 ELIZABETH KLEPPEN PA-C 153317 300 2 153619 FORM 990, PAGE 6, PART VI, LINE 2 PAULA SCHLEDEWITZ GRANT SALVEVOLD CHAIRMAN DIRECTOR FAMILY RELATIONSHIP FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS REVIEWED BY THE ADMINISTRATOR, CFO, AND BOARD OF DIRECTORS BEFORE IT IS FILED. FORM 990, PAGE 6, PART VI, LINE 12C COMPLIANCE IS REVIEWED ANNUALLY. FORM 990, PAGE 6, PART VI, LINE 15A THE ADMINISTRATOR'S COMPENSATION IS APPROVED BY THE BOARD OF DIRECTORS WHICH IS USUALLY BASED ON THE AMOUNT/PERCENTAGE OF RAISE THE REST OF THE EMPLOYEES ARE GOING TO RECEIVE. FORM 990, PAGE 6, PART VI, LINE 15B THE CFO COMPILES INFORMATION FROM THE ANNUAL MHA SALARY SURVEY REGARDING AVERAGE WAGE BEING PAID FOR EACH JOB DESCRIPTION BASED ON PEER GROUP, CRITICAL ACCESS HOSPITALS, OR MHA REGION. THE CFO AND ADMINISTRATOR COMPARE AVERAGES BEING PAID TO THE CURRENT ROOSEVELT MEDICAL CENTER SALARY SCALE TO SEE IF ADJUSTMENTS NEED TO BE MADE TO KEEP EACH JOB COMPETITIVE WITHIN THE INDUSTRY. RECOMMENDATIONS FOR SALARY INCREASES ARE MADE TO THE BOARD OF DIRECTORS FOR APPROVAL OR DISAPPROVAL WHICH IS RECORDED IN THE BOARD MINUTES. FORM 990, PAGE 6, PART VI, LINE 19 DOCUMENTS RELATING TO ROOSEVELT MEDICAL CENTER ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G ADMIN PROF FEES 0 60,010 0 ADMIN PURCHASED SERVICES 0 12,702 0 DIETARY PURCHASED SERVICES 358,810 64,715 0 LAB PROF FEES 29,172 0 0 LAB PURCHASED SERVICES 41,537 0 0 MAINT PURCHASED SERVICES 443 95 2 MEDICAL & SURGICAL PROF FEES 622,427 0 0 MEDICAL & SURGICAL PURCH SVCS 3,572 0 0 MEDICAL RECORDS PURCH SRVCS 0 11,080 0 OT PURCHASED SERVICES 24,995 0 0 PT PURCHASED SERVICES 58,133 0 0 AMBULANCE PURCHASED SERVICES 1,300 0 0 RADIOLOLGY PURCHASED SERVICES 14,708 0 0 SWING BED PROF FEES 636,029 0 0 PHARMACY PURCHASED SVCS 65,192 0 0 BLOOD BANK-PURCHASED SVCS 282 0 0 CLINIC PURCHASED SERVICES 17,650 0 0 TOTAL 1,874,250 148,602 2 ROOSEVELT MEMORIAL HEALTHCARE FOUND PO BOX 419 CULBERTSON MT 59218 810529284 SUPPORT OR MT 501C3 7 N/A false NE MT STAT AIR AMB COOP 519 PLEASANT STREET MILES CITY MT 59301 204748673 AIR AMBUL MT 501C3 12B NA N/A false false false true false false false false false false false false false false true true false false false false ROOSEVELT MEMORIAL HEALTHCARE FOUND C 34538 SUPPORT ROOSEVELT MEMORIAL HEALTHCARE FOUND O 33370 PAYROLL ROOSEVELT MEMORIAL HEALTHCARE FOUND N 2364 OCCUPANCY