2022-04-07T16:02:38-05:00 2021-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2020-07-01 810378200 Livingston Healthcare LIVI 4062223541 320 Alpenglow Lane Livingston MT 59047 Deb Anczak CEO 4062223541 2022-03-24 1 Deb Anczak 999009999 Kim Hunwardsen CPA P00484560 6122536500 2022-03-17 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Deb Anczak 320 Alpenglow Lane Livingston MT 59047 68192939 0 X www.livingstonhealthcare.org X 1955 MT A 25-bed critical access hospital, a multispecialty physician practice, rehabilitation services, and home-based services. 12 9 517 19 0 0 509854 8662467 57582056 59050795 391768 386009 -597492 90540 57886186 68189811 13930 20624 0 0 29508339 32283058 0 0 174466 26980639 25358299 56502908 57661981 1383278 10527830 99491073 92375466 64162588 46859975 35328485 45515491 X Excellence in patient-centered care. 0 0 47382432 20624 59050795 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.LHC provided funding for Windrider Transit in the amount of $10,000 in FY 2021. Windrider provides a free, efficient fixed-route transportation system to citizens and disabled persons in Park County, Montana. Its operations have increased from Monday through Friday, to adding half-day Saturdays, and expanding the service by providing free rides for medical appointmentswithin Livingston city limits and to and from Bozeman, MT. All vehicles are ADA accessible and equipped with lifts. The Windrider bus makes eight stops each day at Livingston HealthCare, and includes multiple daily stops at 27 other locations in Livingston, including to the public library and a local grocery store. In FY 2021, the Windrider bus picked up 4,298 passengers and was driven 249 days, with an average of 17.26 passengers each day. LHC also provides in-kind contributions in the form graphic design for promotional materials. LHC's internal Marketing and Communication team spent 32 hours in FY21 working with Windrider to develop promotional materials, such as brochures, mailer pieces and newsletter content.The LiveWell49 Coalition is dedicated to embracing a culture of health in Park County through creative community solutions and effective outreach. LiveWell49 acts as the backbone organization for entities and individuals working to improve the health of Park County citizens and acts as the hub for all resources and information involved in its mission. LiveWell49 brings stakeholders in the community together to network, collaborate and share information to create efficiencies and build relationships within organizations. The focus of the LiveWell49Resilience Project is mental health promotion and suicide prevention in Park County. Livingston HealthCare has committed to providing in-kind contributions to increase the capacity of LiveWell49 Coalition and the LW49 Resilience Project by financially contributing to the support of the LiveWell49 Facilitator (LHC Community Health Coordinator) and the LiveWell49 Program Assistant (LHC Community Health Assistant). 47382432 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 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 58 0 1 517 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 9 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X Kris Kester 4062223541 320 Alpenglow Lane Livinston MT 59047 Denis Prager President 15.00 1.00 X X 0 0 0 Shiell Anderson Vice President 2.00 0.00 X X 0 0 0 Dan Kaul Treasurer 2.00 0.00 X X 0 0 0 Kristen Galbraith Secretary 2.00 0.00 X X 0 0 0 D Scott Coleman MD Director, Family Medicine 40.00 1.00 X 301761 0 27200 David Stanley Director 2.00 0.00 X 0 0 0 Douglas P Wadle MD Director, Internal Medicin 40.00 0.00 X 302258 0 27125 Joseph Swindlehurst Director (Jul-Apr) 2.00 0.00 X 0 0 0 Mary Ann Bearden Director 2.00 4.00 X 0 0 0 Michael Schaer Director 2.00 0.00 X 0 0 0 Jeffry Lindenbaum MD Director 2.00 0.00 X 0 0 0 Michelle Becker Director 2.00 0.00 X 0 0 0 Laurie Smith Director 2.00 0.00 X 0 0 0 Deb Anczak CEO 40.00 1.00 X 0 0 0 Kris Kester CFO 40.00 1.00 X 147398 0 11867 Krista Arnet MD ER Physician 40.00 0.00 X 380787 0 36153 Kyle Arnet MD ER Physician 40.00 0.00 X 374477 0 36153 Henry Pinango Internal Medicine Provider 40.00 0.00 X 348956 0 33861 Raymond Wright MD ER Physician 40.00 0.00 X 344735 0 32681 Joseph Reyna CRNA 40.00 0.00 X 266455 0 30499 2466827 0 235539 42 0 1 0 Billings Clinic PO Box 30977 Billings MT 591070977 IS & Administration Fees 1437439 Billings Clinic Laboratory PO Box 30977 Billings MT 591070977 Telerad Services 687046 DPHHS PO Box 4369 Helena MT 596044369 Lab Services 383604 Medical Solutions PO Box 310737 Des Moines IA 503310737 Contract Staffing 270169 PPR LLC PO Box 310852 Des Moines IA 503310852 Contract Staffing 233515 10 400547 8214553 47367 8662467 Net Patient Service Revenue 621110 57286075 57286075 340B Pharmacy Revenue 446110 1009221 1009221 Supporting Revenue 621110 755499 755499 59050795 389137 389137 90540 0 90540 90540 90540 3128 -3128 -3128 -3128 68189811 59050795 0 476549 X 20624 20624 859821 536557 323264 87457 59984 27473 25229705 20731935 4422157 75613 1018361 838997 178702 662 3271620 2675603 585584 10433 1816094 1466897 341917 7280 325575 325575 194922 36071 146661 12190 75129 69577 5552 7077289 5768899 1300669 7721 147537 17888 123274 6375 1806275 1221724 575818 8733 1079844 160792 919052 608130 457279 150851 118771 105436 13335 163423 95847 63422 4154 1388743 1388743 3318224 3318224 760074 449665 310409 Medical Supplies 6970186 6895585 74562 39 Repairs and Maintenance 671550 656146 15404 Food 329091 321839 7252 323536 157697 157598 8241 57661981 47382432 10105083 174466 8502458 3892178 9860367 7560883 9084894 10416140 1576215 1628414 203721 324617 59925373 20039911 42082366 39885462 27912045 28396656 269007 271116 99491073 92375466 3992460 4921681 16156070 2425767 36956774 35594525 4984920 2072364 3918002 64162588 46859975 X 35328485 45515491 35328485 45515491 99491073 92375466 10527830 -340824 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3021307 1357828 771479 5150614 2480033 570837 154145 183708 3021307 1503731 1545780 264106 833584 2480033 1432806 101575 30650 1503731 436740 907288 88778 1432806 0.57457 0.42543 0.00000 0 1 1 5951320 5951320 35760151 8646729 27113422 16659177 10522271 6136906 1554725 870911 683814 39885462 Professional Liability Claims 121500 Deferred Compensation Liability 2090383 Estimated Third-Party Payor Settlements 1706119 3918002 X 69572087 -340824 2123647 1782823 67789264 400547 400547 68189811 57666050 4069 4069 57661981 0 57661981 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 2,123,647. Part XI, Line 4b - Other Adjustments: Foundation Contribution to Hospital that is Eliminated on Audited Financials 400,547. Part XII, Line 2d - Other Adjustments: Foundation Expenses Reported on a Separate Form 990 4,069. 1 1 X 0 1 X 1 1 0 0 380000 380000 0.00660 380000 380000 0.00660 90093 90093 0.00160 1127216 313058 814158 0.01410 54080 54080 0.00090 1271389 313058 958331 0.01660 1651389 313058 1338331 0.02320 1 3143614 171327 20337728 20107639 230089 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 19 1 1 1 1 X See Part V, Supplement Information X 1 19 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, Supplement Information X See Part V, Supplement Information X See Part V, Supplement Information X X X X X X 1 X 0 X X X X 1 X 0 1 Livingston Healthcare Part V, Section B, Line 5: To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey also was implemented as part of this process. A list of recommended participants was provided by Park County Health Department and Livingston HealthCare; this list included names and contact information for physicians, public health representatives, other health professionals, social service providers, and a variety of other community leaders. Potential participants were chosen because of their ability to identify primary concerns of the populations with whom they work, as well as of the community overall. Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 53 community stakeholders took part in the Online Key Informant Survey. Through this process, input was gathered from several individuals whose organizations work with low-income, minority, or other medically underserved populations. Livingston Healthcare Part V, Section B, Line 6a: Bozeman Health Livingston Healthcare Part V, Section B, Line 6b: Park County Health Department Livingston Healthcare Part V, Section B, Line 11: In the most recent CHNA, the following needs were identified and prioritized: (1) Behavioral Health, (2) Nutrition, Physical Activity & Weight, (3) Oral Health, (4) Dementia/Alzheimer's Disease, (5) Injury and Violence, (6) Heart Disease and Stroke, (7) Respiratory Diseases, (8) Cancer, (9) Access to Health Services, and (10) Infant Health and Family Planning. These are considered needs in both the town of Livingston and surrounding areas of Park county. Livingston HealthCare took these needs and developed an implementation plan which focuses on behavioral health, community wellness, and access to care.Due to limited staff time and resources, the following items will not be addressed by the facility but will be addressed at a future time as they relate to community wellness: Oral Health, Dementia/Alzheimer's Disease, Cancer, Infant Health and Family Planning, Heart Disease and Stroke, as well as Injury and Violence.In the current fiscal year, Livingston HealthCare has taken a number steps to address some of the needs identified in the CHNA. Regarding behavioral health, in conjunction with the Livingston School District, Livingston HealthCare implemented a school-based outpatient treatment for behavioral health, broadening access to pediatric and adolescent behavior health, now in its second year. To that end, Livingston HealthCare continues to provide a clinical psychologist to provide these services. In regard to Nutrition, Physical Activity and Weight, Livingston HealthCare continues to provide its popular "Healthy Steps" program providing guided exercise activities in the outpatient gym. Livingston HealthCare has also hired and employs a registered dietitian to provide diabetes education and an internal medicine provider who specializes in weight management. Livingston HealthCare also hosted a community flu and COVID vaccine clinic to further increase community wellness. Regarding access to care, Livingston HealthCare has taken several actions. Livingston HealthCare has also worked to expand services and evaluated and improved access to providers by hiring additional family practice and internal medicine providers, as well as expanding outreach services which include ENT, cardiology, orthopedics and urology. Livingston HealthCare continues to evaluate and recruit for additional service lines that will provide needed access to care in the community. Livingston Healthcare Part V, Section B, Line 13h: Presumptive eligibility is used. If a patient is a Medicaid patient, the Hospital writes off to charity care any portion of charges that is denied by Medicaid. Livingston Healthcare Part V, Section B, Line 24: The Hospital does not provide elective services under the financial assistance policy. Schedule H, Part V, Section B, Line 16a-c: The FAP, FAP application, and plain language summary of the FAP can be found at:https://www.livingstonhealthcare.org/Patients-Visitors/Patient-Financial-Services.aspx Schedule H, Part V, Section B, Line 7a and 10a: CHNA and Implementation Strategy:https://www.livingstonhealthcare.org/About-Us/Community-Health-Needs-Assessment.aspx 4 1 - LHC Clinic 320 Aplenglow Ln Livingston MT 59047 Rural Health Clinic 2 - Livingston Healthcare Home CareHospice 320 Aplenglow Ln Livingston MT 59047 Home Care 3 - Livingston Urgent Care 104 Centennial Dr 103 Livingston MT 59047 Clinic 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 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 10.9% 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 5.45% 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 page 13 of the attached audited financial statements. Part III, Line 8: LHC provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services.Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall, if any, is considered a community benefit. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare cost report for the year.Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare Services. Part III, Line 9b: Once a patient is approved for financial assistance, it is expected the patient continue to meet his/her financial commitments to Livingston Healthcare. If a patient is approved for a percentage allowance due to financial hardship and the patient does not make the required initial payment within 60 days toward their part of the bill, the financial assistance allowance will be reversed and the patient will owe the entire amount. The organization recommends that the patient make a good faith payment at the beginning of the financial assistance period.LHC sends notification to the patients 30 days prior to sending to collections. LHC does not send patient accounts to collections until 180 days from the date of the invoice. If the patient applies for financial assistance within 240 days of the date of the invoice, LHC will cease extraordinary collection actions and process the application. Part VI, Line 2: The hospital Leadership meets often with city, county, and school leadership to discuss and plan shared needs within Livingston/Park County boundaries. Most recently these shared need discussions have been around building a new community pool/community center, expansion of medical services within the school (Park Clinic) system, and joint efforts toward bringing additional mental health services to students in the Park County school district. Part VI, Line 3: Financial assistance will be provided to Livingston Healthcare patients who meet specified financial criteria and request such assistance. A notice of availability of financial assistance program will be posted at patient registration sites within each facility and presented to patients upon request. Schedule H, Part V, Section B, line 16a-16i list other ways the organization informs and educates patients and person who may be eligible for financial assistance. Part VI, Line 4: Livingston is a city in and the county seat of Park County, Montana, United States. The population was approximately 7,784 people in 2018. Livingston is located in southwestern Montana, on the Yellowstone River, north of Yellowstone National Park. The median income for a household in Livingston in 2018 was about $42,635. Part VI, Line 5: Livingston HealthCare's governing body is comprised of persons who reside in the organization's primary service area who 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.In FY 2021 the hospital continued programs and events that focus on community health and wellness, including family-centered prenatal education classes, Strong People, Strong Bones classes, Dine with a Dietician Lunch and Learns, the Livingston Trails Rx 5K Race, Community Health Day at the local farmers market and Fall Health Festival at the hospital. 0 0 0 0 0 0 0 0 0 Krista Arnet MD ER Physician 380787 0 0 0 0 0 27200 0 11877 0 419864 0 0 0 Kyle Arnet MD ER Physician 374477 0 0 0 0 0 27200 0 11877 0 413554 0 0 0 Henry Pinango Internal Medicine Provider 348956 0 0 0 0 0 25011 0 11452 0 385419 0 0 0 Raymond Wright MD ER Physician 328735 0 16000 0 0 0 11200 0 24405 0 380340 0 0 0 Douglas P Wadle MD Director, Internal Medicin 302258 0 0 0 0 0 11200 0 18480 0 331938 0 0 0 D Scott Coleman MD Director, Family Medicine 301761 0 0 0 0 0 27200 0 2811 0 331772 0 0 0 Joseph Reyna CRNA 266455 0 0 0 0 0 7179 0 25310 0 298944 0 0 0 Kris Kester CFO 147398 0 0 0 0 0 3111 0 20256 0 170765 0 0 0 Part I, Line 3 The CEO is paid by an unrelated management company, Billings Clinic. LHC paid Billings Clinic $325,575 for CEO services. Billings Clinic uses methods in Part I, line 3 to establish reasonable compensation. The LHC Board of Directors reviews and approves the contract annually. Babs Brandfass Spouse of Board Member 27473 Employee Compensation 0 Paula Coleman Spouse of Board Member 59984 Employee Compensation 0 Form 990, Part VI, Section A, line 1 The Board shall have as a standing committee an Executive Committee. The Executive Committee shall consist of at least four members of the Board, which shall include the Chairperson, Vice Chairperson, Secretary, and Treasurer. If none of the officers named in the previous sentence is a Class B Director, a Class B Director shall be the fifth member of the Executive Committee. 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. The Executive Committee did not meet in the fiscal year. Form 990, Part VI, Section A, line 3 The CEO was paid by an unrelated management company, Billings Clinic. LHC paid Billings Clinic $325,575 for CEO services. Form 990, Part VI, Section A, line 7a Through an affiliations agreement Billings Clinic has the authority to approve three of the 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. The CFO compensation is reviewed and approved by the CEO. 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 IX, line 11g Contracted Services: Program service expenses 4,778,231. Management and general expenses 1,214,620. Fundraising expenses 7,701. Total expenses 6,000,552. Licenses, Fees, and Taxes: Program service expenses 803,827. Management and general expenses 0. Fundraising expenses 20. Total expenses 803,847. Other Fees: Program service expenses 186,841. Management and general expenses 86,049. Fundraising expenses 0. Total expenses 272,890. Livingston Healthcare Foundation 320 Alpenglow Ln Livingston MT 59047 810621997 To Support Livingston Healthcare Programs MT 501(c)(3) Line 7 N/A 0 The Ough Charitable Trust (dissolved 22421) 320 Alpenglow Ln Livingston MT 59047 816080844 To support Livingston Healthcare Programs MT 501(c)(3) Line 12c, III-FI Livingston Healthcare Foundation 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0