2021-05-12T13:24:12-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 264230898 Barrett Hospital Development Corporation BARR 4066833000 600 Highway 91 South Dillon MT 59725 Tina Giem CFO 4066833000 2021-05-07 1 Kim Hunwardsen CPA P00484560 6122536500 2021-05-07 2019 2022-09-23 18:48:47Z Barrett Hospital & Healthcare Tina Giem 600 Highway 91 South Dillon MT 59725 36751474 0 X www.barretthospital.org X 2009 MT Barrett Hospital & HealthCare provides compassionate care, healing, and health-improving service to all community members throughout life's journey. 5 4 317 64 0 0 476569 668323 34944307 35653358 338616 190333 61624 65042 35821116 36577056 15000 0 0 0 20256548 19846233 0 0 0 15215150 16518267 35486698 36364500 334418 212556 57530416 69015190 30446963 41610867 27083453 27404323 X Barrett Hospital & HealthCare provides compassionate care, healing, and health-improving service to all community members throughout life's journey. 0 0 33096088 35653358 Barrett Hospital & HealthCare is an 18 licensed bed acute care critical access hospital. Our patients are served by an inpatient hospital, 24-hour emergency department, and a provider based clinic. Our ancillary services include diagnostic imaging, laboratory, inpatient and outpatient surgery, physical and occupational therapy, home health, hospice, cardiac rehab, pharmacy, cardiopulmonary, respiratory and diabetic education.The hospital provided 1,576 days of acute care services, 304 observation days and 743 swing bed days. In addition, the hospital provided 27,777 clinic visits, 28,353 outpatient visits, 4,064 emergency room visits, 2,907 home health visits and 1,598 hospice visits. 33096088 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 59 0 1 317 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 1 1 0 1 0 0 1 0 0 0 1 1 1 1 1 0 0 1 0 X Tina Giem 4066833006 600 Highway 91 South Dillon MT 59725 Gregory Moore ED Physician 31.20 0.00 X 373423 0 39315 Sandra McIntyre Clinic Physician 40.00 0.00 X 299454 0 42122 Michael Clarke ED Physician 31.20 0.00 X 300042 0 33387 Kelly Smith Clinic Physician 40.00 2.00 X 282774 0 35057 Meghan Combs Clinic Physician 40.00 0.00 X 287204 0 21003 Richard Achter CFO 40.00 0.00 X 152976 0 11936 Carol Kennedy CCO 40.00 0.00 X 135634 0 19413 Patti Mitchell Chair 0.50 0.00 X X 6945 0 0 Nate Finch Vice Chair 0.50 2.00 X X 0 0 0 Joe Morstein Director 0.50 0.00 X 0 0 0 Shane Puyear Director 0.50 0.00 X 0 0 0 Lawrence Morrisroe Director 0.50 0.00 X 0 0 0 Ken Westman CEO 40.00 2.00 X 0 0 0 1838452 0 202233 28 0 1 0 Daniel Richards 13929 Buck Hollow Dove Bluffdale UT 84065 Physician 240700 CompHealth PO Box 972651 Dallas TX 75397 Physician 217462 Shafi Shafaieh 133 N Colorado St Dillon MT 59725 Physician 186245 Gallatin Gynecology PC 767 Triple Tree Road Bozeman MT 59715 Physician 165825 Eide Bailly LLP PO Box 7112 Billings MT 59103 Accounting Services 122135 5 327598 322441 18284 668323 Net Patient Service Revenue 621110 34858066 34858066 Mortgage Subsidy 900099 412399 412399 Property Taxes 900099 73662 73662 309231 309231 35653358 316400 316400 105393 40351 65042 65042 65042 8000 87917 46150 -87917 -38150 -126067 -126067 36577056 35653358 0 255375 X 319981 6288 313693 15661634 15095960 565674 663564 626181 37383 2126436 2009162 117274 1074618 1016809 57809 530270 530270 36653 36653 76776 76776 2094 2094 3647324 2765721 881603 89349 86601 2748 678277 528222 150055 44528 25603 18925 805750 805700 50 39120 30528 8592 139960 129401 10559 1331739 1331221 518 1878890 1878890 827165 696998 130167 Medical Supplies 3773422 3773422 Repairs and Maintenance 818449 801502 16947 Provision for Bad Debts 728648 728648 MT Medicaid 364697 246887 117810 705156 512344 192812 36364500 33096088 3268412 0 950 925 5368632 17835920 4774759 4685509 699758 779749 379730 362173 52511340 20716889 33029259 31794451 13163499 13467160 46036 22762 67793 66541 57530416 69015190 3125759 3452986 9415671 26473482 25536749 2772700 847722 432761 30446963 41610867 X 27083453 27404323 27083453 27404323 57530416 69015190 212556 108314 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2094 0 0 0 2094 0 Part II-B, Line 1: The Organization is a member of several organizations that take part in lobbying. A portion of the dues paid to the various organizations is for lobbying costs. These various organizations advocate on behalf of their members by supporting legislation that is in their collective interests. 1844813 1844813 35793881 9233631 26560250 13766785 10819903 2946882 1105861 663355 442506 31794451 Estimated Third Party Payor Settlements 432761 432761 34381992 108314 -2060387 -1952073 36334065 242991 242991 36577056 34304113 0 34304113 2060387 2060387 36364500 Part XI, Line 2d - Other Adjustments: Interest expense reported in revenue on financial statements -1,331,739. Provision for bad debt reported in revenue on financial statements -728,648. Part XI, Line 4b - Other Adjustments: Contributions reported in fund balance on financial statements 242,991. Part XII, Line 4b - Other Adjustments: Interest expense reported in revenue on financial statements 1,331,739. Provision for bad debt reported in revenue on financial statements 728,648. 1 1 X 1 X 0 1 1 0 1 1 390000 390000 0.01090 390000 390000 0.01090 25393 10400 14993 0.00040 342165 13000 329165 0.00920 10840113 7106028 3734085 0.10480 11207671 7129428 4078243 0.11440 11597671 7129428 4468243 0.12530 42160 42160 0.00120 21490 21490 0.00060 49295 33372 15923 0.00040 112945 33372 79573 0.00220 1 728648 0 8964354 8980824 -16470 X 1 1 1 1 Barrett Hospital Development Corp 600 MT Hwy 91 S Dillon MT 59725 www.barretthospital.org 13549 X X X X Barrett Hospital Development Corporation 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X www.barretthospital.org X 1 19 1 www.barretthospital.org 0 1 X 200.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Barrett Hospital Development Corporation Part V, Section B, Line 5: Barrett Hospital & HealthCare and the Beaverhead County Health Department participated in the Community Health Services Development (CHSD) program, administered by the Montana Office of Rural Health, which was utilized to create the CHNA. A steering committee was convened to assist Barrett Hospital & HealthCare and Beaverhead County Health Department in conducting a CHSD. A diverse group of community members representing various organizations and populations within the community (ex. Public health, elderly, uninsured) came together in January 2020. The Steering Committee met twice during the CHSD process; first to discuss health concerns in the community and offer their perspective in designing the survey instrument, and again to review results of the survey and key informant interviews and to assist in prioritization of health needs. In February 2020, surveys were mailed out to residents in Beaverhead and Madison Counties, Barrett Hospital & HealthCare's service area. Survey respondents had the ability to complete the survey mailed to them, or via an online survey hosted at Montana State University's Human Ecology Learning and Problem Solving (HELPS) 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-Overall health of the communityBarrett Hospital & HealthCare provided a list of outpatient and inpatient admissions. Those zip codes with the greatest number of admissions were selected to be included in the survey. A random list of 800 residents was then selected with the assistance of the MSU HELPS Lab.Additionally, 15 key informant interviews were conducted in March and April of 2020. Participants were identified as people living in Barrett Hospital & HealthCare's and the Beaverhead County Health Department's service area. Barrett Hospital Development Corporation Part V, Section B, Line 6b: Beaverhead County Public Health Barrett Hospital Development Corporation Part V, Section B, Line 11: In the current year, the facility finalized goals outlined in the 2017 CHNA. The 2020 CHNA was performed in collaboration with Beaverhead County Health to determine the current needs of the community. The 2020-2023 implementation plan, addressing the community health needs, was adopted and work has begun to achieve first steps towards those needs.Barrett Hospital & HealthCare's Community Steering Committee identified the most important health needs to be addressed by reviewing the CHNA, secondary data, community demographics, and input from representatives representing the broad interest of the community. Services needed within the community were identified as follows:1. Additional mental health resources2. Paid staffing for EMS3. Economic growth4. Support services for low-income individuals and families5. Affordability6. General/basic retail The prioritized health needs as determined through the assessment process and which the facility will be addressing relates to the following healthcare issues:1. Mental and Behavioral Health2. Access to Healthcare ServicesThe strategy to implement the aforementioned needs is outlined as follows:1. Expansion of telehealth services by investigating EMR-integrated home monitoring as an addition to telehealth provider visits; explore feasibility of developing and implementing tele-family planning services at Beaverhead County Health Department; market telehealth services and educate the community on availability and access options and determine feasibility of expanding child tele-behavioral health services in partnership with Shodair Children's Hospital.2. Expansion of pain management Services by implementing a pain management program at Barrett Hospital & HealthCare; market pain management services and educate the community on the availability and access options.3. Expansion of resources and support programs that address population health needs and champion prevention by continuing active participation in ACO MSSP to promote wellness care and better manage chronic illness; develop a patient recruitment/referral process for community partners and clinic to improve community wide participation in the Health Improvement Program; continue participation in other (e.g. BCBS) population health management programs and explore additional options for clinically integrated networks with a focus on wellness promotion and chronic care management; and explore options for the Beaverhead County Public Health to assist in promoting wellness activities and chronic care management. 4. Reduction of barriers to accessing care through strategic partnerships with community organizations by enhancing collaboration between Barrett Hospital & HealthCare, the Beaverhead County Public Health and other social service organizations to better address area socioeconomic needs; collaborate with community partners to identify and catalogue social services within Beaverhead County; work with partners to streamline referral processes to area social services. Explore utilization of the Connect Program offered through DPHHS; and develop and disseminate community and service provider education on new/updated community resources and referral processes.The steering and implementation planning committees completed the following to prioritize the community health needs: - Reviewed the organizations' presence in the community (i.e. activities already being done to address community need)- Considered entities outside of the hospital and public health which may serve as collaborators in executing the facility's implementation plan- Assessed the health indicators of the community through available secondary data- Evaluated the feedback received from consultations with those representing the community's interests.The following needs were identified, however are unable to be addressed at this time:1. Lower cost of health insurance and payment assistance programs.Lowering the cost of health insurance is an issue that is beyond the control of both the hospital and the public health department. According to iVantage Health Analytics, Barrett Hospital and HealthCare is one of the lowest cost CAHs in the nation and our internal pricing methodology places us at the median or lower for our Montana competition. Barrett Hospital and HealthCare has implemented and advertised a payment assistance program to the best of our ability and this is outside of the purview of public health.2. Dermatology and ENT ServicesBarrett Hospital and HealthCare previously engaged with an ENT, but ultimately the partnership was not successful. Dermatologists are in short supply and have not had interest in doing outreach. Part V, Line 16a-16c: Part V, Line 16a, FAP Website:https://www.barretthospital.org/patient-financial-informationPart V, Line 16b, FAP Application Website:https://www.barretthospital.org/patient-financial-informationPart V, Line 16c, FAP Plain Language Summary Website:https://www.barretthospital.org/patient-financial-information Part I, Line 3c: The Organization does not provide discounted care. If a patient qualifies for financial assistance, their full bill is written off. Part I, Line 6a: The organization mailed the community benefit report to their Beaverhead County residents as well as portions of Madison and Jefferson county. The community benefit report is also available on the facility website and in public waiting areas throughout the facility. 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 and Health Professions Education on line 7f were determined using actual costs. Subsidized health services on line 7g was determined using the costing methods to prepare the cost reports. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator is $728,648. Part II, Community Building Activities: Barrett Hospital & Healthcare is an active community emergency preparedness advocate and partners with the county Public Health Director and community organizations (e.g. YMCA) on community wellness initiatives. Barrett Hospital & HealthCare maintains over a mile of walking trails on the campus grounds for community member use. Barrett Hospital & HealthCare partners with local volunteer EMS services and law enforcement to provide education and training. Part III, Line 2: Bad debt expense is reported at charges as recorded by the organization. All discounts and payments on a patient's account are accounted for prior to determining bad debt expense. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 18 and 19 of the attached audited financial statements. Part III, Line 8: The facility is designated as a Critical Access Hospital and is reimbursed by Medicare at 101% of Medicare's costs. There was a shortfall for 2019 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Medicare allowable costs were obtained from the 2019 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: Once a patient applies for financial assistance, their accounts are held at Barrett Hospital & HealthCare or at our extended business office until a determination has been made on their eligibility for financial assistance. Accounts are not sent to collections during the period the patient is eligible for assistance. If an application does not contain all necessary documentation, the patient is notified of all missing elements and an extended deadline is set for the patient to provide additional documentation. All applicants for financial assistance are notified in writing upon approval or denial of financial assistance. Part VI, Line 2: Barrett Hospital & HealthCare uses various tools throughout the year to assess additional community health needs including utilization of a Patient/Family Advisory Council, reviewing patient surveys regarding services provided at Barrett Hospital, and participating in community-wide health initiatives. Part VI, Line 3: Barrett Hospital & HealthCare is committed to implementing and applying their billing and collection policy in a consistent manner while making every effort to assist patients with limited means to receive the support necessary for their financial obligations whether the patient is insured or uninsured.Financial Assistance Policy (FAP) information can be found on our website. The FAP is distributed in multiple patient areas of our clinic (exam rooms/front desk) and hospital (public areas/registration desks). Our Financial Assistance Policy is advertised monthly in a local publication and copies have been mailed out to area businesses and churches in our service area to be posted in their buildings. There is written notification regarding our FAP on every bill that is sent to the patient/guarantor. When calling patients to educate them on their benefits, we advise patients that if they have concerns about the estimated patient costs that they can discuss them with our financial counselors. All patients calling in to discuss their bills or setup payment plans are routed through the financial counselors for process consistency and to provide the best resources available to the patient. A financial assistance notification also prints on after visit summaries and discharge instructions that are provided to patients after all visits. Part VI, Line 4: Barrett Hospital & HealthCare serves the majority of Beaverhead County and Western Madison County residents. The primary service area includes 9 zip codes through Beaverhead County and 5 zip codes in Madison County. The size and rural makeup of Barrett Hospital's service area play a significant role in the services Barrett Hospital & HealthCare provides. Beaverhead County is the largest county in the State of Montana and consists of a population of approximately 9,246 with a population density of 1.7 people per square mile. The nearest major hospital is 64.4 miles from Barrett Hospital.The population aged 65+ in Beaverhead County is 20.6% which is higher than the demographics for the State of Montana (17.2%) and national demographics (14.9%) for this population group. The upsurge in population aged 65+ continues to increase the need for senior services including healthcare.Socioeconomic factors also play a role in the health of the population that Barrett Hospital & HealthCare services. Beaverhead County has a higher percentage of the population that falls below the federal poverty levels and higher uninsured rates than National and State of Montana measures. 16.1% of the population of Beaverhead County is considered low income and falls below the federal poverty levels compared to 14.4% for the State of Montana. The median income for Beaverhead County is $43,880, which is lower than the Montana median income of $50,801. Beaverhead County also has an uninsured rate of 18%, as compared to the State of Montana rate of 17% and the national measure at 15.7%. Part VI, Line 5: Barrett Hospital & HealthCare is dedicated to providing high value healthcare and services for our community. All surplus revenues are reinvested into the facility, equipment, or programs at Barrett Hospital & HealthCare. The funds are utilized for quality initiatives to improve patient care, expand our facility, expand available services, and advance training programs. As a not-for-profit health system, Barrett Hospital & HealthCare reinvests profits into the community by helping manage chronic conditions including diabetes, promoting wellness, and providing programs to serve the poor and uninsured. In addition, Barrett Hospital is invested in the education and training of physician residents, medical students and other medical professional students at our site including 23 physician resident/students and PA/NP students and 13 occupational therapy, nursing, EMT, laboratory scientists and diagnostic imaging students. Barrett Hospital also had 10 students job shadow.Barrett Hospital & HealthCare offers low cost wellness programs (e.g. weight loss, lab screenings, student-athlete sports physicals) to the community, is an active community emergency preparedness partner, provides trauma prevention education, and partners with the county Public Health Director and community organizations (e.g. YMCA) on community wellness initiatives. Barrett Hospital & HealthCare sponsors the local Cancer Support Community gatherings and maintains over a mile of walking trails on the campus grounds for community member use. Barrett Hospital & HealthCare subsidizes the Home Health and Hospice programs for the community and partners with local volunteer EMS services and law enforcement to provide education and training.Barrett Hospital & HealthCare participates in government sponsored health programs including Medicare, Medicaid, CHIP, Veteran's Affairs, and Tricare. Barrett Hospital & HealthCare relies on community involvement to help keep in touch with the current needs of the community. Barrett Hospital & HealthCare has a 5 member board of trustees. The members of the board are publicly elected residents of Beaverhead County. In addition, Barrett Hospital has a large volunteer program. Approximately 64 volunteers contribute their time and efforts to the hospital. The hospital also relies on community members for various advisory councils including the Patient Advisory Council. Barrett Hospital & HealthCare is the only hospital in Beaverhead County. Medical staff privileges in the hospital are open to all qualified physicians and providers. Barrett Hospital operates an emergency room that is accessible to anyone needing care regardless of their ability to pay. The emergency room has approximately 4,000 visits annually.Additionally, Barrett Hospital and HealthCare operates a walk-in clinic 5 days per week. 0 0 0 0 0 0 0 0 0 Gregory Moore ED Physician 335527 0 12896 0 25000 0 19600 0 20963 0 413986 0 0 0 Sandra McIntyre Clinic Physician 253849 0 20605 0 25000 0 16800 0 26570 0 342824 0 0 0 Michael Clarke ED Physician 277892 0 13482 0 8668 0 12097 0 22538 0 334677 0 0 0 Kelly Smith Clinic Physician 243774 0 20000 0 19000 0 14000 0 22305 0 319079 0 0 0 Meghan Combs Clinic Physician 238204 0 30000 0 19000 0 7058 0 15193 0 309455 0 0 0 Richard Achter CFO 144096 0 0 0 8880 0 10758 0 2380 0 166114 0 0 0 Carol Kennedy CCO 128671 0 0 0 6963 0 6963 0 13549 0 156146 0 0 0 Part I, Line 3 Ken Westman, the CEO, receives compensation from an unrelated management company, HealthTech Management Services. The organization relies on HealthTech Management Services to have a process in place for determining compensation for our CEO. Form 990, Part VI, Section A, line 3 HealthTech Management Services provides general management services including the employment of our CEO, Ken Westman. Ken Westman received $260,000 in compensation from HealthTech Management Services during the 2019 calendar year. Form 990, Part VI, Section A, line 4 The Organization's Bylaws were amended during the year. Changes were made to more specifically outline the board's composition. The board shall consist of no less than three nor more than seven voting members. Each Board Member elected to the Board of Directors will hold office for three years. There is no limit to the number of terms that an individual may serve as an elected Voting Board Member. The initial Voting Board Members as of the approval of the restated Bylaws, shall be designated and approved by the Member. Thereafter, at each annual meeting of the Board of Directors, the incumbent Board of Directors shall accept nominations for the remaining new directors, to replace Directors whose terms are expiring. After nominations are received, each incumbent Director shall vote for as many of the nominees as there are positions to be filled. Form 990, Part VI, Section A, line 6 The sole member of the organization is the Public Hospital District, Beaverhead County (d/b/a Barrett Hospital and Healthcare) a Montana statutory public hospital district. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b An electronic copy of the 990 is presented to the Board during their regular board meeting for review and approval. Form 990, Part VI, Section B, line 12c Annually all employees, the CEO, and board members are required to complete a conflict of interest statement. All possible conflicts of interest are reviewed by the Compliance Committee. The Committee determines what, if any, action is necessary for the individual with the potential conflict to take to avoid said conflict. For board members, this would include recusing themselves during discussions/voting on related matters. Form 990, Part VI, Section B, line 15b Ken Westman receives compensation from an unrelated management company, HealthTech Management Services. The organization relies on HealthTech Management Services to have a process in place for determining compensation for our CEO. The Board of Directors approves the management agreement. Barrett Hospital & HealthCare participates in an annual salary survey with the Montana Hospital Association, which reviews all employee salary ranges, including the CFO, with like healthcare organizations throughout the State of Montana. The salary of the CCO is compared to national salary surveys, and all compensation grades are adjusted, as necessary, and reviewed with Leadership Council for approval. Physician/provider compensation is reviewed for fair market value with legal counsel upon execution or renewal of an employment agreement or contract. The Board of Directors reviews and approves all physician/provider agreements/contracts. The Board of Directors approves all other wages/salaries, including that of the CFO and CCO during the annual budget process. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and financial statements available upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 1,322,977. Management and general expenses 881,603. Fundraising expenses 0. Total expenses 2,204,580. Professional Fees: Program service expenses 480,938. Management and general expenses 0. Fundraising expenses 0. Total expenses 480,938. Physician Fees: Program service expenses 961,806. Management and general expenses 0. Fundraising expenses 0. Total expenses 961,806. Public Hospital District for Beaverhead County 600 Highway 91 South Dillon MT 59725 810357909 Healthcare MT N/A 0 Barrett Hospital Foundation Inc 600 Highway 91 South Dillon MT 59725 363597000 Fundraising for Hospital MT 501(c)(3) Line 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1