2021-05-17T11:34:43-05:00 2020-06-30 390758449 WIPFLI LLP 101 EAST FRONT STREET 301 MISSOULA MT 59802 990 2019-07-01 810245848 ROUNDUP MEMORIAL HOSPITAL ASSOCIATION ROUN 4063232301 PO BOX 40 ROUNDUP MT 59072 HOLLY WOLFF CEO 4063232301 2021-05-03 1 PHILIP L YASENAK CPA P01248379 4067281800 2021-05-03 2019 2022-09-23 18:48:47Z HOLLY WOLFF PO BOX 40 ROUNDUP MT 59072 11790303 0 X WWW.RMHMT.ORG X 1979 MT PROVIDE HEALTHCARE SERVICES 6 6 124 11 0 0 593386 1549056 9637623 9839058 4002 4918 499518 397271 10734529 11790303 0 0 0 0 4487981 4437303 0 0 0 5098231 5183307 9586212 9620610 1148317 2169693 7630190 11993764 3244840 5438721 4385350 6555043 X IT IS THE MISSION OF THE ROUNDUP MEMORIAL HOSPITAL TO ACCEPT THE ONGOING CHALLENGE OF PROVIDING FOR THE HEALTHCARE NEEDS OF ALL OF OUR CITIZENS. IT IS OUR SINCERE DESIRE TO HEAL THE SICK AND COMFORT THE SUFFERING WITH ALL THE RESOURCES WE HAVE AVAILABLE. AS GOOD STEWARDS OF THESE INSTITUTIONS, EMPLOYEES WILL HELP ENSURE THE SURVIVAL OF THE HOSPITAL BY BEING COMMITTED TO THE CARE AND WELL-BEING OF THOSE THEY SERVE. 0 0 7681524 10236329 CRITICAL ACCESS HOSPITAL - ROUTINE SERVICE FOR ADULTS, PEDIATRICS, AND SWING BED. RURAL HEALTH CLINIC WITH FOUR PROVIDERS. OTHER SERVICES INCLUDE BUT ARE NOT LIMITED TO ANCILLARIES; CT SCANS; LABORATORY; PHYSICAL, THERAPIES AND REHABILITATION; PHARMACY; EMERGENCY ROOM; X-RAY; DEXASCAN; CHRONIC CARE AND DIABETES MANAGEMENT; CENTRAL SUPPLY; INTRAVENOUS SOLUTIONS; ULTRASOUND; ELECTROCARDIOGRAPHY; OBSERVATION; BLOOD BANK; AND PATHOLOGY. 7681524 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 26 0 1 124 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 1 0 0 1 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X ROUNDUP MEMORIAL HOSPITAL ASSOCIATION 4063232301 1202 THIRD STREET WEST ROUNDUP MT 59702 X JOHN PFISTER PRESIDENT 1.00 X X 0 0 0 MARK ROSEBUSH DMD VICE PRESIDENT 0.50 X X 0 0 0 KEN MOSDAL TREASURER 0.50 X X 0 0 0 BRYAN ADOLPH DIRECTOR 0.50 X 0 0 0 MARSHALL WHITE MD DIRECTOR 0.50 X 0 0 0 LEONARD WALL DIRECTOR 0.50 X 0 0 0 HOLLY WOLFF CEO 40.00 X 0 0 0 ANNE MARIE KLOPPEL CFO 40.00 X 0 0 0 VALERI RUSSELL PA 40.00 X 158174 0 12903 BRYNN BIXBY PA 40.00 X 156591 0 1906 KEVIN CRISWELL PHYSICAL THERAPIST 40.00 X 147138 0 10498 461903 0 25307 3 0 1 0 BILLINGS CLINIC PO BOX 30357 BILLINGS MT 59107 MANAGEMENT SERVICES 1612749 PRAIRIE TRAVELERS 130 3RD STREET S 2 GLASGOW MT 59230 CONTRACT SERVICES 199585 WILDERNESS MEDICAL STAFFING 1124 W RIVERSIDE AVE 215 SPOKANE WA 99201 CONTRACT SERVICES 190444 YELLOWSTONE VALLEY TRAVELERS PO BOX 51197 BILLINGS MT 59105 CONTRACT SERVICES 163063 4 968874 580182 1549056 INPATIENT/OUTPATIENT REVENUE 621110 9691483 9691483 OTHER OPERATING REVENUE 900099 107826 107826 340B REVENUE 446110 39749 39749 9839058 4918 4918 420 0 420 420 420 TAX REVENUE 900099 380877 380877 REBATES/REFUNDS 900099 15974 15974 396851 11790303 10236329 0 4918 X 3683759 3173329 510430 41930 41930 401622 313489 88133 309992 218980 91012 95739 53923 41816 100953 100953 33937 33937 2067062 1659825 407237 18312 18312 39662 9649 30013 261487 6996 254491 222550 150694 71856 16082 11587 4495 24799 16395 8404 41731 41731 431024 428411 2613 68557 68557 MEDICAL SUPPLIES 799718 799700 18 BAD DEBT EXPENSE 477331 477331 REPAIRS & MAINTENANCE 204138 204062 76 OTHER SUPPLIES 142130 124779 17351 138095 32374 105721 9620610 7681524 1939086 0 936813 2318527 979202 4320407 1442087 1091728 120726 135349 54994 164055 12615919 9012236 3418644 3603683 3100 11100 674624 348915 7630190 11993764 1603971 592380 0 3346646 1640869 1499695 3244840 5438721 X 4268540 6468618 116810 86425 4385350 6555043 7630190 11993764 2169693 0 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5913795 5139963 773832 6202033 3872273 2329760 500091 500091 3603683 X 11312972 0 11312972 477331 477331 11790303 9143279 0 9143279 477331 477331 9620610 PART X, LINE 2: THE HOSPITAL IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL IS ALSO EXEMPT FROM STATE TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF MONTANA TAX LAWS. THE HOSPITAL APPLIES GENERALLY ACCEPTED ACCOUNTING PRINCIPLES FOR RECOGNITION OF UNCERTAINTY IN INCOME TAXES AND PRESCRIBING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR THE RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. IN THE COURSE OF ITS ASSESSMENT, THE HOSPITAL HAS DETERMINED THAT IT IS SUBJECT TO EXAMINATION OF ITS INCOME TAX FILINGS IN THE UNITED STATES AND STATE JURISDICTIONS FOR THE PRIOR THREE TAX YEARS. IN THE EVENT THAT THE HOSPITAL IS ASSESSED PENALTIES AND OR INTEREST, PENALTIES WILL BE CHARGED TO MISCELLANEOUS EXPENSE AND INTEREST WILL BE CHARGED TO INTEREST EXPENSE. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 477,331. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 477,331. 1 1 1 X 125.000000000000 1 X 1 1 0 0 66502 66502 0.00730 2429280 2809664 0 0.00000 2495782 2809664 66502 0.00730 6974 2100 4874 0.00050 6974 2100 4874 0.00050 2502756 2811764 71376 0.00780 0 477331 190932 3860809 3899509 -38700 X 1 1 1 1 ROUNDUP MEMORIAL HOSPITAL ASSOCIATION 1202 3RD STREET WEST ROUNDUP MT 59072 X X RURAL HEALTH CLINIC ROUNDUP MEMORIAL HOSPITAL ASSOC 1 0 0 1 X X X X X X X X 17 1 0 1 1 X WWW.RMHMT.ORG X 1 17 1 WWW.RMHMT.ORG 0 1 X 125.000000000000 200.000000000000 1 1 X X X 1 X WWW.RMHMT.ORG X WWW.RMHMT.ORG X X 1 X 0 X 1 X 0 0 ROUNDUP MEMORIAL HOSPITAL ASSOC PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST ROUNDUP MEMORIAL HEALTHCARE IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN FEBRUARY 2018. 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 FOCUS GROUPS AND TO ASSIST IN THE PRIORITIZATION OF HEALTH NEEDS TO ADDRESS. ROUNDUP MEMORIAL HOSPITAL ASSOC PART V, SECTION B, LINE 6B: THE MONTANA OFFICE OF RURAL HEALTHTHE NATIONAL RURAL HEALTH RESOURCE CENTER ROUNDUP MEMORIAL HOSPITAL ASSOC PART V, SECTION B, LINE 11: THE FOLLOWING SIGNIFICANT NEEDS WERE IDENTIFIED IN THE CHNA AND ARE BEING ADDRESSED AT THIS TIME: GOAL 1: IMPROVE ACCESS TO HEALTHCARE SERVICES IN MUSSELSHELL COUNTY STRATEGY 1.1: INCREASE ACCESS TO MENTAL HEALTH SERVICES ACTIVITIES: IDENTIFY AND CATALOGUE AVAILABLE MENTAL HEALTH RESOURCES IN THE RMH SERVICE AREA; CREATE A RESOURCE TO EDUCATE PROVIDERS AND COMMUNITY ON AVAILABLE MENTAL HEALTH SERVICES; EXPLORE ALTERNATIVE METHODS TO OFFER/PROVIDE MENTAL HEALTH SERVICES (I.E. TELEHEALTH) STRATEGY 1.2: INCREASE AWARENESS OF AVAILABLE FINANCIAL ASSISTANCE OPTIONS AT RMH ACTIVITIES: EXPLORE NEW MEDIA OUTREACH OPPORTUNITIES TO INFORM RMH SERVICE AREA OF AVAILABLE FINANCIAL ASSISTANCE PROGRAMS; CONTINUE EDUCATING RMH PATIENTS ABOUT FINANCIAL ASSISTANCE PROGRAM AT INTAKE AND DISCHARGE. STRATEGY 1.3: CONTINUE RECRUITMENT AND RETENTION EFFORTS TO ENSURE ACCESS TO HEALTHCARE SERVICES ACTIVITIES: WORK WITH STUDER GROUP TO ENHANCE EMPLOYEE RETENTION AT RMH; EXPLORE OPPORTUNITIES TO EXPAND AVAILABLE SPECIALTY SERVICES (ON-SITE OR VIA TELEHEALTH) AT RMH.GOAL 2: INCREASE AWARENESS OF SERVICES AVAILABLE AT RMH. STRATEGY 2.1: IMPROVE AND EXPAND MARKETING AND ADVERTISING EFFORTS. ACTIVITIES: EXPLORE DEVELOPMENT OF MONTHLY NEWSLETTER (INCLUDING MONTHLY TOPICS, VISITING SPECIALISTS, HEALTH TOPICS); DEVELOP METHOD FOR COMMUNITY MEMBERS TO SIGN UP FOR ELECTRONIC NEWSLETTER AND CREATE MARKETING CAMPAIGN; DEVELOP A MECHANISM TO CAPTURE PATIENT TESTIMONIALS TO SHARE WITH COMMUNITY; CONTINUE WEEKLY CEO COMMUNITY RADIO SHOW/CHAT. STRATEGY 2.2: IMPROVE COMMUNITY COORDINATION OF SERVICES TO ENHANCE AWARENESS OF LOCAL RESOURCES. ACTIVITIES: DETERMINE FEASIBILITY OF FORMING A COMMUNITY HEALTH COALITION TO SHARE AND COORDINATE LOCAL RESOURCES; DETERMINE POTENTIAL PARTNERS AND STAKEHOLDERS WHO WOULD PARTICIPATE IN COMMUNITY HEALTH COALITION (PUBLIC HEALTH, SENIOR CENTER, POLICE, EMS, SCHOOLS, ETC.).GOAL 3: ENHANCE COMMUNITY KNOWLEDGE OF AVAILABLE HEALTH AND WELLNESS PROGRAMS/EFFORTS IN MUSSELSHELL COUNTY. STRATEGY 3.1: CONTINUE PROMOTING HEALTH AND WELLNESS SERVICES AVAILABLE LOCALLY. ACTIVITIES: HOST AND PROMOTE RMH ANNUAL HEALTH FAIR; EXPLORE ADDITIONAL COMMUNITY SPONSORS, BOOTHS, ETC. TO EXPAND EDUCATIONAL AND SERVICE OFFERINGS; SPONSOR A 5K COMMUNITY FUN RUN; CONTINUE OFFERING PREVENTATIVE SCREENINGS, BLOOD DRAWS AND OTHER RESOURCES AT HEALTH FAIR. STRATEGY 3.2: CONTINUE TO PROVIDE CHRONIC DISEASE AND DIABETIC MANAGEMENT PROGRAM AT RMH. ACTIVITIES: CONTINUE TO EDUCATE AND PROMOTE PROGRAM TO POTENTIAL PARTICIPANTS AND COMMUNITY; OBTAIN DIABETIC MANAGEMENT ACCREDITATION. STRATEGY 3.3: CONTINUE TO PROVIDE RMH SUPPORT AND LEADERSHIP IN LOCAL HEALTH AND WELLNESS EFFORTS IN MUSSELSHELL COUNTY. ACTIVITIES: EXPLORE OPPORTUNITIES TO ENHANCE COMMUNITY ENGAGEMENT IN COMMUNITY COALITIONS, WORK GROUPS, ETC. (EX. CHAMBER); CONTINUE RMH STAFF PARTICIPATION IN LAC, MENTAL HEALTH COUNCIL, AND LOCAL EMERGENCY PREPAREDNESS COUNCIL. STRATEGY 3.4: PROMOTE HEALTH AND WELLNESS IN PARTNERSHIP WITH LOCAL SCHOOLS. ACTIVITIES: PROVIDE RMH STAFF AT LOCAL SCHOOLS TO OFFER SPORTS PHYSICALS 1X/YEAR; SUPPORT HEALTH AND SAFETY PROGRAMS FOR LOCAL YOUTH (EX. TEXTING AND DRIVING, DRINKING AND DRIVING, SEATBELT USE)THE FOLLOWING NEEDS ARE NOT BEING ADDRESSED AT THIS TIME:NEED 1: THE COMMUNITY IDENTIFIED A NEED FOR BETTER DRINKING WATER AND FLOOD CONTROL TO IMPROVE THE HEALTH OF THE COMMUNITY. JUSTIFICATION: THIS NEED IS NOT WITHIN OUR MISSION OR ABILITIES. NEED 2: TOP DESIRED LOCAL HEALTHCARE SERVICES IDENTIFIED WERE ALTERNATIVE MEDICINE AND DERMATOLOGY. JUSTIFICATION: ALTERNATIVE MEDICINE IS NOT WITHIN OUR MISSION OR SCOPE AND THERE IS AN INSUFFICIENT DEMAND TO SUPPORT A SPECIALTY CLINIC FOR DERMATOLOGY. LIMITED DERMATOLOGY SERVICES ARE PROVIDED THROUGH THE CLINIC. PART I, LINE 7: THE COST-TO-CHARGE RATIO WAS USED TO CALCULATE THE FIGURES IN THE TABLE. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. PART I, LN 7 COL(F): THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX, LINE 25 HAS BEEN SUBTRACTED FROM TOTAL OPERATING EXPENSES IN THE CALCULATION OF THE COST-TO-CHARGE RATIO FROM WORKSHEET 2. PART III, LINE 2: NET BAD DEBT EXPENSE RECORDED IN THE GENERAL LEDGER (EXPENSE LESS RECOVERIES). PART III, LINE 3: WE ESTIMATE APPROXIMATELY 40% OF TOTAL BAD DEBT IS ATTRIBUTABLE TO PATIENTS THAT WOULD LIKELY BE ELIGIBLE UNDER THE FINANCIAL ASSISTANCE POLICY. PART III, LINE 4: THE FOOTNOTE DESCRIBING BAD DEBT IS ON PAGE 5 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. MEDICARE RATES DO NOT ALWAYS ALIGN WITH THE ACTUAL COSTS OF TREATMENT. BY CONTINUING TO TREAT PATIENTS ELIGIBLE UNDER MEDICARE, THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE ORGANIZATION USED AMOUNTS FROM THEIR MEDICARE COST REPORT TO DETERMINE LINE 6. PART III, LINE 9B: POLICY STATES UP FRONT THAT ADMISSIONS REPRESENTATIVE IS TO GIVE FINANCIAL ASSISTANCE PAPERWORK WITH INFORMAION ON CHARITY CARE AT THE TIME OF ADMISSION. FOLLOW UP CONSULTATION IS DONE LATER TO INCLUDE FINANCIAL ASSISTANCE DISCUSSIONS WITH PATIENT. PART VI, LINE 2: IN 2018, THE HOSPITAL CONDUCTED A NEEDS ASSESSMENT. THE STEERING COMMITTEE INCLUDED REPRESENTATIVES FROM THE LOCAL MEDIA, EMS, PUBLIC HEALTH, THE SCHOOL SYSTEM, AGENCY ON AGING, AND MENTAL HEALTH IN ADDITION TO THE HOSPITAL CLINICAL AND ADMINISTRATIVE STAFF. ONE FOCUS GROUP AND FIVE KEY INFORMANT MEETINGS WERE HELD TO GATHER INFORMATION ON HEALTHCARE NEEDS AND DESIRES. PART VI, LINE 3: WHEN A PATIENT INDICATES THAT A FINANCIAL HARDSHIP EXISTS, THE HOSPITAL PROVIDES INFORMATION ON THE HOSPITAL CHARITY PLAN AND OTHER STATE AND FEDERAL ASSISTANCE PROGRAMS. PART VI, LINE 4: ROUNDUP MEMORIAL HEALTHCARE (RMH) IS THE SOLE COMMUNITY HEALTHCARE PROVIDER FOR MUSSELSHELL COUNTY, A RURAL AREA WITH A POPULATION DENSITY OF 2.4 PER SQUARE MILE. NO OTHER HOSPITALS SERVE THE COMMUNITY AND THE NEAREST HEALTHCARE FACILITY IS LOCATED IN BILLINGS, 45 MILES TO THE SOUTH. PER THE 2010 FEDERAL CENSUS, THE COUNTY POPULATION WAS 4,538; THE PER CAPITA INCOME IN THE COUNTY IS $19,164 AND THE PERCENTAGE OF PERSONS BELOW THE POVERTY LINE WAS 20.5 PERCENT. IN 2006, 26.4 PERCENT OF MUSSELSHELL COUNTY WAS UNINSURED. THE HEALTH RESOURCES AND SERVICES ADMINISTRATION HAS DESIGNATED MUSSELSHELL COUNTY AS AN UNDERSERVED AREA WITH A SCORE OF 16. 0 0 0 0 0 0 0 0 0 VALERI RUSSELL PA 158174 0 0 0 0 0 4309 0 8594 0 171077 0 0 0 BRYNN BIXBY PA 156591 0 0 0 0 0 1906 0 0 0 158497 0 0 0 KEVIN CRISWELL PHYSICAL THERAPIST 147138 0 0 0 0 0 3864 0 6634 0 157636 0 0 0 BILLINGS CLINIC INC ORGANIZATION'S CEO & CFO ARE EMPLOYEES OF BILLINGS CLINIC 1612749 HOLLY WOLFF, CEO, AND ANNE MARIE KLOPPEL, CFO, ARE EMPLOYEES OF THE BILLINGS CLINIC, INC., THE INDEPENDENT CONTRACTOR HIRED TO MANAGE THE HOSPITAL, AND RECEIVED ALL COMPENSATION FOR THEIR SERVICES AS CEO AND CFO, RESPECTIVELY, FROM BILLINGS CLINIC, INC. 0 FORM 990, PART VI, SECTION A, LINE 2 LEONARD WALL AND BRYAN ADOLPH - FAMILY RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS CONTRACTED WITH BILLINGS CLINIC TO PROVIDE MANAGEMENT SERVICES. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OF HOSPITAL ASSOCIATION 501 (C)(3) FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS REVIEWED BY THE CEO, CFO, AND CONTROLLER AND IS DISTRIBUTED TO THE BOARD BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE OFFICER MONITORS AND EVALUATES CONFLICT OF INTEREST ISSUES. FORM 990, PART VI, SECTION B, LINE 15 THE CEO IS COMPENSATED ACCORDING TO ARRANGEMENTS WITH THE MANAGEMENT AGREEMENT WITH BILLINGS CLINIC, WHO RECOMMENDS THE CEO SALARY TO THE BOARD FOR APPROVAL. THE HOSPITAL UTILIZES THE MONTANA HOSPITAL ASSOCIATION AND ASSOCIATED EMPLOYEES SALARY SURVEY TO DETERMINE SALARIES OF KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 19 AVAILABLE UPON REQUSET TO THE CEO. FORM 990, PART IX, LINE 11G OTHER FEES & CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,659,825. MANAGEMENT AND GENERAL EXPENSES 407,237. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,067,062. FORM 990, PART XII, LINE 2C: THERE IS NO SEPARATE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. THE BOARD OF DIRECTORS ASSUMES THIS OVERSIGHT RESPONSIBILITY. THE BOARD HIRES THE AUDIT FIRM AND MEETS WITH THE AUDIT TEAM AT THE CONCLUSION OF THE AUDIT. THE BOARD IS ALSO AVAILABLE FOR ANY QUESTIONS THAT ARISE THROUGHOUT THE AUDIT.