2021-04-09T15:48:30-05:00 2020-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2019-07-01 363808993 Fallon Medical Complex Inc FALL 4067783331 PO Box 820 Baker MT 59313 David Espeland CEO 4067783331 2021-04-08 1 Kim C Hunwardsen P00484560 6122536500 2021-04-08 2019 2022-09-23 18:48:47Z See Schedule O David Espeland PO Box 820 Baker MT 59313 12113397 0 X www.fallonmedical.org X 1991 MT Providing healthcare services 7 7 106 61 0 0 179735 406302 11087683 11685773 -7858 -1356 3159 -8040 11262719 12082679 39474 32873 0 0 4430460 5480226 0 0 0 6228356 6238345 10698290 11751444 564429 331235 19363593 25565031 1346633 7073726 18016960 18491305 X Fallon Medical Complex, in its innovative pursuit of Friends Healing Friends, provides comfort, compassion, and excellence in the promotion of quality of life to all individuals. 0 0 9117887 32873 10515598 FMC is a sole community provider of healthcare services in rural Fallon County, Montana. It is predominantly a primary care provider for its service area, consisting of a number of entities structured under a charitable non-profit corporation. It strives to excel at offering family practice and preventative health outpatient services, routine hospital, lab and fully digital diagnostic services, 24-hour emergency care, intermediate swing bed long-term care, home-based skilled and personal care, and physical and occupational therapy.Fallon Medical Complex (FMC) provides quality health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation of FMC, it is recognized that not all individuals possess the ability to purchase these essential services. It is FMC's mission to serve the surrounding area by providing health care services to all community members.FMC provides medical services to individuals who are determined unable to purchase such services through FMC's Financial Assistance policy and guidelines. In addition to free and/or subsidized care, services are also provided at below cost rates to persons covered by government programs. Recognizing its mission to the community, services are provided to both Medicare and Medicaid patients. The unreimbursed value of providing care to these patients, based on established rates is $31,000 for the year ended June 30, 2020. FMC's Critical Access Hospital provides 24 hour x 7 days a week Emergency Room services, observation, Acute Care, Swing Bed services and onsite ancillary lab and diagnostic imaging services. During fiscal year ended June 30, 2020, FMC provided over 306 days of hospital services, 5,959 days of swing bed care, 949 ER visits, and over 7,800 outpatient visits. 1308191 1170175 FMC Community Clinic (Rural Health Clinic) operates under the same mission as FMC by providing family health care to over 6,700 patient visits per year. The four providers (one physician and three mid-levels) also provide ER coverage 24 hours, 7 days a week. 12940 One of FMC's operating philosophies states that education programs are necessary to enhance the competence of personnel in the healthcare system as well as to assist in the attainment of both personal and organizational goals. To this end, not only does the organization routinely budget $30,000 or more in continuing education for its employees, it also provides job shadowing to area students (typically 3-5 students per year) who may be interested in a healthcare career, in addition to offering routine Certified Nursing Assistant training programs (to about 5-10 prospective aides per year).FMC also hosts numerous college students seeking careers as doctors (1-2 per year), physician assistants (1-2 per year), and various other disciplines, such as nursing, radiology & laboratory technology and physical therapy. FMC further believes that it is its responsibility to take a leadership role in informing the public about healthcare subjects of relevance or interest through community education. This objective is supported through a number of channels, which includes routine "Lunch and Learn" sessions provided by medical professionals (about 6 times per year), weekly public service announcements on the local radio station, and an annual health fair which is attended by people from all over the service area. 10439018 1 1 0 1 0 0 0 0 1 1 1 0 1 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 0 0 0 1 18 0 1 106 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 1 1 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X Marjorie Losing 4067785303 PO Box 820 Baker MT 593130820 David Espeland Chief Executive Officer 40.00 0.00 X 135458 0 23461 Katherine Ernest PA-C 40.00 0.00 X 130635 0 9102 Susan G Lunde DON 40.00 0.00 X 105460 0 10549 Marjorie Losing Chief Financial Officer 40.00 0.00 X 80616 0 21997 Betty Mueller President 0.50 0.00 X X 0 0 0 Doug Varner Vice President 0.50 0.50 X X 0 0 0 Richard Menger Secretary 0.50 0.00 X X 0 0 0 Merri Burns Trustee 0.50 0.00 X 0 0 0 Shane Bettenhausen Trustee 0.50 0.00 X 0 0 0 Bryant Steen Trustee 0.50 0.00 X 0 0 0 Alice Kay Schweigert Trustee 0.50 0.00 X 0 0 0 452169 0 65109 3 0 1 0 MT Health Network 111 S 7th St Ste 241 Miles City MT 59301 Contracted Nursing and Xray 445339 Rural Medical Partners 4956 Curran Court Grand Forks ND 58201 Locum Physicians 423492 Focus Staff Services 8848 Greenville Ave Dallas TX 75243 Contract Staffing 249299 Prairie Travelers 130 3rd St S 2 Glasgow MT 59230 Contract Nursing 210516 Medical Solutions LLC PO Box 310737 Des Moines IA 50331 Contract Staffing 179209 12 5789 283493 117020 406302 Net Patient Service Revenue 621110 10739662 10739662 County Subsidy 900099 849500 849500 Meals on Wheels 900099 45687 45687 Cafeteria 722514 28396 28396 22528 22528 11685773 2072 2072 19250 27290 -8040 -8040 -8040 3428 -3428 -3428 -3428 12082679 11685773 0 -9396 X 32873 32873 269197 269197 31742 31742 3483156 3012868 470288 1002172 919867 82305 416809 394996 21813 277150 251957 25193 3138528 3044005 94523 22505 9003 13502 152845 116935 35910 165454 145169 20285 180604 179378 1226 8097 6407 1690 2595 2595 952416 802544 149872 131495 100116 31379 Medical Supplies 515292 515292 Repairs and Maintenance 458014 391338 66676 Bad Debt 296581 296581 Food 97216 97216 116703 88136 28567 11751444 10439018 1312426 0 5479779 11692917 2965972 2612701 190271 215754 23114 26650 21932895 12886969 9279044 9045926 68154 68443 1357259 1502640 0 400000 19363593 25565031 732040 1888957 4387 3695424 330 1629 69876 438445 847500 540000 201771 1346633 7073726 X 17675997 18070152 340963 421153 18016960 18491305 19363593 25565031 X 331235 143110 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 163 163 0 Part II-B, Line 1: Fallon Medical Complex reimburse certain professional membership dues of employees. A portion of such membership dues are used by the professional association for lobbying activities. FMC also pays for dues to the MT Hospital Association and MT Health Care Association and a percentage of those dues are also used by the professional association for lobbying activities. 0 1 X 255821 2754 258575 244418 10000 1403 255821 243715 703 244418 243034 681 243715 230502 10000 2532 243034 0.16260 0.74660 0.09080 0 1 1 96521 96521 18164775 10382469 7782306 3286934 2308525 978409 384665 195975 188690 9045926 Investment in Foundation 1386008 F Investment in Cooperative 116632 F 1502640 Due to County 201771 201771 X 11842137 -267832 -267832 12109969 -27290 -27290 12082679 11482153 27290 27290 11454863 296581 296581 11751444 Part IV, Line 2b: The complex acts as a custodian for the funds of some residents. Resident funds totaled $1,629 and $330 at June 30, 2020 and 2019, respectively. Part V, Line 4: Friends of FMC Foundation, Inc. holds the permanently restricted funds to provide a source of income to be used for Long Term Care, and/or equipment purchases on behalf of Fallon Medical Complex, and for scholarships. The principal has been invested and the generated income (temporarily restricted) is used for said purpose. Part X, Line 2: The Complex believes 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 financial statements. The Complex 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: Equity in Earnings of Affiliate recorded in revenue for financial statements 28,749. Provision for Bad Debts -296,581. Part XI, Line 4b - Other Adjustments: Rental Expenses recorded in revenue for Form 990 -27,290. Part XII, Line 2d - Other Adjustments: Rental Expenses recorded in revenue for Form 990 27,290. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts 296,581. 1 1 X 1 X 1 X 1 1 0 0 34000 34000 0.00300 1433660 1275089 158571 0.01380 13827 7002 6825 0.00060 1481487 1282091 199396 0.01740 60805 30179 30626 0.00270 10949 10949 0.00100 2578133 1808838 769295 0.06720 2414 2414 0.00020 2652301 1839017 813284 0.07110 4133788 3121108 1012680 0.08850 1 1249 1249 0.00010 1 531 531 0.00000 1 600 600 0.00010 1 107722 45687 62035 0.00540 2 1312 1312 0.00010 6 111414 45687 65727 0.00570 0 296581 17498 3622171 3640335 -18164 X 1 1 1 1 Fallon Medical Complex Inc 202 South 4th Street West Baker MT 59313 www.fallonmedical.org 13128 X X X Outpatient Clinic - RHC Fallon Medical Complex Inc 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X http://www.fallonmedical.org/ X X 1 18 1 http://www.fallonmedical.org/ 0 1 X 150.000000000000 250.000000000000 X X X X 1 1 X X X 1 X www.fallonmedical.org X www.fallonmedical.org X www.fallonmedical.org X X X X X X X 1 X 0 X X X X 1 X 0 0 Fallon Medical Complex, Inc. Part V, Section B, Line 5: During the Community Health Services Development Process, Fallon Medical Complex conducted three focus group meetings that were open to the public. Steering committee participants were selected based on their involvement with community development and healthcare services, including: local business men and women, Fallon County commissioners, healthcare personnel, and representatives from the Council on Aging and the South Eastern Montana Area Revitalization Team (SMART). Fallon Medical Complex, Inc. Part V, Section B, Line 7d: Available in FMC's Quality Improvement Department Fallon Medical Complex, Inc. Part V, Section B, Line 11: Our Board of Trustees passed a resolution on August 7, 2019 to approve our most recent Implementation Plan, based on collective needs identified in our CHNA plan, which was completed two months earlier. This plan identified three goals, to be supported with a number of strategic initiatives:Goal # 1: Improve population health in FMC's service area, by working to enhance chronic care services and prevention outreach.Goal #2: Enhance behavioral health services (mental, behavioral, SUD) in FMC's service area, initially by assessing gaps in current services, then seeking out opportunities for improvements.Goal #3: Improve access to health care services and enhance continuity of care at FMC by increasing access to both specialty and primary care services, as well as improving community education and outreach.The actions taken to address the needs included:Goal # 1: Improve population health in FMC's service area, by working to enhance chronic care services and prevention outreach. We have been striving to enhance participation in a Chronic Care Management HRSA grant offered by the Montana Health Network (MHN). Accordingly, our patient enrollees increased from 2 to 11 during FY2020. This program has received additional funding to continue it for at least two more years. Furthermore, we continued to offer Lunch & Learns on relevant topics, including chronic disease management, during the winter months, and the MHN HRSA grant provided chronic care outreach materials for patient distribution.Goal #2: Enhance behavioral health services (mental, behavioral, SUD) in FMC's service area, initially by assessing gaps in current services, then seeking out opportunities for improvements. We did convene community stakeholders to assess available behavioral, mental, and SUD resources, gaps, and opportunities. Unfortunately, our lead employee moved out-of-town and then Covid-19 hit us, which changed our priorities. We did, however, agree to participate in a separate behavioral health grant through the Montana Health Network, which is currently developing the scope of their project. They have arranged for a Bozeman physician to work with patients remotely over telemedicine, which we intend to utilize as we see a need. Lastly, we continue to provide and promote community medication and needle disposal.Goal #3: Improve access to health care services and enhance continuity of care at FMC by increasing access to both specialty and primary care services, as well as improving community education and outreach. Just prior to the start of FY2020, we hired a full-time occupational therapist (OT). Up until that point, we were receiving part-time services from a contract OT. During FY2020, our OT continued to build her business, which included notifying referring providers, educating patients, and expanding her realm of influence. As a result, her practice is building. In addition, we have continued to seek out opportunities to expand onsite and telemedicine specialty services. The increased use of Zoom during Covid-19 has enhanced acceptance by providers of providing remote services, which increases access. We have continued to explore alternative models of provider staffing in our clinic too. Unfortunately, we experienced turnover and extended leave of absence by providers, which required us to adversely increase our use of locums. We have appointed an employee to work with the clinic to define workflow processes and propose alternatives of how to improve them. Lastly, we are taking another run at redesigning our website to make it more user-friendly and patient-focused. We intend to increase the amount of information about healthcare related resources, including our own services, and a more effective calendar of upcoming programs.FMC chose not to address the following needs identified during the CHNA process:1) CHNA focus groups felt that healthcare costs seemed higher at FMC than other hospitals in the region. Hospitals cannot collude to fix prices, which is a federal trade offense. To do an arms-length pricing analysis, we purchased a database of peer group aggregate pricing from our accountants for hospitals located within our region. This database helped us understand where our pricing might be higher than our competition. In addition, all hospitals are required to post their Charge Master on their websites, which can be accessed for price comparisons.2) About a third of our survey respondents indicated that they did not know or were unsure of programs that assist people with paying their healthcare bills. We offer a financial assistance program for those with a demonstrated need, as do various community partners (such as Council on Aging and philanthropic organizations.) We intend to include a list of potential programs in the resource manual to be developed under our Implementation Plan.3) Less than 10% of survey respondents indicated that they were unable to get or take their medications regularly due to cost. We offer a 340(b) program that provides low-cost assistance with medication expenses in collaboration with Baker Rexall Drug. Qualified patients must demonstrate a need, from which they receive a discount card that entitles them to significantly lower pricing on many medications.4) Housing was discussed as a concern at all focus groups. Unfortunately, we cannot address or resolve the issue of housing. We, too, experience a hardship while trying to recruit staff members and providers. We have explored building our own housing, but persistent annual operating losses have prevented us from accumulating the required capital. Our Foundation Coordinator does participate in two local economic development groups which strive to address issues such as this one.5) Unintentional injury death rate (per 100,000 population) for Fallon County is 65.6 compared to 41.3 from Montana. We are aware of the high incidence of accidental deaths in our county. Our providers do counsel patients on safe practices, such as wearing helmets and seatbelts, being cautious around farm animals, etc. Nonetheless, the responsibility to provide public education about limiting unsafe occupational and recreational practices falls within the realm of Public Health and the MT Dept of Health and Human Services. It is their responsibility to monitor widespread health risks and to implement various programs to curtail further injuries, infections, or loss of life. Fallon Medical Complex, Inc. Part V, Section B, Line 16j: FMC provides a summary of the financial assistance policy to patients upon admission. FMC also attaches a summary of the policy to billing invoices and posts a plain language summary in the facility's emergency and waiting rooms, admissions offices, public health, courthouse, and senior citizen center. 2 1 - Community Clinic 202 South 4th Street West Baker MT 59313 Outpatient Clinic - RHC 2 - Wibaux Clinic 710 Drake Street Wibaux MT 59353 Outpatient Clinic Part I, Line 3c: We do include an asset and liability test for those who qualify between 200-250%. Anyone at or below 150% qualifies for free care. Anyone who does not qualify for free care, with income between 151% and 250% qualifies for discounted care. Because the test of discounted care considers net assets and the patient's medical bills are included in liabilities, a medically indigent could qualify for discounted care under this program. Part I, Line 7: Charity care expense was converted to cost based on an overall cost-to-charge ratio addressing all patient segments. Cost of other means tested government programs, community health improvement services and community benefit operations, health professions education, and cash and in-kind contributions to community groups are based on costs recorded in the general ledger and estimated costs. Medicaid, Subsidized health services, and costs of other means-tested government programs are determined based on costing methods used to prepare the cost report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator of the calculation was $296,581. Part II, Community Building Activities: FMC participates in a number of community building activities to improve our community. Our Foundation Coordinator has been a member of the local housing board, searching for ways to address our community's chronic housing shortage by facilitating the construction of new housing and the renovation of existing housing. In addition, FMC manages a senior independent living complex for Fallon County. Although the county does reimburse direct expenses for maintenance, one of our employees acts as a "property manager," coordinating tenant turnover, fielding questions or concerns, calling for property services, etc.From an economic development standpoint, our Foundation Director has also been a board member of our local Southeastern Montana Revitalization Team (SMART) which is dedicated to revitalizing the economic climate in the area. They are focused on building community infrastructure, as well as attracting new businesses and finding ways to provide housing for incoming workers and their families. In addition, our Foundation Director is a board member on the Eastern Montana Economic Development Authority (EMEDA), which has been actively pursuing the creation of a licensed child daycare, none of which currently exist in Fallon County. Lastly, to help keep local commerce alive, our Foundation Coordinator is Treasurer for the Baker Chamber of Commerce, actively participating in meetings and events, including hosting their monthly meeting on a rotating basis. One of the Chamber's primary events, the Fall Festival, is coordinated by FMC staff, who also participate in the Chili Cook-off event every year.To further support the community, several FMC employees frequently participate in disaster preparedness meetings and events through the Fallon County Local Emergency Preparedness Committee (LEPC). This group meets regularly to discuss disaster preparedness activities, to review the response of similar groups to disasters across the nation, to determine ways to enhance the effectiveness of disaster response in our area and to conduct table top exercises that simulate potential local disasters. We have also dedicated staff time and resources to acquiring knowledge in the Hospital Emergency Incident Command System (HEICS), a nationally recognized program in incident management. Since the advent of the Covid-19 pandemic, we have activity participated in local, state, and federal initiatives to curb its spread and to keep our community as safe as possible. Through years of training in disaster preparedness, we had developed the necessary organizational tools and ramped up an adequate (initial) supply of PPE to weather the storm. Collaboratively, we distributed PPE to public health, law enforcement, EMS, and fire control officials until their own supplies could be built up.Our CEO is a licensed Landscape Architect with a strong interest in improving and maintaining our environment. He plans, installs, and maintains the grounds surrounding our facility, to ensure its long-term viability and meaningful contribution towards the effective healing of our patients. Our CEO also participates in community initiatives regarding environmental improvements when asked.In an effort to assist with leadership development, two staff members routinely provide assistance with youth leadership programs. For instance, one of our Physical Therapists has acted as a 4H leader for several years, participating in youth developmental programs that provide hands-on learning activities to youth. In addition, our CEO provides coaching and judging for our local Business Professionals of America (BPA) chapter, which teaches basic and advanced business skills to high school students. Our CEO has also acted as a judge for local Speech and Drama events, which helps high school students gain valuable skills in public speaking and performing.FMC participates in coalition building by contributing to collaborative efforts that address health and safety issues, including LEPC and HEICS mentioned earlier, with other healthcare entities and emergency service providers. Our CEO is also a board member on a frontier facilities initiative sponsored by the Montana Health Network (MHN). This group strives to find collaborative programs that benefit small rural hospitals patients through increased access to services. For instance, the hospitals have collaborated in a HRSA grant has been funding a chronic care consortium to more closely monitor patients with chronic conditions and to proactively attend to their needs. The overall goal is to address their health issues on a more consistent and timely basis, thereby increasing their health status while decreasing the cost of care. Lastly, we collaborate with Holy Rosary Healthcare in Miles City, MT to offer a medically guided wellness program called "Healthy Lifestyles" which focuses on nutrition, exercise and mental wellbeing. The purpose of the program is to help participants make long-term, sustainable changes to live a more healthful life. Participants receive 1:1 personal coaching as well as regular group education sessions via telemedicine.One of our larger efforts to assist with community health improvement is to take an active role in offering, serving and significantly subsidizing noon meals to seniors. FMC collaborates with our local Council on Aging to serve 1,788 meals each year to seniors in our facility dining room as well as an additional 2,501 meals through Meals on Wheels. This program promotes health and well-being of our seniors by providing nutritious meals to those who might otherwise not receive them, especially those who are home bound.FMC's workforce development support is largely focused on healthcare careers. We annually work with the local school system to offer "Medical Explorers," which allows students to ask medical professionals questions about their job and learn about the myriad of healthcare careers. Some years we are able to secure a patient simulator to give students a real-life experience. Additionally, we allow students of all levels to request an opportunity to job shadow a healthcare professional. In the past, students have observed lab techs, radiology techs, therapists, nurses, doctors and mid-levels in their daily activities of providing care for patients. Our CEO and Foundation Director serve on two Montana healthcare-related scholarship committees. Their participation on these committees promotes healthcare-related careers by helping to fund college educations. Part III, Line 2: Bad debt expense is reported as charges at gross charges recorded by the organization.Bad debts are expensed when accounts are determined uncollectible (charges less any payments or insurer discounts) and any payments toward bad debt are booked as bad debt recovery. Part III, Line 3: The estimated amount of bad debt expense attributable to patients eligible under the organization's charity care policy is 5.9% (based upon US Census Bureau Quickfacts for percent of citizens below the poverty level in Fallon County). Fallon Medical Complex is estimating the amount of bad debt to be charity care based on the percentage of demographics below charity care income/asset levels. This identifies a reasonable percentage of individuals who potentially qualify for charity care but may not have applied and therefore were written off to bad debt. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 10 of the attached audited financial statements. Part III, Line 8: Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.All of the Medicare shortfall should be treated as a community benefit. The Organization treats individuals regardless of the ability to pay. It is a community benefit to be able to treat all individuals at the local hospital and clinic. Part III, Line 9b: Once a patient has been determined by FMC to be eligible for financial assistance, that patient shall not receive any future bills based upon undiscounted gross charges on approved account balances. Requests for financial assistance shall be processed promptly. FMC shall notify the patient in writing within 30 days of receipt of a completed application. Collection activity will be suspended while a financial assistance application is under review. Normal collection efforts will resume if the application is not returned in a timely fashion or after the write-off is complete and the patient owes a balance. Part VI, Line 2: We have traditionally received input about unmet community health care needs from a number of sources: a) citizens, board members, patients, and residents expressing an idea or a concern, b) suggestions from consultants who were hired to provide a study of our operations, c) the county or state health department providing observations or data regarding the health status of our specific population, d) staff members gleaning information from an education program or from reviewing professional journals and periodicals regarding the latest equipment or trends in patient and resident care, e) suggestions from the public posted on our website, etc. We have completed a formal Community Health Services Development assessment through Montana State University, the result of which is available on our website, www.fallonmedical.org. Subsequent to the CHNA, we developed a 3 year implementation plan to address the most important health needs in our community. This plan is also published on our website. Information from all of these sources is analyzed on a case by case basis by the department manager who would be responsible for implementing the program. The manager determines the program's merit relative to our stated mission as well as what resources would be necessary to implement the program. The manager submits the analysis to our internal Operational Review Committee, which looks at its impact facility-wide and its feasibility. If it progresses past this committee, it is then evaluated by our management team, who analyzes the finer details. Ultimately, it is discussed at the Board of Trustees level to seek their input and approval, if necessary. Part VI, Line 3: We notify our patients of our financial assistance program through a number of methods; (1) we post the charity care policy, or a summary thereof, and financial assistance contact information in admissions areas, emergency rooms, facility website, other areas of our facility in which eligible patients are likely to be present, public health department, senior citizen center and courthouse; (2) we make available a copy of the policy, or a summary thereof, and financial assistance contact information to patients as part of the intake process; (3) we provide a copy of the policy, or a summary thereof, and financial assistance contact information to patients with discharge materials; (4) we include the policy, or a summary thereof, along with financial assistance contact information, in patient bills; and/or (5) we discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assist the patient with qualification for such programs, where applicable. In addition, we offer the free services of a certified "Navigator" who can assist the public while evaluating health insurance choices offered in the ACA Marketplace. Part VI, Line 4: Fallon Medical Complex (FMC) is a sole community health care provider for a rural population in excess of 7,200 people spread over seven counties. In addition to serving Fallon County, located in southeastern Montana, FMC also provides health care for three bordering Montana counties (Carter, Wibaux, and part of Custer) and three adjacent North Dakota counties (Slope, Golden Valley, and part of Bowman). Considered "frontier" by the Montana Department of Public Health and Human Services, this region boasts less than two residents per square mile. FMC operates a critical access hospital, a rural health clinic, and a home care and personal services agency. Although Carter County operates a Critical Access Hospital and a Rural Health Clinic in Ekalaka, MT (35 miles to the south), facilities offering the next highest level of care are over 80 miles from Baker, necessitating a drive of nearly two hours in inclement weather. Two primary care physicians and two mid levels (physician assistants and/or family nurse practitioners) practice full time in Baker and see patients two days a week in our satellite clinic in Wibaux, MT. In addition, FMC's physicians supervise physician assistants in Ekalaka, MT and in Wibaux, MT. All in all, the DHHS Bureau of Primary Health Care has designated FMC's service area as a Health Professional Shortage Area (HPSA) due to: a) a high population-to-physician ratio (greater than 3,500:1), b) the extreme remoteness of this facility, c) sparseness of our service area, and d) excessive distances to alternative providers.The majority of patients in FMC's service area are Caucasian (96%), older than age 45 (52%) and have graduated from high school (96.2%). The per capita income is about $31,902 per year (compared to $27,309 for all of Montana) and the unemployment rate is 1.3% (compared to 3.8%). About 8.5% of the population is below the Federal Poverty Level and roughly 6.5% of the population does not have health insurance. Of those with health insurance, 22% are covered by Medicare, and 6% are covered by Medicaid. Of those people on Medicaid, 21% receive mental health services. In all, according to a Robert Wood Johnson Foundation study, Fallon County is ranked 3 out of 47 for "health factors," based on health behaviors, clinical care, social and economic factors, and physical environment.Like most rural Montana areas, FMC's service area economy is largely based on agriculture. Wheat and barley are major farm crops and cattle and sheep dominate the local livestock production. The other major contributor towards the local economy is oil and gas exploration and extraction. Many residents are employed by large energy exploration and drilling companies or smaller energy-related service companies. The area recently entered the alternative energy arena when wind farms began cropping up across the wind-swept prairie. Part VI, Line 5: All members of the Board of Trustees reside in our primary service area and are neither employees, contractors, nor family members of FMC. They are not compensated for their participation on the board and must be interested in, and willing to work towards, the best interests of health care in our service area. The board strives to find trustee candidates from all corners of FMC's service area, as well as diversity in gender and occupations. The Board is comprised of individuals who work as educators, ranchers, small business owners, retirees, and oil company managers.One of the board's responsibilities is to maintain and oversee FMC's Medical Staff. As such, they are responsible for granting privileges to qualified physicians and mid-levels (providers) based on education and skills confirmed through a structured credentialing process. The board extends medical staff privileges to all qualified providers that have an interest in providing services to our patients and who complete our formal application process. This process includes conducting due diligence through background checks, verification of education and credentials, and personal and professional reference checks. Providers may offer their services directly in our community or remotely via telemedicine systems.Given the isolated rural location of FMC as well as its limited service area population, the facility typically does not generate surplus funds from operations. A delicate balance exists between forecasting an anticipated revenue stream and attempting to match up operational expenses. Given that no revenue is guaranteed, adjustments must be made throughout each fiscal year to ensure the facility's ongoing solvency. Accordingly, FMC has not realized a net profit from operations for over 20 years.Most "surplus" funds are derived from gifts, grants, and fundraising efforts, all of which are generally focused on acquiring capital for the acquisition of patient care equipment. Some of these purchases are meant to upgrade equipment that has reached the end of its useful life cycle, in which case we strive to leverage design or technology improvements to provide greater comfort and effectiveness for the benefit of our patients. And in some cases, we use the funding to start a new service which was identified through our various needs assessments.FMC is predominantly a sole community "primary care" provider for its service area. Its system, or complex, of health care services was created out of necessity due to its remoteness. FMC lacks the resources and service area population to offer specialized medical services and/or conduct formal medical education and medical research. For the most part, we have striven to incrementally improve and enhance our core service offerings in an effort to increase the overall health status of our patients and residents. Accordingly, we strive to excel at primary care, offering family practice and preventative health outpatient services, routine hospital and fully digital diagnostic services, 24-hour emergency care (available to all regardless of ability to pay), long-term care, home-based skilled and personal care, and physical and occupational therapy. FMC is a sole community "primary care" provider, operating a 24-hour emergency room available to all patients regardless of an ability to pay. Its ER includes a telemedicine connection to the Avera eCare Network which offers on-demand board certified physicians on call 24-hours a day.In an effort to provide comprehensive medical care to the community, various providers from neighboring communities routinely offer services to patients at FMC. For instance, chiropractic, dental, and hearing aid clinics are held regularly in Baker. In addition, FMC's primary medical care is augmented by visiting physicians such as Obstetricians and Pediatricians.In addition, our Telemedicine system is routinely used by participants in a Chemical Dependency (CD) support, education, and life skill class, allowing participants to interact with other participants and counselors in neighboring communities without having to drive for more than an hour each way multiple times each month. It is also used to conduct Healthy Lifestyles classes in conjunction with Holy Rosary Healthcare in Miles City, MT and to connect our patients with specialists located at Billings Clinic. Although we are not a formal teaching facility, we do host multiple students annually who are seeking careers in healthcare related disciplines. This includes high school students who would like to job shadow, to medical students who are completing a primary care rural rotation. We have a number of cooperative agreements with colleges and universities across the nation that allow students a variety of clinical experiences, from observation of care by a trained professional to providing limited patient services under direct supervision. In the past few years, we have hosted students pursuing careers as nurses, lab techs, radiology techs, physician assistants, physical therapists and physicians, coming from Pennsylvania, Washington State, Florida, Utah and Montana.In addition, FMC's Hospital Helpers organization has 30 members who volunteer their time by fundraising for various projects, working in our long term care area -- operating a beauty shop, visiting with residents, and providing assistance with activities -- and managing a small gift shop in the hospital. All of the money raised by this group is gifted to the facility for the purchase of essential furniture, fixtures, and equipment. The community also provides 36 specialty volunteers who offer their talents to our facility. For example, various music groups provide events throughout the year and clergy from surrounding churches hold regular church services and help with special needs. Volunteers also read newspapers and books, hold bible study classes, and decorate rooms and hallways for our residents.FMC operates a foundation that exists solely to attract and manage funds from donors who would like to provide financial support in the furtherance of FMC's mission. This separate non-profit entity is governed by its own Board of Directors, which raises the funds, manages the investments, and determines how the funds should be spent. One of their most actively managed efforts is the awarding of scholarships to students from our service area seeking healthcare careers.We also encourage our staff to be involved in community-related boards and programs. For instance, our Foundation Coordinator has been a member of a local housing board, searching for ways to address our community's chronic housing shortage, as well as a county-supported economic revitalization team, and the local chamber of commerce. Furthermore, a number of employees participate in disaster preparedness meetings through the Local Emergency Preparedness Committee and provide leadership roles in Boy Scouts, 4H, Business Professionals of America, Medical Explorers and Speech and Drama.Lastly, FMC participates in many government-sponsored health care programs, including Medicare, Medicaid, Champus/Tricare, CHIP, and VA Choice. Plus, we recently agreed to participate in the newly expanded Medicaid program (HELP) offered in Montana. We have also embraced participation in a number of voluntary government-sponsored programs that focus on quality assurance and process improvement, both independently, as well as through collaborative efforts with other Montana hospitals and associations (such as the Montana Health Network, the Montana Hospital Association, the Mountain-Pacific Quality Health Foundation and the Hospital Improvement Innovation Network). 1 Friends of FMC Foundation Inc PO BOX 820 Baker MT 59313 431975486 501(c)(3) 32873 Cost In kind donation of wages and supplies 1 0 Part I, Line 2: The organization pays for the salaries and wages of the Foundation Director for Friends of FMC Foundation, a related organization, as well as small amounts of supplies. X X 0 0 0 0 0 0 0 0 0 David Espeland Chief Executive Officer 135458 0 0 0 0 0 5088 0 18384 0 158930 0 0 0 Darryl Espeland Employee and brother of CEO 31742 Compensation 0 Form 990, Part VI, Section A, line 6 The members of the Corporation shall consist of all trustees and those individuals who apply for membership and fulfill the qualifications for membership which are established by the Board of Trustees. Form 990, Part VI, Section A, line 7a Elections for Trustees shall be held at the annual membership meeting, or by written ballot if authorized by the Board of Trustees. Any vacancy occurring on the Board of Trustees may be filled by appointment by the President of the Board of Trustees subject to confirmation by a majority of the members of the Board present at the next regular meeting of the Board following such appointment. Form 990, Part VI, Section A, line 8b The organization does not have a committee that acts on behalf of the governing board. Form 990, Part VI, Section B, line 11b The Form 990 is emailed to the Board of Trustees for their review and they are allowed to comment prior to filing. Form 990, Part VI, Section B, line 12c The organization's policy requires a duty to disclose any conflicts annually as well as during discussions. The conflict of interest policy covers all members of the board, officers and employees. Board Members, officers and employees complete a questionnaire annually addressing potential areas of conflicts. Conflicts are determined by each individual. Conflicts are determined by each individual, but reviewed at the board level. If a conflict arises, the board member abstains from voting on matters that gave rise to the conflict. Form 990, Part VI, Section B, line 15 The Montana Hospital Association (MHA) publishes its compensation data for all classifications of healthcare workers annually. The data pertaining to facilities comparable in size is used to determine executive and officer compensation. The Board may also choose to call their peers in other facilities to substantiate the MHA data and to confirm the appropriateness of any proposed compensation. The board votes and approves the compensation for officers such as the CEO and CFO. The decisions are documented on an annual basis when salaries are approved. The process last took place at the end of fiscal year 06/30/20 and the board approval of the budget for FY2021 was at the 06/03/2020 Board Meeting. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy and financial statements are available for inspection at the corporation's place of business upon request. Form 990, Part IX, line 11g Contract Services: Program service expenses 1,841,639. Management and general expenses 1,908. Fundraising expenses 0. Total expenses 1,843,547. Professional Services: Program service expenses 1,157,226. Management and general expenses 73,172. Fundraising expenses 0. Total expenses 1,230,398. Other Fees: Program service expenses 45,140. Management and general expenses 19,443. Fundraising expenses 0. Total expenses 64,583. Form 990, Part XI, line 9: Correction of an Error - Unrecorded investment in a cooperative 114,361. Equity in Earnings of Affiliate recorded in Revenue for Financial Statement 28,749. Form 990, Page 1, Line C: Fallon Medical Complex, Inc. is doing business under the following names: Community Clinic, Home Care Services, Fallon Memorial Hospital, and Wibaux Clinic. Friends of FMC Foundation PO Box 820 Baker MT 59313 431975486 Foundation/Fundraising MT 501(c)(3) Line 7 N/A 0 0 1 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0