2020-06-09T10:02:38-05:00 2019-06-30 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2018-07-01 810231784 BILLINGS CLINIC % CONNIE PREWITT BILL 4062382500 2800 TENTH AVENUE NORTH BILLINGS MT 59101 CONNIE PREWITT CFO 4062382500 2020-06-15 true Adam R Smith CPA P00958966 7194714290 167.68.126.162 84022720201615000001 2020-06-09 P 7A8E4E6C55496AC813B37C00A7D0D4376FF3E547 92A75B55B8292751772432B3C3EF096EC78527EF 2018 2020-09-23 17:36:50Z Scott Ellner 2800 TENTH AVENUE NORTH BILLINGS MT 59101 2343233454 false X WWW.BILLINGSCLINIC.ORG X 1907 MT BILLINGS CLINIC IS MONTANA'S LARGEST HEALTHCARE ORGANIZATION CONSISTING OF A 304 BED HOSPITAL, PRIMARY CARE AND OVER 50 MULTI SPECIALITY CLINICS. 11 8 4999 200 18079878 7538158 3949753 3823440 762286536 756822281 11140468 17946646 13693404 18733224 791070161 797325591 273494 410918 0 0 379579592 394056994 0 0 0 331021358 328929259 710874444 723397171 80195717 73928420 882833730 1051858268 262095510 336321091 620738220 715537177 X BILLINGS CLINIC MISSION IS HEALTH CARE, EDUCATON AND RESEARCH. BILLINGS CLINIC WILL PROVIDE BEST IN NATION CLINICAL QUALITY, PATIENT SAFETY, SERVICE AND VALUE. true false 334297324 238332 433434922 BILLINGS CLINIC IS A 304 BED HOSPITAL PROVIDING SURGICAL, LABOR AND DELIVERY, PSYCHIATRIC, CANCER CARE, NEONATAL SERVICES AND ACUTE CARE. BILLINGS CLINIC HAD OVER 15,800 ADMISSIONS IN FY19. 207494890 147931 292574435 BILLINGS CLINIC HAS OVER 440 PHYSICIANS AND ADVANCED PRACTITIONERS OFFERING MORE THAN 50 SPECIALTIES. PRIMARY CARE IS AVAILABLE AT MULTIPLE LOCATIONS INCLUDING BILLINGS CLINIC DOWNTOWN, HEIGHTS, WEST END, CODY WY, MILES CITY AND BOZEMAN. IN ADDITION, BILLINGS CLINIC CONDUCTS SPECIALTY CARE CLINICS FOR MORE THAN 20 REGIONAL LOCATIONS IN MONTANA, WYOMING AND NORTH DAKOTA. BILLINGS CLINIC HAD OVER 820,000 PATIENT VISITS IN FY19. 34582482 24655 31310837 BILLINGS CLINIC SPECIALTY PHARMACY FOCUSES ON THE PHARMACY CARE OF CHRONIC, RARE OR COMPLEX CONDITIONS THAT REQUIRE SPECIALTY MEDICATIONS. SPECIALTY MEDICATIONS TYPICALLY REQUIRE SPECIAL HANDLING, ADMINISTRATION OR MONITORING BEYOND THAT WHICH A TRADITIONAL RETAIL PHARMACY CAN PROVIDE. WE WORK TO ENSURE APPROPRIATE MEDICATION USE AND PROMOTE ADHERENCE. BILLINGS CLINIC SPECIALTY PHARMACY IS PART OF THE LARGEST HEALTH CARE SYSTEM IN THE REGION. OUR STAFF WORKS WITH YOU, YOUR PROVIDER AND YOUR INSURANCE COMPANY TO MAKE SURE YOUR NEEDS ARE MET. OUR GOAL IS TO MAKE BILLINGS CLINIC A ONE-STOP SOLUTION. 576374696 true true false true false false false false false true true false false true true false false true false false false false false false false false true true true true true true false false false false false false false true false true false false false false true true true true false true 193 0 4999 true true true false false false false false false false false false true false X 11 8 true false false false false false false true true false false true true true true true true true true true true X CONNIE PREWITT 4062382134 2800 TENTH AVENUE NORTH BILLINGS MT 59101 DAVID BROWN BOARD MEMBER 5.0 0.0 X 6000 0 0 JOY OTT BOARD CHAIRPERSON 5.0 0.0 X X 0 0 14418 ELIZABETH FULTON BOARD TREASURER 5.0 0.0 X X 0 0 7613 LIL ANDERSON BOARD SECRETARY 5.0 0.0 X X 4500 0 6000 PENNI NANCE BOARD VICE CHAIR 5.0 0.0 X X 6000 0 0 CRAIG BARTHOLOMEW BOARD MEMBER 5.0 0.0 X 0 0 6545 ROBERT PUERINGER MD PHYSICIAN BOARD MEMBER 60.0 0.0 X 438632 0 55540 WILLIAM EBZERY BOARD MEMBER 5.0 0.0 X 6000 0 0 FRANK REED BOARD MEMBER 5.0 0.0 X 3000 0 0 KEITH COOK BOARD MEMBER 5.0 3.0 X 4500 0 6000 RANDALL GIBB CEO 60.0 1.0 X X 1227942 0 48499 John Schallenkamp MD PHYSICIAN BOARD MEMBER/INterim CO-CEO 60.0 0.0 X 594691 0 60392 CONNIE PREWITT CHIEF FINANCIAL OFFICER 60.0 0.0 X 675933 0 54323 Robert Merchant MD Interim Co-CEO 60.0 0.0 X 501170 0 49209 Scott A Sample Physician 60.0 0.0 X 964414 0 56636 Barry N Smith Physician 60.0 0.0 X 901408 0 48933 Brian R Rah Physician 60.0 0.0 X 900652 0 47212 Mark MOrasch Physician 60.0 0.0 X 895729 0 49891 Jared J Lund Physician 60.0 0.0 X 872912 0 48744 Clayton H McCracken Former Physician Board Member 40.0 0.0 X 298464 0 53997 Darrell Ehrlick Former Board Member 0.0 0.0 X 30969 0 0 8332916 0 613952 548 true true false HAyes Locums 6700 N Andrews Ave STE 600 FORT LAUDERDALE FL 33309 Physicians Services 7868865 Sodexo PO BOX 360170 PITTSBURGH PA 15251 Food Service 3720470 Medefis Consolidated PO Box 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102843036 0 Due to MDOR 553630 Deposits 9490 Interest rate Swap Agreement 18283497 Estimated Claims Liability 11253213 Accrued Interest 2029394 Provision for Unpaid Claims 11175228 Unearned Premiums 429763 43734215 SCHEDULE D, PART V, LINE 4 THE ORGANIZATION'S ENDOWMENT CONSISTS OF APPROXIMATELY 82 INDIVIDUAL FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES. THE ENDOWMENT INCLUDES BOTH DONOR-RESTRICTED ENDOWMENT FUNDS AND FUNDS DESIGNATED BY THE GOVERNING BODY TO FUNCTION AS ENDOWMENTS. ENDOWMENT FUNDS ARE INVESTED AND HELD TO PROVIDE GROWTH OVER THE LONG-TERM. Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true X true X true X true true true false true true 12784393 12784393 0.01760 114624524 106174180 8450344 0.01160 127408917 106174180 21234737 0.02920 3973618 378345 3595273 0.00490 9399893 5793400 3606493 0.00500 29420921 23521217 5897704 0.00820 1528764 229518 1299246 0.00180 1055400 1055400 0.00150 45378596 29922480 15454116 0.02140 172787513 136096660 36688853 0.05060 28680 28680 0.00000 194418 194418 0.00030 45 1426 1426 0.00000 835000 835000 0.00120 45 1059524 1059524 0.00150 false 14065078 235924012 292261369 -56337357 X true true 1 1 BILLINGS CLINIC 2800 TENTH AVENUE NORTH BILLINGS MT 59101 WWW.BILLINGSCLINIC.COM 13345 X X X X X 1 BILLINGS CLINIC false false true X X X X X X X X X 17 true true true true X SEE PART V, Section C FOR URL X WWW.HEALTHYBYDESIGNYELLOWSTONE.ORG true 17 true WWW.HEALTHYBYDESIGNYELLOWSTONE.ORG false true X 200. 400. X X X X X true true X X X X true X WWW.BILLINGSCLINIC.COM/FINASSIST X WWW.BILLINGSCLINIC.COM/FINASSIST X See Part V,Section C for URL X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 THE 2016-17 COMMUNITY HEALTH NEEDS ASSESSMENT FOR YELLOWSTONE COUNTY IS A SYSTEMATIC, DATA-DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS, BEHAVIORS AND NEEDS OF OUR POPULATION. SUBSEQUENTLY, THIS INFORMATION MAY BE USED TO INFORM DECISIONS AND GUIDE EFFORTS TO IMPROVE COMMUNITY HEALTH AND WELLNESS. THERE ARE THREE COMPONENTS THAT ARE ESSENTIAL IN RENDERING A COMPLETE PICTURE OF THE HEALTH OF YELLOWSTONE COUNTY: (1) THE COMMUNITY HEALTH SURVEY [PRIMARY QUANTITATIVE DATA]; (2) EXISTING DATA [SECONDARY QUANTITATIVE DATA]; AND (3) ONLINE KEY INFORMANT DATA [PRIMARY QUALITATIVE DATA]. THE COMMUNITY HEALTH SURVEY DEVELOPED FOR THIS STUDY GIVES US A COMPLETE AND TIMELY VIEW OF THE HEALTH STATUS AND BEHAVIORS OF AREA RESIDENTS THROUGH A RANDOMIZED TELEPHONE SURVEY OF 400 YELLOWSTONE COUNTY ADULTS. ALL ADMINISTRATION OF THE SURVEYS, DATA COLLECTION AND DATA ANALYSIS WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. (PRC). THE SAMPLE DRAWN FOR THIS SURVEY IS REPRESENTATIVE OF THE ADULT YELLOWSTONE COUNTY POPULATION IN TERMS OF DEMOGRAPHIC AND SOCIOECONOMIC CHARACTERISTICS, AS WELL AS GEOGRAPHICAL LOCATION. THE MAXIMUM ERROR RATE ASSOCIATED WITH THE TOTAL SAMPLE OF 400 IS 14.9% AT THE 95 PERCENT LEVEL OF CONFIDENCE. EXISTING VITAL STATISTICS AND OTHER DATA ARE INCORPORATED INTO THIS ASSESSMENT FOR YELLOWSTONE COUNTY. COMPARISONS ARE ALSO MADE, WHERE AVAILABLE, TO STATE AND NATIONAL BENCHMARKS. FURTHERMORE, WHEREVER POSSIBLE, HEALTH PROMOTION GOALS OUTLINED IN HEALTHY PEOPLE 2020 ARE INCLUDED. TO SOLICIT INPUT FROM KEY INFORMANTS, THOSE INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED AS PART OF THIS PROCESS. 194 PARTICIPANTS INCLUDED HEALTHCARE PROVIDERS, PUBLIC HEALTH REPRESENTATIVES, GOVERNMENT REPRESENTATIVES, EDUCATORS, BUSINESS LEADERS, AND A VARIETY OF OTHER COMMUNITY LEADERS AND COMMUNITY MEMBERS. SCHEDULE H, PART V, SECTION B, LINE 6A&6B BILLINGS CLINIC'S COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED IN A PRE-EXISTING COMMUNITY HEALTH PARTNERSHIP, THE ALLIANCE, WITH ST. VINCENT HEALTHCARE (HOSPITAL ORGANIZATION) AND RIVERSTONE HEALTH (PUBLIC HEALTH DEPARTMENT FOR CITY AND COUNTY). THE ALLIANCE ALSO CONDUCTED A CHNA IN 2006, 2011 AND 2014 SCHEDULE H, PART V, SECTION B, LINE 7A Direct URL for the CHNA: https://www.billingsclinic.com/app/files/public/4109/2019-2020-Community-N eeds-Health-Assesment-Report.pdf SCHEDULE H, PART V, SECTION B, LINE 11 Billings Clinic has been addressing the needs that we have the resources to address, based on strategies to align, enhance and develop programs based on a set of criteria established by our Community Health Improvement Task Force. We are following our 2017-2020 Community Health Improvement Plan (CHIP). A new CHNA process began in the spring of 2019 and will be completed and released in early 2020. The county-wide 2017 Community Health Needs Assessment that we participated in identified the following community health "Areas of Opportunity": - Access to health care services: cost of prescriptions, appointment availability, find a physician - Cancer: cancer deaths (prostate and colorectal); cancer incidence; female breast cancer screening; cervical cancer screening. - Dementia, including Alzheimer's disease: deaths - Diabetes: prevalence or borderline/pre-diabetes - Heart disease and stroke: deaths and prevalence of high blood pressure - Infant health and family planning: low-weight births and infant mortality - Injury and violence: motor vehicle crash deaths, seatbelt usage, firearm-related deaths, firearm storage and safety - Mental health: fair/poor mental health, diagnosed depression, suicide deaths, suicide ideation - Nutrition, physical activity and weight: adult obesity - Potentially-disabling conditions: activity limitations; back pain prevalence; blindness/vision - Respiratory diseases: chronic lower respiratory disease; pneumonia/influenza deaths - Substance abuse: cirrhosis/liver disease deaths; drug-induced deaths; personal impact of substance abuse - Tobacco use: cigarette smoking prevalence Billings Clinic addresses these needs at the organizational level with efforts to improve awareness and education, as well as to remove barriers to care. Work is done with clinical departments, service lines, nursing and medical education, community relations, population health, care management, city/county health department, and the state and federal government. At this time, Billings Clinic does not have the resources necessary to address all needs, although we are part of several community-wide coalition to address these in a collaborative way. The needs we are unable to directly address include lack of transportation as a barrier to access (member of Billings Transportation Coalition) and access to dental care (we do not offer dental services). In some areas we don't offer any services, but we do advocate on policy such as seat belt usage, firearm safety, and expanding health insurance coverage. Our CHNA was focused on the Yellowstone County, our primary service area where the majority of our patients come from. CHNA prioritization meetings, with more than 100 community members attending, resulted in a priority of "healthy weight" based on 1. the scope and severity and 2. the ability to impact. Healthy weight includes the components of physical activity, nutrition and social connection. These three topics can benefit many of the community health opportunities, including chronic diseases such as diabetes and heart disease, mental health, and adult obesity, as well as primary prevention efforts targeted at kids and teens. The Yellowstone County CHNA process included prioritizing healthy weight at the county level for work based on the model of "Collective Impact," working together towards a common goal with shared resources. We based our Community Health Improvement Plan (CHIP) on that priority, with three strategies that Billings Clinic supports within our organization and across all of Yellowstone County. Overview: Strategy 1 - Healthy Food Retail and Healthy Food Procurement Current Situation: While an individual can avoid physical activity by simply not doing it, daily consumption of food is a necessary part of survival. However, Yellowstone County residents experience several barriers to consuming healthy foods, including affordability and availability. What if your morning latte came with a side of fresh fruit or a simple salad? One key strategy for increasing access to healthy foods, such as fruits and vegetables, is to encourage our local food retailers and institutions to stock and promote these items. Activities selected below aim to increase the prevalence of healthy foods throughout our daily lives, so that the healthy choice is the easy choice. Strategy Description: There is strong evidence that a strategy focused on healthy food retail and healthy food procurement methods is an effective approach to improve healthy weight and increased consumption of nutritional foods. Retail environments and institutional meal offerings, including schools, workplaces, neighborhood convenience stores, and coffee shops, can each play a significant role in consumer food choices, for better or worse. This is especially true for residents of neighborhoods that lack access to full-service grocery stores, who otherwise may find it easier to find junk food than fruits and vegetables. Examples of proven activities related to this strategy include increasing retail offerings to include nutritious options, intentional product placement and marketing of these foods, while de-emphasizing unhealthy products such as tobacco, alcohol, sugary drinks and other junk foods. Sources: ChangeLab Solutions, US Surgeon General, CDC Winnable Battles, Procurement - City Health Overview: Strategy 2 - Creating and Improving Access to Places, Parks, and Playgrounds for Physical Activity and Creating and Maintaining Safe Neighborhoods Current Situation: Yellowstone County and Billings have several beautiful parks and places for recreation. However, the ability to access these destinations without a car, and safety concerns related to some of these destinations are barriers to their enjoyment. One key strategy for promoting use of existing facilities, including parks and bikeways, is to normalize their use. Activities selected below promote the normalization of active transportation and parks to increase physical activity. The more this infrastructure is utilized, the safer and popular it becomes. Strategy Description: There is strong evidence that a strategy focused on creating and improving access to places for physical activity, maintaining safe neighborhoods, and improving access to parks and playgrounds is an effective approach to improve healthy weight and physical activity. Examples of proven activities related to this strategy include increased access to facilities such as walking trails and exercise spaces, joint and shared use agreements, Complete Streets policies, Complete Parks, safe routes to school and parks, and zoning that promotes accessibility and activity. Overview: Strategy 3 - Provide Space for Organized Activities that Encourage Social Participation and Inclusion Current Situation: Overweight and obese adults are more likely to report a number of adverse health conditions, including fair/poor overall health and fair/poor mental health. Yellowstone County residents are increasingly active; however, disparities persist among lower-income residents and seniors. Key informants noted a lack of supportive built environment that does not always support healthy living as a significant concern. Local senior service and mental health representatives believe identification and development of community gathering places would be beneficial to their respective clients as social isolation and inactivity are often interwoven. A key strategy to promote activity and social engagement is to enhance or create spaces that are welcoming and accessible to all, with organized activities and opportunities for social engagement. Strategy Description: The evidence states this is an effective strategy for improved weight and increased physical activity by creating safe, attractive opportunities for all residents to be active and engaged. Research shows that perceptions of poor safety, unwelcoming spaces, and inaccessibility are all barriers to activity and that social engagement is associated with better health outcomes. SCHEDULE H, PART V, SECTION B, LINE 16C DIRECT URL FOR PLAIN LANGUAGE SUMMARY: https://www.billingsclinic.com/app/files/public/3205/Financial-Assistance- Policy-Summary.pdf Schedule H, Part V, Section B, Line 16i Translation of FAP for LEP Populations: Billings Clinic has considered the need for a plain language summary for those with limited english proficiency. We have translation of most languages available to patients through our MARTTI translation services, online or by phone translation for discussing and translating financial assistance materials. 14 BILLINGS CLINIC 1045 N 30TH STREET BILLINGS MT 59101 OUTPATIENT CLINIC BILLINGS CLINIC MILES CITY 620 SOUTH HAYNES AVENUE MILES CITY MT 59301 OUTPATIENT CLINIC BILLINGS CLINIC HEIGHTS 760 WICKS LANE BILLINGS MT 59105 OUTPATIENT CLINIC BOZEMAN OBGYN 925 HIGHLAND BLVD BOZEMAN MT 59715 OBSTETRICS AND GYNECOLOGY CLIN BILLINGS CLINIC SURGERY CENTER 2929 TENTH AVENUE NORTH BILLINGS MT 59101 OUTPATIENT SURGERY CENTER BILLINGS CLINIC WEST 2675 CENTRAL AVENUE BILLINGS MT 59102 OUTPATIENT CLINIC BEHAVIORAL HEALTH CENTER 1020 NORTH 27TH STREET 4TH FL BILLINGS MT 59101 OUTPATIENT MENTAL HEALTH Center BILLINGS CLINIC CODY 201 YELLOWSTONE AVENUE CODY WY 92414 Outpatient Clinic BILLINGS CLINIC CANCER CENTER 801 NORTH 29TH STREET BILLINGS MT 59101 CANCER CARE, INFUSION, PSYCHIATRIC CENTER 1020 NORTH 27TH STREET BILLINGS MT 59101 INPATIENT PSYCHIATRIC CENTER HOME OXYGEN 801 N 27TH STREET BILLINGS MT 59101 DURABLE MEDICAL EQUIPMENT LIVINGSTON HOME OXYGEN 1201 US HWY 10 WEST LIVINGSTON MT 59047 DURABLE MEDICAL EQUIPMENT BOZEMAN PEDIATRICS 1819 S 22ND STREET BOZEMAN MT 59715 PEDIATRIC OUTPATIENT CENTER Medicine BILLINGS CLINIC ORTHOPEDICS 2702 8TH AVENUE NORTH BILLINGS MT 59101 ORTHOPEDICS AND SPORTS SCHEDULE H, PART I, Line 3c Description of additional criteria to determine financial assistance: IN addition to the federal poverty guidelines Billings Clinic also uses asset level, medical indigency, insurance status, underinsurance status and residency in determining eligibility for financial assistance SCHEDULE H, PART I, LINE 6A RELATED ORGANIZATION ANNUAL COMMUNITY BENEFIT REPORT: STILLWATER COMMUNITY HOSPITAL, A RELATED CRITICAL ACCESS HOSPITAL, PREPARES THEIR OWN INDEPENDENT COMMUNITY BENEFIT REPORT. SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. BILLINGS CLINIC USED THE SAME COST-TO-CHARGE RATIO THROUGHOUT THE ENTIRE SCHEDULE TO DETERMINE THE COST OF THOSE ACTIVITIES. SCHEDULE H, PART I, LINE 7G SUBSIDIZED HEALTH SERVICE COSTS: SUBSIDIZED HEALTH SERVICES INCLUDES VARIOUS PHYSICIAN CLINICS IN ORDER TO BETTER SERVE THE MONTANA AREAS. MANY CRITICAL SERVICES WERE NOT FULLY REIMBURSED SUCH AS BEHAVIORAL HEALTH, PEDIATRIC SPECIALTIES, SEXUAL ASSAULT NURSE EXAMINATION AND RURAL OUTREACH CLINICS. PRIMARY CARE CLINICS WERE ONLY INCLUDED IF THEY WERE IN RURAL, UNDERSERVED AREAS OUTSIDE OUR PRIMARY SERVICE AREA. TOTAL COSTS FOR THE SUBSIDIZED SERVICES WERE $29,140,371 AND NET COMMUNITY BENEFIT OF THOSE SERVICES WAS DETERMINED TO BE $5,707,340. SCHEDULE H, PART II COMMUNITY BUILDING ACTIVITIES: BILLINGS CLINIC'S COMMUNITY BUILDING ACTIVITIES INCLUDE DISASTER PLANNING, ADVOCACY FOR PATIENT CARE, HEALTH CARE AND COMMUNITY HEALTH; SCIENCE EXPO FOR WORKFORCE DEVELOPMENT; AND THE RECENT STATE OF MONTANA IMPLEMENT EARLY CHILDHOOD (PRE-KINDERGARTEN) EDUCATION PROGRAMS FOR UNDERSERVED FAMILIES AROUND THE STATE. SCHEDULE H, PART III, SECTION A, LINE 2 THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED June 30,, 2019. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT AS COMMUNITY BENEFIT: THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. Schedule H, Part III, Section B, Line 8 ALLOWABLE MEDICARE COSTING METHODOLOGY: BILLINGS CLINIC ESTIMATES THAT 45 PERCENT OF BILLINGS CLINIC'S MEDICARE SHORTFALLS SHOULD BE COUNTED AS COMMUNITY BENEFIT. OUR RATIONALE IS THAT 45 PERCENT IS THE BEST ESTIMATE OF THE PERCENTAGE OF MONTANA'S MEDICARE POPULATION (65 AND OLDER) WHO ARE AT OR BELOW 200% OF FEDERAL POVERTY LEVEL, BASED ON MEDICARE AND U.S. CENSUS DATA, AND THOSE PATIENTS WOULD QUALIFY FOR FULL FINANCIAL ASSISTANCE. A HIGHER PERCENTAGE WOULD QUALIFY FOR PARTIAL FINANCIAL ASSISTANCE WITH INCOMES FROM 200- 400 PERCENT OF FEDERAL POVERTY LEVEL. FOR THE CALCULATION OF THE UNREIMBURESED COST OF MEDICARE A RATIO OF PATIENT COST-TO CHARGES USING WORKSHEET 2 WAS UTILIZED AND APPLIED TO GROSS MEDICARE CHARGES. WE DO NOT USE THE MEDICARE COST REPORT FOR THIS NUMBER. THE COST REPORT ONLY CAPTURES REVENUE RELATED TO THE FACILITY AND DOES NOT CAPTURE REVENUE/LOSSES RELATED TO CLINICAL PROFESSIONAL SERVICES, WHICH ARE A SUBSTANTIAL PORTION OF MEDICARE SHORTFALLS. Schedule H, Part III, Section B, Line 9b COLLECTION PRACTICES: BILLINGS CLINIC HAD A FORMAL, WRITTEN POLICY IN TAX YEAR 2018, (OHA-205 "PATIENT FINANCIAL SERVICES"). WE DID HAVE A COLLECTION PROCESS, WHICH WAS USED TO SCREEN PATIENTS FOR FINANCIAL ASSISTANCE PRIOR TO MAKING PAYMENT ARRANGEMENTS FOR CARE. THE POLICY APPILES EQUALLY TO ALL PATIENTS - INSURED, UNDER-INSURED AND UNINSURED. ONCE A DETERMINATION HAS BEEN MADE AND ADJUSTMENTS APPLIED TO THE ACCOUNT BALANCE, ANY REMAINING BALANCE WOULD FALL INTO THE REGULAR GUIDELINES OF COLLECTION, GIVING PATIENTS FINANCING OPTIONS THAT WILL WORK WITHIN THEIR MONTHLY BUDGET. PATIENTS WHO CANNOT MEET THE REQUIREMENTS OF A PAYMENT ARRANGEMENT SHOULD APPLY FOR FINANCIAL ASSISTANCE. IF THEY DON'T QUALIFY FOR FINANCIAL ASSISTANCE, THEY WILL BE OFFERED INTEREST-FREE PAYMENT PLANS FOR 12 MONTHS AND THEN A LOAN. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: SINCE 1994, BILLINGS CLINIC, RIVERSTONE HEALTH AND ST. VINCENT HEALTHCARE HAVE BEEN WORKING TOGETHER AS THE ALLIANCE, CREATING AND SUSTAINING INNOVATIVE PROGRAMS THAT ADDRESS COMPLEX COMMUNITY-WIDE HEALTH ISSUES. RIVERSTONE HEALTH IS THE PUBLIC HEALTH DEPARTMENT FOR THE YELLOWSTONE COUNTY AND ST. VINCENT HEALTHCARE IS A 501(C)(3) HEALTHCARE ENTITY ALSO SERVING THE BILLINGS AREA. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY ASSISTANCE: ALL PATIENTS MAY APPLY FOR FINANCIAL ASSISTANCE. INFORMATIONAL BROCHURES WITH ONE-PAGE PLAIN LANGUAGE SUMMARY AND APPLICATION FORMS ARE AVAILABLE AT REGISTRATION DESKS IN THE CLINIC AND THE HOSPITAL, THE EMERGENCY DEPARTMENT DISCHARGE DESK, AND ON OUR WEBSITE AT WWW.BILLINGSCLINIC.COM/FINASSIST. OUR WEBPAGE INCLUDES THE FULL FINANCIAL ASSISTANCE POLICY. PATIENTS CAN ALSO CALL A DIRECT LINE TO TALK TO A PATIENT FINANCIAL REPRESENTATIVE. INFORMATION ABOUT FINANCIAL ASSISTANCE IS PRINTED ON THE BACK OF PATIENT BILLS. PATIENTS HOSPITALIZED WITHOUT IDENTIFIYING A THIRD PARTY PAYER SOURCE ARE SCREENED FOR COVERAGE/ASSISTANCE (DISABILITY, MEDICAID, VETERANS ADMINSTRATION, INDIAN HEALTH SERVICES AND WORKERS COMPENSATIONS). APPLICATIONS ARE MAILED TO PATIENTS WHOSE PAYMENT PATTERN INDICATES THAT THEY MAY NEED ASSISTANCE. PATIENT FINANCIAL SERVICES STAFF IS AVAILABLE TO HELP ANY PATIENT NEEDING ASSISTANCE COMPLETING AN APPLICATION. LANGUAGE TRANSLATION SERVICES ARE ALSO AVAILABLE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: BILLINGS CLINIC IS BASED IN BILLINGS, MONTANA AND IS MONTANA'S LARGEST HEALTH CARE ORGANIZATION SERVING A VAST REGION COVERING MUCH OF MONTANA, WYOMING AND NORTH DAKOTA. BILLINGS CLINIC IS ONE OF MONTANA'S LARGEST EMPLOYERS WITH APPROXIATELY 4,300 EMPLOYEES INCLUDING MORE THAN 450 PHYSICIANCS AND ADVANCED PRACTITIONERS OFFERING MORE THAN 50 SPECIALTIES. COMMUNITY BENEFIT INCLUDES HEALTH CARE SERVICES PROVIDED AT BILLINGS CLINIC LOCATIONS, INCLUDING THE HOSPITAL, MAIN CLINIC, BRANCH CLINICS AND OUTREACH CLINICS. BILLINGS CLINIC SPECIALISTS PROVIDE 122 OUTREACH CLINICS PER MONTH AT 20 DIFFERENT REGIONAL LOCATIONS FOR THE RESIDENTS OF MONTANA, WYOMING AND NORTH DAKOTA. Schedule H, Part Vi, Line 5 PROMOTION OF COMMUNITY HEALTH: AS A NOT-FORPROFIT COMMUNITY-GOVERNED ORGANIZATION, WORKING WITH OTHER ORGANIZATIONS IN THE COMMUNITY TO ADDRESS THE HEALTH CARE NEEDS IS AN IMPORTANT PART OF OUR MISSION. BILLINGS CLINIC HAS BEEN INVOLVED IN MEETING THE NEEDS OF INDIVIDUALS AND COMMUNITIES THROUGH COOPERATIVE EFFORTS WITH OTHER ORGANIZATIONS IN YELLOWSTONE COUNTY AND IN OUR REGION. COMMUNITY HEALTH COLLABORATION SINCE 1994, BILLINGS CLINIC, RIVERSTONE HEALTH AND ST. VINCENT HEALTHCARE HAVE BEEN WORKING TOGETHER, CREATING AND SUSTAINING INNOVATIVE PROGRAMS THAT ADDRESS COMPLEX COMMUNITY-WIDE HEALTH ISSUES. THEIR PURPOSE IS TO CREATE SUSTAINED CHANGE IN HOW OUR COMMUNITY RESPONDS TO THE CHALLENGE OF THE HIGH COST OF PRESCRIPTION DRUGS FOR THE UNINSURED AND THE POPULATION LIFESTYLE ISSUES OF OBESITY, POOR NUTRITION AND PHYSICAL ACTIVITY HABITS. THESE ARE EXAMPLES OF THE PAST AND FUTURE SUCCESSES OF THE ALLIANCE'S EFFORTS. COMMUNITY CRISIS CENTER - THE COMMUNITY CRISIS CENTER (CCC), ENHANCES\ACCESS TO BEHAVIORAL HEALTH CARE IN BILLINGS. THE CCC HAS SUCCESSFULLY REDUCED INAPPROPRIATE UTILIZATION OF LOCAL EMERGENCY DEPARTMENTS, DECREASED THE NUMBER OF SHORT-TERM INPATIENT HOSPITAL ADMISSIONS, AND HAS BEEN A DRIVING FORCE IN REDUCING THE IN MATE POPULATION AT THE YELLOWSTONE COUNTY DETENTION FACILITY. MEDICATION ASSISTANCE PROGRAM (MAP) - MAP HELPS PATIENTS AFFORD THE PRESCRIPTION DRUGS THEY NEED BY CONNECTING INDIVIDUALS WITH AVAILABLE PATIENT ASSISTANCE PROGRAMS OFFERING DISCOUNTED OR FREE PRESCRIPTION MEDICATION. MAP ASSISTS LOW INCOME, UNINSURED OR UNDER INSURED PEOPLE IN GETTING THE MEDICATIONS THEY NEED, BUT CAN'T AFFORD. HEALTHY BY DESIGN - TO HELP RECOGNIZE ORGANIZATIONS IN YELLOWSTONE COUNTY COMMITTED TO IMPROVING OUR COMMUNITY'S HEALTH, BILLINGS CLINIC, RIVERSTONE HEALTH, AND ST. VINCENT HEALTHCARE LAUNCHED A COMMUNITY HEALTH COALITION CALLED HEALTHY BY DESIGN. HEALTHY BY DESIGN ENCOURAGES, RECOGNIZES, EDUCATES AND CREATES A STANDARD OF EXCELLENCE FOR PROMOTING HEALTHY LIFESTYLES BY ENCOURAGING ACTIVE LIVING AND HEALTHY CHOICES THAT SHAPE THE FUTURE OF THE COMMUNITY. Schedule H, Part VI, Line 6 AFFILIATED HEALTH CARE SYSTEM: BILLINGS CLINIC HAS AN AFFILIATED RELATIONSHIP WITH BEARTOOTH BILLINGS CLINIC AND STILLWATER HOSPITAL ASSOCIATION. EACH HOSPITAL IS A MONTANA NON-PROFIT CORPORATION. BEARTOOTH AND STILLWATER HAVE BEEN AFFILIATES OF BILLINGS CLINIC SINCE 2002 WITH A SHARED MANAGEMENT AGREEMENT. WITHIN THE AGREEMENT BILLINGS CLINIC PROVIDES MANAGEMENT, DIGITAL INFORMATION SYSTEMS, AND ANCILLARY SUPPORT SERVICES TO AREA HOSPITALS AND CLINICS. THE AFFILIATION BRINGS A STRONGER ALIGNMENT WITHIN THE GROUP DUE TO A DESIRE TO STABILIZE AND ENHANCE THE LEVEL AND SCOPE OF HEALTH CARE SERVICES AVAILABLE IN EACH COMMUNITY. THE AFFILIATION ALLOWED THEM TO STRENGTHEN THEIR COMMITMENT TO QUALITY, PATIENT SAFETY AND SERVICE VALUES. true RONALD MCDONALD HOUSE 1144 NORTH 32ND STREET BILLINGS MT 59101 810400667 501(C)(3) 5200 SPONSOR FUNDRAISINT FAMILY SERVICE OF BILLINGS PO BOX 1020 BILLINGS MT 59101 810485182 501(C)(3) 5500 To support Operations Billings Clinic Foundation 2917 Tenth Avenue North Billings MT 59101 810407289 501(c)(3) 15166 Support PRogram Community Crisis Center LLC 704 North 30th Street Billings MT 59101 203231164 501(c)(3) 81191 Support OPerations 4 ACADEMIC SCHOLARSHIPS 88 20900 SCHEDULE I, PART I, LINE 2 Description of monitoring process for Scholarships and grants: BILLINgS CLINIC AWARDS SCHOLARSHIPS TO INDIVIDUALS WHO EXHIBIT A STRONG DESIRE AND POTENTIAL TO EXCEL IN THE HEALTHCARE FIELD. BILLINGS CLINIC ALSO PROVIDES GRANTS TO OTHER HEALTH RELATED ORGANIZATIONS. MONTHLY FINANCIAL REPORTS ARE REVIEWED AND SIGNED BY THE GRANT MANAGER, AND THEN SUBMITTED FOR APPROVAL OF THE DRAWING OF FUNDS FOR GRANTS. X X X X X false true false false false false false true false ROBERT PUERINGER MD PHYSICIAN BOARD MEMBER 434590 0 0 0 4042 0 30572 0 24968 0 494172 0 CONNIE PREWITT CHIEF FINANCIAL OFFICER 490938 0 133380 0 51615 0 24025 0 30298 0 730256 0 38816 RANDALL GIBB CEO 913644 0 268238 0 46060 0 24025 0 24474 0 1276441 0 32107 Clayton H McCracken Former Physician Board Member 295025 0 3439 28446 25551 352461 Scott A Sample Physician 959511 0 0 0 4903 0 24025 0 32611 0 1021050 0 Barry N Smith Physician 863731 0 33717 0 3960 0 24025 0 24908 0 950341 0 Brian R Rah Physician 897418 0 0 0 3234 0 24025 0 23187 0 947864 0 Mark MOrasch Physician 843656 0 50000 0 2073 0 22809 0 27082 0 945620 0 Jared J Lund Physician 870608 0 0 0 2304 0 24025 0 24719 0 921656 0 Darrell Ehrlick Former Board Member 30969 0 0 0 0 0 0 0 0 0 30969 0 John Schallenkamp MD PHYSICIAN BOARD MEMBER/INterim CO-CEO 591500 3191 27036 33356 655083 Robert Merchant MD Interim Co-CEO 409939 40750 50481 0 0 501170 Schedule J, Part I, Line 4b Description of Non-qualified retirement plan: The billings clinic supplemental retirement agreement for senior executives (SERP) is a non-elective 457(f) agreement and provides for annual deferrals, which become vested and payable after 4 years. The Following Individuals received a payment during the 2018 calendar year which is included in other reportable compensation on Schedule J, Part II, Column B: Connie Prewitt - 38,816 Randall Gibb - 32,107 Schedule J, Part I, Line 7 DESCRIPTION OF NON-FIXED PAYMENTS: THE BOARD OF DIRECTORS ANNUALLY DETERMINES THE INCENTIVE PLAN AMOUNT FOR THE CEO AND THE SENIOR EXECUTIVE TEAM BASED ON AN EXTERNAL COMPENSATION STUDY. THE AVAILABILITY OF THE INCENTIVE IS AWARDED BASED ON FINANCIAL PERFORMANCE AS WELL AS ORGANIZATIONAL PERFORMANCE MEASUREMENTS IN QUALITY, PATIENT SATISFACTION, EMPLOYEE SATISFACTION AND THE INDIVIDUAL GOALS SET EACH YEAR IF THE TARGET IS TRIGGERED. THE INCENTIVE IS PAID ONLY IF TRIGGERED FOLLOWING THE FINANCIAL AUDIT PRESENTATION. A Montana Facility Finance Authority 364615155 2018-10-01 56580000 REFUND 2011 BONDS false false false B Montana Facility Finance Authority 364615155 61204KLQ2 2018-10-01 125786085 REFUND 2008/2011 Issue false false false A 0 0 56580000 0 0 0 0 0 0 0 0 56580000 true false false true B 161152 0 125786085 40609644 0 0 0 0 0 0 0 85176141 true false false true A false false false false 0 false false false true B false false false false 0 false false false true A false true false false false false 0 false 0 true B false true false false true false 0 true Bayerische Landesban 2.75 true false true A true B true CRAIG BARThOLOMEW SEE PART V 1082580 PURCHASE OF OFFICE SUPPLIES false Schedule L, Part IV Relationship Between Interested Person & the Organization: Line 1, Column B - Craig Bartholomew, is a board member of Billings Clinic and owns an office supply company. Billings clinic purchased office supplies from the company. Transactions were conducted at arm's length for fair value with the knowledge and approval of the board. FORM 990, PART III, Line 2 Description of New program services: Billings Clinic has started a specialty pharmacy focusing on the pharmacy care of Chronic, rare or complex conditions that require specialty medicines. See Part III, Line 4c for the description of the activity. FORM 990, PART VI, SECTION A, LINE 2 BUSINESS OR FAMILY TRANSACTION: CONNIE PREWITT, JOY OTT, AND RANDALL GIBB HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE DIRECTORS OR OFFICERS OF THE SUBSIDIARY NEW WEST DISCLOSED ON SCHEDULE R, PART IV. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW 990: THE 990 REVIEW IS COMPLETED BEFORE THE RETURN IS FILED. IT IS REVIEWED BY THE CFO AND THEN THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS TO MONITOR CONFLICT OF INTEREST POLICY: THE COMPLIANCE OFFICER ALONG WITH THE GOVERNANCE AND NOMINATING COMMITTEE OF THE BOARD OF DIRECTORS IS RESPONSIBLE FOR MONITORING THE EFFECTIVENESS OF THE CONFLICT OF INTEREST REPORTING AND MANAGEMENT FOR BILLINGS CLINIC. IN ADDITION, BILLINGS CLINIC VICE PRESIDENTS ARE RESPONSIBLE FOR ENSURING THAT THEIR DIRECT REPORTS ARE COMPLYING WITH THIS POLICY. FORM 990, PART VI, SECTION B, LINE 15A & 15b PROCESS TO DETERMINE CEO COMPENSATION: BILLINGS CLINIC HAS AN EXECUTIVE COMPENSATION PROGRAM ADMINISTERED ANNUALY BY INDEPENDENT TRUSTEES FOLLOWING BEST PRACTICES AND THE HIGHEST REGULATORY STANDARDS EXPECTED OF A NOT-FOR PROFIT ORGANIZATION. THEY FOLLOW BOARD APPROVED CHARTER AND OVERALL EXECUTIVE COMPENSATION PHILOSOPHY WHICH DEFINES THE MARKET AS A COMPARABLE SET OF NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. THEY LOOK AT RELEVANT MARKET DATA OF SIMILAR ROLES IN SIMILAR ORGANIZATIONS. ANNUAL DISCLOSURE OF THE COMMITTEE'S ACTIONS AND DECISIONS TO THE FULL BOARD IS REQUIRED. SULLIVAN COTTER PERFORMED THE COMPENSATION REVIEW IN 2018. FORM 990, PART VI, SECTION C, LINE 19 BILLINGS CLINIC MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC ON AN AS NEEDED BASIS. Form 990, Part XI, Line 9 Other Changes in Net Assets: (3,347,065)- Change in Fair Value of INterest Rate Swap 11,662,787 - Change in Interest of Foundation 772,126 - Change in Interest of Affiliates 9,087,848 - Total MONTANA HEALTHCARE INDEMNITY LLC 2800 TENTH AVENUE NORTH BILLINGS MT 59101 810231784 INSUR CAPTIVE MT 5774468 16413176 BILLINGS CLI SPECIALTY SUPPLIES AND SERVICES LLC 2800 TENTH AVENUE NORTH BILLINGS MT 59101 364871868 SPEC. SUPPLY MT 30917639 3254543 BILLINGS CLI BILLINGS CLINIC FOUNDATION 2917 TENTH AVENUE NORTH BILLINGS MT 59101 810407289 FUNDRAISING MT 501(C)(3) 7 BILLINGS CLI true STILLWATER HOSPITAL ASSOCIATION 710 N 11TH STREET COLUMBUS MT 59019 810286525 HOSPITAL MT 501(C)(3) 3 BILLINGS CLI true NEW WEST HEALTH SERVICES 130 NEILL AVENUE HELENA MT 59601 841418136 INSURANCE SAL MT BILLINGS CLINIC C CORP -638041 2578035 0.65000 true BILLINGS CLINIC EXPRESS CARE 2800 TENTH AVENUE NORTH BILLINGS MT 59101 463355499 OUTPATIENT CL MT BILLINGS CLINIC C CORP -720344 533675 1.00000 true true true true true false false false false false false false true true true true true true false false Billings Clinic Express Care A 151538 InterCo Amount Billings Clinic Foundation C 3623743 INTERCO AMOUNT New West Health Services D 41159369 INTERCO AMOUNT New West Health Services D 3729961 InterCo Amount Billings Clinic FOundation D 483647 Interco Amount Stillwater Hospital Association D 689448 Interco Amount Billings Clinic Express Care D 5302125 Interco Amount Stillwater Hospital Association L 464149 InterCo Amount Stillwater Hospital Association P 1175218 InterCo Amount Stillwater Hospital Association Q 6778858 INterCo Amount