2019-02-12T08:49:45-06:00 2017-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2017-01-01 810392231 Wheatland Memorial Healthcare WHEA 4066324351 PO Box 287 Harlowton MT 59036 Rick Poss CEO 4066324351 2019-02-05 1 Kim Hunwardsen CPA P00484560 6122536500 2019-02-04 199.247.42.23 2019-02-05 10:52:02 CS 42220420183130353e69 2018-11-09 P 330E77A2EC15986A2DC713C7FDB26B906589BB96 6ECD4448988750106123FDC789D6ADA2AEDCDED1 2017 2019-02-21 02:37:17Z X Rick Poss PO Box 287 Harlowton MT 59036 8247596 0 X www.wheatlandmemorial.org X 1951 MT To provide healthcare services to the surrounding community 6 6 105 15 0 0 524321 314249 6028801 7002553 40138 174690 16929 17663 6610189 7509155 1747 2000 0 0 3915103 4024087 0 0 0 3196808 3349754 7113658 7375841 -503469 133314 5514204 6431322 1486418 2231064 4027786 4200258 X Responsive to the communities we serve, Wheatland Memorial Healthcare is dedicated to providing sustainable quality care with respect, compassion and teamwork. 0 0 5569005 2000 7002553 As a Critical Access Hospital, Wheatland Memorial Healthcare provides a broad range of primary care services to the local community regardless of ability to pay. The objective for operating the Hospital and its various departments is to meet the mission of being responsive to the communities we serve and providing sustainable quality health care with respect, compassion and teamwork.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. Continued on Schedule O.The amounts of charges foregone were $28,104, for the year ended December 31, 2017. The estimated cost of providing these services was approximately $24,000 for the years ended December 31, 2017, calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. 5569005 1 1 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 12 0 1 105 1 0 0 0 0 0 0 0 0 0 0 X 6 6 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 0 0 0 X Patrick McConnell 4066573821 PO Box 37000 Billings MT 59107 X June Voldseth Chairperson 1.00 X X 0 0 0 Aubrey Miller Vice Chairperson 0.50 X X 0 0 0 Jenny Peters Secretary/Treasurer 0.20 X X 0 0 0 Don Amundson Trustee 0.20 X 0 0 0 Tom Bennett Trustee 0.20 X 0 0 0 Katie Rein Trustee 0.20 X 0 0 0 Brad Howell CEO (Jan-Aug) 30.00 X 0 0 0 Mary Ruyter Interim CEO (Sept-Oct) 40.00 X 0 0 0 Rick Poss Interim CEO (Nov-Dec) 30.00 X 0 0 0 Kyle Gee CFO 10.00 X 0 0 0 Hannah Sexton PA Physician Assistant 40.00 X 187201 0 0 Kary Engle PA-C Certified Physician Assist 40.00 X 154400 0 9484 Rebecca Sturdevant FNP Family Nurse Practitioner 40.00 X 120140 0 4806 Karen Tomlinson Lab Tech 40.00 X 117938 0 4718 579679 0 19008 4 0 1 0 Billings Clinic PO Box 30357 Billings MT 59107 Mgmt & Consulting Services 468463 Eide Bailly LLP 4310 17th Ave S Fargo ND 581082545 Accounting and IT services 147430 Wilderness Medical Staffing 1124 West Riverside Spokane WA 99201 Traveler Provider Staffing 103990 3 75492 238757 314249 Patient service revenu 622110 6939743 6939743 62810 62810 7002553 40022 40022 19267 1604 17663 17663 17663 870005 1500 736516 321 133489 1179 134668 134668 7509155 7002553 0 192353 2000 2000 3437416 2895669 541747 85503 69727 15776 260130 227582 32548 241038 204179 36859 424483 424483 24367 24367 55420 55420 8444 8444 699634 618974 80660 6544 4560 1984 213042 145327 67715 83699 5714 77985 158170 128158 30012 44882 31952 12930 31632 21825 9807 29711 29711 487931 487931 64040 64040 Medical supplies 295318 295318 Repairs, maintenance & 285106 120057 165049 Bad debt expense 199858 199858 Food expense 75612 75608 4 161861 4855 157006 7375841 5569005 1806836 0 193029 162719 1048117 1532852 149288 183625 54120 48024 7640864 5329469 1481844 2311395 2125316 1898727 304149 293980 158341 0 5514204 6431322 998695 881470 4646 3238 353077 1282792 130000 63564 1486418 2231064 X 3640732 3820651 387054 379607 4027786 4200258 5514204 6431322 133314 39158 0 X X 0 1 X 0 0 X 0 1 X 60308 60308 2872517 2401887 470630 4701323 2927582 1773741 6716 6716 2311395 Estimated third-party payor settlements 63564 63564 X Part IV, Line 2b: The Hospital acts as custodian for funds of certain swing bed patients. These funds are included in assets limited as to use and accounts payable in the financial statements. Swing bed patient trust funds totaled $3,238 and $4,646 at December 31, 2017 and 2016, respectively. Part X, Line 2: The Hospital is organized as a Montana nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from Federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose, if applicable. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization business Income Tax Return (Form 990-T) with the IRS. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. 1 1 X 1 X 1 X 175.000000000000 1 1 0 1 1 24000 24000 0.00330 24000 24000 0.00330 1889817 1675889 213928 0.02980 1889817 1675889 213928 0.02980 1913817 1675889 237928 0.03310 0 199858 25382 2180481 2201111 -20630 X 1 1 1 1 Wheatland Memorial Healthcare PO Box 287 Harlowton MT 59036 www.wheatlandmemorial.org 13546 X X X X Provider based RHC - Bair Memorial Clinic Wheatland Memorial Healthcare 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X See Part V, Section C X 1 16 1 See Part V, Section C 0 1 X 100.000000000000 175.000000000000 X X X 1 1 X X X X 1 X www.wheatlandmemorial.org/resources/compassionate-care/ X www.wheatlandmemorial.org/resources/compassionate-care/ X www.wheatlandmemorial.org/resources/compassionate-care/ X X X X X X 1 X 0 X X X X 1 X 0 1 Wheatland Memorial Healthcare Part V, Section B, Line 5: A Steering Committee was convened to assist Wheatland Memorial Healthcare in conducting its CHNA. A diverse group of community members representing various organizations and populations within the community (ex. Public health, elderly, uninsured) came together in June 2016.Steering Committee Board Of Trustee Jenny PetersLeslie Aiton, Department HeadRick Poss, CEOAlison Fenley, DONJane Moe, Marketing DirectorNatalie Claiborne, Office of Rural Health Sue Woods, RN Public Health Director Heather Thom, RN CMHD Wheatland Memorial Healthcare Part V, Section B, Line 11: 2017 updates regarding the needs identified on the 2016 Community Health Needs Assessment are as follows: Improve access to healthcareIn 2017 Wheatland Memorial Healthcare has finalized the contracts for Sleep Studies and we are working on rearranging office/facility space to best utilize care space. Wheatland Memorial has also implemented the use of the Zio Patch that is a new form of ambulatory cardiac monitoring described as a wearable patch. The Hospital purchased a new Ultrasound Machine, and a vein finder for better patient care and upgraded our CT Scanner to a 64 slice. The T1 line secure connection with Billings Clinic was completed. The Hospital is working with local agencies for mental health opportunities. Accommodate community needsWheatland has published articles in the newspaper and on social media on chronical disease, health and wellness. Wheatland Memorial Healthcare partnered with the Drivers' Education Program held a texting and driving course in October 2017. WMH Trauma Coordinator has done a number of "Stop the Bleed" training throughout our service area. The Hospital developed a program to Debrief Critical Stress at the workplace/Trauma Events for staff or community members free of charge. Enhance awarenessThe Hospital created newsletters highlighting services, education, staffing and philanthropy. An open house chalk night (partnering with our local chamber) was held Sept. 11th 2018 and offered tours of newly remodeled bathroom, CT Scanner room and eEmergency demos. The Hospital's Medical Provider speaks at local high school sports meetings to raise awareness on concussions and The Impact Test which provides a baseline test on all students in sport related activities. Community Care Coordination The Hospital advertised for a position for 6 months, however, the position was removed because of lack of grant funding as the pilot program was completed. Leadership will reassess in the upcoming fiscal year. There was communication on partnering with Lewistown Care Coordinator in June 2018. The Hospital hopes to start up this program in 2019. Wheatland Memorial Healthcare Part V, Section B, Line 16j: A summary of the financial assistance policy and information on how to obtain an application or view the entire policy is posted in the emergency room, waiting rooms, and admission areas of the Hospital. A summary is also available on the Hospital's website. The financial assistance policy is also provided with the initial collection effort notices. Wheatland Memorial Healthcare Part V, Section B, Line 24: All individuals eligible under the hospital financial assistance policy are provided a discount for emergency and other medically necessary care. The financial assistance policy does not apply to elective procedures. Therefore, FAP-eligible patients without insurance may be charged gross charges on elective procedures. However patient payments are eligible for other discounts from gross charges. Schedule H, Part V, Section B, Line 7a: CHNA Report:http://www.wheatlandmemorial.org/resources/community-health-needs-assessment-report-2016/ Schedule H, Part V, Section B, Line 10a: Implementation Strategy:http://www.wheatlandmemorial.org/resources/chna-implementation-plan/ Part I, Line 3c: At 101%-125% of FPG patients receive a 75% write-offAt 126%-150% of FPG patients receive a 50% write-offAt 151%-175% of FPG patients receive a 25% write-offOver 175% of FPG patients do not receive a write-off Part I, Line 6a: Wheatland Memorial's annual community benefit report can be found on their website. Part I, Line 7: Charity care was recorded at cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The cost for subsidized health services on line 7g was determined using the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $199,858. Part III, Line 2: Patient accounts are not classified as bad debt until every effort is made to collect on the account. Insurance is filed and all payments are applied including contractual allowances and discounts. Any payment on an account that was written off to bad debt reduces bad debt expense in the current year. Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: The estimated amount of the Organization's bad debt expense attributable to patients eligible under the Organization's charity care policy is calculated by using the percentage of individuals within the community who are below the federal poverty level at 12.7%. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 7 of the attached audited financial statements. Part III, Line 8: Wheatland Memorial Healthcare is a critical access hospital and in prior years has not shown a Medicare shortfall. There was a shortfall for 2017 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit. Total revenue received from Medicare is the gross reimbursement plus settlement. Both total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. Part III, Line 9b: The Hospital is aware of patients who are in the process of applying for financial assistance and these accounts are not sent to collections. If a patient does not cooperate or is not in compliance with their payment arrangement the account is turned over to a collection agency. Collection efforts cease while a patient is under review for charity care or while a patient is in compliance with a payment arrangement. After financial assistance is awarded, any personal portion due follows the same collection procedure as other accounts. Part VI, Line 2: Wheatland Memorial Healthcare assesses the needs of the community through patient surveys, general public surveys, and community meetings. A Steering Committee was convened to assist Wheatland Memorial Healthcare in conducting its CHNA. The Hospital used a diverse group of community members representing various organizations and populations within the community. The 12/31/2016 needs assessment and implementation strategy is posted to the Hospital website. Part VI, Line 3: Wheatland Memorial Healthcare tries to determine if patients qualify or possibly qualify for any financial assistance either at registration or discharge. We notify patients of our programs by making available financial assistance brochures in waiting rooms, emergency room areas, and other patient access areas and local newspaper ads. Financial assistance information is provided in all correspondence regarding patient bills. We also have staff available to assist in applications for state aid. Part VI, Line 4: Wheatland Memorial Healthcare (WMH) is a 25-bed critical access hospital and rural health clinic located in Harlowton, Montana. Harlowton is a ranching community in central Montana with approximately 1.6 people per square mile. The 2017 population of Harlowton was 932 and Wheatland County was 2,109. WMH serves residents of Wheatland, Golden Valley, Judith Basin and portions of Sweet Grass and Meagher counties. The most common industries are management, farming, fishing, and construction. The nearest tertiary care facility is 93 miles south east of Harlowton, in Billings, MT. The next closest tertiary care facility is 130 miles north west of Harlowton, in Great Falls, MT. Lewistown which is 60 miles north from WMH, has a secondary care facility. The median household income in Wheatland County was $36,076, and individuals living below the federal poverty level in was 12.7%. Part VI, Line 5: Our Board is comprised of members within our local and outlying service area. These Members are not employees or contractors of the organization. At this time the Organization has lacked excess funds from operations but has pursued grants aggressively in order to replace aging equipment and establish community health programs that will allow us to continue serving the health care needs of our community during these challenging economic times. Our emergency room is available 24/7 and serves all individuals regardless of ability to pay. We extend privileges to medical staff that are licensed and qualified. The Hospital provides space for immunization clinics to ensure children in the community receive recommended immunizations. We also provide space for the regional WIC (Women, Infants and Children) clinic to promote the services offered by that organization. The Hospital has established a strong working relationship with the chaplains of several churches who provide support to patients and families of the facility and participate in care planning and regular meetings. The CEO regularly attends county commissioner meetings to provide the community with an update of the events going on at the Hospital. Board members also frequently attend these commissioner meetings. The Hospital and its attached rural health clinic is the sole provider of health care services within the community. 0 0 0 0 0 0 0 0 0 Hannah Sexton PA Physician Assistant 187201 0 0 0 0 0 0 0 0 0 187201 0 0 0 Kary Engle PA-C Certified Physician Assist 154400 0 0 0 0 0 4984 0 4500 0 163884 0 0 0 Schedule J, Part I, Question 3: Wheatland Memorial Healthcare does not pay compensation to the CEO directly. The CEO is a common law employee of and compensated by Billings Clinic. Billings Clinic determines compensation based on the processes described in Part I, Question 3 and other methods they have established. Form 990, Amended return explanation The organization amended the 2017 return on Part VII, Section B. Billings Clinic is listed as an independent contractor. The amount in column (c) was updated to reflect the correct amount paid to Billings Clinic for services in 2017. Form 990, Part VI, Section A, line 3 The CEO and CFO positions at Wheatland Memorial Healthcare are considered common law employees of Billings Clinic. Billings Clinic may, in its discretion at any time, remove and replace the CEO and CFO. The CEO has the responsibility of supervising management, administration the operation of Wheatland Memorial Healthcare. The CFO has the responsibility of managing the Organization's finances. Brad Howell - CEO (Jan-Aug) Salary $50,191 Pension 1,825 Other benefits 18,551 Mary Ruyter, Interim CEO (Sept-Oct) Salary $52,800 Rick Poss, Interim CEO (Nov-Dec) Salary $26,000 Kyle Gee, CFO Salary $27,060 Mary, Rick, and Kyle were billed at an hourly rate to approximate salary and benefits so these were not broken out for those individuals. Form 990, Part VI, Section A, line 8b The Organization does not have committees with authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b A copy of the completed Form 990 is provided to the Board Members before it is filed. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c All officers, trustees, and key employees are required upon hire and at least annually thereafter to disclose any conflicts or potential conflicts and sign a conflict of interest policy. A conflict of interest can be considered to exist in any instance where the actions or activities of an individual on behalf of Wheatland Memorial also involve the obtaining of an improper gain or advantage, or adverse effect on the interests of Wheatland Memorial. The CEO reviews the statements and investigates all disclosures of possible conflicts of interest. The CEO prepares a report for the Executive Committee. The Executive Committee is responsible for final review and investigation of potential conflicts of interest and presentation of its findings to the Wheatland Memorial Board of Directors on an annual basis. Upon disclosure of a possible conflict of interest, Board Members will refrain from deliberating on the matter until all relevant and pertinent facts and circumstances have been disclosed and any potential conflict has been avoided or resolved. The individual with a conflict is not allowed to be present when the matter is discussed or voted upon. All matters of discussion are documented. Form 990, Part VI, Section B, line 15 The CEO and CFO are common law employees of Billings Clinic. Billings Clinic determines compensation based on methods they have established. The Board of Directors approves the management relationship with Billings Clinic. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. The financial statements are also attached to the Form 990. Form 990, Part XII, line 2c: The CEO of Wheatland Memorial Healthcare is responsible for oversight of the audit of its financial statements and selection of an independent accountant. Wheatland Memorial Healthcare Foundation PO Box 287 Harlowton MT 59036 454035841 Support Wheatland Memorial Healthcare MT 501(c)(3) Line 12a, I Wheatland Memorial Healthcare 1 0 0 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0