2017-05-10T11:30:57-06:00 2016-06-30 GREEN HEALTH GROUP PC 110 5TH ST S SUITE 106 GLASGOW MT 592302338 990 2015-07-01 810231786 FRANCES MAHON DEACONESS HOSPITAL FRAN 4062283500 621 3RD STREET SOUTH GLASGOW MT 59230 CAMI KALINSKI DIRECTOR OF FINANCE 4062283660 2017-05-09 true DANIEL GREEN P01311679 4062632615 2017-05-10 2015 2021-01-29 14:40:06Z CAMI KALINSKI 621 3RD STREET SOUTH GLASGOW MT 59230 25247228 false X WWW.FMDH.ORG X 1914 MT TO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY. 9 9 286 8 481503 -291655 87387 172481 24252363 23774422 499071 575527 936050 724798 25774871 25247228 0 0 12586920 12807130 0 41455 9549034 9535125 22135954 22342255 3638917 2904973 58087704 60728898 3748035 3306496 54339669 57422402 TO ADVANCE THE COORDINATED DELIVERY OF HEALTH SERVICES, GUIDED WITH RESPECT FOR THE INDIVIDUAL NEEDS OF OUR PATIENTS, THEREBY IMPROVING THE HEALTH OF OUR REGIONAL COMMUNITY. false false 16063368 23774422 PROVIDE QUALITY MEDICAL CARE TO PATIENTS. 16063368 true true false true false false false false false false true false true true true true false true false false false false false false false false true true false false true false false false false false false false true true false false false false true true true false false true 12 0 true 286 true true true false false false false false false false false false X 9 9 false false false false true true false true true false false true true true true true true true true false X CAMI KALINSKI 4062283500 621 3RD ST S GLASGOW MT 59230 KAREN BREIGENZER PRESIDENT 2.00 X 0 0 0 KEVIN MILLER VICE PRESIDE 1.00 X 0 0 0 KRIS SIMENSEN SECRETARY/TR 1.00 X 0 0 0 CAROL BUCHHEIT DIRECTOR 1.00 X 0 0 0 TERRY COLBRESE DIRECTOR 1.00 X 0 0 0 KERRY KINGSLEY DIRECTOR 1.00 X 0 0 0 AMY CAPDEVILLE DIRECTOR 1.00 X 0 0 0 DON FAST DIRECTOR 1.00 X 0 0 0 BUTCH TEWELL DIRECTOR 1.00 X 0 0 0 RANDALL G HOLOM CEO 40.00 X 257396 0 18058 ELLEN GUTTENBERG COO 40.00 X 150053 0 17090 CAMI KALINSKI DIRECTOR OF 40.00 X 118626 0 4425 WALTER SMITH DO 40.00 X 508476 0 11537 KEVIN ROSS MD 14.00 26.00 X 452966 0 20812 ANNE MILLARD BRADLEY MD 15.00 25.00 X 370121 0 16198 ROBERT CROCHELT MD 2.00 32.00 X 300194 0 5333 DONNA SMITH MD 5.00 30.00 X 299575 0 11664 2457407 105117 20 false true false MCKINSTRY ESSENTION LLC PO BOX 3895 SEATTLE WA 98124 CONSTRUCTION 881625 GE HEALTHCARE PO BOX 96483 CHICAGO IL 60693 SERV CONTRACTS 470108 HAYES LOCUMS LLC 6700 N ANDREWS AVE SUITE 600 FT LAUDERDALE FL 33309 TEMP PROVIDERS 432768 MEDICAL INFORMATION TECHNOLOGY INC PO BOX 74569 CHICAGO IL 60696 DATA PROCESSING 152652 MEDICUS HOSPITALISTS WEST LLC 22 ROULSTON RD WINDHAM NH 03087 TEMPORARY SERVI 108775 5 50015 122466 30000 172481 PATIENT REVENUE 621500 22864322 22864322 PROFESSIONAL RADIOLOGY 621110 686736 390066 296670 HI-LINE MEDICAL SRVCS RENT 531120 93633 93633 GLASGOW CLINIC RENT 531120 91200 91200 OTHER RENTAL INCOME 531120 38531 38531 23774422 575527 575527 PARTNERSHIP INCOME 900099 698603 698603 COUNTY CONTRIBUTION 900099 26195 26195 724798 25247228 24593244 481503 569971 569971 9961350 8413576 1519232 28542 264625 200970 62722 933 1173251 891258 272422 9571 837933 678909 156966 2058 156181 156181 49900 49900 1292367 1083415 208952 121480 121480 668195 306546 361629 20 326099 326099 144135 107461 36343 331 127062 113427 13635 1910290 1910290 215941 9497 206444 MEDICAL SUPPLIES 3038802 3038802 REPAIRS & MAINTENANCE 1037308 569246 468062 FOOD & DIETARY SUPPLIES 210342 210342 MISCELLANEOUS 85734 30770 54964 151289 83050 68239 22342255 16063368 6237432 41455 1793996 2239818 7845484 6883452 3227707 3325827 3912758 3808583 733081 788163 258790 274847 35802053 23743739 11223814 12058314 16685661 16684641 12406413 14665253 58087704 60728898 2179456 2297068 218302 169041 1350277 840387 3748035 3306496 X 54339669 57422402 54339669 57422402 58087704 60728898 2904973 177760 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 3524 3524 false SCHEDULE C, PART II-B, LINE 1 2.44 PERCENT OF MHA DUES PAID TO MHA, WHICH WAS 614, AND 22.12 PERCENT OF DUES PAID TO MHA FOR AHA, WHICH WAS 2,910, WERE USED FOR LOBBYING EXPENSES BY MHA. 88748 88748 22575884 13718979 8856905 13137421 10024760 3112661 12058314 US GOVERNMENT & AGENCY SECURITIES 10599966 F CORPORATE DEBT SECURITIES 3077448 F BROKERED CERTIFICATES OF DEPOSIT 2817056 F BANK CERTIFICATES OF DEPOSIT 190171 C 16684641 INTERCOMPANY AND OTHER RECEIVABLES 10203787 NE MT STAT AIR AMBULANCE INVESTMENT 2833783 INTEREST IN FMDH FOUNDATION 957134 MEDICARE/MEDICAID RECEIVABLE 670549 14665253 MEDICARE & MEDICAID PAYABLE 682497 NET INVESTMENT IN PRAIRIE RIDGE VILL 157890 840387 X 25424988 177760 177760 25247228 25247228 22342255 22342255 22342255 SCHEDULE D, PAGE 3, PART X IT IS THE JUDGMENT OF MANAGEMENT THAT THE COMPANY HAS NO SIGIFICANT UNCERTAIN TAX POSITIONS THAT WOULD BE SUBJECT TO CHANGE UPON EXAMINATION BY THE INTERNAL REVENUE SERVICE. THIS FOOTNOTE IS ON PAGE 9 OF THE AUDITED FINANCIAL STATEMENTS. true true true X true X true true true false true true 499442 499442 0.02130 499442 499442 0.02130 15000 15000 0.00060 4153892 1958332 2195560 0.09350 34286 34286 0.00150 4203178 1958332 2244846 0.09560 4702620 1958332 2744288 0.11690 true 409895 8198304 8253388 -55084 X true true PRAIRIE RIDGE VILLAG ASSISTED LIVING 0.50000 NE MT STAT AIR AMBUL AIR AMBULANCE 0.33000 1 1 FRANCES MAHON DEACONESS HOSPITAL 621 3RD ST S GLASGOW MT 59230 WWW.FMDH.ORG X X X X FRANCES MAHON DEACONESS HOSPITAL 1 false false true X X X X X X X X X X 15 true false false true X WWW.FMDH.ORG X true 15 true WWW.FMDH.ORG false false true X 100.000000000000 200.000000000000 X X X X true true X X X X true X WWWFMDHORG X WWWFMDHORG X WWWFMDHORG X X X X X X true X true X X X X true X false true FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 5 TO SOLICIT INPUT FROM INDIVIDUALS WHO HAVE A BROAD INTEREST IN THE HEALTH OF THE COMMUNITY, AN ONLINE KEY INFORMANT SURVEY WAS IMPLEMENTED AS PART OF THE CHNA PROCESS AND SENT TO A LIST OF RECOMMENDED PARTICIPANTS INCLUDING PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS AND A VARIETY OF OTHER COMMUNITY LEADERS. ALSO, INPUT WAS GATHERED FROM SEVERAL INDIVIDUALS WHOSE ORGANIZATIONS WORK WITH LOW-INCOME, MINORITY, AND OTHER MEDICALLY UNDERSERVED POPULATIONS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. THE PARTICIPANTS WERE CONTACTED BY EMAIL, INTRODUCING THE PURPOSE OF THE SURVEY AND PROVIDING A LINK TO TAKE THE SURVEY ONLINE. IN ALL, 63 COMMUNITY STAKEHODLERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY. THE INPUT WAS GATHERED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. ON BEHALF OF FRANCES MAHON DEACONESS HOSPITAL IN THE SPRING OF 2016. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 11 AS REQUIRED BY THE IRS IMPLEMENTING REGULATIONS, FMDH PRIORITIZED THE IDENTIFIED NEEDS TO IDENTIFY THOSE NEEDS THAT IT COULD EFFICACIOUSLY ADDRESS GIVEN THE RESOURCE LIMITATIONS INHERENT IN A SMALL RURAL HOSPITAL OPERATION. THE ONLINE KEY INFORMANT SURVEY PRESENTED THE STAKEHOLDERS WITH 20 HEALTH TOPICS AND WERE ASKED TO RATE EACH AS A MAJOR PROBLEM, MODERATE PROBLEM, MINOR PROBLEM, OR NOT A PROBLEM AT ALL IN THEIR OWN COMMUNITY. FOR MAJOR PROBLEM RESPONSES, THE FOLLOWING WERE RANKED AS TOP CONCERNS FOR THE FRANCES MAHON DEACONESS HOSPITAL SERVICE AREA: MENTAL HEALTH, TOBACCO USE, SUBSTANCE ABUSE, AND CANCER. THROUGH A MEETING WITH INTERNAL AND EXTERNAL STAKEHOLDERS, PRIORITIZATION WAS ACCOMPLISHED USING A PRIORITIZATION EXERCISE THAT SCORED THE SCOPE & SEVERITY OF THE PROBLEM BY CONSIDERATION OF THREE FACTORS AND ABILITY TO IMPACT, BOTH RATED ON A SCALE OF 1 TO 10 FROM LEAST SEVERE TO MOST SEVERE. BASED ON THE SEVERITY OF THE RATINGS, FRANCES MAHON DEACONESS HOSPITAL CHOSE TO PRIORITIZE THE FOLLOWING TOP HEALTH NEEDS OF THE COMMUNITY TO ADDRESS IN ITS IMPLEMENTATION STRATEGY IN THE COMING YEARS: HEART DISEASE & STROKE, NUTRITION, PHYSICAL ACTIVITY & WEIGHT, AND MENTAL HEALTH. FMDH IS ADDRESSING THE PRIORITIZED HEALTH NEEDS BY THREE OVERALL GOALS: THE FIRST GOAL IS TO IMPROVE CARDIOVASCULAR HEALTH BY IMPLEMENTING AND SUPPORTING EVIDENCE BASED APPROACHES TO IMPACT BEHAVIORS AFFECTING CARDIOVASCULAR HEALTH. ONE STRATEGY FOR ADDRESSING THIS GOAL IS TO BUILD AWARENESS OF OPPORTUNITIES IN THE COUNTY TO PARTICIPATE IN COMMUNITY FITNESS PROGRAMS BY DEVELOPING AND PROMOTING A COMMUNITY FITNESS RESOURCES LIST. THE SECOND GOAL IS TO IMPROVE THE HEALTH OF OUR COMMUNITY BY IMPLEMENTING AND SUPPORTING EVIDENCE BASED APPROACHES TO IMPACT BEHAVIORS RELATED TO NUTRITION, WEIGHT AND PHYSICAL ACTIVITY THEREBY HAVING A POSITIVE IMPACT ON A MUILTITUDE OF HEALTH CONDITIONS. A STRATEGY FOR ADDRESSING THIS GOAL IS TO HAVE A FOCUSED PUBLIC AWARENESS CAMPAIGN ON FITNESS AND EXERCISE SUCH AS COMMUNICATING EXCLUSIVELY ABOUT EXERCISE AND FITNESS IN AT LEAST 75% OF ALL COMMUNICATION FOR 12 MONTHS. THE THIRD GOAL IS TO UTILIZE EVIDENCE BASED TACTICS TO ADDRESS BARRIERS TO ACCESSING MENTAL HEALTH SERVICES BY AUGMENTING THE RANGE AND ACCESSIBILITY OF MENTAL/BEHAVIORAL HEALTH SERVICES. A STRATEGY FOR ADDRESSING THIS GOAL IS TO ADVOCATE FOR MENTAL HEALTH LEGISLATION BY FOCUSING ADVOCACY EFFORTS ON LEGISLATION THAT INCREASES FUNDING FOR AND AVAILABILITY OF MENTAL/BEHAVIORAL HEALTH SERVICES. ADDITIONAL STRATEGIES TO ACCOMPLISH THE THREE GOALS ARE IDENTIFIED IN THE IMPLEMENTATION STRATEGY. NINE ADDITIONAL SIGNFICANT HEALTH NEEDS THAT EMERGED FROM THIS COMMUNITY HEALTH NEEDS ASSESSMENT ARE OUTLINED BELOW. THESE NEEDS WILL NOT BE SPECIFICALLY ADDRESSED IN THE IMPLEMENTATION STRATEGY, ALTHOUGH SOME MAY BE ADDRESSED IN SOME WAY THROUGH PROGRAMS TARGETING THE TOP HEALTH NEEDS WHICH WILL BE ADDRESSED. 1. SUBSTANCE ABUSE - FMDH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE MENTAL HEALTH WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S SUBSTANCE ABUSE, AND THAT A SEPARATE SET OF SUBSTANCE ABUSE INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 2. TOBACCO USE - FMDH HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE CARDIOVASCULAR HEALTH WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S TOBACCO USE, AND THAT A SEPARATE SET OF TOBACCO INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 3. CANCER - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 4. IMMUNIZATION & INFECTIOUS DISEASES - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 5. INJURY & VIOLENCE PREVENTION - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 6. INFANT HEALTH & FAMILY PLANNING - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 7. STD HIV/AIDS - FMDH BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. 8. DIABETES - FMDH FEELS THAT EFFORTS OUTLINED HEREIN TO IMPROVE NUTRITION, WEIGHT AND PHYSICAL ACTIVITY WILL HAVE A POSITIVE IMPACT ON THE COMMUNITY'S DIABETIC POPULATION, AND THAT A SEPARATE SET OF DIABETIC- SPECIFIC INITIATIVES WAS NOT NECESSARY GIVEN LIMITED RESOURCES. 9. ACCESS TO HEALTH CARE SERVICES - ADVISORY COMMITTEE MEMBERS FELT THAT MORE PRESSING HEALTH NEEDS EXISTED. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 16I THE OTHER WAYS FMDH PUBLICIZES THE FINANCIAL ASSISTANCE POLICY ARE AS FOLLOWS: 1. THE APPLICATION FOR FINANCIAL ASSISTANCE FORM IS OFFERED IN THE FMDH PATIENT OPTION LETTER AND OTHER MAILINGS. 2. A PLAIN LANGUAGE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS OFFERED TO ALL PATIENTS UPON ADMISSION OR DISCHARGE FROM FMDH, AND IT IS INCLUDED WITH PATIENT BILLING STATEMENTS. 3. FMDH WILL PUBLISH THE PLAIN LANGUAGE SUMMARY OF THE POLICY IN THE FMDH HEALTH AND WELLNESS SECTION OF THE LOCAL NEWSPAPER ON AT LEAST AN ANNUAL BASIS. 4. FMDH WILL DISCUSS FINANCIAL ASSISTANCE WITH PATIENTS WHEN THEY CALL ABOUT THEIR BILL. 5. FMDH EMPLOYS A FINANCIAL COUNSELOR WHO HELPS PATIENTS NAVIGATE THROUGH THEIR FINANCIAL OPTIONS AND HER CONTACT INFORMATION IS MADE AVAILABLE IN THE LOCAL NEWSPAPER IN THE QUARTERLY WELLNESS SECTION AS WELL AS ON OUR WEBSITE. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 22D AGB PERCENTAGE IS DETERMINED ANNUALLY BY USING A 12 MONTH MEASUREMENT PERIOD UTILIZING THE LOOK BACK METHOD. THE AGB PERCENTAGE IS ALL CLAIMS ALLOWED BY MEDICARE AND ALL PRIVATE HEALTH INSURERS DIVIDED BY GROSS CHARGES FOR THOSE CLAIMS. ALL CLAIMS INCLUDED ARE THOSE FOR THE HOSPITAL AND GLASGOW CLINIC AS WELL AS FOR HI-LINE MEDICAL SERVICES, AS IT IS A SIGNIFICANTLY RELATED ENTITY. THE MEASUREMENT PERIOD IS 7/1 THROUGH 6/30 OF EACH YEAR AND THE START DATE FOR THE NEW CALCULATION WILL BE 10/1 OF EACH YEAR WHICH IS WITHIN THE 120 DAY REQUIREMENT. FACILITY 1, FRANCES MAHON DEACONESS HOSPITAL - PART V, LINE 24 SOME SERVICES PROVIDED BY THE HOSPITAL ARE CONSIDERED ELECTIVE. ELECTIVE SERVICES ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE THUS A PERSON QUALIFYING FOR A DISCOUNT FOR MEDICALLY NECESSARY SERVICES MAY NEED TO PAY FULL PRICE FOR ELECTIVE SERVICES. THE FAP ADDRESSES WHAT SERVICES ARE DEEMED ELECTIVE. 1 GLASGOW CLINIC PC 621 THIRD STREET SOUTH GLASGOW MT 59230 RURAL HEALTH CLINIC PART I, LINE 7G - SUBSIDIZED HEALTH SERVICES EXPLANATION PHYSICIAN PROFESSIONAL SERVICES MAKE UP 1,201,044 OF COLUMN C, 274,214 OF COLUMN D, AND 926,830 OF COLUMN E. THE COST OF BAD DEBT REMOVED FROM THE COMMUNITY BENEFIT EXPENSE IN COLUMN C IS 87,332. FRANCES MAHON DEACONESS HOSPITAL'S EFFORTS TO RECRUIT AND RETAIN PHYSICIANS AND OTHER PROVIDERS ARE DEPENDENT ON OUR ABILITY TO COMPETE WITH ALL OTHER COMMUNITIES THAT ARE RECRUITING SIMILAR PHYSICIANS AND PROVIDERS. BECAUSE OF OUR SMALL COMMUNITY SIZE AND REMOTE LOCATION FAR REMOVED FROM MEDICAL COMMUNITIES OF GREATER SCOPE, WE EMPLOY PHYSICIANS AND SUBSIDIZE PHYSICIAN PRACTICES TO OFFER APPROPRIATELY COMPETITIVE SALARIES AND PRACTICE ENVIRONMENTS (SPECIFICALLY, REASONABLE CALL SCHEDULES). WE BELIEVE OUR ABILITY TO OFFER CORE NECESSARY PRIMARY CARE AND EMERGENCY SERVICES IS DEPENDENT ON SUBSIDIZATION. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION USED ADJUSTED COST TO CHARGE RATIOS FOR PATIENT CARE FROM THE MEDICARE COST REPORT, ADJUSTED FOR BED TAX AND COMMUNITY BENEFIT. BAD DEBT EXPENSE AND CHARITY CARE ARE ALREADY EXCLUDED FROM THE MEDICARE COST REPORT. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY THE ORGANIZATION'S PATIENT CARE COST TO CHARGE RATIO, AFTER ELIMINATING BAD DEBT, CHARITY CARE, BED TAX, AND COMMUNITY BENEFIT EXPENSE, IS APPLIED TO GROSS BAD DEBT CHARGES TO ARRIVE AT THE COST OF BAD DEBT. DISCOUNTS REDUCE REVENUE AND ARE NOT RECORDED AS BAD DEBT. PAYMENTS RECEIVED ON PREVIOUSLY WRITTEN OFF ACCOUNTS ARE RECORDED AS RECOVERIES OF BAD DEBT WHICH REDUCE BAD DEBT EXPENSE. NONE OF THE BAD DEBT IS CONSIDERED ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE. BAD DEBTS ARE AN INEVITABLE RESULT OF OPERATING A NON PROFIT HOSPITAL. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE BAD DEBT EXPENSE FOOTNOTE IS ON PAGES 7 & 8 OF THE AUDITED FINANCIAL STATEMENTS. PART III, LINE 8 - MEDICARE EXPLANATION THERE IS A MEDICARE SHORTFALL SINCE CRITICAL ACCESS HOSPITALS ARE REIMBURSED 101 PERCENT OF COST FROM MEDICARE, BUT THIS IS THEN REDUCED BY THE 2 PERCENT SEQUESTRATION ADJUSTMENT. THIS MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT SINCE THE HOSPITAL IS PROVIDING MEDICARE PATIENT CARE SERVICES AT LESS THAN THE COST. MEDICARE COSTS ON PART III, LINE 6 ARE DIRECTLY FROM THE MEDICARE COST REPORT. MEDICARE REVENUE ON PART III, LINE 5 IS DIRECTLY FROM THE MEDICARE COST REPORT. THE ELECTRONIC HEALTH RECORD CAPITAL COSTS AND RELATED INCENTIVE PAYMENTS ARE EXCLUDED FROM THIS CALCULATION. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE ORGANIZATION USES A SLIDING SCALE BASED ON FEDERAL POVERTY GUIDELINES, COMBINED WITH AN ASSET TEST AND A MEDICALLY INDIGENT TEST REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. THE ORGANIZATION DOES NOT ATTEMPT TO COLLECT CHARGES APPROVED AS CHARITY OR FINANCIAL ASSISTANCE. FOR PATIENTS THAT HAVE HAD A PORTION OF THEIR ACCOUNT WRITTEN OFF AS FINANCIAL ASSISTANCE AND THAT LATER DEFAULT ON THE PORTION THAT WAS DETERMINED TO BE THEIR RESPONSIBILITY, AND THEREFORE IS NOT CONSIDERED CHARITY CARE OR FINANACIAL ASSISTANCE, THE ORGAINIZATION DOES ATTEMPT TO COLLECT THIS BALANCE. PART VI, LINE 2 - NEEDS ASSESSMENT PURSUANT TO THE PROVISIONS OF THE AFFORDABLE CARE ACT, FRANCES MAHON DEACONESS HOSPITAL COMPLETED A COMMUNITY NEEDS ASSESSMENT AND IMPLEMENTATION PLAN DURING FISCAL YEARS 2013 & 2016 (TAX YEARS 2012 & 2015). BOTH ASSESSMENTS ARE LOCATED ON THE ENTITY'S WEBSITE. HOWEVER, FRANCES MAHON DEACONESS HOSPITAL (FMDH) HAS TRADITIONALLY INCLUDED COMMUNITY NEEDS ASSESSMENTS IN ITS PLANNING FOR MANY YEARS AND UTILIZES MANY METHODS OF ASSESSING THE PATIENT SERVICES NEEDS FOR OUR SERVICE AREA. THESE INCLUDE BUT ARE NOT LIMITED TO: ANALYSIS OF OUTMIGRATION STATISTICS OBTAINED THROUGH ACCESS TO THE COMPDATA DATABASE PROVIDED THROUGH THE MONTANA HOSPITAL ASSOCIATION AND MODELING OF PATIENT TO POPULATION RATIOS TO IDENTIFY AND PLAN FOR THE APPROPRIATE PROVIDER MIX TO SERVE THE COMMUNITY. IN ADDITION, FMDH PARTICIPATED IN AN AREA HEALTH EDUCATION CENTER LEAD COMMUNITY HEALTH SERVICES DEVELOPMENT ASSESSMENT. IDEAS GENERATED OUT OF EACH OF THESE EFFORTS ARE THEN EVALUATED AS TO THE CAPABILITIES OF OUR ORGANIZATION TO DEVELOP IDENTIFIED SERVICES. MINIMUM CRITERIA FOR DEVELOPMENT OF NEW OR MODIFICATION OF EXISTING SERVICES ARE: THE NEW OR MODIFIED SERVICE CAN REASONABLY FINANCIALLY SUPPORT ITS OPERATION; WE HAVE OR CAN ACQUIRE THE NECESSARY PERSONNEL WITH THE CREDENTIALS TO DELIVER THE SERVICE AND RETAIN ENOUGH PERSONNEL WITH THE REQUIRED SKILL SETS TO AVOID INTERRUPTION OF SERVICE DELIVERY IF SAID PERSONNEL TURN OVER; THE SERVICES CAN BE DELIVERED IN A MANNER THAT ACHIEVES APPROPRIATELY HIGH LEVELS OF PATIENT SATISFACTION. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FRANCES MAHON DEACONESS HOSPITAL EMPLOYS A FINANCIAL COUNSELOR WHO HAS THE SOLE RESPONSIBILITY TO WORK WITH PATIENTS TO NAVIGATE OUR FINANCIAL ASSISTANCE PROGRAM. ALL PATIENTS ARE SENT INFORMATION AT THE INITIAL BILLING FOR DELIVERED PATIENT SERVICES THAT DESCRIBES OUR FINANCIAL ASSISTANCE PROGRAM. OUR WEBSITE HAS INFORMATION ABOUT OUR FINANCIAL ASSISTANCE PROGRAM ALONG WITH ACCESS TO THE APPLICATION. FRANCES MAHON DEACONESS HOSPITAL ALSO EMPLOYS TWO STAFF MEMBERS THAT ARE CERTIFIED APPLICATION COUNSELORS THAT HELP COMMUNITY MEMBERS WITH APPLYING FOR INSURANCE AND MEDICAID ON THE MARKETPLACE. PART VI, LINE 4 - COMMUNITY INFORMATION FRANCES MAHON DEACONESS HOSPITAL IS LOCATED IN GLASGOW MONTANA WHICH IS OVER FOUR HOURS HIGHWAY TRAVEL TIME AWAY FROM ANY TERTIARY MEDICAL CENTER. WHILE OUR PRIMARY SERVICE AREA CONSISTS OF GLASGOW MONTANA AND VALLEY COUNTY, OUR FACILITY AND SPECIALTY SERVICES ALSO DRAW FROM PORTIONS OF THE SURROUNDING COUNTIES OF DANIELS, ROOSEVELT, AND PHILLIPS. THE AREA IS PRIMARILY AGRICULTURAL BASED WITH LOW POPULATION DENSITIES WHICH HOUSES A TOTAL POPULATION OF 24,113 RESIDENTS OVER 13,843.20 SQUARE MILES. THE DIFFERENT AGE GROUPS OF THE SERVICE AREA ARE AS FOLLOWS: 26.2% ARE INFANTS, CHILDREN OR ADOLESCENTS AGES 0-17; ANOTHER 57.1% ARE AGES 18 TO 64, WHILE 16.7% ARE AGES 65 AND OLDER. THE POPULATION IS MOSTLY WHITE, BUT PORTIONS OF OUR EXTENDED SERVICE AREA HAVE HIGH POPULATIONS OF NATIVE AMERICAN ANCESTRY (29.8% IN THE TOTAL SERVICE AREA) TO WHICH WE PROVIDE SERVICES. THE STATISTICS PROVIDED ABOVE ARE BASED ON THE US CENSUS BUREAU AMERICAN COMMUNITY SURVEY 5-YEAR ESTIMATES (2009-2013). PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH FRANCES MAHON DEACONESS HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF. WE ARE GOVERNED BY A VOLUNTARY BOARD OF COMMUNITY PERSONS REPRESENTING MOST OF THE INDIVIDUAL TOWNS OR GEOGRAPHICAL AREAS OF OUR PRIMARY SERVICE AREA. FOR NONELECTIVE SERVICES, WE TREAT PATIENTS WITHOUT REGARD TO ABILITY TO PAY, CONSISTENT WITH OUR ORIGINS AS A HILL BURTON FUNDED FACILITY. ALTHOUGH OUR HILL BURTON OBLIGATION WAS SATISFIED MANY YEARS AGO, WE STILL ADHERE TO THE PRINCIPLES INHERENT IN THAT OBLIGATION. SURPLUS FUNDS ARE RETAINED WITHIN THE ORGANIZATION TO ASSURE FULFILLMENT OF OUR CHARITABLE MISSION BOTH IN THE PRESENT AND IN THE FUTURE. PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM FRANCES MAHON DEACONESS HOSPITAL PROVIDES HOSPITAL INPATIENT AND OUTPATIENT SERVICES. GLASGOW CLINIC PC PROVIDES PROFESSIONAL PRIMARY CARE PHYSICIAN AND MIDLEVEL PROVIDER SERVICES. HI-LINE MEDICAL SERVICES INC PROVIDES SPECIALTY PHYSICIAN AND RETAIL PHARMACY SERVICES. ADDITIONAL INFORMATION PART I, LINE 6A: THE FORM 990 SCHEDULE H IS CONSIDERED AN ANNUAL COMMUNITY BENEFIT REPORT AND IT IS AVAILABLE TO THE PUBLIC ON OUR WEBSITE. PART I, LINE 7E: FMDH CONTRACTED WITH AN OUTSIDE COMPANY TO COMPILE THE COMMUNITY HEALTH NEEDS ASSESSMENT INFORMATION. PART I, LINE 7I: FMDH CONTRIBUTED TO THE SCHOOLS IN VALLEY COUNTY FOR THE HEALTHY SCHOOL SNACK PROGRAM. PART V: GLASGOW CLINIC PC IS A SEPARATE ORGANIZATION THAT IS A RURAL HEALTH CLINIC AND IS WHOLLY OWNED AND OPERATED BY FRANCES MAHON DEACONESS HOSPITAL (FMDH). THEIR REVENUES AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990. HI-LINE MEDICAL SERVICES, INC IS A SEPARATE ORGANIZATION THAT INCLUDES SPECIALTY PHYSICIAN PRACTICES AND A RETAIL PHARMACY. FMDH WHOLLY OWNS AND MANAGES THIS ENTITY AND SUBSIDIZES THE PHYSICIAN PRACTICES AS NEEDED TO ASSURE ACCESS TO AS FULL OF A SCOPE OF SERVICES AS IS APPROPRIATE GIVEN THE NEEDS OF THE COMMUNITY WE SERVE. HI-LINE MEDICAL SERVICES' REVENUES AND EXPENSES ARE NOT INCLUDED ON FMDH'S FORM 990, EXCEPT THAT THE SUBSIDIZED PHYSICIAN ACTIVITY IS SHOWN ON SCHEDULE H, PART I, LINE 7G. X true true X X X false false false false false false false false false RANDALL G HOLOM CEO 257396 9275 8783 275454 ELLEN GUTTENBERG COO 150053 5553 11537 167143 WALTER SMITH DO 508476 11537 520013 KEVIN ROSS MD 452966 9275 11537 473778 ANNE MILLARD BRADLEY MD 370121 7215 8983 386319 ROBERT CROCHELT MD 300194 5324 9 305527 DONNA SMITH MD 299575 5418 6246 311239 SCHEDULE J, PAGE 1, PART I, LINE 1A GOLF CLUB MEMBERSHIP FOR THE CEO IS PAID BY THE ORGANIZATION. THIS IS NOT TREATED AS TAXABLE COMPENSATION SINCE IT IS CONSIDERED PUBLIC RELATIONS WHICH IS PART OF THE CEO'S JOB RESPONSIBILITY. SCHEDULE J, PART III A PERCENTAGE OF THE COMPENSATION PAID TO KEVIN ROSS M.D. (66%), ANNE MILLARD BRADLEY M.D. (63%), DONNA SMITH M.D. (85%), AND ROBERT CROCHELT, M.D. (95%) IS AN EXPENSE OF GLASGOW CLINIC PC, A RELATED COMPANY, BUT WAS PAID THROUGH FRANCESS MAHON DEACONESS HOSPITAL AS A CENTRAL PAYMASTER. FIRST COMMUNITY BANK BOARD MEMBERS 761441 BANKING & INVESTING false SCHEDULE L, PART V THE HOSPITAL CEO AND ONE BOARD MEMBER ARE BOTH BOARD MEMBERS OF FIRST COMMUNITY BANK, PLUS THE BOARD MEMBER IS ALSO AN OFFICER OF THE BANK. THE HOSPITAL HAS BANK ACCOUNTS AND INVESTMENTS WITH FIRST COMMUNITY BANK. THE BUSINESS RELATIONSHIP WITH THE BANK IS MANAGED BY THE DIRECTOR OF FINANCIAL SERVICES OF THE HOSPITAL AND SHE HAS A DIRECT REPORTING RELATIONSHIP TO THE BOARD FINANCE COMMITTEE IN THIS REGARD. FURTHER, ANY DECISION MADE BY THE DIRECTOR OF FINANCIAL SERVICES IS GOVERNED BY POLICIES AND PROCEDURES APPROVED BY THE ENTIRE BOARD OF TRUSTEES ON THE RECOMMENDATION OF THE FINANCE COMMITTEE. ADDITIONALLY, FOR ANY PARTICULAR BUSINESS TRANSACTION OR DECISION THAT DIRECTLY INVOLVES FIRST COMMUNITY BANK, THE CEO AND THE BOARD MEMBER WITH A CONFLICT OF INTEREST LEAVE THE BOARD MEETING WHILE THE REMAINING BOARD MEMBERS DELIBERATE OR ACT ON THE MATTER. THE TRANSACTION DOLLAR AMOUNT SHOWN ABOVE IS THE NET INCREASE IN THE HOSPITAL'S BANK ACCOUNT AND INVESTMENT BALANCES WITH FIRST COMMUNITY BANK AND AFFILIATED COMPANIES FOR THE FISCAL YEAR. X LUCAS DEVICE 2 30000 FAIR VALUE false false false FORM 990, PAGE 6, PART VI, LINE 6 MEMBERSHIP IN THE FRANCES MAHON DEACONESS HOSPITAL CORPORATION (FMDH) IS ACHIEVED BY VIRTUE OF DONATING AT LEAST 100 TO FMDH, TO THE FRANCES MAHON DEACONESS HOSPITAL FOUNDATION (ALTHOUGH THE FOUNDATION IS A SEPARATE CHARITABLE ENTITY AND NOT CONTROLLED BY THE FMDH CORPORATION, ITS STATED PURPOSE IS TO SUPPORT FMDH AND THE DELIVERY OF HEALTHCARE SERVICES IN VALLEY COUNTY, MONTANA, THROUGH CHARITABLE DONATIONS SUPPORTING SERVICES DEVELOPMENT AND EQUIPMENT PURCHASES), AND LUKE'S 100 (ANOTHER LOCAL CHARITABLE ORGANIZATION SEPARATE FROM FMDH BUT WHICH SUPPORTS FMDH THROUGH ANNUAL DONATIONS). THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE CONTROL OVER FMDH. FORM 990, PAGE 6, PART VI, LINE 7A THERE ARE NO DISTINCT CLASSES OF MEMBERS; ALL MEMBERS ARE PART OF A SINGLE MEMBERSHIP CLASS. THE MEMBERS ELECT ALL MEMBERS OF THE FMDH BOARD OF TRUSTEES. ELECTION OF THE GOVERNING BOARD IS THE SOLE AUTHORITY GRANTED TO FMDH CORPORATION MEMBERS AND THEY EXERCISE NO OTHER GOVERNANCE OR CONTROL OVER FMDH. FORM 990, PAGE 6, PART VI, LINE 11B THE FORM 990 IS REVIEWED BY THE CEO AND DIRECTOR OF FINANCIAL SERVICES AND IS MADE AVAILABLE FOR THE BOARD'S REVIEW PRIOR TO BEING FILED. FORM 990, PAGE 6, PART VI, LINE 12C CONFLICTS OF INTEREST ARE REQUIRED TO BE REPORTED AT THE FIRST MEETING OF EACH CALENDAR YEAR. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST THEY ARE REQUIRED TO LEAVE THE BOARD MEETING WHILE THE BUSINESS IS BEING DISCUSSED OR ACTED UPON. FORM 990, PAGE 6, PART VI, LINE 15A THE BOARD OF TRUSTEES APPROVES THE CEO'S COMPENSATION. FORM 990, PAGE 6, PART VI, LINE 15B THE BOARD OF TRUSTEES APPROVES THE COMPENSATION FOR ALL PHYSICIANS EMPLOYED BY FMDH. THE CEO APPROVES THE COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES. FORM 990, PAGE 6, PART VI, LINE 19 ALL WRITTEN POLICIES ARE KEPT IN THE OFFICE OF THE DIRECTOR OF FINANCIAL SERVICES AND ARE AVAILABLE UPON REQUEST. FMDH FOUNDATION 621 3RD STREET SOUTH GLASGOW MT 59230 810406872 SUPPORT MT 501C3 7 NA false PRAIRIE RIDGE VILLAGE LLP 521 4TH AVE S GLASGOW MT 59230 810515202 ASSTLIVING MT 501C3 9 NA false NE MT STAT AIR AMBULANCE COOPERATIV 519 PLEASANT STREET MILES CITY MT 59301 204748673 AIR AMBULA MT 501C3 11B NA false HI-LINE MEDICAL SERVICES INC 621 THIRD STREET SOUTH GLASGOW MT 59230 208393201 PHYSICIANS MT N/A false GLASGOW CLINIC PC 621 THIRD STREET SOUTH GLASGOW MT 59230 810341714 CLINIC MT N/A false true false false true false false false false false true false false false false true true true true false FMDH FOUNDATION O 41455 STAFF & OTHER ITEMS GLASGOW CLINIC PC J 91200 RENTAL INCOME GLASGOW CLINIC PC R 505208 CHANGE IN RECEIVABLE HI-LINE MEDICAL SERVICES INC J 93633 RENTAL INCOME HI-LINE MEDICAL SERVICES INC R 487489 CHANGE IN RECEIVABLE NORTHEAST MT STAT AIR AMBULANCE Q 33623 CONTRACT STAFF NORTHEAST MT STAT AIR AMBULANCE P 30135 CONTRACT STAFF PRAIRIE RIDGE VILLAGE LLP D 3722936 LOAN BALANCE PRAIRIE RIDGE VILLAGE LLP A 198124 INTEREST RECEIVED ON LOAN