2017-07-13T12:56:50-05:00 2016-12-31 910189318 Moss Adams LLP 805 SW Broadway Suite 1200 Portland OR 97205 990 2016-01-01 810232122 Benefis Hospitals Inc BENE 4064552563 1101 26th Street South Great Falls MT 59405 TERRY OLINGER President Acute Care Group 4064552563 2017-06-29 1 Wendy Campos P00448102 5032421447 2017-06-29 12.129.7.100 2017-06-29 18:35:59 PD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 92E4E1887166A1A95AEA2354EF277E907B8DEB06 2016 2021-01-29 14:40:06Z TERRY OLINGER 1101 26th Street South Great Falls MT 59405 869353074 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 569 BED HOSPITAL, PROVIDING INPATIENT, OUTPATIENT AND SENIOR SERVICES. 11 6 2812 749 1532095 0 206203 341575 858395675 862656743 441875 557825 1636771 2274054 860680524 865830197 10512 3501065 0 0 139395265 123169990 0 0 0 700759906 713108415 840165683 839779470 20514841 26050727 402310610 405994504 350528453 328235124 51782157 77759380 X WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 0 0 777470288 3501065 859842842 BENEFIS HOSPITALS, INC. OPERATES A 569 LICENSED BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE ORGANIZATION PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. The organization provides long term care services. THE HOSPITAL ALSO PROVIDES PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH A FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. ALSO PROVIDES SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY and INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS and RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART and VASCULAR, SPORTS MEDICINE, MED SPA and VEIN CENTER. ALSO PROVIDES HOSPICE AND senior care SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 777470288 1 1 0 0 0 0 0 1 1 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 1 0 1 122 0 1 2812 1 1 1 0 0 0 0 0 0 0 0 0 X 11 6 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X Forrest Ehlinger 4064555479 1101 26th Street South GREAT FALLS MT 59405 Marilyn K Rose Chair 4.00 X X 0 0 0 Bill Ferrin Vice Chair 2.00 X X 0 0 0 Elton J Adams MD Director 2.00 48.00 X 0 337731 15549 Judy Borland MD Director 2.00 48.00 X 0 216368 6582 Robert M Grasseschi MD Director (through 12/31) 2.00 48.00 X 0 386058 14565 Brian Loucks Director 2.00 X 0 0 0 Melchisedek Margaris MD Director 2.00 X 30667 0 0 Senator Llew Jones Director (From 5/26) 2.00 X 0 0 0 Senator Ed Buttrey Director (through 2/1) 2.00 X 0 0 0 Dave Richards Director & System Board Liaison 4.00 4.00 X 0 0 0 Gregory Tierney MD Director 30.00 30.00 X 0 760244 38804 Terry Olinger President Acute Care Group 26.00 34.00 X X 0 545581 123460 Kathy Hill Chief Operating Officer 50.00 X 181267 0 19392 Paul Dolan MD Chief Medical Information Officer 25.00 25.00 X 399573 0 28372 Rayn Ginnaty Vice President of Nursing 50.00 X 239076 0 26942 Amy Beames Pres Sr Srvcs & Legislative Affairs 38.00 22.00 X 0 240373 30583 Joseph LoDuca Jr CAO Cancer & Heart Services 50.00 X 180842 0 18622 Peter Gray Executive Director Senior Services 50.00 X 179160 0 18220 Adam Elliot Medical Physicist 50.00 X 172644 0 19702 Dave Runkel Director Pharmacy 50.00 X 171406 0 18578 Greg Hilpert Director Radiology and Lab 50.00 X 161212 0 18583 1715847 2486355 397954 77 0 1 0 Aramark 27310 NETWORK PLACE Chicago IL 606731273 Contracted Food Services 3840735 Aramark 27310 NETWORK PLACE Chicago IL 606731273 Clinical Engineering Services 3731186 Precyse 275 DRUMMERS LANE ST 200 WAYNE PA 19087 Medical Records Services 3326379 Aero Air LLC 2050 NE 25TH AVE HILLSBORO OR 97124 Flight Transportation Services 2284630 Metro Aviation Inc PO Box 7008 Shreveport LA 71137 Flight Transportation Services 2029022 40 255040 86535 341575 PATIENT SERVICES 621990 853826367 853826367 OTHER OPERATIONS 621990 6147905 5232859 915046 CAFETERIA 722210 1898855 1898855 Meaningful Use Funds 621990 783494 783494 joint venture 621110 122 122 862656743 488601 488601 3612 0 3612 3612 3612 2774638 7081 2712210 285 62428 6796 69224 69224 1395981 810382 585599 617049 -31450 VENDOR REBATE/DISCOUNT 900099 1199191 1199191 Other Income 900099 485652 485652 1684843 865830197 859842842 1532095 4113685 3501065 3501065 925288 925288 124967 124967 101039626 101039626 3391040 3391040 10336415 10336415 7352654 7352654 54644472 54644472 243216 243216 7103186 7103186 4752 4752 1190796 1190796 3578542 3578542 236163 236163 4960352 4960352 9604163 9604163 319230 319230 contractual adj/charity 476676165 476676165 Medical Supplies 68305424 68305424 Other expenses 54404527 54090971 313556 Purchased Services 19078560 19078560 12758867 12758867 839779470 777470288 62309182 0 -3608498 -2463782 307303682 331521266 154 9141362 8471556 548809 473204 198698019 130705854 72026164 67992165 14901164 95 8619 0 1989154 0 402310610 405994504 239492400 322674062 111732 96774 106951516 0 3972805 5464288 350528453 328235124 X 51782157 77759380 51782157 77759380 402310610 405994504 X 26050727 -73382 -122 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 179972 X 0 1 19373 55705 57955 17122 0 45491495 9199900 36291595 5978505 743078 5235427 146292815 119982143 26310672 935204 780733 154471 67992165 THIRD-PARTY SETTLEMENTS 4312090 EST 340b liability 1152198 5464288 X Part III, Line 4: THE ORGANIZATION'S COLLECTION IS ARTWORK THAT IS DISPLAYED IN ITS SLETTEN CANCER CENTER AND PROVIDES AN ENVIRONMENT THAT IS HELPFUL FOR PATIENTS. Part IV, Line 1b: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. Part X, Line 2: The Organization is a notforprofit corporation and has been recognized as tax exempt pursuant to Section 501(c)(3) of the IRC. The Organization is exempt from federal income tax under Section 501(c)(3) of the IRC except to the extent of unrelated business taxable income as defined under IRC Sections 511 through 515. Effective January 1, 2009, the Organization adopted accounting for uncertain tax positions. The accounting standard prescribes a recognition threshold and measurement process for uncertain tax positions. The Organization had no uncertain tax positions as of December 31, 2016 or 2015. 1 1 X 1 X 1 X 1 1 0 1 1 3501065 3501065 0.01000 3501065 3501065 0.01000 624337 624337 0.00180 109574 109574 0.00030 19757760 19757760 0.05620 185778 185778 0.00050 1235039 1235039 0.00350 21912488 21912488 0.06230 25413553 25413553 0.07230 4150 4150 0.00000 6570 6570 0.00000 1980 1980 0.00000 450 450 0.00000 13150 13150 0.00000 1 11679583 0 141857761 162750684 -20892923 X 1 1 2 1 BENEFIS HOSPITALS INC EAST CAMPUS 1101 26TH STREET SOUTH GREAT FALLS MT 59405 X X X A 2 BENEFIS HOSPITALS INC WEST CAMPUS 500 15TH AVENUE SOUTH GREAT FALLS MT 59405 X X A BENEFIS HOSPITALS INC 0 0 1 X X X X X X X X X 16 1 0 1 1 X http://www.benefis.org/Main/healthsystem.aspx X 1 16 1 http://www.benefis.org/Main/healthsystem.aspx 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X http://www.benefis.org/Main/billing.aspx X HTTP://WWW.BENEFIS.ORG/MAIN/BILLING.ASPX X HTTP://WWW.BENEFIS.ORG/MAIN/BILLING.ASPX X X X X 1 X 0 X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: BENEFIS HOSPITALS, INC. EAST CAMPUS, - Facility 2: BENEFIS HOSPITALS, INC. WEST CAMPUS BENEFIS HOSPITALS, INC. Part V, Section B, line 5: (1) BENEFIS HOSPITALS PROVIDED LEADERSHIP, IN CONJUNCTION WITH THE CASCADE COUNTY CITY-COUNTY HEALTH DEPARTMENT, AND THE UNITED WAY, TO REVIEW THE ORIGINAL CHNA AND PLAN OUT THE 2015 SURVEY PROCESS THAT WOULD SUPPORT THE 2016 CHNA. AS PART OF ITS CONTINUING WORK, STEERING COMMITTEE REVIEWED THE RESULT FROM THE CHNA SURVEY AND IS FURTHER DEVELOPING AND UPDATING THE CASCADE COUNTY CHIP REPORT. COMMUNITY INVOLVEMENT IS CENTRAL TO THIS WORK AND IS ASSURED THROUGH CONTINUED REPRESENTATION FROM THE CENTER FOR MENTAL HEALTH; THE GREAT FALLS PUBLIC SCHOOL SYSTEM; GATEWAY SERVICES (ALCOHOL AND DRUG ABUSE TRATMENT); BENEFIS HOSPITALS, INC; INDIAN FAMILY HEALTH CLINIC; PLANNED PARENTHOOD; AND THE UNITED WAY, AMONG OTHER COMMUNITY GROUPS WITH A COMMITMENT TO PUBLIC HEALTH AND HEALTHY COMMUNITIES.(2) THE STEERING COMMITTEE'S COMPREHENSIVE CHNA SURVEY WAS SENT OUT TO 1,500 INDIVIDUAL RESIDENCES IN THE COMMUNITY AS A MEANS OF OBTAINING COMMUNITY RESIDENTS' INPUT. 311 SURVEY RESPONSES WERE RETURNED.(3) ON JANUARY 21, 2016, A TWO HOUR COMMUNITY TOWN HALL WAS CONDUCTED. SIXTY RESIDENTS, AND INDIVIDUALS PRIMARILY REPRESENTING HEALTH FOCUSED COMMUNITY AGENCIES AND ORGANIZATIONS, ATTENDED. THE MEETING INCLUDED A REVIEW AND DISCUSSION OF THE 2013 CHNA, AND THE ATTENDEES CAME TO A CONSENSUS REGARDING THE CURRENT HEALTH PRIORITIES OF CASCADE COUNTY. THE GROUP DECIDED TO CONTINUE ADDRESSING THE THREE COMMUNITY HEALTH PRIORITIES THAT WERE PUT IN PLACE AT THE LAST ASSESSMENT (HEALTHY WEIGHT, SUBSTANCE ABUSE, ACCESS TO HEALTH CARE) AND TO AFFIRM A FOURTH PRIORITY AREA (CHILD ABUSE AND NEGLECT). SPECIFYING THESE HEALTH PRIORITIES GIVES FOCUS TO THE COMMUNITY HEALTH IMPROVEMENT PLAN AND RELATED STEERING COMMITTEE S WHICH CONTINUE TO ENGAGE COMMUNITY AGENCIES.(4) THE STEERING COMMITTEE PRESENTED (4) THE STEERING COMMITTEE PRESENTED INFORMATION FROM THE CHNA, RESULTS OF THE TOWN HALL MEETING, AND A SUMMARY OF ACTIVITIES AND IMPACTS, TO CIVIC GROUPS IN CASCADE COUNTY FROM FEBRUARY-APRIL 2016. BENEFIS HOSPITALS, INC. Part V, Section B, line 6b: ALLIANCE FOR YOUTHBENEFIS HEALTH SYSTEMCASCADE CITY-COUNTY HEALTH DEPARTMENTCASCADE COUNTY COMMISSIONCASCADE COUNTY LAW CLINICCENTER FOR MENTAL HEALTH CHAMBER OF COMMERCECITY OF GREAT FALLS CITY OF GREAT FALLS COMMISSIONCOMMUNITY HEALTH CARE CENTERFAMILY CONNECTIONSGATEWAYGET FIT GREAT FALLSGREAT FALLS COLLEGE MSUGREAT FALLS PUBLIC SCHOOLSHOLY SPIRITJUVENILE PROBATIONLACMONTANA STATE LEGISLATORMSU EXTENSIONOPPORTUNITIES INC.PLANNED PARENTHOOD OF MONTANAPRIVATE COUNSELORSSMOOTH TRANSITIONSST. VINCENT DE PAULSTATE CHILD/ FAMILIES ADVOCACY UNITED WAYUNIVERSITY OF GREAT FALLSVOICES OF HOPEYWCA BENEFIS HOSPITALS, INC. Part V, Section B, line 11: THE CASCADE COUNTY COMMUNITY HEALTH IMPROVEMENT PLANNING COALITION SERVES AS A STEERING COMMITTEE FOR CHIP IMPLEMENTATION. THIS COMMITTEE MET REGULARLY DURING 2016 TO FACILITATE COMMUNITY PARTNERSHIPS AND LINKAGES TO ADDRESS THE IDENTIFIED HEALTH PRIORITIES OF CASCADE COUNTY. THE COMMITTEE, THROUGH STRONG COMMUNITY INPUT, IDENTIFIED RESOURCES TO ASSIST WITH ADDRESSING THE PRIORITY AREAS AND HAS WORKED ON DEVELOPING AN UPDATED IMPLEMENTATION PLAN RELATED TO THE 2016 CHNA PRIORITIZED NEEDS. THE COMMITTEE IS FOCUSED ON DATA BASED GOAL SETTING AND HAS IDENTIFIED EVIDENCE BASED STRATEGIES THAT ALIGN WITH COMMUNITY NEEDS. BENEFIS HOSPITALS, INC. Part V, Section B, line 13h: - Homeless- Deceased with no estate- Mentally incapacitated with no one to act on his or her behalf- Medicaid eligible, but not on the date of service or for non-covered services- Enrolled in one or more governmental programs for low-income individuals having eligibility criteria at or below 200% of the Federal Poverty Guidelines - Incarceration in a penal institution 1 1 - Grandview at Benefis 3015 18th Avenue South GREAT FALLS MT 59405 Assisted Living Facility PART I, LINE 7, COLUMN (F): THE BAD DEBT AND CONTRACTUAL ALLOWANCES ARE INCLUDED ON FORM 990 PART IX, LINE 25(A) AND 25(E), BUT ARE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $11,679,583 AND $476,676,165 RESPECTIVELY. Part I, Line 7: The cost to charge ratio is used to calculate the total community benefit expense. PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED. Part III, Line 2: THE COSTING METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO. Part III, Line 4: SEE NOTE 2 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. Part III, Line 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS, AND IS PAID SUBSTANTIALLY LESS THAN ITS COSTS DUE TO THE REIMBURSEMENT METHODOLOGY USED BY MEDICARE. Part III, Line 9b: Persons determined to be eligible for 100 % charity care shall not receive a bill for services or be subject to collection procedures. Persons determined to be eligible for a reduction of a percentage of charges under the charity care program less than 100% shall not be billed or subject to collection procedures for the portion of the bill that is reduced under the sliding fee scale, only the out of pocket responsibility. Part VI, Line 2: BENEFIS HOSPITALS, INC. HISTORICALLY HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. THE HOSPITAL HAS ASSEMBLED A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO CONDUCTED A COMMUNITY NEEDS ASSESSMENT IN 2016, AS CONTEMPLATED BY IRC SECTION 501(R). Part VI, Line 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND A COMMUNICATION OF FINANCIAL ASSISTANCE IS STATED ON EACH BILLING STATEMENT. Part VI, Line 4: THE ORGANIZATION'S SERVICE AREA IS 38,000 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 164,000, WITH AN AVERAGE POPULATION DENSITY OF 4.3 PER SQUARE MILE. THE SERVICE AREA IS APPROXIMATELY 49.7% FEMALE AND 50.3 % MALE. APPROXIMATELY 6.9% OF THE POPULATION IS UNDER 5 YEARS OF AGE, APPROXIMATELY 58.7% IS BETWEEN THE AGES OF 18 AND 65, AND APPROXIMATELY 17.5% OF THE POPULATION IS OVER THE AGE OF 65. THE SERVICE AREA IS 81.4% WHITE, 13.6% NATIVE AMERICAN, WITH THE REMAINDER AFRICAN-AMERICAN OR MULTIPLE RACES. THE AVERAGE HOUSEHOLD SIZE IS 2.5 PEOPLE, WITH APPROXIMATELY 65.0% OF ALL HOUSING UNITS BEING OWNER OCCUPIED. THE AVERAGE PER CAPITA INCOME IS $23,686 WITH THE MEDIAN HOUSEHOLD INCOME BEING $42,264; 17.2% OF THE POPULATION LIVES IN POVERTY. DATA IS BASED ON U.S. CENSUS BUREAU 2015 ESTIMATES. Part VI, Line 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). Part VI, Line 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. Part VI, Line 7, Reports Filed With States MT 1 CHARITY HEALTH CARE SERVICES 3501065 Part I, Line 2: THE ORGANIZATION provides emergency and medically necessary healthcare services for free or at discounted rates to certain patients who are uninsured or have limited insurance available. Generally speaking, patients eligible for discounted charges must have family incomes under 400% of the Federal Poverty Guidelines, while patients eligible for free care must have family incomes under 200% of the Federal Poverty Guidelines; in both cases, patients must not have available assets above established thresholds. IN ORDER TO QUALIFY A PATIENT MUST COMPLETE AND SUBMIT A FINANCIAL ASSISTANCE APPLICATION. THE ORGANIZATION ACQUIRES DOCUMENTS WITH THE APPLICATION TO VERIFY THE APPLICANT'S QUALIFICATIONS FOR ASSISTANCE. X X X X 0 1 0 0 0 0 0 1 0 Elton J Adams MD Director 0 203573 0 122158 0 12000 0 6788 0 8761 0 353280 0 0 Judy Borland MD Director 0 216368 0 0 0 0 0 5165 0 1417 0 222950 0 0 Robert M Grasseschi MD Director (through 12/31) 0 304247 0 33561 0 48250 0 3910 0 10655 0 400623 0 0 Gregory Tierney MD Director 0 230691 0 278513 0 251040 0 30009 0 8795 0 799048 0 0 Terry Olinger President Acute Care Group 0 376522 0 102791 0 66268 0 122856 0 604 0 669041 0 58350 Kathy Hill Chief Operating Officer 150102 0 31165 0 0 0 9604 0 9788 0 200659 0 0 0 Paul Dolan MD Chief Medical Information Officer 279541 0 54194 0 65838 0 19552 0 8820 0 427945 0 65838 0 Rayn Ginnaty Vice President of Nursing 206280 0 32796 0 0 0 26382 0 560 0 266018 0 0 0 Amy Beames Pres Sr Srvcs & Legislative Affairs 0 195932 0 44441 0 0 0 24090 0 6493 0 270956 0 0 Joseph LoDuca Jr CAO Cancer & Heart Services 147988 0 32854 0 0 0 8079 0 10543 0 199464 0 0 0 Peter Gray Executive Director Senior Services 146001 0 33159 0 0 0 7680 0 10540 0 197380 0 0 0 Adam Elliot Medical Physicist 172644 0 0 0 0 0 9140 0 10562 0 192346 0 0 0 Dave Runkel Director Pharmacy 155958 0 15448 0 0 0 8032 0 10546 0 189984 0 0 0 Greg Hilpert Director Radiology and Lab 132516 0 28696 0 0 0 9863 0 8720 0 179795 0 0 0 Part I, Line 4b BENEFIS HEALTH SYSTEM, INC PROVIDES A SECTION 457 NONQUALIFIED DEFERRED COMPENSATION PLAN FOR Dr. Dolan, Dr. Tierney, Mr. Olinger, and Ms. Ginnaty, who meet the requirements of the plan. DR. DOLAN and Mr. Olinger each received payouts from the plan in 2016. Part I, Line 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM. PAYMENTS PURSUANT TO THE INCENTIVE PLAN ARE SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. THE SYSTEM HAS ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, FINANCE/OPERATIONS, AND COMMUNITY BENEFIT. THE INDIVIDUAL PERFORMANCE OBJECTIVES ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM INCENTIVE PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY OVERALL PERFORMANCE. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. Danielle Tierney FAMILY MEMBER OF Gregory Tierney, MD, director 61657 COMPENSATION 0 Paula Olinger FAMILY MEMBER OF Terry Olinger, officer 63310 compensation 0 FORM 990, PART VI, SECTION A, LINE 1B THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NON-PROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO ELECT ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS'S OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. Form 990, Part VI, Section A, line 2 CERTAIN OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. Such business relationships are undertaken in the ordinary course of business. Form 990, Part VI, Section A, line 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS, AS THE PARENT AND SYSTEM ENTITY, PROVIDES THE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT NON-PROFIT CORPORATE ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES - MANAGEMENT, PLANNING, BUDGETING AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES AND FUNCTIONS - MANAGEMENT OF INFORMATION TECHNOLOGY SERVICES - OVERSIGHT OF QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGEMENT OF REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT THE FOLLOWING PERSONS LISTED IN PART VII WERE COMPENSATED BY BHS: TERRY OLINGER - $669,041 (COMPENSATION FOR SERVICES AS OFFICER OF BHS) Form 990, Part VI, Section A, line 6 The sole corporate member of the organization is Benefis Health System, inc., a Montana not-for-profit public benefit corporation that has been recognized by the IRS as described in IRC Section 501(c)(3). Form 990, Part VI, Section A, line 7a AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. (ACTING THROUGH ITS OWN GOVERNING BODY) ELECTS THE BOARD OF DIRECTORS OF THE ORGANIZATION. Form 990, Part VI, Section A, line 7b AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. Form 990, Part VI, Section B, line 11b THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. Prior to filing, a copy of this form 990 was presented to the Benefis Health System, Inc. board by the accounting firm. Form 990, Part VI, Section B, line 12c BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND VOTING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. Form 990, Part VI, Section B, line 15 THE COMPENSATION OF THE EXECUTIVE TEAM, INCLUDING THE PRESIDENT ACUTE CARE GROUP, CHIEF MEDICAL INFORMATION OFFICER, VICE PRESIDENT OF NURSING, CHIEF OPERATING OFFICER AND PRESIDENT SENIOR SERVICES & LEGLISLATIVE AFFAIRS, WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILAR SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. Form 990, Part VI, Section C, line 19 BENEFIS HOSPITALS, INC. PROVIDES COPIES OF AUDITED FINANCIAL STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. Form 990, Part XI, line 9: TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA PHYSICIANS 176. TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA Hospitals -298. 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