2016-11-14T14:29:51-06:00 2015-12-31 450250958 Eide Bailly LLP 1545 Associates Dr Ste 101 Dubuque IA 520022299 990 2015-01-01 810392231 Wheatland Memorial Healthcare WHEA 4066324351 PO Box 287 Harlowton MT 59036 Kyle Gee CFO 4066324351 2016-11-09 1 Carmen Krantz P00031958 5635561790 2016-11-09 2015 2017-02-10 21:41:12Z Brad Howell PO Box 287 Harlowton MT 59036 5972154 0 X www.wheatlandmemorial.org X 1951 MT To provide healthcare services to the surrounding community 6 6 100 12 0 0 185738 164323 5207888 5715235 -48684 76699 27912 15897 5372854 5972154 1500 125 0 0 3288162 3601661 0 0 0 2710879 2873933 6000541 6475719 -627687 -503565 6543383 5882151 1511087 1428860 5032296 4453291 X Responsive to the communities we serve, Wheatland Memorial Healthcare is dedicated to providing sustainable quality care with respect, compassion and teamwork. 0 0 4967541 125 5715235 As a Critical Access Hospital, Wheatland Memorial Healthcare provides a broad range of primary care services to the local community. 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 $22,790 for the year ended December 31, 2015. Total direct and indirect costs related to these foregone charges were approximately $24,000 at December 31, 2015, based on an average ratio of cost to gross charges. 4967541 1 1 0 0 0 0 0 0 1 0 1 0 0 1 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 13 0 1 100 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 0 1 0 0 0 X Kyle Gee 4066573821 PO Box 37000 Billings MT 59107 Aubrey Miller Chairperson 1.00 0.00 X X 0 0 0 June Voldseth Vice Chairperson 0.50 0.00 X X 0 0 0 Don Amundson Secretary/Treasurer 0.20 0.20 X X 0 0 0 Jenny Peters Trustee 0.20 0.00 X 0 0 0 Tom Bennett Trustee 0.20 0.00 X 0 0 0 Sarah Mauws Trustee 0.20 0.00 X 0 0 0 Leta Nash Trustee until 01/15/2015 0.20 0.00 X 0 0 0 Lorraine Peterson Trustee until 12/31/2015 0.20 0.00 X 0 0 0 Brad Howell CEO commencing Dec. 2015 30.00 0.00 X 0 0 0 Kyle Gee CFO 10.00 0.00 X 0 0 0 Mike Zwicker CEO until May 2015 40.00 0.00 X 0 0 0 Larry Putnam Interim CEO - June - Aug 2015 40.00 0.00 X 0 0 0 Tim Russell Interim CEO - Sept - Oct 2015 40.00 0.00 X 0 0 0 Charlotte Jutila MD Cardiologist 33.00 0.00 X 195124 0 15493 Taylor Lies PA-C Physician Assistant 40.00 0.00 X 126366 0 7667 Hannah Sexton MPA-C Certified Physician Assistant 40.00 0.00 X 102665 0 0 Rebecca Sturdevant FNP Family Nurse Practitioner 40.00 0.00 X 134576 0 2969 558731 0 26129 4 0 1 0 Billings Clinic PO Box 37000 Billings MT 59107 Management, accounting and IT services 1260764 Eide Bailly LLP PO Box 2545 Fargo ND 58108 Accounting and IT services 155596 2 12268 63139 88916 164323 Patient service revenu 622110 5264963 5264963 Electronic health reco 900099 425917 425917 Supporting revenue 900099 24355 24355 5715235 61046 61046 13697 13697 2200 0 2200 2200 2200 15653 0 15653 15653 15653 5972154 5715235 0 92596 125 125 3075102 2644979 430123 74141 58044 16097 203883 176509 27374 248535 213930 34605 288821 288821 17932 17932 41038 41038 9240 9240 534176 279069 255107 13174 9349 3825 179999 119839 60160 202538 202538 122249 122249 132995 109786 23209 35101 19586 15515 29946 29946 472486 472486 54433 54433 Bad debt expense 340833 340833 Medical supplies 293554 293554 Equipment rent/lease 102447 77257 25190 2971 2971 6475719 4967541 1508178 0 544 266749 507112 1117162 884290 119631 131103 21728 26771 6317220 4537596 2158491 1779624 2020732 1631615 295777 290490 23673 519440 630602 6543383 5882151 777817 597929 16665 3588 716605 713008 0 114335 1511087 1428860 X 4496818 4010849 535478 442442 5032296 4453291 6543383 5882151 -503565 -75440 0 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 83558 83558 2963822 2284606 679216 3212569 2252990 959579 57271 57271 1779624 Other receivables 68611 Electronic health record incentive 555005 Due from Wheatland Memorial Healthcare Foundation 6986 630602 Estimated third-party payor settlements 114335 114335 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 $3,588 at December 31, 2015. 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 0.00390 24000 24000 0.00390 1558914 1048789 510125 0.08320 1558914 1048789 510125 0.08320 1582914 1048789 534125 0.08710 0 340833 35106 1829259 1844519 -15260 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 13 1 0 0 1 X www.wheatlandmemorial.org X 1 13 1 www.wheatlandmemorial.org 0 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 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 April 2013.Steering Committee 1. Foundation/Marketing Director, Wheatland Memorial Healthcare 2. Martinsdale Community Member and Business Owner 3. Director of Nursing, Wheatland Memorial Healthcare 4. CEO, Wheatland Memorial Healthcare 5. Hospital Guild Volunteer 6. Human Resources, Wheatland Memorial Healthcare 7. County Commissioner and Rancher 8. Harlowton Community Member and Business Owner 9. Board Member, Wheatland Memorial Healthcare Wheatland Memorial Healthcare Part V, Section B, Line 11: Access to Healthcare ServicesWheatland Memorial Healthcare (WMH) finalized contracts and credentialed a Pulmonologist and a Certified Sleep Doctor for a Sleep Lab in 2013. We designated a space, finalized a fee structure, and marketed the sleep lab. We successfully did a number of sleep studies locally in 2014. Unfortunately, WMH had challenges with the Certified Sleep Doctors schedule. He was struggling to keep his commitment with Rocky Mountain Sleep Disorders. After many failed attempts to find a new Certified Sleep Doctor and keep the lab going it closed in early 2015. Wheatland Memorial Healthcare has been creative when it has come to offering pulmonary services. We recently established pulmonary function testing in-house. Patients must be referred by a medical provider. We are currently marketing capabilities in the community. Wheatland Memorial Healthcare nurses did a Lifestyle Balance accountability group open to community members and employees in June 2015. The program had 11 participants and was deemed successful. We have plans to do another winter/spring course depending on clinic staffing. Plan for ExpansionIn 2014, Wheatland Memorial Healthcare purchased a large piece of property in front of the hospital. Currently WMH owns all the property in front of the hospital on the main highway through town. A committee along with some board members is doing a cost analysis on space, needs and outcomes. WMH has explored moving the Physical Therapy department off campus to provide more space for more equipment and private provider space while working with patients. We are weighing out all options and doing a cost analysis.Wheatland Memorial Healthcare is building relationships with donors and Grantors that give for bricks and mortar. Education and OutreachThe Hospital advertised counseling services that were available in the community, especially for substance abuse counseling and metal health. These services were added to our newly launched website in 2015. We also ran a full page feature on the local NAMI group and awareness on mental health on our website and in our newsletter annually and numerous articles have been written for the local newspaper regarding mental health issues. NAMI groups were invited to set up informal booths at local health fairs free of charge. Wheatland Memorial Healthcare Part V, Section B, Line 16i: 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 was 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. 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 $340,833. 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 10.3%. 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 2013 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 assessed the needs of the community through patient surveys, general public surveys, and community meetings. After review of these, the Hospital created a plan of action to address the needs of the community and monitored the implementation. The needs assessment and implementation strategy was posted to the Hospital's website by 12/31/2013. The next CHNA is in process and will be completed by 12/31/2016. 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 2013 population of Harlowton was estimated at 991, with WMH serving residents of Wheatland, Golden Valley, Judith Basin and portions of Sweet Grass and Meagher counties. 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 Harlowton was $23,636, compared to $41,994 for the state of Montana. Individuals below the federal poverty level in Wheatland County was 10.3%, compared to above 14% for the state of Montana. 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 Charlotte Jutila MD Cardiologist 195124 0 0 0 0 0 7962 0 7542 0 210628 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 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, 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. Mike Zwicker - CEO through May 2015 Salary $88,229 (this includes a $50,000 severance) Pension 2,258 Other benefits 4,382 Larry Putnam - Interim CEO June - August 2015 Consultant fee of $36,750 Tim Russell - Interim CEO September - October 2015 Salary $ 5,400 Pension 350 No additional benefits Brad Howell - Current CEO hired December 2015 Salary $ 4,204 Pension 420 Other benefits 375 Kyle Gee, CFO Salary $44,790 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 11 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 is a common law employee 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 11a, I Wheatland Memorial Healthcare 1 0 0 1 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0