2016-11-04T08:32:59-05:00 2015-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2015-01-01 810232121 Bozeman Deaconess Health Services BOZE 4065855000 915 Highland Boulevard Bozeman MT 59715 Gordon Davidson CFO/VP of Finance 4065855000 2016-11-03 1 Kim Hunwardsen CPA P00484560 6122536500 2016-11-03 2015 2017-02-10 21:41:12Z Bozeman Health Gordon Davidson 915 Highland Boulevard Bozeman MT 59715 250686170 0 X www.bozemandeaconess.org X 1911 MT To improve community health and quality of life for residents and visitors of the Bozeman, MT area. 11 10 2276 245 1311692 -272912 2067539 1360972 226325372 243243458 5704523 4015698 541594 521110 234639028 249141238 1610001 623600 0 0 101786134 117496661 0 0 0 110123291 117186530 213519426 235306791 21119602 13834447 396406654 404683357 117155952 115530049 279250702 289153308 X To improve community health and quality of life. 0 0 62782447 56347221 Bozeman Deaconess Health Group consists of our departments that provide physician services to outpatients. The number of Medicare and Medicaid patients seen in 2015 decreased from about 44% of total visits in 2014 to 42% of total visits in 2015. Revenue for these patients and uninsured patients totaled 45% of all clinic revenue. Total operating revenues were $56,347,221 with associated operating expenses of $62,782,447. The loss of $6,435,226 is reflective of our commitment to provide access to all patients regardless of their ability to pay. 22162349 56617170 Bozeman Deaconess Surgical Services strives to offer a wide array of surgical options using state of the art technology. Of the 6,040 inpatient and outpatient surgeries, about 34% were Medicare and Medicaid patients, which comprised 41% ($23,141,922) of total revenue from these services ($56,617,170). Over 60% of the Medicare/Medicaid revenues were unreimbursed ($13,992,055) and written off, along with another $5,903,294 from other payors. Our operating room also recorded $15,702,214 in operating expenses plus another $6,460,135 of indirect overhead. 13344132 24149596 The Emergency Room at Bozeman Deaconess Health Services is one of the busiest departments in our organization, with just over 30,000 visits in 2015. Approximately 35% of these visits were from Medicare and Medicaid patients, comprising $8,756,624 of the $24,149,596 of the gross revenue. Over 60% of the Medicare/Medicaid revenue were unreimbursed ($5,289,254) and written off, along with almost 36% of the remaining revenue ($5,514,684). Direct and indirect expenses incurred in supporting the operation of this emergency room accumulated to $13,344,132. 85975766 623600 106241943 Bozeman Deaconess Health Services operates an 86 bed hospital facility (Hospital), along with a 43 unit assisted living home and a 115 unit independent living home (Hillcrest Senior Living or HSL). A new 4 bed hospital, Big Sky Medical Center, was opened in Big Sky. In addition, Bozeman Health Urgent Cares continues to provide walk-in resources. All patient and resident service revenue from these operations are used to provide health care services, health care promotion, and health care education to Bozeman, Big Sky and the surrounding communities. 85975766 623600 106241943 184264694 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 192 0 1 2276 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 X Gordon Davidson 4065851036 915 Highland Blvd Bozeman MT 59715 Julie Jackson Chair (as of 7/1/15) 1.00 X X 0 0 0 Terry Cunningham Chair (thru 6/30/15) 1.00 X X 0 0 0 Brian Brown 1st Vice Chair 1.00 X X 0 0 0 Katie Daughenbaugh 2nd Vice Chair 1.00 X X 0 0 0 Dr Dane Sobek Secretary / Cardiology 1.00 X X 627941 0 61987 John Murdoch Treasurer 1.00 X X 0 0 0 Kerri Brown Trustee 1.00 X 0 0 0 Rev Dave McConnell Trustee 1.00 X 0 0 0 Dennis Munson Trustee 1.00 X 0 0 0 Kerry Petitt Trustee 1.00 X 0 0 0 Walt Sales Trustee 1.00 X 0 0 0 Robert Watson Trustee 1.00 X 0 0 0 Gordon Davidson Interim CEO/VP Finance/CFO 50.00 X 399031 0 61113 Dr David Chen Interim CEO/CMO 50.00 X 397150 0 40521 Kevin Pitzer CEO/President (partial year) 50.00 X 613130 0 33806 Elizabeth Lewis Senior VP Operations/Legal 50.00 X 338534 0 57080 Hugh Hetherington MD Otolaryngology/Plastic Surgery 50.00 X 556987 0 63434 Annie Castillo MD Oncology 50.00 X 529022 0 15900 Nathanial Madsen MD Cardiology 50.00 X 546181 0 55835 Ken May MD Oncology 50.00 X 600229 0 26316 Blair Erb MD Cardiology 50.00 X 626834 0 57487 5235039 0 473479 143 0 1 0 Langlas & Associates - Bozeman 1019 E Main St Ste 101 Bozeman MT 59715 Construction 14566060 Martel Construction Inc 1203 S Church Bozeman MT 59715 Construction 11470375 Sanford Health PO Box 5074 Sioux Falls SD 57117 Software Build/Hosting 7375279 Absaroka Emergency Physicians 1184 N 15th Street Suite 1 Bozeman MT 59715 ER Physicians Fee 5524392 Arbor Medic PO Box 10305 bozeman MT 59715 Landscaping/Lawn/Snow Removal 868367 52 1360972 1360972 Patient service revenu 622110 222373516 222029071 344445 Resident service reven 623000 6313068 6313068 Other Joint Venture Re 423000 4168529 4168529 Pharmacy Revenue 446110 4011325 3492178 519147 Cafeteria Revenue 722210 1621219 1621219 4755801 4406679 349122 243243458 2963207 2963207 1304959 783849 521110 521110 98978 422132 1813574 761083 0 -761083 1813574 1052491 1052491 249141238 242030744 1311692 4437830 623600 623600 2601738 682088 1919650 93158141 75547269 17610872 4255361 3461057 794304 10834619 8624014 2210605 6646802 5267195 1379607 468439 468439 88800 88800 60133 60133 606074 606074 21306507 10650198 10656309 2379504 262905 2116599 4045182 1214613 2830569 3115086 636200 2478886 502311 338023 164288 334874 225349 109525 2277073 2277073 15144589 15144589 2221365 601398 1619967 Medical Supplies 43923321 43815224 108097 Provision for Bad Debts 9623436 9623436 Equipment Rent & Mainte 8583750 4833779 3749971 Taxes & Licenses 1372480 72305 1300175 1133606 364379 769227 235306791 184264694 51042097 0 29015934 21687710 33007908 34374057 450218 401518 6355209 6977267 2322930 1810883 313003575 144075958 137605442 168927617 142419529 126050801 1488754 22646 16719795 16078906 10891838 10493626 16129097 17858326 396406654 404683357 32026166 31975864 365123 423116 66621214 62528669 179507 3088675 17963942 17513725 117155952 115530049 X 273114036 282036280 4496434 5411160 1640232 1705868 279250702 289153308 396406654 404683357 X 13834447 -3804601 -127240 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 0 1 52400 0 1 7733 60133 0 Part II-B, Line 1: Hired consultant to provide lobbying services in connection with governmental affairs representation to ensure hospital, community, and employee interests and needs are represented. Bozeman Deaconess Health Services reimburses certain professional membership dues of employees, a portion of such membership dues are used by the professional associations for lobbying activities. These are dues for MHA and AHA. The Chief Medical Officer for Bozeman Health served on the Healthcare Advisory Committee. This involved approximately twelve hours of time. 13788550 99933 216493 176755 13928221 12396438 785403 619492 12783 13788550 10913019 15645 1686800 219026 12396438 9765686 385183 873051 110901 10913019 9735942 398579 -284159 84676 9765686 0.75000 0.15000 0.10000 0 1 1 7005002 2167165 9172167 180577094 82742069 97835025 101797841 59495935 42301906 21456473 1837954 19618519 168927617 Estimated Third-party Payor Settlements 463513 Deposits 8028717 Capitalized Lease Obligation 9021495 17513725 X Part V, Line 4: Each endowment fund is privy to a separate agreement. Donations made for each purpose shall be received, held, and invested by the Bozeman Deaconess Foundation according to established policies governing gift acceptance, investment, and distribution. The principal of the fund shall be retained in perpetuity. The interest income is utilized for the greatest needs of the designated department. Policy says the organization can use a portion of interest for operations. The endowment fund reported in Line 1 is currently being held by a related organization, Bozeman Health Foundation, and benefits BDHS. Part X, Line 2: The Organization consists of Montana nonprofit corporations 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 Organization 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. The Organization files an Exempt Organization Business Income Tax Return (Form 990T) with the IRS to report its unrelated business taxable income. The Organization 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 consolidated financial statements. The Organization 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 1 1 0 1 1 8009111 480102 7529009 0.03340 14032630 9306074 4726556 0.02090 22041741 9786176 12255565 0.05430 635486 166820 468666 0.00210 33426 33426 0.00010 38938494 28552585 10385909 0.04600 706992 706992 0.00310 40314398 28719405 11594993 0.05130 62356139 38505581 23850558 0.10560 1 10261215 41996865 42984701 -987836 X 1 1 2 1 Bozeman Deaconess Health Services 915 Highland Blvd Bozeman MT 59715 www.bozemanhealth.org 12933 X X X 2 Big Sky Medical Center 334 Town Center Ave Big Sky MT 59716 www.bigskymedicalcenter.com 13563 X X X Bozeman Deaconess Health Services 1 0 0 1 X X X X X X X X 15 1 0 1 1 X See Part V Line 7d X See Part V Line 7d 1 15 1 See Part V Line 7d 0 0 1 X 150.000000000000 250.000000000000 X X X 1 1 X X X 1 X http://www.bozemanhealth.org/Deaconess-Hospital/For-Patients-Visitors/Finan X http://www.bozemandeaconess.org/Our-Services/Financial-Services.aspx X http://www.bozemandeaconess.org/Our-Services/Financial-Services.aspx X X X X X 1 X 0 X X X X 1 X 0 1 Big Sky Medical Center LLC 2 1 1 0 0 1 X 150.000000000000 250.000000000000 X X X 1 1 X X X 1 X http://www.bozemanhealth.org/Deaconess-Hospital/For-Patients-Visitors/Finan X http://www.bozemandeaconess.org/our-services/financial-services.aspx X http://www.bozemandeaconess.org/our-services/financial-services.aspx X X X X X 1 X 0 X X X X 1 X 0 1 Bozeman Deaconess Health Services Part V, Section B, Line 5: BDHS partnered with Gallatin City-County Health Department and Community Health Partners, a federally qualified health center in Gallatin and Park County. (Please see BDHS 2015-2017 Community Benefit Plan pages 8-12). BDHS also solicited input from a variety of healthcare providers, public health representatives, as well as community, business, and government leaders through an online survey. (Please see BDHS 2015-2017 Community Benefit Plan pages 13-15 and accompanying appendices). Bozeman Deaconess Health Services Part V, Section B, Line 6b: BDHS partnered with Gallatin City-County Health Department and Community Health Partners, a federally qualified health center in Gallatin and Park County. Bozeman Deaconess Health Services Part V, Section B, Line 7d: Line 7a: http://www.bozemanhealth.org/For-Community/Community-Benefit.aspx http://www.bozemanhealth.org/documents/Content/BDHS-2015-2017- Community-Benefit-Plan_3.7.16-(1).pdfLine 7b: http://bozemanregion2014.healthforecast.net/ http://healthygallatin.org/healthy-people-families/how-healthy-is- your-community/Line 10: http://www.bozemanhealth.org/documents/Content/BDHS-2015-2017- Community-Benefit-Plan_3.7.16-(1).pdf Big Sky Medical Center, LLC Part V, Section B, Line 2: Hospital license granted December 10, 2015. Bozeman Deaconess Health Services Part V, Section B, Line 11: All four identified priority needs listed as Strategic Issues in our Community Benefit Plan are being addressed and we continue to actively collaborate with the community in addressing these needs. The following updates relate to initiatives/strategies to address needs identified based on the 2015 CHNA conducted jointly by Bozeman Deaconess Health Services (BDHS), Gallatin City and County Health Department (GCCHD) and Community Health Partners (CHP).Strategic Issue #1: Improving Access to Healthcare Services Preventive health services* Mobile Outreach Health Screenings - The mobile health screening van (HealthCare Connections, HCC) provides free screenings for breast and colon cancer, heart disease, stroke, diabetes, osteoporosis and obesity as well as free vaccinations for Tdap (tetanus and pertussis or whooping cough), flu (seasonal) and pneumonia. - The HealthCare Connections-Mobile Health Screenings (HCC) exceeded 2015 targets of 5% increase from prior year. - Health screenings were up by 18% - Number of vaccinations given increased 11.4% * BH Annual Health Fair - Offered access to reduced price blood draws and FOBT's as well as free preventive screenings (bone density, heart monitoring facial skin checks, glucose sticks, oximetry, blood pressure, vision, hearing, and depression). - 72 employees helped - 723 community members attended, with over 350 adults (50% of attendees) availing of the reduced health screens* Big Sky Annual Health Fair - Offered access to reduced price blood draws and FOBT's as well as free preventive screenings (bone density, glucose sticks, blood pressure, and BMI) - 5 employees helped - 21 attended the fair* HCC participated in the Gallatin County Goodwill Event, Project Homeless and Veterans Stand Down.Healthy Gallatin Access Committee BH continues to provide leadership and support to this committee. For 2015, the committee meeting discussions moved to a review of the work plan and priorities for 2015.Children's Immunization and Flu Awareness CampaignBH conducted press releases to the media as well around 30 posts on social media.Strategic Issue #2: Increase Collective Impact Through Strategic Partnerships with the CommunityOngoing Partnerships & Collaborations* Healthy Gallatin: BH continues to provide leadership, support and work on the Healthy Gallatin Collaboration Committee, now known as the Interagency Committee. Includes various organizations including: - Gallatin City-County Health Department (GCCHD) - Community Health Partners (CHP) - Montana State University (MSU) - Local Government Center - Dept of Health & Human Development - SNAP Ed ProgramGallatin County Planning & Community Development - Gallatin Mental Health Center - Gallatin Valley Land Trust - Montana Team Nutrition - Montana Nutrition & Physical Activity Program - Gallatin Valley Farm to School - Willing Workers Ladies Aid (Gallatin Gateway) - Belgrade Chamber of Commerce - Greater Gallatin United Way - Three Rivers Clinic - Thrive - Early Childhood Community Council - Gallatin Valley YMCA - Bozeman School District - Belgrade School District - Alcohol & Drug Services of Gallatin Co - HRDC - Food Bank, Streamline - YPR - Health Matters* MSU/Health Sciences Education - WWAMI - Nursing - Emergency Department / EMT - Surgical Services - Pharmacy - Cancer Center - Laboratory Services - Radiology - Rehabilitation Services - Nutrition Services* School Districts in Gallatin County - via GoNoodle Program* Gallatin Mental Health, Western Montana Mental Health Services* Cancer Support Community* HighlandGlen Nature Preserve - GVLT - Bridger Ski FoundationSupporting Community Groups* Help Center* Cancer Support Community Montana* Eagle Mount* Reel Recovery* Share - Pregnancy & Infant Loss* Haven (New Beginnings Corporate Partnership)* Health Mothers Healthy Babies* Bozeman Health Scholarship Program* Greater Gallatin United WayBH Senior Leadership Community Board Services* Big Sky Medical Center* Community Health Partners (CHP)* Bozeman Broadband Initiative* Bozeman Economic Development Council* Northern Rocky Mountain EDD* Human Resources Development Council (HRDC)* Prospera Business Network* Rotary* US BankTelehealth* A task force was formed to look into using telehealth, including the completion of a needs assessment.Expand Utility of BH Health Information Center (BH HIC)* BH HIC arranged 12 health forums talking about nutrition, prostate health, cardiovascular disease and diabetes, sleep conditions and mind and body medicine.* As a member of the Cancer Committee, reporting to the committee the types of cancer screenings held by BH, the HCC and cancer education programs, like the forums.* Participant in quarterly meetings and contributor of the Tri-County Cancer Coalition, working with the group to develop an action plan for cancer Prevention and Early Detection.* BH Supports the GCCHD Immunization Coalition by attending quarterly meetings.Strategic Issue #3: Addressing Obesity, Poor Nutrition and Lack of Physical ActivityHealthy Gallatin Nutrition & Physical Activity CommitteeBH has provided facilitation, support and leadership and has availed meeting rooms for this newly formed committee, which kicked off on October 27, 2014.Active Afterschool ProgramThe Active Afterschool Program, focused primarily on addressing the growing issue of obesity in children, aims to motivate kids and their families to change/improve behavior towards adapting a healthy lifestyle, focused on nutrition and physical activity. This program is administered in partnership with Gallatin Valley YMCA, and is offered in Sacajawea Middle School to 6th - 8th grade kids.GoNoodle ProgramGoNoodle is a program promoting physical activity for kids, helping them reach 60 minutes of movement daily as recommended by Centers for Disease Control and Prevention. The program channels K-5 classroom energy with short, interactive physical activity breaks or "brain breaks" to improve student health, engagement, behavior and performance. Schools have access to almost 250 interactive games and videos to get kids moving and learning in the classroom. The resources are also available to be utilized at home. During the 2015/2016 school year:- 20,088 Physical Activity Breaks Played (8/1/15 - 5/31/16)- 1,099,738 Student Minutes of Physical Activity (8/1/15 - 5/31/16)- 197 Active Teachers (Sep)- 5,007 Active Students (Sep)- 86% of surveyed teachers reported seeing an improvement in academic achievement since using GoNoodle- 77% of surveyed teachers believe GoNoodle Plus is helping their students succeed in core subjects- Workplan is behing developed for next school year.Strategic Issue #4: Support Community in Addressing Behavioral and Mental Health IssuesSupporting Community GroupsNAMI-NAMI Montana is the Montana Chapter of the National Alliance on Mental Illness (NAMI). NAMI is the nation's largest grassroots organization for people with mental illnesses and their families. Founded in 1979, NAMI has affiliates in every state and in more than 1,100 local communities across the country. NAMI Montana supports, educates, and advocates for Montanans with severe mental illnesses and their families. In 2015 Bozeman Deaconess Hospital contributed $25,000 to NAMI, as well as $346,000 to Western Montana Mental Health to support mental health crisis programs in the area.GoNoodle Program on Positively Impacting Behavior/Mental Health of StudentsAlong with physical activity breaks, GoNoodle has provided the PERFECT outlet for students to take control over their emotions, regroup, and reset, leaving them ready to learn again. Should a student find him/herself struggling with an emotion or behavior, using GoNoodle to calm down is an optimal solution. For example, students may participate in "Flow" activities from GoNoodle, which ask a series of questions from the student to see how they are feeling, and then lead them through a series of mental imaging and meditation exercises (about 3-5 min.) to respond accordingly. In 2015/16 school year, over 150,000 minutes (about 15%) of GoNoodle activity for Bozeman Health was of the calming variety. Bozeman Deaconess Health Services Part V, Section B, Line 16i: Medical Advocacy Services in Healthcare (MASH) will give out our financial application after determining patient is ineligible for federal and state programs.A summary of the financial assistance policy is attached to billing invoices, posted in patient admissions areas, and provided to patients on admission to the hospital facility. Big Sky Medical Center, LLC Part V, Section B, Line 16i: Medical Advocacy Services in Healthcare (MASH) will give out our financial application after determining patient is ineligible for federal and state programs. A summary of the financial assistance policy is attached to billing invoices, posted in patient admissions area, and provided to patient on admission to the hospital facility. Bozeman Deaconess Health Services Part V, Section B, Line 22d: BDHS uses the Look Back Method. Big Sky Medical Center, LLC Part V, Section B, Line 22d: BSMC used the Prospective Method for 2015. Bozeman Deaconess Health Services 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 billed gross charges on elective procedures. Big Sky Medical Center, LLC 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 billed gross charges on elective procedures. Schedule H, Part V, Section B, Line 7a: http://www.bozemanhealth.org/For-Community/Community-Benefit.aspxhttp://www.bozemanhealth.org/documents/Content/BDHS-2015-2017-Community-Benefit-Plan_3.7.16-(1).pdf Schedule H, Part V, Section B, Line 7b: http://bozemanregion2014.healthforecast.net/http://healthygallatin.org/healthy-people-families/how-healthy-is-your-community/ Schedule H, Part V, Section B, Line 10: http://www.bozemanhealth.org/documents/Content/BDHS-2015-2017-Community-Benefit-Plan_3.7.16-(1).pdf 7 1 - Deaconess Intercity Imaging LLC 915 Highland Blvd Bozeman MT 59715 Outpatient Imaging Center 2 - Rocky Mountain Surgery Center LLC 1450 Ellis St Suite 101 Bozeman MT 59715 Outpatient Surgical Center 3 - Hillcrest Senior Living 1201 Highland Blvd Bozeman MT 59715 Independent and Assisted Living Facility 4 - Hospice of Southwest Montana LLC 3810 Valley Commons Dr Ste 1 Bozeman MT 59715 Hospice Services 5 - Family Doctors Urgent Care LLC 120 N 19th Avenue Bozeman MT 59715 Outpatient Health Care 6 - Bozeman Health Urgent Cares LLC 106 W Main Bozeman MT 59715 Outpatient Health Care 7 - Bozeman Health Clinical Research LLC 950 Stoneridge Dr 1 Bozeman MT 59718 Outpatient Health Care Clinical Trials Part I, Line 3c: Any individual and their dependents who are at 150% of the Federal Poverty income level or below will be eligible to receive a 100% write-off of the self-pay portion of incurred charges, upon completion of an application. Any uninsured individual with income under 250% of the Federal Poverty Guidelines (FPG) will be eligible to receive a discount from charges based on certain guidelines. Completion of the Financial Assistance application will be required. In some cases, full or partial assistance may be provided to insured individuals with gross family incomes above 250% of the FPG adjusted for family size. Catastrophic Financial Assistance is available to individuals who have a large balance remaining after all third party payments have been taken into account. The balance under consideration is that amount which is deemed to be the patient's financial responsibility. If such responsibility is greater than 50% of the family's annual household income, the excess amount will be treated as Catastrophic Financial Assistance and written off of the patient's account. This assistance is available without respect to the FPG, but they must follow the same process as all other patients seeking financial assistance based upon FPG. Asset tests are not used for determining any level of financial assistance. All decisions regarding financial assistance are in the sole discretion of BDHS. Prior to providing services, BDHS will make an effort to notify the patient regarding their eligibility for financial assistance. Part I, Line 6a: The organization's community benefit report can be found on its website at http://www.bozemandeaconess.org/For-Community/News-Reports.aspx. Part I, Line 7: The cost to charge ratio from Worksheet 2 was used to obtain the costs related to Charity Care, Medicaid, and Other Means-Tested Programs. All Other Benefits were calculated using our internal costing system. This system assigns all direct expenses to separate cost centers (departments) and accounts. Indirect costs are then allocated to applicable departments based on appropriate statistics. For example, Engineering and Environmental services would be allocated based on square footage whereas Information Systems and Benefits are allocated based on an accumulated cost percentage as determined by the Medicare Cost Report. Our internal system does record patient revenues based on type (inpatient vs. outpatient vs. emergency) and payor (Medicaid, Medicare, Commercial, Self-Pay, etc.). Related costs are then determined based on the pro-rated share as a percentage of the total. For example, if Medicaid comprises 7% of a department's revenue, Medicaid expenses are calculated at 7% of the total as well. Part I, Line 7g: Amount of cost attributable to a physician clinic is $37,880,813. All costs associated with a provider-based clinic operational department were considered part of this total. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator is $9,623,436. Part III, Line 2: Bad debt is reported at charges as recorded by the organization and included joint ventures. Bad debt is reported based upon actual bad debt expense net of discounts and contractual adjustments, less recoveries. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses is located in Footnote 1 on page 9 of the attached financial statements. Part III, Line 8: The entire amount of shortfall should be considered a community benefit.The Medicare shortfall represents a cost absorbed by the Hospital as a result of providing care to Medicare patients. The contract driving this loss is a nondiscretionary contract, as is providing the services to this population of individuals. The cost of providing this benefit to the community should be reportable as such. Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.For the Joint Ventures, Net Medicare Revenue was used as the revenue received, and that percentage of total revenues was applied against operating expenses to determine related costs. The Joint Venture portion of the shortfall is $767,508. Part III, Line 9b: Bozeman Health's Financial Assistance Policy explains the patient notification practice that includes providing the patient, either directly or through its contracted collection agency with at least one written notice informing the patient about the Extraordinary Collection Actions that we intend to take if the patient does not submit an Application for Financial Assistance or pay the amount due by at least thirty days following the date of the notice. The notice will include a copy of the plain language summary and will not be mailed or delivered to a patient earlier than 30 days prior to the end of the Notification Period. No Extraordinary Collection Actions will be undertaken during the 120 day Notification Period, during which time we will take reasonable efforts to determine whether the patient is eligible for Financial Assistance. After the 120 day Notification Period, an Extraordinary Collection Action will be undertaken only if the patient has received the 30 day written notice described above. Extraordinary Collection Actions are defined as those actions that may be taken in the event of non-payment following the expiration of the notification period. These may include the reporting of adverse information about the individual to consumer credit reporting agencies or credit bureaus, garnishment of an individual's wages, and/or commencement of a legal civil action against an individual. Part VI, Line 2: Bozeman Deaconess Health Services completed a community health needs assessment in 2015. Part VI, Line 3: Bozeman Deaconess Health Services is deeply committed to providing financial assistance to patients needing, but unable to afford, medically necessary health care services. BDHS posts notice of its Financial Assistance Policy in all admitting areas, as well as on the website. At the earliest feasible time, BDHS will attempt to determine whether a patient has third party coverage for any part of the hospital services provided. If a patient does not have third party coverage, a patient advocate from the MASH program will screen all inpatient cases and any outpatient cases exceeding $1,000 in total charges to determine if the patient qualifies for third party funding. If not, the patient advocate will explain the Financial Assistance Policy and give the patient an application if desired. In circumstances where payment in full will cause financial hardship that will significantly harm the patient or patient's family, the applicant may be asked to visit with Consumer Credit Counseling Services to further review their financial situations. Upon request, patients may be asked to complete an application for Medicaid participation or for coverage by other governmental payment programs. Patient bills also contain billing information explaining financial options and provide contact information to the appropriate resources. Part VI, Line 4: BDHS primarily serves Gallatin, Park, and Madison Counties with residents accounting for 86% of total inpatient admissions at BDHS in 2015 (Gallatin = 76.2%, Park=6.4%, Madison=3.3%). Based on the most recent (2015) Population Estimates from the US Census Bureau, population for the 3-County area was estimated at 124,626, up 10.4%, an increase of about 11,786 residents compared to 2010. Gallatin County* Gallatin County's population in 2015 is estimated at 100,739, up 12.5% since Census 2010 (89,513). * Seventy percent of that growth is due to net migration, while only 30% from natural increase (i.e. births vs deaths).* Now the 3rd most populous county in Montana, it has grown at a faster rate than the two most populated counties: Yellowstone (6.1%), or Missoula (4.5%).* It's annual growth rate in 2015 at 3.6% is a 5-yr record high.* The Bozeman Micropolitan Area (which covers the entire Gallatin County), is the 6th fastest growing micropolitan area for two years in a row now.* Adults age 25 to 44 years are the largest segment; the 65 & over are the smallest but fastest growing. Its median age is 33.2 in 2015.* In 2015, there were slightly more male (51%) than female (49%), driven by the 18-44 year age group, but overall female population grew 1.2x faster than males between 2010 and 2015. However, when broken down by age group, males 65 & over grew 1.3x faster than their female counterparts.Park & Madison Counties* For both Park and Madison Counties, growth between 2010 and 2015 has remained under 3% (Park=2.1%, Madison=2.9%).* Unlike Gallatin whose largest segment is the 25-44 yo age group, majority of population in Park and Madison are adults age 45 years & over (Park=52%, Madison=66%)* And while Gallatin is experiencing growth in all age groups, Park and Madison are experiencing growth only in the 18-24 & 65 & over age groups. Part VI, Line 5: As a sole community hospital, Bozeman Deaconess Health Services is committed to providing quality care and promoting health to the very community that supports us. Our governing body is represented by individuals of our community, with all but one being independent to our organization. To ensure immediate access to care, BDHS has an open medical staff and requires each medical staff member to care for anyone presenting a need for care in the Emergency Department. We also devote a significant amount of surplus funds to maintaining a high level of patient care through quality initiatives and technology investments.BDHS gives back to its community through community benefit opportunities, which at just over $23.5 million comprised 10% of our total operating expenses in 2015.Various employees, physicians, administrators, and board members of the Hospital are actively involved in volunteer roles including community board positions in numerous other activities, groups, and organizations that actively promote the health of the community. Part VI, Line 6: Bozeman Deaconess Health Services owned a majority interest in Deaconess Intercity Imaging, LLC, Rocky Mountain Surgery Center and Bozeman Health Urgent Cares in 2015. In addition, a new hospital, Big Sky Medical Center, was also opened in December 2015. These organizations hold similar policies regarding providing care to all members of the community and offering financial assistance as determined by ability to pay. 1 Western Montana Mental Health Center Bldg T-9 Fort Missoula Rd Missoula MT 59804 810307814 501(c)(3) 346000 Support community health crisis programs within our service area Greater Gallatin United Way 945 Technology Blvd 101F Bozeman MT 59718 810384820 501(c)(3) 50000 Support human service needs within our service area Community Health Partners 126 S Main Street Livingston MT 59047 841420492 501(c)(3) 37000 Support community health programs within our service area Cancer Support Community 102 S 11th Ave Bozeman MT 59715 810542266 501(c)(3) 64400 Support community health programs within our service area Healthy Mothers Healthy Babies 400 N Park Ave Helena MT 59601 810436517 501(c)(3) 10000 Support community health programs within our service area Livingston Healthcare 504 S 13th St Livingston MT 59047 810378200 501(c)(3) 50000 Support community health programs within our service area Nami Montana 616 Helena Ave 218 Helena MT 59601 810441706 501(c)(3) 25000 Support community mental health crisis programs within our service area Ruby Valley Hospital PO Box 336 Sheridan MT 59749 810247889 501(c)(3) 27000 Support healthcare service programs in rural areas 8 0 Part I, Line 2: Recipients of grants and assistance prepare informational reports substantiating the use of the funds that were earmarked to support community health programs. Involvement of Bozeman Deaconess Health Services staff and/or administration as volunteers in the activities being supported also ensures proper usage of funds. X 1 1 X X X X 0 0 0 0 0 1 0 1 0 Dr Dane Sobek Secretary / Cardiology 577026 0 50375 0 540 0 39792 0 22982 0 690715 0 0 0 Gordon Davidson Interim CEO/VP Finance/CFO 312105 0 71920 0 15006 0 44519 0 18046 0 461596 0 0 0 Dr David Chen Interim CEO/CMO 365180 0 31142 0 828 0 16340 0 25630 0 439120 0 0 0 Kevin Pitzer CEO/President (partial year) 409467 0 178323 0 25340 0 18302 0 16965 0 648397 0 0 0 Elizabeth Lewis Senior VP Operations/Legal 260359 0 70180 0 7995 0 42485 0 16046 0 397065 0 0 0 Hugh Hetherington MD Otolaryngology/Plastic Surgery 504430 0 51009 0 1548 0 36853 0 27367 0 621207 0 0 0 Annie Castillo MD Oncology 509413 0 18061 0 1548 0 15900 0 787 0 545709 0 0 0 Nathanial Madsen MD Cardiology 495521 0 50300 0 360 0 36117 0 20505 0 602803 0 0 0 Ken May MD Oncology 416528 0 183341 0 360 0 15900 0 11187 0 627316 0 0 0 Blair Erb MD Cardiology 575286 0 50000 0 1548 0 33852 0 24422 0 685108 0 0 0 Part I, Line 1a Per contract, the CEO is reimbursed for two business trips per year where his spouse accompanies him. These are reported as taxable compensation. Part I, Line 6 A physician listed in Part VII, Section A, receives incentive compensation based on actual Relative Value Unit's (RVU's) produced in excess of targets. The total of the incentive is calculated by taking the excess RVU's times a RVU converter. The RVU converter is based upon net earnings from services provided by the physician. Part I, Line 7 The Board establishes goals each year and if met, there is compensation tied to them. All such compensation is reviewed by the independent compensation specialists. Incentive compensation is determined by achieving financial performance in excess of budgeted performance, and achieving pre-determinded goals dealing with patient quality, patient satisfaction and employee satisfaction. This applies to all Senior Administration and all Physicians (with one exception described in Schedule J, Part I line 6a) who receive compensation and includes incentive compensation reflected in Part II, column B(ii). A Montana Facility Finance Authority 364615155 61240MBM8 2014-11-05 23005852 Refinance 2004 bond issued 3/4/2004 & fund add'n of Big Sky Medical Facility 0 0 0 B Montana Facility Finance Authority 364615155 61204EAH8 2010-04-22 6645000 Refinancing of 1998 bond debt issued 9/2/1998 0 0 0 C Montana Facility Finance Authority 810302402 61204MAS6 2011-09-28 20680164 To fund structure and equipment of new ER, acquisition of Legacy condos 0 0 0 D Montana Facility Finance Authority 364615155 2015-09-10 19522471 Refinance 2005 bond issued 12/1/2015 0 0 0 A 280253 23005852 377976 17500000 5127876 2015 1 0 0 1 B 4005000 6645000 132900 6512100 2010 1 0 1 1 C 3020785 20693206 401295 20278869 2013 0 0 1 1 D 19522471 243567 19278904 2015 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 D 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 0 0 1 0 0 0 0 1 D 0 0 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 Date Rebate Computation Performed Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 06/30/2014 Issuer Name: Montana Facility Finance Authority Date the Rebate Computation was Performed: 06/01/2014 Schedule K, Part II, Line 3, column(C): The amount on line 3 includes $20,680,164 of proceeds and $13,042 of interest earned. Schedule K, Part I, Line B(e): Part I issue price and Part II Line 3 bond proceeds differ due to interest earned on the proceeds. Schedule K, Part I, Line C(e): Part I issue price and Part II Line 3 bond proceeds differ due to interest earned on the proceeds. Form 990, Part VI, Section A, line 7a The Yellowstone Conference of the Methodist Church confirms the Board Members and has authority to appoint the clergy member of the board. Form 990, Part VI, Section A, line 7b Changing the Articles of Incorporation in relationship to the process of selecting board membership must be approved by the Yellowstone Conference of the United Methodist Church. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11 The Finance Committee will review Form 990 in detail and will make a recommendation to the full Board for approval before filing of the Form 990. The CFO reviews the Form 990 at a higher level with the board before approval is granted. Form 990, Part VI, Section B, line 12c In-house Counsel identifies potential conflicts from annual disclosures and informs the Board Chair. The Board Chair discusses the conflict and decides whether the conflict is of such a nature to exclude the conflicted party from discussion and/or vote. This policy covers all Board members, Officers, Senior Administration, and key employees. Form 990, Part VI, Section B, line 15 The Executive Committee receives a formal presentation by an independent compensation consultant (as selected by the Board) qualified to perform compensation reviews including usage of comparability data. This person presents recommendations to the Compensation Committee of the Board. The Compensation Committee makes recommendations to the full Board on an annual basis for Officers and Senior Administration. This annual process was performed in fall 2015 to determine 2016 compensation. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and all tax related information required to be available for public inspection are available via walk-in, telephone call, e-mail, and/or mail-in request. The audited financial statements are required to be attached to the Form 990 and provided to the Municipal Securities Rulemaking Board, which is our tax-exempt bonds trustee, via an on-line, central filing location called Electronic Municipal Market Access (EMMA). The financial statements can be obtained by the general public at the EMMA website. Form 990, Part XI, line 9: Transfers to related parties -1,107,602. Change in interest of Foundation 980,362. Hillcrest Senior Living LLC 1201 Highland Blvd Bozeman MT 59715 810232121 Independent and Assisted Living Home MT 6781259 27939639 Bozeman Deaconess Health Services Bozeman Health Clinical Research LLC 950 Stoneridge Dr 1 Bozeman MT 59715 471323951 Healthcare clinical research MT 131370 154516 Bozeman Deaconess Health Services Big Sky Medical Center LLC 334 Town Center Ave Big Sky MT 59716 474718253 Healthcare - Inpatient and Outpatient Servcies MT 267175 31765547 Bozeman Deaconess Health Services Bozeman Deaconess Foundation dba Bozeman Health Foundation 931 Highland Blvd Suite 3200 Bozeman MT 59715 841407943 Raise funds to support Bozeman Deaconess Health Services MT 501(c)(3) Line 7 Bozeman Deaconess Health Services 1 Deaconess Intercity Imaging LLC 915 Highland Blvd Bozeman MT 59715 810666871 Healthcare - Imaging Services MT Bozeman Deaconess Health Services Related 1449061 2118483 0 1 0.77500 Rocky Mountain Surgical Center LLC 1450 Ellis St Suite 101 Bozeman MT 59715 364462300 Healthcare - Surgical Services MT Bozeman Deaconess Health Services Related 2794666 3577957 0 0 0.51010 Family Doctors Urgent Care LLC 120 N 19th Ave Suite A Bozeman MT 59715 810532877 Healthcare - Physician Outpatient Care MT Bozeman Deaconess Health Services Related 11937 342337 0 0 0.83760 Bozeman Health Urgent Cares LLC 915 Highland Blvd Bozeman MT 59715 465318746 Healthcare - Physician Outpatient Care MT Bozeman Deaconess Health Services Related -268439 0 1 1.00000 Spanish Peaks Plaza LLC 120 N 19th Ave Suite A Bozeman MT 59718 810539803 Rental Real Estate for VA Med Clinic & Chiro MT Bozeman Deaconess Health Services Related 10541 160700 0 1 0.44990 Bozeman Deaconess Real Estate Development Corp PO Box 10490 Bozeman MT 59719 205496567 Sale of real estate property and residences to seniors MT Bozeman Deaconess Health Services C 153758 8100779 1.00000 1 0 1 1 1 0 0 0 0 0 1 1 1 1 1 1 1 1 1 1 Deaconess Intercity Imaging LLC J 320952 General ledger and corp. records Deaconess Intercity Imaging LLC L 126506 General ledger and corp. records Deaconess Intercity Imaging LLC Q 2385446 General ledger and corp. records Deaconess Intercity Imaging LLC S 1691825 General ledger and corp. records Bozeman Deaconess Foundation C 1360972 General ledger and corp. records Bozeman Deaconess Foundation R 658364 General ledger and corp. records Bozeman Deaconess Foundation L 51484 General ledger and corp. records Bozeman Deaconess Foundation Q 80721 General ledger and corp. records Rocky Mountain Surgical Center LLC S 2599884 General ledger and corp. records Bozeman Health Urgent Cares LLC B 498500 General ledger and corp. records