2015-04-15T15:39:23-05:00 2014-05-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2013-06-01 810233121 ST PETER'S HOSPITAL STPE 4064442100 2475 BROADWAY HELENA MT 59601 JOHN GREEN CHIEF FINANCIAL OFFICER 4064442100 2015-04-15 1 KIM HUNWARDSEN CPA P00484560 6122536500 2015-04-15 2013 2016-02-25 16:41:14Z NATHAN C OLSON 2475 BROADWAY HELENA MT 59601 196573513 0 X WWW.STPETES.ORG X 1883 MT PROVIDE EXCEPTIONAL AND COMPASSIONATE HEALTH CARE. 15 12 1399 128 439587 0 431149 368808 181045731 188857015 5087195 6911026 96880 74486 186660955 196211335 41566 0 0 0 85201123 88376462 0 0 370467 88008785 93415996 173251474 181792458 13409481 14418877 251823454 270879956 78667157 75692392 173156297 195187564 X ST. PETER'S HOSPITAL PARTNERS WITH OUR PATIENTS, COMMUNITY, AND MEDICAL STAFF TO PROVIDE EXCEPTIONAL AND COMPASSIONATE HEALTH CARE. 0 0 126669853 188857015 ST. PETER'S HOSPITAL IS A 123-BED ACUTE CARE HOSPITAL FACILITY SERVING RESIDENTS OF LEWIS AND CLARK COUNTY AND PORTIONS OF JEFFERSON, BROADWATER, MEAGHER AND POWELL COUNTIES. ST. PETER'S IS THE SOLE FACILITY IN THE PRIMARY SERVICE AREA. DURING THE YEAR ENDED MAY 31, 2014 THE HOSPITAL PROVIDED AT COST A TOTAL OF $19,084,411 IN COMMUNITY BENEFIT. OF THIS TOTAL $3,863,850 WAS FOR MEDICAL SERVICES TO INDIVIDUALS WHO WERE DETERMINED UNABLE TO PURCHASE SUCH SERVICES UNDER THE HOSPITAL'S CHARITY CARE POLICY. IN ADDITION TO FREE CARE AND/OR SUBSIDIZED CARE, CARE IS ALSO PROVIDED AT BELOW COST RATES TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. THE TOTAL OPERATING LOSS FOR PROVIDING CARE TO MEDICAID PATIENTS WAS $1,940,638. THE HOSPITAL PROVIDED $12,653,943 IN SUBSIDIZED HEALTH SERVICES DURING THE YEAR, INCLUDING ACUTE PATIENT CARE FOR MEDICAL, SURGICAL, PEDIATRIC AND BEHAVIORAL HEALTH PATIENTS, OUTPATIENT PHARMACY, PULMONARY REHAB, DIALYSIS, CLINICAL NUTRITION, ANTICOAGULATION, AND HOSPITALISTS SERVICES, PHYSICIAN CLINICS AND IN-HOME NURSING AND OXYGEN SERVICES. TO FULFILL ITS MISSION OF COMMUNITY SERVICE, THE ORGANIZATION 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 ORGANIZATION DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS PATIENT SERVICE REVENUE. 22353504 THE HOSPITAL OPERATES SEVERAL PHYSICIAN CLINICS, EMPLOYING 66 PHYSICIANS AND PHYSICIAN ASSISTANTS AND NURSE PRACTITIONERS. WITHOUT THE HOSPITAL'S ASSISTANCE, LEWIS AND CLARK COUNTY WOULD BE WITHOUT MANY NEEDED MEDICAL AND SURGICAL SPECIALTIES. PHYSICIANS IN THE SPECIALTIES OF FAMILY PRACTICE, INTERNAL MEDICINE, NEUROLOGY, RHEUMATOLOGY, GASTROENTEROLOGY, ENT, CARDIOLOGY, GENERAL SURGERY, ALLERGY, NEPHROLOGY, RADIATION AND MEDICAL ONCOLOGY HAD APPROXIMATELY 226,807 PATIENT ENCOUNTERS. 149023357 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 0 1 176 0 1 1399 1 1 1 0 0 0 0 0 0 0 0 0 X 15 12 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X JOHN GREEN CFO 4064442100 2475 BROADWAY HELENA MT 59601 PATTY NELSON CHAIR 1.00 0.00 X X 0 0 0 WILLIAM NORTHEY VICE CHAIR 1.00 0.00 X X 0 0 0 GUY ALMQUIST TREASURER 1.00 0.00 X X 0 0 0 JOHN GALT MD BOARD MEMBER/CHIEF OF STAFF ELECT 40.00 0.00 X 13691 0 0 DUANE BRUCE BOARD MEMBER COMMUNITY RELATIONS CHAIR 1.00 0.00 X 0 0 0 GAYLE SHIRLEY BOARD MEMBER COMMUNITY RELATIONS COMMITTEE MEMBER 1.00 0.00 X 0 0 0 KELLY PARSLEY BOARD MEMBER QUALITY COMMITTEE MEMBER 1.00 0.00 X 0 0 0 TOM STRIZICH MD BOARD MEMBER/CHIEF OF STAFF 40.00 0.00 X 23064 0 0 MICHAEL HAY BOARD MEMBER 1.00 0.00 X 0 0 0 MICK ROBINSON BOARD MEMBER 1.00 0.00 X 0 0 0 KAREN HICKS BOARD MEMBER 1.00 0.00 X 0 0 0 ROGER STONE BOARD MEMBER 1.00 0.00 X 0 0 0 MARK TAYLOR MEMBER AT LARGE 1.00 0.00 X 0 0 0 NATHAN C OLSON CEO 40.00 1.00 X X 408145 0 33549 RUSS BELL BOARD MEMBER 1.00 1.00 X 0 0 0 JOHN GREEN CFO 40.00 0.00 X 256115 0 31745 DR MICHAEL LEE PHYSICIAN 40.00 0.00 X 722959 0 23114 MR MATTHEW MCLAREN PHYSICIAN 40.00 0.00 X 562184 0 28004 DR JAMES TARVER PHYSICIAN 40.00 0.00 X 564770 0 39807 DR JAMES SEIBLY PHYSICIAN 40.00 0.00 X 523052 0 29673 DR THOMAS WEINER PHYSICIAN 40.00 0.00 X 1574785 0 34822 MARIA BRAMAN MD FORMER CHAIR 40.00 0.00 X 314597 0 34922 JOHN SOLHEIM FORMER PRESIDENT/CEO 0.00 0.00 X 516545 0 6037 TOM GREGG PAST INTERIM CEO 0.00 0.00 X 409761 0 17776 5889668 0 279449 93 1 1 0 HORIZON MENTAL HEALTH MANAGEMENT PO BOX 840839 DALLAS TX 75284 MANAGEMENT SERVICES 3168192 COMPHEALTH PO BOX 57915 SALT LAKE CITY UT 84107 LOCUM COVERAGE 851919 GE HEALTHCARE PO BOX 414-SN471 MILWAUKEE WI 53201 BIOMEDICAL SERVICES 808801 ARUP LABORATORIES 500 CHIPETA WAY SALT LAKE CITY UT 84108 LAB TESTING SERVICES 731665 CAPITAL MEDICAL ANESTHESIA PO BOX 5179 HELENA MT 59601 ANESTHESIA SERVICES 701664 36 127641 164167 77000 368808 PATIENT SERVICE REVENUE 622110 125197523 125197523 PHARMACY 446110 58290666 58290666 OTHER SERVICES 900099 2937722 2681926 255796 INCOME FROM JOINT VENTURES 900099 1007171 940458 66713 CAFETERIA 722210 674623 664033 10590 749310 642822 106488 188857015 6932114 6932114 310430 105146 293618 47472 16812 57674 74486 74486 21088 -21088 -21088 -21088 196211335 188417428 439587 6985512 1091914 177129 914785 412040 412040 67658751 55538809 11866874 253068 6700550 5185343 1500398 14809 8175705 6281064 1845146 49495 4337502 3431331 889851 16320 381173 2050 379123 69930 69930 62788 62788 488382 488382 15144632 12328718 2808331 7583 289499 51773 221781 15945 1233801 386246 840281 7274 2954062 306388 2647674 1920055 270127 1646762 3166 198900 120550 80314 -1964 281295 162313 118254 728 1244061 1244061 7753014 4937981 2814797 236 1695572 1695572 MEDICAL SUPPLIES, OTHER 44667299 43459924 1203568 3807 BAD DEBT EXPENSE 13184050 13184050 BED TAX 1421300 1421300 OTHER TAXES 52535 13595 38940 373648 69094 304554 181792458 149023357 32398634 370467 24687067 24245876 26768453 30653779 3948805 3455205 3569726 3864513 2339570 2737361 175665104 83386300 96015775 92278804 72359338 92410541 21522128 20660730 612592 573147 251823454 270879956 18873326 17870393 37016209 36816993 67629 22777622 20937377 78667157 75692392 X 160820583 181554614 4332327 5203325 8003387 8429625 173156297 195187564 251823454 270879956 X 14418877 3115864 4496526 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 50 0 1 10000 1 150 0 1 52342 62542 0 PART II-B, LINE 1: THE HOSPITAL HIRED A CONSULTANT TO PROVIDE LOBBYING SERVICES IN CONNECTION WITH GOVERNMENTAL AFFAIRS REPRESENTATION TO ENSURE HOSPITAL, COMMUNITY, AND EMPLOYEE INTERESTS AND NEEDS ARE REPRESENTED. IN ADDITION, A PORTION OF AHA/MHA DUES ARE ATTRIBUTED TO LOBBYING SERVICES. A GRANT WAS MADE TO ASSIST WITH BRINGING MEDICAID EXPANSION TO THE THE LEGISLATURE. 11606682 393168 968936 274850 12693936 10598351 64337 979412 35418 11606682 10709927 489607 -542431 58752 10598351 9692852 127911 1052329 163165 10709927 7514363 1405761 928225 155497 9692852 0.66000 0.34000 0 1 1 3745203 3745203 95546218 28512227 67033991 74184797 54272494 19912303 2188886 601579 1587307 92278804 INVESTMENT IN JOINT VENTURES 2580414 F INTEREST IN ST. PETER'S FOUNDATION 13919596 F LTD CLASS INVESTMENTS 4160720 F 20660730 ESTIMATED THIRD-PARTY SETTLEMENTS 699957 LIABILITY FOR PENSION BENEFITS 20237420 20937377 X 182960379 -13184050 -13184050 196144429 488382 -421476 66906 196211335 168461116 341090 341090 168120026 488382 13184050 13672432 181792458 PART V, LINE 4: ENDOWMENT FUNDS ARE RESTRICTED FOR SUPPORT OF HOSPITAL PROGRAMS AND SERVICES AND FOR CAPITAL PURCHASES AND IMPROVEMENTS IN ACCORDANCE WITH BOARD POLICIES AND/OR DONOR RESTRICTIONS. PART X, LINE 2: THE HOSPITAL AND FOUNDATION ARE MONTANA NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL AND THE FOUNDATION ARE ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. PEAK HEALTH HELENA, LLC IS A LIMITED LIABILITY AND TREATED AS A PARTNERSHIP FOR FEDERAL AND STATE INCOME TAX PURPOSES. 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 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. THE ORGANIZATION'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2011. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS IN REVENUES ON FINANCIAL STATEMENTS -13,184,050. PART XI, LINE 4B - OTHER ADJUSTMENTS: RENTAL EXPENSES RECORDED IN EXPENSES FOR FINANCIAL STATEMENTS -341,090. BOOK/TAX ADJUSTMENT FOR PARTNERSHIPS -80,386. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES RECORDED IN EXPENSES FOR FINANCIAL STATEMENTS 341,090. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS IN REVENUES FOR FINANCIAL STATEMENTS 13,184,050. 1 1 X 1 X 1 X 1 1 1 0 1 1 6113072 2249222 3863850 0.02290 10103353 8162715 1940638 0.01150 16216425 10411937 5804488 0.03440 463881 159764 304117 0.00180 52761988 40108045 12653943 0.07500 329303 329303 0.00200 53555172 40267809 13287363 0.07880 69771597 50679746 19091851 0.11320 1 13184050 0 67626749 69315313 -1688564 X 1 1 1 HELENA SURGICENTER LLC SURGERY CENTER 0.50000 0.09150 0.05290 1 1 ST PETER'S HOSPITAL 2475 BROADWAY HELENA MT 59601 WWW.STPETES.ORG 13346 X X X PHYSICIAN CLINICS & URGENT CARE SERVICES ST PETER'S HOSPITAL 1 1 X X X X X X X X X 12 1 0 1 X HTTP://WWW.STPETES.ORG/CHNA X X X X X 1 0 1 1 150.000000000000 1 250.000000000000 1 X X X X X 1 1 X X X 1 0 X X X X X 1 X 0 1 ST. PETER'S HOSPITAL PART V, SECTION B, LINE 3: A CONSULTANT WAS ENGAGED TO FACILITATE THE COMMUNITY NEEDS ASSESSMENT THROUGH USE OF INTERVIEWS AND FOCUS GROUPS UTILIZING REPRESENTATIVES FROM PUBLIC HEALTH, PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY LEADERS. ST. PETER'S HOSPITAL PART V, SECTION B, LINE 6I: THE IMPLEMENTATION STRATEGY MAY BE FOUND AT HTTP://WWW.STPETES.ORG/SPH-CHIP. ST. PETER'S HOSPITAL PART V, SECTION B, LINE 14G: A COPY OF THE FINANCIAL ASSISTANCE POLICY IS INCLUDED ON THE WEBSITE. ADDITIONALLY, A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS POSTED IN THE FACILITY'S EMERGENCY ROOM AND WAITING ROOMS AND ADMISSIONS OFFICES. THE SUMMARY IS ALSO PROVIDED TO PATIENTS UPON ADMISSION TO THE HOSPITAL FACILITY. ST. PETER'S HOSPITAL PART V, SECTION B, LINE 18E: THE POLICY IS PUBLISHED ON THE STPETES.ORG WEBSITE. ST. PETER'S HOSPITAL PART V, SECTION B, LINE 20D: CURRENTLY UNINSURED PATIENTS ARE GIVEN A 3% DISCOUNT ON THEIR BILL PRIOR TO DETERMINATION OF QUALIFYING FOR PATIENT ASSISTANCE. UPON DETERMINATION THAT PATIENTS DO QUALIFY FOR PATIENT ASSISTANCE, A DISCOUNT IS APPLIED BASED ON THE QUALIFYING LEVEL FOR A DISCOUNT BETWEEN 15% AND 100%. THE ORGANIZATION UPDATES THE SLIDING SCALE ON AN ANNUAL BASIS AS THE POVERTY GUIDELINES ARE PUBLISHED. IN THE CURRENT YEAR IN EXCESS OF 75% OF THE ASSISTANCE GIVEN WAS AT THE 100% LEVEL. THE LOWEST LEVEL OF 15% IS NEARLY 190% OF THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. ST. PETER'S HOSPITAL PART V, SECTION B, LINE 22: 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. 2 HOSPICE & HOMELINK OF ST PETER'S HOSP 201 SOUTH CALIFORNIA HELENA MT 59601 HOSPICE AND HOME HEALTH APEX OF ST PETER'S HOSPITAL 201 SOUTH CALIFORNIA HELENA MT 59601 HOME OXYGEN SERVICES PART I, LINE 6A: THE ORGANIZATION'S COMMUNITY BENEFIT REPORT CAN BE FOUND ON ITS WEBSITE AT WWW.STPETES.ORG. PART I, LINE 7: CHARITY CARE, UNREIMBURSED MEDICAID AND SUBSIDIZED HEALTH SERVICES ARE CONVERTED TO COST USING THE COST TO CHARGE RATIO DERIVED FROM THE HOSPITAL'S COST ALLOCATION SYSTEM. THE COST ALLOCATION SYSTEM ADDRESSES ALL PATIENT SEGMENTS. THE COSTS ARE ESTIMATED BY ALLOCATING DEPARTMENTAL COSTS BASED ON DIRECT COSTS LESS ANY OTHER OPERATING REVENUE THEN BY DOING AN ALLOCATION OF BENEFITS, DEPRECIATION AND OTHER OVERHEAD COSTS. COMMUNITY HEALTH IMPROVEMENT SERVICES AND CASH AND IN-KIND CONTRIBUTIONS ARE EXPENSES INCURRED AND TRACKED IN THE CBISA PROGRAM. PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES INCLUDES $8,124,009 OF COSTS ATTRIBUTABLE TO A PHYSICIAN CLINIC. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATIONS WAS $13,184,050. PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED AT CHARGES AS RECORDED BY THE ORGANIZATION.BAD DEBT EXPENSE IS REPORTED NET OF DISCOUNTS AND CONTRACTUAL ALLOWANCES. A PAYMENT ON AN ACCOUNT PREVIOUSLY WRITTEN OFF REDUCES BAD DEBT EXPENSE IN THE CURRENT YEAR.THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THESE EXPENSES REPRESENT AN OVERALL SHORTFALL OF THE DIRECT MEDICARE PATIENT POPULATION. THE COSTS THEMSELVES ARE THEREFORE A COMMUNITY BENEFIT AS THE COMMUNITY WOULD NOT RECEIVE THESE SERVICES IF WE DID NOT PROVIDE THEM. TOTAL MEDICARE REVENUE AND MEDICARE ALLOWABLE COSTS OF CARE ARE CALCULATED USING A COST ALLOCATION METHOD CONSISTENT WITH THE COST REPORT. PART III, LINE 9B: ST. PETER'S HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO RENDER NECESSARY HEALTH CARE SERVICES TO ALL PERSONS IN NEED OF SUCH CARE, REGARDLESS OF RACE, CREED, COLOR OR ECONOMIC CIRCUMSTANCES. ST. PETER'S HOSPITAL RECOGNIZES THAT PAYMENT FOR SERVICES RENDERED IS DUE AND PAYABLE AT THE TIME OF SERVICE. THE HOSPITAL ACCEPTS INSURANCE ASSIGNMENTS AND SOME OTHER APPROVED ARRANGEMENTS FOR DELAYED PAYMENT. FINANCIAL ASSISTANCE IS AVAILABLE FOR ALL QUALIFIED PATIENTS. PATIENTS NOT COVERED BY INSURANCE OR UNABLE TO PAY IN FULL FOR SERVICES RENDERED MUST CONTACT THE APPROPRIATE PATIENT ACCOUNT REPRESENTATIVE WHO WILL ASSIST THE PATIENT AND/OR FAMILY IN DETERMINING IF HE/SHE QUALIFIES FOR PATIENT ASSISTANCE. COLLECTION ACTIVITY WILL BE SUSPENDED WHILE A FINANCIAL ASSISTANCE APPLICATION IS UNDER REVIEW. PART VI, LINE 2: ST. PETER'S HOSPITAL CONDUCTS A COMMUNITY SURVEY EVERY THREE YEARS. THE COMMUNITY SURVEY IS PERFORMED BY AN INDEPENDENT CONTRACTOR THAT SELECTS AN ADEQUATE SAMPLE SIZE FOR THE AREA. THE HOMES OF ST. PETER'S HOSPITAL EMPLOYEES ARE EXCLUDED FROM THE SURVEY. THE SURVEY INCLUDES QUESTIONS RELATED TO EVALUATING THE COMMUNITY'S EXPERIENCE AND ABILITY TO ACCESS HEALTHCARE. THE SURVEY HELPS TO IDENTIFY SPECIALTY AREAS OF CONCERN. THE RESULTS OF THE SURVEYS ARE REVIEWED BY THE SENIOR MANAGEMENT TEAM AS WELL AS THE BOARD TO IDENTIFY THE AREAS OF FOCUS. IN 2013, THE ST. PETER'S BOARD OF DIRECTORS, MADE UP OF COMMUNITY MEMBERS, PHYSICIANS, AND SENIOR MANAGEMENT, WORKED WITH A CONSULTANT TO DEVELOP ST. PETER'S COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP). BASED ON THE FINDINGS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THE BOARD AND ITS COMMUNITY RELATIONS COMMITTEE PRIORITIZED COMMUNITY HEALTH NEEDS FOR THE ORGANIZATION. THE COMMUNITY RELATIONS COMMITTEE REPRESENTS A BROAD RANGE OF COMMUNITY INTERESTS AND GIVES FINAL APPROVAL OF THE CHNA AND CHIP. THE PUBLIC RELATIONS AND MARKETING DEPARTMENT IS RESPONSIBLE FOR THE FACILITATION AND IMPLEMENTATION OF THE CHNA AND CHIP. DURING 2014 THE COMBINED COMMUNITY AND COMMITTEE CONTINUED TO WORK ON THE VARIOUS ASPECTS OF THE REPORT. PART VI, LINE 3: ST. PETER'S HOSPITAL (1) POSTS ITS CHARITY CARE POLICY ON ITS WEB SITE AS WELL AS AT THE ADMITTING DESK, EMERGENCY ROOM, ON THE MONTHLY STATEMENTS AND CASHIER AREAS IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT; (2) OFFERS A SUMMARY OF OUR POLICY AND APPLICATION TO SELF-PAY PATIENTS WITH CONTACT INFORMATION TO PATIENTS AS PART OF THE INTAKE PROCESS; (3) PROVIDES A COPY OF FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS WITH DISCHARGE MATERIALS; (4) FINANCIAL COUNSELORS DISCUSS WITH PATIENTS EXPECTING TO OWE MORE THAN $500 THE AVAILABILITY OF PATIENT ASSISTANCE AND VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. PART VI, LINE 4: ST. PETER'S HOSPITAL IS A 123-BED ACUTE CARE HOSPITAL FACILITY SERVING RESIDENTS OF LEWIS AND CLARK COUNTY AND PORTIONS OF JEFFERSON, BROADWATER, MEAGHER AND POWELL COUNTIES. ST. PETER'S IS THE SOLE FACILITY IN THE PRIMARY SERVICES AREA. THE HOSPITAL FINANCIAL PAYOR MIX CONSISTED OF 5.6% SELF-PAY PATIENTS, 7.1% OF MEDICAID PATIENTS AND 47.4% MEDICARE PATIENTS. APPROXIMATELY 15.6% OF THE POPULATION IS AGE 65 AND OLDER. THE AVERAGE PER CAPITA INCOME IS $29,785 AND APPROXIMATELY 13.5% OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. THE NEAREST HOSPITAL IN THE AREA IS APPROXIMATELY 35 MILES FROM ST. PETER'S CAMPUS. PART VI, LINE 5: THE ORGANIZATION'S GOVERNING BODY MEMBERS RESIDE IN THE COMMUNITY. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. SURPLUS FUNDS ARE USED TO MAKE CAPITAL PURCHASES AND UPGRADES TO THE FACILITIES.ST. PETER'S HOSPITAL IS THE SOLE ACUTE CARE PROVIDER IN THE PRIMARY SERVICE AREA MADE UP OF LEWIS & CLARK COUNTY AND THE NORTHERN PORTION OF JEFFERSON COUNTY. THERE IS A POPULATION OF APPROXIMATELY 76,850. OUT-MIGRATION IS GENERALLY LIMITED TO TERTIARY SERVICES NOT AVAILABLE AT ST. PETER'S HOSPITAL INCLUDING CARDIAC SURGERY AND NEO-NATAL CARE. ST. PETER'S HOSPITAL PROVIDES CARE TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. ST. PETER'S HOSPITAL MAINTAINS CHARGES AS ONE OF THE LOWEST HOSPITALS WITHIN THE STATE DEPENDING ON THE SERVICES BEING PROVIDED. ST. PETER'S HOSPITAL SPONSORS SEVERAL WELLNESS SCREENINGS, HEALTH FAIRS AND EDUCATIONAL LECTURES, CLASSES, AND EVENTS THROUGHOUT THE YEAR TO PROMOTE BETTER LIVING, NUTRITION AND GOOD HEALTH. CONTINUING EDUCATION IS ALSO PROVIDED TO THE MEMBERS OF THE MEDICAL COMMUNITY ON AN ON-GOING BASIS. IN ADDITION, ST. PETER'S HOSPITAL HAD 15,556 VOLUNTEER HOURS FROM THE COMMUNITY ASSISTING IN A VARIETY OF ROLES WITHIN THE ORGANIZATION.ST. PETER'S HOSPITAL MADE $326,863 OF CASH AND IN-KIND DONATIONS TO A VARIETY OF ORGANIZATIONS WITHIN THE COMMUNITY. THIS INCLUDES BUT IS NOT LIMITED TO CR ANDERSON MIDDLE SCHOOL FOR ITS HONOR STUDENT PROGRAM, ANGEL FUND TO PURCHASE CLOTHING AND SCHOOL SUPPLIES FOR YOUTH, HELENA HIGH SCHOOL, LEWIS AND CLARK COUNTY FOR CRISIS RESPONSE TEAM, HEALTHY MOTHER'S/HEALTHY BABIES, HOSA, FRIENDSHIP CENTER, FLORENCE CRITTENTON, YMCA, GOD'S LOVE, CARROLL COLLEGE ATHLETICS WITH EMERGENCY SERVICES AT EVENTS, CARROLL COLLEGE NURSING DEPARTMENT WITH MEDICAL SUPPLIES NEEDED FOR LEARNING LABS, EXPLORATION WORKS WITH MEDICAL SUPPLIES NEEDED FOR STUDENT SCIENCE EXPERIMENTS, UNITED WAY TO ASSIST LOW-INCOME AND HOMELESS RESIDENTS WITH BASIC NEEDS, SPIRIT OF SERVICE CAMPAIGN BY PROVIDING SUPPLIES AND VOLUNTEERS TO HELP ELDERLY RESIDENTS AND OTHERS WITH SPECIAL NEEDS IMPROVE THEIR HOMES AND YARDS, KAY MCKENNA YOUTH FOUNDATION TO PROVIDE SAFE SUMMER YOUTH ACTIVITIES, ARCHIE BRAY FOUNDATION, HELENA FOOD SHARE PROGRAM FOR BACK PACK PROGRAM IN THE SCHOOLS AND BIG BROTHERS AND SISTERS. THE DONATIONS WERE MADE TO ASSIST THESE COMMUNITY SPONSORS IN THEIR VARIOUS PROGRAMS.ST. PETER'S HOSPITAL IS THE SOLE COMMUNITY ACUTE CARE FACILITY WITHIN THE IMMEDIATE AREA. ST. PETER'S HOSPITAL ALSO MAINTAINS A 24 BED BEHAVIORAL HEALTH INPATIENT ADULT AND GERIATRIC UNIT. THIS IS THE ONLY FACILITY WITHIN THE SERVICE AREA. ST. PETER'S HOSPITAL OPERATES AN EMERGENCY ROOM AND TWO URGENT CARE CLINICS THAT PROVIDE SERVICES TO ALL REGARDLESS OF ABILITY TO PAY. X X X 1 1 X X X X X 1 0 0 0 0 0 0 0 0 NATHAN C OLSON CEO 370096 0 30262 0 7787 0 15300 0 19567 0 443012 0 0 0 JOHN GREEN CFO 219547 0 34042 0 2526 0 10829 0 22270 0 289214 0 0 0 DR MICHAEL LEE PHYSICIAN 721720 0 0 0 1239 0 9069 0 14376 0 746404 0 0 0 MR MATTHEW MCLAREN PHYSICIAN 562136 0 0 0 48 0 7500 0 20835 0 590519 0 0 0 DR JAMES TARVER PHYSICIAN 562757 0 0 0 2013 0 15300 0 24837 0 604907 0 0 0 DR JAMES SEIBLY PHYSICIAN 519510 0 0 0 3542 0 8919 0 21084 0 553055 0 0 0 DR THOMAS WEINER PHYSICIAN 1572222 0 0 0 2563 0 15042 0 21460 0 1611287 0 0 0 MARIA BRAMAN MD FORMER CHAIR 279582 0 34553 0 462 0 15300 0 21046 0 350943 0 0 0 JOHN SOLHEIM FORMER PRESIDENT/CEO 0 0 0 0 516545 0 0 0 6037 0 522582 0 0 0 TOM GREGG PAST INTERIM CEO 153819 0 58625 0 197317 0 9118 0 10158 0 429037 0 0 0 PART I, LINE 1A PRESIDENT/CEO RECEIVES REIMBURSEMENT FOR MEMBERSHIP DUES PAID TO A SOCIAL CLUB. THE PRESIDENT/CEO IS PROVIDED TRAVEL FOR COMPANION FOR ONE BUSINESS FUNCTION PER YEAR. ALL AMOUNTS ARE REPORTED AS TAXABLE COMPENSATION. PART I, LINE 4A JOHN SOLHEIM RECEIVED SEVERANCE DURING FISCAL 2014 FOR SERVICES PROVIDED FOR FISCAL YEARS PRIOR TO 2013. THIS PACKAGE WAS FULLY ACCRUED IN THE FISCAL 2012 FINANCIALS. TOM GREGG RECEIVED SEVERANCE DURING FISCAL 2014 RELATED TO SERVICES PROVIDED AS INTERIM CEO FOR FISCAL 2013. THIS PACKAGE WAS FULLY ACCRUED IN THE FISCAL 2013 FINANCIALS. A MONTANA FACILITY FINANCE AUTHORITY 810302402 61204JBY9 2007-03-22 22826511 FUND MED OFFICE BLDG & WOMEN & CHILDREN'S BED WING & REFUND BONDS 1/23/97 0 0 0 B MONTANA FACILITY FINANCE AUTHORITY 810302402 2013-03-13 21435000 TO REFINANCE 2004 BOND SERIES ISSUED MAY 6, 2004 0 0 0 A 7100000 23439515 1659659 465447 353863 14743608 7154609 2009 1 0 1 1 B 175000 21435000 338736 21096264 2013 0 1 1 1 A 0 0 0 0 0.00320 0.00320 0 0 1 B 0 0 0 0 0.00420 0.00420 0 0 1 A 0 0 0 1 0 0 0 0 1 B 0 0 0 0 0 0 0 0 1 A 1 B 1 JAMES TARVER HIGHLY COMPENSATED EMPLOYEE PROMISSORY NOTE X 200000 67629 0 0 1 67629 MARIA BRAMAN FORMER BOARD CHAIR 187229 PURCHASE OF LAB AND INVENTORY 0 MARIA BRAMAN FORMER BOARD CHAIR 171960 LAB SERVICES 0 FORM 990, PART VI, SECTION A, LINE 1 THE EXECUTIVE COMMITTEE CONSISTS OF THE OFFICERS OF THE BOARD OF DIRECTORS, PAST CHAIR OF THE BOARD PROVIDED HE/SHE CONTINUES TO BE A DIRECTOR, AND THE CHIEF OF STAFF. IF THE PAST CHAIR OF THE BOARD IS UNABLE TO SERVE, THE BOARD CHAIR MAY APPOINT ANOTHER MEMBER TO THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE HOSPITAL DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT ANY ACTION DOES NOT CONFLICT WITH THE POLICIES OF THE BOARD OF DIRECTORS AND ALL MATTERS OF MAJOR IMPORTANCE ARE REFERRED TO THE BOARD OF DIRECTORS. SHOULD ANY MATTER OF EXTREME URGENCY ARISE BETWEEN THE REGULAR MEETINGS OF THE BOARD OF DIRECTORS, IT IS THE DUTY OF THE EXECUTIVE COMMITTEE TO REQUEST THE PRESIDENT CALL A SPECIAL MEETING OF THE BOARD OF DIRECTORS. MINUTES OF THE EXECUTIVE COMMITTEE ARE SUBMITTED TO THE BOARD OF DIRECTORS AND ITS ACTIONS ARE SUBJECT TO APPROVAL OR DISAPPROVAL AT THE NEXT REGULAR BOARD MEETING. THE COMMITTEE IS RESPONSIBLE FOR CONDUCTING THE PRESIDENT'S EVALUATION, SETTING THE PRESIDENT'S COMPENSATION AND NEGOTIATING THE TERMS OF THE PRESIDENT'S EMPLOYMENT CONTRACT. FORM 990, PART VI, SECTION A, LINE 7A THE NOMINATING COMMITTEE SOLICITS QUALIFIED CANDIDATES FOR MEMBERSHIP ON THE BOARD OF DIRECTORS AND PRESENTS A SLATE TO THE BOARD OF DIRECTORS WITH ONE CANDIDATE FOR EACH POSITION TO BE FILLED. MEMBERS OF THE BOARD OF DIRECTORS MAY SUBMIT THE NAMES OF POTENTIAL CANDIDATES TO THE NOMINATING COMMITTEE FOR THE COMMITTEE'S CONSIDERATION. THE NOMINATING COMMITTEE'S SLATE OF POTENTIAL CANDIDATES IS SUBMITTED TO THE BOARD AT THE BOARD OF DIRECTOR'S ANNUAL MEETING. FIVE MEMBERS OF THE BOARD OF DIRECTORS SERVE BY VIRTUE OF THE OFFICES AND FOR THE DURATION OF THE TIME THEY REMAIN IN OFFICE; THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE HOSPITAL, THE CHIEF-OF-STAFF OF THE HOSPITAL, THE CHIEF-OF-STAFF ELECT OF THE HOSPITAL, THE ST. PETER MEDICAL GROUP PRESIDENT, AND THE ST. PETER'S FOUNDATION CHAIR. FORM 990, PART VI, SECTION B, LINE 11 A ROUGH DRAFT OF THE FORM 990 IS REVIEWED BY THE CEO AND CFO AS WELL AS THE FINANCE COMMITTEE PRIOR TO FULL BOARD APPROVAL OF THE FINAL FORM 990 PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS ALL BOARD MEMBERS, OFFICERS, SENIOR ADMINISTRATION AND KEY EMPLOYEES. THE BOARD IDENTIFIES POTENTIAL CONFLICTS AND DETERMINES IF VOTING ON RELATED ITEMS WOULD BE A CONFLICT OF INTEREST IF A CONFLICT IS DETERMINED TO EXIST, THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE CONFLICTED ITEM. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT COMPENSATION CONSULTANT PERFORMS A REVIEW OF SALARIES AND BENEFITS USING DATA FROM COMPARABLE HEALTHCARE FACILITIES. A REPORT IS PREPARED AND PRESENTED TO THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS, WHICH USES THE REPORT TO DETERMINE OFFICER AND SENIOR MANAGEMENT COMPENSATION. THE INFORMATION IS THEN REVIEWED WITH THE BOARD OF DIRECTORS. THE ANNUAL PROCESS WAS PERFORMED DURING 2013. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: MINIMUM PENSION LIABILITY ADJUSTMENT 3,118,904. CHANGE IN PERMANENTLY AND TEMPORARILY RESTRICTED NET ASSETS OF FOUNDATION 1,297,236. BOOK/TAX ADJUSTMENT FOR PARTNERSHIPS 80,386. ST PETER'S HOSPITAL FOUNDATION 2475 BROADWAY HELENA MT 59601 810392270 RAISE FUNDS TO SUPPORT ST. PETER'S HOSPITAL MT 501(C)(3) LINE 11A, I ST PETER'S HOSPITAL 1 PEAK HEALTH LLC 2475 BROADWAY AVENUE HELENA MT 59601 271863807 HEALTH CLUB MT N/A UNRELATED 8748 2011964 0 0 0.65000 PEAK HEALTH REALTY LLC 2475 BROADWAY AVENUE HELENA MT 59601 272492966 RENTAL PROPERTY MT N/A UNRELATED -79124 -220102 0 0 0.65000 PEAK HEALTH HELENA LLC 2475 BROADWAY AVENUE HELENA MT 59601 271863807 HEALTH CLUB MT N/A UNRELATED 179423 -54356 0 0 0.65000 0 0 1 0 0 0 0 0 0 1 1 0 1 0 1 1 1 0 1 ST PETER'S HOSPITAL FOUNDATION C 127641 FMV ST PETER'S HOSPITAL FOUNDATION M 370468 COST