2015-05-11T15:17:21-05:00 2014-06-30 410746749 CLIFTONLARSONALLEN LLP 220 SOUTH SIXTH STREET SUITE 300 MINNEAPOLIS MN 55402 990 2013-07-01 810384618 BIG HORN HOSPITAL ASSOCIATION BIGH 4066652310 17 NORTH MILES AVENUE HARDIN MT 59034 KRISTI GATRELL CEO 4066652310 2015-05-01 1 ROBERT E SCHILE P00369682 6123764500 2013 2016-03-07 17:11:31Z TERRY BULLIS 17 NORTH MILES AVENUE HARDIN MT 59034 14281280 0 X WWW.BIGHORNHOSPITAL.ORG X 1980 MT TO PROVIDE QUALITY MEDICAL AND HEALTH SERVICES IN BIG HORN COUNTY AND SURROUNDING AREAS. 7 6 254 15 0 0 708499 219531 14285092 13784431 127350 62453 85977 80064 15206918 14146479 39142 68003 0 0 7936146 8133295 0 0 13259 6146861 6265696 14122149 14466994 1084769 -320515 13512461 12622964 3925523 3584489 9586938 9038475 X BIG HORN HOSPITAL ASSOCIATION, ALONG WITH ITS AFFILIATED STAFF, WILL WORK TOGETHER TO PROVIDE QUALITY MEDICAL AND HEALTH SERVICES IN BIG HORN COUNTY AND SURROUNDING AREAS. 0 0 12878362 68003 12816113 BIG HORN HOSPITAL ASSOCIATION IS COMPRISED OF BIG HORN HOSPITAL AND HERITAGE ACRES. BIG HORN HOSPITAL IS A 25-BED ACUTE CARE HOSPITAL. HERITAGE ACRES IS A 36-BED NURSING CARE FACILITY AND A 10-UNIT ASSISTED LIVING AND 10-UNIT INDEPENDENT LIVING. DURING THE YEAR ENDED JUNE 30, 2014, BIG HORN COUNTY MEMORIAL HOSPITAL PROVIDED 623 DAYS OF PATIENT SERVICES, 7,884 OUTPATIENT VISITS (INCLUDING 4,203 ER VISITS) AND 3,187 DAYS OF RESIDENT SERVICES; HERITAGE ACRES PROVIDED 11,215 DAYS OF LONG TERM CARE RESIDENT SERVICES AND 3,549 DAYS OF ASSISTED LIVING RESIDENT SERVICES. BIG HORN HOSPITAL ASSOCIATION PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDED CARE TO THESE PATIENTS WAS $244,302 FOR THE YEAR ENDED JUNE 30, 2014. 12878362 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 33 0 254 1 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X ROXIE CAIN CONTROLLER 4066659222 17 N MILES AVENUE HARDIN MT 59034 TERRY BULLIS CHAIRMAN 0.40 0.20 X X 0 0 0 C WILLIAM FISHER VICE CHAIRMAN 0.40 0.20 X X 0 0 0 JAMES SEYKORA SECRETARY 0.40 0.20 X X 0 0 0 COLLEEN SCHAAK TREASURER 0.40 X X 0 0 0 CHAD FENNER MEMBER 0.40 X 0 0 0 GARY OSTAHOWSKI MD MEMBER 0.40 X 0 0 0 THOR TORSKE MEMBER 0.40 X 0 0 0 GEORGE MINDER FORMER CEO 36.00 4.00 X 119995 0 18720 ROXIE CAIN CONTROLLER 39.00 1.00 X 85530 0 18720 KRISTI GATRELL CEO 40.00 X 106137 0 15305 ANGELA SMITH PROVIDER 40.00 X 105115 0 2500 LINDA TROYER PROVIDER 40.00 X 109234 0 2755 LARRY CURTIS CRNA 40.00 X 166178 0 2500 692189 0 60500 5 0 1 0 BILLINGS CLINIC PO BOX 30977 BILLINGS MT 59107 RAD READING FEES & IS MAINTENANCE 266100 AMN HEALTHCARE ALLIED INC PO BOX 281939 ATLANTA GA 30384 LABORATORY TECHNICIANS 231398 NXC IMAGING 2118 4TH AVENUE SOUTH MINNEAPOLIS MN 55404 EQUIPMENT MAINTENANCE 229830 3 17906 140531 61094 219531 PATIENT REVENUE 621110 12816113 12816113 OTHER PATIENT REVENUE 900099 968318 968318 13784431 62453 62453 175394 134801 40593 40593 40593 CAFETERIA 722210 39471 39471 39471 14146479 12816113 0 1110835 X 68003 68003 239555 226296 13259 6558388 6095511 462877 94688 82381 12307 748726 636341 112385 491938 392657 99281 3888 3888 76058 76058 1601645 1440167 161478 34468 1950 32518 329014 276442 52572 20504 12097 8407 236920 236920 68443 65984 2459 61489 61489 1192386 1149460 42926 127613 127613 BAD DEBT 1035707 1035707 MEDICAL SUPPLIES 606712 606712 OTHER EXPENSES 318016 243386 74630 FOOD 245543 245543 307290 289101 18189 14466994 12878362 1575373 13259 536926 1169948 1379263 1513192 3848709 2297131 116575 188026 219728 197884 110013 100848 18974389 12299665 7259634 6674724 7208 0 34405 481211 13512461 12622964 1946094 1555820 88001 72001 490000 400000 40608 41604 1174197 1345522 186623 169542 3925523 3584489 X 9408420 8859790 178518 178685 9586938 9038475 13512461 12622964 -320515 81982 -309930 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 979 979 0 PART II-B, LINE 1: A PORTION OF THE DUES PAID TO THE MONTANA HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND LEADING AGE (FORMERLY AAHSA) ARE USED FOR LOBBYING PURPOSES. 1 1 X 410491 410491 13613665 9462073 4151592 4928553 2837592 2090961 21680 21680 6674724 CONSTRUCTION PAYABLE 169542 169542 PART IV, LINE 2B: THE HOSPITAL ACTS AS A CUSTODIAN FOR THE FUNDS OF THE NURSING HOME RESIDENTS. THOSE FUNDS APPEAR AS RESTRICTED CASH AND ACCOUNTS PAYABLE IN THE BALANCE SHEET. 1 1 X 1 X 1 X 1 1 1 0 0 203792 203792 0.01410 2298453 2068685 229768 0.01590 2502245 2068685 433560 0.03000 2502245 2068685 433560 0.03000 1 1035707 0 4461826 4499526 -37700 X 1 0 1 1 BIG HORN HOSPITAL ASSOCIATION 17 NORTH MILES AVENUE HARDIN MT 59034 WWW.BIGHORNHOSPITAL.ORG 98140 X X X BIG HORN HOSPITAL ASSOCIATION 1 1 X X X X X X X X X 12 1 0 1 X WWW.BIGHORNHOSPITAL.ORG X X X X X 1 0 1 1 150.000000000000 1 300.000000000000 1 X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 BIG HORN HOSPITAL ASSOCIATION PART V, SECTION B, LINE 3: THE HOSPITAL CONTRACTED WITH MONTANA STATE UNIVERSITY - BOZEMAN TO CONDUCT A SURVEY ON THE HOSPITAL'S BEHALF. MSU - BOZEMAN SENT A COMMUNITY HEALTH SURVEY TO A RANDOM SAMPLE OF BIG HORN COUNTY RESIDENTS. BIG HORN HOSPITAL ASSOCIATION PART V, SECTION B, LINE 12I: IN ADDITION TO A PATIENT'S INCOME LEVEL, A POSSIBLE REVIEW OF THE FOLLOWING ASSETS MAY ALSO BE USED TO DETERMINE THE PATIENT'S ELIGIBILITY FOR DISCOUNTED CARE: CASH, SAVINGS, STOCKS, OTHER LIQUID ASSETS SUCH AS: HOME, LAND, NUMBER OF VEHICLES, PERSONAL PROPERTY USED IN THE PRODUCTION OF INCOME AND OTHER PERSONAL PROPERTY OF REASONABLE VALUE. BIG HORN HOSPITAL ASSOCIATION PART V, SECTION B, LINE 14G: WHEN OUR PATIENT ACCOUNTS REPRESENTATIVE BECOMES AWARE OF A PATIENTS POTIENTAL FINANCIAL HARDSHIP AND/OR SELF PAY STATUS A COMMUNITY CARE APPLICATION IS SENT TO THAT INDIVIDUAL. BIG HORN HOSPITAL ASSOCIATION PART V, SECTION B, LINE 20D: ROCKY MOUNTAIN HEALTH NETWORK NEGOTIATES COMMERCIAL PAYER CONTRACTS ON BEHALF OF BIG HORN HOSPITAL ASSOCIATION. ROCKY MOUNTAIN HEALTH NETWORK NEGOTIATES A 5% DISCOUNT FOR MOST OF OUR COMMERCIAL PAYERS, SO THAT IS OUR ESTIMATE OF AMOUNTS GENERALLY BILLED. WHEN AN INDIVIDUAL QUALIFIES FOR FINANCIAL ASSISTANCE, WE PROVIDE A 5% ADJUSTMENT THEN PROVIDE AN ADDITIONAL FINANCIAL ASSISTANCE DISCOUNT TO ENSURE THAT NO FAP-ELIGIBLE INDIVIDUAL EVER PAYS MORE THAN AMOUNTS GENERALLY BILLED. 1 HERITAGE ACRES 200 NORTH MITCHELL AVENUE HARDIN MT 59034 EXTENDED CARE FACILITY (SNF, ASSISTED LIVING, INDEPENDENT LIVING) PART I, LINE 7: A COST-TO-CHARGE RATIO DERIVED USING WORKSHEET 2 FROM THE IRS WAS USED TO CALCULATE THE AMOUNTS IN PART I, LINE 7. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE EQUAL TO $1,035,707 INCLUDED IN FORM 990, PART IX, LINE 25 WAS EXCLUDED IN CALCULATING THE PERCENT OF TOTAL EXPENSE IN SCHEDULE H, PART I, LINE 7, COLUMN F. PART III, LINE 4: PART III, LINE 4: THE FOLLOWING IS FROM THE "PATIENT AND RESIDENT ACCOUNTS RECEIVABLE" PARAGRAPH IN NOTE 1 TO THE HOSPITAL'S FINANCIAL STATEMENTS:"THE HOSPITAL REPORTS PATIENT AND RESIDENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYORS, PATIENTS, RESIDENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT AND RESIDENT, THE HOSPITAL BILLS THIRD-PARTY PAYORS DIRECTLY AND BILLS THE PATIENTS AND RESIDENT WHEN THE PATIENT AND RESIDENT'S LIABILITY IS DETERMINED. PATIENT AND RESIDENT ACCOUNTS RECEIVABLE ARE ORDINARILY DUE IN FULL WHEN BILLED. DELINQUENT RECEIVABLES ARE WRITTEN OFF BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE PATIENT AND RESIDENT OR THIRD-PARTY PAYOR."THE AMOUNT OF BAD DEBT EXPENSE REPORTS IN PART III, LINE 2 IS CALCULATED AS FOLLOWS: PAYMENT ARRANGEMENT INCLUDE PROSPECTIVELY DETERMINED RATES PER DISCHARGE, REIMBURSED COSTS, DISCOUNTED CHARGES AND PER DIEM PAYMENTS. NET PATIENT SERVICE REVENUE IS REPORTED AT THE ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYORS, AND OTHERS FOR SERVICES RENDERED, INCLUDING ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYORS. PART III, LINE 8: THERE IS NO MEDICARE SHORTFALL. BIG HORN HOSPITAL ASSOCIATION IS A CRITICAL ACCESS HOSPITAL WHICH IS REIMBURSED BY MEDICARE AT 101% OF COST.THE MEDICARE ALLOWABLE COSTS REPORTED ON PART III, LINE 6 WERE DERIVED USING THE 2014 FILED MEDICARE COST REPORT. PART VI, LINE 2: THE HOSPITAL HAS DONE A MAIL SURVEY TO HELP ASSESS THE NEEDS OF THE COMMUNITY. BHHA ALSO USES COMMUNICATION WITH THE PHYSICIAN PRACTICE AS TO WHAT WOULD BE USEFUL AND NEEDED BY THEIR PATIENT POPULATION. PART VI, LINE 3: THE FACILITY KEEPS FORMS ON HAND THAT ARE AVAILABLE (IN PLAIN SIGHT) FOR DIFFERENT GOVERNMENT PROGRAMS SUCH AS HEALTH MT KIDS. THE PATIENT ACCOUNTS REPRESENTATIVE WILL INFORM ANY PRIVATE PAY PATIENT OF OUR COMMUNITY CARE AND WILL ALSO RELAY THIS INFORMATION TO CUSTOMERS WHEN DISCUSSING PAYMENT OPTIONS FOR OUTSTANDING BILLS. PART VI, LINE 4: BHHA SERVERS A HIGH POVERTY LEVEL. THEY ARE ON THE EDGE OF THE CROW INDIAN RESERVATION AND HAVE A LOT OF CUSTOMERS WHO UTILIZE INDIAN HEALTH SERVICES AS A PAYOR SOURCE FOR HEALTH CARE. THEIR POPULATION HAS A LARGE POPULATION OF MEDICARE AND MEDICAID CUSTOMERS. AS THEY SERVE A SMALL TOWN IN MONTANA, THE POPULATION CONSISTS OF A LOT OF CHILDREN AS WELL AS ELDERLY, BOTH OF WHICH UTILIZE OUR HEALTHCARE SYSTEM. PART VI, LINE 5: BHHA DOES HAVE A COMMUNITY BOARD TO HELP NOT ONLY "RUN" THE FACILITY WITH POLICIES AND PROCEDURES, BUT TO GIVE INPUT TO THE MANAGEMENT TEAM ABOUT THE NEEDS THEY SEE FOR THE COMMUNITY IN WHICH THEY LIVE. BHHA IS DEVELOPING MORE EDUCATIONAL PROGRAMS FOR ITEMS SUCH AS WOMEN'S HEALTH, DIABETES MANAGMENT AND SMOKING CESSATION.BHHA USES THE LOCAL PAPERS AS AN OUTLET FOR GIVING THE PUBLIC INFORMATION ON DIFFERENT TYPE OF HEALTH CONCERNS, SUCH AS DIABETES, WEIGHT LOSS, ETC. THEIR PUBLIC HEALTH EDUCATOR IS DEVELOPING A HEALTH COUNCIL TO HELP EDUCATE AND SHARE IDEAS WITH OTHER HEALTH PROVIDERS IN THE COMMUNITY AS TO THE TYPE OF SERVICES NEEDED IN THE AREA AND HOW TO GET THOSE SERVICES TO THE POPULATION. 1 BIG HORN COUNTY HOSPITAL AND HEALTH CARE FOUNDATION 17 NORTH MILES AVENUE HARDIN MT 59034 810504410 501(C)(3) 43443 TO SUPPORT GENERAL OPERATIONS HERITAGE ACRES AUXILIARY LIMITED PO BOX 474 HARDIN MT 59034 810444017 501(C)(3) 12280 TO SUPPORT GENERAL OPERATIONS BIG HORN COUNTY MEMORIAL HOSPITAL AUXILIARY HC 36 BOX 2065 HARDIN MT 59034 810428249 501(C)(3) 12280 TO SUPPORT GENERAL OPERATIONS 3 0 PART I, LINE 2: THE GRANTS MADE WERE AN EQUITY TRANSFER AND PASSING ALONG DONATIONS TO RELATED ORGANIZATIONS. THESE FUNDS ARE TRACKED THROUGH THE ORGANIZATION'S INTERNAL FINANCIAL REPORTING PROCESS. 0 0 0 0 0 0 0 0 0 LARRY CURTIS CRNA 166178 0 0 0 0 0 2500 0 0 0 168678 0 0 0 VERA OSTAHOWSKI EMPLOYEE'S SPOUSE IS A BOARD MEMBER 42974 EMPLOYEE OF BIG HORN HOSPITAL ASSOCIATION 0 FORM 990, PART VI, SECTION A, LINE 7A THE CHAIR OF THE BIG HORN COUNTY COMMISSIONERS IS AUTOMATICALLY DEEMED A MEMBER OF THE BOARD OF DIRECTORS OF BIG HORN HOSPITAL ASSOCIATION. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED IN DETAIL BY THE CONTROLLER AND CEO. THE FORM 990 WAS PRESENTED TO THE BOARD MEMBERS AT A BOARD MEETING PRIOR TO BEING FILED WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C REGULAR COMPLIANCE MEETINGS DISCUSS ANY ACTUAL CONFLICTS OR POTENTIAL CONFLICTS. THERE IS ALSO A HOTLINE NUMBER TO CALL FOR COMPLIANCE OR HIPAA ISSUES THAT IS OPERATED BY MONTANA HOSPITAL ASSOCIATION, NOT BIG HORN HOSPITAL ASSOCIATION. BOARD MEMBERS SIGN YEARLY CONFLICT OF INTEREST STATEMENTS AND IF A CONFLICT OCCURS ON A SPECIFIC ITEM, THEY ABSTAIN FROM THE VOTE ON THAT ITEM. THERE ARE TWO BOARD MEMBERS THAT HAVE SPOUSES EMPLOYED BY BIG HORN HOSPITAL ASSOCIATION. THEY ABSTAIN FROM ANY VOTES THAT WOULD AFFECT WAGES AND BENEFITS FOR EMPLOYEES. FORM 990, PART VI, SECTION B, LINE 15A BIG HORN HOSPITAL ASSOCIATION UTILIZES THE MONTANA STATE SALARY SURVEY TO MAKE SURE EMPLOYEE WAGES ARE COMPARABLE TO SIMILAR JOBS IN SIMILAR AREAS. EXPERIENCE IS ALSO A FACTOR IN THE WAGE. THIS PROCESS WAS LAST DONE IN 2014. THE BOARD REVIEWS AND APPROVES THE CEO'S COMPENSATION. THIS WAS LAST DONE IN 2014. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE MADE AVAILABE TO THE PUBLIC UPON REQUEST TO THE BUSINESS OFFICE. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,440,167. MANAGEMENT AND GENERAL EXPENSES 161,478. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,601,645. BIG HORN COUNTY MEMORIAL HOSPITAL AND HEALTHCARE FOUNDATION 17 N MILES AVENUE HARDIN MT 59034 810504410 HOSPITAL FUNDRAISING MT 501(C)(3) LINE 11A, I BIG HORN HOSPITAL ASSOCIATION 1 BIG HORN COUNTY MEMORIAL HOSPITAL AUXILIARY HC 36 BOX 2065 HARDIN MT 59034 810428249 FUNDS TO BENEFIT BIG HORN COUNTY MEMORIAL HOSPITAL MT 501(C)(3) LINE 11B, II N/A 0 HERITAGE ACRES AUXILIARY LIMITED PO BOX 474 HARDIN MT 59034 810444017 FUNDS TO BENEFIT HERITAGE ACRES NURSING HOME MT 501(C)(3) LINE 11B, II N/A 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 0