2015-11-10T13:19:31-06:00 2014-12-31 450250958 Eide Bailly LLP 1545 Associates Dr Ste 101 Dubuque IA 520022299 990 2014-01-01 810392231 Wheatland Memorial Healthcare WHEA 4066324351 PO Box 287 Harlowton MT 59036 Kyle Gee CFO 4066324351 2015-11-04 1 Carmen Krantz P00031958 5635561790 2015-11-04 2014 2016-02-25 16:41:14Z Larry Putnam PO Box 287 Harlowton MT 59036 5505522 0 X www.wheatlandmemorial.org X 1951 MT To provide healthcare services to the surrounding community 6 6 94 12 0 0 297118 185738 5199445 5207888 121770 -48684 31479 27912 5649812 5372854 1500 1500 0 0 3340514 3288162 0 0 604 1852079 2710879 5194093 6000541 455719 -627687 7187843 6543383 1532636 1511087 5655207 5032296 X Responsive to the communities we serve, Wheatland Memorial Healthcare is dedicated to providing sustainable quality care with respect, compassion and teamwork. 0 0 4806070 1500 5207888 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 $30,423 for the year ended December 31, 2014. Total direct and indirect costs related to these foregone charges were approximately $31,000 at December 31, 2014, based on an average ratio of cost to gross charges. 4806070 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 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 21 0 1 94 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 Lorraine Peterson Chairperson 4.00 1.00 X X 0 0 0 Leta Nash Vice Chairperson 2.00 1.00 X X 0 0 0 Aubrey Miller Secretary/Treasurer 2.00 1.00 X X 0 0 0 Don Amundson Trustee 2.00 1.00 X 0 0 0 Jenny Peters Trustee 2.00 1.00 X 0 0 0 Susan Moore Trustee until July 2014 2.00 1.00 X 0 0 0 June Voldseth Trustee 2.00 1.00 X 0 0 0 Mike Zwicker CEO 40.00 1.00 X 0 0 0 Doug Lewis CFO 40.00 1.00 X 80443 0 576 Charlotte Jutila MD Cardiologist 33.00 0.00 X 206353 0 11509 286796 0 12085 1 0 1 0 Eide Bailly LLP PO Box 2545 Fargo ND 58108 Accounting and IT services 207463 Wilderness Medical Staffing PO Box 442 Red Lodge MT 59068 Temporary staffing 167276 Billings Clinic PO Box 37000 Billings MT 59107 Management, accounting and IT services 165306 Prairie Travelers 130 3rd Street South Ste 2 Glasgow MT 59230 Temporary staffing 117383 4 55000 130738 185738 Patient service revenue 622110 4828121 4828121 Electronic health record incentiv 900099 333562 333562 Supporting revenue 900099 46205 46205 5207888 37000 37000 25512 25512 2400 0 2400 2400 2400 46984 0 132668 46984 -132668 -85684 -85684 5372854 5207888 0 -20772 X 1500 1500 81023 81023 2674428 2334896 339532 74493 62038 12455 224493 204151 20342 233725 195733 37992 216329 216329 20954 20954 33950 33950 617991 419118 198873 11525 7480 4045 194032 71253 122779 36423 36423 125513 125513 167175 155047 12128 24356 13430 10926 14390 14390 538240 538240 26092 26092 Medical supplies 297087 297087 Bad debt expense 294679 294679 Equipment rent/lease 88461 71515 16946 3682 3078 604 6000541 4806070 1193867 604 628148 266749 876647 1117162 112110 119631 13942 21728 6223600 4065109 1934028 2158491 2399775 2020732 263102 295777 24641 23673 935450 519440 7187843 6543383 664017 777817 343165 17880 16665 397574 716605 110000 0 1532636 1511087 X 4841570 4496818 813637 535478 5655207 5032296 7187843 6543383 -627687 13907 -9131 0 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 X 83558 83558 1875926 1547485 328441 4206845 2517624 1689221 57271 57271 2158491 Other receivables 143101 Electronic health record incentive 149353 Estimated third-party payor settlements 220000 Due from Wheatland Memorial Healthcare Foundation 6986 519440 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 $16,665 at December 31, 2014. 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 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. The Hospital is no longer subject to federal or state tax examinations by tax authorities for the years before 2011. 1 1 X 1 X 1 X 175.000000000000 1 1 0 1 1 31000 31000 0.00540 31000 31000 0.00540 16385 16385 0.00290 1445399 806570 638829 0.11200 9600 9600 0.00170 1471384 806570 664814 0.11660 1502384 806570 695814 0.12200 1 500 500 0.00010 1 500 500 0.00010 0 294679 1729 1206695 1216528 -9833 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 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: The Organization will not address the following needs:1. Unintentional injuries - This issue is addressed through schools and other local organizations. There are opportunities to educate the community about safety through safety classes at the school and bicycle helmet education during the health fair.2. Childhood immunizations - A large proportion of the community may opt out of childhood immunizations due to religious beliefs and customs.3. Delay of healthcare services including cost, too long of a wait for an appointment and no insurance - Wheatland Memorial Healthcare hosts an educational event about the Insurance Exchange to assist the public in answering questions or to sign up for insurance. Operating hours of the clinic will be expanded to improve the availability of healthcare services.4. More primary care providers - Wheatland Memorial Healthcare does not have the capacity and the community does not demonstrate enough demand to justify the addition of more primary providers to the hospital staff.5. Cancer care - Wheatland Memorial Healthcare does not have the financial capacity to provide oncology services.6. Need for lactation consultant - There is currently not enough demand in Wheatland County to justify hiring a lactation consultant. 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 V, Section B, Line 16 Financial Assistance Policy Website Availability Wheatland Memorial Healthcare Part V, Section B, line 16c website: www.wheatlandmemorial.org 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 converted to cost on line 7a based on the cost-to-charge ratio derived from Worksheet 2. Community health improvement services reported on line 7e are reported from expenses recorded in the general ledger. The cost for subsidized health services on line 7g was determined using the Medicare Cost Report. Cash and in-kind contributions reported on line 7i are reported based on the FMV of the in-kind contribution. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $294,679. Part II, Community Building Activities: The Hospital serves on Chamber of Commerce committees. The committee advocates and furthers the interest of businesses in the community providing economic growth. More jobs means less unemployment and poverty and this increases the health of the community as a whole. 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 based on an estimate of charges foregone to gross patient charges. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 8 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. When pursuing collection of all patient account balances (whether self-pay or otherwise), all collection agencies and third party bill handlers working accounts on behalf of the Hospital, shall not employ debtors prison. Liens on principal residences may only be imposed with the prior approval of the Administrator and such liens will not be used to force foreclosure and sale of such properties. Foreclosure on any other appropriately attached assets may be exercised through garnishments or other means as permitted by state law.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. 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 2011 population of Harlowton is estimated at 1,505 people, 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 2010 median household income in Harlowton was $29,187, compared to $41,430 for the state of Montana. Individuals below the federal poverty level in Wheatland County for 2011 was 17.2%, compared to 15.2% 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 206353 0 0 0 0 0 8029 0 3491 0 217873 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 Mike Zwicker, CEO, is a common law employee of Billings Clinic. Billings Clinic may, in its discretion at any time, remove and replace the CEO. The CEO has the responsibility of supervising management, administration the operation of Wheatland Memorial Healthcare. Mike Zwicker was compensated $119,090 in 2014 for his services. Salary $98,663 Pension $4,944 Other benefits $15,483 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. 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 IX, line 11g Professional Fees: Program service expenses 292,650. Management and general expenses 7,385. Fundraising expenses 0. Total expenses 300,035. Repairs, maintenance and contracts: Program service expenses 111,378. Management and general expenses 191,013. Fundraising expenses 0. Total expenses 302,391. Recruitment: Program service expenses 15,090. Management and general expenses 475. Fundraising expenses 0. Total expenses 15,565. 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 0 0 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0