2011-05-11T19:09:30-07:00 2010-06-30 990 2009-07-01 810231784 BILLINGS CLINIC BILL 4062382134 2800 Tenth Avenue North Billings MT 59101 Connie F Prewitt 4062382134 2011-05-09 2009 2016-02-24 21:20:13Z Nicholas Wolter MD 2800 Tenth Avenue N Billings MT 59101 926574385 0 X billingsclinic.com X 1907 MT Billings Clinic will be a national leader in providing the best clinical quality, patient safety, service and value. 12 9 3867 285 4289301 186909 5693843 5252157 451968251 486738291 -4043389 4176066 9879486 13867154 463498191 510033668 0 0 0 0 246829655 262345592 0 0 0 216244036 224834233 463073691 487179825 424500 22853843 471413009 497625440 231877980 231421885 239535029 266203555 Billings Clinic is a not-for-profit, physician-led, multispecialty medical group practice integrated with a hospital and long term care facility, serving the communities of Montana, northern Wyoming and the western Dakotas. Their mission is healthcare, education and research. 0 0 174216713 0 269715600 Hospital patient care 174378290 0 187993084 Clinic patient care 11285456 0 7861985 Nursing home patient care 0 0 0 Other 8627026 0 21167622 Other program services 8627026 0 21167622 368507485 1 1 0 1 0 0 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 197 0 1 3867 1 1 1 0 0 0 0 0 0 0 0 12 9 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Billings Clinic 4062382134 2800 Tenth Ave North Billings MT 59101 W Ballard 2 X 3750 0 1500 D Brown 2 X 0 0 5721 T Hathaway 2 X 0 0 6898 L Knight 2 X 0 0 7229 P Nance 2 X 1500 0 1500 J Ott 2 X 0 0 5460 L Overstreet 2 X 0 0 6898 M Schaer 5 X 7500 0 3000 J ShepardLovell 2 X 0 0 6582 Dr J Millikan 95 X 568808 0 34741 Dr C McCracken 80.00 X 319795 0 30289 Dr N Wolter 60 X X 584429 0 193066 C Prewitt 68.00 X 128328 0 32277 D Ebel 40.00 X 231750 0 0 Dr Wentzell 50 X 971774 0 34229 Dr Morone 95.00 X 878534 0 32107 Dr Lindenbaum 60 X 826293 0 31917 Dr Sample 90 X 822716 0 32253 Dr Purcell 60 X 819322 0 30485 Dr J Knostman 0.00 X 11230 0 1245 6175729 0 497397 327 1 1 0 Hardy Construction Box 1203 Billings MT 59103 Building contractor 8699987 Sodexo C/O Billings Clinic Billings MT 59101 Patient food service 4960655 Huron Consulting 8044 Solutions Center Chicago IL 606778000 Consulting 2741594 MD Network Box 731 Cody WY 82414 Transcription services 1846286 Langlas & Asso 2270 Grant Road Billings MT 59102 Building contractor 1597771 47 0 0 0 5252157 0 0 0 5252157 Patient service revenue 622000 482448990 482448990 0 0 Reference lab 621500 3701457 0 3701457 0 Optical shop 446130 587844 0 587844 0 0 0 0 0 486738291 4617064 0 0 4617064 0 0 0 0 0 0 0 0 670392 0 83827 0 586565 0 586565 0 0 586565 415685698 20568 416045241 102023 -359543 -81455 -440998 0 0 -440998 0 439884 309626 130258 0 0 130258 Insurance premiums 524298 4593969 4593969 0 0 Share of JV 621300 1911056 1911056 0 0 6645306 6645306 0 0 13150331 510033668 495599321 4289301 4892889 2064707 0 2064707 0 0 218599104 177044790 41554314 0 8507589 6961515 1546074 0 19646456 14171155 5475301 0 13527736 10605086 2922650 0 976183 22709 953474 0 158148 0 158148 0 34606 0 34606 0 572412 0 572412 0 30580951 11298060 19282891 0 817914 63497 754417 0 91462510 87470704 3991806 0 4619318 493479 4125839 0 6530806 3340378 3190428 0 2218647 1436266 782381 0 319748 109958 209790 0 10587931 114023 10473908 0 16842344 13068162 3774182 0 10689086 4538350 6150736 0 Bad debt 36731905 33174679 3557226 0 Repairs 5378756 4082920 1295836 0 Bed tax 3471427 284915 3186512 0 Recruitment 1466329 10279 1456050 0 Dues and fees 928942 158390 770552 0 446270 58170 388100 0 487179825 368507485 118672340 0 32676908 17087854 22509743 21883719 0 0 67179356 68297133 0 0 0 0 8605654 8546299 6249792 6794151 5059160 5524333 390119356 203411628 189729277 186707728 94028931 139090983 0 16035420 12191155 4209259 3722305 25129509 27779780 471413009 497625440 50659671 47708467 0 0 0 0 151503289 144839706 0 0 0 0 2382969 2531045 0 0 27332051 36342667 231877980 231421885 X 214546713 240597129 7993304 7725992 16995012 17880434 239535029 266203555 471413009 497625440 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 34606 34606 487145219 487179825 1000000 250000 0 0 1000000 1000000 1000000 1000000 4000000 6000000 184134 136064 105276 34606 460080 250000 250000 250000 250000 1000000 1500000 0 0 0 0 0 18575246 665198 399625 0 0 0 19640069 17655956 1048699 -194238 0 120464 0 18389953 0.09 0.91 0 0 1 1 0 17998001 17998001 0 143495043 55073805 88421238 0 1810962 1348039 462923 0 196000511 139680367 56320144 0 30814839 7309417 23505422 186707728 Less than 5% of total assets 12191155 F 12191155 Beneficial interest in Billings Clinic Foundation 27779780 27779780 0 Swap valuation 22153253 Claims reserve 6312390 Provision for unpaid claims 7877024 36342667 510033668 487179825 22853843 3779428 0 0 0 35255 3814683 26668526 513813096 3779428 0 0 0 3779428 510033668 0 0 0 510033668 487179825 0 0 0 0 0 487179825 0 0 0 487179825 SchD_P05_S00_L04 Schedule D, Part V, Line 4 Endowment funds are to be invested and held in perpetuity to provide a source of income for Billings Clinic programs and needs. SchD_P10_S00_L00 Schedule D, Part X The Organization adopted the provisions of ASC 740, Income Taxes. ASC 740 clarifies the accounting for uncertainty in income taxes recognized in an organization's financial statemnts in accordance with the ASC and prescribes a recognition threshold and measurment standard for the financial statement recognition and measurement of an income tax postition taken or expected to be taken in a tax return. The Organization has reviewed its tax positions for all open tax years and has concluded no reserves are requred. SchD_P11_S00_L08 Schedule D, Part XI, Line 8 Transfer of donated equipment from Billings Clinic Foundation 1 1 1 X 1 X 1 1 0 1 1 39940 13635106 0 13635106 0.0303 95257 36729054 38077061 -1348007 0 0 0 0 0 0 0 135197 50364160 38077061 12287099 0.0303 34 119822 3649555 490443 3159112 0.007 5 3268 2375037 475455 1899582 0.0042 13 185931 49449675 38051078 11398597 0.0253 1 6756 2511363 486874 2024489 0.0045 6 8749 279250 0 279250 0.0006 59 324526 58264880 39503850 18761030 0.0416 59 459723 108629040 77580911 31048129 0.0719 1 3744 0 3744 0 0 0 0 0 0 1 250 2392 0 2392 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 152079 0 152079 0 3 293 66168 33453 32715 0 0 0 0 0 0 6 543 224383 33453 190930 0 0 16604938 1136455 145111020 166121165 -21010145 X 1 1 Billings Clinic

2800 Tenth Avenue N Billings MT 59101

X X X X 7 outpatient physician clinics 1 DME supplies Billings Clinic Aspen Meadows

3155 Avenue C Billings MT 59102

Long term care and assisted living facility Billings Clinic TCU

2800 Tenth Avenue N Billings MT 59101

TCU Billings Clinic Dialysis Center

2800 Tenth Avenue N Billings MT 59101

Dialysis unit Billings Clinic Sheridan Dialysis

1401 West 5th St Sheridan WY 82801

Dailysis unit Bozeman Dialysis Center

931 Highland Blvd Bozeman MT 59715

Dialysis unit Billings MRI Center

1041 North 29th St Billings MT 59101

Medical imaging Livingston Imaging Center

504 S 13th ST Livingston MT 59047

Medical imaging The Federal Poverty Guidelines (FPG) are utilized to determine eligibility. In addition, Billings Clinic utilizes a calculator that has built into the formulas the FPG and the cost of living within our area to help determine the patient's ability to pay. There are individuals who do receive free care, without co-pay, and we are currently updating our policy to reflect that. Our application requires submitting bank statement and investment account information to consider assets as part of the process. The application includes: o Completed and signed application and financial assistance checklist completed. o Letter of need completed. o Complete copies of previous years federal and state tax returns, all pages, all schedules, all W-2's. o Debt to income ratio o Type of employment (part/time, seasonal, etc.) o Copies of earnings for last three months for each person in the household, i.e., paystubs, social security, pensions, unemployment benefits, etc. Profit and Loss statement for self employed applicants. o Copies of last three months bank statements, savings statements, investment account statements. o Letters of support from assisting party if household is receiving assistance from family and/or friends. o Award letters from SNAP, LIEAP, TANF, college loans, general assistance, etc. o If currently unemployed, when was last day of work? o How they spend their income (Information from bank statements). For the calculation of the unreimbursed cost of charity care and Medicaid, a ratio of patient care cost to charges using worksheet 2 was utilized. For the calculation of the cost of subsidized services, individual department cost to charge ratios were used, rather than facility wide. Included as subsidized health services are the unreimbursed cost attributable to our rural primary care physician clinics and regional physician outreach clinics (minus bad debt, charity care, Medicaid and Medicare) at a total net benefit of $3,419,815. (Outreach clinic numbers include costs of travel, physician compensation and benefits minus reimbursement.) We provide rural outreach clinics in areas of Montana and Wyoming that do not offer specialty physician services, including cardiology and oncology. This service allows rural patients access to care that may be unattainable to them if required to drive 60 to 300 miles away to Billings, Montana. Physician outreach is especially beneficial to the elderly, frail, ill, single parents and others who would have trouble traveling, or who could not take time off from their job, farm or ranch. Bad debt expense included on Form 990, Part IX, line 25, column A, but subtracted for purposes of calculating the percentage column is $36,731,905. For the calculation of the unreimbursed cost of bad debt, a ratio of patient care cost to charges using worksheet 2 was utilized and applied to charges written off to bad debt. The facility does not routinely discount patient charges and any payments received would reduce the bad debt expense. At this time, the provider does not have a methodology in place to determine amounts applicable to patients who would qualify for charity care, but did not provide sufficient information. Many of these accounts are written off to charity care under the organization's current policies, based upon known factors, such as, homelessness. Others are written off to bad debt, but cannot be identified. We do have a number that would cover possible patients who would have qualified for charity care in the hospital only, but did not provide enough information to qualify. That amount is a cost of $1,136,455. For the calculation of the unreimbursed cost of Medicare. a ratio of patient care cost to charges using worksheet 2 was utilized and applied to gross Medicare charges. Billings Clinic provided care to 30,614 Medicare recipients, with a total of 374,738 clinic and hospital encounters, at an unreimbursed cost of $21,010,145. We do not use the Cost Report for this number. The Cost Report only captures revenue related to the facility and does not capture revenue/losses related to clinical professional services, which are a substantial portion of Billings Clinic Medicare shortfalls. In addition, we believe that 46 percent of Billings Clinic's Medicare shortfalls ($9,664,666) should be counted as a community benefit. Our rationale is that 46 percent is the best estimate of the percentage of Montana's Medicare population who are at or below 300% of Federal Poverty Level, based on U.S. Census data. The upper limit of our financial assistance policy is 300%. The collection policy screens patients for financial assistance prior to making payment arrangements for care. The policy applies equally to all patients - insured, under-insured or uninsured. Once a determination has been made and adjustments applied to the account balance, any remaining balance would fall into the regular guidelines of collection, giving patients financing options that will work within their monthly budget. # of each type of facility, other than those required to be licensed already noted in part V. Billings Clinic participated in a Community Health Needs Assessment process in 2006 and again in 2010 in collaboration with St. Vincent Healthcare and Riverstone Health, the public health department in our city/county, to better identify medical/health needs of Yellowstone County residents. The needs assessment included qualitative and quantitive research with input from a broad spectrum of participants, including community members, public health officials and health care providers. The assessment guides collective and individual organization's efforts to improve the health status, increase life span, and improve the overall quality of life of county residents. The 2010 assessment results will be available in late January of 2011 to help with future community benefit planning. Patient Education of Eligibility for Assistance: * All patients may apply for financial assistance - informational brochures and applications are available at registration desks in the clinic and hospital, the Emergency Department discharge desk, care management staff and on our website at billingsclinic.com. * Information about financial assistance is printed on the back of patient bills. * Patients hospitalized without identifying a third party payer source are screened for coverage/assistance - SSI (Social Security Supplemental income, if approved will qualify for Medicaid), SSDI (Social Security Disability Income), Veterans' Administration, Indian Health Services, Workers Compensation, Medicaid, Crime Victims, and health insurance coverage. * A Financial Assistance brochure is mailed to new patients (Clinic and Hospital) in their pre-admission packets. These packets are mailed to all patients, even if they cannot be reached by phone in advance. * An application is mailed to patients whose payment pattern indicates that they may need assistance. * Staff is available to help any patient needing assistance to complete an application. * According to our existing Financial Application policy, a patient is not eligible for charity assistance if the account is sent to bad debt. We do bring accounts back in house for charity assistance on a case-by-case basis. * An account is sent to bed debt at least 120 days after they are considered just "self-pay", at least three statements, and/or multiple attempts to contact the patient. Billings Clinic is based in Billings, Montana, the largest city in Montana, with more than 142,000 people in Yellowstone County. In Billings there are two not-for-profit hospitals of similar size. Billings Clinic's defined service area includes 560,404 people living in 40 counties in eastern Montana and northern Wyoming, covering 121,000 square miles or roughly the size of the state of New Mexico. Thirty-eight of those 40 counties are either wholly or partly designated as Health Professional Shortage Areas (HPSA) by the US Department of Health and Human Services, Health Resources and Services Administration under the Primary Medical Care discipline. The area includes five American Indian Reservations and an American Indian population of 38,882, or 6.9% of the service area's population. The US Census Bureau 2008 estimates show that 27.3% of Montana families are below 200% of the Federal Poverty level, compared to 26.6% for the nation and Montana is ranked 13th lowest of 50 states in Median Family Income. Montana is ranked 12th highest among 50 states in the percent of people below age 65 who were without health insurance coverage in 2008, with 18.9% uninsured and looking at all age groups, including the age 65+, Montana ranks 13th highest with 16.1% uninsured in 2008. Community Building Activities include community health advocacy, workforce development and partnerships with local, state and regional government and health care organizations to address health issues. For example, one of Billings Clinic's Medical Directors, Doug Carr, MD, works as a loaned executive (about 250 hours per year) for the City-County Health Board and is currently the chair of that Board. The Health Board works for overall community health, primary prevention and helping the underserved. Much of our Community Building Activities are hours worked by several of our executives and our public affairs director for the Alliance, comprised of leaders from Billings Clinic, St. Vincent Healthcare and Riverstone Health (city/county public health). Projects or outcomes of the Alliance partnerships include: * Community Crisis Center - enhances access to behavioral health care in Billings in response to identified community need. The Center is staffed 24 hours per day, seven days per week with a combination of registered nurses, licensed mental health therapists, and mental health technicians. During a stay that must be less than 24 hours, clients are stabilized and assessed to facilitate the development of a crisis management plan. * Medication Assistance Program (MAP) - helps patients afford the prescription drugs they need by connecting individuals with available patient assistance programs offering discounted or free prescription medication. MAP assists low income, uninsured or under- insured people in getting the medications they need, but can't afford. * Plan to Improve the Community's Health (PITCH) - The purpose of PITCH is to provide a framework for a community that is healthy by design, i.e., to intentionally influence the environment in which people live, work, and play such that positive health effects are enhanced and negative health effects are mitigated. * Healthy by Design - To help recognize organizations in Yellowstone County committed to improving our community's health, Healthy by Design encourages, recognizes, educates and creates a standard of excellence for promoting healthy lifestyles by encouraging active living and healthy choices that shape the future of the community. * Healthy Places - The Alliance organizations have developed a program aimed at improving the health of our community. Some of the ways include: community planning (Health Impact Assessments), safe routes to school and strengthened nutrition policies in schools. Billings Clinic is an integrated health care organization, combining a not-for-profit multi-specialty medical group practice with a hospital and long term care facility. Our organization promoted community health in many ways in Fiscal Year 2010, including: * Substantial financial assistance and charity care was provided to patients in need. Billings Clinic provides more charity care than another other hospital or health care organization in Montana. * Care was provided to Medicare and Medicaid patients, as well as SCHIP for children. * Our Board's governance and nominating committee reviewed the entire 990, including Schedule H, which was then discussed with the entire Board of Directors. * Billings Clinic is a teaching hospital and supports, along with Riverstone Health and St. Vincent Healthcare, the only post-graduate medical education in Montana - the Montana Family Medicine Residency Program. Nearly 90 percent of the graduates establish a practice in rural, medically underserved settings in Montana. In addition we provide ongoing preceptorships for medical, nursing and pharmacy students so that they can obtain real-life experience during college and graduate school. * Billings Clinic is a Medicaid disproportionate share hospital serving a significantly disproportionate number of low-income patients. * Billings Clinic has the only inpatient psychiatric services available in our region of central and eastern Montana and northern Wyoming, despite significant financial loss. We are committed to mental health care and continually work to find ways to reach those in need in the region, such as through telemedicine programs and education for primary care providers. * Our full-time emergency department is maintained where no one is denied care, within our capacity to provide care. * Our board of directors is composed of community members who reside in the primary service area. Only three out of 12 board members are employees - two are employed physicians and one is our CEO. * Medical staff privileges are open to all qualified physicians in our community. Operating surpluses are directed solely toward meeting our charitable purposes, including education, research, capital expenses, debt amortization, patient care improvements and medical education. N/A X X 1 1 X X X X X 0 1 0 0 0 1 0 0 0 Dr N Wolter 584189 0 0 0 240 0 183822 0 9245 0 777496 0 0 0 C Prewitt 118088 0 10000 0 240 0 30000 0 2277 0 160605 0 0 0 Dr J Millikan 559476 0 8451 0 880 0 25626 0 9115 0 603548 0 0 0 Dr C McCracken 310538 0 0 0 9257 0 23237 0 7052 0 350084 0 0 0 Dr J Knostman 0 0 0 0 11230 0 1245 0 0 0 12475 0 0 0 Dr Wentzell 622452 0 349222 0 100 0 21775 0 12454 0 1006003 0 0 0 Dr Morone 642015 0 233899 0 2620 0 20425 0 11681 0 910640 0 0 0 Dr Lindenbaum 407048 0 419185 0 60 0 20669 0 11249 0 858211 0 0 0 Dr Sample 822716 0 0 0 0 0 21034 0 11219 0 854969 0 0 0 Dr Purcell 806016 0 13126 0 180 0 19294 0 11191 0 849807 0 0 0 SchJ_P01_S00_L01a Schedule J, Part I, Line 1a Billings Clinic periodically arranges and pays for charter travel for management and/or Board members attending governance education conferences, State legislative hearings and association meetings. There were 9 of these flights in FY10. Billings Clinic also pays for the travel expenses of spouses of Board members attending organizationally approved/arranged goverance education. This reimbursement is reported as income consistent with the Board travel reimbursement policy. SchJ_P01_S00_L04 Schedule J, Part I, Line 4 Supplemental Retirement Agreement (CEO) - nonelective 457(f) plan provides for fixed annual deferrals in amounts ranging from $115,000 to $165,000, which become vested and payable after continued employment on June 30, 2013 or earlier death, disability, involuntary termination without cause, or involuntary termination for good reason following a change in control of the corporation. Physician 457(f) Plan - Nonelective 457(f) plan provides for one-time deferral of $200,000 in August 2006 to become vested and payable on July 1, 2010 or in a prorated amount on earlier death, disability or involuntary termination of employment without cause. Executive 457(f) Plan - Nonelective 457(f) plan provides fixed annual deferrals for Vice Presidents ($30,000) and Executive Directors ($15,000), each of which becomes vested and payable after 4 years, or upon attainment of age 62, death, disability, involuntary termination without cause, or involuntary termination for good reason following a chnage in control of the corporation, and unless vested is forfeited on termination of employment. SchJ_P01_S00_L06 Schedule J, Part I, Line 6 The Board of Directors annually determines the incentive plan amount for the CEO and the Senior Executive Team based on an external compensation study. The availability of the incentive is triggered by the organizational operating margin performance target. The incentive is awarded based on financial performance as well as organizational performance measurements in quality, service satisfaction, both patient and employee satisfaction and then individual goals set each year if the target is triggered. The incentive is paid only if triggered following the financial audit presentation. Montana Facility Finance Authority 810302402 2008-05-30 60000000 Property, plant and equipment 0 0 Montana Facility Finance Authority 810302402 2009-06-24 12720000 Property, plant and equipment 0 0 60000000 5535735 0 0 1200000 0 53264265 2009 0 0 1 1 12720000 58000 12662000 2009 0 0 1 1 0 0 0 0 1 0 0 0 1 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 F990_P06_S0B_L11 Form 990, Part VI, Section B, Line 11 The 990 reveiw is as follows: 1)CFO, 2)Executive group, 3)Governance and Nominating Committee of the Board, 4)Board of Directors F990_P06_S0B_L12c Form 990, Part VI, Section B, Line 12c The Governance and Nominating Committee of the Board, according to their charter, reviews annually the disclosure statements of the Board of Directors and senior executives and takes action to resolve conflicts. A Conflict of Interest Review Panel, chaired by the Compliance Officer, as outlined in organizational policy, is responsible for reviewing disclosed conflicts and approving necessary conflict management plans of all other interested persons at Billings Clinic. F990_P06_S0B_L15 Form 990, Part VI, Section B, Line 15 Billings Clinic has an executive compensation program administered by independent trustees following best practices and the highest regulatory standards expected of a not-for-profit organization. They follow a board apporved charter and overall executive compensation philosophy which defines the market as a comparable set of not-for-profit health care delivery systems. They look at relevant market data of similar roles in similar organizations. Annual disclosure of the committee's actions and decisions to the full Board is required. F990_P06_S0C_L19 Form 990, Part VI, Section C, Line 19 Billings Clinic makes its tax forms available for public inspection through individual request. Montana Healthcare Indemnity 2800 Tenth Avenue N Billings MT 59101 810231784 Insurance captive MT 4593969 8212343 Billings Clinic Billings Clinic Foundation 2917 Tenth Avenue N Billings MT 59101 810407289 Fund raising MT 501(c)(3) 7 Billings Clinic 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 1 Billings Clinic Foundation c 5252157