2011-05-16T20:41:59-05:00 2010-06-30 CHMS PC 741 3rd Ave S Glasgow MT 59230 990 2009-07-01 816016016 GLENDIVE MEDICAL CENTER GLEN 4063653306 202 PROSPECT DRIVE GLENDIVE MT 59330 BARBARA MARKHAM 4063653306 2011-05-16 1 Diana W Mattfeldt CPA 4062289391 2009 2016-02-24 21:20:13Z BARBARA MARKHAM 202 PROSPECT DRIVE GLENDIVE MT 59330 32699104 0 X WWW.GMC.ORG X 1964 MT COMMITTED TO CARING, HEALING, AND A HEALTHIER COMMUNITY THROUGH THE PROCUREMENT OF HEALTH SERVICES. 10 9 576 260 0 0 363944 161471 31479180 32287439 12312 219394 23650 30800 31879086 32699104 0 0 15790783 16311283 0 31806 15083093 15142385 30873876 31453668 1005210 1245436 60184627 59068667 37319080 34957684 22865547 24110983 0 0 24173876 32287439 REVENUE AND EXPENSES RELATED TO PATIIENT CARE. 24173876 1 1 1 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 41 0 576 1 0 0 0 0 0 0 0 10 9 0 0 0 0 0 0 0 1 1 0 1 1 1 1 1 1 1 1 1 1 0 X BARBARA MARKHAM CFO 4063453301 608 REGAL GLENDIVE MT 59330 DAVID LINN 2.00 X 0 0 0 MAUREEN LUNDMAN 1.00 X 0 0 0 LAURA GLUECKERT 1.00 X 0 0 0 TAMMY KANE 1.00 X 0 0 0 ARTHUR K FINK 40.00 X X 256816 0 65424 BRUCE BAINBRIDGE 1.00 X 0 0 0 MELONIE BEELER 1.00 X 0 0 0 SANDRA CARGILL 1.00 X 0 0 0 STEVEN RAY 1.00 X 0 0 0 KYLE VOSS DVM 1.00 X 0 0 0 KEVIN MAXWELL 40.00 X X 569354 0 135160 SCOTT DUKE 50.00 X X 214292 0 126906 BARBARA MARKHAM 50.00 X 109867 0 28070 JUDY COURTNEY 50.00 X 182425 0 31685 DALE ADISHIAN 40.00 X 621145 0 64356 JOSEPH LEAL 40.00 X 263406 0 25346 SONJA SAMSOONDAR MD 40.00 X 251499 0 31365 2468804 0 508312 8 0 1 0 HIGH TECH CONSTRUCTION 1201 4 AVENUE NORTH BILLINGS MT 59107 CONSTRUCTION 9330685 SODEXO INC 10 EARHART DRIVE WILLIAMSVILLE NY 14221 DIETARY MANAGEMENT 895645 MT HEALTH NETWORK 11 SOUTH 7TH STREETSUITE 241 MILES CITY MT 59301 CONTRACT NURSING 501496 COMPHEALTH MEDICAL STAFFING 1550 W ROSEDALE ST DALLAS TX 75397 CRNA CONTRACT LABOR 363358 JGA ARCHITECTS 3395 GABEL ROAD BILLINGS MT 59102 ARCHITECTUAL 229372 5 112260 31076 18135 161471 PATIENT SERVICES 900099 32287439 32287439 32287439 219394 219394 30800 30800 30800 30800 32699104 32537633 0 0 494074 187376 306698 12580218 9987325 2592893 311231 241152 70079 1793407 1399804 393603 1132353 881922 250431 757391 393228 361137 3026 4855 4855 2414692 1949875 461390 3427 59773 1103 58329 341 5323632 4832959 478753 11920 1379173 982205 384668 12300 104378 53745 49841 792 502313 502313 2132649 1990218 142431 354823 327335 27488 BAD DEBTS 1135538 1135538 TAXES & LICENSES 501805 474266 27539 CLINIC BUILDING RENT 340471 340471 EMPLOYEE RECRUITMENT 72042 72042 NURSES DORM EXPENSES 58850 58850 31453668 24173876 7247986 31806 1490265 840146 2214234 5203055 8233897 8350414 1880304 2597538 285061 240230 1354970 1517465 118899 174011 55776654 24052470 23470451 31724184 1754381 1886010 14946514 2198045 4435651 4337569 60184627 59068667 7044354 5268313 30274726 29689371 37319080 34957684 X 22865547 24110983 22865547 24110983 60184627 59068667 X 0 1 0 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3114 0 0 0 0 0 0 0 0 0 Part I-A, Line 1: Organizations Direct and Indirect Political Campaign Activities: PORTION OF MHA DUES USED FOR LOBBYING. 139683 139683 42214965 12733127 29481838 13422006 11319343 2102663 31724184 ACCRUED INTEREST RECEIVABLE 24714 GABERT MEDICAL SERVICES INVESTMENT 2150000 HEALTH NET LLC. 198367 OFF-SITE RESIDENCE 508427 MEDICARE/MEDICAID RECEIVABLE 491056 BOND ISSUE COSTS 965005 4337569 32699104 31453668 1245436 1245436 1 1 1 X 1 X 1 1 1 0 1 1 347 484746 0 484746 0.01600 507 3348360 3859152 -510792 0.00000 854 3833106 3859152 -26046 0.01600 5 11068 98833 5883 92950 0.00310 2 34 43346 0 43346 0.00140 7 3862 7561689 5935839 1625850 0.05360 2 262 106793 0 106793 0.00350 16 15226 7810661 5941722 1868939 0.06160 16 16080 11643767 9800874 1842893 0.07760 1 14 2980 2980 0.00010 1 14 2980 2980 0.00010 1 731404 133349 5285163 5320207 -35044 X 1 1 NA GLENDIVE MEDICAL CENTER

202 PROSPECT DRIVE GLENDIVE MT 59330

X X X X GLENDIVE MEDICAL CENTER NURSING HOME

202 PROSPECT DRIVE GLENDIVE MT 59330

71 BED SKILLED NURSING HOME GLENDIVE MEDICAL CENTER HOME HEALTH

202 PROSPECT DRIVE GLENDIVE MT 59330

HOME HEALTH FOR DAWSON, WIBAUX, MCCONE AND PRAIRIE GLENDIVE MEDICAL CENTER HOSPICE

202 PROSPECT DRIVE GLENDIVE MT 59330

X HOSPICE FOR DAWSON AND WIBAUX COUNTIES EASTERN MONTANA VETERANS HOME

2000 MONTANA AVENUE GLENDIVE MT 59330

80 BED VETERANS SKILLED NURSING HOME THE HERITAGE ON MERRILL AVENUE

1313 NORTH MERRILL AVENUE GLENDIVE MT 59330

13 SUITE ASSISTED LIVING CENTER Part I, Line 3c: Part 1, Line 3C - N/APart 1, Line 6A - N/A Part I, Line 7: Cost to charge ratio was utilized for Charity Care. For subsidized health services actual direct costs and receipts of the departments along with the step down allocation of the annual cost report for 2010 to allocate the correct overhead to the subsidized services since these allocations directly affect the Medicare and Medicaid reimbursement of the cost reimbursed areas(shifting overhead costs to the PPS and non reimbursed areas of the organization) and must be considered when determining the various shortfalls. Part I, Line 7g: Subsidized health services line DOES NOT include any costs attributable to a physician clinic. Part I, Line 7f: Bad debt expense was determined by taking the actual dollar balance of each account transferred to collection agencies and bankruptcies which were written off. These were offset by all bad debt recoveries( the total amount the person paid to the collection agencies against their bad debt accounts or paid directly to the medical center). The cost to charge ratio was then applied to the net amount. Part III, Line 4: The following is part of Footnote A in GMC's audited financial statement - "Accounts Receivable are carried net of an estimate for uncollectibles and allowances. Accounts which are not considered collectible are written off against the allowance account. Allowances for uncollectible accounts are set based on historical loss rates applied to aged accounts receivable. Bad debts are classified as an operating expense.Line 2, Bad debt expense was determined by taking the actual dollar balance of each account transferred to collection agencies and bankruptcies which were written off. These were offset by all bad debt recoveries( the total amount the person paid to the collection agencies against their bad debt accounts or paid directly to the medical center). The cost to charge ratio was then applied to the net amount. Line 3 - The amount shown to be attributable to patients eligible for Charity Care was primarily applications that were submitted without the necessary information or paperwork to enable the completion of the application even with the collection department aggressively working with the parties through letters, telephone calls and meetings Therefore, as shown in Item 3 below, with the education and assistance provided, the amount reported is appropriate. Part III, Line 8: Since this facility is a critical access hospital, and since it is required that only allowable Medicare costs from the Cost Report be reported in Part III, results in the CAH short fall calculated to being zero. The other allowable Medicare costs on this Cost Report, are Home Health, Hospice, and Skilled Nursing Facility. All of those had shortfalls. Therefore, the Medicare shortfall is included in the Subsidized Health Services in Part I, Line 7. Thus Part III line 7, based on the reporting requirements end being zero.As noted in the Schedule H instructions, the cost report does not reflect certain programs which GMC provides Durable Medical Equipment, Medicare Part C, Medicare Part D, and Provider Based Services Emergency Room Providers, Certified Nurse Anesthetists, and Radiologists. Since GMC is in a very rural area, to have 24 hour coverage by these providers for our service area is definitely a quality and safety issue, and therefore, a community benefit.Due to utilizing the allowable Medicare cost from the cost report, Part III does not reflect the fact that there is Medicare shortfall to this facility, due to a number of factors such as the following 1. Any non patient revenue received for reimbursable departments must be offset against expenses. But at the same time, it is not allowed to offset revenue again expenses of non-reimbursable departments. This results in substantial shifting of a substantial amount of administrative expenses to the non reimbursable areas due to allocation of the administrative costs being based on total expense without the offset of revenue on the non reimbursable departments.2. Allocating administrative expense based on the percent of total expense also shifts an excess of costs to areas such as GMCs retail pharmacy due to high cost of drugs again resulting in overstating administrative expenses in a non reimbursable department which in turn lowers reimbursement to Medicare reimbursable departments.3. Medicare Advantage (Part C) plans are creating additional cost and shortfall and are not currently reported in Part III. 4. Medicare Part D - With two nursing homes, being in a very rural area with no other area pharmacies providing Unit Dose dispensing which is required for the safety of our residents, GMC again is seeing a shortfall which is not being reported while providing the necessary services to our local residents and is definitely a benefit to the resident and their families.The following is the calculation of the true shortfall for 2010 from Medicare based on the cost to charge ratio of services provided used for bad debt expense and charity care. This results in all other private pay patients paying more to cover this Medicare shortfall since GMC does not receive any tax support or outside funding.Medicare Total Charges for all services - $14,530,824Cost to Charge ratio of 0.661 - Cost - $9,604,874Medicare Revenue - $8,736,360Shortfall - $868,514 Part III, Line 9b: Bad Debt Policy -PROCEDURES: All accounts, including Medicare and Medicaid, will be processed in a consistent manner before transferring said accounts to a collection agency.1.Statements on self pay balances will be sent monthly.2.Uncompensated Care information will be provided to all patients.3.A final notice stating the account will be turned over to a collection agency within ten days will be sent after the designated number of statements, set in the billing parameters of the Information System, has been sent showing that no payments have been received.4.Accounts can be returned from the collection agency if it has been determined the account qualifies for uncompensated care.5.After twelve months, if no payments have been received by the collection agency, accounts may be returned to GMC. Part VI, Line 2: Needs Assessment - 1. Over the past years, Glendive Medical Center has identified and prioritized community needs through a variety of community surveys in collaboration with various organizations including the City of Glendive and Dawson County. 2. Public meetings were held by Glendive Medicare Center at various times to receive Community input. 3. Strategic Planning sessions are held by GMC to plan and prioritize the needs of the Community on an annual basis. These sessions include the Board of Directors, Foundation Board of Directors, Physicians and other Medical Providers and the Administration of GMC. Over the past years, areas identified and services implemented from the community's surveys included the need for Hospice, Assisted Living and Behavior Health Services. 4. Another Community Survey is planned during calendar year 2011. Community leaders from the medical center, public health, schools, economic development committee, and city and county governments are currently meeting concerning this assessment. They will jointly plan and conduct a community based assessment. Part VI, Line 3: Patient Education of eligibility for assistance -Glendive Medical Center(GMC) provides information and education concerning assistance through various programs and the organizations charity care policy in a variety of ways. Some of those are:1. Through our social services department, patient financial services and other areas, assistance is offered and given to all patients and their families about available programs.2. GMC's website, www.gmc.org, provides charity care and other financial assistance policies and procedures including applications.3. Signage is posted in the various admission areas in the facilities providing information concerning charity care and other financial assistance available through GMC.4. A Guest Information Book for the patient and their familys use is in each patients room and other areas providing various information including financial assistance information that is available which includes charity care and the appropriate personnel to contact if they have not been contacted. Contact information for our social services department if the person needs assistance or has questions about the various government and other programs available in the area is also provided in the information book.5. GMC's monthly statement provides information of the person(s) to contact if financial assistance is needed. At the same time, with all collection letters, our credit and collection department mails financial assistance information which includes an application and the contact person at GMC who can assist them.6. GMC employees are aware of the financial assistance programs and are able to provide direction to patients or their families in their departments concerning charity care. Quarterly at the CEO forums, the employees are provided with the amount of charity care provided by the facility while expressing the importance of providing the free care for people that are in need. Part VI, Line 4: 4. Community Information -GMC's primary service area is Dawson County on the eastern edge of Montana. GMCs secondary service areas are surrounding counties, McCone, Richland, Fallon, Prairie and Wibaux. Projections by the National Planning Association Data Services, Inc. show that Dawson County will experience a decrease in population from the 2000 Census until after 2020 when a slow and steady growth pattern is projected. The population aged 65 and over in Dawson County decreased by 4.4% from the 2000 census to 2006 but is projected to increase approximately 10% by 2010 and an additional 20% by 2020. The population of Dawson County was estimated to be 8,520 in 2010. Approximately 12,000 persons are in the total area GMC serves. The projected increase in population and area health care services is related to the increase in the senior population and energy-related services in the area.Glendive is a medical, retail and agricultural trade center for the county and the surrounding communities within a 30-60 mile radius. Glendives economic base is closely tied to agriculture and the transportation industry, particularly rail services. GMC is the largest employer in Glendive. Other significant employers in the GMCs service area are state, county and city governments, Burlington Northern Santa Fe Railway, Glendive Public Schools, Dawson County Community College and Williston Basin Interstate Pipeline.Dawson County is designated as a Health Professional Shortage Area (HPSA) with shortages of primary medical care and mental health providers. Beginning July, 2010 GMC has a psychiatrist on staff, the only one east of Billings, MT, 200 miles to the West. The Behavior Care Unit opened in July, 2010 as part of the Critical Access Hospital to provide a needed service throughout Eastern Montana and Western North Dakota.The service area residents see GMC and their providers as someone they can come to receive treatment, without regard to whether they have insurance or are uninsured, knowing they will be treated and cared for in a respectful and caring manner,GMC also provides outreach in various ways to the very small critical access frontier facilities as small as one bed facilities in neighboring counties and to four counties in the service area for home care services in sparsely populated areas.There are no other providers in the GMCs primary service area. Sidney Health Center, a critical access hospital located 50 miles north of Glendive, and Holy Rosary Medical Center, a critical access hospital located 70 miles south of Glendive, are the closest facilities. Part VI, Line 5: Community Building Activities -The amount reported in Part II for Community Building Activities provided assistance by GMC leaders to develop and maintain an active Economic Development Committee formed to assist in projects to enhance the health, safety and well being of the community of Glendive. The initial activity of this committee during the past several years was obtaining funds and building low income housing for seniors in the community which has been completed. This was a community benefit providing safe housing for those seniors in an area of housing shortages.This committee is made up of community leaders and has the support of this community. It is currently working to bring new businesses that are needed in the area which will create additional employment opportunities for the areas population. Also, these new businesses will provide additional services to the area which will enhance the ability to recruit healthcare providers and professionals to this community. Due to Glendives setting in a remote rural area, this is always a challenge as shown by the Dawson Countys designation as a HSPA area which was discussed in Item 4. Part VI, Line 6: Other information -GMC Board of DirectorsThe governing body of the GMC is its Board of Directors (the Board), which consists of eleven members. The Board includes the Chief of the Medical Staff and one member of GMCs active medical staff. Other members are selected to promote a representative composition of the Board by gender, rural/urban, professional/non-professional and geography. Board members are selected from the GMCs service area by the Boards nominating committee and approved by the existing Board members. The members of the Board serve in a voluntary capacity and receive no compensation for their services.Members of the Board have various relationships with services or products, who may, from time to time, have dealings with the GMC, but these relationships are not considered to be material. The Chief of Staff and member of the medical staff are employed by the GMC as physicians and medical advisors. The Board has an established conflict of interest policy to detect and manage such relationships.GMC Medical StaffThe active medical staff of GMC is comprised of eleven (11) physicians and thirteen (13) allied health professionals. These providers are all employed by GMC and provide services at all of GMC facilities including the attached Clinic and two of the frontier critical access hospitals in McCone and Prairie County.. Ten (10) of the eleven (11) physicians who are members of the active medical staff are board certified. A Specialty Clinic at GMC is utilized by physicians from Billings, MT. and Bismarck ND to provide services that are not available by the GMC Medical Staff. The patients are able to stay at home in Glendive and have the services provided by the out of town physician locally without traveling great distances. GMC extends medical staff privileges to all qualified physicians in the area who at this time are all employees of GMC. GMC also extends those privileges to the qualified specialty physicians who provide services through the Specialty Clinic.GMC Surplus FundsAll funds in excess of expenses are utilized in the following ways: 1. Utilized for the facilities debt service payments on the 2008 $30,000,000 bond issue obtained to provide a much needed expansion and renovation of the Surgery Suite, an additional nursing home wing and expansion and renovation of the emergency department. 2. A substantial amount of funds are needed each year and utilized for the ongoing capital needs of the facility to insure the appropriate equipment is available to meet the needs of our community. All departments have a three to five year plan in place to forecast these needs.3. Continued assistance to providers and professional staff for education to maintain GMCs standards to provide the care needed to our community.4. To increase reserve funds to insure the ability to continue meeting the above obligations in future years when surplus funds are not available. Part VI, Line 7: Affiliated Health Care System N/A X X X X 0 0 0 0 0 0 0 0 0 ARTHUR K FINK 256816 0 0 0 0 0 35878 0 29546 0 322240 0 315312 0 KEVIN MAXWELL 569354 0 0 0 0 0 89347 0 45813 0 704514 0 247319 0 SCOTT DUKE 214292 0 0 0 0 0 99950 0 26956 0 341198 0 278938 0 JUDY COURTNEY 182425 0 0 0 0 0 6917 0 24768 0 214110 0 0 0 DALE ADISHIAN 621145 0 0 0 0 0 12360 0 51996 0 685501 0 696937 0 JOSEPH LEAL 263406 0 0 0 0 0 0 0 25346 0 288752 0 270986 0 SONJA SAMSOONDAR MD 251499 0 0 0 0 0 0 0 31365 0 282864 0 0 0 MONTANA FINANCE AUTHORITY 810302402 06121PFE5 1999-08-29 1590000 CONSTRUCTION - SEE SCHEDULE O 0 0 MONTANA FINANCE AUTHORITY 364615155 612043GD5 2008-07-01 29716927 CONSTRUCTION - SEE SCHEDULE O 0 0 1614370 157258 31800 1425312 1997 0 0 1 1 30587166 2098389 3134539 594338 1783498 20085103 2011 0 0 0 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 GABERT MEDICAL SERVICES TO FUND OPERATIONS X 2419744 0 1 1 PHYSICIAN LOAN RECEIVABLE HOUSING X 177794 0 1 1 2597538 Form 990, Part VI, Section B, line 11 A COPY OF THE 990 WAS MADE AVAILABLE TO THE CFO AND DISTRIBUTED TO THE BOARD FOR REVIEW. Form 990, Part VI, Section B, line 12c AT EACH BOARD MEETING CONFLICTS OF INTEREST ARE DISCUSSED IF THERE ARE ANY. Form 990, Part VI, Section B, line 15 A MARKET SALARY SURVEY IS PERFORMED AND COMPARED TO OFFICERS AND KEY EMPLOYEES SALARY AND APPROVED BY THE BOARD. Form 990, Part VI, Section C, line 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE KEPT AT THE HOSPITAL AND ARE AVAILABLE UPON REQUEST. THE BEGINING BALANCES RELATING TO INVESTMENTS ON LINES 11 & 12 HAVE BEEN ADJUSTED TO REFLECT A SWITCH FROM VALUING SECURITIES AT COST TO VALUING THEM AT MARKET. THE PRIOR YEAR AMOUNT WAS LISTED AT COST. BEGINING NET ASSETS WERE ALSO ADJUSTED TO REFLECT THIS CHANGE. THE TOTAL AMOUNT OF THE ADJUSTMENT IS $224,980 WHICH WAS REFLECTED IN THE ENTITIE'S 2008 TAX FILING ON SCHEDULE D PART XI LINE 9. PART 1 LINE A REMODEL AND EXPAND CLINIC FACILITIES, CENTRALIZED MEDICAL RECORDS DEPARTMENT, HOME HEALTH CARE OFFICES, AND CENTERALIZED CONFERENCE ROOMS FOR THE MEDICAL CENTER. A PORTION OF THE PROCEEDS WAS USED FOR A NEW INFORMATION SYSTEM WITH CLINICAL AND FINANCIAL APPLICATIONS. PART 1 LINE B CONSTRUCTING, EQUIPPING AND FURNISHING A THREE SUITE SURGERY CENTER IN THE MEDICAL CENTER, RENOVATION AND EXPANDING THE EMERGENCY DEPARTMENT INCLUDING AN AMBULANCE CANOPY, BUILDING A NEW NURSING HOME WING DUE TO THE NEED TO DEMOLISH EXISTING NURSING HOME WING DUE TO THE SURGERY CENTER CONSTRUCTION, REPLACEMENT OF STEAM BOILERS WITH A NEW BOILER PLANT, AND RENOVATION AND EXPANDING THE PARKING AREA WERE THE PRIMARY USE OF THE PROCEEDS. GLENDIVE MEDICAL CENTER FOUNDATION 202 PROSPECT GLENDIVE MT 59330 810440518 RAISING FUNDS FOR GLENDIVE MEDICAL CENTER AND COMMUNITY MEDICAL NEEDS MT GABERT MEDICAL CLINIC INC 107 DILWORTH GLENDIVE MT 59330 810477745 PROVIDES COMPREHENSIVE MEDICAL CARE AND RELATED HEALTH SERVICES. MT C 1.00000 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 GLENDIVE MEDICAL CENTER FOUNDATION C 112260 HEALTH NET LLC 11 SOUTH 7THSUITE 241 MILES CITY MT 59301 810506005 DATA PROCESSING MT 1 198367 0 1