2023-11-14T18:47:59-06:00 2022-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY SUITE 1400 PORTLAND OR 97205 990 2022-01-01 810232122 BENEFIS HOSPITALS INC BENE 4064552563 1101 26TH STREET SOUTH GREAT FALLS MT 59405 GREGORY TIERNEY MD CHIEF MEDICAL OFFICER 4064552563 2023-11-13 1 GREGORY TIERNEY MD 999009999 0 WENDY CAMPOS P00448102 5032421447 2023-11-13 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z GREGORY TIERNEY MD 1101 26TH STREET SOUTH GREAT FALLS MT 59405 541788020 0 X WWW.BENEFIS.ORG X 1897 MT BENEFIS HOSPITALS, INC. IS A 569 BED HOSPITAL, PROVIDING INPATIENT, OUTPATIENT AND SENIOR SERVICES. 11 7 3111 584 1357973 0 14512291 13255555 545795345 524791189 1021897 631533 2829343 2376353 564158876 541054630 0 12750 0 0 157920192 174420606 0 0 0 355838861 354865414 513759053 529298770 50399823 11755860 1107455974 1215177347 811118390 907082010 296337584 308095337 X WE PROVIDE EXCELLENT CARE FOR ALL, HEALING BODY, MIND AND SPIRIT. 0 0 384267308 12750 521842341 BENEFIS HOSPITALS, INC. OPERATES A 569 LICENSED BED, TWO-CAMPUS FACILITY PROVIDING ACUTE CARE, REHABILITATION SERVICES, AND PSYCHIATRIC HEALTH SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE ORGANIZATION PROVIDES OUTPATIENT MEDICAL AND SURGICAL SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. THE ORGANIZATION PROVIDES LONG TERM CARE SERVICES. THE HOSPITAL ALSO PROVIDES PRIMARY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH A FAMILY PRACTICE DEPARTMENT. THE FAMILY PRACTICE DEPARTMENT SEES PATIENTS OF ALL AGES, FROM NEWBORN TO THE ELDERLY. ALSO PROVIDES SPECIALTY CARE TO GREAT FALLS AND THE SURROUNDING REGION THROUGH OUR INTERNAL MEDICINE AND SPECIALTY CARE DEPARTMENTS. THESE DEPARTMENTS INCLUDE: INTERNAL MEDICINE, NEUROLOGY, NEUROSCIENCES, OBSTETRICS, GYNECOLOGY AND INFERTILITY, PAIN MANAGEMENT, PEDIATRICS, PLASTICS AND RECONSTRUCTIVE SURGERY, PULMONARY AND CRITICAL CARE MEDICINE, RHEUMATOLOGY, MEDICAL ONCOLOGY, RADIATION ONCOLOGY, UROLOGY, WOUND CARE, ANESTHESIOLOGY, ENDOCRINOLOGY, GASTROENTEROLOGY, GERIATRICS, HEART AND VASCULAR, SPORTS MEDICINE, MED SPA AND VEIN CENTER. ALSO PROVIDES HOSPICE AND SENIOR CARE SERVICES TO THE PUBLIC REGARDLESS OF ABILITY TO PAY. 384267308 1 1 0 0 0 0 0 1 1 0 1 0 0 0 1 1 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 0 0 0 1 113 0 1 3111 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 7 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X FORREST EHLINGER 4064555479 1101 26TH STREET SOUTH GREAT FALLS MT 59405 BILL FERRIN CHAIR 2.00 X X 0 0 0 BRIAN LOUCKS VICE CHAIR 2.00 X X 0 0 0 MARILYN K ROSE DIRECTOR 2.00 X 0 0 0 JUDY BORLAND MD DIRECTOR 2.00 20.00 X 0 106641 9245 VARGHESE PARAMBI MD DIRECTOR 2.00 48.00 X 0 649912 48004 MELCHISEDEK MARGARIS MD DIRECTOR 2.00 48.00 X 0 302991 40133 SENATOR LLEW JONES DIRECTOR 2.00 X 0 0 0 TAMMY LACEY DIRECTOR 2.00 X 0 0 0 DAVE RICHARDS DIRECTOR & SYSTEM BOARD LIAISON 2.00 4.00 X 0 0 0 GREGORY TIERNEY MD DIRECTOR & CHIEF MEDICAL OFFICER 19.00 41.00 X X 0 654721 197703 JEFFREY BAKER MD DIRECTOR 2.00 48.00 X 0 570738 35297 FORREST EHLINGER CHIEF RESOURCES OFFICER & EVP 27.00 33.00 X 0 648517 169523 RAYN GINNATY CHIEF NURSING OFFICER 48.00 2.00 X 374744 0 60835 KATHY HILL CHIEF OPERATING OFFICER 25.00 25.00 X 262843 0 43363 JAMIE LEONARD DIRECTOR OF PHARMACY 50.00 X 192332 0 36576 ADAM ELLIOT MEDICAL PHYSICIST 50.00 X 208901 0 45312 JANELLE NELSON EXECUTIVE DIRECTOR MIHA 50.00 X 182393 0 24036 DARCI BARSOTTI MANAGER PHARMACY 50.00 X 223324 0 15810 DEBRA VANCE DIRECTOR OF NURSING 50.00 X 185313 0 25595 1629850 2933520 751432 259 0 1 0 NUWEST GROUP HOLDINGS LLC PO BOX 940 ROSEVILLE CA 95661 CONTRACTED MEDICAL STAFF 12077015 THOMAS CUISINE MANAGEMENT 770 E FRANKLIN RD MERIDIAN ID 83642 CONTRACTED FOOD SERVICES 4058252 BARTON ASSOCIATES INC PO BOX 417844 BOSTON MA 022417844 LOCUMS 2947920 COMPHEALTH ASSOCIATES INC PO BOX 972651 DALLAS TX 753972651 LOCUMS 2255974 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 753972633 LOCUMS 1642617 34 265464 12776551 213540 13255555 PATIENT SERVICES 621990 515082868 515082868 OTHER OPERATIONS 621990 7571074 6761366 809708 CAFETERIA 722513 2139140 2139140 JOINT VENTURE 621110 -1893 -1893 524791189 575494 575494 3300 0 3300 3300 3300 56039 0 56039 56039 56039 1617266 733390 883876 548265 335611 VENDOR REBATE/DISCOUNT 900099 1085735 1085735 OTHER INCOME 900099 403442 403442 1489177 541054630 521842341 1357973 4598761 12750 12750 741784 631695 110089 22246 18944 3302 142417502 121281238 21136264 4793868 3876390 917478 15947687 12851803 3095884 10497519 8488444 2009075 69398988 69398988 25268720 8179164 17089556 51994 28365 23629 3300744 3062757 237987 43805 11289 32516 5120196 1740754 3379442 557792 395324 162468 4269310 4269310 11710277 8991252 2719025 8491 3624 4867 MEDICAL SUPPLIES 94255531 91484091 2771440 PROVIDER CONT. SERVICES 93553365 89144021 4409344 BAD DEBT 12638822 12638822 34687379 21426581 13260798 529298770 384267308 145031462 0 -5091957 -3620544 1001721329 1110096958 11363605 11278023 633307 868925 236499558 146311678 88677247 90187880 10152443 6366105 1107455974 1215177347 783888090 892390147 8897101 44106 18333199 14647757 811118390 907082010 X 296337584 308095337 296337584 308095337 1107455974 1215177347 X 11755860 1893 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 179972 X 0 1 35155 32473 42561 25067 0 300158 300158 63019853 21830908 41188945 9403855 2903254 6500601 161462987 120427538 41035449 2312705 1149978 1162727 90187880 THIRD-PARTY SETTLEMENTS 7212163 CAPITAL LEASES 7435594 14647757 X PART III, LINE 4: THE ORGANIZATION'S COLLECTION IS ARTWORK THAT IS DISPLAYED IN SEVERAL LOCATIONS AND PROVIDES AN ENVIRONMENT THAT IS BENEFICIAL TO PATIENTS. PART IV, LINE 1B: THE ORGANIZATION MAINTAINS TRUST ACCOUNTS FOR PATIENTS LIVING IN THE ONSITE NURSING HOME. PART X, LINE 2: THE ORGANIZATION COMPRISES SEVERAL CORPORATIONS THAT ARE EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE IRC, EXCEPT TO THE EXTENT OF UNRELATED BUSINESS TAXABLE INCOME AS DEFINED UNDER IRC SECTIONS 511 THROUGH 515, AND SEVERAL LIMITED LIABILITY COMPANIES. THE ORGANIZATION HAS ADOPTED ACCOUNTING FOR UNCERTAIN TAX POSITIONS, WHICH IS AN ACCOUNTING STANDARD THAT PRESCRIBES A RECOGNITION THRESHOLD AND MEASUREMENT PROCESS FOR UNCERTAIN TAX POSITIONS. THE ORGANIZATION HAD NO UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2022 OR 2021. 1 1 X 1 X 1 X 1 1 1 0 1 1 2369227 2369227 0.00460 2369227 2369227 0.00460 438146 438146 0.00080 5621846 5621846 0.01090 24789161 24789161 0.04800 108807 108807 0.00020 721912 721912 0.00140 31679872 31679872 0.06130 34049099 34049099 0.06590 31150 31150 0.00010 11245 11245 0.00000 42395 42395 0.00010 1 12638822 97882383 104419642 -6537259 X 1 1 2 1 BENEFIS HOSPITALS INC EAST CAMPUS 1101 26TH STREET SOUTH GREAT FALLS MT 59405 X X X A 2 BENEFIS HOSPITALS INC WEST CAMPUS 500 15TH AVENUE SOUTH GREAT FALLS MT 59405 X X A BENEFIS HOSPITALS INC 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE PART V X 1 20 1 SEE PART V 0 1 X 200.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X SEE PART V X SEE PART V X SEE PART V X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B, LINE 7A: WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS PART V, SECTION B, LINE 10A: WWW.BENEFIS.ORG/ABOUT-BENEFIS/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS THE IMPLEMENTATION STRATEGY FOR THE 2022 COMMUNITY HEALTH NEEDS ASSESSMENT WAS ADOPTED IN 2023. PART V, SECTION B, LINE 16A, FAP WEBSITE: WWW.BENEFIS.ORG/PATIENTS-VISITORS/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16B, FAP APPLICATION WEBSITE: WWW.BENEFIS.ORG/PATIENTS-VISITORS/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE PART V, SECTION B, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE: WWW.BENEFIS.ORG/PATIENTS-VISITORS/PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: BENEFIS HOSPITALS, INC. EAST CAMPUS, - FACILITY 2: BENEFIS HOSPITALS, INC. WEST CAMPUS BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CREATED IN PARTNERSHIP WITH HEALTHY LIVES, VIBRANT FUTURES (HLVF) COALITION AND IS THE RESULT OF MANY PEOPLE AND PARTNERS IN CASCADE COUNTY, MONTANA. (1) AN ONLINE SURVEY WAS CONDUCTED TO GET FEEDBACK FROM THE PUBLIC. ADDITIONAL FEEDBACK WAS RECEIVED FROM THE INDIAN FAMILY HEALTH CLINIC AND IN RESPONSE THE HOSPITAL BEGAN WORKING WITH THIS CLINIC TO HELP MAKE THE SURVEY MORE INCLUSIVE FOR NATIVE AMERICANS AND REFLECTIVE OF CULTURAL DIFFERENCES. DISTRIBUTING THE SURVEY ONLINE DID NOT APPEAR TO SKEW THE DATA AGE OR GENDER WISE, BUT THERE WERE SIGNIFICANTLY MORE NATIVE AMERICANS THAT PARTICIPATED IN THE SURVEY THIS YEAR, WITH AN INCREASE FROM 5% IN 2018 TO 17.5% IN 2021. THIS CAN ALSO BE ATTRIBUTED TO THE ADDITIONAL EFFORTS BY THE INDIAN FAMILY HEALTH CLINIC TO DISTRIBUTE TO THEIR PATIENTS IN OFFICE. A LARGE INCREASE IN NUMBER OF SURVEYS TAKEN WAS NOTED, INCREASING FROM 560 RESPONDENTS IN 2018 TO 1077 IN 2021. (2) ON JANUARY 27, 2022, A SYMPOSIUM WAS CONDUCTED IN WHICH LOCAL STAKEHOLDERS FROM THE PUBLIC AND A VARIETY OF AGENCIES CONVENED TO REVIEW THE RESULTS OF THE SURVEY AND OFFER FEEDBACK.(3) REPORT DATA, INCLUDING THE COUNTY HEALTH RANKINGS AND ROADMAPS SYSTEM, DEVELOPED BY THE UNIVERSITY OF WISCONSIN'S POPULATION HEALTH INSTITUTE, IN COLLABORATION WITH THE ROBERT WOOD JOHNSON FOUNDATION, AND THE COMMUNITY NEEDS INDEX WAS USED. BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 6B: ALLUVION HEALTHTHE BENEFIS HEALTH SYSTEM FOUNDATIONBENEFIS NATIVE AMERICAN PROGRAMSCASCADE CITY-COUNTY HEALTH DEPARTMENTALCOHOLICS ANONYMOUS AND NARCOTICS ANONYMOUSCHILD AND FAMILY SERVICES DIVISION OF DPHHSCHILDREN'S RECEIVING HOMEDANDELION FOUNDATIONEXTENSION OFFICEFAMILY CONNECTIONSFAMILY PROMISEGREAT FALLS CLINICGREAT FALLS PUBLIC SCHOOLSINDIAN FAMILY HEALTH CLINICMALMSTROM AIRFORCE BASEMANY RIVERS WHOLE HEALTHOPPORTUNITIES INC.PLANNED PARENTHOODRE FAMILY SERVICESROCKY MOUNTAIN TREATMENT CENTERTHE RESCUE MISSIONTHE YWCA OF GREAT FALLSUNITED WAY OF CASCADE COUNTYVOICE OF HOPE BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 11: IN ADDRESSING THE ACCESS TO CARE PRIORITY, WE ARE COMMITTED TO REINVESTING INTO PROGRAMS, STAFFING, TECHNOLOGY, TREATMENT, AND TRAINING. WE PLAN TO REINVEST $245 MILLION INTO FACILITY, TECHNOLOGY, AND EQUIPMENT FOR ENHANCED PATIENT CARE INCLUDING:- IMPROVING ELECTRONIC MEDICAL RECORD SYSTEM- EXPANDING THE ENDOSCOPY LABORATORY- ENHANCING URGENT CARE/EMPLOYEE HEALTH- ADDING SPECIALTY PHARMACY SERVICES- CREATING A RESIDENCY PROGRAM- EXPANDING BEHAVIORAL HEALTH SERVICES- REVISIONING SLETTEN CANCER INSTITUTE- RENOVATING DERMATOLOGY SPACE- EXPANDING PATIENT ACCESS CENTER- FACILITATING MEDICAID REENROLLMENT- CONTINUED RECRUITMENTTO ADDRESS SUBSTANCE MISUSE, OUR FOCUS IS CONTINUED INVOLVEMENT WITH THE LOCAL SUBSTANCE ABUSE PREVENTION ALLIANCE. THIS INCLUDES MAINTAINING DRUG TAKEBACK DROP BOXES AT VARIOUS LOCATIONS. WE ALSO CONTINUE TO SUPPORT OTHER COMMUNITY ORGANIZATIONS WITH GOALS TO REDUCE SUBSTANCE MISUSE IN OUR COMMUNITY.THE HEALTHY WEIGHT PRIORITY WILL BE ADDRESSED THROUGH CONTINUED SUPPORT FOR HEALTHY LIFESTYLE PROGRAMS AND SERVICES THAT PROMOTE NUTRITION AND FITNESS. TO ADDRESS HUNGER PROBLEMS DUE TO ECONOMIC AND OTHER REASONS, CONTINUED SUPPORT WILL BE PROVIDED TO GREAT FALLS COMMUNITY FOOD BANK. PROVIDING OPTIMUM NUTRITION AND MITIGATING WEIGHT LOSS DURING CANCER TREATMENT CAN HAVE MULTIPLE BENEFITS FOR PATIENTS. THE CURRENT SLETTEN CANCER INSTITUTE RENOVATION PROJECT INCLUDES ESTABLISHMENT OF A TEACHING KITCHEN WHERE CANCER PATIENTS WILL LEARN FROM TRAINED DIETITIANS, CHEFS, AND EACH OTHER. EVENTUALLY, THE PROGRAM OFFERING THROUGH THIS KITCHEN MAY EXPAND TO FOCUS ON PATIENTS FACING OTHER TYPES OF CONDITIONS BEYOND CANCER.THE FOCUS ON DECREASING CHILD ABUSE AND NEGLECT, BENEFIS IS PREPARED TO SUPPORT COMMUNITY EFFORTS TO IMPLEMENT NEW STRATEGIES TO IMPROVE FAMILY DYNAMICS. BENEFIS WOMEN'S AND CHILDREN'S CENTER WILL CONTINUE TO PROMOTE PROVIDER COLLABORATION AND EXPAND ITS MULTIDISCIPLINARY APPROACH TO HELPING PATIENTS AND FAMILIES ADDRESS COMPLEX ISSUES THAT CAN LEAD TO ABUSE. CONTINUED SUPPORT WILL BE PROVIDED TO LOCAL ORGANIZATIONS WITH FOCUSED INITIATIVES TO COMBAT CHILD ABUSE AND NEGLECT. BENEFIS HOSPITALS, INC. PART V, SECTION B, LINE 13H: - HOMELESS- DECEASED WITH NO ESTATE- MENTALLY INCAPACITATED WITH NO ONE TO ACT ON HIS OR HER BEHALF- MEDICAID ELIGIBLE, BUT NOT ON THE DATE OF SERVICE OR FOR NON-COVERED SERVICES- ENROLLED IN ONE OR MORE GOVERNMENTAL PROGRAMS FOR LOW-INCOME INDIVIDUALS HAVING ELIGIBILITY CRITERIA AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES - INCARCERATION IN A PENAL INSTITUTION 10 1 - BENEFIS NORTHWEST 25 14TH AVENUE NW GREAT FALLS MT 59404 OUTPATIENT URGENT CARE & PRIMARY CARE SERVICES 2 - BENEFIS FOOT AND ANKLE CLINIC OF MT 1301 11TH AVENUE S SUITE 6 GREAT FALLS MT 59405 OUTPATIENT PODIATRY SERVICES 3 - GRANDVIEW AT BENEFIS 3015 18TH AVENUE SOUTH GREAT FALLS MT 59405 ASSISTED LIVING FACILITY 4 - BENEFIS SLETTEN CANCER INSTITUTE 1117 29TH STREET SOUTH GREAT FALLS MT 59405 OUTPATIENT ONCOLOGY SERVICES 5 - BENEFIS ORTHOPEDIC CENTER OF MONTANA 1401 25TH STREET SOUTH GREAT FALLS MT 59405 COMPREHENSIVE ORTHOPEDIC SERVICES 6 - BENEFIS MED SPA 400 13TH AVE SOUTH GREAT FALLS MT 59405 DAY SPA SERVICES 7 - BENEFIS HELENA NORTHEAST 2960 NORTH WASHINGTON STREET HELENA MT 59602 URGENT CARE SERVICES 8 - BENEFIS HELENA IMAGING 3510 PTARMIGAN LANE HELENA MT 59602 MRI SERVICES 9 - BENEFIS HELENA IMAGING 25 MEDICAL PARK DRIVE HELENA MT 59601 IMAGING CENTER 10 - BENEFIS HELENA DOWNTOWN 55 WEST 14TH STREET SUITE 102 HELENA MT 59601 OUTPATIENT CARE SERVICES PART I, LINE 7: THE COST TO CHARGE RATIO IS USED TO CALCULATE THE TOTAL COMMUNITY BENEFIT EXPENSE. PART I, LINE 7G: THE ORGANIZATION AS PART OF ITS COMMUNITY BENEFIT INCLUDES THE COST OF SUBSIDIZED HEALTH SERVICES ATTRIBUTABLE TO SERVICES IT OFFERS THAT ARE SOLE COMMUNITY RESOURCES AND IF ABSENT WOULD NOT BE OFFERED IN THE SERVICE AREA. THE ORGANIZATION ONLY REPORTS THE SERVICES IF THEY ARE SUBSIDIZED. PART I, LN 7 COL(F): BAD DEBT OF $12,638,822 ARE INCLUDED ON FORM 990 PART IX, LINE 24(C) BUT ARE SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN. PART I, LINE 7I, COLUMN (C): BENEFIS HOSPITALS, INC. HAS A RELATED ORGANIZATION, BENEFIS HEALTH SYSTEM FOUNDATION, INC., THAT CONDUCTS FUNDRAISING EFFORTS FOR COMMUNITY PROGRAMS ON ITS BEHALF. THE COST OF THE FOUNDATION'S FUNDRAISING DIRECTLY ASSOCIATED WITH THE HOSPITAL'S COMMUNITY PROGRAMS IS INCLUDED IN THE TOTAL COMMUNITY BENEFIT EXPENSE. PART III, LINE 2: THE METHODOLOGY UTILIZED TO CALCULATE THE COST OF THE ORGANIZATION'S BAD DEBT EXPENSE IS A COST TO CHARGE RATIO. PART III, LINE 4: SEE NOTE 2 ON PAGE 12 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT ANY SHORTFALL REPORTED IN LINE 7 SHOULD BE TREATED AS COMMUNITY BENEFIT. THE ORGANIZATION USED ITS COST TO CHARGE RATIO TO OBTAIN THE MEDICARE ALLOWABLE COST REPORTED IN PART III, SECTION B. THE ORGANIZATION HAS A CONSIDERABLE POPULATION OF MEDICARE PATIENTS AND IS PAID SUBSTANTIALLY LESS THAN ITS TOTAL COSTS. TOTAL COSTS INCLUDE COSTS THAT ARE EXCLUDED BY MEDICARE'S REIMBURSEMENT METHODOLOGY.AS THE FOLLOWING RECONCILIATION OF MEDICARE COST REPORT TO TOTAL MEDICARE REVENUE AND EXPENSES DEMONSTRATES, THE TOTAL MEDICARE SHORTFALL IS $61,787,414: $97,882,383 MEDICARE NET REVENUE AS REPORTED ON PART III, SECTION B, LINE 5 $64,654,419 MEDICARE CLAIMS PAID BUT EXCLUDED FROM COST REPORT (OUTPATIENT FEE SCHEDULE, PHYSICIANS & OTHER MISCELLANEOUS) $161,028,297 TOTAL MEDICARE NET REVENUE $104,419,642 MEDICARE ALLOWABLE COSTS AS REPORTED ON PART III, SECTION B, LINE 6 $63,004,856 MEDICARE COST DEPARTMENTS EXCLUDED FROM COST REPORT (OUTPATIENT FEE SCHEDULE, PHYSICIANS & OTHER MISCELLANEOUS) $72,922,919 MEDICARE COST REPORT REVENUE AND EXPENSE ADJUSTMENTS $222,825,712 TOTAL MEDICARE COSTS ($61,797,414) TOTAL SHORTFALL ON MEDICARE PART III, LINE 9B: PERSONS DETERMINED TO BE ELIGIBLE FOR 100 % CHARITY CARE SHALL NOT RECEIVE A BILL FOR SERVICES OR BE SUBJECT TO COLLECTION PROCEDURES. PERSONS DETERMINED TO BE ELIGIBLE FOR A REDUCTION OF A PERCENTAGE OF CHARGES UNDER THE CHARITY CARE PROGRAM LESS THAN 100% SHALL NOT BE BILLED OR SUBJECT TO COLLECTION PROCEDURES FOR THE PORTION OF THE BILL THAT IS REDUCED UNDER THE SLIDING FEE SCALE, ONLY THE OUT OF POCKET RESPONSIBILITY. PART VI, LINE 2: HISTORICALLY, BENEFIS HOSPITALS, INC. HAS ASSESSED THE HEALTH NEEDS OF THE COMMUNITIES WITHIN ITS SERVICE AREA THROUGH DIRECT OBSERVATION AND EXPERIENCE, AS WELL AS THROUGH THE USE OF CERTAIN SECONDARY DATA COMPILED BY INDEPENDENT SOURCES. IN 2022, THE HOSPITAL PARTNERED WITH A TEAM OF HEALTH CARE PROVIDERS, COMMUNITY AGENCIES, CLINICS, LOCAL HEALTH DEPARTMENTS, AND OTHER PUBLIC HEALTH PROFESSIONALS WHO CONDUCTED A COMMUNITY NEEDS ASSESSMENT, AS CONTEMPLATED BY IRC SECTION 501(R). PART VI, LINE 3: THE ORGANIZATION HAS POSTED IN REGISTRATION AREAS, EMERGENCY ROOMS, AND FINANCIAL ASSISTANCE AREAS A SUMMARY OF ITS FINANCIAL ASSISTANCE POLICY ALONG WITH BROCHURES THAT DEFINE THE POLICY. THE POLICY AND APPLICATION IS AVAILABLE ONLINE AND A COMMUNICATION OF FINANCIAL ASSISTANCE IS STATED ON EACH BILLING STATEMENT. PART VI, LINE 4: THE ORGANIZATION'S SERVICE AREA IS 41,233 SQUARE MILES AND HAS A POPULATION OF APPROXIMATELY 239,000, WITH AN AVERAGE POPULATION DENSITY OF 5.8 PER SQUARE MILE. THE SERVICE AREA IS APPROXIMATELY 49.6% FEMALE AND 50.4 % MALE. APPROXIMATELY 24.2% OF THE POPULATION IS UNDER 18 YEARS OF AGE AND APPROXIMATELY 19.4% OF THE POPULATION IS OVER THE AGE OF 65. THE SERVICE AREA IS 84.3% WHITE, 10.6% NATIVE AMERICAN, WITH THE REMAINDER AFRICAN-AMERICAN OR OTHER RACES. THE AVERAGE HOUSEHOLD SIZE IS 2.5 PEOPLE, WITH APPROXIMATELY 68.8% OF ALL HOUSING UNITS BEING OWNER OCCUPIED. THE AVERAGE PER CAPITA INCOME IS $28,799 WITH THE MEDIAN HOUSEHOLD INCOME BEING $52,307; 13.1% OF THE POPULATION LIVES IN POVERTY. DATA IS BASED ON U.S. CENSUS BUREAU 2022 ESTIMATES. PART VI, LINE 5: THE ORGANIZATION HELPS DEVELOP THE COMMUNITY THROUGH PARTICIPATION IN COMMUNITY LEADERSHIP ACTIVITIES, IMPROVED HEALTH ADVOCACY WITH COMMUNITY CLINICS, HEALTH FAIRS AND SUPPORT OF GENERAL HEALTH CLINICS. THE ORGANIZATION PROVIDES SUPPORT TO INDIAN HEALTH FACILITY CLINICS. BENEFIS HOSPITALS, INC. PROMOTES THE HEALTH OF PERSONS RESIDING THROUGHOUT ITS SERVICE AREA. THE HOSPITAL OPERATES AN EMERGENCY ROOM OPEN TO ALL PERSONS, WITHOUT REGARD TO ABILITY TO PAY, AND PARTICIPATES IN GOVERNMENT SPONSORED HEALTHCARE PAYMENT PROGRAMS. THE HOSPITAL USES ANY SURPLUS FUNDS TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND OR IMPROVE ITS FACILITIES, AND ADVANCE ITS MEDICAL TRAINING, EDUCATION, AND RESEARCH PROGRAMS. THE HOSPITAL'S BOARD OF DIRECTORS (AND THAT OF BENEFIS HEALTH SYSTEM, ITS SOLE CORPORATE MEMBER) CONSISTS PRIMARILY OF INDIVIDUALS REPRESENTING THE COMMUNITY. THE HOSPITAL MAINTAINS AN OPEN MEDICAL STAFF, WITH MEMBERSHIP AND PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS AND HEALTHCARE PROFESSIONALS, AS SET FORTH IN THE MEDICAL STAFF BYLAWS, RULES, AND REGULATIONS. IN THESE AND OTHER RESPECTS, THE HOSPITAL IS ORGANIZED AND OPERATED IN A MANNER THAT PROMOTES THE HEALTH OF THE COMMUNITY AND THEREFORE FULFILLS CHARITABLE PURPOSES WITHIN THE MEANING OF INTERNAL REVENUE CODE SECTION 501(C)(3). PART VI, LINE 6: THE ORGANIZATION IS PART OF AN INTEGRATED HEALTHCARE DELIVERY SYSTEM AND AS SUCH COORDINATES EFFORTS BETWEEN ALL SYSTEM ENTITIES TO REDUCE DUPLICATION AND PROMOTE THE BROADEST OFFERING OF SERVICES. 1 CHOUTEAU COUNTY HOSPITAL DISTRICT 1501 ST CHARLES ST FORT BENTON MT 59442 810348783 GOVERNMENT 0 12750 FMV 17 WELCH ALLYN VITAL SIGNS MONITORS GENERAL SUPPORT 1 0 PART I, LINE 2: BENEFIS HAS A FULL-TIME GRANTS MANAGER, WHO OVERSEES INTERNAL CONTROLS. A GRANTS HANDBOOK DETAILING PROCEDURES ALONG WITH ROLES/RESPONSIBILITIES FOR BOTH PRE AND POST AWARD HAS BEEN DEVELOPED, APPROVED BY ADMINISTRATION, AND IS IN PLACE. THE GRANTS MANAGER ENSURES STAFF MEMBERS INVOLVED WITH A GRANT-FUNDED PROJECT ARE AWARE OF THESE PROCEDURES AND THEIR RESPECTIVE RESPONSIBILITIES. ALL GRANTS ARE MADE IN THE UNITED STATES. 1 1 0 0 0 0 0 1 0 GREGORY TIERNEY MD DIRECTOR & CHIEF MEDICAL OFFICER 0 591642 0 17100 0 45979 0 177574 0 20129 0 852424 0 23979 FORREST EHLINGER CHIEF RESOURCES OFFICER & EVP 0 513850 0 16167 0 118500 0 148018 0 21505 0 818040 0 92000 VARGHESE PARAMBI MD DIRECTOR 0 274050 0 375862 0 0 0 14290 0 33714 0 697916 0 0 JEFFREY BAKER MD DIRECTOR 0 420993 0 149745 0 0 0 18300 0 16997 0 606035 0 0 RAYN GINNATY CHIEF NURSING OFFICER 338130 0 13698 0 22916 0 50871 0 9964 0 435579 0 21906 0 MELCHISEDEK MARGARIS MD DIRECTOR 0 300991 0 0 0 2000 0 13132 0 27001 0 343124 0 0 KATHY HILL CHIEF OPERATING OFFICER 170827 0 6302 0 85714 0 16382 0 26981 0 306206 0 44714 0 ADAM ELLIOT MEDICAL PHYSICIST 208901 0 0 0 0 0 12274 0 33038 0 254213 0 0 0 DARCI BARSOTTI MANAGER PHARMACY 163317 0 22857 0 37150 0 11499 0 4311 0 239134 0 0 0 JAMIE LEONARD DIRECTOR OF PHARMACY 183936 0 6396 0 2000 0 11781 0 24795 0 228908 0 0 0 DEBRA VANCE DIRECTOR OF NURSING 161569 0 21744 0 2000 0 11775 0 13820 0 210908 0 0 0 JANELLE NELSON EXECUTIVE DIRECTOR MIHA 149492 0 32901 0 0 0 10904 0 13132 0 206429 0 0 0 PART I, LINE 3 THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM OF BENEFIS HOSPITALS, INC. WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. PART I, LINES 4A-B LINE 4A: DARCI BARSOTTI, $35,150 LINE 4B: BENEFIS HEALTH SYSTEM, INC PROVIDES A SECTION 457F NONQUALIFIED DEFERRED COMPENSATION PLAN FOR DR. TIERNEY, MS. GINNATY, MS. HILL, AND MR. EHLINGER, WHO MEET THE REQUIREMENTS OF THE PLAN. DR. TIERNEY, MS. GINNATY, MS. HILL, AND MR. EHLINGER RECEIVED PAYOUTS FROM THE PLAN IN 2022. PART I, LINE 7 BENEFIS HEALTH SYSTEM, INC. AND ITS AFFILIATES (INCLUDING THE ORGANIZATION) MAINTAIN AN INCENTIVE COMPENSATION PLAN THAT INCORPORATES BOTH SHARED AND INDIVIDUAL GOALS FOR MEMBERS OF THE EXECUTIVE AND MANAGEMENT LEADERSHIP TEAMS. PAYMENTS PURSUANT TO THE INCENTIVE PLAN ARE SUBJECT TO A PRECONDITION THAT THE SYSTEM MUST ACHIEVE BUDGETED OPERATING PERFORMANCE. THE SYSTEM HAS ADOPTED SHARED PERFORMANCE OBJECTIVES INCLUDING SYSTEM GROWTH AS WELL AS MEASURES TIED TO WORKFORCE, PATIENT EXPERIENCE, PATIENT SAFETY, CLINICAL QUALITY, AND FINANCE/OPERATIONS. THE INDIVIDUAL PERFORMANCE OBJECTIVES ADOPTED ARE BASED ON AN ARRAY OF QUALITY, FINANCIAL, OPERATIONAL AND STRATEGIC INITIATIVES. INCENTIVE OPPORTUNITY LEVELS ARE CALCULATED BASED ON PREDETERMINED PERCENTAGES OF EACH EXECUTIVE'S AND MANAGER'S BASE SALARY, AND VARY BASED ON THE ACHIEVEMENT OF THRESHOLD, TARGET OR STRETCH LEVELS AS TO EACH PERFORMANCE OBJECTIVE. THE SYSTEM ALSO MAINTAINS A LONG-TERM INCENTIVE PLAN DIRECTED AT RECRUITING AND RETAINING EXECUTIVE LEADERSHIP. PAYMENTS UNDER THE LONG-TERM INCENTIVE PLAN ARE CONDITIONED ON AN EXECUTIVE REMAINING EMPLOYED BY THE SYSTEM AND MAINTAINING SATISFACTORY OVERALL PERFORMANCE. INCENTIVE OPPORTUNITIES UNDER THE LONG-TERM PLAN ARE APPROVED IN ADVANCE BY THE BENEFIS HEALTH SYSTEM, INC. COMPENSATION COMMITTEE, WITH LATER PAYOUTS APPROVED BY THE COMMITTEE BASED ON ACTUAL PERFORMANCE RESULTS. BRYCE EHLINGER FAMILY MEMBER OF FORREST EHLINGER, OFFICER 22246 COMPENSATION 0 PART VI, SECTION A, LINE 1B: THE ORGANIZATION IS AN AFFILIATE OF BENEFIS HEALTH SYSTEM, INC. (BHS), A TAX EXEMPT MONTANA NONPROFIT CORPORATION SERVING AS THE PARENT ENTITY OF AN INTEGRATED SYSTEM OF PROVIDER ORGANIZATIONS ADDRESSING THE HEALTH NEEDS OF PERSONS THROUGHOUT NORTH CENTRAL MONTANA. AS THE CORPORATE MEMBER OF THE ORGANIZATION, BHS HOLDS VARIOUS RESERVED POWERS IN RELATION TO THE ORGANIZATION, INCLUDING THE AUTHORITY TO APPROVE THE ELECTION OF INDIVIDUALS TO ITS BOARD OF DIRECTORS. THE BOARD OF DIRECTORS OF THE ORGANIZATION INCLUDES CERTAIN INDIVIDUALS WHO ARE EMPLOYED BY THE ORGANIZATION OR ITS AFFILIATES, AND WHO MAY NOT BE CONSIDERED "INDEPENDENT" FOR PURPOSES OF FORM 990. HOWEVER, AS ACKNOWLEDGED BY THE IRS IN ITS "CPE TEXT FOR FISCAL YEAR 1997", IN A MULTI-ENTITY HOSPITAL SYSTEM, THE BOARD OF A SUBSIDIARY NON-PROFIT HEALTH CARE ORGANIZATION IS CONSIDERED TO BE COMPRISED OF INDEPENDENT COMMUNITY MEMBERS IF IT IS CONTROLLED BY AN EXEMPT ORGANIZATION WHOSE OWN BOARD IS COMPRISED OF A MAJORITY OF VOTING MEMBERS WHO ARE INDEPENDENT COMMUNITY MEMBERS. THE ORGANIZATION MEETS THIS STANDARD BECAUSE IT IS A CONTROLLED SUBSIDIARY OF BHS, AND BHS'S OWN GOVERNING BOARD INCLUDES INDEPENDENT COMMUNITY MEMBERS AS A MAJORITY THEREOF. FORM 990, PART VI, SECTION A, LINE 2 CERTAIN OFFICERS AND DIRECTORS LISTED IN PART VII ALSO HOLD OFFICER AND/OR DIRECTOR POSITIONS IN RELATION TO THE ORGANIZATION'S AFFILIATES (AS IDENTIFIED IN SCHEDULE R) AND, IN THAT REGARD, MAY BE CONSIDERED TO HAVE BUSINESS RELATIONSHIPS WITH EACH OTHER. SUCH BUSINESS RELATIONSHIPS ARE UNDERTAKEN IN THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION A, LINE 3 PURSUANT TO A CONTRACTUAL ARRANGEMENT, THE ORGANIZATION OBTAINS CERTAIN MANAGEMENT AND ADMINISTRATIVE SERVICES FROM ITS PARENT ENTITY, BENEFIS HEALTH SYSTEM, INC. (BHS). BHS, AS THE PARENT AND SYSTEM ENTITY, PROVIDES THE SERVICES TO ITS SUBSIDIARY TAX-EXEMPT NON-PROFIT CORPORATE ENTITIES ON A CENTRALIZED BASIS. THE SERVICES INCLUDE THE FOLLOWING: - MANAGEMENT OF HUMAN RESOURCES INCLUDING POLICIES AND PRACTICES AND BENEFITS - MANAGEMENT, PLANNING, BUDGETING, AND REPORTING OF FINANCIAL OPERATIONS - MANAGEMENT OF BILLING AND COLLECTIONS POLICIES AND FUNCTIONS - MANAGEMENT OF INFORMATION TECHNOLOGY SERVICES - OVERSIGHT OF QUALITY STANDARDS, COMPLIANCE AND RISK MANAGEMENT - MANAGEMENT OF REGIONAL, COMMUNITY AND GOVERNMENT RELATIONS AND MARKETING - MANAGEMENT OF GRANTS DEVELOPMENT THE FOLLOWING PERSONS LISTED IN PART VII WERE COMPENSATED BY BHS: FORREST EHLINGER - $818,040 (COMPENSATION FOR SERVICES AS OFFICER OF BHS) GREGORY TIERNEY - $852,425 (COMPENSATION FOR SERVICES AS KEY EMPLOYEE OF BHS AND AS AN OFFICER OF BMG) FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER OF THE ORGANIZATION IS BENEFIS HEALTH SYSTEM, INC., A MONTANA NOT-FOR-PROFIT PUBLIC BENEFIT CORPORATION THAT HAS BEEN RECOGNIZED BY THE IRS AS DESCRIBED IN IRC SECTION 501(C)(3). FORM 990, PART VI, SECTION A, LINE 7A AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. (ACTING THROUGH ITS OWN GOVERNING BODY) ELECTS THE BOARD OF DIRECTORS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B AS THE SOLE CORPORATE MEMBER OF THE ORGANIZATION, BENEFIS HEALTH SYSTEM, INC. RETAINS CERTAIN RESERVED POWERS WITH RESPECT TO THE ORGANIZATION, INCLUDING AUTHORITY OVER MATTERS SUCH AS (WITHOUT LIMITATION) THE ORGANIZATION'S MISSION AND VISION STATEMENTS, STRATEGIC AND LONG-TERM PLANS, ELECTION OF ITS DIRECTORS AND OFFICERS, ANNUAL CAPITAL AND OPERATING BUDGETS, CHARITY CARE AND COMMUNITY BENEFIT POLICIES, AND ANY AMENDMENTS TO ITS ARTICLES OF INCORPORATION AND BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THIS FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT PERSONNEL OF BENEFIS HEALTH SYSTEM, INC. IN COLLABORATION WITH ITS ACCOUNTING FIRM. PRIOR TO FILING, A COPY OF THIS FORM 990 WAS PRESENTED TO THE BENEFIS HEALTH SYSTEM, INC. BOARD BY THE ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS ANNUALLY COMPLETE A FORM TO DISCLOSE INTERESTS THAT COULD GIVE RISE TO CONFLICTS. IN ADDITION, AT THE START OF EACH BOARD MEETING, MEMBERS ARE ASKED TO INDICATE WHETHER THEY HAVE A CONFLICT OF INTEREST WITH RESPECT TO ANY ITEMS ON THE AGENDA FOR THE MEETING. CONSISTENT WITH THE ORGANIZATION'S CONFLICTS OF INTEREST POLICY, BOARD MEMBERS ARE PROHIBITED FROM PARTICIPATING IN DELIBERATIONS AND VOTING ON ANY MATTERS AS TO WHICH THEY HAVE A CONFLICT. FORM 990, PART VI, SECTION B, LINE 15 THE COMPENSATION OF THE SENIOR EXECUTIVE TEAM WAS SET BY THE INDEPENDENT COMPENSATION COMMITTEE OF BENEFIS HEALTH SYSTEM, INC., WHICH IS CHARGED WITH ADMINISTERING THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY, POLICIES, AND PROGRAMS IN THE MANNER SET FORTH IN THE COMMITTEE'S WRITTEN CHARTER. THE COMMITTEE'S RESPONSIBILITIES INCLUDE (I) DETERMINING APPROPRIATE COMPENSATION FOR ALL EXECUTIVES AND OTHER KEY EMPLOYEES, (II) EVALUATING AND ADOPTING EXECUTIVE COMPENSATION PLANS, POLICIES, AND PROGRAMS, (III) REVIEWING AND APPROVING EXECUTIVE BENEFIT PLANS, AND (IV) VERIFYING THAT COMPENSATION IS APPROPRIATELY AND FULLY DISCLOSED AND REPORTED. THE COMMITTEE HAS ENGAGED AN INDEPENDENT COMPENSATION CONSULTING FIRM TO ASSIST IN ENSURING THAT AMOUNTS PAID TO THE SYSTEM'S EXECUTIVES ARE CONSISTENT WITH REASONABLE, FAIR-MARKET LEVELS. THE PROCESS FOLLOWED BY THE COMMITTEE, INCLUDING THE DATA RELIED UPON AND THE COMMITTEE'S DECISIONS, WAS THOROUGHLY AND TIMELY DOCUMENTED. THIS PROCESS IS COMPLETED ON AN ANNUAL BASIS. THE COMPENSATION OF THE ORGANIZATION'S KEY EMPLOYEES AND MANAGERS WAS SET BY THEIR RESPECTIVE SUPERVISORY EXECUTIVES IN CONSULTATION WITH BENEFIS HEALTH SYSTEM, INC.'S HUMAN RESOURCES DEPARTMENT AND EXECUTIVE LEADERSHIP, BASED ON A REVIEW OF INDEPENDENT DATA AS TO AMOUNTS PAID BY SIMILAR SITUATED ORGANIZATIONS FOR PERSONS PERFORMING COMPARABLE SERVICES. FORM 990, PART VI, SECTION C, LINE 19 BENEFIS HOSPITALS, INC. PROVIDES COPIES OF AUDITED FINANCIAL STATEMENTS AND FORM 990 TO THE PUBLIC UPON REQUEST DURING NORMAL BUSINESS HOURS. FORM 990, PART XI, LINE 9: TAX VS. BOOK INCOME FROM NORTH CENTRAL MONTANA PHYSICIANS 1,893. 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