2024-04-29T06:51:14-05:00 2023-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-07-01 264230898 Barrett Hospital Development Corporation BARR 4066833000 600 Highway 91 South Dillon MT 59725 Tina Giem CFO 4066833000 2024-04-26 1 Tina Giem 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2024-04-26 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Barrett Hospital & Healthcare Taylor Rose 600 Highway 91 South Dillon MT 59725 42769165 0 X www.barretthospital.org X 2009 MT Provision of healthcare services to all community members throughout life's journey. 5 4 296 34 0 0 570069 118129 42114730 42183721 717061 360571 67921 52482 43469781 42714903 18121 0 0 0 20852958 20934517 0 0 0 20701333 19969426 41572412 40903943 1897369 1810960 64346161 65656408 27916571 27144395 36429590 38512013 X Barrett Hospital & HealthCare provides compassionate care, healing, and health-improving service to all community members throughout life's journey. 0 1 37082627 0 42183721 Barrett Hospital & HealthCare is an 18 licensed bed acute care critical access hospital. Our patients are served by an inpatient hospital, 24-hour emergency department and a provider-based clinic. Our ancillary services include diagnostic imaging, laboratory, inpatient and outpatient surgery, physical and occupational therapy, non-surgical pain management, integrated behavioral health, transitional care, chronic care management, cardiac rehab, pharmacy, cardiopulmonary, respiratory therapy and diabetic education.Continued on Schedule OThe hospital provided 1,697 days of acute care services, 333 observation days and 600 swing bed days. In addition, the hospital provided 26,005 clinic visits, 30,751 outpatient visits, 4,537 emergency room visits, and prior to its cessation in early 2023, 1,351 home health visits. 37082627 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 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 0 0 0 1 71 0 1 296 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 1 0 0 1 0 0 1 0 0 0 1 1 1 1 1 1 0 1 0 X Tina Giem 4066833006 600 Highway 91 South Dillon MT 59725 Patti Mitchell Chair 0.50 0.00 X X 8836 0 0 Nate Finch Vice Chair 0.50 0.00 X X 0 0 0 Susan Briggs Director 0.50 0.00 X 0 0 0 Shane Puyear Director 0.50 0.00 X 0 0 0 Lawrence Morrisroe Director 0.50 0.00 X 0 0 0 Scott Manis Interim CEO (Jul-Sept) 40.00 2.00 X 0 0 0 Taylor Rose CEO starting September 40.00 2.00 X 0 0 0 Tina Giem CFO 40.00 0.50 X 157773 0 24161 Sandra McIntyre Physician 40.00 0.00 X 378899 0 48560 Gregory Moore Physician 40.00 0.00 X 348334 0 42145 Hallie Tipton Physician 40.00 0.00 X 336245 0 45743 Kelly Smith Physician 40.00 0.00 X 329572 0 20500 Patrick Rasch Physician 40.00 0.00 X 318470 0 53983 1878129 0 235092 29 0 1 0 Forefront Healthcare LLC 22622 Harper Ave Saint Claires Shores MI 48080 Culinary and Environmental 1226499 HealthTech Management Services 5110 Maryland Way Ste 200 Brentwood TN 37027 Management Services 839671 Berkley Life & Health PO Box 639794 Cincinnati OH 45263 Risk Management 312845 David Fortenberry 605 7th Ave East Kalispell MT 59901 Physician 260250 Daniel Richards 13929 Buck Hollow Cove Bluffdale UT 84065 Physician 169850 14 86105 13100 18924 118129 Net Patient Service Revenue 621110 40851049 40851049 Mortgage Subsidy 900099 355251 355251 977421 977421 42183721 383247 383247 84068 31586 52482 52482 52482 22676 -22676 -22676 -22676 42714903 42183721 0 413053 X 176281 5450 170831 16442392 15719305 723087 703631 666117 37514 2479823 2348217 131606 1132390 1072542 59848 697376 697376 51848 51848 106363 106363 1911 1911 6507710 5548656 959054 102095 101995 100 578442 492389 86053 54126 23671 30455 606175 606125 50 40584 14436 26148 135903 125884 10019 1201737 1188670 13067 2241452 2011613 229839 1063316 948249 115067 Medical Supplies 4195887 4195876 11 Repairs and Maintenance 763538 738126 25412 MT Medicaid Bed Tax 467220 340660 126560 Provision for Bad Debts 437822 437822 715921 496824 219097 40903943 37082627 3821316 0 925 925 13011850 13391837 5693940 5484170 913576 920356 338967 553217 56583563 26449479 29993547 30134084 14259812 14974625 14948 22269 118596 174925 64346161 65656408 3145884 2915720 42471 19466 23509491 22421623 1218725 1787586 27916571 27144395 X 36429590 38512013 36429590 38512013 64346161 65656408 1810960 271463 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1911 0 0 0 1911 0 Part II-B, Line 1: The Organization is a member of several organizations that take part in lobbying. A portion of the dues paid to the various organizations is for lobbying costs. These various organizations advocate on behalf of their members by supporting legislation that is in their collective interests. 1796813 1796813 35939201 12066409 23872792 15999910 12922880 3077030 2847639 1460190 1387449 30134084 Estimated Third Party Payor Settlements 1040819 Leases 746767 1787586 41346807 271463 -1639559 -1368096 42714903 0 42714903 39264384 0 39264384 1639559 1639559 40903943 Part XI, Line 2d - Other Adjustments: Interest expense reported in revenue on financial statements -1,201,737. Provision for bad debt reported in revenue on financial statements -437,822. Part XII, Line 4b - Other Adjustments: Interest expense reported in revenue on financial statements 1,201,737. Provision for bad debt reported in revenue on financial statements 437,822. 1 1 X 1 X 0 1 1 0 1 1 365000 365000 0.00900 365000 365000 0.00900 4758 3183 1575 0.00000 633663 10000 623663 0.01540 10857436 8448035 2409401 0.05950 11495857 8461218 3034639 0.07490 11860857 8461218 3399639 0.08390 1921 1921 0.00000 2157 2157 0.00010 52071 28581 23490 0.00060 56149 28581 27568 0.00070 1 437822 0 9713292 9655667 57625 X 1 1 1 1 Barrett Hospital Development Corp 600 MT Hwy 91 S Dillon MT 59725 www.barretthospital.org 13549 X X X X Provider based clinic Barrett Hospital Development Corporation 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X www.barretthospital.org X 1 22 1 www.barretthospital.org 0 1 X 200.000000000000 X X X X X 1 1 X X X 1 X See Part V, Section C X See Part V, Section C X See Part V, Section C X X X X X X 1 X 0 X X X X 1 X 0 0 Barrett Hospital Development Corporation Part V, Section B, Line 5: A steering committee was convened to assist Barrett Hospital & HealthCare and Beaverhead County Health Department in conducting a CHSD. A diverse group of community members representing various organizations and populations within the community (ex. Elderly, young families, uninsured) came together in January 2023. The Steering Committee met twice during the CHSD process; first to discuss health concerns in the community and offer their perspective in designing the survey instrument, and again to review results of the survey and to assist in prioritization of health needs. In February 2023, surveys were mailed out to residents in Beaverhead County. Survey respondents had the ability to complete the survey mailed to them, or via an online survey hosted at Montana State University's Human Ecology Learning and Problem Solving (HELPS) web portal. The survey was based on a design that has been used extensively in the states of Washington, Wyoming, Alaska, Montana and Idaho. The survey was designed to provide each facility with information from local residents regarding:-Demographics of respondents-Hospitals, primary care providers and specialists used, plus reasons for selection-Local healthcare provider usage-Services preferred locally-Perception and satisfaction of local healthcareBarrett Hospital & HealthCare and Beaverhead County Public Health Department provided aggregated lists of outpatient and inpatient encounters and information regarding service area zip codes. Those zip codes with the greatest number of encounters were selected to be included in the survey. A random list of 800 residents was then selected with the assistance of the MSU HELPS Lab. Residence was stratified in the initial sample selection so that each area would be represented in proportion to the overall served population and the proportion of past encounters. Focus groups and 5 key informant interviews were conducted between December 2022 and March 2023 to identify important local healthcare issues, how to improve the health of the community, and gaps in health services. It was intended that this research would help determine the awareness of local programs and services, as well as the level of satisfaction with local services, providers and facilities. Barrett Hospital Development Corporation Part V, Section B, Line 6b: Beaverhead County Public Health Barrett Hospital Development Corporation Part V, Section B, Line 11: The following is a summary of results identified in the most recent CHNA as needs:1. Access to Healthcare Services and Resources2. Chronic Disease Management & Prevention3. Mental and Behavioral Health4. Socioeconomic & Built EnvironmentNeeds identified but not addressed in the most recent CHNA are, lowering cost of health insurance and care and patient difficulty in getting/affording prescriptions or taking medications regularly. The rationale behind not addressing these issues is that lowering the cost of health insurance, as well as prescription medications, is an issue that is beyond the control of the hospital.Due to timing of the most recent CHNA, the needs addressed during fiscal year 2023 were those identified by the previous CHNA.During the course of the year, Barrett Hospital & HealthCare continued its work on many of the needs addressed in the 2020 CHNA. Barrett Hospital & HealthCare partnered with Frontier Psychiatry to provide tele-psychiatry services in the emergency department. These services were replaced in September of 2022 by Providence and are an ongoing service provided. The move to Providence for tele-psych services in the emergency department lead to better continuity of ongoing care for that service. The partnership is an integral component of the value of care offered, improving crisis response in the emergency department.Tele-family planning services is currently under review, as a small pool of patients were seen during the height of the Covid 19 pandemic, however continuation of tele-health for these types of services is under review as the facility currently contracts with Community Health Center providers. It has been identified that telehealth may need to be utilized due to distance barriers. Marketing of telehealth services and community education on the availability of options, as well as how to access such options, is ongoing via strategy and marketing meetings and avenues.The pain management program continued to grow, providing improved local access for patients and increased community awareness of the service. Marketing of the program continues in an effort to educate the community on the availability and access to the program, but implementation of the service itself has been completed.The hospital continues active participation in ACO MSSP to promote wellness care and better manage chronic illnesses and promote population health initiatives. Collaboration with community partners to identify and catalogue social services in Beaverhead County was completed over the course of the year. This included partnering with Public Health to conduct an environmental scan and update available mental health providers and services. Work to improve access to mental and behavioral health services remains active between Barrett Hospital and local school counselors. The hospital continues to remain active in LAC and ACES, promoting campaigns for mental health awareness. Participation in a grant for community crisis response continues, while exploration of another grant for a MACT team is being investigated.Barrett Hospital & HealthCare was able to utilize funds for tele-behavioral health equipment, safety/infections control, books and supplies, and is currently determining feasibility of expanding child tele-behavioral health services via a partnership with Shodair Children's Hospital. Barrett Hospital & HealthCare continues to offer integrated behavioral health care into primary care functions, while also developing tools and workflows for screening and follow-up care. Part V, Line 16a-16c: Part V, Line 16a, FAP Website:https://www.barretthospital.org/patient-financial-informationPart V, Line 16b, FAP Application Website:https://www.barretthospital.org/patient-financial-informationPart V, Line 16c, FAP Plain Language Summary Website:https://www.barretthospital.org/patient-financial-information Part I, Line 3c: The Organization does not provide discounted care. If a patient qualifies for financial assistance, the full patient balance is written off. Part I, Line 6a: The organization mailed the community benefit report to their Beaverhead County residents as well as portions of Madison and Jefferson county. The community benefit report is also available on the facility website and in public waiting areas throughout the facility. Part I, Line 7: Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Community Health Services on line 7e and Health Professions Education on line 7f were determined using actual costs. Subsidized health services on line 7g was determined using the costing methods to prepare the cost reports. Part I, Ln 7 Col(f): The amount of bad debt expense removed from the denominator is $437,822. Part II, Community Building Activities: Barrett Hospital & Healthcare is an active community emergency preparedness advocate and partners with the county Public Health Director and community organizations (e.g. YMCA) on community wellness initiatives. Barrett Hospital & HealthCare maintains over a mile of walking trails on the campus grounds for community member use. Barrett Hospital & HealthCare partners with local volunteer EMS services and law enforcement to provide education and training. Part III, Line 2: Bad debt expense is reported at charges as recorded by the organization. All discounts and payments on a patient's account are accounted for prior to determining bad debt expense. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 17 and 18 of the attached audited financial statements. Part III, Line 8: The facility is designated as a Critical Access Hospital and is reimbursed by Medicare at 101% of Medicare's costs.Medicare allowable costs were obtained from the 2022 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: Once a patient applies for financial assistance, their accounts are held at Barrett Hospital & HealthCare or at our extended business office until a determination can be made on their eligibility for financial assistance. Accounts are not sent to collections during the period the patient is eligible for assistance. If an application does not contain all necessary documentation, the patient is notified of all missing elements and an extended deadline is set for the patient to provide additional documentation. All applicants for financial assistance are notified in writing upon approval or denial of financial assistance. Part VI, Line 2: Barrett Hospital & HealthCare uses various tools throughout the year to assess additional community health needs including utilization of a Patient/Family Advisory Council, reviewing patient surveys regarding services provided at Barrett Hospital, and participating in community-wide health initiatives. Part VI, Line 3: Barrett Hospital & HealthCare is committed to implementing and applying their billing and collection policy in a consistent manner while making every effort to assist patients with limited means to receive the support necessary for their financial obligations whether the patient is insured or uninsured.Financial Assistance Policy (FAP) information can be found on our website. The FAP is distributed in multiple patient areas of our clinic (exam rooms/front desk) and hospital (public areas/registration desks). Our Financial Assistance Policy is advertised monthly in a local publication and copies have been mailed out to area businesses and churches in our service area to be posted in their buildings. There is written notification regarding our FAP on every bill that is sent to the patient/guarantor. When calling patients to educate them on their benefits, we advise patients that if they have concerns about the estimated patient costs that they can discuss them with our financial counselors. All patients calling in to discuss their bills or setup payment plans are routed through the financial counselors for process consistency and to provide the best resources available to the patient. A financial assistance notification also prints on after visit summaries and discharge instructions that are provided to patients after all visits. Part VI, Line 4: Barrett Hospital & HealthCare serves the majority of Beaverhead County and Western Madison County residents. The primary service area includes 9 zip codes through Beaverhead County and 5 zip codes in Madison County. The size and rural makeup of Barrett Hospital's service area play a significant role in the services Barrett Hospital & HealthCare provides. Beaverhead County is the largest county in the State of Montana and consists of a population of approximately 9,246 with a population density of 1.7 people per square mile. The nearest major hospital is 64.4 miles from Barrett Hospital.The population aged 65+ in Beaverhead County is 20.6% which is higher than the demographics for the State of Montana (17.2%) and national demographics (14.9%) for this population group. The upsurge in population aged 65+ continues to increase the need for senior services including healthcare.Socioeconomic factors also play a role in the health of the population that Barrett Hospital & HealthCare services. Beaverhead County has a higher percentage of the population that falls below the federal poverty levels and higher uninsured rates than National and State of Montana measures. 16.1% of the population of Beaverhead County is considered low income and falls below the federal poverty levels compared to 14.4% for the State of Montana. The median income for Beaverhead County is $43,880, which is lower than the Montana median income of $50,801. Beaverhead County also has an uninsured rate of 18%, as compared to the State of Montana rate of 17% and the national measure at 15.7%. Part VI, Line 5: Barrett Hospital & HealthCare is dedicated to providing high value healthcare and services for our community. All surplus revenues are reinvested into the facility, equipment, or programs at Barrett Hospital & HealthCare. The funds are utilized for quality initiatives to improve patient care, expand our facility, expand available services, and advance training programs. As a not-for-profit health system, Barrett Hospital & HealthCare reinvests profits into the community by helping manage chronic conditions including diabetes, promoting wellness, and providing programs to serve the poor and uninsured. In addition, Barrett Hospital is invested in the education and training of physician residents, medical students and other medical professional students at our site including 19 physician resident/students and PA/NP students and 15 occupational therapy, nursing, EMT, laboratory scientists and diagnostic imaging students. Barrett Hospital & HealthCare offers low cost wellness programs (e.g. weight loss, lab screenings, student-athlete sports physicals) to the community, is an active community emergency preparedness partner, provides trauma prevention education, and partners with the county Public Health Director and community organizations (e.g. YMCA) on community wellness initiatives. Barrett Hospital & HealthCare sponsors the local Cancer Support Community gatherings and maintains over a mile of walking trails on the campus grounds for community member use. Barrett Hospital & HealthCare subsidizes the Home Health and Hospice programs for the community and partners with local volunteer EMS services and law enforcement to provide education and training.Barrett Hospital & HealthCare participates in government sponsored health programs including Medicare, Medicaid, CHIP, Veteran's Affairs, and Tricare. Barrett Hospital & HealthCare relies on community involvement to help keep in touch with the current needs of the community. Barrett Hospital & HealthCare has a 5 member board of trustees. The members of the board are publicly elected residents of Beaverhead County. In addition, Barrett Hospital has a large volunteer program. Approximately 30 volunteers contribute their time and efforts to the hospital. The hospital also relies on community members for various advisory councils including the Patient Advisory Council. Barrett Hospital & HealthCare is the only hospital in Beaverhead County. Medical staff privileges in the hospital are open to all qualified physicians and providers. Barrett Hospital operates an emergency room that is accessible to anyone needing care regardless of their ability to pay. The emergency room has approximately 4,000 visits annually.Additionally, Barrett Hospital and HealthCare operates a walk-in clinic 5 days per week. 0 0 0 0 0 0 0 0 0 Sandra McIntyre Physician 225243 0 126656 0 27000 0 20500 0 28120 0 427519 0 0 0 Gregory Moore Physician 323698 0 0 0 24636 0 19140 0 23065 0 390539 0 0 0 Hallie Tipton Physician 204903 0 110842 0 20500 0 20500 0 25303 0 382048 0 0 0 Patrick Rasch Physician 191933 0 106037 0 20500 0 20500 0 33543 0 372513 0 0 0 Kelly Smith Physician 219001 0 90071 0 20500 0 20500 0 0 0 350072 0 0 0 Tina Giem CFO 148034 0 0 0 9739 0 9739 0 14483 0 181995 0 0 0 Part I, Line 3 Scott Manis, Interim CEO, and Taylor Rose, CEO, receive compensation from an unrelated management company, HealthTech Management Services. The organization relies on HealthTech Management Services to have a process in place for determining compensation for the CEO. Form 990, Part III, line 3 The organization has ceased operations of Western Vein Clinic, Home Health, and Hospice. Form 990, Part VI, Section A, line 3 HealthTech Management Services provides general management services including the employment of our Interim CEO, Scott Manis and subsequently our CEO, Taylor Rose. Scott Manis received $354,018 in compensation and benefits from HealthTech Management Services during the 2022 calendar year. Taylor Rose started with the organization in September of 2022, receiving $121,478 in calendar year 2022 compensation. Form 990, Part VI, Section A, line 6 The sole member of the organization is the Public Hospital District, Beaverhead County (d/b/a Barrett Hospital and Healthcare) a Montana statutory public hospital district. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b An electronic copy of the 990 is presented to the Board during their regular board meeting for review and approval. Form 990, Part VI, Section B, line 12c Annually all employees, the CEO, and board members are required to complete a conflict of interest statement. All possible conflicts of interest are reviewed by the Compliance Committee. The Committee determines what, if any, action is necessary for the individual with the potential conflict to take to avoid said conflict. For board members, this would include recusing themselves during discussions/voting on related matters. Form 990, Part VI, Section B, line 15b Interim CEO, Scott Manis, and CEO, Taylor Rose receive compensation from an unrelated management company, HealthTech Management Services. The organization relies on HealthTech Management Services to have a process in place for determining compensation for our CEO. The Board of Directors approves the management agreement. Barrett Hospital & HealthCare participates in an annual salary survey with the Montana Hospital Association, which reviews all employee salary ranges, including the CFO, with like healthcare organizations throughout the State of Montana. Physician/provider compensation is reviewed for fair market value with legal counsel upon execution or renewal of an employment agreement or contract. The Board of Directors reviews and approves all physician/provider agreements/contracts. The Board of Directors approves all other wages/salaries, including that of the CFO during the annual budget process. Form 990, Part VI, Section C, line 19 The Organization makes its governing documents, conflict of interest policy and financial statements available upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 2,459,634. Management and general expenses 959,054. Fundraising expenses 0. Total expenses 3,418,688. Professional Fees: Program service expenses 1,984,495. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,984,495. Physician Fees: Program service expenses 1,104,527. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,104,527. Public Hospital District for Beaverhead County 600 Highway 91 South Dillon MT 59725 810357909 Healthcare MT N/A 0 Barrett Hospital Foundation Inc 600 Highway 91 South Dillon MT 59725 363597000 Fundraising for Hospital MT 501(c)(3) Line 7 N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 1 0 1