Community Benefit Insight - Tax-exempt hospital

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Madison Valley Hospital Inc

Madison Valley Medical Center

217 North Main
Ennis, MT 59019

Bed count	16	Medicare provider number	271329	Member of the Council of Teaching Hospitals	YES	Children's hospital	NO

EIN: 810236460

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

17.41%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 102,019 0.75 %
Medicaid as % of operating expenses	$ 401,138 2.93 %
Costs of other means-tested government programs as % of operating expenses	$ 13,780 0.10 %
Health professions education as % of operating expenses	$ 241,320 1.76 %
Subsidized health services as % of operating expenses	$ 1,415,698 10.35 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 186,713 1.36 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 20,778 0.15 %
Community building* as % of operating expenses	$ 65,733 0.48 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 65,733 0.48 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 0 0 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 65,733 100 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 12,237
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 12,237
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 437,305 3.20 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2022 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 236,121 53.99 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 11630669 including grants of $ 0) (Revenue $ 13836440)
THE MADISON VALLEY MEDICAL CENTER PROVIDES HEALTHCARE AND HOSPITAL SERVICES TO THE LOCAL COMMUNITY AND SURROUNDING AREA. THE PROVIDERS IN THE CLINIC HAD 8,098 VISITS. THE OBSERVATION, INPATIENT, AND SWING BED DAYS FOR THE HOSPITAL TOTAL 959 FOR FY2022.ON MAY 1, 2021, THE CITY COMMISSION OF ENNIS, MONTANA CONVEYED ITS AMBULANCE RELATED ASSETS TO THE HOSPITAL IN RETURN FOR THE HOSPITAL'S COMMITMENT TO CONTINUE TO PROVIDE EMERGENCY AMBULANCE TRANSPORTATION SERVICES IN THE ENNIS COMMUNITY. IN FY2022, THE AMBULANCE SERVICE RESPONDED TO 373 CALLS, WITH 140 OF THOSE CALLS BEING NON-BILLABLE.ON FEBRUARY 16, 2022, MADISON VALLEY MEDICAL CENTER OPENED A RETAIL PHARMACY TO BETTER SERVE THE ENNIS COMMUNITY. IN FY2022, THE RETAIL PHARMACY FILLED OVER 9,500 PRESCRIPTIONS.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

MADISON VALLEY MEDICAL CENTER
PART V, SECTION B, LINE 5: A STEERING COMMITTEE WAS CONVENED TO ASSIST MADISON VALLEY MEDICAL CENTER IN CONDUCTING CHSD. A DIVERSE GROUP OF COMMUNITY MEMBERS REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY (EX. PUBLIC HEALTH, ELDERLY, UNINSURED) CAME TOGETHER IN MARCH 2020. IN JUNE 2020, SURVEYS WERE MAILED OUT TO THE RESIDENTS IN THE MADISON VALLEY MEDICAL CENTER HOSPITAL DISTRICT. SURVEY RESPONDENTS HAD THE ABILITY TO COMPLETE THE SURVEY MAILED TO THEM, OR VIA AN ONLINE SURVEY HOSTED AT MONTANA STATE UNIVERSITY'S HELPS LAB WEB PORTAL. IN ADDITION, KEY INFORMANT INTERVIEWS WERE CONDUCTED TO IDENTIFY IMPORTANT LOCAL HEALTHCARE ISSUES, HOW TO IMPROVE THE HEALTH OF THE COMMUNITY, AND GAPS IN HEALTH SERVICES.

MADISON VALLEY MEDICAL CENTER
PART V, SECTION B, LINE 6A: LIVINGSTON HEALTHCARE

MADISON VALLEY MEDICAL CENTER
PART V, SECTION B, LINE 6B: BOZEMAN HEALTHCOMMUNITY HEALTH PARTNERSGALLATIN COUNTY HEALTH DEPARTMENTPARK COUNTY HEALTH DEPARTMENT

MADISON VALLEY MEDICAL CENTER
"PART V, SECTION B, LINE 11: BASED ON THE RESULTS OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE MADISON VALLEY MEDICAL CENTER BOARD OF DIRECTORS, LEADERSHIP TEAM AND MEDICAL PROVIDERS IDENTIFIED THE MOST IMPORTANT HEALTH NEEDS. THE GROUPS DETERMINED WHICH NEEDS COULD BE ADDRESSED WHILE CONSIDERING MADISON VALLEY MEDICAL CENTER'S RESOURCES AND LIMITATIONS. THE NEEDS WERE PRIORITIZED USING THE ORGANIZATION'S MISSION, VISION AND VALUES. THESE STRATEGIC INITIATIVES ARE PUBLISHED IN OUR CURRENT IMPLEMENTATION PLAN. GOAL 1: IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES IN MADISON CO. STRATEGY 1.1: ENGAGE WITH COMMUNITY PARTNERS TO IMPROVE ACCESS TO MENTAL AND BEHAVIORAL HEALTH SERVICES. CONVENE PRIVATE PRACTICE MENTAL/BEHAVIORAL HEALTH PROVIDERS IN AREA TO EXPLORE OPPORTUNITIES TO SUPPORT LOCAL SERVICES (ED SUPPORT, REFERRALS, EDUCATIONAL SUPPORT, ETC.)CONTINUE TO PARTICIPATE IN LOCAL MENTAL HEALTH ADVISORY COMMITTEE.WORK WITH COMMUNITY PARTNERS AND AREA PROVIDERS TO HELP REDUCE BARRIERS AND STIGMA ASSOCIATED WITH MENTAL HEALTH CREATE WELLNESS PROGRAMMING/EDUCATION TO SUPPORT BEHAVIORAL HEALTH (PHYSICAL HEALTH, MINDFULNESS ETC.) CATALOGUE AVAILABLE MENTAL/BEHAVIORAL HEALTH SERVICES IN MADISON CO./SURROUNDING AREA AND DEVELOP OUTREACH/EDUCATION STRATEGY WITH COMMUNITY PARTNERS. STRATEGY 1.2: ENHANCE AVAILABILITY OF MENTAL AND BEHAVIORAL HEALTH SERVICES.EXPLORE OPPORTUNITIES TO EXPAND BEHAVIORAL HEALTH COVERAGE (EXPAND WORKFORCE, PROVIDER TYPE) AT MVMC.DETERMINE FEASIBILITY OF OFFERING ADDITIONAL TELE-MENTAL HEALTH SERVICES (EXPLORE ON-DEMAND MODELS).CONTINUE TO PROVIDE TELEHEALTH CONSULTS/VISITS AND CRISIS RESPONSE AT MVMC.CONTINUE TO PARTICIPATE IN INTEGRATED BEHAVIORAL HEALTH GRANT AND WORK TOWARDS SUSTAINABILITY/EXPANSION.ESTABLISH PARTNERSHIP WITH BOZEMAN HEALTH AND BIG SKY MEDICAL CENTER TO PROVIDE BEHAVIORAL HEALTH SERVICES IN THE BIG SKY AREA.GOAL 2: IMPROVE ACCESS TO HEALTHCARE SERVICES IN MADISON CO.STRATEGY 2.1: IMPROVE COMMUNITY ACCESS TO SPECIALTY SERVICES.EXPLORE OPPORTUNITIES TO BRING ON MORE SPECIALTY SERVICES SUCH AS CHIROPRACTIC AND ORTHOPEDIC, FOOT CARE ETC. INCREASE ACCESS TO ONSITE ONCOLOGY SERVICES AND DETERMINE FEASIBILITY OF BRINGING CHEMOTHERAPY INFUSION SERVICES TO MVMC. EXPAND CARDIOLOGY SERVICES (ONSITE CARDIAC STRESS TESTING AND ECHO STRESS TESTING)STRATEGY 2.2: ENHANCE ACCESS TO PRIMARY CARE AND SUPPORTIVE HEALTHCARE SERVICES.EXPLORE MODELS FOR AFTER-HOURS OR EXPANDED HOURS CLINIC (EXPANDED WALK-IN CLINIC HOURS, ON-DEMAND TELEMEDICINE VISITS).ESTABLISH AMBULANCE SERVICES WITHIN MADISON VALLEY MEDICAL CENTER.PROVIDE EXPANDED OUTPATIENT AND RETAIL PHARMACY SERVICES WITHIN THE HOSPITAL.REESTABLISH 340B PHARMACY PROGRAM TO EXPAND ACCESS TO AFFORDABLE PHARMACY RESOURCES.PARTNER WITH SENIOR CENTER TO ENHANCE AND EXPAND TRANSPORTATION SERVICES IN MADISON CO.STRATEGY 2.3: PROVIDE RESOURCES AND PROGRAMS THAT IMPROVE ACCESS TO WELLNESS AND PREVENTATIVE HEALTH SERVICES IN MADISON COUNTY.EXPAND NEW SOCIAL MEDIA STRATEGY TO EXPAND OUTREACH AND COMMUNITY KNOWLEDGE OF HEALTH TOPICS AND SERVICES.CONTINUE TO OFFER PRESENTATIONS AND OUTREACH MATERIALS TO VARIOUS LOCAL PARTNERS (EX. SENIOR CENTER, LIONS CLUB, CHAMBER OF COMMERCE, LOCAL CHURCHES).IMPLEMENT MONTHLY/QUARTERLY NEWSLETTER (VIRTUAL AND PRINT) TO SHARE HEALTH TOPICS AND IMPROVE AWARENESS OF AVAILABLE HEALTH SERVICES.THE FOLLOWING HEALTH CONCERNS AND SPECIALTY MEDICINE SERVICES WERE NOT ABLE TO BE ADDRESSED AT THIS TIME. 1. SENIOR NEEDS: A. TOP ADDITIONAL SENIOR SERVICES THAT SURVEY RESPONDENTS WOULD LIKE TO SEE LOCALLY WERE: ""SENIOR RETIREMENT HOUSING/COMMUNITY"", ""HOME HEALTH AND ""ASSISTED LIVING FACILITY.""B. KEY INFORMANT INTERVIEW PARTICIPANTS EXPRESSED CONCERNS ABOUT LOCAL SENIOR SERVICES. SEVERAL FELT THE LOCAL NURSING HOME/ASSISTED LIVING CENTERS ARE AT CAPACITY AND OFTEN UNDERSTAFFED.C. KEY INFORMANT PARTICIPANTS MENTIONED THAT SENIORS FREQUENTLY SEEK HELP NAVIGATING MEDICARE AND OTHER PROGRAMS.RATIONALE: MVMC'S MISSION IS NOT RELATED TO RETIREMENT HOUSING OR ASSISTED LIVING SERVICES. HOME HEALTH REQUIRES A CERTIFICATE OF NEED WHICH IS NOT CURRENTLY POSSIBLE IN MADISON COUNTY. WE CURRENTLY ASSIST PATIENTS WITH MEDICARE ELIGIBILITY AND ANSWER QUESTIONS REGARDING BENEFIT STRUCTURE."

MADISON VALLEY MEDICAL CENTER
PART V, SECTION B, LINE 24: PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE MAY BE BILLED AT AN AMOUNT EQUAL TO GROSS CHARGES FOR PROCEDURES AND SUPPLIES THAT ARE DETERMINED TO BE ELECTIVE OR NON-MEDICALLY NECESSARY.

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 6A:
MADISON VALLEY MEDICAL CENTER FOUNDATION

PART I, LINE 7:
THE HOSPITAL USED WORKSHEET 2 TO DETERMINE A COST-TO-CHARGE RATIO OF 1.05 USED IN THE CALCULATION OF PART I, LINE 7A AND LINE 7C.

PART I, LINE 7G:
THE RURAL HEALTH CLINIC AND EMERGENCY DEPARTMENT OPERATE AT A LOSS CALCULATED BY TAKING THE ALLOWABLE COSTS TO OPERATE FROM THE MEDICARE COST REPORT AND OFFSETTING REVENUES.

PART II, COMMUNITY BUILDING ACTIVITIES:
THE HOSPITAL OFFERS ANNUAL HEALTH FAIR LABS THROUGHOUT THE YEAR WHICH PROMOTES THE HEALTH OF THE COMMUNITY BY ENCOURAGING CITIZENS TO RECEIVE LAB TESTS AT A NOMINAL FEE, AND AT A DATE THAT'S CONVENIENT FOR THEM.

PART III, LINE 2:
CALCULATED BASED ON THE TOTAL BAD DEBT OF THE FACILITY FOR FISCAL YEAR 2022 (FOUND IN THE FACILITY'S 2022 AUDITED FINANCIAL STATEMENTS) MULTIPLIED BY THE COST-TO-CHARGE RATIO CALCULATED ON WORKSHEET 2 OF THE 2021 SCHEDULE H.

PART III, LINE 3:
CALCULATED BASED ON THE ASSUMPTION THAT A LARGE PORTION OF PRIVATE PAY PATIENTS SENT TO BAD DEBT WOULD HAVE QUALIFIED FOR FINANCIAL ASSISTANCE HAD THEY APPLIED. MADISON VALLEY MEDICAL CENTER ESTIMATES THAT 54% OF PRIVATE PAY ACCOUNTS WOULD QUALIFY FOR FINANCIAL ASSISTANCE OR EXPANDED MEDICAID HAD THEY BEEN WILLING TO APPLY. THE ESTIMATED BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE IS CALCULATED AS THE FACILITY'S TOTAL BAD DEBT EXPENSE MULTIPLIED BY THE COST-TO-CHARGE RATIO CALCULATED ON WORKSHEET 2 OF THE 2021 SCHEDULE H AND THE ESTIMATED PORTION OF BAD DEBT ACCOUNTS ELIGIBLE FOR FINANCIAL ASSISTANCE.

PART III, LINE 4:
THE FOOTNOTE THAT DESCRIBES BAD DEBT CAN BE FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8:
THIS AMOUNT REFLECTS THE ACTUAL AMOUNT RECEIVED FROM MEDICARE RELATED TO MEDICARE SERVICES BILLED. THE COSTING METHODOLOGY USED WAS THE STANDARD ALLOWABLE COST FROM THE MEDICARE COST REPORT 2552-10.

PART III, LINE 9B:
TO RECEIVE ASSISTANCE, PATIENTS MUST COMPLETE AN APPLICATION ACCOMPANIED BY PROOF OF INCOME AND A WRITTEN STATEMENT OF NON-QUALIFICATION FOR GOVERNMENT ASSISTANCE. THE APPLICATION IS REVIEWED AND A WRITTEN DETERMINATION IS PROVIDED TO THE PATIENT. THE PATIENT MAY QUALIFY FOR A DISCOUNT OF UP TO 100% ON THEIR BILL BASED ON CURRENT FEDERAL POVERTY GUIDELINES. IF THE PATIENT HAS A BALANCE REMAINING, A PAYMENT PLAN MAY BE SET UP AT THIS TIME, USING GUIDELINES FOR PRIVATE PAY PATIENTS.

PART VI, LINE 2:
THE ORGANIZATION UTILIZES OR RELIES UPON THE INFORMATION CONTAINED WITHIN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED. IN ADDITION, IPADS ARE LOCATED OUTSIDE OF THE LAB AND CLINIC TO ALLOW FOR QUICK SURVEY RESPONSES. INFORMATION FROM THE SURVEYS ARE REVIEWED ON A MONTHLY BASIS AS PART OF THE QUALITY IMPROVEMENT PROGRAM WITHIN THE ORGANIZATION. COMMENTS SPECIFIC TO DEPARTMENTS RECEIVED FROM THE SURVEYS ARE DISTRIBUTED TO THE APPROPRIATE DEPARTMENT MANAGER FOR RESPONSE AND CORRECTIVE ACTION WHERE NECESSARY.

PART VI, LINE 3:
PATIENTS ARE NOTIFIED OF OUR FINANCIAL ASSISTANCE PROGRAM BY VERBAL AND WRITTEN EFFORTS AT THE TIME OF SERVICE, BY TELEPHONE, AS WELL AS BY WRITTEN NOTICE ON STATEMENTS ON EACH ACCOUNT. THE FINANCIAL ASSISTANCE PROGRAM IS ALSO AVAILABLE ON THE WEBSITE.

PART VI, LINE 4:
THE GEOGRAPHIC AREA THAT THE CENTER SERVICES IS APPROXIMATELY 650 SQUARE MILES CONSISTING OF 80 MILES NORTH TO SOUTH AND 10 MILES EAST TO WEST. THE GEOGRAPHIC AREA IS IN SOUTHWESTERN MONTANA AND IS COMPRISED OF THE ENNIS AND HARRISON TAX DISTRICTS, WHICH ARE NO. 53 AND NO. 23, RESPECTIVELY. THE POPULATION OF THIS AREA IS APPROXIMATELY 3,000 BUT INCREASES TO 5-6,000 FROM MAY TO SEPTEMBER. MEDICARE AGE POPULATION IS SLIGHTLY ABOVE STATE AND NATIONAL AVERAGES.

Operating expenses	$ 13,682,173
Total amount spent on community benefits as % of operating expenses	$ 2,381,446 17.41 %