Continuing the Crook County News Since 1884
Aug. 26
CROOK COUNTY MEDICAL SERVICES DISTRICT FINAL
BOARD OF TRUSTEES MINUTES
August 26, Monday, 2019, 3:00 p.m. – CCMSD Conference Room
Persons in Attendance: Sandy Neiman, President; Connie Lindmier, Secretary-Treasurer; Joey Kanode, Trustee; Trish Habeck, Trustee; absent Mark Erickson, Trustee.
Nathan Hough, CEO; Karl Rude, HMS; Bonnie LeSueur, HMS.
Kyle Ridgeway, legal-by zoom/phone.
Jeff Knoblock, Eide-Bailey-Audit by phone.
Call to Order: President Sandy Neiman called the meeting to order at 2:59 p.m.
Public Comments: None
Agenda: Joey Kanode made the motion to accept the agenda with the change to have Audit report after minutes. Trish Habeck seconded the motion. Motion carried.
Approval of Minutes: Discussion on minutes: inspection-July `18k, State not City; Website – continuing updates; chargemaster – no changes so far; Nathan is working on the review.
Joey Kanode made the motion to accept the agenda with the change to have Audit report first. Trish Habeck seconded the motion. Motion carried.
Audit Report: Jeff Knoblock of Eide Bailey reviewed the report and audit. He noted that the written letter, governance letter, is materially correct. Risk based approach is used. Revenue being reported was evaluated and expenses were reported in the correct period.
Accrual basis was used, and uses the process of understanding internal controls and processes. Findings and items on financial control and are in compliance in connection with the audit.
Letter issued shows accounting processes. Changes in process are noted. No changes for last year, buy 2020 and will show some changes in rules.
Key areas:
Estimates – what was expected to collect vs what was billed.
Medicare cost report, etc. under cost-based reimbursement.
Razor to Athena – some issues getting information out of the system still existed in 2018. It is improving, but some issues remained. Process changes are happening in Athena, etc. It will impact the 2019 financials.
Adjustments & corrections:
5 items were evaluated in 2017 and 2018 processes. They are not necessarily material to financial statements, but Jeff wants the Board to know.
- Prior year past adjustments. Revenue related to services provided thru 6-2017, not recorded until 2018.
- Final calculated management fee-difference of $15,000.00+- impacted 2018.
- Current year items – adjustment of late charges, Athena issues fixed in July 2018. +-$67,000.00. 201`9 will show +-$67,000.00 revenue instead of 2018. Correction item will be handled in 2019 cost report.
- Wyoming bed tax-one payment June 30, 2018 was paid 2019 year period. Correction $64,000.00+- reflected in 2019. Net impact will be $3,000.00+-.
- Net income for 2018 was understated $20,000.00+- to $26,000.00+-.
Granted-related expenses were reclassified in some issues.
Bad debt recoveries – 2 issues adjustments were recorded appropriately. +-$39,000.00.
Old Moorcroft clinic building and un-depreciated value of the building was taken off the books.
Some assets were shown as un-depreciated-Jeff explained those assets-roof replacement in 2011. Building was placed in service in 1992, according to the record-January 1, 1992 with 40 year life.
Adjusted investment in joint venture – Bear Lodge - $33,000.00 adjusted.
AS valuations: allowances for bad debt and contractual – offset/increased bottom line on allowance side, and decreased on cost adjustment side.
Items:
Razor installed – qualified for incentive payment for Medicare at that time. Amount received was tied to amount of payments to Razor.
Adjustment was recorded to carry eventual payback for that incentive program. Medicare has closed the time to report. Be aware that it is still being carried as a liability on the books. Sandy stated that was an adjustment to Athena.
Jeff stated that it has been adjusted by Medicare – based on contract with Razor. Address it thru Athena.
Management team signed off on approval.
Final opinion states that financial statements are presented fairly etc. It is an unmodified clean opinion.
Discussion continued on Medicare and Razor.
Financial Report: Bonnie LeSueur
Bear Lodge Rehabilitation: reviewed
AR Aging: reviewed
Balance Sheet: June and July 2019 reviewed
Income Statement: June and July 2019 reviewed
Bank listing: reviewed. Nathan will call Sundance Bank to clear up the construction account 1286 and get rid of those two accounts at the earliest convenience.
Joey Kanode made the motion to close the two accounts, 1289 and 0369, at the earliest availability. Trish Habeck seconded the motion. Motion carried.
Audit by Eide-Bailey – see above
Check Register: Joey Kanode made the motion to table the check register this meeting and review all next meeting. Trish Habeck seconded the motion. Motion carried.
Vendor Aging:
Payroll: Joey Kanode made the motion to approve payroll for July. Connie Lindmier seconded the motion. Motion carried.
July 12 - $168,667.93 July 26 - $177,085.69 Total = $345,753.62
Board Treasurer’s report:
Super Now Savings: 7/31/2019 – Balance - $6,656.79
8/23/2019 – Deposit – County tax - $4,448.25
8/26./2019 – Balance $11,105.04
Checking: 7/31/2019 – Interest $ + 1.16 = $4,273.91
8/1/2019 – WPDN legal - $2,610.00 = $1,663.91
Trish Habeck made the motion to ratify the Board Treasurer’s report as presented. Joey Kanode seconded the motion. Motion carried.
OLD BUSINESS:
CT Remodel Helmsley: Inspection will was August 22, 2019.
CT – Heating / air - none
Hulett Clinic / Foundation: Judy Hutchinson of the Foundation had sent an email letter to the Board, stating land has been purchased. Karl & Mike Burke will be in Hulett Wednesday – hopefully Judy will meet with them to view the land in Hulett. They will get specific measurements, etc. Mike Burke will view to see if he becomes a part of the project. Foundation will work with the person they choose to go with.
CEO Report & Management Report: Nathan Hough.
Moorcroft clinic – two bids required with a $10,500.00 threshold. Tucker will work on it. Lights, interior and exterior lights. Sandy asked Kyle if all construction or repairs have to be advertised. Monetary amount over $25,000.00 requires bids.
Kyle recommended the Board set a policy setting the amount to require bids. It is good to set a limit on all bids, including the generator. Sandy recommended anything over $10,000.00 be bid. Discussion followed: Set a policy to set amount of $10,000.00 or over for public bids construction or repair projects, except emergency situations. HMS will put together a proposed policy for threshold amounts, a formal policy that is written and Board to approve at the next board meeting.
Anything over $10,000.00 must have bids.
Anything over $25,000.00 must be put in the paper, public notification.
Exclusions: if only one manufacturer, etc.
Nathan asked to have questions on policy of what to send to Kyle – don’t depend a lot on legal fees by having Kyle read this – or on the other end, legal items – why was it not sent to Kyle?
Roof – has been fixed
Hallway ceiling – on hold
Privileging – Nathan will bring to next meeting.
LTC. – 29 residents in-house now. Joey asked about lighting in LTC in the old back area – he suggested to replace old bulbs with LED.
Website – continuing
Open house – went well. They had a nice salad bar. Small numbers.
Generator – one o the companies does not want to help with installation. The other company is working on update. Bigger tanks need to be on bids. Nathan hoped to have quotes on generators, but quotes are delayed.
Ambulance – No updates. Waiver was discussed, 34.1 miles to Spearfish. Nathan explained that under critical access hospitals, B2 billing process – they have to go thru Spearfish to get to Rapid City. Medicare – Rulebook says 35+ miles driving distances minimum. Does the same exemption stand for higher level of service (CCMSD hospital)?
Updates –
HCap surveys – Nathan reviewed the survey, and explained it. They are working on updating adjusted score by improving service in specific areas. All surveys had 6 or above.
Beds – budget included 11 new acute care demo beds - $12,000.00. Base price of one bed is usually $13,000.00. Demo beds came with built-in add-ons. They are very nice, a very good deal. We still have 5 to get.
NEW BUSINESS
EXECUTIVE SESSION
Adjourn
Next Meetings: September ____________________ p.m. Hospital Conference Room