10 W Fallon Ave Baker, MT 59313
Fallon County of Montana

FMC Board of Trustees Meeting – August 2023

FMC Board of Trustees Meeting – August 2023



Wednesday, August 2, 2023

MEMBERS PRESENT                                     ABSENT                          

Doug Varner, Board President                         Evelyn Neary, Board Member

Curt Arnell, Vice President                    

Alice Kay Schweigert, Board Member

Elaine Stanhope, Board Member

David Kirschten, Board Member

Erin Lutts, Board Member

OTHERS PRESENT                                        PRESENTERS PRESENT

David Espeland, CEO                                      Gina Manhart, FNP

Marjorie Losing, CFO                                      Mary Grube, Clinic Manager

Heather Schwindt, Recorder                            Susan Stevens, Recruitment / IT

                                                                      Jim Cusimano, Big Sky Financial

I.   CALL TO ORDER Doug called the meeting of the FMC Board of Trustees to order at 5:30 p.m. in the FMC Community Room. 

II.  PUBLIC INPUT – There was no public input.


     No additions or corrections to the July 5, 2023 board minutes as distributed.  David Kirschten made a motion to approve the minutes Elaine seconded. All ayes, 0 nays. Minutes stand approved as written.

     No additions or corrections to the February 20, 2023 Special Meeting board minutes as distributed.  Alice Kay made a motion to approve the minutes.  Curt seconded.  All ayes, 0 nays.  Minutes stand approved as written.


FNP: Gina Manhart, FNP, reported that she is still transitioning into her new role as a clinic provider, and that some recent improvements have made the transition better and easier.  She inquired if we are still hoping to have three fulltime providers scheduled to allow for more flexibility in taking scheduled leave.  Discussion followed that we are still recruiting for both a fulltime mid-level as well as fulltime physician. In the meantime, we signed a contract with Patrick Smith for 10 days a month over three months starting next month.  Erin asked if Gina is being denied time off.  Mary noted that Gina has not been denied any requests, but she has been unsure about being able to approve a request for September.  However, with Patrick signing on, it is likely we can accomdate it.

Gina also noted that she stays late more often to get her notes into the new system as there is now a time constraint on entering them. It was explained the new system has different modes of inputting notes, and each provider has their own preference.  Perhaps one of the other methods would be more expedient.

     Gina notified the board that she will have her application for student loan reimbursement ready by the September 2023 meeting. Doug asked when Gina would be able to enter the FMC 401(k) plan.  It was noted that rehired employees have to wait one year after a defined break in service period, whereas new employees only have to wait for six months.  This is an regulatory oversight due to recent changes made to the federal 401(k) law.  Financial advisors are frustrated with it, but don’t anticipate it being changed anytime soon.

Gina thanked the board for their time and for status update on additional providers.  Gina left the meeting.

Clinic Manager: Mary Grube, Clinic Manager, reported we are recruiting for 2 nurses in the Community Clinic. We need another fulltime nurse for our anticipated third fulltime provider.  In addition, some of our traveling specialists, such as Miles City’s OB-GYN, pay to use one of our staff nurses. A PRN nurse would allow us to continue providing that courtesy.  Doug asked why we need a 1:1 ratio, and it was explained that the nurses do initial assessments, but then also have to do notes in the EMR, callbacks for follow up care, and each provider has a different preference on how to get their notes to their nurse, taking more time if you are switching in between providers daily.

Recruitment / IT: Susan Stevens shared we are still hoping to hear from Tylyn Bova, NP, however we will not hold the position open if another candidate is offered to us.  We are still actively recruiting for a fulltime physician through our dedicated search firm.  They are running into the same issues we have experienced in the past: No mountains, no Walmart, low pay, etc.  A fulltime family doctor will help alleviate some of Dr. Sullivan’s responsibilities while he is here each month.  For example, Dr. Sullivan has trauma training this month, cutting a day out of his patient schedule.

Doug asked how often providers and nursing staff need to do training.  Both professions need a defined number of education hours each year in order to maintain their licensure.  However, the MT legislature passed a law this year removing that requirement for nurses.  Our travel providers typically do their training during their time away from FMC.

On the IT side, Susan reported that our staff is ahead of other facilities that have implemented Thrive.  Therefore, we are finding the kinks in the system sooner.  Patient notes are not all located in the same tab as they were in the previous system.  Where the notes are are held depends on how the provider enters them.  Each provider has their own preference, which creates confusion.  In addition, when we get notes from another facility, they are also saved somewhere different.  There is not a “Google Search” in each patient’s file, so providers have to hunt and peck, taking time and creating frustration.

Susan and Mary left the meeting.

V. JIM CUSIMANO – Big Sky Financial

    1. Investment Update: Jim Cusimano distributed our quarterly investment results.  Our initial investment made in December 2022 started with $2.0 million, of which $1.4 Million was invested in fixed income accounts and the rest in traditional stocks.  One of the Treasury Bills with a 4% interest rate recently matured at 6 months; he has re-invested the money.  Jim did not invest all the money right away and is holding funds to be available when good bargains become available.  It was noted that if at any point we need cash, Jim would look for the investments that would have no penalty or the lowest penalty possible.

    The board asked the difference between the different types of bonds and how you get a bond “on sale.”  Jim explained.  Marjorie asked how we report investment returns for tax purposes.  Jim stated that she should discuss that topic with our accountant to ensure that we are reporitng investment returns properly. (Enclosure)


    June 2023 Interim Financials:  Marjorie reported to the board that the estimated budget to implement Thrive was $100,000.  The total cost to implement was $115,000, and ongoing maintenance of $19,040 will be paid each month.  To date, we have spent a total of $294,000 implementing and using Thrive.  All updates to Thrive are part of the monthly maintenance fee. Our previous system did not include updates in the monthly maintenance, which costed us extra.

    Marjorie went over the June interim financials, noting that there is already a $50,000 difference from the published report.  Some invoices for professional fees were emailed to the previous Clinic Manager, and weren’t discovered until recently.  There were 15 In-patient days and 26 skilled days in June.  Gross Revenue for the month of June was $686,000, about $200,000 under budget.  Net Operating Revenue was $617,000, about $290,000 under budget.  Contractual adjustments are currently negative, but should become positive when we start receiving $10,000 for inpatient and skilled days starting July 1, 2023.  Professional fees are understated at this time, as mentioned previously. Total expenses are at $957,000, about $30,000 under budget.  Operating Loss was ($360,000.00), while the Net Loss after applying non-operating income was about ($200,000).  Just over $1.0 million was received from Medicare in the month of June as a cost report interim settlement, making our change in cash equivalents ($3.5 million).  Without that settlement, it would have been ($4.5 million).  However, $2.0 million was sent to our investment advisor, making our change in equivalents due to operations only ($1.5 million).

    Year to date, Gross Patient Revenue $8.7 million, which is $2.0 million on the negative side of the budget.  Net operating revenue is $10.0 million, which is $1.0 million on the negative side of the budget.  Total expenses $12.2 million, with $380,000 on the positive side of the budget.  Operating loss of ($2.2 million), putting it at $700,000 on the negative side of the budget.  Non-operating Income was $528,000, for a total Net Loss of $1.7 Million or about $580,000 on the negative side of the budget.

    Swing days, skilled days and ancillary days were all below budget.  The only things not below budget were MRI and blood bank.  PT and OT held their own this fiscal year. Doug asked why the inpatient days noted as Level 1 were not previously budgeted.  Marjorie explained that the new EMR system tracks the Med/Surg levels on a point system, making the tracking of levels more accurate. This will allow for more accurate budgeting. Doug asked about the employee numbers going from 83 down to 77.  Margie confirmed that we did have some turnover, but we have hired some of the positions back already during the start of FY2024, so the number of FTE’s will be going back up next month.  

    Grasslands Credit Union Signing Authority:  Account signing authority can’t be granted until authorization of individuals is reflected in the board minutes. It was discussed that David E., Marjorie, and Doug should be the authorized signers on the Grasslands account.  Elaine made a motion to that effect, Erin seconded.  All aye, 0 nay.  Motion passed.

    Denbury Gift: Denbury gifted FMC $15,000.  They had asked for a list of our needs, which was sent to them with an articulation of “urgency” and “need.”  They asked the gift be used for greatest benefit to the organization.  Curt will bring in the check when it is cut so we can publicize it


    A.   Brittany Bettenhausen, DPT, Contract Renewal: Brittany   accepted and signed her contract renewal and thanked the Board for the accommodation of a 4-day work week.

    B.    Corporate By-Laws Review:  The board has been reviewing a number of suggested changes to the by-laws over the past few months, as offered by our attorney in November 2022.  The result of that review was the creation of a “clean” document that is to be sent back to our attorney for review prior to the next meeting. (Enclosure)


    1. Physical Therapist Contract Renewal:  Victoria Susa’s contract is coming due in October.  The board reviewed her performance and evaluated her current pay relative to her peers and the 2023 MHA Salary Survey.  Curt made a motion to the propose terms of a renewal agreement, Erin seconded.  All aye, 0 Nay.  Motion passed.
    • Power Outage:  Late last month we experienced a facility-wide power event that lasted about 24 hours.  We have an agreement with MDU to curtail the use of utility power by turning on our generators at their request.  MDU scheduled an event, the day before, and we were told to go to divert status the next day. The diversion to our generators went as planned, but MDU notified us that we could return to utility power, one of our transfer switches failed when turning the power back on. Only part of the building complex had power at that time.  After working with our generator maintenance company and Direct Electric, it was finally determined that it was an MDU problem, not a failed switch.  MDU came onsite the next day and said that we had lost part of our power supply due to a blown fuse.  MDU said that the load on their system was high because of air conditioners running, and because of increased power use in the oil field; they thought the power surge from switch back to utility blew the fuse.  Brad as able to locate a replacement internally.  The power outage also affected our HVAC controls, cutting out all air conditioning to the building.  After diagnosing the issue, Brad was able to reboot system and get things running again.  This emergency will meet our requirement to log our response to a disaster.

    The Board adjourned their regular session having completed the agenda.

    CLOSED EXECUTIVE SESSION                     

    s\ Doug Varner, President

    s\ Heather Schwindt, Recorder