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

FMC Board of Trustees Meeting September 2022

FMC Board of Trustees Meeting September 2022



Wednesday, September 7, 2022

MEMBERS PRESENT                              

Betty Mueller, President

Doug Varner, Vice-President

Rich Menger, Secretary                             

Alice Kay Schweigert, Board Member

Curt Arnell, Board Member

Elaine Stanhope, Board Member

            OTHERS PRESENT                      

            David Espeland, CEO

            Marjorie Losing, CFO

            Marissa Skogen, Recorder


Betty called the meeting of the FMC Board of Trustees to order at 5:30 p.m. in the FMC Community Room. 

II.         PUBLIC INPUT – No public input.

III.        APPROVAL OF MINUTES           

No additions or corrections to the August 3, 2022 Board minutes as distributed.  Minutes stand approved as written.


Judy McWilliams – Quality Assurance: Judy reviewed the Implementation Plan based off the Community Health Needs Assessment (CHNA) report completed in June. FMC participates in the CHNA and Implementation Plan in order to meet the requirements of being a tax-exempt hospital per the IRS.  Marjorie then tracks our implementation plan progress on our annual 990 Schedule A. The Montana Office of Rural Health assisted us throughout the whole CHNA process by virtue of a grant. The CHNA questionnaire was randomly sent to 600 community members by a third-party vendor to complete. Another opportunity for participation was via focus groups. Those who couldn’t attend a focus group were provided the opportunity to “key informant” interviews. All of this information was distributed through Facebook, the newspaper, and on the radio. The Implementation Plan is now completed and must be approved by resolution of the governing board and then posted on the FMC website by September 15, 2022. The Implementation Planning Committee is made up of FMC employees, due to employees being responsible for getting the work done using the resources we have and partnering with who we need to. The Implementation Plan includes demographics, county indicators, county partnerships, facility resources, and needs of the community. The CHNA needs were prioritized, and based off of those criteria; three goals were created to address over the next two years: 1) mental and behavioral health, 2) access to healthcare services, and 3) chronic care prevention and management. A strategy was developed for each goal and placed on a planning grid that explains who is responsible for it; the timeline of the process; who any partners will be; any potential barriers; and who has the final approval. MSU assisted in wrapping up the project and recognizing the anticipated impact of it, how we’d keep track of our progress, and measure our success. The two community concerns that we couldn’t address were the cost of medications and the number of community members that need public assistance. Neither of these issues are within our capabilities.  Betty proposed to accept the resolution as written. No members of the board were opposed. The resolution was accepted as written.

Judy then presented the Montana Flex Program Lean Study which is a lean healthcare internship through the MSU-Industrial Management Systems Engineering Program. They provide interns to conduct rapid process improvement projects to eight critical access hospitals in Montana every year. You must apply to be chosen as one the hospitals. The lean student, Nejc, spent two weeks at FMC implementing a process improvement for clinic provider scheduling and ER call. We had asked for input from all of the providers, although not all did so. Additional information was given to the Lean student to work with to address all concerns. Additionally, we asked him to establish a format for the providers to meet national standards of outpatient clinic productivity in relation to direct patient care time along with indirect patient care time (research, medications, etc.). It was asked of Nejc to provide different staffing models for facilities that are similar to ours in both location and size. Nejc presented seven different models to FMC for possible solutions. The pros and cons were discussed pertaining to each clinic model and any hardships that may arise with each model.  (Enclosures)

Donna Halmans – H.I.M.: Donna reported on her first year as manager in the Health Information Management department. Donna and her technician at the time were able to get caught up in the H.I.M. department without needing to hire an additional employee; however, that technician has since resigned so Donna is looking for another technician. Donna and the Board of Trustees discussed the potential of her position being combined with the Business Office Manager and her assuming both roles. The roles and responsibilities were discussed and what potential scenarios would look like if she assumed

the additional role.


Jim Cusimano, CFP with Big Sky Financial Planning explained his proposal based on a Board-recommended investment amount. He explained why a 60-40 split is an appropriate division of assets: 60% equities and 40% fixed assets.  The fee structure would be a tiered structure that would be billed monthly and automatically deducted from the cash in the account. We could get to the various tiers either through investment performance or cash infusions.  Once a tier is reached, the account stays there, regardless if cash is withdrawn.

Jim shared the markets in context and how markets change daily. Jim reported on the approximate rates for fixed income investments. He further explained that the equity investments would be diversified between 800-900 companies in various sectors. The risk score for FMC was calculated and FMC fell in the middle of the scale meaning it would be a balanced portfolio.  Jim further addressed the Board of Trustees’ questions and concerns pertaining to the investments. Marjorie Losing explained that unexpected expenses arising due to changes in electronic medical record (EMR) implementation may change the proposed amount invested.  (Enclosure)


Marjorie Losing went over the June 2022 Year End Report in great detail with the Board of Trustees.

Margie also reported that Eide Bailley auditors are planning to be onsite September 19th-22nd. Board members are welcome to be there to visit and ask questions. (Enclosure)


  1. Provider Updates – Gina Manhart, FNP and Caleb Bettenhausen, PA-David updated the Board about Gina’s transition of starting in the clinic as a provider. He informed them of the process of getting her hired quickly and how FMC was able to do so due to her already being licensed in Montana. She is waiting for her Drug Enforcement Administration (DEA) certification to be finalized.  David reported that Caleb signed his contract for the next year as well as the amendment for his current contract ending October 12, 2022. The Board of Trustees agreed to hold off on signing these two documents until further discussion is held.

The clinic provider staffing model was reviewed and details were discussed.

  • Physician Recruitment Brochure: David shared the brochure that would potentially be given to recruiting companies to show providers what we have to offer. The aim is to have Baker be more appealing to hire a full-time provider in the clinic. It shares details specific to Baker that could draw potential providers to want to work here. The compensation package for providers in the brochure was deliberated and it was agreed upon that the salary would be a range. (Enclosure)
  • AE Human Resources Study: Marissa Skogen informed the board about the Associated Employers (AE) Human Resources Needs Assessment/Audit (HRNA) occurring on September 15, 2022. AE employees will be taking an in-depth look through HR-related material, including, but not limited to FMC forms, personnel files, processes, as well as interviewing staff to assess where FMC could improve and where they are doing a great job. AE is looking to assist in assessing the HR department per the Board’s request. David and Marissa informed the board of the scope of responsibilities required of her and how certain responsibilities were given to Payroll to reduce redundancy of the actions involved. (Enclosures)
  • Behavioral Health Updates – Frontier Psychiatry & Community Effort: David informed the board that Dr. Ghomi, MD, co-founder of Frontier Psychiatry is interested in creating a proposal for FMC in order to see Long-Term Care (LTC) residents via telehealth who have a need for their services. David informed the Board that we have an integrated behavioral health program that we are implementing in the clinic. It entails screening every patient that checks into the clinic using a form that they fill out in the waiting room. The screening process will inform FMC whether or not that patient should be evaluated by a behavioral health specialist/counselor. The counselor would then meet with the patient to evaluate and make the determination as to whether or not the patient should seek further treatment by a psychiatrist which would be Frontier Psychiatry. The patient would then see the psychiatrist virtually.

Joe Epley is heading up an effort to address behavioral issues in the community, including stopping community suicides. They are trying to identify the needs of the community in hopes to gather the necessary resources to meet those needs. David explains that Joe will do focus groups at FMC with staff to gather various viewpoints and information regarding mental health.

  • Consideration of Corporate Membership Applications: Marissa Skogen presented recent Corporate Membership Applications to the Board of Trustees. It was moved and seconded that the applications be approved. The motion carried.


  1. Welcome Elaine Stanhope, New Trustee: Betty Mueller and the Board of Trustees welcomed Elaine Stanhope as a trustee on the Board. Elaine filled the spot of Shane Bettenhausen who had resigned as a trustee in May.
  • Deficiency-Free Surveys: Rural Health Clinic, Lab, Pharmacy: David reminded the board that FMC gets surveyed 2 to 5 times a year to ensure that we are fulfilling the requirements and meeting the regulations of those entities that we have contracts with. David shared that the Dietary department was deficiency free this year. The Rural Health Clinic surveyors only survey FMC once every 6 or 7 years. This year they also declared FMC deficiency free. Lab and Pharmacy were given deficiency free, as in most years. David reviewed with the Board that last year’s Critical Access Hospital surveys included visits from the compliance division, the licensure bureau, and the fire-life-survey department. FMC has a clean bill of health on all surveys this year.
  • Letter for FY2021 Audit & SEFA Single Audit: Margie updated the Board about the upcoming annual audit scheduled for September 19th. FMC is also subject to the single audit due to receiving Provider Relief Funds over the amount of $750,000 for Covid-19. Auditors will verify the money was spent appropriately and according to regulations. The SEFA audit will be a separate audit from the annual audit. Doug made the motion that we stay with Eide Bailley for our audit. Rich seconded the motion. The motion was approved. (Enclosures)
  • Proposed Trustee Letter of Interest Policy: Discussion was had about the current process in place for an interested person to get onto the Board of Trustees. A proposed policy was presented to the board to clearly define the process of becoming a board member. Rich made a motion to accept the policy as written. Alice Kay seconded. The motion carried. (Enclosure)
  • Appointment of Nominating Committee: David reported that per the by-laws, nominations must be made 30 days prior to the annual election; this would require the corporation to make nominations by early November. That means that the Board of Trustees must come up with a nominating committee at the September regular meeting. The nominating committee must make at least one nomination to fill each open trustee position. Betty Mueller, Doug Varner, Curt Arnell, and Alice Kay Schweigert were chosen to be the nominating committee. Further discussion was had between the board members about the nominating committee process.
  • Provider Credentialing: A list of providers were presented to the Board of Trustees for consideration to be credentialed for privileges at FMC. David explained the credentialing process and requested the Board’s approval of the providers’ credentialing based on recommendations from him and Dr. Sullivan. Rich maded a motion to accept the list as presented. Elaine Stanhope seconded the motion. The motion carried.


The Board adjourned their regular session having completed the agenda.

s/ Doug Varner, President

s/ Marissa Skogen, Recorder