2023-05-12T15:24:13-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 836000182 Hot Springs County Hospital Dist HOTS 3078643121 150 E Arapahoe Street Thermopolis WY 82443 Kevin Benson CFO 3078643121 2023-05-12 1 Kevin Benson 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-05-11 0 AAL1 IAL1 2021 2023-04-26 12:10:37Z Hot Springs Health Scott Alwin 150 E Arapahoe Street Thermopolis WY 82443 37293298 0 X hotspringshealth.com X Hosp. Dist. 1944 WY Partnering with our community for quality health and healing. 5 5 213 6 0 0 3617256 4163098 27547965 33067275 101550 10845 1572942 47488 32839713 37288706 0 0 0 0 14542824 16152153 0 0 0 14640988 18441331 29183812 34593484 3655901 2695222 55349867 50611148 37736858 30308507 17613009 20302641 X Partnering with our community for quality health and healing. 0 0 30959231 33103388 Hot Springs County Hospital District (the Hospital), a not for profit and governmental hospital, provides compassionate medical care for all, regardless of their ability to pay. The Hospital offers 24/7 emergency care (2,504 visits), inpatient services (1,186 patient days), outpatient services (18,242 visits), HSH-Basin Clinic (4,013 visits), HSH-Thermopolis Clinic (12,407 visits), HSH-Worland Clinic (6,946 visits), HSH-Surgical Clinic (1,302 visits), HSH-Riverton Clinic (1,490 visits), and HSH-Shoshoni Clinic (803 visits).The Hospital has a financial assistance program under which services are provided for free or at a reduced rate. Charity Care awarded under the financial assistance program totaled $510,987. The cost of charity care for the year ended June 30, 2022 based on direct and indirect cost of providing charity care services was $350,026.Many employees are teachers in the education programs open to the public such as Certified Nursing Assistant and CardioPulmonary Resuscitation. An agreement with the University of Wyoming, Central Wyoming College and Northeastern Wyoming College encourages nursing, pharmacy, and social services students to intern at the Hospital. Health information links are available on the Hospital website.Comfort carts and free meals are available for families during stressful conditions. HSH-Clinics provide reduced or free exams for school athletics, medicine assistance, blood pressure screening and community education seminars. The Hospital offers scholarships to qualifying candidates wanting to advance their education to the betterment of the Hospital and Community. Community Resource Training for High School Students and the WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) medical education program, which promotes medical education in Western States, are two long-time programs in which the Hospital participates. 30959231 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 86 0 1 213 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X Kevin Benson 3078643121 150 E Arapahoe Street Thermopolis WY 82443 Wade Bomengen Family/ER/OB Physician 40.00 X 492004 0 48031 Jason Weyer Family/ER/OB Physician 40.00 X 456363 0 47327 Hallie Bischoff Family/ER/OB Physician 40.00 X 368008 0 47779 Mathey Mattson Family/ER/OB Physician 40.00 X 384599 0 29497 Susan Bright Family/ER/OB Physician 40.00 X 277315 0 44795 Shelly Larson CFO thru January 2022 40.00 X 145662 0 28307 Scott Alwin - CCO Dec-Mar CEO starting April 40.00 X 13270 0 0 Margie Molitor CEO until March 40.00 X 0 0 0 Steve Miller Interim CFO (Jan-Mar) 40.00 X 0 0 0 Kevin Benson CFO starting March 2022 40.00 X 0 0 0 Bill Williams Chairman 2.00 X X 0 0 0 Heath Overfield Vice Chairman 2.00 X X 0 0 0 David Koerwitz Secretary 2.00 X X 0 0 0 Dan Herdt Director thru December 2021 2.00 X 0 0 0 Jessica Benefiel Director starting January 2022 2.00 X 0 0 0 Melissa Johnson Director 2.00 X 0 0 0 2137221 0 245736 27 0 1 0 Sletten Construction of WY 3225 Big Horn Ave Cody WY 82414 Construction 3207296 Healthtech Management Serv 5110 Maryland Way Suite 200 Brentwood TN 37027 Management/contract srv 884975 Medical Solutions LLC PO Box 850861 Minneapolis MN 55485 Staffing agency 782380 Holistic Pain Management 3780 N Garfield Ave Ste 101 Loveland CO 80538 Staffing agency 572220 Mortimore Ambulance 620 Arapahoe Street Thermopolis WY 82443 Ambulance services 335268 13 4153229 9869 4163098 Patient Service Revenue 621110 31049915 31049915 Other Supporting Revenue 900099 1569736 1569736 Property Tax Revenue 900099 447624 447624 33067275 10845 10845 15967 4592 11375 11375 11375 Insurance Proceeds 900099 36113 36113 36113 37288706 33103388 0 22220 X 283667 283667 13006055 12285669 720386 317918 299199 18719 1594755 1491819 102936 949758 879428 70330 667872 667872 130405 130405 63550 63550 5625246 4953358 671888 32338 5057 27281 552631 442653 109978 94575 94575 287606 287606 124407 98781 25626 72530 305 72225 723709 723709 3201875 2721594 480281 223182 189705 33477 Medical Supplies 4229257 4226746 2511 Bad Debt Expenses 1619817 1619817 Sub./Books/Periodicals 483920 344082 139838 Debt Issuance Costs 155367 155367 153044 139761 13283 34593484 30959231 3634253 0 10931994 8144572 7745402 7066750 4664838 5137042 13500 910766 937221 188624 126819 45269372 16613826 30257575 28655546 637168 543198 55349867 50611148 5329216 3170784 320607 154886 32087035 26149363 0 833474 37736858 30308507 X 9888679 13235891 7724330 7066750 17613009 20302641 55349867 50611148 2695222 -5590 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 343520 343520 17282974 4398217 12884757 25901105 11299603 14601502 1741773 916006 825767 28655546 Estimated Third-Party Payor Settlements 206741 Leases 610735 CMS Advance Payments 15998 833474 34789813 -2498893 -2498893 37288706 0 37288706 32094591 0 32094591 2498893 2498893 34593484 Part XI, Line 2d - Other Adjustments: Interest expense reported in expense for Form 990 -723,709. Debt issuance costs reported in expense for Form 990 -155,367. Bad debt expenses reported in expense for Form 990 -1,619,817. Part XII, Line 4b - Other Adjustments: Interest expense reported in revenue in Financials 723,709. Debt issuance costs reported in revenue in Financials 155,367. Bad debt expenses reported in revenue in Financials 1,619,817. 1 1 X 1 X 1 X 1 1 0 0 350026 350026 0.01060 1842399 1045007 797392 0.02420 2192425 1045007 1147418 0.03480 267639 59128 208511 0.00630 3565721 2879617 686104 0.02080 3833360 2938745 894615 0.02710 6025785 3983752 2042033 0.06190 0 1619817 485945 13743973 13495937 248036 X 1 1 1 1 Hot Springs County Hospital District 150 E Arapahoe Street Thermopolis WY 82443 www.hotspringshealth.com 713163 X X X X Pain clinic Hot Springs County Hospital District 1 0 0 1 X X X X X X X X 19 1 0 1 1 X https://hotspringshealth.com/about-us X 1 19 1 https://hotspringshealth.com/about-us 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X https://hotspringshealth.com/financial-services X https://hotspringshealth.com/financial-services X https://hotspringshealth.com/financial-services X X X X X X 1 X 0 X X X 1 X 0 0 Hot Springs County Hospital District Part V, Section B, Line 5: The community health needs assessment steering committee is comprised of the following hospital representatives: CEO, RNs and Chief Nursing Officer. The steering committee also comprised of the following community represenatives: BSW Social Worker, Hot Springs County Public Health, Public Health Officer and Hot Springs County Community Prevention Program Coordinator. In addition, members of the Hot Springs County Prevention Coalition provided input for the development of the community health needs assessment. The members included, an RN, Public Health Officer, Coordinator, Hot Springs County Community Prevention Program, Wellspring Counseling, Assistant County Attorney, Executive Director Thermopolis Chamber of Commerce, Hot Springs County Victim Witness Program, Wyoming Pioneer Home Administrator, Public Health Response Coordinator, Hot Springs County Sheriff Department, Wisdom Tree Counseling, Executive Director Wellspring Counseling Services, Executive Director Hope Agency, Executive Director Childrens Resource Center, Administrative Assistant Hot Springs County Commissioners, Hot Springs County Youth Alternatives, Supervisor Department of Family Services, Hot Springs County School District Counselor, and Head Start. Hot Springs County Hospital District Part V, Section B, Line 11: The community health needs were prioritized based on the following five criteria:1. Magnitude/scale of the problem2. Severity of the problem3. Health disparities4. Importance to the community5. Ability to leverage the three priority community health needs chosen were behavioral health, poverty, and opioidsThe needs identified in the 2019 CHNA were behavior health, poverty and use of opiods. All three were addressed in the tax year.The goal for behavioral health is to have more access to behavioral health services. Poverty goals included decreasing poverty and increasing services. The opioid goals include reduction in use and education. The community partners for these three initiatives include Hot Springs County Prevention Coalition, Hot Springs County School District 1, Wellspring Counseling Center, law enforcement, the county attorney's office, Hope Agency, Wisdom Tree Counseling, Youth Alternatives Program, Help Center, Yellowstone Community Assistance Network, Department of Family Services, Hot Springs County Public Health, Ministerial Alliance, River of Life Fellowship, Hot Springs County Senior Center, Messiah's Mall.During the current tax year the following actions were taken to address the identified needs:Behavioral Health:-Expanded access to mental health counselors through recruitment and retention for practices and possible telemedicine program provided for the community-Expanded services for children with a variety of behavioral health needs including developmental delays and behavioral issues through the school system-Created more community awareness on suicide, alcohol/drugs/tobacco use and abuse, and mental health crisisPoverty:-Educated the community on lower cost preventative services-Established people in the community willing to help with insurance applications-Educated the front-line workers on resources available in the community -Provided programs to assist with financial empowerment (budgeting and sensible nutrition)Opioid Crisis:-HSH-Thermopolis Clinic closely monitors the pain contracts. Contract medications are reviewed and attempts are made to decrease when able.-HSH-Thermopolis Clinic and Hospital Providers complete education on every patient with opioids. Hot Springs County Hospital District Part V, Section B, Line 13b: See Part V, line 13h Hot Springs County Hospital District Part V, Section B, Line 13h: The facility's criteria for eligibility for free or discounted care is based on the federal poverty guidelines, family size, and the patient's equity resources (assets less medical debt). In addition, the patient and family members must receive a denial from Medicaid or other public assistance programs. Extenuating circumstances (death, acts of nature, etc.) are considered in determining eligibility for financial assistance. Part V, line 20d, No Presumtive Eligibility Determination: The Hospital does not make presumptive eligibility determinations. A patient needs to apply for financial assistance based on most current circumstances to be considered eligible. 6 1 - Hot Springs Health Thermopolis 150 East Arapahoe Street Thermopolis WY 82443 Rural Health Clinic 2 - HSH Red Rock Family Practice - Worland 1125 Charles Avenue Worland WY 93502 Rural Health Clinic 3 - Hot Springs Health Big Horn Clinic 156 North 6th Street Basin WY 82410 Rural Health Clinic 4 - Hot Springs Health Surgical Clinic 112 East Arapahoe Street Thermopolis WY 82443 Surgical Clinic 5 - Hot Springs Health Riverton 2002 West Sunset Drive Riverton WY 82501 Rural Health Clinic 6 - Hot Springs Health Shoshoni 702 E 2nd Street Shoshoni WY 82649 Rural Health Clinic Part I, Line 3c: The facility's criteria for eligibility for free or discounted care is based on the federal poverty guidelines, family size, and the patient's equity resources (assets less medical debt). In addition, the patient and family members must receive a denial from Medicaid or other public assistance programs. Extenuating circumstances (death, acts of nature, etc.) are considered in determining eligibility for financial assistance. Part I, Line 7: Line 7a Financial Assistance at cost was calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Line 7b, Medicaid was calculated using Worksheet 3. Line 7g, Subsideized Health Services, was calculated using Worksheet 6. Line 7e was calcuated based on actual cost. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 1,619,817. Part III, Line 2: The organization determines its estimate of bad debt provisions based on its historical write off and recovery information. Part III, Line 3: The estimated dollar amount of the organization's bad debt expense that reasonably is attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy, but for whom insufficient information was obtained to determine their eligibility, was estimated to be 30%. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 16 of the attached audited financial statements. Part III, Line 8: The hospital is licensed by the Centers for Medicare and Medicaid Services as a critical access hospital. As a critical access hospital, it is reimbursed on 101% of costs less the 2% sequestration adjustment. The hospital utilized the annual cost report for fiscal year June 30, 2022, which it is required to submit to the Centers for Medicare and Medicaid Services as the source to determine the Medicare allowable costs of care in connection with the revenue received from Medicare.The Hospital provides services to patients under the Medicare program knowing they will not recover all the costs associated with providing these services. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall, if any, is considered a community benefit. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare cost report for the year. Part III, Line 9b: The hospital makes every effort to complete a financial evaluation at the earliest possible point in the revenue cycle for all patients indicating an inability to meet their financial obligations. A financial assistance program application is completed once all other options for reimbursements have been exhausted. The hospital policy indicates it will send a notice to the patient within 30 days of services to notify the patient that financial assistance is available. The hospital policy does not send patient accounts to collections until after 120 days after the date of the first invoice of the service. If a patient submits a financial assistance application within 240 days after the date of the first invoice of the services, the hospital removes the patient account from collections. Part VI, Line 2: HSH utilized both quantitative and qualitive methods in assessing community health care needs. From a qualitative standpoint, a variety of sources were used to identify community health trends and health disparities from various sources, such as Hot Springs County Public Health, Center for Disease Control, etc. Every effort was made to obtain the most current data. Data was analyzed for comparison purposes with the state, other counties within the state, and local data collected by the Hot Springs County Prevention Coalition. Qualitative data collection included interviews with key stakeholders, a community survey and four focus groups. In addition to patient surveys, the Hot Springs County Prevention Coalition meets once a month to discuss the needs and ways to address these needs. Part VI, Line 3: We inform our patients of the Financial Assistance program through various means, such as signage in the admissions area and Emergency Department and all statements have verbiage for Financial Assistance availability and contact information. Financial assistance information and application are also available on our website. Part VI, Line 4: Hot Springs Health is located in the rural community in the Central Wyoming. Being one of the smallest counties in the state, Hot Springs County is largely an agricultural and ranching community. According to the 2017 census, there were approximately 4,696 residents in the county. Hot Springs County population of persons under the age of five is 5.3%, persons under age of eighteen is 21.3%, persons over age sixty-five is 25.5%. The percent of females in the county is $49.3%. Veterans from years 2013-2017 totaled 612 individuals, ranking above the Wyoming average with 12.71% of the residents having a veteran status.The median household income in HS County for 2017 was $48,403, mean household income was $64,864, and per capita income in the past 12 months of 2017 was $30,939. For Wyoming the median household income is $60,938 and the mean household income is $76,731. The median earning for workers in Wyoming was $32,205 and in HS County was $30,775. The median earnings for males working full-time in Wyoming was $53,727 and in HS County was $49,038. The median earnings for females working full-time in Wyoming was $37,915 and in HS County $41,220.HS County exceeds the state average in relation to poverty level at 12.1% vs state average of 11.3%. Hot Springs County School District is a Title 1 School. Free and reduced meals are provided to 53.5% of elementary school families and 39.68% of the entire district. Single family homes equal 265 of our population. More than one quarter of our population is age 65 or older. Of those aged 60 years and older, 20% receive food stamps. Part VI, Line 5: The Board of Directors is comprised of residents of Hot Springs County representing various backgrounds. They are not employees of HSH, nor contractors, nor family members. Any surplus funds are directed towards patient care by investing into modern equipment and technology and providing medical education to our clinical personnel to provide the best care to our community.HSH extends medical staff privileges to all qualified physicians in the community.HSH is the only Critical Access Hospital in the Hot Springs County.HSH provides chemotherapy and biotherapy services, immunotherapy, and blood transfusions, thus allowing patients to receive treatments right here, at home, without having to travel long distances. Holistic pain management is available to our community at our Specialty Clinic. Rehabilitation services provided at HSH include physical therapy, speech/language pathology and occupational therapy. HSH provides a 24-hour Emergency room that is available to all regardless of ability to pay.HSH participates in the HRSA Rural Residency Planning and Development Program offering a Rural Residency Training Track to medical residents who have an interest in working in rural hospitals. 0 0 0 0 0 0 0 0 0 Wade Bomengen Family/ER/OB Physician 485065 0 6939 0 0 0 11200 0 36925 0 540129 0 0 0 Jason Weyer Family/ER/OB Physician 417863 0 38500 0 0 0 11600 0 35817 0 503780 0 0 0 Hallie Bischoff Family/ER/OB Physician 342992 0 25016 0 0 0 11600 0 36272 0 415880 0 0 0 Mathey Mattson Family/ER/OB Physician 365224 0 19375 0 0 0 11600 0 17982 0 414181 0 0 0 Susan Bright Family/ER/OB Physician 257482 0 19833 0 0 0 11550 0 33331 0 322196 0 0 0 Shelly Larson CFO thru January 2022 145662 0 0 0 0 0 6252 0 22148 0 174062 0 0 0 Part I, Line 3, Methods to Establish CEP Compensation: The organization contracted an unrelated management company, Healthtech Management Services, Inc., for CEO services. The board of directors reviews the contract using compensation surveys. A Hot Springs County Hospital District 836000182 000000000 2021-11-10 5336000 Refinance 12/20/18 Series 2018B Tax Exempt Bonds 0 0 0 B Hot Springs County Hospital District 836000182 000000000 2021-07-01 21346000 Refinance 12/18/18 Series 2018A Tax Exempt Bonds 0 0 0 A 69833 5336000 5336000 1 0 1 1 B 462804 21346000 61693 21284317 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 Form 990, Part VI, Section A, line 1a The organization has an Executive Committee that can make decisions on behalf of the full governing board in between the board meetings. The Executive Committee consists of the board Chairman, Vice Chairman, and the Secretary/Treasurer. Form 990, Part VI, Section A, line 3 HSCHD Contracts with Healthtech Management Services, Inc. for management services including the CEO position. The CEO is employed by Healthtech Management Services, Inc. During calendar year 2021, Margie Molitor was paid $334,750 for CEO services. Scott Alwin was also contracted from April 2022 through June 2022 as CEO. He was not paid in calendar year 2021 for services as CEO. Form 990, Part VI, Section A, line 7a The board members are elected by the citizens of Hot Springs County. Form 990, Part VI, Section B, line 11b The current fiscal year 6/30/22 Form 990 was presented to the finance committee of the board of trustees for discussion and review. The entire board of directors approved the current fiscal year 6/30/22 Form 990 at a regularly scheduled board meeting. Form 990, Part VI, Section B, line 12c The hospital has a formal conflict of interest policy which requires employees to make a prompt written full disclosure of any potential situation which may involve a conflict of interest. The policy provides a list of potential conflicts. Employees who violate the policy are subject to disciplinary action up to and including termination. The policy is reviewed at least 2 times a year with employees at the annual skills fair and the annual employee evaluation. The employee completes and signs a new disclosure at the time of their evaluation. The hospital does require governing board members, officers, managers, and medical representatives with administrative responsibility to disclose in writing all potential conflicts of interest on an annual basis as well. Form 990, Part VI, Section B, line 15 The organization pays an unrelated management company, Healthtech Management Services, Inc., for CEO services. Annually the board of directors reviews the CEO contract presented by HealthTech. The organization completes an annual review of other key employees and completes a comparison of salaries with Wyoming Hospital Association salary survey data. The annual review is completed by the CEO. Form 990, Part VI, Section C, line 19 The organization is a governmental entity. All board of trustee meetings are public meetings. All reports (not considered confidential) are subject to the open meeting laws under state of Wyoming laws. In addition, these documents are available for public inspection in accordance with federal and state law. Form 990, Part IX, line 11g Maintenance Contracts: Program service expenses 498,926. Management and general expenses 3,466. Fundraising expenses 0. Total expenses 502,392. Physician/Provider Fees: Program service expenses 1,213,885. Management and general expenses 1,539. Fundraising expenses 0. Total expenses 1,215,424. Consulting/Contracted Services: Program service expenses 1,101,281. Management and general expenses 323,650. Fundraising expenses 0. Total expenses 1,424,931. Other Fees: Program service expenses 2,139,266. Management and general expenses 343,233. Fundraising expenses 0. Total expenses 2,482,499.