2025-05-09T09:48:20-05:00 2024-06-30 910189318 MOSS ADAMS LLP 101 SECOND STREET SUITE 900 SAN FRANCISCO CA 94105 990 2023-07-01 200752156 INCLINE VILLAGE COMMUNITY HOSPITAL FOUNDATION INCL 7758334100 880 ALDER AVENUE INCLINE VILLAGE NV 89451 KARLI EPSTEIN EXECUTIVE DIRECTOR 7758334100 2025-05-06 1 0 WENDY CAMPOS P00448102 4159561500 2025-05-06 2023 2025-03-06 01:10:19Z KARLI EPSTEIN 880 ALDER AVENUE INCLINE VILLAGE NV 89451 22484153 0 X HTTPS://WWW.TFHD.COM/IVCH/GIVING/ X 2004 NV ASSIST INCLINE VILLAGE COMMUNITY HOSPITAL TO DELIVER QUALITY EMERGENCY & PRIMARY HEALTH CARE SERVICES 10 9 0 25 0 0 3824581 1318607 0 0 153012 362590 -22047 25102 3955546 1706299 611749 7180956 0 0 0 0 0 0 0 7981 54682 619730 7235638 3335816 -5529339 7454890 1875689 88297 0 7366593 1875689 X OUR MISSION IS TO ASSIST THE INCLINE VILLAGE COMMUNITY HOSPITAL IN DELIVERING THE HIGHEST QUALITY EMERGENCY AND PRIMARY HEALTH CARE SERVICES BY PROCURING FINANCIAL RESOURCES, IMPROVING COMMUNITY AWARENESS AND INVOLVING COMMUNITY RESIDENTS AND VISITORS IN DEVELOPING A LONG-TERM VISION FOR COMPREHENSIVE HEALTH CARE IN THE COMMUNITIES OF THE NORTH SHORE OF LAKE TAHOE, INCLUDING KINGS BEACH, CRYSTAL BAY AND INCLINE VILLAGE. 1 0 6963508 6908826 THE IVCHF DIAGNOSTIC IMAGING IMPROVEMENT PROJECT INCLUDES RENOVATIONS TO THE X-RAY AND CT DIAGNOSTIC IMAGING ROOMS, TO SUPPORT THE REPLACEMENT OF THE NEAR END-OF-LIFE FIXED X-RAY MACHINE AND REPLACE THE CURRENT 16 SLICE CT SCANNER WITH A STATE-OF-THE-ART, 128 SLICE CT SCANNER FOR IVCH. THE PROJECT EXPANDED IN FISCAL YEAR 2024 TO INCLUDE ADDING 3D MAMMOGRAPHY, WHICH INVOLVES A COMPLETE RENOVATION TO THE FORMER MEDICAL RECORDS SPACE, AND THE ADDITION OF A NEW OUTPATIENT ULTRASOUND MACHINE. A NEW 3-D MAMMOGRAPHY MACHINE WAS ALSO PURCHASED AND INSTALLED FOR PATIENT DIAGNOSTIC EXAMS AT IVCH. 134483 134483 THE IVCHF INCLINE VILLAGE ORAL HEALTH IMPROVEMENT FOR CHILDREN PROGRAM PROVIDES A COMPREHENSIVE ORAL HEALTH IMPROVEMENT PROGRAM OFFERING ORAL HEALTH SCREENINGS, FLUORIDE VARNISH APPLICATION, DENTAL SEALANT APPLICATION AND ORAL HEALTH EDUCATION TO CHILDREN AND YOUTH. EQUIPMENT, SUPPLIES AND PROVIDER FEES FOR THE PROGRAM ARE PURCHASED TO SUPPORT THE PROVISION OF ORAL HEALTH CARE SERVICES TO 400+ PUBLIC SCHOOL YOUTH IN INCLINE VILLAGE, NV. 42070 42070 THE IVCHF BEHAVIORAL HEALTH PROGRAM IN PRIMARY CARE AT INCLINE VILLAGE COMMUNITY HOSPITAL SUPPORTS A PROGRAM THAT PROVIDES BEHAVIORAL HEALTH SERVICES AT THE HOSPITAL. THIS PROGRAM PROVIDES SUPPORT FOR A BEHAVIORAL HEALTH INTENSIVIST (A MEDICAL STAFF POSITION) TO INTEGRATE BEHAVIORAL HEALTH INTO PRIMARY CARE TO INCREASE RATES OF DEPRESSION SCREENING, INCREASE ACCESS TO BEHAVIORAL HEALTH SERVICES AND IMPROVE THE MENTAL AND BEHAVIORAL HEALTH OF PATIENTS. 95577 95577 THE FOUNDATION PROVIDED SUPPORT FOR EMERGENCY SERVICES, SUPPLYING NEEDED EQUIPMENT AND DISASTER SUPPLIES, AND OTHER MISCELLANEOUS PROGRAMS. 95577 95577 7235638 1 1 0 0 0 0 0 0 0 1 0 0 0 1 0 0 1 1 0 0 0 0 0 0 1 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 10 9 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X TIM CLEARY 7758334100 880 ALDER AVENUE INCLINE VILLAGE NV 89451 HARRY WEIS DIRECTOR AND TFHD CEO (THRU 06/24) 0.50 39.50 X X 0 961264 60317 CRYSTAL FELIX TFHD CFO, TREASURER 0.50 39.50 X 0 521948 66988 LOUIS WARD INTERIM CEO, TFHD & DIRECTOR 0.50 39.50 X X 0 475190 59940 JAYE CHASSEUR CONTROLLER, TFHD 0.50 39.50 X 0 269132 39423 KARLI EPSTEIN EXECUTIVE DIRECTOR 24.00 16.00 X 0 202211 47057 WALTER L BINDER PRESIDENT 0.50 0.00 X X 0 0 0 DEBBIE CASTELLO VICE-PRESIDENT 0.50 0.00 X X 0 0 0 NAN HEALY SECRETARY 0.50 0.00 X X 0 0 0 GARY FINCH MEMBER AT LARGE 0.50 0.00 X 0 0 0 KEVIN HANNA DIRECTOR (THRU 01/24) 0.50 0.00 X 0 0 0 SUSANNA KINTZ DIRECTOR (THRU 01/24) 0.50 0.00 X 0 0 0 WARREN KOCMOND MEMBER AT LARGE 0.50 0.00 X 0 0 0 EARL NEMSER MEMBER AT LARGE 0.50 0.00 X 0 0 0 MYLES RINER DIRECTOR 0.50 0.00 X 0 0 0 DENISE SEMINETTA DIRECTOR 0.50 0.00 X 0 0 0 JULIE TEEL DIRECTOR 0.50 0.00 X 0 0 0 0 2429745 273725 0 0 1 0 0 593916 32115 692576 66691 1318607 359948 359948 20682348 20679706 2642 2642 2642 123250 593916 98148 25102 25102 1706299 0 0 387692 7180956 7180956 SUPPLIES 54682 54682 7235638 7235638 0 0 824311 330117 264586 0 6261725 1429072 104268 116500 7454890 1875689 88297 0 88297 0 X 3234136 1553938 4132457 321751 7366593 1875689 7454890 1875689 X -5529339 26203 12232 X 0 1 X 1 0 X X 1 TAHOE FOREST HOSPITAL DISTRICT 946004062 6 1 7180956 0 1 7180956 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 104268 13325 1093 116500 89004 5500 10699 935 104268 105084 4300 -20380 89004 64806 20500 19778 105084 52432 11100 1274 64806 0.00000 0.62090 0.37910 1 0 0 ENDOWMENT: BENEFICIAL INTEREST IN TRUST 116500 116500 2347319 26203 504437 110380 641020 1706299 0 1706299 7838223 504437 98148 602585 7235638 0 7235638 PART V, LINE 4: THE PURPOSE OF THE ENDOWMENT AND IMPROVEMENT FUNDS IS TO PROVIDE SUPPORT TO OR FOR THE BENEFIT OF THE FOUNDATION AND ITS ACTIVITIES IN PURSUIT OF ITS MISSION TO DELIVER OPTIMAL HEALTH CARE SERVICES IN THE COMMUNITIES SERVED BY INCLINE VILLAGE COMMUNITY HOSPITAL. PART XI, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN BENEFICIAL INTEREST IN TRUST 12,232. SPECIAL EVENT EXPENSES 98,148. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL EVENT EXPENSES 98,148. BEACH BOYS CONCERT AND FUNDRAISER 717166 593916 123250 34978 63170 717166 593916 123250 34978 63170 98148 25102 1 TAHOE FOREST HOSPITAL DISTRICT PO BOX 759 TRUCKEE CA 96160 946004062 115(1) 7180956 0 TO SUPPORT AND ENHANCE HEALTHCARE IN THE DISTRICT'S SERVICE AREA 1 0 PART I, LINE 2: THE FOUNDATION EXISTS TO SUPPORT AND ENHANCE HEALTHCARE IN THE INCLINE VILLAGE COMMUNITY HOSPITAL'S SERVICE AREA. ACCORDINGLY, THE FOUNDATION'S ASSISTANCE REPRESENTS PAYMENTS DIRECTLY MADE TO THE DISTRICT IN FURTHERANCE OF THESE PURPOSES. THE BOARD OF DIRECTORS FROM THE FOUNDATION AND THE DISTRICT PERFORM MONITORING PROCEDURES TO ENSURE THAT THE ASSISTANCE PROVIDED BY THE FOUNDATION IS USED TO SUPPORT AND ENHANCE HEALTHCARE IN INCLINE VILLAGE COMMUNITY HOSPITAL'S SERVICE AREA. 0 0 0 0 0 0 1 1 0 HARRY WEIS DIRECTOR AND TFHD CEO (THRU 06/24) 0 746740 0 188213 0 26311 0 34854 0 25463 0 1021581 0 0 CRYSTAL FELIX TFHD CFO, TREASURER 0 437549 0 72867 0 11532 0 42351 0 24637 0 588936 0 0 LOUIS WARD INTERIM CEO, TFHD & DIRECTOR 0 431824 0 28750 0 14616 0 36146 0 23794 0 535130 0 0 JAYE CHASSEUR CONTROLLER, TFHD 0 236819 0 28954 0 3359 0 27299 0 12124 0 308555 0 0 KARLI EPSTEIN EXECUTIVE DIRECTOR 0 164135 0 27799 0 10277 0 15662 0 31395 0 249268 0 0 PART I, LINE 3 THE FOUNDATION RELIED ON A RELATED ORGANIZATION THAT USED ONE OR MORE OF THE METHODS TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION. PART I, LINE 6 CURRENT EMPLOYEES OF THE RELATED ORGANIZATION, TAHOE FOREST HOSPITAL DISTRICT (DISTRICT) WHO MEET THE PLAN CRITERIA ARE ELIGIBLE TO PARTICIPATE IN A GAIN SHARING PROGRAM. CERTAIN PROGRAM METRICS MUST BE ACHIEVED IN ORDER FOR THE GAIN SHARING POOL TO BE ACTIVE FOR THE FISCAL YEAR. THE POOL OF GAIN SHARING FUNDS IS CALCULATED AS A PERCENTAGE OF AUDITED NET INCOME OF THE DISTRICT, TIERED FOR DIFFERENT LEVELS OF NET INCOME OF THE DISTRICT OVERALL. ELIGIBLE EMPLOYEES, WHICH MAY INCLUDE OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES OF THE DISTRICT THAT ALSO SERVE THE FOUNDATION THAT ARE EMPLOYED BY THE DISTRICT RECEIVE A PRO-RATA SHARE OF THE GAIN SHARING POOL BY ALLOCATING THE EMPLOYEE'S SALARY AGAINST THE TOTAL SALARY OF ALL ELIGIBLE EMPLOYEES. THE FOUNDATION DOES NOT INCUR ANY EXPENSES UNDER THIS PLAN. PART I, LINE 7 CERTAIN KEY PERSONNEL OF THE RELATED ORGANIZATION, TAHOE FOREST HOSPITAL DISTRICT (DISTRICT) THAT SERVE THE FOUNDATION ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION PLAN WHICH AWARDS A PERCENTAGE OF BASE COMPENSATION FOR THE FISCAL YEAR. ELIGIBLE EMPLOYEES OF THE DISTRICT INCLUDE OFFICERS, KEY PERSONNEL, AND OTHER EMPLOYEES AT THE DISCRETION OF THE CEO THAT MAY ALSO SERVE THE FOUNDATION. FOR THE INCENTIVE COMPENSATION TO BE AWARDED, CERTAIN FINANCIAL TARGETS AND ACHIEVEMENT OF ANNUAL GOALS AND STRATEGIC OBJECTIVES MUST BE MET. THE CEO MAY USE DISCRETION OVER THE INCENTIVE COMPENSATION AWARDED, BUT ALL PAYOUTS UNDER THE PLAN ARE DETERMINED AFTER ACCEPTANCE OF THE DISTRICT'S AUDITED FINANCIAL STATEMENT BY THE BOARD OF DIRECTORS. THE FOUNDATION DOES NOT INCUR ANY EXPENSES UNDER THIS PLAN. X 1 66691 FMV 0 0 1 0 PART I, COLUMN (B): COLUMN (B) REPORTS THE NUMBER OF CONTRIBUTORS. FORM 990, PART III, LINE 2 SEE PROGRAM SERVICE NARRATIVE IN FROM 990, PART III, LINE 4C. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE FOUNDATION IS TAHOE FOREST HOSPITAL DISTRICT. FORM 990, PART VI, SECTION A, LINE 7A THE FOUNDATION'S BOARD OF DIRECTORS ARE ELECTED BY THE SOLE MEMBER, TAHOE FOREST HOSPITAL DISTRICT. FORM 990, PART VI, SECTION A, LINE 7B AMENDMENTS TO THE BYLAWS AND CHANGES TO THE NUMBER OF DIRECTORS MUST BE APPROVED BY THE SOLE MEMBER, TAHOE FOREST HOSPITAL DISTRICT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS REVIEWED BY THE EXECUTIVE DIRECTOR. THE EXECUTIVE DIRECTOR ALSO REVIEWS THE FORM 990 WITH THE CHAIRMAN OR TREASURER OF THE BOARD AND THE FOUNDATION'S ACCOUNTANT IN PERSON, VIA EMAIL, OR THROUGH A BOARD MEETING. A COPY OF FORM 990 IS DISTRIBUTED TO THE REMAINDER OF THE BOARD VIA EMAIL OR THROUGH A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C THE FOUNDATION'S CONFLICT OF INTEREST POLICY APPLIES TO ALL PERSONS HOLDING POSITIONS OF RESPONSIBILITY AND TRUST ON BEHALF OF INCLINE VILLAGE COMMUNITY HOSPITAL FOUNDATION, INCLUDING, BUT NOT LIMITED TO MEMBERS OF THE BOARD OF DIRECTORS, VOLUNTEER COMMITTEE MEMBERS, AND TAHOE FOREST HOSPITAL DISTRICT STAFF (BOARD/STAFF/VOLUNTEERS). COVERED PERSONS ARE REQUIRED TO ANNUALLY COMPLETE A DISCLOSURE STATEMENT FOR POTENTIAL RELATIONSHIPS AS WELL AS DISCLOSING ANY INTEREST THAT MAY IMPACT THE DECISION-MAKING PROCESS WHENEVER THERE IS ANY DOUBT ABOUT WHETHER DISCLOSURE IS REQUIRED. IF A COVERED PERSON HAS AN INTEREST IN A PROPOSED TRANSACTION WITH THE FOUNDATION, HE OR SHE MUST MAKE FULL DISCLOSURE OF SUCH INTEREST BEFORE ANY DISCUSSION OR NEGOTIATION OF THE TRANSACTION AND ABSTAIN FROM DECISION-TAKING ACTIONS. IF A CONFLICT, OR THE POTENTIAL APPEARANCE OF A CONFLICT EXISTS, THE BOARD MEMBER MUST RECUSE THEMSELVES BY NOT INFLUENCING, ATTEMPTING TO INFLUENCE, OR PARTICIPATING IN THAT DISCUSSION AND/OR VOTE MADE BY REMAINING MEMBERS THAT DO NOT HAVE AN INTEREST. FORM 990, PART VI, SECTION C, LINE 19 ANY INTERESTED PARTIES WHO DESIRE TO OBTAIN A COPY OF ANY OF THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS CAN CONTACT THE OFFICE AND REQUEST A PAPER COPY. ANY DOCUMENTS REQUESTED ARE PRINTED AND HANDED TO THE INTERESTED PARTY AT THE OFFICE. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN TRUST 12,232. TAHOE FOREST HOSPITAL DISTRICT PO BOX 759 TRUCKEE CA 96160 946004062 HEALTHCARE CA N/A 0 TAHOE FOREST HEALTH SYSTEM FOUNDATION PO BOX 2508 TRUCKEE CA 96160 943047869 HEALTHCARE CA 501(C)(3) LINE 12A, I TAHOE FOREST HOSPITAL DISTRICT 0 TAHOE INSTITUTE FOR RURAL HEALTH RESEARCH PO BOX 759 TRUCKEE CA 96160 352372175 IMPROVE AFFORDABILITY OF HIGH QUALITY HEALTHCARE CA 501(C)(3) LINE 12A, I TAHOE FOREST HOSPITAL DISTRICT 0 THE TRUCKEE SURGERY CENTER LLC 10770 DONNER PASS ROAD SUITE 201 TRUCKEE CA 96161 273943102 AMBULATORY SURGERY CENTER CA N/A 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 0 TAHOE FOREST HOSPITAL DISTRICT B 7180956 FMV TAHOE FOREST HOSPITAL DISTRICT N 165025 FMV TAHOE FOREST HOSPITAL DISTRICT O 215217 FMV TAHOE FOREST HOSPITAL DISTRICT P 186444 FMV