2023-10-31T15:05:42-05:00 2022-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2022-01-01 810475376 PLAINS HOSPITAL CORPORATION PLAI 4068264800 PO BOX 768 PLAINS MT 59859 GREGORY S HANSON MD CEO 4068264800 2023-10-31 1 GREGORY HANSON MD 999009999 0 TERRI REXRODE CPA MST P00096513 9206620016 2023-10-31 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CLARK FORK VALLEY HOSPITAL CARLA NEIMAN PO BOX 768 PLAINS MT 59859 33053689 0 X WWW.CFVH.ORG X 1992 MT CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK IS A 16-BED CRITICAL ACCESS FACILITY SERVING THE RESIDENTS OF SANDERS COUNTY AND THE SURROUNDING AREA SINCE 1971 (INCORPORATED IN 1992). 10 7 304 25 0 0 6004354 1490784 30188397 29242009 403871 109549 674658 96331 37271280 30938673 0 0 0 0 16926406 17618913 0 0 0 11385857 12049754 28312263 29668667 8959017 1270006 35008073 32052568 13965525 10949723 21042548 21102845 X CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK WILL PARTNER WITH OUR COMMUNITIES TO IMPROVE THE HEALTH OF THOSE WE SERVE. 0 0 25897240 0 29238389 THE HOSPITAL PROVIDED 1,365 DAYS OF ACUTE CARE SERVICES AND 8,143 DAYS OF SKILLED NURSING CARE. IN ADDITION, THE HOSPITAL PROVIDED 7,818 OBSERVATION HOURS, 18,169 RURAL HEALTH CLINIC VISITS, AND 3,299 HOME HEALTH VISITS. THE HOSPITAL PROVIDED $521,181 IN CHARITABLE SERVICES TO PATIENTS UNABLE TO PAY FOR HEALTH CARE SERVICES. HOSPITAL SERVICES INCLUDE ACUTE CARE, SWINGBED, SKILLED NURSING, EMERGENCY CARE, OBSTETRICS, LABORATORY, RADIOLOGY, PHARMACY, RESPIRATORY THERAPY, EKG, ULTRASOUND, CT SCANNER, DIABETES MANAGEMENT, SURGERY, HOME HEALTH AND HOSPICE.THE HOSPITAL CONTINUED ITS WORK WITH THE NATIONAL RURAL ACO AND EXPERIENCED SUCCESS THROUGH CARE COORDINATION AND FOCUSED QUALITY IMPROVEMENT EFFORTS IN PURSUIT OF MEDICARE SHARED SAVINGS. 25897240 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 75 0 304 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 1 1 X X CARLA NEIMAN CFO 4068264800 PO BOX 768 PLAINS MT 59859 GREGORY HANSON MD PRESIDENT/CEO 40.00 X X 268842 0 43917 CARLA NEIMAN CFO 40.00 X X 161321 0 13384 MICHAEL R BAXTER CHAIR 2.00 X X 0 0 0 JESSICA VALENTINE MD CHIEF OF STAFF 20.00 X 302400 0 35129 DENISE BENSON MEMBER 2.00 X 0 0 0 BINA EGGENSPERGER MEMBER 2.00 X 0 0 0 JAMES GILLHOUSE MEMBER 2.00 X 0 0 0 VIRGINIA HOLLAND MEMBER 2.00 X 0 0 0 DEVIN HUNTLEY MEMBER 2.00 X 0 0 0 ERIN MCCARTHY MEMBER 2.00 X 0 0 0 DARREN HERZOG M.D. 40.00 X 490970 0 25722 RICHARD INGLE M.D. 40.00 X 258332 0 16504 JEANNE WILLIAMS M.D. 40.00 X 225205 0 21647 BARRY FOWLER DIRECTOR HR/ENV/PLANT/DIETARY 40.00 X 135452 0 19128 LISA EBERHARDT DIRECTOR OF NURSING 40.00 X 139222 0 21822 1981744 0 197253 26 0 1 0 MCKINSTRY ESSENTION LLC PO BOX 3895 SEATTLE WA 98124 HVAC SERVICES 797057 COMMUNITY TECHNOLOGIESTEGRIA 1255 FOURIER DR STE 101 MADISON WI 53717 E.H.R. SERVICES 390323 MONIDA SHARED IMAGING 1200 S RESERVE SUITE H MISSOULA MT 59801 MRI SERVICES 362694 WILDHORSE MANAGEMENT PO BOX 1310 PLAINS MT 59859 SURGEON 330000 FUSION MEDICAL STAFFING LLC 11808 GRANT ST SUITE 100 OMAHA NE 68164 TRAVELING STAFF SERVICES 262831 11 55000 1435784 1490784 PATIENT SERVICE REVENUE 621400 28626131 28626131 340(B) PHARMACY REVENUE 456110 516233 516233 JOINT VENTURE MRI INCOME 621400 72083 72083 MOB RENTAL 621400 23942 23942 MEDICAL RECORDS 621400 3620 3620 29242009 317724 317724 10775 0 10775 10775 10775 1905341 1500 2115016 0 -209675 1500 -208175 -208175 CAFETERIA REVENUE 722514 70926 70926 14630 14630 85556 30938673 29238389 0 209500 X 824993 337529 487464 13818045 12423840 1394205 176815 149707 27108 1541183 1358741 182442 1257877 1138580 119297 24950 318 24632 53254 53254 8739 8739 4153671 3675853 477818 738282 648375 89907 44678 40421 4257 486628 322322 164306 132570 114070 18500 269755 269755 761290 524220 237070 289298 289298 MEDICAL SUPPLIES & DRUG 3778818 3721780 57038 BAD DEBT 533154 533154 LICENSES & TAXES 513551 263482 250069 RECRUITMENT 112898 21324 91574 148218 64471 83747 29668667 25897240 3771427 0 15114369 11980717 3233150 3788556 285372 377985 1540697 1576161 33165 173863 19334531 14853351 3926426 4481180 8827388 7593477 2047506 2080629 35008073 32052568 3498971 3907487 1203737 0 6013668 5877735 3249149 1164501 13965525 10949723 X 20743586 20837810 298962 265035 21042548 21102845 35008073 32052568 1270006 -1209709 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 8739 8739 0 PART II-B, LINE 1: THE FACILITY PAYS DUES TO THE MONTANA HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND AMERICAN ASSOCIATION FOR HOMES AND SERVICES FOR THE AGING. A PORTION OF THE DUES ARE USED FOR LOBBYING ACTIVITIES ON BEHALF OF THE MEMBERS OF THE ASSOCIATIONS. 298962 24630 -3557 55000 265035 276209 35413 6340 19000 298962 259724 32424 4061 20000 276209 251904 47631 -4180 35631 259724 246299 35135 578 30108 251904 0.00000 0.00000 1.00000 0 1 1 249632 249632 8186128 6323185 1862943 10898771 8530166 2368605 4481180 MEDICARE RECEIVABLE 1211579 HOSPITAL BED TAX RECEIVABLE 658645 INVESTMENT IN JOINT VENTURE 18347 ROU ASSETS - OPERATING 158959 ROU ASSETS - FINANCE 33099 2080629 MEDICAID PAYABLE 1130855 FINANCE LEASE OBLIGATIONS 33646 1164501 29174737 -1205494 -533154 -1738648 30913385 25288 25288 30938673 29135513 0 29135513 533154 533154 29668667 PART V, LINE 4: THE ENDOWMENT FUNDS CONSIST OF FUNDS HELD BY CLARK FORK VALLEY HOSPITAL FOUNDATION, INC. AND FUNDS DESIGNATED FOR CAPITAL PROJECTS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -533,154. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTRICTED CONTRIBUTIONS 24,630. RESTRICTED INTEREST INCOME 658. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 533,154. 1 1 X 1 X 1 X 1 1 0 1 1 328669 328669 0.01130 2355010 2378560 0 0.00000 2683679 2378560 328669 0.01130 47864 1721 46143 0.00160 202747 1000 201747 0.00690 4116646 2675430 1441216 0.04950 29435 29435 0.00100 4396692 2678151 1718541 0.05900 7080371 5056711 2047210 0.07030 1 50 400 400 0.00000 1 50 400 400 0.00000 0 533154 133288 8548906 8602133 -53227 X 1 1 1 1 CLARK FORK VALLEY HOSPITAL 10 KRUGER ROAD PLAINS MT 59859 WWW.CFVH.ORG 10608 X X X X CLARK FORK VALLEY HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 0 0 1 X SEE PART V, SECTION C X X 1 20 1 SEE PART V, SECTION C 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X 1 X HTTPS://WWW.CFVH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.CFVH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ X HTTPS://WWW.CFVH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE/ X X X X X 1 X 0 X X X X 1 X 0 0 CLARK FORK VALLEY HOSPITAL PART V, SECTION B, LINE 5: WE SELECTED KEY INFORMANTS IN OUR COMMUNITY BY IDENTIFYING INDIVIDUALS WHOSE WORK ENCOMPASSES AND INFLUENCES MULTIPLE LEVELS OF SOCIOECONOMIC FACTORS I.E., HEALTH, EDUCATION, VOLUNTEERISM, FINANCE, ETC. AND DIRECTLY SERVICES COMMUNITY MEMBERS IN THOSE CAPACITIES. WE ALSO ENSURED KEY INFORMANTS WERE SELECTED FROM MULTIPLE COMMUNITIES TO PROVIDE BROADER INPUT AND REPRESENTATION OF OUR COUNTY. CLARK FORK VALLEY HOSPITAL PART V, SECTION B, LINE 7D: SCHEDULE H, PART V, LINE 7A & 10A:HTTPS://WWW.CFVH.ORG/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENTSPLANS/ CLARK FORK VALLEY HOSPITAL PART V, SECTION B, LINE 11: CURRENTLY, CFVH IS WORKING ON THE IMPLEMENTATION PLAN DEVELOPED IN 2020 TO ADDRESS THE FEASIBLE NEEDS THROUGH OUR ORGANIZATION, IDENTIFIED IN THE 2020 CHNA. THE THREE PRIORITIES IDENTIFIED WERE CHOSEN BECAUSE THEY WOULD HAVE THE MOST IMPACT THROUGHOUT SANDERS COUNTY AND THESE THREE REMAIN WITHIN THE MISSION OF CFVH AND ARE CONSTRAINED WITHIN ITS CURRENT RESOURCE CAPACITY. THE FOCUS OF THE 2020-2023, TRIENNIUM HAS TO DATE AND WILL REMAIN FOR THE FORESEEABLE FUTURE, MANAGING THE OUTBREAK AND EFFECTS OF THE SARS-COVID-19 PANDEMIC. PRIORITIES ONE AND TWO ARE BEING ADDRESSED AS THEY COME INTO FOCUS THROUGH RELATION TO COVID-19 AND AS WE HAVE BANDWIDTH TO ADDRESS THE RELEVANT ISSUES. PRIORITY THREE, MANAGING AND PREVENTING CHRONIC DISEASE, IS A WORK IN PROGRESS WITH THE DEVELOPMENT OF NEW PROGRAMS IN ADDITION TO PROGRAMS ALREADY IN PLACE. HEALTH COACHING, DIABETES PREVENTION PROGRAM, AND STRONGBODIES EVIDENCE-BASED LOW IMPACT WEIGHT BEARING PROGRAM HAVE BEEN IN PLACE, WITH COVID-19 RESTRICTIONS, TO HELP ADDRESS THAT PRIORITY. 7 1 - CFVH NURSING HOME 10 KRUGER ROAD PLAINS MT 59859 SKILLED NURSING FACILITY 2 - CFVH HOME HEALTH AGENCY 10 KRUGER ROAD PLAINS MT 59859 HOME HEALTH AGENCY 3 - CFVH HOSPICE 10 KRUGER ROAD PLAINS MT 59859 HOSPICE CARE 4 - PLAINS FAMILY MEDICINE 10 KRUGER ROAD PLAINS MT 59859 RURAL HEALTH CLINIC 5 - HOT SPRINGS FAMILY MEDICINE 209 MAIN STREET HOT SPRINGS MT 59845 RURAL HEALTH CLINIC 6 - THOMPSON FALLS FAMILY MEDICINE 120 POND STREET THOMPSON FALLS MT 59873 RURAL HEALTH CLINIC 7 - TF FAMILY MEDICINE PHYSCIAL THERAPY 1707 MAIN STREET EAST THOMPSON FALLS MT 59873 RURAL HEALTH CLINIC PART I, LINE 7: WORKSHEET 2 (COST-TO-CHARGE RATIO) WAS USED FOR THE COSTING METHODOLOGY FOR FINANCIAL ASSISTANCE; SCHEDULE C ON THE FYE 2022 COST REPORT WAS USED FOR COSTING METHODOLOGY FOR NON-COST-BASED SUBSIDIZED SERVICES. PART I, LINE 7G: SUBSIDIZED SERVICES INCLUDE LONG TERM CARE AND HOME HEALTH/HOSPICE PROGRAMS. 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 $ 533,154. PART II, COMMUNITY BUILDING ACTIVITIES: ATTENDING MEETINGS AND ACTIVELY PARTICIPATING IN THE PLAINS BASEBALL ASSOCIATION. PART III, LINE 3: WE HAVE ESTIMATED THAT APPROXIMATELY 25% OF OUR BAD DEBT IS ASSOCIATED WITH PATIENTS WHO DO NOT RESPOND TO OUR REQUESTS FOR FINANCIAL INFORMATION OR COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. PART III, LINE 4: WHILE THE FACILITY DOES NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE IN ITS FINANCIAL STATEMENTS, THE NOTE FOR PATIENT ACCOUNTS RECEIVABLE DESCRIBES HOW PROBABLE UNCOLLECTABLE ACCOUNTS ARE CHARGED TO BAD DEBT EXPENSE. THE RELEVANT NOTE CAN BE FOUND ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.BAD DEBT EXPENSE IS REPORTED AS IT IS REPORTED ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THIS INCLUDES BAD DEBT WRITE-OFFS, AS WELL AS A REASONABLE ALLOWANCE FOR DOUBTFUL ACCOUNTS STILL INCLUDED IN ACCOUNTS RECEIVABLE AT YEAR-END. BAD DEBT EXPENSE IS REPORTED NET OF RECOVERIES FOR THE YEAR AND ADJUSTED TO COST WITH THE COST-TO-CHARGE RATIO WORKSHEET.THE AMOUNT REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 3 IS 25% OF THE TOTAL BAD DEBT EXPENSE AT COST, WHICH IS THE ORGANIZATION'S BEST ESTIMATE OF THE PROPORTION OF BAD DEBT ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE, HAD THE ORGANIZATION BEEN SUCCESSFUL IN OBTAINING THEIR COOPERATION FOR AN APPLICATION FOR FINANCIAL ASSISTANCE, BASED ON THE COLLECTORS' EXPERIENCE AND RESPONSE RECEIVED.IT WOULD BE REASONABLE TO ASSUME THAT 25% OF BAD DEBT EXPENSE ESTIMATED AS ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE BE CONSIDERED A COMMUNITY BENEFIT, SIMILAR TO A BONAFIDE CHARITY CARE. PART III, LINE 8: THE FACILITY IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BY MEDICARE AT 101% OF MEDICARE'S COSTS.THE TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FACILITY'S FILED 2022 MEDICARE COST REPORT. PART III, LINE 9B: MEDICAID CO-PAYS AND INELIGIBLE BILLS FOR MEDICAID PATIENTS THAT ARE UNCOLLECTIBLE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN MADE WILL BE AUTOMATICALLY DEEMED ELIGIBLE FOR CHARITY DISCOUNT. IN CERTAIN SITUATIONS, CIRCUMSTANCES MAY INDICATE THAT A PATIENT WOULD QUALIFY FOR CHARITY CARE, DESPITE THE FACT THAT THE PATIENT IS UNWILLING OR UNABLE TO COOPERATE WITH THE APPLICATION PROCESS. AN EXAMPLE MIGHT BE A HOMELESS PERSON OR TRANSIENT WHO HAS LEFT THE AREA OR AN INDIVIDUAL WHO HAS QUALIFIED FOR MEDICAID IN THE PAST BUT DID NOT MEET THE DEADLINE TO REAPPLY FOR BENEFITS. IN A CASE SUCH AS THIS, THE PATIENT CAN BE CLASSIFIED AS "DEEMED QUALIFIED" FOR CHARITY ASSISTANCE, WITH APPROPRIATE DOCUMENTATION EXPLAINING THE RATIONALE PLACED ON FILE. SUCH CASES WILL BE APPROVED ON AN INDIVIDUAL BASIS BY THE REVENUE CYCLE MANAGER AND/OR THE CFO. IN ADDITION, FINAL EVALUATION OF ACCOUNTS ELIGIBLE FOR BAD DEBT WRITE-OFF ARE REVIEWED TO IDENTIFY PATIENTS WHO HAVE QUALIFIED FOR CHARITY CARE IN THE PAST FOR ADDITIONAL QUALIFICATION EFFORTS OR POSSIBLE "DEEMED" STATUS. PART VI, LINE 2: THE HOSPITAL'S GOVERNING BOARD INCLUDES DIVERSE REPRESENTATION FROM EACH OF OUR VARIOUS COMMUNITIES AND WE DRAW ON THIS RESOURCE, AS WELL AS OUR PROVIDERS, STAFF, AND PATIENTS FOR INPUT REGARDING EMERGING NEEDS IN OUR SERVICE AREA. STRATEGIC PLANNING IS CONDUCTED ON AN ANNUAL BASIS INVOLVING THE BOARD AND VARIOUS STAKEHOLDERS AND, THROUGH THIS PROCESS, COMMUNITY NEEDS THAT HAVE BEEN IDENTIFIED ARE EVALUATED ALONG WITH POTENTIAL ADJUSTMENTS TO PROGRAMS AND SERVICES TO MEET THESE NEEDS. PART VI, LINE 3: THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS COMMUNICATED TO PATIENTS THROUGH THE FOLLOWING MEANS: HOSPITAL WEBSITE, ENCLOSURES WITH BILLS AND STATEMENTS, NOTICES IN ADMISSIONS AREA FOR THE HOSPITAL AND EMERGENCY ROOM, AND DIRECTLY THROUGH HOSPITAL STAFF WHO ARE EDUCATED ON THE AVAILABILITY OF THE PROGRAM. FINANCIAL COUNSELORS ARE PLACED AT VARIOUS SERVICE LOCATIONS TO ASSIST PATIENTS, AND THEY ARE WELL-VERSED ON EXTERNAL RESOURCES THAT MIGHT BE AVAILABLE TO ASSIST PATIENTS WITH FINANCIAL OBLIGATIONS FOR HEALTH CARE, AS WELL AS OUR IN-HOUSE PROGRAMS. PART VI, LINE 4: CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK SERVES THE RESIDENTS OF SANDERS COUNTY. THIS RURAL COUNTY IS IN WESTERN MONTANA WITH A POPULATION OF APPROXIMATELY 12,400 IN 2020. THE HOSPITAL IS CENTRALLY LOCATED IN THE COUNTY WITHIN THE COMMUNITY OF PLAINS AND OPERATES REMOTE FAMILY PRACTICE CLINIC AND THOMPSON FALLS AND HOT SPRINGS. THE MEDIAN INCOME IN SANDERS COUNTY IS AMONG THE LOWEST IN THE STATE OF MONTANA (55TH OF 56 COUNTIES IN 2021) AND THE UNEMPLOYMENT RATE IS AMONG THE HIGHEST IN THE STATE AT 4.20% IN 2021. APPROXIMATELY 16.3% OF COUNTY RESIDENTS LIVE BELOW THE POVERTY LEVEL AND APPROXIMATELY 15.2% OF RESIDENTS UNDER THE AGE OF 65 LACKED HEALTH INSURANCE IN 2021. THE COUNTRY HAS AN AGING POPULATION WITH A MEDIAN AGE OF 54.5 IN 2020. THE HOSPITAL IS THE SOLE PROVIDER OF ACUTE HEALTH CARE SERVICES IN THE COUNTY AND IS ITS LARGEST EMPLOYER. PART VI, LINE 5: THE HOSPITAL IS AN INDEPENDENT 501(C)(3) ENTITY AND IS ESSENTIALLY OWNED BY THE COMMUNITIES IT SERVES. THE GOVERNING BOARD IS COMPRISED PRIMARILY OF LOCAL INDIVIDUALS WHO REPRESENT A CROSS SECTION OF THE COMMUNITIES AND DEMOGRAPHIC GROUPS SERVED BY THE ORGANIZATION. THESE INDIVIDUALS CONTRIBUTE THEIR INSIGHT TO THE GOVERNANCE OF THE ORGANIZATION BASED ON THEIR EXPERIENCE IN THE COMMUNITY AS HEALTH CARE CONSUMERS, BUSINESS OWNERS, AND COMMUNITY LEADERS. THEY ALSO ACT AS ADVOCATES IN THEIR COMMUNITIES FOR HEALTH CARE ISSUES AND RESOURCES MADE AVAILABLE THROUGH THE ORGANIZATION. THE HOSPITAL AND ITS AFFILIATED ENTITIES FULLY PARTICIPATE IN ALL GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS AND CONTRACTS WITH MOST PRIVATE PAYERS FOR SERVICES IN AN EFFORT TO ENABLE FULL ACCESS TO ITS SERVICES, REGARDLESS OF THE SPONSOR OF CARE. THE HOSPITAL TAKES A LEADERSHIP ROLE IN THE COMMUNITY WITH RESPECT TO HEALTH CARE COMMUNICATION AND EDUCATION, PROVIDING PRESS RELEASES TO LOCAL NEWSPAPERS, SPEAKERS TO COMMUNITY GROUPS, PARTICIPATION IN COMMUNITY EVENTS, PARTICULARLY THOSE THAT ARE HEALTH RELATED, AND WORKING WITH SCHOOLS IN OUR AREA TO PROMOTE WELLNESS AND HEALTH CARE CAREERS. THE HOSPITAL COLLABORATES WITH COUNTY GOVERNMENT AND VARIOUS AGENCIES TO PLAN FOR DISASTERS. THE HOSPITAL ALSO COLLABORATES WITH THE COUNTY HEALTH DEPARTMENT AND OTHER LOCAL PROVIDERS IN PLANNING FOR PUBLIC HEALTH CONCERNS, SUCH AS PANDEMIC, FLU VACCINE AVAILABILITY, ETC. THE HOSPITAL, THROUGH ITS HOSPICE AGENCY, CONDUCTS GRIEF SUPPORT GROUPS AND REFERS PATIENTS IN FAMILIES TO VARIOUS RESOURCES IN THE COMMUNITY TO ASSIST THEM IN THEIR TIME OF NEED. X X X X 0 0 0 0 0 0 0 0 0 DARREN HERZOG M.D. 490970 0 0 0 0 0 0 0 25722 0 516692 0 0 0 JESSICA VALENTINE MD CHIEF OF STAFF 302400 0 0 0 0 0 9150 0 25979 0 337529 0 0 0 GREGORY HANSON MD PRESIDENT/CEO 262947 0 5895 0 0 0 8512 0 35405 0 312759 0 0 0 RICHARD INGLE M.D. 233332 0 25000 0 0 0 0 0 16504 0 274836 0 0 0 JEANNE WILLIAMS M.D. 225205 0 0 0 0 0 6900 0 14747 0 246852 0 0 0 CARLA NEIMAN CFO 157757 0 3564 0 0 0 5063 0 8321 0 174705 0 0 0 LISA EBERHARDT DIRECTOR OF NURSING 135781 0 3441 0 0 0 600 0 21222 0 161044 0 0 0 BARRY FOWLER DIRECTOR HR/ENV/PLANT/DIETARY 132438 0 3014 0 0 0 0 0 19128 0 154580 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B A DRAFT COPY OF FORM 990 IS PROVIDED TO THE CLIENT PRIOR TO FILING. THE DRAFT IS ALSO PROVIDED TO THE BOARD FOR APPROVAL BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION MAINTAINS A COMPREHENSIVE ORGANIZATIONAL INTEGRITY (COI) PROGRAM. ALL EMPLOYEES ARE REQUIRED TO READ AND SIGN THE STANDARDS OF CONDUCT DOCUMENT THAT INCLUDES AN EXTENSIVE COI POLICY. THE ORGANIZATIONAL INTEGRITY OFFICER PRESENTS THE IMPORTANCE OF COMPLIANCE AND INTEGRITY IN ALL ASPECTS OF THE BUSINESS TO ALL NEW EMPLOYEES AND DURING ANNUAL INSERVICE. ADDITIONALLY, THE ORGANIZATION UTILIZES THE SERVICES OF AN ANONYMOUS REPORTING SERVICE TO FURTHER SEEK REPORTS ON COI AND OTHER COMPLIANCE ISSUES. POTENTIAL COMPLIANCE VIOLATIONS, INCLUDING COI, ARE PROMPTLY INVESTIGATED. THE COMPLIANCE COMMITTEE MEETS AT LEAST QUARTERLY TO REVIEW VARIOUS AREAS OF THE ORGANIZATION FOR POTENTIAL COMPLIANCE VIOLATIONS. BOARD MEMBERS AND SENIOR MANAGERS ARE REQUIRED TO SIGN COI STATEMENTS ANNUALLY. BOARD MEMBERS, EXECUTIVE MANAGEMENT, PHYSICIANS, AND VOLUNTEER LEADERS ARE COVERED UNDER THE COI POLICY. IF PRESENT, POTENTIAL CONFLICTS OF INTEREST ARE DETERMINED BY SENIOR MANAGEMENT, THE ORGANIZATION'S INTEGRITY OFFICE, AND THE BOARD. ACTUAL CONFLICTS ARE REVIEWED BY SENIOR MANAGEMENT AND THE INTEGRITY OFFICER. IF A CONFLICT IS DETERMINED TO EXIST, PERSONS DETERMINED TO HAVE A CONFLICT OF INTEREST ARE EXCUSED FROM PARTICIPATION IN ACTIONS WHERE THE CONFLICT LIES. FORM 990, PART VI, SECTION B, LINE 15A THE HOSPITAL PRIMARILY USES THE MONTANA HOSPITAL ASSOCIATION'S ANNUAL WAGE SURVEY TO REVIEW SALARY COMPARABILITY TO SIMILAR ORGANIZATIONS IN THE STATE OF MONTANA. THE HOSPITAL ALSO USES RESOURCES SUCH AS MEDICAL GROUP MANAGEMENT ASSOCIATION (FOR PROVIDER COMPENSATION INFORMATION), INDUSTRY SURVEYS & PUBLICATIONS, AND CONSULTATIONS WITH OTHER ORGANIZATIONS AND PROVIDERS. THE BOARD HAS FULL DETERMINATION OF THE CEO'S COMPENSATION. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 THE FACILITY'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,432,509. MANAGEMENT AND GENERAL EXPENSES 477,818. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,910,327. TECHNICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,901,299. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,901,299. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 342,045. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 342,045. CLARK FORK VALLEY HOSPITAL FOUNDATION INC PO BOX 768 PLAINS MT 59859 810304386 FUNDRAISING FOR CLARK FORK VALLEY HOSPITAL MT 501(C)(3) LINE 12A, I CLARK FORK VALLEY HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 CLARK FORK VALLEY HOSPITAL FOUNDATION INC C 55000 CASH - FOUNDATION BOARD APPROVAL