2019-09-18T11:36:40-05:00 2018-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2018-01-01 880405927 Washoe Barton Medical Clinic WASH 7757821500 1107 Hwy 395 Gardnerville NV 89410 Colleen Reid CFO 7757821500 2019-09-17 1 DEB NELSON CPA P01264758 7012398500 2019-09-17 216.147.181.45 2019-09-17 15:02:53 CD P 66CC91E6B7F11C4783FFFA5645E675327CB67316 66CC91E6B7F11C4783FFFA5645E675327CB67316 2018 2019-02-21 02:37:17Z Carson Valley Medical Center Colleen Reid 1107 Hwy 395 Gardnerville NV 89410 80172092 0 X carsonvalleymedicalcenter.org X 1999 NV Nevada non-profit corporation which operates as the sole hospital in the county. 6 6 510 21 0 0 0 61417 65685889 61778124 210876 232575 -199741 106056 65697024 62178172 0 0 0 0 29577996 25868556 0 0 5832 31961078 31933298 61539074 57801854 4157950 4376318 65169389 69734332 12514989 12723713 52654400 57010619 X Our mission is to care for your health and wellness. Our vision is to strengthen our community by providing accessible, affordable, high quality healthcare to all. 0 0 39296409 40781894 Washoe Barton Medical Clinic dba Carson Valley Medical Center:Carson Valley Medical Center covers a service area that includes approximately 50,000 residents. A focus on patient centered care and quality have resulted in Carson Valley Medical Center consistently ranking high in patient satisfaction on both inpatient and outpatient consumer satisfaction surveys. Carson Valley Medical Center facilities include a full-service hospital, Emergency Room, Infusion, Lab, Medical Imaging, Physical and Respiratory Therapy, Senior Mental Health, Sleep & Neurodiagnostic Lab, Wound Care and Telemedicine. Clinics include Carson Valley Medical Center Senior Care (a provider-based clinic servicing patients over 65), Job's Peak Internal Medicine & Family Practice, Topaz Ranch Medical Clinic, Minden Family Medicine and Complete Care, Ironwood Primary Care, Ironwood Urgent Care and Occupational Health Clinics. 5737893 13531249 Pharmacy:Program expenses are used in the provision of health care services to the community. Carson Valley Medical Center provides inpatient and outpatient pharmaceutical services for the hospital and outpatient clinics. In 2018, there were higher patient acuities and more chemotherapy patients than the previous year. In 2018, 126,747 pharmacy orders were processed. 6234389 7464981 Surgery:Program expenses are used in the provision of surgical services to the community. Carson Valley Medical Center provides inpatient and outpatient surgery services. Emergency and elective surgeries are performed by general and specialty surgeons. In 2018, 1,257 surgeries were performed at Carson Valley Medical Center. 51268691 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 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 1 1 1 0 0 0 1 177 0 1 510 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 0 1 1 X Jeff Prater 7757821500 1107 Highway 395 N Gardnerville NV 89410 Richard Derby Chairman 0.50 X 0 0 0 Dawn Ahner Secretary 0.50 X 0 0 0 Paul Fry III Board Member 0.50 X 4500 0 0 Clint Purvance Board Member 0.50 X 0 0 0 Josiah Johnson Board Member 0.50 X 0 0 0 Hakeem Olanrewaju Board Member (Mar-Dec) 0.50 X 0 0 0 Mike Ellis CFO (Jan-Feb) 40.00 X 34846 0 2473 Allan Scroggins Interim CFO Consultant (Mar-Aug) 40.00 X 245803 0 0 Shannon Albert Interim CEO (Jan-May) 40.00 X 146470 0 22473 Jeff Prater CEO (Jun-Dec) 40.00 X 148599 0 1651 Colleen Reid CFO (Dec) 40.00 X 45078 0 0 Brandon Battis Pharmacist 40.00 X 160221 0 34192 Greg Ponsness Pharmacy Manager 40.00 X 158655 0 28303 Kathryn Cocking Chief Nursing Officer 40.00 X 148428 0 7897 Valerie Harrell Medical Imaging Technician 40.00 X 129996 0 23884 Timothy O'Neill Physician Assistant 40.00 X 134446 0 4664 1357042 0 125537 35 0 1 0 Renown Health Medical Group 780 Kuenzli St Ste 202 Reno NV 89502 Physician Salary, IT, Physician Read Fee 2191496 Leman Medical Corporation 1122 Monterra Dr Minden NV 89423 ER Physician Group 2139288 Barton Healthcare Systems 2170 South Ave South Lake Tahoe CA 96150 IT, Lab, Pathology 1099480 Rural Physicians Group 10624 S Eastern Ave Suite A263 Henderson NV 89502 Hospitalist Physician Group 756994 AYA Healthcare Inc PO Box 123519 Dallas TX 753123519 Contract Staffing 674645 21 45020 16397 61417 Net Patient Services 621400 61136379 61136379 Other Supporting Revenue 900099 641745 641745 61778124 376371 376371 214769 108713 106056 106056 106056 17741411 17878904 6303 -137493 -6303 -143796 -143796 62178172 61778124 0 338631 X 659345 659345 19635392 16988940 2646452 334626 306465 28161 3761672 3149407 612265 1477521 1259307 218214 82384 82384 114149 114149 5092 5092 9049 9049 11905196 10712558 1192638 337194 332178 5016 779016 680498 98518 177691 44448 133243 452891 346481 106410 51400 22787 28613 166545 79257 87288 327914 282984 44930 2771218 2720188 51030 594099 339662 254437 Medical Supplies 10373245 10371745 1500 Bad Debts 3112928 3112928 Equipment Rental/Lease 178170 174177 3993 495117 339589 149696 5832 57801854 51268691 6527331 5832 13773548 15869145 8665567 8746177 1318762 1531019 424816 497358 53134963 26717292 23796549 26417671 14750814 14986750 1264329 1270508 1175004 415704 65169389 69734332 3546575 4315663 133889 0 6230329 5703816 2436623 2249000 167573 455234 12514989 12723713 X 52654400 56974970 35649 52654400 57010619 65169389 69734332 X 4376318 -9100 -10999 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 5092 5092 0 Part II-B, Line 1: Dues paid to associations that are required to report lobby activities. Total dues paid was $104,004. The portion attributable to lobbying activities as reported by the associations was $5,092. 187000 3428979 3615979 34933876 15911315 19022561 13656339 10202538 3453801 928769 603439 325330 26417671 Other Liabilities 455234 455234 X 59248485 -9100 -3026554 -3035654 62284139 9049 -115016 -105967 62178172 54885124 205247 205247 54679877 9049 3112928 3121977 57801854 Part X, Line 2: The Medical Center is organized as a Nevada nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Medical Center has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Included in Expenses on Form 990 -3,112,928. Foundation Revenue Included in Consolidated Financial 86,374. Part XI, Line 4b - Other Adjustments: Rental Expenses Included in Expenses of Financial Statements -108,713. Loss Included in Expenses on Form 990 -6,303. Part XII, Line 2d - Other Adjustments: Foundation Expenses Included in Consolidated Financial Statements 90,231. Rental Expenses Included in Revenue on Form 990 108,713. Loss Included in Revenue on Form 990 6,303. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial 3,112,928. 1 1 X 1 X 250.000000000000 1 X 1 1 0 1 1 693000 693000 0.01270 3673395 2659760 1013635 0.01850 4366395 2659760 1706635 0.03120 589405 50547 538858 0.00990 7320225 2030916 5289309 0.09670 58150 58150 0.00110 7967780 2081463 5886317 0.10770 12334175 4741223 7592952 0.13890 5 2100 2100 0.00000 5 2100 2100 0.00000 1 3112928 0 23275543 23280310 -4767 X 1 1 1 1520 VRR LLC Real Estate 0.10000 0.00000 0.90000 1 1 Carson Valley Medical Center 1107 Hwy 395 Gardnerville NV 89410 www.cvmchospital.org 3986RUH-14 X X X X 3 provider based clinics Carson Valley Medical Center 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X See Section C, line 7d X 1 16 1 See Section C, line 7d 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X X 1 X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X X X X X X 1 X 0 X X X X 1 X 0 0 Carson Valley Medical Center Part V, Section B, Line 5: The 2016 Douglas County Community Health Needs Assessment was conducted March - June 2016. The committee included: Carson Valley Medical Center, Health & Human Services (Douglas County Public Health), Government Officials, Fire & Paramedic District, Douglas County Social Services, Partnership of Community Resources, and University of Nevada Reno School of Medicine/Office of Statewide Initiatives. The three components of the 2016 assessment process included:1. A Community Survey was disseminated to all community members to gather input on their health status and views of that of the community as a whole. This survey was developed by the University of Nevada's Office of Statewide Initiatives and sponsored by Carson Valley Medical Center. In addition, a focus group was held to gather information specifically from Spanish-speaking community members. All members of the planning committee aided in the distribution of the Community Survey, and Partnership of Community Resources and CCHHS coordinated the implementation of the focus group for Spanish-speaking community members. 2. A data set using the Nevada Core Health Indicators (v. 1.0) that showcases data on a variety of health outcomes from not only Douglas County, but also the surrounding communities and the state and national levels where available. This data set was compiled by CCHHS staff. 3. A Local Public Health System Performance Assessment (LPHSPA), which brings representatives from a broad spectrum of community organizations together to discuss how well local organizations work together to address community health needs and other public health services. The organization and implementation of this portion of the assessment was the focus of the planning committee. Carson Valley Medical Center Part V, Section B, Line 6b: Health & Human Services (Douglas County Public Health), Government Officials, Fire & Paramedic District, Douglas County Social Services, Partnership of Community Resources, and University of Nevada Reno School of Medicine/Office of Statewide Initiatives. Carson Valley Medical Center Part V, Section B, Line 7d: http://cvmchospital.org/about_us/health_needs_assessment.aspx Carson Valley Medical Center Part V, Section B, Line 11: For the 2016 Community Health Needs Assessment - the following were the community needs identified and addressed in the 2017 - 2019 implementation plan as well as actions that Carson Valley Medical Center has taken to address these areas.1) Cost of Healthcare: * Carson Valley Medical Center has continued to expand wellness programs and affordable screening promotions that give patients options for affordable healthcare screenings and resources. * Carson Valley Medical Center promotes the income-based sliding fee scale at its two rural health clinics. 2) Substance Abuse: * Carson Valley Medical Center has identified the Partnership of Community Resources as a key community partner; and as such Carson Valley Medical Center has a position on the board of directors and actively supports the goals and programs of this non-profit whose mission is to address substance abuse problems, awareness and prevention in our community. * Carson Valley Medical Center developed a plan to expand additional outpatient behavioral health and substance abuse support programs - to be available to our community in 2019. 3) Access to Healthcare: * Carson Valley Medical Center has extended hours for outpatient services including Saturday hours for diagnostic imaging and lab; as well as expanded weekday hours for selected key services. * Carson Valley Medical Center continually works to ensure that we are in-network with all major insurance companies, to be sure that insurance coverage is not a barrier to access for our community. * Carson Valley Medical Center has increased the availability of primary care providers - with same day and walk in appointments available in the primary care clinics. 5 1 - Ironwood Primary Care 897 Ironwood Dr Minden NV 89423 Medical Clinic 2 - Occupational Medicine 897 Ironwood Drive Minden NV 89243 Medical Clinic 3 - Ironwood Urgent Care 897 Ironwood Dr Minden NV 89423 Medical Clinic 4 - Job's Peak Internal Medicine & Family 1520 Virginia Ranch Rd Unit B Gardnerville NV 89410 Medical Clinic 5 - Alpine Medical (Closed May 2018) 1667 Lucerne St Minden NV 89423 Medical Clinic Part I, Line 6a: The organization's community benefit report is available upon request and is posted at www.cvcmhospital.org/about_us/ Part I, Line 7: Part I, Line 7a:Financial Assistance was calculated using the cost-to-charge ratio. All patient segments are addressed using this method. The methodology used is to be in compliance with laws and regulations set forth by Medicare and the filing of the annual cost report. Part I, Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services was calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers.Part I, line 7e:Community health improvement services are actual costs reported in the general ledger. Part I, line 7i:Cash and in-kind donations are actual costs reported in the general ledger. Part I, Line 7g: Carson Valley Medical Center runs 8 physician clinics to treat patients in the community. The clinics need to be subsidized by the hospital to meet their payroll and other monthly expense needs. The subsidized health services amount includes $2,925,537 associated with two rural health clinics and $3,557,045 from physician clinics. 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 $ 3,112,928. Part II, Community Building Activities: Carson Valley Medical Center offers a series of community support groups provided as a free service to engage our community members in education, guidance, and support to improve their health and their quality of life. The support groups including weight management, Alzheimer's support, coping with change, grief, and diabetes. Part III, Line 2: The Hospital uses the reserve method in recognizing bad debt expense based on historical trends and information available at the time of recognition. We do not classify amounts that could be attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy without sufficient information. Part III, Line 3: The Hospital reported bad debt in accordance with HFMA Statement 15, and therefore, bad debt expense does not include charity care. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses is located on page eight of the attached financial statements. Part III, Line 8: The expenses represent an overall shortfall of the Medicare patient population. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The general billings and collections policy applies to all patients, including any application under the charity care policy. The Hospital does not send patient accounts to collections before 120 days of the date of the first invoice. The Hospital will pull back patient accounts from collections if a patient submits a financial assistance application within 240 days of the date of the first invoice. Part VI, Line 2: In addition to the community health needs assessment, Carson Valley Medical Center regularly assesses data trends and utilization data from internal sources as well as secondary sources (state and local agencies, Nevada Rural Hospital Partners, Nevada Hospital Association, etc.) to assess community need. Carson Valley Medical Center partners with local development authority, Chambers of Commerce, and government committees to ensure Carson Valley Medical Center is responding to the needs of the community. Part VI, Line 3: Communication is via website, brochures, telephone and in person. Website is www.cvmchospital.org/patients_visitors/financial_assistance.aspx Part VI, Line 4: Carson Valley Medical Center serves Douglas County -- an area spanning 710 square miles and including eight ZIP codes: 89705 (south Carson City), 89460 (Gardnerville Ranchos), 89411 (Genoa), 89423 (Minden), 89448 (Zephyr Cove), 89449 (Stateline), 89444 (Topaz Ranch) and 89410 (Gardnerville); as well as outlying areas that include Wellington NV, Markleeville, CA and Coleville, CA. This broad area encompasses various neighborhood settings, including both rural and suburban areas. Carson Valley Medical Center is in Douglas County, NV - which has a population of 47,118 (84% white, 12% Hispanic, 2% Native American). Median household income: $56,613, with 10.2 percent of population in poverty. (Data from Carson City Health & Human Services: Primary & Secondary Data Sets, 2016). Part VI, Line 5: The majority of the organization's board of directors is comprised of persons serving in the medical community of the greater Northern Nevada area. The organization extends medical staff privileges to credentialed and approved practitioners in its community. The organization's mission is to promote the health and wellness of the Carson Valley and its visitors. Surplus funds are used to acquire equipment and resources that improve patient care.Carson Valley Medical Center Emergency Room is available to all patients, regardless of ability to pay.Carson Valley Medical Center is committed - as the community hospital - to promote the health of the members of the community. We do so through community outreach and wellness programs, including reaching out to local employers in our workplace wellness programs and offering low cost and free screenings to detect and prevent illness and disease. The hospital operates a 24 hour emergency room for medically necessary care to all regardless of ability to pay. The hospital participates in education and training of healthcare professionals. The hospital participates in government-sponsored health programs such as all Medicaid, Medicare, Tricare, all Veterans Administration healthcare and Indian Health Services. The organization is the sole community hospital in Douglas County. The organization currently has 21 active volunteers. The organization has numerous employees involved in local and state community programs including Douglas County Business Council, Minden Rotary, Carson Valley Chamber of Commerce, Nevada Rural Hospital Partners, National Association for Healthcare Quality, American Hospital Association, MGMA, Boy Scouts of America, Family Support Council of Douglas County, Partnership of Community Resources, Tahoe Youth and Family Services, Kiwanis Club of Carson Valley, and the Douglas County Community and Senior Center.Community outreach and education are provided to our community members to increase awareness of prevalent health issues and promote healthy behaviors and lifestyles. Programs include workplace wellness, health fairs, career days, and services provided at large-scale community events. The organization is responsive to the community needs such as opportunities for community involvement in governance and advisory groups. The organization serves as a vehicle for attracting and effectively uses donated funds. Part VI, Line 6: Although this hospital is not in an affiliated health system, it does have two parent companies serving different communities, in different states. One is approximately 15 miles away while the other is approximately 45 miles away. Part VI, Line 7, Reports Filed With States NV,CA X X 1 0 0 0 0 0 0 0 0 Allan Scroggins Interim CFO Consultant (Mar-Aug) 245803 0 0 0 0 0 0 0 0 0 245803 0 0 0 Shannon Albert Interim CEO (Jan-May) 143246 0 2945 0 279 0 3711 0 18761 0 168942 0 0 0 Jeff Prater CEO (Jun-Dec) 121041 0 27277 0 281 0 0 0 9364 0 157963 0 0 0 Brandon Battis Pharmacist 156936 0 3285 0 0 0 5772 0 28420 0 194413 0 0 0 Greg Ponsness Pharmacy Manager 154980 0 3225 0 450 0 5672 0 22632 0 186959 0 0 0 Kathryn Cocking Chief Nursing Officer 143540 0 2968 0 1920 0 5222 0 10326 0 163976 0 0 0 Valerie Harrell Medical Imaging Technician 127366 0 2630 0 0 0 2632 0 21253 0 153881 0 0 0 Part I, Line 4a Mike Ellis received severance payments of $11,538. A Douglas County Nevada 886000031 2013-04-17 8700000 Refinance 2003 bond issued 04/15/2003; purchase & build urgent care center 0 0 0 A 2853461 8700000 174000 2621962 5904038 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 1 1 0 0 0 1 A 0 Date Rebate Computation Performed Issuer Name: Douglas County, Nevada Date the Rebate Computation was Performed: 10/08/2018 Form 990, Part VI, Section A, line 2 Hakeem Olanrewaju has a business relationship with Sy Johnson and Dawn Ahner. Clint Purvance has a business relationship with Richard Derby. Form 990, Part VI, Section A, line 6 The Corporation shall have two (2) Members, which shall be Renown Health and Barton Healthcare System. Form 990, Part VI, Section A, line 7a Each member shall have the right to appoint 50% of the board members. Each member has the right to remove any or all of its designated directors at any time and from time to time. Form 990, Part VI, Section A, line 7b The following actions or items will require the approval of the Members prior to implementation or becoming effective: (a) Approval of long-term or material agreements involving more than two hundred fifty thousand dollars, including but not limited to borrowings, equity financings or capitalized leases, and agreements involving the sale or disposition of assets which involve the receipt or payment of more than two hundred fifty thousand dollars; (b) Approval of the Corporation's strategic plan and selection or approval of the manager or senior executives of the Corporation; (c) Any amendment or modification of the Corporation's Articles of Incorporation or the Bylaws; (d) Approval of the Corporation's operating and capital budgets (e) Admit any additional members; (f) Approval of any capital or other investment (including real property) or purchase in excess of the amount approved in the annual budget and any revisions thereto; (g) A sale, lease, conveyance or other transfer of all or substantially all of the assets of the Corporation; and (h) A merger, consolidation, reorganization or dissolution of the Corporation. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b A draft copy of the Form 990 is reviewed in detail by the organization's Chief Finance Officer. An electronic copy of the Form 990 is sent to all voting members of the board of directors for their review and comments prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers directors, officers and managing employees of Carson Valley Medical Center. According to established policies there is an on-going review of contracts and enforcement is handled by the Corporate Compliance Officer. If a potential conflict is disclosed the interested person is required to leave the Board or committee meeting while the matter is discussed and voted upon. The remaining Board or committee members determine if a conflict does exist. Form 990, Part VI, Section B, line 15a The CEO, CFO, and key employees' compensation are determined using a regionally recognized market survey and competitor comparisons. The CEO's compensation is also reviewed and approved by the board of directors. The compensation is reviewed annually. The CEO and Human Resources review the compensation of the CFO. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, line 11g Repairs and Maintenance : Program service expenses 796,917. Management and general expenses 58,962. Fundraising expenses 0. Total expenses 855,879. Consulting : Program service expenses 123,582. Management and general expenses 578,906. Fundraising expenses 0. Total expenses 702,488. Other : Program service expenses 951,293. Management and general expenses 54,494. Fundraising expenses 0. Total expenses 1,005,787. Purchased Services : Program service expenses 349,512. Management and general expenses 348,470. Fundraising expenses 0. Total expenses 697,982. Contract : Program service expenses 857,991. Management and general expenses 0. Fundraising expenses 0. Total expenses 857,991. Consulting-401K : Program service expenses 0. Management and general expenses 15,990. Fundraising expenses 0. Total expenses 15,990. Medical Purchased Services: Program service expenses 7,633,263. Management and general expenses 135,816. Fundraising expenses 0. Total expenses 7,769,079. Form 990, Part XI, line 9: Net Assets Adjustment -10,999. Carson Valley Medical Center Rural Health Clinic LLC 1107 Highway 395 Gardnerville NV 89410 261513495 Rural health and senior care clinic NV 0 0 Washoe Barton Medical Clinic Carson Valley Medical Center Foundation Inc 1107 Highway 395 Gardnerville NV 89410 364649725 Charitable Foundation NV 501(c)(3) Line 7 Washoe Barton Medical Clinic 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0