2018-05-11T09:46:11-05:00 2017-06-30 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2016-07-01 840255530 Lutheran Hospital Association of the San Luis Valley % THE ORGANIZATION LUTH 7195892511 106 BLANCA AVENUE ALAMOSA CO 81101 KONNIE MARTIN CEO 7195892511 2018-05-15 true Adam R Smith CPA P00958966 7194714290 167.68.126.162 84022720181315000004 2018-05-11 P B98F60208C01E221655A9D02B96D47F177C0D12C 7E88F371C52F321CAC265BAA5887B5821BA85A3C 2016 2021-01-29 14:40:06Z San Luis Valley Health KONNIE MARTIN 106 BLANCA AVENUE ALAMOSA CO 81101 88987565 false X WWW.SANLUISVALLEYHEALTH.ORG X 1928 CO TO BE A PREMIER, FULLY INTEGRATED RURAL HEALTH CARE SYSTEM PROVIDING EXCEPTIONAL PATIENT-CENTERED SERVICES TO THE SAN LUIS VALLEY. 15 10 829 14 0 1623975 891320 84893888 87415565 84996 200051 286657 411125 86889516 88918061 22221 78942 0 0 44015010 50204609 0 0 269571 38932263 36347411 82969494 86630962 3920022 2287099 84611576 89586153 31577655 33678186 53033921 55907967 X AN UNCONDITIONAL COMMITMENT TO EXCELLENCE BY PROVIDING QUALITY, COMPASSIONATE CARE GUIDED BY OUR VALUES. WE ACCEPT RESPONSIBILITY FOR PROVIDING SERVICES TO OUR COMMUNITY THAT ARE OF THE HIGHEST CALIBER OF SERVICE AND STANDARD PERFORMANCE, WHILE DEMONSTRATING OUR ADOPTED VALUES. false false 65428875 78942 87333505 SAN LUIS VALLEY HEALTH WAS FORMED JULY 1, 2013. PRIOR TO THE MERGER THAT CREATED SAN LUIS VALLEY HEALTH, THE HOSPITAL OPERATED AS AN INDEPENDENT, NOT-FOR-PROFIT HOSPITAL FOR OVER 83 YEARS. THE MERGER BROUGHT TOGETHER SAN LUIS VALLEY REGIONAL MEDICAL CENTER AND CONEJOS COUNTY HOSPITAL. PRIOR TO THE MERGER, CONEJOS COUNTY HOSPITAL HAD BEEN MANAGED BY SAN LUIS VALLEY REGIONAL MEDICAL CENTER SINCE 2003. SLV HEALTH SERVES THE SIX COUNTIES OF THE SAN LUIS VALLEY WITH A POPULATION OF JUST UNDER 50,000 AND AN AREA OF OVER 8,200 SQUARE MILES; LARGER THAN THE STATE OF NEW JERSEY. SLV HEALTH EMPLOYS OVER 600 EMPLOYEES AND IS THE LARGEST EMPLOYER IN THE SAN LUIS VALLEY. THE TRUSTEES, PROVIDERS AND STAFF OF SLV HEALTH ARE UNDERSTANDABLY PROUD OF THEIR TRADITION FOR PROVIDING CARE AND SERVICE TO OUR COMMUNITIES. SERVING OUR LOW-INCOME COMMUNITY MEANS THAT WE HAVE A CHALLENGING PAYER MIX WITH HIGH MEDICAID, UNINSURED AND RELATIVELY LOW COMMERCIAL PERCENTAGES. THIS HAS LED TO OUR ORGANIZATION BEING RESOURCEFUL, CREATIVE AND INNOVATIVE IN ORDER TO CONTINUE SERVICE WITH POSITIVE OPERATING MARGINS. OVER THE LAST TEN YEARS, OUR GROSS REVENUE HAS INCREASED FROM $20M TO $190M AND THE NUMBER OF PATIENTS SERVED HAS EXPANDED SEVERAL FOLD. NEW SERVICES HAVE BEEN ADDED IN MEDICATION ONCOLOGY, INPATIENT REHABILITATION, SLEEP DISORDERS, WOMEN'S IMAGING CENTER, FIXED WING MEDICAL TRANSPORTATION, GENETIC COUNSELING, BEHAVIORAL HEALTH, CARDIOLOGY, CHIROPRACTIC, ONCOLOGY/INFUSION THERAPY, UROLOGY AND MORE. 65428875 true true false true false false false false false true true false false true true false false true false false false false false false false false true true true false true false false false false false false true false false false false false false true true false false true 90 0 829 true false false false false false false false false false false X 15 10 true false false false false false false true true false false true true true true true true true true false X THE ORGANIZATION 7195892511 106 BLANCA AVENUE ALAMOSA CO 81101 X Karla Hardesty President 2.0 0.0 X X 2750 0 0 Jim Ehrlich Vice President 2.0 0.0 X X 600 0 0 Kendall Knaus Secretary/Treasurer 2.0 0.0 X X 51500 0 0 Jan Gay Trustee 2.0 1.0 X 800 0 0 Patrick Crowder Trustee 2.0 0.0 X 900 0 0 Kathy Lorenz Trustee 2.0 1.0 X 600 0 0 Cheri Crowder Trustee 2.0 1.0 X 1000 0 0 Rosalie Martinez Trustee 2.0 2.0 X 500 0 0 Donald Shawcroft Trustee 2.0 1.0 X 500 0 0 Richard Martin Trustee 2.0 0.0 X 600 0 0 Kasey Russell Trustee 2.0 0.0 X 300 0 0 Susan Geiger Trustee, Physician 40.0 0.0 X 107431 0 5317 Dennard Ellison Trustee, Physician 40.0 0.0 X 395838 0 25676 Nuwan Pilapitiya Trustee, Physician 40.0 0.0 X 227071 0 24046 CArmelo Hernandez Trustee, Physician 40.0 0.0 X 297282 0 18725 Konnie Martin CEO 40.0 2.0 X 370785 0 25713 Shane Mortensen CFO 40.0 2.0 X 201273 0 22695 Patti Thompson COO 40.0 0.0 X 215549 0 17391 Greg McAuliffe CMO 25.0 0.0 X 342724 0 12810 Kelly Gallegos CCH Administrator 40.0 0.0 X 158560 0 13270 Antonio Gurule Clinic Administrator 40.0 0.0 X 118500 0 14646 Robert Marshall Physician 40.0 0.0 X 421362 0 25713 Maureen Cooper Physician 40.0 0.0 X 447602 0 25587 David Geiger Physician 38.0 0.0 X 407020 0 25257 Carissa Tripi Physician 40.0 0.0 X 533988 0 25713 James Grigsby Physician 40.0 0.0 X 404588 0 25713 4709623 0 308272 68 false true false CARETECH SOLUTIONS INC PO Box 674271 DETROIT MI 48267 CONTRACT SERVICES 1452750 WEATHERBY LOCUMS PO Box 972633 DALLAS TX 75397 CONTRACT LABOR 247419 Hankins Orthapaedic 2708 S Pennisula Dr DAYTONA BEACH FL 32118 CONTRACT LABOR 455400 Mountain Iron Services 281 Tall Spruce Circle BRIGHTON CO 80601 CONTRACT SERVICES 346691 INNOVA EMERGENCY MEDICAL ASSOCIATES PO Box 912601 DENVER CO 802912601 CONTRACT LABOR 2235925 11 28693 74319 788308 12250 891320 PATIENT SERVICE REVENUE 561110 43712460 43712460 MEDICARE/MEDICAID 561110 42327450 42327450 ELECTRONIC HEALTH RECORD PAYMENTS 900099 458562 458562 AMBULANCE DISTRICT REVENUE 621910 375060 375060 340B PAYMENTS 900099 324242 324242 217791 217791 87415565 200051 200051 0 0 49388 69504 -20116 0 -20116 -20116 0 0 0 0 0 0 0 0 0 0 CAFETERIA SALES 722514 223083 223083 ABSTRACTS REVENUE 900099 23508 1866 21642 MISCELLANEOUS REVENUE 900099 184650 131207 53443 431241 88918061 87548638 478103 78942 78942 0 0 0 2982939 1515969 1451963 15007 454776 454776 38290779 30979315 7146696 164768 1229219 999980 223963 5276 4730920 3764400 946154 20366 2515976 1989754 515385 10837 0 163161 163161 120201 120201 4858 4858 0 0 5007909 3114414 1893495 83961 82901 1060 1607942 283562 1320447 3933 1989381 854530 1134851 0 842327 528737 313590 419809 264702 155097 10 0 17539 17539 857361 857361 0 3097315 2336444 760871 1211224 511924 697853 1447 MEDICAL SUPPLIES 11565127 11565127 PROVIDER FEES 2958246 2958246 BAD DEBT 1758532 1758532 REPAIRS & MAINTENANCE 2297607 1082526 1215081 2344911 386995 1911049 46867 86630962 65428875 20932516 269571 1082910 993780 18752351 23982564 15139 7861 11132401 11808096 0 0 0 0 0 0 1332005 1710359 2165053 2078969 74567080 41796769 32619857 32770311 11615599 10017387 12100 12100 416948 759406 0 0 5467213 5445320 84611576 89586153 9703161 12488811 0 0 74786 171139 0 0 0 0 0 0 21529177 20743030 0 0 270531 275206 31577655 33678186 X 52616975 55148569 416946 759398 0 0 53033921 55907967 84611576 89586153 X 2287099 244489 342458 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 4858 4858 false schedule c, Part II-B, Line 1i Description of lobbying activities: San Luis Valley Health received correspondence from the Colorado Health and Hospital Association and the American Hospital Association regarding their membership dues. A portion of their dues were attributable to lobbying and appear on line 1i. 35345 10980 43 46368 24766 10547 32 35345 10388 14360 18 24766 4373 6009 6 10388 3701 668 4 4373 1.00000 false true true 3432682 3432682 42433623 21351858 21081765 25005934 19702889 5303045 3694841 742022 2952819 32770311 HUD REFINANCING COSTS 1314954 MOUNTAIN STATE SSA RECEIVABLE 677652 MALPRACTICE RECEIVABLE 275000 HUD ESCROW 3177714 5445320 0 ASSET RETIREMENT OBLIGATION 270531 OTHER LIABILITY 4675 275206 87523181 244489 196829 441318 87081863 1836198 1836198 88918061 84649135 69504 69504 84579631 2051331 2051331 86630962 SCHEDULE D, PART V, LINE 4 Describe the intended uses of the organization's endowment funds: SAN LUIS VALLEY HEALTH FOUNDATION (THE FOUNDATION) AND THE MEDICAL CENTER ARE FINANCIALLY INTERRELATED ORGANIZATIONS. THE MISSION OF THE FOUNDATION IS TO SUPPORT THE HEALTH CARE SERVICES OF THE MEDICAL CENTER AND THE COMMUNITIES IT SERVES. THE MEDICAL CENTER ACCOUNTS FOR ITS INTEREST IN THE NET ASSETS OF THE FOUNDATION IN A MANNER SIMILAR TO THE EQUITY METHOD. THE TEMPORARILY RESTRICTED NET ASSETS REPRESENTS THE INTEREST IN THE NET ASSETS OF THE FOUNDATION. WHEN ASSETS ARE TRANSFERRED TO THE SLVH BY THE FOUNDATION, THE CONTRIBUTIONS ARE RESTRICTED TO THE PURCHASE OF EQUIPMENT AND FACILITY EXPANSION. Schedule D, Part X, Line 2 Uncertain Tax Positions: Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. SCHEDULE D, PART XI, LINE 2D REVENUE ON BOOKS, NOT ON RETURN: change in investment in foundation 342,458 rental expenses reclassed from expense to revenue 69,504 Change in SSA Account (215,133) Total 196,829 SCHEDULE D, PART XI, LINE 4B REVENUE ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE RECLASSED FROM EXPENSE TO REVENUE 1,758,532 CONTRIBUTIONS REVENUE RECLASSED FROM EXPENSE 77,666 Total 1,836,198 SCHEDULE D, PART XII, LINE 2D EXPENSE ON BOOKS, NOT ON RETURN: RENTAL EXPENSES RECLASSED FROM EXPENSE TO REVENUE 69,504 SCHEDULE D, PART XII, LINE 4B EXPENSE ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE RECLASSED FROM EXPENSE TO REVENUE 1,758,532 CONTRIBUTIONS REVENUE RECLASSED FROM EXPENSE 77,666 Change in SSA Account 215,133 TOTAL 2,051,331 true true X true X true X true true false true true 468500 44993 423507 0.00500 25379863 23307067 2072796 0.02450 292749 166580 126169 0.00150 26141112 23518640 2622472 0.03100 278953 44121 234812 0.00280 247939 247939 0.00290 171298 97345 73953 0.00090 589 589 91229 91229 0.00110 790008 141466 648522 0.00770 26931120 23660106 3270994 0.03870 7352 7352 3666 3666 8323 8323 467 467 13339 13339 6449 6449 36263 36263 75859 75859 true 1758532 21376672 19937955 1438717 X true true 2 1 Lutheran Hospital of SLV 106 Blanca Avenue Alamosa CO 81101 www.sanluisvalleyhealth.org 011001 X X X X 1 2 Conejos County Hospital 19021 US Hwy 285 La Jara CO 81140 www.sanluisvalleyhealth.org 011020 X X X 1 1 false false true X X X X X X X X X 15 true false false true X SEE PART V, SECTION C FOR URL X true 15 true SEE PART V, SECTION C FOR URL false true X 100 200. X X X true true X X X X true X part v, section c for url X part v, section c for url X part v, section c for url X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 Input from Representatives of the Community: SLVH leadership representatives, in collaboration with Colorado Rural Health center, conducted a survey of interested San Luis Valley residents. The survey included 44 questions on a variety of health and provider issues. The health questionnaire for SLVH was distributed by the hospital and the community group members using paper and web-based surveys. They were given to the community group following the first meeting and participants were encouraged to have their colleagues, friends, and family complete the survey as well. To aid leadership representatives in the assessment of the communitys health needs, the community group was comprised of interested agencies and organizations serving health, education, commercial and government interests in the San Luis Valley. - Adams State University - Adams State University Veterans Program - Blue Peaks Developmental Services - City of Alamosa and City Council - City of Monte Vista and City Council - Rio Grande County Public Health - San Luis Valley Behavioral Health Group - San Luis Valley Development Resource Group - San Luis Valley Public Health Partnerships - San Luis Valley Small Business Development Center - Valley Wide Health Systems - Valley Wide Health Systems, Nurse-Family Partnerships SCHEDULE H, PART V, SECTION B, LINE 7A Hospital facility's website where CHNA is made Widely Available: http://www.sanluisvalleyhealth.org/sites/default/files/images/chna_final_r eport-slvh-6-16.pdf The CHNA can also be found by going to the home page of organization's website under quick links, click on "get financial assistancea link to the most recent CHNA is listed under the community needs assessment heading. SCHEDULE H, PART V, SECTION B, LINE 10A Website where the Implementation strategy is made widely available: HTTP://WWW.SANLUISVALLEYHEALTH.ORG/SITES/DEFAULT/FILES/IMAGES/CHNA_FINAL_R EPORT-SLVH-6-16.PDF THE IMPLEMENTATION STRATEGY IS LOCATED ON PAGE 10 OF THE CHNA EXECUTIVE SUMMARY WHICH CAN BE FOUND by going to the home page of organization's website, under quick links click on "get financial assistance," click on the "2016 executive summary." SCHEDULE H, PART V, SECTION B, LINE 11 San Luis Valley Health (SLVH) developed responses to identified community needs based on organizational capacity and mission of the corporation. The primary need identified by the survey was for substance abuse services.SLVH has hired an additional Behavioral Health Therapist and has increased care coordination services in its busiest primary health care clinic where Screening Brief Intervention and Referral to Treatment (SBIRT) screenings are completed. SLVH has also coordinated case conferences and community dialogues with San Luis Valley Behavioral Health Group to work on identified challenges and opportunities for improvement on an ongoing and as needed basis.Hospital and clinic staff participate in the SLV Neonatal Task Force, and recently the outpatient Quality Improvement Committee has begun work to update opioid pain management guidelines for the organization. SLVH developed strategies, or is already addressing all other needs identified in the 2016 CHNA. San Luis Valley Health continued to work on the needs identified in the 2016 CHNA in 2017 through the following initiatives. THE PRIMARY NEED IDENTIFIED IN THE 2016 NEED ASSESSMENT WAS FOR SUBSTANCE ABUSE SERVICES AND MENTAL HEALTH CARE. ALL SLVH PRIMARY CARE CLINICS PROVIDE SCREENING BRIEF INTERVENTION REFERRAL tO TREATMENT (SBIRT), DRUG ABUSE SCREENING TESTS (DAST), PAIN MANAGEMENT AGREEMENTS, PRESCRIPTION DRUG MONITORING, REFERRAL TO MEDICATION ASSISTED TREATMENT (MAT), SOCIAL SUPPORTS AND CARE COORDINATION FOR PATIENTS AT RISK OR USING SUBSTANCES. OTHER ANCILLARY SUPPORTS INCLUDE PHYSICAL THERAPY AND CHIROPRACTIC TREATMENT. SLVH EMERGENCY DEPARTMENTS ARE IMPLEMENTING CLINICAL GUIDELINES FOR ALTERNATIVES TO OPIOIDS (ALTO) TO HELP ADDRESS THE OPIOID EPIDEMIC. SLVH STAFF CONTINUE TO PARTICIPATE IN COMMUNITY COLLABORATIONS TO STRENGTHEN SUBSTANCE ABUSE RESOURCES IN THE SAN LUIS VALLEY. ADDITIONALLY, SLVH WAS AWARDED GRANT FUNDING TO ADVANCE BEHAVIORAL HEALTH AND CARE COORDINATION IN ITS SYSTEM OF CARE. TWO FTE HAVE BEEN HIRED AND A THIRD POSITION IS IN PROCESS. THESE STAFF WILL PARTICIPATE IN THE DEVELOPMENT OF INTEGRATED BEHAVIORAL HEALTH TREATMENT PLANS AND FOLLOW UP ON EMERGENCY ROOM AND HOSPITAL UTILIZATION IN ORDER TO POSITIVELY IMPACT CLINICAL OUTCOMES, PATIENT/PROVIDER SATISFACTION, AND COST OF CARE. Schedule H, Part V, Section B, Line 16a URL where FAP is made widely available on a website: http://www.sanluisvalleyhealth.org/sites/default/files/images/financial_as sistance_policy_0.pdf The financial assistance policy can also be found by going to the home page of organization's website, under quick links click on "get financial assistancethere will be a "Financial Assistance policy" hyperlink. Schedule H, Part V, Section B, Line 16B URL where FAP application form is made widely available on a website: http://www.sanluisvalleyhealth.org/sites/default/files/images/charity_care _application.pdf The FAP Application form can also be found by going to the home page of organization's website, under quick links click on "get financial assistancethere will be an "application" hyperlink. Schedule H, Part V, Section B, Line 16C URL where the plain language summary of the fap is made widely available on a website: http://www.sanluisvalleyhealth.org/sites/default/files/images/plain_langua ge_summary_3252016.pdf The plain language summary can also be found by going to the home page of organization's website, under quick links click on "get financial assistancethere will be a "plain language summary" hyperlink. 5 Stuart Avenue Clinic 2115 Stuart St Alamosa CO 81101 Physician Clinic Rural Health Clinic - Antonito 115 Main St Antonito CO 81120 Rural Health Clinic Rural Health Clinic - La Jara 509 Main St La Jara CO 81140 Rural Health Clinic Rural Health Clinic - Monte Vista 103 Chico Court Monte Vista CO 81144 Rural Health Clinic Monte Vista Pro Therapy 2360 Sherman Avenue Monte Vista CO 81144 sports medicine physical therapy SCHEDULE H, Part I, Line 7 THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A,7B & 7C. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS. SCHEDULE H, Part I, Line 7, Column (f) TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = 1,758,532. SCHEDULE H, PART II ALL COMMUNITY BUILDING ACTIVITIES ARE IMPLEMENTED BASED UPON THE COMMUNITY NEEDS IDENTIFIED IN THE COMMUNITY NEEDS ASSESSMENT CONDUCTED EVERY THREE YEARS, AS WELL AS VARIOUS COMMUNITY PARTNERSHIP MEETINGS. SCHEDULE H, PART III, Section A, LINE 2 the Organization analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. SCHEDULE H, PART III, Section A, LINE 3 THE ORGANIZATION DOES NOT CONSIDER ANY OF ITS BAD DEBT EXPENSE TO BE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART III, Section A, LINE 4 THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, Section B, LINE 8 THE COSTING METHODOLOGY TO DETERMINE LINE 6 WAS THE OVERALL FACILITY COST-TO-CHARGE RATIO. THE TIMING OF REVENUES FROM MEDICARE WILL NOT ALWAYs CORRESPOND TO THE TIMING OF THE EXPENSES. BASED ON MEDICARE COST REPORTS FILED AFTER THE END OF THE YEAR THERE MAY BE ADDITIONAL REVENUES DUE THE HOSPITAL OR AMOUNTS DUE BACK TO MEDICARE. THE SURPLUS OR (SHORTFALL) FOR THE LAST THREE YEARS IS AS FOLLOWS: 6/30/15 85,840 6/30/16 (631,830) 6/30/17 1,438,717 SCHEDULE H, PART III, Section C, LINE 9b For patients who are known to qualify for financial assistance, the collection process follows these steps: a. Patients are contacted by brochure, mail and phone calls from a Financial Counselor, or the Patient Access Manager. Letters sent, brochures given and outbound phone calls and responses are noted in patient notes in the patient's profile. b. Patients who qualify for assistance will present information to the Financial Counselors who will update the registration section of the patient profile. Bilingual counselors or interpreters are available. c. Patients will be informed of their responsibility to pay co-payments or other sliding fee patient responsibility amounts. They will be informed in person and by phone whenever possible. Payment plans are always offered for patients who cannot afford their portion. d. Patients who do not pay their portion or co-payment will receive an invoice, printed in English and Spanish, directing them to pay or to call. If the patient calls and requests assistance from the Financial Counselor, they will be directed to the customer service phone number. e. Patients will receive up to 3 letters and 2 phone calls from a contracted, 3rd party vendor who have bilingual specialists. When 90 days have passed without any response from the patient, the account will be reviewed by the Patient Access Manager as well as the Patient Account Manager-Cash Posting, both members of the Business Revenue Cycle team. f. Upon review, if the portion is deemed to be the responsibility of the patient, the process toward collections will begin. A letter is sent to the patient from the third party company. The third party collection company follows legal proceedings at this point. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: SLV HEALTH SUBMITS MANY GRANTS EVERY YEAR TO IMPROVE COMMUNITY HEALTH. EACH GRANT INCLUDES A SUMMARY OF KNOWN HEALTH DATA TO JUSTIFY THE NEED FOR THE FUNDS. AS A CONSEQUENCE WE ARE VERY ATTUNED TO OUR COMMUNITY HEALTH NEEDS. THROUGH COMMUICATION WITH PROVIDERS AND COMMUNITY NON-PROFITS, THIS NEED IS ADDRESSED AS REQURIRED. SAMPLE CURRENT AND PAST PROGRAMMING HAVE INCLUDED FREE COLONOSCOPIES, BREAST HEALTH RELATED TESTING, PSA TESTING AND MUCH MORE. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: SLV HEALTH PROVIDES A PATIENT FINANCIAL COUNSELOR WHO IDENTIFIES RESOURCES AND ELIGIBILITY ASSESMENT FOR PROGRAMS THROUGH FEDERAL AND STATE GOVERNMENT PROGRAMS, AS WELL AS GRANT FUNDED PROGRAM. WE ALSO PROVIDE A SLIDING FEE SCALE FOR SERVICE FOR THOSE SELF PAY PATIENTS NOT FITTING WITHIN ANY OF THESE PROGRAMS. PAY PLANS ARE ALSO SET UP FOR SELF PAY PATIENTS. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: Five out of six counties served by SLVH are designated as a Medically Underserved Area and as Health Professional Shortage Areas, and have one of the highest Medicaid populations in the state. With an average household income 1/2 that of Colorados average, the challenges are daunting in providing healthcare in a low income, medically underserved area. Individuals below poverty level in the SLV region average 20.2% which is higher than the state average (12.7%) and rank among the highest in percentage of poverty in the state; median household incomes ($36,926) are far short of Colorados $60,629 [2011-2015 American Community Survey 5-Year Estimates]. The majority of SLVH patients are representative of low-income populations with nearly 71% of patients enrolled in Medicare and/or Medicaid in 2016. The SLV also has pockets of diverse populations including college students, Guatemalan, Amish, seasonal and migrant farmworkers, and other international religious sectors that all have unique needs. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: SLVH is active in the community and supports staff who provide community resources in areas that include health education and information, promoting safety and wellness to the general population, and sponsors behavioral health support groups. Hospital leadership and clinical providers conduct health education information in the areas of adolescent health, care for patients with dementia, skin care, and womens health. SLVH staff also participate in community health initiatives such as adolescent prevention coalitions, opioid use/abuse task force, a neonatal task force, coordination of health care services across the continuum, and workforce development issues. Patient and Family Advisory Councils have also been established to bring the voice of patients and their families into program design and improvement processes. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: SLV HEALTH HAS A PROFESSIONAL AFFILIATION WITH CENTURA HEALTH SYSTEMS TO COORDINATE CARE FOR OUR SHARED PATIENTS. Schedule H, Part VI, Line 7 State Filing of Community Benefit Report: The community Benefit report is filed in Colorado. true ADAMS STATE University Foundation 208 EDGEMONT BLVD ALAMOSA CO 81101 846027518 501(c)(3) 8350 EDUCATION 1 0 Schedule I, Part I, Line 2 Organization's procedures for monitoring the use of grant funds: FUNDS YRE PROVIDED TO BE USED FOR DESIGNATED PURPOSES ONLY. ALL GRANTEES ARE SELECTED AND STRICTLY SCREENED BY THE MEDICAL CENTER. MULTI-YEAR AGREEMENTS ARE MADE WITH THE RECIPIENT ORGANIZATIONS AND ARE EVALUATED ON AN ANNUAL BASIS BEFORE FUNDING IS CONTINUED. X X false false false false false false false true false Dennard Ellison Trustee, Physician 393516 2322 13213 12463 421514 Nuwan Pilapitiya Trustee, Physician 226628 443 11610 12436 251117 Konnie Martin CEO 291061 78482 1242 13250 12463 396498 Shane Mortensen CFO 166867 32874 1532 10386 12309 223968 Patti Thompson COO 179428 34507 1614 10862 6529 232940 Greg McAuliffe CMO 282353 53513 6858 12180 630 355534 Kelly Gallegos CCH Administrator 132208 25937 415 1045 12225 171830 Robert Marshall Physician 385840 33110 2412 13250 12463 447075 Maureen Cooper Physician 440744 6858 13250 12337 473189 David Geiger Physician 370504 32815 3701 13250 12007 432277 Carissa Tripi Physician 508502 25000 486 13250 12463 559701 James Grigsby Physician 402266 2322 13250 12463 430301 CArmelo Hernandez Trustee, Physician 296040 1242 13250 5475 316007 SCHEDULE J, PART I, LINE 7 NON-FIXED PAYMENTS: PHYSICIANS MAY EARN A PRODUCTIVITY BONUS. SENIOR MANAGEMENT IS ELIGIBLE FOR ANNUAL VARIABLE PAY UP TO 35% FOR CEO AND 20% FOR ALL OTHER SENIOR MANAGEMENT BASED UPON CRITERIA INCLUDING HOSPITAL WIDE MEASURES AND POSITION SPECIFIC GOALS. VARIABLE PAY IS AWARDED AT THE DISCRETION OF THE BOARD FOR THE CEO AND THE CEO FOR ALL OTHER SENIOR MANAGEMENT. DAVID GEIGER see part V 454776 employment wages SCHEDULE L, PART IV, COLUMN B Relationship between interest person and the organization: BOARD MEMBER SUSAN GEIGER HAS A FAMILY RELATIONSHIP WITH EMPLOYEE DAVID GEIGER, WHO RECEIVED EMPLOYMENT WAGES FROM THE ORGANIZATION DURING THE YEAR. FORM 990, PART VI, SECTION A, LINE 2 Family/Business Relationships: BOARD OF DIRECTOR MEMBERS CHERI CROWDER AND PATRICK CROWDER HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B Process to Review the Form 990: THE 990 IS PREPARED BY A THIRD PARTY ORGANIZATION, REVIEWED BY THE CFO AND CEO, AND APPROVED BY THE FINANCE COMMITTEE. THE BOARD OF DIRECTORS IS ALSO PROVIDED A COPY OF THE 990 FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C Process for Monitoring Compliance with Conflict of Interest Policy: SAN LUIS VALLEY HEALTH HAS A CURRENT CONFLICT OF INTEREST POLICY THAT IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES AND THE CEO. THE REVIEW PROCESS IS CONDUCTED FIRST WITH THE CEO AND THEN THE BOARD OF TRUSTEES. WHEN NECESSARY, THE POLICY HAS BEEN REVIEWED BY LEGAL COUNSEL. EACH YEAR, TRUSTEES ARE ASKED TO REVIEW THE POLICY AND CONFIRM AND AMEND ANY POTENTIAL CONFLICT. THESE CONFLICTS ARE REVIEWED BY THE CEO AND THE ENTIRE BOARD. CONFLICTS ARE ROUTINELY DISCUSSED AND ARE THE RESPONSIBILITY OF ALL BOARD MEMBERS TO DISCLOSE; EITHER FOR THEMSELVES OR OTHERS. THE BOARD CHAIRMAN WILL MAKE A DECISION AS TO THE NATURE OF THE CONFLICT AND THE APPROPRIATE ACTION ACCORDING TO THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A Review of CEO or Top Management Official Compensation: HUMAN RESOURCES PROVIDES THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY SURVEY DATA FROM CHA, AHA, AND HFMA. AFTER STUDYING THE DATA, THE EXECUTIVE COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD IN EXECUTIVE SESSION. THE FULL BOARD APPROVES THE CEO'S COMPENSATION. SLVH CONDUCTS AN ANNUAL EVALUATION AND QUARTERLY REVIEWS OF THE CEO'S PERFORMANCE, WHICH IS DOCUMENTED. COMPENSATION FOR THE CEO IS DETERMINED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15B Review of Other Officer or Key Employees Compensation: HUMAN RESOURCES GATHERS COMPENSATION SURVEY DATA FROM CHA, AHA, AND HFMA. HUMAN RESOURCES MAKES RECOMMENDATIONS FOR OTHER OFFICERS' COMPENSATION AND PROVIDES SURVEY DATA TO THE CEO. THE CEO PERFORMS EVALUATIONS AND DETERMINES ALL OF THE WAGE CHANGES FOR THE OTHER OFFICERS ON AN ANNUAL BASIS. ALL CHANGES ARE DOCUMENTED. FORM 990, PART VI, SECTION C, LINE 19 Describe how Governing Documents are made Available to the Public: THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 Other changes in net assets: change in investment in foundation 342,458 CHANGE IN SSA Account (215,133) Total 127,325 SAN LUIS VALLEY HEALTH FOUNDATION 106 BLANCA AVENUE ALAMOSA CO 81101 203799814 FUNDRAISING CO 501(C)(3) LINE 7 SLVH true CONEJOS COUNTY HOSPITAL FOUNDATION 19021 US HWY 285 LA JARA CO 81140 320379184 FUNDRAISING CO 501(C)(3) LINE 7 SLVH true false false true false false false false false false false false true true true true true true false false