2017-11-10T17:11:47-06:00 2016-12-31 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2016-01-01 880502320 CARSON TAHOE REGIONAL HEALTHCARE CARS 7754457901 PO BOX 2168 CARSON CITY NV 89702 ANN BECK VICE PRESIDENT & CFO 7754457901 2017-11-08 1 KURT BENNION CPA P01469618 4252506100 67.137.57.251 2017-11-08 19:11:30 PS P 9AD29FA46B8615F2777C89FEDEB19E0AFF07ACA7 2A84415A8DDCE084F3B0EA99B42C2CE0BBFF9642 2016 2017-02-10 21:41:12Z EDWARD EPPERSON PO BOX 2168 CARSON CITY NV 89702 345008972 0 X WWW.CARSONTAHOE.COM X 2001 NV TO ENHANCE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE. 11 7 1776 178 0 0 25977 2166715 269347466 289612219 2464578 1117353 -425551 11418 271412470 292907705 0 12414690 0 0 95635628 104156486 0 0 534473 152851210 161458717 248486838 278029893 22925632 14877812 336175858 346080390 142395210 135619728 193780648 210460662 X TO ENHANCE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE. 1 0 196208897 12414690 289612219 CARSON TAHOE REGIONAL MEDICAL CENTER IS THE MAIN HUB OF CARSON TAHOE HEALTH SYSTEM. LOCATED IN NORTH CARSON CITY, NEVADA, THE REGIONAL MEDICAL CENTER PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES FOR OVER 250,000 PEOPLE. THESE SERVICES ARE PROVIDED REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY. CARSON TAHOE'S MISSION IS TO ENHANCE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVICE.THE REGIONAL MEDICAL CENTER PROVIDES CARE TO PERSONS, SOME OF WHOM ARE COVERED BY GOVERNMENTAL PROGRAMS INCLUDING MEDICARE AND MEDICAID, AS WELL AS MEDICALLY INDIGENT PATIENTS UNABLE TO PAY. THE COST OF DIRECT AND INDIRECT COSTS FOR SERVICES FURNISHED UNDER ITS CHARITY CARE POLICY WERE APPROXIMATELY $2.36 MILLION IN 2016. THE HOSPITAL ALSO SPONSORS HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY INCLUDING WELLNESS EDUCATION AND SUPPORT. THE HOSPITAL HAD 1,074 INPATIENT DISCHARGES, 4,607 INPATIENT DAYS, AND 248,622 OUTPATIENT REGISTRATIONS IN 2016. CARSON TAHOE REGIONAL MEDICAL CENTER CONSISTS OF AN ACUTE CARE REGIONAL MEDICAL CENTER WITH 159 LICENSED BEDS, INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES WITH A TOTAL OF 46 LICENSED BEDS, A FREE-STANDING LICENSED EMERGENT CARE CENTER, 2 URGENT CARES, ACCREDITED CANCER CENTER, PHYSICIAN CLINICS, RETAIL CLINICS, IMAGING CENTERS, PAIN MANAGEMENT CENTER, THERAPY, REHABILITATION AND SEVERAL MEDICAL OFFICE BUILDINGS. 196208897 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 0 0 0 0 1 1 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 104 0 1776 1 0 0 0 0 0 1 1 0 0 0 0 X 11 7 1 0 1 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 0 0 1 0 NV X MARLENE HARRIS 7754457901 PO BOX 2168 CARSON CITY NV 89702 DON HATAWAY CHAIR 1.00 1.00 X X 0 10084 0 GILBERT YANUCK VICE CHAIR 1.00 0.00 X X 0 0 0 ELIZABETH DUFFRIN TREASURER 1.00 1.00 X X 0 9100 0 JEFFREY BASA MD SECRETARY 1.00 0.00 X X 0 2534 0 BRUCE ROBERTSON ASSISTANT SECRETARY 1.00 1.00 X X 0 9100 0 ED EPPERSON FELLOW, ACHE PRESIDENT & CEO 35.90 4.10 X X 0 673266 40925 KEVIN HALLOW MD VICE CHIEF OF STAFF 1.00 0.00 X 0 0 0 KENT GABRIEL MD DIRECTOR & CHIEF OF STAFF 39.00 1.00 X 0 36922 369 FREEMAN JOHNSON DIRECTOR 1.00 0.00 X 0 0 0 JAMES MANNING DIRECTOR 1.00 0.00 X 0 0 0 LAWRENCE MESSINA DIRECTOR 1.00 1.00 X 0 10300 0 DAVID STRULL MD DIRECTOR 1.00 0.00 X 0 0 0 ANN BECK VICE PRESIDENT & CFO 35.90 4.10 X 0 399534 27675 CYNTHIA KUPERUS DIRECTOR, PERIOPERATIVE SERVICES 40.00 0.00 X 211531 0 20267 TRACEY MCCOLLUM DIRECTOR, NURSING SERVICES 40.00 0.00 X 192017 0 19712 WAYNE MITCHELL DIRECTOR, PHARMACY CLINICAL 40.00 0.00 X 183878 0 19268 SCOTT MATTES DIRECTOR, ANCILLARY SERVICES 40.00 0.00 X 174160 0 18374 KEVIN FLYNN MANAGER, PHARMACY OPERATIONS 40.00 0.00 X 158334 0 18005 919920 1150840 164595 103 0 1 0 LAKE TAHOE REGIONAL HOSPITALISTS 1535 MEDICAL PKWY STE B CARSON CITY NV 89703 PHYSICIAN SERVICES 2279156 COMPREHENSIVE PAIN CARE INC 973 MICA DR 200 CARSON CITY NV 89705 PHYSICIAN SERVICES 1308633 NUANCE COMMUNICATIONS INC 1 WAYSIDE ROAD BURLINGTON MA 01803 TRANSCRIPTION SERVICES 954371 DIVERSIFIED CLINICAL SERVICES 5220 BELFORT ROAD JACKSONVILLE FL 32256 CONTRACT LABOR 896698 NORTHERN NV ANESTHESIA ASSOCIATES 2805 MOUNTAIN ST STE B CARSON CITY NV 89703 PHYSICIAN SERVICES 818927 51 80241 1516154 570320 2166715 PATIENT SERVICES 621110 286311816 286311816 NONPATIENT SERVICES 621110 3300403 3300403 289612219 2602917 2602917 50545618 32050 51255162 808070 -709544 -776020 -1485564 -1485564 0 80241 19215 -19215 -19215 49453 18820 30633 30633 292907705 289612219 0 1128771 12308234 12308234 106456 106456 83599747 64242677 19185398 171672 2707336 2110561 591023 5752 11795211 8229931 3547582 17698 6054192 4692006 1349387 12799 98125 98125 22625300 14864972 7739579 20749 23684 3198 17196 3290 2842697 1612131 1222375 8191 9002286 3707802 5289394 5090 76891 47179 28346 1366 21787 17791 3996 4087592 4087592 14575782 5924227 8651555 129156 129156 MEDICAL SUPPLIES 55289807 54863731 426076 SHARED SERVICES 24428966 24428966 BAD DEBT EXPENSE 18784775 18784775 REPAIRS AND MAINTENANCE 6413083 4315842 2097241 3058786 377384 2393536 287866 278029893 196208897 81286523 534473 8934149 12747014 36413319 33779077 5569590 5176535 4960717 6172695 304423398 134065052 173422943 170358346 98231778 111598807 6254583 6247916 2388779 0 336175858 346080390 22710615 22015990 1066827 474011 101354170 97484684 4808461 4227588 4424000 3946129 8031137 7471326 142395210 135619728 X 193780648 210390501 0 70161 193780648 210460662 336175858 346080390 X 14877812 723024 1079178 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 7109 7109 0 PART II-B, LINE 1: A PORTION OF THE MEMBERSHIP DUES PAID TO THE NEVADA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION WERE USED BY THOSE GROUPS TO LOBBY ON BEHALF OF CARSON TAHOE REGIONAL HEALTHCARE AND OTHER MEMBERS. 55929108 -221485 55707623 47561580 8000000 367528 55929108 46688963 872617 47561580 44747459 1941504 46688963 54112358 1285697 10650596 44747459 1.00000 0.00000 0.00000 0 0 22225019 22225019 146133977 44020143 102113834 16978156 9554721 7423435 116046988 80490188 35556800 3039258 3039258 170358346 MARKET VALUE OF SWAP 6951967 DUE TO AFFILIATES 519359 7471326 X 270827444 814055 814055 270013389 22894316 22894316 292907705 246974919 38035 38035 246936884 31093009 31093009 278029893 PART V, LINE 4: THE FUNDS ARE DESIGNATED FOR CAPITAL IMPROVEMENTS, TO MEET BOND REQUIREMENTS, AND TO PROVIDE FUNDS FOR HEALTH CARE PROGRAM. PART X, LINE 2: THE HOSPITAL HAS BEEN RECOGNIZED AS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (CODE). HOWEVER, THE HEALTH SYSTEM IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. UNDER FASB ASC 740, INCOME TAXES, THE COMPANY IS REQUIRED TO RECOGNIZE A LIABILITY FOR EACH UNCERTAIN TAX POSITION AT THE AMOUNT ESTIMATED TO BE REQUIRED TO SETTLE THE ISSUES. THERE WERE NO LIABILITIES RECORDED FOR UNCERTAIN TAX POSITIONS FOR THE YEAR ENDED DECEMBER 31, 2016. PART XI, LINE 2D - OTHER ADJUSTMENTS: LOSS ON DISPOSAL OF PROPERTY 776,020. SPECIAL FUNDRAISING EVENT EXPENSES 19,215. CHARITABLE GAMING EXPENSES 18,820. PART XI, LINE 4B - OTHER ADJUSTMENTS: INVESTMENT RETURN 1,892,897. DONATED PROPERTY 673,187. CHANGE IN TEMPORARILY RESTRICTED NET ASSETS 70,161. FOUNDATION REALIZED GAIN ON INVESTMENTS 476. PROVISION FOR BAD DEBTS 18,784,775. TRANSFER OF ASSETS FROM CRTH FOUNDATION 1,472,820. PART XII, LINE 2D - OTHER ADJUSTMENTS: SPECIAL FUNDRAISING EVENT EXPENSES 19,215. CHARITABLE GAMING EXPENSES 18,820. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 18,784,775. RELATED PARTY TRANSFERS 12,308,234. HOPEFEST 2016 67032 67032 7675 ART BEAUTY & COMMUNITY 13209 13209 11540 80241 80241 19215 19215 -19215 49453 10000 8820 0 0.00000 49453 10000 8820 18820 30633 NV 1 0 1 0 1.00000 0.00000 MELISSA DAVIS PO BOX 2168 CARSON CITY NV 89702 0 KITTY MCKAY 0 EVENT ORGANIZER X 1 30633 1 1 X 1 X 1 X 1 1 1 0 1 1 2360466 2360466 0.00910 34974220 20190091 14784129 0.05700 37334686 20190091 17144595 0.06610 3920122 89834 3830288 0.01480 293962 0 293962 0.00110 249724 0 249724 0.00100 4463808 89834 4373974 0.01690 41798494 20279925 21518569 0.08300 31720 31720 0.00010 31720 31720 0.00010 1 18784775 0 109163873 99215724 9948149 X 1 1 1 1 CARSON TAHOE REGIONAL MEDICAL CENTER 1600 MEDICAL PARKWAY CARSON CITY NV 89703 WWW.CARSONTAHOE.COM 4466HOS-21 X X X CARSON TAHOE REGIONAL HEALTHCARE 0 0 1 X X X X X X X X X 16 1 1 0 1 X WWW.CARSONTAHOE.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT X 1 16 0 1 0 1 X 200.000000000000 400.000000000000 X X X X 1 1 X X X X 1 X HTTPS://WWW.CARSONTAHOE.COM/FINANCIALSERVICES X HTTPS://WWW.CARSONTAHOE.COM/FINANCIALSERVICES X HTTPS://WWW.CARSONTAHOE.COM/FINANCIALSERVICES X X X X X 1 X 0 X X X X 1 X 0 0 CARSON TAHOE REGIONAL HEALTHCARE PART V, SECTION B, LINE 5: TO ENSURE THE BEST REPRESENTATION OF THE POPULATION, A TELEPHONE INTERVIEW METHODOLOGY - INCORPORATING BOTH LANDLINE AND CELL PHONE INTERVIEWS - WAS EMPLOYED. A RANDOM SAMPLE OF 800 INDIVIDUALS AGE 18 AND OLDER IN THE PRIMARY SERVICE AREA RESULTED IN 338 SURVEYS IN CARSON CITY, 271 IN DOUGLAS COUNTY, 150 IN LYON COUNTY AND 41 IN OTHER AREAS. TO SOLICIT INPUT FROM KEY INFORMANTS, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HELATH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATION WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. IN ALL, 136 COMMUNITY STAKEHOLDERS PARTICIPATED IN THE ONLINE KEY INFORMANT SURVEY. SEE PAGES 13 AND 14 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT FOR A FULL LIST OF ORGANIZATIONS, AGENCIES AND BUSINESSES THAT PARTICIPATED OF THE ONLINE KEY INFORMANT SURVEY PARTICIPANTS. CARSON TAHOE REGIONAL HEALTHCARE PART V, SECTION B, LINE 6A: A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH CARSON TAHOE CONTINUING CARE HOSPITAL, THE OTHER HOSPITAL OWNED BY CARSON-TAHOE HEALTH SYSTEM. CARSON TAHOE REGIONAL HEALTHCARE PART V, SECTION B, LINE 11: IN 2016, THE HOSPITAL ADDRESSED SIX AREAS IDENTIFIED IN THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT WITH RESOURCES AND PARTNERSHIPS IN THE COMMUNITY. THE AREAS ADDRESSED WERE: ACCESS TO HEALTH SERVICES; DIABETES ISSUES AND TREATMENT; CANCER SCREENING AND TREATMENT; MENTAL HEALTH AND MENTAL DISORDERS (INCLUDING DEMENTIAS AND ALZHEIMER'S DISEASE); NUTRITION ISSUES; PHYSICAL ACTIVITY AND WEIGHT ISSUES; AND, MATERNAL, INFANT AND CHILD HEALTH. THE AREAS IDENTIFIED BUT NOT ADDRESSED BECAUSE THEY WERE OUTSIDE THE HOSPITAL'S CORE SPHERE OF INFLUENCE INCLUDED DISABILITY, INJURY AND VIOLENCE, AND ORAL HEALTH.IN 2016, THE HOSPITAL ALSO CONDUCTED A NEW COMMUNITY HEALTH NEEDS ASSESSMENT, WHICH IT IS USING TO DETERMINE APPROPRIATE FUTURE ACTIONS TO BEST SERVE OUR COMMUNITY'S NEEDS. 17 1 - CARSON TAHOE SIERRA SURGERY CENTER 1400 MEDICAL PARKWAY CARSON CITY NV 89703 INPATIENT AND OUTPATIENT SURGERY 2 - CARSON TAHOE MEDICAL OFFICE BUILDING 1470 MEDICAL PARKWAY STE 140 CARSON CITY NV 89703 CARDIAC REHAB, OP CARDIOLOGY IMAGING, HEALTH CLASSES, COUNSELING & LECTURES 3 - CARSON TAHOE MINDEN MEDICAL CENTER 925 IRONWOOD DRIVE MINDEN NV 89703 EMERGENT CARE, LAB, IMAGING, THERAPY & CARDIOLOGY 4 - CARSON TAHOE CANCER CENTER 1535 MEDICAL PARKWAY CARSON CITY NV 89703 OUTPATIENT AMBULATORY INFUSION CENTER 5 - CARSON TAHOE SPECIALTY MEDICAL CENTER 775 FLEISCHMANN WAY CARSON CITY NV 89703 LAB, IP & OP BEHAVIORAL HEALTH AND EEG 6 - CARSON TAHOE SURGERY CENTER 973 MICA DRIVE CARSON CITY NV 89705 OUTPATIENT SURGERY AND PAIN MANAGEMENT 7 - CARSON TAHOE DAYTON MEDICAL CENTER 901 MEDICAL CENTER DRIVE DAYTON NV 89403 URGENT CARE AND OUTPATIENT LAB 8 - CARSON MALL 1201 S CARSON STREET CARSON CITY NV 89701 URGENT CARE AND THERAPY 9 - CARSON TAHOE CLINIC AT WALMART 3770 US HWY 395 S CARSON CITY NV 89705 CLINIC 10 - CARSON TAHOE CLINIC AT WALMART 3200 MARKET STREET CARSON CITY NV 89706 CLINIC 11 - CARSON TAHOE CLINIC AT WALMART 1511 GRANT STREET GARDNERVILLE NV 89410 CLINIC 12 - CARSON TAHOE BEHAVIORAL HEALTH 1080 N MINNESOTA STREET CARSON CITY NV 89703 INPATIENT BEHAVIORAL HEALTH 13 - CARSON TAHOE MEDICAL GROUP (RENO) 6880 S MCCARRAN BLVD STE 4 RENO NV 89509 CARDIOLOGY 14 - CARSON TAHOE CENTER FOR WOUND HEALING 6630 S MCCARRAN BLVD STE 202 RENO NV 89509 OUTPATIENT WOUND TREATMENT 15 - CARSON TAHOE CARDIOLOGY 276 KINGSBURY GRADE STE 101 STATELINE NV 89449 CARDIOLOGY 16 - CARSON TAHOE CARDIOLOGY 306 SURPRISE STREET YERINGTON NV 89447 CARDIOLOGY 17 - CARSON TAHOE CARDIOLOGY 85 SIERRA PARK ROAD MAMMOTH LAKES CA 93547 CARDIOLOGY PART I, LINE 3C: TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER CARSON TAHOE REGIONAL HEALTHCARE'S FINANCIAL ASSISTANCE PROGRAM, AN INDIVIDUAL MUST:1. LIVE WITHIN CARSON TAHOE'S PRIMARY SERVICE AREA;2. RECEIVE MEDICALLY NECESSARY CARE;3. HAVE HOUSEHOLD GROSS INCOME LESS THAN 400% OF FEDERAL POVERTY LEVELS; 4. APPLY FOR GOVERNMENT ASSISTANCE IF UNINSURED; 5. SUBMIT A BILL FOR INSURANCE COVERAGE IF INSURED; AND5. COMPLETE A FINANCIAL ASSISTANCE APPLICATION.INDIVIDUALS MAY NOT BE REQUIRED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION IF THEY ARE ELIGIBLE FOR STATE ASSISTANCE PROGRAMS (FOOD STAMPS, PHARMACEUTICAL ASSISTANCE PROGRAMS, WELFARE, ETC.) OR ARE CURRENTLY ELIGIBLE FOR MEDICARE BUT WERE NOT ELIGIBLE ON THE DATE THEY RECEIVED MEDICAL CARE. PART I, LINE 7: THE AMOUNTS IN PART I, LINES 7A, 7B AND 7C WERE CALCULATED USING THE IRS WORKSHEETS BASED ON A COST-TO-CHARGE RATIO. THE AMOUNTS REPORTED IN PART I, LINES 7E, 7F AND 7I ARE ACTUAL COSTS AND REVENUES. 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 $ 18,784,775. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY BUILDING ACTIVITIES INCLUDED STAFF TIME SPENT IN SUPPORT OF COMMUNITY EMERGENCY PREPAREDNESS AND DISASTER READINESS, AS WELL AS HOSPITAL REPRESENTATION ON COMMUNITY PANELS AND SUPPORT FOR THE COMMUNITY'S SPOOKTACTULAR AND EGGSTRAVAGANZA EVENTS. PART III, LINE 2: IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 3: THE HOSPITAL CANNOT ESTIMATE WITH REASONABLE ACCURACY THE PORTION OF THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLE" PARAGRAPH IN NOTE 2 ON PAGE 10 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE MEDICARE ALLOWABLE COSTS WERE CALCULATED USING CARSON TAHOE REGIONAL MEDICAL CENTER'S 2016 MEDICARE COST REPORT. PART III, LINE 9B: POLICIES IN EFFECT DURING 2016 ARE THE SAME AS CARSON-TAHOE HEALTH SYSTEM AND CARSON TAHOE CONTINUING CARE HOSPITAL. THE APPLICATION PERIOD FOR COMPLETION OF A FINANCIAL ASSISTANCE APPLICATION IS AVAILABLE FOR A MINIMUM OF 240 DAYS FROM THE TIME OF PATIENT SERVICE. PART VI, LINE 2: THE MOST CURRENT NEEDS ASSESSMENT WAS CONDUCTED IN 2016. NEEDS WERE IDENTIFIED USING DIRECT PATIENT AND PHYSICIAN FEEDBACK, SURVEY RESPONSES AND BEST PRACTICE INFORMATION FROM OTHER ORGANIZATIONS. INFORMATION OBTAINED FROM THE PREVIOUS NEEDS ASSESSMENT CONDUCTED IN 2010 RECOGNIZED THE COMMUNITY'S NEED FOR BETTER ACCESS TO HEALTHCARE. IN RESPONSE, CARSON TAHOE HAS ESTABLISHED CARDIOLOGY CLINICS AND CLINICS AT WALMART IN OUTLYING AREAS. THE HEALTHCARE SYSTEM RELIES ON INTELLIMED SERVICES TO REPORT INFORMATION ON MIGRATION OF SERVICES WITHIN THE PRIMARY AND SECONDARY MARKETS THEN UTILIZES INFORMATION GATHERED TO FORMULATE NEEDS ASSESSMENT. OUR HEALTHCHECK LABORATORY SERVICES OFFER HEALTH SCREENING AT DISCOUNTED RATES AS A RESULT OF FEEDBACK FROM PHYSICIANS AND COMMUNITY REQUESTS. WE WORK WITH NEVADA STATE HEALTH AND HUMAN SERVICES IN IDENTIFYING AREAS OF NEED. CDC AND INFECTION CONTROL MONITOR INDUSTRY TRENDS AND ADVISE POSSIBLE AREAS OF FOCUS. PART VI, LINE 3: INFORMATION IS PROVIDED TO THE PATIENT AT THE TIME OF REGISTRATION, BOTH IN WRITING AND THROUGH DIRECT DISCUSSION WITH PATIENTS. INFORMATION IS PROVIDED IN THE PATIENT'S BILL. ELIGIBILITY REPRESENTATIVES AND FINANCIAL COUNSELORS ARE LOCATED ON SITE. PART VI, LINE 4: THE HOSPITAL'S COMMUNITY CONSISTS OF A SMALL URBAN AREA AND A LARGE RURAL POPULATION IN EXCESS OF 250,000 PEOPLE, COVERING NORTHERN NEVADA AND EASTERN CALIFORNIA, LARGEST DEMOGRAPHIC AGE IS 50 AND ABOVE. PART VI, LINE 5: USE OF SURPLUS FUNDS ALLOWS FACILITY TO UPDATE MEDICAL EQUIPMENT AND TECHNOLOGY WHICH PROVIDE ADVANCEMENTS IN PATIENT CARE. CARSON TAHOE PARTICIPATES WITH CARSON CITY HEALTH AND HUMAN SERVICES IN THE COMMUNITY HEALTH IMPROVEMENHT PLAN 2020. CARSON TAHOE PROVIDES OUTREACH PROGRAMS, HEALTH FAIRS, WELLNESS PROGRAMS, BUSINESS HEALTH PARTNERSHIPS, SEMINARS, LECTURES AND EDUCATIONAL FORUMS TO HELP PROMOTE A HEALTHIER COMMUNITY. THE WOMEN'S HEALTH INSTITUTE PROVIDES FREE HEALTH RESOURCES, CLASSES AND GUIDANCE. CARSON TAHOE IS COMMITTED TO PROVIDING THE BEST HEALTHCARE AVAILABLE TO ALL COMMUNITY MEMBERS REGARDLESS OF THEIR ABILITY TO PAY. PART VI, LINE 6: CARSON TAHOE REGIONAL HEALTHCARE IS A PART OF CARSON TAHOE HEALTH SYSTEM IN CARSON CITY, NEVADA. THE SYSTEM IS COMPRISED OF THE FOLLOWING ENTITIES:CARSON TAHOE REGIONAL HEALTHCARE OWNS AND OPERATES:- CARSON TAHOE REGIONAL MEDICAL CENTER IS AN ACUTE CARE HOSPITAL LICENSED FOR 144 BEDS WITH A 24-HOUR EMERGENCY ROOM.- SIERRA SURGERY HOSPITAL IS A SURGICAL HOSPITAL CONSISTING OF 15 BEDS, 6 SURGICAL SUITES AND A FULL ARRAY OF IMAGING SERVICES, INCLUDING MRI AND CT SCANNING.- CANCER CENTER PROVIDES FOR EVERY ASPECT OF CANCER CARE FROM A MEDICAL AND RADIATION ONCOLOGY PRACTICE ALONGSIDE A COMPREHENSIVE CANCER RESOURCE CENTER AND INFUSION CENTER.- SPECIALTY MEDICAL CENTER PROVIDES OUTPATIENT LABORATORY, IMAGING, WOUND CARE AND BEHAVIORAL HEALTH SERVICES AND INPATIENT PSYCHIATRICT SERVICES.- MINDEN MEDICAL CENTER INCLUDES PHYSICIAN OFFICES, THE MINDEN EMERGENT AND URGENT CARE CENTER, AND OUTPATIENT LABORATORY AND RADIOLOGY SERVICES.- SURGERY CENTER IS A BUILDING OWNED BY CTRH BUT LEASED TO OTHER MEDICAL PROVIDERS IN THE COMMUNITY.- THREE WALK-IN CLINICS AT WALMARTS- TWO CENTERS FOR WOUND HEALING- TWO URGENT CARE CLINICS- TWO THERAPY CLINICS- ONE CARDIAC REHAB FACILITYCARSON TAHOE CONTINUING CARE HOSPITAL IS A LONG-TERM ACUTE CARE HOSPITAL.CARSON TAHOE PHYSICIAN CLINICS IS A MULTISPECIALTY MEDICAL GROUP THAT EMPLOYS 28 PHYSICIANS AT 14 LOCATIONS WITH SPECIALTIES THAT INCLUDE CARDIOLOGY, ENDOCRINOLOGY, FAMLIY MEDICINE, INTERNAL MEDICINE, ONCOLOGY, PSYCHIATRY, AND RHEUMATOLOGY.CARSON TAHOE HEALTH SYSTEM IS THE PARENT ORGANIZATION AND PROVIDES MANAGEMENT AND ADMINISTRATIVE SERVICES TO THE REST OF THE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NV 1 CARSON-TAHOE HEALTH SYSTEM PO BOX 2168 CARSON CITY NV 89702 880502318 501(C)(3) 9700000 GENERAL OPERATING SUPPORT 1 0 PATIENT NON-MEDICAL FINANCIAL ASSISTANCE 79 106456 PART I, LINE 2: TRANSFERS TO RELATED ORGANIZATIONS ARE MONITORED THORUGH COMMON MANAGEMENT. GRANTS TO UNRELATED ORGANIZATIONS ARE GIVEN TO QUALIFIED CHARITIES AND GOVERNMENTS, BUT CARSON TAHOE REGIONAL HEALTHCARE DOES NOT MONITOR HOW THE RECIPIENT ORGANIZATION USES THE FUNDS. INDIVIDUAL ASSISTANCE IS GIVEN DIRECTLY TO CREDITORS TO ENSURE THE MONEY IS USED FOR THE APPROPRIATE PURPOSE. 0 0 0 0 0 0 1 0 0 ED EPPERSON FELLOW, ACHE PRESIDENT & CEO 0 567171 0 106095 0 0 0 31250 0 9675 0 714191 0 0 ANN BECK VICE PRESIDENT & CFO 0 334351 0 65183 0 0 0 18000 0 9675 0 427209 0 0 CYNTHIA KUPERUS DIRECTOR, PERIOPERATIVE SERVICES 189144 0 22387 0 0 0 10592 0 9675 0 231798 0 0 0 TRACEY MCCOLLUM DIRECTOR, NURSING SERVICES 170484 0 21533 0 0 0 10037 0 9675 0 211729 0 0 0 WAYNE MITCHELL DIRECTOR, PHARMACY CLINICAL 171850 0 12028 0 0 0 9593 0 9675 0 203146 0 0 0 SCOTT MATTES DIRECTOR, ANCILLARY SERVICES 156773 0 17387 0 0 0 8699 0 9675 0 192534 0 0 0 KEVIN FLYNN MANAGER, PHARMACY OPERATIONS 152412 0 5922 0 0 0 8330 0 9675 0 176339 0 0 0 PART I, LINE 3 THE FOLLOWING WERE USED BY CARSON-TAHOE HEALTH SYSTEM TO DETERMINE THE PRESIDENT & CEO'S COMPENSATION. 1. COMPENSATION COMMITTEE 2. INDEPENDENT COMPENSATION CONSULTANT 3. WRITTEN EMPLOYMENT CONTRACT 4. COMPENSATION SURVEY OR STUDY 5. APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 6 NET INCOME IS A TRIGGER FEATURE FOR THE AT-RISK INCENTIVE PLAN FOR CARSON-TAHOE HEALTH SYSTEM. A CARSON CITY NEVADA 886000189 145810BQ9 2003-12-03 50000000 CONSTRUCTION OF REGIONAL MEDICAL 0 0 0 B CARSON CITY NEVADA 886000189 145810BR7 2005-10-27 15000000 CONSTRUCTION OF REGIONAL MEDICAL 0 0 0 C CARSON CITY NEVADA 886000189 145810CP0 2012-09-06 57151648 REFUNDING 2002 & 2003A BONDS 0 0 0 A 11675000 50000000 502639 466372 49030989 2005 0 0 1 1 B 3065000 15000000 231750 63764 14704486 2005 0 0 1 1 C 8820060 57151648 56404387 747261 2012 1 1 1 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 A 0 1 0 0 1 0 0 0 0 B 0 1 0 0 1 0 0 0 0 C 0 1 0 0 0 0 0 0 0 A 0 B 0 C 0 FORM 990, PART III, LINE 2 EFFECTIVE JANUARY 2016, CARSON TAHOE HEALTH FOUNDATION DISSOLVED ITS CORPORATE STRUCTURE AND TRANSFERRED ITS ASSETS TO THE HOSPITAL. THE FOUNDATION CONTINUES ITS OPERATIONS AS A DEPARTMENT WITHIN THE HOSPITAL. FORM 990, PART VI, SECTION A, LINE 1 THE BOARD OF DIRECTORS HAS AN EXECUTIVE COMMITTEE CONSISTING OF THE CHAIR OF THE BOARD, THE CEO, AND FOUR OTHER MEMBERS OF THE BOARD OF DIRECTORS. BETWEEN BOARD MEETINGS, EXCEPT AS ITS POWERS ARE OTHERWISE LIMITED, THE EXECUTIVE COMMITTEE HAS AND EXERCISES THE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE ORGANIZATION. NO ACT OF THE EXECUTIVE COMMITTEE, WHEN EXERCISING THE DELEGATED POWERS OF THE BOARD, ARE VALID UNLESS APPROVED BY THE VOTE OR WRITTEN CONSENT OF A MAJORITY OF THE BOARD. FORM 990, PART VI, SECTION A, LINE 2 ED EPPERSON, DON HATAWAY, JONATHAN MILLER, KENT GABRIEL, M.D., JEFFREY BASA, M.D., AND DAVID STRULL, M.D. ALL HAVE A BUSINESS RELATIONSHIP DUE TO ALSO SERVING AS OFFICERS OR BOARD MEMBERS OF A RELATED FOR-PROFIT ENTITY, CARSON TAHOE PHYSICIAN CLINICS. BOTH CARSON TAHOE REGIONAL HEALTHCARE AND CARSON TAHOE PHYSICIAN CLINICS REPORT TO THE SAME PARENT COMPANY, CARSON-TAHOE HEALTH SYSTEM. FORM 990, PART VI, SECTION A, LINE 4 THE BYLAWS WERE AMENDED IN JULY 2016 TO CLARIFY THAT THE VICE CHIEF OF STAFF OR ACTING CHIEF OF STAFF MAY ATTEND A BOARD MEETING IN THE ABSENCE OF THE CHIEF OF STAFF, BUT THAT OTHER BOARD MEMBERS MAY NOT DESIGNATE A PROXY TO PARTICIPATE IN BOARD MEETINGS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS CARSON-TAHOE HEALTH SYSTEM, A TAX EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS APPOINTED BY CARSON-TAHOE HEALTH SYSTEM, THE PARENT COMPANY. FORM 990, PART VI, SECTION A, LINE 7B THE APPROVAL OF CARSON-TAHOE HEALTH SYSTEM IS REQUIRED FOR EACH OF THE FOLLOWING: (A) ANY AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION OR BYLAWS; (B) THE ESTABLISHMENT OF ANY NEW CORPORATION, LIMITED LIABILITY COMPANY OR PARTNERSHIP OR THE MERGER, DISSOLUTION OR CONSOLIDATION OF THE ORGANIZATION; (C) ANY MORTGAGE, SALE, LEASE, EXCHANGE OR PLEDGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; (D) ANY CHANGE IN LONG-TERM DEBT ARRANGEMENTS OF THE ORGANIZATION OR ANY OF ITS SUBSIDIARIES OR AFFILIATED ORGANIZATIONS THAT WILL AFFECT THE CREDITWORTHINESS OF THE ORGANIZATION; (E) THE STRATEGIC PLAN OF THE ORGANIZATION; (F) THE ESTABLISHMENT OR CHANGE OF THE PHILOSOPHY ACCORDING TO WHICH THE ORGANIZATION OPERATES; (G) APPROVAL OF THE CONTRACT OF EMPLOYMENT OF THE CEO OF THE ORGANIZATION; AND (H) THE DETERMINATION OF THE AMOUNT OF ANY COMPENSATION FOR MEMBERS OF THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION ENGAGED AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND REVIEW THE 990. THE 990 WAS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND THE ACCOUNTING PERSONNEL WITH THE INDEPENDENT ACCOUNTING FIRM. THROUGH THE REVIEW PROCESS, ANY CLARIFICATIONS OR CORRECTIONS THAT NEEDED TO BE MADE WERE MADE. THE FORM 990 WAS THEN REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD WITH THE INDEPENDENT ACCOUNTING FIRM. ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE RAISED WERE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEEDED TO BE MADE WERE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES WAS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY APPLIES TO ALL VOTING MEMBERS OF THE GOVERNING BOARD AND COMMITTEES WITH BOARD-DESIGNATED POWERS, EXECUTIVE OFFICERS, AND OTHER INDIVIDUALS IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE. EACH COVERED INDIVIDUAL IS GIVEN A COPY OF THE POLICY AND COMPLETES A CONFLICT OF DISCLOSURE STATEMENT ANNUALLY. EACH INDIVIDUAL DISCLOSES FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OF DUALITY OF INTEREST OR RESPONSIBILITY, WHETHER INDIVIDUAL, PERSONAL, OR BUSINESS WHICH EXISTS OR APPEARS TO EXIST. AT ANY TIME THAT AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST IS IDENTIFIED, THE REMAINING MEMBERS OF THE BOARD OR COMMITTEE SHALL REVIEW THE MATTER AND DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. THE INDIVIDUAL WITH THE POTENTIAL CONFLICT MAY NOT BE PRESENT WHEN THE MATTER IS DISCUSSED AND THE VOTE IS TAKEN. IF A CONFLICT OF INTEREST IS IDENTIFIED, THE DISINTERESTED MEMBERS OF THE GOVERNING BOARD OR COMMITTEE EXERCISE DUE DILIGENCE TO DETERMINE WHETHER THE ORGANIZATION COULD OBTAIN A MORE ADVANTAGEOUS TRANSACTION. AFTER INVESTIGATING ALTERNATIVES, THE BOARD OR COMMITTEE MAY APPROVE THE TRANSACTION ONLY IF THE DISINTESTERED MEMBERS DETERMINE BY MAJORITY VOTE THAT (A) THE TRANSACTION IS IN THE BEST INTEREST OF THE ORGANIZATION AND (B) THE TRANSACTION IS FAIR AND REASONABLE TO THE ORGANIZATION GIVEN THE IDENTIFIED ALTERNATIVES. IF THE GOVERNING BOARD OR A COMMITTEE HAS REASON BELIEVE AN INDIVIDUAL HAS FAILED TO DISCLOSE A CONFLICT OF INTEREST, THE INDIVIDUAL IS GIVEN A CHANCE TO ADDRESS THE SITUATION. AFTER HEARING THE INDIVIDUAL'S RESPONSE AND CONDUCTING FURTHER INVESTIGATION AS MAY BE WARRANTED, THE BOARD OR COMMITTEE DETERMINES WHETHER THE INDIVIDUAL HAS VIOLATED THE CONFLICT OF INTEREST POLICY. IF AN INDIVIDUAL IS DETERMINED TO HAVE VIOLATED THE POLICY, APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTIONS ARE TAKEN, WHICH MAY INCLUDE REMOVAL FROM THE BOARD OR COMMITTEE OR TERMINATION EMPLOYMENT. FORM 990, PART VI, SECTION B, LINE 15 CARSON-TAHOE HEALTH SYSTEM'S EXECUTIVE COMPENSATION COMMITTEE DETERMINES THE TOTAL COMPENSATION PACKAGE FOR THE CEO BASED ON MARKET SURVEYS POSITIONED SO THAT MIDPOINT WILL TARGET THE 50TH PERCENTILE. INCENTIVES WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 50TH PERCENTILE FOR ON-PLAN PERFORMANCE. ACHIEVING MAXIMUM INCENTIVES MAY RAISE TOTAL COMPENSATION TO APPROXIMATELY THE 65TH PERCENTILE. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS. THE LAST REVIEW WAS CONDUCTED BY THE HAY GROUP IN 2016. BASE SALARIES FOR OTHER OFFICERS AND KEY EMPLOYEES WILL BE POSITIONED SO THAT MIDPOINTS TARGET THE 50TH PERCENTILE. EXECUTIVE SALARIES WILL BE ADMINISTERED WITHIN RANGES BUILT AROUND THE 50TH PERCENTILE AND BASED ON PERFORMANCE, EXPERIENCE, TENURE, AND OTHER RELEVANT FACTORS AS EVALUATED BY CEO. INCENTIVE WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 50TH PERCENTILE FOR ON-PLAN PERFORMANCE. ACHIEVING MAXIMUM INCENTIVES MAY RAISE TOTAL COMPENSATION TO APPROXIMATELY THE 65TH PERCENTILE. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS. THE LAST REVIEW WAS CONDUCTED BY THE HAY GROUP IN 2016. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN FAIR VALUE OF INTEREST RATE SWAP ADJUSTMENT 1,079,170. ROUNDING ADJUSTMENT 8. CARSON-TAHOE HEALTH SYSTEM 1600 MEDICAL PARKWAY CARSON CITY NV 89703 880502318 PARENT ORGANIZATION NV 501(C)(3) LINE 12B, II N/A 0 CTRH AUXILIARY 1600 MEDICAL PARKWAY CARSON CITY NV 89703 886007118 SUPPORT CTRH NV 501(C)(3) LINE 12D, III-O N/A 0 CARSON TAHOE PHYSICIAN CLINICS 1600 MEDICAL PARKWAY CARSON CITY NE 89703 020566741 PHYSICIAN GROUP NV N/A C 0 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 1 0 0