SAN LUIS VALLEY REGIONAL MEDICAL CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- SAN LUIS VALLEY REGIONAL MEDICAL CENTER (EIN 84-0255530)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-09
- IRS object ID
- 201711299349301571
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-09T12:03:43-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 South Tejon Suite 800 | AddressLine1Txt |
| City | Colorado Springs | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 809039848 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 840255530 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lutheran Hospital Association of the San | BusinessNameLine1Txt |
| Business Name Line2 | Luis Valley | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % THE ORGANIZATION | InCareOfNm |
| Business Name Control | LUTH | BusinessNameControlTxt |
| Phone | 7195892511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 106 BLANCA AVENUE | AddressLine1Txt |
| City | ALAMOSA | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81101 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KONNIE MARTIN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7195892511 | PhoneNum |
| Signature | 2017-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Adam R Smith CPA | PreparerPersonNm |
| PTIN | P00958966 | PTIN |
| Phone | 7194714290 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | San Luis Valley Health | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | KONNIE MARTIN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 106 BLANCA AVENUE | AddressLine1Txt |
| City | ALAMOSA | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $87,133,628 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SANLUISVALLEYHEALTH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1928 | FormationYr |
| Legal Domicile State | CO | LegalDomicileStateCd |
| Activity Or Mission | TO BE A PREMIER, FULLY INTEGRATED RURAL HEALTH CARE SYSTEM PROVIDING EXCEPTIONAL PATIENT-CENTERED SERVICES TO THE SAN LUIS VALLEY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 766 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,350,586 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,623,975 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $78,441,288 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $84,893,888 | CYProgramServiceRevenueAmt |
| PY Investment Income | $54,705 | PYInvestmentIncomeAmt |
| CY Investment Income | $84,996 | CYInvestmentIncomeAmt |
| PY Other Revenue | $405,530 | PYOtherRevenueAmt |
| CY Other Revenue | $286,657 | CYOtherRevenueAmt |
| PY Total Revenue | $80,252,109 | PYTotalRevenueAmt |
| CY Total Revenue | $86,889,516 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $21,072 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $22,221 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $42,467,097 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $44,015,010 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $234,823 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $34,501,920 | PYOtherExpensesAmt |
| CY Other Expenses | $38,932,263 | CYOtherExpensesAmt |
| PY Total Expenses | $76,990,089 | PYTotalExpensesAmt |
| CY Total Expenses | $82,969,494 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,262,020 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,920,022 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $73,754,094 | TotalAssetsBOYAmt |
| Total Assets EOY | $84,611,576 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $24,770,669 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $31,577,655 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $48,983,425 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $53,033,921 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $64,553,161 | ExpenseAmt |
| Grant | $22,221 | GrantAmt |
| Revenue | $85,234,551 | RevenueAmt |
| Desc | SAN LUIS VALLEY HEALTH WAS FORMED JULY 1, 2013. PRIOR TO THE MERGER THAT CREATED SAN LUIS VALLEY HEALTH IT 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. SLV HEALTH'S OPERATING EXPENSE PER ADJUSTED PATIENT DAY IS $2,999 COMPARED TO A COLORADO AVERAGE OF $3,367 AND A RURAL HOSPITAL AVERAGE OF $3,753. OVER THE LAST TEN YEARS, OUR GROSS REVENUE HAS INCREASED FROM $20M TO $120M 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 AND MORE. | Desc |
| Total Program Service Expenses | $64,553,161 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 96 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 766 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 7195892511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 106 BLANCA AVENUE | AddressLine1Txt |
| City | ALAMOSA | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 81101 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (25 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Karla Hardesty | ||||||||
| President | 2.0 | 0.0 | Yes (X) | Yes (X) | $2,550 | $0 | $0 | |
| Jim Ehrlich | ||||||||
| Vice President | 2.0 | 0.0 | Yes (X) | Yes (X) | $800 | $0 | $0 | |
| Kendall Knaus | ||||||||
| Secretary/Treasurer | 2.0 | 0.0 | Yes (X) | Yes (X) | $51,500 | $0 | $0 | |
| Jan Gay | ||||||||
| Trustee | 2.0 | 1.0 | Yes (X) | $1,000 | $0 | $0 | ||
| Patrick Crowder | ||||||||
| Trustee | 2.0 | 0.0 | Yes (X) | $500 | $0 | $0 | ||
| Kathy Lorenz | ||||||||
| Trustee | 2.0 | 1.0 | Yes (X) | $800 | $0 | $0 | ||
| Cheri Crowder | ||||||||
| Trustee | 2.0 | 1.0 | Yes (X) | $800 | $0 | $0 | ||
| Rosalie Martinez | ||||||||
| Trustee | 2.0 | 2.0 | Yes (X) | $1,000 | $0 | $0 | ||
| Donald Shawcroft | ||||||||
| Trustee | 2.0 | 1.0 | Yes (X) | $600 | $0 | $0 | ||
| Richard Martin | ||||||||
| Trustee | 2.0 | 0.0 | Yes (X) | $600 | $0 | $0 | ||
| Kasey Russell | ||||||||
| Trustee | 2.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Susan Geiger | ||||||||
| Trustee, Physician | 40.0 | 0.0 | Yes (X) | $108,141 | $0 | $5,353 | ||
| Dennard Ellison | ||||||||
| Trustee, Physician | 40.0 | 0.0 | Yes (X) | $409,248 | $0 | $33,406 | ||
| Nuwan Pilapitiya | ||||||||
| Trustee, Physician | 40.0 | 0.0 | Yes (X) | $206,300 | $0 | $28,800 | ||
| Konnie Martin | ||||||||
| CEO | 40.0 | 2.0 | Yes (X) | $346,935 | $0 | $33,532 | ||
| Shane Mortensen | ||||||||
| CFO | 40.0 | 1.0 | Yes (X) | $199,411 | $0 | $29,289 | ||
| Patti Thompson | ||||||||
| COO | 40.0 | 0.0 | Yes (X) | $215,799 | $0 | $19,641 | ||
| Greg McAuliffe | ||||||||
| CMO | 40.0 | 0.0 | Yes (X) | $339,924 | $0 | $32,985 | ||
| Kelly Gallegos | ||||||||
| CCH Administrator | 40.0 | 0.0 | Yes (X) | $154,005 | $0 | $25,423 | ||
| Antonio Gurule | ||||||||
| Clinic Administrator | 40.0 | 0.0 | Yes (X) | $153,256 | $0 | $16,901 | ||
| Robert Marshall | ||||||||
| Physician | 40.0 | 0.0 | $419,839 | $0 | $31,564 | Yes (X) | ||
| Maureen Cooper | ||||||||
| Physician | 40.0 | 0.0 | $461,463 | $0 | $30,569 | Yes (X) | ||
| Steven Kitchen | ||||||||
| Physician | 40.0 | 0.0 | $441,426 | $0 | $31,786 | Yes (X) | ||
| Carissa Tripi | ||||||||
| Physician | 40.0 | 0.0 | $578,340 | $0 | $31,267 | Yes (X) | ||
| James Grigsby | ||||||||
| Physician | 40.0 | 0.0 | $419,678 | $0 | $33,268 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $4,513,915 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $383,784 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 69 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| CARETECH SOLUTIONS INC | |||||
| PO Box 674271 | DETROIT | MI | 48267 | CONTRACT SERVICES | $1,568,855 |
| WEATHERBY LOCUMS | |||||
| PO Box 972633 | DALLAS | TX | 75397 | CONTRACT LABOR | $344,283 |
| ARUP Laboratories | |||||
| 500 Chipeta Way | SALT LAKE CITY | UT | 84108 | CONTRACT LABOR | $206,357 |
| MEDICUS HOSPITALISTS WEST LLC | |||||
| 22 ROULSTON ROAD | WINDHAM | NH | 03087 | CONTRACT SERVICES | $577,394 |
| INNOVA EMERGENCY MEDICAL ASSOCIATES | |||||
| PO Box 912601 | DENVER | CO | 802912601 | CONTRACT LABOR | $1,338,565 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $23,063 | RelatedOrganizationsAmt |
| Government Grants | $915,452 | GovernmentGrantsAmt |
| All Other Contributions | $685,460 | AllOtherContributionsAmt |
| Noncash Contributions | $20,064 | NoncashContributionsAmt |
| Total Contributions | $1,623,975 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 900099 | $41,997,144 | $41,997,144 |
| MEDICARE/MEDICAID | 900099 | $41,525,283 | $41,525,283 |
| ELECTRONIC HEALTH RECORD PAYMENTS | 900099 | $582,084 | $582,084 |
| AMBULANCE DISTRICT REVENUE | 621910 | $380,475 | $380,475 |
| 340B PAYMENTS | 900099 | $175,051 | $175,051 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $233,851 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $233,851 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $84,893,888 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $250,376 | TotalRevenueColumnAmt |
| Exclusion | $250,376 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $74,504 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $72,665 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $1,839 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,839 | TotalRevenueColumnAmt |
| Exclusion | $1,839 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $6,067 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $171,447 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$165,380 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$165,380 | TotalRevenueColumnAmt |
| Exclusion | -$165,380 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $8,995 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,995 | TotalRevenueColumnAmt |
| Exclusion | $8,995 | ExclusionAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| CAFETERIA SALES | 900099 | $203,537 | $203,537 | |
| LOSS ON RETIREMENT OF BONDS | 900099 | -$285,889 | -$285,889 | |
| ABSTRACTS REVENUE | 900099 | $18,381 | $18,381 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $339,794 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $322,282 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $17,512 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $275,823 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $86,889,516 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $85,234,551 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $30,990 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,221 | TotalAmt |
| Program Services | $22,221 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,384,491 | TotalAmt |
| Program Services | $825,522 | ProgramServicesAmt |
| Management And General | $1,542,942 | ManagementAndGeneralAmt |
| Fundraising | $16,027 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,925 | TotalAmt |
| Program Services | $436,925 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,963,001 | TotalAmt |
| Program Services | $27,821,026 | ProgramServicesAmt |
| Management And General | $6,084,955 | ManagementAndGeneralAmt |
| Fundraising | $57,020 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,190,971 | TotalAmt |
| Program Services | $981,464 | ProgramServicesAmt |
| Management And General | $207,584 | ManagementAndGeneralAmt |
| Fundraising | $1,923 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,689,103 | TotalAmt |
| Program Services | $2,966,123 | ProgramServicesAmt |
| Management And General | $716,305 | ManagementAndGeneralAmt |
| Fundraising | $6,675 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,350,519 | TotalAmt |
| Program Services | $1,864,313 | ProgramServicesAmt |
| Management And General | $481,620 | ManagementAndGeneralAmt |
| Fundraising | $4,586 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $144,450 | TotalAmt |
| Management And General | $144,450 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $205,375 | TotalAmt |
| Management And General | $205,375 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,644 | TotalAmt |
| Management And General | $119,644 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,955 | TotalAmt |
| Management And General | $2,955 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,659,949 | TotalAmt |
| Program Services | $4,772,276 | ProgramServicesAmt |
| Management And General | $1,887,673 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,926 | TotalAmt |
| Program Services | $15,354 | ProgramServicesAmt |
| Management And General | $110,010 | ManagementAndGeneralAmt |
| Fundraising | $2,562 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,817,871 | TotalAmt |
| Program Services | $664,143 | ProgramServicesAmt |
| Management And General | $1,048,948 | ManagementAndGeneralAmt |
| Fundraising | $104,780 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,941,767 | TotalAmt |
| Program Services | $824,278 | ProgramServicesAmt |
| Management And General | $1,117,489 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $813,685 | TotalAmt |
| Program Services | $648,759 | ProgramServicesAmt |
| Management And General | $164,926 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $365,946 | TotalAmt |
| Program Services | $209,042 | ProgramServicesAmt |
| Management And General | $156,116 | ManagementAndGeneralAmt |
| Fundraising | $788 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,684 | TotalAmt |
| Management And General | $15,684 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $944,677 | TotalAmt |
| Program Services | $707,298 | ProgramServicesAmt |
| Management And General | $237,379 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,384,394 | TotalAmt |
| Program Services | $2,551,759 | ProgramServicesAmt |
| Management And General | $832,635 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,206,400 | TotalAmt |
| Program Services | $547,075 | ProgramServicesAmt |
| Management And General | $658,661 | ManagementAndGeneralAmt |
| Fundraising | $664 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $9,018,135 | $9,018,135 | |
| PROVIDER FEES | $2,753,749 | $2,753,749 | |
| BAD DEBT | $5,548,592 | $5,548,592 | |
| REPAIRS & MAINTENANCE | $2,590,283 | $1,013,949 | $1,576,334 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,270,781 | TotalAmt |
| Program Services | $361,158 | ProgramServicesAmt |
| Management And General | $869,825 | ManagementAndGeneralAmt |
| Fundraising | $39,798 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $82,969,494 | TotalAmt |
| Program Services | $64,553,161 | ProgramServicesAmt |
| Management And General | $18,181,510 | ManagementAndGeneralAmt |
| Fundraising | $234,823 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $850,351 | BOYAmt |
| EOY | $1,082,910 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,884,099 | BOYAmt |
| EOY | $18,752,351 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $99,859 | BOYAmt |
| EOY | $15,139 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,308,490 | BOYAmt |
| EOY | $11,132,401 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,293,568 | BOYAmt |
| EOY | $1,332,005 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,661,158 | BOYAmt |
| EOY | $2,165,053 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $71,318,507 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $38,698,650 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,131,341 | BOYAmt |
| EOY | $32,619,857 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,107,403 | BOYAmt |
| EOY | $11,615,599 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $100 | BOYAmt |
| EOY | $12,100 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,970 | BOYAmt |
| EOY | $416,948 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,126,755 | BOYAmt |
| EOY | $5,467,213 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,754,094 | BOYAmt |
| EOY | $84,611,576 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,818,653 | BOYAmt |
| EOY | $9,703,161 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $81,102 | BOYAmt |
| EOY | $74,786 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,175,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,277,299 | BOYAmt |
| EOY | $21,529,177 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,418,615 | BOYAmt |
| EOY | $270,531 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $24,770,669 | BOYAmt |
| EOY | $31,577,655 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,692,461 | BOYAmt |
| EOY | $52,616,975 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $290,964 | BOYAmt |
| EOY | $416,946 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,983,425 | BOYAmt |
| EOY | $53,033,921 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $73,754,094 | BOYAmt |
| EOY | $84,611,576 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,920,022 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $37,564 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $92,910 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $2,955 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $2,955 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | schedule c, Part II-B, Line 1i | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $24,766 | BeginningYearBalanceAmt |
| Contributions | $10,547 | ContributionsAmt |
| Investment Earnings Or Losses | $32 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $35,345 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $10,388 | BeginningYearBalanceAmt |
| Contributions | $14,360 | ContributionsAmt |
| Investment Earnings Or Losses | $18 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $24,766 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $4,373 | BeginningYearBalanceAmt |
| Contributions | $6,009 | ContributionsAmt |
| Investment Earnings Or Losses | $6 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $10,388 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $3,701 | BeginningYearBalanceAmt |
| Contributions | $668 | ContributionsAmt |
| Investment Earnings Or Losses | $4 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $4,373 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $0 | BeginningYearBalanceAmt |
| Contributions | $3,698 | ContributionsAmt |
| Investment Earnings Or Losses | $3 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $3,701 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 1.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,432,682 | OtherCostOrOtherBasisAmt |
| Book Value | $3,432,682 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $41,848,335 | OtherCostOrOtherBasisAmt |
| Depreciation | $19,929,497 | DepreciationAmt |
| Book Value | $21,918,838 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,893,983 | OtherCostOrOtherBasisAmt |
| Depreciation | $18,104,628 | DepreciationAmt |
| Book Value | $5,789,355 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,143,507 | OtherCostOrOtherBasisAmt |
| Depreciation | $664,525 | DepreciationAmt |
| Book Value | $1,478,982 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $32,619,857 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| HUD REFINANCING COSTS | $1,371,714 |
| MOUNTAIN STATE SSA RECEIVABLE | $892,785 |
| MALPRACTICE RECEIVABLE | $25,000 |
| HUD ESCROW | $3,177,714 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,467,213 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ASSET RETIREMENT OBLIGATION | Desc |
| Amt | $270,531 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $270,531 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $81,438,777 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $37,564 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $198,641 | OtherRevenueAmt |
| Revenue Not Reported | $236,205 | RevenueNotReportedAmt |
| Revenue Subtotal | $81,202,572 | RevenueSubtotalAmt |
| Other Revenues Not Included | $5,686,944 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $5,686,944 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $86,889,516 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $77,388,281 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $72,665 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $72,665 | ExpensesNotReportedAmt |
| Expenses Subtotal | $77,315,616 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $5,653,878 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $5,653,878 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $82,969,494 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 125,976 rental expenses reclassed from expense to revenue 72,665 Total 198,641 |
| SCHEDULE D, PART XI, LINE 4B | REVENUE ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE RECLASSED FROM EXPENSE TO REVENUE 5,548,592 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT 33,066 CONTRIBUTIONS REVENUE RECLASSED FROM EXPENSE 105,286 Total 5,686,944 |
| SCHEDULE D, PART XII, LINE 2D | EXPENSE ON BOOKS, NOT ON RETURN: RENTAL EXPENSES RECLASSED FROM EXPENSE TO REVENUE 72,665 |
| SCHEDULE D, PART XII, LINE 4B | EXPENSE ON RETURN, NOT ON BOOKS: BAD DEBT EXPENSE RECLASSED FROM EXPENSE TO REVENUE 5,548,592 CONTRIBUTIONS REVENUE RECLASSED FROM EXPENSE 105,286 TOTAL 5,653,878 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $316,290 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $194,791 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $121,499 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,257,784 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $25,794,599 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,463,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01890 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $389,944 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $416,618 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$26,674 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,964,018 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $26,406,008 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,558,010 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02050 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $206,437 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $40,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $165,596 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $683,640 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $683,640 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00880 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,106 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,106 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $92,346 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $92,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $984,529 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $40,841 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $943,688 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01210 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $28,948,547 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $26,446,849 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,501,698 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03260 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,543 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,543 | NetCommunityBenefitExpnsAmt |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,627 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,627 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $477 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $477 | NetCommunityBenefitExpnsAmt |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,647 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $16,647 | NetCommunityBenefitExpnsAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $5,548,592 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $0 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $17,751,421 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $18,383,251 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$631,830 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 2 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp (2 entries)
| FacilityFacilityNum | Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Website AddressWebsiteAddressTxt | State LicenseStateLicenseNum | Licensed HospitalLicensedHospitalInd | General Medical And SurgicalGeneralMedicalAndSurgicalInd | Teaching HospitalTeachingHospitalInd | Emergency Room24 HrsEmergencyRoom24HrsInd | Facility Reporting GroupFacilityReportingGroupCd | Critical Access HospitalCriticalAccessHospitalInd |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Lutheran Hospital of SLV | ||||||||||||
| 1 | 106 Blanca Avenue | Alamosa | CO | 81101 | www.sanluisvalleyhealth.org | 011001 | Yes (X) | Yes (X) | Yes (X) | Yes (X) | 1 | |
| Conejos County Hospital | ||||||||||||
| 2 | 19021 US Hwy 285 | La Jara | CO | 81140 | www.sanluisvalleyhealth.org | 011020 | Yes (X) | Yes (X) | 1 | Yes (X) | ||
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C FOR URL | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C FOR URL | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250. | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | part v, section c for url | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | part v, section c for url | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | part v, section c for url | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Medicare Rates | Yes (X) | MedicareRatesInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| 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. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, Part I, Line 7, Column (f) | TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = 5,548,592. 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 | 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 II | Several of the Community Building Activities listed were conducted during hospital week. SLVH targeted activities during the week that had a community service focus to help build partnerships with local community residents, as well as community resource partners. Those listed on the previous page primarily had a focus aimed at the social determinants that affect a population's health status- healthy food choices, healthy food access, and providing affordable housing options in SLVHs service area. Other activities listed include the installation of fire alarms in houses in coordination with the Red Cross, and the Rio Frio which promotes and provides a winter wellness activity in our community. Participation in these events helps meet the basic, day-to-day health needs of the SLV population that impacts overall health status. |
| 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 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: 6/30/14 (1,203,813) 6/30/15 85,840 6/30/16 (631,830) |
| 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (13 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dennard Ellison | ||||||||||||||
| Trustee, Physician | $406,959 | $0 | $0 | $0 | $2,289 | $0 | $12,318 | $0 | $21,088 | $0 | $442,654 | $0 | $0 | $0 |
| Nuwan Pilapitiya | ||||||||||||||
| Trustee, Physician | $205,955 | $0 | $0 | $0 | $345 | $0 | $10,581 | $0 | $18,219 | $0 | $235,100 | $0 | $0 | $0 |
| Konnie Martin | ||||||||||||||
| CEO | $269,973 | $0 | $75,774 | $0 | $1,188 | $0 | $13,151 | $0 | $20,381 | $0 | $380,467 | $0 | $0 | $0 |
| Shane Mortensen | ||||||||||||||
| CFO | $167,151 | $0 | $31,509 | $0 | $751 | $0 | $10,309 | $0 | $18,980 | $0 | $228,700 | $0 | $0 | $0 |
| Patti Thompson | ||||||||||||||
| COO | $181,431 | $0 | $33,578 | $0 | $790 | $0 | $10,245 | $0 | $9,396 | $0 | $235,440 | $0 | $0 | $0 |
| Greg McAuliffe | ||||||||||||||
| CMO | $281,003 | $0 | $52,326 | $0 | $6,595 | $0 | $13,093 | $0 | $19,892 | $0 | $372,909 | $0 | $0 | $0 |
| Kelly Gallegos | ||||||||||||||
| CCH Administrator | $129,873 | $0 | $23,895 | $0 | $237 | $0 | $6,335 | $0 | $19,088 | $0 | $179,428 | $0 | $0 | $0 |
| Antonio Gurule | ||||||||||||||
| Clinic Administrator | $144,095 | $0 | $8,556 | $0 | $605 | $0 | $7,760 | $0 | $9,141 | $0 | $170,157 | $0 | $0 | $0 |
| Robert Marshall | ||||||||||||||
| Physician | $377,118 | $0 | $40,467 | $0 | $2,254 | $0 | $13,026 | $0 | $18,538 | $0 | $451,403 | $0 | $0 | $0 |
| Maureen Cooper | ||||||||||||||
| Physician | $457,857 | $0 | $0 | $0 | $3,606 | $0 | $11,527 | $0 | $19,042 | $0 | $492,032 | $0 | $0 | $0 |
| Steven Kitchen | ||||||||||||||
| Physician | $432,635 | $0 | $5,119 | $0 | $3,672 | $0 | $13,248 | $0 | $18,538 | $0 | $473,212 | $0 | $0 | $0 |
| Carissa Tripi | ||||||||||||||
| Physician | $552,835 | $0 | $25,000 | $0 | $505 | $0 | $13,250 | $0 | $18,017 | $0 | $609,607 | $0 | $0 | $0 |
| James Grigsby | ||||||||||||||
| Physician | $417,374 | $0 | $0 | $0 | $2,304 | $0 | $13,250 | $0 | $20,018 | $0 | $452,946 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVID GEIGER | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | see part V | RelationshipDescriptionTxt |
| Transaction | $436,925 | TransactionAmt |
| Transaction | employment wages | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV, COLUMN B | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 125,976 CHANGE IN FAIR VALUE OF INTEREST RATE SWAP AGREEMENT (33,066) Total 92,910 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| SAN LUIS VALLEY HEALTH FOUNDATION | ||||||||||
| 106 BLANCA AVENUE | ALAMOSA | CO | 81101 | 203799814 | FUNDRAISING | CO | 501(C)(3) | LINE 7 | SLVH | Yes (true) |
| CONEJOS COUNTY HOSPITAL FOUNDATION | ||||||||||
| 19021 US HWY 285 | LA JARA | CO | 81140 | 320379184 | FUNDRAISING | CO | 501(C)(3) | LINE 7 | SLVH | Yes (true) |
| SLV MEDICAL CTR EMPLOYEE BEN TRUST | ||||||||||
| 106 BLANCA AVENUE | ALAMOSA | CO | 81101 | 840909851 | HEALTH PLAN | CO | 501(C)(9) | NA | false | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SLV MEDICAL CTR EMPLOYEE BEN TRUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | M | TransactionTypeTxt |
| Involved | $3,218,276 | InvolvedAmt |
| Method Of Amount Determination | premiums paid | MethodOfAmountDeterminationTxt |
Comments