2017-10-23T14:18:43-05:00 2016-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2016-01-01 880405927 Washoe Barton Medical Clinic WASH 7757821500 1107 Hwy 395 Gardnerville NV 89410 Preston Becker CEO 7757821500 2017-10-23 1 KIM C HUNWARDSEN P00484560 7012398500 2017-10-23 209.243.15.107 2017-10-23 14:09:44 CD P 6C9B1A35775087DBDB8A6D25ECA509C7F6C27838 66CC91E6B7F11C4783FFFA5645E675327CB67316 2016 2021-01-29 14:40:06Z Carson Valley Medical Center Preston Becker 1107 Hwy 395 Gardnerville NV 89410 62298317 0 X carsonvalleymedicalcenter.org X 1999 NV Nevada non-profit corporation which operates as the sole hospital in the county. 6 6 470 25 0 0 8406 109742 58568143 61655317 79863 148728 -64432 -187312 58591980 61726475 0 0 0 0 27140236 28119685 0 0 0 27022841 29073512 54163077 57193197 4428903 4533278 59057574 62378645 15023805 13823465 44033769 48555180 X Our mission is to care for your health and wellness. Our vision is to strengthen our community by providing accessible, affordable, high quality healthcare to all. 0 0 43166223 41255861 Carson Valley Medical Center covers a service area that includes approximately 50,000 residents. A focus on patient centered care and quality have resulted in CVMC consistently ranking high in patient satisfaction on both inpatient and outpatient consumer satisfaction surveys. CVMC facilities include a full-service hospital, CVMC Senior Care (a provider-based clinic serving patients over 65), Job's Peak Internal Medicine & Family Practice, Topaz Ranch Medical Clinic, Minden Family Medicine and Complete Care, Alpine Medical, Ironwood Primary Care, Ironwood Urgent Care and Occupational Health Clinics. 5133579 9469451 Program expenses are used in the provision of health care services to the community. Carson Valley Medical Center provides inpatient and outpatient pharmaceutical services for the hospital and outpatient clinics. In 2016, there were higher patient acuities and more chemotherapy patients than the previous year. In 2016, 101,327 pharmacy orders were processed. 2831679 6966760 Program expenses are used in the provision of inpatient and outpatient lab services to the community. Carson Valley Medical Center provides 24 hour lab care for inpatients and outpatients with specially trained staff. Community lab draws are available monthly, offering affordable lab tests without a doctor's order or appointment. In 2016, 40,426 patient visits with 115,610 tests were performed by the lab. 774713 3963245 A Cardiology practice continues to provide on-site cardiology services on both an inpatient and outpatient basis. Referrals have increased our CT Scans (Computed tomography) from the previous year. In 2016 4,764 tests were performed by the Imaging CT Scan Department. 774713 3963245 51906194 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 104 0 1 470 1 0 0 0 0 0 0 0 0 0 0 X 6 6 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 X Preston Becker 7757821500 1107 Highway 395 N Gardnerville NV 89410 Dawn Ahner Chair 0.50 X X 0 0 0 Richard Derby Secretary/Treasurer 0.50 X X 0 0 0 Clint Purvance Board Member 0.50 X 0 0 0 Larry Trilops Board Member (Jan-Feb) 0.50 X 0 0 0 Greg Boyer Board Member 0.50 X 0 0 0 Paul J Fry III Board Member 0.50 X 2560 0 0 Tony Slonim Board Member (Mar-Dec) 0.50 X 0 0 0 Julie Howes Director of Finance (Jan-Aug) 40.00 X 89164 0 18444 Susan Davila President/CEO (Jan-Feb) 40.00 X 73661 0 2046 Shannon Albert Interim President/CEO (Mar-May) 40.00 X 113298 0 6120 Preston Becker President/CEO (Jun-Dec) 40.00 X 100761 0 0 Greg Ponsness Director of Pharmacy 40.00 X 159185 0 29701 Rose Brown Ultrasound Technician 40.00 X 137773 0 8949 Linda Lilleboe Director of Operations 40.00 X 129626 0 13594 Brandon Battis Pharmacist 40.00 X 159474 0 24411 Kathryn Cocking Director of Clinical Services 40.00 X 146745 0 15766 1112247 0 119031 34 0 1 0 Leman Medical Corporation 1122 Monterra Dr Minden NV 89423 Medical Services 2126231 Rural Physicians Group 10624 S Eastern Ave Suite A263 Henderson NV 89052 Medical Services 693000 Associated Anesthesiologists 1 E Liberty St Suite 555 Reno NV 89501 Medical Services 418917 Sierra Nevada Surgical Assoc PO Box 4237 Carson City NV 89702 Medical Services 367650 South Lake Ortho Coverage Corp PO Box 7901S Lake Tahoe CA 96158 Medical Services 309350 15 103742 6000 109742 Net Patient Services 621400 60723576 60723576 Other Supporting Revenue 900099 931741 931741 61655317 162357 162357 165040 352352 -187312 -187312 -187312 180226 25635 216455 3035 -36229 22600 -13629 -13629 61726475 61655317 0 -38584 449401 449401 23075358 20857369 2217989 295075 259258 35817 3024163 2548175 475988 1275688 1090973 184715 83283 83283 84870 84870 10561 10561 4651077 4006186 644891 236474 232669 3805 791930 690245 101685 103357 47918 55439 401184 398643 2541 61183 21162 40021 164443 106714 57729 384053 384053 2806229 2806229 411555 80139 331416 Bad Debts 9594717 9594717 Medical Supplies 8595997 8595997 Rental/Lease 158003 158003 534596 411797 122799 57193197 51906194 5287003 0 16979203 20756506 6791560 8209492 1285579 1200836 412868 308845 47038829 22627047 25578581 24411782 5544295 5637288 1177255 1180705 1288233 673191 59057574 62378645 3256735 3697608 1069215 601577 7424078 6740584 3106204 2616123 167573 167573 15023805 13823465 X 44033769 48555180 44033769 48555180 59057574 62378645 4533278 -11867 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3312 0 0 0 3312 0 Part II-B, Line 1: The organization pays membership dues to the American Hospital Association, Nevada Hospital Association, Retain Assoc of NV, Assoc for Healthcare Philanthropy, Society for HR Management, Medical Group Assoc, CA Society of CPA's, Nat'l Assoc of Rural Health Clinics, NV Assoc of Employers, Assoc of Nutrition & Foodservice Prof, National Rural Health Assoc, and Nat'l Assoc for Healthcare Quality. A portion of the dues paid are used for lobbying activities on behalf of their members to build a support base on measures that would benefit and improve access to health care in Nevada. 187000 2850407 3037407 29986670 13472432 16514238 12980476 8702187 4278289 1034276 452428 581848 24411782 Other Liabilities 167573 167573 X 52517314 -11867 -9516485 -9528352 62045666 10561 -329752 -319191 61726475 48054621 466702 466702 47587919 10561 9594717 9605278 57193197 Part X, Line 2: The Medical Center is organized as a Nevada nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial Statements -9,594,717. Foundation Revenue Included in Consolidated Financial Statements 78,232. Part XI, Line 4b - Other Adjustments: Gain on Disposal of Assets Included in Expenses on Financial Statements 22,600. Rental Expenses Included in Expenses of Financial Statements -352,352. Part XII, Line 2d - Other Adjustments: Gain on Disposal of Assets Included in Expenses on Financial Statements -22,600. Foundation Expenses Included in Consolidated Financial Statements 136,950. Rental Expenses Included in Expenses of Financial Statements 352,352. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial Statements 9,594,717. 1 1 X 1 X 1 X 1 1 0 1 1 417000 417000 0.00880 4828134 2379376 2448758 0.05140 5245134 2379376 2865758 0.06020 463052 33265 429787 0.00900 6906885 2009781 4897104 0.10290 83900 83900 0.00180 7453837 2043046 5410791 0.11370 12698971 4422422 8276549 0.17390 7 2640 2640 0.00010 7 2640 2640 0.00010 0 9594717 85152 19434623 19445331 -10708 X 1 1 1 1520 VRR LLC Real Estate 0.10000 0.90000 1 1 Washoe Barton Medical Clinic 1107 Hwy 395 Gardnerville NV 89410 www.cvmchospital.org 3986RUH-14 X X X X 1 provider based clinic Washoe Barton Medical Clinic 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X See Section C X 1 16 1 See Section C 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X X X X X X 1 X 0 X X X X 1 X 0 0 Washoe Barton Medical Clinic Part V, Section B, Line 5: The 2016 Douglas County Community Health Needs Assessment was conducted March - June 2016. The committee included: Carson Valley Medical Center, Health & Human Services (Douglas County Public Health), Government Officials, Fire & Paramedic District, Douglas County Social Services, Partnership of Community Resources, and University of Nevada Reno School of Medicine/Office of Statewide Initiatives. The three components of the 2016 assessment process included:1. A Community Survey, disseminated to all community members to gather input on their health status and views of that of the community as a whole. This survey was developed by the University of Nevada's Office of Statewide Initiatives and sponsored by CVMC. In addition, a focus group was held to gather information specifically from Spanish-speaking community members. All members of the planning committee aided in the distribution of the Community Survey, and Partnership of Community Resources and CCHHS coordinated the implementation of the focus group for Spanish-speaking community members. 2. A data set using the Nevada Core Health Indicators (v. 1.0) that showcases data on a variety of health outcomes from not only Douglas County, but also the surrounding communities and the state and national levels where available. This data set was compiled by CCHHS staff. A Local Public Health System Performance Assessment (LPHSPA), which brings representatives from a broad spectrum of community organizations together to discuss how well local organizations work together to address community health needs and other public health services. The organization and implementation of this portion of the assessment was the focus of the planning committee. Washoe Barton Medical Clinic Part V, Section B, Line 6b: Health & Human Services (Douglas County Public Health), Government Officials, Fire & Paramedic District, Douglas County Social Services, Partnership of Community Resources, and University of Nevada Reno School of Medicine/Office of Statewide Initiatives. Washoe Barton Medical Clinic Part V, Section B, Line 11: CVMC addressed each of the needs identified in the CHNA. Due to the timing of the CHNA and Implementation Strategy, CVMC was in the process of addressing the needs identified at year end. These needs will be addressed as follows:The significant (top 3) needs were identified as cost of healthcare, substance abuse, access to healthcare.1) Cost of Healthcare: CVMC will expand wellness programs that give patients options for affordable healthcare screenings and resources.2) Substance Abuse: CVMC will strengthen strategic partnership with Partnership of Community Resources - a local nonprofit designed to address substance abuse problems, awareness and prevention. * Ensure a CVMC executive sits on the PCR board of directors. * Implement annual meeting of the CVMC Executive Team and the PCR Executive Director to discuss issues and trends. 3) Access to Healthcare: * CVMC will look at extended hours for outpatient services. * CVMC will expand outreach programs that bring services to key groups in the community (i.e. workplace wellness program, potential services to youth via school or after school programs). * Assess local transportation barriers for senior population needing healthcare services. * Assess insurance contracts at CVMC. * Recruit primary care providers to reduce wait time for primary care appointments. Schedule H, Part V, Section B, Line 7 and Line 10: http://cvmchospital.org/about_us/health_needs_assessment.aspx 7 1 - Minden Family Medicine 1649 Lucerne St Units A B Minden NV 89243 Medical Clinic 2 - Ironwood Primary Care 897 Ironwood Dr Minden NV 89423 Medical Clinic 3 - Occupational Medicine 897 Ironwood Drive Minden NV 89243 Medical Clinic 4 - Ironwood Urgent Care 897 Ironwood Dr Minden NV 89423 Medical Clinic 5 - Job's Peak Internal Medicine & Family 1520 Virginia Ranch Rd Unit B Gardnerville NV 89410 Medical Clinic 6 - Alpine Medical 1667 Lucerne St Minden NV 89423 Medical Clinic 7 - Topaz Ranch Medical Center 3919 Carter Wellington NV 89444 Medical Clinic Part I, Line 6a: The organization's community benefit report is available upon request and is posted at www.cvcmhospital.org/about_us/ Part I, Line 7: Part I, Line 7a:Financial Assistance was calculated using the cost-to-charge ratio. All patient segments are addressed using this method. The methodology used is to be in compliance with laws and regulations set forth by Medicare and the filing of the annual cost report. Part I, Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services was calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers.Part I, line 7e:Community health improvement services are actual costs reported in the general ledger. Part I, line 7i:Cash and in-kind donations are actual costs reported in the general ledger. Part I, Line 7g: Washoe Barton Medical Clinic runs 8 physician clinics to treat patients in the community. The clinics need to be subsidized by the hospital to meet their payroll and other monthly expense needs. 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 $ 9,594,717. Part II, Community Building Activities: CVMC offers seven support groups that fall under the community building definition - topics have been addressed to meet the needs stated by our patients and our community. Part III, Line 2: The Hospital uses the reserve method in recognizing bad debt expense based on historical trends and information available at the time of recognition. We do not classify amounts that could be attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy without sufficient information. Part III, Line 3: The Hospital applied the charity care as a percentage of total patient revenues to bad debt expense to estimate the amount bad debt that would be charity care if sufficient information was obtained to determine their eligibility. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses is located on page seven and eight of the attached financial statements. Part III, Line 8: The expenses represent an overall shortfall of the Medicare patient population. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The general billings and collections policy applies to all patients, including any application under the charity care policy. The Hospital does not send patient accounts to collections before 120 days of the date of the first invoice. The Hospital will pull back patient accounts from collections if a patient submits a financial assistance application within 240 days of the date of the first invoice. Part VI, Line 2: In addition to the community health needs assessment, CVMC regularly assesses data trends and utilization data from internal sources as well as secondary sources (state and local agencies, Nevada Rural Hospital Partners, Nevada Hospital Association, etc.) to assess community need. CVMC partners with local development authority, Chambers of Commerce, and government committees to ensure CVMC is responding to the needs of the community. Part VI, Line 3: Communication is via website, brochures, telephone and in person. Website is www.cvmchospital.org/patients_visitors/financial_assistance.aspx Part VI, Line 4: Carson Valley Medical Center (CVMC), serves Douglas County -- an area spanning 710 square miles and includes a total of seven zip code areas: 89705 (south Carson City), 89460 (Gardnerville), 89411 (Genoa), 89423 (Minden), 89448 (Lake Tahoe towns, including Stateline), 89449 (Lakeridge), and 89410 (Topaz Lake and Dresslerville); as well as outlying areas that include Wellington NV, Topaz Ranch Estates, Markleeville, CA and Coleville, CA. This broad area encompasses varied neighborhood settings, including both rural and suburban areas. CVMC is in Douglas County, NV - which has a population of 47,118 (84% white, 12% Hispanic, 2% Native American). Median household income: $56, 613, 10.2% of population in poverty. (Data from Carson City Health & Human Services: Primary & Secondary Data Sets, 2016). Part VI, Line 5: The majority of the organization's board of directors is comprised of persons serving in the medical community of the greater Northern Nevada area. The organization extends medical staff privileges to credentialed and approved practitioners in its community. The organization's mission is to promote the health and wellness of the Carson Valley and its visitors. Surplus funds are used to acquire equipment and resources that improve patient care.CVMC is committed - as the community hospital - to promote the health of the members of the community. We do so through community outreach and wellness programs, including reaching out to local employers in our workplace wellness programs and offering low cost and free screenings to detect and prevent illness and disease. The hospital operates a 24 hour emergency room for medically necessary care to all regardless of ability to pay. The hospital participates in education and training of healthcare professionals. The hospital participates in government-sponsored health programs such as all Medicaid, Medicare, Tricare, all Veterans Administration healthcare and Indian Health Services. The organization is the sole community hospital in Douglas County. The organization currently has 32 active volunteers. The organization has numerous employees involved in local and state community programs including Boy Scouts, Rotary, Chamber of Commerce, NHRP, NRH, HFMA, AMA, National Association for Healthcare Quality, Business Council, and the Douglas County Community and Senior Center.Community outreach and education are provided to our community members to increase awareness of prevalent health issues and promote healthy behaviors and lifestyles. Programs include workplace wellness, health fairs, career days, and services provided at large-scale community events. The organization is responsive to the community needs such as opportunities for community involvement in governance and advisory groups. The organization serves as a vehicle for attracting and effectively uses donated funds. Part VI, Line 6: Although this hospital is not in an affiliated health system, it does have two parent companies each about 45 miles away serving different communities, in different states. Part VI, Line 7, Reports Filed With States NV,CA X X 0 0 0 0 0 0 0 0 0 Greg Ponsness Director of Pharmacy 159185 0 0 0 0 0 5501 0 24494 0 189180 0 0 0 Brandon Battis Pharmacist 159474 0 0 0 0 0 211 0 24200 0 183885 0 0 0 Kathryn Cocking Director of Clinical Services 146745 0 0 0 0 0 211 0 16755 0 163711 0 0 0 A Douglas County Nevada 886000031 2013-04-17 8700000 Refinance 2003 bond issued 04/15/2003; purchase & build urgent care center 0 0 0 A 1785834 8700000 174000 2621962 5904038 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 A 0 Form 990, Part VI, Section A, line 2 Dawn Ahner, Greg Boyer, and Tony Slonim have a business relationship. Form 990, Part VI, Section A, line 6 The Corporation shall have two (2) Members, which shall be Renown Health and Barton Healthcare System. Form 990, Part VI, Section A, line 7a Each member shall have the right to appoint 50% of the board members. Each member has the right to remove any or all of its designated directors at any time and from time to time. Form 990, Part VI, Section A, line 7b The following actions or items will require the approval of the Members prior to implementation or becoming effective: (a) Approval of long-term or material agreements involving more than two hundred fifty thousand dollars, including but not limited to borrowings, equity financings or capitalized leases, and agreements involving the sale or disposition of assets which involve the receipt or payment of more than two hundred fifty thousand dollars; (b) Approval of the Corporation's strategic plan and selection or approval of the manager or senior executives of the Corporation; (c) Any amendment or modification of the Corporation's Articles of Incorporation or the Bylaws; (d) Approval of the Corporation's operating and capital budgets (e) Admit any additional members; (f) Approval of any capital or other investment (including real property) or purchase in excess of the amount approved in the annual budget and any revisions thereto; (g) A sale, lease, conveyance or other transfer of all or substantially all of the assets of the Corporation; and (h) A merger, consolidation, reorganization or dissolution of the Corporation. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b A draft copy of the Form 990 is reviewed in detail by the organization's Chief Finance Officer. An electronic copy of the Form 990 is sent to all voting members of the board of directors for their review and comments prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers directors, officers and managing employees of CVMC. According to established policies there is an on-going review of contracts and enforcement is handled by the Corporate Compliance Officer. If a potential conflict is disclosed the interested person is required to leave the Board or committee meeting while the matter is discussed and voted upon. The remaining Board or committee members determine if a conflict does exist. Form 990, Part VI, Section B, line 15 The CEO, Finance Director/CFO, and key employees' compensation are determined using a regionally recognized market survey and competitor comparisons. The CEO's compensation is also reviewed and approved by the board of directors. The compensation is reviewed annually. The CEO and Human Resources review the compensation of the Finance Director/CFO. The compensation of the key employees is reviewed by the CEO, Human Resources, and board. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request. Carson Valley Medical Center Rural Health Clinic LLC 1107 Highway 395 Gardnerville NV 89410 261513495 Rural health and senior care clinic NV 0 0 Washoe Barton Medical Center Carson Valley Medical Center Foundation Inc 1107 Highway 395 Gardnerville NV 89410 364649725 Charitable Foundation NV 501(c)(3) Line 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 Carson Valley Medical Center Foundation Inc C 103472 General Ledger