2015-11-13T15:30:42-06:00 2014-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-01-01 880405927 Washoe Barton Medical Clinic WASH 7757821500 1107 HWY 395 Gardnerville NV 89410 Susan K Davila CEO 7757821500 2015-11-13 1 Kim Hunwardsen CPA P00484560 6122536500 2015-10-26 2014 2016-04-25 22:37:26Z Carson Valley Medical Center Susan K Davila 1107 HWY 395 Gardnerville NV 89410 53667547 0 X carsonvalleymedicalcenter.org X 1999 NV Nevada non-profit corporation which operates as the sole hospital in the county. 6 5 415 1025 0 0 152383 160450 52412719 53019802 -9238 121807 297098 17992 52852962 53320051 0 0 0 0 19002901 25748564 0 0 0 29674529 24359072 48677430 50107636 4175532 3212415 52875413 56638699 16376592 17006387 36498821 39632312 X Our mission is your health and wellness. 0 0 4269919 6762783 Program expenses are used in the provision of surgical services to the community. Washoe Barton Medical Clinic (dba Carson Valley Medical Center) provides inpatient and outpatient surgery services. Emergency and elective surgeries are performed by general and specialty surgeons. In 2014, 1,510 surgeries were performed at Carson Valley Medical Center. 2333826 6110450 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 2014, 36,991 patient visits with 96,480 tests were performed by the lab. 2802468 5396877 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 2014, there were higher acuities and more chemotherapy patients than the previous year. In 2014, 61,238 pharmacy orders were processed. 34212672 34749692 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 number one in patient satisfaction among full-service hospitals in our region. 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, Herbig, and Ironwood Urgent Care. 34212672 34749692 43618885 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 1 0 0 0 0 1 1 1 0 0 0 1 123 0 1 415 1 0 0 0 0 0 0 0 0 0 0 X 6 5 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 0 X Julie Howes 7757821511 1107 Highway 395 N Gardnerville NV 89410 John Williams Chair 0.50 X X 0 0 0 Dawn Ahner Secretary/Treasurer 0.50 X X 0 0 0 Clint Purvance Board Member 0.50 X 0 0 0 Larry Trilops Board Member 0.50 X 0 0 0 Paul J Fry II Board Member 0.50 X 0 0 0 Randy Ross Board Member 0.50 X 0 0 0 Julie Howes Director of Finance (Feb-Dec) 40.00 X 86070 0 15494 Susan Davila President/CEO 40.00 X 190261 0 8872 Thomas Hunter Director of Pharmacy 40.00 X 148499 0 23111 Rose Brown Ultrasound Technician 40.00 X 138036 0 6372 Timothy O'Neill Physician Assistant 40.00 X 128617 0 0 Linda Lilleboe Director of Operations 40.00 X 126116 0 6372 Christine Raynes Director of Clinical Services 40.00 X 126440 0 23111 944039 0 83332 16 0 1 0 Leman Medical Corporation 1122 Monterra Dr Minden NV 89423 Emergency Room Medical Group 1947975 South Tahoe Anesthesia Medical Group PO Box 5641 Portland OR 972285641 Anesthesia Medical Group 465893 The Neenan Company LLP 2607 Midpoint Drive Fort Collins CO 80525 Construction Company 402522 Quest Diagnostics PO Box 51048 Los Angeles CA 900741048 Laboratory Results 212521 Sierra Nevada Surgical Assoc PO Box 4237 Carson City NV 89702 Surgery Medical Group 212025 10 150000 10000 450 160450 Net Patient Services 621400 51503249 51503249 Other Supporting Revenue 900099 1516553 1516553 53019802 124126 124126 363169 345177 17992 17992 17992 648 1671 -648 -1671 -2319 -2319 53320051 53019802 0 139799 298807 298807 21511409 19188501 2322908 230460 190686 39774 2522219 2097741 424478 1185669 993270 192399 94052 94052 31986 31986 252058 252058 3598787 1880683 1718104 178520 52524 125996 633190 395543 237647 2805 2805 500798 461107 39691 65632 21237 44395 107428 25009 82419 439710 439710 2423572 2423572 411456 77555 333901 Bad Debt Expenses 9012232 9012232 Medical Supplies 6007971 6007971 Rental/Lease 154558 154558 444317 196986 247331 50107636 43618885 6488751 0 5430493 1173584 1664826 16119100 7741418 6469392 1314235 1282296 291900 328875 47577776 19792093 27876459 27785683 3799547 2521128 5550 4750985 958641 52875413 56638699 3064558 3477509 1536953 8398468 7918693 4658445 3896737 255121 176495 16376592 17006387 X 36369094 39632312 129727 0 36498821 39632312 52875413 56638699 3212415 -77774 -1150 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3031 0 0 0 3031 0 Part II-B, Line 1: The organization pays membership dues to the Nevada Hospital Association, National Association for Healthcare Quality, American Hospital Association and Retail Association of Nevada. 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. 2850407 2850407 29908651 11286298 18622353 14015314 8163561 5851753 803404 342234 461170 27785683 Other Liabilities 176495 176495 X 44859720 -8807179 -8807179 53666899 -346848 -346848 53320051 41617501 522097 522097 41095404 9012232 9012232 50107636 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 properly reported all income subject to unrelated business income tax on the 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. The Organization's federal Form 990T filings are no longer subject to federal tax examinations by tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial Statements -9,012,232. Foundation Income Included in Consolidated Financial Statements 75,326. Net Assets Released from Restrictions 129,727. Part XI, Line 4b - Other Adjustments: Loss on Disposal of Assets Included in Expenses on Financial Statements -1,671. Rental Expenses Included in Expenses of Financial Statements -345,177. Part XII, Line 2d - Other Adjustments: Loss on Disposal of Assets Included in Expenses on Financial Statements 1,671. Foundation Expenses Included in Consolidated Financial Statements 175,249. Rental Expenses Included in Expenses of Financial Statements 345,177. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial Statements 9,012,232. 1 1 X 1 X 1 X 1 1 0 1 1 497000 497000 0.01210 2860015 1415652 1444363 0.03510 3357015 1415652 1941363 0.04720 24 3546 410706 31560 379146 0.00920 7656116 1975176 5680940 0.13820 84000 84000 0.00200 24 3546 8150822 2006736 6144086 0.14940 24 3546 11507837 3422388 8085449 0.19660 1 9012232 0 17638332 17662396 -24064 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.cmvchospital.org 3986RUH-14 X X X X 1 provider based clinic Washoe Barton Medical Clinic 1 0 0 1 X X X X X 13 1 0 1 1 X www.carsonvalleymedicalcenter.org X 1 13 1 www.cvmchospital.org/cha 0 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X X X X X X 1 X 0 X X X 1 X 0 0 Washoe Barton Medical Clinic Part V, Section B, Line 5: The CHNA involved community focus group sessions and key informant interviews. Primary data collection included the community health survey administration and reports. Secondary data included county-level and sub-county-level community health profiles. Washoe Barton Medical Clinic Part V, Section B, Line 11: Need: Cost of Healthcare - CVMC provides annual education through printed materials and events to educate patients of their options for affordable healthcare, as well as financial assistance options. In 2014, CVMC opened the CVMC Urgent Care to offer patients a lower cost alternative for their urgent medical needs. In 2015, the CVMC Community Wellness program was expanded to offer affordable health screenings and preventative health resources to our community.Need: Obesity - CVMC created an outpatient nutritional services program and offers regular nutrition education sessions to our community.Need: Access to Healthcare - In 2014, CVMC opened the CVMC Urgent Care to offer patients expanded access to healthcare services beyond traditional office hours. An effort has also been made to partner with the Douglas County Community Center to provide basic medical screenings and services on site on a monthly basis. CVMC also offers telemedicine to use technology to increase access.Need: Drug Abuse - CVMC partners with the local agency Partnership of Community Resources to tackle this issue in our community.Need: Mental Illness - CVMC's geriatric mental wellness clinic has expanded its outreach services to the community to help identify and treat patients with mental illness in our community. We hope to collaborate with our local VA to provide mental health services to our local veterans. Washoe Barton Medical Clinic Part V, Section B, Line 22d: CVMC provides charity care on a sliding fee scale. The charity care discount is provided directly to gross charges, resulting in these individuals paying less than the average insured individual. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Washoe Barton Medical Clinic Part V, Section B, line 16a website: www.cvmchospital.org/patients_visitors Washoe Barton Medical Clinic Part V, Section B, line 16b website: www.cvmchospital.org/patients_visitors/financial_assistance.aspx Washoe Barton Medical Clinic Part V, Section B, line 16c website: www.cvmchospital.org/patients_visitors/financial_assistance.aspx 6 Job's Peak Internal Medicine & Family 1520 Virginia Ranch Rd Unit B Gardnerville NV 89410 Medical Clinic Ironwood 897 Ironwood Dr Minden NV 89423 Medical Clinic Minden Family Medicine & Complete Care 1649 Lucerne St Units A B Minden NV 89243 Medical Clinic Topaz Ranch Medical Center 3919 Carter Wellington NV 89444 Medical Clinic Alpine Medical 1667 Lucerne St Minden NV 89423 Medical Clinic Herbig Family Medical 1540 Hwy 395 Gardnerville NV 89410 Medical Clinic Part I, Line 6a: The organization's community benefit report is available upon request. Part I, Line 7: The costing methodology used for line 7a is 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:Unreimbursed Medicaid was calculated using the cost-to-charge ratio derived from Worksheet 2.Part I, line 7e:Community health improvement services 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 7i:Cash and in-kind donations are actual costs reported in the general ledger. 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 $ 9,012,232. 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 4: The footnote to the organization's financial statements that describes bad debt expenses is located in Footnote 1 on page 8 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. Part VI, Line 2: CVMC conducts a study or focus group to gather primary data from our community that we serve. That data is combined with secondary data gathered from the state or other local agencies to gain a true picture of the health needs of our community. Surveys are given to both inpatients and outpatients. Informal feedback is also gathered from patients and focus groups. Part VI, Line 3: Charity determination may be initiated by the hospital admitting/registration personnel, financial counselors, or patient accounting staff. Policy packets are given to the patient. The packets have a summary of requirements to be met. The patient returns the packet and requirements and then the admitting personnel forwards that information to the billing office. Part VI, Line 4: CVMC serves the Carson Valley region of northern Nevada, which includes primarily Douglas County, NV but also very small portions of Lyon County and the southern portion of Carson City. The population of Douglas County is 47,223, which increased 13.3% between the 2000 and 2010 census. The proportion of Douglas County residents over the age of 65 is 20.3%. Douglas County has the highest per capital income in the state of Nevada. The proportion of the population over age 25 with high school degrees is 92.8%. The proportion of the population that has a bachelor's degree is 25.9%. 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 35 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, Community Center (serving cake and providing free health screening and information on site).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. 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 1 0 0 0 0 0 Susan Davila President/CEO 153866 0 36395 0 0 0 0 0 9075 0 199336 0 0 0 Thomas Hunter Director of Pharmacy 143461 0 5038 0 0 0 0 0 23241 0 171740 0 0 0 Part I, Line 5 The Organization has a senior management incentive program and management accountabilities program which includes specific criteria in order for them to receive additional compensation. A Douglas County Nevada 886000031 2013-04-17 8700000 Refinance 2003 bond issued 04/15/2003; purchase and build urgent care center 0 0 0 A 781307 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 Optima Healthcare Board member's sister is CEO of Optima Healthcare 360039 Contracted services 0 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 11 A draft copy of the Form 990 is reviewed in detail by the organization's Finance Director. 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, 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. 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 150000 Actual Amount