2014-05-14T17:38:01-05:00 2013-06-30 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2012-07-01 840255530 Lutheran Hosp Assoc of the San Luis Valley % THE ORGANIZATION LUTH 7195892511 106 Blanca Avenue Suite Alamosa CO 81101 Konnie Martin 7194714290 2014-05-15 true 7194714290 2012 2015-11-30 17:44:51Z Konnie Martin CEO 106 Blanca Avenue Alamosa CO 81101 63781815 false X www.slvrmc.org X 1928 CO The hospital provides inpatient, outpatient, and emergency care services to patients in the San Luis Valley. In addition, they also sponsor community programs, such as a weight loss program. 11 7 657 60 0 0 767665 710660 63284527 62005021 316205 211199 121112 62734 64489509 62989614 23865 7000 0 0 32513132 33753674 0 0 289862 30350344 29548314 62887341 63308988 1602168 -319374 68010817 66066389 27164301 24928623 40846516 41137766 X AN UNCONDITIONAL COMMITMENT TO EXCELLENCE BY PROVIDING QUALITY, COMPASSIONATE CARE GUIDED BY OUR VALUES. WE ACCEPT RESPONSIBILITY FOR PROVIDING SERVICES TO OUR COMMUNITY THAT ARE OF THE HIGHEST CALIBER OF SERVICE AND STANDARD PERFORMANCE, WHILE DEMONSTRATING OUR ADOPTED VALUES. false false 47383053 7000 61900246 San Luis Valley Regional Medical Center (SLVRMC) has operated as an independent, not-for-profit hospital for over 83 years. SLVRMC 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. Including our relationship with Conejos County Hospital, SLVRMC employs almost 600 and is the largest employer in the San Luis Valley. The trustees, providers and staff of SLVRMC 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. SLVRMC'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 eight years, our gross revenue has increased from $20M to $60M and the number of patients served has expanded several fold. New services have been added in medication oncology, inpatient rehabilitation, dialysis, sleep disorders, women's imaging center, fixed wing medical transportation, genetic counseling, behavioral health, cardiology, chiropractic, oncology/infusion therapy and more. 47383053 true true false true false false false false false true true false false false true false true false false false false false false false false false true true true false true true false false false false false false false false true false false false false false false true true false true false true 95 0 true 657 true false false false false false false false false false false X 11 7 true false true false false false false true true false false true true true true true true true true false X THE ORGANIZATION 7195892511 106 BLANCA AVENUE Alamosa CO 81101 JAN GAY 2.0 2.0 X X 2500 0 0 karla hardesty 2.0 2.0 X X 1200 KENDAL KNAUS MD 2.0 X X 34500 JIM EHRLICH 2.0 X PATRICK CROWDER 2.0 X 808 KATHY LORENZ 2.0 X 883 cheri crowder 2.0 2.0 X 1200 ROSALIE MARTINEZ 2.0 X steven w kitchen 40.0 X 551391 38649 david frow 40.0 X 499684 38098 susan geiger 40.0 X 106926 4782 dennard ellison 40.0 X 408781 36564 russell johnson 38.0 2.0 X 364194 38829 henry garvin 8.0 32.0 X 202790 31322 konnie martin 40.0 X 226483 30205 patti thompson 40.0 X 46040 greg mcauliffe md 40.0 X 294372 37948 shane mortensen 38.0 2.0 X 161115 33022 david geiger 40.0 X 365316 37565 robert marshall 40.0 X 327477 36718 bethany l kolb 40.0 X 292030 11053 olivier de raet 40.0 X 274886 27928 annaeliese keller 40.0 X 262802 15946 helen lester 40.0 X 133214 4779 4558592 0 423408 54 true true false ARUP LABORATORIES PO BOX 27964 SALT LAKE CITY UT 84127 CONTRACT SERVICES 187008 CARETECH SOLUTIONS INC PO BOX 674271 DETROIT MI 48267 CONTRACT SERVICES 1172206 NUANCE COMMUNICATIONS PO BOX 2561 CAROL STREAM IL 60132 CONTRACT SERVICES 428009 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 CONTRACT LABOR 339127 HSS PO Box 17033 DENVER CO 80201 contract services 182757 14 50270 306621 353769 710660 PATIENT SERVICE REVENUE 900099 31956025 31956025 MEDICARE/MEDICAID 900099 27292192 27292192 AMBULANCE DISTRICT REVENUE 621910 368435 368435 MANAGEMENT FEES 900099 840450 840450 EHR MEANINGFUL USE 900099 1204413 1204413 343506 173088 170418 62005021 208019 208019 0 0 77432 82617 -5185 0 -5185 -5185 705684 7080 705684 3900 3180 3180 3180 0 0 0 OTHER REVENUE 900099 65643 65643 DRUGS- NON PATIENT 900099 2276 2276 67919 62989614 61900246 0 378708 7000 7000 0 0 0 1712984 1321085 379686 12213 0 26712490 20600225 5921819 190446 925047 713682 204767 6598 2607918 2012031 577286 18601 1795235 1301837 477996 15402 0 84757 84757 103592 103592 6815 6815 0 0 4066449 1586286 2477764 2399 188987 2421 153473 33093 2057874 827905 1225868 4101 1050541 1050541 0 1522626 1376134 146492 327703 227197 95837 4669 0 16800 11756 5044 736421 736421 0 3074680 1844808 1229872 344543 227584 116959 MEDICAL SUPPLIES 5465639 5415277 50362 PROVIDER FEES 4275679 4275679 BAD DEBT 5606260 5606260 COLLECTION EXPENSE 382285 382285 236663 25886 208437 2340 63308988 47383053 15636073 289862 737138 1069989 14162280 10897195 47326 117248 8541292 9316217 0 0 0 0 0 0 882684 887822 1078526 1113349 60147696 29235004 30964222 30912692 9873090 9973969 191667 100 94572 134718 0 0 1438020 1643090 68010817 66066389 6815807 6170511 0 0 61713 18210 14895000 14345000 0 0 0 0 3215410 2797593 0 0 2176371 1597309 27164301 24928623 X 40751944 41003048 94572 134718 0 0 40846516 41137766 68010817 66066389 X -319374 -35111 645735 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 6815 false false 6815 false Part II-B, Line 1g Dir. contact with legislators, their staff, gov't officials, etc. San Luis Valley Regional Medical Center 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. 94572 40146 134718 86517 8055 94572 133304 46787 86517 76317 56987 133304 117490 41173 76317 1.00000 false true true 3284829 3284829 33996864 14311713 19685151 20305132 14493801 5811331 2560871 429490 2131381 30912692 0 ASSET RETIREMENT OBLIGATION 270531 INTEREST RATE SWAP AGREEMENT 1326778 1597309 63682855 -35111 728352 693241 62989614 62989614 63391605 82617 82617 63308988 63308988 Schedule D, Part V, Line 4 Intended Uses of Endowment Funds San Luis Valley Regional Medical Center 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 Medical Center 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 Other revenue on books not on return change in fair market value of interest rate swap 605,589 change in fair market value of investment in foundation 40,146 rental expenses reclassed to income 82,617 Schedule D, Part XII, Line 2d Other expenses on books not on return rental expenses reclassed to income 82,617 true true X true X 40. true X true true false false 112483 112483 0.00180 17024923 10661462 6363461 0.10050 3675215 2725380 949836 0.01500 20812621 13386842 7425780 0.11730 139995 139995 0.00220 29950 29950 0.00050 847 847 82531 82531 0.00130 253323 253323 0.00400 21065944 13386842 7679103 0.12130 5625 5625 0.00010 11990 11990 0.00020 1343 1343 18958 18958 0.00030 true 5606260 10332044 12654129 -2322085 X true false 1 1 Lutheran Hospital of SLV

106 Blanca Avenue Alamosa CO 81101

www.sanluisvalleyhealth.org X X X Lutheran Hospital of SLV true X X X X X X X X X 12 true true true X X X X X X X X X X true false true true 40. true 250. true X true true X X X X X true false X X X true X false false 2 Lutheran Hospital of SLV

2115 Stuart St Alamosa CO 81101

Physician Clinic Lutheran Hospital of SLV

103 Chico Ct Monte Vista CO 81144

Physician Clinic Free and discounted care Part I Line 3c The hospital uses a sliding scale based on family income to determine eligibility for free and discounted care. The sliding scale provides free care and discounted care up to 40% and 250%, respectively, of the Federal Poverty Guidelines. Part I Line 7 Total bad debt expense removed from the denominator prior to the percentage calculation = 5,606,260. 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. PART III, LINE 4 Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Medical Center 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. For receivables associated with services provided to patients who have third-party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectible accounts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a significant provision for uncollectible accounts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. THE ADMINISTRATIVE REQUIREMENTS TO DETERMINE WHETHER PATIENTS WHO DO NOT COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS WOULD HAVE QUALIFIED FOR CHARITY CAN BE BURDENSOME, PARTICULARLY FOR SMALL BALANCES, SO A REASONABLE ESTIMATE, BASED ON BROAD DEMOGRAPHIC DATA, SHOULD BE SUFFICIENT TO JUSTIFY COMMUNITY BENEFIT TREATMENT. Medicare PART III, 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: 6/30/11 (3,610,290) 6/30/12 3,092,126 6/30/13 (2,322,085) NEEDS ASSESSMENT SLVRMC 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SLVRMC 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. COMMUNITY INFORMATION SLVRMC SERVICES THE ENTIRE SAN LUIS VALLEY WHICH HAS A POPULATION OF NEARLY 50,000 RESIDENTS WITHIN 6 COUNTIES. THE SLV IS GEOGRAPHICALLY LIMITED DUE TO ITS SURROUNDING MOUNTAIN PASSES THAT SOMETIMES MAKES IT DIFFICULT TO TRAVEL ELSEWHERE WHEN CARE ISN'T AVAILABLE HERE. OF THE SIX COUNTIES IN THE VALLEY, TWO OF THESE COUNTIES ARE AMONG THE FIVE POOREST COUNTIES IN COLORADO. MEDIAN INCOME LEVELS ARE APPROXIMATELY $34,971 COMPARED TO $54,411 STATEWIDE. APPROXIMATELY 20% OF HOUSEHOLDS IN THE SIX COUNTY AREA ARE BELOW THE FEDERAL POVERTY LINE. APPROXIMATELY 69% OR OUR PAYER MIX COMES FROM UNINSURED, MEDICARE, MEDICAID, CICP, OR SELF-PAY. PROMOTION OF COMMUNITY HEALTH SLVRMC is very active in the community in providing resources, information and donations to promote healthy living in school, business' and the general population. SLVRMC provides free or reduced rate physicals for students and other programs. SLVRMC staff is very active in the community serving on related boards and providing other community benefit while on the hospital payroll. SLVRMC provides many speaking tours on health related topics all over the San Luis Valley to inform and instruct residents on various issues. AFFILIATED HEALTH CARE SYSTEM SLVRMC HAS A PROFESSIONAL AFIILIATION WITH CENTURA HEALTH SYSTEMS TO COORDINATE CARE FOR OUR SHARED PATIENTS. part v, section b, line 3 input from representatives of the community In February 2013 evening meetings in Alamosa and in Conejos County were held. Community members were given time to share and prioritize the health issues that they see in the San Luis Valley. The Project Management met with the various Public Health agencies to discuss strategies to address the identified priority areas. Suggestions made were integrated into the CHNA. part v, section b, line 4 other hospital facilities involved with chna the chna for SLVRMC was conducted with conejos county hospital corporation. part v, section b, line 5 describe how chna is made widely available to the public the CHNA executive summary for SLVRMC is available at: http://www.sanluisvalleyhealth.org/sites/default/files/documents/Executive Summary_0.pdf part v, section b, line 6 implementation strategy for chna the implementation strategy to address each community health need identified through the chna is available on the CHNA executive summary at: http://www.sanluisvalleyhealth.org/sites/default/files/documents/Executive Summary_0.pdf true ADAMS STATE COLLEGE 208 EDGEMONT BLVD ALAMOSA CO 81102 846000542 GOVERNMENT 7000 EDUCATION 1 PROCEDURES FOR MONITORING THE USE OF GRANT FUNDS IN THE U.S. PART I, LINE 2 FUNDS ARE PROVIDED TO BE USED FOR DESIGNATED PURPOSES ONLY. ALL GRANTEES ARE SELECTED AND STRICTLY SCREENED BY THE MEDICAL CENTER. MULTI-YEAR AGREEMENTS ARE MADE WITH THE RECIPIENT ORGANIZATIONS AND ARE EVALUATED ON AN ANNUAL BASIS BEFORE FUNDING IS CONTINUED. X X X true false false false false false false true false steven w kitchen 530298 18689 2404 15000 23649 590040 0 david frow 457858 38219 3607 15000 23098 537782 russell johnson 255608 91637 16949 11649 27180 403023 0 henry garvin 168862 33775 153 8759 22563 234112 0 konnie martin 187769 38300 414 4227 25978 256688 0 helen lester 38465 16451 78298 4779 137993 greg mcauliffe md 244466 48250 1656 11265 26683 332320 shane mortensen 135097 25760 258 7089 25933 194137 dennard ellison 390782 17999 11234 25330 445345 david geiger 323707 34148 7461 12916 24649 402881 robert marshall 326701 776 12508 24210 364195 bethany l kolb 274593 17437 2077 8976 303083 olivier de raet 264570 10003 313 4683 23245 302814 annaeliese keller 254320 8417 65 3949 11997 278748 SEVERANCE PAYMENTS PART I, LINE 4A THE FOLLOWING AMOUNTS LISTED ARE SEVERANCE PAYMENTS: HELEN LESTER $63,440 NON-FIXED PAYMENTS PART I, LINE 7 CLINICAL KEY EMPLOYEES 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 AWARED AT THE DISCRETION OF THE BOARD FOR THE CEO AND THE CEO FOR ALL OTHER SENIOR MANAGEMENT. A ALAMOSA COUNTY STATE OF COLORADO 846000733 2005-02-17 11355000 HOSPITAL IMPROVEMENTS false false false B ALAMOSA COUNTY STATE OF COLORADO 846000733 2007-04-26 6505000 PURCHASE 2115 STUART & IMPROVEMENT false false false A 2465000 0 11355000 157158 0 0 362859 0 0 10992141 0 0 2005 false false true true B 1050000 0 6505000 31610 0 0 130100 81852 0 6293048 0 0 2007 false false true true A false true false false 0.01000 0.00000 0.01000 true false 0.00000 false true B false true false false 0.02000 0.00000 0.02000 true false false true A false false false true true true morgan stanley cap 20.28 false false false 0 false true B false false false true true true morgan stanley cap 15. false false false 0 false true A true B true part iv, question 2c date ARBITRAGE rebate computation performed THE ALAMOSA COUNTY, CO SERIES 2005 BOND ARBITRAGE REBATE LIABILITY CALCULATION WAS PERFORMED ON SEPTEMBER 29, 2011. THE ALAMOSA COUNTY, CO SERIES 2007 BOND ARBITRAGE REBATE LIABILITY CALCULATION WAS PERFORMED ON MAY 15, 2012. DAVID GEIGER EMPLOYEE WAGES false PART IV, COLUMN C BUSINESS TRANSACTIONS WITH INTERESTED PERSONS BOARD MEMBER SUSAN GEIGER HAS A FAMILY RELATIONSHIP WITH HIGHEST COMPENSATED EMPLOYEE DAVID GEIGER. THE AMOUNT OF WAGES PAID CAN BE FOUND ON SCHEDULE J, PART II, LINE 9. Part VI, Question 11b Describe process to review 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. Part VI, Question 12c Monitoring of the the conflict of interest policy San Luis Valley Regional Medical Center 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. Part VI, Question 15a Executive 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. SLVRMC conducts an annual evaluation and quarterly reviews of the CEO's performance, which is documented. Compensation for the CEO is determined annually. Part VI, Question 15b Other officer 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. Part VI, Question 19 Describe how documents are made available to the public The governing documents, conflict of interest policy, and financial statements are available to the public upon request. SCHEDULE B GRANTS FROM SLVRMC FOUNDATION THE SLVRMC FOUNDATION, A RELATED ORGANIZATION, RECORDED TOTAL GRANTS TO THE MEDICAL CENTER OF $55,863. HOWEVER, THE MEDICAL CENTER HAS ONLY RECORDED GRANTS RECEIVED FROM THE FOUNDATION OF $50,270. THIS DISCREPANCY IS RELATED TO IN-KIND GRANTS FROM SLVRMC FOUNDATION WHICH ARE IMMATERIAL TO THE MEDICAL CENTER AND NEVER RECORDED. PART XI, LINE 9 OTHER CHANGES IN NET ASSETS CHANGE IN FAIR MARKET VALUE OF INTEREST RATE SWAP 605,589 CHANGE IN FAIR MARKET VALUE OF INVESTMENT IN FOUNDATION 40,146 TOTAL OTHER CHANGES TO NET ASSETS 645,735 PART VI, question 2 OFFICER, DIRECTOR, TRUSTEE FAMILY/BUSINESS RELATIONSHIP BOARD OF DIRECTOR MEMBERS CHERI CROWDER AND PATRICK CROWDER HAVE A FAMILY RELATIONSHIP. part vi, question 4 changes to organizational documents since prior 990 the by-laws of the organization have been changed to allow no fewer than 11 and no more than 15 trustees. SLVRMC FOUNDATION 106 BLANCA AVENUE ALAMOSA CO 81101 203799814 FUNDRAISING CO 501(c)(3) LINE 7 SLVRMC true CONEJOS COUNTY HOSPITAL CORPORATION PO BOX 639 LA JARA CO 81140 710947623 HOSPITAL CO 501(c)(3) LINE 3 SLVRMC true SLV MEDICAL CTR EMPLOYEE BEN TRUST 106 BLANCA AVENUE ALAMOSA CO 81101 840909851 HEALTH PLAN CO 501(c)(9) na false false false true true false false false false false false true true false true false true false false SAN LUIS VALLEY REGIONAL MEDICAL CENTER FDN C 50270 CASH PAID CONEJOS COUNTY HOSPITAL CORPORATION K 840450 CASH RECEIVED CONEJOS COUNTY HOSPITAL CORPORATION D 184467 LOAN AMOUNT CONEJOS COUNTY HOSPITAL CORPORATION P 1016001 INVOICES SLVRMC EMPLOYEE BENEFIT TRUST M 2099575 CASH PAID