2024-05-08T11:50:00-05:00 2023-06-30 460403496 CASEY PETERSON LTD 909 ST JOSEPH ST STE 101 RAPID CITY SD 57701 990 2022-07-01 830300467 POWELL VALLEY HEALTH CARE INC POWE 3077542267 777 AVENUE H POWELL WY 82435 JOY COULSTON CEO 3077542267 2024-05-07 1 JOY COULSTON 999009999 1 KAYLA GIESEY CPA P01874520 6053481930 2024-05-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z POWELL VALLEY HOSPITAL JOY COULSTON 777 AVENUE H POWELL WY 82435 79721172 0 X WWW.PVHC.ORG X 1992 WY PROVISION OF HEALTHCARE SERVICES 12 8 566 32 0 0 1331504 1376957 65784437 77769620 16557 14826 44080 559769 67176578 79721172 36314 43364 0 0 36676012 41117650 0 0 72081 30420464 36712447 67132790 77873461 43788 1847711 36247758 35316975 10799578 8021084 25448180 27295891 X CARING FOR YOU 0 0 63665219 43364 77811000 POWELL VALLEY HEALTH CARE, INC. (HOSPITAL) PROVIDES QUALITY CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION OF THE HOSPITAL, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE THESE ESSENTIAL SERVICES. IT IS THE HOSPITAL'S MISSION TO SERVE THE SURROUNDING AREA BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION TO ALL COMMUNITY MEMBERS. DURING THE YEAR ENDED JUNE 30, 2023, THE HOSPITAL PROVIDED $282,634 OF MEDICAL SERVICES, BASED ON THE AMOUNTS OF CHARGES FOREGONE, UNDER THE HOSPITAL'S CHARITY CARE POLICY AND GUIDELINES TO INDIVIDUALS WHO WERE DETERMINED UNABLE TO PURCHASE SUCH SERVICES. IN ADDITION TO FREE CARE AND/OR SUBSIDIZED CARE, CARE IS ALSO PROVIDED AT BELOW COST RATES TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS. RECOGNIZING ITS MISSION TO THE COMMUNITY, SERVICES ARE PROVIDED TO BOTH MEDICARE AND MEDICAID PATIENTS. THE UNREIMBURSED VALUE (BASED ON COST) OF PROVIDING CARE TO ALL PATIENTS WAS $5,936,480 FOR THE YEAR ENDED JUNE 30, 2023. DURING THE FISCAL YEAR ENDED JUNE 30, 2023, THE HOSPITAL PROVIDED 2,736 DAYS OF HOSPITAL SERVICES, THE NURSING HOME PROVIDED 18,989 DAYS OF RESIDENT SERVICES, AND THE ASSISTED LIVING FACILITY PROVIDED 6,441 DAYS OF RESIDENT SERVICES. THE HOSPITAL ALSO PROVIDES COMMUNITY CARE AND SERVICES THROUGH MANY HEALTH ACTIVITIES AND PROGRAMS PROVIDED TO SUPPORT THE COMMUNITY. THESE ACTIVITIES INCLUDE SUPPORT TO HERITAGE HEALTH CENTER CLINIC, A COMMUNITY HEALTH CENTER FQHC, WELLNESS PROGRAM, COMMUNITY EDUCATION PROGRAM, SPECIAL PROGRAMS FOR SPECIFIC PURPOSES, AND A VARIETY OF COMMUNITY SUPPORTED ACTIVITIES. 63665219 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 34 0 1 566 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X THE ORGANIZATION 3077542267 777 AVENUE H POWELL WY 82435 RJ KOST PRESIDENT 1.00 1.00 X X 0 0 0 CHRIS COX VICE PRESIDENT 1.00 1.00 X X 0 0 0 BONITA KATZ SECRETARY 1.00 1.00 X X 0 0 0 NATHANIEL RIEB MD TREASURER 1.00 X X 0 0 0 SYD THOMPSON DIRECTOR 1.00 1.00 X 0 0 0 SHELLY HILL DIRECTOR 1.00 1.00 X 0 0 0 JONI BENNETT DIRECTOR 1.00 1.00 X 0 0 0 SCOTT MCKENZIE DIRECTOR 1.00 1.00 X 0 0 0 BRIAN JONES DIRECTOR 1.00 X 0 0 0 AARON BILLIN MD DIRECTOR/PHYSICIAN 40.00 X 312966 0 38119 VALERIE LENGFELDER MD DIRECTOR/PHYSICIAN 40.00 X 272099 0 38845 JENKINS CLARKSON DIRECTOR/PHYSICIAN 40.00 X 428628 0 38647 TERRY ODOM CEO 40.00 X 238769 0 20748 JOY COULSTON CFO 40.00 X 198232 0 31063 WILLIAM JARVIS PHYSICIAN 40.00 X 867099 0 38647 CARLETTA COLLINS PHYSICIAN 40.00 X 557394 0 38647 NICOLE MASON PHYSICIAN 40.00 X 352978 0 38647 KELLY CHRISTENSEN PHYSICIAN 40.00 X 387176 0 37316 BRIAN KELLY PHYSICIAN 40.00 X 519984 0 38647 4135325 0 359326 57 0 1 0 BILLINGS CLINIC PO BOX 30977 BILLINGS MT 59107 MANAGEMENT SERVICES 2828525 FOCUSONE 13609 CALIFORNIA STREET SUITE 420 OMAHA NE 68154 TRAVELING/CONTRACT STAFF 1910906 NORTH PLATTE PHYSICAL THERAPY INC PO BOX 1790 DOUGLAS WY 82633 PHYSICAL THERAPY 1334371 HOLISTIC PAIN MANAGEMENT PO BOX 1476 LOVELAND CO 80537 PAIN MANAGEMENT SERVICES 1073270 340B HOLDINGS LLC 10181 SCRIPPS GATEWAY COURT SAN DIEGO CA 92131 PRESCRIPTION ADMINISTRATION SERVICES 558939 14 49290 1150970 176697 1376957 PATIENT SERVICE REVENUE 621110 75995419 75995419 PHARMACY CONTRACT REVENUE 456110 1156436 1156436 OTHER INCOME 621110 404892 404892 CAFETERIA 722514 212873 212873 77769620 14826 14826 41380 0 41380 41380 41380 INSURANCE RECOVERIES 900099 518389 518389 518389 79721172 77811000 0 533215 X 43364 43364 1618115 1129303 488812 29233159 24666743 4513838 52578 608461 487177 120672 612 7683470 4427315 3255720 435 1974445 1612392 357805 4248 613438 613438 18808 18808 50994 50994 8511293 7481546 1029605 142 198397 99084 97056 2257 198073 111403 86670 1229584 151126 1078079 379 1469685 657977 811708 187576 168293 19162 121 138126 4117 134009 925677 381261 544416 749955 749955 MEDICAL SUPPLIES 14233428 14233428 PROVISION FOR BAD DEBTS 5830756 5830756 PROVISION FOR INSURANCE 998967 998967 FOOD 642466 597730 33427 11309 715224 583237 131987 77873461 63665219 14136161 72081 9995491 5408357 192637 0 18271610 15115099 236511 319298 1715383 1842799 620592 445923 15778941 10059820 5215534 5719121 0 6466378 36247758 35316975 5332522 4913636 7764 7879 3038324 3099569 2420968 0 10799578 8021084 X 25448180 27295891 25448180 27295891 36247758 35316975 1847711 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 62680 62995 67552 58123 1 X 2216833 737233 1479600 12053007 9057291 2995716 1509101 265296 1243805 5719121 ESTIMATED THIRD-PARTY SETTLEMENTS 6466378 6466378 X 74240416 350000 -5830756 -5480756 79721172 0 79721172 72392705 350000 350000 72042705 5830756 5830756 77873461 PART IV, LINE 1B: THE ORGANIZATION IS ACTING AS AN AGENT FOR THE PVHC AUXILIARY PART IV, LINE 2B: THE ORGANIZATION HOLDS FUNDS IN TRUST ON BEHALF OF NURSING HOME RESIDENTS. PART X, LINE 2: AS OF JUNE 30, 2023, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS THAT QUALIFY FOR EITHER RECOGNITION OR DISCLOSURE IN THE FINANCIAL STATEMENTS. THE HOSPITAL'S INCOME TAX FILINGS ARE SUBJECT TO AUDIT BY VARIOUS TAXING AUTHORITIES. THE HOSPITAL IS NO LONGER SUBJECT TO FEDERAL AND STATE INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR FISCAL YEARS BEFORE 2020. MANAGEMENT CONTINUALLY EVALUATES EXPIRING STATUTES OF LIMITATION, AUDITS, PROPOSED SETTLEMENTS, CHANGES IN TAX LAW, AND NEW AUTHORITATIVE RULINGS. THE HOSPITAL BELIEVES ESTIMATES ARE APPROPRIATE BASED ON CURRENT FACTS AND CIRCUMSTANCES. INTEREST AND PENALTIES ASSESSED BY INCOME TAXING AUTHORITIES, IF ANY, ARE INCLUDED IN INTEREST EXPENSE. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISIONS FOR BAD DEBTS ARE NETTED AGAINST THE REVENUE IN THE FS -5,830,756. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISIONS FOR BAD DEBTS ARE NETTED AGAINST REVENUE IN THE FS 5,830,756. 1 1 X 1 X 1 X 1 1 0 0 167035 167035 0.00230 7076539 6358298 718241 0.01000 7243574 6358298 885276 0.01230 24 295806 2100 293706 0.00410 13448166 8087878 5360288 0.07440 24 13743972 8089978 5653994 0.07850 24 20987546 14448276 6539270 0.09080 97913 97913 0.00140 97913 97913 0.00140 0 5830756 792983 22988490 24593745 -1605255 X 1 1 1 1 POWELL VALLEY HOSPITAL 777 AVENUE H POWELL WY 82435 X X X POWELL VALLEY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X HTTPS://WWW.PVHC.ORG/ X X 1 21 1 HTTPS://WWW.PVHC.ORG 0 1 X 100.000000000000 200.000000000000 X X X 1 1 X X X X 1 X HTTPS://WWW.PVHC.ORG X HTTPS://WWW.PVHC.ORG X HTTPS://WWW.PVHC.ORG X X X X 1 X 0 X 1 X 0 0 POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 5: IN FISCAL YEAR 2022 (TAX YEAR 2021), A CHNA WAS COMPLETED. ALL PARK COUNTY RESIDENTS WERE GIVEN THE OPPORTUNITY TO FILL OUT THE ONLINE SURVEY. A TOTAL OF 555 INDIVIDUALS RESPONDED TO THE SURVEY. POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 6A: CODY REGIONAL HEALTH POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 6B: HERITAGE HEALTH CENTERPARK COUNTY PUBLIC HEALTHHEALTHY PARK COUNTY POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 7D: WE HAVE TV MONITORS IN VARIOUS LOCATIONS ON CAMPUS. THE CHNA IS ADVERTISED THERE, WHERE INDIVIDUALS MAY ACCESS THE DOCUMENT SO GUESTS KNOW THEY CAN READ THE RESULTS ON OUR WEBSITE. POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 11: OUR COLLABORATIVE CHNA THAT WAS COMPLETED IN COOPERATION WITH PVHC, CODY REGIONAL, PARK COUNTY PUBLIC HEALTH, HERITAGE HEALTH CENTER, AND HEALTHY PARK COUNTY IDENTIFIED MENTAL HEALTH, SUBSTANCE ABUSE, AND SUICIDE AS THREE OF THE TOP FIVE COMMUNITY HEALTH ISSUES. THESE ARE THE PRIMARY ISSUES WE CHOSE TO FOCUS ON.IN RESPONSE TO THE ABOVE MENTIONED COLLABORATIVE CHNA, PVHC HAS ADDED A FULL TIME PSYCHIATRIC NURSE PRACTITIONER. THIS PROVIDES A FULL TIME CLINIC TO SUPPORT MENTAL HEALTH IN POWELL AND THE SURROUNDING COMMUNITIES. THIS PRACTICE OPERATES WITH THE SUPPORT OF A SOCIAL WORKER TO ADD A VALUABLE RESOURCE TO OUR COMMUNITY. WE PARTICIPATE IN THE YELLOWSTONE BEHAVIORAL MENTAL HEALTH BOARD TO PROVIDE INPUT AND AWARENESS OF RESOURCES TO BETTER SERVE OUR PATIENTS. TO BRING AWARENESS TO SUICIDE PREVENTION AND PROMOTE THE USE OF THE 1-800 HELP LINE, WE DESIGNED T-SHIRTS WITH THIS INFORMATION AND PROVIDED THEM TO OUR STAFF. WE PROVIDE A SECURED COMMUNICATION IPAD FOR ED PATIENTS WITH SUICIDAL IDEATIONS TO COMMUNICATE DIRECTLY WITH COUNCILORS WITH FACILITIES WITHIN THE STATE OF WYOMING. WE ALSO PARTICIPATE IN THE HIGH SCHOOL AND COLLEGE DRUG ABUSE AWARENESS TRAINING IN CONJUNCTION WITH THE POWELL POLICE DEPARTMENT, INCLUDING PERIODIC MEETINGS REGARDING CURRENT DRUG ABUSE TRENDS IN OUR AREA. TO ADDRESS CANCER CARE, OUR FACILITY DIRECTLY EMPLOYS AN ONCOLOGIST AND A NURSE PRACTITIONER TO PROVIDE A FULL-TIME CLINIC TO ADDRESS THESE NEEDS WITHIN OUR COMMUNITY; IN CONJUNCTION WITH THIS, WE ALSO PROVIDE AN INFUSION CENTER WITH THE ABILITY TO PROVIDE CARE FOR UP TO 10 PATIENTS. THIS INCLUDES CHEMOTHERAPY SO PATIENTS DO NOT HAVE TO TRAVEL OUTSIDE OUR COMMUNITY FOR CARE. IN RESPONSE TO OBESITY AND PHYSICAL ACTIVITY WITHIN OUR COMMUNITY, WE PROVIDE CARDIAC AND PULMONARY REHABILITATION. OUR PROGRAM FOR CARDIAC REHAB HAS A FULL SCHEDULE, AND WE HAVE SEEN SUCCESS WITH MANY PATIENTS ALLOWING THEM TO LIVE MORE ACTIVE LIFESTYLES. WE ALSO EMPLOY TWO DIABETIC EDUCATORS TO PROVIDE EDUCATION TO OUR COMMUNITY THROUGH PROVIDER REQUESTS, IN-HOSPITAL VISITS, AND COMMUNITY MEETINGS AND EDUCATION.THE HEALTHY PARK COUNTY WEBSITE PROVIDES NUMEROUS RESOURCES AND INFORMATION THAT HAS BEEN PUT IN PLACE TO ADDRESS THESE ISSUES. ALL ORGANIZATIONS WORK TOGETHER ON THE HEALTHY PARK COUNTY INITIATIVE OF THE PARK COUNTY HEALTH COALITION. HEALTHY PARK COUNTY MEETS MONTHLY TO DISCUSS THESE VARIOUS HEALTH TOPICS AND INITIATIVES AS WELL AS PROGRESS AND ACCOMPLISHMENTS. POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 13B: IN ADDITION TO PROVIDING FREE OR DISCOUNTED CARE BASED ON FEDERAL PROVERTY GUIDELINES, WE REVIEW INCOME TAX RETURNS AND PAY STUBS. THIS INFORMATION HELPS US MORE ACCURATELY DETERMINE A PATIENT'S ABILITY TO PAY. POWELL VALLEY HOSPITAL PART V, SECTION B, LINE 16J: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS MADE AVAILABLE TO THE COMMUNITY ON THE HOSPITAL'S WEBSITE, ATTACHED TO BILLING INVOICES, POSTED IN THE HOSPITAL EMERGENCY ROOM AND WAITING ROOMS, POSTED IN THE HOSPITAL ADMISSIONS OFFICES, AND PROVIDED, IN WRITING, TO PATIENTS ON ADMISSION TO THE HOSPITAL. 3 1 - POWELL VALLEY CLINIC 777 AVENUE H POWELL WY 82435 OUTPATIENT PHYSICIAN CLINIC 2 - POWELL VALLEY CARE CENTER 777 AVENUE H POWELL WY 82435 NURSING HOME 3 - HEARTLAND ASSISTED LIVING 777 AVENUE H POWELL WY 82435 ASSISTED LIVING FACILITY PART I, LINE 3C: IN ADDITION TO PROVIDING FREE OR DISCOUNTED CARE BASED ON FEDERAL PROVERTY GUIDELINES, WE REVIEW INCOME TAX RETURNS AND PAY STUBS. THIS INFORMATION HELPS US MORE ACCURATELY DETERMINE A PATIENT'S ABILITY TO PAY PART I, LINE 6B. THE COMMUNITY BENEFIT REPORT IS POSTED ON THE ORGANIZATION'S WEBSITE. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST TO THE CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. THE EXPENSES ASSOCIATED WITH COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E WERE DETERMINED USING AN AVERAGE HOURLY RATE FOR STAFF TIME, SPACE USE, AND AMBULANCES. CASH AND IN-KIND CONTRIBUTIONS TO COMMUNITY GROUPS, LINE 7I, WERE REPORTED BASED ON ACTUAL EXPENSES RECORDED IN THE ORGANIZATION'S GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. PART I, LN 7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR OF THE CALCULATION ON PART 1, LINE 7 COLUMN F WAS $5,830,756. PART II, COMMUNITY BUILDING ACTIVITIES: AT POWELL VALLEY HEALTH CARE, WE UNDERSTAND THAT HEALTHCARE IS EVOLVING. THE ADVANCEMENT IN MEDICINE AND STRIDES IN TECHNOLOGY ARE PROVIDING LOCAL COMMUNITIES ACCESS TO BETTER HEALTHCARE. OUR BOARD OF TRUSTEES IS COMPRISED PRIMARILY OF LOCAL BUSINESS LEADERS WHO RESIDE IN OUR PRIMARY SERVICE AREA. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOPSITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED THROUGH LICENSURE. OUR EMERGENCY ROOM IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR AND IS AVAILABLE TO ALL REGARDLESS OF A PATIENT'S ABILITY TO PAY. EXCESS FUNDS ARE REINVESTED AND USED FOR PATIENT CARE AND FACILITY UPGRADES. PART III, LINE 3: THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS 13.6% (BASED UPON US CENSUS BUREAU QUICKFACTS FOR PERCENTAGE OF CITIZENS BELOW THE POVERTY LEVEL IN THE CITY OF POWELL, WY). THIS REPRESENTS A REASONABLE PERCENTAGE OF INDIVIDUALS WHO POTENTIALLY QUALIFY FOR CHARITY CARE, BUT MAY NOT HAVE APPLIED AND THEREFORE WERE WRITTEN OFF TO BAD DEBT. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT IS REPORTED AS CHARGES INCURRED DURING THE YEAR. THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE IS FOUND ON PAGE 21 OF THE ATTACHED DRAFT AUDITED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS OF CARE ARE BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. POWELL VALLEY HEALTH CARE PROVIDES SERVICES TO PATIENTS UNDER THE MEDICARE PROGRAM WITH THE KNOWLEDGE THAT THE COST REIMBURSEMENTS WILL NOT RESULT IN RECOVERY OF ALL THE COSTS ASSOCIATED WITH PROVIDING THESE SERVICES. PROVIDING THESE SERVICES IS ESSENTIAL TO THESE PATIENTS AND THE COMMUNITY AND INCREASES THEIR ACCESS TO HEALTHCARE SERVICES. THEREFORE, THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. PART III, LINE 9B: POWELL VALLEY HEALTH CARE, INC. TRIES TO DETERMINE IF A PATIENT NEEDS FINANCIAL ASSISTANCE BEFORE SERVICES ARE RENDERED, EXCEPT IN EMERGENCY SITUATIONS. NO PATIENT IS DENIED ACUTE CARE IN AN EMERGENCY SITUATION. THE HEALTH CENTER WILL PURSUE ALL POSSIBLE FORMS OF THIRD-PARTY PAYMENTS SUCH AS INSURANCE, STATE MEDICAID PROGRAMS, AND COUNTY INDIGENT CARE PROGRAMS BEFORE GRANTING FINANCIAL ASSISTANCE. COLLECTION EFFORTS ARE NOT PURSUED DURING THIS TIME. COLLECTION EFFORTS ARE NOT PURSUED WHILE A COMPLETED CHARITY CARE APPLICATION IS UNDER REVIEW. DECISIONS ON CHARITY CARE APPLICATIONS ARE MADE WITHIN 30 DAYS OF THE COMPLETED APPLICATION. ONCE A DECISION IS MADE, ANY PERSONAL PORTION DUE WILL FOLLOW THE SAME COLLECTION PROCEDURES AS OTHER ACCOUNTS. IF A DETERMINATION FOR FINANCIAL ASSISTANCE IS MADE ON AN ACCOUNT OR FURTHER INSURANCE PROCESSING IS NEEDED AFTER AN ACCOUNT IS SENT TO COLLECTIONS, ALL COLLECTION EFFORTS WILL CEASE AND ANY NEGATIVE REPORTING WILL BE REVERSED. PART VI, LINE 2: POWELL VALLEY HEALTH CARE IS SERVED BY A PUBLICLY ELECTED DISTRICT BOARD. THE BOARD MEMBERS ACTIVELY PROVIDE INFORMATION RELATIVE TO THE HEALTH CARE NEEDS OF THE COMMUNITY. ADDITIONALLY, WE SURVEY PATIENTS, RESIDENTS, AND THEIR FAMILIES AND IN DOING SO, LOOK FOR TRENDS AND/OR SUGGESTIONS FOR IMPROVEMENTS/EXPANSION/OR INITIATION OF SERVICES. OUR GUEST RELATIONS PROCESS ALSO ASSISTS US IN IDENTIFYING ANY UNMET COMMUNITY HEALTH NEEDS. ADMINISTRATION, PROVIDERS AND THE BOARD TRUSTEES ALSO REVIEW COUNTY-WIDE MARKET/UTILIZATION DATA ANNUALLY. PART VI, LINE 3: POWELL VALLEY HEALTH CARE IS COMMITTED TO PROVIDING FINANCIAL ASSISTANCE TO PERSONS WHO HAVE HEALTH CARE NEEDS AND ARE UNABLE TO PAY FOR MEDICALLY NECESSARY CARE. WE STRIVE TO ENSURE THAT PEOPLE WHO ARE UNINSURED, UNDERINSURED, INELIGIBLE FOR A GOVERNMENT PROGRAM, OR OTHERWISE UNABLE TO PAY ARE STILL ABLE TO RECEIVE CARE. NOTIFICATIONS ABOUT CHARITY CARE ARE INCLUDED IN PATIENT BILLS, POSTED IN EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, THE BUSINESS OFFICE, AND WAITING ROOMS. INFORMATION IS ALSO INCLUDED IN PATIENT INFORMATION PACKETS. STAFF ALSO DISCUSS FINANCIAL ASSISTANCE UPON ADMISSION AND DISCHARGE. PART VI, LINE 4: POWELL VALLEY HEALTHCARE IS A 25-BED CRITICAL ACCESS HOSPITAL, 100-BED INTERMEDIATE CARE NURSING FACILITY, A 24-APARTMENT ASSISTED LIVING FACILITY, AND A PHYSICIANS CLINIC LOCATED IN THE NORTHWEST CORNER OF WYOMING, 75 MILES EAST OF YELLOWSTONE NATIONAL PARK, AND 98 MILES SOUTH OF BILLINGS, MT. POWELL HAS A DIVERSE COMMERCIAL, INDUSTRIAL, EDUCATIONAL, AND AGRICULTURAL/RANCHING BASED ECONOMY. IN 2022, 13.6% OF THE RESIDENTS LIVED IN POVERTY. THE MEDIAN HOUSEHOLD INCOME WAS $62,899 AND THE POPULATION WAS 6,517. THE NEAREST CITY WITH A POPULATION OF 50,000+ IS BILLINGS, MT. THE NEAREST HOSPITALS ARE NORTH BIG HORN HOPSITAL DISTRICT, A CRITICAL ACCESS HOSPITAL LOCATED APPROXIMATELY 22 MILES NORTHEAST AND WEST PARK HOSPITAL, A CRITICAL ACCESS HOSPITAL LOCATED APPROXIMATELY 25 MILES SOUTHWEST. NET REVENUE FROM MEDICARE AND MEDICAID ACCOUNT FOR 32.80% AND 6.76% OF TOTAL NET REVENUE, RESPECTIVELY. PART VI, LINE 5: AT POWELL VALLEY HEALTH CARE, WE UNDERSTAND THAT HEALTHCARE IS EVOLVING. THE ADVANCEMENT IN MEDICINE AND STRIDES IN TECHNOLOGY ARE PROVIDING LOCAL COMMUNITIES ACCESS TO BETTER HEALTHCARE. OUR BOARD OF TRUSTEES IS COMPRISED PRIMARILY OF LOCAL BUSINESS LEADERS WHO RESIDE IN OUR PRIMARY SERVICE AREA. TO MEET THE NEEDS OF OUR COMMUNITY, THE HOPSITAL EXTENDS PRIVILEGES TO MEDICAL STAFF THAT ARE QUALIFIED THROUGH LICENSURE. OUR EMERGENCY ROOM IS AVAILABLE 24 HOURS A DAY, 7 DAYS A WEEK, 365 DAYS A YEAR AND IS AVAILABLE TO ALL REGARDLESS OF A PATIENT'S ABILITY TO PAY. EXCESS FUNDS ARE REINVESTED AND USED FOR PATIENT CARE AND FACILITY UPGRADES. 1 TUITION REIMBURSEMENTS 12 43364 PART I, LINE 2: THE ORGANIZATION PROVIDED TUITION REIMBURSEMENT TO EMPLOYEES. TUITION REIMBURSEMENTS ARE PAID OUT AT 50% OF TUITION AFTER EMPLOYEES SHOW PASSING GRADES. X 0 0 0 0 0 1 0 0 0 WILLIAM JARVIS PHYSICIAN 650000 0 125440 0 91659 0 9150 0 29497 0 905746 0 0 0 CARLETTA COLLINS PHYSICIAN 539834 0 17560 0 0 0 9150 0 29497 0 596041 0 0 0 BRIAN KELLY PHYSICIAN 519984 0 0 0 0 0 9150 0 29497 0 558631 0 0 0 JENKINS CLARKSON DIRECTOR/PHYSICIAN 325000 0 0 0 103628 0 9150 0 29497 0 467275 0 0 0 KELLY CHRISTENSEN PHYSICIAN 221822 0 126139 0 39215 0 12200 0 25116 0 424492 0 0 0 NICOLE MASON PHYSICIAN 221822 0 107361 0 23795 0 9150 0 29497 0 391625 0 0 0 AARON BILLIN MD DIRECTOR/PHYSICIAN 279313 0 0 0 33653 0 8622 0 29497 0 351085 0 0 0 VALERIE LENGFELDER MD DIRECTOR/PHYSICIAN 221806 0 0 0 50293 0 9348 0 29497 0 310944 0 0 0 TERRY ODOM CEO 228161 0 0 0 10608 0 7163 0 13585 0 259517 0 0 0 JOY COULSTON CFO 180232 0 0 0 18000 0 5947 0 25116 0 229295 0 0 0 PART I, LINE 5 BONUSES ARE CALCULATED AS A PERCENTAGE OF NET REVENUE PER QUARTER PER CONTRACT FOR EACH INDIVIDUAL BASED ON BILLED CHARGES FOR THAT QUARTER. STEPHEN KATZ HUSBAND OF BOARD MEMBER BONITA KATZ 326987 COMPENSATION & BENEFITS 0 FORM 990, PART VI, SECTION A, LINE 7A SEVEN BOARD MEMBERS FROM THE HOSPITAL DISTRICT BOARD OF TRUSTEES SHALL BE APPOINTED BY VIRTUE OF THEIR ELECTION TO THE HOSPITAL DISTRICT BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B A BOARD MEMBER WHO IS FROM THE HOSPITAL DISTRICT BOARD OF TRUSTEES MAY ONLY BE REMOVED BY ACTION OF THE DISTRICT BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B A COPY OF FORM 990 IS PROVIDED TO THE CEO AND CFO TO REVIEW. THE CEO OR CFO WILL EITHER MAKE CHANGES OR APPROVE THE FORM 990. AFTER THE FORM 990 IS FINALIZED BUT PRIOR TO BEING FILED, A COPY WILL BE PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 12C INDIVIDUALS COVERED BY THE CONFLICT OF INTEREST POLICY INCLUDE MEMBERS OF THE BOARD OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES (IF APPLICABLE). THE PROCESS USED TO DETERMINE IF ANY CONFLICTS OF INTEREST EXIST CONSISTS OF SENDING THE MEMBERS A DOCUMENT FOR THEM TO COMPLETE PRIOR TO THE BOARD OF DIRECTORS MEETING. EACH INDIVIDUAL COMPLETES THE DOCUMENT WHICH ENTAILS DISCLOSING ANY POSSIBLE CONFLICTS AND RETURNS FOR REVIEW TO THE PRESIDENT OF THE BOARD. IF A MEMBER HAS A CONFLICT THEY ARE NOT ALLOWED TO VOTE ON THE CONFLICTED ISSUES. FORM 990, PART VI, SECTION B, LINE 15A COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC BY REQUEST. THE PUBLIC MAY REQUEST A COPY BY CALLING, VIA MAIL, OR WALK-IN. FORM 990, PART IX, LINE 11G CONTRACTED SERVICES: PROGRAM SERVICE EXPENSES 7,481,546. MANAGEMENT AND GENERAL EXPENSES 1,029,605. FUNDRAISING EXPENSES 142. TOTAL EXPENSES 8,511,293. FORM 990, PART XII, LINE 2C: THIS PROCESS HAS NOT CHANGED FROM THE PREVIOUS YEAR. POWELL HOSPITAL DISTRICT #1 777 AVENUE H POWELL WY 82435 830200759 RELATED - PROVISION OF HEALTH CARE SERVICES WY GOVERNMENT N/A N/A 0 POWELL MEDICAL FOUNDATION PO BOX 801 POWELL WY 82435 742275540 PROMOTE PUBLIC HEALTH AND IMPROVE FACILITIES AROUND THE CITY OF POWELL, WY WY 501(C)(3) LINE 8 N/A 0 0 0 1 1 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 POWELL HOSPITAL DISTRICT K 460000 ACTUAL RENT PAID FOR BUILDINGS POWELL HOSPITAL DISTRICT N 350000 FMV OF DONATED USE OF FACILITIES POWELL MEDICAL FOUNDATION O 64983 CASH PAID BY PVHC FOR PMF'S EXP POWELL MEDICAL FOUNDATION C 49290 CASH PAID POWELL HOSPITAL DISTRICT D 11297 RECEIVABLES FROM PHD AT YEAR END