2025-04-30T16:10:50-05:00 2024-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2023-07-01 836000182 Hot Springs County Hospital District HOTS 3078643121 150 E Arapahoe Street Thermopolis WY 82443 Natalya Keller CFO 3078643121 2025-04-30 1 1 Kim Hunwardsen CPA P00484560 6122536500 2025-04-30 2023 2025-03-06 01:10:19Z Hot Springs Health Scott Alwin 150 E Arapahoe Street Thermopolis WY 82443 40363150 0 X hotspringshealth.com X 1944 WY Partnering with our community for quality health and healing. 5 5 208 5 0 0 627940 567205 34765400 39572274 87828 205836 13985 17585 35495153 40362900 0 0 0 0 18382386 17966636 0 0 0 19872450 22614032 38254836 40580668 -2759683 -217768 47109074 46080502 29568690 28757886 17540384 17322616 X Partnering with our community for quality health and healing. 0 0 35832055 39572274 Hot Springs County Hospital District (the Hospital), a not for profit and governmental hospital, provides compassionate medical care for all, regardless of their ability to pay. The Hospital offers 24/7 emergency care (2,767 visits), inpatient services (1,217 patient days), outpatient services (17,165 visits), HSH-Thermopolis Clinic (13,120 visits), HSH-Worland Clinic (7,876 visits), HSH-Riverton Clinic (3,316 visits), and HSH-Shoshoni Clinic (548 visits).The Hospital has a financial assistance program under which services are provided for free or at a reduced rate. Charity care based on Continued on Schedule O...charges awarded under the financial assistance program totaled $264,034. The cost of charity care for the year ended June 30, 2024 based on direct and indirect cost of providing charity care services was $173,972.Many employees are teachers in the education programs open to the public such as Certified Nursing Assistant and CardioPulmonary Resuscitation. An agreement with the University of Wyoming, Central Wyoming College and Northeastern Wyoming College encourages nursing, pharmacy, and social services students to intern at the Hospital. Health information links are available on the Hospital website.Comfort carts and free meals are available for families during stressful conditions. HSH-Clinics provide reduced or free exams for school athletics, medicine assistance, blood pressure screening and community education seminars. The Hospital offers scholarships to qualifying candidates wanting to advance their education to the betterment of the Hospital and Community. Community Resource Training for High School Students and WWAMI (Washington, Wyoming, Alaska, Montana, Idaho) medical education program, which promotes medical education in Western States, are two long-time programs in which the Hospital participates.The Hospital offers Family Medicine Residency Program "Rural Training Track" for 2nd and 3rd-year residents. The goal is to train Family Medicine Physicians who become highly skilled rural physicians and leaders in Wyoming's rural communities and beyond. 35832055 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 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 0 0 0 0 0 1 89 0 1 208 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 5 0 1 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 0 0 0 X Scott Alwin 3078643121 150 E Arapahoe Street Thermopolis WY 82443 Bill Williams Chairman (Until 5/24) 2.00 X X 0 0 0 Melissa Johnson-Vice Chairman (Until 5/24)/Chairman (Beg 6/24) 2.00 X X 0 0 0 David Koerwitz Secretary 2.00 X X 0 0 0 Jessica Benefiel Director 2.00 X 0 0 0 Aimee Kay Director 2.00 X 0 0 0 John Anderson Director (Beg 6/2024) 2.00 X 0 0 0 Scott Alwin CEO 40.00 X 0 0 0 Kevin Benson CFO (Until 2/4/24) 40.00 X 208933 0 21915 Gregory Brickner Interim CFO (Beg Dec 2023) 40.00 X 0 0 0 Dan Hemann CCO 40.00 X 192679 0 36112 Verlene Luna CPCO (Until 12/3/23) 40.00 X 173620 0 18160 Wade Bomengen Physician 40.00 X 701802 0 43764 Jason Weyer Physician 40.00 X 710088 0 30748 Mathey Mattson Physician 40.00 X 551015 0 38082 Hallie Bischoff Physician 40.00 X 533272 0 43892 Nicole Jamieson Physician 40.00 X 447643 0 35686 3519052 0 268359 32 0 1 0 Medical Solutions LLC PO Box 850861 Minneapolis MN 55485 Staffing Agency 1401506 Healthtech Management Service 2745 N Dallas Pkwy Ste100 Plano TX 75093 Staffing Agency/Consulting 988868 Gem City Bone & Joint PC 1909 Vista Drive Laramie WY 82070 Medical Services 548059 Holistic Pain Management 3780 N Garfield Ave Ste 101 Loveland CO 80538 Medical Services 525360 Mortimore Ambulance 620 Arapahoe Street Thermopolis WY 82443 Ambulance services 426365 19 214246 352959 567205 Patient Service Revenue 621110 35862781 35862781 Property & Sales Tax Revenue 900099 1729931 1729931 340B Pharmacy Revenue 456110 1396541 1396541 Other Supporting Revenue 900099 583021 583021 39572274 205836 205836 17835 250 17585 17585 17585 40362900 39572274 0 223421 X 490687 109912 380775 14633365 13791850 841515 377839 360207 17632 1500754 1404810 95944 963991 888252 75739 723792 723792 114275 114275 52576 52576 7076792 5898967 1177825 27381 950 26431 623734 418938 204796 2698 1337 1361 341579 341579 110034 72497 37537 116269 116269 658832 658832 3529835 2849268 680567 310331 263782 46549 Medical Supplies 6388126 6387643 483 Bad Debt Expense 1976223 1976223 Subscriptions/Books/Per 403434 258131 145303 Food 109773 109106 667 48348 39771 8577 40580668 35832055 4748613 0 6777913 7971111 5887420 5731771 5229250 4628570 1045310 840663 290504 487564 40142977 16194766 25806283 23948211 472561 419146 1599833 2053466 47109074 46080502 2297614 2373181 25521818 24881100 1749258 1503605 29568690 28757886 X 11652964 11590845 5887420 5731771 17540384 17322616 47109074 46080502 -217768 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 343520 343520 17094312 5560518 11533794 22411905 10516433 11895472 293240 117815 175425 23948211 Leases 269371 Subscription IT Liabilities 1234234 1503605 37727845 -2635055 -2635055 40362900 0 40362900 37945613 0 37945613 2635055 2635055 40580668 Part XI, Line 2d - Other Adjustments: Interest expense reported in expense for Form 990 -658,832. Bad debt expenses reported in expense for Form 990 -1,976,223. Part XII, Line 4b - Other Adjustments: Interest expense reported in revenue in Financials 658,832. Bad debt expenses reported in revenue in Financials 1,976,223. 1 1 X 1 X 1 X 1 1 0 0 173972 173972 0.00450 2640325 1951634 688691 0.01780 2814297 1951634 862663 0.02230 220584 54583 166001 0.00430 4674672 3720842 953830 0.02470 4895256 3775425 1119831 0.02900 7709553 5727059 1982494 0.05130 0 1976223 592867 14430775 14399521 31254 X 1 1 1 1 Hot Springs County Hospital District 150 E Arapahoe Street Thermopolis WY 82443 www.hotspringshealth.com 713163 X X X X Pain clinic; 6 Provider Based Clinics Hot Springs County Hospital District 1 0 0 1 X X X X X X X X 22 1 0 1 1 X https://hotspringshealth.com X 1 22 1 https://hotspringshealth.com 0 1 X 100.000000000000 300.000000000000 X X X X X 1 1 X X X 1 X https://hotspringshealth.com X https://hotspringshealth.com X https://hotspringshealth.com X X X X X X 1 X 0 X X X 1 X 0 0 Hot Springs County Hospital District Part V, Section B, Line 5: Community Surveys were conducted to collect input from the community members who represented the broad interest of the community. A community survey link was open during the month of October 2022. Also, paper copies of the community survey were distributed in various public locations during this same time period. There was a total of 233 survey respondents. Hot Springs County Hospital District Part V, Section B, Line 11: The following needs were identified in the most recent Community Health Needs Assessment:1) Mental Health/Substance Abuse/Suicide2) Chronic Disease/Prevention Medicine & Education3) Access to healthcareThe Hospital has continued to research options to address the need of Mental Health/Substance Abuse/Suicide Prevention. The Hospital continued to use OneWyo Opioid Settlement funding to participate in community-wide education and public media campaigns targeting opioid use disorder, safe medication disposal, reducing stigma, and increasing public awareness about treatment options available to our community. The hospital will host a community-wide training for emergency room personnel, EMTs and other first responders and law enforcement addressing the ethical and fair treatment of opioid overdose patients, post-discharge planning, community referrals for Medication Assisted Treatment, recovery case management and/or supportive services, Narcan use and safety, etc. Using these funds, HSH continues to work with appropriate agencies to locate a medication drop box on the hospital campus for safe disposal of opioids for those in recovery and to reduce access to opioids in the community. Hot Springs County Hospital District Part V, Section B, Line 13b: See Part V, line 13h Hot Springs County Hospital District Part V, Section B, Line 13h: The facility's criteria for eligibility for free or discounted care is based on the federal poverty guidelines, family size, and the patient's equity resources (assets less medical debt). In addition, the patient and family members must receive a denial from Medicaid or other public assistance programs. Extenuating circumstances (death, acts of nature, etc.) are considered in determining eligibility for financial assistance. Part V, line 20d, No Presumtive Eligibility Determination: The Hospital does not make presumptive eligibility determinations. A patient needs to apply for financial assistance based on most current circumstances to be considered eligible. Part I, Line 3c: The facility's criteria for eligibility for free or discounted care is based on the federal poverty guidelines, family size, and the patient's equity resources (assets less medical debt). In addition, the patient and family members must receive a denial from Medicaid or other public assistance programs. Extenuating circumstances (death, acts of nature, etc.) are considered in determining eligibility for financial assistance. Part I, Line 7: Line 7a Financial Assistance at cost was calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Line 7b, Medicaid was calculated using Worksheet 3. Line 7g, Subsidized Health Services, was calculated using Worksheet 6. Line 7e was calcuated based on actual cost. 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 $ 1,976,223. Part III, Line 2: The organization determines its estimate of bad debt provisions based on its historical write off and recovery information. Part III, Line 3: The estimated dollar amount of the organization's bad debt expense that reasonably is attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy, but for whom insufficient information was obtained to determine their eligibility, was estimated to be 30%. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 17 of the attached audited financial statements. Part III, Line 8: The hospital is licensed by the Centers for Medicare and Medicaid Services as a critical access hospital. As a critical access hospital, it is reimbursed on 101% of costs less the 2% sequestration adjustment. The hospital utilized the annual cost report for the current fiscal year, which it is required to submit to the Centers for Medicare and Medicaid Services as the source to determine the Medicare allowable costs of care in connection with the revenue received from Medicare.The Hospital provides services to patients under the Medicare program knowing they will not recover 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 entire Medicare shortfall, if any, is considered a community benefit. The Organization reported only those allowable costs and Medicare reimbursements reported in the Medicare cost report for the year. Part III, Line 9b: The hospital makes every effort to complete a financial evaluation at the earliest possible point in the revenue cycle for all patients indicating an inability to meet their financial obligations. A financial assistance program application is completed once all other options for reimbursements have been exhausted. The hospital policy indicates it will send a notice to the patient within 30 days of services to notify the patient that financial assistance is available. The hospital policy does not send patient accounts to collections until after 120 days after the date of the first invoice of the service. If a patient submits a financial assistance application within 240 days after the date of the first invoice of the services, the hospital removes the patient account from collections. Part VI, Line 2: Patient Satisfaction Surveys are sent out to measure the progress of improving the areas of needs. The Foundation Director is a member of the HSC Prevention Coalition and Human Resources Council; both of these organizations are involved in assessing community health and other needs. The Hot Springs County Prevention Coalition meets once a month to discuss the needs and ways to address these needs. Part VI, Line 3: We inform our patients of the Financial Assistance program through various means, such as signage in the admissions area and Emergency Department and all statements have verbiage for Financial Assistance availability and contact information. Financial assistance information and application are also available on our website. Part VI, Line 4: Hot Springs Health is located in a rural community in central Wyoming. Being one of the smallest counties in the state, Hot Springs County is largely an agricultural and ranching community. According to the 2017 census, there were approximately 4,696 residents in the county. Hot Springs County population of persons under the age of five is 5.3%, persons under age of eighteen is 21.3%, persons over age sixty-five is 25.5%. The percent of females in the county is $49.3%. Veterans from years 2013-2017 totaled 612 individuals, ranking above the Wyoming average with 12.71% of the residents having a veteran status.The median household income in HS County for 2017 was $48,403, mean household income was $64,864, and per capita income in the past 12 months of 2017 was $30,939. For Wyoming the median household income is $60,938 and the mean household income is $76,731. The median earning for workers in Wyoming was $32,205 and in HS County was $30,775. The median earnings for males working full-time in Wyoming was $53,727 and in HS County was $49,038. The median earnings for females working full-time in Wyoming was $37,915 and in HS County $41,220.HS County exceeds the state average in relation to poverty level at 12.1% vs state average of 11.3%. Hot Springs County School District is a Title 1 School. Free and reduced meals are provided to 53.5% of elementary school families and 39.68% of the entire district. Single family homes equal 265 of our population. More than one quarter of our population is age 65 or older. Of those aged 60 years and older, 20% receive food stamps. Part VI, Line 5: The Board of Directors is comprised of residents of Hot Springs County representing various backgrounds. They are not employees of HSH, nor contractors, nor family members. Any surplus funds are directed towards patient care by investing into modern equipment and technology and providing medical education to our clinical personnel to provide the best care to our community.HSH extends medical staff privileges to all qualified physicians in the community.HSH is the only Critical Access Hospital in the Hot Springs County.HSH provides chemotherapy and biotherapy services, immunotherapy, and blood transfusions, thus allowing patients to receive treatments right here, at home, without having to travel long distances. Holistic pain management is available to our community at our Specialty Clinic. Rehabilitation services provided at HSH include physical therapy, speech/language pathology and occupational therapy. HSH provides a 24-hour Emergency room that is available to all regardless of ability to pay.HSH participates in the HRSA Rural Residency Planning and Development Program offering a Rural Residency Training Track to medical residents who have an interest in working in rural hospitals. 0 0 0 0 0 0 0 0 0 Wade Bomengen Physician 679302 0 22500 0 0 0 13200 0 30672 0 745674 0 0 0 Jason Weyer Physician 687588 0 22500 0 0 0 0 0 30847 0 740935 0 0 0 Mathey Mattson Physician 529765 0 21250 0 0 0 13200 0 24882 0 589097 0 0 0 Hallie Bischoff Physician 510772 0 22500 0 0 0 13200 0 30800 0 577272 0 0 0 Nicole Jamieson Physician 447643 0 0 0 0 0 13200 0 22594 0 483437 0 0 0 Kevin Benson CFO (Until 2/4/24) 194000 0 7500 0 7433 0 8229 0 13786 0 230948 0 0 0 Dan Hemann CCO 179679 0 13000 0 0 0 7965 0 28247 0 228891 0 0 0 Verlene Luna CPCO (Until 12/3/23) 168620 0 5000 0 0 0 0 0 18260 0 191880 0 0 0 Part I, Line 3, Methods to Establish CEO Compensation: The organization contracted an unrelated management company, Healthtech Management Services, Inc., for CEO services. The board of directors reviews the contract using compensation surveys. A Hot Springs County Hospital District 836000182 000000000 2021-11-10 5336000 Refinance 12/20/18 Series 2018B Tax Exempt Bonds 0 0 0 B Hot Springs County Hospital District 836000182 000000000 2021-07-01 21346000 Refinance 12/18/18 Series 2018A Tax Exempt Bonds 0 0 0 A 285778 5336000 5336000 1 0 1 1 B 1506280 21346000 61693 21284317 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 A 0 0 0 0 1 0 0 0 0 B 0 0 0 0 0 0 0 0 0 A 0 B 0 Form 990, Part VI, Section A, line 1a The organization has an Executive Committee that can make decisions on behalf of the full governing board in between the board meetings. The Executive Committee consists of the board Chairman, Vice Chairman, and the Secretary/Treasurer. Form 990, Part VI, Section A, line 3 HSCHD contracts with Healthtech Management Services, Inc. for management services including the CEO position. The CEO is employed by Healthtech Management Services, Inc. During calendar year 2023, HSCHD paid Healthtech Management Services, Inc. $337,708 for the CEO services of Scott Alwin. During the year HSCHD contracted with Impekkable for Interim CFO services of Gregory Brickner. HSCHD paid $21,450 for his Interim CFO services for calendar year 2023. Form 990, Part VI, Section A, line 7a The board members are elected by the citizens of Hot Springs County. Form 990, Part VI, Section B, line 11b The Form 990 was presented to the finance committee of the board of trustees for discussion and review. The entire board of directors approved the Form 990 at a regularly scheduled board meeting. Form 990, Part VI, Section B, line 12c The hospital has a formal conflict of interest policy which requires employees to make a prompt written full disclosure of any potential situation which may involve a conflict of interest. The policy provides a list of potential conflicts. Employees who violate the policy are subject to disciplinary action up to and including termination. The policy is reviewed at least 2 times a year with employees at the annual skills fair and the annual employee evaluation. The employee completes and signs a new disclosure at the time of their evaluation. The hospital does require governing board members, officers, managers, and medical representatives with administrative responsibility to disclose in writing all potential conflicts of interest on an annual basis as well. Form 990, Part VI, Section B, line 15 The organization pays an unrelated management company, Healthtech Management Services, Inc., for CEO services. Annually the board of directors reviews the CEO contract presented by HealthTech. The organization completes an annual review of other key employees and completes a comparison of salaries with Wyoming Hospital Association salary survey data. The annual review is completed by the Chief Human Resources Officer and reviewed at the meeting of the Executives for final approval. Form 990, Part VI, Section C, line 19 The organization is a governmental entity. All board of trustee meetings are public meetings. All reports (not considered confidential) are subject to the open meeting laws under state of Wyoming laws. In addition, these documents are available for public inspection in accordance with federal and state law. Form 990, Part IX, line 11g Maintenance Contracts: Program service expenses 609,844. Management and general expenses 249. Fundraising expenses 0. Total expenses 610,093. Physician/Provider Fees: Program service expenses 2,097,961. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,097,961. Consulting/Contracted Services: Program service expenses 1,557,085. Management and general expenses 824,206. Fundraising expenses 0. Total expenses 2,381,291. Other Fees: Program service expenses 1,634,077. Management and general expenses 353,370. Fundraising expenses 0. Total expenses 1,987,447.