PLAINS HOSPITALS INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PLAINS HOSPITALS INC (EIN 81-0475376)
- Tax period
- 2020-01-01 to 2020-12-31
- Filed
- 2021-11-08
- IRS object ID
- 202133129349303628
- Schema version
- 2020v4.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-11-08T16:21:26-06:00 | ReturnTs |
| Tax Period End | 2020-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 12237 | AddressLine1Txt |
| City | GREEN BAY | CityNm |
| State Abbreviation | WI | StateAbbreviationCd |
| ZIP | 543072237 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810475376 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PLAINS HOSPITAL CORPORATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PLAI | BusinessNameControlTxt |
| Phone | 4068264800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 768 | AddressLine1Txt |
| City | PLAINS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59859 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREGORY S HANSON MD | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 4068264800 | PhoneNum |
| Signature | 2021-11-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | GREGORY | PersonFirstNm |
| Person Last | HANSON MD | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | TERRI REXRODE CPA MST | PreparerPersonNm |
| PTIN | P00096513 | PTIN |
| Phone | 9206620016 | PhoneNum |
| Preparation | 2021-11-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CARLA NEIMAN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 768 | AddressLine1Txt |
| City | PLAINS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59859 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,919,289 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CFVH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1992 | FormationYr |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Activity Or Mission | CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK IS A 16-BED CRITICAL ACCESS FACILITY SERVING THE RESIDENTS OF SANDERS COUNTY AND THE SURROUNDING AREA SINCE 1971 (INCORPORATED IN 1992). OUR MISSION: CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK WILL PARTNER WITH OUR COMMUNITIES TO IMPROVE THE HEALTH OF THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 279 | TotalEmployeeCnt |
| Total Volunteers | 32 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $79,468 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,575,692 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,197,221 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $28,758,740 | CYProgramServiceRevenueAmt |
| PY Investment Income | $218,210 | PYInvestmentIncomeAmt |
| CY Investment Income | $227,603 | CYInvestmentIncomeAmt |
| PY Other Revenue | $514,373 | PYOtherRevenueAmt |
| CY Other Revenue | $348,252 | CYOtherRevenueAmt |
| PY Total Revenue | $27,009,272 | PYTotalRevenueAmt |
| CY Total Revenue | $30,910,287 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,823,547 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,539,512 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,951,747 | PYOtherExpensesAmt |
| CY Other Expenses | $11,963,499 | CYOtherExpensesAmt |
| PY Total Expenses | $25,775,294 | PYTotalExpensesAmt |
| CY Total Expenses | $27,503,011 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,233,978 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,407,276 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,499,617 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,925,347 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,856,366 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $17,601,359 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $8,643,251 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,323,988 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK WILL PARTNER WITH OUR COMMUNITIES TO IMPROVE THE HEALTH OF THOSE WE SERVE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $24,273,435 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $28,678,774 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDED 1,446 DAYS OF ACUTE CARE SERVICES AND 9671 DAYS OF SKILLED NURSING CARE. IN ADDITION, THE HOSPITAL PROVIDED 5611 OBSERVATION HOURS, 20381 RURAL HEALTH CLINIC VISITS, AND 2669 HOME HEALTH VISITS. THE HOSPITAL PROVIDED $628,127 IN CHARITABLE SERVICES TO PATIENTS UNABLE TO PAY FOR HEALTH CARE SERVICES. HOSPITAL SERVICES INCLUDE EMERGENCY CARE, OBSTETRICS, LABORATORY, RADIOLOGY, PHARMACY, RESPIRATORY THERAPY, EKG, ULTRASOUND, CT SCANNER, DIABETES MANAGEMENT, SURGERY, HOME HEALTH AND HOSPICE.THE HOSPITAL SIGNIFICANTLY EXPANDED ITS ORTHOPEDIC SURGERY PROGRAM AFTER RECRUITING A HIGHLY QUALIFIED EMPLOYED ORTHOPEDIC SURGEON, PERFORMING 308 ORTHOPEDIC CASES DURING 2020.THE HOSPITAL CONTINUED ITS WORK WITH THE NATIONAL RURAL ACO AND EXPERIENCED SUCCESS THROUGH CARE COORDINATION AND FOCUSED QUALITY IMPROVEMENT EFFORTS IN PURSUIT OF MEDICARE SHARED SAVINGS. | Desc |
| Total Program Service Expenses | $24,273,435 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | Yes (1) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (1) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 279 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CARLA NEIMAN CFO | PersonNm |
| Phone | 4068264800 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 768 | AddressLine1Txt |
| City | PLAINS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59859 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| ROBERT BLEASE | |||||||
| MD | 40.00 | Yes (X) | $550,604 | $0 | $10,102 | ||
| JEANNIE WILLIAMS | |||||||
| MD | 40.00 | Yes (X) | $225,248 | $0 | $26,817 | ||
| ERIK NEVATT | |||||||
| MD | 40.00 | Yes (X) | $222,455 | $0 | $16,160 | ||
| TIM JOHNSTON | |||||||
| NURSE ANESTHESTIST | 40.00 | Yes (X) | $183,629 | $0 | $26,857 | ||
| DAVE BOHARSKI | |||||||
| NURSE ANESTHESTIST | 40.00 | Yes (X) | $186,578 | $0 | $8,261 | ||
| GREGORY HANSON MD | |||||||
| PRESIDENT/CEO | 40.00 | $244,616 | $0 | $36,700 | Yes (X) | ||
| CARLA NEIMAN | |||||||
| CFO | 40.00 | $139,048 | $0 | $11,646 | Yes (X) | ||
| MICHAEL R BAXTER | |||||||
| CHAIR | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ERIKA LAWYER | |||||||
| VICE CHAIR | 2.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| RONALD BLACK MD | |||||||
| MEDICAL STAFF/PHYSICAN MEMBER | 40.00 | $262,730 | $0 | $44,150 | Yes (X) | ||
| JESSICA VALENTINE MD | |||||||
| CHIEF OF STAFF | 20.00 | $257,732 | $0 | $29,750 | Yes (X) | ||
| DENISE BENSON | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| BINA EGGENSPERGER | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| JAMES GILLHOUSE | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| VIRGINIA HOLLAND | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| DEVIN HUNTLEY | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| ERIN MCCARTHY | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,272,640 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $210,443 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 18 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MONIDA SHARED IMAGING | |||||
| 1200 S RESERVE SUITE H | MISSOULA | MT | 59801 | MRI SERVICES | $351,219 |
| WILDHORSE MANAGEMENT | |||||
| PO BOX 1310 | PLAINS | MT | 59859 | SURGEON | $327,500 |
| PROVIDENCE HEALTH & SERVICES | |||||
| PO BOX 84395 | SEATTLE | WA | 981245692 | E.H.R. SERVICES | $261,461 |
| QUANTUM HEALTH PROFESSIONALS | |||||
| 6901 SHAWNEE MISSION PARKWAY SUITE | OVERLAND PARK | KS | 66202 | TRAVELERS | $127,449 |
| MEDICAL SOLUTIONS LLC | |||||
| PO BOX 310737 | DES MOINES | IA | 503310737 | TRAVELERS | $119,035 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $20,000 | RelatedOrganizationsAmt |
| Government Grants | $1,400,961 | GovernmentGrantsAmt |
| All Other Contributions | $154,731 | AllOtherContributionsAmt |
| Total Contributions | $1,575,692 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $28,615,466 | $28,615,466 | |
| CAFETERIA | 621400 | $77,850 | $77,850 | |
| JOINT VENTURE MRI INCOME | 621400 | $49,191 | $49,191 | |
| MOB RENTAL | 621400 | $14,117 | $14,117 | |
| MEDICAL RECORDS | 621400 | $2,116 | $2,116 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $28,758,740 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $193,308 | TotalRevenueColumnAmt |
| Exclusion | $193,308 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,589 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,589 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,589 | TotalRevenueColumnAmt |
| Exclusion | $18,589 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $23,297 | SecuritiesAmt |
| Other | $20,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $9,002 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $23,297 | SecuritiesAmt |
| Other | $10,998 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $34,295 | TotalRevenueColumnAmt |
| Exclusion | $34,295 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER OPERATING REVENUE | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $329,663 | TotalRevenueColumnAmt |
| Exclusion | $329,663 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $329,663 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,910,287 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,678,774 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $655,821 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,026,371 | TotalAmt |
| Program Services | $594,361 | ProgramServicesAmt |
| Management And General | $432,010 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,825,999 | TotalAmt |
| Program Services | $10,644,004 | ProgramServicesAmt |
| Management And General | $1,181,995 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,411 | TotalAmt |
| Program Services | $132,503 | ProgramServicesAmt |
| Management And General | $22,908 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,190,288 | TotalAmt |
| Program Services | $1,036,144 | ProgramServicesAmt |
| Management And General | $154,144 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,341,443 | TotalAmt |
| Program Services | $1,238,487 | ProgramServicesAmt |
| Management And General | $102,956 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,312 | TotalAmt |
| Management And General | $30,312 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,800 | TotalAmt |
| Management And General | $42,800 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,323,790 | TotalAmt |
| Program Services | $2,904,647 | ProgramServicesAmt |
| Management And General | $419,143 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $709,911 | TotalAmt |
| Program Services | $636,585 | ProgramServicesAmt |
| Management And General | $73,326 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,390 | TotalAmt |
| Program Services | $238,961 | ProgramServicesAmt |
| Management And General | $107,429 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,826 | TotalAmt |
| Program Services | $75,306 | ProgramServicesAmt |
| Management And General | $5,520 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $326,796 | TotalAmt |
| Program Services | $326,796 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $936,499 | TotalAmt |
| Program Services | $686,950 | ProgramServicesAmt |
| Management And General | $249,549 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $221,701 | TotalAmt |
| Program Services | $221,701 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUG | $4,658,722 | $4,592,396 | $66,326 |
| LICENSES & TAXES | $543,245 | $325,252 | $217,993 |
| BAD DEBT | $506,624 | $506,624 | |
| DUES & SUBSCRIPTIONS | $108,518 | $27,254 | $81,264 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $127,365 | TotalAmt |
| Program Services | $85,464 | ProgramServicesAmt |
| Management And General | $41,901 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,503,011 | TotalAmt |
| Program Services | $24,273,435 | ProgramServicesAmt |
| Management And General | $3,229,576 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,182,264 | BOYAmt |
| EOY | $12,691,350 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,856,177 | BOYAmt |
| EOY | $3,896,971 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $267,132 | BOYAmt |
| EOY | $201,146 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $863,863 | BOYAmt |
| EOY | $1,215,878 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,312 | BOYAmt |
| EOY | $27,020 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,376,945 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $14,107,021 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,227,337 | BOYAmt |
| EOY | $4,269,924 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,313,413 | BOYAmt |
| EOY | $5,739,130 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,757,119 | BOYAmt |
| EOY | $1,883,928 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,499,617 | BOYAmt |
| EOY | $29,925,347 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,504,987 | BOYAmt |
| EOY | $4,233,834 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $3,000,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,694,189 | BOYAmt |
| EOY | $7,039,506 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $657,190 | BOYAmt |
| EOY | $3,328,019 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,856,366 | BOYAmt |
| EOY | $17,601,359 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,383,527 | BOYAmt |
| EOY | $12,047,779 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $259,724 | BOYAmt |
| EOY | $276,209 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,643,251 | BOYAmt |
| EOY | $12,323,988 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,499,617 | BOYAmt |
| EOY | $29,925,347 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,407,276 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $273,461 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 0 | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $6,128 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $6,128 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | THE FACILITY PAYS DUES TO THE MONTANA HOSPITAL ASSOCIATION, AMERICAN HOSPITAL ASSOCIATION, AND AMERICAN ASSOCIATION FOR HOMES AND SERVICES FOR THE AGING. A PORTION OF THE DUES ARE USED FOR LOBBYING ACTIVITIES ON BEHALF OF THE MEMBERS OF THE ASSOCIATIONS. | ExplanationTxt |
Schedule D IRS990ScheduleD
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $259,724 | BeginningYearBalanceAmt |
| Contributions | $32,424 | ContributionsAmt |
| Investment Earnings Or Losses | $4,061 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $20,000 | OtherExpendituresAmt |
| End Year Balance | $276,209 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $251,904 | BeginningYearBalanceAmt |
| Contributions | $47,631 | ContributionsAmt |
| Investment Earnings Or Losses | -$4,180 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $35,631 | OtherExpendituresAmt |
| End Year Balance | $259,724 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $246,299 | BeginningYearBalanceAmt |
| Contributions | $35,135 | ContributionsAmt |
| Investment Earnings Or Losses | $578 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $30,108 | OtherExpendituresAmt |
| End Year Balance | $251,904 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $238,845 | BeginningYearBalanceAmt |
| Contributions | $22,625 | ContributionsAmt |
| Investment Earnings Or Losses | $922 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $16,093 | OtherExpendituresAmt |
| End Year Balance | $246,299 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $216,125 | BeginningYearBalanceAmt |
| Contributions | $44,750 | ContributionsAmt |
| Investment Earnings Or Losses | $2,130 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $24,160 | OtherExpendituresAmt |
| End Year Balance | $238,845 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $249,632 | OtherCostOrOtherBasisAmt |
| Book Value | $249,632 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,373,233 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,055,645 | DepreciationAmt |
| Book Value | $1,317,588 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $10,754,080 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,051,376 | DepreciationAmt |
| Book Value | $2,702,704 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,269,924 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| MEDICARE RECEIVABLE | $790,998 |
| HOSPITAL BED TAX RECEIVABLE | $1,063,197 |
| INVESTMENT IN JOINT VENTURE | $29,733 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,883,928 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| MEDICAID PAYABLE | $694,719 |
| PAYROLL PROTECTION PROGRAM LOAN | $2,633,300 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $3,328,019 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $30,677,124 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $273,461 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$506,624 | OtherRevenueAmt |
| Revenue Not Reported | -$233,163 | RevenueNotReportedAmt |
| Revenue Subtotal | $30,910,287 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,910,287 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $26,996,387 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $26,996,387 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $506,624 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $506,624 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,503,011 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART V, LINE 4: | THE ENDOWMENT FUNDS CONSIST OF FUNDS HELD BY CLARK FORK VALLEY HOSPITAL FOUNDATION, INC. AND FUNDS DESIGNATED FOR CAPITAL PROJECTS. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -506,624. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 506,624. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $657,852 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,552 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $641,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02330 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,809,528 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,132,711 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,467,380 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,149,263 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $641,300 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02330 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $90,546 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $16,552 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $73,994 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00270 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $37,970 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $37,970 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,326,505 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,929,928 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $396,577 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01440 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,202 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $22,202 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,477,223 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,946,480 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $530,743 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01930 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,944,603 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $6,095,743 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,172,043 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04260 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $296,375 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $126,656 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,610,020 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,636,520 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$26,500 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 10 KRUGER ROAD | AddressLine1Txt |
| City | PLAINS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59859 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CFVH.ORG | WebsiteAddressTxt |
| State License | 10608 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 20 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/RAW/UPLOAD/CLARK-FORK-SITE-325/MEDIA/R | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/RAW/UPLOAD/CLARK-FORK-SITE-325/MEDIA/R | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/RAW/UPLOAD/CLARK-FORK-SITE-325/MEDIA/R | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CLARK FORK VALLEY HOSPITAL | PART V, SECTION B, LINE 5: WE SELECTED KEY INFORMANTS IN OUR COMMUNITY BY IDENTIFYING INDIVIDUALS WHOSE WORK ENCOMPASSES AND INFLUENCES MULTIPLE LEVELS OF SOCIOECONOMIC FACTORS I.E. HEALTH, EDUCATION, VOLUNTEERISM, FINANCE, ETC. AND DIRECTLY SERVICES COMMUNITY MEMBERS IN THOSE CAPACITIES. WE ALSO ENSURED KEY INFORMANTS WERE SELECTED FROM MULTIPLE COMMUNITIES TO PROVIDE BROADER INPUT AND REPRESENTATION OF OUR COUNTY. |
| CLARK FORK VALLEY HOSPITAL | PART V, SECTION B, LINE 7D: SCHEDULE H, PART V, LINE 7A & 10A:HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/IMAGE/UPLOAD/CLARK-FORK-SITE-325/MEDIA/D29142D0383542E5B44B25C857C3619A/2020-CHNA-REPORT-CFVH-FINAL.PDF |
| CLARK FORK VALLEY HOSPITAL | PART V, SECTION B, LINE 11: CURRENTLY, CFVH IS FOLLOWING THE IMPLEMENTATION PLAN DEVELOPED IN 2020 TO ADDRESS THE FEASIBLE NEEDS THROUGH OUR ORGANIZATION, IDENTIFIED IN THE 2020 CHNA. THE THREE PRIORITIES IDENTIFIED WERE CHOSEN BECAUSE THEY WOULD HAVE THE MOST IMPACT THROUGHOUT SANDERS COUNTY AND THESE THREE REMAIN WITHIN THE MISSION OF CFVH AND ARE CONSTRAINED WITHIN ITS CURRENT RESOURCE CAPACITY. THE FOCUS OF THE 2020-2023, TRIENNIUM HAS TO DATE AND WILL REMAIN FOR THE FORESEEABLE FUTURE, MANAGING THE OUTBREAK AND EFFECTS OF THE SARS-COVID-19 PANDEMIC. THE OTHER ITEMS AND THE THREE PRIORITIES ARE BEING ADDRESSED AS THEY COME INTO FOCUS THROUGH RELATION TO COVID-19 AN AS WE HAVE BANDWIDTH TO ADDRESS THE RELEVANT ISSUES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - PLAINS FAMILY MEDICINE | ||||
| 10 KRUGER ROAD | PLAINS | MT | 59859 | RURAL HEALTH CLINIC |
| 2 - THOMPSON FALLS FAMILY MEDICINE | ||||
| 120 POND STREET | THOMPSON FALLS | MT | 59873 | RURAL HEALTH CLINIC |
| 3 - CFVH NURSING HOME | ||||
| 10 KRUGER ROAD | PLAINS | MT | 59859 | SKILLED NURSING FACILITY |
| 4 - HOT SPRINGS FAMILY MEDICINE | ||||
| 209 MAIN STREET | HOT SPRINGS | MT | 59845 | RURAL HEALTH CLINIC |
| 5 - CFVH HOME HEALTH AGENCY | ||||
| 10 KRUGER ROAD | PLAINS | MT | 59859 | HOME HEALTH AGENCY |
| 6 - CFVH HOSPICE | ||||
| 10 KRUGER ROAD | PLAINS | MT | 59859 | HOSPICE CARE |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | WORKSHEET 2 (COST-TO-CHARGE RATIO) WAS USED FOR THE COSTING METHODOLOGY. |
| PART I, LINE 7G: | NONE OF THE SUBSIDIZED SERVICES WERE FROM PHYSICIAN CLINICS. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY BUILDING ACTIVITIES CONSISTED OF BUSINESS DEVELOPMENT AND HEALTH EDUCATION TO OUR COMMUNITY. THE HOSPITAL CONDUCTED ACTIVITIES IN SUPPORT OF CANCER NETWORK, CHILDBIRTH/LACTATION CLASSES, WORKFORCE DEVELOPMENT, AND COMMUNITY DEVELOPMENT. THE HOSPITAL ALSO PROVIDED SPACE FREE OF CHARGE TO RESIDENT/MEDICAL STUDENTS AND NON-PROFIT GROUPS WORKING IN THE BETTERMENT OF THE LOCAL COMMUNITY. THE HOSPITAL CUT OR CUT BACK ON SOME OF THE NORMAL COMMUNITY OUTREACH PROGRAMS DUE TO THE PANDEMIC SUCH AS ART ON THE WALL, STRONG WOMEN, AND YOGA FOR EVERYONE. |
| PART III, LINE 4: | WHILE THE FACILITY DOES NOT HAVE A NOTE REGARDING BAD DEBT EXPENSE IN ITS FINANCIAL STATEMENTS, THE NOTE FOR PATIENT ACCOUNTS RECEIVABLE DESCRIBES HOW PROBABLE UNCOLLECTABLE ACCOUNTS ARE CHARGED TO BAD DEBT EXPENSE. THE RELEVENT NOTE CAN BE FOUND ON PAGE 10 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.BAD DEBT EXPENSE IS REPORTED AS IT IS REPORTED ON THE ORGANIZATION'S FINANCIAL STATEMENTS. THIS INCLUDES BAD DEBT WRITE-OFFS, AS WELL AS A REASONABLE ALLOWANCE FOR DOUBTFUL ACCOUNTS STILL INCLUDED IN ACCOUNTS RECEIVABLE AT YEAR-END. BAD DEBT EXPENSE IS REPORTED NET OF RECOVERIES FOR THE YEAR AND ADJUSTED TO COST WITH THE COST-TO-CHARGE RATIO WORKSHEET.THE AMOUNT REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 3 IS 25% OF THE TOTAL BAD DEBT EXPENSE AT COST, WHICH IS THE ORGANIZATION'S BEST ESTIMATE OF THE PROPORTION OF BAD DEBT ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE, HAD THE ORGANIZATION BEEN SUCCESSFUL IN OBTAINING THEIR COOPERATION FOR AN APPLICATION FOR FINANCIAL ASSISTANCE, BASED ON THE COLLECTORS' EXPERIENCE AND RESPONSE RECEIVED.IT WOULD BE REASONABLE TO ASSUME THAT 25% OF BAD DEBT EXPENSE ESTIMATED AS ATTRIBUTABLE TO PATIENTS WHO WOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE BE CONSIDERED A COMMUNITY BENEFIT, SIMILAR TO A BONAFIDE CHARITY CARE. |
| PART III, LINE 8: | THE FACILITY IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL AND IS REIMBURSED BY MEDICARE AT 101% OF MEDICARE'S COSTS.THE TOTAL REVENUE RECEIVED FROM MEDICARE AND RELATED MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE FACILITY'S FILED 2020 MEDICARE COST REPORT. |
| PART III, LINE 9B: | MEDICAID CO-PAYS AND INELIGIBLE BILLS FOR MEDICAID PATIENTS THAT ARE UNCOLLECTIBLE AFTER REASONABLE COLLECTION EFFORTS HAVE BEEN MADE WILL BE AUTOMATICALLY DEEMED ELIGIBLE FOR CHARITY DISCOUNT. IN CERTAIN SITUATIONS, CIRCUMSTANCES MAY INDICATE THAT A PATIENT WOULD QUALIFY FOR CHARITY CARE, DESPITE THE FACT THAT THE PATIENT IS UNWILLING OR UNABLE TO COOPERATE WITH THE APPLICATION PROCESS. AN EXAMPLE MIGHT BE A HOMELESS PERSON OR TRANSIENT WHO HAS LEFT THE AREA OR AN INDIVIDUAL WHO HAS QUALIFIED FOR MEDICAID IN THE PAST BUT DID NOT MEET THE DEADLINE TO REAPPLY FOR BENEFITS. IN A CASE SUCH AS THIS, THE PATIENT CAN BE CLASSIFIED AS "DEEMED QUALIFIED" FOR CHARITY ASSISTANCE, WITH APPROPRIATE DOCUMENTATION EXPLAINING THE RATIONALE PLACED ON FILE. SUCH CASES WILL BE APPROVED ON AN INDIVIDUAL BASIS BY THE REVENUE CYCLE MANAGER AND/OR THE CFO. IN ADDITION, FINAL EVALUATION OF ACCOUNTS ELIGIBLE FOR BAD DEBT WRITE-OFF ARE REVIEWED TO IDENTIFY PATIENTS WHO HAVE QUALIFIED FOR CHARITY CARE IN THE PAST FOR ADDITIONAL QUALIFICATION EFFORTS OR POSSIBLE "DEEMED" STATUS. |
| PART VI, LINE 2: | THE HOSPITAL'S GOVERNING BOARD INCLUDES DIVERSE REPRESENTATION FROM EACH OF OUR VARIOUS COMMUNITIES AND WE DRAW ON THIS RESOURCE, AS WELL AS OUR PROVIDERS, STAFF, AND PATIENTS FOR INPUT REGARDING EMERGING NEEDS IN OUR SERVICE AREA. STRATEGIC PLANNING IS CONDUCTED ON AN ANNUAL BASIS INVOLVING THE BOARD AND VARIOUS STAKEHOLDERS AND, THROUGH THIS PROCESS, COMMUNITY NEEDS THAT HAVE BEEN IDENTIFIED ARE EVALUATED ALONG WITH POTENTIAL ADJUSTMENTS TO PROGRAMS AND SERVICES TO MEET THESE NEEDS. |
| PART VI, LINE 3: | THE AVAILABILITY OF THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM IS COMMUNICATED TO PATIENTS THROUGH THE FOLLOWING MEANS: HOSPITAL WEBSITE, ENCLOSURES WITH BILLS AND STATEMENTS, NOTICES IN ADMISSIONS AREA FOR THE HOSPITAL AND EMERGENCY ROOM, AND DIRECTLY THROUGH HOSPITAL STAFF WHO ARE EDUCATED ON THE AVAILABILITY OF THE PROGRAM. FINANCIAL COUNSELORS ARE PLACED AT VARIOUS SERVICE LOCATIONS TO ASSIST PATIENTS, AND THEY ARE WELL-VERSED ON EXTERNAL RESOURCES THAT MIGHT BE AVAILABLE TO ASSIST PATIENTS WITH FINANCIAL OBLIGATIONS FOR HEALTH CARE, AS WELL AS OUR IN-HOUSE PROGRAMS. |
| PART VI, LINE 4: | CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK SERVES THE RESIDENTS OF SANDERS COUNTY. THIS RURAL COUNTY IS LOCATED IN WESTERN MONTANA WITH A POPULATION OF APPROXIMATELY 12,100. THE HOSPITAL IS CENTRALLY LOCATED IN THE COUNTY WITHIN THE COMMUNITY OF PLAINS AND OPERATES 3 RURAL HEALTH CLINICS LOCATED IN PLAINS, HOT SPRINGS, AND THOMPSON FALLS. THE MEDIAN INCOME IN SANDERS COUNTY IS AMONG THE LOWEST IN THE STATE OF MONTANA (48TH OF 56 COUNTIES IN 2021) AND THE UNEMPLOYMENT RATE SITS AT 4.0% (2021). APPROXIMATELY 16% OF COUNTY RESIDENTS LIVE BELOW THE POVERTY LEVEL AND APPROXIMATELY 30% OF RESIDENTS UNDER THE AGE OF 65 LACKED HEALTH INSURANCE IN 2019. THE COUNTY WAS THE 4TH OLDEST COUNTY IN MONTANA WHEN COMPARED BY MEDIAN AGE IN 2019. THE HOSPITAL IS THE SOLE PROVIDER OF ACUTE HEALTH CARE SERVICES IN THE COUNTY AND ITS LARGEST EMPLOYER. |
| PART VI, LINE 5: | THE HOSPITAL IS AN INDEPENDENT 501(C)(3) ENTITY AND IS ESSENTIALLY OWNED BY THE COMMUNITIES IT SERVES. THE GOVERNING BOARD IS COMPRISED PRIMARILY OF LOCAL INDIVIDUALS WHO REPRESENT A CROSS SECTION OF THE COMMUNITIES AND DEMOGRAPHIC GROUPS SERVED BY THE ORGANIZATION. THESE INDIVIDUALS CONTRIBUTE THEIR INSIGHT TO THE GOVERNANCE OF THE ORGANIZATION BASED ON THEIR EXPERIENCE IN THE COMMUNITY AS HEALTH CARE CONSUMERS, BUSINESS OWNERS, AND COMMUNITY LEADERS. THEY ALSO ACT AS ADVOCATES IN THEIR COMMUNITIES FOR HEALTH CARE ISSUES AND RESOURCES MADE AVAILABLE THROUGH THE ORGANIZATION. THE HOSPITAL AND ITS AFFILIATED ENTITIES FULLY PARTICIPATE IN ALL GOVERNMENT-SPONSORED HEALTH CARE PROGRAMS AND CONTRACTS WITH MOST PRIVATE PAYERS FOR SERVICES IN AN EFFORT TO ENABLE FULL ACCESS TO ITS SERVICES, REGARDLESS OF THE SPONSOR OF CARE. THE HOSPITAL TAKES A LEADERSHIP ROLE IN THE COMMUNITY WITH RESPECT TO HEALTH CARE COMMUNICATION AND EDUCATION, PROVIDING PRESS RELEASES TO LOCAL NEWSPAPERS, SPEAKERS TO COMMUNITY GROUPS, PARTICIPATION IN COMMUNITY EVENTS, PARTICULARLY THOSE THAT ARE HEALTH RELATED, AND WORKING WITH SCHOOLS IN OUR AREA TO PROMOTE WELLNESS AND HEALTH CARE CAREERS. THE HOSPITAL COLLABORATES WITH COUNTY GOVERNMENT AND VARIOUS AGENCIES TO PLAN FOR DISASTERS. THE HOSPITAL ALSO COLLABORATES WITH THE COUNTY HEALTH DEPARTMENT AND OTHER LOCAL PROVIDERS IN PLANNING FOR PUBLIC HEALTH CONCERNS, SUCH AS PANDEMIC, FLU VACCINE AVAILABILITY, ETC. THE HOSPITAL, THROUGH ITS HOSPICE AGENCY, CONDUCTS GRIEF SUPPORT GROUPS AND REFERS PATIENTS IN FAMILIES TO VARIOUS RESOURCES IN THE COMMUNITY TO ASSIST THEM IN THEIR TIME OF NEED. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROBERT BLEASE | ||||||||||||||
| MD | $550,604 | $0 | $0 | $0 | $0 | $0 | $8,550 | $0 | $1,552 | $0 | $560,706 | $0 | $0 | $0 |
| JEANNIE WILLIAMS | ||||||||||||||
| MD | $225,248 | $0 | $0 | $0 | $0 | $0 | $7,039 | $0 | $19,778 | $0 | $252,065 | $0 | $0 | $0 |
| ERIK NEVATT | ||||||||||||||
| MD | $222,455 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,160 | $0 | $238,615 | $0 | $0 | $0 |
| TIM JOHNSTON | ||||||||||||||
| NURSE ANESTHESTIST | $183,629 | $0 | $0 | $0 | $0 | $0 | $5,689 | $0 | $21,168 | $0 | $210,486 | $0 | $0 | $0 |
| DAVE BOHARSKI | ||||||||||||||
| NURSE ANESTHESTIST | $186,578 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $8,261 | $0 | $194,839 | $0 | $0 | $0 |
| GREGORY HANSON MD | ||||||||||||||
| PRESIDENT/CEO | $240,904 | $0 | $3,712 | $0 | $0 | $0 | $7,744 | $0 | $28,956 | $0 | $281,316 | $0 | $0 | $0 |
| CARLA NEIMAN | ||||||||||||||
| CFO | $139,048 | $0 | $0 | $0 | $0 | $0 | $4,452 | $0 | $7,194 | $0 | $150,694 | $0 | $0 | $0 |
| RONALD BLACK MD | ||||||||||||||
| MEDICAL STAFF/PHYSICAN MEMBER | $262,730 | $0 | $0 | $0 | $0 | $0 | $8,489 | $0 | $35,661 | $0 | $306,880 | $0 | $0 | $0 |
| JESSICA VALENTINE MD | ||||||||||||||
| CHIEF OF STAFF | $257,732 | $0 | $0 | $0 | $0 | $0 | $8,071 | $0 | $21,679 | $0 | $287,482 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT COPY OF THE 990 IS PROVIDED TO THE CLIENT PRIOR TO FILING. THE DRAFT IS ALSO PROVIDED TO THE BOARD FOR APPROVAL BEFORE FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION MAINTAINS A COMPREHENSIVE ORGANIZATIONAL INTEGRITY (COI) PROGRAM. ALL EMPLOYEES ARE REQUIRED TO READ AND SIGN THE STANDARDS OF CONDUCT DOCUMENT THAT INCLUDES AN EXTENSIVE COI POLICY. THE ORGANIZATIONAL INTEGRITY OFFICER PRESENTS THE IMPORTANCE OF COMPLIANCE AND INTEGRITY IN ALL ASPECTS OF THE BUSINESS TO ALL NEW EMPLOYEES AND DURING ANNUAL INSERVICE. ADDITIONALLY, THE ORGANIZATION UTILIZES THE SERVICES OF AN ANONYMOUS REPORTING SERVICE TO FURTHER SEEK REPORTS ON COI AND OTHER COMPLIANCE ISSUES. POTENTIAL COMPLIANCE VIOLATIONS, INCLUDING COI, ARE PROMPTLY INVESTIGATED. THE COMPLIANCE COMMITTEE MEETS AT LEAST QUARTERLY TO REVIEW VARIOUS AREAS OF THE ORGANIZATION FOR POTENTIAL COMPLIANCE VIOLATIONS. BOARD MEMBERS AND SENIOR MANAGERS ARE REQUIRED TO SIGN COI STATEMENTS ANNUALLY. BOARD MEMBERS, EXECUTIVE MANAGEMENT, PHYSICIANS, AND VOLUNTEER LEADERS ARE COVERED UNDER THE COI POLICY. IF PRESENT, POTENTIAL CONFLICTS OF INTEREST ARE DETERMINED BY SENIOR MANAGEMENT, THE ORGANIZATION'S INTEGRITY OFFICE, AND THE BOARD. ACTUAL CONFLICTS ARE REVIEWED BY SENIOR MANAGEMENT AND THE INTEGRITY OFFICER. IF A CONFLICT IS DETERMINED TO EXIST, PERSONS DETERMINED TO HAVE A CONFLICT OF INTEREST ARE EXCUSED FROM PARTICIPATION IN ACTIONS WHERE THE CONFLICT LIES. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE HOSPITAL PRIMARILY USES THE MONTANA HOSPITAL ASSOCIATION'S ANNUAL WAGE SURVEY TO REVIEW SALARY COMPARABILITY TO SIMILAR ORGANIZATIONS IN THE STATE OF MONTANA. THE HOSPITAL ALSO USES RESOURCES SUCH AS MEDICAL GROUP MANAGEMENT ASSOCIATION (FOR PROVIDER COMPENSATION INFORMATION), INDUSTRY SURVEYS & PUBLICATIONS, AND CONSULTATIONS WITH OTHER ORGANIZATIONS AND PROVIDERS. THE BOARD HAS FULL DETERMINATION OF THE CEO'S COMPENSATION. DECISIONS ARE MADE BY THOSE WITHOUT CONFLICT AND THE DECISIONS ARE DOCUMENTED. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE FACILITY'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,219,932. MANAGEMENT AND GENERAL EXPENSES 419,143. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,639,075. TECHNICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,343,880. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,343,880. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 340,835. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 340,835. |
| FORM 990, PART XII, LINE 2C | THERE HAVE BEEN NO CHANGES FROM PRIOR YEARS. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 768 | AddressLine1Txt |
| City | PLAINS | CityNm |
| State Abbreviation | MT | StateAbbreviationCd |
| ZIP | 59859 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 810304386 | EIN |
| Primary Activities | FUNDRAISING FOR CLARK FORK VALLEY HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12A, I | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (1) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK VALLEY HOSPITAL FOUNDATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $20,000 | InvolvedAmt |
| Method Of Amount Determination | FOUNDATION BOARD APPROVAL | MethodOfAmountDeterminationTxt |