2021-11-08T16:21:26-06:00 2020-12-31 390758449 WIPFLI LLP PO BOX 12237 GREEN BAY WI 543072237 990 2020-01-01 810475376 PLAINS HOSPITAL CORPORATION PLAI 4068264800 PO BOX 768 PLAINS MT 59859 GREGORY S HANSON MD CEO 4068264800 2021-11-08 1 GREGORY HANSON MD 999009999 TERRI REXRODE CPA MST P00096513 9206620016 2021-11-08 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z CLARK FORK VALLEY HOSPITAL CARLA NEIMAN PO BOX 768 PLAINS MT 59859 30919289 0 X WWW.CFVH.ORG X 1992 MT 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. 12 8 279 32 0 0 79468 1575692 26197221 28758740 218210 227603 514373 348252 27009272 30910287 0 0 0 0 14823547 15539512 0 0 0 10951747 11963499 25775294 27503011 1233978 3407276 20499617 29925347 11856366 17601359 8643251 12323988 X CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK WILL PARTNER WITH OUR COMMUNITIES TO IMPROVE THE HEALTH OF THOSE WE SERVE. 0 0 24273435 0 28678774 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. 24273435 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 36 0 279 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 8 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X CARLA NEIMAN CFO 4068264800 PO BOX 768 PLAINS MT 59859 ROBERT BLEASE MD 40.00 X 550604 0 10102 JEANNIE WILLIAMS MD 40.00 X 225248 0 26817 ERIK NEVATT MD 40.00 X 222455 0 16160 TIM JOHNSTON NURSE ANESTHESTIST 40.00 X 183629 0 26857 DAVE BOHARSKI NURSE ANESTHESTIST 40.00 X 186578 0 8261 GREGORY HANSON MD PRESIDENT/CEO 40.00 X 244616 0 36700 CARLA NEIMAN CFO 40.00 X 139048 0 11646 MICHAEL R BAXTER CHAIR 2.00 X X 0 0 0 ERIKA LAWYER VICE CHAIR 2.00 X X 0 0 0 RONALD BLACK MD MEDICAL STAFF/PHYSICAN MEMBER 40.00 X 262730 0 44150 JESSICA VALENTINE MD CHIEF OF STAFF 20.00 X 257732 0 29750 DENISE BENSON MEMBER 2.00 X 0 0 0 BINA EGGENSPERGER MEMBER 2.00 X 0 0 0 JAMES GILLHOUSE MEMBER 2.00 X 0 0 0 VIRGINIA HOLLAND MEMBER 2.00 X 0 0 0 DEVIN HUNTLEY MEMBER 2.00 X 0 0 0 ERIN MCCARTHY MEMBER 2.00 X 0 0 0 2272640 0 210443 18 0 1 0 MONIDA SHARED IMAGING 1200 S RESERVE SUITE H MISSOULA MT 59801 MRI SERVICES 351219 WILDHORSE MANAGEMENT PO BOX 1310 PLAINS MT 59859 SURGEON 327500 PROVIDENCE HEALTH & SERVICES PO BOX 84395 SEATTLE WA 981245692 E.H.R. SERVICES 261461 QUANTUM HEALTH PROFESSIONALS 6901 SHAWNEE MISSION PARKWAY SUITE OVERLAND PARK KS 66202 TRAVELERS 127449 MEDICAL SOLUTIONS LLC PO BOX 310737 DES MOINES IA 503310737 TRAVELERS 119035 5 20000 1400961 154731 1575692 PATIENT SERVICE REVENUE 621400 28615466 28615466 CAFETERIA 621400 77850 77850 JOINT VENTURE MRI INCOME 621400 49191 49191 MOB RENTAL 621400 14117 14117 MEDICAL RECORDS 621400 2116 2116 28758740 193308 193308 18589 0 18589 18589 18589 23297 20000 0 9002 23297 10998 34295 34295 OTHER OPERATING REVENUE 621400 329663 329663 329663 30910287 28678774 0 655821 X 1026371 594361 432010 11825999 10644004 1181995 155411 132503 22908 1190288 1036144 154144 1341443 1238487 102956 30312 30312 42800 42800 3323790 2904647 419143 709911 636585 73326 346390 238961 107429 80826 75306 5520 326796 326796 936499 686950 249549 221701 221701 MEDICAL SUPPLIES & DRUG 4658722 4592396 66326 LICENSES & TAXES 543245 325252 217993 BAD DEBT 506624 506624 DUES & SUBSCRIPTIONS 108518 27254 81264 127365 85464 41901 27503011 24273435 3229576 0 4182264 12691350 3856177 3896971 267132 201146 863863 1215878 32312 27020 18376945 14107021 4227337 4269924 5313413 5739130 1757119 1883928 20499617 29925347 3504987 4233834 0 3000000 7694189 7039506 657190 3328019 11856366 17601359 X 8383527 12047779 259724 276209 8643251 12323988 20499617 29925347 3407276 273461 0 X X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 6128 6128 0 PART II-B, LINE 1: 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. 259724 32424 4061 20000 276209 251904 47631 -4180 35631 259724 246299 35135 578 30108 251904 238845 22625 922 16093 246299 216125 44750 2130 24160 238845 0.00000 0.00000 1.00000 0 1 1 249632 249632 7373233 6055645 1317588 10754080 8051376 2702704 4269924 MEDICARE RECEIVABLE 790998 HOSPITAL BED TAX RECEIVABLE 1063197 INVESTMENT IN JOINT VENTURE 29733 1883928 MEDICAID PAYABLE 694719 PAYROLL PROTECTION PROGRAM LOAN 2633300 3328019 30677124 273461 -506624 -233163 30910287 0 30910287 26996387 0 26996387 506624 506624 27503011 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. 1 1 X 1 X 1 X 1 1 0 1 1 657852 16552 641300 0.02330 1809528 3132711 0 0.00000 2467380 3149263 641300 0.02330 90546 16552 73994 0.00270 37970 37970 0.00140 3326505 2929928 396577 0.01440 22202 22202 0.00080 3477223 2946480 530743 0.01930 5944603 6095743 1172043 0.04260 0 296375 126656 9610020 9636520 -26500 X 1 1 1 1 CLARK FORK VALLEY HOSPITAL 10 KRUGER ROAD PLAINS MT 59859 WWW.CFVH.ORG 10608 X X X X CLARK FORK VALLEY HOSPITAL 1 0 0 1 X X X X X X X X X 20 1 0 0 1 X SEE SUPPLEMENTAL INFORMATION X X 1 20 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 250.000000000000 X X X 1 1 X X X 1 X HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/RAW/UPLOAD/CLARK-FORK-SITE-325/MEDIA/R X HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/RAW/UPLOAD/CLARK-FORK-SITE-325/MEDIA/R X HTTPS://RES.CLOUDINARY.COM/DPMYKPSIH/RAW/UPLOAD/CLARK-FORK-SITE-325/MEDIA/R X X X X X 1 X 0 X X X 1 X 0 0 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. 6 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 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. X X X X 0 0 0 0 0 0 0 0 0 ROBERT BLEASE MD 550604 0 0 0 0 0 8550 0 1552 0 560706 0 0 0 JEANNIE WILLIAMS MD 225248 0 0 0 0 0 7039 0 19778 0 252065 0 0 0 ERIK NEVATT MD 222455 0 0 0 0 0 0 0 16160 0 238615 0 0 0 TIM JOHNSTON NURSE ANESTHESTIST 183629 0 0 0 0 0 5689 0 21168 0 210486 0 0 0 DAVE BOHARSKI NURSE ANESTHESTIST 186578 0 0 0 0 0 0 0 8261 0 194839 0 0 0 GREGORY HANSON MD PRESIDENT/CEO 240904 0 3712 0 0 0 7744 0 28956 0 281316 0 0 0 CARLA NEIMAN CFO 139048 0 0 0 0 0 4452 0 7194 0 150694 0 0 0 RONALD BLACK MD MEDICAL STAFF/PHYSICAN MEMBER 262730 0 0 0 0 0 8489 0 35661 0 306880 0 0 0 JESSICA VALENTINE MD CHIEF OF STAFF 257732 0 0 0 0 0 8071 0 21679 0 287482 0 0 0 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. CLARK FORK VALLEY HOSPITAL FOUNDATION INC PO BOX 768 PLAINS MT 59859 810304386 FUNDRAISING FOR CLARK FORK VALLEY HOSPITAL MT 501(C)(3) LINE 12A, I CLARK FORK VALLEY HOSPITAL 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 CLARK FORK VALLEY HOSPITAL FOUNDATION INC C 20000 FOUNDATION BOARD APPROVAL