PLAINS HOSPITALS INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- PLAINS HOSPITALS INC (EIN 81-0475376)
- Tax period
- 2024-01-01 to 2024-12-31
- Filed
- 2025-08-29
- IRS object ID
- 202542419349301659
- Schema version
- 2024v5.0
- 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 L
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2025-08-29T16:12:35-04:00 | ReturnTs |
| Tax Period End | 2024-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 200079326 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DZA PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12015 E MAIN AVE | AddressLine1Txt |
| City | SPOKANE VALLEY | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-01-01 | 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 HANSON MD | PersonNm |
| Person Title | PRESIDENT/CEO | PersonTitleTxt |
| Phone | 4068264800 | PhoneNum |
| Signature | 2025-08-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | RIKKI PATCH | PreparerPersonNm |
| PTIN | P01472231 | PTIN |
| Phone | 5092420874 | PhoneNum |
| Preparation | 2025-08-29 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | 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 | GREGORY HANSON MD | 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 | $36,916,194 | GrossReceiptsAmt |
| Group Return For Affiliates | false | 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 WILL PARTNER WITH OUR COMMUNITIES TO IMPROVE THE HEALTH OF THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 292 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $216,307 | PYContributionsGrantsAmt |
| CY Contributions Grants | $161,350 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $30,442,304 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $32,709,639 | CYProgramServiceRevenueAmt |
| PY Investment Income | $513,526 | PYInvestmentIncomeAmt |
| CY Investment Income | $467,633 | CYInvestmentIncomeAmt |
| PY Other Revenue | $649,960 | PYOtherRevenueAmt |
| CY Other Revenue | $167,223 | CYOtherRevenueAmt |
| PY Total Revenue | $31,822,097 | PYTotalRevenueAmt |
| CY Total Revenue | $33,505,845 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $18,156,333 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,055,081 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $2,231 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,270,940 | PYOtherExpensesAmt |
| CY Other Expenses | $13,530,125 | CYOtherExpensesAmt |
| PY Total Expenses | $30,427,273 | PYTotalExpensesAmt |
| CY Total Expenses | $32,585,206 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,394,824 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $920,639 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $33,652,283 | TotalAssetsBOYAmt |
| Total Assets EOY | $35,178,397 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,846,483 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,130,763 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,805,800 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $24,047,634 | 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 | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $27,264,215 | ExpenseAmt |
| Revenue | $32,709,639 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDED 1,959 DAYS OF ACUTE CARE SERVICES AND 9,829 DAYS OF SKILLED NURSING CARE. IN ADDITION, THE HOSPITAL PROVIDED 9,864 OBSERVATION HOURS AND 21,824 RURAL HEALTH CLINIC VISITS. THE HOSPITAL PROVIDED 686,101 IN CHARITABLE SERVICES TO PATIENTS UNABLE TO PAY FOR HEALTH CARE SERVICES. HOSPITAL SERVICES INCLUDE ACUTE CARE, SWING BED, SKILLED NURSING, EMERGENCY CARE, LABORATORY, RADIOLOGY, PHARMACY, RESPIRATORY THERAPY, PHYSICAL THERAPY, EKG, ULTRASOUND, MAMMOGRAPHY, CT SCANNER, DIABETES MANAGEMENT, SURGERY, AND HOSPICE. SEE CONTINUATION ON SCHEDULE O | Desc |
| Total Program Service Expenses | $27,264,215 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (true) | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 83 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 292 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | Yes (true) | InvestmentInJointVentureInd |
| Written Policy Or Procedure | Yes (true) | WrittenPolicyOrProcedureInd |
| 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 | 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 (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|
| DARREN HERZOG | |||||||
| M.D. | 40.00 | Yes (X) | $600,033 | $0 | $33,917 | ||
| GREGORY HANSON MD | |||||||
| PRESIDENT/CE | 40.00 | $315,522 | $0 | $46,500 | Yes (X) | Yes (X) | |
| JESSICA VALENTINE | |||||||
| M.D. | 40.00 | Yes (X) | $303,237 | $0 | $35,397 | ||
| MATTHEW INGLE | |||||||
| M.D. | 40.00 | Yes (X) | $278,853 | $0 | $20,948 | ||
| JOSHUA SPAKE | |||||||
| M.D. | 40.00 | Yes (X) | $277,639 | $0 | $7,680 | ||
| BARBARA STEWARD | |||||||
| M.D. | 40.00 | Yes (X) | $281,465 | $0 | $2,770 | ||
| RICHARD INGLE | |||||||
| M.D. | 40.00 | $272,836 | $0 | $5,701 | Yes (X) | ||
| CARLA NEIMAN | |||||||
| CFO | 40.00 | $182,554 | $0 | $34,958 | Yes (X) | ||
| KATRINA CULMER | |||||||
| CHIEF OF STA | 40.00 | $210,783 | $0 | $3,487 | Yes (X) | ||
| BINA EGGENSPERGER | |||||||
| CHAIR | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| BRIAN MEADEN | |||||||
| VICE CHAIR | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| ERIN MCCARTHY | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| MICHAEL BAXTER | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| VIRGINIA HOLLAND | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| TRISTA FEIST BROWN | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| ERIKA LAWYER | |||||||
| MEMBER | 2.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,722,922 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $191,358 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 32 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| AMN HEALTHCARE ALLIED INC | |||||
| PO BOX 281939 | ATLANTA | GA | 303841943 | TRAVELING STAFF | $404,915 |
| MONIDA SHARED IMAGING | |||||
| 1200 S RESERVE STE H | MISSOULA | MT | 59801 | MRI SERVICES | $400,896 |
| TEGRIA | |||||
| PO BOX 735734 | DALLAS | TX | 753735734 | E.H.R. SERVICES | $381,506 |
| WILDHORSE MANAGEMENT | |||||
| PO BOX 1310 | PLAINS | MT | 59859 | SURGEON | $378,400 |
| MEDICAL SOLUTIONS LLC | |||||
| 1010 N 102ND ST | OMAHA | NE | 68114 | TRAVELING STAFF | $289,943 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $26,335 | RelatedOrganizationsAmt |
| Government Grants | $60,516 | GovernmentGrantsAmt |
| All Other Contributions | $74,499 | AllOtherContributionsAmt |
| Noncash Contributions | $26,016 | NoncashContributionsAmt |
| Total Contributions | $161,350 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621400 | $32,218,611 | $32,218,611 |
| 340(B) PHARMACY REVENUE | 456110 | $466,320 | $466,320 |
| JOINT VENTURE MRI INCOME | 621400 | $20,227 | $20,227 |
| MEDICAL RECORDS | 621400 | $4,481 | $4,481 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $32,709,639 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $679,113 | TotalRevenueColumnAmt |
| Exclusion | $679,113 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,750 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $36,750 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,750 | TotalRevenueColumnAmt |
| Exclusion | $36,750 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,198,869 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,410,349 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$211,480 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$211,480 | TotalRevenueColumnAmt |
| Exclusion | -$211,480 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $117,969 | $117,969 |
| MISCELLANEOUS | 900099 | $12,504 | $12,504 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $130,473 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $33,505,845 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $32,709,639 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $634,856 | 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 | $1,072,343 | TotalAmt |
| Program Services | $492,807 | ProgramServicesAmt |
| Management And General | $579,536 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,878,235 | TotalAmt |
| Program Services | $13,018,833 | ProgramServicesAmt |
| Management And General | $1,859,402 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,414 | TotalAmt |
| Program Services | $126,414 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,745,306 | TotalAmt |
| Program Services | $1,473,480 | ProgramServicesAmt |
| Management And General | $271,826 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,232,783 | TotalAmt |
| Program Services | $1,049,615 | ProgramServicesAmt |
| Management And General | $183,168 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,705 | TotalAmt |
| Management And General | $3,705 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,549 | TotalAmt |
| Management And General | $58,549 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,741 | TotalAmt |
| Management And General | $24,741 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,810,960 | TotalAmt |
| Program Services | $3,469,366 | ProgramServicesAmt |
| Management And General | $1,341,495 | ManagementAndGeneralAmt |
| Fundraising | $99 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $679,461 | TotalAmt |
| Program Services | $412,569 | ProgramServicesAmt |
| Management And General | $264,760 | ManagementAndGeneralAmt |
| Fundraising | $2,132 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,584 | TotalAmt |
| Program Services | $16,709 | ProgramServicesAmt |
| Management And General | $48,875 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $495,108 | TotalAmt |
| Program Services | $402,230 | ProgramServicesAmt |
| Management And General | $92,878 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $165,594 | TotalAmt |
| Program Services | $150,134 | ProgramServicesAmt |
| Management And General | $15,460 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $252,067 | TotalAmt |
| Program Services | $195,352 | ProgramServicesAmt |
| Management And General | $56,715 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $796,403 | TotalAmt |
| Program Services | $621,958 | ProgramServicesAmt |
| Management And General | $174,445 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $357,476 | TotalAmt |
| Program Services | $219,566 | ProgramServicesAmt |
| Management And General | $137,910 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | $4,516,830 | $4,516,830 | |
| LICENSES & TAXES | $678,638 | $635,736 | $42,902 |
| REPAIRS & MAINTENANCE | $448,643 | $429,276 | $19,367 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,366 | TotalAmt |
| Program Services | $33,340 | ProgramServicesAmt |
| Management And General | $143,026 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $32,585,206 | TotalAmt |
| Program Services | $27,264,215 | ProgramServicesAmt |
| Management And General | $5,318,760 | ManagementAndGeneralAmt |
| Fundraising | $2,231 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $383,497 | BOYAmt |
| EOY | $689,954 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,368,594 | BOYAmt |
| EOY | $14,132,690 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,392,595 | BOYAmt |
| EOY | $4,195,617 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,694,140 | BOYAmt |
| EOY | $1,475,977 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,191 | BOYAmt |
| EOY | $30,630 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $19,876,534 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,890,698 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,225,570 | BOYAmt |
| EOY | $3,985,836 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,276,121 | BOYAmt |
| EOY | $8,682,835 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,280,575 | BOYAmt |
| EOY | $1,984,858 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,652,283 | BOYAmt |
| EOY | $35,178,397 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,038,066 | BOYAmt |
| EOY | $4,619,451 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,339,026 | BOYAmt |
| EOY | $5,243,026 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,469,391 | BOYAmt |
| EOY | $1,268,286 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,846,483 | BOYAmt |
| EOY | $11,130,763 | 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 | $22,805,800 | BOYAmt |
| EOY | $24,047,634 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,805,800 | BOYAmt |
| EOY | $24,047,634 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,652,283 | BOYAmt |
| EOY | $35,178,397 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $920,639 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $321,195 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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 | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $1,615 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $1,615 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO STATE AND NATIONAL HOSPITAL ASSOCIATIONS. THE ASSOCIATIONS USE A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
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 | $8,336,395 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,694,653 | DepreciationAmt |
| Book Value | $1,641,742 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,290,507 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,196,045 | DepreciationAmt |
| Book Value | $2,094,462 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,985,836 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| MEDICAID SUPPLEMENTAL PAYMENTS | $1,536,222 |
| OTHER RECEIVABLES | $182,578 |
| ESTIMATED THIRD-PARTY SETTLEMENTS | $172,974 |
| OPERATING LEASE RIGHT-OF-USE ASSETS | $63,427 |
| INVESTMENT IN JOINT VENTURE | $29,657 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,984,858 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| ESTIMATED THIRD-PARTY SETTLEMENTS | $1,204,859 |
| OPERATING LEASE LIABILITIES | $63,427 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,268,286 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $33,802,299 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $321,195 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $321,195 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,481,104 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $24,741 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $24,741 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $33,505,845 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $32,560,465 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $32,560,465 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $24,741 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $24,741 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $32,585,206 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE HOSPITAL EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WERE CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF DECEMBER 31, 2024 AND 2023, THE HOSPITAL HAS NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $404,800 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $404,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01240 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,950,822 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,950,822 | DirectOffsettingRevenueAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,355,622 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,950,822 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $404,800 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01240 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Persons Served | 3767 | PersonsServedCnt |
| Total Community Benefit Expns | $43,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $230 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $42,786 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 19 | PersonsServedCnt |
| Total Community Benefit Expns | $132,885 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $132,885 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,282,033 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,671,673 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $610,360 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01870 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 40 | ActivitiesOrProgramsCnt |
| Persons Served | 34920 | PersonsServedCnt |
| Total Community Benefit Expns | $129,439 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $129,439 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 49 | ActivitiesOrProgramsCnt |
| Persons Served | 38706 | PersonsServedCnt |
| Total Community Benefit Expns | $3,587,373 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,671,903 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $915,470 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02810 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 49 | ActivitiesOrProgramsCnt |
| Persons Served | 38706 | PersonsServedCnt |
| Total Community Benefit Expns | $8,942,995 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,622,725 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,320,270 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04050 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 3 | ActivitiesOrProgramsCnt |
| Persons Served | 20985 | PersonsServedCnt |
| Total Community Benefit Expns | $3,426 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 587 | PersonsServedCnt |
| Total Community Benefit Expns | $250 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $250 | NetCommunityBenefitExpnsAmt |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $106,663 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $106,663 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00330 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 4 | ActivitiesOrProgramsCnt |
| Persons Served | 21572 | PersonsServedCnt |
| Total Community Benefit Expns | $110,339 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $110,339 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00340 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $451,724 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $112,931 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,220,473 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $10,339,053 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$118,580 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp
Entity Name EntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MONIDA SHARED IMAGIN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | MRI SERVICES | PrimaryActivitiesTxt |
| Org Profit Or Ownership | 0.13000 | OrgProfitOrOwnershipPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 RD | 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 | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 23 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.CFVH.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 23 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | 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 (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, PAGE 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, PAGE 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, PAGE 8 | 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 (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| 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 (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, CLARK FORK VALLEY HOSPITAL - PART V, LINE 3E | IDENTIFICATION AND PRIORITIZATION OF SIGNIFICANT HEALTH NEEDS BEGIN ON PAGE 9 OF THE CHNA LOCATED ON THE HOSPITAL'S WEBSITE. |
| FACILITY 1, CLARK FORK VALLEY HOSPITAL - PART V, 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. |
| FACILITY 1, CLARK FORK VALLEY HOSPITAL - PART V, LINE 7D | SCHEDULE H, PART V, LINE 7A & 10A: A COPY OF THE MOST RECENTLY ADOPTED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY CAN BE FOUND ON THE HOSPITAL'S WEBSITE AT THE FOLLOWING URL: WWW.CFVH.ORG/ABOUT-US/COMMUNITY-HEALTH-ASSESSMENTSPLANS/ |
| FACILITY 1, CLARK FORK VALLEY HOSPITAL - PART V, LINE 11 | FOUR TOP PRIORITIES WERE IDENTIFIED IN THE 2023 CHNA, AS FOLLOWS: - MENTAL HEALTH AND SUBSTANCE ABUSE PREVENTION - IMPROVING ACCESS TO CARE - SENIOR SERVICES - EMERGENCY SERVICES MENTAL HEALTH & SUBSTANCE ABUSE: NEAR THE END OF 2023 ONE OF OUR VALUED BEHAVIORAL HEALTH PROVIDERS RETIRED, LEAVING US SHORT OF STAFF TO PROVIDE THESE SERVICES. WE BEGAN ACTIVELY RECRUITING A REPLACEMENT PRIOR TO THE INDIVIDUAL'S RETIREMENT, WHICH IS A CHALLENGE IN OUR RURAL SETTING. WE COLLABORATED WITH THE MONTANA HEALTHCARE FOUNDATION AND RECEIVED GRANT FUNDING TO ASSIST WITH SUPPORT OF A PRE-LICENSED PROVIDER WHILE THEY COMPLETE THEIR REQUIRED PRACTICUM HOURS WHICH ARE GENERALLY NOT BILLABLE. WE HAVE RECENTLY BEEN ABLE TO EMPLOY A PRE-LICENSED ADDICTION COUNSELOR UNDER THIS PROGRAM TO SUPPLEMENT OUR SERVICES, WHICH IS EXTREMELY IMPORTANT AS SUBSTANCE ABUSE IS FREQUENTLY A CONTRIBUTING FACTOR IN PATIENTS WHO SUFFER FROM MENTAL HEALTH DISORDERS. THIS NEW PROVIDER WILL HELP TO EXPAND OUR SUPPORTIVE SERVICES IN CONJUNCTION WITH OUR IMPLEMENTATION PLAN AS HE COMPLETES HIS LICENSURE. WE HAVE ALSO FACILITATED CLASSES FOR STAFF AND COMMUNITY MEMBERS IN MENTAL HEALTH FIRST AID. IMPROVING ACCESS TO CARE: IN THE FALL OF 2023 WE EMPLOYED A NEW PROVIDER AND ADDED A WALK-IN CLINIC WITHIN THE RHC IN PLAINS. THIS HAS GREATLY ENHANCED ACCESS TO SAME DAY CARE IN THE CLINIC AND HELPED TO AVOID THE NEED FOR PATIENTS TO RELY ON THE EMERGENCY ROOM FOR NON-EMERGENT NEEDS. WE HAVE ALSO DEVELOPED RELATIONSHIPS WITH ADDITIONAL SPECIALTY CARE PROVIDERS, SUCH AS OB GYN AND PODIATRY, WHO WILL PROVIDE INTERMITTENT SERVICES IN OUR CLINIC. IN ORDER TO SUPPORT THIS EFFORT, WE HAVE EXPANDED THE PLAINS RHC TO ADD ADDITIONAL SPACE TO SUPPORT VISITING SPECIALTY PROVIDERS. AT THE END OF 2023 WE WERE FORCED TO TERMINATE OB SERVICES AT OUR HOSPITAL, BUT WE ARE SUPPORTING CONTINUED ACCESS TO PRENATAL CARE WITH THE VISITING OB GYN AND WITH RELATIONSHIPS WITH OTHER OB PROVIDERS IN THE REGION. ADDITIONALLY, WE HAVE PRIMARY CARE PROVIDERS WHO ARE COMMITTED TO PROVIDING POST-NATAL AND PEDIATRIC CARE FOR THOSE FAMILIES THAT ARE FORCED TO DELIVER THEIR BABY OUT OF THE COUNTY. WE TERMINATED OUR HOME HEALTH AGENCY AT THE END OF 2023, BUT WE ARE CONTINUING TO PROVIDE HOME SERVICES WITH A VISITING NURSE PROGRAM IN OUR RHC AND HOME REHAB SERVICES FOR THOSE PATIENTS WHO ARE HOMEBOUND. WE EMPLOYED A NEW CLINIC MANAGER WHO IS COMMITTED TO EXPANDING ACCESS IN OUR CLINICS IN A MYRIAD OF WAYS AND THIS WORK IS IN PROGRESS. SENIOR SERVICES: WE ARE CONTINUING TO PROVIDE SPACE, VOLUNTEERS AND OTHER SUPPORTIVE SERVICES TO ASSIST VARIOUS AGENCIES THAT SUPPORT AREA SENIORS. VARIOUS PROGRAMS ARE OFFERED THROUGHOUT THE YEAR. WE PARTNER WITH THE SANDERS COUNTY COUNCIL ON AGING, SANDERS COUNTY TRANSPORTATION, VA AND THE SANDERS COUNTY HOUSING COUNCIL. EMERGENCY MEDICAL SERVICES: CFVH SUPPORTS OUR FOUR VOLUNTEER AMBULANCE SERVICES THROUGHOUT THE COUNTY BY ASSISTING WITH EDUCATION, MEDICAL DIRECTION, SPACE AND OTHER SUPPORTS. WE ARE ALSO ACTIVELY INVOLVED AT THE COUNTY LEVEL WITH EMERGENCY MANAGEMENT AND RESPONSE PLANNING AND ORGANIZATION. UNADDRESSED NEEDS: SOCIAL DETERMINANTS OF HEALTH WAS ALSO IDENTIFIED AS A HIGH PRIORITY IN OUR CHNA, SPECIFICALLY WITH RESPECT TO HOUSING, TRANSPORTATION AND AFFORDABLE DAYCARE. WE ARE LIMITED IN OUR ABILITY TO ADDRESS THIS OVERWHELMING NEED ON OUR OWN, BUT WE CONTINUOUSLY LOOK FOR OPPORTUNITIES TO WORK WITH COMMUNITY COALITIONS TO ADDRESS RELATED NEEDS. FOR EXAMPLE, OUR COMMUNITY IS SERIOUSLY LACKING IN RESOURCES FOR CHILDCARE. VOLUNTEERS FROM THE HOSPITAL ARE WORKING WITH A LOCAL TASK FORCE TO IDENTIFY OPPORTUNITIES TO EXPAND THE AVAILABILITY OF CHILDCARE AND CFVH WILL CONSIDER HOW WE CAN PROVIDE TANGIBLE SUPPORT TO THIS EFFORT AS THE PROCESS MOVES FORWARD. WITH REGARD TO TRANSPORTATION WE COLLABORATE WITH THE SANDERS COUNTY TRANSPORTATION TASK FORCE AND PROVIDE PARKING SPACE TO SUPPORT VA TRANSPORTATION IN THE COUNTY. |
| 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 |
|---|---|---|---|---|
| CLARK FORK VALLEY NURSING HOME | ||||
| 10 KRUGER RD | PLAINS | MT | 59859 | SKILLED NURSING FACILITY |
| CLARK FORK VALLEY HOSPICE | ||||
| 10 KRUGER RD | PLAINS | MT | 59859 | HOSPICE CARE |
| PLAINS FAMILY MEDICINE | ||||
| 10 KRUGER RD | PLAINS | MT | 59859 | RURAL HEALTH CLINIC |
| HOT SPRINGS FAMILY MEDICINE | ||||
| 209 MAIN ST | HOT SPRINGS | MT | 59845 | RURAL HEALTH CLINIC |
| THOMPSON FALLS FAMILY MEDICINE | ||||
| 120 POND ST | THOMPSON FALLS | MT | 59873 | RURAL HEALTH CLINIC |
| TF FAMILY MEDICINE PHYSICAL THERAPY | ||||
| 1707 MAIN ST E | THOMPSON FALLS | MT | 59873 | OUTPATIENT DEPARTMENT |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | WORKSHEET 2 (COST-TO-CHARGE RATIO) WAS USED FOR THE COSTING METHODOLOGY FOR FINANCIAL ASSISTANCE; SCHEDULE C ON THE FYE 2024 COST REPORT WAS USED FOR COSTING METHODOLOGY FOR NON-COST-BASED SUBSIDIZED SERVICES. |
| SCHEDULE H, PART II | THE HOSPITAL IS A MEMBER OF THE HOT SPRINGS CHAMBER OF COMMERCE. THIS GROUP WORKS COLLABORATIVELY TO SUPPORT THE BUSINESS COMMUNITY AND SERVICES SUPPORTING THE COMMUNITY OF HOT SPRINGS WHERE THE HOSPITAL PROVIDES PRIMARY CARE, REHAB, AND BEHAVIORAL HEALTH SERVICES. |
| SCHEDULE H, PART III, LINE 2 | THE HOSPITAL USED THE RATIO OF PATIENT CARE COSTS TO CHARGES TO DETERMINE THE COST OF BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, LINE 3 | WE HAVE ESTIMATED THAT APPROXIMATELY 25% OF OUR BAD DEBT IS ASSOCIATED WITH PATIENTS WHO DO NOT RESPOND TO OUR REQUESTS FOR FINANCIAL INFORMATION OR COMPLETE AN APPLICATION FOR FINANCIAL ASSISTANCE. |
| SCHEDULE H, PART III, LINE 4 | THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 4, ON PAGE 12, OF THE AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS INCLUDED IN FOOTNOTE 10 BEGINNING ON PAGE 18 OF THE AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT. THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. |
| SCHEDULE H, 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. |
| SCHEDULE H, 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. THE HOSPITAL IS CONTINUALLY TAKING IN INFORMATION AND DECIDING HOW THE HOSPITAL CAN BETTER SERVE ITS COMMUNITY BASED ON NEED. |
| SCHEDULE H, PART VI, LINE 3 | THE AVAILABLILITY 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. |
| SCHEDULE H, PART VI, LINE 4 | CLARK FORK VALLEY HOSPITAL AND FAMILY MEDICINE NETWORK SERVES THE RESIDENTS OF SANDERS COUNTY. THIS RURAL COUNTY IS IN WESTERN MONTANA WITH A POPULATION OF APPROXIMATELY 13,400 IN 2022. THE HOSPITAL IS CENTRALLY LOCATED IN THE COUNTY WITHIN THE COMMUNITY OF PLAINS AND OPERATES REMOTE FAMILY PRACTICE CLINICS IN THOMPSON FALLS AND HOT SPRINGS. THE MEDIAN INCOME IN SANDERS COUNTY IS AMONG THE LOWEST IN THE STATE OF MONTANA (48TH OR 56 COUNTIES IN 2022) AND THE UNEMPLOYMENT RATE IS AMONG THE HIGHEST IN THE STATE AT 6.80% IN 2024. APPROXIMATELY 17.3% OF COUNTY RESIDENTS LIVE BELOW THE POVERTY LEVEL AND APPROXIMATELY 16% OF RESIDENTS UNDER THE AGE OF 65 LACKED HEALTH INSURANCE IN 2022. THE COUNTRY HAS AN AGING POPULATION WITH A MEDIAN AGE OF 54.7 IN 2022. 14.3% OF SANDERS COUNTY RESIDENTS HAVE A DISABILITY. THE HOSPITAL IS THE SOLE PROVIDER OF ACUTE HEATLH CARE SERVICES IN THE COUNTY AND IS ITS LARGEST EMPLOYER. |
| SCHEDULE H, 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. MEDICAL STAFF PRIVILEGES AT THE HOSPITAL ARE OPEN TO ALL MEDICAL PROVIDERS WITH ACTIVE LICENSURE. WHILE THE CREDENTIALING PROCESS ENSURES PRACTITIONERS OF THE HIGHEST CALIBER ARE PRIVILEGED, PRACTITIONERS FROM NUMEROUS SPECIALTIES ARE ENCOURAGED TO MEET THE EVER EXPANDING HEALTHCARE NEEDS OF THE COMMUNITY. AS A NON-PROFIT CORPORATION, THE HOSPITAL DOES NOT HAVE ANY SHAREHOLDERS AND SURPLUS FUNDS ARE REINVESTED INTO THE FACILITY, EQUIPMENT, AND EMPLOYEE EDUCATION. THE ABSENCE OF SHAREHOLDERS ELIMINATES THE POTENTIAL FOR CONFLICTS OF INTEREST RELATED TO INFLATED PROFIT MARGINS AND ALLOWS THE HOSPITAL TO FOCUS ON MEETING THE HEALTH AND WELFARE NEEDS OF THE COMMUNITIES IT SERVES. |
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 | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount |
|---|---|---|---|---|---|---|
| DARREN HERZOG | ||||||
| M.D. | $533,685 | $66,348 | $23,000 | $10,917 | $633,950 | |
| GREGORY HANSON MD | ||||||
| PRESIDENT/CEO | $266,945 | $44,077 | $30,500 | $16,000 | $362,022 | $4,500 |
| JESSICA VALENTINE | ||||||
| M.D. | $303,237 | $22,737 | $12,660 | $338,634 | ||
| MATTHEW INGLE | ||||||
| M.D. | $271,776 | $6,577 | $11,231 | $9,717 | $299,801 | $500 |
| JOSHUA SPAKE | ||||||
| M.D. | $259,173 | $15,866 | $7,680 | $285,319 | $2,600 | |
| BARBARA STEWARD | ||||||
| M.D. | $244,979 | $30,411 | $2,770 | $284,235 | $6,075 | |
| RICHARD INGLE | ||||||
| M.D. | $251,097 | $21,739 | $5,701 | $278,537 | ||
| CARLA NEIMAN | ||||||
| CFO | $167,306 | $12,623 | $30,500 | $4,458 | $217,512 | $2,625 |
| KATRINA CULMER | ||||||
| CHIEF OF STAFF | $189,032 | $21,001 | $3,487 | $214,270 | $750 | |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| MATTHEW INGLE | |||
| FAMILY | $257,905 | EMPLOYEE COMP. | false |
| NICK LAWYER | |||
| FAMILY | $122,267 | EMPLOYEE COMP. | false |
| JESSICA CARDENAS | |||
| FAMILY | $18,295 | EMPLOYEE COMP. | false |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MEDICAL EQUIP. | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $26,016 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | false | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | false | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | false | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE M, PAGE 2, PART II | FormAndLineReferenceDesc |
| Explanation | SCHEDULE M, PART I, COLUMN (B) IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III | THE HOSPITAL CONTINUED ITS WORK WITH THE CVS RURAL ACO AND EXPERIENCED SUCCESS THROUGH CARE COORDINATION AND FOCUSED QUALITY IMPROVEMENT EFFORTS IN PURSUIT OF MEDICARE SHARED SAVINGS. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS INCLUDES CHARITY CARE LISTED ON FORM 990, PAGE 2, AS WELL AS 8,578,702 FOR MEDICARE, 2,813,256 FOR MEDICAID, AND 4,247,863 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE 990 IS PROVIDED TO MANAGEMENT WHO REVIEWS THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PRESENTED TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879-TE AUTHORIZING THE PREPARER TO E-FILE THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | THE HOSPITAL 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 IN- SERVICE. 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 HOSPITAL'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, PAGE 6, PART VI, 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, PAGE 6, PART VI, LINE 15B | SEE FORM 990, PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990, PART IX, LINE 11G | PROVIDER PROFESSIONAL FEES 3,469,366 1,341,495 99 |
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 FDN | 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 | FUNDRAISE | PrimaryActivitiesTxt |
| Legal Domicile State | MT | LegalDomicileStateCd |
| Exempt Code Section | 501C3 | ExemptCodeSectionTxt |
| Public Charity Status | 12A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLARK FORK | BusinessNameLine1Txt |
| Business Name Line2 | VALLEY HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |