2018-10-12T13:58:45-05:00 2017-12-31 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2017-01-01 880405927 Washoe Barton Medical Clinic WASH 7757821500 1107 Hwy 395 Gardnerville NV 89410 Jeff Prater Current CEO 7757821500 2018-10-11 1 KIM C HUNWARDSEN P00484560 7012398500 2018-10-11 216.147.170.229 2018-10-11 13:37:49 CD P 66CC91E6B7F11C4783FFFA5645E675327CB67316 66CC91E6B7F11C4783FFFA5645E675327CB67316 2017 2018-06-14 16:35:46Z Carson Valley Medical Center Jeff Prater 1107 Hwy 395 Gardnerville NV 89410 66840204 0 X carsonvalleymedicalcenter.org X 1999 NV Nevada non-profit corporation which operates as the sole hospital in the county. 5 5 511 16 0 0 109742 0 61655317 65685889 148728 210876 -187312 -199741 61726475 65697024 0 0 0 0 28119685 29577996 0 0 0 29073512 31961078 57193197 61539074 4533278 4157950 62378645 65169389 13823465 12514989 48555180 52654400 X Our mission is to care for your health and wellness. Our vision is to strengthen our community by providing accessible, affordable, high quality healthcare to all. 0 0 41470662 38994314 Carson Valley Medical Center covers a service area that includes approximately 50,000 residents. A focus on patient centered care and quality have resulted in CVMC consistently ranking high in patient satisfaction on both inpatient and outpatient consumer satisfaction surveys. CVMC facilities include a full-service hospital, CVMC Senior Care (a provider-based clinic serving patients over 65), Job's Peak Internal Medicine & Family Practice, Topaz Ranch Medical Clinic, Minden Family Medicine and Complete Care, Alpine Medical, Ironwood Primary Care, Ironwood Urgent Care and Occupational Health Clinics. 6278851 12569905 Program expenses are used in the provision of health care services to the community. Carson Valley Medical Center provides inpatient and outpatient pharmaceutical services for the hospital and outpatient clinics. In 2017, there were higher patient acuities and more chemotherapy patients than the previous year. In 2017, 113,458 pharmacy orders were processed. 2844402 7442129 Program expenses are used in the provision of inpatient and outpatient lab services to the community. Carson Valley Medical Center provides 24 hour lab care for inpatients and outpatients with specially trained staff. Community lab draws are available monthly, offering affordable lab tests without a doctor's order or appointment. In 2017, 40,649 patient visits with 119,814 tests were performed by the lab. 5402683 6679541 Surgery Department: In 2017 1,316 inpatient and outpatient surgeries were performed by the Surgery Department. CVMC Surgery Department has had longer and more complex cases that required more time in the OR and utilized more hardware and supplies. We also started a new service line called Pain Management. This service provides pain pump insertion, removal and maintenance. 5402683 6679541 55996598 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 175 0 1 511 1 0 0 0 0 0 0 0 0 0 0 X 5 5 1 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 1 1 X Jeff Prater 7757821500 1107 Highway 395 N Gardnerville NV 89410 Richard Derby Chairman 0.50 X X 0 0 0 Henry Seybold Secretary/Treasurer 0.50 X X 0 0 0 Clint Purvance Board Member 0.50 X 0 0 0 Paul J Fry III Board Member 0.50 X 6000 0 0 Sy Johnson Board Member 0.50 X 0 0 0 Dawn Ahner Board Member (Jan-Feb) 0.50 X 0 0 0 Preston Becker President/CEO 40.00 X 215541 0 24538 Mike Ellis Director of Finance/CFO (Mar-Dec) 40.00 X 119827 0 8793 Greg Ponsness Director of Pharmacy 40.00 X 159281 0 15168 Rose Brown Ultrasound Technician 40.00 X 131028 0 9868 Brandon Battis Pharmacist 40.00 X 154016 0 27658 Kathryn Cocking Director of Clinical Servi 40.00 X 144363 0 12696 Timothy O'Neil Physician Assistant 40.00 X 126572 0 4430 1056628 0 103151 28 0 1 0 Leman Medical Corporation 1122 Monterra Dr Minden NV 89423 Physician Services 2103013 Renown Health Medical Group 780 Kuenzli St Ste 202 Reno NV 89502 Physician Services 1619429 Barton Healthcare Systems 2170 South Ave South Lake Tahoe CA 96158 IT Staffing and Support Services 1580381 Rural Physicians Group 10624 S Eastern Ave Suite A263 Henderson NV 89052 Physician Services 715770 AYA Healthcare Inc PO Box 123519 Dallas TX 753123519 Nurse Staffing Services 555972 22 Net Patient Services 621400 64891168 64891168 Other Supporting Revenue 900099 794721 794721 65685889 291833 291833 152872 352613 -199741 -199741 -199741 709610 790567 -80957 -80957 -80957 65697024 65685889 0 11135 369548 369548 24351387 21828325 2523062 328280 277641 50639 3157462 2651546 505916 1371319 1171811 199508 83264 83264 77111 77111 8824 8824 4700757 3975525 725232 311875 311514 361 833515 743436 90079 139725 71701 68024 415843 415843 64920 32652 32268 173240 113411 59829 352296 352296 2864464 2864464 316617 63985 252632 Bad Debts 10446791 10446791 Medical Supplies 10440555 10440555 Equipment Rental/Lease 175482 171489 3993 555799 415909 139890 61539074 55996598 5542476 0 20756506 13773548 8209492 8665567 1200836 1318762 308845 424816 48623685 24827136 24411782 23796549 5637288 14750814 1180705 1264329 673191 1175004 62378645 65169389 3697608 3546575 601577 133889 6740584 6230329 2616123 2436623 167573 167573 13823465 12514989 X 48555180 52654400 48555180 52654400 62378645 65169389 4157950 -58730 0 X 0 1 X 1 0 X 0 0 0 0 0 1 4598 0 0 0 4598 0 Part II-B, Line 1: The organization pays membership dues to the American Hospital Association, Nevada Hospital Association, Retail Assoc of NV, Assoc for Healthcare Philanthropy, Society for HR Management, Medical Group Management Assoc, Nat'l Assoc of Rural Health Clinics, NV Assoc of Employers, Assoc of Nutrition & Foodservice Prof and National Rural Health Assoc, A portion of the dues paid are used for lobbying activities on behalf of their members to build a support base on measures that would benefit and improve access to health care in Nevada. 187000 2850407 3037407 30274085 14578213 15695872 13718172 9726501 3991671 1594021 522422 1071599 23796549 Other Liabilities 167573 167573 X 55629500 -58730 -10352583 -10411313 66040813 8824 -352613 -343789 65697024 51480138 396679 396679 51083459 8824 10446791 10455615 61539074 Part X, Line 2: The Medical Center is organized as a Nevada nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Organization is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Organization has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. The Organization believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Organization would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial Statements -10,446,791. Foundation Revenue Included in Consolidated Financial Statements 94,208. Part XI, Line 4b - Other Adjustments: Rental Expenses Included in Expenses of Financial Statements -352,613. Part XII, Line 2d - Other Adjustments: Foundation Expenses Included in Consolidated Financial Statements 44,066. Rental Expenses Included in Expenses of Financial Statements 352,613. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Included in Revenue of Financial Statements 10,446,791. 1 1 X 1 X 1 X 1 1 0 1 1 543000 543000 0.01060 5062126 2422122 2640004 0.05170 5605126 2422122 3183004 0.06230 544715 35635 509080 0.01000 6272032 2197846 4074186 0.07970 78000 78000 0.00150 6894747 2233481 4661266 0.09120 12499873 4655603 7844270 0.15350 7 3250 3250 0.00010 7 3250 3250 0.00010 0 10446791 111653 21530809 21541587 -10778 X 1 1 1 1520 VRR LLC Real Estate 0.10000 0.90000 1 1 Washoe Barton Medical Clinic 1107 Hwy 395 Gardnerville NV 89410 www.cvmchospital.org 3986RUH-14 X X X X 1 provider based clinic Washoe Barton Medical Clinic 1 0 0 1 X X X X X X X X X 16 1 0 1 1 X See Section C, line 7d X 1 16 1 See Section C, line 7d 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X www.cvmchospital.org/patients_visitors/financial_assistance.aspx X X X X X X 1 X 0 X X X X 1 X 0 0 Washoe Barton Medical Clinic Part V, Section B, Line 5: The 2016 Douglas County Community Health Needs Assessment was conducted March - June 2016. The committee included: Carson Valley Medical Center, Health & Human Services (Douglas County Public Health), Government Officials, Fire & Paramedic District, Douglas County Social Services, Partnership of Community Resources, and University of Nevada Reno School of Medicine/Office of Statewide Initiatives. The three components of the 2016 assessment process included:1. A Community Survey, disseminated to all community members to gather input on their health status and views of that of the community as a whole. This survey was developed by the University of Nevada's Office of Statewide Initiatives and sponsored by CVMC. In addition, a focus group was held to gather information specifically from Spanish-speaking community members. All members of the planning committee aided in the distribution of the Community Survey, and Partnership of Community Resources and CCHHS coordinated the implementation of the focus group for Spanish-speaking community members. 2. A data set using the Nevada Core Health Indicators (v. 1.0) that showcases data on a variety of health outcomes from not only Douglas County, but also the surrounding communities and the state and national levels where available. This data set was compiled by CCHHS staff. A Local Public Health System Performance Assessment (LPHSPA), which brings representatives from a broad spectrum of community organizations together to discuss how well local organizations work together to address community health needs and other public health services. The organization and implementation of this portion of the assessment was the focus of the planning committee. Washoe Barton Medical Clinic Part V, Section B, Line 6b: Health & Human Services (Douglas County Public Health), Government Officials, Fire & Paramedic District, Douglas County Social Services, Partnership of Community Resources, and University of Nevada Reno School of Medicine/Office of Statewide Initiatives. Washoe Barton Medical Clinic Part V, Section B, Line 7d: http://cvmchospital.org/about_us/health_needs_assessment.aspx Washoe Barton Medical Clinic Part V, Section B, Line 11: The current Community Health Needs Assessment (CHNA) for CVMC for years 2016-2019 addressed the following three major needs: Cost of Healthcare, Access to Healthcare, and Substance Abuse.In 2017: the following activities took place as a part of our three year plan to address the needs identified in the CHNA.Cost of Healthcare:Expand wellness programs that give patients options for affordable healthcare screenings and resources.- In 2017, 730 patients benefited from the discounted, sliding scale fee at one of CVMC's Rural Health Clinics - a 30% increase over previous year.- CVMC provides > $500,000 in free or discounted wellness services to our community each year- 2017, CVMC expanded the Community Wellness Program to include A1C diabetes screening, vitamin D screening, EKG, and thyroid screening. In 2017, 770 discounted lab draws were provided.Substance Abuse:Strengthen strategic partnership with Partnership of Community Resources - a local nonprofit designed to address substance abuse problems, awareness and prevention.- Ensure CVMC executive sits on the PCR board of directors. In 2017, CVMC Director of Clinical Services joined as an active member of the Partnership of Community Resources Advisory Board.Access to Healthcare:CVMC has identified opportunities to expand the Community Wellness Program, which gives affordable and convenient options for health screenings to our community as well as the need to increase the number of primary care providers in our community to reduce wait times for primary care needs - also reducing the reliance on the ER for non-emergent healthcare needs.- In 2017/2018, CVMC expanded wellness programs to offer more screenings available without an order.- In 2017, CVMC recruited four new primary care providers to reduce wait time for primary care appointments. 7 1 - Minden Family Medicine 1649 Lucerne St Units A B Minden NV 89243 Medical Clinic 2 - Ironwood Primary Care 897 Ironwood Dr Minden NV 89423 Medical Clinic 3 - Occupational Medicine 897 Ironwood Drive Minden NV 89243 Medical Clinic 4 - Ironwood Urgent Care 897 Ironwood Dr Minden NV 89423 Medical Clinic 5 - Job's Peak Internal Medicine & Family 1520 Virginia Ranch Rd Unit B Gardnerville NV 89410 Medical Clinic 6 - Alpine Medical 1667 Lucerne St Minden NV 89423 Medical Clinic 7 - Topaz Ranch Medical Center 3919 Carter Wellington NV 89444 Medical Clinic Part I, Line 6a: The organization's community benefit report is available upon request and is posted at www.cvcmhospital.org/about_us/ Part I, Line 7: Part I, Line 7a:Financial Assistance was calculated using the cost-to-charge ratio. All patient segments are addressed using this method. The methodology used is to be in compliance with laws and regulations set forth by Medicare and the filing of the annual cost report. Part I, Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services was calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers.Part I, line 7e:Community health improvement services are actual costs reported in the general ledger. Part I, line 7i:Cash and in-kind donations are actual costs reported in the general ledger. Part I, Line 7g: Washoe Barton Medical Clinic runs 8 physician clinics to treat patients in the community. The clinics need to be subsidized by the hospital to meet their payroll and other monthly expense needs. The subsidized health services amount includes $2,569,150 associated with two rural health clinics and $2,735,166 from physician clinics. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 10,446,791. Part II, Community Building Activities: CVMC offers seven community support groups addressing the health needs and topics that meet the needs of our community as defined in the most recent Community Health Needs Assessment and other patient feedback mechanisms. Part III, Line 2: The Hospital uses the reserve method in recognizing bad debt expense based on historical trends and information available at the time of recognition. We do not classify amounts that could be attributable to patients who likely would qualify for financial assistance under the hospital's financial assistance policy without sufficient information. Part III, Line 3: The Hospital applied the charity care as a percentage of total patient revenues to bad debt expense to estimate the amount bad debt that would be charity care if sufficient information was obtained to determine their eligibility. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses is located on page seven of the attached financial statements. Part III, Line 8: The expenses represent an overall shortfall of the Medicare patient population. The costs themselves are a community benefit as the community would not receive these services if we did not provide them. Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The general billings and collections policy applies to all patients, including any application under the charity care policy. The Hospital does not send patient accounts to collections before 120 days of the date of the first invoice. The Hospital will pull back patient accounts from collections if a patient submits a financial assistance application within 240 days of the date of the first invoice. Part VI, Line 2: In addition to the community health needs assessment, CVMC regularly assesses data trends and utilization data from internal sources as well as secondary sources (state and local agencies, Nevada Rural Hospital Partners, Nevada Hospital Association, etc.) to assess community need. CVMC partners with local development authority, Chambers of Commerce, and government committees to ensure CVMC is responding to the needs of the community. Part VI, Line 3: Communication is via website, brochures, telephone and in person. Website is www.cvmchospital.org/patients_visitors/financial_assistance.aspx Part VI, Line 4: Carson Valley Medical Center (CVMC), serves Douglas County -- an area spanning 710 square miles and includes a total of seven zip code areas: 89705 (south Carson City), 89460 (Gardnerville), 89411 (Genoa), 89423 (Minden), 89448 (Lake Tahoe towns, including Stateline), 89449 (Lakeridge), and 89410 (Topaz Lake and Dresslerville); as well as outlying areas that include Wellington NV, Topaz Ranch Estates, Markleeville, CA and Coleville, CA. This broad area encompasses varied neighborhood settings, including both rural and suburban areas. CVMC is in Douglas County, NV - which has a population of 47,118 (84% white, 12% Hispanic, 2% Native American). Median household income: $56, 613, 10.2% of population in poverty. (Data from Carson City Health & Human Services: Primary & Secondary Data Sets, 2016). Part VI, Line 5: The majority of the organization's board of directors is comprised of persons serving in the medical community of the greater Northern Nevada area. The organization extends medical staff privileges to credentialed and approved practitioners in its community. The organization's mission is to promote the health and wellness of the Carson Valley and its visitors. Surplus funds are used to acquire equipment and resources that improve patient care.CVMC Emergency Room available to all patients, regardless of ability to pay.CVMC is committed - as the community hospital - to promote the health of the members of the community. We do so through community outreach and wellness programs, including reaching out to local employers in our workplace wellness programs and offering low cost and free screenings to detect and prevent illness and disease. The hospital operates a 24 hour emergency room for medically necessary care to all regardless of ability to pay. The hospital participates in education and training of healthcare professionals. The hospital participates in government-sponsored health programs such as all Medicaid, Medicare, Tricare, all Veterans Administration healthcare and Indian Health Services. The organization is the sole community hospital in Douglas County. The organization currently has 22 active volunteers. The organization has numerous employees involved in local and state community programs including Douglas County Business Council, Minden Rotary, Carson Valley Chamber of Commerce, Nevada Rural Hospital Partners, National Association for Healthcare Quality, American Hospital Association, MGMA, Boy Scouts of America, Family Support Council of Douglas County, Partnership of Community Resources, Tahoe Youth and Family Services, and the Douglas County Community and Senior Center.Community outreach and education are provided to our community members to increase awareness of prevalent health issues and promote healthy behaviors and lifestyles. Programs include workplace wellness, health fairs, career days, and services provided at large-scale community events. The organization is responsive to the community needs such as opportunities for community involvement in governance and advisory groups. The organization serves as a vehicle for attracting and effectively uses donated funds. Part VI, Line 6: Although this hospital is not in an affiliated health system, it does have two parent companies serving different communities, in different states. One is approximately 15 miles away while the other is approximately 45 miles away. Part VI, Line 7, Reports Filed With States NV,CA X X 0 0 0 0 0 0 0 0 0 Preston Becker President/CEO 188671 0 26600 0 270 0 4619 0 20349 0 240509 0 0 0 Greg Ponsness Director of Pharmacy 158831 0 0 0 450 0 5604 0 9784 0 174669 0 0 0 Brandon Battis Pharmacist 154016 0 0 0 0 0 4312 0 23356 0 181684 0 0 0 Kathryn Cocking Director of Clinical Servi 142488 0 0 0 1875 0 5110 0 7795 0 157268 0 0 0 A Douglas County Nevada 886000031 2013-04-17 8700000 Refinance 2003 bond issued 04/15/2003; purchase & build urgent care center 0 0 0 A 2311518 8700000 174000 2621962 5904038 2013 1 0 1 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 A 0 Form 990, Part VI, Section A, line 2 Dawn Ahner has a business relationship with Sy Johnson and Henry Seybold. Form 990, Part VI, Section A, line 6 The Corporation shall have two (2) Members, which shall be Renown Health and Barton Healthcare System. Form 990, Part VI, Section A, line 7a Each member shall have the right to appoint 50% of the board members. Each member has the right to remove any or all of its designated directors at any time and from time to time. Form 990, Part VI, Section A, line 7b The following actions or items will require the approval of the Members prior to implementation or becoming effective: (a) Approval of long-term or material agreements involving more than two hundred fifty thousand dollars, including but not limited to borrowings, equity financings or capitalized leases, and agreements involving the sale or disposition of assets which involve the receipt or payment of more than two hundred fifty thousand dollars; (b) Approval of the Corporation's strategic plan and selection or approval of the manager or senior executives of the Corporation; (c) Any amendment or modification of the Corporation's Articles of Incorporation or the Bylaws; (d) Approval of the Corporation's operating and capital budgets (e) Admit any additional members; (f) Approval of any capital or other investment (including real property) or purchase in excess of the amount approved in the annual budget and any revisions thereto; (g) A sale, lease, conveyance or other transfer of all or substantially all of the assets of the Corporation; and (h) A merger, consolidation, reorganization or dissolution of the Corporation. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b A draft copy of the Form 990 is reviewed in detail by the organization's Chief Finance Officer. An electronic copy of the Form 990 is sent to all voting members of the board of directors for their review and comments prior to filing with the Internal Revenue Service. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers directors, officers and managing employees of CVMC. According to established policies there is an on-going review of contracts and enforcement is handled by the Corporate Compliance Officer. If a potential conflict is disclosed the interested person is required to leave the Board or committee meeting while the matter is discussed and voted upon. The remaining Board or committee members determine if a conflict does exist. Form 990, Part VI, Section B, line 15 The CEO, CFO, and key employees' compensation are determined using a regionally recognized market survey and competitor comparisons. The CEO's compensation is also reviewed and approved by the board of directors. The compensation is reviewed annually. The CEO and Human Resources review the compensation of the CFO. The compensation of the key employees is reviewed by the CEO, Human Resources, and board. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are available to the public upon request. Carson Valley Medical Center Rural Health Clinic LLC 1107 Highway 395 Gardnerville NV 89410 261513495 Rural health and senior care clinic NV 0 0 Washoe Barton Medical Center Carson Valley Medical Center Foundation Inc 1107 Highway 395 Gardnerville NV 89410 364649725 Charitable Foundation NV 501(c)(3) Line 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0