2016-05-11T14:31:45-05:00 2015-06-30 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2014-07-01 840255530 LUTHERAN HOSP ASSOC OF THE SAN LUIS VALLEY % THE ORGANIZATION LUTH 7195892511 106 BLANCA AVENUE ALAMOSA CO 81101 KONNIE MARTIN CEO 7195892511 2016-05-16 true Rita F Worster CPA P00290681 7194714290 2014 2016-08-17 19:52:53Z SAN LUIS VALLEY HEALTH KONNIE MARTIN CEO 106 BLANCA AVENUE ALAMOSA CO 81101 80512717 false X WWW.SANLUISVALLEYHEALTH.ORG X 1928 CO TO BE A PREMIER, FULLY INTEGRATED RURAL HEALTH CARE SYSTEM PROVIDING EXCEPTIONAL PATIENT-CENTERED SERVICES TO THE SAN LUIS VALLEY. 14 9 788 14 0 1346376 1350586 72868307 78441288 200907 54705 369334 405530 74784924 80252109 7000 21072 0 0 41213971 42467097 0 0 225353 32701431 34501920 73922402 76990089 862522 3262020 69310715 73754094 23646974 24770669 45663741 48983425 X AN UNCONDITIONAL COMMITMENT TO EXCELLENCE BY PROVIDING QUALITY, COMPASSIONATE CARE GUIDED BY OUR VALUES. WE ACCEPT RESPONSIBILITY FOR PROVIDING SERVICES TO OUR COMMUNITY THAT ARE OF THE HIGHEST CALIBER OF SERVICE AND STANDARD PERFORMANCE, WHILE DEMONSTRATING OUR ADOPTED VALUES. false false 61148976 21072 78618216 SAN LUIS VALLEY HEALTH WAS FORMED JULY 1, 2013. PRIOR TO THE MERGER THAT CREATED SAN LUIS VALLEY HEALTH IT OPERATED AS AN INDEPENDENT, NOT-FOR-PROFIT HOSPITAL FOR OVER 83 YEARS. THE MERGER BROUGHT TOGETHER SAN LUIS VALLEY REGIONAL MEDICAL CENTER AND CONEJOS COUNTY HOSPITAL. PRIOR TO THE MERGER, CONEJOS COUNTY HOSPITAL HAD BEEN MANAGED BY SAN LUIS VALLEY REGIONAL MEDICAL CENTER SINCE 2003. SLV HEALTH SERVES THE SIX COUNTIES OF THE SAN LUIS VALLEY WITH A POPULATION OF JUST UNDER 50,000 AND AN AREA OF OVER 8,200 SQUARE MILES; LARGER THAN THE STATE OF NEW JERSEY. SLV HEALTH EMPLOYS ALMOST 600 AND IS THE LARGEST EMPLOYER IN THE SAN LUIS VALLEY. THE TRUSTEES, PROVIDERS AND STAFF OF SLV HEALTH ARE UNDERSTANDABLY PROUD OF THEIR TRADITION FOR PROVIDING CARE AND SERVICE TO OUR COMMUNITIES. SERVING OUR LOW-INCOME COMMUNITY MEANS THAT WE HAVE A CHALLENGING PAYER MIX WITH HIGH MEDICAID, UNINSURED AND RELATIVELY LOW COMMERCIAL PERCENTAGES. THIS HAS LED TO OUR ORGANIZATION BEING RESOURCEFUL, CREATIVE AND INNOVATIVE IN ORDER TO CONTINUE SERVICE WITH POSITIVE OPERATING MARGINS. SLV HEALTH'S OPERATING EXPENSE PER ADJUSTED PATIENT DAY IS $2,999 COMPARED TO A COLORADO AVERAGE OF $3,367 AND A RURAL HOSPITAL AVERAGE OF $3,753. OVER THE LAST NINE YEARS, OUR GROSS REVENUE HAS INCREASED FROM $20M TO $60M AND THE NUMBER OF PATIENTS SERVED HAS EXPANDED SEVERAL FOLD. NEW SERVICES HAVE BEEN ADDED IN MEDICATION ONCOLOGY, INPATIENT REHABILITATION, SLEEP DISORDERS, WOMEN'S IMAGING CENTER, FIXED WING MEDICAL TRANSPORTATION, GENETIC COUNSELING, BEHAVIORAL HEALTH, CARDIOLOGY, CHIROPRACTIC, ONCOLOGY/INFUSION THERAPY AND MORE. 61148976 true true false true false false false false false true true false false false true false false true false false false false false false false false true true false false true true false false false false false false false false true false false false false false false true true false false true 94 0 true 788 true false false false false false false false false false false X 14 9 true false false false false false false true true false false true true true true true true true true false X THE ORGANIZATION 7195892511 106 BLANCA AVENUE ALAMOSA CO 81101 JAN GAY TRUSTEE 2.0 2.0 X 1000 0 0 KARLA HARDESTY PRESIDENT 2.0 0.0 X X 2250 0 0 KENDAL KNAUS MD SECRETARY/TREASURER 2.0 0.0 X X 53600 0 0 JIM EHRLICH VICE PRESIDENT 2.0 0.0 X X 0 0 0 PATRICK CROWDER TRUSTEE 2.0 0.0 X 800 0 0 KATHY LORENZ TRUSTEE 2.0 2.0 X 600 0 0 CHERI CROWDER TRUSTEE 2.0 2.0 X 1000 0 0 ROSALIE MARTINEZ TRUSTEE 2.0 2.0 X 800 0 0 STEVEN W KITCHEN PHYSICIAN 40.0 0.0 X 458425 0 27252 NUWAN PILAPITIYA PHYSICIAN 40.0 0.0 X 209502 0 24397 SUSAN GEIGER PHYSICIAN 40.0 0.0 X 110349 0 3258 DENNARD ELLISON PHYSICIAN 40.0 0.0 X 400095 0 27267 DONALD SHAWCROFT TRUSTEE 2.0 2.0 X 600 0 0 RICHARD MARTIN TRUSTEE 2.0 0.0 X 0 0 0 KONNIE MARTIN CEO 40.0 2.0 X 304787 0 28766 PATTI THOMPSON CNO 40.0 0.0 X 182968 0 14885 GREG MCAULIFFE MD CMO 40.0 0.0 X 293393 0 28225 SHANE MORTENSEN CFO 40.0 1.0 X 171740 0 25008 KELLY GALLEGOS CCH ADMINISTRATOR 40.0 0.0 X 129520 0 25338 ROBERT MARSHALL PHYSICIAN 40.0 0.0 X 370595 0 26877 DAVID GEIGER PHYSICIAN 40.0 0.0 X 392774 0 27252 CLIFFORD ROBBINS PHYSICIAN 40.0 0.0 X 332502 0 15938 CARISSA TRIPI PHYSICIAN 40.0 0.0 X 524193 0 26216 JAMES GRIGSBY PHYSICIAN 40.0 0.0 X 397959 0 27880 4339452 0 328559 61 false true false CARETECH SOLUTIONS INC PO BOX 674271 DETROIT MI 48267 CONTRACT SERVICES 1321077 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 CONTRACT LABOR 562711 COMPHEALTH PO BOX 972651 DALLAS TX 75397 CONTRACT LABOR 294020 MEDICUS HOSPITALISTS WEST LLC 22 ROULSTON ROAD WINDHAM NH 03087 CONTRACT SERVICES 984388 INNOVA EMERGENCY MEDICAL ASSOCIATES PO BOX 912601 DENVER CO 802912601 CONTRACT LABOR 739503 10 9085 678647 662854 1350586 PATIENT SERVICE REVENUE 900099 32138339 32138339 MEDICARE/MEDICAID 900099 44536790 44536790 ELECTRONIC HEALTH RECORD PAYMENTS 900099 611391 611391 AMBULANCE DISTRICT REVENUE 621910 374005 374005 340B PAYMENTS 900099 307948 307948 472815 472815 78441288 232652 232652 0 0 78747 82661 -3914 0 -3914 -3914 177947 -177947 -177947 -177947 0 0 0 CAFETERIA SALES 900099 179077 179077 LAUNDRY 900099 33522 33522 ABSTRACTS 900099 21810 21810 175035 155118 19917 409444 80252109 78618216 283307 21072 21072 0 0 0 2522352 1967932 540695 13725 0 32790640 25547496 7105628 137516 1172409 915335 251802 5272 3736352 2912102 807183 17067 2245344 1653374 579620 12350 0 93476 93476 188741 188741 8225 8225 0 0 6845174 5709296 1135878 125542 99494 26048 2590393 973054 1605304 12035 1212290 606145 606145 0 2225310 1820078 405232 234426 145439 87647 1340 0 10605 5992 4613 685595 67467 618128 0 3528348 3050541 477807 704411 528128 176283 MEDICAL SUPPLIES 7408105 7340593 67512 PROVIDER FEES 3595155 3595155 BAD DEBT 4269693 4269693 COLLECTION EXPENSE 376128 376128 400303 20084 380219 76990089 61148976 15615760 225353 397727 850351 13290216 15884099 144538 99859 10319292 12308490 0 0 0 0 0 0 1112397 1293568 1676455 1661158 67890805 37759464 30961958 30131341 10088991 10107403 100 100 197866 290970 0 0 1121175 1126755 69310715 73754094 5978683 7818653 0 0 2081 81102 13770000 13175000 0 0 0 0 2399493 2277299 0 0 1496717 1418615 23646974 24770669 X 45465875 48692461 197866 290964 0 0 45663741 48983425 69310715 73754094 X 3262020 -110191 167855 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 8225 false false 8225 false schedule c, Part II-B, Line 1g San Luis Valley Health received correspondence from the Colorado Health and Hospital Association and the American Hospital Association regarding their membership dues. A portion of their dues were attributable to lobbying. 197866 93098 290964 134718 63148 197866 94572 40146 134718 86517 8055 94572 133304 46787 86517 1.00000 false true true 3432682 3432682 37475856 18756701 18719155 24162158 18414569 5747589 2820109 588194 2231915 30131341 0 ASSET RETIREMENT OBLIGATION 270531 INTEREST RATE SWAP AGREEMENT 1123934 RELATED PARTY PAYABLE 24150 1418615 80531205 -110191 428463 318272 80212933 39176 39176 80252109 77211521 260608 260608 76950913 39176 39176 76990089 SCHEDULE D, PART V, LINE 4 SAN LUIS VALLEY HEALTH FOUNDATION (THE FOUNDATION) AND THE MEDICAL CENTER ARE FINANCIALLY INTERRELATED ORGANIZATIONS. THE MISSION OF THE FOUNDATION IS TO SUPPORT THE HEALTH CARE SERVICES OF THE MEDICAL CENTER AND THE COMMUNITIES IT SERVES. THE MEDICAL CENTER ACCOUNTS FOR ITS INTEREST IN THE NET ASSETS OF THE FOUNDATION IN A MANNER SIMILAR TO THE EQUITY METHOD. THE TEMPORARILY RESTRICTED NET ASSETS REPRESENTS THE INTEREST IN THE NET ASSETS OF THE FOUNDATION. WHEN ASSETS ARE TRANSFERRED TO THE SLVH BY THE FOUNDATION, THE CONTRIBUTIONS ARE RESTRICTED TO THE PURCHASE OF EQUIPMENT AND FACILITY EXPANSION. Schedule D, Part X, Line 2 Management has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements. Schedule D, Part XI, Line 2d change in fair market value of interest rate swap 74,755 change in fair market value of investment in foundation 93,100 rental expenses reclassed from expense to revenue 82,661 asset disposal reclassed from expense to revenue 177,947 Total 428,463 Schedule D, Part XII, Line 2d rental expenses reclassed from expense to revenue 82,661 asset disposal reclassed from expense to revenue 177,947 Total 260,608 schedule d, part xi, line 4b grant revenue classed as expense on financial statements 39,176 schedule d, part xii, line 4b grant revenue classed as expense on financial statements 39,176 true true X true X 40. true X true true false false 154861 13706 141155 0.00190 26792863 25793887 998976 0.01370 594822 1030920 -436098 27542546 26838513 704033 0.01560 150658 150658 0.00210 223044 223044 0.00310 1879 1879 91883 91883 0.00130 467464 467464 0.00650 28010010 26838513 1171497 0.02210 75 75 0.00000 223 223 0.00000 535 535 0.00000 1169 1169 0.00000 2002 2002 0.00000 true 4269693 13941423 13855583 85840 X true true 2 1 Lutheran Hospital of SLV 106 Blanca Avenue Alamosa CO 81101 www.sanluisvalleyhealth.org X X X X 1 2 Conejos County Hospital 19021 US Hwy 285 La Jara CO 81140 www.sanluisvalleyhealth.org X X X 1 1 false false true X X X X X X X X X 12 true false false true X SEE PART V, SECTION C FOR URL X true 12 true SEE PART V, SECTION C FOR URL false false true 40. 250. X X X true true X X true X see part v, sec. c for url X see part v, sec. c for url X X X X true X false X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 Input from Representatives of the Community IN FEBRUARY 2013 EVENING MEETINGS IN ALAMOSA AND IN CONEJOS COUNTY WERE HELD. COMMUNITY MEMBERS WERE GIVEN TIME TO SHARE AND PRIORITIZE THE HEALTH ISSUES THAT THEY SEE IN THE SAN LUIS VALLEY. THE PROJECT MANAGEMENT MET WITH THE VARIOUS PUBLIC HEALTH AGENCIES TO DISCUSS STRATEGIES TO ADDRESS THE IDENTIFIED PRIORITY AREAS. SUGGESTIONS MADE WERE INTEGRATED INTO THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 6A Other facilities involved with the CHNA THE CHNA FOR SLV HEALTH WAS CONDUCTED WITH CONEJOS COUNTY HOSPITAL (CCH). At the time of the CHNA, SLV Health and CCH were separate legal entities. The two entities merged July 1, 2013. SCHEDULE H, PART V, SECTION B, LINE 7A Describe how the CHNA is made Widely Available to the Public THE CHNA EXECUTIVE SUMMARY FOR SLV HEALTH IS AVAILABLE AT: http://www.sanluisvalleyhealth.org/sites/default/files/documents/Executive Summary_0.pdf SCHEDULE H, PART V, SECTION B, LINE 10A Implementation strategy for chna THE IMPLEMENTATION STRATEGY TO ADDRESS EACH COMMUNITY HEALTH NEED IDENTIFIED THROUGH THE CHNA IS AVAILABLE ON THE CHNA EXECUTIVE SUMMARY AT: http://www.sanluisvalleyhealth.org/sites/default/files/documents/Executive Summary_0.pdf SCHEDULE H, PART V, SECTION B, LINE 11 Needs Addressed from CHNA the most significant need addressed in the latest community health needs assessment was outreach to spanish speaking individuals in the community. Approximately 28.35% of the identified community speaks spanish and the hospital addressed this need by translating the financial assistance policy, brochures, signage and posters in the clinic and hospital into spanish. additionally, spanish language pamphlets are distributed in various public facilities, such as child care centers and food banks. Schedule H, Part V, Section B, Line 16a Describe how the FAP is made widely available to the public: The FAP for SLV Health is available at: http://www.sanluisvalleyhealth.org/sites/default/files/images/charity%20ca re%20english.pdf Schedule H, Part V, Section B, Line 16C Describe how a plain language summary of the fap is made widely available: A Plain Language Summary of the FAP for SLV Health is made available at: http://www.sanluisvalleyhealth.org/sites/default/files/images/charity%20ca re%20english.pdf 4 Lutheran Hospital of SLV 2115 Stuart St Alamosa CO 81101 Physician Clinic Lutheran Hospital of SLV 103 Chico Ct Monte Vista CO 81144 Physician Clinic Lutheran Hospital of SLV - RHC 115 Main St Antonito CO 81120 Rural Health Clinic Lutheran Hospital of SLV - RHC 509 Main St La Jara CO 81140 Rural Health Clinic Schedule H, Part I, Line 7 Bad Debt Expense TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = 4,269,693. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS. SCHEDULE H, PART III, SECTION A, LINE 4 Accounts Receivable ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ADMINISTRATIVE REQUIREMENTS TO DETERMINE WHETHER PATIENTS WHO DO NOT COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS WOULD HAVE QUALIFIED FOR CHARITY CAN BE BURDENSOME, PARTICULARLY FOR SMALL BALANCES, SO A REASONABLE ESTIMATE, BASED ON BROAD DEMOGRAPHIC DATA, SHOULD BE SUFFICIENT TO JUSTIFY COMMUNITY BENEFIT TREATMENT. SCHEDULE H, PART III, SECTION B, LINE 8 Medicare THE COSTING METHODOLOGY TO DETERMINE LINE 6 WAS THE OVERALL FACILITY COST-TO-CHARGE RATIO. THE TIMING OF REVENUES FROM MEDICARE WILL NOT ALWAYS CORRESPOND TO THE TIMING OF THE EXPENSES. BASED ON MEDICARE COST REPORTS FILED AFTER THE END OF THE YEAR THERE MAY BE ADDITIONAL REVENUES DUE THE HOSPITAL OR AMOUNTS DUE BACK TO MEDICARE. THE SURPLUS OR (SHORTFALL) FOR THE LAST THREE YEARS IS AS FOLLOWS: 6/30/13 (2,322,085) 6/30/14 (1,203,813) 6/30/15 85,840 SCHEDULE H, PART III, SECTION C, LINE 9B Collections Process For patients who are known to qualify for financial assistance, the collection process follows these steps: a. Patients are contacted by brochure, mail and phone calls from a Financial Counselor, or the Patient Access Manager. Letters sent, brochures given and outbound phone calls and responses are noted in patient notes in the patient's profile. b. Patients who qualify for assistance will present information to the Financial Counselors who will update the registration section of the patient profile. Bilingual counselors or interpreters are available. c. Patients will be informed of their responsibility to pay co-payments or other sliding fee patient responsibility amounts. They will be informed in person and by phone whenever possible. Payment plans are always offered for patients who cannot afford their portion. d. Patients who do not pay their portion or co-payment will receive an invoice, printed in English and Spanish, directing them to pay or to call. If the patient calls and requests assistance from the Financial Counselor, they will be directed to the customer service phone number. e. Patients will receive up to 3 letters and 2 phone calls from a contracted, 3rd party vendor who have bilingual specialists. When 90 days have passed without any response from the patient, the account will be reviewed by the Patient Access Manager as well as the Patient Account Manager-Cash Posting, both members of the Business Revenue Cycle team. f. Upon review, if the portion is deemed to be the responsibility of the patient, the process toward collections will begin. A letter is sent to the patient from the third party company. The third party collection company follows legal proceedings at this point. SCHEDULE H, PART VI, LINE 2 Needs Assessment SLV HEALTH SUBMITS MANY GRANTS EVERY YEAR TO IMPROVE COMMUNITY HEALTH. EACH GRANT INCLUDES A SUMMARY OF KNOWN HEALTH DATA TO JUSTIFY THE NEED FOR THE FUNDS. AS A CONSEQUENCE WE ARE VERY ATTUNED TO OUR COMMUNITY HEALTH NEEDS. THROUGH COMMUICATION WITH PROVIDERS AND COMMUNITY NON-PROFITS, THIS NEED IS ADDRESSED AS REQURIRED. SAMPLE CURRENT AND PAST PROGRAMMING HAVE INCLUDED FREE COLONOSCOPIES, BREAST HEALTH RELATED TESTING, PSA TESTING AND MUCH MORE. SCHEDULE H, PART VI, LINE 3 Patient Education of Eligibility for Assistance SLV HEALTH PROVIDES A PATIENT FINANCIAL COUNSELOR WHO IDENTIFIES RESOURCES AND ELIGIBILITY ASSESMENT FOR PROGRAMS THROUGH FEDERAL AND STATE GOVERNMENT PROGRAMS, AS WELL AS GRANT FUNDED PROGRAM. WE ALSO PROVIDE A SLIDING FEE SCALE FOR SERVICE FOR THOSE SELF PAY PATIENTS NOT FITTING WITHIN ANY OF THESE PROGRAMS. PAY PLANS ARE ALSO SET UP FOR SELF PAY PATIENTS. SCHEDULE H, PART VI, LINE 4 Community Information SLV HEALTH SERVICES THE ENTIRE SAN LUIS VALLEY WHICH HAS A POPULATION OF NEARLY 50,000 RESIDENTS WITHIN 6 COUNTIES. THE SLV IS GEOGRAPHICALLY LIMITED DUE TO ITS SURROUNDING MOUNTAIN PASSES THAT SOMETIMES MAKES IT DIFFICULT TO TRAVEL ELSEWHERE WHEN CARE ISN'T AVAILABLE HERE. THE AVERAGE POVERTY LEVEL IS APPROXIMATELY 23.05% COMPARED TO COLORADO AVERAGE OF 12.9%. MEDIAN INCOME LEVELS ARE APPROXIMATELY $35,457 COMPARED TO $58,433 STATEWIDE. 61% OF HOUSEHOLDS IN THE SIX COUNTY AREA ARE MODERATE TO LOW INCOME. APPROXIMATELY 69% OF OUR PAYER MIX COMES FROM UNINSURED, MEDICARE/MEDICAID PATIENTS, CICP, OR SELF-PAY. SCHEDULE H, PART VI, LINE 5 Promotion of Community Health SLV HEALTH IS VERY ACTIVE IN THE COMMUNITY IN PROVIDING RESOURCES, INFORMATION AND DONATIONS TO PROMOTE HEALTHY LIVING IN SCHOOL, BUSINESS' AND THE GENERAL POPULATION. SLV Health Provides free or reduced rate physicals for students and other programs. SLV Health staff is very active in the community serving on related boards and providing other community benefit while on the hospital payroll. SLV Health provides many speaking tours on health related topics all over the San Luis Valley to inform and instruct residents on various issues. SLV Health has initiated teh GetHealthySLV.org website to inform community members of their health care resources and to learn about healthy habits. SLV health has also established three patient advisory councils to help us improve our healthcare services for diabetes, health disease and cancer. SCHEDULE H, PART VI, LINE 6 Affiliated Health Care System SLV HEALTH HAS A PROFESSIONAL AFFILIATION WITH CENTURA HEALTH SYSTEMS TO COORDINATE CARE FOR OUR SHARED PATIENTS. X X X false false false false false false false true false STEVEN W KITCHEN PHYSICIAN 455217 0 0 0 3208 0 7800 0 19452 0 485677 0 0 0 NUWAN PILAPITIYA PHYSICIAN 209340 0 0 0 162 0 6438 0 17959 0 233899 0 0 0 KONNIE MARTIN CEO 234727 0 51957 0 18103 0 7800 0 20966 0 333553 0 0 0 PATTI THOMPSON CNO 166615 0 16012 0 341 0 5577 0 9308 0 197853 0 0 0 GREG MCAULIFFE MD CMO 263830 0 26055 0 3508 0 7800 0 20425 0 321618 0 0 0 SHANE MORTENSEN CFO 156221 0 15200 0 319 0 5365 0 19643 0 196748 0 0 0 DENNARD ELLISON PHYSICIAN 381619 0 0 0 18476 0 7800 0 19467 0 427362 0 0 0 KELLY GALLEGOS CCH ADMINISTRATOR 117456 0 11969 0 95 0 4151 0 21187 0 154858 0 0 0 ROBERT MARSHALL PHYSICIAN 340125 0 28940 0 1530 0 7800 0 19077 0 397472 0 0 0 DAVID GEIGER PHYSICIAN 342823 0 30823 0 19128 0 7800 0 19452 0 420026 0 0 0 CLIFFORD ROBBINS PHYSICIAN 330397 0 1440 0 665 0 7800 0 8138 0 348440 0 0 0 CARISSA TRIPI PHYSICIAN 493707 0 30000 0 486 0 7800 0 18416 0 550409 0 0 0 JAMES GRIGSBY PHYSICIAN 378629 0 0 0 19330 0 7800 0 20080 0 425839 0 0 0 SCHEDULE J, PART I, LINE 7 CLINICAL KEY EMPLOYEES MAY EARN A PRODUCTIVITY BONUS. SENIOR MANAGEMENT IS ELIGIBLE FOR ANNUAL VARIABLE PAY UP TO 35% FOR CEO AND 20% FOR ALL OTHER SENIOR MANAGEMENT BASED UPON CRITERIA INCLUDING HOSPITAL WIDE MEASURES AND POSITION SPECIFIC GOALS. VARIABLE PAY IS AWARED AT THE DISCRETION OF THE BOARD FOR THE CEO AND THE CEO FOR ALL OTHER SENIOR MANAGEMENT. A ALAMOSA COUNTY STATE OF COLORADO 846000733 011583AB7 2005-02-17 11355000 HOSPITAL IMPROVEMENTS false false false B ALAMOSA COUNTY STATE OF COLORADO 846000733 011583ab7 2007-04-26 6505000 PURCHASE 2115 STUART&IMPROVEMENTS false false false A 3230000 0 11565184 0 0 0 362859 0 0 11202325 0 0 2007 false false true true B 1455000 0 6597643 0 0 0 130100 81852 0 6385691 0 0 2009 false false true true A false true false false 0.01000 0.00000 0.01000 true false 0.00000 false true B false true false false 0.02414 0.00000 0.02414 true false 0.00000 false true A false false false true true true MORGAN STANLEY CAP 20.282 false false false 0 false true B false false false true true true MORGAN STANLEY CAP 15. false false false 0 false true A true B true SCHEDULE K, PART IV, LINE 2C THE ALAMOSA COUNTY, CO SERIES 2005 BOND ARBITRAGE REBATE LIABILITY CALCULATION WAS PERFORMED ON SEPTEMBER 29, 2011. THE ALAMOSA COUNTY, CO SERIES 2007 BOND ARBITRAGE REBATE LIABILITY CALCULATION WAS PERFORMED ON MAY 15, 2012. DAVID GEIGER EMPLOYEE WAGES false SCHEDULE L, PART IV, COLUMN C BOARD MEMBER SUSAN GEIGER HAS A FAMILY RELATIONSHIP WITH HIGHEST COMPENSATED EMPLOYEE DAVID GEIGER. THE AMOUNT OF WAGES PAID CAN BE FOUND ON SCHEDULE J, PART II, LINE 10. FORM 990, PART VI, SECTION A, LINE 2 BOARD OF DIRECTOR MEMBERS CHERI CROWDER AND PATRICK CROWDER HAVE A FAMILY RELATIONSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE 990 IS PREPARED BY A THIRD PARTY ORGANIZATION, REVIEWED BY THE CFO AND CEO, AND APPROVED BY THE FINANCE COMMITTEE. THE BOARD OF DIRECTORS IS ALSO PROVIDED A COPY OF THE 990 FOR REVIEW PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C SAN LUIS VALLEY HEALTH HAS A CURRENT CONFLICT OF INTEREST POLICY THAT IS REVIEWED ANNUALLY BY THE BOARD OF TRUSTEES AND THE CEO. THE REVIEW PROCESS IS CONDUCTED FIRST WITH THE CEO AND THEN THE BOARD OF TRUSTEES. WHEN NECESSARY, THE POLICY HAS BEEN REVIEWED BY LEGAL COUNSEL. EACH YEAR TRUSTEES ARE ASKED TO REVIEW THE POLICY AND CONFIRM AND AMEND ANY POTENTIAL CONFLICT. THESE CONFLICTS ARE REVIEWED BY THE CEO AND THE ENTIRE BOARD. CONFLICTS ARE ROUTINELY DISCUSSED AND ARE THE RESPONSIBILITY OF ALL BOARD MEMBERS TO DISCLOSE; EITHER FOR THEMSELVES OR OTHERS. THE BOARD CHAIRMAN WILL MAKE A DECISION AS TO THE NATURE OF THE CONFLICT AND THE APPROPRIATE ACTION ACCORDING TO THE POLICY. FORM 990, PART VI, SECTION B, LINE 15A HUMAN RESOURCES PROVIDES THE EXECUTIVE COMMITTEE OF THE BOARD WITH SALARY SURVEY DATA FROM CHA, AHA, AND HFMA. AFTER STUDYING THE DATA, THE EXECUTIVE COMMITTEE MAKES RECOMMENDATIONS TO THE FULL BOARD IN EXECUTIVE SESSION. THE FULL BOARD APPROVES THE CEO'S COMPENSATION. SLVH CONDUCTS AN ANNUAL EVALUATION AND QUARTERLY REVIEWS OF THE CEO'S PERFORMANCE, WHICH IS DOCUMENTED. COMPENSATION FOR THE CEO IS DETERMINED ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15B HUMAN RESOURCES GATHERS COMPENSATION SURVEY DATA FROM CHA, AHA, AND HFMA. HUMAN RESOURCES MAKES RECOMMENDATIONS FOR OTHER OFFICERS' COMPENSATION AND PROVIDES SURVEY DATA TO THE CEO. THE CEO PERFORMS EVALUATIONS AND DETERMINES ALL OF THE WAGE CHANGES FOR THE OTHER OFFICERS ON AN ANNUAL BASIS. ALL CHANGES ARE DOCUMENTED. 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. FORM 990, PART XI, LINE 9 CHANGE IN FAIR MARKET VALUE OF INTEREST RATE SWAP 74,755 CHANGE IN FAIR MARKET VALUE OF INVESTMENT IN FOUNDATION 93,100 Total 167,855 SAN LUIS VALLEY HEALTH FOUNDATION 106 BLANCA AVENUE ALAMOSA CO 81101 203799814 FUNDRAISING CO 501(C)(3) LINE 7 SLVH true CONEJOS COUNTY HOSPITAL FOUNDATION 19021 US HWY 285 LA JARA CO 81140 320379184 FUNDRAISING CO 501(C)(3) LINE 7 SLVH true SLV MEDICAL CTR EMPLOYEE BEN TRUST 106 BLANCA AVENUE ALAMOSA CO 81101 840909851 HEALTH PLAN CO 501(C)(9) NA false false false true true false false false false false false false true true false true false true false false SLVRMC EMPLOYEE BENEFIT TRUST M 3659274 CASH PAID