CLEARWATER VALLEY HOSPITAL & CLINICS INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization: CLEARWATER VALLEY HOSPITAL & CLINICS INC (EIN 82-0497771)
Tax period: 2012-07-01 to 2013-06-30
Filed: 2014-05-05
IRS object ID: 201421259349301762
Schema version: 2012v2.3
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 I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2014-05-05T13:46:52-05:00	Timestamp
Tax Period End Date	2013-06-30	TaxPeriodEndDate
Return Type	990	ReturnType
Tax Period Begin Date	2012-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	820497771	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Clearwater Valley Hospital and Clinics Inc	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% LENNE BONNER	InCareOfName
Name Control	CLEA	NameControl
Phone	2084764555	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	301 Cedar Ave	AddressLine1
Address Line2	Suite	AddressLine2
City	Orofino	City
State	ID	State
ZIP Code	83544	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	LENNE BONNER	Name
Title	CFO	Title
Date Signed	2014-05-02	DateSigned

Field	Value	IRS element (for citing)
Tax Year	2012	TaxYear
Build TS	2015-11-30 17:44:51Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	Patrick Branco	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	301 Cedar Ave	AddressLine1
City	Orofino	City
State	ID	State
ZIP Code	83544	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	20729752	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.ESSENTIAHEALTH.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1997	YearFormation
State Legal Domicile	ID	StateLegalDomicile
Activity Or Mission Description	We are called to make a healthy difference in people's lives.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	12	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	218	TotalNbrEmployees
Total Nbr Volunteers	71	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	267243	ContributionsGrantsPriorYear
Contributions Grants Current Year	289593	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	19376156	ProgramServiceRevenuePriorYear
Program Service Revenue CY	20361372	ProgramServiceRevenueCY
Investment Income Prior Year	13771	InvestmentIncomePriorYear
Investment Income Current Year	-4913	InvestmentIncomeCurrentYear
Other Revenue Prior Year	31183	OtherRevenuePriorYear
Other Revenue Current Year	23664	OtherRevenueCurrentYear
Total Revenue Prior Year	19688353	TotalRevenuePriorYear
Total Revenue Current Year	20669716	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	1575	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	24025	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	11651680	SalariesEtcPriorYear
Salaries Etc Current Year	11539707	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	41393	TotalFundrsngExpCurrentYear
Other Expense Prior Year	7486925	OtherExpensePriorYear
Other Expenses Current Year	8450506	OtherExpensesCurrentYear
Total Expenses Prior Year	19140180	TotalExpensesPriorYear
Total Expenses Current Year	20014238	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	548173	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	655478	RevenuesLessExpensesCY
Total Assets BOY	9804145	TotalAssetsBOY
Total Assets EOY	11252434	TotalAssetsEOY
Total Liabilities BOY	3072586	TotalLiabilitiesBOY
Total Liabilities EOY	3866051	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	6731559	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	7386383	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	WE ARE CALLED TO MAKE A HEALTHY DIFFERENCE IN PEOPLE'S LIVES.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	17050220	Expense
Grants	24025	Grants
Revenue	20361372	Revenue
Description	See schedule O	Description
Total Program Service Expense	17050220	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	true	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	50	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	218	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	12	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	true	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
States Where Copy Of Return Is Filed	ID	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	LENNE BONNER	NamePerson
Telephone Number	2084764555	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	301 CEDAR ST	AddressLine1
City	Orofino	City
State	ID	State
ZIP Code	83544	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (23 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Average Hours Per Week RelatedAverageHoursPerWeekRelated	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
Marjorie Kuchynka
Board SECRET/TREASUR THRU 9/12	1.0	1.0	X	X	0	0	0
Larry Coonts
Board VICE CHAIR	1.0	1.0	X	X	0	0	0
Maurice Masar MD
Board Director	1.0	1.0	X		0	0	0
Gary Rehder
Board Director	1.0	1.0	X		0	0	0
Dan Davis
Board CHAIR	1.0	6.0	X	X	0	0	0
Sister Mary Rochefort
Board Director	1.0	1.0	X		0	0	0
Sister Barbara Jean Glodowski
Board Director THRU 9/12	1.0	1.0	X		0	0	0
Bryan Higgins
Board Director THRU 9/12	1.0	1.0	X		0	0	0
Lee Pippenger
Board SECRETARY/TREASURER	1.0	1.0	X	X	0	0	0
Michael Hedrix
Board Director THRU 1/13	1.0	59.0	X		0	330038	63788
Kelly McGrath MD
Board Director	39.0	1.0	X		225911	0	30254
Alvin SECREST III MD
Board Director	1.0	39.0	X		0	252202	34395
LONNIE SIMPSON
BOARD DIRECTOR	1.0	1.0	X		0	0	0
LENNY HILL
BOARD DIRECTOR	1.0	1.0	X		0	0	0
SISTER MARJORIE SCHMIDT
BOARD DIRECTOR	1.0	1.0	X		0	0	0
PAUL NUSSER
BOARD DIRECTOR	1.0	1.0	X		0	0	0
Lenne Bonner
INTERIM PRESIDENT/CFO	25.0	25.0		X	176640	0	31028
Clayton Bunt MD
Physician	40.0	0.0			197242	0	28124	X
Michael Meza MD
Physician	40.0	0.0			168135	0	22317	X
Enrique Montana MD
Surgeon	40.0	0.0			173217	0	15255	X
PHILLIP PETERSEN MD
PHYSICIAN	40.0	0.0			180911	0	29878	X
KIMBERLY CAMPBELL MD
PHYSICIAN	40.0	0.0			189721	0	21445	X
Colleen Meza
President	0.0	0.0			0	229210	1894		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1311777	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	811450	TotalReportableCompFrmRltdOrgs
Total Other Compensation	278378	TotalOtherCompensation
Number Individuals GT100 K	16	NumberIndividualsGT100K
Formers Listed	true	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
DMS Imaging Inc
26273 Network Place	CHICAGO	IL	60673	Mobile Radiology	399672
GRITMAN MEDICAL CENTER
700 S MAIN STREET	MOSCOW	ID	83843	RADIOLOGY SERVICES	249176
Palouse Imaging Consultants
PO BOX 9583	MOSCOW	ID	83843	Radiology Services	245615
Wendi Richardson
PO Box 1916	OROFINO	ID	83544	CRNA	183227
CHG COMPANIES INC
PO BOX 972651	DALLAS	TX	75397	PHYSICIAN SERVICES	137093

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	6	NumberOfContractorsGT100K
Government Grants	234117	GovernmentGrants
All Other Contributions	55476	AllOtherContributions
Total Contributions	289593	TotalContributions

Program Service Revenue ProgramServiceRevenue

Field	Value	IRS element (for citing)
Description	HOSPITAL & CLINIC SERVICES	Description
Business Code	621110	BusinessCode
Total Revenue Column	20361372	TotalRevenueColumn
Related Or Exempt Function Income	20361372	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	20361372	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	17830	TotalRevenueColumn
Exclusion	$17,830	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	37293	Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	60036	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	37293	Securities
Other	-60036	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	-22743	TotalRevenueColumn
Exclusion	-$22,743	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount
VENDING SALES	722514	11315	$11,315
FITNESS DUES	713940	7800	$7,800
MEDICAL RECORDS COPIES	561439	4549	$4,549

Field	Value	IRS element (for citing)
Total Other Revenue	23664	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	20669716	TotalRevenueColumn
Related Or Exempt Function Income	20361372	RelatedOrExemptFunctionIncome
Exclusion	$18,751	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	24025	Total
Program Services	24025	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	0	Total

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	418646	Total
Program Services	198663	ProgramServices
Management And General	219983	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	9314759	Total
Program Services	8082767	ProgramServices
Management And General	1206680	ManagementAndGeneral
Fundraising	25312	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	313934	Total
Program Services	272470	ProgramServices
Management And General	40264	ManagementAndGeneral
Fundraising	1200	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	819885	Total
Program Services	706232	ProgramServices
Management And General	112533	ManagementAndGeneral
Fundraising	1120	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	672483	Total
Program Services	575724	ProgramServices
Management And General	94258	ManagementAndGeneral
Fundraising	2501	Fundraising

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	2262	Total
Management And General	2262	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	33096	Total
Management And General	33096	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	1548	Total
Management And General	1548	ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	4978	Total
Management And General	4978	ManagementAndGeneral

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	2568982	Total
Program Services	2381844	ProgramServices
Management And General	187138	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	26049	Total
Program Services	135	ProgramServices
Management And General	25914	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	1620933	Total
Program Services	1418495	ProgramServices
Management And General	200043	ManagementAndGeneral
Fundraising	2395	Fundraising

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	154260	Total
Program Services	110871	ProgramServices
Management And General	42172	ManagementAndGeneral
Fundraising	1217	Fundraising

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	278399	Total
Program Services	204224	ProgramServices
Management And General	72394	ManagementAndGeneral
Fundraising	1781	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	228474	Total
Program Services	195196	ProgramServices
Management And General	33234	ManagementAndGeneral
Fundraising	44	Fundraising

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	93611	Total
Program Services	73681	ProgramServices
Management And General	19930	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	18120	Total
Program Services	14864	ProgramServices
Management And General	3256	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	725139	Total
Program Services	521174	ProgramServices
Management And General	198242	ManagementAndGeneral
Fundraising	5723	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	277232	Total
Program Services	267860	ProgramServices
Management And General	9372	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral	FundraisingFundraising
BAD DEBT EXPENSE	1235790	1235790
MEDICAL SUPPLIES	480287	480287
AFFILIATE SUPPORT FEE	395415	245157	150258
DUES & SUBSCRIPTIONS	305931	40761	265070	100

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	20014238	Total
Program Services	17050220	ProgramServices
Management And General	2922625	ManagementAndGeneral
Fundraising	41393	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	725	BOY
EOY	725	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	2075777	BOY
EOY	1258939	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	84635	BOY
EOY	90770	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	3629626	BOY
EOY	4033802	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	15000	BOY
EOY	0	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	420413	BOY
EOY	408479	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	69581	BOY
EOY	116193	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	7699737	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	3845116	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	3064385	BOY
EOY	3854621	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	444003	BOY
EOY	1488905	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	9804145	BOY
EOY	11252434	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	1784673	BOY
EOY	1923790	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	126510	BOY
EOY	903926	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	1161403	BOY
EOY	1038335	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	3072586	BOY
EOY	3866051	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	6731559	BOY
EOY	7386383	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	6731559	BOY
EOY	7386383	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	9804145	BOY
EOY	11252434	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	655478	ReconcilationRevenueExpenses
Reconciliation Unrealized Invest	-654	ReconciliationUnrealizedInvest
Info In Schedule O Part XII	X	InfoInScheduleOPartXII
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited

FS Audited Basis FSAuditedBasis

Field	Value	IRS element (for citing)
Financial Statement Consolidated	X	FinancialStatementConsolidated

Field	Value	IRS element (for citing)
Audit Committee	true	AuditCommittee
Federal Grant Audit Required	true	FederalGrantAuditRequired
Federal Grant Audit Performed	true	FederalGrantAuditPerformed

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

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)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$1,548	OtherActivitiesAmount
Total Lobbying Expenditures IIB	1548	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Schedule C, Part II-B	Identifier
Explanation	Lobbying activity explanation: Clearwater Valley Hospital and Clinics, Inc. pays dues to certain organizations related to the industry which have lobbying expenses. The amount listed is the percentage of the dues paid that were used for lobbying.	Explanation

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Current Year Minus3 Years		CurrentYearMinus3Years
Current Year Minus4 Years		CurrentYearMinus4Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	116169	OtherCostOrOtherBasis
Book Value	116169	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	1499216	OtherCostOrOtherBasis
Depreciation	773149	Depreciation
Book Value	726067	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	6211	OtherCostOrOtherBasis
Depreciation	4348	Depreciation
Book Value	1863	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	5396342	OtherCostOrOtherBasis
Depreciation	3040719	Depreciation
Book Value	2355623	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	681799	OtherCostOrOtherBasis
Depreciation	26900	Depreciation
Book Value	654899	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3854621	TotalOfBookValueLandBuildings
Financial Derivatives		FinancialDerivatives
Closely Held Equity Interests		CloselyHeldEquityInterests

Other Securities OtherSecurities

Field	Value	IRS element (for citing)
Description	POOLED INVESTMENT FUND	Description
Book Value	1488905	BookValue
Method Of Valuation	F	MethodOfValuation

Field	Value	IRS element (for citing)
Total Of Book Value Securities	1488905	TotalOfBookValueSecurities
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescription	AmountAmount
BUILDING LEASE LIABILITY	$819,278
PAYABLES TO RELATED TAX-EXEMPT ORGS	$219,057

Field	Value	IRS element (for citing)
Total Of Amounts	1038335	TotalOfAmounts

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent100	X	Pcent100
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	167	PersonsServed
Total Community Benefit Expense	199305	TotalCommunityBenefitExpense
Net Community Benefit Expense	199305	NetCommunityBenefitExpense
Percent Of Total Expense	0.01060	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	3480	PersonsServed
Total Community Benefit Expense	2385080	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1971527	DirectOffsettingRevenue
Net Community Benefit Expense	413553	NetCommunityBenefitExpense
Percent Of Total Expense	0.02200	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Persons Served	3647	PersonsServed
Total Community Benefit Expense	2584385	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1971527	DirectOffsettingRevenue
Net Community Benefit Expense	612858	NetCommunityBenefitExpense
Percent Of Total Expense	0.03260	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	5	NumberOfActivitiesOrPrograms
Persons Served	4376	PersonsServed
Total Community Benefit Expense	154343	TotalCommunityBenefitExpense
Net Community Benefit Expense	154343	NetCommunityBenefitExpense
Percent Of Total Expense	0.00820	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Persons Served	24	PersonsServed
Total Community Benefit Expense	41110	TotalCommunityBenefitExpense
Net Community Benefit Expense	41110	NetCommunityBenefitExpense
Percent Of Total Expense	0.00220	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	1386	TotalCommunityBenefitExpense
Net Community Benefit Expense	1386	NetCommunityBenefitExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Persons Served	899	PersonsServed
Total Community Benefit Expense	12527	TotalCommunityBenefitExpense
Net Community Benefit Expense	12527	NetCommunityBenefitExpense
Percent Of Total Expense	0.00070	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	14	NumberOfActivitiesOrPrograms
Persons Served	5299	PersonsServed
Total Community Benefit Expense	209366	TotalCommunityBenefitExpense
Net Community Benefit Expense	209366	NetCommunityBenefitExpense
Percent Of Total Expense	0.01120	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	14	NumberOfActivitiesOrPrograms
Persons Served	8946	PersonsServed
Total Community Benefit Expense	2793751	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1971527	DirectOffsettingRevenue
Net Community Benefit Expense	822224	NetCommunityBenefitExpense
Percent Of Total Expense	0.04380	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$1,235,790	BadDebtExpenseAmount
Amount Attributable To	13500	AmountAttributableTo
Amount Reimbursed By Medicare	8778594	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	8691677	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	86917	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Other	X	Other

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	Clearwater Valley Hospital and Clinic	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	301 Cedar Ave	AddressLine1
City	Orofino	City
State	ID	State
ZIP Code	83544	ZIPCode

Field	Value	IRS element (for citing)
Website Address	www.essentiahealth.org	WebsiteAddress
Licensed Hospital	X	LicensedHospital
General Medical And Surgical	X	GeneralMedicalAndSurgical
Critical Access Hospital	X	CriticalAccessHospital
Er24 Hours	X	Er24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	Clearwater Valley Hospital & Clinics	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	true	CHNAConducted
Community Definition	X	CommunityDefinition
Community Demographics	X	CommunityDemographics
Existing Resources	X	ExistingResources
How Data Obtained	X	HowDataObtained
Community Health Needs	X	CommunityHealthNeeds
Other Health Issues	X	OtherHealthIssues
Identifying Process	X	IdentifyingProcess
Consulting Process	X	ConsultingProcess
Information Gaps	X	InformationGaps
Other	X	Other
Needs Assessment Conducted	12	NeedsAssessmentConducted
Take Into Account	true	TakeIntoAccount
Other Facilities	true	OtherFacilities
CHNA Widely Available	true	CHNAWidelyAvailable
Own Website	X	OwnWebsite
On Request	X	OnRequest
Adopt Implement Strategy	X	AdoptImplementStrategy
Execute Implement Strategy	X	ExecuteImplementStrategy
Develop Community Plan	X	DevelopCommunityPlan
Participate Community Plan	X	ParticipateCommunityPlan
Include Operational Plans	X	IncludeOperationalPlans
Adopt Budget	X	AdoptBudget
Prioritize Health Needs	X	PrioritizeHealthNeeds
Prioritize Services	X	PrioritizeServices
All Needs Addressed	false	AllNeedsAddressed
Organization Incur Excise Tax	false	OrganizationIncurExciseTax
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	100	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	200.	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Insurance Status	X	InsuranceStatus
Medicaid Medicare	X	MedicaidMedicare
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	false	IncludesPublicityMeasures
Actions On Nonpayment	true	ActionsOnNonpayment
Collection Activities	false	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Average Negotiated Rates	X	AverageNegotiatedRates
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	4	NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
Orofino Medical Clinic
301 Cedar Avenue	Orofino	ID	83544	Primary Care Clinic
Kooskia Medical Clinic
201 Thenon Street	Kooskia	ID	83539	PRIMARY CARE CLINIC
Pioneer Medical Center
105 Carle Street	Pierce	ID	83546	Primary Care Clinic
OROFINO PHYSICAL THERAPY CLINIC
153 JOHNSON AVE	OROFINO	ID	83544	PHYSICAL THERAPY CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)

IdentifierIdentifier	ExplanationExplanation
Schedule H, Part VI, Line 1	Provide the description required for Part I, lines 3c, 6a, 7g, 7, column (f), 7; Part II; Part III, lines 2, 3, 4, 8, 9b; Part V, lines 1j, 3, 4, 5a, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, 22: Part I, line 3c If asset levels are deemed to be significant, no discounted or free care will be offered, even if they meet the income thresholds. Part I, line 6a Clearwater Valley Hospital and Clinics, Inc.'s community benefit information is consolidated into the Essentia Health community benefit information which is included in the Essentia Health annual report. The annual report is made available to the public at www.essentiahealth.org. Essentia Health, headquartered in Duluth, Minn., is an integrated health system serving patients in Minnesota, Wisconsin, North Dakota and Idaho and is Clearwater Valley Hospital and Clinics, Inc.'s parent corporation. Part 1, line 7g Not Applicable. Part I, line 7, column (f) Bad debt expense that was subtracted from total expense to obtain the % of community benefit to total expense amounted to $1,235,790 Part I, line 7 The cost to charge ratio derived from Worksheet 2, Ratio of Patient Care Cost-to-Charges was used to calculate the costs for the following community benefits: Charity Care and Unreimbursed Medicaid. Actual costs were used for the remainder of the community benefits reported. Part II Not applicable, no community building activities. Part III, line 2 Discounts, charity care, and bad debt expense are accounted for as reductions to revenue. Bad debt expense on patient accounts would be identified as any balance on the account, less any previous payments and discounts, that has aged and is absent of any payments. If, during the collection process, it becomes known that the patient qualifies for charity care, the amounts included within bad debt expense would be reclassified to charity care. Part III, Line 3 Clearwater Valley Hospital and Clinics, Inc. applied a high-level, conservative analytic review by taking the ratio of charitable allowances to gross patient revenue and multiplying against bad debt expense to arrive at an approximation of charity care that resides in bad debt. Part III, Line 3 Clearwater Valley Hospital and Clinics, Inc. is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the cost of bad debt as a community benefit. As a tax exempt hospital, we must provide the necessary services regardless of the patient's ability to pay for that care. In doing so, Essentia Health makes quality patient care available to all in our community, regardless of their economic means. Part III, line 4 The page number of the audit that contains the footnote describing the organization's bad debt expense is page 12. Part III, line 8 The methodology used in determining the reported Medicare Allowable Costs begins with the hospital's general ledger system. The costs are obtained from the general ledger and then adjusted and reported in accordance with Centers for Medicare Services (CMS) "cost finding" guidelines as published in their Provider Reimbursement Manual. Once the Medicare allowable costs are determined from the hospital's cost report, any costs attributed to subsidized health services, and Medical Education, are removed. Part III, line 8 Clearwater Valley Hospital and Clinics, Inc. is a part of a larger organization, Essentia Health. Essentia Health and its member organizations incorporate the full value of the Medicare shortfall as a community benefit. The rationale for the organization's opinion is providing care for the elderly and serving Medicare patients is an essential part of the community benefit standard. Medicare, like Medicaid, does not pay the full cost of care and it is likely to get worse. Many Medicare beneficiaries are poor and are eligible for Medicaid in addition to Medicare. Medicare underpayment must be shouldered by the hospital in order to continue treating the community's elderly and poor. These underpayments represent a real cost of serving the community. Part III, line 8 Each Essentia Health hospital is required to file a Medicare cost report 5 months after the close of their fiscal year. The cost report provides Medicare with information that is used to determine utilization and spending trends but also is used to set future payment rates for most Medicare services. If the interim payments paid to a hospital are higher or lower than the filed cost report allowable reimbursement there will be a settlement for that fiscal year. This can be due to changes in utilization or cost of providing services for Critical Access Hospitals (CAH) or differences between interim and final payment factors for Disproportionate Share, Bad Debts, or Indirect Medical Education for non-CAH hospitals. An estimate for these settlements is recorded at the close of the fiscal year. If the estimate varies from the final settlement received 6-7 months after the fiscal year ends then these amounts are recorded as prior year Medicare revenue. Part III, line 9b At any stage of the patient experience, including collections, a determination may be made that the patient qualifies for Financial Assistance. All collection efforts must be suspended while a patient's Financial Assistance application is being considered and until the patient is notified regarding the determination of eligibility. Once eligibility (or lack of eligibility) is determined, amounts still owed by patients will be collected in the same manner as all other patient bills. Part V, line 1j The Community Health Needs Assessment also includes a Community Health Profile. The profile is based on data from the Behavioral Risk Factors Surveillance System and the University of Wisconsin Population Health Institute County Health Rankings.
SCHEDULE H, PART VI, LINE 1 CONT.	Part V, line 3 A Community/Patient Focus Group was held for community members to identify and prioritize their community health needs. In addition, persons were and will be consulted at Town Hall Meetings, which are the first step in addressing each prioritized health need. During the Town Hall Meeting, intervention options for meeting the health need were presented, and participants selected the option best suited to their community. Individuals from the following organizations attended the Town Hall Meeting (names and titles available upon request): Community/Patient Focus Group, Public Health - Idaho North Central District, Business Psychology Associates, Allen Counseling Services, Region II Mental Health Board, and Nimiipuu Health. See the CHNA posted on the website listed in Part V, Line 5a for a list of organizations that were invited to, but did not attend the town hall meetings. An employee of Public Health - Idaho North Central District (name and title available upon request) attended the Community/Patient Focus Group and the Town Hall Meeting and provided input on the community health needs and intervention options for addressing the highest priority health need. Two individuals from Nimiipuu Health attended both the Community/Patient Focus Group and the Town Hall Meeting and provided input on the community health needs and intervention options for addressing the highest priority health need. These individuals provide health education and home visits to the tribal community. The majority of Clearwater, Idaho, and Lewis Counties are rural according to the 2012 UWPHI County Health Rankings data: 57.3% (Clearwater), 79.1% (Idaho), and 100% (Lewis). Given the known health disparities of rural populations, all attendees of the Community/Patient Focus Group and Town Hall Meetings are representatives and/or members of medically-underserved and low income populations, as well as populations with chronic disease needs. Community/Patient Focus Group participants were specifically instructed to consider themselves as representatives of the community-at-large. Participants at the Town Hall Meetings served more formal leadership or representative roles. The current and former Chairs of Regional Mental Health Boards attended both the Community/Patient Focus Group and the Town Hall Meeting. Elected officials from Clearwater County and Cottonwood City Council (names and titles available upon request) attended the Community/Patient Focus Group. In Clearwater, Idaho, and Lewis Counties, over 88% of individuals are Caucasian. However, as attendees at the Community/Patient Focus Group were instructed to act as representatives of the entire community, and data stratified by race/ethnicity were presented, health needs of minority populations were considered. Additionally, two individuals from Nimiipuu Health attended both the Community/Patient Focus Group and the Town Hall Meeting and provided input on the community health needs and intervention options for addressing the highest priority health need. These individuals provide health education and home visits to the tribal community. Part V, line 4 In the interest of efficiency, cost effectiveness, and alignment with Essentia Health population health strategies, the hospital facility's CHNA was conducted in a coordinated process with fourteen other Essentia Health hospital facilities. While still allowing for tailoring to each particular hospital facility, procedures were standardized across hospital facilities. The hospital facilities included in this coordinated process are: Essentia Health Ada in Ada, MN; Clearwater Valley Hospital and Clinics, Inc. in Orofino, ID; Essentia Health Deer River in Deer River, MN; Essentia Health Virginia in Virginia, MN; Essentia Health Holy Trinity Hospital in Graceville, MN; Essentia Health West in Fargo, ND; Minnesota Valley Health Center, Inc. in Le Sueur, MN; Essentia Health Northern Pines in Aurora, MN; Essentia Health Sandstone in Sandstone, MN; Essentia Health Duluth in Duluth, MN; Essentia Health St. Joseph's Medical Center in Brainerd, MN; Essentia Health St. Mary's Hospital-Superior in Superior, WI; St. Mary's Hospital, Inc. in Cottonwood, ID; Essentia Health St. Mary's Medical Center in Duluth, MN; and Essentia Health St. Mary's-Detroit Lakes in Detroit Lakes, MN. Since Essentia Health West joined the collaborative effort on February 1, 2013, not all aspects of the Essentia Health West CHNA are coordinated with those of the other hospital facilities. Clearwater Valley Hospital and Clinics, Inc. did and will collaborate more closely with one of the Essentia Health hospitals in particular - St. Mary's Hospital, Inc. in Cottonwood, ID - by holding joint Community/Patient Focus Groups, Town Hall Meetings, and Intervention Planning Meetings. Additional collaboration between the two hospitals will occur as the interventions progress. Part V, line 5a The CHNA is posted under the "Community Health" tab on the hospital facility's homepage at http://www.smh-cvhc.org Part V, line 5c This box was not checked, so not applicable. Part V, line 6i This box was not checked, so not applicable. Part V, line 7 Seven health needs were identified through the CHNA. Of those health needs, three were selected as the highest priority health needs that have/will be addressed over the next three years as a part of the hospital facility's implementation strategies. The hospital facility will not directly meet the four unprioritized health needs due to resource constraints. Rather than inadequately addressing all health needs, the hospital facility will focus resources, financial and otherwise, on their community's three prioritized health needs in order to foster success in meeting those health needs. Despite not directly meeting the unprioritized needs, interventions addressing the three prioritized health needs may partially address the unprioritized health needs that overlap with the prioritized health needs. If the unprioritized health needs remain in the next CHNA cycle, they may be directly addressed at that time. The four unprioritized health needs are as follows: Reduction of excessive/binge drinking Immunizations Preventative care Secondary prevention/screening Part V, line 10 Checked "Yes", so not applicable. Part V, Line 11 Checked "Yes", so not applicable. Part V, line 12h This box was not checked, so not applicable. Part V, Line 14 Clearwater Valley Hospital & Clinics, Inc. did not have language in their financial assistance policy stating how the policy was to be publicized as of year-end. Since year-end, the policy has been revised to add language stating how the policy was to be publicized. Despite not having language in their policy, the organization did publicize their financial assistance policy throughout the year. Part VI, line 3 describes how Clearwater informed patients of the financial assistance policy. Part V, line 14g This box was not checked, so not applicable. Part V, line 16e This box was not checked, so not applicable. Part V, line 17e This box was not checked, so not applicable. Part V, line 18e This box was not checked, so not applicable. Part V, line 19c This box was not checked, so not applicable. Part V, line 19d This box was not checked, so not applicable. Part V, line 20d This box was not checked, so not applicable. Part V, line 21 Answered "No" so not applicable. Part V, line 22 Answered "No" so not applicable.
PART VI, LINE 2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B: Clearwater Valley Hospital and Clinics, Inc. is overseen by a volunteer board of directors consisting of representatives of its service area. These directors bring community health needs to the table. In addition, service usage patterns are monitored by administrators, doctors are consulted for needed care improvements in regular medical staff meetings, and an organization-wide quality council monitors quality improvement data regularly. We also have regular meetings with community partners to assess specific population health indicators. The hospital participated in a 10-county assessment of health needs in conjunction with Public Health. Employees of the hospital regularly attend regional meetings to assess community health needs. The hospital participated with Public Health in a regional community health needs survey in 2013. The results of that survey are being analyzed for potential improvements to patient care.
PART VI, LINE 3	Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's charity care policy: Notification of Financial Information including Charity Care is made widely available to the public in the admitting, billing and patient/family reception areas. Reference to the program is also contained in the hospital admissions packet. The Financial Counselor visits uninsured or underinsured patients or their family during their stay, whenever possible, to discuss financial arrangements. Charity Care applications, Medicaid applications, and County forms are distributed at that time. Follow up calls are made after discharge to finalize arrangements. This information is provided to anyone requesting it, whether they request it in person, by mail, or by phone. Signs indicating the availability of charity care are posted in the ER area, the inpatient family waiting room, business office and admitting area. The signs provide a phone number and contact information. All staff with public and patient contact, including but not restricted to billing and emergency staff will refer patients to the Financial Counselor for detailed explanations of the Charity Care program and application forms. The Financial Counselor will do the appropriate follow up. Based on the information gathered by the Financial Arrangement worksheet, the Financial Counselor will determine whether the account should be directed to a bank loan, Medicaid, County Social Services, or Charity Care. The patient will then complete the Determination Form and forward to the Business Office Manager for approval.
PART VI, LINE 4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves: Clearwater Valley Hospital & Clinics, Inc. is located in Orofino, ID. Clearwater Valley Hospital & Clinics, Inc. is a part of the larger Essentia Health system, which is defined in Part VI, line 6. Clearwater Valley Hospital & Clinics, Inc. operates 1 hospital and 4 clinics that serve the communities of Idaho, Lewis and Clearwater counties covering 2,400 square miles. The overall community is classified as rural. Clearwater Valley Hospital & Clinics, Inc. covers a service region of approximately 10,000 people. The service region age distribution is 21.3% under the age of 18; 57.8% between the ages of 18 and 65; and 20.9% over the age of 65. The racial makeup of the service region is 99.3% Caucasian; 0.1% Black or African American; 0.5% Asian and other 0.1%. The gender split ratio is 50.4% women and 49.6% men. The average income for the service area is approximately $43,000. Approximately 12.8% of the population falls below the federal poverty guidelines. Clearwater Valley Hospital & Clinics, Inc., along with Essentia Health is committed to serve patients regardless of their ability to pay. 4.9% net revenue dollars were from self pay patients. In addition, approximately 9.2% of their net revenue dollars were Medicaid recipients. A large portion of the population lacks medical insurance. As mentioned above, Clearwater Valley Hospital & Clinics, Inc. is part of a larger system, Essentia Health. Essentia Health staffs hospitals and clinics in federally-recognized underserved areas and supports the health of its communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into its smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. There are no other hospitals outside of the Essentia Health umbrella that service the community.
PART VI, LINE 5	Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting the health of the community: Clearwater Valley Hospital and Clinics, Inc.'s Board of Directors is composed of volunteer representatives from the communities it serves. The hospital extends medical staff privileges to all qualified physicians in the community who are properly screened. In addition, the hospital serves as a clinical practice site for many students in x-ray technology, nursing, physician assistant, nurse practitioner, and medical residency programs. This is especially important because Idaho has one of the lowest physician per capita rates in the nation. Clearwater Valley Hospital and Clinics, Inc. has expanded its use of telehealth services to improve patient care. These types of services are extremely important for expanding access to health care in rural America. It takes close to 12 hours to drive from the northern part of our state to the southern border. Add to that river canyons, mountains and treacherous roads and you'll have a better understanding of the challenge of commuting to receive health care specialty services. The closest large urban centers are either three or five hours away. Having specialists 'see' our patients and consult with our physicians using teleconferencing and other telemedicine equipment allows us to access cardiologists, hospitalists, adult and child psychiatrists, surgical specialists, emergency department specialists and soon, a dermatologist. In our rural area we don't have the patient base necessary to establish full time specialty care. However, we have the same types of illnesses and injuries that people have in larger cities. Using technology to bring those specialists to our area so people can receive their healthcare locally is vital to providing a fuller range of medical care to our patients. Clearwater Valley Hospital and Clinics, Inc. regularly reviews facilities and equipment and develops an attrition process to replace aging plant operations & equipment. They also look for opportunities to bring new services to the communities via investing in new skills and technology where appropriate.
PART VI, LINE 6	If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served: Clearwater Valley Hospital and Clinics, Inc. is part of Essentia Health, an integrated health system of 16 hospitals, 65 clinics, eight long-term care facilities, two assisted living facilities, four independent living facilities in four states: Minnesota, Wisconsin, North Dakota and Idaho. The health system serves a predominantly rural population whose median incomes generally fall below averages of the states where they live. The presence of our clinics and hospitals ensures that people with few economic resources don't have to drive an hour or more to receive basic (and in some cases life-saving) medical care. In addition to staffing hospitals and clinics in federally-recognized underserved areas, we support the health of our communities through an active outreach program that brings specialists like oncologists, cardiologists, neurologists and others into our smaller communities. This eliminates barriers to care for many patients, particularly those who are elderly, living on low incomes, or are faced with other challenges that make it difficult to travel long distances for care. Our size and integrated structure allow us to offer patients services often found only in larger urban settings. Services ranging from chemotherapy to congestive heart failure management and hospice are available to patients in many of the rural communities we serve. Essentia Health also supports the health of our rural communities through active research and clinical trials by the Essentia Institute of Rural Health. The Institute conducts clinical, translational and health services research with a primary focus on the needs of rural Americans. Essentia Health is also serving patients through the use of the Epic electronic health record (EHR). The vast majority of Essentia's hospitals and clinics are using a fully-integrated EHR for patient care. Technology like the electronic health record and Essentia's telehealth program allows health clinicians to share test results and consult with colleagues in real time across great distances. Medical information is no longer lost in the shuffle of paper records - an important consideration in a region where patients must often be transferred to a larger Essentia facility for complex surgeries or medical care. Essentia is also actively working with government agencies and insurers to develop innovative, cost-effective approaches to care that will improve health outcomes while reducing overall costs to patients and insurers. This innovation can be found in our use of remote home monitors for patients with congestive heart failure to a focus on using a team-based approach to helping patients manage chronic diseases. Essentia Health is committed to helping patients and their families lead active and fulfilling lives in the small and large communities where they live. We hope to become a model of health care delivery, particularly in rural areas, in the years to come.
PART VI, LINE 7	If applicable, identify all states with which the organization, or a related organization, files a community benefit report: Clearwater Valley Hospital & Clinics, Inc. files a community benefit report in Idaho.
PART VI, LINE 8	If applicable, for each hospital facility in a facility reporting group provide the description required for Part V, Section B, Lines 1J, 3, 4, 5C, 6I, 7, 10, 11, 12H, 14G, 16E, 17E, 19C, 20D, 21, and 22: Not Applicable.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	Essentia Health Foundation	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	502 E 2nd St	AddressLine1
City	Duluth	City
State	MN	State
ZIP Code	55805	ZIPCode

Field	Value	IRS element (for citing)
EIN Of Recipient	271984704	EINOfRecipient
IRC Section	501(c)(3)	IRCSection
Amount Of Cash Grant	19515	AmountOfCashGrant
Purpose Of Grant	Program Support	PurposeOfGrant

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	1	TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	Schedule I, Part I, Line 2	Identifier
Explanation	PROCEDURES FOR MONITORING USE OF GRANT FUNDS: Clearwater Valley Hospital and Clinics, Inc. MANAGEMENT REVIEWS THE GRANT ACTIVITY BY REVIEWING AND DOCUMENTING EACH EXPENDITURE REQUEST AND APPROVING THE EXPENSE.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	X	CompensationCommittee
Independent Consultant	X	IndependentConsultant
Compensation Survey	X	CompensationSurvey
Board Or Committee Approval	X	BoardOrCommitteeApproval
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

TitleTitle	Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
Colleen Meza
President	0	157754	0	22395	0	49061	0	0	0	1894	0	231104	0	48225
Lenne Bonner
INTERIM PRESIDENT/CFO	154857	0	21783	0	0	0	7594	0	23434	0	207668	0	0	0
Clayton Bunt MD
Physician	177739	0	19503	0	0	0	8118	0	20006	0	225366	0	0	0
Michael Meza MD
Physician	150617	0	17518	0	0	0	6913	0	15404	0	190452	0	0	0
Enrique Montana MD
Surgeon	164687	0	8530	0	0	0	7067	0	8188	0	188472	0	0	0
Michael Hedrix
Board Director THRU 1/13	0	259344	0	30536	0	40158	0	32333	0	31455	0	393826	0	35375
Kelly McGrath MD
Board Director	214845	0	11066	0	0	0	9339	0	20915	0	256165	0	0	0
Alvin SECREST III MD
Board Director	0	238506	0	13696	0	0	0	10000	0	24395	0	286597	0	0
PHILLIP PETERSEN MD
PHYSICIAN	173756	0	7155	0	0	0	7595	0	22283	0	210789	0	0	0
KIMBERLY CAMPBELL MD
PHYSICIAN	167440	0	22281	0	0	0	0	0	21445	0	211166	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)

IdentifierIdentifier	ExplanationExplanation
Form 990, Part I, Line 3	Establishing CEO's compensation: Clearwater Valley Hospital and Clinics, Inc. relied on Essentia Health's, related organization of Clearwater Valley Hospital and Clinics, Inc. methods for establishing Clearwater Valley Hospital and Clinics, Inc. President's compensation: a compensation committee, independent compensation consultant, compensation survey or study, and approval by the board or compensation committee.
Form 990, Part I, Line 4a	Severance payment: The individual listed as Former in Form 990, Part VII, Section A, Line 1a is not receiving a termination payment.
Form 990, Part I, Line 4b	Supplemental nonqualified retirement plan: Essentia Health's nonqualified retirement plan is offered to designated Essentia Health executives. There is a minimum two year vesting date or automatically upon reaching retirement age, death, disability or involuntary termination without cause. Benefits are subject to income taxes upon vesting and payable from Essentia Health's general assets. Reported as Other Reportable Compensation in Schedule J, Part II, Column B (iii), the following individuals listed in Form 990, Part VII, Section A, Line 1a received payment of the vested benefit from the supplemental nonqualified retirement plan during the year: Colleen Meza $48,225 Michael Hedrix $35,375 Reported as Retirement and Other Deferred Compensation in Schedule J, Part II, Column C, Essentia Health made contributions, subject to the vesting terms, during the year into the supplemental nonqualified retirement plan on behalf of the following individual listed in Form 990, Part VII, Section A, Line 1a: Michael Hedrix $7,333

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (13 entries)

IdentifierIdentifier	ExplanationExplanation	Return ReferenceReturnReference
Form 990, Part III, LINE 4	Program service accomplishments: Clearwater Valley Hospital and Clinics, Inc. is created & organized exclusively for charitable, religious, educational & scientific purposes. Clearwater Valley Hospital and Clinics, Inc. is created & organized to own, maintain, operate & conduct, directly or indirectly, & to assist & coordinate activities of facilities for health care, education, care for the aged & social services. In keeping with its mission, Clearwater Valley is committed to serve all members of its communities by providing free care and/or subsidized care, care for the persons covered by governmental programs at below cost, & providing health activities & programs to support the community. During fiscal year 2013, Clearwater Valley had 765 admissions involving 2,841 hospital patient days and 36,321 outpatient visits in the hospital, emergency room, & clinics. Charity care is provided through many reduced price services & free programs offered throughout the year based upon activities & services which Clearwater Valley believes will serve a bona fide need. These include health fairs, immunizations clinics, health education classes, rural education training, & wellness programs. Clearwater Valley provided approximately $199,000 in charity care as well as an additional $413,000 of costs incurred in excess of Medicaid payments received during the fiscal year ended June 30, 2013. Further community benefits provided during the fiscal year include education and workforce development of over $41,000, community services of over $154,000, and cash & in-kind donations of over $12,000.
Form 990, Part VI, Line 2	Family Relationship: Lenne Bonner, current Officer, and Bryan Higgins, Board Director thru 9/12, have a family relationship.
Form 990, Part VI, Line 6	Members of Organization: Critical Access Group is the sole member of Clearwater Valley Hospital and Clinic's Inc. and may elect one or more members of the governing body as described in Schedule O Part VI Line 7a. Member, Essentia Health, has reserved powers with respect to Clearwater Valley Hospital and Clinics, Inc. as described in Schedule O Part VI Line 7b.
Form 990, Part VI, Line 7A	Members with right to elect governing body: Critical Access Group appoints and removes Clearwater Valley Hospital and Clinics, Inc.'s governing body.
Form 990, Part VI, Line 7B	Governance, Management, and Disclosure: Clearwater Valley Hospital and Clinics, Inc. is a subsidiary of Essentia Health, whose Board of Directors has reserved powers with respect to this corporation and its subsidiaries, and all of the other direct and indirect subsidiaries of Essentia Health (collectively, the "System"). Essentia Health's reserved powers are as follows: Strategic and Business Plans. Authority to create, and to approve, the System's strategic and business plans. Mission. Authority to create, and to approve, the mission, purpose and vision statements for all entities in the System by the affirmative vote of at least 67% of the Essentia Health board of directors. Debt. Approval of the incurrence of debt by, and the creation of all mortgages, liens, security interests, or other encumbrances on the assets of, all entities in the System in excess of the single or annual aggregate dollar limits prescribed in writing by the Essentia Health board of directors, and the authority to cause all entities in the System to participate in System borrowing. Governing Instruments. Authority to cause, and to approve, amendments of the articles of incorporation and bylaws of all entities in the System. Mergers and Acquisitions. Authority to cause, and to approve, all mergers, consolidations, and dissolutions of all entities in the System. Affiliations and Joint Ventures. Authority to cause, and to approve, all affiliations, joint ventures and other alliances with third parties of all entities in the System. Transfer of Assets Within the System. Authority to transfer assets, including cash, between and among entities within the System; provided, however, that Essentia Health shall not have authority to require any entity in the System to transfer assets (a) that would cause such entity to be in default of its covenants or obligations under any bond or other financing documents; (b) from the Catholic entities to the secular entities or from the secular entities to the Catholic entities in a manner or to an extent that would cause the Catholic entities to be in violation of the Ethical and Religious Directives for Catholic Health Care Services (ERDs) in the judgment of the local ordinary; or (c) such that money generated by services at secular facilities within the System by procedures that are contrary to the ERDs would be used at the Catholic entities or money generated by Catholic entities would be used in the providing of services contrary to the ERDs at secular facilities within the System. Transfer of Assets Outside the System. Authority to cause, and to approve, the sale, lease or other transfer of assets of all entities in the System to parties outside of the System when the asset's value exceeds the single or annual aggregate dollar limits prescribed in writing by the Essentia Health board of directors. Services. Authority to cause, and to approve, the addition of new services and service locations and the discontinuance of services and service locations within all entities in the System. Budgets. Approval of capital and operating budgets of all entities in the System. Professional Services. Selection of the general legal counsel and external auditors of all entities in the System. Acquisitions. Authority to cause, and to approve, all acquisitions by and formations of entities in the System. Marketing. Authority to implement System-wide marketing and promotional activities. Compliance Plans. Authority to create, and to approve, corporate compliance, safety and risk management plans for entities within the System. Quality Plan. Authority to create, and to approve, the System's quality plan. Non-Budgeted Purchases. Approval of non-budgeted capital purchases and leases in excess of the single or annual aggregate dollar limits prescribed in writing by Essentia Health for entities within the System. Human Resources. Authority to create human resource policies and procedures within the System. Reserved Powers. Authority to create additional Essentia Health reserved powers by the affirmative vote of at least 80% of the Essentia Health board of directors (excluding the Essentia Health CEO); provided, however, that any additional Essentia Health reserved powers shall not contravene or hinder the reserved powers of Benedictine Sisters Benevolent Association.
Form 990, Part VI, Line 11A	Form 990 review process: The 2012 Form 990 including all schedules was reviewed by Clearwater Valley Hospital and Clinics, Inc.'s management and stewardship committee on April 15th, 2014 prior to filing with the Internal Revenue Service. Clearwater Valley Hospital and Clinics, Inc.'s Chief Financial Officer led the review of the form and schedules and any questions were discussed. Each current director of the governing body received a final copy of the 2012 Form 990.
Form 990, Part VI, Line 12C	Monitoring and enforcing Conflict of Interest policy: Essentia Health's comprehensive conflict of interest program prevents, detects and resolves actual conflicts of interests or the actual or potential appearance of such. Fiduciaries, defined as an Essentia Health board member/trustee, officer, board committee member, senior management employee, or any others considered to be in a position of influence, are covered under Essentia's conflict of interest program. Upon initial appointment, each fiduciary must complete an initial conflict of interest statement and disclosure questionnaire. At the conclusion of each fiscal year, each fiduciary must complete an annual conflict of interest statement and disclosure questionnaire. As needed, a fiduciary will update his/her most recently completed questionnaire each time the fiduciary becomes aware of a financial interest, a potential conflict, or change to any information that the fiduciary previously reported. Essentia Health's Chief Compliance Officer will collect the questionnaires and evaluate the disclosures. If a fiduciary has a potential conflict of interest, the Chief Compliance Officer or designee may request additional information from the fiduciary, the management team, and others. During the evaluation process, the Chief Compliance Officer may also consult with Essentia Health's Board and Audit Committee Chairs, senior management, legal department, or appropriate representatives from Essentia Health. The Chief Compliance Officer reports to the Essentia Health Audit Committee and the Essentia Health Board of Directors any actual or potential conflicts of interest disclosed by the fiduciary, along with recommended actions. The Essentia Health Board of Directors (or designee) will then determine whether to approve the situation or to implement special controls to manage the potential conflict of interest. The Chief Compliance Officer will then officially notify the fiduciary in writing of the board's decision. The decision of whether or not the disclosure constitutes a conflict or not will be at the Essentia Health Board of Director's (or designee) sole discretion, and its concern must be the welfare of Essentia Health and its affiliate(s) and the advancement of its purposes. When the Essentia Health Board of Directors (or designee) considers a Fiduciary's disclosure as a Conflict of Interest, special controls will be identified to manage, eliminate or reduce the likelihood and/or appearance of a conflict arising. Controls may include but are not limited to: A. If the conflict involves an on-going matter or relationship, the Fiduciary must not participate in Board, Board committee or management discussions related to the conflict and must recuse themselves and if appropriate, withdraw, from any Board meeting or portion thereof where the matter is being discussed and during the vote on the potential Conflict of Interest. The Fiduciary may answer questions at the Board's or the Board Committee's request. B. If the conflict involves a specific transaction or decision, the Fiduciary will fully disclose their interest and all related material facts. The Board or committee of the Board will determine whether the contemplated transaction may be authorized as just, fair, and reasonable to Essentia Health or its affiliate(s). If the Board determines a conflict does not exist, the Fiduciary may proceed with the transaction; however, he or she will not be eligible to vote on related issues should they arise. If the Board determines a conflict does exist, the Fiduciary will be notified of the decision regarding whether the contemplated transaction will be authorized as just, fair, and reasonable.
Form 990, Part VI, LINE 15A & B	Process for determining compensation: Clearwater Valley Hospital and Clinics, Inc.'s Interim President/Chief Financial Officer's compensation was subsequently reviewed after June 30, 2013. There were no other officers or key employees listed in Part VII, Section A, Line 1A.
Form 990, Part VI, LINE 19	Availability of governing documents, conflict of interest policy, & financial statements to the public: Clearwater Valley Hospital and Clinics, Inc. makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Clearwater Valley Hospital and Clinics, Inc. is part of Essentia Health's consolidated financial statements which are included in Essentia Health's annual report posted on Essentia Health's web site.
FORM 990, PART XII, LINE 3	Consolidated A-133: Clearwater Valley Hospital and Clinics, Inc., as part of Essentia Health's consolidated financial statements, was required and underwent a consolidated audit set forth in the Single Audit Act and OMB Circular A-133. The consolidated audit is reviewed by the Essentia Health Audit Committee.
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	DESCRIPTION:PURCHASED SERVICES TOTAL FEES:2212128	FORM 990 PART IX LINE 11G
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	DESCRIPTION:CONSULTING FEES TOTAL FEES:265214	FORM 990 PART IX LINE 11G
OTHER FEES FOR SERVICES FOR NON-EMPLOYEES	DESCRIPTION:RECRUITMENT FEES TOTAL FEES:91640	FORM 990 PART IX LINE 11G

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (27 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
Brainerd Lakes Integrated Health System
2024 S 6th St	Brainerd	MN	56401	371532145	SUPPORT ORG	MN	501(c)(3)	11 Type II	ESSENTIA	true
Brainerd Medical Center Inc
2024 S 6th St	Brainerd	MN	56401	371532148	Clinic	MN	501(c)(3)	3	BLIHS	true
Bridges Medical Center
201 9th St W	Ada	MN	56510	200479568	Clinic/Hosp	MN	501(c)(3)	3	INNOVIS	true
DL Surgery Center (thru 73112)
1027 Washington Ave	Detroit Lakes	MN	56501	263837203	ASC	MN	501(c)(3)	3	CAG	true
CRITICAL ACCESS GROUP
503 E 3rd ST Ste 400	Duluth	MN	55805	261219624	Support ORG	MN	501(c)(3)	11 Type II	Essentia	true
St Joseph's Medical Center
523 N 3rd St	Brainerd	MN	56401	410695602	CLINIC/HOSP	MN	501(c)(3)	3	BLIHS	true
St Mary's EMS
1027 Washington Ave	Detroit Lakes	MN	56501	411805811	Emerg SrvCS	MN	501(c)(3)	9	SMRHC	true
St Mary's Hospital Inc
PO Box 137	Cottonwood	ID	83522	820226453	Clinic/Hosp	ID	501(c)(3)	3	CAG	true
St Mary's Innovis Health
1027 Washington Ave	Detroit Lakes	MN	56501	262861321	Clinic	MN	501(c)(3)	3	INNOVIS	true
St Mary's Regional Health Center
1027 Washington Ave	Detroit Lakes	MN	56501	411620386	Clinic/Hosp	MN	501(c)(3)	3	INNOVIS	true
Essentia Health
502 E 2nd St	Duluth	MN	55805	200360007	Support ORG	MN	501(c)(3)	11TypeIIIFI	NA	false
Innovis Health LLC
3000 32nd Ave	Fargo	ND	58103	261175213	Clinic/Hosp	DE	501(c)(3)	3	Essentia	true
Midwest Medical Equipment & Supply Inc
4418 Haines Rd	Duluth	MN	55811	411674021	Medical Equip	MN	501(c)(3)	9	SMMC	true
SMDC Medical Center
502 E 2nd St	Duluth	MN	55805	411878730	Clinic/Hosp	MN	501(c)(3)	3	SMDCHS	true
Pine Medical Center
109 Court Ave S	Sandstone	MN	55072	411884597	HOSPITAL/NURS	MN	501(c)(3)	3	SMDCHS	true
Polinsky Medical Rehabilitation Center
530 E 2nd St	Duluth	MN	55805	410691275	Clinic	MN	501(c)(3)	3	SMMC	true
St Mary's Duluth Clinic Health System
407 E 3rd St	Duluth	MN	55805	411836633	SUPPORT ORG	MN	501(c)(3)	11 Type II	Essentia	true
St Mary's HoSpital of Superior
3500 Tower Ave	Superior	WI	54880	411811073	Clinic/Hosp	WI	501(c)(3)	3	SMMC	true
St Mary's Medical Center
407 E 3rd St	Duluth	MN	55805	410695604	HOSPITAL	MN	501(c)(3)	3	SMDCHS	true
The Duluth Clinic Ltd
400 E 3rd St	Duluth	MN	55805	410883623	Clinic	MN	501(c)(3)	3	SMDCHS	true
First Care Medical Services
900 Hilligoss Blvd SE	Fosston	MN	56542	410706143	Clinic/Hosp	MN	501(c)(3)	3	INNOVIS	true
Minnesota Valley Health Center
621 S 4th St	Le Sueur	MN	56058	410837659	Hospital/NURS	MN	501(c)(3)	3	CAG	true
Essentia Institute of Rural Health
502 E 2nd St	Duluth	MN	55805	271291124	Research	MN	501(c)(3)	4	Essentia	true
ESSENTIA Health Foundation
502 E 2nd St	Duluth	MN	55805	271984704	Foundation	MN	501(c)(3)	7	ESSENTIA	true
NORTHERN PINES MEDICAL CENTER
5211 HWY 110	AURORA	MN	55705	410841441	HOSPITAL/NURS	MN	501(c)(3)	3	SMDCHS	true
GRACEVILLE HEALTH CENTER
115 WEST SECOND ST	GRACEVILLE	MN	56240	410726173	CLINIC/HOSP	MN	501(c)(3)	3	INNOVIS	true
DEER RIVER HEALTHCARE CENTER INC
115 10TH AVE NE	DEER RIVER	MN	56636	410844574	HOSPITAL/NURS	MN	501(c)(3)	3	SMDCHS	true

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

Field	Value	IRS element (for citing)
Business Name Line1	PMC-Gateway Imaging LLC	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	109 Court Ave S	AddressLine1
City	Sandstone	City
State	MN	State
ZIP Code	55072	ZIPCode

Field	Value	IRS element (for citing)
EIN	261634764	EIN
Primary Activity	Imaging Servi	PrimaryActivity
Legal Domicile State	MN	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Predominant Income Type	N/A	PredominantIncomeType
Share Of Total Income	0	ShareOfTotalIncome
Share Of EOY Assets	0	ShareOfEOYAssets
Code V	$0	CodeVAmount
Percentage Ownership	0.00000	PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	Province Or StateAddressForeign/ProvinceOrState	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile Foreign CountryLegalDomicileForeignCountry	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Controlled OrgControlledOrg	Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	Legal Domicile StateLegalDomicileState
Essentia Health Insurance Services SPC
94 Solaris Ave PO Box 69	Grand Cayman	Cayman Islands	CJ	KY1-1102	000000000	Insurance	CJ	NA	Foreign Corp	0	0	0.00000	true
East Range Clinics LTD
					410909915	Clinics		NA	C CORP	0	0	0.00000	true	910 6th Ave N	Virginia	MN	55792	MN

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Dividends Related Organization	false	DividendsRelatedOrganization
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	true	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (6 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
St Mary's Hospital Inc
P	862781	ACTUAL COSTS
St Mary's Hospital Inc
Q	934264	ACTUAL COSTS
St Mary's Hospital Inc
O	1655286	ACTUAL COSTS
Critical Access Group
M	403320	ACTUAL COSTS
Critical Access Group
P	662223	ACTUAL COSTS
Essentia Health
P	346217	ACTUAL COSTS

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	Schedule R, Part II, Column (a)	Identifier
Explanation	Name: The following Essentia Health entities have a doing business as name. Legal Name; Doing Business As Name Brainerd Lakes Integrated Health System; Essentia Health Central Brainerd Medical Center, Inc.; Essentia Health Brainerd Specialty Clinic Bridges Medical Center; Essentia Health Ada Deer River Healthcare Center, Inc.; Essentia Health Deer River First Care Medical Services; Essentia Health Fosston Graceville Health Center; Essentia Health Holy Trinity Hospital Innovis Health, LLC; Essentia Health West Midwest Medical Equipment & Supply Inc.; Essentia Health Medical Equipment and Supplies Northern Pines Medical Center; Essentia Health Northern Pines Pine Medical Center; Essentia Health Sandstone Polinsky Medical Rehabilitation Center; Essentia Health Polinsky Medical Rehabilitation Center SMDC Medical Center; Essentia Health Duluth St. Joseph's Medical Center; Essentia Health St. Joseph's Medical Center St. Mary's Duluth Clinic Health System; Essentia Health East St. Mary's Hospital of Superior; Essentia Health St. Mary's Hospital-Superior St. Mary's Medical Center; Essentia Health St. Mary's Medical Center St. Mary's Regional Health Center; Essentia Health St. Mary's-Detroit Lakes	Explanation