2023-11-09T08:05:43-06:00 2022-12-31 450250958 Eide Bailly LLP 1730 Burnt Boat Loop Ste 100 Bismarck ND 585030886 990 2022-01-01 841276376 Valley Citizens Foundation for Health Care Inc VALL 7196574105 310 County Rd 14 Del Norte CO 81132 Tyler Off Chair 7196574105 2023-11-08 1 Tyler Off 999009999 1 Lisa Chaffee CPA P00193453 7012551091 2023-11-08 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Rio Grande Hospital Greg Porter 310 County Rd 14 Del Norte CO 81132 31635902 0 X www.rio-grande-hospital.org X 1994 CO To ensure the health care needs of the Western San Luis Valley community are met. 10 10 239 23 796976 0 6689342 3830150 24658217 27713491 208643 -222417 0 1964 31556202 31323188 0 0 0 0 12590243 13033985 0 0 700 12163218 15340884 24753461 28374869 6802741 2948319 54610809 55053021 24855672 22349565 29755137 32703456 Rio Grande Hospital is part of Valley Citizens Foundation for Health Care, Inc., a community nonprofit organization whose mission is to provide health care to the Western San Luis Valley. 0 0 23816697 26916515 Rio Grande Hospital (RGH) is a licensed 17 bed critical access hospital located in Del Norte, Colorado. Rio Grande Hospital is a Level IV Trauma Center in the State of Colorado. Rio Grande Hospital has been a Level IV Trauma Center since 1999. We are actively involved with the San Luis Valley RETAC. Del Norte is located in the southwestern area of the state 225 miles southwest of Denver and 45 minutes west of Alamosa, Colorado in the San Luis Valley. 23816697 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 26 0 1 239 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Greg Porter 7196572510 0310 County Road 14 Del Norte CO 81132 Clifford Robins MD ER Physician 40.00 X 365402 0 8254 Patrick Thompson ER Physician 40.00 X 338985 0 32401 Daniel MacDougal ER Physician 40.00 X 308315 0 31487 Ely Walker ER Physician 40.00 X 299831 0 31112 Angel Rivera-Castro ER Physician 40.00 X 248046 0 15754 Arlene Harms CEO 40.00 X 176004 0 13608 Greg Porter CFO 40.00 X 121803 0 11959 Joel Condren Chair (Jan-Mar) 0.50 X X 0 0 0 Tyler Off Vice Chair Jan- Mar)/Chair (Apr-Dec) 0.50 X X 0 0 0 Emily Brown Secretary Jan- Mar)/Vice Chair (Apr-Dec) 0.50 X X 0 0 0 Julie Sauvigne Director 0.50 X 0 0 0 Sharon Nash Director 0.50 X 0 0 0 Leah Weyers Director 0.50 X 0 0 0 Kazie Deacon Director 0.50 X 0 0 0 Tom Haefli Director (Sep-Dec) 0.50 X 0 0 0 Gail Mattive Director (Sep-Dec) 0.50 X 0 0 0 Starr Pearson Director (Apr-Dec) 0.50 X 0 0 0 Tyler Hathorn Director 0.50 X 0 0 0 Dr Dale Berkbigler Director (Jan-Sept) 0.50 X 0 0 0 Neil Walters Director (Jan-Mar) 0.50 X 0 0 0 1858386 0 144575 19 0 1 0 Alcon Construction 12233 CR 5 South Alamosa CO 81132 Construction Contractor 1583138 Key & Lauer Architects PC 11681 Voyager Parkway 200 Colorado Springs CO 80921 Architects 197691 Monarch Anesthesia LLC PO Box 1308 Salida CO 81201 Anesthesia 103600 3 91730 12102 2643095 1083223 5600 3830150 Net Patient Service Revenue 622110 25529012 25529012 Pharmacy Revenue 456110 2066208 1269232 796976 Supporting Revenue 900099 118271 118271 27713491 78661 78661 301078 -301078 -301078 -301078 13600 91730 11636 1964 1964 31323188 26916515 796976 -220453 X 323373 323373 10542868 9295079 1247789 157892 143140 14752 1272550 1105217 167333 737302 632150 105152 5840 5840 86168 86168 5292721 4415132 877589 25814 25814 4977693 4270057 707636 301422 301422 387727 387727 34444 34444 102211 102211 657814 657814 1281924 1281924 240495 240495 Medical supplies and eq 1106552 1106552 Provider Fee Tax Expens 781345 781345 58714 58014 700 28374869 23816697 4557472 700 25490234 26117495 3496964 3485429 1114834 1327169 426159 243561 33387011 16441391 15806885 16945620 1872959 2400705 6402774 4170891 0 362151 54610809 55053021 2106746 2508464 1315166 1139171 18933068 18603927 1977100 0 523592 98003 24855672 22349565 X 29355137 32303456 400000 400000 29755137 32703456 54610809 55053021 2948319 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 358226 358226 27496001 12722900 14773101 5163035 3681984 1481051 369749 36507 333242 16945620 Certificate of Deposits 4170891 C 4170891 Lease Liability 98003 98003 X 31322488 -700 -700 31323188 0 31323188 28374169 0 28374169 700 700 28374869 Part X, Line 2: The Hospital believes that they have appropriate support for any tax positions taken affecting their annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Indirect fundraising expenses recorded in expenses on Form 990 -700. Part XII, Line 4b - Other Adjustments: Indirect fundraising expenses recorded in revenue on financial statements 700. Keeping Dream Alive 2022 105330 91730 13600 11636 105330 91730 13600 11636 11636 1964 1 1 X 1 X 1 X 1 1 0 0 304000 304000 0.01070 304000 304000 0.01070 3500 3500 0.00010 19750 19750 0.00070 8910033 4821351 4088682 0.14410 7576 7576 0.00030 8940859 4821351 4119508 0.14520 9244859 4821351 4423508 0.15590 1 250 2559 2559 0.00010 6 7566 7566 0.00030 1 22816 22816 0.00080 2 300 2220 2220 0.00010 10 550 35161 35161 0.00130 0 976394 488197 6096459 6101348 -4889 X 1 1 1 1 Rio Grande Hospital 0310 County Road 14 Del Norte CO 81132 www.rio-grande-hospital.org 251011 X X X X Outpatient services and Clincs Rio Grande Hospital 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X See Part V, Page 7, Line 7d X 1 21 1 https://riograndehospital.org/chna/ 0 1 X 100.000000000000 200.000000000000 X 1 1 X X X X 1 X rio-grande-hospital.org/financial-assistance/ X rio-grande-hospital.org/financial-assistance/ X rio-grande-hospital.org/financial-assistance/ X X X X X X X 1 X 0 X X X X 1 X 0 0 Rio Grande Hospital Part V, Section B, Line 5: Three methods were used to collect primary data: three community meetings, a smaller community focus group meeting, and an online survey between the September 2021 and December 2021. Over 170 community members and agencies were emailed and/or mailed invitations to the community meetings. These individuals were chosen based on their involvement with other hospital work, past participation, or representation of key sectors of RGH's service population. These groups included public health, social services, behavioral health, school districts, long term care facilities, churches, non-profits, workforce centers, banks, ambulance services, fire departments, sheriff's offices, head start, agricultural cooperatives, emergency management, health educators, economic development, outdoor groups, higher education, county commissioners, veterans, and RGH and Clinic staff. Rio Grande Hospital Part V, Section B, Line 7d: https://riograndehospital.org/chna/ Rio Grande Hospital Part V, Section B, Line 11: The Organization completed the most recent CHNA and Implementation Strategy in 2021. RGH identified the following in 20211) Improve referral system for patients needing specialist2) Create a reminder system for preventative and wellness visits3) Provide community education on ALTO (alternatives to opiods)4) Continue to expand Telehealth services5) Explore other potential specialty services6) Expand medical tourismThe hospital during 2022 has focused on addressing the needs raised during the 2021 CHNA. Rio Grande Hospital has multiple committees and staff working on the list of CHNA action items. RGH is looking at additional services to be operated out of the current facilities. These include primary care servcies and specialty services. Examples include: dermatology. This requires working with another hospital to share a dermatologist. The clinics have projects for family notification for immunizations, well child visits, annual visits, and preventative visits for adults. The hospital has ALTO (Alternatives to Opioids) and MAT (medication assisted treatment) education and a team review of medical services provided. Our recovery clinic continues to be funded via a state grant and is expected to remain operational into the future. RGH has adopted electronic equipment to allow interpretation services at the hospital, ER and clinics. Billing continues to review and implement revised patient billing practices. RGH clinics continue to monitor patient communication of provider and nurse follow-up. RGH is examining services provided for treatment of children. Chat-bot has been added to the website to provide more information of COVID and vaccines. Telehealth services continue to evolve. RGH continues to examine expansion of services. RGH is aware of the Medical Tourism impact on the community as an estimated 30,000 visitors come through our service area annually. RGH is fully involved in Wellness and has planned an $8,000,000 expansion of a wellness center, housing and greenhouse. Heath fairs are being redesigned and projected to be reimplemented in 2023. Community partnerships continue to develop with a key push to expand the health wellness board scope and community involvement. The hospital is involved in Spanish outreach to the farm workers that make the family farms of the valley thrive. Rio Grande Hospital Part V, Section B, Line 13b: The Rio Grande Hospital has two specific policies that affect patients who qualify for charity care. The first policy is the State's Colorado Indigent Care Program (CICP) which has specific rules the State requires for participation. The second is a policy which offers discounts for patients who do not qualify for the State's CICP program listed above.The Colorado Indigent Care Program offers a sliding fee scale to residents of the State of Colorado based upon 250% of the federal poverty guidelines. The program requirements can be seen at any admission desk of the Rio Grande Hospital and on the website for Colorado Indigent Care Program. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital offers an additional charity care program for those not qualifying for the State's program based upon 200% of the federal poverty guidelines with a sliding scale which offers up to 100% discount on services provided. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital's complete charity care policy is posted at all locations within the Hospital that provide services. Rio Grande Hospital Part V, Section B, Line 16j: Information is available on the website in both English and Spanish. Paper copies are available at all hospital and clinic admission offices. 4 1 - Rio Grande Hospital Clinic Del Norte 310 County Road 14 Del Norte CO 81132 Medical Clinic 2 - Rio Grande Hospital Clinic Creede 802 Rio Grande Avenue Creede CO 81130 Medical Clinic 3 - Rio Grande Hospital Clinic South Fork 62 Park Drive South Fork CO 81154 Medical Clinic 4 - Rio Grande Hospital Clinic Monte Vista 1033 2nd Avenue Monte Vista CO 81124 Medical Clinic Part I, Line 3c: The Rio Grande Hospital has two specific policies that affect patients who qualify for charity care. The first policy is the State's Colorado Indigent Care Program (CICP) that has specific rules the State requires for participation. The second is a policy that offers discounts for patients who do not qualify for the State's CICP program listed above.The Colorado Indigent Care Program offers a sliding fee scale to residents of the State of Colorado based upon 250% of the federal poverty guidelines. The program requirements can be seen at any admission desk of the Rio Grande Hospital and on the website for Colorado Indigent Care Program. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital offers an additional charity care program for those not qualifying for the State's program based upon 200% of the federal poverty guidelines with a sliding scale that offers up to 100% discount on services provided. The Admission Clerks and Financial Counselor of the Hospital can provide more information to anyone interested.The Hospital's complete charity care policy is posted at all locations within the Hospital that provide services. Part I, Line 7: Line 7a Financial Assistance was converted to cost based on an average ratio of costs to gross charges.Line 7g Subsidized Health Services was determined using the Medicare Cost Report.Lines 7e, 7f and 7i are based on actual expenses. Part I, Line 7g: Subsidized health services includes costs of $3,379,061 from rural health clinics. Part II, Community Building Activities: The data in Community Building represents the following community benefits: Sport Physicals to 300 kids; South Fork Logger days wellness Booth; Health and Wellness Board Community; and community Trunk or Treat. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients. Part III, Line 3: The estimated amount of the organization's implicit price concessions attributable to patients that would be eligible under the organization's charity care policy was calculated as a percentage of the accounts sent to collections that were identified as being eligible for charity care if the patient would have applied for assistence. In 2022, after review of the accounts recommended for collections, 50.0% of the accounts were marked charity care assistance regardless of patients applying for assistance. The accounts included many patients who lapse their Medicaid or financial assistance programs. Part III, Line 4: The footnote to the Organization's financial statements that describes implicit price concessions can be found on page 13 and 14 of the attached audited financial statements. Part III, Line 8: Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, if there is a Medicare shortfall the entire Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by CMS. Part III, Line 9b: The Organization requires payment in full upon receipt of the bill. If payment in full is not plausible the patient must establish a payment plan within 120 days from the date of the invoice for the services provided or it will be released to a collection agency to recover these payments. The Hospital does not charge interest on the accounts with payment plans that extend beyond 12 months. For patients that are known to qualify for charity care or financial assistance the State of Colorado requires them to complete a form to apply under one of the two policies offered: Colorado's Indigient Care (CICP) program for state residents or the alternative policy for patients that do not qualify under the CICP program. Patients have 90 days upon the day of service to complete the application. If the remaining patient balance on accounts that qualify under these charity care policies is greater than $25 it will fall under the hospital collection policy guidelines. Balances under $25 can be written off as an administrative adjustment. The Hospital staff discusses these options with these patients, as well as the Business Office that handles the collection of payments. These policies are also posted throughout the Hospital. The Hospital has the administrative authority to write off any amounts they deem will be charity care, such as those that are medically indigent and those amounts under the $25 threshold. The policy states accounts eligible for financial assistance are to be addressed within 240 days of the first bill. Part VI, Line 2: Rio Grande Hospital uses the executive team to review progress on the CHNA implementation strategy. In addition, the hospital sponsors the Health and Wellness Board which meets monthly at the hospital or on-line via zoom. This is a collaboration of agencies, organizations and individuals serving our community. It includes Rio Grande County (RGC) Public Health, RGC Social Services for Rio Grande an Mineral Counties, RGC Jail Nurse, Colorado Employment Division, School Nurses, School Principals, Behavior Health, San Luis Valley Transportation. The Health and Wellness Board covers a multitude of community services which include physical health, mental health, housing, jobs, schools, youth, seniors, jails, vulnerable populations, chronic diseases, and community threats such as Covid and Opioid addiction.Rio Grande Hospital continues to use the Hospital's Patient Family Advisory Committee (PFAC) on a quarterly basis. It had 3 meetings in 2021 due to Covid-19 Part VI, Line 3: Rio Grande Hospital posts signs at admissions and at all intake sites informing the patients of programs available for financial assistance. The Hospital has a Financial Counselor available during business hours Monday thru Friday to assist and educate patients in providing information and filing forms for financial assistance. The Hospital reviews patient status and contacts patients it believes are eligible for financial assistance. The Hospital offers copies of their assistance programs upon request. The Hospital offers payment programs based upon patients providing essential personal financial data. Part VI, Line 4: Rio Grande Hospital (RGH) is a licensed 17 bed critical access hospital located in Del Norte, Colorado. Rio Grande Hospital is a Level IV Trauma Center in the State of Colorado. Rio Grande Hospital has been a Level IV Trauma Center since 1999. We are actively involved with the San Luis Valley RETAC.Del Norte is located in the southwestern area of the state 225 miles southwest of Denver and 45 minutes west of Alamosa, Colorado in the San Luis Valley. Rio Grande Hospital serves a catchment area of approximately 100 miles with elevations ranging from 7,814 feet in Del Norte to 11,800 feet at the Summitville Mines to 9,800 feet at Brown Lakes above Creede, Colorado. Our economy thrives from agriculture and tourism. The San Luis Valley is known for farming of potatoes, wheat, barley and canola which increases the risk of job related trauma. The nearest Level IV Trauma Center is Pagosa Springs Medical Center 1.25 hours west of Del Norte. The closest Level II Trauma Center is located in Pueblo. The closest Level III Trauma Center is located in San Luis Valley Regional Medical Center in Alamosa, which is approximately 45 minutes east of Del Norte. The population base for Rio Grande County is 11,736. Creede has a population of 698 residents. During the months of June, July, and August the population of this area increases by three times. Rio Grande County has 64% of residents living below 250% of the federal poverty level.Rio Grande Hospital sees tourists who have been hunting, skiing, hiking, fishing, camping, and riding ATVs in the mountains. They also treat tourists who visit the San Luis Valley for the warm summer temperatures. With the San Juan Mountains of the Continental Divide bordering the San Luis Valley on the west side, tourism is an all year round industry. RGH has a five bed Emergency Department. Medical emergencies consist of chest pain, acute myocardial infractions, shortness of breath, nausea, vomiting, dehydration, and altitude illnesses.Rio Grande Hospital has four satellite clinics located in Monte Vista, Del Norte, South Fork and Creede. Part VI, Line 5: The Organization's governing body is comprised of persons who reside in the Organization's primary service area who are neither employees nor contractors of the Organization, nor family members thereof. We note one exception, a physician serving on the board. The Organization also extends medical staff privileges to other qualified physicians in the community. Due to the nature of the long term debt agreements being federally insured by the USDA, the Organization is required to apply any surplus funds into a reserve account. Surplus funds used to improve the facilities and equipment to improve patient care are subject to approval from USDA. Rio Grande Hospital is involved in a number of community health activities. The Hospital is a major provider in the annual health fair offering multiple health tests at discounts to the general public. It annually provides flu shots to the general public for a discounted price. The Hospital provides a women's workshop on reducing risk factors for heart disease and breast cancer at South Fork. The RGH is instrumental in providing health fair services in Del Norte, South Fork and assisting in Center, Creede and the Rural Electric Cooperative. The Hospital offers school physicals free or at a reduced cost to all the kids at schools in the Hospital service area. The discount is dependent upon school programs. It serves Del Norte, Monte Vista, and Creede High Schools and Grade Schools.The Rio Grande Hospital would not exist or be able to operate without the assistance of grants and donations. The Hospital, through volunteer hours of the Board and employees, annually puts on a dinner and fund raising night. In addition we receive support from the South Fork Ladies Golf Association, the South Fork Kiwanis Club, and multiple smaller organizations and church groups. The Hospital provides four clinics in four communities. These clinics are unable to operate without the support subsidies provided by the Hospital. The Hospital utilizes the key staff from the Hospital to support each clinic. The key supporting staff include technical staff from nursing, radiology and laboratory in addition to the administrative support staff of billing and accounting. The clinics are up to 45 miles in distance from the main campus. Our primary clinic is located on our main campus. The clinics offer open house days annually to allow the community to meet the staff and examine the facilities.The Hospital and its staff are involved in many community events including the Monte Vista Stampede Parade, the Del Norte Covered Wagon Parade and Parade of Lights.The Hospital is in its fifth year of the Wound Care services which include the hyperbaric chamber for advance wound care. The Hospital is in its forth year for Cardiac Rehab. Rio Grande Hospital has been a community partner in testing and providing vaccine to the communities it serves. The Hospital has been offering wound care services, cardiac rehab services, and is advancing towards community dermatology services and pain management services. We additionally offer Physical Therapy staff to schools for their sport programs. X X X 0 0 0 0 0 0 0 0 0 Clifford Robins MD ER Physician 365402 0 0 0 0 0 0 0 9118 0 374520 0 0 0 Patrick Thompson ER Physician 338985 0 0 0 0 0 10452 0 22813 0 372250 0 0 0 Daniel MacDougal ER Physician 308315 0 0 0 0 0 9538 0 22813 0 340666 0 0 0 Ely Walker ER Physician 299831 0 0 0 0 0 9163 0 22813 0 331807 0 0 0 Angel Rivera-Castro ER Physician 248046 0 0 0 0 0 7500 0 9118 0 264664 0 0 0 Arlene Harms CEO 176004 0 0 0 0 0 5354 0 8254 0 189612 0 0 0 Form 990, Part VI, Section A, line 8b There are no committees with authority to act on behalf of the Board. Form 990, Part VI, Section B, line 11b The CFO reviewed the Form 990. Upon his review, a copy of the Form 990 was provided to the Board electronically before it was filed with the IRS. Form 990, Part VI, Section B, line 12c Each Board Member fills out an affidavit annually. The CEO and Chair of the Board review the affidavits. The Compliance Officer of the Hospital also separately reviews the affidavits from the CEO and Chair of the Board. Board Members that have a conflict abstain from voting on the issue. Form 990, Part VI, Section B, line 15a A committee is formed to review the compensation of the CEO. During the review process comparison data from other hospitals is used. The committee makes a recommendation to the Board of Directors. The Board of Directors then approves the compensation according to the policy and substantiates the deliberation and decision in the Board minutes. This process is reviewed annually in December. CFO compensation is reviewed by the CEO. The CEO uses the Colorado Hospital Association Wage and Salary report to determine the CFO compensation. A formal evaluation is completed at that time. This process is reviewed annually in April. There are no other officers or key employees. Form 990, Part VI, Section C, line 19 The Organization's governing documents, conflict of interest policy, and financial statements are available to the public upon request. Form 990, Part IX, line 11g Purchased Services: Program service expenses 3,791,634. Management and general expenses 866,766. Fundraising expenses 0. Total expenses 4,658,400. Professional Fees: Program service expenses 623,498. Management and general expenses 0. Fundraising expenses 0. Total expenses 623,498. Acct Collection Agency Fees: Program service expenses 0. Management and general expenses 10,473. Fundraising expenses 0. Total expenses 10,473. Admin Professional Fee: Program service expenses 0. Management and general expenses 350. Fundraising expenses 0. Total expenses 350. Rio Grande Hospital Foundation Inc 0310 County Road 14 Del Norte CO 81132 272624064 Fundraising for Hospital CO 501(c)(3) Line 12b, II Valley Citizens Foundation for Health Care Inc 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0