2025-03-06T17:05:26-06:00 2024-06-30 410746749 CLIFTONLARSONALLEN LLP 10700 NORTHUP WAY SUITE 200 BELLEVUE WA 98004 990 2023-07-01 300975387 IVINSON MEMORIAL HOSPITAL IVIN 3077422141 255 NORTH 30TH STREET LARAMIE WY 82072 DOUG FAUS PRESIDENT & CEO 3077422141 2025-03-04 1 1 KURT BENNION CPA P01469618 4252506100 2025-03-04 2023 2025-03-06 01:10:19Z DOUG FAUS 255 NORTH 30TH STREET LARAMIE WY 82072 217506196 0 X WWW.IVINSONHOSPITAL.ORG X 2017 WY TRUSTED PARTNERS IN WORLD-CLASS HEALTHCARE. 10 9 789 52 0 0 668080 5110136 139581066 146585633 5798217 8623229 1137674 1289370 147185037 161608368 3750863 1642924 0 0 55094899 59738731 0 0 613368 67862383 71283276 126708145 132664931 20476892 28943437 365736374 417938891 22758603 24818893 342977771 393119998 X TRUSTED PARTNERS IN WORLD-CLASS HEALTHCARE. BUILDING TRUST WITH OUR PATIENTS AND WITH EACH OTHER. 0 0 109759613 1642924 147215839 IVINSON MEMORIAL HOSPITAL SERVES THE RESIDENTS OF ALBANY COUNTY, WYOMING AND THE SURROUNDING AREA. LARAMIE IS THE LARGEST CITY IN THE SERVICE AREA WITH A POPULATION OF APPROXIMATELY 32,000. THE SERVICES PROVIDED TO THE COMMUNITY ARE BEHAVIORAL HEALTH (INPATIENT), CARDIAC REHAB, CARDIOPULMONARY, CHAPLAIN, DIALYSIS, DISCHARGE PLANNING / SOCIAL SERVICES, EMERGENCY SERVICES, INFECTION CONTROL, INPATIENT ACUTE CARE, INTENSIVE CARE UNIT, IVINSON MEDICAL GROUP, LAB (ANATOMIC / CLINICAL), NUTRITIONAL COUNSELING, OB/GYN, ONCOLOGY, PEDIATRICS, PHARMACY, RADIATION THERAPY, RADIOLOGY / DIAGNOSTIC IMAGING, RADIOLOGY - MRI, RADIOLOGY - CT, RADIOLOGY - NUCLEAR MEDICINE, RADIOLOGY - MAMMOGRAPHY, REHAB - PHYSICAL / OCCUPATIONAL THERAPY, SLEEP LAB, SPEECH PATHOLOGY - INPATIENT (INCLUDING SWING BEDS)/ OUTPATIENT, SURGERY SERVICES, AND ULTRASOUND.FOR THE YEAR ENDED JUNE 30, 2024, IMH HAD THE FOLLOWING STATISTICS:ADMISSIONS - 1,866EMERGENCY VISITS - 12,356URGENT CARE - 7,675OUTPATIENT VISITS - 91,096CLINIC VISITS - 52,219IMH ALSO PROVIDED $1,642,924 IN CHARITY CARE FOR THE YEAR ENDED JUNE 30, 2024.IN 2023, IVINSON WAS AWARDED AN E-QUAL HONOR ROLL AWARD FOR STROKE CARE BY THE AMERICAN COLLEGE OF EMERGENCY PHYSICIANS. RECIPIENTS FOR STROKE CARE ARE RECOGNIZED FOR ARRIVAL TO COMPUTED TOMOGRAPHY (CT) SCAN TIME FOR HEMORRHAGIC OR ISCHEMIC STROKE PATIENTS, AND DOOR-TO-NEEDLE TIME FOR ISCHEMIC STROKE PATIENTS. IN THE SPRING OF 2023, IVINSON RECEIVED AN A GRADE FROM THE LEAPFROG GROUP. THIS NATIONAL DISTINCTION IS AWARDED TO IVINSON BY THE LEAPFROG GROUP FOR RECEIVING TOP MARKS IN HOSPITAL SAFETY AND PROTECTING PATIENTS FROM PREVENTABLE HARM AND ERRORS. IVINSON IS AMONG 3,000 GENERAL HOSPITALS GRADED BY THE LEAPFROG GROUP, INCLUDING 9 WYOMING HOSPITALS. IN ADDITION, IVINSON RECEIVED 2023 LARAMIE'S BEST OF THE BEST AWARDS IN THE FOLLOWING CATEGORIES: BEST AUDIOLOGY/HEARING CLINIC, BEST FAMILY PRACTICE, BEST WOMEN'S HEALTH SERVICES AND BEST PLACE TO WORK. IVINSON HAS BEEN RECOGNIZED BY THE CHARTIS RURAL HOSPITAL PERFORMANCE INDEX AS A TOP 100 RURAL AND COMMUNITY HOSPITAL. 109759613 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 1 0 0 1 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 103 0 1 789 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JAMES BANDS 3077554603 255 NORTH 30TH STREET LARAMIE WY 82072 BURK YOUNG MD PHYSICIAN 40.00 0.00 X 967472 0 33652 JOHN KENNEDY MD PHYSICIAN 40.00 0.00 X 608169 0 56827 JOHN ULLRICH MD PHYSICIAN 40.00 0.00 X 471363 0 60096 GARY GRAHAM MD PHYSICIAN 40.00 0.00 X 475886 0 53026 ERIC UHLMAN MD PHYSICIAN 40.00 0.00 X 498629 0 28933 JAMES BANDS CFO 38.00 2.00 X 427839 0 46248 NICOLE ROONEY CNO 40.00 0.00 X 358089 0 55837 TERRY MOSS COO 40.00 0.00 X 370888 0 39452 SAGAN WHEELER CHRO 40.00 0.00 X 232512 0 40259 DOUG FAUS CEO 40.00 0.00 X X 0 0 0 JOSEPH STEINER CHAIR THEN PAST CHAIR 3.00 0.00 X X 0 0 0 GARY CRUM TREASURER THEN CHAIR 3.00 0.00 X X 0 0 0 CATIE BALLARD PAST CHAIR THEN MEMBER 3.00 0.00 X 0 0 0 BRAD JACKSON VICE CHAIR 3.00 0.00 X X 0 0 0 PAM DUNNUCK MEMBER THEN TREASURER 2.00 0.00 X X 0 0 0 DENNIS COOK SECRETARY (THROUGH OCT. 2023) 3.00 0.00 X X 0 0 0 JACKIE GONZALES MEMBER THEN SECRETARY 2.00 0.00 X X 0 0 0 PETER GOSAR MEMBER (THROUGH OCT. 2023) 2.00 0.00 X 0 0 0 STAN GUNSTREAM MD MEMBER 2.00 0.00 X 0 0 0 ROLAND MALDONADO MEMBER (THROUGH OCT. 2023) 2.00 0.00 X 0 0 0 RICK MELONE MEMBER 2.00 0.00 X 0 0 0 SHARON WEBER MEMBER 2.00 0.00 X 0 0 0 4410847 0 414330 96 0 1 0 NCAP IMH LLC 3702 AUTOMATION WAY STE 3 FORT COLLINS CO 80525 ANESTHESIA PROVIDERS 3678466 GH PHIPPS WYOMING LLC 1482 COMMERCE DR UNIT Y LARAMIE WY 82070 CONSTRUCTION 2234110 SUMMIT MEDICAL GROUP LLC 700 CENTRAL EXPRESSWAY S STE 400 ALLEN TX 75035 ED PHYSICIANS 1002319 ATLAS MEDSTAFF 11159 MILL VALLEY RD OMAHA NE 68154 TEMPORARY STAFFING 752822 REVENUE ENTERPRISES LLC 3131 S VAUGHN WAY SUITE 500 AURORA CO 80014 ACCOUNTS RECEIVABLE 643462 17 3093487 2016649 5110136 PATIENT SERVICE REVENUES 621110 146585633 146585633 146585633 7892077 7892077 599488 0 599488 599488 599488 56588953 55857801 731152 731152 731152 70745 40027 30718 30718 CAFETERIA 722310 568390 568390 MISCELLANEOUS INCOME 900099 90774 90774 659164 161608368 147215839 0 9282393 X 1642924 1642924 2377824 82785 2295039 45201164 40925746 4036244 239174 1550718 1301750 248968 7453109 6048961 1379349 24799 3155916 2486892 631183 37841 76361 76361 99566 99566 777688 777688 17454636 16528648 925988 556537 15278 229705 311554 1939035 779177 1159858 2687159 1455095 1232064 1963876 110270 1853606 176352 107886 68466 6132727 3313280 2819447 1107095 1107095 MEDICAL SUPPLIES 28050342 25695275 2355067 BAD DEBT EXPENSE 8818967 8818967 FOOD 648135 256171 391964 REPAIRS & MAINTENANCE 439085 110053 329032 355715 80455 275260 132664931 109759613 22291950 613368 7863859 5686356 18798487 7007663 9483950 12467593 1585412 1661143 1446382 1452738 118917102 38444773 73686336 80472329 178961483 227287470 39504836 40386371 -1005 0 34406634 41517228 365736374 417938891 9487496 12130473 12898091 12282875 373016 405545 22758603 24818893 X 281268899 325440100 61708872 67679898 342977771 393119998 365736374 417938891 X 28943437 14120725 7078065 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 0 0 0 0 1 20702 20702 0 PART II-B, LINE 1: IVINSON MEMORIAL HOSPITAL PAYS MEMBERSHIP DUES TO THE WYOMING HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THOSE DUES ARE USED BY THE ASSOCIATIONS TO LOBBY ON BEHALF OF THEIR MEMBERS FOR HEALTH-RELATED ISSUES, INCLUDING IVINSON MEMORIAL HOSPITAL. 45159000 7338337 37820663 29263521 6189083 23074438 35259253 24917353 10341900 9235328 9235328 80472329 REAL ESTATE AND HEDGE FUNDS 40386371 C 40386371 DUE FROM RELATED ORGANIZATION 12053000 BENEFICIAL INTEREST IN FOUNDATION 29058683 RIGHT-OF-USE ASSETS, NET 405545 41517228 RIGHT-OF-USE LEASE LIABILITIES 405545 405545 X 171785806 14120725 1128974 7353450 22603149 149182657 12425711 12425711 161608368 122361139 1128974 992945 2121919 120239220 12425711 12425711 132664931 PART X, LINE 2: THE HOSPITAL IS ORGANIZED AS WYOMING NONPROFIT CORPORATIONS AND HAVE BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE (IRC) SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO THEIR EXEMPT PURPOSE. THE HOSPITAL BELIEVES THAT THEY HAVE APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING THEIR ANNUAL FILING REQUIREMENTS, AND AS SUCH, DO 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: CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 7,078,065. RELATED ORGANIZATION REVENUE 235,358. GIFT SHOP COST OF GOODS SOLD 40,027. PART XI, LINE 4B - OTHER ADJUSTMENTS: ELIMINATING ENTRIES 834,845. PROVISION FOR BAD DEBTS 8,818,967. CHARITY CARE REPORTED AS GRANTS 1,642,924. AMORTIZATION ON DONATED USE OF BUILDING 1,128,975. PART XII, LINE 2D - OTHER ADJUSTMENTS: GIFT SHOP COST OF GOODS SOLD 40,027. RELATED ORGANIZATION EXPENSES 952,918. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS 8,818,967. CHARITY CARE REPORTED AS GRANTS 1,642,924. ELIMNATING ENTRIES 834,845. AMORTIZATION ON DONATED USE OF BUILDING 1,128,975. CENTRAL AMERICA AND THE CARIBBEAN - ANTIGUA & BARBUDA, ARUBA, BAHAMAS, 0 0 INVESTMENTS 9422393 0 0 0 0 0 0 9422393 0 9422393 0 0 0 0 0 0 1 1 X 1 X 1 X 1 1 1 0 0 773002 773002 0.00770 7645447 3086103 4559344 0.04550 8418449 3086103 5332346 0.05320 615036 615036 0.00610 615036 615036 0.00610 9033485 3086103 5947382 0.05930 1 8818967 1472767 31443461 103659652 -72216191 X 1 1 1 1 IVINSON MEMORIAL HOSPITAL 255 NORTH 30TH STREET LARAMIE WY 82072 WWW.IVINSONHOSPITAL.ORG 15271 X X X IVINSON MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X HTTPS://WWW.IVINSONHOSPITAL.ORG/CHNA X X 1 22 1 HTTPS://WWW.IVINSONHOSPITAL.ORG/CHNA 0 1 X 150.000000000000 300.000000000000 X X 1 1 X X X X 1 X WWW.IVINSONHOSPITAL.ORG/FINANCIAL-ASSISTANCE X WWW.IVINSONHOSPITAL.ORG/FINANCIAL-ASSISTANCE X WWW.IVINSONHOSPITAL.ORG/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 IVINSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IVINSON MEMORIAL HOSPITAL ENGAGED SUPPORT FROM UCHEALTH COMMUNITY HEALTH IMPROVEMENT TO ASSIST WITH THE DEVELOPMENT OF THE CHNA. A MULTI-PHASED APPROACH WAS USED TO IDENTIFY THE TOP HEALTH PRIORITIES FOR FUTURE IMPACT. BETWEEN NOVEMBER 2022 AND APRIL 2023, IVINSON CONDUCTED THE CHNA WHICH PROVIDED AN OPPORTUNITY FOR THE HOSPITAL TO ENGAGE PUBLIC HEALTH EXPERTS, MEDICAL PROVIDERS AND COMMUNITY STAKEHOLDERS IN A FORMAL PROCESS TO ENSURE THAT COMMUNITY BENEFIT PROGRAMS AND RESOURCES ARE FOCUSED ON SIGNIFICANT HEALTH NEEDS IDENTIFIED WITHIN THE COMMUNITY. THE PROCESS INCLUDED:1. A COMPREHENSIVE ANALYSIS OF LOCAL, STATE AND, WHERE AVAILABLE, NATIONAL POPULATION HEALTH INDICATORS.2. REQUISITION OF COMMUNITY INPUT ON LOCAL HEALTH ISSUES THROUGH A PUBLIC MEETING AND A WEB-BASED SURVEY.3. A WEB-BASED SURVEY DISTRIBUTED TO HEALTHCARE PROVIDERS AT IVINSON TO GATHER INPUT ON COMMUNITY HEALTH NEEDS. IVINSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 7D: IVINSON OFFICIALS HAVE GONE TO MULTIPLE COMMUNITY MEETINGS, MEETING WITH LAW ENFORCEMENT, NONPROFITS AND OTHER LOCAL ORGANIZATIONS TO TALK ABOUT AND DISTRIBUTE IVINSON'S CHNA AND IMPLEMENTATION PLAN. IVINSON'S CHNA HAS ALSO BEEN PUBLICLY DISCUSSED IN LOCAL MEDIA WHEN TALKING ABOUT MENTAL HEALTH. IVINSON MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: TO GATHER INPUT ON THE MOST SIGNIFICANT HEALTH ISSUES, IVINSON PROVIDED A WEB-BASED SURVEY TO HEALTHCARE PROVIDERS IN ALBANY COUNTY. IVINSON ALSO HOSTED A PUBLIC MEETING WITH MULTI-SECTOR REPRESENTATION WHERE PARTICIPANTS HAD THE OPPORTUNITY TO RESPOND TO THE SURVEY AND PROVIDE VERBAL FEEDBACK. RESPONDENTS WERE ASKED TO RANK EACH OF THE SIGNIFICANT ISSUES IDENTIFIED ABOVE AND DESCRIBE OTHER HEALTH ISSUES FOR CONSIDERATION. FROM THIS REVIEW, THE MOST SIGNIFICANT ISSUES IDENTIFIED WERE:1. ACCESS TO CARE2. BEHAVIORAL HEALTH (INCLUDING SUBSTANCE USE DISORDERS AND SUICIDE)3. CHRONIC CONDITIONS4. MATERNAL HEALTH5. SOCIAL AND ECONOMIC FACTORSIVINSON'S SENIOR LEADERSHIP TEAM (SLT) REVIEWED ALL FINDINGS OBTAINED FROM THE ACTIVITIES DESCRIBED PREVIOUSLY TO IDENTIFY HEALTH NEEDS PRIORITIES FOR THE CHNA AND CONSIDERED THE FOLLOWING CRITERIA DURING THE DECISION-MAKING PROCESS:1. SCOPE AND SEVERITY OF THE HEALTH NEED2. POTENTIAL FOR IVINSON TO IMPACT THE HEALTH NEED3. ALIGNMENT WITH IVINSON STRATEGIES, AS WELL AS LOCAL, STATE AND NATIONAL OBJECTIVES4. ECONOMIC FEASIBILITY TO ADDRESS THE HEALTH NEEDIVINSON'S SLT IDENTIFIED THE FOLLOWING HEALTH NEEDS AS PRIORITIES FOR THE 2023-2025 CHNA: SOCIAL AND ECONOMIC FACTORS AND BEHAVIORAL HEALTH SERVICES.IN RESPONSE TO THE COMMUNITY NEEDS, IVINSON ENACTED THE FOLLOWING:WE HAVE BEEN WORKING ON THE BEHAVIORAL HEALTH NEEDS AND SOCIAL AND ECONOMIC FACTORS THAT IMPACT BEHAVIORAL HEALTH OF THE COMMUNITY AS NOTED BELOW:1. 4-H IVINSON PURCHASED OF TWO COWS AND ONE PIG AT A COST OF $19,250.00 FOR FOOD DISTRIBUTION IN ALBANY COUNTY. PAID FOR MEAT PROCESSING ON $2,465.00 AND DONATED THE PROCESSED MEAT TO THE LARAMIE SOUP KITCHEN AND LARAMIE INTERFAITH. 2. WORK WITH MEALS OF HOPE FOR A MEAL PACKING EVENT, UTILIZING VOLUNTEERED TIME FROM HOSPITAL LEADERSHIP TO PACK 10,000 OF SHELF STABLE MEALS, TOTALING $3,400. 3. DONATION OF 20 TURKEYS AND ADDITIONAL FOOD FOR HOLIDAY BASKETS THAT WERE DONATED TO THE SOUP KITCHEN, TOTALLING $1,188. 4. PARTNER WITH THE ALBANY COUNTY SCHOOL DISTRICT TO PROVIDE WATER BOTTLES TO 500 MIDDLE SCHOOL STUDENTS AND OTHER STUDENTS ACROSS THE DISTRICT TO INCREASE AWARENESS OF HOW HYDRATION IMPACTS, HEALTH, LEARNING AND PERFORMANCE. 5. SUPPORTING UNITED WAY OF ALBANY COUNTY AND 16 NONPROFIT ORGANIZATIONS WITH $10,000 FROM IVINSON THAT GOES TO ORGANIZATIONS THAT ARE WORKING TO IMPROVE HOUSING, FOOD SECURITY, ACCESS TO HEALTHY FOODS, ACCESS TO HEALTHCARE SERVICES, TRANSPORTATION, MENTAL HEALTH SERVICES, CHILDCARE, EDUCATION AND OTHER COMMUNITY RESOURCES. 6. WORKING WITH ALBANY CARE TEAM, MADE UP OF ALBANY COUNTY SHERRIFF'S OFFICE, UNIVERSITY OF WYOMING POLICE DEPARTMENT, LARAMIE POLICE DEPARTMENT AND VOLUNTEERS OF AMERICA (VOA). DONATION OF $2,287 TO PURCHASE TABLETS TO BE USED BY LAW ENFORCEMENT IN THE FILED TO SUPPORT MENTAL HEALTH IN THE FIELD AND DECREASE TRANSFERS TO IVINSON MEMORIAL HOSPITAL'S BEHAVIORAL HEALTH UNIT.7. DIRECT $2,000 DONATION TO SOUP KITCHEN FOR FOOD SECURITY, GIVEN AT FUNDRAISING EVENT.8. WORKING WITH LARAMIE CONNECTIONS SUPPORTING TRANSPORTATION OPERATIONS WITH $10,000 FROM IVINSON TO CONTINUE PROVIDING FREE TRANSPORTATION FOR MEDICAL, GROCERY, SHOPPING AND OTHER NEEDS. 9. WORKING WITH THE CATHEDRAL HOME, GIVING $10,000 TO SUPPORT THEIR RESOURCE CENTER, PROVIDING LOW COST COUNSELING SERVICES AND OTHER MENTAL HEALTH RESOURCES TO INDIVIDUALS AND FAMILIES IN ALBANY COUNTY. 10. PROVIDE FINANCIAL SUPPORT TO THE EPPSON CENTER'S SENIOR ASSISTED TRANSPORTATION SERVICES (SATS) FOR TRANSPORTATION BARRIERS FOR 2,471 RIDES IN ALBANY COUNTY, WYOMING. THIS IS A DONATION FROM IVINSON OF $14,826.00 FOR THE YEAR. 11. HOSTING CRISIS INTERVENTION TRAININGS AT IVINSON.12. TEACHING FREE SUCIDE PREVENTION TRAINING, QUESTION, PURSUADE, REFER AT IVINSON, A COURSE SIMILAR TO CPR COURSES THAT ARE AVAILABLE TO ANYONE.13. PARTICIPATE IN LOCAL SERVICE CLUBS AND PROFESSIONAL ORGANIZATIONS THAT FOCUS ON COMMUNITY DEVELOPMENT AND WELLBEING, INCLUDING LARAMIE CHAMBER BUSINESS ALLIANCE, LARAMIE ROTARY, ALBANY COUNTY EARLY CHILDHOOD DEVELOPMENT COALITION, COALITION TO PREVENT SUICIDE AND SUBSTANCE ABUSE AND KIWANAS CLUB AS AN IVINSON REPRESENTATIVE IN THESE SERVICE PROGRAMS. 14. WORKING WITH THE DOWNTOWN CLINIC AND IVINSON PROVIDERS TO PROVIDE $475,655.00 OF CARE DONATED TO DOWNTOWN CLINIC UNINSURED AND UNDERINSURED PATIENTS. 15. PSA DAY, WHICH IS A FREE EVENT FOR ALL MALES IN ALBANY, COUNTY WYOMING WHERE PATIENTS GET THEIR BLOOD DRAWN AND THEIR PROSTATE SPECIFIC ANTIGEN CHECKED. THIS IS A PARTNERSHIP WITH WWAMI (UNIVERSITY OF WYOMING MEDICAL SCHOOL STUDENTS) AND IMH CANCER CENTER STAFF. WWAMI PROVIDED 20 STUDENTS AND IMH CANCER CENTER PROVIDED 4 STAFF. 33 MEN PARTICIPATED IN TESTING AND 3 ABNORMAL RESULTS WERE FOUND.16. WORKING WITH UCH TO USE TELEHEALTH WITH MENTAL HEALTH EXAMINERS AND IMH ER, 91 PATIENTS WERE SEEN FOR EVALUATIONS. 17. WORKING WITH ALBANY COUNTY ATTORNEY'S ON EMERGENCY DETENTIONS, ALBANY COUNTY MENTAL HEALTH BOARD, ALBANY COUNTY SHERIFF, LARAMIE POLICE DEPARTMENT, UW POLICE, VOA, UW PSYCHOLOGY DEPARTMENT GATEKEEPING PROGRAM FOR MENTAL HEALTH. 18. PROVIDE 520 POUNDS OF FOOD FROM THE IVINSON KITCHEN TO THE LOCAL FOOD BANKS TO INCREASE ACCESS TO FOOD. PART I, LINE 3C: TO QUALIFY FOR ASSISTANCE UNDER IVINSON MEMORIAL HOSPITAL'S FINANCIAL ASSISTANCE POLICY, AN INDIVIDUAL MUST BE UNINSURED, UNDERINSURED, INELIGIBLE FOR ANY GOVERNMENT HEALTH CARE BENEFIT PROGRAM, AND UNABLE TO PAY FOR EMERGENCY TREATMENT OR MEDICALLY NECESSARY CARE. THE FOLLOWING FACTORS ARE CONSIDERED IN DETERMINING THE AMOUNT OF FINANCIAL ASSISTANCE GRANTED:1. INDIVIDUAL OR FAMILY INCOME AND NET WORTH;2. EMPLOYMENT STATUS AND EARNING CAPACITY;3. FAMILY SIZE;4. OTHER FINANCIAL OBLIGATIONS; AND5. OTHER SOURCES OF PAYMENT FOR THE SERVICES RENDERED. PART I, LINE 7: THE COMMUNITY BENEFIT EXPENSES WERE CALCULATED USING THE SCHEDULE H INSTRUCTIONS' WORKSHEETS TO CALCULATE A COST-TO-CHARGE RATIO, WHICH WAS THEN APPLIED TO TOTAL EXPENSES. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 8,818,967. PART III, LINE 2: IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. PART III, LINE 3: THE PORTION OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE WAS ESTIMATED USING THE PERCENTAGE OF THE SERVICE AREA IDENTIFIED AS LIVING BELOW THE FEDERAL POVERTY LEVEL BASED ON THE MOST RECENT U.S. CENSUS DATA. ACCORDING TO THE U.S. CENSUS BUREAU, 16.7% OF ALBANY COUNTY RESIDENTS LIVED BELOW THE FEDERAL POVERTY LEVEL AS OF JULY 1, 2024. PART III, LINE 4: SEE THE "PATIENT ACCOUNTS RECEIVABLES" PARAGRAPH ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR AN EXPLANATION OF IVINSON MEMORIAL HOSPITAL'S BAD DEBT EXPENSE. PART III, LINE 8: THE MEDICARE REVENUES AND ALLOWABLE COSTS OF CARE WERE CALCULATED USING THE JUNE 30, 2024 MEDICARE COST REPORT. THE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT SINCE IVINSON MEMORIAL HOSPITAL PROVIDES THESE SERVICES TO THE ELDERLY INDIVIDUALS IN OUR COMMUNITY WHO WOULD LIKELY HAVE DIFFICULTY OBTAINING SUFFICIENT MEDICAL CARE WITHOUT THE MEDICARE PROGRAM. PART III, LINE 9B: IVINSON MEMORIAL HOSPITAL BILLS OUT ANY INSURANCE PRIOR TO BILLING THE PATIENT. THESE BILLS NORMALLY GO OUT WITHIN 7 DAYS OF THE SERVICE DATE. AFTER THE INSURANCE COMPANY HAS PAID ITS SHARE OF THE MEDICAL BILL, THE ACCOUNT IS POSTED FOR PAYMENTS AND ADJUSTMENTS AND THEN THE FIRST BILL IS SUBMITTED TO THE PATIENT. THREE STATEMENT CYCLES (MONTHLY) ARE SENT TO THE GUARANTOR FOR UNPAID ACCOUNTS BEFORE ANY REFERRAL TO AN OUTSIDE COLLECTION AGENCY IS MADE. EACH ACCOUNT IS INDIVIDUALLY REVIEWED PRIOR TO BEING SENT TO COLLECTION. IF THE PATIENT REQUESTS FINANCIAL ASSISTANCE, ALL BILLING/COLLECTION ACTIVITY IS SUSPENDED UNTIL A DETERMINATION IS MADE REGARDING THE PATIENT'S REQUEST FOR ASSISTANCE. EACH REQUEST IS REVIEWED BY THE BUSINESS OFFICE STAFF FOR COMPLETENESS AND QUALIFICATION AND THEN FURTHER REVIEWED BY THE PATIENT FINANCIAL SERVICES DIRECTOR AND CFO. THE PATIENT THEN RECEIVES A CALL AND A LETTER EXPLAINING THE DETERMINATION. PART VI, LINE 2: BETWEEN NOVEMBER 2022 AND APRIL 2023, IVINSON CONDUCTED OUR COMMUNITY HEALTH NEEDS ASSESSMENT, WITH FEEDBACK FROM PUBLIC HEALTH EXPERTS, MEDICAL PROVIDERS AND COMMUNITY STAKEHOLDERS IN A FORMAL PROCESS TO IDENTIFY SIGNIFICANT HEALTH NEEDS. IVINSON ENGAGED SUPPORT FROM UCHEALTH TO ASSIST IN THE RESEARCH AND DEVELOPMENT OF THE CHNA WHICH INCLUDED DATA ANALYSIS ON THE LOCAL, STATE AND NATIONAL LEVELS REGARDING HEALTH INDICATORS, A PUBLIC MEETING TO REQUEST FEEDBACK AND A WEB BASED SURVEY TO GATHER INPUT ON COMMUNITUY HEALTH NEEDS. THIS CULMINATION OF THIS DATA IS REVIEWED BY IVINSON LEADERSHIP TO IDENTIFY RECCOMENDED HEALTH NEEDS AREA OF FOCUS. THEIR REPORT IS PRESENTED TO THE IVINSON BOARD OF DIRECTORS FOR REVIEW AND APPROVAL. OUR 2023-2025 CHNA WAS APPROVED IN APRIL OF 2023. PART VI, LINE 3: IVINSON MEMORIAL HOSPITAL EDUCATES THE PUBLIC ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE THROUGH THE FOLLOWING PROCESSES:1. INFORMATION ON BILLING STATEMENTS AND PATIENT CONSENT FORMS;2. INFORMATION POSTED IN EMERGENCY ROOMS, ADMITTING LOCATIONS, WAITING ROOMS, THE BUSINESS OFFICE, AND OTHER PUBLIC PLACES;3. PUBLICATION ON THE HOSPITAL'S WEBSITE;4. PUBLICATION ON BROCHURES AVAILABLE IN PATIENT ACCESS SITES AND OTHER LOCATIONS IN THE COMMUNITY; AND5. REFERRALS GIVEN TO SPECIFIC PATIENTS BY HOSPITAL STAFF. PART VI, LINE 4: THE HOSPITAL'S PRIMARY SERVICE AREA IS ALBANY COUNTY, WYOMING. THE LARGEST CITY IN THE COUNTY IS LARAMIE. THE SECONDARY SERVICE AREA INCLUDES SEVERAL ADDITIONAL COUNTIES IN WYOMING AND PARTS OF NORTHERN COLORADO. PART VI, LINE 6: IVINSON MEMORIAL HOSPITAL AFFILIATED WITH UCH AS THEY PROVIDE IVINSON MEMORIAL HOSPITAL A CEO BUT IVINSON MEMORIAL HOSPITAL IS INDEPENDENT AND IS OPERATED BY A FULLY INDEPENDENT BOARD OF DIRECTORS. 1 CHARITY CARE 473 1642924 0 N/A N/A PART I, LINE 2: CHARITY CARE IS AWARDED BASED ON FINANCIAL NEED AND A SLIDING FEE SCALE. X X X X 0 0 0 0 0 0 0 0 0 BURK YOUNG MD PHYSICIAN 964635 0 0 0 2837 0 3556 0 30096 0 1001124 0 0 0 JOHN KENNEDY MD PHYSICIAN 606821 0 0 0 1348 0 23490 0 33337 0 664996 0 0 0 JOHN ULLRICH MD PHYSICIAN 469845 0 0 0 1518 0 30000 0 30096 0 531459 0 0 0 GARY GRAHAM MD PHYSICIAN 474896 0 0 0 990 0 19689 0 33337 0 528912 0 0 0 ERIC UHLMAN MD PHYSICIAN 494331 0 0 0 4298 0 13583 0 15350 0 527562 0 0 0 JAMES BANDS CFO 262379 0 155821 0 9639 0 12911 0 33337 0 474087 0 0 0 NICOLE ROONEY CNO 212650 0 144507 0 932 0 22500 0 33337 0 413926 0 0 0 TERRY MOSS COO 244643 0 123623 0 2622 0 8933 0 30519 0 410340 0 0 0 SAGAN WHEELER CHRO 147590 0 84264 0 658 0 6928 0 33331 0 272771 0 0 0 FORM 990, PART VI, SECTION A, LINE 1A THE COMMITTEES OF THE BOARD SHALL HAVE AND EXERCISE AUTHORITY OF THE BOARD OF DIRECTORS IN THE MANAGEMENT OF THE CORPORATION. HOWEVER, NO SUCH COMMITTEE SHALL HAVE THE AUTHORITY OF THE BOARD OF DIRECTORS IN REFERENCE TO AUTHORIZING DISTRIBUTIONS, ELECTING, APPOINTING OR REMOVING ANY DIRECTOR, AMENDING THE ARTICLES OF INCORPORATION, AMENDING, ALTERING OR REPEALING THE BYLAWS; APPROVING A PLAN OF MERGER, OR APPROVING A SALE, LEASE, EXCHANGE OR OTHER DISPOSITION OF ALL, OR SUBSTANTIALLY ALL OF THE CORPORATION'S PROPERTY, WITH OR WITHOUT GOODWILL, OTHERWISE THAN IN THE USUAL AND REGULAR COURSE OF BUSINESS, OR VOLUNTARILY DISSOLVING OR REVOKING A VOLUNTARY DISSOLUTION OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 3 THE CEO IS PROVIDED THROUGH AN AFFILIATION AGREEMENT WITH UCHEALTH. THE CEO'S COMPENSATION IS REVIEWED AND DETERMINED BY IVINSON MEMORIAL HOSPITAL'S BOARD OF DIRECTORS. THE CEO'S EMPLOYMENT WITH UCHEALTH IS CONTINGENT UPON HIM SERVING AS THE CEO OF IVINSON MEMORIAL HOSPITAL AND THEIR CONTINUED ENGAGEMENT WITH IVINSON MEMORIAL HOSPITAL. DOUG FAUS RECEIVED THE FOLLOWING COMPENSATION IN CALENDAR YEAR 2023 FOR HIS SERVICES AS PRESIDENT & CEO: TAXABLE COMPENSATION: BASE: $433,241 TAXABLE BONUS COMPENSATION: $314,259 OTHER TAXABLE COMPENSATION: $2,352 NONTAXABLE DEFERRED COMPENSATION: $30,822 OTHER NONTAXABLE BENEFITS: $26,026 FORM 990, PART VI, SECTION A, LINE 7B SUBJECT TO ANY CONSENTS OF THE DISTRICT AS REQUIRED UNDER THE LEASE AND IMH'S BYLAWS, THE BOARD OF DIRECTORS SHALL HAVE THE POWER TO ALTER, AMEND, OR REPEAL THE BYLAWS OR ADOPT NEW BYLAWS. HOWEVER, THE BOARD OF DIRECTORS MAY NOT AMEND THE BYLAWS, WITHOUT THE DISTRICT'S PREVIOUS APPROVAL, TO (A) APPOINT THE INITIAL ELECTED DIRECTORS PROVIDED IN SECTION 4.4 OR (B) REMOVE OR MODIFY SECTION 14.7 REGARDING CONFLICTS BETWEEN THE LEASE AND THE BYLAWS. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 WAS PREPARED BY AN INDEPENDENT CPA FIRM WITH INFORMATION PROVIDED BY MANAGEMENT. THE 990 WAS REVIEWED IN ITS ENTIRETY BY THE FINANCE COMMITTEE OF THE BOARD PRIOR TO FILING. IN ADDITION, THE ENTIRE BOARD WAS GIVEN THE OPPORTUNITY TO REVIEW PRIOR TO ITS FILING. FORM 990, PART VI, SECTION B, LINE 12C IVINSON MEMORIAL HOSPITAL HAS A CONFLICT OF INTEREST POLICY THAT COVERS ALL BOARD MEMBERS, OFFICERS, DIRECTORS, MANAGERS, SUPERVISORS AND HIGHLY COMPENSATED EMPLOYEES. ALL COVERED INDIVIDUALS COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT UPON JOINING IVINSON MEMORIAL HOSPITAL AND ANNUALLY THEREAFTER. ALL COVERED INDIVIDUALS HAVE AN OBLIGATION TO DISCLOSE ALL INTERESTS, ACTIONS OR RELATIONSHIPS THAT CREATE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST OR THAT COULD CREATE SUCH. AFTER SUCH DISCLOSURE, THE INDIVIDUAL LEAVES THE MEETING WHILE THE BOARD, COMMITTEE OR SUPERVISOR DETERMINES WHETHER A CONFLICT EXISTS. IF A CONFLICT IS DEEMED TO EXIST, THE RELEVANT BODY EVALUATES WHETHER A MORE BENEFICIAL TRANSACTION IS AVAILABLE TO IVINSON MEMORIAL HOSPITAL. IF A MORE BENEFICIAL TRANSACTION IS NOT IDENTIFIED, THE RELEVANT BODY VOTES WHETHER TO ENTER THE TRANSACTION THAT INVOLVES THE CONFLICT OF INTEREST. THE INDIVIDUAL WITH THE CONFLICT DOES NOT PARTICIPATE IN THE VOTE. RECORDS ARE KEPT OF ALL SITUATIONS THAT INVOLVE AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST. IF AN INDIVIDUAL FAILS TO DISCLOSE A CONFLICT OF INTEREST, THE INDIVIDUAL IS GIVEN THE OPPORTUNITY TO EXPLAIN, AFTER WHICH THE RELEVANT BODY DETERMINES APPROPRIATE DISCIPLINARY ACTION, IF ANY. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD'S COMPENSATION COMMITTEE REVIEWS THE CEO'S COMPENSATION ANNUALLY. THIS COMMITTEE UTILIZES DATA FROM AN INDEPENDENT COMPENSATION CONSULTANT. THE DATA IS CREATED BASED ON COMPARABLE FACILITIES IN THE GEOGRAPHIC REGION. THE COMMITTEES DECISION IS DOCUMENTED IN THE BOARD MINUTES. THE CEO REVIEWS THE COMPENSATION OF OTHER KEY EMPLOYEES. THE CEO UTILIZES DATA FROM AN INDEPENDENT COMPENSATION CONSULTANT WHO PREPARE THE DATA FROM LIKE-SIZED HOSPITALS WITHIN THE GEOGRAPHIC REGION. THIS INFORMATION IS REVIEWED AND APPROVED BY THE BOARD'S COMPENSATION COMMITTEE ANNUALLY AS WELL. COMPENSATION REVIEWS WERE LAST CONDUCTED IN 2024. FORM 990, PART VI, SECTION C, LINE 19 IVINSON MEMORIAL HOSPITAL'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FINANCIAL AND OPERATIONAL DATA IS ALSO PROVIDED SEMI-ANNUALLY TO THE ALBANY COUNTY HOSPITAL DISTRICT AND THE ALBANY COUNTY BOARD OF COMMISSIONERS, WHICH PRESENTATION IS OPEN TO THE PUBLIC. FORM 990, PART IX, LINE 11G PURCHASE SERVICES: PROGRAM SERVICE EXPENSES 16,528,648. MANAGEMENT AND GENERAL EXPENSES 925,988. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,454,636. FORM 990, PART XI, LINE 9: CHANGE IN BENEFICIAL INTEREST IN FOUNDATION 7,078,065. FORM 990, PART XII, LINE 2C: THE PROCESS FOR OVERSIGHT AND SELECTION OF AN INDEPENDENT ACCOUNTANT HAS NOT CHANGED FROM THE PRIOR YEAR. IMH QALICB 255 NORTH 30TH STREET LARAMIE WY 82072 843157045 SUPPORT IVINSON MEMORIAL HOSPITAL WY 501(C)(3) LINE 12B, II IMH 1 MEDICINE BOW TECHNOLOGIES INC 3821 BEECH STREET LARAMIE WY 82072 721620736 INFORMATION SERVICES WY IVINSON MEMORIAL HOSPITAL C 1.00000 0 1 0 0 1 1 0 0 0 0 0 1 1 0 1 1 0 0 0 0 IMH QALICB A 599488 FAIR MARKET VALUE IMH QALICB L 235357 COST