2025-10-24T10:28:53-05:00 2024-12-31 390758449 WIPFLI LLP 105 E PINE ST UPPER FLOOR MISSOULA MT 59802 990 2024-01-01 820497771 CLEARWATER VALLEY HOSPITAL AND CLINICS INC CLEA 2084764555 301 CEDAR OROFINO ID 83544 JYL RULAND CFO 2084764555 2025-08-25 1 1 SAM BRUNSON CPA P01696998 4067281800 2025-08-25 2024 2025-03-06 01:10:19Z CLEARWATER VALLEY HEALTH LENNE BONNER 301 CEDAR OROFINO ID 83544 30792634 0 X WWW.SMH-CVH.ORG X 1997 ID WE IMPROVE HEALTHCARE ONE PATIENT AT A TIME IN A FRIENDLY AND PROFESSIONAL CULTURE COMMITTED TO SUPERIOR QUALITY AND SAFETY. 12 11 248 10 0 0 360473 487230 25379510 29823908 119470 180676 125340 283578 25984793 30775392 27861 12636 0 0 15919086 18709501 0 0 0 7828164 9249496 23775111 27971633 2209682 2803759 18948139 22336967 3461874 4057341 15486265 18279626 X WE IMPROVE HEALTHCARE ONE PATIENT AT A TIME IN A FRIENDLY AND PROFESSIONAL CULTURE COMMITTED TO SUPERIOR QUALITY AND SAFETY. 0 0 19847571 12636 29823908 CLEARWATER VALLEY HOSPITAL AND CLINICS (CVHC) IS CREATED AND ORGANIZED TO OWN, MAINTAIN, OPERATE AND CONDUCT, DIRECTLY OR INDIRECTLY, AND TO ASSIST AND COORDINATE ACTIVITIES OF FACILITIES FOR HEALTH CARE, EDUCATION, CARE FOR THE AGED AND SOCIAL SERVICES, INCLUDING CHARITABLE CARE TO PERSONS UNABLE TO PAY. CVHC OPERATES A 23-BED CRITICAL ACCESS HOSPITAL THAT PROVIDES GENERAL MEDICAL AND SURGICAL CARE FOR INPATIENT, OUTPATIENT, AND EMERGENCY ROOM PATIENTS IN CLEARWATER COUNTY AND THE SURROUNDING AREAS AND PRIMARY CARE CLINICS IN OROFINO AND PIERCE. CVHC PROVIDED 1,853 HOSPITAL PATIENT DAYS, 14,205 OUTPATIENT VISITS, 4,106 ER VISITS, AND 19,770 CLINIC ENCOUNTERS DURING THE YEAR. CONTINUED ON SCHEDULE O...CVHC PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS $260,976 FOR CHARITY CARE, $8,378,515 FOR MEDICARE, $3,804,410 FOR MEDICAID, AND $4,175,851 FOR OTHER THIRD-PARTY PAYORS FOR THE YEAR. 19847571 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 102 0 1 248 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JYL RULAND 2084764555 301 CEDAR OROFINO ID 83544 KELLY MCGRATH DIRECTOR/CMO 20.00 20.00 X 333122 0 42388 CINDY O'BRIEN CHAIR 1.00 1.00 X X 0 0 0 KIM INGRAM VICE CHAIR 1.00 1.00 X X 0 0 0 CHRISTINA ULMER SECRETARY 1.00 1.00 X X 0 0 0 MATT SARTINI DIRECTOR 1.00 1.00 X 0 0 0 PAUL NUSSER DIRECTOR 1.00 1.00 X 0 0 0 SISTER LISA MAURER DIRECTOR 1.00 1.00 X 0 0 0 RENE FORSMAN DIRECTOR 1.00 1.00 X 0 0 0 JEREMY EVANS DIRECTOR 1.00 1.00 X 0 0 0 SISTER BARBARA JEAN GLODOWSKI DIRECTOR 1.00 1.00 X 0 0 0 MARK IMUS DIRECTOR 1.00 1.00 X 0 0 0 CHRISTOPHER RIGGERS DIRECTOR 1.00 1.00 X 0 0 0 MICHELE BOUIT DIRECTOR/KH CFO 1.00 40.00 X 0 692999 36330 JYL RULAND CFO 30.00 30.00 X 166696 0 32962 LENNE BONNER PRESIDENT/CEO 30.00 30.00 X 0 343307 33015 KARIN SCHMIDOVA PHYSICIAN 40.00 0.00 X 383074 0 38485 SHELLY FRAYSER PHYSICIAN 40.00 0.00 X 365081 0 35112 ALLY LOVELAND PHYSICIAN 40.00 0.00 X 312637 0 13695 REBECCA KATZMAN PHYSICIAN 40.00 0.00 X 380475 0 27513 COLLEEN SHOLAR PHYSICIAN 40.00 0.00 X 367825 0 39601 2308910 1036306 299101 46 0 1 0 PALOUSE IMAGING CONSULTANTS PLLC PO BOX 9583 MOSCOW ID 83843 RADIOLOGY READS 433176 DMS IMAGING PO BOX 670747 DALLAS TX 752670747 MRI RADIOLOGY READS 321975 RICHARDSON ENTERPRISES INC PO BOX 1916 OROFINO ID 83544 ANESTHESIA COVERAGE 294861 NEWPORT HEALTH SERVICES LLC 4 CORPORATE PLAZA SUITE 150 NEWPORT BEACH CA 92660 SLEEP LAB MANAGEMENT 188075 DR PETER NELSON NORTH 17919 PALMINO ROAD COLBERT WA 99005 ER MD COVERAGE 152155 5 67752 419478 3000 487230 PATIENT SERVICE REVENUE 621110 29471296 29471296 PHARMACY 340B REVENUE 456110 352612 352612 29823908 167918 167918 6000 0 6000 6000 6000 30000 17242 12758 12758 12758 MEDICARE SHARED SAVINGS 900099 215343 215343 MISCELLANEOUS REVENUE 900099 62235 62235 277578 30775392 29823908 0 464254 12636 12636 951488 676422 275066 14721903 11347141 3374762 479213 369361 109852 1432416 12758 1419658 1124481 866712 257769 13229 13229 1058 1058 222 222 2703351 2167266 536085 52422 66 52356 231889 96772 135117 152944 22198 130746 237887 226168 11719 111913 77503 34410 28352 28352 849387 849387 94922 3473 91449 PHARMACEUTICALS 1451620 1451620 MEDICAL SUPPLIES 975295 975295 BAD DEBT EXPENSE 882099 882099 DUES & SUBSCRIPTIONS 816735 44045 772690 646171 616036 30135 27971633 19847571 8124062 0 1009528 1169337 3638573 3910348 77442 104241 3392076 5110791 350879 542582 236247 312145 21652360 12226393 8878250 9425967 1088770 1148942 276374 612614 18948139 22336967 1718244 2191712 677 844873 353209 898080 1512420 3461874 4057341 X 15486265 18279626 15486265 18279626 18948139 22336967 2803759 1644 -12042 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1058 1058 0 PART II-B, LINE 1: THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO NATIONAL AND STATE HOSPITAL ASSOCIATION. THE ASSOCIATIONS USE A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. 116169 116169 11409152 4575285 6833867 6211 6211 0 8448846 6951411 1497435 1671982 693486 978496 9425967 POOLED INVESTMENT FUND 1148942 F 1148942 DUE TO RELATED ORGANIZATION 877971 CAPITAL LEASE OBLIGATION 157935 DEFERRED COMPENSATION 395179 OPERATING LEASE OBLIGATION 81335 1512420 1 1 X 1 X 175.000000000000 1 X 1 1 0 1 1 139764 139764 0.00520 3036673 1865849 1170824 0.04320 3176437 1865849 1310588 0.04840 2 86 1124 1124 0.00000 1 1 16500 16500 0.00060 3958627 2209243 1749384 0.06460 3 87 3976251 2209243 1767008 0.06520 3 87 7152688 4075092 3077596 0.11360 1 865944 0 13555744 13640497 -84753 X 1 1 1 1 CLEARWATER VALLEY HOSPITAL & CLINIC 301 CEDAR OROFINO ID 83544 WWW.SMH-CVH.ORG X X X X X CLEARWATER VALLEY HEALTH 1 0 0 1 X X X X X X X X X 23 1 1 1 1 X WWW.SMH-CVH.ORG X 1 23 1 WWW.SMH-CVH.ORG 0 1 X 175.000000000000 250.000000000000 X X X X X 1 1 X X X X 1 X WWW.SMH-CVH.ORG X WWW.SMH-CVH.ORG X WWW.SMH-CVH.ORG X X X X X 1 X 0 X X X X 1 X 0 0 CLEARWATER VALLEY HEALTH PART V, SECTION B, LINE 5: DURING 2022 AND EARLY 2023, CLEARWATER VALLEY HEALTH ANALYZED DATA, CONVENED PUBLIC MEETINGS WITH COMMUNITY PARTNERS, SOUGHT INPUT ON HEALTH PRIORITIES FROM COMMUNITY MEMBERS, AND LED A PROCESS TO IDENTIFY THE PRIORITY AREAS FOR THE 2023 - 2025 COMMUNITY HEALTH NEEDS ASSESSMENT. THE PARTNERS REPRESENTED THE PUBLIC HEALTH PERSPECTIVE AND THE INTERESTS OF MEMBERS OF MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS, OR INDIVIDUALS. OTHER ORGANIZATIONS REPRESENTED ON THE STEERING COMMITTEE INCLUDED: BOARD OF EDUCATION MEMBERS, CLEARWATER ECONOMIC DEVELOPMENT COUNCIL, OROFINO AMBULANCE, LOCAL BUSINESS LEADERS, OROFINO CHAMBER OF COMMERCE, OROFINO POLICE DEPARTMENT, CITY OF OROFINO, AND FAITH-BASED ORGANIZATIONS. CLEARWATER VALLEY HEALTH PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED IN COLLABORATION WITH ST. MARY'S HEALTH, A RELATED ORGANIZATION, IN ORDER TO ALIGN RESOURCES AND STRENGTHS TO BETTER SERVE OUR COMMUNITIES. CLEARWATER VALLEY HEALTH PART V, SECTION B, LINE 6B: CLEARWATER VALLEY HEALTH WORKED IN CONJUNCTION WITH THE UNIVERSITY OF WASHINGTON - "RURAL HEALTH LAB", AND THE INSTITUTE OF TRANSLATIONAL HEALTH SCIENCES TO CONDUCT OUR COMMUNITY HEALTH NEEDS ASSESSMENT AND IDAHO PUBLIC HEALTH, NORTH CENTRAL REGION, TO CONDUCT OUR NEEDS ASSESSMENT. CLEARWATER VALLEY HEALTH PART V, SECTION B, LINE 11: THE SIGNIFICANT NEEDS IDENTIFIED IN THE MOST RECENT ASSESSMENT ARE DEATHS OF DESPAIR (SUICIDE), OBESITY/HEALTHY LIFESTYLE, HEALTHCARE ACCESS, AND CANCER SCREENINGS. WITH FEW EXCEPTIONS, CLEARWATER VALLEY HEALTH PLAYS A PRIMARY ROLE IN ESTABLISHING THE FRAMEWORK FOR PROGRESS IN EACH OF THESE AREAS. PRIORITY AREA #1: DEATHS OF DESPAIRCLEARWATER VALLEY HEALTH WILL CONTINUE TO OFFER SUICIDE PREVENTION TRAINING FOR THE COMMUNITY, DISTRIBUTE GUNLOCKS FOR THOSE THAT WANT THEM, INCREASE STAFF & COMMUNITY TRAINING AROUND SUICIDE PREVENTION, AWARENESS, AND DE-ESCALATION, AND EXPAND BEHAVIORAL HEALTH AND COUNSELING SERVICES.PRIORITY AREA #2: OBESITY/HEALTHY LIFESTYLEOROFINO OFFERS A ROBUST OUTDOOR LIFESTYLE FOR ITS CITIZENS AND GUESTS. FISHING, HUNTING, SWIMMING, AND HIKING ARE ALL AVAILABLE RIGHT OUTSIDE YOUR DOOR. STRONG YOUTH PROGRAMS SUCH AS BASEBALL AND SOCCER ARE ALSO AVAILABLE TO THE AREA'S CHILDREN, AND A SKATE PARK AND A PUBLIC SWIMMING POOL ARE IN THE PROCESS OF BEING BUILT TO ADD TO THE COMMUNITIES' ALREADY RICH RESOURCES. CLEARWATER VALLEY HEALTH WILL CONTINUE TO BUILD UPON THESE AVAILABLE RESOURCES TO OFFER COMMUNITY WALKS, VIRTUAL HEALTH CHALLENGES, EXPAND NUTRITIONAL COUNSELING AND DIABETES EDUCATION, AND SUPPORT THE COMMUNITY PARK EXPANSION AND OTHER RELATED HEALTHY LIFESTYLE INITIATIVES.PRIORITY AREA #3: HEALTHCARE ACCESS40.3% OF POPULATION IN CLEARWATER, IDAHO, AND LEWIS COUNTIES LIVE IN AN AREA AFFECTED BY HEALTH PROFESSIONAL SHORTAGES AS COMPARED TO 23% OF U.S. RESIDENTS. THE ISSUE INCREASED DURING THE COVID-19 PANDEMIC, WITH PEOPLE MOVING INTO OUR RURAL COMMUNITIES.AREAS OF SPECIFIC FOCUS INCLUDE:1. GROW ALREADY SUCCESSFUL PARTNERSHIPS WITH LOCAL AND REGIONAL TRAINING PROGRAMS (AREA HIGH SCHOOLS, HOSA PROGRAMS, WWAMI, ETC.) TO DEVELOP A LOCAL HEALTHCARE WORKFORCE FOR NOW AND IN THE FUTURE.2. EXPAND TELEHEALTH (VIRTUAL CARE) TO INCLUDE PRIMARY CARE, SPECIALTY CARE, AND BEHAVIORAL HEALTH.3. ADD NEW SERVICE LINES LOCALLY, INCLUDING SLEEP LAB, ORTHOPEDIC SERVICES, AND CHEMOTHERAPY INFUSIONS.PRIORITY AREA #4: CANCER SCREENINGSIDAHO PUBLIC HEALTH DISTRICT 2 HAS A BREAST CANCER INCIDENCE RATE HIGHER THAN OTHER IDAHO HEALTH DISTRICTS, AND SIGNIFICANTLY HIGHER THAN THE U.S. "AVERAGE". ADDITIONALLY, BREAST CANCER IS MORE LIKELY TO BE DIAGNOSED AT A LATE STAGE, COMPARED TO OTHER AREAS OF THE U.S. IDAHO RANKS 49TH OUT OF 53 U.S. STATES, TERRITORIES, AND THE DISTRICT OF COLUMBIA FOR BREAST CANCER SCREENINGS. COLORECTAL CANCER AND LUNG CANCER ALSO HAVE POOR SCREENING RATES.1. CLEARWATER VALLEY HEALTH & ST. MARY'S HEALTH HAVE PURCHASED A NEW MAMMOGRAPHY TRUCK THAT WILL SIGNIFICANTLY INCREASE OUR ABILITY TO OFFER ACCESS TO SCREENINGS FOR OUR PATIENTS AND COMMUNITIES. 2. ADDING NEW SERVICE LINES TO INCLUDE LOW DOSE CT SCANS FOR LUNG CANCER SCREENING AND INCREASE CANCER SCREENING BY UTILIZING OUR QUALITY METRICS AND COMMUNITY EDUCATION. 2 1 - CLEARWATER VALLEY OROFINO HEALTH CENTER 1055 RIVERSIDE AVE OROFINO ID 83544 OUTPATIENT CLINIC 2 - CLEARWATER VALLEY PIONEER MEDICAL CLINIC 105 W CARLE STREET PIERCE ID 83546 OUTPATIENT CLINIC PART I, LINE 3C: ASSETS WILL BE CONSIDERED ALONG WITH THE PATIENT'S INCOME TO DETERMINE ELIGIBILITY FOR THE FINANCIAL ASSISTANCE PROGRAM. ASSETS MAY INCLUDE, BUT ARE NOT LIMITED TO, SUCH ITEMS AS CHECKING AND SAVINGS ACCOUNTS, IRAS, 401(K)S, 403(B)S, PENSIONS, HEALTH SAVINGS ACCOUNTS, ADDITIONAL PROPERTY, AND ANY OTHER RETIREMENT FUNDING. PART I, LINE 7: THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES (WORKSHEET 2) FOR FIGURES REPORTED IN THE TABLE RELATED TO CHARITY CARE AND UNREIMBURSED MEDICAID (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, TOTAL COMMUNITY BENEFIT, AND TOTAL COMMUNITY BUILDING EXPENSES). ACTUAL COSTS WERE USED FOR THE REMAINDER OF THE COMMUNITY BENEFITS REPORTED. PART I, LINE 7G: THE HOSPITAL HAS INCLUDED COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G IN THE AMOUNT OF $3,958,627 IN COLUMN C AND $2,209,243 IN COLUMN D. 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 $ 882,009. PART III, LINE 2: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. 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: IF, DURING THE COLLECTION PROCESS, IT BECOMES KNOWN THAT A PATIENT QUALIFIES FOR CHARITY CARE, THE AMOUNTS INCLUDED WITHIN BAD DEBT EXPENSE WOULD BE RECLASSIFIED TO CHARITY CARE. THEREFORE, NO AMOUNTS RECORDED AS BAD DEBT EXPENSE ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. THE HOSPITAL INCORPORATES 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, WE MAKE QUALITY PATIENT CARE AVAILABLE TO ALL IN OUR COMMUNITY, REGARDLESS OF THEIR ECONOMIC MEANS. PART III, LINE 4: PAGE 17 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS CONTAINS A FOOTNOTE DESCRIBING BAD DEBT EXPENSE. PART III, LINE 8: THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. THE REPORTED MEDICARE ALLOWABLE COSTS ARE OBTAINED FROM THE HOSPITAL'S 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 SERVICES, AND MEDICAL EDUCATION, ARE REMOVED AND REPORTED SEPARATELY. EXPLANATION FOR ANY PRIOR YEAR SETTLEMENTS FOR MEDICARE-RELATED SERVICES IN THE CURRENT TAX YEAR: THE 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.ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS REPORTED IN PART III, LINE 7 ARE TREATED AS COMMUNITY BENEFIT. THE RATIONALE FOR THE HOSPITAL'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 9B: THE POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR THE FINANCIAL ASSISTANCE POLICY (FAP) AND FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE, AND THE PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS/HER PAYMENT AGREEMENTS. THE HOSPITAL OFFERS EXTENDED PAYMENT PLANS TO ELIGIBLE PATIENTS AND WILL NOT CHARGE A PATIENT THE GROSS AMOUNT OF CHARGES FOR ANY UNINSURED TREATMENT. UNINSURED DISCOUNTS WILL BE APPLIED TO THE GROSS CHARGES PRIOR TO ANY FINANCIAL ASSISTANCE OR OTHER DISCOUNTS. IF AT ANY TIME THE HOSPITAL RECOGNIZES THAT A PATIENT MAY BE ELIGIBLE FOR STATE OR FEDERAL PROGRAMS, A REPRESENTATIVE WILL ASSIST THE PATIENT IN OBTAINING INFORMATION ABOUT THESE PROGRAMS OR PROVIDE CONTACT INFORMATION FOR THESE PROGRAMS. THE HOSPITAL CONTRACTS WITH AN OUTSIDE PATIENT ADVOCACY AGENCY, WHICH MAY PROVIDE ASSISTANCE TO THE UNINSURED PATIENT IN APPLYING TO CERTAIN STATE AND FEDERAL PROGRAMS. AT ANY STAGE OF THE PATIENT EXPERIENCE AND UP THROUGH THE COLLECTION PROCESS, THE PATIENT MAY EXPRESS A CONCERN THAT THEY ARE UNABLE TO PAY THEIR BILL IN FULL OR MEET THE PAYMENT PLAN REQUIREMENTS. AT THAT TIME, THE PATIENT WILL BE GIVEN EVERY OPPORTUNITY TO COMPLETE AND SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. THE HOSPITAL TRAINS ITS OUTSIDE DEBT COLLECTION AGENCIES AND ATTORNEYS ABOUT THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION ABOUT THE FAP OR SUBMIT AN APPLICATION FOR FINANCIAL ASSISTANCE. THE HOSPITAL REQUIRES ITS OUTSIDE COLLECTION AGENCIES AND ATTORNEYS TO REFER PATIENTS WHO MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE BACK TO THE HOSPITAL.IF A PATIENT HAS SUBMITTED AN APPLICATION FOR FINANCIAL ASSISTANCE AFTER AN ACCOUNT HAS BEEN REFERRED FOR COLLECTION ACTIVITY, THE HOSPITAL SUSPENDS ALL COLLECTION ACTIVITY UNTIL THE PATIENT'S FINANCIAL ASSISTANCE APPLICATION HAS BEEN PROCESSED AND THE HOSPITAL HAS NOTIFIED THE PATIENT OF ITS DECISION. PATIENTS ARE ADVISED AT THAT TIME TO NOTIFY THE COLLECTION AGENCY TO HOLD THEIR ACCOUNT. THE OUTSIDE DEBT COLLECTION AGENCIES ARE NOTIFIED BY THE HOSPITAL ONCE AN ACCOUNT ADJUSTMENT HAS BEEN MADE. PART VI, LINE 2: WE ASSESS AND RESPOND TO THE HEALTH CARE NEEDS OF THE COMMUNITIES WE SERVE THROUGH MANY WAYS INCLUDING THE FOLLOWING:MARKETING RESEARCH - CLEARWATER VALLEY HEALTH AND ST. MARY'S HEALTH REVIEW INTERNAL DATA TO BETTER UNDERSTAND THE NEEDS AND USES(S) OF OUR SERVICES. THIS INCLUDES ACCESS TO SERVICE AREAS (I.E. PRIMARY CARE), PAYOR INFORMATION, AND OVERALL GAPS IN SERVICES. ASSESSMENTS HAVE RESULTED IN STRATEGIC PLANS FOR GROWING SERVICES, AS WELL AS CHANGES TO INTERNAL PROCESSES FOR HEALTH CARE ACCESS.POPULATION CARE MANAGEMENT - WE REGULARLY COMPARE OUR HEALTH RANKINGS AND RATINGS TO STATE AND NATIONAL DATA TO IDENTIFY THE GREATEST AREAS OF HEALTH CARE NEEDS. WE PREPARE INTERVENTIONS TARGETED TO AREAS OF GREATEST NEED, SUCH AS UNCONTROLLED DIABETES OR PRE-DIABETES. WE THEN MEASURE THE EFFECT OF INTERVENTIONS COMPARED TO OVERALL COUNTY RANKINGS. WE USE THIS DATA TO ASSESS THE IMPLICATIONS OF EXPANDING PILOT PROGRAMS.PLANNED INTERACTION WITH VARIOUS COMMUNITY HEALTH, HEALTHCARE, AND SOCIAL WELFARE GROUPS - AN UMBRELLA COALITION OF COMMUNITY HEALTH, HEALTHCARE, AND SOCIAL WELFARE GROUPS MEET REGULARLY TO SHARE PERSPECTIVES ON COMMUNITY NEEDS AND THE ROLE THE HOSPITAL CAN PLAY IN ADDRESSING THOSE NEEDS AS A COLLABORATIVE PARTNER. INTERACTIONS HAVE RESULTED IN SUCCESSFUL PROGRAMS FOR NURSE CASE MANAGEMENT, COMMUNITY REFERRAL COORDINATOR, COMMUNITY HEALTH WORKER, AND BENEFITS COUNSELOR POSITIONS.INTERNAL QUALITY INDICATORS - WE TRACK DATA THAT LEAD TO THE IMPROVED CARE AND TREATMENT OF PATIENTS WITH CHRONIC DISEASES, TOBACCO USE, AND MENTAL HEALTH CONDITIONS. THIS INCLUDES PATIENT ACTIVITY AND OUTCOMES, ALLOWING FOR THE HOSPITAL TO BETTER IDENTIFY THE NEEDS OF THE PATIENTS, WHICH CAN BE UTILIZED TO ASSESS THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE. HEALTH DATA PROVIDED BY PAYOR ORGANIZATIONS, NAMELY GOVERNMENT AND COMMERCIAL HEALTH INSURERS - THIS HEALTH DATA TYPICALLY INVOLVES MEDICAL TREATMENT AND OUTCOMES THAT REFLECT TRENDS OF UNHEALTHY LIFESTYLES AND BEHAVIORS. OUR OBJECTIVE IS TO UNDERSTAND THESE RELATIONSHIPS AND TO DEVELOP ACTION STEPS TO INTERVENE ON THE FRONT END TO PREVENT SUCH MEDICAL SITUATIONS FROM OCCURRING. EXAMPLES INCLUDE MANAGEMENT OF DIABETES, INCREASE ACCESS TO CANCER SCREENINGS, AND EXPANDED BEHAVIORAL HEALTH.THE CHNA CAN BE FOUND ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTPS://SMH-CVH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ PART VI, LINE 3: THE HOSPITAL MAKES INFORMATION ON ITS FINANCIAL ASSISTANCE POLICY (FAP) READILY AVAILABLE TO PATIENTS. INFORMATION ABOUT FINANCIALS ASSISTANCE PROGRAMS IS AVAILABLE ON THE HOSPITAL WEBSITE (SMH-CVH.ORG) WHERE THE INFORMATION AND APPLICATION ARE EASILY ACCESSIBLE TO BE VIEWED, DOWNLOADED, AND PRINTED AT NO CHARGE TO THE PATIENT. NOTICES ON THE AVAILABILITY OF FINANCIAL ASSISTANCE ARE CONSPICUOUSLY POSTED IN EMERGENCY ROOM DEPARTMENTS. FINANCIAL ASSISTANCE INFORMATION IS AVAILABLE DURING THE PRE-ADMISSION FINANCIAL SCREENING, AT THE TIME OF REGISTRATION, AND PRIOR TO A HOSPITAL DISCHARGE. INFORMATION ABOUT THE FAP IS IN COLLECTION LETTERS AND PATIENT STATEMENTS.FAP INFORMATION AND/OR APPLICATIONS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. THE HOSPITAL EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS PROVIDING DIRECT PATIENT TREATMENT AND WHO WORK IN ADMISSIONS, BILLING, AND COLLECTIONS, ABOUT THE EXISTENCE OF THE FAP AND HOW A PATIENT MAY OBTAIN MORE INFORMATION. ANNUAL EDUCATION/AWARENESS OF THE FAP IS PROVIDED TO ENSURE ALL EMPLOYEES WITH PATIENT CONTACT ARE AWARE OF THE PROGRAM AND HOW PATIENTS CAN OBTAIN ADDITIONAL INFORMATION.CLINICAL AND HOSPITAL STAFF WHO PROVIDE DIRECT PATIENT CARE HAVE KNOWLEDGE OF THE FAP AND KNOW TO DIRECT PATIENTS TO A REGISTRATION INTERVIEWER OR BUSINESS OFFICE REPRESENTATIVE. REGISTRATION STAFF UNDERSTAND THE POLICY, KNOW WHERE THE RELATED DOCUMENTS ARE LOCATED, AND WHERE TO DIRECT THE PATIENT FOR MORE INFORMATION ON THE FAP. DESIGNATED EMPLOYEES (FINANCIAL COUNSELORS & PATIENT ACCOUNTS REPRESENTATIVES) HAVE A THOROUGH UNDERSTANDING OF THE FAP AND OFFER THE INFORMATION ON THE FAP TO THOSE PATIENTS WHO MAKE AN INQUIRY ABOUT THE PROGRAM OR ARE DETERMINED THROUGH A FINANCIAL SCREENING TO BE ELIGIBLE FOR THIS PROGRAM. PATIENT ADVOCACY SERVICES ALSO INFORM THE PATIENT ABOUT THE AVAILABILITY OF ASSISTANCE. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT, A PATIENT'S GUARANTOR, A FAMILY MEMBER, CLOSE FRIEND, OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. THE ORGANIZATION RESPONDS TO ANY ORAL OR WRITTEN REQUESTS FOR MORE GENERAL INFORMATION ON THE FAP MADE BY A PATIENT OR ANY INTERESTED PARTY.DUE TO THE SMALL SIZES OF THE LIMITED ENGLISH PROFICIENCY (LEP) POPULATIONS OF THE COMMUNITIES SERVED BY THE HOSPITAL, SMH WAS NOT REQUIRED TO TRANSLATE THE FINANCIAL ASSISTANCE POLICY (FAP), THE FAP APPLICATION FORM, OR THE PLAIN LANGUAGE SUMMARY OF THE FAP TO OTHER LANGUAGE.THE FAP, FAP APPLICATION AND FAP PLAIN LANGUAGE SUMMARY CAN BE FOUND ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTPS://APPS.PARAHCFS.COM/PTT/FINALLINKS/CLEARWATER_V2.ASPX PART VI, LINE 4: THE HOSPITAL IS IN OROFINO, IDAHO AND OPERATES A CRITICAL ACCESS HOSPITAL AND 2 CLINICS THAT SERVE THE COMMUNITIES OF CLEARWATER, LEWIS, AND IDAHO COUNTIES COVERING 11,500 SQUARE MILES. THE OVERALL COMMUNITY IS DESIGNATED NOT ONLY AS RURAL, BUT ALSO AS FRONTIER. FRONTIER REGIONS ARE DEFINED AS THE MOST GEOGRAPHICALLY REMOTE, SPARSELY POPULATED, AND UNDEVELOPED TERRAIN IN THE UNITED STATES.THE SERVICE AREA IS APPROXIMATELY 30,000 PEOPLE WITH AN AGE DISTRIBUTION OF 19% UNDER THE AGE OF 18; 53% BETWEEN THE AGES OF 18 AND 65; AND 28% OVER THE AGE OF 65. THE RACIAL MAKEUP OF THE SERVICE AREA IS 89% CAUCASIAN; 4% HISPANIC, AND 7% OTHER. THE GENDER SPLIT RATIO IS 47% WOMEN AND 53% MEN. THE AVERAGE INCOME FOR THE SERVICE AREA IS APPROXIMATELY $59,800. THE HOSPITAL IS COMMITTED TO SERVING PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. APPROXIMATELY 3.1% OF GROSS REVENUE DOLLARS WERE FROM SELF-PAY PATIENTS AND 13.1% OF MEDICAID RECIPIENTS. THE HOSPITAL HAS A CLINIC IN THE PIERCE-WEIPPE SERVICE AREA THAT IS CURRENTLY DESIGNATED AS A MEDICALLY UNDERSERVED AREA. THERE ARE 2 OTHER HOSPITALS THAT SERVE THE COMMUNITY. PART VI, LINE 5: THE HOSPITAL BOARD OF DIRECTORS IS COMPOSED MAINLY OF VOLUNTEER REPRESENTATIVES FROM THE PRIMARY SERVICE AREA AND DEDICATES TIME TO ENSURING THEY UNDERSTAND THE HEALTH AND WELFARE NEEDS OF OUR COMMUNITY. THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO ARE PROPERLY SCREENED. ALL APPLICANTS THAT APPLY MUST MEET THE CREDENTIALING STANDARDS AND BE APPROVED BY THE GOVERNING BOARD TO PROVIDE SERVICES AT THE HOSPITAL. 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 PHYSICIANS PER CAPITAL RATES IN THE NATION. ANY SURPLUS FUNDS ARE REINVESTED INTO THE FACILITY, EQUIPMENT, AND EMPLOYEE EDUCATION. WE REGULARLY REVIEW FACILITIES AND EQUIPMENT AND DEVELOP AN ATTRITION PROCESS TO REPLACE AGING PLANT OPERATIONS AND EQUIPMENT. WE ARE ALSO LOOKING FOR OPPORTUNITIES TO BRING NEW SERVICES TO THE COMMUNITIES VIA INVESTING IN NEW SKILLS AND TECHNOLOGY WHERE APPROPRIATE.THE HOSPITAL ENGAGED COMMUNITIES IN COMING TOGETHER AND CREATING SOCIAL CONNECTIVITY THROUGH SUPPORT OF LOCAL EVENTS AND COMMUNITY PROGRAMS. THESE INCLUDE THE FORMATION OF COMMUNITY AND SCHOOL GARDENS, HEALTH TALKS, SPONSORSHIP OF RACES, AND PARTICIPATION IN COUNTY FAIR ACTIVITIES.WE PROMOTE BETTER MENTAL HEALTH BY BRINGING CHILDREN AND ADULT PSYCHIATRISTS TO OUR FRONTIER COMMUNITIES USING TELEMEDICINE. THIS MODEL HAS WON STATE AND NATIONAL AWARDS FOR INNOVATION IN REACHING THE MEDICALLY UNDERSERVED. WE ARE ALSO ACTIVE PARTICIPANTS IN NATIONAL DEMONSTRATION PROJECTS AND OTHER COLLABORATIONS TO PROVIDE AN EVIDENCE BASE FOR EFFECTIVE PROCESSES PROMOTING RURAL HEALTH.IN ADDITION TO THE ACTIVITIES LISTED IN PART I, LINE 7 AS WELL AS PART V, SECTION B, LINE 11, SOME OTHER PROJECTS UNDERTAKEN BY CVH INCLUDE THE FOLLOWING:MOST MONTHS WE HAVE AN OVERALL THEME TARGETING A CHRONIC DISEASE STATE WITH SPECIAL PROGRAMS AND OUTREACH TO OUR COMMUNITIES (I.E. FEBRUARY IS HEART MONTH, OCTOBER IS BREAST CANCER AWARENESS, NOVEMBER IS DIABETES AWARENESS, ETC.). DOC TALKS ARE GEARED TO THE MONTHLY THEME WITH SCREENINGS AND INFORMATION PROVIDED AT THE EVENTS. OUR CARE MANAGERS, REFERRAL COORDINATORS, AND QUALITY DIRECTORS ARE ESPECIALLY ACTIVE IN COORDINATING THESE ACTIVITIES AND REACHING OUT TO PATIENTS WHO MAY NOT BE AWARE OF THE SERVICES OFFERED. COMMUNITY HEALTH WORKERS ARE HOSTING CHRONIC DISEASE SELF-MANAGEMENT AND CHRONIC PAIN SELF-MANAGEMENT CLASSES THROUGHOUT OUR SERVICE AREA. COLON CANCER AWARENESS AND SCREENING HAS BEEN A MAJOR OUTREACH EFFORT AT HEALTH FAIRS, LOCAL BAZAARS, SOME OF THE FARMER'S MARKET DAYS, AND WITHIN ALL THE CLINICS OVER THE PAST YEAR.THE HOSPITAL IS AN ACTIVE PARTICIPANT IN ATTENDING AND SITTING ON THE BOARDS OF THE LOCAL HUMAN NEED COUNCILS WITHIN THE SERVICE AREAS. WE HAVE A PRESENCE ON MULTIPLE COALITIONS THROUGHOUT THE NORTHERN UNITED STATES AND NORTH CENTRAL IDAHO. THIS IS OFTEN ACCOMPLISHED BY PHONE CONFERENCING TO PARTICIPATE IN THE DISCUSSIONS AND GROWTH WITHOUT INCURRING TRAVEL EXPENSES. WE ARE ALSO ACTIVELY ENGAGED IN STATE COALITIONS ON CHRONIC DISEASE AND COMMUNITY HEALTH WORKER PROGRAMS (OFTEN SEEN AS MENTORS WITHIN THESE GROUPS FOR THE ACCOMPLISHMENTS ACHIEVED OVER THE PAST FEW YEARS). FUNDRAISERS AND VOLUNTEER EFFORTS ARE ESTABLISHED AND ONGOING WITH LOCAL FOOD BANKS, CLOTHING DISTRIBUTION DRIVES, AND OTHER VOLUNTEERS THAT ARE GEARED AROUND NATURAL DISASTERS AND OTHER NEEDS WITHIN OUR AREA. EFFORTS ARE BEING MADE TO BRING SAFE WALKING AND BIKE TRAILS TO COMMUNITIES WITHIN OUR SERVICE AREAS. A RESULT OF ALMOST EVERY SURVEY AND CONVERSATION IS THAT THE COMMUNITIES WANT MORE WAYS TO ENGAGE SAFELY IN PHYSICAL ACTIVITY AT LITTLE OR NO EXPENSE. COMMUNITY HEALTH WORKERS HAVE WORKED WITH COMMUNITY PARTNERS TO HOST WEEKLY WALKS THROUGHOUT THE REGION PROVIDING BOTH AN EDUCATION COMPONENT AND A SAFE WALKING PATH FOR THE DAY. COMMUNITY HEALTH WORKERS COORDINATE AND HOST SCREENING EVENTS IN VARIOUS LOCATIONS THROUGHOUT THE SERVICE AREA TO HELP SCREEN FOR DIABETES, DEPRESSION, SDOH ISSUES, AND COLON CANCER. SOME OF THE SCREENING EVENTS ARE HELD IN CONJUNCTION WITH A FOOD BANK DISTRIBUTION SITE.THE HOSPITAL IS PART OF KOOTENAI HOSPITAL DISTRICT DBA KOOTENAI HEALTH, A FULLY INTEGRATED HEALTH SYSTEM WITH FACILITIES IN IDAHO. KOOTENAI HEALTH REINVESTS SURPLUS REVENUES INTO TECHNOLOGY, INFRASTRUCTURE AND CLINICAL PROGRAMS TO INCREASE THE HEALTH AND VITALITY OF THE COMMUNITIES WE SERVE. KOOTENAI HEALTH PROVIDES SERVICES IN RURAL COMMUNITIES AND IS COMMITTED TO ELIMINATING GEOGRAPHIC BARRIERS TO CARE. WE INVEST IN FACILITY UPGRADES, TECHNOLOGY, AND STAFFING THAT ENHANCE CARE IN THESE COMMUNITIES TO ENSURE PATIENTS CAN RECEIVE AS MUCH CARE AS POSSIBLE CLOSE TO HOME. TELEHEALTH ALLOWS PATIENTS TO RECEIVE CARE FROM A PROVIDER IN THEIR HOME. TELEHEALTH APPOINTMENTS TAKE PLACE IN LOCAL CLINICS OR HOSPITALS THROUGH SECURE INTERACTIVE VIDEOCONFERENCING. PATIENTS FEEL LIKE THEY ARE IN THE SAME ROOM AS THEIR DOCTOR. THIS EXPERIENCE OFFERS THE SAME HIGH-QUALITY CARE THAT PATIENTS EXPECT DURING AN IN-PERSON VISIT.ON MAY 26, 2015, THE DISTRICT BOARD VOTED TO DEVELOP A CLINICAL INTEGRATION NETWORK CALLED KOOTENAI CARE NETWORK, LLC, (KCN) A NON-PROFIT, WHOLLY OWNED SUBSIDIARY. THE GOAL OF THE NETWORK IS TO IMPROVE THE OVERALL HEALTH OF THE COMMUNITY THROUGH THE DELIVERY OF EFFICIENT, HIGH-QUALITY CARE THROUGH THE INTEGRATION OF INDEPENDENT AND EMPLOYED PHYSICIANS, HOSPITALS, POST-ACUTE CARE PROVIDERS AND PAYERS. AS OF DECEMBER 31, 2023, THERE WERE OVER 600 PARTICIPATING PROVIDERS, AND 61,500 LIVES COVERED IN THE NETWORK. KOOTENAI ACCOUNTABLE CARE, LLC WAS FORMED IN 2017 WITH KCN AS ITS SOLE MEMBER, FOR PURPOSES OF PARTICIPATING AS A MEDICARE SHARED SAVINGS PROGRAM. IN ADDITION, KOOTENAI VALUE CARE, LLC WAS FORMED IN 2021 WITH KCN AS ITS SOLE MEMBER, FOR PURPOSES OF PARTICIPATING IN THE IDAHO MEDICAID VALUE CARE PROGRAM.KCN HAS A TEAM OF CARE MANAGERS TO HELP PATIENTS WITH CHRONIC CONDITIONS TO MANAGE THEIR CARE. THESE CHRONIC CONDITIONS INCLUDE CHRONIC OBSTRUCTIVE PULMONARY DISEASE, HEART FAILURE, DEPRESSION, AND ANXIETY. THE CARE MANAGERS WORK WITH A VARIETY OF PATIENTS, CAREGIVERS, AND HEALTHCARE EXPERTS WITHIN KCH TO PROVIDE EFFICIENT, HIGH-QUALITY CARE FOR THE COMMUNITY.EACH YEAR KOOTENAI HEALTH MAKES SUBSTANTIAL FINANCIAL AND IN-KIND DONATIONS THAT BENEFIT THE COMMUNITY. THESE INCLUDE DONATIONS TO GROUPS SUCH AS THE SUICIDE PREVENTION ACTION NETWORK AND THE COMMUNITY CANCER FUND. KOOTENAI HEALTH PROVIDES FREE AND LOW-COST HEALTH SCREENINGS AND SUPPORT GROUPS FOR PATIENTS WITH DIABETES, CANCER, MENDED HEARTS, PARKINSON'S, AND PULMONARY DISEASE. KOOTENAI HEALTH PROVIDES TRAINING OPPORTUNITIES FOR PHYSICIANS, NURSES, AND OTHER HEALTHCARE WORKERS. TOGETHER, THESE SERVICES ARE IMPROVING HOW PEOPLE ARE CARED FOR IN THE GEOGRAPHICALLY DIVERSE COMMUNITIES WE SERVE. PART VI, LINE 6: CLEARWATER VALLEY HEALTH IS PART OF KOOTENAI HOSPITAL DISTRICT (THE DISTRICT). THE DISTRICT IS ORGANIZED AND EXISTS AS A POLITICAL SUBDIVISION UNDER THE LAWS OF THE STATE OF IDAHO TO PROVIDE HEALTH CARE SERVICES WITHIN THE DISTRICT WHICH INCLUDES ALL OF KOOTENAI COUNTY AS WELL AS ADDITIONAL COUNTIES WITHIN IDAHO. THE DISTRICT IS INVOLVED IN SEVERAL JOINT RELATIONSHIPS TO PROVIDE NEEDED HEALTH SERVICES TO NORTH IDAHO RESIDENTS. THESE RELATIONSHIPS ARE IN THE AREAS OF IMAGING SERVICES, MAGNETIC RESONANCE IMAGING SERVICES, REHABILITATION SERVICES, AMBULATORY SURGICAL SERVICES, AND RADIATION THERAPY SERVICES.WE ALSO SUPPORT COMMUNITY HEALTH THROUGH THE KOOTENAI HEALTH FOUNDATION AND THROUGH CONTRIBUTIONS THAT FOCUS ON PROGRAMS AND SERVICES THAT BENEFIT THE OVERALL HEALTH OF THE COMMUNITIES WE SERVE. 1 KOOTENAI HEALTH FOUNDATION 2003 KOOTENAI HEALTH WAY COEUR DALENE ID 83814 921896475 501(C)(3) 0 10827 COST SHARED EMPLOYEE SALARY AND BENEFITS ADMINISTRATIVE SUPPORT 1 PART I, LINE 2: CLEARWATER VALLEY HOSPITAL AND CLINICS, INC.'S MANAGEMENT REVIEWS THE GRANT ACTIVITY BY REVIEWING AND DOCUMENTING EACH EXPENDITURE REQUEST AND APPROVING THE EXPENSE. X X X X 0 0 0 0 0 0 0 0 0 MICHELE BOUIT DIRECTOR/KH CFO 0 501572 0 173254 0 18173 0 12723 0 23607 0 729329 0 0 KARIN SCHMIDOVA PHYSICIAN 382824 0 250 0 0 0 13800 0 24685 0 421559 0 0 0 REBECCA KATZMAN PHYSICIAN 268557 0 102574 0 9344 0 13800 0 13713 0 407988 0 0 0 COLLEEN SHOLAR PHYSICIAN 251153 0 110821 0 5851 0 13800 0 25801 0 407426 0 0 0 SHELLY FRAYSER PHYSICIAN 354751 0 10330 0 0 0 13800 0 21312 0 400193 0 0 0 LENNE BONNER PRESIDENT/CEO 0 300494 0 42813 0 0 0 12532 0 20483 0 376322 0 0 KELLY MCGRATH DIRECTOR/CMO 313587 0 15259 0 4276 0 13800 0 28588 0 375510 0 0 0 ALLY LOVELAND PHYSICIAN 275654 0 35000 0 1983 0 0 0 13695 0 326332 0 0 0 JYL RULAND CFO 158146 0 8550 0 0 0 7277 0 25685 0 199658 0 0 0 FORM 990, PART VI, SECTION A, LINE 6 KOOTENAI HOSPITAL DISTRICT DBA KOOTENAI HEALTH IS THE SOLE MEMBER OF CLEARWATER VALLEY HOSPITAL AND CLINICS, INC. AND MAY ELECT ONE OR MORE MEMBERS OF THE GOVERNING BODY AS DESCRIBED IN SCHEDULE O, PART VI, LINE 7A. KOOTENAI HOSPITAL DISTRICT 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, SECTION A, LINE 7A KOOTENAI HOSPITAL DISTRICT APPOINTS AND REMOVES CLEARWATER VALLEY HOSPITAL AND CLINICS, INC. GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 7B KOOTENAI HOSPITAL DISTRICT HAS RESERVED POWERS AS FOLLOWS: STRATEGIC AND BUSINESS PLANS AUTHORITY TO CREATE AND TO APPROVE CLEARWATER VALLEY'S STRATEGIC AND BUSINESS PLANS. MISSION AUTHORITY TO CREATE AND TO APPROVE THE MISSION PURPOSE AND VISION STATEMENT FOR CLEARWATER VALLEY. DEBT APPROVAL OF THE INCURRENCE OF DEBT BY AND THE CREATION OF ALL MORTGAGES, LIENS, SECURITY INTERESTS, OR OTHER ENCUMBRANCES ON THE ASSETS OF CLEARWATER VALLEY IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY THE KH BOARD OF DIRECTORS. GOVERNING INSTRUMENTS AUTHORITY TO CAUSE AND APPROVE AMENDMENTS OF THE ARTICLES OF INCORPORATION AND BYLAWS OF CLEARWATER VALLEY. MERGERS AND ACQUISITIONS AUTHORITY TO CAUSE AND TO APPROVE ALL MERGERS, CONSOLIDATIONS, AND DISSOLUTIONS OF CLEARWATER VALLEY. AFFILIATIONS AND JOINT VENTURES AUTHORITY TO CAUSE AND APPROVE ALL AFFILIATIONS, JOINT VENTURES AND OTHER ALLIANCES BETWEEN THIRD PARTIES AND CLEARWATER VALLEY. TRANSFER OF ASSETS AUTHORITY TO CAUSE AND TO APPROVE THE SALE, LEASE, OR OTHER TRANSFER OF CLEARWATER VALLEY ASSETS WHEN THE ASSET'S VALUE EXCEEDS THE SINGLE OR AGGREGATE DOLLAR LIMIT PRESCRIBED IN WRITING BY THE KH BOARD OF DIRECTORS. SERVICES AUTHORITY TO CAUSE AND TO APPROVE THE DISCONTINUANCE OF SERVICES AND SERVICE LOCATIONS OF CLEARWATER VALLEY. BUDGETS APPROVAL OF CAPITAL AND OPERATING BUDGETS OF CLEARWATER VALLEY. PROFESSIONAL SERVICES SELECTION OF THE GENERAL LEGAL COUNSEL AND EXTERNAL AUDITORS OF CLEARWATER VALLEY. ACQUISITIONS AUTHORITY TO CAUSE AND TO APPROVE ALL ACQUISITIONS BY AND FORMATIONS OF ENTITIES BY CLEARWATER VALLEY. MARKETING AND BRANDING AUTHORITY TO IMPLEMENT CLEARWATER VALLEY MARKETING, BRANDING, AND PROMOTIONAL ACTIVITIES. COMPLIANCE PLANS AUTHORITY TO CREATE AND TO APPROVE CORPORATE COMPLIANCE, SAFETY AND RISK MANAGEMENT PLANS FOR CLEARWATER VALLEY. QUALITY PLAN AUTHORITY TO CREATE TO APPROVE CLEARWATER VALLEY'S QUALITY PLAN. NON-BUDGETED PURCHASES APPROVAL OF NON-BUDGETED CAPITAL PURCHASES, OPERATING EXPENSES, AND LEASES IN EXCESS OF THE SINGLE OR ANNUAL AGGREGATE DOLLAR LIMITS PRESCRIBED IN WRITING BY KH FOR CLEARWATER VALLEY. HUMAN RESOURCES AUTHORITY TO CREATE HUMAN RESOURCE POLICIES AND PROCEDURES FOR CLEARWATER VALLEY. RESERVED POWERS AUTHORITY TO CREATE ADDITIONAL KH RESERVED POWERS BY THE AFFIRMATIVE VOTE OF AT LEAST 75% OF THE KH BOARD OF DIRECTORS (EXCLUDING THE KH PRESIDENT). FORM 990, PART VI, SECTION B, LINE 11B A COPY OF THE 990 IS PROVIDED TO THE CEO AND CFO WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PROVIDED TO THE BOARD OF DIRECTORS. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CFO SIGNS THE FORM 8879-TE AUTHORIZING THE PREPARER TO E-FILE THE RETURN. FORM 990, PART VI, SECTION B, LINE 12C CVHC REQUIRES BOARD MEMBERS AND OFFICERS OF THE ORGANIZATION TO ANNUALLY DISCLOSE POTENTIAL CONFLICTS. IF A POTENTIAL CONFLICT EXISTS, THEY ARE REVIEWED BY THE BOARD AND THE INDIVIDUAL WITH THE POTENTIAL CONFLICT ABSTAINS FROM VOTING ON THE ISSUE. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF THE CEO IS SET BY THE INDEPENDENT, EXECUTIVE COMPENSATION COMMITTEE OF KOOTENAI HEALTH'S BOARD OF DIRECTORS. THE EXECUTIVE COMPENSATION COMMITTEE ENGAGES QUALIFIED INDEPENDENT COMPENSATION ADVISORS TO PROVIDE OBJECTIVE AND IMPARTIAL COMPARATIVE DATA AND TO EXPRESS OPINIONS ON TOTAL COMPENSATION REASONABLENESS. THE INDEPENDENT ADVISOR MONITORS COMPARABILITY DATA AND MARKETPLACE TRENDS, MAKES APPROPRIATE RECOMMENDATIONS REGARDING SALARY RANGES, AND PERIODICALLY REVIEWS THE MARKET COMPETITIVENESS OF KOOTENAI HEALTH EXECUTIVE COMPENSATION PACKAGES. CEO COMPENSATION RANGE IS DERIVED FROM STATE HOSPITAL ASSOCIATION SALARY SURVEYS AND OTHER REGIONAL COMPENSATION SURVEYS. ADDITIONALLY, CEO COMPENSATION IS DETERMINED UNDER A YEARLY PERFORMANCE EVALUATION. THIS PRACTICE IS ALSO FOLLOWED FOR THE CFO POSITION AND FOR OTHER COMPENSATED OFFICERS AND KEY EMPLOYEES. THE ANNUAL DELIBERATION AND DECISIONS PROCESS IS SUBSTANTIATED. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. ST MARY'S HOSPITAL INC PO BOX 137 COTTONWOOD ID 83522 820226453 HOSPITAL ID 501(C)(3) LINE 3 KOOTENAI HEALTH 1 KOOTENAI HEALTH 2003 KOOTENAI HEALTH WAY COEUR DALENE ID 83814 820380784 HOSPITAL ID 501(C)(3) LINE 3 N/A 0 KOOTENAI URGENT CARE LLC 700 IRONWOOD DR SUITE 120E COEUR DALENE ID 83814 MEDICAL ID N/A 0 0 KOOTENAI OUTPATIENT SURGERY 707 IRONWOOD DR COEUR DALENE ID 83814 SURGERY ID N/A 0 0 KOOTENAI OUTPATIENT IMAGING 700 W IRONWOOD DR SUITE 175 COEUR DALENE ID 83814 IMAGING ID N/A 0 0 0 1 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 0 0