Community Benefit Insight - Tax-exempt hospital

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Carson Tahoe Regional Healthcare

Carson Tahoe Regional Healthcare

1600 Medical Parkway
Carson City, NV 89702

Bed count	211	Medicare provider number	290019	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 880502320

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

11.97%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 2,902,342 0.81 %
Medicaid as % of operating expenses	$ 23,339,109 6.54 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 381,562 0.11 %
Subsidized health services as % of operating expenses	$ 13,259,850 3.71 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 1,772,603 0.50 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 1,073,790 0.30 %
Community building* as % of operating expenses	$ 7,915 0.00 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 7,915 0.00 %
Physical improvements and housing as % of community building expenses	$ 0 0 %
Economic development as % of community building expenses	$ 0 0 %
Community support as % of community building expenses	$ 7,915 100 %
Environmental improvements as % of community building expenses	$ 0 0 %
Leadership development and training for community members as % of community building expenses	$ 0 0 %
Coalition building as % of community building expenses	$ 0 0 %
Community health improvement advocacy as % of community building expenses	$ 0 0 %
Workforce development as % of community building expenses	$ 0 0 %
Other as % of community building expenses	$ 0 0 %
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 25,417,945 7.12 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 0 0 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 254203173 including grants of $ 22833071) (Revenue $ 346131178)
CARSON TAHOE REGIONAL MEDICAL CENTER IS THE MAIN HUB OF CARSON TAHOE HEALTH SYSTEM. LOCATED IN NORTH CARSON CITY, NEVADA, THE REGIONAL MEDICAL CENTER PROVIDES INPATIENT AND OUTPATIENT MEDICAL SERVICES FOR OVER 250,000 PEOPLE. THESE SERVICES ARE PROVIDED REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE, OR ABILITY TO PAY. CARSON TAHOE'S MISSION IS TO ENHANCE THE HEALTH AND WELL-BEING OF THE COMMUNITIES WE SERVE.CARSON TAHOE REGIONAL MEDICAL CENTER CONSISTS OF AN ACUTE CARE REGIONAL MEDICAL CENTER WITH 159 LICENSED BEDS, INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES WITH A TOTAL OF 52 LICENSED BEDS, A FREE-STANDING LICENSED EMERGENT CARE CENTER, 2 URGENT CARES, ACCREDITED CANCER CENTER, RETAIL CLINICS, IMAGING CENTERS, PAIN MANAGEMENT CENTER, THERAPY, REHABILITATION AND SEVERAL MEDICAL OFFICE BUILDINGS. THE REGIONAL MEDICAL CENTER PROVIDES CARE TO PERSONS, SOME OF WHOM ARE COVERED BY GOVERNMENTAL PROGRAMS INCLUDING MEDICARE AND MEDICAID, AS WELL AS MEDICALLY INDIGENT PATIENTS UNABLE TO PAY. THE HOSPITAL SPONSORS HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY, INCLUDING WELLNESS EDUCATION AND SUPPORT. THE HOSPITAL HAD 11,127 INPATIENT DISCHARGES, 56,827 INPATIENT DAYS, AND 81,789 OUTPATIENT VISITS IN 2021.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

CARSON TAHOE REGIONAL HEALTHCARE
PART V, SECTION B, LINE 5: TO ENSURE THE BEST REPRESENTATION OF THE POPULATION, A TELEPHONE INTERVIEW METHODOLOGY - INCORPORATING BOTH LANDLINE AND CELL PHONE INTERVIEWS - WAS EMPLOYED. A RANDOM SAMPLE OF 800 INDIVIDUALS AGE 18 AND OLDER IN THE PRIMARY SERVICE AREA RESULTED IN 362 SURVEYS IN CARSON CITY, 299 IN DOUGLAS COUNTY AND 139 IN LYON COUNTY.TO SOLICIT INPUT FROM KEY INFORMANTS, AN ONLINE KEY INFORMANT SURVEY WAS ALSO IMPLEMENTED. THESE INDIVIDUALS INCLUDED PHYSICIANS, PUBLIC HEALTH REPRESENTATIVES, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND A VARIETY OF OTHER COMMUNITY LEADERS. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATION WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. IN ALL, 95 COMMUNITY STAKEHOLDERS PARTICIPATED IN THE ONLINE KEY INFORMANT SURVEY. SEE PAGE 12 OF THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT FOR A FULL LIST OF ORGANIZATIONS, AGENCIES AND BUSINESSES THAT PARTICIPATED OF THE ONLINE KEY INFORMANT SURVEY.

CARSON TAHOE REGIONAL HEALTHCARE
PART V, SECTION B, LINE 6A: A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH CARSON TAHOE CONTINUING CARE HOSPITAL, THE OTHER HOSPITAL OWNED BY CARSON-TAHOE HEALTH SYSTEM.

CARSON TAHOE REGIONAL HEALTHCARE
PART V, SECTION B, LINE 7D: THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT AND IMPLEMENTATION STRATEGY ARE AVAILABLE ONLINE AT WWW.CARSONTAHOE.COM/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.HTML.

CARSON TAHOE REGIONAL HEALTHCARE
"PART V, SECTION B, LINE 11: IN 2021, CARSON TAHOE CONTINUED TO RESPOND TO COVID-19 PANDEMIC SURGES WITHIN THE COMMUNITY BUT ALSO BEGAN TO READDRESS AREAS IDENTIFIED IN THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT WITH RESOURCES AND PARTNERSHIPS IN THE COMMUNITY WITH A LARGE FOCUS ON MENTAL HEALTH.MENTAL HEALTH AMERICA RANKS STATES ACCORDING TO PREVALENCE OF MENTAL ILLNESS AND ACCESS TO CARE. NEVADA RANKS AS THE 51ST, THE LAST, STATE IN THE COUNTRY FOR OVERALL MENTAL HEALTH SERVICES. ""FOR EVERY 580 PEOPLE LIVING IN NEVADA, THERE IS AT LEAST 1 MENTAL HEALTH PROVIDER. NEVADA HAS THE HIGHEST PREVALENCE OF MENTAL ILLNESS AND LOWEST ACCESS TO CARE AMONG YOUTH. 2 OUT OF 3 NEVADAN ADULTS WITH A MENTAL ILLNESS RECEIVED NO TREATMENT"" (CHEANG). THE COVID PANDEMIC SIGNIFICANTLY IMPACTED NEVADANS AS EVIDENCED BY CDC DATA SHOWING, ""NEVADA RANKED FIRST IN THE COUNTRY WITH REGARD TO THE NUMBER OF ADULTS (34%) EXPERIENCING SYMPTOMS CONSISTENT WITH DEPRESSION AND 8TH WITH REGARD TO ANXIETY (39.9%). NEVADA RANKED SECOND, NATIONALLY, WITH 47.3% OF ADULTS SHOWING SIGNS OF BOTH DEPRESSION AND ANXIETY"" (STATE OF NEVADA COMMISSION ON BEHAVIORAL HEALTH). THERE HAS ALSO BEEN A NOTABLE INCREASE IN MENTAL HEALTH RELATED EMERGENCY DEPARTMENT VISITS AMONG THE CHILD AND ADOLESCENT POPULATION NOT ONLY IN NEVADA, BUT NATIONWIDE. THE AAP, AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY (AACAP) AND CHILDREN'S HOSPITAL ASSOCIATION HAVE DECLARED A NATIONAL EMERGENCY IN CHILDREN'S MENTAL HEALTH. AACAP REPORTED, ""BEFORE THE PANDEMIC, RATES OF CHILDHOOD MENTAL HEALTH CONCERNS AND SUICIDE HAD BEEN RISING STEADILY FOR AT LEAST A DECADE. BY 2018, SUICIDE WAS THE SECOND LEADING CAUSE OF DEATH FOR YOUTH AGES 10-24 YEARS"" (AMERICAN ACADEMY OF PEDIATRICS). THE PRIMARY INTENT OF CARSON TAHOE HEALTH, BEHAVIORAL HEALTH SERVICES (BHS) IS TO IMPROVE THE MENTAL HEALTH AND WELL-BEING OF INDIVIDUALS RESIDING IN THE COMMUNITIES SERVED. BHS HAS BEEN PROVIDING SERVICES ACROSS THE REGION FOR 33 YEARS. BHS SERVICES INCLUDE:- 52 INPATIENT PSYCHIATRIC AND SUBSTANCE ABUSE BEDS FOR ADULTS AND GERIATRIC PATIENTS- 15 BED PSYCHIATRIC EMERGENCY SERVICES, 24/7 MALLORY BEHAVIORAL HEALTH CRISIS CENTER- OUTPATIENT PSYCHIATRIC AND SUBSTANCE ABUSE SERVICES FOR CHILDREN, ADOLESCENCES, ADULTS AND GERIATRIC PATIENTS- FIRST EPISODE PSYCHOSIS PROGRAM SERVING INDIVIDUALS AND THEIR FAMILIES - TWO ASSERTIVE COMMUNITY TREATMENT (ACT) PROGRAMS SERVING SMI AND/OR CO-OCCURRING DISORDERS. THE HOSPITAL DIVERSION ACT PROVIDES TREATMENT AND REHABILITATION TO CLIENTS WITH CHRONIC, SEVERE MENTAL ILLNESS. THE EARLY DIVERSION ACT AIMS TO REDUCE AN INDIVIDUAL'S RISK FOR LAW ENFORCEMENT INTERACTIONS OR POTENTIAL ARRESTS. - COMMUNITY OUTREACH AND EDUCATION TO INCLUDE SCHOOL SUICIDE RISK ASSESSMENTS CARSON CITY, DAYTON, AND DOUGLAS COUNTY SCHOOL DISTRICTS. BHS USES A MULTIDISCIPLINARY APPROACH TO PROVIDE COMPASSIONATE, COST-EFFECTIVE OPTIONS FOR CARE CLOSE TO HOME. PATIENTS ARE ACCEPTED 24-HOURS A DAY. THE TEAM EMPLOYS A HOLISTIC APPROACH TO CARE AND INCLUDES PSYCHIATRISTS, PSYCHIATRIC NURSE PRACTITIONERS, SOCIAL WORKERS, MARRIAGE AND FAMILY THERAPISTS, CLINICAL PROFESSIONAL COUNSELORS, ADDICTIONS COUNSELORS, ACTIVITIES SPECIALISTS, CASE MANAGERS AND PSYCHIATRIC NURSING STAFF. CONFIDENTIAL ASSESSMENTS AND REFERRALS ARE AVAILABLE FREE OF CHARGE, EITHER BY PHONE OR IN PERSON, TO DETERMINE APPROPRIATENESS FOR PROGRAMS. REFERRALS CAN BE MADE FROM MANY SOURCES, SUCH AS HOSPITALS, PHYSICIANS, MENTAL HEALTH AGENCIES, SOCIAL SERVICE AGENCIES, ASSISTED LIVING FACILITIES, SKILLED NURSING FACILITIES, FAMILY, FRIENDS, AND SELF-REFERRALS. MALLORY BEHAVIORAL HEALTH CRISIS CENTER PROVIDES 24-HOUR HELP TO THOSE SUFFERING FROM A MENTAL HEALTH OR SUBSTANCE USE EMERGENCY. WORKING CLOSELY WITH STATE AND LOCAL MENTAL HEALTH AGENCIES AND IN CONJUNCTION WITH LOCAL LAW ENFORCEMENT AND EMERGENCY RESPONDERS, MALLORY CRISIS CENTER SERVES AN AT-RISK POPULATION BY PROVIDING IMMEDIATE ACCESS TO THE CRITICAL CARE THEY NEED, WITHOUT HAVING TO GO THROUGH THE EMERGENCY DEPARTMENT OR JAIL. THIS INNOVATIVE MODEL OFFERS A MULTIDISCIPLINARY TEAM APPROACH, INCLUDING PSYCHIATRY, NURSING, COUNSELING AND CASE MANAGEMENT, WHO WORK TOGETHER TO DETERMINE THE BEST TREATMENT OPTIONS AVAILABLE. CURRENT PROJECTS:- ZERO SUICIDE STATE WIDE INITIATIVE - PROPOSALS SUBMITTED FOR FOUR YOUTH SAPTA/MENTAL HEALTH BLOCK GRANTS (IOP, ACT, COAST AND YOUTH CRISIS STABILIZATION CENTER)- PEER SUPPORT SERVICES SAPTA/MENTAL HEALTH BLOCK GRANTSCHOOLS AND YOUTH:BHS CURRENTLY HAS MEMORANDA OF UNDERSTANDING (MOU) IN PLACE TO PROVIDE SUICIDE RISK ASSESSMENTS FOR CARSON CITY, DAYTON, AND DOUGLAS COUNTY SCHOOL DISTRICTS. - 51 CRISIS SUICIDE RISK ASSESSMENTS (IN SCHOOLS) FOR 2021- ASSISTANCE AND SUPPORT FOR LOCAL SCHOOLS WHEN DELIVERING SIGNS OF SUICIDE (SOS) TRAININGS- DAILY CTH PEDIATRIC THERAPY SESSIONS TO THOSE AWAITING PSYCHIATRIC INPATIENT- WORKING WITH THE CARSON CITY SCHOOL DISTRICT TO PROVIDE THERAPY, IN THE SCHOOL SETTING, FOR STUDENTS IN NEED OF THIS LEVEL OF SUPPORT.PROVIDED MENTAL HEALTH EDUCATION/TRAININGS TO COMMUNITY:ALL BHS MENTAL HEALTH TRAININGS AND EDUCATION SERIES ARE DELIVERED, TO THE COMMUNITY, AND FREE OF CHARGE.- CTH STAFF TRAININGS ON CAREGIVER BURNOUT AND SELF CARE - SAFETALK SUICIDE PREVENTION TRAINING AND MENTAL HEALTH FIRST AID - CRISIS INTERVENTION TRAINING (CIT) (CARSON, LYON, CHURCHILL, DOUGLAS SHERIFF DEPTS.)- CARSON FIRE/PARAMEDICS - NURSING PROGRAMS WNC, UNR, TRUCKEE MEADOWS- CPI NONVIOLENT CRISIS INTERVENTION TRAINING FOR CTH EMPLOYEES PARTICIPATION IN COMMUNITY OUTREACH EVENTS AND HEALTH FAIRS:BHS PARTICIPATES IN COMMUNITY EVENTS TO EDUCATE, SPREAD AWARENESS AND REDUCE STIGMA. WITH THE GOAL TO BUILD HEALTHY AND HELPFUL PARTNERSHIPS WITH COMMUNITY RESOURCES. - NEVADA'S RECOVERY AND PREVENTION (NRAP) 5K WALK/RUN- SUICIDE PREVENTION WALK- WESTERN NEVADA COLLEGE HEALTH AND BENEFITS FAIR- SENIOR CELEBRATION HEALTH FAIR- WALK TO END ALZHEIMER'S - CARSON CITY SHERIFF'S NIGHT OUT- CARSON HIGH SCHOOL HEALTH FAIR- FERNLEY COMMUNITY HEALTH FAIRPARTNERSHIPS AND COLLABORATION WITH COMMUNITY STAKEHOLDERS:BHS PARTICIPATES IN STATE MEETINGS AS WELL AS COMMUNITY MEETINGS TO PARTNER, EDUCATE, SPREAD AWARENESS AND REDUCE STIGMA. WITH THE GOAL TO INCREASE SERVICES AND DEVELOP STRONGER PARTNERSHIPS.- NATIONAL ALLIANCE ON MENTAL ILLNESS (NAMI) WESTERN NEVADA - NEVADA COALITION FOR SUICIDE PREVENTION - CARSON CITY COMMUNITY COALITION- CARSON CITY PARTNERSHIP- CARSON CITY BEHAVIORAL HEALTH TASKFORCE- SENIOR SERVICE NETWORK - DOUGLAS COUNTY PARTNERSHIP- MOBILE OUTREACH SAFETY TEAM (MOST) ALL COUNTIES- NEVADA OFFICE OF SUICIDE PREVENTION- NORTHERN REGIONAL BEHAVIORAL HEALTH POLICY BOARDTHOUGH WE CANNOT ADDRESS ALL THE ISSUES IDENTIFIED IN THE CHNA REPORT, WE ARE BEING PROACTIVE BY COLLABORATING WITH OTHER COMMUNITY AGENCIES AS WE REALIZE THE VALUE OF A COMMUNITY WIDE COLLECTIVE IMPACT APPROACH."

Supplemental Information

Schedule H (Form 990) Part VI

PART I, LINE 3C:
TO QUALIFY FOR FINANCIAL ASSISTANCE UNDER CARSON TAHOE REGIONAL HEALTHCARE'S FINANCIAL ASSISTANCE PROGRAM, AN INDIVIDUAL MUST:1. LIVE WITHIN CARSON TAHOE'S PRIMARY SERVICE AREA;2. RECEIVE MEDICALLY NECESSARY CARE;3. HAVE HOUSEHOLD GROSS INCOME LESS THAN 400% OF FEDERAL POVERTY LEVELS; 4. APPLY FOR GOVERNMENT ASSISTANCE IF UNINSURED; 5. SUBMIT A BILL FOR INSURANCE COVERAGE IF INSURED; AND5. COMPLETE A FINANCIAL ASSISTANCE APPLICATION.INDIVIDUALS MAY NOT BE REQUIRED TO COMPLETE A FINANCIAL ASSISTANCE APPLICATION IF THEY ARE ELIGIBLE FOR STATE ASSISTANCE PROGRAMS (FOOD STAMPS, PHARMACEUTICAL ASSISTANCE PROGRAMS, WELFARE, ETC.) OR ARE CURRENTLY ELIGIBLE FOR MEDICARE BUT WERE NOT ELIGIBLE ON THE DATE THEY RECEIVED MEDICAL CARE.

PART I, LINE 7:
THE AMOUNTS IN PART I, LINES 7A THROUGH 7C WERE CALCULATED USING THE IRS WORKSHEETS BASED ON A COST-TO-CHARGE RATIO. THE AMOUNTS REPORTED IN PART I, LINES 7E THROUGH 7I ARE ACTUAL COSTS AND REVENUES.

PART I, LINE 7G:
SUBSIDIZED HEALTH SERVICES INCLUDE DIABETES EDUCATION AND OUTPATIENT CLINICS.

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 $ 25,417,945.

PART II, COMMUNITY BUILDING ACTIVITIES:
COMMUNITY BUILDING ACTIVITIES INCLUDED STAFF TIME SPENT IN SUPPORT OF COMMUNITY EMERGENCY PREPAREDNESS AND DISASTER READINESS, AS WELL AS HOSPITAL REPRESENTATION ON COMMUNITY PANELS.

PART III, LINE 2:
IN EVALUATING THE COLLECTABILITY 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 UNCOLLECTIBLE ACCOUNTS. 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 UNCOLLECTIBLE ACCOUNTS, IF NECESSARY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE HOSPITAL RECORDS A PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE.

PART III, LINE 3:
THE HOSPITAL CANNOT ESTIMATE WITH REASONABLE ACCURACY THE PORTION OF THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS WHO WOULD QUALIFY FOR FINANCIAL ASSISTANCE BUT DID NOT COMPLETE AN APPLICATION.

PART III, LINE 4:
"SEE THE ""PATIENT ACCOUNTS RECEIVABLE"" PARAGRAPH IN NOTE 2 ON PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS."

PART III, LINE 8:
THE MEDICARE ALLOWABLE COSTS WERE CALCULATED USING CARSON TAHOE REGIONAL MEDICAL CENTER'S 2021 MEDICARE COST REPORT.CARSON TAHOE REGIONAL MEDICAL CENTER CONSIDERS THE MEDICARE SHORTFALL TO BE A COMMUNITY BENEFIT. THE COMMUNITY MEMBERS UTILIZING MEDICARE TEND TO BE MEDICALLY UNDERSERVED AND MAY NOT BE ABLE TO AFFORD HEALTHCARE IF NOT FOR THE MEDICARE PROGRAM.

PART III, LINE 9B:
POLICIES IN EFFECT DURING 2021 ARE THE SAME AS CARSON-TAHOE HEALTH SYSTEM AND CARSON TAHOE CONTINUING CARE HOSPITAL. THE APPLICATION PERIOD FOR COMPLETION OF A FINANCIAL ASSISTANCE APPLICATION IS AVAILABLE FOR A MINIMUM OF 240 DAYS FROM THE TIME OF PATIENT SERVICE.

PART VI, LINE 2:
THE MOST CURRENT NEEDS ASSESSMENT WAS CONDUCTED IN 2019. NEEDS WERE IDENTIFIED USING DIRECT PATIENT AND PHYSICIAN FEEDBACK, SURVEY RESPONSES AND BEST PRACTICE INFORMATION FROM OTHER ORGANIZATIONS.

PART VI, LINE 3:
INFORMATION IS PROVIDED TO THE PATIENT AT THE TIME OF REGISTRATION, BOTH IN WRITING AND THROUGH DIRECT DISCUSSION WITH PATIENTS. INFORMATION IS PROVIDED IN THE PATIENT'S BILL. ELIGIBILITY REPRESENTATIVES AND FINANCIAL COUNSELORS ARE LOCATED ON SITE.

PART VI, LINE 4:
THE HOSPITAL'S COMMUNITY CONSISTS OF A SMALL URBAN AREA AND A LARGE RURAL POPULATION IN EXCESS OF 250,000 PEOPLE, COVERING NORTHERN NEVADA AND EASTERN CALIFORNIA. THE LARGEST DEMOGRAPHIC AGE IS 50 AND ABOVE.

PART VI, LINE 5:
USE OF SURPLUS FUNDS ALLOWS FACILITY TO UPDATE MEDICAL EQUIPMENT AND TECHNOLOGY WHICH PROVIDE ADVANCEMENTS IN PATIENT CARE. CARSON TAHOE PARTICIPATES WITH CARSON CITY HEALTH AND HUMAN SERVICES IN THE COMMUNITY HEALTH IMPROVEMENT PLAN 2020. CARSON TAHOE PROVIDES OUTREACH PROGRAMS, HEALTH FAIRS, WELLNESS PROGRAMS, BUSINESS HEALTH PARTNERSHIPS, SEMINARS, LECTURES AND EDUCATIONAL FORUMS TO HELP PROMOTE A HEALTHIER COMMUNITY. THE CENTER FOR HEALTH PROMOTION PROVIDES FREE HEALTH RESOURCES, CLASSES AND GUIDANCE. CARSON TAHOE IS COMMITTED TO PROVIDING THE BEST HEALTHCARE AVAILABLE TO ALL COMMUNITY MEMBERS REGARDLESS OF THEIR ABILITY TO PAY.

PART VI, LINE 6:
CARSON TAHOE REGIONAL HEALTHCARE IS A PART OF CARSON-TAHOE HEALTH SYSTEM IN CARSON CITY, NEVADA. THE SYSTEM IS COMPRISED OF THE FOLLOWING ENTITIES:CARSON TAHOE REGIONAL HEALTHCARE OWNS AND OPERATES:- CARSON TAHOE REGIONAL MEDICAL CENTER IS AN ACUTE CARE HOSPITAL LICENSED FOR 211 BEDS WITH A 24-HOUR EMERGENCY ROOM.- CANCER CENTER PROVIDES FOR EVERY ASPECT OF CANCER CARE FROM A MEDICAL AND RADIATION ONCOLOGY PRACTICE ALONGSIDE A COMPREHENSIVE CANCER RESOURCE CENTER AND INFUSION CENTER.- SPECIALTY MEDICAL CENTER PROVIDES OUTPATIENT LABORATORY, WOUND CARE AND BEHAVIORAL HEALTH SERVICES AND INPATIENT PSYCHIATRICT SERVICES.- MINDEN MEDICAL CENTER INCLUDES PHYSICIAN OFFICES, THE MINDEN EMERGENT AND URGENT CARE CENTER, AND OUTPATIENT LABORATORY AND RADIOLOGY SERVICES.- THREE WALK-IN CLINICS AT WALMARTS- TWO CENTERS FOR WOUND HEALING- TWO URGENT CARE CLINICS- TWO THERAPY CLINICS- ONE CARDIAC REHAB FACILITYCARSON TAHOE CONTINUING CARE HOSPITAL IS A LONG-TERM ACUTE CARE HOSPITAL LICENSED FOR 29 BEDS.CARSON TAHOE PHYSICIAN CLINICS IS A MULTISPECIALTY MEDICAL GROUP THAT EMPLOYS 83 PROVIDERS AT 14 LOCATIONS WITH SPECIALTIES THAT INCLUDE NEUROSURGERY, CARDIOLOGY, ENDOCRINOLOGY, FAMLIY MEDICINE, INTERNAL MEDICINE, ONCOLOGY, PSYCHIATRY, RHEUMATOLOGY, PAIN MANAGEMENT, INTERVENTIONAL CARDIOLOGY AND CARDIOTHORACIC SURGERY.CARSON-TAHOE HEALTH SYSTEM IS THE PARENT ORGANIZATION AND PROVIDES MANAGEMENT AND ADMINISTRATIVE SERVICES TO THE REST OF THE SYSTEM.

PART VI, LINE 7, REPORTS FILED WITH STATES
NV

Operating expenses	$ 357,024,058
Total amount spent on community benefits as % of operating expenses	$ 42,729,256 11.97 %