Community Benefit Insight - Tax-exempt hospital

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Washoe Barton Medical Clinic

Carson Valley Medical Center

1107 Us Highway 395
Gardnerville, NV 89410

Bed count	23	Medicare provider number	291306	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 880405927

Display data for year:

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

10.13%

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	$ 724,000 1.02 %
Medicaid as % of operating expenses	$ 2,734,742 3.87 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 3,141,299 4.44 %
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.	$ 507,214 0.72 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 55,091 0.08 %
Community building* as % of operating expenses	$ 480 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)	5
Physical improvements and housing	0
Economic development	0
Community support	5
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	$ 480 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	$ 480 100 %
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	$ 2,828,488 4.00 %
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	$ 31,367 1.11 %

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 $ 45067862 including grants of $ 0) (Revenue $ 43434440)
Washoe Barton Medical Clinic dba Carson Valley Medical Center:Carson Valley Medical Center is a 25-bed hospital that covers a service area that includes approximately 50,000 residents. A focus on patient centered care and quality have resulted in Carson Valley Medical Center consistently ranking high in patient satisfaction on both inpatient and outpatient consumer satisfaction surveys. Carson Valley Medical Center facilities include a full-service hospital, Emergency Room, Infusion, Lab, Medical Imaging, Physical and Respiratory Therapy, Mental Health, Sleep & Neurodiagnostic Lab, Wound Care and Telemedicine. Clinics include Carson Valley Medical Center Senior Care (a provider-based clinic (Continued on SCH O)servicing patients over 65), Job's Peak Internal Medicine & Family Practice, Topaz Ranch Medical Clinic, Minden Family Medicine and Complete Care, Ironwood Primary Care, Ironwood Urgent Care and Occupational Health Clinics.

4B (Expenses $ 9259616 including grants of $ 0) (Revenue $ 25509201)
Pharmacy:Program expenses are used in the provision of health care services to the community. Carson Valley Medical Center provides inpatient and outpatient pharmaceutical services for the hospital and outpatient clinics. In 2021, there were higher patient acuities and more patient volume than the previous year. In 2021, 190,042 pharmacy orders were processed.

4C (Expenses $ 7507121 including grants of $ 0) (Revenue $ 10740244)
Surgery:Program expenses are used in the provision of surgical services to the community. Carson Valley Medical Center provides inpatient and outpatient surgery services. Emergency and elective surgeries are performed by general and specialty surgeons. In 2021, 1,513 surgeries were performed at Carson Valley Medical Center.

Facility Information

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

Carson Valley Medical Center
Part V, Section B, Line 5: In 2019, A Community Health Needs Assessment was conducted on behalf of Carson Valley Medical Center by Professional Research Consultants, Inc. (PRC). Methodology: This assessment incorporates data from both quantitative and qualitative sources. Quantitative data input includes secondary research (vital statistics and other existing health related data) that allows for comparison to benchmark data at the state and national levels. Qualitative data input includes primary research gathered through the Online Key Informant Survey. The study area for this effort is Douglas County, Nevada. This community definition was determined based on the areas of residence of most recent patients of Carson Valley Medical Center.To solicit input from key informants, those individuals who have a broad interest in the health of the community, an Online Key Informant Survey was implemented as part of this process. A list of recommended participants was provided by Carson Valley Medical Center; this list included names and contact information for 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 populations with whom they work, as well as of the community overall.Key informants were contacted by email, introducing the purpose of the survey and providing a link to take the survey online; reminder emails were sent as needed to increase participation. In all, 33 community stakeholders took part in the Online Key Informant Survey.Through this process, input was gathered from several individuals whose organizations work with low-income, minority, or other medically underserved populations. In the online survey, key informants were asked to rate the degree to which various health issues are a problem in their own community. Follow-up questions asked them to describe why they identify problem areas as such, and how these might better be addressed. Results of their ratings, as well as their verbatim comments, are included throughout this report as they relate to the various other data presented. NOTE: The Online Key Informant Survey was designed to gather input regarding participants' opinions and perceptions of the health needs of the residents in the area. Thus, these findings are based on perceptions, not facts.

Carson Valley Medical Center
Part V, Section B, Line 6b: Final participation included representatives of the organizations: Carson Valley Medical Center/ Minden Family Medicine, Carson Valley Chamber of Commerce, Douglas County School District, Douglas County Sheriff's Office, DP Consulting, East Fork Fire Protection District, Me for Incredible Youth (MEFIYI), Minden Family Medicine, Rural Health Clinic (CVMC), REMSA/Care Flight, Renown Health, Senior Care, Sierra Nevada ENT and Hearing Aid Center, Tahoe Fracture and Orthopedics, The RecordCourier Newspaper.

Carson Valley Medical Center
Part V, Section B, Line 7d: http://cvmchospital.org/about_us/health_needs_assessment.aspx

Carson Valley Medical Center
Part V, Section B, Line 11: For the 2019 Community Health Needs Assessment - the following were the community needs identified and addressed in the 2019 - 2020 implementation plan as well as actions that CVMC has taken to address these areas.The Areas of Opportunity were determined after consideration of various criteria, including: standing in comparison with benchmark data; the preponderance of significant findings within topic areas; the magnitude of the issue in terms of the number of persons affected; and the potential health impact of a given issue. These also take into account those issues of greatest concern to the community stakeholders (key informants) giving input to this process.1) Access to Health Services - lack of health insurance for children and adults and the primary care physician ratio2) Heart Disease & Stroke - high blood cholesterol3) Infant Health & Family Planning - low-weight births4) Injury & Violence - unintentional injury deaths5) Mental Health - suicide deaths *ranked as a top concern in the Online Key Informant Survey 6) Nutrition, Physical Activity & Weight - low food access *ranked as a top concern in the Online Key Informant Survey7) Substance Abuse - excessive drinking *ranked as a top concern in the Online Key Informant Survey 8) Tobacco Use - cigarette smoking prevalenceCVMC did not address infant health and family planning as that is covered in our community by the community health department, who we work closely with. Access to health services and unintentional injury deaths were not specifically addressed in the current year initiatives.Specifically, actions taken to address the top three areas of need for the year 2021 include:1) Mental Health- Suicide Deaths: CVMC continued to grow our outpatient behavioral health clinic.2) Nutrition, Physical Activity and Weight - Increased the nutritional counseling appointments by 96% from 2019. The Hospital continued the Stay Hydrated campaign by attending over 90 events with our hydration station.3) Substance Abuse - Excessive Drinking: Continued support/partnership with Partnership of Community Resources.In addition, we continue to operate and grow the cancer clinic, which had significant growth in patient visits in 2021.

Carson Valley Medical Center
Part V, Section B, Line 16j: English and Spanish are readily available and if another language is needed, then the FAP is translated into that language.

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 7:
Line 7a:Financial Assistance was calculated by multiplying the ratio of cost to gross charges for the Organization by the gross uncompensated charges associated with providing charity care to its patients.Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services are calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers. Line 7e:Community health improvement services are actual costs reported in the general ledger. Line 7i:Cash and in-kind donations are actual costs reported in the general ledger.

Part I, Line 7g:
Carson Valley Medical Center runs seven physician clinics to treat patients in the community. The clinics need to be subsidized by the hospital to meet their payroll and other monthly expense needs. The subsidized health services amount includes $3,586,428 associated with two rural health clinics and $3,567,251 from physician clinics.

Part II, Community Building Activities:
"Community Support includes support groups provided to the community by CVMC. These include ""coping with change,"" grief, Alzheimer's caregiver, diabetes, and weight management support groups."

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 Hospital estimated the amount of implicit price concessions attributable to patients eligible under the organization's financial assistance policy by applying the percentage of charity care to total patient gross charges to the implicit price concessions.

Part III, Line 4:
The financial statement footnote regarding implicit price concessions may be found on page 13 and 14 of the attached financial statements.

Part III, Line 8:
Total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.

Part III, Line 9b:
The general billings and collections policy applies to all patients, including any application under the charity care policy. The Hospital does not send patient accounts to collections before 120 days of the date of the first invoice. The Hospital will pull back patient accounts from collections if a patient submits a financial assistance application within 240 days of the date of the first invoice.

Part VI, Line 2:
In addition to the community health needs assessment, CVMC regularly assesses data trends and utilization data from internal sources as well as secondary sources (state and local agencies, Nevada Rural Hospital Partners, Nevada Hospital Association, etc.) to assess community need. CVMC partners with local development authority, Chambers of Commerce, and government committees to ensure CVMC is responding to the needs of the community.

Part VI, Line 3:
Communication is via website, brochures, telephone and in person. Website is www.cvmchospital.org/patients_visitors/financial_assistance.aspx

Part VI, Line 4:
Carson Valley Medical Center (CVMC), serves Douglas County which is an area spanning 710 square miles and includes eight ZIP codes: 89705 (south Carson City), 89460 (Gardnerville Ranchos), 89411 (Genoa), 89423 (Minden), 89448 (Zephyr Cove), 89449 (Stateline), 89444 (Topaz Ranch) and 89410 (Gardnerville). It also includes outlying areas that include Wellington NV, Markleeville, CA and Coleville, CA. This broad area encompasses various neighborhood settings, including both rural and suburban areas. CVMC is in Douglas County, NV, which has a population of 49,463 (80% white, 14% Hispanic, 2% Native American). Median household income is $61,176, with 9.8 percent of population in poverty. (Data from Carson City Health & Human Services: Primary & Secondary Data Sets, 2019).

Part VI, Line 5:
The majority of the organization's board of directors is comprised of persons serving in the medical community of the greater Northern Nevada area. The organization extends medical staff privileges to credentialed and approved practitioners in its community. The organization's mission is to promote the health and wellness of the Carson Valley and its visitors. Surplus funds are used to acquire equipment and resources that improve patient care.CVMC Emergency Room available to all patients, regardless of ability to pay.CVMC is committed - as the community hospital - to promote the health of the members of the community. We do so through community outreach and wellness programs, including reaching out to local employers in our workplace wellness programs and offering low cost and free screenings to detect and prevent illness and disease. The hospital operates a 24 hour emergency room for medically necessary care to all regardless of ability to pay. The hospital participates in education and training of healthcare professionals. The hospital participates in government-sponsored health programs such as all Medicaid, Medicare, Tricare, all Veterans Administration healthcare and Indian Health Services. The organization is the sole community hospital in Douglas County. The organization currently has 17 active volunteers. The organization has numerous employees involved in local and state community programs including Douglas County Business Council, Minden Rotary, Carson Valley Chamber of Commerce, Nevada Rural Hospital Partners, National Association for Healthcare Quality, American Hospital Association, MGMA, Boy Scouts of America, Family Support Council of Douglas County, Partnership of Community Resources, Tahoe Youth and Family Services, Kiwanis, and the Douglas County Community and Senior Center.Community outreach and education are provided to our community members to increase awareness of prevalent health issues and promote healthy behaviors and lifestyles. Programs include workplace wellness, health fairs, career days, and services provided at large-scale community events. The organization is responsive to the community needs such as opportunities for community involvement in governance and advisory groups. The organization serves as a vehicle for attracting and effectively uses donated funds.

Part VI, Line 6:
Although this hospital is not in an affiliated health system, it does have two members, each about 45 miles away serving different communities.

Operating expenses	$ 70,713,639
Total amount spent on community benefits as % of operating expenses	$ 7,162,346 10.13 %