Community Benefit Insight - Tax-exempt hospital

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Central Valley Medical Center

Central Valley Medical Center

48 West 1500 North
Nephi, UT 84648

Bed count	25	Medicare provider number	461304	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 870419324

Display data for year:

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

10.22%

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	$ 519,316 0.99 %
Medicaid as % of operating expenses	$ 484,130 0.92 %
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	$ 4,031,943 7.66 %
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.	$ 185,144 0.35 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 160,500 0.30 %
Community building* as % of operating expenses	$ 3,750 0.01 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	YES
Number of activities or programs (optional)	2
Physical improvements and housing	0
Economic development	0
Community support	1
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	1
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	$ 3,750 0.01 %
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	$ 3,200 85.33 %
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	$ 550 14.67 %
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	$ 2,025,452 3.85 %
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	$ 441,564 21.80 %

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 $ 44966033 including grants of $ 197950) (Revenue $ 52721611)
Central Valley Medical Center operates a hospital and three medical clinics providing medical care to rural communities.

Facility Information

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

Central Valley Medical Center
Part V, Section B, Line 5: Central Valley Medical Center distributed surveys to the public through various methods in order to receive feedback for the CHNA. Secondary data collection included a combination of data collected from sources of health statistics from a variety of local, state, and national information sources such as the Utah Department of Health and the United States Census Bureau. CVMC engaged Local Interagency Council to conduct focus group interviews and discuss survey results with CVMC Physicians and Juab Unites Motivating Prevention (JUMP).

Central Valley Medical Center
Part V, Section B, Line 11: CVMC will address the following needs that were identified in its most recent Community Health Needs Assessment: Mental Health, Obesity and Physical Activity, and Preventative and Routine Care.CVMC will not directly address the identified needs of Joint/Back Pain, Diabetes, Heart Disease, and Substance and Alcohol Abuse due to financial constraints. However, CVMC believes it will positively impact these areas through the three areas it has chosen to address.CVMC focused on addressing needs from the prior CHNA and Implementation Strategy for FY22, as follows.Urology We are continually attempting to bring this service to our community but Urologists are in extreme short supply. Attempts have been made for a Urologist to come to our community at least once a month with no success.CardiologyThis need was met in prior years.Oncology / Cancer TreatmentsThis need was met in prior years. Mental Health / Psychiatric CareWe have started the recruiting process to bring additional mental health providers to the community.Dialysis / Kidney ServicesFurther investigation of potential dialysis/kidney services showed that most dialysis is either being done in the patient's home or is moving to be home based. The need for hospital or outpatient based dialysis is changing and the need is becoming non-existent.

Central Valley Medical Center
Part V, Section B, Line 13h: In addition to utilizing FPG to determine eligibility for financial assistance, the organization also considers the patient's insurance and underinsurance status, and factors that result in presumptive eligibility.

Schedule H, Part V, Section B, Line 7a:
The Community Health Needs Assessment is available at:https://www.centralvalleymedicalcenter.com/about-cvmc/community-health-needs-assessment/

Schedule H, Part V, Section B, Line 10a:
The Implementation Strategy is available at:https://www.centralvalleymedicalcenter.com/about-cvmc/community-health-needs-assessment/

Part V, Lines 16a-16c
The FAP, FAP application, and plain language summary are available at:https://www.centralvalleymedicalcenter.com/patients-visitors/accounts-billing/financial-assistance/

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
In addition to FPG, CVMC considers medical indigency, the patient's insurance and underinsurance status, and factors that result in presumptive eligibility.FPG levels are used to determine annual maximum amounts owed based on family size. Amounts above the annual limit are adjusted off.

Part I, Line 7:
Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. The amount reported on Line 7b was calculated using IRS Worksheet 3. The amount reported on line 7e was calculated using IRS Worksheet 4. The amount reported on line 7i was derived directly from the general ledger.

Part I, Line 7g:
The amount reported on line 7g was calculated using internal cost accounting records. Physician clinic expense of $10,654,118 is included in line 7g as well as revenue of $7,881,509 for a net community benefit from physician clinics of $2,772,609.

Part III, Line 2:
The amount on line 2 represents implicit price concessions. The Organization determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
The estimated amount of the organization's implicit price concessions attributable to patients eligible under the organization's charity care policy was calculated by applying the estimated percentage of the service area below 150% of poverty guidelines, which is 21.8% for the area, to the amount of implicit price concessions.

Part III, Line 4:
The footnote that describes implicit price concessions is on page 13 and 14 of the attached financial statements.

Part III, Line 8:
Medicare allowable cost of care was calculated from the Medicare cost report for fiscal year ending 6/30/22.Many patients in our service area qualify for Medicare. The facility provides services to these patients even through Medicare reimbursement is not sufficient to cover the cost of providing this care. Providing services to this population promotes access to healthcare services which are needed in our community, thereby providing a benefit to our community.

Part III, Line 9b:
Efforts are made to identify individuals up front that would qualify for discounted or free care through our FAP. If not identified at time of service, three patient notices over a 120 day period are sent on all patient accounts indicating amounts owed before collection efforts are initiated. As individuals/families are identified and an application process is initiated, collection efforts are suspended for 120 days to allow for a financial assistance application to be completed and evaluated for qualification. Qualified FAP applications are valid for 1 year and patient accounts are adjusted according to qualified amounts for each calendar year. Individuals known to qualify for financial assistance are reminded to complete an application for assistance if the qualification year has lapsed.CVMC will not engage in extraordinary collection actions before it makes reasonable effort to determine whether a patient is eligible for financial assistance under it's FAP. Reasonable efforts include:1. Validating that the patient owes the unpaid bills and that all sources of third party payment have been identified and billed by the hospital;2. Documentation that Central Valley Medical Center has offered or has attempted to offer the patient the opportunity to apply for charity care pursuant to this policy and that the patient has not complied with the hospital's application requirements;3. Documentation that the patient has been offered a payment plan but has not honored the terms of that plan.

Part VI, Line 2:
Outside of the required triannual community health needs assessment, the hospital holds physician meetings monthly that allow for physician input on needed services or equipment or other areas of needs and concerns. Administration lives in the community and listens to friends and neighbors for potential health needs that can be met. The hospital also has a patient suggestion box.

Part VI, Line 3:
CVMC has signs informing patients of its charity care policy in admissions areas, emergency rooms, and other areas of the organization's facilities in which eligible patients are likely to be present. A summary copy of the policy and financial assistance contact information is provided to patients as part of the registration process. A financial counselor is available to discuss with the patient the availability of various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable.

Part VI, Line 4:
CVMC is located in Nephi, Utah, which is often referred to as the center of Utah, geographically. Nephi is a small rural town with a population of 6,000 located in Juab County, which has a population of approximately 11,250. The facility serves populations primarily from Juab, Sanpete, and Millard Counties. All three counties are considered rural and are sparsely populated. Because CVMC is situated near the convergence of several major highway systems (I-15, SR 132 and SR 28), the facility also serves populations from other neighboring counties, along with many travelers along I-15 and visitors recreating in nearby outdoor attractions, such as, the Little Sahara Desert, Mount Nebo, and Yuba Lake.

Part VI, Line 5:
All of CVMC's board of Directors is comprised of persons who reside in CVMC's primary service area and are neither employees nor contractors of CVMC and are not family members of CVMC's officers or key employees. The Board of Directors help in monitoring the pulse of the community and make recommendations for needs and concerns that CVMC may address. Health leadership activities in the community have developed greater awareness and understanding of health needs for the provision of healthcare for all. Medical staff privileges are extended to all qualified physicians that desire to practice at CVMC. Surplus funds are used to provide services not otherwise cost effective that are needed in the community such as Labor and Delivery services, Home Health and Hospice services and Physician Clinics in outlying areas and to support a charity program providing free or reduced price care to low income patients. CVMC's Emergency Department is available 24/7 to all in need regardless of their ability to pay. CVMC is the sole hospital in Juab County and serves all patients including those with Medicare and Medicaid coverage and those without insurance coverage.Excess funds have been used multiple times to provide additional patient care space including emergency, women's health and surgery space to better serve our community and meet the needs of a growing population. This is a sizable investment from our surplus funds to further our mission of providing healthcare in our community. Juab County Utah is projected to increase population from 12,000 to approximately 60,000 people by the year 2050 which will increase healthcare demand significantly. Our strategic plan is guiding us to meet this demand.Basic Life Support, Advanced Cardiac Life Support, and Pediatric Advance Life Support trainings are also offered to the community.

Operating expenses	$ 52,664,180
Total amount spent on community benefits as % of operating expenses	$ 5,381,033 10.22 %