2024-08-12T08:36:44-05:00 2023-09-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-10-01 454551946 Teton Valley Health Care Inc TETO 2083542383 120 East Howard Avenue Driggs ID 83422 Troy Christensen CEO 2083542383 2024-08-08 1 1 Kim Hunwardsen CPA P00484560 6122536500 2024-08-08 2022 2024-08-08 14:25:15Z Troy Christensen 120 East Howard Avenue Driggs ID 83422 27414791 0 X www.tvhcare.org X 2012 ID To encourage and support a healthier community. 5 5 184 6 0 0 214638 2998346 24443855 24400569 3286 1998 339362 13878 25001141 27414791 15672 66763 0 0 14802881 15992584 0 0 138954 11876032 13247548 26694585 29306895 -1693444 -1892104 17925102 17374110 2679284 4020396 15245818 13353714 X To encourage and support a healthier community. 0 1 22958166 66763 24237972 The organization operates a critical access hospital and two rural health clinics. The hospital admitted 174 patients that spent 870 cumulative days on the acute floor. The emergency department experienced 3,403 visits. 692 surgical procedures were performed. The two rural health clinics provided 14,901 visits during this same period. 189919 176475 Cache Clinic was a private pay clinic that was discontinued in fiscal year 2023. 23148085 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 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 1 1 1 1 0 0 1 41 0 1 184 1 0 0 0 0 0 0 0 0 0 0 X 5 5 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X Leianne Everett 2083546340 120 East Howard Avenue Driggs ID 83422 JoAnne Kay - Vice Chair (Until Jan 23)/Chair (From Jan 23) 1.00 0.00 X X 0 0 0 Aaron Hansen Treasurer (Until Oct 22) 1.00 0.00 X X 0 0 0 Janet Conway Treasurer (From Nov 22) 1.00 0.00 X X 0 0 0 Kevin Mayberry Secretary Until Jan 23)/Vice Chair (From Feb 23) 1.00 0.00 X X 0 0 0 Ken Dunn Director Until Jan 23)/Secretary (From Feb 23) 1.00 1.00 X X 0 0 0 Anjali Tate Director 1.00 0.00 X 0 0 0 Troy Christensen CEO (From Sept 23) 40.00 0.00 X 0 0 0 Nathan Levanger CMO Interim CEO (Until Aug 23) 40.00 0.00 X 340830 0 19034 Lori Leianne Everett CFO (From June 23) 40.00 0.00 X 0 0 0 Tish Miller CFO (Until May 23) 40.00 0.00 X 280062 0 37567 Maria Kennah CAO (As of Jan 23) 40.00 0.00 X 326426 0 20179 Taylor Nelson CRNA 40.00 0.00 X 265196 0 26812 Chad Horrocks Family Practice Physician 32.00 0.00 X 273444 0 32426 Stephen Houmes ED Physician 48.00 0.00 X 337035 0 51453 Maurice Brown Orthopedic Surgeon 40.00 0.00 X 447135 0 119694 Juanita Prissel Family Practice Physician 40.00 0.00 X 285073 0 25102 Keith Gnagey Former CEO 0.00 0.00 X 363929 0 23223 2919130 0 355490 28 1 1 0 PMNagle Consulting LLC 3816 Salish Trail Stevensville MT 59870 Revenue Cycle Consulting 383500 Daniel Smith 2425 S 60th E Idaho Falls ID 83406 Physician Services 355183 Connected Health Care Inc 1408 East 13th Street Austin TX 78702 Contract Labor 227063 Pharmgo LLC 1790 Deer Valley Dr Idaho Falls ID 83401 Contract Pharmacist 201071 Quallvis 1601 Assembly St 1439 Columbia SC 29201 Contract Labor 161665 10 197249 2695135 105962 2998346 Patient Service Revenue 624100 23912157 23912157 340B Revenue 456110 185531 185531 302881 302881 24400569 1998 1998 13878 0 13878 13878 13878 27414791 24414447 0 1998 X 66763 66763 934052 934052 329893 329893 12509985 11294311 1159884 55790 179114 163613 14839 662 1113483 897549 212720 3214 926057 746539 178811 707 49890 49890 73250 73250 5678430 3773031 1904001 1398 281912 315 281559 38 210240 79273 130943 24 304068 214916 88424 728 149370 85715 63516 139 11736 11736 870797 818268 52529 263647 229260 34387 Medical Supplies 4196720 4137815 58821 84 Lease and Rental Expens 508289 209952 222937 75400 Recruitment Expense 359502 156472 203030 Repairs and Maintenance 250603 247371 3232 39094 15186 23138 770 29306895 23148085 6019856 138954 7613752 580971 660423 3417948 21194 3789494 4829124 1085216 1184320 93775 54753 16143375 12713495 3942442 3429880 740000 3855920 17925102 17374110 2253120 2469154 426164 282825 0 1268417 2679284 4020396 X 15245818 13353714 15245818 13353714 17925102 17374110 -1892104 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1137 1137 0 Schedule C, Part II-B, Line 1 The Hospital does not directly perform any lobbying activities. The Hospital pays membership dues to National and State Hospital Associations. The associations use a portion of such dues to carry out lobbying activities. 92671 92671 8167889 6189676 1978213 7650912 6487316 1163596 231903 36503 195400 3429880 ERC Receivable 2426570 Operating ROU Assets 1176762 Financing ROU Assets 55339 Related Party Receivable 197249 3855920 Operating Lease Liability 1211102 Financing Lease Liability 57315 1268417 X 27369791 -45000 -45000 27414791 0 27414791 29261895 0 29261895 45000 45000 29306895 Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Grant expense included in revenue in expenses on Form 990 -45,000. Part XII, Line 4b - Other Adjustments: Grant expense included in revenue in financials 45,000. 1 1 X 1 X 1 X 1 1 1 0 0 178000 178000 0.00610 2389033 1244495 1144538 0.03910 2567033 1244495 1322538 0.04520 17574 17574 0.00060 11317259 5228598 6088661 0.20780 11334833 5228598 6106235 0.20840 13901866 6473093 7428773 0.25360 5563 5563 0.00020 1292 1292 0.00000 6855 6855 0.00020 1 1454934 145493 6329094 6362601 -33507 X 1 1 1 1 Teton Valley Health Care Inc 120 East Howard Ave Driggs ID 83422 www.tvhcare.org 31 X X X X Teton Valley Health Care Inc 1 0 0 1 X X X X X X X X X 21 1 0 1 1 X www.tvhcare.org X 1 21 1 www.tvhcare.org 0 1 X 200.000000000000 350.000000000000 X X 1 1 X X X 1 X www.tvhcare.org X www.tvhcare.org X www.tvhcare.org X X X X X X X 1 X 0 X X X X 1 X 0 1 Teton Valley Health Care Inc. Part V, Section B, Line 5: Community opinion data was gathered through surveys and interviews. A CHNA survey was deployed to local expert advisors and the general public to gain input on local health needs and the needs of priority populations. Local expert advisors were local individuals selected according to criteria required by the Federal guidelines and regulations and the Hospital's desire to represent the region's geographically diverse population. 410 survey responses from community members were gathered.Focus groups and individual interviews were conducted to validate survey findings, gather additional information, and gain additional input from priority populations including seniors, racial and ethnic minority groups, and young adults.The survey respondents participated in a structured communication technique called the "Wisdom of Crowds" method. This approach relies on the assumption that the collective wisdom of participants is superior to the opinion of any one individual, regardless of their professional credentials.Input was obtained from the required three minimum sources and expanded to include other representative groups. TVHC asked all those participating in the written comment solicitation process to self-identify into any of thefollowing representative classifications. Participants self-identified as follows:1) Public Health Official2) Government Employee or Representative3) Minority or Underserved Population4) Chronic Disease Groups5) Community Resident6) Educator7) Healthcare Professional8) OtherInformation analysis augmented by local opinions showed how Teton County relates to its peers in terms of primary and chronic needs as well as other issues of uninsured persons, low income persons and minority groups; espondents commented on certain population groups or people with certain situations that may need help to improve their condition and if so, who needs to do what. Teton Valley Health Care Inc. Part V, Section B, Line 6b: TVHC partnered with QHR Health to complete a CHNA report. Teton Valley Health Care Inc. Part V, Section B, Line 11: The Hospital does not have adequate resources to solve all the significant needs identified. Some issues are beyond the mission of the Hospital and action is best suited for a response by others. Some improvements will require personal actions by individuals rather than the response of an organization. We view this as a plan for how we, along with other area organizations and agencies, can collaborate to bring the best each has to offer to support change and to address the most pressing identified needs. The significant health needs identified in the latest CHNA were: * Affordable Housing * Behavior Health: Mental Health and Drug/Substance Abuse * Affordability of Healthcare * Education System * Access to Healthcare Services: Presence of Services * Access to Senior Services * Livable Wage * Access to Childcare, * Access to Healthy Food * CancerTVHC addresses these areas through identified programs and resources as well as collaboration with other local organizations/agencies. Metrics are included for each health need to track progress.The Hospital is continually assessing the health needs of our community and deciding how we can better serve our community based on need.In the most recent CHNA we identified the biggest concerns for our community, and the corresponding needs that our organization should focus on from a healthcare perspective. While we understand that these are needs that our community has, we do believe other organizations in the community will be better suited to address access to childcare, access to healthy food, access to senior services, livable wages and the education system.TVHC has been working on the following needs identified in the 2022 CHNA: Mental Health; Healthcare Services affordability; Physical Presence of healthcare services; Cancer Care; Drug/Substance Abuse. We have implemented a telemedicine mental and behavioral health program in our clinics to increase access to services for mental and behavioral health and those struggling with drug/substance abuse issues. Our CFO has improved our financial support services to better serve our community that cannot afford the care they need. Our foundation has raised funding to support healthcare for our lower income patients, where the hospital's financial support services does not fill the need. We have expanded services and hired additional physicians, as well as offering better services for our cancer patients. We are also exploring expanding services to include the on-site presence of an oncologist some time during this year. In addition, during the year the Hospital expanded services relating to swing-bed and swing bed supporting services. Teton Valley Health Care Inc. Part V, Section B, Line 16j: TVHC collaborates with the Community Resource Center of Teton Valley to ensure that they are aware of our resources so that they can share our FAP with their clientele. Teton Valley Health Care Inc. Part V, Section B, Line 24: The financial assistance policy clearly states that it provides free or discounted services for medically necessary care. We do not discount services provided in our aesthetics department. 3 1 - Driggs Health Clinic 283 North First East Driggs ID 83422 Rural Health Clinic 2 - Victor Health Clinic 83 N Main Street Victor ID 83455 Rural Health Clinic 3 - Cache Clinic 852 Valley Center Drive Driggs ID 83422 Outpatient Clinic Part I, Line 7: The Organization calculated the cost for providing financial assistance reported in Part I, line 7a by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to its patients. Medicaid on line 7b and subsidized health services on line 7g are reported according to costs allocated to the relevant costs centers on the Medicare Cost Report. The Organization used actual expenses to determine the cost for Community Health Improvement Services line 7e. Part I, Line 7g: The subsidized health services includes costs of $6,602,920 from rural health clinics. Part II, Community Building Activities: Teton Valley Health Care provided a community breakfast for breast cancer awareness, as well a hosted Tough Enough to Wear Pink for breast cancer awareness. In addition, the organization hosted a community booth to recruit staff to their area, and hosted high school field trips to the hospital to provide education about medical careers. 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 that would qualify for community benefit if patients completed the financial assistance application by multiplying the line 2 implicit price concessions by the percentage of the population that is under the FPG. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 12 and 13 of the attached audited financial statements. Part III, Line 8: Any shortfall should be treated as community benefit. A facility must be able to recover its costs in order to continue to provide quality care to Medicare patients and the community as a whole. Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall, if any, is considered a community benefit.Medicare allowable costs of care are based on 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 Hospital's business office staff follow up on accounts 60 to 90 days after the accounts are billed. The staff contact the insurers to verify claims have been received and to resend the claims if necessary. After verifying claims have been received, the staff continue to contact the insurers every 30 days, as necessary, to follow up on the status of the claims. Once insurance balances are exhausted, the remaining self-pay balances are then managed by the Hospital self pay division which attempts to collect for 120 days. If payment for non-Medicare accounts is still not collected or if payment terms are not adhered to then the balance is sent to Kinum for precollections for 30 days and at day 151 unpaid accounts are forwarded to collections. Medicare accounts are returned to the Hospital and written off as uncollectible Medicare bad debt. If a patient begins the financial assistance application at any point, the Hospital will pull the client out of collections to work through the application process. Part VI, Line 2: Management, Hospital department staff and managers, and the Board of Directors are comprised of members within the community. They are able to gather and communicate the health care needs of the community itserves and continually address them at staff and board meetings. TVHC has providers on boards, such as Ski Patrol and Search & Rescue, and TVHC participaties in several Hospital Consumer Assessment of Healthcare Providers and System (HCAHPS) Patients' Perspectives of Care Surveys throughout the year. Part VI, Line 3: In compliance with the collection policies of TVHC, an annual review is performed for all credit/collection and financial assistance policies. Once reviewed and revised, the information is distributed to the community in a variety of ways. The facility published a brochure that is placed in public areas of all the TVHC facilities, as well as included in all formal admission packets to patients. The patient account representative's hand out the information during patient consults as well. The information is also available on the TVHC website and included with every patient account statement.Signs and/or Rack Cards are posted at each point of patient registration and in waiting areas. Financial Assistance information is posted on the organization's website and on patient statements. CFO and/or Revenue Cycle representatives attend community functions to inform the community of financial assistance programs. Medical staff and managers are educated annually on the policy to promote at time of care if appropriate. Patient Financial Advocates promote and provide financial counseling. Part VI, Line 4: Teton County Idaho covers 450 square miles of Southeastern Idaho. The 2020 population was 11,630 compared to a 2010 population of 10,170. Median age is 36.3, median household income is $54,896 compared to $48,905for the State of Idaho, and an unemployment rate of 4% compared to 3.9% for the state and 4.9% for the U.S. Hispanics make up 17.7% of the population with 80.2% white/non-Hispanic.Teton Valley Health Care, Inc. (TVHC) has been serving the healthcare needs of the Teton County area since 1938. The Hospital is now a nonprofit, thirteen bed critical access facility built in 1997. TVHC offers a continuum of care including inpatient hospital services, outpatient services as well as outpatient clinics in the cities of Victor and Driggs. TVHC employs over 220 individuals, with an annual payroll in excess of 12.5 million. Part VI, Line 5: Teton Valley Health Care's Board of Directors is comprised of community members representing multiple facets of the community from the financial sector to small business owners to retirees. The Board has dedicatedtheir time to ensuring they understand the health and welfare needs of greater community.Medical staff privileges at TVHC are open to all medical providers with active licensure. While they have instituted an arduous credentialing process to ensure practitioners of the highest caliber are privileged, they encourage practitioners from numerous specialties to meet the ever expanding healthcare needs of the community.As a non-profit corporation, TVHC does not have any shareholders. Therefore surplus funds are reinvested into the facility's equipment and employee education. The absence of shareholders eliminates the potential for conflicts of interest related to attaining inflated profit margins and allows Teton Valley Healthcare to focus on what is important; meeting the health and welfare needs of the communities they serve in an economically viable fashion.The Hospital participates in multiple activities within its community to promote the health of the community it serves including donating to an annual health fair where medical tests are provided at reduced prices to ensure the community knows their numbers and risks and focusing on prevention and intervention.In addition, the Hospital continues to collaborate with local officials to provide needed services and donates time and effort to the community. We provide substantial amounts of uncompensated care to individuals that are in need.One of the services provided to patients is Chronic Care Management. The Hospital has two nurses who create care plans with patients from referrals of our Primary care providers in the clinics. The provide monthly follow up phone calls with these patients to check on them and make sure they have what they need to follow their care plans. They also educate patients on how to best manage their chronic conditions. They do A1c testing for patients. They also meet face to face with patients throughout the week to help them overcome barriers to their care plans. In fiscal year 2023 the nurses provided services of $128,575 that were not billed out for reimbursement.The Hospital also hosts a booth at several area events to promote health, hospital services, and provide resources. In addition the Hospital provides sponsorships for several area events such as Snowscapes Downtown, 4th of July Parade, Teton County Fair, Music on Main, Turkey Trot fun run, Shakespeare in the Park, Plein Air Festival, and Meet and Greet for Community. 1 Teton Valley Health Care Foundation Inc 120 East Howard Ave Driggs ID 83422 932017214 45000 0 Transfer grant funds received by TVHC to the Foundation Teton Valley Foundation PO Box 50 Victor ID 83455 870766886 7950 0 Sponsor Music on Main and Kolter Ice Arena 2 0 Part I, Line 2: At the start of each fiscal year, we pinpoint potential sponsorships and determine the funding for each. Our team ensures representation at every sponsored event, either by attending in person or through staff presence. Post-event, we assess the sponsorship's impact by analyzing the exposure and awareness generated for TVHC, the value received relative to our investment, and decide if future sponsorship is merited based on its success. X X 1 0 0 0 0 0 0 0 0 Maurice Brown Orthopedic Surgeon 297833 0 149302 0 0 0 0 0 119727 0 566862 0 0 0 Stephen Houmes ED Physician 337035 0 0 0 0 0 0 0 51480 0 388515 0 0 0 Keith Gnagey Former CEO 172242 0 55931 0 135756 0 0 0 23244 0 387173 0 0 0 Nathan Levanger CMO Interim CEO (Until Aug 23) 300830 0 40000 0 0 0 9465 0 9616 0 359911 0 0 0 Maria Kennah CAO (As of Jan 23) 295766 0 30660 0 0 0 0 0 20217 0 346643 0 0 0 Tish Miller CFO (Until May 23) 227023 0 53039 0 0 0 5427 0 32215 0 317704 0 0 0 Juanita Prissel Family Practice Physician 285073 0 0 0 0 0 4112 0 21038 0 310223 0 0 0 Chad Horrocks Family Practice Physician 224037 0 49407 0 0 0 5819 0 26655 0 305918 0 0 0 Taylor Nelson CRNA 265196 0 0 0 0 0 5432 0 21427 0 292055 0 0 0 Part I, Line 4a Keith Gnagney received $135,756 in severance pay for calendar year 2022. Form 990, Part III, line 3 Teton Valley Health Care ceased operations of Cash Clinic, LLC, a disregarded entity and closed the clinic. Form 990, Part VI, Section A, line 1a The Executive Committee consists of the officers of the board and immediate past Chair of the Hospital Board. The Executive Committee can transact regular business on behalf of the board between the governing board meetings. Any matters of substantial importance must be ratified by the governing board. Form 990, Part VI, Section A, line 6 The members of Teton Valley Health Care, Inc. (TVHC) shall consist of a broad representation of the public that TVHC serves and the majority of the members must be citizens of Teton County, Idaho, including residents of each incorporated city in Teton County, Idaho, and the unincorporated area of Teton County. There shall be at least five members which are elected by a majority vote of the existing members. Each member is entitled one vote on any matter submitted to a vote at a meeting of the members. Form 990, Part VI, Section A, line 7a Each member is entitled to vote on any matter submitted to a vote at a meeting of the members, including the election of the Board of Directors. Meetings are held annually as well as any special meetings called by the CEO or at the written request of the members. Form 990, Part VI, Section B, line 11b A copy of the 990 is provided to the CFO and CEO who review the form, schedules and related attachments. Any comments or questions are addressed with the preparer and a final draft is presented to the Board of Directors who then approve the 990. Once management is satisfied with the 990, the CEO signs the Form 8879-TE authorizing the preparer to e-file the return. Form 990, Part VI, Section B, line 12c TVCH has officers and board members annually review the conflict of interest policy. An individual is required to disclose to the Board of Directors if a potential conflict arises. The remaining board members discuss the situation with the absence of the individual to determine if a conflict of enough significance and materiality exists. If a conflict with a board member is signficant and material enough, the individual may be suspended or terminated. Form 990, Part VI, Section B, line 15a The Board reviews and approves management wages each year. The sources utilized by TVHC in regards to original fair market value of the CEO salary was an executive compensation survey, published by Critical Data, Inc., and the Idaho Hospital Association (IHA) annual salary survey. These surveys are utilized for setting the salary levels of employees at TVHC. The IHA survey itemizes all hospitals as a group, CAH hospitals, and hospitals by region. The CEO base salary increase is equal to the average percent increase of all employees. The Board approves the annual incentive compensation of the CEO. The CEO reviews and approves the CFO compensation based on similar compensation survey sources. In regard to setting the salary levels of physicians, TVHC utilizes the MGMA physician compensation and production survey as well as other surveys. This survey itemizes salaries and productivity by physician speciality, years in practice, geographic region, and other categories. TVHC strives to pay market level salaries to all employees of the organization. It is our goal to recruit and retain top talent in every venue, while controlling salary and benefit costs within established targets. Form 990, Part VI, Section C, line 19 TVHC makes its governing documents, conflict of interest policy, and financial statements available to the public upon request. Form 990, Part IX, line 11g Contract Services: Program service expenses 3,773,031. Management and general expenses 1,904,001. Fundraising expenses 1,398. Total expenses 5,678,430. Cache Clinic LLC (dissolved Oct 2023) 120 E Howard Driggs ID 83422 Clinic ID 176684 0 Teton Valley Health Care Inc Teton Valley Health Care Foundation 120 E Howard Ave Driggs ID 83422 932017214 Foundation ID 501(c)(3) Line 7 Teton Valley Health Care Inc 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 Teton Valley Health Care Foundation C 197249 Accrual Method