Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Carson Tahoe Regional Healthcare
Employer identification number
88-0502320
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization?
................
11g(i)
(ii)
a family member of a person described in (i) above?
......................
11g(ii)
(iii)
a 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of support?
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3..
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public Support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2011.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2010.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
6
Total. Add lines 1 through 5.
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c
Add lines 7a and 7b..
8
Public Support (Subtract line 7c from line 6.)
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2007
(b) 2008
(c) 2009
(d) 2010
(e) 2011
(f) Total
9
Amounts from line 6...
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13
Total support (Add lines 9, 10c, 11 and 12.).
14
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2011 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2010 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2011 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2010 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2011.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2010.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information.
Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2011
Additional Data
Software ID:
Software Version:
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
Carson Tahoe Regional Healthcare
Employer identification number
88-0502320
Identifier
Return Reference
Explanation
EXEMPT PURPOSE ACHIEVEMENTS FOR PROGRAM SERVICES
PART III, LINE 4A
CARSON TAHOE REGIONAL MEDICAL CENTER IS THE MAIN HUB OF CARSON TAHOE HEALTH. 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 SERVICE. THE REGIONAL MEDICAL CENTER PROVIDES CARE TO PERSONS, SOME OF WHOM ARE COVERED BY GOVERNMENTAL PROGRAMS INCLUDING MEDICARE AND MEDICAID, AS WELL AS MEDICALLY INDIGNENT PATIENTS UNABLE TO PAY. THE COMPENSATED VALUE OF PROVIDING CARE TO THESE PATIENTS APPROXIMATED $25.4 MILLION IN 2011. THE HOSPITAL ALSO SPONSORS HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY INCLUDING WELLNESS EDUCATION AND SUPPORT. THE HOSPITAL HAD 11,000 INPATIENT ADMISSIONS, 45,000 INPATIENT DAYS, AND 156,000 OUTPATIENT REGISTRATIONS IN 2011. CARSON TAHOE HEALTH CONSISTS OF AN ACUTE CARE REGIONAL MEDICAL CENTER WITH 144 LICENSED BEDS, INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES WITH A TOTAL OF 40 LICENSED BEDS, A FREE-STANDING LICENSED EMERGENT CARE CENTER, 2 URGENT CARES, OUTPATIENT SURGERY CENTER, ACCREDITED CANCER CENTER, PHYSICIAN CLINICS, RETAIL CLINICS, IMAGING CENTERS, PAIN MANAGEMENT CENTER, THERAPY, REHABILITATION AND SEVERAL MEDICAL OFFICE BUILDINGS.
GOVERNING BODY AND MANAGEMENT
PART VI, SECTION A, LINES 6, 7A & 7B
THE SOLE MEMBER OF THE ORGANIZATION IS CARSON-TAHOE HEALTH SYSTEM, A TAX EXEMPT ORGANIZATION. THE MEMBER ELECTS THE MEMBERS OF THE GOVERNING BODY. CERTAIN DECISIONS OF THE GOVERNING BODY ARE SUBJECT TO APPROVAL BY THE MEMBER, INCLUDING: ANY AMENDMENT OR RESTATEMENT OF THE ARTICLES OF INCORPORATION, LIMITED LIABILITY COMPANY OR PARTNERSHIP OR THE MERGER, DISSOLUTION OR CONSOLIDATION OF THE ORGANIZATION; ANY MORTGAGE, SALE, LEASE, EXCHANGE OR PLEDGE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION; ANY CHANGE IN LONG-TERM DEBT ARRANGEMENTS OF THE ORGANIZATION OR ANY OF ITS SUBSIDIARIES OR AFFILIATED ORGANIZATIONS; THE STRATEGIC PLAN OF THE ORGANIZATION; THE ESTABLISHMENT OR CHANGE OF THE PHILOSOPHY ACCORDING TO WHICH THE ORGANIZATION OPERATES; APPROVAL OF THE CONTRACT OF EMPLOYMENT OF THE CEO OF THE ORGANIZATION; AND THE DETERMINATION OF THE AMOUNT OF ANY COMPENSATION FOR MEMBERS OF THE BOARD.
FORM 990 REVIEW PROCESS
PART VI, SECTION B, LINE 11B
THE ORGANIZATION ENGAGES AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND REVIEW THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND THE ACCOUNTING PERSONNEL WITH THE INDEPENDENT ACCOUNTING FIRM. THROUGH THE REVIEW PROCESS, ANY CLARIFICATIONS OR CORRECTIONS THAT NEED TO BE MADE ARE MADE. THE FORM 990 IS THEN REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD WITH THE INDEPENDENT ACCOUNTING FIRM. ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE RAISES ARE ADDRESSED AND ANY CORRECTIONS FOR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE FORM 990.
COMPLIANCE WITH CONFLICT OF INTEREST POLICY
PART VI, SECTION B, LINE 12C
AT THE TIME OF HIRE (OR ELECTION IN THE CASE OF TRUSTEES), THE CEO OR HIS DESIGNEE SHALL PROVIDE TO THE BOARD AND ALL EXECUTIVE OFFICERS, STAFF, AND VOLUNTEERS, A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WHEREIN IT IS BELIEVED A CONFLICT MAY ARISE. SUCH ANNUAL MONITORING AND REVIEW PROCEDURES SHALL BE PART OF THE CORPORATE COMPLIANCE PLAN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE BOARD CONCERNING ANY INTEREST DISCLOSED. EACH MEMBER OF THE BOARD OF TRUSTEES AND ALL EXECUTIVE MANAGEMENT SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OF DUALITY OF INTEREST OR RESPONSIBILITY, WHETHER INDIVIDUAL, PERSONAL, OR BUSINESS WHICH MAY EXIST OR APPEAR TO EXIST TO CARSON TAHOE REGIONAL HEALTHCARE OR ANY SYSTEM ENTITY ON ANY MATTER OF BUSINESS WHICH MAY COME BEFORE THE BOARD (INCLUDING ITS COMMITTEES).
PROCESS FOR DETERMINING COMPENSATON
PART VI, SECTION B, LINE 15A
BASE SALARIES FOR OFFICERS AND KEY EMPLOYEES WILL BE POSITIONED SO THAT MIDPOINTS TARGET THE 50TH PERCENTILE. EXECUTIVE SALARIES WILL BE ADMINISTERED WITHIN RANGES BUILT AROUND THE 50TH PERCENTILE AND BASED ON PERFORMANCE, EXPERIENCE, TENURE, AND OTHER RELEVANT FACTORS AS EVALUATED BY CEO. INCENTIVE WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 50TH PERCENTILE FOR ON-PLAN PERFORMANCE. ACHIEVING MAXIMUM INCENTIVES MAY RAISE TOTAL COMPENSATION TO APPROXIMATELY THE 65TH PERCENTILE. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS. THE EXECUTIVE COMPENSATION COMMITTEE WILL DETERMINE THE TOTAL COMPENSATION PACKAGE FOR THE CEO BASED ON MARKET SURVEYS POSITIONED SO THAT MIDPOINT WILL TARGET THE 50TH PERCENTILE. INCENTIVE WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 50TH PERCENTILE FOR ON-PLAN PERFORMANCE. ACHIEVING MAXIMUM INCENTIVES MAY RAISE TOTAL COMPENSATION TO APPROXIMATELY THE 65TH PERCENTILE. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS. THE LAST REVIEW WAS CONDUCTED BY THE HAY GROUP IN 2010. A WRITTEN OPINION FROM THE HAY GROUP WAS RECEIVED STATING THAT THE EXECUTIVE COMPENSATION PACKAGES DO NOT CONSTITUTE EXCESS BENEFIT TRANSACTIONS.
PROCESS FOR MAKING GOVERNING DOCUMENTS AVAILABLE TO THE PUBLIC
PART VI, SECTION C, LINE 19
CARSON TAHOE MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
PROCESS OF EVALUATING PARTICIPATION IN JOINT VENTURE ARRANGEMENTS
PART VI, SECTION C, LINE 16A/B
THE ORGANIZATION IS CURRENTLY DEVELOPING A WRITTEN POLICY WITH ACCOMPANYING PROCEDURES TO ENSURE THAT ALL JOINT VENTURES AND SIMILAR ARRANGEMENTS WITH TAXABLE ENTITIES ARE EVALUATED AND MONITORED TO SAFEGUARD THE ORGANIZATION'S EXEMPT STATUS WITH RESPECT TO SUCH ARRANGEMENTS.
OTHER CHANGES IN FUND BALANCES
PART XI, LINE 5
CARSON TAHOE CARDIOLOGY CAPITAL CONTRIBUTION 3,922,680 UNREALIZED GAIN 71,577 CHANGE IN FAIR VALUE OF SWAP (3,848,072) ROUNDING 1 ----------- OTHER CHANGE IN FUND BALANCE 146,186
BUSINESS RELATIONSHIPS
PART VI, LINE 2
ED EPPERSON, ANDREA WEED, PETER LIVERMORE, DON HATAWAY, JAMES GIBSON, AND JO SAULISBERRY ALL HAVE A BUSINESS RELATIONSHIP DUE TO ALSO SERVING AS OFFICERS OR BOARD MEMBERS OF A RELATED FOR-PROFIT ENTITY, CARSON TAHOE PHYSICIAN CLINICS.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.