Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (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 listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| (A)
CARSON TAHOE REGIONAL HEALTHCARE |
880502320 | 03 | Yes | 0 | 0 | |
Total 1
|
0 | |||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (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 VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
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|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
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| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
|---|---|
| Schedule A, Part IV, Section A, line 6: | Grants are discussed by a grant committee and evenly distributed between |
| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 2 | The main hospital of Carson Tahoe Regional Health separated out it's supporting G&A departments and created a new parent company called Carson Tahoe Health System (CTHS). The same work is being done, as was done in prior years. This G&A is not considered Program services for the parent company CTHS. |
| FORM 990, PART III, LINE 4A | 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 indigent patients unable to pay. The cost of direct and indirect costs for services furnished under its charity care policy were approximately $3.5M in 2014. The Health System also sponsors health activities and programs to support the community including wellness education and support. In year 2014, the Health System (all entities) had 11,395 inpatient admissions, 57,947 inpatient days, 260,238 outpatient registrations, 115,480 outpatient imaging visits, and 66,239 emergent/ urgent care visits. 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 long term continuing care hospital with 29 licensed beds, a surgery hospital which is 70% owned, 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. |
| FORM 990, PART VI, SECTION A, LINE 1A | The CTHS Executive Committee had six (6) members in 2014 and did not have any meetings in 2014. |
| FORM 990, PART VI, SECTION A, LINE 2 | Ed Epperson, Andrea Weed, Don Hataway, James Gibson, Jonathan Miller, and Dr. Upton all have a business relationship due to also serving as officers or board members of a related for-profit entity, Carson Tahoe Physician Clinics. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE-MEMBER OF THE ORGANIZATION IS CARSON-TAHOE HEALTH SYSTEM, A TAX EXEMPT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | The member elects the members of the governing body. The membership represents the board, and governing members. |
| FORM 990, PART VI, SECTION A, LINE 7B | Carson Tahoe Health System is 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, PART VI, SECTION B, LINE 11 | 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. |
| FORM 990, PART VI, SECTION B, LINE 12C | At the time of hire (or election in the case of board of directors), 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 directors 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 Health SYstem, or any system entity on any matter of business which may come before the board (including its committees.) |
| FORM 990, 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. |
| FORM 990, PART VI, SECTION B, LINE 15B | 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 2013. A written opinion from the Hay Group was received stating that the executive compensation packages do not constitute excess benefit transactions. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, Part XI, line 9 | TRANSFER FROM CTRH 8,400,000 DISREGARDED ENTITIES CAPITAL CONTRIBUTED 2014 4,700,000 CHANGE IN NET ASSETS OF DISREGARDED ENTITIES PER BOOKS 635,125 MISCELLANEOUS ADJUSTMENT -290 ----------- TOTAL TO PART XI, LINE 9 13,734,835 |
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