TY 2019 Form 990

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)	(E) Reportable compensation from related organizations (W-2/1099-MISC)
(1) ROBERT FARNSWORTH...................................................................... CHAIR	1.00 .................	X	X		0	0
(2) DOUG FIX...................................................................... VICE CHAIR	1.00 .................	X	X		0	0
(3) SUE KIRKHAM...................................................................... DIRECTOR	1.00 .................	X			0	0
(4) ROBERT JONES...................................................................... DIRECTOR	1.00 .................	X			0	0
(5) DAVID EVERETT...................................................................... DIRECTOR	1.00 .................	X			0	0
(6) BETH LOGAN...................................................................... DIRECTOR	1.00 .................	X			0	0
(7) SAM CRANE...................................................................... DIRECTOR	1.00 .................	X			0	0
(8) DEE GULLEDGE...................................................................... DIRECTOR	1.00 .................	X			0	0
(9) JONAS MUNGER...................................................................... DIRECTOR	32.00 .................	X			426,984	52,415
(10) KIM BRANDAU...................................................................... DIRECTOR	32.00 .................	X			380,621	26,221
(11) JENNIFER SADOFF...................................................................... CEO	40.00 .................		X		217,207	26,145
(12) RICHARD WHITE...................................................................... CFO	40.00 .................		X		170,113	27,353
(13) DYLAN COLE...................................................................... CHIEF MED OF	32.00 .................			X	453,144	52,415
(14) KENNETH WILLIAMS...................................................................... PHYSICIAN	32.00 .................			X	381,919	52,415
(15) MICHAEL QUINN...................................................................... SURGEON	32.00 .................			X	335,059	29,002
(16) WHITNEY MACK...................................................................... PHYSICIAN	32.00 .................			X	312,842	19,752
(17) PAUL JOHNSON...................................................................... PHYSICIAN	32.00 .................			X	311,142	19,752

(A) Name and business address	(B) Description of services	(C) Compensation
PAUL ROBERT REAY, PO BOX 487 MONTICELLO,UT84532	ER PHYSICIAN	460,794
MICHAEL A KUEBER JR, 2280 ROCK VALLEY RD GRAND JUNCTION,CO81507	ER PHYSICIAN	348,880
ANGELA ALEXANDER MD PLLC, PO BOX 775688 STEAMBOAT SPRINGS,CO80477	ER PHYSICIAN	309,233
SCHERER MEDICAL 1575 OLD MAIL TRAIL MOAB,UT84532	ER PHYSICIAN	303,953
STEVEN V ROUZER, 270 STEWART LANE MOAB,UT84532	ER PHYSICIAN	220,473
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization 11

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

Page 2

Part II

Support Schedule for Organizations Described in Sections 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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. 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 ....................... right arrow

33 1/3% support test—2018. If the organization did not check a 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 ..................... right arrow

17a

10%-facts-and-circumstances test—2019. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. 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 ....... right arrow

33 1/3% support tests—2018. 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 .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	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

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

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 2019 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-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b........... SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......................
b	Total lobbying expenditures to influence a legislative body (direct lobbying) ........................
c	Total lobbying expenditures (add lines 1a and 1b) ............................................................
d	Other exempt purpose expenditures ...............................................................................
e	Total exempt purpose expenditures (add lines 1c and 1d) ..................................................
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................................................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ...................................................................................................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2019

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

3,633

Total. Add lines 1c through 1i ....................................................................................................

3,633

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
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.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
SchDMd Bullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements ......................	2a
b	Total acreage restricted by conservation easements ....................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....

Part V

Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(c) Two years back	(d) Three years back	(e) Four years back

1a	Beginning of year balance ....
b	Contributions ...
c	Net investment earnings, gains, and losses
d	Grants or scholarships ...
e	Other expenditures for facilities and programs ...
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b) Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value

1a	Land .....	929,520		929,520
b	Buildings ....	26,203,872	12,162,293	14,041,579
c	Leasehold improvements
d	Equipment ....	9,115,227	7,185,644	1,929,583
e	Other .....	2,511,244	1,754,000	757,244
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				17,657,926

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b) Book value	(c) Method of valuation: Cost or end-of-year market value
(1) Financial derivatives.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	36,232,847
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIII.) ............	2d	4,017
e	Add lines 2a through 2d .....................			2e	4,017
3	Subtract line 2e from line 1..................			3	36,228,830
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIII.) ...........	4b
c	Add lines 4a and 4b....................			4c
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	36,228,830

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	33,043,286
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities .........	2a
b	Prior year adjustments ............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIII.) ............	2d	4,017
e	Add lines 2a through 2d....................			2e	4,017
3	Subtract line 2e from line 1...................			3	33,039,269
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIII.) ............	4b
c	Add lines 4a and 4b.....................			4c
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	33,039,269

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation
SCHEDULE D, PAGE 3, PART X	THE HOSPITAL IS ORGANIZED AS A UTAH NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL IS REQUIRED TO FILE AN ANNUAL RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. 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 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.
SCHEDULE D, PAGE 4, PART XI, LINE 2D	FUNDRAISING EVENT EXPENSES 4,017
SCHEDULE D, PAGE 4, PART XII, LINE 2D	FUNDRAISING EVENT EXPENSES 4,017

Schedule D (Form 990) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" on Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization
MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

Part I

Fundraising Activities.Complete if the organization answered "Yes" on Form 990, Part IV, line 17.

Form 990-EZ filers are not required to complete this part.

Indicate whether the organization raised funds through any of the following activities. Check all that apply.

a	Mail solicitations	e	Solicitation of non-government grants
b	Internet and email solicitations	f	Solicitation of government grants
c	Phone solicitations	g	Special fundraising events
d	In-person solicitations

Did the organization have a written or oral agreement with any individual (including officers, directors, trustees

or key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services?

YesNo

If "Yes," list the 10 highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










Total . . . . . . . . . . . . . . . . . . . .

List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2019

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" on Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 GOLF TOURNAMENT (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . . . .	18,429	18,429
2	Less: Contributions . . . .	4,300	4,300
3	Gross income (line 1 minus line 2) . . . . . .	14,129	14,129

4	Cash prizes . . . . .
5	Noncash prizes . . . .	100	100
6	Rent/facility costs . . . .	3,396	3,396
7	Food and beverages . . .
8	Entertainment . . . .
9	Other direct expenses . . .	521	521
10	Direct expense summary. Add lines 4 through 9 in column (d) . . . . . . . . . .		4,017
11	Net income summary. Subtract line 10 from line 3, column (d). . . . . . . . . .		10,112

Part III

Gaming. Complete if the organization answered "Yes" on Form 990, Part IV, line 19, or reported more than $15,000 on Form 990-EZ, line 6a.

		(a) Bingo	(b) Pull tabs/Instant bingo/progressive bingo	(c) Other gaming	(d) Total gaming (add col.(a) through col.(c))
1	Gross revenue . . . . .

2	Cash prizes . . . . .
3	Noncash prizes . . . .
4	Rent/facility costs . . . .
5	Other direct expenses . . .

Volunteer labor . . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

Direct expense summary. Add lines 2 through 5 in column (d) . . . . . . . . . . right arrow

Net gaming income summary. Subtract line 7 from line 1, column (d). . . . . . . . . right arrow

Enter the state(s) in which the organization conducts gaming activities:

Is the organization licensed to conduct gaming activities in each of these states? . . . . . . . .

YesNo

If "No," explain:

10a

Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? . . .

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2019

Page 3

Does the organization conduct gaming activities with nonmembers? . . . . . . . . . . .

YesNo

Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity

formed to administer charitable gaming? . . . . . . . . . . . . . . . . .

YesNo

Indicate the percentage of gaming activity conducted in:

The organization's facility . . . . . . . . . . . . . . . . . .

13a

An outside facility . . . . . . . . . . . . . . . . . . . .

13b

Enter the name and address of the person who prepares the organization's gaming/special events books and records:

Name

Address

15a

Does the organization have a contract with a third party from whom the organization receives gaming

revenue? . . . . . . . . . . . . . . . . . . . . . . . .

YesNo

If "Yes," enter the amount of gaming revenue received by the organization right arrow

$ and the

amount of gaming revenue retained by the third party right arrow

$ .

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

Is the organization required under state law to make charitable distributions from the gaming proceeds to

retain the state gaming license? . . . . . . . . . . . . . . . . . . .

YesNo

Enter the amount of distributions required under state law distributed to other exempt organizations or spent

in the organization's own exempt activities during the tax year right arrow

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v); and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information. See instructions.

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) . . .	811,700		811,700	2.460 %
b	Medicaid (from Worksheet 3, column a) . . . . .	2,607,087	2,607,087
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	3,418,787	2,607,087	811,700	2.460 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
f	Health professions education (from Worksheet 5) . . .
g	Subsidized health services (from Worksheet 6) . . . .	3,284,837	2,919,226	365,611	1.110 %
h	Research (from Worksheet 7) .
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .	322,806		322,806	0.980 %
j	Total. Other Benefits . .	3,607,643	2,919,226	688,417	2.080 %
k	Total. Add lines 7d and 7j .	7,026,430	5,526,313	1,500,117	4.540 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,514,550

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

402,328

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

9,467,055

Enter Medicare allowable costs of care relating to payments on line 5.....

9,514,833

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-47,778

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

Page

Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	MOAB VALLEY HEALTHCARE INC 450 WEST WILLIAMS WAY MOAB,UT845320998 WWW.MRHMOAB.ORG 2013-HOSP-45117	X	X	X	X

Schedule H (Form 990) 2019

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	MOAB VALLEY HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 19

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): WWW.MRHMOAB.ORG

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 19

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): SEE PART V, LINE 7D FOR FULL URL

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	MOAB VALLEY HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 100.000000000000%
and FPG family income limit for eligibility for discounted care of 400.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

SEE PART V, PAGE 8

The FAP application form was widely available on a website (list url):

SEE PART V, PAGE 8

A plain language summary of the FAP was widely available on a website (list url):
SEE PART V, PAGE 8

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	MOAB VALLEY HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	MOAB VALLEY HEALTHCARE INC
Name of hospital facility or letter of facility reporting group

Yes

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
FACILITY 1, MOAB VALLEY HEALTHCARE, INC. - PART V, LINE 3E	IDENTIFICATION AND PRIORITIZATION OF HEALTH NEEDS BEGIN ON PAGE 31 OF THE CHNA LOCATED ON THE HOSPITAL'S WEBSITE.
FACILITY 1, MOAB VALLEY HEALTHCARE, INC. - PART V, LINE 5	MOAB REGIONAL HOSPITAL PARTNERED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER (NRHRC) TO CONDUCT ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY BY MAILING OUT 800 SURVEYS TO A RANDOM STRATIFIED SAMPLE OF COMMUNITY MEMBERS. NRHRC FACILITATED A SERIES OF FOCUS GROUPS MADE UP OF A DIVERSE GROUP OF COMMUNITY MEMBERS, REPRESENTING VARIOUS ORGANIZATIONS AND POPULATIONS WITHIN THE COMMUNITY TO SUPPLEMENT THE ASSESSMENT WITH QUALITATIVE DATA. THE FOCUS GROUPS INCLUDED: HEALTHCARE PROFESSIONALS; COMMUNITY LEADERS; YOUTH ORGANIZATIONS AND PARENTS; SENIORS; AND MULTICULTURAL GROUPS. AN EXTENSIVE LIST OF INVITEES WAS COMPILED BY THE MRH DIRECTOR OF COMMUNITY RELATIONS TO ENSURE QUALITY REPRESENTATION OF VARIOUS COMMUNITY ORGANIZATIONS, GOVERNMENT COUNCILS AND LOCAL RESIDENTS.
FACILITY 1, MOAB VALLEY HEALTHCARE, INC. - PART V, LINE 6B	MOAB REGIONAL HOSPITAL PARTNERED WITH THE NATIONAL RURAL HEALTH RESOURCE CENTER TO CONDUCT ITS 2019 COMMUNITY HEALTH NEEDS ASSESSMENT TO IMPROVE THE UNDERSTANDING OF THE HEALTH STATUS OF THE COMMUNITY IT SERVES.
FACILITY 1, MOAB VALLEY HEALTHCARE, INC. - PART V, LINE 7D	THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS DISTRIBUTED TO LOCAL INTERESTED AGENCIES, INCLUDING THE SOUTH EASTERN UTAH HEALTH DEPARTMENT, THE MOAB FREE HEALTH CLINIC, AND ALL COMMUNITY LEADERS INVOLVED IN THE FOCUS GROUP. HARD COPIES OF THE LATEST COMMUNITY HEALTH NEEDS ASSESSMENT AND MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY ARE ALSO AVAILABLE UPON REQUEST WITHOUT CHARGE AND POSTED ON THE HOSPITAL WEBSITE AT THE FOLLOWING URL: HTTP://MRHMOAB.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/
FACILITY 1, MOAB VALLEY HEALTHCARE, INC. - PART V, LINE 11	AFTER RECEIVING THE 2019 COMMUNITY HEALTH NEEDS ASSESSMENT RESULTS, THE MOAB REGIONAL HOSPITAL COMMUNITY RELATIONS DIRECTOR INVITED COMMUNITY AND HOSPITAL LEADERS TO PARTICIPATE IN A STRATEGIC PLANNING SESSION TO PRIORITIZE TARGET AREAS FOR THE COMMUNITY HEALTH ASSESSMENT ACTION PLAN. THE DATA WAS ALSO SHARED AND DISCUSSED WITH HOSPITAL LEADERSHIP GROUPS AND GOVERNING BODIES. THE TOP THREE IDENTIFIED HEALTH NEEDS INCLUDE: 1) ACCESS TO MENTAL AND BEHAVIORAL HEALTHCARE 2) ACCESS TO PRIMARY CARE PROVIDERS AND SPECIALISTS 3) REMOVE FINANCIAL BARRIERS TO CARE THE HOSPITAL IS ADDRESSING THESE NEEDS USING THE FOLLOWING STRATEGIES: RECRUIT FULL-TIME PSYCHIATRIST, PSYCHOLOGIST, AND CHILD PSYCHIATRIST ADD MID-LEVEL PROVIDER TO WORK WITH PSYCHIATRIST FOR BEHAVIORAL HEALTH PATIENTS AND MENTAL HEALTH PROGRAM NURSE COORDINATOR PROVIDE ACCESS TO TELE-MENTAL HEALTH PROVIDE SPONSORSHIP TO COMMUNITY ORGANIZATIONS THAT ARE WORKING TO REDUCE RISK FACTORS AND INCREASE PROTECTIVE FACTORS RECRUIT FAMILY PRACTICE PHYSICIAN WITH OB, NURSES FOR TRIAGE AND CARE COORDINATION, AND VISITING SPECIALISTS SUCH AS CARDIOLOGIST,OTOLARYNGOLOGIST (ENT), PEDIATRICIAN, GERONTOLOGIST ADD OUT-PATIENT NURSING SERVICES PROGRAM MANAGER AND ONCOLOGY NAVIGATOR IMPLEMENT ECHO PROGRAM EMPLOY FULL-TIME FINANCIAL NAVIGATORS REDUCE LAB CHARGES EXPAND LOW-COST BLOOD DRAWS THROUGHOUT THE YEAR MRH IS NOT ACTIVELY FOCUSING RESOURCES ON THE OTHER HEALTH CONCERNS OUTLINED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT INCLUDING: ILLEGAL AND PRESCRIPTION DRUG USE/UNDERAGE ALCOHOL, TOBACCO, AND DRUG USE. THERE ARE MANY OTHER COMMUNITY ORGANIZATIONS, SUCH AS THE SOUTHEAST UTAH HEALTH DEPARTMENT, THE MOAB FREE HEALTH CLINIC, AND FAMILY SUPPORT SERVICES, THAT HAVE ROBUST PROGRAMS THAT ADDRESS THESE CONCERNS. THE HOSPITAL SUPPORTS AND PARTNERS WITH THESE ORGANIZATIONS WHEN APPROPRIATE; HOWEVER, THE HOSPITAL FELT THAT THE COMMUNITY HEALTH ASSESSMENT ACTION PLAN GOALS SHOULD ADDRESS GAPS IN LOCAL SERVICES RATHER THAN DUPLICATING AVAILABLE PROGRAMS. MRH WILL COLLABORATE WITH OTHER COMMUNITY CHAMPIONS ON THIS EFFORT. MRH IS CONTINUALLY ASSESSING THE HEALTH NEEDS OF OUR COMMUNITY AND DECIDING HOW WE CAN BETTER SERVE OUR COMMUNITY BASED ON NEED.
FACILITY 1, MOAB VALLEY HEALTHCARE, INC. - PART V, LINE 16J	THE SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED IN THE EMERGENCY AND WAITING ROOMS. PATIENTS ARE PROVIDED FINANCIAL AID INFORMATION AND AN APPLICATION AT THE TIME OF SERVICE. THE HOSPITAL ALSO INFORMS PATIENTS THAT FINANCIAL AID IS AVAILABLE IN ALL INVOICES. IN ADDITION, THE HOSPITAL PUBLICIZED THE FINANCIAL ASSISTANCE POLICY THROUGH NEWSPAPER ARTICLES AND EDUCATIONAL SEMINARS WITH THE COMMUNITY SENIOR CITIZENS AND MINORITY POPULATIONS. THE LATEST FINANCIAL ASSISTANCE POLICY (FAP) IS AVAILABLE ON THE HOSPITAL WEBSITE AS FOLLOWS. FAP: HTTP://MRHMOAB.ORG/WP-CONTENT/UPLOADS/2018/06/FINANCIAL-AID-POLICY-MRH.PDF FAP APPLICATION: HTTP://MRHMOAB.ORG/WP-CONTENT/UPLOADS/2017/07/FIN-AID-APPLICATION-2017.PDF FAP PLAIN LANGUAGE SUMMARY: HTTP://MRHMOAB.ORG/WP-CONTENT/UPLOADS/2015/11/FINANCIAL-SUMMARY-AND- DIRECTION.PDF

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?
Name and address		Type of Facility (describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
SCHEDULE H, PART I, LINE 7G	THE HOSPITAL HAS INCLUDED COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G IN THE AMOUNT OF 2,668,557 IN COLUMN C AND 2,484,391 IN COLUMN D.
SCHEDULE H, PART I, LINE 7	THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES FOR FIGURES REPORTED IN THE TABLE (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, TOTAL COMMUNITY BENEFIT, AND TOTAL COMMUNITY BUILDING EXPENSES).
SCHEDULE H, PART II	GRAND COUNTY IS DESIGNATED AS MEDICALLY UNDERSERVED AND HAS A SHORTAGE IN THE AREA OF HEALTH PROFESSIONALS. THE HOSPITAL IS CONTINUALLY RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO ITS RURAL SERVICE AREA TO HELP IMPROVE ACCESS TO HEALTHCARE SERVICES AS IDENTIFIED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT.
SCHEDULE H, PART III, LINE 2	BAD DEBT EXPENSE ON LINE 2 IS REPORTED AT CHARGES.
SCHEDULE H, PART III, LINE 3	THE HOSPITAL DETERMINED THE ESTIMATED AMOUNT OF BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR CHARITY CARE BY REVIEWING THEIR RECORDS FOR THE PERCENTAGE OF PATIENTS THAT WOULD HAVE BEEN ELIGIBLE HAD THEY COMPLETED THE FINANCIAL ASSISTANCE PROCESS. THE HOSPITAL ESTIMATED 16% OF ITS BAD DEBTS WOULD HAVE QUALIFIED.
SCHEDULE H, PART III, LINE 4	THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE 2019 AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 5, ON PAGE 12, OF THE AUDITED FINANCIAL STATEMENTS ATTACHED. THE PROVISION FOR BAD DEBTS IS INCLUDED IN FOOTNOTE 10 OF THE AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, LINE 8	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 IS CONSIDERED A COMMUNITY BENEFIT. MEDICARE ALLOWABLE COST IS BASED ON THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES & REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES.
SCHEDULE H, PART III, LINE 9B	IT IS THE POLICY OF MOAB REGIONAL HOSPITAL TO UTILIZE A COLLECTION AGENCY AS A RESOURCE FOR COLLECTING BAD DEBT. ALL PATIENTS WILL RECEIVE A MONTHLY STATEMENT REGARDING ANY OPEN BALANCES ON THEIR ACCOUNTS. THE PATIENT WILL RECEIVE TWO STATEMENTS APPROXIMATELY 30 DAYS APART. THE THIRD STATEMENT AT 90 DAYS WILL BE STAMPED FINAL NOTICE. AT 120 DAYS AFTER THE FIRST BILLING IF THE OPEN BALANCE HAS NOT BEEN ADDRESSED BY THE PATIENT THESE ACCOUNTS WILL BE FORWARDED ON TO THE COLLECTION AGENCY FOR ADDITIONAL ACTION (E.G. ACCRUING INTEREST, GARNISHING OF WAGES AND LEGAL ACTION) IF NECESSARY. IF AT ANY TIME DURING THE COLLECTION ACTIONS THE COLLECTION AGENCY DETERMINES THE PATIENT WOULD BE POTENTIALLY ELIGIBLE FOR FINANCIAL ASSISTANCE, THE AGENCY WILL ENCOURAGE THE PATIENT TO CONTACT THE HOSPITAL TO APPLY FOR FINANCIAL ASSISTANCE. ONCE THE PATIENT CONTACTS THE HOSPITAL, THE ACCOUNT IS IMMEDIATELY MOVED TO "APPLYING FOR ASSISTANCE" STATUS AND NO FURTHER COLLECTION ACTIONS ARE TAKEN. THE PATIENT THEN HAS AN ADDITIONAL 120 DAYS TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. IF THE INDIVIDUAL RECEIVES DISCOUNTED CARE, THE REMAINING SELF-PAY PORTION IS MOVED TO AN INTEREST-FREE MONTHLY PAYMENT PLAN. IF AFTER SIX MONTHS THERE ARE NO FURTHER PAYMENTS MADE, THE HOSPITAL CONTACTS THE PATIENT TO DETERMINE IF THE PATIENT NEEDS TO LOWER THEIR MONTHLY PAYMENT AND INCREASE THE PAYMENT TIMELINE.
SCHEDULE H, PART VI, LINE 2	IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED EVERY THREE YEARS, THE HOSPITAL REVIEWS LOCAL THIRD PARTY HEALTH DATA, SUCH AS DATA FROM THE HEALTH DEPARTMENT AND THE UTAH STUDENT HEALTH RISK AND POPULATION (SHARP) SURVEY. MRH ALSO COLLECTS FEEDBACK FROM PATIENTS TO HELP IMPROVE SERVICES. COPIES ARE AVAILABLE AT THE HOSPITAL UPON REQUEST OF THE MOST RECENTLY ADOPTED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY OR A COPY CAN BE FOUND AT THE HOSPITAL'S WEBSITE AT THE FOLLOWING URL: HTTPS://MRHMOAB.ORG/WP-CONTENT/UPLOADS/2020/07/2019-CHNA-REPORT-FINAL- POSTED-ON-WEBSITE-COMPRESSED.PDF HTTPS://MRHMOAB.ORG/WP-CONTENT/UPLOADS/2020/07/2019-CHNA-IMPLEMENTAION- PLAN-FINAL-POSTED-ON-WEBSITE-2.PDF
SCHEDULE H, PART VI, LINE 3	THE HOSPITAL POSTS ITS CHARITY CARE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ADMISSIONS AREAS, EMERGENCY ROOMS, AND OTHER AREAS OF THE ORGANIZATION'S FACILITIES IN WHICH ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. IT ALSO PROVIDES A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION IN ITS ADMISSION PACKET AS PART OF THE INTAKE PROCESS. A COPY OF THE POLICY, OR A SUMMARY THEREOF, AND FINANCIAL ASSISTANCE CONTACT INFORMATION TO PATIENTS ARE ALSO INCLUDED WITH DISCHARGE MATERIALS. ASSIGNED HOSPITAL STAFF ALSO DISCUSSES WITH THE PATIENT THE AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID OR STATE PROGRAMS, AND ASSISTS THE PATIENT WITH QUALIFICATION FOR SUCH PROGRAMS, AS APPLICABLE.
SCHEDULE H, PART VI, LINE 4	THE HOSPITAL'S DEFINED SERVICE AREA EXTENDS OUT APPROXIMATELY 70 MILES IN ALL DIRECTIONS CAPTURING A SERVICE AREA POPULATION OF APPROXIMATELY 16,350. THE ENTIRE SERVICE AREA IS RURAL OR FRONTIER IN NATURE. IT INCLUDES THE SETTLEMENTS OF MOAB (7,500), GREEN RIVER (1,500), THOMPSON (100), LA SAL (250), MONTICELLO (3,000), AND BLANDING (4,000). MOST ALL OF THESE COMMUNITIES HAVE AGRICULTURE, MINING, OR TOURISM AS A PRIMARY ECONOMIC BASE. SMALL HOSPITALS SERVE MONTICELLO AND BLANDING, BUT MAJOR SURGICAL AND ANCILLARY SERVICES ARE PROVIDED IN MOAB. THE LARGER COMMUNITIES IN COLORADO - CORTEZ AND GRAND JUNCTION - OFFER SECONDARY CARE HOSPITALS, BUT ARE 100+ MILES AWAY FROM ANY OF THE COMMUNITIES DESCRIBED. GRAND COUNTY IS PRIMARILY DRIVEN BY A STRONG OUTDOOR RECREATION-BASED TOURISM INDUSTRY. ALTHOUGH LOCAL TOURIST ATTRACTIONS DRAW A STEADY INFLUX OF VISITORS OF OVER 2+ MILLION ANNUALLY AND GENERATE SUBSTANTIAL LOCAL REVENUES, GRAND COUNTY'S RURAL LOCATION AND LOW INDUSTRIAL DIVERSITY HAS IMPEDED THE DEVELOPMENT OF MAJOR GROWTH DRIVERS OUTSIDE OF TOURISM. UNEMPLOYMENT IN THE COUNTY EXCEEDS UTAH AND U.S. LEVEL, AND THE LACK OF HIGH PAYING INDUSTRIES CORRESPONDS TO BELOW AVERAGE HOUSEHOLD INCOME LEVELS. THE MEDIAN AGE OF GRAND COUNTY'S POPULATION IS 39.4 YEARS COMPARED WITH UTAH'S POPULATION AT 29.5 YEARS AND THE U.S. FIGURE OF 36.8 YEARS. ANNUAL AVERAGE HOUSEHOLD INCOME FOR GRAND COUNTY IS 50,331, COMPARED WITH 68,450 AND 67,315 FOR UTAH AND THE U.S. RESPECTIVELY. APPROXIMATELY 32% OF THE COUNTY'S HOUSEHOLDS' INCOME LEVELS FALL UNDER 25,000 THRESHOLD. EDUCATIONALLY, 29.9% ARE HIGH SCHOOL GRADUATES, 30.3% HAVE COMPLETED ASSOCIATES DEGREES, AND 14.7% HOLD BACHELOR'S DEGREES WITH 8.3% HAVING EARNED ADVANCED DEGREES AT THE MASTERS OR PH.D. LEVELS. APPROXIMATELY 33.5% OF THE HOSPITAL'S PATIENT MIX IS MEDICARE WITH 13.6% COVERED BY THE MEDICAID PROGRAM.
SCHEDULE H, PART VI, LINE 5	THE HOSPITAL'S GOVERNING BODY IS COMPRISED EXCLUSIVELY OF CITIZENS RESIDING IN MOAB, MOST OF WHOM HAVE BEEN RESIDENTS FOR DECADES. THE MEMBERS BRING AN EXCELLENT MIX OF SKILLS AND EXPERIENCES TO THE BOARD THAT WELL SERVE THE NEEDS OF THE HOSPITAL. BOARD MEMBERS RANGE FROM A RETIRED HEALTH DEPARTMENT ADMINISTRATOR, TO GRAND COUNTY SCHOOL DISTRICT ADMINISTRATOR, TO PHYSICIANS, TO BUSINESS OWNERS. THIS VOLUNTEER BOARD DEDICATES TIME TO ENSURING THEY UNDERSTAND THE HEALTH AND WELFARE NEEDS OF OUR COMMUNITY. THE HOSPITAL EXTENDS MEMBERSHIP AND, ACCORDINGLY, MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY WHO QUALIFY. AS A NON-PROFIT CORPORATION, THE HOSPITAL DOES NOT HAVE ANY SHAREHOLDERS. EXCESS FUNDS FROM OPERATIONS ARE APPLIED TO EDUCATIONAL PROGRAMS DESIGNED TO ADDRESS SPECIFIC NEEDS OF THE COMMUNITY SUCH AS: SUBSTANCE ABUSE, YOUTH HEALTH PROFESSIONAL EDUCATION, DIABETES, CHILDBIRTH, CHRONIC DISEASE/CANCER, AND NUTRITION. THE HOSPITAL PARTICIPATES IN MULTIPLE ACTIVITIES WITHIN ITS COMMUNITY TO PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES. THE HOSPITAL IS A MEMBER OF THE MOAB CHAMBER OF COMMERCE, AND HOSTS AN ANNUAL LUNCHEON AT THE HOSPITAL TO SUPPORT LOCAL BUSINESS DEVELOPMENT AND COLLABORATION. THE HOSPITAL ALSO SUPPORTS THE CHAMBER'S ANNUAL FUNDRAISER BANQUET THAT SUPPORTS LOCAL BUSINESS DEVELOPMENT AND ALSO SPONSORS THE CHAMBER'S GOLF TOURNAMENT TO HELP SUPPORT THE CHAMBER'S SCHOLARSHIP PROGRAM. THE HOSPITAL MADE FINANCIAL CONTRIBUTIONS TO LOCAL ORGANIZATIONS DURING THE YEAR. THESE ORGANIZATIONS INCLUDED YOUTH-ORIENTED ORGANIZATIONS, MENTORING PROGRAMS, THE LOCAL EDUCATION FOUNDATION, MENTAL HEALTH/BEHAVIORAL HEALTH TREATMENT CENTER, AND THE LOCAL DOMESTIC VIOLENCE SHELTER. THE FUNDING PROVIDES CRUCIAL PROGRAM SUPPORT TO AGENCIES THAT MAKE IMPORTANT IMPACTS ON THE LOCAL COMMUNITY. THE HOSPITAL COMMUNITY RELATIONS DIRECTOR PARTICIPATES IN THE MOAB COMMUNITY ACTION COALITION. THIS COALITION PRIMARILY FOCUSES ON UTILIZING COMMUNITY RESOURCES AND ORGANIZATIONAL COLLABORATION TO REDUCE YOUTH ALCOHOL AND SUBSTANCE MISUSE. THE HOSPITAL IS ALSO A MEMBER OF THE SOUTHEASTERN ADDICTION MEDICINE COALITION, WHICH ADDRESSES COMMUNITY OPIOID ABUSE. THE HOSPITAL PARTICIPATES IN THE GRAND COUNTY HIGH SCHOOL CAREER FAIR EACH YEAR. MRH STAFF SUCH AS NURSES, RADIOLOGY TECHNOLOGISTS AND ADMINISTRATIVE PERSONNEL PROVIDE INFORMATION TO HIGH SCHOOL JUNIORS ON CAREER DEVELOPMENT AND PURSUING CAREERS IN THE MEDICAL FIELD. THE HOSPITAL OFFERS AN INFUSION THERAPY PROGRAM FOR CANCER PATIENTS, MITIGATING THE NEED FOR THE PATIENT TO TRAVEL A MINIMUM OF THREE HOURS (ROUND TRIP) FOR CHEMO TREATMENT. EMERGENCY ROOM SERVICES ARE AVAILABLE TO ALL REGARDLESS OF ABILITY TO PAY. THE HOSPITAL SERVES AS A SITE FOR THE CLINICAL TRAINING OF NURSES, AND RESIDENTS IN FAMILY MEDICINE, GENERAL SURGERY, AND ORTHOPEDIC SURGERY NEEDING TO COMPLETE A RURAL ROTATION. THE HOSPITAL IS A SOLE COMMUNITY PROVIDER WITH THE NEAREST (SMALLER) HOSPITAL APPROXIMATELY 55 MILES AWAY. THE HOSPITAL'S DIETICIAN AND SELECT NURSING AND ADMINISTRATIVE PERSONNEL ARE VERY ACTIVE IN MULTIPLE COMMUNITY INITIATIVES TO ADDRESS SUBSTANCE USE, BEHAVIORAL HEALTH, UNDERAGE SUBSTANCE USE, AND DIABETES PREVENTION. THE HOSPITAL ALSO SPONSORS OR HOSTS HEALTH FAIRS, BLOOD DRIVES, AND COMMUNITY INITIATIVES FOCUSING ON SPECIFIC COMMUNITY NEEDS. THE HOSPITAL ALSO REGULARLY PARTNERS AND PROVIDES SUPPORT TO THE LOCAL FREE HEALTH CLINIC. MEDICAL TENT AT MOAB HALF MARATHON: EACH YEAR 5000+ OUT-OF-TOWN RUNNERS VISIT MOAB TO PARTICIPATE IN THREE HALF MARATHONS RUN THROUGHOUT THE YEAR. LOCATED AT THE FINISH LINE OF EACH RACE, THE MEDICAL TENTS ARE STAFFED BY EMERGENCY DEPARTMENT PHYSICIANS AND NURSES WHO ARE AVAILABLE TO ATTEND TO A VARIETY OF MEDICAL NEEDS, FROM DEHYDRATION TO BLISTERS. NURSES ARE ALSO STATIONED ALONG THE LAST PART OF THE RACE COURSE TO LOOK FOR RUNNERS WHO MAY EXPERIENCE CARDIAC EVENTS NEAR THE FINISH LINE AS THEY FINISH THE RACE. ADDRESSING MANY OF THE ISSUES AT THE FINISH LINE OF THESE RACES HAS KEPT THE MRH EMERGENCY ROOM FROM BECOMING OVERWHELMED. COMMUNITY HEALTH FAIR: MOAB IS AN ISOLATED RURAL COMMUNITY LOCATED OVER 100 MILES AWAY FROM A MAJOR CITY. AS SUCH, MANY PEOPLE DON'T HAVE EASY ACCESS TO HEALTH INFORMATION AND SPECIALISTS LOCATED OUTSIDE OUR SMALL TOWN. MOAB REGIONAL HOSPITAL PROVIDED A HEALTH FAIR THAT BROUGHT TOGETHER A VARIETY OF HEALTH PROVIDERS FROM AROUND THE REGION TO SET UP BOOTHS AND PROVIDE INFORMATION TO COMMUNITY MEMBERS WHO ATTENDED. LOW COST BLOOD DRAWS WERE OFFERED THE MONTH PRIOR TO THE HEALTH FAIR, AND APPROXIMATELY 370 COMMUNITY MEMBERS PARTICIPATED IN THE LOW COST BLOOD DRAW OPPORTUNITY AND ATTENDED THE EVENT. SKINNY TIRE FESTIVAL & CENTURY TOUR AID STATION: MOAB REGIONAL HOSPITAL STAFFS TWO AID STATIONS PER YEAR FOR SKINNY TIRE EVENTS, A LOCAL ORGANIZATION WHICH RAISES MONEY FOR CANCER SUPPORT AND RESEARCH. DURING EACH RACE, MRH PROVIDES AN AID STATION WHERE BIKERS CAN RE-FUEL ON FOOD AND WATER AND ADDRESS ANY MEDICAL OR MECHANICAL ISSUES. DINNER WITH A DOC PROGRAM: MOAB REGIONAL HOSPITAL PROVIDES FREE EDUCATIONAL ACCESS TO MEDICAL SPECIALISTS AND HEALTHCARE PROVIDERS THROUGH ITS DINNER WITH A DOC PROGRAM. MRH HOSTED COMMUNITY DINNERS ON THE FOLLOWING TOPICS: ALLERGIES & SINUSITIS; SKIN CANCER AWARENESS; INTEGRATIVE MEDICINE; PLANTAR FASCIITIS; STROKE EDUCATION; AND SMOKING CESSATION. THESE EVENTS SERVED OVER 120 COMMUNITY MEMBERS. DIABETES EDUCATION: MOAB REGIONAL HOSPITAL HOSTED FREE FOUR-DAY DIABETES EDUCATION CLASSES. THE HOSPITAL PARTNERED WITH A VISITING ENDOCRINOLOGIST AND A LOCAL PHARMACIST TO INCREASE THE EDUCATIONAL COMPONENTS OF THE CLASS. TWO REGISTERED DIABETES NURSE EDUCATORS PROVIDED INFORMATION ON EXERCISE, NUTRITION AND MEDICATION MANAGEMENT. YOUTH HEALTH EDUCATION: MOAB REGIONAL HOSPITAL PARTNERED WITH THE LOCAL AFTERSCHOOL YOUTH PROGRAM, BEACON, TO PROVIDE A HANDS-ON DAY OF HEART HEALTH EDUCATION. MRH ALSO PROVIDED MATURATION EDUCATION PRESENTATIONS FOR THE 5TH GRADERS AT THE LOCAL ELEMENTARY SCHOOL AND CHARTER SCHOOL. BREAST CANCER AWARENESS: MOAB REGIONAL HOSPITAL PROVIDED LOW-COST MAMMOGRAPHY VOUCHERS DURING THE MONTH OF OCTOBER TO UNINSURED WOMEN WHO DID NOT QUALIFY FOR THE HEALTH DEPARTMENT'S MAMMOGRAPHY VOUCHER PROGRAM. MRH ALSO SPONSORED A MAMMOGRAPHY AWARENESS CAMPAIGN IN THE LOCAL PAPERS AND ON SOCIAL MEDIA. ADVANCED DIRECTIVE WORKSHOPS: GRAND COUNTY HOSPICE AND MRH PUT ON TWO FREE ADVANCED DIRECTIVE WORKSHOPS FOR THE COMMUNITY. THE WORKSHOPS ARE FACILITATED BY THE DIRECTOR AND MEDICAL DIRECTOR OF GRAND COUNTY HOSPICE. WORKSHOP ATTENDEES RECEIVE INFORMATION ON THE IMPORTANCE OF PREPARING THE NECESSARY LEGAL DOCUMENTATION IN CASE THEY ARE UNABLE TO MAKE MEDICAL DECISIONS ON THEIR OWN BEHALF. "DEATH OVER DINNER": MOAB REGIONAL HOSPITAL AND GRAND COUNTY HOSPICE HOSTED FREE "DEATH OVER DINNER" COMMUNITY DINNER EVENTS. THESE EVENTS WERE HELD IN HONOR OF HOSPICE AND PALLIATIVE CARE MONTH, AND ARE INTENDED TO ADDRESS AND BREAK DOWN THE SOCIETAL STIGMAS SURROUNDING DEATH AND DYING. THE ULTIMATE GOAL OF THESE EVENTS IS TO ENCOURAGE ATTENDEES TO HOST THEIR OWN DEATH OVER DINNER EVENT WITH FRIENDS AND FAMILY AS THE FACILITATION INFORMATION IS FREE AND ACCESSIBLE TO ANYONE WHO HAS INTERNET ACCESS. SERIOUS ILLNESS CONVERSATION TRAINING: MRH AND GRAND COUNTY HOSPICE PARTNERED WITH SLC-BASED NON-PROFIT HEALTH INSIGHT TO HOST A "SERIOUS ILLNESS CONVERSATION TRAINING" FOR LOCAL PRIMARY CARE PROVIDERS, NURSES AND SOCIAL WORKERS THAT HAVE REGULAR CONVERSATIONS WITH COMMUNITY MEMBERS REGARDING ADVANCED CARE PLANNING. ATTENDEES INCLUDED PHYSICIANS FROM WESTERN COLORADO AND SE UTAH REGION. RURAL STROKE SUMMIT: MRH HOSTED UTAH'S FIRST RURAL STROKE SUMMIT, FEATURING VASCULAR NEUROLOGIST SPECIALISTS FROM THE UNIVERSITY OF UTAH AND FIRST RESPONDERS FROM CLASSIC AIR MEDICAL. 35 PEOPLE PARTICIPATED, INCLUDING MEDICAL PROFESSIONALS AND LEADERSHIP FROM SEVERAL HEALTHCARE PROVIDERS IN SE UTAH. THE GOAL OF THE RURAL STROKE SUMMIT IS TO PROVIDE A PLATFORM FROM WHICH MEDICAL PROVIDERS CAN ENHANCE THE EFFICIENCY, EFFICACY AND UNIFORMITY OF RURAL STROKE RESPONSE ACROSS THE SE UTAH REGION. CHILDBIRTH CLASSES: MOAB REGIONAL HOSPITAL HOSTS SIX-SESSION CHILDBIRTH EDUCATION CLASSES AT NO-COST FOR FAMILIES DELIVERING BABIES AT MRH; THE CLASSES ARE ALSO OPEN TO THOSE DELIVERING AT OTHER FACILITIES. THE CLASSES ARE FACILITATED BY THE OBSTETRIC NURSING TEAM AT MRH. THE CLASSES PROVIDE EXPECTANT PARENTS WITH INFORMATION ON PRENATAL CARE, PAIN MANAGEMENT TECHNIQUES DURING LABOR, THE STAGES OF LABOR, AND OTHER CHILDBIRTH RELATED TOPICS THAT HELP PREPARE THE PARENTS FOR DELIVERY. THE CLASSES ALSO INCLUDE A BREASTFEEDING EDUCATIONAL SESSION. THESE CLASSES ARE EXTREMELY POPULAR AND WELL ATTENDED, AND HELP THE MRH MEDICAL PROVIDERS AND NURSING STAFF BETTER ASSIST PATIENTS DURING THE BIRTHING PROCESS, WITH THE ULTIMATE INTENTION OF ACHIEVING THE MOST POSITIVE POST- DELIVERY OUTCOMES. IN ADDITION, THE HOSPITAL IS CONTINUALLY WORKING WITH LOCAL OFFICIALS TO PROVIDE NEEDED

Schedule H (Form 990) 2019

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Schedule I
(Form 990)

Department of the Treasury
Internal Revenue Service

Grants and Other Assistance to Organizations,
Governments and Individuals in the United States

Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
MOAB VALLEY HEALTHCARE INC

Employer identification number
87-0543342

Part I

General Information on Grants and Assistance

Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................

Yes No

Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.

Part II

Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient

that received more than $5,000. Part II can be duplicated if additional space is needed.

(a) Name and address of organization or government	(b) EIN	(c) IRC section (if applicable)	(d) Amount of cash grant	(e) Amount of non-cash assistance	(f) Method of valuation (book, FMV, appraisal, other)	(g) Description of noncash assistance	(h) Purpose of grant or assistance
(1) UTAH STATE UNIVERSITY OLD MAIN HILL LOGAN,UT84322	87-6000528	501C3	300,000				BUILDING

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.

(a) Type of grant or assistance	(b) Number of recipients	(c) Amount of cash grant	(d) Amount of noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
SCHEDULE I, PAGE 1, PART I, LINE 2	REQUESTS FOR FINANCIAL ASSISTANCE ARE APPROVED BY THE BOARD PRIOR TO DISBURSEMENT. ANY ORGANIZATION RECEIVING AN AWARD MUST SIGN AN AGREEMENT BEFORE THE FUNDS ARE DISPURSED STATING THE FUNDS WILL BE USED FOR THE STATED PURPOSE AS LISTED IN THEIR GRANT APPLICATION.

Schedule I (Form 990) 2019

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Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1JONAS MUNGER DIRECTOR	(i) (ii)	426,984 -------------	-------------	-------------	26,700 -------------	25,715 -------------	479,399 -------------	-------------
2KIM BRANDAU DIRECTOR	(i) (ii)	380,621 -------------	-------------	-------------	8,000 -------------	18,221 -------------	406,842 -------------	-------------
3JENNIFER SADOFF CEO	(i) (ii)	217,207 -------------	-------------	-------------	8,888 -------------	17,257 -------------	243,352 -------------	-------------
4RICHARD WHITE CFO	(i) (ii)	170,113 -------------	-------------	-------------	6,923 -------------	20,430 -------------	197,466 -------------	-------------
5DYLAN COLE CHIEF MED OFFICER	(i) (ii)	453,144 -------------	-------------	-------------	26,700 -------------	25,715 -------------	505,559 -------------	-------------
6KENNETH WILLIAMS PHYSICIAN	(i) (ii)	381,919 -------------	-------------	-------------	26,700 -------------	25,715 -------------	434,334 -------------	-------------
7MICHAEL QUINN SURGEON	(i) (ii)	335,059 -------------	-------------	-------------	11,200 -------------	17,802 -------------	364,061 -------------	-------------
8WHITNEY MACK PHYSICIAN	(i) (ii)	312,842 -------------	-------------	-------------	11,200 -------------	8,552 -------------	332,594 -------------	-------------
9PAUL JOHNSON PHYSICIAN	(i) (ii)	311,142 -------------	-------------	-------------	11,200 -------------	8,552 -------------	330,894 -------------	-------------

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2019

Additional Data

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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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

MOAB VALLEY HEALTHCARE INC

Employer identification number

87-0543342

Return Reference	Explanation
FORM 990	FORM 990, PART III, LINE 4A - FIRST ACCOMPLISHMENT - CONTINUATION THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 1,531,509 FOR CHARITY CARE, 1,451,953 FOR MEDICAID, 10,179,445 FOR MEDICARE, AND 10,765,151 FOR OTHER THIRD-PARTY PAYERS DURING THE YEAR. THE HOSPITAL IS THE LEADING HEALTHCARE FACILITY IN SOUTHEASTERN UTAH AND THE LARGEST PRIVATE EMPLOYER IN GRAND COUNTY. THE DEMAND FOR BOTH INPATIENT AND OUTPATIENT SERVICES HAS INCREASED SIGNIFICANTLY AS THE NEAREST TERTIARY HOSPITAL IS OVER 100 MILES AWAY, MAKING MRH A KEY COMPONENT TO THE HEALTH AND WELL-BEING OF THE 10,012 GRAND COUNTY RESIDENTS WHO CALL THE REGION HOME AND THE 2+ MILLION ANNUAL VISITORS TO THE REGION. ALL OF THE HOSPITAL'S 17 ACUTE CARE BEDS ARE ALSO LICENSED AS SWING BEDS. THE EMERGENCY DEPARTMENT IS VERY BUSY DUE TO THE EXTREME NATURE OF THE RECREATIONAL ACTIVITIES MOAB IS KNOWN FOR, AS IS THE ORTHOPEDIC DEPARTMENT THAT CAN ACCOMMODATE MOST INJURIES AND ELECTIVE PROCEDURES LOCALLY. MRH OWNS AND OPERATES THE MOAB REGIONAL MEDICAL CLINIC, A MULTI-SPECIALTY CLINIC LOCATED ADJACENT TO MOAB REGIONAL HOSPITAL. THE CLINIC MEDICAL STAFF INCLUDES FIVE PRIMARY CARE PHYSICIANS, ONE GENERAL SURGEON, ONE ORTHOPEDIC SURGEON, AND A BEHAVIORAL HEALTH PROVIDER; URGENT CARE SERVICES AS WELL AS ADDITIONAL PRIMARY CARE AND WOMEN'S HEALTH SERVICES ARE PROVIDED BY THREE PHYSICIAN'S ASSISTANTS. THE CLINIC ALSO SUPPORTS A VARIETY OF VISITING MEDICAL SPECIALISTS, INCLUDING CARDIOLOGY, GYNECOLOGY, INTEGRATIVE MEDICINE, NEUROLOGY, ONCOLOGY, PLASTIC SURGERY, AND PODIATRY. GRAND COUNTY HOSPICE, AN AFFILIATE OF MRH, PROVIDES COMPREHENSIVE END-OF- LIFE CARE FOR INDIVIDUALS IN THE AREA. HOSPICE STAFF PROVIDES IN-HOME MEDICAL AND PAIN MANAGEMENT CARE WITH THE GOAL OF HELPING PATIENTS MAINTAIN THE HIGHEST QUALITY OF LIFE POSSIBLE IN THEIR FINAL DAYS OF LIFE. ABSENCE OF THIS PROGRAM IN THE COMMUNITY WOULD CREATE A DIFFICULT SITUATION AT THE VERY TIME WHEN THESE SERVICES ARE MOST NEEDED. MOAB REGIONAL HOSPITAL'S ADDITIONAL PATIENT SERVICES INCLUDE INFUSION THERAPY SERVICES. UNDER THE DIRECTION OF LOCAL CHEMOTHERAPY CERTIFIED NURSES, AND WITH OVERSIGHT BY VISITING ONCOLOGISTS FROM GRAND JUNCTION, COLORADO, LOCAL AND REGIONAL CANCER PATIENTS ARE SPARED THE DIFFICULT EXPERIENCE OF HAVING TO DRIVE TWO TO FOUR HOURS ONE WAY TO A LARGE HOSPITAL FOR THEIR CHEMOTHERAPY AND OTHER INTRAVENOUS TREATMENTS. THIS ALSO ALLOWS THEM TO STAY IN THEIR OWN HOMES WHEN RECEIVING THERAPY. THE COMMUNITY HAS LAUDED THIS SERVICE AS A MOST WELCOME ADDITION TO THE HOSPITAL'S SERVICES. PHARMACY AND OTHER SUPPORT SERVICES HAVE MADE THIS PROGRAM VIABLE IF NOT PROFITABLE. MRH, IN PARTNERSHIP WITH THE UNIVERSITY NEUROPSYCHIATRIC INSTITUTE (UNI) AT THE UNIVERSITY OF UTAH, ALSO BEGAN OFFERING ADDICTION MEDICINE SERVICES TO PATIENTS WITH SUBSTANCE USE DISORDER. PHYSICIANS FROM UNI PROVIDE MEDICATION ASSISTED TREATMENT TO PATIENTS ONCE A MONTH AT MOAB REGIONAL HOSPITAL. THERE IS SIGNIFICANT DEMAND FOR THIS PROGRAM AS THERE ARE VERY LIMITED RESOURCES AVAILABLE FOR THIS TYPE OF HEALTH CARE IN SOUTHEAST UTAH. THE PHYSICIANS ARE ALSO SERVING AS PROJECT CONSULTANTS AS MRH WORKS TO DEVELOP ITS OWN, STAND-ALONE ADDICTION MEDICINE CLINIC.
FORM 990, PAGE 6, PART VI, LINE 11B	A COPY OF THE 990 IS PROVIDED TO THE CFO AND BOARD FINANCE COMMITTEE WHO REVIEW THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A FINAL DRAFT IS PROVIDED TO THE BOARD WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN.
FORM 990, PAGE 6, PART VI, LINE 12C	THE HOSPITAL REQUIRES BOARD MEMBERS AND OFFICERS OF THE ORGANIZATION TO REVIEW THE POLICY ANNUALLY AND TO DISCLOSE POTENTIAL CONFLICTS. IF A CONFLICT EXISTS THEY ARE REVIEWED BY THE BOARD AND THE INDIVIDUAL WITH THE CONFLICT ABSTAINS FROM VOTING ON THE ISSUE.
FORM 990, PAGE 6, PART VI, LINE 15A	COMPENSATION OF THE CEO IS SET BY THE INDEPENDENT, VOLUNTEER BOARD OF DIRECTORS. CEO COMPENSATION RANGE IS DERIVED FROM THE UTAH HOSPITAL ASSOCIATION SALARY SURVEYS AND OTHER REGIONAL COMPENSATION SURVEYS. ADDITIONALLY, CEO COMPENSATION IS DETERMINED UNDER A YEARLY PERFORMANCE EVALUATION. THIS PRACTICE IS ALSO FOLLOWED FOR THE CFO POSITION AND FOR OTHER COMPENSATED OFFICERS AND KEY EMPLOYEES. THE ANNUAL DELIBERATION AND DECISION PROCESS IS SUBSTANTIATED.
FORM 990, PAGE 6, PART VI, LINE 15B	SEE FORM 990, PART VI, LINE 15A ABOVE.
FORM 990, PAGE 6, PART VI, LINE 19	THE HOSPITAL MAKES GOVERNING DOCUMENTS AND ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE PUBLIC DISCLOSURE COPY OF THE FORM 990.
FORM 990, PART IX, LINE 11G	3,734,036 425,533 0
FORM 990, PART XI, LINE 9	FUNDRAISING EVENT EXPENSES 4,017 FUNDRAISING EVENT EXPENSES -4,017

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:
Software Version:

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	404,907	39,990
9	Program service revenue (Part VIII, line 2g) .........	36,459,120	34,921,765
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	156,279	852,941
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	384,545	414,134
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	37,404,851	36,228,830
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	4,500	301,000
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	17,127,028	18,436,995
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....		0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	14,646,457	14,301,274
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	31,777,985	33,039,269
19	Revenue less expenses. Subtract line 18 from line 12.......	5,626,866	3,189,561
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	56,955,341	59,235,123
21	Total liabilities (Part X, line 26).............	28,135,592	27,225,813
22	Net assets or fund balances. Subtract line 21 from line 20.....	28,819,749	32,009,310

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 26,550,721 including grants of $ 301,000 ) (Revenue $ 34,921,765 )
	MOAB REGIONAL HOSPITAL (MRH) OPERATES A 17-BED ACUTE CARE CRITICAL ACCESS HOSPITAL (CAH), WHICH PROVIDES EMERGENCY, INPATIENT, OUTPATIENT, ACUTE CARE AND SUBACUTE SERVICES IN HOSPITAL AND CLINIC SETTINGS. THE HOSPITAL PROVIDED 5,426 EMERGENCY DEPARTMENT VISITS, 1,923 DAYS OF INPATIENT SERVICES, 24,861 CLINIC VISITS, 4,137 HOSPICE DAYS, AND 68 BIRTHS DURING THE YEAR. SEE CONTINUATION ON SCHEDULE O.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses26,550,721

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	2,989,031	305,470

		Business Code
2a	NET PATIENT SERVICE REVENUE	624100	34,429,905	34,429,905
b	CARE CENTER MANAGEMENT FEES	561000	491,860	491,860
c
d
e
f	All other program service revenue.
g	Total. Add lines 2a–2f .....		34,921,765

1	Briefly describe the organization’s mission or most significant activities: OUR DEDICATED TEAM PUTS THE PATIENT FIRST, DELIVERS QUALITY COST-EFFECTIVE HEALTHCARE AND PROMOTES WELLNESS TO ALL WE SERVE.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	10
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	8
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	285
6	Total number of volunteers (estimate if necessary) .............	6	29
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c	4,300
d	Related organizations		1d
e	Government grants (contributions)		1e	26,150

f	All other contributions, gifts, grants, and similar amounts not included above		1f	9,540

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		39,990

3 Investment income (including dividends, interest, and othersimilar amounts) ......			860,164			860,164
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents		83,896	6a
b	Less: rental expenses			6b
c	Rental income or (loss)		83,896	6c
d	Net rental income or (loss).......			83,896			83,896
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses	7,223		7b
c	Gain or (loss)	-7,223		7c
d	Net gain or (loss).........			-7,223			-7,223
8a	Gross income from fundraising events (not including $ 4,300of contributions reported on line 1c). See Part IV, line 18 ....
			8a	14,129
b	Less: direct expenses ...		8b	4,017
c	Net income or (loss) from fundraising events..			10,112
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a
b	Less: cost of goods sold ..		10b
c	Net income or (loss) from sales of inventory..
Business Code			Miscellaneous Revenue
11a	CAFETERIA			243,641			243,641
b	OTHER REVENUE			56,108			56,108
c	REBATES			20,377			20,377
d	All other revenue ....
e	Total. Add lines 11a–11d ......			320,126
12	Total revenue. See instructions.....			36,228,830	34,921,765		1,256,963

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	301,000	301,000
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	1,327,060	886,241	440,819
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	13,694,117	11,125,402	2,568,715
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	517,470	420,515	96,955
9	Other employee benefits .......	1,793,617	1,458,999	334,618
10	Payroll taxes ...........	1,104,731	875,762	228,969
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	103,460		103,460
c	Accounting ...........	68,100		68,100
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......	4		4
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	4,159,569	3,734,036	425,533
12	Advertising and promotion ....	74,452	748	73,704
13	Office expenses .......	934,383	680,640	253,743
14	Information technology ......	287,159	166,943	120,216
15	Royalties ..
16	Occupancy ...........	501,592	368,869	132,723
17	Travel ............	171,998	124,440	47,558
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	67,456	45,506	21,950
20	Interest ...........	1,725,803	1,194,785	531,018
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,145,598	1,665,143	480,455
23	Insurance ...	269,047	256,553	12,494
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	MEDICAL SUPPLIES & DRUGS	2,743,360	2,743,360
b	REPAIRS AND MAINTENANCE	803,760	465,232	338,528
c	OTHER EXPENSES	245,533	36,547	208,986
d
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	33,039,269	26,550,721	6,488,548	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			980	1	150,748
2	Savings and temporary cash investments .........			18,367,942	2	24,002,273
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			5,428,063	4	5,612,265
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
					6
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			1,005,875	8	876,071
9	Prepaid expenses and deferred charges ......			416,355	9	563,633
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	38,759,863
b	Less: accumulated depreciation	10b	21,101,937	18,874,182	10c	17,657,926
11	Investments—publicly traded securities .			9,913,765	11	8,921,216
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 ..			122,673	13	138,036
14	Intangible assets ...............			325,000	14	292,500
15	Other assets. See Part IV, line 11 ...........			2,500,506	15	1,020,455
16	Total assets. Add lines 1 through 15 (must equal line 33)...			56,955,341	16	59,235,123

17	Accounts payable and accrued expenses .....	3,174,693	17	3,064,633
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........		20
21	Escrow or custodial account liability. Complete Part IV of Schedule D		21
22	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
			22
23	Secured mortgages and notes payable to unrelated third parties ..	24,960,899	23	24,161,180
24	Unsecured notes and loans payable to unrelated third parties ..		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D		25
26	Total liabilities. Add lines 17 through 25..	28,135,592	26	27,225,813

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........	28,819,749	27	32,009,310
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	28,819,749	32	32,009,310
33	Total liabilities and net assets/fund balances ........	56,955,341	33	59,235,123