Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2019 | (b) 2020 | (c) 2021 | (d) 2022 | (e) 2023 | (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 on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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): |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2023 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2023 |
(iii) Distributable Amount for 2023 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2023 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2023 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2023: | ||||
| a From 2018....... | ||||
| b From 2019....... | ||||
| c From 2020....... | ||||
| d From 2021....... | ||||
| e From 2022....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2023 distributable amount | ||||
|
i
Carryover from 2018 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2023 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2023 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2023, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2023. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2024. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2019..... | ||||
| b Excess from 2020..... | ||||
| c Excess from 2021..... | ||||
| d Excess from 2022..... | ||||
| e Excess from 2023..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
| Return Reference | Explanation |
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| FORM 990, PART III, LINE 3 | THE HOSPITAL FACILITY CLOSED IN JUNE 2023. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE SOLE MEMBER OF THE ORGANIZATION IS CARSON-TAHOE HEALTH SYSTEM, A TAX EXEMPT ORGANIZATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | CARSON-TAHOE HEALTH SYSTEM, THE SOLE MEMBER, HAS THE RIGHT TO APPOINT TWO CORPORATE MEMBER DIRECTORS OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD OF DIRECTORS OF CARSON TAHOE CONTINUING CARE HOSPITAL ("THE HOSPITAL") MAY NOT, WITHOUT THE EXPRESS WRITTEN CONSENT OF CARSON-TAHOE HEALTH SYSTEM, THE SOLE MEMBER, HAVE THE POWER TO TAKE ANY OF THE FOLLOWING ACTIONS: (1) ANY FUNDAMENTAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE HOSPITAL; (2) THE INCURRENCE OF DEBT, INCLUDING WITHOUT LIMITATION, BORROWINGS, GUARANTEES, LOANS, ENCUMBRANCES, OPERATING LEASES, PURCHASE OR LEASE OF REAL ESTATE, AND CAPITAL LEASES, IN EXCESS OF $250,000, MEASURED IN AN ANNUAL AGGREGATE; (3) ANY MERGER OR CONSOLIDATION TO WHICH THE HOSPITAL IS A PARTY; (4) THE SALE OR DISPOSITION OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE HOSPITAL; (5) POLICIES PERTAINING TO CHARITY CARE; (6) ANY RELEASE OR CANCELLATION OF INDIVIDUAL CLAIMS IN EXCESS OF $250,000; (7) ANY CAPITAL EXPENDITURES WHICH IN THE AGGREGATE EXCEED $250,000 ANNUALLY; (8) APPOINTMENT AND REMOVAL OF THE SOLE CORPORATE MEMBER DIRECTORS; (9) THE DEFENSE, SETTLEMENT OR RESOLUTION OF ANY DISPUTE INVOLVING THE HOSPITAL IN WHICH THE AMOUNT IN CONTROVERSY IS IN EXCESS OF $250,000; (10) THE DEFENSE, SETTLEMENT OR RESOLUTION OF ANY REGULATORY CHALLENGES TO THE LEGAL STRUCTURE OF THE HOSPITAL, ALLEGED OVERPAYMENTS FROM ANY GOVERNMENTAL AGENCY OR ANY ALLEGATIONS FROM A GOVERNMENTAL AGENCY OF FRAUD AND ABUSE; AND (11) AMENDMENTS TO THE ARTICLES OF INCORPORATION AND BYLAWS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION ENGAGED AN INDEPENDENT ACCOUNTING FIRM TO PREPARE AND REVIEW THE 990. THE 990 WAS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND THE ACCOUNTING PERSONNEL WITH THE INDEPENDENT ACCOUNTING FIRM. THROUGH THE REVIEW PROCESS, ANY CLARIFICATIONS OR CORRECTIONS THAT NEEDED TO BE MADE WERE MADE. THE FORM 990 WAS THEN REVIEWED BY THE FINANCE COMMITTEE OF THE BOARD WITH THE INDEPENDENT ACCOUNTING FIRM. ANY QUESTIONS OR CONCERNS THE FINANCE COMMITTEE RAISED WERE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEEDED TO BE MADE WERE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES WAS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | ACTUAL OR POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED BY THE INTERESTED PARTY TO THE BOARD OR A COMMITTEE. IF ANY INTERESTED PERSON BECOMES AWARE OF A POTENTIAL CONFLICT BEFORE THE MATTER IS UNDER CONSIDERATION BY THE GOVERNING BODY OR THE COMMITTEE THEN THE INTERESTED PERSON MAY DISCLOSE THE POTENTIAL CONFLICT OF INTEREST TO THE HOSPITAL'S MANAGEMENT PERSONNEL OR THE CHAIR OF THE BOARD. AN INTERESTED PERSON MAY MAKE A PRESENTATION AND ANSWER QUESTIONS POSED AT A BOARD OR COMMITTEE MEETING, BUT AFTER THE PRESENTATION, HE OR SHE SHALL LEAVE THE MEETING DURING THE DISCUSSION OF, AND VOTE ON, THE TRANSACTION OR ARRANGEMENT INVOLVING THE POTENTIAL CONFLICT OF INTEREST. THE CHAIR OF THE BOARD OR COMMITTEE SHALL, IF HE OR SHE DEEMS APPROPRIATE, APPOINT A DISINTERESTED PERSON OR COMMITTEE TO INVESTIGATE THE POTENTIAL CONFLICT OF INTEREST AND ALTERNATIVES TO THE APPLICABLE TRANSACTION OR ARRANGEMENT OR OTHER RESOLUTION OF A POTENTIAL CONFLICT OF INTEREST. AFTER EXERCISING DUE DILIGENCE, THE BOARD OR COMMITTEE SHALL DETERMINE WHETHER THE ORGANIZATION CAN OBTAIN WITH REASONABLE EFFORTS A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT FROM A PERSON OR ENTITY THAT WOULD NOT GIVE RISE TO A CONFLICT OF INTEREST. IF A MORE ADVANTAGEOUS TRANSACTION OR ARRANGEMENT IS NOT REASONABLY POSSIBLE UNDER CIRCUMSTANCES NOT PRODUCING A CONFLICT OF INTEREST, THE BOARD OR COMMITTEE SHALL DETERMINE BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS WHETHER THE TRANSACTION OR ARRANGEMENT IS IN THE HOSPITAL'S BEST INTEREST, FOR ITS OWN BENEFIT, AND WHETHER IT IS REASONABLE. EMPLOYEES AND OTHERS ENGAGED BY THE BOARD MUST SEEK GUIDANCE AND APPROVAL FROM APPROPRIATE MANAGEMENT PERSONNEL PRIOR TO PURSUING ANY BUSINESS OR PERSONAL ACTIVITY THAT MIGHT CONSTITUTE A CONFLICT OF INTEREST. CARSON TAHOE CONTINUING CARE HOSPITAL'S CHIEF EXECUTIVE, WORKING WITH THE CHAIR, WILL BE RESPONSIBLE TO ENSURE THOSE CONDUCTING AUDITING AND MONITORING REVIEWS OF INTERNAL CONTROL ARE FREE FROM ANY CONFLICTS OF INTEREST OR OTHER INFLUENCES THAT WOULD IMPAIR THEIR ABILITY TO OBJECTIVELY CARRY OUT THEIR DUTIES WITHOUT BIAS. IF THE BOARD OR COMMITTEE OF CARSON TAHOE CONTINUING CARE HOSPITAL HAS REASONABLE CAUSE TO BELIEVE A BOARD OR COMMITTEE MEMBER OR EMPLOYEE HAS FAILED TO DISCLOSE ACTUAL OR POSSIBLE CONFLICTS OF INTEREST, THE MEMBER OR EMPLOYEE WILL BE INFORMED OF THE BASIS FOR SUCH BELIEF AND AFFORDED AN OPPORTUNITY TO EXPLAIN THE ALLEGED FAILURE TO DISCLOSE. IF, AFTER HEARING AN EMPLOYEE'S OR DIRECTOR'S RESPONSE, AND AFTER MAKING FURTHER INVESTIGATION AS WARRANTED BY THE CIRCUMSTANCES, IT IS DETERMINED THAT THERE WAS A FAILURE TO DISCLOSE, THERE WILL BE APPROPRIATE DISCIPLINARY AND CORRECTIVE ACTION, WHICH COULD INCLUDE, WITHOUT LIMITATION, TERMINATION OF THE PERSON'S EMPLOYMENT OR DIRECTORSHIP. THE CEO OR HIS OR HER DESIGNEE SHALL PROVIDE TO THE BOARD AND ALL EXECUTIVE OFFICERS, STAFF, AND VOLUNTEERS, A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM AND QUESTIONNAIRE, WHICH SHALL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS OR CIRCUMSTANCES WHEREIN IT IS BELIEVED A CONFLICT MAY ARISE. SUCH ANNUAL MONITORING AND REVIEW PROCEDURES SHALL BE PART OF THE CORPORATE COMPLIANCE PLAN. AN APPROPRIATE REPORT SHALL BE SUBMITTED TO THE BOARD CONCERNING ANY INTEREST DISCLOSED. EACH MEMBER OF THE BOARD AND ALL EXECUTIVE MANAGEMENT SHALL DISCLOSE FULLY AND FRANKLY ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS OF DUALITY OF INTEREST OR RESPONSIBILITY, WHETHER INDIVIDUAL, PERSONAL, OR BUSINESS, WHICH MAY EXIST OR APPEAR TO EXIST TO CARSON TAHOE CONTINUING CARE HOSPITAL ON ANY MATTER OF BUSINESS WHICH MAY COME BEFORE THE BOARD (INCLUDING ITS COMMITTEES). |
| FORM 990, PART VI, SECTION B, LINE 15 | CARSON-TAHOE HEALTH SYSTEM'S EXECUTIVE COMPENSATION COMMITTEE DETERMINES THE TOTAL COMPENSATION PACKAGE FOR THE CEO BASED ON MARKET SURVEYS POSITIONED SO THAT MIDPOINT WILL TARGET THE 50TH PERCENTILE. INCENTIVES WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 50TH PERCENTILE FOR ON-PLAN PERFORMANCE. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS. THE LAST REVIEW WAS CONDUCTED BY LONGNECKER IN 2023. BASE SALARIES FOR OTHER OFFICERS AND KEY EMPLOYEES WILL BE POSITIONED SO THAT MIDPOINTS TARGET THE 50TH PERCENTILE. EXECUTIVE SALARIES WILL BE ADMINISTERED WITHIN RANGES BUILT AROUND THE 50TH PERCENTILE AND BASED ON PERFORMANCE, EXPERIENCE, TENURE, AND OTHER RELEVANT FACTORS AS EVALUATED BY CEO. INCENTIVES WILL BE POSITIONED TO PROVIDE TOTAL CASH COMPENSATION AT THE 50TH PERCENTILE FOR ON-PLAN PERFORMANCE. ACHIEVING MAXIMUM INCENTIVES MAY RAISE TOTAL COMPENSATION TO APPROXIMATELY THE 65TH PERCENTILE. BENEFITS WILL BE POSITIONED AT MARKET COMPETITIVE LEVELS. THE LAST REVIEW WAS CONDUCTED BY LONGNECKER IN 2023. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 272,995. MANAGEMENT AND GENERAL EXPENSES 126,009. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 399,004. PHYSICIAN PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 64,179. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 64,179. OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 2,475. MANAGEMENT AND GENERAL EXPENSES 1,050. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,525. SHARED SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 555,132. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 555,132. |
| FORM 990, PART XI, LINE 9: | TRANSFER OF NET ASSETS TO CARSON TAHOE REGIONAL HEALTHCARE -854,142. |
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