2021-05-17T18:08:17-05:00 2020-06-30 721396621 CARR RIGGS & INGRAM LLC 2403 82ND STREET LUBBOCK TX 79423 990 2019-07-01 850141285 CIBOLA GENERAL HOSPITAL CIBO 5052874446 1016 E ROOSEVELT AVE GRANTS NM 87020 JIM HERMES CFO 5052874446 2021-05-17 1 JIMMY D PENDERGRASS P00087378 8067456789 2021-05-17 2019 2022-09-23 18:48:47Z JIM HERMES 1016 E ROOSEVELT AVE GRANTS NM 87020 32290166 0 X WWW.CIBOLAHOSPITAL.COM X 1959 NM TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY WITHOUT REGARD TO ABILITY TO PAY BY UTILIZING STATE OF THE ART PRACTICES AND EQUIPMENT TO PROVIDE QUALITY CARE. 9 8 240 0 0 0 35838 1125309 29053579 30469568 109088 125424 83062 569865 29281567 32290166 31000 31000 0 0 14941866 19234309 0 0 0 16251304 14885663 31224170 34150972 -1942603 -1860806 35400715 37512954 3393764 7376275 32006951 30136679 X TO PROVIDE EXCELLENT HEALTH CARE TO THE COMMUNITY BY COMMITTING TO SERVICE, QUALITY, FINANCIAL STABILITY, AND GROWTH. THE ORGANIZATION STRIVES TO PROVIDE PATIENTS AND FAMILIES WITH QUALITY SERVICE BY IMPLEMENTING NATIONAL BEST PRACTICES AS STANDARDS. IT ALSO MAINTAINS FINANCIAL STABILITY TO ENSURE ITS CONTINUANCE AND GROWTH SO THAT HEALTH CARE IS ACCESIBLE THROUGH THE HOSPITAL AND ITS PHYSICIAN PARTNERSHIPS. 0 0 23998756 31000 31039433 THE ORGANIZATION PROVIDES PATIENT CARE TO THE RESIDENTS OF GRANTS, NEW MEXICO AND OUTLYING COMMUNITIES WITHOUT REGARD TO ABILITY TO PAY. THERE ARE APPOXIMATELY 27,000 RESIDENTS IN THE CIBOLA COUNTY, NM COMMUNITY. CIBOLA COUNTY HOSPITAL UTILIZES STATE OF THE ART EQUIPMENT AND THE HIGHEST HEALTH CARE STANDARDS TO PROVIDE QUALITY HEALTH CARE. DURING THE FISCAL YEAR, THE ORGANIZATION HAD ABOUT 825 INPATIENT ADMISSIONS SERVED IN ITS 25-BED FACILITY. THE HOSPITAL ALSO HAD ABOUT 17,200 OUTPATIENT VISITS, 9,000 EMERGENCY ROOM VISITS, AND ABOUT 21,600 CLINIC VISITS. THE ORGANIZATION'S STAFF WORK HAD TO MEET PATIENT NEEDS AND THEY FEEL EVERY PATIENT ENCOUNTER IS AN ACCOMPLISHMENT. 23998756 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 99 0 1 240 1 0 0 0 0 0 0 0 0 0 0 X 9 8 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NM X CIBOLA GENERAL HOSPITAL 5052874446 1016 E ROOSEVELT AVE GRANTS NM 87020 BOB TENEQUER CHAIRMAN 3.00 X X 0 0 0 JEFF RIMEL TREASURER 3.00 X X 0 0 0 NESTOR GRIEGO VICE CHAIRMAN 3.00 X X 0 0 0 DR ANN CHURCH CHIEF OF MEDICAL STAFF/MEM 3.00 X X 334343 0 0 CARLOS TAPIA MEMBER 3.00 X 0 0 0 KENDRA BROWN MEMBER 3.00 X 0 0 0 CHASE ELKINS SECRETARY 3.00 X X 0 0 0 ROBERT WINDHORST MEMBER 3.00 X 0 0 0 EILEEN YARBOROUGH MEMBER 3.00 X 0 0 0 THOMAS WHELAN CEO 40.00 X 192511 0 0 JIM HERMES CFO 40.00 X 30769 0 0 WALTER BRIDGES SURGEON 40.00 X 378928 0 0 JOSEPH CHARLES PHYSICIAN 40.00 X 299122 0 0 KARL GUTIERREZ PHYSICIAN 40.00 X 236684 0 0 CONRAD CASTELLINO PHYSICIAN 40.00 X 275976 0 0 ARNOLD VALDIVIA PHYSICIAN 40.00 X 340809 0 0 2089142 0 0 17 0 1 0 EMCARE INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 EMERGENCY PHYSICIANS 1386272 VISTA STAFFING SOLUTIONS FILE 50834 LOS ANGELES CA 90074 STAFFING SERVICES 381295 QUEST DIAGNOSTICS PO BOX 912501 PASADENA CA 91110 DIAGNOSTIC IMAGING SOLUTIONS 319940 HARMONIX TECHNOLOGIES PO BOX 57055 ALBUQUERQUE NM 87187 IMFORMATION TECHNOLOGY SOLUTIONS 315375 SHARED IMAGING INC LOCK BOX 88544 MILWAUKEE WI 53288 DIAGNOSTIC IMAGING SOLUTIONS 306108 15 1125309 1125309 ACUTE CARE HOSPITAL SERVICES 622110 25692695 25692695 OTHER PROGRAM REVENUE 622110 2889473 2889473 CIBOLA COUNTY MILL LEVY SUBSIDY 921190 1887400 1887400 30469568 125424 125424 OTHER MISCELLANEOUS 900099 470165 470165 FOOD SERVICE INCOME 900099 99700 99700 569865 32290166 31039433 0 125424 31000 31000 15469341 12375473 3093868 3764968 3011974 752994 2356147 2356147 396991 396991 979777 774514 205263 782196 782196 PURCHASED SERVICES 5023870 2385836 2638034 MEDICAL, RX & FOOD SUPP 2531222 2193051 338171 REPAIRS & MAINTENANCE 1242869 344399 898470 OTHER EXPENSES 1101309 355004 746305 471282 171358 299924 34150972 23998756 10152216 0 7093895 10620927 6412111 5427041 260942 338025 754381 730512 15925724 11376624 4725409 4549100 15744071 15847349 409906 0 35400715 37512954 3393764 7376275 3393764 7376275 X 32006951 30136679 32006951 30136679 35400715 37512954 X -1860806 -10166 700 X 0 1 X 1 0 X 3948309 3097576 850733 11573484 8279048 3294436 403931 403931 4549100 CERTIFICATES OF DEPOSIT 15847349 F 15847349 32290166 0 32290166 0 32290166 34150972 0 34150972 0 34150972 SCHEDULE D, PART VI, LINE 1(E): THIS LINE CONTAINS THE ORGANIZATION'S TOTAL NONDEPRECIABLE CONSTRUCTION IN PROCESS BALANCE. 1 1 1 X 350.000000000000 1 X 100.000000000000 1 1 0 0 314957 314957 0.00920 8829251 6862638 1966613 0.05760 9144208 6862638 2281570 0.06680 34822 34822 0.00100 34822 34822 0.00100 9179030 6862638 2316392 0.06780 1 4331695 1727636 3447034 7656604 -4209570 X 1 1 1 1 CIBOLA GENERAL HOSPITAL INC 1016 E ROOSEVELT AVE GRANTS NM 87020 WWW.CIBOLAHOSPITAL.COM X CIBOLA GENERAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 17 1 0 0 1 X HTTP://WWW.CIBOLAHOSPITAL.COM/ 0 0 1 X 350.000000000000 100.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.CIBOLAHOSPITAL.COM// X WWW.CIBOLAHOSPITAL.COM X X X 1 X 1 X X X 1 0 0 CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 5: FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOUGHT INPUT FROM ALL PERSONS IN ITS SERVICE AREA, INCLUDING COUNTY GOVERNMENT AND LEADERS OF THE BUSINESS COMMUNITY. THE NEEDS ASSESSMENT WAS OFFERED ONLINE FROM A LINK TO IT IN THE HOSPITAL'S WEBSITE, AND WAS ALSO OFFERED IN A PAPER VERSION TO ANY WHO PREFERRED IT THAT WAY. THE PERSONS CONSULTED INCLUDED, BUT WERE NOT LIMITED TO, THE CEO, CFO, CCO, HR DIRECTOR, ALL MEMBERS OF THE BOARD, AND THE MEDICAL STAFF. THE NEEDS ASSESSMENT WAS HEAVILY ADVERTISED IN THE MEDIA. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE HOSPITAL AND BOARD PRACTICE ONGOING PROMOTION OF HEALTH IMPROVEMENT. COMMUNITY HEALTH IA PROMOTED IN THE FOLLOWING WAY: (1) THE HOSPITAL BOARD IS A COMMUNITY-BASED, ALL VOLUNTEER GROUP. (2) SURPLUS FUNDS ARE USED TO REINVEST IN THE FACILITIES TO KEEP THEM STATE OF THE ART. (3) FINANCIAL SUPPORT TO THE LOCAL COLLEGE FUNDS THE SALARY OF THE NURSING PROGRAM DIRECTOR. (4) THE HOSPITAL CO-SPONSORS AN ANNUAL HEALTH FAIR TO EDUCATE THE COMMUNITY. (5) ANNUAL VACCINATION CLINICS ARE STAFFED BY HOSPITAL NURSES. (6) FREE CLASSES ARE SPONSORED IN DIABETES EDUCATION, CHILDBIRTH AND BREASTFEEDING. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 18E: OUTSIDE COLLECTION AGENCIES ARE USED. THE RECOVERY RATES BY THESE AGENCIES ARE TYPICALLY UNDER 10%. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 20E: PATIENTS ARE NOTIFIED UPON ADMISSION AND DISCHARGE OF THE FINANCIAL ASSISTANCE PROGRAM. ALSO, THE ORGANIZATION DOCUMENTS ITS DETERMINATION OF ELIGIBILITY AND NOTIFIES PATIENTS OF THE POLICY IN COMMUNICATIONS WITH PATIENTS REGARDING THEIR BILLS. PART I, LINE 7: AMOUNT REPORTED ON LINE A, COLUMN C IS BASED ON THE ORGANIZATION'S COST TO CHARGE RATIO. LINE B, COLUMN D USES COST TO CHARGE RATION OFFSET BY A CONTRACTUAL PERCENTAGE LEADING TO THE AMOUNT REPORTED IN COLUMN E. LINE E, COLUMN C AND LINE F, COLUMN C ARE BASED ON ACTUAL COST. ALSO, LINE 7, COLUMN G IS NOT APPLICABLE; THEREFORE NOTHING ENTERED. PART I, LINE 3C THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: (1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. (2) PROOF OF HOUSEHOLD INCOME. AND (3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. PART III, LINE 4: THERE IS NO MENTION OF BAD DEBT EXPENSE NOR ITS CALCULATION METHODOLOGY WITHIN AUDITED FINANCIAL STATEMENT REPORT. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL SHOULD BE REGARDED AS COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CONSIDERED IN THE PROCESS. PART VI, LINE 3: THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: (1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. (2) PROOF OF HOUSEHOLD INCOME. AND (3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. PART VI, LINE 7, REPORTS FILED WITH STATES NM PART VI, LINE 2: THE ORGANIZATION OBTAINS A GREAT AMOUNT OF INFORMAL FEEDBACK FROM PATIENTS AND VISITORS. PART VI, LINE 3: IF DURING THE PATIENT REGISTRATION PROCESS IT IS DETERMINED THAT THE PATIENT LACKS THE ABILITY TO PAY, THEN THE REGISTRATION PERSON WILL PRESENT THE PATIENT THE INFORMATION NEEDED FOR HIM/HER TO APPLY FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: CIBOLA GENERAL HOSPITAL PROVIDES MEDICAL SERVICES IN A COUNTY THAT REPRESENTS APPROXIMATELY 28,000 RESIDENTS. PART VI, LINE 5: A TRANSPARENT BOARD, INVOLVED MEDICAL STAFF, AND EMPLOYEES WHO ARE ALSO CITIZEN-STAKEHOLDERS HELP PROMOTE COMMUNITY HEALTH. PART VI, LINE 6: THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. 0 SCHOLARSHIPS 10 31000 0 X X 0 0 0 0 0 0 0 0 0 DR ANN CHURCH CHIEF OF MEDICAL STAFF/MEM 334343 0 0 0 0 0 0 0 0 0 334343 0 0 0 THOMAS WHELAN CEO 192511 0 0 0 0 0 0 0 0 0 192511 0 0 0 WALTER BRIDGES SURGEON 378928 0 0 0 0 0 0 0 0 0 378928 0 0 0 JOSEPH CHARLES PHYSICIAN 299122 0 0 0 0 0 0 0 0 0 299122 0 0 0 KARL GUTIERREZ PHYSICIAN 236684 0 0 0 0 0 0 0 0 0 236684 0 0 0 CONRAD CASTELLINO PHYSICIAN 275976 0 0 0 0 0 0 0 0 0 275976 0 0 0 ARNOLD VALDIVIA PHYSICIAN 340809 0 0 0 0 0 0 0 0 0 340809 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A CIBOLA COUNTY APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE A COUNTY COMMISSIONER. THE HOSPITAL BOARD APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE THE CHIEF OF THE MEDICAL STAFF. THE 9TH MEMBER OF THE BOARD IS APPOINTED AT THE FIRST ANNUAL MEETING BASED ON A MAJORITY VOTE OF THE OTHER 8 BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD WILL REFER SIGNIFICANT CAPITAL PROJECT PROPOSALS AND TRUSTEE APPOINTMENTS TO THE COUNTY COMMISSIONER FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES, OFFICERS AND EMPLOYEES ARE REQUIRED ANNUALLY TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST IN WRITING. THE FORM IS SIGNED AND DATED, AND MONITORED BY THE COMPLIANCE COORDINATOR. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS AND HIGHLY PAID EMPLOYEES IS DETERMINED BY REVIEW OF COMPARABLE PAY FOR COMPARABLE DUTIES BY RECRUITERS, AND/OR OTHER CONSULTANTS. ALL AMOUNTS ARE APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS AND TAX FORMS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ALSO, THE CEO REPORTS REGULARLY TO THE COUNTY COMMISSION AT A PUBLIC MEETING AND THE BOARD HOLDS MONTHLY PUBLIC MEETINGS. FORM 990, PART XI, LINE 9: PRIOR PERIOD AUDIT ADJUSTMENT 700.