2019-05-15T11:34:24-05:00 2018-06-30 ERNST & YOUNG US LLP 2 N CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2017-07-01 860100882 VERDE VALLEY MEDICAL CENTER % JOHN A CORTESE CPA VERD 9286396442 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 JOHN CORTESE NAH TREASURER 9282143545 2019-05-13 true BRENDA D GRIESEMER P00264669 6023223000 2019-05-14 164.57.159.253 86597020191355000006 2019-05-15 P AF004A83757AE4CCCA4D7F5FBE81B297DEDD339B 537EC6986AB1F8F0FDE33F35764D968E98BC4D64 2017 2019-02-21 02:37:17Z FLORENCE L SPYROW 1200 N Beaver St FLAGSTAFF AZ 86001 153247214 false X WWW.NAHEALTH.COM X 1939 AZ IMPROVING HEALTH, HEALING PEOPLE. 13 12 0 427 21842 0 172703 234107 139024701 145593886 4507716 4291197 2725395 3128024 146430515 153247214 5144373 422195 0 0 63871889 61147860 0 0 0 66623873 65146357 135640135 126716412 10790380 26530802 290675049 310358710 82572407 75050207 208102642 235308503 X IMPROVING HEALTH, HEALING PEOPLE. false false 101171162 422195 135152875 TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY THROUGH INPATIENT, OUTPATIENT AND EMERGENCY HOSPITAL CARE AND RELATED MEDICAL SERVICES, CHARITY CARE AND COMMUNITY SERVICE. TOTAL INPATIENT DISCHARGES WERE 5,078 AND 18,695 PATIENT DAYS. OUTPATIENT VISITS APPROXIMATED 669,849 AND 26,133 EMERGENCY VISITS. 6103138 0 11702132 TO PROVIDE EMERGENCY SERVICES, CANCER TREATMENT, AND OTHER ANCILLARY SERVICES TO THE COMMUNITY THROUGH THE OPERATION OF THE VERDE VALLEY MEDICAL CENTER SEDONA CAMPUS. EMERGENCY VISITS WERE 6,895. RADIATION ONCOLOGY PROCEDURES WERE 11,737. MEDICAL IMAGING PROCEDURES WERE 12,754. LABORATORY PROCEDURES WERE 39,117. PHYSICAL THERAPY VISITS WERE 45,855. 1541078 0 1504980 TO PROVIDE GERIATRIC PSYCHIATRIC SERVICES TO THE COMMUNITY THROUGH THE OPERATION OF THE SENIOR BEHAVIORAL HEALTH UNIT. DISCHARGES WERE 193 AND PATIENT DAYS WERE 1,904. 0 0 0 108815378 true false false true false false false false false false true false false true true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true true true false false true X 168 0 true 0 true true false false false false false false false false false X 13 12 false false false false true true true true true false false true true true true true true true true false AZ X JOHN A CORTESE CPA 9282143545 914 N SAN FRANCISCO ST SUITE M FLAGSTAFF AZ 86001 FLORENCE SPYROW NAH PRESIDENT/CEO (AS OF 3/18) 4.0 36.0 X X 0 430515 16100 ALICE GAGNAIRE RN DIRECTOR/CHAIR 1.0 2.0 X X 0 0 0 SHAWN ORME DIRECTOR/VICE CHAIR 1.0 6.0 X X 0 0 0 CHARLES MARR DIRECTOR/TREASURER 1.0 7.0 X X 0 0 0 ELIZABETH MCFARLAND DIRECTOR/SECRETARY 1.0 2.0 X X 0 0 0 ANDREW ALDRIDGE MD DIRECTOR 1.0 2.0 X 0 0 0 JANET CORRIGAN DIRECTOR (AS OF 09/17) 1.0 2.0 X 0 0 0 WILLIAM JEFFERS DIRECTOR 1.0 2.0 X 0 0 0 RICHARD KRUSE DIRECTOR 1.0 2.0 X 0 0 0 WILLIAM RILEY DIRECTOR (AS OF 10/17) 1.0 2.0 X 0 0 0 KENNETH SALCE MD DIRECTOR 1.0 2.0 X 0 0 0 RAY SELNA DIRECTOR 1.0 3.0 X 0 0 0 GUADALUPE WOODSON FNP DIRECTOR 1.0 2.0 X 0 0 0 ROBERT THAMES NAH PRESIDENT/CEO (THRU 3/18) 1.0 39.0 X X 0 571379 30711 CAROLE PEET CAO (AS OF 01/18) 40.0 0.0 X 0 0 0 JAMES P SCHUESSLER INTERIM VVMC CAO (THRU 1/18) 40.0 0.0 X 0 271200 0 JEFFREY TREASURE NAH CHIEF FIN OFF 1.0 39.0 X 0 366723 33531 HU BLAKE CHIEF MED INFORMATICS OFFICER 2.0 38.0 X 0 303811 39980 BARBARA FIRMINGER CHIEF ACCESS OFF (THRU 06/18) 17.0 23.0 X 0 305892 29172 LORI GREEN CNO 40.0 0.0 X 0 187949 24972 LEON PONTIKES VVMC & NAHPG CMO 24.0 16.0 X 0 488577 39941 LORI SMITHSON DIRECTOR NURSING 40.0 0.0 X 0 181064 12057 DEBORAH ASHBY CLINICAL RESOURCES COORDINATOR 40.0 0.0 X 0 175396 38913 PAUL PREFONTAINE DIR REHAB CLINIC (THRU 5/18) 40.0 0.0 X 0 160974 25576 CHERYL CHASE MANAGER - PHARMACY OPERATIONS 40.0 0.0 X 0 159251 36006 CHARLES SECHRIST PHARMACIST 40.0 0.0 X 0 152390 48897 RICK PETERSON VP SUPPORT SVCS (THRU 1/17) 0.0 0.0 X 0 244378 4673 JOHN DEMPSEY VP NAH/PRES LCMC 0.0 40.0 X 0 322795 65655 0 4322294 446184 0 true true false HEALTHCARE SELECT DEPT LA 24465 PASADENA CA 911854465 CONTRACT LABOR 1701084 EMCARE PHYSICIAN SERVICES INC 7032 COLLECTIONS CENTER DR CHICAGO IL 60693 CONTRACT LABOR 689097 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 554809146 LABORATORY SERVICES 685231 TUCKER MILLER LLLD 1440 E MISSOURI AVENUE SUITE C-150 PHOENIX AZ 85014 LEGAL SERVICES 560000 CRITICAL CARE CONSULTANTS PLLC PO BOX 967 FLAGSTAFF AZ 86002 MEDICAL SERVICES 553553 22 0 234107 0 234107 NET PATIENT SERVICES REVENUE 622110 85490862 85490862 0 0 LABORATORY SERVICES 621500 56526696 56504854 21842 0 LABORATORY PATHOLOGY SERVICES 621500 3576328 3576328 0 0 145593886 3032425 3032425 0 0 340081 340081 0 340081 340081 1235280 23492 1235280 23492 1258772 1258772 0 0 0 0 0 0 0 0 0 MEANINGFUL USE INCENTIVE 900099 60834 60834 0 0 CAFETERIA SALES 722514 748303 748303 0 0 GIFT SHOP 900099 218817 218817 0 0 1759989 1759989 0 0 2787943 153247214 148359987 21842 4631278 X 422195 422195 0 0 0 0 0 0 1170830 38470 1132360 0 0 0 51483360 44050799 7432561 0 2994471 2524256 470215 0 2050624 1728619 322005 0 3448575 2907053 541522 0 0 0 0 0 89667 88900 767 0 101851 0 101851 0 6355 6355 0 0 0 0 0 0 0 6564140 3889604 2674536 0 61381 22159 39222 0 7496757 5529045 1967712 0 0 0 0 0 0 0 0 0 1851267 1717882 133385 0 259341 132161 127180 0 0 0 0 0 0 0 0 0 1364777 1043056 321721 0 0 0 0 0 8236052 6793024 1443028 0 1613880 1460942 152938 0 EXP REIMBURSEMENT TO NAH 17307639 16517939 789700 0 MEDICAL SUPPLIES 18041243 18041243 0 0 MEDICAL PURCHASE SERVICES 1752200 1752200 0 0 OTHER FEES AND TAXES 165874 20394 145480 0 233933 135437 98496 126716412 108815378 17901034 0 0 5245 6045 20230125 36971442 0 0 25801894 19664110 0 0 0 0 0 0 2574122 2813532 1592225 1429628 191018639 122632346 69289754 68386293 155531665 165444687 0 0 0 0 0 0 15650019 15642973 290675049 310358710 14097480 11957729 0 0 0 0 46542796 45489399 0 0 0 0 0 0 0 0 21932131 17603079 82572407 75050207 X 208102642 235308503 0 0 0 0 208102642 235308503 290675049 310358710 X 26530802 6139786 0 0 0 -5464727 X false true X true false X false false false 0 false 0 false 0 false 0 false 0 false 0 true 6355 6355 false PART II-B, LINE 1F VERDE VALLEY MEDICAL CENTER PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION, THE AMERICA'S ESSENTIAL HOSPITALS AND THE ARIZONA HEALTH COLLABORATIVE. A PERCENTAGE OF THIS AMOUNT, TOTALING $6,355, WAS ESTIMATED TO BE ATTRIBUTABLE TO LOBBYING RELATED TO HEALTHCARE ADVOCACY AT THE FEDERAL, STATE, REGIONAL, AND LOCAL LEVELS. 5026702 5026702 104497638 67858129 36639509 1014335 794323 220012 60135217 48688418 11446799 20344747 5291476 15053271 68386293 VVMC INVESTMENT TO NAHPG 11173972 LAND HELD FOR FUTURE USE 3547606 GAAP PRESENTATION OF INSURANCE 543611 SPLIT DOLLAR PLAN 215232 SMC CAMPUS DONATED ART 133530 SECURITY DEPOSITS 33946 CANCER CENTER DONATED ART 10256 APS REFUNDABLE REBATES -15180 15642973 0 MINIMUM PENSION LIABILITY 15179300 MALPRACTICE RESERVE 1880168 GAAP PRESENTATION-INSURANCE LIAB 543611 17603079 X SCHEDULE D, PART X, LINE 2 THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION'S MANAGEMENT IS NOT AWARE OF ANY EVENTS THAT WOULD CAUSE THE CORPORATION TO LOSE ITS TAX-EXEMPT STATUS. MANAGEMENT HAS REVIEWED ALL OPEN TAX YEARS AND HAS DETERMINED THAT THE CORPORATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS. true true X true X true X false true true false true true 3486561 0 3486561 0.02750 19984755 14790000 5194755 0.04100 0 0 0 0.00000 23471316 14790000 8681316 0.06850 0 0 0 0 23471316 14790000 8681316 0.06850 true 24460398 6292348 44529299 44797040 -267741 X true true 1 1 VERDE VALLEY MEDICAL CENTER 269 S CANDY LANE COTTONWOOD AZ 86326 HTTPS://NAHEALTH.COM H0122 X X X VERDE VALLEY MEDICAL CENTER 1 false false true X X X X X X X X X 15 false true false true X SEE SCH H, PART V, SECTION C X true 16 true SEE SCH H, PART V, SECTION C false true X 200. 400. X X X X X true true X X X true X See Sch H, Part V, Section C X See Sch H, Part V, Section C X SEE SCH H, PART V, SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT "CHNA", A FOCUS GROUP WAS HELD IN NOVEMBER 2015 IN COLLABORATION WITH COCONINO AND YAVAPAI COUNTIES AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS. KEY INFORMANTS IN THE COMMUNITY INCLUDED: REPRESENTATIVES FROM PUBLIC HEALTH, PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY LEADERS. A LIST OF RECOMMENDED PARTICIPANTS FOR THE FOCUS GROUP WAS PROVIDED BY VERDE VALLEY MEDICAL CENTER. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. FOCUS GROUP CANDIDATES WERE FIRST CONTACTED BY LETTER TO REQUEST THEIR PARTICIPATION. FOLLOW-UP PHONE CALLS WERE THEN MADE TO ASCERTAIN WHETHER THEY WOULD BE ABLE TO ATTEND. CONFIRMATION CALLS WERE PLACED THE DAY BEFORE THE GROUPS WERE SCHEDULED TO INSURE A REASONABLE TURNOUT. AUDIO FROM THE FOCUS GROUP SESSION WAS RECORDED, FROM WHICH VERBATIM COMMENTS IN THIS REPORT ARE TAKEN. THERE ARE NO NAMES CONNECTED WITH THE COMMENTS, AS PARTICIPANTS WERE ASKED TO SPEAK CANDIDLY AND ASSURED OF CONFIDENTIALITY. THIS BOX IS CHECKED "NO" BECAUSE THE HOSPITAL SOLICITED ONLY ORAL, AND NOT WRITTEN COMMENTS ON THE 2012 CHNA AND IMPLEMENTATION STRATEGY WHEN DEVELOPING THE 2015 CHNA. THIS WAS NOT REQUIRED AT THE TIME THAT CHNA WAS PREPARED, BUT WILL BE IMPLEMENTED IN FUTURE CHNA DEVELOPMENT. SCHEDULE H, PART V, SECTION B, LINE 6a THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN CONJUNCTION WITH ITS RELATED HOSPITAL FACILITY, FLAGSTAFF MEDICAL CENTER. SCHEDULE H, PART V, SECTION B, LINE 7A AND 10 THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT AND 2016 IMPLEMENTATION STRATEGY ARE AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://NAHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 11 VVMC RANKED HEALTH ISSUES IDENTIFIED BY THE CHNA AGAINST THE FOLLOWING ESTABLISHED, UNIFORM CRITERIA: MAGNITUDE - THE NUMBER OF PERSONS AFFECTED; IMPACT/SERIOUSNESS - THE DEGREE TO WHICH THE ISSUE AFFECTS OR EXACERBATES QUALITY OF LIFE AND HEALTH-RELATED ISSUES; FEASIBILITY - THE ABILITY TO REASONABLY IMPACT THE ISSUES, GIVEN AVAILABLE RESOURCES; AND CONSEQUENCES OF INACTION - THE RISK OF NOT ADDRESSING THE PROBLEM AT THE EARLIEST OPPORTUNITY. AREAS OF OPPORTUNITY WERE PRIORITIZED AS FOLLOWS: ACCESS TO HEALTHCARE SERVICES CANCER MATERNAL, INFANT, AND CHILD HEALTH INJURY & VIOLENCE PREVENTION MENTAL HEALTH & MENTAL DISORDERS RESPIRATORY HEALTH ACCESS TO HEALTH SERVICES: THE ORGANIZATION BEGAN "BEWELLNOW", ITS TELEHEALTH PRIMARY AND URGENT CARE PROGRAM. THE ORGANIZATION STARTED A TRANSITIONS CLINIC FOR THOSE PATIENTS WHO ARE NOT ABLE TO SEE THEIR PRIMARY CARE PROVIDER ("PCP") WITHIN 72 HOURS OF DISCHARGE OR WHO NEED SAME DAY SERVICE FROM A PCP. THE ORGANIZATION IS WORKING WITH A TRANSPORTATION GROUP FOR BETTER RIDE OPTIONS FOR PATIENTS. THE ORGANIZATION IS BEGINNING A COMMUNITY HEALTH WORKER PROGRAM. THE ORGANIZATION IS BROADENING OUR COMMUNITY PARAMEDICINE PROGRAM. INJURY AND VIOLENCE PREVENTION: THE ORGANIZATION CONSISTENTLY SCREENS ALL EMERGENCY DEPARTMENT ("ED") PATIENTS FOR DOMESTIC VIOLENCE. THE ORGANIZATION'S COMMUNITY PARAMEDICINE PROGRAM CONDUCTS HOME ASSESMENTS THAT INCLUDE FALL PREVENTION. MENTAL HEALTH AND MENTAL DISORDERS: THE ORGANIZATION IS HOSTING A MENTAL FIRST AID PROGRAM AND PERFORMS DEPRESSION SCREENING FOR ALL RELATED PHYSICIAN CLINIC PATIENTS. RESPIRATORY DISEASE: THE ORGANIZATION IS INCREASING HEALTH INSURANCE PREMIUMS FOR EMPLOYEE AND EMPLOYEE DEPENDENTS WHO USE TOBACCO PRODUCTS. HEALTH PRIORITIES NOT CHOSEN AND REASON: SUBSTANCE ABUSE - VVMC CURRENTLY PARTICIPATES IN COMMUNITY COLLABORATIONS TO ADDRESS SUBSTANCE ABUSE. THESE COLLABORATIONS ARE LED BY OTHER COMMUNITY ORGANIZATIONS WHO HAVE EXPERTISE AND RESOURCES DIRECTED SPECIFICALLY TOWARD EDUCATION AND PREVENTION EFFORTS. VVMC WILL CONTINUE TO BE A COMMUNITY PARTNER WITH THESE COLLABORATIONS RUN THROUGH OTHER ORGANIZATIONS. ORAL HEALTH - ORAL HEALTH PROGRAMS FOR COMMUNITY MEMBERS ARE OFFERED THROUGH THE FEDERALLY QUALIFIED HEALTH CENTER ("FQHC"), INDIAN HEALTH, AND REGIONAL PROVIDERS. VVMC SUPPORTS THESE EFFORTS WHEN EMERGENCY OR TRAUMA CARE IS REQUIRED. MATERNAL, INFANT AND CHILD HEALTH - VVMC PARTICIPATES IN CHILDREN'S HEALTH AND REHABILITATION, INPATIENT OBSTETRICS, NICU, PEDIATRICS AND PICU SERVICES. VVMC PROVIDES FAMILY AND PEDIATRIC PRIMARY CARE. PRENATAL PROGRAMS, NUTRITIONAL SUPPORT AND INSURANCE COVERAGE ARE PROVIDED BY THE FQHC'S, LOCAL PROVIDERS, AND FEDERAL AND STATE PROGRAMS. THESE PROGRAMS LEAD THE MAIN EFFORTS IN PRENATAL CARE, TEEN PREGNANCY PREVENTION AND HIGH RISK PREGNANCIES. SEXUALLY TRANSMITTED DISEASES - THE NORTHERN ARIZONA COUNTY HEALTH DEPARTMENTS ARE THE REGIONAL LEADS FOR PREVENTING, MONITORING AND EDUCATING THE PUBLIC ABOUT SEXUALLY TRANSMITTED DISEASES. SCHEDULE H, PART V, SECTION B, LINE 13B ELIGIBILITY FOR FINANCIAL ASSISTANCE IS BASED ON THE INCOME AND FAMILY SIZE OF THE PATIENT/GUARANTOR. INCOME LEVELS ARE BASED ON THE FEDERAL POVERTY LEVELS ("FPL") PUBLISHED BY THE FEDERAL REGISTER ANNUALLY. HOUSEHOLD MEMBERS ARE DEFINED AS ALL DEPENDENTS AND ADULTS PRESIDING WITH THE PATIENT. APPLICANTS WITH HOUSEHOLD INCOME OF 400% OF FPL OR LOWER MAY RECEIVE FINANCIAL ASSISTANCE BASED UPON A TIERED DISCOUNT. Schedule H, Part V, SECTION B, LINES 16A-C THE FINANCIAL ASSISTANCE POLICY ("FAP"), PLAIN LANGUAGE SUMMARY AND APPLICATION ARE AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://NAHEALTH.COM/PATIENT-RIGHTS-POLICIES/FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16I Disclosures in accordance with Revenue Procedure 2015-21: Verde Valley Medical Center (Hospital) is compliant with the Section 501(r) statute and has made a good-faith effort to be fully compliant with the requirements of the section 501(r) regulations. The Hospital has identified some temporary gaps in compliance with the regulations. The Hospital has not identified any persons directly affected by the temporary gaps in compliance. The Hospital was providing financial assistance as part of a formal program that was clearly communicated to patients and the general public. The Hospital had English versions of FAP, FAP application, etc. posted on its website, outreach was done for minority communities, and translation services were available in the facility. The temporary gaps related to having its FAP, FAP application and plain language summary translated into the primary language(s) spoken by LEP populations and posting those translated documents on its website. The Hospital has corrected these gaps by translating the FAP, FAP application and plain language summary into the primary language(s) spoken by LEP populations and will post those translated documents on its website around the time of filing this return. The Hospital will continue to monitor its compliance with the Section 501(r) regulations and procedures will be put in place to maintain compliance through quarterly reviews of its website and reassessments of the LEP populations every three years. 10 VVMC SEDONA CAMPUS 3700 WEST HIGHWAY 89A SEDONA AZ 86366 EMERGENCY SERVICES, LAB, RADIOLOGY, & PHYSICIAN OFFICES VVMC MEDICAL OFFICE BUILDING 294 WEST HIGHWAY 89A COTTONWOOD AZ 86326 PHYSICIAN OFFICES, SLEEP LAB NAHPG - EMPLOYED PHYSICIAN OFFICES 450 S WILLARD ST STE 1011051071 COTTONWOOD AZ 86326 PHYSICIAN OFFICES VVMC CAMP VERDE CAMPUS 1298 W FINNIE FLAT RD CAMP VERDE AZ 86322 MEDICAL OFFICES, RADIOLOGY LAB, PHYSICAL THERAPY VERDE VALLEY MEDICAL IMAGING CENTER 450 S WILLIARD ST STE 103 109 11 COTTONWOOD AZ 86326 RADIOLOGY, LAB ENTIRECARE REHAB & SPORT MEDICINE-SEDONA 35 DRY CREEK ROAD SEDONA AZ 86336 PHYSICAL THERAPY NAHPG - FAMILY PRACTICE PHYSICIAN OFFICE 199 S CANDY LANE SUITE 1A COTTONWOOD AZ 86326 PHYSICIAN OFFICE VILLAGE OF OAKCREEK-MEDICAL OFFICE Bldg 61 BELL ROCK PLAZA SUITE A B C SEDONA AZ 86351 PHYSICIAN OFFICES, LAB ENTIRECARE REHAB & SPORT MEDICINE - VOC 6560 HIGHWAY 179 SUITES 118 120 SEDONA AZ 86351 PHYSICAL THERAPY CAMP VERDE HEALTH CENTER 460 FINNEY FLATS ROAD CAMP VERDE AZ 86322 MEDICAL OFFICES, RADIOLOGY, LAB, PHYSICAL THERAPY SCHEDULE H, PART I, LINE 3C A. PRESUMED FINANCIAL ASSISTANCE ELIGIBILITY I. ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM ("AHCCCS") IS ARIZONA'S MEDICAID AGENCY. IF PATIENT IS AWARDED AHCCCS COVERAGE BUT COVERAGE IS NOT RETROACTIVE TO THE DATE OF SERVICE, THE PATIENT WILL BE CONSIDERED ELIGIBLE FOR FINANCIAL ASSISTANCE; II. PATIENT HAD AHCCCS COVERAGE THE MONTH PRECEDING AND THE MONTH POST SERVICES; iii. INDIGENT BASED UPON RESIDENCY VALIDATION; iv. PATIENT'S SERVICES ARE COVERED UNDER A GRANT THAT HAS EXHAUSTED FUNDING; v. PATIENT IS INCARCERATED AND THE CARE IS NOT THE FINANCIAL RESPONSIBILITY OF THE LOCAL, STATE, OR FEDERAL INSTITUTION; vi. PATIENT PROVIDES AN INVALID SOCIAL SECURITY NUMBER; vii. AHCCCS COVERED PATIENTS WHO EXCEED MAXIMUM ALLOWABLE DAYS; viii. DECEASED; ix. BANKRUPTCY. b. PRESUMED FINANCIAL ASSISTANCE IS BY ENCOUNTER ONLY AND CANNOT BE USED FOR FUTURE BALANCES. c. EXCEPTION/FINANCIAL ASSISTANCE COMMITTEE i. PATIENTS/GUARANTORS REQUESTING EXCEPTIONS CAN APPEAL AN OUTCOME BY ESCALATION TO THE FINANCIAL ASSISTANCE COMMITTEE; ii. THE FINANCIAL ASSISTANCE COMMITTEE IS COMPRISED OF THE EXECUTIVE DIRECTOR OF REVENUE CYCLE, CONTROLLER, DIRECTOR OF PATIENT FINANCIAL SERVICES, AND CLINICAL DEPARTMENT DIRECTOR FOR THE AFFECTED AREAS OF CARE. iii. COMMITTEE FINDINGS ARE DOCUMENTED AND MAILED TO THE PATIENT/GUARANTOR. iv. REMAINING BALANCES AFTER COMMITTEE FINDINGS REQUIRE AN ESTABLISHED PAYMENT PLAN TO REMAIN IN GOOD STANDING. CHARITY CARE INCOME LEVELS ARE BASED ON THE FEDERAL POVERTY GUIDE PUBLISHED IN THE FEBRUARY FEDERAL REGISTER ON AN ANNUAL BASIS. A TIERED METHOD IS UTILIZED FOR DETERMINING WHETHER A PATIENT IS ELIGIBLE FOR 100%, 75%, 50%, 25%, OR 15% WRITE-OFF OF THE SELF PAY BALANCE. A PATIENT WHO IS NOT ELIGIBLE FOR PRESUMED FINANCIAL ASSISTANCE MAY APPEAL THE OUTCOME TO THE FINANCIAL ASSISTANCE COMMITTEE. SCHEDULE H, PART I, LINE 6A THE INFORMATION FOR THE COMMUNITY BENEFITS REPORT IS GATHERED BY THE COMMUNITY RELATIONS DEPARTMENT WHICH IS A DEPARTMENTS OF NORTHERN ARIZONA HEALTHCARE. FLAGSTAFF MEDICAL CENTER AND VERDE VALLEY MEDICAL CENTER ARE IDENTIFIED SEPARATELY ON THESE REPORTS. THE COMMUNITY BENEFIT REPORT IS AVAILABLE AT: HTTPS://NAHEALTH.COM/COMMUNITY-HEALTH-NEEDS-ASSESsMENT SCHEDULE H, PART I, LINE 7 VERDE VALLEY MEDICAL CENTER USED A COST-TO-CHARGE RATIO, WHERE APPLICABLE, TO CALCULATE THE MOST ACCURATE COST OF CHARITY CARE AND OTHER COMMUNITY BENEFITS REPORTED IN LINE 7. SCHEDULE H, PART II COMMUNITY BUILDING IS A FOCUS AT VERDE VALLEY MEDICAL CENTER. COMMUNITY BUILDING IS ADVANCED BY VERDE VALLEY MEDICAL CENTER THROUGH ITS SUPPORT OF PHYSICIAN RECRUITMENT AND WORK WITH VARIOUS COMMUNITY ORGANIZATIONS, INCLUDING LOCAL SCHOOLS, THE COTTONWOOD AND SEDONA CHAMBER OF COMMERCE, AND THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. SCHEDULE H, PART III, LINE 2 BAD DEBT AMOUNTS ARE FROM THE BILLING SOFTWARE AND A MONTHLY CALCULATED AMOUNT BASED ON THE ACCOUNTS RECEIVABLE BALANCES BY FINANCIAL CLASS - PRIMARILY SELF-PAY. ACCOUNTS REFERRED TO BAD DEBT AS DEFINED IN NORTHERN ARIZONA HEALTHCARE POLICY ARE AUTOMATICALLY ADJUSTED BY A FILE UPLOAD PROCESS USING A DEDICATED TRANSACTION CODE. SCHEDULE H, PART III, LINE 3 THE ACTUAL CHARITY CARE AMOUNTS ARE FROM THE BILLING SOFTWARE WHICH IDENTIFIES THE AMOUNTS THAT ARE DIRECTLY RELATED TO PATIENTS WHO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY (FAP). THE FINANCIAL ASSISTANCE ADJUSTMENT PERCENTAGE IS DETERMINED BASED UPON THE FEDERAL POVERTY LINE GRID AS DEFINED IN NORTHERN ARIZONA HEALTHCARE'S FAP. THE ADJUSTMENT IS MANUALLY ENTERED INTO THE BILLING SOFTWARE WITH A DEDICATED TRANSACTION CODE. REMAINING BALANCES ARE THE RESPONSIBILITY OF THE PATIENT. SCHEDULE H, PART III, LINE 4 FOOTNOTE 2 TO THE FINANCIAL STATEMENTS INDICATES NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE RECEIVED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. MANAGEMENT ESTIMATES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON THE HISTORICAL COLLECTION EXPERIENCE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. MANAGEMENT ESTIMATES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON THE HISTORICAL COLLECTION EXPERIENCE. SCHEDULE H, PART III, LINE 8 THE SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS THE FY2018 MEDICARE COST REPORT FOR THE ORGANIZATION. A CONTRACTED COST REPORT PROFESSIONAL PREPARED AN ANALYSIS OF THE AMOUNT BASED ON THE SUBMITTED COST REPORT FOR VERDE VALLEY MEDICAL CENTER. FOR FY2018 MEDICARE IS A SHORTFALL PRIMARILY BECAUSE THE ORGANIZATION RECEIVES LOWER MEDICARE REIMBURSEMENTS AS A SOLE COMMUNITY HOSPITAL, AS DEFINED AND DESIGNATED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN YEARS WHEN THERE IS A SHORTFALL, THE ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE ORGANIZATION'S MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, WHETHER OR NOT THIS SERVICE IS PROVIDED AT A LOSS, THEREBY RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF THE MEDICARE BENEFICIARIES, MANY OF WHOM WOULD QUALIFY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART III, LINE 9B ACCORDING TO OUR CHARITY CARE POLICY, THE FINANCIAL COUNSELORS ASSESS THE PATIENT'S ABILITY TO PAY AT TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR CHARITY CARE CONSIDERATION. IF THE PATIENT DOESN'T QUALIFY FOR CHARITY CARE ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR A LONG-TERM PAYMENT PROGRAM. IF THE CHARITY APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW-UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. SCHEDULE H, PART VI, LINE 2 VERDE VALLEY MEDICAL CENTER ASSESSED COMMUNITY HEALTHCARE NEEDS THROUGH A SURVEY DESIGNED AND ADMINISTERED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. THIS SURVEY WAS LAST CONDUCTED IN 2016 AND WAS A FOLLOW-UP TO OTHER SURVEYS THE HOSPITAL HAS CONDUCTED. THE SURVEY INSTRUMENT USED FOR THIS STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS, AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. SCHEDULE H, PART VI, LINE 3 THE VERDE VALLEY MEDICAL CENTER (VVMC) WEBSITE HAS A BILLING CONTACT NUMBER. BEFORE PRE-ADMISSION, PATIENTS ARE CONTACTED BY VVMC'S CASHIER. WHEN PATIENTS ARE CONTACTED, THEY ARE EDUCATED OF THE FINANCIAL ASSISTANCE POLICY. VVMC FINANCIAL COUNSELORS ASSIGNED TO EACH NURSING UNIT ARE ABLE TO ANSWER OR ASSIST WITH BILLING QUESTIONS. AT EACH PATIENT REGISTRATION DESK ARE DISPLAYS AND BROCHURES OF THE BILLING INFORMATION, INCLUDING THE FINANCIAL ASSISTANCE POLICY. ACCORDING TO THE POLICY, THE FINANCIAL COUNSELORS ASSESS THE PATIENTS' ABILITY TO PAY AT THE TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR CHARITY CARE CONSIDERATION. IF THE PATIENT DOESN'T QUALIFY FOR CHARITY CARE ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR A LONG-TERM PAYMENT PROGRAM. IF THE CHARITY APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW-UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. SCHEDULE H, PART VI, LINE 4 VERDE VALLEY MEDICAL CENTER IS A 99-BED ADULT AND PEDIATRIC SOLE COMMUNITY HOSPITAL AND 11-BED GERIATRIC PSYCHIATRY. THE HOSPITAL IS LOCATED IN COTTONWOOD, ARIZONA BUT THE PRIMARY SERVICE AREA INCLUDES COTTONWOOD, CLARKDALE, JEROME, SEDONA, VILLAGE OF OAK CREEK, RIMROCK, CAMP VERDE, LAKE MONTEZUMA, AND CORNVILLE WHICH COVERS APPROXIMATELY A 50-SQUARE MILE SPAN. THE CLOSEST HOSPITAL TO THE NORTH IS FLAGSTAFF MEDICAL CENTER (VVMC AFFILIATE), WHICH IS 70 MILES. THE CLOSEST HOSPITAL TO THE SOUTH IS 40 MILES. THE POPULATION IN THE PRIMARY SERVICE AREA IS APPROXIMATELY 73,000. THE HOSPITAL GROSS PAYOR MIX IS AS FOLLOWS: MEDICARE 62%, AHCCCS/MEDICAID 17%, COMMERCIAL/OTHER 17%, AND SELF PAY 4%. VERDE VALLEY MEDICAL CENTER IS THE LARGEST EMPLOYER IN THE COMMUNITY. THE PRIMARY SERVICE AREA DOES NOT HAVE MUCH INDUSTRY AND THE COMMUNITY HAS MANY SMALL BUSINESS ORGANIZATIONS. SCHEDULE H, PART VI, LINE 5 COMMUNITY HEALTH AND COMMUNITY BUILDING ARE A FOCUS AT VERDE VALLEY MEDICAL CENTER AS EVIDENCED BY THE NUMEROUS ACTIVITIES SPONSORED EACH YEAR. THE CANCER CENTER AT SEDONA CAMPUS HOSTS A SERIES OF FREE OR LOW-COST SCREENINGS DESIGNED TO HELP RESIDENTS IN THE COMMUNITY DETECT ISSUES AS SOON AS POSSIBLE. COMMUNITY BUILDING IS ADVANCED BY VERDE VALLEY MEDICAL CENTER THROUGH ITS SUPPORT OF PHYSICIAN RECRUITMENT AND WORK WITH VARIOUS COMMUNITY ORGANIZATIONS INCLUDING THE COTTONWOOD AND SEDONA CHAMBER OF COMMERCE AND THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. SCHEDULE H, PART VI, LINE 6 VERDE VALLEY MEDICAL CENTER IS AFFILIATED WITH FLAGSTAFF MEDICAL CENTER. THE BOARD MEMBER MEETINGS ARE COMBINED. THE COMMUNITY BENEFIT REPORT IS SUMMARIZED TOGETHER AND POSTED ON THE HOSPITAL'S WEBSITE. true Northern Arizona Healthcare Foundation 1200 N Beaver Street Flagstaff AZ 86001 813137336 501(c)(3) 422195 Endowment and Comm Benefit 1 0 SCHEDULE I, PART I, LINE 2 DONATIONS TO OTHER TAX-EXEMPT ENTITIES ARE MADE IN SUPPORT OF THEIR MISSIONS AND VVMC RELIES UPON THE GOVERNANCE PRACTICES OF RECIPIENT ORGANIZATIONS. true true false false false false false true false FLORENCE SPYROW NAH PRESIDENT/CEO (AS OF 3/18) 0 397762 0 30000 0 2753 0 16100 0 0 0 446615 0 0 HU BLAKE CHIEF MED INFORMATICS OFFICER 0 294991 0 4950 0 3870 0 16100 0 23880 0 343791 0 0 BARBARA FIRMINGER CHIEF ACCESS OFF (THRU 06/18) 0 295196 0 10000 0 696 0 10756 0 18416 0 335064 0 0 LORI GREEN CNO 0 187558 0 0 0 391 0 10948 0 14024 0 212921 0 0 RICK PETERSON VP SUPPORT SVCS (THRU 1/17) 0 68568 0 0 0 175810 0 2798 0 1875 0 249051 0 0 LEON PONTIKES VVMC & NAHPG CMO 0 480421 0 6134 0 2022 0 16100 0 23841 0 528518 0 0 JAMES P SCHUESSLER INTERIM VVMC CAO (THRU 1/18) 0 271200 0 0 0 0 0 0 0 0 0 271200 0 0 ROBERT THAMES NAH PRESIDENT/CEO (THRU 3/18) 0 561977 0 0 0 9402 0 10800 0 19911 0 602090 0 0 JEFFREY TREASURE NAH CHIEF FIN OFF 0 364172 0 0 0 2551 0 16100 0 17431 0 400254 0 0 LORI SMITHSON DIRECTOR NURSING 0 154923 0 0 0 26141 0 5300 0 6757 0 193121 0 0 DEBORAH ASHBY CLINICAL RESOURCES COORDINATOR 0 146825 0 11169 0 17402 0 28554 0 10359 0 214309 0 0 PAUL PREFONTAINE DIR REHAB CLINIC (THRU 5/18) 0 158955 0 0 0 2019 0 4805 0 20771 0 186550 0 0 CHERYL CHASE MANAGER - PHARMACY OPERATIONS 0 158863 0 250 0 138 0 10230 0 25776 0 195257 0 0 CHARLES SECHRIST PHARMACIST 0 151520 0 0 0 870 0 27126 0 21771 0 201287 0 0 JOHN DEMPSEY VP NAH/PRES LCMC 0 275187 0 18121 0 29487 0 39922 0 25733 0 388450 0 0 SCHEDULE J, PART I, LINE 1 A/B SUPPLEMENTAL COMPENSATION INFORMATION ALL COMPENSATION, BENEFITS AND REIMBURSEMENTS ARE PAID BY NORTHERN ARIZONA HEALTHCARE, THE PARENT ORGANIZATION. GROSS-UP OF TAXES IS DONE ON ALL EMPLOYEE GIFT CERTIFICATES OF $25 OR MORE. IN PRACTICE, THE BOARD MEMBER AND OFFICER BUSINESS TRAVEL EXPENSES ARE APPROVED BY THE NEXT HIGHEST LEVEL. SCHEDULE J, PART I, LINE 3 CEO COMPENSATION IS DERIVED BY THE PARENT ORGANIZATION, NORTHERN ARIZONA HEALTHCARE, BY THE FOLLOWING METHODS: COMPENSATION COMMITTEE, WRITTEN CONTRACT, INDEPENDENT CONSULTANT, COMPENSATION SURVEY, AND RECOMMENDATION OF COMPENSATION COMMITTEE TO BOARD FOR APPROVAL. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS WERE MADE AS FOLLOWS. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(III): RICK PETERSON $175,089 SCHEDULE J, PART I, LINE 4B CERTAIN INDIVIDUALS PARTICIPATE IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THERE WERE NO PAYOUTS DURING THE YEAR. SCHEDULE J, PART I, LINE 7 THE FOLLOWING INDIVIDUALS RECEIVED DISCRETIONARY ONE-TIME BONUSES DURING THE YEAR. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(II): FLORENCE SPYROW $30,000 BARBARA FIRMINGER $10,000 DEBORAH ASHBY $11,169 JOHN DEMPSEY $18,121 NORTHERN ARIZONA HEALTHCARE CORPORATION MAKES DISCRETIONARY PAYMENTS TO PHYSICIANS BASED ON QUALITY GOALS. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(II): LEON PONTIKES $6,134 HU BLAKE $4,950 SCHEDULE J, PART II THE FOLLOWING INDIVIDUALS PARTICIPATE IN A DEFINED BENEFIT RETIREMENT PLAN. AS SUCH, ACTUARIAL INCREASES IN THEIR ACCOUNTS ARE REPORTED ON PART II, COLUMN (C) AS DEFERRED COMPENSATION. INCREASE DUE TO ACTUARIAL BENEFIT: JOHN DEMPSEY ($3,178) THE FOLLOWING INDIVIDUALS CASHED OUT ACCUMULATED PTO DURING THE YEAR. THESE AMOUNTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(III): DEBORAH ASHBY $16,930 JOHN DEMPSEY $27,506 SCHEDULE J, PART II ADDITIONAL INFORMATION VVMC PAID B.E. SMITH, INC. $271,200 DURING 2017 FOR INTERIM CAO SERVICES RENDERED BY JAMES SCHUESSLER. A INDUSTRIAL DEVELOPMENT AUTHORITY YAVAPAI COUNTY 860376099 985900CX5 2011-10-12 13829141 SEE PART VI false false false B INDUSTRIAL DEVELOPMENT AUTHORITY YAVAPAI COUNTY 860376099 2015-06-30 37340563 SEE PART VI false false false A 0 0 13829141 0 0 0 133606 0 0 0 13695535 0 2011 true false true true B 0 0 37340563 0 0 0 338010 0 0 0 37002552 0 2015 true false true true A false false true true false 0 false false false true B true true true true false 0 false false false true A false false true false false false 0 false 0 false true B false false true false false false 0 false 0 false true A true B true SCHEDULE K, PART I, COLUMN F BOND A - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2011. THIS ISSUE REFUNDS THE 1996A AND 1998 SERIES BONDS. THE TOTAL ISSUANCE PRICE WAS $78,923,520 WHICH WAS ALLOCATED $65,094,379 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $13,829,141 TO VERDE VALLEY MEDICAL CENTER. BOND B - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2015A AND 2015B. THIS ISSUE REFUNDS THE 2008A AND 2008B BONDS. THE TOTAL ISSUANCE PRICE OF SERIES 2015A WAS $80,395,000 WHICH WAS ALLOCATED $37,213,977 TO FLAGSTAFF MEDICAL CENTER (FMC), $9,274,438 TO VERDE VALLEY MEDICAL CENTER, AND $33,906,585 TO NORTHERN ARIZONA HEALTHCARE OUTPATIENT SURGERY CENTER. THE 2015A BONDS WERE ALSO USED, IN PART, TO FINANCE "NEW MONEY" PROJECTS. $33,611,679 WAS USED FOR ACQUISITION OF SUMMIT SURGERY CENTER. TOTAL ISSUANCE PRICE OF SERIES 2015B WAS $45,635,975 WHICH WAS ALLOCATED $17,569,850 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $28,066,125 TO VERDE VALLEY MEDICAL CENTER. FORM 990, PART I, LINE 6 VOLUNTEERS WORK IN ALMOST EVERY DEPARTMENT IN THE HOSPITAL AND AT OUR OFFSITE LOCATIONS, SUCH AS VERDE VALLEY MEDICAL CENTER (VVMC) SEDONA CAMPUS, CAMP VERDE, AND VILLAGE OF OAK CREEK. THEY PERFORM CLERICAL AND RECEPTION DUTIES IN MANY DEPARTMENTS, SERVE AS PATIENT AND VISITOR GREETERS, SUPPLY DISTRIBUTION, LANDSCAPING, NUTRITIONAL SERVICES - PASS TRAYS, PARTICIPATE IN VARIOUS ACTIVITIES WITH THE SENIOR BEHAVIORAL HEALTH PATIENTS, LIBRARY, TRANSPORT, AND MAKE PILLOWS AND TEDDY BEARS (CRAFTS). FORM 990, PART III, LINE 4A VERDE VALLEY MEDICAL CENTER'S MISSION AND VISION -------------------------------------------------------------- MISSION - IMPROVING HEALTH, HEALING PEOPLE. VISION - ALWAYS BETTER CARE. EVERY PERSON, EVERY TIME...TOGETHER. FORM 990, PART V, LINE 2A; PART VII, SECTION A, AND PART IX VERDE VALLEY MEDICAL CENTER DOES NOT HAVE EMPLOYEES, BUT SHARES THE COST OF PERSONNEL, SERVICES, AND EXPENSES WITH NORTHERN ARIZONA HEALTHCARE CORPORATION, A RELATED TAX-EXEMPT ORGANIZATION AND VVMC'S SOLE MEMBER. FORM 990, PART VI, LINE 1 THE BOARD OF DIRECTORS DELEGATES AUTHORITY TO AN EXECUTIVE COMMITTEE IN AN EMERGENCY SITUATION ONLY. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE INDIVIDUALS THEN SERVING AS THE EXECUTIVE COMMITTEE OF NAH, AUTOMATICALLY AND WITHOUT SEPARATE ELECTION. THE EXECUTIVE COMMITTEE SHALL ONLY MEET IF A QUORUM OF THE BOARD IS IMPOSSIBLE AND AN URGENT BOARD VOTE IS REQUIRED. IN SUCH CASES IT SHALL EXERCISE THE POWER AND AUTHORITY OF THE BOARD, AND SHALL REPORT ANY ACTIONS TAKEN AT THE FOLLOWING BOARD MEETING. FORM 990, PART VI, LINE 6 NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE CORPORATE MEMBER OF VERDE VALLEY MEDICAL CENTER. FORM 990, PART VI, LINE 7A THE BOARD OF DIRECTORS IS DETERMINED BY THE ORGANIZATIONS MEMBER, NORTHERN ARIZONA HEALTHCARE (NAH). THE DIRECTORS AT ALL TIMES SHALL BE, AUTOMATICALLY AND WITHOUT THE NEED OF A SEPARATE ELECTION, THE INDIVIDUALS SERVING AS DIRECTORS OF NAH. FORM 990, PART VI, LINE 7B NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE VOTING MEMBER. The following actions may be initiated by the Member in its sole and absolute discretion: a) Adoption of the consolidated annual budget for the System and any amendments b) The selection and retention of the President and Chief ADMINISTRATIVE Officer of this Corporation c) The selection of banking affiliations, accounting firms, legal counsel as well as approval of the engagement of any consultants not specifically provided for in an approved budget d) The selection of the manner and location of investment of any retained earnings e) Authorization of standing or ad hoc committees for controlled subsidiaries within the System. THE MEMBER MAY NOT TRANSFER ITS MEMBERSHIP OR ANY RIGHTS ARISING THEREFROM. FORM 990, PART VI, LINE 11b THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM BASED ON DATA GATHERED BY THE CORPORATE TREASURER/INTERNAL AUDIT DIRECTOR AND THE ORGANIZATION'S FINANCIAL OPERATIONS GROUP. THE CEO AND/OR CFO REVIEWS THE DRAFT FORM 990 AND PROVIDES ADDITIONAL COMMENTS. THE FINAL DRAFT VERSION OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE MAY 15 DUE DATE. ANY ADDITIONAL COMMENTS SUGGESTED BY THE GOVERNING BODY ARE THEN INCORPORATED INTO THE FINAL VERSION OF THE FORM 990 TO BE FILED WITH THE IRS BY THE FINAL DUE DATE. IF ANY SUGGESTED CHANGES ARE MATERIAL OR SIGNIFICANT, AN ADDITIONAL DRAFT IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, LINE 12C THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY (BOARD POLICY 6.1). THIS IS ACCOMPLISHED BY A NUMBER OF MECHANISMS. FIRST, THE CONFLICT OF INTEREST QUESTIONNAIRE IS REVIEWED BY THE BOARD DEVELOPMENT COMMITTEE. AS PART OF THE QUESTIONNAIRE, SELF-DISCLOSURE IS REQUIRED BY BOARD MEMBERS, OFFICERS, AND VPS. IN ADDITION, INDIVIDUAL DISCLOSURE BY BOARD MEMBERS OCCURS AT BOARD MEETINGS WHEN NECESSARY. A BOARD MEMBER MUST EXCLUDE HIMSELF OR HERSELF FROM VOTING ON AN ISSUE IN WHICH HE OR SHE MAY HAVE A CONFLICT OF INTEREST. THE CONTROLLER REVIEWS POTENTIAL CONFLICTS AND FOLLOWS UP WITH ANY ADDITIONAL QUESTIONS, IF NECESSARY. THEN THE SUMMARY OF RESPONSES AND CONFLICTS ARE BROUGHT BEFORE THE BOARD DEVELOPMENT COMMITTEE, WHICH MAKES A DETERMINATION AS TO WHETHER A CONFLICT EXISTS. FORM 990, PART VI, LINES 15A & 15B THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER OFFICERS INCLUDES THE PREPARATION OF COMPARABLE DATA BY WILLIS TOWERS WATSON, AN INDEPENDENT CONSULTING FIRM. IN ADDITION, THIS INFORMATION IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND IS DOCUMENTED IN THE BOARD MINUTES. THE MOST RECENT REVIEW WAS PERFORMED IN FEBRUARY 2018. FORM 990, PART VI, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ARIZONA DEPARTMENT OF HEALTH SERVICES. IN ADDITION, THEY ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AS PART OF THE ORGANIZATION'S CONTINUING DISCLOSURE DOCUMENTS THAT ARE REQUIRED BY ITS PUBLIC DEBT REQUIREMENTS. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, AS THIS IS NOT REQUIRED. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS $ 4,055,235 - DECREASE PENSION PLAN VALUATION ($ 2) - ROUNDING ($ 9,519,960) - TRANSFER TO AFFILIATES ______________ ($ 5,464,727) - TOTAL FLAGSTAFF MEDICAL CENTER PO BOX 1268 FLAGSTAFF AZ 86002 860110232 HEALTHCARE AZ 501(c)(3) 3 NAH true NORTHERN ARIZONA HEALTHCARE CORPORATION PO BOX 1268 FLAGSTAFF AZ 86002 742410946 HEALTHCARE AZ 501(c)(3) 10 NA false false false false false false false false true true false false false true false true true true true true FLAGSTAFF MEDICAL CENTER P 68657998 COST