2018-02-07T17:42:43-06:00 2017-03-31 STOCKMAN KAST RYAN & CO LLP 102 N CASCADE AVENUE SUITE 400 COLORADO SPRINGS CO 80903 990 2016-04-01 841465990 Arkansas Valley Regional Medical Center % JANETTE BENDER ARKA 7193836026 1100 Carson Avenue La Junta CO 81050 JANETTE BENDER CFO 7193836026 2018-01-31 true DOREEN B MERZ P00841439 7196301186 173.227.191.210 84355620180385000028 2018-02-07 P 22E4054D71EB0A5C4347EFF4CD59692BDF5FAEDF A40A782555DF013B161847E6538FCB9794CCE8A5 2016 2021-01-29 14:40:06Z Lynn Crowell 1100 carson avenue la junta CO 81050 42675589 false X WWW.avrmc.org X 1998 CO THE CENTER IS A COMMUNITY-OWNED ORGANIZATION PROVIDING HIGH QUALITY, RESPECTFUL, AND COMPASSIONATE HEALTH CARE SERVICES TO INDIVIDUALS & FAMILIES IN SOUTHEAST COLORADO. 11 11 447 90 0 117992 74814 40636895 41601308 147964 44814 564530 166106 41467381 41887042 0 0 0 0 20777143 20169724 0 0 0 20211108 21610672 40988251 41780396 479130 106646 32456983 34340430 4905575 6682376 27551408 27658054 THE CENTER IS A COMMUNITY-OWNED ORGANIZATION THAT WILL WORK IN PARTNERSHIP WITH THE COMMUNITIES WE SERVE TO PROMOTE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND FAMILES IN SOUTHEASTERN COLORADO. false false 31522195 41767414 The Medical Center operates as an acute-care hospital and long-term care nursing home and PROVIDes inpatient, outpatient, and emergency HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF RACE AND INSURANCE. 31522195 true true false true false false false false false true true false false false false true true false false false false false false false false false true true false false true false false false false false true false true false false false false false false false false false true X 113 0 447 true false false false false false false false false false false false false false false X 11 11 false true false false false false false false false false false true true true true true true true true false CO X JANETTE BENDER 7193836001 1100 CARSON AVENUE la junta CO 81050 Robert W Blair Board Chairman 1.0 0.0 X X 0 0 0 Joseph Pentlicki Board Member 1.0 0.0 X 0 0 0 Ron Davis Board Member 1.0 0.0 X 0 0 0 Betty Velasquez Board Member/City Council 1.0 0.0 X 0 0 0 Rob Pickering Board Secretary/Treasurer 1.0 0.0 X X 0 0 0 Dale L Leighty Board Vice-Chairman 1.0 0.0 X X 0 0 0 Margie Gardner Board Member 1.0 0.0 X 0 0 0 H Randolph Frank MD Board Member 1.0 0.0 X 0 0 0 Patrick Hancock Board Member 1.0 0.0 X 0 0 0 Janette Bender CFO 40.0 0.0 X 131939 0 26464 Carrie Cutrell CNO 40.0 0.0 X 134102 0 25936 James S Brady Physician 40.0 0.0 X 450698 0 41209 Jesus E Carale Physician 40.0 0.0 X 459024 0 42038 Kent E Gay Physician 40.0 0.0 X 300026 0 45496 Thomas M Jackson Physician 40.0 0.0 X 300026 0 34595 Michael K Morley Physician 40.0 0.0 X 650025 0 14187 2425840 0 229925 14 false true false QUORUM HEALTH 105 Continental Pl BRENTWOOD TN 370271018 Management Services 647301 Barton Associates PO Box 417844 BOSTON MA 022417844 Staffing Service 442096 Comprehensive Pharmacy Services PO Box 638316 CINCINNATI OH 45263 Medical Services 435525 Healthcare Resource Group 12610 East Mirabeau Parkway SPOKANE VALLEY WA 99216 Medical Services 332140 Jackson Coker PO Box 277638 ATLANTA GA 303847638 Medical Services 311395 21 69014 5800 74814 PATIENT SERVICE REVENUE 900099 41601308 41601308 41601308 40290 40290 0 0 154242 175179 -20937 0 -20937 -20937 614642 3250 613368 1274 3250 4524 4524 0 0 0 0 0 0 21532 0 21532 21532 CAFETERIA 900099 138977 138977 MEDICAL RECORDS 900099 10753 10753 RECOVERY OF COSTS 900099 15781 15781 165511 41887042 41767414 44814 0 0 0 0 318441 318441 0 16300806 12136818 4163988 0 3550477 2639457 911020 0 647301 647301 28013 28013 62004 62004 2010 2010 0 0 7802885 6783570 1019315 0 5079902 3721520 1358382 0 0 531272 342365 188907 0 0 0 42121 30858 11263 0 2214350 1622226 592124 0 BAD DEBT EXPENSE 1627806 1627806 REPAIRS & MAINTENANCE 1282487 939546 342941 OTHER OPERATING EXPENSES 1190775 872359 318416 UTILITIES 1099746 805670 294076 41780396 31522195 10258201 0 1309011 796520 3304467 1094631 0 0 4540333 10330573 0 0 0 0 0 0 1357358 1362747 678847 642452 55010791 35445919 20717058 19564872 0 0 0 0 0 0 0 0 549909 548635 32456983 34340430 4166645 5829673 0 0 0 0 0 0 0 0 0 0 738930 852703 0 0 0 0 4905575 6682376 X 27001499 27109419 0 0 549909 548635 27551408 27658054 32456983 34340430 106646 X false true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true 2010 2010 PART II-B , LINE 1(I) ALLOCABLE PORTION OF DUES PAID TO CHA AND AHA DESIGNATED AS LOBBYING EXPENSES 549909 -1274 548635 552221 -2312 549909 554639 -2418 552221 559127 -4488 554639 557188 1939 559127 1.00000 true false 16655 16655 31693331 16041934 15651397 961992 763193 198799 22285516 18640792 3644724 53297 53297 19564872 0 0 X 40434415 175179 175179 40259236 1627806 1627806 41887042 40327769 175179 175179 40152590 1627806 1627806 41780396 PART V, Line 4 The Medical Center is the sole beneficiary of the Bertha Elrod Copeland and James Evan Copeland Hospital Trust (the Trust), a charitable trust whose principal is to be held in perpetuity. Assets of the Trust are invested and administered by a trustee and distributions are made to the Medical Center. The use of the distributions received from the Trust is restricted to the purchase of equipment. PART X, LINE 2 The Medical Center is exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code. In addition, the Medical Center qualifies for the charitable contribution deduction. The Medical Center believes that it does not have any uncertain tax positions that are material to the financial statements. The Medical Center's income tax returns for 2014 through the current period remain open to examination by the Internal Revenue Service and relevant state authorities. PART XI, LINE 2D RENTAL EXPENSES OF $175,179 WERE RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN. PART XI, LINE 4B BAD DEBT EXPENSE WAS TAKEN AGAINST PATIENT REVENUE PER THE AUDIT, BUT RECLASSED AS AN EXPENSE IN THE AMOUNT OF $1,627,806 FOR THE TAX RETURN. PART XII, LINE 2D RENTAL EXPENSES OF $175,179 WERE RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN. PART XII, LINE 4B BAD DEBT EXPENSE WAS TAKEN AGAINST PATIENT REVENUE PER THE AUDIT, BUT RECLASSED AS AN EXPENSE IN THE AMOUNT OF $1,627,806 FOR THE TAX RETURN. true true true X true X true true true false true true 534275 534275 0.01330 12843518 5177002 7666516 0.19090 13377793 5177002 8200791 0.20420 13377793 5177002 8200791 0.20420 876329 876329 0.02000 4297 4297 0.00010 880626 880626 0.02010 true 1627806 4814656 9681400 -4866744 X true NONE NONE 1 1 ARKANSAS VALLEY REGIONAL MEDICAL CTR 1100 CARSON AVENUE LA JUNTA CO 81050 State Lic. #010210 X X X LONG-TERM NURSING State Lic. #020211 ARKANSAS VALLEY REGIONAL MEDICAL CTR 1 false false true X X X X X X X X X 16 true false true true X www.avrmc.org X true 16 true www.avrmc.org false true X 0. 250. X true true X X X true X www.avrmc.org X X X X true X X true X X X true X false false SUPPLEMENTAL INFORMATION SCHEDULE H, PART V, SECTION B, LINE 5 We deployed a CHNA Round 1 survey to our Local Expert Advisors to gain input on local health needs and the needs of priority populations. Local Expert Advisors were local individuals selected according to criteria required by the Federal guidelines and regulations and the Hospitals desire to represent the regions geographically and ethnically diverse population. We received community input from 26 Local Expert Advisors. Survey responses started September 21, 2015 and ended with the last response on October 26, 2015. All written comments are presented verbatim in the Appendix to this report. Information analysis augmented by local opinions showed how Otero County relates to its peers in terms of primary and chronic needs and other issues of uninsured persons, low-income persons, and minority groups. Respondents commented on whether they believe certain population groups ("Priority Populations") need help to improve their condition, and if so, who needs to do what to improve the conditions of these groups. Local opinions of the needs of Priority Populations was abstracted in the following "take-away"comments: Literacy barriers are limiting access to care Lack of palliative care services Shortage of healthcare providers Ongoing preventative education, particularly for diabetes, is needed When the analysis was complete, we put the information and summary conclusions before our Local Expert Advisors who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional comments of need, and new needs did emerge from this exchange. Consultation with 20 Local Experts occurred again via an internet-based survey ("Round 2", explained below) beginning November 16, 2015 and ending January 11, 2016. Having taken steps to identify potential community needs, the Local Experts then participated in a structured communication technique called a "Wisdom of Crowds" method. The premise of this approach relies on a panel of experts with the assumption that the collective wisdom of participants is superior to the opinion of any one individual, regardless of their professional credentials. In the AVRMC process, each Local Expert had the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. While there were a few opinions of the data conclusions not being completely accurate, the vast majority of comments agreed with our findings. We developed a summary of all needs identified by any of the analyzed data sets. The Local Experts then allocated 100 points among the potential significant need candidates, including the opportunity to again present additional needs that were not identified from the data. A rank order of priorities emerged, with some needs receiving none or virtually no support, and other needs receiving identical point allocations. We dichotomized the rank order of prioritized needs into two groups: "Significant"other Identified Needs". Our criteria for identifying and prioritizing Significant Needs was based on a descending frequency rank order of the needs based on total points cast by the Local Experts, further ranked by a descending frequency count of the number of local experts casting any points for the need. By our definition, a Significant Need had to include all rank ordered needs until at least fifty percent (50%) of all points were included and to the extent possible, represented points allocated by a majority of voting local experts. The determination of the break point - "Significant" as opposed to "other" - was a qualitative interpretation by Quorum and the AVRMC executive team where a reasonable break point in rank order occurred. SCHEDULE H, PART V, SECTION B, LINE 6b The Hospital collaborated and obtained assistance in conducting this CHNA from Quorum Health Resources (QHR). SCHEDULE H, PART V, SECTION B, LINE 11 We do not have adequate resources to solve all the problems identified. Some issues are beyond the mission of the hospital and action is best suited for a response by others. Some improvements will require personal actions by individuals rather than the response of an organization. We view this as a plan for how we, along with other organizations and agencies, can collaborate to bring the best each has to offer to address the more pressing identified needs. By definition, the needs identified as LOW Priority and for which AVRMC holds LOW RESPONSIBILITY for implementation are needs to which the hospital may devote resources while (in most cases) monitoring but otherwise not addressing. Reasons for this response: Actions required are beyond the mission of AVRMC; AVRMC can be more effective applying its resources to higher priority needs; The hospital does not possess the expertise necessary for substantive positive improvement; Actions contemplated for implementation fall more appropriately to the responsibility of others; Other than providing encouragement, implementation efforts for some needs require appropriate actions by individuals modifying their personal habits rather than a response by an organization or the Health System; The best use of AVRMC resources is to focus on resolving or improving higher priority needs rather than attempting to respond to everything with small, perhaps ineffective, efforts. SCHEDULE H, PART V, SECTION B, LINE 13B The only Charity Care defined for AVRMC's purpose is patients that qualify for Colorado Indigent Care. SCHEDULE H, PART V, SECTION B, LINE 18d THE CENTER ATTEMPTS TO OBTAIN COLLECTIONS THROUGH THE USE OF placing liens on residences and GARNISHING WAGES FROM CLIENTS WITH OUTSTANDING BALANCES. SCHEDULE H, PART V, SECTION B, LINE 19d THE CENTER ATTEMPTS TO OBTAIN COLLECTIONS THROUGH THE USE OF placing liens on residences and GARNISHING WAGES FROM CLIENTS WITH OUTSTANDING BALANCES. SUPPLEMENTAL INFORMATION SCHEDULE H, PART III, LINE 2 THE COST METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED AS BAD DEBT EXPENSE IS USING A COST-TO-CHARGE RATIO. THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS IS MULTIPLIED BY THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATE THE ESTIMATED COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS. A number of patients are truly unable to pay their out-of-pocket liability, but do not complete the process required to apply for financial assistance under the Hospital's charity care policy. These patients would qualify for charity care if they completed the paperwork, so the bad debt expense associated with treating them should be treated as community benefit. Sch H Part III, Section A, line 4. SEE PAGE 7,8, and 11 OF THE ATTACHED AUDIT REPORT FOR DESCRIPTION FROM THE AUDIT OF BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 8 MEDICARE COSTS WERE CALCULATED FROM THE MEDICARE COST REPORT FOR THE FYE MARCH 31, 2017. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. SCHEDULE H, PART VI, LINE 2 The CHNA is the primary method to assess the health care needs of the community served. SCHEDULE H, PART VI, LINE 3 THE ORGANIZATION PROVIDES A BROCHURE TO EACH PATIENT OUTLINING THE GUIDELINES USED TO DETERMINE ELIGIBILITY FOR ASSISTANCE. SCHEDULE H, PART VI, LINE 4 AVRMC, in conjunction with Quorum, defines its service area as Otero County in Colorado, which includes the following ZIP codes: 81039 Fowler 81050 La Junta 81058 Manzanola 81067 Rocky Ford In 2014, the Hospital received 72.0% of its patients from this area. County data is used as most information is not available at the geographic level of a zip code. The 2015 population for Otero County is estimated to be 19,013, and is expected to increase at a rate of 0.5%, projecting a 2020 population of 19,100. The population increase is in contrast to the Colorado state average rate of population increase of 6.3% and the national growth rate of 3.5%. Approximately 55.1% of the Otero County population is of white, non-Hispanic ethnic origin, compared to the U.S. population percentage of 61.8%. The Hispanic population of Otero County is 41.2%, compared to 17.6% nationally. The 65+ population of Otero County is 19.7% of the total population compared to the overall U.S. at 14.7%. The 2015 percentage of child-bearing-age females in Otero County is 17.0%, while in Colorado as a whole it is 19.9%, and for the U.S. it is 19.7%. The 2015 Otero County Median Household Income is $34,037, which is considerably lower than the national median household income of $53,375. Otero County's unemployment rate as of 2015 is 4.7%. This is less than the national unemployment rate of 5.1%. SCHEDULE H, PART VI, LINE 5 Arkansas Valley Regional Medical Center's board of directors is comprised of persons who reside in the La Junta, Colorado area. The majority of the organization's board members are neither employees nor contractors of the medical center. The board of directors is made mostly of community business people interested in maintaining quality health care in La Junta. SCHEDULE H, PART VI, LINE 6 N/A SCHEDULE H, PART VI, LINE 7 N/A X false false false false false false false true false Janette Bender CFO 131914 0 25 0 0 0 5936 0 20528 0 158403 0 0 Carrie Cutrell CNO 134077 0 25 0 0 0 4641 0 21295 0 160038 0 0 James S Brady Physician 450673 0 25 0 0 0 11925 0 29284 0 491907 0 0 Jesus E Carale Physician 458999 0 25 0 0 0 11916 0 30122 0 501062 0 0 Kent E Gay Physician 300001 0 25 0 0 0 11374 0 34122 0 345522 0 0 Thomas M Jackson Physician 300001 0 25 0 0 0 10904 0 23691 0 334621 0 0 Michael K Morley Physician 650000 0 25 0 0 0 0 0 14187 0 664212 0 0 PART I, LINE 7 The physician contracts allow for a QUARTERLY BONUS IF THEIR RELATIVE VALUE UNITS charged exceed quarterly benchmark standards. Dale Leighty BOARD VICE-CHAIR 2015219 LINE OF CREDIT false PART IV, LINE 1 The Hospital has some bank accounts and their line of credit with First National Bank for which Dale Leighty (board vice-chairman) is the President. Balance of the line of credit at year end is $2,015,219. SUPPLEMENTAL INFORMATION PART VI, SECTION A, LINE 3 THE ORGANIZATION CONTRACTS WITH QUORUM HEALTH RESOURCES, A HEALTHCARE MANAGEMENT COMPANY, TO PROVIDE SPECIALIZED HEALTHCARE SERVICES. THE CEO IS AN EMPLOYEE OF THE HEALTHCARE MANAGEMENT COMPANY. THE BOARD OF DIRECTORS WORKS IN CONJUNCTION WITH THE MANAGEMENT COMPANY AND THE BOARD HAS ULTIMATE AUTHORITY AND RESPONSIBILITY FOR THE ORGANIZATION. PART VI, SECTION B, LINE 11B THE 990 is reviewed by the CEO, CFO, approved and signed by them. Then the Board is informed that the Form has been submitted. PART VI, SECTION B, LINE 12C EACH YEAR ALL KEY MEMBERS AND BOARD MEMBERS SUBMIT CONFLICTS OF INTEREST TO REGULARLY REVIEW ANY POSSIBLE CONFLICTS WITH THE WRITTEN CONFLICT OF INTEREST POLICY. PART VI, SECTION B, LINE 15C THE BOARD EVALUATES AND APPROVES WAGE PARAMETERS TO DETERMINE THE COMPENSATION OF INDEPENDENT PERSONS AND MANAGEMENT. PART VI, SECTION C, LINE 19 ORGANIZATIONAL DOCUMENTS ARE AVAILABLE AT PUBLIC BOARD MEETINGS AND UPON REQUEST. FORM 990 PART IX LINE 11G DESCRIPTION:PROVIDER FEES TOTAL FEES:1965466 FORM 990 PART IX LINE 11G DESCRIPTION:CONTR. LABOR & PHYSICIAN FEES TOTAL FEES:5837419