2017-11-15T18:32:44-07:00 2016-12-31 JWT and Associates 1111 East Herndon Avenue Fresno CA 93720 990 2016-01-01 860732836 Cobre Valley Regional Medical Center COBR 9284253261 5880 S Hospital Drive Globe AZ 85501 Neal Jensen CEO 9284253261 2017-06-12 1 Jeremy Ware P00642659 5594317708 2017-06-09 96.67.208.101 2016 2017-02-10 21:41:12Z CVRMC 5880 South Hospital Drive Globe AZ 85501 46053722 0 X www.cvrmc.org X 1988 AZ The Organization will provide medical services which will be competitive with those charged for similar services by comparable facilities. The Organization will also allow a portion of its services and facilities to be used for charity patients. 9 9 251 0 0 0 19355 45370 43501631 45415650 252975 104065 293049 488637 44067010 46053722 0 0 0 0 21832577 22588216 0 0 0 19801680 22353618 41634257 44941834 2432753 1111888 73614645 77563562 38690465 41006343 34924180 36557219 The Mission of our Hospital is to develop and maintain a local health care delivery system that serves the region with quality, efficiency and compassion. Our mission is your health. 0 0 33706376 0 45415650 Along with providing acute healthcare services to the community as a non-profit entity, Cobre Valley Regional Medical Center (CVRMC) is committed to the many communities we serve. Several members of our administration, directors, managers, and staff serve on various community associations including: Chambers of Commerce, Rotary, Work Force Development, Economic Development, Cancer Awareness Committees, Diabetes Education, Grief Support Teams, Scholarship Committees, Aquatic Center and Youth Athletic Programs, to name just a few. CVRMC has its finger on the pulse of the community, provides charitable care with purpose, and offers educational services and programs for the good of our public. Several stakeholders from across Gila County and the CVRMC service region are currently working through a community-driven Community Health Improvement Plan (CHIP) which is addressing the most pressing health issues facing our residents. Led by the Gila County Division of Health and Emergency Management (GCDHEM) and CVRMC, community members and organizations have come together to work through actions to affect change for the health needs of our communities. The process of the Community Health Needs Assessment took place from September 2015 through December of 2015. The Community Health Improvement Plan was produced from the data collected from the needs of our population and GCDHEM and CVRMC are currently working with community organizations to formulate concrete actions to address the four health priorities identified in the CHIP: Obesity, Substance Abuse, Access to Quality Healthcare - Including Mental Health Services, and Sexual Health. The first CHNA and CHIP was completed by CVRMC in 2013 with many action plans driving the success of our identified community health issues. Together, with the collaboration of GCDHEM and many health care organizations and professionals of our service area, we will respond to the identified needs of all our diverse communities with this next CHIP. The Expansion Project of CVRMC began in February of 2015 and is expected to complete in August of 2016. The new construction includes all new, family-centered, single-patient rooms - Med/Surg, ICU, and Family Birth Center - which will bring comfort to the patients and their families we serve. The expansion also included new pharmacy, cath lab, wound center, infusion center, café and kitchen, gift shop, and conference rooms. The 11,000 square feet of new physician offices and exam rooms will provide for growth and will centralize services for the convenience of our patients. CVRMC sponsors an annual health fair, working with other local and state social and charitable agencies to distribute and disseminate health, wellness, safety and other valuable information. Without any charge to our communities, CVRMC sponsors diabetic workshops, birthing and new baby care classes, customer service training, and grief support meetings. Many community organizations have taken advantage of the conference rooms CVRMC has to offer free of charge for meetings and educational training. Some examples of these groups are Teenage Outreach for Pregnancy Services, Rotary Club, Little League, EMS Training, Gila Community College and many more. Meeting places are difficult to find in our rural community and CVRMC is pleased to accommodate our neighboring associations. CVRMC is continually upgrading and improving equipment. Much of the equipment that is replaced is still viable and is passed on to education facilities, fire departments, or other local agencies that will continue to get useful years for their programs and services. Supplies are also donated regularly to EMS, schools, senior citizen groups, and other organizations in need of medical and or other types of supplies. The PACT Committee, comprised of CVRMC staff, dedicates its efforts to making a difference in employee and community relations. The PACT Committee is instrumental in the activities of many hospital activities, promoting employee engagement and satisfaction. The PACT Committee also helps CVRMC employees through the HOPE (Helping Our People in Emergencies) Fund. Donations made to the HOPE fund are used in times of emergency for employees. The PACT Committee also ensures the hospital's presence in community events to build public support and trust. As we celebrate 103 years of service to the Globe-Miami and surrounding communities, CVRMC continues to evolve with the changing needs of our population base. Healthcare is ever moving and advancing and CVRMC is progressing with the demands of our target markets. The continued accomplishments we have made are a direct result of a dedicated and compassionate workforce, a steadfast Board of Directors, and strong supporting management which is focused on one mission - the mission of health with quality, efficiency, and compassion. With the development of our next 3-year strategic plan, we are focused on these areas: The Patient Experience (Quality and Customer Service) People Growth Community (including the CHNA and CHIP) Today, the healthcare arena is facing some monumental changes and challenges. This strategic plan encompasses our accountability and compassion to patients and families; our respect and collaboration to all who surround us; our earnest responsibility to grow with the needs of our population; and our social and public responsibility as healthcare leaders of our communities. Yesterday, today, and tomorrow, CVRMC is committed to our communities with an unwavering dedicated spirit. 0 0 0 33706376 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 40 0 1 251 1 0 0 0 0 0 0 X 9 9 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 AZ X Addy Kelly 9284021123 5880 S Hospital Drive Globe AZ 85501 Byron Belew Chairperson 1 0 X 0 0 0 Ed Carpenter Secretary 1 0 X 0 0 0 Fernando Shipley Treasurer 1 0 X 0 0 0 Jim Rasmussen Vice Chairman 1 0 X 0 0 0 Janice Cook Director 1 0 X 0 0 0 Jendean Sartain Director 1 0 X 0 0 0 Gary Gustason Director 1 0 X 0 0 0 Brad Werrell Director 1 0 X 0 0 0 Alan Osumi Director 1 0 X 0 0 0 Eddie Koury Director 1 0 X 0 0 0 Robert Hollis Director 1 0 X 0 0 0 Joseph Ring Director 1 0 X 0 0 0 Thomas Hansen Physician 40 0 X 346607 0 0 Dana Miller Physician 40 0 X 318511 0 0 Anthony Daniels Physician 40 0 X 273966 0 0 Binoy Chandra Physician 40 0 X 261002 0 0 Phoung Nguyen Physician 40 0 X 218587 0 0 1418673 0 0 6 0 1 0 Cobre Valley Heart Institute 2055 Highway 60 Globe AZ 85501 Cardiologist 706453 VTR Cobre Valley PO Box 846208 Dallas TX 75284 Rent and associated services 385654 SHC Services Po Box 27124 Salt Lake City UT 84127 Contract Labor 267377 Comphealth PO Box 972651 Dallas TX 75397 OB Lucum Services 238556 ARUP Laboratories PO Box 27964 Salt Lake City UT 84127 Lab Testing 218996 9 0 0 0 0 0 45370 0 45370 Net patient service revenue 621400 45415650 45415650 0 0 0 0 0 0 45415650 104065 0 0 104065 0 0 0 0 0 0 0 0 56232 0 0 0 56232 0 56232 0 0 56232 0 0 0 432405 432405 0 0 432405 46053722 45848055 0 160297 X 18696235 14022176 4674059 3891981 2918986 972995 8555751 6416813 2138938 1139343 854507 284836 557653 418240 139413 2223139 1667354 555785 694183 520637 173546 Supplies 6957295 5217971 1739324 0 Equipment rental and maintenance 1145260 858945 286315 0 1080994 810747 270247 44941834 33706376 11235458 0 4026681 2470171 13760606 13742434 300538 6493388 7623229 2224931 1612065 1408183 1421360 467240 463176 78699276 34494485 25770190 44204791 19463426 5725798 73614645 77563562 4447988 5867399 32851225 32692536 522330 2446408 868922 0 38690465 41006343 X 34382309 35936906 541871 620313 0 0 34924180 36557219 73614645 77563562 1111888 521151 0 0 0 0 X 0 1 X 1 0 X 0 904177 904177 0 21589670 13797786 7791884 0 0 0 0 0 23412815 20696699 2716116 0 32792614 0 32792614 44204791 Assets limited as to use 5536849 Bond Issuance Costs 188949 5725798 46574873 521151 0 0 0 521151 46053722 0 0 0 46053722 44941834 0 0 0 0 0 44941834 0 0 0 44941834 1 1 X 1 X 1 X 1 1 0 1 1 2790989 14941280 0 0 17732269 0 0 0 0 0 0 0 0 0 0 0 17732269 0 0 0 1 2035316 2035316 12918817 12633742 285075 X 1 1 1 1 Cobre Valley Regional Medical Center 5880 South Hospital Drive Globe AZ 85501 www.cvrmc.org X X X X Cobre Valley Regional Medical Center 1 0 0 1 X X X X X X X 15 1 0 0 1 X cvrmc.org 1 15 1 cvrmc.org 0 0 1 X 300 300 1 1 1 1 0 1 0 0 Schedule H, Part V, Section B, Line 5-Cobre Valley Regional Medical Center Cobre Valley Regional Medical Center The recent movement to transform public health and health systems stresses that where we live work play pray and learn determines our health and well being. Schedule H, Part V, Section B, Line 11-Cobre Valley Regional Medical Center Cobre Valley Regional Medical Center See other disclosures for Schedule H. 4 Cobre Valley Surgical Services 5860 South Hospital Drive Globe AZ 85501 Surgical Clinic Schedule H, Part I, Line 7 Hospital uses cost to charge ratio. Schedule H, Part III, Section A, Line 4 PATIENT ACCOUNTS RECEIVABLE CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES INSURANCE COMPANIES AND PRIVATE PATIENTS. THE HOSPITAL MANAGES ITS RECEIVABLES BY REGULARLY REVIEWING THE ACCOUNTS INQUIRING WITH RESPECTIVE PAYORS AS TO COLLECTABILITY AND PROVIDING FOR ALLOWANCES ON THEIR ACCOUNTING RECORDS FOR ESTIMATED CONTRACTUAL ADJUSTMENTS AND NONCOLLECTIBLE ACCOUNTS. Schedule H, Part III, Section B, Line 8 The costing methodology is Cost to Charge as calculated by the annual Medicare cost report. Schedule H, Part III, Section C, Line 9b CVRMC MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE FROM CVRMC AND A PATIENTS GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH CVRMC Schedule H, Part VI, Line 2 Currently, CVRMC utilizes several methods of assessing community healthcare needs. Evaluating the health needs of the CVRMC service area leads to identifying physicians needed in the area as well as recognizing those services that are required to address illnesses which can be targeted for community education and intervention. Community Feedback CVRMC utilizes many methods of community feedback for needs determination. Our patients, their families, and the greater community enlighten our organization through patient surveys and direct comments. CVRMC strives to give the very best care, and in order to accomplish that goal, it is vital that patient and community comments and concerns are addressed. Professional Research Consultants conducts outpatient surveys for the Outpatient Surgery, Physical Therapy, Registration, Med Surg ICU, Obstetrics, Respiratory Therapy, Emergency, Laboratory, Clinics, and Radiology Departments on patient satisfaction. PRC also conducts the inpatient, Hospital Consumers Assessment of Healthcare Providers and Systems survey which measures patient satisfaction in multiple areas including promptness and efficiency of the admission and registration process, length of time waiting, nursing care, physician care, teamwork, discharge instructions, safety, cleanliness of the facility, food service, overall quality of care, and the likelihood of recommending the hospital to relatives and friends. Statistics regarding patient feedback are calculated on a weekly basis and distributed to all department directors with a hard copy, graphs are posted, and emails are dispersed to ensure all staff is informed of results. Management is then able to make necessary assessments of weak areas and strategically plan for improvements. Audio of the actual phone surveys are also available to all management. Many changes within CVRMC have been made as a direct result of the feedback obtained in these surveys. Additional information available upon request and at www.CVRMC.com Schedule H, Part VI, Line 3 Education of Financial Assistance to Patients at CVRMC In public waiting areas of Cobre Valley Regional Medical Center, posters explain to patients in common language that CVRMC is a Medicare AHCCCS Medicaid participating facility. In addition, posters and signs in these areas explain to the patient what financial obligations may occur and if additional billing will be submitted by providers. If, at the time of admission or visit, the patient does not have third party insurance coverage, the patient is offered an AHCCCS application for health-care coverage through public programs. In addition, staff members in the ER are trained to run searches to determine if a patient has existing coverage. Below is a description of the Patient Education Policy followed by a copy of the Patient Financial Assistance and Discount Program. When neither existing insurance coverage nor AHCCCS eligibility is available, the Patient Account Services department talks to the patient about the Cobre Valley Regional Medical Center's Charity Care program. The patient is offered an AHCCCS application, and a financial contract. The patient is advised they must complete the AHCCCS application, appointment, etc. If the patient is denied by AHCCCS, they are to present the denial to the Patient Accounting Department. When the patient is offered the financial assistance application, demonstrable proof of income, living expenses, size of household and proof of AHCCCS denial are required for completion of the application. Included in the income computation are earnings from employment and other income such as child support, alimony, social security and from any other sources. When requesting proof of living expenses, patients are asked to provide documentation of expenses associated with housing, utilities, transportation, insurance, food, other medical bills, and all other living expenses. After all information is obtained and reviewed, the Federal Poverty Income Guidelines and Discount Table is now being used to calculate the total discount that can be offered to the patient. Once this is compiled, Patient Account Services signs off on the Financial Assistance Form which is forwarded to the Director, CFO, and CEO for approval, as appropriate. (CVRMC is highly dependent on payment rates set by Medicare and Medicaid, both of which generally don't cover costs. At CVRMC, about two thirds of patient revenue comes from these government payers. Changes at the federal level, specifically the Patient Protection and Affordable Care Act, will continue to change how CVRMC informs and educates patients and families regarding their eligibility for assistance.) POLICY OVERVIEW Cobre Valley Regional Medical Center (CVRMC) is committed to providing financial assistance to persons who have health care needs and are uninsured. Consistent with its mission to deliver quality healthcare in a safe, respectful, and efficient manner, CVRMC strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. PURPOSE This Policy provides a fair and comprehensive system of distributing free or discounted medical care to uninsured patients within the available resources of Cobre Valley Regional Medical Center. The Policy addresses: Eligibility criteria for financial assistance; The extent to which financial assistance includes free or discounted care; The basis for calculating amounts charged to individuals who are eligible for assistance under this policy; The method for applying for assistance; Measures to widely publicize the Policy Additional information regarding Financial Assistance to Patients available upon request or at www.CVRMC.com. Schedule H, Part VI, Line 4 Cobre Valley Regional Medical Center CVRMC is located in Globe, Arizona and serves a population of 45,000 within a radius of 65 miles in a full service acute care facility. This population includes both the primary, secondary, and partner service areas. CVRMC is located in the heart of the copper belt of Arizona and serves many rural copper communities within the region including its neighboring towns of Miami and Superior to the west, Kearny, Hayden, and Winkelman to the south. The communities of Roosevelt, Pleasant Valley Young are located to the north. The San Carlos Apache Nation, our service area partner, borders Globe to the east. CVRMC serves as an acute medical surgical, obstetric, orthopedic, pediatric, and family practice provider for all the residents of these communities. The CVRMC primary and secondary service area communities are located in two counties, Gila and Pinal. Based on the 2010 U. S. Census, approximately 23% of the total population in Gila County was over the age of 65 while in neighboring Pinal County it was 15%, compared to 14% for Arizona and 13 % for the United States. The five leading causes of death among adults age 65 and older in Gila and Pinal Counties are heart disease, cancer, chronic lower respiratory diseases, cerebrovascular disease, and diabetes. Total reported number of people with disabilities within Gila County is 22,453 and 63,082 for Pinal County. Additional information related to populations, including charts and graphs, available upon request or at www.CVRMC.com Schedule H, Part VI, Line 5 Cobre Valley Regional Medical Center CVRMC has a health commitment to our employees, physicians, health and wellness organizations, our board of directors, benefactors, volunteers, and most importantly, to our patients and families of the region we serve. CVRMC is inclusive, collaborative, and effective regarding community building activities and donations. The mission of CVRMC is: To develop and maintain a local healthcare delivery system that serves the region with quality, efficiency, and compassion. Our mission is your health. This is a living statement within each of our employees who work to provide direct or indirect patient care and is the driving force when setting goals, purchasing equipment, hiring employees, and planning activities throughout the region. The CVRMC Standards of Performance are the required code of conduct which will ensure the mission of CVRMC is carried forth. These standards include personal behaviors regarding privacy, attitude, communication, teamwork, courtesy, accountability, appearance, responsiveness, and safety. Through our community benefit and building activities, utilizing the standards of performance as the driving force, CVRMC is demonstrating accountability, gaining community trust, and fulfilling our mission to all our constituents of our service region. CVRMC receives expert operational support services through HealthTech Management Services. These areas of expertise include quality patient care, finance, revenue cycle, materials management, and strategic planning. The resources HealthTech Management Services provide are invaluable in assisting the CVRMC Board of Directors, administration, physicians, directors, and clinical and non-clinical staff in fulfilling the hospitals mission of Quality, Efficiency, Compassion, and Health for all our communities. Through our strategic planning process, CVRMC identified The Patient Experience, People, Growth, and Community as our key strategic goals for the next three years. These goals are not independent of each other, but rather interdependent, connected and overlapping, each individual function thriving on the success of the others. Additional information available upon request or by visiting www.CVRMC.com. Schedule H, Part VI, Line 6 CVRMC History Cobre Valley Regional Medical Center has been serving patients of the copper belt region of Arizona for over 100 years. Originally a miners hospital, Miami Inspiration Hospital opened to serve miners and their families in 1913. Eventually the aging, crowded Miami Inspiration Hospital could no longer accommodate the growing patient load and a larger, up to date hospital was needed, and during the 1960s, plans were formulated for a new hospital at another location. In 1967, the resident patients and the staff were transferred to the newly completed hospital in the Miami Gardens area where the hospital still stands today. Today, Cobre Valley Regional Medical Center is a 25 bed Critical Access Hospital located in Globe Miami, Arizona. It serves a population of roughly 42,000 within a radius of 65 miles in a full service acute care facility with a medical staff of more than 55 active physicians, numerous visiting specialists, community, and emergency doctors. Adjacent to the San Carlos Apache Reservation, CVRMC serves as an acute obstetric and surgical provider for reservation residents referred by their hospital. The area also has a significant Hispanic population and several other ethnic minorities. CVRMC is governed by a Board of Directors made up of a cross section of community members from many different professions including a mine accountant, a rancher retired engineer, an insurance agent, a business owner, county government, and medical professionals. The CVRMC Board of Directors meet once a month and act as a trustee for the assets and investments of the hospital for the people of the service area. The board also selects, advises, and evaluates the CEO of the hospital; grants physician staff privileges and ensures that quality medical care is maintained. Responsibilities also include providing direction for the affairs of the hospital and to ensure the development and growth of CVRMC is directed toward fulfilling the mission statement To develop and maintain a healthcare delivery system that serves the region with quality, efficiency, and compassion. Our mission is your health. Additional information available upon request or by visiting www.CVRMC.com. Schedule H, Part VI, Line 7 Arizona and available to all at www.CVRMC.com X 0 0 0 0 0 0 0 0 0 Dana Miller Physician 318511 0 0 0 0 0 0 0 0 0 318511 0 0 0 Binoy Chandra Physician 261002 0 0 0 0 0 0 0 0 0 261002 0 0 0 Phoung Nguyen Physician 218587 0 0 0 0 0 0 0 0 0 218587 0 0 0 Thomas Hansen Physician 346607 0 0 0 0 0 0 0 0 0 346607 0 0 Anthony Daniels Physician 273966 0 0 0 0 0 0 0 0 0 273966 0 0 0 Form 990, Part VI, Section A, Line 3 The CEO and CFO duties are carried out by employees of HealthTech Management Services, Inc. an unrelated management company. Compensation is included in the management fee paid to HealthTech Management Services. Form 990, Part VI, Section B, Line 11b A CPA firm prepares and reviews the Form 990 from data gathered and provided by CVRMC. The return is then provided to the CFO for review and approval. Any questions or concerns the CFO has are addressed and any corrections or clarifications are made. The final form 990, with all required schedules, is made available to the full board prior to filing with the IRS. Form 990, Part VI, Section B, Line 12c Board members and officers are covered by the organization's conflict of interest policy and are required to annually complete a questionnaire disclosing any and all possible conflicts of interest. Form 990, Part VI, Section B, Line 15 The Officer's compensation is determined by a review conducted by Healthtech management services, Inc. using data provided by a nationally recognized management consulting firm, along with Form 990 data from comparable organizations and other hospitals managed by Healthtech. Once this information has been compiled and reviewed, a meeting is held with the board and a decision is made on the Officers' compensation. Form 990, Part VI, Section C, Line 19 Available upon request. Form 990, Part IX, Line 11g Contract labor, Physician fees and Purchased Services