BISBEE HOSPITAL ASSOCIATION: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- BISBEE HOSPITAL ASSOCIATION (EIN 86-0334996)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-02-15
- IRS object ID
- 201710469349303041
- Schema version
- 2015v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-15T15:47:54-06:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 480573184 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIER CARR & MONROE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4801 E BROADWAY BLVD STE 501 | AddressLine1Txt |
| City | TUCSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 857113648 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860334996 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BISBEE HOSPITAL ASSOCIATIONINC | BusinessNameLine1Txt |
| Business Name Line2 | D/B/A COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BISB | BusinessNameControlTxt |
| Phone | 5204325383 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856031327 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JAMES DICKSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5204325383 | PhoneNum |
| Signature | 2017-02-07 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID B BARBER CPACFE | PreparerPersonNm |
| PTIN | P00348638 | PTIN |
| Phone | 5206248229 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JAMES DICKSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856031327 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $35,089,354 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CQCH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY BY PROVIDING LEADERSHIP AND VISION TO ADDRESS OPPORTUNITIES AND CHALLENGES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 308 | TotalEmployeeCnt |
| Total Volunteers | 14 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $424,545 | PYContributionsGrantsAmt |
| CY Contributions Grants | $225,924 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $27,929,835 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $34,722,239 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$71,148 | PYInvestmentIncomeAmt |
| CY Investment Income | $28,286 | CYInvestmentIncomeAmt |
| PY Other Revenue | $79,787 | PYOtherRevenueAmt |
| CY Other Revenue | $69,404 | CYOtherRevenueAmt |
| PY Total Revenue | $28,363,019 | PYTotalRevenueAmt |
| CY Total Revenue | $35,045,853 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $42,210 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,333,584 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $16,493,351 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,866,082 | PYOtherExpensesAmt |
| CY Other Expenses | $12,866,121 | CYOtherExpensesAmt |
| PY Total Expenses | $25,199,666 | PYTotalExpensesAmt |
| CY Total Expenses | $29,401,682 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,163,353 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,644,171 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $34,030,434 | TotalAssetsBOYAmt |
| Total Assets EOY | $40,005,000 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,916,841 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,247,199 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $22,113,593 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,757,801 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY BY PROVIDING LEADERSHIP AND VISION TO ADDRESS OPPORTUNITIES AND CHALLENGES. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $23,041,422 | ExpenseAmt |
| Grant | $42,210 | GrantAmt |
| Revenue | $34,722,239 | RevenueAmt |
| Desc | TO PROVIDE HEALTHCARE SERVICES THROUGH IN-PATIENT, OUT-PATIENT,24-HOUR EMERGENCY SERVICES AND RURAL HEALTH CLINIC TO THE RESIDENTS OF BISBEE & SURROUNDING COMMUNITIES. | Desc |
| Total Program Service Expenses | $23,041,422 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 111 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 308 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | 0 | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | 0 | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5204325383 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856031327 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| KATHLEEN HEARD | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JOHN HARRIS | |||||||
| CHAIR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| ROSALIE BUTLER | |||||||
| SECRETARY | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| DENNIS GALLUS | |||||||
| VICE CHAIR | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| DENNIS NELSON | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LAURA CHAVEZ | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| GARY DILLARD | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| PETER CARBERRY | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT HOWELL | |||||||
| TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| LAWANA DIFFLE | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ROSA ANEL LOPEZ | |||||||
| DIRECTOR | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JAMES DICKSON | |||||||
| CEO | 40.00 | $353,893 | $0 | $96,974 | Yes (X) | ||
| JAMES EHASZ | |||||||
| CFO | 40.00 | $164,808 | $0 | $10,355 | Yes (X) | ||
| JOSE ROMO MD | |||||||
| SURGEON | 40.00 | $359,231 | $0 | $22,680 | Yes (X) | ||
| HEIDI LODGE MD | |||||||
| PHYSICIAN | 40.00 | $314,218 | $0 | $20,866 | Yes (X) | ||
| DANIEL ROE MD | |||||||
| ER PHYSICIAN | 40.00 | $553,450 | $0 | $28,837 | Yes (X) | ||
| BRIAN MILES MD | |||||||
| PHYSICIAN | 40.00 | $246,890 | $0 | $11,053 | Yes (X) | ||
| PANAYOTIS ELLINAS MD | |||||||
| PHYSICIAN | 40.00 | $274,372 | $0 | $19,284 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,266,862 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $210,049 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| LABORATORY CORPORATION OF AMERICA | |||||
| 5005 S 40TH ST | PHOENIX | AZ | 85040 | LAB SERVICE | $421,626 |
| EVIDENT | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | COMPUTER SERVICE | $347,401 |
| JOHN WAYTUK | |||||
| 101 COLE AVE | BISBEE | AZ | 85603 | ER PHYSICIAN | $311,405 |
| CERNER | |||||
| 2800 ROCKCREEK PARKWAY | NORTH KANSAS CITY | MO | 64117 | COMPUTER SERVICE | $250,791 |
| DEVENEY GROUP ARCHITECTS | |||||
| 201 W INDIAN SCHOOL RD | PHOENIX | AZ | 85013 | ARCHITECTURAL SERVICE | $154,211 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $37,507 | FundraisingAmt |
| Government Grants | $176,017 | GovernmentGrantsAmt |
| All Other Contributions | $12,400 | AllOtherContributionsAmt |
| Total Contributions | $225,924 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $34,722,239 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,722,239 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $34,722,239 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,036 | TotalRevenueColumnAmt |
| Exclusion | $23,036 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $30,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $24,750 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,250 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,250 | TotalRevenueColumnAmt |
| Exclusion | $5,250 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $37,507 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $18,751 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$18,751 | TotalRevenueColumnAmt |
| Exclusion | -$18,751 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 900099 | $79,257 | $79,257 |
| MEDICAL RECORDS | 900099 | $8,898 | $8,898 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $88,155 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,045,853 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $34,722,239 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $97,690 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,210 | TotalAmt |
| Program Services | $12,210 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,000 | TotalAmt |
| Program Services | $30,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $667,040 | TotalAmt |
| Management And General | $667,040 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,065,627 | TotalAmt |
| Program Services | $10,487,843 | ProgramServicesAmt |
| Management And General | $2,577,784 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $188,761 | TotalAmt |
| Program Services | $161,951 | ProgramServicesAmt |
| Management And General | $26,810 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,673,270 | TotalAmt |
| Program Services | $1,277,216 | ProgramServicesAmt |
| Management And General | $396,054 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $898,653 | TotalAmt |
| Program Services | $711,098 | ProgramServicesAmt |
| Management And General | $187,555 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,145 | TotalAmt |
| Program Services | $20,008 | ProgramServicesAmt |
| Management And General | $122,137 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $90,900 | TotalAmt |
| Management And General | $90,900 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,940,951 | TotalAmt |
| Program Services | $2,192,808 | ProgramServicesAmt |
| Management And General | $748,143 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $177,145 | TotalAmt |
| Management And General | $177,145 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,995 | TotalAmt |
| Program Services | $56,179 | ProgramServicesAmt |
| Management And General | $36,816 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $256,415 | TotalAmt |
| Program Services | $248,598 | ProgramServicesAmt |
| Management And General | $7,817 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,819 | TotalAmt |
| Program Services | $105,392 | ProgramServicesAmt |
| Management And General | $50,427 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $346,344 | TotalAmt |
| Management And General | $346,344 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,459,076 | TotalAmt |
| Program Services | $1,249,661 | ProgramServicesAmt |
| Management And General | $209,415 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $412,843 | TotalAmt |
| Program Services | $373,441 | ProgramServicesAmt |
| Management And General | $39,402 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PROVISION FOR UNCOLLECT | $2,832,544 | $2,832,544 | |
| SUPPLIES | $2,436,641 | $2,209,800 | $226,841 |
| REPAIRS & MAINTENANCE | $349,122 | $281,936 | $67,186 |
| UTILITIES | $305,620 | $305,620 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $867,561 | TotalAmt |
| Program Services | $485,117 | ProgramServicesAmt |
| Management And General | $382,444 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,401,682 | TotalAmt |
| Program Services | $23,041,422 | ProgramServicesAmt |
| Management And General | $6,360,260 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,568,884 | BOYAmt |
| EOY | $7,944,443 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,157,455 | BOYAmt |
| EOY | $3,704,849 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,576,589 | BOYAmt |
| EOY | $4,854,497 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $598,923 | BOYAmt |
| EOY | $718,407 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $121,113 | BOYAmt |
| EOY | $129,910 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $33,898,767 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $13,296,576 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,455,951 | BOYAmt |
| EOY | $20,602,191 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,508,486 | BOYAmt |
| EOY | $1,984,831 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,033 | BOYAmt |
| EOY | $40,872 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $25,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,030,434 | BOYAmt |
| EOY | $40,005,000 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,520,001 | BOYAmt |
| EOY | $3,025,157 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,396,840 | BOYAmt |
| EOY | $9,222,042 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,916,841 | BOYAmt |
| EOY | $12,247,199 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,066,674 | BOYAmt |
| EOY | $27,713,632 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $46,919 | BOYAmt |
| EOY | $44,169 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,113,593 | BOYAmt |
| EOY | $27,757,801 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $34,030,434 | BOYAmt |
| EOY | $40,005,000 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $5,644,171 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $37 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,392,664 | OtherCostOrOtherBasisAmt |
| Book Value | $1,392,664 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,983,491 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,967,643 | DepreciationAmt |
| Book Value | $15,015,848 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,227,991 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,328,933 | DepreciationAmt |
| Book Value | $1,899,058 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,294,621 | OtherCostOrOtherBasisAmt |
| Book Value | $2,294,621 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,602,191 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LONG-TERM DEBT | Desc |
| Amt | $9,222,042 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $9,222,042 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $34,958,188 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $37 | NetUnrealizedGainsInvstAmt |
| Revenue Not Reported | $37 | RevenueNotReportedAmt |
| Revenue Subtotal | $34,958,151 | RevenueSubtotalAmt |
| Other Revenues Not Included | $87,702 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $87,702 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $35,045,853 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $29,313,980 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $29,313,980 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $87,702 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $87,702 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $29,401,682 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECEIVED ITS LETTER OF DETERMINATION FROM THE INTERNAL REVENUE SERVICE IN 1977. CERTAIN UNRELATED BUSINESS INCOME MAY BE SUBJECT TO INCOME TAX. THE HOSPITAL FOLLOWS FASB CODIFICATION 740-10-50 FOR DISCLOSURE OF INCOME TAX RELATED MATTERS. THE STANDARD SETS A "MORE LIKELY THAN NOT" CRITERION FOR RECOGNIZING THE TAX BENEFITS OF UNCERTAIN TAX POSITIONS. THE HOSPITAL BELIEVES THAT ITS INCOME TAX FILING POSITIONS AND DEDUCTIONS WILL BE SUSTAINED UPON EXAMINATION AND, ACCORDINGLY, HAVE NOT RECORDED ANY RESERVES OR RELATED ACCRUALS FOR INTEREST AND PENALTIES IN THE ACCOMPANYING FINANCIAL STATEMENTS FOR UNCERTAIN INCOME TAX POSITIONS. INCOME TAX RELATED INTEREST AND PENALTIES ARE REPORTED IN GENERAL AND ADMINISTRATIVE EXPENSES WHEN INCURRED. NO INCOME TAX EXAMINATIONS ARE CURRENTLY UNDERWAY OR ANTICIPATED. THE STATUTE OF LIMITATIONS IS THREE YEARS FOR FEDERAL INCOME TAX PURPOSES AND FOUR YEARS FOR THE STATE OF ARIZONA. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | DONATION INCOME INCLUDED IN EXPENSES 49,909. PROGRAM EXPENSE INCLUDED IN INCOME 56,545. FUNDRAISING EXPENSES -18,752. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | DONATION INCOME INCLUDED IN EXPENSES 49,909. PROGRAM EXPENSES INCLUDED IN INCOME 56,545. FUNDRAISING EXPENSES -18,752. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $37,507 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $37,507 | CharitableContriEvent1Amt |
| Other Direct Expenses Event1 | $18,751 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $37,507 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $37,507 | CharitableContributionsTotAmt |
| Oth Direct Expnss Total Events | $18,751 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $18,751 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$18,751 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $143,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $143,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $143,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $143,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00540 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $136,196 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $136,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $136,196 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $136,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00510 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $279,196 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $279,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01050 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $35,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $35,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $50,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $50,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00190 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $191,921 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $191,921 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $18,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 8 | ActivitiesOrProgramsCnt |
| Total Community Benefit Expns | $294,921 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $294,921 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,151,693 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,075,847 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,180,557 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,894,957 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$714,400 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85603 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://COPPERQUEENHOSPITAL.WIX.COM/CQCH#!COMMUNITY-INFO | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTPS://WWW.COCHISE.AZ.GOV/HEALTH-AND-SOCIAL-SERVICES/C | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://CQCH.ORG/RESOURCES/COMMUNITY/ | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COPPER QUEEN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6A: SOUTHEAST ARIZONA MEDICAL CENTERBENSON HOSPITALNORTHERN COCHISE COMMUNITY HOSPITAL |
| COPPER QUEEN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: THE HOSPITAL COLLABORATED WITH THE COCHISE COUNTY TO CONDUCT THE COCHISE COUNTY CHNA IN DECEMBER 2012. CHNA IDENTIFIED HEALTH CONCERNS FOR THE COCHISE COUNTY, INCLUDING DIABETES, OBESITY, AND AGING PROBLEMS. THE HOSPITAL IMPLEMENTED HEALTH LIVING PROGRAM, ANTIMICROBIAL STEWARDSHIP PROGRAM, MOBILE EYE CLINIC, 340 B DRUG PROGRAM, AND HOSPITAL VACCINATION PROGRAM TO ADDRESS THE ISSUES IDENTIFIED IN THE CHNA. |
| COPPER QUEEN COMMUNITY HOSPITAL | PART V, SECTION B, LINE 22D: ANY PATIENT THAT DOES NOT HAVE INSURANCE IS AUTOMATICALLY GIVEN A 50% DISCOUNT ON THE COST OF THEIR MEDICAL CARE. IF THE PATIENT MAKES LESS THAN 200% OF THE FEDERAL POVERTY LEVEL THEY WILL RECEIVE AN ADDITIONAL DISCOUNT BEYOND THE INITAL 50%. THE DISCOUNT WILL BE DETERMINED USING A SLIDING FEE SCALE DISCOUNT. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - COPPER QUEEN MEDICAL ASSOCIATES-DOUGLAS | ||||
| 100 E 5TH ST | DOUGLAS | AZ | 85607 | RURAL HEALTH CLINIC |
| 2 - COPPER QUEEN MEDICAL ASSOCIATES-BISBEE | ||||
| 101 COLE AVE | BISBEE | AZ | 85603 | RURAL HEALTH CLINIC |
| 3 - COPPER QUEEN MEDICAL ASSOCIATES-PALOMINA | ||||
| 10524 HIGHWAY 92 | HEREFORD | AZ | 85615 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COST ACCOUNTING SYSTEM WAS USED TO REPORT THE SUBSIDIZED HEALTH SERVICES REVENUE AND EXPENSE. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, AND ETC.) |
| PART I, LINE 7, COLUMN (F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,832,544. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | N/A. |
| PART III, LINE 4: | FINANCIAL NOTES REGARDING BAD DEBTS, PAGE 11 OF AUDITED FINANCIAL STATEMENTSTHE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, THE AGE OF ACCOUNTS, THE PAYOR MIX, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS.BAD DEBTS ARE MONITORED BY MANAGEMENT AND ARE DETERMINED TO BE DELINQUENT BASED UPON REVIEW OF AGING REPORTS COUPLED WITH CORRESPONDENCE WITH PATIENTS AND THIRD-PARTY PAYORS. BAD DEBTS ARE WRITTEN OFF WHEN ALL REASONABLE ATTEMPTS TO COLLECT THE DEBT HAVE BEEN EXHAUSTED.A COST TO CHARGES RATIO IS USED TO DETERMINE THE BAD DEBT EXPENSE AT COST. SHORTFALL IS NOT INCLUDED AS PART OF COMMUNITY BENEFIT. |
| PART VI, LINE 2: | THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES BASED UPON HISTORICAL SERVICES PROVIDED. |
| PART VI, LINE 3: | IT IS DONE UNDER ADMISSION. THE PATIENTS ARE PROVIDED A COPY OF FINANICAL ASSISTANCE POLICY UPON ADMISSION. FINANIAL ASSISTANCE CONTACT INFORMATION IS ALSO POSTED IN THE LOBBY, EMERGENCY ROOM AND OTHER PATIENT AREA. PATIENTS WITH PAST DUE BALANCES ARE SENT A LETTER ADVISING THEM OF THE AVAILABILITY OF ASSISTANCE BEFORE THEY ARE SENT TO COLLECTIONS. |
| PART VI, LINE 4: | THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES TO RESIDENTS WITHIN BISBEE, ARIZONA COMMUNITY AND ADJACENT AREAS. THE HOSPITAL ALSO OPERATES A HOME HEALTH AGENCY IN THE SAME GEOGRAPHIC AREA AND THREE RURAL HEALTH CLINICS LOCATED IN BISBEE, DOUGLAS AND PALOMINAS, ARIZONA. |
| PART VI, LINE 5: | N/A |
| PART VI, LINE 6: | N/A |
| PART VI, LINE 7, REPORTS FILED WITH STATES | AZ |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARIZONA LIONS VISION CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3003 S COUNTRY CLUB RD | AddressLine1Txt |
| City | TUCSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85713 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 860289608 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $12,210 | CashGrantAmt |
| Purpose Of Grant | FOR SUPPORTING OF GENERAL OPERATION. | PurposeOfGrantTxt |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS AND AWARDS | GrantTypeTxt |
| Recipient | 15 | RecipientCnt |
| Cash Grant | $30,000 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION HAS A LEADERSHIP MEETING TO REVIEW STUDENTS' SCHOLARSHIP APPLICATION. THE APPLICATIONS ARE ON FILE IN THE HUMAN RESOURCE DEPARTMENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES DICKSON | ||||||||||||||
| CEO | $353,893 | $0 | $0 | $0 | $0 | $0 | $35,389 | $0 | $61,585 | $0 | $450,867 | $0 | $0 | $0 |
| JAMES EHASZ | ||||||||||||||
| CFO | $164,808 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,355 | $0 | $175,163 | $0 | $0 | $0 |
| JOSE ROMO MD | ||||||||||||||
| SURGEON | $359,231 | $0 | $0 | $0 | $0 | $0 | $10,777 | $0 | $11,903 | $0 | $381,911 | $0 | $0 | $0 |
| HEIDI LODGE MD | ||||||||||||||
| PHYSICIAN | $314,218 | $0 | $0 | $0 | $0 | $0 | $9,427 | $0 | $11,439 | $0 | $335,084 | $0 | $0 | $0 |
| DANIEL ROE MD | ||||||||||||||
| ER PHYSICIAN | $553,450 | $0 | $0 | $0 | $0 | $0 | $16,604 | $0 | $12,233 | $0 | $582,287 | $0 | $0 | $0 |
| BRIAN MILES MD | ||||||||||||||
| PHYSICIAN | $246,890 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,053 | $0 | $257,943 | $0 | $0 | $0 |
| PANAYOTIS ELLINAS MD | ||||||||||||||
| PHYSICIAN | $274,372 | $0 | $0 | $0 | $0 | $0 | $8,231 | $0 | $11,053 | $0 | $293,656 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE DRAFT OF 990 FORM AND RELATED SCHEDULES ARE SENT TO AND REVIEWED BY BOARD MEMBERS AND MANAGEMENT BEFORE FILING. COMMENTS AND CHANGES ARE COMMUNICATED WITH THE TAX PREPARER AND ADDRESSED ACCORDINGLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE COMPENSATION IS SET BY THE BOARD BASED UPON REVIEW OF AN ANNUAL SALARY SURVEY BY THE ARIZONA HOSPITAL ASSOCIATION. THE HOSPITAL ALSO CONTRACTS WITH AN OUTSIDE CONSULTANT WHO ADVISES THE BOARD REGARDING EXECUTIVE COMPENSATION. THE ABOVE MENTIONED PROCESS IS UTILIZED IN SETTING SALARIES OF ALL OF THE EXECUTIVE TEAM AT THE HOSPITAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE TO THE PUBLIC THROUGH THE STATE UAR REPORT AND THE FEDERAL MEDICARE COST REPORT. |
| FORM 990, PART IX, LINE 11G | MEDICAL PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,182,180. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,182,180. OTHER: PROGRAM SERVICE EXPENSES 1,010,628. MANAGEMENT AND GENERAL EXPENSES 748,143. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,758,771. |
| FORM 990 PART XII, LINE 2C | THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT PROCESS OR SELECTION PROCESS FROM PRIOR YEAR. |