2016-03-11T10:54:12-06:00 2015-04-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2014-05-01 840469270 Colorado West Healthcare System COLO 9702566201 2021 N 12th Street Grand Junction CO 815012980 Christian Thomas CEO/CFO 9702566201 2016-02-29 1 KIM C HUNWARDSEN P00484560 6122536500 2016-02-29 2014 2016-08-17 19:52:53Z Community Hospital Grand Junction Christian Thomas 2021 N 12th Street Grand Junction CO 815012980 96921523 0 X www.yourcommunityhospital.com X 1956 CO Improve the health and quality of life of the individuals and communities we serve. 12 7 808 89 197417 187725 48613 667481 80658828 94920568 455794 -60882 334561 219046 81497796 95746213 45195 49653 0 0 37510368 45133689 0 0 0 39477590 47333829 77033153 92517171 4464643 3229042 46848904 61639365 19572418 31133837 27276486 30505528 The mission of Colorado West Healthcare System and Community Hospital is to improve the health and quality of life of the individuals and communities we serve. 0 0 85756802 49653 94942197 Community Hospital provides inpatient, outpatient, emergency, urgent, primary and home health care services to communities in western Colorado. During fiscal year 2015, Community Hospital had 6,388 patient days, 19,127 emergency room visits, 18,438 urgent care visits, 35,437 primary care visits, and performed 3,231 surgeries. 85756802 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 162 0 1 808 1 1 1 0 0 0 0 0 0 0 0 0 X 12 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CO X Jon Hooker 9702576295 2021 N 12th Street Grand Junction CO 81501 X Larry Kent Chairman 1.50 0.00 X X 0 0 0 R Curt Hatch Vice Chairman 1.50 0.00 X X 0 0 0 Michael Daniels Secretary 1.50 0.00 X X 0 0 0 David F Vargo Treasurer 1.50 0.00 X X 0 0 0 Monty Langston MD Board Member 1.00 0.00 X 0 0 0 Sam Starritt Board Member 1.00 0.00 X 0 0 0 Dean Havlik MD Chief of Staff Board Member 1.50 0.00 X 0 0 0 Amir Beshai MD Board Member 1.00 0.00 X 0 0 0 Tarek Arja DO Board Member 1.50 0.00 X 0 0 0 Jon Maraschin Board Member 1.50 0.00 X 0 0 0 Danny Mistry MD Board Member 1.50 0.00 X 0 0 0 Deedra Copeland Shear Board Member 1.50 0.00 X 0 0 0 Christian Thomas CEO/CFO 40.00 0.80 X 0 0 0 David Murray CCO 40.00 0.00 X 155762 0 12466 Donald Nicolay Chief Medical Officer 40.00 0.00 X 197366 0 5749 Karston Carr Specialty Care 36.00 0.00 X 366604 0 18414 Donald Maier Internal Medicine Physician 36.00 0.00 X 310765 0 13779 Rohn McCune ER Physician 36.00 0.00 X 303294 0 17064 Marc Breen ER Physician 36.00 0.00 X 296663 0 9695 David Johansen Internal Medicine Physician 36.00 0.00 X 294965 0 13081 1925419 0 90248 54 0 1 0 Shaw Construction 760 Horizon Dr Suite 201 Grand Junction CO 81506 Construction 1809657 Community Anesthesia Consultants 2754 Compass Dr Grand Junction CO 81506 Physician Services 885455 Quorum Healthcare Resources LLC 105 Continental Pl Brentwood TN 37027 Management Agreement 883441 HSS Inc 990 S Broadway St Denver CO 80209 Security Services 541925 Mayo Collaborative Services Inc 200 1st St SW Rochester MN 55905 Lab Diagnostics 519013 41 642421 25060 667481 Patient Service Revenue 621110 93714091 93714091 Other Revenue 621110 888592 888592 EHR 621110 713348 713348 Cafeteria Revenue 621110 282166 282166 Equity in Subsidiary Income 900099 -677629 -677629 94920568 100917 100917 977553 1139352 -161799 -161799 -161799 57587 35958 21629 21629 Investment in LLC's 900099 197417 197417 197417 95746213 94942197 197417 -60882 49653 49653 385225 385225 461464 461464 36697689 35549883 1147806 855373 827580 27793 4212566 4057676 154890 2521372 2418409 102963 637957 637957 232623 232623 94000 94000 3729 3729 8930344 7902715 1027629 478324 478324 3304403 3192548 111855 3906302 3186536 719766 276975 115408 161567 107538 107073 465 345915 345915 2203571 2203571 952222 5897 946325 UBI Tax 72000 72000 Medical Supplies 14313574 14313574 Bad Debt 4776581 4776581 Provider Taxes 3134582 3134582 3563189 2625684 937505 92517171 85756802 6760369 0 8212189 1983518 10358335 15381582 1444047 932118 2643281 2904171 382893 2839742 65523643 28820414 20101126 36703229 537375 537375 2997567 -19030 172091 376660 46848904 61639365 8117703 11598644 9241459 19535193 2213256 0 19572418 31133837 X 27276486 30505528 27276486 30505528 46848904 61639365 3229042 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3729 3729 0 Part II-B, Line 1: The Organization pays dues to the Colorado Hospital Association and a portion of that money is used for lobbying activities. 4446302 4446302 15507233 9570419 5936814 24632257 18936257 5696000 20937851 313738 20624113 36703229 X 91005590 -4776581 -4776581 95782171 -35958 -35958 95746213 87776548 35958 35958 87740590 4776581 4776581 92517171 Part X, Line 2: The Hospital is organized as a Colorado nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Interal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital files an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS to report its unrelated business taxable income. Income tax expense, if any, is included in other expenses in the consolidated statements of operations. The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. The Hospital's federal Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2011. Part XI, Line 2d - Other Adjustments: Provision for Uncollectible Accounts -4,776,581. Part XI, Line 4b - Other Adjustments: Gift Shop Merchandise for Sale recorded as Expenses for Financial Statements -35,958. Part XII, Line 2d - Other Adjustments: Gift Shop Merchandise for Sale recorded as Expenses for Financial Statements 35,958. Part XII, Line 4b - Other Adjustments: Provision for Uncollectible Accounts 4,776,581. 1 1 X 1 X 1 X 1 1 0 1 1 285000 285000 0.00320 14419248 12396720 2022528 0.02310 334517 248549 85968 0.00100 15038765 12645269 2393496 0.02730 770 770 0.00000 11362 11362 0.00010 270813 270813 0.00310 282945 282945 0.00320 15321710 12645269 2676441 0.03050 1 4776581 0 14555056 19897012 -5341956 X 1 1 1 Grand Junction Medical Center Property Rental 0.09800 0.00000 0.40200 2 Canyon View ASC LLC Ambulatory Surgery Center 0.51000 0.00000 0.49000 4 Physicians Choice Real Estate LLC Property Rental 0.62900 0.37100 1 1 Community Hospital 2021 N 12th St Grand Junction CO 815012980 http://www.yourcommunityhospital.com/ 011119 X X X Community Hospital 1 0 0 1 X X X X X X X X X 12 1 1 0 1 X https://secure.yourcommunityhospital.com/Community_Health_Needs_Assessment. X 1 12 1 https://secure.yourcommunityhospital.com/PDFs/CHNA%20Implementation%20Strat 0 0 1 X 200.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X http://www.yourcommunityhospital.com/Billing.cfm X X 1 X 0 X X X X 1 X 0 0 Community Hospital Part V, Section B, Line 5: Community Hospital worked with the Mesa County Health Department and a number of other local hospitals and organizations in Mesa County. This collaborative approach enabled the group to identify areas where the various organizations might work together to achieve needed improvements. Throughout the process members of the community were included in discussions to ensure views of the entire community were heard. Community Hospital Part V, Section B, Line 6a: The CHNA was conducted with the following other hospital facilities: Family Health West Hospital, St. Mary's Hospital & Regional Medical Center, Mind Springs Hospital, Inc. Community Hospital Part V, Section B, Line 11: Community Hospital was an active participant in this CHNA in collaboration with the Mesa County Health Department and a number of other local hospitals and organizations in Mesa County. This collaborative approach enabled the group to identify areas where the various organizations might work together to achieve needed improvements. Community Hospital has been utilizing this assessment as a guide for providing programs to address identified community health needs in support of the collaborators and with the mission of our organization "to improve the health and quality of life of the individuals and communities we serve."We do not have adequate resources to solve all problems identified. Some issues identified are beyond the mission of the health system 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 plan as providing guidance around how we, along with other area organizations and agencies, can collaborate to make the best medical care available to the citizens of our community.Access to Health Care - Community Hospital has been very successful in its mission to recruit new primary care providers in this service area. We have grown the number of providers in our employment model and we have assisted our community partner practices by recruiting providers into their businesses. In addition, we have provided practice management services and an electronic medical records system to enhance the operations of our local health department's safety net clinic to improve access to uninsured and underinsured community members. We have also expanded our direct contract relationships with employer groups in the community to provide 24/7 primary care services at a minimal cost to the employees and health plan members within their populations.Tobacco Use - Community Hospital continues to partner with local agencies to provide services where there are gaps with tobacco cessation resources. We've offered classes to the community and to our employer group partners.Obesity - We have formed a Community Hospital interdisciplinary population health management team that is focusing on diabetes. We're developing automated communication platforms in the areas of our emergency department, urgent care facilities, primary care facilities and in the transition phases when a patient is admitted and when the patient is discharged; transitioning the care and appropriate clinical information to the appropriate outpatient provider/service. Our target population pilot groups are our employer groups who have contracted with us for primary care services as well as patients who utilize our system. We have hired RN Care Coordinators who quarterback the team of providers; which now includes our health coach/care coordinators as extenders. We have supported the local Diabetes Counts program for young diabetics and have coordinated efforts with other local initiatives. Created and supported by an interdisciplinary team, we've also launched a new weight management program, Project U, for community members. We will continue to work with other community agencies.Screening and Early Detection - With our Community Health Partnership worksite wellness program, we have continued to improve the number of participants in our onsite health screenings. We have also removed financial barriers for annual screening and early detection opportunities through our plan design for our own health plan members. Our enhancement with the health department clinic has also increased this capacity in our community as well.Built Environment - We have participated in the planning efforts of our goals to promote health through advocacy for a well-constructed and inclusive built environment. And we have plans to implement these plans when we build our new hospital facility. The Built Environment includes safe trails and walkways to increase and encourage physical activity of our residents, sidewalks to provide contiguous, safe pathways for our students, a walking path around the entire new hospital campus, plus exercise equipment for path walkers, joggers, and employees along the way. As a hospital organization, it is as critical for us to demonstrate our commitment to our employee's health and wellbeing as it is for us to promote health in our community. We're doing our part to support a built environment.Building a Sense of Community - Community Hospital feels very strongly about being involved in our community. We encourage active participation and service on community committees and boards as volunteers and organizational support for collaborative initiatives that benefit the overall health of our community. We are and continue to be strong players and often times are the leaders in this effort.Parenting - Community Hospital certainly supports efforts in the community and while we do this by engaging with our patients and our patients' families on a daily basis, we utilize the expertise of our community partners and resources that are available to address this community need.Emotional and Social Well-Being - Community Hospital is an active participant in the community-wide effort to address specific mental health issues that continue to plague us. We have several teams of clinicians that work with other clinicians from other agencies and institutions; identifying processes to fill the gaps.In addition to the above, we have expanded our service lines with adding an Internal Medicine group of physicians and staff as employees; increasing our access and capacity for serving a broader clientele.Community Hospital actively engages in community task forces and committees for suicide prevention, crisis teams and other mental/behavioral health related initiatives. We have employed behavioral health specialists who provide services to patients in our Emergency Department in crisis situations; to patients of our primary care practices in crisis situations; to employees/families through EAP services offered by local employers; to patients through our Outpatient Behavioral Health service; to members of our CHP employer group medical clinic; and to participants in our Lifestyle Medicine program. Community Hospital Part V, Section B, Line 16i: Summary on website, posted in ER and waiting rooms, posted in admissions offices, and provided on admission. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Community Hospital Part V, Section B, line 16a website: http://www.yourcommunityhospital.com/Billing.cfm 12 First Choice Same Day Surgical Center 2596 F Road Grand Junction CO 81505 Outpatient Surgical Services Grand Valley Primary Care 603 28 1/4 Road Grand Junction CO 81506 Primary Physician Care Therapy Works at Community Hospital 2004 N 12th St Grand Junction CO 81501 Rehabilitation Programs Occupational Health 2004 N 12th St Grand Junction CO 81501 Employment-related Exam Services Grand Valley Urgent Care 1060 Orchard Ave Suite N Grand Junction CO 81501 Urgent Medical Services EAP Behavioral Health Services 2021 N 12th St Grand Junction CO 81501 Counseling Services Home Health 2021 N 12th St Grand Junction CO 81501 Home Care Services Orchard Pharmacy 1060 Orchard Ave Suite N Grand Junction CO 81501 Pharmacy Colorado Mesa University Student Health 1060 Orchard Ave Suite N Grand Junction CO 81501 Student Medical Services Canyon View Urgent Care 2373 G Road Suite 160 Grand Junction CO 81505 Urgent Medical Services Colorado West Woman Care of the Grand Va 2020 N 12th St Grand Junction CO 81501 Obstetrics and Gynecology Internal Medicine Assoc of the Grand Va 744 Horizon Dr Suite 310 Grand Junction CO 81506 Internal Medicine Part I, Line 6a: The community benefit report is available upon request. Part I, Line 7: Line 7a was calculated by multiplying the ratio of cost to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care to patients.Lines 7b-7c were determined using the overall cost to charge ratio. Lines 7e, 7f, and 7i are actual expenses from the general ledger. Part I, Ln 7 Col(f): The Bad Debt expense included in Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $4,776,581. Part III, Line 3: Community Hospital follows Healthcare Financial Management Association Statement No. 15, and therefore bad debt does not include amounts that would be attributable to charity care. Bad debt on line 2 is reported at charges. Part III, Line 4: The footnote that describes bad debt expense is found on page 10 of the attached audit report. Part III, Line 8: The Medicare cost report was used to determine the amount of the Medicare shortfall.The organization estimates 100% should be considered a community benefit. If these individuals did not qualify for Medicare, they would qualify for financial assistance, based on the demographics of the community in which we operate. Part III, Line 9b: Part of the Hospital's financial assistance and charity care policy provides for a financial counselor to meet with all uninsured patients prior to discharge from the Hospital. Every effort is made to work with self-pay patients to determine financial assistance eligibility. Collections actions are not taken until eligibility is determined. Part VI, Line 2: Community Hospital develops its strategic plan both internally and supported by Quorum Health Resources to assess the healthcare needs of the community it serves. This plan includes market assessment of the service area and local demographic characteristics, clinical service line utilization and projections for inpatient, ambulatory, and provider practices. Clinical foci resulting from the same are diabetes, obesity, and primary care access. Part VI, Line 3: Part of the Hospital's written financial assistance and charity care policy provides for financial counselors to meet with all uninsured patients prior to discharge. The Hospital's billing team may also inform patients of the Hospital's financial assistance and charity care program. Part VI, Line 4: The Hospital's primary service area is western Colorado and the residents of Mesa County. Mesa County's population is approximately 150,000 with 15% of the population being over the age of 65. Community Hospital captures 12% of the area's healthcare market for those patients requiring inpatient stays. 1 Community Hospital Foundation 2021 N 12th Street Grand Junction CO 815012980 742576856 501(c)(3) 49653 Executive Director salary contribution 1 0 Part I, Line 2: Colorado West Healthcare System provides assistance to Community Hospital Foundation, a related organization. The Foundation Director's compensation is paid by Colorado West Healthcare System. The Foundation reimburses the Hospital for a portion of his salary and the remaining amount is considered a donation to the Foundation. The CEO of the Hospital also serves on the board of the Foundation and monitors the appropriate use of the funds. X 0 0 0 0 0 0 0 1 0 David Murray CCO 155762 0 0 0 0 0 6807 0 7820 0 170389 0 0 0 Donald Nicolay Chief Medical Officer 197366 0 0 0 0 0 1957 0 7145 0 206468 0 0 0 Karston Carr Specialty Care 366604 0 0 0 0 0 10353 0 11052 0 388009 0 0 0 Donald Maier Internal Medicine Physician 310765 0 0 0 0 0 8112 0 8876 0 327753 0 0 0 Rohn McCune ER Physician 303294 0 0 0 0 0 8172 0 11882 0 323348 0 0 0 Marc Breen ER Physician 296663 0 0 0 0 0 7364 0 5315 0 309342 0 0 0 David Johansen Internal Medicine Physician 294965 0 0 0 0 0 7414 0 8127 0 310506 0 0 0 Part I, Line 7 Quorum Health Resources, a management company, compensates the CEO. His compensation includes a set amount plus a bonus if certain criteria are met. The bonus eligibility is based on a scorecard of thirteen metrics, focused around the Pillars of Excellence - quality, service, financial, growth, and people. Community Anesthesia Consultants Board Member Monty Langston is a partner 955403 Payments for Physician Services 0 Western Orthopedics & Sports Medicine Board Member Danny Mistry is a partner 398960 Payments for Physician Services 0 Kathleen Maraschin Wife of Board Member Jon Maraschin 87393 Compensation 0 Jana Thomas Wife of CEO Christian Thomas 12948 Compensation 0 Mary Thibault Sister of CCO David Murray 88028 Compensation 0 Lynn Nicolay RN Wife of Chief Medical Officer Donald Nicolay 39481 Compensation 0 Kelly Mistry MD Wife of Board Member Danny Mistry, MD 233614 Compensation 0 The Pathology Group PC Board Member Dean Havlik is a partner 137385 Payments for pathology contract 0 Urology Associates Amir Beshai, MD is a partner 351600 payments for urology services 0 Marc Thiboult Brother-in-law of CCO David MurrayX 29239 Compensation 0 Form 990, Part VI, Section A, line 1 The Executive Committee shall be composed of the Chairperson, Vice Chairperson, Treasurer, Secretary, Chief of Staff, and the President/CEO. The Executive Commitee shall meet upon the call of the Chairperson to: A. Review upcoming Board of Trustee meetings. B. Act on behalf of the Board of Trustees between regular or special meetings of the Board and then report actions to the Board of Trustees. C. Communicate to keep the Board of Trustees, medical staff and administration of the Hospital aware of pertinent actions taken or contemplated by one or the other, and to make recommendations to the Board of Trustees on major expenditures. D. Consider issues affecting medical care that arise in the operation and affairs of the Hospital. E. Perform the annual evaluation of the President/CEO. F. Perform any other actions the Board of Trustees deems necessary, as instructed by the Board of Trustees. Form 990, Part VI, Section A, line 3 The Hospital has a management agreement with Quorum Health Resources. Christian Thomas, CEO, is compensated by Quorum Health Resources. His compensation for calendar year 2014 was $436,144. Form 990, Part VI, Section B, line 11 The 990 is prepared by the Hospital's independent CPA firm and reviewed by the Hospital's accounting staff and Administration, including the CEO, Controller, and Compliance Officer. A preliminary draft is presented to the Board of Directors for detailed review and approval. A final copy of the 990 is provided to all board members prior to the final filing with the IRS. Form 990, Part VI, Section B, line 12c The Hospital's conflict of interest policy is maintained and managed by the Chief Compliance Officer on an annual basis. All board members, officers, and key employees are required to complete a conflict of interest disclosure form and submit it to the compliance department. That documentation is reviewed by and retained by the compliance officer. Any conflicts of interest that arise are addressed by the compliance department and the Board of Trustees. All board members, officers, and key employees are required to notify the facility of any changes during the year. Form 990, Part VI, Section B, line 15 Community Hospital is a Quorum Health Resources managed hospital whereby the CEO is an employee of the management company. Salary and benefits for the CEO are based on the management company's salary survey data for hospitals of comparable size and is approved by the Executive Committee of the Board of Trustees. Salaries and benefits for other members of senior management are based on salary survey data compiled by the Hospital's HR department and are approved by the Board of Directors through the annual budget process. Form 990, Part VI, Section C, line 19 Governing documents, policies and procedures, and audited financial statements are made available to the public upon request on a case by case basis. Community Hospital Foundation 2021 N 12th St Grand Junction CO 815042980 742576856 Fundraising CO 501(c)(3) Line 11c, III-FI Colorado West Healthcare System 1 Physicians Choice Real Estate LLC 2012 N 12th St Grand Junction CO 815012980 841601063 Real Estate Commercial Rental CO Colorado West Healthcare System Related 171798 1819072 0 0 0.62940 Canyon View ASC 2373 G Road Ste 180 Grand Junction CO 81505 455352976 Ambulatory Surgery Center CO Colorado West Healthcare System Related -841630 2234194 0 0 0.51000 Doctor's Clinic Building Inc 1060 Orchard Ave Grand Junction CO 81501 840507943 Real Estate Rental CO Colorado West Healthcare System C -201283 409050 1.00000 1 0 1 1 0 0 1 0 0 0 0 1 0 0 1 1 1 1 0 1 Physicians Choice Real Estate LLC F 176235 Cash Physicians Choice Real Estate LLC K 518607 Cash Doctor's Clinic Building Inc K 201159 Cash Community Hospital Foundation C 642421 Cash