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ARKANSAS VALLEY REGIONAL MEDICAL CENTER 07011998: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
ARKANSAS VALLEY REGIONAL MEDICAL CENTER 07011998 (EIN 84-1465990)
Tax period
2011-04-01 to 2012-03-31
Filed
2013-02-15
IRS object ID
201310469349301686
Schema version
2011v1.5
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-02-15T12:17:14-06:00Timestamp
Tax Period End Date2012-03-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1STOCKMAN KAST RYAN & CO LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1102 N CASCADE AVENUE SUITE 400AddressLine1
CityCOLORADO SPRINGSCity
StateCOState
ZIP Code80903ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-04-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN841465990EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Arkansas Valley Regional Medical CenterBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% JANETTE BENDERInCareOfName
Name ControlARKANameControl
Phone7193836026Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line11100 Carson AvenueAddressLine1
CityLa JuntaCity
StateCOState
ZIP Code81050ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJANETTE BENDERName
TitleCHIEF FINANCIAL OFFICERTitle
Date Signed2013-02-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameDOREEN B MERZName
Phone7196301186Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonLynn CrowellNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line11100 carson avenueAddressLine1
Cityla juntaCity
StateCOState
ZIP Code81050ZIPCode
FieldValueIRS element (for citing)
Gross Receipts47716211GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.avrmc.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1998YearFormation
State Legal DomicileCOStateLegalDomicile
Activity Or Mission DescriptionTHE CENTER IS A COMMUNITY-OWNED ORGANIZATION PROVIDING HIGH QUALITY, RESPECTFUL, AND COMPASSIONATE HEALTH CARE SERVICES TO INDIVIDUALS & FAMILIES IN SOUTHEAST COLORADO.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees541TotalNbrEmployees
Total Nbr Volunteers80TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year9200ContributionsGrantsPriorYear
Contributions Grants Current Year59194ContributionsGrantsCurrentYear
Program Service Revenue Prior Year39075209ProgramServiceRevenuePriorYear
Program Service Revenue CY44286585ProgramServiceRevenueCY
Investment Income Prior Year-448442InvestmentIncomePriorYear
Investment Income Current Year90789InvestmentIncomeCurrentYear
Other Revenue Prior Year454455OtherRevenuePriorYear
Other Revenue Current Year293218OtherRevenueCurrentYear
Total Revenue Prior Year39090422TotalRevenuePriorYear
Total Revenue Current Year44729786TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year0GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year22721301SalariesEtcPriorYear
Salaries Etc Current Year22706214SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year15823795OtherExpensePriorYear
Other Expenses Current Year21566024OtherExpensesCurrentYear
Total Expenses Prior Year38545096TotalExpensesPriorYear
Total Expenses Current Year44272238TotalExpensesCurrentYear
Revenues Less Expenses Prior Year545326RevenuesLessExpensesPriorYear
Revenues Less Expenses CY457548RevenuesLessExpensesCY
Total Assets BOY38537716TotalAssetsBOY
Total Assets EOY40444057TotalAssetsEOY
Total Liabilities BOY4228109TotalLiabilitiesBOY
Total Liabilities EOY5679402TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY34309607NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY34764655NetAssetsOrFundBalancesEOY
Mission DescriptionTHE CENTER IS A COMMUNITY-OWNED ORGANIZATION THAT WILL WORK IN PARTNERSHIP WITH THE COMMUNITIES WE SERVE TO PROMOTE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND FAMILES IN SOUTHEASTERN COLORADO.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense33478008Expense
Revenue44579803Revenue
DescriptionThe Medical Center operates as an acute-care hospital and long-term care nursing home and PROVIDes inpatient, outpatient, and emergency HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF RACE AND INSURANCE.Description
Total Program Service Expense33478008TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntityfalseRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Info In Schedule O Part VXInfoInScheduleOPartV
Number Forms Transmitted With1096269NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Number Of Employees541NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Filed Lieu1041falseFiledLieu1041
Licensed More Than One StatefalseLicensedMoreThanOneState
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodyfalseMinutesOfGoverningBody
Minutes Of CommitteesfalseMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonJANETTE BENDERNamePerson
Telephone Number7193836001TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line11100 CARSON AVENUEAddressLine1
Cityla juntaCity
StateCOState
ZIP Code81050ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationHighest Compensated EmployeeHighestCompensatedEmployee
Robert W Blair
Board Chairman1.0XX000
Thomas C Brown
Board Secretary/Treasurer1.0XX
Jim Clawson
Board Vice-Chairman1.0XX
Ron Davis
Board Member1.0X
H Randolph Frank MD
Board Member1.0X
Evan Gamboa
Board Member1.0X
Margie Gardner
Board Member1.0X
Sylvia Gobin
Board Member1.0X
Dale L Leighty
Board Member1.0X
Bill Schmidt
Board Member1.0X
Richard A Shand MD
Board Member1.0X
Lynn Crowell
CEO40.0X21895850886
Janette Bender
CFO40.0X13609216684
Carrie Cutrell
CNO40.0X12328725412
Michael Morley
Ortho Physician40.08602791801X
Jesus Carale
Gastro Physician40.050824726341X
Thomas M Jackson
Surgeon40.030095426200X
Kent E Gay
Surgeon40.028846218471X
Amar Jetty
Hospitalist40.021068335726X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2646962TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation201521TotalOtherCompensation
Number Individuals GT100 K12NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
QUORUM HEALTH RESOURCES
PO BOX 305172 DPT 7NASHVILLETN372305172MANAGEMENT FEES592234
MICHAEL MARTINO
622 CARSON AVENUELA JUNTACO81050PHYSICIAN CONTRACTED499470
TRANE
FILE 56718LOS ANGELESCA900746718HVAC REPAIR421996
DELTA LOCUM
PO BOX 202940DALLASTX753202056CONTRACT LABOR330455
GE HEALTHCARE
20225 WATERTOWER BLVDBROOKFIELDWI53045MAINTENANCE CONTRACT257566
FieldValueIRS element (for citing)
Number Of Contractors GT100 K15NumberOfContractorsGT100K
All Other Contributions59194AllOtherContributions
Noncash Contributions725NoncashContributions
Total Contributions59194TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT SERVICE REVENUEDescription
Business Code900099BusinessCode
Total Revenue Column44286585TotalRevenueColumn
Related Or Exempt Function Income44286585RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue44286585TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column89064TotalRevenueColumn
Exclusion$89,064ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real221023Real

Less Rental Expenses LessRentalExpenses

FieldValueIRS element (for citing)
Real120378Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real100645Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column100645TotalRevenueColumn
Related Or Exempt Function Income100645RelatedOrExemptFunctionIncome

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities2750724Securities
Other60635Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities2750724Securities
Other58910Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other1725Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column1725TotalRevenueColumn
Exclusion$1,725ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory90051GrossSalesOfInventory
Cost Of Goods Sold56413CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column33638TotalRevenueColumn
Related Or Exempt Function Income33638RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA900099135837135837
MEDICAL RECORDS9000991516515165
MISCELLANEOUS INCOME90009979337933
FieldValueIRS element (for citing)
Total Other Revenue158935TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column44729786TotalRevenueColumn
Related Or Exempt Function Income44579803RelatedOrExemptFunctionIncome
Exclusion$90,789ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total3131057Total
Program Services2543658ProgramServices
Management And General587399ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15590508Total
Program Services12370421ProgramServices
Management And General3220087ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total371329Total
Program Services303201ProgramServices
Management And General68128ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3613320Total
Program Services3111123ProgramServices
Management And General502197ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total0Total

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total586377Total
Program Services469102ProgramServices
Management And General117275ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total46222Total
Program Services36978ProgramServices
Management And General9244ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total42000Total
Program Services33600ProgramServices
Management And General8400ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total6904327Total
Program Services2893065ProgramServices
Management And General4011262ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total0Total

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total5288565Total
Program Services4170304ProgramServices
Management And General1118261ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total420266Total
Program Services312137ProgramServices
Management And General108129ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total0Total

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total26216Total
Program Services20973ProgramServices
Management And General5243ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1783655Total
Program Services1426924ProgramServices
Management And General356731ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total0Total

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE30590283059028
REPAIRS & MAINTENANCE1166673933338233335
OTHER OPERATING EXPENSES1019767815814203953
UTILITIES1222928978342244586

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total44272238Total
Program Services33478008ProgramServices
Management And General10794230ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2554272BOY
EOY1239924EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY4962067BOY
EOY3729663EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4289953BOY
EOY6021012EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY1304165BOY
EOY1594109EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY655169BOY
EOY655980EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis52936638LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec27874695LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY24129086BOY
EOY25061943EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY15175BOY
EOY1507191EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY627829BOY
EOY634235EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY38537716BOY
EOY40444057EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3697331BOY
EOY4916483EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY462990BOY
EOY685872EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY67788BOY
EOY77047EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY4228109BOY
EOY5679402EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY33749566BOY
EOY34207467EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY560041BOY
EOY557188EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY34309607BOY
EOY34764655EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY38537716BOY
EOY40444057EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses457548ReconcilationRevenueExpenses
Reconcilation Other Changes-2500ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteefalseAuditCommittee
Financial Statement SeparateXFinancialStatementSeparate
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance560041BeginningOfYearBalance
Investment Earnings Or Losses-2853InvestmentEarningsOrLosses
End Of Year Balance557188EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance563460BeginningOfYearBalance
Investment Earnings Or Losses-3419InvestmentEarningsOrLosses
End Of Year Balance560041EndOfYearBalance
FieldValueIRS element (for citing)
Current Year Minus2 YearsCurrentYearMinus2Years
Current Year Minus3 YearsCurrentYearMinus3Years
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgstrueEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis9546OtherCostOrOtherBasis
Book Value9546BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis29678220OtherCostOrOtherBasis
Depreciation11142424Depreciation
Book Value18535796BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis867602OtherCostOrOtherBasis
Depreciation595829Depreciation
Book Value271773BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis20665003OtherCostOrOtherBasis
Depreciation16136442Depreciation
Book Value4528561BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1716267OtherCostOrOtherBasis
Book Value1716267BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings25061943TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionDEFERRED COMP PLAN LIABILITYDescription
Amount$77,047Amount
FieldValueIRS element (for citing)
Total Of Amounts77047TotalOfAmounts
Total Revenue44729786TotalRevenue
Total Expenses44272238TotalExpenses
Excess Or Deficit For Year457548ExcessOrDeficitForYear
Net Unrealized GL On Investments-7624NetUnrealizedGLOnInvestments
Other$5,124OtherAmount
Total Adjustments-2500TotalAdjustments
Excess Or Deficit Per FS455048ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt44847664TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-7624NetUnrealizedGainsInvestments
Other Revenues159008OtherRevenues
Revenue Not Rptd F990151384RevenueNotRptdF990
Revenue Subtotal44696280RevenueSubtotal
Other Revenues Not Included33506OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt33506RevenueNotRptdOnFinStmt
Total Revenue Per Form99044729786TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt44392616TotExpensesEtcAuditedFinclStmt
Other Expenses Included120378OtherExpensesIncluded
Expenses Not Rptd F990120378ExpensesNotRptdF990
Expenses Subtotal44272238ExpensesSubtotal
Total Expenses Per Form99044272238TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)

IdentifierIdentifierExplanationExplanation
PART V, Line 4The Medical Center is the sole beneficiary of the Bertha Elrod Copeland and James Evan Copeland Hospital Trust (the Trust), a charitable trust whose principal is to be held in perpetuity. Assets of the Trust are invested and administered by a trustee and distributions are made to the Medical Center. The use of the distributions received from the Trust is restricted to the purchase of equipment. PART X, LINE 2 THE MEDICAL CENTER DOES NOT BELIEVE IT HAS ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS.
PART XII, LINE 2DTHE GIFT SHOP TRANSFERRED $38,630 TO THE MEDICAL CENTER. THE GIFT SHOP IS UNDER THE SAME EIN# AS THE MEDICAL CENTER AND DOES NOT FILE A SEPARATE TAX RETURN. RENTAL EXPENSE OF $120,378 WAS RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN.
PART XII, LINE 4BTHE GIFT SHOP WHICH IS A DIRECTLY CONTROLLED ENTITY OF THE MEDICAL CENTER AND IS REGISTERED UNDER THE SAME EIN # AS THE MEDICAL CENTER RECORDED NET INCOME FROM OPERATIONS OF $33,506.
PART XIII, LINE 2DRENTAL EXPENSE OF $120,378 WAS RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1411466TotalCommunityBenefitExpense
Direct Offsetting Revenue1394943DirectOffsettingRevenue
Net Community Benefit Expense131564NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense9565242TotalCommunityBenefitExpense
Direct Offsetting Revenue4357836DirectOffsettingRevenue
Net Community Benefit Expense5207406NetCommunityBenefitExpense
Percent Of Total Expense0.12640PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense10976708TotalCommunityBenefitExpense
Direct Offsetting Revenue5752779DirectOffsettingRevenue
Net Community Benefit Expense5338970NetCommunityBenefitExpense
Percent Of Total Expense0.12680PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense4751TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense4751NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense592705TotalCommunityBenefitExpense
Direct Offsetting Revenue449132DirectOffsettingRevenue
Net Community Benefit Expense143573NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Research Research

FieldValueIRS element (for citing)
Total Community Benefit Expense0TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense0NetCommunityBenefitExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense11968TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense11968NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense609424TotalCommunityBenefitExpense
Direct Offsetting Revenue449132DirectOffsettingRevenue
Net Community Benefit Expense160292NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11586132TotalCommunityBenefitExpense
Direct Offsetting Revenue6201911DirectOffsettingRevenue
Net Community Benefit Expense5499262NetCommunityBenefitExpense
Percent Of Total Expense0.12710PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Total Community Building Expense2000TotalCommunityBuildingExpense
Net Community Building Expense2000NetCommunityBuildingExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Other Other

FieldValueIRS element (for citing)
Total Community Building Expense0TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense0NetCommunityBuildingExpense

Total Total

FieldValueIRS element (for citing)
Total Community Building Expense2000TotalCommunityBuildingExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Building Expense2000NetCommunityBuildingExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$3,059,028BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare11040458AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare10668364CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall372094MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

FieldValueIRS element (for citing)
Business Name Line1NONEBusinessNameLine1
FieldValueIRS element (for citing)
Description Ent Primary ActivityNONEDescriptionEntPrimaryActivity
Organization Profit Or Ownership0.00000OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership0.00000OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership0.00000PhysicansProfitOrOwnership
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1ARKANSAS VALLEY REGIONAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line11100 CARSON AVENUEAddressLine1
CityLA JUNTACity
StateCOState
ZIP Code81050ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
OtherLong-term NursingOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1ARKANSAS VALLEY REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreefalseUsesFPGFree
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent250.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit Lien On ResidenceXPermitLienOnResidence
Collection ActivitiestrueCollectionActivities
Lien On ResidenceXLienOnResidence
Other ActionsXOtherActions
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
IdentifierPART VI, SUPPLEMENTAL INFORMATIONIdentifier
ExplanationSchedule H, Part II, line 4 The Medical Center participates in a recycling initive to support and encourage the reduction of garbage and encourage a healthier environment. SCHEDULE H, PART III, LINE 4 THE COST METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED AS BAD DEBT EXPENSE IS USING A COST-TO-CHARGE RATIO. THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS IS MULTIPLIED BY THE RATIO OF PATIENT CARE COST TO CHARGES TO CALCULATE THE ESTIMATED COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS. A number of patients are truly unable to pay their out-of-pocket liability, but do not complete the process required to apply for financial assistance under the Hospital's charity care policy. These patients would qualify for charity care if they completed the paperwork, so the bad debt expense associated with treateing them should be treated as community benefit. SCHEDULE H, PART III, LINE 8 MEDICARE COSTS WERE CALCULATED FROM THE MEDICARE COST REPORT FOR THE FYE MARCH 31, 2012. IRS Revenue ruling 69-545, which establised the community benefit standard for nonprofit hospitals, states that if a hospital serves paitients with government health benefits, including medicare, then thisis an indication that the hospital operates to promote the health of the community. This implies that treating medicare patients is a community benefit. Schedule H Part V line 9. The Hospital uses CICP poverty level guidelines to determine eligibility for discounts and assistance. SCHEDULE H, PART V, LINE 16E THE CENTER ATTEMPTS TO OBTAIN COLLECTIONS THROUGH THE USE OF GARNISHING WAGES FROM CLIENTS WITH OUTSTANDING BALANCES. SCHEDULE H, PART VI, LINE 2 We deployed a Community Health Need Assessment survey within the local population for any resident to complete. We received community input from 104 area residents from a survey completed online during the period April 1, 2012 through June 30, 2012; The terms of gaining input stipulated each respondent would remain anonymous; The internet-based survey was promoted through a paid advertisement in a local newspaper, at a health fair, and distributed to local civic and health organizations with a request for participation. Preliminary conclusions were presented to a local group of experts who were asked to validate prior assessments and to establish priority among various identified health and medical issues; and Information analysis augmented by local opinions showed how Otero County relates among its peers in terms of primary and chronic needs, as well as other issues of uninsured persons, low-income persons, and minority groups; respondents commented on if they believe certain population groups (or people with certain situations) need help to improve their condition and if so, who needs to do what. When the analysis was complete, we put the information and summary conclusions before a local group of experts who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional statements of need; new needs could, and did, emerge from this exchange. Consultation with local experts was accomplished by having the local experts complete a survey individually. The survey identifying potential community needs the local experts participated in was a structured communication Delphi method technique, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The process encourages experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process was completed in one round which identified the most pressing, highest priority community needs. In the AVRMC process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving virtually no support and other needs receiving identical point allocations. We dichotomized the rank order into two groups: high priority needs and low priority needs. The determination of the break point, high as opposed to low, was a qualitative interpretation by QHR and the AVRMC executive team. When presented to the AVRMC executive team, the dichotomized need rank order identified which needs the hospital considered high responsibility to respond vs. low responsibility to respond. The result provided a matrix of needs and guided the hospital in developing its implementation response. Leading issues seem to relate to a lack of affordable health insurance coverage and the cost of medical care. Responses noted four topics as their most serious concerns: No health insurance is a major concern to 76% of respondents; Teen birth/pregnancy is a major concern to 63% of respondents; Diabetes is a major concern to 59% of respondents; and Unhealthy food choices and obesity are major concerns to 55% of respondents. Mental health issues present as a focus on alcohol use, drug abuse, and smoking among youth as well as adult abuse of alcohol and drugs. Regardless of age, prescription abuse is also present as a focus; and Comments about individual, family, and healthy living concerns revolve around healthy living and healthcare availability. SCHEDULE H, PART VI, LINE 3 The organization provides a brochure to each patient outlining the guidelines used to determine eligibility for assistance. SCHEDULE H, PART VI, LINE 4 In 2010, the Medical Center received 82.4% of its patients from the hospital's Primary Service Area. The Otero County 81050 and 81067 zip codes comprise 64.8% of all patients. County data is used as most information is not available at the geographic level of a zip code. The 2011 population for Otero County is estimated to be 18,345, but is expected to decline at a rate of 4%, projecting a 2016 population of 17,607. The population loss is in contrast to the Colorado state average rate of population increase of +7.2% and the national growth rate of +4%. The 65+ population of Otero County is 18.6% of the total population compared to the overall U.S. at 13.3%. The number of child-bearing-age females in the U.S. is expected to decrease 5.5%, while in Colorado it is expected to increase 2.1% by 2015. The Otero County 2011 Median Household Income is $42,283, which is considerably lower than the national median income of $67,529. Otero County's unemployment rate as of April 2012 is 9.2%19, larger than the national unemployment rate of 8.1%. SCHEDULE H, PART VI, LINE 5 Arkansas Valley Regional Medical Center's board of directors is comprised of persons who reside in the La Junta, Colorado area. The majority of the organization's board members are neither employees nor contractors of the medical center. The board of directors is made mostly of community business people interested in maintaining quality health care in La Junta. SCHEDULE H, PART VI, LINE 6 N/A SCHEDULE H, PART VI, LINE 7 N/A N/AExplanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrg
Lynn Crowell
1870741500016884523845648269844
Janette Bender
1260921000095077177152776
Michael Morley
5000013602781801862080
Jesus Carale
341016167231165009841534588
Thomas M Jackson
300000954220004200327154
Kent E Gay
288462167391732306933
Amar Jetty
210683330002726246409

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPART I, LINE 7Identifier
ExplanationThe physician contracts allow for a QUARTERLY BONUS IF THEIR RELATIVE VALUE UNITS charged exceed quarterly benchmark standards.Explanation

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV (2 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
DALE LEIGHTY
BOARD MEMBER753750CD'S HELD AT BANKfalse
BOB BLAIR
BOARD MEMBER682097CD'S HELD AT BANKfalse

Form990 Schedule L Part V Form990ScheduleLPartV (2 entries)

IdentifierIdentifierExplanationExplanation
PART IV, LINE 1DALE LEIGHTY IS A MEMBER ON THE BOARD OF DIRECTORS AND ALSO THE PRESIDENT OF FIRST NATIONAL BANK OF LAS ANIMAS WHERE THE MEDICAL CENTER Holds a certificate of Deposit.
PART IV, LINE 2BOB BLAIR IS A MEMBER ON THE BOARD OF DIRECTORS AND ALSO THE PRESIDENT OF COLORADO EAST BANK WHERE THE MEDICAL CENTER holds a certificate of deposit.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierSUPPLEMENTAL INFORMATIONIdentifier
ExplanationPart VI, Section A, line 3 The organization contracts with Quorum Health Resources, A healthcare management company, to provide specialized healthcare services. The CEO is an employee of the healthcare management company. The board of directors works in conjunction with the management company and the board has ultimate authority and responsibility for the organization. PART VI, SECTION B, LINE 11B THE BOARD REVIEWS AND APPROVES THE 990 BEFORE IT IS FILED. PART VI, SECTION B, LINE 12C EACH YEAR ALL KEY MEMBERS AND BOARD MEMBERS SUBMIT CONFLICTS OF INTEREST TO REGULARLY REVIEW ANY POSSIBLE CONFLICTS WITH THE WRITTEN CONFLICT OF INTEREST POLICY. PART VI, SECTION B, LINE 15C THE BOARD EVALUATES AND APPROVES WAGE PARAMETERS TO DETERMINE THE COMPENSATION OF INDEPENDENT PERSONS AND MANAGEMENT. PART VI, SECTION C, LINE 19 ORAGNIZATIONAL DOCUMENTS ARE AVAILABLE AT PUBLIC BOARD MEETINGS AND UPON REQUEST. PART XI, LINE 5 UNREALIZED LOSSES = ($7,624) TRANSFER FROM GIFT SHOP = $38,630 GIFT SHOP INCOME = ($33,506) NET CHANGES = ($2,500)Explanation