2013-02-15T12:17:14-06:00 2012-03-31 STOCKMAN KAST RYAN & CO LLP 102 N CASCADE AVENUE SUITE 400 COLORADO SPRINGS CO 80903 990 2011-04-01 841465990 Arkansas Valley Regional Medical Center % JANETTE BENDER ARKA 7193836026 1100 Carson Avenue La Junta CO 81050 JANETTE BENDER 2013-02-15 true DOREEN B MERZ 7196301186 2011 2016-02-25 16:41:14Z Lynn Crowell 1100 carson avenue la junta CO 81050 47716211 false X WWW.avrmc.org X 1998 CO THE CENTER IS A COMMUNITY-OWNED ORGANIZATION PROVIDING HIGH QUALITY, RESPECTFUL, AND COMPASSIONATE HEALTH CARE SERVICES TO INDIVIDUALS & FAMILIES IN SOUTHEAST COLORADO. 11 11 541 80 0 9200 59194 39075209 44286585 -448442 90789 454455 293218 39090422 44729786 0 0 0 0 22721301 22706214 0 0 0 15823795 21566024 38545096 44272238 545326 457548 38537716 40444057 4228109 5679402 34309607 34764655 THE CENTER IS A COMMUNITY-OWNED ORGANIZATION THAT WILL WORK IN PARTNERSHIP WITH THE COMMUNITIES WE SERVE TO PROMOTE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND FAMILES IN SOUTHEASTERN COLORADO. false false 33478008 44579803 The Medical Center operates as an acute-care hospital and long-term care nursing home and PROVIDes inpatient, outpatient, and emergency HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF RACE AND INSURANCE. 33478008 true true false false false false false false false true true false false false true true true false false false false false false false false false true true false false true false false false false false true false true false false false false false false false false false false true X 269 0 541 true false false false false false false false false false false false false false false false X 11 11 true true false false false false false false false false false true true true true true true true true false X JANETTE BENDER 7193836001 1100 CARSON AVENUE la junta CO 81050 Robert W Blair 1.0 X X 0 0 0 Thomas C Brown 1.0 X X Jim Clawson 1.0 X X Ron Davis 1.0 X H Randolph Frank MD 1.0 X Evan Gamboa 1.0 X Margie Gardner 1.0 X Sylvia Gobin 1.0 X Dale L Leighty 1.0 X Bill Schmidt 1.0 X Richard A Shand MD 1.0 X Lynn Crowell 40.0 X 218958 50886 Janette Bender 40.0 X 136092 16684 Carrie Cutrell 40.0 X 123287 25412 Michael Morley 40.0 X 860279 1801 Jesus Carale 40.0 X 508247 26341 Thomas M Jackson 40.0 X 300954 26200 Kent E Gay 40.0 X 288462 18471 Amar Jetty 40.0 X 210683 35726 2646962 0 201521 12 false true false QUORUM HEALTH RESOURCES PO BOX 305172 DPT 7 NASHVILLE TN 372305172 MANAGEMENT FEES 592234 MICHAEL MARTINO 622 CARSON AVENUE LA JUNTA CO 81050 PHYSICIAN CONTRACTED 499470 TRANE FILE 56718 LOS ANGELES CA 900746718 HVAC REPAIR 421996 DELTA LOCUM PO BOX 202940 DALLAS TX 753202056 CONTRACT LABOR 330455 GE HEALTHCARE 20225 WATERTOWER BLVD BROOKFIELD WI 53045 MAINTENANCE CONTRACT 257566 15 59194 725 59194 PATIENT SERVICE REVENUE 900099 44286585 44286585 44286585 89064 89064 0 0 221023 120378 100645 100645 100645 2750724 60635 2750724 58910 1725 1725 1725 0 0 90051 56413 33638 33638 CAFETERIA 900099 135837 135837 MEDICAL RECORDS 900099 15165 15165 MISCELLANEOUS INCOME 900099 7933 7933 158935 44729786 44579803 90789 0 0 0 0 3131057 2543658 587399 0 15590508 12370421 3220087 371329 303201 68128 3613320 3111123 502197 0 586377 469102 117275 46222 36978 9244 42000 33600 8400 0 0 0 6904327 2893065 4011262 0 5288565 4170304 1118261 0 0 420266 312137 108129 0 0 0 26216 20973 5243 0 1783655 1426924 356731 0 BAD DEBT EXPENSE 3059028 3059028 REPAIRS & MAINTENANCE 1166673 933338 233335 OTHER OPERATING EXPENSES 1019767 815814 203953 UTILITIES 1222928 978342 244586 44272238 33478008 10794230 0 2554272 1239924 4962067 3729663 0 0 4289953 6021012 0 0 0 0 0 0 1304165 1594109 655169 655980 52936638 27874695 24129086 25061943 15175 1507191 0 0 0 0 0 0 627829 634235 38537716 40444057 3697331 4916483 0 0 0 0 0 0 0 0 0 0 462990 685872 0 0 67788 77047 4228109 5679402 X 33749566 34207467 0 0 560041 557188 34309607 34764655 38537716 40444057 X 457548 -2500 X false true false X false X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 560041 -2853 557188 563460 -3419 560041 1.00000 true false 9546 9546 29678220 11142424 18535796 867602 595829 271773 20665003 16136442 4528561 1716267 1716267 25061943 0 DEFERRED COMP PLAN LIABILITY 77047 77047 44729786 44272238 457548 -7624 5124 -2500 455048 44847664 -7624 159008 151384 44696280 33506 33506 44729786 44392616 120378 120378 44272238 44272238 PART V, Line 4 The Medical Center is the sole beneficiary of the Bertha Elrod Copeland and James Evan Copeland Hospital Trust (the Trust), a charitable trust whose principal is to be held in perpetuity. Assets of the Trust are invested and administered by a trustee and distributions are made to the Medical Center. The use of the distributions received from the Trust is restricted to the purchase of equipment. PART X, LINE 2 THE MEDICAL CENTER DOES NOT BELIEVE IT HAS ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. PART XII, LINE 2D THE 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 4B THE 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 2D RENTAL EXPENSE OF $120,378 WAS RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN. true true true X true X true true true false true true 1411466 1394943 131564 0.00040 9565242 4357836 5207406 0.12640 0 0 0 10976708 5752779 5338970 0.12680 4751 0 4751 0.00000 0 0 0 592705 449132 143573 0.00000 0 0 0 11968 0 11968 0.00030 609424 449132 160292 0.00030 11586132 6201911 5499262 0.12710 0 0 0 0 0 0 0 0 0 2000 2000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2000 0 2000 true 3059028 0 11040458 10668364 372094 X true NONE NONE 0.00000 0.00000 0.00000 1 1 ARKANSAS VALLEY REGIONAL MEDICAL CENTER

1100 CARSON AVENUE LA JUNTA CO 81050

X X X Long-term Nursing ARKANSAS VALLEY REGIONAL MEDICAL CENTER 1 true false true 250. true X true true X X X X X X true X X true X X X X X X true X false false PART VI, SUPPLEMENTAL INFORMATION Schedule 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/A X false false false false false false false true false Lynn Crowell 187074 15000 16884 5238 45648 269844 Janette Bender 126092 10000 9507 7177 152776 Michael Morley 500001 360278 1801 862080 Jesus Carale 341016 167231 16500 9841 534588 Thomas M Jackson 300000 954 22000 4200 327154 Kent E Gay 288462 16739 1732 306933 Amar Jetty 210683 33000 2726 246409 PART I, LINE 7 The physician contracts allow for a QUARTERLY BONUS IF THEIR RELATIVE VALUE UNITS charged exceed quarterly benchmark standards. DALE LEIGHTY BOARD MEMBER 753750 CD'S HELD AT BANK false BOB BLAIR BOARD MEMBER 682097 CD'S HELD AT BANK false PART IV, LINE 1 DALE 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 2 BOB 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. SUPPLEMENTAL INFORMATION Part VI, Section A, line 3 The organization contracts with Quorum Health Resources, A healthcare management company, to provide specialized healthcare services. The CEO is an employee of the healthcare management company. The board of directors works in conjunction with the management company and the board has ultimate authority and responsibility for the organization. PART VI, SECTION B, LINE 11B THE 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)