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COLORADO WEST HEALTHCARE SYSTEM: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COLORADO WEST HEALTHCARE SYSTEM (EIN 84-0469270)
Tax period
2011-05-01 to 2012-04-30
Filed
2013-03-13
IRS object ID
201340729349300224
Schema version
2011v1.2
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)
Timestamp2013-03-13T14:10:30-07:00Timestamp
Tax Period End Date2012-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHADWICKSTEINKIRCHNERDAVIS & CO PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1225 NORTH 5TH STREET SUITE 401AddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012645ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN840469270EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLORADO WEST HEALTHCARE SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLONameControl
Phone9702566321Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWESLEY WHITEName
TitleCHIEF FINANCIAL OFFICERTitle
Phone9702566321Phone
Date Signed2013-01-21DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
NameORVILLE F PETERSEN CPAName
Phone9702453000Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHRIS THOMASNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code81501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts79278133GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.YOURCOMMUNITYHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileCOStateLegalDomicile
Activity Or Mission DescriptionTHE 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.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees680TotalNbrEmployees
Total Nbr Volunteers122TotalNbrVolunteers
Total Gross UBI168554TotalGrossUBI
Contributions Grants Prior Year53029ContributionsGrantsPriorYear
Contributions Grants Current Year382462ContributionsGrantsCurrentYear
Program Service Revenue Prior Year70616577ProgramServiceRevenuePriorYear
Program Service Revenue CY76640907ProgramServiceRevenueCY
Investment Income Prior Year50438InvestmentIncomePriorYear
Investment Income Current Year914062InvestmentIncomeCurrentYear
Other Revenue Prior Year871597OtherRevenuePriorYear
Other Revenue Current Year413835OtherRevenueCurrentYear
Total Revenue Prior Year71591641TotalRevenuePriorYear
Total Revenue Current Year78351266TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year30824918SalariesEtcPriorYear
Salaries Etc Current Year34723454SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year38808076OtherExpensePriorYear
Other Expenses Current Year39272532OtherExpensesCurrentYear
Total Expenses Prior Year69632994TotalExpensesPriorYear
Total Expenses Current Year73995986TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1958647RevenuesLessExpensesPriorYear
Revenues Less Expenses CY4355280RevenuesLessExpensesCY
Total Assets BOY33692434TotalAssetsBOY
Total Assets EOY37977618TotalAssetsEOY
Total Liabilities BOY17731060TotalLiabilitiesBOY
Total Liabilities EOY17412495TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15961374NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY20565123NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF COLORADO WEST HEALTHCARE SYSTEM AND COMMUNITY HOSPITAL IS TO IMPROVE THEMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense49273152Expense
Revenue78341508Revenue
DescriptionCOMMUNITY HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, URGENT, PRIMARY AND HOME HEALTH CARE SERVICES TO COMMUNITIES IN WESTERN COLORADO. DURING FISCAL YEAR 2012, COMMUNITY HOSPITAL HAD 5,953 PATIENT DAYS, 15,262 EMERGENCY ROOM VISITS, 12,308 URGENT CARE VISITS, 16,129 PRIMARY CARE VISITS, AND PERFORMED 4,717 SURGERIES.Description
Total Program Service Expense49273152TotalProgramServiceExpense
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 EndowmentsfalseTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvesttrueReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiestrueFundraisingActivities
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 DQPtrueLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationtrueBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshptrueOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096136NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees680NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
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
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
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 BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
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 VenturetrueInvestmentInJointVenture
Written Policy Or ProcedurefalseWrittenPolicyOrProcedure
States Where Copy Of Return Is FiledCOStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9702566321TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREET GRANDAddressLine1
CityJUNCTIONCity
StateCOState
ZIP Code81501ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (24 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
AMIR BESHAI MD
BOARD MEMBER1.00X000
MONTY LANGSTON MD
BOARD MEMBER1.00X000
LARRY KENT
BOARD MEMBER1.50X000
DAVID VARGO
BOARD MEMBER1.50X000
SCOTT MERCIER
CHAIRMAN1.50X000
SAM STARRITT
BOARD MEMBER1.00X000
TAREK ARJA
BOARD MEMBER1.50X000
JON MARASCHIN
BOARD MEMBER1.50X000
WILLIAM MOELLER
BOARD MEMBER1.50X000
R CURT HATCH
VICE CHAIRPERSON/TREASURER1.50000X
MICHAEL DANIELS
SECRETARY1.50000X
SALLY GAGLIONE
CHIEF OF STAFF1.50000X
CHRISTIAN THOMAS
CEO40.0051047600X
ELIZABETH BRICKER
CHIEF NURSING OFFICER40.0014407806318X
WESLEY WHITE
CHIEF FINANCIAL OFFICER401712326846X
DAVID MURRAY
CHIEF COMPLIANCE OFFICER401354047380X
DONALD NICOLAY
CHIEF MEDICAL OFFICER401770787452X
DEBORA RIGGLE
VP OF ANCILLARY SERVICES401179036131X
CONNIE MACK
VP BUSINESS DEVELOPMENT40829186185X
JULIE MILLS
ER PHYSICIAN362391366030X
MARC BREEN
ER PHYSICIAN362544314807X
SCOTT VINCENT
ER PHYSICIAN362480877311X
FILIP BABNIC
HOSPITALIST402335436142X
DEBRA J SMITH
ER PHYSICIAN362334145401X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2547700TotalReportableCompFromOrg
Total Other Compensation70003TotalOtherCompensation
Number Individuals GT100 K11NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcestrueCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
COMMUNITY ANESTHESIA CONSULTANTS
2754 COMPASS DR STE 170GRAND JUNCTIONCO81506PHYSICIAN SERVICES983695
QUORUM HEALTH RESOURCES
105 CONTINENTAL PLBRENTWOODTN37027MANAGEMENT799195
SIEMENS MEDICAL SOLUTIONS
51 VALLEY STREAM PKWYMALVERNPA19355HEALTHCARE PRODUCTS967111
CARDINAL HEALTH PHARMACEUTICAL DIST
4875 FLORENCE STDENVERCO80239PHARMACEUTICAL SUPPLY1175692
CARDINAL HEALTH MEDICAL PRODUCTS
525 W MONROE 7TH FLRCHICAGOIL60661HEALTHCARE PRODUCTS1516522
FieldValueIRS element (for citing)
Number Of Contractors GT100 K65NumberOfContractorsGT100K
All Other Contributions382462AllOtherContributions
Total Contributions382462TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code622000BusinessCode
Total Revenue Column76640907TotalRevenueColumn
FieldValueIRS element (for citing)
Total Program Service Revenue76640907TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column117720TotalRevenueColumn
Exclusion$117,720ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other1704000Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other907658Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other796342Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column796342TotalRevenueColumn
Exclusion$796,342ExclusionAmount
FieldValueIRS element (for citing)
Gross Income Fundraising Events28967GrossIncomeFundraisingEvents
Fundraising Direct Expenses19209FundraisingDirectExpenses

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column9758TotalRevenueColumn
Exclusion$9,758ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
OTHER REVENUE622000-211-211
INVESTMENT IN LLC561490168554168554
EQUITY IN SUBSIDIARIES INCOME561440235734235734
FieldValueIRS element (for citing)
Total Other Revenue404077TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column78351266TotalRevenueColumn
Related Or Exempt Function Income76876430RelatedOrExemptFunctionIncome
Unrelated Business Revenue168554UnrelatedBusinessRevenue
Exclusion$923,820ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total643755Total
Program Services0ProgramServices
Management And General643755ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total26763559Total
Program Services19512570ProgramServices
Management And General7250989ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total254424Total
Program Services254424ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total5093233Total
Program Services5067617ProgramServices
Management And General25616ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1968483Total
Program Services1676729ProgramServices
Management And General291754ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total799194Total
Program Services0ProgramServices
Management And General799194ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total134720Total
Program Services0ProgramServices
Management And General134720ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total118300Total
Program Services0ProgramServices
Management And General118300ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3498641Total
Program Services2462600ProgramServices
Management And General1036041ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total381114Total
Program Services0ProgramServices
Management And General381114ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total3367054Total
Program Services1740633ProgramServices
Management And General1626421ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total1902515Total
Program Services1894978ProgramServices
Management And General7537ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total156924Total
Program Services42356ProgramServices
Management And General114568ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total585333Total
Program Services365835ProgramServices
Management And General219498ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1726766Total
Program Services1726766ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total735642Total
Program Services-6937ProgramServices
Management And General742579ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
BAD DEBTS7539396075393960
COLLECTION COSTS53405005340500
EQUIPMENT LEASE/RENT64157764157700
MEDICAL SUPPLIES103649061036490600

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total6786400Total
Program Services3529098ProgramServices
Management And General3257302ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total73995986Total
Program Services49273152ProgramServices
Management And General24722834ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY4942506BOY
EOY6857812EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY815152BOY
EOY815061EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY8264880BOY
EOY9224161EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY102811BOY
EOY102811EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY87411BOY
EOY1226033EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2785941BOY
EOY2569862EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY344714BOY
EOY326381EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis40638316LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec26730455LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY13808581BOY
EOY13907861EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY2434862BOY
EOY2581682EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY105576BOY
EOY365954EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33692434BOY
EOY37977618EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY7398301BOY
EOY8287275EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY1104101BOY
EOY718924EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
EOY8123882EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY8946214BOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY282444BOY
EOY282414EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY17731060BOY
EOY17412495EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15961374BOY
EOY20565123EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15961374BOY
EOY20565123EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33692434BOY
EOY37977618EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses4355280ReconcilationRevenueExpenses
Reconcilation Other Changes248469ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

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

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6338909OtherCostOrOtherBasis
Book Value6338909BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10422350OtherCostOrOtherBasis
Depreciation8248057Depreciation
Book Value2174293BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis22953889OtherCostOrOtherBasis
Depreciation18178675Depreciation
Book Value4775214BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis923168OtherCostOrOtherBasis
Depreciation303723Depreciation
Book Value619445BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings13907861TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENT IN DOCTOR'S CLINIC BUILDING1862454C
INVESTMENT IN COMMUNITY HEALTH PROVIDERS ORG10226C
INVESTMENT IN FCSDCS LLC805018C
INVESTMENT IN PHYSICIAN'S CHOICE REAL ESTATE-106016C
OTHER INVESTMENTS10000C
FieldValueIRS element (for citing)
Total Of Book Value Program Related2581682TotalOfBookValueProgramRelated

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
DescriptionCURRENT RELATED COMPANY PAYABLEDescription
Amount$282,414Amount
FieldValueIRS element (for citing)
Total Of Amounts282414TotalOfAmounts
Total Revenue78351266TotalRevenue
Total Expenses73995986TotalExpenses
Excess Or Deficit For Year4355280ExcessOrDeficitForYear
Other-$120,332OtherAmount
Total Adjustments-120332TotalAdjustments
Excess Or Deficit Per FS4234948ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt70685606TotRevenueEtcAuditedFinclStmt
Revenue Subtotal70685606RevenueSubtotal
Other Revenues Not Included7665660OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt7665660RevenueNotRptdOnFinStmt
Total Revenue Per Form99078351266TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt66450656TotExpensesEtcAuditedFinclStmt
Expenses Subtotal66450656ExpensesSubtotal
Other Expenses Not Included7545330OtherExpensesNotIncluded
Expenses Not Rptd On Fin Stmt7545330ExpensesNotRptdOnFinStmt
Total Expenses Per Form99073995986TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (6 entries)

IdentifierIdentifierExplanationExplanation
Pt XI Line 8BOOK-TAX DIFFERENCE IN SUBSIDIARIES INCOME (116,506)
NET FUNDRAISING INCOME (9,758) FUNDRAISING INCOME RECLASSIFIED 5,934
Pt XII Line 4bBOOK-TAX DIFFERENCE IN SUBSIDIARIES INCOME 116,506
BAD DEBT EXPENSE 7,539,396 NET FUNDRAISING INCOME 9,758
Pt XIII Line 4bBAD DEBT EXPENSE 7,539,396
FUNDRAISING INCOME RECLASSIFIED 5,934

Schedule G IRS990ScheduleG

Events Information EventsInformation

FieldValueIRS element (for citing)
Name Of Event1TOUR OF THE VALLEYNameOfEvent1
Gross Receipts Event123887GrossReceiptsEvent1
Gross Revenue Event123887GrossRevenueEvent1
Non Cash Prizes Event14608NonCashPrizesEvent1
Rent Facility Costs Event16917RentFacilityCostsEvent1
Food And Beverage Event12387FoodAndBeverageEvent1
Other Direct Expenses Event12954OtherDirectExpensesEvent1
Name Of Event2MAGNET 5KNameOfEvent2
Gross Receipts Event25080GrossReceiptsEvent2
Gross Revenue Event25080GrossRevenueEvent2
Non Cash Prizes Event21311NonCashPrizesEvent2
Food And Beverage Event246FoodAndBeverageEvent2
Other Direct Expenses Event2986OtherDirectExpensesEvent2
Gross Receipts Total28967GrossReceiptsTotal
Gross Revenue Total Events28967GrossRevenueTotalEvents
Non Cash Prizes Total Events5919NonCashPrizesTotalEvents
Rent Facility Costs Total Events6917RentFacilityCostsTotalEvents
Food And Beverage Total Events2433FoodAndBeverageTotalEvents
Other Direct Expenses Total Events3940OtherDirectExpensesTotalEvents
Direct Expense Summary Events19209DirectExpenseSummaryEvents
Net Income Summary9758NetIncomeSummary

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense2051448TotalCommunityBenefitExpense
Direct Offsetting Revenue1209439DirectOffsettingRevenue
Net Community Benefit Expense842009NetCommunityBenefitExpense
Percent Of Total Expense0.01140PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense9124169TotalCommunityBenefitExpense
Direct Offsetting Revenue6296633DirectOffsettingRevenue
Net Community Benefit Expense2827536NetCommunityBenefitExpense
Percent Of Total Expense0.03820PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense2029961TotalCommunityBenefitExpense
Direct Offsetting Revenue415035DirectOffsettingRevenue
Net Community Benefit Expense1614926NetCommunityBenefitExpense
Percent Of Total Expense0.02180PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense13205578TotalCommunityBenefitExpense
Direct Offsetting Revenue7921107DirectOffsettingRevenue
Net Community Benefit Expense5284471NetCommunityBenefitExpense
Percent Of Total Expense0.07140PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense35050TotalCommunityBenefitExpense
Direct Offsetting Revenue3730DirectOffsettingRevenue
Net Community Benefit Expense31320NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense1861TotalCommunityBenefitExpense
Net Community Benefit Expense1861NetCommunityBenefitExpense
Percent Of Total Expense0.00000PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense217341TotalCommunityBenefitExpense
Net Community Benefit Expense217341NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense254252TotalCommunityBenefitExpense
Direct Offsetting Revenue3730DirectOffsettingRevenue
Net Community Benefit Expense250522NetCommunityBenefitExpense
Percent Of Total Expense0.00330PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense13459830TotalCommunityBenefitExpense
Direct Offsetting Revenue7924837DirectOffsettingRevenue
Net Community Benefit Expense5534993NetCommunityBenefitExpense
Percent Of Total Expense0.07470PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$2,914,384BadDebtExpenseAmount
Amount Reimbursed By Medicare13327649AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16928977CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-3601328MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
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 Line1COMMUNITY HOSPITALBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedfalseCHNAConducted
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent40FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent250FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
State RegulationXStateRegulation
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Permit Report To Credit AgencyXPermitReportToCreditAgency
Permit LawsuitXPermitLawsuit
Permit Lien On ResidenceXPermitLienOnResidence
Collection ActivitiestrueCollectionActivities
Report To Credit AgencyXReportToCreditAgency
LawsuitXLawsuit
Lien On ResidenceXLienOnResidence
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Other Actions TakenXOtherActionsTaken
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargestrueGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities9NumberOfOtherFacilities

Other Facilities OtherFacilities (9 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
FIRST CHOICE SAME DAY SURGICAL CENTER
2596 F ROADGRAND JUNCTIONCO81505OUT-PATIENT SURGICAL SERVICES
GRAND VALLEY PRIMARY CARE
603 28 1/4 ROADGRAND JUNCTIONCO81506PRIMARY PHYSICIAN CARE
THERAPY WORKS AT COMMUNITY HOSPITAL
2004 N 12TH STREETGRAND JUNCTIONCO81501REHABILITATION PROGRAMS
OCCUPATIONAL HEALTH
2004 N 12TH STREETGRAND JUNCTIONCO81501EMPLOYMENT RELATED EXAM SERVICES
GRAND VALLEY URGENT CARE
1060 ORCHARD SUITE NGRAND JUNCTIONCO81501URGENT MEDICAL SERVICES
EAPBEHAVIORAL HEALTH SERVICES
1300 N 7TH STREET SUITE 4GRAND JUNCTIONCO81501COUNSELING SERVICES
HOME HEALTH
2021 N 12THGRAND JUNCTIONCO81501HOME CARE SERVICES
ORCHARD PHARMACY
1060 ORCHARD AVEGRAND JUNCTIONCO81501PHARMACY
COLORADO MESA UNIVERSITY STUDENT HEALTH CENTER
1060 ORCHARD AVE SUITE NGRAND JUNCTIONCO81501STUDENT MEDICAL SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (27 entries)

IdentifierIdentifierExplanationExplanation
Pt III Line 4THE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON FACTORS
SURROUNDING THE CREDIT RISK OF SPECIFIC CUSTOMERS, HISTORICAL TRENDS AND OTHER INFORMATION.
Pt III Line 8APPROXIMATELY 75% OR $2,700,996 OF THE MEDICARE SHORTAGE SHOULD BE TREATED
AS COMMUNITY BENEFIT.
Pt III Line 9bPART OF THE HOSPITAL'S FINANCIAL ASSISTANCE AND CHARITY CARE WRITTEN
POLICY PROVIDES FOR A FINANCIAL COUNSELOR TO MEET WITH ALL UNINSURED PATIENTS PRIOR TO
DISCHARGE FROM THE HOSPITAL.
Pt VI Line 2COMMUNITY HOSPITAL USES THE STRATEGIC PLAN PROVIDED 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.
Pt VI Line 3PART 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.
Pt VI Line 4THE 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.
Pt VI Line 5COMMUNITY HOSPITAL EXPANDED ITS SERVICES TO MEET COMMUNITY
NEEDS WITH THE OPENING OF GRAND VALLEY URGENT CARE AND GRAND VALLEY PRIMARY
CARE. DURING THE 2010 FISCAL YEAR, THREE PRIMARY PHYSICIANS WERE RECRUITED
TO HELP MEET THE SHORTAGE OF PRIMARY CARE PHYSICIANS IN MESA COUNTY. THE
HOSPITAL ALSO CREATED PROGRAMS WITH SEVERAL MEDICAL SCHOOLS, UNIVERSITIES,
COLLEGES AND TRADE SCHOOLS TO PROVIDE CLINICAL ROTATION EXPERIENCE
WITH THEIR STUDENTS INCLUDING; PHYSICIANS, NURSES, AND ANCILLARY
SUPPORT OCCUPATIONS.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
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 OrgtrueCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (9 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
CHRISTIAN THOMAS
510476510476
ELIZABETH BRICKER
1440781458251747
WESLEY WHITE
1712321729871755
DONALD NICOLAY
17707818310824103620
JULIE MILLS
23913624273025501044
MARC BREEN
25443126088325163936
SCOTT VINCENT
24808725446624433936
FILIP BABNIC
23354323699724101044
DEBRA J SMITH
23341424115523405401

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPt I Line 6aIdentifier
ExplanationTHE CEO'S COMPENSATION INCLUDES AN ELIGIBLE BONUS BASED ON A SCORECARD OF THIRTEEN METRICS, ONLY ONE OF WHICH IS BASED ON THE EARNINGS OF THE ORGANIZATION.Explanation

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonDR LOU BAIRNamePerson
Purpose Of LoanLEGAL SETTLEMENTPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$164,110OriginalPrincipalAmount
Balance Due102811BalanceDue
DefaulttrueDefault
Approved By BoardtrueApprovedByBoard
Written AgreementtrueWrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due102811TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV (6 entries)

RelationshipRelationshipAmount Of TransactionAmountOfTransactionDescription Of TransactionDescriptionOfTransactionSharing Of RevenuesSharingOfRevenues
MARY THIBAULT
SISTER OF CCO500HONORARIUM TO SPEAK AT FUNCTIONfalse
WESTERN ORTHOPEDICS & SPORTS MEDICINE
PARTNER FORMER BOARD MEMBER146000PAYMENTS FOR PHYSICIAN SERVICESfalse
SURGICAL ASSOCIATES
PARTNER FORMER BOARD MEMBER108800PAYMENTS FOR PHYSICIAN SERVICESfalse
MESA WOMEN'S HEALTH CARE
PARTNER FORMER BOARD MEMBER54900PAYMENTS FOR PHYSICIAN SERVICESfalse
ASPEN LEAR INTERNAL MEDICINE
PARTNER FORMER BOARD MEMBER37005PAYMENTS FOR PHYSICIAN SERVICESfalse
COMMUNITY ANESTHESIA
PARTNER BOARD MEMBER914948PAYMENTS FOR PHYSICIAN SERVICESfalse

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (32 entries)

IdentifierIdentifierExplanationExplanation
Pt VI, Line 3THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH QUORUM HEALTH
RESOURCES.
Pt VI, Line 11aTHE 990 IS PREPARED BY THE HOSPITAL'S INDEPENDENT CPA FIRM AND REVIEWED
BY THE HOSPITAL'S ACCOUNTING STAFF AND ADMINISTRATION, INCLUDING THE CEO, CFO,
AND COMPLIANCE OFFICER. A PRELIMINARY DRAFT IS PRESENTED TO THE EXECUTIVE
FINANCE COMMITTEE OF 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.
Pt VI, Line 12cTHE 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.
Pt VI, Line 15COMMUNITY HOSPITAL IS A QUORUM HEALTH RESOURCES MANAGED HOSPITAL
WHEREBY THE CEO IS AN EMPLOYEE OF THE MANAGMENT 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.
Pt VI, Line 19GOVERNING DOCUMENTS, POLICIES AND PROCEDURES, AND AUDITED FINANCIAL
Form 990, Part IX, Line 24fPHYSICIAN FEES 2716388. 2716388. OTHER EXPENSES 4070012. 812710. 3257302.
STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST ON A CASE
BY CASE BASIS.
Pt XIPRIOR PERIOD ADJUSTMENT FOR INVESTMENT IN HEALTHCARE
MANAGEMENT LLC 213,759
PRIOR PERIOD ADJUSTMENT FOR FUNDRAISING CLEARING ACCOUNTS 34,710

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode
FieldValueIRS element (for citing)
EIN742576856EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateCOLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusIPublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1COLORADO WEST HEALTHCARE SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgfalseControlledOrg

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PHYSICIANS CHOICE REAL ESTATE LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12012 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode
FieldValueIRS element (for citing)
EIN841601063EIN
Primary ActivityREAL ESTATE COMMERCIAL RENTALPrimaryActivity
Legal Domicile StateCOLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1COLORADO WEST HEALTHCARE SYSTEMBusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeRELATEDPredominantIncomeType
Share Of Total Income64558ShareOfTotalIncome
Share Of EOY Assets1902854ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnerfalseGeneralOrManagingPartner
Percentage Ownership0.54710PercentageOwnership

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
DOCTOR'S CLINIC BUILDING INC
1060 ORCHARD AVEGRAND JUNCTIONCO81501840507943REAL ESTATE RENTALCOCOLORADO WEST HEALTHCARE SYSTEMC121004820847131.00000
COMMUNITY HEALTH PROVIDERS ORGANIZATION INC
2021 N 12TH STGRAND JUNCTIONCO81501841081855INSURANCECOCOLORADO WEST HEALTHCARE SYSTEMC300311890.50000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (8 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
COMMUNITY HOSPITAL FOUNDATION
c292123CASH PAID
DOCTORS CLINIC BUILDING INC
j272527CASH PAID
PHYSICIANS CHOICE REAL ESTATE LLC
j493756CASH PAID
COMMUNITY HOSPITAL FOUNDATION
m
DOCTORS CLINIC BUILDING INC
n471324CASH PAID
DOCTORS CLINIC BUILDING INC
o1910
COMMUNITY HOSPITAL FOUNDATION
p1162
PHYSICIANS CHOICE REAL ESTATE LLC
r191906