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REHABILITATION SVCS PART I LINE 3C 1. PHILOSOPHY: IN KEEPING WITH SIERRA VISTA REGIONAL HEALTH CENTER'S VISION TO BE A LEADER IN IMPROVING THE COMMUNITY'S HEALTH CARE STATUS, IT IS CONSIDERED NOT ONLY NECESSARY BUT ALSO APPROPRIATE TO MAKE ADJUSTMENT TO PATIENT CARE CHARGES UNDER CERTAIN CIRCUMSTANCES. IT IS NOT THE INTENT OF THIS POLICY TO RESTRICT THIS PRACTICE, BUT TO ESTABLISH CLEAR GUIDELINES BY WHICH TO ACCOMPLISH THE TASK. 2. DEFINITIONS: BECAUSE ADJUSTMENTS CAN OCCUR FOR SEVERAL REASONS, IT IS NECESSARY TO DEFINE CERTAIN TYPES OF ADJUSTMENTS. A. UNCOMPENSATED CARE: UNCOMPENSATED CARE/CHARITY CARE IS DEFINED AS SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE TO PAY BASED ON INCOME LEVEL, FINANCIAL ANALYSIS, DEMOGRAPHIC INDICATORS AND/OR FURTHER HEALTHCARE NEEDS BASED ON DIAGNOSIS OR CATASTROPHIC CIRCUMSTANCES. B. SELF -PAY DISCOUNT: A PAYMENT ADJUSTMENT MAY OCCUR WHEN THE PATIENT AGREES TO MAKE IMMEDIATE OR PROMPT PAYMENT IN RETURN FOR A REDUCTION IN THE AMOUNT DUE. C. PROCESS: ALL ADJUSTMENTS OF PATIENT CARE CHARGES REQUESTED SHALL BE APPROVED BY PERSONS DESIGNATED AS FOLLOWS: - $25,000 + CFO - $5,000 TO $24,999 DIRECTOR OF REVENUE MANAGEMENT - $101 TO $4999 ASSISTANT MANAGER OF A/R - $1.00 TO $100 A/R STAFF - SELF PAY DISCOUNTS. : A SELF PAY DISCOUNT OF 50% WILL BE APPLIED AT THE TIME OF BILLING. D. PLEASE NOTE ON SELF PAY AFTER INSURANCE, THERE IS NO DISCOUNT ON DEDUCTIBLES OR CO-PAYS AS THIS IS PART OF THE CONTRACTUAL RELATIONSHIP BETWEEN THE PAYER AND THE SUBSCRIBER. ONLY COINSURANCE BALANCES ARE ELIGIBLE FOR DISCOUNTS. E. A COINSURANCE DISCOUNT OF 30% WILL BE APPLIED AT THE TIME OF BILLING. F. UNCOMPENSATED CARE - CHARITY CARE POLICY REQUEST FOR CHARITY CARE (FINANCIAL ASSISTANCE): FINANCIAL ASSISTANCE REQUEST MAY BE MADE BY THE PATIENT, OUTSIDE HEALTH CARE PROVIDERS, COMMUNITY OR RELIGIOUS GROUPS, SOCIAL SERVICES, FAMILY MEMBERS, AND SVRHC PERSONNEL. THE FINANCIAL COUNSELOR WILL KEEP ON FILE (AND FOR REFERENCE) AN ANNUAL "POVERTY GUIDELINES" AS PUBLISHED BY THE FEDERAL REGISTRY. 1. ELIGIBILITY CONSIDERATIONS FOR FINANCIAL ASSISTANCE: - FINANCIAL ASSISTANCE IS SECONDARY TO ALL OTHER FINANCIAL RESOURCES AVAILABLE TO THE PATIENT INCLUDING INSURANCE, GOVERNMENT PROGRAMS, THIRD PARTY LIABILITY, AND PERSONAL ASSETS. - FULL FINANCIAL ASSISTANCE WILL BE PROVIDED TO A PATIENT/GUARANTOR WITH A GROSS FAMILY INCOME 200% OF THE FEDERAL POVERTY GUIDELINES. DEPENDENT UPON THE ELIGIBILITY CRITERIA FOR THE AHCCCS PROGRAMS - MOST PROGRAMS AHCCCS ELIGIBILITY 100% FPL (FEDERAL POVERTY LEVEL) - A PATIENT /GUARANTOR WILL BE GIVEN PARTIAL FINANCIAL ASSISTANCE BASED ON HIS OR HER INCOME LEVEL UP TO 800% OF THE POVERTY GUIDELINES. - COSMETIC AND OTHER SERVICES THAT ARE NOT MEDICALLY NECESSARY ARE NOT ELIGIBLE FOR FINANCIAL ASSISTANCE - OTHER CATASTROPHIC CIRCUMSTANCES MAY BE CONSIDERED IN THE CHARITY DECISION. - AHCCCS ELIGIBILITY WITHIN 60 DAYS OF SERVICE WILL BE PROOF OF INDIGENCE - MEDICAL INDIGENCE -EVALUATE ADDITIONAL CIRCUMSTANCE - MEDICAL BILLS (COMBINED) GREATER THAN 1 YEAR TIMES ANNUAL INCOME - CATASTROPHIC EVENT/DIAGNOSIS - ASSET AVAILABILITY - PATIENTS/GUARANTORS WILL BE ASKED TO COMPLETE AN APPLICATION FOR ASSISTANCE AND PROVIDE PROOF OF INCOME SUCH AS EMPLOYER PAYMENTS STUBS, BANK STATEMENTS AND/OR TAX RETURN. 2. DETERMINATION: - PATIENTS/GUARANTORS WILL BE NOTIFIED OF FINANCIAL ASSISTANCE DETERMINATION BY PHONE OR IN WRITING. - PATIENTS/GUARANTORS MAY APPEAL A FINANCIAL ASSISTANCE DETERMINATION BY PROVIDING ADDITIONAL INFORMATION SUCH AS INCOME VERIFICATION OR AN EXPLANATION OF EXTENUATING CIRCUMSTANCES TO THE FINANCIAL COUNSELOR FOR REVIEW. - SVRHC'S DECISION TO PROVIDE FINANCIAL ASSISTANCE IN NO WAY AFFECTS THE PATIENTS/GUARANTOR FINANCIAL OBLIGATION TO THEIR PHYSICIAN OR OTHER HEALTH CARE PROVIDERS. PART I LINE 6A THE ORGANIZATION DID NOT PREPARE A COMMUNITY BENEFIT REPORT FOR THIS TAX YEAR, BUT HAS DONE ONE IN THE PAST AND IS SCHEDULED TO COMPLETE ONE IN FY 12. PART I LINE 7 COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE IS PRIMARILY THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF SCHEDULE H. OTHER COSTS COME FROM OUR FY2011 COST REPORT. BAD DEBT EXPENSE OF $4,192,925 WAS SUBTRACTED FROM TOTAL EXPENSES FOR THE DENOMINATOR IN DETERMINING THE PERCENTAGES IN COLUMN F. PART II COMMUNITY BUILDING ACTIVITIES SIERRA VISTA REGIONAL HEALTH CENTER'S MISSION REFLECTS THE PHILOSOPHY THAT WE WILL PROVIDE HEALTHCARE EDUCATION, RESOURCES, AND PROGRAMS TO CITIZENS WITHIN THE COMMUNITY IN ADDITION TO THOSE WHO ARE UNDERINSURED AND UNINSURED. THIS TYPE OF COMMUNITY BENEFIT INCLUDES THE COST OF TRADITIONAL CHARITY CARE, UNPAID PORTIONS OF AHCCCS, AND SUPPLIES OR STAFF TIME VOLUNTEERED ON BEHALF OF THE COMMUNITY. THROUGH OUR WELLNESS DEPOT IN THE MALL AT SIERRA VISTA, OUR COMMUNITY BENEFIT COORDINATOR HAS IMPLEMENTED AND HOSTED APPROXIMATELY 133 DIFFERENT HEALTH AND WELLNESS RELATED PROGRAMS AND EVENTS FOR THE PUBLIC. THE OVERWHELMING RESPONSE TO THESE OFTEN FREE EDUCATIONAL SYMPOSIUMS HAS BEEN NOTHING BUT POSITIVE. IN SOME CASES, WE'VE EVEN SAVED LIVES BY RECOGNIZING HIGH BLOOD PRESSURE, SYMPTOMS OF HEART DISEASE, AND TEACHING THE NEW HANDS ONLY METHOD OF CPR. WE KNOW THAT OUR WELLNESS DEPOT HAS A VERY POSITIVE IMPACT WITHIN THE COMMUNITY BECAUSE WE HEAR TIME AND AGAIN HOW THANKFUL THE COMMUNITY IS FOR PROVIDING OUTREACH TO THOSE WHO MAY NOT HAVE REGULAR ACCESS TO HEALTHCARE. THROUGH THE DEPOT, WE'VE TOUCHED ABOUT 25,000 LIVES WITHIN THE LAST TWO YEARS WHICH IS AN INCREDIBLE NUMBER OF PEOPLE WE ARE REACHING. SIERRA VISTA REGIONAL HEALTH CENTER ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE FINANCIALLY VIABLE. THE DEVELOPMENT AND VALUE OF THESE PROGRAMS IS BASED ON A COMMUNITY HEALTH CARE ASSESSMENT PERFORMED BY AN INDEPENDENT COMPANY. ONGOING COMMUNITY OUTREACH PROGRAMS: ADULT HEARING LOSS GROUP ADVANCED DIRECTIVES ALZHEIMER EDUCATIONAL CLASSES ANIMAL THERAPY ARTHRITIS PROGRAMS ARTHRITIS SELF-HELP CLASSES BABY SIGN LANGUAGE CLASSES BETTER BREATHERS CLUB BLOOD PRESSURE CHECKS BODY MASS INDEX BRAIN WAVES CHILD BRAIN DEVELOPMENT BREASTFEEDING 101 CARDIAC & PULMONARY REHABILITATION CHAIR YOGA CHOLESTEROL EDUCATION: KNOW WHAT YOUR NUMBERS MEAN COMPRESSION ONLY CPR CONGESTIVE HEART FAILURE CLASSES DIABETES EDUCATION DIABETES SUPPORT GROUP FLU PRECAUTION PROGRAMS FLU VACCINE CLINICS FOOD DRIVES HEALTHY LIFESTYLE CHOICES HELP WITH MEDICARE HOSPICE BEREAVEMENT GROUP KIDS SPORTS TEAMS 1ST AID KITS KIGONG LIVING WILLS MALL WALKERS PROGRAM MUSIC THERAPY NUTRITION CLASSES FOR CHILDREN OLD MEDICATION DISPOSAL PARISH NURSE PROGRAM PERINATAL GRIEF SUPPORT POSTPARTUM DEPRESSION INFORMATION POTTY TRAINING PRENATAL CLASSES PULMONARY REHABILITATION PULSE OXYGEN TESTS SHINGLES AWARENESS SMART TEEN EATING PROGRAM TOBACCO SUPPORT GROUP SPEAKERS BUREAU STORYTIME STROKE/BRAIN INJURY SUPPORT GROUP SUN SAFETY TELECARE HOME BOUND VICAP SPACE AND SUPPLIES VIRTUAL TOUR KITS FOR ALL SCHOOLS WATER SAFETY WEIGHT MANAGEMENT PROGRAM WELLNESS DEPOT ZUMBA GOLD FOR SENIORS SPECIAL COMMUNITY OUTREACH PROGRAMS: A BUYERS GUIDE TO HOME HEALTHCARE A MATTER OF BALANCE ACUPRESSURE ACUPUNCTURE AQUATIC THERAPY: THE MANY BENEFITS OF WATER BAT EDUCATION BONE MARROW COLLECTION BREAST CANCER AWARENESS CHOLESTEROL TESTING CHRONIC DISEASE MANAGEMENT COLORECTAL CANCER AWARENESS DIGITAL MAMMOGRAPHY EDUCATION EPILEPSY 101 FALL INTO STEP FECAL BLOOD OCCULT TESTING GLUTEN FREE DIET HEALTH FAIRS HEALTHY LIFESTYLE CHOICES HEALTHY LIVING TO 100 HEART HEALTH HEART SAVING CT SCANNING EDUCATION HPV: WHAT EVERY WOMAN SHOULD KNOW HYPNOTHERAPY FOR WEIGHT LOSS, QUITTING SMOKING & DEPRESSION IMMUNIZATION INFORMATION LAUGHTER YOGA LIVING VEGAN/MEATLESS MONDAY LONG TERM CARE PLANNING MEDICAL IDENTITY THEFT MEDITATION MENTAL HEALTH MRSA AWARENESS MRSA FOR PARENTS OSTEOPOROSIS EDUCATIONS PEACEFUL DYING: HOSPICE MONTH RADICAL SELF CARE FOR THE MODERN WOMAN SCIENCE CARE: WHOLE BODY DONATION SENIOR SCAMS SHAKEN BABY SOLAR COOKING STRENGTH TRAINING FOR THE OLDER ADULT STRESS ON YOUR HEART STRESS RELIEF FOR THE HOLIDAYS SURVIVAL STRATEGIES FOR THE HOLIDAYS SURVIVING THE HOLIDAYS WITH HUMOR TICKET TO WORK WHAT IS HOME CARE? WOMEN & HEART DISEASE WOMEN & A PLANT BASED DIET WORK INCENTIVES WITH COCHISEABILITY & SSI EDUCATION SIERRA VISTA REGIONAL HEALTH CENTER, THE LARGEST NONPROFIT MEDICAL CENTER IN SOUTHEASTERN ARIZONA, OFFERS EXTENSIVE GRADUATE MEDICAL EDUCATION AND A RESOURCE MENTOR PROGRAM FOR NURSES, PHYSICIANS, AND OTHER HEALTHCARE PROFESSIONALS. EDUCATIONAL OFFERINGS INCLUDE: - SVRHC IS HOME TO THE ONLY COUNTY-WIDE INTERNAL MEDICINE & FAMILY RESIDENCY PROGRAMS - SVRHC PROVIDES TRAINING AT THE HOSPITAL TO NURSES FROM COCHISE COLLEGE - SVRHC HOSTS NURSING, REHABILITATION, PHARMACY, LABORATORY, DIAGNOSTIC IMAGING STUDENTS - SVRHC PROVIDES HOUSING AND MEALS TO MEDICAL STUDENTS AND RESIDENTS - THE SUMMER VOLUNTEEN PROGRAM PROVIDES REAL WORLD JOB EXPERIENCE AND MENTORING FOR STUDENTS INTERESTED IN PURSUING HEALTHCARE CAREERS COMMUNITY EVENTS THE HOSPITAL SPONSORS ORGANIZATIONS AND EVENTS IN THE COMMUNITY WHICH PROMOTE HEALTHY LIFE STYLES AND/OR DISEASE PREVENTION/INFORMATION. SOME OF THESE INCLUDE: AMERICAN CANCER SOCIETY FORGACH HOUSE (BATTERED WOMEN/CHILDREN) GOOD NEIGHBOR ALLIANCE (MEN'S SHELTER) UNITED WAY MARCH OF DIMES JUST KIDS, INC (CLOTHING PROGRAM) SIERRA VISTA OPEN HIGH SCHOOL SCHOLARSHIPS COLLEGE SCHOLARSHIPS SENIOR EXPO FT. HUACHUCA HEALTH DAY CHAMBER BUSINESS EXPO CHAMBER HEALTH DAY SCHOOL CAREER DAYS MOUNTAIN EMPIRE ROTARY SACA AMERICAN RED CROSS FIREFIGHTER'S TOY DRIVE VICAP SIERRA VISTA AND TOMBSTONE -PROJECT GRADUATION (DRUG/ALCOHOL FREE EVENING FOR GRADUATING SENIORS) CARONDELET HEALTH FOUNDATION ARTHRITIS FOUNDATION COMFORT ZONE (FREE BLOOD PRESSURE CHECKS) MINISTRY FAIR (FREE BLOOD PRESSURE CHECKS) FEEDBACK SIERRA VISTA REGIONAL HEALTH CENTER PROVIDES MANY OPPORTUNITIES FOR COMMUNITY MEMBERS TO PROVIDE US FEEDBACK ON THE PROGRAMS AND SERVICES DELIVERED BY THE HOSPITAL. THESE PROGRAMS INCLUDE: SVRHC AUXILIARY SVRHC FOUNDATION FACILITY TOURS VOLUNTEER SERVICES COMMUNITY BREAKFASTS PRESS GANEY SURVEYS SUGGESTION BOXES COMMUNITY ASSESSMENTS WEB SITE CLERGY BREAKFASTS ANNUAL REPORT PASTORAL BREAKFASTS FACEBOOK HEALTH BEAT COMMUNICATION STATISTICS COMMUNITY SPEAKERS 3,542 ATTENDANCE AT SPEAKING ENGAGEMENTS 6,300 SUPPORT GROUPS/CLASSES 2,100 COMMUNITY FEEDBACK OVER 3,000 WEB SITE HITS 3.9 MILLION ANNUAL VISITORS TO DEPOT 9,184 DIRECT MAIL OF HEALTH BEAT 51,000 12 TIMES PER YEAR DIRECT MAIL OF ANNUAL REPORT 51,000 1 TIME PER YEAR PART III LINE 4 THE BAD DEBT EXPENSE (AT COST) WAS CALCULATED USING THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF SCHEDULE H. THE BAD DEBT EXPENSE IS RECORDED ON THE FINANCIALS AT GROSS CHARGES. EVERY EFFORT IS MADE TO IDENTIFY CHARITY PATIENTS AT THE POINT OF SERVICE SO NONE OF THE PATIENTS WRITTEN OFF TO BAD DEBT SHOULD HAVE BEEN ELIGIBLE FOR CHARITY CARE. IT IS POSSIBLE THAT SOME PATIENTS REFUSED TO COMPLETE THE CHARITY APPLICATION SO THAT NEED COULD NOT BE DETERMINED. PART III LINE 8 MEDICARE ALLOWABLE COSTS WERE CALCULATED USING THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2 OF SCHEDULE H. MEDICARE CHARGES FOR CATH LAB WERE EXCLUDED SINCE THEY WERE REPORTED AS PART OF THE SUBSIDIZED HEALTH SERVICES. EXPENSE FOR HEALTH PROFESSIONAL EDUCATION WAS THEN EXCLUDED FROM RESULTING COST. THE ENTIRE SHORTFALL CALCULATED SHOULD BE ATTRIBUTABLE TO COMMUNITY BENEFIT, SINCE THERE ARE NO OTHER HOSPITALS IN THE AREA THAT COULD PROVIDE CARE FOR THESE PATIENTS. PART III LINE 9B BAD DEBT REVIEW - HEALTH CARE OUT SOURCING NETWORK (HON) WILL PROVIDE A LISTING WEEKLY OF ACCOUNTS FOR POSSIBLE APPROVAL FOR BAD DEBT PROCESSING. - ALL ACCOUNTS WILL HAVE BEEN IN SELF PAY COLLECTIONS FOR 120 DAYS PRIOR TO ASSIGNMENT. - ALL ACCOUNTS WILL BE SCREENED TO ENSURE THAT THE CO-PAY AND OR DEDUCTIBLE AMOUNT IS CORRECT. - ALL ACCOUNTS WILL BE SCREENED PRIOR TO BAD DEBT PLACEMENT FOR POSSIBLE PAYMENTS, OTHER THIRD PARTY INSURANCE AND/OR OTHER AGENCY. - A LISTING OF ANY ACCOUNTS TO BE PULLED FROM COLLECTIONS WILL BE PROVIDED BACK TO HON FOR FURTHER WORK UP. PART VI, LINE 2 NEEDS ASSESSMENT A COMMUNITY HEALTH ASSESSMENT WAS PERFORMED BY HMS ASSOCIATES, A NATIONAL COMPANY FOR SIERRA VISTA REGIONAL HEALTH CENTER IN JULY, 2007. THE COMPANY CONDUCTED THE SURVEY UTILIZING THREE TYPES OF INFORMATION: A. STATISTICS ON DEATHS, BIRTHS, SERVICE USE B. COMMUNITY SURVEYS C. OPINIONS OF KEY ORGANIZATIONS THE ASSESSMENT COVERED ALL OF THE HOSPITAL'S SERVICE AREAS WITHIN THE COUNTY AND KEY EFFORTS INCLUDED DURING THE ANALYSIS WERE: GATHERING DATA, ASSIGNING DATA TO HEALTHY PEOPLE PROGRAM CATEGORIES, COMPARING DATA TO BENCHMARKS, ANALYZING DATA AND SELECTING PRIORITIES, AND SUMMARIZING FINDINGS. THE ASSESSMENT WAS THE FOUNDATION FOR SVRHC'S COMMUNITY BENEFIT PLAN WHICH INCLUDES ACTIVITIES AND PROGRAMS TO IMPROVE THE COMMUNITY HEALTH OF OUR CITIZENS. PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SIERRA VISTA REGIONAL HEALTH CENTER INFORMS AND EDUCATES OUR PATIENTS AND COMMUNITY MEMBERS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS AND UNDER THE HOSPITAL'S CHARITY CARE POLICY IN THE FOLLOWING WAYS: A. INFORMATION ON ELIGIBILITY ASSISTANCE IS PROVIDED ON THE WEBSITE, AT THE HOSPITAL'S WELLNESS DEPOT, AND IN PAMPHLETS. B. EACH PATIENT IS VISITED BY AN ELIGIBILITY SPECIALIST TO DISCUSS ONE-ON-ONE ELIGIBILITY ASSISTANCE. C. THERE ARE POSTED SIGNS WITHIN THE HOSPITAL NOTIFYING PATIENTS/COMMUNITY MEMBERS ON ASSISTANCE. D. FOR PATIENTS UNABLE TO INTERACT WITH AN ELIGIBILITY SPECIALIST AT THE TIME OF ARRIVAL THROUGH THE EMERGENCY ROOM, THE DEMOGRAPHICS AND INFORMATION SHEET IS VIEWED BY THE SPECIALIST AND CONTACT IS MADE WITH EACH ONE TO DISCUSS ELIGIBILITY. E. THERE IS A STATEMENT ON EACH BILL SENT TO ALL PATIENTS ABOUT ELIGIBILITY ASSISTANCE. PART VI, LINE 4 COMMUNITY INFORMATION THE HOSPITAL UTILIZED THE DEMOGRAPHIC INFORMATION PROVIDED BY THE ASSESSMENT ON THE POPULATIONS OF THE CITIES WITHIN COCHISE COUNTY AND INFUSED THESE FINDINGS INTO OUR PLAN. WE LOOKED AT THE POPULATION SIZE AND DENSITY, DISTRIBUTION, AND VITAL STATISTICS OF EACH CITY COUPLED WITH THE HEALTH NEED FINDINGS TO ESTABLISH EDUCATION AND PROGRAMS FOR THE POPULACE. SOME OF THE DEMOGRAPHIC INFLUENCES UNIQUE TO OUR SERVICE AREA INCLUDE THE FOLLOWING: A. DUE TO ANTICIPATED POPULATION GROWTH, THE NEED FOR SERVICES WILL GROW BY 50% OVER THE NEXT 20 YEARS B. THE POPULACE OF 50+ YEARS IS PROJECTED TO GROW BY 54% OVER THE NEXT 20 YEARS C. RETIREE GROWTH IS ALSO PROJECTED TO GROW BY 18% OVER THE NEXT 20 YEARS D. POPULATIONS DENSITY VARIES (FROM 500 TO 65,000) DUE TO MOST OF OUR SERVICE AREA BEING RURAL E. ALL OF OUR SERVICE AREA HAS CULTURAL SENSITIVITY CHARACTERISTICS F. THE POPULACE HAS SPECIAL POPULATIONS WITHIN OF GROUP HOMES, ARMED FORCES, CIVILIAN VETERANS (TWO AGE GROUPS - 18 TO 64 AND OVER 64) G. DEMOGRAPHICS SHOW HIGH HEALTH RISK BEHAVIOR LEVELS, POOR HEALTH STATUS, AND CONSIDERABLE CONCERN BY COMMUNITY LEADERS AND KEY HEALTH CARE PROVIDERS WITHIN THE COUNTY H. ACCESS TO CARE WAS A MAJOR CONCERN IDENTIFIED FOR THE COUNTY I. THE COUNTY RELIES ON THE EMERGENCY ROOM FOR CARE MORE THAN ANY OTHER COUNTY IN THE STATE PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH SEE NARRATIVE FOR SCHEDULE H, PART II PART VI, LINE 6 AFFILATED HEALTH CARE SYSTEM THE HOSPITAL WAS NOT PART OF AN AFFILIATED HEALTH SYSTEM. PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT THERE ARE NO STATES IN WHICH THE ORGANIZATION FILES A COMMUNITY BENEFIT REPORT. false SCHOLARSHIPS 7 5500 PROCEDURES FOR MONITORING FUNDS PART I, LINE 2 SCHOLARSHIP FUNDS ARE PROVIDED TO COCHISE COLLEGE, AND THE COLLEGE ADMINISTERS THE PROGRAM. X X X X true true false false false false false false false BRUCE NORTON 213828 0 48402 0 3804 0 55677 0 22586 0 344297 0 0 0 MARIE WURTH 157520 0 32440 0 2058 0 17555 0 20013 0 229586 0 0 0 REBECCA MCCALMONT 138690 0 31116 0 2190 0 33230 0 20366 0 225592 0 0 0 MARGARET HEPBURN-SVRHC 126160 0 200 0 3667 0 7124 0 11930 0 149081 0 0 0 MARGARET HEPBURN-TERM 0 0 0 0 792940 0 0 0 0 0 792940 0 0 0 MARGARET HEPBURN-RETIRE 0 0 0 0 409763 0 0 0 0 0 409763 0 0 0 MARGARET HEPBURN-PTO 0 0 0 0 180449 0 0 0 0 0 180449 0 0 0 MARGARET HEPBURN-CHN 269386 0 114472 0 0 0 0 0 0 0 383858 0 0 0 SCHEDULE J, PART II ADDITIONAL COMPENSATION INFORMATION ON APRIL 17, 2010 SIERRA VISTA REGIONAL HEALTH CENTER (SVRHC) ENTERED INTO AN AFFILIATION AGREEMENT WITH THE CARONDELET HEALTH NETWORK (CHN). AS A RESULT OF THAT AGREEMENT THE EMPLOYMENT OF MS HEPBURN, CEO, WAS TERMINATED. SHE WAS PAID BY SVRHC ACCORDING TO THE TERMS OF HER EMPLOYMENT CONTRACT. BEGINNING APRIL 17, 2010, MS HEPBURN BECAME EMPLOYED BY THE CHN. SHE WAS ASSIGNED BY CHN TO SERVE AS THE CEO OF SVRHC FOR THE PURPOSE OF CARRYING OUT THE GOALS AND OBJECTIVES OF THE AFFILIATION AGREEMENT. UNDER THE AGREEMENT SVRHC REIMBURSED THE CHN FOR THOSE SERVICES BEGINNING APRIL 17, 2010. IN ORDER TO MORE CLEARLY REFLECT THE ELEMENTS OF HER COMPENSATION, FIVE LINES OF DISCLOSURE HAVE BEEN PRESENTED ON THE FORM 990 PART VII AND SCHEDULE J PART II. AMOUNTS PAID BY SVRHC THROUGH APRIL 16, 2010 $ 130,027 CONTRACT TERMINATION $ 792,940 RETIREMENT SERP ACCOUNT $ 409,763 PAID TIME OFF ACCRUED $ 180,449 SALARY PAID BY CHN $ 383,858 SCHEDULE J, PART I, LINE 4A CONTRACT TERMINATION PAYMENT MARGARET HEPBURN, CEO, RECEIVED A TERMINATION PAYMENT OF $792,940 DURING 2010. THIS AMOUNT IS DISCLOSED IN PART II, COLUMN Biii AS OTHER TAXABLE COMPENSATION. SCHEDULE J, PART I, LINE 4B ADDITIONAL COMPENSATION INFORMATION MARGARET HEPBURN, CEO, ACCRUED SERP BENEFITS OF $110,989 AND WAS PAID OUT AN ADDITIONAL $298,774 FROM THE SERP. THE TOTAL of $409,763 IS DISCLOSED IN PART II, COLUMN Biii AS OTHER TAXABLE COMPENSATION. REBECCA MCCALMONT, BRUCE NORTON AND MARIE WURTH ALSO PARTICIPATE IN THE SERP PLAN. SCHEDULE J, PART I, LINE 7 BONUS PROGRAM THE EXECUTIVE TEAM, WHICH CONSISTS OF THE CEO, CFO, VICE PRESIDENTS, DIRECTORS, AND MANAGERS, ARE ELIGIBLE FOR PARTICIPATION IN THE BONUS PROGRAM. THE AMOUNT OF BONUS IS DETERMINED BY A BONUS MATRIX, ONE OF THE COMPONENTS OF WHICH IS AN EARNINGS TRIGGER. NONE OF THE BONUS MATRIX IS DISCRETIONARY OR NON-FIXED; THEREFORE, THIS QUESTION IS ANSWERED NO. THE INDUSTRIAL DEV AUTHORITY OF COUNTY OF COCHISE 860445518 191320BL3 2003-06-05 2670000 REFUND BONDS ISSUED ON 12/31/1996 false false false 0 0 2670000 0 0 0 53400 0 0 0 0 0 2003 true false true true false false false false true 0.00000 0.00000 0.00000 true false false false false true FORM 990, PART I, LINE 6 VOLUNTEER SERVICES VOLUNTEERS IMPACT EVERY DEPARTMENT AND ARE A SOURCE OF COMFORT TO PATIENTS AND FAMILY MEMBERS. THE QUALITY OF CARE THAT SVRHC PROVIDES IS NOT JUST A RESULT OF THE OUTSTANDING STAFF AND PHYSICIANS, BUT ALSO A DIRECT IMPACT FROM THE FRIENDLINESS AND CHEERY ATTITUDES EACH VOLUNTEER GIVES TO THE HOSPITAL. VOLUNTEERS SACRIFICE THEIR TIME AND ENERGY AS AMBASSADORS FOR SVRHC AND ARE TRUE GEMS IN THE COMMUNITY. WE UTILIZE VOLUNTEERS IN MOST OF THE DEPARTMENTS HERE AT THE HOSPITAL. THESE AREAS INCLUDE CLINICAL DEPARTMENTS SUCH AS MATERNAL CHILD, MED. SURGICAL, ICU/TELE, EMERGENCY DEPARTMENTS AND REHABILITATION SERVICES. OUR VOLUNTEERS WORK CLOSELY WITH OUR NURSING STAFF AND TECHNICIANS TO LEND ASSISTANCE WHENEVER NEEDED. THEY HELP GREET PATIENTS AND FAMILY MEMBERS, ANSWER PHONES, STOCK SMALL SUPPLIES, CREATE PACKETS, HELP WITH CHARTS AND TAKE ITEMS TO PATIENTS' ROOMS SUCH AS FLOWERS OR MAIL. OUR NON-CLINICAL DEPARTMENTS INCLUDE MEDICAL RECORDS, CLIENT SERVICES, HUMAN RESOURCES, PATIENT ACCOUNTS AND NUTRITION & FOOD SERVICES. OUR VOLUNTEERS HELP OUT IN THESE AREAS BY MAKING COPIES, DATA ENTRY, PUTTING TOGETHER PACKETS, ANSWERING PHONES, COVERING THE OFFICE FOR MEETINGS, MAKING FILES AND DOING FOOD PREPARATION. TRAINING IS REQUIRED WHICH PROVIDES VOLUNTEERS THE NECESSARY TRAINING AND TOOLS TO ASSIST THESE SPECIAL CLIENTS IN THEIR DAILY LIVES. WE ARE REQUIRED TO HAVE A CERTAIN PERCENTAGE OF VOLUNTEER HOURS TO STAFF HOURS TO MAINTAIN OUR STATUS AND MEET MEDICARE GUIDELINES. FORM 990, PART III, LINE 3 DESCRIPTION OF DISCONTINUED OPERATIONS IN JANUARY 2011 THE HOSPITAL DISCONTINUED OPERATING ITS DME (DURABLE MEDICAL EQUIPMENT) DEPARTMENT OPERATING UNDER THE BUSINESS NAME OF SIERRA MEDICAL EQUIPMENT. WITH SEVERAL OTHER COMPANIES IN THE COMMUNITY PROVIDING THE SAME SERVICES AND EQUIPMENT THE HOSPITAL FELT IT NO LONGER SERVED THE COMMUNITY'S NEEDS. FORM 990, PART III, LINE 4A EXEMPT PURPOSE ACHIEVEMENTS SIERRA VISTA REGIONAL HEALTH CENTER (SVRHC) OPERATES AN 84 BED SHORT-TERM PRIMARY CARE FACILITY IN RURAL ARIZONA. SVRHC PROVIDES A FULL RANGE OF INPATIENT, OUTPATIENT, DIAGNOSTIC AND REHABILITATION SERVICES. SERVICES PROVIDED FOR YEAR ENDED JUNE 30, 2011 INCLUDED 16,906 INPATIENT PATIENT DAYS, 100,093 OUTPATIENT REGISTRATIONS AND 26,570 EMERGENCY ROOM VISITS. IN SUPPORT OF ITS MISSION AND PHILOSOPHY THE HOSPITAL PROVIDES CARE TO ALL PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE AND ACCORDINGLY THEY ARE NOT RECORDED AS REVENUE. CHARITY CARE SERVICES TOTALED APPROXIMATELY $1,248,000 WHEN MEASURED AT THE HOSPITAL'S ESTABLISHED RATES. THE HOSPITAL PROVIDES CARE TO PATIENTS WHO HAVE ENTERED THE COMMUNITY ILLEGALLY. THE CHARGES FOR THESE PATIENTS ARE PARTIALLY REIMBURSED UNDER SECTION 1011 OF THE MEDICARE PRESCRIPTION DRUG IMPROVEMENT AND MODERNIZATION ACT OF 2003. THE UNREIMBURSED COSTS FOR SERVING THESE PATIENTS WERE APPROXIMATELY $12,000. PUBLIC PROGRAMS SUCH AS AHCCCS AND MEDICARE PROVIDE FOR THE POOR, INDIGENT AND ELDERLY. PUBLIC PROGRAMS DO NOT ALWAYS COVER THE COSTS OF PROVIDING THESE SERVICES; THE UNREIMBURSED COSTS OF THE MEDICARE PROGRAM WERE APPROXIMATELY $8,186,000. BENEFITS PROVIDED TO THE COMMUNITY INCLUDE THE COST OF PROVIDING SERVICES TO OTHER POPULATIONS WHO MAY QUALIFY AS POOR BUT MAY NEED SPECIAL SERVICES AND SUPPORT. THIS TYPE OF COMMUNITY BENEFIT INCLUDES THE COST OF PROGRAMS FOR SENIOR CITIZENS SUCH AS HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, IT ALSO INCLUDES COSTS INCURRED BY THE HOSPITAL FOR TRAINING HEALTH PROFESSIONALS SUCH AS MEDICAL RESIDENTS, NURSING STUDENTS IN ALLIED HEALTH PROFESSIONALS. THE HOSPITAL ALSO COMMITS SIGNIFICANT TIME AND RESOURCES TO ENDEAVORS AND CRITICAL SERVICES WHICH MEET OTHERWISE UNFILLED COMMUNITY NEEDS. MANY OF THESE ACTIVITIES ARE SPONSORED WITH THE KNOWLEDGE THAT THEY WILL NOT BE FINANCIALLY VIABLE. THE DEVELOPMENT OF THESE PROGRAMS IS BASED UPON A COMMUNITY ASSESSMENT PERFORMED BY AN INDEPENDENT COMPANY. SUCH ENDEAVORS INCLUDE LOCAL CHARITIES, NOT-FOR-PROFIT ORGANIZATIONS, YOUTH GROUPS AND OTHER PATIENT SUPPORT GROUPS SUCH AS BUT NOT INCLUSIVE OF: HEALTH SCREENINGS AND ASSESSMENTS, CANCER AND OTHER SUPPORT GROUPS, FREE TRANSPORTATION, MEALS AND MEDICATIONS FOR TRANSIENT PATIENTS WHEN NEEDED, THE AMERICAN HEART ASSOCIATION, MARCH OF DIMES, CANCER SOCIETY, AMERICAN RED CROSS, PRENATAL CLASSES, SENIOR OLYMPICS, HEALTH FAIRS, BLOOD PRESSURE CHECKS, HEALTH CAREER SCHOLARSHIPS FOR HIGH SCHOOL AND COLLEGE STUDENTS, BOY SCOUTS OF AMERICA, LITTLE LEAGUE AND PARTICIPATION IN REGULAR BLOOD DRIVES. FORM 990, PART VI, LINE 11B PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE 990 IS PREPARED BY THE CONTROLLER CAREFULLY CONSIDERING THE ORGANIZATION'S ENTRIES ON THE RETURN. THOSE QUESTIONS CONCERNING COMPENSATION HAVE BEEN REVIEWED WITH THE VICE PRESIDENT OF HUMAN RESOURCES AND ALL COMPENSATION HAS BEEN SUPPLIED BY THE HUMAN RESOURCES DEPARTMENT. THE ENTIRE RETURN HAS BEEN REVIEWED FOR CORRECTNESS WITH THE CFO. ONCE COMPLETED THE RETURN WAS THEN REVIEWED BY E&Y TAX DEPARTMENT. BEFORE THE FINAL RETURN IS FILED, THE COMPLETED 990 AND 990T IS REVIEWED WITH THE FINANCE COMMITTEE OF THE BOARD HIGHLIGHTING THE AREAS OF SIGNIFICANCE TO A GOVERNING BODY. A COMPLETED COPY IS MADE AVAILABLE FOR ALL TRUSTEES PRIOR TO FILING. ANSWERS ARE PROVIDED TO ANY QUESTIONS OR CONCERNS. FORM 990, PART VI, LINE 12C PROCESS TO MONITOR TRANSACTIONS FOR CONFLICT OF INTEREST THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY. THE FOLLOWING PROCEDURES ARE EMPLOYED. ALL OFFICERS, LEADERS OR IDENTIFIED OTHERS SHALL COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AND SUBMIT IT TO THE HOSPITAL ANNUALLY. THE TERM "CONFLICT OF INTEREST" MEANS THAT CIRCUMSTANCES WHERE THE BEST INTERESTS OF SIERRA VISTA REGIONAL HEALTH CENTER (SVRHC) CONFLICT WITH EITHER THE ECONOMIC, PROFESSIONAL, POLITICAL OR PERSONAL INTERESTS OF ONE OR MORE OFFICERS, LEADERS OR IDENTIFIED OTHER OF SVRHC. THE RELATIONSHIP BETWEEN SVRHC AND ITS OFFICERS, LEADERS AND IDENTIFIED OTHERS IS ONE WHICH IS COMPLEX AND CHANGING. THERE ARE CIRCUMSTANCES WHICH MAY EXIST WHICH MAY INTERTWINE THE INTERESTS OF SVRHC AND ITS OFFICERS, LEADERS AND IDENTIFIED OTHERS. IN ORDER TO RECOGNIZE AND EFFECTIVELY DEAL WITH CIRCUMSTANCES OF THIS NATURE THE FOLLOWING POLICY HAS BEEN ADOPTED. ANY AND ALL CONFLICTS OF INTEREST SHALL BE DISCLOSED TO THE HOSPITAL EITHER AT THE TIME OF HIRE, INCEPTION OF RELATIONSHIP AND/OR AT THE TIME OF AN INITIAL AGREEMENT/CONTRACT OR AT ANY TIME A CONFLICT OF INTEREST OCCURS. A CONFLICT OF INTEREST QUESTIONNAIRE IS SUBMITTED TO THE HOSPITAL. FAILURE TO COMPLETE AND SUBMIT A QUESTIONNAIRE WILL RESULT IN THE OFFICER LEADER OR IDENTIFIED OTHER BEING REMOVED FROM THEIR RELATIONSHIP WITH THE HOSPITAL. WHILE THIS IS AN ANNUAL REQUIREMENT, IT IS NOT MEANT TO TAKE THE PLACE OF IMMEDIATE AND APPROPRIATE DISCLOSURE OF A CONFLICT OF INTEREST BY AN OFFICER, LEADER OR IDENTIFIED OTHER TO THE HOSPITAL WHEN CIRCUMSTANCES OCCUR. ANY POTENTIAL CONFLICT OF INTEREST SHALL BE DISCLOSED TO THE HOSPITAL. THE POTENTIAL CONFLICT WILL BE REVIEWED EITHER BY THE CEO/PRESIDENT OR HIS/HER DESIGNEE(S) OR BY THE BOARD OF TRUSTEES' CHAIRPERSON OR HIS/HER DESIGNEE(S) DEPENDING ON THE NATURE OF THE POTENTIAL CONFLICT. A DECISION PERTAINING TO THE CONFLICT OF INTEREST AND THE OFFICER'S, LEADER'S AND IDENTIFIED OTHER'S ABILITY TO CONTINUE IN HIS/HER POSITION AND/OR RELATIONSHIP WILL BE DETERMINED AND SHARED WITH THE OFFICER, LEADER OR IDENTIFIED OTHER. FORM 990, PART VI, LINES 15A AND 15B PROCEDURES USED TO DETERMINE COMPENSATION IT IS THE POLICY OF SIERRA VISTA REGIONAL HEALTH CENTER THAT AN EXECUTIVE'S BASE SALARY WILL BE MAINTAINED AT OR ABOVE THE 50TH PERCENTILE AND THAT ANNUALLY THE BOARD OF TRUSTEES WILL DEVELOP A COMPENSATION PLAN UTILIZING A THIRD PARTY CONSULTANT AND CURRENT MARKET DATA. IT IS THE POLICY OF SIERRA VISTA REGIONAL HEALTH CENTER THAT EXECUTIVES WILL BE PAID AN INCENTIVE BONUS BASED UPON AN ANNUAL PLAN COMPRISED OF FINANCIAL AND NON-FINANCIAL METRICS APPROVED BY THE BOARD OF TRUSTEES, THE PLAN WILL BE APPROPRIATELY ALIGNED WITH THE PROBABILITY OF ACHIEVEMENT. PROCEDURE: - ENGAGE AN INDEPENDENT COMPANY TO CONDUCT A COMPENSATION VALUATION STUDY OF COMPENSATION ARRANGEMENTS IN TAX- EXEMPT ORGANIZATIONS UNDER THE INTERMEDIATE SANCTIONS LEGISLATION. - THE INDEPENDENT COMPANY WILL PROVIDE THE SVRHC BOARD OF TRUSTEES' EXECUTIVE COMPENSATION COMMITTEE COMPETITIVE MARKET DATA TO INCLUDE: A CONFIRMATION OF THE SCOPE, DATA CUTS AND SURVEY SOURCES WITH THE HUMAN RESOURCE TEAM. PROVIDE MARKET COMPARABILITY DATA IN ORDER TO REVIEW THE COMPETITIVENESS OF SVRHC'S PROGRAM. RESEARCH MARKET PRACTICES FOR BOTH SHORT AND LONG TERM PLANS TO DETERMINE ALIGNMENT. REVIEW EXECUTIVE BENEFIT AND PERQUISITE PREVALENCE DATA. - THE INDEPENDENT COMPANY WILL SELECT RELEVANT DATA AND ADJUST THE DATA TO ACCURATELY REFLECT THE SIZE AND SCOPE OF SVRHC'S ROLES AND MEDIAN REVENUE SIZE. - THE INDEPENDENT COMPANY WILL UTILIZE THE SAME METHODOLOGY TO CONDUCT A REVIEW OF INCENTIVE BONUS PLANS FOR THE EXECUTIVE STAFF. - THE INDEPENDENT COMPANY WILL CONSIDER THE FOLLOWING WHEN REVIEWING A PARTICULAR INDIVIDUAL'S COMPENSATION: PRIOR SKILLS AND EXPERIENCE OF INCUMBENTS IN THE ROLE. THE MIX OF COMPENSATION ELEMENTS AND OTHER REWARD COMPONENTS. THE HOSPITAL'S PERFORMANCE VERSUS COMPARABLE PEER PERFORMANCE. THE ABILITY OF THE HOSPITAL TO PAY AT COMPETITIVE LEVELS. - THE INDEPENDENT COMPANY WILL MAKE RECOMMENDATIONS FOR COMPENSATION AND BONUS PERCENTAGES FOR THE EXECUTIVE STAFF TO THE SVRHC BOARD OF TRUSTEES EXECUTIVE COMPENSATION COMMITTEE. - THE COMMITTEE WILL REVIEW THE RECOMMENDATIONS AND FORWARD THEM TO THE ENTIRE SVRHC BOARD OF TRUSTEES FOR APPROVAL. FORM 990, PART VI, LINE 19 AVAILABILITY OF CERTAIN DOCUMENTS TO GENERAL PUBLIC THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 5 OTHER CHANGES IN NET ASSETS UNREALIZED GAIN ON INVESTMENTS $ 2,377,438 TEMPORARILY RESTRICTED GRANTS AND CONTRIBUTIONS 52,047 AMOUNTS RELEASED FROM RESTRICTIONS (24,855) ----------- TOTAL $ 2,404,630 =========== SVRHC PROPERTIES LLC 300 EL CAMINO REAL SIERRA VISTA AZ 85635 860186064 MOB AZ 0 0 NA SVRHC FOUNDATION 300 EL CAMINO REAL SIERRA VISTA AZ 85625 860729397 FUND RAISING AZ 501(C)(3) 509 (A)(2) NA SIERRA VISTA COMMUNITY HOSPITAL AUX INC 300 EL CAMINO REAL SIERRA VISTA AZ 85625 860431251 FUND RAISING AZ 501(C)(3) 509 (A)(2) NA ARIZONA FAMILY CARE ASSOCIATES 6 SOUTH 2ND ST SIERRA VISTA AZ 85635 PHYSICIANS GROUP AZ NA C CORP 0 0 0.59170 false false true false false false false false false false false false true false false false false true SVRHC FOUNDATION C 126009 SVRHC AUXILIARY c 95000