CIBOLA GENERAL HOSPITAL CORPORATION: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- CIBOLA GENERAL HOSPITAL CORPORATION (EIN 85-0141285)
- Tax period
- 2022-07-01 to 2023-06-30
- Filed
- 2024-05-14
- IRS object ID
- 202401359349300835
- Schema version
- 2022v5.0
- 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-05-14T07:53:19-05:00 | ReturnTs |
| Tax Period End | 2023-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 721396621 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CARR RIGGS & INGRAM LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2424 LOUISIANA BLVD NE STE 300 | AddressLine1Txt |
| City | ALBUQUERQUE | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 87110 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 850141285 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIBOLA GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CIBO | BusinessNameControlTxt |
| Phone | 5052874446 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E ROOSEVELT AVE | AddressLine1Txt |
| City | GRANTS | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 87020 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JIM HERMES | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5052874446 | PhoneNum |
| Signature | 2024-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JIM | PersonFirstNm |
| Person Last | HERMES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARIA MATONTI | PreparerPersonNm |
| PTIN | P01790899 | PTIN |
| Phone | 5058832727 | PhoneNum |
| Preparation | 2024-05-13 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JIM HERMES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E ROOSEVELT AVE | AddressLine1Txt |
| City | GRANTS | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 87020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $47,456,085 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CIBOLAHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1959 | FormationYr |
| Legal Domicile State | NM | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY WITHOUT REGARD TO ABILITY TO PAY BY UTILIZING STATE OF THE ART PRACTICES AND EQUIPMENT TO PROVIDE QUALITY CARE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 325 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,534,826 | PYContributionsGrantsAmt |
| CY Contributions Grants | $263,772 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $42,345,599 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $46,726,955 | CYProgramServiceRevenueAmt |
| PY Investment Income | $110,914 | PYInvestmentIncomeAmt |
| CY Investment Income | $129,509 | CYInvestmentIncomeAmt |
| PY Other Revenue | $10,002 | PYOtherRevenueAmt |
| CY Other Revenue | $335,849 | CYOtherRevenueAmt |
| PY Total Revenue | $44,001,341 | PYTotalRevenueAmt |
| CY Total Revenue | $47,456,085 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $24,209,364 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $27,468,307 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $21,380,815 | PYOtherExpensesAmt |
| CY Other Expenses | $22,865,882 | CYOtherExpensesAmt |
| PY Total Expenses | $45,590,179 | PYTotalExpensesAmt |
| CY Total Expenses | $50,334,189 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,588,838 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,878,104 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $41,581,720 | TotalAssetsBOYAmt |
| Total Assets EOY | $39,614,068 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,736,014 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,646,466 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $33,845,706 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $30,967,602 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE EXCELLENT HEALTH CARE TO THE COMMUNITY BY COMMITTING TO SERVICE, QUALITY, FINANCIAL STABILITY, AND GROWTH. THE ORGANIZATION STRIVES TO PROVIDE PATIENTS AND FAMILIES WITH QUALITY SERVICE BY IMPLEMENTING NATIONAL BEST PRACTICES AS STANDARDS. IT ALSO MAINTAINS FINANCIAL STABILITY TO ENSURE ITS CONTINUANCE AND GROWTH SO THAT HEALTH CARE IS ACCESIBLE THROUGH THE HOSPITAL AND ITS PHYSICIAN PARTNERSHIPS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,610,588 | ExpenseAmt |
| Revenue | $47,062,804 | RevenueAmt |
| Desc | THE ORGANIZATION PROVIDES PATIENT CARE TO THE RESIDENTS OF GRANTS, NEW MEXICO AND OUTLYING COMMUNITIES WITHOUT REGARD TO ABILITY TO PAY. THERE ARE APPOXIMATELY 27,000 RESIDENTS IN THE CIBOLA COUNTY, NM COMMUNITY. CIBOLA COUNTY HOSPITAL UTILIZES STATE OF THE ART EQUIPMENT AND THE HIGHEST HEALTH CARE STANDARDS TO PROVIDE QUALITY HEALTH CARE. DURING THE FISCAL YEAR, THE ORGANIZATION HAD ABOUT 1,104 INPATIENT ADMISSIONS SERVED IN ITS 25-BED FACILITY. THE HOSPITAL ALSO HAD ABOUT 23,647 OUTPATIENT VISITS, 14,858 EMERGENCY ROOM VISITS, AND ABOUT 30,660 CLINIC VISITS. THE ORGANIZATION'S STAFF WORK HARD TO MEET PATIENT NEEDS AND THEY FEEL EVERY PATIENT ENCOUNTER IS AN ACCOMPLISHMENT. | Desc |
| Total Program Service Expenses | $36,610,588 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 88 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 325 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NM | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIBOLA GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5052874446 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E ROOSEVELT AVE | AddressLine1Txt |
| City | GRANTS | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 87020 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| EILEEN YARBOROUGH | |||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KENDRA BROWN | |||||||
| VICE CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR STACEY DIMITT | |||||||
| CHIEF OF MEDICAL STAFF/MEM | 40.00 | Yes (X) | Yes (X) | $351,487 | $0 | $17,519 | |
| ROBERT WINDHORST | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| RON ORTIZ | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| KEVIN BRANUM | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| JOAN GILMORE | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| STEPHANIE RIVARD | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| HARRY SHESHKI | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| THOMAS WHELAN | |||||||
| CEO | 40.00 | Yes (X) | $215,388 | $0 | $21,066 | ||
| JIM HERMES | |||||||
| CFO | 40.00 | Yes (X) | $182,785 | $0 | $9,953 | ||
| ABDUL AHMED | |||||||
| PHYSICIAN | 40.00 | $376,115 | $0 | $17,000 | Yes (X) | ||
| SNOW MARIKA PETERSEN | |||||||
| PHYSICIAN | 40.00 | $421,908 | $0 | $19,500 | Yes (X) | ||
| AMANDA YOUNG | |||||||
| PHYSICIAN | 40.00 | $410,480 | $0 | $22,076 | Yes (X) | ||
| ALFREDO NEVAREZ | |||||||
| PHYSICIAN | 40.00 | $442,012 | $0 | $22,076 | Yes (X) | ||
| ANALISA VILLARREAL | |||||||
| PHYSICIAN | 40.00 | $346,668 | $0 | $17,907 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,746,843 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $147,097 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 55 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FEDKO EMERGENCY PHYSICIANS NM LLC | |||||
| 1202 HIGHWAY 60 | SOCORRO | NM | 87801 | EMERGENCY DEPT MANAGEMENT | $2,250,000 |
| GE MEDICAL SYSTEMS | |||||
| 3000 N GRANDVIEW BLVD | WAUKESHA | WI | 53188 | SERVICE/MTNCE ON IMAGING EQUPMT | $1,477,343 |
| CERNER | |||||
| 2800 ROCK CREEK PKWY | KANSAS CITY | MO | 64117 | DATA PROCESSING SERVICES | $1,330,307 |
| QUORUM HEALTH RESOURCES | |||||
| 1573 MALLORY LN STE 100 | BRENTWOOD | TN | 37027 | HOSPITAL ADVISORY SERVICES | $1,324,237 |
| CARDINAL HEALTH RESOURCES | |||||
| 7000 CARDINAL PL | DUBLIN | OH | 43017 | MEDICAL/SURGICAL & DRUGS | $1,061,833 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 27 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $188,772 | GovernmentGrantsAmt |
| All Other Contributions | $75,000 | AllOtherContributionsAmt |
| Total Contributions | $263,772 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| ACUTE CARE HOSPITAL SERVICES | 622110 | $42,245,077 | $42,245,077 |
| PATIENT SAFETY NET CARE POOL | 622110 | $2,741,215 | $2,741,215 |
| CIBOLA COUNTY MILL LEVY SUBSIDY | 921190 | $1,541,947 | $1,541,947 |
| OTHER PROGRAM REVENUE | 622110 | $198,716 | $198,716 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $46,726,955 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $129,509 | TotalRevenueColumnAmt |
| Exclusion | $129,509 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| OTHER INCOME | 900099 | $201,269 | $201,269 |
| FOOD SERVICE INCOME | 722514 | $134,580 | $134,580 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $335,849 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,456,085 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $47,062,804 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $129,509 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $798,198 | TotalAmt |
| Program Services | $184,503 | ProgramServicesAmt |
| Management And General | $613,695 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,073,581 | TotalAmt |
| Program Services | $16,555,186 | ProgramServicesAmt |
| Management And General | $5,518,395 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $659,873 | TotalAmt |
| Program Services | $494,905 | ProgramServicesAmt |
| Management And General | $164,968 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,166,615 | TotalAmt |
| Program Services | $1,624,961 | ProgramServicesAmt |
| Management And General | $541,654 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,770,040 | TotalAmt |
| Program Services | $1,327,530 | ProgramServicesAmt |
| Management And General | $442,510 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $59,040 | TotalAmt |
| Program Services | $27,749 | ProgramServicesAmt |
| Management And General | $31,291 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $299,487 | TotalAmt |
| Management And General | $299,487 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,790 | TotalAmt |
| Management And General | $38,790 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,656,493 | TotalAmt |
| Program Services | $4,656,493 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $56,391 | TotalAmt |
| Program Services | $56,391 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,351,757 | TotalAmt |
| Program Services | $2,513,818 | ProgramServicesAmt |
| Management And General | $837,939 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $603,269 | TotalAmt |
| Program Services | $301,635 | ProgramServicesAmt |
| Management And General | $301,634 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,869 | TotalAmt |
| Program Services | $7,869 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,462,827 | TotalAmt |
| Program Services | $1,097,120 | ProgramServicesAmt |
| Management And General | $365,707 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,218,608 | TotalAmt |
| Program Services | $913,956 | ProgramServicesAmt |
| Management And General | $304,652 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $7,040,937 | $3,309,240 | $3,731,697 |
| MEDICAL, RX & FOOD SUPP | $4,053,509 | $3,526,553 | $526,956 |
| MISCELLANEOUS EXP | $16,905 | $12,679 | $4,226 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,334,189 | TotalAmt |
| Program Services | $36,610,588 | ProgramServicesAmt |
| Management And General | $13,723,601 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,136,657 | BOYAmt |
| EOY | $6,171,851 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $7,342,974 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,939,683 | BOYAmt |
| EOY | $9,872,226 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,079,129 | BOYAmt |
| EOY | $1,207,723 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $517,462 | BOYAmt |
| EOY | $578,796 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $26,693,351 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,252,853 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,098,385 | BOYAmt |
| EOY | $14,440,498 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,810,404 | BOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,581,720 | BOYAmt |
| EOY | $39,614,068 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,001,082 | BOYAmt |
| EOY | $4,226,580 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,734,932 | BOYAmt |
| EOY | $4,419,886 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,736,014 | BOYAmt |
| EOY | $8,646,466 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,845,706 | BOYAmt |
| EOY | $30,967,602 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $33,845,706 | BOYAmt |
| EOY | $30,967,602 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,581,720 | BOYAmt |
| EOY | $39,614,068 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,878,104 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,357,620 | OtherCostOrOtherBasisAmt |
| Depreciation | $931,326 | DepreciationAmt |
| Book Value | $4,426,294 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,358,560 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,426,138 | DepreciationAmt |
| Book Value | $1,932,422 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,564,740 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,895,389 | DepreciationAmt |
| Book Value | $7,669,351 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $412,431 | OtherCostOrOtherBasisAmt |
| Book Value | $412,431 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,440,498 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LONG-TERM LEASE LIABILITY | Desc |
| Amt | $4,419,886 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,419,886 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $47,456,085 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $47,456,085 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $47,456,085 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $50,334,189 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $50,334,189 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $50,334,189 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART VI, LINE 1(E): | FormAndLineReferenceDesc |
| Explanation | THIS LINE CONTAINS THE ORGANIZATION'S TOTAL NONDEPRECIABLE CONSTRUCTION IN PROCESS BALANCE. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 350.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $729,891 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $729,891 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01450 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,797,275 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,580,238 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,217,037 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02420 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,527,166 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,580,238 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,946,928 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03870 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,347 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,347 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00080 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,347 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $51,347 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,578,513 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,580,238 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,998,275 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03970 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,117,452 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,045,235 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $4,078,063 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,531,722 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,453,659 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIBOLA GENERAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E ROOSEVELT AVE | AddressLine1Txt |
| City | GRANTS | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 87020 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CIBOLAHOSPITAL.COM | WebsiteAddressTxt |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CIBOLA GENERAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTP://WWW.CIBOLAHOSPITAL.COM/ | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTP://WWW.CIBOLAHOSPITAL.COM/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 350.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 100.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTP://WWW.CIBOLAHOSPITAL.COM// | FAPAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.CIBOLAHOSPITAL.COM | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Other Actions Taken | Yes (X) | OtherActionsTakenInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| CIBOLA GENERAL HOSPITAL, INC. | PART V, SECTION B, LINE 5: FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOUGHT INPUT FROM ALL PERSONS IN ITS SERVICE AREA, INCLUDING COUNTY GOVERNMENT AND LEADERS OF THE BUSINESS COMMUNITY. THE NEEDS ASSESSMENT WAS OFFERED ONLINE FROM A LINK TO IT IN THE HOSPITAL'S WEBSITE, AND WAS ALSO OFFERED IN A PAPER VERSION TO ANY WHO PREFERRED IT THAT WAY. THE PERSONS CONSULTED INCLUDED, BUT WERE NOT LIMITED TO, THE CEO, CFO, CCO, HR DIRECTOR, ALL MEMBERS OF THE BOARD, AND THE MEDICAL STAFF. THE NEEDS ASSESSMENT WAS HEAVILY ADVERTISED IN THE MEDIA. |
| CIBOLA GENERAL HOSPITAL, INC. | PART V, SECTION B, LINE 11: THE HOSPITAL AND ITS BOARD PRACTICE ONGOING PROMOTION OF HEALTH IMPROVEMENT. COMMUNITY HEALTH IS PROMOTED IN THE FOLLOWING WAY: (1) THE HOSPITAL BOARD IS A COMMUNITY-BASED, ALL VOLUNTEER GROUP; (2) SURPLUS FUNDS ARE USED TO REINVEST IN THE FACILITIES TO KEEP THEM STATE OF THE ART; (3) FINANCIAL SUPPORT TO THE LOCAL COLLEGE FUNDS THE SALARY OF THE NURSING PROGRAM DIRECTOR; (4) THE HOSPITAL CO-SPONSORS AN ANNUAL HEALTH FAIR TO EDUCATE THE COMMUNITY; (5) ANNUAL VACCINATION CLINICS ARE STAFFED BY HOSPITAL NURSES; AND (6) FREE CLASSES ARE SPONSORED IN DIABETES EDUCATION, CHILDBIRTH, AND BREASTFEEDING. |
| CIBOLA GENERAL HOSPITAL, INC. | PART V, SECTION B, LINE 18E: OUTSIDE COLLECTION AGENCIES ARE USED. THE RECOVERY RATES BY THESE AGENCIES ARE TYPICALLY UNDER 10%. |
| CIBOLA GENERAL HOSPITAL, INC. | PART V, SECTION B, LINE 20E: PATIENTS ARE NOTIFIED UPON ADMISSION AND DISCHARGE OF THE FINANCIAL ASSISTANCE PROGRAM. ALSO, THE ORGANIZATION DOCUMENTS ITS DETERMINATION OF ELIGIBILITY AND NOTIFIES PATIENTS OF THE POLICY IN COMMUNICATIONS WITH PATIENTS REGARDING THEIR BILLS. |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | AMOUNT REPORTED ON LINE A, COLUMN C IS BASED ON THE ORGANIZATION'S COST TO CHARGE RATIO. LINE B, COLUMN D USES COST TO CHARGE RATION OFFSET BY A CONTRACTUAL PERCENTAGE LEADING TO THE AMOUNT REPORTED IN COLUMN E. LINE E, COLUMN C AND LINE F, COLUMN C ARE BASED ON ACTUAL COST. ALSO, LINE 7, COLUMN G IS NOT APPLICABLE; THEREFORE NOTHING ENTERED. |
| PART I, LINE 3C | THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: (1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. (2) PROOF OF HOUSEHOLD INCOME. AND (3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. |
| PART III, LINE 4: | THERE IS NO MENTION OF BAD DEBT EXPENSE NOR ITS CALCULATION METHODOLOGY WITHIN AUDITED FINANCIAL STATEMENT REPORT. |
| PART III, LINE 8: | THE ENTIRE MEDICARE SHORTFALL SHOULD BE REGARDED AS COMMUNITY BENEFIT. |
| PART III, LINE 9B: | PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CONSIDERED IN THE PROCESS. |
| PART VI, LINE 3: | THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: (1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. (2) PROOF OF HOUSEHOLD INCOME. AND (3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | NM |
| PART VI, LINE 2: | THE ORGANIZATION OBTAINS A GREAT AMOUNT OF INFORMAL FEEDBACK FROM PATIENTS AND VISITORS. |
| PART VI, LINE 3: | IF DURING THE PATIENT REGISTRATION PROCESS IT IS DETERMINED THAT THE PATIENT LACKS THE ABILITY TO PAY, THEN THE REGISTRATION PERSON WILL PRESENT THE PATIENT THE INFORMATION NEEDED FOR HIM/HER TO APPLY FOR FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | CIBOLA GENERAL HOSPITAL PROVIDES MEDICAL SERVICES IN A COUNTY THAT REPRESENTS APPROXIMATELY 27,000 RESIDENTS. |
| PART VI, LINE 5: | A TRANSPARENT BOARD, INVOLVED MEDICAL STAFF, AND EMPLOYEES WHO ARE ALSO CITIZEN-STAKEHOLDERS HELP PROMOTE COMMUNITY HEALTH. |
| PART VI, LINE 6: | THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ALFREDO NEVAREZ | ||||||||||||||
| PHYSICIAN | $442,012 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,076 | $0 | $464,088 | $0 | $0 | $0 |
| SNOW MARIKA PETERSEN | ||||||||||||||
| PHYSICIAN | $421,908 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $19,500 | $0 | $441,408 | $0 | $0 | $0 |
| AMANDA YOUNG | ||||||||||||||
| PHYSICIAN | $410,480 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $22,076 | $0 | $432,556 | $0 | $0 | $0 |
| ABDUL AHMED | ||||||||||||||
| PHYSICIAN | $376,115 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,000 | $0 | $393,115 | $0 | $0 | $0 |
| DR STACEY DIMITT | ||||||||||||||
| CHIEF OF MEDICAL STAFF/MEM | $351,487 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,519 | $0 | $369,006 | $0 | $0 | $0 |
| ANALISA VILLARREAL | ||||||||||||||
| PHYSICIAN | $346,668 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $17,907 | $0 | $364,575 | $0 | $0 | $0 |
| THOMAS WHELAN | ||||||||||||||
| CEO | $215,388 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $21,066 | $0 | $236,454 | $0 | $0 | $0 |
| JIM HERMES | ||||||||||||||
| CFO | $182,785 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $9,953 | $0 | $192,738 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 7A | CIBOLA COUNTY APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE A COUNTY COMMISSIONER. THE HOSPITAL BOARD APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE THE CHIEF OF THE MEDICAL STAFF. THE 9TH MEMBER OF THE BOARD IS APPOINTED AT THE FIRST ANNUAL MEETING BASED ON A MAJORITY VOTE OF THE OTHER 8 BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE BOARD WILL REFER SIGNIFICANT CAPITAL PROJECT PROPOSALS AND TRUSTEE APPOINTMENTS TO THE COUNTY COMMISSIONER FOR APPROVAL. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL TRUSTEES, OFFICERS AND EMPLOYEES ARE REQUIRED ANNUALLY TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST IN WRITING. THE FORM IS SIGNED AND DATED, AND MONITORED BY THE COMPLIANCE COORDINATOR. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION OF OFFICERS AND HIGHLY PAID EMPLOYEES IS DETERMINED BY REVIEW OF COMPARABLE PAY FOR COMPARABLE DUTIES BY RECRUITERS, AND/OR OTHER CONSULTANTS. ALL AMOUNTS ARE APPROVED BY THE BOARD. |
| FORM 990, PART VI, SECTION C, LINE 19 | ALL GOVERNING DOCUMENTS AND TAX FORMS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ALSO, THE CEO REPORTS REGULARLY TO THE COUNTY COMMISSION AT A PUBLIC MEETING AND THE BOARD HOLDS MONTHLY PUBLIC MEETINGS. |
| FORM 990, PART XII, LINE 2C: | THE BOARD SELECTS THE AUDITORS AND OVERSEES THE AUDIT PROCESS; THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
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