2023-03-16T09:39:47-05:00 2022-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2021-07-01 860334996 BISBEE HOSPITAL ASSOCIATION INC BISB 5204325383 101 COLE AVE BISBEE AZ 85603 ROBERT SEAMON CEO 5204325383 2023-03-14 1 ROBERT SEAMON 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2023-03-08 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z COPPER QUEEN COMMUNITY HOSPITAL ROBERT SEAMON 101 COLE AVE BISBEE AZ 85603 66227471 0 X WWW.CQCH.ORG X 1977 AZ TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY. 12 12 468 12 0 0 4391403 1662329 55297239 64302475 24922 -129274 135953 237955 59849517 66073485 186486 56749 0 0 25012124 28566546 0 0 0 23678274 30661929 48876884 59285224 10972633 6788261 78895216 83487894 16050630 13948268 62844586 69539626 THE MISSION OF BISBEE HOSPITAL ASSOCIATION INC D/B/A COPPER QUEEN COMMUNITY HOSPITAL ("CQCH") IS TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY BY PROVIDING LEADERSHIP AND VISION TO ADDRESS OPPORTUNITIES AND CHALLENGES. 0 0 44781935 56749 64416567 TO PROVIDE HEALTHCARE SERVICES THROUGH IN-PATIENT, OUT-PATIENT, 24- HOUR EMERGENCY SERVICES, SPECIALTY CARE, AND RURAL HEALTH CLINICS TO THE RESIDENTS OF BISBEE & SURROUNDING COMMUNITIES IN SOUTHERN ARIZONA. 44781935 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 146 0 468 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X HEATHER LUNDSTROM 5204325383 101 COLE AVENUE BISBEE AZ 85603 DENNIS GALLUS PRESIDENT 3.00 X X 0 0 0 DENNIS NELSON VICE PRESIDENT 1.00 X X 0 0 0 ROSALIE BUTLER TREASURER 1.00 X X 0 0 0 LAWANA DIFFLE SECRETARY 1.00 X X 0 0 0 PETER CAMPBELL DIRECTOR 1.00 X 0 0 0 LAURA CHAVEZ DIRECTOR 1.00 X 0 0 0 PATRICK COGHLAN MD DIRECTOR 1.00 X 0 0 0 KATHLEEN HEARD DIRECTOR 1.00 X 0 0 0 HEIDI LODGE DIRECTOR 1.00 X 0 0 0 ROSA ANEL LOPEZ DIRECTOR 1.00 X 0 0 0 REBECCA OROZCO DIRECTOR 1.00 X 0 0 0 SYLVIA VALENZUELA DIRECTOR 1.00 X 0 0 0 ROBERT SEAMON CEO 40.00 X 378263 0 33900 HEATHER LUNDSTROM CFO 40.00 X 232452 0 17960 SUZANNE DALY GASTROENTEROLOGY PHYSICIAN 40.00 X 535026 0 33900 CRISTIAN LAGUILLO FAMILY PHYSICIAN 40.00 X 359157 0 28460 HEIDI LODGE INTERNAL MEDICINE PHYSICIAN 40.00 X 377334 0 34460 EDWARD MILLER SURGICAL PHYSICIAN 40.00 X 373016 0 34460 RICHARD SNURE SURGICAL PHYSICIAN 32.00 X 354582 0 27400 2609830 0 210540 45 0 1 0 AERGO SOLUTIONS LLC 33 WOOD AVENUE S ISELIN NJ 08830 FINANCIAL SERVICES 1649198 CERNER 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 COMPUTER SUPPORT 1545331 ADAPTIVE WORKFORCE SOLUTIONS 3451 S MERCY ROAD 103 GILBERT AZ 85297 CONTRACT NURSES 1084744 DIVERSIFIED DESIGN 3237 E FT LOWELL RD TUSCON AZ 85716 CONSTRUCTION CONTRACTOR 591843 AUTHORITY RX LLC 7111 W 151ST ST SUITE 292 OVERLAND PARK KS 66223 340B CONSULTANT 299133 31 1466372 195957 1662329 PATIENT SERVICE REVENUE 621400 63194728 63194728 340B REVENUE 621400 1107747 1107747 64302475 24712 24712 153986 -153986 -153986 -153986 CAFETERIA 722514 94645 94645 MEDICAL RECORDS 561000 3476 3476 139834 114092 25742 237955 66073485 64416567 0 -5411 X 56749 56749 662574 662574 22514871 17870086 4644785 370319 311383 58936 3497724 2718741 778983 1521058 1175793 345265 26525 26525 20619 20619 2733893 2733893 8169464 7678831 490633 461530 461530 505945 92030 413915 1544472 175430 1369042 1460982 829966 631016 141456 106814 34642 57625 28022 29603 99399 71752 27647 1839706 1328000 511706 26283 26283 SUPPLIES EXPENSE 6009821 5988695 21126 BAD DEBT EXPENSE 5567790 5567790 TAXES AND LICENSES 1055254 0 1055254 REPAIRS AND MAINTENANCE 634717 631016 3701 306448 150837 155611 59285224 44781935 14503289 0 33981303 33845270 6522766 6570491 9026301 8665353 1416069 1347866 616978 1353829 53665202 23150651 26694043 30514551 637756 544534 0 646000 78895216 83487894 4742291 3978764 8222887 8061602 3085452 1907902 16050630 13948268 X 62844586 69539626 62844586 69539626 78895216 83487894 6788261 -93221 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2977 2977 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ARIZONA HOSPITAL ASSOCIATION (AHA) AND ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION (AZHHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES ARE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT AND THAT IS REPORTED BACK TO THE HOSPITAL AS A MEMBER. 1239431 1239431 36484138 11734087 24750051 81938 19289 62649 14325611 11397275 2928336 1534084 1534084 30514551 REFUNDABLE ADVANCE 1207902 UNEARNED GRANT REVENUE 700000 1907902 1 1 X 1 X 250.000000000000 1 X 1 1 0 0 295062 295062 0.00550 18194604 19818818 0 0.00000 18489666 19818818 295062 0.00550 7248922 3492174 3756748 0.06990 56749 56749 0.00110 7305671 3492174 3813497 0.07100 25795337 23310992 4108559 0.07650 1 977 977 0.00000 1 977 977 0.00000 0 1383544 691772 6216236 6382371 -166135 X 1 1 1 1 BISBEE HOSPITAL ASSOCIATION INC DBA COPPER QUEEN COMMUNITY 100 E 5TH ST DOUGLAS AZ 85607 HTTPS://CQCH.ORG/ RGH0098 X X X X BISBEE HOSPITAL ASSOCIATION INC 1 0 0 1 X X X X X X X X X 19 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION 1 19 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X WWW.CQCH.ORG/FINANCIAL-ASSISTANCE X WWW.CQCH.ORG/FINANCIAL-ASSISTANCE X WWW.CQCH.ORG/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 5: THE 2020 NEEDS SURVEY WAS DESIGNED TO ASSESS THE COMMUNITY MEMBERS' PERSPECTIVES, ATTITUDES AND FEELINGS ABOUT THE NEEDS IN THEIR COMMUNITY, NEIGHBORHOOD OR GROUP; ISSUES THEY PERCEIVE AS A COMMUNITY PROBLEM; AND THEIR DEFINITIONS OF "PERSONAL HEALTH AND "COMMUNITY HEALTH". THE SURVEY DEPLOYED WAS COMPOSED OF TWENTY-TWO QUESTIONS. SIX QUESTIONS COLLECTED DEMOGRAPHIC INFORMATION TO BETTER UNDERSTAND HOW NEEDS CORRELATED TO LOCATION. 170 SURVEYS WERE COLLECTED. EVERY COMMUNITY IN OUR SERVICE AREA WAS REPRESENTED IN THE RESPONSES RECEIVED. BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 6A: OTHER HOSPITAL FACILITIES:BENSON COMMUNITY HOSPITALNORTHERN COCHISE COMMUNITY HOSPITAL BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 6B: ORGANIZATIONS OTHER THAN HOSPITAL FACILITIES:COCHISE HEALTH AND SOCIAL SERVICESLEGACY FOUNDATION OF SOUTHEAST ARIZONA BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 11: THE HOSPITAL COLLABORATED WITH THE COCHISE COUNTY TO CONDUCT THE COCHISE COUNTY CHNA IN 2020. CHNA IDENTIFIED HEALTH CONCERNS FOR THE COCHISE COUNTY, INCLUDING DIABETES, OBESITY, AND AGING PROBLEMS. THE HOSPITAL IMPLEMENTED THE HEALTH LIVING PROGRAM, ANTIMICROBIAL STEWARDSHIP PROGRAM, MOBILE EYE CLINIC, 340B DRUG PROGRAM, AND HOSPITAL VACCINATION PROGRAM TO ADDRESS THE ISSUES IDENTIFIED IN THE CHNA.DURING THE YEAR, WE WERE NOT ABLE TO HAVE THE MOBILE EYE CLINIC DUE TO COVID, HOWEVER WE HAVE RESTARTED THAT PROGRAM IN 2021. WE ALSO ARE PUTTING FORTH EFFORT AROUND DIABETES BY WORKING WITH OUR INSURANCE COMPANIES TO IDENTIFY THOSE WHO NEED APPOINTMENTS AND HAVE HIRED A FULLTIME PERSON TO HELP COORDINATE GETTING THOSE IDENTIFIED APPOINTMENTS WITH OUR PROVIDERS. BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 13H: PURSUANT TO ARIZONA PUBLIC ACT 03-266, ANY UNINSURED (AS DEFINED BY THE ACT) HOSPITAL PATIENT WHOSE INCOME (ALONE, WITHOUT REGARD TO AVAILABLE ASSETS) FALLS BELOW 250% OF THE FPGS WILL NOT BE CHARGED MORE THAN THE HOSPITAL'S COST OF PROVIDING SERVICES TO THE PATIENT.THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE AND THERE IS A LACK OF CORRESPONDING SUPPORTING DOCUMENTATION. HOWEVER, THERE IS OFTEN ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH EXTERNAL SOURCES WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO OFFER THE PATIENT CHARITY CARE ASSISTANCE. IN THE EVENT THERE IS NO CONCRETE EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, CQCH MAY USE OUTSIDE SOURCES IN DETERMINING CHARITY CARE ELIGIBILITY PRESUMPTIVELY. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF THE PRESUMPTIVE CIRCUMSTANCES, THE DISCOUNT THAT WILL BE GRANTED IS A 100% WRITE OFF OF THE ACCOUNT BALANCE. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES INCLUDING:(1) HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC(2) DECEASED WITH NO SPOUSE AND NO ESTATE(3) APPROVED BY THE COURT FOR BANKRUPTCY BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 16J: CQCH PROVIDES AN ADVOCATE AT LOCAL HEALTH FAIRS PUT ON BY THE HOSPITAL OR OTHERS TO INFORM COMMUNITY MEMBERS OF THE BENEFIT AND ASSIST IF NEEDED. WE ALSO ADVERTISE ON SOCIAL MEDIA LETTING PATIENTS KNOW WE HAVE SOMEONE AVAILABLE MON-FRI TO HELP DISCUSS AND ASSIST WITH FILLING OUT THE ASSISTANCE PAPERWORK. PART V, SECTION B, LINE 7A: HTTPS://WWW.CQCH.ORG/_FILES/UGD/6B8C2F_30439C574A174754948A039079A5A945.PDF PART V, SECTION B, LINE 10A: HTTPS://WWW.CQCH.ORG/PRICING-TRANSPARENCY 5 1 - PALOMINAS PRIMARY CARE CLINIC 10524 HIGHWAY 92 PALOMINAS AZ 85615 RURAL HEALTH CLINIC/PHYSICAL THERAPY 2 - DOUGLAS PRIMARY CARE CLINIC 100 E 5TH ST DOUGLAS AZ 85607 RURAL HEALTH CLINIC/QUICK CARE 3 - BISBEE PRIMARY CARE CLINIC 7 BISBEE ROAD BISBEE AZ 85603 RURAL HEALTH CLINIC 4 - TOMBSTONE PRIMARY CARE CLINIC 7 N SAN DIEGO ST TOMBSTONE AZ 85638 RURAL HEALTH CLINIC 5 - HEREFORD PRIMARY CARE CLINIC 4524 E HEREFORD ROAD HEREFORD AZ 85615 RURAL HEALTH CLINIC/PHYSICAL THERAPY PART I, LINE 3C: A PATIENT WILL BE DEEMED TO HAVE FINANCIAL NEED BASED ON THE FEDERAL POVERTY LEVELS (FPG) IN EFFECT FROM TIME TO TIME. INCOME INCLUDES SALARIES AND WAGES, LEGAL JUDGMENTS, UNEMPLOYMENT COMPENSATION, WORKER'S COMPENSATION, DIVIDENDS, INTEREST CHECKS AND OTHER RECURRENT SOURCES OF INCOME. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FROM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,567,790. PART II, COMMUNITY BUILDING ACTIVITIES: WE RESTARTED OUR LIONS CLUB EYE EXAMS, WHICH WE PAY FOR, FOR THE COMMUNITY. WE HELD A FEW FREE PRODUCE GIVE AWAYS FOR OUR EMPLOYEES AND MEMBERS OF THE COMMUNITY. WE ALSO OFFER OUR MENTAL HEALTH PROFESSIONAL TO OUR AREA FIREFIGHTERS, POLICE AND EMT'S WHEN THERE IS A TRAGIC ACCIDENT OR DEATH OF CHILDREN. WE ALSO DO SEVERAL OUTREACH TEACHINGS AT OUR LOCAL SENIOR HOMES AS WELL AS IN OUR SCHOOLS. DIFFERENT TOPICS WOULD BE NUTRITION, PROPER HYGIENE, AND UNDERSTANDING YOUR NUMBERS (BLOOD PRESSURE, A1C). PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: FOOTNOTE 1 OF FINANCIAL STATEMENTS: PATIENT ACCOUNTS RECEIVABLE ARE REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE ARE RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS THAT REFLECT MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A DEBT COLLECTION POLICY THAT INCORPORATES THE REQUIREMENTS OF 501(R). THE POLICY DEFINES THE PROCEDURES FOR REASONABLE EFFORTS NECESSARY TO PERFORM PRIOR TO ENGAGING IN COLLECTION EFFORTS AND EXTRAORDINARY COLLECTION ACTIONS. THE POLICY PROVIDES A TIMELINE FOR CERTAIN TOUCHPOINTS WITH A PATIENT TO ENSURE THEY ARE INCLUDED IN THE FINANCIAL ASSISTANCE PROGRAM IF ELIGIBLE. THE POLICY ALSO ADDRESS THE CEASE OF ACTIONS WHEN ELIGIBILITY OR POTENTIAL ELIGIBILITY IS DISCOVERED WHILE IN PROGRESS OF COLLECTION ACTIVITIES. PART VI, LINE 2: CQCH DID ANOTHER SURVEY TO PATIENTS ASKING ABOUT HEALTHCARE NEEDS FOR THEM AND OUR COMMUNITY. WE CONTINUE TO COLLABORATE WITH OUTSIDE ORGANIZATIONS TO UTILIZE THE DATA TO ASSESS THE HEALTH CARE NEEDS IN THE COMMUNITY. CQCH ALSO STARTED A PATIENT FAMILY PARTNERSHIP COUNCIL WHICH MEETS MONTHLY TO GO OVER PERSONAL CONCERNS OR AREAS THAT OUR ORGANIZATION CAN IMPROVE PATIENT CARE AND SATISFACTION. PART VI, LINE 3: CQCH HIRED A NEW PATIENT ADVOCATE TO WORK WITH PATIENTS AND ASSIST WITH ELIGIBILITY AND BILLING QUESTIONS AND CONCERNS. WE ALSO HAND OUT ASSISTANCE PACKAGES WHEN WE HAVE PATIENTS PRESENT WITHOUT INSURANCE. WE CONTINUE TO USE 250% OF POVERTY GUIDELINES TO HELP MORE OF OUR COMMUNITY. CQCH ALSO GOES THROUGH OUR SELF-PAY PATIENTS AND SEND OUT FINANCIAL ASSISTANCE PACKETS TO THEM AS WELL AS FOLLOW UP WITH PHONE CALLS. PART VI, LINE 4: LOCATED IN THE SOUTHEAST CORNER OF ARIZONA AND COVERING MORE THAN FOUR MILLION ACRES (6,165 SQUARE MILES), THIS COUNTY CONTAINS AN ACTIVE MILITARY BASE, RANCHES AND FARMS, SIGHTSEEING DESTINATIONS AND IT BORDERS THE COUNTRY OF MEXICO TO ITS SOUTH.ACCORDING TO ESTIMATES BY THE US CENSUS BUREAU, IN 2020 THE COUNTY WAS HOME TO 125,447 PEOPLE FROM ALL TYPES OF BACKGROUNDS, WITH A VARIETY OF SOCIAL, ECONOMIC, AND HEALTHCARE NEEDS. THE COUNTY'S RESIDENTS COME FROM DIVERSE CULTURES AND LIFESTYLES, FROM TOMBSTONE TO BISBEE, TO SIERRA VISTA AND FORT HUACHUCA, FROM WILLCOX TO DOUGLAS AND ALL OF THE RURAL UNINCORPORATED TOWNS IN BETWEEN AND ALONG THE MEXICAN BORDER.UNLIKE THE MAJORITY OF COUNTIES IN ARIZONA, COCHISE COUNTY CONTINUES TO SEE A DECLINE IN POPULATION. THE US CENSUS BUREAU'S 2021 POPULATION ESTIMATES INDICATE THERE ARE NOW 126,050 RESIDENTS IN THE COUNTY. PART VI, LINE 5: -AT EACH OF OUR RHC'S WE HOLD ANNUAL HEALTH FAIR TO HELP EDUCATE THE COMMUNITY ABOUT OUR ORGANIZATION AND OUTSIDE ORGANIZATIONS - $3,500 -CQCH PARTICIPATES IN BOTH THE PALOMINO'S AND SIERRA VISTA SCHOOL DISTRICTS ANNUAL EMPLOYEE WELLNESS EVENTS. SCHOLARSHIPS FOR HIGH SCHOOL STUDENTS $17,500 -PARTNERS WITH BORDERLANDS PRODUCE TO BRING FRESH FRUITS AND VEGETABLES TO DOUGLAS AND PALOMINO'S $32,000 -ATTENDS LOCAL HEALTH FAIRS AND EVENTS $5,000 -COLLABORATES WITH COCHISE COUNTY HEALTH DEPARTMENT AND COORDINATES ADVERTISING $7,500. PART VI, LINE 6: N/A 1 COPPER QUEEN COMMUNITY HOSPITAL FOUNDATION 101 COLE AVENUE BISBEE AZ 85603 842690938 501(C)(3) 50000 0 ANNUAL PAYMENT TO DICKSON FUND THROUGH FOUNDATION 1 0 PART I, LINE 2: THE ORGANIZATION HAS A LEADERSHIP MEETING TO REVIEW FUNDING REQUESTS AND EVALUATES THOSE IN LIGHT OF THE ORGANIZATION'S MISSION FOR IMPROVING THE QUALITY OF HEALTH CARE IN SOUTHERN ARIZONA. X X X X 0 0 0 0 0 0 0 0 0 SUZANNE DALY GASTROENTEROLOGY PHYSICIAN 519068 0 15958 0 0 0 26000 0 7900 0 568926 0 0 0 ROBERT SEAMON CEO 307683 0 70580 0 0 0 26000 0 7900 0 412163 0 0 0 HEIDI LODGE INTERNAL MEDICINE PHYSICIAN 323936 0 53398 0 0 0 25000 0 9460 0 411794 0 0 0 EDWARD MILLER SURGICAL PHYSICIAN 310000 0 63016 0 0 0 25000 0 9460 0 407476 0 0 0 CRISTIAN LAGUILLO FAMILY PHYSICIAN 334016 0 20333 0 4808 0 19000 0 9460 0 387617 0 0 0 RICHARD SNURE SURGICAL PHYSICIAN 352772 0 1810 0 0 0 19500 0 7900 0 381982 0 0 0 HEATHER LUNDSTROM CFO 163962 0 68490 0 0 0 6500 0 11460 0 250412 0 0 0 JAMES LUNDSTROM HUSBAND OF CFO 107996 EMPLOYMENT COMPENSATION 0 JOEY DEETER PARTNER OF CEO 64946 EMPLOYMENT COMPENSATION 0 MEYSA ROBERTS DAUGHTER OF CFO 10162 EMPLOYMENT COMPENSATION 0 FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT 990 FORM AND RELATED SCHEDULES ARE SENT TO AND REVIEWED BY BOARD MEMBERS AND MANAGEMENT BEFORE FILING. COMMENTS AND CHANGES ARE COMMUNICATED WITH THE TAX PREPARER AND ADDRESSED ACCORDINGLY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR HAVING A CONFLICT OF INTEREST ON ANY MATTER BEING CONSIDERED BY THE BOARD OF DIRECTORS SHALL DISCLOSE TO THE OTHER DIRECTORS THE EXISTENCE OF SUCH CONFLICT OF INTEREST, AND THE DISCLOSURE SHALL BE NOTED IN THE MINUTES OF THE MEETING AND SUCH DIRECTOR SHALL ABSTAIN FROM ANY FURTHER ACTION OF DISCUSSION CONCERNING SAID ITEM OF BUSINESS, AND MAY BE REQUIRED TO REMOVE HIM/HERSELF FROM THE FORUM. THE FOREGOING REQUIREMENT SHALL NOT BE CONSTRUED SO AS TO PREVENT A DIRECTOR HAVING A CONFLICT OF INTEREST WITH THE CORPORATION FROM ANSWERING PERTINENT QUESTIONS OF OTHER DIRECTORS CONCERNING SAID ITEM OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION IS SET BY THE BOARD BASED UPON REVIEW OF A BI-ANNUAL SALARY SURVEY BY THE ARIZONA HOSPITAL ASSOCIATION. THE HOSPITAL ALSO CONTRACTS WITH AN OUTSIDE CONSULTANT WHO ADVISES THE BOARD REGARDING EXECUTIVE COMPENSATION. THIS PROCESS IS UTILIZED IN SETTING SALARIES OF ALL THE EXECUTIVE TEAM AT THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE TO THE PUBLIC THROUGH THE STATE UAR REPORT AND THE FEDERAL MEDICARE COST REPORT. FORM 990, PART IX, LINE 11G LAB SERVICES: PROGRAM SERVICE EXPENSES 1,525,452. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,525,452. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,987,187. MANAGEMENT AND GENERAL EXPENSES 490,633. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,477,820. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 831,048. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 831,048. ANESTHESIOLOGIST SERVICES: PROGRAM SERVICE EXPENSES 154,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 154,943. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 180,201. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 180,201.