2022-05-05T09:12:27-05:00 2021-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2020-07-01 860334996 BISBEE HOSPITAL ASSOCIATION INC BISB 5204325383 101 COLE AVE BISBEE AZ 85603 ROBERT SEAMON CEO 5204325383 2022-04-26 1 ROBERT SEAMON 999009999 MICHAEL J PETERSON CPA P01833529 2187224705 2022-04-26 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z COPPER QUEEN COMMUNITY HOSPITAL ROBERT SEAMON 101 COLE AVE BISBEE AZ 85603 59864589 0 X WWW.CQCH.ORG X 1977 AZ TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY. 11 11 468 13 0 0 5430730 4391403 47752821 55297239 253608 24922 85367 135953 53522526 59849517 141236 186486 0 0 23570009 25012124 0 0 0 22291546 23678274 46002791 48876884 7519735 10972633 70289811 78895216 18344395 16050630 51945416 62844586 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 37554908 186486 55336809 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. 37554908 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 0 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 11 11 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 0 0 0 PETE CAMPBELL DIRECTOR 1.00 X 0 0 0 PETER CARBERRY DIRECTOR(THRU JANUARY) 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 303557 0 10327 HEATHER LUNDSTROM CFO 40.00 X 166874 0 13203 SUZANNE DALY GASTROENTEROLOGY PHYSICIAN 40.00 X 575275 0 16293 CRISTIAN LAGUILLO FAMILY PHYSICIAN 40.00 X 250539 0 8526 HEIDI LODGE INTERNAL MEDICINE PHYSICIA 40.00 X 327365 0 13065 EDWARD MILLER SURGICAL PHYSICIAN 40.00 X 315125 0 14076 RICHARD SNURE SURGICAL PHYSICIAN 32.00 X 339987 0 6793 2278722 0 82283 61 0 1 0 DIVERSIFIED DESIGN 3237 E FT LOWELL RD TUSCON AZ 85716 CONSTRUCTION CONTRACTOR 2303742 AERGO SOLUTIONS LLC 33 WOOD AVENUE S ISELIN NJ 08830 FINANCIAL SERVICES 1304437 CERNER 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 COMPUTER SUPPORT 760447 JOHN WAYTUK 1048 SUSAN LAKE TEMPE AZ 85281 MEDICAL PROVIDER 566360 JULIA BROWN 3807 N CAMINO DE OESTE TUSCON AZ 85745 MEDICAL PROVIDER 324428 40 4231733 159670 4391403 PATIENT SERVICE REVENUE 621400 54239546 54239546 340B REVENUE 621400 1057693 1057693 55297239 39994 39994 15072 -15072 -15072 -15072 CAFETERIA 722514 89537 89537 MEDICAL RECORDS 561000 2960 2960 43456 39570 3886 135953 59849517 55336809 0 121305 X 186486 186486 493962 493962 19572930 15873429 3699501 402781 324436 78345 3174270 2527063 647207 1368181 1083538 284643 125007 125007 39454 39454 1712407 1712407 6940699 6075827 864872 486209 1592 484617 183401 91693 91708 659609 60681 598928 1619730 810460 809270 335706 300495 35211 46079 9942 36137 290332 216551 73781 2299281 1714975 584306 482937 482937 SUPPLIES EXPENSE 4151312 4142553 8759 BAD DEBT EXPENSE 3559738 3559738 REPAIRS AND MAINTENANCE 505690 503701 1989 DUES AND SUBSCRIPTIONS 126469 24704 101765 114214 47044 67170 48876884 37554908 11321976 0 29427218 33981303 6947588 6522766 6860057 9026301 1172866 1416069 414125 616978 48623418 21929375 24911925 26694043 233620 637756 322412 0 70289811 78895216 5176375 4742291 8511537 8222887 4656483 3085452 18344395 16050630 X 51945416 62844586 51945416 62844586 70289811 78895216 X 10972633 69497 -142960 X X 0 1 X 1 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3973 3973 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ARIZONA ALLIANCE FOR COMMUNITY HEALTH CENTERS (AACHC). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE ORGANIZATION ALSO PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION (AZHHA). A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. 1193761 1193761 30415535 11199027 19216508 50318 9225 41093 13013874 10721123 2292751 3949930 3949930 26694043 REFUNDABLE ADVANCE 2352334 UNEARNED GRANT REVENUE 300000 ACCOUNTS PAYABLE TO THIRD-PARTY REIMBURSEMENT PROGRAMS 433118 3085452 1 1 X 1 X 250.000000000000 1 X 1 1 0 0 202271 202271 0.00410 14500477 16592260 0 0.00000 14702748 16592260 202271 0.00410 5051509 2514456 2537053 0.05190 203986 203986 0.00420 5255495 2514456 2741039 0.05610 19958243 19106716 2943310 0.06020 0 907891 453945 5787842 5978905 -191063 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 1 1 X X X X 1 X WWW.CQCH.ORG/RESOURCES/COMMUNITY/ X WWW.CQCH.ORG/RESOURCES/COMMUNITY/ X WWW.CQCH.ORG/RESOURCES/COMMUNITY/ 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 FOR 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. PART V, SECTION B, LINE 7A: HTTPS://CQCH.ORG/WP-CONTENT/UPLOADS/2020/06/CQCH-2019-CHIP.CHNA_.PDF PART V, SECTION B, LINE 10A: HTTPS://CQCH.ORG/WP-CONTENT/UPLOADS/2020/06/CQCH-2019-CHIP.CHNA_.PDF 4 1 - CQHC - DOUGLAS PRIMARY CARE CLINIC 100 E 5TH ST DOUGLAS AZ 85607 RURAL HEALTH CLINIC/QUICK CARE 2 - CQHC - BISBEE PRIMARY CARE CLINIC 101 COLE AVE BISBEE AZ 85603 RURAL HEALTH CLINIC 3 - CQHC - PALOMI PRIMARY CARE CLINIC 10524 HIGHWAY 92 HEREFORD AZ 85615 RURAL HEALTH CLINIC 4 - CQHC - TOMBSTONE PRIMARY CARE CLINIC 7 N SAN DIEGO ST TOMBSTONE AZ 85638 RURAL HEALTH CLINIC 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 7G: THE ORGANIZATION INCLUDED THE ACTIVITY OF FOUR RURAL HEALTH CLINICS FOR SUBSIDIZED HEALTH SERVICES. PART II, COMMUNITY BUILDING ACTIVITIES: WE DID NOT PERFORM IN 2021 DUE TO COVID-19. 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 IS RECORDED IN THE ACCOMPANYING BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS AND AN ALLOWANCE FOR DOUBTFUL ACCOUNTS, WHICH REFLECT MANAGEMENT'S BEST ESTIMATE OF THE AMOUNTS THAT WILL NOT BE COLLECTED. MANAGEMENT PROVIDES FOR CONTRACTUAL ADJUSTMENTS UNDER TERMS OF THIRD-PARTY REIMBURSEMENT AGREEMENTS THROUGH A REDUCTION OF GROSS PATIENT SERVICE REVENUE AND A CREDIT TO ACCOUNTS RECEIVABLE. IN ADDITION, MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY FROM UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS.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 CREATED AND DISTRIBUTED A SURVEY TO PATIENTS ASKING ABOUT THEIR HEALTHCARE NEEDS. ADDITIONALLY, WE COLLABORATE WITH OUTSIDE ORGANIZATIONS AND UTILIZE DATA THEY COMPILE TO ASSESS THE HEALTH CARE NEEDS IN OUR COMMUNITY. PART VI, LINE 3: CQCH ADDED TWO PATIENT ADVOCATES TO WORK WITH PATIENTS AND ASSIST WITH ELIGIBILITY. WHEN THEY AREN'T AVAILABLE OR UNDER URGENT NEEDS THIS IS DONE AT TIME OF ADMISSION. WE HAVE ALSO REVISED OUR ASSISTANCE TO 250% OF POVERTY GUIDELINES TO HELP MORE OF OUR COMMUNITY. WE HAVE ALSO EXTENDED THE POLICY DURING COVID TO THOSE WHO APPLIED FOR THE MEDICAID PROGRAM BUT WHO WERE NOT GETTING TIMELY RESPONSES DUE TO MOST ENTITIES EITHER BEING CLOSED OR EMPLOYEES WORKING FROM HOME. CQCH HAS ALLOWED THEM A 6 MONTH CHARITY GRACE PERIOD WHILE WAITING FOR THEIR ELIGIBILITY. 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 2010 THE COUNTY WAS HOME TO 131,346 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 2015 POPULATION ESTIMATES INDICATE THERE ARE NOW 126,427 RESIDENTS IN THE COUNTY, THE FOURTH ANNUAL DECLINE IN THE PAST FIVE YEARS. 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 - $3500 CQCH PARTICIPATES IN BOTH THE PALOMINO'S AND SIERRA VISTA SCHOOL DISTRICTS ANNUAL EMPLOYEE WELLNESS EVENTS . SCHOLARSHIPS FOR HIGH SCHOOL STUDENTS $17,500 SPONSORS LOCAL HEALTH FOCUSED EVENTS PUT OF BY PARTNER ORGANIZATIONS $25,000 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) 100000 TO START JAMES DICKSON SCHOLARSHIP CITY OF BISBEE 76 ERIE STREET BISBEE AZ 85603 866000235 GOV'T 33000 FOR EMERGENCY RADIOS COCHISE COLLEGE FOUNDATION 4190 W HWY 80 DOUGLAS AZ 85607 860211414 501(C)(3) 20000 FUNDS PROVIDED FOR A VIRTUAL CADAVER 3 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 573845 0 1430 0 0 0 9500 0 6793 0 591568 0 0 0 RICHARD SNURE SURGICAL PHYSICIAN 338539 0 1448 0 0 0 0 0 6793 0 346780 0 0 0 HEIDI LODGE INTERNAL MEDICINE PHYSICIA 322296 0 5069 0 0 0 4712 0 8353 0 340430 0 0 0 EDWARD MILLER SURGICAL PHYSICIAN 310000 0 5125 0 0 0 5723 0 8353 0 329201 0 0 0 ROBERT SEAMON CEO 275827 0 27730 0 0 0 3534 0 6793 0 313884 0 0 0 CRISTIAN LAGUILLO FAMILY PHYSICIAN 245426 0 5113 0 0 0 173 0 8353 0 259065 0 0 0 HEATHER LUNDSTROM CFO 163300 0 3574 0 0 0 3350 0 9853 0 180077 0 0 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 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, WHICH 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 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 1,271,395. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,271,395. OTHER: PROGRAM SERVICE EXPENSES 4,280,699. MANAGEMENT AND GENERAL EXPENSES 168,412. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,449,111. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 235,570. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 235,570. ANESTHESIOLOGIST SERVICES: PROGRAM SERVICE EXPENSES 94,483. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,483. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 193,680. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 193,680. INFORMATION SYSTEMS SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 696,460. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 696,460. FORM 990, PART XI, LINE 9: TRANSFER OF NET ASSETS TO FOUNDATION -142,960. FORM 990, PART XII, LINE 2C: THE PROCESS HAS NOT CHANGED SINCE THE PRIOR YEAR. FORM 990, PART XII, LINE 3B THE ORGANIZATION IS REQUIRED TO BE INCLUDED IN A SINGLE AUDIT FOR THE YEAR ENDED 06/30/2021. THE DEADLINE FOR THIS FILING FALLS AFTER THE DEADLINE FOR THE 990 FOR THE SAME FISCAL YEAR END. THE SINGLE AUDIT WILL NOT BE FINALIZED AT THE TIME OF THIS SUBMISSION.