BISBEE HOSPITAL ASSOCIATION: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- BISBEE HOSPITAL ASSOCIATION (EIN 86-0334996)
- Tax period
- 2019-07-01 to 2020-06-30
- Filed
- 2021-05-06
- IRS object ID
- 202141269349300139
- Schema version
- 2019v5.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2021-05-06T12:01:45-05:00 | ReturnTs |
| Tax Period End | 2020-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 390758449 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WIPFLI LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1502 LONDON ROAD SUITE 200 | AddressLine1Txt |
| City | DULUTH | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 55812 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860334996 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BISBEE HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BISB | BusinessNameControlTxt |
| Phone | 5204325383 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85603 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROBERT SEAMON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5204325383 | PhoneNum |
| Signature | 2021-05-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MICHAEL J PETERSON CPA | PreparerPersonNm |
| PTIN | P01833529 | PTIN |
| Phone | 2187224705 | PhoneNum |
| Preparation | 2021-05-04 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROBERT SEAMON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85603 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $53,539,791 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CQCH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1977 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 446 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $109,206 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,430,730 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $49,151,870 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $47,752,821 | CYProgramServiceRevenueAmt |
| PY Investment Income | $231,010 | PYInvestmentIncomeAmt |
| CY Investment Income | $253,608 | CYInvestmentIncomeAmt |
| PY Other Revenue | $158,413 | PYOtherRevenueAmt |
| CY Other Revenue | $85,367 | CYOtherRevenueAmt |
| PY Total Revenue | $49,650,499 | PYTotalRevenueAmt |
| CY Total Revenue | $53,522,526 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $106,977 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $141,236 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,974,106 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $23,570,009 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,649,436 | PYOtherExpensesAmt |
| CY Other Expenses | $22,291,546 | CYOtherExpensesAmt |
| PY Total Expenses | $41,730,519 | PYTotalExpensesAmt |
| CY Total Expenses | $46,002,791 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $7,919,980 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $7,519,735 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $57,680,811 | TotalAssetsBOYAmt |
| Total Assets EOY | $70,289,811 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $13,266,667 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $18,344,395 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $44,414,144 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $51,945,416 | NetAssetsOrFundBalancesEOYAmt |
| Mission | 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. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $37,455,634 | ExpenseAmt |
| Grant | $141,236 | GrantAmt |
| Revenue | $47,752,821 | RevenueAmt |
| Desc | 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. | Desc |
| Total Program Service Expenses | $37,455,634 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | 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 | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | 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 | Yes (1) | 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 | 132 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 446 | 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 | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HEATHER LUNDSTROM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5204325383 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85603 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| SUZANNE DALY | |||||||
| GASTROENTEROLOGY PHYSICIAN | 40.00 | Yes (X) | $620,122 | $0 | $7,193 | ||
| CRISTIAN LAGUILLO | |||||||
| FAMILY PHYSICIAN | 40.00 | Yes (X) | $353,961 | $0 | $9,284 | ||
| HEIDI LODGE | |||||||
| INTERNAL MEDICINE PHYSICIAN | 40.00 | Yes (X) | $322,142 | $0 | $25,235 | ||
| EDWARD MILLER | |||||||
| SURGICAL PHYSICIAN | 40.00 | Yes (X) | $326,923 | $0 | $9,871 | ||
| RICHARD SNURE | |||||||
| SURGICAL PHYSICIAN | 40.00 | Yes (X) | $320,272 | $0 | $15,123 | ||
| ROBERT SEAMON | |||||||
| CEO | 40.00 | $314,904 | $0 | $7,836 | Yes (X) | ||
| HEATHER LUNDSTROM | |||||||
| CFO | 40.00 | $193,644 | $0 | $8,984 | Yes (X) | ||
| DENNIS GALLUS | |||||||
| PRESIDENT | 3.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ROBERT HOWELL | |||||||
| VICE PRESIDENT (THRU NOVEMBER) | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| REBECCA OROZCO | |||||||
| VICE PRESIDENT | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| KATHLEEN HEARD | |||||||
| TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ROSALIE BUTLER | |||||||
| SECRETARY | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| PETER CARBERRY | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| LAURA CHAVEZ | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| PATRICK COGHLAN MD | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| LAWANA DIFFLE | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| GARY DILLARD | |||||||
| DIRECTOR (THRU OCTOBER) | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| ROSA ANEL LOPEZ | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| DENNIS NELSON | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| SYLVIA VALENZUELA | |||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,451,968 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $83,526 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 26 | 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 |
|---|---|---|---|---|---|
| CERNER | |||||
| 2800 ROCKCREEK PKWY | KANSAS CITY | MO | 64117 | COMPUTER SUPPORT | $692,328 |
| JOHN WAYTUK | |||||
| 1048 SUSAN LANE | TEMPE | AZ | 85281 | MEDICAL PROVIDER | $570,300 |
| AERGO | |||||
| 33 WOOD AVENUE S | ISELIN | NJ | 08830 | FINANCIAL SERVICES | $436,901 |
| JULIA BROWN | |||||
| 3807 N CAMINO DE OESTE | TUCSON | AZ | 85745 | MEDICAL PROVIDER | $375,640 |
| CALVIN A SCHULER | |||||
| PO BOX 456 | DRAGOON | AZ | 85609 | MEDICAL PROVIDER | $318,540 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 28 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $30,994 | FundraisingAmt |
| Government Grants | $5,281,546 | GovernmentGrantsAmt |
| All Other Contributions | $118,190 | AllOtherContributionsAmt |
| Total Contributions | $5,430,730 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $46,440,017 | $46,440,017 |
| 340B REVENUE | 621400 | $1,312,804 | $1,312,804 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $47,752,821 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $251,608 | TotalRevenueColumnAmt |
| Exclusion | $251,608 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,000 | TotalRevenueColumnAmt |
| Exclusion | $2,000 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $6,900 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $30,994 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $17,265 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$10,365 | TotalRevenueColumnAmt |
| Exclusion | -$10,365 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 722514 | $80,217 | $80,217 |
| MEDICAL RECORDS | 561000 | $5,839 | $5,839 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,676 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $6,264 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $3,412 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $95,732 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $53,522,526 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $47,759,085 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $332,711 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,441 | TotalAmt |
| Program Services | $139,441 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,795 | TotalAmt |
| Program Services | $1,795 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $525,367 | TotalAmt |
| Management And General | $525,367 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,593,599 | TotalAmt |
| Program Services | $16,266,345 | ProgramServicesAmt |
| Management And General | $2,327,254 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $292,970 | TotalAmt |
| Program Services | $249,476 | ProgramServicesAmt |
| Management And General | $43,494 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,856,680 | TotalAmt |
| Program Services | $2,446,903 | ProgramServicesAmt |
| Management And General | $409,777 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,301,393 | TotalAmt |
| Program Services | $1,108,190 | ProgramServicesAmt |
| Management And General | $193,203 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $94,542 | TotalAmt |
| Management And General | $94,542 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,752 | TotalAmt |
| Management And General | $39,752 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,243,981 | TotalAmt |
| Management And General | $1,243,981 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,222,361 | TotalAmt |
| Program Services | $5,308,146 | ProgramServicesAmt |
| Management And General | $914,215 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,520 | TotalAmt |
| Program Services | $6,205 | ProgramServicesAmt |
| Management And General | $581,315 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,547 | TotalAmt |
| Program Services | $106,680 | ProgramServicesAmt |
| Management And General | $120,867 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $535,187 | TotalAmt |
| Program Services | $79,811 | ProgramServicesAmt |
| Management And General | $455,376 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,017,849 | TotalAmt |
| Program Services | $777,040 | ProgramServicesAmt |
| Management And General | $240,809 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $446,902 | TotalAmt |
| Program Services | $370,592 | ProgramServicesAmt |
| Management And General | $76,310 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,719 | TotalAmt |
| Program Services | $18,525 | ProgramServicesAmt |
| Management And General | $34,194 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $298,100 | TotalAmt |
| Program Services | $237,875 | ProgramServicesAmt |
| Management And General | $60,225 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,358,015 | TotalAmt |
| Program Services | $1,881,626 | ProgramServicesAmt |
| Management And General | $476,389 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $465,815 | TotalAmt |
| Management And General | $465,815 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES EXPENSE | $4,015,913 | $4,005,701 | $10,212 |
| BAD DEBT EXPENSE | $3,946,635 | $3,946,635 | |
| REPAIRS AND MAINTENANCE | $459,686 | $455,117 | $4,569 |
| DUES AND SUBSCRIPTIONS | $138,635 | $30,717 | $107,918 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $140,387 | TotalAmt |
| Program Services | $18,814 | ProgramServicesAmt |
| Management And General | $121,573 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,002,791 | TotalAmt |
| Program Services | $37,455,634 | ProgramServicesAmt |
| Management And General | $8,547,157 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,956,601 | BOYAmt |
| EOY | $29,427,218 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,199,476 | BOYAmt |
| EOY | $6,947,588 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,215,494 | BOYAmt |
| EOY | $6,860,057 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $969,262 | BOYAmt |
| EOY | $1,172,866 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $499,745 | BOYAmt |
| EOY | $414,125 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $45,692,904 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $20,780,979 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,615,329 | BOYAmt |
| EOY | $24,911,925 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $224,904 | BOYAmt |
| EOY | $233,620 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $322,412 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,680,811 | BOYAmt |
| EOY | $70,289,811 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,397,813 | BOYAmt |
| EOY | $5,176,375 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,825,745 | BOYAmt |
| EOY | $8,511,537 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $43,109 | BOYAmt |
| EOY | $4,656,483 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,266,667 | BOYAmt |
| EOY | $18,344,395 | 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 | $44,414,144 | BOYAmt |
| EOY | $51,945,416 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,414,144 | BOYAmt |
| EOY | $51,945,416 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $57,680,811 | BOYAmt |
| EOY | $70,289,811 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $7,519,735 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $11,537 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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 C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,884 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,884 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,193,761 | OtherCostOrOtherBasisAmt |
| Book Value | $1,193,761 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $30,396,601 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,264,377 | DepreciationAmt |
| Book Value | $20,132,224 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,598,879 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,516,602 | DepreciationAmt |
| Book Value | $3,082,277 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $503,663 | OtherCostOrOtherBasisAmt |
| Book Value | $503,663 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,911,925 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | REFUNDABLE ADVANCE | Desc |
| Amt | $4,656,483 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,656,483 | TotalLiabilityAmt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | GOLF TOURNAMENT | Event1Nm |
| Gross Receipts Event1 | $37,894 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $30,994 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $6,900 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $1,261 | NonCashPrizesEvent1Amt |
| Rent Facility Costs Event1 | $3,760 | RentFacilityCostsEvent1Amt |
| Entertainment Event1 | $6,900 | EntertainmentEvent1Amt |
| Other Direct Expenses Event1 | $5,344 | OtherDirectExpensesEvent1Amt |
| Gross Receipts Total | $37,894 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $30,994 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $6,900 | GrossRevenueTotalEventsAmt |
| Non Cash Prizes Total Events | $1,261 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $3,760 | RentFcltyCostsTotalEventsAmt |
| Entertainment Total Events | $6,900 | EntertainmentTotalEventsAmt |
| Oth Direct Expnss Total Events | $5,344 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $17,265 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$10,365 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| 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 | $114,364 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $114,364 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,151,028 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,105,669 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,045,359 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06620 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,265,392 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,105,669 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,159,723 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06870 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,125,695 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,539,578 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,586,117 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05620 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,375 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $70,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,196,070 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,539,578 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,656,492 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05770 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,461,462 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,645,247 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,816,215 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12640 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $999,239 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $499,619 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,254,541 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,324,265 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$69,724 | 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 | BISBEE HOSPITAL ASSOCIATION INC DBA COPPER QUEEN COMMUNITY | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E 5TH ST | AddressLine1Txt |
| City | DOUGLAS | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85607 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HTTPS://CQCH.ORG/ | WebsiteAddressTxt |
| State License | RGH0098 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BISBEE HOSPITAL ASSOCIATION 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SUPPLEMENTAL INFORMATION | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SUPPLEMENTAL INFORMATION | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 | WWW.CQCH.ORG/RESOURCES/COMMUNITY/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.CQCH.ORG/RESOURCES/COMMUNITY/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.CQCH.ORG/RESOURCES/COMMUNITY/ | 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 |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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. |
| 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 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 |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 THREE RURAL HEALTH CLINICS FOR SUBSIDIZED HEALTH SERVICES. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | CQCH SUPPORTS THE LION MOBILE EYE UNIT BY DONATING $16,000 PER YEAR. THIS ORGANIZATION PROVIDES FREE EYE EXAMS AND EYE GLASSES TO THOSE WHO ARE UNINSURED OR UNDERINSURED. A DONATION IS MADE IN THE AMOUNT OF $5,000 FOR HEALTHCARE SCHOLARSHIP. THIS IS THROUGH A PROGRAM WITH BISBEE HIGH SCHOOL AND DOUGLAS HIGH SCHOOL. MULTIPLE $250 DONATIONS ARE MADE ANNUALLY TO SUPPORT LOCAL LITTLE LEAGUE TEAMS, POP WARNER FOOTBALL TEAMS AND CHEER LEADING. ALL DONATIONS SUPPORT HEALTH AND WELLNESS THEMED ORGANIZATIONS AND EVENTS. |
| 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 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 - $3,500. CQCH PARTICIPATES IN BOTH THE PALOMINAS AND SIERRA VISTA SCHOOL DISTRICTS ANNUAL EMPLOYEE WELLNESS EVENTS - $1,500 LIONS CLUB MOBILE EYE UNIT $16,000 (PROVIDES EYE GLASS AND EXAMS TO UNINSURED OR UNDERINSURED). SCHOLARSHIPS FOR HIGH SCHOOL STUDENTS $12,500 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 PALOMINAS $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 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Recipient EINRecipientEIN | IRC SectionIRCSectionDesc | Cash GrantCashGrantAmt | Purpose Of GrantPurposeOfGrantTxt |
|---|---|---|---|---|---|---|---|
| CITY OF BISBEE | |||||||
| 76 ERIE STREET | BISBEE | AZ | 85603 | 866000235 | GOV'T | $40,000 | FOR RADIOS AND A 911 TOWER |
| DIABETES PREVENTION AND AID FUND | |||||||
| 270 W PRODUCE RESCUE | NOGALES | AZ | 85621 | 860804743 | 501(C)(3) | $20,375 | PAID FOR PRODUCE FOR THE COMMUNITIES. |
| BISBEE VOGUE | |||||||
| PO BOX 1099 | BISBEE | AZ | 85603 | 860713130 | 501(C)(3) | $10,000 | SPONSORED COMMUNITY STAIR CLIMB. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 3 | Total501c3OrgCnt |
| Total Other Org | 0 | TotalOtherOrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| 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 (7 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SUZANNE DALY | ||||||||||||||
| GASTROENTEROLOGY PHYSICIAN | $545,122 | $0 | $75,000 | $0 | $0 | $0 | $0 | $0 | $7,193 | $0 | $627,315 | $0 | $0 | $0 |
| CRISTIAN LAGUILLO | ||||||||||||||
| FAMILY PHYSICIAN | $283,751 | $0 | $65,402 | $0 | $4,808 | $0 | $0 | $0 | $9,284 | $0 | $363,245 | $0 | $0 | $0 |
| HEIDI LODGE | ||||||||||||||
| INTERNAL MEDICINE PHYSICIAN | $285,223 | $0 | $36,919 | $0 | $0 | $0 | $10,288 | $0 | $14,947 | $0 | $347,377 | $0 | $0 | $0 |
| EDWARD MILLER | ||||||||||||||
| SURGICAL PHYSICIAN | $321,923 | $0 | $5,000 | $0 | $0 | $0 | $508 | $0 | $9,363 | $0 | $336,794 | $0 | $0 | $0 |
| RICHARD SNURE | ||||||||||||||
| SURGICAL PHYSICIAN | $320,272 | $0 | $0 | $0 | $0 | $0 | $7,176 | $0 | $7,947 | $0 | $335,395 | $0 | $0 | $0 |
| ROBERT SEAMON | ||||||||||||||
| CEO | $264,904 | $0 | $50,000 | $0 | $0 | $0 | $0 | $0 | $7,836 | $0 | $322,740 | $0 | $0 | $0 |
| HEATHER LUNDSTROM | ||||||||||||||
| CFO | $171,133 | $0 | $22,511 | $0 | $0 | $0 | $0 | $0 | $8,984 | $0 | $202,628 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE DRAFT OF 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 PREPARED 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 822,486. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 822,486. OTHER: PROGRAM SERVICE EXPENSES 851,057. MANAGEMENT AND GENERAL EXPENSES 371,094. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,222,151. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 3,440,864. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,440,864. ANESTHESIOLOGIST SERVICES: PROGRAM SERVICE EXPENSES 95,493. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 95,493. MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 98,246. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 98,246. INFORMATION SYSTEMS SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 543,121. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 543,121. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE SUITE 212 | AddressLine1Txt |
| City | BISBEE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85603 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 842690938 | EIN |
| Primary Activities | TO SUPPORT COPPER QUEEN COMMUNITY HOSPITAL | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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