2020-10-02T16:47:54-07:00 2019-12-31 JWT LLP 1111 E Herndon Fresno CA 93720 990 2019-01-01 860732836 COBRE VALLEY REGIONAL MEDICAL CENTER COBR 9284253261 5880 S Hospital Drive Globe AZ 85501 Neal Jensen CEO 9284253261 2020-08-07 1 Jeremy Ware P00642659 5594317708 2020-07-31 172.58.35.167 2019 2021-01-29 14:40:06Z CVRMC 5880 S Hospital Drive Globe AZ 85501 63908496 0 X www.cvrmc.org X 1967 AZ The Mission of our Hospital is to develop and maintain a local health care delivery system that serves the region with quality, efficiency and compassion. 9 9 456 0 0 0 58856 15977 54546904 63220329 221140 307662 907483 364528 55734383 63908496 0 0 0 0 25753214 29331148 0 0 0 27074669 30312625 52827883 59643773 2906500 4264723 81050182 89057165 41007162 43331029 40043020 45726136 X The Mission of our Hospital is to develop and maintain a local health care delivery system that serves the region with quality, efficiency and compassion. 1 0 49929242 0 63220329 Along with providing acute healthcare services to the community as a non-profit entity, Cobre Valley Regional Medical Center (CVRMC) is committed to the many communities we serve. Several members of our administration, directors, managers, and staff serve on various community associations including: Chambers of Commerce, Rotary, Work Force Development, Economic Development, Cancer Awareness Committees, Diabetes Education, Grief Support Teams, Scholarship Committees, Aquatic Center, Housing Committees, Community Development, and Youth Athletic Programs, to name just a few. CVRMC has its finger on the pulse of the community, provides charitable care with purpose, and offers educational services and programs for the good of our public. CVRMC continues to work with Gila County on the four health priorities identified by the Community Health Needs Assessment conducted with Gila County in late 2015. These health priorities are Obesity, Substance Abuse, Access to Quality Healthcare Including Mental Health Services, and Sexual Health. Several stakeholders from across Gila County and the CVRMC service region are still actively working with the Community Health Improvement Plan (CHIP) which was developed through the process. The first CHNA and CHIP was completed by CVRMC in 2013, the second in late 2015, and the next scheduled for 2019. Together, with the collaboration of CVRMC, other healthcare organizations, and professionals of our service area, we will respond to the identified needs of all our diverse communities with the continuing CHIP. The Expansion Project of CVRMC began in February of 2015 and the first phase completed in October of 2016. The new construction included all new, family-centered, single-patient rooms Med/Surg, ICU, and Family Birth Center which has brought much comfort to the patients and their families we serve. The expansion also included a new pharmacy, cath lab, wound center, infusion center, cafe and kitchen, gift shop, and conference rooms. The 11,000 square feet of new physician offices and exam rooms provide for growth and have centralized services for the convenience of our patients. The Emergency Department, Outpatient Surgery, and Wound Center areas completed in 2017. CVRMC has seen continuous growth and increase patient volumes since the opening of the expansion. Both in-patient and out-patient growth has seen significant gains. 2018 saw the hiring of another general surgeon, a new Chief Financial Officer, a new Chief Nursing Officer, two new mid-level providers, a new podiatrist, and a contracted agreement for oncology/hematology services. CVRMC also saw our Clinics at the Hospital and Family Practice Clinic become RHC status and the new Tonto Basin Clinic is our newest licensed Outpatient Treatment Center. An Observation Unit opened in the old Med/Surg area of the hospital in August. Future plans are to implement in-patient dialysis, hyperbaric therapy, and full service oncology to include radiation. The bi-annual CVRMC Health Fair continues to draw vendors from all over the state. Although the health fair in 2018 had some adverse weather, everything was moved into the lobby area of the hospital and continued forward. The purpose of the CVRMC Health Fair is to build relationships with other local and state social and charitable agencies to distribute health, wellness, safety and other valuable information to our communities. Many vendors engage children and adults with "hands-on" activities to improve health and wellness. Without any charge to our communities, CVRMC sponsors cancer support groups, workshops, birthing and new baby care classes, customer service training, and grief support meetings. Many community organizations have taken advantage of the conference rooms CVRMC has to offer, free of charge, for meetings and educational training. Some examples of these groups are Teenage Outreach for Pregnancy Services, Rotary Club, Little League, EMS Training, Gila Community College meetings, drug awareness meetings and many more. Meeting places are difficult to find in our rural community and CVRMC is pleased to accommodate our neighboring associations. CVRMC is continually upgrading and improving equipment. Much of the equipment that is replaced is still viable and is passed on to education facilities, fire departments, or other local agencies that will continue to get useful years for their programs and services. Supplies are also donated regularly to EMS, schools, senior citizen groups, and other organizations in need of medical and or other types of supplies. The PACT Committee, comprised of CVRMC staff, dedicates its efforts to making a difference in employee and community relations. The PACT Committee is instrumental in the activities of many hospital activities, promoting employee engagement and satisfaction. The PACT Committee also helps CVRMC employees through the HOPE (Helping Our People in Emergencies) Fund. Donations made to the HOPE fund are used in times of emergency for employees. The Community Fund is used to help people of our communities who have been faced with a tragedy fire, illness, disease. The PACT Committee holds fund raisers to build the Community Fund and the PACT Committee also participates in community events to ensure the hospital's presence and to build public support and trust. A summary of services CVRMC provides to its service area are: Chronic Care Management, Emergency Services, Orthopedics, Imaging, Laser Vein Center, Surgical Services, Pharmacy, Physical Therapy (5 star rating), Chemotherapy, Wound Center, OB/GYN, Cath Lab, Specialty Clinic, Sleep Center, Family Practice, Skin Clinic, Pediatrics, Laboratory, and Outlying Family Care Clinics in Young, Kearny, and Superior. As we celebrate 106 years of service to the Globe-Miami and surrounding communities, CVRMC continues to evolve with the changing needs of our population base. Healthcare is ever moving and advancing and CVRMC is progressing with the demands of our target markets. The continued accomplishments we have made are a direct result of a dedicated and compassionate workforce, a steadfast Board of Directors, and strong supporting management team which is focused on one mission the mission of health with quality, efficiency, and compassion. With the development of our next 3-year strategic plan, we are focused on these areas The Patient Experience (Quality and Customer Service); People; Growth; Community; Financial Stewardship Today, the healthcare arena is facing some monumental changes and challenges. This strategic plan encompasses our accountability and compassion to patients and families; our respect and collaboration to all who surround us; our earnest responsibility to grow with the needs of our population; and our social and public responsibility as healthcare leaders of our communities. Yesterday, today, and tomorrow, CVRMC is committed to our communities with an unwavering dedicated spirit. 0 0 0 49929242 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 84 0 1 456 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 1 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 AZ X Neal Jensen 9284021123 5880 S Hospital Drive Globe AZ 85501 Steven J Sawyer Physician 40 0 X 706771 0 0 Scott Croft Physician 40 0 X 625454 0 0 Peter R Seipel Physician 40 0 X 528714 0 0 Travis B Charles Physician 40 0 X 313821 0 0 Mark Ellis Physician 40 0 X 313750 0 0 Fernando Shipley Board Chair 1 0 X 0 0 0 Robert Hollis Board Vice Chair 1 0 X 0 0 0 Judy Bessee Board Treasurer 1 0 X 0 0 0 James Rasmussen Board Secretary 1 0 X 0 0 0 Ed Carpenter Board Trustee 1 0 X 0 0 0 Janice Cook Board Trustee 1 0 X 0 0 0 Carolyn Haro Board Trustee 1 0 X 0 0 0 Jendean Sartain Board Trustee 1 0 X 0 0 0 Alan Osumi Board Trustee 1 0 X 0 0 0 2488510 0 0 0 0 1 0 Rural Physicians Management Co LLC 10624 S Eastern Ave Ste A 263 Henderson NV 89052 Hospitalist Services 703975 Cardiovascular Associates of Arizona 2683 E Mead Place Chandler AZ 85249 Cardiology Services 488825 Snehal Thakkar Oncology PLLC 11177 East Ironwood Drive Scottsdale AZ 85259 Oncology Services 519646 ARUP Laboratories PO Box 27964 Salt Lake City UT 84127 Laboratory Services 368788 John R Fierro 1852 E Huber Street Mesa AZ 85203 Pharmacy Services 220227 13 0 0 0 0 0 15977 0 15977 Net patient service revenue 621400 63220329 63220329 0 0 0 0 0 0 63220329 307662 0 0 307662 0 0 0 0 0 0 0 0 72567 0 0 0 72567 0 72567 0 0 72567 0 0 0 291961 291961 0 0 291961 63908496 63512290 0 380229 X 23511413 18809130 4702283 5819735 4655788 1163947 10083213 8066570 2016643 925521 740417 185104 1782915 1426332 356583 4528245 3622596 905649 798192 638554 159638 Supplies 9755373 9755373 0 0 Equipment 1123422 898738 224684 0 1315744 1315744 0 0 59643773 49929242 9714531 0 10694500 17170371 14429122 16739474 9384691 9318763 496766 285070 1491785 1930176 497849 735917 88220540 47662709 42029332 40557831 2026137 2319563 81050182 89057165 7531142 10601134 31351978 30627788 2124042 2102107 0 41007162 43331029 X 39360679 45034872 682341 691264 40043020 45726136 81050182 89057165 4264723 1418393 0 0 0 0 X 0 1 X 1 0 X 0 904177 904177 0 56693363 0 56693363 0 0 0 0 0 29607776 0 29607776 0 1015224 47662709 -46647485 40557831 0 X 65326889 1418393 0 0 0 1418393 63908496 0 0 0 63908496 59643773 0 0 0 0 0 59643773 0 0 0 59643773 Schedule D, Part X, Line 2 The Hospital is a not-for-profit organization formed under the laws of the State of Arizona. The Hospital has been determined to be exempt from income taxes under Section 501(c)(3) of the Internal Revenue Code by the United States of America's Internal Revenue Service (IRS) and under similar codes by the State of Arizona. Accordingly, no provision for income taxes is included in the accompanying financial statements. The tax years of 2016 through 2019 remain open and subject to examination by the appropriate government agencies of the United States and the State of Arizona. 1 1 X 1 X 1 X 1 1 1 0 1 1 7233204 7233204 30359525 30359525 0 0 37592729 0 37592729 0 0 0 0 0 0 0 0 0 37592729 0 37592729 0 1 6944035 6944035 15031930 15854260 -822330 X 1 1 1 1 Cobre Valley Regional Medical Center 5880 South Hospital Drive Globe AZ 85501 www.cvrmc.org X X X X Cobre Valley Regional Medical Center 1 1 0 1 X X X X X X X 16 1 0 0 1 X cvrmc.org 1 16 1 cvrmc.org 0 0 1 X 200 200 1 1 1 X www.cvrmc.org X www.cvrmc.org X www.cvrmc.org X X X X X 1 0 X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Cobre Valley Regional Medical Center CHNA Schedule H, Part V, Section B, Line 11-Cobre Valley Regional Medical Center Website Schedule H, Part I, Line 3a Part VI, Question 3 continued DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY Financial assistance will be determined through an individual assessment of financial need, including an application process in which the patient or the patient's guarantor is required to cooperate and submit all documentation necessary to make the determination of financial need; a reasonable effort by the CVRMC to explore and assist patients in applying for appropriate alternative sources of payment and coverage from public and private payment programs; and will take into account the patient's assets and other financial resources. It is preferred but not required that a request for financial assistance and a determination of financial need occur prior to rendering of medically necessary services. The need for financial assistance shall be re-evaluated at each subsequent rendering of medically necessary services, if the last financial evaluation was completed more than one hundred eighty days prior, and at any time additional information relevant to the eligibility of the patient for financial assistance becomes known. The granting of financial assistance shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, socio-economic, sexual orientation or religious affiliation. In determining whether each individual qualifies for Financial Assistance, only those patient billings not covered by other county or governmental assistance programs should also be considered. Many applicants are not aware that they may be eligible for assistance such as AHCCCS or other government or private funded programs. Persons eligible for programs such as AHCCCS but whose eligibility status is not established for the period during which the medical services were rendered may be granted Financial Assistance for those services. CVRMC may make the granting of Financial Assistance contingent upon applying for governmental program assistance. This may be prudent, especially if the patient requires ongoing services. EXCLUSIONS This policy and the Financial Assistance Program do not apply to the portion of charges an insured patient is personally responsible for, i.e., co-pays, co-insurance, and deductibles, and does not apply to elective procedures except as may be determined in the sole discretion of CVRMC on a case-by-case basis. METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE A copy of this Policy and Financial Assistance applications will be made available at the Hospital or by contacting Patient Accounts/Billing Office at 928-425-3261. Individuals who feel that they qualify for financial assistance under this Policy, or have requested that financial assistance be provided, are required to submit an application on the Hospital provided form during the Application Period. It is the applicant's responsibility to provide proof of household income and/or any other information provided on the application as requested by the Hospital. The applicant is required to submit all information required on the financial assistance application form, including, but not limited to, the following information: Copy of AHCCCS denial letter May be waived on a case by case basis Copies of pay stubs for the last 2 pay periods Number of dependents claimed on tax return Copies of bills showing expenses DISCOUNT Household incomes that exceed 400% of the FPG, where the patient is medically indigent, are evaluated based on their special circumstances. Family size (See Note For More Than 8 Members) 2018 Federal Poverty Guideline (FPG) 100% 150% of Federal Poverty Guidelines 200% of Federal Poverty Guidelines 250% of Federal Poverty Guidelines 300% of Federal Poverty Guidelines 400% of Federal Poverty Guidelines This Policy, an application, a plain language summary of the Policy, and any notices or publications regarding the Policy will be made available on the Hospital's website (www.CVRMC.org) in pdf form. The Policy, applications, and plain language summaries shall be available upon request, without charge at the Patient Accounts and Billing Department and by mail. A plain language summary shall be conspicuously displayed in Hospital patient waiting areas and in the Patient Accounts/Billing Department in a manner that is reasonably calculated to attract visitors' attention. A plain language summary of this Policy and a copy of the financial assistance application will be provided to all patients upon admission or registration at the Hospital or Clinics ACTIONS THAT MAY BE TAKEN IN EVENT OF NONPAYMENT OR INSUFFICIENT PAYMENT Accounts for hospital services for patients who are able, but unwilling, to pay are considered noncollectable bad debts and will be referred to outside agencies for collections. REGULATORY REQUIREMENTS In implementing this policy, CVRMC management and CVRMC facilities shall comply with all federal, state and local laws, rules and regulations that may apply to activities conducted pursuant to this policy. ACCOUNTING FOR FINANCIAL ASSISTANCE CVRMC will track and monitor Financial Assistance care being granted and will account for the write-offs as a separate Deduction from the Revenue general ledger account. RECORDKEEPING Records relating to potential Financial Assistance applicants must be readily available. CVRMC will maintain a spreadsheet of all applicants and final disposition. Notes relating to the Financial Assistance application and approval or denial should be entered on the patient's account. APPLICATION OF POLICY This policy does not create an obligation to discount for any charges or services not included in the Hospital bill at the time of service. This policy does not apply to services provided within the Hospital by physicians or other medical providers including Emergency physicians Anesthesiologists, Radiologists, Pathologist, etc. Schedule H, Part I, Line 5a Question 5 continued The Cath Lab is now being used for a multitude of cardiac, venous, and arterial services which in the past, patients had to travel up to two hours to receive. The Cath Lab is steadily increasing in patient volume. The "Clinics at the Hospital," also a Rural Health Clinic designation, houses OB/GYN, Orthopedics, Podiatry, and Pediatric services. The area has 14 exam rooms, and 2 procedure rooms. Patients with appointments have a separate entry away from the hospital entrance. The design of this clinic has provided operation efficiencies and has created opportunities for enhanced clinical collaboration between physicians and staff. The Observation Unit is located in the old Med/Surg area of the hospital. It has provided patients an outpatient status for a short time to allow doctors to determine if they are well enough to be released or admitted as an in-patient for a higher level of care. Community Programs and Improvements to Services Information Systems and the Region Cobre Valley Regional Medical Center has had a long history of technological innovation within the facility with many departments integrated electronically so that current information is readily available to staff and practitioners within the facility. 2019 saw the beginning of Phase 1 to upgrade to "Meditech Enhance" from "Meditech 6.0." This change will be beneficial to the patient as well as all departments and clinics. "Enhance" will give put the entire CVRMC healthcare system under one EMR. The projected "go live" date is August of 2020. Since 2014, the patient portal has been the platform for patients to obtain medical records. It has provided patients secure online access to personal health information. Using a secure username and password, patients can view health information such as their recent doctor visits, medications, and lab results for example. By improving patient-provider communication and empowering patients a more active role in their health, the result should be improved patient outcomes. Cobre Valley Regional Medical Center is striving to be the leader of healthcare in the service area, accountable for the health of the population served. Partnerships with the Gila County Health Department, the Tobacco Cessation Program, the Meth Coalition, Haven of Globe, Heritage Healthcare Center, Gila County Community College, etc., and the local media have been established and can provide a forum for information dissemination and actual intervention services. Employee Education Cobre Valley Regional Medical Center's commitment to higher education for employees is evident in the continuation of tuition assistance. Employees are encouraged to further their education which in turn provides better care for patients. The tuition assistance program is a benefit provided to assist employees in improving their job capabilities within their work environment. Standards of Performance and Customer Service Training - The CVRMC Standards of Performance were designed and created by a team of hospital staff whose goal was to develop a set of performance expectations for every employee to follow at all times. At CVRMC our position descriptions outline the duties and responsibilities every individual is accountable for in the commission of their respective jobs. The CVRMC Standards of Performance offers a definition and framework of behaviors that every employee will exhibit when interacting with patients, customers, and co-workers. These standards also provide the criteria by which an employee is evaluated. In our Standards of Performance we identify patients, customers, and co-workers as our target service populations. At CVRMC we consider "customers" to include Physicians, Families, Vendors, Suppliers, and anyone else that we have contact with and the behavior expectations include privacy, attitude, communication, teamwork, courtesy, accountability, appearance, responsiveness, and safety. Every employee of CVRMC is required to attend customer service training to help drive our mission statement and to guide them in the standards of performance at every level of the organization. This customer training is also offered to every physician, their office staff, and organizations within the region, free of charge, in order to create a regional culture of courtesy and respect. Community Involvement Employees of CVRMC are encouraged to volunteer and be involved in charitable community organizations. These associations include Rotary, the Community Concert Association, Little League, United Fund, Elks, County Fairs, blood drives, CARE Fair, Relay for Life, Health Fair, Adopt a Highway, school boards, March of Dimes, youth soccer, youth basketball, the library, job shadowing programs, Meals on Wheels, economic development, Meth Coalition, AZ Youth Partnership, church charities, and the Globe-Miami and Superior Chambers of Commerce, to name a few. Employees who are involved beyond the hospital facility make a connection to the communities served. Community Health Needs Assessment and Implementation Plan CVRMC conducted the next "Community Health Needs Assessment." Data was collected through surveys, focus groups and face-to-face interviews. From this data and resource information a new "Community Health Implementation Plan" is being developed and will address the identified health concerns of the region CVRMC serves. Quality Initiatives Quality is in every aspect of hospital care the people, equipment, service, response to occurrences, hospital environment, buildings, etc. CVRMC works to bring quality to every facet of the organization. Other CVRMC is involved in many other community activities which help promote and support the mission of the hospital. These activities include the Annual Leadership Retreat, CV Auxiliary, Career Day, Certifications and Training, Childbirth Classes, Smoke Free/Tobacco Free Campaign, Easter Egg Hunt, County Fair, Grief Support, Downtown Halloween Trick or Treat, Horseshoe Tournament, STEM activities, job shadowing, and workforce development, to name a few. Summary and Future Cobre Valley Regional Medical Center has kept its finger on the pulse of its service region throughout 2019, reaching out to help the area in many different aspects, contributing millions of dollars in community benefit and charity care. With the challenges healthcare presents at both the national and state levels, the focus in 2020 will be on the patient experience, people, growth, and community as we continue to respond to the service area needs and fulfill our mission: "To develop and maintain a healthcare delivery system that serves the region with quality, efficiency, and compassion." Schedule H, Part I, Line 7 Cost to charge ratio. Schedule H, Part II, Line 2 Essay 2 Continued: Medical Staff Development Plan The approach used to project physician need for Cobre Valley Regional Medical Center's service area included the following: Defining the CVRMC service area and market share by service area and service line Projecting the service area's population growth and characteristics for the next five years Taking into account competition and other local circumstances such as, in-migration, out-migration Developing a profile of the current medical staff including number, FTE, specialty, age, activity Identifying an appropriate demand model from among the available physician need estimation tools Utilizing the above information, estimates are developed projecting the number of physicians by specialty required to serve the CVRMC service region. Methods used to project physician need include: Demographics-Population The source for the population is the Claritas Update Demographics (CUD) product. Estimates are data prepared for the current year and projections are prepared for dates five years in the future. The CUD is brought up to date each year for many geographic levels including national, state, county, city/town, census tract and block group. Data is also available for commonly used areas as metropolitan areas, ZIP Codes, and other media areas. Because it is produced for small areas, the update can be easily aggregated to custom geographic areas specified by the user. Provider Supply Provider supply is provided by CVRMC management. Much of the physician information is obtained by medical staff rosters and the survey responses. The information gathered for the provider supply is the provider name, specialty, town in which they practice, office days and times, birth date, and any information about their practice. The office days and times are used to calculate a provider full-time equivalent (FTE). Provider Demand The two models used to determine provider demand and community need are the: 1. Population Based Model which is obtained by multiplying Thomson Reuters' physician- to-population ratios by the population of the service area. 2. Productivity Based Model provides data on current and projected physician resources required within a defined market. Service Area Definition A service area definition takes into consideration multiple factors including patient origin, market share, population and geography. The service area is defined as the geographic area from which a healthcare facility draws at least 75% of its patients and in which it maintains a considerable share of the healthcare market. The first step in defining CVRMC's service area is identification of the communities from which the hospital draws 75% of patients, and to assess the hospital's market share in each of these communities. The service area was then divided into two service areas: Primary and Secondary. Three ZIP Codes have been identified as CVRMC's primary service area and seven Zip Codes comprise the secondary service area. Population Trends Population trends by ZIP Code are provided for the primary and secondary service areas of CVRMC as well as population trends by age. As the population trends increase or decrease, and healthcare needs change with age, it is definitely something to consider when strategically planning for future needs. Demographic snapshots are also provided by the report for each of the service areas that reflect various characteristics, including the education, household income, and ethnicity. These are important factors to consider when establishing marketing and public relations messages. Those in CVRMC's primary and secondary service areas are primarily White and Hispanic; have a lower percentage than the U.S. with a high school degree, and a higher percentage than the U.S. with lower incomes. Diagnosis-Related Groups Groups of patients tend to have common demographic, diagnostic, and therapeutic attributes that determine their healthcare needs. Diagnosis-Related Groups (DRG) form a manageable, clinically coherent set of patient classes relating CVRMC's case mix to the resource demands and the associated costs experienced by the hospital. Database of Admissions Queries of the CVRMC Admissions database are a quick analytical source for determining the major health issues of the region. From this information education, prevention, and intervention can be determined and implemented in community benefit programs or released to other regional health organizations for tracking and trending the impact of their programs within the region. Case Management, Discharge Planning, and Social Work Through case management, discharge planning, and social work provided by CVRMC, data is generated by specific diagnosis related groups. This diagnosis data by group could be used to identify key risks for change, i.e. tobacco cessation or weight management programs. Many of these groups move on to long-term care facilities, hospice services, or home care needs. Community Health Needs Assessment and Implementation Plan 2019 The excerpt below is from the 2019 Needs Assessment conducted by Pinnacle Prevention. "Research shows that economic conditions have a significant impact on population health. Residents within the region frequently describe their communities as close-knit and demonstrate a willingness to help neighbors in need." CVRMC Board of Directors The CVRMC Board of Directors is strategically designed to encompass a variety of professions from the region. Mining, county government, ranching, banking, insurance, business, and medical professionals make-up the members of the board which bring a diversity of ideas and information regarding healthcare needs within the service region. Other Data from the National Health Association and the Arizona Health Association gives CVRMC comparisons to national and state averages for specific health issues. Connectivity to organizations such as the County Health Department, regional school districts, and other health, safety, and regional associations provides information regarding health issues and needs. Schedule H, Part III, Section A, Line 4 AR Schedule H, Part III, Section B, Line 8 Medicare Schedule H, Part III, Section C, Line 9b Collections Schedule H, Part VI, Line 2 Currently, CVRMC utilizes several methods of assessing community healthcare needs. Evaluating the health needs of the CVRMC service area leads to identifying physicians needed in the area as well as recognizing those services that are required to address illnesses which can be targeted for community education and intervention. Community Feedback CVRMC utilizes many methods of community feedback for needs determination. Our patients, their families, and the greater community enlighten our organization through patient surveys and direct comments. CVRMC strives to give the very best care, and in order to accomplish that goal, it is vital that patient and community comments and concerns are addressed. Professional Research Consultants (PRC) conducts outpatient surveys for the Outpatient Surgery, Physical Therapy, Registration, Med/Surg/ICU, Obstetrics, Respiratory Therapy, Emergency, Laboratory, Clinics, and Radiology Departments on patient satisfaction. PRC also conducts the inpatient, Hospital Consumers Assessment of Healthcare Providers and Systems (HCAHPS) survey which measures patient satisfaction in multiple areas including promptness and efficiency of the admission and registration process, length of time waiting, nursing care, physician care, teamwork, discharge instructions, safety, cleanliness of the facility, food service, overall quality of care, and the likelihood of recommending the hospital to relatives and friends. Statistics regarding patient feedback are calculated on a weekly basis and distributed to all department directors with a hard copy, graphs are posted, and e-mails are dispersed to ensure all staff is informed of results. Management is then able to make necessary assessments of weak areas and strategically plan for improvements. Audio of the actual phone surveys are also available to all management. Many changes within CVRMC have been made as a direct result of feedback obtained in these surveys. Hospital Consumers Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey method conducted nationally and is publicly reported regarding the patients' opinions and observations regarding their hospital care. This survey is helpful in determining how CVRMC measures against other hospitals across the nation. The public reporting aspect of this survey is a motivation factor for the hospital as a whole to improve quality of care, focusing on the patients' needs. These objective and meaningful comparisons of hospitals on topics that are important to the consumer and the public reporting aspect of HCAHPS serves as a transparency tool which drives accountability and improves quality of care. Direct feedback from patients and family members is also a tool utilized for needs assessment. One of the many advantages of a rural hospital is the personal relationships the staff and patients are able to build. Direct phone calls, e-mails, or letters received from patients after their care has been provided is a valuable source of information for determining need. Comment/Compliment cards are also available throughout the hospital for direct responses from patients and their families. SQSS Strategic Quality Support System is a quality improvement initiative which tracks concerns and complaints of patients by networking and connecting all involved in one platform for resolution. This program builds trust through service recovery. Building trust is a fundamental characteristic necessary in any relationship and as issues are resolved in a constructive, inclusive approach, our customers are more willing to utilize more services and voice opinions about services that should be brought to the service area. Legislative Actions Legislative decisions will have a dramatic effect on the direction CVRMC will move regarding community benefit as well as how healthcare for the region will be financed and delivered. CVRMC will continue to offer community benefit programs within its budgetary means in response to the needs of the region served. CVRMC will continue to strive for growth, bringing new services and structures to the hospital while focusing on wellness and prevention. CVRMC has kept a close eye on any legislation that would affect the future of rural hospitals and any work that needs to be accomplished regarding legislative change. Some of these influences/legislative changes include the CAH Pool, opioid legislation, health insurance, etc. The Payer Mix By identifying "customers," CVRMC is able to determine to whom services are provided. This information is invaluable for the strategic planning and management of the hospital in regards to new services and/or the addition of new providers. The payer mix also provides valuable information regarding the mix of services needed, education programs, new outreach programs, and future demands. The payer mix is also a very good indicator of the social economic structure of the community, allowing CVRMC to tailor programs to better meet the communities' needs. Schedule H, Part VI, Line 3 Education of Financial Assistance to Patients at CVRMC Cobre Valley Regional Medical Center (CVRMC) is committed to providing financial assistance to persons who have health care needs and are uninsured. Consistent with its mission to deliver quality healthcare in a safe, respectful, and efficient manner, CVRMC strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. CVRMC has a comprehensive system of providing charity care service or discounted medical care to uninsured patients within the available resources of Cobre Valley Regional Medical Center and/or Clinics. CVRMC addresses with the patient: Eligibility criteria for financial assistance The extent to which financial assistance includes charity care or discounted care The basis for calculating amounts charged to individuals who are eligible for assistance under this policy The method for applying for assistance All emergency and medically necessary inpatient and outpatient hospital services provided to uninsured individuals, who qualify for assistance, are individually and privately consulted regarding a payment structure. CVRMC also works with patients with high deductibles and/or out-of-pocket costs. This is also done on an individual basis through a private conversation. Measures to Widely Publicize the Policy The Financial Assistance Policy is made available at different times of a patient's care at registration, admission, and discharge. Individual who feel that they qualify for financial assistance or have requested financial assistance, submit an application. Personal financial information is requested on the application, the application is reviewed, and the applicant is informed within 30 days. A discount schedule is also used based on the patient's individual circumstances. Financial assistance information is published on the hospital website, are available upon request for pick-up at the hospital or can be mailed to the patient. POLICY OVERVIEW Cobre Valley Regional Medical Center (CVRMC) is committed to providing financial assistance to persons who have health care needs and are uninsured. Consistent with its mission to deliver quality healthcare in a safe, respectful, and efficient manner, CVRMC strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. PURPOSE This Policy provides a fair and comprehensive system of providing charity care service or discounted medical care to uninsured patients within the available resources of Cobre Valley Regional Medical Center (the "Hospital and/or Clinics"). The Policy addresses: Eligibility criteria for financial assistance; The extent to which financial assistance includes charity care or discounted care; The basis for calculating amounts charged to individuals who are eligible for assistance under this policy; The method for applying for assistance; Measures to widely publicize the Policy RESPONSIBILITY It is the responsibility of the Hospital Board of Directors to ensure that this Policy is being administered and carried out in a consistent manner and within the guidelines set forth in controlling laws and regulations. SCOPE This Policy applies to all emergency and medically necessary inpatient and outpatient hospital services provided to Uninsured individuals who qualify for assistance in accordance with the terms and conditions herein. It also applies to CVRMC employed physician services, clinic services, or other services that may be offered by the Hospital. Any services deemed non-medically necessary or cosmetic in nature are not eligible for financial assistance. DEFINITIONS The following definitions shall apply to this Policy: "AGB discount percentage" is determined by dividing the sum of all claims Medically Necessary services provided at Cobre Valley Regional Medical Center paid during the Relevant Period by Medicare fee-for-service and all private health insurers as primary payors, together with any associated portions of these claims paid by Medicare beneficiaries or insured individuals in the form of co-pays, co-insurance or deductibles. "Application Period": The period during which the Hospital must accept and process an application for assistance under this Policy in order to have made "reasonable efforts" to determine whether the patient is an individual who is eligible for assistance under this Policy. The Application Period ends on the 240th day the Hospital provides the individual with the first statement for care provided. "Extraordinary Collection Action" or "ECA": Actions taken by the Hospital against a patient or any other individual who has accepted or is required to accept responsibility for the patient's bills that involve (i) a legal or judicial process; (ii) selling an individual's debt to a third party; or (iii) reporting adverse information about the individual to a consumer credit agency or credit bureau. "Gross Charges": The Hospital's full, established price for medical care that it consistently and uniformly charges all patients before applying any contractual allowances, discounts, or deductions. "Household Income": Means the total income of all members living in the individual's household. "Individuals who are eligible for assistance under this Policy": An individual who is uninsured and is eligible for financial assistance under this Policy. "Individuals who qualify for financial assistance": Individuals who are eligible for assistance under this Policy and who have submitted a completed financial assistance application within required time periods as set forth herein and have been approved for financial assistance according to the processes set forth herein. "Medically Indigent": Individuals who do not have health insurance and who are not eligible for other health care coverage, such as Medicare, Medicaid, or private health insurance. "Notification Period": Begins on the first date care is provided and ends on the 120th day after the Hospital provides the individual with the first bill for care. "Uninsured": A patient (or his or her financially responsible individual) has no insurance or medical coverage under governmental programs and is not eligible for any other third party payment. Schedule H, Part VI, Line 4 Cobre Valley Regional Medical Center (CVRMC) is located in Globe, Arizona and serves a population of 40,000 within a 65 mile radius in a full-service acute care facility. This population includes both the primary, secondary, and partner service areas. CVRMC is located in the heart of the copper belt of Arizona and serves many rural copper communities within the region including its neighboring towns of Miami and Superior to the west, Kearny, Hayden, and Winkelman to the south. The communities of Roosevelt, Tonto Basin, and Pleasant Valley/Young are located to the north. The San Carlos Apache Nation, our service area partner, borders Globe to the east. CVRMC serves as an acute medical/surgical, obstetric, orthopedic, pediatric, family practice provider, and a multitude of other services for all the residents of these communities. The CVRMC primary and secondary service area communities are located in two counties, Gila and Pinal. Based on the 2010 U. S. Census, approximately 23% of the total population in Gila County was over the age of 65 while in neighboring Pinal County it was 15%, compared to 14% for Arizona and 13 % for the United States. The five leading causes of death among adults age 65 and older in Gila and Pinal Counties are heart disease, cancer, chronic lower respiratory diseases, cerebrovascular disease, and diabetes. Total reported number of people with disabilities within Gila County is 22,453 and 63,082 for Pinal County. Globe and Miami, Arizona Primary Service Area (62.7% Inpatient Patient Origin) Globe, Miami and the unincorporated areas nearby (including Inspiration, Claypool, Central Heights, and Midland City) are commonly called Globe-Miami. The towns are located on the northeastern slope of the Pinal Mountains, and are surrounded (except to the east) by the Tonto National Forest. Globe-Miami is located on U.S. Routes 60 and 70, and is served industrially by the Arizona Eastern Railway Globe-Miami are located in Gila County with a total population of 18,134 according to the 2010 census. Globe's economy remains dependent on the mining industry, but as the county seat, county as well as city government employment are the highest numbers of jobs within the city. Tourism and retirees are also important in Globe's economy. Miami borders Globe to the west and copper mining accounts for the largest number of jobs in Miami according to the 2014 annual report of the Arizona State Mine Inspector. Freeport McMoRan currently employs approximately 800 employees at its Miami operations; KGBM employs approximately 60 at its Carlota facility as it anticipates to continue the SX-EW operations. Capstone Pinto Valley Mine employs approximately 300, while BHP Billiton has shut down, but employs several contracted employees to oversee the closed mine sites. Resolution Copper, the deepest underground mine in the world, is continuing to grow its employee base as the mine reaches production stages. As of 2019, Miami was home to one of the last 4 copper smelters in the United States. Below is the housing status and demographic information for the population of Globe-Miami and the unincorporated areas: Housing Status for Globe-Miami, U.S. Census 2010 (in housing units unless noted) Total 9,090 Occupied 7,253 Owner-occupied 5,324 Population in owner-occupied (number of individuals) 12,727 Renter-occupied 1,929 Population in renter-occupied( number of individuals ) 4,827 Households with individuals under 18 2,099 Vacant 1,837 Vacant: for rent 319 Vacant: for sale 142 Male 9,102 Female 9,032 Under 18 4,195 18 & over 13,939 20-24 989 25-34 1,787 35-49 3,146 50-64 4,104 65 & over 3,486 Population by Ethnicity Hispanic or Latino 6,175 Non Hispanic or Latino 11,959 Population by Race White 14,862 African American 130 Asian 129 American Indian and Alaska Native 692 Native Hawaiian and Pacific Islander 15 Other 1,784 Identified by two or more 522 Roosevelt, Arizona Primary Service Area (2.5% Inpatient Patient Origin) Roosevelt is located 20 miles north of CVRMC and is a major center for fishing, boating, camping, water skiing, and other recreational water sports. The community of Roosevelt was developed after the construction of a masonry dam on the Salt River in 1911, Roosevelt Dam, making it the oldest artificial reservoir in Arizona and the largest within the boundaries of the state. The population of Roosevelt is estimated at 220 with many visitors moving in and out of the area depending on the season. Schedule H, Part VI, Line 4 Cont Pleasant Valley-Young, Arizona Secondary Service Area Surrounded by the Tonto National Forest, Pleasant Valley-Young is a community in Gila County situated in the beautiful pines of the mountains. There are two main dirt roads in and out of Young, one from the north and one from the south, but no fully paved road to a connecting highway. Globe is 65 miles to the south of Young. According to the 2010 U. S. Census, Pleasant Valley-Young had a population of 376 people, 320 households, and 132 families living in the Pleasant Valley-Young area. The racial makeup was 100% White. The 320 households are comprised of 15.3% with children under the age of 18 living with them, 50.9% were married couples living together, 4.7% had a female householder with no husband present, and 39.7% were non-families. Individuals made up 33.4% of all households and 10.3% had someone living alone who was 65 years of age or older. The average household size was 2.08 and the average family size was 2.65. The median age was 51.5. Several small businesses exist in Pleasant Valley-Young. A gas station, convenience store, auto parts store, motel, thrift shore, library, and refuse service are among the businesses. Cobre Valley Regional Medical Center services the primary medical needs of the area with a medical clinic. The median income for a household in the Pleasant Valley-Young area is $26,250, and the median income for a family was $24,886. Males had a median income of $21,000 versus $26,458 for females. The per capita income for the area was $16,943. Kearny, Arizona - Secondary Service Area (8% Inpatient Patient Origin) Kearny is located in Pinal County and was built by the Kennecott Mining Company in 1958 as a planned community to accommodate the populations of nearby Ray, Sonora and Barcelona, which were eventually swallowed by Kennecott's expanding open-pit copper mine. The town sits near the Gila River in the Copper Basin area along with its sister cities of Hayden and Winkelman. The economic base of Kearny is the Ray mine and the Hayden Smelter, both owned and operated by ASARCO. Total 2010 Census Population for KEARNY, AZ 1,950 HOUSEHOLDS BY TYPE Total households for KEARNY, AZ 756 Family households (families) [7] 534 With own children under 18 years 191 Husband-wife family 401 With own children under 18 years 127 Male householder, no wife present 37 With own children under 18 years 17 Female householder, no husband present 96 With own children under 18 years 47 Nonfamily households [7] 222 Householder living alone 197 Male 98 65 years and over 36 Female 99 65 years and over 67 Households with individuals under 18 years 239 Households with individuals 65 years and over 282 Average household size of KEARNY, AZ 2.58 Average family size for KEARNY, AZ [7] 3.09 POPULATION BY RACE FOR KEARNY, AZ What is the Population of KEARNY, AZ 1,950 One Race 1,883 White 1,623 Black or African American 9 American Indian and Alaska Native 15 Asian 8 Asian Indian 0 Chinese 2 Filipino 3 Japanese 2 Korean 0 Vietnamese 0 Other Asian [1] 1 Native Hawaiian and Other Pacific Islander 1 Native Hawaiian 0 Guamanian or Chamorro 1 Samoan 0 Other Pacific Islander [2] 0 Some Other Race 227 Two or More Races 67 White; American Indian and Alaska Native [3] 10 White; Asian [3] 1 White; Black or African American [3] 4 White; Some Other Race [3] 45 Hayden, Arizona - Secondary Service Area Hayden is located in Gila county with the economic base being the Hayden Smelter, one of four smelters in the United States. Total 2010 Census Population for HAYDEN, AZ 662 HOUSEHOLDS BY TYPE Total households for HAYDEN, AZ 236 Family households (families) [7] 163 With own children under 18 years 50 Husband-wife family 98 With own children under 18 years 25 Male householder, no wife present 15 With own children under 18 years 9 Female householder, no husband present 50 With own children under 18 years 16 Nonfamily households [7] 73 Householder living alone 61 Male 30 65 years and over 10 Female 31 65 years and over 24 Households with individuals under 18 years 74 Households with individuals 65 years and over 93 Average household size of HAYDEN, AZ 2.81 Average family size for HAYDEN, AZ [7] 3.39 POPULATION BY RACE FOR HAYDEN, AZ What is the Population of HAYDEN, AZ 662 One Race 651 White 423 Black or African American 0 American Indian and Alaska Native 1 Asian 2 Asian Indian 1 Chinese 0 Filipino 1 Japanese 0 Korean 0 Vietnamese 0 Other Asian [1] 0 Native Hawaiian and Other Pacific Islander 0 Native Hawaiian 0 Guamanian or Chamorro 0 Samoan 0 Other Pacific Islander [2] 0 Some Other Race 225 Two or More Races 11 White; American Indian and Alaska Native [3] 2 White; Asian [3] 7 White; Black or African American [3] 0 White; Some Other Race [3] 1 Winkelman, Arizona Secondary Service Area (1.8% Inpatient Patient Origin) Winkelman is located in Gila county with over 95% of the population living within Gila County. The major employment is the copper industry of the ASARCO Mine. Schedule H, Part VI, Line 5 Cobre Valley Regional Medical Center has been serving patients of the copper belt region of Arizona for over 107 years. Originally a miner's hospital, Miami-Inspiration Hospital, built on a hill above the Town of Miami, opened to serve miners and their families in 1913. Eventually the aging, crowded Miami-Inspiration Hospital could no longer accommodate the growing patient load and a larger, up-to-date hospital was needed. During the early 1960's, plans were formulated for a new hospital at another location. In 1967, the resident patients and the staff were transferred to the newly completed hospital in the Miami Gardens area where the hospital still stands today. During the next eleven years, an outstanding group of "company" physicians tended the patients at Miami-Inspiration Hospital. In 1978, the Board of Directors contracted with a health maintenance organization from Phoenix to manage the hospital. The CVRMC Board of Directors meet once a month and act as a trustee for the assets and investments of the hospital for the people of the service area. The board also selects, advises, and evaluates the CEO of the hospital; grants physician staff privileges and ensures that quality medical care is maintained. Responsibilities also include providing direction for the affairs of the hospital and to ensure the development and growth of CVRMC is directed toward fulfilling the mission statement "To develop and maintain a healthcare delivery system that serves the region with quality, efficiency, and compassion. Our mission is your health." The hospital is a leader among small rural facilities in implementing new technologies both clinically and in the information area. Direct patient care technologies are kept up-to-date. Health Information Systems within the facility have kept pace with information technology upgrades. The hospital is working on its third Strategic Five (5) Year Information Technology Plan which will enhance the technological innovations already in place by melding all of the active patient records into a database that will provide a comprehensive chart on each patient within the Cobre Valley Regional Medical Center system, accessible to authorized individuals that will give each practitioner the access to more meaningfully, salient, current information to provide optimal care to each patient. As the role of the facility has solidified within the community, the CVRMC Board and Administration recognized that needs existed in some of the outlying communities. Healthcare for residents of Superior, Kearny, Tonto Basin, and Young was limited to single facilities in each community staffed sporadically by medical personnel. Their location meant that healthcare visits to organizations or offices with greater access to general medical services often involved travel of up to 2 hours, usually in one of two directions and, in the case of Young, affected dramatically by weather. Realizing that this lack of medical service directly affected the health and well-being of residents of these three areas, Cobre Valley Regional Medical Center was determined to optimize local healthcare services. CVRMC has established and staffed health clinics in all four areas with professional and ancillary staffing and services which removes the necessity for patients to travel many miles for such things as laboratory testing and pharmacy services. For many years the Town of Superior did without any medical services, forcing residents to travel at least 40 minutes to the nearest clinic. CVRMC established a clinic in the older downtown area of Superior several years ago and committed to the residents of Superior the construction of a new, modern facility. Plans to build a new clinic for the residents of the Town of Kearny are underway. In 2019, the only pharmacy in the Kearny area closed its doors. CVRMC began the process of starting a pharmacy in Kearny. On the west side of the hospital campus, the 5,000 square foot Family Practice Clinic opened its doors in May of 2012. Today the clinic is designated as a Rural Health Clinic with 6 physicians and 4 PAs. The Red Rock Clinic became part of the CVRMC system and was also designated at a Rural Health Clinic in late 2019. CVRMC is continuing laser vein services to alleviate and prevent venous stasis ulcers which lead to severe complications for patients. With the completion of the hospital expansion project, CVRMC has continued to see in-patient volume rise along with ancillary service numbers. In-patient dialysis was added to the list of services provided, eliminating the need to travel if a patient was on dialysis. CVRMC is currently working on Level III Trauma Center Designation in order to evaluate and serve more patients at home. Renovation to the emergency department completed in late 2017. The lobby increased in size and two sets of double doors prevent cold or hot wind to enter the main lobby area for the comfort of our patients. The future is bringing renovations to the emergency department, wound center, outpatient surgery, and central supply/sterilization areas. The CVRMC Wound Clinic opened in April of 2013. The newly constructed wound center completed at the end of 2017 and provides 5 patient bays and two hyperbaric chambers were installed in 2019. The wound center continues to treat chronic wounds caused by diabetes, circulatory problems, injuries, or other conditions and for those hard to treat wounds, hyperbaric treatments have been very successful. The CVRMC Sleep Center provides patients the ability to receive sleep study services within town. Sleep services have been provided by CVRMC since 2010. The newly constructed Outpatient Surgical Services department began seeing patients in November of 2017. It consists of 9 pre-op bays, one of them being a negative pressure room. The location of this new area is close to the operating rooms as well as the cath lab and wound center. The retail and in-patient pharmacy is located in the lobby area of the hospital and provides quick service to the general public and those in the hospital. A tube-system provides for quick exchange of prescriptions and pharmacy exchanges throughout the hospital. The pharmacy is also open on Saturdays for the convenience of those working customers. X 0 0 0 0 0 0 0 0 0 Steven J Sawyer Physician 706771 0 0 0 0 0 0 0 0 0 706771 0 0 0 Scott Croft Physician 625454 0 0 0 0 0 0 0 0 0 625454 0 0 0 Peter R Seipel Physician 528714 0 0 0 0 0 0 0 0 0 528714 0 0 0 Travis B Charles Physician 313821 0 0 0 0 0 0 0 0 0 313821 0 0 0 Mark Ellis Physician 313750 0 0 0 0 0 0 0 0 0 313750 0 0 0 Form 990, Part III, Line 2 During the fiscal year, the hospital added infusion and chemotherapy outpatient services. Form 990, Part VI, Section A, Line 3 The CEO and CFO duties are carried out by employees of HealthTech Management Services, Inc. an unrelated management company. Compensation is included in the management fee paid to HealthTech Management Services. Form 990, Part VI, Section A, Line 4 Changes to corporate bylaws were made to allow for the provision of a parent corporation. Form 990, Part VI, Section B, Line 11b A CPA firm prepares and reviews the Form 990 from data gathered and provided by CVRMC. The return is then provided to the CFO for review and approval. Any questions or concerns the CFO has are addressed and any corrections or clarifications are made. The final form 990, with all required schedules, is made available to the full board prior to filing with the IRS. Form 990, Part VI, Section B, Line 12c Board members and officers are covered by the organization's conflict of interest policy and are required to annually complete a questionnaire disclosing any and all possible conflicts of interest. Form 990, Part VI, Section B, Line 15 The Officer's compensation is determined by a review conducted by Healthtech management services, Inc. using data provided by a nationally recognized management consulting firm, along with Form 990 data from comparable organizations and other hospitals managed by Healthtech. Once this information has been compiled and reviewed, a meeting is held with the board and a decision is made on the Officers' compensation. Form 990, Part VI, Section C, Line 19 Available upon request. Form 990, Part IX, Line 11g Purchased and professional services.