2020-06-10T13:52:20-05:00 2019-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2018-07-01 860334996 BISBEE HOSPITAL ASSOCIATION INC D/B/A COPPER QUEEN COMMUNITY HOSPITAL BISB 5204325383 101 COLE AVE BISBEE AZ 85603 ROBERT SEAMON CEO 5204325383 2020-06-08 1 MICHAEL J PETERSON CPA P01833529 2187224705 2020-06-08 71.13.38.61 2020-06-08 16:15:34 CD P E4255D669FE7A429B540D12C0E645A16D05D3497 9747BB8E0DC0E78824B7C9EDF76D609BB7F00C05 2018 2020-11-19 02:30:22Z ROBERT SEAMON 101 COLE AVE BISBEE AZ 85603 49667120 0 X WWW.CQCH.ORG X 1977 AZ TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY. 11 11 395 34 0 0 183084 109206 42753522 49151870 -10658 231010 72395 158413 42998343 49650499 29140 106977 0 0 20127513 20974106 0 0 0 17828766 20649436 37985419 41730519 5012924 7919980 50689751 57680811 14210717 13266667 36479034 44414144 THE MISSION OF BISBEE HOSPITAL ASSOCIATION INC D/B/A COPPER QUEEN COMMUNITY HOSPITAL ("CQCH") IS TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY BY PROVIDING LEADERSHIP AND VISION TO ADDRESS OPPORTUNITIES AND CHALLENGES. 0 0 35131857 106977 49286548 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. 35131857 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 1 0 1 1 1 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 1 136 0 1 395 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X HEATHER LUNDSTROM 5204325383 101 COLE AVENUE BISBEE AZ 85603 PETER CARBERRY DIRECTOR 2.00 X 0 0 0 LAURA CHAVEZ DIRECTOR 2.00 X 0 0 0 PATRICK COGHLAN MD DIRECTOR 2.00 X 0 0 0 LAWANA DIFFLE DIRECTOR 2.00 X 0 0 0 GARY DILLARD DIRECTOR 2.00 X 0 0 0 JOHN HARRIS DIRECTOR (THRU DECEMBER) 2.00 X 0 0 0 ROSA ANEL LOPEZ DIRECTOR 2.00 X 0 0 0 DENNIS NELSON DIRECTOR 2.00 X 0 0 0 ROSALIE BUTLER SECRETARY 4.00 X X 0 0 0 KATHLEEN HEARD TREASURER 4.00 X X 0 0 0 ROBERT HOWELL VICE PRESIDENT 4.00 X X 0 0 0 DENNIS GALLUS PRESIDENT 4.00 X X 0 0 0 HEATHER LUNDSTROM CFO 40.00 X 212870 0 9812 JAMES DICKSON CEO (THRU JULY) 40.00 X 217280 0 27772 ROBERT SEAMON CEO (BEG AUG) 40.00 X 86539 0 2705 DANIEL ROE EMERGENCY ROOM PHYSICIAN 40.00 X 547910 0 28607 JENNIFER MILLER EMERGENCY ROOM PHYSICIAN 40.00 X 345600 0 8140 HEIDI LODGE INTERNAL MEDICINE PHYSICIAN 40.00 X 300959 0 23916 PEGGY AVINA FAMILY PHYSICIAN 40.00 X 298152 0 16102 RICHARD SNURE SURGICAL PHYSICIAN 40.00 X 286627 0 6580 2295937 0 123634 35 0 1 0 CERNER 2800 ROCKCREEK PARKWAY KANSAS CITY MO 64117 COMPUTER SUPPORT 923398 JOHN WAYTUK 1048 W SUSAN LANE TEMPE AZ 85281 MEDICAL PROVIDER 599190 ARIZONA AMBULANCE PO BOX 1988 SIERRA VISTA AZ 85636 AMBULANCE SERVICE 362052 JACKSON HEALTH & THEATER 11103 KILKERRAN CT LAS VEGAS NV 89141 MEDICAL PROVIDER 350100 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LAB SERVICES 316379 26 9744 99462 109206 PATIENT SERVICE REVENUE 621400 47985019 47985019 340B REVENUE 621400 1166851 1166851 49151870 230010 230010 1000 0 1000 1000 1000 29100 9744 16621 12479 12479 CAFETERIA 722514 85209 85209 MEDICAL RECORDS 561000 6919 6919 53806 41550 12256 145934 49650499 49286548 0 254745 X 78627 78627 28350 28350 467733 467733 16396890 14370332 2026558 219734 193869 25865 2696988 2310281 386707 1192761 1038567 154194 77949 77949 158744 158744 654556 654556 5206613 4823964 382649 439577 12221 427356 354549 139078 215471 724186 141033 583153 1095006 915819 179187 481523 414361 67162 106277 65094 41183 346988 276886 70102 2365144 1887314 477830 439177 439177 UNCOLLECTABLE ACCOUNT P 3889888 3889888 SUPPLIES EXPENSE 3728135 3719552 8583 REPAIRS AND MAINTENANCE 343857 268689 75168 DUES AND SUBSCRIPTIONS 100429 88712 11717 136838 30043 106795 41730519 35131857 6598662 0 11010587 13956601 5845436 4389544 6479569 9215494 874857 969262 144796 499745 45352934 19737605 25452446 25615329 447352 2574597 434708 460239 50689751 57680811 4331907 4397813 9765700 8825745 113110 43109 14210717 13266667 X 36479034 44414144 36479034 44414144 50689751 57680811 7919980 15130 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 18314 18314 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ARIZONA ALLIANCE FOR COMMUNITY HEALTH CENTERS (AACHC). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. THE ORGANIZATION ALSO PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION (AZHHA). A PORTION OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT. 1193761 1193761 28656436 9356892 19299544 14370202 10380713 3989489 1132535 1132535 25615329 OTHER LIABILITIES 43109 43109 45685385 15130 15130 45670255 3980244 3980244 49650499 37750275 0 37750275 3980244 3980244 41730519 PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,889,888. DONATIONS 106,977. FUNDRAISING EVENT EXEPENSES -16,621. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 3,889,888. DONATION EXPENSE 106,977. FUNDRAISING EVENT EXPENSES -16,621. GOLF TOURNAMENT 37894 8794 29100 6362 7280 2704 1 950 950 275 38844 9744 29100 6362 7280 275 2704 16621 12479 1 1 X 1 X 250.000000000000 0 1 1 0 0 82670 82670 0.00220 13187808 13511963 0 0.00000 13270478 13511963 82670 0.00220 6586774 1705536 4881238 0.12900 27676 27676 0.00070 6614450 1705536 4908914 0.12970 19884928 15217499 4991584 0.13190 0 887283 443641 5374741 5468243 -93502 X 1 1 1 1 BISBEE HOSPITAL ASSOCIATION INC DBA COPPER QUEEN COMMUNITY 100 E 5TH ST DOUGLAS AZ 85607 HTTPS://CQCH.ORG/ RGH0098 X X X X BISBEE HOSPITAL ASSOCIATION INC DBA CO 1 0 0 1 X X X X X X X X X 16 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION X 1 16 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 250.000000000000 1 1 X X X X 1 X WWW.CQCH.ORG/RESOURCES/COMMUNITY/ X WWW.CQCH.ORG/RESOURCES/COMMUNITY/ X WWW.CQCH.ORG/RESOURCES/COMMUNITY/ X X X X X X X 1 X 0 X X X X 1 X 0 0 SCHEDULE H NAME: THE ORGANIZATION, BISBEE HOSPITAL ASSOCIATION INC D/B/A COPPER QUEEN COMMUNITY HOSPITAL WILL SUBSEQUENTLY BE REFERRED TO AS "CQCH". 3 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 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 I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 3,889,888. 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 ASSES 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. PART VI, LINE 4: LOCATED IN THE SOUTHEAST CORNER OF ARIZONA AND COVERING MORE THAN FOUR MILLION ACRES (6,165 SQUARE MILES), THIS COUNTY CONTAINS AN ACTIVE MILITARY BASE, RANCHES AND FARMS, SIGHTSEEING DESTINATIONS AND IT BORDERS THE COUNTRY OF MEXICO TO ITS SOUTH.ACCORDING TO ESTIMATES BY THE US CENSUS BUREAU, IN 2010 THE COUNTY WAS HOME TO 131,346 PEOPLE FROM ALL TYPES OF BACKGROUNDS, WITH A VARIETY OF SOCIAL, ECONOMIC AND HEALTHCARE NEEDS. THE COUNTY'S RESIDENTS COME FROM DIVERSE CULTURES AND LIFESTYLES, FROM TOMBSTONE TO BISBEE, TO SIERRA VISTA AND FORT HUACHUCA, FROM WILLCOX TO DOUGLAS AND ALL OF THE RURAL UNINCORPORATED TOWNS IN BETWEEN AND ALONG THE MEXICAN BORDER.UNLIKE THE MAJORITY OF COUNTIES IN ARIZONA, COCHISE COUNTY CONTINUES TO SEE A DECLINE IN POPULATION. THE US CENSUS BUREAU'S 2015 POPULATION ESTIMATES INDICATE THERE ARE NOW 126,427 RESIDENTS IN THE COUNTY, THE FOURTH ANNUAL DECLINE IN THE PAST FIVE YEARS. PART VI, LINE 5: AT EACH OF OUR RHC'S WE HOLD ANNUAL HEALTH FAIR TO HELP EDUCATE THE COMMUNITY ABOUT OUR ORGANIZATION AND OUTSIDE ORGANIZATIONS - $3500 CQCH PARTICIPATES IN BOTH THE 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 1 COCHISE COLLEGE FOUNDATION 4190 W HWY 80 DOUGLAS AZ 85607 860211414 501(C)(3) 27676 TO SUPPORT THE PURCHASE OF CPR AND OTHER MANIKINS FOR PROGRAMS. 1 0 SCHOLARSHIPS AND AWARDS 19 28350 PART I, LINE 2: THE ORGANIZATION HAS A LEADERSHIP MEETING TO REVIEW FUNDING REQUESTS AND EVALUATES THOSE IN LIGHT OF THE ORGANIZATION'S MISSION FOR IMPROVING THE QUALITY OF HEALTH CARE IN SOUTHERN ARIZONA. X X X X 0 0 0 0 0 0 0 0 0 HEATHER LUNDSTROM CFO 163644 0 49226 0 0 0 0 0 9812 0 222682 0 0 0 JAMES DICKSON CEO (THRU JULY) 212503 0 4777 0 0 0 15996 0 11776 0 245052 0 0 0 DANIEL ROE EMERGENCY ROOM PHYSICIAN 430353 0 68624 0 48933 0 14159 0 14448 0 576517 0 0 0 JENNIFER MILLER EMERGENCY ROOM PHYSICIAN 338400 0 0 0 7200 0 0 0 8140 0 353740 0 0 0 HEIDI LODGE INTERNAL MEDICINE PHYSICIAN 235866 0 62497 0 2596 0 8280 0 15636 0 324875 0 0 0 PEGGY AVINA FAMILY PHYSICIAN 238995 0 54830 0 4327 0 7962 0 8140 0 314254 0 0 0 RICHARD SNURE SURGICAL PHYSICIAN 286627 0 0 0 0 0 0 0 6580 0 293207 0 0 0 JAMES DICKSON FORMER CEO FROM APRIL 2018 THROUGH JUNE 2018, THE FORMER CEO OF THE HOSPITAL RECEIVED APPROXIMATELY $19,156 IN EXCESS COMPENSATION IN CONNECTION WITH HIS RETIREMENT. AT THE HOSPITAL'S REQUEST, THE FORMER EXECUTIVE REIMBURSED THE HOSPITAL IN FULL. IN ADDITION, FOLLOWING AN INTERNAL REVIEW, THE HOSPITAL DETERMINED THAT THE FORMER EXECUTIVE WAS REIMBURSED FOR PERSONAL EXPENSES IN THE AMOUNT OF $1,548 AND $848 DURING FISCAL YEARS 2015 AND 2017, RESPECTIVELY. IN REPAYING THE HOSPITAL, THE FORMER EXECUTIVE DID NOT CONCEDE THAT HE RECEIVED ANY IMPROPER PAYMENTS OR REIMBURSEMENTS. THE HOSPITAL IMPLEMENTED INTERNAL CONTROL CHANGES TO AVOID ANY FUTURE RECURRENCE. 1 0 0 JOHN HARRIS FORMER VOTING MEMBER OF THE BOARD 351888 PURCHASE OF LAND FOR USE OF THE HOSPITAL. 0 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 696,943. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 696,943. OTHER: PROGRAM SERVICE EXPENSES 1,058,526. MANAGEMENT AND GENERAL EXPENSES 382,649. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,441,175. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 3,068,495. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,068,495.