2018-11-15T09:21:12-06:00 2017-12-31 450250958 Eide Bailly LLP 4310 17th Ave S PO Box 2545 Fargo ND 581082545 990 2017-01-01 841337350 Southwest Health System Inc SOUT 9705656666 1311 North Mildred Cortez CO 81321 Anthony Sudduth Interim CEO 9705656666 2018-11-15 1 Kim C Hunwardsen P00484560 7012398500 2018-11-14 216.147.170.229 2018-11-15 08:30:56 CS P 66CC91E6B7F11C4783FFFA5645E675327CB67316 B602D594AFD2B0B327E07A06F36CA6A7E42546D0 2017 2019-02-21 02:37:17Z Anthony Sudduth 1311 North Mildred Cortez CO 81321 58314656 0 X www.swhealth.org X 1996 CO To provide quality healthcare to our community. 7 5 546 6 0 0 4815390 568791 64891396 57653201 63153 82834 -565552 9830 69204387 58314656 0 0 0 0 34158946 36893325 0 0 0 24325555 28360979 58484501 65254304 10719886 -6939648 55063464 63195440 23581615 38662370 31481849 24533070 To provide the highest quality health care to our community by bringing excellence and service together to promote, improve and restore health. 0 0 49939734 57653201 During 2017, Southwest Health Systems served approximately 40,597 inpatients and outpatients, 36,692 patients were served through our physician clinics, and 14,351 patients were seen in our emergency room. 49939734 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 34 0 1 546 1 0 0 0 0 0 0 0 0 0 0 X 7 5 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 CO X Rick Schrader 9705642153 1311 North Mildred Cortez CO 81321 Paul Deshayes Chair 1.50 X X 0 0 0 Scott Steeves Vice Chair/CRNA 1.50 X X 117574 0 0 Steve Fusco Sec/Treas (Jan-Aug)/Trustee (Aug-Dec) 5.50 X X 0 0 0 Tom Rice Sec/Treas (Aug-Dec) 1.00 X X 0 0 0 Dan Valverde Trustee (Jan-Aug) 1.00 X 0 0 0 Dolores Sheets Trustee 0.50 X 0 0 0 Terry Cook Trustee/Podiatrist 41.00 X 320743 0 30500 Kyle Cruzan Trustee 0.50 X 0 0 0 William Kent Rogers CEO 40.00 X 242631 0 35543 Angela Kobel CFO 40.00 X 149545 0 14174 Kevin Matteson General Surgery 40.00 X 485354 0 48820 Randy Davidson ER Physician 48.60 X 402271 0 33559 Douglas Bagge Orthopedic Surgeon 40.00 X 508791 0 36249 David Buckwalter ER Physician 44.10 X 338246 0 26306 Peter Razma Clinic Physician 40.00 X 405912 0 27948 2971067 0 253099 57 0 1 0 Impact Advisors Box 379 Naperville IL 605660379 Business Consulting 902635 Managing IT 4 U 125 S Yale Villa Park IL 60181 Business Consulting 244050 QHR 1573 Mallory Lane Suite 200 Brentwood TN 37027 Business Consulting 186635 Patrick McLaughlin 575 Rivergate Ln Ste 109 Durango CO 81301 Pain Management Physicians 161000 Animas Spine 575 Rivergate Ln Ste 109 Durango CO 81301 Spine Care Clinic 150500 8 568791 568791 Net Patient Service Revenue 621400 54223996 54223996 Sales and Use Tax Revenue 900099 1345270 1345270 Pharmacy 446110 1222366 1222366 Meaningful Use Medicare 621400 246308 246308 615261 615261 57653201 62139 62139 9830 0 9830 9830 9830 20695 0 20695 20695 20695 58314656 57653201 0 92664 923504 341087 582417 29490844 24068149 5422695 320339 255727 64612 4371295 2805922 1565373 1787343 1394350 392993 64395 64395 128738 128738 4279125 2142378 2136747 2537747 1753743 784004 702694 702694 101294 76722 24572 184173 85615 98558 493311 493311 1952048 1952048 Provision for Bad Debts 5374152 5374152 Medical Supplies 3962979 3962979 Equipment Rental and Ma 3526911 1374751 2152160 Printing and Publicatio 41111 22288 18823 5012301 3133818 1878483 65254304 49939734 15314570 0 2951124 974156 4300000 1091524 13601418 12074242 7517 1370969 1427110 1041564 1384455 74219493 35740560 13727648 38478933 15924350 5797876 2146391 1959627 55063464 63195440 5838996 11096630 16208861 25804187 562557 283970 200000 971201 1277583 23581615 38662370 X 26978889 24282665 4502960 250405 31481849 24533070 55063464 63195440 -6939648 -9131 0 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 1915 1915 0 Part II-B, Line 1: The lobbying expense is the allocable portion of dues paid to CHA and AHA disclosed as lobbying activity. The organizations provide the percentage to use for allocation purposes. 83500 83500 24105643 12611774 11493869 25871023 22711291 3159732 24159327 417495 23741832 38478933 Estimated Third Party Payor Settlements 999533 Deferred Compensation Liability 278050 1277583 X 52931373 -9131 -5374152 -5383283 58314656 0 58314656 59880152 0 59880152 5374152 5374152 65254304 Part X, Line 2: The Health System is organized as a nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Health System is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Health System believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Health System would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Reported in Expenses for Tax Purposes -5,374,152. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Reported in Expenses for Tax Purposes 5,374,152. 1 1 X 1 X 250.000000000000 1 X 1 1 0 0 133000 133000 0.00220 15915662 13238254 2677408 0.04470 16048662 13238254 2810408 0.04690 15384 15384 0.00030 10518877 3832314 6686563 0.11170 9185 9185 0.00020 10543446 3832314 6711132 0.11220 26592108 17070568 9521540 0.15910 1 5374152 0 16012599 16071980 -59381 X 1 1 1 Southwest Healthnet PHO Insurance Contract Management 0.51000 0.49000 1 1 Southwest Memorial Hospital 1311 North Mildred Cortez CO 81321 www.swhealth.org 012206 X X X X Southwest Memorial Hospital 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X http://www.swhealth.org/about/chna X 1 16 1 http://www.swhealth.org/about/chna 0 1 X 250.000000000000 400.000000000000 X 1 1 X X X X 1 X http://www.swhealth.org/ X http://www.swhealth.org/ X http://www.swhealth.org/ X X X X X X X 1 X 0 X X X X 1 X 0 0 Southwest Memorial Hospital Part V, Section B, Line 5: Southwest Health System conducted online surveys, paper surveys, in-person interviews, and collected information through heavy community engagement. Surveys were conducted by the marketing department, law enforcement, the public health department, and community ambassadors.For the Community Health Needs Assessment Survey, Southwest Health System received community input from 223 area residents; survey responses started October 24, 2016 and ended with the last response on Friday, November 4th, 2016. Southwest Health System also conducted a separate survey regarding obstetrics and pediatrics from April 1st, 2016 to April 28th, 2016 with a total of 144 respondents for feedback and opinions about service availability and needs for the community. This survey was conducted online through the SHS Marketing Department, Rocky Mountain Medicaid Care Coordinators, and sent through numerous community coalitions and distribution groups for community related information. The terms of gaining input stipulated each respondent would remain anonymous; the internet based survey was promoted through email lists of health coalitions, law enforcement, public health, and community advocacy groups, paid advertisement through social media, and distributed to local civic and health organizations with a request for participation. Low-Income/Medically Underserved/Minority Representation Groups: Nurse Family Partnership- Spanish speaking client and administrator, Southwest Open School Parents, Women Infant Children Program Administrator and clients, Montezuma County Veterans Services Administrator and clients, Bridge Homeless Shelter Administration and Day labor client, Behavioral Health counselor at Axis, Montezuma County School District, Montezuma County Employee, Pinon Project, Mancos Food Share, Good Samaritan, Ute Mountain Ute Tribal Leadership, Ute Mountain Ute Tribal HR, School-Based Health Center Clinical Staff, Dove Creek Clinic, Recovery Center Administrator. Other: Dolores Fire, TeamUP, Aflac Insurance, Montezuma County Commissioner, City of Cortez Mayor, Montezuma County Sheriff's Office, Cortez Police Department, Osprey Packs, Montezuma County Health Department, Southwest Health System Staff, Cortez Fire, Cortez Chamber of Commerce. Southwest Memorial Hospital Part V, Section B, Line 11: The items with the most significant needs or issues included healthcare cost, maternal and child health, diabetes, alcohol and substance abuse and cancer. Healthcare Cost: Southwest Health System provides Patient Financial Counseling to all community members, regardless of income level. We support state and federal initiatives to address uninsured and under insured population groups and have recently changed our internal financial assistance plan (FAP) from 250% FPL to 400% FPL. Our facility partners with the Pinon Project in Montezuma County to provide additional financial resources to navigate insurance in the service area. We participate in Southwest HealthNet, a Physician Hospital Organization (PHO) to provide additional access to healthcare resources with partner healthcare practices and also assists with workers compensation in the service area. We will continue to participate in all managed care plans that help us improve access for members of communities we serve, and reduce financial burdens of healthcare needs to consumers.Maternal and Child Health: Southwest Health System added 1 Obstetrics provider in 2016 for a total of 3 in the Southwest Medical Group family and partners with Hope Barkhurst, MD as an additional provider of obstetric services in the service area. Southwest Health System has engaged with a family practice obstetrics provider which will bring us to 4 full-time OB providers by December of 2017. We will also add another location to address a large gap in services in Dolores, Colorado. We also provide in-school healthcare services including family planning services to help curb the teen birth numbers in our community.Diabetes: Southwest Health System Diabetes Education provides individual sessions where patients can meet with a diabetes educator. Educational sessions can be tailored to meet the specific needs of the individual. A referral from the patient's provider is required. Diabetes Education provides group sessions which includes a free six week class to learn about diabetes. The class topics include: Understanding diabetes and monitoring blood sugars, healthy eating and carbohydrate counting, medications and physical activity, high and low blood sugar management, understanding diabetes related complications, living with diabetes. Anyone can attend. We also provide pre-diabetes classes in a group setting in which participants discuss risk factors and healthy behaviors needed to manage prediabetes and possibly prevent or delay the onset of Type 2 diabetes. Classes are held at the hospital campus. Diabetes Education provides a diabetes support group that meets on the first Wednesday each month at 3:30 pm at the hospital. The class provides an opportunity for people with any type of diabetes to learn new information and share their experiences to help them manage living with diabetes. A participant does not need a referral from their provider. Nutrition Education works closely with diabetes education and is led by a Registered Dietitian and Nutritionist who provides nutrition counseling and education including but not limited to: weight loss, childhood obesity, diabetes, celiac disease, cancer, Crohn's and Ulcerative Colitis, heart disease, IBS, kidney disease, and weight gain. The Nutrition Education Department at SHS also provides family counseling, meal planning, grocery store tours, and classroom education for community members including youth, and cooking tutorials. They also host a Weight Loss Surgery support group on the first Thursday of each month.Alcohol and Substance Abuse: Southwest Health System partners with Axis Health System to provide mental and behavioral health crisis services in the Emergency Department as needed. We employ medical social workers who support physicians and patients for an integrated health care model. Southwest Health System is a part of the Axis Intergovernmental Detox Facility agreement and provides payment on behalf of the Montezuma County Sheriff's Office and Cortez Police Department to support the detox center operated in Durango, Colorado. We work closely with other agencies to actively monitor mental and behavioral health trends, policy, and community needs so we can quickly respond to better serve our community. We plan to engage in mental and behavioral health telemedicine in the ER to improve initial assessment time for crisis services, which include assessment to those dealing with substance abuse. This service will start to improve care coordination and should eventually lower the cost of care for alcohol, substance, and crisis related interventions. Southwest Health System supports the Bridge Shelter both with tangible and monetary donations to ensure proper care for homeless community members.Cancer: Southwest Health System is developing an arrangement to offer oncology services at Southwest Medical Group Specialty Clinic one day per week and to consult with the Infusion Clinic located on the Southwest Memorial Hospital Campus. Southwest Health System collaborates with the Women's Wellness Connection to provide free and low cost preventative screenings and treatment for breast and cervical cancers to women who meet certain criteria. Southwest Health System purchased a 3D mammography system in 2016, also referred to as Digital Breast Tomosynthesis (DBT) Southwest Health System hosts an Infusion Clinic on the Mildred Road campus. Our foundation provides emergency assistance to cancer patients to help with expenses incurred while undergoing cancer treatment.In 2017 Southwest Health System continued the construction on the New Patient Wing and Medical Office Building to help address the needs above.We were not able to address the following needs identified in the comments section of the 2016 Community Health Needs Assessment because they were out of our scope of work; we were unable to provide personnel to meet those needs; we were unable to recruit to fill the need; another organization currently fulfills that need; and we were unable to expand our line of services to fill that particular need. The needs identified were providing programs for stress management, hosting and managing a smoking cessation program, refocusing on population health and creating a community-wide preventative health program, hiring a rheumatologist, and building an inpatient drug rehab and detox center within Montezuma County. Southwest Memorial Hospital Part V, Section B, Line 16j: Policy communication is included in the quarterly newsletter. 10 1 - Southwest Memorial Primary Care 33 North Elm Cortez CO 81321 Rural Health Clinic 2 - Cortez Primary Care 118 North Chestnut Cortez CO 81321 Rural Health Clinic 3 - Cortez Orthopedics 33 South Market Cortez CO 81321 Orthopedic Physician Office 4 - Southwest Walk-In Clinic 2095 Dolores Road Cortez CO 81321 Rural Health Clinic 5 - SW Memorial Hospital Draw Station 111 North Park Cortez CO 81321 Lab Draw Station 6 - Mancos Valley Clinic 111 Railroad Ave Mancos CO 81328 Rural Health Clinic 7 - SW Memorial Physicians 33 South Market Cortez CO 81321 Physician Office 8 - Red Rock Podiatry 1280 N Mildred Rd Cortez CO 81321 Clinic 9 - Four Corners Surgical 111 North Park Cortez CO 81321 Surgical Center 10 - Southwest School-Based Health Center 418 South Sligo Street Cortez CO 81321 Rural Health Clinic Part I, Line 3c: In addition to the FPG, the Organization considers medical indigency when determining eligibility for financial assistance. Part I, Line 7: The organization used a cost-to-charge ratio for lines 7a. Unreimbursed Medicaid was calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers. The information for lines 7e and 7i was derived from information in the general ledger and other financial data related specifically to the various types of community benefits. Part I, Line 7g: The amounts reported in Subsidized Health Services includes costs of $6,505,261 for a rural health clinic. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 5,374,152. Part III, Line 2: The bad debt on line 2 is reported at charges. The Health System reports patient accounts receivable for services rendered at net realizable amounts from third party payers, patients, and others. The Health System provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. Part III, Line 4: The footnote to the organization's financial statements that describes bad debt expenses can be found on page eight of the attached audited financial statements. Part III, Line 8: One hundred percent of any shortfall should be treated as community benefit. A facility must be able to recover its costs in order to continue to provide quality care to Medicare patients and the community as a whole. Services are provided to patients under the Medicare program knowing that not all costs associated with providing these services will be recovered. Providing these services is essential to these patients and the community and increases their access to healthcare services. Therefore, the entire Medicare shortfall is considered a community benefit.Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: The Organization refrains from sending patient accounts to collection until 120 days after the date of the first post-discharge billing statement. If a patient applies for financial assistance within 240 days of the date of the first post-discharge billings statement the Organization will pull the accounts from collections. Part VI, Line 2: The Community Health Needs Assessment (CHNA) is done at least every three years. The CHNA serves as the foundation for developing strategic priorities and goals. In addition to the CHNA data collection and analysis, input is received from medical staff, hospital leadership, and the board. All data is then consolidated into a strategic plan. A CHNA was conducted in 2016, adopted by the board in February 2016. Part VI, Line 3: Patients are sent letters describing the programs available to assist with their medical bills. The letter explains the process and the documents needed to complete the assistance applications(s). The letter also encourages the patient to check their eligibility with their state Medicaid office. Follow-up appointments are scheduled with financial counselors to complete the assistance applications. Part VI, Line 4: Geographically, the primary service area (PSA) of SWMH is comprised of seven zip codes within Montezuma County in southwest Colorado. The PSA is situated between the mountains to the east and deserts to the west. Montezuma County is rural and heavily agricultural and very dependent upon tourism. The 2013 population for Montezuma County is estimated to be 26,015 and is expected to increase at a rate of 4.1%, which is in contrast to the 3.9% national rate of growth and the Colorado growth rate of 6.1%. Montezuma County in 2017 anticipates a population of 27,088. According to the population estimates utilized by Truven, provided by the Neilson Company, the 2013 median age for the county is 41.9 years, older than the Colorado median age (36.4 years) and older than the national median age (36.8 years). The 2013 median household income for the area is $41,025, which is lower than the Colorado median income of $55,085 and the national median income of $49,559. Median household wealth value is above the national but below the Colorado value. Median home values show the same pattern as household wealth. Montezuma's unemployment rate as of October 2013 was 7.6%, which is slightly better than the 7.9% statewide and the national civilian unemployment rate. The portion of the population in the county over 65 is 15.2%, well above the Colorado average of 10.8%. The portion of the population of women of childbearing age is 17.1%, considerably below the Colorado average of 20.1%. Part VI, Line 5: SHS's Board of Directors is comprised of persons who reside in the primary service area (PSA) and are neither employees nor independent contractors of SHS, with the exception of one board member who is a Podiatrist at SHS and one member who is an independent contractor as a CRNA. Medical staff privileges are open to all qualified physicians. Surplus funds are used to improve the care of patients. SHS holds education health seminars, open at no charge to community members, and participates in health fairs with free and low cost screening exams. The partnership with Livewell Colorado was designed to promote healthy lifestyles by assisting with programs that encourage healthy eating and exercise. In 2017, the program continued to assist with the farm to school program which introduces students to farming and eventually leads to students growing their own vegetables in school gardens. In addition, there was also support for the cooking matters program, which teaches health shopping and cooking. There was also a heavy emphasis on eat local eat healthy (ELEH), which promotes eating locally grown products which will benefit the local economy and the general health of the community. X X 0 1 0 0 0 0 0 0 0 Terry Cook Trustee/Podiatrist 257295 0 18152 0 45296 0 0 0 30506 0 351249 0 0 0 William Kent Rogers CEO 232611 0 0 0 10020 0 5050 0 30498 0 278179 0 0 0 Angela Kobel CFO 130772 0 0 0 18773 0 3075 0 11104 0 163724 0 0 0 Kevin Matteson General Surgery 485354 0 0 0 0 0 24000 0 24820 0 534174 0 0 0 Randy Davidson ER Physician 360194 0 0 0 42077 0 16338 0 17226 0 435835 0 0 0 Douglas Bagge Orthopedic Surgeon 437890 0 0 0 70901 0 5400 0 30855 0 545046 0 0 0 David Buckwalter ER Physician 292430 0 0 0 45816 0 0 0 26311 0 364557 0 0 0 Peter Razma Clinic Physician 366082 0 20000 0 19830 0 0 0 27953 0 433865 0 0 0 Part I, Line 4b W. Kent Rogers, CEO, participated in a 457(f) retirement plan. He contributed $10,896 in 2017. There were no employer contributions. A Montezuma County Colorado 846000786 2016-11-15 39261315 Construct EMS facility & hospital improvements & refund bond issued 9/27/07 0 0 0 A 39261315 456933 791139 19200198 8564261 10248784 0 1 0 0 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 1 0 0 0 1 A 1 Terry Cook Board Member Business Loan X 89493 7517 0 1 1 7517 Form 990, Part VI, Section A, line 8b There are no committees that are able to act on behalf of the board. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by a third party, reviewed in detail by the Chief Financial Officer, and then submitted to the governing board for review. It is approved by the Board of Directors prior to filing with the IRS. Form 990, Part VI, Section B, line 12c Conflict of interest policies cover the Board of Directors, senior leadership, department directors, all employees, and volunteers. Potential conflicts are reviewed annually at the level above the individual involved and prohibits or requires disclosure of any conflict. Form 990, Part VI, Section B, line 15a Annually the Board of Directors review the CEO compensation using regional and national data. Additionally, there was a review of all hospital salaries in November 2017 utilizing data from the Colorado Hospital Association. Annually the CEO reviews the compensation for the CFO and key employees. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policies, and financial statements are all made available to the public upon request.