2018-05-07T12:17:43-05:00 2017-06-30 205949532 RICCI & COMPANY LLC 6200 UPTOWN BLVD NE STE 400 ALBUQUERQUE NM 87110 990 2016-07-01 850141285 CIBOLA GENERAL HOSPITAL CIBO 5052874446 1016 E ROOSEVELT AVE GRANTS NM 87020 ED BROWN INTERIM CFO 5052874446 2018-05-02 1 MARIA MATONTI P01790899 5053380800 2016 2022-09-23 18:48:47Z ED BROWN 1016 E ROOSEVELT AVE GRANTS NM 87020 26806860 0 X WWW.CIBOLAHOSPITAL.COM X 1958 NM TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY WITHOUT REGARD TO ABILITY TO PAY BY UTILIZING STATE OF THE ART PRACTICES AND EQUIPMENT TO PROVIDE QUALITY CARE. 9 9 273 9 0 0 39926 34470 21596698 26545399 157772 130803 5297506 95634 27091902 26806306 0 0 0 0 15042549 15414891 0 0 0 11192308 12521084 26234857 27935975 857045 -1129669 45261272 42220774 3480014 1822355 41781258 40398419 X TO PROVIDE EXCELLENT HEALTH CARE TO THE COMMUNITY BY COMMITTING TO SERVICE, QUALITY, FINANCIAL STABILITY, AND GROWTH. THE ORGANIZATION STRIVES TO PROVIDE PATIENTS AND FAMILIES WITH QUALITY SERVICE BY IMPLEMENTING NATIONAL BEST PRACTICES AS STANDARDS. IT ALSO MAINTAINS FINANCIAL STABILITY TO ENSURE ITS CONTINUANCE AND GROWTH SO THAT HEALTH CARE IS ACCESSIBLE THROUGH THE HOSPITAL AND ITS PHYSICIAN PARTNERSHIPS. 0 0 19416901 26545399 THE ORGANIZATION PROVIDES PATIENT CARE TO THE RESIDENTS OF GRANTS, NEW MEXICO AND OUTLYING COMMUNITIES WITHOUT REGARD TO ABILITY TO PAY. THERE ARE APPROXIMATELY 27,200 RESIDENTS IN THE CIBOLA COUNTY, NM COMMUNITY. CIBOLA COUNTY HOSPITAL UTILIZES STATE OF THE ART EQUIPMENT AND THE HIGHEST HEALTH CARE STANDARDS TO PROVIDE QUALITY HEALTH CARE. DURING THE FISCAL YEAR, THE ORGANIZATION HAD ABOUT 825 INPATIENT ADMISSIONS SERVED IN ITS 25-BED FACILITY. THE HOSPITAL ALSO HAD ABOUT 17,200 OUTPATIENT VISITS, ABOUT 9,200 EMERGENCY ROOM VISITS, AND ABOUT 21,600 CLINIC VISITS. THE ORGANIZATION'S STAFF WORK HAD TO MEET PATIENT NEEDS AND THEY FEEL EVERY PATIENT ENCOUNTER IS AN ACCOMPLISHMENT. 19416901 1 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 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 66 0 1 273 1 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 NM X X THE ORGANIZATION 5052874446 1016 E ROOSEVELT AVE GRANTS NM 87020 BOB TENEQUER CHAIRMAN 2.00 X X 0 0 0 NESTOR GRIEGO VICE CHAIRMAN 2.00 X X 0 0 0 DR ANN CHURCH CHIEF OF STAFF/MEMBER 2.00 X X 332307 0 53365 CARLOS TAPIA MEMBER 2.00 X 0 0 0 EILEEN YARBOROUGH MEMBER 2.00 X 0 0 0 CHASE ELKINS SECRETARY 2.00 X 0 0 0 PAUL MILAN TREASURER 2.00 X 0 0 0 JUDY MARTINEZ MEMBER 2.00 X 0 0 0 ROBERT WINDHORST COUNTY COMM/MEMBER 2.00 X 0 0 0 THOMAS WHELAN CEO 40.00 X 193517 0 28157 ED BROWN INTERIM CFO 40.00 X 0 0 0 ARNOLD VALDIVIA PHYSICIAN 40.00 X 422562 0 66497 WALTER BRIDGES SURGEON 40.00 X 415389 0 65453 JOSEPH CHARLES PHYSICIAN 40.00 X 332307 0 53365 KARL GUTIERREZ SURGEON 40.00 X 311022 0 50268 DIEGO FLORENTIN RODRIGUEZ PHYSICIAN 40.00 X 301619 0 48900 2308723 0 366005 19 0 1 1 EMCARE INC 1717 MAIN ST STE 5200 DALLAS TX 75201 EMERGENCY DEPT MANAGEMENT 901502 CARDINAL HEALTH 7000 CARDINAL PLACE DUBLIN OH 43017 MEDICAL/SURGICAL & DRUGS 629470 MEDHOST OF TENNESSEE 3102 WEST END AVE NASHVILLE TN 37203 DATA PROCESSING SERVICES 566916 HOLOGIC INC 250 CAMPUS DR MARLBOROUGH MA 01752 MEDICAL SUPPLIES & EQUIPMENT 510300 ARAMARK CHICAGO 4200 S HALSTED ST CHICAGO IL 60609 PLANT & ENV SVCS MGMT & FOOD 368753 29 8180 26290 34470 ACUTE CARE HOSPITAL SERVICES 622110 24733963 24733963 CIBOLA COUNTY MILL LEVY SUBSIDY 921190 1391636 1391636 OTHER PROGRAM REVENUE 622110 419800 419800 26545399 131357 131357 554 -554 -554 -554 FOOD SERVICES INCOME 900099 95634 95634 95634 26806306 26545399 0 226437 453446 453446 12239961 9724797 2515164 1876481 1490887 385594 845003 671365 173638 108576 108576 30435 30435 1087698 1087698 82234 82234 313936 313936 350259 350259 135856 78359 57497 1316358 858630 457728 335328 335328 PURCHASED SERVICES 4758222 2903874 1854348 MEDICAL, RX, & FOOD SUP 2251290 1894806 356484 REPAIRS & MAINTENANCE 1239029 430598 808431 RENTALS, LEASES, DUES, 511863 275887 235976 27935975 19416901 8519074 0 9726932 3369899 2712860 2861262 214773 208640 325533 260340 19279181 9421275 9739427 9857906 22541747 25662727 45261272 42220774 3480014 1822355 3480014 1822355 X 41781258 40398419 41781258 40398419 45261272 42220774 X -1129669 -28326 -224844 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 161000 161000 7388073 2541784 4846289 2292640 788757 1503883 9372053 6090734 3281319 65415 65415 9857906 CERTIFICATES OF DEPOSIT 25662727 F 25662727 26777980 -28326 -28326 26806306 0 26806306 27935975 0 27935975 0 27935975 SCHEDULE D, PART VI, LINE 1(E): THIS LINE CONTAINS THE ORGANIZATION'S TOTAL NONDEPRECIABLE CONSTRUCTION IN PROCESS BALANCE. 1 1 1 X 350.000000000000 1 X 100.000000000000 1 1 0 0 340113 340113 0.01220 6494131 3663397 2830734 0.10130 6834244 3663397 3170847 0.11350 80000 80000 0.00290 80000 80000 0.00290 6914244 3663397 3250847 0.11640 1 2739863 1083106 3090292 5180663 -2090371 X 1 1 1 1 CIBOLA GENERAL HOSPITAL INC 1016 E ROOSEVELT AVE GRANTS NM 87020 WWW.CIBOLAHOSPITAL.COM X CIBOLA GENERAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X HTTP://WWW.CIBOLAHOSPITAL.COM/ 1 16 1 HTTP://WWW.CIBOLAHOSPITAL.COM/ 0 1 X 350.000000000000 100.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.CIBOLAHOSPITAL.COM/ X WWW.CIBOLAHOSPITAL.COM X X X 1 X 1 X X X X 1 0 0 CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 5: FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOUGHT INPUT FROM ALL PERSONS IN ITS SERVICE AREA, INCLUDING COUNTY GOVERNMENT AND LEADERS OF THE BUSINESS COMMUNITY. THE NEEDS ASSESSMENT WAS OFFERED ONLINE FROM A LINK TO IT IN THE HOSPITAL'S WEBSITE, AND WAS ALSO OFFERED IN A PAPER VERSION TO ANY WHO PREFERRED IT THAT WAY. THE PERSONS CONSULTED INCLUDED, BUT WERE NOT LIMITED TO, THE CEO, CFO, CCO, HR DIRECTOR, ALL MEMBERS OF THE BOARD, AND THE MEDICAL STAFF. THE NEEDS ASSESSMENT WAS HEAVILY ADVERTISED IN THE MEDIA. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE HOSPITAL AND ITS BOARD PRACTICE ONGOING PROMOTION OF HEALTH IMPROVEMENT. COMMUNITY HEALTH IS PROMOTED IN THE FOLLOWING WAY: (1) THE HOSPITAL BOARD IS A COMMUNITY-BASED, ALL VOLUNTEER GROUP. (2)SURPLUS FUNDS ARE USED TO REINVEST IN THE FACILITIES TO KEEP THEM STATE OF THE ART. (3) FINANCIAL SUPPORT TO THE LOCAL COLLEGE FUNDS THE SALARY OF THE NURSING PROGRAM DIRECTOR. (4) THE HOSPITAL CO-SPONSORS AN ANNUAL HEALTH FAIR TO EDUCATE THE COMMUNITY. (5) ANNUAL VACCINATION CLINICS ARE STAFFED BY HOSPITAL NURSES. AND (6) FREE CLASSES ARE SPONSORED IN DIABETES EDUCATION, CHILDBIRTH, AND BREASTFEEDING. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 18E: OUTSIDE COLLECTION AGENCIES ARE USED. THE RECOVERY RATES BY THESE AGENCIES ARE TYPICALLY UNDER 10%. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 20E: PATIENTS ARE NOTIFIED UPON ADMISSION AND DISCHARGE OF THE FINANCIAL ASSISTANCE PROGRAM. ALSO, THE ORGANIZATION DOCUMENTS ITS DETERMINATION OF ELIGIBILITY AND NOTIFIES PATIENTS OF THE POLICY IN COMMUNICATIONS WITH PATIENTS REGARDING THEIR BILLS. PART V, SECTION B, LINE 22 EXPLANATION: THE GROSS AMOUNT CHARGED IS THE SAME FOR ALL. IF A PATIENT GETS FINANCIAL ASSISTANCE, THEN A PORTION OF THE BILL, OR ALL OF IT, IS WRITTEN OFF AS A CHARITABLE WRITE-OFF. PART I, LINE 3C: THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: 1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. 2) PROOF OF HOUSEHOLD INCOME. AND 3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. PART I, LINE 7: AMOUNT REPORTED ON LINE A, COLUMN C IS BASED ON THE ORGANIZATION'S OVERALL COST TO CHARGE RATIO. LINE B, COLUMN D USES COST TO CHARGE RATIO OFFSET BY A CONTRACTUAL PERCENTAGE LEADING TO THE AMOUNT REPORTED IN COLUMN E. LINE E, COLUMN C AND LINE F, COLUMN C ARE BASED ON ACTUAL COST. ALSO, LINE 7, COLUMN G IS NOT APPLICABLE; THEREFORE NOTHING ENTERED. PART III, LINE 4: THERE IS NO MENTION OF BAD DEBT EXPENSE NOR ITS CALCULATION METHODOLOGY WITHIN THE AUDITED FINANCIAL STATEMENT REPORT. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL SHOULD BE REGARDED AS COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CONSIDERED IN THE PROCESS. PART VI, LINE 2: THE ORGANIZATION OBTAINS A GREAT AMOUNT OF INFORMAL FEEDBACK FROM PATIENTS AND VISITORS. PART VI, LINE 3: IF DURING THE PATIENT REGISTRATION PROCESS IT IS DETERMINED THAT THE PATIENT LACKS THE ABILITY TO PAY, THEN THE REGISTRATION PERSON WILL PRESENT THE PATIENT THE INFORMATION NEEDED FOR HIM/HER TO APPLY FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: CIBOLA GENERAL HOSPITAL PROVIDES MEDICAL SERVICES IN A COUNTY THAT REPRESENTS APPROXIMATELY 28,000 RESIDENTS. PART VI, LINE 5: A TRANSPARENT BOARD, INVOLVED MEDICAL STAFF, AND EMPLOYEES WHO ARE ALSO CITIZEN-STAKEHOLDERS HELP PROMOTE COMMUNITY HEALTH. PART VI, LINE 6: THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES NM X X 0 0 0 0 0 0 0 0 0 DR ANN CHURCH CHIEF OF STAFF/MEMBER 332307 0 0 0 0 0 0 0 53365 0 385672 0 0 0 THOMAS WHELAN CEO 193517 0 0 0 0 0 0 0 28157 0 221674 0 0 0 ARNOLD VALDIVIA PHYSICIAN 422562 0 0 0 0 0 0 0 66497 0 489059 0 0 0 WALTER BRIDGES SURGEON 415389 0 0 0 0 0 0 0 65453 0 480842 0 0 0 JOSEPH CHARLES PHYSICIAN 332307 0 0 0 0 0 0 0 53365 0 385672 0 0 0 KARL GUTIERREZ SURGEON 311022 0 0 0 0 0 0 0 50268 0 361290 0 0 0 DIEGO FLORENTIN RODRIGUEZ PHYSICIAN 301619 0 0 0 0 0 0 0 48900 0 350519 0 0 0 FORM 990, PART VII, SECTION A, LINE 5 EXPLANATION: THE CURRENT INTERIM CHIEF FINANCIAL OFFICER (ED BROWN) IS AN INDEPENDENT CONTRACTOR PAID THROUGH AN UNRELATED ENTITY, EDWARD A. BROWN FINANCIAL SERVICES LLC (A SINGLE-MEMBER LLC). HE STARTED WORKING FOR THE HOSPITAL IN JULY 2016. FOR HIS SERVICES TO THE ORGANIZATION, HE WAS PAID $110,540 FOR TIME PERIOD JULY 2016-DECEMBER 2016. THIS AMOUNT WAS FOR HIS SALARY, BENEFITS, TRAVEL AND OTHER EXPENSE REIMBURSEMENT. HIS FISCAL YEAR PAYMENT (JULY 2016-JUNE 2017) WAS $221,080. THE OUTGOING CHIEF FINANCIAL OFFICER (JAMES RIMEL) WAS EMPLOYED BY QUORUM, THE ORGANIZATION'S PRIOR MANAGMENT COMPANY, UNTIL JUNE 2016. HE WAS PAID $123,117 ($93,879 SALARY PLUS BENEFITS OF $29,238) FOR HIS CALENDAR YEAR SERVICES (JANUARY 2016-JUNE 2016). FORM 990, PART VI, SECTION A, LINE 7A CIBOLA COUNTY APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE A COUNTY COMMISSIONER. THE HOSPITAL BOARD APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE THE CHIEF OF THE MEDICAL STAFF. THE 9TH MEMBER OF THE BOARD IS APPOINTED AT THE FIRST ANNUAL MEETING BASED ON A MAJORITY VOTE OF THE OTHER 8 BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD WILL REFER SIGNIFICANT CAPITAL PROJECT PROPOSALS AND TRUSTEE APPOINTMENTS TO THE COUNTY COMMISSIONER FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES, OFFICERS AND EMPLOYEES ARE REQUIRED ANNUALLY TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST IN WRITING. THE FORM IS SIGNED AND DATED, AND MONITORED BY THE COMPLIANCE COORDINATOR. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS AND HIGHLY PAID EMPLOYEES IS DETERMINED BY REVIEW OF COMPARABLE PAY FOR COMPARABLE DUTIES BY RECRUITERS, AND/OR OTHER CONSULTANTS. ALL AMOUNTS ARE APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS AND TAX FORMS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ALSO, THE CEO REPORTS REGULARLY TO THE COUNTY COMMISSION AT A PUBLIC MEETING AND THE BOARD HOLDS MONTHLY PUBLIC MEETINGS. FORM 990, PART VI, SECTION A, LINE 3 EXPLANATION: THE HOSPITAL WAS MANAGED BY QHR, AKA QUORUM HEALTH RESOURCES UNTIL FEBRUARY 29, 2016. STARTING IN MARCH 2016, THE BOARD OF DIRECTORS AND CHIEF EXECUTIVE OFFICER MADE ALL MANAGEMENT DECISIONS. THE ORGANIZATION IS NOW ONLY AN ADVISORY CLIENT OF QHR. FORM 990, PART XI, LINE 9: PRIOR PERIOD AUDIT ADJUSTMENT -224,844. FORM 990, PART XII, LINE 2C: THE BOARD SELECTS THE AUDITORS AND OVERSEES THE AUDIT PROCESS; THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.