2017-05-12T14:54:42-05:00 2016-06-30 ERNST & YOUNG US LLP 2 NORTH CENTRAL AVE STE 2300 PHOENIX AZ 85004 990 2015-07-01 860100882 Verde Valley Medical Center % JOHN CORTESE CPA VERD 9286396442 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 JEFFREY TREASURE NAH CFO 9282143545 2017-05-12 true MICHAEL J PAYNE P01442310 6023223000 2015 2021-01-29 14:40:06Z ROBERT P THAMES 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 146389849 false X WWW.NAHEALTH.COM X 1939 AZ WILL PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. 13 12 0 395 53745 0 889167 466960 126628973 140533926 3194364 647333 3596602 2984873 134309106 144633092 488186 147773 0 0 62139510 60567892 0 0 760849 65025996 61393701 127653692 122109366 6655414 22523726 267939944 274524805 79482941 89689394 188457003 184835411 WILL PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. false false 93870943 147773 131411599 TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY THROUGH INPATIENT, OUTPATIENT AND EMERGENCY HOSPITAL CARE AND RELATED MEDICAL SERVICES, CHARITY CARE AND COMMUNITY SERVICE. TOTAL INPATIENT DISCHARGES WERE 4,629 AND 19,290 PATIENT DAYS. OUTPATIENT VISITS APPROXIMATED 44,263 AND 24,956 EMERGENCY VISITS. 5891897 0 10298567 TO PROVIDE EMERGENCY SERVICES, CANCER TREATMENT AND OTHER ANCILLARY SERVICES TO THE COMMUNITY THROUGH THE OPERATION OF THE VERDE VALLEY MEDICAL CENTER SEDONA CAMPUS. EMERGENCY VISITS WERE 7,342. RADIATION ONCOLOGY PROCEDURES WERE 13,622. MEDICAL IMAGING PROCEDURES WERE 11,398. 1501097 0 1441240 TO PROVIDE GERIATRIC PSYCHIATRIC SERVICES TO THE COMMUNITY THROUGH THE OPERATION OF THE SENIOR BEHAVIORAL HEALTH UNIT. DISCHARGES WERE 177 AND PATIENT DAYS 2,097. 0 0 0 101263937 true true false true false false false false false true true false false true true true false true false false false false false false true false true true true true true true false false false false false false false false false true false true false false true true true true false false true X 195 0 true 0 true true false false false false true true false false false false X 13 12 false false true false true true true true true false false true true true true true true true true true true AZ X JOHN CORTESE CPA 9282143545 914 N SAN FRANCISCO ST SUITE M FLAGSTAFF AZ 86001 X ANDREW ALDRIDGE MD DIRECTOR (AS OF 10/15) 1.0 2.0 X 0 0 0 SAMUEL BUTMAN DIR/PAST CHIEF STAFF (TO 9/15) 1.0 40.0 X X 0 0 0 JAMES DORMAN DIRECTOR (AS OF 10/15) 1.0 2.0 X 0 0 0 RICHARD CRANMER Director/Past Chair 2.0 1.0 X X 0 0 0 BARBARA DEMBER Dir/VVMC Pres/CEO (Thru 7/15) 40.0 0.0 X X 0 553679 22734 WAYNE FOX CPA DIRECTOR (AS OF 10/15) 1.0 2.0 X 0 0 0 ALICE GAGNAIRE RN DIRECTOR (AS OF 10/15) 1.0 4.0 X 0 0 0 WILLIAM JEFFERS DIRECTOR (AS OF 10/15) 1.0 4.0 X 0 0 0 RICHARD KRUSE DIRECTOR/TREASURER 1.0 3.0 X X 0 0 0 STEVEN KURZWEIL DIR/CHIEF OF STAFF (THRU 9/15) 1.0 0.0 X X 0 0 0 JAMES LEDBETTER Director (THRU 9/15) 2.0 0.0 X 0 0 0 CHARLES MARR DIRECTOR/VICE CHAIR 6.0 1.0 X X 0 0 0 ELIZABETH MCFARLAND DIRECTOR (THRU 9/15) 1.0 0.0 X 0 0 0 SHAWN ORME Director/Chair 5.0 1.0 X X 0 0 0 JAMES PARKEL Director (THRU 9/15) 2.0 0.0 X 0 0 0 KENNETH SALCE MD DIRECTOR (AS OF 10/15) 1.0 1.0 X 0 0 0 MATIAS SANDOVAL DIRECTOR (THRU 9/15) 1.0 0.0 X 0 0 0 RAY SELNA Director/Secretary 2.0 1.0 X X 0 0 0 ROBERT THAMES DIRECTOR/NAH CEO 0.0 40.0 X X 0 444857 29885 GUADALUPE WOODSON FNP DIRECTOR (AS OF 10/15) 1.0 1.0 X 0 0 0 JEFFREY TREASURE CFO (AS OF 12/15) 0.0 40.0 X 0 31923 0 HOPE WADE INTERIM CFO (THRU 12/15) 0.0 40.0 X 0 180007 6142 SUSANNE MAIDEN CNO/VP/Interim CAO 40.0 0.0 X 0 265086 29345 RICK PETERSON VP SUPPORT SERVICES 40.0 0.0 X 0 255214 35062 DEBORAH ASHBY Clinical Resources Coordinator 40.0 0.0 X 0 176637 39193 PAUL PREFONTAINE DIRECTOR REHABILITATION SYSTEM 40.0 0.0 X 0 166032 32630 LORI STEVENS Director Nursing 40.0 0.0 X 0 164006 26830 SUZANNE BALLARD DIRECTOR QUALITY SYSTEMS 40.0 0.0 X 0 163168 20296 REBECCA KHIN PHARMACIST 40.0 0.0 X 0 150892 38464 John Dempsey VP NAH/Pres LCMC 0.0 40.0 X 0 456110 181355 0 3007611 461936 0 true true false healthcare select DEPT LA 24465 PASADENA CA 91185 CONTRACT LABOR 2699309 CONIFER HEALTH SOLUTIONS LLC 1500 S DOUGLASS RD ANAHEIM CA 92806 HEALTHCARE FIN SVCS 1910032 MAYO COLLABORATIVE SERVICES PO BOX 9146 MINNEAPOLIS MN 55480 LABORATORY SERVICES 538068 hayes locums LLC 6700 n andrews ave fort lauderdale FL 33309 PHYSICIAN LOCUM SVCS 221564 EMERGENCY MEDICINE PHYSICIANS 4535 Dressler Road NW CANTON OH 44718 PHYSICIAN LOCUM SVCS 210333 18 86286 257512 123162 22119 466960 NET PATIENT SERVICES REVENUE 622110 83163501 83163501 0 0 LABORATORY SERVICES 621500 53442654 53388939 53715 0 LABORATORY PATHOLOGY SERVICES 621500 3927771 3927741 30 0 140533926 2782947 2782947 0 0 377367 377367 0 377367 377367 -412403 0 1723211 -412403 -1723211 -2135614 -2135614 23572 86286 33546 -9974 -9974 0 0 MEANINGFUL USE INCENTIVE 900099 845775 845775 0 0 CAFETERIA SALES 722514 577896 577896 0 0 GIFT SHOP 900099 206949 206949 0 0 986860 986860 0 0 2617480 144633092 143097661 53745 1014726 X 114227 114227 33546 33546 0 0 0 0 1746826 1345016 401810 0 0 0 0 0 48573043 39826962 8473203 272878 2744316 2219878 504026 20412 3944151 3190425 724390 29336 3559556 2879326 653754 26476 0 0 0 0 112704 87255 25449 0 73802 0 73802 0 25843 0 25843 0 0 0 0 0 0 0 5524066 2389976 2846386 287704 161632 28203 74490 58939 7333124 5104575 2196387 32162 0 0 0 0 0 0 0 0 1843269 1681573 149415 12281 248632 112068 136075 489 0 0 0 0 0 0 0 0 1389126 1056377 332749 0 0 0 0 0 8637169 7603809 1027872 5488 1044898 917602 127296 0 MEDICAL SUPPLIES 16085029 16085029 0 0 EXP REIMBURSEMENT TO NAH 15634065 14705319 925996 2750 MEDICAL PURCHASE SERVICES 1676746 1676746 0 0 REGISTRATION SERVICES 1069844 0 1069844 0 533752 206025 315793 11934 122109366 101263937 20084580 760849 0 4895 5245 22951814 30677932 0 0 19821011 20050643 0 0 0 0 0 0 2628715 2514361 1932581 1454772 180434892 110200072 67742741 70234820 134004559 132031927 0 0 0 0 1916526 0 16937102 17555105 267939944 274524805 15449630 12915931 0 0 0 0 48912721 47928453 0 0 0 0 0 0 0 0 15120590 28845010 79482941 89689394 X 188457003 184784411 0 51000 0 0 188457003 184835411 267939944 274524805 X 22523726 -4129941 0 0 0 -22015377 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 false 0 false 0 true 25843 25843 false SCHEDULE C, PART II-B, LINE 1F VERDE VALLEY MEDICAL CENTER PAID DUES TO THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. A PERCENTAGE OF THIS AMOUNT, TOTALLING $25,843, WAS ESTIMATED TO BE ATTRIBUTABLE TO LOBBYING RELATED TO HEALTHCARE ADVOCACY AT THE FEDERAL, STATE, REGIONAL, AND LOCAL LEVELS. 4156348 602187 133764 7593 307444 64099 4513163 3984487 1113890 64455 9445 929756 67283 4156348 3633768 528277 418492 6902 529321 59827 3984487 1.00000 false false 3746702 3746702 96844881 60139556 36705325 936383 456953 479430 58528456 45058987 13469469 20378470 4544576 15833894 70234820 VVMC INVESTMENT TO NAHPG 11173972 LAND HELD FOR FUTURE USE 4827606 GAAP PRESENTATION OF INSURANCE 822256 UNAMORTIZED BOND ISSUE 377416 SPLIT DOLLAR PLAN 215232 SMC CAMPUS DONATED ART 133530 SECURITY DEPOSITS 25446 CANCER CENTER DONATED ART 10256 SEVEN CANYONS CLUB MEMBERSHIP 10000 APS REFUNDABLE REBATES -40609 17555105 0 MINIMUM PENSION LIABILITY 26697859 MALPRACTICE RESERVE 1324895 GAAP PRESENTATION-INSURANCE LIAB 822256 28845010 X SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS ARE INTENDED TO: (1) ADDRESS COMMUNITY HEALTH CARE NEEDS; (2) ADHERE TO THE CORE MISSION OF THE HOSPITAL; OR (3) REFLECT PROJECTS THAT ARE DEEMED IN THE BEST INTEREST OF THE HOSPITAL. SCHEDULE D, PART X, LINE 2 THE CORPORATION IS A NOT-FOR-PROFIT CORPORATION AND IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAXES IS INCLUDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE CORPORATION'S MANAGEMENT IS NOT AWARE OF ANY EVENTS THAT WOULD CAUSE THE CORPORATION TO LOSE ITS TAX-EXEMPT STATUS. MANAGEMENT HAS REVIEWED ALL OPEN TAX YEARS AND HAS DETERMINED THAT THE CORPORATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS. 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X X X X X true true X X X X true X See Sch H, Part V, Section C X See Sch H, Part V, Section C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT "CHNA", A FOCUS GROUP WAS HELD IN NOVEMBER 2015 IN COLLABORATION WITH COCONINO AND YAVAPAI COUNTIES AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS. KEY INFORMANTS IN THE COMMUNITY INCLUDED: REPRESENTATIVES FROM PUBLIC HEALTH, PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY LEADERS. A LIST OF RECOMMENDED PARTICIPANTS FOR THE FOCUS GROUP WAS PROVIDED BY VERDE VALLEY MEDICAL CENTER. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. FOCUS GROUP CANDIDATES WERE FIRST CONTACTED BY LETTER TO REQUEST THEIR PARTICIPATION. FOLLOW-UP PHONE CALLS WERE THEN MADE TO ASCERTAIN WHETHER THEY WOULD BE ABLE TO ATTEND. CONFIRMATION CALLS WERE PLACED THE DAY BEFORE THE GROUPS WERE SCHEDULED TO INSURE A REASONABLE TURNOUT. AUDIO FROM THE FOCUS GROUP SESSION WAS RECORDED, FROM WHICH VERBATIM COMMENTS IN THIS REPORT ARE TAKEN. THERE ARE NO NAMES CONNECTED WITH THE COMMENTS, AS PARTICIPANTS WERE ASKED TO SPEAK CANDIDLY AND ASSURED OF CONFIDENTIALITY. THIS BOX IS CHECKED "NO" BECAUSE THE HOSPITAL SOLICITED ONLY ORAL, AND NOT WRITTEN COMMENTS ON THE 2012 CHNA AND IMPLEMENTATION STRATEGY WHEN DEVELOPING THE 2015 CHNA. THIS WAS NOT REQUIRED AT THE TIME THAT CHNA WAS PREPARED, BUT WILL BE IMPLEMENTED IN FUTURE CHNA DEVELOPMENT. SCHEDULE H, PART V, SECTION B, LINE 6a THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN CONJUNCTION WITH ITS RELATED HOSPITAL FACILITY, FLAGSTAFF MEDICAL CENTER. Schedule H, Part V, Line 7A THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://NAHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 10A THE 2016 IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://NAHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 11 VVMC RANKED HEALTH ISSUES IDENTIFIED BY THE CHNA AGAINST THE FOLLOWING ESTABLISHED, UNIFORM CRITERIA: MAGNITUDE - THE NUMBER OF PERSONS AFFECTED; IMPACT/SERIOUSNESS - THE DEGREE TO WHICH THE ISSUE AFFECTS OR EXACERBATES QUALITY OF LIFE AND HEALTH-RELATED ISSUES; FEASIBILITY - THE ABILITY TO REASONABLY IMPACT THE ISSUES, GIVEN AVAILABLE RESOURCES; AND CONSEQUENCES OF INACTION - THE RISK OF NOT ADDRESSING THE PROBLEM AT THE EARLIEST OPPORTUNITY. AREAS OF OPPORTUNITY WERE PRIORITIZED AS FOLLOWS: ACCESS TO HEALTHCARE SERVICES CANCER MATERNAL, INFANT, AND CHILD HEALTH INJURY & VIOLENCE PREVENTION MENTAL HEALTH & MENTAL DISORDERS RESPIRATORY HEALTH Access to Health Services: The organization began "BeWellNow", its telehealth primary and urgent care program. The organization started a Transitions Clinic for those patients who are not able to see their primary care provider ("PCP") within 72 hours of discharge or who need same day service from a PCP. The organization is working with Transportation group for better ride options for patients. The organization is beginning a Community Health Worker program. The organization is broadening our Community Paramedicine program. Injury and Violence Prevention: The organization consistently screens all emergency department ("ED") patients for domestic violence. The organizations Community Paramedicine program conducts home assessments that include fall prevention. Mental Health and Mental Disorders: The organization is hosting a Mental First Aid program and performs depression screening for all related physician clinic patients. Respiratory Disease: The organization is increasing health insurance premiums for employee and employee dependents who use tobacco products. HEALTH PRIORITIES NOT CHOSEN AND REASON: SUBSTANCE ABUSE - VVMC HAS LIMITED RESOURCES, SERVICES AND EXPERTISE AVAILABLE TO ADDRESS ALCOHOL, TOBACCO AND OTHER DRUG ISSUES. OTHER COMMUNITY ORGANIZATIONS HAVE INFRASTRUCTURE AND PROGRAMS IN PLACE TO BETTER MEET THIS NEED. LIMITED RESOURCES EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. FAMILY PLANNING - VVMC BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. ARTHRITIS, OSTEOPOROSIS & CHRONIC BACK CONDITIONS - VVMC OFFERS PHYSICAL THERAPY AND JOINT REPLACEMENT CLASSES. HOWEVER THE PREVENTION OF THESE CONDITIONS IS ADDRESSED BY THE STATE AND COUNTY HEALTH DEPARTMENTS, SO WE HAVE EXCLUDED THIS AREA AS CHOSEN FOR ACTION. ORAL HEALTH - VVMC BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. INJURY & VIOLENCE PREVENTION - VVMC BELIEVES THAT THIS PRIORITY AREA FALLS MORE WITHIN THE PURVIEW OF THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS. LIMITED RESOURCES AND LOWER PRIORITY EXCLUDED THIS AS AN AREA CHOSEN FOR ACTION. SCHEDULE H, PART V, LINE 13(B) Eligibility for charitable assistance is based on the income and family size of the patient/guarantor. Income levels are based on the federal poverty levels ("FPL") published by the Federal Register annually. Household members are defined as all dependents and adults residing with the patient. Applicants with household income of 400% of FPL or lower may receive financial assistance based upon a tiered discount. Schedule H, Part V, line 16A and B THE FINANCIAL ASSISTANCE POLICY ("FAP") AND APPLICATION ARE AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://NAHEALTH.COM/PATIENT-RIGHTS-POLICIES/FINANCIAL-ASSISTANCE Sch H, Part V, Line 22d AMOUNTS GENERALLY BILLED ("AGB"): HOSPITAL-SPECIFIC AGB PERCENTAGE MEANS, FOR EACH HOSPITAL, A PERCENTAGE IS DERIVED BY DIVIDING (1) THE SUM OF ALL CLAIMS FOR MEDICALLY NECESSARY SERVICES PROVIDED AT SUCH HOSPITAL PAID DURING THE RELEVANT PERIOD BY (2) ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBES. THE AGB PERCENTAGE IS CALCULATED BY JANUARY 31 AND IS EFFECTIVE UNTIL THE NEXT ANNUAL CALCULATION. THE CALCULATION SHALL COMPLY WITH THE "LOOK-BACK METHOD" DESCRIBED IN TREASURY REGULATION 1-501(R)-5(B)(1)(B). 10 VVMC SEDONA CAMPUS 3700 WEST HIGHWAY 89A SEDONA AZ 86336 EMERGENCY SERVICES, LAB, RADIOLOGY, AND PHYSICIAN OFFICES VVMC MEDICAL OFFICE BUILDING 294 WEST HIGHWAY 89A COTTONWOOD AZ 86326 PHYSICIAN OFFICES SLEEP LAB NAHPG - EMPLOYED PHYSICIAN OFFICES 450 S WILLARD ST SUITE 101 107 COTTONWOOD AZ 86326 PHYSICIAN OFFICES VV MEDICAL IMAGING CENTER 450 S WILLARD ST SUITE 109 111 1 COTTONWOOD AZ 86326 X-RAY LAB CAMP VERDE HEALTH CENTER 460 FINNEY FLATS ROAD CAMP VERDE AZ 86322 OFFICE X-RAY LAB PHYSICAL THERAPY NAHPG - FAMILY PRACTICE PHYSICIAN OFFICE 199 S CANDY LANE SUITE 1A COTTONWOOD AZ 86326 PHYSICIAN OFFICE ENTIRECARE REHABSPORTS MEDICINE-SEDONA 35 DRY CREEK ROAD SEDONA AZ 86336 PHYSICAL THERAPY VOC MOB 61 BELL ROCK PLAZA SUITE A B AND sedona AZ 86351 PHYSICIAN OFFICES PHLEBOTOMY LAB ENTIRECARE REHAB AND SPORTS MEDICINE-VOC 6560 HIGHWAY 179 SUITES 118 120 SEDONA AZ 86351 PHYSICAL THERAPY VVMC AMBULATORY CENTER 300 WEST HIGHWAY 89A COTTONWOOD AZ 86326 SURGERY ENDOSCOPY SCHEDULE H, PART I, LINE 3C a. PRESUMED FINANCIAL ASSISTANCE ELIGIBILITY i. ARIZONA HEALTHCARE COST CONTAINMENT SYSTEM ("AHCCS") IS ARIZONA'S MEDICAID AGENCY. IF PATIENT IS AWARDED AHCCCS COVERAGE BUT COVERAGE IS NOT RETROACTIVE TO THE DATE OF SERVICE, THE PATIENT WILL BE CONSIDERED ELIGIBLE FOR FINANCIAL ASSISTANCE; ii. PATIENT HAD AHCCCS COVERAGE THE MONTH PRECEDING AND THE MONTH POST SERVICES; iii. INDIGENT BASED UPON RESIDENCY VALIDATION; iv. PATIENTS SERVICES ARE COVERED UNDER A GRANT THAT HAS EXHAUSTED FUNDING; v. PATIENT IS INCARCERATED AND THE CARE IS NOT THE FINANCIAL RESPONSIBILITY OF THE LOCAL, STATE, OR FEDERAL INSTITUTION; vi. PATIENT PROVIDES AN INVALID SOCIAL SECURITY NUMBER; vii. AHCCCS COVERED PATIENTS WHO EXCEED MAXIMUM ALLOWABLE DAYS; viii. DECEASED; ix. BANKRUPTCY. b. PRESUMED FINANCIAL ASSISTANCE IS BY ENCOUNTER ONLY AND CANNOT BE USED FOR FUTURE BALANCES. c. EXCEPTION/FINANCIAL ASSISTANCE COMMITTEE i. PATIENTS/GUARANTORS REQUESTING EXCEPTIONS CAN APPEAL AN OUTCOME BY ESCALATION TO THE FINANCIAL ASSISTANCE COMMITTEE; ii. THE FINANCIAL ASSISTANCE COMMITTEE IS COMPRISED OF THE EXECUTIVE DIRECTOR OF REVENUE CYCLE, CONTROLLER, DIRECTOR OF PATIENT FINANCIAL SERVICES, AND CLINICAL DEPARTMENT DIRECTOR FOR THE AFFECTED AREAS OF CARE. iii. COMMITTEE FINDINGS ARE DOCUMENTED AND MAILED TO THE PATIENT/GUARANTOR. iv. REMAINING BALANCES AFTER COMMITTEE FINDINGS REQUIRE AN ESTABLISHED PAYMENT PLAN TO REMAIN IN GOOD STANDING. CHARITY CARE INCOME LEVELS ARE BASED ON THE FEDERAL POVERTY GUIDE PUBLISHED IN THE FEBRUARY FEDERAL REGISTER ON AN ANNUAL BASIS. A TIERED METHOD IS UTILIZED FOR DETERMINING WHETHER A PATIENT IS ELIGIBLE FOR 100%, 75%, 50%, 25%, OR 15% WRITE-OFF OF THE SELF PAY BALANCE. A patient who is not eligible for presumed financial assistance may appeal the outcome to the Financial Assistance Committee. SCHEDULE H, PART I, LINE 6A THE INFORMATION FOR THE COMMUNITY BENEFITS REPORT IS GATHERED BY THE COMMUNITY RELATIONS DEPARTMENT WHICH IS A DEPARTMENT OF NORTHERN ARIZONA HEALTHCARE. FLAGSTAFF MEDICAL CENTER AND VERDE VALLEY MEDICAL CENTER ARE IDENTIFIED SEPARATELY ON THESE REPORTS. THE COMMUNITY BENEFIT REPORT IS AVAILABLE AT: https://nahealth.com/about-us/community-health-needs-assessment SCHEDULE H, PART I, LINE 7 VERDE VALLEY MEDICAL CENTER USED A COST-TO-CHARGE RATIO, WHERE APPLICABLE, TO CALCULATE THE MOST ACCURATE COST OF CHARITY CARE AND OTHER COMMUNITY BENEFITS REPORTED IN LINE 7. SCHEDULE H, PART II COMMUNITY BUILDING IS A FOCUS AT VERDE VALLEY MEDICAL CENTER. COMMUNITY BUILDING IS ADVANCED BY VERDE VALLEY MEDICAL CENTER THROUGH ITS SUPPORT OF PHYSICIAN RECRUITMENT AND WORK WITH VARIOUS COMMUNITY ORGANIZATIONS INCLUDING LOCAL SCHOOLS, THE COTTONWOOD AND SEDONA CHAMBER OF COMMERCE, AND THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. SCHEDULE H, PART III, LINE 2 BAD DEBT AMOUNTS ARE FROM THE BILLING SOFTWARE AND A MONTHLY CALCULATED AMOUNT BASED ON THE ACCOUNTS RECEIVABLE BALANCES BY FINANCIAL CLASS - PRIMARILY SELF-PAY. ACCOUNTS REFERRED TO BAD DEBT AS DEFINED IN NORTHERN ARIZONA HEALTHCARE POLICY ARE AUTOMATICALLY ADJUSTED BY A FILE UPLOAD PROCESS USING A DEDICATED TRANSACTION CODE. SCHEDULE H, PART III, LINE 3 THE ACTUAL CHARITY CARE AMOUNTS ARE FROM THE BILLING SOFTWARE WHICH IDENTIFIES THE AMOUNTS THAT ARE DIRECTLY RELATED TO PATIENTS WHO QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY (FAP). THE FINANCIAL ASSISTANCE ADJUSTMENT PERCENTAGE IS DETERMINED BASED UPON THE FEDERAL POVERTY LINE GRID AS DEFINED IN NORTHERN ARIZONA HEALTHCARE'S FAP. THE ADJUSTMENT IS MANUALLY ENTERED INTO THE BILLING SOFTWARE WITH A DEDICATED TRANSACTION CODE. REMAINING BALANCES ARE THE RESPONSIBILITY OF THE PATIENT. Schedule H, Part III, Line 4 FOOTNOTE 2 TO THE FINANCIAL STATEMENTS INDICATES NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE RECEIVED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. MANAGEMENT ESTIMATES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON THE HISTORICAL COLLECTION EXPERIENCE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. MANAGEMENT ESTIMATES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON THE HISTORICAL COLLECTION EXPERIENCE. SCHEDULE H, PART III, LINE 8 THE SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS THE FY2016 MEDICARE COST REPORT FOR THE ORGANIZATION. MEDICARE REPRESENTS 37% OF THE ORGANIZATIONS GROSS CHARGES. FOR FY2016 MEDICARE IS A SURPLUS PRIMARILY BECAUSE THE ORGANIZATION RECEIVES HIGHER MEDICARE REIMBURSEMENTS AS A SOLE COMMUNITY HOSPITAL, AS DEFINED AND DESIGNATED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN YEARS WHEN THERE IS A SHORTFALL, THE ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE ORGANIZATIONS MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, WHETHER OR NOT THIS SERVICE IS PROVIDED AT A LOSS, THEREBY RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF THE MEDICARE BENEFICIARIES, MANY OF WHOM WOULD QUALIFY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART III, LINE 9B ACCORDING TO OUR CHARITY CARE POLICY, THE FINANCIAL COUNSELORS ASSESS THE PATIENT'S ABILITY TO PAY AT TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR CHARITY CARE CONSIDERATION. IF THE PATIENT DOESN'T QUALIFY FOR CHARITY CARE ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR A LONG-TERM PAYMENT PROGRAM. IF THE CHARITY APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW-UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. SCHEDULE H, PART VI, LINE 2 VERDE VALLEY MEDICAL CENTER ASSESSES COMMUNITY HEALTHCARE NEEDS THROUGH A SURVEY DESIGNED AND ADMINISTERED BY PROFESSIONAL RESEARCH CONSULTANTS, INC. THIS SURVEY WAS LAST CONDUCTED IN 2015 AND WAS A FOLLOW-UP TO OTHER SURVEYS THE HOSPITAL HAS CONDUCTED. THE SURVEY INSTRUMENT USED FOR THIS STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS, AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. SCHEDULE H, PART VI, LINE 3 THE VERDE VALLEY MEDICAL CENTER (VVMC) WEBSITE HAS A BILLING CONTACT NUMBER. BEFORE PRE-ADMISSION, PATIENTS ARE CONTACTED BY VVMC'S CASHIER. WHEN PATIENTS ARE CONTACTED, THEY ARE EDUCATED OF THE FINANCIAL ASSISTANCE POLICY. VVMC FINANCIAL COUNSELORS ASSIGNED TO EACH NURSING UNIT ARE ABLE TO ANSWER OR ASSIST WITH BILLING QUESTIONS. AT EACH PATIENT REGISTRATION DESK ARE DISPLAYS AND BROCHURES OF THE BILLING INFORMATION, INCLUDING THE FINANCIAL ASSISTANCE POLICY. ACCORDING TO THE POLICY, THE FINANCIAL COUNSELORS ASSESS THE PATIENTS' ABILITY TO PAY AT TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR CHARITY CARE CONSIDERATION. IF THE PATIENT DOESN'T QUALIFY FOR CHARITY CARE ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR A LONG-TERM PAYMENT PROGRAM. IF THE CHARITY APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. SCHEDULE H, PART VI, LINE 4 VERDE VALLEY MEDICAL CENTER IS A 99-BED ADULT AND PEDIATRIC SOLE COMMUNITY HOSPITAL AND 11-BED GERIATRIC PSYCHIATRY. THE HOSPITAL IS LOCATED IN COTTONWOOD, ARIZONA BUT THE PRIMARY SERVICE AREA INCLUDES COTTONWOOD, CLARKDALE, JEROME, SEDONA, VILLAGE OF OAK CREEK, RIMROCK, CAMP VERDE, LAKE MONTEZUMA, AND CORNVILLE WHICH COVERS APPROXIMATELY A 50-SQUARE MILE SPAN. THE CLOSEST HOSPITAL TO THE NORTH IS FLAGSTAFF MEDICAL CENTER (VVMC AFFILIATE), WHICH IS 70 MILES. THE CLOSEST HOSPITAL TO THE SOUTH IS 40 MILES. THE POPULATION IN THE PRIMARY SERVICE AREA IS APPROXIMATELY 73,000. THE HOSPITAL GROSS PAYOR MIX IS AS FOLLOWS: MEDICARE 62%, AHCCCS/MEDICAID 17%, COMMERCIAL/OTHER 18%, AND SELF PAY 3%. VERDE VALLEY MEDICAL CENTER IS THE LARGEST EMPLOYER IN THE COMMUNITY. THE PRIMARY SERVICE AREA DOES NOT HAVE MUCH INDUSTRY AND THE COMMUNITY HAS MANY SMALL BUSINESS ORGANIZATIONS. SCHEDULE H, PART VI, LINE 5 COMMUNITY HEALTH AND COMMUNITY BUILDING ARE A FOCUS AT VERDE VALLEY MEDICAL CENTER AS EVIDENCED BY THE NUMEROUS ACTIVITIES SPONSORED EACH YEAR. THE CANCER CENTER AT SEDONA CAMPUS HOSTS A SERIES OF FREE OR LOW-COST SCREENINGS DESIGNED TO HELP RESIDENTS IN THE COMMUNITY DETECT ISSUES AS SOON AS POSSIBLE. FIT KIDS OF ARIZONA, WHICH WORKS TO REDUCE THE HEALTH CONSEQUENCES OF CHILDHOOD OBESITY BY PROMOTING HEALTHY LIFESTYLES, AND THE DIABETES TOGETHER COMMUNITY COLLABORATION ARE VERDE VALLEY MEDICAL CENTERS'S PREMIER COMMUNITY HEALTH INITIATIVES. COMMUNITY BUILDING IS ADVANCED BY VERDE VALLEY MEDICAL CENTER THROUGH ITS SUPPORT OF PHYSICIAN RECRUITMENT AND WORK WITH VARIOUS COMMUNITY ORGANIZATIONS INCLUDING THE COTTONWOOD AND SEDONA CHAMBER OF COMMERCE AND THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. SCHEDULE H, PART VI, LINE 6 VERDE VALLEY MEDICAL CENTER IS AFFILIATED WITH FLAGSTAFF MEDICAL CENTER. THE BOARD MEMBER MEETINGS ARE COMBINED. THE COMMUNITY BENEFIT REPORT IS SUMMARIZED TOGETHER AND POSTED ON THE HOSPITAL'S WEBSITE. true Camp Verde School District 410 Camp Lincoln Rd Camp Verde AZ 86322 866003046 school 12364 0 Fit Kids at School Program City of Cottonwood 827 N Main St Cottonwood AZ 86326 866007877 government 11500 0 Lookin' Good Cottonwood & Mem Run Cottonwood-Oak Creek School District 1 N Willard St Cottonwood AZ 86326 866000563 school 11113 0 PROGRAM SUPPORT Humane Society of Sedona 2115 Shelby Dr Sedona AZ 86336 237276252 501(C)(3) 12250 0 Seniors for Seniors Program Mingus Union High School 1801 E Fir St Cottonwood AZ 86326 866006215 school 45000 0 NURSING PROGRAM Sedona Chamber of Commerce PO Box 478 Sedona AZ 86339 860134659 501(C)(6) 10000 0 SCF - Title Sponsor for Sedona Marathon Sedona International Film Festival 2030 Arizona 89A Sedona AZ 86336 200351857 501(c)(3) 7000 0 SPONSORSHIP 6 1 nursing scholarships 5 33546 SCHEDULE I, PART I, LINE 2 DONATIONS TO OTHER TAX-EXEMPT ENTITIES ARE MADE IN SUPPORT OF THEIR MISSIONS AND VVMC RELIES UPON THE GOVERNANCE PRACTICES OF RECIPIENT ORGANIZATIONS. true true false false false false false true false BARBARA DEMBER Dir/VVMC Pres/CEO (Thru 7/15) 0 320408 0 99682 0 133589 0 10600 0 12134 0 576413 0 0 ROBERT THAMES DIRECTOR/NAH CEO 0 302952 0 127500 0 14405 0 9696 0 20189 0 474742 0 0 HOPE WADE INTERIM CFO (THRU 12/15) 0 167550 0 12261 0 196 0 5142 0 1000 0 186149 0 0 John Dempsey FORMER VP NAH/Pres LCMC 0 334407 0 72204 0 49499 0 155917 0 25438 0 637465 0 32101 SUSANNE MAIDEN CNO/VP/Interim CAO 0 226781 0 36039 0 2266 0 13444 0 15901 0 294431 0 0 RICK PETERSON VP SUPPORT SERVICES 0 211872 0 37573 0 5769 0 15321 0 19741 0 290276 0 0 DEBORAH ASHBY Clinical Resources Coordinator 0 165752 0 8503 0 2382 0 28478 0 10715 0 215830 0 0 PAUL PREFONTAINE DIRECTOR REHABILITATION SYSTEM 0 144778 0 18243 0 3011 0 8702 0 23928 0 198662 0 0 LORI STEVENS Director Nursing 0 149773 0 12428 0 1805 0 10091 0 16739 0 190836 0 0 SUZANNE BALLARD DIRECTOR QUALITY SYSTEMS 0 149740 0 12509 0 919 0 9843 0 10453 0 183464 0 0 REBECCA KHIN PHARMACIST 0 146759 0 3614 0 519 0 18429 0 20035 0 189356 0 0 SCHEDULE J, PART I, LINE 1 A/B ALL COMPENSATION, BENEFITS AND REIMBURSEMENTS ARE PAID BY NORTHERN ARIZONA HEALTHCARE CORPORATION, THE PARENT ORGANIZATION. BOARD MEMBER AND OFFICER BUSINESS TRAVEL EXPENSES, SUCH AS AIRLINE AND MEALS, FOR SPOUSES WERE PAID AND INFORMATION GATHERED FOR W-2 AND 1099 REPORTING. GROSS UP OF TAXES IS DONE ON ALL EMPLOYEE GIFT CERTIFICATES. THE BOARD MEMBER AND OFFICER BUSINESS TRAVEL EXPENSES ARE APPROVED BY NEXT HIGHEST LEVEL. AMOUNTS PAID BY THE PARENT (NAH) FOR "COMPANION TRAVEL" FOR SPOUSES OF THE DIRECTORS WERE AS FOLLOWS: NONE. SCHEDULE J, PART I, LINE 3 CEO COMPENSATION IS DERIVED BY THE PARENT ORGANIZATION, NORTHERN ARIZONA HEALTHCARE, BY THE FOLLOWING METHODS: COMPENSATION COMMITTEE, WRITTEN CONTRACT, INDEPENDENT CONSULTANT, COMPENSATION SURVEY, AND RECOMMENDATION OF COMPENSATION COMMITTEE TO BOARD FOR APPROVAL. SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS WERE MADE AS FOLLOWS. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(iii): BARBARA DEMBER $129,094 SCHEDULE J, PART I, LINE 4B CERTAIN EMPLOYEES RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN DURING 2015 AS FOLLOWS: JOHN DEMPSEY: $32,101 THIS AMOUNT WAS INCLUDED IN TAXABLE WAGES AND IS REPORTED IN SCHEDULE J, PART II, COLUMN B(III) AND ALSO IN COLUMN F SINCE THIS AMOUNT HAS PREVIOUSLY BEEN REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. SCHEDULE J, PART I, LINE 7 NORTHERN ARIZONA HEALTHCARE CORPORATION MAKES DISCRETIONARY PAYMENTS AS PART OF A SHORT-TERM INCENTIVE PLAN (STIP). PAYMENTS ARE BASED ON MEETING VARIOUS ORGANIZATIONAL GOALS. SCHEDULE J PART II THE FOLLOWING INDIVIDUALS PARTICIPATE IN A DEFINED BENEFIT RETIREMENT PLAN. AS SUCH, ACTUARIAL INCREASES IN THEIR ACCOUNTS ARE REPORTED ON PART II, COLUMN (C) AS DEFERRED COMPENSATION. INCREASE DUE TO ACTUARIAL BENEFIT: JOHN DEMPSEY $111,008 THE FOLLOWING INDIVIDUALS RECEIVED ONE-TIME SIGN-ON BONUSES. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(ii): ROBERT P. THAMES $52,500 JEFFREY TREASURE $25,000 THE FOLLOWING INDIVIDUALS RECEIVED A ONE-TIME PAYMENT FOR RELOCATION. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(iii): ROBERT P. THAMES $13,074 A Industrial Development Authority Yavapai County 860376099 985900CX5 2011-10-12 13829141 SEE PART VI false false false B Industrial Development Authority Yavapai County 860376099 2015-06-30 37340563 SEE PART VI false false false A 0 0 13829141 0 0 0 133606 0 0 0 13695535 0 2011 true false true true B 0 0 37340563 0 0 0 338010 0 0 0 37002552 0 2015 true false true true A false false true true false 0.00000 0.00000 0.00000 false false false true B false false true true false 0 false false false true A false false true false false false 0 false 0 false true B false false true false false false 0 false 0 false true A true B true SCHEDULE K, PART I, COLUMN(F) LINE A - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2011. THIS ISSUE REFUNDS THE 1996A AND 1998 SERIES BONDS. TOTAL ISSUANCE PRICE WAS $78,923,520 WHICH WAS ALLOCATED $65,094,379 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $13,829,141 TO VERDE VALLEY MEDICAL CENTER. LINE B - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2015A AND 2015B. THIS ISSUE REFUNDS THE 2008A and 2008B BONDS. TOTAL ISSUANCE PRICE OF SERIES 2015A WAS $80,395,000 WHICH WAS ALLOCATED $37,213,075 TO FLAGSTAFF MEDICAL CENTER (FMC), $9,274,438 TO VERDE VALLEY MEDICAL CENTER, AND $33,906,585 TO NORTHERN ARIZONA HEALTHCARE OUTPATIENT SURGERY CENTER. THE 2015A BONDS WERE ALSO USED, IN PART, TO FINANCE "NEW MONEY" PROJECTS. $33,611,679 WAS USED FOR ACQUISTION OF SUMMIT SURGERY CENTER. TOTAL ISSUANCE PRICE OF SERIES 2015B WAS $45,615,000 WHICH WAS ALLOCATED $17,569,850 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $28,066,125 TO VERDE VALLEY MEDICAL CENTER. LEDBETTER LAW FIRM JAMES LEDBETTER/DIRECTOR 124462 legal services false X 7 2008 FMV X 223 FMV X 5042 FMV X 2 900 FMV X Memberships/Passes 15 7762 FMV X CERTIFICATES 0 3542 fmv X TICKETS 47 1946 FMV X JEWELRY 9 757 FMV X Alcohol 1 100 FMV false true false SCHEDULE M, PART I, COLUMN (B) THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN COLUMN (B). FORM 990, PART I, LINE 6 VOLUNTEERS WORK IN ALMOST EVERY DEPARTMENT IN THE HOSPITAL AND AT OUR OFFSITE LOCATIONS, SUCH AS VERDE VALLEY MEDICAL CENTER (VVMC) SEDONA CAMPUS, CAMP VERDE, AND VILLAGE OF OAK CREEK. THEY PERFORM CLERICAL AND RECEPTION DUTIES IN MANY DEPARTMENTS, SERVE AS PATIENT AND VISITOR GREETERS, SUPPLY DISTRIBUTION, LANDSCAPING, NUTRITIONAL SERVICES - PASS TRAYS, PARTICIPATE IN VARIOUS ACTIVITIES WITH THE SENIOR BEHAVIORAL HEALTH PATIENTS, LIBRARY, TRANSPORT, AND MAKE PILLOWS AND TEDDY BEARS (CRAFTS). FORM 990 PART III LINE 4A FLAGSTAFF MEDICAL CENTER'S MISSION, VISION, AND VALUES --------------------------------------------- MISSION - FLAGSTAFF MEDICAL CENTER WILL PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. VISION - FLAGSTAFF MEDICAL CENTER WILL BE A MODEL HEALTHCARE SYSTEM DISTINGUISHED BY OUR PEOPLE, QUALITY, SERVICE AND OUR DEDICATION TO COMMUNITY HEALTH SOLUTIONS. VALUES: -PATIENTS - WE ARE COMMITTED TO MEETING THE NEEDS AND EXCEEDING THE EXPECTATIONS OF OUR PATIENTS. - COLLEAGUES - WE WILL CREATE AN ORGANIZATIONAL CULTURE WHERE COLLEAGUES FEEL VALUED AND TAKE A SENSE OF PRIDE IN THEIR WORK. - QUALITY - WE CONTINUOUSLY STRIVE TO ACHIEVE EXCELLENCE AT ALL LEVELS IN THE ORGANIZATION. - SAFETY - WE ARE COMMITTED TO MAINTAINING A SAFE ENVIRONMENT FOR OUR PATIENTS, VISITORS AND COLLEAGUES. - LEADERSHIP - WE PROMOTE LEADERSHIP AS AN ATTITUDE, NOT A POSITION, PUTTING VALUE ON BOTH PEOPLE AND THE WORK THEY DO. - TEAMWORK - WE ARE COLLEAGUES WORKING TOGETHER, SHARING KNOWLEDGE, TALENTS AND SKILLS TO ACHIEVE COMMON GOALS. - INTEGRITY - WE WILL BE FORTHRIGHT, HONEST AND RESPECTFUL. - DIVERSITY - WE EMBRACE THE DIVERSITY OF OUR PEOPLE, PATIENTS AND THE COMMUNITIES WE SERVE. FORM 990, PART V, LINE 2A; PART VII, SECTION A, AND PART IX VERDE VALLEY MEDICAL CENTER DOES NOT HAVE EMPLOYEES, BUT SHARES THE COST OF PERSONNEL, SERVICES, AND EXPENSES WITH NORTHERN ARIZONA HEALTHCARE CORPORATION, A RELATED TAX-EXEMPT ORGANIZATION AND VVMC'S SOLE MEMBER. FORM 990, PART VI, LINE 1 THE BOARD OF DIRECTORS DELEGATES AUTHORITY TO AN EXECUTIVE COMMITTEE IN AN EMERGENCY SITUATION ONLY. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE INDIVIDUALS THEN SERVING AS THE EXECUTIVE COMMITTEE OF NAH, AUTOMATICALLY AND WITHOUT SEPARATE ELECTION. THE EXECUTIVE COMMITTEE SHALL ONLY MEET IF A QUORUM OF THE BOARD IS IMPOSSIBLE AND AN URGENT BOARD VOTE IS REQUIRED. IN SUCH CASES IT SHALL EXERCISE THE POWER AND AUTHORITY OF THE BOARD, AND SHALL REPORT ANY ACTIONS TAKEN AT THE FOLLOWING BOARD MEETING. FORM 990, PART VI, LINE 4 THE VERDE VALLEY MEDICAL CENTER BOARD WAS INTEGRATED INTO THE NORTHERN ARIZONA HEALTHCARE BOARD IN OCTOBER 2015. NORTHERN ARIZONA HEALTHCARE MOVED FROM A HOLDING COMPANY TO AN OPERATING COMPANY, SUCCESSFULLY INTEGRATING THREE SEPARATE BOARDS TO ONE SYSTEM BOARD. BOARD BYLAWS AND ARTICLES OF INCORPORATION WERE REWRITTEN TO ACHIEVE "BEST PRACTICE." THE ORGANIZATION MADE THE FOLLOWING SIGNIFICANT CHANGES TO THE BYLAWS, EFFECTIVE ON AUGUST 18, 2016: ARTICLE II: THE CORPORATION SHALL HAVE A SINGLE CLASS OF VOTING MEMBERS, AND THE SOLE MEMBER OF THAT CLASS IS NORTHERN ARIZONA HEALTHCARE CORPORATION. The following actions may be initiated by the Member in its sole and absolute discretion: a) Adoption of the consolidated annual budget for the System and any amendments b) The selection and retention of the President and Chief Executive Officer of this Corporation c) The selection of banking affiliations, accounting firms, legal counsel as well as approval of the engagement of any consultants not specifically provided for in an approved budget d) The selection of the manner and location of investment of any retained earnings e) Authorization of standing or ad hoc committees for controlled subsidiaries within the System ARTICLE III: THE DIRECTORS AT ALL TIMES SHALL BE, AUTOMATICALLY AND WITHOUT THE NEED OF A SEPARATE ELECTION, THE INDIVIDUALS SERVING AS DIRECTORS OF NAH. THE BYLAWS NO LONGER INCLUDE A PROVISION REGARDING THE MINIMUM OR MAXIMUM NUMBER OF BOARD MEMBERS, SINCE THE BOARD OF DIRECTORS FOR VVMC, FMC, AND NAH HAVE MERGED INTO ONE BOARD AS OF OCTOBER 2015. ARTICLE IV: THE OFFICERS OF THE BOARD ARE NOW LISTED AS THE PRESIDENT AND CEO, A CHAIR AND VICE-CHAIR, A SECRETARY, AND A TREASURER. EACH IS A VOTING MEMBER OF THE BOARD. ARTICLE V: DIRECTORS AND OFFICERS OF THE CORPORATION, OTHER THAN THE CEO WHO IS A FULL-TIME EMPLOYEE HIRED TO RUN THE DAY-TO-DAY OPERATIONS, SHALL NOT RECEIVE COMPENSATION FOR SERVING AS DIRECTORS AND/OR OFFICERS, BUT MAY RECEIVE REASONABLE COMPENSATION FOR OTHER PERSONAL SERVICES RENDERED WHICH ARE NECESSARY TO CARRYING OUT THE EXEMPT PURPOSES OF THE CORPORATION TO THE EXTENT PERMISSIBLE UNDER THE CORPORATION'S POLICIES AND PROCEDURES. ARTICLE VI: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE INDIVIDUALS THEN SERVING AS THE EXECUTIVE COMMITTEE OF NAH, AUTOMATICALLY AND WITHOUT SEPARATE ELECTION. ARTICLE VII: THE BYLAWS NOW CONTAIN PROCEDURES REQUIRING CONDUCT IN ACCORDANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, AND ANNUAL DISCLOSURE OF CONFLICTS. ARTICLE XII: IN ORDER TO BE GRANTED AN AMENDMENT THERE MUST BE A SUPER-MAJORITY (75%) OF DIRECTORS IN OFFICE AND ELIGIBLE TO VOTE. FORM 990, PART VI, LINE 6 NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE CORPORATE MEMBER OF VERDE VALLEY MEDICAL CENTER. FORM 990, PART VI, LINE 7A THE BOARD OF DIRECTORS IS DETERMINED BY THE ORGANIZATIONS MEMBER, NORTHERN ARIZONA HEALTHCARE (NAH). THE DIRECTORS AT ALL TIMES SHALL BE, AUTOMATICALLY AND WITHOUT THE NEED OF A SEPARATE ELECTION, THE INDIVIDUALS SERVING AS DIRECTORS OF NAH. FORM 990, PART VI, LINE 7B NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE VOTING MEMBER. The following actions may be initiated by the Member in its sole and absolute discretion: a) Adoption of the consolidated annual budget for the System and any amendments b) The selection and retention of the President and Chief Executive Officer of this Corporation c) The selection of banking affiliations, accounting firms, legal counsel as well as approval of the engagement of any consultants not specifically provided for in an approved budget d) The selection of the manner and location of investment of any retained earnings e) Authorization of standing or ad hoc committees for controlled subsidiaries within the System. THE MEMBER MAY NOT TRANSFER ITS MEMBERSHIP OR ANY RIGHTS ARISING THEREFROM. FORM 990, PART VI, LINE 11b THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM BASED ON DATA GATHERED BY THE CONTROLLER AND THE ORGANIZATION'S FINANCIAL OPERATIONS GROUP. THE CFO REVIEWS THE DRAFT FORM 990 AND PROVIDES ADDITIONAL COMMENTS. THE FINAL DRAFT VERSION OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE MAY 15 DUE DATE. ANY ADDITIONAL COMMENTS SUGGESTED BY THE GOVERNING BODY ARE THEN INCORPORATED INTO THE FINAL VERSION OF THE FORM 990 TO BE FILED WITH THE IRS BY THE FINAL DUE DATE. IF ANY SUGGESTED CHANGES ARE MATERIAL OR SIGNIFICANT, AN ADDITIONAL DRAFT IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, LINE 12C THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY (BOARD POLICY 6.1). THIS IS ACCOMPLISHED BY A NUMBER OF MECHANISMS. FIRST, THE CONFLICT OF INTEREST QUESTIONNAIRE IS REVIEWED BY THE GOVERNANCE COMMITTEE OF THE BOARD. AS PART OF THE QUESTIONNAIRE, SELF-DISCLOSURE IS REQUIRED BY BOARD MEMBERS, OFFICERS, AND VPS. IN ADDITION, INDIVIDUAL DISCLOSURE BY BOARD MEMBERS OCCURS AT BOARD MEETINGS WHEN NECESSARY. A BOARD MEMBER MUST EXCLUDE HIMSELF OR HERSELF FROM VOTING ON AN ISSUE IN WHICH HE OR SHE MAY HAVE A CONFLICT OF INTEREST. THE CONTROLLER REVIEWS POTENTIAL CONFLICTS AND FOLLOWS UP WITH ANY ADDITIONAL QUESTIONS, IF NECESSARY. THEN THE SUMMARY OF RESPONSES AND CONFLICTS ARE BROUGHT BEFORE THE GOVERNANCE COMMITTEE, WHICH MAKES A DETERMINATION AS TO WHETHER A CONFLICT EXISTS. FORM 990, PART VI, LINES 15A & 15B THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER OFFICERS INCLUDES THE PREPARATION OF COMPARABLE DATA BY WILLIS TOWERS WATSON, AN INDEPENDENT CONSULTING FIRM. IN ADDITION, THIS INFORMATION IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND IS DOCUMENTED IN THE BOARD MINUTES. THE MOST RECENT REVIEW WAS PERFORMED IN SEPTEMBER 2016. FORM 990, PART VI, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ARIZONA DEPARTMENT OF HEALTH SERVICES. IN ADDITION, THEY ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AS PART OF THE ORGANIZATION'S CONTINUING DISCLOSURE DOCUMENTS THAT ARE REQUIRED BY ITS PUBLIC DEBT REQUIREMENTS. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, AS THIS IS NOT REQUIRED. FORM 990, PART XI, LINE 9 Other Changes in Net Assets 30,120 Transfer from Affiliates ( 8,834,473) Decrease Pension Plan Valuation (13,212,187) Rounding 1,163 ------------ Total $(22,015,377) FLAGSTAFF MEDICAL CENTER PO BOX 1268 FLAGSTAFF AZ 86002 860110232 HEALTHCARE AZ 501(c)(3) 3 NAH false NORTHERN ARIZONA HEALTHCARE CORPORATION PO BOX 1268 FLAGSTAFF AZ 86002 742410946 HEALTHCARE AZ 501(c)(3) 9 NA false false false false false false false false true true false false false true false false true true true true