2016-01-12T12:36:41-07:00 2015-06-30 990 2014-07-01 850141285 Cibola General Hospital Inc CIBO 5052874446 1016 E Roosevelt Avenue Grants NM 87020 Bob Phillips Interim CEO 5052875300 2016-01-12 2014 2016-04-25 22:37:26Z Cibola General Hospital Bob Phillips 1016 East Roosevelt Avenue Grants NM 87020 28497833 0 X http://www.cibolahospital.com/ X 1958 NM To provide health care services to our community, without regard to ability to pay, utilizing state of the art practices and equipment to provide care second to none. 9 9 245 0 0 0 4030 2161 22397119 21898903 70351 -25649 5106802 5237155 27578302 27112570 0 0 0 0 13269047 13442122 0 0 0 10195984 10261013 23465031 23703135 4113271 3409435 40389253 43311611 2886435 2387398 37502818 40924213 To provide excellent health care that our community is proud of by committing to: SERVICE (Meet expectations of patients & families). QUALITY (Establish national best practices as standards) PEOPLE (Embrace personal role to help meet Organization's goals). FINANCE (Maintain financial stability to ensure we continue to meet the needs of our Community). GROWTH (Improve Access to care through physicians partnerships and new services). 0 0 15627565 2161 27110409 Our program service is providing patient care to the residents of our service area, therefore, we consider each patient encounter an accomplishment. 0 0 0 See number 1 0 0 0 See number 1. 0 0 0 15627565 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 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 0 0 0 245 1 0 0 0 0 0 0 X 9 9 0 1 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NM X J F Rimel 5052874446 1016 E Roosevelt Avenue Grants NM 87020 Ron Ortiz Board Chair 2 0 X 0 0 0 Nestor Griego Secretary 2 0 X 0 0 0 Judy Martinez Member 2 0 X 0 0 0 Bob Tenequer Vice Chair 2 0 X 0 0 0 Paul Milan Treasurer 2 0 X 0 0 0 Karl Gutierrez MD Chief of Medical Staff 2 0 X 0 0 0 Carlos Tapia Member 2 0 X 0 0 0 Chase Elkins Member 2 0 X 0 0 0 Lloyd Felipe Member 2 0 X 0 0 0 Bob Phillips Interim Chief Executive Officer 40 0 X 0 0 0 James F Rimel Assistant Administrator and CFO 40 0 X 0 0 0 Joseph Charles MD Obstetrics Gynecology Physician 40 0 X 320000 0 0 Ann Church MD General Surgeon 40 0 X 320000 0 0 Patricia Rocha MD FP / OB Physician 40 0 X 266266 0 0 Diego Florentin MD Internist 40 0 X 218792 0 0 Angela Studer Certified Registered Nurse Anesthetist 40 0 X 214999 0 0 1340057 0 0 18 0 1 0 EmCare Inc 1717 Main Street Ste 5200 Dallas TX 75201 Emergency Room Physician Coverage 767984 Medhost of Tennessee 3102 West End Avenue Nashville TN 37203 Computer Processing 595433 Quorum Health Resources 105 Continental Place Brentwood TN 37027 Hospital Management 327389 Life Coach Plus 699 Old Church Road Corrales NM 87048 Social Work & Case Management 294840 Harmonix Technologies 4915 Paseo Del Norte Suite A Memphis NM 87113 Information Technology support 232032 11 0 0 0 0 0 2161 0 2161 Acute Care Hospital Services 622000 21898903 21898903 0 0 0 0 0 0 21898903 137153 137153 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 -162802 0 0 0 -162802 -162802 -162802 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6622418 1385263 5237155 5237155 0 0 0 27112570 27110409 0 0 0 0 0 0 0 0 0 0 372326 0 372326 0 0 0 0 0 10609683 8282151 2327532 0 0 0 0 0 1658672 1295422 363250 0 801441 622720 178721 0 327389 0 327389 0 87739 0 87739 0 36730 0 36730 0 0 0 0 0 0 0 0 0 0 0 758394 758394 0 0 100967 0 100967 0 286634 0 286634 0 0 0 0 0 0 0 0 0 294770 0 294770 0 131380 61774 69606 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1383180 931175 452005 0 222081 0 222081 0 Supplies 1478045 1184399 293646 0 Purchased Services 3449452 1865777 1583675 0 Repairs & Maintenance 879543 420712 458831 0 Leases, rentals, dues licenses, taxes etc. 824709 205041 619668 0 0 0 0 0 23703135 15627565 8075570 0 8147080 6533626 0 0 0 0 3525839 3425419 0 0 0 0 0 0 191427 214469 288808 279369 17904469 7342686 11609974 10561783 0 0 0 0 16626125 22296945 0 0 0 0 40389253 43311611 2886435 2387398 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2886435 2387398 X 37502818 40924213 0 0 0 0 37502818 40924213 40389253 43311611 X 3409435 11963 0 0 0 -3 X 1 X 1 X 1 0 X 128777 0 128777 7153160 0 1209162 5943998 2219743 0 1291291 928452 8189816 0 4842233 3347583 212973 0 0 212973 10561783 0 C 0 C 0 Certificates of deposit 22296945 F 22296945 28497833 0 0 0 1385263 1385263 27112570 0 0 0 27112570 25088398 0 0 0 1385263 1385263 23703135 0 0 0 23703135 Schedule D, Part XI, Line 2d Cost of Goods Sold not included in revenue. Schedule D, Part XII, Line 2d Cost of goods sold not included in expenses. 1 1 1 X 5 0 1 1 1 0 0 333163 0 333163 0.014 6180070 4659530 1520540 0.064 0 0 0 0 0 0 6513233 4659530 1853703 0.078 45222 0 45222 0.002 80000 0 80000 0.003 0 0 0 0 0 0 0 0 0 0 0 0 0 125222 0 125222 0.005 0 0 6638455 4659530 1978925 0.083 0 0 0 0 1 1312587 656293 4677283 6160612 -1483329 X 1 1 Quorum Health Resources Manages the Hospital under a management contract. 0 0 0 1 1 Cibola General Hospital Inc 1016 E Roosevelt Avenue Grants NM 87020 www.cibolahospital.com 6079 X Cibola General Hospital Inc 1 1 0 1 X X X X X X X X X 13 1 0 0 1 X http://www.cibolahospital.com/ X 1 13 0 0 0 1 X X X X X 1 1 X X X X 1 X http://www.cibolahospital.com/ X http://www.cibolahospital.com/ 1 X 1 X X X X X 1 X 0 0 Schedule H, Part V, Section B, Line 5-Cibola General Hospital Inc Cibola General Hospital Inc - The Community Health Needs Assessment sought input from all persons in our 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 to do 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. Schedule H, Part V, Section B, Line 11-Cibola General Hospital Inc The Hospital and its Board practice ongoing promotion of health improvement. Community health is promoted in the following ways. Hospital Board is a community-based, all volunteer group. Surplus funds are used to reinvest in our facilities to keep them state of the art. Financial support to the local college funds the salary of the Nursing program administrator. The Hospital co-sponsors an annual health fair to educate the community. Annual vaccination clinics are staffed by Hospital nurses. Free classes are sponsored in diabetes management, childbirth, and breastfeeding. Employees volunteer for the Relay For Life each year. Schedule H, Part V, Section B, Line 18d-Cibola General Hospital Inc Outside collections agencies are used. The recovery rates by these agencies are typically under 10%. Schedule H, Part V, Section B, Line 22d-Cibola General Hospital Inc 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. Schedule H, 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. (3) Disclosure of any other support received. Schedule H, Part I, Line 7 Amount reported on Line a column c is based on our 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 f column c are based on actual cost. Schedule H, Part I, Line 7, Column f Not applicable; not included. Schedule H, Part I, Line 7g Not applicable. Schedule H, Part III, Section A, Line 4 There is no mention of Bad debt expense nor its calculation methodology within the audited financial statements. Schedule H, Part III, Section B, Line 8 The entire Medicare shortfall should be regarded as Community Benefit. Schedule H, Part III, Section C, Line 9b Yes, patients eligible for financial assistance are considered in our process. We take the phrase "known to qualify for financial assistance" to mean a patient who has gone through the qualification process and has been approved for financial assistance. A patient who has qualified for financial assistance is not subject to further collection efforts. Schedule H, Part VI, Line 2 We get lots of informal feedback from patients and visitors. Our executives are active in community organizations whose members talk to them about concerns and suggestions for improvement of health and health care. Quorum Health Resources, the management company of the Hospital, assisted us in our most recent needs assessment. Schedule H, 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 to the patient the information needed for them to apply for Financial Assistance. The patient will be referred to the on staff financial counselors. These financial counselors will make a concerted effort to assist the patient in correctly and completely filling out the paperwork, and guiding them to the appropriate available resources. Schedule H, Part VI, Line 4 Cibola General Hospital, Inc. provides medical services in a county that represents 28,000 lives. Our population is 21% White, 37% Hispanic, 1% Black, and 41% Native American. Our population is impacted significantly by many chronic illnesses including diabetes, hypertension, obesity and cardiovascular disease. Community outreach is the answer to this problem. Cibola General Hospital, Inc. is the sole hospital for our region. The community depends on us to provide access to both primary and specialty care. Our efforts to find better ways to coordinate care are based on evidence that better coordinated care reduces overall costs of care and improves quality. Our hospital owned clinic (Cibola Family Health Center) allows for greater access to patient care. Schedule H, Part VI, Line 5 A transparent Board, involved medical staff, and employees who are also citizens-stakeholders conduct regular activities to elevate health awareness and encourage wellness. Schedule H, Part VI, Line 6 We have no such affiliations. Schedule H, Part VI, Line 7 Copies of our Form 990 and related schedules, which document our community benefit efforts, are filed annually with the State of New Mexico. X X 0 0 0 0 0 0 0 0 0 Joseph Charles MD Obstetrics Gynecology Physician 320000 0 0 0 0 0 0 0 0 0 320000 0 0 0 Ann Church MD General Surgeon 320000 0 0 0 0 0 0 0 0 0 320000 0 0 0 Patricia Rocha MD FP / OB Physician 266266 0 0 0 0 0 0 0 0 0 266266 0 0 0 Diego Florentin MD Internist 218792 0 0 0 0 0 0 0 0 0 218792 0 0 0 Angela Studer Certified Registered Nurse Anesthetist 214999 0 0 0 0 0 0 0 0 0 214999 0 0 0 Form 990, Part VI, Section A, Line 3 Yes, the Hospital is managed by QHR, aka Quorum Health Resources. Form 990, Part VI, Section A, Line 7a The 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 will be appointed based on majority vote of the other 8 members of the Board, at their first meeting. Form 990, Part VI, Section A, Line 7b The Board will refer significant capital project proposals ad Trustee appointments to the County Commission for approval. Form 990, Part VI, Section B, Line 11b The 990 and related schedules were 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 each year, 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 The Hospital operates in a climate of transparency. In addition to the Board holding monthly public meetings, the CEO reports regularly to the County Commission at a public meeting, to brief them on financial and other significant activities. Form 990, Part XI, Line 9 Rounding. Filing is not late; it is timely.