2015-03-16T17:12:06-05:00 2014-04-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2013-05-01 840469270 Colorado West Healthcare System COLO 9702566201 2021 N 12th Street Grand Junction CO 815012980 Christian Thomas CEO/CFO 9702566201 2015-03-16 1 KIM C HUNWARDSEN P00484560 6122536500 2015-03-11 2013 2016-02-25 16:41:14Z Community Hospital Grand Junction Christian Thomas 2021 N 12th Street Grand Junction CO 815012980 82322281 0 X www.yourcommunityhospital.com X 1956 CO The mission of Colorado West Healthcare System and Community Hospital is to improve the health and quality of life of the individuals and communities we serve. 12 7 712 85 303068 288082 70515 48613 78967905 80658828 -1048742 455794 323982 334561 78313660 81497796 0 45195 0 0 34543712 37510368 0 0 0 41132834 39477590 75676546 77033153 2637114 4464643 38511750 46848904 15680568 19572418 22831182 27276486 X The mission of Colorado West Healthcare System and Community Hospital is to improve the health and quality of life of the individuals and communities we serve. 1 1 71393054 45195 80683982 Community Hospital provides inpatient, outpatient, emergency, urgent, primary and home health care services to communities in western Colorado. During fiscal year 2014, Community Hospital had 5,464 patient days, 16,146 emergency room visits, 17,088 urgent care visits, 36,399 primary care visits, and performed 3,862 surgeries. 71393054 1 1 0 1 0 0 0 0 0 0 1 0 1 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 167 0 1 712 1 1 1 0 0 0 0 0 0 0 0 0 X 12 7 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 1 0 CO X Jon Hooker 9702576295 2021 N 12th Street Grand Junction CO 81501 Larry Kent Chairman 1.50 0.00 X X 0 0 0 R Curt Hatch Vice Chairman 1.50 0.00 X X 0 0 0 Michael Daniels Secretary 1.50 0.00 X X 0 0 0 David F Vargo Treasurer 1.50 0.00 X X 0 0 0 Monty Langston MD Board Member 1.00 0.00 X 0 0 0 Sam Starritt Board Member 1.00 0.00 X 0 0 0 Dean Havlik MD Chief of Staff Board Member 1.50 0.00 X 0 0 0 Amir Beshai MD Board Member 1.00 0.00 X 0 0 0 Tarek Arja DO Board Member 1.50 0.00 X 0 0 0 Jon Maraschin Board Member 1.50 0.00 X 0 0 0 Danny Mistry MD Board Member 1.50 0.00 X 0 0 0 Deedra Copeland Shear Board Member 1.50 0.00 X 0 0 0 Christian Thomas CEO/CFO 40.00 0.80 X 0 0 0 David Murray CCO 40.00 0.00 X 148904 0 8615 Donald Nicolay Chief Medical Officer 40.00 0.00 X 192259 0 5157 Kristin Gundt Chief Nursing Officer 40.00 0.00 X 120782 0 7948 Scott Vincent ER Physician 36.00 0.00 X 300796 0 8122 Debra Smith ER Physician 36.00 0.00 X 295882 0 11215 Marc Breen ER Physician 36.00 0.00 X 280985 0 7653 Rebecca Burton Hospitalist 40.00 0.00 X 265564 0 11048 Kelly Mistry Hospitalist 40.00 0.00 X 261234 0 6449 Wesley White Former CFO 40.00 0.00 X 242961 0 2831 2109367 0 69038 42 1 1 0 Boulder Associates 1426 Pearl St Ste 300 Boulder CO 80302 Construction 1870927 Community Anesthesia Consultants 2754 Compass Dr Grand Junction CO 81506 Physician Services 1206985 Quorum Healthcare Resources LLC 105 Continental Pl Brentwood TN 37027 Management Agreement 690957 Mountain Valley Contracting Inc 2481 Commerce Blvd Grand Junction CO 81505 Construction 601586 HSS Inc 990 S Broadway St Denver CO 80209 Security Services 547463 16 13000 35613 48613 Patient Service Revenue 621110 79312119 79312119 EHR 621110 964086 964086 Other Revenue 621110 339574 339574 Cafeteria Revenue 621110 246809 246809 Equity in Subsidiary Income 900099 -203760 -203760 80658828 4992 4992 1212458 761656 450802 450802 450802 31489 25150 6339 6339 62833 37679 25154 25154 Investment in LLC's 900099 303068 303068 303068 81497796 80683982 303068 462133 45195 45195 508594 508594 633417 633417 28539298 27804602 734696 648998 621854 27144 5046101 4835051 211050 2133960 2032561 101399 505447 505447 227035 227035 132108 132108 3729 3729 7473533 6772226 701307 357565 357565 2971472 2856984 114488 3891124 3107905 783219 178802 75310 103492 110553 106969 3584 430575 430575 1778967 1778967 591460 5370 586090 Medical Supplies 9124426 9124426 Bad Debt 5901582 5901582 Provider Taxes 3210145 3210145 Equipment Lease/Rent 968974 968974 1620093 719647 900446 77033153 71393054 5640099 0 7477439 8212189 7175922 10358335 936793 1444047 2592126 2643281 522439 382893 47855407 27754281 15855826 20101126 1292750 537375 2461391 2997567 197064 172091 38511750 46848904 6650265 8117703 313733 8251473 9241459 465097 2213256 15680568 19572418 X 22831182 27276486 22831182 27276486 38511750 46848904 X 4464643 -19339 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3729 3729 0 Part II-B, Line 1: The Organization pays dues to the Colorado Hsopital Association and a portion of that money is used for lobbying activities. 5478611 5478611 13459482 8980358 4479124 23644574 18463069 5181505 5272740 310854 4961886 20101126 Investment in Doctor's Clinic Building, Inc. 2396398 C Investment in Community Health Providers 10312 C Investment in Physicians Choice Real Estate -223872 C Other Investments 10003 C Investment in Grand Junction Med Ctr 500000 C Investment in Canyon View ASC 304726 C 2997567 Intercompany Payable 1808708 Estimated Third-Party Payor Settlement 404548 2213256 X 75614554 -5901582 -5901582 81516136 -18340 -18340 81497796 71169250 37679 37679 71131571 5901582 5901582 77033153 Part X, Line 2: The Hospital is organized as a Colorado nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Interal Revenue Code Section 501(c)(3). The Hospital 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 Hospital files an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS to report its unrelated business taxable income. Income tax expense, if any, is included in other expenses in the consolidated statements of operations. The Hospital 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 Hospital 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. The Hospital's federal Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2010. Part XI, Line 2d - Other Adjustments: Provision for Uncollectible Accounts -5,901,582. Part XI, Line 4b - Other Adjustments: Gift Shop Merchandise for Sale recorded as Expenses for Financial Statements -37,679. Net Fundraising Revenue 6,339. Foundation Contribution 13,000. Part XII, Line 2d - Other Adjustments: Gift Shop Merchandise for Sale recorded as Expenses for Financial Statements 37,679. Part XII, Line 4b - Other Adjustments: Provision for Uncollectible Accounts 5,901,582. Tour of the Valley 21562 21562 21439 Magnet 5K 9927 9927 3711 31489 31489 25150 25150 6339 1 1 X 1 X 1 X 1 1 0 1 1 1862000 1244289 617711 0.00870 12735234 8483500 4251734 0.05980 1530924 445446 1085478 0.01530 16128158 10173235 5954923 0.08380 182674 182674 0.00260 11287 11287 0.00020 224013 224013 0.00310 417974 417974 0.00590 16546132 10173235 6372897 0.08970 1 5901582 0 12778925 18062947 -5284022 X 1 1 1 Grand Junction Medical Center Property Rental 0.09080 0.00000 0.40200 2 Canyon View ASC LLC Ambulatory Surgery Center 0.51000 0.00000 0.49000 3 Community Health Providers Organization Inc Liaison between Insurance Comanies and the Physicians 0.50000 0.50000 4 Physicians Choice Real Estate LLC Property Rental 0.58200 0.44100 1 1 Community Hospital 2021 N 12th St Grand Junction CO 815012980 http://www.yourcommunityhospital.com/ 011119 X X X Community Hospital 1 1 X X X X X X X X 12 1 1 1 X http://www.yourcommunityhospital.com/inde X X X X X X X X X X 1 0 1 1 200.000000000000 1 250.000000000000 1 X X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 Community Hospital Part V, Section B, Line 3: Community Hospital worked with the Mesa County Health Department and a number of other local hospitals and organizations in Mesa County. This collaborative approach enabled the group to identify areas where the various organizations might work together to achieve needed improvements. Throughout the process members of the community were included in discussions to ensure views of the entire community were heard. Community Hospital Part V, Section B, Line 4: The CHNA was conducted with the following other hospital facilities: Family Health West Hospital, St. Mary's Hospital & Regional Medical Center, Colorado West Mental Health. Community Hospital Part V, Section B, Line 6i: Community Hospital was an active participant in this CHNA in collaboration with the Mesa County Health Department and a number of other local hospitals and organizations in Mesa County. This collaborative approach enabled the group to identify areas where the various organizations might work together to achieve needed improvements. Community Hospital has been utilizing this assessment as a guide for providing programs to address identified community health needs in support of the collaborators and with the mission of our organization..."to improve the health and quality of life of the individuals and communities we serve."Access to Health Care - Community Hospital has been very successful in its mission to recruit new primary care providers in this service area. We have grown the number of providers in our employment model and we have assisted our community partner practices by recruiting providers into their businesses. In addition, we have provided practice management services and an electronic medical records system to enhance the operations of our local health department's safety net clinic to improve access to uninsured and underinsured community members. We have also expanded our direct contract relationships with employer groups in the community to provide 24/7 primary care services at a minimal cost to the employees and health plan members within their populations.In progress; we have continued to add more providers to improve access; we've extended current employer group medical clinic agreements for additional plan years with enhanced benefits and we've introduced new employer groups to our partnership.Tobacco Use - Community Hospital continues to partner with local agencies to provide services where there are gaps with tobacco cessation resources. We've offered classes to the community and to our employer group partners.In progress; we continue to offer classes to the employer groups and have increased attention to individuals through one-on-one interactions with our health care team, especially our health coach/health promotion team.Obesity - We have formed a Community Hospital interdisciplinary population health management team that is focusing on diabetes. We're developing automated communication platforms in the areas of our emergency department, urgent care facilities, primary care facilities and in the transition phases when a patient is admitted and when the patient is discharged; transitioning the care and appropriate clinical information to the appropriate outpatient provider/service. Our target population pilot groups are our employer groups who have contracted with us for primary care services as well as patients who utilize our system. We have hired RN Care Coordinators who quarterback the team of providers; which now includes our health coach/care coordinators as extenders. We have supported the local Diabetes Counts program for young diabetics and have coordinated efforts with other local initiatives. Created and supported by an interdisciplinary team, we've also launched a new weight management program, Project U, for community members. We will continue to work with other community agencies.In progress; in addition to the above, we have participated in train the trainer programs and have implemented Be Well programs and Cooking Matters programs.Screening and Early Detection - With our Community Health Partnership worksite wellness program, we have continued to improve the number of participants in our onsite health screenings. We have also removed financial barriers for annual screening and early detection opportunities through our plan design for our own health plan members. Our enhancement with the health department clinic has also increased this capacity in our community as well.In progress; we have increased the number of partnering employers that have implemented onsite health screenings.Built Environment - We have participated in the planning efforts of our goals to promote health through advocacy for a well-constructed and inclusive built environment. And we have plans to implement these plans when we build our new hospital facility. We have broken ground and begun the construction of our replacement facility. Our plans are to open in spring 2016.Building a Sense of Community - Community Hospital feels very strongly about being involved in our community. We encourage active participation and service on community committees and boards as volunteers and organizational support for collaborative initiatives that benefit the overall health of our community. We are and continue to be strong players and often times are the leaders in this effort.In progress and growing; Community Hospital released its Fiscal Year 14 Annual Report highlighting that we provided over $4.3 million in charity care, $6 million of bad debt and over $700,000 in non-profit support to many community organizations.Parenting - Community Hospital certainly supports efforts in the community and while we do this by engaging with our patients and our patients' families on a daily basis, we utilize the expertise of our community partners and resources that are available to address this community need.With the addition of our pediatric primary care providers and the ob/gyn providers, we have been much more active with supporting community parenting efforts.Emotional and Social Well-Being - Community Hospital is an active participant in the community-wide effort to address specific mental health issues that continue to plague us. We have several teams of clinicians that work with other clinicians from other agencies and institutions; identifying processes to fill the gaps.In addition to the above, we have expanded our service lines with adding an Internal Medicine group of physicians and staff as employees; increasing our access and capacity for serving a broader clientele.In progress; the growth and expansion of our provider base has allowed us to be more involved with collaborative efforts in the community and has allowed additional capacity for serving a broader clientele. Community Hospital Part V, Section B, Line 14g: Summary on website, posted in ER and waiting rooms, posted in admissions offices, and provided on admission. 12 First Choice Same Day Surgical Center 2596 F Road Grand Junction CO 81505 Outpatient Surgical Services Grand Valley Primary Care 603 28 1/4 Road Grand Junction CO 81506 Primary Physician Care Therapy Works at Community Hospital 2004 N 12th St Grand Junction CO 81501 Rehabilitation Programs Occupational Health 2004 N 12th St Grand Junction CO 81501 Employment-related Exam Services Grand Valley Urgent Care 1060 Orchard Ave Suite N Grand Junction CO 81501 Urgent Medical Services EAP Behavioral Health Services 2021 N 12th St Grand Junction CO 81501 Counseling Services Home Health 2021 N 12th St Grand Junction CO 81501 Home Care Services Orchard Pharmacy 1060 Orchard Ave Suite N Grand Junction CO 81501 Pharmacy Colorado Mesa University Student Health 1060 Orchard Ave Suite N Grand Junction CO 81501 Student Medical Services Canyon View Urgent Care 2373 G Road Suite 160 Grand Junction CO 81505 Urgent Medical Services Colorado West Woman Care of the Grand Va 2020 N 12th St Grand Junction CO 81501 Obstetrics and Gynecology Internal Medicine Assoc of the Grand Va 744 Horizon Dr Suite 310 Grand Junction CO 81506 Internal Medicine Part I, Line 6a: The community benefit report is available upon request. Part I, Line 7: Lines 7a-7c were determined using the overall cost to charge ratio. Lines 7e, 7f, and 7i are actual expenses from the general ledger. Part I, Ln 7 Col(f): The Bad Debt expense included in Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $5,901,582. Part III, Line 3: Community Hospital follows Healthcare Financial Management Association Statement No. 15, and therefore bad debt does not include amounts that would be attributable to charity care. Bad debt on line 2 is reported at charges. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 10 of the attached audit report. Part III, Line 8: The organization estimates 75% should be considered a community benefit. If these individuals did not qualify for Medicare, they would qualify for financial assistance, based on the demographics of the community in which we operate. Part III, Line 9b: Part of the Hospital's financial assistance and charity care policy provides for a financial counselor to meet with all uninsured patients prior to discharge from the Hospital. Every effort is made to work with self-pay patients to determine financial assistance eligibility. Collections actions are not taken until eligibility is determined. Part VI, Line 2: Community Hospital develops its strategic plan both internally and supported by Quorum Health Resources to assess the healthcare needs of the community it serves. This plan includes market assessment of the service area and local demographic characteristics, clinical service line utilization and projections for inpatient, ambulatory, and provider practices. Clinical foci resulting from the same are diabetes, obesity, and primary care access. Part VI, Line 3: Part of the Hospital's written financial assistance and charity care policy provides for financial counselors to meet with all uninsured patients prior to discharge. The Hospital's billing team may also inform patients of the Hospital's financial assistance and charity care program. Part VI, Line 4: The Hospital's primary service area is western Colorado and the residents of Mesa County. Mesa County's population is approximately 150,000 with 15% of the population being over the age of 65. Community Hospital captures 12% of the area's healthcare market for those patients requiring inpatient stays. Part VI, Line 5: Community Hospital expanded its services to meet community needs with the opening of Grand Valley Urgent Care and Grand Valley Primary Care during the 2010 fiscal year. Three primary physicians were recruited to help meet the shortage of primary care physicians in Mesa County. The Hospital also created programs with several medical schools, universities, colleges and trade schools to provide clinical rotation experience with their students including physicians, nurses and ancillary support occupations. 1 Community Hospital Foundation 2021 N 12th Street Grand Junction CO 815012980 742576856 501(c)(3) 45195 Executive Director salary contribution 1 0 Part I, Line 2: Colorado West Healthcare System provides assistance to Community Hospital Foundation, a related organization. The Foundation Director's compensation is paid by Colorado West Healthcare System. The Foundation reimburses the Hospital for a portion of his salary and the remaining amount is considered a donation to the Foundation. The CEO of the Hospital also serves on the board of the Foundation and monitors the appropriate use of the funds. X X X 0 0 0 0 0 0 0 1 0 David Murray CCO 148904 0 0 0 0 0 3681 0 7107 0 159692 0 0 0 Donald Nicolay Chief Medical Officer 192259 0 0 0 0 0 1925 0 6650 0 200834 0 0 0 Scott Vincent ER Physician 300796 0 0 0 0 0 3052 0 8094 0 311942 0 0 0 Debra Smith ER Physician 295882 0 0 0 0 0 6663 0 7677 0 310222 0 0 0 Marc Breen ER Physician 280985 0 0 0 0 0 5871 0 4475 0 291331 0 0 0 Rebecca Burton Hospitalist 265564 0 0 0 0 0 6496 0 7315 0 279375 0 0 0 Kelly Mistry Hospitalist 261234 0 0 0 0 0 5291 0 3921 0 270446 0 0 0 Wesley White Former CFO 242961 0 0 0 0 0 1839 0 1665 0 246465 0 0 0 Part I, Line 7 Quorum Health Resources, a management company, compensates the CEO. His compensation includes an eligible bonus based on a scorecard of thirteen metrics, focused around the Pillars of Excellence - quality, service, financial, growth, and people. Community Anesthesia Consultants Board Member Monty Langston is a partner 126985 Payments for Physician Services 0 Western Therapeutics LLC Board Member Amir Beshai is a partner 257600 Payments for Physician Services 0 Kathleen Maraschin Wife of Board Member Jon Maraschin 79437 Compensation 0 Jana Thomas Wife of CEO Christian Thomas 18402 Compensation 0 Mary Thibault Sister of CCO David Murray 76115 Compensation 0 Lynn Nicolay Wife of Chief Medical Officer Donald Nicolay 26645 Compensation 0 Kelly Mistry Wife of Board Member Danny Mistry, MD 267365 Compensation 0 The Pathology Group PC Board Member Dean Havlik is a partner 128991 Payments for Lab Director 0 Form 990, Part III, line 2 Colorado West Woman Care of the Grand Valley opened March 2014 providing gynecology services. Internal Medicine Associates of the Grand Valley opened December 2013 providing primary care services. Form 990, Part III, line 3 First Choice Same Day Outpatient Surgery Center closed March 2014. Form 990, Part VI, Section A, line 1 The Executive Committee shall be composed of the Chairperson, Vice Chairperson, Treasurer, Secretary, Chief of Staff, and the President/CEO. The Executive Commitee shall meet upon the call of the Chairperson to: A. Review upcoming Board of Trustee meetings. B. Act on behalf of the Board of Trustees between regular or special meetings of the Board and then report actions to the Board of Trustees. C. Communicate to keep the Board of Trustees, medical staff and administration of the Hospital aware of pertinent actions taken or contemplated by one or the other, and to make recommendations to the Board of Trustees on major expenditures. D. Consider issues affecting medical care that arise in the operation and affairs of the Hospital. E. Perform the annual evaluation of the President/CEO. F. Perform any other actions the Board of Trustees deems necessary, as instructed by the Board of Trustees. Form 990, Part VI, Section A, line 3 The Hospital has a management agreement with Quorum Health Resources. Christian Thomas, CEO, is compensated by Quorum Health Resources. His compensation for calendar year 2013 was $365,089. Form 990, Part VI, Section B, line 11 The 990 is prepared by the Hospital's independent CPA firm and reviewed by the Hospital's accounting staff and Administration, including the CEO, Controller, and Compliance Officer. A preliminary draft is presented to the Board of Directors for detailed review and approval. A final copy of the 990 is provided to all board members prior to the final filing with the IRS. Form 990, Part VI, Section B, line 12c The Hospital's conflict of interest policy is maintained and managed by the Chief Compliance Officer on an annual basis. All board members, officers, and key employees are required to complete a conflict of interest disclosure form and submit it to the compliance department. That documentation is reviewed by and retained by the compliance officer. Any conflicts of interest that arise are addressed by the compliance department and the Board of Trustees. Form 990, Part VI, Section B, line 15 Community Hospital is a Quorum Health Resources managed hospital whereby the CEO is an employee of the management company. Salary and benefits for the CEO are based on the management company's salary survey data for hospitals of comparable size and is approved by the Executive Committee of the Board of Trustees. Salaries and benefits for other members of senior management are based on salary survey data compiled by the Hospital's HR department and are approved by the Board of Directors through the annual budget process. Form 990, Part VI, Section C, line 19 Governing documents, policies and procedures, and audited financial statements are made available to the public upon request on a case by case basis. Form 990, Part XI, line 9: Net Fundraising Revenue Not Recorded for Financial Statement Purposes -6,339. Foundation Contribution Not Recorded for Financial Statement Purposes -13,000. Community Hospital Foundation 2021 N 12th St Grand Junction CO 815042980 742576856 Fundraising CO 501(c)(3) Line 11a, I Colorado West Healthcare System 1 Physicians Choice Real Estate LLC 2012 N 12th St Grand Junction CO 815012980 841601063 Real Estate Commercial Rental CO Colorado West Healthcare System Related 117340 1721555 0 0 0.58200 Canyon View ASC 2373 G Road Ste 180 Grand Junction CO 81505 455352976 Ambulatory Surgery Center CO Colorado West Healthcare System Related -2411 761987 0 0 0.51000 Doctor's Clinic Building Inc 1060 Orchard Ave Grand Junction CO 81501 840507943 Real Estate Rental CO Colorado West Healthcare System C 1686278 2567183 1.00000 1 0 0 1 0 0 1 0 0 0 0 1 0 0 1 1 1 1 0 1 Physicians Choice Real Estate LLC F 87035 Accrual Physicians Choice Real Estate LLC K 508020 Accrual Doctor's Clinic Building Inc K 261592 Accrual