2014-02-17T12:09:28-06:00 2013-03-31 STOCKMAN KAST RYAN & CO LLP 102 N CASCADE AVENUE SUITE 400 COLORADO SPRINGS CO 80903 990 2012-04-01 841465990 Arkansas Valley Regional Medical Center % JANETTE BENDER ARKA 7193836026 1100 Carson Avenue Suite La Junta CO 81050 JANETTE BENDER 7193836023 2014-02-15 true DOREEN B MERZ 7196301186 2012 2015-11-30 17:44:51Z Lynn Crowell 1100 carson avenue la junta CO 81050 40708095 false X WWW.avrmc.org X 1998 CO THE CENTER IS A COMMUNITY-OWNED ORGANIZATION PROVIDING HIGH QUALITY, RESPECTFUL, AND COMPASSIONATE HEALTH CARE SERVICES TO INDIVIDUALS & FAMILIES IN SOUTHEAST COLORADO. 11 11 382 80 0 59194 12559 44286585 40094373 90789 95970 293218 363593 44729786 40566495 0 0 0 0 22706214 21173561 0 0 0 21566024 23199446 44272238 44373007 457548 -3806512 40444057 36398149 5679402 5431649 34764655 30966500 THE CENTER IS A COMMUNITY-OWNED ORGANIZATION THAT WILL WORK IN PARTNERSHIP WITH THE COMMUNITIES WE SERVE TO PROMOTE THE HEALTH AND WELL-BEING OF INDIVIDUALS AND FAMILES IN SOUTHEASTERN COLORADO. false false 34263524 40457966 The Medical Center operates as an acute-care hospital and long-term care nursing home and PROVIDes inpatient, outpatient, and emergency HEALTH CARE SERVICES TO THE COMMUNITY REGARDLESS OF RACE AND INSURANCE. 34263524 true true false true false false false false false true true false false false true true true false false false false false false false false false true true false false true false false false false false true false true false false false false false false false false false true X 206 0 382 true false false false false false false false false false false false false false false X 11 11 false true false false false false false false false false false true true true true true true true true false X JANETTE BENDER 7193836001 1100 CARSON AVENUE la junta CO 81050 Robert W Blair 1.0 X X 0 0 0 Evan Gamboa 1.0 X X Jim Clawson 1.0 X X Ron Davis 1.0 X Betty Velasquez 1.0 X Rob Pickering 1.0 X Margie Gardner 1.0 X H Randolph Frank MD 1.0 X Dale L Leighty 1.0 X Patrick Hancock 1.0 X Richard A Shand MD 1.0 X Lynn Crowell 40.0 X 207080 53427 Janette Bender 40.0 X 122115 38019 Carrie Cutrell 40.0 X 121430 74711 Michael Morley 40.0 X 787025 4469 Jesus Carale 40.0 X 476617 75884 Thomas M Jackson 40.0 X 295499 10505 Kent E Gay 40.0 X 298046 58698 James S Brady 40.0 X 359588 67270 2667400 0 382983 14 false true false QUORUM HEALTH RESOURCES PO BOX 305172 DPT 7 NASHVILLE TN 372305172 MANAGEMENT FEES 612075 MICHAEL MARTINO 622 CARSON AVENUE LA JUNTA CO 81050 PHYSICIAN CONTRACTED 385870 TRANE FILE 56718 LOS ANGELES CA 900746718 HVAC REPAIR 316567 MEDICAL INFORMATION TECH PO BOX 74569 CHICAGO IL 60696 MAINTENANCE CONTRACT 332605 GE HEALTHCARE 20225 WATERTOWER BLVD BROOKFIELD WI 53045 MAINTENANCE CONTRACT 307818 21 12559 12559 PATIENT SERVICE REVENUE 900099 40094373 40094373 40094373 93957 93957 0 0 211593 124911 86682 0 86682 86682 18702 16689 2013 2013 2013 0 0 34941 34941 34941 CAFETERIA 900099 140428 140428 MEDICAL RECORDS 900099 10230 10230 MISCELLANEOUS INCOME 900099 91312 91312 241970 40566495 40457966 95970 0 0 0 0 657618 657618 0 17692350 12962287 4730063 365795 272768 93027 2457798 2043897 413901 0 612075 612075 31970 31970 47379 47379 1102 1102 0 0 7924090 7844413 79677 0 5214116 3730657 1483459 0 0 409502 256185 153317 0 0 0 21199 15117 6082 0 2374899 1693567 681332 0 BAD DEBT EXPENSE 2664463 2664463 REPAIRS & MAINTENANCE 1274402 908790 365612 OTHER OPERATING EXPENSES 1415060 1009094 405966 UTILITIES 1209189 862286 346903 44373007 34263524 10109483 0 1239924 287275 3729663 2744144 0 0 6021012 4489962 0 0 0 0 0 0 1594109 1593344 655980 680133 54638402 30249593 25061943 24388809 1507191 1557547 0 0 0 0 0 0 634235 656935 40444057 36398149 4916483 4773265 0 0 0 0 0 0 0 0 0 0 685872 560576 0 0 77047 97808 5679402 5431649 X 34207467 30407373 0 0 557188 559127 34764655 30966500 40444057 36398149 -3806512 8357 X false true X false false X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED true 1102 1102 PART II-B , LINE 1(I) ALLOCABLE PORTION OF DUES PAID TO CHA AND AHA DEISGNATED AS LOBBYING EXPENSES 557188 1939 559127 560041 -2853 557188 563460 -3419 560041 1.00000 true false 9546 9546 30284722 12082516 18202206 867602 639239 228363 22880942 17527838 5353104 595590 595590 24388809 0 DEFERRED COMP PLAN LIABILITY 97808 97808 X 38035300 8357 124911 133268 37902032 2664463 2664463 40566495 41833455 124911 124911 41708544 2664463 2664463 44373007 PART V, Line 4 The Medical Center is the sole beneficiary of the Bertha Elrod Copeland and James Evan Copeland Hospital Trust (the Trust), a charitable trust whose principal is to be held in perpetuity. Assets of the Trust are invested and administered by a trustee and distributions are made to the Medical Center. The use of the distributions received from the Trust is restricted to the purchase of equipment. PART X, LINE 2 The Medical Center believes that it does not have any uncertain tax positions that are material to the financial statements. The Medical Centers income tax returns for 2010 through the current period remain open to examination by the Internal Revenue Service and relevant state authorities. PART XI, LINE 2D RENTAL EXPENSES OF $124,911 WAS RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN. PART XI, LINE 4B BAD DEBT EXPENSE WAS TAKEN AGAINST PATIENT REVENUE PER THE AUDIT, BUT RECLASSED AS AN EXPENSE IN THE AMOUNT OF $2,664,463 FOR THE TAX RETURN. PART XII, LINE 2D RENTAL EXPENSES OF $124,911 WAS RECLASSED FROM EXPENSES TO BE SHOWN NET AGAINST RENTAL INCOME ON PAGE 9 OF THE TAX RETURN. PART XII, LINE 4B BAD DEBT EXPENSE WAS TAKEN AGAINST PATIENT REVENUE PER THE AUDIT, BUT RECLASSED AS AN EXPENSE IN THE AMOUNT OF $2,664,463 FOR THE TAX RETURN. true true true X true X true true true false true true 2266130 1804248 461882 0.01110 9016269 5248697 3767572 0.09030 11282399 7052945 4229454 0.10140 366986 65649 301337 0.00720 8583 8583 0.00020 375569 65649 309920 0.00740 11657968 7118594 4539374 0.10880 27 8583 8583 0.00020 36 61404 61404 0.00150 63 69987 69987 0.00170 true 2664463 8469718 8519897 -50179 X true NONE NONE 1 1 ARKANSAS VALLEY REGIONAL MEDICAL CTR

1100 CARSON AVENUE LA JUNTA CO 81050

X X X LONG-TERM NURSING ARKANSAS VALLEY REGIONAL MEDICAL CTR 1 true X X X X X X X X X 12 true false true X X X X X X X false false true false true 250. true X true true X X X X X true X X true X X X X true X false false SUPPLEMENTAL INFORMATION SCHEDULE H, PART III, LINE 4 THE COST METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED AS BAD DEBT EXPENSE IS USING A COST-TO-CHARGE RATIO. THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS IS MULTIPLIED BY THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATE THE ESTIMATED COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS. A number of patients are truly unable to pay their out-of-pocket liability, but do not complete the process required to apply for financial assistance under the Hospital's charity care policy. These patients would qualify for charity care if they completed the paperwork, so the bad debt expense associated with treating them should be treated as community benefit. SEE PAGE 8 OF THE ATTACHED AUDIT REPORT FOR DESCRIPTION FROM THE AUDIT OF BED DEBT EXPENSE. SCHEDULE H, PART III, LINE 8 MEDICARE COSTS WERE CALCULATED FROM THE MEDICARE COST REPORT FOR THE FYE MARCH 31, 2013. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. SCHEDULE H, PART V, SECTION B, LINE 3 In the AVRMC process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving virtually no support and other needs receiving identical point allocations. We received community input from 104 area residents from a survey completed online during the period April 1, 2012 through June 30, 2012; The terms of gaining input stipulated each respondent would remain anonymous; The internet-based survey was promoted through a paid advertisement in a local newspaper, at a health fair, and distributed to local civic and health organizations with a request for participation. Preliminary conclusions were presented to a local group of experts who were asked to validate prior assessments and to establish priority among various identified health and medical issues. When the analysis was complete, we put the information and summary conclusions before a local group of experts who were asked to agree or disagree with the summary conclusions. SCHEDULE H, PART V, SECTION B, LINE 7 We do not have adequate resources to solve all the problems identified. Some issues are beyond the mission of the hospital and action is best suited for a response by others. Some improvements will require personal actions by individuals rather than the response of an organization. We view this as a plan for how we, along with other organizations and agencies, can collaborate to bring the best each has to offer to address the more pressing identified needs. By definition, the needs identified as LOW Priority and for which AVRMC holds LOW RESPONSIBILITY for implementation are needs to which the hospital may devote resources while (in most cases) monitoring but otherwise not addressing. Reasons for this response: Actions required are beyond the mission of AVRMC; AVRMC can be more effective applying its resources to higher priority needs; The hospital does not possess the expertise necessary for substantive positive improvement; Actions contemplated for implementation fall more appropriately to the responsibility of others; Other than providing encouragement, implementation efforts for some needs require appropriate actions by individuals modifying their personal habits rather than a response by an organization or the Health System; The best use of AVRMC resources is to focus on resolving or improving higher priority needs rather than attempting to respond to everything with small, perhaps ineffective, efforts. SCHEDULE H, PART V, SECTION B, LINE 17E THE CENTER ATTEMPTS TO OBTAIN COLLECTIONS THROUGH THE USE OF GARNISHING WAGES FROM CLIENTS WITH OUTSTANDING BALANCES. SCHEDULE H, PART VI, LINE 2 We deployed a Community Health Need Assessment survey within the local population for any resident to complete. We received community input from 104 area residents from a survey completed online during the period April 1, 2012 through June 30, 2012; The terms of gaining input stipulated each respondent would remain anonymous; The internet-based survey was promoted through a paid advertisement in a local newspaper, at a health fair, and distributed to local civic and health organizations with a request for participation. Preliminary conclusions were presented to a local group of experts who were asked to validate prior assessments and to establish priority among various identified health and medical issues; and Information analysis augmented by local opinions showed how Otero County relates among its peers in terms of primary and chronic needs, as well as other issues of uninsured persons, low-income persons, and minority groups; respondents commented on if they believe certain population groups (or people with certain situations) need help to improve their condition and if so, who needs to do what. When the analysis was complete, we put the information and summary conclusions before a local group of experts who were asked to agree or disagree with the summary conclusions. They were free to augment potential conclusions with additional statements of need; new needs could, and did, emerge from this exchange. Consultation with local experts was accomplished by having the local experts complete a survey individually. The survey identifying potential community needs the local experts participated in was a structured communication Delphi method technique, originally developed as a systematic, interactive forecasting method which relies on a panel of experts. The process encourages experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process was completed in one round which identified the most pressing, highest priority community needs. In the AVRMC process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving virtually no support and other needs receiving identical point allocations. We dichotomized the rank order into two groups: high priority needs and low priority needs. The determination of the break point, high as opposed to low, was a qualitative interpretation by QHR and the AVRMC executive team. When presented to the AVRMC executive team, the dichotomized need rank order identified which needs the hospital considered high responsibility to respond vs. low responsibility to respond. The result provided a matrix of needs and guided the hospital in developing its implementation response. Leading issues seem to relate to a lack of affordable health insurance coverage and the cost of medical care. Responses noted four topics as their most serious concerns: No health insurance is a major concern to 76% of respondents; Teen birth/pregnancy is a major concern to 63% of respondents; Diabetes is a major concern to 59% of respondents; and unhealthy food choices and obesity are major concerns to 55% of respondents. Mental health issues present as a focus on alcohol use, drug abuse, and smoking among youth as well as adult abuse of alcohol and drugs. Regardless of age, prescription abuse is also present as a focus; and Comments about individual, family, and healthy living concerns revolve around healthy living and healthcare availability. SCHEDULE H, PART VI, LINE 3 THE ORGANIZATION PROVIDES A BROCHURE TO EACH PATIENT OUTLINING THE GUIDELTNES USED TO DETERMINE ELTGTBILITY FOR ASSISTANCE. SCHEDULE H, PART VI, LINE 4 In 2010, the Medical Center received 82.4% of its patients from the hospital's Primary Service Area. The Otero County 81050 and 81067 zip codes comprise 64.8% of all patients. County data is used as most information is not available at the geographic level of a zip code. The 2011 population for Otero County is estimated to be 18,345, but is expected to decline at a rate of 4%, projecting a 2016 population of 17,607. The population loss is in contrast to the Colorado state average rate of population increase of +7.2% and the national growth rate of +4%. The 65+ population of Otero County is 18.6% of the total population compared to the overall U.S. at 13.3%. The number of child-bearing-age females in the U.S. is expected to decrease 5.5%, while in Colorado it is expected to increase 2.1% by 2015. The Otero County 2011 Median Household Income is $42,283, which is considerably lower than the national median income of $67,529. Otero County's u X false false false false false false false true false Lynn Crowell 199820 7260 5286 48141 260507 Janette Bender 122095 20 5747 32272 160134 Carrie Cutrell 121410 20 5759 68952 196141 Michael Morley 607700 179325 4469 791494 Jesus Carale 417904 58713 11587 64297 552501 Thomas M Jackson 295499 10505 306004 Kent E Gay 298046 11475 47223 356744 James S Brady 359588 11475 55795 426858 PART I, LINE 7 The physician contracts allow for a QUARTERLY BONUS IF THEIR RELATIVE VALUE UNITS charged exceed quarterly benchmark standards. DALE LEIGHTY BOARD MEMBER 256290 CD'S HELD AT BANK false BOB BLAIR BOARD MEMBER 183194 CD'S HELD AT BANK false PART IV, LINE 1 DALE LEIGHTY IS A MEMBER ON THE BOARD OF DIRECTORS AND ALSO THE PRESIDENT OF FIRST NATIONAL BANK OF LAS ANIMAS WHERE THE MEDICAL CENTER Holds a certificate of Deposit. PART IV, LINE 2 BOB BLAIR IS A MEMBER ON THE BOARD OF DIRECTORS AND ALSO THE PRESIDENT OF COLORADO EAST BANK WHERE THE MEDICAL CENTER holds a certificate of deposit. SUPPLEMENTAL INFORMATION PART VI, SECTION A, LINE 3 THE ORGANIZATION CONTRACTS WITH QUORUM HEALTH RESOURCES, A HEALTHCARE MANAGEMENT COMPANY, TO PROVIDE SPECIALIZED HEALTHCARE SERVICES. THE CEO IS AN EMPLOYEE OF THE HEALTHCARE MANAGEMENT COMPANY. THE BOARD OF DIRECTORS WORKS IN CONJUNCTION WITH THE MANAGEMENT COMPANY AND THE BOARD HAS ULTIMATE AUTHORITY AND RESPONSIBILITY FOR THE ORGANIZATION. PART VI, SECTION B, LINE 11B THE BOARD REVIEWS AND APPROVES THE 990 BEFORE IT IS FILED. PART VI, SECTION B, LINE 12C EACH YEAR ALL KEY MEMBERS AND BOARD MEMBERS SUBMIT CONFLICTS OF INTEREST TO REGULARLY REVIEW ANY POSSIBLE CONFLICTS WITH THE WRITTEN CONFLICT OF INTEREST POLICY. PART VI, SECTION B, LINE 15C THE BOARD EVALUATES AND APPROVES WAGE PARAMETERS TO DETERMINE THE COMPENSATION OF INDEPENDENT PERSONS AND MANAGEMENT. PART VI, SECTION C, LINE 19 ORGANIZATIONAL DOCUMENTS ARE AVAILABLE AT PUBLIC BOARD MEETINGS AND UPON REQUEST.