2014-03-14T09:22:30-05:00 2013-04-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2012-05-01 840469270 Colorado West Healthcare System COLO 9702566201 2021 N 12th Street Grand Junction CO 815012980 Christian Thomas 9702566201 2014-03-13 1 KIM C HUNWARDSEN P00484560 6122536500 2014-03-13 2012 2015-11-30 17:44:51Z Community Hospital Grand Junction Christian Thomas 2021 N 12th Street Grand Junction CO 815012980 81122163 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 9 710 92 295152 280533 382462 70515 76640907 78967905 914062 -1048742 413835 323982 78351266 78313660 0 0 0 0 34723454 34543712 0 0 0 39272532 41132834 73995986 75676546 4355280 2637114 37977618 38511750 17412495 15680568 20565123 22831182 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. 0 0 69561422 78994481 Community Hospital provides inpatient, outpatient, emergency, urgent, primary and home health care services to communities in western Colorado. During fiscal year 2013, Community Hospital had 4,690 patient days, 15,228 emergency room visits, 15,433 urgent care visits, 20,559 primary care visits, and performed 4,214 surgeries. 69561422 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 1 0 0 1 135 0 1 710 1 1 1 0 0 0 0 0 0 0 0 0 X 12 9 0 1 0 0 0 0 0 1 0 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 Scott R Mercier 1.50 0.00 X X 0 0 0 R Curt Hatch 1.50 0.00 X X 0 0 0 Michael Daniels 1.50 0.00 X X 0 0 0 David F Vargo 1.50 0.00 X X 0 0 0 Monty Langston MD 1.00 0.00 X 0 0 0 Sam Starritt 1.00 0.00 X 0 0 0 Larry Kent 1.50 0.00 X 0 0 0 Amir Beshai MD 1.00 0.00 X 0 0 0 Tarek Arja DO 1.50 0.00 X 0 0 0 Jon Maraschin 1.50 0.00 X 0 0 0 William Moeller DO 1.50 0.00 X 0 0 0 Sally Gaglione MD Chief of Staff 1.50 0.00 X 0 0 0 Christian Thomas 40.00 0.80 X 0 0 0 Wesley White 40.00 0.00 X 176141 0 4671 David Murray 40.00 0.00 X 143387 0 5672 Donald Nicolay 40.00 0.00 X 175677 0 4637 Kristin Gundt 40.00 0.00 X 116351 0 22688 Scott Vincent 36.00 0.00 X 288541 0 7362 Brian Kempton 36.00 0.00 X 337156 0 7842 Marc Breen 36.00 0.00 X 267911 0 3870 Rebecca Burton 40.00 0.00 X 253524 0 5588 William Gattis 36.00 0.00 X 258286 0 7057 2016974 0 69387 30 0 1 0 Community Anesthesia Consultants 2754 Compass Dr Grand Junction CO 81506 Physician Services 1148623 Quorum Healthcare Resources 105 Continental Pl Brentwood TN 37027 Management Agreement 935303 HSS 900 S Broadway St Denver CO 80209 Security Services/Equip. Maint. 573509 Physicians Choice Real Estate 2021 N 12th St Grand Junction CO 81501 Medical Office Rental 500208 Western Slope Cardiology 2643 Patterson Rd Grand Junction CO 81506 Physician Services 380862 35 53310 17205 70515 Patient Service Revenue 621110 76075463 76075463 Other Revenue 621110 2356666 2356666 Equity in Subsidiary Income 900099 272301 272301 Cafeteria Revenue 621110 263475 263475 78967905 93972 93972 522308 1070666 1327333 1408355 -805025 -337689 -1142714 -1142714 31174 28920 2254 2254 70471 43895 26576 26576 Investment in LLC's 900099 295152 295152 295152 78313660 78994481 295152 -1046488 658119 658119 147985 147985 27470674 26376533 1094141 257697 241728 15969 4039675 3789344 250331 1969562 1864203 105359 485715 485715 199309 199309 111600 111600 7226052 6648478 577574 297969 297969 2649873 2551748 98125 3630279 2854940 775339 228341 80681 147660 85797 85797 506153 506153 1761068 1761068 497311 6940 490371 Bad Debt 8983152 8983152 Medical Supplies 8682664 8682664 Provider Taxes 3222132 3222132 Equipment Lease/Rent 663247 663247 1902172 796660 1105512 75676546 69561422 6115124 0 6857812 7477439 9224161 7175922 102811 1226033 936793 2569862 2592126 326381 522439 44166690 28310864 13907861 15855826 815061 1292750 2581682 2461391 365954 197064 37977618 38511750 8287275 6650265 718924 313733 8123882 8251473 282414 465097 17412495 15680568 X 20565123 22831182 20565123 22831182 37977618 38511750 X 2637114 -368801 -2254 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 3876915 1602374 5479289 12129851 8600733 3529118 24848306 19402781 5445525 1709244 307350 1401894 15855826 Investment in Doctor's Clinic Building, Inc. 2034978 C Investment in Community Health Providers 28918 C Investment in Physicians Choice Real Estate -112501 C Other Investments 9996 C Investment in Grand Junction Med Ctr 500000 C 2461391 Intercompany Payable 3910 Estimated Third-Party Payor Settlement 461187 465097 X 69372149 -8983152 -8983152 78355301 -41641 -41641 78313660 66737289 43895 43895 66693394 8983152 8983152 75676546 Description of Uncertain Tax Positions Under FIN 48: 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 -8,983,152. Part XI, Line 4b - Other Adjustments: Gift Shop Merchandise for Sale recorded as Expenses for Financial Statements -43,895. Net Fundraising Revenue 2,254. Part XII, Line 2d - Other Adjustments: Gift Shop Merchandise for Sale recorded as Expenses for Financial Statements 43,895. Part XII, Line 4b - Other Adjustments: Provision for Uncollectible Accounts 8,983,152. Tour of the Valley 22538 22538 26236 Magnet 5K 8636 8636 2684 31174 31174 28920 28920 2254 1 1 X 1 X 1 X 1 1 0 1 1 1693000 1601407 91593 0.00140 8698514 5852013 2846501 0.04270 1575242 426645 1148597 0.01720 11966756 7880065 4086691 0.06130 153492 153492 0.00230 12761 12761 0.00020 238264 238264 0.00360 404517 404517 0.00610 12371273 7880065 4491208 0.06740 1 8983152 0 11746131 16416406 -4670275 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 0.55900 0.44100 1 1 Community Hospital

2021 N 12th St Grand Junction CO 815012980

X X X Community Hospital 1 1 X X X X X X X X 12 1 1 1 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 9 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 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, L7 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 $8,983,152. Part III, Line 4: 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.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. 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 5c: The CHNA Report is available at the facility's website: http://www.yourcommunityhospital.com/index.cfm 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.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.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.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.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. 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.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.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. 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. Part VI, Line 2: Community Hospital develops its strategic plan 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. 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. X X X 0 0 0 0 0 0 0 1 0 Wesley White 176141 0 0 0 0 0 1791 0 5460 0 183392 0 0 0 David Murray 143387 0 0 0 0 0 1476 0 6307 0 151170 0 0 0 Donald Nicolay 175677 0 0 0 0 0 1757 0 6116 0 183550 0 0 0 Scott Vincent 288541 0 0 0 0 0 2926 0 7660 0 299127 0 0 0 Brian Kempton 337156 0 0 0 0 0 3406 0 7660 0 348222 0 0 0 Marc Breen 267911 0 0 0 0 0 2686 0 4238 0 274835 0 0 0 Rebecca Burton 253524 0 0 0 0 0 2564 0 5868 0 261956 0 0 0 William Gattis 258286 0 0 0 0 0 2621 0 7280 0 268187 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 1304312 Payments for Physician Services 0 Western Therapeutics LLC Board Member Amir Beshai is a partner 158950 Payments for Physician Services 0 Kathleen Maraschin Wife of Board Member Jon Maraschin 43910 Compensation 0 Jana Thomas Wife of CEO Christian Thomas 29850 Compensation 0 Mary Thibault Sister of CCO David Murray 49302 Compensation 0 Lynn Nicolay Wife of Chief Medical Officer Donald Nicolay 24923 Compensation 0 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 2012 was $374,911. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the board. 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 Executive Finance Committee of 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. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Net Fundraising Revenue -2,254. 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 97555 1773645 0 0 0.55900 Canyon View ASC 2373 G Road Ste 180 Grand Junction CO 81505 455352976 Ambulatory Surgery Center CO Colorado West Healthcare System Related 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 2853761 2132689 1.00000 1 0 0 1 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 1 Community Hospital Foundation C 53310 Accrual Physicians Choice Real Estate LLC K 502812 Accrual Doctor's Clinic Building Inc K 272527 Accrual