CIBOLA GENERAL HOSPITAL CORPORATION: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- CIBOLA GENERAL HOSPITAL CORPORATION (EIN 85-0141285)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-06-16
- IRS object ID
- 201441679349301319
- Schema version
- 2012v2.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Reasonable Cause Explanation
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-06-16T13:08:04-07:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 850141285 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cibola General Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CIBO | NameControl |
| Phone | 5052874446 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E Roosevelt Avenue | AddressLine1 |
| City | Grants | City |
| State | NM | State |
| ZIP Code | 87020 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Bob Phillips | Name |
| Title | Interim CEO | Title |
| Phone | 5052875300 | Phone |
| Date Signed | 2014-06-16 | DateSigned |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cibola General Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Bob Phillips | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E Roosevelt Avenue | AddressLine1 |
| City | Grants | City |
| State | NM | State |
| ZIP Code | 87020 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 29257556 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | http://www.cibolahospital.com/ | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1958 | YearFormation |
| State Legal Domicile | NM | StateLegalDomicile |
| Activity Or Mission Description | 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. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 195 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1377 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 4450 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 23704132 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23412736 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 102703 | InvestmentIncomePriorYear |
| Investment Income Current Year | 72306 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4105786 | OtherRevenuePriorYear |
| Other Revenue Current Year | 4501165 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 27913998 | TotalRevenuePriorYear |
| Total Revenue Current Year | 27990657 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12058373 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12888586 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9253102 | OtherExpensePriorYear |
| Other Expenses Current Year | 9784488 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21311475 | TotalExpensesPriorYear |
| Total Expenses Current Year | 22673074 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 6602523 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5317583 | RevenuesLessExpensesCY |
| Total Assets BOY | 31319772 | TotalAssetsBOY |
| Total Assets EOY | 37099471 | TotalAssetsEOY |
| Total Liabilities BOY | 2614235 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3090993 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 28705537 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 34008478 | NetAssetsOrFundBalancesEOY |
| Mission Description | 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). | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 15098216 | Expense |
| Grants | 4450 | Grants |
| Revenue | 23412736 | Revenue |
| Description | Our program service is providing patient care to the residents of our service area, therefore, we consider each patient encounter an accomplishment. | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 15098216 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 1 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 195 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NM | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | J F Rimel | NamePerson |
| Telephone Number | 5052874446 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E Roosevelt Avenue | AddressLine1 |
| City | Grants | City |
| State | NM | State |
| ZIP Code | 87020 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Institutional TrusteeInstitutionalTrustee | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee | FormerFormer |
|---|---|---|---|---|---|---|---|---|---|
| Ron Ortiz | |||||||||
| Board Chair | 2 | 0 | X | 0 | 0 | 0 | |||
| Les Gaines | |||||||||
| Vice Chair | 2 | 0 | X | 0 | 0 | 0 | |||
| Nestor Griego | |||||||||
| Member | 2 | 0 | X | 0 | 0 | 0 | |||
| Paul Milan | |||||||||
| Member | 2 | 0 | X | 0 | 0 | 0 | |||
| Karl Gutierrez MD | |||||||||
| Chief of Medical Staff | 2 | 0 | X | 0 | 0 | 0 | |||
| Laura Council | |||||||||
| Member | 2 | 0 | X | 0 | 0 | 0 | |||
| Karna Patel MD | |||||||||
| Member | 2 | 0 | X | 0 | 0 | 0 | |||
| Carlos Tapia | |||||||||
| Member | 2 | 0 | X | 0 | 0 | 0 | |||
| Bob Tenequer | |||||||||
| Member | 2 | 0 | X | 0 | 0 | 0 | |||
| Michael Makosky | |||||||||
| Chief Executive Officer | 40 | 0 | 0 | 0 | 0 | X | |||
| James F Rimel | |||||||||
| Assistant Administrator and CFO | 40 | 0 | 0 | 0 | 0 | X | |||
| Ann Church MD | |||||||||
| Obstetrics Gynecology Physician | 40 | 0 | 320000 | 0 | 0 | X | |||
| David Gammon MD | |||||||||
| Internal Medicine Physician | 40 | 239378 | 0 | 0 | X | ||||
| Angela Studer | |||||||||
| Certified Registered Nurse Anesthetist | 40 | 0 | 227424 | 0 | 0 | X | |||
| Patricia Rocha MD | |||||||||
| Family Practice and Obstetrics Physician | 40 | 0 | 214634 | 0 | 0 | X | |||
| Merton Johnson | |||||||||
| Certified Registered Nurse Anesthetist | 40 | 0 | 202300 | 0 | 0 | X | |||
| Charles Onyeama MD | |||||||||
| Pediatrician | 0 | 0 | 285516 | 0 | 0 | X | |||
| Karla Vitale DO | |||||||||
| Family Practice and Obstetrics Physician | 0 | 0 | 214357 | 0 | 0 | X | |||
| Pamela Akin | |||||||||
| Chief Nursing and Chief Clinical Officer | 0 | 0 | 131574 | 0 | 0 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1835183 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 0 | TotalOtherCompensation |
| Number Individuals GT100 K | 10 | NumberIndividualsGT100K |
| Formers Listed | 1 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| EmCare Inc | |||||
| 1717 Main Street Ste 5200 | Dallas | TX | 75201 | Emergency Room Physician Coverage | 702066 |
| Healthcare Management Systems | |||||
| 3102 West End Avenue | Nashville | TN | 37203 | Computer Processing | 335959 |
| Quorum Health Resources | |||||
| 105 Continental Place | Brentwood | TN | 37027 | Hospital Management | 244705 |
| Life Coach Plus Inc | |||||
| 699 Old Church Road | Corrales | NM | 87048 | Social Work and Case Management | 207726 |
| Tricore Reference Laboratory | |||||
| 2811 Stanford NE | Albuquerque | NM | 87107 | Clinical Pathology Services | 175256 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 0 | GovernmentGrants |
| All Other Contributions | 4450 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 4450 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | General medical and surgical hospitals | Description |
| Business Code | 622110 | BusinessCode |
| Total Revenue Column | 23412736 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23412736 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23412736 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 79088 | TotalRevenueColumn |
| Related Or Exempt Function Income | 79088 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | -6782 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | -6782 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -6782 | TotalRevenueColumn |
| Related Or Exempt Function Income | -6782 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 0 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 0 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Gaming | 0 | GrossIncomeGaming |
| Gaming Direct Expenses | 0 | GamingDirectExpenses |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 5768064 | GrossSalesOfInventory |
| Cost Of Goods Sold | 1266899 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4501165 | TotalRevenueColumn |
| Related Or Exempt Function Income | 4501165 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 27990657 | TotalRevenueColumn |
| Related Or Exempt Function Income | 27986207 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 334549 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 334549 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10270614 | Total |
| Program Services | 7923835 | ProgramServices |
| Management And General | 2346779 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1493176 | Total |
| Program Services | 1152732 | ProgramServices |
| Management And General | 340444 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 790247 | Total |
| Program Services | 608490 | ProgramServices |
| Management And General | 181757 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 313314 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 313314 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52343 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 52343 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 74418 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 74418 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Fundraising | 0 | Fundraising |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 945303 | Total |
| Program Services | 945303 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 211028 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 211028 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 219516 | Total |
| Program Services | 8214 | ProgramServices |
| Management And General | 211302 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 295536 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 295536 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 135602 | Total |
| Program Services | 61186 | ProgramServices |
| Management And General | 74416 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1035218 | Total |
| Program Services | 737532 | ProgramServices |
| Management And General | 297686 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 387629 | Total |
| Program Services | 0 | ProgramServices |
| Management And General | 387629 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Supplies | 1549332 | 1206268 | 343064 | 0 |
| Purchased Services | 3007165 | 1843235 | 1163930 | 0 |
| Repairs and Maintenance | 830451 | 379154 | 451297 | 0 |
| Leases and Rentals | 470324 | 174157 | 296167 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 257309 | Total |
| Program Services | 58110 | ProgramServices |
| Management And General | 199199 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22673074 | Total |
| Program Services | 15098216 | ProgramServices |
| Management And General | 7574858 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 750 | BOY |
| EOY | 7083029 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4428705 | BOY |
| EOY | 3041655 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8752993 | BOY |
| EOY | 5483105 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 241914 | BOY |
| EOY | 223920 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 318231 | BOY |
| EOY | 422225 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 17708218 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 6502111 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9819430 | BOY |
| EOY | 11206107 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7757749 | BOY |
| EOY | 9639430 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31319772 | BOY |
| EOY | 37099471 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2402766 | BOY |
| EOY | 2903191 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 187802 | BOY |
| EOY | 187802 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 23667 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2614235 | BOY |
| EOY | 3090993 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28705537 | BOY |
| EOY | 34008478 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 28705537 | BOY |
| EOY | 34008478 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 31319772 | BOY |
| EOY | 37099471 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 5317583 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | -14642 | ReconciliationUnrealizedInvest |
| Reconcilation Donated Services | 0 | ReconcilationDonatedServices |
| Reconcilation Invest Expenses | 0 | ReconcilationInvestExpenses |
| Reconcilation Prior Adjustment | 0 | ReconcilationPriorAdjustment |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 1 | AccountantCompileOrReview |
Accountant Compile Or Review Basis AccountantCompileOrReviewBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | 1 | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 733729 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Book Value | 733729 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 7402637 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 636406 | Depreciation |
| Book Value | 6766231 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 1934451 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 1006739 | Depreciation |
| Book Value | 927712 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 7206686 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 4858966 | Depreciation |
| Book Value | 2347720 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 430715 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 430715 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11206107 | TotalOfBookValueLandBuildings |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Certificates Of Deposit | Description |
| Book Value | 9639430 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Program Related | 9639430 | TotalOfBookValueProgramRelated |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Footnote In Part XIII | X | FootnoteInPartXIII |
| Tot Revenue Etc Audited Fincl Stmt | 29257556 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 0 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 0 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 1266899 | OtherRevenues |
| Revenue Not Rptd F990 | 1266899 | RevenueNotRptdF990 |
| Revenue Subtotal | 27990657 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 27990657 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 23939973 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 0 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 1266899 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 1266899 | ExpensesNotRptdF990 |
| Expenses Subtotal | 22673074 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 22673074 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchD_P10_S00_L01 | Schedule D, Part X, Line 1 | Federal Income Taxes |
| SchD_P10_S00_L02 | Schedule D, Part X, Line 2 | The footnotes contain no such references. |
| SchD_P11_S00_L02d | Schedule D, Part XI, Line 2d | Cost of Goods Sold is excluded from revenue reported on Part VIII, Line 12, column A. |
| SchD_P12_S00_L02d | Schedule D, Part XII, Line 2d | ost of goods sold is excluded from expenses reported on Part IX, Line 25, column A. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 500 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 677336 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 677336 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5454549 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4347497 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1107052 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.049 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 6131885 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4347497 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1784388 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.079 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 88985 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 88985 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.004 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 80000 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 80000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.004 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.0 | PercentOfTotalExpense |
Research Research
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 168985 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 168985 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.008 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 6300870 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4347497 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1953373 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.087 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $1,908,011 | BadDebtExpenseAmount |
| Amount Attributable To | 954055 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 4712759 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4959051 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -246292 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Quorum Health Resources | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | Manages the Hospital under a management contract. | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0 | OrganizationProfitOrOwnership |
| Officers Etc Profit Or Ownership | 0 | OfficersEtcProfitOrOwnership |
| Physicans Profit Or Ownership | 0 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cibola General Hospital Inc | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1016 E Roosevelt Avenue | AddressLine1 |
| City | Grants | City |
| State | NM | State |
| ZIP Code | 87020 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.cibolahospital.com | WebsiteAddress |
| Critical Access Hospital | X | CriticalAccessHospital |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Cibola General Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | 1 | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 13 | NeedsAssessmentConducted |
| Take Into Account | 1 | TakeIntoAccount |
| Other Facilities | 0 | OtherFacilities |
| CHNA Widely Available | 1 | CHNAWidelyAvailable |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | 1 | AllNeedsAddressed |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTax |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 500 | FPGFreePercent |
| Uses FPG Discounted | 0 | UsesFPGDiscounted |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | 1 | ExplainsApplicationMethod |
| Includes Publicity Measures | 1 | IncludesPublicityMeasures |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | 1 | ActionsOnNonpayment |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 1 | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (17 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L03c | Schedule H, Part I, Line 3c | The applicant for Financial Assistance must submit the following as substantiation of income: (1) Completed Financial Analysis form, which requires disclosure of the 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 tax filing status. (4) Disclosure of other income-supporting benefits received. |
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | Amount reported on Line a Column c is based on our cost to charge ratio. Line b column d uses cost to charge ratio offset by a contractual percentage leading to amount reported in column e. Line e column c and line f column c are based on cost. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | We calculate Bad Debt expense based upon taking 100% of certain Accounts Receivable and assuming uncollectibilty. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | Cost calculated based on cost to charge ratio. We feel that the entire shortfall should be considered Community Benefit. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | We follow currrent law with respect to when we present bills, and when not, when dealing with patients known to qualify for financial assistance - essentially, we present no bills unless the terms of the assistance are not followed by the patient or responsible party. |
| SchH_P05_S0B_L03 | Schedule H, Part V, Section B, Line 3 | line 3 Section B Part V 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 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. |
| SchH_P05_S0B_L11 | Schedule H, Part V, Section B, Line 11 | Income and household expenses are the qualifying criteria for discounted care. |
| SchH_P05_S0B_L16 | Schedule H, Part V, Section B, Line 16 | Outside collections agencies are used. The recovery rates by these agencies are typically under 10%. |
| SchH_P05_S0B_L20 | Schedule H, Part V, Section B, Line 20 | The Hospital will bill the patient based upon its fee schedule, but patient will pay whatever portion of the bill our process determines he or she is liable for (or nothing at all), and the remaining balance will be written off as a charitable write off. |
| SchH_P05_S0B_L22 | Schedule H, Part V, Section B, Line 22 | 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. |
| SchH_P06_S00_L01 | Schedule H, Part VI, Line 1 | line 3c Part I The applicant for Financial Assistance must submit the following as substantiation of income: 1. Completed Financial Analysis form, which requires disclosure of the 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. 2. Disclosure of tax filing status. 4. Disclosure of other income supporting benefits received. Part II. The Hospital continues to host meeting space for various groups such as an MS Support Group, Breastfeeding group, Diabetes Support, and Childbirth Classes. We also are a strong presence at the annual Relay for Life event typically held in June. These activities do not involve any significant expense to the Hospital, as volunteer labor is used. lines 2, 3 & 4; Part III. We used calculated Cost to Charge ratio of 43.9% to determine cost of bad Debt. We make every effort to educate the uninsured or underinsured about our Financial Assistance policies. Nonetheless, we estimate that about half the Bad Debts we have arise from persons who would likely qualify for Financial Assistance, but refuse to fill out the required paperwork to permit us to assess them. Accordingly, we feel that we are providing a community benefit when a service falls into Bad Debt as a result of failure to apply for assistance. In our audited financial statements, there is no specific footnote description of Bad Debts methodology. line 8 Part III. Our position is that the entire $246,292 shortfall should be considered Community benefit. Our mission obligates us to provide care to the individuals of Cibola County. We are the only hospital available for 63 miles, and so we naturally are providing a substantial community benefit to our Medicare patient population. The source of the information reported in Part III, Section B is our 2012 Medicare Cost Report. The revenue is from Worksheet E-1 of the Cost Report. The cost is based on our total Medicare charges, times the 43.9% overall cost to charge ratio. line 9b; Part III. 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. |
| SchH_P06_S00_L02 | 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. |
| SchH_P06_S00_L03 | 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. |
| SchH_P06_S00_L04 | 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 newly-constructed hospital owned clinic (Cibola Family Health Center) allows for greater access to patient care. |
| SchH_P06_S00_L05 | Schedule H, Part VI, Line 5 | 5. Promotion of Community Health 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. The upcoming needs assessment will guide Hospital management in designing health promotions that will be specific to our county, as well as being cost-effective. |
| SchH_P06_S00_L06 | Schedule H, Part VI, Line 6 | We have no such affiliations. |
| SchH_P06_S00_L07 | 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Ann Church MD | ||||||||||||||
| Obstetrics Gynecology Physician | 320000 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 320000 | 0 | 0 | 0 |
| David Gammon MD | ||||||||||||||
| Internal Medicine Physician | 239387 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 239387 | 0 | 0 | 0 |
| Angela Studer | ||||||||||||||
| Certified Registered Nurse Anesthetist | 227424 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 227424 | 0 | 0 | 0 |
| Patricia Rocha MD | ||||||||||||||
| Family Practice and Obstetrics Physician | 214634 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 214634 | 0 | 0 | 0 |
| Merton Johnson | ||||||||||||||
| Certified Registered Nurse Anesthetist | 202300 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 202300 | 0 | 0 | 0 |
| Charles Onyeama MD | ||||||||||||||
| Pediatrician | 285516 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 285516 | 0 | 0 | 0 |
| Karla Vitale DO | ||||||||||||||
| Family Practice and Obstetrics Physician | 214357 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 214357 | 0 | 0 | 0 |
| Pamela Akin | ||||||||||||||
| Chief Nursing and Chief Clinical Officer | 131574 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 131574 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (7 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L03 | Form 990, Part VI, Section A, Line 3 | Yes, we are managed by QHR (Quorum Health Resources). |
| F990_P06_S0A_L07a | Form 990, Part VI, Section A, Line 7a | The trustees hold the power to nominate for approval by Cibola County Government, new trustees when there are openings. |
| F990_P06_S0A_L07b | Form 990, Part VI, Section A, Line 7b | The Trustees refer certain significant decisions, such as Trustee appointments, and major capital projects, to the County Commission for their apporval. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | The 990 and related schedules were provided to all members of the governing body prior to the filing of the form. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | All directors, officers and employees are required to disclose any potential or actual conflicts of interest each year. The form is signed and dated by each person. These are collected and monitored by the Hospital's Compliance Officer. |
| F990_P06_S0B_L15 | 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 recruiter or consultants. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | The Hospital operates in a climate of transparency. In addition to the Board holding monthly public Board meetings, the CEO reports quarterly to the County Commissioners at a public meeting, to present operating results and significant activities. |
Reasonable Cause Explanation ReasonableCauseExplanation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | We are requesting abeyance of any applicable penalties for the following reasons: First, we made a timely paper filing prior to our extended due date of February 15, 2014. Secondly, we made what we feel were reasonable efforts to understand the law as it pertains to the number of returns that require an organization to EFile. We are a small hospital which does its own 990, and are aware of how to get to the IRS documentation, however, we rely on our good faith interpretation of what we read to be sure we comply with the law. Thus, until notified by a telephone call, we were unaware that we were not compliant. We thank the Service for its consideration of our request. | Explanation |
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