BISBEE HOSPITAL ASSOCIATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- BISBEE HOSPITAL ASSOCIATION (EIN 86-0334996)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-04-01
- IRS object ID
- 201300919349300120
- Schema version
- 2011v1.5
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-04-01T17:57:04-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480573184 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIER CARR & MONROE LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4801 E BROADWAY BLVD STE 501 | AddressLine1 |
| City | TUCSON | City |
| State | AZ | State |
| ZIP Code | 857113648 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860334996 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BISBEE HOSPITAL ASSOCIATIONINC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | BISB | NameControl |
| Phone | 5204325383 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1 |
| City | BISBEE | City |
| State | AZ | State |
| ZIP Code | 856031327 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JAMES DICKSON | Name |
| Title | CEO | Title |
| Phone | 5204325383 | Phone |
| Date Signed | 2013-03-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DAVID B BARBER CPACFE | Name |
| PTIN | P00348638 | PTIN |
| Phone | 5206248229 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | JAMES DICKSON | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1 |
| City | BISBEE | City |
| State | AZ | State |
| ZIP Code | 856031327 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 24698328 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CQCH.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1977 | YearFormation |
| State Legal Domicile | AZ | StateLegalDomicile |
| Activity Or Mission Description | AHSSTO PROVIDE HEALTHCARE SERVICES TO THE BISBEE ARIZONA COMMUNITY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 10 | NbrIndependentVotingMembers |
| Total Nbr Employees | 267 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 123533 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1107741 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 21747190 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 23479236 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -149491 | InvestmentIncomePriorYear |
| Investment Income Current Year | -8408 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 115492 | OtherRevenuePriorYear |
| Other Revenue Current Year | 93938 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21836724 | TotalRevenuePriorYear |
| Total Revenue Current Year | 24672507 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 74703 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 44789 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 12335164 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 12482967 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 7774643 | OtherExpensePriorYear |
| Other Expenses Current Year | 8442495 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 20184510 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20970251 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1652214 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 3702256 | RevenuesLessExpensesCY |
| Total Assets BOY | 19720901 | TotalAssetsBOY |
| Total Assets EOY | 21717401 | TotalAssetsEOY |
| Total Liabilities BOY | 8070020 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6364264 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 11650881 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 15353137 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO PROVIDE HEALTHCARE SERVICES TO THE BISBEE ARIZONA COMMUNITY. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 17547418 | Expense |
| Revenue | 23509561 | Revenue |
| Description | TO PROVIDE HEALTHCARE SERVICES THROUGH IN-PATIENT, OUT-PATIENT,24-HOUR EMERGENCY SERVICES AND RURAL HEALTH CLINIC TO THE RESIDENTS OF BISBEE & SURROUNDING COMMUNITIES. | Description |
| Total Program Service Expense | 17547418 | 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 | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | 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 | 1 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 1 | GrantsToOrganizations |
| Grants To Individuals | 1 | 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 |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 71 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 267 | 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 |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 10 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 0 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | 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 | 0 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 0 | 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 | AZ | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5204325383 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVENUE | AddressLine1 |
| City | BISBEE | City |
| State | AZ | State |
| ZIP Code | 856031327 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| BOB HOWELL | |||||||
| PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| KATHLEEN HEARD | |||||||
| VICE PRESIDENT | 1.00 | X | 0 | 0 | 0 | ||
| ROSALIE BUTLER | |||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | ||
| JOHN HARRIS | |||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| DENNIS NELSON | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JOHN GOLDTHORPE | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| LAURA CHAVEZ | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| GARY DILLARD | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| PETER CARBERRY | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DENNIS GALLUS | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| JAMES DICKSON | |||||||
| CEO | 40.00 | 232705 | 0 | 24701 | X | ||
| DIANE MOORE | |||||||
| CFO | 40.00 | 142513 | 0 | 12003 | X | ||
| JOSE ROMO | |||||||
| DOCTOR | 40.00 | 315383 | 0 | 17189 | X | ||
| HEIDI LODGE | |||||||
| DOCTOR | 40.00 | 290313 | 0 | 16437 | X | ||
| DANIEL ROE | |||||||
| DOCTOR | 40.00 | 512856 | 0 | 23114 | X | ||
| BRUCE CURTIS | |||||||
| DOCTOR | 40.00 | 196342 | 0 | 13618 | X | ||
| MURADI NAJIBULLAH | |||||||
| DOCTOR | 40.00 | 195993 | 0 | 13608 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1886105 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 120670 | TotalOtherCompensation |
| Number Individuals GT100 K | 19 | NumberIndividualsGT100K |
| Formers Listed | 0 | 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 |
|---|---|---|---|---|---|
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | EMR SYSTEMS | 585490 |
| LABORATORY CORP OF AMERICA | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LAB | 307565 |
| SIEMENS HEALTHCARE DIAGNOSTICS | |||||
| PO BOX 121102 | DALLAS | TX | 75312 | DIAGNOSTIC | 224606 |
| WAYTUK JOHN P MD | |||||
| 4119 E SELLS DR | PHOENIX | AZ | 85018 | MEDICAL | 200650 |
| PIATT DAVID W MD | |||||
| 4539 W POWELL DR | PHOENIX | AZ | 85087 | MEDICAL | 147800 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Fundraising Events | 19785 | FundraisingEvents |
| Government Grants | 1064735 | GovernmentGrants |
| All Other Contributions | 23221 | AllOtherContributions |
| Total Contributions | 1107741 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PATIENT SERVICE REVENU | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 23479236 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23479236 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 23479236 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10529 | TotalRevenueColumn |
| Exclusion | $10,529 | ExclusionAmount |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 18937 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -18937 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -18937 | TotalRevenueColumn |
| Exclusion | -$18,937 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 2100 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 19785 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 6884 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -4784 | TotalRevenueColumn |
| Exclusion | -$4,784 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 900099 | 63591 | $63,591 | |
| MISC. REVENUE-RELATED- | 900099 | 30325 | 30325 | |
| MEDICAL RECORDS | 900099 | 4806 | $4,806 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 98722 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24672507 | TotalRevenueColumn |
| Related Or Exempt Function Income | 23509561 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $55,205 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 26999 | Total |
| Program Services | 26999 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17790 | Total |
| Program Services | 17790 | ProgramServices |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 411922 | Total |
| Management And General | 411922 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9869771 | Total |
| Program Services | 8736087 | ProgramServices |
| Management And General | 1133684 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 224215 | Total |
| Program Services | 184662 | ProgramServices |
| Management And General | 39553 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1296420 | Total |
| Program Services | 1205321 | ProgramServices |
| Management And General | 91099 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 680639 | Total |
| Program Services | 573508 | ProgramServices |
| Management And General | 107131 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 156962 | Total |
| Management And General | 156962 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 257155 | Total |
| Management And General | 257155 | ManagementAndGeneral |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10310 | Total |
| Management And General | 10310 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1925473 | Total |
| Program Services | 1566152 | ProgramServices |
| Management And General | 359321 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 207981 | Total |
| Management And General | 207981 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88013 | Total |
| Program Services | 52026 | ProgramServices |
| Management And General | 35987 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39036 | Total |
| Program Services | 19996 | ProgramServices |
| Management And General | 19040 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 148632 | Total |
| Program Services | 105520 | ProgramServices |
| Management And General | 43112 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 348883 | Total |
| Program Services | 348883 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1166844 | Total |
| Program Services | 1166844 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 322571 | Total |
| Management And General | 322571 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| SUPPLIES | 1719886 | 1717229 | 2657 |
| PROVISION FOR UNCOLLECT | 913843 | 913843 | |
| REPAIRS & MAINTENANCE | 440686 | 383286 | 57400 |
| UTILITIES | 219902 | 219902 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 476318 | Total |
| Program Services | 309370 | ProgramServices |
| Management And General | 166948 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20970251 | Total |
| Program Services | 17547418 | ProgramServices |
| Management And General | 3422833 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2381873 | BOY |
| EOY | 3262309 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2999800 | BOY |
| EOY | 2054465 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3241055 | BOY |
| EOY | 4316882 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 527687 | BOY |
| EOY | 530035 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 72649 | BOY |
| EOY | 202473 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 18953224 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8151501 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10446162 | BOY |
| EOY | 10801723 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 500000 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 51675 | BOY |
| EOY | 49514 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19720901 | BOY |
| EOY | 21717401 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2472811 | BOY |
| EOY | 2795601 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5597209 | BOY |
| EOY | 3568663 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8070020 | BOY |
| EOY | 6364264 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11555269 | BOY |
| EOY | 15288895 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 95612 | BOY |
| EOY | 64242 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11650881 | BOY |
| EOY | 15353137 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19720901 | BOY |
| EOY | 21717401 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 3702256 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | 1 | FederalGrantAuditRequired |
| Federal Grant Audit Performed | 1 | FederalGrantAuditPerformed |
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) |
|---|---|---|
| Other Cost Or Other Basis | 893568 | OtherCostOrOtherBasis |
| Book Value | 893568 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11394889 | OtherCostOrOtherBasis |
| Depreciation | 4757933 | Depreciation |
| Book Value | 6636956 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5705632 | OtherCostOrOtherBasis |
| Depreciation | 3393568 | Depreciation |
| Book Value | 2312064 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 959135 | OtherCostOrOtherBasis |
| Book Value | 959135 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10801723 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | LONG-TERM DEBT | Description |
| Amount | $3,568,663 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3568663 | TotalOfAmounts |
| Total Revenue | 24672507 | TotalRevenue |
| Total Expenses | 20970251 | TotalExpenses |
| Excess Or Deficit For Year | 3702256 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 3702256 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 24698328 | TotRevenueEtcAuditedFinclStmt |
| Revenue Not Rptd F990 | 0 | RevenueNotRptdF990 |
| Revenue Subtotal | 24698328 | RevenueSubtotal |
| Other Revenues Not Included | -25821 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -25821 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 24672507 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20996072 | TotExpensesEtcAuditedFinclStmt |
| Losses Reported | 18937 | LossesReported |
| Other Expenses Included | 6884 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 25821 | ExpensesNotRptdF990 |
| Expenses Subtotal | 20970251 | ExpensesSubtotal |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 20970251 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | Identifier |
| Return Reference | PART X: | ReturnReference |
| Explanation | THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL RECEIVED ITS LETTER OF DETERMINATION FROM THE INTERNAL REVENUE SERVICE IN 1977. CERTAIN UNRELATED BUSINESS INCOME MAY BE SUBJECT TO INCOME TAX. THE HOSPITAL FOLLOWS FASB CODIFICATION 740-10-50 FOR DISCLOSURE OF INCOME TAX RELATED MATTERS. THE STANDARD SETS A "MORE LIKELY THAN NOT" CRITERION FOR RECOGNIZING THE TAX BENEFITS OF UNCERTAIN TAX POSITIONS. THE HOSPITAL BELIEVES THAT ITS INCOME TAX FILING POSITIONS AND DEDUCTIONS WILL BE SUSTAINED UPON EXAMINATION AND, ACCORDINGLY, HAVE NOT RECORDED ANY RESERVES OR RELATED ACCRUALS FOR INTEREST AND PENALTIES IN THE ACCOMPANYING FINANCIAL STATEMENTS FOR UNCERTAIN INCOME TAX POSITIONS. INCOME TAX RELATED INTEREST AND PENALTIES ARE REPORTED IN GENERAL AND ADMINISTRATIVE EXPENSES WHEN INCURRED. NO INCOME TAX EXAMINATIONS ARE CURRENTLY UNDERWAY OR ANTICIPATED. THE STATUTE OF LIMITATIONS IS THREE YEARS FOR FEDERAL INCOME TAX PURPOSES AND FOUR YEARS FOR THE STATE OF ARIZONA. | Explanation |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 21885 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 19785 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 2100 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 4595 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 1290 | RentFacilityCostsEvent1 |
| Other Direct Expenses Event1 | 999 | OtherDirectExpensesEvent1 |
| Gross Receipts Total | 21885 | GrossReceiptsTotal |
| Charitable Contributions Total | 19785 | CharitableContributionsTotal |
| Gross Revenue Total Events | 2100 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 4595 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 1290 | RentFacilityCostsTotalEvents |
| Other Direct Expenses Total Events | 999 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 6884 | DirectExpenseSummaryEvents |
| Net Income Summary | -4784 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 271000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 271000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01350 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7016745 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6030476 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 986269 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04920 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7287745 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6030476 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1257269 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06270 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 27199 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 27199 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 27199 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 27199 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00140 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 7314944 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 6030476 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1284468 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06410 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $778,270 | BadDebtExpenseAmount |
| Amount Attributable To | 389135 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5206870 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5491201 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -284331 | 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 |
| 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 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 101 COLE AVE | AddressLine1 |
| City | BISBEE | City |
| State | AZ | State |
| ZIP Code | 85603 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COPPER QUEEN COMMUNITY HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| Eligibility Criteria Explained | 1 | EligibilityCriteriaExplained |
| Uses FPG Free | 1 | UsesFPGFree |
| FPG Free Percent | 200.000000000000 | FPGFreePercent |
| Uses FPG Discounted | 1 | UsesFPGDiscounted |
| FPG Discount Percent | 200.000000000000 | FPGDiscountPercent |
| Explains Basis | 1 | ExplainsBasis |
| Income Level | X | IncomeLevel |
| 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 Report To Credit Agency | X | PermitReportToCreditAgency |
| Collection Activities | 1 | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Nondiscrim Emergency Care Policy | 1 | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | 0 | AmountsGenerallyBilled |
| Gross Charges | 0 | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 3 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (3 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| COPPER QUEEN MEDICAL ASSOCIATES-DOUGLAS | ||||
| 100 E 5TH ST | DOUGLAS | AZ | 85607 | RURAL HEALTH CLINIC |
| COPPER QUEEN MEDICAL ASSOCIATES-BISBEE | ||||
| 101 COLE AVE | BISBEE | AZ | 85603 | RURAL HEALTH CLINIC |
| COPPER QUEEN MEDICAL ASSOCIATES-PALOMINA | ||||
| 10524 HIGHWAY 92 | HEREFORD | AZ | 85615 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| ExplanationExplanation | IdentifierIdentifier | Return ReferenceReturnReference |
|---|---|---|
| PART I, LINE 7: THE COST ACCOUNTING SYSTEM WAS USED TO REPORT THE SUBSIDIZED HEALTH SERVICES REVENUE AND EXPENSE. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, AND ETC.) | ||
| PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 913843. | ||
| PART II: N/A. | ||
| PART III, LINE 4: FINANCIAL NOTES REGARDING BAD DEBTS, PAGE 11 OF AUDITED FINANCIAL STATEMENTSTHE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, THE AGE OF ACCOUNTS, THE PAYOR MIX, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS.BAD DEBTS ARE MONITORED BY MANAGEMENT AND ARE DETERMINED TO BE DELINQUENT BASED UPON REVIEW OF AGING REPORTS COUPLED WITH CORRESPONDENCE WITH PATIENTS AND THIRD-PARTY PAYORS. BAD DEBTS ARE WRITTEN OFF WHEN ALL REASONABLE ATTEMPTS TO COLLECT THE DEBT HAVE BEEN EXHAUSTED.A COST TO CHARGES RATIO IS USED TO DETERMINE THE BAD DEBT EXPENSE AT COST. SHORTFALL IS NOT INCLUDED AS PART OF COMMUNITY BENEFIT. | ||
| PART V, SECTION B, LINE 19D: ANY PATIENT THAT DOES DOES HAVE INSURANCE IS AUTOMATICALLY GIVEN A 50% DISCOUNT ON THE COST OF THEIR MEDICAL CARE. IF THE PATIENT MAKES LESS THAN 200% OF THE FEDERAL POVERTY LEVEL THEY WILL RECEIVE AN ADDITIONAL DISCOUNT BEYOND THE INITAL 50%. THE DISCOUNT WILL BE DETERMINED USING A SLIDING FEE SCALE DISCOUNT. | COPPER QUEEN COMMUNITY HOSPITAL | |
| PART VI, LINE 2: THE ORGANIZATION ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES BASED UPON HISTORICAL SERVICES PROVIDED. | ||
| PART VI, LINE 3: IT IS DONE UNDER ADMISSION. THE PATIENTS ARE PROVIDED A COPY OF FINANICAL ASSISTANCE POLICY UPON ADMISSION. FINANIAL ASSISTANCE CONTACT INFORMATION IS ALSO POSTED IN THE LOBBY, EMERGENCY ROOM AND OTHER PATIENT AREA. PATIENTS WITH PAST DUE BALANCES ARE SENT A LETTER ADVISING THEM OF THE AVAILABILITY OF ASSISTANCE BEFORE THEY ARE SENT TO COLLECTIONS. | ||
| PART VI, LINE 4: THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY SERVICES TO RESIDENTS WITHIN BISBEE, ARIZONA COMMUNITY AND ADJACENT AREAS. THE HOSPITAL ALSO OPERATES A HOME HEALTH AGENCY IN THE SAME GEOGRAPHIC AREA AND THREE RURAL HEALTH CLINICS LOCATED IN BISBEE, DOUGLAS AND PALOMINAS, ARIZONA. | ||
| PART VI, LINE 5: N/A | ||
| PART VI, LINE 6: N/A | ||
| AZ | REPORTS FILED WITH STATES | PART VI, LINE 7 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | 1 | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARIZONA LIONS VISION CENTER | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3003 S COUNTRY CLUB RD | AddressLine1 |
| City | TUCSON | City |
| State | AZ | State |
| ZIP Code | 85713 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 860289608 | EINOfRecipient |
| IRC Section | 501C(3) | IRCSection |
| Amount Of Cash Grant | 12060 | AmountOfCashGrant |
| Purpose Of Grant | FOR SUPPORTING OF GENERAL OPERATION. | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part III Form990ScheduleIPartIII (2 entries)
| Type Of GrantTypeOfGrant | Number Of RecipientsNumberOfRecipients | Amount Of Cash GrantAmountOfCashGrant |
|---|---|---|
| SCHOLARSHIPS | 8 | 12500 |
| HEALTH CLUB ASSISTANCE | 2 | 5000 |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCEDURE FOR MONITORING GRANTS IN THE U.S.: | Identifier |
| Return Reference | PART I, LINE 2: | ReturnReference |
| Explanation | SCHEDULE I, PART I, LINE 2: THE ORGANIZATION HAS A LEADERSHIP MEETING TO REVIEW STUDENTS' SCHOLARSHIP APPLICATION. THE APPLICATIONS ARE ON FILE IN THE HUMAN RESOURCE DEPARTMENT. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | X | IndependentConsultant |
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Compensation Survey | X | CompensationSurvey |
| 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 (7 entries)
| 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES DICKSON | |||||||||||||
| 232705 | 0 | 0 | 0 | 0 | 0 | 16973 | 0 | 7728 | 0 | 257406 | 0 | 0 | 0 |
| DIANE MOORE | |||||||||||||
| 142513 | 0 | 0 | 0 | 0 | 0 | 4275 | 0 | 7728 | 0 | 154516 | 0 | 0 | 0 |
| JOSE ROMO | |||||||||||||
| 315383 | 0 | 0 | 0 | 0 | 0 | 9461 | 0 | 7728 | 0 | 332572 | 0 | 0 | 0 |
| HEIDI LODGE | |||||||||||||
| 290313 | 0 | 0 | 0 | 0 | 0 | 8709 | 0 | 7728 | 0 | 306750 | 0 | 0 | 0 |
| DANIEL ROE | |||||||||||||
| 512856 | 0 | 0 | 0 | 0 | 0 | 15386 | 0 | 7728 | 0 | 535970 | 0 | 0 | 0 |
| BRUCE CURTIS | |||||||||||||
| 196342 | 0 | 0 | 0 | 0 | 0 | 5890 | 0 | 7728 | 0 | 209960 | 0 | 0 | 0 |
| MURADI NAJIBULLAH | |||||||||||||
| 195993 | 0 | 0 | 0 | 0 | 0 | 5880 | 0 | 7728 | 0 | 209601 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (3 entries)
| Return ReferenceReturnReference | ExplanationExplanation |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11 | THE DRAFT OF 990 FORM AND RELATED SCHEDULES ARE SENT TO AND REVIEWED BY BOARD MEMBERS AND MANAGEMENT BEFORE FILING. COMMENTS AND CHANGES ARE COMMUNICATED WITH THE TAX PREPARER AND ADDRESSED ACCORDINGLY. |
| FORM 990, PART VI, SECTION B, LINE 15 | EXECUTIVE COMPENSATION IS SET BY THE BOARD BASED UPON REVIEW OF AN ANNUAL SALARY SURVEY BY THE ARIZONA HOSPITAL ASSOCIATION. THE HOSPITAL ALSO CONTRACTS WITH AN OUTSIDE CONSULTANT WHO ADVISES THE BOARD REGARDING EXECUTIVE COMPENSATION. THE ABOVE MENTIONED PROCESS IS UTILIZED IN SETTING SALARIES OF ALL OF THE EXECUTIVE TEAM AT THE HOSPITAL. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE TO THE PUBLIC THROUGH THE STATE UAR REPORT AND THE FEDERAL MEDICARE COST REPORT. |