2013-05-13T20:21:46-05:00 2012-06-30 ERNST & YOUNG US LLP TWO NORTH CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2011-07-01 860100882 VERDE VALLEY MEDICAL CENTER % JOHN CORTESE CPA VERD 9286396442 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 GREG KUZMA 2013-05-13 6023223000 2011 2016-02-25 16:41:14Z JAMES BLEICHER 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 150474378 false X WWW.VERDEVALLEYMEDICALCENTER.COM X 1939 AZ TO PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. 11 7 0 387 0 0 578407 679720 146151007 144815588 -196191 2113499 1914509 2247674 148447732 149856481 567899 249706 0 0 76129119 76973597 0 0 594575 62456669 65156709 139153687 142380012 9294045 7476469 230023777 230505315 89253790 98198782 140769987 132306533 X SEE SCHEDULE O false false 114818192 249706 135129750 TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE. TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY THROUGH ITS INPATIENT, OUTPATIENT AND EMERGENCY HOSPITAL CARE AND RELATED MEDICAL SERVICES, CHARITY CARE AND COMMUNITY SERVICE. TOTAL INPATIENT DISCHARGES WERE 5,098 AND 19,306 PATIENT DAYS, OUTPATIENT VISITS APPROXIMATED 41,483 AND 23,012 EMERGENCY VISITS. 4650802 0 9409396 TO PROVIDE EMERGENCY SERVICES, CANCER TREATMENT AND OTHER ANCILLARY SERVICES TO THE COMMUNITY THROUGH THE OPERATION OF THE VVMC SEDONA CAMPUS. EMERGENCY VISITS WERE 7,276. RADIATION ONCOLOGY PROCEDURES WERE 11,811 MEDICAL IMAGING PROCEDURES 7,401. 993256 0 1682565 TO PROVIDE GERIATRIC PSYCHIATRIC SERVICES TO THE COMMUNITY THROUGH THE OPERATION OF THE SENIOR BEHAVIORAL HEALTH UNIT. DISCHARGES WERE 189 AND PATIENT DAYS 1,922. 120462250 true true false true false false false false false false true false false false true true false true false false false false false false true false true true true true true true false false false false false false false false true true false false false false true true true true false false true 239 0 true 0 false false false false false true true false false false false X 11 7 false false false false true true true true true false false true true true true true true true true true true AZ X JOHN CORTESE CPA 9282143545 914 N SAN FRANCISCO ST SUITE M FLAGSTAFF AZ 86001 X PAUL HANSON MD 10.0 X X 47700 5464 0 RON BARBER 9.0 X X 0 0 0 RICHARD CRANMER 4.0 X X 0 0 0 ALAN EVERETT 3.0 X 0 656 0 JAMES LEDBETTER 2.75 X 0 0 0 SHAWN ORME 2.5 X 0 969 0 MATIAS SANDOVAL 5.0 X X 0 683 0 RAY SELNA 4.0 X X 0 0 0 TOM TAYLOR 4.0 X 0 729 0 JAMES BLEICHER MD 30.0 X X 0 498033 26353 SAMUEL BUTMAN MD 40.0 X X 0 662921 15670 JOHN DEMPSEY 6.0 X 0 430982 175204 GREGORY KUZMA 6.0 X 0 401576 212390 NICK PASLIDIS 40.0 X 0 356198 7685 RICK PETERSON 40.0 X 0 184642 18894 JENNIFER BREWER 40.0 X 0 212702 101084 BARBARA DEMBER 40.0 X 0 211551 23757 HARRY ALBERTI MD 40.0 X 0 213759 22141 BRUCE PEEK MD 40.0 X 0 770466 21377 JOHN SCHOR MD 40.0 X 0 650868 24838 BRADLEY D WILLIAMS 40.0 X 0 590343 25793 JACK WYLIE 40.0 X 0 567726 0 STEPHEN BLAIR FAULKNER 40.0 X 0 548036 0 47700 6308304 675186 79 false true false LABCORP OF AMERICAN HOLDINGS PO BOX 2240 BURLINGTON NC 272162240 LABORATORY SERVICES 595488 CAREFUSION SOLUTIONSPYXIS 25082 NETWORK PLACE CHICAGO IL 606731250 MAINTENANCE SERVICES 565784 SPECIALISTS HOSPITAL MEDICINE 1140 MONROE AVE NW STE 150 GRAND RAPIDS MI 49503 LOCUM TENANTS 429444 MEDICUS HOSPITALISTS SVCS LLC 7 INDUSTRIAL WAY STE 5 SALUM NH 03079 MED STAFFING/CNSLTNG 153324 SALLOUM MEDICAL SERVICES PLLC 14632 S 24TH WAY PHOENIX AZ 85048 PROF. & TECH. SVCS 152880 14 57600 353820 268300 9000 679720 PATIENT SERVICES REVENUE 622110 144815588 144815588 144815588 1738501 1738501 0 0 853542 853542 853542 853542 928931 2727 556660 928931 -553933 374998 374998 49246 57600 61237 -11991 -11991 0 0 CAFETERIA SALES 722320 495141 495141 GIFT SHOP 900099 171261 171261 ALL OTHER REVENUE 900099 739721 739721 1406123 149856481 146221711 0 2955050 232973 232973 16733 16733 0 0 3074009 2044951 1029058 0 0 58150422 51158544 6811182 180696 4091498 3502707 573478 15313 7743574 6629227 1085365 28982 3914094 3350832 548613 14649 0 282264 104475 177789 0 67872 0 67872 0 11399 0 11399 0 0 0 7632331 4448463 2871441 312427 467310 37245 427331 2734 21825613 19692933 2114260 18420 0 0 2898983 2550833 348150 0 448265 184917 262231 1117 0 0 993205 826243 153897 13065 0 10110639 8966911 1139284 4444 1453441 1307353 146088 0 REGISTRATION SERVICES 1571118 0 1571118 0 MEDICAL PURCHASE SERVICES 1196161 1196161 0 0 AIR AMBULANCE PURCHASE SVCS 1137805 1137805 0 0 EXP REIMBURSEMENT TO NAH 14561653 12814255 1747398 0 498650 258689 237233 2728 142380012 120462250 21323187 594575 4000 4300 18951232 15186111 0 0 15221584 15302137 6691 0 0 0 108445 26196 2286641 2282843 7828814 1558970 161932170 87900449 72641865 74031721 104426009 113066922 0 0 0 0 375562 2096092 8172934 6950023 230023777 230505315 11510086 13236972 0 0 0 0 56207691 54059256 0 0 0 0 698726 401018 0 0 20837287 30501536 89253790 98198782 X 140769987 132306533 0 0 0 0 140769987 132306533 230023777 230505315 X 7476469 -15939923 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 11399 false false false 11399 false LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1F VERDE VALLEY MEDICAL CENTER PAID DUES TO THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. A PERCENTAGE OF THIS AMOUNT OR $11,399 WAS ESTIMATED TO BE ATTRIBUTABLE TO LOBBYING RELATED TO HEALTH CARE ADVOCACY AT THE FEDERAL, STATE, REGIONAL, AND LOCAL LEVELS. 3746702 3746702 91067701 44826893 46240808 1007442 164129 843313 54864722 39484913 15379809 11245603 3424514 7821089 74031721 0 MINIMUM PENSION LIABILITY 28667315 PROFESSIONAL GENERAL LIABILITY 1834221 30501536 ASC (740) FOOTNOTE SCHEDULE D, PART X, LINE 2 IN ACCORDANCE WITH ACCOUNTING GUIDANCE, MANAGEMENT HAS REVIEWED ALL OPEN TAX YEARS AND HAS DETERMINED THAT THE CORPORATION HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS. COPPER BALL 94944 57600 37344 0 4537 14625 14800 7100 10526 LOVEN 5K RUN 11902 0 11902 0 500 0 2400 0 4638 1 111 2000 106846 57600 49246 0 5037 14625 17311 7100 17164 61237 -11991 true true X true X 125. true X 175. false true true false true true 923117 0 923117 0.00650 19989750 12132245 7857505 0.05520 20912867 12132245 8780622 0.06170 1015237 345200 670037 0.00470 2246061 0 2246061 0.01580 67219 0 67219 0.00050 292560 0 292560 0.00210 3621077 345200 3275877 0.02310 24533944 12477445 12056499 0.08480 false 6894850 923117 65329000 85371000 -20042000 X true true 1 1 VERDE VALLEY MEDICAL CENTER

269 S CANDY LANE COTTONWOOD AZ 86326

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460 FINNEY FLATS ROAD CAMP VERDE AZ 86322

OFFICE X-RAY LAB PHYSICAL THERAPY VVMC AMBULATORY CENTER

300 WEST HIGHWAY 89A COTTONWOOD AZ 86336

SURGERY ENDOSCOPY VVMC MOB

294 WEST HIGHWAY 89A COTTONWOOD AZ 86336

PHYSICIAN OFFICES SLEEP LAB VOC MOB

61 BELL ROCK PLAZA SEDONA AZ 86351

PHYSICIAN OFFICES EMPLOYED PHYSICIAN OFFICE

450 WILLARD ST STE 101 107 COTTONWOOD AZ 86336

PHYSICIAN OFFICE FAMILY PRACTICE PHYSICIAN OFFICE

199 S CANDY LANE STE 1A COTTONWOOD AZ 86326

PHYSICIAN OFFICE VVMC SEDONA CAMPUS

3700 WEST HIGHWAY 89A SEDONA AZ 86336

OUTPATIENT AND EMERGENCY SERVICES SCHEDULE H, PART I, LINE 3C: FINANCIAL ASSISTANCE INCOME LEVELS ARE BASED ON THE FEDERAL POVERTY GUIDE PUBLISHED IN THE FEBRUARY FEDERAL REGISTER ON AN ANNUAL BASIS. A TIERED METHOD IS UTILIZED FOR DETERMINING WHETHER A PATIENT IS ELIGIBLE FOR 100%, 75%, 50%, 25%, OR 15% WRITE-OFF OF THE SELF PAY BALANCE. OTHER CONSIDERATIONS SUCH AS DISPOSABLE ASSETS ARE CONSIDERED IN THE EVALUATION OF ELIGIBILITY. A DISPOSABLE ASSET MAY BE EXPENSIVE JEWELRY, PLEASURE HORSES, RECREATIONAL VEHICLES, ETC. SCHEDULE H, PART I, LINE 6A: THE INFORMATION FOR THE COMMUNITY BENEFITS REPORT IS GATHERED BY THE COMMUNITY RELATIONS DEPARTMENT WHICH IS A DEPARTMENT OF NORTHERN ARIZONA HEALTHCARE. FLAGSTAFF MEDICAL CENTER AND VERDE VALLEY MEDICAL CENTER ARE IDENTIFIED SEPARATELY ON THESE REPORTS. THE COMMUNITY BENEFIT REPORT IS AVAILABLE ON THE WEBSITE. SCHEDULE H, PART I, LINE 7: VERDE VALLEY MEDICAL CENTER USED A COST-TO-CHARGE RATIO, WHERE APPLICABLE, TO CALCULATE THE MOST ACCURATE COST OF CHARITY CARE AND OTHER COMMUNITY BENEFITS REPORTED IN LINE 7. SCHEDULE H, PART III, LINE 4: THE FOOTNOTE TO THE FINANCIAL STATEMENT INDICATES NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE RECEIVED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. MANAGEMENT ESTIMATES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON THE HISTORICAL COLLECTION EXPERIENCE. THE COSTING METHODOLOGY USED TO DETERMINE THE BAD DEBT COST COMES FROM THE PERCENTAGE CALCULATED IN SCHEDULE H PART I WORKSHEET 2. AS A NOT-FOR-PROFIT ENTITY, SERVICES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND MAKING THIS AVAILABLE TO THE COMMUNITY QUALIFIES BAD DEBT AS A COMMUNITY BENEFIT. SCHEDULE H, PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE OUR MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE WHETHER OR NOT THIS SERVICE IS PROVIDED AT A LOSS TO THE HOSPITAL. MEDICARE IS A LARGE PORTION OF THE HOSPITAL'S PAYOR MIX (62%) AND IS A SIGNIFICANT LOSS FOR A 99-BED SOLE COMMUNITY HOSPITAL. THE HOSPITAL PROVIDES CARE REGARDLESS OF THIS SIGNIFICANT LOSS AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF THE MEDICARE BENEFICIARIES. MANY OF THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY WERE NOT IN THE MEDICARE PROGRAM. THE MEDICARE AMOUNTS WERE OBTAINED FROM THE PD&R AND COST REPORT. SCHEDULE H, PART III, LINE 9B: BEFORE PRE-ADMISSION AND IF PATIENT IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE VERDE VALLEY MEDICAL CENTER'S CASHIER COLLECTS 50% OF THE ESTIMATED LIABILITY. THE REST OF THE 50% IS SET UP ON A 6 MONTH PAYMENT PLAN WITH A SELF PAY REPRESENTATIVE OF THE CENTRAL BUSINESS OFFICE. SCHEDULE H, PART VI, LINE 2: NEEDS ASSESSMENT VERDE VALLEY MEDICAL CENTER ASSESSES COMMUNITY HEALTHCARE NEEDS THROUGH A SURVEY DESIGNED AND ADMINISTERED BY THE PROFESSIONAL RESEARCH CONSULTANTS. THIS SURVEY WAS LAST CONDUCTED IN 2012 AND WAS A FOLLOW-UP TO OTHER SURVEYS THE HOSPITAL HAS CONDUCTED. THE SURVEY INSTRUMENT USED FOR THIS STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS, AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. SCHEDULE H, PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE VERDE VALLEY MEDICAL CENTER (VVMC) WEBSITE HAS A BILLING CONTACT NUMBER. BEFORE PRE-ADMISSION, PATIENTS ARE CONTACTED BY THE VVMC'S CASHIER. WHEN PATIENTS ARE CONTACTED, THEY ARE EDUCATED OF THE FINANCIAL ASSISTANCE POLICY. VVMC FINANCIAL COUNSELORS ASSIGNED TO EACH NURSING UNIT ARE ABLE TO ANSWER OR ASSIST WITH BILLING QUESTIONS. AT EACH PATIENT REGISTRATION DESK ARE DISPLAYS AND BROCHURES OF THE BILLING INFORMATION, INCLUDING THE FINANCIAL ASSISTANCE POLICY. ACCORDING TO THE POLICY, THE FINANCIAL COUNSELORS ASSESS THE PATIENT'S ABILITY TO PAY AT TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR CHARITY CARE CONSIDERATION. IF PATIENT DOESN'T QUALIFY FOR CHARITY CARE ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR LONG-TERM PAYMENT PROGRAM. IF THE CHARITY APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. SCHEDULE H, PART VI, LINE 4: COMMUNITY INFORMATION VERDE VALLEY MEDICAL CENTER IS A 99-BED ADULT AND PEDIATRIC, SOLE COMMUNITY HOSPLITAL, AND 11-BED GERIATRIC PSYCHIATRY SOLE COMMUNITY HOSPITAL. THE HOSPITAL IS LOCATED IN COTTONWOOD, ARIZONA BUT THE PRIMARY SERVICE AREA INCLUDES COTTONWOOD, CLARKDALE, JEROME, SEDONA, VILLAGE OF OAK CREEK, RIMROCK, AND CORNVILLE WHICH COVERS APPROXIMATELY A 50 SQUARE MILE SPAN. THE CLOSEST HOSPITAL TO THE NORTH IS FLAGSTAFF MEDICAL CENTER (VVMC AFFILIATE) WHICH IS 70 MILES. THE CLOSEST HOSPITAL TO THE SOUTH IS 40 MILES. THE POPULATION IN THE PRIMARY SERVICE AREA IS APPROXIMATELY 73,000. THE HOSPITAL PAYOR MIX IS AS FOLLOWS: MEDICARE 62%, AHCCCS/MEDICAID 14%, COMMERCIAL/OTHER 19%, AND SELF PAY 5%. VERDE VALLEY MEDICAL CENTER IS THE LARGEST EMPLOYER IN THE COMMUNITY. THE PRIMARY SERVICE AREA DOES NOT HAVE MUCH INDUSTRY AND THE COMMUNITY HAS MANY SMALL BUSINESS ORGANIZATIONS. SCHEDULE H, PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH VERDE HEALTHCARE INITIATIVE, LLC (VHI) WAS FORMED IN MARCH 2010 AND IS 100% OWNED BY VERDE VALLEY MEDICAL CENTER (VVMC). THE GENERAL PURPOSE OF VHI IS TO BE AN INCUBATOR FOR INNOVATIVE COMMUNITY HEALTH CARE BY PROVIDING FINANCIAL SUPPORT TO SERVICES AND PROGRAMS WHICH PROMOTE AND ADVANCE THE HEALTH OF THE PEOPLE OF COTTONWOOD, VERDE VALLEY, SEDONA AND OTHER GEOGRAPHICAL AREAS SERVED BY VERDE VALLEY MEDICAL CENTER. THE LLC IS FUNDED BY A BOARD APPROVED PERCENTAGE OF NET OPERATING INCOME. ONE OF THE COMPLETED PROJECTS WAS DEVELOPING AN EDUCATION AND EXERCISE REGIMEN WHICH LED TO A DRAMATIC REDUCTION IN CARDIOLOGY READMISSIONS. VHI HAS PUT TOGETHER A SERIES OF COMMUNITY EDUCATION PROJECTS AIMED AT CHANGING HEALTH/LIFESTYLE BEHAVIORS. INCLUDED IN THIS LIST IS A JUVENILE DIABETIC PROGRAM, A FAMILY HEALTH EDUCATION PROGRAM AIMED AT LOW INCOME FAMILIES IN THE BEAVER CREEK SCHOOL DISTRICT, (WHICH WAS CO-VENTURED WITH THE NORTHERN ARIZONA COUNCIL OF GOVERNMENTS - THE PROGRAM CREATED BY THE UCLA MEDICAL CENTER AND JOHNSON AND JOHNSON MEDICAL), AN AREA-WIDE FITNESS PROGRAM DESIGNED BY DR. CHARLES CORBIN, A PROFESSOR AT ARIZONA STATE UNIVERSITY. THIS PROGRAM IS A MULTI-DISCIPLINE PROGRAM ADMINISTERED IN PUBLIC SCHOOLS. VHI ALSO HAS WORKED WITH NORTHERN ARIZONA UNIVERSITY AND THEIR SCHOOL OF DENTAL HYGIENE IN PROVIDING TREATMENT AND ORAL HEALTH EDUCATION TO LOW INCOME FAMILIES. VHI DOES NOT GIVE ANY GRANTS BUT IS WILLING TO WORK WITH EXISTING ORGANIZATIONS TO HELP CHANGE BEHAVIORS. VHI HAS NO PAID STAFF BUT DOES HIRE NEEDED SERVICES ON A CASE BY CASE BASIS. VHI IS GOVERNED BY A THREE-MEMBER BOARD. IN ADDITION, THE VVMC FOUNDATION HAS DESIGNATED COMMUNITY FUNDS AND SUPPORTS THE SCHOOLS, HOUSE OF RUTH, AND VERDE VALLEY SANCTUARY. SCHEDULE H, PART VI, LINE 6: AFFILIATED HEALTH CARE SYSTEM VERDE VALLEY MEDICAL CENTER IS AFFILIATED WITH FLAGSTAFF MEDICAL CENTER. THE BOARD MEMBER MEETINGS ARE COMBINED. THE COMMUNITY BENEFIT REPORT IS SUMMARIZED TOGETHER AND POSTED ON THE HOSPITAL'S WEB SITE. IN THE LAST COUPLE OF YEARS A SYSTEMWIDE QUALITY CARDIOLOGY PROGRAM WAS STARTED AND PHYSICIAN ARE EMPLOYED OR CONTRACTED AT BOTH INSTITIUTIONS TO PROVIDE TIMELY PATIENT CARE. true YAVAPAI HELPLINE PO BOX 387 PRESCOTT AZ 863020387 273443476 501(C)(3) 10000 FUNDING FOR CENTRAL COMMUNICATION HELP RESOURCE CENTER VERDE VALLEY CAREGIVERS 345 JORDAN RD SEDONA AZ 86336 860725787 501(C)(3) 9091 ONGOING SUPPORT FOR SENIOR IN-HOME ASSISTANCE PROG VERDE VALLEY SANCTUARY 401 N 16THS ST COTTONWOOD AZ 86326 860741314 501(C)(3) 6500 ONGOING SUPPORT TO HELP WOMEN AND CHILDREN WHO ARE VICTIMS OF DOMESTIC VIOLENCE TRAUMA INTERVENTION PROGRAM OF ARIZONA PO BOX 25195 PRESCOTT VALLEY AZ 86312 204433209 501(C)(3) 8360 ONGOING SUPPORT FOR VOLUNTEER TRAUMA COUNCELORS VIA SCF SEDONA SUNRISE CENTER FOR ADULTS 110 INDIAN CLIFFS RD SEDONA AZ 86336 262252125 501(C)(3) 8362 ONGOING SUPPORT FOR SENIOR DAYCARE CENTER VIA SCF CORNUCOPIA - HARMONY HEALTH PO BOX 126 CORNUCOPIA WI 54827 860990310 501(C)(3) 5919 HARMONY HEALTH PLAN VIA SEDONA COMMUNITY FOUNDATION CITY OF COTTONWOOD 827 N MAIN COTTONWOOD AZ 86326 866007877 GOVERNMENT 10000 LOOKIN' GOOD COTTONWOOD SPONSORSHIP N ARIZONA TENNIS ASSOCIATION 1016 W UNIV AVE STE 204 FLAGSTAFF AZ 86001 860995753 501(C)(3) 6000 TITLE SPONSORSHIP BRUCE HORNSBY FUNDRAISING CONCERT CAMP VERDE UNITED CHRISTIAN SCHOOL 903 FINNIE FLAT RD CAMP VERDE AZ 86322 860793544 SCHOOL 5700 FUNDING FOR PHYSICAL EDUCATION AND NUTRITION PROGRAM VERDE VALLEY SENIOR CENTER 500 E CHERRY ST COTTONWOOD AZ 86326 860328194 501(C)(3) 7100 FUNDING TO BUILD GREENHOUSE IN COTTONWOOD MINGUS UNION HIGH SCHOOL 1801 E FIR ST COTTONWOOD AZ 86326 866006215 SCHOOL 24181 FACILITATE CONTINUING GENERAL STUDIES COTTONWOOD OAK CREEK SCHOOL DISTRICT 1 N WILLARD ST COTTONWOOD AZ 86326 866000563 SCHOOL 9760 PROGRAM ASSISTANCE YAVAPAI COMMUNITY COLLEGE 1100 E SHELDON PRESCOTT AZ 86301 237232985 SCHOOL 28000 FACILITATE EXPANSION OF NURSING PROGRAM YAVAPAI COUNTY WELLNESS CLINIC 1090 COMMERCE DRIVE PRESCOTT AZ 86305 866000561 501(C)(3) 94000 PROVIDE LAB & MEDICAL IMAGING SERVICES FOR LOW INCOME 14 0 STUDENT LOANS 4 16733 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I, LINE 2 YAVAPAI COLLEGE - MONITOR SCHOOL PROGRAM AND MAKE SURE THEY HAVE THE APPROPRIATE INSTRUCTORS AND OTHER EMPLOYEES PER THE AGREEMENT; YAVAPAI COMMUNITY WELLNESS CENTER - PATIENT'S INCOMES ARE SCREENED BY THE COUNTY FOR THOSE QUALIFIED TO RECEIVE FREE SERVICES, PATIENTS ARE IDENTIFIED ON PRESCRIPTIONS FOR LAB AND RADIOLOGY SERVICES, THEY ARE REGISTERED UNDER THE COUNTY AND TOTAL DOLLARS USED IS ACCUMULATED IN THE SYSTEM; STUDENT LOANS - STUDENTS ARE CHECKED EACH SEMESTER TO MAKE SURE THEY ARE STILL IN THE PROGRAM AND WHEN THEY GRADUATE THEY ARE TO BE EMPLOYED OR PAYBACK THE LOAN WHICH IS MONITORED BY THE EDUCATION DEPARTMENT AND HUMAN RESOURCES. false false false false false false false false false JAMES BLEICHER MD 0 370011 0 128022 0 0 0 9800 0 16553 0 524386 0 0 JOHN DEMPSEY 0 328790 0 94289 0 7903 0 158651 0 16553 0 606186 0 0 GREGORY KUZMA 0 330585 0 70991 0 0 0 201289 0 11101 0 613966 0 0 RICK PETERSON 0 157114 0 27057 0 471 0 3556 0 15338 0 203536 0 0 JENNIFER BREWER 0 179286 0 33416 0 0 0 89723 0 11361 0 313786 0 0 BARBARA DEMBER 0 180107 0 31444 0 0 0 7204 0 16553 0 235308 0 0 HARRY ALBERTI MD 0 199992 0 13767 0 0 0 6543 0 15598 0 235900 0 0 BRUCE PEEK MD 0 693410 0 77056 0 0 0 9800 0 11577 0 791843 0 0 SAMUEL BUTMAN MD 0 550014 0 112907 0 0 0 9800 0 5870 0 678591 0 0 JOHN SCHOR MD 0 474185 0 176683 0 0 0 9800 0 15038 0 675706 0 0 BRADLEY D WILLIAMS 0 555578 0 34765 0 0 0 9800 0 15993 0 616136 0 0 JACK WYLIE 0 540010 0 27716 0 0 0 0 0 0 0 567726 0 0 STEPHEN BLAIR FAULKNER 0 336086 0 211950 0 0 0 0 0 0 0 548036 0 0 NICK PASLIDIS 0 279955 0 62360 0 13883 0 1896 0 5789 0 363883 0 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 1 A/B ALL COMPENSATION, BENEFITS AND REIMBURSEMENTS ARE PAID BY NORTHERN ARIZONA HEALTHCARE CORPORATION, THE PARENT ORGANIZATION. BOARD MEMBER AND OFFICERS BUSINESS TRAVEL EXPENSES, SUCH AS AIRLINE AND MEALS, FOR COMPANIONS WERE PAID AND REPORTED ON A W-2 OR 1099. GROSS UP OF TAXES IS DONE ON ALL EMPLOYEE GIFT CERTIFICATES OF $25 OR MORE. THE BOARD MEMBER AND OFFICER BUSINESS TRAVEL EXPENSES ARE APPROVED BY NEXT HIGHEST LEVEL. AMOUNTS PAID BY THE PARENT (NAH) FOR "COMPANION TRAVEL" WERE FOR SPOUSES OF THE FOLLOWING DIRECTORS: SHAWN ORME: $548 RAY SELNA: $440 TOM TAYLOR: $729 SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART I, LINE 3 CEO COMPENSATION IS DERIVED BY A RELATED ENTITY - NORTHERN ARIZONA HEALTHCARE CORPORATION. SCHEDULE J, PART II THE FOLLOWING INDIVIDUALS PARTICIPATE IN A DEFINED BENEFIT RETIREMENT PLAN. AS SUCH, ACTUARIAL INCREASES IN THEIR ACCOUNTS ARE REPORTED ON PART II, COLUMN (C) AS DEFERRED COMPENSATION. FOR THE CURRENT YEAR, THE INCREASES WERE SUBSTANTIALLY MORE THAN NORMAL DUE TO A DECREASE IN THE DISCOUNT RATE USED IN THE ACTUARIAL ANALYSIS AS FOLLOWS: INCREASE DUE INCREASE DUE TO BENEFIT TO DECREASE IN ACCRUAL DISCOUNT RATE TOTAL JOHN J. DEMPSEY 57,015 101,636 158,651 GREGORY KUZMA 43,310 157,979 201,289 JENNIFER BREWER 28,252 61,471 89,723 INDUSTRIAL DEVELOPMENT AUTHORITY YAVAPAI COUNTY 860376099 2008-07-25 11393572 SEE PART VI false false false INDUSTRIAL DEVELOPMENT AUTHORITY YAVAPAI COUNTY 860376099 985900BTS 2009-01-08 32468925 SEE PART VI false false false INDUSTRIAL DEVELOPMENT AUTHORITY YAVAPAI COUNTY 860376099 985900CX5 2011-10-12 13829141 SEE PART VI false false false 0 0 11393572 0 0 11392216 0 0 1356 0 0 0 true false true true 0 0 32468925 0 0 32039951 363004 0 65970 0 0 0 true false true true 0 0 13829141 0 0 13695535 133606 0 0 0 0 0 2011 true false true true false false true true false 0.00000 0.00000 0.00000 true false false true true false 0.00000 0.00000 0.00000 true false false false false 0.00970 0.00000 0.00970 true false true false 0 false 0 false true false true false 0 false 0 false true false false false 0 false 0 false false X SEE SCHEDULE O 0 0 CELESTE CORREA MD HARRY ALBERTI, MD/SPOUSE 200226 EMPLOYEE COMPENSATION false LEDBETTER LAW FIRM JAMES LEDBETTER, DIRECTOR 118991 LEGAL SERVICES false ORGANIZATION'S MISSION STATEMENT FORM 990, PART III, LINE 1 TO PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. VOLUNTEER SERVICES FORM 990, PART I, LINE 6 VOLUNTEERS WORK IN ALMOST EVERY DEPARTMENT IN THE HOSPITAL AND AT OUR OFFSITE LOCATIONS, SUCH AS VVMC SEDONA CAMPUS, CAMP VERDE, VILLAGE OF OAK CREEK. THEY PERFORM CLERICAL AND RECEPTION DUTIES IN MANY DEPARTMENTS, SERVE AS PATIENT AND VISITOR GREETERS, SUPPLY DISTRIBUTION, LANDSCAPING, NUTRITIONAL SERVICES - PASS TRAYS, PARTICIPATE IN VARIOUS ACTIVITIES WITH THE SENIOR BEHAVIORAL HEALTH PATIENTS, LIBRARY, TRANSPORT, AND MAKE PILLOWS AND TEDDY BEARS (CRAFTS). DESCRIPTION OF THE MEMBERS OF THE ORGANIZATION AND THEIR RIGHTS FORM 990, PART VI, LINE 6 NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE CORPORATE MEMBER OF VERDE VALLEY MEDICAL CENTER. DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS FORM 990, PART VI, LINE 7A THE VERDE VALLEY MEDICAL CENTER (VVMC) GOVERNANCE COMMITTEE NOMINATES FOR POSITIONS ON THE VVMC BOARD OF DIRECTORS. DIRECTORS ARE ELECTED BY THE BOARD OF DIRECTORS OF THE SOLE CORPORATE MEMBER, NORTHERN ARIZONA HEALTHCARE CORPORATION (NAHC) FROM THE NOMINATIONS THAT HAVE BEEN PROVIDED. NAHC ELECTS THOSE PERSONS NOMINATED UNLESS THE BOARD OF DIRECTORS OF THE NAHC BY A SUPER MAJORITY VOTE DETERMINES THAT A NOMINEE'S ELECTION WOULD BE DETRIMENTAL TO THE BEST INTERESTS OF VVMC OR NAHC. DECISIONS REQUIRING APPROVAL & TYPE OF VOTING RIGHTS FORM 990, PART VI, LINE 7B AS SOLE CORPORATE MEMBER, NORTHERN ARIZONA HEALTHCARE CORPORATION (NAHC) APPROVES THE BOARD OF DIRECTORS THAT ARE ELECTED BY THIS ENTITY. ALSO AS SOLE CORPORATE MEMBER, NAHC HAS RESERVED THE RIGHT AND AUTHORITY TO APPROVE OR DISAPPROVE THOSE ACTS OR POWERS AS SET FORTH IN THE "RESERVED POWERS CHART" THAT IS PART OF THE BYLAWS. DESCRIPTION OF 990 REVIEW PROCESS FORM 990, PART VI, LINE 11B THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM BASED ON DATA GATHERED BY THE CONTROLLER AND THE ORGANIZATION'S FINANCIAL OPERATIONS GROUP. THE CFO REVIEWS THE DRAFT FORM 990 AND PROVIDES ADDITIONAL COMMENTS. THE FINAL DRAFT VERSION OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND KEY OFFICERS AT A BOARD MEETING HELD PRIOR TO THE MAY 15 DUE DATE FOR THE FORM 990. A REPRESENTATIVE FROM THE ACCOUNTING FIRM ATTENDS THE MEETING AND EXPLAINS SOME OF THE SIGNIFICANT DISCLOSURES IN THE FORM 990. ANY ADDITIONAL COMMENTS SUGGESTED BY THE GOVERNING BODY ARE THEN INCORPORATED INTO THE FINAL VERSION OF THE FORM 990 TO BE FILED WITH THE IRS BY THE FINAL DUE DATE. IF ANY SUGGESTED CHANGES ARE MATERIAL OR SIGNIFICANT, AN ADDITIONAL DRAFT IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST FORM 990, PART VI, LINE 12C POLICY IS REVIEWED ANNUALLY AND REQUIRES THEY REPORT CHANGES IN CIRCUMSTANCES - NEW JOB/POSITION OR BUSINESS, SIGNIFICANT PURCHASE/SALE OF PROPERTY, SIGNIFICANT INVESTMENT CHANGE. THE BOARD DIRECTORS AND CEO FILL OUT THE BOARD CONFLICT OF INTEREST QUESTIONNAIRE WHICH IS REVIEWED BY THE LEGAL DEPARTMENT. THE RESTRICTIONS IMPOSED WOULD DEPEND WHAT THE CONFLICT IS; HOWEVER, IF A DISCUSSION PURSUES AND A BOARD MEMBER HAS A CONFLICT IDENTIFIED BY HIM AND OTHERS, THE DIRECTOR WILL LEAVE THE ROOM. THE DIRECTORS AND VPS ALSO HAVE A POLICY AND QUESTIONNAIRE THAT IS FILLED OUT ANNUALLY. ANY YES RESPONSE IS SIGNALED BY SYSTEM TO SEND TO LEGAL FOR REVIEW. DESCRIPTION OF COMPENSATION PROCESS FORM 990, PART VI, LINES 15A & 15B DETERMINATION OF CEO SALARY IS GUIDED BY INDEPENDENT PERSONS, INVOLVING A BOARD-DESIGNATED COMPENSATION COMMITTEE THAT MAKES A RECOMMENDATION TO THE BOARD; BASED UPON BOARD DEVELOPED AND APPROVED COMPENSATION PHILOSOPHY; DERIVED FROM NATIONWIDE COMPARABLE DATA THAT IS COLLECTED BY THE INDEPENDENT PERSONS; APPROVED BY ENTIRE BOARD OF DIRECTORS AFTER DELIBERATION. VICE PRESIDENT COMPENSATION IS GUIDED BY INDEPENDENT PERSONS; BASED UPON BOARD DEVELOPED AND APPROVED COMPENSATION PHILOSOPHY; DERIVED FROM NATIONWIDE COMPARABLE DATA THAT IS COLLECTED BY THE INDEPENDENT PERSONS; DETERMINED BY THE VP'S SUPERVISOR. THE LAST TIME THE BOARD REVIEWED AND DOCUMENTED THE COMPENSATION WAS IN AUGUST 2012. AVAILABILITY OF CERTAIN DOCUMENTS TO THE GENERAL PUBLIC FORM 990, PART VI, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ARIZONA DEPARTMENT OF HEALTH SERVICES. IN ADDITION, THEY ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AS PART OF THE ORGANIZATION'S CONTINUING DISCLOSURE DOCUMENTS THAT ARE REQUIRED BY ITS PUBLIC DEBT REQUIREMENTS. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII ALAN EVERETT SERVES ON THE BOARD OF NAHC AND VERDE VALLEY MEDICAL CENTER (VVMC). HE DEVOTED 3 HOURS PER WEEK TO EACH ORGANIZATION. JAMES LEDBETTER SERVES ON THE BOARD OF NAHC AND VVMC. HE DEVOTED 2.75 HOURS PER WEEK TO EACH ORGANIZATION. SHAWN ORME SERVES ON THE BOARD OF NAHC AND VVMC. SHE DEVOTED 2.50 HOURS PER WEEK TO EACH ORGANIZATION. MATIAS SANDOVAL SERVES ON THE BOARD OF NAHC AND VVMC. HE DEVOTED 5 HOURS PER WEEK TO EACH ORGANIZATION. GREGORY KUZMA IS THE VP AND CHIEF FINANCIAL OFFICER OF NAHC, FMC AND VVMC. HE DEVOTED 20 HOURS PER WEEK TO NAHC, 14 HOURS TO FMC, AND 6 HOURS PER WEEK TO VVMC. JAMES BLEICHER IS CO-CEO OF NAHC AND PRESIDENT AND CHIEF EXECUTIVE OFFICER OF VVMC. HE DEVOTES 10 HOURS PER WEEK TO NAHC AND 30 HOURS PER WEEK TO VVMC. JOHN DEMPSEY IS THE EXECUTIVE VP OF LAW & ETHICS OF NAHC, FMC AND VVMC. HE DEVOTED 20 HOURS PER WEEK TO NAHC, 14 HOURS TO FMC, AND 6 HOURS PER WEEK TO VVMC. TOM TAYLOR SERVES ON THE BOARDS OF BOTH NAH AND VVMC. HE DEVOTED 4 HOURS PER WEEK TO EACH ORGANIZATION. ALL THEIR COMPENSATION IS PAID BY NAHC. OTHER CHANGES IN NET ASSETS FORM 990, PART XI, LINE 5 UNREALIZED GAIN/LOSS $ (507,179) NET ASSET TRANSFERS TO/FROM AFFILIATE (1,271,862) DECREASE IN UNFUNDED PENSION LIABILITY (14,160,000) ROUNDING (882) ------------- TOTAL (15,939,923) ============= SUPPLEMENTAL INFORMATION SCHEDULE K, PART I LINE A - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2008A. THIS ISSUE REFUNDS BONDS FROM 12/12/96 AND 10/31/02. TOTAL ISSUANCE PRICE WAS $57,096,705 WHICH WAS ALLOCATED $45,703,133 TO FLAGSTAFF MEDICAL CENTER AND $11,393,572 TO VERDE VALLEY MEDICAL CENTER. LINE B - THE NAME OF THE ISSUE IS $52,795,000 HOSPITAL REVENUE BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2008B. THIS ISSUE REFUNDS BONDS FROM 1/27/05. TOTAL ISSUANCE PRICE WAS $52,795,000 WHICH WAS ALLOCATED $20,326,075 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $32,468,925 TO VERDE VALLEY MEDICAL CENTER. THE 2008B BONDS WERE ALSO USED, IN PART, TO FINANCE "NEW MONEY" PROJECTS. $10,073,432.20 WAS USED FOR FMC BUILDINGS AND LONG LIVED EQUIPMENT. LINE C - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2011. THIS ISSUE REFUNDS THE 1996A AND 1998 SERIES BONDS. TOTAL ISSUANCE PRICE WAS $78,923,520 WHICH WAS ALLOCATED $65,111,905 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $13,811,616 TO VERDE VALLEY MEDICAL CENTER. 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