COBRE VALLEY REGIONAL MEDICAL CENTER: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- COBRE VALLEY REGIONAL MEDICAL CENTER (EIN 86-0732836)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-15
- IRS object ID
- 201313199349311001
- Schema version
- 2012v2.1
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-15T17:30:19-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1 |
| City | WICHITA | City |
| State | KS | State |
| ZIP Code | 672066601 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860732836 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COBRE VALLEY REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % JAMES R CHILDERS | InCareOfName |
| Name Control | COBR | NameControl |
| Phone | 9284253261 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5880 S HOSPITAL DRIVE | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | GLOBE | City |
| State | AZ | State |
| ZIP Code | 85501 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | NEAL JENSEN | Name |
| Title | OFFICER | Title |
| Phone | 9284253261 | Phone |
| Date Signed | 2013-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ELIZABETH S HOGAN | Name |
| Phone | 3162652811 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | NEAL JENSEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5880 S HOSPITAL DRIVE | AddressLine1 |
| City | GLOBE | City |
| State | AZ | State |
| ZIP Code | 85501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 37530903 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CVRMC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1988 | YearFormation |
| State Legal Domicile | AZ | StateLegalDomicile |
| Activity Or Mission Description | SEE SCHEDULE O | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 330 | TotalNbrEmployees |
| Total Nbr Volunteers | 45 | TotalNbrVolunteers |
| Total Gross UBI | 11195 | TotalGrossUBI |
| Contributions Grants Prior Year | 18949 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 98658 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 39131569 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 36799904 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 270397 | InvestmentIncomePriorYear |
| Investment Income Current Year | 271600 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 340353 | OtherRevenuePriorYear |
| Other Revenue Current Year | 351079 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 39761268 | TotalRevenuePriorYear |
| Total Revenue Current Year | 37521241 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 19402028 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 18937222 | 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 | 16715774 | OtherExpensePriorYear |
| Other Expenses Current Year | 16557637 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 36117802 | TotalExpensesPriorYear |
| Total Expenses Current Year | 35494859 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 3643466 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2026382 | RevenuesLessExpensesCY |
| Total Assets BOY | 42109294 | TotalAssetsBOY |
| Total Assets EOY | 43588938 | TotalAssetsEOY |
| Total Liabilities BOY | 14752678 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13839199 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 27356616 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 29749739 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | THE MISSION OF OUR HOSPITAL IS TO DEVELOP AND MAINTAIN A LOCAL HEALTH CARE DELIVERY SYSTEM THAT SERVES THE REGION WITH QUALITY, EFFICIENCY AND COMPASSION. OUR MISSION IS YOUR HEALTH. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 29489859 | Expense |
| Revenue | 36054453 | Revenue |
| Description | THE ORGANIZATION WILL PROVIDE MEDICAL SERVICES WHICH WILL BE COMPETITIVE WITH THOSE CHARGED FOR SIMILAR SERVICES BY COMPARABLE FACILITIES. THE ORGANIZATION WILL ALSO ALLOW A PORTION OF ITS SERVICES AND FACILITIES TO BE USED FOR CHARITY PATIENTS. ALONG WITH PROVIDING ACUTE HEALTH CARE SERVICES TO THE COMMUNITY AS A NOT FOR PROFIT ENTITY, COBRE VALLEY REGIONAL MEDICAL CENTER (CVRMC) HOSTS MANY EDUCATIONAL PROGRAMS AVAILABLE TO THE RESIDENTS IN THE SERVICE AREA. SEE SCHEDULE O FOR CONTINUATION. | Description |
| Total Program Service Expense | 29489859 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 99 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 330 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | AZ | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JAMES R CHILDERS | NamePerson |
| Telephone Number | 9284021123 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5880 S HOSPITAL DRIVE | AddressLine1 |
| City | GLOBE | City |
| State | AZ | State |
| ZIP Code | 85501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| No Listed Persons Compensated | X | NoListedPersonsCompensated |
Form990 Part VII Section A Form990PartVIISectionA (16 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ED CARPENTER | |||||||
| DIRECTOR/CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | |
| BYRON BELEW | |||||||
| DIRECTOR/VICE CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | |
| JIM RASMUSSEN | |||||||
| DIRECTOR/TREASURER | 1.0 | X | X | 0 | 0 | 0 | |
| JANICE COOK | |||||||
| DIRECTOR/SECRETARY | 1.0 | X | X | 0 | 0 | 0 | |
| JENDEAN SARTAIN | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| GARY GUSTASON MD | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BRAD WERRELL DO | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| KANE GRAVES | |||||||
| DIRECTOR/SECRETARY | 1.0 | X | X | 0 | 0 | 0 | |
| FERNANDO SHIPLEY | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| NEAL JENSEN | |||||||
| CEO | 40.0 | X | 0 | 0 | 0 | ||
| JAMES CHILDERS | |||||||
| CFO | 40.0 | X | 0 | 0 | 0 | ||
| ANDRADE-ORTIZ WERNER | |||||||
| PHYSICIAN | 40.0 | 395905 | 0 | 14399 | X | ||
| MILLER DANA L | |||||||
| PHYSICIAN | 40.0 | 386292 | 0 | 28059 | X | ||
| CHANDRA BINOY | |||||||
| PHYSICIAN | 40.0 | 340364 | 0 | 10530 | X | ||
| NGUYEN PHUONG | |||||||
| PHYSICIAN | 40.0 | 251801 | 0 | 21941 | X | ||
| PEIFER PETER B | |||||||
| PA | 40.0 | 222142 | 0 | 23138 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1596504 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 98067 | TotalOtherCompensation |
| Number Individuals GT100 K | 34 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| HEALTHTECH MANAGEMENT SVCS INC | |
| MANAGEMENT SERVICES | 758284 |
| ARUP LABORATORIES | |
| LAB REFERENCE TESTS | 193477 |
| SHC SERVICES | |
| RN TRAVELER LABOR | 181242 |
| INGLISH PHYSICAL THERAPY | |
| CONTRACT PT SERVICES | 173180 |
| DELTA FLEX TRAVELERS | |
| PT TRAVELER SERVICES | 152897 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 17 | NumberOfContractorsGT100K |
| All Other Contributions | 98658 | AllOtherContributions |
| Total Contributions | 98658 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621300 | BusinessCode |
| Total Revenue Column | 36799904 | TotalRevenueColumn |
| Related Or Exempt Function Income | 36799904 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 36799904 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 271600 | TotalRevenueColumn |
| Exclusion | $271,600 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 99911 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 9662 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 90249 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 90249 | TotalRevenueColumn |
| Exclusion | $90,249 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| CAFETERIA/CATERING REVENUE | 722514 | 150904 | 139709 | 11195 |
| EQUIPMENT/SUPPLIES | 900099 | 49754 | 49754 | |
| LANDSCAPING/JANITORIAL | 900099 | 28611 | 28611 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 31561 | TotalRevenueColumn |
| Related Or Exempt Function Income | 31561 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 260830 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 37521241 | TotalRevenueColumn |
| Related Or Exempt Function Income | 37049539 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 11195 | UnrelatedBusinessRevenue |
| Exclusion | $361,849 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15768175 | Total |
| Program Services | 14141528 | ProgramServices |
| Management And General | 1626647 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 458326 | Total |
| Program Services | 417839 | ProgramServices |
| Management And General | 40487 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1630002 | Total |
| Program Services | 1481506 | ProgramServices |
| Management And General | 148496 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1080719 | Total |
| Program Services | 947407 | ProgramServices |
| Management And General | 133312 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 758981 | Total |
| Management And General | 758981 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82393 | Total |
| Management And General | 82393 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88283 | Total |
| Management And General | 88283 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4501721 | Total |
| Program Services | 3758720 | ProgramServices |
| Management And General | 743001 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 537305 | Total |
| Program Services | 401392 | ProgramServices |
| Management And General | 135913 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 554744 | Total |
| Program Services | 93325 | ProgramServices |
| Management And General | 461419 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145363 | Total |
| Program Services | 77944 | ProgramServices |
| Management And General | 67419 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 414567 | Total |
| Program Services | 75646 | ProgramServices |
| Management And General | 338921 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1944358 | Total |
| Program Services | 1166779 | ProgramServices |
| Management And General | 777579 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 373023 | Total |
| Program Services | 68066 | ProgramServices |
| Management And General | 304957 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| MEDICAL SUPPLIES | 4889834 | 4889834 | |
| REPAIRS & MAINTENANCE | 910891 | 757189 | 153702 |
| BAD DEBT EXPENSE | 745451 | 745451 | |
| EQUIPMENT RENTAL & MAINTENANCE | 281193 | 182366 | 98827 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 329530 | Total |
| Program Services | 284867 | ProgramServices |
| Management And General | 44663 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35494859 | Total |
| Program Services | 29489859 | ProgramServices |
| Management And General | 6005000 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 294210 | BOY |
| EOY | 44159 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19787605 | BOY |
| EOY | 18261228 | 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 | 4978930 | BOY |
| EOY | 5569572 | 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 | 1210789 | BOY |
| EOY | 1334398 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76984 | BOY |
| EOY | 316938 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 41795003 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 25670765 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13869124 | BOY |
| EOY | 16124238 | 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 | 0 | BOY |
| EOY | 0 | 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 | 1891652 | BOY |
| EOY | 1938405 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42109294 | BOY |
| EOY | 43588938 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5523891 | BOY |
| EOY | 4511344 | 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 | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6370000 | BOY |
| EOY | 6065000 | 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 | 1904857 | BOY |
| EOY | 2498653 | 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 | 953930 | BOY |
| EOY | 764202 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14752678 | BOY |
| EOY | 13839199 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27014174 | BOY |
| EOY | 29332361 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 342442 | BOY |
| EOY | 417378 | 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 | 27356616 | BOY |
| EOY | 29749739 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 42109294 | BOY |
| EOY | 43588938 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2026382 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 366741 | ReconciliationUnrealizedInvest |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $1,774 | GrantsOtherOrganizationsAmount |
| Total Lobbying Expenditures IIB | 1774 | TotalLobbyingExpendituresIIB |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1F | ReturnReference |
| Explanation | A PORTION OF THE ANNUAL DUES PAID TO THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION ARE USED FOR LOBBYING. | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 904177 | OtherCostOrOtherBasis |
| Book Value | 904177 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18729260 | OtherCostOrOtherBasis |
| Depreciation | 10316332 | Depreciation |
| Book Value | 8412928 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 18390879 | OtherCostOrOtherBasis |
| Depreciation | 13961144 | Depreciation |
| Book Value | 4429735 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3770687 | OtherCostOrOtherBasis |
| Depreciation | 1393289 | Depreciation |
| Book Value | 2377398 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 16124238 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | ACCRUED RETIREE HEALTH | Description |
| Amount | $764,202 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 764202 | TotalOfAmounts |
| Tot Revenue Etc Audited Fincl Stmt | 37152193 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 366741 | NetUnrealizedGainsInvestments |
| Other Revenues | -745451 | OtherRevenues |
| Revenue Not Rptd F990 | -378710 | RevenueNotRptdF990 |
| Revenue Subtotal | 37530903 | RevenueSubtotal |
| Other Revenues Not Included | -9662 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | -9662 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 37521241 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 34759070 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 9662 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 9662 | ExpensesNotRptdF990 |
| Expenses Subtotal | 34749408 | ExpensesSubtotal |
| Other Expenses Not Included | 745451 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 745451 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 35494859 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XI, LINE 2D | BAD DEBT EXPENSE RECLASSED TO EXPENSE (745,451) RECONCILIATION OF REVENUE SCHEDULE D, PART XI, LINE 4B RENTAL EXPENSES RECLASSED TO REVENUE (9,662) |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XII, LINE 2D | RENTAL EXPENSES RECLASSED TO REVENUE 9,662 RECONCILIATION OF EXPENSES SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE RECLASSED FROM REVENUE 745,451 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1641799 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1641799 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04720 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8685127 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11800794 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -3115667 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 10326926 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11800794 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -1473868 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 17 | NumberOfActivitiesOrPrograms |
| Persons Served | 1296475 | PersonsServed |
| Total Community Benefit Expense | 150449 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 150449 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00430 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 88334 | PersonsServed |
| Total Community Benefit Expense | 394524 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 394524 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01140 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 197052 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 197052 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00560 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 19 | NumberOfActivitiesOrPrograms |
| Persons Served | 1384809 | PersonsServed |
| Total Community Benefit Expense | 742025 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 742025 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02130 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 19 | NumberOfActivitiesOrPrograms |
| Persons Served | 1384809 | PersonsServed |
| Total Community Benefit Expense | 11068951 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 11800794 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -731843 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00000 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $745,451 | BadDebtExpenseAmount |
| Amount Attributable To | 0 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7428676 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7553325 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -124649 | 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 | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | 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 | COBRE VALLEY REGIONAL MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 5880 S HOSPITAL DRIVE | AddressLine1 |
| City | GLOBE | City |
| State | AZ | State |
| ZIP Code | 85501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CVRMC.ORG | WebsiteAddress |
| 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 | COBRE VALLEY REGIONAL MEDICAL CENTER | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| COBRE VALLEY SURGICAL SERVICES | ||||
| 5860 SOUTH HOSPITAL DRIVE SUITE 10 | GLOBE | AZ | 85501 | OUTPATIENT SURGERY |
| KEARNY CLINIC | ||||
| 100 TILBURY AVENUE | KEARNY | AZ | 85237 | OUTPATIENT CLINIC |
| PLEASANT VALLEY COMMUNITY MEDICAL CENTER | ||||
| 124 N TEWKSBURY BLVD | YOUNG | AZ | 85554 | OUTPATIENT CLINIC |
| SUPERIOR CLINIC | ||||
| 14 N MAGMA AVENUE | SUPERIOR | AZ | 85273 | OUTPATIENT CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| COSTING METHODOLOGY | SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. |
| ESTIMATE OF BAD DEBT EXPENSE | SCHEDULE H, PART III, SECTION A, LINE 2 | BAD DEBTS ARE RECORDED USING THE SELF PAY ACCOUNTS RECEIVABLE(A/R) AGINGS AND WE USE A RANGE OF PERCENTAGES FROM 25% TO 100% BASED ON THE AGE OF THE BALANCE. THE OLDER THE BALANCE DUE, THE HIGHER THE AMOUNT RESERVED AS BAD DEBT. ACTUAL ACCOUNTS DEEMED UNCOLLECTIBLE AFTER MULTIPLE BILLING AND FOLLOWUP EFFORTS, ARE WRITTEN OFF ACTIVE A/R AND REFERRED TO COLLECTION AGENCIES. |
| BAD DEBT EXPENSE FOOTNOTE | SCHEDULE H, PART III, SECTION A, LINE 4 | PATIENT ACCOUNTS RECEIVABLE CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. THE HOSPITAL MANAGES ITS RECEIVABLES BY REGULARLY REVIEWING THE ACCOUNTS, INQUIRING WITH RESPECTIVE PAYORS AS TO COLLECTIBILITY AND PROVIDING FOR ALLOWANCES ON THEIR ACCOUNTING RECORDS FOR ESTIMATED CONTRACTUAL ADJUSTMENTS AND UNCOLLECTIBLE ACCOUNTS. |
| MEDICARE | SCHEDULE H, PART III, SECTION B, LINE 8 | THE ANNUAL MEDICARE COST REPORT IS THE SOURCE FOR THE COSTING METHODOLOGY FOR SCHEDULE H, PART III, SECTION B, LINE 6. COLLECTION PRACTICES SCHEDULE H, PART III, SECTION C, LINE 9B CVRMC MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE FROM CVRMC, AND A PATIENT'S GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH CVRMC. FOR PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE AND WHO ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR HOSPITAL BILLS, CVRMC MAY OFFER INTEREST-FREE EXTENDED PAYMENT PLANS FOR UP TO 12 MONTHS TO ELIGIBLE PATIENTS, AND WILL NOT IMPOSE WAGE GARNISHMENTS OR LIENS ON PRIMARY RESIDENCES NOR SEND UNPAID BILLS TO OUTSIDE COLLECTION AGENCIES. AFTER 12 MONTHS, CVRMC, AT ITS OPTION, MAY SEND UNPAID ACCOUNTS TO COLLECTIONS. |
| CHARGES FOR MEDICAL CARE | SCHEDULE H, PART V, LINE 20 | ALL PATIENTS ARE CHARGED THE SAME STANDARD CHARGES FOR ALL SERVICES RENDERED. |
| NEEDS ASSESSMENT | SCHEDULE H, PART VI, LINE 2 | PLEASE REFER TO PDF ATTACHMENT OF SCHEDULE H, PART VI NARRATIVE RESPONSES. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | SCHEDULE H, PART VI, LINE 3 | PLEASE REFER TO PDF ATTACHMENT OF SCHEDULE H, PART VI NARRATIVE RESPONSES. |
| COMMUNITY INFORMATION | SCHEDULE H, PART VI, LINE 4 | PLEASE REFER TO PDF ATTACHMENT OF SCHEDULE H, PART VI NARRATIVE RESPONSES. |
| PROMOTION OF COMMUNITY HEALTH | SCHEDULE H, PART VI, LINE 5 | PLEASE REFER TO PDF ATTACHMENT OF SCHEDULE H, PART VI NARRATIVE RESPONSES. |
| AFFILIATED HEALTH CARE SYSTEM | SCHEDULE H, PART VI, LINE 6 | N/A |
| STATE FILING OF COMMUNITY BENEFIT REPORT | 990 SCHEDULE H, PART VI | AZ, |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ANDRADE-ORTIZ WERNER | ||||||||||||||
| PHYSICIAN | 395905 | 0 | 0 | 0 | 0 | 0 | 14073 | 0 | 326 | 0 | 410304 | 0 | 0 | 0 |
| MILLER DANA L | ||||||||||||||
| PHYSICIAN | 386292 | 0 | 0 | 0 | 0 | 0 | 12313 | 0 | 15746 | 0 | 414351 | 0 | 0 | 0 |
| CHANDRA BINOY | ||||||||||||||
| PHYSICIAN | 340364 | 0 | 0 | 0 | 0 | 0 | 10362 | 0 | 168 | 0 | 350894 | 0 | 0 | 0 |
| NGUYEN PHUONG | ||||||||||||||
| PHYSICIAN | 251801 | 0 | 0 | 0 | 0 | 0 | 8807 | 0 | 13134 | 0 | 273742 | 0 | 0 | 0 |
| PEIFER PETER B | ||||||||||||||
| PA | 222142 | 0 | 0 | 0 | 0 | 0 | 8157 | 0 | 14981 | 0 | 245280 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S MISSION | FORM 990, PART I, LINE 1 | THE ORGANIZATION WILL PROVIDE MEDICAL SERVICES WHICH WILL BE COMPETITIVE WITH THOSE CHARGED FOR SIMILAR SERVICES BY COMPARABLE FACILITIES. THE ORGANIZATION WILL ALSO ALLOW A PORTION OF ITS SERVICES AND FACILITIES TO BE USED FOR CHARITY PATIENTS. PROGRAM SERVICE ACCOMPLISHMENTS CONTINUED FORM 990, PART III, LINE 4A THE HOSPITAL AND STAFF HOST AND SPONSOR AN ANNUAL HEALTH FAIR WORKING WITH OTHER AREA AGENCIES TO DISTRIBUTE AND DISSEMINATE HEALTH, WELLNESS, AND INFORMATION. THE HOSPITAL ALSO SPONSORS DIABETIC WORKSHOPS, BIRTHING AND NEW BABY CARE CLASSES. THE EMERGENCY DEPARTMENT (ED) AT CVRMC IS THE BASE STATION FOR THE THREE FIRE/EMS DEPARTMENTS IN THE SERVICE AREA. THE HOSPITAL SPONSORS MONTHLY TRAINING TO FIREFIGHTERS AND PARAMEDICS AS WELL AS MEDICAL SUPERVISION AT NO COST TO THE DEPARTMENTS. THE ED ALSO IS A CLINICAL TRAINING SITE FOR PARAMEDICS AND PHYSICIAN ASSISTANTS TO FULFILL CLINICAL INTERNSHIP REQUIREMENTS IN THEIR CURRICULUM. CVRMC IS ALSO THE CLINICAL TRAINING SITE FOR STUDENTS ATTENDING NURSING PROGRAMS AT GILA COMMUNITY COLLEGE AND EASTERN ARIZONA COMMUNITY COLLEGE. DELEGATION OF CONTROL TO A MANAGEMENT COMPANY OR OTHER PERSON FORM 990, PART VI, SECTION A, LINE 3 THE CEO AND CFO DUTIES ARE CARRIED OUT BY EMPLOYEES OF HEALTHTECH MANAGEMENT SERVICES, INC., AN UNRELATED MANAGEMENT COMPANY. NEAL JENSEN AND JAMES CHILDERS ARE EMPLOYEES OF HEALTHTECH AND SERVE AS THE TOP MANAGEMENT AND FINANCIAL OFFICIALS OF COBRE VALLEY REGIONAL MEDICAL CENTER. NEAL JENSEN RECEIVED TOTAL COMPENSATION OF $285,176 AND JAMES CHILDERS RECEIVED TOTAL COMPENSATION OF $200,661 FROM HEALTHTECH MANAGEMENT SERVICES, INC. FOR THE 2012 CALENDAR YEAR. THIS COMPENSATION IS INCLUDED IN THE MANAGEMENT FEE PAID TO HEALTHTECH MANAGEMENT SERVICES, INC. AND REPORTED ON PART VII, SECTION B OF THE 990. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE RETURN IS THEN PROVIDED TO THE CHIEF FINANCIAL OFFICER FOR REVIEW AND APPROVAL. ANY QUESTIONS OR CONCERNS THE CFO HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO THE ENTIRE BOARD PRIOR TO FILING WITH THE IRS. |
| CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND OFFICERS ARE COVERED BY THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND ARE REQUIRED TO ANNUALLY COMPLETE A QUESTIONNAIRE DISCLOSING ANY AND ALL POSSIBLE CONFLICTS OF INTEREST. ANY POTENTIAL CONFLICTS ARE REVIEWED BY THE CEO WITH THE BOARD OF DIRECTORS AND HOSPITAL COUNSEL, WHO THEN DECIDE IF AN ACTUAL CONFLICT OF INTEREST EXISTS. THE INTERESTED PERSON RECUSES HIMSELF/HERSELF FROM THE MEETING AND DOES NOT PARTICIPATE IN THE DISCUSSION OF, OR VOTING ON ANY MATTERS REGARDING THE CONFLICT. |
| REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION | FORM 990, PART VI, SECTION A, LINE 15A | THE CEO'S COMPENSATION IS DETERMINED BY A REVIEW CONDUCTED BY HEALTHTECH MANAGEMENT SERVICES, INC. USING DATA PROVIDED BY A NATIONALLY RECOGNIZED MANAGEMENT CONSULTING FIRM, ALONG WITH FORM 990 DATA FROM COMPARABLE ORGANIZATIONS AND OTHER HOSPITALS MANAGED BY HEALTHTECH. ONCE THIS INFORMATION HAS BEEN COMPILED AND REVIEWED, A MEETING IS HELD WITH THE BOARD AND A DECISION IS MADE ON THE CEO'S COMPENSATION. |
| REVIEW OF OTHER OFFICER OR KEY EMPLOYEES COMPENSATION | FORM 990, PART VI, SECTION A, LINE 15B | SALARY SURVEYS OF OTHER SIMILARLY SIZED HOSPITALS WITH EQUIVALENT SERVICES AND SCOPE OF OPERATIONS, ARE USED TO SET COMPENSATION LEVELS. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENTS ARE READILY AVAILABLE IN THE ADMINISTRATIVE OFFICE, UPON REQUEST. |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT LABOR TOTAL FEES:1354438 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:461528 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:2685755 |
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