2013-11-15T17:30:19-06:00 2012-12-31 BKD LLP 1551 N WATERFRONT PKWY STE 300 WICHITA KS 672066601 990 2012-01-01 860732836 COBRE VALLEY REGIONAL MEDICAL CENTER % JAMES R CHILDERS COBR 9284253261 5880 S HOSPITAL DRIVE Suite GLOBE AZ 85501 NEAL JENSEN 9284253261 2013-11-15 true ELIZABETH S HOGAN 3162652811 2012 2016-03-07 17:11:31Z NEAL JENSEN 5880 S HOSPITAL DRIVE GLOBE AZ 85501 37530903 false X WWW.CVRMC.ORG X 1988 AZ SEE SCHEDULE O 8 8 330 45 11195 18949 98658 39131569 36799904 270397 271600 340353 351079 39761268 37521241 0 0 0 0 19402028 18937222 0 0 0 16715774 16557637 36117802 35494859 3643466 2026382 42109294 43588938 14752678 13839199 27356616 29749739 X 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. false false 29489859 36054453 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. 29489859 true false false true false false false false false false true false false false true false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false false true 99 0 true 330 true true true false false false false false false false false false X 8 8 false true false false false false false true true false false true true true true true true true true false AZ X JAMES R CHILDERS 9284021123 5880 S HOSPITAL DRIVE GLOBE AZ 85501 X ED CARPENTER 1.0 X X 0 0 0 BYRON BELEW 1.0 X X 0 0 0 JIM RASMUSSEN 1.0 X X 0 0 0 JANICE COOK 1.0 X X 0 0 0 JENDEAN SARTAIN 1.0 X 0 0 0 GARY GUSTASON MD 1.0 X 0 0 0 BRAD WERRELL DO 1.0 X 0 0 0 KANE GRAVES 1.0 X X 0 0 0 FERNANDO SHIPLEY 1.0 X 0 0 0 NEAL JENSEN 40.0 X 0 0 0 JAMES CHILDERS 40.0 X 0 0 0 ANDRADE-ORTIZ WERNER 40.0 X 395905 0 14399 MILLER DANA L 40.0 X 386292 0 28059 CHANDRA BINOY 40.0 X 340364 0 10530 NGUYEN PHUONG 40.0 X 251801 0 21941 PEIFER PETER B 40.0 X 222142 0 23138 1596504 0 98067 34 false true false 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 17 98658 98658 NET PATIENT SERVICE REVENUE 621300 36799904 36799904 36799904 271600 271600 0 0 99911 9662 90249 0 90249 90249 0 0 0 0 CAFETERIA/CATERING REVENUE 722514 150904 139709 11195 EQUIPMENT/SUPPLIES 900099 49754 49754 LANDSCAPING/JANITORIAL 900099 28611 28611 31561 31561 260830 37521241 37049539 11195 361849 0 0 0 0 0 0 15768175 14141528 1626647 458326 417839 40487 1630002 1481506 148496 1080719 947407 133312 758981 758981 82393 82393 88283 88283 0 0 0 4501721 3758720 743001 0 537305 401392 135913 0 0 554744 93325 461419 145363 77944 67419 0 0 414567 75646 338921 0 1944358 1166779 777579 373023 68066 304957 MEDICAL SUPPLIES 4889834 4889834 REPAIRS & MAINTENANCE 910891 757189 153702 BAD DEBT EXPENSE 745451 745451 EQUIPMENT RENTAL & MAINTENANCE 281193 182366 98827 329530 284867 44663 35494859 29489859 6005000 0 294210 44159 19787605 18261228 0 0 4978930 5569572 0 0 0 0 0 0 1210789 1334398 76984 316938 41795003 25670765 13869124 16124238 0 0 0 0 0 0 0 0 1891652 1938405 42109294 43588938 5523891 4511344 0 0 0 0 6370000 6065000 0 0 0 0 1904857 2498653 0 0 953930 764202 14752678 13839199 X 27014174 29332361 342442 417378 0 0 27356616 29749739 42109294 43588938 2026382 366741 X false true X true false X true 1774 1774 GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES SCHEDULE C, PART II-B, LINE 1F A PORTION OF THE ANNUAL DUES PAID TO THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION ARE USED FOR LOBBYING. 904177 904177 18729260 10316332 8412928 18390879 13961144 4429735 3770687 1393289 2377398 16124238 0 ACCRUED RETIREE HEALTH 764202 764202 37152193 366741 -745451 -378710 37530903 -9662 -9662 37521241 34759070 9662 9662 34749408 745451 745451 35494859 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 true true X true X true X true true false true true 1641799 1641799 0.04720 8685127 11800794 -3115667 0.00000 10326926 11800794 -1473868 0.00000 17 1296475 150449 150449 0.00430 2 88334 394524 394524 0.01140 197052 197052 0.00560 19 1384809 742025 742025 0.02130 19 1384809 11068951 11800794 -731843 0.00000 true 745451 0 7428676 7553325 -124649 X true true 1 1 COBRE VALLEY REGIONAL MEDICAL CENTER

5880 S HOSPITAL DRIVE GLOBE AZ 85501

WWW.CVRMC.ORG X X X X COBRE VALLEY REGIONAL MEDICAL CENTER true true 100 true 400. true X X X X X X X true true X X X X true false X X X X true X false false 4 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 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, X X X false false false false false false false false false ANDRADE-ORTIZ WERNER 395905 0 0 0 0 0 14073 0 326 0 410304 0 0 0 MILLER DANA L 386292 0 0 0 0 0 12313 0 15746 0 414351 0 0 0 CHANDRA BINOY 340364 0 0 0 0 0 10362 0 168 0 350894 0 0 0 NGUYEN PHUONG 251801 0 0 0 0 0 8807 0 13134 0 273742 0 0 0 PEIFER PETER B 222142 0 0 0 0 0 8157 0 14981 0 245280 0 0 0 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