COLORADO WEST HEALTHCARE SYSTEM: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
COLORADO WEST HEALTHCARE SYSTEM (EIN 84-0469270)
Tax period
2009-05-01 to 2010-04-30
Filed
2011-03-15
IRS object ID
201140749349300919
Schema version
2009v1.3
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

FieldValueIRS element (for citing)
Timestamp2011-03-15T13:18:29-07:00Timestamp
Tax Period End Date2010-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1CHADWICKSTEINKIRCHNERDAVIS & CO PCBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1225 NORTH 5TH STREET SUITE 401AddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012645ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN840469270EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLORADO WEST HEALTHCARE SYSTEM DBA COMMUNITY HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLONameControl
Phone9702566321Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameWES WHITEName
TitleCHIEF FINANCIAL OFFICERTitle
Phone9702566321Phone
Date Signed2011-03-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameORVILLE F PETERSEN CPAName
Phone9702453000Phone
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCHRIS THOMASNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code81501ZIPCode
FieldValueIRS element (for citing)
Gross Receipts68627956GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteWWW.YOURCOMMUNITYHOSPITAL.COMWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1956YearFormation
State Legal DomicileCOStateLegalDomicile
Activity Or Mission DescriptionTHE MISSION OF COLORADO WEST HEALTHCARE SYSTEM AND COMMUNITY HOSPITAL IS TO IMPROVE THE HEALTH AND QUALITY OF LIFE OF THE INDIVIDUALS AND COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body12NbrVotingMembersGoverningBody
Nbr Independent Voting Members12NbrIndependentVotingMembers
Total Nbr Employees700TotalNbrEmployees
Total Nbr Volunteers103TotalNbrVolunteers
Total Gross UBI102737TotalGrossUBI
Contributions Grants Prior Year206021ContributionsGrantsPriorYear
Contributions Grants Current Year89096ContributionsGrantsCurrentYear
Program Service Revenue Prior Year65664279ProgramServiceRevenuePriorYear
Program Service Revenue CY67698495ProgramServiceRevenueCY
Investment Income Prior Year38182InvestmentIncomePriorYear
Investment Income Current Year-6460InvestmentIncomeCurrentYear
Other Revenue Prior Year679383OtherRevenuePriorYear
Other Revenue Current Year812335OtherRevenueCurrentYear
Total Revenue Prior Year66587865TotalRevenuePriorYear
Total Revenue Current Year68593466TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year30427776SalariesEtcPriorYear
Salaries Etc Current Year31125971SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year35322653OtherExpensePriorYear
Other Expenses Current Year38977107OtherExpensesCurrentYear
Total Expenses Prior Year65750429TotalExpensesPriorYear
Total Expenses Current Year70103078TotalExpensesCurrentYear
Revenues Less Expenses Prior Year837436RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-1509612RevenuesLessExpensesCY
Total Assets BOY33237626TotalAssetsBOY
Total Assets EOY31936782TotalAssetsEOY
Total Liabilities BOY18060026TotalLiabilitiesBOY
Total Liabilities EOY18185564TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY15177600NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY13751218NetAssetsOrFundBalancesEOY
Mission DescriptionTHE MISSION OF COLORADO WEST HEALTHCARE SYSTEM AND COMMUNITY HOSPITAL IS TO IMPROVE THEMissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense54481161Expense
Revenue68408093Revenue
DescriptionCOMMUNITY HOSPITAL PROVIDES INPATIENT, OUTPATIENT, EMERGENCY, URGENT, PRIMARY AND HOME HEALTH CARE SERVICES TO COMMUNITIES IN WESTERN COLORADO. DURING FISCAL YEAR 2010, COMMUNITY HOSPITAL HAD 6,895 PATIENT DAYS, 14,608 EMERGENCY ROOM VISITS, 6,739 URGENT CARE VISITS, 3,749 PRIMARY CARE VISITS, AND PERFORMED 4,632 SURGERIES.Description
Total Program Service Expense54481161TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedtrueBalanceSheetAmountsReported
Independent Audit Financial StmttrueIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPtrueLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096128NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees700NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionstrueQuidProQuoContributions
Quid Pro Quo DisclosuretrueQuidProQuoDisclosure
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Excess Business HoldingsfalseExcessBusinessHoldings
Taxable DistributionsfalseTaxableDistributions
Distribution To DonorfalseDistributionToDonor
Nbr Voting Governing Body Members12NbrVotingGoverningBodyMembers
Number Independent Voting Members12NumberIndependentVotingMembers
Family Or Business RelationshiptrueFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledCOStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

FieldValueIRS element (for citing)
Business Name Line1THE HOSPITALBusinessNameLine1
FieldValueIRS element (for citing)
Telephone Number9702566321TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREET GRANDAddressLine1
CityJUNCTIONCity
StateCOState
ZIP Code81501ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (27 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
DAVID PRICE
CHAIRPERSON2.00X000
R CURT HATCH
2010 VICE CHAIRPERSON/2009 TREASURER2.00X000
DAN THOMAS
2009 VICE-CHAIRPERSON2.00X000
MICHAEL DANIELS
SECRETARY2.00X000
MITCHELL COPELAND DO
CHIEF OF STAFF2.00X009208
STEVEN O'DELL DO
BOARD MEMBER1.50X0017102
KEVIN HOWELL DO
BOARD MEMBER1.50X0031800
AMIR BESHAI MD
BOARD MEMBER1.00X000
KELLY KING DO
BOARD MEMBER1.00X0068360
J DALE UTT DO
BOARD MEMBER1.00X001833
WILLIAM WATERHOUSE MD
BOARD MEMBER1.00X000
MONTY LANGSTON MD
BOARD MEMBER1.00X00110987
LARRY KENT
BOARD MEMBER1.50X000
DAVID VARGO
BOARD MEMBER1.50X000
SCOTT MERCIER
BOARD MEMBER1.50X000
SAM STARRITT
BOARD MEMBER1.00X000
CHRISTIAN THOMAS
CEO40.0032461900X
ELIZABETH BRICKER
CHIEF NURSING OFFICER401425634407X
WESLEY WHITE
CHIEF FINANCIAL OFFICER401717724969X
DAVID MURRAY
CHIEF COMPLIANCE OFFICER401356294953X
DONALD NICOLAY
CHIEF MEDICAL OFFICER401718003732X
DEBORA RIGGLE
VP OF ANCILLARY SERVICES401194504599X
PAUL NUMSEN
ER PHYSICIAN362475528040X
JOSEPH KUPETS
ER PHYSICIAN362453276861X
JULIE MILLS
ER PHYSICIAN362499515306X
DEBRA SMITH
ER PHYSICIAN362468416864X
SCOTT VINCENT
ER PHYSICIAN362423758096X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2297879TotalReportableCompFromOrg
Total Other Compensation297117TotalOtherCompensation
Number Individuals GT100 K11NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
COMMUNITY ANESTHESIA CONSULTANTS
2754 COMPASS DR STE 300GRAND JUNCTIONCO81506PHYSICIAN SERVICES887896
QUORUM HEALTH RESOURCES
105 CONTINENTAL PLBRENTWOODTN37027MANAGEMENT695378
JOHNSON & JOHNSON HCS
425 HOES LNPISCATAWAYNJ08854BUSINESS SERVICES791338
CARDINAL HEALTH PHARMACEUTICAL DIST
7000 CARDINAL PLDUBLINOH43017PHARMACEUTICAL SUPPLY1221641
CARDINAL HEALTH MEDICAL PRODUCTS
7000 CARDINAL PLDUBLINOH43017HEALTH-CARE PRODUCTS1785624
FieldValueIRS element (for citing)
Number Of Contractors GT100 K67NumberOfContractorsGT100K
All Other Contributions89096AllOtherContributions
Total Contributions89096TotalContributions

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionPATIENT REVENUEDescription
Business Code622000BusinessCode
Total Revenue Column67698495TotalRevenueColumn
Related Or Exempt Function Income67698495RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue67698495TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column28030TotalRevenueColumn
Exclusion$28,030ExclusionAmount

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other34490Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-34490Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-34490TotalRevenueColumn
Exclusion-$34,490ExclusionAmount

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
OTHER REVENUE622000709598709598
INVESTMENT IN LLC561490102737102737
FieldValueIRS element (for citing)
Total Other Revenue812335TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column68593466TotalRevenueColumn
Related Or Exempt Function Income68408093RelatedOrExemptFunctionIncome
Unrelated Business Revenue102737UnrelatedBusinessRevenue
Exclusion-$6,460ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total401782Total
Program Services0ProgramServices
Management And General401782ManagementAndGeneral
Fundraising0Fundraising

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total25147083Total
Program Services18042928ProgramServices
Management And General7104155ManagementAndGeneral
Fundraising0Fundraising

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total349334Total
Program Services349334ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total3379510Total
Program Services3353058ProgramServices
Management And General26452ManagementAndGeneral
Fundraising0Fundraising

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1848262Total
Program Services1583187ProgramServices
Management And General265075ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total887896Total
Program Services0ProgramServices
Management And General887896ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total291629Total
Program Services0ProgramServices
Management And General291629ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total69600Total
Program Services0ProgramServices
Management And General69600ManagementAndGeneral
Fundraising0Fundraising

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3130704Total
Program Services2488869ProgramServices
Management And General641835ManagementAndGeneral
Fundraising0Fundraising

Advertising Advertising

FieldValueIRS element (for citing)
Total408461Total
Program Services0ProgramServices
Management And General408461ManagementAndGeneral
Fundraising0Fundraising

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total15147350Total
Program Services13973404ProgramServices
Management And General1173946ManagementAndGeneral
Fundraising0Fundraising

Occupancy Occupancy

FieldValueIRS element (for citing)
Total492439Total
Program Services487734ProgramServices
Management And General4705ManagementAndGeneral
Fundraising0Fundraising

Travel Travel

FieldValueIRS element (for citing)
Total191413Total
Program Services144729ProgramServices
Management And General46684ManagementAndGeneral
Fundraising0Fundraising

Interest Interest

FieldValueIRS element (for citing)
Total663202Total
Program Services418866ProgramServices
Management And General244336ManagementAndGeneral
Fundraising0Fundraising

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total2940408Total
Program Services2940408ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Insurance Insurance

FieldValueIRS element (for citing)
Total660856Total
Program Services0ProgramServices
Management And General660856ManagementAndGeneral
Fundraising0Fundraising

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneralFundraisingFundraising
COLLECTION FEES41187304118730
LICENSES & TAXES273526447502287760
RECRUITMENT COSTS42566142566100
PHYSICIAN FEES2255060225506000
BAD DEBTS7859625785962500

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total2867404Total
Program Services113548ProgramServices
Management And General2753856ManagementAndGeneral
Fundraising0Fundraising

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total70103078Total
Program Services54481161ProgramServices
Management And General15621917ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2582161BOY
EOY2140165EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1346206BOY
EOY697758EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY6475469BOY
EOY8058807EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY32293BOY
EOY1176EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY2996703BOY
EOY2952013EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY200231BOY
EOY284288EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis41695792LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec26624998LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY16832381BOY
EOY15070794EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY2487367BOY
EOY2613350EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY284815BOY
EOY118431EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY33237626BOY
EOY31936782EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY5239739BOY
EOY6389735EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY3495627BOY
EOY2101764EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
EOY102811EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY8888642BOY
EOY8408530EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY436018BOY
EOY1182724EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY18060026BOY
EOY18185564EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY15177600BOY
EOY13751218EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY15177600BOY
EOY13751218EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY33237626BOY
EOY31936782EOY
FieldValueIRS element (for citing)
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii
Public Support Total1700PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

FieldValueIRS element (for citing)
Total0Total
FieldValueIRS element (for citing)
Public Support Pertcentage1700PublicSupportPertcentage170
Public Support Total5090PublicSupportTotal509
Public Support Percentage5090PublicSupportPercentage509
Investment Income Percentage0InvestmentIncomePercentage

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule D IRS990ScheduleD

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis6795630OtherCostOrOtherBasis
Book Value6795630BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis10543216OtherCostOrOtherBasis
Depreciation7627418Depreciation
Book Value2915798BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis11184OtherCostOrOtherBasis
Depreciation1118Depreciation
Book Value10066BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis23982895OtherCostOrOtherBasis
Depreciation18660151Depreciation
Book Value5322744BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis362867OtherCostOrOtherBasis
Depreciation336311Depreciation
Book Value26556BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings15070794TotalOfBookValueLandBuildings

Investments Program Related InvestmentsProgramRelated (5 entries)

DescriptionDescriptionBook ValueBookValueMethod Of ValuationMethodOfValuation
INVESTMENT IN DOCTOR'S CLINIC BUILDING1955994C
INVESTMENT IN COMMUNITY HEALTH PROVIDERS ORG18065C
INVESTMENT IN FCSDCS LLC805920C
INVESTMENT IN PHYSICIAN'S CHOICE REAL ESTATE-175727C
OTHER INVESTMENTS9098C
FieldValueIRS element (for citing)
Total Of Book Value Program Related2613350TotalOfBookValueProgramRelated

Other Assets OtherAssets (4 entries)

DescriptionDescriptionBook ValueBookValue
BOND ISSUANCE COSTS22264
DUE FROM SUBSIDIARIES60550
LOAN ORIGINATION COSTS35617
ESTIMATED THIRD PARTY SETTLMENT RECEIVABLE
FieldValueIRS element (for citing)
Total Book Value Other Assets118431TotalBookValueOtherAssets

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
CURRENT RELATED COMPANY PAYABLE
ESTIMATED THIRD PARTY SETTLEMENT PAYABLE$1,182,724
FieldValueIRS element (for citing)
Total Of Amounts1182724TotalOfAmounts
Total Revenue68593466TotalRevenue
Total Expenses70103078TotalExpenses
Excess Or Deficit For Year-1509612ExcessOrDeficitForYear
Excess Or Deficit Per FS-1509612ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt68951169TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-4797NetUnrealizedGainsInvestments
Other Revenues362500OtherRevenues
Revenue Not Rptd F990357703RevenueNotRptdF990
Revenue Subtotal68593466RevenueSubtotal
Total Revenue Per Form99068593466TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt70103078TotExpensesEtcAuditedFinclStmt
Expenses Subtotal70103078ExpensesSubtotal
Total Expenses Per Form99070103078TotalExpensesPerForm990

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent250XPcent250
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1886403TotalCommunityBenefitExpense
Net Community Benefit Expense1886403NetCommunityBenefitExpense
Percent Of Total Expense0.02690PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense7237057TotalCommunityBenefitExpense
Direct Offsetting Revenue4809050DirectOffsettingRevenue
Net Community Benefit Expense2428007NetCommunityBenefitExpense
Percent Of Total Expense0.03460PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense1703667TotalCommunityBenefitExpense
Direct Offsetting Revenue328860DirectOffsettingRevenue
Net Community Benefit Expense1374807NetCommunityBenefitExpense
Percent Of Total Expense0.01960PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense10827127TotalCommunityBenefitExpense
Direct Offsetting Revenue5137910DirectOffsettingRevenue
Net Community Benefit Expense5689217NetCommunityBenefitExpense
Percent Of Total Expense0.08110PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense31037TotalCommunityBenefitExpense
Net Community Benefit Expense31037NetCommunityBenefitExpense
Percent Of Total Expense0.00040PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Total Community Benefit Expense34813TotalCommunityBenefitExpense
Net Community Benefit Expense34813NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense204607TotalCommunityBenefitExpense
Net Community Benefit Expense204607NetCommunityBenefitExpense
Percent Of Total Expense0.00290PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense270457TotalCommunityBenefitExpense
Net Community Benefit Expense270457NetCommunityBenefitExpense
Percent Of Total Expense0.00380PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense11097584TotalCommunityBenefitExpense
Direct Offsetting Revenue5137910DirectOffsettingRevenue
Net Community Benefit Expense5959674NetCommunityBenefitExpense
Percent Of Total Expense0.08490PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$3,379,639BadDebtExpenseAmount
Amount Attributable To844910AmountAttributableTo
Amount Reimbursed By Medicare11738636AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16346868CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-4608232MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part V Form990ScheduleHPartV (2 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeLicensed HospitalLicensedHospitalGeneral Medical And SurgicalGeneralMedicalAndSurgical
COMMUNITY HOSPITAL
2021 N 12TH STREETGRAND JUNCTIONCO815012980X
FIRST CHOICE SAME DAY SURGICAL CENTER
2596 F ROADGRAND JUNCTIONCO81505X

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
Bad Debt FootnoteTHE HOSPITAL ESTABLISHES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON FACTORSBadDebtFootnote
Shortfall As Community BenefitAPPROXIMATELY 75% OR $3,456,174 OF THE MEDICARE SHORTAGE SHOULD BE TREATEDShortfallAsCommunityBenefit
Debt Collection PolicyPART OF THE HOSPITAL'S FINANCIAL ASSISTANCE AND CHARITY CARE WRITTENDebtCollectionPolicy
Needs AssessmentCOMMUNITY HOSPITAL USES THE STRATEGIC PLAN PROVIDED BY QUORUM HEALTHNeedsAssessment
Patient Education AssistancePART OF THE HOSPITAL'S WRITTEN FINANCIAL ASSISTANCE AND CHARITY CARE POLICYPatientEducationAssistance
Community InformationTHE HOSPITAL'S PRIMARY SERVICE AREA IS WESTERN COLORADO AND THECommunityInformation
Other InformationCOMMUNITY HOSPITAL EXPANDED ITS SERVICES TO MEET COMMUNITYOtherInformation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrg
CHRISTIAN THOMAS
3182636356832325451
WESLEY WHITE
17177218361767413133
DONALD NICOLAY
17180016321755322100
PAUL NUMSEN
24755236002555924440
JOSEPH KUPETS
24532724482521884413
JULIE MILLS
2499518042552574502
DEBRA SMITH
24684124482537054416
SCOTT VINCENT
24237536962504714400

Schedule L IRS990ScheduleL

Loan Table LoanTable

FieldValueIRS element (for citing)
Name PersonDR LOU BAIRNamePerson
Purpose Of LoanLEGAL SETTLEMENTPurposeOfLoan
Loan From OrganizationXLoanFromOrganization
Original Principal$164,110OriginalPrincipalAmount
Balance Due102811BalanceDue
DefaulttrueDefault
Approved By BoardtrueApprovedByBoard
Written AgreementtrueWrittenAgreement
FieldValueIRS element (for citing)
Total Balance Due102811TotalBalanceDue

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (32 entries)

IdentifierIdentifierExplanationExplanation
Pt VI-A, Line 2DIRECTORS MITCHELL COPELAND, STEVEN O'DELL, KEVIN HOWELL, AND DALE UTT
ARE PARTNERS IN A RELATED ENTITY, PHYSICIANS CHOICE REAL
ESTATE.
Pt VI-A, Line 3THE HOSPITAL HAS A MANAGEMENT AGREEMENT WITH QUORUM HEALTH
RESOURCES.
Pt VI-B, Line 11ATHE 990 IS PREPARED BY THE HOSPITAL'S INDEPENDENT CPA FIRM AND REVIEWED
BY THE HOSPITAL'S ACCOUNTING STAFF AND ADMINISTRATION, INCLUDING THE CEO, CFO,
AND COMPLIANCE OFFICER. A PRELIMINARY DRAFT IS PRESENTED TO THE EXECUTIVE
FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR DETAILED REVIEW AND APPROVAL.
A FINAL COPY OF THE 990 IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO THE FINAL
FILING WITH THE
IRS.
Pt VI-B, Line 12cTHE HOSPITAL'S CONFLICT OF INTEREST POLICY IS MAINTAINED AND MANAGED
BY THE CHIEF COMPLIANCE OFFICER. ON AN ANNUAL BASIS, ALL BOARD MEMBERS,
OFFICERS, AND KEY EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST
DISCLOSURE FORM AND SUBMIT IT TO THE COMPLIANCE DEPARTMENT. THAT
DOCUMENTATION IS REVIEWED BY AND RETAINED BY THE COMPLIANCE OFFICER.
ANY CONFLICTS OF INTEREST THAT ARISE ARE ADDRESSED BY THE COMPLIANCE
DEPARTMENT AND THE BOARD OF
TRUSTEES.
Pt VI-B, Line 15COMMUNITY HOSPITAL IS A QUORUM HEALTH RESOURCES MANAGED HOSPITAL
WHEREBY THE CEO IS AN EMPLOYEE OF THE MANAGMENT COMPANY. SALARY AND BENEFITS
FOR THE CEO ARE BASED ON THE MANAGEMENT COMPANY'S SALARY SURVEY DATA
FOR HOSPITALS OF COMPARABLE SIZE AND IS APPROVED BY THE EXECUTIVE
COMMITTEE OF THE BOARD OF TRUSTEES. SALARIES AND BENEFITS FOR OTHER
MEMBERS OF SENIOR MANAGEMENT ARE BASED ON SALARY SURVEY DATA COMPILED
BY THE HOSPITAL'S HR DEPARTMENT AND ARE APPROVED BY THE BOARD OF
DIRECTORS THROUGH THE ANNUAL BUDGET
PROCESS.
Pt VI-C, Line 19GOVERNING DOCUMENTS, POLICIES AND PROCEDURES, AND AUDITED FINANCIAL
STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST ON A CASE
BY CASE BASIS.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY HOSPITAL FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12021 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode
FieldValueIRS element (for citing)
EIN742576856EIN
Primary ActivitiesFUNDRAISINGPrimaryActivities
Legal Domicile StateCOLegalDomicileState
Exempt Code Section501(C)(3)ExemptCodeSection
Public Charity StatusIPublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1COLORADO WEST HEALTHCARE SYSTEMBusinessNameLine1

Form990 Schedule R Part III Form990ScheduleRPartIII

Name Of Related Org NameOfRelatedOrg

FieldValueIRS element (for citing)
Business Name Line1PHYSICIANS CHOICE REAL ESTATE LLCBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12012 N 12TH STREETAddressLine1
CityGRAND JUNCTIONCity
StateCOState
ZIP Code815012980ZIPCode
FieldValueIRS element (for citing)
EIN841601063EIN
Primary ActivityREAL ESTATEPrimaryActivity
Legal Domicile StateCOLegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1NABusinessNameLine1
FieldValueIRS element (for citing)
Predominant Income TypeINVESTMENTPredominantIncomeType
Share Of Total Income109113ShareOfTotalIncome
Share Of EOY Assets1469040ShareOfEOYAssets
Disproportionate AllocationsfalseDisproportionateAllocations
General Or Managing PartnertrueGeneralOrManagingPartner

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Type Of EntityTypeOfEntityShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsPercentage OwnershipPercentageOwnership
DOCTOR'S CLINIC BUILDING INC
1060 ORCHARD AVEGRAND JUNCTIONCO81501840507943REAL ESTATECONAC112426821032801.00000
COMMUNITY HEALTH PROVIDERS ORGANIZATION INC
2021 N 12TH STGRAND JUNCTIONCO81501841081855INSURANCECONAC21300260530.50000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgstrueRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (5 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
DOCTOR'S CLINIC BUILDING
d39744
COMMUNITY HEALTH PROVIDERS' ORGANIZATION INC
d21267
COMMUNITY HOSPITAL FOUNDATION
e451
DOCTOR'S CLINIC BUILDING
j554027
PHYSICIAN'S CHOICE REAL ESTATE
j634057

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