2024-05-14T07:53:19-05:00 2023-06-30 721396621 CARR RIGGS & INGRAM LLC 2424 LOUISIANA BLVD NE STE 300 ALBUQUERQUE NM 87110 990 2022-07-01 850141285 CIBOLA GENERAL HOSPITAL CIBO 5052874446 1016 E ROOSEVELT AVE GRANTS NM 87020 JIM HERMES CFO 5052874446 2024-05-13 1 JIM HERMES XXX-XX-XXXX 1 MARIA MATONTI P01790899 5058832727 2024-05-13 3 AAL1 IAL1 2022 2023-04-26 12:10:37Z JIM HERMES 1016 E ROOSEVELT AVE GRANTS NM 87020 47456085 0 X WWW.CIBOLAHOSPITAL.COM X 1959 NM TO PROVIDE HEALTH CARE SERVICES TO THE COMMUNITY WITHOUT REGARD TO ABILITY TO PAY BY UTILIZING STATE OF THE ART PRACTICES AND EQUIPMENT TO PROVIDE QUALITY CARE. 9 9 325 9 0 0 1534826 263772 42345599 46726955 110914 129509 10002 335849 44001341 47456085 0 0 0 0 24209364 27468307 0 0 0 21380815 22865882 45590179 50334189 -1588838 -2878104 41581720 39614068 7736014 8646466 33845706 30967602 X TO PROVIDE EXCELLENT HEALTH CARE TO THE COMMUNITY BY COMMITTING TO SERVICE, QUALITY, FINANCIAL STABILITY, AND GROWTH. THE ORGANIZATION STRIVES TO PROVIDE PATIENTS AND FAMILIES WITH QUALITY SERVICE BY IMPLEMENTING NATIONAL BEST PRACTICES AS STANDARDS. IT ALSO MAINTAINS FINANCIAL STABILITY TO ENSURE ITS CONTINUANCE AND GROWTH SO THAT HEALTH CARE IS ACCESIBLE THROUGH THE HOSPITAL AND ITS PHYSICIAN PARTNERSHIPS. 0 0 36610588 47062804 THE ORGANIZATION PROVIDES PATIENT CARE TO THE RESIDENTS OF GRANTS, NEW MEXICO AND OUTLYING COMMUNITIES WITHOUT REGARD TO ABILITY TO PAY. THERE ARE APPOXIMATELY 27,000 RESIDENTS IN THE CIBOLA COUNTY, NM COMMUNITY. CIBOLA COUNTY HOSPITAL UTILIZES STATE OF THE ART EQUIPMENT AND THE HIGHEST HEALTH CARE STANDARDS TO PROVIDE QUALITY HEALTH CARE. DURING THE FISCAL YEAR, THE ORGANIZATION HAD ABOUT 1,104 INPATIENT ADMISSIONS SERVED IN ITS 25-BED FACILITY. THE HOSPITAL ALSO HAD ABOUT 23,647 OUTPATIENT VISITS, 14,858 EMERGENCY ROOM VISITS, AND ABOUT 30,660 CLINIC VISITS. THE ORGANIZATION'S STAFF WORK HARD TO MEET PATIENT NEEDS AND THEY FEEL EVERY PATIENT ENCOUNTER IS AN ACCOMPLISHMENT. 36610588 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 88 0 1 325 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 NM X CIBOLA GENERAL HOSPITAL 5052874446 1016 E ROOSEVELT AVE GRANTS NM 87020 EILEEN YARBOROUGH CHAIRMAN 2.00 X X 0 0 0 KENDRA BROWN VICE CHAIRMAN 2.00 X X 0 0 0 DR STACEY DIMITT CHIEF OF MEDICAL STAFF/MEM 40.00 X X 351487 0 17519 ROBERT WINDHORST MEMBER 2.00 X 0 0 0 RON ORTIZ MEMBER 2.00 X 0 0 0 KEVIN BRANUM MEMBER 2.00 X 0 0 0 JOAN GILMORE MEMBER 2.00 X 0 0 0 STEPHANIE RIVARD MEMBER 2.00 X 0 0 0 HARRY SHESHKI MEMBER 2.00 X 0 0 0 THOMAS WHELAN CEO 40.00 X 215388 0 21066 JIM HERMES CFO 40.00 X 182785 0 9953 ABDUL AHMED PHYSICIAN 40.00 X 376115 0 17000 SNOW MARIKA PETERSEN PHYSICIAN 40.00 X 421908 0 19500 AMANDA YOUNG PHYSICIAN 40.00 X 410480 0 22076 ALFREDO NEVAREZ PHYSICIAN 40.00 X 442012 0 22076 ANALISA VILLARREAL PHYSICIAN 40.00 X 346668 0 17907 2746843 0 147097 55 0 1 0 FEDKO EMERGENCY PHYSICIANS NM LLC 1202 HIGHWAY 60 SOCORRO NM 87801 EMERGENCY DEPT MANAGEMENT 2250000 GE MEDICAL SYSTEMS 3000 N GRANDVIEW BLVD WAUKESHA WI 53188 SERVICE/MTNCE ON IMAGING EQUPMT 1477343 CERNER 2800 ROCK CREEK PKWY KANSAS CITY MO 64117 DATA PROCESSING SERVICES 1330307 QUORUM HEALTH RESOURCES 1573 MALLORY LN STE 100 BRENTWOOD TN 37027 HOSPITAL ADVISORY SERVICES 1324237 CARDINAL HEALTH RESOURCES 7000 CARDINAL PL DUBLIN OH 43017 MEDICAL/SURGICAL & DRUGS 1061833 27 188772 75000 263772 ACUTE CARE HOSPITAL SERVICES 622110 42245077 42245077 PATIENT SAFETY NET CARE POOL 622110 2741215 2741215 CIBOLA COUNTY MILL LEVY SUBSIDY 921190 1541947 1541947 OTHER PROGRAM REVENUE 622110 198716 198716 46726955 129509 129509 OTHER INCOME 900099 201269 201269 FOOD SERVICE INCOME 722514 134580 134580 335849 47456085 47062804 0 129509 798198 184503 613695 22073581 16555186 5518395 659873 494905 164968 2166615 1624961 541654 1770040 1327530 442510 59040 27749 31291 299487 299487 38790 38790 4656493 4656493 56391 56391 3351757 2513818 837939 603269 301635 301634 7869 7869 1462827 1097120 365707 1218608 913956 304652 PURCHASED SERVICES 7040937 3309240 3731697 MEDICAL, RX & FOOD SUPP 4053509 3526553 526956 MISCELLANEOUS EXP 16905 12679 4226 50334189 36610588 13723601 0 9136657 6171851 7342974 8939683 9872226 1079129 1207723 517462 578796 26693351 12252853 12098385 14440498 9810404 41581720 39614068 3001082 4226580 4734932 4419886 7736014 8646466 X 33845706 30967602 33845706 30967602 41581720 39614068 -2878104 0 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 5357620 931326 4426294 3358560 1426138 1932422 17564740 9895389 7669351 412431 412431 14440498 LONG-TERM LEASE LIABILITY 4419886 4419886 47456085 0 47456085 0 47456085 50334189 0 50334189 0 50334189 SCHEDULE D, PART VI, LINE 1(E): THIS LINE CONTAINS THE ORGANIZATION'S TOTAL NONDEPRECIABLE CONSTRUCTION IN PROCESS BALANCE. 1 1 1 X 350.000000000000 1 X 100.000000000000 1 1 0 0 729891 729891 0.01450 5797275 4580238 1217037 0.02420 6527166 4580238 1946928 0.03870 11347 11347 0.00020 40000 40000 0.00080 51347 51347 0.00100 6578513 4580238 1998275 0.03970 1 2117452 1045235 4078063 6531722 -2453659 X 1 1 1 1 CIBOLA GENERAL HOSPITAL INC 1016 E ROOSEVELT AVE GRANTS NM 87020 WWW.CIBOLAHOSPITAL.COM X CIBOLA GENERAL HOSPITAL INC 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X HTTP://WWW.CIBOLAHOSPITAL.COM/ 1 22 1 HTTP://WWW.CIBOLAHOSPITAL.COM/ 0 1 X 350.000000000000 100.000000000000 X X X X 1 1 X X X X 1 X HTTP://WWW.CIBOLAHOSPITAL.COM// X WWW.CIBOLAHOSPITAL.COM X X X 1 X 1 X X X X 1 0 0 CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 5: FOR THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE HOSPITAL SOUGHT INPUT FROM ALL PERSONS IN ITS SERVICE AREA, INCLUDING COUNTY GOVERNMENT AND LEADERS OF THE BUSINESS COMMUNITY. THE NEEDS ASSESSMENT WAS OFFERED ONLINE FROM A LINK TO IT IN THE HOSPITAL'S WEBSITE, AND WAS ALSO OFFERED IN A PAPER VERSION TO ANY WHO PREFERRED IT THAT WAY. THE PERSONS CONSULTED INCLUDED, BUT WERE NOT LIMITED TO, THE CEO, CFO, CCO, HR DIRECTOR, ALL MEMBERS OF THE BOARD, AND THE MEDICAL STAFF. THE NEEDS ASSESSMENT WAS HEAVILY ADVERTISED IN THE MEDIA. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 11: THE HOSPITAL AND ITS BOARD PRACTICE ONGOING PROMOTION OF HEALTH IMPROVEMENT. COMMUNITY HEALTH IS PROMOTED IN THE FOLLOWING WAY: (1) THE HOSPITAL BOARD IS A COMMUNITY-BASED, ALL VOLUNTEER GROUP; (2) SURPLUS FUNDS ARE USED TO REINVEST IN THE FACILITIES TO KEEP THEM STATE OF THE ART; (3) FINANCIAL SUPPORT TO THE LOCAL COLLEGE FUNDS THE SALARY OF THE NURSING PROGRAM DIRECTOR; (4) THE HOSPITAL CO-SPONSORS AN ANNUAL HEALTH FAIR TO EDUCATE THE COMMUNITY; (5) ANNUAL VACCINATION CLINICS ARE STAFFED BY HOSPITAL NURSES; AND (6) FREE CLASSES ARE SPONSORED IN DIABETES EDUCATION, CHILDBIRTH, AND BREASTFEEDING. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 18E: OUTSIDE COLLECTION AGENCIES ARE USED. THE RECOVERY RATES BY THESE AGENCIES ARE TYPICALLY UNDER 10%. CIBOLA GENERAL HOSPITAL, INC. PART V, SECTION B, LINE 20E: PATIENTS ARE NOTIFIED UPON ADMISSION AND DISCHARGE OF THE FINANCIAL ASSISTANCE PROGRAM. ALSO, THE ORGANIZATION DOCUMENTS ITS DETERMINATION OF ELIGIBILITY AND NOTIFIES PATIENTS OF THE POLICY IN COMMUNICATIONS WITH PATIENTS REGARDING THEIR BILLS. PART I, LINE 7: AMOUNT REPORTED ON LINE A, COLUMN C IS BASED ON THE ORGANIZATION'S COST TO CHARGE RATIO. LINE B, COLUMN D USES COST TO CHARGE RATION OFFSET BY A CONTRACTUAL PERCENTAGE LEADING TO THE AMOUNT REPORTED IN COLUMN E. LINE E, COLUMN C AND LINE F, COLUMN C ARE BASED ON ACTUAL COST. ALSO, LINE 7, COLUMN G IS NOT APPLICABLE; THEREFORE NOTHING ENTERED. PART I, LINE 3C THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: (1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. (2) PROOF OF HOUSEHOLD INCOME. AND (3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. PART III, LINE 4: THERE IS NO MENTION OF BAD DEBT EXPENSE NOR ITS CALCULATION METHODOLOGY WITHIN AUDITED FINANCIAL STATEMENT REPORT. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL SHOULD BE REGARDED AS COMMUNITY BENEFIT. PART III, LINE 9B: PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE ARE CONSIDERED IN THE PROCESS. PART VI, LINE 3: THE APPLICANT FOR FINANCIAL ASSISTANCE MUST SUBMIT THE FOLLOWING AS PROOF OF INCOME: (1) COMPLETED FINANCIAL ANALYSIS FORM, INCLUDING NUMBER OF PERSONS IN THE HOUSEHOLD, LOCATION OF EMPLOYER AND LENGTH OF EMPLOYMENT, DISCLOSURE OF PROPERTY AND REAL ESTATE OWNED, INCOME OF RESPONSIBLE PARTY AND SPOUSE, BANK BALANCES, AND LISTING OF MONTHLY EXPENSES. (2) PROOF OF HOUSEHOLD INCOME. AND (3) DISCLOSURE OF ANY OTHER SUPPORT RECEIVED. PART VI, LINE 7, REPORTS FILED WITH STATES NM PART VI, LINE 2: THE ORGANIZATION OBTAINS A GREAT AMOUNT OF INFORMAL FEEDBACK FROM PATIENTS AND VISITORS. PART VI, LINE 3: IF DURING THE PATIENT REGISTRATION PROCESS IT IS DETERMINED THAT THE PATIENT LACKS THE ABILITY TO PAY, THEN THE REGISTRATION PERSON WILL PRESENT THE PATIENT THE INFORMATION NEEDED FOR HIM/HER TO APPLY FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: CIBOLA GENERAL HOSPITAL PROVIDES MEDICAL SERVICES IN A COUNTY THAT REPRESENTS APPROXIMATELY 27,000 RESIDENTS. PART VI, LINE 5: A TRANSPARENT BOARD, INVOLVED MEDICAL STAFF, AND EMPLOYEES WHO ARE ALSO CITIZEN-STAKEHOLDERS HELP PROMOTE COMMUNITY HEALTH. PART VI, LINE 6: THE ORGANIZATION IS NOT A PART OF AN AFFILIATED HEALTH CARE SYSTEM. X X 0 0 0 0 0 0 0 0 0 ALFREDO NEVAREZ PHYSICIAN 442012 0 0 0 0 0 0 0 22076 0 464088 0 0 0 SNOW MARIKA PETERSEN PHYSICIAN 421908 0 0 0 0 0 0 0 19500 0 441408 0 0 0 AMANDA YOUNG PHYSICIAN 410480 0 0 0 0 0 0 0 22076 0 432556 0 0 0 ABDUL AHMED PHYSICIAN 376115 0 0 0 0 0 0 0 17000 0 393115 0 0 0 DR STACEY DIMITT CHIEF OF MEDICAL STAFF/MEM 351487 0 0 0 0 0 0 0 17519 0 369006 0 0 0 ANALISA VILLARREAL PHYSICIAN 346668 0 0 0 0 0 0 0 17907 0 364575 0 0 0 THOMAS WHELAN CEO 215388 0 0 0 0 0 0 0 21066 0 236454 0 0 0 JIM HERMES CFO 182785 0 0 0 0 0 0 0 9953 0 192738 0 0 0 FORM 990, PART VI, SECTION A, LINE 7A CIBOLA COUNTY APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE A COUNTY COMMISSIONER. THE HOSPITAL BOARD APPOINTS 4 BOARD MEMBERS, ONE OF WHOM WILL BE THE CHIEF OF THE MEDICAL STAFF. THE 9TH MEMBER OF THE BOARD IS APPOINTED AT THE FIRST ANNUAL MEETING BASED ON A MAJORITY VOTE OF THE OTHER 8 BOARD MEMBERS. FORM 990, PART VI, SECTION A, LINE 7B THE BOARD WILL REFER SIGNIFICANT CAPITAL PROJECT PROPOSALS AND TRUSTEE APPOINTMENTS TO THE COUNTY COMMISSIONER FOR APPROVAL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 AND RELATED SCHEDULES ARE REVIEWED BY THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 12C ALL TRUSTEES, OFFICERS AND EMPLOYEES ARE REQUIRED ANNUALLY TO DISCLOSE ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST IN WRITING. THE FORM IS SIGNED AND DATED, AND MONITORED BY THE COMPLIANCE COORDINATOR. FORM 990, PART VI, SECTION B, LINE 15 COMPENSATION OF OFFICERS AND HIGHLY PAID EMPLOYEES IS DETERMINED BY REVIEW OF COMPARABLE PAY FOR COMPARABLE DUTIES BY RECRUITERS, AND/OR OTHER CONSULTANTS. ALL AMOUNTS ARE APPROVED BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 ALL GOVERNING DOCUMENTS AND TAX FORMS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ALSO, THE CEO REPORTS REGULARLY TO THE COUNTY COMMISSION AT A PUBLIC MEETING AND THE BOARD HOLDS MONTHLY PUBLIC MEETINGS. FORM 990, PART XII, LINE 2C: THE BOARD SELECTS THE AUDITORS AND OVERSEES THE AUDIT PROCESS; THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.