2024-05-07T14:52:16-05:00 2023-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2022-07-01 860334996 BISBEE HOSPITAL ASSOCIATION INC BISB 5204325383 101 COLE AVE BISBEE AZ 85603 ROBERT SEAMON CEO 5204325383 2024-05-07 1 ROBERT SEAMON 999009999 1 MICHAEL J PETERSON CPA P01833529 2187224705 2024-05-07 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z COPPER QUEEN COMMUNITY HOSPITAL ROBERT SEAMON 101 COLE AVE BISBEE AZ 85603 73288262 0 X WWW.CQCH.ORG X 1977 AZ TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY. 12 11 493 11 0 0 1662329 1880875 64302475 68868358 -129274 1262757 237955 1197166 66073485 73209156 56749 59117 0 0 28566546 33195298 0 0 0 30661929 29734370 59285224 62988785 6788261 10220371 83487894 92763573 13948268 12951812 69539626 79811761 X THE MISSION OF BISBEE HOSPITAL ASSOCIATION INC D/B/A COPPER QUEEN COMMUNITY HOSPITAL ("CQCH") IS TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY BY PROVIDING LEADERSHIP AND VISION TO ADDRESS OPPORTUNITIES AND CHALLENGES. 1 0 47249560 59117 69910158 TO PROVIDE HEALTHCARE SERVICES THROUGH IN-PATIENT, OUT-PATIENT, 24- HOUR EMERGENCY SERVICES, SPECIALTY CARE, AND RURAL HEALTH CLINICS TO THE RESIDENTS OF BISBEE & SURROUNDING COMMUNITIES IN SOUTHERN ARIZONA. 47249560 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 191 0 493 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 11 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X HEATHER LUNDSTROM 5204325383 101 COLE AVENUE BISBEE AZ 85603 VINOD SINGH GASTROENTEROLOGY PHYSICIAN 40.00 X 648345 0 10423 HEIDI LODGE INTERNAL MEDICINE PHYSICIAN 40.00 X 468351 0 26526 CRISTIAN LAGUILLO FAMILY PHYSICIAN 40.00 X 422530 0 25359 ERIK ARELLANO DIRECTOR/FAMILY PHYSICIAN 40.00 X 433721 0 24707 PEGGY AVINA FAMILY PHYSICIAN 40.00 X 442769 0 25503 SEAN SPURR FAMILY PHYSICIAN 40.00 X 407600 0 22729 ROBERT SEAMON CEO 40.00 X 377624 0 29203 HEATHER LUNDSTROM CFO 40.00 X 266911 0 20174 ROSA ANEL LOPEZ PRESIDENT 3.00 X X 0 0 0 DENNIS GALLUS DIRECTOR/PRESIDENT 3.00 X X 0 0 0 PATRICK COGHLAN MD VICE PRESIDENT/DIRECTOR 1.00 X X 0 0 0 DENNIS NELSON DIRECTOR/VICE PRESIDENT 1.00 X X 0 0 0 LAWANA DIFFLE SECRETARY 1.00 X X 0 0 0 REBECCA OROZCO SECRETARY/DIRECTOR 1.00 X X 0 0 0 ROSALIE BUTLER TREASURER 1.00 X X 0 0 0 PETER CAMPBELL DIRECTOR 1.00 X 0 0 0 LAURA CHAVEZ DIRECTOR 1.00 X 0 0 0 KATHLEEN HEARD DIRECTOR 1.00 X 0 0 0 SYLVIA VALENZUELA DIRECTOR 1.00 X 0 0 0 3467851 0 184624 95 0 1 0 CERNER 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 COMPUTER SUPPORT 1833585 AERGO SOLUTIONS LLC 33 WOOD AVENUE S ISELIN NJ 08830 FINANCIAL SERVICES 1526834 DIVERSIFIED DESIGN 3237 E FT LOWELL RD TUSCON AZ 85716 CONSTRUCTION CONTRACTOR 613820 ADAPTIVE WORKFORCE SOLUTIONS 3451 S MERCY ROAD 103 GILBERT AZ 85297 CONTRACT NURSES 514896 AUTHORITY RX LLC 7111 W 151ST ST SUITE 292 OVERLAND PARK KS 66223 340B CONSULTANT 463882 24 946600 934275 1880875 PATIENT SERVICE REVENUE 621400 67135341 67135341 340B REVENUE 621400 1733017 1733017 68868358 1341863 1341863 79106 -79106 -79106 -79106 CAFETERIA 722514 77206 77206 MEDICAL RECORDS 561000 4373 4373 1115587 1041800 73787 1197166 73209156 69910158 0 1418123 X 59117 59117 1163813 1163813 26040311 21584169 4456142 399313 342232 57081 3753576 2978172 775404 1838285 1443494 394791 19418 19418 29332 29332 2912237 2912237 2668 2668 7486349 7152123 334226 555914 2192 553722 621077 125753 495324 1671478 107771 1563707 1542269 862391 679878 215688 149941 65747 83202 32343 50859 270733 195430 75303 2167275 1564458 602817 27444 27444 SUPPLIES EXPENSE 6125389 6115053 10336 BAD DEBT EXPENSE 3628454 3628454 TAXES AND LICENSES 1199312 11507 1187805 REPAIRS AND MAINTENANCE 715525 710083 5442 460606 184877 275729 62988785 47249560 15739225 0 33845270 44936020 6570491 456576 8665353 10996900 1347866 1916501 1353829 1060078 57467379 25199137 30514551 32268242 544534 596299 646000 532957 83487894 92763573 3978764 5150163 8061602 7765292 1907902 36357 13948268 12951812 X 69539626 79811761 69539626 79811761 83487894 92763573 10220371 51764 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 2668 2668 0 PART II-B, LINE 1: THE ORGANIZATION PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE ARIZONA HOSPITAL ASSOCIATION (AHA) AND ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION (AZHHA). THESE DUES ARE PRIMARILY FOR ACCESS TO EDUCATIONAL MATERIALS AND STAFF TRAINING AND DEVELOPMENT. A PORTION OF THE ANNUAL DUES ARE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTH CARE ENVIRONMENT AND THAT IS REPORTED BACK TO THE HOSPITAL AS A MEMBER. 1239432 1239432 38427962 12847536 25580426 81938 29352 52586 17409890 12322249 5087641 308157 308157 32268242 LEASE OBLIGATION: FINANCE LEASE 36357 36357 1 1 X 1 X 250.000000000000 1 X 1 1 0 0 234588 234588 0.00370 19337520 21872700 0 0.00000 19572108 21872700 234588 0.00370 10676765 3242686 7434079 0.11800 59711 59711 0.00090 10736476 3242686 7493790 0.11890 30308584 25115386 7728378 0.12260 3 1665 0 0.00000 3 1665 0 0.00000 0 863010 431505 6114179 6095864 18315 X 1 1 1 1 BISBEE HOSPITAL ASSOCIATION INC DBA COPPER QUEEN COMMUNITY 100 E 5TH ST DOUGLAS AZ 85607 HTTPS://CQCH.ORG/ RGH0098 X X X X BISBEE HOSPITAL ASSOCIATION INC 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X SEE SUPPLEMENTAL INFORMATION 1 22 1 SEE SUPPLEMENTAL INFORMATION 0 1 X 100.000000000000 250.000000000000 X X X X 1 1 X X X X 1 X WWW.CQCH.ORG/FINANCIAL-ASSISTANCE X WWW.CQCH.ORG/FINANCIAL-ASSISTANCE X WWW.CQCH.ORG/FINANCIAL-ASSISTANCE X X X X X X X 1 X 0 X X X X 1 X 0 0 BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 5: THE 2023 NEEDS SURVEY WAS DESIGNED TO ASSESS THE COMMUNITY MEMBERS' PERSPECTIVES, ATTITUDES, AND FEELINGS ABOUT THE NEEDS IN THEIR COMMUNITY, NEIGHBORHOOD OR GROUP; ISSUES THEY PERCEIVE AS A COMMUNITY PROBLEM; AND THEIR DEFINITIONS OF "PERSONAL HEALTH AND "COMMUNITY HEALTH". THE SURVEY WAS AVAILABLE ONLINE OR ON PAPER (BY REQUEST) AND WAS DISTRIBUTED TO OVER 50,000 HOUSEHOLDS ACROSS COCHISE COUNTY. SURVEY QUESTIONS WERE DIVIDED INTO FIVE TOPIC AREAS INCLUDING RESPONDENT DEMOGRAPHICS, PHYSICAL/MENTAL HEALTH, HEALTHCARE ACCESS, QUALITY OF LIFE, AND SUGGESTIONS FOR IMPROVEMENT. WE ALSO CONDUCTED A SERIES OF FOUR FOCUS GROUPS THROUGHOUT THE COUNTY, WITH ONE OCCURRING IN EACH OF THE 4 DEFINED QUADRANT AREAS: BENSON, SIERRA VISTA, BISBEE/DOUGLAS, AND WILLCOX. BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 6A: THE CHNA WAS CONDUCTED WITH THE FOLLOWING COLLABORATIVE PARTNERS: BENSON HOSPITAL, CANYON VISTA MEDICAL CENTER, AND NORTHERN COCHISE COMMUNITY HOSPITAL BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 6B: THE CHNA WAS CONDUCTED WITH THE FOLLOWING COLLABORATIVE PARTNERS: FUTURE OF ARIZONA, CHIRICAHUA COMMUNITY HEALTH CENTERS, INC., COCHISE COUNTY SCHOOL SUPERINTENDENTS OFFICE, COCHISE COUNTY SHERIFF'S OFFICE, FIRST THINGS FIRST, LEGACY FOUNDATION OF SOUTHEASTERN ARIZONA, AND THE UNIVERSITY OF ARIZONA COOPERATIVE EXTENSION. BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 11: THE HOSPITAL COLLABORATED WITH THE COCHISE COUNTY TO CONDUCT THE COCHISE COUNTY CHNA IN 2023. CHNA IDENTIFIED HEALTH CONCERNS FOR THE COCHISE COUNTY, INCLUDING DIABETES, OBESITY, AND AGING PROBLEMS. IT WAS ALSO IDENTIFIED THAT THERE IS A LIMITED NUMBER OF SPECIALISTS AND BEHAVIOR HEALTH PROFESSIONALS. ACCESS TO AID PROGRAMS WAS ALSO IDENTIFIED IN OUR AREA AND THE COMMUNITY WOULD LIKE TO SEE RESOURCES FOCUSED ON BRINGING GOOD JOBS AND AFFORDABLE FOOD TO THE REGION. THE HOSPITAL IMPLEMENTED THE HEALTH LIVING PROGRAM, ANTIMICROBIAL STEWARDSHIP PROGRAM, MOBILE EYE CLINIC, 340B DRUG PROGRAM, AND HOSPITAL VACCINATION PROGRAM TO ADDRESS THE ISSUES IDENTIFIED IN THE CHNA. THE HOSPITAL ALSO HIRED ADDITIONAL SPECIALISTS INCLUDING PODIATRY, WOUND CARE, UROGYNECOLOGY AND HAVE SECURED A UROLOGIST FOR 2024. WE HAVE ALSO ADDED 2 ADDITIONAL BEHAVIOR HEALTH PROFESSIONALS TO OUR TEAM. OUR ORGANIZATION HAS ALSO INCREASED OUR WAGE SCALES TO RECRUIT AND RETAIN EMPLOYEES AND OFFER FREE INSURANCE TO OUR FULL TIME EMPLOYEES. BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 13H: PURSUANT TO ARIZONA PUBLIC ACT 03-266, ANY UNINSURED (AS DEFINED BY THE ACT) HOSPITAL PATIENT WHOSE INCOME (ALONE, WITHOUT REGARD TO AVAILABLE ASSETS) FALLS BELOW 250% OF THE FPGS WILL NOT BE CHARGED MORE THAN THE HOSPITAL'S COST OF PROVIDING SERVICES TO THE PATIENT.THERE ARE INSTANCES WHEN A PATIENT MAY APPEAR ELIGIBLE FOR CHARITY CARE DISCOUNTS, BUT THERE IS NO FINANCIAL ASSISTANCE FORM ON FILE AND THERE IS A LACK OF CORRESPONDING SUPPORTING DOCUMENTATION. HOWEVER, THERE IS OFTEN ADEQUATE INFORMATION PROVIDED BY THE PATIENT OR THROUGH EXTERNAL SOURCES WHICH COULD PROVIDE SUFFICIENT EVIDENCE TO OFFER THE PATIENT CHARITY CARE ASSISTANCE. IN THE EVENT THERE IS NO CONCRETE EVIDENCE TO SUPPORT A PATIENT'S ELIGIBILITY FOR CHARITY CARE, CQCH MAY USE OUTSIDE SOURCES IN DETERMINING CHARITY CARE ELIGIBILITY PRESUMPTIVELY. ONCE DETERMINED, DUE TO THE INHERENT NATURE OF THE PRESUMPTIVE CIRCUMSTANCES, THE DISCOUNT THAT WILL BE GRANTED IS A 100% WRITE OFF OF THE ACCOUNT BALANCE. PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES INCLUDING:(1) HOMELESS OR RECEIVED CARE FROM A HOMELESS CLINIC(2) DECEASED WITH NO SPOUSE AND NO ESTATE(3) APPROVED BY THE COURT FOR BANKRUPTCY BISBEE HOSPITAL ASSOCIATION INC PART V, SECTION B, LINE 16J: CQCH PROVIDES AN ADVOCATE AT LOCAL HEALTH FAIRS PUT ON BY THE HOSPITAL OR OTHERS TO INFORM COMMUNITY MEMBERS OF THE BENEFIT AND ASSIST IF NEEDED. WE ALSO ADVERTISE ON SOCIAL MEDIA LETTING PATIENTS KNOW WE HAVE SOMEONE AVAILABLE MON-FRI TO HELP DISCUSS AND ASSIST WITH FILLING OUT THE ASSISTANCE PAPERWORK. SCHEDULE H, PART V, LINE 3 CQCH WAS ACTIVELY INVOLVED IN THE WHOLE PROCESS OF CONDUCTING THE CHNA, AS WERE OTHER HOSPITALS IN THE COUNTY. THE HOSPITAL IDENTIFIED THE AREAS OF CONCERN AND HIGHER RISK COMMUNITIES, DRAFTED THE SURVEY QUESTIONNAIRES, AND LED THE DIRECTION OF HOW THE ASSESSMENT SHOULD BE CONDUCTED BY LECROY & MILLIGAN ASSOCIATES WHO WERE HIRED BY COCHISE COUNTY HEALTH AND SOCIAL SERVICES THROUGH A GRANT, TO DO DATA COLLECTION AND COMPILE THE REPORT. THERE WERE CHALLENGES WITH THE TIMING OF THE FINAL REPORT. THE COUNTY HEALTH DEPARTMENT HAD TURNOVER IN STAFFING, INCLUDING THE RESIGNATION OF BOTH THE HEALTH DIRECTOR AND HER DEPUTY IN MAY. THE STEERING COMMITTEE OF THE PROJECT HAD TO TAKE A LEAVE OF ABSENCE FOR HEALTH REASONS. IN A SMALL COMMUNITY AND RURAL COUNTY, IT IS DIFFICULT TO EFFECTIVELY REPLACE THOSE POSITIONS. FOR THAT SAME REASON, CONDUCTING THE CHNA WITH OTHER ORGANIZATIONS AND HEALTH DEPARTMENTS INCREASES THE DATA GATHERED AND POTENTIAL IMPACT IN IMPROVING THE COMMUNITY. IT ALSO ASSISTED WITH THE COST OF COMPLETING THE ASSESSMENT. THE INFORMATION CONTAINED BELOW IS FOR THE CHNA THAT WAS CONDUCTED BUT NOT FORMALLY COMPLETED UNTIL SHORTLY AFTER THE TAX YEAR ENDED 06/30/2023. PART V, SECTION B, LINE 7A: HTTPS://WWW.CQCH.ORG/PRICING-TRANSPARENCY PART V, SECTION B, LINE 10A: HTTPS://WWW.CQCH.ORG/PRICING-TRANSPARENCY 5 1 - DOUGLAS PRIMARY CARE CLINIC 100 E 5TH ST DOUGLAS AZ 85607 RURAL HEALTH CLINIC/QUICK CARE 2 - PALOMINAS PRIMARY CARE CLINIC 10524 HIGHWAY 92 PALOMINAS AZ 85615 RURAL HEALTH CLINIC/PHYSICAL THERAPY 3 - BISBEE PRIMARY CARE CLINIC 7 BISBEE ROAD BISBEE AZ 85603 RURAL HEALTH CLINIC 4 - TOMBSTONE PRIMARY CARE CLINIC 7 N SAN DIEGO ST TOMBSTONE AZ 85638 RURAL HEALTH CLINIC 5 - HEREFORD PRIMARY CARE CLINIC 4524 E HEREFORD ROAD HEREFORD AZ 85615 RURAL HEALTH CLINIC/PHYSICAL THERAPY PART I, LINE 3C: A PATIENT WILL BE DEEMED TO HAVE FINANCIAL NEED BASED ON THE FEDERAL POVERTY LEVELS (FPG) IN EFFECT FROM TIME TO TIME. INCOME INCLUDES SALARIES AND WAGES, LEGAL JUDGMENTS, UNEMPLOYMENT COMPENSATION, WORKER'S COMPENSATION, DIVIDENDS, INTEREST CHECKS AND OTHER RECURRENT SOURCES OF INCOME. PART I, LINE 7: THE COSTING METHODOLOGY USED ON FROM 990 IS BASED ON A COST-TO-CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990. PART II, COMMUNITY BUILDING ACTIVITIES: WE PROVIDE LIONS CLUB EYE EXAMS, WHICH WE PAY FOR, FOR THE COMMUNITY. WE ALSO OFFER OUR MENTAL HEALTH PROFESSIONALS TO OUR AREA FIREFIGHTERS, POLICE AND EMT'S WHEN THERE IS A TRAGIC ACCIDENT OR DEATH OF CHILDREN. WE ALSO DO SEVERAL OUTREACH TEACHINGS AT OUR LOCAL SENIOR HOMES AS WELL AS IN OUR SCHOOLS. DIFFERENT TOPICS WOULD BE NUTRITION, PROPER HYGIENE, AND UNDERSTANDING YOUR NUMBERS (BLOOD PRESSURE, A1C). WE ALSO PARTNER WITH CHIRICAHUA TO PROVIDE MAMMOGRAPHY SERVICES TO THEIR PATIENTS. PART III, LINE 2: THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST-TO-CHARGE RATIO, WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES EXCLUDING THE PROVISION FOR BAD DEBT, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST-TO-CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE YEAR TO ESTIMATE THE COST OF CARE OF PATIENTS WHO HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO RECOGNIZES THAT IT ALSO PROVIDES A DISCOUNT TO SELF-PAY OR UNINSURED PATIENTS. THESE AMOUNTS ARE EXCLUDED FROM GROSS PATIENT SERVICE REVENUE ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL. PART III, LINE 3: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY RESPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE HOSPITAL HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE IS REPORTED AT THE AMOUNT THAT REFLECTS THE CONSIDERATION TO WHICH THE ORGANIZATION EXPECTS TO BE ENTITLED IN EXCHANGE FOR PROVIDING PATIENT CARE SERVICES. PATIENT ACCOUNTS RECEIVABLE IS RECORDED IN THE ACCOMPANYING CONSOLIDATED BALANCE SHEETS NET OF CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS THAT REFLECT MANAGEMENT'S ESTIMATE OF THE TRANSACTION PRICE. THE ORGANIZATION ESTIMATES THE TRANSACTION PRICE BASED ON NEGOTIATED CONTRACTUAL AGREEMENTS, HISTORICAL EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS, AND IMPLICIT PRICE CONCESSIONS AND IS RECORDED THROUGH A REDUCTION OF GROSS REVENUE AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF THE CHANGE.IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE HOSPITAL ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE AMOUNTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY.FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. PART III, LINE 8: THE MEDICAL CENTER PROVIDES CARE TO INDIVIDUALS WHERE GOVERNMENT DEPARTMENTS DETERMINE THE AMOUNT OF REIMBURSEMENT OF SERVICE REGARDLESS OF THE COST TO PROVIDE THE SERVICE. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DOES NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT THE HOSPITAL AS WELL AS RADIOLOGIST, RESPIRATORY THERAPY, URGENT CARE, OR ANESTHESIA PROFESSIONAL SERVICES. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT THE HOSPITAL PROVIDES TO THE COMMUNITY AND SURROUNDING AREA. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST-TO-CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTH CARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY. PART III, LINE 9B: THE ORGANIZATION HAS A DEBT COLLECTION POLICY THAT INCORPORATES THE REQUIREMENTS OF 501(R). THE POLICY DEFINES THE PROCEDURES FOR REASONABLE EFFORTS NECESSARY TO PERFORM PRIOR TO ENGAGING IN COLLECTION EFFORTS AND EXTRAORDINARY COLLECTION ACTIONS. THE POLICY PROVIDES A TIMELINE FOR CERTAIN TOUCHPOINTS WITH A PATIENT TO ENSURE THEY ARE INCLUDED IN THE FINANCIAL ASSISTANCE PROGRAM IF ELIGIBLE. THE POLICY ALSO ADDRESS THE CEASE OF ACTIONS WHEN ELIGIBILITY OR POTENTIAL ELIGIBILITY IS DISCOVERED WHILE IN PROGRESS OF COLLECTION ACTIVITIES. PART VI, LINE 2: CQCH DID ANOTHER SURVEY TO PATIENTS ASKING ABOUT HEALTHCARE NEEDS FOR THEM AND OUR COMMUNITY. WE CONTINUE TO COLLABORATE WITH OUTSIDE ORGANIZATIONS TO UTILIZE THE DATA TO ASSESS THE HEALTH CARE NEEDS IN THE COMMUNITY. CQCH ALSO STARTED A PATIENT FAMILY PARTNERSHIP COUNCIL WHICH MEETS MONTHLY TO GO OVER PERSONAL CONCERNS OR AREAS THAT OUR ORGANIZATION CAN IMPROVE PATIENT CARE AND SATISFACTION. PART VI, LINE 3: CQCH HIRED A NEW PATIENT ADVOCATE TO WORK WITH PATIENTS AND ASSIST WITH ELIGIBILITY AND BILLING QUESTIONS AND CONCERNS. WE ALSO HAND OUT ASSISTANCE PACKAGES WHEN WE HAVE PATIENTS PRESENT WITHOUT INSURANCE. WE CONTINUE TO USE 250% OF POVERTY GUIDELINES TO HELP MORE OF OUR COMMUNITY. CQCH ALSO GOES THROUGH OUR SELF-PAY PATIENTS AND SEND OUT FINANCIAL ASSISTANCE PACKETS TO THEM AS WELL AS FOLLOW UP WITH PHONE CALLS. PART VI, LINE 4: LOCATED IN THE SOUTHEAST CORNER OF ARIZONA AND COVERING MORE THAN FOUR MILLION ACRES (6,165 SQUARE MILES), THIS COUNTY CONTAINS AN ACTIVE MILITARY BASE, RANCHES AND FARMS, SIGHTSEEING DESTINATIONS AND IT BORDERS THE COUNTRY OF MEXICO TO ITS SOUTH.ACCORDING TO ESTIMATES BY THE US CENSUS BUREAU, IN 2020 THE COUNTY WAS HOME TO 125,447 PEOPLE FROM ALL TYPES OF BACKGROUNDS, WITH A VARIETY OF SOCIAL, ECONOMIC, AND HEALTHCARE NEEDS. THE COUNTY'S RESIDENTS COME FROM DIVERSE CULTURES AND LIFESTYLES, FROM TOMBSTONE TO BISBEE, TO SIERRA VISTA AND FORT HUACHUCA, FROM WILLCOX TO DOUGLAS AND ALL OF THE RURAL UNINCORPORATED TOWNS IN BETWEEN AND ALONG THE MEXICAN BORDER.UNLIKE THE MAJORITY OF COUNTIES IN ARIZONA, COCHISE COUNTY CONTINUES TO SEE A DECLINE IN POPULATION. THE US CENSUS BUREAU'S 2021 POPULATION ESTIMATES INDICATE THERE ARE NOW 126,050 RESIDENTS IN THE COUNTY. PART VI, LINE 5: AT EACH OF OUR RHC'S WE HOLD ANNUAL HEALTH FAIR TO HELP EDUCATE THE COMMUNITY ABOUT OUR ORGANIZATION AND OUTSIDE ORGANIZATIONS - $3,500 CQCH PARTICIPATES IN BOTH THE PALOMINO'S AND SIERRA VISTA SCHOOL DISTRICTS ANNUAL EMPLOYEE WELLNESS EVENTS. SCHOLARSHIPS FOR HIGH SCHOOL STUDENTS $20,000. ATTENDS LOCAL HEALTH FAIRS AND EVENTS $5,000 COLLABORATES WITH COCHISE COUNTY HEALTH DEPARTMENT AND COORDINATES ADVERTISING $7,500. PART VI, LINE 6: N/A 1 COPPER QUEEN COMMUNITY HOSPITAL FOUNDATION 101 COLE AVENUE BISBEE AZ 85603 842690938 501(C)(3) 59117 0 ANNUAL PAYMENT TO DICKSON FUND AND OTHER FUND THROUGH FOUNDATION 1 0 PART I, LINE 2: THE ORGANIZATION HAS A LEADERSHIP MEETING TO REVIEW FUNDING REQUESTS AND EVALUATES THOSE IN LIGHT OF THE ORGANIZATION'S MISSION FOR IMPROVING THE QUALITY OF HEALTH CARE IN SOUTHERN ARIZONA. X X X X 0 0 0 0 0 0 0 0 0 VINOD SINGH GASTROENTEROLOGY PHYSICIAN 595673 0 52672 0 0 0 1462 0 8961 0 658768 0 0 0 HEIDI LODGE INTERNAL MEDICINE PHYSICIAN 455963 0 12388 0 0 0 13037 0 13489 0 494877 0 0 0 CRISTIAN LAGUILLO FAMILY PHYSICIAN 379827 0 27799 0 14904 0 11870 0 13489 0 447889 0 0 0 ERIK ARELLANO DIRECTOR/FAMILY PHYSICIAN 402551 0 31170 0 0 0 11258 0 13449 0 458428 0 0 0 PEGGY AVINA FAMILY PHYSICIAN 414970 0 27799 0 0 0 12054 0 13449 0 468272 0 0 0 SEAN SPURR FAMILY PHYSICIAN 404866 0 2734 0 0 0 9900 0 12829 0 430329 0 0 0 ROBERT SEAMON CEO 342155 0 35469 0 0 0 16857 0 12346 0 406827 0 0 0 HEATHER LUNDSTROM CFO 193001 0 73910 0 0 0 5850 0 14324 0 287085 0 0 0 JAMES LUNDSTROM HUSBAND OF CFO 121192 EMPLOYMENT COMPENSATION 0 JOEY DEETER PARTNER OF CEO 85129 EMPLOYMENT COMPENSATION 0 ELIZABETH SILVA DAUGHTER IN LAW OF HR DIRECTOR 48001 EMPLOYMENT COMPENSATION 0 HOPE TERRAIN-SILVA GRANDDAUGHTER OF HR DIRECTOR 38537 EMPLOYMENT COMPENSATION 0 FORM 990, PART III, LINE 2 WE ADDED ADDITIONAL BEHAVIORAL HEALTH PROVIDERS TO HELP WITH THE NEED AROUND MENTAL HEALTH IN OUR COMMUNITIES. WE ALSO STARTED A WOUND CARE CLINIC IN OUR DOUGLAS LOCATION AS MANY PEOPLE WERE HAVING TO TRAVEL TO TUCSON OR FARTHER FOR TREATMENT, IN MANY CASES THEY JUST WEREN'T GETTING THE CARE NEEDED. FORM 990, PART VI, SECTION B, LINE 11B THE DRAFT 990 FORM AND RELATED SCHEDULES ARE SENT TO AND REVIEWED BY BOARD MEMBERS AND MANAGEMENT BEFORE FILING. COMMENTS AND CHANGES ARE COMMUNICATED WITH THE TAX PREPARER AND ADDRESSED ACCORDINGLY PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C ANY DIRECTOR HAVING A CONFLICT OF INTEREST ON ANY MATTER BEING CONSIDERED BY THE BOARD OF DIRECTORS SHALL DISCLOSE TO THE OTHER DIRECTORS THE EXISTENCE OF SUCH CONFLICT OF INTEREST, AND THE DISCLOSURE SHALL BE NOTED IN THE MINUTES OF THE MEETING AND SUCH DIRECTOR SHALL ABSTAIN FROM ANY FURTHER ACTION OF DISCUSSION CONCERNING SAID ITEM OF BUSINESS, AND MAY BE REQUIRED TO REMOVE HIM/HERSELF FROM THE FORUM. THE FOREGOING REQUIREMENT SHALL NOT BE CONSTRUED SO AS TO PREVENT A DIRECTOR HAVING A CONFLICT OF INTEREST WITH THE CORPORATION FROM ANSWERING PERTINENT QUESTIONS OF OTHER DIRECTORS CONCERNING SAID ITEM OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 15 EXECUTIVE COMPENSATION IS SET BY THE BOARD BASED UPON REVIEW OF A BI-ANNUAL SALARY SURVEY BY THE ARIZONA HOSPITAL ASSOCIATION. THE HOSPITAL ALSO CONTRACTS WITH AN OUTSIDE CONSULTANT WHO ADVISES THE BOARD REGARDING EXECUTIVE COMPENSATION. THIS PROCESS IS UTILIZED IN SETTING SALARIES OF ALL THE EXECUTIVE TEAM AT THE HOSPITAL. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE TO THE PUBLIC THROUGH THE STATE UAR REPORT AND THE FEDERAL MEDICARE COST REPORT. FORM 990, PART IX, LINE 11G LAB SERVICES: PROGRAM SERVICE EXPENSES 1,229,725. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,229,725. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 5,111,450. MANAGEMENT AND GENERAL EXPENSES 334,226. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,445,676. EMERGENCY SERVICES: PROGRAM SERVICE EXPENSES 585,993. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 585,993. ANESTHESIOLOGIST SERVICES: PROGRAM SERVICE EXPENSES 224,955. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 224,955.