2025-04-09T11:16:15-05:00 2024-06-30 390758449 WIPFLI LLP 1502 LONDON ROAD SUITE 200 DULUTH MN 55812 990 2023-07-01 860334996 BISBEE HOSPITAL ASSOCIATION INC BISB 5204325383 101 COLE AVE BISBEE AZ 85603 ROBERT SEAMON CEO 5204325383 2025-04-09 1 1 MICHAEL J PETERSON CPA P01833529 2187224705 2025-04-08 2023 2025-03-06 01:10:19Z COPPER QUEEN COMMUNITY HOSPITAL ROBERT SEAMON 101 COLE AVE BISBEE AZ 85603 88077888 0 X WWW.CQCH.ORG X 1977 AZ TO MAINTAIN AND SUPPORT ACCESS TO PRIMARY HEALTHCARE THROUGHOUT SOUTHERN COCHISE COUNTY. 11 10 493 11 0 0 1880875 114743 68868358 83790699 1262757 2340771 1197166 1755731 73209156 88001944 59117 67768 0 0 33195298 37584505 0 0 0 29734370 36262520 62988785 73914793 10220371 14087151 92763573 108180060 12951812 14204390 79811761 93975670 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. 0 0 55839872 67768 85312305 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. 55839872 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 1 198 0 493 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 10 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 ERIK ARELLANO MD DIR./HOSP./FAMILY & OP PHYS. 40.00 X 419208 0 22335 ROSA ANEL LOPEZ PRESIDENT 3.00 X X 0 0 0 PATRICK COGHLAN MD VICE PRESIDENT/DIRECTOR 1.00 X X 0 0 0 REBECCA OROZCO SECRETARY/DIRECTOR 1.00 X X 0 0 0 ROSALIE BUTLER TREASURER (THRU AUG. '23) 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 LAWANA DIFFIE DIRECTOR 1.00 X 0 0 0 DENNIS GALLUS DIRECTOR 3.00 X 0 0 0 KATHLEEN HEARD DIRECTOR 1.00 X 0 0 0 DENNIS NELSON DIRECTOR 1.00 X 0 0 0 SYLVIA VALENZUELA DIRECTOR 1.00 X 0 0 0 ROBERT SEAMON CEO 40.00 X 419723 0 29813 HEATHER LUNDSTROM CFO 40.00 X 263671 0 20164 RICHARD SNURE MD GEN SURGEON/MED. DIR./HOSP./OP PHYS. 40.00 X 402734 0 22086 PEGGY AVINA MD MED. DIR./HOSP./FAMILY & OP PHYS. 40.00 X 400896 0 22386 HEIDI LODGE MD MED. DIR./HOSP./INT. MED. & OP PHYS. 40.00 X 383413 0 22746 VINOD SINGH MD GI & OP PHYSICIAN 40.00 X 382356 0 22086 SEAN SPURR DO MED. DIR./HOSP./INT. MED. & OP PHYS. 40.00 X 377163 0 22729 3049164 0 184345 79 0 1 0 AERGO SOLUTIONS LLC 33 WOOD AVENUE S ISELIN NJ 08830 FINANCIAL SERVICES 1635051 CERNER 2800 ROCKCREEK PKWY KANSAS CITY MO 64117 COMPUTER SUPPORT 1035101 SPS ARCHITECTS 8681 E VIA DE NEGOCIO SCOTTSDALE AZ 85258 ARCHITECT FOR NEW BUILDING 802368 CANYON BUILDERS 4750 N LA CHOLLA BLVD TUCSON AZ 85705 CONSTRUCTION CONTRACTOR 595665 PAYTECH 7979 E TUFTS AVE SUITE 1000 DENVER CO 80237 PAYROLL COMPANY 514552 35 10255 104488 114743 PATIENT SERVICE REVENUE 621400 82592884 82592884 340B REVENUE 621400 1197815 1197815 83790699 2416715 2416715 75944 -75944 -75944 -75944 CAFETERIA 722514 101235 101235 MEDICAL RECORDS 561000 6530 6530 1647966 1521606 126360 1755731 88001944 85312305 0 2574896 67768 67768 1232432 1232432 29040294 23421876 5618418 775144 636354 138790 4402556 3484396 918160 2134079 1674088 459991 24459 24459 27287 27287 3061179 3061179 3151 3151 7388452 7152114 236338 746100 1134 744966 614485 142854 471631 1802576 134045 1668531 1795636 1096706 698930 244447 190443 54004 86536 50099 36437 235465 135735 99730 2324671 1340071 984600 31955 31955 SUPPLIES EXPENSE 7685756 7679391 6365 BAD DEBT EXPENSE 7571859 7571859 TAXES AND LICENSES 1223851 16020 1207831 REPAIRS AND MAINTENANCE 726895 723956 2939 667760 320963 346797 73914793 55839872 18074921 0 44936020 54045414 456576 492797 10996900 13526389 1916501 2436554 1060078 1557071 61086052 27396551 32268242 33689501 596299 673057 532957 1759277 92763573 108180060 5150163 6189382 7765292 7524718 36357 490290 12951812 14204390 X 79811761 93975670 79811761 93975670 92763573 108180060 14087151 76758 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 3151 3151 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. 1255685 1255685 38587140 14010302 24576838 50318 39416 10902 18383347 13346833 5036514 2809562 2809562 33689501 LEASE OBLIGATION: FINANCE LEASE 490290 490290 1 1 X 1 X 1 X 1 1 0 0 371984 371984 0.00560 17580228 25105039 0 0.00000 17952212 25105039 371984 0.00560 13718270 3785636 9932634 0.14970 50000 50000 0.00080 13768270 3785636 9982634 0.15050 31720482 28890675 10354618 0.15610 9546 9546 0.00010 9546 9546 0.00010 0 1783632 891816 9684064 9641951 42113 X 1 1 1 1 BISBEE HOSPITAL ASSOCIATION INC DBA COPPER QUEEN COMMUNITY 101 COLE AVE BISBEE AZ 85603 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 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 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: COPPER QUEEN COMMUNITY HOSPITAL (CQCH) IS DEDICATED TO IMPROVING HEALTHCARE ACCESS IN SOUTHERN COCHISE COUNTY THROUGH LEADERSHIP, VISION, AND SERVICE DELIVERY. THEIR MISSION IS TO SUPPORT AND MAINTAIN PRIMARY HEALTHCARE ACCESS DESPITE THE COUNTY'S VAST SIZE. CQCH HAS EXPANDED GEOGRAPHICALLY WITH NEW PRIMARY CARE CLINICS IN TOMBSTONE AND HEREFORD, ALONGSIDE EXISTING CLINICS IN BISBEE, DOUGLAS, AND PALOMINAS. ADDITIONALLY, THEY OFFER A RANGE OF SPECIALTIES, INCLUDING CARDIOLOGY, ORTHOPEDICS, AND BEHAVIORAL HEALTH SERVICES, WITH PLANS FOR FURTHER GROWTH. CQCH'S COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IDENTIFIED THREE PRIORITIES: ACCESS TO GOOD HEALTHCARE: CQCH AIMS TO IMPROVE EQUITABLE ACCESS TO HEALTHCARE BY FILLING PRIMARY CARE PROVIDER POSITIONS, EXPANDING BEHAVIORAL HEALTH SERVICES, AND OFFERING MORE SPECIALIZED SERVICES LIKE UROLOGY AND PHYSICAL THERAPY. OTHER STRATEGIES INCLUDE EXTENDING QUICK CARE HOURS, ADDING A NEW WOUND CARE SERVICE, EXPANDING MOBILE MRI AVAILABILITY, AND INCREASING PATIENT AWARENESS OF SPECIALTY SERVICES. AVAILABILITY OF GOOD JOBS: AS CQCH EXPANDS, THEY ARE COMMITTED TO PROVIDING EMPLOYMENT OPPORTUNITIES, WITH PLANS TO INCREASE THEIR WORKFORCE TO 444 FULL-TIME EMPLOYEES AND 44 CONTRACTORS. FULL-TIME EMPLOYEES RECEIVE COMPREHENSIVE HEALTH BENEFITS, AND CQCH SUPPORTS LOCAL BUSINESSES. ACCESS TO HEALTHY AND AFFORDABLE FOODS: CQCH IS TACKLING FOOD INSECURITY IN THE COMMUNITY BY HIRING A COMMUNITY HEALTH WORKER TO ADDRESS SOCIAL DETERMINANTS OF HEALTH AND SUPPORTING LOCAL FOOD BANKS. THEY ALSO PROVIDE FREE ACCESS TO FRESH PRODUCE THROUGH THE "PRODUCE ON WHEELS" PROGRAM. THROUGH THESE STRATEGIES, CQCH AIMS TO INCREASE HEALTHCARE ACCESS, PROVIDE STABLE JOBS, AND IMPROVE FOOD SECURITY IN COCHISE COUNTY. 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. PART V, SECTION B, LINE 7A: HTTPS://WWW.CQCH.ORG/COPY-OF-PUBLIC-NOTICES PART V, SECTION B, LINE 10A: HTTPS://WWW.CQCH.ORG/COPY-OF-PUBLIC-NOTICES 7 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 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 6 - CQCH DOUGLAS PHYISCAL THERAPY 500 CHIRICAHUA ROAD BUILDING C DOUGLAS AZ 85607 PHYSICAL THERAPY 7 - CQCH BISBEE PHYSICAL THERAPY 850 WEST HIGHWAY 92 BISBEE AZ 85603 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 I, LINE 7G: THE COST OF SUBSIDIZED SERVICES IS BASED ON THE COST ALLOCATIONS FROM THE MEDICARE COST REPORT. ALLOWABLE COSTS ARE ASSIGNED DIRECTLY TO DEPARTMENTS THROUGHOUT THE YEAR AND THEN THE COST REPORT USES THE ALLOCATION METHODOLOGY TO ASSIGN ALL OTHER COSTS TO CALCULATE SERVICE LINE COSTS. SUBSIDIZED HEALTH SERVICES INCLUDE THE OPERATION OF THE HOSPITAL'S RURAL HEALTH CLINICS. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 7,571,859. 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: WE COORDINATE WITH OUR LOCAL HEALTH DEPARTMENT TO SERVE ADDITIONAL NEEDS OF THE COMMUNITY. WE ARE COLLABORATING WITH TUCSON MEDICAL CENTER TO PROVIDE FRESH FOOD TO OUR COMMUNITIES, AS THIS WAS IDENTIFIED ON OUR NEEDS ASSESSMENT AS A NEED IN THE AREA. 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) 50000 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 ROBERT SEAMON CEO 380097 0 39626 0 0 0 17691 0 12122 0 449536 0 0 0 ERIK ARELLANO MD DIR./HOSP./FAMILY & OP PHYS. 416401 0 2807 0 0 0 9386 0 12949 0 441543 0 0 0 RICHARD SNURE MD GEN SURGEON/MED. DIR./HOSP./OP PHYS. 400000 0 2734 0 0 0 9900 0 12186 0 424820 0 0 0 PEGGY AVINA MD MED. DIR./HOSP./FAMILY & OP PHYS. 398143 0 2753 0 0 0 9437 0 12949 0 423282 0 0 0 HEIDI LODGE MD MED. DIR./HOSP./INT. MED. & OP PHYS. 379786 0 3627 0 0 0 9797 0 12949 0 406159 0 0 0 VINOD SINGH MD GI & OP PHYSICIAN 380769 0 1587 0 0 0 9900 0 12186 0 404442 0 0 0 SEAN SPURR DO MED. DIR./HOSP./INT. MED. & OP PHYS. 374429 0 2734 0 0 0 9900 0 12829 0 399892 0 0 0 HEATHER LUNDSTROM CFO 191286 0 72385 0 0 0 5808 0 14356 0 283835 0 0 0 JOEY DEETER PARTNER OF CEO 114411 EMPLOYMENT COMPENSATION 0 ELIZABETH SILVA DAUGHTER IN LAW OF HR DIRECTOR 53668 EMPLOYMENT COMPENSATION 0 HOPE TERRAIN-SILVA GRANDDAUGHTER OF HR DIRECTOR 42473 EMPLOYMENT COMPENSATION 0 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 AGAINST NATIONAL BENCHMARKS. 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.