TY 2014 Form 990

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)	(C) Position (do not check more than one box, unless person is both an officer and a director/trustee)
(1) Byron Belew........................................................................ Chairperson	1 .......................0	X		0
(2) Ed Carpenter........................................................................ Secretary	1 .......................0	X		0
(3) Fernando Shipley........................................................................ Treasurer	1 .......................0	X		0
(4) Jim Rasmussen........................................................................ Vice Chairman	1 .......................0	X		0
(5) Janice Cook........................................................................ Director	1 .......................0	X		0
(6) Jendean Sartain........................................................................ Director	1 .......................0	X		0
(7) Gary Gustason........................................................................ Director	1 .......................0	X		0
(8) Brad Werrell........................................................................ Director	1 .......................0	X		0
(9) Alan Osumi........................................................................ Director	1 .......................0	X		0
(10) Eddie Koury........................................................................ Director	1 .......................0	X		0
(11) Robert Hollis........................................................................ Director	1 .......................0	X		0
(12) Joseph Ring........................................................................ Director	1 .......................0	X		0
(13) Dana Miller........................................................................ Physician	40 .......................0		X	318,511
(14) Binoy Chandra........................................................................ Physician	40 .......................0		X	261,002
(15) Phuong Nguyen........................................................................ Physician	40 .......................0		X	218,587
(16) Anthony Daniels........................................................................ Physician	40 .......................0		X	273,966
(17) Thomas Hansen........................................................................ Physician	40 .......................0		X	346,607

(A) Name and business address	(B) Description of services	(C) Compensation
Comphealth PO Box 972651 Dallas,TX75397	OB Locum Services	238,556
Cobre Valley Heart Institute 2055 Highway 60 Globe,AZ85501	Cardiologist	706,453
VTR Cobre Valley PO Box 846208 Dallas,TX75284	Rent and associated services	385,654
SHC Services PO Box 27124 Salt Lake City,UT84127	Contract Labor	267,377
ARUP Laboratories PO Box 27964 Salt Lake City,UT84127	Lab Testing	218,996
2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	16,404,014	13,123,211	3,280,803
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	3,696,387	2,957,110	739,277
10	Payroll taxes ...........
11	Fees for services (non-employees):
a	Management ......
b	Legal .........
c	Accounting ...........
d	Lobbying ...........
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	6,057,759	4,846,207	1,211,552
12	Advertising and promotion ....
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,122,098	897,678	224,420
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........	324,650	259,720	64,930
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	2,194,042	1,755,234	438,808
23	Insurance ..............	596,053	476,842	119,211
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	Medical Supplies	6,222,313	5,977,850	244,463	0
b	Repairs and maintenance	1,129,179	903,343	225,836	0
c	Debt extinguisment	229,742	0	229,742	0
d
e	All other expenses	994,899	793,789	201,110
25	Total functional expenses. Add lines 1 through 24e	38,971,136	31,990,984	6,980,152	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	2,772,095	1	4,324,087
2	Savings and temporary cash investments .........	13,338,734	2	13,790,474
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	6,230,467	4	5,079,527
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
			6
7	Notes and loans receivable, net .............		7	1,321,717
8	Inventories for sale or use ..............	1,308,738	8	1,352,028
9	Prepaid expenses and deferred charges ..........	422,132	9	395,247
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	46,069,027
b	Less: accumulated depreciation .....	10b	29,982,932	16,708,638	10c	16,086,095
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	2,510,076	15	28,729,141
16	Total assets. Add lines 1 through 15 (must equal line 34)......	43,290,880	16	71,078,316
	17	Accounts payable and accrued expenses .........	3,655,375	17	3,866,718
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	5,745,000	20	33,000,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,758,907	23	1,102,111
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................	1,334,093	25	336,000
26	Total liabilities. Add lines 17 through 25.........	12,493,375	26	38,304,829
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	30,338,171	27	32,231,839
28	Temporarily restricted net assets ...........	459,334	28	541,648
29	Permanently restricted net assets ...........	0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances ...........	30,797,505	33	32,773,487
34	Total liabilities and net assets/fund balances ........	43,290,880	34	71,078,316

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

Cobre Valley Regional Medical Center

Employer identification number

86-0732836

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions.

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

Provide the following information about the supported organization(s).

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..
11	Total support Add lines 7 through 10.

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2013. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2014. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2013. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:	14000267
Software Version:	v1.00

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below. SchCMd Bullet

Attach to Form 990 or Form 990-EZ.
SchCMd Bullet

Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

If the organization answered "Yes" to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" to Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Cobre Valley Regional Medical Center

Employer identification number

86-0732836

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2014

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check SchCMd Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated group totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(e) Total

2a	Lobbying nontaxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots nontaxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2014

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

For each "Yes" response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? ..........................

Total. Add lines 1c through 1i ...............................

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."

Dues, assessments and similar amounts from members .....................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ............................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:	14000267
Software Version:	v1.00

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet

Attach to Form 990.
Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Cobre Valley Regional Medical Center

Employer identification number

86-0732836

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register ....................	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................

Yes No

In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:

(i)

Revenue included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:

Revenue included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 52283D

Schedule D (Form 990) 2014

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIII and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability?

Yes No

If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII .......

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current year	(b)Prior year	b (c)Two years back	(d)Three years back	(e)Four years back
1a	Beginning of year balance ....
b	Contributions ........
c	Net investment earnings, gains, and losses
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Temporarily restricted endowment SchDMd Bullet

The percentages in lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. See Form 990, Part X, line 10.

Description of property		(a) Cost or other basis (investment)	(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	0	904,177		904,177
b	Buildings ................	0	21,427,805	11,993,173	9,434,632
c	Leasehold improvements ............	0	0	0	0
d	Equipment ................	0	21,338,447	17,989,759	3,348,688
e	Other .................	0	2,398,598	0	2,398,598
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......					16,086,095

Schedule D (Form 990) 2014

Page 3

Part VII

InvestmentsOther Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)		(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1) Bond Issue Costs				206,125
(2) Assets limited as to use				28,523,016







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				28,729,141

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes		0
Third Party Settlements		336,000








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		336,000
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII

Schedule D (Form 990) 2014

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......			1	40,947,118
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	153,723
b	Donated services and use of facilities .........	2b	0
c	Recoveries of prior year grants ...........	2c	0
d	Other (Describe in Part XIII.) ............	2d	0
e	Add lines 2a through 2d .....................			2e	153,723
3	Subtract line 2e from line 1.....................			3	40,793,395
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a	0
b	Other (Describe in Part XIII.) ...........	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	40,793,395

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........			1	38,971,136
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a	0
b	Prior year adjustments ..............	2b	0
c	Other losses ................	2c	0
d	Other (Describe in Part XIII.) ............	2d	0
e	Add lines 2a through 2d......................			2e	0
3	Subtract line 2e from line 1.....................			3	38,971,136
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a	0
b	Other (Describe in Part XIII.) ............	4b	0
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	38,971,136

Part XIII

Supplemental Information

Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.

Return Reference	Explanation

Schedule D (Form 990) 2014

Additional Data

Software ID:	14000267
Software Version:	v1.00

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Cobre Valley Regional Medical Center

Employer identification number

86-0732836

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...

Yes

If "Yes," was it a written policy? .......................

Yes

If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

which of the following was the family income limit for eligibility for discounted care: .........

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.

Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

Yes

Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............

Did the organization prepare a community benefit report during the tax year? ..........

Yes

If "Yes," did the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Financial Assistance and Certain Other Community Benefits at Cost

Financial Assistance and Means-Tested Government Programs		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a	Financial Assistance at cost (from Worksheet 1) ..			2,638,437
b	Medicaid (from Worksheet 3, column a) ....			11,084,329
c	Costs of other means-tested government programs (from Worksheet 3, column b) .			0
d	Total Financial Assistance and Means-Tested Government Programs .	0	0	13,722,766	0	0	0 %
Other Benefits				208,460
e	Community health improvement services and community benefit operations (from Worksheet 4) ..			208,460
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..	0	0	208,460	0	0	0 %
k	Total. Add lines 7d and 7j .	0	0	13,931,226	0	0	0 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.

		(a) Number of activities or programs (optional)	(b) Persons served (optional)	(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development
9	Other
10	Total

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

3,208,616

Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......

3,208,616

Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

12,088,076

Enter Medicare allowable costs of care relating to payments on line 5.....

12,911,454

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-823,378

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

Yes

Part IV

Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership %	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2014

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Part VFacility Information

Section A. Hospital Facilities (list in order of size from largest to smallest—see instructions) How many hospital facilities did the organization operate during the tax year?1 Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Cobre Valley Regional Medical Center 5880 South Hospital Drive Globe,AZ85501 www.cvrmc.org	X	X	X	X

Schedule H (Form 990) 2014

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Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)

	Cobre Valley Regional Medical Center
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12....................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

Information gaps that limit the hospital facility’s ability to assess the community’s health needs

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Did the hospital facility make its CHNA report widely available to the public? ..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): cvrmc.org

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 14

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): cvrmc.org

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	Cobre Valley Regional Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

Did the hospital facility have in place during the tax year a written financial assistance policy that:

Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of %
and FPG family income limit for eligibility for discounted care of %

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	Cobre Valley Regional Medical Center
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (check all that apply):

Notified individuals of the financial assistance policy on admission

Notified individuals of the financial assistance policy prior to discharge

Notified individuals of the financial assistance policy in communications with the individuals regarding the individuals’ bills

Documented its determination of whether individuals were eligible for financial assistance under the hospital facility’s financial assistance policy

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.

The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged

The hospital facility used the average of its three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged

The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged

Other (describe in Section C)

During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ................................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 5-Cobre Valley Regional Medical Center	As part of the 990 IRS reporting for 501C 3 organizations, CVRMC, along with members of the community, was required to conduct a Community Health Needs Assessment. The first step in the process was to accumulate information related to the health of the community from sources such as the Environmental Assessment and Market Share Report HealthTech and The Gila County Health Department Community Health Improvement Plan. A Community Advisory Committee was organized to share ideas, information, and to develop a survey which was used to gather more data for the assessment. From this data and resource information, five key areas of health issues and needs were identified. The Community Health Needs Implementation Plan was developed as a plan of action to address the identified concerns. Through the implementation plan, key strategies can be executed by the community as a whole to promote health care.
Schedule H, Part V, Section B, Line 11-Cobre Valley Regional Medical Center	CVRMC uses outpatient surveys, Hospital Consumers Assessment of Healthcare Providers and Systems, and direct feedback to properly assess the needs of the communities it serves. Board input is vital to the success of the implementation strategy of the Community Health Needs Assessment.

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, from largest to smallest) How many non-hospital health care facilities did the organization operate during the tax year?4
Name and address		Type of Facility (describe)
1	Cobre Valley Surgical Services 5860 South Hospital Drive Globe,AZ85501	Surgical Clinic.
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

Page

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Form and Line Reference	Explanation
Schedule H, Part I, Line 2	Part VI Line 2 CONTINUED Arizona hospital discharge database from the Arizona Department of Health Services Thomson Reuters Market Expert is the source of the Medicare market share, demographics, insurance estimates and market volume projections Service areas are determined by analyzing the ZIP Codes from several perspectives including patient origin, market share, population, and geographic location of the ZIP Code. This information along with payer mix information can determine the inpatient market share by service area, discharges, inpatients market share by payer mix in the primary service area, inpatients market share by payer mix in the secondary service area, service line market share of primary service area, service line market share of the secondary service area, market share of emergency visits in the primary service area, market share of emergency visits in the secondary service area, and Medicare outpatient volume, and market share by competing hospitals in the metropolitan areas. Population trends are another determination for needs assessment. Population trends by ZIP Code are provided for the primary and secondary service areas of CVRMC as well as population trends by age. As the population trends increase or decrease, and health care needs change with age, it is definitely something to consider when strategically planning for future needs. Demographic snapshots are also provided by the report for each of the service areas that reflect various characteristics, including the education, household income, and ethnicity. These are important factors to consider when establishing marketing and public relations messages. Those in CVRMCs primary and secondary service areas are primarily White and Hispanic have a lower percentage than the U.S. with a high school degree, and a higher percentage than the U.S. with lower incomes. Diagnosis-Related Groups Groups of patients tend to have common demographic, diagnostic, and therapeutic attributes that determine their health care needs. Diagnosis-Related Groups DRG form a manageable, clinically coherent set of patient classes relating CVRMCs case mix to the resource demands and the associated costs experienced by the hospital. Database of Admissions Queries of the CVRMC Admissions database are a quick analytical source for determining the major health issues of the region. From this information education, prevention, and intervention can be determined and implemented in community benefit programs or released to other regional health organizations for tracking and trending the impact of their programs within the region. Case Management, Discharge Planning, and Social Work Through case management, discharge planning, and social work provided by CVRMC, data is generated by specific diagnosis related groups. This diagnosis data by group could be used to identify key risks for change, i.e. tobacco cessation or weight management programs. Many of these groups move on to long term care facilities, hospice services, or home care needs. CVRMC Board of Directors The CVRMC Board of Directors is strategically designed to encompass a variety of professions from the region. Mining, county government, ranching, banking, insurance, business, and medical professionals make up the members of the board which bring a diversity of ideas and information regarding health care needs within the service region. Other Data from the National Health Association and the Arizona Health Association gives CVRMC comparisons to national and state averages for specific health issues. Connectivity to organizations such as the County Health Department, regional school districts, and other health, safety, and regional associations provides information regarding health issues and needs. Diagnosis reports Chronic disease data
Schedule H, Part I, Line 3a	Part VI, Line 3 CONTINUED DETERMINATION OF FINANCIAL ASSISTANCE ELIGIBILITY Financial assistance will be determined through an individual assessment of financial need, including an application process in which the patient or the patients guarantor is required to cooperate and submit all documentation necessary to make the determination of financial need a reasonable effort by the CVRMC to explore and assist patients in applying for appropriate alternative sources of payment and coverage from public and private payment programs and will take into account the patients assets and other financial resources. It is preferred but not required that a request for financial assistance and a determination of financial need occur prior to rendering of medically necessary services. The need for financial assistance shall be reevaluated at each subsequent rendering of medically necessary services, if the last financial evaluation was completed more than one hundred eighty days prior, and at any time additional information relevant to the eligibility of the patient for financial assistance becomes known. The granting of financial assistance shall be based on an individualized determination of financial need, and shall not take into account age, gender, race, socioeconomic, sexual orientation or religious affiliation. In determining whether each individual qualifies for Financial Assistance, only those patient billings not covered by other county or governmental assistance programs should also be considered. Many applicants are not aware that they may be eligible for assistance such as AHCCCS or other government or private funded programs.Persons eligible for programs such as AHCCCS but whose eligibility status is not established for the period during which the medical services were rendered may be granted Financial Assistance for those services. CVRMC may make the granting of Financial Assistance contingent upon applying for governmental program assistance. This may be prudent, especially if the patient requires ongoing services. EXCLUSIONS 1. This policy and the Financial Assistance Program do not apply to the portion of charges an insured patient is personally responsible for, i.e., copays, coinsurance, and deductibles, and does not apply to elective procedures except as may be determined in the sole discretion of CVRMC on a case by case basis. METHOD FOR APPLYING FOR FINANCIAL ASSISTANCE 1. A copy of this Policy and Financial Assistance applications will be made available at the Hospital or by contacting Patient Accounts Billing Office at 9284253261. 2. Individuals who feel that they qualify for financial assistance under this Policy, or have requested that financial assistance be provided, are required to submit an application on the Hospital provided form during the Application Period. It is the applicants responsibility to provide proof of household income and or any other information provided on the application as requested by the Hospital. 3. The applicant is required to submit all information required on the financial assistance application form, including, but not limited to, the following information: a. Copy of AHCCCS denial letter May be waived on a case by case basis b. Copies of pay stubs for the last 2 pay periods c. Number of dependents claimed on tax return d. Copies of bills showing expenses 4. Failure to provide this information will result in an incomplete application, which may result in the individual being denied assistance under this Policy. 5. Completed applications shall be returned to the Patient Accounts/Billing Department within the Application Period. All eligible applications will be processed within 30 calendar days. Federal Poverty Guidelines as of 2014 2013 Federal 150% of 200% of 250% of 400% of Family size Note For each additional family member add 4,060 DISCOUNT Household incomes that exceed 400% of the FPG, where the patient is medically indigent, are evaluated based on their special circumstances. PATIENT CHARGES $1,000 $1,001 2,000 2,001 3,500 3,501 5,000 5,001 10,000 10,000 Income Level 0 100% FPG 100% 100% 100% 100% 100% 100% 100% AND 150% FPG 80% 85% 90% 95% 95% 95% 150% AND 200% FPG 70% 75% 80% 85% 85% 85% 200% AND 250% FPG 56% 56% 56% 60% 65% 65% 250% AND 300% FPG 56% 56% 56% 56% 56% 56% 300% AND 400% FPG 56% 56% 56% 56% 56% 56% PUBLICATION OF POLICY 1 This Policy, an application, a plain language summary of the Policy, and any notices or publications regarding the Policy will be made available on the Hospital's website www.CVRMC.org in pdf form. 2 The Policy, applications, and plain language summaries shall be available upon request, without charge at the Patient Accounts Billing Department and by mail. 3 A plain language summary shall be conspicuously displayed in Hospital patient waiting areas and in the Patient Accounts Billing Department in a manner that is reasonably calculated to attract visitors attention. 4 A plain language summary of this Policy and a copy of the financial assistance application will be provided to all patients upon admission or registration at the Hospital or Clinics. ACTIONS THAT MAY BE TAKEN IN EVENT OF NONPAYMENT OR INSUFFICIENT PAYMENT 1. Accounts for hospital services for patients who are able, but unwilling, to pay are considered uncollectible bad debts and will be referred to outside agencies for collections. REGULATORY REQUIREMENTS 1. In implementing this policy, CVRMC management and CVRMC facilities shall comply with all federal, state and local laws, rules and regulations that may apply to activities conducted pursuant to this policy. ACCOUNTING FOR FINANCIAL ASSISTANCE 1. CVRMC will track and monitor Financial Assistance care being granted and will account for the write offs as a separate Deduction from the Revenue general ledger account. RECORDKEEPING 1. Records relating to potential Financial Assistance applicants must be readily available. CVRMC will maintain a spreadsheet of all applicants and final disposition of the patients account. APPLICATION OF POLICY 1. This policy does not create an obligation to discount for any charges or services not included in the Hospital bill at the time of service. This policy does not apply to services provided within the Hospital by physicians or other medical providers including Emergency Physicians, Anesthesiologists, Radiologists, Pathologist, etc.
Schedule H, Part I, Line 4	Part VI, Line 4 CONTINUED Kearny, Arizona Secondary Service Area 8% Inpatient Patient Origin Kearny is located in Pinal County and was built by the Kennecott Mining Company in 1958 as a planned community to accommodate the populations of nearby Ray, Sonora and Barcelona, which were eventually swallowed by Kennecotts expanding open pit copper mine. The town sits near the Gila River in the Copper Basin area along with its sister cities of Hayden and Winkelman. The economic base of Kearny is the Ray mine and the Hayden Smelter, both owned and operated by ASARCO. Total 2010 Census Population for KEARNY, AZ 1,950 HOUSEHOLDS BY TYPE Total households for KEARNY, AZ 756 Family households families 534 With own children under 18 years Husband wife family 191 401 With own children under 18 years 127 Male householder, no wife present 37 With own children under 18 years 17 Female householder, no husband present 96 With own children under 18 years 47 Nonfamily households 222 Householder living alone 197 Male 98 65 years and over 36 Female 99 65 years and over Households with individuals under 18 years 67 239 Households with individuals 65 years and over Average household size of KEARNY, AZ 282 2.58 Average family size for KEARNY, AZ 3.09 POPULATION BY RACE FOR KEARNY, AZ What is the Population of KEARNY, AZ 1,950 One Race 1,883 White 1,623 Black or African American 9 American Indian and Alaska Native 15 Asian 8 Asian Indian 0 Chinese 2 Filipino 3 Japanese 2 Korean 0 Vietnamese 0 Other Asian 1 Native Hawaiian and Other Pacific Islander 1 Native Hawaiian 0 Guamanian or Chamorro 1 Samoan 0 Other Pacific Islander 0 Some Other Race 227 Two or More Races 67 White American Indian and Alaska Native 10 White; Asian 1 White; Black or African American 4 White; Some Other Race 45 Hayden, Arizona - Secondary Service Area Hayden is located in both Gila and Pinal counties with the economic base being the Hayden Smelter, one of four smelters in the United States. Total 2010 Census Population for HAYDEN, AZ 662 HOUSEHOLDS BY TYPE Total households for HAYDEN, AZ 236 Family households families 163 With own children under 18 years Husband wife family 50 98 With own children under 18 years 25 Male householder, no wife present 15 With own children under 18 years 9 Female householder, no husband present 50 With own children under 18 years 16 Nonfamily households 73 Householder living alone 61 Male 30 65 years and over 10 Female 31 65 years and over Households with individuals under 18 years 24 74 Households with individuals 65 years and over Average household size of HAYDEN, AZ 93 2.81 Average family size for HAYDEN, AZ 3.39 POPULATION BY RACE FOR HAYDEN, AZ What is the Population of HAYDEN, AZ 662 One Race 651 White 423 Black or African American 0 American Indian and Alaska Native 1 Asian 2 Asian Indian 1 Chinese 0 Filipino 1 Japanese 0 Korean 0 Vietnamese 0 Other Asian 0 Native Hawaiian and Other Pacific Islander 0 Native Hawaiian 0 Guamanian or Chamorro 0 Samoan 0 Other Pacific Islander 0 Some Other Race 225 Two or More Races 11 White; American Indian and Alaska Native 2 White; Asian 7 White; Black or African American 0 White; Some Other Race [3] 1 Winkelman, Arizona - Secondary Service Area (1.8% Inpatient Patient Origin) Winkelman is located in Gila and Pinal counties with over 95% of the population living within Gila County. The major employment is the copper industry of the ASARCO Mine. Total 2010 Census Population for WINKELMAN, AZ 353 HOUSEHOLDS BY TYPE Total households for WINKELMAN, AZ 136 Family households families 86 With own children under 18 years 22 Husband wife family 54 With own children under 18 years 10 Male householder, no wife present 13 With own children under 18 years 4 Female householder, no husband present 19 With own children under 18 years 8 Nonfamily households 50 Householder living alone 39 Male 14 65 years and over 8 Female 25 65 years and over 16 Households with individuals under 18 years 34 Households with individuals 65 years and over Average household size of WINKELMAN, AZ 66 2.6 Average family size for WINKELMAN, AZ 3.28 POPULATION BY RACE FOR WINKELMAN, AZ What is the Population of WINKELMAN, AZ 353 One Race 342 White 214 Black or African American 2 American Indian and Alaska Native 13 Asian 2 Asian Indian 0 Chinese 0 Filipino 0 Japanese 2 Korean 0 Vietnamese 0 Other Asian 0 Native Hawaiian and Other Pacific Islander 0 Native Hawaiian 0 Guamanian or Chamorro 0 Samoan 0 Other Pacific Islander 0 Some Other Race 111 Two or More Races 11 White; American Indian and Alaska Native 1 White; Asian 1 White; Black or African American 0 White; Some Other Race 8 Superior, Arizona - Secondary Service Area 1.4% Inpatient Patient Origin Superior is located in Pinal County 25 miles west of Globe. The town has survived many ups and downs of the copper mining industry throughout the years but during the most recent years is capitalizing on its unique and picturesque location. The town is in a rebuilding phase in its economy and is looking to the areas of tourism and the opportunity for a new underground mine, Resolution Copper, to open in the next 4 years. Total 2010 Census Population for SUPERIOR, AZ HOUSEHOLDS BY TYPE Total households for SUPERIOR, AZ 1,103 Family households families 709 With own children under 18 years 236 Husband wife family 477 With own children under 18 years 132 Male householder, no wife present 70 With own children under 18 years 28 Female householder, no husband present 162 With own children under 18 years 76 Nonfamily households 394 Householder living alone 333 Male 175 65 years and over 61 Female 158 65 years and over 95 Households with individuals under 18 years 321 Households with individuals 65 years and over 409 Average household size of SUPERIOR, AZ 2.57 Average family size for SUPERIOR, AZ 3.2 POPULATION BY RACE FOR SUPERIOR, AZ What is the Population of SUPERIOR, AZ 2,837 One Race 2,729 White 2,000 Black or African American 17 American Indian and Alaska Native 56 Asian 18 Asian Indian 1 Chinese 4 Filipino 4 Japanese 8 Korean 0 Vietnamese 0 Other Asian 1 Native Hawaiian and Other Pacific Islander 0 Native Hawaiian 0 Guamanian or Chamorro 0 Samoan 0 Other Pacific Islander 0 Some Other Race 638 Two or More Races 108 White American Indian and Alaska Native 23 White Asian 3 White Black or African American 15 White Some Other Race 49
Schedule H, Part I, Line 5a	Part VI, Question 5 CONTINUED The obvious extension of this success is to integrate local physicians offices into the system so information may be obtained quickly to the benefit of the patient and the provider. This has been accomplished through the direction of the Board of Directors, Administration, and the cooperation of the hospitals I.T. Department, trainers, physicians and their office staffs. As an additional component, referring and consultant physicians have been added so they have current information available as well. These benchmarks were achieved within the time frame identified in the five year I.T. Strategic Plan and have proven very beneficial to both patients and practitioners. Having information readily available has reduced visit times in the Emergency Department and optimized care in the physicians offices. The patient portal became operational in September of 2014. It has provided patients secure online access to personal health information. Using a secure username and password, patients can view health information such as their recent doctor visits, medications, and lab results for example. By improving patient-provider communication and empowering patients a more active role in their health, the result should be improved patient outcomes. Cobre Valley Regional Medical Center is striving to be the leader of health care in the service area, accountable for the health of the population served. Partnerships with the Gila County Health Department, the Tobacco Cessation Program, the Meth Coalition, Haven of Globe, Heritage Health Care Center, Gila County Community College, etc., and the local media have been established and can provide a forum for information dissemination and actual intervention services. Employee Education Cobre Valley Regional Medical Centers commitment to higher education for employees is evident in the continuation of tuition assistance. Employees are encouraged to further their education which in turn provides better care for patients. The tuition assistance program is a benefit provided to assist employees in improving their job capabilities within their work environment. Standards of Performance and Customer Service Training The CVRMC Standards of Performance were designed and created by a team of hospital staff whose goal was to develop a set of performance expectations for every employee to follow at all times. At CVRMC our position descriptions outline the duties and responsibilities every individual is accountable for in the commission of their respective jobs. The CVRMC Standards of Performance offers a definition and framework of behaviors that every employee will exhibit when interacting with patients, customers, and co-workers. These standards also provide the criteria by which an employee of CVRMC is evaluated. In our Standards of Performance we identify patients, customers, and co workers as our target service populations. At CVRMC we consider customers to include Physicians, Families, Vendors, Suppliers, and anyone else that we have contact with and the behavior expectations include privacy, attitude, communication, teamwork, courtesy, accountability, appearance, responsiveness, and safety. Every employee of CVRMC is required to attend customer service training to help drive our mission statement and to guide them in the standards of performance at every level of the organization. This customer training is also offered to every physician, their office staff, and organizations within the region, free of charge, in order to create a regional culture of compassionate health care. Community Involvement Employees of CVRMC are encouraged to volunteer and be involved in charitable community organizations. These associations include Rotary, the Community Concert Association, Little League, United Fund, Elks, County Fairs, blood drives, CARE Fair, Relay for Life, Health Fair, Adopt a Highway, school boards, March of Dimes, youth soccer, youth basketball, the library, job shadowing programs, Meals on Wheels, economic development, Meth Coalition, AZ Youth Partnership, church charities, and the Globe Miami and Superior Chambers of Commerce, to name a few. Employees who are involved beyond the hospital facility make a connection to the communities served. Wellness Program During 2014, CVRMC lost the coordinator of the Wellness Program. CVRMC is currently looking into re-implementing this program knowing healthier employees give better care. It is CVRMCs policy to engage employees as partners in assuring their best possible health and in reducing preventable healthcare costs for our employees provide a supportive work environment that promotes the optimal health and well being of our employees. Health Fair CVRMC hosts an annual health fair to promote good health awareness and to encourage participants to assume responsibility for their own health by providing free health screenings. Many community organizations are also encouraged to participate to bring their valuable health and safety information to one location, CVRMC campus, for the convenience of the people we serve. This year the health fair grew from 80 community associations participating to more than 90 organizations. Community organizations participating include local fire departments, law enforcement agencies, hospice care facilities, medical air ambulances, marrow donor program, donor networks, massage therapy, the American Heart Association, and many other organizations. The number of community members in attendance grew from over 800 to nearly 1,000 this year. CVRCM will continue to host this annual health event for the communities served. Internships For countless years CVRMC has provided internships for medical related fields such as RNs, CNAs, Physician Assistants, OR Techs, Radiology Techs, Phlebotomists, Respiratory Therapists, CRNAs, Medical Assistants, and Doctors of Osteopathy. These internships are provided free of charge and facilitate schools across Arizona A.T. Stills, Midwestern, Bryman, Central Arizona College, Apollo College, Pima, and Gila Community College. The advancement of medical professions is the responsibility of all medical facilities. CVRMC understands its role in resourcing the future of health care professionals and is committed to the interns we serve. Strategic Planning By aligning the direction of the 2012 Strategic Plan with the mission, vision, and values of CVRMC, the plan has been a cornerstone in implementing strategies in the areas of physician relations and capacity, customer service and quality, image and perception of CVRMC, workforce development, and regional growth. The next review of the strategic plan is scheduled for early 2015.
Schedule H, Part I, Line 5b	Part VI, Question 5 CONTINUED Community Health Needs Assessment and Implementation Plan CVRMC, along with members of the community, conducted a Community Health Needs Assessment. The first step in the process was to accumulate information related to the health of the community from sources such as the Environmental Assessment and Market Share Report HealthTech and The Gila County Health Department Community Health Improvement Plan. A Community Advisory Committee was organized to share ideas, information, and to develop a survey which was used to gather more data for the assessment. From this data and resource information, five key areas of health issues and needs were identified Urgent Care Access to Care Specialty Services Mental Health Preventative Care The Community Health Needs Implementation Plan is a plan of action to address the identified concerns of the region CVRMC serves. Expansion Construction Remodel The Board of Directors, Administration, and the staff of CVRMC have been working with architects, designers, and construction personnel for the 67,000 square foot expansion project slated to begin the first part of 2015. The purpose of the expansion is to provide more modern, single patient familycentered patient rooms and new amenities including physician offices, family birth center, ICU rooms, pharmacy, cath lab, wound center, family lounges, conference space, cafe and kitchen, and gift shop. The design will provide operational efficiencies and create opportunities for enhanced clinical collaboration. Other CVRMC is involved in many other community activities which help promote and support the mission of the hospital. These activities include the Annual Leadership Retreat, CV Auxiliary, Career Day, Certifications and Training, Childbirth Classes, Smoke Free Tobacco Free Campaign, Easter Egg Hunt, County Fair, Downtown Halloween Trick or Treat, Horseshoe Tournament, STEM activities, and Workforce Development. Summary and Future Cobre Valley Regional Medical Center has kept its finger on the pulse of its service region throughout 2014, reaching out to help the area in many different aspects, contributing over 2 million in community benefit and charity care. With the challenges health care reform presents at both the national and state levels, the focus in 2015 will be on customer service, growth, education, quality, technology, promotion of wellness, physician employeecommunity relations, communication, and fairness as we continue to respond to the service area needs and fulfill our mission To develop and maintain a healthcare delivery system that serves the region with quality, efficiency, and compassion.
Schedule H, Part I, Line 7	Cost to Charge ratio.
Schedule H, Part III, Section A, Line 4	PATIENT ACCOUNTS RECEIVABLE CONSIST OF AMOUNTS OWED BY VARIOUS GOVERNMENTAL AGENCIES, INSURANCE COMPANIES AND PRIVATE PATIENTS. THE HOSPITAL MANAGES ITS RECEIVABLES BY REGULARLY REVIEWING THE ACCOUNTS, INQUIRING WITH RESPECTIVE PAYORS AS TO COLLECTABILITY AND PROVIDING FOR ALLOWANCES ON THEIR ACCOUNTING RECORDS FOR ESTIMATED CONTRACTUAL ADJUSTMENTS AND NONCOLLECTABLE ACCOUNTS.
Schedule H, Part III, Section B, Line 8	The costing methodology is Cost to Charge, as calculated by the annual Medicare cost report.
Schedule H, Part III, Section C, Line 9b	CVRMC MANAGEMENT SHALL DEVELOP POLICIES AND PROCEDURES FOR INTERNAL AND EXTERNAL COLLECTION PRACTICES THAT TAKE INTO ACCOUNT THE EXTENT TO WHICH THE PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE, A PATIENT'S GOOD FAITH EFFORT TO APPLY FOR A GOVERNMENTAL PROGRAM OR FOR FINANCIAL ASSISTANCE FROM CVRMC, AND A PATIENTS GOOD FAITH EFFORT TO COMPLY WITH HIS OR HER PAYMENT AGREEMENTS WITH CVRMC.
Schedule H, Part VI, Line 2	Cobre Valley Regional Medical Center CVRMC completed our Community Health Needs Assessment in October of 2013. The Cobre Valley Community Health Needs Advisory Board consists of city government, county government, chambers of commerce, economic development, industry and business, public education, technology education, higher education, physicians, skilled nursing facilities, nursing homes, mental health professionals, county health, religious leaders, and service organizations. The first step in the process was to accumulate information related to the health of the community from sources such as the Environmental Assessment and Market Share Report HealthTech and The Gila County Health Department Community Health Improvement Plan. The Cobre Valley Community Health Needs Advisory Board was organized to share ideas, information, and to develop a survey which was used to gather more data for the assessment. From this data and resource information, five key areas of health issues and needs were identified Urgent Care Access to Care Specialty Services Mental Health Preventative Care The Community Health Needs Implementation Plan is a strategic plan of action to address the identified concerns. Currently, CVRMC utilizes several methods of assessing community health care needs. Evaluating the health needs of the CVRMC service area leads to identifying physicians needed in the area as well as recognizing those illnesses which can be targeted for community education and intervention. Community Feedback CVRMC utilizes many methods of community feedback for needs determination. Our patients, their families, and the greater community enlighten our organization through patient surveys and direct comments. CVRMC strives to give the very best care and in order to accomplish that goal, it is vital that patient and community comments and concerns are addressed. Professional Research Consultants PRC conducts outpatient surveys for the Outpatient Surgery, Physical Therapy, Registration, MedSurgICU, Obstetrics, Respiratory Therapy, Emergency, Laboratory, Clinics, and Radiology Departments on patient satisfaction. PRC also conducts the inpatient, Hospital Consumers Assessment of Healthcare Providers and Systems HCAHPS survey which measures patient satisfaction in multiple areas including promptness and efficiency of the admission and registration process, length of time waiting, nursing care, physician care, teamwork, discharge instructions, safety, cleanliness of the facility, food service, overall quality of care, and the likelihood of recommending the hospital to relatives and friends. Statistics regarding patient feedback are calculated on a weekly basis and distributed to all department directors with a hard copy, graphs are posted, and emails are dispersed to ensure all staff is informed of results. Management is then able to make necessary assessments of weak areas and strategically plan for improvements. Audio of the actual phone surveys are also available to all management. Many changes within CVRMC have been made as a direct result of the feedback obtained in these surveys. Hospital Consumers Assessment of Healthcare Providers and Systems HCAHPS is a standardized survey method conducted nationally and is publicly reported regarding the patients opinions and observations regarding their hospital care. This survey is helpful in determining how CVRMC measures against other hospitals across the nation. The public reporting aspect of this survey is a motivation factor for the hospital as a whole to improve quality of care, focusing on the patients needs. These objective and meaningful comparisons of hospitals on topics that are important to the consumer and the public reporting aspect of HCAHPS serves as a transparency tool which drives accountability and improves quality of care. Direct feedback from patients and family members is also a tool utilized for needs assessment. One of the many advantages of a rural hospital is the personal relationships the staff and patients are able to build. Direct phone calls, emails, or letters received from patients after their care has been provided is a valuable source of information for determining need. Legislative Actions Legislative decisions will have a dramatic effect on the direction CVRMC will move regarding community benefit as well as how healthcare for the region will be financed and delivered. As healthcare reform moves forth, CVRMC will continue to offer community benefit programs within its budgetary means in response to the needs of the region served. With changes to the Arizona Health Care Cost Containment System AHCCCS, CVRMC will continue to strive for growth, bringing new services to the hospital while focusing on prevention. The Payer Mix By identifying customers, CVRMC is able to determine to whom services are provided. This information is invaluable for the strategic planning and management of the hospital in regards to new services and or the addition of new providers. The payer mix also provides valuable information regarding the mix of services needed, education programs, new outreach programs, and future demands. The payer mix is also a very good indicator of the social economic structure of the community, allowing CVRMC to tailor programs to better meet the communities needs. Medical Staff Development Plan The approach used to project physician need for Cobre Valley Regional Medical Center's service area included the following Defining the CVRMC service area and market share by service area and service line Projecting the service areas population growth and characteristics for the next five years Taking into account competition and other local circumstances such as, inmigration, outmigration Developing a profile of the current medical staff including number, FTE, specialty, age, activity Identifying an appropriate demand model from among the available physician need estimation tools. Utilizing the above information, estimates are developed projecting the number of physicians by specialty required to serve the CVRMC service region. Methods used to project physician need include Demographics Population The source for the population is the Claritas Update Demographics CUD product. Estimates are data prepared for the current year and projections are prepared for dates five years in the future. The CUD is brought up to date each year for many geographic levels including national, state, county, city town, census tract and block group. Data is also available for commonly used areas as metropolitan areas, ZIP Codes, and other media areas. Because it is produced for small areas, the update can be easily aggregated to custom geographic areas specified by the user. Provider Supply Provider supply is provided by CVRMC management. Much of the physician information is obtained by medical staff rosters and the survey responses. The information gathered for the provider supply is the provider name, specialty, town in which they practice, office days and times, birth date, and any information about their practice. The office days and times are used to calculate a provider full time equivalent FTE. Provider Demand The two models used to determine provider demand and community need are the 1. Population Based Model which is obtained by multiplying Thomson Reuters physician to population ratios by the population of the service area. 2. Productivity Based Model provides data on current and projected physician resources required within a defined market. Service Area Definition A service area definition takes into consideration multiple factors including patient origin, market share, population and geography. The service area is defined as the geographic area from which a health care facility draws at least 75% of its patients and in which it maintains a considerable share of the health care market. The first step in defining CVRMCs service area is identification of the communities from which the hospital draws 75% of patients, and to assess the hospitals market share in each of these communities. The service area was then divided into two service areas Primary and Secondary. Three ZIP Codes have been identified as CVRMCs primary service area and five Zip Codes comprise the secondary service area. Out Migration Data CVRMC is located 85 miles southeast of the largest metropolitan area in Arizona. The cities of Phoenix, Mesa, and Tempe are the out migration areas patients of the CVRMC service area sometimes choose for health care services. Out migration data is provided by the HealthTech Strategic Planning department in the Environmental Assessment and Market Share Report. Two data sources are used
Schedule H, Part VI, Line 3	In public waiting areas of Cobre Valley Regional Medical Center, multilingual posters explain to patients in common language that CVRMC is a Medicare AHCCCS Medicaid participating facility. In addition, posters and signs in these areas explain to the patient what financial obligations may occur and if additional billing will be submitted by providers. If, at the time of admission or visit, the patient does not have third party insurance coverage, the patient is offered an AHCCCS application for health-care coverage through public programs. In addition, staff members in the ER are trained to run searches to determine if a patient has existing coverage. Below is a description of the Patient Education Policy followed by a copy of the Patient Financial Assistance and Discount Program. When neither existing insurance coverage nor AHCCCS eligibility is available, the Patient Account Services department talks to the patient about the Cobre Valley Regional Medical Centers Charity Care program. The patient is offered an AHCCCS application, and a financial contract. The patient is advised they must complete the AHCCCS application, appointment, etc. If the patient is denied by AHCCCS, they are to present the denial to the Patient Accounting Department. When the patient is offered the financial assistance application, demonstrable proof of income, living expenses, size of household and proof of AHCCCS denial are required for completion of the application. Included in the income computation are earnings from employment and other income such as child support, alimony, social security and from any other sources. When requesting proof of living expenses, patients are asked to provide documentation of expenses associated with housing, utilities, transportation, insurance, food, other medical bills, and all other living expenses. After all information is obtained and reviewed, the Federal Poverty Income Guidelines and Discount Table is now being used to calculate the total discount that can be offered to the patient. Once this is compiled, Patient Account Services PAS signs off on the Financial Assistance Form which is forwarded to the Director, CFO, and CEO for approval, as appropriate. CVRMC is highly dependent on payment rates set by Medicare and Medicaid, both of which generally don't cover costs. At CVRMC, about 67% of patient revenue comes from these government payers. Changes at the federal level, specifically the Patient Protection and Affordable Care Act, will continue to change how CVRMC informs and educates patients and families regarding their eligibility for assistance. Cobre Valley Regional Medical Center is committed to providing financial assistance to persons who have health care needs and are uninsured. Consistent with its mission to deliver quality healthcare in a safe, respectful, and efficient manner, CVRMC strives to ensure that the financial capacity of people who need health care services does not prevent them from seeking or receiving care. PURPOSE This Policy provides a fair and comprehensive system of distributing free or discounted medical care to uninsured patients within the available resources of Cobre Valley Regional Medical Center the Hospital and or Clinics. The Policy addresses Eligibility criteria for financial assistance The extent to which financial assistance includes free or discounted care The basis for calculating amounts charged to individuals who are eligible for assistance under this policy The method for applying for assistance Measures to widely publicize the Policy RESPONSIBILITY It is the responsibility of the Hospital Board of Directors to ensure that this Policy is being administered and carried out in a consistent manner and within the guidelines set forth in controlling laws and regulations. SCOPE This Policy applies to all emergency and medically necessary inpatient and outpatient hospital services provided to Uninsured individuals who qualify for assistance in accordance with the terms and conditions herein. It also applies to CVRMC employed physician services, clinic services, or other services that may be offered by the Hospital. Any services deemed nonmedically necessary or cosmetic in nature are not eligible for financial assistance. DEFINITIONS The following definitions shall apply to this Policy AGB discount percentage is determined by dividing the sum of all claims Medically Necessary services provided at Cobre Valley Regional Medical Center paid during the Relevant Period by Medicare fee-for-service and all private health insurers as primary payors, together with any associated portions of these claims paid by Medicare beneficiaries or insured individuals in the form of co-pays, co-insurance or deductibles. Application Period: The period during which the Hospital must accept and process an application for assistance under this Policy in order to have made reasonable efforts to determine whether the patient is an individual who is eligible for assistance under this Policy. The Application Period ends on the 240th day the Hospital provides the individual with the first statement for care provided. individual who has accepted or is required to accept responsibility for the patients bills that involve i a legal or judicial process; ii selling an individual's debt to a third party or iii reporting adverse information about the individual to a consumer credit agency or credit bureau. Gross Charges The Hospitals full, established price for medical care that it consistently and uniformly charges all patients before applying any contractual allowances, discounts, or deductions. Household Income Means the total income of all members living in the individuals household. Individuals who are eligible for assistance under this Policy: An individual who is uninsured and is eligible for financial assistance under this Policy. Individuals who qualify for financial assistance: Individuals who are eligible for assistance under this Policy and who have submitted a completed financial assistance application within required time periods as set forth herein and have been approved for financial assistance according to the processes set forth herein. Medically Indigent Individuals who do not have health insurance and who are not eligible for other health care coverage, such as Medicare, Medicaid, or private health insurance. Notification Period Begins on the first date care is provided and ends on the 120th day after the Hospital provides the individual with the first bill for care. Uninsured A patient or his or her financially responsible individual has no insurance or medical coverage under governmental programs and is not eligible for any other third party payment. ELIGIBILITY FOR FINANCIAL ASSISTANCE 1 Uninsured Status to be verified through state websites or other third party eligibility systems 2 Citizenship Individuals must be U.S. citizens a. Patients who are not legal U.S. citizens are not eligible for Financial Assistance. However, they are encouraged to inquire about emergency health care services through the Federal Emergency Services Program FESP provided by AHCCCS. Patients who do not meet the qualifications of this program will be able to receive the Self-Pay discount. 3 Federal Poverty Level The applican's household income must be at or below 400% of the Federal Poverty Guidelines 4 Homeless Individuals without a payment source may be classified as eligible for Financial Assistance if it is determined that they do not have a job, mailing address, residence, or insurance. Consideration must also be given to classifying emergency room patients who do not provide adequate information as to their financial status. In many instances, these patients are homeless and have few resources to cover the cost of their care. 5 Bankruptcy Individuals who are in bankruptcy or recently completed bankruptcy may be eligible for Financial Assistance. 6 Special circumstances In rare occasions, a patients individual circumstances may be such that while they do not meet the regular Financial Assistance criteria in this policy, they do not have the ability to pay their Hospital bill. In these situations, with the approval of the CVRMC CEO CFO, part or all of their cost of care may be written off. There must be complete documentation of why the decision was made to do so and why the patient did not meet the regular criteria. 7 Deceased patients without an estate or third party coverage will be eligible for financial assistance.
Schedule H, Part VI, Line 4	Cobre Valley Regional Medical Center CVRMC is located in Globe, Arizona and serves a population of 45,000 within a radius of 65 miles in a full service acute care facility. This population includes both the primary and secondary service areas. CVRMC is located in the heart of the copper belt of Arizona and serves many rural copper communities within the region including its neighboring towns of Miami, Superior to the west, Kearny, Hayden, and Winkelman to the south. The Apache San Carlos Nation borders Globe to the east and Roosevelt, Pleasant Valley Young are located to the north. CVRMC serves as an acute medical surgical and obstetric provider for all the residents of these communities, with the clinic and hospital located on the San Carlos Apache Nation referring many patients to CVRMC. The CVRMC primary and secondary service area communities are located in two counties, Gila and Pinal. Based on the 2010 U. S. Census, approximately 23% of the total population in Gila County was over the age of 65 while in neighboring Pinal County it was 15%, compared to 14% for Arizona and 13 % for the United States. The five leading causes of death among adults age 65 and older in Gila and Pinal Counties are heart disease, cancer, chronic lower respiratory diseases, cerebrovascular disease, and diabetes. Total reported number of people with disabilities within Gila County is 22,453 and 63,082 for Pinal County. Globe and Miami, Arizona Primary Service Area 62.7% Inpatient Patient Origin Globe, Miami and the unincorporated areas nearby including Inspiration, Claypool, Central Heights, and Midland City are commonly called Globe Miami. The towns are located on the northeastern slope of the Pinal Mountains, and are surrounded except to the east by the Tonto National Forest. Globe Miami is located on U.S. Routes 60 and 70, and is served industrially by the Arizona Eastern Railway Globe-Miami are located in Gila County with a total population of 18,134. Globe's economy remains heavily dependent on the mining industry, but as the county seat, county as well as city government employment are the highest numbers of jobs within the city. Tourism and retirees are also among the most important in Globe's economy. Miami borders Globe to the west and copper mining accounts for the largest number of jobs in Miami according to the 2004 annual report of the Arizona State Mine Inspector. Freeport McMoRan currently employs approximately 1,000 at its Miami operations; KGBM employs approximately 100 at its Carlota facility; Capstone Pinto Valley Mine employs approximately 300, while BHP Billiton employs 50 employees at the Miami operations. As of 2012, Miami was home to one of the last 4 copper smelters in the United States. Below is the housing status and demographic information for the population of Globe-Miami and the unincorporated areas Housing Status for Globe Miami, U.S. Census 2010 in housing units unless noted Total 9,090 Occupied 7,253 Owner occupied 5,324 Population in owner occupied number of individuals 12,727 Renter occupied 1,929 Population in renter-occupied number of individuals 4,827 Households with individuals under 18 2,099 Vacant 1,837 Vacant for rent 319 Vacant for sale 142 Male 9,102 Female 9,032 Under 18 4,195 18 & over 13,939 20 - 24 989 25 34 1,787 35 49 3,146 50 64 4,104 65 over 3,486 Population by Ethnicity Hispanic or Latino 6,175 Non Hispanic or Latino 11,959 Population by Race White 14,862 African American 130 Asian 129 American Indian and Alaska Native 692 Native Hawaiian and Pacific Islander 15 Other 1,784 Identified by two or more 522 Roosevelt, Arizona Primary Service Area 2.5% Inpatient Patient Origin Roosevelt is located 20 miles north of CVRMC and is a major center for fishing, boating, camping, water skiing, and other recreational water sports. The community of Roosevelt was developed after the construction of a masonry dam on the Salt River in 1911, making it the oldest artificial reservoir in Arizona and the largest within the boundaries of the state. The population of Roosevelt is estimated at 220 with many visitors moving in and out of the area depending on the season. San Carlos Apache Nation San Carlos, Ft. Apache, and Peridot, Arizona Secondary Service Area 20.8% Inpatient Patient Origin The San Carlos Apache Indian Reservation is located 4 miles east of Globe and is located in Gila, Graham, and Pinal Counties. The San Carlos Reservation is home to a number of Apache tribes relocated from traditional Apache homelands from Arizona and New Mexico in 1871. The San Carlos Reservation is one of the poorest Native American communities in the United States, with the median annual household income being approximately $13,000. About 60% of the people live under the poverty level, and one fourth of the active labor force is unemployed. The population of the San Carlos Reservation is just over 10,000 residents with its largest communities being San Carlos, Ft. Thomas, and Peridot, Arizona. The Apache Gold Casino employs 300 people while hunting, fishing, boating, camping, and gaming are attractions to tourists visiting the area. AZ San Carlos CCD, Gila County, US Census 2010 Population Total Population 4,780 Housing Status in housing units unless noted Total 1,171 Occupied 1,059 Owner occupied 769 Population in owner occupied number of individuals 3,295 Renter occupied 290 Population in renter occupied number of individuals 1,474 Households with individuals under 18 706 Vacant 112 Vacant: for rent 13 Vacant: for sale 0 Population by Sex Age Male 2,296 Female 2,484 Under 18 1,889 18 over 2,891 20 24 454 25 34 617 35 49 732 50 64 610 65 over 237 Population by Ethnicity Hispanic or Latino 152 Non Hispanic or Latino 4,628 Population by Race White 28 African American 1 Asian 0 American Indian and Alaska Native 4,727 Native Hawaiian and Pacific Islander 1 Other 2 Identified by two or more 21 AZ San Carlos CCD, Graham County, US Census 2010 Population Total Population 5,288 Housing Status in housing units unless noted Total 1,455 Occupied 1,261 Owner-occupied 950 Population in owner-occupied 3,992 number of individuals Renter-occupied 311 Population in renter-occupied 1,296 number of individuals Households with individuals under 18 758 Vacant 194 Vacant: for rent 12 Vacant: for sale 1 Population by Sex/Age Male 2,607 Female 2,681 Under 18 1,965 18 over 3,323 20 24 450 35 49 918 50 64 748 65 over 353 Population by Ethnicity Hispanic or Latino 205 Non Hispanic or Latino 5,083 Population by Race White 112 African American 5 Asian 1 American Indian and Alaska Native 5,108 Native Hawaiian and Pacific Islander 0 Other 14 Identified by two or more 48 Pleasant Valley Young, Arizona Secondary Service Area Surrounded by the Tonto National Forest, Pleasant Valley Young is a community in Gila County situated in the beautiful pines of the mountains. There are two main dirt roads in and out of Young, one from the north and one from the south, but no fully paved road to a connecting highway. Globe is 65 miles to the south of Young. According to the 2010 U. S. Census, Pleasant Valley Young had a population of 376 people, 320 households, and 132 families living in the Pleasant Valley Young area. The racial makeup was 100% White. The 320 households are comprised of 15.3% with children under the age of 18 living with them, 50.9% were married couples living together, 4.7% had a female householder with no husband present, and 39.7% were non-families. Individuals made up 33.4% of all households and 10.3% had someone living alone who was 65 years of age or older. The average household size was 2.08 and the average family size was 2.65. The median age was 51.5. Several small businesses exist in Pleasant Valley Young. A gas station, convenience store, auto parts store, motel, thrift shore, library, and refuse service are among the businesses. Cobre Valley Regional Medical Center services the primary medical needs of the area with a medical clinic. The median income for a household in the Pleasant Valley Young area is $26,250, and the median income for a family was $24,886. Males had a median income of $21,000 versus $26,458 for females. The per capita income for the area was $16,943.
Schedule H, Part VI, Line 5	CVRMC History Cobre Valley Regional Medical Center has been serving patients of the copper belt region of Arizona for over 100 years. Originally a miners hospital, Miami Inspiration Hospital opened to serve miners and their families in 1913. Eventually the aging, crowded Miami Inspiration Hospital could no longer accommodate the growing patient load and a larger, up to date hospital was needed, and during the 1960s, plans were formulated for a new hospital at another location. In 1967, the resident patients and the staff were transferred to the newly completed hospital in the Miami Gardens area where the hospital still stands today. During the next eleven years, an outstanding group of company physicians tended the patients at Miami Inspiration Hospital. In 1978, the Board of Directors contracted with a Health Maintenance Organization from Phoenix to manage the hospital. The year 1980 was a turning point for Miami Inspiration Hospital. The HMO contract was not renewed, and the Board hired a hospital management firm to carry on the hospitals business. At the same time, local physicians were given contractual agreements to care for the miners and their families. The physicians were also granted privileges to admit and care for non-company patients. It was at this point in time the hospital became a community hospital. Three years later the administrative positions were taken over by local individuals. With the closure of the county hospital, Gila General, in 1991, Miami Inspiration Hospital became the sole provider of acute medical care in the Globe Miami and surrounding areas. Additional personnel were hired, the acute care unit was upgraded and new equipment and computers were put into service. Some already cramped departments became even more overworked, and plans for enlargement and improvement of these areas were initiated. In 1992, the administration of the hospital was taken over by Brim Healthcare now HealthTech, with the mining companies opting to get out of the healthcare business; the name of the hospital was changed to Cobre Valley Community Hospital. The plans to enlarge and improve the hospital facilities became a high priority, and the radiology and laboratory departments were enlarged and modernized. Meanwhile, plans for a major expansion of several departments were initiated, and large, new, state of the art emergency, surgery and intensive care departments were completed in early 1997. In 2003, additional renovations were made to address the Laboratory, Radiology, Medical Records, Administration, and most inpatient care areas. This renovation project also included a steel building for housing records and warehousing supplies. Through the next 13 years, under the management of Brim Healthcare now HealthTech, Cobre Valley Community Hospital CVCH continued to provide the best services available, adding new services, new technology, and new equipment in all departments. Through growth and expansion of the past few years, CVCH opened clinics in Young, Kearny, and Superior. In March of 2010, Cobre Valley Community Hospital went through a name change to Cobre Valley Regional Medical Center CVRMC. The new name is a reflection of the customers, patients, and geographic area served by the expanding facility. Many services were added including urology, cardiology, wound care, and laser vein procedures. The word Cobre is Spanish for copper. The communities of the region served by CVRMC exist because of the long history of copper mining. The words, Cobre Valley, were preserved in honor of all our copper miners for their commitment and fortitude to supply the world with the natural resource our region is known for, copper. CVRMC Today Today, Cobre Valley Regional Medical Center is a 25 bed Critical Access Hospital located in Globe Miami, Arizona. It serves a population of roughly 42,000 within a radius of 65 miles in a full service acute care facility with a medical staff of more than 55 active physicians, numerous visiting specialists, community, and emergency doctors. Adjacent to the San Carlos Apache Reservation, CVRMC serves as an acute medical surgical and obstetric provider for reservation residents referred by their clinic and or hospital. The area also has a significant Hispanic population and several other ethnic minorities. CVRMC is governed by a Board of Directors made up of a cross section of community members from many different professions including a mine manager, a rancher retired engineer, an insurance agent, a business owner, county government, and medical professionals. The CVRMC Board of Directors meet once a month and act as a trustee for the assets and investments of the hospital for the people of the service area. The board also selects, advises, and evaluates the CEO of the hospital grants physician staff privileges and ensures that quality medical care is maintained. Responsibilities also include providing direction for the affairs of the hospital and to ensure the development and growth of CVRMC is directed toward fulfilling the mission statement To develop and maintain a healthcare delivery system that serves the region with quality, efficiency, and compassion. The hospital is a leader among small rural facilities in implementing new technologies both clinically and in the information area. Direct patient care technologies are kept up to date. Health Information Systems within the facility have kept pace with information technology upgrades taking place frequently and well ahead of deadlines imposed by outside entities or federal mandates. The hospital is completing its second Strategic Five Year Information Technology Plan in advance of federal mandates that require an electronic medical record and will meet the federal definition and rules regarding meaningful use. It comprehensively integrates the entire patient experience with the hospital and includes interfaces with physician offices and a tertiary provider allowing them to view laboratory and radiology reports as soon as they are available. The next five year plan is to enhance the technological innovations already in place by melding all of the active patient records into a database that will provide a comprehensive chart on each patient within the Cobre Valley Regional Medical Center system, accessible to authorized individuals that will give each practitioner the access to more meaningfully, salient, current information to provide optimal care to each patient. As the role of the facility has solidified within the community, the Board and administrative staff recognized that needs existed in some of the outlying communities. Health care for residents of Superior, Kearny and Young was limited to single facilities in each community staffed sporadically by medical personnel. Their location meant that health care visits to organizations or offices with greater access to general medical services often involved travel of up to 2 hours, usually in one of two directions and, in the case of Young, affected dramatically by weather. Realizing that this lack of medical service directly affected the health and well-being of residents of these three areas, CVRMC was determined to optimize local health care services. CVRMC has established and staffed health clinics in all three areas with professional and ancillary staffing and services which obviates the necessity for clients to travel many miles for such things as laboratory testing and pharmacy services. Community Programs and Improvements to Services Construction and Growth For many years the Town of Superior did without any medical services, forcing residents to travel at least 40 minutes to the nearest clinic. CVRMC established a clinic in the older downtown area of Superior 12 years ago and committed to the residents of Superior the construction of a new, modern facility. CVRMC completed new construction on an up to date medical clinic in Superior in August 2012. The more than 5,500 square foot clinic will house xray, pharmacy, and currently has 10 exam rooms. Services include complete family care, physical therapy, laboratory, general surgery consults, minor procedures, simple fracture care, simple laceration repairs, basic dermatology care, preventative exams, women's exams, child well visits, occupational medicine, CDL physicals, pre-employment physicals, surgical consultations, and courier pharmacy service. On the west side of the hospital campus, the newly constructed, state of the art, 5,000 square foot Surgical Services Clinic opened its doors in May of 2012. General surgery consultations, OB GYN, and other specialty services are offered in this clinic.

Schedule H (Form 990) 2014

Additional Data

Software ID:	14000267
Software Version:	v1.00

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

Cobre Valley Regional Medical Center

Employer identification number

86-0732836

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..

Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ................

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Participate in, or receive payment from, an equity-based compensation arrangement? .........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2014

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.

(A) Name and Title		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation in column(B) reported as deferred in prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1Dana MillerPhysician	(i) (ii)	318,511 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	318,511 ............................... 0	0 ............................... 0
2Binoy ChandraPhysician	(i) (ii)	261,002 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	261,002 ............................... 0	0 ............................... 0
3Phuong NguyenPhysician	(i) (ii)	218,587 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	218,587 ............................... 0	0 ............................... 0
4Anthony DanielsPhysician	(i) (ii)	273,966 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	273,966 ............................... 0	0 ............................... 0
5Thomas HansenPhysician	(i) (ii)	346,607 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	346,607 ............................... 0	0 ............................... 0

Schedule J (Form 990) 2014

Page 3

Part III

Supplemental Information

Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.

Return Reference	Explanation

Schedule J (Form 990) 2014

Additional Data

Software ID:	14000267
Software Version:	v1.00

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

Cobre Valley Regional Medical Center

Employer identification number

86-0732836

Return Reference	Explanation
Form 990, Part VI, Section A, Line 3	The CEO and CFO duties are carried out by employees of HealthTech Management Services, Inc. and unrelated management company. Neal Jensen and James Childers are employees of HealthTech and serve as the top management and financial officials of Cobre Valley Regional Medical Center. Compensation is included in the management fee paid to HealthTech Management Services.
Form 990, Part VI, Section B, Line 11b	A CPA firm prepares and reviews the Form 990. The return is then provided to the CFO for review and approval. Any questions or concerns the CFO has are addressed and any corrections or clarifications are made. The final form 990, with all required schedules, is made available to the full board prior to filing with the IRS.
Form 990, Part VI, Section B, Line 12c	Board members and officers are covered by the organization's conflict of interest policy and are required to annually complete a questionnaire disclosing any and all possible conflicts of interest.
Form 990, Part VI, Section B, Line 15	The Officer's compensation is determined by a review conducted by Healthtech management services, Inc. using data provided by a nationally recognized management consulting firm, along with Form 990 data from comparable organizations and other hospitals managed by Healthtech. Once this information has been compiled and reviewed, a meeting is held with the board and a decision is made on the Officers' compensation.
Form 990, Part VI, Section C, Line 19	Available upon request.
Form 990, Part IX, Line 11g	Purchased services, professional fees and contract physicians.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:	14000267
Software Version:	v1.00

1	Briefly describe the organization’s mission or most significant activities: The Organization will provide medical services which will be competitive with those charged for similar services by comparable facilities. The Organization will also allow a portion of its services and facilities to be used for charity patients.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	9
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	9
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	332
6	Total number of volunteers (estimate if necessary) .............	6	40
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	20,297	89,759
9	Program service revenue (Part VIII, line 2g) .........	36,553,655	40,090,188
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	659,149	291,374
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	327,429	322,074
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	37,560,530	40,793,395
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	19,290,073	20,100,401
16a	Professional fundraising fees (Part IX, column (A), line 11e).....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	17,245,304	18,870,735
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	36,535,377	38,971,136
19	Revenue less expenses. Subtract line 18 from line 12.......	1,025,153	1,822,259
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	43,290,880	71,078,316
21	Total liabilities (Part X, line 26).............	12,493,375	38,304,829
22	Net assets or fund balances. Subtract line 21 from line 20.....	30,797,505	32,773,487

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 31,990,984 including grants of $ 0 ) (Revenue $ 40,284,475 )
	Cobre Valley Regional Medical Center (CVRMC) provides medical services which will be competitive with those charged for similar services by comparable facilities. CVRMC will also allow a portion of its services and facilities to be used for charity patients. Along with providing acute health care services to the community as a non-profit entity, Cobre Valley Regional Medical Center hosts many educational programs available to the residents in the service area. CVRMC sponsors an annual health fair, working with other local and state social and charitable agencies to distribute and disseminate health, wellness, safety and other valuable information. Without any charge to our communities, CVRMC sponsors diabetic workshops, birthing and new baby care classes, customer service training, and grief support meetings. Many community organizations have taken advantage of the conference rooms CVRMC has to offer free of charge for meetings and educational training. Some examples of these groups are Teenage Outreach for Teen Pregnancy, Rotary Club, Little League, EMS Training, Gila Community College and many more. Meeting places are difficult to find in our rural community and CVRMC is pleased to accommodate our neighboring associations. CVRMC is continually upgrading and improving equipment. Much of the equipment that is replaced is still viable and is passed on to education facilities, fire departments, or other local agencies that will continue to get useful years for their programs and services. Supplies are also donated regularly to EMS, schools, senior citizen groups, and other organizations in need of medical and or other types of supplies. The PACT Committee, comprised of CVRMC staff, dedicates its efforts to making a difference in employee and community relations. The PACT Committee is instrumental in the activities of many hospital activities, promoting employee engagement and satisfaction. The PACT Committee also helps CVRMC employees through the HOPE (Helping Our People in Emergencies) Fund. Donations made to the HOPE fund are used in times of emergency for employees. The PACT Committee also ensures the hospital's presence in community events to build public support and trust. Together, with the assistance of health care organizations and professionals of our service area, a well- constructed Community Health Needs Assessment and Implementation Plan has been established and is responding to the identified needs of all our diverse communities, providing charitable care with purpose, and offers educational services and programs for the good of our public.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services (Describe in Schedule O.)
	(Expenses $ 0 including grants of $ 0 ) (Revenue $ 0 )
4e	Total program service expenses31,990,984

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	1,418,673	0	0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512-514
1a	Federated campaigns..1a		0
b	Membership dues....1b		0
c	Fundraising events....1c		0
d	Related organizations...1d		0
e	Government grants (contributions)1e		82,314

f	All other contributions, gifts, grants, and similar amounts not included above1f		7,445

g	Noncash contributions included in lines 1a-1f:$		0
h	Total. Add lines 1a-1f.......			89,759
			Business Code
2a	Net Patient Service Revenue		622000	40,090,188	40,090,188	0	0
b
c
d
e
f	All other program service revenue .			0	0	0	0
g	Total. Add lines 2a–2f........			40,090,188
3	Investment income (including dividends, interest, and other similar amounts).......			291,374	0	0	291,374
4	Income from investment of tax-exempt bond proceeds..			0	0	0	0
5	Royalties...........			0	0	0	0
		(i) Real	(ii) Personal
6a	Gross rents	127,787	0
b	Less: rental expenses	0	0
c	Rental income or (loss)	127,787	0
d	Net rental income or (loss).......			127,787	127,787	0	0
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)	0	0
d	Net gain or (loss)..........
8a	Gross income from fundraising events (not including $ 0 of contributions reported on line 1c). See Part IV, line 18 ..
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....			194,287	194,287	0	0
e	Total. Add lines 11a–11d ......			194,287
12	Total revenue. See Instructions......			40,793,395	40,412,262	0	291,374


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			2,772,095	1	4,324,087
2	Savings and temporary cash investments .........			13,338,734	2	13,790,474
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			6,230,467	4	5,079,527
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
					6
7	Notes and loans receivable, net .............				7	1,321,717
8	Inventories for sale or use ..............			1,308,738	8	1,352,028
9	Prepaid expenses and deferred charges ..........			422,132	9	395,247
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	46,069,027
b	Less: accumulated depreciation .....	10b	29,982,932	16,708,638	10c	16,086,095
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			2,510,076	15	28,729,141
16	Total assets. Add lines 1 through 15 (must equal line 34)......			43,290,880	16	71,078,316
17	Accounts payable and accrued expenses .........			3,655,375	17	3,866,718
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			5,745,000	20	33,000,000
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,758,907	23	1,102,111
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D....................			1,334,093	25	336,000
26	Total liabilities. Add lines 17 through 25.........			12,493,375	26	38,304,829
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			30,338,171	27	32,231,839
28	Temporarily restricted net assets ...........			459,334	28	541,648
29	Permanently restricted net assets ...........			0	29	0
	Organizations that do not follow SFAS 117 (ASC 958), check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds ........				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances ...........			30,797,505	33	32,773,487
34	Total liabilities and net assets/fund balances ........			43,290,880	34	71,078,316