TY 2015 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	0	0
(2) Ed Carpenter...................................................................... Secretary	1 ................. 0	X		0	0	0
(3) Fernando Shipley...................................................................... Treasurer	1 ................. 0	X		0	0	0
(4) Jim Rasmussen...................................................................... Vice Chairman	1 ................. 0	X		0	0	0
(5) Janice Cook...................................................................... Director	1 ................. 0	X		0	0	0
(6) Jendean Sartain...................................................................... Director	1 ................. 0	X		0	0	0
(7) Gary Gustason...................................................................... Director	1 ................. 0	X		0	0	0
(8) Brad Werrell...................................................................... Director	1 ................. 0	X		0	0	0
(9) Alan Osumi...................................................................... Director	1 ................. 0	X		0	0	0
(10) Eddie Koury...................................................................... Director	1 ................. 0	X		0	0	0
(11) Robert Hollis...................................................................... Director	1 ................. 0	X		0	0	0
(12) Joseph Ring...................................................................... Director	1 ................. 0	X		0	0	0
(13) Thomas Hansen...................................................................... Physician	40 ................. 0		X	434,412	0	0
(14) Dana Miller...................................................................... Physician	40 ................. 0		X	357,354	0	0
(15) Anthony Daniels...................................................................... Physician	40 ................. 0		X	406,006	0	0
(16) Binoy Chandra...................................................................... Physician	40 ................. 0		X	322,409	0	0

(A) Name and business address	(B) Description of services	(C) Compensation
Cobre Valley Heart Institute 2055 Highway 60 Globe,AZ85501	Cardiologist	309,447
ARUP Laboratories PO Box 27964 Salt Lake City,UT84127	Lab Testing	286,050
Globe Medical Properties PO Box 257 Emerson,NJ07630	Rent and associated services	264,989
Robert Half Technology PO Box 743295 Los Angeles,CA90074	Staffing	217,399
Corthall Laundry Service PO Box 742268 Atlanta,GA30374	Laundry	169,438
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 12

- 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.
right arrow

Attach to Form 990 or Form 990-EZ.
right arrow

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

OMB No. 1545-0047

2015

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 (Form 990 or 990-EZ))

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 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2014 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2015. 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—2014. 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—2015. 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—2014. 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) 2015

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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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) 2011	(b) 2012	(c) 2013	(d) 2014	(e) 2015	(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 2015 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2014 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2015 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2014 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2015. 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—2014. 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) 2015

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 (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) 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 section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

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

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 9a) 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 9a) 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 section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b 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

Schedule A (Form 990 or 990-EZ) 2015

Page 5

Part IV

Supporting Organizations (continued)

Yes

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

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, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) 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) 2015

Page 6

Part V

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

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

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) 2015

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations (continued)

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 2015 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-2015	(iii) Distributable Amount for 2015
1 Distributable amount for 2015 from Section C, line 6
2 Underdistributions, if any, for years prior to 2015 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2015:
a
b
c
d From 2013.......
e From 2014.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2015 distributable amount
i Carryover from 2010 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2015 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2015 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2015, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2015. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2016. Add lines 3j and 4c.
8 Breakdown of line 7:
a
b
c Excess from 2013.......
d From 2014.......
e From 2015.......

Schedule A (Form 990 or 990-EZ) (2015)

Schedule A (Form 990 or 990-EZ) 2015

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) 2015

Additional Data

Software ID:	15000352
Software Version:	v1.00


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


b	If "Yes," explain the arrangement in Part XIII and complete the following table:		Amount
c	Beginning balance .............................	1c
d	Additions during the year ............................	1d
e	Distributions during the year ..........................	1e
f	Ending balance ................................	1f

(a) Description	(b) Book value
(1) Assets limited as to use	19,266,843
(2) Bond Issuance Costs	196,583
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........	19,463,426

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total revenue, gains, and other support per audited financial statements .......	1	44,067,010
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains (losses) on investments ....	2a	0
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	0
3	Subtract line 2e from line 1..................	3	44,067,010
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	44,067,010

Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1	Total expenses and losses per audited financial statements ...........	1	41,634,257
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	41,634,257
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	41,634,257

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on 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

2015

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) . . .			2,504,851
b	Medicaid (from Worksheet 3, column a) . . . . .			13,153,095
c	Costs of other means-tested government programs (from Worksheet 3, column b) . .
d	Total Financial Assistance and Means-Tested Government Programs . . . . .	0	0	15,657,946	0	0	0 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).
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	0	0	0	0 %
k	Total. Add lines 7d and 7j .	0	0	15,657,946	0	0	0 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2015

Schedule H (Form 990) 2015

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. ......

2,453,229

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. ......

2,453,229

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).....

12,756,378

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

11,942,089

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

814,289

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) 2015

Page

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) 2015

Page 4

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 15

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

6 a

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 15

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

12b

If "Yes" on 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) 2015

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

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

Yes

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) 2015

Page 6

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 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 19. (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) 2015

Page 7

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	The recent movement to transform public health and health systems stresses that where we live, work, play, pray and learn determines our health and well being. It helps to shift our focus from treating disease and sickness towards prevention and collaboration in order to improve the quality of life for all citizens. Social, economic, political, environmental and individual factors all have a role to play in our health problems, and most importantly, in the solutions. Conducting a Community Health Needs Assessment and Community Health Improvement Plan are the most important first steps in transforming health and wellness. From September 2015 through February 2016, stakeholders across Gila County and the CVRMC service region engaged in a community driven process to identify the most pressing health issues facing residents. Lead by the Gila County Division of Health and Emergency Management and CVRMC, community members and organizations came together to provide valuable insights on experiences of health and sickness, as well as realistic ways to affect change. The CHNA and CHIP documents, found on our website www.CVRMC.org, outline that process and the plan of action to improve health for all residents across Gila County and the CVRMC service region. The Community Health Needs Assessment describes the health of residents across Gila County and the CVRMC service region. No single agency or organization can make measurable improvements in public health alone; therefore, to achieve a greater impact in improving the health of residents, GCDHEM collaborated with CVRMC to strengthen their collective impact with shared resources and expertise to complete the 2015 CHNA. This collaborative effort provides shared ownership for improving community health. To identify those health outcomes with the greatest potential for improvement, the CHNA collaboration explored the countys population demographics and social and economic realities while capturing community and partner input. The end result is a comprehensive summary of leading health issues affecting Arizonans across Gila County and the CVRMC service region. The GCDHEM and CVRMC used the Mobilizing for Action through Planning and Partnerships methodology to conduct the 2015 CHNA. MAPP emphasizes a community driven approach and builds on previous experiences and lessons learned from the 2012 GCDHEM CHA and the 2013 CVRMC CHNA. To ensure a comprehensive approach, the 2015 CHNA relies on the collection and analysis of secondary, quantitative, morbidity, and mortality data from thirty six priority health indicators, in alignment with the CDC Community Health Status Indicators , as well as primary, qualitative data collected from community stakeholders, key informants, and community members at large through 637 surveys and community engagement through six focus groups and fourteen key informant interviews. Where available, health status indicators are compared with other peer counties across the U.S. based on the variables. While the CHNA illustrates disease rates and individual health behaviors, the selected measures provide a broader analysis of factors that affect peoples health. This includes capturing environmental conditions that contribute to health, such as access to healthy foods. The CHA highlights disparities related to health status and community conditions through a data driven analysis. The 2015 CHNA for Gila County and the CVRMC service region set out to gain a more comprehensive picture of health issues facing Gila County residents and the CVRMC region. Through a systematic analysis of secondary data, primary quantitative and qualitative research through community engagement, specific key findings were identified across all or most sources of data. These findings are specifically outlined in the CHNA document found on the CVRMC website, www.CVRMC.org. The effort to assess and address the health needs was a joint effort led by the GCDHEM and CVRMC in cooperation with multiple community organizations that made up the CHIP Advisory Committee. All of the members in the CHIP Advisory Committee expressed their commitment to being part of the solution, developing new partnerships, and understand health in the most holistic way possible. They also agreed that they wanted an actionable, comprehensive, and useful plan that not only reflects the needs and the diversity of community, but also represents what the community wants. The committee met once every week for the course of two months and utilized the Mobilizing Action for Planning and Partnerships framework to review the results from the CHA, pinpoint the key criteria used to prioritize community health needs, and develop detailed goals, objectives, and strategies to guide them in taking action to create change over the next five years. Using the criteria of size, seriousness, feasibility, potential for collective impact, and influence, a structured process designed to ensure input from all participants, the Advisory Committee identified 12 health issues from the CHA to be considered for prioritization. After thoughtful dialogue around these 12 health issues the committee came to consensus on four health priorities to address in the CHIP. 1. Obesity 2. Substance Abuse 3. Access to Quality Healthcare, including Mental Health Services 4. Sexual Health The CHIP Advisory Committee identified long-term and short term goals for "Obesity", "Substance Abuse", and "Sexual Health" using an Asset based Analysis Approach in order to educate each other on current efforts, opportunities to collaborate, and potential gaps to fill. Next, the committee brainstormed strategies and tactics to support the goals. With the help of facilitators and subject matter experts, key evidence-based strategies were highlighted within the list of ideas. For "Access to Quality Healthcare, including Mental Health Services", a SWOT Analysis was used to explore existing strengths and brainstorm opportunities while faced with known weaknesses and threats. GCDHEM, in collaboration with CVRMC, will be responsible for maintaining ongoing community engagement in the implementation of the CHIP. Gila County will continue quarterly meetings with the CHIP Advisory Committee to periodically review the plan, track and evaluate progress made in implementing strategies, and propose changes when greater impact can be achieved by modifying approaches. CVRMC has incorporated the CHNA and CHIP in their strategic action plans under the strategic goal of "Community." When needed, and as recommended by the Advisory Committee, workgroups focusing on particular goals will be established to ensure successful implementation. GCDHEM and CVRMC acknowledge that health improvements cannot be achieved alone. While participating in the development of the CHIP, partners demonstrated enthusiasm for ensuring that the plan is utilized to improve the health of Gila County and the CVRMC service region. This enthusiasm relates not only to the important priorities outlined in the CHIP, but also in the spirit of partnership that is required to work together across organizations to achieve the CHIP goals. Currently, CVRMC utilizes several methods of assessing community healthcare needs. Evaluating the health needs of the CVRMC service area leads to identifying physicians needed in the area as well as recognizing those services that are required to address 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 conducts outpatient surveys for the Outpatient Surgery, Physical Therapy, Registration, Med Surg ICU, 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 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.
Schedule H, Part V, Section B, Line 11-Cobre Valley Regional Medical Center	See other disclosures for Schedule H.

Schedule H (Form 990) 2015

Page 8

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) 2015

Page 9

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	The recent movement to transform public health and health systems stresses that where we live, work, play, pray and learn determines our health and well being. It helps to shift our focus from treating disease and sickness towards prevention and collaboration in order to improve the quality of life for all citizens. Social, economic, political, environmental and individual factors all have a role to play in our health problems, and most importantly, in the solutions. Conducting a Community Health Needs Assessment and Community Health Improvement Plan are the most important first steps in transforming health and wellness. From September 2015 through February 2016, stakeholders across Gila County and the CVRMC service region engaged in a community driven process to identify the most pressing health issues facing residents. Lead by the Gila County Division of Health and Emergency Management and CVRMC, community members and organizations came together to provide valuable insights on experiences of health and sickness, as well as realistic ways to affect change. The CHNA and CHIP documents, found on our website www.CVRMC.org, outline that process and the plan of action to improve health for all residents across Gila County and the CVRMC service region. The Community Health Needs Assessment describes the health of residents across Gila County and the CVRMC service region. No single agency or organization can make measurable improvements in public health alone; therefore, to achieve a greater impact in improving the health of residents, GCDHEM collaborated with CVRMC to strengthen their collective impact with shared resources and expertise to complete the 2015 CHNA. This collaborative effort provides shared ownership for improving community health. To identify those health outcomes with the greatest potential for improvement, the CHNA collaboration explored the countys population demographics and social and economic realities while capturing community and partner input. The end result is a comprehensive summary of leading health issues affecting Arizonans across Gila County and the CVRMC service region. The GCDHEM and CVRMC used the Mobilizing for Action through Planning and Partnerships methodology to conduct the 2015 CHNA. MAPP emphasizes a community driven approach and builds on previous experiences and lessons learned from the 2012 GCDHEM CHA and the 2013 CVRMC CHNA. To ensure a comprehensive approach, the 2015 CHNA relies on the collection and analysis of secondary, quantitative, morbidity, and mortality data from thirty six priority health indicators, in alignment with the CDC Community Health Status Indicators , as well as primary, qualitative data collected from community stakeholders, key informants, and community members at large through 637 surveys and community engagement through six focus groups and fourteen key informant interviews. Where available, health status indicators are compared with other peer counties across the U.S. based on the variables. While the CHNA illustrates disease rates and individual health behaviors, the selected measures provide a broader analysis of factors that affect peoples health. This includes capturing environmental conditions that contribute to health, such as access to healthy foods. The CHA highlights disparities related to health status and community conditions through a data driven analysis. The 2015 CHNA for Gila County and the CVRMC service region set out to gain a more comprehensive picture of health issues facing Gila County residents and the CVRMC region. Through a systematic analysis of secondary data, primary quantitative and qualitative research through community engagement, specific key findings were identified across all or most sources of data. These findings are specifically outlined in the CHNA document found on the CVRMC website, www.CVRMC.org. The effort to assess and address the health needs was a joint effort led by the GCDHEM and CVRMC in cooperation with multiple community organizations that made up the CHIP Advisory Committee. All of the members in the CHIP Advisory Committee expressed their commitment to being part of the solution, developing new partnerships, and understand health in the most holistic way possible. They also agreed that they wanted an actionable, comprehensive, and useful plan that not only reflects the needs and the diversity of community, but also represents what the community wants. The committee met once every week for the course of two months and utilized the Mobilizing Action for Planning and Partnerships framework to review the results from the CHA, pinpoint the key criteria used to prioritize community health needs, and develop detailed goals, objectives, and strategies to guide them in taking action to create change over the next five years. Using the criteria of size, seriousness, feasibility, potential for collective impact, and influence, a structured process designed to ensure input from all participants, the Advisory Committee identified 12 health issues from the CHA to be considered for prioritization. After thoughtful dialogue around these 12 health issues the committee came to consensus on four health priorities to address in the CHIP. 1. Obesity 2. Substance Abuse 3. Access to Quality Healthcare, including Mental Health Services 4. Sexual Health The CHIP Advisory Committee identified long-term and short term goals for "Obesity", "Substance Abuse", and "Sexual Health" using an Asset based Analysis Approach in order to educate each other on current efforts, opportunities to collaborate, and potential gaps to fill. Next, the committee brainstormed strategies and tactics to support the goals. With the help of facilitators and subject matter experts, key evidence-based strategies were highlighted within the list of ideas. For "Access to Quality Healthcare, including Mental Health Services", a SWOT Analysis was used to explore existing strengths and brainstorm opportunities while faced with known weaknesses and threats. GCDHEM, in collaboration with CVRMC, will be responsible for maintaining ongoing community engagement in the implementation of the CHIP. Gila County will continue quarterly meetings with the CHIP Advisory Committee to periodically review the plan, track and evaluate progress made in implementing strategies, and propose changes when greater impact can be achieved by modifying approaches. CVRMC has incorporated the CHNA and CHIP in their strategic action plans under the strategic goal of "Community." When needed, and as recommended by the Advisory Committee, workgroups focusing on particular goals will be established to ensure successful implementation. GCDHEM and CVRMC acknowledge that health improvements cannot be achieved alone. While participating in the development of the CHIP, partners demonstrated enthusiasm for ensuring that the plan is utilized to improve the health of Gila County and the CVRMC service region. This enthusiasm relates not only to the important priorities outlined in the CHIP, but also in the spirit of partnership that is required to work together across organizations to achieve the CHIP goals. Currently, CVRMC utilizes several methods of assessing community healthcare needs. Evaluating the health needs of the CVRMC service area leads to identifying physicians needed in the area as well as recognizing those services that are required to address 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 conducts outpatient surveys for the Outpatient Surgery, Physical Therapy, Registration, Med Surg ICU, 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 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.
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	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 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. 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. CVRMC will continue to strive for growth, bringing new services and structures to the hospital while focusing on wellness and 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 Centers 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, in migration, 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 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. 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 healthcare facility draws at least 75 percent of its patients and in which it maintains a considerable share of the healthcare market. The first step in defining CVRMCs service area is identification of the communities from which the hospital draws 75 percent of patients, and to assess the hospital's 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 healthcare 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. 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 healthcare 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 healthcare needs. Diagnosis Related Groups 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 healthcare 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.
Schedule H, Part VI, Line 3	In public waiting areas of Cobre Valley Regional Medical Center, multi lingual posters explain to patients in common language that CVRMC is a Medicare/AHCCCS 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 signs off on the Financial Assistance Form which is forwarded to the Director, CFO, and CEO for approval, as appropriate. POLICY OVERVIEW 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 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 non-medically 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. "Extraordinary Collection Action" or "ECA": Actions taken by the Hospital against a patient or any other 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 individuals debt to a third party; or (iii) reporting adverse information about the individual to a consumer credit agency or credit bureau. 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 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 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 applicant'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 patient's 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 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, obstetric, orthopedic, pediatric, and family practice provider for all the residents of these communities. 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 percent of the total population in Gila County was over the age of 65 while in neighboring Pinal County it was 15 percent, compared to 14 percent for Arizona and 13 percent 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 percent Inpatient Patient Origin Globe, Miami and the unincorporated areas nearby are commonly called Globe Miami. The towns are located on the northeastern slope of the Pinal Mountains, and are surrounded 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. Globes 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 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 2014 annual report of the Arizona State Mine Inspector. Freeport McMoRan currently employs approximately 900 employees at its Miami operations; KGBM employs approximately 85 at its Carlota facility as it continues into a 5-year, shut down phase; Capstone Pinto Valley Mine employs approximately 300, while BHP Billiton employs 30 employees at the Miami Unit Operation. 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: Available upon request. Housing Status for Globe Miami, U.S. Census 2010 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 percent 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 percen 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 percent 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	Cobre Valley Regional Medical Center has a health commitment to our employees, physicians, health and wellness organizations, our board of directors, benefactors, volunteers, and most importantly to our patients and families of the region we serve. CVRMC is striving to be more inclusive, collaborative, and effective regarding community building activities and donations. The mission of CVRMC is: "To develop and maintain a local health care delivery system that serves the region with quality, efficiency, and compassion. Our mission is your health." This is a living statement within each of our employees who work to provide direct or indirect patient care and is the driving force when setting goals, purchasing equipment, hiring employees, and planning activities throughout the region. The CVRMC Standards of Performance are the required code of conduct which will ensure the mission of CVRMC is carried forth. These standards include personal behaviors regarding privacy, attitude, communication, teamwork, courtesy, accountability, appearance, responsiveness, and safety. Through our community benefit and building activities, utilizing the standards of performance as the driving force, CVRMC is demonstrating accountability, gaining community trust, and fulfilling our mission to all our constituents of our service region. CVRMC receives expert operational support services through HealthTech Management Services. These areas of expertise include quality patient care, finance, revenue cycle, materials management, and strategic planning. The resources HealthTech Management Services provide are invaluable in assisting the CVRMC Board of Directors, administration, physicians, directors, and clinical and non-clinical staff in fulfilling the hospital's mission of Quality, Efficiency, and Compassion. Every three years, CVRMC has a strategic planning meeting with HealthTech Management Services. The meeting held on August 7 and 8, 2015, consisted of the CVRMC Board of Directors, Administration Team, and key advisors from HealthTech, who facilitated the meeting. The result of the meeting is the Strategic Plan which will guide and direct the leaders of CVRMC into the next three years. Through our strategic planning process, CVRMC identified The Patient Experience, People, Growth, and Community as our key strategic goals for the next three years. These goals are not independent of each other, but rather interdependent, connected and overlapping, each individual function thriving on the success of the others. The Patient Experience is defined as the combination of customer service and the quality provided to patients and families receiving services at CVRMC and its surrounding clinics. CVRMC will foster an environment where the quality of care and customer service provided to our patients, physicians and employees is relentlessly pursued with a philosophy of continuous improvement in delivery and outcome. People make the difference in the delivery of care and in the lives of our patients, physicians, fellow workers, and associates. CVRMC is committed to cultivate a workforce and medical provider community that are highly engaged, accountable, collaborative and committed to fulfilling the mission of maintaining a local healthcare delivery system that serves the region with quality, efficiency, and compassion. Growth, in both services and facilities, will provide for the needs of all the communities that depend on the healthcare provided by CVRMC. It is a strategy of CVRMC to aggressively pursue an increased share of the market and reduce out-migration by improving, expanding, adding and promoting services and physical structures that meet service area needs and are clinically and financially feasible. Community is the heart of our healthcare mission. Focused on promoting healthy living and prevention of chronic diseases, CVRMC realizes healthier communities are safer, have a stronger environment, are socially connected, and have people who truly care for one another. CVRMC has a commitment to care for its communities and the overall health of the people who make these communities great. Through strategic planning, relationship building, and collaboration, CVRMC will be able to address community health needs and move our population to a healthier state. Community Health Needs Assessment/Implementation with the Gila County Health Department From September 2015 through February 2016, stakeholders across Gila County and the CVRMC service region engaged in a community-driven process to identify the most pressing health issues facing residents. Lead by the Gila County Division of Health and Emergency Management and CVRMC, community members and organizations came together to provide valuable insights on experiences of health and sickness, as well as realistic ways to affect change. Through the process of the Community Health Needs Assessment, the following characteristics surfaced regarding Gila County and the CVRMC service region: Available upon request. The CHNA generated the data through community surveys, focus groups, and key informant interviews. The Community Health Implementation Plan will guide GCDHEM, CVRMC, and our partners to collaborate and respond to key factors that may be limiting our communities' ability to lead full, happy and healthy lives. Both the Community Health Needs Assessment and Implementation Plan are found on the CVRMC website. Community Benefit o "One Call" is a new service implemented by CVRMC in late 2015. The phone service is to help reduce the number of calls a customer needs to make in order to obtain information on health needs and/or social service agencies within the service region. "One Call" is a free service open to the general public and is staffed by a registered nurse who can also act as a liaison between medical staff, medical health facilities, and social services on behalf of the user. o "Healthy Living from the Inside Out" is a region-wide radio program which promotes health and wellness. Different topics are addressed each month with a health professional from CVRMC speaking to the listening audience and answering any phone questions. Topics have included educational information on diabetes, heart disease, nutrition, healthy pregnancy, exercise and wellness, to name a few. o The CVRMC Health Fair, over the past 7 years, saw a rapid increase in participation of health and wellness organizations as well as public attendance. In 2010, an estimated 500 members of our communities attended the health fair with 42 organizations providing health and wellness information. Public attendance has remained steady at about 1,000 for the past four years with participation of health o Donations to Community Organizations CVRMC recognizes the need to contribute to local organizations to help support their causes in regards to awareness, fundraising, promoting health/exercise/wellness, education, or finding a cure for cancer. The March of Dimes, Relay for Life, and Little League programs are examples. The State of Arizona has made drastic educational funding reductions the past several years and many schools in our service region have cut physical and health education programs in order to provide the basic requirements of English, Math, Science, and Social Studies. Cobre Valley Regional Medical Center chose to sponsor Copper Cities Youth Sports, Little League teams, Ray Elementary, Superior athletics, Miami Soccer, Globe High Cheer, to name just a few. Many youth programs are entirely dependent on the contributions of the major organizations of the area mining organizations, city and county governments, trucking industries, etc., and CVRMC, the regional medical provider. Many CVRMC employees donate time and expertise to speak at career fairs for the regional high schools, provide job shadowing experiences for the 7 regional high schools, and many tours for civic organizations and elementary/junior high students. The Globe Active Adult Center was given an electric wheel chair which was donated to CVRMC from a local family. Building networks of support has become part of the culture of CVRMC. Scholarship money was given to several organizations supporting the advancement in health education. As CVRMC, along with Gila County, moves forward to promote health and wellness within our service communities, our response to the needs of special populations will be essential for the reporting standards for "Community Health Needs." Together, with the assistance of health care organizations and professionals of our 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.
Schedule H, Part VI, Line 7	State of Arizona.

Schedule H (Form 990) 2015

Additional Data

Software ID:	15000352
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 2015 (Part V, line 2a) ......	5	381
6	Total number of volunteers (estimate if necessary) .............	6	0
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) .........	89,759	19,355
9	Program service revenue (Part VIII, line 2g) .........	40,090,188	43,501,631
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	291,374	252,975
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	322,074	293,049
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	40,793,395	44,067,010
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)	20,100,401	21,832,577
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)....	18,870,735	19,801,680
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	38,971,136	41,634,257
19	Revenue less expenses. Subtract line 18 from line 12.......	1,822,259	2,432,753
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	71,078,316	73,614,645
21	Total liabilities (Part X, line 26).............	38,304,829	38,690,465
22	Net assets or fund balances. Subtract line 21 from line 20.....	32,773,487	34,924,180

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 34,140,966 including grants of $ 0 ) (Revenue $ 43,501,631 )
	Along with providing acute health care services to the community as a non-profit entity, CVRMC is committed to the many communities we serve. Several members of our administration, directors, managers, and staff serve on various community associations including: Chambers of Commerce, Rotary, Work Force Development, Economic Development, Cancer Awareness Committees, Diabetes Education, Grief Support Teams, Scholarship Committees, and Youth Athletic Programs, to name just a few. CVRMC has its finger on the pulse of the community, provides charitable care with purpose, and offers educational services and programs for the good of our public. From September 2015 through February 2016, stakeholders across Gila County and the CVRMC service region engaged in a community-driven process to identify the most pressing health issues facing our residents through the Community Health Needs Assessment and Implementation Plan (CHNA and CHIP) process. Lead by the Gila County Division of Health and Emergency Management (GCDHEM) and CVRMC, community members and organizations came together to provide valuable insights on experiences of health and sickness, as well as realistic ways to affect change. The process of the Community Health Needs Assessment took place from September 2015 through December of 2015. The Community Health Improvement Plan was produced from the data collected from the needs of our population and GCDHEM and CVRMC are currently working with community organizations to formulate concrete actions to address the four health priorities identified in the CHIP: Obesity, Substance Abuse, Access to Quality Healthcare - Including Mental Health Services, and Sexual Health. The first CHNA and CHIP was completed by CVRMC in 2013 with many action plans driving the success of our identified community health issues. Together, with the collaboration of GCDHEM and many health care organizations and professionals of our service area, we will respond to the identified needs of all our diverse communities with this next CHIP. The Expansion Project of CVRMC began in February of 2015 and is expected to complete in August of 2016. The new construction includes all new, family-centered, single-patient rooms - Med/Surg, ICU, and Family Birth Center - which will bring comfort to the patients and their families we serve. The expansion also included new pharmacy, cath lab, wound center, infusion center, café and kitchen, gift shop, and conference rooms. The 11,000 square feet of new physician offices and exam rooms will provide for growth and will centralize services for the convenience of our patients. 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 Pregnancy Services, 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. As we celebrate 103 years of service to the Globe-Miami and surrounding communities, CVRMC continues to evolve with the changing needs of our population base. Healthcare is ever moving and advancing and CVRMC is progressing with the demands of our target markets. The continued accomplishments we have made are a direct result of a dedicated and compassionate workforce, a steadfast Board of Directors, and strong supporting management which is focused on one mission - the mission of health with quality, efficiency, and compassion. With the development of our next 3-year strategic plan, we are focused on these areas: The Patient Experience (Quality and Customer Service) People Growth Community (including the CHNA and CHIP) Today, the healthcare arena is facing some monumental changes and challenges. This strategic plan encompasses our accountability and compassion to patients and families; our respect and collaboration to all who surround us; our earnest responsibility to grow with the needs of our population; and our social and public responsibility as healthcare leaders of our communities. Yesterday, today, and tomorrow, CVRMC is committed to our communities with an unwavering dedicated spirit.

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 expenses34,140,966

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	1,520,181	0	0

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	0

f	All other contributions, gifts, grants, and similar amounts not included above		1f	19,355

g	Noncash contributions included in lines 1a-1f:$ 0
h Total.Add lines 1a-1f.......		19,355

			Business Code
2a	Net Patient Service Revenue	622000	43,501,631	43,501,631	0	0
b
c
d
e
f	All other program service revenue.			0	0	0	0
g Total.Add lines 2a–2f.....			43,501,631

3 Investment income (including dividends, interest, and othersimilar amounts) ..........			252,975	0	0	252,975
4 Income from investment of tax-exempt bond proceeds			0	0	0	0
5 Royalties...........			0	0	0	0
		(ii) Personal	(i) Real
6a	Gross rents	0	67,485
b	Less: rental expenses	0	0
c	Rental income or (loss)	0	67,485
d	Net rental income or (loss)......			67,485	0	0	67,485
		(ii) Other	(i) Securities
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 $ 0of 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..
Business Code			Miscellaneous Revenue
11a
b
c
d	All other revenue ....			225,564	225,564	0	0
e	Total. Add lines 11a–11d ......			225,564
12	Total revenue. See Instructions......			44,067,010	43,727,195	0	320,460

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21
2	Grants and other assistance to individuals in the United States. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the United States. 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	17,555,073	14,044,058	3,511,015
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....
9	Other employee benefits .......	4,277,504	3,422,003	855,501
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)	6,477,797	5,182,238	1,295,559
12	Advertising and promotion ....
13	Office expenses .......
14	Information technology ......
15	Royalties ..
16	Occupancy ...........	1,135,712	908,570	227,142
17	Travel ............
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....
20	Interest ...........	339,605	271,684	67,921
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	2,320,338	1,856,270	464,068
23	Insurance ...	563,034	450,427	112,607
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	Supplies	6,661,336	5,932,336	729,000	0
b	Equipment Rental	1,152,392	921,914	230,478	0
c
d
e	All other expenses	1,151,466	1,151,466
25	Total functional expenses. Add lines 1 through 24e	41,634,257	34,140,966	7,493,291	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).

1	Cash–non-interest-bearing ........			4,324,087	1	4,026,681
2	Savings and temporary cash investments .........			13,790,474	2	13,760,606
3	Pledges and grants receivable, net ......				3
4	Accounts receivable, net .............			5,079,527	4	6,493,388
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 ....			1,321,717	7	2,224,931
8	Inventories for sale or use ........			1,352,028	8	1,408,183
9	Prepaid expenses and deferred charges ......			395,247	9	467,240
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	58,063,547
b	Less: accumulated depreciation	10b	32,293,357	16,086,095	10c	25,770,190
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 ...........			28,729,141	15	19,463,426
16	Total assets. Add lines 1 through 15 (must equal line 34)...			71,078,316	16	73,614,645

17	Accounts payable and accrued expenses .....	3,866,718	17	4,447,988
18	Grants payable ...		18
19	Deferred revenue .........		19
20	Tax-exempt bond liabilities .........	33,000,000	20	32,851,225
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 ..	1,102,111	23	522,330
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	336,000	25	868,922
26	Total liabilities. Add lines 17 through 25..	38,304,829	26	38,690,465

	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets	32,231,839	27	34,382,309
28	Temporarily restricted net assets ...........	541,648	28	541,871
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 ...........	32,773,487	33	34,924,180
34	Total liabilities and net assets/fund balances ........	71,078,316	34	73,614,645

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 ....

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 ......

1a	Land ...	0	904,177		904,177
b	Buildings	0	21,472,805	12,917,343	8,555,462
c	Leasehold improvements	0	0	0	0
d	Equipment ...	0	21,935,752	19,376,014	2,559,738
e	Other ...	0	13,750,813	0	13,750,813
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..					25,770,190

(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
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

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

(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

1.(a) Description of liability	(b) Book value
(1) Federal income taxes
Third Party Settlements	868,922
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	868,922
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

(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 on 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)
1Thomas HansenPhysician	(i) (ii)	434,412 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	434,412 ------------- 0	0 ------------- 0
2Anthony DanielsPhysician	(i) (ii)	406,006 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	406,006 ------------- 0	0 ------------- 0
3Dana MillerPhysician	(i) (ii)	357,354 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	357,354 ------------- 0	0 ------------- 0
4Binoy ChandraPhysician	(i) (ii)	322,409 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	0 ------------- 0	322,409 ------------- 0	0 ------------- 0

Return Reference	Explanation
Form 990, Part III, Line 3	From Schedule H Part VI, Line 3DETERMINATION 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 patient's 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 patient's 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 re-evaluated 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, socio-economic, 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., co pays, co insurance, 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 928 425 3261. 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 applicant's 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: Copy of AHCCCS denial letter May be waived on a case by case basis Copies of pay stubs for the last 2 pay periods Number of dependents claimed on tax return 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. 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 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. the patient's 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. RELATED WEBSITES: Available upon request.
Form 990, Part VI, Section A, Line 3	The CEO and CFO duties are carried out by employees of HealthTech Management Services, Inc. an unrelated management company. 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 from data gathered and provided by CVRMC. 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	Contract labor, Physician fees and Purchased Services.