Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
|
Total |
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Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 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. | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 | ||||||
Calendar year (or fiscal
year beginning in) ![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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.) | ||||||
Calendar year
(or fiscal year beginning in)
![]() |
(a) 2020 | (b) 2021 | (c) 2022 | (d) 2023 | (e) 2024 | (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 on 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.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 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) |
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| 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 0.015 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 0.035 | 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 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2024 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2024 |
(iii) Distributable Amount for 2024 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2024 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2024 (reasonable cause required-- explain in Part VI).
See instructions. |
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| 3 Excess distributions carryover, if any, to 2024: | ||||
| a From 2019....... | ||||
| b From 2020....... | ||||
| c From 2021....... | ||||
| d From 2022....... | ||||
| e From 2023....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2024 distributable amount | ||||
|
i
Carryover from 2019 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2024 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2024 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2024, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2024. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
7 Excess distributions carryover to 2025. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2020..... | ||||
| b Excess from 2021..... | ||||
| c Excess from 2022..... | ||||
| d Excess from 2023..... | ||||
| e Excess from 2024..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | 24020490 |
| Software Version: | 2024v5.2 |
| Return Reference | Explanation |
|---|---|
| Form 990, Part VI, Section A, Line 3 | The CEO and CFO duties are carried out by employees of HealthTech Management Services, Inc. (HealthTech), an unrelated management company. Compensation is included in the management fee paid to HealthTech. The management fee for 2024 was $1,031,112. |
| Form 990, Part VI, Section B, Line 11b | A CPA firm prepared and reviews the form 990 from data gathered and provided by the CVRMC. The return is then provided to the CFO for review and approval. Any questions or concerns the CFO has are addressed and any correction or clarifications are made. The final Form 990, with all required schedules, is made available to the full board prior to filing. |
| 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 15a | The Officers' 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 B, Line 15b | The Officers' 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 XI, Line 9 | Net assets changes in assets held with donor restrictions = $140593 |
| Form 990 Schedule H, Part 3(c) | Funds were approved by the Board of Directors as pledged to a new city park in the amount of $2.25M. The project will be a collaborative effort funded by several local organizations. |
| Form 990, Part VI, Section A | Please see note on Part VI, Section A, Line 3. Officers of the organization are provided by a management company.Voting Board member Dr. Alan Osumi was compensated by CVRMC for medical staff leadership services provided. Dr. Osumi's compensation did not exceed the allowable amount to maintain voting independence, nor did it meet the requirements to be reported on Schedule L. See Part VI, Section A, Line 1b. |
| Form 990, Part X Balance Sheet, Line 15, Other Assets | Other Assets: Other assets consist of bond issuance costs for the Series 2014 Bonds and other loan fees. These deferred costs are amortized over the straight-line method over the life of the bonds and loans, ending balance was $127,874. Cash and cash equivalents held in reserve for debt service totaled $1,326,855, $653,993 was held for the 457(f) plan, and $923,313 in fixed income securities in the form of corporate bonds and notes. Other assests also include Land held for investment, in the amount of $56,870. |
| Form 990, Schedule H Part V, Section D - Facility Information | Facilities are listed in order from Largest to smallest. Please disregard the number appearing to the left of the name of the facility, which does not have any significance. |
| Form 990, Schedule H Part VI, Line 5-Promotion of Community Health | Continued from Schedule H.THE TUITION ASSISTANCE PROGRAM IS A BENEFIT PROVIDED TO ASSIST EMPLOYEES IN IMPROVING THEIR JOB CAPABILITIES WITHIN THEIR WORK ENVIRONMENT. THE HOSPTIAL ALSO SPONSORS A NURSING PROFESSOR POSITION AT THE LOCAL COMMUNITY COLLEGE TO ENHANCE AND ASSURE THE STRENGTH OF THE LOCAL NURSING PROGRAM.STANDARDS OF PERFORMANCE AND CUSTOMER SERVICE TRAINING THE CVRMC STANDARDS OF PERFORMANCE ARE DESIGNED AND CREATED BY A TEAM OF HOSPITAL STAFF AND CONSIST OF A SET OF PERFORMANCE EXPECTATIONS FOR EVERY EMPLOYEE TO FOLLOW AT ALL TIMES. AT CVRMC OUR POSITION DESCRIPTIONS OUTLINE THE DUTIES AND RESPONSIBILITIES EVERY INDIVIDUAL IS ACCOUNTABLE FOR IN THE COMMISSION OF THEIR RESPECTIVE JOBS. THE CVRMC STANDARDS OF PERFORMANCE OFFERS A DEFINITION AND FRAMEWORK OF BEHAVIORS THAT EVERY EMPLOYEE WILL EXHIBIT WHEN INTERACTING WITH PATIENTS, CUSTOMERS, ANDCO-WORKERS. THESE STANDARDS ALSO PROVIDE THE CRITERIA BY WHICH AN EMPLOYEE IS EVALUATED.IN OUR STANDARDS OF PERFORMANCE, WE IDENTIFY PATIENTS, CUSTOMERS, AND CO-WORKERS AS OUR TARGET SERVICE POPULATIONS. AT CVRMC WE CONSIDER CUSTOMERS TO INCLUDE PHYSICIANS, FAMILIES, VENDORS, SUPPLIERS, AND ANYONE ELSE THAT WE HAVE CONTACT WITH AND THE BEHAVIOR EXPECTATIONS INCLUDE PRIVACY, ATTITUDE, COMMUNICATION, TEAMWORK, COURTESY, ACCOUNTABILITY, APPEARANCE, RESPONSIVENESS, AND SAFETY.EVERY EMPLOYEE OF CVRMC IS REQUIRED TO ATTEND CUSTOMER SERVICE TRAINING TO HELP DRIVE OUR MISSION STATEMENT AND TO GUIDE THEM IN THE STANDARDS OF PERFORMANCE AT EVERY LEVEL OF THE ORGANIZATION. THIS CUSTOMER TRAINING IS ALSO OFFERED TO EVERY PHYSICIAN, THEIR OFFICE STAFF, AND ORGANIZATIONS WITHIN THE REGION, FREE OF CHARGE, IN ORDER TO CREATE A REGIONAL CULTURE OF COURTESY AND RESPECT.SAN CARLOS, PARTNER SERVICE AREA - ADJACENT TO THE SAN CARLOS APACHE RESERVATION, CVRMC SERVES AS A PARTNER IN ACUTE OBSTETRIC, PODIATRY, ORTHOPEDIC, ONCOLOGY AND SURGICAL SERVICES FOR RESERVATION RESIDENTS REFERRED BY THEIR HOSPITAL OR THE CVRMC HOSPITAL PHYSICIANS WHO MAINTAIN CLINICAL HOURS AT SAN CARLOS. |
| Form 990, Schedule H, Line 7g | Subsidy paid for hospital-based physician services to ensure the community had access to these physicians. Subsidy represents amount paid in excess of physician billings for services. |
| Form 990, Schedule I, Part II & Form 990 Part IX, Ln 1 | Grants to domestic organizations and governments in excess of $5000 (a total of $18,800) are required to be reported on Schedule I, Part II. Those have been listed accordingly. Other, minor grants were given that did not exceed the $5000 threshold, thus not reported on Schedule I, but are reflected in the total of grants to organizations/governments ($30,777) on Form 990, Part IX, Line 1 - Grants and other assistance. |
| Software ID: | 24020490 |
| Software Version: | 2024v5.2 |