4A (Expenses $ 33395718 including grants of $ 0) (Revenue $ 38479349)
THE MEDICAL CENTER OPERATES AN ACUTE-CARE HOSPITAL AND LONG-TERM CARE NURSING HOME AND PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES TO THE COMMUNITY REGARDLESS OF RACE AND INSURANCE. THE MEDICAL CENTER PROVIDED 4,191 INPATIENT DAYS, 43,030 OUTPATIENT VISITS, 12,532 EMERGENCY ROOM VISITS, AND 155 BIRTHS DURING THE YEAR. THE MEDICAL CENTER ALSO PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 362,707 FOR CHARITY CARE, 28,044,938 FOR MEDICARE, 14,503,803 FOR MEDICAID, AND 5,452,603 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR.

FACILITY 1, ARKANSAS VALLEY REGIONAL MEDICAL - PART V, LINE 3E
IDENTIFICATION AND PRIORITIZATION OF HEALTH NEEDS ARE ADDRESSED BEGINNING ON PAGE 47, OF THE LATEST CHNA LOCATED ON THE WEBSITE.

FACILITY 1, ARKANSAS VALLEY REGIONAL MEDICAL - PART V, LINE 5
"WE DEPLOYED A CHNA ROUND I SURVEY TO OUR LOCAL EXPERT ADVISORS TO GAIN INPUT ON LOCAL HEALTH NEEDS AND THE NEEDS OF PRIORITY POPULATIONS. LOCAL EXPERT ADVISORS WERE LOCAL INDIVIDUALS SELECTED ACCORDING TO CRITERIA REQUIRED BY THE FEDERAL GUIDELINES AND REGULATIONS AND THE HOSPITALS DESIRE TO REPRESENT THE REGIONS GEOGRAPHICALLY AND ETHNICALLY DIVERSE POPULATION. WE RECEIVED COMMUNITY INPUT FROM 26 LOCAL EXPERT ADVISORS. SURVEY RESPONSES STARTED SEPTEMBER 21, 2015 AND ENDED WITH THE LAST RESPONSE ON OCTOBER 26, 2015. ALL WRITTEN COMMENTS ARE PRESENTED VERBATIM IN THE APPENDIX TO THIS REPORT. INFORMATION ANALYSIS AUGMENTED BY LOCAL OPINIONS SHOWED HOW OTERO COUNTY RELATES TO ITS PEERS IN TERMS OF PRIMARY AND CHRONIC NEEDS AND OTHER ISSUES OF UNINSURED PERSONS, LOW-INCOME PERSONS, AND MINORITY GROUPS. RESPONDENTS COMMENTED ON WHETHER THEY BELIEVE CERTAIN POPULATION GROUPS (""PRIORITY POPULATIONS"") NEED HELP TO IMPROVE THEIR CONDITION, AND IF SO, WHO NEEDS TO DO WHAT TO IMPROVE THE CONDITIONS OF THESE GROUPS. LOCAL OPINIONS OF THE NEEDS OF PRIORITY POPULATIONS WERE ABSTRACTED IN THE FOLLOWING ""TAKEAWAY"" COMMENTS. LITERACY BARRIERS ARE LIMITING ACCESS TO CARE, LACK OF PALLIATIVE CARE SERVICES, SHORTAGE OF HEALTH CARE PROVIDERS. ONGOING PREVENTATIVE EDUCATION, PARTICULARLY FOR DIABETES, IS NEEDED WHEN THE ANALYSIS WAS COMPLETE. WE PUT THE INFORMATION AND SUMMARY CONCLUSIONS BEFORE OUR LOCAL EXPERT ADVISORS WHO WERE ASKED TO AGREE OR DISAGREE WITH THE SUMMARY CONCLUSIONS. THEY WERE FREE TO AUGMENT POTENTIAL CONCLUSIONS WITH ADDITIONAL COMMENTS OF NEED, AND NEW NEEDS DID EMERGE FROM THIS EXCHANGE. CONSULTATION WITH 20 LOCAL EXPERTS OCCURRED AGAIN VIA AN INTERNET BASED SURVEY, (""ROUND 2"", EXPLAINED BELOW) BEGINNING NOVEMBER 16, 2015 AND ENDING JANUARY 11, 2016. HAVING TAKEN STEPS TO IDENTIFY POTENTIAL COMMUNITY NEEDS, THE LOCAL EXPERTS THEN PARTICIPATED IN A STRUCTURED COMMUNICATION TECHNIQUE CALLED A ""WISDOM OF CROWDS"" METHOD. THE PREMISE OF THIS APPROACH RELIES ON A PANEL OF EXPERTS WITH THE ASSUMPTION THAT THE COLLECTIVE WISDOM OF PARTICIPANTS IS SUPERIOR TO THE OPINION OF ANY ONE INDIVIDUAL, REGARDLESS OF THEIR PROFESSIONAL CREDENTIALS. IN THE AVRMC PROCESS, EACH LOCAL EXPERT HAD THE OPPORTUNITY TO INTRODUCE NEEDS PREVIOUSLY UNIDENTIFIED AND TO CHALLENGE CONCLUSIONS DEVELOPED FROM THE DATA ANALYSIS. WHILE THERE WERE A FEW OPINIONS OF THE DATA CONCLUSIONS NOT BEING COMPLETELY ACCURATE, THE VAST MAJORITY OF COMMENTS AGREED WITH OUR FINDINGS. WE DEVELOPED A SUMMARY OF ALL NEEDS IDENTIFIED BY ANY OF THE ANALYZED DATA SETS. THE LOCAL EXPERTS THEN ALLOCATED 100 POINTS AMONG THE POTENTIAL SIGNIFICANT NEED CANDIDATES, INCLUDING THE OPPORTUNITY TO AGAIN PRESENT ADDITIONAL NEEDS THAT WERE NOT IDENTIFIED FROM THE DATA. A RANK ORDER OF PRIORITIES EMERGED, WITH SOME NEEDS RECEIVING NONE OR VIRTUALLY NO SUPPORT, AND OTHER NEEDS RECEIVING IDENTICAL POINT ALLOCATIONS. WE DICHOTOMIZED THE RANK ORDER OF PRIORITIZED NEEDS INTO TWO GROUPS ""SIGNIFICANT- AND ""OTHER"" IDENTIFIED NEEDS. OUR CRITERIA FOR IDENTIFYING AND PRIORITIZING SIGNIFICANT NEEDS WAS BASED ON A DESCENDING FREQUENCY RANK ORDER OF THE NEEDS BASED ON TOTAL POINTS CAST BY THE LOCAL EXPERTS, FURTHER RANKED BY A DESCENDING FREQUENCY COUNT OF THE NUMBER OF LOCAL EXPERTS CASTING ANY POINTS FOR THE NEED. BY OUR DEFINITION, A SIGNIFICANT NEED HAD TO INCLUDE ALL RANK ORDERED NEEDS UNTIL AT LEAST FIFTY PERCENT (50%) OF ALL POINTS WERE INCLUDED AND TO THE EXTENT POSSIBLE, REPRESENTED POINTS ALLOCATED BY A MAJORITY OF VOTING LOCAL EXPERTS. THE DETERMINATION OF THE BREAK POINT - ""SIGNIFICANT"" AS OPPOSED TO ""OTHER"" - WAS A QUALITATIVE INTERPRETATION BY QUORUM AND THE AVRMC EXECUTIVE TEAM WHERE A REASONABLE BREAK POINT IN RANK ORDER OCCURRED."

FACILITY 1, ARKANSAS VALLEY REGIONAL MEDICAL - PART V, LINE 6B
THE HOSPITAL COLLABORATED WITH AND OBTAINED ASSISTANCE IN CONDUCTING THIS CHNA FROM QUORUM HEALTH RESOURCES (QHR).

FACILITY 1, ARKANSAS VALLEY REGIONAL MEDICAL - PART V, LINE 11
WE DO NOT HAVE ADEQUATE RESOURCES TO SOLVE ALL THE PROBLEMS IDENTIFIED. SOME ISSUES ARE BEYOND THE MISSION OF THE HOSPITAL AND ACTION IS BEST SUITED FOR A RESPONSE BY OTHERS. SOME IMPROVEMENTS WILL REQUIRE PERSONAL ACTIONS BY INDIVIDUALS RATHER THAN THE RESPONSE OF AN ORGANIZATION. WE VIEW THIS AS A PLAN FOR HOW WE, ALONG WITH OTHER ORGANIZATIONS AND AGENCIES, CAN COLLABORATE TO BRING THE BEST EACH HAS TO OFFER TO ADDRESS THE MORE PRESSING IDENTIFIED NEEDS. BY DEFINITION, THE NEEDS IDENTIFIED AS LOW PRIORITY AND FOR WHICH AVRMC HOLDS LOW RESPONSILBILITY FOR IMPLEMENTATION ARE NEEDS TO WHICH THE HOSPITAL MAY DEVOTE RESOURCES WHILE (IN MOST CASES) MONITORING BUT OTHERWISE NOT ADDRESSING. REASONS FOR THIS RESPONSE INCLUDE THE FOLLOWING: ACTIONS REQUIRED ARE BEYOND THE MISSION OF AVRMC, AVRMC CAN BE MORE EFFECTIVE APPLYING ITS RESOURCES TO HIGHER PRIORITY NEEDS, THE HOSPITAL DOES NOT POSSESS THE EXPERTISE NECESSARY FOR SUBSTANTIVE POSITIVE IMPROVEMENT, ACTIONS CONTEMPLATED FOR IMPLEMENTATION FALL MORE APPROPRIATELY TO THE RESPONSIBILITY OF OTHERS OTHER THAN PROVIDING ENCOURAGEMENT, AND IMPLEMENTATION EFFORTS FOR SOME NEEDS REQUIRE APPROPRIATE ACTIONS BY INDIVIDUALS MODIFYING THEIR PERSONAL HABITS RATHER THAN A RESPONSE BY AN ORGANIZATION OR THE HEALTH SYSTEM. THE BEST USE OF AVRMC RESOURCES IS TO FOCUS ON RESOLVING OR IMPROVING HIGHER PRIORITY NEEDS RATHER THAN ATTEMPTING TO RESPOND TO EVERYTHING WITH SMALL, PERHAPS INEFFECTIVE, EFFORTS.

FACILITY 1, ARKANSAS VALLEY REGIONAL MEDICAL - PART V, LINE 13B
THE ONLY CHARITY CARE DEFINED BY AVRMC'S PURPOSE IS PATIENTS THAT QUALIFY FOR COLORADO INDIGENT CARE.

PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION
THE COSTING METHODOLOGY USED TO DETERMINE THE FINANCIAL ASSISTANCE IS THE COST TO CHARGE RATIO.

PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY
THE COST METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED AS BAD DEBT EXPENSE IS USING A COST-TO-CHARGE RATIO. THE AMOUNT OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS IS MULTIPLIED BY THE RATIO OF PATIENT CARE COST TO CHARGES CALCULATE THE ESTIMATED COST OF BAD DEBTS ATTRIBUTABLE TO PATIENT ACCOUNTS. A NUMBER OF PATIENTS ARE TRULY UNABLE TO PAY THEIR OUT- OF-POCKET LIABILITY, BUT DO NOT COMPLETE THE PROCESS REQUIRED TO APPLY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. THESE PATIENTS WOULD QUALIFY FOR CHARITY CARE IF THEY COMPLETED THE PAPERWORK, SO THE BAD DEBT EXPENSE ASSOCIATED WITH TREATING THEM SHOULD BE TREATED AS A COMMUNITY BENEFIT.

BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS
THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 3 ON PAGE 12 OF THE AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS ALSO INCLUDED IN FOOTNOTE 3 OF THE AUDITED FINANCIAL STATEMENTS.

PART III, LINE 8 - MEDICARE EXPLANATION
MEDICARE SHORTFALL WAS CALCULATED USING THE MEDICARE COST REPORT FOR THE YEAR. IRS REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR NONPROFIT HOSPITALS, STATES THAT IF A HOSPITAL SERVES PATIENTS WITH GOVERNMENT HEALTH BENEFITS, INCLUDING MEDICARE, THEN THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THIS IMPLIES THAT TREATING MEDICARE PATIENTS SHOULD BE INCLUDED AS A COMMUNITY BENEFIT.

PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION
PATIENTS ARE NOTIFIED OF THE FINANCIAL ASSISTANCE PROGRAM VIA PATIENT FINANCIAL COUNSELORS, BROCHURES AVAILABLE IN THE ADMISSION AND BUSINESS OFFICE AREAS OF THE HOSPITAL, AND ON OUR WEBSITE AT THE FOLLOWING URL: HTTP://WWW.AVRMC.ORG/GETPAGE.PHP?NAME=FINANCIAL- ASSISTANCE-PRGRAM&SUB=FOR%20PATIENTS

PART VI, LINE 2 - NEEDS ASSESSMENT
THE CHNA IS THE PRIMARY METHOD TO ASSESS THE HEALTH CARE NEEDS OF THE COMMUNITY SERVED. HOSPITAL DEPARTMENT MANAGERS, MANAGEMENT, AND THE BOARD OF DIRECTORS ARE COMPRISED OF MEMBERS WITHIN THE COMMUNITY. THEY ARE ABLE TO GATHER AND COMMUNICATE THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES AND CONTINUALLY ADDRESS THEM AT STAFF AND BOARD MEETINGS. THE MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY AND COMMUNITY HEALTH NEEDS ASSESSMENT CAN BE FOUND AT THE FOLLOWING URL: HTTP://WWW.AVRMC.ORG/GETPAGE.PHP?NAME=COMMUNITY-HEALTH- NEEDS&CHILD=COMMUNITY+HEALTH+NEEDS

PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE
THE MEDICAL CENTER PROVIDES A BROCHURE TO EACH PATIENT OUTLINING THE GUIDELINES TO DETERMINE ELIGIBILITY FOR ASSISTANCE. IF APPROPRIATE, WE GET THEM AN APPOINTMENT WITH A FINANCIAL COUNSELOR. THE BROCHURE CAN BE FOUND ON OUR WEBSITE AT THE FOLLOWING URL: HTTP://WWW.AVRMC.ORG/GETPAGE.PHP?NAME=FINANCIAL-ASSISTANCE-PRGRAM&SUB=FOR %20PATIENTS

PART VI, LINE 4 - COMMUNITY INFORMATION
AVRMC, IN CONJUNCTION WITH QUORUM, DEFINES ITS SERVICE AREA AS OTERO COUNTY IN COLORADO, WHICH INCLUDES THE FOLLOWING ZIP CODES: 81039 FOWLER, 81050 LA JUNTA, 81058 MANZANOLA, AND 81067 ROCKY FORD. IN 2014, THE HOSPITAL RECEIVED 72.0% OF ITS PATIENTS FROM THIS AREA. COUNTY DATA IS USED AS MOST INFORMATION IS NOT AVAILABLE AT THE GEOGRAPHIC LEVEL OF A ZIP CODE. THE 2015 POPULATION FOR OTERO COUNTY IS ESTIMATED TO BE 19,013, AND IS EXPECTED TO INCREASE AT A RATE OF 0.5%, PROJECTING A 2020 POPULATION OF 19,100. THE POPULATION INCREASE IS IN CONTRAST TO THE COLORADO STATE AVERAGE RATE OF POPULATION INCREASE OF 6.3% AND THE NATIONAL GROWTH RATE OF 3.5%. APPROXIMATELY 55.1 % OF THE OTERO COUNTY POPULATION IS OF WHITE, NON- HISPANIC ETHNIC ORIGIN, COMPARED TO THE U S POPULATION PERCENTAGE OF 61.8%. THE HISPANIC POPULATION OF OTERO COUNTY IS 41.2%, COMPARED TO 17.6% NATIONALLY. THE 65+ POPULATION OF OTERO COUNTY 1S 19.7% OF THE TOTAL POPULATION COMPARED TO THE OVERALL US AT 14.7%. THE 2015 PERCENTAGE OF CHILD-BEARING-AGE FEMALES IN OTERO COUNTY IS 17.0%, WHILE IN COLORADO AS A WHOLE IT IS 19.9%, AND FOR THE US 19.7%. THE 2015 OTERO COUNTY MEDIAN HOUSEHOLD INCOME IS 34,037, WHICH IS CONSIDERABLY LOWER THAN THE NATIONAL MEDIAN HOUSEHOLD INCOME OF 53,375. OTERO COUNTY'S UNEMPLOYMENT RATE AS OF 2015 IS 4.7%. THIS IS LESS THAN THE NATIONAL UNEMPLOYMENT RATE OF 5.1%.

PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH
THE MEDICAL CENTER'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE LA JUNTA, COLORADO AREA. THE MAJORITY OF THE ORGANIZATION'S BOARD MEMBERS ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE MEDICAL CENTER. THE BOARD OF DIRECTORS IS MADE MOSTLY OF COMMUNITY BUSINESS PEOPLE INTERESTED IN MAINTAINING QUALITY HEALTH CARE IN LA JUNTA. MEDICAL STAFF PRIVILEGES ARE OPEN TO ALL MEDICAL PROVIDERS WITH ACTIVE LICENSURE. WE ENCOURAGE PRACTITIONERS FROM NUMEROUS SPECIALTIES TO MEET THE EVER EXPANDING HEALTHCARE NEEDS OF THE COMMUNITY. ANY SURPLUS FUNDS ARE REINVESTED INTO OUR FACILITIES, EQUIPMENT, AND EMPLOYEE EDUCATION.

PART VI, LINE 6 - AFFILIATED HEALTH CARE SYSTEM
N/A

PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT
COLORADO