2025-11-12T17:55:26-06:00 2024-12-31 Sorren Inc 102 N CASCADE AVENUE SUITE 400 COLORADO SPRINGS CO 80903 990 2024-01-01 840586742 TRINIDAD AREA HEALTH ASSOCIATION % MT SAN RAFAEL HOSPITAL TRIN 7198469213 410 BENEDICTA AVENUE TRINIDAD CO 81082 Calvin Carey CFO 7198469213 2025-11-17 true true DOREEN B MERZ P00841439 7196301186 2025-11-17 2024 2025-03-06 01:10:19Z MT SAN RAFAEL HOSPITAL Kimberly Lucero 410 BENEDICTA AVENUE TRINIDAD CO 81082 51520453 false X www.msrhc.org X 1969 CO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITIES WE SERVE AND IN A MANNER WHERE PATIENTS RECEIVE COMPASSIONATE AND PERSONALIZED CARE. 6 4 274 3 0 157307 839003 46871298 47814644 427802 955845 686408 1332744 48142815 50942236 0 0 0 0 22587622 22815771 0 0 0 24538887 26186712 47126509 49002483 1016306 1939753 63520379 66291497 33941594 34759026 29578785 31532471 X MT. SAN RAFAEL HOSPITAL IS COMMITTED TO PROVIDE QUALITY HEALTHCARE TO THE COMMUNITIES WE SERVE AND IN A MANNER WHERE PATIENTS RECEIVE COMPASSIONATE AND PERSONALIZED CARE. false false 46528542 49124183 MT SAN RAFAEL HOSPITAL PROVIDES GENERAL MEDICAL AND SURGICAL CARE FOR INPATIENT, OUTPATIENT, AND EMERGENCY ROOM PATIENTS, AND PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMS. MT SAN RAFAEL IS A 25 BED CRITICAL ACCESS FACILITY SERVICING THE MEDICAL AND SURGICAL NEEDS OF TRINIDAD RESIDENTS AND THE SURROUNDING AREAS. DURING 2024, PATIENT DAYS TOTALED 1,701, ER VISITS 10,132, SURGERIES 703, OP VISITS 43,685. 46528542 true true false false false false false false false false true false false false false true true false false false false false false false true false true true false false true false false false false false false false true false false false false false false false false false true 64 0 274 true false false false false false false false false false false false false false false false X 6 4 false true false false false false false true true false false true true true true true true true true true true CO X MT SAN RAFAEL HOSPITAL 7198469213 410 BENEDICTA AVENUE Trinidad CO 81082 X Damian Mizera Member/Ortho Surgeon 40.0 0.0 X 606184 0 56886 James Conrad Surgeon 40.0 0.0 X 504822 0 64296 Jose M Flores VP Med Staff Affairs 40.0 0.0 X 396927 0 46599 Joseph Jimenez MD Physician 40.0 0.0 X 393114 0 12114 Precious Castro-FloresMD Physician 40.0 0.0 X 361255 0 35955 Thomas Goodell MD Physician 40.0 0.0 X 293872 0 40453 Kevin McClintock Physician 40.0 0.0 X 275578 0 44197 Kimberly Lucero CEO 40.0 0.0 X 284371 0 18127 Shannon Castellano CNO 40.0 0.0 X 168852 0 28759 Kathleen Griego Board President 1.0 0.0 X X 0 0 0 Joe DeGarbo SEC/TREASURER 1.0 0.0 X X 0 0 0 Mike Tranter Member 1.0 0.0 X 0 0 0 Rhonda Epper Member 1.0 0.0 X 0 0 0 Toni DeAngelis Member 1.0 0.0 X X 0 0 0 Pamala Nelson Member 1.0 0.0 X 0 0 0 Calvin Carey CFO 40.0 0.0 X 0 0 0 3284975 0 347386 39 false true false INNOVA EMERGENCY MEDICAL ASSOC 700 N COLORADO BLVD DENVER CO 80206 ED PHYSICIAN COVERAG 1456322 SOUTHERN COLORADO CRNA ASSOC 13850 US HIGHWAY 350 TRINIDAD CO 81082 CRNA COVERAGE 394785 CHRIS POLAND CRNA LLC 206 Tyson Ct TRINIDAD CO 81082 CRNA COVERAGE 334917 MCAA Consulting PO Box 1685 EVANSVILLE WY 82636 CFO 226976 Sarah Pander 2006 Tranquility Lane LEAGUE CITY TX 77573 Ultrasound Tech 170529 9 788664 50339 839003 PATIENT SERVICES 621110 47595533 47595533 INCENTIVE PAYMENTS 621110 219111 219111 47814644 985442 985442 0 0 13497 13497 0 13497 13497 543430 573027 -29597 -29597 -29597 28395 5190 23205 23205 0 0 0 0 0 0 ANCILLARY SERVICES 621110 1296042 1296042 1296042 50942236 49124183 979050 0 0 0 0 1606705 1304207 302498 0 14565495 14023096 542399 278148 278148 5073497 5073497 1291926 1224517 67409 226976 226976 424929 424929 298710 298710 0 0 0 9813691 9812654 1037 0 0 827442 814253 13189 0 0 755159 755159 0 0 0 816103 816103 0 2308449 2268454 39995 356977 356977 MEDICAL SUPPLIES 4882030 4882030 BAD DEBT EXPENSE 4115861 4115861 OTHER EXPENSE 868255 589638 278617 REPAIRS AND MAINTENANCE 492130 492096 34 49002483 46528542 2473941 0 X 621534 3182001 12444742 11492921 0 0 4673169 5460595 0 0 0 0 0 0 545914 790665 357291 457979 68755486 31151641 38697705 37603845 6180024 7303491 0 0 0 0 0 0 0 0 63520379 66291497 3522384 5106143 0 0 0 0 0 0 0 0 0 0 30419210 29652883 0 0 0 0 33941594 34759026 X 29578785 31532471 0 0 29578785 31532471 63520379 66291497 1939753 13933 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 284448 284448 38581357 9797362 28783995 28608816 21176190 7432626 1280865 178089 1102776 37603845 0 0 X 46845498 13933 5190 19123 46826375 4115861 4115861 50942236 44891812 5190 5190 44886622 4115861 4115861 49002483 Schedule D, PART 2, LINE 2 The Hospital is exempt from federal income taxes under Section 501(c)(3) of the Internal Revenue Code and a similar provision of state law. However, the Hospital is subject to federal income tax on any unrelated business taxable income. The Hospital believes that it does not have any uncertain tax positions that are material to the financial statements. Schedule D, PART XI, Line 2d Other: $5,190. Fundraising event expenses reported as expenses in the audited financial statements, reclassified to revenue for the tax return. Schedule D, PART XI, Line 4b OTHER: $4,115,861. BAD DEBT EXPENSE REPORTED WITHIN REVENUE, IN THE AUDITED FINANCIAL STATEMENTs, RECLASSIFIED TO EXPENSE FOR THE TAX RETURN. Schedule D, Part XII, Line 2d OTHER: $5,190. FUNDRAISING EVENT EXPENSES REPORTED AS EXPENSES IN THE AUDITED FINANCIAL STATEMENTs, RECLASSIFIED TO REVENUE FOR THE TAX RETURN. Schedule D, Part XII, Line 4b OTHER: $4,115,861. BAD DEBT EXPENSE REPORTED WITHIN REVENUE, IN THE AUDITED FINANCIAL STATEMENTs, RECLASSIFIED TO EXPENSE FOR THE TAX RETURN. Golf Tournament 28395 28395 1400 3790 0 28395 28395 1400 3790 5190 23205 true true true X true X true true false true true 771559 771559 0.01720 9501900 4782566 4719334 0.10510 10273459 4782566 5490893 0.12230 79017 79017 0.00170 35664275 1561747 25887163 0.57670 35743292 1561747 25966180 0.57840 46016751 6344313 31457073 0.70070 false 4115861 8306762 8296759 10003 X true true 1 1 TRINIDAD AREA HEALTH ASSOCIATION 410 BENEDICTA AVENUE TRINIDAD CO 81082 WWW.MSRHC.ORG 010704 X X X X 1 TRINIDAD AREA HEALTH ASSOCIATION 1 false false true X X X X X X X X 24 true false true true X WWW.MSRHC.ORG true 24 true SEE FULL WEBSITE IN PART V false true X 250. 0. X X X X true true X X X true X WWW.MSRHC.ORG X WWW.MSRHC.ORG X WWW.MSRHC.ORG X X X X X X true false X X X X true X false false PART V,SECTION B, LINE 5 Completion of the MSRH Community Health Needs Assessment (CHNA) followed a modified outline designed by the Center for Rural Health at the University of North Dakota for the North Dakota Critical Access Hospitals. The sections of this CHNA generally follow their suggested methodology, but were only slightly modified to meet the needs of MSRH. A first meeting was held in person during the month of March 2024. This meeting was a general review of health information on a county level. The participants were asked to review the survey that would go out to the public to make sure we were able to get information to help the hospital assess the health needs of the community. The survey was further revised by One Health Insights (OHI) and Mt. San Rafael Hospital to ensure the questions asked would help the Senior Leadership Team and Board decide on the best course of action for the hospital. Before the survey was distributed to the community, special care was taken to ensure the verbiage was inclusive. Members of the committee volunteered to make sure it was delivered to the Native American and Latin communities. Once the community had been given time to fill out the survey, OHI collected the data and reviewed the findings with community members from various departments within the hospital. This meeting allowed the group to review the information collected in the survey and prioritize the most important health issues that could and should be addressed, given the resources of Mt. San Rafael Hospital. Key findings from the survey were reviewed to see what needed to be addressed by the hospital and what needed to be given priority. As the survey was reviewed by Hospital staff, areas of focus and clarification were outlined. The Senior Leadership Team wanted to ensure the CHNA was not only dealing with the opinions of the community, they wanted to make sure they had the data to make appropriate decisions. Employees from MSRH decided on several goals to work on over the next few years that would allow them to better serve the community. These goals were then compiled into a Community Health Implementation Plan (CHIP) for them to track progress. That plan was started in Action Strategy, an online tool to track and monitor progress on the CHIP. Action Strategy also made the plan accessible in Word and Excel formats in case MSRH decided not to use the electronic format. Finally, a revised CHNA was prepared and taken to the Board of Directors for their input and approval. See MSRHC's CHNA for further details. PART V, SECTION B, LINE 6B The CHNA was conducted with one or more organizations other than MSRH as seen in the Appendix of the CHNA: Las Animas County Department of Human Services Las Animas County-Huerfano Counties District Health Department City of Trinidad Trinidad School District Number 1 Trinidad State College Salud Family Health Center One Health Insights Trinidad Area Health Association Trinidad Ambulance District Huerfano and Las Animas Counties Early Childhood Advisory Council PART V, SECTION B, LINE 10A https://www.msrhc.org/docs/Mt_San_Rafael_Hospital_CHNA_2024F.pdf PART V, SECTION B, LINE 11 IMPLEMENTATION PLAN IN ADDITION TO THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), HOSPITALS ARE REQUIRED TO DEVELOP A COMMUNITY HEALTH IMPLEMENTATION PLAN (CHIP) TO OUTLINE THEIR STRATEGIES FOR ADDRESSING THE ISSUES IDENTIFIED IN THE CHNA. THIS PLAN ALLOWS THE IRS TO EVALUATE WHAT HOSPITALS ARE DOING TO MEET COMMUNITY NEEDS AND HELPS JUSTIFY THEIR 501(C)(3) STATUS. MT. SAN RAFAEL HOSPITAL'S CHIP REFLECTS STAFF DECISIONS, WITH INPUT FROM THE COMMUNITY, ON THE ACTIONS NECESSARY TO MEET THESE NEEDS. THE FOLLOWING SIX AREAS WILL GUIDE MSRH IN BETTER SERVING THE COMMUNITY'S HEALTHCARE REQUIREMENTS: 1. GROW AND STRENGTHEN SURGICAL SERVICES. MSRH WILL STRENGTHEN AND GROW GENERAL SURGERY, GASTROENTEROLOGY, ORTHOPEDICS, AND OPHTHALMOLOGY THROUGH A FOCUS ON INCREASING SERVICE CAPACITY. 2. HELP PATIENTS RECEIVE SPECIALTY CARE CLOSER TO HOME. MSRH WILL REDUCE THE UNNECESSARY TRANSFER OF PATIENTS TO OUTSIDE FACILITIES THROUGH UNDERSTANDING PATTERNS AND WORKING TO REDUCE RETENTION AND REFERRAL BARRIERS. 3. EXPAND ONCOLOGY PROGRAM. MSRH WILL INCREASE PATIENT CAPACITY WITH UCHEALTH. ADDITIONALLY, MSRH WILL WORK TO ESTABLISH A PARTNERSHIP WITH ROCKY MOUNTAIN CANCER CENTERS TO IDENTIFY WHICH CANCER TREATMENTS CAN BE PROVIDED LOCALLY AND EXPLORE PARTNERSHIPS WITH NEARBY LABS AND COMPOUNDING PHARMACIES TO IMPROVE SERVICE DELIVERY. 4. ENHANCE SERVICE LINE AWARENESS. MSRH PLANS TO INCREASE AWARENESS THROUGH MARKETING SERVICES THAT WERE LESS KNOWN IN THE COMMUNITY. THIS WILL BE DONE THROUGH IMPROVING SOCIAL MEDIA MARKETING, SUPPORTING AND PARTICIPATING IN COMMUNITY EVENTS, AND HOSTING BUSINESS LEADER LUNCHEONS TO BRING AWARENESS AND BENEFITS OF THE HOSPITAL. 5. PARTNERING WITH THE COMMUNITY. WORK WITH LOCAL ORGANIZATIONS TO ENHANCE SERVICES IN OPTOMETRY, TRANSPORTATION, ADDICTION RECOVERY, AND MENTAL HEALTH, ENSURING A COMPREHENSIVE APPROACH TO COMMUNITY HEALTH AND WELLBEING. 6. HEALTH AND NUTRITIONAL EDUCATION. MSRH WILL IMPROVE THE IMPACT OF DIABETIES AND OTHER WEIGHT RELATED HEALTHCARE ISSUES THROUGH HIRING A DIETICIAN, COACHING AND EDUCATING THE COMMUNITY ON HOW THEY CAN IMPROVE THEIR HEALTH. BY FOCUSING ON THESE AREAS, MSRH AIMS TO ADDRESS THE COMMUNITY'S HEALTHCARE NEEDS MORE EFFECTIVELY AND FULFILL ITS MISSION AS A 501(C)(3)ORGANIZATION. THESE SIX AREAS OF FOCUS WILL BE ADDRESSED OVER THE NEXT THREE YEARS. IN DOING SO, MSRH EXPECTS THE COMMUNITY WILL SEE IMPROVED HEALTH AND COMMUNITY SUPPORT FOR THE HOSPITAL AND OTHER HEALTHCARE ORGANIZATIONS IN THE AREA. PART V, LINE 22D AND 24 ALL PATIENTS ARE CHARGED THE SAME REGARDLESS OF FINANCIAL CLASS. PART I, LINE 7 The hospital uses the cost to charge ratio as computed in the Medicare cost report. Bad debts excluded from column f calculations equal $4,115,861. Part III, Line 4 The Hospital provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions for its major payor groups. Accounts are considered delinquent and subsequently written off based on individual credit evaluation and specific circumstances of the patient or third-party payer. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Rationale for including bad debt as community benefit: 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 community benefit. Part III, Line 8 The Medicare allowable costs of care are pulled from the Medicare cost and reimbursement summary of the medicare cost report. 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 is a community benefit. That treating Medicare patients is a community benefit. Part III, Line 9B THE HOSPITAL HAS A SLIDING SCALE CHARITY CARE POLICY. Part IV, Line 4 Community Information: Mount San Rafael Hospital is located in Trinidad, Colorado. Trinidad is approximately 200 miles south of Denver, Colorado. MSRH principally serves the residents of Las Animas County with a population of Approximately 14,500 persons. MSRH is the only hospital in the County. See the Community Health Needs assessment page 10 for detailed description of the residents and demographics. Part VI, Line 2 The Hospital utilizes the survey and data from the Community Health Needs assessment to assess the health needs of the community. Part VI, Line 3 The organization informs and educates patients and persons regarding their eligibility for assistance through printed material, financial counselors and via the website. When an un-insured patient presents themselves for an appointment at the hospital, RHC or Emergency Room visit, the Patient Access Representative will register the patient and present them with a business card that has the hospitals financial counselors name and phone number and request that they get an appointment to apply for aid. The hospital financial counselor will review their case and will offer a plan that qualifies for financial assistance. If patient does not qualify for Medicaid or CICP they will be screened to see if they qualify for the hospitals sliding fee schedule, Charity Care. The patient will be required to pay any co-pay due for the qualifying plan. Part VI, Line 5 The Hospital's Board of Directors is comprised of persons inside the primary service area and are concerned with the health of the community as a whole. Part VI, Line 6 Trinidad Area Health Association, DBA Mt San Rafael Hospital is not part of an affiliated health care system. Part VI, Line 7 Community Benefit report is filed with Colorado. X X X X false false false false false false false true false Thomas Goodell MD Physician 293592 280 8998 31455 334325 Precious Castro-FloresMD Physician 288375 72880 17996 17959 397210 Damian Mizera Member/Ortho Surgeon 606184 10350 46536 663070 Jose M Flores VP Med Staff Affairs 273582 123345 18016 28583 443526 James Conrad Surgeon 504822 17760 46536 569118 Kimberly Lucero CEO 284091 280 16253 1874 302498 Shannon Castellano CNO 168573 279 8898 19861 197611 Kevin McClintock Physician 272424 3154 16099 28098 319775 Joseph Jimenez MD Physician 267412 125702 12114 405228 Sch J Part I line 7 Physicians receive a quarterly incentive bonus for productivity and all employees receive a one time Christmas bonus. Sch J, Part II, Line 3,4 Board members, Dr. Damian Mizera, and Dr. Joes M. Flores, received COMPENSATIOn FOR the medical SERVICES They provided to THE ORGANIZATION, AND did NOT receive compensation for their board member services. MCAA Consulting Owned by former officer 226976 Contracted CFO Services false FORM 990, PART I, LINE 6 VOLUNTEERS ARE PART OF MSP AUXILLARY GROUP AND PROVIDE VOLUNTEER SERVICES to COVER the GIFT SHOP AND MAIN LOBBY FRONT DESK COVEAGE. FORM 990, PART VI, Section A, LINE 3 THE ORGANIZATION HIRED CALVIN CAREY, OF MCAA CONSULTING, FOR CONTRACTED CFO SERVICES, for THE 2024 CALENDAR YEAR. CALVIN CAREY RECEIVED COMPENSATION THROUGH MCAA CONSULTING FOR SERVICES PROVIDED TO THE FILING ORGANIZATION, FOR THE CALENDAR YEAR 2024, THE SPECIFIC AMOUNT IS NOT KNOWN. CALVIN CAREY IS A FORMER OFFICER OF THE FILING ORGANIZATION. THE COST OF THE CONTRACTED CFO SERVICES FOR THE YEAR ARE REFLECTED ON FORM 990, PART IX, Line 11a. FORM 990, PART VI, Section A, LINE 8A MINUTES MAINTAINED AT 410 BENEDICTA AVENUE TRINIDAD, CO 81082 FORM 990, PART VI, Section A, LINE 8B MINUTES MAINTAINED AT 410 BENEDICTA AVENUE TRINIDAD, CO 81082 FORM 990, PART VI, Section B, LINE 11B The Form 990 IS REVIEWED BY THE BOARD OF TRUSTEES, FINANCE COMMITTEE, AND THEN RECOMMENDED TO THE ENTIRE BOARD OF TRUSTEES FOR FOR COMMENT and approval, prior to filing with the IRS. FORM 990, PART VI, Section B, LINE 12C ANNUALLY, THE ORGANIZATION REVIEWS AND DISCUSSES THE CONFLICT-OF-INTEREST POLICY AND REQUIREs THAT EACH officer and BOARD MEMBER LIST AND ACKNOWLEDGE ANY KNOWN CONFLICTS. CORPORATE COMPLIANCE PROGRAMS AND EDUCATION THROUGH INSERVICE SESSIONS COVER ONGOING RESPONSIBILITIES OF DISCLOSING ANY CONFLICTS Of Interest. VIOLATORS OF CONFLICT OF INTEREST WILL BE REMOVED FROM THE BOARD. AT EACH BOARD MEETING, IF THERE IS A DISCUSSION OF SELECTING OR ENGAGING A VENDOR OR SERVICE PROVIDER, ALL IN ATTENDANCE ARE ASKED TO RECUSE THEMSELVES FROM THIS DISCUSSION IF THERE COULD BE A PERCEIVED CONFLICT. FORM 990, PART VI, Section B, LINE 15A & B THE BOARD OF trustees COMPLETES AN ANNUAL PERFORMANCE REVIEW OF THE CEO AND CFO. THE BOARD REVIEWS COMPENSATION INFORMATION ON THE COMPENSATION OF INDIVIDUALS IN LIKE POSITIONS AND IN COMPARABLE ORGANIZATIONS. THE BOARD APPROVES ANY CHANGES IN COMPENSATION BASED ON MERIT, PERFORMANCE, AND MARKET ADJUSTMENTS. FORM 990, PART VI, Section C, LINE 19 THE ORGANIZATION WILL PROVIDE IN A TIMELY MANNER, COPIES OF ALL GOVERNING DOCUMENTS, INCLUDING ITS CONFLICT-OF-INTEREST POLICIES AND FINANCIAL STATEMENTS WHEN REQUESTED IN WRITING OR IN PERSON. Form 990, Part VII, Section A, Line 2,3 Board members, Dr. Damian Mizera, and Dr. Joes M. Flores, received compensation FOR the medical SERVICES They provided to THE ORGANIZATION, AND did NOT receive compensation for their board member services. Form 990, part X, column A, line 1 and 2 COLUMN (A) BEGINNING YEAR BALANCE: LINE 2, SAVINGS AND TEMPORARY CASH INVESTMENTS, WAS ADJUSTED TO RECLASSIFY INTEREST-BEARING ACCOUNTS FROM LINE 1 CASH, NON-INTEREST-BEARING TO LINE 2. FORM 990 PART IX LINE 11G DESCRIPTION:AGENCY/CONTRACT LABOR TOTAL FEES:783584 FORM 990 PART IX LINE 11G DESCRIPTION:HPF FEES TOTAL FEES:1672373 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - MEDICAL TOTAL FEES:1474488 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - OTHER TOTAL FEES:3814618 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES - MEDICAL TOTAL FEES:2068628