WINSLOW MEMORIAL HOSPITAL INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- WINSLOW MEMORIAL HOSPITAL INC (EIN 86-0107344)
- Tax period
- 2022-10-01 to 2023-09-30
- Filed
- 2024-06-17
- IRS object ID
- 202421699349300627
- Schema version
- 2022v5.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2024-06-17T08:46:03-05:00 | ReturnTs |
| Tax Period End | 2023-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 345 N REID PL STE 400 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571037034 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860107344 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINSLOW MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WINS | BusinessNameControlTxt |
| Phone | 9282896303 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 N WILLIAMSON AVE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | LONA KING | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9282896303 | PhoneNum |
| Signature | 2024-06-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | LONA | PersonFirstNm |
| Person Last | KING | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAURIE HANSON CPA | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2024-06-14 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COLORADO MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN J DEMPSEY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 N WILLIAMSON AVE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $40,856,792 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | LCMCWMH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1951 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | COMPASSIONATE CARE FOR NORTHEASTERN ARIZONA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 328 | TotalEmployeeCnt |
| Total Volunteers | 21 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $5,422,826 | PYContributionsGrantsAmt |
| CY Contributions Grants | $128,120 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $41,606,246 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,454,131 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$232,119 | PYInvestmentIncomeAmt |
| CY Investment Income | $25,563 | CYInvestmentIncomeAmt |
| PY Other Revenue | $33,584 | PYOtherRevenueAmt |
| CY Other Revenue | $29,490 | CYOtherRevenueAmt |
| PY Total Revenue | $46,830,537 | PYTotalRevenueAmt |
| CY Total Revenue | $40,637,304 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $6,685 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $5,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $21,826,876 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $22,343,692 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $21,005,716 | PYOtherExpensesAmt |
| CY Other Expenses | $21,277,026 | CYOtherExpensesAmt |
| PY Total Expenses | $42,839,277 | PYTotalExpensesAmt |
| CY Total Expenses | $43,625,718 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,991,260 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,988,414 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $48,891,404 | TotalAssetsBOYAmt |
| Total Assets EOY | $46,386,356 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $18,782,886 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $19,271,171 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $30,108,518 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $27,115,185 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | COMPASSIONATE CARE FOR NORTHEASTERN ARIZONA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $36,018,524 | ExpenseAmt |
| Grant | $5,000 | GrantAmt |
| Revenue | $40,454,131 | RevenueAmt |
| Desc | WINSLOW MEMORIAL HOSPITAL D/B/A LITTLE COLORADO MEDICAL CENTER (LCMC) GENERAL MEDICAL & SURGICAL HOSPITAL - PRIMARILY ENGAGED IN PROVIDING DIAGNOSTIC, MEDICAL TREATMENT (BOTH SURGICAL AND NONSURGICAL) TO PATIENTS WITH A WIDE VARIETY OF MEDICAL CONDITIONS. LCMC MAINTAINED 25-BEDS, PROVIDED INPATIENTS WITH FOOD SERVICES THAT MET THEIR NUTRITIONAL REQUIREMENTS, AND USED AN ORGANIZED STAFF OF PHYSICIANS AND OTHER MEDICAL STAFF TO PROVIDE PROFESSIONAL CARE SERVICES AS WELL AS OTHER SERVICES. THESE SERVICES INCLUDE OUTPATIENT SERVICES, ANATOMICAL PATHOLOGY SERVICES, DIAGNOSTIC X-RAY SERVICES, CLINICAL LABORATORY SERVICES, OPERATING ROOM SERVICES FOR A VARIETY OF PROCEDURES, AND PHARMACY SERVICES IN THE CITY OF WINSLOW, NAVAJO COUNTY, ARIZONA. LCMC MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES WHICH INCLUDE THE COST OF SUPPLIES AND SERVICES FURNISHED UNDER THE CHARITY CARE POLICY ALONG WITH ASSOCIATED EQUIVALENT SERVICE STATISTICS. | Desc |
| Total Program Service Expenses | $36,018,524 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 328 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | 0 | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LONA KING | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9282894691 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 NORTH WILLIAMSON AVENUE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (21 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| THOMAS GREENWOOD MD | ||||||||
| DIRECTOR, CHIEF OF STAFF | 40.00 | 0.50 | Yes (X) | $241,001 | $0 | $46,171 | ||
| JR DESPAIN | ||||||||
| CHAIRPERSON | 5.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| FRANK ARMAO MD | ||||||||
| SECRETARY/TREASURER | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| RHONDA GREER | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| CHRIS BAVASI | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| ROBERT SALABYE | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| ROBERTA CANO | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| DARRIN FRY | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH MCKEY | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| GREG HACKLER | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| ALLYSEN KELLY | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| SAGE WHITE MD | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| KATHLEEN SMITH | ||||||||
| DIRECTOR | 1.00 | 0.50 | Yes (X) | $0 | $0 | $0 | ||
| JOHN J DEMPSEY | ||||||||
| CEO | 40.00 | 0.00 | $369,224 | $0 | $24,624 | Yes (X) | ||
| LONA KING | ||||||||
| CFO FROM 09/2022 | 40.00 | 0.00 | $62,677 | $0 | $2,677 | Yes (X) | ||
| JANICE FREET | ||||||||
| CFO; RETIRED 12/2022 | 40.00 | 0.00 | $282,620 | $0 | $22,467 | Yes (X) | ||
| BRIAN BUCINA MD | ||||||||
| SURGEON | 40.00 | 0.00 | $426,136 | $0 | $45,749 | Yes (X) | ||
| RANDALL REID MD | ||||||||
| GENERAL MEDICINE | 40.00 | 0.00 | $293,837 | $0 | $48,350 | Yes (X) | ||
| REBECCA HEWARD | ||||||||
| INFORMATIC NURSE | 36.00 | 0.00 | $162,447 | $0 | $6,433 | Yes (X) | ||
| PAMELA RULAND | ||||||||
| RN | 36.00 | 0.00 | $194,730 | $0 | $18,283 | Yes (X) | ||
| JAMES PAGE | ||||||||
| GENERAL MEDICINE | 40.00 | 0.00 | $208,727 | $0 | $39,194 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,241,399 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $253,948 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MEDICAL SOLUTIONS | |||||
| 1010 N 102ND ST SUITE 300 | OMAHA | NE | 68114 | CONTRACTED HEALTHCARE | $1,562,492 |
| XTEND | |||||
| 90 VOLUNTEER DR SUITE 150 | HENDERSONVILLE | TN | 37075 | COLLECTION SERVICES | $647,217 |
| WINNCARE | |||||
| 1031 N WARREN | WINSLOW | AZ | 86047 | HEALTHCARE SERVICES | $426,479 |
| JG ANESTHESIA | |||||
| 2973 N KRISTEN DR | FLAGSTAFF | AZ | 86001 | ANESTHESIA | $389,325 |
| UNITIMED | |||||
| 11516 NICHOLAS ST SUITE 300 | OMAHA | NE | 68154 | CONTRACTED HEALTHCARE | $383,538 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 17 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $128,120 | AllOtherContributionsAmt |
| Noncash Contributions | $76,668 | NoncashContributionsAmt |
| Total Contributions | $128,120 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621400 | $39,032,778 | $39,032,778 |
| PHARMACY REVENUE | 900099 | $447,651 | $447,651 |
| MEAL & VENDING REVENUE | 900099 | $61,183 | $61,183 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $912,519 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $912,519 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,454,131 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $77,106 | TotalRevenueColumnAmt |
| Exclusion | $77,106 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,490 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $29,490 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,490 | TotalRevenueColumnAmt |
| Exclusion | $29,490 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $167,945 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $219,488 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $167,945 | SecuritiesAmt |
| Other | -$219,488 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$51,543 | TotalRevenueColumnAmt |
| Exclusion | -$51,543 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,637,304 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,454,131 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $55,053 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,000 | TotalAmt |
| Program Services | $5,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,011,369 | TotalAmt |
| Program Services | $307,458 | ProgramServicesAmt |
| Management And General | $703,911 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,627,895 | TotalAmt |
| Program Services | $14,705,870 | ProgramServicesAmt |
| Management And General | $1,922,025 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $600,484 | TotalAmt |
| Program Services | $469,902 | ProgramServicesAmt |
| Management And General | $130,582 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,857,069 | TotalAmt |
| Program Services | $2,575,501 | ProgramServicesAmt |
| Management And General | $281,568 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,246,875 | TotalAmt |
| Program Services | $1,058,212 | ProgramServicesAmt |
| Management And General | $188,663 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $198,495 | TotalAmt |
| Management And General | $198,495 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $118,141 | TotalAmt |
| Management And General | $118,141 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,955,529 | TotalAmt |
| Program Services | $8,805,210 | ProgramServicesAmt |
| Management And General | $150,319 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,453 | TotalAmt |
| Program Services | $4,960 | ProgramServicesAmt |
| Management And General | $41,493 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,360,271 | TotalAmt |
| Program Services | $770,095 | ProgramServicesAmt |
| Management And General | $1,590,176 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $510,860 | TotalAmt |
| Management And General | $510,860 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $462,820 | TotalAmt |
| Program Services | $462,236 | ProgramServicesAmt |
| Management And General | $584 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $20,572 | TotalAmt |
| Program Services | $20,572 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $222,152 | TotalAmt |
| Program Services | $180,064 | ProgramServicesAmt |
| Management And General | $42,088 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $635,646 | TotalAmt |
| Program Services | $499,386 | ProgramServicesAmt |
| Management And General | $136,260 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,794,314 | TotalAmt |
| Program Services | $1,485,706 | ProgramServicesAmt |
| Management And General | $308,608 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $499,329 | TotalAmt |
| Program Services | $421,385 | ProgramServicesAmt |
| Management And General | $77,944 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $3,391,941 | $3,367,401 | $24,540 |
| EQUIPMENT RENTAL & MAIN | $201,299 | $199,891 | $1,408 |
| FOOD | $155,611 | $150,140 | $5,471 |
| DUES AND SUBSCRIPTIONS | $69,371 | $43,310 | $26,061 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,634,222 | TotalAmt |
| Program Services | $486,225 | ProgramServicesAmt |
| Management And General | $1,147,997 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,625,718 | TotalAmt |
| Program Services | $36,018,524 | ProgramServicesAmt |
| Management And General | $7,607,194 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $22,853,658 | BOYAmt |
| EOY | $19,667,637 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,035,668 | BOYAmt |
| EOY | $6,253,124 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,270,371 | BOYAmt |
| EOY | $1,168,355 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $446,528 | BOYAmt |
| EOY | $519,995 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $35,956,328 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $21,499,105 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,009,459 | BOYAmt |
| EOY | $14,457,223 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,242,470 | BOYAmt |
| EOY | $1,464,569 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,799,862 | BOYAmt |
| EOY | $1,889,753 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $233,388 | BOYAmt |
| EOY | $205,099 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $760,601 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,891,404 | BOYAmt |
| EOY | $46,386,356 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,075,912 | BOYAmt |
| EOY | $4,125,366 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,558,141 | BOYAmt |
| EOY | $13,223,972 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,148,833 | BOYAmt |
| EOY | $1,921,833 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,782,886 | BOYAmt |
| EOY | $19,271,171 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,108,518 | BOYAmt |
| EOY | $27,115,185 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $30,108,518 | BOYAmt |
| EOY | $27,115,185 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $48,891,404 | BOYAmt |
| EOY | $46,386,356 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$2,988,414 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$4,919 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $207,873 | OtherCostOrOtherBasisAmt |
| Book Value | $207,873 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,880,606 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,385,495 | DepreciationAmt |
| Book Value | $9,495,111 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,484,680 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,113,610 | DepreciationAmt |
| Book Value | $4,371,070 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $383,169 | OtherCostOrOtherBasisAmt |
| Book Value | $383,169 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,457,223 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $562,801 |
| SETTLEMENT AGREEMENT | $90,000 |
| DEFERRED COMPENSATION | $477,750 |
| CAPITAL LEASES | $30,682 |
| OPERATING LEASE LIABILITIES | $760,600 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,921,833 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $40,632,385 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$4,919 | OtherRevenueAmt |
| Revenue Not Reported | -$4,919 | RevenueNotReportedAmt |
| Revenue Subtotal | $40,637,304 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $40,637,304 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $43,625,718 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $43,625,718 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $43,625,718 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -4,919. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $374,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $374,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00860 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $374,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $374,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00860 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $90,722 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $90,722 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00210 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,973,411 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,265,314 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,708,097 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03920 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,064,133 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,265,314 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,798,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04130 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,438,133 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,265,314 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,172,819 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04990 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,980,698 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,347,279 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,356,160 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,358,126 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,966 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COLORADO MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 N WILLIAMSON AVE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | LCMCWMH.COM | WebsiteAddressTxt |
| State License | RGH 0076 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COLORADO MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE NARRITAVE ON 7D | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE NARRITAVE ON 7D | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE 16A-C NARRATIVE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE 16A-C NARRATIVE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE 16A-C NARRATIVE | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 5: LCMC SOLICITED INPUT FROM MULTIPLE SOURCES IN THE COMMUNITY, INCLUDING GROUPS THAT WORK WITH DISADVANTAGED POPULATIONS. NAVAJO COUNTY PARTNERED WITH LCMC TO CONDUCT THE CHNA DURING THE YEAR ENDED 9/30/23. THIS EFFORT INCLUDED SOLICITED INPUT THROUGH FOCUS GROUPS, TOWN MEETINGS, COMMUNITY COALITIONS, COMMUNITY HEALTH SURVEYS, PUBLIC HEALTH AND HOSPITAL DATA, INTERVIEWS WITH MENTAL AND BEHAVIORAL HEALTH PROVIDERS, EMERGENCY SERVICES PERSONNEL, A COMMUNITY ADVISORY COMMITTEE, VOLUNTEER ORGANIZATIONS, AND INDIAN HEALTH SERVICES TO IDENTIFY THE NEEDS OF THE COMMUNITY. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 6B: NAVAJO COUNTY PUBLIC HEALTH SERVICES DISTRICT, SUMMIT HEALTHCARE, CARE1ST HEALTH PLAN ARIZONA, AZ@WORK, COMMUNITY BRIDGES, CHANGEPOINT INTEGRATED HEALTH, NAVAJO COUNTY CRIMINAL JUSTICE, NEXUS COALITION, AND MENTAL HEALTH ADVOCATE. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 7D: LINE 7A: HOSPITAL WEBSITELCMCWMH.COM/FILE/94894C45-62D1-4538-B108-913E2CD891A6LINE 10: WEBSITE FOR IMPLEMENDATION PLANLCMCWMH.COM/FILE/4D2DD6ED-3414-4220-90A4-56E11FDE4AC1 |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 11: NEEDS IDENTIFIED IN THE CHNA IMPLEMENTATION STRATEGY FOR FYE JUNE 30, 2020 INCLUDE THE FOLLOWING:1. DRUG AND ALCOHOL USE DISORDER2. HEALTH PROVIDER SHORTAGES3. CHRONIC HEALTH ISSUES4. SOCIO-ECONOMIC CONDITIONS5. COVID-19 PANDEMICTHE FOLLOWING ACTIONS WERE TAKEN DURING FYE JUNE 30, 2023 AND PRIOR YEARS TO ADDRESS THE IDENTIFIED NEEDS:1. DRUG AND ALCOHOL USE DISORDERA. LCMC PARTICIPATED IN A COMMUNITY BEHAVIORAL HEALTH TASK FORCE THAT HAS MET MONTHLY SINCE NOV 2022. THE TEAM HAS FOCUSED ON SUBSTANCE USE DISORDER (SUD), ACCESS TO PROVIDERS, TRANSITION OF CARE FROM INCARCERATION, COMMUNITY EDUCATION, FENTANYL TESTING AND CURRENT STATS. THE TASK FORCE INCLUDES MEMBERS FROM LCMC, WINSLOW INDIAN HEALTHCARE CENTER (WIHCC), LAW ENFORCEMENT, FIRE, ACTION MEDICAL, CHANGE POINT, COMMUNITY BRIDGES INC. (CBI), NAVAJO COUNTY, WINSLOW GUIDANCE ASSOC., CARE FIRST AND BCBS.B. LCMC PARTICIPATED IN THE SUD TASK FORCE LED BY NAVAJO COUNTYC. LCMC IMPLEMENTED A TELEHEALTH PROJECT TO CONNECT EMERGENCY DEPARTMENT PATIENTS AND INPATIENTS WITH BEHAVIORAL HEALTH AND ADDICTION PROVIDERS FROM CBI.D. LCMC IS IN THE PROCESS OF IMPLEMENTING A TELEHEALTH PROJECT IN THE CLINIC TO CONNECT PATIENTS TO MENTAL HEALTH AND ADDICTION PROVIDERS FROM CBI. THIS IS ON TRACK FOR A SEPTEMBER 2023 GO-LIVE.2. HEALTH PROVIDER SHORTAGEA. WE HAVE PARTNERED WITH FLAGSTAFF SURGICAL ASSOCIATE PROVIDERS TO FILL THE 2 SURGEON VACANCIES AT WIHCC, SO WE CONTINUE TO HAVE 24/7 SURGICAL COVERAGE.B. LITTLE COLORADO PHYSICIAN OFFICE (LCPO) HIRED 1.5 NURSE PRACTITIONER FULL TIME EMPLOYEES TO COVER OUTPATIENT PRIMARY CARE, URGENT CARE AND WOUND CARE.C. LCPO INCREASED CARDIOLOGY VISITING PROVIDER TIME TO TWICE A MONTH AND STARTED SOME OUTPATIENT CARDIAC TESTING.3. CHRONIC HEALTH ISSUESA. LCPO STARTED A CHRONIC CARE MANAGEMENT PROGRAM IN THE CLINIC.B. LCMC CARE COORDINATION PARTICIPATED IN THE CHRONIC CONDITIONS TASK FORCE WITH NAVAJO COUNTY AND NORTH COUNTRY. WE STARTED PARTNERING TO PROVIDE EDUCATION CLASSES FOR THE COMMUNITY ONCE A MONTH INCLUDING TOPICS SUCH AS CAR SEAT EDUCATION, DIABETES EDUCATION, CAREGIVER SUPPORT, ETC.C. WE PROVIDED COMMUNITY EDUCATION EVENTS FOR DIABETES.D. IMPLEMENTED A PROGRAM TO PROMOTE ANNUAL WELLNESS VISITS.E. COORDINATED A WINSLOW COMMUNITY DAY MAY 2023, PROVIDED HEALTH EDUCATION AND FREE LAB TESTING, SET UP 30 VENDORS. AT LEAST 150 PEOPLE ATTENDED.4. SOCIO-ECONOMIC CONDITIONSA. CONTINUED TO PROVIDE FOOD TO SENIORS THROUGH MEALS ON WHEELS FOR OUR HOMEBOUND SENIORS AND PROVIDED LUNCHTIME MEALS THROUGH THE CAFETERIA BY DELIVERING MEALS TO SENIORS IN A DRIVE THRU METHOD.B. ASSISTED ST MARY'S FOOD BANK TO PROVIDE FOOD BOXES MONTHLY.C. SOCIAL SERVICES HAS CONTINUED TO OFFER ROBUST SUPPORT FOR ALL OF OUR PATIENTS WHO NEED ASSISTANCE, BOTH IN THE CLINIC AND ALL AREAS OF THE HOSPITAL, CONNECTING THEM WITH COMMUNITY RESOURCES AND PROVIDING TRANSPORTATION AS NEEDED.5. COVID-19 PANDEMICA. CONTINUED TO OFFER TESTING AND VACCINES.B. WE OFFER HOME TEST KITS AND PAXLOVID.LCMC COMPLETED A CHNA FOR FYE JUNE 30, 2023 AND IDENTIFIED THE FOLLOWING PRIORITY NEEDS:1. SOCIAL DETERMINANTS OF HEALTH2. SUBSTANCE ABUSE3. MENTAL HEALTH4. SEXUALLY TRANSMITTED INFECTIONS (STI'S)5. CHRONIC DISEASESALL IDENTIFIED NEEDS ARE ADDRESSED IN THE IMPLEMENTATION STRATEGY. THE TOP HEALTH PRIORITIES IN THE 2022 CHNA WERE SIMILAR TO THOSE IDENTIFIED IN THE PRIOR REPORT. DUE TO TIMING OF THE COMPLETION OF THE 2022 CHNA AND IMPLEMENTATION STRATEGY, LCMC FOCUSED ON MEETING THE STRATEGIES DETERMINED IN THE PRIOR IMPLEMENTATION STRATEGY. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON A CASE-BY-CASE BASIS. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 16J: PART V, SECTION B, LINE 16A -THE FINANCIAL ASSISTANCE POLICY IS POSTED:HTTPS://WWW.LCMCWMH.COM/FILE/A587ABFE-B07A-4C0D-87A0-B0278C60FCA0LINE 16B- THE FAP APPLICATION IS POSTED:HTTPS://WWW.LCMCWMH.COM/FILE/5A00B739-9D5D-4F5D-864B-00466A313B3FLINE 16C- THE FAP PLAIN LANGUAUGE SUMMARY IS POSTED: HTTPS://WWW.LCMCWMH.COM/FILE/73FEE2D1-A3A0-4C2A-A0C6-AA7A9A5636FDPART V, SECTION B, LINE 16J:A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, ADMISSIONS OFFICE AND WAS MADE AVAILABLE UPON REQUEST.MORE THAN THE LESSER OF 5% OR 1,000 INDIVIDUALS IN THE SERVICE AREA ARE LEP. HOWEVER, THE LANGUAGE SPOKEN, NAVAJO, RECENTLY BECAME A WRITTEN LANGUAGE. THE FACILITY HAS STAFF WHO SPEAK NAVAJO AND ARE ABLE TO ASSIST PATIENTS IN COMPLETING FINANCIAL ASSISTANCE FORMS, BECAUSE THE FORMS ARE STILL PREDOMINATELY IN ENGLISH. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - LITTLE COLORADO PHYSICIANS OFFICE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 E LEE STREET | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | PROVIDER BASED RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO UTILIZING FPG TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE HOSPITAL CONSIDERED MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS OF PATIENTS. PRESUMPTIVE ELIGIBILITY MAY BE USED ON A CASE-BY-CASE BASIS. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7E WAS DETERMINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS DETERMINED BASED ON THE COST REPORT. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDES NET COMMUNITY BENEFIT EXPENSE FROM THE CLINIC OF $2,496,924. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | LCMC GAVE $5,000 TO THE LOCAL SENIOR CENTER TO HELP FUND MEALS ON WHEELS AND OTHER HEALTH AND WELLNESS INITIATIVES. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. |
| PART III, LINE 3: | THE IMPLICIT PRICE CONCESSION INCLUDES AN ESTIMATED $1,347,278.81 OF CHARITY CARE-ELIGIBLE ACCOUNTS THAT ARE CURRENTLY LISTED AS AN IMPLICIT PRICE CONCESSION. UPON REVIEWING THE ACCOUNTS AND THE POVERTY LEVELS OF NAVAJO AND APACHE COUNTIES IN ARIZONA, IT WAS FOUND THAT ABOUT 27.05% OF THE OUTSTANDING BALANCES MAY HAVE BEEN ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. ALSO FOR THIS REVIEW PROCESS, ANY FAMILIES WITH PRIOR APPLICATIONS FOR CHARITY CARE WERE GIVEN CONSIDERATION. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSION IS LOCATED IN FOOTNOTE 1 ON PAGES 12 & 13 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2023. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | ONCE THE BALANCE ON THE PATIENT'S ACCOUNT IS READY FOR BILLING THE PATIENT RECEIVES AN INITIAL STATEMENT. THE PATIENT WILL THEN RECEIVE A SECOND STATEMENT AT DAY 30 ALONG WITH A FOLLOW UP PHONE CALL, A THIRD STATEMENT AT DAY 60, AND A FINAL STATEMENT AT DAY 90 WITH A FOLLOW UP PHONE CALL. THE 90 DAY LETTER INFORMS THE PATIENT THAT COLLECTION ACTIONS WILL BEGIN AT 120 DAYS IF NO ATTEMPTS HAVE BEEN MADE TO RESOLVE THEIR ACCOUNT. THE PATIENT'S ACCOUNT IS TURNED TO COLLECTIONS AT DAY 121 WITH A NOTIFICATION LETTER SENT TO THE PATIENT INFORMING THEM OF SUCH. IF OUR COLLECTION AGENCY IDENTIFIES A PATIENT IS MEETING FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA, THE PATIENT'S ACCOUNT MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE. COLLECTION ACTIVITY WILL BE SUSPENDED ON ACCOUNTS, AND THE FINANCIAL ASSISTANCE APPLICATION WILL BE REVIEWED. IF THE ENTIRE ACCOUNT BALANCE IS ADJUSTED, THE ACCOUNT WILL BE RETURNED. IF A PARTIAL ADJUSTMENT OCCURS, THE PATIENT FAILS TO COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS, OR IF THE PATIENT IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY WILL RESUME. REQUESTS FOR CHARITY SHALL BE PROCESSED PROMPTLY AND LITTLE COLORADO MEDICAL CENTER SHALL NOTIFY THE PATIENT OR APPLICANT IN WRITING WITHIN 30 DAYS OF RECEIPT OF A COMPLETED APPLICATION. ACCOUNTS ELIGIBLE FOR CHARITY CARE ARE TO BE ADDRESSED WITHIN 240 DAYS OF FIRST BILL. |
| PART VI, LINE 2: | LCMC ASSESSES HEALTH NEEDS BY EVALUATING THE PATIENTS SERVED IN THE CLINICS AND HOSPITAL. LCMC HAS STAFF THAT PARTICIPATE IN VARIOUS ORGANIZATIONS INCLUDING THE COUNCIL FOR AGING, ALICE'S PLACE, THE WINSLOW ROTARY, ETC. STAFF ARE MADE AWARE OF NEEDS OF THE COMMUNITY THROUGH THEIR INVOLVEMENT WITH THESE ORGANIZATIONS. ADDITIONALLY, LCMC HAS MONTHLY MEDICAL EXECUTIVE AND BI-ANNUAL MEDICAL STAFF MEETINGS TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. |
| PART VI, LINE 3: | LCMC'S PATIENT BILLING STATEMENTS HAVE A NARRATIVE ATTACHED DESCRIBING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THE CONTACT INFORMATION FOR HOW TO OBTAIN ADDITIONAL INFORMATION. NOTICES OF FINANCIAL ASSISTANCE AVAILABILITY ARE POSTED IN THE ER, WAITING ROOMS, AND ADMISSIONS OFFICE. |
| PART VI, LINE 4: | LCMC IS LOCATED IN THE COMMUNITY OF WINSLOW WHICH IS LOCATED IN NAVAJO COUNTY, ARIZONA, AND SERVES THE HEALTHCARE NEEDS OF THE COMMUNITY AND SURROUNDING AREAS. THE SERVICE AREA IS MOSTLY RURAL WITH A POPULATION OF APPROXIMATELY 24,790 PEOPLE. THE AVERAGE HOUSEHOLD INCOME IS $43,918 WITH 31.6% OF THE POPULATION HAVING AN INCOME OF LESS THAN $35,000. MORE THAN 40% OF THE PATIENTS SERVED BY LCMC ARE ON THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM, AND MORE THAN 60% OF THE SERVICE AREA ARE OF NATIVE AMERICAN DESCENT. THE NEAREST HOSPITAL IS 60 MILES FROM WINSLOW. WINSLOW IS IN AN AREA FEDERALLY DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA, A MEDICALLY UNDERSERVED AREA, AND A PERSISTENT POVERTY COUNTY. |
| PART VI, LINE 5: | LCMC'S BOARD OF DIRECTORS ALL RESIDE IN THE ORGANIZATION'S SERVICE AREA WITH THE EXCEPTION OF FOUR MEMBERS AT LARGE, ONE RESIDES IN PHOENIX, AZ, ONE RESIDES IN PAYSON, AZ, AND TWO RESIDE IN FLAGSTAFF, AZ. IN ADDITION, NONE OF THE BOARD MEMBERS ARE RELATED TO THE ORGANIZATION. LCMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROVIDERS IN ITS COMMUNITY AND SURROUNDING AREA FOR SOME OR ALL OF ITS DEPARTMENTS. LCMC REINVESTS SURPLUS FUNDS, IF ANY, TO IMPROVEMENTS IN PATIENT CARE, INCLUDING BUT NOT LIMITED TO EXPANSION OF SERVICES OFFERED, PATIENT EDUCATION, EMPLOYEE EDUCATION, AND EQUIPMENT AND FACILITY RENOVATIONS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (1) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRIAN BUCINA MD | ||||||||||||||
| SURGEON | $423,926 | $0 | $1,000 | $0 | $1,210 | $0 | $11,775 | $0 | $34,499 | $0 | $472,410 | $0 | $0 | $0 |
| JOHN J DEMPSEY | ||||||||||||||
| CEO | $331,574 | $0 | $37,650 | $0 | $0 | $0 | $13,379 | $0 | $11,767 | $0 | $394,370 | $0 | $0 | $0 |
| RANDALL REID MD | ||||||||||||||
| GENERAL MEDICINE | $290,967 | $0 | $1,000 | $0 | $1,870 | $0 | $13,484 | $0 | $35,390 | $0 | $342,711 | $0 | $0 | $0 |
| JANICE FREET | ||||||||||||||
| CFO; RETIRED 12/2022 | $241,620 | $0 | $41,000 | $0 | $0 | $0 | $12,284 | $0 | $10,704 | $0 | $305,608 | $0 | $0 | $0 |
| THOMAS GREENWOOD MD | ||||||||||||||
| DIRECTOR, CHIEF OF STAFF | $240,001 | $0 | $1,000 | $0 | $0 | $0 | $11,129 | $0 | $35,567 | $0 | $287,697 | $0 | $0 | $0 |
| JAMES PAGE | ||||||||||||||
| GENERAL MEDICINE | $207,727 | $0 | $1,000 | $0 | $0 | $0 | $4,155 | $0 | $35,523 | $0 | $248,405 | $0 | $0 | $0 |
| PAMELA RULAND | ||||||||||||||
| RN | $188,730 | $0 | $6,000 | $0 | $0 | $0 | $8,569 | $0 | $10,066 | $0 | $213,365 | $0 | $0 | $0 |
| REBECCA HEWARD | ||||||||||||||
| INFORMATIC NURSE | $156,377 | $0 | $6,000 | $0 | $70 | $0 | $6,433 | $0 | $373 | $0 | $169,253 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | LCMC ENTERED INTO AN AGREEMENT WITH JOHN DEMPSEY TO PAY HIM A RETENTION BONUS WHICH VESTED ON 7/31/2020. THE FULL RETENTION BONUS WILL BE PAID OVER AN EIGHT-YEAR PERIOD. THIS DEFERRED COMPENSATION BENEFIT BECAME EFFECTIVE JANUARY 1, 2019. MONTHLY PAYMENTS BEGAN ON JULY 1, 2020. JOHN DEMPSEY WAS PAID $37,650 IN DEFERRED COMPENSATION IN CALENDAR YEAR 2022. |
| PART I, LINE 7 | BONUSES WERE PROVIDED BASED ON COMPLETION OF TASKS DETERMINED AS PART OF EACH INDIVIDUALS PERFORMANCE PLANS. |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | INSTRUMENT TRAYS | Desc |
| Contribution | 2 | ContributionCnt |
| Noncash Contributions Rpt F990 | $76,668 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FMV | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, COLUMN (B): | FormAndLineReferenceDesc |
| Explanation | COLUMN B REPRESENTS THE NUMBER OF ITEMS RECEIVED. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | ALL COMMITTEES UTILIZED BY LCMC ARE STRICTLY ADVISORY IN NATURE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S CEO AND CFO WILL REVIEW THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REVIEWED ON AN ANNUAL BASIS. BOARD MEMBERS, OFFICERS, AND MANAGERS ARE COVERED UNDER LITTLE COLORADO MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. WHEN A CONFLICT OF INTEREST ARISES, THE COVERED PERSON IS TO DISCLOSE THE CONFLICT TO HIS OR HER IMMEDIATE SUPERVISOR BEFORE A DECISION INVOLVING THE AREA OF CONFLICT IS MADE. MEMBERS WITH A CONFLICT OF INTEREST ARE ALSO NOT ALLOWED TO PARTICIPATE IN THE DECISION MAKING PROCESS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE ORGANIZATION REVIEWS AND DETERMINES THE CEO'S COMPENSATION EVERY FEW YEARS. THE ORGANIZATION BRINGS IN THE LEDBETTER LAW FIRM, PLC TO AID IN DETERMINING THE REASONABLENESS OF THE COMPENSATION. THE LAW FIRM CONSIDERS CEO COMPENSATION FROM OTHER HOSPITALS WITHIN THE CRITICAL ACCESS HOSPITALS IN ARIZONA, WHICH LCMC IS APART OF. THIS DATA IS COLLECTED THROUGH THE ARIZONA HOSPITAL ASSOCIATION. LEDBETTER LAW FIRM PLC WAS ENGAGED TO REVIEW AND ANALYZE THE COMPENSATION FOR THE CEO IN 2017. THE BOARD OF DIRECTORS APPROVED THE COMPENSATION RECOMMENDATION. NO PAY ADJUSTMENTS HAVE BEEN PROVIDED SINCE THAT TIME. THE BOARD AND OUTSIDE LEGAL COUNSEL REVIEW THE CEO'S COMPENSATION ANNUALLY. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 4,213,882. MANAGEMENT AND GENERAL EXPENSES 73,855. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,287,737. PROFESSIONAL FEES - MEDICAL: PROGRAM SERVICE EXPENSES 3,216,854. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,216,854. PURCH SVCES-OTHER: PROGRAM SERVICE EXPENSES 1,374,474. MANAGEMENT AND GENERAL EXPENSES 76,464. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,450,938. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -4,919. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COLORADO HEALTHCARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 NORTH WILLIAMSON AVENUE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208504703 | EIN |
| Primary Activities | CHARITABLE | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINSLOW MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |
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