COMMUNITY HOSPITAL ASSOCIATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION INC (EIN 86-0096775)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-04
- IRS object ID
- 202213089349302006
- Schema version
- 2021v4.2
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-04T10:28:12-05:00 | ReturnTs |
| Tax Period End | 2021-12-31 | 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 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860096775 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 9286845421 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Patti Clavette | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9286845421 | PhoneNum |
| Signature | 2022-11-04 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Patti | PersonFirstNm |
| Person Last | Clavette | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2022-11-04 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jackie Lundblad | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,605,433 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wickhosp.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | Provide quality health and wellness services where patient, family and community come first. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 368 | TotalEmployeeCnt |
| Total Volunteers | 63 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $9,204,402 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,508,190 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $38,026,074 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $41,812,342 | CYProgramServiceRevenueAmt |
| PY Investment Income | $49,156 | PYInvestmentIncomeAmt |
| CY Investment Income | $182,484 | CYInvestmentIncomeAmt |
| PY Other Revenue | $92,925 | PYOtherRevenueAmt |
| CY Other Revenue | $102,417 | CYOtherRevenueAmt |
| PY Total Revenue | $47,372,557 | PYTotalRevenueAmt |
| CY Total Revenue | $45,605,433 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,918,998 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,055,134 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $170,245 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $23,330,952 | PYOtherExpensesAmt |
| CY Other Expenses | $26,558,138 | CYOtherExpensesAmt |
| PY Total Expenses | $44,249,950 | PYTotalExpensesAmt |
| CY Total Expenses | $46,613,272 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $3,122,607 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,007,839 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $38,344,388 | TotalAssetsBOYAmt |
| Total Assets EOY | $37,961,811 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,486,540 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $28,807,223 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,857,848 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $9,154,588 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide quality health and wellness services where the patient, family and community come first. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $42,877,108 | ExpenseAmt |
| Revenue | $41,812,342 | RevenueAmt |
| Desc | Community Hospital Association, Inc. d/b/a Wickenburg Community Hospital is a 25-bed critical access hospital that provides inpatient and outpatient diagnostic and therapeutic health care services to the residents and visitors of greater Wickenburg, Arizona, a rural community of approximately 23,000. The Hospital operates physician clinics and a surgery center in the same geographic area. | Desc |
| Total Program Service Expenses | $42,877,108 | 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 | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 67 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 368 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | Yes (1) | 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 | Patti Clavette | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9286681837 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| Michell Wagner | ||||||||
| Orthopedic Surgeon | 40.00 | Yes (X) | $361,473 | $0 | $19,971 | |||
| Todd Kravetz MD - Chief of | ||||||||
| Staff, Clinical Medical Director | 40.00 | $303,787 | $0 | $45,747 | Yes (X) | |||
| Juan Vazquez | ||||||||
| Physician | 40.00 | Yes (X) | $270,875 | $0 | $43,483 | |||
| Robert Ripley | ||||||||
| General Surgeon | 40.00 | Yes (X) | $264,629 | $0 | $32,855 | |||
| Jackie Lundblad | ||||||||
| CEO | 39.00 | $229,413 | $0 | $29,533 | Yes (X) | |||
| Diane Bejerano | ||||||||
| Family Physician | 40.00 | Yes (X) | $241,581 | $0 | $10,292 | |||
| Steven Berstein | ||||||||
| Radiologist | 40.00 | Yes (X) | $223,160 | $0 | $18,630 | |||
| Roger Rose | ||||||||
| Director of Pharmacy Services | 40.00 | $181,330 | $0 | $11,675 | Yes (X) | |||
| Peter Stachowicz | ||||||||
| COO | 39.00 | $175,612 | $0 | $15,672 | Yes (X) | |||
| Linda Rankin | ||||||||
| CNO | 40.00 | $185,996 | $0 | $3,499 | Yes (X) | |||
| Dede Schmallen | ||||||||
| CHRO | 40.00 | $164,045 | $0 | $16,278 | Yes (X) | |||
| Patti Clavette | ||||||||
| CFO | 39.00 | $136,081 | $0 | $26,556 | Yes (X) | |||
| Dee Pollock | ||||||||
| Chair | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Brian Warnock | ||||||||
| Vice Chair | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Virginia Collier | ||||||||
| Secretary | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Dean Sandvik | ||||||||
| Treasurer | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| Dave Bennett | ||||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Bob Dunn | ||||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Jenifer Finley | ||||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Bob Johnson | ||||||||
| Director | 1.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,737,982 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $274,191 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 26 | 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 |
|---|---|---|---|---|---|
| Emergency Physicians LLC | |||||
| 1210 Pebble Springs | Prescott | AZ | 86301 | Physician Staffing | $2,353,248 |
| Nordic Consulting Partners Inc | |||||
| PO Box 415000 | Nashville | TN | 37241 | Consulting | $940,129 |
| Rural Physicians Management Company LLC | |||||
| 10624 S Eastern Ave Ste A-263 | Henderson | NV | 89052 | Physician Staffing | $751,004 |
| Voyageur Radiology LLC | |||||
| 323 Washington Ave N Suite 200 | Minneapolis | MN | 55401 | Imaging | $597,623 |
| Alliance Physical Therapy Group LLC | |||||
| 607 Dewey Ave NW Suite 300 | Grand Rapids | MI | 49501 | Physician Staffing | $582,154 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 16 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $3,243,840 | GovernmentGrantsAmt |
| All Other Contributions | $264,350 | AllOtherContributionsAmt |
| Total Contributions | $3,508,190 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621990 | $38,620,566 | $38,620,566 |
| 340B Drug Program | 621990 | $1,155,299 | $1,155,299 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,036,477 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,036,477 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $41,812,342 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $182,484 | TotalRevenueColumnAmt |
| Exclusion | $182,484 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $102,417 | 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 | $102,417 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $102,417 | TotalRevenueColumnAmt |
| Exclusion | $102,417 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,605,433 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $41,812,342 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $284,901 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,544,758 | TotalAmt |
| Management And General | $1,544,758 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,458,540 | TotalAmt |
| Program Services | $15,300,393 | ProgramServicesAmt |
| Fundraising | $158,147 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,425 | TotalAmt |
| Program Services | $233,425 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,656,047 | TotalAmt |
| Program Services | $1,656,047 | ProgramServicesAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,162,364 | TotalAmt |
| Program Services | $1,053,454 | ProgramServicesAmt |
| Management And General | $96,812 | ManagementAndGeneralAmt |
| Fundraising | $12,098 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,588 | TotalAmt |
| Program Services | $2,588 | ProgramServicesAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,721 | TotalAmt |
| Program Services | $71,721 | ProgramServicesAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $67,734 | TotalAmt |
| Program Services | $67,734 | ProgramServicesAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,352,431 | TotalAmt |
| Program Services | $9,845,395 | ProgramServicesAmt |
| Management And General | $1,507,036 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $754,662 | TotalAmt |
| Program Services | $754,662 | ProgramServicesAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $940,494 | TotalAmt |
| Program Services | $940,494 | ProgramServicesAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,257,579 | TotalAmt |
| Program Services | $1,257,579 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,713 | TotalAmt |
| Program Services | $47,713 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $467,927 | TotalAmt |
| Program Services | $115,528 | ProgramServicesAmt |
| Management And General | $352,399 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,177,415 | TotalAmt |
| Program Services | $2,112,501 | ProgramServicesAmt |
| Management And General | $64,914 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $415,302 | TotalAmt |
| Program Services | $415,302 | ProgramServicesAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt |
|---|---|---|
| Medical Supplies | $7,163,315 | $7,163,315 |
| AHCCCS Tax | $852,930 | $852,930 |
| Repairs & Maintenance | $645,217 | $645,217 |
| Food | $68,909 | $68,909 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,201 | TotalAmt |
| Program Services | $272,201 | ProgramServicesAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,613,272 | TotalAmt |
| Program Services | $42,877,108 | ProgramServicesAmt |
| Management And General | $3,565,919 | ManagementAndGeneralAmt |
| Fundraising | $170,245 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,858,794 | BOYAmt |
| EOY | $4,549,410 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,110,554 | BOYAmt |
| EOY | $7,195,603 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,665,970 | BOYAmt |
| EOY | $1,102,029 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $271,376 | BOYAmt |
| EOY | $477,212 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $34,829,739 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $15,565,551 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,672,008 | BOYAmt |
| EOY | $19,264,188 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,373,177 | BOYAmt |
| EOY | $4,500,137 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,392,509 | BOYAmt |
| EOY | $873,232 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,344,388 | BOYAmt |
| EOY | $37,961,811 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,114,335 | BOYAmt |
| EOY | $6,849,415 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,993,409 | BOYAmt |
| EOY | $16,792,935 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $300,000 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,378,796 | BOYAmt |
| EOY | $4,864,873 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,486,540 | BOYAmt |
| EOY | $28,807,223 | 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 | $10,377,811 | BOYAmt |
| EOY | $8,643,642 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $480,037 | BOYAmt |
| EOY | $510,946 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,857,848 | BOYAmt |
| EOY | $9,154,588 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $38,344,388 | BOYAmt |
| EOY | $37,961,811 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,007,839 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$148,152 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$370,854 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | -$176,415 | 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 | 0 | FederalGrantAuditRequiredInd |
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 | $1,518,183 | OtherCostOrOtherBasisAmt |
| Book Value | $1,518,183 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,944,876 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,527,573 | DepreciationAmt |
| Book Value | $12,417,303 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,689 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,263 | DepreciationAmt |
| Book Value | $12,426 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,857,587 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,843,060 | DepreciationAmt |
| Book Value | $5,014,527 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $494,404 | OtherCostOrOtherBasisAmt |
| Depreciation | $192,655 | DepreciationAmt |
| Book Value | $301,749 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $19,264,188 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| CMS Advanced Payments | $2,227,863 |
| Capital Leases | $1,223,359 |
| Estimated Third-Party Payor Settlements | $953,169 |
| 457b Retirement Liability | $460,482 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,864,873 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $45,280,866 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$148,152 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$176,415 | OtherRevenueAmt |
| Revenue Not Reported | -$324,567 | RevenueNotReportedAmt |
| Revenue Subtotal | $45,605,433 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $45,605,433 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $46,613,272 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $46,613,272 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $46,613,272 | 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 of Foundation -176,415. |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 240.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $114,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $114,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,776,619 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,163,227 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $613,392 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01320 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,890,619 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,163,227 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $727,392 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01560 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $70,426 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $70,426 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,083 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,083 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,930,642 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,471,006 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,459,636 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03130 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,049,151 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,471,006 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,578,145 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03380 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,939,770 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,634,233 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,305,537 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04940 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,765,411 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $14,764 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $14,715,796 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $14,655,587 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $60,209 | 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 | Wickenburg Community Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.wickhosp.com | WebsiteAddressTxt |
| State License | RGH3505 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| 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 | Wickenburg Community Hospital | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | See Page 8 | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | See Page 8 | 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 | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 240.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| 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 Page 8 | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Page 8 | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | See Page 8 | 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 |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| 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 | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Wickenburg Community Hospital | Part V, Section B, Line 5: The development of the CHNA survey process began with the formation of the 2019 project team. The survey was delivered both in English and in Spanish, electronically and by paper to meet the needs of the majority of residents in the regional service area. Distribution of the survey was accomplished through community partnerships with the town of Wickenburg, Wickenburg Chamber of Commerce, Wickenburg Unified School District, Wickenburg Ranch and the Wickenburg Health Care Coalition. The Coalition is a nonprofit, nonpartisan, community collaboration organized to support a healthy, active lifestyle in the town of Wickenburg and surrounding areas, and by notification in the town newspaper.Wickenburg Community Hospital and each community partner distributed the survey electronically and/or by paper to their clients, employees, families, and other community members throughout the region. They also published display ads in the town newspaper and encouraged regional residents to take the anonymous survey online through Survey Monkey or by paper which was distributed and collected through the region at various locations. |
| Wickenburg Community Hospital | Part V, Section B, Line 11: The 2019 CHNA identified five significant health needs in the community. These needs are Overall Health Status, Barriers to Accessing Health Care, Use of Services, Defining a Healthy Community and Increase Respondents in decreasing order by intensity as indicated from secondary and primary research. In 2021, the organization did not address the need to increase respondents identified in our assessment. This will be addressed in 2022 when the next assessment is open. We plan to increase the awareness of this assessment and its importance by using more public channels: paper, electronically (social media & email) and through person to person conversation in our organization as well as at community events.The following actions were taken to address the needs identified from the 2019 CHNA: 1) Improvements in our surgical center by partnering with Rural Partners in Medicine and adding another specialist who can provide care for hands. This has allowed us meet the needs of more community members suffering with issues in their hands and elbows. We continue work on the expansion of specialty providers for the community. 2) We have continued to partner with the local newspaper, The Wickenburg Sun, to issue a free health and wellness magazines to the community. We have also provided free safety education from our emergency department which is delivered both in the local paper and through our social media and email channels. We also provide weekly article publications to help educate the community on topics like nutrition, disease & treatment education, as well as continued awareness of COVID-19 and other AZDH information. 3) We have increased the number of community awareness publications both in the local paper as well as electronic communication channels (including adding a newsletter via email) to better inform the public about preventive care and how to access it. 4) Wickenburg Community Hospital has opened more employee positions for our community by growing our service lines and continues to contribute by offering multiple job opportunities. |
| Schedule H, Part V, Section B, Line 10a: | Line 10a:https://www.wickhosp.com/wp-content/uploads/2020/12/2019-CHNA-Implementation-Strategy-1.pdf |
| Schedule H, Part V, Section B, Line 7a: | https://www.wickhosp.com/wp-content/uploads/2020/06/2019-CHNA-Report.pdf |
| Schedule H, Part V, Section B, Line 16a-16c: | Line 16a:https://www.wickhosp.com/wp-content/uploads/2016/01/Financial-Assistance-Policy.pdfLine 16b:https://www.wickhosp.com/wp-content/uploads/2018/09/Financial-Assistance-Application-Letter-App.pdfLine 16c:https://www.wickhosp.com |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Community Hospital Clinic - Wickenburg | ||||
| 519 Rose Lane | Wickenburg | AZ | 85390 | Primary Care Clinic, Rural Health Clinic |
| 2 - Community Hospital Clinic - Congress | ||||
| 26750 S Santa Fe Road Suite B | Congress | AZ | 85332 | Primary Care Clinic, Rural Health Clinic |
| 3 - Community Hospital Clinic - Wittmann | ||||
| 32919 Center St | Wittmann | AZ | 85361 | Primary Care Clinic, Rural Health Clinic |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Part I, line 7a:Financial Assistance was calculated using the cost-to-charge ratio. All patient segments are addressed using this method. The methodology used is to be in compliance with laws and regulations set forth by Medicare and the filing of the annual cost report. Part I, Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services were calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers. Part I, line 7e and 7f:Community health improvement services and health professions education are actual costs reported in the general ledger. |
| Part I, Line 7g: | Line 7g includes $614,301 of expenses related to a rural health clinic. |
| Part III, Line 2: | The amount reported on line 2 represents implicit price concessions. The implicit price concessions included represent the difference between amounts billed to patients and the amounts the Hospital expects to collect based on its collection history with those patients. |
| Part III, Line 3: | The organization calculated the amount of implicit price concessions attributable to patients eligible under the financial assistance policy by applying the percentage of charity care of total net patient revenue to the amount of line 2 implicit price concessions. |
| Part III, Line 4: | The financial statement footnote regarding implicit price concessions may be found on page 11 and 12 of the attached financial statements. |
| Part III, Line 8: | Medicare allowable costs were obtained from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services.If there is a shortfall, the entire Medicare shortfall is a community benefit. Medicare patients are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key community benefit. |
| Part III, Line 9b: | The accounts remain in the program for a period of 120 days, if no payments are being made, or longer if the payments are being made on the outstanding balance. After this time period and collection efforts have been exhausted, the accounts will then be placed into a "collection" status, and sent to our Collection Agency; Revenue Enterprise for Health Care, to further final collection efforts. After these accounts have been placed with the Collection Agency and have no activity for 120 days, they will be returned to the business officer for additional consideration and disposition of account. During the entire 240 days they will accept applications for financial assistance. |
| Part VI, Line 2: | Community Hospital Association, Inc. continually assesses the community's medical needs through the relationship of our staff to community leaders and community programs that identify community needs, often medical in nature. Although the hospital is not always in a position to expand services and meet all identified needs, maintaining a core menu of services that meets the greatest community need has and continues to direct our strategic planning. |
| Part VI, Line 3: | All uninsured and under-insured patients at time of registration are provided with options available in our community for payment of the services provided. This is most often verbal along with a written charity care application. |
| Part VI, Line 4: | Wickenburg Community Hospital serves a primary service area population of approximately 23,000 in a rural service area clustered around Wickenburg, AZ. Wickenburg Community Hospital is the only hospital in the service area. The distribution of service area population by age is 0-17, 21%; 18-44, 25%; 45-64, 29%; 65+, 24%. The service area is home to a great number of winter residents, changing the population significantly from winter months to summer months, when the population grows by approximately 40%. |
| Part VI, Line 5: | The Hospital's governing body is comprised of persons who reside in the Organization's primary service area. The Hospital applies any surplus funds to improve the Facility and equipment to improve patient care. The Hospital also extends medical staff privileges to other qualified physicians in the community.Wickenburg Community Hospital, designated as a critical access hospital, serves a rural population approximately 35 miles West of the urban area of the greater Phoenix market place of Surprise, AZ. While the distance is not overly great, many of our patients come from rural areas West and North of Wickenburg, requiring them to drive much greater distances to obtain health care services if Wickenburg Community Hospital was not available to them. The most important service we provide is our emergency services and could not exist without our critical access hospital status. Additionally, our rural health clinic provides access to primary care providers in our community that probably would not exist if the hospital did not employ these providers. The availability of diagnostic services locally is very important to our community as a higher average age exists in our community, making it difficult to drive longer distances and spend a greater amount of time in obtaining diagnostic services required by their primary care providers. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | 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 | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Michell Wagner | ||||||||||||||
| Orthopedic Surgeon | $359,615 | $0 | $260 | $0 | $1,598 | $0 | $19,951 | $0 | $5,728 | $0 | $387,152 | $0 | $0 | $0 |
| Todd Kravetz MD - Chief of | ||||||||||||||
| Staff, Clinical Medical Director | $245,209 | $0 | $55,915 | $0 | $2,663 | $0 | $13,849 | $0 | $37,606 | $0 | $355,242 | $0 | $0 | $0 |
| Juan Vazquez | ||||||||||||||
| Physician | $227,411 | $0 | $42,378 | $0 | $1,086 | $0 | $19,331 | $0 | $29,861 | $0 | $320,067 | $0 | $0 | $0 |
| Robert Ripley | ||||||||||||||
| General Surgeon | $255,386 | $0 | $7,645 | $0 | $1,598 | $0 | $20,570 | $0 | $17,982 | $0 | $303,181 | $0 | $0 | $0 |
| Jackie Lundblad | ||||||||||||||
| CEO | $228,599 | $0 | $0 | $0 | $814 | $0 | $4,844 | $0 | $27,853 | $0 | $262,110 | $0 | $0 | $0 |
| Diane Bejerano | ||||||||||||||
| Family Physician | $215,053 | $0 | $23,933 | $0 | $2,595 | $0 | $9,866 | $0 | $6,132 | $0 | $257,579 | $0 | $0 | $0 |
| Steven Berstein | ||||||||||||||
| Radiologist | $183,160 | $0 | $40,000 | $0 | $0 | $0 | $0 | $0 | $24,338 | $0 | $247,498 | $0 | $0 | $0 |
| Roger Rose | ||||||||||||||
| Director of Pharmacy Services | $178,834 | $0 | $100 | $0 | $2,396 | $0 | $3,567 | $0 | $10,873 | $0 | $195,770 | $0 | $0 | $0 |
| Peter Stachowicz | ||||||||||||||
| COO | $172,879 | $0 | $100 | $0 | $2,633 | $0 | $3,060 | $0 | $14,912 | $0 | $193,584 | $0 | $0 | $0 |
| Linda Rankin | ||||||||||||||
| CNO | $177,710 | $0 | $0 | $0 | $8,286 | $0 | $3,479 | $0 | $1,575 | $0 | $191,050 | $0 | $0 | $0 |
| Dede Schmallen | ||||||||||||||
| CHRO | $163,382 | $0 | $0 | $0 | $663 | $0 | $3,416 | $0 | $15,087 | $0 | $182,548 | $0 | $0 | $0 |
| Patti Clavette | ||||||||||||||
| CFO | $134,783 | $0 | $0 | $0 | $1,298 | $0 | $2,726 | $0 | $25,648 | $0 | $164,455 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a | FormAndLineReferenceDesc |
| Explanation | Description of health club dues: Wickenburg Community Hospital reimburses employees for health club dues which are recorded in the individuals' taxable compensation. Golf club dues were paid to the golf club by the organization, but are not paid for a specific employee. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 8b | The organization does not have any committees with the authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared by a third party and is reviewed by the CFO. A copy of the Form 990 is made available to the governing board prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | All board members and officers are covered under the policy. In connection with any actual or possible conflict of interest, an interested person must disclose the existence of any financial interest and conflict of interest and be given the opportunity to disclose all material facts to the board of directors of the organization. In addition, all interested persons review and sign a compliance certificate annually. After disclosure of any potential conflicts and all material facts, and after any discussion with the interested person, he/she shall leave the governing board meeting and is recused from the discussion and voting on the issue. The remaining board members shall decide if a conflict of interest exists. |
| Form 990, Part VI, Section B, line 15a | Review of CEO or top management official compensation: The board chairman, with consultation of other members of the board, reviews independent survey data acquired through the Arizona Hospital & Healthcare Association on executive salaries and reviews the performance of the CEO. This review is done annually by the board in executive session. The salary is documented on a personnel action form (PAF), entered into the payroll system, and then added to the HR file. Review of other officer or key employees compensation: The CEO and HR director use the Arizona Hospital & Healthcare Association survey data to review all positions in the facility, including key employees and other officers. The salary is documented on a Personnel Action Form (PAF), entered into the payroll system, and then added to the HR file. |
| Form 990, Part VI, Section C, line 19 | Governing documents, conflict of interest policy, and financial statements are made available to the public by a formal request in writing. |
| Form 990, Part IX, line 11g | Purchased Services: Program service expenses 6,262,394. Management and general expenses 1,300,161. Fundraising expenses 0. Total expenses 7,562,555. Professional Fees: Program service expenses 3,583,001. Management and general expenses 206,875. Fundraising expenses 0. Total expenses 3,789,876. |
| Form 990, Part XI, line 9: | Change in Interest of Foundation -176,415. |
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