2020-11-12T15:06:29-06:00 2019-12-31 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2019-01-01 860096775 COMMUNITY HOSPITAL ASSOCIATION INC % THE ORGANIZATION COMM 9286845421 520 ROSE LANE WICKENBURG AZ 85390 JACKIE LUNDBLAD CFO 9286845421 2020-05-15 true Adam R Smith CPA P00958966 7194714290 167.68.126.162 84022720203175000001 2020-11-12 P 26C3A9CF11B26F9C2D280370FFBE8B4C03C04303 B8601661B03FC4D2A23395C902C3A2BF7CEEDF55 2019 2021-01-29 14:40:06Z WICKENBURG COMMUNITY HOSPITAL JIM TAVARY 520 ROSE LANE WICKENBURG AZ 85390 39972307 false X WWW.WICKHOSP.COM X 1946 AZ TO PROVIDE QUALITY HEALTH AND WELLNESS SERVICES WHERE THE PATIENT, FAMILY AND COMMUNITY COME FIRST. 10 10 316 58 0 527043 1184601 42899640 38661755 19130 74878 1569281 51073 45015094 39972307 0 0 0 0 17035482 19039073 0 0 157167 27914046 23541717 44949528 42580790 65566 -2608483 34225103 30512691 23834649 22942122 10390454 7570569 TO PROVIDE QUALITY HEALTH AND WELLNESS SERVICES WHERE THE PATIENT, FAMILY, AND COMMUNITY COME FIRST. false false 38569150 38711373 PROVIDE 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. 38569150 true true false true false false false false false false true false false false false false true false false false false false false false false false true true false false true false false false false false false false false true false false false false true true true false false true 93 0 316 true false false false false false false false false false false false false X 10 10 false false false false false false false true true false false true true true true true true false false false X THE ORGANIZATION 9286845421 520 ROSE LANE WICKENBURG AZ 85390 X MITCHELL WAGNER SURGEON 40.0 0.0 X 522571 0 13231 ROBERT RIPLEY SURGEON 40.0 0.0 X 443405 0 42990 TODD KRAVETZ CHIEF OF STAFF 40.0 0.0 X 295066 0 45911 JEREMY BRAMWELL PHYSICIAN 40.0 0.0 X 242580 0 48994 LISA ERLINGER ANESTHESIOLOGIST 40.0 0.0 X 235867 0 39501 Laura Meaney ANESTHESIOLOGIST 40.0 0.0 X 202641 0 29652 JAMES TAVARY CHIEF EXECUTIVE OFFICER 39.0 1.0 X 194991 0 36741 ROGER ROSS DIRECTOR OF PHARMACY SERVICES 40.0 0.0 X 185682 0 10673 JACQUELINE LUNDBLAD CHIEF FINANCIAL OFFICER 39.0 1.0 X 165787 0 26795 BETSY DEIBEL DIRECTOR/SECRETARY 1.0 0.0 X X 0 0 0 BOB JOHNSON DIRECTOR 1.0 0.0 X 0 0 0 BRIAN WARNOCK DIRECTOR 1.0 0.0 X 0 0 0 DEE POLLOCK DIRECTOR/CHAIRMAN OF THE BOARD 1.0 0.0 X X 0 0 0 HUNT SPEAR DIRECTOR/PRESIDENT FDN BOARD 1.0 0.0 X X 0 0 0 JEANNE MORRIS DIRECTOR 1.0 0.0 X 0 0 0 JOHN COOK DIRECTOR 1.0 0.0 X 0 0 0 KEVIN CLOE DIRECTOR 1.0 0.0 X 0 0 0 RICH NEWMAN DIRECTOR 1.0 0.0 X 0 0 0 RICHARD ABBUHL DIRECTOR/VICE CHAIRMAN 1.0 0.0 X X 0 0 0 TROY JONES DMD DIRECTOR 1.0 0.0 X 0 0 0 2488590 0 294488 30 false true false ALLIANCE HEALTHCARE SERVICES PO BOX 55826 LOS ANGELES CA 90074 IMAGING SERVICES 429750 BLUE SKY HEALTH ADVISORS LLC 14802 N 7TH PLACE PHOENIX AZ 85022 CONSULTING 213525 MEDICAL DIAGNOSTIC 10835 N 25TH AVE SUITE 240 PHOENIX AZ 85029 IMAGING SERVICES 707308 RESOLUTION CONSULTING INC PO BOX 270903 LOUISVILLE CO 80027 CONSULTING 516660 ABM INDUSTRIES INC PO BOX 419860 BOSTON MA 022419860 HOUSEKEEPING 431973 8 1044601 140000 140000 1184601 Patient Service Revenue 621990 37072515 37072515 340B Drug Pricing Program Revenue 621990 1500365 1500365 Rental Income 621990 88875 88875 38661755 33178 33178 0 0 0 0 0 41700 41700 41700 41700 0 0 0 0 0 0 0 0 0 HPSA REVENUE 900099 14596 14596 MEDICAL RECORDS REVENUE 900099 1955 1955 MISCELLANEOUS REVENUE 900099 34522 34522 51073 39972307 38710873 76833 X 0 0 0 0 0 0 15986089 14866345 962577 157167 159611 159611 1840396 1694153 146243 1052977 978054 74923 0 50043 32838 17205 141873 141873 5980 5980 0 0 10084930 9283509 801421 0 593154 355583 237571 177381 176181 1200 0 585539 570082 15457 76199 69466 6733 0 0 486383 34672 451711 0 2122271 2089359 32912 379125 211576 167549 MEDICAL SUPPLIES 6733468 6586805 146663 REPAIRS & MAINTENANCE 867805 834808 32997 AHCCCS Tax 537282 287272 250010 DUES, BOOKS AND SUBSCRIPTIONS 238691 177656 61035 461593 161180 300413 42580790 38569150 3854473 157167 1067707 219931 4186063 2116028 0 0 7537508 6284608 0 0 0 0 0 0 1198269 1493215 234754 122205 39825766 20615463 18723167 19210303 0 0 0 0 0 0 0 0 1277635 1066401 34225103 30512691 5415936 4967039 0 0 0 0 0 0 0 0 0 0 18418713 17975083 0 0 0 0 23834649 22942122 X 9605109 6890093 785345 680476 10390454 7570569 34225103 30512691 X -2608483 -211402 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5980 5980 false 1519772 1519772 24093691 11898939 12194752 14751 247 14504 12265309 8386290 3879019 1947241 344985 1602256 19210303 39760905 -211402 -211402 39972307 39972307 42580790 42580790 42580790 Schedule D, Part X, Line 2 UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. SCHEDULE D, PART XI, LINE 2D REVENUE ON BOOKS, NOT ON RETURN: Change in interest in net assets of wickenburg community hospital foundation (211,204) true true X true X true X 240. true true false false 181989 181989 0.00430 4315824 3500236 815588 0.01920 4497813 3500236 997577 0.02350 10434 10434 0.00020 10434 10434 0.00020 4508247 3500236 1008011 0.02370 true 6597661 1649415 14704004 15009078 -305074 X true true 1 1 WICKENBURG COMMUNITY HOSPITAL 520 ROSE LANE WICKENBURG AZ 85390 WWW.WICKHOSP.COM RGH3505 X X 1 WICKENBURG COMMUNITY HOSPITAL 1 false false true X X X X X X X X X 19 true false false true X SEE PART V, SECTION C, FOR DIRECT URL true 19 true See Part V, Section C, For Direct URL false true X 200. 240. X X X true true X X X X true X See Part V, Section C for URL X See Part V, Section C for URL X PART V, SECTION C FOR URL X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 Describe how the hospital took into account input from person who represent the community: THE DEVELOPMENT OF THE CHNA SURVEY PROCESS BEGAN WITH THE FORMATION OF THE 2019 PROJECT TEAM. A DECISION WAS MADE TO USE THE SURVEY FORMAT SUCCESSFULLY IMPLEMENTED BY THE 2016 PROJECT TEAM AND PARTNERS. THE SURVEY WAS NOT ALTERED IN ANY FASHION AS IT WAS CERTAIN AMONGST THE TEAM THAT CONTRIBUTIONS PROVIDED BY THOSE IN 2013 REMAINED INVALUABLE AND DIVERSE INTO THE ISSUES MOST LIKELY TO BE RELEVANT TO OUR POPULATION. IT WAS ALSO DESIRED AMONGST THE 2016 PROJECT TEAM TO EVALUATE 2016 DATA ALONGSIDE 2013 DATA IN ORDER TO FACILITATE A COMPREHENSIVE PRIORITIZATION OF NEEDS AND STRATEGIES TO ADDRESS THEM. 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; 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. ALSO PUBLISHED DISPLAY ADS IN THE TOWN NEWSPAPER ENCOURAGED REGIONAL RESIDENTS TO TAKE THE ANONYMOUS SURVEY ONLINE THROUGH SURVEY MONKEY OR BY PAPER WHICH WAS DISTRIBUTED AND COLLECTED THROUGHOUT THE REGION AT VARIOUS LOCATIONS. SCHEDULE H, PART V, SECTION B, LINE 7a DIRECT URL FOR CHNA REPORT: THE CHNA CAN BE FOUND THROUGH A HYPERLINK AT THE BOTTOM LEFT ON THE HOME PAGE OF THE ORGANIZATION'S WEBSITE AT HTTP://WICKHOSP.COM/. SCHEDULE H, PART V, SECTION B, LINE 10a DIRECT URL FOR IMPLEMENTATION PLAN: THE IMPLEMENTATION PLAN CAN BE FOUND DIRECTLY IN THE CHNA, LOCATED AT THE VERY END OF THE DOCUMENT. THE CHNA CAN BE FOUND THROUGH A HYPERLINK AT THE BOTTOM LEFT OF THE HOME PAGE OF THE ORGANIZATION'S WEBSITE AT HTTP://WICKHOSP.COM/. SCHEDULE H, PART V, SECTION B, LINE 11 DESCRIBE HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY NEEDS NOT BEING ADDRESSED: THE MOST RECENTLY CONDUCTED CHNA'S IDENTIFIED NEEDS ARE BEING ADDRESSED IN THE FOLLOWING WAYS: THE AVAILABILITY OF LOCAL HEALTHCARE SERVICES IS BEING INCREASED. AFTER YEARS OF STRATEGIC PLANNING AND EFFORT, CHA (COMMUNITY HOSPITAL ASSOCIATION, INC.) OPENED A NEW MOB (MEDICAL OFFICE BUILDING) AND A NEW SURGERY WING IN AUGUST OF 2016. THE MOB EXPANSION MAKES AVAILABLE SIGNIFICANT IMPROVED SPACE FOR BOTH CHA'S EMPLOYED PRIMARY CARE PHYSICIANS AND THE VISITING PHYSICIAN SPECIALISTS. THE SURGERY WING WITH ITS STATE-OF-THE-ART EQUIPMENT ADDS A SERVICE THAT HAS NOT BEEN AVAILABLe LOCALLY FOR OVER 15 YEARS. INCLUDED ARE A VARIETY OF SURGICAL AND DIAGNOSTIC SERVICES RANGING FROM GENERAL, ORTHOPEDIC AND PODIATRIC SURGERY TO ENDOSCOPY AND PAIN MANAGEMENT SERVICES. THE PLANNING AND OPENING OF A NEW CLINIC IN WITTMAN HAS OPENED MORE HEALTHCARE SERVICES TO A UNDER SERVICED AREA. THE MOB AND OTHER EFFORTS HAVE MADE IT POSSIBLE TO ATTRACT A DERMATOLOGY PHYSICIAN GROUP (VISITING PHYSICIAN SPECIALISTS), AN OPHTHALMOLOGIST, AND AN ACUPUNCTURE PROGRAM TO THE COMMUNITY FOR EXPANDED TIMES/SERVICES. THE MOB HAS BEEN EXPANDING SERVICES FOR WOMEN HEALTH SERVICES AND HAS CONTRACTED WITH A OBGYN. CHA MAKES A CONCERTED EFFORT TO HAVE A COMMUNITY AWARENESS OF HEALTH ISSUES. SPECIFIC RESOURCES ARE DEVOTED SUCH AS HAVING A COMMUNITY AWARENESS MANAGER, PLACING HEALTH EDUCATION ARTICLES IN THE LOCAL NEWSPAPER, CONDUCTING EDUCATIONAL MEETINGS/SEMINARS, PARTICIPATING IN HEALTH FAIRS, PROVIDING A FREE SCHOOL-SPORTS PHYSICALS DAY, ETC. SCHEDULE H, PART V, SECTION B, LINE 16A DIRECT URL FOR THE FINANCIAL ASSISTANCE POLICY APPLICATION: https://www.wickhosp.com/wp-content/uploads/2018/09/Financial-Assistance-A pplication-Letter-App.pdf SCHEDULE H, PART V, SECTION B, LINE 16B & 16C DIRECT URL FOR THE FINANCIAL ASSISTANCE POLICY, AND A PLAIN LANGUAGE SUMMARY: https://www.wickhosp.com/patient-information/financial-services/ 2 COMMUNITY HOSPITAL CLINIC - WICKENBURG 519 ROSE LANE WICKENBURG AZ 85390 PRIMARY CARE CLINIC RURAL HEALTH CLINIC COMMUNITY HOSPITAL CLINIC - CONGRESS 26750 S SANTA FE ROAD SUITE B CONGRESS AZ 85332 PRIMARY CARE CLINIC RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 7 CALCULATION OF COMMUNITY BENEFIT EXPENSES: THE ORGANIZATION USED A COST-TO CHARGE RATIO FOR LINES 7A & 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINE 7E WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS. SCHEDULE H, PART III, SECTION A, LINE 2 EXPLAIN THE ORGANIZATION'S METHODOLOGY TO ESTIMATE THE AMOUNT REPORTED FOR BAD DEBT EXPENSE: THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS AND TRENDS. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY: THE HOSPITAL HAS ADOPTED THE NEW REVENUE RECOGNITION STANDARD ASU 2014-09. UNDER ASU 2014-09, THE ESTIMATED AMOUNTS DUE FROM PATIENTS FOR WHICH THE HOSPITAL DOES NOT EXPECT TO BE ENTITLED OR COLLECT FROM THE PATIENTS ARE CONSIDERED IMPLICIT PRICE CONCESSIONS AND EXCLUDED FROM THE HOSPITAL'S ESTIMATION OF THE TRANSACTION PRICE OR REVENUE RECORDED. BAD DEBT EXPENSE WAS NOT SIGNIFICANT TO THE AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED December 31, 2019. HOWEVER, THE HOSPITAL INTERNALLY TRACKS BAD DEBT EXPENSE CONSISTENT WITH HISTORICAL PRACTICES AND THAT AMOUNT HAS BEEN REPORTED ON SCHEDULE H, PART III, SECTION A, LINE 2. THE MANAGER OF PATIENT FINANCIAL SERVICES ESTIMATES THAT APPROXIMATELY 25% OF ALL BAD DEBT WOULD QUALIFY FOR CHARITY CARE, BUT IT IS DIFFICULT TO GET THE PATIENTS TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. SCHEDULE H, PART III, SECTION B, LINE 8 Description of Shortfall: THE ORGANIZATION IS A SOLE COMMUNITY NOT-FOR PROFIT HOSPITAL THAT PROVIDES HEALTHCARE SERVICES TO COMMUNITY RESIDENTS AND VISITORS IN A RURAL SETTING WITH LIMITED ACCESS TO SPECIALIST CARE. ACCESSIBLE, HIGH-QUALITY HEALTHCARE SERVICE IS IMPORTANT FOR THE OVERALL HEALTH OF ALL RESIDENTS AND NOT FULLY AVAILABLE IN MOST RURAL SETTINGS. WHERE MEDICARE IS CALCULATED TO PAY AT EXPECTED COST, RURAL CARE IS OFTEN MORE EXPENSIVE AS PATIENTS TEND TO HAVE A HIGHER THAN AVERAGE ACUITY AND LENGTH OF STAY DUE TO LIMITED SPECIALIST CARE IN THE TREATMENT AND PATIENT CARE FOLLOW UP PROCESS. ADDITIONALLY, PATIENT VOLUMES ARE MORE RESTRICTED AND SEASONALLY IMPACTED IN RURAL SETTINGS AS COMPARED TO METROPOLITAN SETTINGS, WHICH AFFECTS THE HOSPITALS OPPORTUNITY TO SPREAD THE FIXED COSTS OVER MORE PATIENT CARE EXPERIENCES. ALSO RELATIVE TO THE SEASONAL PATIENT FLUCTUATIONS, RURAL HOSPITALS TEND TO HAVE A HIGHER NEED FOR AGENCY TRAVEL NURSES TO SUPPLEMENT THE HIGHER CENSUS TIMES WHICH IS 40% HIGHER COSTS THAN EMPLOYED STAFF. PHYSICIAN RECRUITMENT IS ALSO A MAJOR CHALLENGE FOR SOLE COMMUNITY PROVIDERS AND THEREFORE MUST UTILIZE LOCUM TENENS PHYSICIANS AT A MUCH HIGHER COST THAN EMPLOYED PHYSICIANS. MEDICARE SHORTFALLS IN RURAL SETTINGS REFLECT THE EXCESS COST OF REQUIRED CARE OVER THE CALCULATED AVERAGE EXPECTED COST FOR PARTICIPANTS IN THE MEDICARE PROGRAM. FOR THESE REASONS, MEDICARE SHORTFALLS SHOULD BE CONSIDERED PART OF THE COMMUNITY BENEFIT PROVIDED. SCHEDULE H, PART III, SECTION C, LINE 9B DEBT COLLECTION POLICY: OUR PRACTICE IS TO PROVIDE ALL PATIENTS AT TIME OF REGISTRATION WHO DO NOT DEMONSTRATE THE ABILITY TO PAY FOR THE ANTICIPATED SERVICES (NO INSURANCE, NO DEPOSIT, ETC.) AN OPPORTUNITY TO COMPLETE A CHARITY APPLICATION. THE COLLECTION POLICY REMAINS THE SAME FOR POTENTIAL CHARITY CASES AND ALL AVENUES OF COLLECTION ARE PURSUED, JUST AS IF THE CHARITY APPLICATION HAD NOT BEEN OFFERED. WHILE WE BELIEVE MANY OF THE CHARITY CASES END UP AS A BAD DEBT, IT IS NOT FOR LACK OF EFFORT TO EDUCATE THE POTENTIAL CHARITY APPLICANT OF THE AVAILABILITY OF ASSISTANCE AND KEEP THE AMOUNTS OUT OF OUR BAD DEBT CATEGORY. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: 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. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: 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 WITH A WRITTEN CHARITY CARE APPLICATION. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: WICKENBURG COMMUNITY HOSPITAL SERVES A PRIMARY SERVICE AREA POPULATION OF APPROXIMATELY 17,000 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%. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: 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 WERE 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. X true true X X false false false false false false false false true true JACQUELINE LUNDBLAD CHIEF FINANCIAL OFFICER 165787 0 0 0 0 0 0 0 26795 0 192582 0 JAMES TAVARY CHIEF EXECUTIVE OFFICER 194991 0 0 0 0 0 4678 0 32063 0 231732 0 JEREMY BRAMWELL PHYSICIAN 238941 0 3639 0 0 0 7500 0 41494 0 291574 0 LISA ERLINGER ANESTHESIOLOGIST 235867 0 0 0 0 0 0 0 39501 0 275368 0 MITCHELL WAGNER SURGEON 522571 0 0 0 0 0 7500 0 5731 0 535802 0 ROBERT RIPLEY SURGEON 443405 0 0 0 0 0 7500 0 35490 0 486395 0 TODD KRAVETZ CHIEF OF STAFF 277834 0 17232 0 0 0 7750 0 38161 0 340977 0 ROGER ROSS DIRECTOR OF PHARMACY SERVICES 185682 0 0 0 0 0 0 0 10673 0 196355 0 Laura Meaney ANESTHESIOLOGIST 202641 0 0 0 29652 232293 SCHEDULE J, PART I, LINE 1A DESCRIPTION OF HEALTH CLUB DUES: WICKENBURG COMMUNITY HOSPITAL REIMBURSES FOR HEALTH CLUB DUES WHICH ARE RECORDED IN THE INDIVIDUALS COMPENSATION. GOLF CLUB MEMBERSHIP ARE ALSO PROVIDED. THE FOLLOWING INDIVIDUALS REPORTED ON PART VII PARTICIPATED IN THE HEALTH CLUB AND WERE REIMBURSED AT $40 A MONTH: JAMES TAVARY SCHEDULE J, PART I, LINE 8 PAYMENTS MADE PURSUANT TO AN INITIAL CONTRACT EXCEPTION: MR. TAVARY IS QUALIFIED BY TRAINING AND EXPERIENCE TO ACT AS CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. DUTIES SHALL BE PERFORMED TO THE BEST OF MR. TAVARY'S ABILITY, EXPERIENCE, AND TALENT TO THE REASONABLE SATISFACTION OF THE ORGANIZATION. BASE COMPENSATION IS PAID FOR SERVICES, WITH THE ELIGIBILITY OF PERFORMANCE BASED BONUSES. THE TERM OF THE CONTRACT SHALL BE THREE YEARS, WITH THE POSSIBLITY OF EXTENSION MADE BY MUTUAL AGREEMENT OF THE ORGANIZATION AND MR.TAVARY. Schedule J, Part I, line 9 REBUTTABLE PRESUMPTION PROCEDURE: THE ORGANIZATION FOLLOWS THE REBUTTABLE PRESUMPTION PROCEDURE. Comparability data is used every other year through Pay Factors. A salary range based on position is obtained and then compared to internal equity in determining executive compensation. X 1 140000 Fair Market Value 0 false false false SCHEDULE M, PART I, COLUMN A THE NUMBER IN COLUMN B REPRESENTS THE NUMBER OF CONTRIBUTIONS RECEIVED. FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS PREPARED BY A THIRD PARTY AND IS REVIEWED BY THE CFO. A COPY OF THE 990 IS MADE AVAILABLE TO THE GOVERNING BOARD PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: 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 C, LINE 15a REVIEW OF CEO OR TOP MGMT 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. FORM 990, PART VI, SECTION B, LINE 15B 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 AVAILABLE TO THE PUBLIC: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC BY A FORMAL REQUEST IN WRITING. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCES: Change in interest in net assets of wickenburg community hospital foundation (211,402) FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:4684908 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICIAN FEES TOTAL FEES:3513814 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:1235844 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL SERVICES TOTAL FEES:646443 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTIONS TOTAL FEES:3921 WICKENBURG COMMUNITY FOUNDATION 520 ROSE LANE WICKENBURG AZ 85390 742521618 FUNDRAISING AZ 501(C)(3) LINE 7 NA true false false true true false false false false false false false true true true true true true false true Wickenburg Community Foundation C 1044601 Book Wickenburg Community Foundation q 104084 Book