2019-11-07T07:26:51-06:00 2018-12-31 450250958 EIDE BAILLY LLP 621 N ROBINSON AVE STE 200 OKLAHOMA CITY OK 731026232 990 2018-01-01 860171900 White Mountain Communities Hospital Inc WHIT 9283337142 118 South Mountain Avenue Springerville AZ 85938 Gregory J Was CEO 9283337142 2019-11-06 1 Kim Hunwardsen CPA P00484560 4055942000 2019-11-05 216.147.181.47 2019-11-06 08:58:40 CS P E10085862974BF89EE8F231EB831862A8F193D10 E10085862974BF89EE8F231EB831862A8F193D10 2018 2020-01-14 16:20:31Z White Mountain Regional Medical Center Gregory J Was 118 South Mountain Avenue Springerville AZ 85938 18472593 0 X www.wmrmc.com X 1962 AZ White Mountain Regional Medical Center provides caring services to meet the needs of patients. 8 7 205 36 0 0 187237 249430 19497358 18199488 5465 679 23199 22996 19713259 18472593 5000 0 0 0 9495739 9685471 0 0 0 9635381 8945023 19136120 18630494 577139 -157901 8177599 7432328 3200582 2612753 4977017 4819575 X White Mountain Regional Medical Center - providing affordable, high quality care in our community. 0 1 15330508 18199488 White Mountain Communities Hospital, Inc. dba White Mountain Regional Medical Center (Hospital) is a 21-bed Critical Access Hospital located in Springerville, Arizona, and provides acute care inpatient, outpatient and emergency services to residents of the surrounding communities in the Springerville area.White Mountain Regional Medical Center will provide caring services and operate on a financially sound basis to ensure its continuing ability to meet the needs of patients and the communities it serves. Continued on Schedule O.The Board of Directors and leadership of White Mountain Regional Medical Center recognize the importance of healthcare as a service essential for the well-being of people in the region and as an important part of the community's economy. In July 2018, the Centers for Medicare and Medicaid Services (CMS) accepted our agreement to allow our existing clinic, located at 114 South Mountain Avenue, Springerville, AZ 85938, to participate as a rural health clinic (RHC) in the Medicare program under Title XVIII of the Social Security Act.As a community organization the facility plays a vital role in providing services essential to the quality of life for people in Apache County, Arizona and Catron County, New Mexico.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy was approximately $109,000 for the year ended December 31, 2018. Total direct and indirect costs related to these foregone charges was approximately $47,000 at December 31, 2018, based on an average ratio of cost to gross charges. 15330508 1 0 0 1 0 0 0 0 1 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 64 0 1 205 1 0 0 0 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 X X Finance Department 9283337142 118 South Mountain Avenue Springerville AZ 85938 Mary Nedrow President 1.00 X X 0 0 0 Richard Ayres Vice President 1.00 X X 0 0 0 Ginger Wiltbank Secretary 1.00 X X 0 0 0 John Fredericksen Treasurer 1.00 X X 0 0 0 Gary Davis Board member 1.00 X 0 0 0 James Brown Board member 1.00 X 0 0 0 Paul Drake Board member 1.00 X 0 0 0 Roger Williams Board Chief of Staff 10.00 X 0 0 0 Gregory J Was CEO 40.00 X 165500 0 0 Larry Tyrell CFO 40.00 X 95671 0 0 Carla Rotering MD Pulmonology 40.00 X 232277 0 0 Christine Jackson MD Cardiologist 40.00 X 189493 0 0 Lyle G Trone Manager Pharmacy 40.00 X 165505 0 0 Elena Thompson NP 40.00 X 112462 0 0 Steve Hamblin Physical Therapy 40.00 X 130705 0 0 1091613 0 0 7 0 1 0 Cornerstone 200 N Nebraska St Chandler AZ 85225 ER physician 1524240 McKesson 2222 E Highland Ave Phoenix AZ 85016 Pharmacy services 350917 Entech 7300 W Detroit St Chandler AZ 85226 Medical equip service 295548 Evident 6600 Wall Street Mobile AL 36695 Electronic health records 259105 Medical Diagnostic Imaging 10835 N 25th Ave Phoenix AZ 85029 Imaging 251196 14 242913 6517 1202 249430 Patient Service Revenue 622110 17693453 17693453 District ER services 624230 262500 262500 EHR Incentive 622110 92344 92344 Community Wellness 900099 58392 58392 92799 92799 18199488 679 679 22996 0 22996 22996 22996 18472593 18199488 0 23675 X 261171 261171 109050 109050 7374303 5899400 1474903 1397845 955577 442268 543102 440396 102706 3998 3998 43536 43536 4438 4438 3190545 3071902 118643 40485 21868 18617 561640 360612 201028 331961 60416 271545 358939 350547 8392 67943 56459 11484 25452 16992 8460 49307 46879 2428 775435 451112 324323 241974 241974 Bad debt expense 1659920 1659920 Medical Supplies 1102228 1102228 Repairs and maintenance 395441 392366 3075 Food 71969 69956 2013 19812 18416 1396 18630494 15330508 3299986 0 1600 1600 467861 642281 134126 1184 3350965 2752975 396043 363956 121506 102111 13123504 9715850 3705498 3407654 0 160567 8177599 7432328 1546257 1825608 253947 161602 679521 625543 720857 0 3200582 2612753 X 4977017 4819575 4977017 4819575 8177599 7432328 X -157901 459 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 4438 4438 0 Part II-B, Line 1: White Mountain Communities Hospital paid dues to the Arizona Health Care Association in the amount of $12,125. The portion of the dues attributable to lobbying was 36.6%. 1 16986 19627 20086 16527 0 26067 26067 5130770 3414692 1716078 7940890 6301158 1639732 25777 25777 3407654 X 16793046 -1659920 -1659920 18452966 19627 19627 18472593 16950488 0 16950488 1680006 1680006 18630494 Part IV, Line 1b: White Mountain Regional Medical Center Auxiliary uses the Medical Center's FEIN but has its own checking account. The Auxiliary account balances were not included in the financial statements for the Medical Center. Part X, Line 2: The Hospital is organized as an Arizona nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Hospital is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Hospital is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Hospital has determined it is not subject to unrelated business income tax and has not filed an Exempt Organization Business Income Tax Return (Form 990T) with the IRS. 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: Provision for bad debts included in expenses for Form 990 -1,659,920. Part XI, Line 4b - Other Adjustments: White Mountain Auxiliary revenue included in revenue for Form 990 19,627. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in expenses for Form 990 1,659,920. White Mountain Auxiliary expenses included in expenses for Form 990 20,086. 1 1 X 1 X 1 X 1 1 0 1 1 47000 47000 0.00280 3728607 1693412 2035195 0.11990 3775607 1693412 2082195 0.12270 3158559 1276123 1882436 0.11090 3158559 1276123 1882436 0.11090 6934166 2969535 3964631 0.23360 0 1659920 607531 5995705 5218380 777325 X 1 1 1 1 White Mountain Communities Hospital Inc 118 South Mountain Avenue Springerville AZ 859355104 www.wmrmc.com H2530 X X X X White Mountain Communities Hospital Inc 1 0 0 1 X X X X X X X X 18 1 0 1 1 X See Part V, Page 8 X 1 18 1 See Part V, Page 8 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 X X X 1 X www.wmrmc.com/getpage.php?name=financial_policy X www.wmrmc.com/getpage.php?name=financial_policy X www.wmrmc.com/getpage.php?name=financial_policy X X X X X X 1 X 0 X X X X 1 X 0 0 White Mountain Communities Hospital, Inc. Part V, Section B, Line 5: The community survey was publicized and distributed widely throughout the primary service area. The CHNA survey was available to the community in paper form; electronically on White Mountain Regional Medical Center's website www.wmrmc.com; through social media, and on-line via Survey Monkey at www.surveymonkey.com. The survey was shared in paper form at the following locations:WMRMC Rural Health ClinicWMRMC Jean V. Hall Wellness CenterWMRMC Outpatient Registration WMRMC Governing Board of DirectorsWMRMC AuxiliaryWMRMC EmployeesNorth Country Community Health Center (Eagar, AZ.)North Country Community Health Center (St. Johns, AZ.)Apache County Drug Free Alliance Social MediaApache County Public Health ServicesLittle Colorado Behavioral Health Center (Springerville, AZ)Little Colorado Behavioral Health Center (St. Johns, AZ.)The survey presents an effort to solicit input from the broader community. While, the initiative is informal and non-representative, it does contribute considerable input from the broader community. The survey typically queries respondent's health-related needs and behaviors. This provides both an indication of local demand for health services and the level of satisfaction within the services received. White Mountain Communities Hospital, Inc. Part V, Section B, Line 6b: The Apache County Drug Free Alliance, the Apache County Public Health Services District, Little Colorado Behavioral Health Center, North Country Healthcare, and the Town of Springerville. White Mountain Communities Hospital, Inc. Part V, Section B, Line 11: The Community Health Needs Steering Committee developed a prioritization process and criteria in order to evaluate the significant health needs which were identified in the CHNA survey. The following summarizes each of the identified health needs priorities which is based on data and information gathered through the 2018 CHNA process. The Steering Committee narrowed the top three (3) priority needs (see below):1. Access to Community Resources2. Mental Health Services: Substance Abuse and Suicide Prevention3. Chronic Disease ManagementImplementation Strategies: Community EducationThe Steering Committee developed the following implementation strategies as it relates to community education:- Develop and promote a community educational site and/or newsletters to be shared among local healthcare and community organizations in an effort to increase education in the community.- Strengthen coordination among local healthcare and community organizations to expand educational opportunities within the community.- Partner with local healthcare and community organizations in an effort to encourage community wellness events and programs. - A coalition will be formed by the end of March 2019 to address the health needs priorities, implementation planning and evaluation planning. The coalition will involve multiple community agencies and community leaders. Implementation planning will align with existing assets and programs, as well as, with the goals and objectives outined in the CHNA. The coalition will additionally develop assessment measures to monitor whether or not goals and objectives are met.Priority 1: Access to Community Resources Community outreach is a key component in raising awareness of services available in the community. Establishing partnerships with local healthcare organizations, community organizations and community leaders is vital in increasing the health and wellness of the community. In addition to the implementation strategies developed by the Steering Committee, the Steering Committee developed the following action plan as it relates to community resources:- Develop and promote a community resource site and/or guide to be shared among local healthcare and community organizations in an effort to increase awareness of resources and services available in the community.Priority 2: Mental Health Services: Substance Abuse and Suicide PreventionSubstance abuse and suicide have a major impact on individuals, families and communities. The effects of substance abuse and suicide are cumulative and significantly contribute to social, physical, mental and public health problems. The health impact of substance abuse can furthermore lead to several negative health outcomes. Suicide is a leading cause of death in the United States. More than thirty-three thousand (33,000) people die by suicide each year in the United States. In addition to the implementation strategies developed by the Steering Committee, the Steering Committee developed the following action plan as it relates to substance abuse and suicide prevention:- Provide and expand substance abuse and suicide prevention programs in collaboration with healthcare organizations and providers. - Collaborate with healthcare organizations, community organizations and providers to improve care, awareness, management and promote prevention of substance abuse and suicide. Increase knowledge of substance abuse and suicide warning signs and enhance communication and intervention skills.Priority 3: Chronic Disease ManagementAn integrated care approach to the management of chronic diseases includes screenings, check-ups, monitoring and coordinating treatment, and patient education. Chronic disease management is a critical component of primary care that contributes to improving a patients health and quality of life. In addition to the implementation strategies developed by the Steering Committee, the Steering Committee developed the following action plan as it relates to chronic disease management:- Provide and expand chronic diesease self management programs in collaboration with healthcare organizations, community organizations and providers.- Collaborate with healthcare organizations, community organizations and providers to improve care, awareness, management and promote prevention of chronic diseases.None of the needs identified were addressed during the year as the CHNA was just completed. The needs identified will be addressed over the next three years. White Mountain Communities Hospital, Inc. Part V, Section B, Line 13h: Uninsured Patients having annual household incomes of $125,000 or less may, depending upon their assets and liabilities, qualify for discounted pricing for covered services without having to apply for Medicaid assistance. Under the Charity Care Program, uninsured patients having household incomes at or below 200% of the Federal Poverty Line and insufficient assets may, dependingupon their assets and liabilities, qualify for Charity Care in the form of free Emergent Services and other services required to be provided by WMRMC under EMTALA, subject (in most circumstances) to application for Medicaid, and for discounted pricing for other covered services. Part V, Section B, Line 7a: Community Health Needs Assessment website:https://www.wmrmc.com/docs/2018_WMRMC_CHNA_Report-Final.pdf Part V, Section B, Line 10a: Implementation Strategy website:https://www.wmrmc.com/docs/2018_WMRMC_CHNA_Report-Final.pdf 1 1 - White Mountain Specialty Clinic 114 South Mountain Avenue Springerville AZ 85938 Outpatient treatment center Part I, Line 3c: Uninsured Patients having annual household incomes of $125,000 or less may, depending upon their assets and liabilities, qualify for discounted pricing for covered services without having to apply for Medicaid assistance. Under the Charity Care Program, uninsured patients having household incomes at or below 200% of the Federal Poverty Line and insufficient assets may, depending upon their assets and liabilities, qualify for Charity Care in the form of free Emergent Services and other services required to be provided by WMRMC under EMTALA, subject (in most circumstances) to application for Medicaid, and for discounted pricing for other covered services. Part I, Line 6a: The community benefit report was available upon request at the hospital. 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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report. Part I, Ln 7 Col(f): The amount of bad debt expense removed from total expenses to determine the percentage was $1,659,920. Part III, Line 2: Patient accounts are written off to bad debt after every effort is made to collect the balance and patients are given opportunities to complete charity care applications or set up payment plans. All discounts and contractual adjustments are applied to accounts before they are written off to bad debt. Current payments on accounts previously written off as bad debt reduces bad debt expense.Bad debt expense on line 2 is reported at charges as presented on the financial statements. Part III, Line 3: A reasonable estimate of the Organization's bad debt expense attributable to patients under the Organization's financial assistance policy is 36.6% of bad debt expense. This is based on the percentage of individuals living in poverty. Part III, Line 4: The footnote to the Organization's financial statements can be found on pages 6 and 7 of the attached audited financial statements. Part III, Line 8: White Mountain Regional Medical Center is a critical access hospital. In 2018 the Hospital reported a Medicare surplus. The Hospital provides services to Medicare patients regardless of surplus or shortfall because access to healthcare and individual's health is important to the Hospital and community. Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicaid and Medicare Services.Hospital services reimbursed on a fee schedule are not included in the Medicare calculation per the 990 instructions. Had this been reported the Hospital would have had a loss from Medicare services of $435,535.Medicare fee schedule revenue $ 320,019Medicare estimated costs of care relating to payments (755,553)Net (Shortage) $ (435,534) Part III, Line 9b: If a patient qualifies for financial assistance the patient will in no case be charged more than Amounts Generally Billed for emergency services or other medically necessary services. In addition, they will never be required to make advance payment or other payment arrangements in order to receive emergency services. However, they will be required in most situations to make a substantial advance deposit or other payment arrangements based upon an estimate of the Amounts Generally Billed in order to receive non-emergency services. The account will not be turned over to a collection agency while an application is in process. Any personal amount due will follow normal collection procedures. Part VI, Line 2: In addition to the CHNA, White Mountain Regional Medical Center utilizes HealthStream to conduct patient surveys. Part VI, Line 3: The financial assistance policy, application and plain language summary are provided on the Hospital's website in English and Spanish. The forms are also available at the Hospital. Copies of these documents are also available in the Admitting area located near the main entrance of the Hospital and by mail by contacting Patient Financial Services at 928-333-7150. Part VI, Line 4: White Mountain Regional Medical Center is a 21-bed Critical Access Hospital. The Medical Center serves southern Apache County, Arizona, as well as Catron County, New Mexico. Both are high poverty areas. The population in Springerville, AZ was 1,751. The estimated median household income was $38,333. The unemployment rate was 8.8% and the poverty rate was 36.6%. The most common industries were construction and utilities. The nearest hospital is 45 minutes away in Show Low, Arizona. Part VI, Line 5: The governing body is comprised of persons who reside in the Medical Center's primary service area. White Mountain Regional Medical Center extends medical staff privileges to all qualified physicians. Any surplus funds are used for equipment and facility upgrades to give our patients the latest in technology.White Mountain Regional Medical Center is currently a Level 4 Trauma Center. The Hospital has received Pediatric Emergency Certification. There are several physicians/providers located in the area that routinely use our facility in some capacity. In addition, there are many physicians with sub-specialties that visit the area providing ophthalmology, orthopedic, podiatry, and general surgery close to home, through the White Mountain Specialty Clinic. As it currently operates, White Mountain Regional Medical Center is a 21-bed Critical Access Hospital. In addition to inpatient services, the facility offers: General Outpatient Surgical Services;General Outpatient Medical Services;Emergency Services;Medical Imaging Services, which include X-ray, MRI, C-T Scan, Bone Densitometry, Nuclear Medicine and Ultra Sound;Laboratory Services, which include Blood Bank, Chemistry and Hematology;Cardiopulmonary Services, which include Respiratory Services, Pulmonary Function Services, Sleep Study, EKG Services and Cardiac Stress testing;Inpatient Pharmacy Services; Rehabilitation Services, which include inpatient and outpatient Physical Therapy; Wellness Center; Food Services, which include a consulting Registered Dietitian.We provide workshops for elderly people for services that the hospital provides and other community services provided outside the hospital. Also, we provide diabetes education on diet and ways to control diabetes. These services are provided at no cost. X X 0 0 0 0 0 0 0 0 0 Gregory J Was CEO 164752 0 0 0 748 0 0 0 0 0 165500 0 0 0 Carla Rotering MD Pulmonology 232277 0 0 0 0 0 0 0 0 0 232277 0 0 0 Christine Jackson MD Cardiologist 189493 0 0 0 0 0 0 0 0 0 189493 0 0 0 Lyle G Trone Manager Pharmacy 165505 0 0 0 0 0 0 0 0 0 165505 0 0 0 Tom Hunt Family relationship with Board Member 109050 Compensation and benefits as employee 0 Form 990, Part III, line 3 The Hospital was licensed for 25 beds through June 12, 2018. Effective June 13, 2018 the Hospital amended the facility license with the Arizona Department of Health Services to be 21 beds. Form 990, Part VI, Section A, line 1 The Executive Committee is composed of the officers of President, Vice President, Secretary and Treasurer. The Executive Committee is empowered to act on behalf of the full Board on all matters requiring action and attention between regular Board Meetings or when a Special Meeting would not be timely. All actions of the Executive Committee will be presented at the next regular Board Meeting for information and/or ratification. This Committee, by its own policy, may establish meeting notification requirements. Form 990, Part VI, Section B, line 11b The Form 990 is reviewed by all voting board members at the board meeting prior to filing. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c A Conflict of Interest is completed and signed by officers and Directors on an annual basis. The completed policies are reviewed by the Directors. It is the responsibility of the Directors to make full disclosure of any interest, which might result in a conflict on their part, whether financial or otherwise. At any meeting of the Directors, any Director may declare a conflict of interest prior to the discussion of the issue in question. Any Director may state that he or she feels another Director has a conflict of interest. If a majority of the Directors determine that a conflict does exist, the Director in question will remove himself/herself from any discussion regarding the issue. Form 990, Part VI, Section B, line 15a Compensation for the CEO is determined utilizing a wage watch for comparison salary data, approved by the board and documented in the board minutes. Compensation for the CFO is determined utilizing a wage watch for comparison salary data, approved by the CEO and documented in the personnel file. Form 990, Part VI, Section C, line 19 The organization's governing documents, conflict of interest policy and financial statements are available upon request. Form 990, Part IX, line 11g Purchased services: Program service expenses 384,115. Management and general expenses 86,778. Fundraising expenses 0. Total expenses 470,893. Consulting Fees: Program service expenses 22,849. Management and general expenses 28,885. Fundraising expenses 0. Total expenses 51,734. Contract Labor: Program service expenses 1,236,015. Management and general expenses 2,980. Fundraising expenses 0. Total expenses 1,238,995. Professional fees: Program service expenses 1,427,072. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,427,072. Recruiting: Program service expenses 1,851. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,851. Form 990, Part XI, line 9: Change in White Mountain Regional Medical Center Auxiliary's assets 459.