2018-11-12T15:35:26-06:00 2017-12-31 450250958 EIDE BAILLY LLP 621 N ROBINSON AVE STE 200 OKLAHOMA CITY OK 731026232 990 2017-01-01 860171900 White Mountain Communities Hospital Inc WHIT 9283337142 118 South Mountain Avenue Springerville AZ 85938 Gregory J Was CEO 9283337142 2018-11-08 1 Kim Hunwardsen CPA P00484560 4055942000 2018-11-08 98.173.248.226 2018-11-08 16:36:13 CS P E10085862974BF89EE8F231EB831862A8F193D10 B602D594AFD2B0B327E07A06F36CA6A7E42546D0 2017 2019-02-21 02:37:17Z White Mountain Regional Medical Center Gregory J Was 118 South Mountain Avenue Springerville AZ 85938 19715812 0 X www.wmrmc.com X 1962 AZ White Mountain Regional Medical Center provides caring services to meet the needs of patients. 8 6 180 41 0 0 238337 187237 18138595 19497358 567 5465 20195 23199 18397694 19713259 2850 5000 0 0 9399974 9495739 0 0 0 9649338 9635381 19052162 19136120 -654468 577139 8250862 8177599 3853087 3200582 4397775 4977017 X White Mountain Regional Medical Center - providing affordable, high quality care in our community. 0 0 15927065 5000 19497358 White Mountain Communities Hospital, Inc. dba White Mountain Regional Medical Center (Hospital) is a 25 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. 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 $130,000 for the year ended December 31, 2017. Total direct and indirect costs related to these foregone charges was approximately $56,000 at December 31, 2017, based on an average ratio of cost to gross charges. 15927065 1 0 0 1 0 0 0 0 1 0 1 0 0 0 1 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 23 0 1 180 1 0 0 0 0 0 0 0 0 0 0 X 8 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 AZ X X Finance Department 9283337142 118 South Mountain Avenue Springerville AZ 85938 Mary Nedrow President 1.00 X X 0 0 0 Ryan Patterson Vice President 1.00 X X 0 0 0 Tim Rasmussen 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 Richard Ayres Board member 1.00 X 0 0 0 Paul Drake Board member 1.00 X 0 0 0 Veronica Dowling MD Board Chief of Staff 10.00 X 4000 0 0 Gregory J Was CEO 40.00 X 157494 0 0 Larry Tyrell CFO 40.00 X 95081 0 0 Carla Rotering MD Pulmonology 40.00 X 210985 0 0 Christine Jackson MD Cardiologist 40.00 X 190435 0 0 Lyle G Trone Manager Pharmacy 40.00 X 150267 0 0 Thomas Hunt Physical Therapy 40.00 X 107976 0 0 Steve Hamblin Physical Therapy 40.00 X 132761 0 0 1048999 0 0 6 0 1 0 Cornerstone 200 N Nebraska St Chandler AZ 85225 ER physician 1524240 Entech 7300 W Detroit St Chandler AZ 85226 Medical equip service 298481 Peak Medical Consulting LLC 1810 Rim Road Lakeside AZ 85929 Traveling ER nurses 126500 Triage LLC 12020 Pacific Street Omaha NE 68154 Traveling nurses 112710 4 186772 465 187237 Patient Service Revenue 622110 18737382 18737382 District ER services 624230 511500 511500 EHR Incentive 622110 138019 138019 Community Wellness 900099 57828 57828 52629 52629 19497358 865 865 21704 0 21704 21704 21704 4600 0 4600 4600 4600 4048 2553 1495 1495 19713259 19497358 0 28664 X 5000 5000 256575 4000 252575 107976 107976 7261188 5811585 1449603 1335337 861399 473938 534663 432334 102329 24993 24993 44137 44137 3188 3188 3255947 3177098 78849 52297 24294 28003 566989 362931 204058 316215 66110 250105 413255 395122 18133 53386 44736 8650 59475 30511 28964 44765 44765 840035 840035 246593 275 246318 Bad debt expense 2113037 2113037 Medical Supplies 1088303 1088303 Repairs and maintenance 417235 420674 -3439 Food 72379 71681 698 23152 22011 1141 19136120 15927065 3209055 0 1500 1600 343656 467861 124500 134126 3118968 3350965 333269 396043 141012 121506 12645913 8940415 4187957 3705498 8250862 8177599 2098612 1546257 391965 253947 686532 679521 37500 638478 720857 3853087 3200582 X 4397775 4977017 4397775 4977017 8250862 8177599 X 577139 2103 X 0 1 X 1 0 X 0 0 0 0 0 0 0 0 1 3188 3188 0 Part II-B, Line 1: White Mountain Communities Hospital paid dues to the Arizona Health Care Association in the amount of $11,737. The portion of the dues attributable to lobbying was 27.16%. 1 19089 7171 9274 16986 0 26067 26067 5109652 3248761 1860891 7484418 5691654 1792764 25776 25776 3705498 Estimated third party payor settlements 720857 720857 X 17595604 -2113037 -2113037 19708641 4618 4618 19713259 17016362 0 17016362 2119758 2119758 19136120 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 -2,113,037. Part XI, Line 4b - Other Adjustments: White Mountain Auxiliary revenue included in revenue for Form 990 4,618. Part XII, Line 4b - Other Adjustments: Provision for bad debts included in expenses for Form 990 2,113,037. White Mountain Auxiliary expenses included in expenses for Form 990 6,721. 1 1 X 1 X 1 X 1 1 0 1 1 56000 56000 0.00330 3489142 1717599 1771543 0.10410 3545142 1717599 1827543 0.10740 2039152 451741 1587411 0.09330 2039152 451741 1587411 0.09330 5584294 2169340 3414954 0.20070 0 2113037 745902 6372806 6404635 -31829 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 Provider based - White Mtn Regl Specialty Clinic White Mountain Communities Hospital Inc 1 0 0 1 X X X X X X X X 15 1 0 1 1 X See Part V, Page 8 X 1 15 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 CHNA survey was shared with our community through several venues, social media, electronically, paper copies, flyers and social media. WMRMC also used the annual Health Fair as an event to gather many paper and electronic responses to the survey. The survey was shared in paper form at the following locations: WMRMC Health Fair Mountain Avenue Clinic North Country Clinic Billy Creek Clinic WMRMC Specialty and Family Clinic WMRMC Outpatient Check in WMRMC Jean V. Hall Wellness Center WMRMC Board Members Apache County Fair 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: Apache County Health Department White Mountain Communities Hospital, Inc. Part V, Section B, Line 11: Upon analysis of the CHNA completed between June and September of 2015, the following is a prioritized description of significant health needs and diagnoses within the demographic area of WMRMC: 1. Additional primary care physician to address the top 5 healthcare needs which include: general checkups, allergies, high blood pressure, high cholesterol, injury, sports physicals and diabetes management. 2. Women's Health - Gynecology and family planning services. 3. Diabetes Management 4. Asthma Management 5. Chronic Pain 6. Depression 7. Identify and access to community resources Strategy Rural Health Clinic (diabetes management, asthma management, women's health needs) WMRMC Specialty Clinic is fully engaged in the process of applying for designation as a Rural Health Care Clinic (RHC). Under this designation, WMRMC will receive enhanced reimbursement rates from Medicare and AHCCCS. One of the requirements of an RHC is the employment of a mid-level provider in addition to primary care Physicians. WMRMC recruited and hired a full time Nurse Practitioner in September 2017. The Nurse Practitioner provides pediatric and adult primary care services at the Specialty Clinic. The Nurse Practitioner also provides Women's Health Services. The recruitment of the Nurse Practitioner has assisted WMRMC in addressing the needs of the community as it relates to diabetes management, asthma management and women's health.Diabetes Management: In 2016, WMRMC applied for and received funding to implement the Health Living with Diabetes Program. The diabetes self-management workshops are given two and a half hours once a week for six weeks. Workshops are free of charge and are facilitated by two specially trained leaders. Subject covered include techniques to deal with symptoms of diabetes, fatigue, pain, hyper/hypoglycemia and emotional issues. Participants receive in-depth education on the importance of exercise, diet and medication management. Workshops have been very well attended and we continue to have waiting lists for upcoming workshops. Caring for our Elderly Population: WMRMC continues to engage our elderly population through and Elder Care Forum which occurs on a quarterly basis at the facility. The local resources that assist the elderly meet to discuss gaps in care, and share information to better assist the elderly population. The resources that attend have been expanded from local resources such as the Senior Center, Northern Arizona Council of Governments, the Apache County Public Health Department and many other organizations. This group plans to continue growing resources available to our elderly population by networking and providing education on the available services.Community Knowledge of Resources Available: WMRMC continues to focus on providing resource materials to the community regarding healthcare services available in the area. The resources include information regarding the services the Hospital and other local healthcare organizations provide to the communities. The Marketing and Public Relations Manager continually works with other healthcare related organizations and clinics to ensure information is kept current and available to the community through community events and day to day encounters with community members. 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 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:www.wmrmc.com/getpage.php?name=financial_policy Part V, Section B, Line 10a: Implementation Strategy website:www.wmrmc.com/getpage.php?name=financial_policy 1 1 - White Mountain Regional RehabWellness 118 South Mountain Avenue Springerville AZ 85938 Rehab/Wellness 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. Community health improvement services, line 7e, and cash and in-kind contributions, line 7i are reported based on actual expense and revenue amounts recorded from the events in the general ledger. 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 $2,113,037. 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 35.3% 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. There was a Medicare shortfall for 2016 due to sequestration. Even though Medicare was at a loss, the Hospital provides services to these patients because access to healthcare and individual's health is important to the Hospital. Therefore, the Medicare shortfall is considered a community benefit.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. 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 April and May, 2015, the White Mountain Regional Medical Center and the Apache County Health District co-sponsored the WMRMC and Apache County Community Health Needs Assessment. A broadly representative group of 10 Apache County leaders met over the course of three meetings to identify priorities and devise action strategies. After consideration of a host of information, local health-related priorities were established. The CHNA was approved by the board and posted to the Hospital's website.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 25 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 1,728. The estimated median household income was $37,118. The unemployment rate was 12.7% and the poverty rate was 35.3%. 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 25 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 157098 0 0 0 396 0 0 0 0 0 157494 0 0 0 Carla Rotering MD Pulmonology 210985 0 0 0 0 0 0 0 0 0 210985 0 0 0 Christine Jackson MD Cardiologist 190435 0 0 0 0 0 0 0 0 0 190435 0 0 0 Lyle G Trone Manager Pharmacy 150267 0 0 0 0 0 0 0 0 0 150267 0 0 0 Tom Hunt Family relationship with Board Member 107976 Compensation and benefits as employee 0 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 320,813. Management and general expenses 61,442. Fundraising expenses 0. Total expenses 382,255. Consulting Fees: Program service expenses 36,948. Management and general expenses 17,282. Fundraising expenses 0. Total expenses 54,230. Contract Labor: Program service expenses 1,338,885. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,338,885. Professional fees: Program service expenses 1,457,159. Management and general expenses 0. Fundraising expenses 0. Total expenses 1,457,159. Recruiting: Program service expenses 23,293. Management and general expenses 125. Fundraising expenses 0. Total expenses 23,418. Form 990, Part XI, line 9: Change in White Mountain Regional Medical Center Auxiliary's assets 2,103.