BENSON HOSPITAL CORPORATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- BENSON HOSPITAL CORPORATION (EIN 86-6007695)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-02-21
- IRS object ID
- 201810529349300136
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-02-21T14:57:37-06:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 860683059 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BEACHFLEISCHMAN PC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1985 E RIVER ROAD SUITE 201 | AddressLine1Txt |
| City | TUCSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85718 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 866007695 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BENSON HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | BENS | BusinessNameControlTxt |
| Phone | 5205862261 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 2290 | AddressLine1Txt |
| City | BENSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85602 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | KENNETH GORANSON | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 5205862261 | PhoneNum |
| Signature | 2018-02-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KAREN K MCCLOSKEY CPA | PreparerPersonNm |
| PTIN | P00099644 | PTIN |
| Phone | 5203214600 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 208.87.239.202 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-02-13 | IPDt |
| IP Tm | 14:06:26 | IPTm |
| IP Timezone | US | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 23AB17895BAC7DA56F918F3357BB5DF74DD723A1 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 374F92A1CAE4D53B1A657F70CE012C071B2F41E5 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | RICHARD POLHEBER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 2290 | AddressLine1Txt |
| City | BENSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85602 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $14,249,567 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BENSONHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1960 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | QUALITY MEDICAL CARE INCLUDING EMOTIONAL, SOCIAL AND SPIRITUAL NEEDS | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 174 | TotalEmployeeCnt |
| Total Volunteers | 30 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $928,660 | PYContributionsGrantsAmt |
| CY Contributions Grants | $912,594 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $13,062,315 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $13,262,434 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,237 | PYInvestmentIncomeAmt |
| CY Investment Income | $5,880 | CYInvestmentIncomeAmt |
| PY Other Revenue | $47,682 | PYOtherRevenueAmt |
| CY Other Revenue | $68,659 | CYOtherRevenueAmt |
| PY Total Revenue | $14,045,894 | PYTotalRevenueAmt |
| CY Total Revenue | $14,249,567 | 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 | $8,585,811 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,972,104 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,333,680 | PYOtherExpensesAmt |
| CY Other Expenses | $6,839,788 | CYOtherExpensesAmt |
| PY Total Expenses | $13,919,491 | PYTotalExpensesAmt |
| CY Total Expenses | $15,811,892 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $126,403 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,562,325 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,669,679 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,247,742 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,147,469 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,287,857 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,522,210 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,959,885 | NetAssetsOrFundBalancesEOYAmt |
| Mission | THE MISSION OF BENSON HOSPITAL IS TO STRIVE TO SURPASS THE CUSTOMER'S EXPECTATIONS IN THE DELIVERY OF QUALITY MEDICAL CARE INCLUDING THEIR EMOTIONAL, SOCIAL, AND SPIRITUAL NEEDS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $12,715,857 | ExpenseAmt |
| Revenue | $13,262,434 | RevenueAmt |
| Desc | BENSON HOSPITAL IS A RURAL HOSPITAL THAT PROVIDES MEDICAL CARE ON AN INPATIENT, OUTPATIENT AND EMERGENCY BASIS TO PATIENTS IN AND AROUND THE TOWN OF BENSON, ARIZONA. THE HOSPITAL HAS 22 ACUTE CARE BEDS AND IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL BY THE STATE OF ARIZONA. CARE PROVIDED INCLUDES EMERGENCY, OBSTETRICS, OCCUPATIONAL MEDICINE, RESPIRATORY THERAPY, DIAGNOSTIC IMAGING, NUTRITION SERVICES, LABORATORY SERVICES, PHARMACY, SURGICAL AND PHYSICAL REHABILITATION. CARE IS PROVIDED REGARDLESS OF RACE, CREED, COLOR OR ABILITY TO PAY. | Desc |
| Total Program Service Expenses | $12,715,857 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| 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 | 0 | 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 With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 62 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 174 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | 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 | Yes (1) | 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 | 0 | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | KENNETH GORANSON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5205862261 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 450 S OCOTILLO AVE | AddressLine1Txt |
| City | BENSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85602 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| DAN BARRERA | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| BARBARA HARTLEY | |||||||
| MEMBER | 20.00 | Yes (X) | $196,843 | $0 | $0 | ||
| ANCIETO MALDONADO | |||||||
| MEMBER | 2.00 | Yes (X) | $0 | $0 | $0 | ||
| ANN E COOK | |||||||
| PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| WILLIAM LINDLEY | |||||||
| VICE PRESIDENT | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| BOB LUJAN | |||||||
| SECRETARY/TREASURER | 2.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| RICHARD POHLEBER | |||||||
| CEO | 40.00 | $246,030 | $0 | $5,251 | Yes (X) | ||
| KENNETH GORANSON | |||||||
| CFO | 40.00 | $177,646 | $0 | $13,923 | Yes (X) | ||
| TERESA VINCIFORA | |||||||
| CCO | 40.00 | $159,377 | $0 | $3,486 | Yes (X) | ||
| JAMES RICHEY | |||||||
| PHARMACIST | 40.00 | $156,143 | $0 | $13,200 | Yes (X) | ||
| GARY MALUF | |||||||
| LAB DIRECTOR | 40.00 | $124,371 | $0 | $2,685 | Yes (X) | ||
| JOHN ROBERTS | |||||||
| INFORMATION TECHNOLOGY DIRECTOR | 40.00 | $112,371 | $0 | $11,952 | Yes (X) | ||
| REX HEATON | |||||||
| NURSE PRACTICIONER | 40.00 | $116,871 | $0 | $12,149 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,289,652 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $62,646 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| NES INC | |||||
| PO BOX 277001 | ATLANTA | GA | 30384 | EMERGENCY DEPARTMENT PROFESSIONAL SVCS | $554,900 |
| MEDHOST OF TN INC | |||||
| 2739 MOMENTUM PLACE | CHICAGO | IL | 60689 | ELEC. HEALTH RECORDS, FIN. REP. SYSTEM | $413,401 |
| MEDICAL DIAGNOSTIC IMAGING GROUP | |||||
| PO BOX 17049 | PHOENIX | AZ | 85011 | RADIOLOGY PROFESSIONAL SVCS | $278,020 |
| MEDICAL SOLUTIONS INC | |||||
| 1010 N 102ND ST STE 300 | OMAHA | NE | 68114 | NURSING PROFESSIONAL SERVICES | $153,108 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $904,017 | GovernmentGrantsAmt |
| All Other Contributions | $8,577 | AllOtherContributionsAmt |
| Total Contributions | $912,594 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICES | 621300 | $13,218,296 | $13,218,296 |
| OTHER REVENUE | 621300 | $44,138 | $44,138 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $13,262,434 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,880 | TotalRevenueColumnAmt |
| Exclusion | $5,880 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,800 | 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 | $18,800 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,800 | TotalRevenueColumnAmt |
| Exclusion | $18,800 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 722100 | BusinessCd |
| Total Revenue Column | $49,859 | TotalRevenueColumnAmt |
| Exclusion | $49,859 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $49,859 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,249,567 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $13,262,434 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $74,539 | 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 | $474,064 | TotalAmt |
| Program Services | $118,516 | ProgramServicesAmt |
| Management And General | $355,548 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,039,125 | TotalAmt |
| Program Services | $5,875,963 | ProgramServicesAmt |
| Management And General | $1,163,162 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $79,859 | TotalAmt |
| Program Services | $19,965 | ProgramServicesAmt |
| Management And General | $59,894 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $842,426 | TotalAmt |
| Program Services | $682,681 | ProgramServicesAmt |
| Management And General | $159,745 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $536,630 | TotalAmt |
| Program Services | $437,401 | ProgramServicesAmt |
| Management And General | $99,229 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,949 | TotalAmt |
| Program Services | $5,737 | ProgramServicesAmt |
| Management And General | $17,212 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,432,120 | TotalAmt |
| Program Services | $3,041,790 | ProgramServicesAmt |
| Management And General | $390,330 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $34,717 | TotalAmt |
| Program Services | $8,679 | ProgramServicesAmt |
| Management And General | $26,038 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $41,515 | TotalAmt |
| Program Services | $24,856 | ProgramServicesAmt |
| Management And General | $16,659 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $441,639 | TotalAmt |
| Program Services | $320,622 | ProgramServicesAmt |
| Management And General | $121,017 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,810 | TotalAmt |
| Program Services | $88,986 | ProgramServicesAmt |
| Management And General | $31,824 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,892 | TotalAmt |
| Program Services | $27,880 | ProgramServicesAmt |
| Management And General | $15,012 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $285,418 | TotalAmt |
| Program Services | $185,522 | ProgramServicesAmt |
| Management And General | $99,896 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $162,153 | TotalAmt |
| Program Services | $40,538 | ProgramServicesAmt |
| Management And General | $121,615 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,802,842 | $1,647,680 | $155,162 |
| OTHER EXPENSES | $306,379 | $98,631 | $207,748 |
| PROFESSIONAL DEVELOPMEN | $146,354 | $90,410 | $55,944 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,811,892 | TotalAmt |
| Program Services | $12,715,857 | ProgramServicesAmt |
| Management And General | $3,096,035 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $56,244 | BOYAmt |
| EOY | $44,104 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $755,436 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,921,490 | BOYAmt |
| EOY | $2,433,362 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $397,398 | BOYAmt |
| EOY | $267,459 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $72,526 | BOYAmt |
| EOY | $111,484 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,048,748 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,657,415 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,466,585 | BOYAmt |
| EOY | $2,391,333 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,669,679 | BOYAmt |
| EOY | $5,247,742 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,210,053 | BOYAmt |
| EOY | $1,564,932 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $937,416 | BOYAmt |
| EOY | $722,925 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,147,469 | BOYAmt |
| EOY | $2,287,857 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,522,210 | BOYAmt |
| EOY | $2,959,885 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,522,210 | BOYAmt |
| EOY | $2,959,885 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,669,679 | BOYAmt |
| EOY | $5,247,742 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,562,325 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | 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 | $8,000 | OtherCostOrOtherBasisAmt |
| Book Value | $8,000 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,431,207 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,629,053 | DepreciationAmt |
| Book Value | $1,802,154 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,588,074 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,028,362 | DepreciationAmt |
| Book Value | $559,712 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,467 | OtherCostOrOtherBasisAmt |
| Book Value | $21,467 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,391,333 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $14,249,567 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,249,567 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $14,249,567 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,811,892 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,811,892 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,811,892 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | FINANCIAL STATEMENT FIN 48 (ASC 740) FOOTNOTE: THE HOSPITAL HAS BEEN RECOGNIZED AS A TAX-EXEMPT ORGANIZATION FOR FEDERAL INCOME TAX PURPOSES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS ONLY SUBJECT TO INCOME TAXES ON UNRELATED BUSINESS TAXABLE INCOME (UBTI). ACCORDINGLY, NO PROVISION OR LIABILITY FOR INCOME TAXES IS MADE IN THE FINANCIAL STATEMENTS. MANAGEMENT IS NOT AWARE OF ANY MATTERS THAT WOULD CAUSE THE HOSPITAL TO LOSE ITS TAX-EXEMPT STATUS. MANAGEMENT HAS PERFORMED ITS EVALUATION OF TAX POSITIONS TAKEN ON ALL OPEN TAX RETURNS AND HAS DETERMINED THAT THERE WERE NO POSITIONS TAKEN THAT DO NOT MEET THE "MORE LIKELY THAN NOT" STANDARD. ACCORDINGLY, THERE ARE NO PROVISIONS FOR INCOME TAXES, PENALTIES OR INTEREST RECEIVABLE OR PAYABLE RELATING TO UNCERTAIN INCOME TAX PROVISION IN THE ACCOMPANYING FINANCIAL STATEMENTS. FROM TIME TO TIME, THE HOSPITAL MAY BE SUBJECT TO PENALTIES AND INTEREST ASSESSED BY VARIOUS TAXING AUTHORITIES, WHICH WILL BE CLASSIFIED AS GENERAL AND ADMINISTRATIVE EXPENSES, IF THEY OCCUR. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $177,857 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $177,857 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01120 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,138,383 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,259,147 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $879,236 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05560 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,316,240 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,259,147 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,057,093 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06680 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $11,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $11,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,327,990 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,259,147 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,068,843 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06750 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,555,362 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,654,399 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,139,264 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,484,865 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | BENSON HOSPITAL CORPORATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 450 S OCOTILLO STREET | AddressLine1Txt |
| City | BENSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85602 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BENSON 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 | 15 | 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 | WWW.BENSONHOSPITAL.ORG | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.BENSONHOSPITAL.ORG | 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 | 150.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| 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 | WWW.BENSONHOSPITAL.ORG | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.BENSONHOSPITAL.ORG | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.BENSONHOSPITAL.ORG | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BENSON HOSPITAL | PART V, SECTION B, LINE 5: BENSON HOSPITAL HAD INPUT FROM 5 HEALTH CARE PROFESSIONALS, INCLUDING HOSPITAL STAFF. THE FOLLOWING PROFESSIONALS PROVIDED INPUT: PRESIDENT OF BENSON HOSPITAL GOVERNING BOARD, HOSPITALIST, CHIEF NURSING OFFICER, EMERGENCY ROOM SUPERVISOR, AND NURSING STAFF. |
| BENSON HOSPITAL | PART V, SECTION B, LINE 11: SIGNIFICANT HEALTH NEEDS ARE IDENTIFIED IN THE ASSESSMENT AND ARTICULATED TO THE STRATEGIC PLAN, WITH IMPLEMENTATION STRATEGIES IDENTIFIED AND ASSIGNED TO KEY HOSPITAL PERSONNEL. |
| BENSON HOSPITAL | PART V, SECTION B, LINE 16J: POSTED SIGNS AT FOOD BANK, LIBRARY, POLICE/FIRE STATIONS. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE HOSPITAL USES 150% OF FEDERAL POVERTY GUIDELINES (FPG) FOR FEE CARE. THIS IS THE ONLY TEST USED TO DETERMINE FREE CARE. SELF-PAY PATIENTS HAVE THEIR BILLS DISCOUNTED TO 45% OF THE FEE SCHEDULE WITH AN ADDITIONAL 5% DEDUCTION FOR IMMEDIATE PAYMENT. |
| PART I, LINE 7: | THE FINANCIAL ASSISTANCE IS BASED ON THE CHARITY CARE PROVIDED AT THE COST TO CHARGE RATIO CALCULATED IN WORKSHEET 2. THE GROSS PATIENT CHARGES ARE BASED ON COST REPORT DATA FOR THE CURRENT PERIOD. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | WE PARTICIPATE IN COMMUNITY EVENTS INCLUDING FREE BLOOD PRESSURE SCREENINGS, PARTICIPATION IN THE RELAY FOR LIFE, ONSITE HEALTH FAIRS, AND INVOLVEMENT IN THE RESPIRATORY SUPPORT GROUP. IN ADDITION, THERE ARE REGULAR BLOOD DRIVES HELD ONSITE AS WELL AS DIETARY COUNSELING. |
| PART III, LINE 2: | THE BAD DEBT EXPENSE IS BASED ON HISTORICAL BAD DEBT WRITE OFFS BY FINANCIAL PAY CLASS, I.E., COMMERCIAL INSURANCE, GOVERNMENT PAYERS - MEDICARE AND MEDICAID AND SELF-PAY. THE PAST PERFORMANCE IS USED TO ESTIMATE THE MONTHLY REVENUE AND OUTSTANDING RECEIVABLE BALANCE. THE ESTIMATE IS UPDATED MONTHLY TO REFLECT ACTUAL ACTIVITY TO DATE. ANY DISCOUNTS TO PATIENT BILLS ARE INCLUDED IN THE BAD DEBT EXPENSE SINCE THEY ARE BILLED NET OF ANY CONTRACTUAL ADJUSTMENTS OR SELF-PAY DISCOUNTS. ANY PAYMENTS ON ACCOUNTS ARE APPLIED TO THE ACCOUNTS. IF A PAYMENT IS RECEIVED AFTER AN ACCOUNT HAS BEEN WRITTEN OFF TO BAD DEBT, THE BAD DEBT ACCOUNT WILL BE REDUCED BY THE PAYMENT. |
| PART III, LINE 3: | THE AMOUNT RELATED TO BAD DEBT CANNOT BE QUANTIFIED. THE FINANCIAL ASSISTANCE BENEFIT IS BASED ON THE FEE SCHEDULE RATES DISCOUNTED TO EXPECTED NET REVENUE FOR ALL FINANCIAL CLASSIFICATIONS SO IT COMBINES THE BAD DEBT AND CONTRACTUAL ADJUSTMENTS. |
| PART III, LINE 4: | THE HOSPITAL GRANTS UNSECURED CREDIT TO ITS PATIENTS AND INSURANCE COMPANIES WITHOUT INTEREST. GENERALLY, ACCOUNTS RECEIVABLE ARE CONSIDERED TO BE PAST DUE AFTER 60 DAYS. PATIENT ACCOUNTS RECEIVABLE ALSO INCLUDE AN ESTIMATE FOR CHARGES WITH DATES OF SERVICE PRIOR TO YEAR END THAT WERE SUBSEQUENT TO THAT DATE (UNBILLED ACCOUNTS RECEIVABLE). THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS EQUAL TO THE ESTIMATED COLLECTION LOSSES THAT WILL BE INCURRED. THE ESTIMATED LOSSES ARE BASED ON HISTORICAL COLLECTION EXPERIENCE COUPLED WITH REVIEW OF THE CURRENT STATUS OF EXISTING RECEIVABLES. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. DOUBTFUL ACCOUNTS ARE PERIODICALLY REVIEWED FOR COLLECTABILITY AND ARE CHARGED OFF TO THE ALLOWANCE WHEN MANAGEMENT DETERMINES THAT ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED. |
| PART III, LINE 8: | THE ALLOWABLE COSTS ARE BASED ON THE MEDICARE COST REPORT, SCHEDULE D1 -LINE 49 WHICH IS BASED ON THE NUMBER OF PATIENT DAYS TIMES THE COST PER DIEM. |
| PART III, LINE 9B: | EVERY PATIENT IS INFORMED ABOUT THE FINANCIAL ASSISTANCE PROGRAM PRIOR TO BILLING AND THIS IS OFTEN REVIEWED WHEN COLLECTION CALLS ARE MADE. |
| PART VI, LINE 2: | THE BENSON HOSPITAL HAS AN OPEN DOOR POLICY TO HEAR THE NEEDS AND CONCERNS OF PATIENTS. WE LISTEN TO WHAT OUR COMMUNITY PHYSICIANS SAY ABOUT SERVING THE NEEDS OF THE COMMUNITY. THE HOSPITAL ADMINISTRATION ALSO SURVEYS OTHER SMALL HOSPITALS TO COMPARE SERVICES. THE HOSPITAL SPONSORED A RETREAT TO DISCUSS HEALTHCARE CONCERNS AND INVITED LOCAL PHYSICIANS AS WELL AS COMMUNITY LEADERS TO DEVELOP COMMUNITY HEALTH GOALS AND NEEDS. A COMMUNITY WELLNESS COMMITTEE WAS CREATED BY THE HOSPITAL TO ADDRESS THE CONCERNS. |
| PART VI, LINE 3: | THE BENSON HOSPITAL HAS A STAFF MEMBER WHO IS DEDICATED TO THE EDUCATION OF PATIENTS WHO MAY NEED ASSISTANCE. THAT STAFF MEMBER IS AVAILABLE TO ENROLL PATIENTS IN ALL OF THE APPLICABLE STATE ASSISTANCE PROGRAMS. |
| PART VI, LINE 4: | BENSON HOSPITAL DEFINES THEIR SERVICE AREA AS THE ENTIRE SAN PEDRO VALLEY HOSPITAL DISTRICT (SPVHD), AND AREAS WITHIN A 25 MILE RADIUS OF THE HOSPITAL THAT EXTEND INTO PIMA AND PINAL COUNTIES. THE SPVHD IS A GEOGRAPHICAL AREA OF APPROXIMATELY 1,100 SQUARE MILES IN THE NORTHWEST CORNER OF COCHISE COUNTY. IT CONTAINS THE COMMUNITIES OF BENSON, ST. DAVID, POMERENE AND DRAGOON. TWO MAIN AREAS FALL WITHIN THE 25 MILE RADIUS, BUT OUTSIDE THE BOUNDARIES OF THE DISTRICT. THE J-6/MESCAL AREA EXTENDS INTO PIMA COUNTY. IT IS VISUALIZED AS AN AREA ALONG I-10 GOING WEST SOME 20 MILES FROM THE COCHISE COUNTY LINE. ANOTHER AREA EXTENDS NORTH OF CASCABEL ALONG THE SAN PEDRO RIVER INTO PIMA COUNTY, THEN INTO PINAL COUNTY. COLLECTIVELY, THE SPVHD AND THE J-6/MESCAL AND CASCABEL EXTENSIONS COMPRISE THE BENSON HOSPITAL SERVICE AREA. THIS REGION WAS FOUNDED AS A MINING AND TRANSPORTATION CENTER IN THE LATE 1800'S. IT IS HIGH DESERT, WITH MOUNTAINS, GRASSLANDS AND NATIVE SUCCULENTS PREDOMINATING. SPREAD OVER THE ENTIRE DISTRICT THE POPULATION DENSITY IS ABOUT 17 PERSONS/SQUARE MILE. THE CITY OF BENSON HAS A POPULATION DENSITY OF ABOUT 135 PERSONS/SQUARE MILE. THIS IS A RURAL SETTING. THE SPVHD AREA HAS BEEN ESTIMATED BY THE BENSON HOSPITAL STRATEGIC PLANNING COMMITTEE TO CONTAIN APPROXIMATELY 16,500 PEOPLE. THE J-6 AND CASCABEL EXTENSIONS ARE ESTIMATED TO ADD 1,500 PEOPLE FOR A TOTAL OF 18,000. ALTHOUGH THE U.S. CENSUS GIVES A POPULATION OF 12,500 FOR THIS AREA, THE COMMITTEE'S ESTIMATE INCLUDES WINTER VISITORS WHO ARE NOT COUNTED BY CENSUS METHODS. THE RACIAL MAKEUP IS COMPRISED OF 91% WHITE, 1% AMERICAN INDIAN, 1% BLACK, 1% ASIAN/PACIFIC ISLANDER, 6% OTHER. THE U.S. CENSUS BUREAU CONSIDERS HISPANIC AN ETHNICITY, NOT A RACE, FOR THIS REASON THERE IS NO SEPARATE RACIAL CLASSIFICATION FOR HISPANICS. IF THERE WERE, THE HISPANIC PORTION OF THE AREA WOULD BE AROUND 30%. THE SPVHD POPULATION IS EXPECTED TO GROW APPROXIMATELY 2%/YEAR INTO THE INDEFINITE FUTURE.THE SPVHD AGE DISTRIBUTION IS 21.4% UNDER 20 YEARS OF AGE, 21.4% BETWEEN 20 AND 44, 30.1% BETWEEN 45 AND 64, AND 27.1% OVER 65. ALMOST ONE THIRD OF THE POPULATION IS MEDICARE AGE. THIS HAS IMPLICATIONS FOR HEALTH CARE PLANNING. THE MEDIAN AGE OF THE AREA IS APPROXIMATELY 50. THIS IS RATHER HIGHER THAN COCHISE COUNTY (37), AND THE STATE (34). MALES AND FEMALES ARE APPROXIMATELY 50/50%.THE SPVHD MEDIAN HOUSEHOLD INCOME IS $38,290. THIS IS CONSIDERABLY LOWER THAN THAT FOR THE COUNTY ($44,000), THE STATE ($53,000), AND THE NATION ($55,000). UNEMPLOYMENT IN THE AREA IS HIGHER THAN IN OTHER LOCALITIES. RECENT ESTIMATES SHOW UNEMPLOYMENT HOVERING AROUND 13%. |
| PART VI, LINE 5: | BENSON HOSPITAL FURTHERS ITS EXEMPT PURPOSE IN SEVERAL WAYS. BENSON HOSPITAL IS GOVERNED BY A VOLUNTEER BOARD MADE UP OF MEMBERS FROM THE COMMUNITY. THE HOSPITAL HAS AN OPEN MEDICAL STAFF AND PROMOTES THE HEALTH OF THE COMMUNITY THROUGH EVENTS LIKE HOSTING A HEALTH FAIR, INVOLVEMENT AND SPONSORSHIP IN LOCAL COMMUNITY EVENTS TO PROMOTE HEALTHCARE. THE HOSPITAL PROVIDES A RESPIRATORY SUPPORT GROUP, FREE BLOOD PRESSURE SCREENINGS, AND DIETARY CONSULTATION. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | AZ |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 (5 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BARBARA HARTLEY | ||||||||||||||
| MEMBER | $196,843 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $196,843 | $0 | $0 | $0 |
| RICHARD POHLEBER | ||||||||||||||
| CEO | $244,674 | $0 | $1,356 | $0 | $0 | $0 | $4,886 | $0 | $365 | $0 | $251,281 | $0 | $0 | $0 |
| KENNETH GORANSON | ||||||||||||||
| CFO | $177,115 | $0 | $531 | $0 | $0 | $0 | $4,026 | $0 | $9,897 | $0 | $191,569 | $0 | $0 | $0 |
| TERESA VINCIFORA | ||||||||||||||
| CCO | $159,377 | $0 | $0 | $0 | $0 | $0 | $3,036 | $0 | $450 | $0 | $162,863 | $0 | $0 | $0 |
| JAMES RICHEY | ||||||||||||||
| PHARMACIST | $156,143 | $0 | $0 | $0 | $0 | $0 | $3,434 | $0 | $9,766 | $0 | $169,343 | $0 | $0 | $0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 IS PREPARED BY AN INDEPENDENT CPA AND A DRAFT IS PROVIDED TO THE CFO FOR REVIEW. UPON THE CFO'S APPROVAL, A COPY IS PROVIDED TO THE ENTIRE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY. THE POLICY COVERS THE DIRECTORS, OFFICERS, COMMITTEE MEMBERS OR A PERSON RELATED TO SUCH A PERSON. A CONFLICT IS DEFINED AS A SITUATION WHERE AN INTERESTED PERSON HAS A BENEFICIAL INTEREST OR OTHER LINK TO A TRANSACTION THAT WOULD REASONABLY BE EXPECTED TO EXERT INFLUENCE ON THAT PERSON'S JUDGEMENT. CONFLICTING INTEREST TRANSACTIONS ALSO INCLUDE TRANSACTIONS INVOLVING ENTITIES WITH WHICH AN INTERESTED PERSON IS AFFILIATED, PERSONS WHO CONTROL ENTITIES WITH WHICH AN INTERESTED PERSON IS AFFILIATED AND PERSONS WHO ARE GENERAL PARTNERS, PRINCIPALS, OR EMPLOYERS OF AN INTERESTED PERSON. INTERESTED PERSONS MUST DISCLOSE CONFLICTING INTERESTS TO THE BOARD WHEN AND WHERE APPROPRIATE AND CANNOT PLAY A DIRECT OR INDIRECT ROLE IN DELIBERATIONS OF VOTE ON THE RELATED MATTER. DIRECTORS OR COMMITTEE MEMBERS WHO DO NOT HAVE A CONFLICTING INTEREST WITH THE TRANSACTION VOTE TO APPROVE THE RELATED TRANSACTIONS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE ORGANIZATION'S BYLAWS REQUIRE THAT, IN DETERMINING COMPENSATION FOR ANY OFFICER, DIRECTOR, COMMITTEE MEMBER, OR KEY EMPLOYEE OF THE CORPORATION: A. THE INDIVIDUALS ON THE BOARD THAT APPROVE COMPENSATION ARRANGEMENTS SHALL FOLLOW THE CONFLICTING INTEREST PROVISIONS OF THESE BYLAWS AND THE CORPORATION'S CONFLICT OF INTEREST POLICIES IN EFFECT AT THE TIME OF THE DETERMINATION. B. ANY COMPENSATION ARRANGEMENT MUST BE APPROVED BY THE BOARD IN ADVANCE OF PAYING COMPENSATION. C. THE BOARD SHALL DOCUMENT IN WRITING THE DATE AND TERMS OF EACH APPROVED COMPENSATION ARRANGEMENT. D. THE BOARD SHALL RECORD IN WRITING THE DECISION MADE BY EACH INDIVIDUAL WHO DECIDED OR VOTED ON EACH COMPENSATION ARRANGEMENT. E. THE BOARD WILL APPROVE COMPENSATION ARRANGEMENTS BASED ON INFORMATION ON COMPENSATION PAID BY SIMILARLY-SITUATED TAXABLE OR TAX-EXEMPT ORGANIZATIONS, CURRENT COMPENSATION SURVEYS COMPILED BY INDEPENDENT FIRMS, OR ACTUAL WRITTEN OFFERS FROM SIMILARLY-SITUATED ORGANIZATIONS; AND F. THE BOARD WILL RECORD IN WRITING BOTH THE INFORMATION ON WHICH THE BOARD RELIED TO BASE THE COMPENSATION DECISION AS WELL AS ITS SOURCE. THE LAST REVIEW WAS PERFORMED IN NOVEMBER 2015. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 334,182. MANAGEMENT AND GENERAL EXPENSES 390,330. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 724,512. MEDICAL PROFESSIONALS: PROGRAM SERVICE EXPENSES 2,707,608. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,707,608. |
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