COMMUNITY HOSPITAL ASSOCIATION INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION INC (EIN 86-0096775)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-05
- IRS object ID
- 201833099349302123
- Schema version
- 2017v2.3
- 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 | 2018-11-05T14:57:31-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 South Tejon Suite 800 | AddressLine1Txt |
| City | Colorado Springs | CityNm |
| State Abbreviation | CO | StateAbbreviationCd |
| ZIP | 809039848 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860096775 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % THE ORGANIZATION | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 9286845421 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1Txt |
| City | WICKENBURG | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JACKIE LUNDBLAD | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9286845421 | PhoneNum |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Adam R Smith CPA | PreparerPersonNm |
| PTIN | P00958966 | PTIN |
| Phone | 7194714290 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.126.162 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 84022720183095000001 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-11-05 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | ED42049D66F1046E576A4D4BB44938B540F74564 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 19466AA61A357D31F4873695DF4DFE6460C1305A | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JIM TAVARY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1Txt |
| City | WICKENBURG | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,323,220 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WICKHOSP.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY HEALTH AND WELLNESS SERVICES WHERE THE PATIENT, FAMILY AND COMMUNITY COME FIRST. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 12 | VotingMembersIndependentCnt |
| Total Employee | 301 | TotalEmployeeCnt |
| Total Volunteers | 50 | TotalVolunteersCnt |
| Total Gross UBI | $71,479 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,253,280 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,679 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $29,457,892 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $35,584,544 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$3,028 | PYInvestmentIncomeAmt |
| CY Investment Income | $6,784 | CYInvestmentIncomeAmt |
| PY Other Revenue | $123,714 | PYOtherRevenueAmt |
| CY Other Revenue | $725,213 | CYOtherRevenueAmt |
| PY Total Revenue | $31,831,858 | PYTotalRevenueAmt |
| CY Total Revenue | $36,323,220 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $1,000,000 | 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 | $14,518,782 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $17,155,647 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $18,671,936 | PYOtherExpensesAmt |
| CY Other Expenses | $20,655,521 | CYOtherExpensesAmt |
| PY Total Expenses | $34,190,718 | PYTotalExpensesAmt |
| CY Total Expenses | $37,811,168 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$2,358,860 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,487,948 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $32,931,769 | TotalAssetsBOYAmt |
| Total Assets EOY | $33,544,320 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $20,798,855 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $22,787,142 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $12,132,914 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,757,178 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE QUALITY HEALTH AND WELLNESS SERVICES WHERE THE PATIENT, FAMILY, AND COMMUNITY COME FIRST. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $32,962,538 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $35,983,089 | RevenueAmt |
| Desc | PROVIDE INPATIENT AND OUTPATIENT DIAGNOSTIC AND THERAPEUTIC HEALTH CARE SERVICES TO THE RESIDENTS AND VISITORS OF GREATER WICKENBURG, ARIZONA, A RURAL COMMUNITY OF APPROXIMATELY 23,000. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $390,265 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $220,558 | RevenueAmt |
| Desc | Provide Fitness Center for residents and visitors of greater Wickenburg, Arizona, promoting a wellness environment for the community. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $33,352,803 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 75 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 301 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 12 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 9286845421 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1Txt |
| City | WICKENBURG | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| BETSY DEIBEL | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| BOB JOHNSON | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| BRIAN WARNOCK | |||||||||
| DIRECTOR/TREASURER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| DEE POLLOCK | |||||||||
| DIRECTOR/CHAIRMAN OF THE BOARD | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GARY TURNER | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| JOHN COOK | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| KEVIN CLOE | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| LEONARD KIRSCHNER | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| JEANNE MORRIS | |||||||||
| DIRECTOR/SECRETARY | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| HUNT SPEAR | |||||||||
| DIRECTOR/CHAIRMAN FDN BOARD | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| RICH NEWMAN | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD ABBUHL | |||||||||
| Vice Chairman | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| TROY JONES DMD | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| JAMES TAVARY | |||||||||
| CHIEF EXECUTIVE OFFICER | 39.0 | 1.0 | $194,854 | $0 | $27,514 | Yes (X) | |||
| MICHAEL ELLIS | |||||||||
| CFO (UNTIL 03/2017) | 39.0 | 1.0 | $43,805 | $0 | $2,134 | Yes (X) | |||
| JACQUELINE LUNDBLAD | |||||||||
| CFO (STARTING 03/2017) | 39.0 | 1.0 | $115,392 | $0 | $5,611 | Yes (X) | |||
| TODD KRAVETZ | |||||||||
| CHIEF OF STAFF | 40.0 | 0.0 | $220,002 | $0 | $27,421 | Yes (X) | |||
| ROGER ROSE | |||||||||
| DIRECTOR OF PHARMACY SERVICES | 40.0 | 0.0 | $180,003 | $0 | $10,598 | Yes (X) | |||
| MITCHELL WAGNER | |||||||||
| SURGEON | 40.0 | 0.0 | $499,990 | $0 | $4,779 | Yes (X) | |||
| ROBERT RIPLEY | |||||||||
| SURGEON | 40.0 | 0.0 | $350,002 | $0 | $15,810 | Yes (X) | |||
| JEREMY BRAMWELL | |||||||||
| PHYSICIAN | 40.0 | 0.0 | $175,011 | $0 | $26,468 | Yes (X) | |||
| SUZANNE YOUNG | |||||||||
| PHARMACIST | 40.0 | 0.0 | $160,014 | $0 | $9,284 | Yes (X) | |||
| LISA ERLINGER | |||||||||
| ANESTHESIOLOGIST | 40.0 | 0.0 | $240,011 | $0 | $17,037 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,179,084 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $146,656 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 17 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MEDICAL DIAGNOSTICS | |||||
| 7032 COLLECTION CENTER DR | CHICAGO | IL | 60693 | IMAGING | $601,511 |
| ALLIANCE IMAGING | |||||
| File 55826 | LOS ANGELES | CA | 90074 | IMAGING SERVICES | $517,620 |
| THE CLARO GROUP NORDIC | |||||
| 34522 N SCOTTSDALE ROAD | SCOTTSDALE | AZ | 85262 | CONSULTING | $410,475 |
| AMN HEALTHCARE | |||||
| PO BOX 130 | MORRISTOWN | AZ | 85342 | MEDICAL SERVICES | $363,074 |
| YARNELL MEDICAL INC | |||||
| 111 S TEJON ST SUITE 800 | COLORADO SPRINGS | CO | 80903 | MEDICAL SERVICES | $135,218 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $6,679 | AllOtherContributionsAmt |
| Total Contributions | $6,679 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | Unrelated Business RevenueUnrelatedBusinessRevenueAmt |
|---|---|---|---|---|
| Medicare | 621990 | $14,212,651 | $14,212,651 | |
| Patient Services | 621990 | $18,034,624 | $17,963,145 | $71,479 |
| 340B Drug Pricing Program Revenue | 621990 | $1,777,941 | $1,777,941 | |
| Patient Pharmacy Revenue | 621990 | $1,259,220 | $1,259,220 | |
| Wellness Center | 621990 | $220,558 | $220,558 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $79,550 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $79,550 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $35,584,544 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,784 | TotalRevenueColumnAmt |
| Exclusion | $4,784 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,000 | TotalRevenueColumnAmt |
| Exclusion | $2,000 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| HPSA REVENUE | 900099 | $114,232 | $114,232 | |
| VENDING/CATERING REVENUE | 900099 | $31,907 | $31,907 | |
| LABORATORY FEES | 900099 | $17,222 | $17,222 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $561,852 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $559,128 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $2,724 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $725,213 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,323,220 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $36,203,647 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $71,479 | UnrelatedBusinessRevenueAmt |
| Exclusion | $41,415 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $827,332 | TotalAmt |
| Program Services | $648,434 | ProgramServicesAmt |
| Management And General | $178,898 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,804 | TotalAmt |
| Program Services | $45,804 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,487,701 | TotalAmt |
| Program Services | $12,729,427 | ProgramServicesAmt |
| Management And General | $758,274 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,324 | TotalAmt |
| Program Services | $17,324 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,851,502 | TotalAmt |
| Program Services | $1,625,315 | ProgramServicesAmt |
| Management And General | $226,187 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $925,984 | TotalAmt |
| Program Services | $833,207 | ProgramServicesAmt |
| Management And General | $92,777 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,023 | TotalAmt |
| Management And General | $64,023 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $130,496 | TotalAmt |
| Management And General | $130,496 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,228,112 | TotalAmt |
| Program Services | $5,460,672 | ProgramServicesAmt |
| Management And General | $767,440 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $293,170 | TotalAmt |
| Program Services | $233,203 | ProgramServicesAmt |
| Management And General | $59,967 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $264,993 | TotalAmt |
| Management And General | $264,993 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $344,492 | TotalAmt |
| Program Services | $320,617 | ProgramServicesAmt |
| Management And General | $23,875 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,396 | TotalAmt |
| Program Services | $48,903 | ProgramServicesAmt |
| Management And General | $14,493 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,174 | TotalAmt |
| Program Services | $81,629 | ProgramServicesAmt |
| Management And General | $1,545 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $544,663 | TotalAmt |
| Management And General | $544,663 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,861,084 | TotalAmt |
| Program Services | $976,767 | ProgramServicesAmt |
| Management And General | $884,317 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,940 | TotalAmt |
| Program Services | $100,381 | ProgramServicesAmt |
| Management And General | $301,559 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $6,205,874 | $6,205,874 | |
| PROVISION FOR BAD DEBTS | $3,171,314 | $3,171,314 | |
| REPAIRS & MAINTENANCE | $745,994 | $681,348 | $64,646 |
| DUES, FEES, & SUBS | $51,860 | $27,236 | $24,624 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $200,936 | TotalAmt |
| Program Services | $145,348 | ProgramServicesAmt |
| Management And General | $55,588 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,811,168 | TotalAmt |
| Program Services | $33,352,803 | ProgramServicesAmt |
| Management And General | $4,458,365 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,187,470 | BOYAmt |
| EOY | $3,108,803 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,716 | BOYAmt |
| EOY | $160,537 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,162,092 | BOYAmt |
| EOY | $6,782,461 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,198,595 | BOYAmt |
| EOY | $1,246,855 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $374,263 | BOYAmt |
| EOY | $448,580 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,671,430 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,606,118 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,548,544 | BOYAmt |
| EOY | $20,065,312 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,772 | BOYAmt |
| EOY | $8,022 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,428,317 | BOYAmt |
| EOY | $1,723,750 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,931,769 | BOYAmt |
| EOY | $33,544,320 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,435,921 | BOYAmt |
| EOY | $4,078,945 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,362,934 | BOYAmt |
| EOY | $18,708,197 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,798,855 | BOYAmt |
| EOY | $22,787,142 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,252,677 | BOYAmt |
| EOY | $9,566,403 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $880,237 | BOYAmt |
| EOY | $1,190,775 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,132,914 | BOYAmt |
| EOY | $10,757,178 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $32,931,769 | BOYAmt |
| EOY | $33,544,320 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$1,487,948 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $112,212 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | 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 (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,379,772 | OtherCostOrOtherBasisAmt |
| Book Value | $1,379,772 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $23,760,251 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,169,482 | DepreciationAmt |
| Book Value | $13,590,769 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,690 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,934 | DepreciationAmt |
| Book Value | $2,756 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,722,281 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,135,474 | DepreciationAmt |
| Book Value | $4,586,807 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $800,436 | OtherCostOrOtherBasisAmt |
| Depreciation | $295,228 | DepreciationAmt |
| Book Value | $505,208 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $20,065,312 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Interest in Net Assets of Fdn | Desc |
| Book Value | $1,723,750 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,723,750 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $33,264,118 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $112,212 | OtherRevenueAmt |
| Revenue Not Reported | $112,212 | RevenueNotReportedAmt |
| Revenue Subtotal | $33,151,906 | RevenueSubtotalAmt |
| Other Revenues Not Included | $3,171,314 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $3,171,314 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $36,323,220 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $34,639,854 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $34,639,854 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $3,171,314 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $3,171,314 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $37,811,168 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part X, Line 2 | UNCERTAIN TAX POSITIONS: MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | REVENUE ON BOOKS, NOT ON RETURN: Change in interest in net assets of wickenburg community hospital foundation 112,212 |
| SCHEDULE D, PART XI, LINE 4B | REVENUE ON RETURN, NOT ON BOOKS: Provision for uncollectible accounts reclassed to expense 3,171,314 |
| SCHEDULE D, PART XII, LINE 4B | EXPENSE ON RETURN, NOT ON BOOKS: Provision for uncollectible accounts reclassed to expense 3,171,314 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $194,867 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $194,867 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,639,719 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,292,107 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $347,612 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,834,586 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,292,107 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $542,479 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01560 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $390,265 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $220,558 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $169,707 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $390,265 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $220,558 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $169,707 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00490 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,224,851 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,512,665 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $712,186 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,171,314 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $792,829 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $13,631,106 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,620,445 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,010,661 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WICKENBURG COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1Txt |
| City | WICKENBURG | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.WICKHOSP.COM | WebsiteAddressTxt |
| State License | RGH3505 | StateLicenseNum |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WICKENBURG COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C FOR DIRECT URL | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C, FOR DIRECT URL | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 380. | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | 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 (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | See Part V, Section C for URL | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | See Part V, Section C for URL | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | PART V, SECTION C FOR URL | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | DESCRIBE HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY: THE DEVELOPMENT OF THE CHNA SURVEY PROCESS BEGAN WITH THE FORMATION OF THE 2016 PROJECT TEAM. A DECISION WAS MADE TO USE THE SURVEY FORMAT SUCCESSFULLY IMPLEMENTED BY THE 2013 PROJECT TEAM AND PARTNERS. THE SURVEY WAS NOT ALTERED IN ANY FASHION AS IT WAS CERTAIN AMONGST THE TEAM THAT CONTRIBUTIONS PROVIDED BY THOSE IN 2013 REMAINED INVALUABLE AND DIVERSE INTO THE ISSUES MOST LIKELY TO BE RELEVANT TO OUR POPULATION. IT WAS ALSO DESIRED AMONGST THE 2016 PROJECT TEAM TO EVALUATE 2016 DATA ALONGSIDE 2013 DATA IN ORDER TO FACILITATE A COMPREHENSIVE PRIORITIZATION OF NEEDS AND STRATEGIES TO ADDRESS THEM. THE SURVEY WAS DELIVERED BOTH IN ENGLISH AND IN SPANISH, ELECTRONICALLY AND BY PAPER TO MEET THE NEEDS OF THE MAJORITY OF RESIDENTS IN THE REGIONAL SERVICE AREA. DISTRIBUTION OF THE SURVEY WAS ACCOMPLISHED THROUGH COMMUNITY PARTNERSHIPS WITH THE TOWN OF WICKENBURG, WICKENBURG CHAMBER OF COMMERCE, WICKENBURG UNIFIED SCHOOL DISTRICT, WICKENBURG RANCH, AND THE WICKENBURG HEALTH CARE COALITION; A NONPROFIT, NONPARTISAN, COMMUNITY COLLABORATION ORGANIZED TO SUPPORT A HEALTHY, ACTIVE LIFESTYLE IN THE TOWN OF WICKENBURG AND SURROUNDING AREAS, AND BY NOTIFICATION IN THE TOWN NEWSPAPER. WICKENBURG COMMUNITY HOSPITAL AND EACH COMMUNITY PARTNER DISTRIBUTED THE SURVEY ELECTRONICALLY AND/OR BY PAPER TO THEIR CLIENTS, EMPLOYEES, FAMILIES, AND OTHER COMMUNITY MEMBERS THROUGHOUT THE REGION. ALSO PUBLISHED DISPLAY ADS IN THE TOWN NEWSPAPER ENCOURAGED REGIONAL RESIDENTS TO TAKE THE ANONYMOUS SURVEY ONLINE THROUGH SURVEY MONKEY OR BY PAPER WHICH WAS DISTRIBUTED AND COLLECTED THROUGHOUT THE REGION AT VARIOUS LOCATIONS. |
| SCHEDULE H, PART V, SECTION B, LINE 7A | DIRECT URL FOR CHNA REPORT: THE CHNA CAN BE FOUND THROUGH A HYPERLINK AT THE BOTTOM RIGHT ON THE HOME PAGE OF THE ORGANIZATION'S WEBSITE AT HTTP://WICKHOSP.COM/. |
| SCHEDULE H, PART V, SECTION B, LINE 10A | DIRECT URL FOR IMPLEMENTATION PLAN: THE IMPLEMENTATION PLAN CAN BE FOUND DIRECTLY IN THE CHNA, LOCATED AT THE VERY END OF THE DOCUMENT. The CHNA can be found through a hyperlink at the bottom right of the home page of the organization's website at http://wickhosp.com/. |
| SCHEDULE H, PART V, SECTION B, LINE 11 | DESCRIBE HOW THE HOSPITAL IS ADDRESSING THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA AND ANY NEEDS NOT BEING ADDRESSED: THE MOST RECENTLY CONDUCTED CHNA'S IDENTIFIED NEEDS ARE BEING ADDRESSED IN THE FOLLOWING WAYS: THE AVAILABILITY OF LOCAL HEALTHCARE SERVICES IS BEING INCREASED. AFTER YEARS OF STRATEGIC PLANNING AND EFFORT, CHA (COMMUNITY HOSPITAL ASSOCIATION, INC.) OPENED A NEW MOB (MEDICAL OFFICE BUILDING) AND A NEW SURGERY WING IN AUGUST OF 2016. THE MOB EXPANSION MAKES AVAILABLE SIGNIFICANT IMPROVED SPACE FOR BOTH CHA'S EMPLOYED PRIMARY CARE PHYSICIANS AND THE VISITING PHYSICIAN SPECIALISTS. THE SURGERY WING WITH ITS STATE-OF-THE-ART EQUIPMENT ADDS A SERVICE THAT HAS NOT BEEN AVAILABLE LOCALLY FOR OVER 15 YEARS. INCLUDED ARE A VARIETY OF SURGICAL AND DIAGNOSTIC SERVICES RANGING FROM GENERAL, ORTHOPEDIC AND PODIATRIC SURGERY TO ENDOSCOPY AND PAIN MANAGEMENT SERVICES. THE PLANNING AND OPENING OF A NEW CLINIC IN WITTMAN HAS OPENED MORE HEALTHCARE SERVICES TO A UNDER SERVICED AREA. THE MOB AND OTHER EFFORTS HAVE MADE IT POSSIBLE TO ATTRACT A DERMATOLOGY PHYSICIAN GROUP (VISITING PHYSICIAN SPECIALISTS), AN OPHTHALMOLOGIST, AND AN ACUPUNCTURE PROGRAM TO THE COMMUNITY FOR EXPANDED TIMES/SERVICES. THE MOB HAS BEEN EXPANDING SERVICES FOR WOMEN HEALTH SERVICES AND HAS CONTRACTED WITH A OBGYN. CHA MAKES A CONCERTED EFFORT TO HAVE A COMMUNITY AWARENESS OF HEALTH ISSUES. SPECIFIC RESOURCES ARE DEVOTED SUCH AS HAVING A COMMUNITY AWARENESS MANAGER, PLACING HEALTH EDUCATION ARTICLES IN THE LOCAL NEWSPAPER, CONDUCTING EDUCATIONAL MEETINGS/SEMINARS, PARTICIPATING IN HEALTH FAIRS, PROVIDING A FREE SCHOOL-SPORTS PHYSICALS DAY, ETC. |
| SCHEDULE H, PART V, SECTION B, LINE 16A | DIRECT URL FOR THE FINANCIAL ASSISTANCE POLICY APPLICATION: https://www.wickhosp.com/wp-content/uploads/2018/09/Financial-Assistance-A pplication-Letter-App.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16B & 16C | DIRECT URL FOR THE FINANCIAL ASSISTANCE POLICY, AND A PLAIN LANGUAGE SUMMARY: https://www.wickhosp.com/patient-information/financial-services/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Community Hospital Clinic - WICKENBURG | ||||
| 519 Rose Lane | Wickenburg | AZ | 85390 | PRIMARY CARE CLINIC RURAL HEALTH CLINIC |
| Community Hospital Clinic - Congress | ||||
| 26750 S Santa Fe Road Suite B | Congress | AZ | 85332 | PRIMARY CARE CLINIC RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7, COLUMN F | BAD DEBT EXPENSE: TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = $3,171,314 |
| SCHEDULE H, PART I, LINE 7 | CALCULATION OF COMMUNITY BENEFIT EXPENSES: THE ORGANIZATION USED A COST-TO CHARGE RATIO FOR LINES 7A & 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINE 7E WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | EXPLAIN THE ORGANIZATION'S METHODOLOGY TO ESTIMATE THE AMOUNT REPORTED FOR BAD DEBT EXPENSE: THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION, AND EXISTING ECONOMIC CONDITIONS AND TRENDS. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED AS AN ADJUSTMENT TO REVENUE, NOT BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY: MOST OF THE BAD DEBT EXPENSE RESULTS FROM UNINSURED PATIENTS RECEIVING SERVICES PRIMARILY THROUGH THE EMERGENCY ROOM. THE MANAGER OF PATIENT FINANCIAL SERVICES ESTIMATES THAT APPROXIMATELY 25% OF ALL BAD DEBT WOULD QUALIFY FOR CHARITY CARE, BUT IT IS DIFFICULT TO GET THE PATIENTS TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | FOOTNOTE ON BAD DEBT EXPENSE: SEE PAGE 8-9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS FOR THE FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | MEDICARE SHORTFALL AS A COMMUNITY BENEFIT: MEDICARE PAYS THE CRITICAL ACCESS HOSPITAL 1% LESS THAN ALLOWABLE COST. THIS SHORTFALL MUST BE BORN BY ALL OTHER PAYERS AND PROGRAMS, LIMITING THE PROFITS NECESSARY TO CREATE NEW PROGRAMS AND PROVIDE NECESSARY BENEFITS TO COMMUNITY MEMBERS WHO HAVE NO OR LIMITED RESOURCES TO PAY FOR HEALTHCARE SERVICES. THE COST TO CHARGE RATIO WAS USED TO DETERMINE THE ALLOWABLE COSTS REPORTED ON LINE 6. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | DEBT COLLECTION POLICY: OUR PRACTICE IS TO PROVIDE ALL PATIENTS AT TIME OF REGISTRATION WHO DO NOT DEMONSTRATE THE ABILITY TO PAY FOR THE ANTICIPATED SERVICES (NO INSURANCE, NO DEPOSIT, ETC.) AN OPPORTUNITY TO COMPLETE A CHARITY APPLICATION. THE COLLECTION POLICY REMAINS THE SAME FOR POTENTIAL CHARITY CASES AND ALL AVENUES OF COLLECTION ARE PURSUED, JUST AS IF THE CHARITY APPLICATION HAD NOT BEEN OFFERED. WHILE WE BELIEVE MANY OF THE CHARITY CASES END UP AS A BAD DEBT, IT IS NOT FOR LACK OF EFFORT TO EDUCATE THE POTENTIAL CHARITY APPLICANT OF THE AVAILABILITY OF ASSISTANCE AND KEEP THE AMOUNTS OUT OF OUR BAD DEBT CATEGORY. |
| SCHEDULE H, PART VI, LINE 2 | NEEDS ASSESSMENT: COMMUNITY HOSPITAL ASSOCIATION, INC. CONTINUALLY ASSESSES THE COMMUNITY'S MEDICAL NEEDS THROUGH THE RELATIONSHIP OF OUR STAFF TO COMMUNITY LEADERS AND COMMUNITY PROGRAMS THAT IDENTIFY COMMUNITY NEEDS, OFTEN MEDICAL IN NATURE. ALTHOUGH THE HOSPITAL IS NOT ALWAYS IN A POSITION TO EXPAND SERVICES AND MEET ALL IDENTIFIED NEEDS, MAINTAINING A CORE MENU OF SERVICES THAT MEETS THE GREATEST COMMUNITY NEED HAS AND CONTINUES TO DIRECT OUR STRATEGIC PLANNING. |
| SCHEDULE H, PART VI, LINE 3 | PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ALL UNINSURED AND UNDER-INSURED PATIENTS AT TIME OF REGISTRATION ARE PROVIDED WITH OPTIONS AVAILABLE IN OUR COMMUNITY FOR PAYMENT OF THE SERVICES PROVIDED. THIS IS MOST OFTEN VERBAL WITH A WRITTEN CHARITY CARE APPLICATION. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY INFORMATION: WICKENBURG COMMUNITY HOSPITAL SERVES A PRIMARY SERVICE AREA POPULATION OF APPROXIMATELY 17,000 IN A RURAL SERVICE AREA CLUSTERED AROUND WICKENBURG, AZ. WICKENBURG COMMUNITY HOSPITAL IS THE ONLY HOSPITAL IN THE SERVICE AREA. THE DISTRIBUTION OF SERVICE AREA POPULATION BY AGE IS 0-17, 21%; 18-44, 25%; 45-64, 29%; 65+, 24%. THE SERVICE AREA IS HOME TO A GREAT NUMBER OF WINTER RESIDENTS, CHANGING THE POPULATION SIGNIFICANTLY FROM WINTER MONTHS TO SUMMER MONTHS, WHEN THE POPULATION GROWS BY APPROXIMATELY 40%. |
| SCHEDULE H, PART VI, LINE 5 | PROMOTION OF COMMUNITY HEALTH: WICKENBURG COMMUNITY HOSPITAL, DESIGNATED AS A CRITICAL ACCESS HOSPITAL, SERVES A RURAL POPULATION APPROXIMATELY 35 MILES WEST OF THE URBAN AREA OF THE GREATER PHOENIX MARKET PLACE OF SURPRISE, AZ. WHILE THE DISTANCE IS NOT OVERLY GREAT, MANY OF OUR PATIENTS COME FROM RURAL AREAS WEST AND NORTH OF WICKENBURG, REQUIRING THEM TO DRIVE MUCH GREATER DISTANCES TO OBTAIN HEALTH CARE SERVICES IF WICKENBURG COMMUNITY HOSPITAL WERE NOT AVAILABLE TO THEM. THE MOST IMPORTANT SERVICE WE PROVIDE IS OUR EMERGENCY SERVICES AND COULD NOT EXIST WITHOUT OUR CRITICAL ACCESS HOSPITAL STATUS. ADDITIONALLY, OUR RURAL HEALTH CLINIC PROVIDES ACCESS TO PRIMARY CARE PROVIDERS IN OUR COMMUNITY THAT PROBABLY WOULD NOT EXIST IF THE HOSPITAL DID NOT EMPLOY THESE PROVIDERS. THE AVAILABILITY OF DIAGNOSTIC SERVICES LOCALLY IS VERY IMPORTANT TO OUR COMMUNITY AS A HIGHER AVERAGE AGE EXISTS IN OUR COMMUNITY, MAKING IT DIFFICULT TO DRIVE LONGER DISTANCES AND SPEND A GREATER AMOUNT OF TIME IN OBTAINING DIAGNOSTIC SERVICES REQUIRED BY THEIR PRIMARY CARE PROVIDERS. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (true) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | Yes (true) | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | 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 | Other Compensation Filing OrgOtherCompensationFilingOrgAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JAMES TAVARY | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $194,854 | $0 | $0 | $0 | $0 | $9,743 | $0 | $17,771 | $0 | $222,368 | $0 | $0 | $0 | |
| MITCHELL WAGNER | ||||||||||||||
| SURGEON | $499,990 | $0 | $0 | $0 | $0 | $0 | $0 | $4,779 | $0 | $504,769 | $0 | $0 | $0 | $0 |
| ROBERT RIPLEY | ||||||||||||||
| SURGEON | $350,002 | $0 | $0 | $0 | $0 | $0 | $0 | $15,810 | $0 | $365,812 | $0 | $0 | $0 | $0 |
| JEREMY BRAMWELL | ||||||||||||||
| PHYSICIAN | $175,011 | $0 | $0 | $0 | $0 | $7,500 | $0 | $18,968 | $0 | $201,479 | $0 | $0 | $0 | $0 |
| SUZANNE YOUNG | ||||||||||||||
| PHARMACIST | $160,014 | $0 | $0 | $0 | $0 | $0 | $0 | $9,284 | $0 | $169,298 | $0 | $0 | $0 | $0 |
| LISA ERLINGER | ||||||||||||||
| ANESTHESIOLOGIST | $240,011 | $0 | $0 | $0 | $0 | $0 | $0 | $17,037 | $0 | $257,048 | $0 | $0 | $0 | $0 |
| TODD KRAVETZ | ||||||||||||||
| CHIEF OF STAFF | $220,002 | $0 | $0 | $0 | $0 | $7,750 | $0 | $19,671 | $0 | $247,423 | $0 | $0 | $0 | $0 |
| ROGER ROSE | ||||||||||||||
| DIRECTOR OF PHARMACY SERVICES | $180,003 | $0 | $0 | $0 | $0 | $0 | $0 | $10,598 | $0 | $190,601 | $0 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 1A | INFORMATION REGARDING BENEFITS PROVIDED: GOLF MEMBERSHIP is provided for all staff members. |
| SCHEDULE J, PART I, LINE 8 | PAYMENTS MADE PURSUANT TO AN INITIAL CONTRACT EXCEPTION: MR. TAVARY IS QUALIFIED BY TRAINING AND EXPERIENCE TO ACT AS CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. DUTIES SHALL BE PERFORMED TO THE BEST OF MR. TAVARY'S ABILITY, EXPERIENCE, AND TALENT TO THE REASONABLE SATISFACTION OF THE ORGANIZATION. BASE COMPENSATION IS PAID FOR SERVICES, WITH THE ELIGIBILITY OF PERFORMANCE BASED BONUSES. THE TERM OF THE CONTRACT SHALL BE THREE YEARS, WITH THE POSSIBLITY OF EXTENSION MADE BY MUTUAL AGREEMENT OF THE ORGANIZATION AND MR.TAVARY. |
| Schedule J, Part I, line 9 | REBUTTABLE PRESUMPTION PROCEDURE: THE ORGANIZATION FOLLOWS THE REBUTTABLE PRESUMPTION PROCEDURE. Comparability data is used every other year through PayFactors. A salary range based on position is obtained and then compared to internal equity in determining exectuive compensation. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (20 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | PROCESS TO REVIEW THE FORM 990: THE FORM 990 IS PREPARED BY A THIRD PARTY AND IS REVIEWED BY THE CFO. A COPY OF THE 990 IS MADE AVAILABLE TO THE GOVERNING BOARD PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL BOARD MEMBERS AND OFFICERS ARE COVERED UNDER THE POLICY. IN CONNECTION WITH ANY ACTUAL OR POSSIBLE CONFLICT OF INTEREST, AN INTERESTED PERSON MUST DISCLOSE THE EXISTENCE OF ANY FINANCIAL INTEREST AND CONFLICT OF INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE BOARD OF DIRECTORS OF THE ORGANIZATION. IN ADDITION, ALL INTERESTED PERSONS REVIEW AND SIGN A COMPLIANCE CERTIFICATE ANNUALLY. AFTER DISCLOSURE OF ANY POTENTIAL CONFLICTS AND ALL MATERIAL FACTS, AND AFTER ANY DISCUSSION WITH THE INTERESTED PERSON, HE/SHE SHALL LEAVE THE GOVERNING BOARD MEETING AND IS RECUSED FROM THE DISCUSSION AND VOTING ON THE ISSUE. THE REMAINING BOARD MEMBERS SHALL DECIDE IF A CONFLICT OF INTEREST EXISTS. |
| FORM 990, PART VI, SECTION B, LINE 15A | REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION: THE BOARD CHAIRMAN, WITH CONSULTATION OF OTHER MEMBERS OF THE BOARD, REVIEWS INDEPENDENT SURVEY DATA ACQUIRED THROUGH THE ARIZONA HOSPITAL & HEALTHCARE ASSOCIATION ON EXECUTIVE SALARIES AND REVIEWS THE PERFORMANCE OF THE CEO. THIS REVIEW IS DONE ANNUALLY BY THE BOARD IN EXECUTIVE SESSION. The salary is documented on a personnel action form (PAF), entered into the payroll system, and then added to the HR file. |
| Form 990, Part VI, Section B, line 15b | Review of Other Officer or Key Employees Compensation: The CEO and HR Director use the Arizona Hospital & Healthcare Association survey data to review all positions in the facility, including key employees and other officers. The salary is documented on a personnel action form (PAF), entered into the payroll system, and then added to the HR file. |
| Form 990, Part VI, Section C, line 19 | Governing Documents Available to the Public: Governing documents, conflict of interest policy, and financial statements are made available to the public by a formal request in writing. |
| FORM 990, PART XI, LINE 9 | OTHER CHANGES IN NET ASSETS OR FUND BALANCES: Change in interest in net assets of wickenburg community hospital foundation 112,212 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PATIENT PUTCHASED SERVICES TOTAL FEES:3564504 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:340B MANAGEMENT FEES TOTAL FEES:73654 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARMACY TOTAL FEES:52350 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:IMAGING TOTAL FEES:587289 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RESPITATORY THERAPY TOTAL FEES:99030 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:DIETARY SERVICES TOTAL FEES:3999 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMIN/HUMAN RESOURCES TOTAL FEES:524692 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB TOTAL FEES:314714 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAL RECORDS TOTAL FEES:141234 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICAL THERAPY TOTAL FEES:27942 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAUNDRY/HOUSEKEEPING TOTAL FEES:100878 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:COLLECTION FEES TOTAL FEES:23604 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:IS TOTAL FEES:264993 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MISCELLANEOUS TOTAL FEES:449229 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WICKENBURG COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1Txt |
| City | WICKENBURG | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 742521618 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 7 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | na | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Comments