2017-11-14T10:49:05-06:00 2016-12-31 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2016-01-01 860096775 Community Hospital Association Inc % THE ORGANIZATION COMM 9286845421 520 Rose Lane Wickenburg AZ 85390 JACKIE LUNDBLAD CFO 9286845421 2017-11-15 true ADAM R SMITH CPA P00958966 7194714290 167.68.126.162 84022720173185000003 2017-11-14 P 9FA4587EFF0C3538BA7A022E3664664341CA183B 657019BDA25F639FDA9DE6AEB03101C2A476659E 2016 2017-02-10 21:41:12Z Jim Tavary 520 Rose Lane Wickenburg AZ 85390 31836210 false X www.wickhosp.com X 1946 AZ To provide quality health and wellness services where the patient, family and community come first. 12 12 293 50 129161 3612213 2253280 27452533 29457892 -135171 -3028 -454846 123714 30474729 31831858 0 1000000 0 0 12377361 14518782 0 0 0 14867312 18671936 27244673 34190718 3230056 -2358860 26266200 32931769 10516161 20798855 15750039 12132914 TO PROVIDE QUALITY HEALTH AND WELLNESS SERVICES WHERE THE PATIENT, FAMILY, AND COMMUNITY COME FIRST. false false 29527094 1000000 29181906 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. 329260 244584 Provide Fitness Center for residents and visitors of greater Wickenburg, Arizona, promoting a wellness environment for the community. 29856354 true true false false false false false false false false true false false true false false true false false false false false false false false false true true true false true false false false false false false true false false false false false false true true true false true 92 0 true 293 true true true false false false false false false false false false X 12 12 false false false false false false false true true false false true true true true true true false false false AZ X THE ORGANIZATION 9286845421 520 ROSE LANE Wickenburg AZ 85390 X RICHARD ABBUHL VICE-CHAIRMAN 1.0 0.0 X X 0 0 0 GARY TURNER Director 1.0 0.0 X 0 0 0 DEE POLLOCK Chairman of the board 1.0 0.0 X X 0 0 0 MAUREEN SERRANO secretary 1.0 0.0 X X 0 0 0 BRIAN WARNOCK treasurer 1.0 0.0 X X 0 0 0 JOHN COOK DIRECTOR 1.0 0.0 X 0 0 0 TROY JONES DMD DIRECTOR 1.0 0.0 X 0 0 0 LEONARD KIRSCHNER DIRECTOR 1.0 0.0 X 0 0 0 Betsy Deibel director 1.0 0.0 X 0 0 0 Rich Newman director 1.0 0.0 X 0 0 0 Bob Johnson director 1.0 0.0 X 0 0 0 Kevin Cloe director 1.0 0.0 X 0 0 0 JAMES TAVARY CHIEF EXECUTIVE OFFICER 39.0 1.0 X 195664 0 36336 MICHAEL ELLIS CHIEF FINANCIAL OFFICER 39.0 1.0 X 134175 0 14369 TODD KRAVETZ MD CHIEF OF STAFF 40.0 0.0 X 263013 0 42194 ROGER ROSE DIRECTOR OF PHARMACY SERVICES 40.0 0.0 X 182304 0 19767 MARILYN HALDER PHYSICIAN 40.0 0.0 X 196929 0 31993 SUZANNE YOUNG PHARMACIST 40.0 0.0 X 162213 0 14765 Mitchell Wagner Surgeon 40.0 0.0 X 411245 0 4779 Jeremy Bramwell Physician 40.0 0.0 X 223638 0 33119 Robert Ripley Surgeon 40.0 0.0 X 208205 0 24544 1977386 0 221866 18 false true false EMCARE PHYSICIAN SERVICES INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 PHYSICIANS 195948 Alliance Imaging File 55826 LOS ANGELES CA 90074 IMAGING SERVICES 581999 DENNIS BARRACO 34522 N SCOTTSDALE ROAD SCOTTSDALE AZ 85262 PHYSICIAN SERVICES 126188 YARNELL MEDICAL INC PO BOX 130 MORRISTOWN AZ 85342 PHYSICIAN SERVICES 141218 BKD LLP 111 S TEJON ST SUITE 800 COLORADO SPRINGS CO 80903 ACCOUNTING & TAX 140070 6 2253280 2253280 Medicare 621990 11407850 11407850 Patient Services 621990 14776232 14647071 129161 Drug Pricing Program 621990 1577281 1577281 Patient Pharmacy 621990 1357721 1357721 Wellness Center 621990 244584 244584 94224 94224 29457892 1324 1324 0 0 0 0 0 4352 -4352 -4352 -4352 0 0 0 0 0 0 0 0 0 Other Revenue 900099 90714 64759 25955 LABORATORY FEES 900099 33000 33000 123714 31831858 29426490 129161 22927 X 1000000 1000000 0 0 0 851127 484250 366877 60740 60740 11331568 10477145 854423 24882 24882 1372982 1292917 80065 877483 811672 65811 0 88015 88015 174070 174070 0 0 0 5605189 4800603 804586 0 432988 324741 108247 257300 257300 0 547598 492838 54760 95001 59013 35988 0 94383 32293 62090 0 0 1605847 1445262 160585 423567 391799 31768 MEDICAL SUPPLIES 5047913 5047913 PROVISION FOR BAD DEBTS 2523424 2523424 REPAIRS & MAINTENANCE 539486 422008 117478 DUES, FEES, & SUBS 78456 32626 45830 1158699 132228 1026471 34190718 29856354 4334364 0 1792936 2187470 9890 10716 1000000 0 4215978 5162092 0 0 0 0 0 0 1090630 1198595 442330 374263 36954505 15405961 13958070 21548544 0 0 0 0 0 0 35523 21772 3720843 2428317 26266200 32931769 2523856 2435921 0 0 0 0 0 0 0 0 0 0 7952436 18362934 0 0 39869 0 10516161 20798855 X 12662959 11252677 3087080 880237 0 0 15750039 12132914 26266200 32931769 X -2358860 -1258265 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1379772 1379772 23797775 9173597 14624178 8690 5617 3073 11008607 5971506 5037101 759661 255241 504420 21548544 FOUNDATION 2428317 2428317 27050169 27050169 4781689 4781689 31831858 30667294 30667294 3523424 3523424 34190718 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 4B REVENUE ON RETURN, NOT ON BOOKS: Provision for uncollectible accounts reclassed to expense 2,523,424 Change in interest in net assets of wickenburg community hospital foundation 2,258,265 Total 4,781,689 SCHEDULE D, PART XII, LINE 4B EXPENSE ON RETURN, NOT ON BOOKS: Provision for uncollectible accounts reclassed to expense 2,523,424 Contribution to sole member not on financials 1,000,000 Total 3,523,424 true true X true X true X 380. true true false true true 125545 125545 0.00400 3624186 3036052 588134 0.01860 3749731 3036052 713679 0.02260 329260 244584 84676 0.00270 329260 244584 84676 0.00270 4078991 3280636 798355 0.02530 true 2523424 630856 9458330 10270409 -812079 X true true 1 1 Wickenburg Community Hospital 520 Rose Lane Wickenburg AZ 85390 www.wickhosp.com RGH3505 X X 1 Wickenburg Community Hospital 1 false false true X X X X X X X X X 16 true false false true X SEE PART V, SECTION C, FOR DIRECT URL X true 16 true SEE PART V, SECTION C, FOR DIRECT URL false true X 200. 380. X X X true true X X X X true X See Part V, Section C for URL X PART V, SECTION C FOR URL X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 DESCRIBE HOW THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE COMMUNITY: The development of the CHNA survey process began with the formation of the 2016 Project Team in August. 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 CHNAs 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 CHAs 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 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. 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 & 16C DIRECT URL FOR FINANCIAL ASSISTANCE POLICY AND PLAIN LANGUAGE SUMMARY: http://wickhosp.com/FINANCIAL-SERVICES/ 2 Community Hospital Clinic - WICKENBURG 519 Rose Lane Wickenburg AZ 85390 PRIMARY CARE CLINIC RURAL HEALTH CLINIC Community Hospital Clinic - Congress 26750 S Santa Fe Road Suite B Congress AZ 85332 PRIMARY CARE CLINIC RURAL HEALTH CLINIC Schedule H, Part I, Line 7, Column F BAD DEBT EXPENSE: TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = $2,523,424 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. true Wickenburg Community Hospital Foundation 520 Rose Lane Wickenburg AZ 85390 742521618 501(c)(3) 1000000 Assist the Foundation with carrying out its purpose. 1 Schedule I, Part I, Line 2 Organization's procedures for monitoring the use of grant funds: The hospital has an agreement with the Wickenburg Community Hospital Foundation (foundation) that states all contributions received by the hospital shall be forwarded for receipt by the foundation for the designated facility or department. During 2016, the hospital transferred $1,000,000 to the foundation for a pledge received in the prior year. X true true X X false false false false false false false false true false JAMES TAVARY CHIEF EXECUTIVE OFFICER 195664 0 0 9743 26593 232000 0 TODD KRAVETZ MD CHIEF OF STAFF 263013 0 0 0 0 0 7750 0 34444 0 305207 0 0 0 ROGER ROSE DIRECTOR OF PHARMACY SERVICES 182304 0 0 0 0 0 0 0 19767 0 202071 0 0 0 MARILYN HALDER PHYSICIAN 196929 0 0 0 0 0 7750 0 24243 0 228922 0 0 0 SUZANNE YOUNG PHARMACIST 162213 0 0 0 0 0 0 0 14765 0 176978 0 0 0 Mitchell Wagner Surgeon 411245 0 0 0 0 0 0 0 4779 0 416024 0 0 0 Jeremy Bramwell Physician 223638 0 0 0 0 0 0 0 33119 0 256757 0 0 0 Robert Ripley Surgeon 208205 0 0 0 0 0 0 0 24544 0 232749 0 0 0 Schedule J, Part I, line 1 Information Regarding Benefits Provided: ALL KEY EMPLOYEES ARE PROVIDED WITH A COMPLEMENTARY FITNESS CENTER MEMBERSHIP AT THE WICKENBURG COMMUNITY HOSPITAL FITNESS CENTER. 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, HOWEVER, THE COMPARABILITY DATA USED IS NOT DOCUMENTED, THEREFORE QUESTION 9 IS ANSWERED AS NO. Karen Tavary family member of the organization's CEO 60740 employee wages false 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. 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. 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 -2,258,265 Contribution to Foundation 1,000,000 Total -1,258,265 FORM 990 PART IX LINE 11G DESCRIPTION:PATIENT PURCHASED SERVICES TOTAL FEES:3332287 FORM 990 PART IX LINE 11G DESCRIPTION:340B MANAGEMENT FEES TOTAL FEES:73062 FORM 990 PART IX LINE 11G DESCRIPTION:PHARMACY TOTAL FEES:32206 FORM 990 PART IX LINE 11G DESCRIPTION:IMAGING TOTAL FEES:692830 FORM 990 PART IX LINE 11G DESCRIPTION:RESPIRATORY THERAPY TOTAL FEES:140031 FORM 990 PART IX LINE 11G DESCRIPTION:DIETARY SERVICES TOTAL FEES:83768 FORM 990 PART IX LINE 11G DESCRIPTION:ADMIN/HUMAN RESOURCES TOTAL FEES:388316 FORM 990 PART IX LINE 11G DESCRIPTION:LAB TOTAL FEES:316908 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL RECORDS TOTAL FEES:102202 FORM 990 PART IX LINE 11G DESCRIPTION:PHYSICAL THERAPY TOTAL FEES:120000 FORM 990 PART IX LINE 11G DESCRIPTION:LAUNDRY/HOUSEKEEPING TOTAL FEES:113788 FORM 990 PART IX LINE 11G DESCRIPTION:COLLECTION FEES TOTAL FEES:9943 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:141822 FORM 990 PART IX LINE 11G DESCRIPTION:MISCELLANEOUS TOTAL FEES:58026 Wickenburg Community Hospital Foundation 520 Rose Lane Wickenburg AZ 85390 742521618 Fundraising AZ 501(C)(3) Line 7 na false false false true true false false false false false false false false true true true false true false false WICKENBURG COMMUNITY HOSPITAL FOUNDATION C 2253280 AMOUNT RECEIVED WICKENBURG COMMUNITY HOSPITAL FOUNDATION D 1022596 interco amount WICKENBURG COMMUNITY HOSPITAL FOUNDATION Q 192546 interco amount