2017-05-08T13:49:29-05:00 2016-06-30 390758449 WIPFLI LLP 7601 FRANCE AVENUE SOUTH SUITE 400 MINNEAPOLIS MN 55435 990 2015-07-01 870560763 UTAH NAVAJO HEALTH SYSTEM INC UTAH 4356513291 PO BOX 130 MONTEZUMA CREEK UT 84534 WILLIAM HARRISON CFO 4356513291 2017-05-02 1 TIM A RITTER CPA P00732856 9525483400 2017-05-02 2015 2021-01-29 14:40:06Z MICHAEL JENSEN PO BOX 130 MONTEZUMA CREEK UT 84534 40603214 0 X WWW.UNHSINC.ORG X 1999 UT TO IMPROVE QUALITY OF LIFE THROUGH COMPREHENSIVE, SELF-EMPOWERED, CULTURALLY-SENSITIVE HEALTHCARE AND AMAZING CUSTOMER SERVICE. 10 10 297 10 0 0 17889231 18003990 19554287 22170607 37702 58063 0 294296 37481220 40526956 0 17445 0 0 18515476 20408996 0 0 119994 11923165 12998199 30438641 33424640 7042579 7102316 39829206 46393760 5300923 4881570 34528283 41512190 WE EXIST TO IMPROVE QUALITY OF LIFE THROUGH COMPREHENSIVE, SELF-EMPOWERED, CULTURALLY-SENSITIVE HEALTHCARE AND AMAZING CUSTOMER SERVICE. 0 0 23709819 17445 22170607 THE ORGANIZATION PROVIDES MEDICAL, DENTAL AND BEHAVIORAL HEALTH CARE ON A SLIDING FEE SCALE FOR PATIENTS. A SLIDING SCALE IS IN PLACE TO ADDRESS THE NEEDS OF THE UNINSURED AND UNDERINSURED, PROVIDING REDUCED COSTS ON ALL MEDICAL SERVICES FOR THOSE WHO QUALIFY. QUALIFYING FOR THE PROGRAM IS BASED UPON ANNUAL HOUSEHOLD INCOME. MEDICAL ENCOUNTERS CAN BE SCALED DOWN TO AS LOW AS $15. 23709819 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 200 0 297 1 0 0 0 0 0 0 0 0 0 0 X 10 10 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 UT X WILLIAM HARRISON 4356513291 PO BOX 130 MONTEZUMA CREEK UT 84534 CASSANDRA BELETSO DIRECTOR 1.00 X 4756 0 0 LORISSA JACKSON DIRECTOR 1.00 X 9620 0 0 HARRIETT LANSING DIRECTOR 1.00 X 6395 0 0 KENNETH MILES DIRECTOR 1.00 X 4800 0 0 EDWARD TAPAHA DIRECTOR 1.00 X 4950 0 0 ROBERT WHITEHORSE DIRECTOR 1.00 X 8543 0 0 JAMIE HARVEY CHAIR 1.00 X X 4800 0 0 MELINDA FARLEY VICE CHAIR 1.00 X X 5100 0 0 GLORIA BEGAYE SECRETARY 1.00 X X 6300 0 0 WILFRED JONES TREASURER 1.00 X X 6839 0 0 MICHAEL JENSEN CHIEF EXECUTIVE OFFICER 50.00 X 213961 0 21821 WILLIAM HARRISON CHIEF FINANCIAL OFFICER 50.00 X 118505 0 7667 JAMES W BONDS DOCTOR 40.00 X 368652 0 14864 MAHANA FISHER DOCTOR 40.00 X 432876 0 14564 L VAL JONES DOCTOR 40.00 X 506184 0 21821 CASEY MCCULLOUGH DOCTOR 40.00 X 332697 0 21821 BRIAN F OLSEN DENTIST 40.00 X 211823 0 21821 2246801 0 124379 7 0 1 0 PRECISION REHABILITATION INC PO BOX 745 BLANDING UT 84511 PHYSICAL THERAPY 435737 UNIVERSITY OF UTAH HOSPITALS AND CLINICS PO BOX 511258 LOS ANGELES CA 90051 MEDICAL SERVICES 417712 SAN JUAN REGIONAL MEDICAL CENTER 801 W MAPLE ST FARMINGTON NM 87401 MEDICAL SERVICES 290689 SOUTHWEST MEMORIAL HOSPITAL 1311 N MILDRED RD CORTEZ CO 81321 MEDICAL SERVICES 260023 CEDAR DIAGNOSTICS LLC PO BOX 876 CORTEZ CO 81321 LABORATORY SERVICES 219320 8 18003990 18003990 PATIENT FEES FOR SERVICE 624100 22170607 22170607 22170607 103444 103444 30877 23689 52569 7188 -52569 -45381 -45381 LITIGATION SETTLMENT 900099 230830 230830 63466 63466 294296 40526956 22170607 0 352359 X 17445 17445 393296 393296 13407427 9971359 3329663 106405 645539 382677 257638 5224 4915265 2899228 2016028 9 1047469 757789 281324 8356 42456 42456 67033 67033 38701 38701 4298677 3903540 395137 32506 32506 340704 108639 232065 563312 438618 124694 427210 427210 665284 408778 256506 179196 179196 166 166 1111173 709484 401689 256291 121385 134906 SUPPLIES - MEDICAL & DE 3260434 2983370 277064 EQUIPMENT 838604 146967 691637 PROVISION FOR DOUBTFUL 366269 366269 REPAIR AND MAINTENANCE 205011 127524 77487 305172 116178 188994 33424640 23709819 9594827 119994 5025598 4498678 18268542 24529750 13493 379643 2308388 1717793 3717136 3717136 45994 58213 13604166 6686510 5794282 6917656 3155773 3074891 1500000 1500000 39829206 46393760 2124350 2184156 3176573 2697414 5300923 4881570 X 34528283 41512190 34528283 41512190 39829206 46393760 7102316 -118409 0 X 0 1 X 1 1 1 X 14017586 13698693 13884288 17889231 18003990 77493788 14017586 13698693 13884288 17889231 18003990 77493788 77493788 45077 25740 26098 32176 103444 232535 230830 230830 77957153 91848089 0.99410 0.99790 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 837454 837454 3140401 774264 2366137 855945 358418 497527 5962683 3257286 2705397 2807683 2296542 511141 6917656 40094847 -118409 -366269 -484678 40579525 -52569 -52569 40526956 33110940 52569 52569 33058371 366269 366269 33424640 PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -366,269. PART XI, LINE 4B - OTHER ADJUSTMENTS: LOSS ON FIXED ASSET DISPOSAL -52,569. PART XII, LINE 2D - OTHER ADJUSTMENTS: LOSS ON FIXED ASSET DISPOSAL 52,569. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 366,269. 1 0 0 PART I, LINE 2: THE ORGANIZATION MONITORS WHO THEY MAKE CHARITABLE CONTRIBUTIONS TO CLOSELY. THERE WERE NO ORGANIZATIONS THAT RECEIVED MORE THAN $5,000 IN TAX YEAR 2015. X X 0 0 0 0 0 0 0 0 0 MICHAEL JENSEN CHIEF EXECUTIVE OFFICER 213961 0 0 0 0 0 0 0 21821 0 235782 0 0 0 JAMES W BONDS DOCTOR 368652 0 0 0 0 0 0 0 14864 0 383516 0 0 0 MAHANA FISHER DOCTOR 432876 0 0 0 0 0 0 0 14564 0 447440 0 0 0 L VAL JONES DOCTOR 506184 0 0 0 0 0 0 0 21821 0 528005 0 0 0 CASEY MCCULLOUGH DOCTOR 332697 0 0 0 0 0 0 0 21821 0 354518 0 0 0 BRIAN F OLSEN DENTIST 211823 0 0 0 0 0 0 0 21821 0 233644 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS REVIEWED BY CEO, CFO, AND COO AND THEN PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD REVIEWS THEIR CONFLICT OF INTEREST POLICIES ANNUALLY. THE ORGANIZATION HAS A CONFLICT OF INTEREST POLICY THAT DEFINES WHAT A CONFLICT OF INTEREST IS AND THE RESTRICTIONS THAT APPLY TO ALL BOARD MEMBERS. WHEN A CONFLICT ARISES, THE MEMBER THAT IS CONFLICTED HAS A DUTY TO DISCLOSE IN WRITING TO THE CHAIR OF THE BOARD. THE CHAIR OF THE BOARD THEN PRESENTS TO THE FULL BOARD. THE CONFLICTED MEMBER SHALL HAVE THE OPPORTUNITY TO ADDRESS THE BOARD AND PRESENT ANY NECESSARY ITEMS AND RESPOND TO ANY QUESTIONS. AFTER SUCH PRESENTATION THE CONFLICTED MEMBER SHALL ABSTAIN FROM FURTHER DISCUSSION WITH THE ENTIRE BOARD AND FOR THE VOTE ON THE MATTER. FORM 990, PART VI, SECTION B, LINE 15 NATIONAL AND STATE COMPENSATION STUDY FOR ORGANIZATIONS OF SIMILAR SIZE AND STRUCTURE TO DETERMINE A RANGE OF COMPENSATION. THE CEO'S PERFORMANCE AND COMPENSATION EVALUATION IS HANDLED BY THE BOARD OF DIRECTORS AND THE IS REVIEWED ANNUAL BY ALL MEMBERS OF THE BOARD OF DIRECTORS. THE CEO REVIEWS AND EVALUATES THE CFO, COO, CMO COMPENSATIONS AT THE END OF THE FISCAL YEAR AND THE NEW RATE IS SET ON THE START OF THE NEXT FISCAL YEAR IF ONE IS WARRANTED. REVIEWS ARE DONE ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 ORGANIZING DOCUMENTS ARE AVAILABLE UPON REQUEST, JUST AS THE FORM 990. FORM 990, PART IX, LINE 11G OTHER MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 1,411,317. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,411,317. INPATIENT/OUTPATIENT SERVICES: PROGRAM SERVICE EXPENSES 686,620. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 686,620. RADIOLOGY/X-RAY/IMAGING/LAB: PROGRAM SERVICE EXPENSES 578,057. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 578,057. OTHER PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 52,594. MANAGEMENT AND GENERAL EXPENSES 395,137. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 447,731. PHYSICAL THERAPY: PROGRAM SERVICE EXPENSES 419,268. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 419,268. DENTAL CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 379,704. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 379,704. EMERGENCY ROOM SERVICES: PROGRAM SERVICE EXPENSES 375,980. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 375,980.