WHITE MOUNTAIN REGIONAL MEDICAL CENTER: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- WHITE MOUNTAIN REGIONAL MEDICAL CENTER (EIN 86-0171900)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-15
- IRS object ID
- 201603209349313540
- Schema version
- 2015v2.1
- 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
- Form 990
- Schedule A
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-15T16:00:49-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1601 NW EXPRESSWAY SUITE 1900 | AddressLine1Txt |
| City | OKLAHOMA CITY | CityNm |
| State Abbreviation | OK | StateAbbreviationCd |
| ZIP | 73118 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860171900 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITE MOUNTAIN COMMUNITIES HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WHIT | BusinessNameControlTxt |
| Phone | 9283337142 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | SPRINGERVILLE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85938 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | GREG WAS | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9283337142 | PhoneNum |
| Signature | 2016-11-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | KIM HUNWARDSEN CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 4054783334 | PhoneNum |
| Preparation | 2016-11-01 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITE MOUNTAIN REGIONAL MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GREG WAS | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | SPRINGERVILLE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85938 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,206,921 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.WMRMC.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1962 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | WHITE MOUNTAIN REGIONAL MEDICAL CENTER PROVIDES CARING SERVUCES TO MEET THE NEEDS OF PATIENTS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 233 | TotalEmployeeCnt |
| Total Volunteers | 41 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $729,433 | PYContributionsGrantsAmt |
| CY Contributions Grants | $196,537 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,151,934 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,988,473 | CYProgramServiceRevenueAmt |
| PY Investment Income | $1,342 | PYInvestmentIncomeAmt |
| CY Investment Income | $2,198 | CYInvestmentIncomeAmt |
| PY Other Revenue | $156,265 | PYOtherRevenueAmt |
| CY Other Revenue | $19,713 | CYOtherRevenueAmt |
| PY Total Revenue | $17,038,974 | PYTotalRevenueAmt |
| CY Total Revenue | $18,206,921 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $6,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,190,206 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,445,772 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,347,576 | PYOtherExpensesAmt |
| CY Other Expenses | $8,921,429 | CYOtherExpensesAmt |
| PY Total Expenses | $16,537,782 | PYTotalExpensesAmt |
| CY Total Expenses | $18,373,201 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $501,192 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$166,280 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,495,183 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,059,553 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,864,283 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $4,005,024 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,630,900 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,054,529 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | WHITE MOUNTAIN REGIONAL MEDICAL CENTER - PROVIDING AFFORDABLE, HIGH QUALITY CARE IN OUR COMMUNITY. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $14,887,538 | ExpenseAmt |
| Grant | $6,000 | GrantAmt |
| Revenue | $17,988,473 | RevenueAmt |
| Desc | WHITE MOUNTAIN COMMUNITIES HOSPITAL, INC. DBA WHITE MOUNTAIN REGIONAL MEDICAL CENTER (HOSPITAL) IS A 25 BED CRITICAL ACCESS HOSPITAL LOCATED IN SPRINGERVILLE, ARIZONA, AND PROVIDES ACUTE CARE INPATIENT, OUTPATIENT AND EMERGENCY SERVICES TO RESIDENTS OF THE SURROUNDING COMMUNITIES IN THE SPRINGERVILLE AREA.WHITE MOUNTAIN REGIONAL MEDICAL CENTER WILL PROVIDE CARING SERVICES AND OPERATE ON A FINANCIALLY SOUND BASIS TO ENSURE ITS CONTINUING ABILITY TO MEET THE NEEDS OF PATIENTS AND THE COMMUNITIES IT SERVES. CONTINUED ON SCHEDULE O.THE BOARD OF DIRECTORS AND LEADERSHIP OF WHITE MOUNTAIN REGIONAL MEDICAL CENTER RECOGNIZE THE IMPORTANCE OF HEALTHCARE AS A SERVICE ESSENTIAL FOR THE WELL-BEING OF PEOPLE IN THE REGION AND AS AN IMPORTANT PART OF THE COMMUNITY'S ECONOMY. AS A COMMUNITY ORGANIZATION THE FACILITY PLAYS A VITAL ROLE IN PROVIDING SERVICES ESSENTIAL TO THE QUALITY OF LIFE FOR PEOPLE IN APACHE COUNTY, ARIZONA AND CATRON COUNTY, NEW MEXICO.THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, THEY ARE NOT REPORTED AS REVENUE. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES PROVIDED UNDER THE HOSPITAL'S CHARITY CARE POLICY WAS APPROXIMATELY $21,000 FOR THE YEAR ENDED DECEMBER 31, 2015. TOTAL DIRECT AND INDIRECT COSTS RELATED TO THESE FOREGONE CHARGES WAS APPROXIMATELY $12,000 AT DECEMBER 31, 2015, BASED ON AN AVERAGE RATIO OF COST TO GROSS CHARGES. | Desc |
| Total Program Service Expenses | $14,887,538 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | Yes (1) | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 56 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 233 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FINANCE DEPARTMENT | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9283337142 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | SPRINGERVILLE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85938 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| MARY NEDROW | ||||||||
| PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RYAN PATTERSON | ||||||||
| VICE PRESIDENT | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| TIM RASMUSSEN | ||||||||
| SECRETARY | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN FREDERICKSEN | ||||||||
| TREASURER | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| NADIA COMVALUIS MD | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| GARY DAVIS | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| RICHARD AYRES | ||||||||
| BOARD MEMBER | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| VERONICA DOWLING MD | ||||||||
| BOARD CHIEF OF STAFF | 1.00 | 0.00 | Yes (X) | $16,000 | $0 | $0 | ||
| GREG WAS | ||||||||
| CEO | 40.00 | 0.00 | Yes (X) | $160,429 | $0 | $0 | ||
| LARRY TYRELL | ||||||||
| CFO | 40.00 | 0.00 | Yes (X) | $96,683 | $0 | $0 | ||
| CARLA ROTERING MD | ||||||||
| PULMONOLOGY | 40.00 | 0.00 | $227,955 | $0 | $0 | Yes (X) | ||
| MICHAEL FOOTE MD | ||||||||
| INTERNAL MEDICINE | 40.00 | 0.00 | $181,030 | $0 | $0 | Yes (X) | ||
| CHRISTINE JACKSON MD | ||||||||
| CARDIOLOGIST | 40.00 | 0.00 | $194,387 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $876,484 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $0 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ROUND VALLEY EMERGENCY CARE | |||||
| 4141 W THORNTON | SHOWLOW | AZ | 85901 | ER PHYSICIANS/PA | $1,520,640 |
| EVIDENT | |||||
| PO BOX 850309 | MOBILE | AL | 36685 | INFORMATION TECHNOLOGY | $589,854 |
| ENTECH | |||||
| 7300 W DETROIT ST | CHANDLER | AZ | 85226 | MEDICAL EQUIPMENT SERVICE | $241,493 |
| MEDICAL DIAGNOSTIC IMAGING GROUP | |||||
| PO BOX 17049 | PHOENIX | AZ | 85011 | RADIOLOGY SERVICES | $224,738 |
| LAB CORP | |||||
| PO BOX 12140 | BURLINGTON | NC | 27216 | LABORATORY SERVICES | $106,952 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $196,411 | GovernmentGrantsAmt |
| All Other Contributions | $126 | AllOtherContributionsAmt |
| Total Contributions | $196,537 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 622110 | $16,667,275 | $16,667,275 |
| EHR INCENTIVE | 622110 | $612,603 | $612,603 |
| DISTRICT ER SERVICES | 624230 | $520,000 | $520,000 |
| CHILDCARE REVENUE | 624410 | $55,537 | $55,537 |
| COMMUNITY WELLNESS | 900099 | $47,525 | $47,525 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $85,533 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $85,533 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,988,473 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $958 | TotalRevenueColumnAmt |
| Exclusion | $958 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,500 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $19,500 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,500 | TotalRevenueColumnAmt |
| Exclusion | $19,500 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,240 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,240 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,240 | TotalRevenueColumnAmt |
| Exclusion | $1,240 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $213 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $213 | TotalRevenueColumnAmt |
| Exclusion | $213 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,206,921 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,988,473 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $21,911 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,000 | TotalAmt |
| Program Services | $6,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $273,112 | TotalAmt |
| Program Services | $16,000 | ProgramServicesAmt |
| Management And General | $257,112 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $242,358 | TotalAmt |
| Program Services | $242,358 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,373,702 | TotalAmt |
| Program Services | $5,733,647 | ProgramServicesAmt |
| Management And General | $1,640,055 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $989,869 | TotalAmt |
| Program Services | $563,317 | ProgramServicesAmt |
| Management And General | $426,552 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $566,731 | TotalAmt |
| Program Services | $451,508 | ProgramServicesAmt |
| Management And General | $115,223 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $84,759 | TotalAmt |
| Management And General | $84,759 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $40,975 | TotalAmt |
| Management And General | $40,975 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,126,098 | TotalAmt |
| Program Services | $3,047,855 | ProgramServicesAmt |
| Management And General | $78,243 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,707 | TotalAmt |
| Program Services | $31,461 | ProgramServicesAmt |
| Management And General | $27,246 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $469,462 | TotalAmt |
| Program Services | $247,126 | ProgramServicesAmt |
| Management And General | $222,336 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $356,840 | TotalAmt |
| Program Services | $52,861 | ProgramServicesAmt |
| Management And General | $303,979 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $590,944 | TotalAmt |
| Program Services | $550,967 | ProgramServicesAmt |
| Management And General | $39,977 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,460 | TotalAmt |
| Program Services | $45,111 | ProgramServicesAmt |
| Management And General | $10,349 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,839 | TotalAmt |
| Program Services | $39,686 | ProgramServicesAmt |
| Management And General | $15,153 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,703 | TotalAmt |
| Program Services | $35,703 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $895,824 | TotalAmt |
| Program Services | $895,824 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $211,773 | TotalAmt |
| Program Services | $24 | ProgramServicesAmt |
| Management And General | $211,749 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,253,729 | $1,253,729 | |
| BAD DEBT EXPENSE | $1,173,564 | $1,173,564 | |
| REPAIRS AND MAINTENANCE | $396,069 | $393,906 | $2,163 |
| FOOD | $87,866 | $85,806 | $2,060 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,817 | TotalAmt |
| Program Services | $21,085 | ProgramServicesAmt |
| Management And General | $7,732 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,373,201 | TotalAmt |
| Program Services | $14,887,538 | ProgramServicesAmt |
| Management And General | $3,485,663 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,503 | BOYAmt |
| EOY | $1,600 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $791,861 | BOYAmt |
| EOY | $431,462 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $132,481 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,955,465 | BOYAmt |
| EOY | $2,938,428 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $377,643 | BOYAmt |
| EOY | $360,615 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $153,627 | BOYAmt |
| EOY | $120,125 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $11,884,536 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,271,415 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,079,584 | BOYAmt |
| EOY | $4,613,121 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $135,500 | BOYAmt |
| EOY | $461,721 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,495,183 | BOYAmt |
| EOY | $9,059,553 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $999,412 | BOYAmt |
| EOY | $1,839,237 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $685,875 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,419,924 | BOYAmt |
| EOY | $1,123,067 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $444,947 | BOYAmt |
| EOY | $356,845 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,864,283 | BOYAmt |
| EOY | $4,005,024 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,630,900 | BOYAmt |
| EOY | $5,054,529 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,630,900 | BOYAmt |
| EOY | $5,054,529 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,495,183 | BOYAmt |
| EOY | $9,059,553 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$166,280 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | -$412,068 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $1,977 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $3,679 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,679 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | WHITE MOUNTAIN COMMUNITIES HOSPITAL PAID DUES TO THE ARIZONA HEALTH CARE ASSOCIATION IS THE AMOUNT OF $11,400. 32.27% OF THE DUES WAS ATTRIBUTABLE TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agent Trustee Etc | Yes (1) | AgentTrusteeEtcInd |
| Beginning Balance | $18,780 | BeginningBalanceAmt |
| Additions During Year | $10,876 | AdditionsDuringYearAmt |
| Distributions During Year | $12,853 | DistributionsDuringYearAmt |
| Ending Balance | $16,803 | EndingBalanceAmt |
| Incl Escrow Custodial Acct Liab | 0 | InclEscrowCustodialAcctLiabInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,067 | OtherCostOrOtherBasisAmt |
| Book Value | $26,067 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,084,567 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,906,045 | DepreciationAmt |
| Book Value | $2,178,522 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,748,125 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,365,370 | DepreciationAmt |
| Book Value | $2,382,755 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,777 | OtherCostOrOtherBasisAmt |
| Book Value | $25,777 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,613,121 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INCENTIVE FOR ELECTRONIC HEALTH RECORDS | Desc |
| Book Value | $461,721 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $461,721 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED THIRD PARTY PAYOR SETTLEMENTS | Desc |
| Amt | $356,845 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $356,845 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $17,022,481 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,173,564 | OtherRevenueAmt |
| Revenue Not Reported | -$1,173,564 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,196,045 | RevenueSubtotalAmt |
| Other Revenues Not Included | $10,876 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $10,876 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,206,921 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,186,784 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,186,784 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,186,417 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,186,417 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,373,201 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART IV, LINE 1B: | WHITE MOUNTAIN REGIONAL MEDICAL CENTER AUXILIARY USES THE MEDICAL CENTER'S FEIN BUT HAS ITS OWN CHECKING ACCOUNT. THE AUXILIARY ACCOUNT BALANCES WERE NOT INCLUDED IN THE FINANCIAL STATEMENTS FOR THE MEDICAL CENTER. |
| PART X, LINE 2: | THE HOSPITAL IS ORGANIZED AS AN ARIZONA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE HOSPITAL HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS INCLUDED IN EXPENSES FOR FORM 990 -1,173,564. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | WHITE MOUNTAIN AUXILIARY REVENUE INCLUDED IN REVENUE FOR FORM 990 10,876. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | PROVISION FOR BAD DEBTS INCLUDED IN EXPENSES FOR FORM 990 1,173,564. WHITE MOUNTAIN AUXILIARY EXPENSES INCLUDED IN EXPENSES FOR FORM 990 12,853. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $12,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00070 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,958,385 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,860,970 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,097,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12190 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,970,385 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,860,970 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,109,415 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12260 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $7,073 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $7,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,226,431 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $609,458 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,616,973 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09400 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,240 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,240 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,234,744 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $609,458 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,625,286 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09450 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,205,129 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,470,428 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,734,701 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.21710 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,173,564 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $240,581 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,951,329 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,984,139 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$32,810 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITE MOUNTAIN COMMUNITIES HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | SPRINGERVILLE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 859355104 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.WMRMC.COM | WebsiteAddressTxt |
| State License | H2530 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | PROVIDER BASED - WHITE MTN REGL SPECIALTY CLINIC | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WHITE MOUNTAIN COMMUNITIES HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.WMRMC.COM | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.WMRMC.COM | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.WMRMC.COM | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.WMRMC.COM | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.WMRMC.COM | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| WHITE MOUNTAIN COMMUNITIES HOSPITAL, INC. | PART V, SECTION B, LINE 5: THE CHNA SURVEY WAS SHARED WITH OUR COMMUNITY THROUGH SEVERAL VENUES, SOCIAL MEDIA, ELECTRONICALLY, PAPER COPIES, FLYERS AND SOCIAL MEDIA. WMRMC ALSO USED THE ANNUAL HEALTH FAIR AS AN EVENT TO GATHER MANY PAPER AND ELECTRONIC RESPONSES TO THE SURVEY. THE SURVEY WAS SHARED IN PAPER FORM AT THE FOLLOWING LOCATIONS: WMRMC HEALTH FAIR MOUNTAIN AVENUE CLINIC NORTH COUNTRY CLINIC BILLY CREEK CLINIC WMRMC SPECIALTY AND FAMILY CLINIC WMRMC OUTPATIENT CHECK IN WMRMC JEAN V. HALL WELLNESS CENTER WMRMC BOARD MEMBERS APACHE COUNTY FAIR THE SURVEY PRESENTS AN EFFORT TO SOLICIT INPUT FROM THE BROADER COMMUNITY. WHILE, THE INITIATIVE IS INFORMAL AND NON-REPRESENTATIVE, IT DOES CONTRIBUTE CONSIDERABLE INPUT FROM THE BROADER COMMUNITY. THEY SURVEY TYPICALLY QUERIES RESPONDENT'S HEALTH-RELATED NEEDS AND BEHAVIORS. THIS PROVIDES BOTH AN INDICATION OF LOCAL DEMAND FOR HEALTH SERVICES AND THE LEVEL OF SATISFACTION WITHIN THE SERVICES RECEIVED. |
| WHITE MOUNTAIN COMMUNITIES HOSPITAL, INC. | PART V, SECTION B, LINE 11: UPON ANALYSIS OF THE CHNA COMPLETED BETWEEN JUNE AND SEPTEMBER OF 2015, THE FOLLOWING IS A PRIORITIZED DESCRIPTION OF SIGNIFICANT HEALTH NEEDS AND DIAGNOSES WITHIN THE DEMOGRAPHIC AREA OF WMRMC: 1. ADDITIONAL PRIMARY CARE PHYSICIAN TO ADDRESS THE TOP 5 HEALTHCARE NEEDS WHICH INCLUDE: GENERAL CHECKUPS, ALLERGIES, HIGH BLOOD PRESSURE, HIGH CHOLESTEROL, INJURY, SPORTS PHYSICALS AND DIABETES MANAGEMENT. 2. WOMEN'S HEALTH - GYNECOLOGY AND FAMILY PLANNING SERVICES. 3. DIABETES MANAGEMENT 4. ASTHMA MANAGEMENT 5. CHRONIC PAIN 6. DEPRESSION 7. IDENTIFY AND ACCESS TO COMMUNITY RESOURCES STRATEGY RURAL HEALTH CLINIC (DIABETES MANAGEMENT, ASTHMA MANAGEMENT, WOMEN'S HEALTH NEEDS) WMRMC IS IN FULLY ENGAGED IN THE PROCESS OF TURNING OUR FAMILY AND SPECIALTY CARE CLINIC INTO A RURAL HEALTH CLINIC (RHC). UNDER THIS DESIGNATION, WMRMC WILL RECEIVE ENHANCED REIMBURSEMENT RATES FROM MEDICARE AND AHCCCS. ONE OF THE REQUIREMENTS OF AN RHC IS THE EMPLOYMENT OF A MID-LEVEL PROVIDER IN ADDITION TO PRIMARY CARE PHYSICIANS. THIS WILL ASSIST WMRMC IN ADDRESSING DIABETES MANAGEMENT, ASTHMA MANAGEMENT AND WOMEN'S HEALTH NEEDS THROUGH EXAMS AND REFERRALS. AN ADDITIONAL MEASURE FOR DIABETES MANAGEMENT IS A PLAN TO HAVE OUR PHYSICIANS ENROLL IN A STATE PROGRAM FOR DIABETES MANAGEMENT CALLED, "AGENTS OF CHANGE, FOR DIABETES PREVENTION." THIS PROGRAM'S GOAL IS TO ENROLL PHYSICIAN TEAMS WHO PROMISE TO REFER PRE-DIABETIC PATIENTS TO CENTER FOR DISEASE CONTROL PROGRAMS SO PATIENTS CAN BE AWARE AND LEARN OF THE ILLNESS. PRESCRIPTION MEDICATION NEEDS UPON REVIEW OF THE CHNA DATA, 51% OF PATIENTS ARE NOT COMPLIANT IN TAKING THEIR PRESCRIPTION MEDICATION IN SOME WAY. WMRMC PLANS TO WORK WITH OUR STAFF PHARMACIST IN EDUCATING THE PUBLIC ABOUT THE IMPORTANCE OF TAKING PRESCRIBED MEDICATION. THIS OUTREACH WILL BE EXPLORED AND IMPLEMENTED THROUGH EVENTS LIKE THE HEALTH FAIR, SHARING INFORMATION WITH PATIENTS IN VARIOUS MEDIUMS LIKE SOCIAL MEDIA, PRINT, AND A PARTNERSHIP WITH THE APACHE COUNTY HEALTH DISTRICT. WMRMC HAS MEASURES IN PLACE THROUGH THE DISCHARGE PROCESS, EITHER INPATIENT OR EMERGENCY SERVICES TO MAKE SURE THE PATIENT UNDERSTANDS THE NEED FOR THEIR PRESCRIPTION MEDICATION, DOSAGE REQUIREMENTS AND DURATION OF THE PRESCRIPTION. ADDITIONALLY NURSES EDUCATE PATIENTS WITH A CURRENT LIST OF MEDICATIONS AND EDUCATION ON DISEASE PROCESSES TO ENSURE THE PATIENT UNDERSTANDS THE IMPORTANCE OF COMPLYING WITH PHYSICIAN'S ORDERS. BEHAVIORAL HEALTH NEEDS THOUGH WMRMC DOES NOT PROVIDE PSYCHIATRY/COUNSELING SERVICES, WMRMC WILL BE PARTICIPATING IN A PARTNERSHIP WITH ACPHD IN A CASPER (COMMUNITY ASSESSMENT FOR PUBLIC EMERGENCY RESPONSE TEAM). THIS TEAM WILL INVOLVE INTERVIEWING PEOPLE IN THE COMMUNITY ABOUT BEHAVIORAL HEALTH NEEDS AND PROVIDE VALID, POPULATION-BASED HEALTH INFORMATION ABOUT THE NEEDS OF OUR COMMUNITY. IN ADDITION, ADDITIONAL PRIMARY CARE PHYSICIANS ARE ABLE TO ASSIST PATIENTS THROUGH RESOURCE SHARING AND MANAGING PRESCRIPTIONS FOR PATIENTS WITH MENTAL HEALTH CONCERNS. CARING FOR OUR ELDERLY POPULATION WMRMC HAS ENGAGED OUR ELDERLY POPULATION RESOURCES THROUGH AN ELDER CARE FORUM THAT OCCURS EVERY 3 MONTHS AT THE FACILITY. THE LOCAL RESOURCES THAT ASSIST THE ELDERLY AND CHRONICALLY ILL MEET TO DISCUSS GAPS IN CARE, AND SHARE INFORMATION TO BETTER ASSIST THE COMMUNITY. THOSE RESOURCES INCLUDE: ROUND VALLEY SENIOR CENTER, BEEHIVE HOUSE, ELDER, EMERGENCY MANAGEMENT AND CHRONIC DISEASE MANAGEMENT AT ACPHD, HOSPICE COMPASSUS AND HOSPICE ACCORD, AHCCCS, ALTCS, NAVAJO COUNTY LEGAL AID, AND LITTLE COLORADO BEHAVIORAL HEALTH CENTER ALONG WITH OUR OWN SWING BED PROGRAM. THE FORUMS BEGAN IN JANUARY 2016. COMMUNITY KNOWLEDGE OF RESOURCES AVAILABLE WMRMC IS IN THE PLANNING PROCESS OF CREATING A RESOURCE AREA FOR THE COMMUNITY TO ACCESS INFORMATION ABOUT LOCAL HEALTHCARE RESOURCES IN ITS MAIN RECEPTION AREA. THE RESOURCE AREA WILL INCLUDE INFORMATION ABOUT ALL OF THE SERVICES OUR HOSPITAL PROVIDES, AS WELL AS INFORMATION ABOUT ACPHD PROGRAM INFORMATION. OTHER LOCAL PROVIDERS, LIKE NORTH COUNTRY HEALTH CARE, MOUNTAIN AVENUE CLINIC AND BILLY CREEK CLINIC, WILL ALSO PARTICIPATE AND SHARE THE INFORMATION ABOUT THEIR OFFERINGS. THE PURPOSE OF THE RESOURCE AREA IS TO HAVE A ONE-STOP LOCATION FOR COMMUNITY INFORMATION. THE MARKETING AND PUBLIC RELATIONS MANAGER WILL WORK WITH THE AGENCIES, CLINICS AND PROGRAMS TO KEEP THE INFORMATION CURRENT. ACPHD HAS DONATED MATERIALS TO HANG INFORMATION FOR THE RESOURCE AREA AND WMRMC LADIES' AUXILIARY PLANS TO DONATE A TELEVISION TO DISPLAY PATIENT COMMENTS AND RESOURCE INFORMATION. |
| WHITE MOUNTAIN COMMUNITIES HOSPITAL, INC. | PART V, SECTION B, LINE 13H: UNINSURED PATIENTS HAVING ANNUAL HOUSEHOLD INCOMES OF $125,000 OR LESS MAY, DEPENDING UPON THEIR ASSETS AND LIABILITIES, QUALIFY FOR DISCOUNTED PRICING FOR COVERED SERVICES WITHOUT HAVING TO APPLY FOR MEDICAID ASSISTANCE. UNDER THE CHARITY CARE PROGRAM, UNINSURED PATIENTS HAVING HOUSEHOLD INCOMES AT OR BELOW 200% OF THE FEDERAL POVERTY LINE AND INSUFFICIENT ASSETS MAY, DEPENDINGUPON THEIR ASSETS AND LIABILITIES, QUALIFY CHARITY CARE IN THE FORM OF FREE EMERGENT SERVICES AND OTHER SERVICES REQUIRED TO BE PROVIDED BY WMRMC UNDER EMTALA, SUBJECT (IN MOST CIRCUMSTANCES) TO APPLICATION FOR MEDICAID, AND FOR DISCOUNTED PRICING FOR OTHER COVERED SERVICES. |
| WHITE MOUNTAIN COMMUNITIES HOSPITAL, INC. | PART V, SECTION B, LINE 22D: THE AMOUNTS GENERALLY BILLED IS BASED UPON THE AVERAGE OF THE AMOUNTS THAT WOULD HAVE BEEN PAID TO THE HOSPITAL BY PRIVATE HEALTH INSURERS AND MEDICARE (AND CO-PAYS AND DEDUCTIBLES) FOR THE MEDICALLY NECESSARY SERVICES RECEIVED. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 2 - WHITE MOUNTAIN REGIONAL REHABWELLNESS | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 SOUTH MOUNTAIN AVENUE | AddressLine1Txt |
| City | SPRINGERVILLE | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85938 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | REHAB/WELLNESS CENTER | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | UNINSURED PATIENTS HAVING ANNUAL HOUSEHOLD INCOMES OF $125,000 OR LESS MAY, DEPENDING UPON THEIR ASSETS AND LIABILITIES, QUALIFY FOR DISCOUNTED PRICING FOR COVERED SERVICES WITHOUT HAVING TO APPLY FOR MEDICAID ASSISTANCE. UNDER THE CHARITY CARE PROGRAM, UNINSURED PATIENTS HAVING HOUSEHOLD INCOMES AT OR BELOW 200% OF THE FEDERAL POVERTY LINE AND INSUFFICIENT ASSETS MAY, DEPENDING UPON THEIR ASSETS AND LIABILITIES, QUALIFY CHARITY CARE IN THE FORM OF FREE EMERGENT SERVICES AND OTHER SERVICES REQUIRED TO BE PROVIDED BY WMRMC UNDER EMTALA, SUBJECT (IN MOST CIRCUMSTANCES) TO APPLICATION FOR MEDICAID, AND FOR DISCOUNTED PRICING FOR OTHER COVERED SERVICES. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT WAS AVAILABLE UPON REQUEST AT THE HOSPITAL AND WILL BE POSTED TO OUR WEBSITE IN 2016. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I ARE REPORTED BASED ON ACTUAL EXPENSE AND REVENUE AMOUNTS RECORDED FROM THE EVENTS IN THE GENERAL LEDGER. THE COST FOR SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $1,173,564. |
| PART III, LINE 2: | PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT AFTER EVERY EFFORT IS MADE TO COLLECT THE BALANCE AND PATIENTS ARE GIVEN OPPORTUNITIES TO COMPLETE CHARITY CARE APPLICATIONS OR SET UP PAYMENT PLANS. ALL DISCOUNTS AND CONTRACTUAL ADJUSTMENTS ARE APPLIED TO ACCOUNTS BEFORE THEY ARE WRITTEN OFF TO BAD DEBT. CURRENT PAYMENTS ON ACCOUNTS PREVIOUSLY WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.BAD DEBT EXPENSE ON LINE 2 IS REPORTED AT CHARGES AS PRESENTED ON THE FINANCIAL STATEMENTS. |
| PART III, LINE 3: | A REASONABLE ESTIMATE OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY IS 20.5% OF BAD DEBT EXPENSE. THIS IS BASED ON THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY.THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $1,173,564. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS CAN BE FOUND ON PAGE 7 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | WHITE MOUNTAIN REGIONAL MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL. THERE WAS A MEDICARE SHORTFALL FOR 2015 DUE TO SEQUESTRATION. EVEN THOUGH MEDICARE WAS AT A LOSS, THE HOSPITAL PROVIDES SERVICES TO THESE PATIENTS BECAUSE ACCESS TO HEALTHCARE AND INDIVIDUAL'S HEALTH IS IMPORTANT TO THE HOSPITAL. THEREFORE, THE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT.TOTAL REVENUE RECEIVED FROM MEDICARE (INCLUDING DSH AND IME) IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT (INCLUDING LSA). BOTH THE TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICAID AND MEDICARE SERVICES. |
| PART III, LINE 9B: | IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE PATIENT WILL IN NO CASE BE CHARGED MORE THAN AMOUNTS GENERALLY BILLED FOR EMERGENCY SERVICES OR OTHER MEDICALLY NECESSARY SERVICES. IN ADDITION, THEY WILL NEVER BE REQUIRED TO MAKE ADVANCE PAYMENT OR OTHER PAYMENT ARRANGEMENTS IN ORDER TO RECEIVE EMERGENCY SERVICES. HOWEVER, THEY WILL BE REQUIRED IN MOST SITUATIONS TO MAKE A SUBSTANTIAL ADVANCE DEPOSIT OR OTHER PAYMENT ARRANGEMENTS BASED UPON AN ESTIMATE OF THE AMOUNTS GENERALLY BILLED IN ORDER TO RECEIVE NON-EMERGENCY SERVICES. THE ACCOUNT WILL NOT BE TURNED OVER TO A COLLECTION AGENCY WHILE AN APPLICATION IS IN PROCESS. ANY PERSONAL AMOUNT DUE WILL FOLLOW NORMAL COLLECTION PROCEDURES. |
| PART VI, LINE 2: | IN APRIL AND MAY, 2015, THE WHITE MOUNTAIN REGIONAL MEDICAL CENTER AND THE APACHE COUNTY HEALTH DISTRICT CO?SPONSORED THE WMRMC AND APACHE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENT. A BROADLY REPRESENTATIVE GROUP OF 10 APACHE COUNTY LEADERS MET OVER THE COURSE OF THREE MEETINGS TO IDENTIFY PRIORITIES AND DEVISE ACTION STRATEGIES. AFTER CONSIDERATION OF A HOST OF INFORMATION, LOCAL HEALTH?RELATED PRIORITIES WERE ESTABLISHED. THE CHNA WAS APPROVED BY THE BOARD AND POSTED TO THE HOSPITAL'S WEBSITE. |
| PART VI, LINE 3: | THE FINANCIAL ASSISTANCE POLICY, APPLICATION AND PLAIN LANGUAGE SUMMARY ARE PROVIDED ON THE HOSPITAL'S WEBSITE. THE PLAIN LANGUAGE SUMMARY IS PROVIDED IN ENGLISH AND SPANISH. SPANISH TRANSLATION OF THE FINANCIAL ASSISTANCE POLICY AND APPLICATION AND BILLING POLICY IS AVAILABLE AT THE HOSPITAL. COPIES OF THESE DOCUMENTS ARE ALSO AVAILABLE IN THE ADMITTING AREA LOCATED NEAR THE MAIN ENTRANCE OF THE HOSPITAL AND BY MAIL BY CONTACTING PATIENT FINANCIAL SERVICES AT 928-333-7150. |
| PART VI, LINE 4: | WHITE MOUNTAIN REGIONAL MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL. THE MEDICAL CENTER SERVES SOUTHERN APACHE COUNTY, ARIZONA, AS WELL AS CATRON, COUNTY, NEW MEXICO. BOTH ARE HIGH POVERTY AREAS. THE POPULATION IN SPRINGERVILLE, AZ WAS 1,964 IN 2014. THE ESTIMATED MEDIAN HOUSEHOLD INCOME IN 2013 WAS $36,889 COMPARED TO $48,510 IN ARIZONA. THE UNEMPLOYMENT RATE IN SEPTEMBER 2015 WAS 13.3% COMPARED TO 6.4% IN ARIZONA. THE PERCENTAGE OF RESIDENTS LIVING IN POVERTY IN 2013 WAS 20.5%. (13.7% FOR WHITE NON-HISPANIC RESIDENTS, 32.2% FOR HISPANIC OR LATINO RESIDENTS, 68.7% FOR AMERICAN INDIAN RESIDENTS, 30.2% FOR OTHER RACE RESIDENTS. THE MOST COMMON INDUSTRIES WERE CONSTRUCTION AND UTILITIES. DATA WAS OBTAINED FROM WWW.CITY-DATA.COM. THE NEAREST HOSPITAL IS 45 MINUTES AWAY IN SHOW LOW, ARIZONA. |
| PART VI, LINE 5: | THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE MEDICAL CENTER'S PRIMARY SERVICE AREA. WHITE MOUNTAIN REGIONAL MEDICAL CENTER EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS. ANY SURPLUS FUNDS ARE USED FOR EQUIPMENT AND FACILITY UPGRADES TO GIVE OUR PATIENTS THE LATEST IN TECHNOLOGY.WHITE MOUNTAIN REGIONAL MEDICAL CENTER IS CURRENTLY A LEVEL 4 TRAUMA CENTER. IN 2014, THE HOSPITAL ALSO RECEIVED PEDIATRIC EMERGENCY CERTIFICATION. THERE ARE SEVERAL PHYSICIANS/PROVIDERS LOCATED IN THE AREA THAT ROUTINELY USE OUR FACILITY IN SOME CAPACITY. IN ADDITION, THERE ARE MANY PHYSICIANS WITH SUB-SPECIALTIES THAT VISIT THE AREA PROVIDING OBSTETRICS AND GYNECOLOGY, OPHTHALMOLOGY, ORTHOPEDIC, PODIATRY, AND GENERAL SURGERY CLOSE TO HOME, THROUGH THE WHITE MOUNTAIN SPECIALTY CLINIC. AS IT CURRENTLY OPERATES, WHITE MOUNTAIN REGIONAL MEDICAL CENTER IS A 25 BED CRITICAL ACCESS HOSPITAL. IN ADDITION TO INPATIENT SERVICES, THE FACILITY OFFERS: GENERAL OUTPATIENT SURGICAL SERVICES;GENERAL OUTPATIENT MEDICAL SERVICES;EMERGENCY SERVICES;MEDICAL IMAGING SERVICES, WHICH INCLUDE X-RAY, MRI, C-T SCAN, BONE DENSITOMETRY, NUCLEAR MEDICINE AND ULTRA SOUND;LABORATORY SERVICES, WHICH INCLUDE BLOOD BANK, CHEMISTRY AND HEMATOLOGY;CARDIOPULMONARY SERVICES, WHICH INCLUDE RESPIRATORY SERVICES, PULMONARY FUNCTION SERVICES, SLEEP STUDY, EKG SERVICES AND CARDIAC STRESS TESTING;INPATIENT PHARMACY SERVICES;REHABILITATION SERVICES, WHICH INCLUDE INPATIENT AND OUTPATIENT PHYSICAL THERAPY, AND CHIROPRACTIC;WELLNESS CENTER;FOOD SERVICES, WHICH INCLUDE A CONSULTING REGISTERED DIETITIAN. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | HEALTHCARE TRAINING SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 9 | RecipientCnt |
| Cash Grant | $6,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | WHITE MOUNTAIN REGIONAL MEDICAL CENTER AUXILIARY OFFERS SCHOLARSHIPS TO INDIVIDUALS ENTERING A HEALTH RELATED FIELD. THE GOAL IS TO MAKE IT POSSIBLE FOR THE PEOPLE OF THE AREA TO RECEIVE FIRST CLASS HEALTH CARE AS CLOSE TO HOME AS POSSIBLE. AN APPLICATION MUST BE COMPLETED AND AN INTERVIEW WITH MEMBERS OF THE SCHOLARSHIP COMMITTEE IS REQUIRED IN THE FINAL SELECTION PROCESS. CHECKS ARE WRITTEN TO THE SCHOLARSHIP RECIPIENT'S SCHOOL ON THEIR BEHALF TO ENSURE THE FUNDS ARE USED APPROPRIATELY. A GRADE POINT AVERAGE OF 3.0 IS REQUIRED FOR THE FIRST SEMESTER TO RECEIVE THE SECOND SEMESTER FUNDS. A COPY OF THE CREDITS FROM THE SELECTED INSTITUTION MUST BE RECEIVED TO ENSURE PAYMENT. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| GREG WAS | ||||||||||||||
| CEO | $155,048 | $0 | $5,000 | $0 | $381 | $0 | $0 | $0 | $0 | $0 | $160,429 | $0 | $0 | $0 |
| CARLA ROTERING MD | ||||||||||||||
| PULMONOLOGY | $210,955 | $0 | $17,000 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $227,955 | $0 | $0 | $0 |
| MICHAEL FOOTE MD | ||||||||||||||
| INTERNAL MEDICINE | $177,184 | $0 | $0 | $0 | $3,846 | $0 | $0 | $0 | $0 | $0 | $181,030 | $0 | $0 | $0 |
| CHRISTINE JACKSON MD | ||||||||||||||
| CARDIOLOGIST | $192,637 | $0 | $1,750 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $194,387 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| TOM HUNT | |||
| FAMILY RELATIONSHIP WITH BOARD MEMBER | $130,529 | COMPENSATION AND BENEFITS AS EMPLOYEE | 0 |
| ROBERT MARTIN | |||
| FAMILY RELATIONSHIP WITH BOARD MEMBER | $111,829 | COMPENSATION AND BENEFITS AS EMPLOYEE | 0 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE IS COMPOSED OF THE OFFICERS OF PRESIDENT, VICE PRESIDENT, SECRETARY AND TREASURER. THE EXECUTIVE COMMITTEE IS EMPOWERED TO ACT ON BEHALF OF THE FULL BOARD ON ALL MATTERS REQUIRING ACTION AND ATTENTION BETWEEN REGULAR BOARD MEETINGS OR WHEN A SPECIAL MEETING WOULD NOT BE TIMELY. ALL ACTIONS OF THE EXECUTIVE COMMITTEE WILL BE PRESENTED AT THE NEXT REGULAR BOARD MEETING FOR INFORMATION AND/OR RATIFICATION. THIS COMMITTEE, BY ITS OWN POLICY, MAY ESTABLISH MEETING NOTIFICATION REQUIREMENTS. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE FORM 990 IS REVIEWED BY ALL VOTING BOARD MEMBERS AT THE BOARD MEETING PRIOR TO FILING. THE CEO AND CFO REVIEW THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CONFLICT OF INTEREST IS COMPLETED AND SIGNED BY OFFICERS AND DIRECTORS ON AN ANNUAL BASIS. THE COMPLETED POLICIES ARE REVIEWED BY THE DIRECTORS. IT IS THE RESPONSIBILITY OF THE DIRECTORS TO MAKE FULL DISCLOSURE OF ANY INTEREST, WHICH MIGHT RESULT IN A CONFLICT ON THEIR PART, WHETHER FINANCIAL OR OTHERWISE. AT ANY MEETING OF THE DIRECTORS, ANY DIRECTOR MAY DECLARE A CONFLICT OF INTEREST PRIOR TO THE DISCUSSION OF THE ISSUE IN QUESTION. ANY DIRECTOR MAY STATE THAT HE OR SHE FEELS ANOTHER DIRECTOR HAS A CONFLICT OF INTEREST. IF A MAJORITY OF THE DIRECTORS DETERMINE THAT A CONFLICT DOES EXIST, THE DIRECTOR IN QUESTION WILL REMOVE HIMSELF/HERSELF FROM ANY DISCUSSION REGARDING THE ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15A | COMPENSATION FOR THE CEO IS DETERMINED UTILIZING A WAGE WATCH FOR COMPARISON SALARY DATA, APPROVED BY THE BOARD AND DOCUMENTED IN THE BOARD MINUTES. COMPENSATION FOR THE CFO IS DETERMINED UTILIZING A WAGE WATCH FOR COMPARISON SALARY DATA, APPROVED BY THE CEO AND DOCUMENTED IN THE PERSONNEL FILE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 300,451. MANAGEMENT AND GENERAL EXPENSES 60,229. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 360,680. CONSULTING FEES: PROGRAM SERVICE EXPENSES 5,302. MANAGEMENT AND GENERAL EXPENSES 16,734. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,036. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,383,498. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,383,498. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 1,357,586. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,357,586. RECRUITING: PROGRAM SERVICE EXPENSES 1,018. MANAGEMENT AND GENERAL EXPENSES 1,280. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,298. |
| FORM 990, PART XI, LINE 9: | CHANGE IN WHITE MOUNTAIN REGIONAL MEDICAL CENTER AUXILIARY'S ASSETS 1,977. |
| FORM 990, PART XI, LINE 8: | DURING THE YEAR, THE HOSPITAL HAS CHANGED THEIR POLICY REGARDING RECOGNIZING INCENTIVE FOR ELECTRONIC HEALTH RECORDS. THE REVENUE WILL BE DEFERRED OVER A 5 YEAR PERIOD. THE EFFECT OF THE CHANGE WAS AN INCREASE IN DEFERRED REVENUE OF $412,068 FOR THE PERIOD ENDING DECEMBER 31, 2014. THIS RESULTED IN A REDUCTION OF 2014 EHR INCENTIVE INCOME, AND THEREFORE 2014 ENDING NET ASSETS, OF $412,068. |
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