COMMUNITY HOSPITAL ASSOCIATION INC: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION INC (EIN 86-0096775)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-11
- IRS object ID
- 201413159349301741
- Schema version
- 2013v3.1
- 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 B
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-11T11:52:02-06:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 South Tejon Suite 800 | AddressLine1 |
| City | Colorado Springs | City |
| State | CO | State |
| ZIP Code | 809039848 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860096775 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % THE ORGANIZATION | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 9286844390 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Jim Tavary | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9286844390 | PhoneNum |
| Signature | 2014-10-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Rita F Worster CPA | PreparerPersonNm |
| PTIN | P00290681 | PTIN |
| Phone | 9286844390 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jim Tavary | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,913,751 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wickhosp.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | To provide quality health and wellness services where the patient, family and community come first. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 224 | TotalEmployeeCnt |
| Total Volunteers | 58 | TotalVolunteersCnt |
| Total Gross UBI | $13,673 | TotalGrossUBIAmt |
| PY Contributions Grants | $316,115 | PYContributionsGrantsAmt |
| CY Contributions Grants | $151,771 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $18,004,452 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,642,812 | CYProgramServiceRevenueAmt |
| PY Investment Income | $13,005 | PYInvestmentIncomeAmt |
| CY Investment Income | -$11,916 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$84,640 | PYOtherRevenueAmt |
| CY Other Revenue | -$17,595 | CYOtherRevenueAmt |
| PY Total Revenue | $18,248,932 | PYTotalRevenueAmt |
| CY Total Revenue | $22,765,072 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $10,502,401 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,580,610 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,152,446 | PYOtherExpensesAmt |
| CY Other Expenses | $11,266,788 | CYOtherExpensesAmt |
| PY Total Expenses | $19,654,847 | PYTotalExpensesAmt |
| CY Total Expenses | $21,847,398 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,405,915 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $917,674 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $15,899,677 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,526,294 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,311,418 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $10,675,010 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $6,588,259 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,851,284 | NetAssetsOrFundBalancesEOYAmt |
| Mission | To provide quality health and wellness services where the patient, family, and community come first. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $19,245,527 | ExpenseAmt |
| Revenue | $22,361,852 | RevenueAmt |
| Desc | Provide inpatient and outpatient diagnostic and therapeutic health care services to the residents and visitors of greater Wickenburg, Arizona, a rural community of approximately 23,000. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $386,558 | ExpenseAmt |
| Revenue | $245,855 | RevenueAmt |
| Desc | Provide Fitness Center for residents and visitors of greater Wickenburg, Arizona, promoting a wellness environment for the community. | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Expenses | $19,632,085 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 45 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 224 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 9286844390 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| UWE GROSS | |||||||||
| PRESIDENT | 1.0 | Yes (X) | Yes (X) | ||||||
| BOB MCCOY | |||||||||
| VICE PRESIDENT | 1.0 | Yes (X) | Yes (X) | ||||||
| RICHARD ABBUHL | |||||||||
| SECRETARY | 1.0 | Yes (X) | Yes (X) | ||||||
| GARY TURNER | |||||||||
| TREASURER | 1.0 | Yes (X) | Yes (X) | ||||||
| DENNIS BARRACO DO | |||||||||
| BOARD MEMBER thru 01/2013 | 1.0 | Yes (X) | |||||||
| SALLIE HERSHKOWITZ | |||||||||
| BOARD MEMBER THRU 04/2013 | 1.0 | Yes (X) | |||||||
| Ajai Sawhney MD | |||||||||
| BOARD MEMBER | 1.0 | Yes (X) | |||||||
| KEVIN ARMSTRONG | |||||||||
| BOARD MEMBER | 1.0 | Yes (X) | |||||||
| JOHN SNAVELY | |||||||||
| BOARD MEMBER | 1.0 | Yes (X) | |||||||
| DEE POLLOCK | |||||||||
| BOARD MEMBER | 1.0 | Yes (X) | |||||||
| JOHN COOK | |||||||||
| BOARD MEMBER | 1.0 | Yes (X) | |||||||
| JIM TAVARY | |||||||||
| CHIEF EXECUTIVE OFFICER | 39.0 | Yes (X) | 1.0 | $173,074 | $0 | $22,962 | |||
| JAMES SMITH | |||||||||
| CHIEF FINANCIAL OFFICER | 39.0 | Yes (X) | 1.0 | $153,974 | $13,999 | ||||
| WILLIAM FIRTH MD | |||||||||
| CHIEF OF STAFF & CLNC MED DIR | 40.0 | $237,112 | $42,187 | Yes (X) | |||||
| MARILYN HALDER MD | |||||||||
| PHYSICIAN | 40.0 | $175,121 | $22,252 | Yes (X) | |||||
| TODD KRAVETZ MD | |||||||||
| PHYSICIAN | 40.0 | $231,261 | $30,008 | Yes (X) | |||||
| ROGER ROSE | |||||||||
| PHARMACIST | 40.0 | $177,911 | $14,928 | Yes (X) | |||||
| Linda Brockwell | |||||||||
| Chief Nursing Officer | 40.0 | $102,258 | $7,969 | Yes (X) | |||||
| Nancy Carter | |||||||||
| Physician Assistant | 40.0 | $102,929 | $8,500 | Yes (X) | |||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,353,640 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $162,805 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1 | CityContractorAddress/USAddress/City | StateContractorAddress/USAddress/State | ZIP CodeContractorAddress/USAddress/ZIPCode | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| EMCARE PHYSICIAN SERVICES INC | |||||
| 7032 COLLECTION CENTER DR | CHICAGO | IL | 60693 | PHYSICIANS | $570,666 |
| Medical Diagnostic Imaging Group L | |||||
| PO Box 17049 | PHOENIX | AZ | 85011 | MEDICAL IMAGING | $492,937 |
| CPSI | |||||
| PO Box 850309 | MOBILE | AL | 36685 | Software Services | $278,173 |
| Alliance Imaging | |||||
| File 55826 | LOS ANGELES | CA | 90074 | Medical Imaging | $274,152 |
| DELTA HEALTHCARE PROVIDERS | |||||
| PO BOX 202940 | DALLAS | TX | 75320 | EMPLOYMENT AGENCY | $185,538 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 8 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $140,921 | RelatedOrganizationsAmt |
| All Other Contributions | $10,850 | AllOtherContributionsAmt |
| Total Contributions | $151,771 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE | 621990 | $9,023,802 | $9,023,802 |
| PATIENT SERVICES | 621990 | $10,550,878 | $10,550,878 |
| 340B DRUG PRICING PROGRAM REVENUE | 621990 | $2,219,587 | $2,219,587 |
| EHR INCENTIVE PAYMENTS | 621990 | $544,563 | $544,563 |
| WELLNESS CENTER | 621990 | $245,855 | $245,855 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $58,127 | TotalRevenueColumnAmt |
| Exclusion | $58,127 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,642,812 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,811 | TotalRevenueColumnAmt |
| Exclusion | $2,811 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $77,925 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $131,952 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -$54,027 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$54,027 | TotalRevenueColumnAmt |
| Unrelated Business Revenue | $13,673 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$67,700 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $2,000 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $16,727 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$14,727 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$14,727 | TotalRevenueColumnAmt |
| Exclusion | -$14,727 | ExclusionAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER REVENUE | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $36,432 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,022 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $13,410 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $36,432 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,765,072 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,607,707 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $13,673 | UnrelatedBusinessRevenueAmt |
| Exclusion | -$8,079 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $643,308 | TotalAmt |
| Program Services | $279,299 | ProgramServicesAmt |
| Management And General | $364,009 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,192,459 | TotalAmt |
| Program Services | $7,602,533 | ProgramServicesAmt |
| Management And General | $589,926 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,114,665 | TotalAmt |
| Program Services | $1,099,815 | ProgramServicesAmt |
| Management And General | $14,850 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $630,178 | TotalAmt |
| Program Services | $565,977 | ProgramServicesAmt |
| Management And General | $64,201 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,528 | TotalAmt |
| Management And General | $28,528 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,136 | TotalAmt |
| Management And General | $123,136 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,416,497 | TotalAmt |
| Program Services | $2,215,228 | ProgramServicesAmt |
| Management And General | $201,269 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $213,919 | TotalAmt |
| Program Services | $145,892 | ProgramServicesAmt |
| Management And General | $68,027 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $224,299 | TotalAmt |
| Program Services | $224,299 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $233,151 | TotalAmt |
| Program Services | $222,570 | ProgramServicesAmt |
| Management And General | $10,581 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,887 | TotalAmt |
| Program Services | $32,306 | ProgramServicesAmt |
| Management And General | $7,581 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,219 | TotalAmt |
| Program Services | $62,825 | ProgramServicesAmt |
| Management And General | $5,394 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $496,906 | TotalAmt |
| Management And General | $496,906 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,136,103 | TotalAmt |
| Program Services | $1,127,562 | ProgramServicesAmt |
| Management And General | $8,541 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $234,364 | TotalAmt |
| Program Services | $232,364 | ProgramServicesAmt |
| Management And General | $2,000 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $3,481,129 | $3,481,129 | |
| PROVISION FOR BAD DEBTS | $1,772,906 | $1,772,906 | |
| REPAIRS & MAINTENANCE | $449,237 | $417,597 | $31,640 |
| MISCELLANEOUS | $348,507 | $149,783 | $198,724 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,847,398 | TotalAmt |
| Program Services | $19,632,085 | ProgramServicesAmt |
| Management And General | $2,215,313 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part X | Yes (X) | InfoInScheduleOPartXInd |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $499,550 | BOYAmt |
| EOY | $2,806,368 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $55,906 | BOYAmt |
| EOY | $149,206 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,758,580 | BOYAmt |
| EOY | $3,691,524 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $657,620 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $460,101 | BOYAmt |
| EOY | $493,055 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $289,036 | BOYAmt |
| EOY | $294,345 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,299,481 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,482,955 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,105,882 | BOYAmt |
| EOY | $9,816,526 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $485,931 | BOYAmt |
| EOY | $510,994 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $68,754 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $587,071 | BOYAmt |
| EOY | $3,695,522 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,899,677 | BOYAmt |
| EOY | $21,526,294 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,893,582 | BOYAmt |
| EOY | $3,517,936 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,465,000 | BOYAmt |
| EOY | $5,355,000 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,884,481 | BOYAmt |
| EOY | $1,740,568 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $68,355 | BOYAmt |
| EOY | $61,506 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,311,418 | BOYAmt |
| EOY | $10,675,010 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,451,072 | BOYAmt |
| EOY | $7,366,876 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $137,187 | BOYAmt |
| EOY | $3,484,408 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,588,259 | BOYAmt |
| EOY | $10,851,284 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,899,677 | BOYAmt |
| EOY | $21,526,294 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $917,674 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $3,345,351 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $137,187 | BeginningYearBalanceAmt |
| Contributions | $98,101 | ContributionsAmt |
| Investment Earnings Or Losses | $3,701,284 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $354,063 | OtherExpendituresAmt |
| End Year Balance | $3,582,509 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $98,635 | BeginningYearBalanceAmt |
| Contributions | $217,877 | ContributionsAmt |
| Other Expenditures | $179,325 | OtherExpendituresAmt |
| End Year Balance | $137,187 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $26,885 | BeginningYearBalanceAmt |
| Contributions | $397,587 | ContributionsAmt |
| Other Expenditures | $325,837 | OtherExpendituresAmt |
| End Year Balance | $98,635 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $68,115 | BeginningYearBalanceAmt |
| Contributions | $1,000 | ContributionsAmt |
| Investment Earnings Or Losses | -$3,500 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $38,730 | OtherExpendituresAmt |
| End Year Balance | $26,885 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $116,962 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$16,413 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $32,434 | OtherExpendituresAmt |
| End Year Balance | $68,115 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.02740 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.00000 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.97260 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,199,482 | OtherCostOrOtherBasisAmt |
| Book Value | $1,199,482 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,724,352 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,407,176 | DepreciationAmt |
| Book Value | $6,317,176 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,000 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,037 | DepreciationAmt |
| Book Value | $2,963 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,098,808 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,509,403 | DepreciationAmt |
| Book Value | $1,589,405 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,271,839 | OtherCostOrOtherBasisAmt |
| Depreciation | $564,339 | DepreciationAmt |
| Book Value | $707,500 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,816,526 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| CARE FOUNDATION | $3,307,376 |
| DEFERRED FINANCING COSTS | $388,146 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $3,695,522 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | INSURANCE FINANCING | Desc |
| Amt | $61,506 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $61,506 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $24,469,469 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $3,477,303 | OtherRevenueAmt |
| Revenue Not Reported | $3,477,303 | RevenueNotReportedAmt |
| Revenue Subtotal | $20,992,166 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,772,906 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,772,906 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $22,765,072 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $20,206,444 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $131,952 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $131,952 | ExpensesNotReportedAmt |
| Expenses Subtotal | $20,074,492 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,772,906 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,772,906 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $21,847,398 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Intended use of the organization's endowment funds | Part V, Line 4 The endowment funds are to be used for educational purposes and to acquire property & equipment for the hospital. |
| Uncertain Tax Positions | Part X, Line 2 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. |
| Other revenue included on books, not on return | Part XI, Line 2d Change in interest in net assets of wickenburg community hospital foundation 3,345,351 Rental Expense reclassed from expense to revenue 131,952 Total 3,477,303 |
| Other revenue on return, not on books | Part XI, line 4b Provision for uncollectable accounts reclassed to expense 1,772,906 |
| Other expense on books, not on return | Part XII, Line 2d Rental Expense reclassed from expense to revenue 131,952 |
| Other expense on return, not on books | Part XII, line 4b Provision for uncollectable accounts reclassed to expense 1,772,906 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $81,060 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $81,060 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,270,127 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,153,238 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $116,890 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,351,187 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,153,238 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $197,950 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00980 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $386,558 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $245,855 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $140,703 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00700 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $27,009 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $15,525 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $11,484 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $413,567 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $261,380 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $152,187 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00760 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,764,754 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,414,618 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $350,137 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,772,906 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $886,453 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,080,970 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,174,200 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$93,230 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | Yes (X) | CostAccountingSystemInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.wickhosp.com | WebsiteAddressTxt |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 13 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | see part vi for full URL | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Develop Community Wide Plan | Yes (X) | DevelopCommunityWidePlanInd |
| Exec Community Wide Plan | Yes (X) | ExecCommunityWidePlanInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | FacilityFacilityTxt |
|---|---|---|---|---|
| Community Hospital Clinic - WICKENBURG | ||||
| 519 Rose Lane | Wickenburg | AZ | 85390 | PRIMARY CARE CLINIC RURAL HEALTH CLINIC |
| Community Hospital Clinic - Congress | ||||
| 26750 S Santa Fe Road Suite B | Congress | AZ | 85332 | PRIMARY CARE CLINIC RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| BAD DEBT EXPENSE | SCHEDULE H, PART I, LINE 7, COLUMN F TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = 1,772,906. |
| CALCULATION OF COMMUNITY BENEFIT EXPENSES | SCHEDULE H, PART I, LINE 7 The organization used a cost-to charge ratio for lines 7a, 7b & 7g. 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. |
| FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE | SCHEDULE H, PART III, LINE 4 Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. Bad Debt Expense is determined using the methodology as described in the note to the financial statements as shown above. 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. |
| MEDICARE SHORTFALL AS A COMMUNITY BENEFIT | SCHEDULE H, PART III, LINE 8 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 communtiy members who have no or limited resouces to pay for healthcare services. |
| DEBT COLLECTION POLICY | SCHEDULE H, PART III, LINE 9B 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. |
| INPUT FROM REPRESENTATIVES OF THE COMMUNITY | SCHEDULE H, PART V, LINE 3 In conducting the CHNA for Wickenburg Community Hospital (WCH), WCH gathered data using a survey format designed by the Cochise County Health & Social Services Department for the Cochise County arizona Community Health assessment. The survey was developed in both an English and Spanish language version and were distributed in the following ways/venues: - The survey questions were posted on Survey Monkey - Newspaper display ads in the Wickenburg Sun and the Congress Yellow page encouraged readers to go to a Survey Monkey link sponsored by the Hospital - Notices were mailed/sent electronically to the Town of Wickenburg, Bagdad, Congress and Salome church organizations encouraging participation in the electronic survey through the survey monkey link. - Hard copy surveys and survey collection boxes were placed at various locations throughout the region including medical clinics, grocery stores, and the Wickenburg Chamber of Commerce. - Survey forms were distributed and the survey monkey link was announced at the Town Hall meeting in October 2013 hosted by the Hospital at the Wickenburg Community Center. - Specific survey questions and the full survey was distributed, completed and discussed at focus group meetings sponsored by the hospital and held at locations in Wickenburg, Congress and Salome. - Informational posters were placed throughout communities in the region to encourage participation in the survey through survey monkey. Hospital facility's website where CHNA can be found: http://www.wickhosp.com/greater-wickenburg-region-community-health-needs-a ssessment-final-report-december-2013/ The implementation plan is located on the last page of the CHNA at the above URL. |
| MAXIMUM AMOUNTS CHARGED TO FAP-ELIGIBLE INDIVIDUALS | SCHEDULE H, PART V, LINE 20D During our budget planning process each year we decide, based upon the financial picture for the hosptial, the amount of financial aid that can be planned for eligible individuals for emergency and other medically necessary care. We recognize the majority of bad debts originate in the Emergency Room and plan accordingly, however the maximum amount allowed may exceed the amount planned, based on the operational performance during the year. The Federal poverty guidelines are used in determining the additional adjustments to amounts billed for FAP elgible individuals. |
| NEEDS ASSESSMENT | Community Hospital Association, Inc. continually accesses 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. |
| 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. |
| 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 summer months to winter months, when the population grows by approximately 40%. |
| PROMOTION OF COMMUNITY HEALTH | Wickenburg Community Hospital, designated as a Critical Access Hospital, serves a rural population approximately 35 miles west of the urban area of the greater Phoenix market place of Surprise, AZ. While the distance is not overly great, many of our patients come from rural areas west and north of Wickenburg, requiring them to drive much greater distances to obtain health care services if Wickenburg Community Hospital were not available to them. The most important service we provide is our Emergency Services and could not exist without our Critical Access Hospital status. Additionally, our Rural Health Clinic provides access to primary care providers in our community that probably would not exist if the hospital did not employ these providers. The availability of diagnostic services locally is very important to our community as a higher average age exists in our community, making it difficult to drive longer distances and spend a greater amount of time in obtaining diagnostic services required by their primary care providers. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | false | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | Yes (true) | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JIM TAVARY | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $172,282 | $0 | $0 | $0 | $792 | $0 | $0 | $0 | $22,962 | $0 | $196,036 | $0 | $0 | $0 |
| JAMES SMITH | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $151,183 | $0 | $2,791 | $0 | $13,999 | $167,973 | $0 | |||||||
| WILLIAM FIRTH MD | ||||||||||||||
| CHIEF OF STAFF & CLNC MED DIR | $236,320 | $0 | $792 | $0 | $42,187 | $279,299 | $0 | |||||||
| MARILYN HALDER MD | ||||||||||||||
| PHYSICIAN | $175,001 | $0 | $120 | $0 | $22,252 | $197,373 | $0 | |||||||
| TODD KRAVETZ MD | ||||||||||||||
| PHYSICIAN | $230,985 | $0 | $276 | $0 | $30,008 | $261,269 | $0 | |||||||
| ROGER ROSE | ||||||||||||||
| PHARMACIST | $177,119 | $0 | $792 | $0 | $14,928 | $192,839 | $0 | |||||||
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| REIMBURSEMENT OR PROVISION OF EXPENSES | PART I, QUESTION 1B Golf Club Membership: The Community Hospital Association pays golf club membership dues for James R. Smith, CFO, and James F. Tavary, CEO. A portion of the club dues are treated as taxable income based on a ratio of personal to business use. The personal use of the membership dues are reported on their W-2's. |
| PAYMENTS MADE PURSUANT TO AN INITIAL CONTRACT EXCEPTION | PART I, QUESTION 8 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. |
| REBUTTABLE PRESUMPTION PROCEDURE | PART I, QUESTION 9 THE ORGANIZATION FOLLOWS THE REBUTTABLE PRESUMPTION PROCEDURE, HOWEVER, THE COMPARABILITY DATA USED IS NOT DOCUMENTED, THEREFORE QUESTION 9 IS ANSWERED AS NO. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARIZONA HEALTH FACILITIES AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 860453292 | BondIssuerEIN |
| CUSIP | 040507GK5 | CUSIPNum |
| Bond Issued | 2005-06-09 | BondIssuedDt |
| Issue Price | $6,000,000 | IssuePriceAmt |
| Purpose | CAPITAL PROJECTS AND EQUIPMENT | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $645,000 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $6,072,257 | TotalProceedsAmt |
| In Reserve Fund | $516,905 | InReserveFundAmt |
| Capitalized Interest | $72,257 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $120,000 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $5,390,100 | CapitalExpendituresAmt |
| Other Spent Proceeds | $0 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2007 | SubstantialCompletionYr |
| Current Refunding | false | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | false | MgmtContractBondFincdPropInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Change In Use Bond Financed Prop | 0.00000 | ChangeInUseBondFinancedPropPct |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | false | RebateNotDueYetInd |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | Yes (true) | NoRebateDueInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | false | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART VI, LINE 2C | FormAndLineReferenceDesc |
| Explanation | THE REBATE COMPUTATION WAS PERFORMED ON JUNE 8, 2010 FOR THE PERIOD JUNE 9, 2005 TO MARCH 31, 2010. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (18 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 990 Review Process | Part VI, Line 11b 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. |
| Describe how conflict of interest policy is monitored & enforced | Part VI, Line 12c 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. |
| Describe process for determining compensation | Part VI, Question 15a 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. |
| Describe process for determining compensation | Part VI, Question 15b 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. |
| Describe how documents are made available to the public | Part VI, Line 19 Governing documents, conflict of interest policy, and financial statements are made available to the public by a formal request in writing. |
| Other Changes to Net Assets | Part XI, Line 9 Change in interest in net assets of wickenburg community hospital foundation 3,345,351 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICIAN FEES TOTAL FEES:1284061 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:IMAGING TOTAL FEES:279732 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MEDICAL RECORDS TOTAL FEES:109306 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:340B MANAGEMENT FEE TOTAL FEES:43049 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:HR/RECRUITING TOTAL FEES:88230 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAUNDRY/HOUSEKEEPING TOTAL FEES:80937 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CLINIC FEES TOTAL FEES:70984 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PATIENT SERVICES TOTAL FEES:33990 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB FEES TOTAL FEES:16838 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYSICAL THERAPY TOTAL FEES:24812 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATIVE FEES TOTAL FEES:188593 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MISCELLANEOUS TOTAL FEES:195965 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| Wickenburg Community Hospital Foundation | ||||||||||
| 520 Rose Lane | Wickenburg | AZ | 85390 | 742521618 | Fundraising | AZ | 501(C)(3) | Line 7 | na | false |
| Wickenburg Community Hospital Auxiliary | ||||||||||
| 520 Rose Lane | Wickenburg | AZ | 85390 | 866056824 | Support Org | AZ | 501(C)(3) | 11 TYPE III | NA | false |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| WICKENBURG COMMUNITY HOSPITAL FOUNDATION | ||
| C | $140,921 | AMOUNT RECEIVED |
| WICKENBURG COMMUNITY HOSPITAL FOUNDATION | ||
| Q | $277,906 | ACTUAL AMOUNT |