2014-11-11T11:52:02-06:00 2013-12-31 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2013-01-01 860096775 Community Hospital Association Inc % THE ORGANIZATION COMM 9286844390 520 Rose Lane Suite Wickenburg AZ 85390 Jim Tavary CEO 9286844390 2014-10-28 true Rita F Worster CPA P00290681 9286844390 2013 2015-11-30 17:44:51Z Wickenburg Community Hospital Jim Tavary 520 Rose Lane Wickenburg AZ 85390 22913751 false X www.wickhosp.com X 1946 AZ To provide quality health and wellness services where the patient, family and community come first. 9 9 224 58 13673 316115 151771 18004452 22642812 13005 -11916 -84640 -17595 18248932 22765072 0 0 0 0 10502401 10580610 0 0 0 9152446 11266788 19654847 21847398 -1405915 917674 15899677 21526294 9311418 10675010 6588259 10851284 To provide quality health and wellness services where the patient, family, and community come first. false false 19245527 22361852 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. 386558 245855 Provide Fitness Center for residents and visitors of greater Wickenburg, Arizona, promoting a wellness environment for the community. 19632085 true true false false false false false false false true true false false true true false true false false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false true 45 0 true 224 true true true false false false false false false false false false false false false X 9 9 false false false false false false false true true false false true true true true true true false false false AZ X THE ORGANIZATION 9286844390 520 ROSE LANE Wickenburg AZ 85390 X UWE GROSS PRESIDENT 1.0 X X BOB MCCOY VICE PRESIDENT 1.0 X X RICHARD ABBUHL SECRETARY 1.0 X X GARY TURNER TREASURER 1.0 X X DENNIS BARRACO DO BOARD MEMBER thru 01/2013 1.0 X SALLIE HERSHKOWITZ BOARD MEMBER THRU 04/2013 1.0 X Ajai Sawhney MD BOARD MEMBER 1.0 X KEVIN ARMSTRONG BOARD MEMBER 1.0 X JOHN SNAVELY BOARD MEMBER 1.0 X DEE POLLOCK BOARD MEMBER 1.0 X JOHN COOK BOARD MEMBER 1.0 X JIM TAVARY CHIEF EXECUTIVE OFFICER 39.0 1.0 X 173074 0 22962 JAMES SMITH CHIEF FINANCIAL OFFICER 39.0 1.0 X 153974 13999 WILLIAM FIRTH MD CHIEF OF STAFF & CLNC MED DIR 40.0 X 237112 42187 MARILYN HALDER MD PHYSICIAN 40.0 X 175121 22252 TODD KRAVETZ MD PHYSICIAN 40.0 X 231261 30008 ROGER ROSE PHARMACIST 40.0 X 177911 14928 Linda Brockwell Chief Nursing Officer 40.0 X 102258 7969 Nancy Carter Physician Assistant 40.0 X 102929 8500 1353640 0 162805 8 false true false EMCARE PHYSICIAN SERVICES INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 PHYSICIANS 570666 Medical Diagnostic Imaging Group L PO Box 17049 PHOENIX AZ 85011 MEDICAL IMAGING 492937 CPSI PO Box 850309 MOBILE AL 36685 Software Services 278173 Alliance Imaging File 55826 LOS ANGELES CA 90074 Medical Imaging 274152 DELTA HEALTHCARE PROVIDERS PO BOX 202940 DALLAS TX 75320 EMPLOYMENT AGENCY 185538 8 140921 10850 151771 MEDICARE 621990 9023802 9023802 PATIENT SERVICES 621990 10550878 10550878 340B DRUG PRICING PROGRAM REVENUE 621990 2219587 2219587 EHR INCENTIVE PAYMENTS 621990 544563 544563 WELLNESS CENTER 621990 245855 245855 58127 58127 22642812 2811 2811 0 0 77925 131952 -54027 0 -54027 13673 -67700 2000 16727 -14727 -14727 -14727 0 0 0 OTHER REVENUE 900099 36432 23022 13410 36432 22765072 22607707 13673 -8079 X 0 0 0 0 643308 279299 364009 0 0 8192459 7602533 589926 0 1114665 1099815 14850 630178 565977 64201 0 28528 28528 123136 123136 0 0 0 2416497 2215228 201269 0 213919 145892 68027 224299 224299 0 233151 222570 10581 39887 32306 7581 0 68219 62825 5394 496906 496906 0 1136103 1127562 8541 234364 232364 2000 MEDICAL SUPPLIES 3481129 3481129 PROVISION FOR BAD DEBTS 1772906 1772906 REPAIRS & MAINTENANCE 449237 417597 31640 MISCELLANEOUS 348507 149783 198724 21847398 19632085 2215313 0 X 499550 2806368 55906 149206 0 0 2758580 3691524 0 0 0 0 657620 0 460101 493055 289036 294345 22299481 12482955 10105882 9816526 485931 510994 0 0 0 0 0 68754 587071 3695522 15899677 21526294 1893582 3517936 0 0 0 0 5465000 5355000 0 0 0 0 1884481 1740568 0 0 68355 61506 9311418 10675010 X 6451072 7366876 137187 3484408 0 0 6588259 10851284 15899677 21526294 X 917674 3345351 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 137187 98101 3701284 354063 3582509 98635 217877 179325 137187 26885 397587 325837 98635 68115 1000 -3500 38730 26885 116962 -16413 32434 68115 0.02740 0.00000 0.97260 false true true 1199482 1199482 13724352 7407176 6317176 5000 2037 2963 6098808 4509403 1589405 1271839 564339 707500 9816526 CARE FOUNDATION 3307376 DEFERRED FINANCING COSTS 388146 3695522 0 INSURANCE FINANCING 61506 61506 24469469 3477303 3477303 20992166 1772906 1772906 22765072 20206444 131952 131952 20074492 1772906 1772906 21847398 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 true true X true X true X true true false true true 81060 81060 0.00400 1270127 1153238 116890 0.00580 1351187 1153238 197950 0.00980 386558 245855 140703 0.00700 27009 15525 11484 0.00060 413567 261380 152187 0.00760 1764754 1414618 350137 0.01740 true 1772906 886453 6080970 6174200 -93230 X true false 1 1 Wickenburg Community Hospital 520 Rose Lane Wickenburg AZ 85390 www.wickhosp.com X X Wickenburg Community Hospital 1 true X X X X X X X X X 13 true false true X see part vi for full URL X X X X X true false true true 200. true 400. true X X X X X true true X X X X true false X X X X true X false false 2 Community Hospital Clinic - WICKENBURG 519 Rose Lane Wickenburg AZ 85390 PRIMARY CARE CLINIC RURAL HEALTH CLINIC Community Hospital Clinic - Congress 26750 S Santa Fe Road Suite B Congress AZ 85332 PRIMARY CARE CLINIC RURAL HEALTH CLINIC 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. X false true X X false false false false false false false false true false JIM TAVARY CHIEF EXECUTIVE OFFICER 172282 0 0 0 792 0 0 0 22962 0 196036 0 0 0 JAMES SMITH CHIEF FINANCIAL OFFICER 151183 0 2791 0 13999 167973 0 WILLIAM FIRTH MD CHIEF OF STAFF & CLNC MED DIR 236320 0 792 0 42187 279299 0 MARILYN HALDER MD PHYSICIAN 175001 0 120 0 22252 197373 0 TODD KRAVETZ MD PHYSICIAN 230985 0 276 0 30008 261269 0 ROGER ROSE PHARMACIST 177119 0 792 0 14928 192839 0 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. A ARIZONA HEALTH FACILITIES AUTHORITY 860453292 040507GK5 2005-06-09 6000000 CAPITAL PROJECTS AND EQUIPMENT false false false A 645000 0 6072257 516905 72257 0 120000 0 0 5390100 0 0 2007 false false true true A false false false false 0.00000 0.00000 0.00000 false false 0.00000 false true A false false false true false false 0 false 0 false true A false PART VI, LINE 2C THE REBATE COMPUTATION WAS PERFORMED ON JUNE 8, 2010 FOR THE PERIOD JUNE 9, 2005 TO MARCH 31, 2010. 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 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 false false true true false false false false false false false false true true true false true false false WICKENBURG COMMUNITY HOSPITAL FOUNDATION C 140921 AMOUNT RECEIVED WICKENBURG COMMUNITY HOSPITAL FOUNDATION Q 277906 ACTUAL AMOUNT