KINGMAN HEALTHCARE INC: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
KINGMAN HEALTHCARE INC (EIN 94-2916102)
Tax period
2012-07-01 to 2013-06-30
Filed
2014-02-19
IRS object ID
201430509349300803
Schema version
2012v2.3
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2014-02-19T10:14:51-06:00Timestamp
Tax Period End Date2013-06-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1111 South Tejon Suite 800AddressLine1
CityColorado SpringsCity
StateCOState
ZIP Code809039848ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-07-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN942916102EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Kingman Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% THE ORGANIZATIONInCareOfName
Name ControlKINGNameControl
Phone9287572101Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line13269 Stockton Hill RoadAddressLine1
Address Line2SuiteAddressLine2
CityKingmanCity
StateAZState
ZIP Code86409ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameTimothy BlanchardName
TitleCFOTitle
Phone7194714290Phone
Date Signed2014-02-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone7194714290Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2015-11-30 17:44:51ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonBrian TurneyNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line13269 Stockton Hill RoadAddressLine1
CityKingmanCity
StateAZState
ZIP Code86409ZIPCode
FieldValueIRS element (for citing)
Gross Receipts238543297GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteAZKRMC.comWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1980YearFormation
State Legal DomicileAZStateLegalDomicile
Activity Or Mission DescriptionOUR VISION IS TO BE THE REGION'S best clinical care and patient service through an environment that fosters respect for others and pride in performance.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees2003TotalNbrEmployees
Total Nbr Volunteers305TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Contributions Grants Prior Year286449ContributionsGrantsPriorYear
Contributions Grants Current Year67232ContributionsGrantsCurrentYear
Program Service Revenue Prior Year232335275ProgramServiceRevenuePriorYear
Program Service Revenue CY227275420ProgramServiceRevenueCY
Investment Income Prior Year2369462InvestmentIncomePriorYear
Investment Income Current Year2973911InvestmentIncomeCurrentYear
Other Revenue Prior Year3281083OtherRevenuePriorYear
Other Revenue Current Year2566318OtherRevenueCurrentYear
Total Revenue Prior Year238272269TotalRevenuePriorYear
Total Revenue Current Year232882881TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year186942GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY265386GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year116751079SalariesEtcPriorYear
Salaries Etc Current Year123975680SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year110265451OtherExpensePriorYear
Other Expenses Current Year108372852OtherExpensesCurrentYear
Total Expenses Prior Year227203472TotalExpensesPriorYear
Total Expenses Current Year232613918TotalExpensesCurrentYear
Revenues Less Expenses Prior Year11068797RevenuesLessExpensesPriorYear
Revenues Less Expenses CY268963RevenuesLessExpensesCY
Total Assets BOY239140407TotalAssetsBOY
Total Assets EOY234612368TotalAssetsEOY
Total Liabilities BOY38622450TotalLiabilitiesBOY
Total Liabilities EOY32927483TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY200517957NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY201684885NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOur vision is to provide the region's best clinical care and patient service through an environment that fosters respect for others and pride in performance.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense183804344Expense
Grants265386Grants
Revenue227423226Revenue
DescriptionMohave County is one of the fastest growing counties in Arizona. The area around Kingman which is the county seat is expected to continue growing steadily in the coming years. In response to the growth, KRMC has continued to expand its services. We now offer a full range of health and wellness services, including a wellness and fitness center, multiple primary care physician practices, advanced medical programs in cardiology, cancer, and rehabilitation, and home health and hospice care. Moreover, we are honored to serve as a teaching hospital in affiliation with Midwestern University to train doctors specializing in family practice, dermatology, and emergency medicine. With the growing population we are seeing the following problems and trends: We are seeing an increasing number of uninsured patients in our area. We are experiencing a higher volume of self-pay patients who are waiting to seek medical care until the time that they must go to the emergency room. Our Medicaid population is 15% of our total patient population. Our Medicare population is 53% of total patient population. Major strategies to address identified needs and problems include: We have increased recruitment efforts of RN's, therapists and skilled technicians to meet the growing needs of the community. We continue to recruit physicians of various specialties to the area. We continue to expand our facilities to meet the needs of the community. KRMC is collaborating with community organizations to improve community health, expand access to health care, or in other ways benefit the community. Some examples are: We work with the Women's Health Organization to provide discounted mammography to self-pay patients. We work with the Foster Grandparents Association and provide free physical exams. We pay 50% and write off the other 50% for Victims of Crime collaborating with the Mohave County Attorney's Office. KRMC is a teaching hospital with a GME program in association with Midwestern University. KRMC operates several physician practices and a continuity clinic. There are plans to expand these services to the outlying areas of our community. In recent years, KRMC has expanded services to include services that are not usually found in a rural community such as; cardiac catherization; cancer diagnosis and treatment with a state-of-the-art cancer center; a new outpatient imaging and women's health center; acute rehabilitation unit; cardiac surgical unit for open heart surgery; wound care; and hyperbaric. Our uncompensated care policy is called "Qualifying Discount Program". Our program is defined as Charity Care services provided for which payment is not anticipated because of an inability to pay, and may apply to an entire account balance or a portion of it. Charity Care is separate and distinct from Bad Debts, which are accounts for which credit was extended and payment is anticipated, but not received. Our discount program is based on a percentage of the Federal Poverty Level. KRMC has updated its charity care policy to include those patients whose household income is less than 400% of the FPL. This program is for all patients regardless of their primary insurance status and is based on their family size and income from all sources. Organizational Description for Tax Exemption: KRMC operates an ER that is open to all persons regardless of their ability to pay and complies with all EMTALA regulations. We have notices in the ER that informs the patients of this fact; our admissions staff advises all patients who present for services that we are calling for a nurse and will perform a Medical Screening exam regardless of their ability to pay. We assist them after the medical screening exam with DES applications and in-service them on our Charity Program if should they have an inability to pay. KRMC has an open medical staff with privileges available to all qualified physicians in the area. Kingman Hospital Inc. has a governing body in which independent persons representative of the community comprise a majority. KRMC engages in the training and education of health care professionals with its Graduate Medical Education (GME) program. We participate with Medicare and Medicaid, Champus, Tricare, Veterans Affairs and other governmental health care programs.Description
Total Program Service Expense183804344TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiestrueReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With1096199NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees2003NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocstrueChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicyfalseDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
States Where Copy Of Return Is FiledAZStatesWhereCopyOfReturnIsFiled
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonTHE ORGANIZATIONNamePerson
Telephone Number9287572101TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line13269 STOCKTON HILL ROADAddressLine1
CityKingmanCity
StateAZState
ZIP Code86409ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (34 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationAverage Hours Per Week RelatedAverageHoursPerWeekRelatedKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
DAVE FRENCH
CHAIRMAN1.0XX000
DON VAWTER
VICE-CHAIRMAN1.0XX
KRYSTAL BURGE
SECRETARY1.0XX1.0
ROD MARQUARDT
TREASURER1.0XX
SANDY MOON
DIRECTOR1.0X
CATHY OTT
DIRECTOR1.0X
BARBARA RICCA
DIRECTOR1.0X
JIM BAKER
DIRECTOR1.0X
BRIAN TURNEY
CHIEF EXECUTIVE OFFICER40.0XX556931473401.0
CLAIRE CRUM
DIRECTOR1.0X
JEFF BERGESON
DIRECTOR1.0X
TOM PRICE
DIRECTOR1.0X
MAHMOOD KHAN
DIRECTOR1.0X
SANDRA COFER
DIRECTOR1.0X
DARRELL LAUTARET
DIRECTOR1.0X
TOM CLARK
DIRECTOR1.0X
MIKE ROBERTS
DIRECTOR1.0X
ROBERT DEVRIES
DIRECTOR1.0X
GARY DYKMAN
DIRECTOR1.0X
RENNA MATTHEWS
DIRECTOR1.0X
DENNIS GUSTAFSON
DIRECTOR1.0X
WILLIAM KIRBY
DIRECTOR1.0X
STEVE PEBLEY
DIRECTOR1.0X
DOUG ANGLE
DIRECTOR1.0X
SUSAN CHAN
DIRECTOR1.0X
RYAN KENNEDY
CHIEF OPERATING OFFICER40.0X19811544753
TIMOTHY BLANCHARD
CHIEF FINANCIAL OFFICER40.0X219082378991.0
JEFFREY LUNN MD
CHIEF MEDICAL OFFICER40.056154731942X
DEBORAH BENNETT DO
CHIEF MEDICAL OFFICER40.021147440223X
KATHLEEN NAEGLE MD
PHYSICIAN40.0117834829292X
EMMETT MCELENEY
PHYSICIAN40.093647711590X
ROBERT MATHENEY MD
PHYSICIAN40.076694041166X
HESHAM SAHAWNEH
PHYSICIAN40.065873335211X
EDDIE RAMIREZ
PHYSICIAN40.062418641560X
FieldValueIRS element (for citing)
Total Reportable Comp From Org5911833TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation360976TotalOtherCompensation
Number Individuals GT100 K123NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
HIGH DESERT RADIOLOGY
695 COUNTRY CLUB DRIVEKINGMANAZ86401RADIOLOGISTS5715758
MIDWESTERN UNIVERSITY
19555 N 59TH AVEGLENDALEAZ85308GME PROGRAM1816221
COMPHEALTH ASSOCIATES
PO BOX 972651DALLASTX753972651NURSING AGENCY1700520
AMN HEALTHCARE
FILE 56157LOS ANGELESCA90074NURSE AGENCY1320361
MEDLIANT
969-G EDGEWATER BLVD 698FOSTER CITYCA94404NURSE AGENCY1113446
FieldValueIRS element (for citing)
Number Of Contractors GT100 K57NumberOfContractorsGT100K
Related Organizations8916RelatedOrganizations
All Other Contributions58316AllOtherContributions
Total Contributions67232TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
PATIENT SERVICE REVENUE900099111417057111417057
MEDICARE & MEDICAID REVENUE900099113899568113899568
WELLNESS CENTER REVENUE90009912585251258525
ALLERGY MISC REVENUE9000999112191121
ORTHO MISC REVENUE9000991261412614

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

FieldValueIRS element (for citing)
Total Revenue Column596535TotalRevenueColumn
Related Or Exempt Function Income596535RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue227275420TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column2073559TotalRevenueColumn
Exclusion$2,073,559ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Rents GrossRents

FieldValueIRS element (for citing)
Real306538Real

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real306538Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column306538TotalRevenueColumn
Exclusion$306,538ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Securities6539694Securities

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Securities5539266Securities
Other100076Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Securities1000428Securities
Other-100076Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column900352TotalRevenueColumn
Exclusion$900,352ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Gross Sales Of Inventory19478GrossSalesOfInventory
Cost Of Goods Sold21074CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column-1596TotalRevenueColumn
Exclusion-$1,596ExclusionAmount

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnExclusionExclusionAmountRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
CAFETERIA9000991731491$1,731,491
CHILD CARE624410382079$382,079
MISCELLANEOUS REVENUE900099147806147806
FieldValueIRS element (for citing)
Total Other Revenue2261376TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column232882881TotalRevenueColumn
Related Or Exempt Function Income227423226RelatedOrExemptFunctionIncome
Unrelated Business Revenue0UnrelatedBusinessRevenue
Exclusion$5,392,423ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total265386Total
Program Services265386ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1949306Total
Program Services1539952ProgramServices
Management And General409354ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total94764578Total
Program Services74864017ProgramServices
Management And General19900561ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total2194827Total
Program Services1733913ProgramServices
Management And General460914ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total19041064Total
Program Services15042441ProgramServices
Management And General3998623ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total6025905Total
Program Services4760465ProgramServices
Management And General1265440ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total11189108Total
Program Services8839395ProgramServices
Management And General2349713ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total192569Total
Program Services152130ProgramServices
Management And General40439ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total179900Total
Program Services142121ProgramServices
Management And General37779ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total20741Total
Management And General20741ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total0Total

Advertising Advertising

FieldValueIRS element (for citing)
Total637010Total
Program Services503238ProgramServices
Management And General133772ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total42696188Total
Program Services33729989ProgramServices
Management And General8966199ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total12401275Total
Program Services9797007ProgramServices
Management And General2604268ManagementAndGeneral

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total4758797Total
Program Services3759450ProgramServices
Management And General999347ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total821058Total
Program Services648636ProgramServices
Management And General172422ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total167002Total
Program Services131932ProgramServices
Management And General35070ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total15827316Total
Program Services12503580ProgramServices
Management And General3323736ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total4500576Total
Program Services3555455ProgramServices
Management And General945121ManagementAndGeneral

Other Expenses OtherExpenses (2 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE825033565177651732570
OTHER EXPENSE673097753174721413505

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total232613918Total
Program Services183804344ProgramServices
Management And General48809574ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY305697BOY
EOY157078EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY12809542BOY
EOY7273316EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY43514460BOY
EOY44930367EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY225760BOY
EOY199321EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY5053690BOY
EOY5314112EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY2158691BOY
EOY2269319EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis228946614LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec107056515LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY125592217BOY
EOY121890099EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY41155564BOY
EOY45104909EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY604207BOY
EOY619465EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY7301052BOY
EOY6400582EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY419527BOY
EOY453800EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY239140407BOY
EOY234612368EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY22444367BOY
EOY20433605EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY338789BOY
EOY269030EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY13793930BOY
EOY9884072EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY2045364BOY
EOY2340776EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY38622450BOY
EOY32927483EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY199416884BOY
EOY200440343EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1101073BOY
EOY1244542EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY200517957BOY
EOY201684885EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY239140407BOY
EOY234612368EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses268963ReconcilationRevenueExpenses
Reconciliation Unrealized Invest794406ReconciliationUnrealizedInvest
Reconcilation Other Changes103559ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$20,741DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB20741TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierPart II B, Line 1gIdentifier
Return ReferenceLobbying ExpenseReturnReference
ExplanationKingman Hospital pays annual dues in which a percentage of their dues is attributable to lobbying. The amount shown on the line above represents that percentage.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance149223BeginningOfYearBalance
Contributions65814Contributions
Investment Earnings Or Losses40InvestmentEarningsOrLosses
Other Expenditures24718OtherExpenditures
End Of Year Balance190359EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance166182BeginningOfYearBalance
Contributions71548Contributions
Investment Earnings Or Losses101InvestmentEarningsOrLosses
Other Expenditures88608OtherExpenditures
End Of Year Balance149223EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance118983BeginningOfYearBalance
Contributions92138Contributions
Investment Earnings Or Losses117InvestmentEarningsOrLosses
Other Expenditures45056OtherExpenditures
End Of Year Balance166182EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance101798BeginningOfYearBalance
Contributions62988Contributions
Investment Earnings Or Losses281InvestmentEarningsOrLosses
Other Expenditures46084OtherExpenditures
End Of Year Balance118983EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance108227BeginningOfYearBalance
Contributions15089Contributions
Investment Earnings Or Losses250InvestmentEarningsOrLosses
Other Expenditures21768OtherExpenditures
End Of Year Balance101798EndOfYearBalance
FieldValueIRS element (for citing)
Term Endowment EOY Balance1.00000TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis15662650OtherCostOrOtherBasis
Book Value15662650BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis98288119OtherCostOrOtherBasis
Depreciation38969047Depreciation
Book Value59319072BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis108182525OtherCostOrOtherBasis
Depreciation65210484Depreciation
Book Value42972041BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6813320OtherCostOrOtherBasis
Depreciation2876984Depreciation
Book Value3936336BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings121890099TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (2 entries)

DescriptionDescriptionAmountAmount
ACCRUED RETIREMENT OBLIGATION$1,508,776
ESTIMATED SELF-INSURANCE COSTS$832,000
FieldValueIRS element (for citing)
Total Of Amounts2340776TotalOfAmounts
Tot Revenue Etc Audited Fincl Stmt233901996TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments794406NetUnrealizedGainsInvestments
Other Revenues224709OtherRevenues
Revenue Not Rptd F9901019115RevenueNotRptdF990
Revenue Subtotal232882881RevenueSubtotal
Total Revenue Per Form990232882881TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt232735068TotExpensesEtcAuditedFinclStmt
Other Expenses Included121150OtherExpensesIncluded
Expenses Not Rptd F990121150ExpensesNotRptdF990
Expenses Subtotal232613918ExpensesSubtotal
Total Expenses Per Form990232613918TotalExpensesPerForm990

Form990 Schedule D Part XIII Form990ScheduleDPartXIII (4 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
PART V, LINE 4DESCRIBE THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS:TEMPORARILY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE MEDICAL CENTER HAS BEEN LIMITED BY DONORS TO A SPECIFIC TIME PERIOD OR PURPOSE. THE TEMPORARILY RESTRICTED NET ASSETS ARE AVAILABLE FOR THE PURCHASE OF SUPPLIES AND TO EDUCATE PERSONNEL INVOLVED WITH EMERGENCY PREPAREDNESS.
PART XI, LINE 2DDESCRIPTION OF OTHER:LOSS ON SALE OF ASSETS: 100,076 COST OF GOODS SOLD: 21,074 INCOME FROM INVESTMENT IN FOUNDATION: 103,559 TOTAL: 224,709
PART XII, LINE 2DDESCRIPTION OF OTHERLOSS ON SALE OF ASSETS: 100,076 COST OF GOODS SOLD: 21,074 TOTAL: 121,150
Part X, Line 2Uncertain Tax PositionsManagement has evaluated their income tax positions under the guidance included in ASC 740. Based on their review, management has not identified any material uncertain tax positions to be recorded or disclosed in the financial statements.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense8024689TotalCommunityBenefitExpense
Net Community Benefit Expense8024689NetCommunityBenefitExpense
Percent Of Total Expense0.03570PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense32076305TotalCommunityBenefitExpense
Direct Offsetting Revenue19435607DirectOffsettingRevenue
Net Community Benefit Expense12640698NetCommunityBenefitExpense
Percent Of Total Expense0.05630PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense40100994TotalCommunityBenefitExpense
Direct Offsetting Revenue19435607DirectOffsettingRevenue
Net Community Benefit Expense20665387NetCommunityBenefitExpense
Percent Of Total Expense0.09200PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Total Community Benefit Expense614923TotalCommunityBenefitExpense
Net Community Benefit Expense614923NetCommunityBenefitExpense
Percent Of Total Expense0.00270PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Total Community Benefit Expense544998TotalCommunityBenefitExpense
Net Community Benefit Expense544998NetCommunityBenefitExpense
Percent Of Total Expense0.00240PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense1159921TotalCommunityBenefitExpense
Net Community Benefit Expense1159921NetCommunityBenefitExpense
Percent Of Total Expense0.00510PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense41260915TotalCommunityBenefitExpense
Direct Offsetting Revenue19435607DirectOffsettingRevenue
Net Community Benefit Expense21825308NetCommunityBenefitExpense
Percent Of Total Expense0.09710PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedtrueBadDebtExpenseReported
Bad Debt Expense$8,232,385BadDebtExpenseAmount
Amount Reimbursed By Medicare56097871AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare48318511CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall7779360MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1KINGMAN REGIONAL MEDICAL CENTERBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line13269 STOCKTON HILL ROADAddressLine1
CityKINGMANCity
StateAZState
ZIP Code86409ZIPCode
FieldValueIRS element (for citing)
Website AddressWWW.AZKRMC.COMWebsiteAddress
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Teaching HospitalXTeachingHospital
Er24 HoursXEr24Hours
OtherCANCER CENTER CARDIAC CATH LAB ACUTE REHAC UNITOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1KINGMAN REGIONAL MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
CHNA ConductedtrueCHNAConducted
Community DefinitionXCommunityDefinition
Community DemographicsXCommunityDemographics
Existing ResourcesXExistingResources
How Data ObtainedXHowDataObtained
Community Health NeedsXCommunityHealthNeeds
Other Health IssuesXOtherHealthIssues
Identifying ProcessXIdentifyingProcess
Consulting ProcessXConsultingProcess
Information GapsXInformationGaps
Needs Assessment Conducted12NeedsAssessmentConducted
Take Into AccounttrueTakeIntoAccount
Other FacilitiesfalseOtherFacilities
CHNA Widely AvailabletrueCHNAWidelyAvailable
Own WebsiteXOwnWebsite
On RequestXOnRequest
Adopt Implement StrategyXAdoptImplementStrategy
Execute Implement StrategyXExecuteImplementStrategy
Develop Community PlanXDevelopCommunityPlan
Participate Community PlanXParticipateCommunityPlan
Include Operational PlansXIncludeOperationalPlans
Adopt BudgetXAdoptBudget
Prioritize Health NeedsXPrioritizeHealthNeeds
Prioritize ServicesXPrioritizeServices
All Needs AddressedfalseAllNeedsAddressed
Organization Incur Excise TaxfalseOrganizationIncurExciseTax
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Average Negotiated RatesXAverageNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
NEEDS ASSESSMENTSince 2011, KRMC in partnership with the Mohave County Department of Public Health has led a major community initiative to improve health and quality of life in Mohave County. The Mohave County Community Health Improvement Initiative involves performing a community health assessment and developing a community health improvement plan every three years. A Community Health Needs Assessment (CHNA) for Mohave County was completed in the spring of 2013 and the findings are documented in the Community Health Profile for Mohave County, Arizona, which details health and wellness statistics and community needs for health services in Mohave County communities. Additionally, KRMC developed goals and strategies for addressing the priority health issues identified in the community health assessment, which are documented in the Kingman Regional Medical Center Implementation Plan for the Mohave County Community Health Improvement Initiative. The CHNA and implementation plan are available for the public on the KRMC website http://www.azkrmc.com
COMMUNITY INFORMATIONKingman Regional Medical Center (KRMC) serves an approximate 1500 square-mile geographic area in Mohave County, Arizona called Hospital District Number One of Mohave County. The district includes the City of Kingman (pop. 28,000) and numerous smaller outlaying communities. The total estimated population of the district is 78,000, with an estimated 11.6 persons per square mile. According to the latest statistics of the U.S. Census Bureau, the racial mix of the population is 82% Caucasian, 1.5% African American, 2.6% Native American, and 14.1% Hispanic or Latino origin. U.S. Census Bureau statistics for 20012 show 18.6% of Mohave County's population is 100% below the federal poverty level. The median household income is $39,383. The current unemployment rate in Mohave County is 10.2% (as of June, 2013). Approximately 83.7% of the county's population over age 25 are high school graduates, with 12.2% of the population over age 25 holding a Bachelor's degree or higher.
OTHER INFORMATIONKingman Hospital Incorporated is organized exclusively for charitable, scientific, and educational purposes relating to healthcare in Hospital District #1 of Mohave County. Its primary function is to operate Kingman Regional Medical Center. KHI's Board of Directors consists of 13 members holding terms of five years. All board members are community-minded individuals who do not receive compensation for their services on the KHI Board. All excess funds are kept for the benefit and development of the community's health services as determined by our local board. With this, our hospital average inpatient charges have remained significantly below the Arizona average for the same types of patients. Additionally, excess funds accumulated since KRMC was organized, have been utilized to pay campus expansion / improvements, state-of-the-industry technology, and competitive salaries for employees. Kingman Hospital Inc. continually invests in advanced medical technologies. From specialized diagnostic capabilities to advanced treatments in cardiac care and cancer, patients at KRMC benefit from some of the most sophisticated medical technologies in the region. In 2007, KRMC received the Governor's Arizona Innovation Award in recognition for its investment in technology and services not normally seen in a rural community. KRMC is a major community partner dedicated to enhancing the overall quality-of-life in northwest Arizona. We offer many services and programs to benefit the community, especially our most vulnerable citizens- children, elderly, those in ill health, and those in socio-economic distress. Examples of our community building activities include: - Conducting public health lectures at the hospital and at area nursing homes and businesses (monthly). - Conducting health fairs, which are free and open to the public (8 health fairs per year) - Offering a variety of free support groups to help people who are working to change a behavior or who are dealing with a loss, condition, or disease. - Publishing a quarterly 8-page newsletter (called Healthwise), which contains important health information for the public. The newsletter is free and distributed throughout northwest Arizona. - Providing free growth mats and car seats for babies born at KRMC. - Sponsoring physical fitness programs at community elementary schools to help kids be active, fit, and healthy. - Placing defibulators in our community's high-traffic public places to provide immediate lifesaving treatment to someone with cardiac arrest. - Providing free or low cost mammograms to uninsured or underinsured women residing in the Hospital District of Mohave County. - Providing scholarships for qualified individuals who cannot afford a membership to KRMC's Del E. Webb Wellness Center. - Providing scholarships to help nursing students with their educational costs. - Providing cash contributions, free services, or other support to over 40 local organizations that serve the needs of our community (e.g, Boys & Girls Club, Kingman Food Bank, Sarah's House, etc.). - Helping uninsured/underinsured patients with their healthcare costs through KRMC's charity care program. Additionally, KRMC is one of the area's largest contributors to the local economy. We employ over 1700 people and during the past year spent over $10,000,000 with local businesses.
AFFILIATED HEALTH CARE SYSTEM ROLESN/A
PART I, LINE 7THE ORGANIZATION USED A COST-TO-CHARGE RATIO FOR LINES 7A, 7B, AND 7B. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. THE INFORMATION FOR LINES 7E THROUGH 7I WAS DERIVED FROM INFORMATION IN THE GENERAL LEDGER AND OTHER FINANCIAL DATA RELATED SPECIFICALLY TO THE VARIOUS TYPES OF COMMUNITY BENEFITS.
PART III, LINE 4Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Medical Center analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowances for doubtful accounts and provision for uncollectible accounts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowances for doubtful accounts. For receivables associated with services provided to patients who have third party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for uncollectable accounts, 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 include both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a significant provision for uncollectible accounts in the period of service on the basis of its past experience, which indicates that many of the 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. The Medical Center's allowance for doubtful accounts for self-pay patients decreased from 81% of self-pay accounts receivable at June 30, 2012 to 65% of self-pay accounts receivable at June 30, 2013. In addition, the Medical Center's write-offs decreased approximately $4,000,000 from approximately $8,600,000 for the year ended June 30, 2012, to approximately $12,600,000 for the year ended June 30, 2013. Both changes are primarily due to the Medical Center recording an uninsured discount of 30% and increasing the charity care policy's threshold starting in fiscal year 2013. This discount is recorded for self-pay accounts at the time of billing.
PART III, LINE 8The Organization is a sole community hospital that provides healthcare services to community residents and visitors. Accessible, high-quality healthcare service is important for the overall health of all residents. Were there to be a Medicare shortfall, this would reflect the excess of costs over payments received for participants in the Medicare program. Costs are based on Medicare cost report allocations.
PART III, LINE 9BOnce the patient is billed and contacted, they are informed of options and of the Qualifying Discount Program (QDP). The other options include paying up front or no interest payments within a scheduled number of days. A cash discount is available to the patient. If qualified for the QDP, the appropriate qualifying amount is adjusted to Charity Care. If a balance remains that does not qualify, the patient has cash discount and no interest payment plan as described above. For patients that the hospital is unable to contact: - Eight account statements are sent. - Three letters explaining that if the patient fails to contact Patient Financial Services, collection efforts will be passed to an agency. The above is a minimum of 120 day process for all patient payer types. Once the patient account is submitted to a collection agency, it is adjusted to bad debt.
part v, section b, question 7diabetes, infant mortality, obesity, teen pregancy were identified in the community health needs assessment. these needs were not specifically addressed in the implementation plan as community stakeholders deemed them as having less immediate impact on the community health than other issues they selected.needs identified but not addressed in chna
part v, section b, question 3as part of the community health assessment process, members of the mohave county community health coalition conducted interviews with individuals who represent: a) broad interests of the community, b)populations of need, and c) persons with specialized knowledge in public health.describe how hospital took into account input from community

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantScholarshipsTypeOfGrant
Number Of Recipients94NumberOfRecipients
Amount Of Cash Grant265386AmountOfCashGrant

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierPart I, Question 2Identifier
Return ReferenceProcedures for Monitoring the use of grant funds to U.S.ReturnReference
ExplanationFund usage is predetermined by the Board of Directors of Kingman Regional Medical Center (KRMC). Scholarships are provided to students in the U.S. for tuition and related educational expenses only.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgtrueCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Report Prior990 Filing OrgCompReportPrior990FilingOrg
BRIAN TURNEY
CHIEF EXECUTIVE OFFICER471041688901700015000323406042710
RYAN KENNEDY
CHIEF OPERATING OFFICER168360297551186132892242868
TIMOTHY BLANCHARD
CHIEF FINANCIAL OFFICER19538223700520732692256981
JEFFREY LUNN MD
CHIEF MEDICAL OFFICER509806517411000021942593489
DEBORAH BENNETT DO
CHIEF MEDICAL OFFICER211474866331560251697
KATHLEEN NAEGLE MD
PHYSICIAN9425062358427350219421207640
EMMETT MCELENEY
PHYSICIAN8921064437111590948067
ROBERT MATHENEY MD
PHYSICIAN73482832112960631560808106
HESHAM SAHAWNEH
PHYSICIAN56623055000375031000025211693944
EDDIE RAMIREZ
PHYSICIAN59468612500170001000031560665746

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierPart 1 Question 5Identifier
Return ReferenceExplanation of compensation contingent of RevenuesReturnReference
ExplanationEmployed physicians are eligible for bonuses based on either revenues or business line income depending on their individual employment contracts.Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
Part VI, Question 11Process to review the form 990The Form 990 is prepared by a third party preparer with a detail review being conducted by the general accounting manager and accountant of the organization. A final copy of the Form 990 is then e-mailed to the board of directors before the return is filed with the IRS.
Part VI, Question 12cProcess for monitoring compliance with conflict of interest policyThe executive assistant to the CEO annually distributes the policy documents and forms to all managers and board members. The related forms contain written explanations by managers and board members. If a potential conflict arises, the situation is then reviewed by the CEO. If a conflict of interest covered by this policy exists, whether or not listed on a disclosure form, then the person involved with the potential conflict of interest recuses themself from voting on the matter.
Part VI, Question 15A-BProcess for Determining CompensationA benefits and compensation analyst prepares a study based on external comparisons of similar positions in similar sized organizations in the industry. The study is reviewed by a compensation committee then submitted to the Executive Board for final approval. Contemporaneous documentation and recordkeeping with respect to deliberations and decisions regarding the compensation process are kept on file. This study is conducted annually.
Part VI, Question 19Governing Documents Available to the PublicThe organization makes its governing documents, conflict of interest policy and financial statements available to the public upon request for a valid business purpose.
Part XI, Line 9Other Changes in Net Assets or Fund BalancesChange in Investment of Foundation: 103,559 Total: 103,559
part vi, section a, question 4significant changes to governing documentskingman hospital inc. amended their by-laws to change the number of board of directors of the corporation to no more than 11 elected members and 2 ex-officio voting members.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
NORTHWESTERN ARIZONA REGIONAL INSURANCE
4041 N CENTRAL AVEPHOENIXAZ85012208081486INSURERAZ501(C)(3)LINE 9NAtrue
KINGMAN REGIONAL MEDICAL CENTER FOUNDATI
3269 STOCKTON HILL ROADKINGMANAZ86409742388735FUND RAISINGAZ501(C)(3)LINE 7NAtrue
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgtrueOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolvedMethod Of Amt DeterminationMethodOfAmtDetermination
Northwestern Arizona Regional Insurance Co
q1730967FMV
KINGMAN REGIONAL MEDICAL CENTER FOUNDATION
C8916FMV

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