2014-05-13T12:46:42-05:00 2013-06-30 BKD LLP 6120 S Yale 1400 Tulsa OK 741364223 990 2012-07-01 866007695 BENSON HOSPITAL % KEN GORANSON BENS 5205862261 PO BOX 2290 Suite BENSON AZ 85602 RICH POLHEBER 5205862261 2014-05-13 true 9185842900 2012 2015-11-30 17:44:51Z RICH POLHEBER 450 S OCOTILLO BENSON AZ 85602 12199929 false X www.bensonhospital.org X 1960 AZ THE MISSION OF BENSON HOSPITAL IS TO STRIVE TO SURPASS THE CUSTOMER'S EXPECTATIONS IN THE DELIVERY OF QUALITY MEDICAL CARE INCLUDING THEIR EMOTIONAL, SOCIAL, AND SPIRITUAL NEEDS. 7 7 162 25 0 68904 91530 12688377 11923491 5840 2010 159775 182898 12922896 12199929 0 0 0 0 7352503 7217052 0 0 0 5253362 5638547 12605865 12855599 317031 -655670 6789273 6374073 1233548 1474018 5555725 4900055 THE MISSION OF BENSON HOSPITAL IS TO STRIVE TO SURPASS THE CUSTOMER'S EXPECTATIONS IN THE DELIVERY OF QUALITY MEDICAL CARE INCLUDING THEIR EMOTIONAL, SOCIAL, AND SPIRITUAL NEEDS. false false 10799805 BENSON HOSPITAL IS A RURAL HOSPITAL THAT PROVIDES MEDICAL CARE ON BOTH AN IN AND OUTPATIENT BASIS TO AREA RESIDENTS. CARE PROVIDED INCLUDES EMERGENCY, OBSTETRICS, SURGICAL AND PHYSICAL REHABILITATION. CARE IS PROVIDED REGARDLESS OF RACE, CREED, COLOR OR ABILITY TO PAY. 10799805 true true false true false false false false false false true false false false false false true false false false false false false false false false true true false false true false false false false false true false false false false false false false false false false false true 47 0 true 162 true false false false false false false false false false false false X 7 7 false false false false false false false true true false false true true true true true true true false false AZ X X KEN GORANSON 5205862261 450 S OCOTILLO BENSON AZ 85602 Ann Cook 2.0 X X 0 0 0 Bob Lujan 2.0 X X BARBARA HARTLEY MD 2.0 X Melissa Maize 2.0 X William Lindley 2.0 X Paula Tyler DVM 2.0 X Nick Maldonado 2.0 X Denise Hurtado 40.0 X 120942 0 7478 Ronald A McKinnon 40.0 X 177668 0 8974 Teresa Vincifora 40.0 X 111260 0 0 Kenneth Goranson 40.0 X RICHARD POLHEBER 40.0 X 0 0 Helen Leclair 40.0 X 107472 0 8974 James Richey 40.0 X 140197 0 8974 Gary Maluf 40.0 X 105513 0 5983 763052 0 40383 6 false true false NES Inc PO Box 277001 ATLANTA GA 30384 ER Doctors Contract 1362610 Healthcare Mgmt Systems 3102 West End Ave Ste 400 NASHVILLE TN 37203 COMPUTER SUPPORT 783322 Medhost 6100 W Plano Pkwy 3100 PLANO TX 75093 Software Services 284656 Shared Imaging LLC 801 Phoenix Lake Ave STREAMWOOD IL 60107 Radiology Services 200125 Medical Diagnostic Imaging Group PO Box 17049 PHOENIX AZ 85011 Radiology Services 172974 6 72450 19080 91530 Net Patient Service Revenue 621300 10468205 10468205 San Pedro Tax Levy 900099 890000 890000 AHCCCS EHR Incentive Payment 900099 565286 565286 11923491 2010 2010 0 0 8800 8800 0 8800 8800 0 0 0 0 Cafeteria Income 721210 174098 174098 174098 12199929 11923491 184908 0 0 0 0 409870 338353 71517 36008 29725 6283 5644444 4659563 984881 0 635911 524953 110958 490819 405178 85641 0 9952 9952 0 0 0 0 0 0 14225 11743 2482 0 0 260387 214953 45434 12491 10311 2180 0 0 38128 38128 0 572976 572976 151722 151722 Purchased Services 2923685 2413541 510144 Medical Supplies 1566959 1507717 59242 Professional Development 36369 30023 6346 Dues & Subscriptions 25314 20897 4417 26339 21744 4595 12855599 10799805 2055794 0 689247 158228 812226 324711 0 0 1448784 2633910 0 0 0 0 0 0 293325 295555 102908 113259 6834799 3986389 3442783 2848410 0 0 0 0 0 0 0 0 0 0 6789273 6374073 587080 985393 0 0 0 0 0 0 0 0 0 0 646468 488625 0 0 0 0 1233548 1474018 X 5219098 4900055 336627 0 0 0 5555725 4900055 6789273 6374073 -655670 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 5335 false false false 5335 false false 1 SCHEDULE C, PART II-B, LINE 1F THE ORGANIZATION IS A MEMBER OF THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. A PORTION OF THE DUES PAID ARE ATTRIBUTED TO LOBBYING EXPENSES. 8000 8000 3052766 1220422 1832344 3774033 2765967 1008066 2848410 12199929 12199929 12199929 12855599 12855599 12855599 1 Schedule D, Part XIII MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITION 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. true true true X false true true false true true 57406 57406 0.00450 2775184 2544489 230695 0.01790 2832590 2544489 288101 0.02240 13387 13387 0.00100 13387 13387 0.00100 2845977 2544489 301488 0.02340 true 1532795 2747248 1171497 1575751 X true true 1 1 Benson Hospital

450 S Ocotillo Street Benson AZ 85602

X X X X Benson Hospital 1 true X X X X X X X X X 12 true false true X X X X X X true false true true 100 false true X X true true X X true false X X X X true X false false 1 Sch. H, Part III, Section A, Line 2a Benson Hospital calculates bad debt expense by applying the cost to charge ratio to the total provision for uncollectible accounts. 2 Sch. H, Part III, Section A, Line 4 On the basis of historical experience, the Hospital records a significant provision for uncollectible accounts related to uninsured partient in the period the services are provided. The Hospital provides a provision for uncollectible deductibles and copayments on accounts for which the third party payer has not yet paid or for payers who are known to have financial difficulties that make the realization of amounts due unlikely. 3 Sch. H, Part III, Section B, Line 8a A shortfall should be treated as community benefit. This is the cost of providing services to the community. There are many medicare beneficiaries in the community the hospital serves. 4 Needs Assessment: The Benson Hospital has an open door policy to hear the needs and concerns of patients. We listen to what our community physicians say about serving the needs of the community. The hospital adminstration also surveys other small hospitals to compare services. 5 Patient Education of Eligibility for Assistance The Benson Hospital has a staff member who is dedicated to the education of patients who may need assistance. That staff member is available tp enroll patients in all of the applicable state assistance programs. 6 Community Information The community that the hospital serves is about 14,000 people. The community is a low income farming and ranching community. 7 Promotion of Community Health Benson Hospital furthers its exempt purpose in several ways. Benson Hospital is governed by a volunteer board made up of members from the community. The hospital has an open medical staff and promotes the health of the community through events like hosting a health fair. 8 Sch. H, Part V, Section B, Line 3 We had input form 5 health care professionals including Hospital staff - ER Supervisor, Charge Nurse, Chief Nursing Officer; local physician, and retired county health nurse and president of Benson Hospital Governing Board. 9 Schedule H, Part V, Section B, Line 11 Discount the fee schedule price by 45% with additional 5% discount for cash/prompt payment 10 Schedule H, Part V, Section B, Line 20 The hospital discounted the fee schedule at the estimated Medicaid (AHCCCS) reimbursment rate with an additional 5% for prompt payment. 11 Schedule H, Part III, Section A THE HOSPITAL IS UNABLE TO QUANTIFY THE ESTIMATED AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. 12 SCHEDULE H, PART V, SECTION B, LINE 5A WWW.BENSONHOSPITAL.ORG X X false false false false false false false false false Ronald A McKinnon 177668 0 0 0 0 0 8974 0 0 0 186642 0 0 0 DR BARBARA HARTLEY MD SEE PART V BELOW 120714 HOSPITALIST false Michael Maldonado Son of Nick Maldonado 36008 Employee false 1 Schedule L, Part IV, Line 1 OWNS COMPANY WHICH DOES BUSINESS WITH BENSON HOSPITAL. 1 FORM 990, PART VI, LINE 10 THE FORM 990 WAS REVIEWED AND APPROVED BY THE BOARD PRIOR TO FILING WITH THE IRS. 2 FORM 990, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY IS REVIEWED BY THE BOARD ANNUALLY. BOARD MEMBERS ARE ASKED AT THAT TIME TO DIVULGE ANY CONFLICTS. 3 FORM 990, PART VI, LINE 15A THE GOVERNING BOARD VOTED TO APPROVE THE COMPENSATION OF THE CEO AT THE JUNE BOARD MEETING. THE APPROVAL OF THE COMPENSATION IS DOCUMENTED IN THE BOARD MEETING MINUTES. 4 FORM 990, PART VI, LINE 15B OTHER OFFICERS' COMPENSATION IS REVIEWED ANNUALLY BY THE CEO. 5 FORM 990, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND THE FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.