WHITE MOUNTAIN REGIONAL MEDICAL CENTER: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- WHITE MOUNTAIN REGIONAL MEDICAL CENTER (EIN 86-0171900)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-11-10
- IRS object ID
- 201433149349301548
- 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 G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-11-10T11:25:21-08:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TCA Partners LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 East Herndon Avenue Suite 211 | AddressLine1 |
| City | Fresno | City |
| State | CA | State |
| ZIP Code | 93720 | 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 | 860171900 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | White Mountain Communities Hospital Inc | BusinessNameLine1 |
| Business Name Line2 | dba White Mountain Regional Medical Ctr | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WHIT | BusinessNameControlTxt |
| Phone | 9283337142 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 85938 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Greg Was | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2014-11-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Inger Sullenger CPA | PreparerPersonNm |
| PTIN | P01464277 | PTIN |
| Phone | 5594317708 | PhoneNum |
| Self Employed | Yes (X) | SelfEmployedInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-11-30 17:44:51Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Greg Was | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 859385104 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $17,225,594 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| All Affiliates Included | false | AllAffiliatesIncludedInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wmrmc.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1962 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | WMRMC provides caring services & operates in a financially sound basis to ensure its continuing ability to meet the healthcare needs of patients & the communities it serves. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 5 | VotingMembersIndependentCnt |
| Total Employee | 234 | TotalEmployeeCnt |
| Total Volunteers | 39 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $993,420 | PYContributionsGrantsAmt |
| CY Contributions Grants | $697,820 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $15,416,338 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,537,804 | CYProgramServiceRevenueAmt |
| PY Investment Income | $37,193 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,022 | CYInvestmentIncomeAmt |
| PY Other Revenue | $578,134 | PYOtherRevenueAmt |
| CY Other Revenue | $984,738 | CYOtherRevenueAmt |
| PY Total Revenue | $17,025,085 | PYTotalRevenueAmt |
| CY Total Revenue | $17,221,384 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,978,864 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $9,823,199 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $13,655 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,005,570 | PYOtherExpensesAmt |
| CY Other Expenses | $7,129,937 | CYOtherExpensesAmt |
| PY Total Expenses | $15,984,434 | PYTotalExpensesAmt |
| CY Total Expenses | $16,953,136 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,040,651 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $268,248 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,075,425 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,376,175 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,213,965 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,246,467 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $4,861,460 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,129,708 | NetAssetsOrFundBalancesEOYAmt |
| Mission | The board of directors and leadership at WMRMC recongnize the importance of healthcare as a service essential for the well-being of people in the region and as an important part of the community's economy. See also, Form 990, Part I, Ln 1. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,178,801 | ExpenseAmt |
| Revenue | $16,361,941 | RevenueAmt |
| Desc | The Board of Directors and Leadership at WMRMC recognize the importance of healthcare as a service essential for the well-being of people in the region and as an important part of the community's economy.Patient Services - The organization provides acute inpatient care, emergency health care and outpatient health care services to community members of Southern Apache County, Arizona and Catron County, New Mexico. Recent accomplishments include: implementation of a Swing Bed program; renovation of the Medical/Surgical Department and the Nurse call station.During 2013, the total number of visits was in excess of 15,000. | Desc |
| Total Program Service Expenses | $10,178,801 | 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 | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | 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 | Yes (true) | 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 | false | 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 | Yes (true) | 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 | false | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 58 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 234 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | false | Form990TFiledInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | Yes (true) | NondeductibleContributionsInd |
| Nondeductible Contri Discl | Yes (true) | NondeductibleContriDisclInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Form8282 Filed | 0 | Form8282FiledCnt |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Form8899 Filedind | false | Form8899Filedind |
| Form1098 C Filed | false | Form1098CFiledInd |
| Excess Business Holdings | false | ExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Org Filed In Lieu Of Form1041 | false | OrgFiledInLieuOfForm1041Ind |
| Licensed More Than One State | false | LicensedMoreThanOneStateInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 5 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | 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 | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Finance Department | PersonNm |
| Phone | 9283337142 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 859385104 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionAGrp (18 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Mary Nedrow | ||||||||
| President | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Ryan Patterson | ||||||||
| Vice President | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Nadia Comvaluis MD | ||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| John Fredericksen | ||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Veronica Dowling MD | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $16,000 | $0 | $0 | ||
| Gary Davis | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Scott Hamblin MD | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $41,693 | $0 | $0 | ||
| Travis Udall | ||||||||
| Board Member | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | ||
| Samuel Grant | ||||||||
| CFO/CEO Pt yr | 40.00 | 0.00 | $67,205 | $0 | $9,746 | Yes (X) | ||
| Jim Robertson | ||||||||
| CEO Pt yr 2013 | 40.00 | 0.00 | $0 | $0 | $16,707 | Yes (X) | ||
| Greg Was | ||||||||
| CEO | 40.00 | 0.00 | $0 | $0 | $1,995 | Yes (X) | ||
| Karen Talamantes | ||||||||
| CNO | 40.00 | 0.00 | $66,194 | $0 | $4,654 | Yes (X) | ||
| Sammie Finch | ||||||||
| DON | 40.00 | 0.00 | $81,323 | $0 | $16,707 | Yes (X) | ||
| Carla Rotering MD | ||||||||
| Physician | 40.00 | 0.00 | $239,414 | $0 | $0 | Yes (X) | ||
| Michael Foote MD | ||||||||
| Physician | 40.00 | 0.00 | $204,008 | $0 | $0 | Yes (X) | ||
| Cristine Jackson | ||||||||
| Physician | 40.00 | 0.00 | $124,390 | $0 | $0 | Yes (X) | ||
| Greg Cluff | ||||||||
| Pharmacy Mgr | 40.00 | 0.00 | $123,145 | $0 | $0 | Yes (X) | ||
| Steven Hamblin | ||||||||
| Physical Therpist | 40.00 | 0.00 | $111,359 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,074,731 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $49,809 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | 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 |
|---|---|---|---|---|---|
| Round Valley Emergency Care | |||||
| 4141 W Thornton | Showlow | AZ | 85901 | ER Physicians/PA | $1,480,440 |
| Blue Cross | |||||
| 2444 W Las Palmaritas Dr | Phoenix | AZ | 85069 | EE Health Insurance | $1,390,694 |
| Amerisource Bergen | |||||
| 1825 S 43rd Ave Ste B | Phoenix | AZ | 85009 | Pharmacy Supplies | $450,349 |
| LocumTenensCom | |||||
| 2655 Northwinds Parkway | Alpharetta | GA | 30009 | CRNA Coverage | $300,507 |
| Philips Medical Capital | |||||
| 595 Miner Rd | Cleveland | OH | 44143 | Ultra-Sound Lease | $219,125 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 15 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $21,455 | FundraisingAmt |
| Government Grants | $525,000 | GovernmentGrantsAmt |
| All Other Contributions | $151,365 | AllOtherContributionsAmt |
| Total Contributions | $697,820 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Net Patient Service Revs | Desc |
| Total Revenue Column | $15,537,804 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,537,804 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,537,804 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,022 | TotalRevenueColumnAmt |
| Exclusion | $1,022 | 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 | $18,000 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,000 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,000 | TotalRevenueColumnAmt |
| Exclusion | $18,000 | ExclusionAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Rpt Fundraising Event | $21,455 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $4,210 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$4,210 | TotalRevenueColumnAmt |
| Exclusion | -$4,210 | ExclusionAmt |
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 (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Cafeteria, Childcare, etc | 622000 | $146,811 | $146,811 | |
| Meaningful Use | 622000 | $824,137 | $824,137 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $970,948 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $17,221,384 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $16,361,941 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $161,623 | 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 | $972,536 | TotalAmt |
| Management And General | $972,536 | ManagementAndGeneralAmt |
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 | $6,998,337 | TotalAmt |
| Program Services | $4,580,668 | ProgramServicesAmt |
| Management And General | $2,410,215 | ManagementAndGeneralAmt |
| Fundraising | $7,454 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,229,375 | TotalAmt |
| Program Services | $610,194 | ProgramServicesAmt |
| Management And General | $618,352 | ManagementAndGeneralAmt |
| Fundraising | $829 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $622,951 | TotalAmt |
| Program Services | $359,361 | ProgramServicesAmt |
| Management And General | $262,873 | ManagementAndGeneralAmt |
| Fundraising | $717 | FundraisingAmt |
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 | $83,315 | TotalAmt |
| Management And General | $83,315 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,155 | TotalAmt |
| Management And General | $51,155 | 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 | $2,477,843 | TotalAmt |
| Program Services | $2,419,828 | ProgramServicesAmt |
| Management And General | $58,015 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $401,487 | TotalAmt |
| Program Services | $99,927 | ProgramServicesAmt |
| Management And General | $301,560 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,606 | TotalAmt |
| Program Services | $20,701 | ProgramServicesAmt |
| Management And General | $34,329 | ManagementAndGeneralAmt |
| Fundraising | $3,576 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,047 | TotalAmt |
| Program Services | $13,255 | ProgramServicesAmt |
| Management And General | $60,650 | ManagementAndGeneralAmt |
| Fundraising | $142 | FundraisingAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $69,870 | TotalAmt |
| Program Services | $10,791 | ProgramServicesAmt |
| Management And General | $59,079 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $379,551 | TotalAmt |
| Program Services | $2,689 | ProgramServicesAmt |
| Management And General | $376,862 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,261 | TotalAmt |
| Program Services | $42,621 | ProgramServicesAmt |
| Management And General | $29,462 | ManagementAndGeneralAmt |
| Fundraising | $178 | FundraisingAmt |
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 | $45,271 | TotalAmt |
| Program Services | $23,074 | ProgramServicesAmt |
| Management And General | $22,154 | ManagementAndGeneralAmt |
| Fundraising | $43 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $89,242 | TotalAmt |
| Management And General | $89,242 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $649,947 | TotalAmt |
| Management And General | $649,947 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $189,492 | TotalAmt |
| Program Services | $14,147 | ProgramServicesAmt |
| Management And General | $175,345 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Supplies | $1,284,150 | $1,085,702 | $197,916 | $532 |
| Equipment Rent & Maintenance | $1,036,460 | $764,270 | $272,115 | $75 |
| Licenses | $67,595 | $64,450 | $3,145 | |
| Dues & Subscriptions | $55,208 | $48,743 | $6,397 | $68 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,437 | TotalAmt |
| Program Services | $18,380 | ProgramServicesAmt |
| Management And General | $26,016 | ManagementAndGeneralAmt |
| Fundraising | $41 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,953,136 | TotalAmt |
| Program Services | $10,178,801 | ProgramServicesAmt |
| Management And General | $6,760,680 | ManagementAndGeneralAmt |
| Fundraising | $13,655 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,230 | BOYAmt |
| EOY | $1,380 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $322,308 | BOYAmt |
| EOY | $916,618 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,586,949 | BOYAmt |
| EOY | $1,560,798 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $450,571 | BOYAmt |
| EOY | $493,832 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $66,510 | BOYAmt |
| EOY | $99,434 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $9,872,701 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,737,489 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,474,416 | BOYAmt |
| EOY | $4,135,212 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $173,441 | BOYAmt |
| EOY | $168,901 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,075,425 | BOYAmt |
| EOY | $7,376,175 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,051,860 | BOYAmt |
| EOY | $1,100,304 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $958,547 | BOYAmt |
| EOY | $635,114 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $203,558 | BOYAmt |
| EOY | $511,049 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,213,965 | BOYAmt |
| EOY | $2,246,467 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,861,460 | BOYAmt |
| EOY | $5,129,708 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,861,460 | BOYAmt |
| EOY | $5,129,708 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,075,425 | BOYAmt |
| EOY | $7,376,175 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $268,248 | ReconcilationRevenueExpnssAmt |
| 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
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $26,067 | OtherCostOrOtherBasisAmt |
| Book Value | $26,067 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,010,981 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,587,415 | DepreciationAmt |
| Book Value | $2,423,566 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $4,809,877 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,150,074 | DepreciationAmt |
| Book Value | $1,659,803 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $25,776 | OtherCostOrOtherBasisAmt |
| Book Value | $25,776 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,135,212 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third party payor settlements | Desc |
| Amt | $511,049 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $511,049 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $17,225,594 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $4,210 | OtherRevenueAmt |
| Revenue Not Reported | $4,210 | RevenueNotReportedAmt |
| Revenue Subtotal | $17,221,384 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $17,221,384 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $16,957,346 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $4,210 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $4,210 | ExpensesNotReportedAmt |
| Expenses Subtotal | $16,953,136 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $16,953,136 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part XI, Line 2d: Other revenue amounts included in F/S but not included on form 990 | Special Events Reclassifications $4210 |
| Part XII, Line 2d: Other expenses and losses per audited F/S | Special Events Reclassifications $4210 |
Schedule G IRS990ScheduleG
| Field | Value | IRS element (for citing) |
|---|---|---|
| Agrmt Prof Fundraising Acty | false | AgrmtProfFundraisingActyInd |
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | Fall Into the Wild | NameOfEvent1Amt |
| Gross Receipts Event1 | $21,455 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $21,455 | CharitableContriEvent1Amt |
| Entertainment Event1 | $4,210 | EntertainmentEvent1Amt |
| Gross Receipts Total | $21,455 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $21,455 | CharitableContributionsTotAmt |
| Entertainment Total Events | $4,210 | EntertainmentTotalEventsAmt |
| Direct Expense Summary Events | $4,210 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$4,210 | NetIncomeSummaryAmt |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 100.000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
| Report Publically Available | false | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 110 | PersonsServedCnt |
| Total Community Benefit Expns | $479,751 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $479,751 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02830 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,137,444 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $3,137,444 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18510 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,184,930 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,184,930 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.36480 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 110 | PersonsServedCnt |
| Total Community Benefit Expns | $9,802,125 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,802,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.57820 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 110 | PersonsServedCnt |
| Total Community Benefit Expns | $9,802,125 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,802,125 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.57820 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,184,590 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,182,300 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $15,505,925 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,391,807 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $7,114,118 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| 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 | White Mountain Commun Hosp | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 859385104 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.wmrmc.com | WebsiteAddressTxt |
| State License | H2530 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | White Mountain Commun Hosp | 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 |
| CHNA Conducted | 12 | 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 Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Other Needs Addressed | Yes (X) | OtherNeedsAddressedInd |
| All Needs Addressed | false | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Form4720 Filed | false | Form4720FiledInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 100.0000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 300.0000 | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| 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 |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Lien On Residence | Yes (X) | PermitLienOnResidenceInd |
| Collection Activities | Yes (true) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| 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 |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part V, Line 3 - Account Input from Person Who Represent the Community | Community Survey |
| Part V, Line 6i - Describe Other Needs Identified | Needs will be addressed as Hospital finances permit. |
| Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why | Addressing all needs is not possible at this time due to the overall cost, and financial impact on White Mountain Communities Hospital as a Critical Access Hospital. |
| Part V, Line 20d - Other Billing Determination of Individuals Without Insurance | 20% Discount |
| 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 |
|---|---|---|---|---|
| White Mtn Reg RehabWellness | ||||
| 118 South Mountain Ave | Springerville | AZ | 85938 | Rehab/Wellness Center |
| White Mtn Reg Specialty Clinic | ||||
| 118 South Mountain Ave | Springerville | AZ | 85938 | Specialty Clinic |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) | Based on a sliding scale of family size. Example family of 1 income of $10,890= 100% write-off, Family of 8 with income of $105,364=10 % discount.. |
| Part III, Line 2 - Methodology Used To Estimate Bad Debt Expense | Bad Debt attributable to patient accounts is equal to actual charges written off. Estimated amount of bad debt expense attributable to charity care policy is the cost incurred based on cost to charge ratio. |
| Part III, Line 3 - Methodology of Estimated Amount & Rationale for Including in Community Benefit | Bad Debt attributable to patient accounts is equal to actual charges written off. Estimated amount of bad debt expense attributable to charity care policy is the cost incurred based on cost to charge ratio. |
| Part III, Line 4 - Bad Debt Expense | Bad Debt ExpenseThe Hospital does not include a bad debt expense note in their Financial Statements, but the organization does have a Bad Debt Policy.POLICY: It is the policy of White Mountain Regional Medical Center to establish a consistent procedure to identify and process bad debt accounts. Definition: Bad debt is defined as an uncollectible account.Procedure: The process to determine an uncollectible account will include the patient receiving an initial statement, a follow up statement will be sent in 30 days, a follow up telephone call within the next 30 days with verbal notification of 10 day notice to pay (pre collection notice). A final call will then be made 10 days later with verbal notification of the account pending collection before determining if the account is bad debt. If no payment is received by the time all of the above steps have been taken, the account is then sent to a collection agency and written off as bad debt.The Patient Account Supervisor will keep a yearly spreadsheet and documentation on all bad debt accounts. Other Documentation/Equipment: Bad debt log; Medicare bad debt log.Charity CareThere are notes entitled "Charity Care" and "Charity Care and Community Benefit Expense" included in the Financial Statements:Charity Care: The Hospital accepts all patients regardless of their ability to pay. A patient is classified as a charity patient by reference to certain established policies of the Hospital. Essentially, these policies define charity services as those services for which no payment is anticipated. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as net patient service revenues. Services provided are recorded as gross patient service revenues and then written off entirely as an adjustment to net patient service revenues.CHARITY CARE AND COMMUNITY BENEFIT EXPENSEThe Hospital maintains records to identify and monitor the level of charity care and community service it provides. These records include: the amount of charges foregone, (based on established rates), for services and supplies furnished under its charity care and community service policies; the estimated cost of those services and supplies; and statistics quantifying the level of charity care as a percentage of expenses of the Hospital as a whole. The following is a summary of the Hospital's charity care and community benefit charges foregone for the years ended December 31, 2013 and 2012, in terms of services to the poor and benefits to the broader community: Benefits for the poor: Traditional charity care for 2013, and 2012, respectively: $479,751, $248,323. Unpaid Medicaid program charges for 2013, and 2012, respectively: $3,137,444, $3,207,348. Total quantifiable benefits for the poor, for 2013 and 2012, respectively: $3,617,195, $3,455,671. Benefits for the broader community: Unpaid Medicare program charges and total quantifiable benefits for the broader community, for 2013, and 2012, respectively: $6,184,930, $6,157,700. Total quantifiable community benefits combined, for 2013 and 2012, respectively: $ 9,802,125, $ 9,613,371. |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | Any shortfall is attributable to community benefit. |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | Policy: It is the policy of White Mountain Regional Medical Center to establish a consistent policy to establish a procedure in determining "Charity Cases." Procedure: Charity Care is defined as an inability to pay. The patients indigence must be determined by the facility, not by the patient. This determination may occur at any time prior to the patients account achieving zero balance; prior to admission, at admission, after discharge or during the billing and collection process.The charity determination is to be made based on the patient/responsible partys net worth, net income and the number of members in the household. White Mountain Regional Medical Center bases their charity care on the Federal Poverty Income Guidelines. The facility must determine that no source other than the patient/responsible party would be legally responsible for the patients medical bill. This includes federal, state or local financial programs and/or legal guardians.The patients business office file will contain documentation of the method by which indigence was determined along with all supporting documentation to substantiate the decision. The final determination will be made by the CFO, with the recommendation of the Patient Account Supervisor. |
| Part VI - Needs Assessment | Since the organization is the only Hospital for over 50 miles, it provides services that are not otherwise offered in the community. |
| Part VI - Patient Education of Eligibility for Assistance | All hospital patients are advised of available options, if an inability to pay is expressed. |
| Part VI - Community Information | The Hospital serves Southern Apache County, Arizona, as well as: Catron County, New Mexico. Both are high poverty level areas. |
| Part VI - Community Building Activities | N/A |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | N/A |
| Part VI - Affilated Health Care System Roles and Promotion | N/A |
| Part VI - States Where Community Benefit Report Filed | AZ |
| Part V - Explanation of Number of Facility Type | Besides the main Hospital, there is a rehabilitation/wellness center, and a specialty clinic. |
| Part VI - Additional Information | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | false | InitialContractExceptionInd |
| Rebuttable Presumption Proc | false | RebuttablePresumptionProcInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|
| Carla Rotering MD | ||
| Physician | $239,414 | $239,414 |
| Michael Foote MD | ||
| Physician | $204,008 | $204,008 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part III, Additional Information | FormAndLineReferenceDesc |
| Explanation | Schedule J, Part 1, Line 3: The organization utilizes Wage Watch for comparison salary data, the CEO salary is approved by the Board and the other officers and staff are approved by the CEO and CFO. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| Steve Hamblin | |||
| Fam, Brd Mem | $111,359 | Employed Phys Therap | false |
| Tom Hunt | |||
| Fam, Brd Mem | $79,151 | Employed Phys Therap | false |
| Robert Martin | |||
| Fam, Brd Mem | $74,734 | Employed as IT Mgr | false |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule L, Part V Supplemental Information | FormAndLineReferenceDesc |
| Explanation | Please see explanation of family relationships on Schedule O, as a response to Form 990 Part VI, Line 2: Business or Family Relationship of Officers, Directors, etc. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Line 1a: Explanation of Delegated Broad Authority to Committee | There is no Board delegation of authority to any committees. |
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | The following describes some family relationships: WMRMC employs Board Member Gary Davis' son in law (Tom Hunt) as a physical therapist and his wife (Kathleen Davis) as a PT Transcriptionist; WMRMC employs Board Member Scott Hamblin as a physician, and his brother Steve Hamblin as a physical therapist (Scott Hamblin is not currently a Board Member in 2014, so relationship will cease to be an issue in future); WMRMC employs Board Member Mary Nedrow's son-in-law (Robert Martin)as an IT Manager. The family relationships of Gary Davis; Scott Hamblin; and Mary Nedrow were deemed business relationships (thus reportable as business transactions on Schedule L), due to the value of the transactions exceeding the $10,000 threshold. The requirement to report these family transactions on Schedule L, results in the loss of independence of these board members in voting: per Form 990 instructions. |
| Form 990, Part VI, Line 11b: Form 990 Review Process | The Form 990 is reviewed by all voting Board Members at a Board Meeting prior to filing. |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Done on an annual basis, and the individual signs acknowledgement of policy. |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | The organization utilizes Wage Watch for comparison salary data, the CEO salary is approved by the Board and the other officers and staff are approved by the CEO and CFO. |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The organization utilizes Wage Watch for comparison salary data, the CEO salary is approved by the Board and the other officers and staff are approved by the CEO and CFO. |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Available upon request |
Comments