2012-11-15T11:25:01-06:00 2011-12-31 BKD LLP 111 South Tejon Suite 800 Colorado Springs CO 809039848 990 2011-01-01 860096775 Community Hospital Association Inc % THE ORGANIZATION COMM 9286844390 520 Rose Lane Wickenburg AZ 85390 JR Smith 2012-11-15 true Rita F Worster CPA 7194714290 2011 2016-02-24 21:20:13Z Wickenburg Community Hospital Jim Tavary 520 Rose Lane Wickenburg AZ 85390 16190176 false X www.wickhosp.com X 1946 AZ To provide quality health and wellness services where the patient, family and community come first. 10 10 189 25 19700 256872 279358 14368981 15471509 40359 22232 34996 205013 14701208 15978112 0 0 0 0 7726135 9044336 0 0 0 7662168 8238571 15388303 17282907 -687095 -1304795 18100175 17181960 8622730 9028005 9477445 8153955 TO PROVIDE QUALITY HEALTH AND WELLNESS SERVICES WHERE THE PATIENT, FAMILY, AND COMMUNITY COME FIRST. false false 14568455 0 15518736 Provide inpatient and outpatient diagnostic and therapeutic health care services to the residents and visitors of greater Wickenburg, a rural community of approximately 23,000. 369273 0 237521 Provide Fitness Center for residents and visitors of greater Wickenburg, promoting a wellness environment for the community. 14937728 true true false false false false false false false true true false false false true false true false false false false false false false false false true true false false true true false false false false false false false false false false false false false false false true true true false false true 52 0 true 189 true true true false false false false false false false false false false false false X 10 10 false false false false false false false true true false false true true true true false true false false false AZ X THE ORGANIZATION 9286844390 520 ROSE LANE Wickenburg AZ 85390 X Hank Brubaker 1.0 X X Bob Mccoy 1.0 X X Kevin Armstrong 1.0 X X Uwe Gross 1.0 X X Dennis Barraco DO 1.0 X Sallie Hershkowitz 1.0 X Richard Abbuhl 1.0 X John Snavely 1.0 X Roxie Glover 1.0 X Gary Turner 1.0 X Paul Broser 40.0 X 75901 0 7022 Jim Tavary 39.0 X 177132 14049 James Smith 39.0 X 158439 6051 William Firth MD 40.0 X 255492 29549 Linda Brockwell 40.0 X 102219 6187 Marilyn Halder MD 40.0 X 164884 10091 Anagha Deshmukh MD 40.0 X 137706 5779 1071773 0 78728 6 false true false Emergency Physicial Professional As 1470 W Port Au Prince Lane PHOENIX AZ 85023 PHYSICIANS 651060 Medical Diagnostic Imaging Group L PO Box 17049 PHOENIX AZ 85011 MEDICAL IMAGING 421634 CPSI PO Box 850309 MOBILE AL 366850309 SOFTWARE SUPPORT 312843 Barton Associates Inc 10 Dearborn Road PEABODY MA 01960 staffing services 227057 Quest Diagnostics Inc 3924 Collection Center Dr CHICAGO IL 606930039 LAB SERVICES 179653 7 65982 213376 279358 MEDICARE 621990 8191383 8191383 PATIENT SERVICES 621990 6920699 6920699 EHR INCENTIVE PAYMENTS 621990 121906 121906 WELLNESS CENTER 621990 237521 237521 15471509 58212 58212 0 0 92307 176084 -83777 -83777 19700 -103477 0 35980 -35980 -35980 -35980 0 0 0 OTHER REVENUE 900099 288790 284748 4042 288790 15978112 15756257 19700 -77203 0 0 0 0 723636 447372 276264 0 0 6798392 6080702 717690 0 0 952064 851557 100507 0 570244 501173 69071 0 0 18248 0 18248 0 83390 0 83390 0 0 0 0 2341365 2069460 271905 0 46292 0 46292 0 932573 756142 176431 0 171787 171787 0 0 0 213231 203059 10172 0 54167 42397 11770 0 0 134252 132803 1449 0 518026 0 518026 0 0 1238298 1224203 14095 0 194014 194014 0 0 MEDICAL SUPPLIES 1278532 1278532 0 0 PROVISION FOR BAD DEBTS 597846 597846 0 0 REPAIRS & MAINTENANCE 416550 386681 29869 0 17282907 14937728 2345179 0 2747283 1358734 51203 52758 0 0 1790876 2757013 0 0 0 0 784338 694900 240059 280569 338693 345879 21124086 10465957 11050894 10658129 491277 489656 0 0 0 0 0 0 605552 544322 18100175 17181960 1235394 1316453 0 0 0 0 5670000 5570000 0 0 0 0 1653237 2073661 0 0 64099 67891 8622730 9028005 X 9450560 8055320 26885 98635 0 0 9477445 8153955 18100175 17181960 X -1304795 -18695 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false 26885 397587 325837 98635 68115 1000 -3500 38730 26885 116962 -16413 32434 68115 1146828 5000 -8423 1026443 116962 0.00000 0.00000 1.00000 false true true 1199482 1199482 13354267 6410150 6944117 5412088 3775764 1636324 1158249 280043 878206 10658129 0 INSURANCE FINANCING 67891 67891 15978112 17282907 -1304795 -18695 -18695 -1323490 15537655 176084 176084 15361571 616541 616541 15978112 16861145 176084 176084 16685061 597846 597846 17282907 Intended use of the organization's endowment funds Part, V, Line 4 The endowment funds are to be used for educational purposes and to acquire property & equipment for the hospital. Other changes in net assets Part XI, Line 8 Change in interest in net assets of wickenburg community hospital foundation (18,695) Other revenue included on books, not on return part XII, Line 2d Rental Expense reclassed from expense to revenue 176,084 Other revenue included on return, not on books Part XII, Line 4b Provision for uncollectable accounts reclassed to expense 597,846 Change in interest in net assets of wickenburg community hospital foundation 18,695 Total 616,541 Other expense included on books, not on return Part XIII, Line 2d Rental Expense reclassed from expense to revenue 176,084 Other expense included on return, not on books Part XIII, Line 4b Provision for uncollectable accounts reclassed to expense 597,846 Uncertain Tax Positions Part X, Line 2 MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. true true true X true X true true false false 92835 0 92835 0.00560 1191763 871169 320594 0.01920 0 0 0 0.00000 1284598 871169 413429 0.02480 369273 237522 131751 0.00790 0 0 0 0.00000 40093 23602 16491 0.00100 0 0 0 0.00000 409366 261124 148242 0.00890 1693964 1132293 561671 0.03370 false 597846 298923 5014473 5014473 X true false 1 1 Wickenburg Community Hospital

520 Rose Lane Wickenburg AZ 85390

X X Wickenburg Community Hospital 1 true true 200. true 200. true X X X X X true false true false X X X X true X false true 1 Community Hospital Clinic

519 Rose Lane Wickenburg AZ 85390

Rural Health Clinic PRIMARY CARE CLINIC SCHEDULE H, PART I, LINE 7, COLUMN F BAD DEBT EXPENSE TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = 597,846. SCHEDULE H, PART I, LINE 7 CALCULATION OF COMMUNITY BENEFIT EXPENSES The organization used a cost-to charge ratio for lines 7a 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. SCHEDULE H, PART III, LINE 4 BAD DEBT EXPENSE Accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payer sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payer sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payer has not yet paid, or for payers who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated or provided by policy) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts. The Hospitals allowance for doubtful accounts for self-pay patients increased from 57% of self-pay accounts receivable at December 31, 2010, to 100% of self-pay accounts receivable at December 31, 2011. The Hospitals write-offs decreased approximately $72,000 from approximately $680,000 for the year ended December 31, 2010, to approximately $608,000 for the year ended December 31, 2011. Despite the decrease in write-offs, allowances increased due to both experienced and forecasted negative trends in the collection of amounts from self-pay patients. Bad Debt Expense is determined using the methodology as described in the note to the financial statements as shown above. Most of the bad debt expense results from uninsured patients receiving services primarily through the Emergency Room. The Director of Patient Financial Services estimates that approximately 50% of all bad debt would qualify for charity care, but it is difficult to get the patients to complete the Financial Assistance application. SCHEDULE H, PART III, LINE 8 MEDICARE The Medicare allowable costs is derived from the Medicare Cost Report. As a Critical Access Hospital, Medicare pays our allowable cost plus 1% including Medicare bad debts; therefore there is no Community Benefit for underpayments. SCHEDULE H, PART III, LINE 9B DEBT COLLECTION POLICY Although our collection policy does not address how patients who may qualify for charity care or financial assistance, our practice is to provide all patients at time of registration who do not demonstrate the ability to pay for the anticipated services (no insurance, no deposit, etc.) an opportunity to complete a charity application. Often, the charity application is not returned and charity is not recorded. In that event, the collection policy remains the same for those potential charity cases and all avenues of collection are pursued, just as if the charity application had not been offered. While we believe many or most of the charity cases end up as a bad debt, it is not for lack of effort to educate the potential charity applicant of the availability of assistance and keep the amounts out of our bad debt category. We further believe that many or most of these cases do not consider the impact on their financial credit rating and therefore do not return the application and the supporting documentation to complete the charity funding, and ignore the attempts to collect the medical billings. SCHEDULE H, PART VI NEEDS ASSESSMENT Community Hospital Association, Inc. continually accesses the community's medical needs through the relationship of our staff to community leaders and community programs that identify community needs, often medical in nature. Although the hospital is not always in a position to expand services and meet all identified needs, maintaining a core menu of services that meets the greatest community need has and continues to direct our strategic planning. SCHEDULE H, PART VI PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE All uninsured and under-insured patients at time of registration are provided with options available in our community for payment of the services provided. This is most often verbal with a written Charity Care Application. SCHEDULE H, PART VI COMMUNITY INFORMATION Wickenburg Community Hospital serves a primary service area population of approximately 17,000 in a rural service area clustered around Wickenburg, AZ. Wickenburg Community Hospital is the only hospital in the service area. The distribution of service area population by age is 0-17, 21%; 18-44, 25%; 45-64, 29%; 65+, 24%. The service area is home to a great number of winter residents, changing the population significantly from summer months to winter months, when the population grows by approximately 40%. SCHEDULE H, PART VI PROMOTION OF COMMUNITY HEALTH Wickenburg Community Hospital, designated as a Critical Access Hospital, serves a rural population approximately 35 miles west of the urban area of the greater Phoenix market place of Surprise, AZ. While the distance is not overly great, many of our patients come from rural areas west and north of Wickenburg, requiring them to drive much greater distances to obtain health care services if Wickenburg Community Hospital were not available to them. The most important service we provide is our Emergency Services and could not exist without our Critical Access Hospital status. Additionally, our Rural Health Clinic provides access to primary care providers in our community that probably would not exist if the hospital did not employ these providers. The availability of diagnostic services locally is very important to our community as a higher average age exists in our community, making it difficult to drive longer distances and spend a greater amount of time in obtaining diagnostic services required by their primary care providers. SCHEDULE H, PART V, LINE 19D THE HOSPITAL DETERMINES THE MAXIMUM BY CALCULATING 2% OF THE BUDGET. SCHEDULE H, PARTV, LINE 21 Patients are charged according to the established fee scehule (CDM) for the services provided in the Emergency Room. X false true X X false false false false false false false false true false Jim Tavary 177132 0 0 0 14049 191181 0 James Smith 155875 0 2564 0 6051 164490 0 William Firth MD 218094 37398 0 15500 14049 285041 0 Marilyn Halder MD 164884 0 0 0 10091 174975 0 PART I, QUESTION 1B REIMBURSEMENT OR PROVISION OF EXPENSES Golf Club Membership: The Community Hospital Association pays golf club membership dues for James R. Smith, CFO, and James F. Tavary, CEO. A portion of the club dues are treated as taxable income based on a ratio of personal to business use. The personal use of the membership dues are reported on their W-2's. PART I, QUESTION 8 PAYMENTS MADE PURSUANT TO AN INITIAL CONTRACT EXCEPTION MR. TAVARY IS QUALIFIED BY TRAINING AND EXPERIENCE TO ACT AS CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION. DUTIES SHALL BE PERFORMED TO THE BEST OF MR. TAVARY'S ABILITY, EXPERIENCE, AND TALENT TO THE REASONABLE SATISFACTION OF THE ORGANIZATION. BASE COMPENSATION IS PAID FOR SERVICES, WITH THE ELIGIBILITY OF PERFORMANCE BASED BONUSES. THE TERM OF THE CONTRACT SHALL BE THREE YEARS, WITH THE POSSIBLITY OF EXTENSION MADE BY MUTUAL AGREEMENT OF THE ORGANIZATION AND MR. TAVARY. PART I, QUESTION 9 REBUTTABLE PRESUMPTION PROCEDURE THE ORGANIZATION FOLLOWS THE REBUTTABLE PRESUMPTION PROCEDURE, HOWEVER, THE COMPARABILITY DATA USED IS NOT DOCUMENTED, THEREFORE QUESTION 9 IS ANSWERED AS NO. ARIZONA HEALTH FACILITIES AUTHORITY 860453292 040507GK5 2005-06-09 6000000 CAPITAL PROJECTS AND EQUIPMENT false false false 430000 0 6072257 489656 72257 0 120000 0 0 5390100 0 0 2007 false false true true false false false false 0.00000 0.00000 0.00000 true false false false 0 false 0 false false X Part VI, Question 11b 990 Review Process The Form 990 is prepared by a third party and is reviewed by the CFO. A copy of the 990 is made available to the governing prior to filing with the IRS. Part VI, Question 12c Describe how conflict of interest policy is monitored & enforced All Board members are covered under the policy. Each Board Member must review the policy and sign a compliance certificate annually. The Board reviews the compliance certificates to determine if any conflicts exist. Conflicts are reviewed at the Board level. Any Board member who may have a conflict in any discussion is recused from the discussion and voting on the issue. Part VI, Question 15a Describe process for determining compensation The Board Chairman, with consultation of other members of the Board, reviews independent survey data acquired through the Arizona Hospital & Healthcare Association on executive salaries and reviews the performance of the CEO. This review is done annually by the Board in Executive Session. Part VI, Question 15b Describe process for determining compensation The CEO and HR Director use the Arizona Hospital & Healthcare Association survey data to review all positions in the facility, including key employees and other officers. Part VI, Question 19 Describe how documents are made available to the public Governing documents, conflict of interest policy, and financial statements are made available to the public by a formal request in writing. Part XI, Line 5 Other Changes to Net Assets Change in Interest in Net Assets of Wickenburg Community Hospital Foundation (18,695) HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:Jim Tavary TITLE:Chief Executive Officer HOURS:1 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:James Smith TITLE:Chief Financial Officer HOURS:1 Wickenburg Community Hospital Foundation 520 Rose Lane Wickenburg AZ 85390 742521618 Fundraising AZ 501(c)(3) Line 7 NA true Wickenburg Community Hospital Auxiliary 520 Rose Lane Wickenburg AZ 85390 866056824 Support Org AZ 501(c)(3) 11 Type III NA false false false true true false false false false false false false false true true false true false false WICKENBURG COMMUNITY HOSPITAL FOUNDATION P 95867 AMOUNT PAID