KINGMAN HEALTHCARE INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- KINGMAN HEALTHCARE INC (EIN 94-2916102)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-05-21
- IRS object ID
- 201231429349300603
- Schema version
- 2010v3.7
- 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 C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-05-21T12:41:10-05:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 111 South Tejon Suite 800 | AddressLine1 |
| City | Colorado Springs | City |
| State | CO | State |
| ZIP Code | 809039848 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 942916102 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kingman Hospital Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | KING | NameControl |
| Phone | 9287572101 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3269 Stockton Hill Road | AddressLine1 |
| City | Kingman | City |
| State | AZ | State |
| ZIP Code | 86409 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Timothy Blanchard | Name |
| Title | Chief Financial Officer | Title |
| Date Signed | 2012-05-15 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | David S Mason CPA | Name |
| Phone | 7194714290 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Brian Turney | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3269 Stockton Hill Road | AddressLine1 |
| City | Kingman | City |
| State | AZ | State |
| ZIP Code | 86409 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 228937914 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | AZKRMC.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1980 | YearFormation |
| State Legal Domicile | AZ | StateLegalDomicile |
| Activity Or Mission Description | OUR VISION IS TO BE THE REGION'S LEADING HEALTHCARE PROVIDER THROUGH AN ENVIRONMENT THAT FOSTERS RESPECT FOR OTHERS, PRIDE IN PERFORMANCE, CLINICAL EXCELLENCE AND NATIONALLY RECOGNIZED PATIENT SATISFACTION. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 25 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 25 | NbrIndependentVotingMembers |
| Total Nbr Employees | 1878 | TotalNbrEmployees |
| Total Nbr Volunteers | 262 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2763646 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 394235 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 210163005 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 212359760 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 2146504 | InvestmentIncomePriorYear |
| Investment Income Current Year | 4619352 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 4903124 | OtherRevenuePriorYear |
| Other Revenue Current Year | 3045080 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 219976279 | TotalRevenuePriorYear |
| Total Revenue Current Year | 220418427 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 97336 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 100733 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 101671597 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 111996301 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 100884869 | OtherExpensePriorYear |
| Other Expenses Current Year | 102341086 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 202653802 | TotalExpensesPriorYear |
| Total Expenses Current Year | 214438120 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 17322477 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 5980307 | RevenuesLessExpensesCY |
| Total Assets BOY | 204271205 | TotalAssetsBOY |
| Total Assets EOY | 215559265 | TotalAssetsEOY |
| Total Liabilities BOY | 17703211 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 23286049 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 186567994 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 192273216 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | OUR VISION IS TO BE THE REGION'S LEADING HEALTHCARE PROVIDER THROUGH AN ENVIRONMENT THAT FOSTERS RESPECT FOR OTHERS, PRIDE IN PERFORMANCE, CLINICAL EXCELLENCE AND NATIONALLY RECOGNIZED PATIENT SATISFACTION. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 188717633 | Expense |
| Revenue | 212876812 | Revenue |
| Description | Mohave 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 25% of our total patient population. Our Medicare population is 55% 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. The KRMC Foundation has established the Katherine Duncan Fund as a result of a private donation, to assist those who can not afford to pay. If the patient qualifies for KRMC Charity Care and is left with a private pay balance, they are eligible to receive an additional 25% payment through the Katherine Duncan Fund. In addition, there may be individuals who apply for assistance whose gross income is between 276 to 300% of the Federal Poverty Level that do not qualify for KRMC Qualifying Discount Program. The Katherine Duncan Fund will allow for a payment of 25% toward their balance from the donated funds. There may be exceptions due to circumstances where an individual's financial situation merits a higher percentage of payments through the fund. 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. We provide a discount percentage for family size and income of up to 275% of the FPL. Patients who's gross income is 200% or below receive a 100% adjustments, 200 to 225% a 75% discount, 225 to 250% a 50% discount, 250 to 275% a 25% discount. 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 GME program. We participate with Medicare and Medicaid, Champus, Tricare, Veterans Affairs and other governmental health care programs. | Description |
| Total Program Service Expense | 188717633 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | true | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 184 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 1878 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 25 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 25 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | AZ | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | THE ORGANIZATION | NamePerson |
| Telephone Number | 9287572101 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3269 STOCKTON HILL ROAD | AddressLine1 |
| City | Kingman | City |
| State | AZ | State |
| ZIP Code | 86409 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (35 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Key EmployeeKeyEmployee | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| DAVE FRENCH | ||||||||
| CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | ||
| DON VAWTER | ||||||||
| VICE-CHAIRMAN | 1.0 | X | X | 0 | 0 | 0 | ||
| KRYSTAL BURGE | ||||||||
| SECRETARY | 1.0 | X | X | 0 | 0 | 0 | ||
| DENNIS GUSTAFSON DC | ||||||||
| TREASURER | 1.0 | X | X | 0 | 0 | 0 | ||
| SANDY MOON | ||||||||
| EXECUTIVE BOARD MEMBER | 1.0 | X | 0 | 0 | 0 | |||
| ROD MARQUARDT | ||||||||
| EXECUTIVE BOARD MEMBER | 1.0 | X | 0 | 0 | 0 | |||
| CATHY OTT | ||||||||
| EXECUTIVE BOARD MEMBER | 1.0 | X | 0 | 0 | 0 | |||
| ROBERT MATHENEY MD | ||||||||
| EXECUTIVE BOARD MEMBER | 1.0 | X | 0 | 0 | 0 | |||
| BARBARA RICCA | ||||||||
| EXECUTIVE BOARD MEMBER | 1.0 | X | 0 | 0 | 0 | |||
| GARY DYKMAN | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| WILLIAM KIRBY | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| RENNA MATTHEWS | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| CLAIRE CRUM | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| SANDRA COFER | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| TOM PRICE | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| MAHMOOD KHAN MD | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| DARRELL LAUTERET | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JIM BAKER | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| STEVE PEBLEY | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| SUSAN CHAN | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| TOM CLARK | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| DOUG ANGLE | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| MIKE ROBERTS | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| ROBERT DEVRIES | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JEFFREY BERGESON | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| BRIAN TURNEY | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.0 | X | 538303 | 0 | 32737 | |||
| RYAN KENNEDY | ||||||||
| CHIEF OPERATING OFFICER | 40.0 | X | 203761 | 0 | 22636 | |||
| LAWRENCE LEWIS | ||||||||
| CHIEF ADMINISTRATIVE OFFICER | 40.0 | X | 297643 | 0 | 29698 | |||
| JEFFREY LUNN MD | ||||||||
| CHIEF MEDICAL OFFICER | 40.0 | 491665 | 0 | 28874 | X | |||
| DEBORAH BENNETT DO | ||||||||
| CHIEF MEDICAL OFFICER | 40.0 | 202855 | 0 | 27610 | X | |||
| EMMETT MCELENEY | ||||||||
| PHYSICIAN | 40.0 | 1140113 | 0 | 12802 | X | |||
| JAMES GONZALES | ||||||||
| PHYSICIAN | 40.0 | 898371 | 0 | 21482 | X | |||
| HESHAM SAHAWNEH | ||||||||
| PHYSICIAN | 40.0 | 629270 | 0 | 27319 | X | |||
| STAN ALLEN | ||||||||
| PHYSICIAN | 40.0 | 613806 | 0 | 24476 | X | |||
| EDDIE RAMIREZ | ||||||||
| PHYSICIAN | 40.0 | 603650 | 0 | 38024 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 5619437 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 265658 | TotalOtherCompensation |
| Number Individuals GT100 K | 138 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| HIGH DESERT RADIOLOGY | |||||
| 695 COUNTRY CLUB DRIVE | KINGMAN | AZ | 86401 | RADIOLOGISTS | 4453155 |
| T R ORR INC | |||||
| 3965 N BANK STREET | KINGMAN | AZ | 89409 | CONTRACTOR | 1911583 |
| MIDWESTERN UNIVERSITY | |||||
| 19555 N 59TH AVE | GLENDALE | AZ | 85308 | GME PROGRAM | 1688753 |
| AMN HEALTHCARE | |||||
| FILE 56157 | LOS ANGELES | CA | 90074 | NURSE AGENCY | 1539507 |
| COMPHEALTH MEDICAL STAFFING | |||||
| PO BOX 972670 | DALLAS | TX | 75397 | NURSE AGENCY | 812395 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 34 | NumberOfContractorsGT100K |
| Related Organizations | 169841 | RelatedOrganizations |
| All Other Contributions | 224394 | AllOtherContributions |
| Noncash Contributions | 19841 | NoncashContributions |
| Total Contributions | 394235 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 900099 | 115925554 | 115925554 |
| MEDICARE & MEDICAID REVENUE | 900099 | 94848180 | 94848180 |
| ORTHO MISC REVENUE | 900099 | 2416 | 2416 |
| ALLERGY MISC REVENUE | 900099 | 257058 | 257058 |
| WELLNESS CENTER REVENUE | 900099 | 1132604 | 1132604 |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 193948 | TotalRevenueColumn |
| Related Or Exempt Function Income | 193948 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 212359760 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 2635257 | TotalRevenueColumn |
| Exclusion | $2,635,257 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 791459 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 791459 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 791459 | TotalRevenueColumn |
| Exclusion | $791,459 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8960297 | Securities |
| Other | 1538369 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 6438887 | Securities |
| Other | 2075684 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 2521410 | Securities |
| Other | -537315 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1984095 | TotalRevenueColumn |
| Exclusion | $1,984,095 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | 11339 | GrossSalesOfInventory |
| Cost Of Goods Sold | 4916 | CostOfGoodsSold |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6423 | TotalRevenueColumn |
| Exclusion | $6,423 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|---|
| CAFETERIA | 900099 | 1424615 | $1,424,615 | |
| CHILD CARE | 624410 | 303919 | $303,919 | |
| MISCELLANEOUS REVENUE | 900099 | 43903 | $1,612 | 42291 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 474761 | TotalRevenueColumn |
| Related Or Exempt Function Income | 474761 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 2247198 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 220418427 | TotalRevenueColumn |
| Related Or Exempt Function Income | 212876812 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $7,147,380 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 100733 | Total |
| Program Services | 100733 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1875782 | Total |
| Program Services | 1650687 | ProgramServices |
| Management And General | 225095 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81683985 | Total |
| Program Services | 71881908 | ProgramServices |
| Management And General | 9802077 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2136652 | Total |
| Program Services | 1880254 | ProgramServices |
| Management And General | 256398 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20898189 | Total |
| Program Services | 18390406 | ProgramServices |
| Management And General | 2507783 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5401693 | Total |
| Program Services | 4753490 | ProgramServices |
| Management And General | 648203 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10007474 | Total |
| Program Services | 8806577 | ProgramServices |
| Management And General | 1200897 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 206554 | Total |
| Program Services | 181768 | ProgramServices |
| Management And General | 24786 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 137791 | Total |
| Program Services | 121256 | ProgramServices |
| Management And General | 16535 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1871503 | Total |
| Program Services | 1646923 | ProgramServices |
| Management And General | 224580 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 698491 | Total |
| Program Services | 614672 | ProgramServices |
| Management And General | 83819 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 37838347 | Total |
| Program Services | 33297745 | ProgramServices |
| Management And General | 4540602 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10373942 | Total |
| Program Services | 9129069 | ProgramServices |
| Management And General | 1244873 | ManagementAndGeneral |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3630111 | Total |
| Program Services | 3194498 | ProgramServices |
| Management And General | 435613 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 678252 | Total |
| Program Services | 596862 | ProgramServices |
| Management And General | 81390 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2876 | Total |
| Program Services | 2531 | ProgramServices |
| Management And General | 345 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12622671 | Total |
| Program Services | 11107950 | ProgramServices |
| Management And General | 1514721 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4667701 | Total |
| Program Services | 4107576 | ProgramServices |
| Management And General | 560125 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 17929571 | 15778022 | 2151549 |
| EMPLOYEE & PHYSICIAN RECRUIT | 1429308 | 1257791 | 171517 |
| OTHER EXPENSE | 246494 | 216915 | 29579 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 214438120 | Total |
| Program Services | 188717633 | ProgramServices |
| Management And General | 25720487 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 55645 | BOY |
| EOY | 58010 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 27366175 | BOY |
| EOY | 26704343 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33283823 | BOY |
| EOY | 36573797 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 661034 | BOY |
| EOY | 547440 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3843692 | BOY |
| EOY | 4407994 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2470528 | BOY |
| EOY | 2107628 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 175510921 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 79428812 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 91766359 | BOY |
| EOY | 96082109 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 34884074 | BOY |
| EOY | 40531264 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 706007 | BOY |
| EOY | 746230 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5896088 | BOY |
| EOY | 6609799 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1887507 | BOY |
| EOY | 650000 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1450273 | BOY |
| EOY | 540651 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 204271205 | BOY |
| EOY | 215559265 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15790359 | BOY |
| EOY | 21183028 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 417390 | BOY |
| EOY | 373135 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 63970 | BOY |
| EOY | 37803 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1431492 | BOY |
| EOY | 1692083 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17703211 | BOY |
| EOY | 23286049 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 185704025 | BOY |
| EOY | 191126827 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 863969 | BOY |
| EOY | 1146389 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 186567994 | BOY |
| EOY | 192273216 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 204271205 | BOY |
| EOY | 215559265 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 5980307 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | -275085 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | false | GrantsOtherOrganizations |
| Direct Contact Legislators | true | DirectContactLegislators |
| Direct Contact Legislators | $21,874 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 21874 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part II B, Line 1g | Identifier |
| Return Reference | Lobbying Expense | ReturnReference |
| Explanation | Kingman 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 118983 | BeginningOfYearBalance |
| Contributions | 92138 | Contributions |
| Investment Earnings Or Losses | 117 | InvestmentEarningsOrLosses |
| Other Expenditures | 45056 | OtherExpenditures |
| End Of Year Balance | 166182 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 101798 | BeginningOfYearBalance |
| Contributions | 62988 | Contributions |
| Investment Earnings Or Losses | 281 | InvestmentEarningsOrLosses |
| Other Expenditures | 46084 | OtherExpenditures |
| End Of Year Balance | 118983 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 108227 | BeginningOfYearBalance |
| Contributions | 15089 | Contributions |
| Investment Earnings Or Losses | 250 | InvestmentEarningsOrLosses |
| Other Expenditures | 21768 | OtherExpenditures |
| End Of Year Balance | 101798 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 0.00000 | BoardDesignatedEOYBalance |
| Permanent Endowment EOY Balance | 0.00000 | PermanentEndowmentEOYBalance |
| Term Endowment EOY Balance | 1.00000 | TermEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | true | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | true | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13835458 | OtherCostOrOtherBasis |
| Book Value | 13835458 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 71334355 | OtherCostOrOtherBasis |
| Depreciation | 31992781 | Depreciation |
| Book Value | 39341574 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 81558691 | OtherCostOrOtherBasis |
| Depreciation | 47436031 | Depreciation |
| Book Value | 34122660 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 8782417 | OtherCostOrOtherBasis |
| Book Value | 8782417 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 96082109 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| ACCRUED RETIREMENT OBLIGATION | $1,036,083 |
| ESTIMATED SELF-INSURANCE COSTS | $656,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 1692083 | TotalOfAmounts |
| Total Revenue | 220418427 | TotalRevenue |
| Total Expenses | 214438120 | TotalExpenses |
| Excess Or Deficit For Year | 5980307 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 1463936 | NetUnrealizedGLOnInvestments |
| Other | -$1,739,021 | OtherAmount |
| Total Adjustments | -275085 | TotalAdjustments |
| Excess Or Deficit Per FS | 5705222 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 220569379 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 1463936 | NetUnrealizedGainsInvestments |
| Other Revenues | -1312984 | OtherRevenues |
| Revenue Not Rptd F990 | 150952 | RevenueNotRptdF990 |
| Revenue Subtotal | 220418427 | RevenueSubtotal |
| Total Revenue Per Form990 | 220418427 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 214864157 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 426037 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 426037 | ExpensesNotRptdF990 |
| Expenses Subtotal | 214438120 | ExpensesSubtotal |
| Total Expenses Per Form990 | 214438120 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PART V, LINE 4 | DESCRIBE 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 8 | DESCRIPTION OF OTHER: | INCOME FROM INVESTMENT IN FOUNDATION: 148,486 GOODWILL IMPAIRMENT: (1,887,507) TOTAL: (1,739,021) |
| PART XII, LINE 2D | DESCRIPTION OF OTHER: | LOSS ON SALE OF ASSETS: 537,315 COST OF GOODS SOLD: 4,916 INCOME FROM INVESTMENT IN NARIC: (116,194) INCOME FROM INVESTMENT IN FOUNDATION: 148,486 GOODWILL IMPAIRMENT: (1,887,507) TOTAL: (1,312,984) |
| PART XIII, LINE 2D | DESCRIPTION OF OTHER | LOSS ON SALE OF ASSETS: 537,315 COST OF GOODS SOLD: 4,916 INCOME FROM INVESTMENT IN NARIC: (116,194) TOTAL: 426,037 |
| Part X, Line 2 | Uncertain Tax Positions | 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. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 275. | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1139548 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1139548 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00580 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 40011274 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 30711760 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 9299514 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04720 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 41150822 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 30711760 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10439062 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05300 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 184221 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 184221 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 360048 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 360048 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00180 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 544269 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 544269 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 41695091 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 30711760 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10983331 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05570 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $5,689,053 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 45845355 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 44205385 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 1639970 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kingman Regional Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3269 Stockton Hill Road | AddressLine1 |
| City | Kingman | City |
| State | AZ | State |
| ZIP Code | 86409 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Teaching Hospital | X | TeachingHospital |
| Er24 Hours | X | Er24Hours |
| Other | Cancer Center Cardiac Cath Lab Acute Rehab Unit | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Kingman Regional Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 275. | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | true | GrossCharges |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part V, Question 15 | Permitted Collection Actions against a patient | THE HOSPITAL SENDS STATEMENTS, COLLECTION LETTERS, MAKES PHONE CALLS AND DISCUSSES HOSPITAL DISCOUNT AND CHARITY CARE POLICIES THAT ARE AVAILABLE FOR PATIENTS. |
| PART V, QUESTION 19 | HOW HOSPITAL DETERMINES AMOUNT BILLED FOR THOSE W/O INSURANCE | ALL UNINSURED PATIENTS ARE ELIGIBLE FOR A 25% DISCOUNT WHICH IS EQUAL TO THE AVERAGE COMMERCIAL INSURANCE RATES. |
| PART V, QUESTION 21 | DID HOSPITAL CHARGE AMOUNT EQUAL TO GROSS CHARGE FOR ANY SERVICES | ALL UNINSURED PATIENTS WHO DO NOT MEET THE ELIGIBILITY REQUIREMENTS OF THE CHARITY CARE POLICY OR SELF PAY DISCOUNT CAN QUALIFY FOR A NO INTEREST LOAN FROM THE HOSPITAL OVER 3-5 YEARS. THESE PATIENTS ARE CHARGED TOTAL GROSS CHARGES. NEW POLICY EFFECTIVE FOR FISCAL YEAR 2012 WILL GRANT 30% DISCOUNT TO ALL SELF PAY PATIENTS REGARDLESS OF ABILITY TO PAY. |
| NEEDS ASSESSMENT | A community survey was conducted in September 2007 to help identify the communities perceptions about the services provided at KRMC and what could be done to improve healthcare in our community. In Addition, we rely on our current medical staff to communicate perceived needs and opportunities in the community. The hospital uses Intellimed data that tracks where patients are coming from which shows need for specific services and demographics of patients by zip code. We monitor community growth and identify benchmarks based on demographics of the population and look at the number of cases transferred to other hospitals because we currently do not have that service and/or physician. | |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | During the admission process the patient is given information about ACCHS. KRMC has hired First Source who has staff on-site that visits the patients personally and helps them apply for ACCHS. The patient is notified immediately once they have been approved. In addition, the hospital offers a Qualifying Discount Program that is based on the number of eligible dependents and income. Patients are given the information about the program upon discharge and then referred to Patient Financial Services. Information about the program is also available as an on-line form at our website, https://www.azkrmc.com/ index.php?option=com_content&view=article&id=55&Itemid=161. Inpatient and Emergency Kingman Regional Medical Center (KRMC) contracts with First Source who has staff on-site to screen the self-pay patients personally and help them apply for Medicaid and/or qualify for KRMC's Qualifying Discount Program (Charity Program). The patient is contacted during various stages in their visit or stay at KRMC. If the patient presents through the emergency department, they are first sent through triage and medical screening by an ER physician before a First Source representative talks with them. If the patient becomes an inpatient, KRMC's admitting and patient financial services follow up with First Source to determine the status of the patient's Medicaid or Charity Program eligibility. The patient is notified immediately when they are approved. Information to the public about patient assistance at KRMC is also available on-line at the azkrmc.com website. Outpatient Services KRMC patient financial services staff work proactively with physician offices and ancillary services to pre-approve assistance for scheduled procedures (surgery or op testing). Assistance for self-pay outpatients includes researching and applying for eligibility through Medicare, Medicaid, or the KRMC Charity program. First Source may be contacted with outpatients to assist them in the eligibility process. They also counsel and educate on patient co-pays, deductibles, and how the patient can set up a zero-interest payment arrangement with PFS if they cannot pay in full at the time of service. | |
| COMMUNITY INFORMATION | Kingman 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 92% Caucasian, 1.5% African American, 2.6% Native American, and 14.1% Hispanic or Latino origin. U.S. Census Bureau statistics for 2006 show 16.8% of Mohave County's population is 100% below the federal poverty level and about 38.7% of the population is 200% below the federal poverty level. The median household income is $38,641. The current unemployment rate in Mohave County is 11.1% (as of January, 2011). Approximately 77.5% of the county's population over age 25 are high school graduates, with 9.9% of the population over age 25 holding a Bachelor's degree or higher. | |
| OTHER INFORMATION | Kingman 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 25 members holding terms of five years. All board members are community-minded individuals who receive no 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 1500 people and during the past year spent over $10,000,000 with local businesses. In 2011, and for the sixth time in seven years, KRMC was named by Cleverley + Associates as a national 5-Star Hospital for the value we provide to our community. | |
| AFFILIATED HEALTH CARE SYSTEM ROLES | N/A | |
| PART I, LINE 7, COLUMN F | TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = $17,929,571. | |
| PART I, LINE 7 | THE 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 4 | The Organization reports patient accounts receivable for services rendered at net realizable amounts from third-party payers, patients and others. The organization provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information and existing economic conditions. As a service to the patient, the Organization bills third-party payers directly and bills the patient when the patient's liability is determined. Patient accounts receivable are due in full when billed. Accounts are considered delinquent and subsequently written-off as bad debts based on individual credit evaluation and specific circumstances of the account. The amount reported in the Organization's bad debt expense is estimated by applying a cost-to-charge ratio to the annual bad debt expense. Financial counselors assist patients with financial assistance applications. If the application is completed and the patient is eligible for financial assistance, the account is recorded as a charity care adjustment. If the application is not completed, it is not possible to determine patient eligibility for charity care classification and the account is written off as bad debt. | |
| PART III, LINE 8 | The 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 9B | Collection efforts must exhaust any possibility that the patient will qualify for indigent care programs. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | Scholarships | TypeOfGrant |
| Number Of Recipients | 33 | NumberOfRecipients |
| Amount Of Cash Grant | 100733 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part I, Question 2 | Identifier |
| Return Reference | Procedures for Monitoring the use of grant funds to U.S. | ReturnReference |
| Explanation | Fund 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | X | CompensationCommittee |
| Independent Consultant | X | IndependentConsultant |
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | true | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRIAN TURNEY | |||||||||||||
| 454919 | 0 | 66884 | 0 | 16500 | 0 | 14700 | 0 | 18037 | 0 | 571040 | 0 | 0 | 0 |
| RYAN KENNEDY | |||||||||||||
| 173105 | 0 | 30656 | 0 | 0 | 0 | 4149 | 0 | 18487 | 0 | 226397 | 0 | 0 | 0 |
| LAWRENCE LEWIS | |||||||||||||
| 245585 | 0 | 41427 | 0 | 10631 | 0 | 11440 | 0 | 18258 | 0 | 327341 | 0 | 0 | 0 |
| JEFFREY LUNN MD | |||||||||||||
| 446642 | 0 | 0 | 0 | 45023 | 0 | 7350 | 0 | 21524 | 0 | 520539 | 0 | 0 | 0 |
| DEBORAH BENNETT DO | |||||||||||||
| 202855 | 0 | 0 | 0 | 0 | 0 | 6086 | 0 | 21524 | 0 | 230465 | 0 | 0 | 0 |
| EMMETT MCELENEY | |||||||||||||
| 915100 | 0 | 225013 | 0 | 0 | 0 | 0 | 0 | 12802 | 0 | 1152915 | 0 | 0 | 0 |
| JAMES GONZALES | |||||||||||||
| 342906 | 0 | 526908 | 0 | 28557 | 0 | 0 | 0 | 21482 | 0 | 919853 | 0 | 0 | 0 |
| HESHAM SAHAWNEH | |||||||||||||
| 564270 | 0 | 65000 | 0 | 0 | 0 | 5731 | 0 | 21588 | 0 | 656589 | 0 | 0 | 0 |
| STAN ALLEN | |||||||||||||
| 613806 | 0 | 0 | 0 | 0 | 0 | 2952 | 0 | 21524 | 0 | 638282 | 0 | 0 | 0 |
| EDDIE RAMIREZ | |||||||||||||
| 587150 | 0 | 0 | 0 | 16500 | 0 | 16500 | 0 | 21524 | 0 | 641674 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part 1 Question 5 | Identifier |
| Return Reference | Explanation of compensation contingent of Revenues | ReturnReference |
| Explanation | Employed 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 (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part VI, Question 11 | Process to review the form 990 | The 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 12c | Process for monitoring compliance with conflict of interest policy | The 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-B | Process for Determining Compensation | A 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 19 | Governing Documents Available to the Public | The 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 5 | Other Changes in Net Assets or Fund Balances | Unrealized Gain or Loss: 1,463,936 Goodwill Impairment: (1,887,507) Change in Invesement of Foundation: 148,486 Total: (275,085) |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| NORTHWESTERN ARIZONA REGIONAL INSURANCE | |||||||||
| 4041 N CENTRAL AVE | PHOENIX | AZ | 85012 | 208081486 | INSURER | AZ | 501(c)(3) | LINE 9 | NA |
| KINGMAN REGIONAL MEDICAL CENTER FOUNDATI | |||||||||
| 3269 STOCKTON HILL ROAD | KINGMAN | AZ | 86409 | 742388735 | FUND RAISING | AZ | 501(c)(3) | LINE 7 | NA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | true | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| Northwestern Arizona Regional Insurance Co | |
| q | 1711504 |
| KINGMAN REGIONAL MEDICAL CENTER FOUNDATION | |
| C | 169841 |
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