COMMUNITY HOSPITAL ASSOCIATION INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION INC (EIN 86-0096775)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-15
- IRS object ID
- 201143199349309759
- Schema version
- 2010v3.4
- 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 H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-15T16:27:37-05:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | 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 | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860096775 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 9286844390 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | James R Smith | Name |
| Title | CFO | Title |
| Date Signed | 2011-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Rita F Worster CPA | Name |
| Phone | 7194714290 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Jim Tavary | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 14911672 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.wickhosp.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1946 | YearFormation |
| State Legal Domicile | AZ | StateLegalDomicile |
| Activity Or Mission Description | To provide quality health and wellness services where the patient, family and community come first. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 10 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 9 | NbrIndependentVotingMembers |
| Total Nbr Employees | 189 | TotalNbrEmployees |
| Total Nbr Volunteers | 25 | TotalNbrVolunteers |
| Total Gross UBI | 236931 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -124241 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 105336 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 256872 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 13057544 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 14368981 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 33338 | InvestmentIncomePriorYear |
| Investment Income Current Year | 40359 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 92486 | OtherRevenuePriorYear |
| Other Revenue Current Year | 34996 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 13288704 | TotalRevenuePriorYear |
| Total Revenue Current Year | 14701208 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 6255710 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 7726135 | 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 | 6946155 | OtherExpensePriorYear |
| Other Expenses Current Year | 7662168 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 13201865 | TotalExpensesPriorYear |
| Total Expenses Current Year | 15388303 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 86839 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -687095 | RevenuesLessExpensesCY |
| Total Assets BOY | 18535835 | TotalAssetsBOY |
| Total Assets EOY | 18100175 | TotalAssetsEOY |
| Total Liabilities BOY | 8458020 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 8622730 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 10077815 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 9477445 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide quality health and wellness services where the patient, family, and community come first. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 12883640 | Expense |
| Revenue | 14269957 | Revenue |
| Description | 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. | Description |
| Total Program Service Expense | 12883640 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | 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 | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | 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 | false | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | true | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| 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 | true | 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 | 45 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 189 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | true | UnrelatedBusinessIncome |
| Form990-T Filed | true | Form990-TFiled |
| 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 |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 10 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 9 | 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 | false | WhistleblowerPolicy |
| Document Retention Policy | false | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | 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 | 9286844390 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 ROSE LANE | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|---|
| Uwe Gross | ||||||||
| Board Treasurer | 1.0 | X | X | 0 | 0 | 0 | ||
| Jerry Diddy | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Betsy Deibel | ||||||||
| Board President | 1.0 | X | X | 0 | 0 | 0 | ||
| John Marzolf | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Dennis Barraco DO | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Hank Brubaker | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Sallie Hershkowitz | ||||||||
| Board Vice President | 1.0 | X | X | 0 | 0 | 0 | ||
| John Snavely | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Kevin Armstrong | ||||||||
| Board Secretary | 1.0 | X | X | 0 | 0 | 0 | ||
| Robert McCoy | ||||||||
| Board Member | 1.0 | X | 0 | 0 | 0 | |||
| Paul Broser | ||||||||
| Chief Operating Officer | 40.0 | X | 140558 | 0 | 14386 | |||
| Dale Decker | ||||||||
| Chief Executive Officer | 39.0 | X | 263864 | 0 | 2000 | |||
| James Smith | ||||||||
| Chief Financial Officer | 39.0 | X | 157828 | 0 | 10413 | |||
| Jim Tavary | ||||||||
| Chief Executive Officer | 39.0 | X | 64272 | 0 | 3899 | |||
| William Firth MD | ||||||||
| Chief of Staff & Clnc Med Dir | 40.0 | 242688 | 0 | 29788 | X | |||
| Dov Levine DO | ||||||||
| Physician | 40.0 | 116214 | 0 | 6024 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 985424 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 66510 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | 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 |
|---|---|---|---|---|---|
| QUEST DIAGNOSTICS INC | |||||
| 3924 COLLECTION CENTER DR | CHICAGO | IL | 606930039 | LABORATORY SERVICES | 164162 |
| CPSI | |||||
| PO BOX 850309 | MOBILE | AL | 366850309 | SOFTWARE SUPPORT | 177267 |
| EMERGENCY PHY PROF ASSN | |||||
| 1470 W PORT AU PRINCE LANE | PHOENIX | AZ | 85023 | PHYSICIANS | 648000 |
| MEDICAL DIAGNOSTIC IMAGING GROUP L | |||||
| PO BOX 17049 | PHOENIX | AZ | 85011 | Medical Imaging | 371360 |
| ALLIANCE IMAGING INC | |||||
| FILE 55826 | LOS ANGELES | CA | 900745826 | MEDICAL IMAGING | 146804 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| Related Organizations | 132872 | RelatedOrganizations |
| All Other Contributions | 124000 | AllOtherContributions |
| Total Contributions | 256872 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|
| PATIENT SERVICES | 621990 | 6919406 | 6919406 | |
| WELLNESS CENTER | 812900 | 236931 | 236931 | |
| MEDICARE | 621990 | 7212644 | 7212644 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 14368981 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 72030 | TotalRevenueColumn |
| Exclusion | $72,030 | 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 | 72682 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 178793 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | -106111 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -106111 | TotalRevenueColumn |
| Exclusion | -$106,111 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 31671 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -31671 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -31671 | TotalRevenueColumn |
| Exclusion | -$31,671 | 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 |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | OTHER REVENUE | Description |
| Business Code | 900099 | BusinessCode |
| Total Revenue Column | 141107 | TotalRevenueColumn |
| Related Or Exempt Function Income | 137907 | RelatedOrExemptFunctionIncome |
| Exclusion | $3,200 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 141107 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 14701208 | TotalRevenueColumn |
| Related Or Exempt Function Income | 14269957 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 236931 | UnrelatedBusinessRevenue |
| Exclusion | -$62,552 | 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 | 0 | Total |
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 | 929697 | Total |
| Program Services | 406191 | ProgramServices |
| Management And General | 523506 | 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 | 5630391 | Total |
| Program Services | 4913124 | ProgramServices |
| Management And General | 717267 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 687603 | Total |
| Program Services | 600008 | ProgramServices |
| Management And General | 87595 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 478444 | Total |
| Program Services | 402553 | ProgramServices |
| Management And General | 75891 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 110550 | Total |
| Management And General | 110550 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 86495 | Total |
| Management And General | 86495 | 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 | 1939267 | Total |
| Program Services | 1770730 | ProgramServices |
| Management And General | 168537 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 812925 | Total |
| Program Services | 755759 | ProgramServices |
| Management And General | 57166 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 128155 | Total |
| Program Services | 128155 | ProgramServices |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 318851 | Total |
| Program Services | 310740 | ProgramServices |
| Management And General | 8111 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 19642 | Total |
| Program Services | 11065 | ProgramServices |
| Management And General | 8577 | 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 | 100097 | Total |
| Program Services | 66829 | ProgramServices |
| Management And General | 33268 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 460782 | Total |
| Management And General | 460782 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1180551 | Total |
| Program Services | 1169980 | ProgramServices |
| Management And General | 10571 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192374 | Total |
| Program Services | 192374 | ProgramServices |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| REPAIRS & MAINTENANCE | 450884 | 428613 | 22271 | 0 |
| PROVISION FOR BAD DEBTS | 477981 | 477981 | 0 | 0 |
| MEDICAL SUPPLIES | 1137916 | 1137916 | 0 | 0 |
| OTHER | 245698 | 111622 | 134076 | 0 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15388303 | Total |
| Program Services | 12883640 | ProgramServices |
| Management And General | 2504663 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4510687 | BOY |
| EOY | 2747283 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47948 | BOY |
| EOY | 51203 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 79000 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1752708 | BOY |
| EOY | 1790876 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 868373 | BOY |
| EOY | 784338 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 206305 | BOY |
| EOY | 240059 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 282651 | BOY |
| EOY | 338693 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 20398763 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 9347869 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 9781521 | BOY |
| EOY | 11050894 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 491457 | BOY |
| EOY | 491277 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 515185 | BOY |
| EOY | 605552 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18535835 | BOY |
| EOY | 18100175 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1079558 | BOY |
| EOY | 1235394 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5760000 | BOY |
| EOY | 5670000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1571327 | BOY |
| EOY | 1653237 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 47135 | BOY |
| EOY | 64099 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8458020 | BOY |
| EOY | 8622730 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10009700 | BOY |
| EOY | 9450560 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 68115 | BOY |
| EOY | 26885 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10077815 | BOY |
| EOY | 9477445 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18535835 | BOY |
| EOY | 18100175 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -687095 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 86725 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| 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 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 | 68115 | BeginningOfYearBalance |
| Contributions | 1000 | Contributions |
| Investment Earnings Or Losses | -3500 | InvestmentEarningsOrLosses |
| Other Expenditures | 38730 | OtherExpenditures |
| End Of Year Balance | 26885 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 116962 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -16413 | InvestmentEarningsOrLosses |
| Other Expenditures | 32434 | OtherExpenditures |
| End Of Year Balance | 68115 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 1146828 | BeginningOfYearBalance |
| Contributions | 5000 | Contributions |
| Investment Earnings Or Losses | -8423 | InvestmentEarningsOrLosses |
| Other Expenditures | 1026443 | OtherExpenditures |
| End Of Year Balance | 116962 | 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 | 1199482 | OtherCostOrOtherBasis |
| Book Value | 1199482 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13339176 | OtherCostOrOtherBasis |
| Depreciation | 5818243 | Depreciation |
| Book Value | 7520933 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5161561 | OtherCostOrOtherBasis |
| Depreciation | 3314981 | Depreciation |
| Book Value | 1846580 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 698544 | OtherCostOrOtherBasis |
| Depreciation | 214645 | Depreciation |
| Book Value | 483899 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11050894 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | INSURANCE FINANCING | Description |
| Amount | $64,099 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 64099 | TotalOfAmounts |
| Total Revenue | 14701208 | TotalRevenue |
| Total Expenses | 15388303 | TotalExpenses |
| Excess Or Deficit For Year | -687095 | ExcessOrDeficitForYear |
| Other | $86,725 | OtherAmount |
| Total Adjustments | 86725 | TotalAdjustments |
| Excess Or Deficit Per FS | -600370 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 14966726 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 265518 | OtherRevenues |
| Revenue Not Rptd F990 | 265518 | RevenueNotRptdF990 |
| Revenue Subtotal | 14701208 | RevenueSubtotal |
| Total Revenue Per Form990 | 14701208 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 15567096 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 178793 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 178793 | ExpensesNotRptdF990 |
| Expenses Subtotal | 15388303 | ExpensesSubtotal |
| Total Expenses Per Form990 | 15388303 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part XII, Line 2d | Other revenue included on books, not on return | Change in Interest in Net Assets of Wickenburg Community Hospital Foundation 86,725 Rental expenses netted against rental income on 990 178,793 Total 265,518 |
| Part XIII, Line 2d | Other expenses on books, not on return | Rental expenses netted against rental income on 990 178,793 |
| Endowment intended use | Part V line 4 | The endowment funds are to be used for educational purposes and to acquire property and equipment for the hospital. |
| Part X | 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. |
| Part XI, Line 8 | Other Changes to Net Assets | Change in Interest in Net Assets of Wickenburg Community Hospital Foundation 86,725 |
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 |
| Pcent200 D | X | Pcent200D |
| 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 | 38704 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 38704 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1172767 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1026561 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 146206 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00980 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1211471 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1026561 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 184910 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01240 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 21117 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14925 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6192 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 18346 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 18346 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 39463 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 14925 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 24538 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1250934 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1041486 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 209448 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01400 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $299,127 | BadDebtExpenseAmount |
| Amount Attributable To | 149564 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 4590423 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4590423 | CostOfCareReimbursedByMedicare |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost Accounting System | X | CostAccountingSystem |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | false | 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 | Wickenburg Community Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Clinic | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 519 Rose Lane | AddressLine1 |
| City | Wickenburg | City |
| State | AZ | State |
| ZIP Code | 85390 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | Rural Health Clinic | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SCHEDULE H, PART I, LINE 7, COLUMN F | BAD DEBT EXPENSE | TOTAL BAD DEBT EXPENSE REMOVED FROM THE DENOMINATOR PRIOR TO THE PERCENTAGE CALCULATION = 477,981. |
| 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 | The Hospital reports patient accounts receivable for services rendered at net realizable amounts from third party payers, patients, and others. The hospital provides an allowance for doubtful accounts based upon a review of the outstanding receivables, historical collection information, and existing economic conditions. As a service to the patient, the Hospital 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 credit evaluation and specific circumstances of the account. Bad Debt Expense (at cost) is determined by multiplying the gross bad debts by the cost to charge ratio calculated on Worksheet 2. 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 J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | false | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | 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 (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Paul Broser | |||||||||||||
| 140558 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 14386 | 0 | 154944 | 0 | 0 | 0 |
| Dale Decker | |||||||||||||
| 145676 | 0 | 0 | 0 | 118188 | 0 | 0 | 0 | 2000 | 0 | 265864 | 0 | 0 | 0 |
| James Smith | |||||||||||||
| 155351 | 0 | 0 | 0 | 2477 | 0 | 0 | 0 | 10413 | 0 | 168241 | 0 | 0 | 0 |
| William Firth MD | |||||||||||||
| 219763 | 0 | 22925 | 0 | 0 | 0 | 15500 | 0 | 14288 | 0 | 272476 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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, Dale A. Decker, CEO, 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 4A | SEVERANCE PAYMENTS | DALE A. DECKER- $93,658 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARIZONA HEALTH FACILITIES AUTHORITY | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 860453292 | IssuerEIN |
| CUSIP Number | 040507GK5 | CUSIPNumber |
| Date Issued | 2005-06-09 | DateIssued |
| Issue Price | 6000000 | IssuePrice |
| Description Of Purpose | CAPITAL PROJECTS AND EQUIPMENT | DescriptionOfPurpose |
| Defeased | false | Defeased |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Pool Financing | false | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 330000 | AmountRetired |
| Amount Bond Defeased | 0 | AmountBondDefeased |
| Total Proceeds | 6072257 | TotalProceeds |
| Amount In Reserve Fund | 491277 | AmountInReserveFund |
| Capitalized Interest | 72257 | CapitalizedInterest |
| Refunding Escrow | 0 | RefundingEscrow |
| Issuance Costs From Proceeds | 120000 | IssuanceCostsFromProceeds |
| Credit Enhancement | 0 | CreditEnhancement |
| Working Capital Expenditures | 0 | WorkingCapitalExpenditures |
| Capital Expenditures | 5390100 | CapitalExpenditures |
| Other Spent Proceeds | 0 | OtherSpentProceeds |
| Amount Unspent | 0 | AmountUnspent |
| Year Of Subst Completion | 2007 | YearOfSubstCompletion |
| Current Refunding | false | CurrentRefunding |
| Advance Refunding | false | AdvanceRefunding |
| Final Allocation Made | true | FinalAllocationMade |
| Adequate Books And Recds Maintaind | true | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | false | OwningBondFinancedProperty |
| Any Lease Arrangements | false | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | false | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | false | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | false | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | true | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | false | Form8038TFiled |
| Variable Rate Issue | false | VariableRateIssue |
| Hedge Identified In Books And Recds | false | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | false | GrossProceedsInvested |
| Exception To Rebate | false | ExceptionToRebate |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Emergency Physicians Professional A | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | See Part V Disclosure | Relationship |
| Amount Of Transaction | 648000 | AmountOfTransaction |
| Description Of Transaction | Emergency Physician Services | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Part IV, Column B | Identifier |
| Return Reference | Relationship between interested person and the organization | ReturnReference |
| Explanation | Dennis Barraco, DO serves as a director of the Hospital. He also is a key employee of Emergency Physicians Professional Association. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 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 XI, Line 5 | Other Changes to Net Assets | Change in Interest in Net Assets of Wickenburg Community Hospital Foundation 86,725 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Dale Decker TITLE:Chief Executive Officer HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:James Smith TITLE:Chief Financial Officer HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:Jim Tavary TITLE:Chief Executive Officer HOURS:1 |
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 |
|---|---|---|---|---|---|---|---|---|---|
| Wickenburg Community Hospital Foundation | |||||||||
| 520 Rose Lane | Wickenburg | AZ | 85390 | 742521618 | Fundraising | AZ | 501(c)(3) | Line 7 | NA |
| Wickenburg Community Hospital Auxiliary | |||||||||
| 520 Rose Lane | Wickenburg | AZ | 85390 | 866056824 | Support Org | AZ | 501(c)(3) | 11 Type III | 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 | true | 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 | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital Foundation | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | Line | TransactionType |
| Amount Involved | 117872 | AmountInvolved |