COMMUNITY HOSPITAL ASSOCIATION INC: Form 990, tax year 2022
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION INC (EIN 86-0096775)
- Tax period
- 2022-01-01 to 2022-12-31
- Filed
- 2023-11-15
- IRS object ID
- 202313199349316496
- Schema version
- 2022v5.0
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-11-15T14:03:27-06:00 | ReturnTs |
| Tax Period End | 2022-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Eide Bailly LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 800 Nicollet Mall Ste 1300 | AddressLine1Txt |
| City | Minneapolis | CityNm |
| State Abbreviation | MN | StateAbbreviationCd |
| ZIP | 554027033 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2022-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860096775 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 9286845421 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Patti Clavette | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 9286845421 | PhoneNum |
| Signature | 2023-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Patti | PersonFirstNm |
| Person Last | Clavette | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (1) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kim Hunwardsen CPA | PreparerPersonNm |
| PTIN | P00484560 | PTIN |
| Phone | 6122536500 | PhoneNum |
| Preparation | 2023-11-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2022 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Jackie Lundblad | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $45,431,559 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.wickhosp.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1946 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | Provide quality health and wellness services where patient, family and community come first. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 341 | TotalEmployeeCnt |
| Total Volunteers | 53 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,508,190 | PYContributionsGrantsAmt |
| CY Contributions Grants | $537,651 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $41,812,342 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $44,678,759 | CYProgramServiceRevenueAmt |
| PY Investment Income | $182,484 | PYInvestmentIncomeAmt |
| CY Investment Income | $114,031 | CYInvestmentIncomeAmt |
| PY Other Revenue | $102,417 | PYOtherRevenueAmt |
| CY Other Revenue | $101,118 | CYOtherRevenueAmt |
| PY Total Revenue | $45,605,433 | PYTotalRevenueAmt |
| CY Total Revenue | $45,431,559 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,055,134 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,709,734 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $158,065 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $26,558,138 | PYOtherExpensesAmt |
| CY Other Expenses | $29,987,291 | CYOtherExpensesAmt |
| PY Total Expenses | $46,613,272 | PYTotalExpensesAmt |
| CY Total Expenses | $48,697,025 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,007,839 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$3,265,466 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,961,811 | TotalAssetsBOYAmt |
| Total Assets EOY | $31,918,445 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $28,807,223 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $26,832,530 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,154,588 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,085,915 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | To provide quality health and wellness services where the patient, family and community come first. | MissionDesc |
| Significant New Program Srvc | Yes (1) | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $45,158,144 | ExpenseAmt |
| Revenue | $44,678,759 | RevenueAmt |
| Desc | Community Hospital Association, Inc. d/b/a Wickenburg Community Hospital is a 25-bed critical access hospital that provides inpatient and outpatient diagnostic and therapeutic health care services to the residents and visitors of greater Wickenburg, Arizona, a rural community of approximately 23,000. The Hospital operates physician clinics and a surgery center in the same geographic area. | Desc |
| Total Program Service Expenses | $45,158,144 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | 0 | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | 0 | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 69 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 341 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 13 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Patti Clavette | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9286681837 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| Dee Pollock | |||||||||
| Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Brian Warnock | |||||||||
| Vice Chair | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Virginia Collier | |||||||||
| Secretary | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Dean Sandvik | |||||||||
| Treasurer | 1.00 | 0.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| Dave Bennett | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jenifer Finley | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jan Currier | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Betsy Deibel | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jeanie Hankins | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| John Summers | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Cynthia Clark | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Ed Kientz | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jay Farquhar | |||||||||
| Director | 1.00 | 0.00 | Yes (X) | $0 | $0 | $0 | |||
| Jackie Lundblad | |||||||||
| CEO | 39.00 | 1.00 | Yes (X) | $262,237 | $0 | $24,325 | |||
| Patti Clavette | |||||||||
| CFO | 39.00 | 1.00 | Yes (X) | $149,352 | $0 | $15,916 | |||
| Todd Kravetz MD - Chief of | |||||||||
| Staff, Clinical Medical Di | 40.00 | 0.00 | $331,547 | $0 | $31,583 | Yes (X) | |||
| Peter Stachowicz | |||||||||
| COO | 39.00 | 1.00 | $186,650 | $0 | $8,997 | Yes (X) | |||
| Matthew Jones | |||||||||
| Family Nurse Practitioner | 40.00 | 0.00 | $151,847 | $0 | $2 | Yes (X) | |||
| Juan Vazquez | |||||||||
| Physician | 40.00 | 0.00 | $202,774 | $0 | $22,850 | Yes (X) | |||
| Diane Bejerano | |||||||||
| Family Physician | 40.00 | 0.00 | $314,173 | $0 | $13,785 | Yes (X) | |||
| Brian Schuele | |||||||||
| Director of Pharmacy Services | 40.00 | 0.00 | $146,428 | $0 | $16,501 | Yes (X) | |||
| Jodi Allen | |||||||||
| CNO | 40.00 | 0.00 | $146,486 | $0 | $2,981 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,891,494 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $136,940 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 30 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Innova Emergency Medical Associates PC | |||||
| 9888 W Belleview Ave 5114 | Denver | CO | 80123 | Staffing - ER Physicians | $2,331,493 |
| Rural Partners in Medicine LLC | |||||
| 8181 Arista Pl Suite 100 | Broomfield | CO | 80021 | Management and specialists staffing | $2,074,135 |
| Medical Solutions LLC | |||||
| PO Box 850737 | Minneapolis | MN | 55485 | Staffing - Nurses | $1,268,284 |
| Nordic Consulting Partners Inc | |||||
| PO Box 415000 | Nashville | TN | 37241 | Consulting | $1,058,973 |
| Medely Inc | |||||
| PO BOX 736997 | Dallas | TX | 75373 | Staffing - Nurses | $856,900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 23 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $534,822 | GovernmentGrantsAmt |
| All Other Contributions | $2,829 | AllOtherContributionsAmt |
| Total Contributions | $537,651 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient Service Revenue | 621990 | $41,672,524 | $41,672,524 |
| Pharmacy Revenue | 456110 | $2,013,118 | $2,013,118 |
| 340B Drug Program | 621990 | $471,327 | $471,327 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $521,790 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $521,790 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $44,678,759 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $112,231 | TotalRevenueColumnAmt |
| Exclusion | $112,231 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $101,118 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $101,118 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $101,118 | TotalRevenueColumnAmt |
| Exclusion | $101,118 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,800 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $1,800 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,800 | TotalRevenueColumnAmt |
| Exclusion | $1,800 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $45,431,559 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $44,678,759 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $215,149 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,095,096 | TotalAmt |
| Program Services | $364,967 | ProgramServicesAmt |
| Management And General | $730,129 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,792,785 | TotalAmt |
| Program Services | $14,280,316 | ProgramServicesAmt |
| Management And General | $365,637 | ManagementAndGeneralAmt |
| Fundraising | $146,832 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $196,594 | TotalAmt |
| Program Services | $196,594 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,499,450 | TotalAmt |
| Program Services | $1,389,649 | ProgramServicesAmt |
| Management And General | $109,801 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,125,809 | TotalAmt |
| Program Services | $1,029,952 | ProgramServicesAmt |
| Management And General | $84,624 | ManagementAndGeneralAmt |
| Fundraising | $11,233 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,533 | TotalAmt |
| Program Services | $3,308 | ProgramServicesAmt |
| Management And General | $225 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $263,251 | TotalAmt |
| Program Services | $250,858 | ProgramServicesAmt |
| Management And General | $12,393 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $81,299 | TotalAmt |
| Program Services | $77,472 | ProgramServicesAmt |
| Management And General | $3,827 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,446,059 | TotalAmt |
| Program Services | $13,587,973 | ProgramServicesAmt |
| Management And General | $858,086 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,343,177 | TotalAmt |
| Program Services | $1,257,504 | ProgramServicesAmt |
| Management And General | $85,673 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,023,734 | TotalAmt |
| Program Services | $958,436 | ProgramServicesAmt |
| Management And General | $65,298 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $748,348 | TotalAmt |
| Program Services | $700,615 | ProgramServicesAmt |
| Management And General | $47,733 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,568 | TotalAmt |
| Program Services | $96,026 | ProgramServicesAmt |
| Management And General | $6,542 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $439,998 | TotalAmt |
| Program Services | $92,043 | ProgramServicesAmt |
| Management And General | $347,955 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,086,406 | TotalAmt |
| Program Services | $2,026,203 | ProgramServicesAmt |
| Management And General | $60,203 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $429,492 | TotalAmt |
| Program Services | $402,097 | ProgramServicesAmt |
| Management And General | $27,395 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Medical Supplies | $6,397,628 | $5,989,562 | $408,066 |
| AHCCCS Tax | $928,104 | $868,906 | $59,198 |
| Repairs & Maintenance | $747,491 | $699,813 | $47,678 |
| Food | $80,655 | $75,511 | $5,144 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $865,548 | TotalAmt |
| Program Services | $810,339 | ProgramServicesAmt |
| Management And General | $55,209 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,697,025 | TotalAmt |
| Program Services | $45,158,144 | ProgramServicesAmt |
| Management And General | $3,380,816 | ManagementAndGeneralAmt |
| Fundraising | $158,065 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,549,410 | BOYAmt |
| EOY | $2,093,254 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,195,603 | BOYAmt |
| EOY | $6,238,305 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,102,029 | BOYAmt |
| EOY | $1,142,732 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $477,212 | BOYAmt |
| EOY | $427,629 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $36,202,302 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $17,730,268 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,264,188 | BOYAmt |
| EOY | $18,472,034 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,500,137 | BOYAmt |
| EOY | $323,224 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $2,130,005 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $873,232 | BOYAmt |
| EOY | $1,091,262 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,961,811 | BOYAmt |
| EOY | $31,918,445 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,849,415 | BOYAmt |
| EOY | $6,406,972 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,792,935 | BOYAmt |
| EOY | $16,091,888 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $300,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,864,873 | BOYAmt |
| EOY | $4,333,670 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $28,807,223 | BOYAmt |
| EOY | $26,832,530 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,643,642 | BOYAmt |
| EOY | $4,600,211 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $510,946 | BOYAmt |
| EOY | $485,704 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,154,588 | BOYAmt |
| EOY | $5,085,915 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,961,811 | BOYAmt |
| EOY | $31,918,445 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$3,265,466 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$152,627 | NetUnrlzdGainsLossesInvstAmt |
| Prior Period Adjustments | -$800,000 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $149,420 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,518,183 | OtherCostOrOtherBasisAmt |
| Book Value | $1,518,183 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,014,226 | OtherCostOrOtherBasisAmt |
| Depreciation | $9,340,534 | DepreciationAmt |
| Book Value | $11,673,692 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,689 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,818 | DepreciationAmt |
| Book Value | $9,871 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,810,035 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,159,817 | DepreciationAmt |
| Book Value | $4,650,218 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $845,169 | OtherCostOrOtherBasisAmt |
| Depreciation | $225,099 | DepreciationAmt |
| Book Value | $620,070 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $18,472,034 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Capital Leases | $1,222,523 |
| Estimated Third-Party Payor Settlement | $680,274 |
| 457b Retirement Liability | $323,224 |
| Operating Lease | $2,107,649 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $4,333,670 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $45,426,552 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$152,627 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $149,420 | OtherRevenueAmt |
| Revenue Not Reported | -$3,207 | RevenueNotReportedAmt |
| Revenue Subtotal | $45,429,759 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,800 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,800 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $45,431,559 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $48,695,225 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$1,800 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$1,800 | ExpensesNotReportedAmt |
| Expenses Subtotal | $48,697,025 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $48,697,025 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. |
| Part XI, Line 2d - Other Adjustments: | Change in Interest of Foundation 149,420. |
| Part XI, Line 4b - Other Adjustments: | Gain on sale included in expense on financials 1,800. |
| Part XII, Line 2d - Other Adjustments: | Gain on sale included in revenue on Form 990 -1,800. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 240.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $62,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $62,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,157,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,673,416 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,484,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05100 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,219,582 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,673,416 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,546,166 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05230 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $63,685 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $63,685 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00130 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $9,375 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $9,375 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,713,269 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,182,382 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,530,887 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11360 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $16,786,329 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $11,182,382 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $5,603,947 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11510 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $22,005,911 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $13,855,798 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $8,150,113 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.16740 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $4,016,085 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $17,953 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $12,818,506 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $12,764,595 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $53,911 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 520 Rose Lane | AddressLine1Txt |
| City | Wickenburg | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85390 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.wickhosp.com | WebsiteAddressTxt |
| State License | RGH3505 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wickenburg Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.wickhosp.com | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.wickhosp.com | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 240.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | www.wickhosp.com | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | www.wickhosp.com | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | www.wickhosp.com | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Wickenburg Community Hospital | Part V, Section B, Line 5: Wickenburg Community Hospital (WCH) received help from the Town of Wickenburg, Wickenburg Chamber of Commerce, the Wickenburg Unified School District and Wickenburg Ranch Lifestyles Team in collecting responses for the 2022 CHNA. Through the Chamber of Commerce WCH was able to request participation from My Father's Retirement Ranch, the Wickenburg Community Action Program, and the Wickenburg Community Services Corporation, which are the primary organizations that serve that population. |
| Wickenburg Community Hospital | Part V, Section B, Line 11: The 2022 CHNA identified five significant health needs in the community. In the most recent CHNA conducted the following needs were identified: Improved access to healthcare, major health challenges (joint pain and other aging-related conditions, availability of medical services, heart disease/stroke, obesity and dementia/Alzheimer's disease), general awareness about accessing specific health services, high cost of insurance and healthcare.The organization already addresses the issue of high cost of healthcare by working diligently to maintain contracts with payors and continuously evaluate those contracts for improvement opportunities. WCH also provides financial support for those who qualify for the financial assistance services offered. We will not be seeking additional ways to address this at this time.Due to the timing of the 2022 CHNA the organization did not specifically address these items. However the 2019 CHNA identified similar needs. The 2019 CHNA identified five significant health needs in the community. These needs are Overall Health Status, Barriers to Accessing Health Care, Use of Services, Defining a Healthy Community and Increase Respondents in decreasing order by intensity as indicated from secondary and primary research. The following actions were taken to address the needs identified from the 2022 CHNA and the prior 2019 CHNA: WCH has increased specialty providers in the areas of joint pain and conditions that stem from aging by adding an orthopedic specialist who focuses on joint revision surgeries to the orthopedic team and continues to offer pain management services. The organization is also working to establish an assisted living facility for those in need along with beds for memory care patients. Tele-cardiology has been added to our hospital services to provide high-quality cardiology care for patients. The organization is working to finalize the details for a mobile clinic that can provide access to care for more rural individuals. The mobile clinic will be able to bring care to patients who have transportation barriers to accessing care, and plan for it to be in full service by 2024. To address the issue of awareness about specific health services, WCH will continue to publish awareness media in a multitude of channels including word of mouth through community involvement, and digital and print media. WCH has also embarked on the beginning stages to gather information on how to improve the organization's website, and EMR to enhance communication with the community and ensure they understand how to access the care they need. |
| Schedule H, Part V, Section B, Line 10a: | |
| Schedule H, Part V, Section B, Line 7a: | https://www.wickhosp.com/wp-content/uploads/2023/06/2022-CHNA-WCH.pdf |
| Schedule H, Part V, Section B, Line 16a-16c: | Line 16a:https://www.wickhosp.com/wp-content/uploads/2016/01/Financial-Assistance-Policy.pdfLine 16b:https://www.wickhosp.com/wp-content/uploads/2018/09/Financial-Assistance-Application-Letter-App.pdfLine 16c:https://www.wickhosp.com |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Community Hospital Clinic - Wickenburg | ||||
| 519 Rose Lane | Wickenburg | AZ | 85390 | Primary Care Clinic, Rural Health Clinic |
| 2 - Community Hospital Clinic - Congress | ||||
| 26750 S Santa Fe Road Suite B | Congress | AZ | 85332 | Primary Care Clinic, Rural Health Clinic |
| 3 - Community Hospital Clinic - Wittmann | ||||
| 32919 Center St | Wittmann | AZ | 85361 | Primary Care Clinic, Rural Health Clinic |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Part I, line 7a:Financial Assistance was calculated using the cost-to-charge ratio. All patient segments are addressed using this method. The methodology used is to be in compliance with laws and regulations set forth by Medicare and the filing of the annual cost report. Part I, Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services were calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers. Part I, line 7e and 7f:Community health improvement services and health professions education are actual costs reported in the general ledger. |
| Part I, Line 7g: | Line 7g includes $6,488,699 of expenses related to a rural health clinic. |
| Part III, Line 2: | The amount reported on line 2 represents implicit price concessions. The implicit price concessions included represent the difference between amounts billed to patients and the amounts the Hospital expects to collect based on its collection history with those patients. |
| Part III, Line 3: | The organization calculated the amount of implicit price concessions attributable to patients eligible under the financial assistance policy by applying the percentage of charity care of total net patient revenue to the amount of line 2 implicit price concessions. |
| Part III, Line 4: | The financial statement footnote regarding implicit price concessions may be found on page 12 and 13 of the attached financial statements. |
| Part III, Line 8: | Medicare allowable costs were obtained from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services.If there is a shortfall, the entire Medicare shortfall is a community benefit. Medicare patients are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key community benefit. |
| Part III, Line 9b: | The accounts remain in the program for a period of 120 days, if no payments are being made, or longer if the payments are being made on the outstanding balance. After this time period and collection efforts have been exhausted, the accounts will then be placed into a "collection" status, and sent to our Collection Agency; Revenue Enterprise for Health Care, to further final collection efforts. After these accounts have been placed with the Collection Agency and have no activity for 120 days, they will be returned to the business officer for additional consideration and disposition of account. During the entire 240 days they will accept applications for financial assistance. |
| Part VI, Line 2: | Community Hospital Association, Inc. continually assesses 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. |
| Part VI, Line 3: | 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 along with a written charity care application. |
| Part VI, Line 4: | Wickenburg Community Hospital serves a primary service area population of approximately 23,000 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 winter months to summer months, when the population grows by approximately 40%. |
| Part VI, Line 5: | The Hospital's governing body is comprised of persons who reside in the Organization's primary service area. The Hospital applies any surplus funds to improve the Facility and equipment to improve patient care. The Hospital also extends medical staff privileges to other qualified physicians in the community.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 was 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 | Yes (X) | ClubDuesOrFeesInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Todd Kravetz MD - Chief of | ||||||||||||||
| Staff, Clinical Medical Di | $245,195 | $0 | $83,796 | $0 | $2,556 | $0 | $15,352 | $0 | $16,661 | $0 | $363,560 | $0 | $0 | $0 |
| Diane Bejerano | ||||||||||||||
| Family Physician | $287,480 | $0 | $23,377 | $0 | $3,316 | $0 | $13,783 | $0 | $433 | $0 | $328,389 | $0 | $0 | $0 |
| Jackie Lundblad | ||||||||||||||
| CEO | $261,156 | $0 | $300 | $0 | $781 | $0 | $10,450 | $0 | $14,096 | $0 | $286,783 | $0 | $0 | $0 |
| Juan Vazquez | ||||||||||||||
| Physician | $192,418 | $0 | $9,531 | $0 | $825 | $0 | $8,948 | $0 | $14,332 | $0 | $226,054 | $0 | $0 | $0 |
| Peter Stachowicz | ||||||||||||||
| COO | $185,742 | $0 | $300 | $0 | $608 | $0 | $2,714 | $0 | $6,477 | $0 | $195,841 | $0 | $0 | $0 |
| Patti Clavette | ||||||||||||||
| CFO | $147,871 | $0 | $300 | $0 | $1,181 | $0 | $2,749 | $0 | $13,333 | $0 | $165,434 | $0 | $0 | $0 |
| Brian Schuele | ||||||||||||||
| Director of Pharmacy Services | $143,116 | $0 | $300 | $0 | $3,012 | $0 | $3,170 | $0 | $13,478 | $0 | $163,076 | $0 | $0 | $0 |
| Matthew Jones | ||||||||||||||
| Family Nurse Practitioner | $142,266 | $0 | $8,960 | $0 | $621 | $0 | $0 | $0 | $148 | $0 | $151,995 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 1a | FormAndLineReferenceDesc |
| Explanation | Description of health club dues: Wickenburg community hospital reimburses employees for health club dues which are recorded in the individuals' taxable compensation. Golf club dues were paid to the golf club by the organization, but are not paid for a specific employee. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (8 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, line 2 | The hospital also opened urgent care in 2022. |
| Form 990, Part VI, Section A, line 8b | The organization does not have any committees with the authority to act on behalf of the governing body. |
| Form 990, Part VI, Section B, line 11b | The Form 990 is prepared by a third party and is reviewed by the CFO. A copy of the Form 990 is made available to the governing board prior to filing with the IRS. |
| Form 990, Part VI, Section B, line 12c | All board members and officers are covered under the policy. In connection with any actual or possible conflict of interest, an interested person must disclose the existence of any financial interest and conflict of interest and be given the opportunity to disclose all material facts to the board of directors of the organization. In addition, all interested persons review and sign a compliance certificate annually. After disclosure of any potential conflicts and all material facts, and after any discussion with the interested person, he/she shall leave the governing board meeting and is recused from the discussion and voting on the issue. The remaining board members shall decide if a conflict of interest exists. |
| Form 990, Part VI, Section B, line 15a | Review of CEO or top management official 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. The salary is documented on a personnel action form (PAF), entered into the payroll system, and then added to the HR file. Review of other officer or key employees 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. The salary is documented on a Personnel Action Form (PAF), entered into the payroll system, and then added to the HR file. |
| Form 990, Part VI, Section C, line 19 | Governing documents, conflict of interest policy, and financial statements are made available to the public by a formal request in writing. |
| Form 990, Part IX, line 11g | Professional Fees: Program service expenses 3,612,423. Management and general expenses 178,457. Fundraising expenses 0. Total expenses 3,790,880. Purchased Services: Program service expenses 9,975,550. Management and general expenses 679,629. Fundraising expenses 0. Total expenses 10,655,179. |
| Form 990, Part XI, line 9: | Change in Interest of Foundation 149,420. |