2023-11-15T14:03:27-06:00 2022-12-31 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2022-01-01 860096775 Community Hospital Association Inc COMM 9286845421 520 Rose Lane Wickenburg AZ 85390 Patti Clavette CFO 9286845421 2023-11-15 1 Patti Clavette 999009999 1 Kim Hunwardsen CPA P00484560 6122536500 2023-11-15 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z Wickenburg Community Hospital Jackie Lundblad 520 Rose Lane Wickenburg AZ 85390 45431559 0 X www.wickhosp.com X 1946 AZ Provide quality health and wellness services where patient, family and community come first. 13 13 341 53 0 0 3508190 537651 41812342 44678759 182484 114031 102417 101118 45605433 45431559 0 0 0 0 20055134 18709734 0 0 158065 26558138 29987291 46613272 48697025 -1007839 -3265466 37961811 31918445 28807223 26832530 9154588 5085915 X To provide quality health and wellness services where the patient, family and community come first. 1 0 45158144 44678759 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. 45158144 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 69 0 1 341 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 13 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Patti Clavette 9286681837 520 Rose Lane Wickenburg AZ 85390 Dee Pollock Chair 1.00 0.00 X X 0 0 0 Brian Warnock Vice Chair 1.00 0.00 X X 0 0 0 Virginia Collier Secretary 1.00 0.00 X X 0 0 0 Dean Sandvik Treasurer 1.00 0.00 X X 0 0 0 Dave Bennett Director 1.00 0.00 X 0 0 0 Jenifer Finley Director 1.00 0.00 X 0 0 0 Jan Currier Director 1.00 0.00 X 0 0 0 Betsy Deibel Director 1.00 0.00 X 0 0 0 Jeanie Hankins Director 1.00 0.00 X 0 0 0 John Summers Director 1.00 0.00 X 0 0 0 Cynthia Clark Director 1.00 0.00 X 0 0 0 Ed Kientz Director 1.00 0.00 X 0 0 0 Jay Farquhar Director 1.00 0.00 X 0 0 0 Jackie Lundblad CEO 39.00 1.00 X 262237 0 24325 Patti Clavette CFO 39.00 1.00 X 149352 0 15916 Todd Kravetz MD - Chief of Staff, Clinical Medical Di 40.00 0.00 X 331547 0 31583 Peter Stachowicz COO 39.00 1.00 X 186650 0 8997 Matthew Jones Family Nurse Practitioner 40.00 0.00 X 151847 0 2 Juan Vazquez Physician 40.00 0.00 X 202774 0 22850 Diane Bejerano Family Physician 40.00 0.00 X 314173 0 13785 Brian Schuele Director of Pharmacy Services 40.00 0.00 X 146428 0 16501 Jodi Allen CNO 40.00 0.00 X 146486 0 2981 1891494 0 136940 30 0 1 0 Innova Emergency Medical Associates PC 9888 W Belleview Ave 5114 Denver CO 80123 Staffing - ER Physicians 2331493 Rural Partners in Medicine LLC 8181 Arista Pl Suite 100 Broomfield CO 80021 Management and specialists staffing 2074135 Medical Solutions LLC PO Box 850737 Minneapolis MN 55485 Staffing - Nurses 1268284 Nordic Consulting Partners Inc PO Box 415000 Nashville TN 37241 Consulting 1058973 Medely Inc PO BOX 736997 Dallas TX 75373 Staffing - Nurses 856900 23 534822 2829 537651 Patient Service Revenue 621990 41672524 41672524 Pharmacy Revenue 456110 2013118 2013118 340B Drug Program 621990 471327 471327 521790 521790 44678759 112231 112231 101118 0 101118 101118 101118 1800 0 1800 1800 1800 45431559 44678759 0 215149 X 1095096 364967 730129 14792785 14280316 365637 146832 196594 196594 1499450 1389649 109801 1125809 1029952 84624 11233 3533 3308 225 263251 250858 12393 81299 77472 3827 14446059 13587973 858086 1343177 1257504 85673 1023734 958436 65298 748348 700615 47733 102568 96026 6542 439998 92043 347955 2086406 2026203 60203 429492 402097 27395 Medical Supplies 6397628 5989562 408066 AHCCCS Tax 928104 868906 59198 Repairs & Maintenance 747491 699813 47678 Food 80655 75511 5144 865548 810339 55209 48697025 45158144 3380816 158065 4549410 2093254 7195603 6238305 1102029 1142732 477212 427629 36202302 17730268 19264188 18472034 4500137 323224 2130005 873232 1091262 37961811 31918445 6849415 6406972 16792935 16091888 300000 0 4864873 4333670 28807223 26832530 X 8643642 4600211 510946 485704 9154588 5085915 37961811 31918445 X -3265466 -152627 -800000 149420 X 0 1 X 1 0 X 1518183 1518183 21014226 9340534 11673692 14689 4818 9871 12810035 8159817 4650218 845169 225099 620070 18472034 Capital Leases 1222523 Estimated Third-Party Payor Settlement 680274 457b Retirement Liability 323224 Operating Lease 2107649 4333670 X 45426552 -152627 149420 -3207 45429759 1800 1800 45431559 48695225 -1800 -1800 48697025 0 48697025 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. 1 1 X 1 X 1 X 240.000000000000 1 0 0 62000 62000 0.00130 5157582 2673416 2484166 0.05100 5219582 2673416 2546166 0.05230 63685 63685 0.00130 9375 9375 0.00020 16713269 11182382 5530887 0.11360 16786329 11182382 5603947 0.11510 22005911 13855798 8150113 0.16740 1 4016085 17953 12818506 12764595 53911 X 1 1 1 1 Wickenburg Community Hospital 520 Rose Lane Wickenburg AZ 85390 www.wickhosp.com RGH3505 X X X Wickenburg Community Hospital 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X www.wickhosp.com 1 22 1 www.wickhosp.com 0 1 X 200.000000000000 240.000000000000 X X X 1 1 X X X X 1 X www.wickhosp.com X www.wickhosp.com X www.wickhosp.com X X X X X X 1 X 0 X X X X 1 X 0 0 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 3 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 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. X 1 1 X X 0 0 0 0 0 0 0 0 0 Todd Kravetz MD - Chief of Staff, Clinical Medical Di 245195 0 83796 0 2556 0 15352 0 16661 0 363560 0 0 0 Diane Bejerano Family Physician 287480 0 23377 0 3316 0 13783 0 433 0 328389 0 0 0 Jackie Lundblad CEO 261156 0 300 0 781 0 10450 0 14096 0 286783 0 0 0 Juan Vazquez Physician 192418 0 9531 0 825 0 8948 0 14332 0 226054 0 0 0 Peter Stachowicz COO 185742 0 300 0 608 0 2714 0 6477 0 195841 0 0 0 Patti Clavette CFO 147871 0 300 0 1181 0 2749 0 13333 0 165434 0 0 0 Brian Schuele Director of Pharmacy Services 143116 0 300 0 3012 0 3170 0 13478 0 163076 0 0 0 Matthew Jones Family Nurse Practitioner 142266 0 8960 0 621 0 0 0 148 0 151995 0 0 0 Part I, Line 1a 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. 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.