NORTHERN COCHISE COMMUNITY HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN COCHISE COMMUNITY HOSPITAL INC (EIN 86-0208451)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-11
- IRS object ID
- 202211319349305366
- Schema version
- 2020v4.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-05-11T16:53:07-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 200079326 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DINGUS ZARECOR & ASSOCIATES PLLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12015 E MAIN AVE | AddressLine1Txt |
| City | SPOKANE VALLEY | CityNm |
| State Abbreviation | WA | StateAbbreviationCd |
| ZIP | 99206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860208451 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN COCHISE COMMUNITY | BusinessNameLine1Txt |
| Business Name Line2 | HOSPITAL INC | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 5203843541 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85643 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MONICA SHELDON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5203843541 | PhoneNum |
| Signature | 2022-05-09 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | MONICA | PersonFirstNm |
| Person Last | SHELDON | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | THOMAS DINGUS | PreparerPersonNm |
| PTIN | P00951009 | PTIN |
| Phone | 5092420874 | PhoneNum |
| Preparation | 2022-05-11 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MONICA SHELDON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856431009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $20,842,048 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NCCH.NET | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1966 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE FOR THE HEALTHCARE NEEDS OF THE GREATER WILLCOX COMMUNITY AND SOUTHEAST ARIZONA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 195 | TotalEmployeeCnt |
| Total Volunteers | 16 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $5,570,819 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,406,574 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,237,747 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $15,310,103 | CYProgramServiceRevenueAmt |
| PY Investment Income | $137,439 | PYInvestmentIncomeAmt |
| CY Investment Income | $28,451 | CYInvestmentIncomeAmt |
| PY Other Revenue | $116,698 | PYOtherRevenueAmt |
| CY Other Revenue | $96,920 | CYOtherRevenueAmt |
| PY Total Revenue | $20,062,703 | PYTotalRevenueAmt |
| CY Total Revenue | $20,842,048 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,344,885 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,089,540 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $8,495 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,157,529 | PYOtherExpensesAmt |
| CY Other Expenses | $9,820,075 | CYOtherExpensesAmt |
| PY Total Expenses | $18,502,414 | PYTotalExpensesAmt |
| CY Total Expenses | $17,909,615 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,560,289 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $2,932,433 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $13,030,689 | TotalAssetsBOYAmt |
| Total Assets EOY | $20,177,243 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,678,551 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,643,514 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,352,138 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,533,729 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE FOR THE HEALTHCARE NEEDS OF THE GREATER WILLCOX COMMUNITY AND SOUTHEAST ARIZONA. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $14,407,446 | ExpenseAmt |
| Revenue | $15,310,103 | RevenueAmt |
| Desc | THE CRITCAL ACCESS HOSPITAL PROVIDES HEALTHCARE TO THE GENERAL PUBLIC REGARDLESS OF AGE, RACE, OR ABILITY TO PAY. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, EMERGENCY ROOM, PHYSICAL THERAPY, SPEECH THERAPY, RESP THERAPY, CT SCAN, MRI, RURAL HEALTH CLINIC, LABORATORY SERVICE, AND OTHER HEALTHCARE SERVICES. THE HOSPITAL PROVIDED 553 DAYS OF ACUTE PATIENT SERVICES, 4,240 EMERGENCY ROOM VISITS, AND 9,349 RURAL HEALTH CLINIC VISITS FOR THE YEAR. THE HOSPITAL PROVIDES CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT BELOW COST AND TO INDIVIDUALS WHO ARE UNABLE TO PAY. THE UNREIMBURSED VALUE OF PROVIDING CARE TO THESE PATIENTS WAS 155,158 FOR CHARITY CARE, 5,141,216 FOR MEDICARE, 1,693,890 FOR MEDICAID, AND 3,256,514 FOR OTHER THIRD PARTY PAYORS FOR THE YEAR. | Desc |
| Total Program Service Expenses | $14,407,446 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (true) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | Yes (true) | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 53 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 195 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | THE ORGANIZATION | PersonNm |
| Phone | 5203843541 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85643 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| STEVEN METTS | |||||||
| CHAIR | 5.00 | Yes (X) | $0 | $0 | $0 | ||
| WINFIELD THOMAS | |||||||
| VICE CHAIR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHY COOK | |||||||
| SECRETARY | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| DANIEL WILSON | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROL DUNAGAN | |||||||
| DIRECTOR | 3.00 | Yes (X) | $0 | $0 | $0 | ||
| DAWN WALKER | |||||||
| DIRECTOR | 3.00 | Yes (X) | $18,825 | $0 | $0 | ||
| MONICA SHELDON | |||||||
| CEO | 40.00 | $137,404 | $0 | $12,296 | Yes (X) | ||
| CAROL HOLDEN | |||||||
| CFO THRU NOV | 40.00 | $116,132 | $0 | $18,548 | Yes (X) | ||
| LAUREL KIBLER | |||||||
| NURSE PRACTI | 40.00 | $178,223 | $0 | $13,234 | Yes (X) | ||
| MARTIN DUFOUR | |||||||
| MEDICAL DIRE | 40.00 | $148,940 | $0 | $5,059 | Yes (X) | ||
| CONNIE DINEEN | |||||||
| CNO | 40.00 | $138,238 | $0 | $6,631 | Yes (X) | ||
| WELTON WITTWER | |||||||
| PHYSICAL THE | 40.00 | $129,943 | $0 | $19,614 | Yes (X) | ||
| LISA CRANE | |||||||
| NURSE PRACTI | 40.00 | $127,623 | $0 | $10,769 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $995,328 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $86,151 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (2 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FEDKO EMERGENCY SERVICES | |||||
| PO BOX 742528 | DALLAS | TX | 75374 | ER PHYSICIANS | $3,061,271 |
| SHARED IMAGING LLC | |||||
| LOCK BOX 88544 | MILWAUKEE | WI | 53288 | MRI MAINTENANCE | $123,950 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 2 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $2,238,791 | RelatedOrganizationsAmt |
| Government Grants | $3,017,643 | GovernmentGrantsAmt |
| All Other Contributions | $150,140 | AllOtherContributionsAmt |
| Total Contributions | $5,406,574 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 624100 | BusinessCd |
| Total Revenue Column | $15,310,103 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,310,103 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $15,310,103 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,888 | TotalRevenueColumnAmt |
| Exclusion | $11,888 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50,466 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $50,466 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50,466 | TotalRevenueColumnAmt |
| Exclusion | $50,466 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $16,563 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $16,563 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,563 | TotalRevenueColumnAmt |
| Exclusion | $16,563 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA REVENUE | 722514 | $40,709 | $40,709 |
| OTHER REVENUE | 900099 | $5,745 | $5,745 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $46,454 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $20,842,048 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $15,310,103 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $125,371 | 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 | $278,368 | TotalAmt |
| Management And General | $278,368 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,416,334 | TotalAmt |
| Program Services | $5,245,382 | ProgramServicesAmt |
| Management And General | $1,167,982 | ManagementAndGeneralAmt |
| Fundraising | $2,970 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,495 | TotalAmt |
| Program Services | $88,141 | ProgramServicesAmt |
| Management And General | $24,304 | ManagementAndGeneralAmt |
| Fundraising | $50 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $712,679 | TotalAmt |
| Program Services | $534,622 | ProgramServicesAmt |
| Management And General | $177,754 | ManagementAndGeneralAmt |
| Fundraising | $303 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $569,664 | TotalAmt |
| Program Services | $444,618 | ProgramServicesAmt |
| Management And General | $124,795 | ManagementAndGeneralAmt |
| Fundraising | $251 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,683 | TotalAmt |
| Management And General | $48,683 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,804 | TotalAmt |
| Management And General | $23,804 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,512,705 | TotalAmt |
| Program Services | $4,142,688 | ProgramServicesAmt |
| Management And General | $369,001 | ManagementAndGeneralAmt |
| Fundraising | $1,016 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,775 | TotalAmt |
| Management And General | $30,775 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $918,731 | TotalAmt |
| Program Services | $718,917 | ProgramServicesAmt |
| Management And General | $198,485 | ManagementAndGeneralAmt |
| Fundraising | $1,329 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $599,970 | TotalAmt |
| Program Services | $12,678 | ProgramServicesAmt |
| Management And General | $587,292 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,021 | TotalAmt |
| Program Services | $169,255 | ProgramServicesAmt |
| Management And General | $52,379 | ManagementAndGeneralAmt |
| Fundraising | $1,387 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,608 | TotalAmt |
| Program Services | $15,601 | ProgramServicesAmt |
| Fundraising | $7 | FundraisingAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,745 | TotalAmt |
| Program Services | $6,745 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $61,452 | TotalAmt |
| Program Services | $57,575 | ProgramServicesAmt |
| Management And General | $3,877 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $599,015 | TotalAmt |
| Program Services | $423,443 | ProgramServicesAmt |
| Management And General | $174,760 | ManagementAndGeneralAmt |
| Fundraising | $812 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $292,818 | TotalAmt |
| Program Services | $221,725 | ProgramServicesAmt |
| Management And General | $71,093 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | $1,178,006 | $1,178,006 | ||
| ASSESSMENT FEES | $940,817 | $940,817 | ||
| REPAIRS & MAINTENANCE | $228,594 | $173,839 | $54,428 | $327 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $139,331 | TotalAmt |
| Program Services | $33,394 | ProgramServicesAmt |
| Management And General | $105,894 | ManagementAndGeneralAmt |
| Fundraising | $43 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,909,615 | TotalAmt |
| Program Services | $14,407,446 | ProgramServicesAmt |
| Management And General | $3,493,674 | ManagementAndGeneralAmt |
| Fundraising | $8,495 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,148,332 | BOYAmt |
| EOY | $3,729,114 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,605,488 | BOYAmt |
| EOY | $4,572,663 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $397,956 | BOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,518,512 | BOYAmt |
| EOY | $2,319,642 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $245,142 | BOYAmt |
| EOY | $313,649 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $176,766 | BOYAmt |
| EOY | $209,030 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $3,183,758 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $47,126 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,738,501 | BOYAmt |
| EOY | $3,136,632 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $199,992 | BOYAmt |
| EOY | $5,896,513 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,030,689 | BOYAmt |
| EOY | $20,177,243 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,202,393 | BOYAmt |
| EOY | $1,724,025 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,074,104 | BOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,402,054 | BOYAmt |
| EOY | $7,100,639 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $818,850 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,678,551 | BOYAmt |
| EOY | $9,643,514 | 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 | $7,352,138 | BOYAmt |
| EOY | $10,533,729 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,352,138 | BOYAmt |
| EOY | $10,533,729 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $13,030,689 | BOYAmt |
| EOY | $20,177,243 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $2,932,433 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $152,463 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $96,695 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $3,480 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $3,480 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1 | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL DOES NOT DIRECTLY PERFORM ANY LOBBYING ACTIVITIES. THE HOSPITAL PAYS MEMBERSHIP DUES TO A STATE HOSPITAL ASSOCIATION. THE ASSOCIATION USES A PORTION OF SUCH DUES TO CARRY OUT LOBBYING ACTIVITIES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,483,879 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,867 | DepreciationAmt |
| Book Value | $2,479,012 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,273 | OtherCostOrOtherBasisAmt |
| Book Value | $16,273 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $655,832 | OtherCostOrOtherBasisAmt |
| Depreciation | $42,259 | DepreciationAmt |
| Book Value | $613,573 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $27,774 | OtherCostOrOtherBasisAmt |
| Book Value | $27,774 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,136,632 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| RIGHT OF USE ASSETS | $5,701,272 |
| DUE FROM THE DISTRICT | $176,741 |
| DONATED ARTWORK | $18,500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $5,896,513 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED THIRD PARTY SETTLEMENTS | Desc |
| Amt | $818,850 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $818,850 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PAGE 3, PART X | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL IS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. ACCORDINGLY, NO PROVISION FOR INCOME TAX IS NECESSARY. THE HOSPITAL EVALUATES UNCERTAIN TAX POSITIONS WHEREBY THE EFFECT OF THE UNCERTAINTY WOULD BE RECORDED IF THE OUTCOME WAS CONSIDERED PROBABLE AND REASONABLY ESTIMABLE. AS OF JUNE 30,2021 AND 2020, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS REQUIRING ACCRUAL. AS ORGANIZED, THE DISTRICT IS EXEMPT FROM PAYING FEDERAL INCOME TAXES. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $89,992 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $89,992 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00500 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,188,015 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,904,727 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $283,288 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01580 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,278,007 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,904,727 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $373,280 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02080 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,147,009 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,305,213 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $841,796 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04700 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,147,009 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,305,213 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $841,796 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04700 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,425,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $7,209,940 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,215,076 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06780 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $39,076 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $39,076 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $18,601 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $18,601 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $57,475 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $57,475 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00320 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $115,152 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $115,152 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00640 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,079,018 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,871,708 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,840,912 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $30,796 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | false | 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 | NORTHERN COCHISE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85643 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| 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 | NORTHERN COCHISE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | 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 |
| Other | Yes (X) | OtherInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.NCCH.NET | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.COCHISE.AZ.GOV | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.NCCH.NET | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.NCCH.NET | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.NCCH.NET | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | WWW.NCCH.NET | 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 |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FACILITY 1, NORTHERN COCHISE COMMUNITY HOSPITAL - PART V, LINE 3E | IDENTIFICATION AND PRIORITIZATION OF HEALTH NEEDS BEGIN ON PAGE 42 OF THE CHNA LOCATED ON THE HOSPITAL'S WEBSITE. |
| FACILITY 1, NORTHERN COCHISE COMMUNITY HOSPITAL - PART V, LINE 5 | THE HOSPITAL TOOK INTO ACCOUNT INPUT FROM REPRESENTATIVES OF THE COMMUNITY BY UTILIZING ONLINE SURVEYS AND ONE-ON-ONE PHONE INTERVIEWS WITH COMMUNITY MEMBERS, HEALTH SYSTEM PARTNERS, AND OTHER HEALTH AND SOCIAL SERVICE ORGANIZATIONS SERVING THE VULNERABLE ALONG WITH WRITTEN COMMENTS RECEIVED ON THE HOSPITAL'S MOST RECENTLY CONDUCTED CHNA AND MOST RECENTLY ADOPTED IMPLEMENTATION STRATEGY. |
| FACILITY 1, NORTHERN COCHISE COMMUNITY HOSPITAL - PART V, LINE 6A | THE HOSPITAL CONDUCTED A JOINT CHNA WITH BENSON HOSPITAL. |
| FACILITY 1, NORTHERN COCHISE COMMUNITY HOSPITAL - PART V, LINE 11 | THE HOSPITAL WAS NOT ABLE TO ADDRESS ALL HEALTH NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA DUE TO NOT CURRENTLY HAVING THE STAFF OR FINANCIAL RESOURCES TO DEVOTE TO THE NEED OR OTHER ORGANIZATIONS IN THE SERVICE AREA BEING A BETTER FIT TO ADDRESS THE NEED. THE HOSPITAL IS CONTINUALLY ASSESSING THE HEALTH NEEDS OF THE COMMUNITY AND DECIDING HOW IT CAN BETTER SERVE THE COMMUNITY BASED ON NEED. THE TOP 5 HEALTH NEEDS IDENTIFIED IN THE MOST RECENT ASSESSMENT ARE AS FOLLOWS: 1.MENTAL HEALTH & SUBSTANCE ABUSE 2.GOOD JOBS & HEALTHY ECONOMY 3.AGING CONCERNS & RESOURCES FOR HEALTHY LIVING 4.PRIMARY CARE 5.DENTAL CARE THE HOSPITAL IS ADDRESSING THESE NEEDS USING VARIOUS STRATEGIES THAT INCLUDE THE FOLLOWING: IMPLEMENT DEPRESSION SCREENS IN PRIMARY CARE EVALUATE THE POSSIBILITY OF A COLLABORATIVE EFFORT WITH THE SCHOOL TO INTRODUCE HEALTH CAREERS TO STUDENTS CONTINUE EFFORTS TO (RE)INSTATE LONG TERM SWINGBEDS IN THE COMMUNITY TO PROVIDE A SOURCE OF LTC COLLABORATE WITH THE NONPROFIT THAT RUNS THE SERVICES AT THE SENIOR CENTER TO RE-INITIATE SERVICE WHEN DEEMED SAFE RECRUIT MEDICAL DIRECTOR WHO WILL PROVIDE AT LEAST LIMITED OFFICE HOURS TO THE RHC'S ADD 1 DAY OF RHC PRIMARY CARE WITH CURRENT STAFFING MODEL OF 3 BY INITIATING A 5-DAY /WEEK PROVIDER VS. THE 4-DAY MODEL WITH EXISTING PROVIDERS ADD ADDITIONAL DAYS TO EXISTING PARTIAL WEEK SCHEDULE EVALUATE THE POSSIBILITY OF PROVIDING FLUORIDE TREATMENTS TO MEDICAID CHILDREN. THE HOSPITAL WAS NOT ABLE TO ADDRESS ALL HEALTH NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA DUE TO NOT CURRENTLY HAVING THE STAFF OR FINANCIAL RESOURCES TO DEVOTE TO THE NEED. THE HOSPITAL IS CONTINUALLY ASSESSING THE HEALTH NEEDS OF THE COMMUNITY AND DECIDING HOW IT CAN BETTER SERVE THE COMMUNITY BASED ON NEED. |
| FACILITY 1, NORTHERN COCHISE COMMUNITY HOSPITAL - PART V, LINE 13B | THE HOSPITAL UTILIZES THE POVERTY GUIDELINE PERCENTAGES FOR FINANCIAL ASSISTANCE - 100% DISCOUNT AND LESS BASED ON INCOME. THE HOSPITAL PROVIDES DISCOUNTED CARE BASED ON A CASE BY CASE EVALUATION. ALL INFORMATION IS REVIEWED BY THE PFS DIRECTOR AND COMPARED WITH THE POVERTY GUIDELINES AS WELL AS ALL OUTSTANDING MEDICAL EXPENSES. OTHER FACTORS MAY ALSO CONTRIBUTE TO THE FINAL DECISION. |
| 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 |
|---|---|---|---|---|
| SULPHUR SPRINGS MEDICAL CENTER | ||||
| 900 W SCOTT | WILLCOX | AZ | 85643 | OUTPATIENT CLINIC |
| SUNSITES MEDICAL CENTER | ||||
| 223 N FRONTAGE ROAD | PEARCE | AZ | 85625 | OUTPATIENT CLINIC |
| SPECIALTY CLINICS | ||||
| 900 W SCOTT | WILLCOX | AZ | 85643 | OUTPATIENT CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | THE HOSPITAL PROVIDES DISCOUNTED CARE BASED ON A CASE BY CASE EVALUATION. ALL INFORMATION IS REVIEWED BY THE PFS DIRECTOR AND COMPARED WITH THE POVERTY GUIDELINES AS WELL AS ALL OUTSTANDING MEDICAL EXPENSES. OTHER FACTORS MAY ALSO CONTRIBUTE TO THE FINAL DECISION. |
| SCHEDULE H, PART I, LINE 7G | THE HOSPITAL HAS INCLUDED COSTS ASSOCIATED WITH PHYSICIAN CLINICS AS SUBSIDIZED HEALTH SERVICES IN PART I, LINE 7G IN THE AMOUNT OF 1,371,734 IN COLUMN C AND 828,982 IN COLUMN D. |
| SCHEDULE H, PART I, LINE 7 | THE HOSPITAL APPLIES THE RATIO OF PATIENT CARE COST-TO-CHARGES FOR AMOUNTS REPORTED IN THE TABLE (TOTAL OPERATING EXPENSES LESS NON-PATIENT CARE ACTIVITIES, PROVIDER TAXES, TOTAL COMMUNITY BENEFIT AND TOTAL COMMUNITY BUILDING EXPENSES). |
| SCHEDULE H, PART II | THE HOSPITAL IS A FEDERALLY DESIGNATED CRITICAL ACCESS HOSPITAL (CAH) MEANING THAT IT IS AN ESSENTIAL COMMUNITY PROVIDER. THE HOSPITAL IS CONTINUALLY RECRUITING PHYSICIANS AND OTHER HEALTH PROFESSIONALS TO ITS RURAL SERVICE AREA TO HELP IMPROVE ACCESS TO HEALTHCARE SERVICES AS IDENTIFIED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT. |
| SCHEDULE H, PART III, LINE 2 | THE HOSPITAL USED THE RATIO OF PATIENT CARE COSTS TO CHARGES TO DETERMINE THE COST OF BAD DEBT EXPENSE. |
| SCHEDULE H, PART III, LINE 3 | THE HOSPITAL DID NOT TRACK THE AMOUNT OF BAD DEBT EXPENSE THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY BUT FOR WHOM SUFFICIENT INFORMATION WAS NOT OBTAINED TO MAKE DETERMINATION OF THEIR ELIGIBILITY DURING THE YEAR. |
| SCHEDULE H, PART III, LINE 4 | THE PATIENT ACCOUNTS RECEIVABLE FOOTNOTE OF THE AUDITED FINANCIAL STATEMENTS IS FOUND IN FOOTNOTE 3, ON PAGE 10, OF THE AUDITED FINANCIAL STATEMENTS. THE PROVISION FOR BAD DEBTS IS INCLUDED IN FOOTNOTE 7 STARTING ON PAGE 15 OF THE AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | ANY MEDICARE ALLOWABLE COSTS OF PATIENT CARE SHORTFALLS ARE NOT COUNTED AS COMMUNITY BENEFIT. THESE ALLOWABLE COSTS ARE OBTAINED FROM THE MEDICARE COST REPORT FOR THE YEAR. |
| SCHEDULE H, PART III, LINE 9B | PATIENTS WILL BE CONSIDERED FOR CHARITY OR DISCOUNTED BILLING BASED ON THEIR ABILITY TO PAY AND THE FEDERAL POVERTY GUIDELINES. THE ACCOUNTS OF UNINSURED OR UNDER- INSURED PATIENTS WHO HAVE APPLIED FOR MEDICAL ASSISTANCE OR FINANCIAL ASSISTANCE ARE HELD WITHOUT FURTHER COLLECTION ACTION, UNTIL THE APPLICATION PROCESS HAS BEEN COMPLETE. |
| SCHEDULE H, PART VI, LINE 2 | THE HOSPITAL UTILIZES FEDERAL AND STATE LEVEL SOURCES WHEN ASSESSING THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES. THE HOSPITAL IS COMMITTED TO QUALITY AND AFFORDABLE HEALTHCARE CLOSE TO HOME. AS SUCH, IT WILL CONTINUE TO STRIVE TOWARD ELIMINATING BARRIERS TO TREATMENT IN THE COMMUNITY THAT WOULD PREVENT THE PROVISION OF APPROPRIATE, SAFE, AND ADEQUATE HEALTHCARE TO THE POPULATION IT SERVES. COPIES OF THE MOST RECENTLY ADOPTED COMMUNITY HEALTH NEEDS ASSESSMENT AND IMPLEMENTATION STRATEGY ARE AVAILABLE AT THE HOSPITAL UPON REQUEST OR A COPY CAN BE FOUND AT THE HOSPITAL'S WEBSITE AT THE FOLLOWING URL: HTTP://WWW.NCCH.NET |
| SCHEDULE H, PART VI, LINE 3 | THE HOSPITAL NOTIFIES PATIENTS OF THEIR ELIGIBILITY FOR FINANCIAL ASSISTANCE BY PLACING A BROCHURE IN PUBLIC AREAS OF THE HOSPITAL, AS WELL AS INCLUDING A BROCHURE IN ADMISSION PACKETS TO PATIENTS. THE INFORMATION IS ALSO AVAILABLE ON THE HOSPITAL WEBSITE AND IS MADE AVAILABLE TO LOCAL AGENCIES THAT ASSIST WITH LOW INCOME POPULATIONS. |
| SCHEDULE H, PART VI, LINE 4 | THE POPULATION OF THE NORTHERN COCHISE SERVICE AREA IS NEARLY 13,700. IN 2020, 23% OF THE COUNTYS POPULATION IS AGE 65+, WHILE ONLY 18% OF THE STATES POPULATION IS AGE 65+. AMERICAN INDIANS REPRESENT ABOUT 1.4% OF THE TOTAL POPULATION WHILE HISPANICS REPRESENT ABOUT 42%. BOWIE/WILCOX SERVICE AREA IS DESIGNATED BY HRSA AS A MEDICALLY UNDERSERVED AREA. |
| SCHEDULE H, PART VI, LINE 5 | MANY OF THE HOSPITAL'S BOARD MEMBERS RESIDE IN THE PRIMARY SERVICE AREA RANGING FROM BUSINESS OWNERS TO HOMEMAKERS TO RETIREES REPRESENTING THE COMMUNITY IT SERVES. THIS VOLUNTEER BOARD DEDICATES TIME TO ENSURING THEY UNDERSTAND THE HEALTH AND WELFARE NEEDS OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES AT THE HOSPITAL ARE OPEN TO ALL MEDICAL PROVIDERS WITH ACTIVE LICENSURE. WHILE THE CREDENTIALING PROCESS ENSURES PRACTITIONERS OF THE HIGHEST CALIBER ARE PRIVILEGED, PRACTITIONERS FROM NUMEROUS SPECIALTIES ARE ENCOURAGED TO MEET THE EVER EXPANDING HEALTHCARE NEEDS OF THE COMMUNITY. AS A NON-PROFIT CORPORATION, THE HOSPITAL DOES NOT HAVE ANY SHAREHOLDERS AND SURPLUS FUNDS ARE REINVESTED INTO THE FACILITY, EQUIPMENT, AND EMPLOYEE EDUCATION. THE ABSENCE OF SHAREHOLDERS ALLOWS THE HOSPITAL TO FOCUS ON MEETING THE HEALTH AND WELFARE NEEDS OF THE COMMUNITIES SERVED. THE HOSPITAL PARTICIPATES IN MULTIPLE ACTIVITIES WITHIN ITS COMMUNITY TO PROMOTE THE HEALTH OF THE COMMUNITY IT SERVES INCLUDING THE FOLLOWING: PROVIDING QUARTERLY SENIOR BREAKFASTS, TUITION REIMBURSEMENT FOR HEALTHCARE RELATED DEGREES, PROMOTING SCHOOL PROGRAMS, AND PROVIDING VARIOUS COMMUNITY EDUCATION TO PROMOTE HEALTH WITHIN THE COMMUNITY. IN ADDITION, THE HOSPITAL IS CONTINUALLY WORKING WITH LOCAL OFFICIALS TO PROVIDE NEEDED SERVICES AND DONATE TIME AND EFFORT TO THE COMMUNITY. |
| SCHEDULE H, PART VI, LINE 7 | ARIZONA |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt |
|---|---|---|---|
| LAUREL KIBLER | |||
| NURSE PRACTIONER | $178,223 | $13,234 | $191,457 |
| MARTIN DUFOUR | |||
| MEDICAL DIRECTOR | $148,940 | $5,059 | $153,999 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PAGE 1, PART I, LINE 7 | FormAndLineReferenceDesc |
| Explanation | PURSUANT TO THE HOSPITAL'S EMPLOYEE AGREEMENT WITH THE CEO, AN ANNUAL INCENTIVE BONUS MAY BE PAID. THIS BONUS IS DEPENDENT ON THE ORGANIZATION'S OVERALL FINANCIAL CONDITION AND THE CEO'S ACHIEVEMENT OF A VARIETY OF PREVIOUSLY ESTABLISHED GOALS RELATED TO COMMUNITY INVOLVEMENT, EMPLOYEE DEVELOPMENT, OPERATIONAL COMPLIANCE, INDUSTRY KNOWLEDGE, AND THE IMPLEMENTATION OF NEW PROGRAMS. NO BONUS PAYMENT WAS MADE THIS TAX YEAR. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | VALLEY TELECOM | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | KEY EMPLOYEE | RelationshipDescriptionTxt |
| Transaction | $104,094 | TransactionAmt |
| Transaction | INTERNET/TELECOM | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PAGE 6, PART VI, LINE 4 | EFFECTIVE JUNE 1, 2021, THE ARTICLES OF INCORPORATION FOR THE HOSPITAL WERE AMENDED TO TRANSFER MEMBERSHIP INTEREST TO TMC HEALTHCARE. |
| FORM 990, PAGE 6, PART VI, LINE 6 | TMC HEALTHCARE IS THE SOLE MEMBER OF NORTHERN COCHISE COMMUNITY HOSPITAL. |
| FORM 990, PAGE 6, PART VI, LINE 7A | TMC HEALTHCARE APPOINTS THE HOSPITAL GOVERNING BODY. |
| FORM 990, PAGE 6, PART VI, LINE 11B | A COPY OF THE 990 IS PROVIDED TO THE CEO WHO REVIEWS THE FORM, SCHEDULES AND RELATED ATTACHMENTS. ANY COMMENTS OR QUESTIONS ARE ADDRESSED WITH THE PREPARER AND A DRAFT IS MADE AVAILABLE TO THE BOARD OF DIRECTORS WHO THEN APPROVE THE 990. ONCE MANAGEMENT IS SATISFIED WITH THE 990, THE CEO SIGNS THE FORM 8879-EO AUTHORIZING THE PREPARER TO E-FILE THE RETURN. |
| FORM 990, PAGE 6, PART VI, LINE 12C | ALL OFFICERS AND DIRECTORS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED BY THE COMPLIANCE OFFICER FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. |
| FORM 990, PAGE 6, PART VI, LINE 15A | THE CEO'S COMPENSATION IS DETERMINED ON AN ANNUAL BASIS BY A COMPENSATION COMMITTEE BASED ON COMPARABILITY DATA. THE MAIN SOURCE AVAILABLE TO THE HOSPITAL IN REGARD TO FAIR MARKET VALUE IN SALARIES IS THE STATE HOSPITAL ASSOCIATION ANNUAL SURVEY. THIS SURVEY IS UTILIZED BY THE BOARD IN DETERMINING THE CEO'S COMPENSATION. |
| FORM 990, PAGE 6, PART VI, LINE 15B | SEE FORM 990, PART VI, LINE 15A. |
| FORM 990, PAGE 6, PART VI, LINE 19 | THE HOSPITAL MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | 4,142,688 369,001 1,016 |
| FORM 990, PART XI, LINE 9 | TRANSFER OF ASSETS 96,695 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NORTHERN COCHISE HOSPITAL DISTRICT | |||||||||||
| 901 REX ALLEN DRIVE | WILLCOX | AZ | 85643 | 860208451 | DISTRICT | AZ | 170C1 | N/A | false | ||
| NORTHERN COCHISE HOSPITAL FOUNDATIO | |||||||||||
| 901 REX ALLEN DRIVE | WILLCOX | AZ | 85643 | 460868855 | FUNDRAISE | AZ | 501C3 | N/A | false | 12A | |
| NORTHERN COCHISE HOSPITAL AUXILIARY | |||||||||||
| 901 REX ALLEN DRIVE | WILLCOX | AZ | 85643 | FUNDRAISE | AZ | 501C3 | N/A | false | 12A | ||
| TMC HEALTHCARE | |||||||||||
| 5301 E GRANT ROAD | TUCSON | AZ | 85712 | 202218975 | HOSPITAL | AZ | 501C3 | N/A | false | 12B | |
| TUCSON MEDICAL CENTER | |||||||||||
| 5301 E GRANT ROAD | TUCSON | AZ | 85712 | 860137567 | HOSPITAL | AZ | 501C3 | false | 3 | TMCH | |
| TMC FOUNDATION | |||||||||||
| 5301 E GRANT ROAD | TUCSON | AZ | 85712 | 860504015 | FUNDRAISIN | AZ | 501C3 | N/A | false | 12A | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| NORTHERN COCHISE HOSPITAL DISTRICT | ||
| C | $2,209,902 | GAAP ACCOUNTING |
| NORTHERN COCHISE HOSPITAL DISTRICT | ||
| K | $76,916 | GAAP ACCOUNTING |