WINSLOW MEMORIAL HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- WINSLOW MEMORIAL HOSPITAL INC (EIN 86-0107344)
- Tax period
- 2020-10-01 to 2021-09-30
- Filed
- 2022-08-03
- IRS object ID
- 202212159349300716
- Schema version
- 2020v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-08-03T09:22:46-05:00 | ReturnTs |
| Tax Period End | 2021-09-30 | 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 | 200 E 10TH ST STE 500 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571046375 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860107344 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINSLOW MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | WINS | BusinessNameControlTxt |
| Phone | 9282896303 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 N WILLIAMSON AVE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN J DEMPSEY | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9282896303 | PhoneNum |
| Signature | 2022-07-28 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JOHN | PersonFirstNm |
| Person Last | DEMPSEY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAURIE HANSON CPA | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2022-07-28 | 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 | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COLORADO MEDICAL CENTER | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JOHN J DEMPSEY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 N WILLIAMSON AVE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $47,523,722 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.LCMCWMH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1951 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | COMPASSIONATE CARE FOR NORTHEASTERN ARIZONA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 306 | TotalEmployeeCnt |
| Total Volunteers | 15 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $621,055 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,624,626 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $39,856,629 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $40,629,060 | CYProgramServiceRevenueAmt |
| PY Investment Income | $48,226 | PYInvestmentIncomeAmt |
| CY Investment Income | $251,804 | CYInvestmentIncomeAmt |
| PY Other Revenue | $16,380 | PYOtherRevenueAmt |
| CY Other Revenue | $18,232 | CYOtherRevenueAmt |
| PY Total Revenue | $40,542,290 | PYTotalRevenueAmt |
| CY Total Revenue | $47,523,722 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $6,000 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $7,246 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $19,610,282 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $19,967,271 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $19,174,001 | PYOtherExpensesAmt |
| CY Other Expenses | $18,427,503 | CYOtherExpensesAmt |
| PY Total Expenses | $38,790,283 | PYTotalExpensesAmt |
| CY Total Expenses | $38,402,020 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,752,007 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,121,702 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $44,665,290 | TotalAssetsBOYAmt |
| Total Assets EOY | $47,384,616 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $27,657,751 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $21,261,366 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $17,007,539 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $26,123,250 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | COMPASSIONATE CARE FOR NORTHEASTERN ARIZONA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $31,980,543 | ExpenseAmt |
| Grant | $7,246 | GrantAmt |
| Revenue | $40,629,060 | RevenueAmt |
| Desc | WINSLOW MEMORIAL HOSPITAL D/B/A LITTLE COLORADO MEDICAL CENTER (LCMC) GENERAL MEDICAL & SURGICAL HOSPITAL - PRIMARILY ENGAGED IN PROVIDING DIAGNOSTIC, MEDICAL TREATMENT (BOTH SURGICAL AND NONSURGICAL) TO PATIENTS WITH A WIDE VARIETY OF MEDICAL CONDITIONS. LCMC MAINTAINED 25-BEDS, PROVIDED INPATIENTS WITH FOOD SERVICES THAT MET THEIR NUTRITIONAL REQUIREMENTS, AND USED AN ORGANIZED STAFF OF PHYSICIANS AND OTHER MEDICAL STAFF TO PROVIDE PROFESSIONAL CARE SERVICES AS WELL AS OTHER SERVICES. THESE SERVICES INCLUDE OUTPATIENT SERVICES, ANATOMICAL PATHOLOGY SERVICES, DIAGNOSTIC X-RAY SERVICES, CLINICAL LABORATORY SERVICES, OPERATING ROOM SERVICES FOR A VARIETY OF PROCEDURES, AND PHARMACY SERVICES IN THE CITY OF WINSLOW, NAVAJO COUNTY, ARIZONA. LCMC MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES WHICH INCLUDE THE COST OF SUPPLIES AND SERVICES FURNISHED UNDER THE CHARITY CARE POLICY ALONG WITH ASSOCIATED EQUIVALENT SERVICE STATISTICS. | Desc |
| Total Program Service Expenses | $31,980,543 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | 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 | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 306 | 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 | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | 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 | 0 | 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 | JANICE FREET | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 9282894691 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 NORTH WILLIAMSON AVENUE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| BRIAN BUCINA | ||||||||
| MD, SURGEON | 40.00 | Yes (X) | $441,063 | $0 | $46,666 | |||
| JOHN J DEMPSEY | ||||||||
| CEO | 40.00 | $339,924 | $0 | $43,534 | Yes (X) | |||
| RANDALL REID | ||||||||
| MD, GENERAL MEDICINE | 40.00 | Yes (X) | $330,687 | $0 | $46,942 | |||
| THOMAS GREENWOOD | ||||||||
| DIRECTOR, MD, CHIEF OF STAFF | 40.00 | $321,818 | $0 | $46,909 | 0.50 | Yes (X) | ||
| ELLEN CLAXTON | ||||||||
| MD, GENERAL MEDICINE | 40.00 | Yes (X) | $247,675 | $0 | $23,550 | |||
| JANICE FREET | ||||||||
| CFO | 40.00 | $214,365 | $0 | $19,221 | Yes (X) | |||
| JAMES PAGE | ||||||||
| MD, GENERAL MEDICINE | 40.00 | Yes (X) | $199,025 | $0 | $36,971 | |||
| PAMELA RULAND | ||||||||
| RN | 40.00 | Yes (X) | $191,365 | $0 | $17,782 | |||
| RHONDA GREER | ||||||||
| CHAIRPERSON | 5.00 | $0 | $0 | $0 | Yes (X) | 0.50 | Yes (X) | |
| FRANK ARMAO MD | ||||||||
| SECRETARY/TREASURER | 1.00 | $0 | $0 | $0 | Yes (X) | 0.50 | Yes (X) | |
| JR DESPAIN | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| CHRIS BAVASI | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| ROBERT SALABYE | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| ROBERTA CANO | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| ANDREW DITTO MD | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| DARRIN FRY | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| ELIZABETH MCKEY | ||||||||
| DIRECTOR | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| GREG HACKLER | ||||||||
| DIRECTOR BEG NOV 2020 | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| ALLYSEN KELLY | ||||||||
| DIRECTOR BEG AUG 2021 | 1.00 | $0 | $0 | $0 | 0.50 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,285,922 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $281,575 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 43 | 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 |
|---|---|---|---|---|---|
| MEDICAL SOLUTIONS LLC | |||||
| PO BOX 310737 | DES MOINES | IA | 50331 | TEMP STAFFING | $1,851,751 |
| WINNCARE LLC | |||||
| 1031 N WARREN | WINSLOW | AZ | 86047 | CRNA SERVICES | $399,769 |
| DANIEL WESCHE | |||||
| 1058 N WAKONDA STREET | FLAGSTAFF | AZ | 86004 | CRNA SERVICES | $307,140 |
| ANDREW J ALDRIDGE MD PC | |||||
| 2810 N SANDSTONE WAY | FLAGSTAFF | AZ | 86004 | CRNA SERVICES | $292,460 |
| GITTELMAN ANESTHESIA SERVICES LLC | |||||
| 25587 CONIFER RD | CONIFER | CO | 80433 | CRNA SERVICES | $251,560 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 12 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $6,607,647 | GovernmentGrantsAmt |
| All Other Contributions | $16,979 | AllOtherContributionsAmt |
| Total Contributions | $6,624,626 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 622110 | $39,940,590 | $39,940,590 |
| PHARMACY REVENUE | 900099 | $276,985 | $276,985 |
| MEAL & VENDING REVENUE | 900099 | $41,041 | $41,041 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $370,444 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $370,444 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $40,629,060 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $251,804 | TotalRevenueColumnAmt |
| Exclusion | $251,804 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $18,232 | 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 | $18,232 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,232 | TotalRevenueColumnAmt |
| Exclusion | $18,232 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $47,523,722 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $40,629,060 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $270,036 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,000 | TotalAmt |
| Program Services | $6,000 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,246 | TotalAmt |
| Program Services | $1,246 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,029,193 | TotalAmt |
| Program Services | $396,470 | ProgramServicesAmt |
| Management And General | $632,723 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,895,403 | TotalAmt |
| Program Services | $11,811,524 | ProgramServicesAmt |
| Management And General | $3,083,879 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $544,805 | TotalAmt |
| Program Services | $514,140 | ProgramServicesAmt |
| Management And General | $30,665 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,365,639 | TotalAmt |
| Program Services | $2,212,750 | ProgramServicesAmt |
| Management And General | $152,889 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,132,231 | TotalAmt |
| Program Services | $1,047,592 | ProgramServicesAmt |
| Management And General | $84,639 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $228,197 | TotalAmt |
| Management And General | $228,197 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,990 | TotalAmt |
| Management And General | $72,990 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,483,331 | TotalAmt |
| Program Services | $7,331,604 | ProgramServicesAmt |
| Management And General | $151,727 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,847 | TotalAmt |
| Program Services | $3,388 | ProgramServicesAmt |
| Management And General | $32,459 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,990,289 | TotalAmt |
| Program Services | $1,899,407 | ProgramServicesAmt |
| Management And General | $90,882 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $528,012 | TotalAmt |
| Management And General | $528,012 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $420,944 | TotalAmt |
| Program Services | $419,094 | ProgramServicesAmt |
| Management And General | $1,850 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $64,989 | TotalAmt |
| Program Services | $64,989 | ProgramServicesAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $149,006 | TotalAmt |
| Program Services | $136,031 | ProgramServicesAmt |
| Management And General | $12,975 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $714,077 | TotalAmt |
| Program Services | $552,292 | ProgramServicesAmt |
| Management And General | $161,785 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,644,828 | TotalAmt |
| Program Services | $1,281,673 | ProgramServicesAmt |
| Management And General | $363,155 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $436,636 | TotalAmt |
| Program Services | $371,184 | ProgramServicesAmt |
| Management And General | $65,452 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| SUPPLIES | $2,750,842 | $2,742,323 | $8,519 |
| EQUIPMENT RENTAL & MAIN | $310,445 | $304,894 | $5,551 |
| FOOD | $134,686 | $132,418 | $2,268 |
| DUES AND SUBSCRIPTIONS | $68,942 | $44,132 | $24,810 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,393,442 | TotalAmt |
| Program Services | $707,392 | ProgramServicesAmt |
| Management And General | $686,050 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $38,402,020 | TotalAmt |
| Program Services | $31,980,543 | ProgramServicesAmt |
| Management And General | $6,421,477 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,530,305 | BOYAmt |
| EOY | $21,394,222 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,041,083 | BOYAmt |
| EOY | $7,555,378 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,179,422 | BOYAmt |
| EOY | $1,298,108 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $402,086 | BOYAmt |
| EOY | $539,476 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $37,569,633 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $24,546,735 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,442,363 | BOYAmt |
| EOY | $13,022,898 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,070,031 | BOYAmt |
| EOY | $3,312,856 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $261,678 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,665,290 | BOYAmt |
| EOY | $47,384,616 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,478,451 | BOYAmt |
| EOY | $3,040,253 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,634,037 | BOYAmt |
| EOY | $126,390 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,330,999 | BOYAmt |
| EOY | $13,983,752 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,165,471 | BOYAmt |
| EOY | $3,165,471 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,048,793 | BOYAmt |
| EOY | $945,500 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,657,751 | BOYAmt |
| EOY | $21,261,366 | 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 | $17,007,539 | BOYAmt |
| EOY | $26,123,250 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $17,007,539 | BOYAmt |
| EOY | $26,123,250 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,665,290 | BOYAmt |
| EOY | $47,384,616 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,121,702 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$5,991 | 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 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 D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $135,526 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $72,347 | OtherCostOrOtherBasisAmt |
| Book Value | $207,873 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,912,978 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,057,331 | DepreciationAmt |
| Book Value | $6,855,647 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $19,364,857 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,489,404 | DepreciationAmt |
| Book Value | $4,875,453 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,083,925 | OtherCostOrOtherBasisAmt |
| Book Value | $1,083,925 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,022,898 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp (3 entries)
| DescDesc | Book ValueBookValueAmt | Method ValuationMethodValuationCd |
|---|---|---|
| INVESTMENT IN FOUNDATION | $99,388 | F |
| ASSETS LIMITED AS TO USE | $1,603,568 | F |
| OTHER INVESTMENT | $1,609,900 | F |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $3,312,856 | TotalBookValueSecuritiesAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| ASSET RETIREMENT OBLIGATION | $582,425 |
| SETTLEMENT AGREEMENT | $114,000 |
| DEFERRED COMPENSATION | $249,075 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $945,500 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $47,517,731 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$5,991 | OtherRevenueAmt |
| Revenue Not Reported | -$5,991 | RevenueNotReportedAmt |
| Revenue Subtotal | $47,523,722 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $47,523,722 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $38,402,020 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $38,402,020 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $38,402,020 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 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 IN NET ASSETS OF FOUNDATION -5,991. |
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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 125.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $285,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $285,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00740 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,370,993 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,987,045 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,655,993 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $17,987,045 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $285,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00740 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,986 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,986 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,234,026 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $916,029 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,317,997 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,275,012 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $916,029 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,358,983 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06150 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $20,931,005 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $18,903,074 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,643,983 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06890 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $6,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $3,673,215 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,296,645 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $6,994,546 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,925,293 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $69,253 | 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 | LITTLE COLORADO MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 N WILLIAMSON AVE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.LCMCWMH.COM | WebsiteAddressTxt |
| State License | RGH 0076 | StateLicenseNum |
| 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 | LITTLE COLORADO MEDICAL CENTER | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE 7D NARRATIVE | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.LCMCWMH.COM/ABOUT-US | 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 | 125.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| 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 | HTTPS://WWW.LCMCWMH.COM/PATIENTS---VISITORS | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE 16A-C NARRATIVE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE 16A-C NARRATIVE | 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 |
| Other Publicity | Yes (X) | OtherPublicityInd |
| 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 Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 5: LCMC SOLICITED INPUT FROM MULTIPLE SOURCES IN THE COMMUNITY, INCLUDING GROUPS THAT WORK WITH DISADVANTAGED POPULATIONS. LCMC CONDUCTED THE CHNA DURING THE YEAR ENDED 9/30/20. LCMC SOLICITED INPUT THROUGH FOCUS GROUPS, TOWN MEETINGS, COMMUNITY COALITIONS, COMMUNITY HEALTH SURVEYS, PUBLIC HEALTH AND HOSPITAL DATA, INTERVIEWS WITH MENTAL AND BEHAVIORAL HEALTH PROVIDERS, EMERGENCY SERVICES PERSONNEL, A COMMUNITY ADVISORY COMMITTEE, VOLUNTEER ORGANIZATIONS, AND INDIAN HEALTH SERVICES TO IDENTIFY THE NEEDS OF THE COMMUNITY. DUE TO THE PANDEMIC, ALL OF THIS INFORMATION WAS SOLICITED THROUGH VIDEOCONFERENCING, TELECONFERENCING, AND SURVEYS. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 6B: COLLEGE OF PUBLIC HEALTH, THE UNIVERSITY OF ARIZONA, AND HEALTH EQUITY RESEARCH GROUP, NORTHERN ARIZONA UNIVERSITY. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 7D: THE CHNA REPORT IS AVAILABLE AT HTTPS://WWW.LCMCWMH.COM/ABOUT-US. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 11: NEEDS IDENTIFIED IN THE MOST RECENT CHNA IMPLEMENTATION STRATEGY INCLUDE THE FOLLOWING:1. DRUG AND ALCOHOL USE DISORDER2. HEALTH PROVIDER SHORTAGES3. CHRONIC HEALTH ISSUES4. SOCIO-ECONOMIC CONDITIONS5. COVID-19 PANDEMICLCMC HAD A GOOD IMPLEMENTATION PLAN AND STRATEGIES IN PLACE TO APPROPRIATELY MEASURE, HOWEVER, WE WERE STILL IN THE THROES OF COVID THROUGH MUCH OF THE REPORTING YEAR. THEREFORE, WE REMAINED FOCUSED ON COVID COMMUNITY RELATED EFFORTS.DURING THE CURRENT YEAR, LITTLE COLORADO MEDICAL CENTER AND LITTLE COLORADO PHYSICIAN OFFICES CONTINUED TO SUPPORT THE COMMUNITY THROUGH MEALS ON WHEELS FOR OUR HOMEBOUND SENIORS, AND PROVIDED LUNCHTIME MEALS THROUGH THE CAFETERIA BY DELIVERING MEALS TO SENIORS IN A DRIVE THRU METHOD. WE CONTINUED TO PROVIDE HEALTHIER EATING OPTIONS IN THE CAFETERIA IN A SOCIALLY DISTANCED MANNER. WE ARE CONTINUING TO ASSIST SAINT MARY'S FOOD BANK IN DISTRIBUTING FOOD BOXES MONTHLY, PROVIDING MUCH NEEDED ASSISTANCE TO THE COMMUNITY. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON A CASE-BY-CASE BASIS. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 16J: PART V, SECTION B, LINE 16A, B & C: THE FINANCIAL ASSISTANCE POLICY, APPLICATION, AND PLAIN LANGUAUGE SUMMARY OF THE FAP ARE POSTED ON THE ORGANIZATION'S WEBSITE AT HTTPS://WWW.LCMCWMH.COM/PATIENTS---VISITORS.PART V, SECTION B, LINE 16J:A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, ADMISSIONS OFFICE AND WAS MADE AVAILABLE UPON REQUEST.MORE THAN THE LESSER OF 5% OR 1,000 INDIVIDUALS IN THE SERVICE AREA ARE LEP. HOWEVER, THE LANGUAGE SPOKEN, NAVAJO, RECENTLY BECAME A WRITTEN LANGUAGE. THE FACILITY HAS STAFF WHO SPEAK NAVAJO AND ARE ABLE TO ASSIST PATIENTS IN COMPLETING FINANCIAL ASSISTANCE FORMS, BECAUSE THE FORMS ARE STILL PREDOMINATELY IN ENGLISH. |
| LITTLE COLORADO MEDICAL CENTER | PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - LITTLE COLORADO PHYSICIANS OFFICE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 201 LEE STREET | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | PROVIDER BASED RURAL HEALTH CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO UTILIZING FPG TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE HOSPITAL CONSIDERED MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS OF PATIENTS. PRESUMPTIVE ELIGIBILITY MAY BE USED ON A CASE-BY-CASE BASIS. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINES 7B AND 7E WERE DETERMINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS DETERMINED BASED ON THE COST REPORT. |
| PART I, LINE 7G: | SUBSIDIZED HEALTH SERVICES INCLUDES NET COMMUNITY BENEFIT EXPENSE FROM THE CLINIC OF $3,229,402. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | LCMC GAVE $6,000 TO THE LOCAL SENIOR CENTER TO HELP FUND MEALS ON WHEELS AND OTHER HEALTH AND WELLNESS INITIATIVES. |
| PART III, LINE 2: | THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. |
| PART III, LINE 3: | THE IMPLICIT PRICE CONCESSION INCLUDES AN ESTIMATED $1,296,645 OF CHARITY CARE-ELIGIBLE ACCOUNTS THAT ARE CURRENTLY LISTED AS AN IMPLICIT PRICE CONCESSION. UPON REVIEWING THE ACCOUNTS AND THE POVERTY LEVELS OF NAVAJO AND APACHE COUNTIES IN ARIZONA, IT WAS FOUND THAT ABOUT 35.3% OF THE OUTSTANDING BALANCES MAY HAVE BEEN ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. ALSO FOR THIS REVIEW PROCESS, ANY FAMILIES WITH PRIOR APPLICATIONS FOR CHARITY CARE WERE GIVEN CONSIDERATION. |
| PART III, LINE 4: | THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSION IS LOCATED IN FOOTNOTE 1 ON PAGES 11 & 12 OF THE ATTACHED FINANCIAL STATEMENTS. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2021. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. |
| PART III, LINE 9B: | ONCE THE BALANCE ON THE PATIENT'S ACCOUNT IS READY FOR BILLING THE PATIENT RECEIVES AN INITIAL STATEMENT. THE PATIENT WILL THEN RECEIVE A SECOND STATEMENT AT DAY 30 ALONG WITH A FOLLOW UP PHONE CALL, A THIRD STATEMENT AT DAY 60, AND A FINAL STATEMENT AT DAY 90 WITH A FOLLOW UP PHONE CALL. THE 90 DAY LETTER INFORMS THE PATIENT THAT COLLECTION ACTIONS WILL BEGIN AT 120 DAYS IF NO ATTEMPTS HAVE BEEN MADE TO RESOLVE THEIR ACCOUNT. THE PATIENT'S ACCOUNT IS TURNED TO COLLECTIONS AT DAY 121 WITH A NOTIFICATION LETTER SENT TO THE PATIENT INFORMING THEM OF SUCH. IF OUR COLLECTION AGENCY IDENTIFIES A PATIENT IS MEETING FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA, THE PATIENT'S ACCOUNT MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE. COLLECTION ACTIVITY WILL BE SUSPENDED ON ACCOUNTS, AND THE FINANCIAL ASSISTANCE APPLICATION WILL BE REVIEWED. IF THE ENTIRE ACCOUNT BALANCE IS ADJUSTED, THE ACCOUNT WILL BE RETURNED. IF A PARTIAL ADJUSTMENT OCCURS, THE PATIENT FAILS TO COOPERATE WITH THE FINANCIAL ASSISTANCE PROCESS, OR IF THE PATIENT IS NOT ELIGIBLE FOR FINANCIAL ASSISTANCE, COLLECTION ACTIVITY WILL RESUME. REQUESTS FOR CHARITY SHALL BE PROCESSED PROMPTLY AND LITTLE COLORADO MEDICAL CENTER SHALL NOTIFY THE PATIENT OR APPLICANT IN WRITING WITHIN 30 DAYS OF RECEIPT OF A COMPLETED APPLICATION. ACCOUNTS ELIGIBLE FOR CHARITY CARE ARE TO BE ADDRESSED WITHIN 240 DAYS OF FIRST BILL. |
| PART VI, LINE 2: | LCMC ASSESSES HEALTH NEEDS BY EVALUATING THE PATIENTS SERVED IN THE CLINICS AND HOSPITAL. LCMC HAS STAFF THAT PARTICIPATE IN VARIOUS ORGANIZATIONS INCLUDING THE COUNCIL FOR AGING, ALICE'S PLACE, THE WINSLOW ROTARY, ETC. STAFF ARE MADE AWARE OF NEEDS OF THE COMMUNITY THROUGH THEIR INVOLVEMENT WITH THESE ORGANIZATIONS. ADDITIONALLY, LCMC HAS MONTHLY MEDICAL EXECUTIVE AND BI-ANNUAL MEDICAL STAFF MEETINGS TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. |
| PART VI, LINE 3: | LCMC'S PATIENT BILLING STATEMENTS HAVE A NARRATIVE ATTACHED DESCRIBING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THE CONTACT INFORMATION FOR HOW TO OBTAIN ADDITIONAL INFORMATION. NOTICES OF FINANCIAL ASSISTANCE AVAILABILITY ARE POSTED IN THE ER, WAITING ROOMS, AND ADMISSIONS OFFICE. |
| PART VI, LINE 4: | LCMC IS LOCATED IN THE COMMUNITY OF WINSLOW WHICH IS LOCATED IN NAVAJO COUNTY, ARIZONA, AND SERVES THE HEALTHCARE NEEDS OF THE COMMUNITY AND SURROUNDING AREAS. THE SERVICE AREA IS MOSTLY RURAL WITH A POPULATION OF APPROXIMATELY 21,160 PEOPLE. THE AVERAGE HOUSEHOLD INCOME IS $45,742 WITH 50% OF THE POPULATION HAVING AN INCOME OF LESS THAN $35,000. MORE THAN 40% OF THE PATIENTS SERVED BY LCMC ARE ON THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM, AND MORE THAN 60% OF THE SERVICE AREA ARE OF NATIVE AMERICAN DESCENT. THE NEAREST HOSPITAL IS 60 MILES FROM WINSLOW. WINSLOW IS IN AN AREA FEDERALLY DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA, A MEDICALLY UNDERSERVED AREA, AND A PERSISTENT POVERTY COUNTY. |
| PART VI, LINE 5: | LCMC'S BOARD OF DIRECTORS ALL RESIDE IN THE ORGANIZATION'S SERVICE AREA WITH THE EXCEPTION OF FOUR MEMBERS AT LARGE, ONE RESIDES IN PHOENIX, AZ, ONE RESIDES IN PAYSON, AZ, AND TWO RESIDE IN FLAGSTAFF, AZ. IN ADDITION, NONE OF THE BOARD MEMBERS ARE RELATED TO THE ORGANIZATION. LCMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROVIDERS IN ITS COMMUNITY AND SURROUNDING AREA FOR SOME OR ALL OF ITS DEPARTMENTS. LCMC REINVESTS SURPLUS FUNDS, IF ANY, TO IMPROVEMENTS IN PATIENT CARE, INCLUDING BUT NOT LIMITED TO EXPANSION OF SERVICES OFFERED, PATIENT EDUCATION, EMPLOYEE EDUCATION, AND EQUIPMENT AND FACILITY RENOVATIONS. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINSLOW COUNCIL ON AGING | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 212 EAST SECOND STREET | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 860310351 | RecipientEIN |
| IRC Section | 501(C)(3) | IRCSectionDesc |
| Cash Grant | $6,000 | CashGrantAmt |
| Purpose Of Grant | MEALS ON WHEELS PROGRAM ASSISTANCE | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2: | FormAndLineReferenceDesc |
| Explanation | LCMC PROVIDES ASSISTANCE TO THE COALITION ON AGING TO ASSIST WITH MEALS ON WHEELS, FOOD BANK, AND TRANSPORTATION FOR SENIORS. LCMC MAY PERIODICALLY CONTACT THE COALITION AND REQUEST CONFIRMATION THAT FUNDS ARE USED AS INTENDED. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Independent Consultant | Yes (X) | IndependentConsultantInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | 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 | Yes (1) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| BRIAN BUCINA | ||||||||||||||
| MD, SURGEON | $436,063 | $0 | $5,000 | $0 | $0 | $0 | $12,825 | $0 | $34,570 | $0 | $488,458 | $0 | $0 | $0 |
| JOHN J DEMPSEY | ||||||||||||||
| CEO | $324,774 | $0 | $15,150 | $0 | $0 | $0 | $12,825 | $0 | $31,428 | $0 | $384,177 | $0 | $0 | $0 |
| RANDALL REID | ||||||||||||||
| MD, GENERAL MEDICINE | $325,687 | $0 | $5,000 | $0 | $0 | $0 | $12,825 | $0 | $34,846 | $0 | $378,358 | $0 | $0 | $0 |
| THOMAS GREENWOOD | ||||||||||||||
| DIRECTOR, MD, CHIEF OF STAFF | $316,818 | $0 | $5,000 | $0 | $0 | $0 | $12,825 | $0 | $34,813 | $0 | $369,456 | $0 | $0 | $0 |
| ELLEN CLAXTON | ||||||||||||||
| MD, GENERAL MEDICINE | $245,525 | $0 | $2,150 | $0 | $0 | $0 | $23,550 | $0 | $0 | $0 | $271,225 | $0 | $0 | $0 |
| JANICE FREET | ||||||||||||||
| CFO | $201,865 | $0 | $12,500 | $0 | $0 | $0 | $9,263 | $0 | $10,638 | $0 | $234,266 | $0 | $0 | $0 |
| JAMES PAGE | ||||||||||||||
| MD, GENERAL MEDICINE | $194,025 | $0 | $5,000 | $0 | $0 | $0 | $3,880 | $0 | $33,793 | $0 | $236,698 | $0 | $0 | $0 |
| PAMELA RULAND | ||||||||||||||
| RN | $181,365 | $0 | $10,000 | $0 | $0 | $0 | $8,286 | $0 | $9,871 | $0 | $209,522 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 4B | LCMC ENTERED INTO AN AGREEMENT WITH JOHN DEMPSEY TO PAY HIM A RETENTION BONUS WHICH VESTED ON 7/31/2020. THE FULL RETENTION BONUS WILL BE PAID OVER AN EIGHT-YEAR PERIOD. THIS DEFERRED COMPENSATION BENEFIT BECAME EFFECTIVE JANUARY 1, 2019. MONTHLY PAYMENTS BEGAN ON JULY 1, 2020. JOHN DEMPSEY WAS PAID $12,825 IN DEFERRED COMPENSATION IN 2020. |
| PART I, LINE 7 | BONUSES WERE PROVIDED BASED ON COMPLETION OF TASKS DETERMINED AS PART OF THEIR PERFORMANCE PLANS. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 8B | ALL COMMITTEES UTILIZED BY LCMC ARE STRICTLY ADVISORY IN NATURE. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE ORGANIZATION'S CEO AND CFO WILL REVIEW THE FORM 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REVIEWED ON AN ANNUAL BASIS. BOARD MEMBERS, OFFICERS, AND MANAGERS ARE COVERED UNDER LITTLE COLORADO MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. WHEN A CONFLICT OF INTEREST ARISES, THE COVERED PERSON IS TO DISCLOSE THE CONFLICT TO HIS OR HER IMMEDIATE SUPERVISOR BEFORE A DECISION INVOLVING THE AREA OF CONFLICT IS MADE. MEMBERS WITH A CONFLICT OF INTEREST ARE ALSO NOT ALLOWED TO PARTICIPATE IN THE DECISION MAKING PROCESS. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE ORGANIZATION REVIEWS AND DETERMINES THE CEO'S COMPENSATIONS EVERY FEW YEARS. THE ORGANIZATION BRINGS IN THE LEDBETTER LAW FIRM, PLC TO AID IN DETERMINING THE REASONABLENESS OF THE COMPENSATION. THE LAW FIRM CONSIDERS CEO COMPENSATION FROM OTHER HOSPITALS WITHIN THE CRITICAL ACCESS HOSPITALS IN ARIZONA, WHICH LCMC IS APART OF. THIS DATA IS COLLECTED THROUGH THE ARIZONA HOSPITAL ASSOCIATION. LEDBETTER LAW FIRM PLC WAS ENGAGED TO REVIEW AND ANALYZE THE COMPENSATION FOR THE CEO IN JANUARY, 2019. THE BOARD OF DIRECTORS APPROVED THE COMPENSATION RECOMMENDATION. NO PAY ADJUSTMENTS HAVE BEEN PROVIDED SINCE THAT TIME. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | CONTRACT LABOR: PROGRAM SERVICE EXPENSES 2,932,666. MANAGEMENT AND GENERAL EXPENSES 13,000. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,945,666. PROFESSIONAL FEES - MEDICAL: PROGRAM SERVICE EXPENSES 2,835,420. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,835,420. PURCH SVCES-OTHER: PROGRAM SERVICE EXPENSES 1,563,518. MANAGEMENT AND GENERAL EXPENSES 138,727. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,702,245. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION -5,991. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LITTLE COLORADO HEALTHCARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1501 NORTH WILLIAMSON AVENUE | AddressLine1Txt |
| City | WINSLOW | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 86047 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 208504703 | EIN |
| Primary Activities | CHARITABLE | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 11 | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | WINSLOW MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | 0 | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |