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NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL INC: Form 990, tax year 2017

View the entire original 990 at ProPublica ↗

Organization
NAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL INC (EIN 23-7314364)
Tax period
2017-10-01 to 2018-09-30
Filed
2019-08-15
IRS object ID
201912279349303706
Schema version
2017v2.3
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2019-08-15T17:34:50-05:00ReturnTs
Tax Period End2018-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN430765316PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1RUBINBROWN LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line15851 W CHARLESTON BLVDAddressLine1Txt
CityLAS VEGASCityNm
State AbbreviationNVStateAbbreviationCd
ZIP89146ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2017-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN237314364EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NAVAJO HEALTH FOUNDATION - SAGE MEMORIALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlNAVABusinessNameControlTxt
Phone9287554500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 457AddressLine1Txt
CityGANADOCityNm
State AbbreviationAZStateAbbreviationCd
ZIP86505ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMICHAEL KATIGBAKPersonNm
Person TitleINTERIM CFOPersonTitleTxt
Phone9287554500PhoneNum
Signature2019-08-15SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonHEATHER GRECHPreparerPersonNm
PTINP00165182PTIN
Phone7028789788PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address24.234.153.165IPv4AddressTxt
FieldValueIRS element (for citing)
IP2019-08-15IPDt
IP Tm16:55:10IPTm
IP TimezonePDIPTimezoneCd
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device IdFF1F382E797EE3D05EABFF84EF05A331996E6977AtSubmissionCreationDeviceId
At Submission Filing Device Id157E94362D87AD908323791A79CDD36DEF7C5F04AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2017TaxYr
Build TS2019-02-21 02:37:17ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerMICHAEL KATIGBAKPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 457AddressLine1Txt
CityGANADOCityNm
State AbbreviationAZStateAbbreviationCd
ZIP86505ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$49,439,475GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.SAGEMEMORIAL.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1974FormationYr
Legal Domicile StateAZLegalDomicileStateCd
Activity Or MissionTO PROVIDE QUALITY HEALTHCARE SERVICES IN A FISCALLY RESPONSIBLE MANNER.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee225TotalEmployeeCnt
Total Volunteers30TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$428,929PYContributionsGrantsAmt
CY Contributions Grants$72,017CYContributionsGrantsAmt
PY Program Service Revenue$121,091,212PYProgramServiceRevenueAmt
CY Program Service Revenue$48,816,220CYProgramServiceRevenueAmt
PY Investment Income$278,582PYInvestmentIncomeAmt
CY Investment Income$327,079CYInvestmentIncomeAmt
PY Other Revenue$196,504PYOtherRevenueAmt
CY Other Revenue$206,413CYOtherRevenueAmt
PY Total Revenue$121,995,227PYTotalRevenueAmt
CY Total Revenue$49,421,729CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$10,246,714PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$10,450,050CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$32,084,690PYOtherExpensesAmt
CY Other Expenses$40,104,758CYOtherExpensesAmt
PY Total Expenses$42,331,404PYTotalExpensesAmt
CY Total Expenses$50,554,808CYTotalExpensesAmt
PY Revenues Less Expenses$79,663,823PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,133,079CYRevenuesLessExpensesAmt
Total Assets BOY$143,611,255TotalAssetsBOYAmt
Total Assets EOY$140,195,449TotalAssetsEOYAmt
Total Liabilities BOY$7,544,889TotalLiabilitiesBOYAmt
Total Liabilities EOY$5,262,162TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$136,066,366NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$134,933,287NetAssetsOrFundBalancesEOYAmt
MissionOUR MISSION IS TO PROVIDE QUALITY PATIENT CARE IN A FISCALLY RESPONSIBLE MANNER FOCUSING ON THE PATIENTS PHYSICAL, SOCIAL AND SPIRITUAL WELL-BEING.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$43,552,165ExpenseAmt
Revenue$48,816,220RevenueAmt
DescNAVAJO HEALTH FOUNDATION-SAGE MEMORIAL HOSPITAL CONTRACTED WITH INDIAN HEALTH SERVICES WITH A SELF-DETERMINATION CONTRACT WHICH PROVIDED CARE TO INPATIENTS, OUTPATIENTS, ER PATIENTS, DENTAL, PHYSIOTHERAPY, BEHAVIORIAL HEALTH, OPTOMETRY AND RADIOLOGY. SAGE MEMORIAL HOSPITAL SERVES PRIMARILY MEMBERS OF THE NAVAJO NATION. SAGE MEMORIAL HOSPITAL ALSO ADMINISTERED SPECIAL DIABETES PREVENTION AND TREATMENT FOR NAVAJOS. THE ORGANIZATION HAS DEVELOPED A PUBLIC HEALTH AND SOCIAL SERVICES EMERGENCY RESPONSE PLAN.Desc
Total Program Service Expenses$43,552,165TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit TransYes (1)EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org MemYes (1)BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer EntYes (1)BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related Entity0RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document242IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee225EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or MisuseYes (1)MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of Committees0MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn0AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc0RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1MIKE KATIGBAK INTERIM CFOBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone9287554500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 457AddressLine1Txt
CityGANADOCityNm
State AbbreviationAZStateAbbreviationCd
ZIP86505ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
MAYBELLE KELEWOOD
BOARD TREASURER2.00Yes (X)Yes (X)$21,500$0$0
ANDREW SIMPSON
BOARD MEMBR2.00Yes (X)$21,500$0$0
LINDA S YAZZIE
BOARD VICE CHAIRPERSON THROUGH MARCH 20182.00Yes (X)Yes (X)$22,500$0$0
STENSON WAUNEKA
BOARD CHAIRPERSON5.00Yes (X)Yes (X)$42,000$0$0
JOYCE MOORE
BOARD MEMBER2.00Yes (X)$20,000$0$0
RAY ANN TERRY
BOARD SECRETARY2.00Yes (X)Yes (X)$21,500$0$0
CHANNARONG JARUVANGSANTI
PHARMACIST40.00$171,472$0$0Yes (X)
THERESA HENSLER
PHARMACIST40.00$160,450$0$0Yes (X)
MICHAEL NGUYEN
PHARMACIST40.00$143,639$0$0Yes (X)
PIO M SIAN
PHYSICIAN40.00$262,747$0$0Yes (X)
PAUL E HABENER
PHYSICIAN40.00$148,781$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,036,089TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$0TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K10IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
RAZAGHI HEALTHCARE
7150 E CAMELBACK RD SUITE 444SCOTTSDALEAZ85251MANAGEMENT SERVICES$11,637,539
AB STAFFING SOLUTIONS
2680 S VAL VISTA 152GILBERTAZ85295STAFFING$1,623,898
MANAGEMENT HEALTH SYSTEMS INC
1580 SAWGRASS CORPORATE PKWY SUITESUNRISEFL33323STAFFING$1,533,216
BARTON ASSOCIATES INC
PO BOX 417844BOSTONMA02241STAFFING$1,465,793
AYA HEALTHCARE
5930 CORNERSTONE CT WEST 300SAN DIEGOCA92121STAFFING$837,719
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K21CntrctRcvdGreaterThan100KCnt
All Other Contributions$72,017AllOtherContributionsAmt
Total Contributions$72,017TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
ISDEAA REVENUE900099$29,761,640$29,761,640
NET PATIENT REVENUE900099$18,569,816$18,569,816
OTHER REVENUES900099$484,764$484,764
FieldValueIRS element (for citing)
Total Program Service Revenue$48,816,220TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$327,079TotalRevenueColumnAmt
Exclusion$327,079ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$224,159RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$17,746RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$206,413RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$206,413TotalRevenueColumnAmt
Exclusion$206,413ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$49,421,729TotalRevenueColumnAmt
Related Or Exempt Func Income$48,816,220RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$533,492ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,148,630TotalAmt
Program Services$8,451,508ProgramServicesAmt
Management And General$697,122ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$106,234TotalAmt
Program Services$98,160ProgramServicesAmt
Management And General$8,074ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$597,050TotalAmt
Program Services$551,674ProgramServicesAmt
Management And General$45,376ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$598,136TotalAmt
Program Services$552,558ProgramServicesAmt
Management And General$45,578ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$12,904,652TotalAmt
Program Services$9,033,256ProgramServicesAmt
Management And General$3,871,396ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$684,141TotalAmt
Program Services$478,899ProgramServicesAmt
Management And General$205,242ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$699,580TotalAmt
Program Services$489,706ProgramServicesAmt
Management And General$209,874ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$12,956,480TotalAmt
Program Services$12,647,254ProgramServicesAmt
Management And General$309,226ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$231,672TotalAmt
Program Services$169,196ProgramServicesAmt
Management And General$62,476ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$1,394,813TotalAmt
Program Services$1,040,254ProgramServicesAmt
Management And General$354,559ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$258,909TotalAmt
Program Services$181,236ProgramServicesAmt
Management And General$77,673ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$464,654TotalAmt
Program Services$325,258ProgramServicesAmt
Management And General$139,396ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$401,912TotalAmt
Program Services$310,957ProgramServicesAmt
Management And General$90,955ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$283,210TotalAmt
Program Services$198,803ProgramServicesAmt
Management And General$84,407ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$162,566TotalAmt
Management And General$162,566ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$838,124TotalAmt
Program Services$712,405ProgramServicesAmt
Management And General$125,719ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$385,118TotalAmt
Program Services$331,537ProgramServicesAmt
Management And General$53,581ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
SUPPLIES AND PHARMACEUT$3,139,393$3,060,183$79,210
CONTRACT HEALTH SERVICE$2,666,810$2,666,810
PURCHASED SERVICES$1,788,004$1,537,755$250,249
BAD DEBT EXPENSE$122,818$122,818

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$721,902TotalAmt
Program Services$591,938ProgramServicesAmt
Management And General$129,964ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$50,554,808TotalAmt
Program Services$43,552,165ProgramServicesAmt
Management And General$7,002,643ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$10,966BOYAmt
EOY$1,704,428EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$10,243,276BOYAmt
EOY$95,594,578EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$122,500,000BOYAmt
EOY$321,117EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,287,075BOYAmt
EOY$1,577,737EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$317,230BOYAmt
EOY$409,338EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$353,375BOYAmt
EOY$519,653EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$24,527,558LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$18,467,774LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$6,379,401BOYAmt
EOY$6,059,784EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,179,917BOYAmt
EOY$31,367,531EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,340,015BOYAmt
EOY$2,641,283EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$143,611,255BOYAmt
EOY$140,195,449EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$7,466,206BOYAmt
EOY$4,917,645EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$65,758BOYAmt
EOY$300,883EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,925BOYAmt
EOY$43,634EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,544,889BOYAmt
EOY$5,262,162EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$134,359,037BOYAmt
EOY$133,219,846EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,105,420BOYAmt
EOY$1,111,534EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$601,909BOYAmt
EOY$601,907EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$136,066,366BOYAmt
EOY$134,933,287EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$143,611,255BOYAmt
EOY$140,195,449EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,133,079ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit RequiredYes (1)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (1)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Collection Used PreservationYes (X)CollectionUsedPreservationInd

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$803,062BeginningYearBalanceAmt
Investment Earnings Or Losses$6,113InvestmentEarningsOrLossesAmt
End Year Balance$809,175EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$792,938BeginningYearBalanceAmt
Investment Earnings Or Losses$10,124InvestmentEarningsOrLossesAmt
End Year Balance$803,062EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$769,772BeginningYearBalanceAmt
Investment Earnings Or Losses$23,166InvestmentEarningsOrLossesAmt
End Year Balance$792,938EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$767,958BeginningYearBalanceAmt
Investment Earnings Or Losses$1,814InvestmentEarningsOrLossesAmt
End Year Balance$769,772EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$761,219BeginningYearBalanceAmt
Investment Earnings Or Losses$6,739InvestmentEarningsOrLossesAmt
End Year Balance$767,958EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY0.75000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.25000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org0EndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$26,000OtherCostOrOtherBasisAmt
Book Value$26,000BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$12,831,783OtherCostOrOtherBasisAmt
Depreciation$9,174,748DepreciationAmt
Book Value$3,657,035BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$11,669,775OtherCostOrOtherBasisAmt
Depreciation$9,293,026DepreciationAmt
Book Value$2,376,749BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$6,059,784TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
HOUSING DEPOSITS$14,132
OTHER LIABILITIES$29,502
FieldValueIRS element (for citing)
Total Liability$43,634TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$48,986,092TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$108,558OtherRevenueAmt
Revenue Not Reported-$108,558RevenueNotReportedAmt
Revenue Subtotal$49,094,650RevenueSubtotalAmt
Other Revenues Not Included$327,079OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$327,079RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$49,421,729TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$50,446,248TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$50,446,248ExpensesSubtotalAmt
Other Expenses Not Included$108,560OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$108,560ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$50,554,808TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART III, LINE 4:HUBBELL'S TRADING POST MANAGES ALL COLLECTIONS, OBJECTS AND ARTIFACTS IN ACCORDANCE WITH PROPER MUSEUM STANDARDS AND CONDITIONS.
PART V, LINE 4:THE ENDOWMENT CONSISTS OF SCANDLING MEMORIAL SCHOLARSHIP FUNDS ESTABLISHED TO PROVIDE FINANCIAL SCHOLARSHIP OPPORTUNITIES FOR FULL-TIME NAVAJO COLLEGE STUDENTS.
PART X, LINE 2:FINANCIAL STATEMENT FOOTNOTE 1 PAGE 13 - THE HOSPITAL BELIEVES THAT IT IS IN SUBSTANTIAL COMPLIANCE WITH ALL IRS TAX REGULATIONS AS OF SEPTEMBER 30, 2018, AND THEREFORE HAS NOT RECORDED ANY UNRECOGNIZED TAX BENEFIT OR LIABILITIES FOR INCOME TAXES. SPECIFICALLY, HOSPITAL IS DISCLOSING AN EXCESS BENEFIT TRANSACTION THAT IS ALSO THE SUBJECT OF ONGOING FEDERAL LITIGATION ALLEGING FRAUD, RACKETEERING, CONSPIRACY AND UNLAWFUL TAKING OF $10.8 MILLION AS DESCRIBED MORE THOROUGHLY IN SCHEDULE O HEREIN.
PART XI, LINE 2D - OTHER ADJUSTMENTS:BAD DEBT EXPENSE CLASSIFIED AS REDUCTION OF INCOME ON FINANCIAL STATEMENT -122,818. RENTAL EXPENSE REPORTED AS EXPENSE ON FINANCIAL STATEMENT 17,746. OTHER CLASSIFICATION DIFFERENCES -3,486.
PART XI, LINE 4B - OTHER ADJUSTMENTS:INVESTMENT INCOME INCLUDED AS OTHER INCOME ON FINANCIAL STATEMENT 320,966. TEMPORARILY RESTRICTED INCOME 6,113.
PART XII, LINE 4B - OTHER ADJUSTMENTS:BAD DEBT EXPENSE CLASSIFIED AS REDUCTION OF INCOME ON FINANCIAL STATEMENTS 122,817. RENTAL EXPENSE REPORTED AS EXPENSE ON FINANCIAL STATEMENT -17,746. OTHER CLASSIFICATION DIFFERENCES 3,489.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free Care0FPGReferenceFreeCareInd
FPG Reference Discounted Care0FPGReferenceDiscountedCareInd
Free Care Medically Indigent0FreeCareMedicallyIndigentInd
Financial Assistance Budget0FinancialAssistanceBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$122,818BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$3,668,172ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$3,704,601CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$36,429MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost Accounting SystemYes (X)CostAccountingSystemInd
FieldValueIRS element (for citing)
Written Debt Collection Policy0WrittenDebtCollectionPolicyInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1NAVAJO HEALTH FOUNDATIONSAGE MEMORIALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 457AddressLine1Txt
CityGANADOCityNm
State AbbreviationAZStateAbbreviationCd
ZIP86505ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.SAGEMEMORIAL.ORGWebsiteAddressTxt
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
OtherDENTAL AND OPTOMOLOGYOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1SAGE MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Rpt Available Thru Other MethodYes (X)RptAvailableThruOtherMethodInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt15ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy Attached0StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP Actions On Nonpayment0FAPActionsOnNonpaymentInd
Collection Activities0CollectionActivitiesInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SAGE MEMORIAL HOSPITALPART V, SECTION B, LINE 5: SAGE MEMORIAL HOSPITAL ("SMH") ASSEMBLED AN ASSESSMENT TEAM CONSISTING OF HOSPITAL ADMINISTRATION AND EXECUTIVE LEADERSHIP, PUBLIC HEALTH PROFESSIONALS, AND CLINICAL STAFF. THE TEAM CONDUCTED SURVEYS, INTERVIEWS AND FOCUS GROUPS AND RESEARCHED SECONDARY DATA SOURCES TO OBTAIN RELEVANT COMMUNITY HEALTH INFORMATION. THIS INFORMATION WAS THEN ANALYZED AND CROSS-REFERENCED TO PUBLIC DATABASES TO IDENTIFY THE TOP HEALTH CARE NEEDS OF THE COMMUNITY.THE TEAM TOOK A COMPREHENSIVE APPROACH TO ASSESSING THE NEEDS. FIRST THEY ENGAGED WITH THE COMMUNITY TO CAPTURE INPUT ABOUT HEALTH NEEDS AND FACTORS AFFECTING THE ACCESS AND DELIVERY OF HEALTH CARE SERVICES IN THE REGION. THE ASSESSMENT TEAM INDENTIFIED 2 GROUPS TO REPRESENT THE COMMUNITY'S HEALTH INTEREST. (1) INDIVIDUAL MEMBERS OF THE COMMUNITY AND (2) SAGE'S BOARD OF DIRECTORS WHO ARE ALSO COMMUNITY MEMBERS OF THE NAVAJO NATION. THESE GROUPS PARTICIPATED IN SURVEYS AND FOCUS GROUPS COORDINATED BY ASSESSMENT TEAM MEMBERS WITH PUBLIC HEALTH EXPERTISE. THE TEAM ALSO RESEARCHED SECONDARY DATA SOURCES TO BETTER UNDERSTAND THE DEMOGRAPHICS OF THE COMMUNITY AND ASSOCIATED HEALTH ISSUES. THE RESULTS WERE ANALYZED AND REVIEWED WITH THE SMH EXECUTIVE TEAM, MEDICAL STAFF AND PUBLIC HEALTH EXPERTS IN ORDER TO IDENTIFY AND PRIORITZE THE COMMUNITY'S HEALTH NEEDS.
SAGE MEMORIAL HOSPITALPART V, SECTION B, LINE 7D: PAMPHLETS DISTRIBUTED IN THE LOCAL COMMUNITY.
SAGE MEMORIAL HOSPITALPART V, SECTION B, LINE 11: THE HOSPITAL HAS IDENTIFIED AND PRIORITIZED SIGNIFICANT NEEDS OF THE COMMUNITY. TO ADDRESS THE NEEDS, THE HOSPITAL IS EXPANDING BEHAVIORAL HEALTH SERVICES, INCLUDING IMPLEMENTING AN OUTREACH PROGRAM AND COLLABORATING WITH SCHOOLS; EXPANDING PUBLIC IMMUNIZATION PROGRAMS, NUTRITIONAL EDUCATION PROGRAMS AND EXPANDING CAPACITY FOR PEDIATRIC SERVICES; CONTINUE TO EDUCATE COMMUNITY ABOUT DIABETES AND INCREASE COMMUNITY ACTIVITIES, DEVELOP A WELLNESS PROGRAM, AND EXPAND HEALTH SCREENINGS; EXPAND ACCESSIBILITY TO HEALTHCARE SERVICES AND COORDINATE PATIENT HOME VISITS AND EXPAND ER SERVICES ALONG WITH A FOCUS ON RECRUITING AND TRAINING IN ALL AREAS. LONG TERM PLANS INCLUDE AN OUTPATIENT MEDICAL CENTER AND NEW HOSPITAL.
FieldValueIRS element (for citing)
Facility4FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
1 - OUTPATIENT CLINIC
PO BOX 457GANADOAZ86505OUTPATIENT SERVICES
2 - SPECIALITY CLINIC
PO BOX 457GANADOAZ86505CARDIOLOGY AND ECHO
3 - DENTAL CLINIC
PO BOX 457GANADOAZ86505DENTAL SERVICES
4 - GREASEWOOD CLINIC
PO BOX 457GANADOAZ86505DENTAL AND OUTPATIENT SERVICES

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 3C:THE ORGANIZATION PRIMARILY SERVICES MEMBERS OF THE NAVAJO NATION. UNDER AGREEMENTS WITH INDIAN HEALTH SERVICES, IF TRIBAL MEMBERS DO NOT HAVE INSURANCE AND/OR ARE NOT ELIGIBLE FOR MEDICARE OR MEDICAID, THE HOSPITAL BEARS THE COST OF PROVIDING MEDICAL SERVICES. PRIOR TO COVERING THE COSTS, THE HOSPITAL VERIFIES ALL ALTERNATIVE INSURANCE OPTIONS HAVE BEEN APPLIED FOR AND OBTAINS PROOF OF INDIAN HERITAGE.
PART III, LINE 4:FINANCIAL STATEMENT FOOTNOTE 1 PAGE 9 - THE CARRYING AMOUNT OF PATIENT RECEIVABLES IS REDUCED BY A VALUATION ALLOWANCE THAT REFLECTS MANAGEMENT'S BEST ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS AND THIRD-PARTY PAYORS. MANAGEMENT REVIEWS PATIENT RECEIVABLES BY PAYOR CLASS AND APPLIES PERCENTAGES TO DETERMINE ESTIMATED AMOUNTS THAT WILL NOT BE COLLECTED FROM THIRD PARTIES UNDER CONTRACTUAL AGREEMENTS AND AMOUNTS THAT WILL NOT BE COLLECTED FROM PATIENTS DUE TO BAD DEBTS. MANAGEMENT CONSIDERS HISTORICAL WRITE OFF AND RECOVERY INFORMATION IN DETERMINING THE ESTIMATED BAD DEBT PROVISION. THE DIFFERENCE BETWEEN THE AMOUNTS BILLED AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE VALUATION ALLOWANCE.
PART III, LINE 8:IT IS A COMMUNITY BENEFIT FOR THE HOSPITAL TO PROVIDE SERVICES REGARDLESS OF MEDICARE SURPLUS OR SHORTFALL. THE SOURCE USED IS MEDICARE'S COST REPORT COMPLETED BY THE HOSPITAL FOR FISCAL YEAR END 2017.
PART VI, LINE 2:THE HOSPITAL CONDUCTED ITS MOST RECENT COMMUNITY HEALTH NEEDS ASSESSMENT DURING THE FISCAL YEAR ENDED SEPTEMBER 30, 2016 (TAX YEAR 2015). THE HOSPITAL IS IN THE PROCESS OF COMPLETING A NEW COMMUNITY HEALTH NEEDS ASSESSMENT.
PART VI, LINE 3:UPON ADMITTANCE, PATIENTS ARE INFORMED OF THE POLICIES, EDUCATED ON THE VARIOUS ASSISTANCE PROGRAMS AVAILABLE AND THEY ARE GIVEN FORMS TO ASSIST IN COMPLETING FINANCIAL ASSISTANCE PAPERWORK. THE EMPLOYEES IN ADMITTING HAVE A CHECKLIST OF INFORMATION AND FORMS THEY ARE TO PROVIDE TO THE PATIENTS.
PART VI, LINE 4:THE ORGANIZATION PRIMARILY SERVICES THE MEMBERS OF THE NAVAJO NATION AND OTHER RESIDENTS OF GRAZING DISTRICT 17 AND THE NAZLINI CHAPTER LOCATED WITHIN THE STATE OF ARIZONA.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Housing Allowance Or ResidenceYes (X)HousingAllowanceOrResidenceInd
Written Policy Ref T And E ExpnssYes (1)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (1)SubstantiationRequiredInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
CHANNARONG JARUVANGSANTI
PHARMACIST$171,472$0$0$0$0$0$0$0$0$0$171,472$0$0$0
THERESA HENSLER
PHARMACIST$160,450$0$0$0$0$0$0$0$0$0$160,450$0$0$0
PIO M SIAN
PHYSICIAN$262,747$0$0$0$0$0$0$0$0$0$262,747$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART I, LINE 1AFormAndLineReferenceDesc
ExplanationDUE TO LIMITED HOUSING AVAILABLE IN THE AREA, THE ORGANIZATION OFFERS HOUSING ON PROPERTY FOR A MONTHLY RENTAL FEE.ExplanationTxt

Schedule L IRS990ScheduleL

Disqualified Person Ex Bnft Tr DisqualifiedPersonExBnftTrGrp (3 entries)

Rln Disqualified Person OrgRlnDisqualifiedPersonOrgTxtTransactionTransactionDescTransaction CorrectedTransactionCorrectedInd
RAZAGHI HEALTHCARE
MANAGEMENT COMPANY$10,855,134 UNAUTHORIZED AND UNAPPROVED ACH PAYMENT TO RAZAGHI HEALTHCARE UNDER GUISE OF MANAGEMENT CONTRACT DISPUTE PAYMENT AS DISCLOSED IN SCHEDULE O0
AHMAD RAZAGHI
CEO/RH OWNER/PRESIDENTSAME AS THE DESCRIPTION OF TRANSACTION FOR RAZAGHI HEALTHCARE0
TAUSIF HASAN
CONTRACTED CFO VIA RHSAME AS THE DESCRIPTION OF TRANSACTION FOR RAZAGHI HEALTHCARE0

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (3 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
RAZAGHI DEVELOPMENT COMPANY DBA RAZAGHI HEALTHCARE LLC
OFFICERS AND KEY EMPLOYEES WORK FOR RAZAGHI HEALTHCARE, LLC$6,075,245RAZAGHI HEALTHCARE LLC ("RH") MANAGED HOSPITAL OPERATIONS UNDER A MANAGEMENT CONTRACT, AS FURTHER DISCLOSED IN PART VI, SECTION A, LINE 3. UNDER THE CONTRACT, RH HAD THE AUTHORITY AND RESPONSIBILITY TO OVERSEE THE SUPERVISION AND EFFECTIVE MANAGEMENT OF THE BUSINESS OPERATIONS OF THE HOSPITAL. THE CEO, AHMAD RAZAGHI, CFO, TAUSIF HASAN, AND OTHER KEY EMPLOYEES WERE EMPLOYED BY RH THROUGH AUGUST 2018 WHEN THE MANAGEMENT AGREEMENT ENDED. RH RECEIVED AN HOURLY RATE FOR THE PERSONNEL IT PROVIDED DEPENDING ON THE TYPE OF SERVICE PROVIDED BY THE INDIVIDUAL IN ADDITION TO A MANAGEMENT SERVICE FEE FOR PERFORMING SUCH SERVICES. THE MANAGEMENT AGREEMENT IS CURRENTLY THE SUBJECT OF ONGOING FEDERAL LITIGATION DESCRIBED IN MORE DETAIL IN SCHEDULE O HEREIN. THE HOSPITAL WILL CONTINUE TO WORK WITH ITS LEGAL AND TAX ADVISORS FOR COMPLIANCE WITH ALL REGULATORY AUTHORITIES.0
AHMAD RAZAGHI
CEO/RH OWNER/PRESIDENTPART OF ABOVE0
TAUSIF HASAN
CONTRACTED CFO VIA RHPART OF ABOVE0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (10 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION A, LINE 3THE ORGANIZATION CONTRACTED WITH RAZAGHI DEVELOPMENT COMPANY DBA RAZAGHI HEALTHCARE LLC ("RH") TO MANAGE HOSPITAL OPERATIONS UNDER A MANAGEMENT AGREEMENT. THE SECOND AMENDED MANAGEMENT AGREEMENT BECAME EFFECTIVE JUNE 16, 2017 AND INCLUDED AN EXPIRATION DATE OF SEPTEMBER 30, 2025 BUT ENDED IN AUGUST 2018 AS FURTHER EXPLAINED BELOW. ACCORDING TO THE SECOND AMENDED MANAGEMENT AGREEMENT, ALL MATTERS REQUIRING PROFESSIONAL MEDICAL JUDGMENT REMAINED THE RESPONSIBILITY OF THE HOSPITAL'S MEDICAL STAFF AND PROFESSIONALS. RH HAD THE AUTHORITY AND RESPONSIBILITY TO OVERSEE THE SUPERVISION AND EFFECTIVE MANAGEMENT OF THE DAY-TO-DAY BUSINESS OPERATIONS OF THE HOSPITAL. ADDITIONALLY, RH WAS REQUIRED TO PERFORM THE DUTIES AND RESPONSIBILITIES OF THE CHIEF EXECUTIVE OFFICER, INCLUDING PERSONNEL RECRUITMENT, HIRING, PROMOTION, DISCIPLINING, AND FIRING. THE AGREEMENT ENDED IN AUGUST 2018 AND THE HOSPITAL FILED A CIVIL RICO COMPLAINT IN THE UNITED STATES DISTRICT COURT, DISTRICT OF NEVADA ALLEGING THAT RH COMMITTED FEDERAL AND STATE RACKETEERING AND CONSPIRACY VIOLATIONS AND COMPLETED AN UNLAWFUL AND FRAUDULENT TAKING OF FUNDS UNDER THE GUISE OF A MANAGEMENT AGREEMENT DISPUTE.
FORM 990, PART VI, SECTION A, LINE 5THE HOSPITAL HAD A MANAGEMENT AGREEMENT WITH RAZAGHI DEVELOPMENT COMPANY DBA RAZAGHI HEALTHCARE ("RH") THAT WAS SCHEDULED TO EXPIRE IN SEPTEMBER 2025 BUT WAS ENDED IN AUGUST 2018. IN AUGUST 2018, RH TOOK $10,855,134 UNDER THE GUISE OF A MANGEMENT AGREEMENT DISPUTE. THE TRANSACTION WAS NOT APPROVED BY THE BOARD. THE HOSPITAL HAS FILED A CIVIL RICO COMPLAINT IN THE UNITED STATES DISTRICT COURT, DISTRICT OF NEVADA ALLEGING THAT RH COMMITTED FEDERAL AND STATE RACKETEERING AND CONSPIRACY VIOLATIONS AND COMPLETED AN UNLAWFUL AND FRAUDULENT TAKING OF THE FUNDS. THE COMPLAINT IS SEEKING COMPENSATORY AND PUNITIVE DAMAGES AND EMERGENCY INJUCTIVE RELIEF AGAINST RH, AHMAD RAZAGHI (RH'S OWNER), INDIVIDUALLY, AND TAUSIF HASAN, THE FORMER CFO CONTRACTED THROUGH THE RH MANAGEMENT AGREEMENT. IT IS THE HOSPITAL'S POSITION THAT THE $10.8 MILLION UNAUTHORIZED AND UNAPPROVED ACH WAS FRAUDULENT AND WAS PART OF A CIVIL CONSPIRACY AND THAT AHMAD RAZAGHI AND TAUSIF HASAN BREACHED THEIR FIDUCIARY DUTIES. THE HOSPITAL BELIEVES HAD THERE BEEN A BREACH OF THE MANAGEMENT CONTRACT, THE HOSPITAL SHOULD HAVE BEEN GIVEN A 30 DAY CURE PERIOD AS REQUIRED BY THE CONTRACT AND THAT ANY CONTRACT TERMINATION PAYMENT SHOULD HAVE BEEN CALCULATED PURSUANT TO THE CONTRACT AND APPROVED BY THE BOARD PRIOR TO PAYMENT AND THE FUNDING OF SUCH PAYMENT WOULD HAVE BEEN PAID THROUGH THE RESTRICTED ESCROW ACCOUNT AS DESCRIBED IN AN ESCROW AGREEMENT EXECUTED WITH RESPECT TO THE MANAGEMENT AGREEMENT. INSTEAD OF ARBRITRATION, RH CHOSE TO UNILATERLLY PAY ITSELF $10.8 MILLION WITH MEDICAID (FEDERAL AND STATE FUNDS) WITHOUT THE GOVERNING BOARD'S VERBAL OR WRITTEN APPROVAL.
FORM 990, PART VI, SECTION A, LINE 8BTHE BOARD DID NOT HAVE FORMAL COMMITTEE'S WITH AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY.
FORM 990, PART VI, SECTION B, LINE 11BA SUBSTANTIALLY REVISED DRAFT VERSION OF FORM 990 IS PROVIDED TO THE ENTIRE BOARD PRIOR TO THE FILING OF FORM 990. SUBSEQUENT ADDITIONAL DUE DILIGENCE WITH HOSPITAL LEGAL AND TAX ADVISORS ARE UNDERTAKEN BY THE CFO AND HOSPITAL MANAGEMENT IN ORDER TO COMPLETE AND SUBMIT THE FINAL 990.
FORM 990, PART VI, SECTION B, LINE 12QUESTION 12A - BOARD OF DIRECTORS ARE REQUIRED TO COMPLY WITH THE HOSPITAL'S BYLAWS THAT INCLUDE A CONFLICT OF INTEREST POLICY. QUESTIONS 12B AND C - THE MANAGEMENT COMPANY WAS RESPONSIBLE FOR THE WRITTEN CONFLICT OF INTEREST POLICY AND OTHER OPERATING POLICIES OF THE HOSPITAL. THE MANAGEMENT COMPANY ASSERTED ITS CONTRACTUAL RESPONSIBILITY TO BE THE SOLE PROVIDER OF LEGAL AND OTHER ADVISORS ON BEHALF OF THE HOSPITAL PRIOR TO SEPTEMBER 2018.
FORM 990, PART VI, SECTION B, LINE 15BREMUNERATION OF KEY EXECUTIVES AND OFFICERS WERE COMMENSURATE WITH THE MARKET, ROLE, APPLICANT'S EDUCATION-EXPERIENCE-SKILLS AND WERE SUBJECT TO APPROVAL AND ACCEPTANCE BY THE BOARD OF DIRECTORS. SEVERAL OF THE KEY OFFICERS WERE PAID THROUGH THE MANAGEMENT CONTRACT.
FORM 990, PART VI, SECTION C, LINE 18DOCUMENTS ARE AVAILABLE UPON REQUEST
FORM 990, PART VI, SECTION C, LINE 19DOCUMENTS ARE AVAILABLE UPON REQUEST
FORM 990, PART IX, LINE 11GCONSULTANTS AND AGENCY PERSONNEL: PROGRAM SERVICE EXPENSES 12,647,254. MANAGEMENT AND GENERAL EXPENSES 309,226. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 12,956,480.
FORM 990, PART XII, LINE 2C:PRIOR TO SEPTEMBER 2018, THE OVERSIGHT OF THE AUDIT OF THE ORGANIZATION'S FINANCIAL STATEMENTS WAS PERFORMED BY THE MANAGEMENT COMPANY. FOR THE YEAR ENDED SEPTEMBER 30, 2018, THE EXECUTIVE MANAGEMENT TEAM ALONG WITH ASSISTANCE FROM FINANCIAL CONSULTANTS OVERSAW THE AUDIT. THE AUDITED FINANCIAL STATEMENTS, ALONG WITH FINDINGS NOTED DURING THE AUDIT, WERE PRESENTED TO THE BOARD BY THE INDEPENDENT ACCOUNTING FIRM.