NORTHERN COCHISE COMMUNITY HOSPITAL INC: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- NORTHERN COCHISE COMMUNITY HOSPITAL INC (EIN 86-0208451)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-09-04
- IRS object ID
- 201832479349300983
- Schema version
- 2016v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-09-04T15:40:34-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 480573184 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REGIER CARR & MONROE LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 4801 E BROADWAY BLVD SUITE 501 | AddressLine1Txt |
| City | TUCSON | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85711 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860208451 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN COCHISE COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | NORT | BusinessNameControlTxt |
| Phone | 5203843541 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856431009 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROLAND KNOX | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5203843541 | PhoneNum |
| Signature | 2018-06-18 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DAVID B BARBER CPECFECGMA | PreparerPersonNm |
| PTIN | P00348638 | PTIN |
| Phone | 5206248229 | PhoneNum |
| Preparation | 2018-06-18 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amended Return | Yes (X) | AmendedReturnInd |
| Principal Officer | ROLAND KNOX | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856431009 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,304,517 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.NCCH.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1966 | FormationYr |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE FOR THE HEALTHCARE NEEDS OF THE GREATER WILLCOX COMMUNITY AND SOUTHEAST ARIZONA. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 8 | VotingMembersIndependentCnt |
| Total Employee | 214 | TotalEmployeeCnt |
| Total Volunteers | 28 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | -$1,249 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,878,127 | PYContributionsGrantsAmt |
| CY Contributions Grants | $2,045,210 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,133,975 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,149,413 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$20,091 | PYInvestmentIncomeAmt |
| CY Investment Income | -$3,873 | CYInvestmentIncomeAmt |
| PY Other Revenue | $24,853 | PYOtherRevenueAmt |
| CY Other Revenue | $108,612 | CYOtherRevenueAmt |
| PY Total Revenue | $19,016,864 | PYTotalRevenueAmt |
| CY Total Revenue | $19,299,362 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,654,335 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,437,973 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,472,493 | PYOtherExpensesAmt |
| CY Other Expenses | $10,086,619 | CYOtherExpensesAmt |
| PY Total Expenses | $18,126,828 | PYTotalExpensesAmt |
| CY Total Expenses | $18,524,592 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $890,036 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $774,770 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $6,367,063 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,584,573 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,554,710 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,997,450 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,812,353 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,587,123 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO PROVIDE FOR THE HEALTHCARE NEEDS OF THE GREATER WILLCOX COMMUNITY AND SOUTHEAST ARIZONA. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,793,693 | ExpenseAmt |
| Revenue | $17,149,413 | RevenueAmt |
| Desc | THE HOSPITAL PROVIDES HEALTHCARE TO THE GENERAL PUBLIC REGARDLESS OF AGE, RACE, OR ABILITY TO PAY. SERVICES INCLUDE, BUT ARE NOT LIMITED TO, EMERGENCY ROOM, PHYSICAL THERAPY, SPEECH THERAPY, RESP THERAPY, CT SCAN, MRI, RURAL HEALTH CLINIC, LABORATORY SERVICE, AND OTHER HEALTHECARE SERVICES. | Desc |
| Total Program Service Expenses | $11,793,693 | 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 |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | 0 | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | 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 | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| 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 | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 67 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 214 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (1) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (1) | Form990TFiledInd |
| 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 8 | 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 | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | AZ | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5203843541 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 WEST REX ALLEN DRIVE | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 856431009 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| ROLAND KNOX | |||||||
| EX-OFFICIO DIRECTOR, CEO | 40.00 | Yes (X) | Yes (X) | $191,771 | $0 | $11,489 | |
| STEVE METTS | |||||||
| VICE-CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| DR JAMES MALONE | |||||||
| CHAIRMAN | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CAROL DUNAGAN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATHY COOK | |||||||
| BOARD SECRETARY | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| E RICHARD SINGER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $82,152 | $0 | $0 | ||
| DR DAWN WALKER | |||||||
| DIRECTOR | 1.00 | Yes (X) | $3,862 | $0 | $0 | ||
| WINFIELD THOMAS | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| ELIZABETH KUHN | |||||||
| NURSE PRACTITIONER | 40.00 | $152,938 | $0 | $11,520 | Yes (X) | ||
| HELEN ROWE | |||||||
| PHYSICAL THERAPIST | 40.00 | $102,415 | $0 | $2,252 | Yes (X) | ||
| LAUREL KIBLER | |||||||
| ANP - PROVIDER | 40.00 | $186,395 | $0 | $67 | Yes (X) | ||
| KIMBER AGUIRRE | |||||||
| DIRECTOR OF PATIENT FINANCIAL SERVICE | 40.00 | $105,029 | $0 | $16,726 | Yes (X) | ||
| PAMELA NOLAND | |||||||
| DIRECTOR OF NURSING | 40.00 | $107,515 | $0 | $5,407 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $932,077 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $47,461 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 6 | 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 |
|---|---|---|---|---|---|
| ANTHONY LLEWELLYN MD PLC | |||||
| 5782 PLACITA DELEITE | TUCSON | AZ | 85750 | PHYSICIAN | $388,623 |
| JOSHUA DOPKO MD | |||||
| 3697 PINNACLE COURT | SIERRA VISTA | AZ | 85650 | PHYSICIAN | $334,545 |
| HISHAM HAMAM MD ELHAM MEDICAL INTERNAT | |||||
| PO BOX 12578 | TUCSON | AZ | 85732 | HOSPITALIST | $284,500 |
| JEFFERY B BUSHMAN | |||||
| PO BOX 1115 | WILCOX | AZ | 85644 | PHYSICIAN | $249,960 |
| MARK W KLEVE MD | |||||
| 6378 VANISHING POINTE WAY | TUCSON | AZ | 85746 | PHYSICIAN | $116,176 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $100,537 | FundraisingAmt |
| Related Organizations | $1,935,738 | RelatedOrganizationsAmt |
| Government Grants | $8,935 | GovernmentGrantsAmt |
| Total Contributions | $2,045,210 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 900099 | $16,745,437 | $16,745,437 |
| OTHER SERVICE REVENUE | 900099 | $403,976 | $403,976 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,149,413 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,282 | TotalRevenueColumnAmt |
| Exclusion | $1,282 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,859 | 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 | $63,859 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,859 | TotalRevenueColumnAmt |
| Exclusion | $63,859 | ExclusionAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $5,155 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -$5,155 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$5,155 | TotalRevenueColumnAmt |
| Exclusion | -$5,155 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $2,890 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $100,537 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,890 | TotalRevenueColumnAmt |
| Exclusion | $2,890 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER INCOME | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $41,863 | TotalRevenueColumnAmt |
| Exclusion | $41,863 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $41,863 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $19,299,362 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,149,413 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $104,739 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,139 | TotalAmt |
| Program Services | $88,845 | ProgramServicesAmt |
| Management And General | $263,294 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,762,776 | TotalAmt |
| Program Services | $5,290,605 | ProgramServicesAmt |
| Management And General | $1,472,171 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,773 | TotalAmt |
| Management And General | $92,773 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $730,967 | TotalAmt |
| Management And General | $730,967 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $499,318 | TotalAmt |
| Program Services | $381,135 | ProgramServicesAmt |
| Management And General | $118,183 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $102,762 | TotalAmt |
| Management And General | $102,762 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,830,935 | TotalAmt |
| Program Services | $3,502,004 | ProgramServicesAmt |
| Management And General | $328,931 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,098 | TotalAmt |
| Management And General | $49,098 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,180 | TotalAmt |
| Management And General | $46,180 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,050 | TotalAmt |
| Program Services | $11,043 | ProgramServicesAmt |
| Management And General | $8,007 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,301 | TotalAmt |
| Management And General | $52,301 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $443,587 | TotalAmt |
| Program Services | $195,292 | ProgramServicesAmt |
| Management And General | $248,295 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $352,926 | TotalAmt |
| Program Services | $25,649 | ProgramServicesAmt |
| Management And General | $327,277 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Management And GeneralManagementAndGeneralAmt | Program ServicesProgramServicesAmt |
|---|---|---|---|
| BAD DEBTS | $1,555,203 | $1,555,203 | |
| MATERIALS AND SUPPLIES | $1,221,286 | $85,153 | $1,136,133 |
| REPAIRS AND MAINTENANCE | $881,509 | $313,158 | $568,351 |
| RENT-EQUIPMENT | $489,816 | $94,987 | $394,829 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,041,966 | TotalAmt |
| Program Services | $199,807 | ProgramServicesAmt |
| Management And General | $842,159 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,524,592 | TotalAmt |
| Program Services | $11,793,693 | ProgramServicesAmt |
| Management And General | $6,730,899 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,295,465 | BOYAmt |
| EOY | $276,888 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,161,520 | BOYAmt |
| EOY | $2,445,520 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,995,085 | BOYAmt |
| EOY | $1,734,599 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $128,149 | BOYAmt |
| EOY | $165,565 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $147,949 | BOYAmt |
| EOY | $135,945 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $8,555,247 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,102,961 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,620,395 | BOYAmt |
| EOY | $2,452,286 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $18,500 | BOYAmt |
| EOY | $373,770 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,367,063 | BOYAmt |
| EOY | $7,584,573 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,707,503 | BOYAmt |
| EOY | $1,258,119 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $847,207 | BOYAmt |
| EOY | $1,739,331 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,554,710 | BOYAmt |
| EOY | $2,997,450 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,767,406 | BOYAmt |
| EOY | $4,542,176 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $44,947 | BOYAmt |
| EOY | $44,947 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,812,353 | BOYAmt |
| EOY | $4,587,123 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,367,063 | BOYAmt |
| EOY | $7,584,573 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $774,770 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| 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
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,945,307 | OtherCostOrOtherBasisAmt |
| Depreciation | $663,742 | DepreciationAmt |
| Book Value | $1,281,565 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $329,570 | OtherCostOrOtherBasisAmt |
| Depreciation | $296,443 | DepreciationAmt |
| Book Value | $33,127 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,038,598 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,142,776 | DepreciationAmt |
| Book Value | $895,822 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $241,772 | OtherCostOrOtherBasisAmt |
| Book Value | $241,772 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,452,286 | TotalBookValueLandBuildingsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART X, LINE 2: | FormAndLineReferenceDesc |
| Explanation | THE HOSPITAL HAS BEEN RECOGNIZED AS TAX EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE; HOWEVER, THE HOSPITAL IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. GENERALLY ACCEPTED ACCOUNTING PRINCIPLES FOR INCOME TAXES SETS A "MORE LIKELY THAN NOT" CRITERION FOR RECOGNIZING THE TAX BENEFITS OF UNCERTAIN TAX POSITIONS AND A MEASUREMENT CRITERIA FOR TAX BENEFITS. THE HOSPITAL BELIEVES THAT ITS INCOME TAX FILING POSITIONS AND DEDUCTIONS WILL BE SUSTAINED UPON EXAMINATION AND, ACCORDINGLY, HAVE NOT RECORDED ANY RESERVES OR RELATED ACCRUALS FOR INTEREST AND PENALTIES AT JUNE 30, 2017 FOR UNCERTAIN INCOME TAX POSITIONS PURSUANT TO THE STANDARD. INCOME TAX RELATED INTEREST AND PENALTIES ARE REPORTED IN GENERAL AND ADMINISTRATIVE EXPENSES WHEN INCURRED. THE ACCOMPANYING FINANCIAL STATEMENTS DO NOT INCLUDE ANY INTEREST OR PENALTIES RELATED TO INCOME TAXES. NO INCOME TAX EXAMINATIONS ARE CURRENTLY UNDERWAY OR ANTICIPATED. THE STATUTE OF LIMITATIONS IS THREE YEARS FOR FEDERAL INCOME TAX PURPOSES AND FOUR YEARS FOR THE STATE OF ARIZONA. | ExplanationTxt |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts Event1 | $103,427 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $100,537 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $2,890 | GrossRevenueEvent1Amt |
| Gross Receipts Total | $103,427 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $100,537 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $2,890 | GrossRevenueTotalEventsAmt |
| Net Income Summary | $2,890 | NetIncomeSummaryAmt |
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 |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | 0 | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | 0 | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $48,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $48,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00280 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,523,743 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,221,670 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,302,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,571,743 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,221,670 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,350,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13850 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,571,743 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,221,670 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,350,073 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13850 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $68,967 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $68,967 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $24,824 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $24,824 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $155,758 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $155,758 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00920 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $249,549 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $249,549 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01480 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,534,134 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $4,245,404 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,385,005 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,139,601 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | 0 | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN COCHISE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 901 REX ALLEN DR | AddressLine1Txt |
| City | WILLCOX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85643 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NORTHERN COCHISE COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (1) | 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 | WWW.NCCH.NET | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.COCHISE.AZ.GOV | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.NCCH.NET | 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 | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (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 |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Collection Activities | Yes (1) | CollectionActivitiesInd |
| Reporting To Credit Agency | Yes (X) | ReportingToCreditAgencyInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| NORTHERN COCHISE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 5: THE ASSESSMENT PROCESS WAS INITIATED AND CHAIRED BY COCHISE HEALTH & SOCIAL SERVICES.17 AGENCIES PARTICIPATED IN THE CHNA PROCESS. A QUESTIONNAIRE WAS ALSO UTILIZED AS PART OF THE PROCESS. A TOTAL OF 2,376 SURVEYS WERE RETURNED. |
| NORTHERN COCHISE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6A: BENSON HOSPITALCOPPER QUEEN COMMUNITY HOSPITAL |
| NORTHERN COCHISE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 6B: COCHISE HEALTH & SOCIAL SERVICESLEGACY FOUNDAITON OF SOUTEHRN ARIZONA |
| NORTHERN COCHISE COMMUNITY HOSPITAL | PART V, SECTION B, LINE 11: SEE ATTACHED COMMUNITY HEALTH IMPLEMENTATION PLAN. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - SULPHUR SPRINGS MEDICAL CENTER | ||||
| 900 W SCOTT | WILLCOX | AZ | 85643 | MEDICAL CENTER |
| 3 - SUNSITES MEDICAL CENTER | ||||
| 223 N FRONTAGE RD | PEARCE | AZ | 85625 | MEDICAL CENTER |
| 4 - SPECIALTY CLINICS | ||||
| 900 W SCOTT | WILLCOX | AZ | 85643 | CLINIC |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | THE ORGANIZATION PROVIDES DISCOUNTED CARE BASED ON A CASE BY CASE EVALUATION. ALL INFORMATION IS REVIEWED BY THE PFS DIRECTOR AND COMPARED WITH THE POVERTY GUIDELINES AS WELL AS ALL OUTSTANDING MEDICAL EXPENSES. OTHER FACTORS WILL CONTRIBUTE TO THE FINAL DECISION. |
| PART I, LN 7 COL(F): | THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25(A), THAT IS SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS 1,534,134. |
| PART III, LINE 8: | THE MEDICARE COST OF SERVICES IS BASED UPON DATA FROM THE HOSPITAL'S MEDICARE COST REPORT AND THE COST TO CHARGE RATIO INCLUDED THEREIN. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| Form990 Of Other Organizations | Yes (X) | Form990OfOtherOrganizationsInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (3 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROLAND KNOX | ||||||||||||||
| EX-OFFICIO DIRECTOR, CEO | $191,771 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,489 | $0 | $203,260 | $0 | $0 | $0 |
| ELIZABETH KUHN | ||||||||||||||
| NURSE PRACTITIONER | $152,938 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,520 | $0 | $164,458 | $0 | $0 | $0 |
| LAUREL KIBLER | ||||||||||||||
| ANP - PROVIDER | $186,395 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $67 | $0 | $186,462 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 5 | FormAndLineReferenceDesc |
| Explanation | PURSUANT TO THE ORGANIZATION'S EMPLOYEE AGREEMENT WITH THE CEO, AN ANNUAL INCENTIVE BONUS MAY BE PAID. THIS BONUS IS DEPENDENT ON THE ORGANIZATION'S OVERALL FINANCIAL CONDITION AND THE CEO'S ACHIEVEMENT OF A VARIETY OF PREVIOUSLY ESTABLISHED GOALS RELATED TO COMMUNITY INVOLVEMENT, EMPLOYEE DEVELOPMENT, OPERATIONAL COMPLIANCE, INDUSTRY KNOWLEDGE, AND THE IMPLEMENTATION OF NEW PROGRAMS. NO BONUS PAYMENT WAS MADE IN THE YEAR 2016. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | THE RETURN IS REVIEWED BY THE CEO AND MADE AVAILABLE TO THE BOARD OF DIRECTORS BEFORE IT IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL OFFICERS AND DIRECTORS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED BY THE COMPLIANCE OFFICER FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFLICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. |
| FORM 990, PART VI, SECTION B, LINE 15 | THE CEO'S COMPENSATION IS DETERMINED ON AN ANNUAL BASIS BY A COMPENSATION COMMITTEE BASED ON COMPARABILITY DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER: PROGRAM SERVICE EXPENSES 2,807,127. MANAGEMENT AND GENERAL EXPENSES 129,303. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,936,430. OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 694,877. MANAGEMENT AND GENERAL EXPENSES 199,628. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 894,505. |
| FORM 990, PART XII, LINE 2C: | THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR REVIEW PROCESS DURING THE YEAR. |
| FORM 990, PAGE 1, QUESTION B, AMENDED RETURN | THIS 990 IS AMENDED TO REFLECT 1099 COMPENSATION PAID TO ONE OF THE DIRECTORS OF THE BOARD, DR. SINGER, WHO RECEIVED $82,152 IN COMPENSATION FOR SERVICES RENDERED IN 2016. THAT CHANGE IS REPORTED ON PAGE 7 OF THE 990. THE STATEMENT OF FUNCTIONAL EXPENSES HAS BEEN UPDATED TO REFLECT FISCAL YEAR COMPENSATION TO THE SAME DIRECTOR, THE CHANGE IS REPORTED ON LINE 5 OF PART IX. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Direct Controlling NADirectControllingNACd | Controlled OrganizationControlledOrganizationInd | EINEIN |
|---|---|---|---|---|---|---|---|---|---|---|
| NORTHERN COCHISE HOSPITAL DISTRICT | ||||||||||
| 901 REX ALLEN DR | WILCOX | AZ | 85643 | TO ENSURE THE OPERATION OF THE HOSPITAL WITHIN THE DISTRICT | AZ | 170(C)(1) | N/A | N/A | 0 | |
| NORTHERN COCHISE COMMUNITY HOSPITAL FOUNDATION | ||||||||||
| 901 REX ALLEN DR | WILCOX | AZ | 85643 | TO PERFORM FUNDRAISING ACTIVITIES TO SUPPORT THE HOSPITAL | AZ | 501(C)(3) | 509(A)(3) | N/A | 0 | 460868855 |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ARIZONA HEALTH COLLABORATIVE LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3030 N CENTRAL AVE | AddressLine1Txt |
| City | PHOENIX | CityNm |
| State Abbreviation | AZ | StateAbbreviationCd |
| ZIP | 85012 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 471936880 | EIN |
| Primary Activities | COST CONTAINMENT AND SUPPLY CHAIN OPTIMIZATION | PrimaryActivitiesTxt |
| Legal Domicile State | AZ | LegalDomicileStateCd |
| Predominant Income Type | UNRELATED | PredominantIncomeTypeTxt |
| Share Of Total Income | -$1,249 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $14,827 | ShareOfEOYAssetsAmt |
| Disproportionate Allocations | 0 | DisproportionateAllocationsInd |
| General Or Managing Partner | 0 | GeneralOrManagingPartnerInd |
| Ownership | 0.14000 | OwnershipPct |
| 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 | Yes (1) | 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 | Yes (1) | 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 |
Transactions Related Org TransactionsRelatedOrgGrp (3 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| NORTHERN COCHISE HOSPITAL DISTRICT | ||
| C | $1,822,438 | ACTUAL CASH AMOUNT TRANSFERRED |
| NORTHERN COCHISE HOSPITAL DISTRICT | ||
| K | $46,180 | ACTUAL EXPENSE INCURRED |
| NORTHERN COCHISE COMMUNITY HOSPITAL FOUNDATION | ||
| C | $113,300 | ACTUAL CASH AMOUNT TRANSFERRED |