2017-05-12T14:54:42-05:00 2016-06-30 ERNST & YOUNG US LLP 2 NORTH CENTRAL AVE STE 2300 PHOENIX AZ 85004 990 2015-07-01 860110232 Flagstaff Medical Center % JOHN A CORTESE CPA FLAG 9287793366 POST OFFICE BOX 1268 FLAGSTAFF AZ 860021268 JEFFREY TREASURE NAH CFO 9282143545 2017-05-12 true MICHAEL J PAYNE P01442310 6023223000 2015 2021-01-29 14:40:06Z ROBERT P THAMES 1200 N BEAVER ST FLAGSTAFF AZ 86001 438519961 false X WWW.NAHEALTH.COM X 1936 AZ WILL PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. 13 12 0 656 1120342 -69799 1264906 1307861 384744452 425924675 8939996 8121818 3614467 3103447 398563821 438457801 1224065 899200 0 0 165131833 166996998 0 0 751272 188888684 202487623 355244582 370383821 43319239 68073980 654539176 671843968 175264002 203692160 479275174 468151808 X Flagstaff Medical Center will provide patients with exceptional care while transforming the health of the communities we serve. false false 247881848 899200 399462384 FLAGSTAFF MEDICAL CENTER PROVIDES COMPREHENSIVE HEALTHCARE SERVICES, INCLUDING PRIMARY CARE AND SPECIALTY PHYSICIAN CLINICS, CANCER CENTERS OF NORTHERN ARIZONA HEALTHCARE, ENTIRECARE REHAB & SPORTS MEDICINE, AND FIT KIDS OF ARIZONA. SEE SCHEDULE O FOR FURTHER DETAILS. 21590000 0 18535000 GUARDIAN AIR PROVIDES AIR TRANSPORTATION SERVICES TO PATIENTS THROUGHOUT THE NORTHERN ARIZONA COMMUNITY, ENABLING FLAGSTAFF MEDICAL CENTER TO EXPAND ITS SCOPE OF SERVICES BY SERVING PATIENTS FROM THE MOMENT TREATMENT BEGINS IN THE AIR TRANSPORT. 6993000 0 10064000 GUARDIAN MEDICAL TRANSPORT PROVIDES AMBULANCE SERVICES TO PATIENTS THROUGHOUT THE NORTHERN ARIZONA COMMUNITY, ENABLING FLAGSTAFF MEDICAL CENTER TO EXPAND ITS SCOPE OF SERVICES BY SERVING PATIENTS FROM THE MOMENT TREATMENT BEGINS IN THE GROUND AMBULANCE. 0 0 0 276464848 true true false true false false false false false true true false false false true true false true false false false false false false true false true true true false true true true false false false false false false false false false true false false false true true true true false false true X 537 0 true 0 true true false false false false true true false false false false X 13 12 false false true false true true true true true false false true true true true true true true true true true AZ X JOHN A CORTESE CPA 9282143545 914 N SAN FRANCISCO ST SUITE M FLAGSTAFF AZ 86001 X ANDREW ALDRIDGE MD DIRECTOR 1.0 1.0 X 0 0 0 WILLIAM AUSTIN MD DIRECTOR (THRU 9/15) 1.0 1.0 X 0 56283 0 ALICE GAGNAIRE RN DIRECTOR 1.0 4.0 X 0 0 0 VALERIE CARO DIRECTOR/TREASURER (THRU 9/15) 1.0 0.0 X X 0 0 0 RICHARD CRANMER DIRECTOR 1.0 3.0 X 0 0 0 JAMES DORMAN DIRECTOR/PAST CHAIR 1.0 1.0 X X 0 0 0 WAYNE FOX CPA DIRECTOR/CHAIR 1.0 1.0 X X 0 0 0 WILLIAM JEFFERS DIRECTOR/VICE CHAIR 1.0 4.0 X X 0 0 0 RICHARD KRUSE DIRECTOR (AS OF 10/15) 1.0 3.0 X 0 0 0 THEODORE LEWIS JR MD DIRECTOR (THRU 9/15) 1.0 0.0 X 0 0 0 CHARLES MARR DIRECTOR (AS OF 10/15) 1.0 6.0 X 0 0 0 CYNTHIA MARTIN MD DIRECTOR (THRU 9/15) 1.0 0.0 X 0 12090 0 JOHN MARVEL DIRECTOR (THRU 9/15) 1.0 0.0 X 0 0 0 SHAWN ORME DIRECTOR (AS OF 10/15) 1.0 5.0 X 0 0 0 KENNETH SALCE MD DIRECTOR 1.0 1.0 X 0 0 0 RAY SELNA DIRECTOR (AS OF 10/15) 1.0 2.0 X 0 0 0 ROBERT THAMES NAH PRESIDENT/CEO 0.0 40.0 X X 0 444857 29885 GUADALUPE WOODSON FNP DIRECTOR/SECRETARY 1.0 1.0 X X 0 0 0 RICHARD LANGOSCH INTERIM CEO (THRU 10/15) 40.0 0.0 X 0 0 0 JEFFREY TREASURE CFO (AS OF 12/15) 0.0 40.0 X 0 31923 0 HOPE WADE CFO (THRU 12/15) 0.0 40.0 X 0 180007 6142 MARK CARROLL CHIEF MEDICAL OFFICER 40.0 0.0 X 0 369382 42815 LINDA PARKER INTERIM CNO/VP PATIENT CARE 40.0 0.0 X 0 247686 16285 RICHARD SMITH VP OF DEVELOPMENT/MARKETING 40.0 0.0 X 0 270744 34048 RICHARD NEFF DIRECTOR PHYSICIAN RELATIONS 40.0 0.0 X 0 365500 44095 MARK FOSTER PHYSICIAN 40.0 0.0 X 0 219424 30395 RICHARD MENDRIBIL HEALTH SYSTEMS DIR OF PHARMACY 40.0 0.0 X 0 210407 20172 DALE MERRITT REGISTERED NURSE 40.0 0.0 X 0 207819 30156 BRENDA MUNNS DIRECTOR SURGICAL SERVICES 40.0 0.0 X 0 203808 49522 JOHN DEMPSEY FORMER VP NAH/PRES LCMC 40.0 0.0 X 0 444110 181355 0 3264040 484870 true true false Healthcare Select DEPT la 24465 PASADENA CA 91185 CONTRACT LABOR 7862956 CONIFER HEALTH SOLUTIONS 1500 S DOUGLASS RD ANAHEIM CA 92806 BILLING SERVICES 6672505 FOREST COUNTRY ANESTHESIA 77 W FOREST AVE FLAGSTAFF AZ 86001 ANESTHESIA SERVICES 2770892 PHOENIX CARDIAC SURGERY PLLC 3131 E CLARENDON AVE STE 102 PHOENIX AZ 85016 SURGERY SERVICES 1833326 CRITICAL CARE CONSULTANTS PO BOX 967 FLAGSTAFF AZ 86002 MEDICAL SERVICES 1630240 41 311255 405393 591213 71337 1307861 Patient Services 621110 410248929 410248929 0 0 Pharmacy 446110 7256069 6135727 1120342 0 PHYSICIAN REVENUE 900099 5681292 5681292 0 0 CAFETERIA 900099 2116957 2116957 0 0 INTERCOMPANY RENTAL INCOME 531120 313487 313487 0 0 307941 307941 0 425924675 8055747 8055747 0 0 0 0 0 66071 0 66071 66071 66071 107465 311255 62160 45305 45305 0 0 PROGRAM FEES 900099 541632 541632 0 0 NON PATIENT ROOMS 900099 244730 244730 0 0 STANDBY FEES 900099 135071 135071 0 0 2136709 2136709 0 0 3058142 438457801 427862475 1120342 8167123 X 899200 899200 0 0 0 0 0 0 2229665 1206959 751962 270744 0 0 0 0 130490018 112861316 17362521 266181 8943753 7735486 1190023 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A PERCENTAGE OF THIS AMOUNT, $63,845, WAS ESTIMATED TO BE ATTRIBUTABLE TO LOBBYING RELATED TO HEALTH CARE ADVOCACY AT THE FEDERAL, STATE, REGIONAL AND LOCAL LEVELS. FLAGSTAFF MEDICAL CENTER ALSO PARTICIPATES IN HEALTHCARE-RELATED LOBBYING ACTIVITIES THROUGH THE SOLE COMMUNITY HOSPITAL COALITION. 5355284 2046265 132851 17407 1700082 74363 5742548 4955576 2231957 78473 26231 1811945 72546 5355284 3818218 2491393 210156 16596 1475958 71637 4955576 2836339 2188719 133179 412045 862349 65625 3818218 2426552 1102892 18115 388081 299259 23880 2836339 1.00000 0.00000 0.00000 false false 5901300 5901300 191728621 112000876 79727745 1042857 945610 97247 150857879 114456625 36401254 16158756 0 16158756 138286302 0 MINIMUM PENSION LIABILITY 54095989 MALPRACTICE INSURANCE RESERVE LT 6969931 PATIENT CREDIT BALANCES 2935990 BCBS IBNR 1124109 MALPRACTICE INSURANCE RESERVE ST 861554 BIO-MED RESERVE 202120 WORKER'S COMP LIABILITY 107226 UNEMPLOYMENT 15245 66312164 X SCHEDULE D, PART V, LINE 4 MOST OF THE CURRENT ENDOWMENTS ARE BOARD DESIGNATED. FMC FOUNDATION'S QUASI ENDOWMENTS ARE SPENT ACCORDING TO THE FOLLOWING CRITERIA: 1) ADDRESS COMMUNITY HEALTH CARE NEEDS; 2) ADHERE TO THE CORE MISSION OF THE HOSPITAL; AND/OR 3) REFLECT PROJECTS THAT ARE DEEMED IN THE BEST INTEREST OF THE HOSPITAL. Schedule D, Part X, Line 2 The corporation is a not-for-profit corporation and is exempt from income taxes under section 501(c)(3) of the internal revenue code. Accordingly, no provision for income taxes is included in the accompanying consolidated financial statements. The corporation's management is not aware of any events that would cause the corporation to lose its tax-exempt status. Management has reviewed all open tax years and has determined that the corporation has no significant uncertain tax positions. turquoise ball 224647 152427 72220 24019 3000 Golf Tournamnt 44306 29298 15008 4501 5818 7360 3 141733 129530 12203 6484 3378 7600 410686 311255 99431 10985 33215 17960 62160 37271 true true X true X true X false true false true true 485117 485117 0.00130 104882827 50815000 54067827 0.14600 0 0 0.00000 105367944 50815000 54552944 0.14730 1297968 114981 1182987 0.00320 390752 0 390752 0.00110 1096900 1438171 -341271 2010534 0 2010534 0.00540 4796154 1553152 3243002 0.00880 110164098 52368152 57795946 0.15600 0 0 0 0.00000 2 60 1614 0 1614 0.00000 197 3981 179536 0 179536 0.00050 0 0 0 0.00000 1 15 410 0 410 0.00000 128 42845 35367 0 35367 0.00010 3 60 6691 0 6691 0.00000 1 55677 0 55677 0.00020 0 0 0 0.00000 332 46961 279295 0 279295 0.00080 true 36911000 1436000 113649115 92551346 21097769 X true true 1 1 FLAGSTAFF MEDICAL CENTER 1200 N BEAVER STREET FLAGSTAFF AZ 86001 HTTPS://NAHEALTH.COM HO169 X X X FLAGSTAFF MEDICAL CENTER 1 false false true X X X X X X X X X 15 false true false true X SEE SCH H, PART V, SECTION C X true 16 true SEE SCH H, PART V, SECTION C false true X 200. 400. X X X X X X true true X X X X true X SEE SCH H, PART V, SECTION C X SEE SCH H, PART V, SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, SECTION B, PART V, LINE 5 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT ("CHNA"), A FOCUS GROUP WAS HELD IN NOVEMBER 2015 IN COLLABORATION WITH COCONINO AND YAVAPAI COUNTIES AS PART OF THEIR COMMUNITY HEALTH IMPROVEMENT PLANS. KEY INFORMANTS IN THE COMMUNITY INCLUDED: REPRESENTATIVES FROM PUBLIC HEALTH, PHYSICIANS, OTHER HEALTH PROFESSIONALS, SOCIAL SERVICE PROVIDERS, AND OTHER COMMUNITY LEADERS. A LIST OF RECOMMENDED PARTICIPANTS FOR THE FOCUS GROUP WAS PROVIDED BY FLAGSTAFF MEDICAL CENTER. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED REPRESENTATIVES OF PUBLIC HEALTH, AS WELL AS SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. FOCUS GROUP CANDIDATES WERE FIRST CONTACTED BY LETTER TO REQUEST THEIR PARTICIPATION. FOLLOW-UP PHONE CALLS WERE THEN MADE TO ASCERTAIN WHETHER THEY WOULD BE ABLE TO ATTEND. CONFIRMATION CALLS WERE PLACED THE DAY BEFORE THE GROUPS WERE SCHEDULED TO INSURE A REASONABLE TURNOUT. AUDIO FROM THE FOCUS GROUP SESSION WAS RECORDED, FROM WHICH VERBATIM COMMENTS IN THIS REPORT ARE TAKEN. THERE ARE NO NAMES CONNECTED WITH THE COMMENTS, AS PARTICIPANTS WERE ASKED TO SPEAK CANDIDLY AND ASSURED OF CONFIDENTIALITY. THIS BOX IS CHECKED "NO" BECAUSE THE HOSPITAL SOLICITED ONLY ORAL, AND NOT WRITTEN COMMENTS ON THE 2012 CHNA AND IMPLEMENTATION STRATEGY WHEN DEVELOPING THE 2015 CHNA. THIS WAS NOT REQUIRED AT THE TIME THAT CHNA WAS PREPARED, BUT WILL BE IMPLEMENTED IN FUTURE CHNA DEVELOPMENT. SCHEDULE H, PART V, LINE 6A THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED IN CONJUNCTION WITH ITS RELATED HOSPITAL FACILITY, VERDE VALLEY MEDICAL CENTER. SCHEDULE H, SECTION B, PART V, LINE 7A THE 2015 COMMUNITY HEALTH NEEDS ASSESSMENT IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://NAHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, SECTION B, PART V, LINE 10A THE 2016 IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://NAHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, SECTION B, PART V, LINE 11 FMC RANKED HEALTH ISSUES IDENTIFIED BY THE CHNA AGAINST THE FOLLOWING ESTABLISHED, UNIFORM CRITERIA: MAGNITUDE - THE NUMBER OF PERSONS AFFECTED; IMPACT/SERIOUSNESS - THE DEGREE TO WHICH THE ISSUE AFFECTS OR EXACERBATES QUALITY OF LIFE AND HEALTH-RELATED ISSUES; FEASIBILITY - THE ABILITY TO REASONABLY IMPACT THE ISSUES, GIVEN AVAILABLE RESOURCES; AND CONSEQUENCES OF INACTION - THE RISK OF NOT ADDRESSING THE PROBLEM AT THE EARLIEST OPPORTUNITY. AREAS OF OPPORTUNITY WERE PRIORITIZED AS FOLLOWS: ACCESS TO HEALTHCARE SERVICES INJURY & VIOLENCE PREVENTION MENTAL HEALTH & MENTAL DISORDERS MATERNAL, INFANT AND CHILD HEALTH ORAL HEALTH SUBSTANCE ABUSE SEXUALLY TRANSMITTED DISEASES Access to Health Services: The organization began "BeWellNow", its telehealth primary and urgent care program. The organization started a Transitions Clinic for those patients who are not able to see their primary care provider ("PCP") within 72 hours of discharge or who need same day service from a PCP. The organization is working with Transportation group for better ride options for patients. The organization is beginning a Community Health Worker program. The organization is broadening our Community Paramedicine program. Injury and Violence Prevention: The organization consistently screens all emergency department ("ED") patients for domestic violence. The organizations Community Paramedicine program conducts home assessments that include fall prevention. Mental Health and Mental Disorders: The organization is hosting a Mental First Aid program and performs depression screening for all related physician clinic patients. Respiratory Disease: The organization is increasing health insurance premiums for employee and employee dependents who use tobacco products. HEALTH PRIORITIES NOT CHOSEN FOR ACTION AND REASON: SUBSTANCE ABUSE - FMC CURRENTLY PARTICIPATES IN COMMUNITY COLLABORATIONS TO ADDRESS SUBSTANCE ABUSE. THESE COLLABORATIONS ARE LED BY OTHER COMMUNITY ORGANIZATIONS WHO HAVE EXPERTISE AND RESOURCES DIRECTED SPECIFICALLY TOWARD EDUCATION AND PREVENTION EFFORTS. FMC WILL CONTINUE TO BE A COMMUNITY PARTNER WITH THESE COLLABORATIONS RUN THROUGH OTHER ORGANIZATIONS. ORAL HEALTH - ORAL HEALTH PROGRAMS FOR COMMUNITY MEMBERS ARE OFFERED THROUGH THE FEDERALLY QUALIFIED HEALTH CENTER ("FQHC"), INDIAN HEALTH, AND REGIONAL PROVIDERS. FMC SUPPORTS THESE EFFORTS WHEN EMERGENCY OR TRAUMA CARE IS REQUIRED. MATERNAL, INFANT AND CHILD HEALTH - FMC PARTICIPATES IN CHILDREN'S HEALTH AND REHABILITATION, INPATIENT OBSTETRICS, NICU, PEDIATRICS AND PICU SERVICES. PRENATAL PROGRAMS, NUTRITIONAL SUPPORT AND INSURANCE COVERAGE ARE PROVIDED BY THE FQHC, LOCAL PROVIDERS, AND FEDERAL AND STATE PROGRAMS. THESE PROGRAMS LEAD THE MAIN EFFORTS IN PRENATAL CARE, TEEN PREGNANCY PREVENTION, AND HIGH RISK PREGNANCIES. SEXUALLY TRANSMITTED DISEASES - THE NORTHERN ARIZONA COUNTY HEALTH DEPARTMENTS ARE REGIONAL LEADS FOR PREVENTING, MONITORING, AND EDUCATING THE PUBLIC ABOUT SEXUALLY TRANSMITTED DISEASES. SCHEDULE H, PART V, LINE 13(B) Eligibility for charitable assistance is based on the income and family size of the patient/guarantor. Income levels are based on the FEDERAL POVERTY LEVELS ("FPL") published by the Federal Register annually. Household members are defined as all dependents and adults residing with the patient. Applicants with household income of 400% of FPL or lower may receive financial assistance based upon a tiered discount. SCHEDULE H, SECTION B, PART V, LINES 16A AND B THE FINANCIAL ASSISTANCE POLICY ("FAP") AND APPLICATION ARE AVAILABLE AT THE FOLLOWING WEBSITE: HTTPS://NAHEALTH.COM/PATIENT-RIGHTS-POLICIES/FINANCIAL-ASSISTANCE SCHEDULE H, SECTION B, PART V, LINE 22D AMOUNTS GENERALLY BILLED ("AGB"): HOSPITAL-SPECIFIC AGB PERCENTAGE MEANS, FOR EACH HOSPITAL, A PERCENTAGE IS DERIVED BY DIVIDING (1) THE SUM OF ALL CLAIMS FOR MEDICALLY NECESSARY SERVICES PROVIDED AT SUCH HOSPITAL PAID DURING THE RELEVANT PERIOD BY (2) ALL PRIVATE HEALTH INSURERS AS PRIMARY PAYORS, TOGETHER WITH ANY ASSOCIATED PORTIONS OF THESE CLAIMS PAID BY INSURED INDIVIDUALS IN THE FORM OF CO-PAYS, CO-INSURANCE OR DEDUCTIBES. THE AGB PERCENTAGE IS CALCULATED BY JANUARY 31 AND IS EFFECTIVE UNTIL THE NEXT ANNUAL CALCULATION. THE CALCULATION SHALL COMPLY WITH THE "LOOK-BACK METHOD" DESCRIBED IN TREASURY REGULATION 1-501(R)-5(B)(1)(B). SCHEDULE H, PART I, LINE 3A AND 3B EXPLANATION FOR VARIOUS PERCENTAGES USED: 200% OF THE FEDERAL POVERTY LEVEL ("FPL")= 100% CHARITY WRITE OFF. 201-250% OF FPL = 75% CHARITY WRITE-OFF. 251-300% OF FPL = 50% WRITE-OFF. 301-350% OF FPL = 25% WRITE-OFF. 351-400% OF FPL = 15% WRITE-OFF. SCHEDULE H, PART I, LINE 3C CHARITY CARE INCOME LEVELS ARE BASED ON THE FEDERAL POVERTY GUIDE PUBLISHED IN THE FEBRUARY FEDERAL REGISTER ON AN ANNUAL BASIS. A TIERED METHOD IS UTILIZED FOR DETERMINING WHETHER A PATIENT IS ELIGIBLE FOR 100%, 75%, 50%, 25%, OR 15% WRITE-OFF OF THE SELF PAY BALANCE. SCHEDULE H, PART I, LINE 6A THE INFORMATION FOR THE COMMUNITY BENEFITS REPORT IS GATHERED BY THE COMMUNICATIONS DEPARTMENT, WHICH IS A DEPARTMENT OF NORTHERN ARIZONA HEALTHCARE. FLAGSTAFF MEDICAL CENTER AND VERDE VALLEY MEDICAL CENTER ARE IDENTIFIED SEPARATELY ON THESE REPORTS. THE COMMUNITY BENEFIT REPORT IS AVAILABLE AT: HTTPS://NAHEALTH.COM/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT SCHEDULE H, PART I, LINE 7 FLAGSTAFF MEDICAL CENTER USED A COST-TO-CHARGE RATIO, WHERE APPLICABLE, TO CALCULATE THE MOST ACCURATE COST OF CHARITY CARE AND OTHER COMMUNITY BENEFITS REPORTED IN LINE 7. SCHEDULE H, PART II COMMUNITY BUILDING IS ADVANCED BY FLAGSTAFF MEDICAL CENTER THROUGH ITS SUPPORT OF PHYSICIAN RECRUITMENT AND WORK WITH VARIOUS COMMUNITY ORGANIZATIONS INCLUDING THE AMERICAN CANCER SOCIETY, BIG BROTHERS AND BIG SISTERS, FLAGSTAFF LEADERSHIP PROGRAM, FLAGSTAFF CHAMBER OF COMMERCE AND THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. SCHEDULE H, PART III, LINE 2 THE COSTING METHODOLOGY USED TO DETERMINE THE BAD DEBT COST COMES FROM THE PERCENTAGE CALCULATED IN SCHEDULE H PART I WORKSHEET 2. SCHEDULE H, PART III, LINE 3 FLAGSTAFF MEDICAL CENTER'S CALCULATION OF FINANCIAL ASSISTANCE COST IS BASED ON ACTUAL FINANCIAL ASSISTANCE WRITE-OFFS BY THE BUSINESS OFFICE MULTIPLIED BY THE COST-TO-CHARGE RATIO. ALL OF THE FINANCIAL ASSISTANCE WRITE-OFFS ARE ATTRIBUTABLE TO PATIENTS WHO QUALIFIED UNDER THE FINANCIAL ASSISTANCE POLICY. AS A NOT-FOR-PROFIT ENTITY, SERVICES ARE PROVIDED TO ALL PATIENTS REGARDLESS OF THEIR ABILITY TO PAY AND MAKING THIS AVAILABLE TO THE COMMUNITY QUALIFIES BAD DEBT AS A COMMUNITY BENEFIT. SCHEDULE H, PART III, LINE 4 FOOTNOTE 2 TO THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS INDICATES THAT NET PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT SERVICE REVENUE HAVE BEEN ADJUSTED TO THE ESTIMATED AMOUNTS EXPECTED TO BE RECEIVED BASED ON CONTRACT RATES FOR THE SERVICES RENDERED. THESE ESTIMATED AMOUNTS ARE SUBJECT TO FURTHER ADJUSTMENTS UPON REVIEW BY THIRD-PARTY PAYORS. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD OR DISCOUNTED RATES. HISTORICALLY, A SIGNIFICANT PORTION OF THE UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. ACCORDINGLY, THE CORPORATION RECORDS AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR DOUBTFUL ACCOUNTS, RELATED TO UNINSURED PATIENTS, IN THE PERIOD THE SERVICES WERE PROVIDED USING AN ENTITY WIDE ASSESSMENT BASED ON HISTORICAL COLLECTION EXPERIENCES. MANAGEMENT REGULARLY REVIEWS PAYMENT DATA FOR EACH MAJOR PAYOR IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. DURING 2016, THE CORPORATION EXPERIENCED A SLIGHT DECREASE IN SELF-PAY REVENUE AS A RESULT OF THE ARIZONA MEDICAID RESTORATION PROGRAM AND THE ESTABLISHMENT OF THE STATE INSURANCE EXCHANGE UNDER THE AFFORDABLE CARE ACT. THIS ALSO RESULTED IN A SLIGHT DECREASE IN THE PROVISION FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, LINE 8 THE SOURCE USED TO DETERMINE THE AMOUNT REPORTED ON LINE 6 IS THE FY2016 MEDICARE COST REPORT FOR THE ORGANIZATION. MEDICARE REPRESENTS 37% OF THE ORGANIZATIONS GROSS CHARGES. FOR FY2016 MEDICARE IS A SURPLUS PRIMARILY BECAUSE THE ORGANIZATION RECEIVES HIGHER MEDICARE REIMBURSEMENTS AS A SOLE COMMUNITY HOSPITAL, AS DEFINED AND DESIGNATED BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES. IN YEARS WHEN THERE IS A SHORTFALL, THE ENTIRE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT BECAUSE THE ORGANIZATIONS MISSION IS TO IMPROVE THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, WHETHER OR NOT THIS SERVICE IS PROVIDED AT A LOSS, THEREBY RELIEVING THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST OF THE MEDICARE BENEFICIARIES, MANY OF WHOM WOULD QUALIFY FOR FINANCIAL ASSISTANCE. SCHEDULE H, PART III, LINE 9B ACCORDING TO OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL COUNSELORS ASSESS THE PATIENT'S ABILITY TO PAY AT TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR FINANCIAL ASSISTANCE CONSIDERATION. IF THE PATIENT DOESN'T QUALIFY FOR FINANCIAL ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR A LONG-TERM PAYMENT PROGRAM. IF THE FINANCIAL ASSISTANCE APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. BEFORE PRE-ADMISSION AND IF A PATIENT IS INELIGIBLE FOR FINANCIAL ASSISTANCE, FLAGSTAFF MEDICAL CENTER CALCULATES AN AMOUNT GENERALLY BILLED (AGB) ON A PERIODIC BASIS PER SECTION 501R OF THE TREASURY REGULATIONS. THE CURRENT RATE IS 68% OF GROSS CHARGES. FLAGSTAFF MEDICAL CENTER CURRENTLY OFFERS A 50% DISCOUNT TO THESE PATIENTS, WHICH IS WELL BELOW THE AGB CALCULATION. SCHEDULE H, PART VI, LINE 2 FLAGSTAFF MEDICAL CENTER ASSESSES COMMUNITY HEALTHCARE NEEDS THROUGH A SURVEY DESIGNED AND ADMINISTERED INTERNALLY. THIS SURVEY WAS LAST CONDUCTED IN NOVEMBER 2015 AND WAS A FOLLOW-UP TO OTHER SURVEYS THE HOSPITAL HAS CONDUCTED. THE SURVEY INSTRUMENT USED FOR THIS STUDY IS BASED LARGELY ON THE CENTERS FOR DISEASE CONTROL AND PREVENTION BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, AS WELL AS VARIOUS OTHER PUBLIC HEALTH SURVEYS AND CUSTOMIZED QUESTIONS ADDRESSING GAPS IN INDICATOR DATA RELATIVE TO HEALTH PROMOTION AND DISEASE PREVENTION OBJECTIVES AND OTHER RECOGNIZED HEALTH ISSUES. SCHEDULE H, PART VI, LINE 3 ACCORDING TO OUR FINANCIAL ASSISTANCE POLICY, FINANCIAL COUNSELORS ASSESS THE PATIENT'S ABILITY TO PAY AT TIME OF ADMISSION/REGISTRATION. IF THE PATIENT STATES THAT THEY ARE UNABLE TO PAY OUT-OF-POCKET EXPENSES, A DETERMINATION IS MADE WHETHER COVERAGE IS AVAILABLE THROUGH AHCCCS OR OTHER MEDICAID PROGRAMS. IF NO OUTSIDE ASSISTANCE IS AVAILABLE, AN APPLICATION IS GIVEN TO THE PATIENT TO BE SUBMITTED FOR FINANCIAL ASSISTANCE CONSIDERATION. IF THE PATIENT DOESN'T QUALIFY FOR FINANCIAL ASSISTANCE, INCOME LEVELS ARE ASSESSED TO DETERMINE IF THEY QUALIFY FOR A LONG-TERM PAYMENT PROGRAM. IF THE CHARITY APPLICATION IS NOT TURNED IN AND PAYMENT HAS NOT BEEN MADE AFTER NUMEROUS FOLLOW UP PHONE CALLS, THE PATIENT ACCOUNT GOES TO BAD DEBT. FLAGSTAFF MEDICAL CENTER WEBSITE HAS A BILLING CONTACT NUMBER. BEFORE PRE-ADMISSION, PATIENTS ARE CONTACTED BY FMC'S CASHIER. WHEN PATIENTS ARE CONTACTED, THEY ARE EDUCATED ABOUT THE FINANCIAL ASSISTANCE POLICY. FMC FINANCIAL COUNSELORS ASSIGNED TO EACH NURSING UNIT ARE ABLE TO ANSWER OR ASSIST WITH BILLING QUESTIONS. AT EACH PATIENT REGISTRATION DESK THERE ARE DISPLAYS AND BROCHURES OF THE BILLING INFORMATION, INCLUDING THE FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART VI, LINE 4 THE STUDY AREA FOR THE SURVEY EFFORT (REFERRED TO AS THE "NAH SERVICE AREA"FLAGSTAFF OR VERDE VALLEY REGION" IN THIS REPORT) INCLUDES THE FOLLOWING COUNTIES REPRESENTED IN NORTHERN AZ: APACHE, GILA, MOJAVE, NAVAJO, COCONINO AND YAVAPAI. COCONINO COUNTY (CC) - AS OF 2015, THE TOTAL POPULATION IN COCONINO COUNTY WAS 139,097. THE POPULATION IS EVENLY SPLIT BETWEEN MALES AND FEMALES. THE POPULATION WAS FOUND TO BE 54.9% WHITE (NOT HISPANIC OR LATINO), 27.3% AMERICAN INDIAN OR ALASKAN NATIVE, 13.9% HISPANIC OR LATINO, 1.6% BLACK OR AFRICAN AMERICAN, AND 1.8% ASIAN. MOHAVE COUNTY (MC) - THE TOTAL POPULATION IN MOHAVE COUNTY WAS 204,737 IN 2015. THE COUNTY IS 49.7% FEMALE AND 50.3% MALE. THE MAJORITY OF THE COUNTY IS WHITE (NOT HISPANIC OR LATINO) AT 78%, WHILE THE LARGEST MINORITY GROUP IS HISPANIC OR LATINO AT 15.8% OF THE POPULATION. THE POPULATION IS 2.9% AMERICAN INDIAN OR ALASKAN NATIVE, 1.3% BLACK OR AFRICAN AMERICAN, AND 1.2% ASIAN. GILA COUNTY (GC) - GILA COUNTYS POPULATION WAS 53,159 IN 2015. THE POPULATION WAS FOUND TO BE 50.4% FEMALE AND 49.6% MALE. THE MAJORITY OF THE COUNTY IS WHITE (NOT HISPANIC OR LATINO) AT 63.2%. THE COUNTY IS 18.8% HISPANIC OR LATINO, 16.5% AMERICAN INDIAN OR ALASKAN NATIVE, .9% BLACK OR AFRICAN AMERICAN, AND .8% ASIAN. APACHE COUNTY (AC) - AS OF 2015, THE TOTAL POPULATION IN APACHE COUNTY WAS 71,474. APACHE COUNTY HAS SLIGHTLY MORE FEMALES, WITH 50.6% OF THE POPULATION FEMALE AND 49.4% MALE. THE MAJORITY OF THE POPULATION IS AMERICAN INDIAN OR ALASKAN NATIVE AT 73.5%. THE POPULATION IS 19% WHITE (NOT HISPANIC OR LATINO) AND 6.4% HISPANIC OR LATINO. NAVAJO COUNTY (NC) - THE POPULATION OF NAVAJO COUNTY WAS 108,277 IN 2015. THIS COUNTY IS EVENLY SPLIT BETWEEN MALES AND FEMALES. THE COUNTYS POPULATION IS 42.2% WHITE (NOT HISPANIC OR LATINO), 44.9% NATIVE AMERICAN OR ALASKAN NATIVE, 11.1% HISPANIC, 1.3% BLACK AND .7% ASIAN. YAVAPAI COUNTY (YC) - IN 2015 THERE WERE 222,255 INDIVIDUALS LIVING IN YAVAPAI COUNTY. THE MAJORITY OF THE POPULATION IS WHITE (NOT HISPANIC OR LATINO) AT 80.9%. THE POPULATION IS 14.2% HISPANIC OR LATINO, 2.1% AMERICAN INDIAN OR ALASKAN NATIVE, 1% ASIAN, AND .9% BLACK OR AFRICAN AMERICAN. YAVAPAI IS EXPERIENCING AN EXTREMELY HIGH GROWTH IN HISPANICS. IN THE NEXT 5 YEARS, THE HISPANIC POPULATION IS ESTIMATED TO INCREASE BY 6,424 NEW LIVES. AGE DISTRIBUTION CC - IN 2014, PERSONS UNDER THE AGE OF 18 IS 21.8%, NEARING THE STATE AVERAGE OF 24.1%. AN ESTIMATED 12.3% OF THE POPULATION IS 65 YEARS OR OLDER, AND THIS IS EXPECTED TO INCREASE SLIGHTLY OVER THE NEXT FIVE YEARS TO 13.5%. MC - IT WAS FOUND THAT 18.7% OF MOHAVE COUNTYS RESIDENTS WERE UNDER THE AGE OF 18, WHILE 26.9% WERE OVER THE AGE OF 65. GC - THE POPULATION OF GILA COUNTY HAD 20.4% OF ITS RESIDENTS AGED 18 OR UNDER AND 26.6% AGED 65 OR OLDER IN 2014. AC - IN APACHE COUNTY, PERSONS UNDER THE AGE OF 18 IS 29.3% AND PERSONS OLDER THAT 65 WAS AT 13.5% IN 2014. NC - IT WAS FOUND THAT 28% OF NAVAJO COUNTYS POPULATION IS UNDER THE AGE OF 18 AND 15.8% IS OVER THE AGE OF 65. YC - AN ESTIMATED 28.1% OF THE POPULATION IS 65 YEARS OR OLDER, NEARLY DOUBLING THE STATE ESTIMATED AVERAGE PERCENT OF 15.9%, CARE FOR THE AGING WAS IDENTIFIED BY 20% OF THE RESPONDENTS IN A COMMUNITY HEALTH SURVEY AS A CRITICAL ISSUE. THE POPULATION WITHIN THE AGE OF 65 AND 74 WILL EXPERIENCE THE MOST GROWTH AT 21.53%. PEOPLE BETWEEN THE AGES OF 45 AND 54 PRESENT THE SMALLEST GROWTH AT -12.44% IN THE NEXT FIVE YEARS. YAVAPAI, IN TOTAL, HAS A GREATER PERCENT OF GROWTH THAN THE UNITED STATES AVERAGE IN ALL AGE GROUPS EXCEPT BETWEEN THE AGES OF 45 AND 64. SCHEDULE H, PART VI, LINE 5 COMMUNITY HEALTH AND COMMUNITY BUILDING ARE A FOCUS AT FLAGSTAFF MEDICAL CENTER AS EVIDENCED BY THE NUMEROUS ACTIVITIES SPONSORED EACH YEAR. THE CANCER CENTER AT FMC HOSTS A SERIES OF FREE OR LOW-COST SCREENINGS DESIGNED TO HELP RESIDENTS IN THE COMMUNITY DETECT ISSUES AS SOON AS POSSIBLE. THE SAFE CHILD CENTER IS A CHILD ADVOCACY CENTER THAT SERVES CHILDREN FROM BIRTH THROUGH 18 YEARS OLD AND IS DEDICATED TO REDUCING THE STRESS CHILDREN EXPERIENCE AS VICTIMS OF CRIME. FMC'S PALLIATIVE CARE PROGRAM PROVIDES HIGH QUALITY CARE TO PATIENTS WHO HAVE A CHRONIC DISEASE OR LIFE-THREATENING ILLNESS. FIT KIDS OF ARIZONA, WHICH WORKS TO REDUCE THE HEALTH CONSEQUENCES OF CHILDHOOD OBESITY BY PROMOTING HEALTHY LIFESTYLES, AND THE DIABETES TOGETHER COMMUNITY COLLABORATION ARE FMC'S PREMIER COMMUNITY HEALTH INITIATIVES. THE CARE BEYOND WALLS AND WIRES PROGRAM USES TELEMEDICINE TO MONITOR AND SUPPORT PATIENTS WHO LIVE REMOTELY AND HAVE RECENTLY BEEN DIAGNOSED WITH CONGESTIVE HEART FAILURE. COMMUNITY BUILDING IS ADVANCED BY FMC THROUGH ITS SUPPORT OF PHYSICIAN RECRUITMENT AND WORK WITH VARIOUS COMMUNITY ORGANIZATIONS INCLUDING THE AMERICAN CANCER SOCIETY, BIG BROTHERS AND BIG SISTERS, FLAGSTAFF LEADERSHIP PROGRAM, FLAGSTAFF CHAMBER OF COMMERCE AND THE ARIZONA HOSPITAL AND HEALTHCARE ASSOCIATION. SCHEDULE H, PART VI, LINE 6 FLAGSTAFF MEDICAL CENTER IS AFFILIATED WITH VERDE VALLEY MEDICAL CENTER. THE BOARD MEMBER MEETINGS ARE COMBINED. THE COMMUNITY BENEFIT REPORT IS SUMMARIZED TOGETHER AND POSTED ON THE HOSPITAL'S WEBSITE. true ARIZONA COMMUNITY FOUNDATION 2201 E CAMELBACK RD PHOENIX AZ 85016 860348306 501(C)(3) 8000 ARIZONA SNOWBOWL RESORT PO BOX 40 STE 4058 FLAGSTAFF AZ 86002 860718649 15000 NATE AVERY RUN BOYS AND GIRLS CLUB OF FLAGSTAFF 301 S PASEO DEL FLAG STE 1010 FLAGSTAFF AZ 86001 860688398 501(C)(3) 6000 0 ADAPTIVE SKI PROGRAM COCONINO COMMUNITY COLLEGE 2800 S LONETREE RD FLAGSTAFF AZ 86001 860717956 SCHOOL 105000 0 FLAGSTAFF COMMUNITY FOUNDATION Coconino Econ Sustainable Dev Initiative PO BOX 22110 FLAGSTAFF AZ 86002 261077054 501(C)(3) 10000 0 MEETINGS, SPONSOR, NURSING ECONOMIC COLLABORATIVE OF NORTHERN AZ 201 E BIRCH AVE STE 12 FLAGSTAFF AZ 86001 860699786 501(C)(3) 10000 0 TEACHER AWARDS FLAGSTAFF FAMILY FOOD CENTER 1903 N 2ND ST FLAGSTAFF AZ 86004 860754044 501(C)(3) 10000 0 FIRST ROBOTICS CONFERENCE FLAGSTAFF SYMPHONY ORCHESTRA PO BOX 122 FLAGSTAFF AZ 86002 860186038 501(C)(3) 6000 0 ATHENA AWARDS ANNUAL MEETING FLAGSTAFF UNIFIED SCHOOL DISTRICT 3285 E SPARROW FLAGSTAFF AZ 86004 860593041 SCHOOL 384821 0 FCF JLB PROJECT PO BOX 537 FLAGSTAFF AZ 86002 273224466 501(C)(3) 5500 0 SPONSOR, FSO CONCERT MOUNTAIN CHARTER SCHOOLS 311 W CATTLE DRIVE FLAGSTAFF AZ 86005 953564584 SCHOOL 19840 0 SPONSOR NORTH COUNTRY HEALTHCARE PO BOX 3630 STE 506 FLAGSTAFF AZ 86003 860663432 501(C)(3) 20900 0 TICKETS, CONFERENCES, NURSING NORTHERN ARIZONA UNIVERSITY PO BOX 122 FLAGSTAFF AZ 86002 866004791 SCHOOL 90860 0 NACASA NORTHLAND HOSPICE & PALLIATIVE CARE PO BOX 997 FLAGSTAFF AZ 86002 742385187 501(C)(3) 10000 0 FCF POORE MEDICAL CLINIC 120 W FINE AVE FLAGSTAFF AZ 86001 800751712 501(C)(3) 8500 0 FCF RONALD MCDONALD HOUSE CHARITIES 501 E ROANOK AVE PHOENIX AZ 85004 860483792 501(C)(3) 6000 0 FCF SAN FRANCISCO DE ASIS PARISH 320 W HUMPHREYS ST STE D-1 FLAGSTAFF AZ 86001 300515246 SCHOOL 7105 0 SPONSOR SEDONA INTERNATIONAL FILM FESTIVAL PO BOX 162 STE 4 SEDONA AZ 86339 200351857 501(C)(3) 7000 0 FCF ST MARY'S FOOD BANK ALLIANCE 1801 W State Route 66 FLAGSTAFF AZ 86001 237353532 501(C)(3) 10000 0 DONATION, SPONSOR UNITED WAY OF NORTHERN AZ 1515 E Cedar Ave FLAGSTAFF AZ 86004 860211666 501(C)(3) 35425 0 Fit Kids School Program WILLIAMS UNIFIED SCHOOL DISTRICT PO BOX 427 WILLIAMS AZ 86046 860592836 SCHOOL 106191 0 Fit Kids School Program 20 1 SCHEDULE I, PART IV, PROCEDURES TO MONITOR GRANTS FLAGSTAFF MEDICAL CENTER FOUNDATION - GRANTS 1) INDIVIDUALS ON THE USER LEVEL ARE RESPONSIBLE FOR SCREENING AND IDENTIFYING THE NEEDS FOR DISTRIBUTION OF GRANT FUNDS. 2) DEPARTMENT HEADS AND/OR PROGRAM COORDINATORS MUST VALIDATE AND SIGN ALL REQUESTS FOR PAYMENT OR DISBURSEMENT OF THESE FUNDS. 3) WRITTEN REQUESTS ARE REVIEWED BY THE FOUNDATION SPECIALIST FOR OPERATIONS TO VERIFY AVAILABLE FUND BALANCES AND PROPER ACCOUNT NUMBERS. 4) THE FOUNDATION SPECIALIST FOR GRANTS THEN INITIALS THE DOCUMENTS AFTER VERIFYING THE CRITERIA FOR DISBURSEMENT. 5) THE VICE PRESIDENT OF DEVELOPMENT AUTHORIZES THE DISBURSEMENT OF FUNDS BY SIGNATURE. 6) THE FOUNDATION SCANS ALL DOCUMENTS AND SAVES THEM DIGITALLY ON A SECURE SERVER. 7) ALL ORIGINAL DOCUMENTS ARE SUBMITTED TO ACCOUNTS PAYABLE FOR FINAL RECORDING AND PAYMENT. ORIGINAL DOCUMENTS ARE FILED AND ARCHIVED IN A SECURE LOCATION FOR THE REQUIRED LENGTH OF TIME. FMC RELIES ON THE GOVERNANCE PRACTICES OF THE RECIPIENT ORGANIZATION TO USE THE FUNDS FOR THE INTENDED PURPOSE. false true false false false false false true false ROBERT THAMES NAH PRESIDENT/CEO 0 302952 0 127500 0 14405 0 9696 0 20189 0 474742 0 0 HOPE WADE CFO (THRU 12/15) 0 167550 0 12261 0 196 0 5142 0 1000 0 186149 0 0 MARK CARROLL CHIEF MEDICAL OFFICER 0 323105 0 44829 0 1448 0 15900 0 26915 0 412197 0 0 LINDA PARKER INTERIM CNO/VP PATIENT CARE 0 210964 0 35015 0 1707 0 14845 0 1440 0 263971 0 0 RICHARD SMITH VP OF DEVELOPMENT/MARKETING 0 226783 0 40485 0 3476 0 15900 0 18148 0 304792 0 0 RICHARD NEFF DIRECTOR PHYSICIAN RELATIONS 0 363531 0 0 0 1969 0 15900 0 28195 0 409595 0 0 MARK FOSTER PHYSICIAN 0 212369 0 0 0 7055 0 12975 0 17420 0 249819 0 0 RICHARD MENDRIBIL HEALTH SYSTEMS DIR OF PHARMACY 0 191010 0 14170 0 5227 0 11536 0 8636 0 230579 0 0 DALE MERRITT REGISTERED NURSE 0 200657 0 4300 0 2862 0 4892 0 25264 0 237975 0 0 BRENDA MUNNS DIRECTOR SURGICAL SERVICES 0 186388 0 13965 0 3455 0 32686 0 16836 0 253330 0 0 JOHN DEMPSEY FORMER VP NAH/PRES LCMC 0 331407 0 72204 0 40499 0 155917 0 25438 0 625465 0 32101 SCHEDULE J, PART I, LINE 1A & 1B SUPPLEMENTAL COMPENSATION INFORMATION ALL COMPENSATION, BENEFITS AND REIMBURSEMENTS ARE PAID BY NORTHERN ARIZONA HEALTHCARE, THE PARENT ORGANIZATION. GROSS-UP OF TAXES IS DONE ON ALL EMPLOYEE GIFT CERTIFICATES of $25 OR MORE. IN PRACTICE, THE BOARD MEMBER AND OFFICER BUSINESS TRAVEL EXPENSES ARE APPROVED BY THE NEXT HIGHEST LEVEL. SCHEDULE J, PART I, LINE 3 CEO COMPENSATION IS DERIVED BY THE PARENT ORGANIZATION, NORTHERN ARIZONA HEALTHCARE, BY THE FOLLOWING METHODS: COMPENSATION COMMITTEE, WRITTEN CONTRACT, INDEPENDENT CONSULTANT, COMPENSATION SURVEY, AND RECOMMENDATION OF COMPENSATION COMMITTEE TO BOARD FOR APPROVAL. SCHEDULE J, PART I, LINE 4B CERTAIN EMPLOYEES RECEIVED DISTRIBUTIONS FROM THE SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN DURING 2015 AS FOLLOWS: JOHN DEMPSEY: $32,101 THIS AMOUNT WAS INCLUDED IN TAXABLE WAGES AND IS REPORTED IN SCHEDULE J, PART II, COLUMN B(III) AND ALSO IN COLUMN F SINCE THIS AMOUNT HAS PREVIOUSLY BEEN REPORTED AS DEFERRED COMPENSATION ON A PRIOR FORM 990. SCHEDULE J, PART I, LINE 7 NORTHERN ARIZONA HEALTHCARE CORPORATION MAKES DISCRETIONARY PAYMENTS AS PART OF A SHORT-TERM INCENTIVE PLAN (STIP). PAYMENTS ARE BASED ON MEETING VARIOUS ORGANIZATION GOALS. Schedule J Part II THE FOLLOWING INDIVIDUALS PARTICIPATE IN A DEFINED BENEFIT RETIREMENT PLAN. AS SUCH, ACTUARIAL INCREASES IN THEIR ACCOUNTS ARE REPORTED ON PART II, COLUMN (C) AS DEFERRED COMPENSATION. INCREASE DUE TO ACTUARIAL BENEFIT: JOHN DEMPSEY $111,008 THE FOLLOWING INDIVIDUALS RECEIVED ONE-TIME SIGN-ON BONUSES. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(ii): ROBERT P. THAMES $52,500 JEFFREY TREASURE $25,000 THE FOLLOWING INDIVIDUAL RECEIVED A ONE-TIME PAYMENT FOR RELOCATION. THESE PAYMENTS ARE INCLUDED IN SCHEDULE J, PART II, COLUMN B(iii): ROBERT P. THAMES $13,074 A INDUSTRIAL DEVELOPMENT AUTHORITY OF YAVAPAI COUNTY 860376099 985900cx5 2011-10-12 65094379 See Part VI false false false B INDUSTRIAL DEVELOPMENT AUTHORITY OF YAVAPAI COUNTY 860376099 2015-06-30 54783825 See Part VI false false false A 0 0 65094379 0 0 0 629060 0 0 0 64465319 0 2011 true false true true B 0 0 54783825 0 0 0 1111308 0 0 0 54299049 0 2015 true false true true A false false true true false 0 false false false true B false false true true false 0 false false false true A false false true false false false 0 false 0 false true B false false true false false false 0 false 0 false true A true B true SCHEDULE K, PART I, COLUMN (F) LINE A - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2011. THIS ISSUE REFUNDS THE 1996A AND 1998 SERIES BOND. TOTAL ISSUANCE PRICE WAS $78,923,520, WHICH WAS ALLOCATED $65,094,379 TO FLAGSTAFF MEDICAL CENTER (FMC) AND $13,829,141 TO VERDE VALLEY MEDICAL CENTER (VVMC). LINE B - THE NAME OF THE ISSUE IS HOSPITAL REVENUE REFUNDING BONDS (NORTHERN ARIZONA HEALTHCARE SYSTEM) SERIES 2015A AND 2015B. THIS ISSUE REFUNDS THE 2008A AND 2008B BONDS. TOTAL ISSUANCE PRICE OF SERIES 2015A WAS $80,395,000, WHICH WAS ALLOCATED $37,213,075 TO FMC, $9,274,438 TO VVMC, AND $33,906,585 TO NORTHERN ARIZONA HEALTHCARE OUTPATIENT SURGERY CENTER. THE 2015A BONDS WERE ALSO USED, IN PART, TO FINANCE "NEW MONEY" PROJECTS. $33,611,679 WAS USED FOR ACQUISITION OF SUMMIT SURGERY CENTER. TOTAL ISSUANCE PRICE OF SERIES 2015B WAS $45,635,975, WHICH WAS ALLOCATED $17,569,850 TO FMC AND $28,066,125 TO VVMC. X 1 40 REPLACEMENT COST X 1218 REPLACEMENT COST X 18657 REPLACEMENT COST X 30 401 REPLACEMENT COST X TOYS/CERTIFICATES 905 17066 REPLACEMENT COST X JEWELRY 6 10720 REPLACEMENT COST X ADMISSIONS/MEMBERSHIP 201 23188 REPLACEMENT COST X ALCOHOL 2 47 REPLACEMENT COST false true false SCHEDULE M, PART I, COLUMN B THE ORGANIZATION IS REPORTING THE NUMBER OF CONTRIBUTIONS RECEIVED IN COLUMN (B). THE NUMBER OF CONTRIBUTIONS OR ITEMS CONTRIBUTED IS NOT ASCERTAINABLE FOR THE FOLLOWING DUE TO VOLUME: BOOKS AND PUBLICATIONS CLOTHING AND HOUSEHOLD GOODS FORM 990, PART I, LINE 6 FMC VOLUNTEERS PROVIDE CLERICAL ASSISTANCE IN MULTIPLE DEPARTMENTS AND SUPPORT SERVICES SUCH AS WHEELCHAIR ASSISTANCE AND ESCORTING PATIENTS AND FAMILIES WHO ENTER AT THE MAIN ENTRY. THEY VOLUNTEER AT THE INFORMATION DESK AND GIFT SHOP AND MAKE DELIVERIES OF GIFTS, READING MATERIALS AND MAIL TO PATIENT ROOMS. THEY PROVIDE LOBBY MUSIC, NAVAJO AND SPANISH INTERPRETATION, SPIRITUAL CARE, AND CARING CANINE AND CARING CLOWN VISITS TO PATIENTS. THEY ROCK BABIES IN THE SPECIAL CARE NURSERY, PROVIDE MENDED HEARTS PATIENT AND FAMILY SUPPORT, AND ASSIST AT THE FOUNDATION AND AT SPECIAL EVENTS. VOLUNTEERS ASSIST IN OTHER DEPARTMENTS SUCH AS THE CANCER CENTER, BIOMEDICAL ENGINEERING, MAIL ROOM, NUTRITION SERVICES, PHARMACY, WOMEN AND INFANTS' CENTER, PHYSICAL THERAPY, FIT KIDS, BARIATRIC CLINIC, EMERGENCY AND SURGICAL SERVICES, AND THE TAYLOR HOUSE. FORM 990 PART III LINE 4A ONE OF THE NICEST THINGS ABOUT LIVING IN NORTHERN ARIZONA IS YOU DON'T HAVE TO TRAVEL TO GET EXCELLENT HEALTHCARE. SINCE 1936, FLAGSTAFF MEDICAL CENTER (FMC), A MEMBER OF NORTHERN ARIZONA HEALTHCARE, HAS PROVIDED HIGH QUALITY HEALTHCARE SERVICES TO RESIDENTS AND VISITORS OF NORTHERN ARIZONA. WE ARE DEDICATED TO PATIENT-CENTERED CARE WITH A PERSONAL TOUCH. FMC IS LICENSED BY MEDICARE AND THE STATE OF ARIZONA. FOUNDED BY DR. CHARLES SECHRIST AS FLAGSTAFF HOSPITAL, THE 25-BED HOSPITAL WAS DONATED TO THE COMMUNITY OF FLAGSTAFF IN 1955. TODAY, FLAGSTAFF MEDICAL CENTER REMAINS A NOT-FOR-PROFIT HOSPITAL, GOVERNED BY A VOLUNTEER BOARD OF DIRECTORS. WE TREAT EVERY PATIENT, REGARDLESS OF THEIR ABILITY TO PAY. EVERY YEAR, FLAGSTAFF MEDICAL CENTER INVESTS IN YOUR COMMUNITY HOSPITAL TO ENSURE WE ARE PROVIDING THE BEST, SAFEST CARE, CLOSE TO HOME. WE PROVIDE KEY SERVICES TO NORTHERN ARIZONA RESIDENTS AND VISITORS, INCLUDING A REGIONAL TRAUMA CENTER; OPEN-HEART SURGERY; HIGH-TECH IMAGING; A CANCER CENTER; SURGICAL SERVICES; ORTHOPEDIC SERVICES; WOMEN, INFANTSCHILDREN'S SERVICES; AND MORE. FMC CURRENTLY HAS: - 267 INPATIENT BEDS - 223 PHYSICIANS ON OUR ACTIVE MEDICAL STAFF - 14,234 ANNUAL INPATIENT HOSPITAL ADMISSIONS - 63,165 INPATIENT DAYS - 84,007 ANNUAL OUTPATIENT HOSPITAL VISITS - 46,178 ANNUAL EMERGENCY DEPARTMENT VISITS - 1,152 BABIES BORN THIS YEAR AT FMC FLAGSTAFF MEDICAL CENTER'S MISSION, VISION, AND VALUES --------------------------------------------- MISSION - FLAGSTAFF MEDICAL CENTER WILL PROVIDE PATIENTS WITH EXCEPTIONAL CARE WHILE TRANSFORMING THE HEALTH OF THE COMMUNITIES WE SERVE. VISION - FLAGSTAFF MEDICAL CENTER WILL BE A MODEL HEALTHCARE SYSTEM DISTINGUISHED BY OUR PEOPLE, QUALITY, SERVICE AND OUR DEDICATION TO COMMUNITY HEALTH SOLUTIONS. VALUES: -PATIENTS - WE ARE COMMITTED TO MEETING THE NEEDS AND EXCEEDING THE EXPECTATIONS OF OUR PATIENTS. - COLLEAGUES - WE WILL CREATE AN ORGANIZATIONAL CULTURE WHERE COLLEAGUES FEEL VALUED AND TAKE A SENSE OF PRIDE IN THEIR WORK. - QUALITY - WE CONTINUOUSLY STRIVE TO ACHIEVE EXCELLENCE AT ALL LEVELS IN THE ORGANIZATION. - SAFETY - WE ARE COMMITTED TO MAINTAINING A SAFE ENVIRONMENT FOR OUR PATIENTS, VISITORS AND COLLEAGUES. - LEADERSHIP - WE PROMOTE LEADERSHIP AS AN ATTITUDE, NOT A POSITION, PUTTING VALUE ON BOTH PEOPLE AND THE WORK THEY DO. - TEAMWORK - WE ARE COLLEAGUES WORKING TOGETHER, SHARING KNOWLEDGE, TALENTS AND SKILLS TO ACHIEVE COMMON GOALS. - INTEGRITY - WE WILL BE FORTHRIGHT, HONEST AND RESPECTFUL. - DIVERSITY - WE EMBRACE THE DIVERSITY OF OUR PEOPLE, PATIENTS AND THE COMMUNITIES WE SERVE. FORM 990, PART V, LINE 2A; PART VII, SECTION A, AND PART IX FLAGSTAFF MEDICAL CENTER DOES NOT HAVE EMPLOYEES, BUT SHARES THE COST OF PERSONNEL, SERVICES, AND EXPENSES WITH NORTHERN ARIZONA HEALTHCARE CORPORATION, A RELATED TAX-EXEMPT ORGANIZATION AND FMC'S SOLE MEMBER. FORM 990, PART VI, LINE 1 THE BOARD OF DIRECTORS DELEGATES AUTHORITY TO AN EXECUTIVE COMMITTEE IN AN EMERGENCY SITUATION ONLY. THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE INDIVIDUALS THEN SERVING AS THE EXECUTIVE COMMITTEE OF NAH, AUTOMATICALLY AND WITHOUT SEPARATE ELECTION. THE EXECUTIVE COMMITTEE SHALL ONLY MEET IF A QUORUM OF THE BOARD IS IMPOSSIBLE AND AN URGENT BOARD VOTE IS REQUIRED. IN SUCH CASES IT SHALL EXERCISE THE POWER AND AUTHORITY OF THE BOARD, AND SHALL REPORT ANY ACTIONS TAKEN AT THE FOLLOWING BOARD MEETING. FORM 990, PART VI, LINE 4 THE VERDE VALLEY MEDICAL CENTER BOARD WAS INTEGRATED INTO THE NORTHERN ARIZONA HEALTHCARE BOARD IN OCTOBER 2015. NORTHERN ARIZONA HEALTHCARE MOVED FROM A HOLDING COMPANY TO AN OPERATING COMPANY, SUCCESSFULLY INTEGRATING THREE SEPARATE BOARDS TO ONE SYSTEM BOARD. BOARD BYLAWS AND ARTICLES OF INCORPORATION WERE REWRITTEN TO ACHIEVE "BEST PRACTICE." THE ORGANIZATION MADE THE FOLLOWING SIGNIFICANT CHANGES TO THE BYLAWS, EFFECTIVE ON AUGUST 18, 2016: ARTICLE II: THE CORPORATION SHALL HAVE A SINGLE CLASS OF VOTING MEMBERS, AND THE SOLE MEMBER OF THAT CLASS IS NORTHERN ARIZONA HEALTHCARE CORPORATION. The following actions may be initiated by the Member in its sole and absolute discretion: a) Adoption of the consolidated annual budget for the System and any amendments b) The selection and retention of the President and Chief Executive Officer of this Corporation c) The selection of banking affiliations, accounting firms, legal counsel as well as approval of the engagement of any consultants not specifically provided for in an approved budget d) The selection of the manner and location of investment of any retained earnings e) Authorization of standing or ad hoc committees for controlled subsidiaries within the System ARTICLE III: THE DIRECTORS AT ALL TIMES SHALL BE, AUTOMATICALLY AND WITHOUT THE NEED OF A SEPARATE ELECTION, THE INDIVIDUALS SERVING AS DIRECTORS OF NAH. THE BYLAWS NO LONGER INCLUDE A PROVISION REGARDING THE MINIMUM OR MAXIMUM NUMBER OF BOARD MEMBERS, SINCE THE BOARD OF DIRECTORS FOR VVMC, FMC, AND NAH HAVE MERGED INTO ONE BOARD AS OF OCTOBER 2015. ARTICLE IV: THE OFFICERS OF THE BOARD ARE NOW LISTED AS THE PRESIDENT AND CEO, A CHAIR AND VICE-CHAIR, A SECRETARY, AND A TREASURER. EACH IS A VOTING MEMBER OF THE BOARD. ARTICLE V: DIRECTORS AND OFFICERS OF THE CORPORATION, OTHER THAN THE CEO WHO IS A FULL-TIME EMPLOYEE HIRED TO RUN THE DAY-TO-DAY OPERATIONS, SHALL NOT RECEIVE COMPENSATION FOR SERVING AS DIRECTORS AND/OR OFFICERS, BUT MAY RECEIVE REASONABLE COMPENSATION FOR OTHER PERSONAL SERVICES RENDERED WHICH ARE NECESSARY TO CARRYING OUT THE EXEMPT PURPOSES OF THE CORPORATION TO THE EXTENT PERMISSIBLE UNDER THE CORPORATION'S POLICIES AND PROCEDURES. ARTICLE VI: THE EXECUTIVE COMMITTEE SHALL CONSIST OF THE INDIVIDUALS THEN SERVING AS THE EXECUTIVE COMMITTEE OF NAH, AUTOMATICALLY AND WITHOUT SEPARATE ELECTION. ARTICLE VII: THE BYLAWS NOW CONTAIN PROCEDURES REQUIRING CONDUCT IN ACCORDANCE WITH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY, AND ANNUAL DISCLOSURE OF CONFLICTS. ARTICLE XII: IN ORDER TO BE GRANTED AN AMENDMENT THERE MUST BE A SUPER-MAJORITY (75%) OF DIRECTORS IN OFFICE AND ELIGIBLE TO VOTE. FORM 990, PART VI, LINE 6 NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE CORPORATE MEMBER OF FLAGSTAFF MEDICAL CENTER. FORM 990, PART VI, LINE 7A THE BOARD OF DIRECTORS IS DETERMINED BY THE ORGANIZATIONS MEMBER, NORTHERN ARIZONA HEALTHCARE (NAH). THE DIRECTORS AT ALL TIMES SHALL BE, AUTOMATICALLY AND WITHOUT THE NEED OF A SEPARATE ELECTION, THE INDIVIDUALS SERVING AS DIRECTORS OF NAH. FORM 990, PART VI, LINE 7B NORTHERN ARIZONA HEALTHCARE CORPORATION IS THE SOLE VOTING MEMBER. The following actions may be initiated by the Member in its sole and absolute discretion: a) Adoption of the consolidated annual budget for the System and any amendments b) The selection and retention of the President and Chief Executive Officer of this Corporation c) The selection of banking affiliations, accounting firms, legal counsel as well as approval of the engagement of any consultants not specifically provided for in an approved budget d) The selection of the manner and location of investment of any retained earnings e) Authorization of standing or ad hoc committees for controlled subsidiaries within the System. THE MEMBER MAY NOT TRANSFER ITS MEMBERSHIP OR ANY RIGHTS ARISING THEREFROM. FORM 990, PART VI, LINE 11B THE FORM 990 IS PREPARED BY AN ACCOUNTING FIRM BASED ON DATA GATHERED BY THE CONTROLLER AND THE ORGANIZATION'S FINANCIAL OPERATIONS GROUP. THE CFO REVIEWS THE DRAFT FORM 990 AND PROVIDES ADDITIONAL COMMENTS. THE FINAL DRAFT VERSION OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE MAY 15 DUE DATE. ANY ADDITIONAL COMMENTS SUGGESTED BY THE GOVERNING BODY ARE THEN INCORPORATED INTO THE FINAL VERSION OF THE FORM 990 TO BE FILED WITH THE IRS BY THE FINAL DUE DATE. IF ANY SUGGESTED CHANGES ARE MATERIAL OR SIGNIFICANT, AN ADDITIONAL DRAFT IS DISTRIBUTED TO THE GOVERNING BODY PRIOR TO FILING. FORM 990, PART VI, LINE 12C THE ORGANIZATION REGULARLY MONITORS AND ENFORCES COMPLIANCE WITH ITS CONFLICT OF INTEREST POLICY (BOARD POLICY 6.1). THIS IS ACCOMPLISHED BY A NUMBER OF MECHANISMS. FIRST, THE CONFLICT OF INTEREST QUESTIONNAIRE IS REVIEWED BY THE GOVERNANCE COMMITTEE OF THE BOARD. AS PART OF THE QUESTIONNAIRE, SELF-DISCLOSURE IS REQUIRED BY BOARD MEMBERS, OFFICERS, AND VPS. IN ADDITION, INDIVIDUAL DISCLOSURE BY BOARD MEMBERS OCCURS AT BOARD MEETINGS WHEN NECESSARY. A BOARD MEMBER MUST EXCLUDE HIMSELF OR HERSELF FROM VOTING ON AN ISSUE IN WHICH HE OR SHE MAY HAVE A CONFLICT OF INTEREST. THE CONTROLLER REVIEWS POTENTIAL CONFLICTS AND FOLLOWS UP WITH ANY ADDITIONAL QUESTIONS, IF NECESSARY. THEN THE SUMMARY OF RESPONSES AND CONFLICTS ARE BROUGHT BEFORE THE GOVERNANCE COMMITTEE, WHICH MAKES A DETERMINATION AS TO WHETHER A CONFLICT EXISTS. FORM 990, PART VI, LINES 15A & 15B THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S CEO AND OTHER OFFICERS INCLUDES THE PREPARATION OF COMPARABLE DATA BY WILLIS TOWERS WATSON, AN INDEPENDENT CONSULTING FIRM. IN ADDITION, THIS INFORMATION IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD AND IS DOCUMENTED IN THE BOARD MINUTES. THE MOST RECENT REVIEW WAS PERFORMED IN SEPTEMBER 2016. FORM 990, PART VI, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE AVAILABLE THROUGH THE ARIZONA DEPARTMENT OF HEALTH SERVICES. IN ADDITION, THEY ARE AVAILABLE THROUGH THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) AS PART OF THE ORGANIZATION'S CONTINUING DISCLOSURE DOCUMENTS THAT ARE REQUIRED BY ITS PUBLIC DEBT REQUIREMENTS. THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS OR ITS CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC, AS THIS IS NOT REQUIRED. FORM 990, PART VII NORTHERN ARIZONA HEALTHCARE CORPORATION (NAH) PAID $446,634 TO THE COKER GROUP HOLDINGS, LLC ("COKER") FOR THE SERVICES OF THE INTERIM CFO RICHARD LANGOSCH, WHO IS AN EMPLOYEE OF COKER GROUP. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS Increase in temporarily restricted assets $ 61,650 Additional Pension Liability $ (26,772,326) Transfers to Affiliates $ (40,234,582) -------------- TOTAL $ (66,945,258) TASC LLC (THRU 12312015) 1200 N BEAVER ST FLAGSTAFF AZ 86001 860913157 AMBULATORY SV AZ 0 0 FMC NORTHERN ARIZONA HEALTHCARE PO BOX 1268 FLAGSTAFF AZ 86001 742410946 HEALTHCARE AZ 501(C)(3) 9 NA false VERDE VALLEY MEDICAL CENTER 269 SOUTH CANDY LANE COTTONWOOD AZ 86326 860100882 HEALTHCARE AZ 501(C)(3) 3 NAH false false false false false false false false false false true true false false false true true false true true