LA PAZ REGIONAL HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- LA PAZ REGIONAL HOSPITAL (EIN 86-0260959)
- Tax period
- 2011-10-01 to 2012-09-30
- Filed
- 2013-05-08
- IRS object ID
- 201331289349301153
- Schema version
- 2011v1.5
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-05-08T09:21:13-07:00 | Timestamp |
| Tax Period End Date | 2012-09-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TCA Partners LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 East Herndon Avenue Suite 211 | AddressLine1 |
| City | Fresno | City |
| State | CA | State |
| ZIP Code | 93720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-10-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860260959 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | La Paz Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | LAPA | NameControl |
| Phone | 9286697400 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 W Mohave Rd | AddressLine1 |
| City | Parker | City |
| State | AZ | State |
| ZIP Code | 85344 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | M Victoria Clark | Name |
| Title | CEO | Title |
| Date Signed | 2013-05-08 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Inger Sullenger CPA | Name |
| Phone | 5594317708 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | M Victoria Clark | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 W Mohave Rd | AddressLine1 |
| City | Parker | City |
| State | AZ | State |
| ZIP Code | 85344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22032383 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | lapazhospital.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2000 | YearFormation |
| State Legal Domicile | AZ | StateLegalDomicile |
| Activity Or Mission Description | Healthcare provided: general acute & intensive hospital care; lab; radiology; ultrasound; CT; mammagrophy; MRI; cardiopulmonary; emergency room; urgent care; physical therapy; cardiac rehab.; cardiology; catheterization lab; general & orthopedic surgery; rural hlth clinics. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 12 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 178 | TotalNbrEmployees |
| Total Nbr Volunteers | 170 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 221843 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 458929 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 21123512 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 19629016 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 67323 | InvestmentIncomePriorYear |
| Investment Income Current Year | 42055 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 442883 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1902383 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 21855561 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22032383 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 17500 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 4000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 10305240 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 10469148 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 11111469 | OtherExpensePriorYear |
| Other Expenses Current Year | 11279521 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21434209 | TotalExpensesPriorYear |
| Total Expenses Current Year | 21752669 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 421352 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 279714 | RevenuesLessExpensesCY |
| Total Assets BOY | 21666389 | TotalAssetsBOY |
| Total Assets EOY | 22507058 | TotalAssetsEOY |
| Total Liabilities BOY | 2586177 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 3147132 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 19080212 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 19359926 | NetAssetsOrFundBalancesEOY |
| Mission Description | To provide inpatient, outpatient healthcare and clinic Services to to the residents and visitors of La Paz County and San Bernardino County. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 19003651 | Expense |
| Grants | 4000 | Grants |
| Revenue | 21474068 | Revenue |
| Description | La Paz Regional Hospital is a 25-bed rural hospital, designated a Sole Community Provider by CMS. LPRH operates the hospital and rural health clinics in Salome, Bouse and Quartzsite. The clinics are the only health care available in Salome and Bouse, and the only full time service in Quartzsite. The hospital is the only general hospital in La Paz County. Between our hospital and clinics, we are an essential component of county health and welfare. During the 2012 fiscal year, total inpatient admissions were 608; Adult patient days were 3,030; and total ER visits were 11,086.Our mission is to serve the residents of La Paz County and the surrounding California areas of Big River and Earp, two unincorporated areas without any healthcare resources and several hours from resources in San Bernardino. Our 12 member board of directors are chosen from our communities such that we have representation from across the county. Directors are unpaid and give tirelessly of their time and energies.LPRH saw an decrease in admissions over the prior year, due to the unexpected retirement of a long-term internal medicine physician.The Hospital is operating a satellite x-ray and CT scan unit in Quartzite, Arizona, and a surgical addition in Parker that includes nuclear medicine and a cardiac cath lab. Nuclear medicine opened in November 2009 and the cath lab and surgical suite opened in January 2010. On September 1, 2012, the Hospital opened the Parker Medical Center. | Description |
| Total Program Service Expense | 19003651 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 39 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 178 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Form8886 T Filed | false | Form8886TFiled |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Non Deductible Disclosure | false | NonDeductibleDisclosure |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Quid Pro Quo Disclosure | false | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Form720 Filed | false | Form720Filed |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 12 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Policies Reference Chapters | false | PoliciesReferenceChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | true | InvestmentInJointVenture |
| Written Policy Or Procedure | true | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | AZ | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | James Ehasz | NamePerson |
| Telephone Number | 9286697400 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 W Mohave Rd | AddressLine1 |
| City | Parker | City |
| State | AZ | State |
| ZIP Code | 85344 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Pat Wall | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Jacquelyn Thomason | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Keith Shillito MD | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Janice Shelton | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Amanda Barrera | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Kevin Klopfenstein MD | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Kevin Hess | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Patricia Anderson | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| R O Cramer | |||||||
| Member | 2.00 | X | 0 | 0 | 0 | ||
| Cheryl Montijo | |||||||
| Secretary/Treas | 4.00 | X | 0 | 0 | 0 | ||
| Julian Barbara | |||||||
| Vice Chairman | 4.00 | X | 0 | 0 | 0 | ||
| Juanita Phelps | |||||||
| Chairman | 4.00 | X | 0 | 0 | 0 | ||
| James Ehasz | |||||||
| CFO | 45.00 | 112861 | 0 | 16954 | X | ||
| Bonnie Viloria | |||||||
| DON | 45.00 | 108651 | 0 | 16267 | X | ||
| M Victoria Clark | |||||||
| CEO | 45.00 | 179757 | 0 | 20999 | X | ||
| Norman Mendoza MD | |||||||
| Physician | 45.00 | 232075 | 0 | 28846 | X | ||
| George Franklin DO | |||||||
| Physician | 45.00 | 222008 | 0 | 28048 | X | ||
| Larry Sanders | |||||||
| Pharmacist | 45.00 | 126046 | 0 | 17645 | X | ||
| Michael Roman | |||||||
| Pharmacist | 45.00 | 124621 | 0 | 15078 | X | ||
| Bernie Hatmaker | |||||||
| Dir of Radiology | 45.00 | 118983 | 0 | 12134 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1225002 | TotalReportableCompFromOrg |
| Total Other Compensation | 155971 | TotalOtherCompensation |
| Number Individuals GT100 K | 11 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Sonoran Cardiology | |||||
| PO Box 93370 | Phoenix | AZ | 85070 | Hospitalist | 132037 |
| Kenn Speer | |||||
| 1150 S 8th St | Cottonwood | AZ | 86326 | CRNA | 150000 |
| Jack Dunn MD | |||||
| 2610 Patio Simpatico | Lake Havasu City | AZ | 86406 | Radiologist | 682180 |
| Emcare Physician Services | |||||
| 815 S Palfox St | Pensacola | FL | 32502 | ER Rm Physicians | 304414 |
| William Borman | |||||
| 31798 Rio Vista Rd | Parker | AZ | 85344 | CRNA | 150000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 6 | NumberOfContractorsGT100K |
| All Other Contributions | 458929 | AllOtherContributions |
| Total Contributions | 458929 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient service revenues | Description |
| Total Revenue Column | 19629016 | TotalRevenueColumn |
| Related Or Exempt Function Income | 19629016 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 19629016 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 42055 | TotalRevenueColumn |
| Exclusion | $42,055 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 57331 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 57331 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 57331 | TotalRevenueColumn |
| Exclusion | $57,331 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|
| Meaningful Use | 1599187 | 1599187 |
| Laundry & Meals PIHS | 27750 | 27750 |
| Cafeteria, Tax & Other | 218115 | 218115 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1845052 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22032383 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21474068 | RelatedOrExemptFunctionIncome |
| Exclusion | $99,386 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4000 | Total |
| Program Services | 4000 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 401269 | Total |
| Program Services | 108571 | ProgramServices |
| Management And General | 292698 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 7781640 | Total |
| Program Services | 6536578 | ProgramServices |
| Management And General | 1245062 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 209931 | Total |
| Program Services | 176342 | ProgramServices |
| Management And General | 33589 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1452390 | Total |
| Program Services | 1220008 | ProgramServices |
| Management And General | 232382 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 623918 | Total |
| Program Services | 524091 | ProgramServices |
| Management And General | 99827 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5750 | Total |
| Management And General | 5750 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36000 | Total |
| Management And General | 36000 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1554434 | Total |
| Program Services | 1554434 | ProgramServices |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28409 | Total |
| Program Services | 28409 | ProgramServices |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 581689 | Total |
| Program Services | 488619 | ProgramServices |
| Management And General | 93070 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 22139 | Total |
| Program Services | 11271 | ProgramServices |
| Management And General | 10868 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1579 | Total |
| Program Services | 1579 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1520920 | Total |
| Program Services | 1335520 | ProgramServices |
| Management And General | 185400 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 238717 | Total |
| Program Services | 209617 | ProgramServices |
| Management And General | 29100 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Purchased Svcs | 650388 | 465367 | 185021 |
| Other-Miscellaneous | 1017649 | 917629 | 100020 |
| Equipment Rent & Maintenance | 1872310 | 1834130 | 38180 |
| Supplies | 3668071 | 3545213 | 122858 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81466 | Total |
| Program Services | 42273 | ProgramServices |
| Management And General | 39193 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 21752669 | Total |
| Program Services | 19003651 | ProgramServices |
| Management And General | 2749018 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1220 | BOY |
| EOY | 1340 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3812426 | BOY |
| EOY | 6427176 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2383590 | BOY |
| EOY | 2445253 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 707737 | BOY |
| EOY | 705544 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 415004 | BOY |
| EOY | 222835 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 21931169 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 10083440 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12981352 | BOY |
| EOY | 11847729 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1365060 | BOY |
| EOY | 857181 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21666389 | BOY |
| EOY | 22507058 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 295966 | BOY |
| EOY | 504479 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2290211 | BOY |
| EOY | 2642653 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2586177 | BOY |
| EOY | 3147132 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19080212 | BOY |
| EOY | 19359926 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 19080212 | BOY |
| EOY | 19359926 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21666389 | BOY |
| EOY | 22507058 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 279714 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Separate | X | FinancialStatementSeparate |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
| Federal Grant Audit Performed | false | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 53474 | OtherCostOrOtherBasis |
| Book Value | 53474 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 11620138 | OtherCostOrOtherBasis |
| Depreciation | 3933413 | Depreciation |
| Book Value | 7686725 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 148249 | OtherCostOrOtherBasis |
| Depreciation | 99988 | Depreciation |
| Book Value | 48261 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 10057810 | OtherCostOrOtherBasis |
| Depreciation | 6050039 | Depreciation |
| Book Value | 4007771 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 51498 | OtherCostOrOtherBasis |
| Book Value | 51498 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 11847729 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (2 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| Estimated third party settlmts & Other | $1,981,179 |
| Accrued Payroll | $661,474 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2642653 | TotalOfAmounts |
| Total Revenue | 22032383 | TotalRevenue |
| Total Expenses | 21752669 | TotalExpenses |
| Excess Or Deficit For Year | 279714 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 279714 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 22032383 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 22032383 | RevenueSubtotal |
| Total Revenue Per Form990 | 22032383 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 21752669 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 21752669 | ExpensesSubtotal |
| Total Expenses Per Form990 | 21752669 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent100 | X | Pcent100 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent400 | X | Pcent400 |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | true | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 662001 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 662001 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03040 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 3723637 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1792300 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1931337 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08880 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 33000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 33000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 4418638 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1792300 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2626338 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12070 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 14 | NumberOfActivitiesOrPrograms |
| Persons Served | 2565 | PersonsServed |
| Total Community Benefit Expense | 119000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 119000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00550 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 30 | PersonsServed |
| Total Community Benefit Expense | 35000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 35000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00160 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 18 | NumberOfActivitiesOrPrograms |
| Persons Served | 2595 | PersonsServed |
| Total Community Benefit Expense | 154000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 154000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00710 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 18 | NumberOfActivitiesOrPrograms |
| Persons Served | 2595 | PersonsServed |
| Total Community Benefit Expense | 4572638 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1792300 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 2780338 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.12780 | PercentOfTotalExpense |
Economic Development EconomicDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 5000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 4 | NumberOfActivitiesOrPrograms |
| Persons Served | 60 | PersonsServed |
| Total Community Building Expense | 500 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 500 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 2 | NumberOfActivitiesOrPrograms |
| Persons Served | 2 | PersonsServed |
| Total Community Building Expense | 334 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 334 | NetCommunityBuildingExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 1 | NumberOfActivitiesOrPrograms |
| Persons Served | 100 | PersonsServed |
| Total Community Building Expense | 5000 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 5000 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 7 | NumberOfActivitiesOrPrograms |
| Persons Served | 162 | PersonsServed |
| Total Community Building Expense | 10834 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 10834 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $853,243 | BadDebtExpenseAmount |
| Amount Attributable To | 650000 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7917270 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 10672342 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -2755072 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
Form990 Schedule H Part IV Form990ScheduleHPartIV
Name Of Entity NameOfEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | La Paz Clinical Ventures | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description Ent Primary Activity | Lease Diagnostic Equipment | DescriptionEntPrimaryActivity |
| Organization Profit Or Ownership | 0.69000 | OrganizationProfitOrOwnership |
| Physicans Profit Or Ownership | 0.31000 | PhysicansProfitOrOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 0 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | La Paz Regional Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 Mohave Rd | AddressLine1 |
| City | Parker | City |
| State | AZ | State |
| ZIP Code | 85344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | La Paz Regional Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Other Method | X | OtherMethod |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Develop Community Plan | X | DevelopCommunityPlan |
| Participate Community Plan | X | ParticipateCommunityPlan |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 100.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 400.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Other Actions | X | PermitOtherActions |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Other Actions | X | OtherActions |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Used Other Method | X | UsedOtherMethod |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 4 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (4 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Parker Medical Center | ||||
| 905 S Fiesta | Parker | AZ | 85344 | Rural Health Clinic |
| Bouse Medical Clinic | ||||
| 44031 E Plomosa Rd | Bouse | AZ | 85325 | Rural Health Clinic |
| Tri-Valley Medical Clinic | ||||
| 39726 Harquahala Rd | Salome | AZ | 85348 | Rural Health Clinic |
| La Paz Medical Services | ||||
| 150 E Tyson Rd | Quartzite | AZ | 85359 | Rural Health Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (19 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VI - Additional Information | Part III, Section B, line 8 - The Costing medthodology or source used to determine the amount reported on line 6 of Part III, Section B, is the: Medicare Cost Report. | |
| Part V - Explanation of Number of Facility Type | Besides the main hospital, there are 4 rural health clinics. | |
| Part VI - States Where Community Benefit Report Filed | AZ | |
| Part VI - Affilated Health Care System Roles and Promotion | N/A | |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | N/A | |
| Part VI - Community Building Activities | The Hospital offers Community Health Education in the following forms: CPR/First Aid Classes; Education Website/Community Publications; Health Fairs; Career Fair; Health Matters - Community Publication; and W.A.H.E.C & W.A.C.O.G. programs.Health Screenings are offered to screen: blood pressure; nutrition/obesity; school based screenings; and various other areas. Funding of professional education is offered for nurses and other health professions.Economic Development program is offered, as well as the Government sponsored health care program, PIHS. | |
| Part VI - Community Information | La Paz Regional Hospital serves the residents of La Paz County Arizona and residents of the far Eastern portion of San Bernardino County, California. There are approximately 20,000 residents in our service area. The service area includes the Colorado River Indian Tribe reservation with about 2,500 tribal members. The population is 46% white, 24% Hispanic, 24% Native American,and 6% other. The median household income is $31,000. 25% of the population is below the Federal poverty level. 33% of the population is over the age of 65. La Paz Regional Hospital is very dependent of government health care programs with the majority of its business funded by Medicare and Medicaid.La Paz County has the oldest population average in the USA. It is the poorest County in Arizona. It has the highest unemployment rate in Arizona. There are many winter visitors to the community. | |
| Part VI - Patient Education of Eligibility for Assistance | Information about La Paz Regional Hospital Financial Assistance Program is posted in the registration area of the hospital and all clinics, and is available on website, and published in the newsletter. It is explained upon admission.Any self-pay patient who presents for service is scanned in the Medi-Fax system for eligibility for AHCCCS or Medical if a California resident. The patient is referred to the local DES office for assistance and is informed of the financial assistance program and given an application (available in Spanish, if needed). The LPRH Case Manager meets with every patient. The Case Manager assists the patient in applying for AHCCCS or Medical. He/She helps the patient complete the financial assistance forms. The Case Manager arranges for after inpatient hospital care with the input of the patient. | |
| Part VI - Needs Assessment | La Paz Regional Hospital performs a needs assessment every three years. This is a survey distributed through a general mailing to all La Paz County residents. The survey asks general demographic and health questions and questions about services needed and difficulty in obtaining services. We are very rural,so we ask about what services residents are driving out of the area to receive. The results are tabulated internally and compared to previous surveys. We use this survey to try and provide the services that are needed by our residents that are within the financial ability of La Paz Regional Hospital to provide.A needs assessment is performed with the La Paz County Health Department. Census and other data are also used to assess needs. | |
| Part V, Line 19d - Other Billing Determination of Individuals Without Insurance | Automatic 30% discount for persons with no insurance | Number of Hospital Faciltiy - 0 |
| Part V, Line 16e - Other Collection Actions by Facility or Third Party Engaged | Garnishment of wages | Number of Hospital Faciltiy - 0 |
| Part V, Line 15e - Other Collection Actions Against a Patient | Garnishment of wages | Number of Hospital Faciltiy - 0 |
| Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why | La Paz County is the oldest (by age of residents) County in the United States. It also has one of the poorest and least educated populations in Arizona. There are not enough resources to address all the needs indentified in the assessment. | Number of Hospital Faciltiy - 0 |
| Part V, Line 5c - Description of Making Needs Assessment Widely Available | On La Paz County Website | Number of Hospital Faciltiy - 0 |
| Part V, Line 3 - Account Input from Person Who Represent the Community | Survey of individuals. Consult with County Health Department. Please see attached CHNA. | Number of Hospital Faciltiy - 0 |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | PURPOSE:This Policy is written to establish standards and procedures for Admitting Patients and collecting payments. This policy applies to LaPaz Regional Hospital (LPRH) and the Clinics. POLICY: All Admitting Personnel will be responsible for the following actions: 1.Greet all customers using our current AIDET Customer Service Program. 2.Collect & Input the following data to the CPSI System: a)Copy of Medical Cards (All Insurance); b)Copy of Drivers License or some form of Identification Social Security Card; c) Retirement Date (Medicare) 3. Admitting and Clinic Staff are responsible for ensuring that ALL NON-Emergency and Elective patients are screened for the ability to pay; a)If patients do not have insurance, establish their ability to pay & then brief them on applying for State Aid, supplying appropriate forms; b)If patients do not qualify for State Aid, & are considered not fully able to pay the bill, brief them on LPRHs Financial Assistance Program and the forms for application in accordance with LPRH Policy 2.2.1;c)An estimate of the patient responsibility for the service will be made by Admitting in cooperation with the Business Office. Patients will need to make a deposit of a minimum of 50% of the estimated amount due. If patients do not make the minimum deposit & have not made arrangements to pay for non-emergency & elective procedures, service will not be provided. 4.EMTALA dictates that patients admitted under Emergency Conditions must be seen by a qualified medical professional and receive a medical screening exam prior to Admitting personnel requesting information or obtaining payment. Therefore, Emergency patients will ONLY be contacted after the qualified medical professional has performed a medical screening exam of the patient. Admitting staff will be responsible for calculating the patients expected liability and for requesting that payment prior to discharge. Nursing Staff and Unit Secretaries are required to ensure that Admitting Staff is informed of all discharges in ample time so they can visit the patient in their room to finish the registration process and collect payments if applicable. If the patient is determined not to need emergency service, the service will be treated as non-emergency or elective service & be subject provisions of section 3.c of this policy. 5. For ALL non-emergency and elective services, LPRH Staff personnel will, when scheduling a patient, ensure that the referring Doctor has obtained required Authorizations prior to the procedure. LPRH Staff will inform the patient that Authorization is required for the specific procedure or service and if not on hand, will require the Patient to sign an Insurance Denial Waiver or contact their Doctor to obtain Authorization prior to providing the service. Under no circumstances should LPRH Staff personnel provide services knowingly without authorization being obtained. This will ensure that LPRH will be reimbursed for procedures and services provided. Patients with unpaid prior account balances including accounts sent to bad debt, that are determined to be receiving non-emergency or elective services will need to pay the entire amount of the service in advance of receiving treatment. 6. In calculating charges, LPRH Staff will use the following factors to come up with the amount due: a) Clinic: Collect all Co-Pays and/or Deductibles. Clinic Staff will review Patients prior accounts for outstanding balances & based on Patients requested service, collect for current charges (Per Cost Sheet)& outstanding balances; b) Admitting: The estimated charges will include hospital charges only. (Be advised to consider late or missed charges). Also, check Unpaid PRIOR Account Balances to use as a basis for the estimate. Collect on any outstanding account as well as the new one; c) Payments will also be requested from patients for services requested or authorized that are not covered by their insurer; d)Uninsured patients will be offered an automatic 30% discount, but charity care can be up to 100% depending on income/circumstances. | |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | Our Medicare population is poor and the shortfall should be considered community benefit. | |
| Part III, Line 4 - Bad Debt Expense | There is no financial statement note describing bad debt expense. The cost is computed based on the ratio of cost to charges. There is a financial statement footnote related to charity care:Charity Care: The Hospital generally accepts all patients regardless of their ability to pay. A patient is classified as a charity patient by reference to certain established policies of the Hospital. Essentially, these policies define charity services as those services for which no payment is anticipated. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as net patient service revenues. Services provided are recorded as gross patient service revenues and then written off entirely as an adjustment to net patient service revenues. | |
| Part I, Line 3c - Charity Care Eligibility Criteria (FPG Is Not Used) | Patients with no insurance receive an automatic 30% discount without regard to income. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form990 Of Other Organizations | X | Form990OfOtherOrganizations |
| Written Employment Contract | X | WrittenEmploymentContract |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg |
|---|---|---|---|---|
| Norman Mendoza MD | ||||
| 232075 | 8662 | 20184 | 260921 | 256825 |
| M Victoria Clark | ||||
| 179757 | 6674 | 14325 | 200756 | 228073 |
| George Franklin DO | ||||
| 222008 | 8034 | 20014 | 250056 | 274050 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Schedule R, Part III and Part V | The Hospital is a 69% shareholder in a limited liability corporation (LLC) with certain physicians in a joint venture involved in the operation of an MRI unit based on the Hospital's campus; the imaging equipment at Quartzite; a nuclear medicine machine; and the cath lab equipment. The Hospital intially invested $147,000 towards this venture and income or losses are periodically distributed on a ratio of 69% to the Hospital and 31% to the participating physicians. The LLC is treated on the equity method of accounting for such investments. As of September 30, 2012, the LLC was indebted for capital lease obligations in the combined amount of $1,217,267. The Hospital is the guarantor for this debt. The Hospital leases equipment from the LLC. Total lease payments for the fiscal year 2012 were: $831,276. The Hospital's share of income for the year, was $108,133. | |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Financial statements are available on the State of Arizona website (UAR). Conflict of interest policy is posted on the hospital website. Governing and other public documents can be reviewed upon request. | Form 990, Part VI, Line 19 |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The compensation of the CEO and key employees is reviewed annually by the Human Resources Director and presented to the Board of Directors. Comparative compensation information is gathered from surveys and public disclosure of Form 990 information. The compensation committee of the Board of Directors reviews this information along with the performance of the CEO and key employees to determine their compensation. | Form 990, Part VI, Line 15b |
| Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | The information submitted by the Board is reviewed by a Board Committee and if there is a conflict of interest, the Board member is required to resolve the conflict within 30 days or resign from the Board of Directors. | Form 990, Part VI, Line 12c |
| Form 990, Part VI, Line 11: Form 990 Review Process | The Form 990 is provided to the Board of Directors prior to being filed. The form 990 is discussed at the Board Meeting and any questions answered by the chief Financial Officer. If there are additional questions, the accounting firm that compiled the Form 990 is consulted. | Form 990, Part VI, Line 11 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | La Paz Regional Hospital Auxiliary | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 1606 | AddressLine1 |
| City | Parker | City |
| State | AZ | State |
| ZIP Code | 85344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860516206 | EIN |
| Primary Activities | Support La Paz Regional Hospital | PrimaryActivities |
| Legal Domicile State | AZ | LegalDomicileState |
| Exempt Code Section | 501(c)(3) | ExemptCodeSection |
| Public Charity Status | 509a3 Type III Other | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | false | ControlledOrg |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | La Paz Clinical Ventures LLC | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1200 Mohave Rd | AddressLine1 |
| City | Parker | City |
| State | AZ | State |
| ZIP Code | 85344 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 263388545 | EIN |
| Primary Activity | Diagnostic | PrimaryActivity |
| Legal Domicile State | AZ | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 108133 | ShareOfTotalIncome |
| Share Of EOY Assets | 1008288 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| General Or Managing Partner | true | GeneralOrManagingPartner |
| Percentage Ownership | 0.00690 | PercentageOwnership |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| La Paz Clinical Ventures LLC | ||
| j | 831276 | Contract/Accrl |
| La Paz Clinical Ventures LLC | ||
| d | 1217264 | Cap Lse Value |
| La Paz Regional Hospital Auxiliary | ||
| r | 77000 | Cash Value |