2013-05-08T09:21:13-07:00 2012-09-30 TCA Partners LLP 1111 East Herndon Avenue Suite 211 Fresno CA 93720 990 2011-10-01 860260959 La Paz Regional Hospital LAPA 9286697400 1200 W Mohave Rd Parker AZ 85344 M Victoria Clark 2013-05-08 true Inger Sullenger CPA 5594317708 X 2011 2016-02-25 16:41:14Z M Victoria Clark 1200 W Mohave Rd Parker AZ 85344 22032383 false false X lapazhospital.org X 2000 AZ 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. 12 12 178 170 0 221843 458929 21123512 19629016 67323 42055 442883 1902383 21855561 22032383 17500 4000 0 10305240 10469148 0 0 11111469 11279521 21434209 21752669 421352 279714 21666389 22507058 2586177 3147132 19080212 19359926 To provide inpatient, outpatient healthcare and clinic Services to to the residents and visitors of La Paz County and San Bernardino County. false false 19003651 4000 21474068 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. 19003651 true true false false false false false false false false true false false false true false true false false false false false false false false false true true false false true false false false false false false false false false false false false false false false false true true true false false true 39 0 true 178 true false false false false false false false false false false false 0 false false false false false false false false false false false X 12 12 false false false false false false false true true false false false true true true true true true true true true true AZ X James Ehasz 9286697400 1200 W Mohave Rd Parker AZ 85344 Pat Wall 2.00 X 0 0 0 Jacquelyn Thomason 2.00 X 0 0 0 Keith Shillito MD 2.00 X 0 0 0 Janice Shelton 2.00 X 0 0 0 Amanda Barrera 2.00 X 0 0 0 Kevin Klopfenstein MD 2.00 X 0 0 0 Kevin Hess 2.00 X 0 0 0 Patricia Anderson 2.00 X 0 0 0 R O Cramer 2.00 X 0 0 0 Cheryl Montijo 4.00 X 0 0 0 Julian Barbara 4.00 X 0 0 0 Juanita Phelps 4.00 X 0 0 0 James Ehasz 45.00 X 112861 0 16954 Bonnie Viloria 45.00 X 108651 0 16267 M Victoria Clark 45.00 X 179757 0 20999 Norman Mendoza MD 45.00 X 232075 0 28846 George Franklin DO 45.00 X 222008 0 28048 Larry Sanders 45.00 X 126046 0 17645 Michael Roman 45.00 X 124621 0 15078 Bernie Hatmaker 45.00 X 118983 0 12134 1225002 155971 11 false true false 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 6 458929 458929 Patient service revenues 19629016 19629016 19629016 42055 42055 0 0 57331 57331 57331 57331 0 0 0 0 Meaningful Use 1599187 1599187 Laundry & Meals PIHS 27750 27750 Cafeteria, Tax & Other 218115 218115 1845052 22032383 21474068 99386 0 4000 4000 0 0 401269 108571 292698 0 7781640 6536578 1245062 209931 176342 33589 1452390 1220008 232382 623918 524091 99827 0 5750 5750 36000 36000 0 0 0 1554434 1554434 0 28409 28409 0 0 581689 488619 93070 22139 11271 10868 0 1579 1579 0 0 1520920 1335520 185400 238717 209617 29100 Purchased Svcs 650388 465367 185021 Other-Miscellaneous 1017649 917629 100020 Equipment Rent & Maintenance 1872310 1834130 38180 Supplies 3668071 3545213 122858 81466 42273 39193 21752669 19003651 2749018 0 1220 1340 3812426 6427176 0 2383590 2445253 0 0 0 707737 705544 415004 222835 21931169 10083440 12981352 11847729 0 0 0 0 1365060 857181 21666389 22507058 295966 504479 2290211 2642653 2586177 3147132 X 19080212 19359926 19080212 19359926 21666389 22507058 279714 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 53474 53474 11620138 3933413 7686725 148249 99988 48261 10057810 6050039 4007771 51498 51498 11847729 Estimated third party settlmts & Other 1981179 Accrued Payroll 661474 2642653 22032383 21752669 279714 279714 22032383 22032383 22032383 21752669 21752669 21752669 true true X true X true X true true true false true true 662001 662001 0.03040 3723637 1792300 1931337 0.08880 33000 33000 0.00150 4418638 1792300 2626338 0.12070 14 2565 119000 119000 0.00550 4 30 35000 35000 0.00160 18 2595 154000 154000 0.00710 18 2595 4572638 1792300 2780338 0.12780 5000 5000 0.00020 4 60 500 500 2 2 334 334 1 100 5000 5000 0.00020 7 162 10834 10834 0.00040 true 853243 650000 7917270 10672342 -2755072 X true true La Paz Clinical Ventures Lease Diagnostic Equipment 0.69000 0.31000 1 0 La Paz Regional Hospital

1200 Mohave Rd Parker AZ 85344

X X X La Paz Regional Hospital 1 true X X X X X X X X X true false true X X X X X X X X X X X false true true 100.0000 true 400.0000 true X X X X X X true true X X X X X true X X X true X X X X X X X true X false false 4 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 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. Number of Hospital Faciltiy - 0 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. 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. X X X false false false false false false false false false false 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 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 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 15b 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 12c 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 11 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. La Paz Regional Hospital Auxiliary PO Box 1606 Parker AZ 85344 860516206 Support La Paz Regional Hospital AZ 501(c)(3) 509a3 Type III Other N/A false La Paz Clinical Ventures LLC 1200 Mohave Rd Parker AZ 85344 263388545 Diagnostic AZ NA RELATED 108133 1008288 false true 0.00690 false false false true false false false false false true false false false false false false false true 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