2012-07-30T10:17:03-07:00 2011-09-30 TCA Partners LLP 1111 East Herndon Avenue Suite 211 Fresno CA 93720 990 2010-10-01 860260959 La Paz Regional Hospital LAPA 9286697400 1200 W Mohave Rd Parker AZ 85344 M Victoria Clark 2012-07-30 Inger Sullenger CPA 5594317708 X 2010 2016-02-24 21:20:13Z M Victoria Clark 1200 W Mohave Rd Parker AZ 85344 21855561 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 12 248 34 0 94920 221843 23247809 21123512 84081 67323 331663 442883 23758473 21855561 17500 0 10099380 10305240 0 0 12134106 11111469 22233486 21434209 1524987 421352 21312282 21666389 2653422 2586177 18658860 19080212 To provide healthcare to the residents and visitors of La Paz County and the surrounding California areas of Big River and Earp. false false 18999647 17500 21512485 La Paz Regional Hospital is a 39-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 and served 35,649 patients in 2010. Inpatient admissions were 1125.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 13 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 increase in admissions over the prior year, due to the recruiting of a cardiologist and the addition of a Cath Lab.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. 18999647 true true false false false false false false false false true false false true true false true false false false false false false false false false true true false true true false false false false false false false false false false false false false false false false true true true false false true 44 0 true 248 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 false true true AZ X X James Ehasz 9286697400 1200 W Mohave Rd Parker AZ 85344 Roger Crossman 2.00 X 0 0 0 Robert Wall 2.00 X 0 0 0 R O Cramer 2.00 X 0 0 0 Norman Mendoza MD 45.00 X 226681 0 30144 Melinda Astran MD 45.00 X 193679 0 23340 M Victoria Clark 45.00 X 206181 0 21892 Larry Sanders 45.00 X 140770 0 19108 Kevin Klopfenstein MD 2.00 X 0 0 0 Kevin Hess 2.00 X 0 0 0 Keith Shillito MD 2.00 X 0 0 0 Julian Barbara 4.00 X 0 0 0 Juanita F Phelps 4.00 X 0 0 0 Janice Shelton 2.00 X 0 0 0 James Ehasz 45.00 X 120761 0 16840 Jacquelyn Thomason 2.00 X 0 0 0 George Franklin DO 45.00 X 242630 0 31420 Cheryl Montijo 4.00 X 0 0 0 Bonnie Viloria 45.00 X 107682 0 12153 Bernie Hatmaker 45.00 X 127770 0 10478 Amanda Leivas-Sharpe 2.00 X 0 0 0 1366154 165375 10 false true false William Borman 31798 Rio Vista Rd Parker AZ 85344 CRNA 150000 Western Urological Services 601 W Riverside Dr Ste 3 Parker AZ 85344 Urology 291958 Kenn Speer 1150 S 8th St Cottonwood AZ 86326 CRNA 150000 Jack Dunn MD 2610 Patio Simpatico Lake Havasu City AZ 86406 Radiologist 709779 Emcare Physician Services 815 S Palafox St Pensacola FL 32502 ER Room Physicians 183979 6 84675 123399 13769 221843 Patient service revenues 21123512 21123512 21123512 67323 67323 0 0 53910 53910 53910 53910 0 0 0 0 Laundry & Meals to HIS 68153 68153 Joint Venture 72521 72521 Cafeteria, Tax & Other 248299 248299 388973 21855561 21512485 121233 0 17500 17500 0 0 390613 103586 287027 0 7842525 6579522 1263003 208674 175286 33388 1287047 1081119 205928 576381 484160 92221 0 25182 25182 41250 41250 0 0 0 1303773 1303773 27356 27356 0 0 0 357150 300006 57144 40309 30908 9401 0 11171 10522 649 0 0 1545028 1356689 188339 242113 212599 29514 Supplies 4314585 4210948 103637 Purchased Svcs 124974 124974 Postage and Shipping 34159 11559 22600 Other-Miscellaneous 1139078 1073964 65114 Equipment Rent & Maintenance 1905341 1895176 10165 0 21434209 18999647 2434562 0 904 1220 3983064 3812426 0 2623933 2383590 0 0 0 608544 707737 236739 415004 21700134 8718782 12468950 12981352 0 0 0 0 1390148 1365060 21312282 21666389 227331 295966 2426091 2290211 2653422 2586177 X 18658860 19080212 18658860 19080212 21312282 21666389 421352 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 53474 53474 11644089 3544516 8099573 148249 84025 64224 9211770 5090241 4121529 642552 642552 12981352 Other Receivables 153749 Joint Ventures, La Paz Clinical Ventures 147000 Estimated Third Party Payor Settlements 157352 Deferred Costs & Notes Receivable 835464 Assets limited as to use 71495 1365060 Estimated third party settlmts & Other 1658123 Accrued Payroll 632088 2290211 21855561 21434209 421352 421352 21855561 21855561 21855561 21434209 21434209 21434209 true true X true X 300.000000000 true X true true true false true true 227911 227911 0.01060 1813483 1813483 0.08460 2041394 2041394 0.09520 2041394 2041394 0.09520 1 4800 4800 0.00020 1 60 1500 1500 0.00010 25 2757 169234 169234 0.00790 27 2817 175534 175534 0.00820 true 1178538 707000 8272673 9755492 -1482819 X true true La Paz Clinical Ventures Lease Diagnostic Equipment 0.66000 0.34000 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 11 true false true X X X X X X X X X X false true true 100.0000 true 300.0000 true X X X X X X true true X X X X X X true X X true X X X X X X true X false false 3 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 3 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 Western 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 30% Discount Number of Hospital Faciltiy - 0 Part V, Line 13g - Other Means Hospital Facility Publicized the Policy Posted on Facebook and on newsletters Number of Hospital Faciltiy - 0 Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why There are so many needs in the service area that it would take years to address them all, and most likely there would not be enough resources to address all of the needs. Number of Hospital Faciltiy - 0 Part V, Line 3 - Account Input from Person Who Represent the Community contained in the assessment 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 We are the poorest County in the State of Arizona by the 2010 Census. Most of our patients are at or near the poverty level. The entire 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. true X 0 0 Tuition Reimbursement 3 17500 Cost of Tuition Grantmaker's Description of How Grants are Used Our grants are to empolyees for education to obtain nursing degrees or radiology tech certification. The recipients have an obligation to work for La Paz Regional Hospital for a specified time period, in order for the grant to be forgiven. X X X false false false false false false false false false false Norman Mendoza MD 226681 9067 21077 256825 234755 Melinda Astran MD 193679 7747 15593 217019 M Victoria Clark 206181 8247 13645 228073 187874 Larry Sanders 140770 5631 13477 159878 George Franklin DO 242630 9705 21715 274050 224586 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, 2010, the LLC was indebted for capital lease obligations in the combined amount of $2,413,315. The Hospital is the guarantor for this debt. The Hospital leases equipment from the LLC. Total lease payments for the fiscal year 2010 were: $747,858 (MRI $269,820 and Quartzite Imaging $164,604, Nuclear Medicine $63,180, Cath Lab $250,254). The Hospital's share of income for the year, was $27,585. Form 990, Part VI, Line 19 Form 990, Part VI, Line 19: Other Organization Documents Publicly Available These documents are available upon request. Form 990, Part VI, Line 12c Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts Board members annually complete the conflict of interest statement. CFO reviews every check that is issued. Any questions are brought before the CEO and Board Chair. Form 990, Part VI, Line 11 Form 990, Part VI, Line 11: Form 990 Review Process The Form 990 is prepared by an independent accounting firm. The information for the form is compliled by the Chief Financial Officer and submitted to the accounting firm. The Form 990 is distributed to the Board of Directors a minimum of one week before the Board meeting at which the Form 990 will be reviewed. The Chief Executive Officer and the Chief Financial Officer review the Form 990 with the Board of Directors at this board meeting before the form is submitted to the IRS and the State of Arizona. 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 72521 1361595 false true 0.0066 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 contrct/accrual La Paz Clinical Ventures LLC d 1805305 Cap Lse Value La Paz Regional Hospital Auxiliary r 84675 Cash Value