WHITE MOUNTAIN REGIONAL MEDICAL CENTER: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- WHITE MOUNTAIN REGIONAL MEDICAL CENTER (EIN 86-0171900)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-10-31
- IRS object ID
- 201203059349300130
- Schema version
- 2011v1.2
- 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 | 2012-10-31T11:18:53-07:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | 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 | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 860171900 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | White Mountain Communities Hospital Inc | BusinessNameLine1 |
| Business Name Line2 | dba White Mountain Regional Medical Ctr | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | WHIT | NameControl |
| Phone | 9283337142 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 85938 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Samuel Grant | Name |
| Title | CFO/Interim CEO | Title |
| Date Signed | 2012-10-31 | 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 | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Samuel Grant | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 859385104 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18334621 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | wmrmc.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1962 | YearFormation |
| State Legal Domicile | AZ | StateLegalDomicile |
| Activity Or Mission Description | WMRMC will provide caring services & operate in financially sound basis to ensure its continuing ability to meet the healthcare needs of patients & the communities it serves. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 205 | TotalNbrEmployees |
| Total Nbr Volunteers | 70 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 913434 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 582379 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 17750785 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 17593366 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 863 | InvestmentIncomePriorYear |
| Investment Income Current Year | 1493 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 191139 | OtherRevenuePriorYear |
| Other Revenue Current Year | 157383 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 18856221 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18334621 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 9757055 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 9019530 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 9669272 | OtherExpensePriorYear |
| Other Expenses Current Year | 9100726 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 19426327 | TotalExpensesPriorYear |
| Total Expenses Current Year | 18120256 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -570106 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 214365 | RevenuesLessExpensesCY |
| Total Assets BOY | 6521914 | TotalAssetsBOY |
| Total Assets EOY | 6405482 | TotalAssetsEOY |
| Total Liabilities BOY | 3907676 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2584673 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 2614238 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3820809 | NetAssetsOrFundBalancesEOY |
| Mission Description | The board of directors and leadership at WMRMC recongnize the importance of healthcare as a service essential for the well-being of people in the region and as an important part of the community's economy. See also, Form 990, Part I, Ln 1. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 14492289 | Expense |
| Revenue | 17593366 | Revenue |
| Description | The Board of Directors and Leadership at WMRMC recognize the importance of healthcare as a service essential for the well-being of people in the region and as an important part of the community's economy.Patient Services - The organization provides acute inpatient care, emergency health care and outpatient health care services to community members of Southern Apache County, Arizona and Catron County, New Mexico. Recent accomplishments include: implementation of a Swing Bed program; renovation of the Medical/Surgical Department and the Nurse call station; and the reopening of the Intensive Care Unit. In 2011, the total number of visits was: 16,765. | Description |
| Total Program Service Expense | 14492289 | 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 | true | 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 | true | 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 | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 65 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 205 | 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 | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | 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 | false | InvestmentInJointVenture |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedure |
| States Where Copy Of Return Is Filed | AZ | StatesWhereCopyOfReturnIsFiled |
| Own Website | X | OwnWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Finance Department | NamePerson |
| Telephone Number | 9283337142 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 859385104 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (16 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 |
|---|---|---|---|---|---|---|---|
| Travis Udall | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Scott Hamblin MD | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| Gary Davis | |||||||
| Board Member | 1.00 | X | 0 | 0 | 0 | ||
| James Sielski MD | |||||||
| Chf of Staff | 1.00 | X | 0 | 0 | 0 | ||
| John Fredericksen | |||||||
| Treasurer | 1.00 | X | 0 | 0 | 0 | ||
| Nadia Comvaluis MD | |||||||
| Secretary | 1.00 | X | 0 | 0 | 0 | ||
| Ryan Patterson | |||||||
| Vice President | 1.00 | X | 0 | 0 | 0 | ||
| Mary Nedrow | |||||||
| President | 1.00 | X | 0 | 0 | 0 | ||
| Michael Herring | |||||||
| Current CNO | 40.00 | 90807 | 0 | 0 | X | ||
| Jerry Campeau | |||||||
| CEO | 40.00 | 88451 | 0 | 227 | X | ||
| Samuel Grant | |||||||
| CFO | 40.00 | 15118 | 0 | 1291 | X | ||
| Christine Jackson MD | |||||||
| Physician | 40.00 | 194000 | 0 | 0 | X | ||
| Carla Rotering MD | |||||||
| Physician | 20.00 | 185269 | 0 | 8873 | X | ||
| Everett Smith | |||||||
| Pharmacist | 40.00 | 174648 | 0 | 17982 | X | ||
| Oliver Schelksohn MD | |||||||
| Physician | 40.00 | 166594 | 0 | 10779 | X | ||
| Michael Foote MD | |||||||
| 40.00 | 164396 | 0 | 7557 | X | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1079283 | TotalReportableCompFromOrg |
| Total Other Compensation | 46709 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | 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 |
|---|---|---|---|---|---|
| Round Valley Emergency Care | |||||
| c/o 118 South Mountain Ave | Springerville | AZ | 859385104 | ER Physicians/PA | 866632 |
| Farnam Street Financial Inc | |||||
| 240 Pondview Plaza 5850 Opus Pkwy | Hopkins | MN | 55343 | Equipment Rentals | 509269 |
| Concentric Healthcare Solutions | |||||
| 4250 N Drinkwater Blvd 165 | Scottsdale | AZ | 85251 | Registry/Labor | 311916 |
| Coast to Coast Healthcare Services | |||||
| 5195 Hampstead Village Ctr Ste 256 | New Albany | OH | 43054 | ER Physicians/PA | 1085221 |
| Amerisource Bergen | |||||
| 1825 S 43rd Ave Ste B | Phoenix | AZ | 85009 | Pharmacy/Drugs | 268692 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| All Other Contributions | 582379 | AllOtherContributions |
| Noncash Contributions | 1000 | NoncashContributions |
| Total Contributions | 582379 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net Patient Service Revs | Description |
| Total Revenue Column | 17593366 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17593366 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 17593366 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1493 | TotalRevenueColumn |
| Exclusion | $1,493 | 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 | 12000 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 12000 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12000 | TotalRevenueColumn |
| Exclusion | $12,000 | 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Cafeteria, Rebates, etc. | Description |
| Total Revenue Column | 145383 | TotalRevenueColumn |
| Exclusion | $145,383 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 145383 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18334621 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17593366 | RelatedOrExemptFunctionIncome |
| Exclusion | $158,876 | 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 | 0 | Total |
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 | 195894 | Total |
| Program Services | 156673 | ProgramServices |
| Management And General | 39221 | 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 | 7033280 | Total |
| Program Services | 5625104 | ProgramServices |
| Management And General | 1408176 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1278906 | Total |
| Program Services | 1022848 | ProgramServices |
| Management And General | 256058 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 511450 | Total |
| Program Services | 409049 | ProgramServices |
| Management And General | 102401 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3855 | Total |
| Program Services | 3083 | ProgramServices |
| Management And General | 772 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 88953 | Total |
| Program Services | 71143 | ProgramServices |
| Management And General | 17810 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28620 | Total |
| Program Services | 22890 | ProgramServices |
| Management And General | 5730 | 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 | 2432772 | Total |
| Program Services | 1945692 | ProgramServices |
| Management And General | 487080 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 28436 | Total |
| Program Services | 22743 | ProgramServices |
| Management And General | 5693 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36745 | Total |
| Program Services | 29388 | ProgramServices |
| Management And General | 7357 | ManagementAndGeneral |
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 | 0 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 29767 | Total |
| Program Services | 23807 | ProgramServices |
| Management And General | 5960 | 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 | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 80257 | Total |
| Program Services | 64188 | ProgramServices |
| Management And General | 16069 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 438666 | Total |
| Program Services | 350838 | ProgramServices |
| Management And General | 87828 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 232855 | Total |
| Program Services | 186234 | ProgramServices |
| Management And General | 46621 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Utilities | 355503 | 284326 | 71177 |
| Supplies | 1067573 | 853828 | 213745 |
| Purchased Services | 540848 | 432562 | 108286 |
| Equipment Rent & Maintenance | 1211774 | 969157 | 242617 |
| Bad Debt | 2174222 | 1738908 | 435314 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 349880 | Total |
| Program Services | 279828 | ProgramServices |
| Management And General | 70052 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 18120256 | Total |
| Program Services | 14492289 | ProgramServices |
| Management And General | 3627967 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 675 | BOY |
| EOY | 675 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 284654 | BOY |
| EOY | 416984 | 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 | 2140221 | BOY |
| EOY | 1282876 | 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 | 314834 | BOY |
| EOY | 412608 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6790 | BOY |
| EOY | 8510 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 8060774 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4725824 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2521382 | BOY |
| EOY | 3334950 | 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 | 1253358 | BOY |
| EOY | 948879 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6521914 | BOY |
| EOY | 6405482 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2492360 | BOY |
| EOY | 1017949 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 371551 | BOY |
| EOY | 809832 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 38688 | BOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1005077 | BOY |
| EOY | 756892 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3907676 | BOY |
| EOY | 2584673 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2614238 | BOY |
| EOY | 3820809 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2614238 | BOY |
| EOY | 3820809 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6521914 | BOY |
| EOY | 6405482 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 214365 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 992206 | ReconcilationOtherChanges |
| 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 | 26067 | OtherCostOrOtherBasis |
| Book Value | 26067 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4565692 | OtherCostOrOtherBasis |
| Depreciation | 2380721 | Depreciation |
| Book Value | 2184971 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3469015 | OtherCostOrOtherBasis |
| Depreciation | 2345103 | Depreciation |
| Book Value | 1123912 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 3334950 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (3 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| Other Assets | 31428 |
| Health Care District Receivable | 441919 |
| Construction in Progress | 475532 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 948879 | TotalBookValueOtherAssets |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Estimated third party payor settlements | Description |
| Amount | $756,892 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 756892 | TotalOfAmounts |
| Total Revenue | 18334621 | TotalRevenue |
| Total Expenses | 18120256 | TotalExpenses |
| Excess Or Deficit For Year | 214365 | ExcessOrDeficitForYear |
| Other | $992,206 | OtherAmount |
| Total Adjustments | 992206 | TotalAdjustments |
| Excess Or Deficit Per FS | 1206571 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 19326827 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 992206 | OtherRevenues |
| Revenue Not Rptd F990 | 992206 | RevenueNotRptdF990 |
| Revenue Subtotal | 18334621 | RevenueSubtotal |
| Total Revenue Per Form990 | 18334621 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 18120256 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 18120256 | ExpensesSubtotal |
| Total Expenses Per Form990 | 18120256 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Part XII, Line 2d | Part XII, Line 2d: Other revenue amounts included in F/S but not included on form 990 | Extraordinary Item - Fire recovery $992206 |
| Part XI, Line 8 | Part XI, Line 8: Other Changes in Net Assets or Fund Balances | Extraordinary Gain - Fire Recovery $992206 |
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 |
Discounted Other DiscountedOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Discounted Other Percentage | 100.000000000 | DiscountedOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
| Report Publically Available | false | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 131579 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 131579 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00730 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1567721 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1567721 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.08650 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1699300 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1699300 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09380 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1699300 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1699300 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.09380 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $1,176,689 | BadDebtExpenseAmount |
| Amount Attributable To | 131579 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 13696268 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7412420 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 6283848 | 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 | false | ProvisionForCharityCare |
| 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 | White Mountain Commun Hosp | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 118 South Mountain Ave | AddressLine1 |
| City | Springerville | City |
| State | AZ | State |
| ZIP Code | 859385104 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| 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 | White Mountain Commun Hosp | 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 |
| Take Into Account | false | TakeIntoAccount |
| Other Facilities | false | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | true | 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 | 300.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| 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 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 Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| 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 |
| Lowest Negotiated Rates | X | LowestNegotiatedRates |
| Medicare Rate | X | MedicareRate |
| 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 | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| White Mtn Reg RehabWellness | ||||
| 118 South Mountain Ave | Springerville | AZ | 859385104 | Rehab/Wellness Center |
| White Mtn Reg Specialty Clinic | ||||
| 118 South Mountain Ave | Springerville | AZ | 859385104 | Specialty Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VI - Additional Information | N/A | |
| Part V - Explanation of Number of Facility Type | Besides the main Hospital, there is a rehabilitation/wellness center, and a clinic. | |
| 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 | N/A | |
| Part VI - Community Information | The Hospital serves Southern Apache County, Arizona, as well as: Catron County, New Mexico. Both are high poverty level areas. | |
| Part VI - Patient Education of Eligibility for Assistance | All hospital patients are advised of available options, if an inability to pay is expressed. | |
| Part VI - Needs Assessment | Since the organization is the only Hospital for over 50 miles, it provides services that are not otherwise offered in the community. | |
| Part V, Line 19d - Other Billing Determination of Individuals Without Insurance | 20% Discount | Number of Hospital Faciltiy - 0 |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | Policy: It is the policy of White Mountain Regional Medical Center to establish a consistent policy to establish a procedure in determining "Charity Cases." Procedure: Charity Care is defined as an inability to pay. The patients indigence must be determined by the facility, not by the patient. This determination may occur at any time prior to the patients account achieving zero balance; prior to admission, at admission, after discharge or during the billing and collection process.The charity determination is to be made based on the patient/responsible partys net worth, net income and the number of members in the household. White Mountain Regional Medical Center bases their charity care on the Federal Poverty Income Guidelines. The facility must determine that no source other than the patient/responsible party would be legally responsible for the patients medical bill. This includes federal, state or local financial programs and/or legal guardians.The patients business office file will contain documentation of the method by which indigence was determined along with all supporting documentation to substantiate the decision. The final determination will be made by the CFO, with the recommendation of the Patient Account Supervisor. | |
| Part III, Line 4 - Bad Debt Expense | Bad Debt ExpenseThe Hospital does not include a bad debt expense note in their Financial Statements, but the organization does have a Bad Debt Policy.POLICY: It is the policy of White Mountain Regional Medical Center to establish a consistent procedure to identify and process bad debt accounts. Definition: Bad debt is defined as an uncollectible account.Procedure: The process to determine an uncollectible account will include the patient receiving an initial statement, a follow up statement will be sent in 30 days, a follow up telephone call within the next 30 days with verbal notification of 10 day notice to pay (pre collection notice). A final call will then be made 10 days later with verbal notification of the account pending collection before determining if the account is bad debt. If no payment is received by the time all of the above steps have been taken, the account is then sent to a collection agency and written off as bad debt.The Patient Account Supervisor will keep a yearly spreadsheet and documentation on all bad debt accounts. Other Documentation/Equipment: Bad debt log; Medicare bad debt log.Charity CareThere are notes entitled "Charity Care" and "Charity Care and Community Benefit Expense" included in the Financial Statements:Charity Care: The Hospital 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.CHARITY CARE AND COMMUNITY BENEFIT EXPENSEThe Hospital maintains records to identify and monitor the level of charity care and community service it provides. These records include: the amount of charges foregone, (based on established rates), for services and supplies furnished under its charity care and community service policies; the estimated cost of those services and supplies; and statistics quantifying the level of charity care as a percentage of expenses of the Hospital as a whole. The following is a summary of the Hospital's charity care and community benefit charges foregone for the years ended December 31, 2011 and 2010, in terms of services to the poor and benefits to the broader community: Benefits for the poor: Traditional charity care for 2011, and 2010, respectively: $243,124, $14,531. Unpaid Medicaid program charges for 2011, and 2010, respectively: $2,896,750, $2,928,657. Total quantifiable benefits for the poor, for 2011 and 2010, respectively: $3,139,874, $2,943,188. Benefits for the broader community: Unpaid Medicare program charges and total quantifiable benefits for the broader community, for 2011, and 2010,respectively: $6,380,107, $5,392,052. Total quantifiable community benefits combined, for 2011 and 2010, respectively: $ 9,519,981, $ 8,335,240. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| 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 (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg |
|---|---|---|---|
| Oliver Schelksohn MD | |||
| 166594 | 10779 | 177373 | 137498 |
| Michael Foote MD | |||
| 164396 | 7557 | 171953 | 110749 |
| Everett Smith | |||
| 174648 | 17982 | 192630 | 180375 |
| Christine Jackson MD | |||
| 194000 | 194000 | 158271 | |
| Carla Rotering MD | |||
| 185269 | 8873 | 194142 | |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch J, Part III, Additional Information | Identifier |
| Return Reference | Part III, Additional Information | ReturnReference |
| Explanation | Schedule J, Part 1, Line 3: The organization utilizes Wage Watch for comparison salary data, the CEO salary is approved by the Board and the other officers and staff are approved by the CEO and CFO. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV (3 entries)
| RelationshipRelationship | Amount Of TransactionAmountOfTransaction | Description Of TransactionDescriptionOfTransaction | Sharing Of RevenuesSharingOfRevenues |
|---|---|---|---|
| Mary Nedrow | |||
| Son-In-Law | 63105 | Employed as IT Mgr | false |
| Scott Hamblin | |||
| Brother | 95355 | Employed as Phys Therapist | false |
| Gary Davis | |||
| Son-In-Law | 99993 | Employed as Phys Therapist | false |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Please see explanation of family relationships on Schedule O, as a response to Form 990 Part VI, Line 2: Business or Family Relationship of Officers, Directors, etc. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| Form 990, Part VI, Line 19 | Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Available 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 organization utilizes Wage Watch for comparison salary data, the CEO salary is approved by the Board and the other officers and staff are approved by the CEO and CFO. |
| Form 990, Part VI, Line 12c | Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts | Done on an annual basis, and the individual signs acknowledgement of policy. |
| Form 990, Part VI, Line 11 | Form 990, Part VI, Line 11: Form 990 Review Process | The Form 990 is reviewed by all voting Board Members at a Board Meeting prior to filing. |
| Form 990, Part VI, Line 2 | Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | The following describes some family relationships: WMRMC employs Board Member Gary Davis' son in law (Tom Hunt) as a physical therapist and his wife (Kathleen Davis) as a PT Transcriptionist; WMRMC employs Board Member Scott Hambin as a physician, and his brother Steve Hamblin as a physical therapist; WMRMC employs Board Member Mary Nedrow's son-in-law (Robert Martin)as an IT Manager. The family relationships of Gary Davis; Scott Hamblin; and Mary Nedrow were deemed business relationships (thus reportable as business transactions on Schedule L), due to the value of the transactions exceeding the $10,000 threshold. The requirement to report these family transactions on Schedule L, results in the loss of independence of these board members in voting: per Form 990 instructions. |