2012-10-31T11:18:53-07:00 2011-12-31 TCA Partners LLP 1111 East Herndon Avenue Suite 211 Fresno CA 93720 990 2011-01-01 860171900 White Mountain Communities Hospital Inc dba White Mountain Regional Medical Ctr WHIT 9283337142 118 South Mountain Ave Springerville AZ 85938 Samuel Grant 2012-10-31 true Inger Sullenger CPA 5594317708 X 2011 2016-02-24 21:20:13Z Samuel Grant 118 South Mountain Ave Springerville AZ 859385104 18334621 false false X wmrmc.com X 1962 AZ 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. 8 5 205 70 0 913434 582379 17750785 17593366 863 1493 191139 157383 18856221 18334621 0 0 9757055 9019530 0 0 9669272 9100726 19426327 18120256 -570106 214365 6521914 6405482 3907676 2584673 2614238 3820809 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. false false 14492289 17593366 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. 14492289 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 false true false false false false false false false false false true false false false false false false false false false false false true 65 0 true 205 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 8 5 true false false false false false false true true false false false true true true true true true true true false false AZ X X Finance Department 9283337142 118 South Mountain Ave Springerville AZ 859385104 Travis Udall 1.00 X 0 0 0 Scott Hamblin MD 1.00 X 0 0 0 Gary Davis 1.00 X 0 0 0 James Sielski MD 1.00 X 0 0 0 John Fredericksen 1.00 X 0 0 0 Nadia Comvaluis MD 1.00 X 0 0 0 Ryan Patterson 1.00 X 0 0 0 Mary Nedrow 1.00 X 0 0 0 Michael Herring 40.00 X 90807 0 0 Jerry Campeau 40.00 X 88451 0 227 Samuel Grant 40.00 X 15118 0 1291 Christine Jackson MD 40.00 X 194000 0 0 Carla Rotering MD 20.00 X 185269 0 8873 Everett Smith 40.00 X 174648 0 17982 Oliver Schelksohn MD 40.00 X 166594 0 10779 Michael Foote MD 40.00 X 164396 0 7557 1079283 46709 5 false true false 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 5 582379 1000 582379 Net Patient Service Revs 17593366 17593366 17593366 1493 1493 0 0 12000 12000 12000 12000 0 0 0 0 Cafeteria, Rebates, etc. 145383 145383 145383 18334621 17593366 158876 0 0 0 0 195894 156673 39221 0 7033280 5625104 1408176 0 1278906 1022848 256058 511450 409049 102401 3855 3083 772 88953 71143 17810 28620 22890 5730 0 0 0 2432772 1945692 487080 28436 22743 5693 36745 29388 7357 0 0 0 29767 23807 5960 0 0 80257 64188 16069 0 438666 350838 87828 232855 186234 46621 Utilities 355503 284326 71177 Supplies 1067573 853828 213745 Purchased Services 540848 432562 108286 Equipment Rent & Maintenance 1211774 969157 242617 Bad Debt 2174222 1738908 435314 349880 279828 70052 18120256 14492289 3627967 0 675 675 284654 416984 0 2140221 1282876 0 0 0 314834 412608 6790 8510 8060774 4725824 2521382 3334950 0 0 0 0 1253358 948879 6521914 6405482 2492360 1017949 371551 809832 38688 1005077 756892 3907676 2584673 X 2614238 3820809 2614238 3820809 6521914 6405482 X 214365 992206 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 26067 26067 4565692 2380721 2184971 3469015 2345103 1123912 3334950 Other Assets 31428 Health Care District Receivable 441919 Construction in Progress 475532 948879 Estimated third party payor settlements 756892 756892 18334621 18120256 214365 992206 992206 1206571 19326827 992206 992206 18334621 18334621 18120256 18120256 18120256 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 true true X true X true X 100.000000000 true true false false false false 131579 131579 0.00730 1567721 1567721 0.08650 1699300 1699300 0.09380 1699300 1699300 0.09380 true 1176689 131579 13696268 7412420 6283848 X true false 1 0 White Mountain Commun Hosp

118 South Mountain Ave Springerville AZ 859385104

X X X X White Mountain Commun Hosp 1 true X X X false false true X X X X X X X true true true 100.0000 true 300.0000 true X X X X X X X true true X X X X true X X true X X X X X true X X X false false 2 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 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. Number of Hospital Faciltiy - 0 Part V, Line 19d - Other Billing Determination of Individuals Without Insurance 20% Discount 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. X X false false false false false false false false false false 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 Sch J, Part III, Additional Information Part III, Additional Information 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. 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 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. 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.