2011-05-12T18:12:52-05:00 2010-06-30 Regier Carr & Monroe LLP 4801 E Broadway Blvd Ste 501 Tucson AZ 857113648 990 2009-07-01 860208451 Northern Cochise Community Hospital Inc NORT 5203843541 901 W Rex Allen Drive Willcox AZ 856431009 John Munson 5203843541 2011-05-12 1 David B Barber CPACFE 5206248229 2009 2016-02-24 21:20:13Z John Munson 901 W Rex Allen Drive Willcox AZ 856431009 17441843 0 X www.ncch.net X 1966 AZ To provide for the healthcare needs of the greater Willcox community and Southeast Arizona. 7 7 192 75 0 0 1406935 1436322 13407871 15945796 -230328 27690 36434 32035 14620912 17441843 11642 0 0 8301148 10880994 0 0 6874177 7889459 15186967 18770453 -566055 -1328610 8682901 8414499 5749660 6779789 2933241 1634710 To provide for the healthcare needs of the greater Willcox community and Southeast Arizona. 0 0 14337878 15945796 THE HOSPITAL PROVIDES HEALTHCARE TO THE GENERAL PUBLIC REGARDLESS OF AGE, RACE, OR ABILITY TO PAY. SERVICES INCLUDE, BUT ARE NOT LIMITED TO EMERGENCY ROOM, SURGERY, PHYSICAL THERAPY, SPEECH THERAPY, RESP THERAPY, CT SCAN, MRI, DELIVERY, NURSING HOME SERVICES, RURAL HEALTH CLINIC, AND OTHER SERVICES. THE HOSPITAL PROVIDED 12,230 PATIENT DAYS OF CARE IN FYE 6/30/10; 5,673 EMERGENCY ROOM VISITS; AND 8,324 MEDICAL (MEDICAID) AND $12,948,846 (34%) TO MEDICARE PATIENTS. 14337878 1 1 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 43 0 1 192 1 0 0 0 0 0 0 0 0 0 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 AZ X X John Munson 5203843541 901 W Rex Allen Drive Willcox AZ 856431009 Anselmo Torres 1.00 X 0 0 0 Carol Dunagan 1.00 X 0 0 0 Kathy Cook 1.00 X 0 0 0 Kay Haas 1.00 X 0 0 0 Raymond Scott 1.00 X 0 0 0 Shirley Shotten 1.00 X 0 0 0 HENRY JWEDIG JR 36.00 X X 155157 0 35575 RICHARD H SMITH 40.00 X 245426 0 23338 John R Munson 40.00 X 109380 0 11447 JEFFERY B BUSHMAN 28.00 X 343093 0 24977 MARA OKSHTEYN 32.00 X 210353 0 22697 John M Feeney 36.00 X 108588 0 7486 Sarah D Wilson 40.00 X 106658 0 43446 1278655 0 168966 7 0 1 0 EMCARE PHYSICIAN SERVICES INC 7032 Collections Center Drive CHICAGO IL 60693 ER PHYSICIANS 602897 Shared Imaging Inc PO BOX 88544 MILWAUKEE WI 53295 RADIOLOGY 471060 Elham Medical International Inc PO Box 12578 TUCSON AZ 85732 HOSPITALIST 347850 Alliance Healthcare Services FILE 55826 LOS ANGELES CA 90074 RADIOLOGY 288584 US Teleradiology 1175 Peachtree Street Ste 1425 ATLANTA GA 30361 rADIOLOGY 265943 13 1405002 31320 1436322 Patient service revenu 900099 15887342 15887342 Other service revenue 900099 58454 58454 15945796 27690 27690 32035 32035 32035 32035 17441843 15945796 0 59725 380192 273154 107038 8171734 5871091 2300643 155025 111380 43645 1595294 1146160 449134 578749 415810 162939 86284 55642 30642 63653 41048 22605 1468567 947033 521534 9996 7778 2218 435700 338301 97399 513150 442882 70268 301678 301678 Material and supplies 1584473 1523596 60877 Rent-equipment 808808 784547 24261 Repairs and maintenance 522770 406790 115980 Outside services expens 505167 393093 112074 Dues and subscriptions 257721 257721 1331492 1020174 311318 18770453 14337878 4432575 0 2328086 1398873 245648 2755435 2360272 158910 141932 50051 109712 5709922 2499573 4197899 3210349 121733 18500 8682901 8414499 2424776 2189434 3324884 2245912 0 2344443 5749660 6779789 X 2926444 1597399 6797 37311 2933241 1634710 8682901 8414499 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1168821 438125 730696 148291 63487 84804 3820037 1997961 1822076 572773 572773 3210349 Estimated amounts due to third party payers 2344443 2344443 1 1 X 0 0 0 0 0 0 51837 51837 0.00280 4445640 2513682 1931958 0.10290 4497477 2513682 1983795 0.10570 5414 3420 1994 0.00010 5414 3420 1994 0.00010 4502891 2517102 1985789 0.10580 19493 19493 0.00100 19493 19493 0.00100 1 1672290 0 6683262 6319289 363973 X 1 0 Northern Cochise Community Hospital

901 Rex Allen Dr Willcox AZ 85643

X X X X SULPHUR SPRINGS MEDICAL CENTER

900 W SCOTT Willcox AZ 85643

MEDICAL CENTER SUNSITES MEDICAL CENTER

223 N FRONTAGE RD PEARCE AZ 85625

MEDICAL CENTER NORTHERN COCHISE NURSING HOME

901 Rex Allen Dr willcox AZ 85643

NURSING HOME SPECIALTY CLINICS

900 W SCOTT Willcox AZ 85643

CLINIC SAM SIMON CLINIC

901 Rex Allen Dr willcox AZ 85643

CLINIC SENIOR BEHAVIORAL HEALTH CENTER

901 Rex Allen Dr willcox AZ 85643

MEDICAL CENTER Part I, Line 3c: The organization provides charity care based on a case by case evaluation. All information is reviewed by the PFS Director and compared with the Poverty Guidelines as well as all outstanding medical expenses. Other factors will contribute to the final decision. Part III, Line 4: The Hospital provides an allowance for doubtful accounts based upon a review of outstanding receivables, historical collection information, and existing economic conditions.Bad debts are monitored by management and are determined to be delinquent based upon review of aging reports coupled with correspondence with patients and third-party payors. Bad debts are written off when all reasonable attempts to collect the debt have been exhausted. Part VI, Line 2: The organization assesses the health care needs of the community it serves based upon historical services provided. Part VI, Line 3: It is done under patients' admission. A copy of financial assistance policy is provided to patients upon admission. The policy is also posted in the lobby, emergency room and other patient area. Patients with pass due balances are sent a letter advising them of the availability of assistance before they are sent to collection agency. Part VI, Line 4: The organization provides general medical and surgical care for inpatient, outpatient, and emergency room patients, and participates in the Medicare and Medicaid programs for the residents of Willcox community and Southeast Arizona. Part VI, Line 7: N/A X X X X 0 0 0 0 0 0 0 0 0 HENRY JWEDIG JR 144539 0 10618 0 0 0 4280 0 14484 0 173921 0 0 0 RICHARD H SMITH 216176 0 29250 0 0 0 4994 0 7735 0 258155 0 0 0 JEFFERY B BUSHMAN 296969 0 46124 0 0 0 6230 0 6788 0 356111 0 0 0 MARA OKSHTEYN 195765 0 14588 0 0 0 4580 0 7828 0 222761 0 0 0 Sarah D Wilson 82504 0 24154 0 0 0 2136 0 20122 0 128916 0 0 0 Form 990, Part VI, Section B, line 11 The return is reviewed by the CFO and made available to the Board of Directors before it is filed. Form 990, Part VI, Section B, line 12c ALL OFFICERS AND DIRECTORS ARE REQUIRED TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. THE FORMS ARE REVIEWED BY HUMAN RESOURCES FOR POTENTIAL CONFLICTS. ANY ACTUAL CONFlICTS ARE REVIEWED BY THE BOARD OF DIRECTORS. A PERSON WITH A CONFLICT IS RESTRICTED FROM VOTING ON RELATED MATTERS. Form 990, Part VI, Section B, line 15a THE CEO'S COMPENSATION IS DETERMINED ON AN ANNUAL BASIS BY A COMPENSATION COMMITTEE BASED ON COMPARABILITY DATA. THE CFO'S COMPENSATION IS DETERMINED BY THE CEO. Form 990, Part VI, Section C, line 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. Form 990, Part XI, line 2C Change in committee oversight audit from prior year The organization has a Finance Committee serving as the Audit Committee. The Finance Committee selects the engagement of individual auditor and oversees the individual auditor's work. There is no change from prior year. Northern Cochise Hospital District 901 Rex Allen dr Willcox AZ 85643 Operates Northern Cochise Community Hospital, Inc AZ N/A N/A NA 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Northern Cochise Hospital District C 1405002 Northern Cochise Hospital District Q 388308