2023-11-04T13:05:16-05:00 2022-12-31 FORVIS LLP 14241 DALLAS PARKWAY SUITE 1100 DALLAS TX 75254 990 2022-01-01 860320447 Summit Healthcare Association % DAVID ROTHENBERGER SUMM 9285374375 2200 E Show Low Lake Road Show Low AZ 85901 DAVID ROTHENBERGER CFO 9285374375 2023-11-15 true DAVID ROTHENBERGER 999009999 JEANETTE VERRELLI P00742631 9727028262 2022 2023-04-26 12:10:37Z Summit HC Regional Medical Center Brian Turney 2200 E SHOW LOW LAKE ROAD SHOW LOW AZ 85901 308157154 false X WWW.SUMMITHEALTHCARE.NET X 1976 AZ PROMOTE HEALTH AND WELLNESS TO THE COMMUNITIES WE SERVE. WE INVEST IN STATE-OF-THE-ART EQUIPMENT .... (see Schedule O) 6 4 1526 41 0 0 11237908 1859547 243298763 272415923 1031317 8614194 2738151 1114169 258306139 284003833 0 0 0 0 115505601 113070700 0 0 0 137625962 162524572 253131563 275595272 5174576 8408561 298424920 280929746 136125672 126330916 162299248 154598830 X TRUSTED TO DELIVER EXCEPTIONAL, COMPASSIONATE CARE CLOSE TO HOME. SUMMIT HEALTHCARE CONTINUES TO PROMOTE HEALTH AND WELLNESS TO THE COMMUNITIES WE SERVE. WE INVEST IN STATE-OF-THE-ART EQUIPMENT TO HELP OUR PATIENTS REACH THEIR HEALTH CARE GOALS AND RETURN TO A HEALTHY, ACTIVE LIFESTYLE. false false 224268859 272415923 Summit Healthcare is a licensed 101 Bed not-for-profit Rural Sole Community Hospital. Summit Healthcare is committed to provide exceptional compassionate care to the communities we serve. Summit Healthcare's array of services include a 24 bed emergency department which is pediatric certified, a cardiac and vascular Cath lab, diagnostic imaging which includes MRI, CT, Mammography, Nuclear Medicine, X Ray, Ultrasound and Pet/CT, Home Health Services, IV Therapy, Cancer Center with Medical and Radiation Oncology, Women's and Infant Services, Level II Nursery, Therapy Services with Children's Therapy, Occupational Health Therapy, Physical Therapy and Speech Therapy, Pain Medicine, Surgical Services, Telemedicine, Wound Care and Hyperbarics, 12 bed Geropsych Unit and much more. We opened an urgent care clinic on the first floor of our MOB. In FY2022, At the main hospital we treated 128,631 patients. In our Medical Group Clinic locations we saw 203,793 patients. In 2022 we converted four of our outlying clinics to Rural Health Clinics to better serve those communities in Snowflake/Taylor, Eager/Springerville, and St. Johns. We continued to work with our community to identify new ways the serve them. We were awarded a grant which allowed us to better assist our patients with opioid and substance abuse by adding peer support services and implementing a naloxone distribution program within the community. We worked within our clinically integrated network to offer services to our diabetic patients to assist them in controlling their blood sugar by creating a reach out program by our pharmacist to assist them with continuous glucose monitoring and diabetic management. The clinically integrated network also assisted our chronically ill patients by reaching out to them and assisting them with the management of their specific disease. Summit Healthcare is committed to serving the needs of the community of the White Mountains. 224268859 true true false true false false false false false false true false false true true true false true false false false false false false false false true true false false true true false false false false false false false false false false false false false false true true true true false false true 248 0 true 1526 true false false false false false true true false false false false false false X 6 4 false false false false false false false true true false false true true true true true true true true true true AZ X X DAVID ROTHENBERGER 9285376345 2200 E SHOW LOW LAKE ROAD SHOW LOW AZ 85901 X SAL MALAD PHYSICIAN 40.0 0.0 X 1360476 0 5812 BURKE DELANGE PHYSICIAN 40.0 0.0 X 1147165 0 25349 JAMES OLACK PHYSICIAN 40.0 0.0 X 1048620 0 29872 FARBOD KHAKI PHYSICIAN 40.0 0.0 X 983042 0 22439 DAX TRUJILLO PHYSICIAN 40.0 0.0 X 815333 0 24576 SIMRANJIT GALHOTRA CHIEF OF STAFF/Director 40.0 0.0 X 690512 0 26256 GEOFFREY CORNELSEN PHYSICIAN 40.0 0.0 X 680814 0 20826 LYNN BRYAN PHYSICIAN 40.0 0.0 X 694778 0 6579 JOHN MANSFIELD PHYSICIAN 40.0 0.0 X 691268 0 5516 BRITTANY GREENBAUM PHYSICIAN 40.0 0.0 X 609191 0 13980 SHAWN MORROW CEO 40.0 0.0 X 537159 0 13257 DAVID ROTHENBERGER CHIEF FINANCIAL OFFICER 40.0 0.0 X 312687 0 20084 DOUG WRIGHT Director 40.0 0.0 X 312837 0 14297 JONATHAN FELTON COO 40.0 0.0 X 282807 0 8843 KENNETH ALLEN PHYS Service Officer End:12/22 40.0 0.0 X 273834 0 8536 DAVID MURRAY CHIEF COMPLIANCE OFFICER 40.0 0.0 X 203870 0 3231 CAROLYN JACOBS CNO End: 8/22 40.0 0.0 X 199915 0 5942 CONNIE KAKAVAS CHRO End: 12/22 40.0 0.0 X 182726 0 16028 JAY LARSON CIO Start:6/22 40.0 0.0 X 186126 0 10512 AARON YOUNG CIO END: 06/22 40.0 0.0 X 136474 0 9669 WILLIAM GARDNER II CNO Start: 8/22 40.0 0.0 X 144082 0 1867 PAUL WATSON BOARD CHAIRMAN 4.0 0.0 X X 14400 0 0 NEIL TRAVER Vice Chair 4.0 0.0 X X 14400 0 0 JOHN CORDER Director 4.0 0.0 X 13500 0 0 BECKY THOMPSON Secretary 4.0 0.0 X X 12775 0 0 11548791 0 293471 201 false true false VIRTUAL NEUROLOGY PO BOX 60159 FT MYERS FL 33906 TELENEUROLOGY 553540 HOSPITALIST MEDICINE HEALTHCARE 16 BARLEY GLEN COURT HOCKESSIN DE 19707 HOSPITALIST 1227200 ENSEMBLE HEALTHCARE PARTNERS P O BOX 639076 CINCINNATI OH 45263 REVENUE CYCLE 14175515 OBSTETRIX MEDICAL GROUP OF PHX PC PO BOX 281034 ATLANTA GA 30384 NEONATOLOGY 559430 NORTHEASTERN ANESTHESIA PLLC 20 E WHITE MTN BLVD A5 BOX 149 LAKESIDE AZ 85929 ANESTHESIA 641670 11 1776543 83004 1859547 Net Patient Revenue 622000 267358659 267358659 OTHER OPERATING REVENUE 622000 3550048 3550048 PHARMACY REVENUE 456110 1507216 1507216 272415923 2187937 2187937 0 0 40292 40292 0 40292 40292 30534888 44690 24123691 29630 6411197 15060 6426257 6426257 0 0 0 0 0 0 0 0 0 CAFETERIA AND GIFT SHOP 722511 1007538 1007538 REBATES 900099 430508 430508 LOSS ON ADVANCE REFUNDING 900099 -364169 -364169 1073877 284003833 272415923 9728363 X 0 0 0 0 8052923 2013231 6039692 0 87294288 79686912 7607376 861035 771644 89391 10872038 8376062 2495976 5990416 5086710 903706 0 248123 248123 82632 1850 80782 0 0 411250 411250 51194074 31684938 19509136 683912 127259 556653 2477126 1296546 1180580 376066 276523 99543 0 2706636 777139 1929497 211340 126438 84902 0 321816 196615 125201 3879796 3879796 0 17770196 14971394 2798802 2486868 1870948 615920 MEDICAL SUPPLIES 40659968 38991283 1668685 BAD DEBT EXPENSE 13146574 13146574 GENERAL ASSESSMENT 12033628 12033628 EQUIPMENT & REPAIRS 11067734 8288895 2778839 2766833 664474 2102359 275595272 224268859 51326413 0 0 0 5020093 34297697 0 0 58146595 53348229 0 0 0 0 0 0 4540896 4346745 2804056 4487473 287196233 146901768 179518119 140294465 47271877 16600532 0 0 0 0 0 0 1123284 27554605 298424920 280929746 27656180 29189464 0 0 1614807 388575 52850403 47488584 0 0 0 0 53663062 21887333 0 0 341220 27376960 136125672 126330916 X 161665224 153964745 634024 634085 162299248 154598830 298424920 280929746 X 8408561 -14853507 -1255472 X X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false true 11018 11018 false SCHEDULE C, PART II-B, LINE 1I OTHER LOBBYING ACTIVITIES: THE HOSPITAL PAYS DUES TO VARIOUS ORGANIZATIONS WHERE A PORTION IS ATTRIBUTED TO LOBBYING. 5340953 5340953 145624339 58413119 87211220 26228378 12745127 13483251 107893907 75743522 32150385 2108656 0 2108656 140294465 ROU Asset 25082318 EST 3RD PARTY SETTLEMENTS 2472287 27554605 0 ROU LEASE LIABILITY 27376960 27376960 X 254901469 -14853507 -13162587 -28016094 282917563 411250 675020 1086270 284003833 261036074 -1001374 -1001374 262037448 411250 13146574 13557824 275595272 Schedule D, Part X, Line 2 Income Tax Footnote: The Hospital is exempt from federal and state income taxes under Section 501(c)(3) of the Internal Revenue Code (the "IRC") and similar state provisions. However, income from certain activities not directly related to the Hospital's tax-exempt purpose may be subject to taxation as unrelated business income. In addition, the Hospital qualifies for the charitable contribution deduction under Section 170(b)(1)(A)(iii) of the IRC and has been classified as an organization other than a private foundation under Section 509(a)(1) of the IRC. The Hospital has provided for income taxes on its unrelated business income, which have not been significant, as required by Section 512 of the Code. WMSP elected to be treated as a partnership for federal and state income tax purposes. Members were required to include in their individual income tax returns their share of income or loss, as adjusted to reflect the effects of certain transactions which are afforded different accounting treatments. WMSP income does not qualify as unrelated business income taxes for the Hospital and is not taxable. The Hospital follows the guidance issued by accounting principles generally accepted in the United States of America ("US GAAP"). Under this guidance, the Hospital accounts for the effect of any uncertain tax positions based on whether it is "more-likely-than-not" that the position will be sustained by the taxing authority upon examination. The Hospital routinely evaluates potential uncertain tax positions. The Hospital has identified its status as an exempt organization as a tax position; however, the Organization has determined that such tax position does not result in an uncertainty that requires recognition. The Hospital files informational and income tax returns in the U.S. federal jurisdiction and the state of Arizona. As of December 31, 2022, U.S. federal informational and income tax returns for years ended prior to December 31, 2019 and state returns for years ended prior to December 31, 2018 are closed to assessment. Interest and penalties, if any, are accrued as a component of management and general expenses when assessed. SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIALS WITH RETURN: BAD DEBT EXPENSE $(13,146,574) OTHER RECONCILING DIFFERENCE (16,013) ------------------------ TOTAL $(13,162,587) SCHEDULE D, PART XI, LINE 4B RECONCILIATION OF REVENUE PER AUDITED FINANCIALS WITH RETURN: INVESTMENT INCOME FROM JOINT VENTURE $ 674,959 CONTRIBUTIONS RECEIVED WITH RESTRICTION 61 ------------------------ TOTAL $ 675,020 SCHEDULE D, PART XII, LINE 2D RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS WITH RETURN: NET INCOME FROM JOINT VENTURE $(985,361) OTHER RECONCILING DIFFERENCE (16,013) -------------------- TOTAL $(1,001,374) SCHEDULE D, PART XII, LINE 4B RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS WITH RETURN: BAD DEBT EXPENSE $13,146,574 true true X true X true X true true true false true true 249219 249219 0.00090 63287895 32994120 30293775 0.11540 63537114 32994120 30542994 0.11630 63537114 32994120 30542994 0.11630 true 13146574 55333011 47167043 8165968 X true false White Mountain Surgical Partners Management services 0.685 0.315 1 1 SUMMIT HEALTHCARE ASSOCIATION 2200 E SHOW LOW LAKE RD SHOW LOW AZ 85901 WWW.SUMMITHEALTHCARE.NET H0132 X X X SUMMIT HEALTHCARE ASSOCIATION false false true X X X X X X X X X 20 true false false true X See Part v, Section C X X true 20 true See Part v, Section C false true X 100 300. X X true true X X X true X See Part v, Section C X See Part v, Section C X See Part v, Section C X X X X X X true X false X X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 PERSONS WHO REPRESENT THE COMMUNITY: THE HOSPITAL CREATED A COMMITTEE CALLED "COMMUNITY HEALTH NEEDS COMMITTEEIT CONSISTS OF: NAVAJO COUNTY PUBLIC HEALTH, COMMUNITY COUNSELING CENTERS, COMMUNITY BRIDGES AND VARIOUS RELIGIOUS GROUPS; NAVAJO COUNTY COURTS; AND NAVAJO COUNTY PUBLIC ATTORNEY.A regional focus group was consulted and a wide scale survey of navajo county residents was conducted in October 2020. The survey included over 800 residents. SCHEDULE H, PART V, SECTION B, LINE 7D CHNA MADE WIDELY AVAILABLE: The CHNA is offered at town hall meetings. SCHEDULE H, PART V, SECTION B, LINE 20E EFFORTS TO NOTIFY INDIVIDUALS OF FINANCIAL ASSISTANCE POLICY: PATIENTS ARE NOTIFIED WHEN NEED IS IDENTIFIED. SCHEDULE H, PART V, SECTION B, LINE 11 NEEDS ADDRESSED AND NOT ADDRESSED: Summit Healthcare Association completed a community Health Needs Assessment in cooperation with the following partners: North Country Healthcare, Changepoint Integrated Health, Northland Pioneer College, Northeast Arizona Workforce Solutions and Navajo County Public Health Services District in 2020. This assessment identified needs within our service area by reviewing Epidemiological Data, Community Surveys and Focus Groups. The needs identified in our area were: Substance Abuse, Chronic Disease Management, Mental Health/Emotional Health, Poverty, and Sexually Transmitted Diseases. Each of these need areas had a committed of area wide resources that helped develop an action plan to address each need. 1. Substance Abuse - The committee setup a resource list to communicate with all areas that work with patients needing substance abuse patients. We filed for and received a HRSA Opiod/Substance Abuse grant. Worked with local groups to establish and setup peer support services to assist patients with Substance abuse concerns in the Emergency Department 2. Mental Health/Emotional Health - Worked with the committee to develop and setup resiliency training for our employees and other caregivers throughout Navajo County. 3. Chronic Disease Management - Worked with our Clinically Integrated Network to develop processes to manage patients with chronic diseases. Established process with our pharmacist and diabetic education group to work with patients with diabetes to establish and utilized continuous glucose monitors to improve their diabetes management. 4. Poverty - Committee continues to work with the Navajo-Apache County Regional Network Center which has opened an empowerment center to provide resources to those in need with education, after school programming and on-site childcare components. 5. Sexually Transmitted Diseases - Continue to work with the Navajo County Health Department to provided community education on STDs. We are also able to assist in early screening processes. Schedule H, Part V, Section B, Line 16A, 16B, & 16C MEASURES TO PUBLICIZE THE FINANCIAL ASSISTANCE POLICY: https://summithealthcare.net/billing-information/ Schedule H, Part V, Section B, Line 7A & 10A CHNA & IMPLEMENTATION STRATEGY WEBSITE: https://summithealthcare.net/community-health-needs/ Schedule H, PART V, SECTION B, LINE 13H OTHER FACTORS TO DETERMINE ELIGIBILITY: NUMBER OF DEPENDENTS AND FAMILY SIZE. 18 SUMMIT HEALTHCARE INTERNAL MEDICINE 2450 E SHOW LOW LAKE ROAD BLDG 1 SHOW LOW AZ 85901 INTERNAL MEDICINE SUMMIT HEALTHCARE FAMILY MEDICINE 2963 W WHITE MOUNTAIN BLVD LAKESIDE AZ 85929 FAMILY MEDICINE SUMMIT HEALTHCARE PRACTICE MANAGEMENT 3401 S WHITE MOUNTAIN RD SUITE D SHOW LOW AZ 85901 FAMILY MEDICINE SUMMIT HEALTHCARE HEBER-OVERGAARD COM 2931 S HWY 260 PO BOX 1013 OVERGAARD AZ 85933 FAMILY MEDICINE SUMMIT HEALTHCARE FAMILY MEDICINE SNO 1121 S MAIN STREET SNOWFLAKE AZ 85937 FAMILY MEDICINE SUMMIT HEALTHCARE SNOWLFAKE MEDICAL CENT 590 S MAIN STREET SNOWFLAKE AZ 85937 FAMILY MEDICINE SUMMIT HEALTHCARE FAMILY MEDICINE SHOW L 5171 CUB LAKE ROAD SUITE B270 SHOW LOW AZ 85901 FAMILY MEDICINE, OBSTETRICS/GYNECOLOGY SUMMIT HEALTHCARE HIGH DESERT CLINIC 100 E CODE TALKERS DRIVE HOLBROOK AZ 85025 FAMILY MEDICINE SUMMIT HEALTHCARE FAMILY MEDICINE LAKESI 218 W WHITE MOUNTAIN BLVD LAKESIDE AZ 85929 FAMILY MEDICINE MOUNTAIN FAMILY CARE & WALK IN 320 E DEUCE OF CLUBS SHOW LOW AZ 85901 FAMILY MEDICINE SUMMIT HEALTHCARE HEART LUNG & VASCULA 5300 S SUTTER DRIVE SUITE 1 SHOW LOW AZ 85901 CARDIOLOGY, PULMONOLOGY, NATUROPATHIC MEDICINE SUMMIT HEALTHCARE UROLOGY 2051 E EVERGREEN LANE SUITE 8 SHOW LOW AZ 85901 UROLOGY SUMMIT HEALTHCARE ORTHOPEDIC SURGERY 2051 E EVERGREEN LANE SUITE A SHOW LOW AZ 85901 ORTHOPEDIC SUMMIT HEALTHCARE GENERAL & VASCULAR 5171 CUB LAKE ROAD SUITE H SHOW LOW AZ 85901 GENERAL/VASCULAR SURGERY SUMMIT HEALTHCARE CANCER CENTER 2500 E HUNT STREET SUITE H SHOW LOW AZ 85901 ONCOLOGY SUMMIT HEALTHCARE PAIN CLINIC 1500 S WHITE MOUNTAIN BLVD SUITE SHOW LOW AZ 85901 PAIN MANAGEMENT SUMMIT HEALTHCARE ANESTHESIOLOGY 2200 E SHOW LOW LAKE RD SHOW LOW AZ 85901 ANESTHESIOLOGY SUMMIT HEALTHCARE PLASTIC SURGERY & DERM 2450 E SHOW LOW LAKE RD SUITE 2A SHOW LOW AZ 85901 DERMATOLOGY, PLASTIC SURGERY SCHEDULE H, PART III, SECTION A, LINE 2 BAD DEBT METHODOLOGY: We reserve for bad debt expense for all accounts when they reach an age of 300 days from discharge date of service. We also reserve for bad debt expense on self-pay, workers comp and third part liability claims at 120 days. These reserves generate a good estimate of our overall bad debt expense as an organization. We will write off accounts after they are returned from our collections agencies. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT ATTRIBUTABLE TO PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE: CHARGES TO THE FINANCIAL ASSISTANCE PROGRAM ARE NOT APPLIED TO BAD DEBT. THEREFORE, NONE OF THE ORGANIZATION'S BAD DEBT EXPENSE IS ATTRIBUTABLE TO THE CHARITY CARE POLICY. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: The footnote can be found on page 14 of the audited financial statements. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: The hospital uses the cost to charge ratio to determine medicare costs. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: SUMMIT HEALTHCARE ASSOCIATION DELIVERS COMMUNITY BENEFITS BASED ON THE UNIQUE HEALTH NEEDS OF THEIR RESPECTIVE SERVICE AREAS, REGARDLESS OF SOURCE OR AVAILABILITY OF PAYMENT. THESE PROGRAMS AND SERVICES ARE INTENDED TO IMPROVE ACCESS TO HEALTHCARE, HEALTH STATUS AND THE USE OF HEALTHCARE RESOURCES. SUMMIT HEALTHCARE PROVIDED CHARITY CARE AND COMMUNITY BENEFITS TO MEMBERS OF OUR COMMUNITY AS PART OF ITS VISION; DELIVERING EXCEPTIONAL HEALTH CARE AND PROMOTING WELLNESS FOR THE INDIVIDUAL, THE FAMILY, AND THE COMMUNITY SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: HOSPITAL ADMITTING STAFF MEMBERS ADVISE AND ASSIST ALL SELF-PAY PATIENTS OF THE OPTIONS FOR AVAILABLE ASSISTANCE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: SUMMIT HEALTHCARE ASSOCIATION (THE HOSPITAL) OPERATES SUMMIT HEALTHCARE, AN 89-BED ACUTE CARE HOSPITAL FACILITY. THE HOSPITAL PROVIDES INPATIENT AND OUTPATIENT, HOME HEALTH, IMAGING AND OTHER HEALTH CARE RELATED SERVICES TO THE RESIDENTS OF SHOW LOW, ARIZONA AND THE SURROUNDING WHITE MOUNTAIN COMMUNITIES. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: PLEASE REFER TO INFORMATION CONTAINED IN FORM 990, PART III, LINE 4A SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: N/A SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: AZ SCHEDULE H, PART I, LINE 3C FACTORS OTHER THAN FPG DETERMINING FREE OR DISCOUNTED CARE: THE HOSPITAL USES THE FOLLOWING OTHER CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - FAMILY SIZE - NUMBER OF DEPENDENTS - MEDICAL INDIGENCY SCHEDULE H, PART I, LINE 7 COSTING METHODOLOGY: THE COST TO CHARGE RATIO CALCULATED ON IRS WORKSHEET 2 WAS USED IN THE CALCULATION OF COST ON IRS WORKSHEETS 1 AND 3. SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSES: BAD DEBT EXPENSE OF $13,146,574 WAS INCLUDED IN TOTAL EXPENSE ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT WAS SUBTRACTED FROM TOTAL EXPENSE FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSE IN COLUMN(F). COLUMN(F). Schedule H, Part III, Line 9b COLLECTION POLICY: CHARITY CARE IS DEFINED AS AN INABILITY TO PAY. THE PATIENT'S INDIGENCE MUST BE DETERMINED BY THE FACILITY, NOT BY THE PATIENT. THIS DETERMINATION MAY OCCUR AT ANY TIME PRIOR TO THE PATIENT'S 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 PARTY'S NET WORTH, NET INCOME AND THE NUMBER OF MEMBERS IN THE HOUSEHOLD. SUMMIT HEALTHCARE ASSOCIATION 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 PATIENT'S MEDICAL BILL. THIS INCLUDES FEDERAL, STATE OR LOCAL FINANCIAL PROGRAMS AND/OR LEGAL GUARDIANS. THE PATIENT'S 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. X true true X X X false false false false false true false false true true SIMRANJIT GALHOTRA CHIEF OF STAFF/Director 412871 0 277641 0 0 0 12105 0 14151 0 716768 0 0 0 DOUG WRIGHT Director 282837 0 10000 0 20000 0 1346 0 12951 0 327134 0 0 0 SHAWN MORROW CEO 537159 0 0 0 0 0 1306 0 11951 0 550416 0 0 0 CAROLYN JACOBS CNO End: 8/22 115800 0 0 0 84115 0 4085 0 1857 0 205857 0 0 0 JAY LARSON CIO Start:6/22 186126 0 0 0 0 0 3944 0 6568 0 196638 0 0 0 DAVID ROTHENBERGER CHIEF FINANCIAL OFFICER 311175 0 0 0 1512 0 6640 0 13444 0 332771 0 0 0 JONATHAN FELTON COO 282807 0 0 0 0 0 0 0 8843 291650 0 0 0 DAVID MURRAY CHIEF COMPLIANCE OFFICER 203870 0 0 0 0 0 0 0 3231 207101 0 0 0 KENNETH ALLEN PHYS Service Officer End:12/22 273834 0 0 0 0 0 5781 0 2755 0 282370 0 0 0 CONNIE KAKAVAS CHRO End: 12/22 182726 0 0 0 0 0 4173 0 11855 0 198754 0 0 0 FARBOD KHAKI PHYSICIAN 446426 0 536616 0 0 0 10896 0 11543 0 1005481 0 0 0 DAX TRUJILLO PHYSICIAN 430030 0 376627 0 8676 0 12625 0 11951 0 839909 0 0 0 BURKE DELANGE PHYSICIAN 422265 0 706900 0 18000 0 11298 0 14051 0 1172514 0 0 0 SAL MALAD PHYSICIAN 693812 0 666664 0 0 0 0 0 5812 0 1366288 0 0 0 JAMES OLACK PHYSICIAN 457516 0 591104 0 0 0 17597 0 12275 0 1078492 0 0 0 BRITTANY GREENBAUM PHYSICIAN 484791 0 124400 0 0 0 8218 0 5762 0 623171 0 0 0 GEOFFREY CORNELSEN PHYSICIAN 595806 0 64508 0 20500 0 9947 0 10879 0 701640 0 0 0 JOHN MANSFIELD PHYSICIAN 539144 0 152124 0 0 0 3937 0 1579 0 696784 0 0 0 LYNN BRYAN PHYSICIAN 411117 0 283661 0 0 0 1886 0 4693 0 701357 0 0 0 SCHEDULE J, PART I, LINE 8 PAYMENTS PURSUANT TO INITIAL CONTRACT EXCEPTION: PHYSICIANS HAVE EMPLOYMENT AGREEMENTS SCHEDULE J, PART I, LINE 6A COMPENSATION CONTINGENT ON NET EARNINGS: THE PHYSICIANS RECEIVED INCENTIVE COMPENSATION BONUSES BASED ON RELATIVE VALUE UNITS WRUVS, AND OFFICERS RECEIVED BONUSES BASED ON BUDGET GOALS SCHEDULE J, PART I, LINE 1 GROSS UP PAYMENTS: RETENTION BONUSES ARE GROSSED UP FOR TAXES. THIS IS DONE FOR ALL EMPLOYEES AT 5 YEAR INCREMENTS OF SERVICE. THESE PAYMENTS WERE MADE TO THE FOLLOWING INDIVIDUALS: CAROLYN JACOBS DAVID ROTHENBERGER A THE INDUSTRIAL DEVELOPMENT AUTHORITY OF SHOW LOW 860912110 XXXXXXXXx 2015-08-04 23549000 REFUND 2005 BOND AND PAYING COSTS false false false B THE INDUSTRIAL DEVELOPMENT AUTHORITY OF SHOW LOW 860912110 XXXXXXXXx 2022-08-12 39175000 REPLACE 2017A BONDS false false false A 10592000 0 23549000 0 0 23287023 261977 0 0 0 0 0 2015 false true true true B 3735000 0 39175000 0 0 39170493 0 0 0 0 4507 0 2022 true false false true A false false false false 0 false false false true B false false false false 0 false false false true A true false false false false 0 false 0 false true B false true false false false false 0 false 0 false true A true B true SCHEDULE K, PART I, BOND ISSUES: (A) ISSUER NAME: THE INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF SHOW LOW, ARIZONA (F) DESCRIPTION OF PURPOSE: REFUND 2005 BOND AND PAYING COSTS OF (A) ISSUER NAME: THE INDUSTRIAL DEVELOPMENT AUTHORITY OF THE CITY OF SHOW LOW, ARIZONA (F) DESCRIPTION OF PURPOSE: REPLACE 2017A BONDS FORM 990, PART VI, SECTION B, LINE 11B REVIEW OF RETURN: THE FORM 990 IS REVIEWED IN THE SCHEDULED GOVERNING BOARD MEETING FOLLOWING ITS COMPLETION AND BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C PROCEDURE TO MONITOR COMPLIANCE WITH CONFLICT OF INTEREST POLICY: ALL MEMBERS OF THE GOVERNING BOARD/MEDICAL STAFF/EMPLOYEES ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST FORM ON AN ANNUAL BASIS OR ATTEST TO NO CONFLICTS. ANY FORMS WITH A CONFLICT NOTATED ARE REVIEWED BY THE CHIEF COMPLIANCE OFFICER. ALL CONFLICTS ARE REVIEWED AT THE BOARD LEVEL AND ANY RESTRICTIONS NECESSARY ARE IMPOSED AT THAT LEVEL. ANY BOARD MEMBER THAT HAS A CONFLICT WITH A DECISION THAT NEEDS TO BE MADE AT THE BOARD LEVEL RECUSES THEMSELVES FROM THE DECISION PROCESS. FORM 990, PART VI, SECTION B, LINE 15A & LINE 15B COMPENSATION REVIEW: GALLAGHER COMPLETED A REVIEW OF ALL C-SUITE OFFICERS IN MARCH 2023. KEY EMPLOYEES (PHYSICIAN) COMPENSATION WAS COMPLETED IN JUNE 2022 BY COKER GROUP. WE ALSO COMPLETED ANNUAL SALARY MARKET SURVEYS FOR ALL OF OUR POSITIONS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: The governing documents, conflict of interest policy and audited financial statements are made available upon request. FORM 990, PART XI, LINE 9 CHANGES IN NET ASSETS: CAPITAL DISTRIBUTIONS FOR WMSP, LLC (1,565,874) Net Income attributed to non-controlling interest 310,402 -------------- Total (1,255,472) PART XII, LINE 2C Oversight Process: THE ORGANIZATION DID NOT CHANGE EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. FORM 990, PART I, LINE 1 DESCRIPTION OF ORGANIZATION MISSION Continued: ... TO HELP OUR PATIENTS REACH THEIR HEALTH CARE GOALS AND RETURN TO A HEALTHY, ACTIVE LIFESTYLE. FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED SERVICES TOTAL FEES:33107471 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT LABOR TOTAL FEES:10685445 FORM 990 PART IX LINE 11G DESCRIPTION:MEDICAL PROFESSIONALS TOTAL FEES:7275492 FORM 990 PART IX LINE 11G DESCRIPTION:CME PHYSICIAN SERVICES TOTAL FEES:110579 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PROFESSIONAL SERVICE TOTAL FEES:15087 SUMMIT HEALTHCARE MEDICAL ASSOCIATES LL 2200 E SHOW LOW LAKE ROAD SHOW LOW AZ 85901 PHYSICIAN AZ SHA NORTHEASTERN ARIZONA REGIONAL CARE TEAM 2200 E SHOW LOW LAKE ROAD SHOW LOW AZ 85901 Network AZ SHA WHITE MOUNTAIN SURGICAL PARTNERS LLC 2200 E SHOW LOW LAKE ROAD SHOW LOW AZ 85901 834109264 OUTPATIENT AZ NA RELATED -59758 0 false 0 true 0.68500 false false false false false false false false false false false false true false false false false false true White Mountain Surgical Partners LLC M 3925330 fmv White Mountain Surgical Partners LLC S 3405073 fmv SCHEDULE R, PART I COLUMNS D AND E: THE TOTAL INCOME AND END-OF-YEAR ASSETS CANNOT BE SEPARATELY IDENTIFIED AS THEY ARE CONSOLIDATED AND INTRINSIC TO THE EXEMPT PURPOSES AND REPORTED ACTIVITIES, CONTAINED HERE-IN, OF THE HOSPITAL.