2024-10-11T14:50:03-05:00 2023-12-31 450250958 Eide Bailly LLP 4585 Coleman St Ste 200 Bismarck ND 58503 990 2023-01-01 860096775 Community Hospital Association Inc COMM 9286845421 520 Rose Lane Wickenburg AZ 85390 David Woodruff CFO 9286845421 2024-10-11 1 1 Lisa Chaffee CPA P00193453 7012551091 2024-10-11 2023 2024-10-15 13:58:12Z Wickenburg Community Hospital David Woodruff 520 Rose Lane Wickenburg AZ 85390 49785409 0 X www.wickhosp.com X 1946 AZ Provide quality health and wellness services where patient, family and community come first. 12 12 346 45 0 0 537651 2085080 44678759 47582708 114031 24160 101118 85260 45431559 49777208 0 0 0 0 18709734 20761415 0 0 170698 29987291 28665663 48697025 49427078 -3265466 350130 31918445 32125877 26832530 26801135 5085915 5324742 To provide quality health and wellness services where the patient, family and community come first. 0 0 46358338 47582708 Community Hospital Association, Inc. d/b/a Wickenburg Community Hospital is a 19-bed critical access hospital that provides inpatient and outpatient diagnostic and therapeutic health care services to the residents and visitors of greater Wickenburg, Arizona, a rural community of approximately 23,000. The Hospital operates physician clinics and a surgery center in the same geographic area. 46358338 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 70 0 1 346 1 0 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 0 0 X Nancy Thompson 9286844360 520 Rose Lane Wickenburg AZ 85390 Betsy Deibel Director 1.00 0.00 X 0 0 0 Brian Warnock Vice Chair 1.00 0.00 X X 0 0 0 Cynthia Clark Director 1.00 0.00 X 0 0 0 Dave Bennett Director 1.00 0.00 X 0 0 0 Dean Sandvik Treasurer 1.00 0.00 X X 0 0 0 Deborah Bateman Director 1.00 0.00 X 0 0 0 Dennis Lauterbach Director 1.00 0.00 X 0 0 0 Ed Kientz Chairman 1.00 0.00 X X 0 0 0 Jeanie Hankins Director 1.00 0.00 X 0 0 0 John Summers Secretary 1.00 0.00 X X 0 0 0 Penny Marin Director 1.00 0.00 X 0 0 0 Virginia Collier Director 1.00 0.00 X 0 0 0 David Woodruff CFO (Beg Dec) 39.00 1.00 X 10096 0 20 Jackie Lundblad CEO 39.00 1.00 X 266486 0 37851 Patti Clavette CFO (Jan-Dec) 39.00 1.00 X 152061 0 28775 Brian Schuele Director of Pharmacy Services 40.00 0.00 X 155280 0 34534 Jodie Allen CNO 40.00 0.00 X 153530 0 3091 Peter Stachowicz COO 39.00 1.00 X 190341 0 16216 Todd Kravetz MD - Chief of Staff, Clinical Medical Director 40.00 0.00 X 362956 0 48639 Diane Bejerano Family Physician (Jan-Oct) 40.00 0.00 X 285913 0 10953 Juan Vazquez Patient Accounts Manager 40.00 0.00 X 178423 0 21949 Mandi Filla Family Physician 40.00 0.00 X 211847 0 17633 Matthew Jones Family Nurse Practitioner 40.00 0.00 X 188190 0 20 Richard Melde Family Nurse Practitioner 40.00 0.00 X 195733 0 20 2350856 0 219701 37 0 1 0 Innova Emergency Medical Associates PC 9888 W Belleview Ave 5114 Denver CO 80123 ER Physicians Staffing 2586651 Rural Partners in Medicine LLC 8181 Arista Pl Suite 100 Broomfield CO 80021 Management and specialists staffing 1915703 Rural Physicians Management Company LLC 10624 S Eastern Ave Ste A-263 Henderson NV 89052 Providers staffing 913615 Voyageur Radiology LLC 9975 DELLWOOD ROAD N STILLWATER MN 55082 IMAGING 569765 ABM PO BOX 419860 Boston MA 02241 Housekeeping 541498 18 254375 1830705 450000 2085080 Patient Service Revenue 621990 43951720 43951720 Pharmacy Revenue 456110 2756406 2756406 340B Drug Program 621990 198709 198709 675873 675873 47582708 32361 32361 85260 0 85260 85260 85260 8201 -8201 -8201 -8201 49777208 47582708 0 109420 X 1474177 507391 966786 16040595 15865462 16565 158568 183735 183735 1832338 1777322 55016 1230570 1140686 77754 12130 272 257 15 209936 202591 7345 108775 104969 3806 12200595 11602930 597665 1416177 1335636 80541 1144102 1079035 65067 818928 772354 46574 100023 94334 5689 445395 91236 354159 2138184 2091048 47136 465037 438589 26448 Medical Supplies 6996923 6598993 397930 AHCCCS Tax 1019008 961055 57953 Repairs & Maintenance 788484 743641 44843 Food 87758 82767 4991 726066 684307 41759 49427078 46358338 2898042 170698 2093254 3066040 6238305 6924970 1142732 1080331 427629 365590 37549618 19862198 18472034 17687420 323224 378147 2130005 1668431 1091262 954948 31918445 32125877 6406972 7910247 16091888 15472413 4333670 3418475 26832530 26801135 X 4600211 3892999 485704 1431743 5085915 5324742 31918445 32125877 X 350130 -111303 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1918183 1918183 21014226 10133832 10880394 14689 7372 7317 12996062 9459172 3536890 1606458 261822 1344636 17687420 Capital Leases 955852 Estimated Third-Party Payor Settlement 447754 457b Retirement Liability 378147 Operating Lease 1636722 3418475 X 49674106 -111303 -111303 49785409 -8201 -8201 49777208 49435279 8201 8201 49427078 0 49427078 Part X, Line 2: The Hospital believes that it has appropriate support for any tax positions taken affecting its annual filing requirements, and as such, does not have any uncertain tax positions that are material to the financial statements. The Hospital would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense if such interest and penalties are incurred. Part XI, Line 2d - Other Adjustments: Change in Interest of Foundation -111,303. Part XI, Line 4b - Other Adjustments: Loss on sale included in expense on financials -8,201. Part XII, Line 2d - Other Adjustments: Loss on sale included in expense on financials 8,201. 1 1 X 1 X 1 X 240.000000000000 1 0 0 187000 187000 0.00380 5487763 2810174 2677589 0.05420 5674763 2810174 2864589 0.05800 51842 51842 0.00100 21031 21031 0.00040 16664538 11590686 5073852 0.10270 16737411 11590686 5146725 0.10410 22412174 14400860 8011314 0.16210 1 4330679 60232 12044844 12019463 25381 X 1 1 1 1 Wickenburg Community Hospital 520 Rose Lane Wickenburg AZ 85390 www.wickhosp.com RGH3505 X X X Wickenburg Community Hospital 1 0 0 1 X X X X X X X X X 22 1 0 0 1 X www.wickhosp.com 1 22 1 www.wickhosp.com 0 1 X 200.000000000000 240.000000000000 X X X 1 1 X X X X 1 X www.wickhosp.com X www.wickhosp.com X www.wickhosp.com X X X X X X 1 X 0 X X X X 1 X 0 0 Wickenburg Community Hospital Part V, Section B, Line 5: Wickenburg Community Hospital (WCH) received help from the Town of Wickenburg, Wickenburg Chamber of Commerce, the Wickenburg Unified School District and Wickenburg Ranch Lifestyles Team in collecting responses for the 2022 CHNA. Through the Chamber of Commerce WCH was able to request participation from My Father's Retirement Ranch, the Wickenburg Community Action Program, and the Wickenburg Community Services Corporation, which are the primary organizations that serve that population. Wickenburg Community Hospital Part V, Section B, Line 11: The 2022 CHNA identified five significant health needs in the community. In the most recent CHNA conducted the following needs were identified:1. Self-identified Health Status Being Fair to Poor Health (primarily due to pain associated with the bones or joints, back or neck, arthritis, or lack of mobility)2. Barriers to Accessing Healthcare (lack of health insurance coverage and high cost of care).3. Community Awareness about Health Services.4. Of the top 5 Major Health Challenges identified, aging problems ranked the most significant health challenge, rising above the second ranked challenge, availability of medical services, by 30.76%. The third was reported as heart disease/stroke, then obesity and finally dementia/Alzheimer's disease. 5. Improve Access to HealthcareThe organization cannot change the cost of healthcare insurance as this is out of our purview. This will not be addressed by WCH, but the facility works diligently to reduce costs using the 340B Drug Pricing Program and employs financial counselors to assist patients.The following actions were taken to address the needs identified from the 2022 CHNA:1. WCH has added a pain management specialist to our specialty outpatient services. This specialist can work alongside our sports medicine and orthopedic surgeons to provide care for the pains described.2. The organization provides financial assistance for medically necessary services in a fair, consistent, respectful, and objective manner to the underserved population. WCH employs a Financial Counselor who assists patients with Medicaid and financial assistance applications to determine the level of financial assistance available to them. The organization has also been working diligently to strengthen the contracts with the major health insurance providers and continues to work diligently to stay contracted with as many carriers as possible.3. The organization has updated the website and search engine optimization (SEO). WCH has also begun Pay Per Click (digital ad campaign) for the specialty services being offered in the area to improve search results for those seeking specialty healthcare services. Social media posts have been increased around providers serving in our rural community. The organization also continues to print awareness ads in the local newspaper to reach those who are less likely to utilize a digital device.4. WCH has partnered with Rural Physicians Group to provide additional specialty care in the Acute Care and Emergency Departments. These specialties include Cardiac, Pulmonology/Critical Care, Nephrology and Infections Disease. The addition of these specialties in the hospital will allow many patients to stay local instead of having to be transferred out.5. To improve access to care, WCH has increased the number of primary care visits for each provider from 20 to 25. Also, the Urgent Care Clinic has increased the number of days for service to seven days a week in the winter and six during the summer. To improve ease of making appointments the organization added a link to request an appointment from the main website. In addition, a mobile clinic is in the process of being added to our RHC Wickenburg, which will travel to more rural communities such as Yarnell, Aguila, Wittmann and potentially more as requested by those communities. The initial route will include three clinic days traveling to those in need for improvement of access to primary care. 3 1 - Community Hospital Clinic - Wickenburg 519 Rose Lane Wickenburg AZ 85390 Primary Care Clinic, Rural Health Clinic 2 - Community Hospital Clinic - Congress 26750 S Santa Fe Road Suite B Congress AZ 85332 Primary Care Clinic, Rural Health Clinic 3 - Community Hospital Clinic - Wittmann 32919 Center St Wittmann AZ 85361 Primary Care Clinic, Rural Health Clinic Part I, Line 7: Part I, line 7a:Financial Assistance was calculated using the cost-to-charge ratio. All patient segments are addressed using this method. The methodology used is to be in compliance with laws and regulations set forth by Medicare and the filing of the annual cost report. Part I, Line 7b and 7g:Unreimbursed Medicaid and Subsidized Health Services were calculated using the cost report and analyzing the Medicare ratio of cost to charge for the respective cost centers. Part I, line 7e and 7f:Community health improvement services and health professions education are actual costs reported in the general ledger. Part I, Line 7g: Line 7g includes $6,776,729 of expenses related to a rural health clinic. Part III, Line 2: The amount reported on line 2 represents implicit price concessions. The implicit price concessions included represent the difference between amounts billed to patients and the amounts the Hospital expects to collect based on its collection history with those patients. Part III, Line 3: The organization calculated the amount of implicit price concessions attributable to patients eligible under the financial assistance policy by applying the percentage of charity care of total net patient revenue to the amount of line 2 implicit price concessions. Part III, Line 4: The financial statement footnote regarding implicit price concessions may be found on page 12 and 13 of the attached financial statements. Part III, Line 8: Medicare allowable costs were obtained from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules & regulations set forth by Centers for Medicare and Medicaid Services.If there is a shortfall, the entire Medicare shortfall is a community benefit. Medicare patients are accepted regardless of whether or not a surplus or deficit is realized from providing the services. This basis therefore means providing Medicare services promotes access to healthcare services which is a key community benefit. Part III, Line 9b: The accounts remain in the program for a period of 120 days, if no payments are being made, or longer if the payments are being made on the outstanding balance. After this time period and collection efforts have been exhausted, the accounts will then be placed into a "collection" status, and sent to our Collection Agency; Revenue Enterprise for Health Care, to further final collection efforts. After these accounts have been placed with the Collection Agency and have no activity for 120 days, they will be returned to the business officer for additional consideration and disposition of account. During the entire 240 days they will accept applications for financial assistance. Part VI, Line 2: Community Hospital Association, Inc. continually assesses the community's medical needs through the relationship of our staff to community leaders and community programs that identify community needs, often medical in nature. Although the hospital is not always in a position to expand services and meet all identified needs, maintaining a core menu of services that meets the greatest community need has and continues to direct our strategic planning. Part VI, Line 3: All uninsured and under-insured patients at time of registration are provided with options available in our community for payment of the services provided. This is most often verbal along with a written charity care application. Part VI, Line 4: Wickenburg Community Hospital serves a primary service area population of approximately 23,000 in a rural service area clustered around Wickenburg, AZ. Wickenburg Community Hospital is the only hospital in the service area. The distribution of service area population by age is 0-17, 21%; 18-44, 25%; 45-64, 29%; 65+, 24%. The service area is home to a great number of winter residents, changing the population significantly from winter months to summer months, when the population grows by approximately 40%. Part VI, Line 5: The Hospital's governing body is comprised of persons who reside in the Organization's primary service area. The Hospital applies any surplus funds to improve the Facility and equipment to improve patient care. The Hospital also extends medical staff privileges to other qualified physicians in the community.Wickenburg Community Hospital, designated as a critical access hospital, serves a rural population approximately 35 miles West of the urban area of the greater Phoenix market place of Surprise, AZ. While the distance is not overly great, many of our patients come from rural areas West and North of Wickenburg, requiring them to drive much greater distances to obtain health care services if Wickenburg Community Hospital was not available to them. The most important service we provide is our emergency services and could not exist without our critical access hospital status. Additionally, our rural health clinic provides access to primary care providers in our community that probably would not exist if the hospital did not employ these providers. The availability of diagnostic services locally is very important to our community as a higher average age exists in our community, making it difficult to drive longer distances and spend a greater amount of time in obtaining diagnostic services required by their primary care providers. X 1 1 X X 0 0 0 0 0 0 0 0 0 Todd Kravetz MD - Chief of Staff, Clinical Medical Director 283131 0 77269 0 2556 0 14775 0 39033 0 416764 0 0 0 Jackie Lundblad CEO 264984 0 721 0 781 0 10754 0 29743 0 306983 0 0 0 Diane Bejerano Family Physician (Jan-Oct) 212005 0 71169 0 2739 0 10932 0 5189 0 302034 0 0 0 Mandi Filla Family Physician 211847 0 0 0 0 0 0 0 18876 0 230723 0 0 0 Peter Stachowicz COO 189233 0 500 0 608 0 3023 0 14464 0 207828 0 0 0 Juan Vazquez Patient Accounts Manager 162782 0 14686 0 955 0 4006 0 22536 0 204965 0 0 0 Richard Melde Family Nurse Practitioner 160106 0 35627 0 0 0 0 0 1336 0 197069 0 0 0 Brian Schuele Director of Pharmacy Services 153105 0 1471 0 704 0 3339 0 33351 0 191970 0 0 0 Matthew Jones Family Nurse Practitioner 147922 0 39620 0 648 0 0 0 1861 0 190051 0 0 0 Patti Clavette CFO (Jan-Dec) 150380 0 500 0 1181 0 3031 0 27891 0 182983 0 0 0 Jodie Allen CNO 151904 0 500 0 1126 0 3071 0 933 0 157534 0 0 0 Part I, Line 1a Description of health club dues: Wickenburg Community Hospital reimburses employees for health club dues which are recorded in the individuals' taxable compensation. However, the health club benefit ended on 10/31/2023. Golf club dues were paid to the golf club by the organization, but are not paid for a specific employee. X 1 450000 Apprasial 0 0 0 0 Part I, Column (b): The number of contributions reported in Column (b) represents the number of items donated. Form 990, Part VI, Section A, line 8b The organization does not have any committees with the authority to act on behalf of the governing body. Form 990, Part VI, Section B, line 11b The Form 990 is prepared by a third party and is reviewed by the CFO. A copy of the Form 990 is made available to the governing board prior to filing with the IRS. Form 990, Part VI, Section B, line 12c All board members and officers are covered under the policy. In connection with any actual or possible conflict of interest, an interested person must disclose the existence of any financial interest and conflict of interest and be given the opportunity to disclose all material facts to the board of directors of the organization. In addition, all interested persons review and sign a compliance certificate annually. After disclosure of any potential conflicts and all material facts, and after any discussion with the interested person, he/she shall leave the governing board meeting and is recused from the discussion and voting on the issue. The remaining board members shall decide if a conflict of interest exists. Form 990, Part VI, Section B, line 15a Review of CEO or top management official compensation: The board chairman, with consultation of other members of the board, reviews independent survey data acquired through the Arizona Hospital & Healthcare Association on executive salaries and reviews the performance of the CEO. This review is done annually by the board in executive session. The salary is documented on a personnel action form (PAF), entered into the payroll system, and then added to the HR file. Review of other officer or key employees compensation: The CEO and HR director use the Arizona Hospital & Healthcare Association survey data to review all positions in the facility, including key employees and other officers. The salary is documented on a Personnel Action Form (PAF), entered into the payroll system, and then added to the HR file. Form 990, Part VI, Section C, line 19 Governing documents, conflict of interest policy, and financial statements are made available to the public by a formal request in writing. Form 990, Part IX, line 11g Professional Fees: Program service expenses 4,242,500. Management and general expenses 153,820. Fundraising expenses 0. Total expenses 4,396,320. Purchased Services: Program service expenses 7,360,430. Management and general expenses 443,845. Fundraising expenses 0. Total expenses 7,804,275. Form 990, Part XI, line 9: Change in Interest of Foundation -111,303.