2025-03-27T17:19:10-05:00 2024-09-30 450250958 EIDE BAILLY LLP 345 N REID PL STE 400 SIOUX FALLS SD 571037034 990 2023-10-01 860107344 LITTLE COLORADO MEDICAL CENTER LITT 9282896303 1501 N WILLIAMSON AVE WINSLOW AZ 86047 LONA KING CFO 9282896303 2025-03-27 1 1 LAURIE HANSON CPA P00851848 6053391999 2025-03-27 2023 2025-03-06 01:10:19Z LITTLE COLORADO MEDICAL CENTER TRAVIS UDALL 1501 N WILLIAMSON AVE WINSLOW AZ 86047 43192925 0 X LCMCWMH.COM X 1951 AZ 211 13 12 335 21 0 0 128120 91000 40454131 41958654 25563 676603 29490 34625 40637304 42760882 5000 1136 0 0 22343692 22164209 0 0 0 21277026 20259840 43625718 42425185 -2988414 335697 46386356 45870019 19271171 18418445 27115185 27451574 X COMPASSIONATE CARE FOR NORTHEASTERN ARIZONA. 0 0 38282300 1136 41958654 WINSLOW MEMORIAL HOSPITAL D/B/A LITTLE COLORADO MEDICAL CENTER (LCMC) GENERAL MEDICAL & SURGICAL HOSPITAL - PRIMARILY ENGAGED IN PROVIDING DIAGNOSTIC, MEDICAL TREATMENT (BOTH SURGICAL AND NONSURGICAL) TO PATIENTS WITH A WIDE VARIETY OF MEDICAL CONDITIONS. LCMC MAINTAINED 25-BEDS, PROVIDED INPATIENTS WITH FOOD SERVICES THAT MET THEIR NUTRITIONAL REQUIREMENTS, AND USED AN ORGANIZED STAFF OF PHYSICIANS AND OTHER MEDICAL STAFF TO PROVIDE PROFESSIONAL CARE SERVICES AS WELL AS OTHER SERVICES. THESE SERVICES INCLUDE OUTPATIENT SERVICES, ANATOMICAL PATHOLOGY SERVICES, DIAGNOSTIC X-RAY SERVICES, CLINICAL LABORATORY SERVICES, OPERATING ROOM SERVICES FOR A VARIETY OF PROCEDURES, AND PHARMACY SERVICES IN THE CITY OF WINSLOW, NAVAJO COUNTY, ARIZONA. LCMC MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES WHICH INCLUDE THE COST OF SUPPLIES AND SERVICES FURNISHED UNDER THE CHARITY CARE POLICY ALONG WITH ASSOCIATED EQUIVALENT SERVICE STATISTICS. 38282300 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 1 0 0 0 0 0 0 1 1 0 0 0 1 47 0 1 335 1 0 0 0 0 0 0 0 0 0 0 0 0 X 13 12 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 1 1 1 0 0 X LONA KING 9282894691 1501 NORTH WILLIAMSON AVENUE WINSLOW AZ 86047 BRIAN BUCINA MD SURGEON 40.00 0.00 X 566774 0 46420 JOHN J DEMPSEY CEO UNTIL 04/2024 40.00 0.00 X 357565 0 26407 RANDALL REID MD OB/GYN 40.00 0.00 X 323791 0 53890 THOMAS GREENWOOD MD DIRECTOR, CHIEF OF STAFF 40.00 0.50 X 264504 0 51364 JAMES PAGE GENERAL MEDICINE 40.00 0.00 X 197554 0 46864 PAMELA RULAND RN 36.00 0.00 X 211793 0 20200 LONA KING CFO 40.00 0.00 X 198750 0 18913 REBECCA HEWARD INFORMATICS NURSE 36.00 0.00 X 195019 0 7905 TRAVIS UDALL CEO FROM 01/2024 40.00 0.00 X 0 0 0 JR DESPAIN CHAIRPERSON 5.00 0.50 X X 0 0 0 FRANK ARMAO MD SECRETARY/TREASURER 1.00 0.00 X X 0 0 0 RHONDA GREER DIRECTOR 1.00 0.00 X 0 0 0 CHRIS BAVASI DIRECTOR 1.00 0.00 X 0 0 0 ROBERT SALABYE DIRECTOR 1.00 0.00 X 0 0 0 ROBERTA CANO DIRECTOR 1.00 0.00 X 0 0 0 DARRIN FRY DIRECTOR 1.00 0.00 X 0 0 0 ELIZABETH MCKEY DIRECTOR 1.00 0.00 X 0 0 0 GREG HACKLER DIRECTOR 1.00 0.50 X 0 0 0 ALLYSEN KELLY DIRECTOR 1.00 0.00 X 0 0 0 SAGE WHITE MD DIRECTOR 1.00 0.00 X 0 0 0 KATHLEEN SMITH DIRECTOR 1.00 0.00 X 0 0 0 2315750 0 271963 36 0 1 0 MEDICAL SOLUTIONS PO BOX 850737 MINNEAPOLIS MN 55485 CONTRACTED HEALTHCARE 1562492 XTEND 90 VOLUNTEER DR SUITE 150 HENDERSONVILLE TN 37075 COLLECTION SERVICES 647217 WINNCARE 1031 N WARREN WINSLOW AZ 86047 HEALTHCARE SERVICES 426479 JG ANESTHESIA 2973 N KRISTEN DR FLAGSTAFF AZ 86001 ANESTHESIA 389325 UNITIMED LLC PO BOX 88714 MILWAUKEE WI 53288 HEALTHCARE SERVICES 383538 17 50000 41000 91000 PATIENT SERVICE REVENUE 621400 40235015 40235015 PHARMACY REVENUE 900099 578769 578769 MEAL & VENDING REVENUE 900099 57981 57981 1086889 1086889 41958654 802302 802302 34625 0 34625 34625 34625 306344 0 432043 306344 -432043 -125699 -125699 42760882 41958654 0 711228 X 1136 1136 937880 301317 636563 16878360 16294592 583768 551790 532017 19773 2544571 2296982 247589 1251608 1169573 82035 107291 107291 169492 169492 9225853 9055252 170601 34542 100 34442 2521179 791490 1729689 546073 540323 5750 173800 173800 72284 66460 5824 633697 497823 135874 1654264 1625492 28772 538609 457354 81255 SUPPLIES 3487926 3462767 25159 EQUIPMENT RENTAL & MAIN 295515 293671 1844 FOOD 182832 175539 7293 DUES & SUBSCRIPTIONS 100404 58822 41582 516079 487790 28289 42425185 38282300 4142885 0 19667637 21761077 6253124 5419925 1168355 1182269 519995 477726 35354459 22644721 14457223 12709738 1464569 1658874 1889753 1894950 205099 176809 760601 588651 46386356 45870019 4125366 4077335 13223972 12860954 1921833 1480156 19271171 18418445 X 27115185 27451574 27115185 27451574 46386356 45870019 X 335697 692 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 207873 207873 20944702 12164525 8780177 14132721 10480196 3652525 69163 69163 12709738 ASSET RETIREMENT OBLIGATION 576871 SETTLEMENT AGREEMENT 78000 DEFERRED COMPENSATION 230625 CAPITAL LEASES 6009 OPERATING LEASE LIABILITIES 588651 1480156 X 42761574 692 692 42760882 0 42760882 42425185 0 42425185 0 42425185 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 IN NET ASSETS OF FOUNDATION 692. 1 1 X 1 X 125.000000000000 1 X 1 1 0 0 464000 464000 0.01090 464000 464000 0.01090 46683 46683 0.00110 1774359 1631453 142906 0.00340 1821042 1631453 189589 0.00450 2285042 1631453 653589 0.01540 1 4825697 1325018 5707931 5714269 -6338 X 1 1 1 1 LITTLE COLORADO MEDICAL CENTER 1501 N WILLIAMSON AVE WINSLOW AZ 86047 LCMCWMH.COM RGH 0076 X X X X ONE PROVIDER BASED CLINIC LITTLE COLORADO MEDICAL CENTER 1 0 0 1 X X X X X X X X X 22 1 0 1 1 X SEE NARRITAVE ON 7D X 1 22 1 SEE NARRITAVE ON 7D 0 1 X 125.000000000000 300.000000000000 X X X X X 1 1 X X X X 1 X SEE 16A-C NARRATIVE X SEE 16A-C NARRATIVE X SEE 16A-C NARRATIVE X X X X X X X 1 X 0 X X X X 1 X 0 0 LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 5: LCMC SOLICITED INPUT FROM MULTIPLE SOURCES IN THE COMMUNITY, INCLUDING GROUPS THAT WORK WITH DISADVANTAGED POPULATIONS. NAVAJO COUNTY PARTNERED WITH LCMC TO CONDUCT THE CHNA DURING THE YEAR ENDED 9/30/23. THIS EFFORT INCLUDED SOLICITED INPUT THROUGH FOCUS GROUPS, TOWN MEETINGS, COMMUNITY COALITIONS, COMMUNITY HEALTH SURVEYS, PUBLIC HEALTH AND HOSPITAL DATA, INTERVIEWS WITH MENTAL AND BEHAVIORAL HEALTH PROVIDERS, EMERGENCY SERVICES PERSONNEL, A COMMUNITY ADVISORY COMMITTEE, VOLUNTEER ORGANIZATIONS, AND INDIAN HEALTH SERVICES TO IDENTIFY THE NEEDS OF THE COMMUNITY. LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 6B: NAVAJO COUNTY PUBLIC HEALTH SERVICES DISTRICT, SUMMIT HEALTHCARE, CARE1ST HEALTH PLAN ARIZONA, AZ@WORK, COMMUNITY BRIDGES, CHANGEPOINT INTEGRATED HEALTH, NAVAJO COUNTY CRIMINAL JUSTICE, NEXUS COALITION, AND MENTAL HEALTH ADVOCATE. LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 7D: LINE 7A: HOSPITAL WEBSITELCMCWMH.COM/FILE/E7EF8250-661B-4C54-9C29-F13E2E4C98B4LINE 10: WEBSITE FOR IMPLEMENDATION PLANLCMCWMH.COM/FILE/F0164916-4A6C-438C-80FA-B9E4661B6510 LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 11: NEEDS IDENTIFIED IN THE CHNA IMPLEMENTATION STRATEGY FOR FYE SEPTEMBER 30, 2023 INCLUDE THE FOLLOWING:1. SOCIAL DETERMINANTS OF HEALTH (SDOH)2. SUBSTANCE ABUSE3. MENTAL HEALTH4. SEXUALLY TRANSMITTED INFECTIONS (STI'S)5. CHRONIC DISEASES THE FOLLOWING ACTIONS WERE TAKEN DURING FYE 2024 (ENDING SEPTEMBER 30, 2024) AND PRIOR YEARS TO ADDRESS THE IDENTIFIED NEEDS:SOCIAL DETERMINANTS OF HEALTH1. CMC IS CURRENTLY SCREENING ALL INPATIENTS, OB PATIENTS AND THOSE RECEIVING A SS CONSULT FOR SDOH NEEDS. REFERRALS ARE MADE TO APPROPRIATE RESOURCES.2. LCMC IS ACTIVELY PARTICIPATING IN THE CHIP TEAM FOR NAVAJO COUNTY AND THEY ARE FOCUSED ON INCREASING VISIBILITY AND ACCESS TO FOOD RESOURCES, CHILD CARE AND HOUSING ASSISTANCE.3. LCMC IS PARTICIPATING IN A STATE WIDE ONLINE SDOH REFERRAL PROGRAMSUBSTANCE ABUSE1. LCMC PARTICIPATED IN A COMMUNITY BEHAVIORAL HEALTH TASK FORCE THAT HAS MET MONTHLY SINCE NOV 2022. THE TEAM HAS FOCUSED ON SUBSTANCE USE DISORDER (SUD), ACCESS TO PROVIDERS, TRANSITION OF CARE FROM INCARCERATION, COMMUNITY EDUCATION, FENTANYL TESTING AND CURRENT STATS. THE TASK FORCE INCLUDES MEMBERS FROM LCMC, WINSLOW INDIAN HEALTHCARE CENTER (WIHCC), LAW ENFORCEMENT, FIRE, ACTION MEDICAL, CHANGE POINT, COMMUNITY BRIDGES INC. (CBI), NAVAJO COUNTY, WINSLOW GUIDANCE ASSOC., CARE FIRST AND BCBS.2. LCMC PARTICIPATED IN THE SUD TASK FORCE LED BY NAVAJO COUNTY3. LCMC IMPLEMENTED A TELEHEALTH PROJECT TO CONNECT EMERGENCY DEPARTMENT PATIENTS AND INPATIENTS WITH BEHAVIORAL HEALTH AND ADDICTION PROVIDERS FROM CBI.4. LCMC IS IN THE PROCESS OF IMPLEMENTING A TELEHEALTH PROJECT IN THE CLINIC TO CONNECT PATIENTS TO MENTAL HEALTH AND ADDICTION PROVIDERS FROM CBI. THE PROGRAM WENT LIVE ON OCTOBER 1, 2024. MENTAL HEALTH1. LCMC IS ENGAGED IN THE CHIP MENTAL HEALTH TEAM THROUGH NAVAJO COUNTY. THEY ARE CURRENTLY FOCUSED ON IDENTIFYING SOCIAL CONNECTEDNESS PROGRAMS AND IDENTIFYING GAPS, COLLECTING RESEARCH DATA AND CREATING A LETTER WRITING PROGRAM FOR SENIORS. A RESOURCE MAP IS BEING DEVELOPED FOR THE COMMUNITY TO SEE WHAT MENTAL HEALTH RESOURCES ARE AVAILABLE IN THEIR COMMUNITY.2. LCMC IS PARTICIPATING IN THE NAVAJO COUNTY SUICIDE MORTALITY REVIEWSEXUALLY TRANSMITTED INFECTIONS (STI'S)1. LCMC ATTENDS THE STI FOCUS GROUP WITH NAVAJO COUNTY PUBLIC HEALTH AND COMMUNITY PARTNERS QUARTERLY2. UPDATED STI PREVENTION PAMPHLET CREATED3. PAPER BAGS WITH CONDOMS, LUBE, AND PAMPHLET CREATED AND STOCKED IN ED4. STI AWARENESS BULLETIN BOARD PUT UP IN EDCHRONIC DISEASES1. LCPO STARTED A CHRONIC CARE MANAGEMENT PROGRAM IN THE CLINIC.2. LCMC CARE COORDINATION PARTICIPATED IN THE CHRONIC CONDITIONS TASK FORCE WITH NAVAJO COUNTY AND NORTH COUNTRY. WE STARTED PARTNERING TO PROVIDE EDUCATION CLASSES FOR THE COMMUNITY ONCE A MONTH INCLUDING TOPICS SUCH AS CAR SEAT EDUCATION, DIABETES EDUCATION, CAREGIVER SUPPORT, ETC.3. WE PROVIDED COMMUNITY EDUCATION EVENTS FOR DIABETES AND WILL BE IMPLEMENTING AN INPATIENT DIALYSIS PROGRAM. 4. IMPLEMENTED A PROGRAM TO PROMOTE ANNUAL WELLNESS VISITS.5. COORDINATED A WINSLOW COMMUNITY DAY MAY 2024, PROVIDED HEALTH EDUCATION AND FREE LAB TESTING, SET UP 30 VENDORS. AT LEAST 170 PEOPLE ATTENDED. THIS IS AN ANNUAL EVENT SPONSORED BY LCMC AND 2024 HAD THE HIGHEST COMMUNITY TURNOUT. ALL IDENTIFIED NEEDS ARE ADDRESSED IN THE IMPLEMENTATION STRATEGY. LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 13H: PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON A CASE-BY-CASE BASIS. LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 16J: PART V, SECTION B, LINE 16A -THE FINANCIAL ASSISTANCE POLICY IS POSTED:HTTPS://WWW.LCMCWMH.COM/FILE/5E5BB5A7-5632-44F9-8F7C-DEDA7F9A4835LINE 16B- THE FAP APPLICATION IS POSTED:HTTPS://WWW.LCMCWMH.COM/FILE/75C9AC62-2E68-4F85-BE0E-C9B452E7C9D9LINE 16C- THE FAP PLAIN LANGUAUGE SUMMARY IS POSTED: HTTPS://WWW.LCMCWMH.COM/FILE/1D09717F-33F7-48F7-BA6A-66D7EDC9610DPART V, SECTION B, LINE 16J:A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY WAS POSTED IN THE EMERGENCY ROOM, WAITING ROOMS, ADMISSIONS OFFICE AND WAS MADE AVAILABLE UPON REQUEST.MORE THAN THE LESSER OF 5% OR 1,000 INDIVIDUALS IN THE SERVICE AREA ARE LEP. HOWEVER, THE LANGUAGE SPOKEN, NAVAJO, RECENTLY BECAME A WRITTEN LANGUAGE. THE FACILITY HAS STAFF WHO SPEAK NAVAJO AND ARE ABLE TO ASSIST PATIENTS IN COMPLETING FINANCIAL ASSISTANCE FORMS, BECAUSE THE FORMS ARE STILL PREDOMINATELY IN ENGLISH. LITTLE COLORADO MEDICAL CENTER PART V, SECTION B, LINE 24: THE HOSPITAL FINANCIAL ASSISTANCE POLICY DOES NOT COVER ELECTIVE PROCEDURES. THE HOSPITAL MAY HAVE CHARGED FAP ELIGIBLE PATIENTS GROSS CHARGES FOR SERVICES THAT ARE NOT COVERED UNDER THE FINANCIAL ASSISTANCE POLICY. PART I, LINE 3C: IN ADDITION TO UTILIZING FPG TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE, THE HOSPITAL CONSIDERED MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS OF PATIENTS. PRESUMPTIVE ELIGIBILITY MAY BE USED ON A CASE-BY-CASE BASIS. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7E WAS DETERMINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS DETERMINED BASED ON THE COST REPORT. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE ORGANIZATION DETERMINES ITS ESTIMATE OF IMPLICIT PRICE CONCESSION BASED ON ITS HISTORICAL COLLECTION EXPERIENCE WITH THIS CLASS OF PATIENTS. PART III, LINE 3: THE IMPLICIT PRICE CONCESSION INCLUDES AN ESTIMATED $1,325,018 OF CHARITY CARE-ELIGIBLE ACCOUNTS THAT ARE CURRENTLY LISTED AS AN IMPLICIT PRICE CONCESSION. UPON REVIEWING THE ACCOUNTS AND THE POVERTY LEVELS OF NAVAJO AND APACHE COUNTIES IN ARIZONA, IT WAS FOUND THAT ABOUT 27.46% OF THE OUTSTANDING BALANCES MAY HAVE BEEN ELIGIBLE UNDER THE FACILITY'S CHARITY CARE POLICY. ALSO FOR THIS REVIEW PROCESS, ANY FAMILIES WITH PRIOR APPLICATIONS FOR CHARITY CARE WERE GIVEN CONSIDERATION. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSION IS LOCATED IN FOOTNOTE 1 ON PAGES 11 & 12 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COST OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR THE FISCAL YEAR ENDING 9/30/2024. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY THE CENTERS FOR MEDICARE AND MEDICAID SERVICES.HOSPITAL SERVICES REIMBURSED ON A FEE SCHEDULE ARE NOT INCLUDED IN THE MEDICARE CALCULATION PER THE 990 INSTRUCTIONS. HAD THIS BEEN REPORTED THE HOSPITAL WOULD HAVE HAD A GREATER LOSS FROM MEDICARE SERVICES OF $32,963.MEDICARE FEE SCHEDULE REVENUE: $10,101MEDICARE ESTIMATED COSTS OF CARE RELATING TO PAYMENTS: $(43,064)NET (SHORTAGE): $(32,963) PART III, LINE 9B: ACCOUNTS THAT MEET THE CRITERIA FOR THE FINANCIAL ASSISTANCE POLICY WILL BE WRITTEN OFF IN ACCORDANCE WITH THE FINANCIAL ASSISTANCE POLICY. ACCOUNTS THAT DO NOT MEET THE CRITERIA FOR FINANCIAL ASSISTANCE WILL PROCEED THROUGH THE COLLECTION PROCESS. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT AN ACCOUNT IN COLLECTION BELONGS TO A PATIENT WHO IS ELIGIBLE FOR FINANCIAL ASSISTANCE, THE ACCOUNT WILL BE REMOVED FROM COLLECTION AND RETURNED TO THE HOSPITAL FOR RESOLUTION. PART VI, LINE 2: LCMC ASSESSES HEALTH NEEDS BY EVALUATING THE PATIENTS SERVED IN THE CLINICS AND HOSPITAL. LCMC HAS STAFF THAT PARTICIPATE IN VARIOUS ORGANIZATIONS INCLUDING THE COUNCIL FOR AGING, ALICE'S PLACE, THE WINSLOW ROTARY, ETC. STAFF ARE MADE AWARE OF NEEDS OF THE COMMUNITY THROUGH THEIR INVOLVEMENT WITH THESE ORGANIZATIONS. ADDITIONALLY, LCMC HAS MONTHLY MEDICAL EXECUTIVE AND BI-ANNUAL MEDICAL STAFF MEETINGS TO DETERMINE THE HEALTH NEEDS OF THE COMMUNITY. PART VI, LINE 3: LCMC'S PATIENT BILLING STATEMENTS HAVE A NARRATIVE ATTACHED DESCRIBING THE AVAILABILITY OF FINANCIAL ASSISTANCE AND THE CONTACT INFORMATION FOR HOW TO OBTAIN ADDITIONAL INFORMATION. NOTICES OF FINANCIAL ASSISTANCE AVAILABILITY ARE POSTED IN THE ER, WAITING ROOMS, AND ADMISSIONS OFFICE. PART VI, LINE 4: LCMC IS LOCATED IN WINSLOW WHICH IS PART OF NAVAJO COUNTY, ARIZONA, AND SERVES THE HEALTHCARE NEEDS OF THE COMMUNITY AND SURROUNDING AREAS. THE SERVICE AREA IS MOSTLY RURAL WITH A POPULATION OF APPROXIMATELY 24,790 PEOPLE. THE AVERAGE HOUSEHOLD INCOME IS $43,918 WITH 31.6% OF THE POPULATION HAVING AN INCOME OF LESS THAN $35,000. MORE THAN 40% OF THE PATIENTS SERVED BY LCMC ARE ON THE ARIZONA HEALTH CARE COST CONTAINMENT SYSTEM, AND MORE THAN 67% OF THE SERVICE AREA ARE OF NATIVE AMERICAN DESCENT. THE NEAREST HOSPITAL IS 60 MILES FROM WINSLOW. WINSLOW IS IN AN AREA FEDERALLY DESIGNATED AS A HEALTH PROFESSIONAL SHORTAGE AREA, A MEDICALLY UNDERSERVED AREA, AND A PERSISTENT POVERTY COUNTY. PART VI, LINE 5: LCMC'S BOARD OF DIRECTORS ALL RESIDE IN THE ORGANIZATION'S SERVICE AREA EXCEPT FOR FOUR MEMBERS, ONE RESIDES IN PHOENIX, AZ, ONE RESIDES IN PAYSON, AZ, AND TWO RESIDE IN FLAGSTAFF, AZ. IN ADDITION, NONE OF THE BOARD MEMBERS ARE RELATED TO THE ORGANIZATION. LCMC EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PROVIDERS IN ITS COMMUNITY AND SURROUNDING AREA FOR SOME OR ALL ITS DEPARTMENTS. LCMC REINVESTS SURPLUS FUNDS, IF ANY, TO IMPROVEMENTS IN PATIENT CARE, INCLUDING BUT NOT LIMITED TO EXPANSION OF SERVICES OFFERED, PATIENT EDUCATION, EMPLOYEE EDUCATION, AND EQUIPMENT AND FACILITY RENOVATIONS. X X X X X 0 1 0 0 0 0 0 1 0 BRIAN BUCINA MD SURGEON 563099 0 0 0 3675 0 9875 0 36993 0 613642 0 0 0 JOHN J DEMPSEY CEO UNTIL 04/2024 320665 0 36900 0 0 0 13275 0 15835 0 386675 0 0 0 RANDALL REID MD OB/GYN 320771 0 0 0 3020 0 14566 0 39762 0 378119 0 0 0 THOMAS GREENWOOD MD DIRECTOR, CHIEF OF STAFF 264504 0 0 0 0 0 11867 0 39946 0 316317 0 0 0 JAMES PAGE GENERAL MEDICINE 184459 0 0 0 13095 0 7367 0 39886 0 244807 0 0 0 PAMELA RULAND RN 206793 0 5000 0 0 0 9531 0 10958 0 232282 0 0 0 LONA KING CFO 198750 0 0 0 0 0 8014 0 11337 0 218101 0 0 0 REBECCA HEWARD INFORMATICS NURSE 189074 0 5000 0 945 0 7905 0 296 0 203220 0 0 0 PART I, LINE 4B LCMC ENTERED INTO AN AGREEMENT WITH JOHN DEMPSEY TO PAY HIM A RETENTION BONUS WHICH VESTED ON 7/31/2020. THE FULL RETENTION BONUS WILL BE PAID OVER AN EIGHT-YEAR PERIOD. THIS DEFERRED COMPENSATION BENEFIT BECAME EFFECTIVE JANUARY 1, 2019. MONTHLY PAYMENTS BEGAN ON JULY 1, 2020. JOHN DEMPSEY WAS PAID $36,900 IN DEFERRED COMPENSATION IN CALENDAR YEAR 2023 AND WILL CONTINUE TO RECEIVE THE DEFERRED COMPENSATION UNTIL 2030. PART I, LINE 7 BONUSES WERE PROVIDED BASED ON COMPLETION OF TASKS DETERMINED AS PART OF EACH INDIVIDUALS PERFORMANCE PLANS. THOMAS GREENWOOD FAMILY OWNERSHIP OF WINNCARE LLC 429675 HOSPITALIST 0 FORM 990, PART VI, SECTION A, LINE 8B ALL COMMITTEES UTILIZED BY LCMC ARE STRICTLY ADVISORY IN NATURE. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CEO AND CFO WILL REVIEW THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS REVIEWED ON AN ANNUAL BASIS. BOARD MEMBERS, OFFICERS, AND MANAGERS ARE COVERED UNDER LITTLE COLORADO MEDICAL CENTER'S CONFLICT OF INTEREST POLICY. WHEN A CONFLICT OF INTEREST ARISES, THE COVERED PERSON IS TO DISCLOSE THE CONFLICT TO HIS OR HER IMMEDIATE SUPERVISOR BEFORE A DECISION INVOLVING THE AREA OF CONFLICT IS MADE. MEMBERS WITH A CONFLICT OF INTEREST ARE ALSO NOT ALLOWED TO PARTICIPATE IN THE DECISION MAKING PROCESS. FORM 990, PART VI, SECTION B, LINE 15A THE ORGANIZATION REVIEWS AND DETERMINES THE CEO'S COMPENSATION EVERY FEW YEARS. THE ORGANIZATION BRINGS IN THE LEDBETTER LAW FIRM, PLC TO AID IN DETERMINING THE REASONABLENESS OF THE COMPENSATION. THE LAW FIRM CONSIDERS CEO COMPENSATION FROM OTHER HOSPITALS WITHIN THE CRITICAL ACCESS HOSPITALS IN ARIZONA, WHICH LCMC IS APART OF. THIS DATA IS COLLECTED THROUGH THE ARIZONA HOSPITAL ASSOCIATION. LEDBETTER LAW FIRM PLC WAS ENGAGED TO REVIEW AND ANALYZE THE COMPENSATION FOR THE CEO IN 2024. THE BOARD OF DIRECTORS APPROVED THE COMPENSATION RECOMMENDATION. NO PAY ADJUSTMENTS HAVE BEEN PROVIDED SINCE THAT TIME. THE BOARD AND OUTSIDE LEGAL COUNSEL REVIEW THE CEO'S COMPENSATION ANNUALLY. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,318,623. MANAGEMENT AND GENERAL EXPENSES 81,260. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,399,883. PROFESSIONAL FEES - MEDICAL: PROGRAM SERVICE EXPENSES 3,484,005. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,484,005. PURCH SVCES-OTHER: PROGRAM SERVICE EXPENSES 2,252,624. MANAGEMENT AND GENERAL EXPENSES 89,341. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,341,965. FORM 990, PART XI, LINE 9: CHANGE IN INTEREST IN NET ASSETS OF FOUNDATION 692. LITTLE COLORADO HEALTHCARE FOUNDATION 1501 NORTH WILLIAMSON AVENUE WINSLOW AZ 86047 208504703 CHARITABLE AZ 501(C)(3) LINE 11 WINSLOW MEMORIAL HOSPITAL INC 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0