Community Benefit Insight - Tax-exempt hospital

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White Mountain Communities Hospital Inc

White Mountain Regional Hospital

118 South Mountain Rd
Springerville, AZ 85938

Bed count	25	Medicare provider number	031315	Member of the Council of Teaching Hospitals	NO	Children's hospital	NO

EIN: 860171900

Display data for year:

Community Benefit Spending- 2021
(as % of functional expenses, which all tax-exempt organizations report on Form 990 Schedule H)

11.39%

Spending by Community Benefit Category- 2021
(as % of total functional expenses)

* = CBI denoted preventative categories

Community Benefit Spending Compared to Functional Expenses, 2010-2021

Additional data

Community Benefit Expenditures: 2021

All tax-exempt organizations file a Form 990 with the IRS for every tax year. If the tax-exempt organization operates one or more hospital facilities during the tax year, the organization must attach a Schedule H to Form 990. On Part I of Schedule H, the organization records the expenditures it made during the tax year for various types of community benefits; 9 types are shown on this web tool. By default, this web tool presents community benefit expenditures as a percentage of the organization’s functional expenses, which it reports on Form 990, Part IX, Line 25, Column A. (The more commonly heard term, ‘total operating expenses’, which organizations report to CMS, is generally about 90% of the ‘functional expenses’). The user may change the default to see the dollar expenditures.
Amount spent in the following IRS community benefit categories:

Financial Assistance at cost as % of operating expenses	$ 37,000 0.18 %
Medicaid as % of operating expenses	$ 300,414 1.49 %
Costs of other means-tested government programs as % of operating expenses	$ 0 0 %
Health professions education as % of operating expenses	$ 0 0 %
Subsidized health services as % of operating expenses	$ 1,964,451 9.72 %
Research as % of operating expenses	$ 0 0 %
Community health improvement services and community benefit operations* as % of operating expenses Note: these two community benefit categories are reported together on the Schedule H, part I, line 7e.	$ 0 0 %
Cash and in-kind contributions for community benefit* as % of operating expenses	$ 0 0 %
Community building* as % of operating expenses	$ 0 0 %

* = CBI denoted preventative categories

Community building activities details:

Did tax-exempt hospital report community building activities?	Not available
Number of activities or programs (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Persons served (optional)	0
Physical improvements and housing	0
Economic development	0
Community support	0
Environmental improvements	0
Leadership development and training for community members	0
Coalition building	0
Community health improvement advocacy	0
Workforce development	0
Other	0
Community building expense as % of operating expenses	$ 0 0 %
Physical improvements and housing as % of community building expenses	$ 0
Economic development as % of community building expenses	$ 0
Community support as % of community building expenses	$ 0
Environmental improvements as % of community building expenses	$ 0
Leadership development and training for community members as % of community building expenses	$ 0
Coalition building as % of community building expenses	$ 0
Community health improvement advocacy as % of community building expenses	$ 0
Workforce development as % of community building expenses	$ 0
Other as % of community building expenses	$ 0
Direct offsetting revenue	$ 0
Physical improvements and housing	$ 0
Economic development	$ 0
Community support	$ 0
Environmental improvements	$ 0
Leadership development and training for community members	$ 0
Coalition building	$ 0
Community health improvement advocacy	$ 0
Workforce development	$ 0
Other	$ 0

Other Useful Tax-exempt Hospital Information: 2021

In addition to community benefit and community building expenditures, the Schedule H worksheet includes sections on what percentage of bad debt can be attributable to patients eligible for financial assistance, and questions on the tax-exempt hospital's debt collection policy. When searching a specific tax-exempt hospital in this web tool, Section II provides information about bad debt and the financial assistance policy, and whether the state in which the tax-exempt hospital resides has expanded Medicaid coverage under the federal ACA.

Of the tax-exempt hospital’s overall operating expenses, amount reported as bad debt as % of operating expenses	$ 2,984,007 14.76 %
Is the tax-exempt hospital considered a "sole community hospital" under the Medicare program?	NO

Information about the tax-exempt hospital's Financial Assistance Policy and Debt Collection Policy
The Financial Assistance Policy section of Schedule H has changed over the years. The questions listed below reflect the questions on the 2009-2011 Schedule H forms and the answers tax-exempt hospitals provided for those years. The Financial Assistance Policy requirements were changed under the ACA. In the future, as the Community Benefit Insight web site is populated with 2021 data and subsequent years, the web tool will also be updated to reflect the new wording and requirements. In the meantime, if you have any questions about this section, we encourage you to contact your tax-exempt hospital directly.

Does the organization have a written financial assistance (charity care) policy?	YES
Did the tax-exempt hospital rely upon Federal Poverty Guidelines (FPG) to determine when to provide free or discounted care for patients?	YES
Amount of the tax-exempt hospital’s bad debt (at cost) attributed to patients eligible under the organization’s financial assistance (charity care) policy as % of operating expenses	$ 450,585 15.10 %

Did the tax-exempt hospital, or an authorized third party, take any of the following collection activities before determining whether the patient was eligible for financial assistance:
Under the ACA, states have the choice to expand Medicaid eligibility for their residents up to 138% of the federal poverty guidelines. The Medicaid expansion provision of the ACA did not go into effect until January 2014, so data in this web tool will not reflect each state's current Medicaid eligibility threshold. For up to date information, please visit the Terms and Glossary under the Resources tab.
The federal poverty guidelines (FPG) are set by the government and used to determine eligibility for many federal financial assistance programs. Tax-exempt hospitals often use FPG guidelines in their Financial Assistance policies to determine which patients will qualify for free or discounted care.
In addition to the federal requirements, some states have laws stipulating community benefit requirements as a result of tax-exemption. The laws vary from state to state and may require the tax-exempt hospitals to submit community benefit reports. Data on this web tool captures whether or not a state had a mandatory community benefit reporting law as of 2011. For more information, please see Community Benefit State Law Profiles Comparison at The Hilltop Institute.

Community Health Needs Assessment Activities: 2021

The ACA requires all 501(c)(3) tax-exempt hospitals to conduct a Community Health Needs Assessment (CHNA) every three years, starting with the hospital's tax year beginning after March 23, 2012. The 2011 Schedule H included an optional section of questions on the CHNA process. This web tool includes responses for those hospitals voluntary reporting this information. The web tool will be updated to reflect changes in these questions on the 2012 and subsequent Schedule H forms.

Did the tax-exempt hospital report that they had conducted a CHNA?	YES
Did the CHNA define the community served by the tax-exempt hospital?	YES
Did the CHNA consider input from individuals that represent the broad interests of the community served by the tax-exempt hospital?	YES
Did the tax-exempt hospital make the CHNA widely available (i.e. post online)?	YES
Did the tax-exempt hospital adopt an implementation strategy to address the community needs identified by the CHNA?	YES

Supplemental Information: 2021

This section presents qualitative information submitted by the hospital, verbatim from the 990H record.

Statement of Program Service Accomplishments
Description of the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4A (Expenses $ 16333124 including grants of $ 2250) (Revenue $ 21193955)
White Mountain Communities Hospital, Inc. dba White Mountain Regional Medical Center (Hospital) is a 21-bed Critical Access Hospital located in Springerville, Arizona, and provides acute care inpatient, outpatient and emergency services to residents of the surrounding communities in the Springerville area.White Mountain Regional Medical Center will provide caring services and operate on a financially sound basis to ensure its continuing ability to meet the needs of patients and the communities it serves. Continued on Schedule O.The Board of Directors and leadership of White Mountain Regional Medical Center 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. In July 2018, the Centers for Medicare and Medicaid Services (CMS) accepted our agreement to allow our existing clinic, located at 114 South Mountain Avenue, Springerville, AZ 85938, to participate as a rural health clinic (RHC) in the Medicare program under Title XVIII of the Social Security Act.As a community organization the facility plays a vital role in providing services essential to the quality of life for people in Apache County, Arizona and Catron County, New Mexico.The Hospital provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as revenue. The amount of charges foregone for services provided under the Hospital's charity care policy was approximately $103,000 for the year ended December 31, 2021. Total direct and indirect costs related to these foregone charges was approximately $37,000 as of December 31, 2021, based on an average ratio of cost to gross charges.

Facility Information

Schedule H (Form 990) Section C. Supplemental Information for Part V, Section B.

White Mountain Communities Hospital, Inc.
Part V, Section B, Line 5: The community survey was publicized and distributed widely throughout the primary service area. The CHNA survey was available to the community in paper form; electronically on White Mountain Regional Medical Center's website www.wmrmc.com; through social media, and online via Survey Monkey at www.surveymonkey.com. The survey was shared in paper form at the following locations:Apache County Fair (St. Johns, AZ)WMRMC Rural Health ClinicWMRMC Jean V. Hall Wellness CenterWMRMC Outpatient Registration WMRMC Governing Board of DirectorsWMRMC AuxiliaryWMRMC EmployeesNorth Country Community Health Center (Eagar, AZ)Apache County Drug Free Alliance Social MediaApache County Public Health ServicesLittle Colorado Behavioral Health Center (Springerville, AZ)Little Colorado Behavioral Health Center (St. Johns, AZ)Round Valley Community Services and Senior CenterThe survey presents an effort to solicit input from the broader community. While, the initiative is informal and non-representative, it does contribute considerable input from the broader community. The survey typically queries respondent's health-related needs and behaviors. This provides both an indication of local demand for health services and the level of satisfaction within the services received.

White Mountain Communities Hospital, Inc.
Part V, Section B, Line 6b: The Apache County Drug Free Alliance, the Apache County Public Health Services District, Little Colorado Behavioral Health Center, North Country Healthcare, and the Town of Springerville.

White Mountain Communities Hospital, Inc.
Part V, Section B, Line 11: The CHNA completed in 2021 narrowed the top three (3) priority needs as:1. Access to Specialty Services in our Service Area 2. Access to Mental Health Services: Depression, Anxiety and Substance Abuse 3. Chronic Disease Management The Hospital will spend the next 3 years addressing the needs identified in the 2021 CHNA. Priority 1: Access to Specialty Services in our Service Area1. Implement telehealth specialty services at WMRMC Rural Health Clinic. The telehealth specialty services include cardiology, pulmonology, and behavioral and mental health. 2. WMRMC Rural Health Clinic has implemented home visits that include the following specialty services: pulmonology and podiatry. Home visits allow patients to receive care in the comfort of their homes and do not require an in-office visit. 3. Collaborate with other healthcare organizations, community organizations, and providers to seek other specialty services that will benefit our community4. Collaborate with other health care clinics and providers to bring specialty services to our service area.Priority 2: Mental Health1. Collaborate with Integrative Health Centers to bring in two (2) Nurse Practitioners to address behavioral and mental health needs. Integrative Health Centers focus on the following mental health needs: Psychiatry, Behavioral Health and Addiction Medicine. 2. Explore partnerships with surrounding mental health providers to improve care, awareness, and management and promote the prevention of substance abuse and suicide. Priority 3: Chronic Disease Management1. Partnered with Dave Johnson, a Strategic Health Care Risk and Financial Advisor, to support chronic care management. 2. Provide and expand chronic disease self-management programs in collaboration with healthcare organizations, community organizations, and providers. WMRMC offers discharge instructions to patients to help manage their medications and chronic disease information specific to their needs. 3. Collaborate with healthcare organizations, community organizations, and providers to identify sub-specialties that are disparities in chronic care management. The needs from the 2018 CHNA were also addressed during 2021. The coalition formed to address the needs continued to work on the development of a community educational site and/or newsletters which will be shared among local healthcare and community organizations in an effort to increase education in the community.The coalition continued to work on strengthening coordination among local healthcare and community organizations to expand educational opportunities within the community.The hospital partnered with local healthcare and community organizations in an effort to encourage community wellness events and programs.

White Mountain Communities Hospital, Inc.
Part V, Section B, Line 13h: Uninsured Patients having annual household incomes of $125,000 or less may, depending upon their assets and liabilities, receive a discount to be charged no more than amounts generally billed for medically necessary care. Uninsured patients having household incomes at or below 200% of the Federal Poverty Line will qualify for free emergency care and will receive a discount to be charged no more than amounts generally billed for other medically necessary care. If requested to do so by the hospital, patients may be required to apply for and show denial for Medicaid/AHCCCS coverage.

Part V, Section B, Line 7a:
Community Health Needs Assessment website:https://www.wmrmc.com/getpage.php?name=News_-_CHNA

Part V, Section B, Line 10a:
Implementation Strategy website:https://www.wmrmc.com/getpage.php?name=News_-_CHNA

Supplemental Information

Schedule H (Form 990) Part VI

Part I, Line 3c:
Uninsured Patients having annual household incomes of $125,000 or less may, depending upon their assets and liabilities, receive a discount to be charged no more than amounts generally billed for medically necessary care. Uninsured patients having household incomes at or below 200% of the Federal Poverty Line will qualify for free emergency care and will receive a discount to be charged no more than amounts generally billed for other medically necessary care. If requested to do so by the hospital, patients may be required to apply for and show denial for Medicaid/AHCCCS coverage.

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. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost reports. The cost for subsidized health services reported on line 7g was determined using the Medicare Cost Report.

Part III, Line 2:
The amount reported on line 2 represents implicit price concessions. The Hospital determines its estimate of implicit price concessions based on its historical collection experience with this class of patients.

Part III, Line 3:
The Hospital reasonably estimates the portion of implicit price concessions that could have qualified for charity care. An estimated 15.1% of implicit price concessions in 2021 are attributable to patients potentially eligible for charity care. This is based on the percentage of individuals living below the federal poverty level.

Part III, Line 4:
The footnote to the Organization's financial statements can be found on pages 8 and 9 of the attached audited financial statements.

Part III, Line 8:
White Mountain Regional Medical Center is a critical access hospital. The Hospital provides services to Medicare patients regardless of surplus or shortfall because access to healthcare and individual's health is important to the Hospital and community. Total revenue received from Medicare (including DSH and IME) is the gross reimbursement plus settlement (including LSA). Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by Centers for Medicaid and Medicare 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 loss from Medicare services of $252,734.Medicare fee schedule revenue: $ 251,785Medicare estimated costs of care relating to payments (504,519)Net (Shortage) $ (252,734)

Part III, Line 9b:
If a patient qualifies for financial assistance the patient will in no case be charged more than Amounts Generally Billed for emergency services or other medically necessary services. In addition, they will never be required to make advance payment or other payment arrangements in order to receive emergency services. However, they will be required in most situations to make a substantial advance deposit or other payment arrangements based upon an estimate of the Amounts Generally Billed in order to receive non-emergency services. The account will not be turned over to a collection agency while an application is in process. Any personal amount due will follow normal collection procedures which follows a 120-day notification period and 240-day application period, both beginning on the date of the first post-discharge billing statement. The Hospital also provides a 30-day written notice before any extraordinary collection activities.

Part VI, Line 2:
In addition to the CHNA, White Mountain Regional Medical Center utilizes HealthStream to conduct patient surveys.

Part VI, Line 3:
The financial assistance policy, application and plain language summary are provided on the Hospital's website in English and Spanish. The forms are also available at the Hospital. Copies of these documents are also available in the Admitting area located near the main entrance of the Hospital and by mail by contacting Patient Financial Services at 928-333-7151. A cover letter is included with billing statements to self-pay patients advising where to learn about government funded programs and an explanation on the financial assistance policy.

Part VI, Line 4:
White Mountain Regional Medical Center is a 21-bed Critical Access Hospital. The Medical Center serves southern Apache County, Arizona, as well as Catron County, New Mexico. Both are high poverty areas. The population in Springerville, AZ was 2,208. The estimated median household income was $46,359. The unemployment rate was 11.2% and the poverty rate was 15.1%. The economy of Springerville, AZ employs 819 people. The largest industries are retail trade, accommodation & food services, and health care & social assistance. The highest paying industries are utilities, wholesale trade, and construction. The nearest hospital is 45 minutes away in Show Low, Arizona.

Part VI, Line 5:
The governing body is comprised of persons who reside in the Medical Center's primary service area. White Mountain Regional Medical Center extends medical staff privileges to all qualified physicians. Any surplus funds are used for equipment and facility upgrades to give our patients the latest in technology.White Mountain Regional Medical Center is currently a Level 4 Trauma Center. The Hospital has received Pediatric Emergency Certification. There are several physicians/providers located in the area that routinely use our facility in some capacity. In addition, there are many physicians with sub-specialties that visit the area providing ophthalmology, orthopedic, and general surgery close to home, through the Rural Health Clinic. As it currently operates, White Mountain Regional Medical Center is a 21-bed Critical Access Hospital. In addition to inpatient services, the facility offers: General Outpatient Surgical Services;General Outpatient Medical Services;Emergency Services;Medical Imaging Services, which include X-ray, MRI, C-T Scan, Bone Densitometry, Nuclear Medicine and Ultra Sound;Laboratory Services, which include Blood Bank, Chemistry and Hematology;Cardiopulmonary Services, which include Respiratory Services, Pulmonary Function Services, Sleep Study, EKG Services and Cardiac Stress testing;Inpatient Pharmacy Services; Rehabilitation Services, which include inpatient and outpatient Physical Therapy; Wellness Center; Food Services, which include a consulting Registered Dietitian.

Operating expenses	$ 20,212,558
Total amount spent on community benefits as % of operating expenses	$ 2,301,865 11.39 %