Attach to Form 990 or 990-EZ.| Identifier | Return Reference | Explanation |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERSHIP IN HCSA IS LIMITED TO ENTITIES THAT OWN AND OPERATE ACUTE CARE LICENSED HOSPITAL FACILITIES THAT PROVIDE 24 HOUR EMERGENCY CARE SERVICES IN COCHISE COUNTY, GRAHAM COUNTY, PIMA COUNTY, PINAL COUNTY, AND SANTA CRUZ COUNTY, ARIZONA. | |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH MEMBER HAS THE RIGHT TO APPOINT ONE PERSON TO SERVE AS A DIRECTOR OF HCSA, PROVIDED SUCH PERSON IS EITHER THE CHIEF EXECUTIVE OFFICER OF THE MEMBER OR THE CHIEF EXECUTIVE OFFICER OF A QUALIFIED HOSPITAL OWNED AND OPERATED BY THE MEMBER. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE ORGANIZATION PROVIDES A DRAFT OF FORM 990 TO ITS OFFICERS AND DIRECTORS FOR REVIEW PRIOR TO FILING. | |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST POLICY STATEMENT IS MADE AVAILABLE FOR MEMBERS AT EACH BOARD OF DIRECTORS MEETING. EACH BOARD MEMBER ANNUALLY SIGNS A STATEMENT THAT REAFFIRMS HIS/HER UNDERSTANDING OF HCSA'S CONFLICT OF INTEREST POLICY. BOARD MEMBERS ARE GIVEN AN OPPORTUNITY TO FILE IN WRITING ANY PERCEIVED CONFLICTS OF INTEREST WITH HCSA SO THAT IT BECOMES A MATTER OF EACH MEETING'S RECORD. PERIODIC REVIEWS ARE CONDUCTED BY THE BOARD OR THE BOARD'S APPOINTED COMMITTEE TO ENSURE COMPLIANCE AND CONSISTENCY WITH THE CONFLICT OF INTEREST POLICY. | |
| FORM 990, PART VI, SECTION B, LINE 15A | A MERCER SALARY SURVEY WAS UTILIZED IN CONJUNCTION WITH THE SERVICES OF A HUMAN RESOURCES CONSULTANT TO ESTABLISH THE PRESIDENT'S STARTING SALARY IN 2004. SUBSEQUENTLY, ANNUAL PERFORMANCE OBJECTIVES AND AN EXECUTIVE PERFORMANCE REVIEW HAVE BEEN UTILIZED TO ESTABLISH ANY INCREASES OR BONUSES. | |
| FORM 990, PART VI, SECTION C, LINE 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST AT THE ORGANIZATION'S OFFICE. | |
| FORM 990, PART I, LINE 5, NUMBER OF EMPLOYEES: | PLEASE NOTE THAT COMPENSATION, BENEFITS, AND TAXES AS REPORTED AT PART VII AND PART IX ARE REIMBURSED TO OTHER ORGANIZATIONS FOR THE SERVICES PROVIDED. HCSA DOES NOT HAVE ANY EMPLOYEES. ACCORDINGLY, NO EMPLOYEES ARE REPORTED AT PART I LINE 5 OR PART V LINE 2A. |
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