Attach to Form 990 or Form 990-EZ.
Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
| (i)Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
| Total | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .... | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f).. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support Add lines 7 through 10. | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose...... | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513.. | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 6 | Total. Add lines 1 through 5. | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons... | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2010 | (b) 2011 | (c) 2012 | (d) 2013 | (e) 2014 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
||||
| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e | Discount claimed for blockage or other factors (explain in detail in Part VI): | |||||
| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by .035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| 7 | Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions) | |||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | ||
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
||
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | ||
| 4 Amounts paid to acquire exempt-use assets | ||
| 5 Qualified set-aside amounts (prior IRS approval required) | ||
| 6 Other distributions (describe in Part VI). See instructions | ||
| 7Total annual distributions. Add lines 1 through 6. | ||
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
||
| 9 Distributable amount for 2014 from Section C, line 6 | ||
| 10 Line 8 amount divided by Line 9 amount | ||
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2014 |
(iii) Distributable Amount for 2014 |
|
|---|---|---|---|---|
|
1
Distributable amount for 2014 from Section C, line 6 |
||||
|
2
Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions) |
||||
| 3 Excess distributions carryover, if any, to 2014: | ||||
| a From 2009.......X | ||||
| b From 2010.......X | ||||
| c From 2011.......X | ||||
| d From 2012.......X | ||||
| e From 2013....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2014 distributable amount | ||||
|
i
Carryover from 2009 not applied (see instructions) |
||||
| j Remainder. Subtract lines 3g, 3h, and 3i from 3f. | ||||
| 4Distributions for 2014 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2014 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from 4. | ||||
|
5
Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions) |
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|
6
Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions) |
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|
7 Excess distributions carryover to 2015. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a From 2010.......X | ||||
| b From 2011.......X | ||||
| c From 2012.......X | ||||
| d From 2013....... | ||||
| e From 2014....... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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Attach to Form 990 or 990-EZ.
Information about Schedule O (Form 990 or 990-EZ) and its instructions is at| Return Reference | Explanation |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 2 | ALL OF THE HOSPITAL'S GOVERNING BOARD MEMBERS RECEIVED STIPEND PAYMENTS FOR BOARD OF DIRECTOR SERVICES. THE FOLLOWING BUSINESS TRANSACTIONS/RELATIONSHIPS ARE REPORTED FOR 2014. DOUG WRIGHT MEDICAL DIRECTOR / PHYSICIAN WOUND CARE $144,858 CHIEF OF MEDICAL STAFF UNTIL 05/31/15 $1,500 <10% INVESTOR WHITE MOUNTAIN IMAGING BOARD MEMBER STIPEND $14,400 BECKY THOMPSON OFFICE RENTAL SPACE - PAID TO: OLD BEAR PROPERTIES $75,977 FAMILY RELATION WITH EMPLOYED PHYSICIAN (DR. MULDER) ON CALL PHYSICIAN GROUP $6,076 BOARD MEMBER STIPEND $14,400 THOMAS PAXMAN OFFICE RENTAL SPACE - PAID TO: PINETOP MEDICAL $203,394 ON CALL PHYSICIAN GROUP $7,252 3% INVESTOR IN WHITE MOUNTAIN IMAGING 20% PARTNER & EMPLOYEE OF WHITE MOUNTAIN ER PHYSICIANS $97,200 BOARD MEMBER STIPEND $14,400 JOHN CORDER CORDER COMMUNITY SERVICES SECURITY $8,375 33% OWNER IN CORDER COMMUNITY SERVICES SECURITY BOARD MEMBER STIPEND $14,400 PAUL WATSON TOWN MANAGER OF SNOWFLAKE, ARIZONA REAL ESTATE $0 BOARD MEMBER STIPEND $14,400 NEAL THOMPSON REAL ESTATE BROKER - PINE SHADOWS BOARD MEMBER STIPEND $14,400 DOUGLAS LEE CHIEF OF MEDICAL STAFF AS OF 6/1/2014 EMPLOYED DIRECTOR OF ANESTHESIA $482,506 BOARD MEMBER STIPEND $8,400 ALAN DEWITT CHIEF OF MEDICAL OFFICER OF SUMMIT PHYSICIAN PRACTICES $321,228 PRESIDENT OF SUMMIT PHYSICIAN GROUP, SHMA >10% OWNER OF SNOWFLAKE MEDICAL CENTER BUILDING RENTED BY SUMMIT $102,256 CONNIE KAKAVAS SHOW LOW CITY COUNCILWOMAN CHIEF HUMAN RESOURCES OFFICER OF SUMMIT AFTER CONSIDERATION OF THE ABOVE TRANSACTIONS, BOARD MEMBERS THOMAS PAXMAN, BECKY THOMPSON, AND DOUG WRIGHT, WERE CONSIDERED TO HAVE COMPROMISED THEIR INDEPENDENCE AS VOTING MEMBERS. THESE BOARD MEMBERS EXCUSED THEMSELVES FROM VOTING ON ANY SUBJECTS INVOLVING A CONFLICT OF INTEREST. SUMMIT HEALTHCARE ASSOCIATION IS A 51% OWNER OF WHITE MOUNTAIN IMAGING. SUMMIT LEASES MRI EQUIPMENT FROM WHITE MOUNTAIN IMAGING ALSO. LEASE PAYMENTS IN 2014 WERE $97,200. THE OWNERSHIP INTEREST IN WHITE MOUNTAIN IMAGING BY DOUG WRIGHT AND THOMAS PAXMAN IS LESS THAN 10% AND NOT REPORTABLE ON SCHEDULE L. THE RENTAL FEES FOR MEDICAL OFFICE SPACE FROM BUSINESSES OWNED BY THOMAS PAXMAN AND BECKY THOMPSON WERE GREATER THAN $100K AND REPORTED ON SCHEDULE L. BECKY THOMPSON HAS A CONTROLLING OWNERSHIP INTEREST IN OLD BEAR PROPERTIES, WHICH WAS DEEMED TO COMPROMISE HER VOTING INDEPENDENCE ON SOME ISSUES. SUMMIT HEALTHCARE ASSOCIATION CONTRACTS ER PHYSICIAN SERVICES FROM WHITE MOUNTAIN ER PHYSICIANS OF WHICH DOUG WRIGHT IS A 20% PARTNER AND EMPLOYEE. THE TRANSACTIONS WERE GREATER THAN $100K AND REPORTED ON SCHEDULE L. DOUG WRIGHT'S COMPENSATION AS THE MEDICAL DIRECTOR OF WOUND CARE AND CHIEF OF STAFF, IN AGGREGATE, WAS UNDER THE $100K SCHEDULE L REPORTING THRESHOLD, BUT HAS BEEN LISTED IN PART VII AS REPORTABLE COMPENSATION. DOUG WRIGHT IS NO LONGER CHIEF OF STAFF AS OF JUNE 2014. BECKY THOMPSON IS RELATED TO A PHYSICIAN EMPLOYED BY SUMMIT HEALTHCARE ASSOCIATION. DR. MULDER IS HER COUSIN-IN-LAW AND WAS PAID $158,907. DR. MULDER IS NO LONGER AN EMPLOYED PHYSICIAN AS OF JUNE 2014. SUMMIT HEALTHCARE ASSOCIATION CONTRACTS WITH INDEPENDENT PHYSICIANS FOR ON CALL SERVICES. BECKY THOMPSON, THOMAS PAXMAN AND AN EMPLOYED PHYSICIAN ARE JOINT MEMBERS OF AN ON CALL GROUP CONTACTED BY SUMMIT HEALTHCARE ASSOCIATION. JOHN CORDER IS THE GOVERNING BOARD PRESIDENT AND 33% OWNER IN CORDER COMMUNITY SERVICES, A COMPANY THAT PROVIDES SECURITY SERVICES TO SUMMIT HEALTHCARE ASSOCIATION. TOTAL COMPENSATION TO CORDER COMMUNITY SERVICES WAS LESS THAN $10,000 SO IT WAS NOT REPORTED ON SCHEDULE L. PAUL WATSON IS THE TOWN MANAGER OF SNOWFLAKE, ARIZONA. SNOWFLAKE IS A COMMUNITY PRIMARILY SERVICED BY SUMMIT HEALTHCARE ASSOCIATION. SUMMIT CURRENTLY HAS AN OUTPATIENT IMAGING CENTER AND PHYSICIAN OFFICES IN SNOWFLAKE. PAUL ALSO HAS OUTSIDE BUSINESS INTERESTS, PRIMARILY RELATED TO REAL ESTATE, WITH NEAL THOMPSON, AND THESE BUSINESS TRANSACTIONS ARE NOT RELATED TO SUMMIT. NONE WERE REPORTABLE ON SCHEDULE L AND WERE NOT DEEMED REPORTABLE ON SCHEDULE L. NEAL THOMPSON IS A REAL ESTATE BROKER THAT REPRESENTED THE SELLER IN A LAND TRANSACTION BETWEEN SUMMIT HEALTHCARE ASSOCIATION AND A PROPERTY KNOWN AS PINE SHADOWS. ALAN DEWITT IS THE CHIEF MEDICAL OFFICER AND 100% OWNER OF SNOWFLAKE MEDICAL BUILDING. SUMMIT RENTS THE SNOWFLAKE MEDICAL BUILDING FOR PHYSICIAN PRACTICES. ALAN DEWITT IS ALSO THE PRESIDENT OF THE SUMMIT PHYSICIAN GROUP, SHMA. CONNIE KAKAVAS IS THE CHIEF HUMAN RESOURCES OFFICER OF SUMMIT HEALTHCARE AND IS ALSO A COUNCILWOMAN FOR THE CITY OF SHOW LOW, WHERE SUMMIT IS LOCATED. THERE HAVE BEEN NO CONFLICT OF INTEREST ISSUES TO REPORT. |
| FORM 990, PART VI, SECTION B, LINE 11 | THE 990 IS REVIEWED IN THE SCHEDULED GOVERNING BOARD MEETING FOLLOWING ITS COMPLETION. |
| FORM 990, PART VI, SECTION B, LINE 12C | DIRECTOR OF MEDICAL STAFF/BOARD SERVICES IS RESPONSIBLE FOR MONITORING AND ENSURING RECORDS ARE UPDATED IN A TIMELY MANNER. |
| FORM 990, PART VI, SECTION B, LINE 15 | INDEPENDENT CONSULTING FIRMS ARE HIRED TO REVIEW THE COMPENSATION OF DIRECTORS, OFFICERS, AND KEY EMPLOYEES. FINAL APPROVAL OF TOP MANAGEMENT COMPENSATION IS THE RESPONSIBILITY OF THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE MADE AVAILABLE UP REQUEST. |
| PART XII, LINE 2C | THE ORGANIZATION DID NOT CHANGE EITHER ITS OVERSIGHT PROCESS OR SELECTION PROCESS DURING THE TAX YEAR. |
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