2025-05-14T14:57:50-05:00 2024-06-30 450250958 Eide Bailly LLP 18081 Burt St Ste 200 Omaha NE 680224722 990 2023-07-01 850442957 Clayton Health Systems Inc CLAY 5753747008 300 Wilson Street Clayton NM 88415 Tammie Chavez CEO 5753747008 2025-05-13 1 0 Wendy R Cooley CPA P00484560 4023302660 2025-05-13 2023 2025-03-06 01:10:19Z Union County General Hospital Tammie Chavez 300 Wilson Street Clayton NM 88415 15745146 0 X www.ugch.net X 1996 NM 25-bed acute care critical access hospital serving those in need in and near Union County, NM 5 4 119 9 15105 0 1521019 1533642 12548208 14172540 6467 32964 6000 6000 14081694 15745146 0 0 0 0 7771173 7338102 0 0 0 7568163 9006880 15339336 16344982 -1257642 -599836 14168336 14913998 3470554 4816052 10697782 10097946 X As a full service, acute care hospital in Clayton, NM, Union County General Hospital provides quality healthcare services to the residents of Union County and surrounding areas. 0 0 12461125 14157435 Union County General Hospital is a 25-bed acute care hospital located in Clayton, New Mexico. The Hospital provides services to individuals from Northeastern New Mexico, Southeastern Colorado, Western Panhandle of Oklahoma, and the Western Panhandle of Texas. These services include inpatient, swingbed, various outpatient services, emergency patient care and two rural health clinics. There were a total of 200 admissions and 7,614 patient visits at the Hospital as well as 6,370 patient visits at the Union County Health Center RHC and 426 patient visits at the Des Moines Health Center during fiscal year ending 6/30/2024.(Continued on Schedule O)The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. Charges for charity care provided during June 30, 2024, totaled $254,731 and the estimated cost of providing these services was $191,346 calculated by multiplying the ratio of costs to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care. 12461125 1 0 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 32 0 1 119 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X Terry Lancaster 5753747008 300 Wilson Street Clayton NM 88415 Judith Cooper President 1.00 X X 0 0 0 Nick Diller Vice President 1.00 X X 0 0 0 Craig Reeves Treasurer 1.00 X X 0 0 0 Robert Williams Secretary and CRNA 41.00 X X 175655 0 43885 Paul Briesh Director 1.00 X 0 0 0 Tammie Chavez CEO 40.00 X 0 0 0 Melissa Prante CFO (Until Sept 23) 40.00 X 0 0 0 Jamie Armijo CNP Family Nurse Practitioner 40.00 X 163118 0 47330 Jay Fluhman FNP-C ACNP Certified Nurse Practitioner 40.00 X 150600 0 43453 Russell Lees PT Director of Rehabiliation 40.00 X 140542 0 40143 Mark Van Wormer MD Family Medicine-Chief of Staff 40.00 X 630712 0 67543 Jessica Wright DNP-C Certified Nurse Practitioner 40.00 X 170767 0 36985 1431394 0 279339 8 0 1 0 Community Hospital Consulting 7800 N Dallas Parkway Suite 200 Plano TX 75024 Mgmt and Admin services 926546 CPSI PO Box 11407 Birmingham AL 35246 Operating system 244765 Dr Minh Nguyen MD 3321 Coral Ave Dallas TX 75204 Surgeon 206080 Genex Medical Staffing PO Box 14525 Scottsdale AZ 85267 Locum provider 158661 Aureus Radiology LLC PO Box 850856 Minneapolis MN 55485 Radiology readings 123637 5 1533142 500 1533642 Patient service revenue 621110 12524335 12524335 Pharmacy Revenue 456110 1317106 1317106 Safety Net Care Pool 621110 280000 280000 51099 35994 15105 14172540 32964 32964 6000 0 6000 6000 6000 15745146 14157435 15105 38964 X 197424 197424 6119137 5026421 1092716 108271 88591 19680 537247 442082 95165 376023 310802 65221 873363 478775 394588 5448 5448 62750 62750 1987664 1765822 221842 105298 40009 65289 407428 367605 39823 49751 17584 32167 594422 193469 400953 83014 69536 13478 59142 59142 1027037 562614 464423 671047 671047 Medical Supplies 1282919 1282033 886 Bad debt expense 923929 923929 Repairs and maintenance 441831 346400 95431 Licenses and taxes 274727 264361 10366 157110 83668 73442 16344982 12461125 3883857 0 647141 378374 1443971 2533634 333866 344443 119794 154180 18150373 9688668 9143858 8461705 1457973 1177281 1021733 1864381 14168336 14913998 1366009 1812693 1708774 1195958 395771 1807401 3470554 4816052 X 10571836 10072596 125946 25350 10697782 10097946 14168336 14913998 -599836 0 X 0 1 X 1 0 X 16470 16470 14654868 6961989 7692879 3466481 2726679 739802 12554 12554 8461705 Other accounts receivable 255160 Clayton County Receivable 406055 Employee receivables 42659 ROU Leased Assets 1045943 ROU Subscription IT Assets 114564 1864381 ROU Lease Liabilities 1081806 ROU Subscription IT Liabilities 119213 Estimated third-party payor settlement 606382 1807401 14762075 -983071 -983071 15745146 0 15745146 15361911 0 15361911 983071 983071 16344982 Part XI, Line 2d - Other Adjustments: Interest expense included in revenue for financial statements -59,142. Bad debt expense included in revenue for financial statements -923,929. Part XII, Line 4b - Other Adjustments: Interest expense included in revenue for financial statements 59,142. Bad debt expense included in revenue for financial statements 923,929. 1 1 X 1 X 250.000000000000 1 X 450.000000000000 1 1 0 0 191346 191346 0.01170 1863255 1008252 855003 0.05230 2054601 1008252 1046349 0.06400 2054601 1008252 1046349 0.06400 0 923929 180166 4575869 4646895 -71026 X 1 1 1 1 Union County General Hospital 300 Wilson Street Clayton NM 88415 www.ugch.net 3060 X X X 3 provider based rural health clinics Union County General Hospital 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X http://ucgh.net/about-us/ X 1 21 1 http://ucgh.net/about-us/ 0 1 X 250.000000000000 450.000000000000 X X X 1 1 X X X 1 X ucgh.net/patients/patient-forms-and-policies/ X ucgh.net/patients/patient-forms-and-policies/ X ucgh.net/patients/patient-forms-and-policies/ X X X X X 1 X 0 X X X X 1 X 0 0 Union County General Hospital Part V, Section B, Line 5: UCGH provided CHC Consulting with a list of persons with special knowledge of public health in Union County, including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on under-represented groups. With respect to individuals providing input, it was noted in the CHNA that 81.8% of those providing input are members of a medically underserved, low-income or minority population in the community, or individuals or organizations serving or representing the interests of such populations. 9.1% of those providing input work for a state, local, tribal or regional government public health department with knowledge, information or expertise relevant to the health needs of the community. 9.1% of those providing input are community leaders. Union County General Hospital Part V, Section B, Line 11: The most recently conducted CHNA identified six significant needs in the community served by UCGH, which were determined by assessing the prevalence of the issues identified from the health data findings, combined with the frequency and severity of mentions in community input. The CHNA team and hospital leadership prioritized those needs using a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the hospital's capacity to address the need.The final list of prioritized needs, in descending order, is listed below:1.) Access to Consistent, Local Primary Care Providers2.) Access to Dental Care Services and Providers3.) Access to Specialty Care Services and Providers4.) Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles5.) Access to Mental and Behavioral Health Care Services and Providers6.) Access to Affordable Care and Reducing Health Disparities Among Specific PopulationsPriority 1: Access to Consistent, Local Primary Care ProvidersObjective: Increase access to local primary care services and providers.1.A. Union County General Hospital continues to promote its primary care provider services in order to increase awareness of service offerings in the community. This is done via the local newspaper, local radio stations, social media outlets, and the hospital's website.1.B. Union County General Hospital continues to schedule follow up appointments with patients' primary care provider upon discharge. Priority 2: Access to Dental Care Services and ProvidersObjective: Increase local access to dental health care services.2.A. UCGH will not recruite dentist and dental hygienist providers to the community to increase access to local dental care services. Union County currently has no dental services available. 2.B. Due to a change in governmental funding, UCGH has put the idea of a Dentist on hold. A dentist in the area is more of a community service than revenue for the Hospital, and the Hospital cannot take on that responsibility until it has the income or financial stability to sustain it. Priority 3: Access to Specialty Care Services and ProvidersObjective: Increase access to additional specialist services and providers in the community.3.A. The hospital has a general surgeon that provides rotating coverage to the community once weekly.3.B. Union County General Hospital continues to host a mobile MRI van in the hospital parking lot once a week and assists with scheduling.3.C. Union County General Hospital continues to host a mobile Mammography van in the hospital parking lot 10-12 times per year (as scheduling needs require), and also assist with patient awareness.3.D. The hospital continues to staff a Nuclear Medicine Tech contract, who will come in as needed for nuclear medicine studies.3.E. UCGH provides telemedicine programs in collaboration with the University of New Mexico (UNM) for emergency pediatrics and neurology/neurosurgery services for Strokes.3.F. The hospital continues to evaluate rotating specialist coverage.3.G. Union County General Hospital schedules follow up appointments with patients' providers upon discharge, when necessary.3.H. Union County General Hospital markets its specialty services to the community to increase awareness of its service offerings.3.I. Union County General Hospital has created a specialty clinic in the hospital that will provide services the patients cannot currently receive in Union County.Priority 4: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy LifestylesObjective: Increase healthy lifestyle education and prevention resources at the hospital and in the community.4.A. Union County General Hospital continues to provide CPR training for hospital staff and other health care givers in the community.4.B. The hospital continues to incentivize employees and their families to participate in regular physical activity through a discounted membership at a local gym and recreation facilities, and the golf course.4.C. UCGH continues to participate in the county-wide health fairs, and additional hospital- based health fairs each year, to provide blood pressure screenings, lab tests, as well as many different areas of health and wellness education.4.D. UCGH continues to maintain its status as a Level 4 Trauma Center through the provision of community education surrounding trauma 1-2 times per year (ex: firework safety, no texting and driving).4.E. UCGH continues to provide free flu shots to the community for the donation of 2 non-perishable food items for donation to community food drive.4.F. Many representatives from the hospital serve as members of community organizations, including the Chamber of Commerce, the Rotary Club, the Union County Health Network, and the Local Emergency Planning Committee.4.G. The hospital continues to work with local Emergency Management Services (EMS) to provide trauma education on a regular basis for hospital and EMS staff.4.I. UCGH continues their partnership with the Sexual Assault Prevention program in the community.4.J. Union County General Hospital continues marketing social media, print advertisement and website enhancements to increase professionalism and community awareness of hospital service offerings.4.K. Union County General Hospital engages local employers through the provision of drug screens, TB tests, flu vaccinations and bone scans for staff.4.L. Union County General Hospital continues to participate in the Emergency Planning Committee in the community, which is a collaborative approach that includes nursing, providers and other hospital allied staff, EMS, Flight Crews, the Fire Department, Police staff and the County Emergency Manager.4.M. Union County General Hospital continues to provide education in the lobby of the facility and clinic on a variety of health topics each month.Priority 5: Access to Mental and Behavioral Health Care Services and ProvidersObjective: Increase local access to mental and behavioral health care services. 5.A. UCGH continues to apply for monetary grants to bring more mental and behavioral health care services to the community. 5.B. UCGH continues to review telehealth services for mental and behavioral health care for the community. Priority 6: Access to Affordable Care and Reducing Health Disparities Among Specific PopulationsObjective: Increase local access to affordable health care and reducing health disparities among specific populations.6.A. UCGH has trained and certified a few employees to help our patients apply for Medicaid and other low-income state benefits. 6.B. UCGH has trained and certified a few employees to help our patients apply for Market Place Insurance that is based on patient's income. 6.C. UCGH has trained a few employees to help our patients apply for Medicare. 6.D. UCGH advertises through various venues when it is open enrollment for Medicare and the Market Place Insurance. Union County General Hospital Part V, Section B, Line 13h: Presumptive Eligibility for Financial AssistanceThe hospital may use Discovery Healthcare Consultant Group and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation.Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of yearly household income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance.The hospital may choose to grant financial assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, disabled, transient or incompetent may be valid "prima facie" candidates. In such cases, the hospital may not complete full verification or documentation of any request.Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount. Part I, Line 3c: Presumptive Eligibility for Financial AssistanceThe hospital may use Discovery Healthcare Consultant Group and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation.Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of yearly household income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance.The hospital may choose to grant financial assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, disabled, transient or incompetent may be valid "prima facie" candidates. In such cases, the hospital may not complete full verification or documentation of any request.Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount. 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 report. Part III, Line 2: Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Part III, Line 3: The amount of bad debt estimated to be attributable to patients under the Organization's charity care policy is 19.5%. This was determined by using the percentage of the population in the service area that is under the federal poverty guideline established for charity care. Part III, Line 4: The footnote to the Organization's financial statements can be found on page 12 of the attached audited financial statements. Part III, Line 8: Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. 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 the Centers for Medicare and Medicaid Services. Part III, Line 9b: When a patient has indicated or demonstrated an inability to pay, an appropriate Hospital representative provides the patient with a financial assistance application. Applications must be completed in their entirety before financial assistance can be considered. Patients who qualify for financial assistance from a government program should be referred to the appropriate agency prior to consideration for charity/indigent care. An application for financial assistance from an outside agency should be obtained prior to charity care approval. From the discharge date, monthly statements are sent with information on financial assistance. After the 3rd statement is sent a Patient Financial Consultant works with the patient until deemed uncollectible. Accounts are sent to collections after 180-days from the date of service or date insurance paid. Patients have an additional 120-days to submit an application for financial assistance. Part VI, Line 2: The Hospital assesses the health care needs of the community through public meetings, board meetings, quality assurance meetings, and emergency room call backs. Part VI, Line 3: Patients are educated about financial assistance upon admission to the hospital and at discharge. Financial assistance information is displayed in waiting rooms, emergency rooms, and other areas of the hospital.Applying for financial assistance can be initiated by a patient requesting assistance in person, over the phone at 575-374-2585, through the mail at 300 Wilson St, Clayton, NM 88415, by email at andrea.naranjo@ucgh.net or via the hospital's website www.ucgh.net. Additionally, the hospital can initiate a financial assistance application on behalf of the patient.UCHG has certified its own employee so that patients can apply for Medicaid and other government assistance onsite because there is not a Medicaid office in the county. Patients are notified of this through Facebook, the newspaper, and when the organization sees the need for financial assistance. Part VI, Line 4: Union County General Hospital (UCGH) is a 25-bed acute care hospital located in Clayton, New Mexico. As the key hospital for the region, UCGH offers a wide array of services which includes primary care, emergency care, inpatient care, therapy services, surgical services, swing bed care, a full medical staff and state-of-the-art equipment. UCGH provides the highest quality health care services possible to the residents of Union County and surrounding areas. The defined service area of UCGH is Union County in New Mexico. The population of Union County is expected to decrease from 2022 (4,021) to 2027(4011) by 0.2%, which is 1.2% less growth than the 1.4% expected growth for the state of New Mexico from 2022(2,192,707) to 2027(2,159,693). As of 2022, the racial/ethnic breakout of Union County was 25.9% White Non-Hispanic, 1.6% Black, 39.5% Hispanic, 0.2% Asian, and 32.8% all others. By 2027, the White Non-Hispanic population is expected to decrease by 0.3% while the Black population is not expected to change, the Hispanic population is expected to decrease by 0.2%, the Asian population is not expected to change and all others are expected to decrease by 0.2% in Union County. Union County (42.9 years) has a slightly older median age than New Mexico (38.5 years) (2022).The median household income in Union County and the state is expected to slightly increase over the next five years (2022-2027). Union County ($40,947) has a lower median household income than New Mexico ($56,735) (2022). With respect to education, Union County (12.6%) has a lower percentage of residents with a bachelor or advanced degree than the state (29.0%) (2022). Persons living below the federal poverty level in Union County, NM in 2023 was 19.5%.The closest hospital is Coon Memorial Hospital located 48 miles from Union County General Hospital in Dalhart, TX. The hospital provides general inpatient and outpatient medical and surgical care.The largest industries are public administration, health care & social assistance, and retail trade. Part VI, Line 5: Our Board of Directors is comprised of individuals from the community. The board provides a perspective on the needs of the community. The Hospital extends medical privileges to area physicians. Surplus funds are reinvested into facility and equipment upgrades and free programs throughout the year.During fiscal year 2024 Union County General Hospital did participate in the annual county-wide health fair. A blood draw was done at a discounted rate in April 2024. They also sponsored many different booths with different health needs and health education. X 0 0 0 0 0 0 0 0 0 Mark Van Wormer MD Family Medicine-Chief of Staff 630712 0 0 0 0 0 39900 0 27643 0 698255 0 0 0 Robert Williams Secretary and CRNA 175655 0 0 0 0 0 20790 0 23095 0 219540 0 0 0 Jamie Armijo CNP Family Nurse Practitioner 163118 0 0 0 0 0 12836 0 34494 0 210448 0 0 0 Jessica Wright DNP-C Certified Nurse Practitioner 170767 0 0 0 0 0 9600 0 27385 0 207752 0 0 0 Jay Fluhman FNP-C ACNP Certified Nurse Practitioner 150600 0 0 0 0 0 33991 0 9462 0 194053 0 0 0 Russell Lees PT Director of Rehabiliation 140542 0 0 0 0 0 9001 0 31142 0 180685 0 0 0 Part I, Line 3 The Board of Directors approves the contract with Community Hospital Corporation, the management company that employs the CEO. Form 990, Part VI, Section A, line 1a The Executive Committee consists of at least the President, who shall serve as chairperson of the Executive Committee, the Vice-President, Secretary, and Treasurer. The Executive Committee may consist of all Board members if so designated by the Board. The Executive Committee shall meet at least on a quarterly basis. Between meetings of the Board, the Executive Committee shall possess and may exercise any and all powers of the Board in the management and affairs of the Corporation; provided that all actions of the Executive Committee are subject to the paramount power of the Board and shall not conflict with any expressed policies of the Board. All action taken by the Executive Committee shall be reported to the Board at each regular and annual meeting, and such actions are subject to revision, alteration or change by the Board, provided that rights of third persons shall not be affected thereby. Form 990, Part VI, Section A, line 3 Tammie Chavez, CEO and Melissa Prante, CFO until Sept. 2023) are common law employees of Community Health Corporation (CHC), an unrelated management company. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Compensation and benefits for calendar year 2023 is reported below for services provided to Union County General Hospital. Tammie Chavez: Compensation: $278,104 Other Benefits: $13,946 Melissa Prante: Compensation: $176,570 Other Benefits: $12,339 Form 990, Part VI, Section A, line 7a The Hospital is a component unit of the County and the Board of County Commissioners appoints members to the Board of Trustees of the Hospital. Form 990, Part VI, Section B, line 11b The Form 990 is provided to the governing board prior to filing with the IRS. The CEO and CFO review the Form 990. Form 990, Part VI, Section B, line 12c The Board of Directors and officers are required to complete and sign the conflict of interest statement annually. Any potential conflict arising during the year must be disclosed to the Board. The Board discusses the potential conflicts and determines if actions should be taken. If there is a conflict the board member may be asked to leave the meeting or not vote on the matter. Form 990, Part VI, Section B, line 15 The compensation for the CEO and CFO is determined by a management company. The management company determines the compensation using their processes and the Hospital's Board of Directors votes and approves the management contract. Form 990, Part VI, Section C, line 19 The Hospital's financial statements, governing documents, and conflict of interest policy are available to the public upon request at the Administration Office located at 300 Wilson Street in Clayton, NM. Form 990, Part IX, line 11g Professional Fees: Program service expenses 759,916. Management and general expenses 0. Fundraising expenses 0. Total expenses 759,916. Contract Labor: Program service expenses 414,161. Management and general expenses 0. Fundraising expenses 0. Total expenses 414,161. Purchased services: Program service expenses 591,353. Management and general expenses 221,232. Fundraising expenses 0. Total expenses 812,585. Recruiting: Program service expenses 392. Management and general expenses 610. Fundraising expenses 0. Total expenses 1,002. County of Union PO Box 430 Clayton NM 88415 856000259 Government NM N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1