CLAYTON HEALTH SYSTEMS INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- CLAYTON HEALTH SYSTEMS INC (EIN 85-0442957)
- Tax period
- 2017-07-01 to 2018-06-30
- Filed
- 2019-05-14
- IRS object ID
- 201921349349309932
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-05-14T17:19:28-05:00 | ReturnTs |
| Tax Period End | 2018-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 205949532 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RICCI & COMPANY LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 6200 UPTOWN BLVD NE STE 400 | AddressLine1Txt |
| City | ALBUQUERQUE | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 87110 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 850442957 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CLAYTON HEALTH SYSTEMS INC | BusinessNameLine1Txt |
| Business Name Line2 | DBA UNION COUNTY GENERAL HOSPITAL | BusinessNameLine2Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAY | BusinessNameControlTxt |
| Phone | 5753747008 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WILSON STREET | AddressLine1Txt |
| City | CLAYTON | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TAMMIE STUMP | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 5753747008 | PhoneNum |
| Signature | 2019-05-14 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | MARIA MATONTI | PreparerPersonNm |
| PTIN | P01790899 | PTIN |
| Phone | 5053380800 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 204.98.120.221 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2019-05-14 | IPDt |
| IP Tm | 17:09:29 | IPTm |
| IP Timezone | MD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | EA486A3F91AF06969BBA26ACFDD351BC6C02EF50 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | TAMMIE STUMP | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WILSON STREET | AddressLine1Txt |
| City | CLAYTON | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $9,003,390 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.UGCH.NET | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1997 | FormationYr |
| Legal Domicile State | NM | LegalDomicileStateCd |
| Activity Or Mission | 25-BED ACUTE CARE CRITICAL ACCESS HOSPITAL SERVING THOSE IN NEED IN AND NEAR UNION COUNTY, NM. | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 117 | TotalEmployeeCnt |
| Total Volunteers | 4 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $137,407 | PYContributionsGrantsAmt |
| CY Contributions Grants | $93,328 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $12,376,054 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $8,648,188 | CYProgramServiceRevenueAmt |
| PY Investment Income | $10,369 | PYInvestmentIncomeAmt |
| CY Investment Income | $14,365 | CYInvestmentIncomeAmt |
| PY Other Revenue | $183,903 | PYOtherRevenueAmt |
| CY Other Revenue | $247,509 | CYOtherRevenueAmt |
| PY Total Revenue | $12,707,733 | PYTotalRevenueAmt |
| CY Total Revenue | $9,003,390 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $4,601,719 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $5,723,019 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,927,258 | PYOtherExpensesAmt |
| CY Other Expenses | $5,315,701 | CYOtherExpensesAmt |
| PY Total Expenses | $11,528,977 | PYTotalExpensesAmt |
| CY Total Expenses | $11,038,720 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,178,756 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$2,035,330 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,382,323 | TotalAssetsBOYAmt |
| Total Assets EOY | $14,942,865 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $7,124,212 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $7,720,084 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,258,111 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $7,222,781 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE ORGANIZATION IS A 25-BED ACUTE CARE CRITICAL ACCESS HOSPITAL THAT SERVES THOSE IN NEED IN THE RURAL NEW MEXICO AREA IN, AND AROUND UNION COUNTY, NM. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $8,685,072 | ExpenseAmt |
| Revenue | $8,895,697 | RevenueAmt |
| Desc | THE ORGANIZATION OPERATES A 25-BED ACUTE CARE CRITICAL CARE HOSPITAL THAT 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, OUTPATIENT AND EMERGENCY TYPES OF PATIENT CARE. THERE WERE A TOTAL OF 178 ADMISSIONS AND 9,991 PATIENT VISITS AT UNION COUNTY GENERAL HOSPITAL, AS WELL AS 4,873 AT THE CLAYTON FAMILY PRACTICE CLINIC DURING FISCAL YEAR ENDING 6/30/2018. ALSO, UNION COUNTY GENERAL HOSPITAL IS ONE OF THE SPONSORS OF AN ANNUAL COUNTY-WIDE HEALTH FAIR WHERE HOSPITAL PERSONNEL OBTAIN BLOOD SAMPLES FOR TESTING - 472 PATIENTS WERE DRAWN AT THE HEALTH FAIR, AT SIX LOCAL BUSINESSES, AND SIX SURROUNDING COMMUNITIES BY 50 HOSPITAL PERSONNEL WORKING 175 HOURS. THE PHYSICAL THERAPY DEPARTMENT, AS WELL AS THE RADIOLOGY DEPARTMENT WERE ALSO INVOLVED IN THE HEALTH FAIR, EDUCATING THE PUBLIC ON SERVICES THEY OFFER. | Desc |
| Total Program Service Expenses | $8,685,072 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | 0 | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 44 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 117 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 0 | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | NM | StatesWhereCopyOfReturnIsFldCd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | THE ORGANIZATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5753747008 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WILSON STREET | AddressLine1Txt |
| City | CLAYTON | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (10 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JUDITH COOPER | |||||||
| PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JUDY STEEN | |||||||
| VICE-PRESIDENT | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT WILLIAMS | |||||||
| SEC/TREASURER-CRNA | 1.00 | Yes (X) | Yes (X) | $100,953 | $0 | $9,674 | |
| CRAIG REEVES | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| PAUL BRIESH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| TAMMIE STUMP | |||||||
| CEO/CNO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| TERRI MARTINEZ | |||||||
| CFO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| MARK VANWORMER | |||||||
| CHIEF OF STAFF | 40.00 | Yes (X) | $477,634 | $0 | $15,874 | ||
| STACYE BRADLEY | |||||||
| CCO-DIRECTOR OF NURSING | 40.00 | $116,281 | $0 | $15,287 | Yes (X) | ||
| JAY FLUHMAN | |||||||
| CERTIFIED NURSE PRACTITIONER | 40.00 | $190,290 | $0 | $13,494 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $885,158 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $54,329 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 4 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| COMMUNITY HOSPITAL CONSULTING | |||||
| 7000 N DALLAS PARKWAY | PLANO | TX | 75024 | MGMT & ADMIN SERVICES | $931,595 |
| RHINO MEDICAL SERVICES | |||||
| PO BOX 206912 | DALLAS | TX | 75320 | LOCUM PROVIDER | $797,112 |
| COMPHEALTH MEDICAL SERVICES | |||||
| PO BOX 972670 | DALLAS | TX | 75397 | LOCUM PROVIDER | $152,062 |
| CARDINAL HEALTH | |||||
| PO BOX 847384 | DALLAS | TX | 75284 | MEDICAL SUPPLIES | $125,274 |
| HEALTHCARE SERVICES | |||||
| PO BOX 829677 | PHILADELPHIA | PA | 19182 | LAUNDRY & HOUSEKEEPING SERVICES | $117,785 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $91,378 | GovernmentGrantsAmt |
| All Other Contributions | $1,950 | AllOtherContributionsAmt |
| Total Contributions | $93,328 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE RE | 621400 | $7,527,127 | $7,527,127 |
| COUNTY MILL LEVY/GRT S | 621400 | $1,121,061 | $1,121,061 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $8,648,188 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $14,365 | TotalRevenueColumnAmt |
| Exclusion | $14,365 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | OTHER NON-OPERATING IN | Desc |
| Business | 621400 | BusinessCd |
| Total Revenue Column | $247,509 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $247,509 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $247,509 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,003,390 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $8,895,697 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $14,365 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $694,868 | TotalAmt |
| Program Services | $528,101 | ProgramServicesAmt |
| Management And General | $166,767 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,176,090 | TotalAmt |
| Program Services | $3,173,828 | ProgramServicesAmt |
| Management And General | $1,002,262 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $54,347 | TotalAmt |
| Program Services | $41,304 | ProgramServicesAmt |
| Management And General | $13,043 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $504,700 | TotalAmt |
| Program Services | $383,572 | ProgramServicesAmt |
| Management And General | $121,128 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $293,014 | TotalAmt |
| Program Services | $222,691 | ProgramServicesAmt |
| Management And General | $70,323 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,140 | TotalAmt |
| Program Services | $49,506 | ProgramServicesAmt |
| Management And General | $15,634 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,136 | TotalAmt |
| Program Services | $36,583 | ProgramServicesAmt |
| Management And General | $11,553 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $976,308 | TotalAmt |
| Program Services | $928,183 | ProgramServicesAmt |
| Management And General | $48,125 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,829 | TotalAmt |
| Program Services | $9,750 | ProgramServicesAmt |
| Management And General | $3,079 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $587,492 | TotalAmt |
| Program Services | $446,494 | ProgramServicesAmt |
| Management And General | $140,998 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,942 | TotalAmt |
| Program Services | $20,476 | ProgramServicesAmt |
| Management And General | $6,466 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $230,212 | TotalAmt |
| Program Services | $174,961 | ProgramServicesAmt |
| Management And General | $55,251 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $134,582 | TotalAmt |
| Program Services | $87,437 | ProgramServicesAmt |
| Management And General | $47,145 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,750 | TotalAmt |
| Program Services | $134,330 | ProgramServicesAmt |
| Management And General | $42,420 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $639,183 | TotalAmt |
| Program Services | $485,779 | ProgramServicesAmt |
| Management And General | $153,404 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,077 | TotalAmt |
| Program Services | $224,259 | ProgramServicesAmt |
| Management And General | $70,818 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (3 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| PURCHASED SERVICES | $1,078,687 | $819,802 | $258,885 |
| HOSPITAL & MEDICAL SUPP | $654,209 | $621,499 | $32,710 |
| EQUIPMENT RENTAL & MAIN | $390,154 | $296,517 | $93,637 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,038,720 | TotalAmt |
| Program Services | $8,685,072 | ProgramServicesAmt |
| Management And General | $2,353,648 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,484,572 | BOYAmt |
| EOY | $1,679,552 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,242,890 | BOYAmt |
| EOY | $1,752,629 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,134,889 | BOYAmt |
| EOY | $837,550 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $862,782 | BOYAmt |
| EOY | $776,133 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $207,751 | BOYAmt |
| EOY | $179,415 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,551 | BOYAmt |
| EOY | $43,409 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $14,892,563 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,242,442 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,132,593 | BOYAmt |
| EOY | $9,650,121 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $234,295 | BOYAmt |
| EOY | $24,056 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,382,323 | BOYAmt |
| EOY | $14,942,865 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,948,482 | BOYAmt |
| EOY | $2,309,194 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,175,730 | BOYAmt |
| EOY | $4,498,572 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $912,318 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,124,212 | BOYAmt |
| EOY | $7,720,084 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,208,111 | BOYAmt |
| EOY | $7,172,781 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $50,000 | BOYAmt |
| EOY | $50,000 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,258,111 | BOYAmt |
| EOY | $7,222,781 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,382,323 | BOYAmt |
| EOY | $14,942,865 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$2,035,330 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,644,088 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,856,796 | DepreciationAmt |
| Book Value | $8,787,292 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,155,723 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,385,646 | DepreciationAmt |
| Book Value | $770,077 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $92,752 | OtherCostOrOtherBasisAmt |
| Book Value | $92,752 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,650,121 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ESTIMATED THIRD PARTY SETTLEMENTS | Desc |
| Amt | $912,318 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $912,318 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $9,459,556 | TotalRevEtcAuditedFinclStmtAmt |
| Donated Services And Use Fclts | $456,166 | DonatedServicesAndUseFcltsAmt |
| Revenue Not Reported | $456,166 | RevenueNotReportedAmt |
| Revenue Subtotal | $9,003,390 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $9,003,390 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,494,886 | TotExpnsEtcAuditedFinclStmtAmt |
| Donated Services Use Fclts | $456,166 | DonatedServicesUseFcltsAmt |
| Expenses Not Reported | $456,166 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,038,720 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $11,038,720 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $40,298 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $40,298 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00370 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,345,764 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,345,764 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12190 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,379,791 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $156,123 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,223,668 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.11090 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,765,853 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $156,123 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,609,730 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.23650 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,765,853 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $156,123 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,609,730 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.23650 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,489,674 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $1,117,256 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $3,426,271 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,685,439 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$259,168 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNION COUNTY GENERAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 WILSON ST | AddressLine1Txt |
| City | CLAYTON | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | UNION COUNTY GENERAL HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.UCGH.NET | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.UCGH.NET | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 200.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | WWW.UCGH.NET | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | WWW.UCGH.NET | FAPAppAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit Report To Credit Agency | Yes (X) | PermitReportToCreditAgencyInd |
| Permit Defer Deny Rqr Payment | Yes (X) | PermitDeferDenyRqrPaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| UNION COUNTY GENERAL HOSPITAL | PART V, SECTION B, LINE 5: A COMMUNITY MEETING WAS HELD AT UNION COUNTY GENERAL HOSPITAL. THE HOSPITAL INVITED NUMEROUS MEMBERS OF THE COMMUNITY REPRESENTING A WIDE RANGE OF SECTORS INCLUDING BUSINESS, HEALTH CARE, EDUCATION, AND NON-PROFIT ORGANIZATIONS. A LINK TO A SURVEY FOR ADDITIONAL INPUT TO THE COMMUNITY ASSESSMENT PROCESS WAS INCLUDED WITH THE INVITATION. |
| UNION COUNTY GENERAL HOSPITAL | PART V, SECTION B, LINE 11: NEEDS OF MEMBERS OF THE COMMUNITY WERE OUTLINED AND PRIORITIZED AND ARE CONTINUALLY REVIEWED AND ADDRESSED AS A RESULT OF THE CHNA PREPARED IN 2016. ALL NEEDS WERE ADDRESSED IN THE IMPLEMENTATION PLAN. |
| UNION COUNTY GENERAL HOSPITAL | PART V, SECTION B, LINE 13B: THE ORGANIZATION'S FINANCIAL ASSISTANCE IS A STAIR STEP POLICY THAT STARTS AT 200% AND GOES TO 400%. |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 7: | THE COST METHOD USED TO CALCULATE THE AMOUNTS IN THIS TABLE IS A COST TO CHARGE RATIO. |
| PART I, LN 7 COL(F): | BAD DEBTS ARE RECORDED AS AN OFFSET TO REVENUE; THEY ARE NOT SEPARATELY STATED IN THE AUDIT REPORT OR THE STATEMENT OF FUNCTIONAL EXPENSES ON FORM 990, PART IX. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | COMMUNITY HEALTH IS PROMOTED VIA COMMUNITY SUPPORT AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY. |
| PART III, LINE 4: | PATIENT ACCOUNTS RECEIVABLE REPRESENT THE AMOUNT BILLED BUT UNCOLLECTED FOR SERVICES PROVIDED TO PATIENTS. SUCH RECEIVABLES ARE CARRIED AT THE BILLED AMOUNT LESS ESTIMATES FOR CONTRACTUAL DISCOUNTS AND ALLOWANCES AS WELL AS FOR DOUBTFUL ACCOUNTS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY EXAMINING AGING CATEGORIES BY PAYOR AND BY USING HISTORICAL EXPERIENCE APPLIED TO THE AGING. INDIVIDUAL ACCOUNTS RECEIVABLE ARE WRITTEN OFF WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF PATIENT ACCOUNTS RECEIVABLE PREVIOUSLY WRITTEN OFF ARE RECORDED WHEN RECEIVED. DELINQUENT STATUS IS BASED ON HOW RECENTLY PAYMENTS HAVE BEEN RECEIVED. THE HOSPITAL DOES NOT ACCRUE INTEREST ON PAST-DUE ACCOUNTS. |
| 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. THE HOSPITAL USES MEDICARE COST REPORT ROUTINE COSTS BASED ON MEDICAID OR MEDICARE DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. |
| PART III, LINE 9B: | WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN INABILITY TO PAY, AN APPROPRIATE HOSPITAL REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. APPLICATIONS MUST BE COMPLETE IN THEIR ENTIRETY BEFORE FINANCIAL ASSISTANCE CAN BE CONSIDERED. THOSE PATIENTS WHO QUALITY 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. |
| PART VI, LINE 2: | PUBLIC MEETINGS, BOARD MEETINGS, PERFORMANCE IMPROVEMENT AND QUALITY ASSURANCE MEETINGS, EMERGENCY ROOM CALL BACKS. |
| PART VI, LINE 3: | PATIENTS ARE INFORMED OF THEIR RIGHTS AND ELIGIBILITY FOR ASSISTANCE AS THEY GO THROUGH THE ADMISSIONS PROCESS. |
| PART VI, LINE 4: | UNION COUNTY IS A FRONTIER HOSPITAL WITH A COUNTY POPULATION OF 2,700. THE TOWN OF CLAYTON, WHERE THE HOSPITAL IS LOCATED, IS 45 MILES FROM THE NEAREST HOSPITAL. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (2 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARK VANWORMER | ||||||||||||||
| CHIEF OF STAFF | $477,634 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $15,874 | $0 | $493,508 | $0 | $0 | $0 |
| JAY FLUHMAN | ||||||||||||||
| CERTIFIED NURSE PRACTITIONER | $190,290 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $13,494 | $0 | $203,784 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART VII, SECTION A, LINE 5 EXPLANATION: | FormAndLineReferenceDesc |
| Explanation | THE ORGANIZATION'S CEO AND CFO ARE PAID BY COMMUNITY HOSPITAL CORPORATION, AN UNRELATED ORGANIZATION THAT PROVIDES HOSPITAL ADMINISTRATION SERVICES AS WELL AS HOSPITAL BILLING SERVICES. THE CEO'S 2017 WAGES WERE $177,072 AND BENEFITS PAID ON HER BEHALF WERE $15,247. THE CFO'S 2017 WAGES WERE $144,613 AND BENEFITS PAID ON HER BEHALF WERE $7,422. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE HOSPITAL'S CEO AND CFO ARE EMPLOYED BY A MANAGEMENT COMPANY. THE CEO IS RESPONSIBLE TO CARRY OUT ALL EXECUTIVE-TYPE DUTIES NORMALLY PERFORMED BY AN EMPLOYEE IN THIS POSITION. |
| FORM 990, PART VI, SECTION B, LINE 11B | A DRAFT OF THE ORGANIZATION'S FORM 990 IS PROVIDED TO THE CEO & CFO AND ANY QUESTIONS OR CORRECTIONS ARE ADDRESSED. THEN A COPY OF THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING BOARD MEMBERS PRIOR TO FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE BOARD OF DIRECTORS, CEO AND ALL OTHER OFFICERS ARE REQUIRED TO ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST AS THEY ARISE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'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 XII, LINE 2C: | THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |