2018-05-15T16:03:16-05:00 2017-06-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2016-07-01 850138775 Otero County Hospital Association OTER 5754396100 2669 North Scenic Drive Alamogordo NM 883110597 Peter W Seaman Vice President, Finance 5754396100 2018-05-15 1 LISA CHAFFEE CPA P00193453 7012398500 2018-05-15 2016 2022-09-23 18:48:47Z Gerald Champion Regional Medical Center Robert James Heckert 2669 North Scenic Drive Alamogordo NM 883110597 162651782 0 X www.gcrmc.org X 1947 NM Provision of health care services 11 7 1044 145 -91211 -91211 148883 388919 162037774 159694352 174913 1679263 269996 288697 162631566 162051231 579464 627636 0 0 48621322 53685706 0 0 0 79046534 83569611 128247320 137882953 34384246 24168278 185079319 218941794 85511693 91535660 99567626 127406134 X To be the Organization where patients choose to come, physicians want to practice, and people want to work. 1 1 107318394 627636 159694352 Otero County Hospital Association d/b/a Gerald Champion Regional Medical Center (GCRMC) provides comprehensive healthcare services through its 100-bed hospital (effective January 1, 2017), outpatient ambulatory care facilities, and a multi-specialty physician group. GCRMC receives 80% of its admissions from Otero County. The GCRMC's primary markets are the cities of Alamogordo and Tularosa with secondary markets expanding to more remote areas of Otero County, Lincoln County, Chavez County and beyond. The original facility opened in August 1949 and the current medical center is a state of the art, acute care facility that opened in December 1999.The original hospital opened in 1949 with 26 beds. Today GCRMC is proud to be a 100-bed acute care facility accredited by DNV, including two distinct PPS units: Life Transitions (aka Behavioral Medicine - total 19 beds) and Inpatient Rehabilitation (12 beds). GCRMC shares a unique relationship with Holloman Air Force Base as the first hospital in the United States where active duty military physicians practice in a civilian hospital. This special arrangement allows one facility to meet the combined community and military needs, while serving as a model for the Department of Defense in conserving resources. The delivery mechanisms of care at the hospital include both inpatient and outpatient services: acute care inpatient through medical/surgical, telemetry, maternal child and 12-bed intensive care units; surgery department supported by pre-admit, outpatient care unit and post-anesthesia care unit; outpatient surgery center; provider-based physician practices in the areas of family practice, women's services including obstetrics, medical and radiation oncology, medical cardiology, gastroenterology and endocrinology, internal medicine, orthopedics and general surgery; inpatient and outpatient behavioral health services; cardiac cath lab, inpatient rehabilitation services, including physical and occupational rehab services; inpatient and outpatient CAP certified laboratory services with the capability to perform over 225 different profiles and tests in-house; inpatient and outpatient diagnostic imaging services, including x-ray, 128-slice CT scan, MRI, ultrasound, interventional radiology, radiofrequency ablation and nuclear medicine; inpatient and outpatient comprehensive cardiopulmonary services including behavior sleep medicine, Holter monitoring, event monitoring and impedance cardiography. By the end of 2017, GCRMC employed approximately 840 people. In addition to those employees, GCMRC contracts for services in various departments such as Pharmacy, Anesthesia, Emergency Department and Hospitalist Providers. The medical staff of GCRMC has 221 medical members consisting of 90 active members of whom 44 are employed providers. GCRMC continues to seek opportunities to expand services and improve quality, with the philosophy of not limiting its potential by the designation of "rural hospital," but rather identifying its scope of service based on community needs as a regional medical center. Continued progress and expansion has enhanced GCRMC's commitment to strive for outstanding service and quality; acknowledging that its future is not in its buildings or technology, but rather its people. To this end we support the people of Otero County and outlying service areas with our expanded services and our financial contributions. 107318394 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 102 0 1 1044 1 1 1 0 0 0 0 0 0 0 0 0 X 11 7 0 0 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 1 1 1 NM X Bashar Naser 5754437848 2669 North Scenic Drive Alamogordo NM 88311 Norm Arnold Chairman of the Board 10.00 0.10 X X 24000 0 0 Bill Mershon Vice President 5.00 0.00 X X 0 0 0 Bill Mayton Secretary 5.00 0.10 X X 0 0 0 Fred Baker Director 5.00 0.00 X 0 0 0 James Harris Director 3.00 0.00 X 0 0 0 Greg Richardson MD Director 40.00 0.00 X 345024 0 33049 Robin French Director 3.00 0.00 X 0 0 0 Lisa Thomassie Director (July-March) 3.00 0.00 X 0 0 0 Gary Jackson DO Director 3.00 0.00 X 0 0 0 Andrew Lancaster MD Director/Physician 40.00 0.00 X 259797 0 34557 Kathy Fuller Director 3.00 0.00 X 0 0 0 Robert Martinez Director 3.00 0.00 X 0 0 0 Robert James Heckert CEO 40.00 0.00 X 383463 0 13516 Bashar Naser CFO 40.00 0.00 X 498065 0 34485 Robert Middleton VP of Patient Care/CNO 40.00 0.00 X 225015 0 35412 Albert Esparsen VP of Physician Practice 40.00 0.00 X 182006 0 22088 Peter Seaman VP of Finance 40.00 0.00 X 191043 0 45773 Charles Race Physician 40.00 0.00 X 934223 0 33912 William Pollard Physician 40.00 0.00 X 600083 0 41332 Chris Davis Physician 40.00 0.00 X 492926 0 36722 Katrina Rolen Physician 40.00 0.00 X 536748 0 20211 Ying Zhao Physician 40.00 0.00 X 494554 0 34984 5166947 0 386041 64 0 1 0 Emcare Inc Inpatient Services 7032 Collection Center Drive Chicago IL 60693 Inpatient MD Management 1650000 Completerx LTD 3100 South Gessner Suite 640 Houston TX 77063 Pharmacy Management Services 1627137 Comphealth PO Box 972651 Dallas TX 753972651 Contract Medical Staff 1372454 Coker Group Holdings LLC 2400 Lakeview Parkway Suite 400 Alpharetta GA 30009 Management Consulting 809722 Diamond Healthcare Corp PO Box 85050 Richmond VA 23285 Behavioral Health Management 782902 25 180609 208310 388919 Net Patient Service Revenue 621110 155535290 155535290 Other Revenue 900099 1847636 1847636 Cafeteria/Catering 722320 962221 949410 12811 Cardiac Cath Lab LLC 621400 695923 695923 Alamogordo Surgery Venture, LLC 621400 648339 648339 4943 4943 159694352 1571950 1571950 874354 585657 288697 288697 -104022 392719 122207 0 14894 122207 -14894 107313 107313 162051231 159681541 -91211 2071982 X 627636 627636 2327586 671670 1655916 74212 74212 42525445 28750745 13774700 1058601 873838 184763 4685341 3888190 797151 3014521 2309649 704872 535613 535613 208455 208455 259672 259672 34696064 28136465 6559599 251713 33 251680 8915780 5413594 3502186 325385 68772 256613 1874973 536066 1338907 202001 62353 139648 365642 180506 185136 3657857 3657857 9563881 9563881 2857553 2857553 Medical Supplies 13686173 13686173 Provision for Bad Debts 5458408 5458408 Taxes 250311 250311 Reorganization Costs 141488 141488 318642 108994 209648 137882953 107318394 30564559 0 24490670 28802497 14609024 17140783 4543515 4916354 2020419 2088392 204425191 118030315 82881679 86394876 50569117 74677770 3636059 3604080 857241 803210 1471595 513832 185079319 218941794 14292319 19281253 1063094 894062 67095142 65806251 111231 2949907 5554094 85511693 91535660 X 99567626 127406134 99567626 127406134 185079319 218941794 24168278 3670230 0 X 0 1 X 1 0 X 3437282 3437282 111905757 52602082 59303675 79264117 62315194 16948923 9818035 3113039 6704996 86394876 Estimated Third-Party Payor Settlements 5554094 5554094 X 160707222 3670230 -5599896 -1929666 162636888 -585657 -585657 162051231 132868714 585657 585657 132283057 5599896 5599896 137882953 Part X, Line 2: The Medical Center is organized as a New Mexico nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Medical Center files an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS to report its unrelated business taxable income. The Medical Center believes it has appropriate support for any tax positions taken affecting its annual filing requirements, and, as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurred. The Medical Center's federal Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2014. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Recorded as Income for F/S -5,458,408. Reorganization Costs Recorded as Income for F/S -141,488. Part XI, Line 4b - Other Adjustments: Rental Expenses Recorded as Expense for F/S -585,657. Part XII, Line 2d - Other Adjustments: Rental Expenses Recorded as Expense for F/S 585,657. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Recorded as Income for F/S 5,458,408. Reorganization Costs Recorded as Income for F/S 141,488. 1 1 X 1 X 300.000000000000 0 1 1 1 0 0 898000 898000 0.00680 32506109 30251775 2254334 0.01700 33404109 30251775 3152334 0.02380 78510 78510 0.00060 38782259 14808619 23973640 0.18100 38860769 14808619 24052150 0.18160 72264878 45060394 27204484 0.20540 24700 24700 0.00020 835190 835190 0.00630 859890 859890 0.00650 0 5458408 38231 30747275 32647720 -1900445 X 1 1 1 Alamogordo Surgery Ventures Outpatient Surgery Center 0.40500 0.08000 0.51500 2 Alamogordo Imaging Center Outpatient Radiology Center 0.29790 0.00000 0.70210 3 White Sands Health Care Systems LLC Physician Hospital Organization 0.50000 0.00000 0.50000 4 Gerald Champion-Sierra Providence Cardiac Cath Lab LLC Cardiac Cath Lab 0.51000 0.00000 0.00000 1 1 Gerald Champion Regional Medical Center 2669 North Scenic Drive Alamogordo NM 88311 www.gcrmc.org 6016 X X X 20 Provider Clinics Gerald Champion Regional Medical Center 1 0 0 1 X X X X X X X X X X 15 1 0 1 1 X See Part V, Section C X X 1 15 1 See Part V, Section C 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X https://www.gcrmc.org/patients/financial-arrangements/ X https://www.gcrmc.org/patients/financial-arrangements/ X https://www.gcrmc.org/patients/financial-arrangements/ X X X X X X 1 X 0 X X X X 1 X 0 0 Gerald Champion Regional Medical Center Part V, Section B, Line 3j: Charts related to age, gender, general lifestyles, healthcare metrics. Gerald Champion Regional Medical Center Part V, Section B, Line 5: Conducted focus groups and individual interviews. Gerald Champion Regional Medical Center Part V, Section B, Line 6b: Otero County Community Health CouncilPresbyterian Medical ServicesAlamogordo Public SchoolsDepartment of Public SafetyAlamogordo Chamber of CommerceCOPE OutreachAlamogordo Senior CenterThe Counseling Center Gerald Champion Regional Medical Center Part V, Section B, Line 7d: Hospital website where CHNA and Implementation Plan can be found:https://www.gcrmc.org/wp-content/uploads/2018/01/GCRMC-Brochure-Sinlges.pdf Gerald Champion Regional Medical Center Part V, Section B, Line 11: The hospital's written implementation strategy is included in the facility CHNA document. This document was reviewed by the hospital's CPA auditors and business advisors. Based on the results of this review, all significant needs are being addressed in the assessment. The needs identified include: Access to primary care insurance- affordability, obesity, diabetes, cancer, mental healthcare, heart disease, and health education. The strategy to resolve these issues include expanded hospital resources; such as, establishment of a cardiac rehabilitation program, and collaboration between the hospital and other facilities to address the needs. For example, lending support to the area mental health counseling center to recruit qualified, licensed mental health professionals. 3 1 - ASV dba Scenic View Outpatient Surg Cr 2351 25th Street Alamogordo NM 88311 Outpatient Surgery 2 - Alamogordo Imaging Center 2539 Medical Dr Ste 1010 Alamogordo NM 883108720 Outpatient Radiology 3 - Gerald Champ-Sierra Provid Cardiac Cath 2669 North Scenic Drive Alamogordo NM 88310 Cardiac Cath Lab Part I, Line 3c: The organization uses the Federal Poverty Guidelines when determining free care. Patients who have household income at or below 300% of the FPG are eligible to receive free care. The organization also offers a 25% discount to self-pay patients. In addition, the facility will work with patients on settlements on a case-by-case basis based on specific circumstances, such as catastrophic illness or medical indigence, at the discretion of GCRMC. Determining family need is also based on an application process which takes into account the patient's available assets and all other financial resources available to the patient. Part I, Line 7: The organization used the following to determine the costs for Part I, Line 7:Row a: Charity Care was converted to cost using a cost to charge ratio from the cost accounting system. The cost accounting system addresses all patient segments.Row b: Amounts reported are based on the Medicare Cost Report figures.Row f: Amount reported is based on the actual dollars spent in the activities reported.Row g: Amounts reported are based on the Medicare Cost Report figures. Part I, Line 7g: Part I, Line 7g includes $30,270,874 of costs attributable to a Physician Clinic. Part I, Ln 7 Col(f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $5,458,408. Part III, Line 2: Discounts and payments are taken into account when determining bad debt expense. Part III, Line 3: The Organization estimated the percentage of bad debt that is attributed to charity care by applying the percentage of charity care to total revenues to total bad debt at cost. Therefore the organization estimates that 0.7% of the bad debt expense at cost is attributable to patients eligible under the organization's charity care policy. Care is given to individuals regardless of their ability to pay, and therefore this is a community benefit. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 8 of the attached audit report. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services.Even though Medicare was at a loss, the hospital still provided services to these patients. The elderly are an underserved population who experience issues with access to healthcare services. It is a community benefit to be able to treat them at the local hospital. Part III, Line 9b: GCRMC has implemented a number of different Policy and Procedure statements to govern the details of how its collection practices are implemented and how discounting and collection policies apply to various classes of patients. In general, all patient account guarantors who request financial assistance are asked to provide detailed information regarding their income and assets. For patients who qualify for charity and who are cooperating in good faith to resolve their hospital bills, GCRMC may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to collection agencies, and will cease all collection efforts. Part VI, Line 2: In 2015, Management at GCRMC enlisted the services of MJ Philps to develop a Community Heath Needs Assessment and to provide information from secondary data sources to assist in identifying needs that exist in the community. This includes data from the Center for Disease Control and Prevention to examine trends for stroke, diabetes, heart disease and cancer. It also includes data that identify shortages in healthcare professionals by location. Part VI, Line 3: The hospital has a Charity Care Policy - Gerald Champion Regional Medical Center (GCRMC) will provide understandable, written guidelines to staff and patients relative to how the hospital evaluates and determines: 1) a patient's eligibility for charity care; 2) an uninsured patient's eligibility for discounts; and 3) a patient's eligibility for alternate payment plans.A Summary of the Charity Care Policy is posted in the emergency room and throughout the entire hospital. The patients are also informed through direct communication with financial counselors and these policies are explained in detail to guarantors who advise GCRMC that they are unable to pay their account or need help in structuring an affordable payment plan for their account. The hospital provides services to anyone in need of medical care regardless of the patient's ability to pay for such services. Charity care and discounts for the uninsured will be available for medically necessary hospital care provided to persons who meet the financial and documentation criteria defined in this policy. Determinations hereunder will be based solely on the patient's ability to pay and will not be made on the basis of age, sex, race, creed, disability, sexual orientation or national origin. GCRMC provides financial assistance to patients based on their income, assets, and needs. Through our financial counseling services we assist patients with obtaining financial coverage or low-cost health insurance, or work with patients to arrange a manageable payment plan.Uninsured patients are eligible for a 25% discount. A 25% discount is applied to the total charges of a Self-Pay Patient at the time of service or the 1st billing. Notice will be sent at the time of the 1st billing informing the patient/guarantor that an additional 10% will be deducted if the account is paid within 30 days of the date of service. Part VI, Line 4: Otero County Hospital Association d/b/a Gerald Champion Regional Medical Center ("GCRMC") activities are conducted on its 130-acre campus located in Alamogordo, New Mexico. Alamogordo is approximately 89 miles north of El Paso, Texas and 209 miles southeast of Albuquerque, New Mexico. GCRMC owns and operates a 100 bed care hospital (the "Hospital") on the campus. In addition to the main campus, the Hospital has satellite locations including clinics and physician offices throughout the city. The combined operating space of the main campus and these additional offices totals approximately 432,000 square feet. Other facilities that the Hospital owns located on the main campus include two medical office buildings, Complex A and B that have an outpatient surgery center and an imaging center owned and operated by limited liability companies in which GCRMC has an interest. GCRMC also owns six facilities located off the main campus that are either leased to independent primary care/specialty care providers or occupied by employed physicians. GCRMC's primary service area is Northwestern Otero County from which 84% of its admissions originate. GCRMC is the sole community provider in its primary service area with the nearest tertiary care hospital located approximately 70 miles from the Hospital.The delivery mechanisms of care at the Hospital include both inpatient and outpatient services: 24-hour staffed Level III Trauma Emergency Department; acute care inpatient through Medical/Surgical, Intensive Care, Telemetry, Maternal Child, 38-bed behavioral medicine, and 12-bed inpatient rehabilitation; Surgery Department supported by Pre-admit, Outpatient Care Unit and Post-Anesthesia Care Unit; hospital-owned physician practices in the areas of family practice, women's services including obstetrics, orthopedics, nephrology, internal medicine, outpatient behavioral medicine, pediatrics, gastroenterology and endocrinology; pathologist; certified laboratory services with the capability to perform over 225 different profiles and tests in-house; inpatient and outpatient diagnostic imaging services, including x-ray, 64-slice and PET/CT with 20 slice CT scan, MRI, ultrasound, interventional radiology, radiofrequency ablation and nuclear medicine; inpatient and outpatient comprehensive cardiopulmonary services including behavior sleep medicine, Holter Monitoring, Event Monitoring and Impedance Cardiography.GCRMC and the Holloman Air Force Base (HAFB) 49th Medical Group, a group of approximately 15 military providers and support staff from the HAFB, have enjoyed a close working relationship, and have had shared coverage arrangements. Such arrangements included laboratory and x-ray services in a disaster, obstetrical coverage, and coverage for the HAFB 49th Medical Group when they were deployed for Desert Storm in 1991. Following Desert Storm and the return of the HAFB 49th Medical Group, the DoD made the decision to leave all the obstetrical services with GCRMC and the local obstetricians. As of 2017, Holliman employed approximately 864 civilians. There are 3,348 active military and 6,657 dependents located at the base.GCRMC's primary service area (the "PSA") is in Northwestern Otero County from which most of GCRMC's admissions originate. Located in southeastern New Mexico, Otero County encompasses 6,627 square miles and includes the cities of Alamogordo and Tularosa. According to U.S. Census, the population of Otero County estimated in 2017 was 63,797.The Hospital is the only acute care hospital within the PSA and is a Sole Community Provider. The acute care hospitals that GCRMC considers its main competitors that draw from the PSA are Mountain View Regional Medical Center and Memorial Medical Center both located approximately 75 miles west of Alamogordo in Las Cruces, New Mexico. Management of GCRMC estimates that the market share of admissions to the Mountain View Regional Medical Center and Memorial Medical Center from the PSA average 10% and 5%, respectively.The secondary service area covers a substantial portion of the remainder of Otero County, as well as the south central portion of Lincoln County. The secondary service area includes Ruidoso, the population of which was estimated to be 8,029 in 2010 according to the U.S. Census Bureau. The tertiary service area covers a small portion of Otero County and Chaves County. There are no other major medical centers within Otero County. Part VI, Line 5: The business and affairs of GCRMC are subject to the overall governance and direction of its Board of Directors. The Board of Directors currently includes 11 members. Each member is appointed by the Board of Directors and serves a three-year term in a self-perpetuating board. The Board of Directors fills vacancies that may occur. Officers of the Board of Directors include a Chairman, Vice Chairman, and Secretary/Treasurer. The Board of Directors are business people of the primary service area, with no other connection. GCRMC's medical staff is organized into Divisions of Medicine, Medical Subspecialties, Surgery and Outpatient Services. In addition to specialized medical/surgical services provided by both employed and contracted physicians and medical groups, GCRMC also offers emergency medical services, including a helicopter service which is not owned by GCMRC but is on-site 24 hours a day. GCRMC employs around-the-clock hospitalists, (i.e., physicians who devote their professional time to the care of hospitalized patients). The hospital extends medical staff privileges to all qualified physicians in the community. Surplus funds are re-invested into the purchase of capital equipment, electronic medical record software, continuing education for clinical staff including physicians, and a professionally managed diversified portfolio of marketable securities.GCRMC views the position of sole provider as a significant commitment to the overall health and well-being of the community. In addition to its focus on providing quality healthcare, the organization strives to facilitate and share opportunities to educate and motivate a philosophy of wellness in the community. The primary target is the disease process that we know can be eliminated or improved by changing or modifying human behavior. As with any community, the population served has a variety of educational background. The drive is to develop programs that target the needs and understanding of the community. Physicians/Providers are utilized to provide open forums that present health related issues, i.e. arthritis, nephrology, neurology, orthopedic issues, etc. followed by questions and time for individual discussion. This type of program is offered with a free lunch, educational materials, and if appropriate, free screenings, such as glucose or blood pressure. There is an average of 90 participants in each of these seminars. The organization is very community-minded in its efforts to promote health. Staff participates in Health Fairs in the public schools, and hosts an annual free sports physical clinic for school-age children.At GCRMC, we feel it is important to embrace community needs that promote good citizenship. As an organization we support employee involvement in outside activities through contributions, dedicated time and sponsorship. Administration and staff members serve on community boards, dedicating many hours of support to those organizations. The following classes are provided for the community in our conference room center: Diabetic Education, Narcotics Anonymous, Childbirth Classes, New Baby Class and CPR/Basic Life Support to name a few. GCRMC has been a top supporter of the United Way which provides money for many of the local community organizations. An annual Health Fair is held at the hospital each year. We augment the annual health fair with onsite mini health screenings throughout the year. This is offered to businesses, civic organizations and churches with minimal to no charge. We offer free blood pressure screenings on a walk-in basis with educational materials in both Spanish and English. This allows us to address the high rate of hypertension in our community, its significant effect on other diseases, and an overall wellness picture.GCRMC partners with the American Cancer Society to offer the Look Good Feel Good Program and the Gift Closet. The program is housed off campus in a leased building and has brought a highly valued service to our community. The Gift Closet provides free wigs, prosthesis, supplies, education and support to cancer patients and their families.The opportunity to utilize our speaker's bureau is available to any organization in the community. A presentation regarding health related topics can be prepared with limited notice to meet the needs of the organization. The wealth of knowledge in our organization allows us to create an appropriate fit for the requested need. Part VI, Line 6: n/a Part VI, Line 7, Reports Filed With States NM 1 Alamogordo Rotary PO Box 713 Alamogordo NM 88310 371707667 501(c)(3) 7000 Public Health American Cancer Society 2120 First Avenue Alamogordo NM 88310 841316555 501(c)(3) 12000 Public Health Otero County Economic Development Council 1301 N White Sands Boulevard Alamogordo NM 88310 850304073 501(c)(3) 10000 Public Health PMS Alamogordo 1501 Tenth Street Alamogordo NM 88310 850206810 501(c)(3) 161667 Public Health PMS Chaparral NM Clinic 204 Angelina Chaparral NM 88081 850206810 501(c)(3) 183337 Public Health PMS Sacramento Mountain Center PO Box 686 Cloudcroft NM 88317 850206810 501(c)(3) 75000 Public Health United Way 1501 E Tenth Street Suite B Alamogordo NM 88310 850197559 501(c)(3) 28196 Public Health Otero County Fair Association 401 Fairgrounds Road Alamogordo NM 88310 856011829 501(c)(3) 21276 Public Health Flickinger Center 1110 N New York Avenue Alamogordo NM 88310 850326369 501(c)(3) 7500 Public Health Relay for Life 8500 Menual Boulevard NE Albuquerque NM 87112 841316555 501(c)(3) 7500 Public Health 7 0 Part I, Line 2: The organization only gave grants to government organizations and tax exempt organizations. X 0 1 X X X X 0 1 0 0 0 1 1 0 0 Greg Richardson MD Director 337387 0 6875 0 762 0 12034 0 21396 0 378454 0 0 0 Andrew Lancaster MD Director/Physician 227168 0 32569 0 60 0 6626 0 27958 0 294381 0 0 0 Robert James Heckert CEO 372939 0 9000 0 1524 0 10702 0 2997 0 397162 0 0 0 Bashar Naser CFO 258107 0 239778 0 180 0 7409 0 27166 0 532640 0 0 0 Robert Middleton VP of Patient Care/CNO 178907 0 46000 0 108 0 8194 0 27218 0 260427 0 0 0 Albert Esparsen VP of Physician Practice 147490 0 34000 0 516 0 3066 0 19084 0 204156 0 0 0 Peter Seaman VP of Finance 146281 0 44000 0 762 0 21122 0 25203 0 237368 0 0 0 Charles Race Physician 867380 0 66447 0 396 0 9450 0 24858 0 968531 0 0 0 William Pollard Physician 485826 0 95788 0 18469 0 11423 0 30013 0 641519 0 0 0 Chris Davis Physician 491051 0 1875 0 0 0 11805 0 24917 0 529648 0 0 0 Katrina Rolen Physician 491682 0 45066 0 0 0 11815 0 8396 0 556959 0 0 0 Ying Zhao Physician 316705 0 177711 0 138 0 11307 0 24048 0 529909 0 0 0 Part I, Line 1a Residence was provided to persons listed in Part VII until permanent housing was arranged. Benefit was reported as taxable income to recipients. Part I, Line 4b The following individuals contributed to the hospital's 457(b) Deferred Compensation Plan in FY 2017. The amounts contributed are listed next to the individual's name. The hospital did not match any employee, officer or director contributions. Robert Heckert-$17,308 Gregory Richardson-$17,691 Peter Seaman-$31,000 Charles Race-$2,250 Part I, Line 6 The organization's officers listed in Part VII, Section A are evaluated annually based on a set of evidence based goals that determine their eligibility for additional compensation. The select goals are weighted in a hierarchy of core and job specific competencies, which include quality of care, financial performance and patient perception of care measures. One of the criteria designed to enhance alignment of the organization's goal for continued financial stability is improvement of net earnings of both the hospital, and its related organizations. A New Mexico Hospital Equipment Loan Council 850426875 647370FS9 2012-09-19 70004797 Hospital imp. including new patient tower; refund bonds issued 11/15/07 0 0 0 A 2765000 70180355 5393296 1400096 32310994 31075969 2012 1 0 1 1 A 0 1 0 0 0.02560 0.00000 0.02560 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: New Mexico Hospital Equipment Loan Council Date the Rebate Computation was Performed: 01/09/2014 Schedule K, Part II, Line 11: The other spent proceeds was the amount used to retire the bonds issued in 2007. Schedule K, Part I, Column (e) and Part II, Line 3: The difference between the issue price at Part I Column (e) and the total proceeds of the issue at Part II Line 3 is due to investment earnings on the reserve funds. Greg Richardson Board member Greg Richardson is the President of the ASV, LLC board 5942080 Gerald Champion performs services for ASV, LLC 0 Amy Graham Daughter-in-law of board member Bill Mershon 74212 Compensation 0 Form 990, Part III, line 2 Occupational Health Opened May 2017. Dr. Abood, Internal Medicine, began practice April 2017. Dr. Dharia, Pulmonary Practice, opened March 2017. Form 990, Part III, line 3 Wellness Works began March 2017. This is an expanded service in ER to assist patients with discharge plans. Form 990, Part III, Line 4a, Description of Program Service (continued): GCRMC has, since its inception in 1949, provided quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operations and stability of GCRMC, it is recognized that not all individuals possess the ability to purchase essential medical services and, further, that our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping the GCRMC's commitment to serve our community, we provide: free care and/or subsidized care - care to persons covered by governmental programs at below cost; and health activities and programs to support the community will be considered where the need and/or an individual's inability to pay coexist. Management expanded the Financial Assistance Program from 200% to 300% of FPL effective July 1, 2015. GCRMC maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. Form 990, Part VI, Section A, line 1 The Joint Finance and Executive Committee is chaired by the Vice Chairman of the Board of Directors. In absence of the Vice Chairman, the Chairman of the Board or Secretary of the Board shall chair the committee in that order. The composition of the Joint Finance/Executive Committee shall be determined by the Board of Directors at the annual meeting. The powers and responsibilities of the Committee shall include: Screen Board business and make recommendations for approval in order to enable the full Board to effectively utilize its discussion time; Exercise emergency powers in extraordinary circumstances and make decisions otherwise reserved to the Board of Directors when the Board is not in session; Exercise the power and authority to transact Corporation business which requires immediate action; Serve as audit committee for the Corporation; Serve as ethics committee for the Corporation and be primarily responsible for implementing the conflicts of interest policy of the Corporation; review and make recommendations to the Board of Directors concerning the performance, competence and terms of employment of the Chief Executive Officer; and act in such other situations and capacities as the Board of Directors may designate or specify. Form 990, Part VI, Section A, line 7a At their annual meeting, the Board of Directors shall elect persons to fill such vacancies as may exist to a maximum of 15 Directors. Form 990, Part VI, Section B, line 11b The return is reviewed by the CEO and CFO prior to filing. Form 990, Part VI, Section B, line 12c Each officer, director, and key employee is required to fill out a conflict of interest disclosure annually. The forms are initially reviewed by the CFO. If any conflicts exist, they are reviewed by the Board of Directors. A person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The CEO reports to GCRMC Board of Directors and his salary is determined by the Board of Directors. The Board used comparative salary data obtained from QHR as well as the Modern Healthcare CEO Salary Survey to access the reasonableness of the compensation. Compensation was last determined June 2016 for FY17. Annually GCRMC has a compensation review performed by an independent consulting firm, Coker Group. This review includes compensation of officers as well as physicians. The results of the compensation study are presented to and reviewed by the Board. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statement are all available upon request. Form 990, Part IX, line 11g Consultants: Program service expenses 1,302,790. Management and general expenses 1,464,606. Fundraising expenses 0. Total expenses 2,767,396. Maintenance Contracts: Program service expenses 776,258. Management and general expenses 2,228,195. Fundraising expenses 0. Total expenses 3,004,453. Physician Fees: Program service expenses 5,201,738. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,201,738. Agency Personnel: Program service expenses 3,843,345. Management and general expenses 10,560. Fundraising expenses 0. Total expenses 3,853,905. Contract Dept Fees: Program service expenses 2,852,329. Management and general expenses 1,264,587. Fundraising expenses 0. Total expenses 4,116,916. Surgery Center Fee: Program service expenses 5,942,080. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,942,080. Miscellaneous Fees: Program service expenses 2,798,852. Management and general expenses 1,591,651. Fundraising expenses 0. Total expenses 4,390,503. GCSP Cath Lab Fee: Program service expenses 5,419,073. Management and general expenses 0. Fundraising expenses 0. Total expenses 5,419,073. Gerald Champion Regional Medical Center Foundation Inc 2669 N Scenic Drive Alamogordo NM 88310 850352051 To directly support the mission of the Otero County Hospital Association NM 501(c)(3) Line 12a, I Otero County Hospital Association 1 Alamogordo Surgery Venture LLC 2351 25th Street Alamogordo NM 88310 061791828 Outpatient Surgery Center NM N/A Related 717662 65847 1 1 0.40500 Gerald Champion-Sierra Providence Cardiac Cath Lab LLC 2669 N Scenic Drive Alamogordo NM 88310 611753921 Cardiac Cath Lab NM N/A Related 757305 3260048 1 1 0.51000 1 0 0 0 0 1 0 0 0 1 0 1 0 0 0 1 1 1 0 Alamogordo Surgery Venture LLC F 664000 General Ledger Alamogordo Surgery Venture LLC A 456680 General Ledger Alamogordo Surgery Venture LLC L 5942080 General Ledger Alamogordo Surgery Venture LLC Q 124414 General Ledger Gerald Champion-Sierra Providence Cardiac Cath Lab LLC F 688500 General Ledger Gerald Champion-Sierra Providence Cardiac Cath Lab LLC A 172179 General Ledger Gerald Champion-Sierra Providence Cardiac Cath Lab LLC L 5419073 General Ledger Gerald Champion-Sierra Providence Cardiac Cath Lab LLC Q 914329 General Ledger Gerald Champion-Sierra Providence Cardiac Cath Lab LLC R 3405950 General Ledger