2014-05-15T15:00:46-05:00 2013-06-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2012-07-01 850138775 Otero County Hospital Association OTER 5754396100 2669 North Scenic Drive Alamogordo NM 883110597 Bashar Naser 5754396100 2014-05-15 1 LISA CHAFFEE CPA P00193453 7012398500 2014-05-15 2012 2015-11-30 17:44:51Z Gerald Champion Regional Medical Center Robert James Heckert 2669 North Scenic Drive Alamogordo NM 883110597 103542343 0 X www.gcrmc.org X 1947 NM Provision of health care services 10 9 797 156 8071 0 398171 321516 102068508 103165772 -474237 57029 102443 -328246 102094885 103216071 2850067 484707 0 0 47519208 41411166 0 0 0 75942477 80068476 126311752 121964349 -24216867 -18748278 138177221 154259322 66516738 101147025 71660483 53112297 X To exceed the expectations of our guests through extraordinary customer service, exceptional quality care and innovative technology. 0 0 98589858 484707 103157701 Otero County Hospital Association d/b/a Gerald Champion Regional Medical Center (GCRMC) provides comprehensive healthcare services through its 99-bed hospital, outpatient ambulatory care facilities, and a multi-specialty physician group. GCRMC accounts for more than 80% of hospital admissions in its Otero County primary service area. The GCRMC's primary market is the city of Alamogordo with secondary markets expanding to Tularosa, Holloman Air Force Base and Lincoln County. 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 99-bed acute care facility accredited by DNV, including two distinct PPS units: Life Transitions (12 beds starting July 1, 2010) and Inpatient Rehabilitation (12 beds starting July 1, 2011). 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; hospital-owned physician practices in the areas of family practice, women's services including obstetrics, gastroenterology and endocrinology, internal medicine, orthopedics and general surgery; 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 2013, GCRMC employed approximately 575 people. In addition to those employees, GCMRC contracts for services in various departments such as Food Services, Environmental Services, Pharmacy, Anesthesia, Emergency Services and Hospitalist program. The medical staff of GCRMC has 205 medical members consisting of 90 active members. GCRMC continues to seek opportunities to expand services and improve quality, with the philosophy of not limiting its potential by the designation of "small community", but rather identifying its scope of service based on community needs.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 with our services and our financial contributions. 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 operation 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. 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. 98589858 1 0 0 0 0 0 0 0 0 0 1 0 0 1 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 1 142 0 1 797 1 1 1 0 0 0 0 0 0 0 0 0 X 10 9 0 1 0 0 0 1 0 1 1 0 0 0 1 1 1 1 1 1 0 1 0 NM X Julia Walker-Grinder 5754396100 2669 North Scenic Drive Alamogordo NM 88311 Norm Arnold 10.00 X X 0 0 0 Bill Mershon 5.00 X X 0 0 0 Bill Mayton 5.00 X X 0 0 0 Fred Baker 5.00 X 0 0 0 Jaime Anderson 3.00 X 0 0 0 James Harris 3.00 X 0 0 0 Greg Richardson MD 5.00 X 0 0 0 Robin French 3.00 X 0 0 0 Lisa Thomassie 3.00 X 0 0 0 Arthur Austin MD 40.00 X X 225719 0 27373 Robert James Heckert 40.00 X 0 0 0 Morgan Hay 40.00 X 0 0 0 Michael Rolph 40.00 X 20180 0 0 Martha Gorman 40.00 X 171621 0 8581 Jeffrey Gardner 40.00 X 126488 0 19920 George Massoud 40.00 X 392220 0 30719 Dennis Worthington 40.00 X 389923 0 34367 Charles Race 40.00 X 721984 0 25688 Stefan Korec 40.00 X 489882 0 30990 Joseph Horton 40.00 X 637439 0 26917 3175456 0 204555 56 0 1 0 Cardinal Pharmaceutical 401 Mason Road Lavergne TX 37086 Pharmacy Supplies 7434850 Cerner Corporation 2800 Rockcreek Kansas City MO 641414399 Software & Support 5311079 White & Case LLP 23802 Network Place Chicago IL 606731238 Legal Counsel 4318405 EmCare Inc 7032 Collections Center Drive Chicago IL 60693 Staff-Medical 2418878 Cardinal Medical Supplies PO Box 73112 Dallas TX 753730112 Medical Supplies 1966618 100 303605 17911 321516 Net Patient Service Revenue 900099 100592333 100592333 Other Revenue 900099 773814 773814 Catering 722320 626601 618530 8071 Rental income 531120 589786 589786 Alamogordo Surgery Venture, LLC 621400 462335 462335 120903 120903 103165772 16953 16953 378900 325779 53121 53121 53121 40569 493 40076 40076 40076 Loss on Bond Refinancing 900099 -381367 -381367 -381367 103216071 103157701 8071 -271217 X 484707 484707 992871 992871 33256845 25132673 8124172 632113 480871 151242 4262269 3203543 1058726 2267068 1550416 716652 193589 193589 178649 178649 26889754 19292303 7597451 102216 7831 94385 6936118 4795174 2140944 539783 36285 503498 2028868 595319 1433549 98586 47837 50749 183902 129439 54463 3460100 3460100 9819851 9819851 1826187 1826187 Medical Supplies 12932702 12932702 Provision for Bad Debts 12033135 12033135 Reorganization Costs 2218583 2218583 Gross Receipt/Sales Tax 395399 395399 231054 147503 83551 121964349 98589858 23374491 0 5486057 15715726 13383375 12751967 2788791 3165851 1575612 1025913 180587051 84207304 101035399 96379747 10846031 15225834 719393 739078 54375 70551 2288188 9184655 138177221 154259322 13359288 19476188 70053136 2962454 2701031 5416670 50194996 3500000 66516738 101147025 X 71660483 53112297 71660483 53112297 138177221 154259322 X -18748278 1246 198846 X 0 1 X 1 0 X 3237050 3237050 103746989 33176714 70570275 64450482 47879134 16571348 9152530 3151456 6001074 96379747 Deferred financing costs, net 1986417 Other receivables 2734797 Estimated Third Payor Settlements 963441 Insurance Recovery Receivable 3500000 9184655 Insurance Claims Liability 3500000 3500000 X 89497857 1246 -13469634 -13468388 102966245 249826 249826 103216071 108046043 333412 333412 107712631 14251718 14251718 121964349 Description of Uncertain Tax Positions Under FIN 48: Part X, Line 2: The Medical Center is organized as a New Mexico nonprofit corporation and has been recognized by the Internal Revenue Service 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 requirement, 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 incurreed. The Medical Center's federal Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2008. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Recorded as Income for Financial Statements -12,033,135. Reorganization Costs Recorded as Income for Financial Statements -2,218,583. Book Income ASV LLC 758,002. Book Income White Sands, LLC 24,082. Part XI, Line 4b - Other Adjustments: Rental Expenses Recorded as Expense for Financial Statements -325,779. Catering/Bistro Expenses Recorded as Expense for Financial Statements -7,633. Tax K-1 Income ASV LLC 462,335. Tax K-1 Income Imaging Center, LLC 121,482. Tax K-1 Income White Sands LLC -579. Part XII, Line 2d - Other Adjustments: Rental Expenses Recorded as Expense for Financial Statements 325,779. Catering/Bistro Expenses Recorded as Expense for Financial Statements 7,633. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Recorded as Income for Financial Statements 12,033,135. Reorganization Costs Recorded as Income for Financial Statements 2,218,583. 1 1 X 1 X 1 X 1 1 0 0 1989000 1989000 0.01810 1165910 766020 399890 0.00360 3154910 766020 2388890 0.02170 484707 484707 0.00440 41495248 16404038 25091210 0.22820 41979955 16404038 25575917 0.23260 45134865 17170058 27964807 0.25430 12 66284 66284 0.00060 10 418423 418423 0.00380 711105 711105 0.00650 22 1195812 1195812 0.01090 0 12033135 226742 25552978 24688406 864572 X 1 1 1 Alamogordo Surgery Ventures Outpatient Surgery Center 0.40500 0.00000 0.59500 2 Alamogordo Imaging Center Outpatient Radiology Center 0.29500 0.00000 0.70500 3 White Sands Health Care Systems LLC Physician Hospital Organization 0.50000 0.00000 0.50000 1 1 Gerald Champion Regional Medical Center

2669 North Scenic Drive Alamogordo NM 88311

X X X Gerald Champion Regional Medical Center 1 1 X X X X X X X X X X 12 1 0 1 X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X 1 1 X X 1 0 X X 1 X 0 0 2 ASV dba Scenic View Outpatient Surg Cr

2351 25th Street Alamogordo NM 88311

Outpatient Surgery Alamogordo Imaging Center

2539 Medical Dr Ste 1010 Alamogordo NM 883108720

Outpatient Radiology Part I, Line 3c: The organization uses the Federal Poverty Guidelines when determining free and discounted care. An individual is eligible for free care if their family income is at or below 200% of the Federal Poverty Levels and they are eligible for discounted care if their family income is above 200% but not more than 300% of the Federal Poverty Levels. Patients whose family income exceeds 300% of the federal poverty levels may be eligible to receive discounted rates on a case-by-case basis based on their specific circumstances. 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 were calculated from internal records.Row e: 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 $27,729,670 of costs attributable to a Physician Clinic. Part I, L7 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 $12,033,135. Part II: Gerald Champion helps to promote the health of the communities that it serves through the recruitement of physicians and other providers. The Hospital also supports several organizations throughout the community that encourage and promote the overall health of the community. 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.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 1.88% 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.Discounts and payments are taken into account when determining bad debt expense. 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. 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. Gerald Champion Regional Medical Center Part V, Section B, Line 1j: Charts related to age, gender, general lifestyles, healthcare metrics. Gerald Champion Regional Medical Center Part V, Section B, Line 3: Conducted focus groups, round table discussions, and individual interviews as well as phone surveys. GCRMC spoke with community members. Gerald Champion Regional Medical Center Part V, Section B, Line 5c: GCRMC's CHNA and Strategic Plan is available to the public at: http://www.gcrmc.org/News/StrategicPlan?showBack=true&PageIndex=0 Gerald Champion Regional Medical Center Part V, Section B, Line 6i: GCRMC's CHNA and Strategic Plan is available to the public at: http://www.gcrmc.org/News/StrategicPlan?showBack=true&PageIndex=0 Gerald Champion Regional Medical Center Part V, Section B, Line 7: The need for additional services in Interventional Cardiology was not addressed by fiscal year end June 30, 2013. The implementation of the Interventional Cardiology program is expected in FY2015 and will be a joint venture with Sierra Providence in El Paso, TX. Gerald Champion Regional Medical Center Part V, Section B, Line 14g: GCRMC provides a summary of the financial assistance policy on the hospital website and attached to billing invoices. The hospital also posts a summary in emergency and waiting rooms as well as the facility's admissions offices. Notice of GCRMC's financial assistance policy is included on the patient statements. Part VI, Line 2: Management at GCRMC enlisted the services of Saurage Strategic Marketing Research to complete a quantitative tracking study in 2011. In 2012, a strategic planning meeting for FY 13, 14 and 15 was held and utilized components of the community health needs assessment. Members consisted of physicians, community members and management. Three strategies were:1. Be number one in quality and service in our region2. Have the best healthcare talent in the region3. Evaluate and adapt to serve the health care needs of our community 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 66-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 123-bed acute care hospital (the "Hospital") on the campus. The Hospital is a one-story building with approximately 294,000 square feet. Other facilities that the Hospital owns located on the campus include 2 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 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 (10-bed Intensive Care Unit), Telemetry, Maternal Child, 12-bed gero-psych, 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, gero-psych outpatient, 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, 128-slice and 16-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 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 2012, 3,900 active military and 5,000 dependents are located at the HAFB. In addition, the German Air Force ("GAF") utilizes HAFB as a training facility and has 480 active military and 790 dependents.GCRMC's primary service area (the "PSA") is 30 miles in Northwestern Otero County from which approximately 84% 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 has grown by over 3,400 people since 2000 to 65,703 in 2011.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 MountainView 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. During the fiscal year ended June 30, 2013, management of GCRMC estimates that approximately 84% of inpatients and 93% of total patients seen at GCRMC come from Otero County. Approximately 3.5% of inpatients come from Lincoln County.GCRMC has experienced a slight decline in Medicare Market Share in its PSA since 2009. As of calendar year 2011, GCRMC had an approximate 56% market share of Medicare inpatient volume in the PSA. This represents a 1.3% decline since 2009. For the fiscal year ended June 30, 2013, MountainView Regional Medical Centre and Memorial Medical Center combined had a 19.0% of total Medicare market share in the PSA, remaining consistent with the fiscal year ended June 30, in 2011. The majority of these volumes relate to invasive cardiology (e.g. cardiac catheterization treatment), a service not provided at the Hospital. 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 10 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, and continuing education for clinical staff including physicians.GCRMC views the position of sole provider as a significant commitment to the overall health and well-being of the community. Not satisfied with just providing healthcare; the challenges to overcome are to have a positive effect on the quality of life experience in our community. With this in mind, the organization strives to facilitate and share opportunities to educate and motivate a philosophy of wellness. 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. Flu shots are distributed to community members.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 Reports Filed With States Part VI, Line 7 NM 1 American Cancer Society 2120 1st Ave Alamogordo NM 88310 841316555 501(c)(3) 17078 Public Health Presbyterian Medical Services Chaparral NM Clinic PO Box 112 Carrizozo NM 88301 850206810 501(c)(3) 166670 Public Health Presbyterian Medical Services Sacramento Mountain Center PO BOX 686 Cloudcraft NM 88317 850206810 501(c)(3) 125000 Public Health United Way of Otero County 1601 E 10th Street Suite B Alamogordo NM 88310 850197559 501(c)(3) 18570 Public Health Zia Therapy Center 900 First Street Alamogordo NM 88310 850199135 501(c)(3) 26113 Public Health Presbyterian Medical Services Alamogordo 1501 10th Street Alamogordo NM 88310 850206810 501(c)(3) 100000 Public Health Globus Relief 1775 West 1500 South Salt Lake City UT 84014 841369453 501(c)(3) 17088 Cost Medical Waste Public Health 7 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization only gave grants to government organizations and tax exempt organizations. X X 1 0 0 0 0 0 0 0 0 Arthur Austin MD 225323 0 0 0 396 0 11589 0 16486 0 253794 0 0 0 Martha Gorman 171003 0 0 0 618 0 8581 0 629 0 180831 0 0 0 George Massoud 391991 0 0 0 229 0 12500 0 18819 0 423539 0 0 0 Dennis Worthington 388322 0 1205 0 396 0 12500 0 22569 0 424992 0 0 0 Charles Race 721726 0 0 0 258 0 12500 0 13890 0 748374 0 0 0 Stefan Korec 457516 0 32036 0 330 0 12500 0 19192 0 521574 0 0 0 Joseph Horton 637371 0 0 0 68 0 12500 0 15119 0 665058 0 0 0 Part I, Line 3 The CEO and CFO are paid by an unrelated management company, Quorum Health Resources up until 12/15/2012. At which time, the CEO became an employee of the hospital. The hospital employed an Interim CFO until a permanent CFO is selected. The permanent CFO will be an employee of the hospital. Part I, Line 4a The previous CFO, Morgan Hay, was an employee of QHR and a key employee. QHR was GCRMC's management company. QHR and GCRMC's Management Company agreement was terminated December 2012. GCRMC is now a Strategic Partner with QHR. In December 2012, the CEO, Jim Heckert, was hired as a GCRMC employee. Morgan Hay was not hired by GCRMC and separated from QHR. QHR paid Morgan a severance upon separation. 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 70011320 5224261 1400096 32310994 31075969 2012 1 0 0 1 A 0 0 0 0 0.00000 0.00000 0.00000 0 0 1 A 0 0 0 0 0 0 0 0 1 A 1 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. Alamogordo Surgery Venture LLC Board member Gregory Richardson is the President of the ASV, LLC board 6046265 Performance of services for ASV, LLC 0 Form 990, Part VI, Section A, line 1 Joint Finance/Executive Committee consists of the Board Chair, Vice President, Secretary and three other Directors. The Joint Finance/Executive Committee has the authority to act on behalf of the governing body, when specifically arranged. The Board will then ratify the actions in the following Board of Director's meeting. Form 990, Part VI, Section A, line 3 Gerald Champion Regional Medical Center (GCRMC) had a management agreement with Quorum Health Resources. GCRMC's Chief Executive Office (CEO) and Chief Financial Officer (CFO) were employees of Quorum Health Resources (QHR), an unrelated management company, until 12/16/2012 when the management relationship ended. The Board of Directors retained and hired the CEO as an employee of GCRMC. The CFO was not hired by the Board of Directors. CEO Robert James Heckert's compensation for calendar year 2012 was $347,312. CFO Morgan Hay's compensation for calendar year 2012 was $294,468. Form 990, Part VI, Section A, line 7a Directors shall be elected in the manner, and at the times, prescribed in the Bylaws of the Corporation. Form 990, Part VI, Section B, line 11 The return is reviewed by the CEO and CFO prior to filing. Form 990, Part VI, Section A, Line 6: On February 3, 2011, the duration of the corporation was made perpetual; and henceforth, this corporation shall be a non-membership corporation. Form 990, Part VI, Section A, Line 8b: The Joint Finance/Executive Committee has the authority to act on behalf of the governing board, when specifically arranged. The Board will then ratify the actions in the following Board of Director's meeting. 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 15a As of 12/15/2012, the management agreement with Quorum Health Resources was terminated and the CEO became an employee of GCRMC. 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 December 2012 and will be evaluated on an annual basis. The CFO reports to the CEO and the CFO salary is determined based on GCRMC's HR practices for all other employees. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statement are all available upon request. Other Fees Form 990, Part IX, line 11g Consultants: Program service expenses 629,190. Management and general expenses 518,758. Fundraising expenses 0. Total expenses 1,147,948. Maintenance Contracts: Program service expenses 2,337,650. Management and general expenses 1,992,157. Fundraising expenses 0. Total expenses 4,329,807. Physician Fees: Program service expenses 4,706,856. Management and general expenses 0. Fundraising expenses 0. Total expenses 4,706,856. Agency Personnel: Program service expenses 2,588,951. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,588,951. Contract Dept Fees: Program service expenses 2,439,752. Management and general expenses 4,518,981. Fundraising expenses 0. Total expenses 6,958,733. Surgery Center Fee: Program service expenses 6,009,784. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,009,784. Miscellaneous Fees: Program service expenses 580,120. Management and general expenses 567,555. Fundraising expenses 0. Total expenses 1,147,675. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: ASV Book/K-1 Income Difference 295,667. White Sands Book/K-1 Income Difference -97,400. AIC Book/K-1 Income Difference 579. Alamogordo Surgery Venture LLC 2351 25th Street Alamogordo NM 88310 061791828 Outpatient Surgery Center NM N/A Related 462335 50246 1 0 0.40500 1 0 0 0 0 0 0 0 0 1 0 1 0 0 0 1 1 0 0 Alamogordo Surgery Venture LLC A 688500 General Ledger Alamogordo Surgery Venture LLC J 456681 General Ledger Alamogordo Surgery Venture LLC L 6046265 General Ledger Alamogordo Surgery Venture LLC Q 135230 General Ledger