2012-11-28T11:37:57-06:00 2011-12-31 910189318 MOSS ADAMS LLP 6100 UPTOWN BLVD NE STE 400 ALBUQUERQUE NM 87110 990 2011-01-01 850313268 REHOBOTH MCKINLEY CHRISTIAN HEALTHCARE SERVICES REHO 5058637000 1901 RED ROCK DR GALLUP NM 87301 CEO 5058637000 2012-11-20 1 5058787200 2011 2016-02-24 21:20:13Z X ROGER GLEISNER 1901 RED ROCK DR GALLUP NM 87301 64406783 0 X WWW.RMCH.ORG X 1985 NM THE MISSION OF REHOBOTH MCKINLEY CHRISTIAN HEALTHCARE SERVICES, INC. IS TO SERVE GOD BY MAKING A PROFOUND AND LASTING DIFFERENCE IN THE HEALTH AND QUALITY OF LIFE FOR ALL PEOPLE IN THE COMMUNITY. 13 9 677 46 0 0 555456 2040872 22462285 62050251 -15630 3187 41893 33556 23044004 64127866 27844 52195 0 0 10844014 35001658 0 0 0 11864079 35920361 22735937 70974214 308067 -6846348 41167836 35337651 22509641 23190623 18658195 12147028 X REHOBOTH MCKINLEY CHRISTIAN HEALTHCARE SERVICES, INC. (RMCHCS) WILL BE THE PREFERRED HEALTHCARE PROVIDER ORGANIZATION FOR MCKINLEY COUNTY AND THE SURROUNDING COMMUNITIES. RMCHCS WILL BE RESPONSIVE TO THE HEALTHCARE NEEDS OF THE ENTIRE COMMUNITY. RMCHCS WILL FOCUS ON IMPROVING FINANCIAL AND OPERATIONAL PERFORMANCE WHILE SOLIDIFYING OURSELVES AS AN INTEGRATED HEALTHCARE DELIVERY SYSTEM. WE WILL BE DISTINGUISHED BY: 1) DEMONSTRATED QUALITY, CUSTOMER SERVICES, AND VALUE, 2) SUPERIOR ACCESS, 3) CLINICAL SPECIALTY SERVICES, 4) STRONG HUMAN AND TECHNOLOGICAL RESOURCES, AND 5) A MULTI-CULTURAL ORIENTATION. 0 0 43842993 52195 57894814 HOSPITAL INPATIENT SERVICES INCLUDE A MEDICAL SURGICAL UNIT , WOMEN'S HEALTH, PEDIATRIC AND NEWBORN NURSERY UNITS, INTENSIVE AND CRITICAL CARE UNITS, AND AN INPATIENT DIALYSIS UNIT. HOSPITAL ANCILLARY SERVICES INCLUDE A CARDIOPULMONARY REAHBILITATION UNIT, DIAGNOSTIC IMAGING AND LABORATORY SERVICES, AS WELL AS PHYSICAL REHABILITATION SERVICES. THE MAIN CAMPUS IS ALSO HOME TO THE SURGICAL SERVICES UNIT AND THE EMERGENCY DEPARTMENT. 1159401 1280100 HOME HEALTH IS INTERIM CARE TO HELP PATIENTS TRANSITION FROM AN ACUTE ILLNESS TO CARE AT HOME. DURING THE EPISODE OF CARE, HOME HEALTH STAFF PROVIDE TRAINING FOR THOSE CARING FOR PATIENTS WITH A DISEASE OR LONG-TERM HEALTH ISSUE. HOSPICE IS A PROGRAM FOR PATIENTS WHO HAVE A TERMINAL ILLNESS. THE PROGRAM OFFERS SUPPORT AND GUIDANCE TO END OF LIFE BY PHYSICIAL THERAPISTS, AND OCCUPATIONAL THERAPIST, AND TWO HOME HEALTH ASSISTANTS. STAFF MEMBERS SEE AN AVERAGE OF FIVE PATIENTS A DAY, WITH CARE FOCUSED ON THE FAMILY AS THE UNIT OF CARE. THE HOME CARE SERVICE AREA COVERS A DISTANCE OF ABOUT 30 MILES IN ALL DIRECTIONS SURROUNDING GALLUP. 1214350 2875337 BEHAVIORAL HEALTH SERVICES OFFERS HIGH QUALITY, COMPREHENSIVE BEHAVIORAL HEALTH CARE TO THOSE OF ALL RACES WHO NEED IT. WE BELIEVE IN A HUMANISTIC APPROACH THAT MEETS THE INDIVIDUAL NEEDS OF CLIENTS AND THEIR FAMILIES WITH A SPIRIT OF DIGNITY AND CONFIDENTIALITY. 46216744 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 1 140 0 1 677 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NM X MARY LOU DONKERSLOTT 5058637275 1901 RED ROCK DR GALLUP NM 87301 X TONY D GONZALES 1.00 X 0 0 0 KATHY HEAD 1.00 X X 0 0 0 PRISCILLA SMITH 1.00 X 0 0 0 ERIC D BEGAY 1.00 X 0 0 0 YOGASH KUMAR 1.00 X X 0 0 0 DAVID BISCHOFF 1.00 X X 0 0 0 ANGELO DIPAOLO 1.00 X 0 0 0 SUE EDDY 1.00 X 0 0 0 ERWIN ELBER MD 1.00 X 0 0 0 JOHN LUGINBUHL 1.00 X 0 0 0 JOHN MEZOFF MD 1.00 X X 0 0 0 SHELLEY STAM-MACLAREN MD 32.00 X 153111 0 8808 SHANNON TANNER 1.00 X 0 0 0 BARRY BUTLER 1.00 X 0 0 0 LYNN ISAACSON 1.00 X 0 0 0 ERWIN ELBER MD 40.00 X 344296 0 10669 ROGER GLEISNER 38.00 X X 12940 0 0 JENNIFER DOWLING 1.00 X 0 0 0 KAREN LAUTERMILCH 38.00 X 249894 0 10669 MARK HALL 38.00 X 187694 0 8265 STEVE O'GRADY 38.00 X 0 0 0 MARY L POEL MD 40.00 X 247499 0 10099 MARY JIM MONTGOMERY 40.00 X 322113 0 0 BRYAN KAMPS MD 40.00 X 464406 0 10669 MAHMOOD VAEZZADEH MD 40.00 X 353532 0 869 CHARLES GUIMARAES MD 40.00 X 392571 0 10669 PHILLIP MICKELSEN MD 40.00 X 416651 0 869 PETER TEMPEST MD 40.00 X 323807 0 0 3468514 0 71586 49 0 1 0 STAFF CARE INC 5001 STATESMAN DR IRVING TX 75063 PROFESSIONAL STAFFING 979856 APOGEE MEDICAL MANAGEMENT 2525 E CAMELBACK RD STE 1000 PHOENIX AZ 85016 PROFESSIONAL MEDICAL 910478 COMPHEALTH PO BOX 972651 DALLAS TX 75397 PROFESSIONAL STAFFING 893744 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 PROFESSIONAL MEDICAL 791406 HCCA INTERNATIONAL 7105 S SPRING DR FRANKLIN TN 37067 PROFESSIONAL STAFFING 562910 35 392544 1648328 2040872 NET PATIENT SERVICE 624100 54389871 54389871 MEDICAID/MEDICARE 624100 7063377 7063377 OTHER PROGRAM SERVICES 900099 597003 597003 62050251 3367 3367 309491 278737 30754 30754 30754 180 -180 -180 -180 OTHER INCOME 900099 2802 2802 2802 64127866 62050251 0 36743 25000 25000 27195 27195 1471488 1020407 451081 26150600 19754161 6396439 525301 393975 131326 4805601 3210701 1594900 2048668 1536501 512167 199379 199379 171826 171826 8735551 5261165 3474386 106192 106192 5231804 1352843 3878961 3545185 819041 2726144 626081 352406 273675 5710 2783 2927 406266 406266 2305291 2305291 1155551 1155551 BAD DEBT 5118460 5118460 MEDICAL SUPPLIES 4072050 4071384 666 CONTRACT LABOR 2942041 1985566 956475 PHARMACEUTICALS 1298974 1285156 13818 70974214 46216744 24757470 0 9660982 372647 33723 6987861 8177233 2972777 3563651 1052875 1006337 484932 465178 60344452 43713800 15998151 16630652 3067601 3443943 908934 1678010 41167836 35337651 8250608 11079648 6870000 6580000 874907 436955 6514126 5094020 22509641 23190623 X 18658195 12147028 18658195 12147028 41167836 35337651 X -6846348 335181 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 734969 734969 25467631 18407585 7060046 3356581 1527107 1829474 28837408 22609051 6228357 1947863 1170057 777806 16630652 SERIES 2007 BOND FUNDS 1162023 F INVESTMENT RISK RETENTION GROUP 2281920 F 3443943 ESTIMATED 3RD PARTY SETTLEMENT 5094020 5094020 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL RECOGNIZES THE TAX BENEFIT FROM UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. THE TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE HOSPITAL HAD NO UNRECOGNIZED TAX BENEFITS AT DECEMBER 31, 2011 AND 2010. THE HOSPITAL AND THE FOUNDATION FILES AN EXEMPT ORGANIZATION RETURN AND APPLICABLE UNRELATED BUSINESS INCOME TAX RETURN IN THE U.S. FEDERAL JURISDICTION, NEW MEXICO ATTORNEY GENERAL AND NEW MEXICO DEPARTMENT OF REVENUE. THE HOSPITAL AND THE FOUNDATION ARE NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY TAXING AUTHORITIES FOR YEARS BEFORE FISCAL YEAR 2008 FOR ITS FEDERAL AND STATE FILINGS. 1 1 X 1 X 1 X 1 1 1 0 1 1 2147790 2147790 0.03260 18208271 4615209 13593062 0.20640 20870980 20870980 0.31690 41227041 4615209 36611832 0.55590 137949 137949 0.00210 137949 137949 0.00210 41364990 4615209 36749781 0.55800 18 141443 141443 0.00210 18 141443 141443 0.00210 1 5118549 2560000 12355964 10670142 1685822 X 1 1 1 1 RMCHCS HOSPITAL

1901 RED ROCK DRIVE GALLUP NM 87301

X X X REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE 1 1 1 100.000000000000 1 200.000000000000 1 X X X X 1 1 X X 1 X 0 1 X 0 1 4 COLLEGE CLINIC

2111 COLLEGE DRIVE GALLUP NM 87301

PEDIATRICS, INTERNAL & FAMILY RED ROCK CLINIC

1900 RED ROCK DRIVE GALLUP NM 87301

OB/GYN ORTHOPEDICS VANDEN BOSCH CLINIC

650 VANDEN BOSCH PARKWAY GALLUP NM 87301

ENDOCRINOLOGY, DIABETES CARE BEHAVIORAL HEALTH SERVICES

650 VANDEN BOSCH PARKWAY GALLUP NM 87301

ADDICTION & PSYCHIATRIC SERVICES PART I, LINE 7, COLUMN (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 $ 5118460. SCHEDULE H, PART I, LINE 6A THE HOSPITAL HAS A COMMUNITY BENEFIT REPORT. IT IS MADE AVAILABLE TO THE PUBLIC AT THE FACILITY AND IT IS SUBMITTED TO GOVERNMENT ORGANIZATIONS THAT MAKE THE REPORT AVAILABLE TO THE PUBLIC. PART II: THE HOSPITAL PARTICIPATES IN COMMUNITY EVENTS SUCH AS THE ANNUAL HEALTH FAIR, SMOKING CESSATION CLASSES, STATE DIABETES ADVISORY COUNCIL, REGIONAL TRAUMA PREVENTION DAY, BABY CAR SEAT DISTRIBUTION, AND EMERGENCY PHYSICIAN AND COMMUNITY TEACHING. IN ADDITION THE AUXILARY PROVIDES ANNUAL SCHOLARSHIPS OF $25,000 TO QUALIFIED NURSING STUDENTS. PART III, LINE 4: RATIONAL AND COSTING METHODOLOGY USED IN DETERMINING THE AMOUNTS REPORTED AS BAD DEBT EXPENSE:BAD DEBTS ARE WRITTEN OFF WHEN THEY ARE DEEMED UNCOLLECTIBLE. RMCHCS CALCULATES ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON PERCENTAGES OF ACCOUNTS RECEIVABLE AGING CATEGORIES THAT CONSIDER HISTORICAL WRITE-OFFS BY MAJOR PAYOR CATEGORIES OVER THE PAST SEVERAL YEARS.PATIENT ACCOUNTS ARE FIRST REDUCED BY THE APPLICABLE CONTRACTUAL ALLOWANCE. BAD DEBT EXPENSE IS COMPUTED BY APPLYING THE RESULTING NET AR BALANCES TIMES AN ESTIMATED BAD DEBT PERCENTAGE BASED ON THE AGING OF ACCOUNTS.THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY. THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE; THEREFORE, THEY ARE DEDUCTED FROM GROSS REVENUE. RATIONAL FOR INCLUDING PORTION OF BAD DEBT AS COMMUNITY BENEFIT:MANY PATIENTS THAT WOULD OTHERWISE QUALIFY FOR CHARITY CARE, FAIL TO COMPLETE THE REQUIRED DOCUMENTATION AND INSTEAD LET THE ACCOUNTS GO TO COLLECTIONS AND ULTIMATELY TO BAD DEBT. THE BAD DEBT RELATED TO PATIENTS WHO MAY MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY ARE ESTIMATED AT 50% OF TOTAL BAD DEBT.FINANCIAL STATEMENT FOOTNOTE:THE ALLOWANCE FOR DOUBTFUL PATIENT ACCOUNTS RECEIVABLE IS THAT AMOUNT WHICH, IN MANAGEMENT'S JUDGMENT, IS CONSIDERED ADEQUATE TO REDUCE PATIENT ACCOUNTS RECEIVABLE TO AN AMOUNT THAT IS CONSIDERED TO BE ULTIMATELY COLLECTIBLE. THE HOSPITAL CALCULATES ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON PERCENTAGES OF ACCOUNTS RECEIVABLE AGING CATEGORIES THAT CONSIDER HISTORICAL WRITE-OFFS BY MAJOR PAYOR CATEGORIES OVER THE PAST SEVERAL YEARS.MANAGEMENT BELIEVES THAT THE ALLOWANCES FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ALLOWANCES ARE ADEQUATE. BECAUSE OF THE UNCERTAINTY REGARDING THE ULTIMATE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, THERE IS A POSSIBILITY THAT RECORDED ESTIMATES OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND CONTRACTUAL ALLOWANCES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM.ON A MONTHLY BASIS, THE HOSPITAL EVALUATES PATIENT ACCOUNTS RECEIVABLE BALANCES OLDER THAN SIX MONTHS TO DETERMINE COLLECTABILITY. ACCOUNTS ARE CONSIDERED UNCOLLECTIBLE WHEN THERE HAS BEEN NO RECENT PAYMENT ACTIVITY AND NO OTHER INDICATION THAT PAYMENT WILL BE RECEIVED. THOSE BALANCES THAT ARE CONSIDERED UNCOLLECTIBLE ARE WRITTEN OFF UPON APPROVAL FROM THE DIRECTOR OF PATIENT FINANCIAL SERVICES, CHIEF FINANCIAL OFFICER AND CHIEF EXECUTIVE OFFICER DEPENDING ON THE BALANCE OF THE ACCOUNT. DURING THE YEAR ENDED DECEMBER 31, 2011 AND THE SIXTEEN MONTH PERIOD ENDED DECEMBER 31, 2010, THE HOSPITAL WROTE OFF APPROXIMATELY $5.1 AND $7.7 MILLION, RESPECTIVELY, IN PATIENT ACCOUNTS RECEIVABLE BASED ON THESE PROCEDURES. PART III, LINE 8: A COST TO CHARGE RATIO WAS USED BASED ON THE OVERALL HOSPITAL. PART III, LINE 9B: THE HOSPITAL'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. THE HOSPITAL MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE PART V, SECTION B, LINE 1J: PURSUANT TO IRS ANNOUNCEMENT 2011-37, TAX-EXEMPT ORGANIZATIONS THAT OPERATE ONE OR MORE HOSPITAL FACILITIES ARE NOT REQUIRED TO COMPLETE SCHEDULE H, PART V, SECTION B, LINE 1-7 FOR THE 2011 TAX YEAR. REHOBOTH MCKINLEY CHRISTIAN HEALTHCARE SERVICES HAS ELECTED NOT TO COMPLETE PART V, SECTION B, SO THEY CAN FAMILIARIZE THEMSELVES WITH THE INFORMATION REQUIRED TO REPORT COMPLETE AND ACCURATE INFORMATION ON SECTION B. REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE PART V, SECTION B, LINE 11H: THE FACILITY CHARGES EVERY PATIENT THE SAME REGARDLESS OF THEIR ABILITY TO PAY. THE ACCOUNT WILL SUBSEQUENTLY BE DISCOUNTED OR CHARGED TO CHARITY CARE WRITE OFFS DEPENDING ON THE FAP POLICY. REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE PART V, SECTION B, LINE 13G: FINANCIAL COUNSELORS ASSIST PATIENTS IN PREPARING FINANCIAL ASSISTANCE FORMS. REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE PART V, SECTION B, LINE 15E: ONCE THE PATIENT IS DETERMINED TO QUALIFY FOR FINANCIAL ASSITANCE, NO FURTHER COLLECTION ACTIVITIES ARE CONDUCTED. REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE PART V, SECTION B, LINE 19D: THE FACILITY CHARGES EVERY PATIENT THE SAME REGARDLESS OF THEIR ABILITY TO PAY. THE ACCOUNT WILL SUBSEQUENTLY BE DISCOUNTED OR CHARGED TO CHARITY CARE WRITE OFFS DEPENDING ON THE FAP POLICY. REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE PART V, SECTION B, LINE 21: RMCHCS PROVIDES CHARITY CARE TO PATIENTS WHO ARE FINANCIALLY UNABLE TO PAY FOR HEALTH CARE SERVICES THEY RECEIVE. THE HOSPITAL'S POLICY IS NOT TO PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE. RMCHCS MAINTAINS RECORDS TO IDENTIFY AND MONITOR THE LEVEL OF CHARITY CARE IT PROVIDES. PART VI, LINE 2: COMMUNITY NEEDS ARE ASSESSED THROUGH THE BOARD OF DIRECTORS WITH INPUT FROM OTHER COMMUNITY HEALTHCARE LEADERS. PART VI, LINE 3: PATIENTS WHO PRESENT WITHOUT INSURANCE OR ABILITY TO PAY ARE SEEN BY A FINANCIAL COUNSELOR WHO WILL PROVIDE INFORMATION AND FORMS TO APPLY FOR ASSISTANCE THROUGH VARIOUS FEDERAL AND STATE PROGRAMS, AS WELL AS CRITERIA FOR CHARITY CARE WRITE OFFS. PART VI, LINE 4: GALLUP, WHICH IS THE COUNTY SEAT OF MCKINLEY COUNTY, IS THE HEART OF THE INDIAN SOUTHWEST. SEVENTY-THREE PERCENT OF THE RESIDENTS ARE OF AMERICAN INDIAN DESCENT. GALLUP IS THE ECONOMIC CENTER OF THREE MAJOR INDIAN TRIBES, ZUNI, HOPI, AND NAVAJO AND SERVES THE SURROUNDING AREAS OF NEW MEXICO AND ARIZONA. THE PRIMARY SERVICE AREA (GALLUP) HAS A POPULATION OF 22,000 WITH A SECONDARY SERVICE AREA OF APPROXIMATELY 90,000 PEOPLE. GALLUP IS SITUATED AT 6,515 FEET AND HAS A MILD AND COMFORTABLE FOUR-SEASON CLIMATE. THE LANDSCAPE IS BEAUTIFUL, WITH RED MESAS SURROUNDING THE CITY. GALLUP HAS A UNIQUE BLEND OF INDIGENOUS CULTURE, WITH GENUINE AMERICAN INDIAN AND SOUTHWEST-HISPANIC ARTS AND CRAFTS IN RICH ABUNDANCE. PART VI, LINE 5: REHOBOTH MCKINLEY CHRISTIAN HOSPITAL IS THE MAIN CAMPUS. THIS 69-BED GENERAL ACUTE INPATIENT FACILITY OFFERS A WIDE RANGE OF MEDICAL AND DIAGNOSTIC SERVICES. HOSPITAL INPATIENT SERVICES INCLUDE A MEDICAL SURGICAL UNIT, WOMEN'S HEALTH, PEDIATRIC, AND NEWBORN NURSERY UNITS, INTENSIVE AND CRITICAL CARE UNITS. HOSPITAL ANCILLARY SERVICES INCLUDE A CARDIOPULMONARY REHABILITATION UNIT, DIAGNOSTIC IMAGING AND LABORATORY SERVICES, AS WELL AS PHYSICAL REHABILITATION SERVICES. THE MAIN CAMPUS IS ALSO HOME TO THE SURGICAL SERVICES UNIT AND THE EMERGENCY DEPARTMENT. THE MISSION OF REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES IS TO SERVE GOD BY PROVIDING HEALTH CARE AND PROMOTING WELLNESS FOR ALL PEOPLE. STATEMENT OF PHILOSOPHY- REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES ORIGINATES AND EXISTS ON THE BASIS OF THE BIBLICAL COMMAND TO LOVE GOD AND TO LOVE OUR NEIGHBOR. REALIZING THAT HUMAN BEINGS ARE PLAGUED WITH PROBLEMS OF MIND, BODY, AND SPIRIT, THIS INSTITUTION IS DEDICATED TO THEIR DIAGNOSIS, TREATMENT, AND PREVENTION. IT IS THE GOAL OF THE CORPORATION TO EMBODY THE MEDICAL FACILITIES WITH A SPIRIT OF MERCY THAT RESULTS IN PHYSICAL HEALING. MEDICAL KNOWLEDGE, SKILL, AND HEALING ARE GIFTS FROM GOD; AND, TO WHATEVER EXTENT, THEY ARE EFFECTED AT REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES, INC., HIS NAME IS GLORIFIED AND HIS PURPOSE SERVED. IT IS THE COMPASSION AND LOVE OF CHRIST WHICH SET THE EXAMPLE FOR THE STAFF; AND IT IS HOPED THAT THIS PROVISION OF A CHRISTIAN SETTING WILL PROVIDE PATIENTS AN OPPORTUNITY TO ENCOUNTER CHRIST, THE GREAT PHYSICIAN. REPORTS FILED WITH STATES PART VI, LINE 7 NM 1 RMCHCS FOUNDATION 1901 RED ROCK DR GALLUP NM 87301 850349559 501C3 25000 FMV CAPITAL DONATION 1 SCHOLARSHIPS 11 27194 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: AS PART OF THE OVERALL OPERATION OF THE RELATED ORGANIZATION, RMCHCS FOUNDATION KEEPS CAREFUL TRACK OF THE USE OF FUNDS GRANTED TO REHOBOTH MCKINLEY CHRISTIAN HEALTHCARE SERVICES. X X X X X X 0 0 0 0 0 0 0 0 0 SHELLEY STAM-MACLAREN MD 131612 0 15959 0 5540 0 8022 0 786 0 161919 0 0 0 ERWIN ELBER MD 338665 0 0 0 5631 0 9800 0 869 0 354965 0 0 0 KAREN LAUTERMILCH 249894 0 0 0 0 0 9800 0 869 0 260563 0 0 0 MARK HALL 187694 0 0 0 0 0 7418 0 847 0 195959 0 0 0 MARY L POEL MD 239139 0 8360 0 0 0 9230 0 869 0 257598 0 0 0 MARY JIM MONTGOMERY 322113 0 0 0 0 0 0 0 0 0 322113 0 0 0 BRYAN KAMPS MD 458866 0 0 0 5540 0 9800 0 869 0 475075 0 0 0 MAHMOOD VAEZZADEH MD 262353 0 86000 0 5179 0 0 0 869 0 354401 0 0 0 CHARLES GUIMARAES MD 387031 0 0 0 5540 0 9800 0 869 0 403240 0 0 0 PHILLIP MICKELSEN MD 415677 0 0 0 974 0 0 0 869 0 417520 0 0 0 PETER TEMPEST MD 323807 0 0 0 0 0 0 0 0 0 323807 0 0 0 NM HOSPITAL EQUIPMENT LOAN COUNCIL 850426875 647370ED3 2007-03-20 7245000 REFUNDING PY PROCEEDS & CAPITAL EXPENDITURES 0 0 0 7233936 645300 3924311 144679 2519647 2007 0 0 0 1 0 0 0 0 1 0 0 0 0 0 0 0 ELITE LAUNDRY & DRY CLEANING OWNED BY SISTER OF PRISCILLA SMITH, TRUSTEE 128789 CONTRACT FOR LAUNDRY SERVICES 0 FORM 990, PART VI, SECTION A, LINE 7A THE RMCHCS BOARD OF DIRECTORS IS MADE UP OF FOUR (4) COUNTY APPOINTEES, ONE (1) CHIEF OF STAFF, AND EIGHT (8) COMMUNITY MEMBERS APPOINTED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 11 THE CFO REVIEWS THE FORM 990 PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. THE CFO PRESENTS THE FORM 990 TO THE FINANCE COMMITTEE OF THE BOARD OF TRUSTEES. AT A REGULARLY SCHEDULED MONTHLY MEETING OF THE FULL BOARD OF TRUSTEES, THE TREASURER REVIEWS THE KEY POINTS ON THE FORM 990 WITH THE BOARD, AND THE FINANCE COMMITTEE RECOMMENDS ACCEPTANCE OF THE FORM 990. FORM 990, PART VI, SECTION B, LINE 12C MEMBERS OF THE BOARD OF DIRECTORS COMPLETE A WRITTEN CONFLICT OF INTEREST DISCLOSURE FORM AT THE TIME OF APPOINTMENT. THEY MUST REVIEW AND SUBMIT A CONFLICT OF DISCLOSURE FORM ANNUALLY. THE BOARD OF DIRECTORS REVIEW ALL CONFLICTS AND THE PERSON WITH A CONFLICT IS NOT ALLOWED TO VOTE ON SUCH MATTERS. FORM 990, PART VI, SECTION B, LINE 15A THE HOSPITAL CONTRACTS WITH AN INDEPENDENT OUTSIDE ENTITY FOR A COMPENSATION REVIEW AND RECOMMENDATION FOR THE SALARY AND BENEFITS PROVIDED TO THE CEO. EVERY YEAR THE CEO'S COMPENSATION PACKAGE IS REVIEWED BY THE EXECUTIVE COMMITTEE OF THE BOARD OF TRUSTEES DURING THE ANNUAL EVALUATION OF THE CEO. THE COMPENSATION OF ALL OTHER KEY EMPLOYEES IS DETERMINED BY THE CEO. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 AND FORM 1023 ARE AVAILABLE UPON REQUEST. A PUBLIC DISCLOSURE COPY IS ALSO AVAILABLE TO THE PUBLIC AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART VI, SECTION C, LINE 19 THE GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE GENERAL PUBLIC. HOURS PER WEEK DEVOTED BY INDIVIDUALS FORM 990, PART VII, SECTION A, COLUMN B ROGER GLEISNER, CEO, DIVIDES HIS TIME AS FOLLOWS: RMCHCS - 38 HOURS/WEEK RELATED ORGANIZATION - 2 HOURS/WEEK COMPENSATION OF OFFICER, TRUSTEE, & KEY EMPLOYEES FORM 990, PART VII, SECTION A, COLUMN B SHELLY STAM-MACLAREN MD, TRUSTEE AND ERWIN ELBER MD, TRUSTEE/CHIEF OF STAFF RECEIVED COMPENSATION FOR THEIR SERVICES AS A PHYSICIAN/MEDICAL DOCTOR AND CHIEF OF STAFF, RESPECTIVELY. THEY ARE NOT COMPENSATED AS MEMBERS OF THE BOARD OF TRUSTEES. ROGER GLEISNER RECEIVED COMPENSATION FOR HIS ROLE AS A CONSULTANT TO THE ORGANIZATION PRIOR TO BECOMING A TRUSTEE/CEO AT THE END OF THE YEAR. HE ALSO WAS NOT COMPENSATED AS AN OFFICER/MEMBER OF THE BOARD OF TRUSTEES IN 2011. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 378,889. PRIOR PERIOD ADJUSTMENT -43,708. TOTAL TO FORM 990, PART XI, LINE 5: 335,181. THE 2011 FORM 990 IS AMENDED FOR THE FOLLOWING CHANGES: FORM 990, PAGE 1, SECTION B, AMENDED RETURN: FORM 990, PART I, LINE 4 IS 9. FORM 990, PART VI, SECTION A, LINE 1B IS 9. FORM 990, PART III, LINE 4A EXPENSES ARE $43,842,993; LINE 4E EXPENSES ARE $46,216,744. FORM 990, PART IX, LINE 8, COLUMN B IS $393,975; LINE 8, COLUMN C IS $131,326. FORM 990, PART IX, LINE 9, COLUMN B IS $3,210,701; LINE 9, COLUMN C IS $1,594,900. FORM 990, PART IX, LINE 10, COLUMN B IS $1,536,501; LINE 10, COLUMN C IS $512,167. FORM 990, PART IX, LINE 25, COLUMN B IS $46,216,744; LINE 25, COLUMN C IS $24,757,470. SCHEDULE J, PART I, LINE 4A IS CHECKED "NO" BECAUSE NO ONE RECEIVED A SEVERANCE PAYMENT IN 2011. SCHEDULE L, THE INFORMATION RELATED TO BUSINESS TRANSACTIONS WITH BUTLER OFFICE SUPPLY HAVE BEEN ELIMINATED SINCE ON A TRANSACTIONAL BASIS THEY DID NOT MEET THE THRESHOLD REQUIREMENTS FOR DISCLOSURE AND DID NOT PRESENT AN INDEPENDENCE ISSUE. RMCHCS FOUNDATION 1901 RED ROCK DRIVE GALLUP NM 87301 850349559 SUPPORT RMCHCS NM 501(C)(3) LINE 11C, III-FI N/A 0 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 0