FURP.ORG / PUBLIC DATA EXPLORER

CLAYTON HEALTH SYSTEMS INC: Form 990, tax year 2022

View the entire original 990 at ProPublica ↗

Organization
CLAYTON HEALTH SYSTEMS INC (EIN 85-0442957)
Tax period
2022-07-01 to 2023-06-30
Filed
2024-05-07
IRS object ID
202441289349300444
Schema version
2022v5.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2024-05-07T08:30:59-05:00ReturnTs
Tax Period End2023-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN450250958PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Eide Bailly LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1800 Nicollet Mall Ste 1300AddressLine1Txt
CityMinneapolisCityNm
State AbbreviationMNStateAbbreviationCd
ZIP554027033ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2022-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN850442957EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Clayton Health Systems IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCLAYBusinessNameControlTxt
Phone5753747008PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Wilson StreetAddressLine1Txt
CityClaytonCityNm
State AbbreviationNMStateAbbreviationCd
ZIP88415ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonTammie StumpPersonNm
Person TitleCEOPersonTitleTxt
Phone5753747008PhoneNum
Signature2024-05-06SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstTammiePersonFirstNm
Person LastStumpPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN
FieldValueIRS element (for citing)
IRS Responsible Prty Info CurrYes (1)IRSResponsiblePrtyInfoCurrInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonKim Hunwardsen CPAPreparerPersonNm
PTINP00484560PTIN
Phone6122536500PhoneNum
Preparation2024-05-01PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2022TaxYr
Build TS2023-04-26 12:10:37ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1Union County General HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Principal OfficerTammie StumpPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Wilson StreetAddressLine1Txt
CityClaytonCityNm
State AbbreviationNMStateAbbreviationCd
ZIP88415ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$14,081,694GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.ugch.netWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1996FormationYr
Legal Domicile StateNMLegalDomicileStateCd
Activity Or Mission25-bed acute care critical access hospital serving those in need in and near Union County, NMActivityOrMissionDesc
Voting Members Governing Body5VotingMembersGoverningBodyCnt
Voting Members Independent4VotingMembersIndependentCnt
Total Employee119TotalEmployeeCnt
Total Volunteers4TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$2,112,004PYContributionsGrantsAmt
CY Contributions Grants$1,521,019CYContributionsGrantsAmt
PY Program Service Revenue$13,722,135PYProgramServiceRevenueAmt
CY Program Service Revenue$12,548,208CYProgramServiceRevenueAmt
PY Investment Income$24,494PYInvestmentIncomeAmt
CY Investment Income$6,467CYInvestmentIncomeAmt
PY Other Revenue$6,000PYOtherRevenueAmt
CY Other Revenue$6,000CYOtherRevenueAmt
PY Total Revenue$15,864,633PYTotalRevenueAmt
CY Total Revenue$14,081,694CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$7,934,116PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,771,173CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$8,474,544PYOtherExpensesAmt
CY Other Expenses$7,568,163CYOtherExpensesAmt
PY Total Expenses$16,408,660PYTotalExpensesAmt
CY Total Expenses$15,339,336CYTotalExpensesAmt
PY Revenues Less Expenses-$544,027PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$1,257,642CYRevenuesLessExpensesAmt
Total Assets BOY$16,133,058TotalAssetsBOYAmt
Total Assets EOY$14,168,336TotalAssetsEOYAmt
Total Liabilities BOY$4,177,634TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,470,554TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$11,955,424NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$10,697,782NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionAs a full service, acute care hospital in Clayton, NM, Union County General Hospital provides quality healthcare services to the residents of Union County and surrounding areas.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$11,730,419ExpenseAmt
Revenue$12,548,208RevenueAmt
DescUnion County General Hospital is a 25-bed acute care hospital located in Clayton, New Mexico. The Hospital provides services to individuals from Northeastern New Mexico, Southeastern Colorado, Western Panhandle of Oklahoma, and the Western Panhandle of Texas. These services include inpatient, swingbed, various outpatient services, emergency patient care and two rural health clinics. There were a total of 260 admissions and 7,056 patient visits at the Hospital as well as 6,803 patient visits at the Union County Health Center RHC and 286 patient visits at the Des Moines Health Center during fiscal year ending 6/30/2023.(Continued on Schedule O)The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. Charges for charity care provided during June 30, 2023, totaled $137,333 and the estimated cost of providing these services was $138,142 calculated by multiplying the ratio of costs to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care.Desc
Total Program Service Expenses$11,730,419TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt0ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document32IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee119EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members5GoverningBodyVotingMembersCnt
Independent Voting Member4IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesYes (1)DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Other WebsiteYes (X)OtherWebsiteInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonMelissa PrantePersonNm
Phone5753747008PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Wilson StreetAddressLine1Txt
CityClaytonCityNm
State AbbreviationNMStateAbbreviationCd
ZIP88415ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Robert Williams
Secretary and CRNA41.00Yes (X)Yes (X)$177,610$0$41,423
Judith Cooper
President1.00Yes (X)Yes (X)$0$0$0
Nick Diller
Vice President1.00Yes (X)Yes (X)$0$0$0
Craig Reeves
Treasurer1.00Yes (X)Yes (X)$0$0$0
Paul Briesh
Director1.00Yes (X)$0$0$0
Tammie Stump
CEO40.00Yes (X)$0$0$0
Melissa Prante
CFO40.00Yes (X)$0$0$0
Mark Van Wormer MD
Family Medicine-Chief of Staff40.00$638,224$0$46,248Yes (X)
Jessica Wright DNP-C
Certified Nurse Practitioner40.00$170,871$0$36,623Yes (X)
Jay Fluhman FNP-C ACNP
Certified Nurse Practitioner40.00$188,396$0$43,071Yes (X)
Paul Wheeler MD
Family Medicine40.00$271,158$0$23,485Yes (X)
Russell Lees PT
Director of Rehabiliation40.00$141,289$0$36,984Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,587,548TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$227,834TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K10IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Community Hospital Consulting
7800 N Dallas Parkway Suite 200PlanoTX75024Mgmt and Admin services$887,907
Dr Minh Nguyen MD
3321 Coral AveDallasTX75204Surgeon$354,279
CPSI
PO Box 11407BirminghamAL35246Operating System$253,066
Genex Medical Staffing
PO Box 14525ScottsdaleAZ85267Locum provider$155,022
Krucial Rapid Response
PO Box 25826Overland ParkKS66225Temp Nurses$150,011
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K8CntrctRcvdGreaterThan100KCnt
Government Grants$1,513,443GovernmentGrantsAmt
All Other Contributions$7,576AllOtherContributionsAmt
Total Contributions$1,521,019TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Patient service revenue621110$10,720,939$10,720,939
Pharmacy revenue456110$1,472,057$1,472,057
Safety Net Care Pool621110$294,232$294,232

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$60,980TotalRevenueColumnAmt
Related Or Exempt Func Income$60,980RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$12,548,208TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,467TotalRevenueColumnAmt
Exclusion$6,467ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$6,000RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$6,000RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,000TotalRevenueColumnAmt
Exclusion$6,000ExclusionAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,081,694TotalRevenueColumnAmt
Related Or Exempt Func Income$12,548,208RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$12,467ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$239,063TotalAmt
Program Services$239,063ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,502,829TotalAmt
Program Services$5,490,047ProgramServicesAmt
Management And General$1,012,782ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$106,272TotalAmt
Program Services$87,392ProgramServicesAmt
Management And General$18,880ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$510,300TotalAmt
Program Services$427,083ProgramServicesAmt
Management And General$83,217ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$412,709TotalAmt
Program Services$350,180ProgramServicesAmt
Management And General$62,529ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$991,652TotalAmt
Program Services$593,639ProgramServicesAmt
Management And General$398,013ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$28,725TotalAmt
Management And General$28,725ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$84,500TotalAmt
Management And General$84,500ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,597,057TotalAmt
Program Services$1,425,763ProgramServicesAmt
Management And General$171,294ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$114,905TotalAmt
Program Services$41,637ProgramServicesAmt
Management And General$73,268ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$481,117TotalAmt
Program Services$355,542ProgramServicesAmt
Management And General$125,575ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$39,528TotalAmt
Program Services$19,904ProgramServicesAmt
Management And General$19,624ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$574,407TotalAmt
Program Services$197,366ProgramServicesAmt
Management And General$377,041ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$133,696TotalAmt
Program Services$116,756ProgramServicesAmt
Management And General$16,940ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$53,267TotalAmt
Management And General$53,267ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$752,462TotalAmt
Program Services$293,555ProgramServicesAmt
Management And General$458,907ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$459,837TotalAmt
Management And General$459,837ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical Supplies$1,200,158$1,200,158
Repairs and Maintenance$460,621$379,467$81,154
Licenses and Taxes$231,134$227,062$4,072
Bad Debt$215,928$215,928

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$149,169TotalAmt
Program Services$69,877ProgramServicesAmt
Management And General$79,292ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$15,339,336TotalAmt
Program Services$11,730,419ProgramServicesAmt
Management And General$3,608,917ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$2,332,083BOYAmt
EOY$647,141EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,162,767BOYAmt
EOY$1,443,971EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$402,170BOYAmt
EOY$333,866EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$160,959BOYAmt
EOY$119,794EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$17,899,670LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$8,755,812LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$9,835,111BOYAmt
EOY$9,143,858EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$1,444,137BOYAmt
EOY$1,457,973EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$795,831BOYAmt
EOY$1,021,733EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$16,133,058BOYAmt
EOY$14,168,336EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,112,610BOYAmt
EOY$1,366,009EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$569,066BOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$2,495,958BOYAmt
EOY$1,708,774EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$395,771EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$4,177,634BOYAmt
EOY$3,470,554EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$11,840,806BOYAmt
EOY$10,571,836EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$114,618BOYAmt
EOY$125,946EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$11,955,424BOYAmt
EOY$10,697,782EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$16,133,058BOYAmt
EOY$14,168,336EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss-$1,257,642ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$16,470OtherCostOrOtherBasisAmt
Book Value$16,470BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$14,600,999OtherCostOrOtherBasisAmt
Depreciation$6,400,761DepreciationAmt
Book Value$8,200,238BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$3,220,798OtherCostOrOtherBasisAmt
Depreciation$2,355,051DepreciationAmt
Book Value$865,747BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$61,403OtherCostOrOtherBasisAmt
Book Value$61,403BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$9,143,858TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
Other accounts receivable$261,097
Clayton County receivable$78,573
Employee receivables$25,341
Estimated third party settlements$209,134
ROU Leased Assets$304,082
ROU Subscription IT Assets$143,506
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,021,733TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)

DescDescAmtAmt
ROU Lease Liabilities$251,059
ROU Subscription IT Liabilities$144,712
FieldValueIRS element (for citing)
Total Liability$395,771TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$13,812,499TotalRevEtcAuditedFinclStmtAmt
Other Revenue-$269,195OtherRevenueAmt
Revenue Not Reported-$269,195RevenueNotReportedAmt
Revenue Subtotal$14,081,694RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$14,081,694TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$15,070,141TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$15,070,141ExpensesSubtotalAmt
Other Expenses Not Included$269,195OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$269,195ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$15,339,336TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part XI, Line 2d - Other Adjustments:Interest expense included in revenue for financial statements -53,267. Bad debt expense included in revenue for financial statements -215,928.
Part XII, Line 4b - Other Adjustments:Interest expense included in revenue for financial statements 53,267. Bad debt expense included in revenue for financial statements 215,928.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other250.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd

Discounted Care Oth Percentage DiscountedCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Discounted Care Other450.000000000000DiscountedCareOtherPct
FieldValueIRS element (for citing)
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$138,142TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$138,142NetCommunityBenefitExpnsAmt
Total Expense0.00910TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,065,209TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,422,208DirectOffsettingRevenueAmt
Net Community Benefit Expns$643,001NetCommunityBenefitExpnsAmt
Total Expense0.04250TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,203,351TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,422,208DirectOffsettingRevenueAmt
Net Community Benefit Expns$781,143NetCommunityBenefitExpnsAmt
Total Expense0.05160TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,014,300TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$960,830DirectOffsettingRevenueAmt
Net Community Benefit Expns$53,470NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,014,300TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$960,830DirectOffsettingRevenueAmt
Net Community Benefit Expns$53,470NetCommunityBenefitExpnsAmt
Total Expense0.00350TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,217,651TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,383,038DirectOffsettingRevenueAmt
Net Community Benefit Expns$834,613NetCommunityBenefitExpnsAmt
Total Expense0.05510TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense Reported0BadDebtExpenseReportedInd
Bad Debt Expense$215,928BadDebtExpenseAmt
Bad Debt Expense Attributable$54,197BadDebtExpenseAttributableAmt
Reimbursed By Medicare$4,930,410ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$5,057,787CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$127,377MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Union County General HospitalBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1300 Wilson StreetAddressLine1Txt
CityClaytonCityNm
State AbbreviationNMStateAbbreviationCd
ZIP88415ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.ugch.netWebsiteAddressTxt
State License3060StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd
Other2 provider based rural health clinicsOtherDesc

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Union County General HospitalBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted21CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non Fclts0CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://ucgh.net/about-us/OwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt21ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (1)StrategyPostedWebsiteInd
Strategy Website URLhttp://ucgh.net/about-us/StrategyWebsiteURLTxt
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care250.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care450.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLucgh.net/patients/patient-forms-and-policies/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLucgh.net/patients/patient-forms-and-policies/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLucgh.net/patients/patient-forms-and-policies/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Union County General HospitalPart V, Section B, Line 5: UCGH provided CHC Consulting with a list of persons with special knowledge of public health in Union County, including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on under-represented groups. With respect to individuals providing input, it was noted in the CHNA that 81.8% of those providing input are members of a medically underserved, low-income or minority population in the community, or individuals or organizations serving or representing the interests of such populations. 9.1% of those providing input work for a state, local, tribal or regional government public health department with knowledge, information or expertise relevant to the health needs of the community. 9.1% of those providing input are community leaders.
Union County General HospitalPart V, Section B, Line 11: The most recently conducted CHNA identified six significant needs in the community served by UCGH, which were determined by assessing the prevalence of the issues identified from the health data findings, combined with the frequency and severity of mentions in community input. The CHNA team and hospital leadership prioritized those needs using a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the hospital's capacity to address the need.The final list of prioritized needs, in descending order, is listed below:1.) Access to Consistent, Local Primary Care Providers2.) Access to Dental Care Services and Providers3.) Access to Specialty Care Services and Providers4.) Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles5.) Access to Mental and Behavioral Health Care Services and Providers6.) Access to Affordable Care and Reducing Health Disparities Among Specific PopulationsPriority 1: Access to Consistent, Local Primary Care ProvidersObjective: Increase access to local primary care services and providers.1.A. Union County General Hospital will continue to promote its primary care provider services in order to increase awareness of service offerings in the community. This will be done via the local newspaper, local radio stations, social media outlets, and the hospital's website.1.B. Union County General Hospital will continue to schedule follow up appointments with patients' primary care provider upon discharge.1.C. Union County Health Center has put up an electronic sign on main street to let patients know any updates on Covid Awareness and on any additional hospital and clinic information the community will benefit from. Priority 2: Access to Dental Care Services and ProvidersObjective: Increase local access to dental health care services.2.A. UCGH is currently recruiting dentist and dental hygienist providers to the community to increase access to local dental care services. Union County currently has no dental services available. 2.B. Due to a change in governmental funding, UCGH will have to put the idea of a Dentist on hold. We know that a dentist in our area will be more of a community service than it will be as revenue for the hospital, and we cannot take on that responsibility until we have the income or financial stability to sustain it. Priority 3: Access to Specialty Care Services and ProvidersObjective: Increase access to additional specialist services and providers in the community.3.A. The hospital has a general surgeon that provides rotating coverage to the community once weekly.3.B. Union County General Hospital will continue to host a mobile MRI van in the hospital parking lot once a week and assists with scheduling.3.C. Union County General Hospital will continue to host a mobile Mammography van in the hospital parking lot 10-12 times per year (as scheduling needs require), and also assist with patient awareness.3.D. The hospital will continue to staff a Nuclear Medicine Tech contract, who will come in as needed for nuclear medicine studies.3.E. UCGH provides telemedicine programs in collaboration with the University of New Mexico (UNM) for emergency pediatrics and neurology/neurosurgery services for Strokes.3.F. The hospital is currently evaluating rotating specialist coverage.3.G. Union County General Hospital will continue to schedule follow up appointments with patients' providers upon discharge, when necessary.3.H. Union County General Hospital will continue to market its specialty services to the community to increase awareness of its service offerings.3.I. Union County General Hospital has created a specialty clinic in the hospital that will provide services the patients cannot currently receive in Union County.Priority 4: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy LifestylesObjective: Increase healthy lifestyle education and prevention resources at the hospital and in the community.4.A. Union County General Hospital will continue to provide CPR training for hospital staff and other health care givers in the community.4.B. The hospital will continue to incentivize employees and their families to participate in regular physical activity through a discounted membership at a local gym and recreation facilities, and the golf course.4.C. UCGH will continue to participate in the county-wide health fairs, and additional hospital- based health fairs each year, to provide blood pressure screenings, lab tests, as well as many different areas of health and wellness education.4.D. UCGH will continue to host open house events that include booths for varying community services to share information, educational sessions by providers, blood pressure screenings, lab tests, radiology services, mammography, diabetes finger stick tests, sleep medicine, and the testing of motor skills for physical therapy. Information will be provided in both English and Spanish when possible. 4.E. UCGH will continue to maintain its status as a Level 4 Trauma Center through the provision of community education surrounding trauma 1-2 times per year (ex: firework safety, no texting and driving).4.F. UCGH will continue to provide free flu shots to the community for the donation of 2 non-perishable food items for donation to community food drive.4.G. Many representatives from the hospital serve as members of community organizations, including the Chamber of Commerce, the Rotary Club, the Union County Health Network, and the Local Emergency Planning Committee.4.H. The hospital will continue to work with local Emergency Management Services (EMS) to provide trauma education on a regular basis for hospital and EMS staff.4.I. UCGH will continue their partnership with the Sexual Assault Prevention program in the community.4.J. Union County General Hospital will continue marketing social media, print advertisement and website enhancements to increase professionalism and community awareness of hospital service offerings.4.K. Union County General Hospital will explore engaging local employers through the provision of drug screens, TB tests, flu vaccinations and bone scans for staff.4.L. Union County General Hospital will continue to participate in the Emergency Planning Committee in the community, which is a collaborative approach that includes nursing, providers and other hospital allied staff, EMS, Flight Crews, the Fire Department, Police staff and the County Emergency Manager.4.M. Union County General Hospital will continue to provide education in the lobby of the facility and clinic on a variety of health topics each month.Priority 5: Access to Mental and Behavioral Health Care Services and ProvidersObjective: Increase local access to mental and behavioral health care services. 5.A. UCGH is currently looking into monetary grants to bring more mental and behavioral health care services to the community. 5.B. UCGH is looking into telehealth services for mental and behavioral health care for the community. Priority 6: Access to Affordable Care and Reducing Health Disparities Among Specific PopulationsObjective: Increase local access to affordable health care and reducing health disparities among specific populations.6.A. UCGH has trained and certified a few employees to help our patients apply for Medicaid and other low-income state benefits. 6.B. UCGH has trained and certified a few employees to help our patients apply for Market Place Insurance that is based on patient's income. 6.C. UCGH has trained a few employees to help our patients apply for Medicare. 6.D. UCGH advertises through various venues when it is open enrollment for Medicare and the Market Place Insurance.
Union County General HospitalPart V, Section B, Line 13h: Presumptive Eligibility for Financial AssistanceThe hospital may use Discovery Healthcare Consultant Group and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation.Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of yearly household income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance.The hospital may choose to grant financial assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, disabled, transient or incompetent may be valid "prima facie" candidates. In such cases, the hospital may not complete full verification or documentation of any request.Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount.

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3c:Presumptive Eligibility for Financial AssistanceThe hospital may use Discovery Healthcare Consultant Group and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation.Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of yearly household income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance.The hospital may choose to grant financial assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, disabled, transient or incompetent may be valid "prima facie" candidates. In such cases, the hospital may not complete full verification or documentation of any request.Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount.
Part I, Line 7:Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost report. The cost for subsidized health services reported on line 7g was determined using the cost-to-charge ratio derived from worksheet 2.
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 $ 215,928.
Part III, Line 2:Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision.
Part III, Line 3:The amount of bad debt estimated to be attributable to patients under the Organization's charity care policy is 25.1%. This was determined by using the percentage of the population in the service area that is under the federal poverty guideline established for charity care.
Part III, Line 4:The footnote to the Organization's financial statements can be found on page 12 of the attached audited financial statements.
Part III, Line 8:Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services.
Part III, Line 9b:When a patient has indicated or demonstrated an inability to pay, an appropriate Hospital representative provides the patient with a financial assistance application. Applications must be completed in their entirety before financial assistance can be considered. Patients who qualify for financial assistance from a government program should be referred to the appropriate agency prior to consideration for charity/indigent care. An application for financial assistance from an outside agency should be obtained prior to charity care approval. From the discharge date, monthly statements are sent with information on financial assistance. After the 3rd statement is sent a Patient Financial Consultant works with the patient until deemed uncollectible. Accounts are sent to collections after 180-days from the date of service or date insurance paid. Patients have an additional 120-days to submit an application for financial assistance.
Part VI, Line 2:The Hospital assesses the health care needs of the community through public meetings, board meetings, quality assurance meetings, and emergency room call backs.
Part VI, Line 3:Patients are educated about financial assistance upon admission to the hospital and at discharge. Financial assistance information is displayed in waiting rooms, emergency rooms, and other areas of the hospital.Applying for financial assistance can be initiated by a patient requesting assistance in person, over the phone at 575-374-2585, through the mail at 300 Wilson St, Clayton, NM 88415, by email at andrea.naranjo@ucgh.net or via the hospital's website www.ucgh.net. Additionally, the hospital can initiate a financial assistance application on behalf of the patient.UCHG has certified its own employee so that patients can apply for Medicaid and other government assistance onsite because there is not a Medicaid office in the county. Patients are notified of this through Facebook, the newspaper, and when the organization sees the need for financial assistance.
Part VI, Line 4:Union County General Hospital (UCGH) is a 25-bed acute care hospital located in Clayton, New Mexico. As the key hospital for the region, UCGH offers a wide array of services which includes primary care, emergency care, inpatient care, therapy services, surgical services, swing bed care, a full medical staff and state-of-the-art equipment. UCGH provides the highest quality health care services possible to the residents of Union County and surrounding areas. The defined service area of UCGH is Union County in New Mexico. The population of Union County is expected to decrease from 2022 (4,021) to 2027(4011) by 0.2%, which is 1.2% less growth than the 1.4% expected growth for the state of New Mexico from 2022(2,192,707) to 2027(2,159,693). As of 2022, the racial/ethnic breakout of Union County was 25.9% White Non-Hispanic, 1.6% Black, 39.5% Hispanic, 0.2% Asian, and 32.8% all others. By 2027, the White Non-Hispanic population is expected to decrease by 0.3% while the Black population is not expected to change, the Hispanic population is expected to decrease by 0.2%, the Asian population is not expected to change and all others are expected to decrease by 0.2% in Union County. Union County (42.9 years) has a slightly older median age than New Mexico (38.5 years) (2022).The median household income in Union County and the state is expected to slightly increase over the next five years (2022-2027). Union County ($40,947) has a lower median household income than New Mexico ($56,735) (2022). Union County (25.1%) has a higher percentage of families living below poverty as compared to the state (22.4%) (2022). With respect to education, Union County (12.6%) has a lower percentage of residents with a bachelor or advanced degree than the state (29.0%) (2022). The closest hospital is Coon Memorial Hospital located 48 miles from Union County General Hospital in Dalhart, TX. The hospital provides general inpatient and outpatient medical and surgical care.The largest industries are public administration, health care & social assistance, and retail trade.
Part VI, Line 5:Our Board of Directors is comprised of individuals from the community. The board provides a perspective on the needs of the community. The Hospital extends medical privileges to area physicians. Surplus funds are reinvested into facility and equipment upgrades and free programs throughout the year.During fiscal year 2023 Union County General Hospital did participate in the annual county-wide health fair. A blood draw was done at a discounted rate in April 2023. They also sponsored many different booths with different health needs and health education.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Mark Van Wormer MD
Family Medicine-Chief of Staff$638,224$0$0$0$0$0$21,046$0$25,202$0$684,472$0$0$0
Paul Wheeler MD
Family Medicine$271,158$0$0$0$0$0$0$0$23,485$0$294,643$0$0$0
Jay Fluhman FNP-C ACNP
Certified Nurse Practitioner$188,396$0$0$0$0$0$32,541$0$10,530$0$231,467$0$0$0
Robert Williams
Secretary and CRNA$177,610$0$0$0$0$0$20,790$0$20,633$0$219,033$0$0$0
Jessica Wright DNP-C
Certified Nurse Practitioner$170,871$0$0$0$0$0$12,676$0$23,946$0$207,493$0$0$0
Russell Lees PT
Director of Rehabiliation$141,289$0$0$0$0$0$9,001$0$27,983$0$178,273$0$0$0

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePart I, Line 3FormAndLineReferenceDesc
ExplanationThe Board of Directors approves the contract with Community Hospital Corporation, the management company that employs the CEO.ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 1aThe Executive Committee consists of at least the President, who shall serve as chairperson of the Executive Committee, the Vice-President, Secretary, and Treasurer. The Executive Committee may consist of all Board members if so designated by the Board. The Executive Committee shall meet at least on a quarterly basis. Between meetings of the Board, the Executive Committee shall possess and may exercise any and all powers of the Board in the management and affairs of the Corporation; provided that all actions of the Executive Committee are subject to the paramount power of the Board and shall not conflict with any expressed policies of the Board. All action taken by the Executive Committee shall be reported to the Board at each regular and annual meeting, and such actions are subject to revision, alteration or change by the Board, provided that rights of third persons shall not be affected thereby.
Form 990, Part VI, Section A, line 3Tammie Stump, CEO and Melissa Prante, CFO are common law employees of Community Health Corporation (CHC), an unrelated management company. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Compensation and benefits for calendar year 2022 is reported below for services provided to Union County General Hospital. Tammie Stump: Compensation: $268,61 Other Benefits: $13,260 Melissa Prante: Compensation: $166,289 Other Benefits: $11,608
Form 990, Part VI, Section A, line 7aThe Hospital is a component unit of the County and the Board of County Commissioners appoints members to the Board of Trustees of the Hospital.
Form 990, Part VI, Section B, line 11bThe Form 990 is provided to the governing board prior to filing with the IRS. The CEO and CFO review the Form 990.
Form 990, Part VI, Section B, line 12cThe Board of Directors and officers are required to complete and sign the conflict of interest statement annually. Any potential conflict arising during the year must be disclosed to the Board. The Board discusses the potential conflicts and determines if actions should be taken. If there is a conflict the board member may be asked to leave the meeting or not vote on the matter.
Form 990, Part VI, Section B, line 15The compensation for the CEO and CFO is determined by a management company. The management company determines the compensation using their processes and the Hospital's Board of Directors votes and approves the management contract.
Form 990, Part VI, Section C, line 19The Hospital's financial statements, governing documents, and conflict of interest policy are available to the public upon request at the Administration Office located at 300 Wilson Street in Clayton, NM.
Form 990, Part IX, line 11gProfessional Fees: Program service expenses 456,421. Management and general expenses 0. Fundraising expenses 0. Total expenses 456,421. Contract Labor: Program service expenses 300,660. Management and general expenses 0. Fundraising expenses 0. Total expenses 300,660. Purchased Services: Program service expenses 656,774. Management and general expenses 169,665. Fundraising expenses 0. Total expenses 826,439. Recruiting: Program service expenses 11,908. Management and general expenses 1,629. Fundraising expenses 0. Total expenses 13,537.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1County of UnionBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO Box 430AddressLine1Txt
CityClaytonCityNm
State AbbreviationNMStateAbbreviationCd
ZIP88415ZIPCd
FieldValueIRS element (for citing)
EIN856000259EIN
Primary ActivitiesGovernmentPrimaryActivitiesTxt
Legal Domicile StateNMLegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (1)SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other Org0ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (1)TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd