2023-05-08T14:13:42-05:00 2022-06-30 450250958 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2021-07-01 850442957 Clayton Health Systems Inc CLAY 5753747008 300 Wilson Street Clayton NM 88415 Tammie Stump CEO 5753747008 2023-04-27 1 Tammie Stump 999009999 Kim Hunwardsen CPA P00484560 6122536500 2023-04-26 3 AAL1 IAL1 2021 2023-04-26 12:10:37Z Union County General Hospital Tammie Stump 300 Wilson Street Clayton NM 88415 15873782 0 X www.ugch.net X 1996 NM 25-bed acute care critical access hospital serving those in need in and near Union County, NM 5 4 121 4 0 0 5814163 2112004 13224647 13722135 27877 24494 6400 6000 19073087 15864633 0 0 0 0 7054673 7934116 0 0 0 7843684 8474544 14898357 16408660 4174730 -544027 19342828 16133058 6843377 4177634 12499451 11955424 X As 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. 1 0 13098769 13722135 Union 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 a rural health clinic. There were a total of 249 admissions and 10,132 patient visits at the Hospital as well as 7,422 patient visits at the Union County Health Center RHC and 293 patient visits at the Des Moines Health Center during fiscal year ending 6/30/2022.(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 that 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, 2022 totaled $191,673 and the estimated cost of providing these services was $135,129 calculated by multiplying the ratio of costs to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care. 13098769 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 38 0 1 121 1 0 0 0 0 0 0 0 0 0 0 0 0 X 5 4 0 1 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 0 0 0 X X Melissa Prante 5753747008 300 Wilson Street Clayton NM 88415 Mark Van Wormer MD Family Medicine-Chief of S 40.00 X 654249 0 59855 Paul Wheeler MD Family Medicine 40.00 X 258856 0 23538 Jay Fluhman FNP-C ACNP Certified Nurse Practition 40.00 X 202081 0 42502 Robert Williams Secretary and CRNA 41.00 X X 185938 0 36475 Jamie Armijo FNP-C Certified Nurse Practition 40.00 X 164558 0 38557 Russell Lees PT Director of Rehabiliation 40.00 X 154041 0 36093 Tammie Stump CEO 40.00 X 0 0 0 Melissa Prante CFO 40.00 X 0 0 0 Judith Cooper President 1.00 X X 0 0 0 Nick Diller Vice President 1.00 X X 0 0 0 Craig Reeves Treasurer 1.00 X X 0 0 0 Paul Briesh Director 1.00 X 0 0 0 1619723 0 237020 13 0 1 0 Community Hospital Consulting 7800 N Dallas Parkway Suite 200 Plano TX 75024 Mgmt and Admin services 920985 Delta Locum Tenens PO Box 202940 Dallas TX 75320 Locum provider 261854 Dr Minh Nguyen MD 3321 Coral Ave Dallas TX 75204 Surgeon 148350 Genex Medical Staffing PO Box 14525 Scottsdale AZ 85267 Locum provider 138107 Busby Barnard & HIM Assoc PO Box 5235 Sante Fe NM 87502 Coding & Billing 132001 6 2103196 8808 2112004 Patient service revenue 621110 11700121 11700121 Pharmacy revenue 446110 1297338 1297338 Safety Net Care Pool 621110 645798 645798 78878 78878 13722135 33643 33643 6000 0 6000 6000 6000 9149 -9149 -9149 -9149 15864633 13722135 0 30494 220616 220616 27202 27202 6582913 5583532 999381 112057 93657 18400 572504 485305 87199 418824 357244 61580 897935 542801 355134 61611 61611 38785 38785 1598773 1392628 206145 82902 10882 72020 334532 334532 43840 22569 21271 536067 172106 363961 119407 98601 20806 61216 61216 880997 389182 491815 289082 289082 Bad Debt 1374176 1374176 Medical Supplies 1325013 1325013 Repairs and Maintenance 476655 393952 82703 Licenses and Taxes 224552 217719 6833 129001 57052 71949 16408660 13098769 3309891 0 4899904 2332083 1688913 1162767 376731 402170 142235 160959 18222305 8387194 10627893 9835111 490658 1444137 1116494 795831 19342828 16133058 1725272 1112610 1998499 569066 3112784 2495958 6822 0 6843377 4177634 X 12499451 11840806 0 114618 12499451 11955424 19342828 16133058 -544027 0 X 0 1 X 1 0 X 16470 16470 14526983 5923654 8603329 3578360 2463540 1114820 100492 100492 9835111 14429241 -1435392 -1435392 15864633 0 15864633 14973268 0 14973268 1435392 1435392 16408660 Part XI, Line 2d - Other Adjustments: Interest expense included in revenue for financial statements -61,216. Bad debt expense included in revenue for financial statements -1,374,176. Part XII, Line 4b - Other Adjustments: Interest expense included in revenue for financial statements 61,216. Bad debt expense included in revenue for financial statements 1,374,176. 1 1 X 1 X 250.000000000000 1 X 450.000000000000 1 1 0 0 135129 135129 0.00900 2102945 1377150 725795 0.04830 2238074 1377150 860924 0.05730 1097203 729963 367240 0.02440 1097203 729963 367240 0.02440 3335277 2107113 1228164 0.08170 0 1374176 377898 4745960 4913748 -167788 X 1 1 1 1 Union County General Hospital 300 Wilson Street Clayton NM 88415 www.ugch.net 3060 X X X 3 provider based rural health clinics Union County General Hospital 1 0 0 1 X X X X X X X X X 21 1 0 0 1 X http://ucgh.net/about-us/ X 1 21 1 http://ucgh.net/about-us/ 0 1 X 250.000000000000 450.000000000000 X X X 1 1 X X X 1 X ucgh.net/patients/patient-forms-and-policies/ X ucgh.net/patients/patient-forms-and-policies/ X ucgh.net/patients/patient-forms-and-policies/ X X X X X 1 X 0 X X X X 1 X 0 0 Union County General Hospital Part 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 underrepresented 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 Hospital Part V, Section B, Line 11: The most recently conducted CHNA was completed in 2021 and identified six significant needs in the community. 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.1a. UCGH recruited an additional Family Practice Nurse Practitioner. 1b. UCGH has opened the School Base Clinic in Des Moines and has turned it into a Rural Health Clinic as well as a School Base Clinic. UCGH has added walk-in hours to their operating hours in the Union County Health Center, Clayton, NM. These hours are on Wednesday, Thursday, and Friday from 5:00p.m. to 7:00p.m. Due to Covid-19 the Hospital has been providing telehealth visits for patients through the RHC. 1c. 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, the hospital's website.1d. Union County General Hospital will continue to schedule follow up appointments with patients' primary care provider upon discharge.Priority 2: Access to Dental Care Services and ProvidersObjective: Increase local access to dental health care services.2a. UCGH is currently recruiting dental and dental hygienist providers to the community to increase access to local dental care services. Union County currently has no dental services available. 2b. Due to COVID 19 the dental office and dental providers were put on hold. UCGH is still making this a priority once restrictions are lifted in the state of New Mexico.Priority 3: Access to Specialty Care Services and ProvidersObjective: Increase access to additional specialist services and providers in the community.3a. The hospital has a general surgeon who provides rotating coverage to the community once to twice a month.3b. Union County General Hospital will continue to host a mobile MRI van in the hospital parking lot once a week and assist with scheduling.3c. 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.3d. The hospital will continue to staff a Nuclear Medicine Tech, who will come in as needed for nuclear medicine studies.3e. UCGH provides telemedicine programs in collaboration with the University of New Mexico (UNM) for emergency pediatrics and neurology/neurosurgery services for Strokes.3f. The hospital is currently evaluating rotating specialist coverage.3g. Union County General Hospital will continue to schedule follow up appointments with patients' providers upon discharge, when necessary.3h. Union County General Hospital will continue to market its specialty services to the community to increase awareness of its service offerings.3i. 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.4a. Union County General Hospital will continue to provide CPR training for hospital staff and other health care givers in the community.4b. 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.4c. 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.4d. 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. 4e. 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).4f. 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.4g. 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.4h. 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.4i. UCGH will continue their partnership with the Sexual Assault Prevention program in the community.4j. Union County General Hospital will continue marketing social media, print advertisement and website enhancements to increase professionalism and community awareness of hospital service offerings.4k. Union County General Hospital will explore engaging local employers through the provision of drug screens, TB tests, flu vaccinations and bone scans for staff.4l. 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.4m. 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.4n. Union County General Hospital was unable to do some of these items due to COVID 19; but plan to start back up just as soon as we can, but we will need to do so while keeping patients and community members safe.Priority 5: Access to Mental and Behavioral Health Care Services and ProvidersObjective: Increase local access to mental and behavioral health care services. 5a. UCGH is currently looking into monetary grants to bring more mental and behavioral health care services to the community. 5b. 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.6a. UCGH has trained and certified a few employees to help our patients apply for Medicaid and other low-income state benefits. 6b. UCGH has trained and certified a few employees to help our patients apply for Market Place Insurance that is based on patient's income. 6c. UCGH has trained a few employees to help our patients apply for Medicare. 6d. UCGH advertises through various venues when it is open enrollment for Medicare and the Market Place Insurance. Union County General Hospital Part 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. 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 $ 1,374,176. 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 27.5%. 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 4,021 in 2022 to 4,011 in 2027 by 0.2%. This is 1.2% less growth than the 1.4% expected growth for the state of New Mexico which is 2,192,707 in 2022 to 2,159,693 in 2027. 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 has a slightly older median age of 42.9 years than New Mexico at 38.5 years.The median household income in Union County and the state is expected to slightly increase over the next five years (2022-2027). Union County has a lower median household income at $40,947 than New Mexico at $56,735. Union County has a higher percentage of families living below poverty at 27.5% as compared to the state at 22.4%. With respect to education, Union County has a lower percentage of residents with a bachelor or advanced degree (12.6%) than the state (29.0%). 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 and social assistance, and retail trade. Part VI, Line 5: Our Board of Directors is mostly 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 2022 Union County General Hospital did participate in the annual county-wide health fair. A blood draw was done at a discounted rate in April 2022. They also sponsored many different booths with different health needs and health education. X 0 0 0 0 0 0 0 0 0 Mark Van Wormer MD Family Medicine-Chief of S 654249 0 0 0 0 0 34700 0 25155 0 714104 0 0 0 Paul Wheeler MD Family Medicine 258856 0 0 0 0 0 0 0 23538 0 282394 0 0 0 Jay Fluhman FNP-C ACNP Certified Nurse Practition 202081 0 0 0 0 0 31919 0 10583 0 244583 0 0 0 Robert Williams Secretary and CRNA 185938 0 0 0 0 0 15889 0 20586 0 222413 0 0 0 Jamie Armijo FNP-C Certified Nurse Practition 164558 0 0 0 0 0 14539 0 24018 0 203115 0 0 0 Russell Lees PT Director of Rehabiliation 154041 0 0 0 0 0 9347 0 26746 0 190134 0 0 0 Part I, Line 3 The Board of Directors approves the contract with Community Hospital Corporation, the management company that employs the CEO. Jovanna Stump Daughter of CEO 27202 Compensation and benefits as an employee 0 Form 990, Part III, line 2 Des Moines Health Center is a provider based rural health clinic certified on 6/17/2021. Form 990, Part VI, Section A, line 1a The 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 3 Tammie 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 2021 is reported below for services provided to Union County General Hospital. Tammie Stump: Compensation: $275,820 Pension: $6,947 Benefits: $23,593 Melissa Prante: Compensation: $160,985 Pension: $4,971 Benefits: $23,169 Form 990, Part VI, Section A, line 7a The 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 11b The 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 12c The 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 15 The 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 19 The 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. County of Union PO Box 430 Clayton NM 88415 856000259 Government NM N/A 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1