2020-06-18T15:03:22-05:00 2019-06-30 450250958 EIDE BAILLY LLP 621 N ROBINSON AVE STE 200 OKLAHOMA CITY OK 731026232 990 2018-07-01 850442957 Clayton Health Systems Inc CLAY 5753747008 300 Wilson Street Clayton NM 88415 Tammie Stump CEO 5753747008 2020-06-17 1 Kim Hunwardsen P00484560 4055942000 2020-06-17 216.147.181.47 2020-06-17 15:21:40 CD P 96EA8C5DFC6EFE4FCBF1129FDB3AF0E7B3BD41AE 96EA8C5DFC6EFE4FCBF1129FDB3AF0E7B3BD41AE 2018 2020-09-23 17:36:50Z Union County General Hospital Tammie Stump 300 Wilson Street Clayton NM 88415 11892842 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 4 117 4 0 0 93328 1712975 8648188 10149750 14365 29617 247509 500 9003390 11892842 0 1090 0 0 5723019 6176041 0 0 0 5315701 4891335 11038720 11068466 -2035330 824376 14942865 13862000 7720084 5814843 7222781 8047157 X As a full service, acute care hospital in Clayton, NM, UCGH provides quality healthcare services to the residents of Union County and surrounding areas. 0 0 8098248 1090 10149750 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, outpatient, and emergency patient care. There were a total of 178 admissions and 9,991 patient visits at the Hospital as well as 4,873 patient visits at the Clayton Family Practice Clinic during fiscal year ending 6/30/2019.(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. The Hospital adopted a new charity care policy in 2019. The revised policy provided charity care discounts for services previously reported within net patient service revenue. The impact of these changes was to reduce the allowance and provision for bad debts by approximately $1,628,000 for the year ended June 30, 2019. There were bad debt recoveries as of June 30, 2019 in the amount of $789,158.Charges for charity care provided during June 30, 2019 totaled $1,843,600 and the estimated cost of providing these services was $1,286,832, calculated by multiplying the ratio of costs to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care. 8098248 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 37 0 1 117 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 NM X X Melissa Prante 5753747008 300 Wilson Street Clayton NM 88415 Judith Cooper President 1.00 X X 0 0 0 Judy Steen Vice President 1.00 X X 0 0 0 Robert Williams Secretary and CRNA 40.00 X X 164903 0 16937 Craig Reeves Treasurer 1.00 X X 0 0 0 Paul Briesh Director 1.00 X 0 0 0 Tammie Stump CEO 40.00 X 0 0 0 Melissa Prante CFO began 10/15/2018 40.00 X 0 0 0 Terri Martinez CFO until 12/17/2018 40.00 X 0 0 0 Mark Van Wormer MD Family Medicine-Chief of Staff 40.00 X 539442 0 53656 Stacye Bradley Director of Nursing 40.00 X 134160 0 34175 Jay Fluhman FNP-C ACNP Certified Nurse Practitioner 40.00 X 195571 0 37131 Terry Weaver MD Family Medicine 40.00 X 244880 0 5543 1278956 0 147442 5 0 1 0 Community Hospital Consulting 7000 N Dallas Parkway Plano TX 75024 Mgmt and Admin services 1003377 Genex Medical Staffing PO Box 14525 Scottsdale AZ 85267 Locum provider 150236 Rhino Medical Services PO Box 206912 Dallas TX 75320 Locum provider 141343 Dr Robert Khanlian PO Box 1447 Corrales NM 87048 Locum provider 100699 4 1537975 175000 175000 1712975 Net patient service revenue 622110 7463174 7463174 Safety Net Care Pool 622110 1539309 1539309 Bad debt recoveries 622110 789158 789158 Pharmacy revenue 446110 290346 290346 67763 67763 10149750 29617 29617 500 0 500 500 500 11892842 10149750 0 30117 X 1090 1090 181895 181895 5093288 4275094 818194 40857 34507 6350 550284 463124 87160 309717 261583 48134 369007 369007 23086 23086 35500 35500 1316752 1128717 188035 47595 361 47234 243380 238537 4843 31822 31822 538115 158080 380035 109823 68999 40824 133260 133260 685296 207560 477736 205243 205243 Medical Supplies 675140 675094 46 Repairs and Maintenance 361451 303545 57906 Licenses and Taxes 43271 33424 9847 Dietary 19607 19607 52987 15209 37778 11068466 8098248 2970218 0 2676966 1281137 776133 1153358 179415 234874 43409 75750 15574532 5839067 9650121 9735465 755215 580965 861606 800451 14942865 13862000 2309194 1196441 4498572 4138009 912318 480393 7720084 5814843 X 7172781 7997157 50000 50000 7222781 8047157 14942865 13862000 824376 0 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 21470 21470 12905582 4195769 8709813 2426823 1643298 783525 220657 220657 9735465 Other Accounts Receivable 405777 Clayton County receivable 372177 Employee receivables 22497 800451 Estimated third party settlements 480393 480393 11759582 -133260 -133260 11892842 0 11892842 10935206 0 10935206 133260 133260 11068466 Part XI, Line 2d - Other Adjustments: Interest Expense included in Nonoperating Revenues in FS -133,260. Part XII, Line 4b - Other Adjustments: Interest Expense included in Nonoperating Revenues in FS 133,260. 1 1 X 1 X 250.000000000000 1 X 450.000000000000 1 1 0 1 1 1286832 1286832 0.11630 1354731 489149 865582 0.07820 2641563 489149 2152414 0.19450 1444875 1036260 408615 0.03690 1444875 1036260 408615 0.03690 4086438 1525409 2561029 0.23140 0 0 0 3746385 3813081 -66696 X 1 1 1 1 Union County General Hospital 300 Wilson Street Clayton NM 88415 www.ugch.net 3060 X X X 1 provider based rural health clinic Union County General Hospital 1 0 0 1 X X X X X X X X X 18 1 0 0 1 X http://ucgh.net/about-us/ X 1 18 1 http://ucgh.net/about-us/ 0 1 X 250.000000000000 450.000000000000 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 90% 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. 10% 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. Union County General Hospital Part 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. UCGH is currently recruiting an additional Family Practice physician to the community. 1.B. UCGH has converted the Family Practice Clinic to a Rural Health Clinic (RHC) on May 8, 2018. The UCGH team is evaluating changing the RHC walk-in hours at the facility, and the hospital is currently evaluating the implementation of extended hours (early morning to 6:30pm and staying open through lunch time). 1.C. 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, and during quarterly open house events. 1.D. Union County General Hospital will continue to schedule follow up appointments with patients' primary care provider upon discharge. 1.E. Union County General Hospital will continue to pursue the opening of a new Des Moines School Based Clinic and evaluate opening a half day clinic in Texline. 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. 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 to twice a month. 3.B. Union County General Hospital will continue to host a mobile MRI van in the hospital parking lot once a week, and also 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 assists with scheduling. 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. 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 in order to increase awareness of its service offerings. 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. The hospital 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 chair 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 health care services.5.A. UCGH is currently evaluating the implementation of a telemedicine program in collaboration with the University of New Mexico (UNM) for mental and behavioral health evaluations. 5.B. The hospital will continue to staff a full-time employee who provides social work assistance on a PRN basis to assist with case management services when necessary. 5.C. UCGH will continue to support local mental and behavioral health organizations, such as Valle del Sol and Alternatives to Violence, by connecting applicable patients with resources in the community for them to access. Priority 6: Access to Affordable Care and Reducing Health Disparities Among Specific PopulationsObjective: Increase access to resources and services for underserved and geographically isolated populations.6.A. Union County General Hospital will continue its relationship with the local nursing home, as well as assist with access to medical care for nursing home patients. 6.B. The hospital's lab will continue to increase access to lab work for nursing home residents through conducting lab tests at the nursing home on a daily basis. 6.C. UCGH will continue to partner with the Rotary Club to provide for families in need throughout the community, including collaborating to provide Christmas Food Baskets to underserved families in the community during the holiday season. 6.D. Union County General Hospital will continue to partner with local schools to assist with well child physicals, as well as school physicals, at a reduced cost for patients. 6.E. Union County General Hospital is exploring participating in the 340b Pharmacy Program. 6.F. Union County General Hospital is pursuing grant opportunities to provide gas cards for residents6.G. Union County General Hospital offers an in-house Medicaid assistance program to help residents sign up for Medicaid coverage. 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 6a: The community benefit report is available on the hospital's website. Part I, Ln 7 Col(f): The organization had bad debt recoveries for fiscal year 2019. Part III, Line 2: Patient accounts receivable represent the amount billed but uncollected for services provided to patients. Patient receivables are carried at the billed amount less estimates for contractual discounts and allowances as well as for doubtful accounts. Management determines the allowance for doubtful accounts by examining aging categories by payor and by using historical experience applied to the aging. Individual accounts receivable are written off when deemed uncollectible. Recoveries of patient accounts receivable previously written off are recorded when received. Delinquent status is based on how recently payments have been received. The Hospital does not accrue interest on past due accounts. Part III, Line 3: The Hospital did not have any bad debt expense for fiscal year 2019. The Hospital adopted a new charity care policy in 2019. The revised policy provided charity care discounts for services previously reported within net patient service revenue. The impact of these changes was to reduce the allowance and provision for bad debts by approximately $1,628,000 for the year ended June 30, 2019. The provision for bad debts as of June 30, 2019 totaled $(789,158). Part III, Line 4: The footnote to the Organization's financial statements can be found on page 18 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 complete 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 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. 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 2018 (4,109) to 2023 (3,939) by 4.1%, which is 3.1% less growth than the 1.0% expected growth for the state of New Mexico from 2018 (2,081,363) to 2023 (2,101,278). As of 2018, the racial/ethnic breakout of Union County was 51.5% White Non-Hispanic, 1.8% Black, 42.9% Hispanic, 0.6% Asian, 1.6% American Indian and 1.6% all others. By 2023, the White Non-Hispanic population is expected to decrease by 9.5% and the Asian population by 4.3%, while the Black population is expected to increase by 3.9%, the Hispanic population is expected to increase by 0.6%, the American Indian population is projected to increase by 15.4% and all others is expected to increase by 15.2% in Union County. Union County (41.1 years) has a slightly younger median age than New Mexico (41.9 years) (2018). The median household income in Union County and the state is expected to slightly increase over the next five years (2018-2023). Union County ($38,491) has a lower median household income than New Mexico ($43,040) (2018). Unemployment rates in Union County and the state decreased between 2015 and 2017. In 2017, Union County (3.8%) had a lower unemployment rate than the state (6.2%). Union County (11.3%) has a lower percentage of families living below poverty as compared to the state (15.4%) (2018). Union County (28.5%) also has a lower percentage of children (<18 years) living below poverty than New Mexico (30.1%) (2016). With respect to education, Union County (17.1%) has a lower percentage of residents with a bachelor or advanced degree than the state (26.4%) (2018). In 2015-2016, the percent of students receiving their high school diploma within four years in Union County (92.3%) was higher than the state (72.5%) and national rates (86.1%). As of 2016, Union County (12.3%) has a lower rate of uninsured adults (age 18-64) as compared to the state (13.5%). Union County experienced a larger decline in the percentage of uninsured adults (age 18-64) between 2014 and 2016 (10.9%), while New Mexico experienced a slightly smaller decline (7.5%). In 2018, 15.6% of the insured population in Union County reported receiving Medicaid, which is below the state rate (40.0%). In 2014, the rate of primary care physicians per 100,000 population in Union County (46.5 per 100,000) was lower than the state (84.9 per 100,000) and national rates (87.8 per 100,000). In 2015-2017, the percent of adults (age 18+) that reported experiencing a medical cost barrier in the past 12 months in Union County (9.0%) was lower than the state (14.0%). In 2015-2017, the percent of adults (age 18+) that reported not having one or more person they think of as their personal doctor or health care provider in Union County (34.7%) was slightly higher than the state rate (30.8%).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.Union County General Hospital is one of the sponsors of an annual county-wide health fair where hospital personnel obtain blood samples for testing. There were 472 blood draws at the health fair by 50 hospital personnel working 175 hours. The physical therapy and radiology departments were also involved educating the public on services they offer. X 0 0 0 0 0 0 0 0 0 Robert Williams Secretary and CRNA 164903 0 0 0 0 0 0 0 16987 0 181890 0 0 0 Mark Van Wormer MD Family Medicine-Chief of Staff 539442 0 0 0 0 0 29500 0 24207 0 593149 0 0 0 Stacye Bradley Director of Nursing 134160 0 0 0 0 0 8335 0 25890 0 168385 0 0 0 Jay Fluhman FNP-C ACNP Certified Nurse Practitioner 195571 0 0 0 0 0 27820 0 9361 0 232752 0 0 0 Terry Weaver MD Family Medicine 244880 0 0 0 0 0 0 0 5568 0 250448 0 0 0 Part I, Line 3 The Board of Directors approves the contract with Community Hospital Corporation, the management company. X 1 175000 Appraisal 0 0 0 0 Part I, Column (b): The organization is reporting in Part I, column (b) the number of items contributed. Form 990, Part VI, Section A, line 1 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, Melissa Prante, CFO as of 10/15/18, and Terri Martinez, CFO until 12/17/18 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 is reported for services provided to Union County General Hospital. Tammie Stump $201,522 Melissa Prante 51,816 Terri Martinez 75,970 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. Form 990, Part IX, line 11g Professional Fees: Program service expenses 360,312. Management and general expenses 51,562. Fundraising expenses 0. Total expenses 411,874. Contract Labor: Program service expenses 98,627. Management and general expenses 0. Fundraising expenses 0. Total expenses 98,627. Purchased Services: Program service expenses 478,475. Management and general expenses 102,497. Fundraising expenses 0. Total expenses 580,972. Recruiting: Program service expenses 29,583. Management and general expenses 33,976. Fundraising expenses 0. Total expenses 63,559. 340B Management Fees: Program service expenses 161,720. Management and general expenses 0. Fundraising expenses 0. Total expenses 161,720. County of Union PO Box 430 Clayton NM 88415 856000259 Operating agreement with hospital NM N/A 0 0 0 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 1