2019-05-14T17:19:28-05:00 2018-06-30 205949532 RICCI & COMPANY LLC 6200 UPTOWN BLVD NE STE 400 ALBUQUERQUE NM 87110 990 2017-07-01 850442957 CLAYTON HEALTH SYSTEMS INC DBA UNION COUNTY GENERAL HOSPITAL CLAY 5753747008 300 WILSON STREET CLAYTON NM 88415 TAMMIE STUMP CEO 5753747008 2019-05-14 1 MARIA MATONTI P01790899 5053380800 204.98.120.221 2019-05-14 17:09:29 MD P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 EA486A3F91AF06969BBA26ACFDD351BC6C02EF50 2017 2019-02-21 02:37:17Z TAMMIE STUMP 300 WILSON STREET CLAYTON NM 88415 9003390 0 X WWW.UGCH.NET X 1997 NM 25-BED ACUTE CARE CRITICAL ACCESS HOSPITAL SERVING THOSE IN NEED IN AND NEAR UNION COUNTY, NM. 5 4 117 4 0 0 137407 93328 12376054 8648188 10369 14365 183903 247509 12707733 9003390 0 0 0 0 4601719 5723019 0 0 0 6927258 5315701 11528977 11038720 1178756 -2035330 16382323 14942865 7124212 7720084 9258111 7222781 X THE ORGANIZATION IS A 25-BED ACUTE CARE CRITICAL ACCESS HOSPITAL THAT SERVES THOSE IN NEED IN THE RURAL NEW MEXICO AREA IN, AND AROUND UNION COUNTY, NM. 0 0 8685072 8895697 THE ORGANIZATION OPERATES A 25-BED ACUTE CARE CRITICAL CARE HOSPITAL THAT 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 TYPES OF PATIENT CARE. THERE WERE A TOTAL OF 178 ADMISSIONS AND 9,991 PATIENT VISITS AT UNION COUNTY GENERAL HOSPITAL, AS WELL AS 4,873 AT THE CLAYTON FAMILY PRACTICE CLINIC DURING FISCAL YEAR ENDING 6/30/2018. ALSO, UNION COUNTY GENERAL HOSPITAL IS ONE OF THE SPONSORS OF AN ANNUAL COUNTY-WIDE HEALTH FAIR WHERE HOSPITAL PERSONNEL OBTAIN BLOOD SAMPLES FOR TESTING - 472 PATIENTS WERE DRAWN AT THE HEALTH FAIR, AT SIX LOCAL BUSINESSES, AND SIX SURROUNDING COMMUNITIES BY 50 HOSPITAL PERSONNEL WORKING 175 HOURS. THE PHYSICAL THERAPY DEPARTMENT, AS WELL AS THE RADIOLOGY DEPARTMENT WERE ALSO INVOLVED IN THE HEALTH FAIR, EDUCATING THE PUBLIC ON SERVICES THEY OFFER. 8685072 1 1 0 0 0 0 0 0 0 0 1 0 0 0 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 0 0 0 0 0 0 0 0 0 1 44 0 1 117 1 0 0 0 0 0 0 0 0 0 0 X 5 4 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 0 0 0 NM X X THE ORGANIZATION 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 SEC/TREASURER-CRNA 1.00 X X 100953 0 9674 CRAIG REEVES DIRECTOR 1.00 X 0 0 0 PAUL BRIESH DIRECTOR 1.00 X 0 0 0 TAMMIE STUMP CEO/CNO 40.00 X 0 0 0 TERRI MARTINEZ CFO 40.00 X 0 0 0 MARK VANWORMER CHIEF OF STAFF 40.00 X 477634 0 15874 STACYE BRADLEY CCO-DIRECTOR OF NURSING 40.00 X 116281 0 15287 JAY FLUHMAN CERTIFIED NURSE PRACTITIONER 40.00 X 190290 0 13494 885158 0 54329 4 0 1 0 COMMUNITY HOSPITAL CONSULTING 7000 N DALLAS PARKWAY PLANO TX 75024 MGMT & ADMIN SERVICES 931595 RHINO MEDICAL SERVICES PO BOX 206912 DALLAS TX 75320 LOCUM PROVIDER 797112 COMPHEALTH MEDICAL SERVICES PO BOX 972670 DALLAS TX 75397 LOCUM PROVIDER 152062 CARDINAL HEALTH PO BOX 847384 DALLAS TX 75284 MEDICAL SUPPLIES 125274 HEALTHCARE SERVICES PO BOX 829677 PHILADELPHIA PA 19182 LAUNDRY & HOUSEKEEPING SERVICES 117785 9 91378 1950 93328 NET PATIENT SERVICE RE 621400 7527127 7527127 COUNTY MILL LEVY/GRT S 621400 1121061 1121061 8648188 14365 14365 OTHER NON-OPERATING IN 621400 247509 247509 247509 9003390 8895697 0 14365 694868 528101 166767 4176090 3173828 1002262 54347 41304 13043 504700 383572 121128 293014 222691 70323 65140 49506 15634 48136 36583 11553 976308 928183 48125 12829 9750 3079 587492 446494 140998 26942 20476 6466 230212 174961 55251 134582 87437 47145 176750 134330 42420 639183 485779 153404 295077 224259 70818 PURCHASED SERVICES 1078687 819802 258885 HOSPITAL & MEDICAL SUPP 654209 621499 32710 EQUIPMENT RENTAL & MAIN 390154 296517 93637 11038720 8685072 2353648 0 1484572 1679552 2242890 1752629 1134889 837550 862782 776133 207751 179415 82551 43409 14892563 5242442 10132593 9650121 234295 24056 16382323 14942865 1948482 2309194 5175730 4498572 0 912318 7124212 7720084 X 9208111 7172781 50000 50000 9258111 7222781 16382323 14942865 -2035330 0 X X 0 1 X 1 0 X 12644088 3856796 8787292 2155723 1385646 770077 92752 92752 9650121 ESTIMATED THIRD PARTY SETTLEMENTS 912318 912318 9459556 456166 456166 9003390 0 9003390 11494886 456166 456166 11038720 0 11038720 1 1 X 1 X 1 X 1 1 0 1 1 40298 40298 0.00370 1345764 1345764 0.12190 1379791 156123 1223668 0.11090 2765853 156123 2609730 0.23650 2765853 156123 2609730 0.23650 0 1489674 1117256 3426271 3685439 -259168 X 1 1 1 1 UNION COUNTY GENERAL HOSPITAL 300 WILSON ST CLAYTON NM 88415 X X X UNION COUNTY GENERAL HOSPITAL 0 0 1 X X X X X X X X X 16 1 0 0 1 X WWW.UCGH.NET X 1 16 1 WWW.UCGH.NET 0 1 X 200.000000000000 200.000000000000 X 1 1 X X X 1 X WWW.UCGH.NET X WWW.UCGH.NET X X X 1 X X 0 1 0 0 UNION COUNTY GENERAL HOSPITAL PART V, SECTION B, LINE 5: A COMMUNITY MEETING WAS HELD AT UNION COUNTY GENERAL HOSPITAL. THE HOSPITAL INVITED NUMEROUS MEMBERS OF THE COMMUNITY REPRESENTING A WIDE RANGE OF SECTORS INCLUDING BUSINESS, HEALTH CARE, EDUCATION, AND NON-PROFIT ORGANIZATIONS. A LINK TO A SURVEY FOR ADDITIONAL INPUT TO THE COMMUNITY ASSESSMENT PROCESS WAS INCLUDED WITH THE INVITATION. UNION COUNTY GENERAL HOSPITAL PART V, SECTION B, LINE 11: NEEDS OF MEMBERS OF THE COMMUNITY WERE OUTLINED AND PRIORITIZED AND ARE CONTINUALLY REVIEWED AND ADDRESSED AS A RESULT OF THE CHNA PREPARED IN 2016. ALL NEEDS WERE ADDRESSED IN THE IMPLEMENTATION PLAN. UNION COUNTY GENERAL HOSPITAL PART V, SECTION B, LINE 13B: THE ORGANIZATION'S FINANCIAL ASSISTANCE IS A STAIR STEP POLICY THAT STARTS AT 200% AND GOES TO 400%. PART I, LINE 7: THE COST METHOD USED TO CALCULATE THE AMOUNTS IN THIS TABLE IS A COST TO CHARGE RATIO. PART I, LN 7 COL(F): BAD DEBTS ARE RECORDED AS AN OFFSET TO REVENUE; THEY ARE NOT SEPARATELY STATED IN THE AUDIT REPORT OR THE STATEMENT OF FUNCTIONAL EXPENSES ON FORM 990, PART IX. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY HEALTH IS PROMOTED VIA COMMUNITY SUPPORT AND COMMUNITY HEALTH IMPROVEMENT ADVOCACY. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE REPRESENT THE AMOUNT BILLED BUT UNCOLLECTED FOR SERVICES PROVIDED TO PATIENTS. SUCH 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 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. THE HOSPITAL USES MEDICARE COST REPORT ROUTINE COSTS BASED ON MEDICAID OR MEDICARE DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. PART III, LINE 9B: WHEN A PATIENT HAS INDICATED OR DEMONSTRATED AN INABILITY TO PAY, AN APPROPRIATE HOSPITAL REPRESENTATIVE WILL PROVIDE THE PATIENT WITH A FINANCIAL ASSISTANCE APPLICATION. APPLICATIONS MUST BE COMPLETE IN THEIR ENTIRETY BEFORE FINANCIAL ASSISTANCE CAN BE CONSIDERED. THOSE PATIENTS WHO QUALITY 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. PART VI, LINE 2: PUBLIC MEETINGS, BOARD MEETINGS, PERFORMANCE IMPROVEMENT AND QUALITY ASSURANCE MEETINGS, EMERGENCY ROOM CALL BACKS. PART VI, LINE 3: PATIENTS ARE INFORMED OF THEIR RIGHTS AND ELIGIBILITY FOR ASSISTANCE AS THEY GO THROUGH THE ADMISSIONS PROCESS. PART VI, LINE 4: UNION COUNTY IS A FRONTIER HOSPITAL WITH A COUNTY POPULATION OF 2,700. THE TOWN OF CLAYTON, WHERE THE HOSPITAL IS LOCATED, IS 45 MILES FROM THE NEAREST HOSPITAL. X X 0 0 0 0 0 0 0 0 0 MARK VANWORMER CHIEF OF STAFF 477634 0 0 0 0 0 0 0 15874 0 493508 0 0 0 JAY FLUHMAN CERTIFIED NURSE PRACTITIONER 190290 0 0 0 0 0 0 0 13494 0 203784 0 0 0 PART VII, SECTION A, LINE 5 EXPLANATION: THE ORGANIZATION'S CEO AND CFO ARE PAID BY COMMUNITY HOSPITAL CORPORATION, AN UNRELATED ORGANIZATION THAT PROVIDES HOSPITAL ADMINISTRATION SERVICES AS WELL AS HOSPITAL BILLING SERVICES. THE CEO'S 2017 WAGES WERE $177,072 AND BENEFITS PAID ON HER BEHALF WERE $15,247. THE CFO'S 2017 WAGES WERE $144,613 AND BENEFITS PAID ON HER BEHALF WERE $7,422. FORM 990, PART VI, SECTION A, LINE 3 THE HOSPITAL'S CEO AND CFO ARE EMPLOYED BY A MANAGEMENT COMPANY. THE CEO IS RESPONSIBLE TO CARRY OUT ALL EXECUTIVE-TYPE DUTIES NORMALLY PERFORMED BY AN EMPLOYEE IN THIS POSITION. FORM 990, PART VI, SECTION B, LINE 11B A DRAFT OF THE ORGANIZATION'S FORM 990 IS PROVIDED TO THE CEO & CFO AND ANY QUESTIONS OR CORRECTIONS ARE ADDRESSED. THEN A COPY OF THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS PROVIDED TO ALL VOTING BOARD MEMBERS PRIOR TO FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS, CEO AND ALL OTHER OFFICERS ARE REQUIRED TO ANNUALLY SIGN THE CONFLICT OF INTEREST POLICY AND DISCLOSE ANY POTENTIAL CONFLICTS OF INTEREST AS THEY ARISE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'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 XII, LINE 2C: THE AUDIT PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR.