2016-05-05T16:09:17-05:00 2015-06-30 450250958 EIDE BAILLY LLP 4310 17TH AVE S PO BOX 2545 FARGO ND 581082545 990 2014-07-01 850138775 Otero County Hospital Association OTER 5754396100 2669 North Scenic Drive Alamogordo NM 883110597 Bashar Naser CFO 5754396100 2016-05-05 1 LISA CHAFFEE CPA P00193453 7012398500 2016-05-05 2014 2016-08-17 19:52:53Z Gerald Champion Regional Medical Center Robert James Heckert 2669 North Scenic Drive Alamogordo NM 883110597 135436338 0 X www.gcrmc.org X 1947 NM Provision of health care services 8 7 769 165 73293 -74496 487301 274839 117474311 134815955 58401 56421 35404 24576 118055417 135171791 480383 749793 0 0 38004423 42083053 0 0 0 83288906 77162054 121773712 119994900 -3718295 15176891 140967495 153340242 91862679 89064319 49104816 64275923 X To be the Organization where patients choose to come, physicians want to practice, and people want to work. 1 0 93653537 749793 134811155 Otero County Hospital Association d/b/a Gerald Champion Regional Medical Center (GCRMC) provides comprehensive healthcare services through its 99-bed hospital, outpatient ambulatory care facilities, and a multi-specialty physician group. GCRMC accounts for more than 80% of hospital admissions in its Otero County primary service area. The GCRMC's primary markets are the cities of Alamogordo and Tularosa with secondary markets expanding to more remote areas of Otero County, Lincoln County, Chavez County and beyond. The original facility opened in August 1949 and the current medical center is a state of the art, acute care facility that opened in December 1999.The original hospital opened in 1949 with 26 beds. Today GCRMC is proud to be a 99-bed acute care facility accredited by DNV, including two distinct PPS units: Life Transitions (aka Behavioral Medicine - total 17 beds) and Inpatient Rehabilitation (12 beds starting July 1, 2011). GCRMC shares a unique relationship with Holloman Air Force Base as the first hospital in the United States where active duty military physicians practice in a civilian hospital. This special arrangement allows one facility to meet the combined community and military needs, while serving as a model for the Department of Defense in conserving resources. The delivery mechanisms of care at the hospital include both inpatient and outpatient services: acute care inpatient through medical/surgical, telemetry, maternal child and 12-bed intensive care units; surgery department supported by pre-admit, outpatient care unit and post-anesthesia care unit; outpatient surgery center; provider-based physician practices in the areas of family practice, women's services including obstetrics, medical and radiation oncology, medical cardiology, gastroenterology and endocrinology, internal medicine, orthopedics and general surgery; inpatient and outpatient gero-psych services; inpatient rehabilitation services, including physical and occupational rehab services; inpatient and outpatient CAP certified laboratory services with the capability to perform over 225 different profiles and tests in-house; inpatient and outpatient diagnostic imaging services, including x-ray, 128-slice CT scan, MRI, ultrasound, interventional radiology, radiofrequency ablation and nuclear medicine; inpatient and outpatient comprehensive cardiopulmonary services including behavior sleep medicine, Holter monitoring, event monitoring and impedance cardiography. Additionally, efforts continued during FY15 to refine the contracts and plans for a joint venture with Sierra Providence Health Network to start up a cathlab as the foundation for a new interventional cardiology service line in FY16.By the end of 2015, GCRMC employed approximately 650 people. In addition to those employees, GCMRC contracts for services in various departments such as Food Services, Environmental Services, Pharmacy, Anesthesia, Emergency Department and Hospitalist Providers. The medical staff of GCRMC has 214 medical members consisting of 101 active members of whom 35 are employed providers. GCRMC continues to seek opportunities to expand services and improve quality, with the philosophy of not limiting its potential by the designation of "rural hospital," but rather identifying its scope of service based on community needs as a regional medical center. Management is planning the expansion of the inpatient gero-psych service line with additional beds and expansion of serviced provided (gero-psych, adult, PTSD, military, co-occurring).Continued progress and expansion has enhanced GCRMC's commitment to strive for outstanding service and quality; acknowledging that its future is not in its buildings or technology, but rather its people. To this end we support the people of Otero County and outlying service areas with our expanded services and our financial contributions. GCRMC has, since its inception in 1949, provided quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operations and stability of GCRMC, it is recognized that not all individuals possess the ability to purchase essential medical services and, further, that our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping the GCRMC's commitment to serve our community, we provide: Free Care and/or Subsidized Care - care to persons covered by governmental programs at below cost; and health activities and programs to support the community will be considered where the need and/or an individual's inability to pay coexist. Management is expanding the Financial Assistance Program from 200% to 300% of FPL effective July 1, 2015. GCRMC maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. 93653537 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 106 0 1 769 1 1 1 0 0 0 0 0 0 0 0 0 X 8 7 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 1 1 1 0 NM X Bashar Naser 5754437848 2669 North Scenic Drive Alamogordo NM 88311 Norm Arnold Chairman of the Board 10.00 X X 24000 0 0 Bill Mershon Vice President 5.00 X X 0 0 0 Bill Mayton Secretary 5.00 X X 0 0 0 Fred Baker Director 5.00 X 0 0 0 James Harris Director 3.00 X 0 0 0 Greg Richardson MD Director 5.00 X 0 0 0 Robin French Director 3.00 X 0 0 0 Lisa Thomassie Director 3.00 X 0 0 0 Robert James Heckert CEO 40.00 X 364394 0 20072 Bashar Naser CFO 40.00 X 149583 0 13740 Catherine Rhyne VP of Patient Care/CNO 40.00 X 177419 0 9780 Arthur Austin MD VP of Medical Affairs 40.00 X 300384 0 18943 Albert Esparsen-VP of Physician Practice & Business Office(Nov-June) 40.00 X 16111 0 1017 Dennis Worthington Physician 40.00 X 402936 0 18426 Charles Race Physician 40.00 X 727320 0 24552 Stefan Korec Physician 40.00 X 564434 0 42166 William Pollard Physician 40.00 X 407354 0 25166 Anthony Burton Physician 40.00 X 400580 0 9744 3534515 0 183606 60 0 1 0 Emcare Inpatient Services 7032 Collection Center Drive Chicago IL 60693 Manage Inpatient, ER, Anesthesia Service 4457866 Completerx LTD 3100 South Gessner Ste 640 Houston TX 77063 Pharmacy Services 1530070 Coker Consulting LLC 2400 Lakeview Pkwy Ste 400 Alpharetta GA 30009 Healthcare Business Advisors 726455 Diamond Healthcare PO Box 85050 Richmond VA 232855050 Psychiatric Services 708297 Comphealth PO Box 972651 Dallas TX 753972651 Agency Staffing/Professional Search 550004 28 266161 8678 274839 Net Patient Service Revenue 900099 131405643 131405643 Other Revenue 900099 1118163 1118163 Catering 722320 805508 800708 4800 Alamogordo Surgery Venture, LLC 621400 749407 749407 Rental income 531120 607229 607229 130005 130005 134815955 50627 50627 289123 264547 24576 24576 68493 -43917 1313 4481 0 0 1313 4481 5794 5794 135171791 134811155 73293 12504 X 726191 726191 23602 23602 1344687 1344687 69930 69930 35218196 25784624 9433572 256148 232365 23783 2735457 2196096 539361 2458635 1697314 761321 325195 325195 206588 206588 27610966 19134361 8476605 266210 2455 263755 8194779 5294471 2900308 234763 43225 191538 2064033 527775 1536258 193245 116585 76660 266402 156253 110149 4009032 4009032 10444215 10444215 2573398 2573398 Medical Supplies 11680396 11680396 Provision for Bad Debts 8372701 8372701 Reorganization Costs 260777 260777 Taxes 66565 66565 392789 241206 151583 119994900 93653537 26341363 0 11535978 32133927 13527131 13227056 2829846 3872092 1157059 1322894 186300977 104401330 88358064 81899647 15232483 15283184 546074 2597264 985230 931198 6795630 2072980 140967495 153340242 16994476 17344983 1226018 70111143 68319032 1840390 1051579 2916670 416667 0 706040 91862679 89064319 X 49104816 64275923 49104816 64275923 140967495 153340242 X 15176891 34236 -40020 X 0 1 X 1 0 X 3237050 3237050 104557533 43064689 61492844 74177568 58681184 15496384 4328826 2655457 1673369 81899647 Estimated Third-Party Payor Settlements 706040 706040 X 126781392 34236 -7809770 -7775534 134556926 614865 614865 135171791 111610285 264547 264547 111345738 8649162 8649162 119994900 Part X, Line 2: The Medical Center is organized as a New Mexico nonprofit corporation and has been recognized by the Internal Revenue Service (IRS) as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to income tax on net income that is derived from business activities that are unrelated to its exempt purpose. The Medical Center files an Exempt Organization Business Income Tax Return (Form 990-T) with the IRS to report its unrelated business taxable income. The Medical Center believes it has appropriate support for any tax positions taken affecting its annual filing requirement, and, as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Medical Center would recognize future accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurreed. The Medical Center's federal Form 990-T filings are no longer subject to federal tax examinations by tax authorities for years before 2012. Part XI, Line 2d - Other Adjustments: Provision for Bad Debts Recorded as Income for F/S -8,372,701. Reorganization Costs Recorded as Income for F/S -260,777. Book Income ASV LLC 714,745. Book Income White Sands, LLC 632. Book Income Alamogordo Imaging Center, LLC 124,015. Staff Training Costs -15,684. Part XI, Line 4b - Other Adjustments: Rental Expenses Recorded as Expense for F/S -264,547. Tax K-1 Income ASV LLC 749,407. Tax K-1 Income Imaging Center, LLC 126,856. Tax K-1 Income White Sands LLC 3,149. Part XII, Line 2d - Other Adjustments: Rental Expenses Recorded as Expense for F/S 264,547. Part XII, Line 4b - Other Adjustments: Provision for Bad Debts Recorded as Income for F/S 8,372,701. Reorganization Costs Recorded as Income for F/S 260,777. Staff Training Costs 15,684. 1 1 X 1 X 300.000000000000 0 1 1 0 1 0 503000 503000 0.00450 26577855 19319016 7258839 0.06500 27080855 19319016 7761839 0.06950 32518467 10424523 22093944 0.19790 286670 286670 0.00260 32805137 10424523 22380614 0.20050 59885992 29743539 30142453 0.27000 663550 663550 0.00590 663550 663550 0.00590 0 8372701 38467 28613625 27348337 1265288 X 1 1 1 Alamogordo Surgery Ventures Outpatient Surgery Center 0.40500 0.00000 0.59500 2 Alamogordo Imaging Center Outpatient Radiology Center 0.29500 0.00000 0.70500 3 White Sands Health Care Systems LLC Physician Hospital Organization 0.50000 0.00000 0.50000 1 1 Gerald Champion Regional Medical Center 2669 North Scenic Drive Alamogordo NM 88311 www.gcrmc.org 6016 X X X 13 provider based clinics Gerald Champion Regional Medical Center 1 0 0 1 X X X X X X X X X X 12 1 0 1 1 X http://www.gcrmc.org/News/StrategicPlan?showBack=true&P X 1 14 0 0 0 1 X 200.000000000000 300.000000000000 X X X X 1 1 X X X 1 X http://www.gcrmc.org/News/CharityCare X http://www.gcrmc.org/News/CharityCare X X X 1 X 0 X X X X 1 X 0 0 Gerald Champion Regional Medical Center Part V, Section B, Line 3j: Charts related to age, gender, general lifestyles, healthcare metrics. Gerald Champion Regional Medical Center Part V, Section B, Line 5: Conducted focus groups, round table discussions, and individual interviews as well as phone surveys. GCRMC spoke with community members. Gerald Champion Regional Medical Center Part V, Section B, Line 6b: Otero County Community Health CouncilPresbyterian Medical ServicesAlamogordo Public SchoolsDepartment of Public SafetyAlamogordo Chamber of Commerce Gerald Champion Regional Medical Center Part V, Section B, Line 22d: Patients who have household income at or below 300% of the FPG are eigible to receive free care. The organizationn also offers a 25% discount to self-pay patients. In addition, the facility will work with patients on settlements on a case-by-case basis based on specific circumstances, such as catastrophic illness or medical indigence, at the discretion of GCRMC. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Gerald Champion Regional Medical Center Part V, Section B, line 16a website: http://www.gcrmc.org/News/CharityCare Gerald Champion Regional Medical Center Part V, Section B, line 16b website: http://www.gcrmc.org/News/CharityCare 2 ASV dba Scenic View Outpatient Surg Cr 2351 25th Street Alamogordo NM 88311 Outpatient Surgery Alamogordo Imaging Center 2539 Medical Dr Ste 1010 Alamogordo NM 883108720 Outpatient Radiology Part I, Line 3c: The organization uses the Federal Poverty Guidelines when determining free care. Patients who have household income at or below 300% of the FPG are eigible to receive free care. The organizationn also offers a 25% discount to self-pay patients. In addition, the facility will work with patients on settlements on a case-by-case basis based on specific circumstances, such as catastrophic illness or medical indigence, at the discretion of GCRMC. Determining family need is also based on an application process which takes into account the patient's available assets and all other financial resources available to the patient. Part I, Line 7: The organization used the following to determine the costs for Part I, Line 7:Row a: Charity Care was converted to cost using a cost to charge ratio from the cost accounting system. The cost accounting system addresses all patient segments.Row b : Amounts were calculated from internal records.Row g: Amounts reported are based on the Medicare Cost Report figures.Row i: Amount reported is based on the actual dollars spent in the activities reported. Part I, Line 7g: Part I, Line 7g includes $24,538,148 of costs attributable to a Physician Clinic. Part I, Ln 7 Col(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 $8,372,701. Part III, Line 2: Discounts and payments are taken into account when determining bad debt expense. Part III, Line 3: The Organization estimated the percentage of bad debt that is attributed to charity care by applying the percentage of charity care to total revenues to total bad debt at cost. Therefore the organization estimates that 0.46% of the bad debt expense at cost is attributable to patients eligible under the organization's charity care policy. Care is given to individuals regardless of their ability to pay, and therefore this is a community benefit. Part III, Line 4: Footnote from organization's financial statements: The footnote that describes bad debt expense is found on page 8 of the attached audit report. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by Centers for Medicare and Medicaid Services. Part III, Line 9b: GCRMC has implemented a number of different Policy and Procedure statements to govern the details of how its collection practices are implemented and how discounting and collection policies apply to various classes of patients. In general, all patient account guarantors who request financial assistance are asked to provide detailed information regarding their income and assets. For patients who qualify for charity and who are cooperating in good faith to resolve their hospital bills, GCRMC may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to collection agencies, and will cease all collection efforts. Part VI, Line 2: Management at GCRMC enlisted the services of Coker Group to complete a quantitative tracking study in 2014. In 2012, a strategic planning meeting for FY 13, 14 and 15 was held and utilized components of the community health needs assessment. Members consisted of physicians, community members and management. Three strategies were:1. Be number one in quality and service in our region2. Have the best healthcare talent in the region3. Evaluate and adapt to serve the health care needs of our community Part VI, Line 3: The hospital has a Charity Care Policy - Gerald Champion Regional Medical Center (GCRMC) will provide understandable, written guidelines to staff and patients relative to how the hospital evaluates and determines: 1) a patient's eligibility for charity care; 2) an uninsured patient's eligibility for discounts; and 3) a patient's eligibility for alternate payment plans.A Summary of the Charity Care Policy is posted in the emergency room and throughout the entire hospital. The patients are also informed through direct communication with financial counselors and these policies are explained in detail to guarantors who advise GCRMC that they are unable to pay their account or need help in structuring an affordable payment plan for their account. The hospital provides services to anyone in need of medical care regardless of the patient's ability to pay for such services. Charity care and discounts for the uninsured will be available for medically necessary hospital care provided to persons who meet the financial and documentation criteria defined in this policy. Determinations hereunder will be based solely on the patient's ability to pay and will not be made on the basis of age, sex, race, creed, disability, sexual orientation or national origin. GCRMC provides financial assistance to patients based on their income, assets, and needs. Through our financial counseling services we assist patients with obtaining financial coverage or low-cost health insurance, or work with patients to arrange a manageable payment plan.Uninsured patients are eligible for a 25% discount. A 25% discount is applied to the total charges of a Self Pay Patient at the time of service or the 1st billing. Notice will be sent at the time of the 1st billing informing the patient/guarantor that an additional 10% will be deducted if the account is paid within 30 days of the date of service. Part VI, Line 4: Otero County Hospital Association d/b/a Gerald Champion Regional Medical Center ("GCRMC") activities are conducted on its 66-acre campus located in Alamogordo, New Mexico. Alamogordo is approximately 89 miles north of El Paso, Texas and 209 miles southeast of Albuquerque, New Mexico. GCRMC owns and operates a 99-bed acute care hospital (the "Hospital") on the campus. The Hospital is a one-story building with approximately 294,000 square feet. Other facilities that the Hospital owns located on the campus include 2 medical office buildings, Complex A and B that have an outpatient surgery center and an imaging center owned and operated by limited liability companies in which GCRMC has an interest. GCRMC also owns six facilities located off the campus that are either leased to independent primary care/specialty care providers or occupied by employed physicians. GCRMC's primary service area is Northwestern Otero County from which 84% of its admissions originate. GCRMC is the sole community provider in its primary service area with the nearest tertiary care hospital located approximately 70 miles from the Hospital. The delivery mechanisms of care at the Hospital include both inpatient and outpatient services: 24-hour staffed Level III Trauma Emergency Department; acute care inpatient through Medical/Surgical (10-bed Intensive Care Unit), Telemetry, Maternal Child, 17-bed gero-psych, and 12-bed inpatient rehabilitation; Surgery Department supported by Pre-admit, Outpatient Care Unit and Post-Anesthesia Care Unit; hospital-owned physician practices in the areas of family practice, women's services including obstetrics, orthopedics, nephrology, internal medicine, gero-psych outpatient, pediatrics, gastroenterology and endocrinology; Pathologist; certified laboratory services with the capability to perform over 225 different profiles and tests in-house; inpatient and outpatient diagnostic imaging services, including x-ray, 128-slice and 16-slice CT scan, MRI, ultrasound, interventional radiology, radiofrequency ablation and nuclear medicine; inpatient and outpatient comprehensive cardiopulmonary services including behavior sleep medicine, Holter Monitoring, Event Monitoring and Impedance Cardiography.GCRMC and the Holloman Air Force Base (HAFB) 49th Medical Group, a group of approximately 15 military providers and support staff from the HAFB, have enjoyed a close working relationship, and have had shared coverage arrangements. Such arrangements included laboratory and x-ray services in a disaster, obstetrical coverage, and coverage for the HAFB 49th Medical Group when they were deployed for Desert Storm in 1991. Following Desert Storm and the return of the HAFB 49th Medical Group, the DoD made the decision to leave all the obstetrical services with GCRMC and the local obstetricians. As of 2012, 3,900 active military and 5,000 dependents are located at the HAFB. In addition, the German Air Force ("GAF") utilizes HAFB as a training facility and has 480 active military and 790 dependents.GCRMC's primary service area (the "PSA") is 30 square miles in Northwestern Otero County from which approximately 84% of GCRMC's admissions originate. Located in southeastern New Mexico, Otero County encompasses 6,627 square miles and includes the cities of Alamogordo and Tularosa. According to U.S. Census, the population of Otero County has grown by over 3,400 people since 2000 to 65,703 in 2011.The Hospital is the only acute care hospital within the PSA and is a Sole Community Provider. The acute care hospitals that GCRMC considers its main competitors that draw from the PSA are Mountain View Regional Medical Center and Memorial Medical Center both located approximately 75 miles west of Alamogordo in Las Cruces, New Mexico. Management of GCRMC estimates that the market share of admissions to the MountainView Regional Medical Center and Memorial Medical Center from the PSA average 10% and 5%, respectively. The secondary service area covers a substantial portion of the remainder of Otero County, as well as the south central portion of Lincoln County. The secondary service area includes Ruidoso, the population of which was estimated to be 8,029 in 2010 according to the U.S. Census Bureau. The tertiary service area covers a small portion of Otero County and Chaves County. There are no other major medical centers within Otero County. Part VI, Line 5: The business and affairs of GCRMC are subject to the overall governance and direction of its Board of Directors. The Board of Directors currently includes 10 members. Each member is appointed by the Board of Directors and serves a three-year term in a self-perpetuating board. The Board of Directors fills vacancies that may occur. Officers of the Board of Directors include a Chairman, Vice Chairman, and Secretary/Treasurer. The Board of Directors are business people of the primary service area, with no other connection. GCRMC's medical staff is organized into Divisions of Medicine, Medical Subspecialties, Surgery and Outpatient Services. In addition to specialized medical/surgical services provided by both employed and contracted physicians and medical groups, GCRMC also offers emergency medical services, including a helicopter service which is not owned by GCMRC but is on-site 24 hours a day. GCRMC employs around-the-clock hospitalists, (i.e., physicians who devote their professional time to the care of hospitalized patients). The hospital extends medical staff privileges to all qualified physicians in the community. Surplus funds are re-invested into the purchase of capital equipment, electronic medical record software, and continuing education for clinical staff including physicians.GCRMC views the position of sole provider as a significant commitment to the overall health and well-being of the community. Not satisfied with just providing healthcare; the challenges to overcome are to have a positive effect on the quality of life experience in our community. With this in mind, the organization strives to facilitate and share opportunities to educate and motivate a philosophy of wellness. The primary target is the disease process that we know can be eliminated or improved by changing or modifying human behavior. As with any community, the population served has a variety of educational background. The drive is to develop programs that target the needs and understanding of the community. Physicians/Providers are utilized to provide open forums that present health related issues, i.e. arthritis, nephrology, neurology, orthopedic issues, etc. followed by questions and time for individual discussion. This type of program is offered with a free lunch, educational materials, and if appropriate, free screenings, such as glucose or blood pressure. There is an average of 90 participants in each of these seminars. The organization is very community-minded in its efforts to promote health. Staff participates in Health Fairs in the public schools. Flu shots are distributed to community members.At GCRMC, we feel it is important to embrace community needs that promote good citizenship. As an organization we support employee involvement in outside activities through contributions, dedicated time and sponsorship. Administration and staff members serve on community boards, dedicating many hours of support to those organizations. The following classes are provided for the community in our conference room center: Diabetic Education, Narcotics Anonymous, Childbirth Classes, New Baby Class and CPR/Basic Life Support to name a few. GCRMC has been a top supporter of the United Way which provides money for many of the local community organizations. An annual Health Fair is held at the hospital each year. We augment the annual health fair with onsite mini health screenings throughout the year. This is offered to businesses, civic organizations and churches with minimal to no charge. We offer free blood pressure screenings on a walk-in basis with educational materials in both Spanish and English. This allows us to address the high rate of hypertension in our community, its significant effect on other diseases, and an overall wellness picture.GCRMC partners with the American Cancer Society to offer the Look Good Feel Good Program and the Gift Closet. The program is housed off campus in a leased building and has brought a highly valued service to our community. The Gift Closet provides free wigs, prosthesis, supplies, education and support to cancer patients and their families.The opportunity to utilize our speaker's bureau is available to any organization in the community. A presentation regarding health related topics can be prepared with limited notice to meet the needs of the organization. The wealth of knowledge in our organization allows us to create an appropriate fit for the requested need. Part VI, Line 6: n/a Part VI, Line 7, Reports Filed With States NM 1 PMS Chaparral 204 Angelina Chaparral NM 88081 850206810 501(c)(3) 166670 Public Health PMS Alamogordo 1501 Tenth Street Alamogordo NM 88310 850206810 501(c)(3) 70000 Public Health PMS Sacramento Mountain Center POBox 686 Cloudcroft NM 88317 850206810 501(c)(3) 50000 Public Health Zia Therapy-Z Trans 900 First Street Alamogordo NM 88310 850199165 501(c)(3) 31391 Public Health American Cancer Society 2120 First Avenue Alamogordo NM 88310 841316555 501(c)(3) 22748 Public Health United Way 1601 E Tenth Street Suite B Alamogordo NM 88310 850197559 501(c)(3) 38062 Public Health NMHA Auxiliary 7471 Pan American Freeway NE Albuquerque NM 87109 850137980 501(c)(3) 5651 Public Health Otero Economic Development 1301 N White Sands Blvd Alamogordo NM 88310 850304073 501(c)(3) 10000 Public Health GCRMC Foundation 2669 N Scenic Alamogordo NM 88310 850352051 501(c)(3) 200000 Public Health Church of Jesus Christ of Latter-Day Saints El Paso Texas FM GRoup 400 Rosemont Drive El Paso TX 79922 870234341 501(c)(3) 7856 FMV Light bulbs General Operations 8 0 Patient Care Services - Transportation 168 7269 FMV Transportation 65th Celebration Community Participation 30 15683 650 FMV Toys Part I, Line 2: The organization only gave grants to government organizations and tax exempt organizations. X X X 0 0 0 0 0 0 0 0 0 Robert James Heckert CEO 298620 0 64250 0 1524 0 17500 0 3123 0 385017 0 0 0 Bashar Naser CFO 131866 0 9600 0 8117 0 0 0 15667 0 165250 0 0 0 Catherine Rhyne VP of Patient Care/CNO 155619 0 19600 0 2200 0 0 0 9780 0 187199 0 0 0 Arthur Austin MD VP of Medical Affairs 290388 0 9600 0 396 0 0 0 18943 0 319327 0 0 0 Dennis Worthington Physician 388512 0 14028 0 396 0 0 0 18426 0 421362 0 0 0 Charles Race Physician 725062 0 2000 0 258 0 0 0 24552 0 751872 0 0 0 Stefan Korec Physician 484244 0 79428 0 762 0 17500 0 24666 0 606600 0 0 0 William Pollard Physician 344300 0 62916 0 138 0 0 0 25166 0 432520 0 0 0 Anthony Burton Physician 398184 0 2000 0 396 0 0 0 9744 0 410324 0 0 0 A New Mexico Hospital Equipment Loan Council 850426875 647370FS9 2012-09-19 70004797 Hospital imp. including new patient tower; refund bonds issued 11/15/07 0 0 0 A 70011320 5283184 1400096 32310994 31075969 2012 1 0 1 1 A 0 1 0 0 0.02560 0.02560 0 0 1 A 0 0 0 1 0 0 0 0 1 A 1 Date Rebate Computation Performed Issuer Name: New Mexico Hospital Equipment Loan Council Date the Rebate Computation was Performed: 01/09/2014 Schedule K, Part II, Line 11: The other spent proceeds was the amount used to retire the bonds issued in 2007. Schedule K, Part I, Column (e) and Part II, Line 3: The difference between the issue price at Part I Column (e) and the total proceeds of the issue at Part II Line 3 is due to investment earnings on the reserve funds. Alamogordo Surgery Venture LLC Board member Gregory Richardson is the President of the ASV, LLC board 6047410 Performance of services for ASV, LLC 0 Amy Graham Daughter-in-law of board member William Merson 69930 Compensation 0 Form 990, Part III, line 2 Allergy clinic opened April 2015 Form 990, Part VI, Section A, line 1 Joint Finance/Executive Committee consists of the Board Chair, Vice President, Secretary and three other Directors. The Joint Finance/Executive Committee has the authority to act on behalf of the governing body, when specifically arranged. The Board will then ratify the actions in the following Board of Director's meeting. Form 990, Part VI, Section A, line 6 To qualify for membership the applicant must be: A. Natural person, corporations, partnerships or other organized associations. B. Evidenced by certificates of membership, and one certificate of membership shall be issued for each $10.00 contribution to the association. C. Corporations, partnerships and other organized associations holding membership certificates may be represented in the association by members of such corporations, partnerships, or other associations, or other agents designated representative thereof, to one vote. D. Certificates of membership may be transferred upon such terms and conditions as the association may provide. Form 990, Part VI, Section A, line 7a At their annual meeting, the members shall elect persons to fill such vacancies as may exist on the board of trustees. Form 990, Part VI, Section A, line 7b The following matters shall be authorized only after authorization by the board and upon approval of the members: a. Election and removal of trustees. b. Passing upon reports for previous years. c. Transaction business that comes before the meeting. d. Any other matters required by law to be submitted to the membership or which the board determines by resolution to submit. e. Any changes in the Articles of Incorporation. f. Direct board of directors to review corporate bylaws. Form 990, Part VI, Section B, line 11 The return is reviewed by the CEO and CFO prior to filing. Form 990, Part VI, Section B, line 12c Each officer, director, and key employee is required to fill out a conflict of interest disclosure annually. The forms are initially reviewed by the CFO. If any conflicts exist, they are reviewed by the Board of Directors. A person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The CEO reports to GCRMC Board of Directors and his salary is determined by the Board of Directors. The Board used comparative salary data obtained from QHR as well as the Modern Healthcare CEO Salary Survey to access the reasonableness of the compensation. Compensation was last determined June 2015 for FY16. During FY16 GCRMC had a compensation review performed by an independent consulting firm, Coker Group. This review included compensation of officers as well as physicians. The results of the compensation study were presented to and reviewed by the Board. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statement are all available upon request. Form 990, Part IX, line 11g Consultants: Program service expenses 1,115,959. Management and general expenses 791,407. Fundraising expenses 0. Total expenses 1,907,366. Maintenance Contracts: Program service expenses 1,957,032. Management and general expenses 2,088,634. Fundraising expenses 0. Total expenses 4,045,666. Physician Fees: Program service expenses 3,579,424. Management and general expenses 0. Fundraising expenses 0. Total expenses 3,579,424. Agency Personnel: Program service expenses 1,778,682. Management and general expenses 1,949. Fundraising expenses 0. Total expenses 1,780,631. Contract Dept Fees: Program service expenses 2,140,530. Management and general expenses 3,960,653. Fundraising expenses 0. Total expenses 6,101,183. Surgery Center Fee: Program service expenses 6,047,410. Management and general expenses 0. Fundraising expenses 0. Total expenses 6,047,410. Miscellaneous Fees: Program service expenses 2,515,324. Management and general expenses 1,633,962. Fundraising expenses 0. Total expenses 4,149,286. Form 990, Part XI, line 9: ASV Book/K-1 Income Difference -34,662. White Sands Book/K-1 Income Difference -2,517. AIC Book/K-1 Income Difference -2,841. Alamogordo Surgery Venture LLC 2351 25th Street Alamogordo NM 88310 061791828 Outpatient Surgery Center NM N/A Related 749407 140754 1 0 0.40500 1 0 0 0 0 1 0 0 0 0 0 1 0 0 0 1 1 0 0 Alamogordo Surgery Venture LLC F 648000 General Ledger Alamogordo Surgery Venture LLC A 474123 General Ledger Alamogordo Surgery Venture LLC L 6047410 General Ledger Alamogordo Surgery Venture LLC Q 121797 General Ledger