2015-05-08T12:53:29-05:00 2014-06-30 ERNST & YOUNG US LLP TWO NORTH CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2013-07-01 850127924 SAN JUAN REGIONAL MEDICAL CENTER % RICK WALLACE SANJ 5056096110 801 WEST MAPLE STREET Suite FARMINGTON NM 87401 RICK WALLACE PRESIDENT/CEO 2015-05-07 BRENDA D GRIESEMER P00264669 2013 2016-02-25 16:41:14Z RICK WALLACE 801 WEST MAPLE STREET FARMINGTON NM 87401 252352204 false X WWW.SANJUANREGIONAL.COM X 1953 NM SAN JUAN REGIONAL MEDICAL CENTER'S MISSION IS TO PERSONALIZE HEALTH CARE AND CREATE ENTHUSIASM AND VITALITY IN HEALING. 12 10 2039 200 0 0 3035644 3157786 242954451 244551646 4641962 4642772 0 0 250632057 252352204 240526 256000 0 0 149743126 148475216 0 0 0 94412672 97835271 244396324 246566487 6235733 5785717 354024369 358213520 114456461 108857913 239567908 249355607 X SAN JUAN REGIONAL MEDICAL CENTER'S MISSION IS TO PERSONALIZE HEALTH CARE AND CREATE ENTHUSIASM AND VITALITY IN HEALING. false false 230000018 256000 244551646 ALL ACTIVITY IS DIRECTLY RELATED TO PROVIDING PATIENT MEDICAL SERVICES AND QUALITY HEALTH CARE TO THE COMMUNITY AND SURROUNDING RURAL AREAS. SEE SCHEDULE O FOR OVERVIEW AND PROGRAMS. 230000018 true true false true false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false true false false false false false false true true true false false true 104 0 true 2039 true false false false false false false false false false false X 12 10 false false false false true true false true true false false true true true true true true true true true true NM X RICK WALLACE 5056096110 801 WEST MAPLE STREET FARMINGTON NM 87401 CHARLENE SCOTT CHAIRMAN 6.0 0.0 X X 0 0 0 SANDY WILLIAMS CHAIRMAN (THRU 1/14) 6.0 0.0 X X 0 0 0 JANEL M RYAN 1ST VICE CHAIRMAN 6.0 0.0 X X 0 0 0 JEFF BOWMAN 2ND VICE CHAIRMAN (THRU 10/13) 6.0 0.0 X X TONY ATKINSON SECRETARY 6.0 0.0 X X 0 0 0 RONALD ROSEN TREASURER 6.0 0.0 X X 0 0 0 JAMES SHAHEEN TREASURER(THRU 12/13)/DIRECTOR 6.0 0.0 X X 0 0 0 CHARLES HOFFMAN DIRECTOR/CHIEF OF STAFF 40.0 0.0 X 383606 0 29429 BRUCE BLACK DIRECTOR 6.0 6.0 X 0 0 0 RUSSELL FLOREZ DIRECTOR 6.0 0.0 X 0 0 0 BRUCE GLADE DIRECTOR 6.0 6.0 X 0 0 0 HOLLY ABERNATHY DIRECTOR/VICE CHIEF OF STAFF 40.0 0.0 X 20400 0 0 KAREN MORRISON AUXILIARY REPRESENTATIVE 6.0 6.0 X 0 0 0 JACK EBERHARTMD DIRECTOR 6.0 0.0 X 0 0 0 RICHARD MENNING DIRECTOR/AUX. REP.(THRU 12/13) 6.0 6.0 X X CHRISTIAN MOORE DIRECTOR (THRU 8/13) 6.0 0.0 X 0 0 0 RICK WALLACE PRESIDENT/CEO 40.0 2.0 X 544696 0 59775 JOHN BUFFINGTON COO 40.0 0.0 X 374164 0 57565 J MICHAEL PHILIPS CSO 40.0 0.0 X 387254 0 61775 SUZANNE SMITH CHIEF NURSING OFFICER 40.0 0.0 X 256253 0 47396 TIBOR BOCO DOCTOR 40.0 0.0 X 770871 0 38179 EDWARD MAURIN DOCTOR 40.0 0.0 X 683839 0 30529 CHARLES E WILKINS DOCTOR 40.0 0.0 X 649774 0 37679 MARC A FLITTER DOCTOR 40.0 0.0 X 623131 0 39629 LUTHER B III WEATHERS DOCTOR 40.0 0.0 X 595653 0 29429 5289641 0 431385 225 false true false ARAMARK CLINICAL TECHNOLOGIES PO BOX 100401 PASADENA CA 91189 BOP-MED/HOUSEKEEPING 1850336 RESOURCE ANESTHESIOLOGY 10 COMMERCE DRIVE NEW ROCHELLE NY 10801 ANESTHESIA SERVICES 1695684 TOTAL RENAL CARE INC 6000 FELDWOOD COLLEGE PARK GA 30349 DIALYSIS SERVICES 1543975 QUEST DIAGNOSTICS INC 3924 COLLECTION CENTER CHICAGO IL 60693 CLINICAL LAB SVCS 818009 AUTOMATED RECOVERY SYSTEM PO BOX 1680 FARMINGTON NM 874991680 COLLECTIONS 569492 18 66553 3090128 1105 0 3157786 NET PATIENT SERVICE REVENUE 622110 236616431 236616431 0 0 CAFETERIA 722210 1240253 1240253 0 0 MED OFFICE BUILDING BLDG. RENTAL 531120 402739 402739 0 0 ALL OTHER PROGRAM SERVICE REVENUE 900099 6292223 6292223 0 0 244551646 2928958 2928958 0 0 0 0 0 1722985 -9171 1722985 -9171 1713814 1713814 0 0 0 0 252352204 244551646 0 4642772 256000 256000 0 0 0 0 0 0 2562809 0 2562809 0 182389 182389 0 0 111648608 106895538 4753070 0 5077774 4721123 356651 0 21553112 20009194 1543918 0 7450524 7029541 420983 0 0 0 0 0 311900 38020 273880 0 300000 279555 20445 0 54632 0 54632 0 0 0 587180 0 587180 0 23154937 22618447 536490 0 789701 0 789701 0 25756885 24651515 1105370 0 5665626 5279513 386113 0 0 0 0 0 3936188 3813113 123075 0 418237 313884 104353 0 0 0 0 0 784107 701809 82298 0 2361639 2200693 160946 0 0 0 0 0 13758591 12820942 937649 0 3035949 1585992 1449957 0 MEDICAL SUPPLIES 8770574 8768751 1823 0 EQUIP. RENTAL & MAINTENANCE 8149125 7833999 315126 0 246566487 230000018 16566469 0 0 24670405 26462077 5460974 6705416 268630 269010 32411098 36110445 0 0 0 0 1280416 1536185 3725408 3757446 4036014 4593401 308638965 166207189 150339630 142431776 115090897 120915729 8180149 8714457 0 0 0 0 8560748 6717578 354024369 358213520 27447743 25968073 0 0 0 0 57865446 55417257 0 0 0 0 7826941 6559976 0 0 21316331 20912607 114456461 108857913 X 239567908 249355607 0 0 0 0 239567908 249355607 354024369 358213520 5785717 4001982 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false 0 false 0 false 0 false 0 true 44153 false 0 true 10479 54632 false LOBBYING ACTIVITIES SCHEDULE C, PART II-B LINE 1G - SAN JUAN REGIONAL MEDICAL CENTER PAID NEW MEXICO GOVERNMENT AFFAIRS $44,153 FOR A LOBBYIST IN SANTA FE, NEW MEXICO WHO MONITORS NEW MEXICO STATE LEGISLATIVE ISSUES WITH REGARD TO HOSPITAL ISSUES, KEEPS SAN JUAN REGIONAL MEDICAL CENTER APPRISED OF THOSE ISSUES AND TAKES FEEDBACK TO THE STATE LEGISLATURE. LINE 1I - A PORTION OF THE DUES PAID TO HEALTHCARE ASSOCIATIONS BY SAN JUAN REGIONAL MEDICAL CENTER WAS ALLOCABLE TO LOBBYING ACTIVITIES: 1) NEW MEXICO HOSPITALS AND HEALTH SYSTEMS ASSOCIATION - $10,479 5914672 5914672 103430090 32227883 71202207 75878339 45655457 30222882 121642512 88323849 33318663 1773352 1773352 142431776 0 PROFESSIONAL AND GENERAL INSURANCE 9519000 DUE TO THIRD PARTY PAYORS 8465105 ANESTHESIA LIABILITY 2055038 457(F) EXECUTIVE PENSION LIABILITY 873464 20912607 X SCHEDULE D, PART X, LINE 2 ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, PRESCRIBES CRITERIA FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. ASC 740 ALSO PROVIDES GUIDANCE ON DE-RECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. IN ACCORDANCE WITH THIS ACCOUNTING GUIDANCE, MANAGEMENT HAS REVIEWED ITS TAX POSITIONS AND HAS DETERMINED THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS. true true X true X true X true true true false true true 327 483498 483498 0.00200 327 483498 483498 0.00200 26757 797900 797900 0.00320 32 1971557 1971557 0.00800 159909 137559867 100774878 36784989 0.14920 16590 296918 296918 0.00120 203288 140626242 100774878 39851364 0.16160 203615 141109740 100774878 40334862 0.16360 1272498 1272498 0.00520 1272498 1272498 0.00520 true 32843350 8210838 64178153 71078153 -6900000 X true true FOUR CORNERS ASC AMBULATORY SURGERY CENTER 0.38835 0.61165 1 1 SAN JUAN REGIONAL MEDICAL CENTER 801 West Maple Street Farmington NM 87401 www.sanjuanregional.com 6291 X X X SAN JUAN REGIONAL MEDICAL CENTER 1 true X X X X X X X X X 11 true true true X SEE SCHEDULE H, PART V, SECTION C X WWW.SJRRH.COM X X X X X false false true true 200. true 400. true X X X X X X true true X X X X X true false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 3 AS PART OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA), THERE WERE FIVE FOCUS GROUPS HELD AUGUST 17-19TH, 2011. THE FOCUS GROUP PARTICIPANTS INCLUDED 49 KEY INFORMANTS, INCLUDING PHYSICIANS, OTHER HEALTH PROFESSIONALS, BUSINESS LEADERS, AND OTHER COMMUNITY LEADERS. IN ADDITION, ONE GROUP WAS DEDICATED SPECIFICALLY TO THOSE WHO PROVIDE SERVICES TO NATIVE AMERICANS IN THE COMMUNITY. A LIST OF RECOMMENDED PARTICIPANTS FOR THE FOCUS GROUPS WAS PROVIDED BY SAN JUAN REGIONAL MEDICAL CENTER. POTENTIAL PARTICIPANTS WERE CHOSEN BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK, AS WELL AS OF THE COMMUNITY OVERALL. PARTICIPANTS INCLUDED SEVERAL INDIVIDUALS WHO WORK WITH LOW-INCOME, MINORITY OR OTHER MEDICALLY UNDERSERVED POPULATIONS, AND THOSE WHO WORK WITH PERSONS WITH CHRONIC DISEASE CONDITIONS. A NEW CHNA WILL BE CONDUCTED AND COMPLETED IN THE SPRING OF 2015. SCHEDULE H, PART V, SECTION B, LINE 4 SAN JUAN REGIONAL REHABILITATION HOSPITAL INC. SCHEDULE H, PART V, SECTION B, LINE 5A THE CHNA IS AVAILABLE TO THE PUBLIC USING THE FOLLOWING URL: WWW.SANJUANREGIONAL.COM/COMMUNITY-ASSESSMENT SCHEDULE H, PART V, SECTION B, LINE 6I SAN JUAN REGIONAL MEDICAL CENTER HELD A MEETING OF KEY COMMUNITY LEADERS WHO VOTED ON THE TOP SIX HEALTH PRIORITIES: (1) ACCESS TO HEALTHCARE, (2) CANCER, (3) DIABETES, (4) MATERNAL - INFANT - CHILD HEALTH, (5) MENTAL HEALTH, AND (6) NUTRITION & WEIGHT STATUS. THROUGH THE PARTNERSHIP COMMITTEE OF THE BOARD OF DIRECTORS OF SAN JUAN REGIONAL MEDICAL CENTER, ALL PROJECTS FUNDED BY THE COMMITTEE THROUGH THE COMMUNITY REINVESTMENT FUND MUST TIE TO ONE OF THE TOP SIX PRIORITIES IDENTIFIED IN THE CHNA AND PRIORITIZED BY THE KEY COMMUNITY LEADERS. SCHEDULE H, PART V, SECTION B, LINE 7 THE ENTIRE CHNA IDENTIFIED 28 SPECIFIC HEALTH ISSUES. BUDGETARY CONSTRAINTS, TIME AND LACK OF OTHER NECESSARY RESOURCES PREVENTED US FROM ADDRESSING ALL OF THE ISSUES IN THE REPORT. 24 SJRMC CARDIOLOGY 407 S SWARTZ SUITE 202 FARMINGTON NM 87401 MEDICAL CLINIC SJRMC INTERNAL MEDICINE 407 S SCHWARTZ SUITE 201 FARMINGTON NM 87401 MEDICAL CLINIC SJRMC BLOOMFIELD CLINIC 100 N CHURCH STREET BLOOMFIELD NM 87413 MEDICAL CLINIC SAN JUAN NEURODIAGNOSTIC CENTER 407 S SCHWARTZ STE 101 FARMINGTON NM 87401 MEDICAL CLINIC SAN JUAN PEDIATRICS 407 S SCHWARTZ STE 102 FARMINGTON NM 87401 MEDICAL CLINIC FOUR CORNERS NEUROSURGERY 407 S SCHWARTZ STE 101 FARMINGTON NM 87401 MEDICAL CLINIC SJRMC MIDWIFERY CLINIC 655 WEST PINON FARMINGTON NM 87401 MEDICAL CLINIC OUTPATIENT BEHAVIORAL HEALTH CLINIC 555 S SCHWARTZ FARMINGTON NM 87401 MEDICAL CLINIC URGENT CARE CENTER 4820 E MAIN STREET FARMINGTON NM 87402 URGENT CARE CLINIC SJR WOUND CARE CENTER 4251 ENGLISH ROAD FARMINGTON NM 87402 MEDICAL CLINIC SJR CANCER TREATMENT CENTER 731 W ANIMAS STREET FARMINGTON NM 87401 CANCER TREATMENT SJRMC OUTPATIENT DIAGNOSTIC CENTER 2300 E 30TH STREET BLDG C FARMINGTON NM 87401 DIAGNOSTIC CENTER SJRMC EMS STATION - MEDIC #1 730 S LAKE STREET FARMINGTON NM 87401 EMS STATION SJRMC EMS STATION - MEDIC #2 902 W BROADWAY BLOOMFIELD NM 87412 EMS STATION SJRMC EMS STATION - MEDIC #3 484 S OLIVER STREET AZTEC NM 87410 EMS STATION SJRMC EMS STATION - MEDIC #4 4 CR 3660 KIRTLAND NM 87117 EMS STATION SJRMC EMS STATION - MEDIC #5 3782 ENGLISH RD FARMINGTON NM 87402 EMS STATION SJRMC EMS STATION - MEDIC #6 2014 E 16TH STREET FARMINGTON NM 87401 EMS STATION SJRMC EMS STATION - MEDIC #10 737 W ANIMAS STREET FARMINGTON NM 87401 EMS STATION SJRMC AZTEC CLINIC 120 LLANO STREET AZTEC NM 87410 MEDICAL CLINIC GENERAL SURGERY CLINIC 630 W MAPLE FARMINGTON NM 87401 MEDICAL CLINIC SJRMC AUDIOLOGY 816 W MAPLE FARMINGTON NM 87401 AUDIOLOGY CARE AND SERVICES SJRMC OUTPATIENT REHABILITATION 301 S AUBURN AVE FARMINGTON NM 87401 REHABILITATION SJRMC PEDIATRIC OUTPATIENT REHAB 810 W MAPLE FARMINGTON NM 87401 REHABILITATION SCHEDULE H, PART I, LINE 6A AN ANNUAL REPORT IS PREPARED AND MAILED TO THE CITIZENS OF FARMINGTON, AZTEC, AND BLOOMFIELD, NM AS WELL AS THE SURROUNDING COMMUNITIES. IN THE ANNUAL REPORT IS FINANCIAL INFORMATION FOR THE HOSPITAL, STORIES OF CARE, AND INFORMATION ABOUT NEW PROGRAMS OR SERVICES PROVIDED BY THE HOSPITAL. SCHEDULE H, PART I, LINE 7 SJRMC USES A COST ACCOUNTING SYSTEM WHICH IS A PART OF ITS HOSPITAL INFORMATION SYSTEM. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS. SCHEDULE H, PART II, LINE 7E THE AMOUNTS SUMMARIZED INCLUDE PROGRAMS FOR COMMUNITY HEALTH EDUCATION WHICH INCLUDES: HEALTH FAIRS AND HEALTH EDUCATION SEMINARS LACTATION CONSULTATION AND OUTPATIENT DIETITIAN SERVICES SCHEDULE H, PART I, LINE 7G SAN JUAN REGIONAL MEDICAL CENTER PROVIDES NUMEROUS SUBSIDIZED HEALTH SERVICES TO THE COMMUNITY. THESE SUBSIDIZED HEALTH SERVICES ARE: EMERGENCY AND TRAUMA SERVICES 6,594,275 AMBULATORY CARE CENTERS 14,085,139 ORTHOPEDICS 1,697,439 BEHAVIORAL HEALTH-IP 1,999,388 OUTPATIENT NURSING/WOUND CARE 1,882,175 OUTPATIENT THERAPIES 2,255,932 OBSTETRIC/PEDIATRICS 3,176,173 RENAL 2,573,490 ONCOLOGY 1,380,133 OTHER 1,140,845 ------------ TOTAL 36,784,989 SCHEDULE H, PART II THE FEDERAL GOVERNMENT THROUGH HRSA HAS DESIGNATED SAN JUAN COUNTY AS A SHORTAGE AREA FOR PHYSICIANS. IN ORDER TO REDUCE THIS SHORTAGE SAN JUAN REGIONAL MEDICAL CENTER HAS BEEN RECRUITING FOR PHYSICIANS AND IN THIS EFFORT SPENT $1,538,219 IN FY 2014. SCHEDULE H, PART III, LINE 2 THE FOOTNOTE THAT DESCRIBES THE METHODOLOGY USED IN CALCULATING THE BAD DEBT AMOUNT REPORTED ON LINE 2 IS LOCATED ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 3 THE AMOUNT ON LINE 3 IS AN ESTIMATE BASED ON MANAGEMENT'S BELIEF OF THE PERCENTAGE OF ADDITIONAL FINANCIAL ASSISTANCE COST IF THE PATIENTS WOULD COMPLETE THE FINANCIAL ASSISTANCE APPLICATION. THIS AMOUNT IS CURRENTLY ESTIMATED AT 25% WHAT IS INCLUDED IN OUR BAD DEBT. SCHEDULE H, PART III, LINE 4 THE FOOTNOTE THAT DESCRIBES BAD DEBT IS ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, LINE 8 THE AMOUNT OF MEDICARE SHORTFALL REPORTED ON LINE 7 IS $6,900,000 THIS AMOUNT IS A RESULT OF THE TOTAL REVENUE AND ALLOWABLE COST CALCULATION ON OUR FY 14 COST REPORT. THE HOSPITAL'S ACTUAL EXPENSES ARE ENTERED INTO THE COST REPORT SOFTWARE AND THE ALLOWABLE COSTS ARE DETERMINED BY THE MEDICARE REGULATIONS. THIS MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT BECAUSE, ABSENT THIS PROGRAM, MANY INDIVIDUALS WOULD QUALIFY FOR FINANCIAL ASSISTANCE AND OTHER NEEDS-BASED PROGRAMS. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, THE BURDENS OF THE GOVERNMENT ARE RELIEVED, AND THE AMOUNT SPENT TO COVER THE MEDICARE SHORTFALL IS MONEY NOT AVAILABLE TO COVER FINANCIAL ASSISTANCE AND OTHER COMMUNITY BENEFIT NEEDS. SCHEDULE H, PART III, LINE 9B SAN JUAN REGIONAL MEDICAL CENTER'S (SJRMC) POLICY ON PATIENT ACCOUNT COLLECTIONS STATES "SJRMC WILL NOT ATTEMPT TO COLLECT FROM A PATIENT WHO IS APPLYING FOR THE SAN JUAN COUNTY INDIGENT FUND AS LONG AS THE PATIENT IS COOPERATING WITH THE APPLICATION PROCESS." THE POLICY ALSO STATES "SJRMC WILL NOT COLLECT FROM A PATIENT APPLYING FOR THE COMMUNITY SERVICE FUND (FINANCIAL ASSISTANCE) AS LONG AS THE PATIENT IS COOPERATING WITH THE APPLICATION PROCESS." SCHEDULE H, PART VI, LINE 2 A COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IS CONDUCTED BY SAN JUAN REGIONAL MEDICAL CENTER TO DETERMINE THE HEALTH NEEDS FOR SAN JUAN COUNTY-AND THE FOUR CORNERS REGION-AS PERCEIVED BY THOSE SERVED BY THE HOSPITAL. THE CHNA IS CONDUCTED VIA TELEPHONE SURVEYS IN BOTH ENGLISH AND SPANISH; INTERVIEWS CONDUCTED WITH NATIVE AMERICAN RESPONDENTS; KEY SHAREHOLDERS IN THE PROVISION OF HEALTH CARE IN SAN JUAN COUNTY; AND A SERIES OF FOCUS GROUPS. THE SURVEY IS ALSO SHARED WITH KEY COMMUNITY GROUPS IN A SERIES OF OPEN FORUMS. THE MOST RECENT CHNA OCCURRED IN CY 2011 (FY 2012). THE NEEDS WHICH WERE IDENTIFIED FROM THIS SURVEY INCLUDE: CANCER BARRIERS TO ACCESSING HEALTHCARE SERVICES IMMUNIZATION & INFECTIOUS DISEASES DIABETES MENTAL HEALTH OBESITY AND WEIGHT LOSS ORAL HEALTH PRENATAL CARE RESPIRATORY DISEASE ROUTINE CHECKUPS AND PREVENTIVE SCREENINGS SEXUALLY TRANSMITTED DISEASES TEEN BIRTHS AND UNWED MOTHERS UNINTENTIONAL INJURY SUBSTANCE/TOBACCO USE THE SAN JUAN REGIONAL MEDICAL CENTER BOARD OF DIRECTORS AND HOSPITAL ADMINISTRATION CONDUCTS THE SURVEY FOR THE PURPOSE OF DETERMINING HOW BEST TO DIRECT RESOURCES TO IMPROVE THE HEALTH OF THE FOUR CORNERS WITH THREE GOALS IN MIND: - TO IMPROVE RESIDENTS' HEALTH STATUS, INCREASE THEIR LIFE SPANS, AND ELEVATE THEIR OVERALL QUALITY OF LIFE. - TO REDUCE HEALTH DISPARITIES AMONG RESIDENTS BY IDENTIFYING POPULATION SEGMENTS WHO ARE MOST AT-RISK FOR VARIOUS DISEASES AND INJURIES. INTERVENTION PLANS AIMED AT TARGETING THESE INDIVIDUALS ARE ALSO DEVELOPED TO COMBAT SOME OF THE SOCIO-ECONOMIC FACTORS WHICH HAVE HISTORICALLY HAD A NEGATIVE IMPACT ON RESIDENTS' HEALTH. - TO INCREASE ACCESSIBILITY TO PREVENTIVE SERVICES FOR ALL COMMUNITY RESIDENTS. MORE ACCESSIBLE PREVENTIVE SERVICES WILL PROVE BENEFICIAL IN ACCOMPLISHING THE FIRST GOAL (IMPROVING HEALTH STATUS, INCREASING LIFE SPANS, AND ELEVATING QUALITY OF LIFE), AS WELL AS LOWERING THE COSTS ASSOCIATED WITH CARING FOR LATE-STAGE DISEASES RESULTING FROM A LACK OF PREVENTIVE CARE. A NEW CHNA IS BEING COMPLETED IN THE SPRING OF 2015. SCHEDULE H, PART VI, LINE 3 SAN JUAN REGIONAL MEDICAL CENTER EMPLOYS A NUMBER OF FINANCIAL COUNSELORS AND CUSTOMER SERVICE REPRESENTATIVES WHO WORK ALONGSIDE PATIENTS TO HELP THEM NAVIGATE THEIR PAYMENT, BILLING, AND ASSISTANCE OPTIONS. INFORMATION IS DISSEMINATED TO PATIENTS THROUGH ONLINE AND PAPER RESOURCES LOCATED THROUGHOUT THE HOSPITAL. A WIDELY DISTRIBUTED BROCHURE TITLED, "PAYING FOR HOSPITAL SERVICES AT SAN JUAN REGIONAL MEDICAL CENTER," IS SPECIFICALLY DESIGNED TO HELP PATIENTS UNDERSTAND THEIR HOSPITAL BILL AND INFORM THEM OF THEIR OPTIONS FOR PAYMENT AND ASSISTANCE, INCLUDING INFORMATION ON THE AVAILABILITY OF INDIAN HEALTH SERVICE ASSISTANCE, CASH DISCOUNTS, BILL REDUCTION THROUGH A COMMUNITY SERVICE FUND, SPECIAL FUNDS THROUGH THE SAN JUAN COUNTY INDIGENT FUND, OR MEDICAL HARDSHIP WAIVERS. THE HOSPITAL'S VISION IS TO BE KNOWN AS THE MOST PERSONALIZED QUALITY HEALTHCARE PROVIDER. SAN JUAN REGIONAL MEDICAL CENTER IS ALSO A VALUES-DRIVEN ORGANIZATION WITH A CENTURY OF SERVICE TO THE FOUR CORNERS REGION-DRIVEN BY A SIMPLE YET POWERFUL PRINCIPLE: DO THE RIGHT THING FOR THE PATIENT NO MATTER WHAT. AN INTEGRAL PART OF THIS SACRED TRUST THE COMMUNITY HAS IN ITS HOSPITAL IS ENSURING THAT NO PATIENT FEELS ALONE AND DISCONNECTED DURING AND AFTER THEIR TREATMENT. THEREFORE, IT IS IN THE SPIRIT OF THE HOSPITAL'S VISION AND MISSION TO ENSURE THAT PATIENTS RECEIVE A HIGH LEVEL OF ASSISTANCE WHEN FIGURING OUT THEIR BILL AND OPTIONS. NOT ONLY DOES THE HOSPITAL HAVE FINANCIAL COUNSELORS TO EDUCATE ITS PATIENTS, IT HAS AN IN-HOUSE MEDICAL ADVOCACY SERVICE FOR HEALTHCARE PROGRAM ("MASH") FOR SELF-PAY INDIVIDUALS. THROUGH THE MASH PROGRAM, PATIENT ADVOCATES STAND HAND-IN-HAND WITH PATIENTS TO EXPLORE EVERY POSSIBILITY OF ASSISTANCE. POLICY: SAN JUAN REGIONAL MEDICAL CENTER (SJRMC) WILL RENDER FINANCIAL ASSISTANCE TO PERSONS WITH A DEMONSTRATED INABILITY TO PAY, REGARDLESS OF RACE, COLOR OR CREED. FINANCIAL ASSISTANCE REPRESENTS MEDICAL SERVICES PROVIDED TO A PERSON FOR WHICH THE HOSPITAL HAS NO EXPECTATION OF RECEIVING FULL PAYMENT. FINANCIAL ASSISTANCE ELIGIBILITY DOES NOT ALWAYS MEAN THAT A MEDICAL DEBT OWED TO THE HOSPITAL IS COMPLETELY ELIMINATED. THERE MAY BE A RESIDUAL AMOUNT THE PATIENT OR HOUSEHOLD IS EXPECTED TO PAY. PURPOSE: WE RECOGNIZE THAT IT WILL BE NECESSARY TO IDENTIFY THE MEDICALLY INDIGENT PATIENT AND ESTABLISH THE AMOUNT OF FINANCIAL ASSISTANCE TO BE RENDERED IN A MANNER MOST RESPONSIVE TO THE NEEDS OF THE COMMUNITY. SJRMC WILL CLEARLY DISTINGUISH IT FROM BAD DEBT. FINANCIAL ASSISTANCE WILL BE IDENTIFIED AND RECORDED AS SUCH, AS EARLY AS POSSIBLE IN THE REGISTRATION AND COLLECTION PROCESS. AN INDIVIDUAL WHO IS TOO POOR TO MEET HIS OR HER MEDICAL EXPENSES IS GENERALLY CATEGORIZED AS MEDICALLY INDIGENT. THE TERM INCLUDES PEOPLE WHOSE INCOME IS SUFFICIENT TO PAY FOR BASIC LIVING EXPENSES BUT NOT ADEQUATE TO PAY FOR UNEXPECTED OR LARGE MEDICAL BILLS. ELIGIBILITY WILL BE DECIDED ON A CASE-BY-CASE BASIS. WHILE FAMILY SIZE AND HOUSEHOLD INCOME ARE THE PRIMARY DETERMINANTS, OTHER FACTORS, SUCH AS ASSETS NOT REQUIRED TO MAINTAIN A BASIC STANDARD OF LIVING, MAY BE CONSIDERED. FUTURE EARNING CAPACITY MAY ALSO BE CONSIDERED. GENERAL INFORMATION: ELIGIBILITY REQUIREMENTS (ROUTINE DETERMINATIONS) SJRMC WILL USE THE FOLLOWING ELIGIBILITY CRITERIA TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE AT SJRMC. 1. THE PATIENT'S HOUSEHOLD AVERAGE MONTHLY INCOME AND/OR ASSISTANCE FROM ALL SOURCES FOR THE 12-MONTH PERIOD PRIOR TO RECEIVING SERVICES AT SJRMC, DID NOT EXCEED 400% OF THE MONTHLY FEDERAL POVERTY INCOME GUIDELINES. THE NUMBER OF DEPENDENTS AND OTHERS IN THE HOUSEHOLD MUST BE TAKEN INTO ACCOUNT IN MAKING THIS DETERMINATION. * "PATIENT'S HOUSEHOLD INCOME AND/OR ASSISTANCE" INCLUDES ALL FUNDS RECEIVED BY ALL MEMBERS OF THE PATIENT'S HOUSEHOLD THAT SUPPORT THE HOUSEHOLD. SPECIAL RULES PERTAINING TO HOUSEHOLD INCOME APPLY IN SITUATIONS WHERE AN UNMARRIED ADULT IS LIVING IN THE SAME HOME WITH ANOTHER ADULT. * "HOUSEHOLD" IS DEFINED AS ALL DEPENDENTS AND OTHERS WHO LIVE IN THE SAME RESIDENCE AS THE PATIENT AND/OR GUARANTOR. * A "DEPENDENT" IS DEFINED AS A PERSON WHO CAN BE CLAIMED BY THE GUARANTOR AND/OR PATIENT AS A DEPENDENT ON THEIR FEDERAL TAX RETURN. * "OTHERS" IS DEFINED AS A PERSON WHO RESIDES IN THE GUARANTOR AND/OR PATIENT'S RESIDENCE FOR A MINIMUM OF SIX CONSECUTIVE MONTHS DURING A 12-MONTH PERIOD. THE GUARANTOR AND/OR PATIENT MAY OR MAY NOT BE ABLE TO CLAIM THIS PERSON AS A DEPENDENT ON THEIR FEDERAL TAX RETURN. 2. THE PATIENT HAS NO MEDICAL INSURANCE, LIABILITY OR OTHER THIRD-PARTY COVERAGE THAT WILL PAY FOR THE SERVICES THE PATIENT RECEIVED AT SJRMC. RESIDUAL AMOUNTS AFTER ANY THIRD-PARTY PAYMENTS, SUCH AS DEDUCTIBLES, NON-COVERED AMOUNTS, CO-PAYMENTS AND CO-INSURANCE MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE. THE PATIENT MUST BE PERSONALLY RESPONSIBLE FOR PAYING ANY RESIDUAL AMOUNTS NOT COVERED BY A THIRD PARTY. MEDICARE DEDUCTIBLES AND COINSURANCE MAY BE CONSIDERED FOR FINANCIAL ASSISTANCE. 3. THE PATIENT HAS ASSETS AND RESOURCES, EXCLUDING THEIR PRIMARY RESIDENCE AND AUTOMOBILE(S) OF $5,000 OR LESS. RETIREMENT FUNDS WILL NORMALLY BE EXCLUDED AS ASSETS. SJRMC RESERVES THE RIGHT TO REQUIRE THE PATIENT TO BORROW AGAINST OR EVEN LIQUIDATE SOME OR ALL FUNDS EARMARKED FOR RETIREMENT TO SATISFY THE DEBT OWED TO SJRMC. ELIGIBILITY CRITERIA (PRESUMPTIVE DETERMINATIONS): 1. KNOWN CIRCUMSTANCES SURROUNDING A PATIENT'S PERSONAL SITUATION SUPPORT THE CONCLUSION THAT THEY ARE MEDICALLY INDIGENT. IN ADDITION, THE PATIENT IS EITHER UNABLE TO APPLY FOR THE FINANCIAL ASSISTANCE AND/OR TO PROVIDE REQUIRED SUPPORTING DOCUMENTATION TO MAKE A ROUTINE DETERMINATION OF ELIGIBILITY. 2. PRESUMPTIVE FINANCIAL ASSISTANCE MAY ALSO BE APPROVED IN SITUATIONS WHERE THE PATIENT HAS A "MEDICAL HARDSHIP". A MEDICAL HARDSHIP IS WHERE THE PATIENT DOES NOT MEET THE USUAL CRITERIA TO QUALIFY FOR A FINANCIAL ASSISTANCE ADJUSTMENT BASED ON BEING MEDICALLY INDIGENT. HOWEVER, THEIR DEBT FOR A PARTICULAR MEDICAL EVENT, TO INCLUDE THE DEBT OF OTHER PROVIDERS BESIDES SJRMC, IS PROHIBITIVE BASED ON THEIR AVAILABLE INCOME AND ASSETS AS WELL AS THEIR FUTURE EARNING CAPACITY. MEDICAL HARDSHIP IS DEFINED AS A SITUATION WHERE THE CUMULATIVE MEDICAL DEBTS FOR ONE EPISODE OF CARE EXCEEDS 30% OF THE VALUE OF THE PATIENT'S (OR GUARANTOR, IF PATIENT IS A MINOR OR INCOMPETENT) AVAILABLE INCOME AND ASSETS NOT ESSENTIAL TO A BASIC LIFESTYLE FOR THE 12 MONTHS PRIOR TO THE MEDICAL EVENT. AN "EPISODE OF CARE" BEGINS WITH SERVICES BEING PERFORMED AT SJRMC AND ENDS THE SOONER OF A) SIX MONTHS AFTER THE INITIAL DATE OR B) DISCHARGE FROM AN INPATIENT STAY. THE SERVICES PROVIDED MAY BE FOR MORE THAN ONE ILLNESS OR INJURY AS LONG AS THE SERVICES ARE FOR THE SAME PATIENT. PROCEDURE: 1. A REPRESENTATIVE FROM THE BILLING DEPARTMENT WILL REVIEW THE APPLICATION AND SUBMIT ACCOUNTS FOR REVIEW THAT MEET THE ELIGIBILITY REQUIREMENTS. 2. REVIEW WILL BE PROVIDED BY THE EXECUTIVE DIRECTOR, COORDINATOR OF CASE MANAGEMENT, AND A REPRESENTATIVE FROM THE FINANCIAL DEPARTMENT. ALL ELIGIBLE APPLICATIONS FOR FINANCIAL ASSISTANCE WILL BE CONSIDERED BASED ON INDIVIDUAL MERITS. A. APPROVAL FOR LESS THAN $20,000 WILL BE DECIDED AT THIS LEVEL. B. CASES WITH AMOUNTS GREATER THAN $20,000 WILL BE SUBMITTED WITH COMMITTEE RECOMMENDATIONS FOR APPROVAL OR DENIAL OF FINANCIAL ASSISTANCE FUNDS TO THE BOARD OF DIRECTORS FOR THEIR FINAL DECISION. 3. APPROVED FINANCIAL ASSISTANCE ALLOWANCES WILL BE REPORTED TO THE BOARD OF DIRECTORS. 4. THE FINANCE DEPARTMENT WILL DO THE NECESSARY ADJUSTMENTS AND NOTIFICATIONS TO THE PATIENT. SCHEDULE H, PART VI, LINE 4 SAN JUAN REGIONAL MEDICAL CENTER SERVES THE FOUR CORNERS REGION OF THE UNITED STATES, WHICH IS MOSTLY RURAL. THE HOSPITAL IS LOCATED IN THE REGION'S LARGEST CITY AND ONLY METROPOLITAN AREA, WHICH IS FARMINGTON, NEW MEXICO. OTHER CITIES IN THE REGION INCLUDE CORTEZ AND DURANGO IN COLORADO; MONTICELLO AND BLANDING IN UTAH; KAYENTA AND CHINLE IN ARIZONA; AND SHIPROCK, AZTEC, AND BLOOMFIELD IN NEW MEXICO. THIS REGION ALSO INCLUDES THE NAVAJO NATION. STATISTICS GATHERED FOR THE HOSPITAL'S COMMUNITY NEEDS ASSESSMENT IN 2011 FOR SAN JUAN COUNTY (POPULATION 130,044)-WHICH IS THE PRINCIPAL COUNTY SERVED BY SAN JUAN REGIONAL MEDICAL CENTER-INDICATE THE FOLLOWING POPULATION CHARACTERISTICS: MEN: 49.6% WOMEN: 50.4% AGES 18 AND UNDER: 29% AGES 65+: 10.8% WHITE: 51.6% AMERICAN INDIAN & ALASKA NATIVE: 36.6% HISPANIC: 19.1% THE MEDIAN HOUSEHOLD INCOME FOR SAN JUAN COUNTY IS $46,007. SCHEDULE H, PART VI, LINE 5 IN THE CONSTANT EFFORT TO MEET COMMUNITY NEEDS, SJRMC SEEKS TO IMPROVE PHYSICIAN ACCESS THROUGH A VIGOROUS RECRUITING PROGRAM AND TO PROVIDE COMMUNITY EDUCATION AND MANY OTHER COMMUNITY BENEFIT PROGRAMS. IN FISCAL YEAR 2014, SAN JUAN REGIONAL MEDICAL CENTER PROVIDED BENEFITS TO THE POOR AND THE BROADER COMMUNITY OF OVER $41 MILLION. PROGRAM PERSONS SERVED COMMUNITY BENEFIT TRADITIONAL FINANCIAL ASSISTANCE 327 483,498 COMMUNITY HEALTH EDUCATION 20,566 366,923 DIABETES EDUCATION AND SUPPORT PROGRAMS 1,248 270,607 COMMUNITY FLU VACCINES 4,040 11,175 HEALTH PROFESSIONS EDUCATION: PHYSICIANS AND MEDICAL STUDENTS 32 1,388,154 NURSES/NURSING STUDENTS 20 583,403 SUBSIDIZED HEALTH SERVICES: EMERGENCY SERVICES 54,142 6,594,275 WOMEN'S AND CHILDREN SERVICES 3,472 3,176,173 BEHAVIORAL HEALTH SERVICES 439 1,999,388 OUTPATIENT SERVICES 98,595 18,223,246 OTHER SUBSIDIZED HEALTH SERVICES 3,261 6,791,907 FINANCIAL CONTRIBUTIONS 16,590 296,918 OTHER COMMUNITY SERVICES 2,151 149,195 --------- ------------- TOTAL 204,883 40,334,862 true SAN JUAN UNITED WAY 903 W APACHE FARMINGTON NM 87401 850165322 501(c)(3) 103867 0 COUNSELING FOR VICTIMS OF SEXUAL ASSAULT SAN JUAN COLLEGE FOUNDATION 4601 COLLEGE BLVD FARMINGTON NM 87401 237272197 501(c)(3) 55000 0 BRING HEALTH EDUCATION TO THE LOCAL AREA SEXUAL ASSAULT SERVICES 622 W MAPLE STE H FARMINGTON NM 87401 203187125 501(C)(3) 32500 PROGRAM SUPPORT Galloping Goose Historical Society PO BOX 297 FARMINGTON NM 81323 742501656 501(C)(3) 6000 PROGRAM SUPPORT 4 SCHEDULE I, PART 1, LINE 2 EVENT FUNDING/SPONSORSHIP REQUEST GUIDELINES SAN JUAN REGIONAL MEDICAL CENTER (SJRMC) RECOGNIZES THE VALUE OF COMMUNITY PARTNERSHIPS AND, ON A LIMITED BASIS, OFFERS SUPPORT TO ITS COMMUNITY PARTNERS BY SHARING OUR RESOURCES INCLUDING THE TIME AND TALENT OF OUR PHYSICIANS AND EMPLOYEES, AS WELL AS OUR FINANCIAL AND IN-KIND SUPPORT. SAN JUAN REGIONAL MEDICAL CENTER HAS ESTABLISHED CRITERIA TO ENSURE ALIGNMENT WITH OUR MISSION AND TO ALLOW US TO STRATEGICALLY FOCUS OUR LIMITED RESOURCES IN ORDER TO MAXIMIZE THEIR IMPACT. SPONSORSHIP REQUESTS ARE EVALUATED BASED ON, BUT NOT LIMITED TO, THE FOLLOWING CRITERIA: - ALIGNMENT WITH SJRMC'S MISSION: TO PERSONALIZE HEALTHCARE AND CREATE ENTHUSIASM AND VITALITY IN HEALING. - ALIGNMENT AND OPPORTUNITY TO PROMOTE STRATEGIC SERVICE LINES AND BUSINESS OBJECTIVES - COMMUNITY AND NEIGHBORHOOD DEVELOPMENT - MAGNITUDE OF IMPACT AND REACH (NUMBER OF INDIVIDUALS SERVED) - DEPTH AND BREADTH OF PARTNERSHIP WITH REQUESTING ORGANIZATION ALL REQUESTS MUST BE RECEIVED AT LEAST 4 WEEKS IN ADVANCE OF THE SPONSORSHIP DEADLINE. SPONSORSHIP REQUESTS ARE REVIEWED THROUGH OUR MARKETING DEPARTMENT. THE REQUEST SHOULD PROVIDE APPROPRIATE AND COMPLETE DETAILS REGARDING THE SPONSORSHIP REQUEST. PLEASE BE PREPARED TO PROVIDE THE ADDITIONAL INFORMATION ABOUT YOUR REQUEST, IF NEEDED. SPONSORSHIP REQUESTS OF MORE THAN $3,000 MUST BE REVIEWED BY THE PARTNERSHIP COMMITTEE OF SJRMC'S BOARD OF DIRECTORS. I. APPLICANT INFORMATION: - MUST BE WRITTEN ON OFFICIAL LETTERHEAD - NAME OF PERSON OR ORGANIZATION REQUESTING FUNDING AND/OR SPONSORSHIP - NAME, EMAIL ADDRESS, AND PHONE NUMBER OF PRIMARY CONTACT FOR THE REQUEST/ INDIVIDUAL FILLING OUT THE REQUEST II. EVENT DETAILS: 1. DESCRIPTION (250 WORDS MAXIMUM): - DESCRIBE HOW THE EVENT BEING SPONSORED RELATES TO SJRMC'S MISSION - DESCRIBE THE PURPOSE OF THE EVENT BEING SPONSORED AND THE TARGET AUDIENCE 2. LOGISTICS: - IF AVAILABLE, PROVIDE THE TITLE, DATE, AND TIME OF THE EVENT - IF AVAILABLE AND APPLICABLE, LIST THE PROPOSED EVENT LAYOUT (E.G., PANEL, CONFERENCE, SEMINAR, ETC.) AND AGENDA FOR THE EVENT 3. FUNDING: - INDICATE AMOUNT REQUESTED FROM SJRMC - DESCRIBE THE EXPENSES SJRMC'S FUNDS WILL BE USED TO COVER - PROVIDE WHAT OTHER ORGANIZATIONS ARE SUPPORTING YOUR EVENT (INDICATING AMOUNTS REQUESTED, WHICH ARE PENDING, AND WHICH ARE CONFIRMED) - WHAT WILL SJRMC RECEIVE IN EXCHANGE FOR ITS CONTRIBUTION PLEASE SUBMIT ALL MATERIALS TO: MARKETING MANAGER C/O SAN JUAN REGIONAL MEDICAL CENTER 657 WEST MAPLE STREET FARMINGTON, NM 87401. X X X X false true false false false false false false false CHARLES HOFFMAN DIRECTOR/CHIEF OF STAFF 332638 0 44286 0 6682 0 7650 0 21779 0 413035 0 0 0 RICK WALLACE PRESIDENT/CEO 419837 0 107104 0 17755 0 51101 0 8674 0 604471 0 0 0 JOHN BUFFINGTON COO 280182 0 77314 0 16668 0 35832 0 21733 0 431729 0 0 0 J MICHAEL PHILIPS CSO 289353 0 80721 0 17180 0 37496 0 24279 0 449029 0 0 0 SUZANNE SMITH CHIEF NURSING OFFICER 184218 0 53246 0 18789 0 25617 0 21779 0 303649 0 0 0 TIBOR BOCO DOCTOR 743812 0 10000 0 17059 0 16400 0 21779 0 809050 0 0 0 EDWARD MAURIN DOCTOR 680829 0 3010 0 0 0 8750 0 21779 0 714368 0 0 0 CHARLES E WILKINS DOCTOR 603274 0 30000 0 16500 0 15900 0 21779 0 687453 0 0 0 MARC A FLITTER DOCTOR 604300 0 1090 0 17741 0 17850 0 21779 0 662760 0 0 0 LUTHER B III WEATHERS DOCTOR 565414 0 30120 0 119 0 7650 0 21779 0 625082 0 0 0 SCHEDULE J, PART I, LINE 4B SAN JUAN REGIONAL MEDICAL CENTER HAS A 457(F) DEFERRED COMPENSATION PLAN THAT ALLOWS CERTAIN EXECUTIVES TO CONTRIBUTE MONEY ON A PRE-TAX BASIS INTO INVESTMENTS AND TO ACCUMULATE TAX-DEFERRED EARNINGS. THE FOLLOWING PRE-TAX CALENDAR YEAR 2013 CONTRIBUTIONS TO THE 457(F) PLAN ARE INCLUDED IN SCHEDULE J, PART II, COLUMN (C) AS DEFERRED COMPENSATION: JOHN BUFFINGTON $ 17,982 J. MICHAEL PHILIPS $ 19,646 SUZANNE SMITH $ 10,242 RICK WALLACE $ 33,251 SUPPLEMENTAL COMPENSATION INFORMATION MANAGEMENT INCENTIVE PLAN SAN JUAN REGIONAL MEDICAL CENTER (SJRMC) HAS A SENIOR MANAGEMENT INCENTIVE COMPENSATION PLAN FOR SELECTED SENIOR MANAGEMENT POSITIONS. AN AWARD TARGET IS ESTABLISHED FOR EACH PARTICIPANT. PERFORMANCE IS BASED ON EIGHT GOALS, TWO OF WHICH ARE HOSPITAL EXCESS OF REVENUES OVER EXPENSES PERCENTAGE AND TOTAL HOSPITAL EARNINGS. THE AWARD IS A PERCENTAGE OF BASE PAY IF CERTAIN TARGETS ARE MET. SUPPLEMENTAL COMPENSATION INFORMATION SCHEDULE J, PART II THE COMPENSATION REPORTED IN PART VII FOR HOLLY ABERNATHY, MD IS FOR A DIRECTORSHIP, NOT FOR SERVICES RENDERED AS A BOARD MEMBER. THE COMPENSATION REPORTED FOR CHARLES HOFFMAN MD IS FROM HIS CURRENT EMPLOYMENT, NOT FOR SERVICES RENDERED AS A BOARD MEMBER. A CITY OF FARMINGTON NM - 2004A 856000129 311428AZ9 2004-03-25 16982883 CONSTRUCTION OF TOWER/NEW EQUIP false false false B CITY OF FARMINGTON NM - 2007A 856000129 311428BNS 2007-06-28 12290518 CONSTRUCTION OF CANCER TRMT CENTER false false false C NM HOSPITAL EQUIPMENT LOAN COUNCIL - 2010A2010 840426875 2010-12-21 25773000 REFUND 2004B; FINANCE EQUIP/CONST false false false D NM HOSPITAL EQUIPMENT LOAN COUNCIL - 2010B 840426875 647370FK6 2010-12-21 8800000 CONST MOB PERD/NEURO false false false A 2260000 0 17087788 0 0 0 339658 0 0 16748130 0 0 2007 false false true true B 2605000 0 12457932 0 151201 0 245810 0 0 12212122 0 0 2010 false false true true C 3338676 0 25773063 0 0 0 205429 0 0 25567634 0 0 2011 true false true true D 490000 0 8800248 0 13498 0 13200 0 0 8800495 0 0 2011 false false true true A false false false false 0 false false false true B false false false false 0 false false false true C false false false false 0 false false false true D false false false false 0 false false false true A true false false 0 false 0 false true B true false false 0 false 0 false true C false true false false false false 0 false 0 false true D false true false false true false 0 false 0 false true A true B true C true D true . SCHEDULE K, PART II, LINE 3, COLUMN A-D THE EXCESS OF "TOTAL PROCEEDS" OVER "ISSUE PRICE" IS DUE TO INVESTMENT EARNINGS. SCHEDULE K, PART I, LINE C THE 2010 LEASE PROJECT OBLIGATION PORTION OF THIS ISSUE IN THE AMOUNT OF $8,103,000 HAS NOT BEEN DESIGNATED AS A QUALIFIED TAX-EXEMPT OBLIGATION. THESE ARE BUILD AMERICA BONDS. ANNA BUFFINGTON JOHN BUFFINGTON / COO 124041 EMPLOYEE PAY false ERIC BUFFINGTON JOHN BUFFINGTON / COO 58348 EMPLOYEE PAY false FORM 990, PART I, LINE 6 SJRMC HAS A TOTAL OF 200 VOLUNTEERS THAT PROVIDE SERVICE TO THE FOLLOWING AREAS: ADMINISTRATIVE SUPPORT, CANCER TREATMENT CENTER, CARDIAC REHABILITATION, COURIER/PATIENT TRANSPORT, CRAFTY CREATIONS, DIETARY, GIFT MARKET, INFORMATION DESK, MAIL CALL, MEDICAL RECORDS AND AUXILIARY MEMBERSHIP. FORM 990, PART III, LINE 4 SAN JUAN REGIONAL MEDICAL CENTER (SJRMC) IS A MODERN ACUTE-CARE HOSPITAL LOCATED IN ONE OF THE MOST RURAL AREAS OF THE AMERICAN SOUTHWEST: SAN JUAN COUNTY, NM. A 2010 ESTIMATE OF THE POPULATION OF SAN JUAN COUNTY SHOWS THE COUNTY POPULATION HAS GROWN 14.3% FROM THE YEAR 2000 TO 2010 AND NOW NUMBERS APPROXIMATELY 130,044; 37% OF WHICH IS AMERICAN INDIAN AND ALASKA NATIVE PERSONS. SJRMC IS A SOLE COMMUNITY PROVIDER AND DISPROPORTIONATE SHARE HOSPITAL PROVIDING NEEDED HEALTHCARE TO RESIDENTS OF THE FOUR CORNERS REGION OF NEW MEXICO, ARIZONA, UTAH AND COLORADO. SAN JUAN REGIONAL MEDICAL CENTER'S MISSION IS TO PERSONALIZE HEALTHCARE AND CREATE ENTHUSIASM AND VITALITY IN HEALING. OUR CORE VALUES ARE ACTIVELY TAUGHT, AND REINFORCED, TO STAFF, MANAGEMENT AND PHYSICIANS SO THAT THE ORGANIZATION MAY ACHIEVE EXCELLENCE AND CONSISTENCY IN PATIENT CARE. SJRMC IS A COMMUNITY GOVERNED HOSPITAL THAT WAS FOUNDED IN 1910 BY DRS. A. M. SMITH AND G. W. SAMMONS. THE HOSPITAL CORPORATION IS AN ADVISORY BODY COMPOSED OF UP TO THREE REPRESENTATIVES FROM EACH OF 90 NON-PROFIT ORGANIZATIONS IN SAN JUAN COUNTY. THE CORPORATION MEETS QUARTERLY, AND, AT THEIR ANNUAL MEETING, THEY NOMINATE AND ELECT 9 MEMBERS TO THE GOVERNING BOARD OF DIRECTORS. THE CORPORATION RECEIVES REPORTS FROM THE BOARD OF DIRECTORS AND HOSPITAL ADMINISTRATION ON HOSPITAL OPERATIONS INCLUDING QUALITY AND FINANCE AND PROVIDES FEEDBACK ON COMMUNITY HEALTH ISSUES. SJRMC PROVIDES MEDICAL, SURGICAL, PEDIATRICS, ONCOLOGY, OBSTETRICS, CARDIOLOGY, AND BEHAVIORAL HEALTH INPATIENT CARE. AMBULATORY CARE INCLUDES DAY SURGERY, URGENT CARE, OUTPATIENT DIAGNOSTIC AND TREATMENT SERVICES. SJRMC IS A LEVEL III TRAUMA CENTER THAT PROVIDES GROUND AMBULANCE AND AIR AMBULANCE SERVICE WITH A HELICOPTER AND A FIXED WING AIRCRAFT AS WELL AS SERVICES THROUGH ITS EMERGENCY DEPARTMENT TO ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY. SOME OF OUR OUTPATIENT SERVICES ARE PHYSICIAN CLINICS SPECIALIZING IN CARDIOLOGY, BEHAVIORAL HEALTH, INTERNAL MEDICINE, NEUROSURGERY, NEURODIAGNOSTICS, URGENT CARE CENTER AND PEDIATRICS. OUR FINANCIAL AND IN-KIND CONTRIBUTIONS WENT TO VARIOUS LOCAL CHARITIES SUCH AS NAVAJO MINISTRIES, FAMILY CRISIS CENTER, LOCAL SCHOOL DISTRICTS, SENIOR CENTERS AND TOTAH BEHAVIORAL HEALTH. THE OTHER COMMUNITY SERVICES NOTED ABOVE PROVIDE CARE FOR: SURGERY, GASTROINTESTINAL, ORTHOPEDICS, ONCOLOGY, NEURO AND CARDIAC REHAB. FORM 990, PART VI, LINES 6 AND 7A SAN JUAN REGIONAL MEDICAL CENTER IS A COMMUNITY-GOVERNED HOSPITAL. THE HOSPITAL CORPORATION IS AN ADVISORY BODY COMPOSED OF TWO REPRESENTATIVES FROM ABOUT 90 NON-PROFIT ORGANIZATION MEMBERS IN SAN JUAN COUNTY. AFTER TEN YEARS OF SERVICE AS A REPRESENTATIVE, AN INDIVIDUAL MAY BE DESIGNATED BY THE CORPORATION AS A SENIOR CORPORATE DELEGATE AND SHALL NO LONGER BE CONSIDERED TO BE THE REPRESENTATIVE OF THE MEMBER ORGANIZATION. THE MEMBER ORGANIZATION MAY THEN DESIGNATE ANOTHER REPRESENTATIVE IN ADDITION TO THE SENIOR CORPORATE DELEGATE. THE HOSPITAL CORPORATION MEETS QUARTERLY. AT THEIR ANNUAL MEETING, THEY NOMINATE AND ELECT NINE VOTING MEMBERS TO SJRMC'S BOARD OF DIRECTORS. OF THE NINE, THREE MUST BE ELECTED FROM THE MEMBER REPRESENTATIVES OR SENIOR CORPORATE DELEGATES. IN ADDITION TO THE NINE ELECTED DIRECTORS, THE SJRMC CHIEF OF THE STAFF AND VICE CHIEF OF STAFF AND A HOSPITAL AUXILIARY APPOINTEE ALSO SERVE AS SJRMC DIRECTORS FOR A TOTAL OF TWELVE VOTING MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, LINE 11B THE FORM 990 IS PREPARED BY AN OUTSIDE ACCOUNTING FIRM BASED ON DATA PROVIDED BY MANAGEMENT. A DRAFT COPY OF THE 990 IS PROVIDED TO MANAGEMENT FOR REVIEW. A MEETING IS CONDUCTED BY THE ACCOUNTING FIRM TO REVIEW THE RETURN IN DETAIL WITH MANAGEMENT. ANY QUESTIONS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE TO THE RETURN. THE FINAL DRAFT OF THE FORM 990 IS PROVIDED TO THE AUDIT COMMITTEE ALONG WITH A BRIEF EDUCATION SESSION CONDUCTED BY THE ACCOUNTING FIRM TO DISCUSS THE HIGHLIGHTS OF THE FORM. THE FINAL DRAFT OF THE FORM 990 IS THEN PROVIDED TO EACH BOARD MEMBER PRIOR TO FILING. FORM 990, PART VI, LINE 12C SAN JUAN REGIONAL MEDICAL CENTER HAS A CONFLICT OF INTEREST POLICY THAT EACH BOARD MEMBER, OFFICER AND KEY EMPLOYEE IS REQUIRED TO FILL OUT ON AN ANNUAL BASIS. THIS CONFLICT OF INTEREST POLICY SPECIFICALLY ASKS QUESTIONS REGARDING BUSINESS AND PERSONAL RELATIONSHIPS THAT THEY MAY HAVE WITH ANY OTHER BOARD MEMBER, OFFICER AND KEY EMPLOYEE OF ANY BUSINESS THAT DEALS WITH SAN JUAN REGIONAL MEDICAL CENTER OR ANY OF ITS AFFILIATES. IF A CONFLICT IS IDENTIFIED, IT MUST BE REPORTED TO THE COMPLIANCE OFFICER, AND IF IT CONSTITUTES A BREACH OF EMPLOYMENT, IT MAY LEAD TO DISCIPLINARY ACTION. FORM 990, PART VI, LINES 15A & 15B THE BOARD OF DIRECTORS FOR SAN JUAN REGIONAL MEDICAL CENTER USES THE FOLLOWING COMPARABLE DATA WHEN DETERMINING THE COMPENSATION FOR THE CEO AND SENIOR MANAGEMENT; REGIONAL / LOCAL AREA NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS OF COMPARABLE SIZE, NATIONAL NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS OF COMPARABLE SIZE, AND OTHER RELEVANT COMPARATORS (E.G., FOR PROFIT HEALTHCARE AND/OR GENERAL INDUSTRY ORGANIZATIONS) OF COMPARABLE SIZE AND COMPLEXITY, ONLY WHEN COMPETITIVE CIRCUMSTANCES WARRANT THESE MARKETS. ADDITIONALLY, THE BOARD BI-ANNUALLY HAS AN INDEPENDENT OUTSIDE FIRM COMPARE THE CEO'S COMPENSATION WITH OTHER HEALTHCARE ORGANIZATIONS TO REMAIN COMPETITIVE. THE PROCESS WAS LAST COMPLETED IN 2012. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES WHEN PRESENTED TO THEM. FORM 990, PART VI, LINE 19 SAN JUAN REGIONAL MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SAN JUAN HEALTH PARTNERS 801 WEST MAPLE STREET FARMINGTON NM 87401 272367549 HEALTHCARE NM 501(c)(3) 3 SJRMC true SAN JUAN REGIONAL RHABILITATION HOSPITAL 525 SOUTH SCJWARTZ 2 FARMINGTON NM 87401 850441767 HEALTHCARE NM 501(c)(3) 3 SJRMC true AUXILIARY OF SAN JUAN REGIONAL MED CTR 801 WEST MAPLE STREET FARMINGTON NM 87401 237164296 HOSP. SUPPORT NM 501(C)(3) 11C, III-FI NA false ROBERT W UMBACH CANCER FOUNDATION PO BOX 110 FARMINGTON NM 87499 912082876 CANCER SUPP. NM 501(C)(3) PF SJRMC true SJR HOLDING COMPANY INC 801 W MAPLE STREET FARMINGTON NM 87401 201126483 SUPPORT SERVICES NM SJRMC C Corp 428146 1475061 1.00000 true false false true false false true false false false false false false false false false false true false false SJR HOLDING COMPANY INC F 180000 CASH SAN JUAN REGIONAL REHABILITATION CENTER Q 237799 COST SAN JUAN REGIONAL REHABILITATION CENTER Q 144000 FAIR VALUE AUXILIARY OF SAN JUAN REGIONAL MED CTR C 66553 CASH