2012-05-01T15:52:50-05:00 2011-06-30 ERNST & YOUNG US LLP TWO NORTH CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2010-07-01 850127924 SAN JUAN REGIONAL MEDICAL CENTER SANJ 5053255011 801 WEST MAPLE STREET FARMINGTON NM 87401 RICK WALLACE 2012-05-01 6023223000 2010 2016-02-24 21:20:13Z RICK WALLACE 801 WEST MAPLE STREET FARMINGTON NM 87401 271947840 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 1961 196 1854979 158477 1541754 3330805 251696747 263233116 3294619 5289552 0 0 256533120 271853473 497882 545532 0 0 123698748 139489221 0 0 0 112050508 120915820 236247138 260950573 20285982 10902900 307589892 333796571 94585208 106809500 213004684 226987071 X SAN JUAN REGIONAL MEDICAL CENTER'S MISSION IS TO PERSONALIZE HEALTH CARE AND CREATE ENTHUSIASM AND VITALITY IN HEALING. false false 240669458 0 261378137 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. 240669458 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 true true true true false false false false true true true false false true 415 0 true 1961 true true true false false false false false false false false false X 12 10 true false false false true true false true true false false true true true true true true true true false NM X J MICHAEL PHILIPS 5056096025 801 WEST MAPLE STREET FARMINGTON NM 87401 X MICHAEL JAKINO 6.0 X X 0 0 0 SANDY WILLIAMS 6.0 X X 0 0 0 NORMAN TUCKER 6.0 X X 0 0 0 RONALD CALCOTE MD 6.0 X X 9728 0 0 JAMES SHAHEEN 6.0 X X 0 0 0 JOSEPH RASOR 6.0 X 0 0 0 JEFF BOWMAN 6.0 X 0 0 0 PAUL DESHAYES 6.0 X 0 0 0 CHARLENE SCOTT 6.0 X 0 0 0 DWAYNE GIBBS MD 6.0 X 133799 0 0 CHARLES HOFFMAN MD 40.0 X 380675 0 25454 RICHARD MENNING 6.0 X 0 0 0 SARA KAYNOR 6.0 X 0 0 0 RICK WALLACE 40.0 X 372555 0 46052 JOHN BUFFINGTON 40.0 X 439855 0 57647 J MICHAEL PHILIPS 40.0 X 362033 0 52594 SUZANNE SMITH 40.0 X 233597 0 40604 EDWARD MAURIN MD 40.0 X 639987 0 33704 CHARLES WILKINS MD 40.0 X 626454 0 32839 LUTHER WEATHERS III MD 40.0 X 555147 0 25372 ROBERT SPRUNG MD 40.0 X 466359 0 25614 MARC FLITTER MD 40.0 X 574608 35254 4794797 0 375134 187 false true false OKLAND CONSTRUCTION 1099 MAIN ST DURANGO CO 81301 CONSTRUCTION 6312708 FOUR CORNERS ANESTHESIA 1515 E 20TH ST SUITE A FARMINGTON NM 87401 ANESTHESIA SERVICES 1704004 ARAMARK CLINICAL TECHNOLOGIES PO BOX 100401 PASADENA CA 91189 BIOMED/HOUSEKEEPING 1650530 TOTAL RENAL CARE 6000 FELDWOOD COLLEGE PARK GA 30349 DIALYSIS SERVICES 1582955 CREDIT BUREAU OF FARMINGTON 509 E 20TH STREET FARMINGTON NM 87401 COLLECTIONS 811012 27 3054159 276646 254076 3330805 NET PATIENT SERVICES REVENUE 622110 257618575 257618575 MEDICAL OFFICE BLDG. RENTAL 531120 400466 400466 CAFETERIA 722210 1176533 1176533 REFERENCE LABORATORY 621511 1854979 1854979 ALL OTHER PROGRAM SERVICE REVENUE 900099 2182563 2182563 263233116 3822062 3822062 0 0 1460595 101262 94367 1460595 6895 1467490 1467490 0 0 0 0 271853473 261378137 1854979 5289552 545532 545532 0 0 0 2964985 0 2964985 0 157729 157729 0 0 106093384 101789454 4303930 0 4628950 4269924 359026 0 18347428 16955678 1391750 0 7296745 6829865 466880 0 0 257390 40038 217352 0 283775 255473 28302 0 54658 54658 0 0 0 0 433731 0 433731 0 18807030 17084130 1722900 0 668350 56226 612124 0 42415818 39975908 2439910 0 2901886 0 2901886 0 0 3872128 3647817 224311 0 443906 240035 203871 0 0 1187612 976034 211578 0 2555932 2301023 254909 0 0 11802426 10625344 1177082 0 4142408 3775820 366588 BAD DEBT EXPENSE 31088770 31088770 0 0 260950573 240669458 20281115 0 16717138 15379305 10349992 7205526 326970 336523 23398409 28548327 2914691 2696387 3183135 3562331 2441814 3158268 284775795 127856495 146205806 156919300 92506241 106815387 7828155 7365653 1717541 1809564 307589892 333796571 26045028 26039957 60822390 67636747 5385041 10791375 2332749 2341421 94585208 106809500 X 213004684 226987071 213004684 226987071 307589892 333796571 X 10902900 3079487 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 41832 false true 12826 54658 false SCHEDULE C, PART II-B LINE 1G - SAN JUAN REGIONAL MEDICAL CENTER PAID NEW MEXICO GOVERNMENT AFFAIRS $41,832 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 - $8,690 2) AMERICAN HOSPITAL ASSOCIATION - $4,136 5889671 5889671 101526328 27234817 74291511 65946028 33483209 32462819 100578505 67138469 33440036 10835263 0 10835263 156919300 0 DUE TO THIRD PARTY PAYORS 1955158 457(F) EXECUTIVE PENSION LIABILITY 386263 2341421 ASC 740 FOOTNOTE 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 DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. IN ACCORDANCE WITH THIS ACCOUNTING GUIDANCE, MANAGEMENT HAS REVIEWED ALL OPEN TAX YEARS AND HAS DETERMINED THAT THE COMPANY HAS NO SIGNIFICANT UNCERTAIN TAX POSITIONS. true true X true X 400. true X true true true false true true 838 2360042 1455336 904706 0.00390 838 2360042 1455336 904706 0.00390 11525 682794 682794 0.00300 216 981503 981503 0.00430 170655 164264701 133240081 31024620 0.13500 371934 371934 0.00160 182396 166300932 133240081 33060851 0.14390 183234 168660974 134695417 33965557 0.14780 1550 1550 0.00000 2094811 2094811 0.00910 2096361 2096361 0.00910 true 12054758 3013690 57684968 63359062 -5674094 X true true FOUR CORNERS ASC AMBULATORY SURGERY CENTER 0.38000 0.00000 0.62000 1 1 SAN JUAN REGIONAL MEDICAL CENTER

801 West Maple Street Farmington NM 87401

X X X SAN JUAN REGIONAL MEDICAL CENTER 1 21 SJRMC CARDIOLOGY

407 S SCHWARTZ SUITE 201 FARMINGTON NM 87401

MEDICAL CLINIC SJRMC INTERNAL MEDICINE

407 S SCHWARTZ SUITE 101 FARMINGTON NM 87401

MEDICAL CLINIC SJRMC BLOOMFIELD CLINIC

100 N CHURCH STREET BLOOMFIELD NM 87413

MEDICAL CLINIC SAN JUAN NEURODIAGNOSTIC CENTER

2700 FARMINGTON AVENUE SUITE G FARMINGTON NM 87401

MEDICAL CLINIC SAN JUAN PEDIATRICS

622 WEST MAPLE STREET SUITE F FARMINGTON NM 87401

MEDICAL CLINIC FOUR CORNERS NEUROSURGERY

555 S SCHWARTZ AVENUE FARMINGTON NM 87401

MEDICAL CLINIC SJRMC MIDWIFERY CLINIC

655 WEST PINON FARMINGTON NM 87401

MEDICAL CLINIC OUTPATIENT BEHAVIORAL HEALTH CLINIC

1930 SAN JUAN BLVD SUITE K FARMINGTON NM 87401

MEDICAL CLINIC URGENT CARE CENTER

4820 E MAIN STREET FARMINGTON NM 87402

URGENT CARE CENTER SJR WOUND CARE CENTER

4820 E MAIN FARMINGTON NM 87402

WOUND CARE CENTER 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 87410

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 AZTEC NM 87410

Clinic GENERAL SURGERY CLINIC

630 WEST MAPLE FARMINGTON NM 87401

CLINIC PART I, LINE 6A: AN ANNUAL REPORT IS PREPARED AND MAILED TO THE CITIZENS OF FARMINGTON, NM AND 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. 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. PART I, 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 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 2,602,788 AMBULATORY CARE CENTERS 16,031,035 ORTHOPEDICS 2,011,604 ONCOLOGY 47,080 BEHAVIORAL HEALTH-IP 1,227,193 CARDIAC REHAB 283,373 OUTPATIENT NURSING/WOUND CARE 2,073,948 OUTPATIENT THERAPIES 1,192,580 OBSTETRIC/NURSERY 2,260,343 OTHER 3,294,676 ---------- TOTAL 31,024,620 ========== PART I, LINE 7, COLUMN F: THE AMOUNT OF BAD DEBT EXPENSE WHICH IS SUBTRACTED FROM TOTAL EXPENSES IN THE DENOMINATOR FOR DETERMINING BENEFITS AS A PERCENTAGE OF TOTAL EXPENSES FOR THIS COLUMN IS $31,088,770. COMMUNITY BUILDING ACTIVITIES 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 OVER $2,000,000 IN FY 2011. PART III, LINE 4: THERE IS NO FOOTNOTE IN THE ORGANIZATIONS AUDITED FINANCIALS REGARDING BAD DEBT EXPENSE. THE COST OF OUR BAD DEBT EXPENSE WAS CALCULATED USING A COST-TO-CHARGE RATIO. THE AMOUNT IN 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% THAT IS INCLUDED IN THE COST OF BAD DEBT. PART III, LINE 8: THE AMOUNT OF MEDICARE SHORTFALL REPORTED ON LINE 7 IS $(5,674,094). THIS AMOUNT IS A RESULT OF THE TOTAL REVENUE AND ALLOWABLE COST CALCULATION ON OUR FY 11 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. PART III, LINE 9B: SJRMC POLICY ON PATIENT ACCOUNTS 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." NEEDS ASSESSMENT: A COMMUNITY NEEDS ASSESSMENT 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 NEEDS ASSESSMENT IS CONDUCTED VIA TELEPHONE SURVEYS IN BOTH ENGLISH AND SPANISH; INTERVIEWS CONDUCTED WITH NATIVE AMERICAN RESPONDENTS; AND A SERIES OF FOCUS GROUPS. THE SURVEY IS ALSO SHARED WITH KEY COMMUNITY GROUPS IN A SERIES OF OPEN FORUMS. THE MOST RECENT ASSESSMENT 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. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: 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 MASH PROGRAM FOR SELF-PAY INDIVIDUALS. THROUGH THE MASH PROGRAM, PATIENT ADVOCATES STAND HAND-IN-HAND WITH PATIENTS TO EXPLORE EVERY POSSIBILITY OF ASSISTANCE. COMMUNITY INFORMATION: 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 2008 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. PROMOTION OF COMMUNITY HEALTH: IN THE CONSTANT EFFORT TO MEET COMMUNITY NEED, 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 2011, SAN JUAN REGIONAL MEDICAL CENTER PROVIDED BENEFITS TO THE POOR AND THE BROADER COMMUNITY OF OVER $36 MILLION. PROGRAM PERSONS SERVED COMMUNITY BENEFIT TRADITIONAL FINANCIAL ASSISTANCE 490 904,706 COMMUNITY HEALTH EDUCATION 9,526 230,031 DIABETES EDUCATION AND SUPPORT PROGRAMS 1,162 207,275 COMMUNITY FLU VACCINES 857 13,522 HEALTH CARE SUPPORT SERVICES 22,000 231,028 HEALTH PROFESSIONS EDUCATION: PHYSICIANS AND MEDICAL STUDENTS 185 502,995 NURSES/NURSING STUDENTS 31 236,615 SUBSIDIZED HEALTH SERVICES: EMERGENCY SERVICES 21,944 2,603,041 WOMEN'S AND CHILDREN SERVICES 3,514 2,484,500 RENAL DIALYSIS SERVICES 869 158,203 BEHAVIORAL HEALTH SERVICES 816 1,227,193 OUTPATIENT SERVICES 128,617 19,297,563 OTHER SUBSIDIZED HEALTH SERVICES 5,254,120 SAN JUAN UNITED WAY (CORPORATE MATCH) 114,614* FINANCIAL AND IN-KIND CONTRIBUTIONS 50 371,934 OTHER COMMUNITY SERVICES 14,385 2,224,578 ------- --------- TOTAL 204,446 36,061,918 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. true SAN JUAN COLLEGE 4601 COLLEGE FARMINGTON NM 87402 850295969 SCHOOL 55000 PROGRAM SUPPORT - LADIES CHARITY GOLF CLASSIC 5701 TEE DR FARMINGTON NM 87402 742828869 501(C)(3) 7000 PROGRAM SUPPORT - SAN JUAN COLLEGE FOUNDATION 4601 COLLEGE FARMINGTON NM 87402 850295969 501(C)(3) 65000 DEV MEDICAL ASST SAN JUAN ROTARY CLUB P O BOX 2105 FARMINGTON NM 87499 270412204 501(C)(3) 7500 PROGRAM SUPPORT - SAN JUAN COLLEGE 4601 COLLEGE FARMINGTON NM 87402 850295969 SCHOOL 91936 COST EQUIPMENT PROGRAM SUPPORT - SAN JUAN COUNTY FAIR ASSOCIATION PO BOX 187 FARMINGTON NM 874990187 850315651 501(C)(3) 7574 DONATE TO FOOD SAN JUAN UNITED WAY 903 W APACHE FARMINGTON NM 87401 850165322 501(C)(3) 114614 PROGRAM SUPPORT - KNOWLEDGE EQUIPS INC PO BOX 178 AZTEC NM 87410 263130570 501(C)(3) 15000 PROGRAM SUPPORT - FOUR CORNERS PROFESSIONAL CONF 308 N LOCKE FARMINGTON NM 87401 870022801 501(C)(3) 15000 DONATION FOR SAN JUAN ECONOMIC DEVELOPMENT 5101 COLLEGE FARMINGTON NM 87401 850171302 501(C)(3) 11000 PROGRAM SUPPORT - LEADERSHIP NEW MEXICO 320 GOLD SW STE 221 ALBUQUERQUE NM 87102 850437219 501(C)(3) 6000 PROGRAM SUPPORT - MASADA HOUSE 2404 E 20TH ST FARMINGTON NM 87401 264661551 501(C)(3) 30000 PROGRAM SUPPORT - HOPE CHILDRENS FUND PO BOX 110 FARMINGTON NM 87499 850330156 501(C)(3) 15000 PROGRAM SUPPORT - BLOOMFIELD SENIOR CENTER 124 W ASH BLOOMFIELD NM 87413 856004832 501(C)(3) 16000 PROGRAM SUPPORT - SANE 812 W MAPLE FARMINGTON NM 87401 203187125 501(C)(3) 68908 PROGRAM SUPPORT - 15 0 Form 990, Schedule I Description of Organization's Procedures for Monitoring the Use of Grants 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: Roberta Rogers, Marketing Manager c/o San Juan Regional Medical Center 657 West Maple Street Farmington, NM 87401 e-mail: rrogers@sjrmc.net (505) 609-2240 X X X X false true false false false false false true false CHARLES HOFFMAN MD 336333 0 44342 0 0 0 7350 0 18104 0 406129 0 0 0 RICK WALLACE 344468 0 20000 0 8087 0 30744 0 15308 0 418607 0 0 0 JOHN BUFFINGTON 322137 0 101100 0 16618 0 39543 0 18104 0 497502 0 0 0 J MICHAEL PHILIPS 263067 0 82306 0 16660 0 34490 0 18104 0 414627 0 0 0 SUZANNE SMITH 184046 0 48299 0 1252 0 22500 0 18104 0 274201 0 0 0 EDWARD MAURIN MD 627747 0 12240 0 0 0 15600 0 18104 0 673691 0 0 0 CHARLES WILKINS MD 586604 0 23150 0 16700 0 14735 0 18104 0 659293 0 0 0 LUTHER WEATHERS III MD 534940 0 20100 0 107 0 7350 0 18022 0 580519 0 0 0 ROBERT SPRUNG MD 446187 0 20000 0 172 0 7350 0 18264 0 491973 0 0 0 MARC FLITTER MD 567761 6180 667 17150 18104 609862 0 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN SCHEDULE J, PART I, LINE 4B SAN JUAN REGIONAL MEDICAL CENTER HAS A 457F 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 2010 CONTRIBUTIONS TO THE 457(F) PLAN ARE INCLUDED IN SCHEDULEJ, PART II, COL C AS DEFERRED COMPENSATION: RUTH BROOKS $ 6,925 JOHN BUFFINGTON $22,393 THOMAS DEAN $ 8,836 ROBERT FABREY $16,286 DOUGLAS FRARY $ 7,746 WILLIAM NOEL $ 6,720 J. MICHAEL PHILIPS $17,340 SUZANNE SMITH $ 8,014 RICK WALLACE $23,394 CATHERINE ZAHARKO $ 6,391 NON-FIXED PAYMENTS SCHEDULE J, PART I, LINE 7 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 THE COMPENSATION REPORTED FOR DWAYNE GIBBS MD IS FOR A DIRECTORSHIP STIPEND, NOT FOR SERVICES RENDERED AS A BOARD MEMBER. THE COMPENSATION REPORTED FOR RONALD CALCOTE MD IS FOR A MEDICAL DIRECTOR FET PROGRAM, 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. CITY OF FARMINGTON NM - 2007A 856000129 311428BN5 2007-06-28 12290518 CONSTRUCTION OF CANCER TRMT CENTER false false false CITY OF FARMINGTON NM - 2004A 856000129 311428AZ9 2004-03-25 16982883 CONSTRUCTION OF TOWER/NEW EQUIP false false false NM HOSPITAL EQUIPMENT LOAN COUNCIL - 2010A2010 840426875 2010-12-21 25773000 REFUND 2004B; FINANCE EQUP & CONST false false false NM HOSPITAL EQUIPMENT LOAN COUNCIL - 2010B 840426875 647370FK6 2010-12-21 8800000 CONST MOB PEDS/NEURO RETIRE 07B false false false 1135000 0 12457932 0 151201 0 245810 0 0 12212122 0 0 2010 false false true true 540000 0 17087788 0 0 0 339658 0 0 16748130 0 0 2007 false false true true 0 0 25773063 0 0 0 205429 0 0 1714115 0 485064 2011 false false true true 0 0 8800248 0 13498 0 13200 0 0 6446891 0 3523109 2011 true false true true false false false false false 0.00000 0.00000 0.00000 true false false false false false 0.00000 0.00000 0.00000 true false false false false false 0.00000 0.00000 0.00000 true false false false false false 0.00000 0.00000 0.00000 true false false false false false false true false false false false false false false false false false false false true false false false false PART II, LINE 3, COLUMN A-D THE EXCESS OF "TOTAL PROCEEDS" OVER "ISSUE PRICE" IS DUE TO INVESTMENT EARNINGS. 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. ANNA BUFFINGTON JOHN BUFFINGTON / COO 112923 EMPLOYEE PAY false ERIC BUFFINGTON JOHN BUFFINGTON / COO 44806 EMPLOYEE PAY false FOUR CORNERS RADIOLOGY ASSOCIATES RUTH BROOKS/KEY EMPLOYEE 221008 MEDICAL SERVICES false X 1 56355 COST/SELLING PRICE X FIXED ASSETS - SAN JUAN 4 197721 COST/SELLING PRICE 0 false true false VOLUNTEERS FORM 990, PART I, LINE 6 SJRMC HAS A TOTAL OF 196 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. PROGRAM SERVICE ACCOMPLISHMENTS 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. BUSINESS AND FAMILY RELATIONSHIPS FORM 990, PART VI, LINE 2 DWAYNE GIBBS, M.D. AND RONALD CALCOTE, M.D. HAVE A BUSINESS RELATIONSHIP. MEMBERS AND THEIR RIGHTS 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. DESCRIPTION OF PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW FORM 990 FORM 990, PART VI, LINE 11 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. DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST 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. PROCESS FOR DETERMINING COMPENSATION 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 2009. THE PROCESS IS DOCUMENTED IN THE BOARD MINUTES WHEN PRESENTED TO THEM. AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE GENERAL PUBLIC 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. HOURS DEVOTED TO RELATED ORGANIZATIONS PART VII NORMAN TUCKER, JOSEPH RASOR, AND RICHARD MENNING EACH DEVOTED 2 HOURS PER WEEK AS BOARD MEMBERS TO SAN JUAN REGIONAL REHABILITATION HOSPITAL INC, A RELATED TAX-EXEMPT ORGANIZATION. OTHER CHANGES IN FUND BALANCE FORM 990, PART XI, LINE 5 NET UNREALIZED GAIN $3,079,487 SAN JUAN HEALTH PARTNERS INC 801 WEST MAPLE FARMINGTON NM 87401 272367549 INACTIVE NM 501(C)(3) 3 NA SAN JUAN REGIONAL REHABILITATION HOSP 525 SOUTH SCHWARTZ 2 FARMINGTON NM 87401 850441767 HEALTHCARE NM 501(C)(3) 3 NA SJR HOLDING COMPANY INC 801 W MAPLE STREET FARMINGTON NM 87401 201126483 SUPPORT SERVICES NM SJRMC C-CORP 597414 1587850 1.00000 false false true false false false false false false false false false false false false true false false SJR HOLDING COMPANY INC C 500000 SAN JUAN REGIONAL REHABILITATION HOSPITAL P 112524 SAN JUAN REGIONAL REHABILITATION HOSPITAL P 221109