CLAYTON HEALTH SYSTEMS INC: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CLAYTON HEALTH SYSTEMS INC (EIN 85-0442957)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2012-11-13
- IRS object ID
- 201203199349306340
- Schema version
- 2011v1.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-11-13T19:40:31-07:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 202707086 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TCA Partners LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 E Herndon Avenue Suite 211 | AddressLine1 |
| City | Fresno | City |
| State | CA | State |
| ZIP Code | 93720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 850442957 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clayton Health Systems Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | CLAY | NameControl |
| Phone | 5753742585 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 Harding Street | AddressLine1 |
| City | Clayton | City |
| State | NM | State |
| ZIP Code | 88415 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Don Weidemann | Name |
| Title | CEO | Title |
| Phone | 5753742585 | Phone |
| Date Signed | 2012-08-31 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Jeremy Ware | Name |
| PTIN | P00642659 | PTIN |
| Phone | 5594317708 | Phone |
| Date Prepared | 2012-08-10 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
Doing Business As DoingBusinessAs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1 |
Name Of Principal Officer Business NameOfPrincipalOfficerBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1 |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 Harding Street | AddressLine1 |
| City | Clayton | City |
| State | NM | State |
| ZIP Code | 88415 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12701372 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.unioncountygeneral.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1997 | YearFormation |
| State Legal Domicile | NM | StateLegalDomicile |
| Activity Or Mission Description | 25-bed acute care critical access hospital service those in need in rural New Mexico. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 7 | NbrIndependentVotingMembers |
| Total Nbr Employees | 115 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 440182 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 211224 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 11654608 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 12444851 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 10903 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 526673 | OtherRevenuePriorYear |
| Other Revenue Current Year | 45297 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 12632366 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12701372 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 5100631 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5240056 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6614362 | OtherExpensePriorYear |
| Other Expenses Current Year | 5817574 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 11714993 | TotalExpensesPriorYear |
| Total Expenses Current Year | 11057630 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 917373 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 1643742 | RevenuesLessExpensesCY |
| Total Assets BOY | 16023794 | TotalAssetsBOY |
| Total Assets EOY | 16955856 | TotalAssetsEOY |
| Total Liabilities BOY | 10227804 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 9516124 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5795990 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7439732 | NetAssetsOrFundBalancesEOY |
| Mission Description | The organization is a 25-bed acute care critical access hospital serving those in need in rural New Mexico | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 8846102 | Expense |
| Grants | 0 | Grants |
| Revenue | 12444851 | Revenue |
| Description | The organization is a 25 bed acute care critical access hospital serving those in need in rural New Mexico. Union County General Hospital provides services to individuals from Northern New Mexico, Southeastern Colorado, Western panhandle for Oklahoma and western panhandle of Texas. These services include inpatient, outpatient and emergency types of patient care. There were a total of 27,909 visits, including 6,954 at the Clayton Family Practice Clinic. Union County General Hospital is one of the sponsors of an annual county wide health fair where hospital personnel obtain blood samples for testing. 547 patients were drawn at the health fair, at six local businesses, and six surrounding communities. As a result of patients signing up at the Health Fair, two colonoscopies, three mammograms, one blood profile and four bone densities were done. 20 hospital personnel worked 550 hours the month of the health fair and weeks prior to and after to collect blood samples from employees at local businesses and surrounding communities during their work schedule. The Physical & Occupational Therapy departments did taping and gave samples, gaining a few patients. The Radiology Department handed out literature on the various services they provide. | Description |
| Total Of Other Program Service Exp | 0 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Grnt | 0 | TotalOfOtherProgramServiceGrnt |
| Total Of Other Program Service Rev | 0 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 8846102 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 0 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Subject To Proxy Tax | 0 | SubjectToProxyTax |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 0 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 0 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 1 | ReportOtherLiabilities |
| Report Fin48 Footnote | 0 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 1 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 0 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 1 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 0 | TaxExemptBonds |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 0 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 0 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 0 | RelatedEntity |
| Related Org Controlled Entity | 0 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 12 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 115 | NumberOfEmployees |
| Employment Tax Returns Filed | 1 | EmploymentTaxReturnsFiled |
| Unrelated Business Income | 0 | UnrelatedBusinessIncome |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 7 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 1 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 0 | MembersOrStockholders |
| Election Of Board Members | 0 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 0 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 1 | CompensationProcessCEO |
| Compensation Process Other | 1 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | NM | StatesWhereCopyOfReturnIsFiled |
| Other Website | X | OtherWebsite |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5753742585 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 Harding Street | AddressLine1 |
| City | Clayton | City |
| State | NM | State |
| ZIP Code | 88415 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (11 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| Claude C Austin | |||||||
| President | 2 | X | 0 | 0 | 0 | ||
| Ken Cantrell | |||||||
| Director | 2 | X | 0 | 0 | 0 | ||
| Damon Brown | |||||||
| Secretary | 2 | X | 0 | 0 | 0 | ||
| Effie Walker | |||||||
| Director | 2 | X | 0 | 0 | 0 | ||
| Rosie DeHerrera | |||||||
| Vice President | 2 | X | 0 | 0 | 0 | ||
| Della Wetzel | |||||||
| Director | 2 | X | 0 | 0 | 0 | ||
| Dr Daniel Radunsky | |||||||
| Chief of Staff | 40 | 655343 | 0 | 0 | X | ||
| Donald Weidemann | |||||||
| CEO | 40 | 126078 | 0 | 14500 | X | ||
| Stacye Bradley | |||||||
| Director of Nursing | 40 | 100821 | 0 | 5200 | X | ||
| Jesse Jay Fluhman | |||||||
| Nurse Practionioner | 40 | 123023 | 0 | 7800 | X | ||
| Calvin Schuler | |||||||
| Physician | 40 | 189033 | 0 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1194298 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 27500 | TotalOtherCompensation |
| Number Individuals GT100 K | 5 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Yellowstone Insurance Exchange | |||||
| Nashville | Nashville | TN | 37215 | Insurance | 350291 |
| HealthTech Management | |||||
| Brentwood | Brentwood | TN | 37027 | Management and Billing Services | 305527 |
| Dr Patrick DeBaca | |||||
| Clayton | Clayton | NM | 88415 | Surgery Clinic | 283543 |
| Medical Services Network | |||||
| Roswell | Roswell | NM | 88201 | Anethesia Services | 264885 |
| BCBS of NM | |||||
| Chicago | Chicago | IL | 60673 | Health Insurance | 193169 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Federated Campaigns | 0 | FederatedCampaigns |
| Membership Dues | 0 | MembershipDues |
| Fundraising Events | 0 | FundraisingEvents |
| Related Organizations | 0 | RelatedOrganizations |
| Government Grants | 159293 | GovernmentGrants |
| All Other Contributions | 51931 | AllOtherContributions |
| Noncash Contributions | 0 | NoncashContributions |
| Total Contributions | 211224 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Patient Service Revenue, net | Description |
| Business Code | 621400 | BusinessCode |
| Total Revenue Column | 12444851 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12444851 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Total Oth Program Service Revenue TotalOthProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Related Or Exempt Function Income | 0 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 12444851 | TotalProgramServiceRevenue |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 0 | Securities |
| Other | 0 | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrbtns Rprtd Fundraising Events | 0 | CntrbtnsRprtdFundraisingEvents |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 45297 | TotalRevenueColumn |
| Related Or Exempt Function Income | 45297 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 45297 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12701372 | TotalRevenueColumn |
| Related Or Exempt Function Income | 12490148 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $0 | ExclusionAmount |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4314515 | Total |
| Program Services | 3451612 | ProgramServices |
| Management And General | 862903 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 925541 | Total |
| Program Services | 740433 | ProgramServices |
| Management And General | 185108 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 730733 | Total |
| Program Services | 584586 | ProgramServices |
| Management And General | 146147 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1132194 | Total |
| Program Services | 905755 | ProgramServices |
| Management And General | 226439 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 190200 | Total |
| Program Services | 152160 | ProgramServices |
| Management And General | 38040 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 324253 | Total |
| Program Services | 259402 | ProgramServices |
| Management And General | 64851 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 682578 | Total |
| Program Services | 546062 | ProgramServices |
| Management And General | 136516 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 328678 | Total |
| Program Services | 262942 | ProgramServices |
| Management And General | 65736 | ManagementAndGeneral |
Other Expenses OtherExpenses (2 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| Purchased Services | 1572798 | 1258238 | 314560 | 0 |
| Repairs and Maitenance | 351040 | 280832 | 70208 | 0 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 505100 | Total |
| Program Services | 404080 | ProgramServices |
| Management And General | 101020 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 11057630 | Total |
| Program Services | 8846102 | ProgramServices |
| Management And General | 2211528 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1071433 | BOY |
| EOY | 3217143 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 76055 | BOY |
| EOY | 892118 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2054829 | BOY |
| EOY | 1554893 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 313782 | BOY |
| EOY | 339925 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67080 | BOY |
| EOY | 54696 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 12320605 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 1560348 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11269122 | BOY |
| EOY | 10760257 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1171493 | BOY |
| EOY | 136824 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16023794 | BOY |
| EOY | 16955856 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1135955 | BOY |
| EOY | 569852 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8563237 | BOY |
| EOY | 8021416 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 528612 | BOY |
| EOY | 924856 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10227804 | BOY |
| EOY | 9516124 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5795990 | BOY |
| EOY | 7439732 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5795990 | BOY |
| EOY | 7439732 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 16023794 | BOY |
| EOY | 16955856 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 1643742 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
| General Explanation | NA | GeneralExplanation |
Schedule D IRS990ScheduleD
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Book Value | 0 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 11242288 | OtherCostOrOtherBasis |
| Depreciation | 1092243 | Depreciation |
| Book Value | 10150045 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 1078317 | OtherCostOrOtherBasis |
| Depreciation | 468105 | Depreciation |
| Book Value | 610212 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | 0 | InvestmentCostOrOtherBasis |
| Other Cost Or Other Basis | 0 | OtherCostOrOtherBasis |
| Depreciation | 0 | Depreciation |
| Book Value | 0 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 10760257 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Third Party Payor Settlements | Description |
| Amount | $924,856 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 924856 | TotalOfAmounts |
| Total Revenue | 12701372 | TotalRevenue |
| Total Expenses | 11057630 | TotalExpenses |
| Excess Or Deficit For Year | 1643742 | ExcessOrDeficitForYear |
| Net Unrealized GL On Investments | 0 | NetUnrealizedGLOnInvestments |
| Donated Services And Facilities | 0 | DonatedServicesAndFacilities |
| Investment Expenses | 0 | InvestmentExpenses |
| Prior Period Adjustments | 0 | PriorPeriodAdjustments |
| Other | $0 | OtherAmount |
| Total Adjustments | 0 | TotalAdjustments |
| Excess Or Deficit Per FS | 1643742 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 13157537 | TotRevenueEtcAuditedFinclStmt |
| Net Unrealized Gains Investments | 0 | NetUnrealizedGainsInvestments |
| Donated Srvc And Use Of Facilities | 456165 | DonatedSrvcAndUseOfFacilities |
| Recoveries Of Prior Year Grants | 0 | RecoveriesOfPriorYearGrants |
| Other Revenues | 0 | OtherRevenues |
| Revenue Not Rptd F990 | 456165 | RevenueNotRptdF990 |
| Revenue Subtotal | 12701372 | RevenueSubtotal |
| Investment Expenses Not Included | 0 | InvestmentExpensesNotIncluded |
| Other Revenues Not Included | 0 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 0 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12701372 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11513795 | TotExpensesEtcAuditedFinclStmt |
| Donated Services Use Of Facilities | 456165 | DonatedServicesUseOfFacilities |
| Prior Year Adjustments | 0 | PriorYearAdjustments |
| Losses Reported | 0 | LossesReported |
| Other Expenses Included | 0 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 456165 | ExpensesNotRptdF990 |
| Expenses Subtotal | 11057630 | ExpensesSubtotal |
| Investment Expenses Not Included2 | 0 | InvestmentExpensesNotIncluded2 |
| Other Expenses Not Included | 0 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 0 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 11057630 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 0 | ExpensesExceededBudget |
| Annual Community Benefit Report | 0 | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 988387 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 988387 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.085 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 300112 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 300112 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.026 | PercentOfTotalExpense |
Unreimbursed Costs UnreimbursedCosts
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1873264 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1873264 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.162 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 3161763 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3161763 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.273 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 0 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 0 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.000 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Activities Or Programs | 0 | NumberOfActivitiesOrPrograms |
| Persons Served | 0 | PersonsServed |
| Total Community Benefit Expense | 3161763 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 0 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 3161763 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.273 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $350,615 | BadDebtExpenseAmount |
| Amount Attributable To | 326072 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3622833 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 3755438 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -132605 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Wilson Street | AddressLine1 |
| City | Clayton | City |
| State | NM | State |
| ZIP Code | 88415 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (9 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SchH_P01_S00_L07 | Schedule H, Part I, Line 7 | COST METHOD The cost method used to calculate the amounts in this table is a Cost to Charge ratio. |
| SchH_P01_S00_L072f | Schedule H, Part I, Line 7, Column f | The Bad Debt Expense included on Form 990, Part IX, Line 25 Column A, subtracted for purpose of calculating the percentage in this column is 350,615. |
| SchH_P03_S0A_L04 | Schedule H, Part III, Section A, Line 4 | Patient Accounts Receivable consists of amounts owed by various governmental agencies, insurance companies and private patients. The hospital manages its receivables by regularly reviewing the accounts, inquiring with respective payers as to collectiblity and providing allowances on their accounting records for estimated contractual adjustments and uncollectible accounts. |
| SchH_P03_S0B_L08 | Schedule H, Part III, Section B, Line 8 | Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that that hospital operates to promote the health of the community. The Hospital uses Medicare cost report methodology, which apportions routine costs based on Medicaid or Medicare days to total days and apportions ancillary costs based on program charges to total charges. |
| SchH_P03_S0C_L09b | Schedule H, Part III, Section C, Line 9b | When a patient has indicated or demonstrated an inability to pay, an appropriate hospital representative will provide the patient with a charity care application. Applications must be complete in their entirety before charity care can be considered. Those patients who may qualify for financial assistance from a government program should be referred to the appropriate agency prior to consideration for charity care. An application for financial assistance from an outside agency should be obtained prior to charity care approval. |
| SchH_P06_S00_L02 | Schedule H, Part VI, Line 2 | Public meetings, board meetings, performance improvement and quality assurance meetings, emergency room call backs. |
| SchH_P06_S00_L03 | Schedule H, Part VI, Line 3 | Patients are informed of their rights and eligibility for assistance as they go through the admissions process. |
| SchH_P06_S00_L04 | Schedule H, Part VI, Line 4 | Union County is a frontier hospital with a county population of 2,700. The town of Clayton, where the hospital is located, is 45 miles from the nearest hospital. |
| SchH_P06_S00_L05 | Schedule H, Part VI, Line 5 | Union County General Hospital is one of the sponsors of an annual county wide health fair where hospital personnel obtain blood samples for testing. 547 patients were drawn at the health fair, at six local businesses, and six surrounding communities. As a result of patients signing up at the Health Fair, two colonoscopies, three mammograms, one blood profile and four bone densities were done. 20 hospital personnel worked 550 hours the month of the health fair and weeks prior to and after to collect blood samples from employees at local businesses and surrounding communities during their work schedule. The Physical & Occupational Therapy departments did taping and gave samples, gaining a few patients. The Radiology Department handed out literature on the various services they provide. Quarterly mini health fairs were held at the hospital. Three of our local doctors presented information on men's health, breast cancer, prostate and colon cancer, diabetes and osteoporosis. A cardiologist from Amarillo, TX gave a very informative presentation on heart health. Hospital staff gives flu shots at local businesses once a year. We provide a nurse practitioner, LPN, and receptionist for a school based health clinic in Des Moines, NM, 60 miles from Clayton. During the school year they go twice a month. We give a nursing scholarship annually as well as two scholarships to high school seniors who are going into the healthcare field. The hospital sponsors a local baseball team, supports the 4-H youth at the county fair by purchasing livestock, and sponsors the annual arts festival by purchasing a painting. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (2 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Dr Daniel Radunsky | |||||||||||||
| 655343 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 655343 | 0 | 0 | 0 |
| Calvin Schuler | |||||||||||||
| 189033 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 189033 | 0 | 0 | 0 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| F990_P06_S0A_L02 | Form 990, Part VI, Section A, Line 2 | Claude C Austin and Rosie DeHerrera, Directors, have a business relationship. |
| F990_P06_S0A_L03 | Form 990, Part VI, Section A, Line 3 | The Hospital's CEO, Don Wiedemann, is employed by a management company, Health Tech Management Services. All executive duties of the Chief Executive Officer are carried out by Mr. Wiedemann of Health Tech Management Services. |
| F990_P06_S0B_L11b | Form 990, Part VI, Section B, Line 11b | Form 990 prepared and reviewed by independent accounting firm. A draft of the form 990 is then provided to hospital management and any questions or corrections are addressed. A copy of the final form 990 with all required schedules is then provided to all voting members prior to filing with the IRS. |
| F990_P06_S0B_L12c | Form 990, Part VI, Section B, Line 12c | The Board of Directors, CEO and all other officers are all required to annually sign the conflict of interest policy and disclose any potential conflicts of interest. |
| F990_P06_S0B_L15 | Form 990, Part VI, Section B, Line 15 | The Hospital's CEO is compensated by a management company, Health Tech management services. Annually, a representative from the management company meets with the board of directors to perform an annual evaluation of the CEO's performance, review the New Mexico Hospital services wage and salary survey as a compensation comparable. The board's approval of CEO compensation is documented in the board minutes. |
| F990_P06_S0C_L19 | Form 990, Part VI, Section C, Line 19 | Available upon request |
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