2012-05-15T15:18:34-05:00 2011-06-30 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2010-07-01 850138775 Otero Co Hospital Assoc DBA Gerald Champion Regional Medical Center OTER 5754396100 2669 North Scenic Drive Alamogordo NM 883110597 Morgan Hay 5754396100 2012-05-15 1 Kim Hunwardsen CPA 6122536500 2012-05-15 2010 2016-02-24 21:20:13Z Robert James Heckert 2669 North Scenic Drive Alamogordo NM 883110597 99421205 0 X www.gcrmc.org X 1947 NM Provision of health care services 11 10 816 156 54407 0 650824 392795 104369217 97905894 415907 451731 369638 339404 105805586 99089824 384692 431536 0 0 40663314 43789834 0 0 0 60301384 55348660 101349390 99570030 4456196 -480206 141208367 154449376 49678430 58483892 91529937 95965484 X To exceed the expectations of our guests through extraordinary customer service, exceptional quality care and innovative technology. 1 0 76465949 97851487 Otero County Hospital Association d/b/a Gerald Champion Regional Medical Center (GCRMC) provides comprehensive healthcare services through its 99-bed hospital, outpatient ambulatory care facilities, and a multi-specialty physician group. GCRMC accounts for more than 80% of hospital admissions in its Otero County primary service area. The GCRMC's primary market is the city of Alamogordo with secondary markets expanding to Tularosa, Holloman Air Force Base and Lincoln County. The original facility opened in August 1949 and the current medical center is a state of the art, acute care facility that opened in December 1999. The original hospital opened in 1949 with 26 beds. Today GCRMC is proud to be a 99-bed acute care facility accredited by DNV, including two distinct PPS units: Life Transitions (12 beds starting July 1, 2010) and Inpatient Rehabilitation (12 beds starting July 1, 2011). GCRMC shares a unique relationship with Holloman Air Force Base as the first hospital in the United States where active duty military physicians practice in a civilian hospital. This special arrangement allows one facility to meet the combined community and military needs, while serving as a model for the Department of Defense in conserving resources. The delivery mechanisms of care at the hospital include both inpatient and outpatient services: acute care inpatient through medical/surgical, telemetry, maternal child and 12-bed intensive care units; surgery department supported by pre-admit, outpatient care unit and post-anesthesia care unit; hospital-owned physician practices in the areas of family practice, women's services including obstetrics, gastroenterology and endocrinology, internal medicine, orthopedics and general surgery; inpatient and outpatient CAP certified laboratory services with the capability to perform over 225 different profiles and tests in-house; inpatient and outpatient diagnostic imaging services, including x-ray, 128-slice CT scan, MRI, ultrasound, interventional radiology, radiofrequency ablation and nuclear medicine; inpatient and outpatient comprehensive cardiopulmonary services including behavior sleep medicine, Holter monitoring, event monitoring and impedance cardiography. By the end of 2010, GCRMC employed approximately 700 people. In addition to those employees, GCMRC contracts for services in various departments such as Pharmacy, Anesthesia, Emergency Services and Hospitalist program. The medical staff of GCRMC has 121 medical members consisting of 98 active members and 94 affiliate members. GCRMC continues to seek opportunities to expand services and improve quality, with the philosophy of not limiting its potential by the designation of "small community", but rather identifying its scope of service based on community needs. Continued progress and expansion has enhanced GCRMC's commitment to strive for outstanding service and quality; acknowledging that its future is not in its buildings or technology, but rather its people. To this end we support the people of Otero County with our services and our financial contributions.GCRMC has, since its inception in 1949, provided quality medical healthcare regardless of race, creed, sex, national origin, handicap, age, or ability to pay. Although reimbursement for services rendered is critical to the operation and stability of GCRMC, it is recognized that not all individuals possess the ability to purchase essential medical services and, further, that our mission is to serve the community with respect to providing healthcare services and healthcare education. Therefore, in keeping the GCRMC's commitment to serve our community, we provide: Free Care and/or Subsidized Care - care to persons covered by governmental programs at below cost; and health activities and programs to support the community will be considered where the need and/or an individual's inability to pay coexist.GCRMC maintains records to identify and monitor the level of charity care it provides. These records include the amount of charges foregone for services and supplies furnished under its charity care policy. The amount of charges foregone, based on established rates, was $5,556,965 for the year ended June 30, 2011. 361555 361555 With the assistance of the TSFA Grant funding, GCRMC is able to continue to give the most current and up to date trauma care available. GCRMC has been a Level III Trauma Center for four years. During the FY 2011, 241 patients met trauma registry inclusion. We increased awareness of Emergency/Trauma standards of care to the following departments: Lab, Diagnostic Imaging, the Hospitalists and trauma surgeons. We hold injury prevention at a high priority and have increased injury prevention awareness to our community's youth through attending health fairs, distributing prevention literature, bicycle helmet distribution, car seat programs and DWI awareness through the every 15-minute program.The 2011 emergency room visits were 28,905. The stable flow of patients in emergency room visits from 2009 to 2011 was due to increased cases of H1N1, cut back of hours at the Holloman Air Force Base clinics in 2010 and the elimination of HAFB Nurse Call due to budget constraints in 2010. The closing of a walk-in/urgent clinic and reduction of hours to part time in another clinic that both occurred in 2010 also bring more emergency room patients to Gerald Champion than in the past.Through the Emergency department, we participate in NM Department of Health Regional Emergency Preparedness Coalition and receive grant money for supplies, equipment and other items related to the preparedness or response to hospital emergencies, or the support of the staff to attend/provide training for hospital preparedness. 76827504 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 161 0 1 816 1 1 1 0 0 0 0 0 0 0 0 0 X 11 10 0 1 0 0 1 1 0 1 0 0 0 0 1 1 1 1 1 1 1 1 0 NM X Morgan Hay 5754396100 2669 North Scenic Drive Alamogordo NM 88311 Norm Arnold 10.00 X X 0 0 0 Bill Mayton 5.00 X X 0 0 0 Bill Mershon 5.00 X 0 0 0 Fred Baker 5.00 X 0 0 0 Jaime Anderson 3.00 X 0 0 0 James Harris 3.00 X 0 0 0 Gary Jackson DO 2.00 X 0 0 0 Greg Richardson MD 5.00 X 0 0 0 Robin French 3.00 X 0 0 0 Lisa Thomassie 3.00 X 0 0 0 Arthur Austin MD 40.00 X 221473 0 26683 Robert James Heckert 40.00 X 434930 0 0 Morgan Hay 40.00 X 297856 0 0 Martha Gorman 40.00 X 166323 0 11221 Jeffrey Gardner 40.00 X 124592 0 23920 George Massoud 40.00 X 392462 0 36408 Dennis Worthington 40.00 X 389361 0 39617 Charles Race 40.00 X 685862 0 172 Shahid Mansoor 40.00 X 356561 0 16843 Donald Montoya 40.00 X 357175 0 304 3426595 0 155168 51 0 1 0 Robins & Morton Group Gateway II Bldg 5500 Maryland Sui Brentwood TN 37027 Construction 21066479 Quantum Healthcare Medical Associates PO BOX 634850 Cincinnati OH 452654850 Staff-Medical 1471961 EmCare Inc 7032 Collections Center Drive Chicago IL 60693 Staff-Medical 1171668 Ascension Group Architects 1250 E Copeland Road Suite 500 Arlington TX 76011 Architect 1170680 Labortory Corp PO BOX 12140 Burlington NC 272162140 Laboratory 792590 23 329109 63686 392795 Net Patient Service Re 900099 94926722 94926722 Alamogordo Surgery Ven 621400 1258764 1258764 Other Revenue 900099 874244 874244 Rental income 531120 588886 588886 Imaging Center LLC 621400 197627 197627 59651 5244 54407 97905894 463989 463989 653585 314181 339404 339404 339404 229 4713 2117 15083 -1888 -10370 -12258 -12258 99089824 97851487 54407 791135 431536 431536 1307832 1307832 34558848 24308070 10250778 1374309 1174538 199771 4143820 3689475 454345 2405025 1962041 442984 1492793 1492793 80165 80165 22403128 18422406 3980722 143402 7497 135905 19369690 16559242 2810448 103435 18491 84944 1674672 460905 1213767 141408 60655 80753 242886 109825 133061 202550 202550 7182409 7182409 1097612 1097612 Reorganization Costs 863070 863070 Sales Tax Expense 75716 75716 State Taxation 50 50 275674 201416 74258 99570030 76827504 22742526 0 13263880 11101383 12931542 13919686 2566413 2765140 928938 2541204 167043912 66070930 74762289 100972982 22299134 14344334 11936378 6830021 61875 58125 2457918 1916501 141208367 154449376 9066542 18239114 37570000 36955000 789778 3041888 2500000 49678430 58483892 X 91529937 95965484 91529937 95965484 141208367 154449376 X -480206 4915754 X 0 1 1 X 0 X 2965786 2965786 74371784 23148859 51222925 57959604 41219849 16739755 31746738 1702222 30044516 100972982 Estimated Malpractice Liability 2500000 2500000 99089824 99570030 -480206 4884018 31736 4915754 4435548 104399923 4884018 1491341 6375359 98024564 1065260 1065260 99089824 99964376 394345 394345 99570031 0 99570031 Description of Uncertain Tax Positions Under FIN 48: Part X: The Medical Center is organized as a New Mexico nonprofit corporation and has been recognized by the Internal Revenue Service as exempt from federal income taxes under Internal Revenue Code Section 501(c)(3). The Medical Center is annually required to file a Return of Organization Exempt from Income Tax (Form 990) with the IRS. In addition, the Medical Center is subject to net income that is derived from business activities that are unrelated to its exempt purpose, if any. The Medical Center believes it has appropriate support for any tax positions taken affecting its annual filing requirement, and, as such, does not have any uncertain tax positions that are material to the consolidated financial statements. The Medical Center would recognize further accrued interest and penalties related to unrecognized tax benefits and liabilities in income tax expense, if such interest and penalties are incurreed. The Medical Center's historical Federal and state tax returns are subject to examiniation by tax authorities. Part XI, Line 8 - Other Adjustments: ASV Book/K-1 Income Difference 29,531. White Sands Book/K-1 Income Difference 131. AIC Book/K-1 Income Difference 2,074. Part XII, Line 2d - Other Adjustments: Book Income ASV LLC 1,288,320. Book Income Imaging Center, LLC 199,760. Book Income White Sands, LLC 3,261. Part XII, Line 4b - Other Adjustments: Rental Expenses Recorded as Expense for financial statements -314,181. Tax K-1 Income ASV LLC 1,258,789. Tax K-1 Income Imaging Center, LLC 197,686. Tax K-1 Income White Sands LLC 3,130. Catering/Bistro Expenses Recorded as Expense for Financial Statements -80,164. Part XIII, Line 2d - Other Adjustments: Rental expenses recorded as revenue for Form 990 314,181. Catering/Bistro Expenses Recorded as Expense for Financial Statements 80,164. 1 1 X 1 X 1 X 1 1 1 0 1 1 2445114 2445114 0.02460 14656027 10388979 4267048 0.04290 12210330 12809566 -599236 0.00000 29311471 23198545 6112926 0.06750 8808 8808 0.00010 7687111 7244718 442393 0.00440 228496 228496 0.00230 7924415 7244718 679697 0.00680 37235886 30443263 6792623 0.07430 10000 10000 0.00010 151699 151699 0.00150 767214 767214 0.00770 928913 928913 0.00930 0 3448673 88491 26626358 25688146 938212 X 1 1 1 Alamogordo Surgery Ventures Outpatient Surgery Center 0.40500 0.00000 0.59500 2 Alamogordo Imaging Center Outpatient Radiology Center 0.27900 0.00000 0.72100 3 White Sands Health Care Systems LLC Physician Hospital Organization 0.50000 0.00000 0.50000 1 1 Gerald Champion Regional Medical Center

2669 North Scenic Drive Alamogordo NM 88311

X X X Not Required 1 2 Scenic View Outpatient Surgery Center

2351 25th Street Alamogordo NM 88311

Outpatient Surgery Alamogordo Imaging Center

2539 Medical Dr Ste 1010 Alamogordo NM 883108720

Outpatient Radiology Part I, Line 7: The organization used the following to determine the costs for Part I, Line 7:Row a: Charity Care was converted to cost using a cost to charge ratio from the cost accounting system. The cost accounting system addresses all patient segments.Row b and c: Amounts were calculated from internal records.Row e and i: Amounts reported are based on the actual dollars spent in the activities reported.Row g: Amounts reported are based on the Medicare Cost Report figures. Part I, Line 7g: Part I, Line 7g includes $6,023,705 of costs attributable to a Physician Clinic. Part II: Gerald Champion helps to promote the health of the communities that it serves through the recruitement of physicians and other providers. The Hospital also supports several organizations throughout the community that encourage and promote the overall health of the community. Part III, Line 4: Financial Statement Bad Debt Expense Footnote: Patient accounts receivable are reduced by an allowance for doubtful accounts. In evaluating the collectability of accounts receivable, the Medical Center analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for doubtful accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for doubtful accounts. For receivables associated with services provided to patients who have third-party coverage, the Medical Center analyzes contractually due amounts and provides an allowance for doubtful accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Medical Center records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates, if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for doubtful accounts.Bad debt expense was converted to cost using Worksheet 2, the ratio of cost to charge.The organization estimated the percentage of bad debt at cost that is attributed to charity care by applying the percentage of charity care to total revenues to total bad debt at cost. Therefore the organization estimates that 2.57% of the bad debt expense at cost is attributable to patients eligible under the organization's charity care policy. Care is given to individuals regardless of their ability to pay, and therefore this is a community benefit.Discounts and payments are taken into account when determining bad debt expense. Part III, Line 8: Medicare allowable cost is based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. Part III, Line 9b: GCRMC has implemented a number of different Policy and Procedure statements to govern the details of how its collection practices are implemented and how discounting and collection policies apply to various classes of patients. In general, all patient account guarantors who request financial assistance are asked to provide detailed information regarding their income and assets. For patients who qualify for charity and who are cooperating in good faith to resolve their hospital bills, GCRMC may offer extended payment plans to eligible patients, will not impose wage garnishments or liens on primary residences, will not send unpaid bills to collection agencies, and will cease all collection efforts. Part VI, Line 2: Management at GCRMC enlisted the services of Saurage Strategic Marketing Research to complete a quantitative tracking study. The objects were to develop and implement a needs assessment in the community; identify the critical need of network partners to ensure their viability; identify potential collaborating network partners in the community; and to identify placed-based initiatives that focus on targeting resources to leverage investments. From the study of community leaders and over seven thousand five hundred surveys, a dozen issues were identified for the hospital to consider as we pursue health expansion strategies. Part VI, Line 3: The hospital has a Charity Care Policy - Gerald Champion Regional Medical Center ("GCRMC") will provide understandable, written guidelines to staff and patients relative to how the hospital evaluates and determines: 1) a patient's eligibility for charity care; 2) an uninsured patient's eligibility for discounts; and 3) a patient's eligibility for alternate payment plans.The Charity Care Policy is posted in the emergency room and throughout the entire hospital. The patients are also informed through direct communication with financial counselors and these policies are explained in detail to guarantors who advise GCRMC that they are unable to pay their account or need help in structuring an affordable payment plan for their account. This hospital shall render services to all members of the community who are in need of medical care regardless of the ability of the patient to pay for such services. Charity care and discounts for the uninsured will be available for medically necessary hospital care provided to persons who meet the financial and documentation criteria defined in this policy. Determinations hereunder will be based solely on the patient's ability to pay and will not be made on the basis of age, sex, race, creed, disability, sexual orientation or national origin. GCRMC provides financial assistance to patients based on their income, assets, and needs. Through our financial counseling services we assist patients with obtaining financial coverage or low-cost health insurance, or work with patients to arrange a manageable payment plan.Uninsured patients are eligible for a 25% discount. A 25% discount is applied to the total charges of a Self Pay Patient at the time of service or the 1st billing. Notice will be sent at the time of the 1st billing informing the patient/guarantor that an additional 10% will be deducted if the account is paid within 30 days of the date of service. Part VI, Line 4: GCRMC continues to be the primary provider of healthcare services for all of Alamogordo, Holloman Air Force Base (HAFB), Otero County and part of Lincoln County. As of July 2009, the population of Otero County was 63,201 inclusive of HAFB at 3,761 active military and 4,839 dependents; and the German Air Force at 450 active military and 675 dependents. The primary and secondary service areas are considered to encompass a population of 104,280. According to census.gov the median household income for Alamogordo in the 2006-2010 census was $41,640. 14.1% of the people living in Alamogordo were below the Federal Poverty level according to the 2006-2010 census. We continue to be the in-network provider for the largest employers in our primary service area with over 800 employees.A decrease in primary care physicians and other specialties has contributed to some erosion of our market share. Recruitment has been effective in new providers, i.e., General and Orthopeadic surgeons. Further efforts are to recruit pediatricians and internal medicine. A large portion of the out-migration of the market is due to referrals from GCRMC for services not provided, such as invasive cardiology. Part VI, Line 6: The Board of Directors is the governing body of Gerald Champion Regional Medical Center. The eleven members are business people of the primary service area, with no other connection. The hospital extends medical staff privileges to all qualified physicians in the community. Surplus funds are utilized for the purchase of capital equipment, electronic medical record software, and continuing education for clinical staff including physicians.GCRMC views the position of sole provider as a significant commitment to the overall health and well being of the community. We are not satisfied with just providing healthcare; we are challenged by the opportunity to have a positive effect on the quality of life experience in our community. With this in mind, we strive to facilitate and share opportunities to educate and motivate a philosophy of wellness. Our primary target is the disease process that we know can be eliminated or improved by changing or modifying human behavior. As with any community, we serve a population that varies in its educational background. We strive to develop programs that target the needs and understanding of our audience. We utilize our physicians to provide open forums that present a topic followed by questions and time for individual discussion. This type of program is offered with a free lunch, educational materials, and if appropriate, free screenings, such as glucose or blood pressure. There is an average of 90 participants in each of these seminars. The organization is very community-minded in its efforts to promote health. Staff participate in Health Fairs in the public schools. The organization holds Community Lunch events with Providers speaking to health related issues, i.e. arthritis, nephrology, neurology, orthopedic issues, etc. Flu shots are distributed to community members. Management and staff of GCRMC are part of community organizations. The following classes are provided for the community in our conference room center: Diabetic Education, Sign Language, narcotics Anonymous, Lamaze Classes, Tobacco Cessation, New Baby Class and CPR/Basic Life Support to name a few. We are a top supporter of the United Way which provides money for many of the community organizations. An annual Health Fair is held at the hospital each year. The annual health fair serves approximately 75 community members. We augment the annual health fair with onsite mini health screenings throughout the year. This is offered to businesses, civic organizations and churches with minimal to no charge. We offer free blood pressure screenings on a walk-in basis with educational materials in both Spanish and English. This allows us to address the high rate of hypertension in our community, its significant effect on other diseases, and an overall wellness picture. GCRMC partners with the American Cancer Society to offer the Look Good Feel Good Program and the Gift Closet. The program is housed on campus and has brought a highly valued service to our community. The Gift Closet provides free wigs, prosthesis, supplies, education and support to cancer patients and their families.The opportunity to utilize our speaker's bureau is available to any organization in the community. A presentation regarding health related topics can be prepared with limited notice to meet the needs of the organization. The wealth of knowledge in our organization allows us to create an appropriate fit for the requested need. At GCRMC, we feel it is important to embrace community needs that promote good citizenship. As an organization we support employee involvement in outside activities through contributions, dedicated time and sponsorship. Administration and staff members serve on community boards, dedicating many hours of support to those organizations. During fiscal year 2011 GCRMC administration and staff participated in community projects with various organizations. The total civic contribution to the community by GCRMC was $431,536. Our total civic in-kind contributions were $100,000+ in fiscal year 2011. We also recognized the positive effects of economic growth in the community by contributing $10,000 to the Otero County Economic Development Council in fiscal year 2011. Part VI, Line 7: n/a 1 County of Otero 1000 New York Ave Room 101 Alamogordo NM 88310 856000236 Government 93743 Public Health Otero County Fair Association 410 Fairgrounds Rd Alamogordo NM 88310 856011829 501(c)(3) 17598 Public Relations Presbyterian Medical Services co Chaparral Family Health PO Box 112 Carrizozo NM 88301 850206810 501(c)(3) 133337 Public Health United Way of Otero County 1601 E 10th Street Suite B Alamogordo NM 88310 850197559 501(c)(3) 17659 Public Assistance Otero County Economic Development Council 1301 N White Sands Blvd Alamogordo NM 88310 850304073 501(c)(3) PF 10000 Economic Development Presbyterian Medical Services co Sacramento Mountain Center PO BOX 686 Cloudcraft NM 88317 850206810 501(c)(3) 75000 Public Health Flickinger Center 1101 New York Ave Alamogordo NM 88310 850326369 501(c)(3) 5400 Cultural Development Alamogordo Chamber of Commerce 1301 N White Sands Blvd Alamogordo NM 88310 850109297 501(c)(6) 5486 Public Health Zia Therapy Center 900 First Street Alamogordo NM 88310 850199135 501(c)(3) 9580 Public Health American Cancer Society 2120 1st Ave Alamogordo NM 88310 841316555 501(c)(3) 2500 Public Health 10 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization only gave grants to government organizations and tax exempt organizations. X X 0 0 0 0 0 0 0 1 0 Arthur Austin MD 221077 0 0 0 396 0 11336 0 15757 0 248566 0 0 0 Robert James Heckert 357670 0 70000 0 7260 0 0 0 0 0 434930 0 0 0 Morgan Hay 256356 0 41500 0 0 0 0 0 0 0 297856 0 0 0 Martha Gorman 165705 0 0 0 618 0 11221 0 410 0 177954 0 0 0 George Massoud 391756 0 0 0 706 0 19160 0 17658 0 429280 0 0 0 Dennis Worthington 388526 0 0 0 835 0 19160 0 20867 0 429388 0 0 0 Charles Race 669240 0 16450 0 172 0 0 0 172 0 686034 0 0 0 Shahid Mansoor 349923 0 0 0 6638 0 0 0 17253 0 373814 0 0 0 Donald Montoya 334428 0 12500 0 10247 0 0 0 717 0 357892 0 0 0 Part I, Line 7 The organization paid a bonus to all employees, which was based on performance in areas of customer service and financial measurements, which included operating margin. The bonus was a fixed amount for the entire organization and was divided among all employees. Supplemental Information Part III Schedule J, Part II The CEO and CFO are paid by an unrelated management company, Quorum Health Resources. City of Alamogordo 856000099 2007-11-15 384685000 Hospital Improvement, Expansion 0 0 0 38485000 547533 37936467 2007 1 0 1 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 1 1 0 0 0 0 New Program Services Form 990, Part III, line 2 The Hospital opened a Joint Center for Excellence July 1, 2011. A Sleep Center in Ruidoso also began providing services in February 2011. In addition to these new services, an Inpatient Rehabilitation Unit was opened in July 1, 2011. All three of these new services are in furtherance of their exempt purpose to provide health care services. Form 990, Part VI, Section A, line 3 The organization's CEO and CFO are employees of Quorum Health Resources, an unrelated management company. Form 990, Part VI, Section A, line 6 All members of the community are eligible to become voting members of the organization upon purchase of voting stock. Form 990, Part VI, Section A, line 7a The members have the right to elect the Board of Directors. Form 990, Part VI, Section A, line 8b There are no committees with the authority to act on behalf of the governing board. Form 990, Part VI, Section B, line 11 The return is reviewed by the CEO and CFO prior to filing. Form 990, Part VI, Section B, line 12c Each officer, director, and key employee is required to fill out a conflict of interest disclosure annually. The forms are initially reviewed by the CFO. If any conflicts exist, they are reviewed by the Board of Directors. A person with a conflict is restricted from voting on related matters. Form 990, Part VI, Section B, line 15 The organization's CEO and CFO are employed by Quorum Health Resources (QHR). The organization's Board of Directors approves the contract with QHR annually based on comparability data. In addition, the Joint Finance Committee reviews and approves monthly invoices to the organization for management fees from QHR. In regard to other officers and key employees, the organization used multiple national and regional salary surveys to determine if/when our positions are showing a need for adjustment. Each position within the hospital is compared to any available data from the surveys. If a position shows a need to move to the next pay grade, the hospital determines the hourly amount all of the individual employees within that position need to move. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy and financial statement are all available upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 4,884,018. ASV Book/K-1 Income Difference 29,531. White Sands Book/K-1 Income Difference 131. AIC Book/K-1 Income Difference 2,074. Total to Form 990, Part XI, Line 5: 4,915,754. Alamogordo Surgery Venture LLC 2351 25th Street Alamogordo NM 88310 061791828 Outpatient Surgery Center NM N/A Related 1258789 181114 1 0 0.40500 1 0 1 0 0 0 0 0 1 0 1 0 0 0 1 1 0 0 Alamogordo Surgery Venture LLC A 456680 General Ledger Alamogordo Surgery Venture LLC C 1275750 General Ledger Alamogordo Surgery Venture LLC I Alamogordo Surgery Venture LLC K 257620 General Ledger Alamogordo Surgery Venture LLC O 7559040 General Ledger Alamogordo Surgery Venture LLC P 240467 General Ledger