2012-04-17T10:48:38-05:00 2011-05-31 MOSS ADAMS LLP 6100 UPTOWN BLVD NE STE 400 ALBUQUERQUE NM 87110 990 2010-06-01 850289839 TAOS HEALTH SYSTEMS INC DBA HOLY CROSS HOSPITAL TAOS 5057588883 1397 WEIMER RD TAOS NM 87571 CFO 5057588883 2012-04-02 1 MARLA CASTNER 5058787200 2010 2016-02-24 21:20:13Z PETER HOFSTETTER 1397 WEIMER RD TAOS NM 87571 61634999 0 X WWW.TAOSHOSPITAL.ORG X 1980 NM HOLY CROSS HOSPITAL'S MISSION IS TO CONTINUE TO BE THE REGIONAL HEALTH CARE PROVIDER OF CHOICE WHERE GREAT CARE COMES TOGETHER. 12 12 520 85 -9037 -9037 1206208 1415148 57270123 55406396 211054 309968 527217 755082 59214602 57886594 0 0 0 0 31602625 32559660 0 0 0 28059718 29224422 59662343 61784082 -447741 -3897488 47813812 44942199 8958665 9379352 38855147 35562847 X HOLY CROSS HOSPITAL'S MISSION IS TO CONTINUE TO BE THE REGIONAL HEALTH CARE PROVIDER OF CHOICE WHERE GREAT CARE COMES TOGETHER. 0 0 36013700 53395571 HOSPITAL: HOLY CROSS HOSPITAL IS A REGIONAL ACUTE CARE FACILITY AND WORKS ACTIVELY TO PROVIDE THE HIGHEST QUALITY OF CARE WHILE SERVING A DIVERSE CULTURAL COMMUNITY WITH A POVERTY RATE OF 21%. 35% ARE MEDICARE PATIENTS, 20% ARE MEDICAID PATIENTS AND 10% ARE UNINSURED. THE HOSPITAL PROVIDES A VARIETY OF SERVICES DESIGNED FOR THE EXPRESS GOOD OF THE COMMUNITY, EITHER AT REDUCED COST OR FOR FREE AND FACILITATES THE PROCESS OF PATIENTS APPLYING FOR THE COUNTY INDIGENT PROGRAM WHICH PAYS FOR HOSPITAL SERVICES. 1,294 PATIENTS SUCCESSFULLY APPLIED AND RECEIVED FINANCIAL ASSISTANCE THROUGH THE COUNTY INDIGENT PROGRAM IN FY2011. -414879 CHARITY CARE: BENEFITING THE COMMUNITY WE SERVE IS AN ESSENTIAL EXPRESSION OF OUR MISSION. THE HOSPITAL ASSUMES THAT RESPONSIBILITY BY PROVIDING HOSPITAL/HEALTHCARE SERVICES TO MEMBERS OF THE COMMUNITY WHO ARE UNINSURED AND LACK THE ABILITY TO PAY. DURING THE FISCAL YEAR 2011, TAOS HEALTH SYSTEMS SERVED APPROXIMATELY 959 PATIENTS WHO QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. 2883427 2496062 THE HOSPITAL OWNS AND ACTIVELY RECRUITS DOCTORS TO STAFF A WOMEN'S HEALTH CLINIC, A RURAL HEALTH CLINIC AND A SURGICAL SPECIALTIES CLINIC TO ENSURE THAT THE COMMUNITY'S NEED FOR THESE SERVICES ARE MET. 1190615 290615 OTHER MISCELLANEOUS PATIENT SERVICES TO INCLUDE COMMUNITY HEALTH FAIR, COMMUNITY WELLNESS PROGRAMS, COMMUNITY DEVELOPMENT PROGRAMS, DONATIONS TO COMMUNITY PROGRAMS AND COMMUNITY SCHOLARSHIP COSTS. 1190615 290615 40087742 1 1 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 94 0 1 520 1 1 1 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 NM X RIC EISENRING 5057588883 1397 WEIMER RD TAOS NM 87571 RON BURNHAM 1.00 X X 0 0 0 TIM MARTINEZ 1.00 X X 0 0 0 ANDY TORRES 1.00 X 0 0 0 PAMELA ROMERO 1.00 X X 0 0 0 ANNA MARTINEZ 1.00 X X 0 0 0 SYLVIA VILLAREAL 1.00 X 0 0 0 MICHAEL HOWARD 1.00 X 0 0 0 DAN GUTMAN MD 1.00 X 0 0 0 JEANNIE MASTERS 1.00 X 0 0 0 CHARLIE GONZALES 1.00 X 0 0 0 GUS CORDOVA 1.00 X 0 0 0 LINDA AUBRECHT 1.00 X 0 0 0 GEILAN ISMAIL 1.00 X 0 0 0 PETER HOFSTETTER 40.00 X 267260 0 40089 RICHARD EISENRING 40.00 X 161152 0 23715 MARY ANNA ABEYTA 40.00 X 163274 0 9464 RICHARD MASSEN 40.00 X 349221 0 9464 ALDEN G COCKBURN 40.00 X 365883 0 0 STEPHEN CETRULO 40.00 X 300962 0 4869 SHANTI MOHLING 40.00 X 303632 0 9464 TIMOTHY MOORE 40.00 X 258631 0 4869 2170015 0 101934 34 0 1 0 QUORUM HEALTH RESOURCES LLC 105 CONTINENTAL PLACE BRENTWOOD TN 37027 MANAGEMENT CONTRACTOR 1121285 NORTHERN NM ANESTHESIA PO BOX 1235 RANCHOS DE TAOS NM 87557 ANESTHESIOLOGISTS 1050919 RURAL RADIOLOGY ASSOCIATES PLLC 12687 W CEDAR DR STE 200 DENVER CO 80228 RADIOLOGY 574595 SHARED IMAGING BOX 88544 MILWAUKEE WI 53288 RADIOLOGY 514273 WEATHERBY LOCUMS PO BOX 972633 DALLAS TX 75397 CONTRACT DOCTORS 417015 20 389994 1025154 14999 1415148 NET PATIENT SERVICE RE 624100 55406396 55406396 55406396 179464 179464 3855256 23653 3737806 10599 117450 13054 130504 130504 FOOD SERVICE 722210 403146 403146 INCOME FROM TAOS SPORT 624100 155500 155500 MANAGEMENT SERVICES LE 621910 -9037 -9037 205473 205473 755082 57886594 55767369 -9037 713114 589066 589066 27436898 24076691 3360207 151411 132161 19250 2649372 2322688 326684 1732913 1519228 213685 628413 628413 819028 819028 91838 91838 36910 36910 6444909 4302487 2142422 187661 187661 831994 451502 380492 337359 337359 939337 939337 189622 87105 102517 123402 81342 42060 33731 33731 2515908 2515908 1174435 1070447 103988 SUPPLIES 5794873 5664564 130309 BAD DEBT EXPENSES 5404733 5404733 REPAIRS & MAINTENANCE 1222320 1222320 EQUIPMENT RENTAL 662113 345708 316405 HOSPITAL RELATIONS 253012 253012 1532824 33819 1499005 61784082 40087742 21696340 0 3692795 1816548 3059166 3109804 7993950 7647193 280095 1247678 1689651 1752810 831633 551891 40288536 17497219 21790473 22791317 8476049 6024958 47813812 44942199 5076420 5989660 110508 119269 1502759 2748837 2268978 521586 8958665 9379352 X 38613647 35009358 241500 553489 38855147 35562847 47813812 44942199 X -3897488 605187 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2477720 2477720 12411419 2660246 9751173 3113783 1271820 1841963 21244222 13565153 7679069 1041392 1041392 22791317 ASSETS - LIMITED USE 5370230 NOTES & OTHER RECEIVABLES 103069 OTHER CURRENT ASSETS 140093 INVESTMENT IN TAOS SPORTS MEDICINE, LLC 285088 INVESTMENT IN PHYSICIANS HEALTH ORGANIZATION, INC. 33217 THIRD PARTY PAYOR SETTLEMENTS 93261 6024958 EST THIRD PARTY PAYOR SETTLEMENTS 521586 521586 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: THE HOSPITAL ADOPTED THE PROVISIONS OF FASB, RELATING TO ACCOUNTING FOR UNCERTAIN TAX POSITIONS ON JUNE 1, 2009, WHICH HAD NO FINANCIAL STATEMENT IMPACT TO THE HOSPITAL. THE HOSPITAL RECOGNIZES THE TAX BENEFIT FROM ANY UNCERTAIN TAX POSITIONS ONLY IF IT IS MORE LIKELY THAN NOT THAT THE TAX POSITIONS WILL BE SUSTAINED ON EXAMINATION BY THE TAX AUTHORITIES, BASED ON THE TECHNICAL MERITS OF THE POSITION. ANY SUCH TAX BENEFIT IS MEASURED BASED ON THE LARGEST BENEFIT THAT HAS A GREATER THAN 50% LIKELIHOOD OF BEING REALIZED UPON ULTIMATE SETTLEMENT. THE HOSPITAL HAD NO UNRECOGNIZED TAX BENEFITS WHICH WOULD REQUIRE AN ADJUSTMENT TO THE JUNE 1, 2009 BEGINNING BALANCE OF NET ASSETS AND HAD NO UNRECOGNIZED TAX BENEFITS AT MAY 31, 2011 OR 2010. THE HOSPITAL FILES AN EXEMPT ORGANIZATION RETURN WITH THE INTERNAL REVENUE SERVICE (IRS). THE HOSPITAL IS NO LONGER SUBJECT TO INCOME TAX EXAMINATIONS BY THE IRS FOR TAX YEARS THROUGH MAY 31, 2008. 1 1 1 X 1 X 0 1 0 1 1 2253 2368177 1301894 1066283 0.01890 9980850 13124381 -3143531 0.00000 2253 12349027 14426275 -2077248 0.01890 144 54833 901999 901999 0.01600 144 54833 901999 901999 0.01600 144 57086 13251026 14426275 -1175249 0.03490 0 2702810 1899337 10317075 22998865 -12681790 X 1 1 1 1 HOLY CROSS HOSPITAL

1397 WEIMER RD TAOS NM 87571

X X X NOT REQUIRED 1 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5404733. PART III, LINE 4: PATIENT ACCOUNTS RECEIVABLE ARE STATED AT THE AMOUNT MANAGEMENT EXPECTS TO COLLECT FROM OUTSTANDING BALANCES. ESTIMATED PROVISIONS FOR DOUBTFUL ACCOUNTS ARE RECORDED TO THE EXTENT IS IT PROBABLE A PORTION OR ALL OF A PARTICULAR ACCOUNT WILL NOT BE COLLECTED. THE HOSPITAL DETERMINES IF PATIENT ACCOUNTS RECEIVABLE ARE PAST DUE BASED ON THE DATE THE SERVICE WAS PERFORMED AND THE HOSPITAL DOES NOT CHARGE INTEREST ON PAST DUE AMOUNTS. IN EVALUATING THE COLLECTIBILITY OF ACCOUNTS RECEIVABLE, THE COMPANY CONSIDERS A NUMBER OF FACTORS, INCLUDING THE AGE OF THE ACCOUNTS, CHANGES IN COLLECTION PATTERNS, THE COMPOSITION OF PATIENT ACCOUNTS BY PAYOR TYPE, THE STATUS OF ONGOING DISPUTES WITH THIRD PARTY PAYORS AND GENERAL INDUSTRY CONDITIONS.A HIGH NUMBER OF PATIENTS IN TAOS COUNTY ARE FINANCIALLY UNABLE TO PAY THEIR DEBTS. THE HOSPITAL IS COMMITTED TO SERVING THE COMMUNITIES HEALTHCARE NEEDS INCLUDING THOSE PATIENTS WHO MAY NOT BE ABLE TO AFFORD THE HOSPITAL SERVICES THEY NEED. WE CANNOT ALWAYS IDENTIFY THOSE PATIENTS WHO WOULD QUALIFY FOR CHARITY CARE AT THE TIME OF SERVICE BUT RECOGNIZE THAT MANY OF THOSE PATIENTS WOULD BE ELIGIBLE FOR THE HOSPITAL'S CHARITY CARE. PART III, LINE 8: THE ENTIRE AMOUNT OF MEDICARE SHORTFALL SHOULD BE CONSIDERED COMMUNITY BENEFIT. MEDICARE PATIENTS REPRESENT A SIGNIFICANT PORTION OF THE HOSPITAL'S BUSINESS, APPROXIMATELY 38%. MEDICARE RATES ARE OFTEN OUT OF LINE WITH THE TRUE COSTS OF TREATING MEDICARE PATIENTS. BY SERVING MEDICARE PATIENTS, THE HOSPITAL ALLEVIATES THE FEDERAL GOVERNMENT'S BURDEN FOR DIRECTLY PROVIDING SERVICES AND THIS IS AN INDICATION THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY. THE SHORTFALL WAS COMPUTED BY OBTAINING COST AND REIMBURSEMENT INFORMATION FROM THE FY2011 MEDICARE COST REPORT. PART III, LINE 9B: WHEN AN ACCOUNT IS FINAL BILLED AND IDENTIFIED AS SELF PAY, A LETTER IS SENT TO THE PATIENT REQUESTING EITHER PAYMENT OR THE PATIENT CONTACT THE HOSPITAL TO DISCUSS FINANCIAL ASSISTANCE. PAYMENT PLANS WORKED OUT AND INDIGENT FUND APPLICATIONS CAN BE OBTAINED. ON SELF PAY ACCOUNTS UNDER $1,000 NO CALLS ARE MADE TO THE PATIENT AND COLLECTION EFFORTS ARE THE SAME FOR ALL ACCOUNTS UNLESS THE PATIENT IS MAKING PAYMENTS OR HAD INDICATED THAT THEY WILL APPLY FOR FINANCIAL ASSISTANCE. ON SELF PAY ACCOUNTS $1,000-$5,000 THE PATIENT WILL BE CONTACTED AT LEAST 3 TIMES BY TELEPHONE TO ENCOURAGE THEM TO DISCUSS THEIR BILL AND APPLY FOR ASSISTANCE. PATIENTS AGREEING TO APPLY FOR THE INDIGENT FUND WILL BE GIVEN APPLICATIONS AND ASSISTED IN COMPLETING IF NECESSARY. ON ACCOUNTS UNDER $2,000, INCOMPLETE APPLICATIONS WILL NOT BE ACCEPTED. ON ACCOUNTS OVER $2,000, WE WILL ACCEPT ALL APPLICATIONS AND CALL THE PATIENT WEEKLY FOR 3 WEEKS TO OBTAIN THE MISSING INFORMATION. AFTER 3 WEEKS, WE WILL MAIL THE APPLICATION TO THE PATIENT EXPLAINING THAT WE WERE UNABLE TO PROCESS AND TO BRING THE APPLICATION BACK TO US WHEN IT IS COMPLETE. WHEN PATIENTS APPLY BUT FAIL TO QUALIFY FOR THE INDIGENT FUND WE WILL STILL WORK WITH THEM TO GIVE THEM CHARITY CARE UNDER THE HOSPITALS GUIDELINES. ON SELF PAY ACCOUNTS OVER $5000 THE PATIENT WILL BE CALLED AS SOON AS THE ACCOUNT IS 'IDENTIFIED'. THE PATIENT WILL ALSO BE CALLED PRIOR TO EACH ADDITIONAL COLLECTION LETTER BEING SENT. AFTER ALL APPROPRIATE COLLECTION LETTERS HAVE BEEN SENT AND TELEPHONE CALLS HAVE BEEN MADE AND THE PATIENT HAS NOT MADE AN ATTEMPT TO MAKE SUITABLE ARRANGEMENTS, THE ACCOUNT WILL BE REFERRED TO AN OUTSIDE COLLECTION AGENCY. PART VI, LINE 2: HOLY CROSS HOSPITAL CONTINUES TO COLLABORATE WITH COMMUNITY COALITIONS AND NETWORKS TO ASSESS COMMUNITY HEALTH NEEDS. THE RESULTING COMMUNITY HEALTH PROFILE RESULTS FROM WORK OF COMMUNITY PARTNERS INVOLVED IN EARLY CHILDHOOD EDUCATION NETWORK, DRUG-FREE PARTNERSHIP, TOBACCO-FREE POLICY WORK GROUP AND AFTER SCHOOL NETWORK. COMMUNITY BENEFIT RELIES ON THE MOST UP TO DATE STATE AND FEDERAL DATA TO CREATE ON OVERVIEW OF HEALTH STATUS FOR OUR COMMUNITY AND A NEEDS ASSESSMENT FOR REGIONAL GROWTH AND DEVELOPMENT. PART VI, LINE 3: ON EACH BILL THAT IS MAILED TO THE PATIENT A NOTE IS ATTACHED TELLING THE PATIENT TO CONTACT THE HOSPITAL IF THEY NEED FINANCIAL ASSISTANCE AND A PHONE NUMBER IS PROVIDED. WHEN SELF PAY ACCOUNTS ARE IDENTIFIED, A LETTER IS SENT REQUESTING PAYMENT OF THE BILL OR THE PATIENT TO CONTACT THE HOSPITAL TO DISCUSS FINANCIAL ASSISTANCE. PART VI, LINE 4: HOLY CROSS HOSPITAL EXISTS IN A COMMUNITY WHERE AMERICAN INDIAN, HISPANIC AND ANGLO CULTURES WITH DIVERSE SENSES OF FAMILY, TIME, WORK AND ENVIRONMENT CO-EXIST. THESE CULTURAL THREADS HAVE CREATED A RICH AND COMPLEX LOCAL HERITAGE. TO THE EAST IS THE HIGHEST MOUNTAIN IN THE STATE (WHEELER PEAK AT 13,630 FEET) AND TO THE WEST, A DESERT MESA WHERE WATER IS NOT EASILY ACCESSIBLE AND MANY PEOPLE LIVE WITHOUT INDOOR PLUMBING. THERE IS A DEEP HOPE AND SPIRITUALITY CONTRASTED BY DEEP DESPAIR AND DISENFRANCHISEMENT. WE HAVE THE STRENGTHS OF EXTENDED FAMILIES, SMALL TOWN SOCIAL NETWORKS, AND EXPANSIVE WILDERNESS, YET HAVE SOME OF THE HARSHEST SOCIAL AND ECONOMIC CONDITIONS IN OUR COUNTRY. THE MEDIAN HOME PRICE IS $273,000 AND THE POVERTY RATE IS 21% WHICH IS ROUGHLY 120% THE NM RATE AND NEARLY 200% THE US RATE. THE MEDIAN INCOME IS $25,883 IN PENASCO (A VILLAGE WE SERVE) AND IS $16,875 IN PICURIS PUEBLO COMPARED TO $50,046 NATIONALLY. THE PROPORTION OF TAOS COUNTRY CHILDREN IN IMPOVERISHED OR LOW-INCOME FAMILIES REMAINS AMONG THE HIGHEST IN THE COUNTRY, WITH MORE THAN 25% OF ALL CHILDREN IN POVERTY, 43% NEAR POVERTY, AND MORE THAN HALF LOW-INCOME. UNEMPLOYMENT IS 13%, AND LESS THAN 10% OF EMPLOYERS OFFER HEALTH INSURANCE BENEFITS. THE REGION CONTAINS TWO AMERICAN INDIAN PUEBLOS - TAOS AND PICURIS. OUR SERVICE AREA ENCOMPASSES 23,000 MILES AND 40,000 PEOPLE, 55% OF WHOM ARE HISPANIC, 37% WHITE AND 7.4% NATIVE AMERICAN (US CENSUS BUREAU 2008). PART VI, LINE 6: TAOS HEALTH SYSTEMS, LOCALLY KNOWN AS HOLY CROSS HOSPITAL (HCH) SERVICES FOUR RURAL AND FRONTIER COUNTIES IN NORTHERN NEW MEXICO. WE ARE A LOCAL, INDEPENDENT, NON-PROFIT ORGANIZATION WITH HOLY CROSS HOSPITAL (HCH) AS ITS REGIONAL HUB. HCH HAS ALWAYS BEEN COMMUNITY-FOCUSED. FROM THE DAY IT OPENED UNTIL TODAY, THE DRIVE BEHIND THE HOSPITAL'S PROSPERITY, AND VERY EXISTENCE, HAS COME FROM THE LOCAL RESIDENTS. THROUGHOUT ITS 74 YEAR HISTORY, IT HAS BEEN ABLE TO PROVIDE CARE ONLY BECAUSE OF THE DEDICATION AND HARD WORK OF OUR COMMUNITY. IT IS THIS CERTAINTY WHICH INSPIRES OUR MISSION: TO PROVIDE PREVENTATIVE, CURATIVE, AND SUPPORTIVE HEALTHCARE SERVICES WHILE MAINTAINING HIGH QUALITY STANDARDS AND UTILIZING INNOVATIVE, EDUCATIONAL, AND COST-EFFECTIVE APPROACHES FOR ALL MEMBERS OF THE CULTURALLY-DIVERSE TAOS COMMUNITY AND SURROUNDING AREAS. AS A NON-PROFIT, HCH HAS A LOCAL GOVERNING BOARD THAT INCLUDES PHYSICIANS AND COMMUNITY MEMBERS, WITH EQUAL REPRESENTATION FROM THE OUTLYING VILLAGES OF OUR REGION. IN 1985, THE BOARD OF DIRECTORS TURNED THE HOSPITALS FINANCIAL SITUATION AROUND FROM NEAR-FORECLOSURE; IN 1991, LOCAL VOTERS APPROVED A .5% TAX TO FINANCE A NEW MEDICAL COMPLEX, WHICH OPENED IN 1994. THIS 49 BED MEDICAL COMPLEX IS WHERE HCH IS CURRENTLY HOUSED. IN 2006, NM GOVERNOR BILL RICHARDSON AWARDED $1.1 MILLION TO BUILD A PEDIATRIC CLINIC, WHICH OPENED IN 2010, AND HCH IS PLANNING FOR ITS NEXT EXPANSION. WE EMPLOY PRIMARY CARE PROVIDERS, PEDIATRICIANS, SURGEONS, THE COUNTY'S ONLY OB/GYNS, AND WE OPERATE A REHABILITATION AND PHYSCIAL THERAPY CENTER. THESE SERVICES HAVE GROWN AS COMMUNITY NEEDS HAVE BEEN IDENTIFIED. LOCAL COMMUNITY MEMBERS, ALONGSIDE HOSPITAL ADMINISTRATORS, HAVE DEVELOPED SUSTAINABLE BUSINESS MODELS FOR CONTINUED PROVISION OF THESE SERVICES. OUR COMMUNITY SERVICE PROGRAMS TARGET POPULATIONS FROM PRENATAL CARE TO HIGH SCHOOL STUDENT OUTREACH TO SUPPORT FOR ELDERS WITH CHRONIC DISEASES. THEY ADDRESS SMOKING, CHRONIC DISEASE SUPPORT, HEALTHY PARENTING, AND OTHER TOPICS. IN ALL PROGRAMS, HCH'S APPROACH FOCUSES ON UNDERSTANDING HOW FAMILIES WORK TOGETHER AND CAN BE SUPPORTED TOGETHER, CONSISTENT WITH OUR COMMUNITY'S HISPANIC AND AMERICAN INDIAN TRADITIONS. X X X X X 0 0 0 0 0 0 0 0 0 PETER HOFSTETTER 239000 0 11000 0 17260 0 0 0 40089 0 307349 0 0 0 RICHARD EISENRING 145588 0 9822 0 5742 0 0 0 23715 0 184867 0 0 0 MARY ANNA ABEYTA 163274 0 0 0 0 0 0 0 9464 0 172738 0 0 0 RICHARD MASSEN 349221 0 0 0 0 0 0 0 9464 0 358685 0 0 0 ALDEN G COCKBURN 346562 0 7784 0 11537 0 0 0 0 0 365883 0 0 0 STEPHEN CETRULO 296762 0 0 0 4200 0 0 0 4869 0 305831 0 0 0 SHANTI MOHLING 280349 0 0 0 23283 0 0 0 9464 0 313096 0 0 0 TIMOTHY MOORE 255631 0 0 0 3000 0 0 0 4869 0 263500 0 0 0 FORM 990, PART VI, SECTION A, LINE 3 CONTRACTED TO QUORUM HEALTH RESOURCES FOR MANAGEMENT SERVICES. FORM 990, PART VI, SECTION B, LINE 11 AFTER THE RETURN IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, THE CFO AND CEO REVIEW A COPY OF THE FORM 990 FOR COMPLETENESS AND ACCURACY. ONCE APPROVED BY THE CEO AND CFO, A COPY IS PROVIDED TO THE BOARD OF DIRECTORS FOR REVIEW. THE BOARD OF DIRECTORS THEN APPROVES THE FINAL COPY AND THE RETURN IS FILED. FORM 990, PART VI, SECTION B, LINE 12C THE COMPLIANCE COMMITTEE MONITORS AND ENFORCES THE CONFLICT OF INTEREST POLICY. BOARD MEMBERS, SENIOR LEADERS, DIRECTORS AND KEY EMPLOYEES MUST COMPLETE A CONFLICT OF INTEREST POLICY ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15 AN INDEPENDENT MANAGEMENT COMPANY UTILIZES SURVEYS AND COMPARATIVE DATA TO DETERMINE COMPENSATION FOR THE CEO, TOP MANAGEMENT OFFICIALS, OFFICERS AND KEY EMPLOYEES. FORM 990, PART VI, SECTION C, LINE 18 THE FORM 990 AND FORM 1023 ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE AUDITED FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY, AND ALL OTHER GOVERNING AND ORGANIZING DOCUMENTS ARE AVAILABLE FOR PUBLIC INSPECTION UPON REQUEST. THE CONFLICT OF INTEREST POLICY IS ALSO DISPLAYED ON THE ORGANIZATIONS WEBSITE AND ON POSTERS THROUGHOUT THE HOSPITAL. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 653,666. CONSOLIDATED INCOME 107,021. BOOK/TAX DIFFERENCE IN TSM K-1 -155,500. TOTAL TO FORM 990, PART XI, LINE 5: 605,187. TAOS SURGICAL SPECIALTIES LLC 1397 WEIMER RD TAOS NM 87571 208900049 SURGERY CLINIC NM 1221463 299101 TAOS HEALTH SYSTEMS MOMS LLC 1397 WEIMER RD TAOS NM 87571 208131606 OBSTETRICS & GYN CLINIC NM 1051196 237976 TAOS HEALTH SYSTEMS TAOS SPORTS MEDICINE SERVICE LLC 1398 WEIMER RD STE 103 TAOS NM 87571 850473650 PHSYICAL THERAPY REHABILITATION NM HCH RELATED 155500 286855 0 1 0.63960 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 TAOS SPORTS MEDICINE SERVICES LLC R 145693 TAOS SPORTS MEDICINE SERVICES LLC A 1242