2011-05-06T16:32:14-04:00 2010-06-30 ERNST & YOUNG US LLP TWO NORTH CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2009-07-01 850127924 SAN JUAN REGIONAL MEDICAL CENTER SANJ 5053255011 801 WEST MAPLE STREET FARMINGTON NM 87401 J MICHAEL PHILIPS 2011-05-06 6023223000 2009 2016-02-24 21:20:13Z RICK WALLACE 801 WEST MAPLE STREET FARMINGTON NM 87401 257207914 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 9 1827 179 1680744 178014 10246658 1541754 231483213 251696747 -5847777 3294619 0 0 235882094 256533120 0 497882 0 0 115129497 123698748 0 0 0 105700358 112050508 220829855 236247138 15052239 20285982 286466623 307589892 94512134 94585208 191954489 213004684 SAN JUAN REGIONAL MEDICAL CENTER'S MISSION IS TO PERSONALIZE HEALTH CARE AND CREATE ENTHUSIASM AND VITALITY IN HEALING. false false 215808410 250016033 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 COMMUNITY BENEFIT REPORT. 215808410 true true false true false false false false false true false true false false false false false false false false true true false true true false false false false false false false true true true true false false false false true true false false true 228 0 true 1827 true true true false false false false false false false false 12 9 true false false false true true false true true false false true true true true true true true true true true NM X J MICHAEL PHILIPS 5056096025 801 WEST MAPLE STREET FARMINGTON NM 87401 Sara Kaynor 6.0 X 0 0 0 Mike Jakino 6.0 X X 0 0 0 Norman Tucker 6.0 X X 0 0 0 Ronald Calcote MD 6.0 X X 14041 0 0 James Shaheen 6.0 X X 0 0 0 Joseph Rasor 6.0 X 0 0 0 Sandy Williams 6.0 X X 0 0 0 Jeff Bowman 6.0 X 0 0 0 Paul Deshayes 6.0 X 0 0 0 Dwayne Gibbs MD 6.0 X 109665 0 0 Charles Hoffman MD 40.0 X 383633 0 24952 Richard Menning 6.0 X 0 0 0 Charlene Scott 6.0 X 0 0 0 Rick Wallace 40.0 X 0 0 0 Steve Altmiller 40.0 X 463720 0 25829 J Michael Philips 40.0 X 332741 0 34752 John Buffington 40.0 X 352185 0 34752 Douglas Frary 40.0 X 216611 0 29708 Ruth Brooks 40.0 X 179477 0 17826 Tom Dean 40.0 X 202613 0 22974 Robert Fabrey MD 40.0 X 369668 0 31700 Suzanne Smith 40.0 X 215305 0 30830 Stephen Franken 40.0 X 180653 0 25125 Catherine Zaharko 40.0 X 170543 0 28054 Edward Maurin MD 40.0 X 608053 0 33202 Charles Wilkins MD 40.0 X 572412 0 34752 Luther Weathers III MD 40.0 X 525752 0 24870 Tull Graham MD 40.0 X 469958 0 32423 5367030 0 431749 140 false true false Okland Construction 1099 Main AVE SUITE 202 DURANGO CO 81301 Construction 1882425 Aramark Healthcare Management PO Box 100401 PASADENA CA 91189 Housekeeping/Bio-Med 1682602 Total Renal Care 6000 Feldwood ROAD COLLEGE PARK GA 30349 Dialysis 1474830 Four Corners Anesthesiology 1515 E 20th St Suite A FARMINGTON NM 87401 Anesthesia Services 1207465 MASH Magnolia Ave FT WORTH TX 76104 Obtain Ins coverage 534120 25 1468848 72906 1334446 1541754 NET PATIENT SERVICES REVENUE 622110 244439417 244439417 MEDICAL OFFICE BLDG. RENTAL 531120 2254072 2254072 AMBULANCE SERVICES 621910 477822 477822 CAFETERIA 722210 1088694 1088694 REFERENCE LABORATORY 621511 1680744 1680744 1755998 1755998 251696747 3282584 3282584 0 0 686829 0 0 674794 686829 -674794 12035 12035 0 0 0 0 256533120 250016003 1680744 3294619 497882 497882 0 0 0 2769800 0 2769800 0 122556 122556 0 0 93219202 89071898 4147304 0 3902814 3630096 272718 0 17124481 15949676 1174805 0 6559895 6122294 437601 0 0 182396 48486 133910 0 276995 249370 27625 0 63063 63063 0 0 0 0 384682 0 384682 0 18661089 15546047 3115042 0 597941 0 597941 0 41408388 40979740 428648 0 2194626 0 2194626 0 0 3506286 3425638 80648 0 0 0 1242548 931759 310789 0 2528021 2275896 252125 0 0 10628778 9568746 1060032 0 3050432 0 3050432 0 BAD DEBT EXPENSE 27325263 27325263 0 0 236247138 215808410 20438728 0 15119893 16717138 18334308 10349992 199473 326970 24935492 23398409 3204213 2914691 2784927 3183135 2259985 2441814 262870735 116664929 147806777 146205806 61393311 92506241 8615837 7828155 1812407 1717541 286466623 307589892 21882604 26045028 62756549 60822390 6284673 5385041 3588308 2332749 94512134 94585208 X 191954489 213004684 191954489 213004684 286466623 307589892 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 48259 false true 14795 63054 false SCHEDULE C, PART II-B LINE 1G - SAN JUAN REGIONAL MEDICAL CENTER PAID NEW MEXICO GOVERNMENT AFFAIRS $48,259 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 - $8,423 2) AMERICAN HOSPITAL ASSOCIATION - $6,372 5963865 5963865 71440730 20498972 50941758 89046979 30904568 58142411 86496543 61527414 24969129 9922618 3733975 6188643 146205806 0 DUE TO THIRD PARTY PAYORS 2332749 2332749 ASC 740 FOOTNOTE FORM 990, SCHEDULE D, PART X, LINE 2 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 false true true 759 2784168 1326715 1457453 0.00700 759 2784168 1326715 1457453 0.00700 23140 425416 425416 0.00200 921 491479 491479 0.00240 144024 69255157 49445897 19809260 0.09480 92 499882 2000 497882 0.00240 168177 70671934 49447897 21224037 0.10160 168936 73456102 50774612 22681490 0.10860 6848 6848 1500 1500 1384135 1384135 0.00660 1392483 1392483 0.00660 true 10424588 2606147 54629784 55608766 -978982 X true true FOUR CORNERS ASC AMBULATORY SURGERY CENTER 0.37000 0.00000 0.63000 SAN JUAN REGIONAL MEDICAL CENTER

801 West Maple Street Farmington NM 87401

X X X SJRMC CARDIOLOGY

407 S SCHWARTZ SUITE 201 FARMINGTON NM 87401

MEDICAL CLININC 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 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. SJRMC USES A COST ACCOUNTING SYSTEM WHICH IS A PART OF ITS HOSPITAL INFORMATION SYSTEM. THE SYSTEM ADDRESSES ALL PATIENT SEGMENTS. OF THE AMOUNT REPORTED ON LINE 7G, $11,117,204 WAS RELATED TO SUBSIDIZED SERVICES FOR PHYSICIAN CLINICS. BAD DEBT EXPENSE OF $27,325,263 IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR THE PURPOSE OF CALCULATING THE PERCENTAGE OF NET COMMUNITY BENEFIT. 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 CHARITY CARE COST IF THE PATIENTS WOULD COMPLETE THE CHARITY CARE APPLICATION. THIS AMOUNT IS CURRENTLY ESTIMATED AT 25% THAT IS INCLUDED IN THE COST OF BAD DEBT. THE AMOUNT OF MEDICARE SHORTFALL REPORTED ON LINE 7 IS $978,982 THIS AMOUNT IS A RESULT OF THE TOTAL REVENUE AND ALLOWABLE COST CALCULATION ON OUR FY 10 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 CHARITY CARE 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 CHARITY CARE AND OTHER COMMUNITY BENEFIT NEEDS. 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 (CHARITY CARE) AS LONG AS THE PATIENT IS COOPERATING WITH THE APPLICATION PROCESS." 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 NEXT SCHEDULED ASSESSMENT WILL OCCUR IN FY2012. THE NEEDS WHICH WERE IDENTIFIED FROM THE HOSPITAL'S MOST RECENT SURVEY INCLUDE: ADD/ADHD BARRIERS TO ACCESSING HEALTHCARE SERVICES CIRRHOSIS AND LIVER DISEASE DIABETES FLU VACCINATIONS 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 VIOLENT CRIME 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. 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 PROGRAM FOR SELF-PAY INDIVIDUALS. THROUGH THE PROGRAM, PATIENT ADVOCATES STAND HAND-IN-HAND WITH PATIENTS TO EXPLORE EVERY POSSIBILITY OF ASSISTANCE. 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 124,131)-WHICH IS THE PRINCIPAL COUNTY SERVED BY SAN JUAN REGIONAL MEDICAL CENTER-INDICATE THE FOLLOWING POPULATION CHARACTERISTICS: MEN: 43.3% WOMEN: 51.7% AGES 18 TO 39: 43.5% AGES 40 TO 64: 44.2% AGES 65+: 12.3% WHITE: 44.5% NATIVE AMERICAN: 36.2% HISPANIC: 15.7% LIVING BELOW FEDERAL POVERTY LEVEL: 20% THE MEDIAN HOUSEHOLD INCOME FOR SAN JUAN COUNTY IS $45,971 SJRMC COMMUNITY BUILDING ACTIVITIES ARE A COMBINATION OF PHYSICIAN RECRUITMENT, UNITED WAY PRESENTATIONS AND A PROGRAM WITH BIG BROTHERS BIG SISTERS IN WHICH EMPLOYEES GIVE TIME MENTORING CHILDREN. THE 4 CORNERS REGION HAS BEEN DESIGNATED BY HRSA AS AN AREA WITH A PHYSICIAN SHORTAGE IN PRIMARY CARE, MENTAL HEALTH, DENTAL, AND MEDICALLY UNDERSERVED AREA/POPULATION. FOR THIS REASON SJRMC SPENDS A SIGNIFICANT AMOUNT OF MONEY RECRUITING PHYSICIANS, $1,384,135 IN FISCAL YEAR 2010. THE COMMUNITY HEALTHCARE NEEDS ASSESSSMENT THAT WAS PERFORMED IN FY08 CONTINUES TO GUIDE SJRMC IN PLANNING AND INITIATING PROGRAMS THAT ADDRESS THE IDENTIFED REQUIREMENTS OF OUR COMMUNITY. THE NEXT NEEDS ASSESSMENT IS PLANNED TO BE CONDUCTED DURING FY 2012. IN THE CONSTANT EFFORT TO MEET COMMUNITY NEED SJRMC SEEKS TO IMPROVE PHYSICIAN ACCESS THROUGH A VIGOROUS RECRUITING PROGRAM; PROVIDE COMMUNITY EDUCATION AND MANY OTHER COMMUNITY BENEFIT PROGRAMS. IN FISCAL YEAR 2010, SAN JUAN REGIONAL MEDICAL CENTER PROVIDED BENEFITS TO THE POOR AND THE BROADER COMMUNITY OF OVER $24 MILLION. true SAN JUAN COLLEGE 4601 COLLEGE FARMINGTON NM 87402 850295969 501(C)(3) 19332 FMV NURSE INSTRUCT TIME PROVIDE INSTRUCTION TO NURSING STUDENTS ECHO FOOD BANK 1921 E MURRAY DR FARMINGTON NM 87401 850196667 501(C)(3) 50000 PURCHASE COOLER FOR FOOD STORAGE COMMUNITY HEALTHCARE FUND 1601 E 20TH FARMINGTON NM 87401 113750115 501(C)(3) 11000 DONATION FOR OPERATIONS SAN JUAN UNITED WAY 903 W APACHE FARMINGTON NM 87401 850165322 501(C)(3) 112159 MATCH EMPLOYEE DONATIONS TO UNITED WAY BLOOMFIELD SENIOR CENTER 124 W ASH BLOOMFIELD NM 87413 856004832 501(C)(3) 32000 DIABETES MEALS PROGRAM BOYS AND GIRLS CLUB 1825 E 19TH FARMINGTON NM 87401 856000129 501(C)(3) 13900 FITNESS PROGRAM HOME FOR WOMEN & CHILDREN PO BOX 1805 SHIPROCK NM 87420 850307031 501(C)(3) 56139 LEASE PAYMENTS FOR BUILDING HOPE CHILDRENS FUND PO BOX 110 FARMINGTON NM 87499 850330156 501(C)(3) 30000 DONATION FOR OPERATIONS SAN JUAN UNITED WAY 903 W APACHE FARMINGTON NM 87401 850165322 501(C)(3) 12500 CONTRIBUTE TO FUND TO PROVIDE PROPRANE NM MEDICAL SOCIETY 7770 JEFFERSON NE 400 ALBUQUERQUE NM 87109 850096808 501(c)(3) 32861 SPEAKER FEE FOR ANNUAL CONFERENCE AT NM Medical Society SACRED HEART CATHOLIC CHURCH 404 N ALLEN FARMINGTON NM 87401 850414034 501(C)(1) 20000 MUSIC PROGRAM AND FOUNDATION SAN JUAN ECONOMIC DEVELOPMENT 5101 COLLEGE FARMINGTON NM 87401 850171302 501(C)(3) 10000 PROGRAM SUPPORT SAN JUAN MEDICAL FOUNDATION PO BOX 110 FARMINGTON NM 87499 850330156 501(C)(3) 13000 GOLFING EVENTS SAN JUAN OPEN FOUNDATION 5775 COUNTRY CLUB FARMINGTON NM 87401 342041577 501(C)(3) 6500 SAN JUAN OPEN FOUNDATION GOLF TOURN./CHARITY SAN JUAN SYMPHONY PO BOX 1073 DURANGO CO 81302 237414147 501(C)(3) 20000 DONATION FOR OPERATIONS 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. For 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 false false false false false false true false Charles Hoffman MD 338273 0 38160 0 7200 0 7350 0 17602 0 408585 0 0 0 Steve Altmiller 353143 0 110522 0 55 0 15030 0 10799 0 489549 0 0 0 J Michael Philips 248509 0 68589 0 15643 0 17150 0 17602 0 367493 0 0 0 John Buffington 269429 0 66153 0 16603 0 17150 0 17602 0 386937 0 0 0 Douglas Frary 169677 0 46906 0 28 0 12106 0 17602 0 246319 0 0 0 Ruth Brooks 144014 0 35441 0 22 0 10014 0 7812 0 197303 0 0 0 Tom Dean 173986 0 28614 0 13 0 6532 0 16442 0 225587 0 0 0 Robert Fabrey MD 285760 0 67267 0 16641 0 14328 0 17372 0 401368 0 0 0 Suzanne Smith 171967 0 43309 0 29 0 13228 0 17602 0 246135 0 0 0 Stephen Franken 136483 0 44106 0 64 0 11018 0 14107 0 205778 0 0 0 Catherine Zaharko 135508 0 35015 0 20 0 10534 0 17520 0 198597 0 0 0 Edward Maurin MD 599828 0 0 0 8225 0 15600 0 17602 0 641255 0 0 0 Charles Wilkins MD 555719 0 0 0 16693 0 17150 0 17602 0 607164 0 0 0 Luther Weathers III MD 525684 0 0 0 68 0 7350 0 17520 0 550622 0 0 0 Tull Graham MD 453000 0 0 0 16958 0 14913 0 17510 0 502381 0 0 0 SUPPLEMENTAL COMPENSATION INFORMATION 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. SCHEDULE J-2 THE COMPENSATION REPORTED FOR DWAYNE GIBBS, M.D. IS FOR A DIRECTORSHIP STIPEND, NOT FOR SERVICES RENDERED AS A BOARD MEMBER. THE COMPENSATION REPORTED FOR RONALD CALCOTE, M.D. IS FOR A MEDICAL DIRECTOR FET PROGRAM, NOT FOR SERVICES RENDERED AS A BOARD MEMBER. THE COMPENSATION REPORTED FOR CHARLES HOFFMAN M.D. IS FROM HIS CURRENT EMPLOYMENT, NOT FOR SERVICES RENDERED AS A BOARD MEMBER. PART VII AND SCHEDULE J SUPPLEMENTAL INFORMATION NO COMPENSATION IS REPORTED FOR RICK WALLACE BECAUSE HE DID NOT BEGIN SERVICE UNTIL FEBRUARY 2010 AND THE COMPENSATION REPORTED ON PART VII IS FOR THE CALENDAR YEAR 2009. CITY OF FARMINGTON 856000129 311428BB1 2004-03-25 15000000 CONSTRUCTION OF TOWER/NEW EQUIPMEN false false CITY OF FARMINGTON 856000129 311428BN5 2007-06-28 12290518 CONSTRUCTION OF CANCER CENTER false false CITY OF FARMINGTON 856000129 311428AZ9 2004-03-25 16982883 CONSTRUCTION OF TOWER/NEW EQUIPMEN false false 15689398 0 0 0 363203 0 15326195 2007 false false true true 12457893 0 0 0 245810 0 12212083 2010 false false true true 17087725 0 0 0 339658 0 16748067 2007 false 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 true true false false false false false false false false false false true false false false false false ANNA BUFFINGTON JOHN BUFFINGTON / COO 100726 COMPENSATION AS EMPLOYEE false ERIC BUFFINGTON JOHN BUFFINGTON / COO 20086 COMPENSATION AS EMPLOYEE false SAN JUAN PROFESSIONAL ASSOCIATES GIBBS/V.COS, CALCOTE/SECY 153653 RENTAL PAYMENTS false FOUR CORNERS RADIOLOGY ASSOCIATES RUTH BROOKS/KEY EMPLOYEE 239378 PAYMENT FOR MEDICAL SERVICES false X FIXED ASSETS 1 1334446 COST/SELLING PRICE false true false SUPPLEMENTAL INFORMATION VOLUNTEERS FORM 990, PART I, QUESTION 6 SJRMC HAS A TOTAL OF 179 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, QUESTION 4 2009 SAN JUAN REGIONAL MEDICAL CENTER COMMUNITY BENEFIT 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 2008 ESTIMATE OF THE POPULATION OF SAN JUAN COUNTY SHOWS THE COUNTY POPULATION HAS GROWN 7.6% FROM THE YEAR 2000 TO 2008 AND NOW NUMBERS APPROXIMATELY 122,500; 37% OF WHICH IS AMERICAN INDIAN AND ALASKA NATIVE PERSONS. SJRMC IS 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, QUESTION 2 DWAYNE GIBBS, M.D. AND RONALD CALCOTE, M.D. HAVE A BUSINESS RELATIONSHIP. MEMBERS AND THEIR RIGHTS FORM 990, PART VI, QUESTION 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 ORGANIZATIONS IN SAN JUAN COUNTY. THE CORPORATION MEETS QUARTERLY. AT THEIR ANNUAL MEETING, THEY NOMINATE AND ELECT 12 VOTING MEMBERS OF SJRMC'S BOARD OF DIRECTORS. DESCRIPTION OF PROCESS USED BY MANAGEMENT AND/OR GOVERNING BODY TO REVIEW FORM 990 FORM 990, PART VI, QUESTION 11A 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, QUESTION 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. DESCRIPTION OF PROCESS USED TO DETERMINE COMPENSATION FORM 990, PART VI, QUESTIONS 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 ANNUALLY HAS AN OUTSIDE FIRM COMPARE THE CEO'S COMPENSATION WITH OTHER HEALTHCARE ORGANIZATIONS TO REMAIN COMPETITIVE. THE PROCESS WAS LAST COMPLETED IN 2009. AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS TO THE GENERAL PUBLIC FORM 990, PART VI, QUESTION 19 SAN JUAN REGIONAL MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. METHOD USED TO DETERMINE AMOUNTS IN SCHEDULE R SCHEDULE R, PART V, LINE 2 THE AMOUNTS REPORTED ON SCHEDULE R, PART V, LINE 2 ARE DETERMINED USING THE ACCRUAL METHOD OF ACCOUNTING. THE AMOUNTS REPORTED ON SCHEDULE R, PART V, LINE 2 ARE DETERMINED USING THE ACCRUAL METHOD OF ACCOUNTING. 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