2011-07-15T17:48:01-05:00 2010-08-31 Moss Adams LLP 6100 Uptown Blvd NE Ste 400 Albuquerque NM 87110 990 2009-09-01 850313268 Rehoboth McKinley Christian Healthcare Services REHO 5058637000 1901 Red Rock Dr Gallup NM 87301 Mark Hall 5058637000 2011-07-14 1 Marla Castner 5058787200 2009 2016-02-24 21:20:13Z Karen Lautermilch 1901 Red Rock Dr Gallup NM 87301 67017798 0 X www.rmch.org X 1985 NM THE MISSION OF REHOBOTH MCKINLEY CHRISTIAN HEALTHCARE SERVICES, INC. IS TO SERVE GOD BY PROVIDING HEALTHCARE AND PROMOTING WELLNESS FOR ALL PEOPLE. 15 9 644 100 0 0 9882190 1535700 57627128 65259282 8529 24778 -16547 115952 67501300 66935712 755480 40000 0 32950146 32957722 0 0 32067882 31996066 65773508 64993788 1727792 1941924 40683548 39815837 24944732 21985965 15738816 17829872 Rehoboth McKinley Christian Healthcare Services, Inc. (RMCHCS) will be the preferred healthcare provider organization for McKinley county and the surrounding communities. RMCHCS will be responsive to the healthcare needs of the entire community. RMCHCS will focus on improving financial and operational performance while solidifying ourselves as an integrated healthcare delivery system. We will be distinguished by: 1) demonstrated quality, customer services, and value, 2) superior access, 3) clinical specialty services, 4) Strong human and technological resources, and 5) a multi-cultural orientation. 0 0 42364830 40000 61858124 Provide quality comprehensive healthcare to Gallup, NM and the hospital, three clinics and a 20 bed behavioral health treatment center. As part of their recognition to the needs of the entire community, services are provided to Medicare, Medicaid and direct charity patients. The hospital had 31,904 adjusted patient days. The total value of free and unreimbursed care, services to government programs, community services, and community contributions of the year ended August 31, 2010 is estimated conservatively at $1,859,902. The three clinics provide a broad range of services and specialties, including pediatrics, pulmonology, obstetrics/gynecology, neurology, endocrinology, urology, surgery, orthopedics and nephrology. The program service accomplishments combined clinics had 63,719 patient visits. 883481 842711 Hospice and Home Health - the Hospice operation is a program for patients who have terminal illnesses. The Hospice staff provides 461 visits to community members during the year. The Home Health operation provides interim care to help patients transition from an acute illness to care at home. The Home Health operation, staffed by registered nurses and other certified health care personnel, provides over 4,129 home visits to community members per year. 1179997 2558447 Behavioral Health Services (BHS) - BHS is licensed for 20 beds and also provides outpatient services to the community. BHS offers a high quality, comprehensive approach to the treatment of mental health and substance use disorders. BHS is JCAHO accredited. BHS provides residential treatment, day treatment and intensive outpatient substance-abuse treatment to adults. BHS also provides family and marital therapy and other counseling to children, adolescents, adults and families for psychiatric, emotional and substance use disorders. BHS had 3,605 outpatient visits. 44428308 1 1 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 0 0 0 0 138 0 1 644 1 0 0 0 0 0 0 0 0 0 15 9 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 0 0 NM X Mary Lou Donkersloot 5058637004 1901 Red Rock Dr Gallup NM 87301 Tony D Gonzales 1.00 X X 0 0 0 Kathy Head 1.00 X X 0 0 0 Priscilla Smith 1.00 X X 0 0 0 Eric D Begay 1.00 X X 0 0 0 Oladipo Adeniyi DO 1.00 X 0 0 0 Alan Beamsley DO 1.00 X 0 0 0 David Bischoff 1.00 X 0 0 0 Barry Butler 1.00 X 0 0 0 Jennifer Dowling 1.00 X 0 0 0 Sue Eddy 1.00 X 0 0 0 lynn Isaacson 1.00 X 0 0 0 Bill Lee 1.00 X 0 0 0 John Mezoff MD 1.00 X 0 0 0 Shelley Stam-Maclaren MD 32.00 X 164552 0 13941 Shannon Tanner 1.00 X 0 0 0 karen Lautermilch 38.00 X 112911 0 2341 Mark Hall 38.00 X 179022 0 8265 mary L Poel 40.00 X 237262 0 8866 mary lou monahan 40.00 X 94600 0 0 Bryan Kamps 40.00 X 473731 0 16580 Erwin Richard Elber 40.00 X 334190 0 17506 Carmlita Agodon 40.00 X 323539 0 14408 sharon smith-thomas 40.00 X 318900 0 10180 charles js guimaraes 40.00 X 302102 0 16580 2446209 0 108667 49 0 1 0 Apogee Medical Management 2525 E Camelback Rd Ste 1000 Phoenix AZ 85016 Professional Medical 1290794 Jacobus Consulting 29883 Santa Margarita pkwy rancho st marg CA 92688 Professional Medical 1004914 BE Smith 9777 Ridge Dr Ste 300 Lenexa KS 66219 Professional staffing 949924 Western NM Emergency Physicians PC PO Box 840393 Dallas TX 75284 professional Medical 517606 Integrated Document Solutions Inc 3511 West Commercial Blvd Ft Lauderdale FL 33309 transcription 415156 31 3985 1531715 1535700 NET PATIENT SERVICE 624100 57060243 57060243 medicaid/medicare 624100 7897479 7897479 other program services 900099 301560 301560 65259282 9734 9734 180757 64805 115952 115952 115952 32325 17281 15044 15044 15044 66935712 65259282 0 140730 25000 25000 15000 15000 2499047 1037893 1461154 26008419 20547108 5461311 537883 373928 163955 1960632 1390426 570206 1951741 1449601 502140 97351 97351 100535 100535 6255164 4254841 2000323 133944 584 133360 3420955 673904 2747051 561076 61398 499678 2958293 1131848 1826445 323848 216242 107606 4573 1737 2836 484947 484947 2543797 2543797 1209418 1209418 bad debt 5844248 5844248 medical supplies 3732195 3731206 989 contract labor 3025272 2379930 645342 pharmaceuticals 1300450 1293414 7036 64993788 44428308 20565480 0 6131326 8317637 2320780 1610028 6366020 6941235 4500 5005193 3848144 866009 819901 774966 804388 57348269 42913649 15727331 14434620 2556434 2118536 930989 921348 40683548 39815837 7711173 7446137 7893 7145000 6870000 897605 290947 9190954 7370988 24944732 21985965 X 15738816 17829872 15738816 17829872 40683548 39815837 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 734969 734969 24241694 17551557 6690137 3335516 1300088 2035428 27602319 22991744 4610575 1433771 1070260 363511 14434620 series 2007 bond funds 733223 F investment risk retention group 1385313 F 2118536 estimated 3rd party settlement 7370988 7370988 1 1 X 1 X 1 X 1 1 1 1 1 0 30 1145732 1145732 0.01760 10403250 10015536 387714 0.00600 4237347 5407641 -1170294 0.00000 30 15786329 15423177 363152 0.02360 93668 93668 0.00140 46915 46915 0.00070 517957 517957 0.00800 658540 658540 0.01010 30 16444869 15423177 1021692 0.03370 1 2438961 1219400 19254467 11697095 7557372 X 1 1 RMCHCS HOSPITAL

1901 RED ROCK DRIVE GALLUP NM 87301

X X X COLLEGE CLINIC

2111 COLLEGE DRIVE GALLUP NM 87301

X PEDIATRICS, INTERNAL & FAMILY RED ROCK CLINIC

1900 RED ROCK DRIVE GALLUP NM 87301

X OB/GYN, ORTHOPEDICS, ENT VANDEN BOSCH CLINIC

650 VANDEN BOSCH PARKWAY GALLUP NM 87301

X ENDOCRINOLOGY, DIABETES CARE BEHAVIORAL HEALTH SERVICES

650 VANDEN BOSCH PARKWAY GALLUP NM 87301

ADDICTION & PSYCHIATRIC SERVICES Part III, Line 4: The allowance for doubtful patient accounts receivable is that amount which, in management's judgment, is considered adequate to reduce patient accounts receivable to an amount that is considered to be ultimately collectible. The Hospital calculates its allowance for doubtful accounts based on percentages of accounts receivable aging categories that consider historical write-offs by major payor categories over the past several years.The bad debt related to charity patients is 50% of total bad debt. This is due to the fact that many patients that would otherwise qualify for charity care, fail to complete the required documentation and instead let the accounts go to collections and ultimately to bad debt.Contractual allowances represent the amounts which reduce patient accounts receivable to amounts that are considered to be due from third-party payors based on existing contracts the hospital has with these payors. The contractual allowance percentages are updated several times per year by payor class and line of business and are based upon the accounts within that payor category that have been adjusted over the previous six months for which the total of the payments and adjustments recorded to the account were greater than 90% of the original gross charges. Part III, Line 8: A cost to charge ratio was used based on the overall hospital.The medicare cost report is prepared based on the typical method of eliminating unallowable cost, reclassifying other costs, and dividing the result by total total hospital, or applicable charges. Part III, Line 9b: If a patient is determined to qualify for charity care, the account is written off to a charity care account. If a patient is determined self-pay, the self-pay discounts are posted to the applicable accounts. If the remaining balance is uncollectible, it is written off to bad debt. A financial counselor will provide the patient with forms to fill out. By these forms, it will be determined under the FPG if the account qualifies for a charity care writeoff. If the patient is determined to fall uner the charity care guidelines, the account will be approved by the patient financial services director, and the account will be written off to charity care. Hospital patients who qualify for charity care have no further collection activity. Part VI, Line 2: Community needs are assessed through the Board of Directors and input from other community healthcare leaders. Part VI, Line 3: Patients who present without insurance or ability to pay are seen by a financial counselor who will provide information and forms to apply for assistance through various federal and state programs, as well as criteria for charity write offs. Part VI, Line 4: Gallup, which is the county seat of Mckinley County, is the heart of the Indian Southwest. Seventy-five percent of the residents are of American Indian decent. Gallup is the economic center of three major Indian tribes, Zuni, Hopi, and Navajo and serves the surrounding areas of New Mexico and Arizona. The primary service area (Gallup) has a population of 20,000 with a secondary service area of approximately 90,000 people. Gallup is situated at 6,515 feet and has a mild and comfortable four-season climate. The landscape is beautiful, with red mesas surrounding the City. Gallup has a unique blend of indigenous culture, with genuine American Indian and Southwest-Hispanic arts and crafts in rich abundance. Part VI, Line 6: Rehoboth McKinley Christian Hospital is the main campus. This 69-bed general acute care inpatient facility offers a wide range of medical and diagnostic services. Hospital inpatient services include Medical Surgical, Women's Health, Pediatric, Newborn Nursery, and Intensive and Critical Care Units. Hospital ancillary services include a Cardiopulmonary Rehabilitation, Diagnostic Imaging, sleep lab, and Laboratory Services, as well as Physical Rehabilitation Services. The main campus is also home to the Surgical Services Unit and the Emergency Department. The mission of Rehoboth McKinley Christian Health Care Services is to serve God by providing health care and promoting wellness for all people. Statement of Philosophy- Rehoboth McKinley Christian Health Care Services originates and exists on the basis of the Biblical Command to love God and to love our neighbor. Realizing that human beings are plagued with problems of mind, body, and spirit, this institution is dedicated to their diagnosis, treatment, and prevention. It is the goal of the Corporation to embody the medical facilities with a spirit of mercy that results in physical healing. Medical knowledge, skill, and healing are gifts from God; and, to whatever extent, they are effected at Rehoboth McKinley Christian Health Care Services, Inc., His name is glorified and His purpose served. It is the compassion and love of Christ which set the example for the staff; and it is hoped that this provision of a Christian setting will provide patients an opportunity to encounter Christ, the great Physician. NM 1 RMCHCS Foundation 1901 Red Rock Dr Gallup NM 87301 850349559 501c3 25000 FMV Capital Donation 1 SCHOLARSHIPS 15 15000 FMV X X X X X X 0 0 0 0 0 0 0 0 0 Shelley Stam-Maclaren MD 115852 0 43526 0 5174 0 6630 0 7311 0 178493 0 0 0 Mark Hall 179022 0 0 0 0 0 0 0 8265 0 187287 0 0 0 mary L Poel 204683 0 32579 0 0 0 7886 0 980 0 246128 0 0 0 Bryan Kamps 468557 0 0 0 5174 0 9200 0 7380 0 490311 0 0 0 Erwin Richard Elber 328932 0 0 0 5258 0 9200 0 8306 0 351696 0 0 0 Carmlita Agodon 264847 0 57855 0 837 0 9200 0 5208 0 337947 0 0 0 sharon smith-thomas 202930 0 115970 0 0 0 9200 0 980 0 329080 0 0 0 charles js guimaraes 259891 0 37037 0 5174 0 9200 0 7380 0 318682 0 0 0 NM Hospital Equipment Loan Council 850426875 647370ed3 2007-03-01 7245000 Refunding PY proceeds & capital expenditures 1 0 7233936 645300 3924311 144679 2519647 2007 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 Western NM Emergency Physicians Dr. Beamsley, trustee has an ownership interest 517606 Contract to cover ER 0 elite laundry & Dry Cleaning Owned by sister of Priscilla Smith, Trustee 121711 Contract for laundry services 0 Form 990, Part VI, Section A, line 7a The McKinley County Commissioners appoint 3 of the 13 voting members of the RMCHCS Board of Trustees. The 10 remaining positions on the Board of Trustees are elected on a rotating schedule by all of the 13 voting members of the Board. Form 990, Part VI, Section B, line 11 The CFO reviews the Form 990 prepared by an independent accounting firm. The CFO presents the Form 990 at the monthly meeting of the Finance Committee of the Board of Trustees. At the next regularly scheduled monthly meeting of the full Board of Trustees, the Treasurer reviews the key points on the Form 990 with the Board, and the Finance Committee recommends acceptance of the Form 990. The Form 990 is then filed with the IRS. Form 990, Part VI, Section B, line 12c Each officer, key employee, and member of the board of directors complete a written conflict of interest disclosure form at the time of appointment. They must review and submit a conflict of disclosure form annually. The Board of directors review all conflicts and the person with a conflict is not allowed to vote on such matters. Form 990, Part VI, Section B, line 15a Every 3-5 years, the Board of Trustees contracts with an independent outside entity for a compensation review and recommendation for the salary and benefits provided to the CEO. Every year the CEO's compensation package is reviewed by the Executive Committee of the Board of Trustees during the annual evaluation of the CEO. The compensation of the CFO and all other key employees is determined by the CEO. Form 990, Part VI, Section C, line 18 The Form 990 and Form 1023 are available upon request. A public disclosure copy is also available to the public at the administrative offices of the organization. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are all available upon request. Copies are also available to the public at the administrative offices of the organization. Form 990, Schedule H, Part I, Line 6b community benefit report The hospital does not currently make the community benefit report available to the public. They are in the process of making it available on their website as soon as they have a final revision of the report. Form 990, Part IV, LIne 12a Audited Financial Statements The organization was audited by an independent accounting firm and is included in a consolidated financial statement with related entity, RMCHCS Foundation. The organization has changed their year end to December 31 effective in 2010. As a result, the audit for the current year included 16 months (September 1, 2009 - December 31, 2010). For the current year, there is not an audit report that covers the reportable tax year of September 1, 2009 - August 31, 2010. Form 990, Part XI, Line 2b The organization was audited by an independent accounting firm and is included in a consolidated financial statement with related entity, RMCHCS Foundation. The organization has changed their year end to December 31 effective in 2010. As a result, the audit for the current year included 16 months (September 1, 2009 - December 31, 2010). For the current year, there is not an audit report that covers the reportable tax year of September 1, 2009 - August 31, 2010. The organization has a board finance committee that is responsible for oversight of the audit. This process has not changed from the prior year. RMCHCS FOUNDATION 1901 RED ROCK DRIVE GALLUP NM 87301 850349559 SUPPORT RMCHCS NM 501(c)(3) Line 11c, III-FI N/A 0 1 1 1 0 0 0 0 0 0 0 1 1 1 0 1 0 0