CLAYTON HEALTH SYSTEMS INC: Form 990, tax year 2024
View the entire original 990 at ProPublica ↗
- Organization
- CLAYTON HEALTH SYSTEMS INC (EIN 85-0442957)
- Tax period
- 2024-07-01 to 2025-06-30
- Filed
- 2026-05-15
- IRS object ID
- 202601359349311365
- Schema version
- 2024v5.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2026-05-15T14:28:39+00:00 | ReturnTs |
| Tax Period End | 2025-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 440160260 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Forvis Mazars LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 14221 Dallas Parkway Suite 400 | AddressLine1Txt |
| City | Dallas | CityNm |
| State Abbreviation | TX | StateAbbreviationCd |
| ZIP | 75254 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2024-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 850442957 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Clayton Health Systems Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CLAY | BusinessNameControlTxt |
| Phone | 5753747008 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Wilson Street | AddressLine1Txt |
| City | Clayton | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Brian Roland | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Signature | 2026-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IRS Responsible Prty Info Curr | Yes (true) | IRSResponsiblePrtyInfoCurrInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Andrew J Gray | PreparerPersonNm |
| PTIN | P01517705 | PTIN |
| Phone | 9727028262 | PhoneNum |
| Preparation | 2026-05-15 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2024 | TaxYr |
| Build TS | 2025-03-06 01:10:19Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1Txt |
Principal Ofcr Business Name PrincipalOfcrBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Brian Roland | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Wilson Street | AddressLine1Txt |
| City | Clayton | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,376,809 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.ugch.net | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1996 | FormationYr |
| Legal Domicile State | NM | LegalDomicileStateCd |
| Activity Or Mission | 25-bed acute care critical access hospital serving those in need in and near Union County, NM | ActivityOrMissionDesc |
| Voting Members Governing Body | 5 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 108 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,533,642 | PYContributionsGrantsAmt |
| CY Contributions Grants | $5,786,821 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,172,540 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,544,022 | CYProgramServiceRevenueAmt |
| PY Investment Income | $32,964 | PYInvestmentIncomeAmt |
| CY Investment Income | $40,966 | CYInvestmentIncomeAmt |
| PY Other Revenue | $6,000 | PYOtherRevenueAmt |
| CY Other Revenue | $5,000 | CYOtherRevenueAmt |
| PY Total Revenue | $15,745,146 | PYTotalRevenueAmt |
| CY Total Revenue | $23,376,809 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,338,102 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,401,517 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,006,880 | PYOtherExpensesAmt |
| CY Other Expenses | $10,564,251 | CYOtherExpensesAmt |
| PY Total Expenses | $16,344,982 | PYTotalExpensesAmt |
| CY Total Expenses | $18,965,768 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$599,836 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $4,411,041 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $14,913,998 | TotalAssetsBOYAmt |
| Total Assets EOY | $17,675,146 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $4,816,052 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,166,159 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,097,946 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,508,987 | NetAssetsOrFundBalancesEOYAmt |
| Mission | As a full service, acute care hospital in Clayton, NM, Union County General Hospital provides quality healthcare services to the residents of Union County and surrounding areas. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,602,753 | ExpenseAmt |
| Revenue | $17,544,022 | RevenueAmt |
| Desc | Union County General Hospital is a 25-bed acute care hospital located in Clayton, New Mexico. The Hospital provides services to individuals from Northeastern New Mexico, Southeastern Colorado, Western Panhandle of Oklahoma, and the Western Panhandle of Texas. These services include inpatient, swingbed, various outpatient services, emergency patient care and two rural health clinics. There were a total of 251 admissions and 7,614 patient visits at the Hospital as well as 6,179 patient visits at the Union County Health Center RHC and 394 patient visits at the Des Moines Health Center during fiscal year ending 6/30/2025. (Continued on Schedule O) | Desc |
| Total Program Service Expenses | $15,602,753 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | false | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 36 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 108 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 5 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Policies Reference Chapters | false | PoliciesReferenceChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Written Policy Or Procedure | false | WrittenPolicyOrProcedureInd |
| Other Website | Yes (X) | OtherWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Bruce Naremore | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 5753747008 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Wilson Street | AddressLine1Txt |
| City | Clayton | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (12 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Craig Reeves | |||||||
| Treasurer | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Judith Cooper | |||||||
| President | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Nick Diller | |||||||
| Vice President | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| Robert Williams | |||||||
| Secretary and CRNA | 40.0 | Yes (X) | Yes (X) | $183,318 | $0 | $12,068 | |
| Paul Briesh | |||||||
| Director | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| Tammie Chavez | |||||||
| Chief Executive Officer | 40.0 | Yes (X) | $0 | $0 | $0 | ||
| Terry Lancaster | |||||||
| Chief Financial Officer | 40.0 | Yes (X) | $0 | $0 | $0 | ||
| Amber Brinkman | |||||||
| Registered Nurse | 48.0 | $161,801 | $0 | $7,153 | Yes (X) | ||
| Dr Mark Van Wormer | |||||||
| Doctor of Family Medicine | 40.8 | $640,756 | $0 | $16,637 | Yes (X) | ||
| Jamie Armijo CNP | |||||||
| Family Nurse Practitioner | 40.0 | $181,203 | $0 | $19,868 | Yes (X) | ||
| Jessica Wright DNP-C | |||||||
| Certified Nurse Practitioner | 40.0 | $180,176 | $0 | $12,031 | Yes (X) | ||
| Russell Lees PT | |||||||
| Physical Therapy Director | 40.0 | $162,792 | $0 | $16,517 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,510,046 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $84,274 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Dr Minh Nguyen MD | |||||
| 3321 Coral Ave | Dallas | TX | 75204 | Surgeon | $552,862 |
| Community Hospital Consulting | |||||
| 7800 N Dallas Parkway Suite 200 | Plano | TX | 75024 | Mgmt and Admin Services | $412,589 |
| CPSI | |||||
| PO Box 11407 | Birmingham | AL | 35246 | Operating system | $247,150 |
| Genex Medical Staffing | |||||
| PO Box 14525 | Scottsdale | AZ | 85267 | Locum provider | $160,370 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $5,786,821 | GovernmentGrantsAmt |
| Total Contributions | $5,786,821 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Patient service revenue | 621110 | $13,992,036 | $13,992,036 |
| Pharmacy Revenue | 456110 | $1,398,119 | $1,398,119 |
| Safety Net Care Pool | 621110 | $1,886,508 | $1,886,508 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $267,359 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $267,359 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,544,022 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $40,966 | TotalRevenueColumnAmt |
| Exclusion | $40,966 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,000 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $5,000 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,000 | TotalRevenueColumnAmt |
| Exclusion | $5,000 | ExclusionAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $0 | SecuritiesAmt |
| Other | $0 | OtherAmt |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $0 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,376,809 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,544,022 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $45,966 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $195,386 | TotalAmt |
| Program Services | $195,386 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,007,864 | TotalAmt |
| Program Services | $5,567,214 | ProgramServicesAmt |
| Management And General | $1,440,650 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $141,748 | TotalAmt |
| Program Services | $113,398 | ProgramServicesAmt |
| Management And General | $28,350 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $611,428 | TotalAmt |
| Program Services | $489,142 | ProgramServicesAmt |
| Management And General | $122,286 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $445,091 | TotalAmt |
| Program Services | $356,073 | ProgramServicesAmt |
| Management And General | $89,018 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $492,646 | TotalAmt |
| Program Services | $394,117 | ProgramServicesAmt |
| Management And General | $98,529 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $28,729 | TotalAmt |
| Management And General | $28,729 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,012 | TotalAmt |
| Management And General | $71,012 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,246,545 | TotalAmt |
| Program Services | $1,797,235 | ProgramServicesAmt |
| Management And General | $449,310 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,726 | TotalAmt |
| Program Services | $134,981 | ProgramServicesAmt |
| Management And General | $33,745 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $152,383 | TotalAmt |
| Program Services | $121,906 | ProgramServicesAmt |
| Management And General | $30,477 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $658,344 | TotalAmt |
| Program Services | $526,675 | ProgramServicesAmt |
| Management And General | $131,669 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $112,121 | TotalAmt |
| Program Services | $89,697 | ProgramServicesAmt |
| Management And General | $22,424 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $168,334 | TotalAmt |
| Management And General | $168,334 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,172,471 | TotalAmt |
| Program Services | $937,977 | ProgramServicesAmt |
| Management And General | $234,494 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $931,052 | TotalAmt |
| Program Services | $744,842 | ProgramServicesAmt |
| Management And General | $186,210 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Bad debt expense | $1,751,000 | $1,751,000 | |
| Medical Supplies | $1,471,994 | $1,471,994 | |
| Repairs and maintenance | $366,496 | $293,197 | $73,299 |
| Licenses & Taxes | $294,985 | $235,989 | $58,996 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $477,413 | TotalAmt |
| Program Services | $381,930 | ProgramServicesAmt |
| Management And General | $95,483 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,965,768 | TotalAmt |
| Program Services | $15,602,753 | ProgramServicesAmt |
| Management And General | $3,363,015 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,405,214 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $378,374 | BOYAmt |
| EOY | $3,654,361 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,533,634 | BOYAmt |
| EOY | $2,380,456 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $344,443 | BOYAmt |
| EOY | $297,312 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $154,180 | BOYAmt |
| EOY | $204,613 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,540,316 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $10,440,468 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,461,705 | BOYAmt |
| EOY | $8,099,848 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,177,281 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,864,381 | BOYAmt |
| EOY | $1,633,342 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,913,998 | BOYAmt |
| EOY | $17,675,146 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,812,693 | BOYAmt |
| EOY | $1,413,307 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,195,958 | BOYAmt |
| EOY | $797,702 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,807,401 | BOYAmt |
| EOY | $955,150 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,816,052 | BOYAmt |
| EOY | $3,166,159 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,072,596 | BOYAmt |
| EOY | $14,508,987 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,350 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,097,946 | BOYAmt |
| EOY | $14,508,987 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,913,998 | BOYAmt |
| EOY | $17,675,146 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $4,411,041 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $16,470 | OtherCostOrOtherBasisAmt |
| Book Value | $16,470 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,892,142 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,506,109 | DepreciationAmt |
| Book Value | $7,386,033 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,590,860 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,934,359 | DepreciationAmt |
| Book Value | $656,501 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $40,844 | OtherCostOrOtherBasisAmt |
| Book Value | $40,844 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,099,848 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| ROU Leased Assets | $732,296 |
| Clayton County Receivable | $422,686 |
| Other accounts receivable | $352,309 |
| ROU Subscription IT Assets | $76,376 |
| Employee receivables | $49,675 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,633,342 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Federal Income Taxes | |
| ROU Lease Liabilities | $872,115 |
| ROU Subscription IT Liabilities | $83,035 |
| Estimated third-party payor settlement |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $955,150 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $21,457,475 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$1,919,334 | OtherRevenueAmt |
| Revenue Not Reported | -$1,919,334 | RevenueNotReportedAmt |
| Revenue Subtotal | $23,376,809 | RevenueSubtotalAmt |
| Other Revenues Not Included | $0 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,376,809 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $17,046,434 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $0 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $17,046,434 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,919,334 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,919,334 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $18,965,768 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule D, Part XI, Line 2(d) Other revenues in audited financial statements not in form 990 | Bad debt expense included in revenue for financial statements - -1751000 Interest expense included in revenue for financial statements - -168334 |
| Schedule D, Part XII, Line 4(b) Other expenses in form 990 not in audited financial statements | Interest expense included in revenue for financial statements - 168334 Bad debt expense included in revenue for financial statements - 1751000 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 250 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 450 | DiscountedCareOtherPct |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $403,065 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $403,065 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02365 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,946,010 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,863,168 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,082,842 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12219 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $4,349,075 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,863,168 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,485,907 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14583 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $4,349,075 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,863,168 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,485,907 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14583 | TotalExpensePct |
Physical Imprv And Housing PhysicalImprvAndHousingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Economic Development EconomicDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Environmental Improvements EnvironmentalImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Leadership Development LeadershipDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Coalition Building CoalitionBuildingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 0 | ActivitiesOrProgramsCnt |
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.0 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,751,000 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $341,445 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,432,169 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,592,358 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,839,811 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Wilson Street | AddressLine1Txt |
| City | Clayton | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | www.ugch.net | WebsiteAddressTxt |
| State License | 3060 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 3 Provider Based Rural Health Clinics | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Union County General Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 24 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://ucgh.net/about-us/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 24 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://ucgh.net/about-us/ | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 250.0 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 450.0 | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | ucgh.net/patients/patient-forms-and-policies/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | ucgh.net/patients/patient-forms-and-policies/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | ucgh.net/patients/patient-forms-and-policies/ | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part V, Section B, Line 3E | It is a general assessment of the healthcare needs and resources/gaps for Union County and surrounding areas. We review the market data to determine which services and patients must leave the service area for specific care, as well as the possibility and cost of bringing some of those resources to Clayton or nearby. |
| Schedule H, Part V, Section B, Line 5 Facility , 1 | Facility , 1 - Union County General Hospital (UCGH). UCGH provided CHC Consulting with a list of persons with special knowledge of public health in Union County, including public health representatives, not-for-profit organization professionals, charities and other individuals who focus specifically on under-represented groups. With respect to individuals providing input, it was noted in the CHNA that 81.8% of those providing input are members of a medically underserved, low-income or minority population in the community, or individuals or organizations serving or representing the interests of such populations. 9.1% of those providing input work for a state, local, tribal or regional government public health department with knowledge, information or expertise relevant to the health needs of the community. 9.1% of those providing input are community leaders. |
| Schedule H, Part V, Section B, Line 11 Facility , 1 | Facility , 1 - Union County General Hospital (UCGH). The most recently conducted CHNA identified six significant needs in the community served by UCGH, which were determined by assessing the prevalence of the issues identified from the health data findings, combined with the frequency and severity of mentions in community input. The CHNA team and hospital leadership prioritized those needs using a structured matrix to rank the community health needs based on three characteristics: size and prevalence of the issue, effectiveness of interventions and the hospital's capacity to address the need. The final list of prioritized needs, in descending order, is listed below: 1.) Access to Consistent, Local Primary Care Providers 2.) Access to Dental Care Services and Providers 3.) Access to Specialty Care Services and Providers 4.) Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles 5.) Access to Mental and Behavioral Health Care Services and Providers 6.) Access to Affordable Care and Reducing Health Disparities Among Specific Populations Priority 1: Access to Consistent, Local Primary Care Providers Objective: Increase access to local primary care services and providers. 1.A. Union County General Hospital continues to promote its primary care provider services in order to increase awareness of service offerings in the community. This is done via the local newspaper, local radio stations, social media outlets, and the hospital's website. 1.B. Union County General Hospital continues to schedule follow up appointments with patients' primary care provider upon discharge. Priority 2: Access to Dental Care Services and Providers Objective: Increase local access to dental health care services. 2.A. UCGH will not recruit dentist and dental hygienist providers to the community to increase access to local dental care services. Union County currently has no dental services available. 2.B. Due to a change in governmental funding, UCGH has put the idea of a Dentist on hold. A dentist in the area is more of a community service than revenue for the Hospital, and the Hospital cannot take on that responsibility until it has the income or financial stability to sustain it. Priority 3: Access to Specialty Care Services and Providers Objective: Increase access to additional specialist services and providers in the community. 3.A. The hospital has a general surgeon that provides rotating coverage to the community once weekly. 3.B. Union County General Hospital continues to host a mobile MRI van in the hospital parking lot once a week and assists with scheduling. 3.C. Union County General Hospital continues to host a mobile Mammography van in the hospital parking lot 10-12 times per year (as scheduling needs require), and also assist with patient awareness. 3.D. The hospital continues to staff a Nuclear Medicine Tech contract, who will come in as needed for nuclear medicine studies. 3.E. UCGH provides telemedicine programs in collaboration with the University of New Mexico (UNM) for emergency pediatrics and neurology/neurosurgery services for Strokes. 3.F. The hospital continues to evaluate rotating specialist coverage. 3.G. Union County General Hospital schedules follow up appointments with patients' providers upon discharge, when necessary. 3.H. Union County General Hospital markets its specialty services to the community to increase awareness of its service offerings. 3.I. Union County General Hospital has created a specialty clinic in the hospital that will provide services the patients cannot currently receive in Union County. Priority 4: Prevention, Education and Services to Address High Mortality Rates, Chronic Diseases, Preventable Conditions and Unhealthy Lifestyles Objective: Increase healthy lifestyle education and prevention resources at the hospital and in the community. 4.A. Union County General Hospital continues to provide CPR training for hospital staff and other health care givers in the community. 4.B. The hospital continues to incentivize employees and their families to participate in regular physical activity through a discounted membership at a local gym and recreation facilities, and the golf course. 4.C. UCGH continues to participate in the county-wide health fairs, and additional hospital- based health fairs each year, to provide blood pressure screenings, lab tests, as well as many different areas of health and wellness education. 4.D. UCGH continues to maintain its status as a Level 4 Trauma Center through the provision of community education surrounding trauma 1-2 times per year (ex: firework safety, no texting and driving). 4.E. UCGH continues to provide free flu shots to the community for the donation of 2 non-perishable food items for donation to community food drive. 4.F. Many representatives from the hospital serve as members of community organizations, including the Chamber of Commerce, the Rotary Club, the Union County Health Network, and the Local Emergency Planning Committee. 4.G. The hospital continues to work with local Emergency Management Services (EMS) to provide trauma education on a regular basis for hospital and EMS staff. 4.I. UCGH continues their partnership with the Sexual Assault Prevention program in the community. 4.J. Union County General Hospital continues marketing social media, print advertisement and website enhancements to increase professionalism and community awareness of hospital service offerings. 4.K. Union County General Hospital engages local employers through the provision of drug screens, TB tests, flu vaccinations and bone scans for staff. 4.L. Union County General Hospital continues to participate in the Emergency Planning Committee in the community, which is a collaborative approach that includes nursing, providers and other hospital allied staff, EMS, Flight Crews, the Fire Department, Police staff and the County Emergency Manager. 4.M. Union County General Hospital continues to provide education in the lobby of the facility and clinic on a variety of health topics each month. Priority 5: Access to Mental and Behavioral Health Care Services and Providers Objective: Increase local access to mental and behavioral health care services. 5.A. UCGH continues to apply for monetary grants to bring more mental and behavioral health care services to the community. 5.B. UCGH continues to review telehealth services for mental and behavioral health care for the community. Priority 6: Access to Affordable Care and Reducing Health Disparities Among Specific Populations Objective: Increase local access to affordable health care and reducing health disparities among specific populations. 6.A. UCGH has trained and certified a few employees to help our patients apply for Medicaid and other low-income state benefits. 6.B. UCGH has trained and certified a few employees to help our patients apply for Market Place Insurance that is based on patient's income. 6.C. UCGH has trained a few employees to help our patients apply for Medicare. 6.D. UCGH advertises through various venues when it is open enrollment for Medicare and the Market Place Insurance. |
| Schedule H, Part V, Section B, Line 13 Facility , 1 | Facility , 1 - Union County General Hospital (UCGH). Presumptive Eligibility for Financial Assistance: The hospital may use Discovery Healthcare Consultant Group and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation. Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of yearly household income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance. The hospital may choose to grant financial assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, disabled, transient or incompetent may be valid "prima facie" candidates. In such cases, the hospital may not complete full verification or documentation of any request. Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 0 | FacilityNum |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Schedule H, Part I, Line 3c Presumptive Eligibility for Financial Assistance | The hospital may use Discovery Healthcare Consultant Group and other publicly available information to determine, consistent with applicable legal requirements, estimated household size and income amounts for the basis of determining financial assistance eligibility when a patient does not provide a financial assistance application or supporting documentation. Expired patients, with no surviving spouse, may be deemed to have no income for purposes of calculation of yearly household income. Documentation of income is not required for expired patients; however, documentation of estate assets may be required. The surviving spouse of an expired patient may apply for financial assistance. The hospital may choose to grant financial assistance based solely upon the initial determination. Any patients who are on state assistance, are unemployed, disabled, transient or incompetent may be valid "prima facie" candidates. In such cases, the hospital may not complete full verification or documentation of any request. Patients whose outstanding balance, after payment by all third parties, is at or above 10% of their yearly household income are eligible to receive services at a discounted amount. |
| Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation | 1751000 |
| Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance | Charity care expense was converted to cost on line 7a based on an overall cost-to-charge ratio addressing all patient segments. Unreimbursed Medicaid on line 7b was calculated using the costing methods to prepare the cost report. |
| Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount | Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. |
| Schedule H, Part III, Line 3 Bad Debt Expense Methodology | The amount of bad debt estimated to be attributable to patients under the Organization's charity care policy is 19.5%. This was determined by using the percentage of the population in the service area that is under the federal poverty guideline established for charity care. |
| Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote | The footnote to the Organization's financial statements can be found on page 10 of the attached audited financial statements. |
| Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs | Serving patients with government health benefits, such as Medicare, is a component of the community benefit standard that tax-exempt hospitals are held to. This implies that serving Medicare patients is a community benefit and that the hospital operates to promote the health of the community. Both the total revenue received from Medicare and the Medicare allowable costs are reported from the Medicare Cost Report. The Medicare Cost Report is completed based on the rules and regulations set forth by the Centers for Medicare and Medicaid Services. |
| Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance | When a patient has indicated or demonstrated an inability to pay, an appropriate Hospital representative provides the patient with a financial assistance application. Applications must be completed in their entirety before financial assistance can be considered. Patients who qualify for financial assistance from a government program should be referred to the appropriate agency prior to consideration for charity/indigent care. An application for financial assistance from an outside agency should be obtained prior to charity care approval. From the discharge date, monthly statements are sent with information on financial assistance. After the 3rd statement is sent a Patient Financial Consultant works with the patient until deemed uncollectible. Accounts are sent to collections after 180-days from the date of service or date insurance paid. Patients have an additional 120-days to submit an application for financial assistance. |
| Schedule H, Part V, Section B, Line 16a FAP website | - Union County General Hospital: Line 16a URL: ucgh.net/patients/patient-forms-and-policies/; |
| Schedule H, Part V, Section B, Line 16b FAP Application website | - Union County General Hospital: Line 16b URL: ucgh.net/patients/patient-forms-and-policies/; |
| Schedule H, Part V, Section B, Line 16c FAP plain language summary website | - Union County General Hospital: Line 16c URL: ucgh.net/patients/patient-forms-and-policies/; |
| Schedule H, Part VI, Line 2 Needs assessment | While the CHNA is only performed every 3 years currently, we operate as a public entity in association with Union County government. All of our board meetings are open to the public and we also meet monthly with the Union County Board of Commissioners to report on the financial health of the Hospital as well as any issues, needs or immediate plans for adding services at the Hospital. While CHC assists in the management of the Hospital, we have a local Board of Directors that actively manages and oversees the operations of the Hospital and gather community input on a regular basis. We also have an active website and try to push out education, community events and availability of services at the main campus and our clinics here and in Des Moines. The Hospital regularly goes out to provide health fairs and screenings to communities 25-50 miles from the Hospital - Des Moines, Roy, Tucumcari and such. Their test results are available through our portal and we can assist them with access to any needed followup care. |
| Schedule H, Part VI, Line 3 Patient education of eligibility for assistance | Patients are educated about financial assistance upon admission to the hospital and at discharge, whether for inpatient service, emergency services, or for clinic visits, as well. Financial assistance information is displayed in waiting rooms, emergency rooms, and other areas of the hospital. Applying for financial assistance can be initiated by a patient requesting assistance in person, over the phone at 575-374-2585, through the mail at 300 Wilson St, Clayton, NM 88415, by email at andrea.naranjo@ucgh.net or via the hospital's website www.ucgh.net. Additionally, the hospital will often initiate a financial assistance application on behalf of the patient, either at time of registration or during the discharge process. UCHG has certified its own employee so that patients can apply for Medicaid and other government assistance onsite because there is not a Medicaid office in the county. Patients are notified of this through Facebook, the newspaper, and when the organization sees the need for financial assistance. |
| Schedule H, Part VI, Line 4 Community information | Union County General Hospital (UCGH) is a 25-bed acute care hospital located in Clayton, New Mexico. As the key hospital for the region, UCGH offers a wide array of services which includes primary care, emergency care, inpatient care, therapy services, surgical services, swing bed care, a full medical staff and state-of-the-art equipment. UCGH provides the highest quality health care services possible to the residents of Union County and surrounding areas. The defined service area of UCGH is Union County in New Mexico. The population of Union County is expected to decrease from 2022 (4,021) to 2027(4011) by 0.2%, which is 1.2% less growth than the 1.4% expected growth for the state of New Mexico from 2022(2,192,707) to 2027(2,159,693). As of 2022, the racial/ethnic breakout of Union County was 25.9% White Non-Hispanic, 1.6% Black, 39.5% Hispanic, 0.2% Asian, and 32.8% all others. By 2027, the White Non-Hispanic population is expected to decrease by 0.3% while the Black population is not expected to change, the Hispanic population is expected to decrease by 0.2%, the Asian population is not expected to change and all others are expected to decrease by 0.2% in Union County. Union County (42.9 years) has a slightly older median age than New Mexico (38.5 years) (2022). The median household income in Union County and the state is expected to slightly increase over the next five years (2022-2027). Union County ($40,947) has a lower median household income than New Mexico ($56,735) (2022). With respect to education, Union County (12.6%) has a lower percentage of residents with a bachelor or advanced degree than the state (29.0%) (2022). Persons living below the federal poverty level in Union County, NM in 2023 was 19.5%. The closest hospital is Coon Memorial Hospital located 48 miles from Union County General Hospital in Dalhart, TX. The hospital provides general inpatient and outpatient medical and surgical care. The largest industries are public administration, health care & social assistance, and retail trade. |
| Schedule H, Part VI, Line 5 Promotion of community health | Our Board of Directors is comprised of individuals from the community. The board provides a perspective on the needs of the community. The Hospital extends medical privileges to area physicians. Surplus funds are reinvested into facility and equipment upgrades and free programs throughout the year. During this fiscal year Union County General Hospital did participate in the annual county-wide health fair, at several different locations in Clayton, Roy, Des Moines and at schools and throughout the month of May for walkins to a virtual health screening for all residents. We offer discounted or free rates for that testing and encourage participation, and if warranted, followup care as indicated. |
| Schedule H, Part VI, Line 7 State filing of community benefit report | NM |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Robert Williams | ||||||||||||||
| Secretary and CRNA | $183,318 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,068 | $0 | $195,386 | $0 | $0 | $0 |
| Jamie Armijo CNP | ||||||||||||||
| Family Nurse Practitioner | $181,203 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $19,868 | $0 | $201,071 | $0 | $0 | $0 |
| Jessica Wright DNP-C | ||||||||||||||
| Certified Nurse Practitioner | $180,176 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $12,031 | $0 | $192,207 | $0 | $0 | $0 |
| Dr Mark Van Wormer | ||||||||||||||
| Doctor of Family Medicine | $640,756 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,637 | $0 | $657,393 | $0 | $0 | $0 |
| Russell Lees PT | ||||||||||||||
| Physical Therapy Director | $162,792 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $16,517 | $0 | $179,309 | $0 | $0 | $0 |
| Amber Brinkman | ||||||||||||||
| Registered Nurse | $161,801 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,153 | $0 | $168,954 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Schedule J, Part I, Line 3 Methods used to establish the compensation of the organization's CEO/E.D. | FormAndLineReferenceDesc |
| Explanation | The Board of Directors approves the contract with Community Hospital Corporation, the management company that employs the CEO. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part III, Line 4a Program Service Accomplishments | Union County General Hospital is a 25-bed acute care hospital located in Clayton, New Mexico. The Hospital provides services to individuals from Northeastern New Mexico, Southeastern Colorado, Western Panhandle of Oklahoma, and the Western Panhandle of Texas. These services include inpatient, swingbed, various outpatient services, emergency patient care and two rural health clinics. There were a total of 251 admissions and 7,614 patient visits at the Hospital as well as 6,179 patient visits at the Union County Health Center RHC and 394 patient visits at the Des Moines Health Center during fiscal year ending 6/30/2025. The Hospital provides health care services to patients who meet certain criteria under its charity care policy without charge or at amounts less than established rates. Since the Hospital does not pursue collection of these amounts, they are not reported as patient service revenue. Charges for charity care provided during June 30, 2025, totaled $452,679 and the estimated cost of providing these services was $364,109 calculated by multiplying the ratio of costs to gross charges for the Hospital by the gross uncompensated charges associated with providing charity care. |
| Form 990, Part VI, Line 15 PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL | The compensation for the CEO and CFO is determined by a management company. The management company determines the compensation using their processes and the Hospital's Board of Directors votes and approves the management contract. |
| Form 990, Part VI, Line 1a Delegate broad authority to a committee | The Executive Committee consists of at least the President, who shall serve as chairperson of the Executive Committee, the Vice-President, Secretary, and Treasurer. The Executive Committee may consist of all Board members if so designated by the Board. The Executive Committee shall meet at least on a quarterly basis. Between meetings of the Board, the Executive Committee shall possess and may exercise any and all powers of the Board in the management and affairs of the Corporation; provided that all actions of the Executive Committee are subject to the paramount power of the Board and shall not conflict with any expressed policies of the Board. All action taken by the Executive Committee shall be reported to the Board at each regular and annual meeting, and such actions are subject to revision, alteration or change by the Board, provided that rights of third persons shall not be affected thereby. |
| Form 990, Part VI, Line 3 Delegation of management duties | Tammie Chavez, CEO and Terry Lancaster, CFO (from March 25) are common law employees of Community Health Corporation (CHC), an unrelated management company. The CEO has the responsibility of supervising the management, administration and operation of the Organization. The CFO has the responsibility for managing the Organization's finances. Compensation and benefits for fiscal year is reported below for services provided to Union County General Hospital. Tammie Chavez: Compensation: $297,997 Other Benefits: $16,339 Terry Lancaster: Compensation: $64,027 Other Benefits: $4,928 |
| Form 990, Part VI, Line 7a Members or stockholders electing members of governing body | The Hospital is a component unit of the County and the Board of County Commissioners appoints members to the Board of Trustees of the Hospital. |
| Form 990, Part VI, Line 11b Review of form 990 by governing body | The Form 990 is provided to the governing board prior to filing with the IRS. The CEO and CFO review the Form 990. |
| Form 990, Part VI, Line 12c Conflict of interest policy | The Board of Directors and officers are required to complete and sign the conflict of interest statement annually. Any potential conflict arising during the year must be disclosed to the Board. The Board discusses the potential conflicts and determines if actions should be taken. If there is a conflict the board member may be asked to leave the meeting or not vote on the matter. |
| Form 990, Part VI, Line 19 Required documents available to the public | The Hospital's financial statements, governing documents, and conflict of interest policy are available to the public upon request at the Administration Office located at 300 Wilson Street in Clayton, NM. |
| Form 990, Part VIII, Line 2f Other Program Service Revenue | Other Program Service Revenue - Total Revenue: 267359, Related or Exempt Function Revenue: 267359, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; |
| Form 990, Part IX, Line 11g Other Fees | Professional Fees - Total Expense: 732318, Program Service Expense: 585854, Management and General Expenses: 146464, Fundraising Expenses: ; Contract Labor - Total Expense: 154750, Program Service Expense: 123800, Management and General Expenses: 30950, Fundraising Expenses: ; Purchased Services - Total Expense: 1357713, Program Service Expense: 1086170, Management and General Expenses: 271543, Fundraising Expenses: ; Recruiting - Total Expense: 1764, Program Service Expense: 1411, Management and General Expenses: 353, Fundraising Expenses: ; |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | County of Union | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 430 | AddressLine1Txt |
| City | Clayton | CityNm |
| State Abbreviation | NM | StateAbbreviationCd |
| ZIP | 88415 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 856000259 | EIN |
| Primary Activities | Government | PrimaryActivitiesTxt |
| Legal Domicile State | NM | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |