Attach to Form 990 or Form 990-EZ.
Go to
www.irs.gov/Form990 for instructions and the latest information.
| (i) Name of supported organization | (ii) EIN | (iii) Type of organization (described on lines 1- 10 above (see instructions)) | (iv) Is the organization listed in your governing document? | (v) Amount of monetary support (see instructions) | (vi) Amount of other support (see instructions) | |
|---|---|---|---|---|---|---|
| Yes | No | |||||
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Total |
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Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") .. | ||||||
| 2 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.... | ||||||
| 3 | The value of services or facilities furnished by a governmental unit to the organization without charge.. | ||||||
| 4 | Total. Add lines 1 through 3 | ||||||
| 5 | The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) .. | ||||||
| 6 | Public support. Subtract line 5 from line 4. | ||||||
Calendar year
(or fiscal year beginning in)
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(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 7 | Amounts from line 4.. | ||||||
| 8 | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources... | ||||||
| 9 | Net income from unrelated business activities, whether or not the business is regularly carried on.. | ||||||
| 10 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.).. | ||||||
| 11 | Total support. Add lines 7 through 10 | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 1 | Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") . | ||||||
| 2 | Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose | ||||||
| 3 | Gross receipts from activities that are not an unrelated trade or business under section 513 ..... | ||||||
| 4 | Tax revenues levied for the organization's benefit and either paid to or expended on its behalf... | ||||||
| 5 | The value of services or facilities furnished by a governmental unit to the organization without charge | ||||||
| 6 | Total. Add lines 1 through 5 | ||||||
| 7a | Amounts included on lines 1, 2, and 3 received from disqualified persons | ||||||
| b | Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year. | ||||||
| c | Add lines 7a and 7b.. | ||||||
| 8 | Public support. (Subtract line 7c from line 6.) | ||||||
Calendar year (or fiscal year beginning in) ![]() |
(a) 2017 | (b) 2018 | (c) 2019 | (d) 2020 | (e) 2021 | (f) Total | |
|---|---|---|---|---|---|---|---|
| 9 | Amounts from line 6... | ||||||
| 10a | Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources.. | ||||||
| b | Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975. | ||||||
| c | Add lines 10a and 10b. | ||||||
| 11 | Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on. | ||||||
| 12 | Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) .. | ||||||
| 13 | Total support. (Add lines 9, 10c, 11, and 12.).. | ||||||
| Section A - Adjusted Net Income | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Net short-term capital gain | 1 | ||||
| 2 | Recoveries of prior-year distributions | 2 | ||||
| 3 | Other gross income (see instructions) | 3 | ||||
| 4 | Add lines 1 through 3 | 4 | ||||
| 5 | Depreciation and depletion | 5 | ||||
| 6 | Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) | 6 | ||||
| 7 | Other expenses (see instructions) | 7 | ||||
| 8 | Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) | 8 | ||||
| Section B - Minimum Asset Amount | (A) Prior Year |
(B) Current Year (optional) |
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| 1 | Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): | 1 | ||||
| a | Average monthly value of securities | 1a | ||||
| b | Average monthly cash balances | 1b | ||||
| c | Fair market value of other non-exempt-use assets | 1c | ||||
| d | Total (add lines 1a, 1b, and 1c) | 1d | ||||
| e |
Discount claimed for blockage or other factors (explain in detail in Part VI): |
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| 2 | Acquisition indebtedness applicable to non-exempt use assets | 2 | ||||
| 3 | Subtract line 2 from line 1d | 3 | ||||
| 4 | Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). | 4 | ||||
| 5 | Net value of non-exempt-use assets (subtract line 4 from line 3) | 5 | ||||
| 6 | Multiply line 5 by 0.035 | 6 | ||||
| 7 | Recoveries of prior-year distributions | 7 | ||||
| 8 | Minimum Asset Amount (add line 7 to line 6) | 8 | ||||
| Section C - Distributable Amount | Current Year | |||||
| 1 | Adjusted net income for prior year (from Section A, line 8, Column A) | 1 | ||||
| 2 | Enter 85% of line 1 | 2 | ||||
| 3 | Minimum asset amount for prior year (from Section B, line 8, Column A) | 3 | ||||
| 4 | Enter greater of line 2 or line 3 | 4 | ||||
| 5 | Income tax imposed in prior year | 5 | ||||
| 6 | Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) | 6 | ||||
| Section D - Distributions | Current Year | |
|---|---|---|
| 1 Amounts paid to supported organizations to accomplish exempt purposes | 1 | |
|
2
Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity |
2 | |
| 3 Administrative expenses paid to accomplish exempt purposes of supported organizations | 3 | |
| 4 Amounts paid to acquire exempt-use assets | 4 | |
| 5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) | 5 | |
| 6 Other distributions (describe in Part VI). See instructions | 6 | |
| 7Total annual distributions. Add lines 1 through 6. | 7 | |
|
8
Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions |
8 | |
| 9 Distributable amount for 2021 from Section C, line 6 | 9 | |
| 10 Line 8 amount divided by Line 9 amount | 10 | |
| Section E - Distribution Allocations (see instructions) |
(i) Excess Distributions |
(ii) Underdistributions Pre-2021 |
(iii) Distributable Amount for 2021 |
|
|---|---|---|---|---|
| 1 Distributable amount for 2021 from Section C, line 6 | ||||
|
2
Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI). See instructions. |
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| 3 Excess distributions carryover, if any, to 2021: | ||||
| a From 2016....... | ||||
| b From 2017....... | ||||
| c From 2018....... | ||||
| d From 2019....... | ||||
| e From 2020....... | ||||
| fTotal of lines 3a through e | ||||
| g Applied to underdistributions of prior years | ||||
| h Applied to 2021 distributable amount | ||||
|
i
Carryover from 2016 not applied (see instructions) |
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| j Remainder. Subtract lines 3g, 3h, and 3i from line 3f. | ||||
| 4Distributions for 2021 from Section D, line 7: | ||||
| $ | ||||
| a Applied to underdistributions of prior years | ||||
| b Applied to 2021 distributable amount | ||||
| c Remainder. Subtract lines 4a and 4b from line 4. | ||||
|
5
Remaining underdistributions for years prior to 2021, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions. |
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|
6
Remaining underdistributions for 2021. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions. |
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7 Excess distributions carryover to 2022. Add lines 3j and 4c. |
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| 8 Breakdown of line 7: | ||||
| a Excess from 2017..... | ||||
| b Excess from 2018..... | ||||
| c Excess from 2019..... | ||||
| d Excess from 2020..... | ||||
| e Excess from 2021..... | ||||
| Facts And Circumstances Test |
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| Return Reference | Explanation |
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| Software ID: | |
| Software Version: |
Attach to Form 990 or 990-EZ.
Go to www.irs.gov/Form990 for the latest information.
| Return Reference | Explanation |
|---|---|
| FORM 990, PART III, LINE 4A | PRIMARY HEALTH CARE SERVICES: HMS EMPLOYS BOARD-ELIGIBLE AND CERTIFIED FAMILY PRACTICE PHYSICIANS, CERTIFIED PHYSICIANS ASSISTANTS AND FAMILY NURSE PRACTITIONERS TO SERVE OUR PATIENTS. HMS ALSO PROVIDES THE FOLLOWING ANCILLARY SERVICES: LABORATORY SERVICES - LABORATORY SERVICES ARE REGULATED BY MEDICARE THROUGH THE CLINICAL LABORATORY IMPROVEMENT ACT (CLIA). AT RURAL LOCATIONS, HMS OFFERS CLIA WAIVED LAB SERVICES WHICH ARE A LIMITED AND DEFINED SET OF LAB SERVICES THAT CAN BE DIN-HOUSE. FOR OTHER TESTS, HMS PROVIDES MODERATE COMPLEXITY LAB SERVICES AT ITS CLINIC IN SILVER CITY. THE MAJORITY OF LAB SERVICES CAN BE PROVIDED WITHIN HMS, WHICH CAN SPEED UP THE RESULTS PROCESS AND PROVIDE BETTER PATIENT CARE. LAB SPECIMENS ARE SENT DAILY VIA GRANT COUNTY'S CORRE CAMINOS PUBLIC TRANSPORTATION SYSTEM WHICH IS FUNDED, IN PART, BY HMS. SOME INSURANCE COMPANIES REQUIRE THAT CERTAIN LABS BE SENT TO CERTAIN LABORATORIES IN ALBUQUERQUE OR ELSEWHERE, FOR WHICH HMS WILL MAKE ARRANGEMENTS. HMS ALSO PARTNERS WITH GILA REGIONAL MEDICAL CENTER (GRMC) IN SILVER CITY FOR MORE COMPLICATED LAB PROCESSES. X-RAY SERVICES - BASIC X-RAY SERVICES ARE PROVIDED AT HMS LOCATIONS IN SILVER CITY AND LORDSBURG. ALL OTHER RADIOLOGIC OR OTHER PROCEDURES SUCH AS MAGNETIC RESONANCE IMAGING (MRI) ARE TYPICALLY REFERRED TO GRMC. PATIENT CHOICE IS ALWAYS A CONSIDERATION. PHARMACY - THERE ARE THREE WAYS THAT HMS CAN ASSIST PATIENTS WITH PHARMACY SERVICES BEYOND THE SIMPLE PRESCRIPTION. 1. MEDICATION ASSISTANCE PROGRAM: MANY PHARMACEUTICAL COMPANIES OFFER FREE MEDICATIONS TYPICALLY TO CHRONICALLY ILL PATIENTS WHO QUALIFY FINANCIALLY. THE HMS FAMILY SUPPORT PROGRAM ASSISTS ALL PEOPLE WHO QUALIFY WITH THIS SERVICE, WHETHER THEY ARE HMS PATIENTS OR NOT. THE FAMILY SUPPORT MEDICATION ASSISTANCE PROGRAM (MAP) IS ALSO SUPPORTED BY A NUMBER OF COMMUNITY VOLUNTEERS. 2. 340B PRESCRIPTIONS: HMS HAS ACCESS TO A LIMITED NUMBER OF PRESCRIPTIONS THROUGH THE 340B PROGRAM IN GRANT COUNTY WITH WALGREENS PHARMACY, WAL-MART AND CVS AND THE GENOA PHARMACY IN GRANT AND HIDALGO COUNTIES. THE PROGRAM ALLOWS HMS TO PURCHASE MEDICATIONS AT FEDERAL DRUG PRICES, REDUCING THE PATIENT'S COST. THE PATIENT MUST BE A PATIENT OF HMS, REFERRED ONLY BY HMS PROVIDERS AND BE ELIGIBLE TO THE HMS SLIDING SCALE PROGRAM. 3. EMERGENCY COVERAGE IN HIDALGO COUNTY: HMS COLLABORATES WITH THE HIDALGO COUNTY AMBULANCE SERVICE FOR EMERGENCY SERVICE NEEDS. THE CLINIC IN LORDSBURG WILL SEE MINOR EMERGENCIES, E.G. SUTURES (STITCHES AND BREAKS). FOR GRANT COUNTY PATIENTS, HMS UTILIZES LOCAL AMBULANCE SERVICES FOR EMERGENCIES. HMS PHYSICIANS SHARE AFTER HOURS CALLS WITH OTHER LOCAL PHYSICIANS IN A CALL TEAM AND ARE ABLE TO ATTEND TO PATIENTS THAT ARE REQUIRED TO GO THE HOSPITAL ER IN SILVER CITY. |
| FORM 990, PART III, LINE 4B | BEHAVIORAL HEALTH SERVICES: INTEGRATED BEHAVIORAL HEALTH CARE: BEHAVIORAL HEALTH PROFESSIONALS ARE AVAILABLE TO ASSIST PRIMARY CARE PROVIDERS IDENTIFY AND APPROPRIATELY RESPOND TO EMOTIONAL, BEHAVIORAL AND MENTAL FACTORS THAT IMPACT THE MEDICAL CARE OF PATIENTS. THIS ALLOWS BEHAVIORAL HEALTH PROVIDERS TO SEE PATIENTS IN THE EXAM ROOM IN ORDER TO MAKE A QUICK ASSESSMENT AND PROVIDE A BRIEF, SUPPORTIVE INTERVENTION OR A REFERRAL TO COUNSELING OR PSYCHOTHERAPY SERVICES, EITHER WITHIN HMS OR TO ONE OF THE OTHER AGENCIES PROVIDING A DIFFERENT LEVEL OF CARE WITHIN THE COMMUNITY. QUALIFIED BEHAVIORAL HEALTH PROVIDERS (E.G. PSYCHIATRIC NURSE PRACTITIONERS) MAY ALSO CONSULT WITH PRIMARY CARE PROVIDERS ON APPROPRIATE MEDICATIONS FOR THE PRESENTING CONCERNS. THE GOAL OF THE BEHAVIORAL HEALTH CARE CONSULT ARE BOTH TO ENSURE THE PROPER, CULTURALLY COMPETENT STRATEGY FOR HEALTH CARE IS AGREED UPON BETWEEN PROVIDER AND PATIENT, AND TO HELP THE PATIENT IDENTIFY AND CHANGE ASPECTS OF THEIR LIFE WHICH MAY INTERFERE WITH MAINTAINING THEIR HEALTH AND QUALITY OF LIFE. PSYCHOTHERAPY SERVICES: HMS BEHAVIORAL HEALTH PROFESSIONALS PROVIDE SHORT-TERM AND MEDIUM-TERM INDIVIDUAL AND GROUP COUNSELING AND PSYCHOTHERAPY SERVICES TO HMS PATIENTS. SUCH SERVICES ARE PRINCIPALLY DESIGNED FOR MODERATE TO MEDIUM LEVEL DIFFICULTIES IN LIVING ENCOUNTERED BY PATIENTS. THOSE DEALING WITH SEVERE OR CHRONIC BEHAVIORAL HEALTH CHALLENGES WOULD MOST LIKELY BE REFERRED TO OTHER AGENCIES IN THE REGION FOR A MORE APPROPRIATE LEVEL OF CARE. HMS EMPLOYS STRENGTH-BASED PSYCHOTHERAPEUTIC STRATEGIES THAT ARE VALIDATED EMPIRICALLY FOR THE POPULATIONS SERVED. HMS MAINTAINS AN UNYIELDING COMMITMENT TO THE HIGHEST ETHICAL AND PROFESSIONAL STANDARDS IN THE DELIVERY OF THESE SERVICES. PREVENTIVE CARE: HMS BEHAVIORAL HEALTH PROFESSIONALS RECOGNIZE THAT BEHAVIORAL HEALTH PROBLEMS ARE FREQUENTLY SYMPTOMS OF LESS THAN HEALTHY STANDARDS OF LIVING WITHIN A GIVEN COMMUNITY. THUS HMS IS COMMITTED TO WORKING WITH OTHERS DEDICATED TO IMPROVING THE CONDITIONS OF LIFE IN OUR COMMUNITIES BY PARTICIPATING IN HEALTH FAIRS, CONDUCTING WORKSHOPS AND SPEAKING TO COMMUNITY GROUPS ON ISSUES RELATED TO THE MENTAL AND EMOTIONAL WELL BEING OF THE COMMUNITY. FURTHER, HMS IS ALSO COMMITTED TO CONTRIBUTING TO COMMUNITY RESPONSE PLANS TO EVENTS AND CONDITIONS WHICH ARE RECOGNIZED AS RISK FACTORS FOR EMOTIONAL AND MENTAL WELL-BEING. |
| FORM 990, PART III, LINE 4C | DENTAL SERVICES: IN ADDITION TO PREVENTIVE DENTAL SERVICES, HMS DENTISTS PROVIDE DIAGNOSTIC AND RESTORATIVE DENTAL CARE AND CAN MEET MOST ORAL SURGERY NEEDS OF PATIENTS, INCLUDE FILLINGS, EXTRACTIONS, AND PARTIAL OR FULL PROSTHETICS. PANOREX (PANORAMA) X-RAY SERVICES ARE AVAILABLE AT BOTH LOCATIONS. |
| FORM 990, PART VI, SECTION A, LINE 2 | BUSINESS RELATIONSHIP: BOARD MEMBER FRANK CHAIRES HAVE A BUSINESS RELATIONSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11B | FORM 990 REVIEW PROCESS: THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM BASED ON THE AUDITED FINANCIAL STATEMENTS AND INFORMATION PROVIDED BY MANAGEMENT. THE FORM 990 IS REVIEWED BY THE CFO AND THEN PROVIDED TO THE BOARD OF DIRECTORS AT A BOARD MEETING BEFORE FILING WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: POLICIES AND PROCEDURES WILL BE PREPARED IN HMS'S FUNCTIONAL DEPARTMENTS, INCLUDING PERSONNEL, COMPLIANCE, FINANCIAL, QUALITY IMPROVEMENT, CLINICAL, AND OPERATIONAL. PARTICULAR ATTENTION WILL BE GIVEN TO AREAS OF POTENTIAL RISK IDENTIFIED IN THE RESULTS OF AN AUDIT OR RELEVANT RISK AREAS IDENTIFIED BY THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, OFFICE OF INSPECTOR GENERAL AND OTHER FEDERAL AND STATE GOVERNMENT AGENCIES. THE COMPLIANCE COORDINATOR, MEMBERS OF SENIOR MANAGEMENT, AND/OR EMPLOYEES, WORKING IN THE RELEVANT DEPARTMENT MAY BE INVOLVED IN DRAFTING, REVIEWING, OR OTHERWISE, WITH RESPECT TO THE PROPOSED POLICY AND PROCEDURE. ONCE A DRAFT OR REVISION IS COMPLETE, THE COMPLIANCE COORDINATOR WILL REVIEW THE DRAFT TO ENSURE THAT THE POLICY COMPLIES WITH ALL APPLICABLE LAWS AND REGULATIONS. THE COMPLIANCE COORDINATOR WILL DISTRIBUTE COPIES OF THE PROPOSED POLICY AND PROCEDURE TO THE QUALITY IMPROVEMENT "QI" COMMITTEE. THE POLICY AND PROCEDURE WILL BE REVIEWED AND APPROVED BY THE QI COMMITTEE, AND THEN THE POLICY CHANGES WILL BE PRESENTED TO THE HMS BOARD OF DIRECTORS, FOR REVIEW AND/OR APPROVAL. AFTER THE REVIEW AND APPROVAL OF THE PROPOSED POLICY AND PROCEDURE, A FINAL DRAFT, INDICATING APPROVAL OF THE POLICY AND THE EFFECTIVE DATE, WILL BE PREPARED. NEWLY APPROVED POLICIES AND PROCEDURES WILL BE DISTRIBUTED TO ALL AFFECTED HMS AFFILIATES, AND INCORPORATED INTO HMS'S EDUCATION AND TRAINING EFFORTS. THE COMPLIANCE COORDINATOR WILL PROMPTLY DISTRIBUTE THE NEW/REVISED POLICY AND PROCEDURE TO THE RELEVANT INDIVIDUALS AND REQUIRE ATTESTATION FROM EACH RECIPIENT. |
| FORM 990, PART VI, SECTION B, LINE 15 | COMPENSATION REVIEW: THE BOARD OF DIRECTORS REVIEWED AND APPROVED A REVISED SALARY MATRIX FOR THE ENTIRE ORGANIZATION ON 07/30/2020 BASED ON RECOMMENDATIONS FROM HR. |
| FORM 990, PART VI, SECTION C, LINE 19 | DOCUMENT DISCLOSURE: THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XII, LINE 2C | THERE WAS NO CHANGE IN THE OVERSIGHT PROCESS. |
| Software ID: | |
| Software Version: |