2021-11-08T07:33:14-06:00 2020-12-31 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2020-01-01 481178846 Coffeyville Regional Medical Center Inc COFF 6202511200 1400 W 4th Street Coffeyville KS 67337 BRIAN LAWRENCE CEO 6202511200 2021-11-04 1 BRIAN LAWRENCE 999009999 Eric L Otting P00298454 7852334226 2021-11-04 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z Brian Lawrence 1400 W 4th Street Coffeyville KS 67337 50894205 0 X http://crmcinc.org/ X 1996 KS Medical care and services by an acute care hospital. 7 6 462 62 0 0 1402524 8336538 36909962 42288064 221878 109780 191052 159823 38725416 50894205 14777 5591 0 0 25204216 25937277 0 0 69290 19461657 22660004 44680650 48602872 -5955234 2291333 27096000 38132182 7365277 16298761 19730723 21833421 To promote general health and well being through the development, promotion, improvement, and support of all forms of health care services in Coffeyville, Kansas and the surrounding area. 0 0 43322687 5591 42288064 Coffeyville Regional Medical Center operates an acute care hospital located in southeast Kansas. We provide inpatient, outpatient, urgent and emergent care, and physician services to all patients regardless of race, creed, sex, national origin, sexual preference, or ability to pay. 43322687 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 60 0 1 462 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X Dale Guffey 6202511200 1400 W 4th Coffeyville KS 67337 Neal Barkley Director 2.00 X X 0 0 0 Monte Coffman Chairman 2.00 X X 0 0 0 Debbie Carter Secretary/Treasurer 2.00 X X 0 0 0 Mike Ewy Vice-Chairman 2.00 X 0 0 0 Craig Correll Director 2.00 X 0 0 0 Jeff Morris Director 2.00 X 0 0 0 Dr Garrick Rettele Director 2.00 X 0 0 0 Brian Lawrence CEO 40.00 X 276383 0 27876 Dale Guffey CFO beginning June 2020 40.00 X 90410 0 14747 Michael Orr CFO through May 2020 40.00 X 210914 0 0 Russell Allison Physician 40.00 X 650344 0 45190 Michelle McGuirk Physician 40.00 X 472311 0 36336 Aaron Russell Physician 40.00 X 434778 0 52257 Shravan Gangula Physician 40.00 X 412664 0 55581 Baba Abudu Anesthesiologist 40.00 X 376897 0 44578 2924701 0 276565 25 0 1 0 BKD PO Box 1190 Springfield MO 65801 Consulting services 1692561 Green Country Emergency Physician 1145 S Utica 365 Tulsa OK 74104 ER Coverage 1215469 Spinal Neurosurgical Associates 6921 E 109th St S Tulsa OK 74133 Physician services 453911 Regional Medical Laboratory 4142 South Mingo Road Tulsa OK 74146 Lab services 315818 Medical Information Technology MEDITECH Circle Westwood MA 02090 Computer support 291687 15 454249 7860256 22033 8336538 Net patient service revenue 621110 40658668 40658668 340b Pharmacy 446110 1277600 1277600 Ambulance services 621910 229563 229563 Education, wellness, and miscella 900099 111059 111059 Other patient related services 621110 11174 11174 42288064 106780 106780 27364 0 27364 27364 27364 3000 0 3000 3000 3000 Cafeteria and dietary income 722310 132459 132459 132459 50894205 42288064 0 269603 X 5591 5591 620329 620329 20038310 19073842 918486 45982 1696935 1623953 68998 3984 2261451 2122908 133434 5109 1320252 1237736 79479 3037 116580 116580 51707 51707 8619238 6372925 2244099 2214 105645 105645 131294 83484 45634 2176 54324 47718 6508 98 750278 599097 149940 1241 55700 49227 6444 29 8892 8084 808 114360 114360 2845954 2416275 425512 4167 361843 317843 43349 651 Pharmacy drugs 4283556 4283556 Medical supplies 4076673 4076673 Medicaid provider asses 254808 254808 Dues & subscriptions 214927 163804 51062 61 614225 470803 142881 541 48602872 43322687 5210895 69290 1141237 2178095 1104881 9984806 4679325 5610610 1333231 1667097 365094 270559 70327827 54739661 16000200 15588166 2472032 2832849 27096000 38132182 5211279 5465175 9205451 1978378 1598135 175620 30000 7365277 16298761 X 17244198 19497323 2486525 2336098 19730723 21833421 27096000 38132182 X 2291333 -188635 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5523 0 0 0 5523 0 Part II-B, Line 1: Coffeyville Regional Medical Center, Inc. is a member of the Kansas Hospital Association and American Hospital Association. These organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 370668 30000 17809 17809 400668 370668 22011 22011 370668 370668 28901 28901 370668 370668 33894 33894 370668 370668 370668 1.00000 0 1 1 76477 76477 26538970 19075906 7463064 24877439 18640042 6237397 18834941 17023713 1811228 15588166 Other receivables 291355 Beneficial interest in net assets of foundation 1947521 Sales tax receivable 212903 Estimated third-party payor settlements 381070 2832849 Liability for receivables sold with recourse 30000 30000 X 50705570 -188635 -188635 50894205 0 50894205 48602872 0 48602872 0 48602872 Part V, Line 4: The Coffeyville Regional Medical Center Foundation's endowment consists of a fund established for dietary scholarships. Part X, Line 2: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Part XI, Line 2d - Other Adjustments: Decrease in beneficial interests in net assets of Foundation -188,635. 1 1 1 X 250.000000000000 1 X 1 1 0 1 0 886517 197461 689056 0.01420 7864407 3250310 4614097 0.09490 8750924 3447771 5303153 0.10910 11148220 6028009 5120211 0.10530 11148220 6028009 5120211 0.10530 19899144 9475780 10423364 0.21440 1 1190652 147978 11923683 12577073 -653390 X 1 1 1 1 Coffeyville Regional Medical Center 1400 W 4th Street Coffeyville KS 67337 H063102 X X X Coffeyville Regional Medical Center Inc 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X http://crmcinc.org/about/publications-reports/ X 1 19 0 1 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X http://crmcinc.org/patients-visitors/billing-insurance/financial-assistance X http://crmcinc.org/patients-visitors/billing-insurance/financial-assistance X http://crmcinc.org/patients-visitors/billing-insurance/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Coffeyville Regional Medical Center, Inc Part V, Section B, Line 5: In August 2019, Coffeyville Regional Medical Center in conjunction with the Montgomery County Health Department began the process of updating the 2016 CHNA. The process included requesting various stakeholders in completing an on-line survey which was followed by a Town Hall Discussion in August 2019. The process included a wide variety of stake holders including business owners, civic leaders, consumers of health care, hospital personnel, and other local health care professionals. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 6b: Montgomery County Health Department Coffeyville Regional Medical Center, Inc Part V, Section B, Line 11: Area of need: Economic development-CRMC continues to be very active in the Montgomery County Action Council (MCAC), which is the economic development engine for our county. The Director of Government Relations attends the quarterly meetings and is involved in an ongoing basis to assist in the recruitment of businesses to the region. -CRMC works closely with area Chambers of Commerce to promote healthcare services and education to new businesses and families. Area of need: Primary Care Providers-CRMC continues its effort to recruit primary care providers to join the CRMC medical staff.-CRMC had a total of 9 new physicians and specialists that began working at the Medical Center in 2020. -CRMC continues to work with regional medical schools and residency programs to enhance our visibility to medical students.-CRMC assists community members looking for a primary care provider or those who need assistance in making an appointment for a needed screening. CRMC offers Care Navigation Services to make this an easy process.-CRMC began offering virtual care telemedicine services in the spring of 2020 for primary care visits.Area of need: Chronic Disease Management-CRMC Medical Group Primary Care Clinic offers a full-time registered nurse to serve as the Chronic Care Management Nurse and make visits to chronic care patients of the clinic and transitional care patients.-CRMC did not provide diabetes and self-management classes during 2020 due to the COVID-19 pandemic. -CRMC continues to participate in the Montgomery County Health Coalition via email. -CRMC provided free Colon Cancer Screening kits during the month of March.-CRMC provides monthly health education posters to area businesses and industries and hosts quarterly health challenges.-CRMC provided comprehensive COVID-19 info and updates through various health articles in local newspapers, magazines, and our CRMC Facebook page. Area of need: Obesity, Nutrition, Fitness-CRMC provides on-going low cost or no cost health screenings in the community by hosting on-site workplace wellness events at Kansas Aviation, John Deere, Four County Mental Health, CRMC, and the City of Coffeyville Fire Department. 4 1 - CRMC Medical Group 1400 W 4th Street Coffeyville KS 67337 Surgery and Speciality Clinic 2 - CRMC Medical Group - Coffeyville 1400 W 4th Street Coffeyville KS 67337 Primary Care Physician Clinic 3 - CRMC Medical Group 1717 W 8th Street Coffeyville KS 67337 Women's Health, Obstetrics, and Gynocology 4 - CRMC Medical Group - Independence 122 W Myrtle St Independence KS 67301 Primary Care Physician Clinic Part I, Line 7: Amounts for financial assistance and certain other community benefit programs were obtained using known related charges and cost to charge ratios. The cost to charge ratios used include the overall cost to charge ratio derived from Worksheet 2 as well as individual department cost to charge ratios identified for the calculation of subsidized health services information. Part I, Line 7g: Subsidized health services are made up of services that the Medical Center provides despite a financial loss to the organization. These services include ambulance, home health, respiratory therapy, physical therapy, occupational therapy, speech therapy, and physician clinics. Total costs for physician clinics amount to $7,149,208. Part III, Line 4: The Medical Center provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Medical Center estimates this allowance based on the aging of its accounts receivable and its historical collection experience.Part III, Line 2Provisions for bad debts are related to accounts that have been deemed uncollectible during the year. The uncollectible amount is then written off pursuant with Hospital policy. The cost of the bad debts reported was determined based upon the cost to charge ratio multiplied by the total charges written off to bad debt expense.Part III, Line 3The estimate of bad debt expense attributable to patients who we believe would be eligible under the organization's financial assistance policy was estimated at 15%. The gross charge amount was then adjusted to cost using the overall cost to charge ratio obtained from worksheet 2. It is our belief that much more of the amount written off to bad debts relates to patients that would qualify for charity; however, do not take the time to complete the application process due to their individual circumstances. We believe that this amount should be considered a community benefit because we are legally required to provide medical services to patients regardless of the ability to pay. Part III, Line 8: The 2020 Medicare Cost Report was used to determine the Medicare revenue and related cost. The shortfall is a benefit to the Medical Center's community since it represents health care provided at less than cost to elderly and needy residents of the Medical Center's service area. Part III, Line 9b: Admission representatives review accounts during the admissions process to identify patients with possible financial need. To be considered for charity care, the financial policy states that financial advisors will determine if the patient is eligible to apply for Medicaid or other financial assistance programs. The advisors will then assist the patient through the process of applying for financial assistance programs within and outside of the Medical Center. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and or legal representative. Patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program prior to being considered for charity care. Part VI, Line 2: The Medical Center periodically engages a consulting firm to assist with developing a strategic plan. Part of that process is to interview people in the community for their opinion on what the Medical Center can do to meet the community needs. Interviews include physicians, board members, auxiliary personnel, and business leaders in the community to help get a feel for what they see as most important for our community. Part VI, Line 3: The hospital has signs posted in each admission window and other locations in the hospital encouraging patients to ask about the available payment options and how to apply for financial assistance. The financial assitance policy and application form is also made available on the hospitals website. The patient may be referred to meet with one of the hospital's Financial Advisors, who will determine the patients' eligibility for benefits and help them through the process of applying for assistance. Part VI, Line 4: Coffeyville is located in the southeastern part of Montgomery County, located in Southeast Kansas. It is located 64 miles north of Tulsa, Oklahoma. The US Census Bureau estimates the 2020 population of Montgomery County, Kansas to be 31,829. 20.3% of the population is 65 years of age or older, the median household income is $45,157, and 15.7% of individuals are below poverty level. Part VI, Line 5: Health fairs, fundraising for relay for life, public education, and resources on Coffeyville Regional Medical Center's website are some examples of activities the Medical Center does to support health in the community. X X X 0 0 0 0 0 0 0 0 0 Russell Allison Physician 599026 0 51318 0 0 0 24539 0 20651 0 695534 0 0 0 Michelle McGuirk Physician 418061 0 54250 0 0 0 24539 0 11797 0 508647 0 0 0 Aaron Russell Physician 414778 0 20000 0 0 0 24539 0 27718 0 487035 0 0 0 Shravan Gangula Physician 278625 0 134039 0 0 0 24539 0 31042 0 468245 0 0 0 Baba Abudu Anesthesiologist 376897 0 0 0 0 0 24539 0 20039 0 421475 0 0 0 Brian Lawrence CEO 225430 0 50953 0 0 0 23759 0 4117 0 304259 0 0 0 Michael Orr CFO through May 2020 210914 0 0 0 0 0 0 0 0 0 210914 0 0 0 Mark Slavin Son-in-law of Board Member 106407 Employee Compensation 0 Form 990, Part VI, Section B, line 11b A draft copy of the 990 is reviewed with the finance committee prior to filing. Form 990, Part VI, Section B, line 12c The organization reviews concerns when identified. Members are required to remove themselves from any discussion which may involve a conflict of interest. Form 990, Part VI, Section B, line 15a The salary for the CEO is determined by the Board of Directors and is based upon performance and comparative information obtained from the Kansas Hospital Association wage survey. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Form 990, Part IX, line 11g Physician and specialist fees: Program service expenses 2,147,640. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,147,640. Contract labor: Program service expenses 624,564. Management and general expenses 217,694. Fundraising expenses 0. Total expenses 842,258. Other fees for services: Program service expenses 3,600,721. Management and general expenses 2,026,405. Fundraising expenses 2,214. Total expenses 5,629,340. Form 990, Part XI, line 9: Decrease in beneficial interest in net assets of CRMC Foundation -188,635. Form 990 Part XI, Line 2c: The Finance Committee reviews the audit prior to the presentation to the Board by the auditor. Coffeyville Regional Medical Center Foundation Inc 1400 W 4th Street Coffeyville KS 67337 480981990 To provide philanthropic assistance to Coffeyville Regional Medical Center KS 501(c)(3) Line 7 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0