2017-02-22T16:01:35-06:00 2016-04-30 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2015-05-01 741394418 COLUMBUS COMMUNITY HOSPITAL COLU 9797322371 110 SHULT DRIVE COLUMBUS TX 78934 REGINA WICKE CFO 9797322371 2017-02-22 1 GAYLE DE HAAS P01774581 8067911591 2015 2021-01-29 14:40:06Z JAMES VANEK 110 SHULT DRIVE COLUMBUS TX 78934 32174447 0 X WWW.COLUMBUSCH.COM X 1950 TX IT IS OUR GOAL TO PROVIDE ACCESSIBLE, QUALITY, COST-EFFECTIVE HEALTHCARE TO OUR COMMUNITY. WE ARE RESOLVED TO FOSTER A SAFE AND POSITIVE ENVIROMENT OF ENCOURAGEMENT, GROWTH, CHALLENGE AND CONTINUOUS IMPROVEMENT. 9 9 219 0 0 0 1926393 1664782 27583536 28469822 380896 3943 3261150 2025067 33151975 32163614 0 0 0 0 11102707 10450920 0 0 0 18864355 19687925 29967062 30138845 3184913 2024769 77227072 70627332 8550820 1909960 68676252 68717372 X TO FOSTER A WELLNESS STATE FOR OUR COMMUNITY THROUGH EDUCATION, SUPPORT AND COOPERATION WITH OTHER HEALTH CARE ORGANIZATIONS.TO EMPOWER OUR STAFF TO BE PART OF A COHESIVE PROFESSIONAL DEDICATED INTERDISCIPLINARY TEAM.TO ASSESS THE NEEDS OF OUR COMMUNITY AND PROVIDE APPROPRIATE SERVICES FOR OUR CHANGING HEALTH CARE ENVIRONMENT.TO PROMOTE COLLABORATIVE RELATIONSHIPS WITH OTHER PROVIDERS TO FACILITATE A CONTINUUM OF CARE WITH SHARED SERVICES.TO ESTABLISH AND MAINTAIN AN ECONOMICALLY STABLE FACILITY THROUGH COMMUNITY SUPPORT AND FUNDING WHILE MEETING OUR CHARITABLE GOALS. 0 0 26850667 30460812 COLUMBUS COMMUNITY HOSPITAL IS A 40 BED ACUTE CARE FACILITY OFFERING COMPREHENSIVE HEALTH CARE. THE HOSPITAL HAD 3,765 ACUTE DAYS WITH TOTAL NURSERY DAYS OF 360. THERE WERE 6,641 ER VISITS WITH 2,929 SUGERIES. LAB PROCEDURES AND RADIOLOGY PROCEDURES AVERAGED 9,031 AND 1,913 PER MONTH, RESPECTIVELY. 26850667 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 58 0 1 219 1 0 0 0 0 0 0 0 0 0 0 0 0 X 9 9 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X REGINA WICKE 9797322371 110 SHULT DRIVE COLUMBUS TX 78934 PAT GILLESPIE CHAIRMAN OF THE BOARD 1.00 X 0 0 0 DWAIN DUNGEN VICE-CHAIRMAN OF THE BOARD 1.00 X 0 0 0 MODINA MANGINI SECRETARY 1.00 X 0 0 0 PATTY SIMMONS TRUSTEE 1.00 X 0 0 0 RON RHODES TRUSTEE 1.00 X 0 0 0 RUSTY THEUT TRUSTEE 1.00 X 0 0 0 RIANA JAMISON TRUSTTE 1.00 X 0 0 0 LISA MOELLER TRUSTEE 1.00 X 0 0 0 JAY JOHANNES TRUSTEE 1.00 X 0 0 0 ROBERT F THOMAS CEO (FORMER) 50.00 X 60453 0 0 REGINA WICKE CFO 50.00 X 124642 0 0 JENO HARGROVE CNO 50.00 X 120284 0 0 JAMES VANEK CEO 50.00 X 101460 0 0 CYNTHIA SMITH RN 52.00 X 123917 0 0 PRISCA SOTO RN 40.00 X 104396 0 0 YVONNE WAGNER NP 40.00 X 121500 0 0 ALYSSA BOOKOUT RN 40.00 X 113566 0 0 870218 0 0 7 0 0 0 SDS PHYSICAL THERAPY PO BOX 335 COLUMBUS TX 78934 PHYSICAL THERAPY 1247360 CONCORD MEDICAL GROUP 3004 50TH STREET SUITE D LUBBOCK TX 79413 PHYSICIAN SERVICES 1240115 DRYMALIA CONSTRUCTION CO PO BOX 698 COLUMBUS TX 78934 CONSTRUCTION 452180 TEXAS WOMEN'S CARE PO BOX 280 COLUMBUS TX 78934 PHYSICIAN SERVICES 339968 TROY MILLICAN 1158 ABEL RD NEW ULM TX 78950 PHYSICIAN 284152 18 84525 1580257 13510 1664782 MEDICAL SERVICES 621990 28469822 28469822 28469822 3943 3943 52565 0 52565 52565 52565 44910 84525 10833 34077 34077 UNCOMPENSATED CARE REV 624100 1297330 1297330 INCENTIVE FUNDS 624100 344374 344374 WAIVER 1115 INCOME 624100 176240 176240 120481 120481 1938425 32163614 30460812 0 38020 X 390797 124642 266155 7905117 7404302 500815 2155006 199234 1955772 70384 70384 1000 1000 7396138 7396138 29207 29207 523878 74075 449803 157097 157097 1017590 1017590 48988 33946 15042 30691 30691 1284866 1284866 112067 112067 MEDICAL SUPPLIES 5212235 5212235 BAD DEBT EXPENSE 2840900 2840900 INDIGENT CARE EXPENSE 918400 918400 TAXES 23030 23030 21454 21454 30138845 26850667 3288178 0 504876 1521782 13347176 7907536 4901438 4023550 205224 25946 730792 701452 89527 77546 24838053 11546922 14399976 13291131 1771926 43048063 41306463 77227072 70627332 2130599 1645262 350414 254752 6069794 13 9946 8550820 1909960 X 68676252 68717372 68676252 68717372 77227072 70627332 X 2024769 -1970139 -13510 X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 947680 947680 13856150 3906269 9949881 386243 186339 199904 9627865 7454314 2173551 20115 20115 13291131 INTEREST IN NET ASSETS OF COLUMBUS COMMUNITY HOSPITAL FOUNDATION 40516127 DUE FROM MEDICARE/MEDICAID 376682 DUE FROM COLUMBUS COMMUNITY HOSPITAL FOUNDATION 413654 41306463 PAYABLE TO MEDICARE 2011 9946 9946 X 29320037 -2840900 -2840900 32160937 2677 2677 32163614 27308778 10833 10833 27297945 2840900 2840900 30138845 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL EVALUATES AND ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (FORMERLY FASB INTERPRETATION 48 (FIN 48) ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THIS STANDARD REQUIRES CERTAIN DISCLOSURES ABOUT UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL EVALUATES ANY UNCERTAIN TAX POSITIONS USING THE PROVISIONS OF ASC 450, CONTINGENCIES. AS A RESULT, MANAGEMENT DOES NOT BELIEVE THAT ANY UNCERTAIN TAX POSITIONS CURRENTLY EXIST AND NO LOSS CONTINGENCY HAS BEEN RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS FILED ALL APPLICABLE TAX RETURNS. PART XI, LINE 2D - OTHER ADJUSTMENTS: BAD DEBT EXPENSE -2,840,900. PART XI, LINE 4B - OTHER ADJUSTMENTS: VALUE OF DONATED ITEMS FOR FUNDRAISER AUCTION 13,510. FUNDRAISING EXPNESES -10,833. PART XII, LINE 2D - OTHER ADJUSTMENTS: FUNDRAISING EXPENSES 10,833. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,840,900. AUCTION 129435 84525 44910 7248 3585 129435 84525 44910 7248 3585 10833 34077 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 504608 413714 90894 0.00300 1961363 696930 1264433 0.04200 2465971 1110644 1355327 0.04500 2465971 1110644 1355327 0.04500 1 410345 832029 7508557 9419990 -1911433 X 1 1 1 1 COLUMBUS COMMUNITY HOSPITAL 110 SHULT DRIVE COLUMBUS TX 78934 WWW.COLUMBUSCH.COM 000014 X X X COLUMBUS COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.COLUMBUSCH.COM X 1 15 1 WWW.COLUMBUSCH.COM 1 0 1 X 200.000000000000 500.000000000000 X X X X X 1 1 X X 1 X WWW.COLUMBUSCH.COM X WWW.COLUMBUCH.COM X X 1 X 1 X X X X X 1 X 0 0 COLUMBUS COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: BOARD MEMBERS, COMMUNITY LEADERS ARE ALL ASKED HOW THE HOSPITAL CAN EITHER EXPAND OR IMPLEMENT NEW SERVICES TO BETTER SERVE THE COMMUNITY. 2 1 - FOUR OAKS MEDICAL CLINIC 109 SHULT DRIVE COLUMBUS TX 78934 OUTPATIENT CLINIC 2 - COLUMBUS MEDICAL CLINIC 2122 HWY 71 S COLUMBUS TX 78934 OUTPATIENT CLINIC PART III, LINE 4: THE ALLOWANCE FOR ESTIMATED UNCOLLECTIBLE PATIENT ACCOUNTS RECEIVABLE IS MAINTAINED AT A LEVEL WHICH, IN MANAGEMENT'S JUDGMENT, IS ADEQUATE TO ABSORB PATIENT ACCOUNT BALANCE WRITE-OFFS INHERENT IN THE BILLING PROCESS. THE AMOUNT OF THE ALLOWANCE IS BASED ON MANAGEMENT'S EVALUATION OF THE COLLECTABILITY OF PATIENT ACCOUNTS RECEIVABLE, INCLUDING THE NATURE OF THE ACCOUNTS, CREDIT CONCENTRATIONS, HISTORICAL WRITE-OFF TRENDS, SPECIFIC IMPAIRED ACCOUNTS, AND ECONOMIC CONDITIONS. ALLOWANCES FOR UNCOLLECTIBLES AND CONTRACTUALS ARE GENERALLY DETERMINED BY APPLYING HISTORICAL PERCENTAGES TO FINANCIAL CLASSES WITHIN ACCOUNTS RECEIVABLE. THE ALLOWANCES ARE INCREASED BY A PROVISION FOR BAD DEBT EXPENSES AND CONTRACTUAL ADJUSTMENTS, AND REDUCED BY WRITE-OFFS, NET OF RECOVERIES.THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS CHARITY CARE POLICY WITHOUT CHARGE AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS CHARITY CARE, CHARITY CARE IS EXCLUDED FROM NET PATIENT REVENUE.THE VALUE OF CHARITY CARE PROVIDED BY THE HOSPITAL BASED UPON ITS ESTABLISHED RATES, WAS $1,026,530 IN 2015 AND $1,263,672 IN 2014. ASU 2010-23 REQUIRES CHARITY CARE TO BE DISCLOSED ON A COST BASIS. THE HOSPITAL UTILIZES THE COST TO CHARGE RATIOS, AS CALCULATED BASED ON ITS MOST RECENT COST REPORTS, TO DETERMINE THE TOTAL COST. THE HOSPITAL'S COST OF PROVIDING CHARITY CARE WAS ESTIMATED AT $502,716 AND $616,289 FOR THE YEARS ENDED APRIL 30, 2015 AND 2014, RESPECTIVELY. PART III, LINE 8: THE HOSPITAL CONTINUES TO PROVIDE SERVICES TO THE COMMUNITY. THE AMOUNTS CALCULATED ABOVE ARE REPRESENTED USING THE COST TO CHARGE RATIO CALCULATED THROUGH THE HOSPITAL'S COST REPORT. PART III, LINE 9B: THE DEBT COLLECTION POLICY PROVIDES A PROVISION THAT EXCLUDES THOSE WHO QUALIFY FOR CHARITY FROM EVER BEING A PART OF THE BAD DEBT. PART VI, LINE 2: THE COMMUNITY'S NEEDS ARE ASSESSED THROUGH FORMAL AND INFORMAL FEEDBACK. REAL-TIME FEEDBACK ON THE COMMUNITY'S NEEDS IS SECURED THROUGH INVOLVEMENT AND REPRESENTATION OF THE BOARD OF DIRECTORS. PART VI, LINE 3: THE HOSPITAL POSTS A SUMMARY OF ITS CHARITY CARE POLICY IN ADMISSION AREAS, EMERGENCY ROOMS, AND OTHER AREAS WHERE ELIGIBLE PATIENTS ARE LIKELY TO BE PRESENT. THE HOSPITALS CONDITION OF ADMISSION CONSENT INFORMS THE PATIENTS THAT THEY MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE OR CHARITY CARE AND THEY MAY REQUEST INFORMATION ABOUT THESE PROGRAMS. A SUMMARY OF THE FINANCIALS ASSISTANCE PROGRAM IS PROVIDED TO THE PATIENT DURING THE INTAKE AND DISCHARGE PROCESSES. PATIENTS ARE INFORMED, WHERE APPLICABLE, OF AVAILABILITY OF VARIOUS GOVERNMENT BENEFITS, SUCH AS MEDICAID, AND ASSISTS THE PATIENTS WITH THE QUALIFICATION FOR SUCH PROGRAMS, WHERE APPLICABLE. PART VI, LINE 4: AS OF THE CENSUS OF 2000, THERE WERE 3,916 PEOPLE, 1,497 HOUSEHOLDS, AND 946 FAMILIES RESIDING IN THE CITY. THE POPULATION DENSITY WAS 1,387.5 PEOPLE PER SQUARE MILE. THE RACIAL MAKEUP OF THE CITY WAS 66.55% WHITE, 19.94% AFRICAN AMERICAN, 0.36% NATIVE AMERICAN, 0.33% ASIAN, 0.03% PACIFIC ISLANDER, 10.52% FROM OTHER RACES, AND 2.27% FROM TWO OR MORE RACES. HISPANIC OR LATINO OF ANY RACE WERE 17.62% OF THE POPULATION.THERE WERE 1,497 HOUSEHOLDS OUT OF WHICH 28.4% HAD CHILDREN UNDER THE AGE OF 18 LIVING WITH THEM, 45.8% WERE MARRIED COUPLES LIVING TOGETHER, 14.0% HAD A FEMALE HOUSEHOLDER WITH NO HUSBAND PRESENT, AND 36.8% WERE NON-FAMILIES. 33.0% OF ALL HOUSEHOLDS WERE MADE UP OF INDIVIDUALS AND 19.6% HAD SOMEONE LIVING ALONE WHO WAS 65 YEARS OF AGE OR OLDER. THE AVERAGE HOUSEHOLD SIZE WAS 2.40 AND THE AVERAGE FAMILY SIZE WAS 3.04.IN THE CITY THE POPULATION WAS SPREAD OUT WITH 23.4% UNDER THE AGE OF 18, 8.2% FROM 18 TO 24, 24.2% FROM 25 TO 44, 19.6% FROM 45 TO 64, AND 24.5% WHO WERE 65 YEARS OF AGE OR OLDER. THE MEDIAN AGE WAS 40 YEARS. FOR EVERY 100 FEMALES THERE WERE 88.2 MALES. FOR EVERY 100 FEMALES AGE 18 AND OVER, THERE WERE 84.2 MALES.THE MEDIAN INCOME FOR A HOUSEHOLD IN THE CITY WAS $29,175, AND THE MEDIAN INCOME FOR A FAMILY WAS $40,197. MALES HAD A MEDIAN INCOME OF $30,104 VERSUS $19,077 FOR FEMALES. THE PER CAPITA INCOME FOR THE CITY WAS $15,822. ABOUT 15.5% OF FAMILIES AND 20.5% OF THE POPULATION WERE BELOW THE POVERTY LINE, INCLUDING 32.7% OF THOSE UNDER AGE 18 AND 16.1% OF THOSE AGE 65 OR OVER. FORM 990, PART VI, SECTION B, LINE 11 THE 990 RETURN IS REVIEWED AND APPROVED BY MANAGEMENT. IT IS THEN PRESENTED TO THE BOARD AFTER FILING. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES THE BOARD OF DIRECTORS TO FILL OUT A CONFLICT OF INTEREST FORM ANNUALLY. FORM 990, PART VI, SECTION B, LINE 15A ANNUAL PERFORMANCE-BASED MERIT INCREASE COUPLED WITH REVIEW OF SALARY SURVEY DATA FOR LIKE-SIZED HOSPITALS. FORM 990, PART VI, SECTION C, LINE 19 EXCEPT AS PROVIDED FOR IN THE ORGANIZATION'S FORM 1023 AND FORM 990S, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART IX, LINE 11G MEDICAL PROVIDERS: PROGRAM SERVICE EXPENSES 7,396,138. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,396,138. FORM 990, PART XI, LINE 9: VALUE OF ITEMS DONATED FOR FUNDRAISER AUCTION NOT RECORDED ON BOOKS IN -13,510. ACCORDANCE WITH GAAP COLUMBUS COMMUNITY HOSPITAL FOUNDATION 110 SHULT DRIVE COLUMBUS TX 78934 742464333 TO FURTHER HEALTHCARE SERVICES IN THE COLUMBUS COMMUNITY TX 501(C)(3) PF 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COLUMBUS COMMUNITY HOSPITAL FOUNDATION C 1549861 CASH