2017-10-02T10:51:19-05:00 2016-12-31 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2016-01-01 750711276 CROSBYTON CLINIC HOSPITAL CROS 8066752382 710 WEST MAIN STREET CROSBYTON TX 79322 DEBRA MILLER ADMINISTRATOR 8066752382 2017-10-02 GAYLE DE HAAS P01774581 8067911591 2017-10-02 12.44.95.50 2017-10-02 10:49:31 CD P 00DC5DC89968C6BE560901454C496131615A7D99 00DC5DC89968C6BE560901454C496131615A7D99 2016 2021-01-29 14:40:06Z DEBRA MILLER 710 WEST MAIN STREET CROSBYTON TX 79322 7376371 0 X WWW.CROSBYTONCLINICHOSPITAL.COM X 1945 TX TO PROVIDE HEALTHCARE TO THE CITIZENS OF CROSBY COUNTY AND THE SURROUNDING AREAS. 7 7 119 0 0 0 20 0 5597071 5926615 3577 5274 1374969 1444482 6975637 7376371 0 0 0 0 3278991 3729326 0 0 0 3562615 3249606 6841606 6978932 134031 397439 4540143 4965139 311467 339024 4228676 4626115 SEE SCHEDULE O 0 0 6500755 7371097 OUR HOSPITAL PROVIDES GENERAL MEDICAL SERVICES TO THE CITIZENS OF CROSBYTON AND SURROUNDING AREAS. OUR LARGEST PROGRAMS ARE INPATIENT, SWING BED, AND OUTPATIENT SERVICES. WE OPERATE 25 ACUTE CARE BEDS. IN THE CURRENT YEAR, HOSPITAL PATIENT DAYS WERE 456 AND SWING BED DAYS WERE 258. WE PERFORMED 16,207 LAB PROCEDURES AND 3399 RADIOLOGY PROCEDURES AS WELL AS 1401 PHYSICAL THERAPY AND WOUND CARE VISITS. IN ADDITION, OUR RURAL HEALTH CLINIC LOGGED 6614 VISITS AND OUR EMERGENCY ROOM SAW 2549 PATIENTS. 6500755 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 50 0 1 119 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DEBRA MILLER 8066758700 710 WEST MAIN STREET CROSBYTON TX 79322 DANNY BROOKS ELLISON CHAIRMAN 1.00 1.00 X X 0 0 0 KELLY WING VICE CHAIRMAN 1.00 1.00 X X 0 0 0 JOAN BURKE MURRAY SECRETARY 1.00 1.00 X X 0 0 0 BOBBY MAX HAM DIRECTOR 1.00 1.00 X 0 0 0 LESTER BOWNDS DIRECTOR 1.00 1.00 X 0 0 0 NATHAN BOARDMAN DIRECTOR 1.00 1.00 X 0 0 0 JACKY DEWBRE DIRECTOR 1.00 1.00 X 0 0 0 BELLE C PARKHILL CFO 40.00 X 25000 0 0 DEBRA MILLER ADMINISTRATOR 40.00 40.00 X 81306 0 0 JOHN HODGES FNP 40.00 X 0 140000 0 106306 140000 0 0 0 0 0 STEVE ALLEY MD PA 536 S AYRSHIRE CROSBYTON TX 79322 ER MEDICAL 293700 CONCORD MEDICAL GROUP PO BOX 489 MULESHOE TX 79347 ER MEDICAL 283029 COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK TX 79410 PHYSICIAN SERVICES 231989 WAEL QUBTI MD 16002 CR 1865 LUBBOCK TX 79424 ER MEDICAL 141380 4 NET PATIENT REVENUE 623000 5926615 5926615 5926615 5274 5274 10447 0 10447 10447 10447 340B REVENUE 621990 746362 746362 UPL REVENUE 621990 642003 642003 MISCELLANEOUS 621990 19003 19003 26667 26667 1434035 7376371 7371097 0 5274 X 106306 106306 2741257 2657500 83757 8077 5377 2700 658069 614146 43923 215617 208953 6664 59051 59051 1241731 1136102 105629 7477 6006 1471 100040 79427 20613 218577 194806 23771 4524 4454 70 99629 99629 92296 92296 BAD DEBT 778814 778814 MEDICAL SUPPLIES 322501 322501 PHARMACY 340 B MEDICINE 315043 296781 18262 DUES, LICENSES AND SUBS 9520 3560 5960 403 403 6978932 6500755 478177 0 75406 187321 2393861 2461686 652865 773631 95784 93259 9071 9071 4764520 4255488 569502 509032 743654 931139 4540143 4965139 311467 339024 311467 339024 X 4228676 4626115 4228676 4626115 4540143 4965139 397439 0 X 1 X 1 X 1 0 X 25570 25570 1961907 1686496 275411 2777043 2568992 208051 509032 DUE FROM CROSBYTON HEALTH SERVICES 533385 THIRD PARTY RECIEVABLE 397754 931139 X 6806427 -569944 -569944 7376371 0 7376371 6447543 247425 247425 6200118 778814 778814 6978932 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: CROSBYTON HEALTH SERVICES CORPORATION REVENUE 208,870. BAD DEBT EXPENSE -778,814. PART XII, LINE 2D - OTHER ADJUSTMENTS: CROSBYTON HEALTH SERVICES CORPORATION EXPENSES 247,425. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 778,814. 1 1 X 1 X 1 X 1 1 0 0 286679 552507 0 0.00000 46437 150379 0 0.00000 333116 702886 0 0.00000 333116 702886 0 0.00000 1 594029 213051 1679243 3162366 -1483123 X 1 0 1 1 CROSBYTON CLINIC HOSPITAL 710 WEST MAIN STREET CROSBYTON TX 79322 000176 X X X X CROSBYTON CLINIC HOSPITAL 1 0 0 1 X X X X X X X X X 16 1 0 0 1 X CROSBYTONCLINICHOSPITAL.COM/ X 1 16 1 CROSBYTONCLINICHOSPITAL.COM 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X CROSBYTONCLINICHOSPITAL.COM X X X X X 1 X 0 1 0 0 CROSBYTON CLINIC HOSPITAL PART V, SECTION B, LINE 5: THE CHNA WAS DESIGNED TO TAKE THE MISSION STATED BY THE HOSPITAL TO THE COMMUNITY AND DEVELOP IMPLEMENTABLE STRATEGIES TO ADDRESS THE NEEDS IDENTIFIED. BY LISTENING TO THE MEMBERS OF THE COMMUNITY, AND REVIEWING DEMOGRAPHIC AND STATISTICAL DATA, THE HOSPITAL CAN GAIN INFORMATION ON HEALTH STATUS, AND ON WHERE THE GAPS IN HEALTHCARE DELIVERY CURRENTLY EXIST. FURTHER, IT IDENTIFIED OPPORTUNITIES FOR GROWTH THAT MAY EXIST FOR THE HOSPITAL BY ASKING FOR DIRECT INPUT FROM COMMUNITY MEMBERS AND SOLIDIFIED THE HOSPITAL'S ROLE AS A PARTNER IN IMPROVING THE OVERALL HEALTH, EDUCATION, AND ECONOMIC DEVELOPMENT OF CROSBY COUNTY, TEXAS. THE CHNA INCLUDED SURVEYS, INTERVIEWS, AND FOCUS GROUPS WITH REPRESENTATIVES FROM THE FOLLOWING GROUPS:1. BUSINESS LEADERS2. HEALTHCARE PROFESSIONALS3. MINORITY COMMUNITY (HISPANIC AND AFRICAN AMERICAN)4. SENIOR CITIZENS5. SCHOOL DISTRICT7. LOW-INCOME PERSONS8. HOSPITAL ADMINISTRATION AND GOVERNANCE9. SUFFERERS OF CHRONIC DISEASES10. MEMBERS OF THE COMMUNITY UNDERSERVED BY THE HOSPITALADDITIONALLY, INTERVIEWS WERE HELD WITH CURRENT AND FORMER PATIENTS AND THE HOSPITAL CEO. THE SURVEY WAS DESIGNED TO IDENTIFY SELECT MEMBERS OF THE COMMUNITY WHO WERE REQUIRED BY THE ACA TO BE INCLUDED. THOSE WHO PARTICIPATED IN THE SURVEY AND VOLUNTEERED TO BE INCLUDED IN A FOCUS GROUP WERE THEN INTERVIEWED TO FURTHER DEVELOP THE RESULTS OF THIS CHNA. ALTHOUGH THE RESULTS WERE BROAD, COMMON NEEDS AND SOLUTIONS WERE IDENTIFIED THROUGH THE SURVEY, AND THE FOCUS GROUPS WERE TASKED WITH PRIORITIZING THE NEEDS AND SOLUTIONS PROPOSED. CROSBYTON CLINIC HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING LIST ARE NEEDS WERE IDENTIFIED THROUGH THE CHNA COMPLETED IN 2016 AND HOW THE HOSPITAL INTENDS TO ADDRESS THOSE NEEDS.1. SPECIALISTS OR SERVICES AND PHYSICIAN AVAILABILITY - THE HOSPITAL WILL CONTINUE TO RECRUIT AND MAINTAIN RETENTION EFFORTS FOR PHYSICIANS.2. LACK OF RELIABLE TRANSPORTATION DUE TO LACK OF SPECIALISTS AND SERVICES IN CROSBYTON - THE HOSPITAL WILL TRY TO RECRUIT SPECIALISTS TO VISIT CROSBYTON ON A PERIODIC BASIS. IN ADDITION, THE HOSPITAL WILL EVALUATE TRANSPORTATION POSSIBILITIES AND OPPORTUNITIES WITH SURROUNDING COMMUNITIES.3. LACK OF USABLE INSURANCE FOR LOW INCOME HOUSEHOLDS - THE HOSPITAL WILL INCREASE AWARENESS OF CHARTIY AND INDIGENT CARE PROGRAMS AVAILABLE TO THE COMMUNITY.4. CHRONIC DISEASES, HEALTHY LIVING, SEX EDUCATION, ALCOHOL AND SUBSTANCE ABUSE, AND MENTAL HEALTH NEEDS - THE HOSPITAL WILL RESEARCH OPPORTUNITIES TO BETTER MARKET HEALTH EDUCATION IN THE COMMUNITY, SEARCH FOR OPPORTUNITIES TO WORK COOPERATIVELY WITH LOCAL ORGANIZATIONS TO INCREASE AWARENESS AND PREVENTION OF CHRONIC DISEASES, DEVELOP PROGRAMS TO INCREASE AWARENESS AND PREVENTION MARKETED TO THE UNDERSERVED, PROVIDE PATIENTS WITH RESOURCES IN ENGLISH AND SPANISH, AND PROMOTE AWARENESS OF EXISTING RESOURCES, PROGRAMS AND EQUIPMENT DESIGNED TO MEET THE NEEDS OF PATIENTS WITH CHRONIC DISEASES. 1 1 - REEVES RHOADES TERRACE 640 SOUTH HARRISON CROSBYTON TX 79322 ASSISTED LIVING FACILITY PART III, LINE 4: PLEASE SEE PAGES 7-9 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: THE ORGANIZATION UTILIZES A COST TO CHARGE RATIO DETERMINED BY THEIR ANNUAL MEDICARE COST REPORT TO DETERMINE THE AMOUNT ON SCHEDULE H, PART III, SECTION B LINE 6. ALL OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. SENIOR MANAGEMENT CONSIDERS, COMPLETES, AND FINALIZES ALL DOCUMENTATION BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C VERBAL AND WRITTEN DOCUMENTATION CONCERNING ANY CONFLICT OF INTEREST OCCUR DURING EMPLOYEE REVIEW AND DURING FISCAL YEAR END. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, BOARD COMMITTEE, AND COMPLETE BOARD OF DIRECTORS RESEARCH AND REVIEW ALL DATA PROVIDED DURING THE SEARCH PROCESS. SEVERAL REDUCTION LAYERS ARE INVOLVED WHEN MORE THAN SEVERAL CANDIDATES ARE INVOLVED. MARKET DATA IS USED TO CONSIDER COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 18 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 VI, SECTION C, LINE 19 THE ORGANIZATIONAL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROGRAM SERVICE FEES: PROGRAM SERVICE EXPENSES 1,136,102. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,136,102. OTHER MANAGEMENT AND GENERAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 105,629. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 105,629. CROSBYTON HEALTH SERVICES 710 WEST MAIN STREET CROSBYTON TX 79322 752916531 ASSISTED LIVING TX 501(C)(3) LINE 12A, I CROSBYTON CLINIC HOSPITAL 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CROSBYTON HEALTH SERVICES D BOOK