2017-11-08T10:25:34-06:00 2016-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2016-01-01 481178846 Coffeyville Regional Medical Center Inc COFF 6202511200 1400 W 4th Street Coffeyville KS 67337 Mark Woodring CEO 6202511200 2017-11-06 1 Eric L Otting P00298454 7852334226 2017-11-06 98.172.114.81 2017-11-06 11:35:40 CS P C25D5B149A5DEB5B624D2ED84480DFAE7FBA67D7 C25D5B149A5DEB5B624D2ED84480DFAE7FBA67D7 2016 2021-01-29 14:40:06Z Mark Woodring 1400 W 4th Street Coffeyville KS 67337 46694321 0 X http://crmcinc.org/ X 1996 KS Medical care and services by an acute care hospital. 7 7 503 70 1120 0 662719 2515486 40023835 43359033 348341 284527 212728 535275 41247623 46694321 11760 9986 0 0 20245201 24694103 0 0 44695 24410542 22340989 44667503 47045078 -3419880 -350757 39609755 35038334 8416669 4140128 31193086 30898206 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 42327358 9986 43688626 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, or ability to pay. 42327358 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 1 0 0 0 0 1 0 0 0 1 90 0 1 503 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Mark Woodring CEO 6202511200 1400 W 4th Coffeyville KS 67337 Mike Ewy Vice Chairman 2.00 X X 0 0 0 Debbie Carter Secretary/Treasurer 2.00 X X 0 0 0 Judy Hiner Director 2.00 X 0 0 0 Neal Barkley Chairman 2.00 X X 0 0 0 Monte Coffman Director 2.00 X 0 0 0 Dr Garrick Rettele Director 2.00 X 0 0 0 Jeff Morris Director 2.00 X 0 0 0 Mark Woodring CEO 40.00 X 245165 0 40219 Dean Ohmart CFO 40.00 X 155272 0 19472 Kalapurakkal Menon Physician 40.00 X 629371 0 41596 Baba Abudu Anesthesiologist 40.00 X 365712 0 41596 James Lin Physician 40.00 X 650956 0 40456 Anne Hogsett Physician 40.00 X 318377 0 37421 Dara Gibson Physician 40.00 X 296425 0 41596 2661278 0 262356 26 0 1 0 Green Country Emergency Physicians 4500 S Garnett Rd Ste 300 Tulsa OK 74146 ER Coverage 830545 Spinal Neurosurgical Associates 6921 E 109th St S Tulsa OK 74133 Physician 821248 Alliance Recruiting PO Box 670416 Dallas TX 75267 Hospitalist services 663739 Medical Information Technology Meditech Circle Westwood MA 02090 IT services 358172 Silvercreek Medical 2400 N Broadway Pittsburg KS 66762 Billing services 346109 18 90793 2299970 124723 44000 2515486 Net patient service revenue 621990 43012381 43012381 Other patient related services 621990 284197 284197 Educ, lifeline, wellness and misc 900099 62455 62455 43359033 281977 281977 55261 0 55261 55261 55261 2550 0 2550 2550 2550 EHR incentive revenue 900099 325930 325930 Cafeteria and dietary income 722210 151851 151851 Catering revenue 722320 1120 1120 1113 1113 480014 46694321 43688626 1120 489089 X 9986 9986 448884 448884 19311402 17876859 1403034 31509 1593985 1479726 111658 2601 2060600 1876045 181193 3362 1279232 1184205 92940 2087 97608 97608 70604 70604 72365 72365 7490801 6221114 1269687 125350 121097 4253 170112 117022 53090 57265 52248 4902 115 1001785 808241 191641 1903 179146 166636 12510 38548 35118 3430 66364 66364 3130862 2686059 441685 3118 460195 363310 96885 Medical supplies 4664563 4664563 Pharmacy drugs 3468212 3468212 Medicaid provider asses 266238 266238 Repairs and maintenance 262296 262296 718675 602019 116656 47045078 42327358 4673025 44695 1261133 594062 5476063 3793243 5456165 5285721 14384 1324502 1401804 783838 676482 67598081 49529517 19870455 18068564 2583894 2751758 2839321 2466700 39609755 35038334 3516070 3814076 3669868 930731 21052 300000 305000 8416669 4140128 X 28823947 28538086 1998471 1989452 370668 370668 31193086 30898206 39609755 35038334 X -350757 64896 -9019 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 11643 1 19000 0 0 30643 0 Part II-B, Line 1: Coffeyville Regional Medical Center, Inc. is a member of the Kansas Hospital Association. This organization engages in lobbying activities for hospital and general health care interests as part of the services provided to members. The Medical Center also contracted for lobbying services to represent the Medical Center's interests. 370668 370668 370668 370668 370668 370668 370668 370668 370668 370668 1.00000 0 1 1 76477 76477 26693322 16582018 10111304 21595518 17986153 3609365 19232764 14961346 4271418 18068564 Other receivables 106580 Beneficial interest in net assets of foundation 2360120 2466700 Liability for receivables sold with recourse 55000 Estimated third-party payor settlements 250000 305000 X 46750198 64896 64896 46685302 9019 9019 46694321 47045078 0 47045078 0 47045078 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 4b - Other Adjustments: Contributions for purchase of property and equipment 9,019. 1 1 1 X 1 X 185.000000000000 1 1 0 1 0 889359 170666 718693 0.01530 7141116 5009950 2131166 0.04530 8030475 5180616 2849859 0.06060 124780 5122 119658 0.00250 9017064 6201808 2815256 0.05980 9300 9300 0.00020 9151144 6206930 2944214 0.06250 17181619 11387546 5794073 0.12310 1 1894290 254582 14711150 16711520 -2000370 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 16 1 0 1 1 X http://crmcinc.org X 1 16 0 1 0 1 X 100.000000000000 185.000000000000 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 X X X X X 1 X 0 X X X 1 X 1 0 Coffeyville Regional Medical Center, Inc Part V, Section B, Line 5: In August 2016 Coffeyville Regional Medical Center in conjunction with the Coffeyville and Independence Chambers of Commerce, Montgomery County Health Department, Ministerial Association, Community Health Center of SE Kansas, and Four County Mental Health began the process of updating the 2013 CHNA. The process included requesting various stakeholders in completing an on-line survey which was followed by a Town Hall Discussion in September 2016. 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: Coffeyville and Independence Chambers of Commerce, Montgomery County Health Department, Ministerial Association, Community Health Center of SE Kansas, and Four County Mental Health Coffeyville Regional Medical Center, Inc Part V, Section B, Line 11: Area of Need: Economic Development- Hospital staff have joined the Montgomery County Economic Development Advisory Group to help lead local efforts and activity to recruit new business and retain existing businesses.- CRMC partners with local High School, Field Kindley High School, to offer high school seniors the opportunity of performing rotations through the different departments of the hospital through their On The Job Training program.- CRMC continues to partner with Coffeyville Junior College and Labette Junior College for radiology and nursing students to have rotations within our hospital.- Human Resources representatives attend recruiting fairs and job fairs in area schools and businesses to educate the community on jobs available at the hospital.- CRMC participates in promotions of the area Chambers of Commerce by providing healthcare materials/education that is provided to new businesses and families of Montgomery County.Area of Need: Primary Care Providers- CRMC recruited Dr. Anne Hogsett, Internal Medicine, to lead our Hospitalist Program, and Susan Jenkins, CRNA was added to our surgical team.- CRMC opened a new medical clinic in Independence, KS - CRMC Medical Group. This new location housed primary care, pediatrics, and OB/GYN physicians and extenders.Area of Need: Chronic Disease Management- CRMC continues to have a dietician onsite 2 days a week.- CRMC actively participates in the County Wellness Coalition.- CRMC provided free FIT Tests during March (Colorectal Cancer Month) through the Tatman Cancer Center.- Provided free and low cost cancer screenings during March at CRMC Medical Group location in Coffeyville and Independence. Screenings included Pap smear and skin cancer.- CRMC participated in the annual American Cancer Society "Relay for Life" in Coffeyville. CRMC served 85 cancer survivors and family members at the event and raised $11,000.- "I am Living Hope" - this print and social media campaign featured 4 breast cancer survivors and their stories of hope and encouragement.- CRMC hosted the 29th annual Cancer Symposium in September 2016 which includes several speakers on the topic.- Pretty in Pink - Breast Cancer Awareness events were held at two locations in October of 2016 - Independence (103 in attendance) and Coffeyville (79 in attendance). These events promoted the importance of breast health.- Website Education included: - 7 Reasons to Exercise During and After Cancer Treatment - 5 Tips to Help You Quit Smoking - When should you have Breast Reconstruction Surgery? - What Is Your Risk of Developing Cancer? - Quiz: How Much Do You Know About Skin Cancer? - Do You Need to Be Screened for Lung Cancer? - How Often Do Women Need Pap Tests? - Talk to Your Doctor About Prostate Cancer - When Should I get a Mammogram? - Fight Cancer from Your Kitchen - Tanning This Summer? Remember Melanoma - Does Exercise Affect Breast Cancer Recovery?- CRMC published an annual Cancer Report.- CRMC sponsors the annual Pink Night at the "Interstate Fair and Rodeo" in Coffeyville.- CRMC also held a "Let's Talk Teal" breakfast with the Coffeyville Area Chamber of Commerce.- CRMC sent "Have Faith in Heart" kits to local clergy to promote education on women and heart disease within their congregations.- CRMC participated in the national campaign - Little Hats, Big Hearts for raising awareness for children born with heart defects. Each baby born at CRMC in the month of February gets a special red hat from the American Heart Association.- Fair and Rodeo Sponsorship Night - Tough Enough To Wear Pink Breast Cancer Awareness - Honored our Cancer Survivors by having them sit in Chute heaven and giving them free tickets to the rodeo and educating them about Breast Cancer Awareness by wearing Pink - August 2016 and 2017. Shirts were also sold and the proceeds went back to our Care N' Share Fund through CRMC Foundation that helps CRMC Cancer Patients.- CRMC continues to provide Annual Mammogram Discount coupons to any women who schedule their mammogram in the months of October or April.Area of Need: Affordable/Safe Housing- Although not a part of CRMC's mission of critical operations, CRMC will partner on any tactics implemented by the city or county.Area of Need: Wellness, Nutrition, Fitness- CRMC began publishing and distributing a new health education magazine called "Health Partners" in October 2016. This magazine is designed to provide information about services available at CRMC, highlight new physicians, and provide health education and a listing of all CRMC providers. CRMC published 10,000 per quarter - mailing out 8,200 and delivering the remainder to area businesses, churches, libraries, and schools. The magazine is free of charge to the community.- In August 2016, CRMC launched a newly re-designed website. The new site is user friendly, easy to navigate, and provides a more comprehensive listing of services, centers, and providers. Site improvements include: - Comprehensive listing of services, including contact information and providers. - Health information library which changes monthly and seasonally. The information provides practical and easy tips on how to live a healthier lifestyle, nutritional recipes, and wellness/prevention information, quizzes, and assessments.- CRMC attended the Health on Purpose health fair by providing informational brochures on Cancer Services, Rehabilitation, Home Health, CRMC Medical Group, Women's Health, and General Services of the hospital - September 2016. - CRMC provided discounted lab draws for the Health on Purpose Health Fair and had a table with informational brochures to educate the community.- Launched a walking club called the CRMC Basement Bunch. Members can join free, log their miles, and walk on the indoor track - January 2016.- CRMC Cafeteria has implemented portion controlled snacks such as cheese and cracker cups, veggie and dip cups, health sandwiches, 100 calorie greek yogurt, and an upgraded salad bar with a protein choice to put on your salad.- Facebook and Twitter was revamped to help target the healthy recipes and articles from our website to facebook and twitter.- Started CRMC Health Partners magazine which highlights important health topics, services, and medical providers. CRMC distributes 10,000 magazines quarterly.- CRMC re-established the SANE/SART program. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 23: During preparation of the 2016 990 tax return, the Medical Center discovered that there were a few isolated incidences during 2016 when FAP - eligible individuals were inadvertently charged amounts in excess of amounts generally billed. The Medical Center noted that some of these accounts were subsequently written off and others have paid a portion of the amounts charged, with one paying $9.70 more than AGB. The Medical Center is implementing corrective actions related to these patients. 1 1 - CRMC Primary Care Center 808 Willow Street Coffeyville KS 67337 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, physical therapy, occupational therapy, speech therapy, and physician clinics. 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% which was based on previous years charges written off for patients with incomplete charity care applications. 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. Part III, Line 8: The 2016 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 2016 population of Montgomery County, Kansas to be 32,746. 19.0% of the population is 65 years of age or older, the median household income is $41,083, and 19.9% 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 0 0 0 0 0 0 0 0 0 Mark Woodring CEO 245165 0 0 0 0 0 22950 0 17269 0 285384 0 0 0 Dean Ohmart CFO 155272 0 0 0 0 0 14253 0 5219 0 174744 0 0 0 Kalapurakkal Menon Physician 629371 0 0 0 0 0 24327 0 17269 0 670967 0 0 0 Baba Abudu Anesthesiologist 365712 0 0 0 0 0 24327 0 17269 0 407308 0 0 0 James Lin Physician 650956 0 0 0 0 0 24327 0 16129 0 691412 0 0 0 Anne Hogsett Physician 288377 0 30000 0 0 0 24327 0 13094 0 355798 0 0 0 Dara Gibson Physician 296425 0 0 0 0 0 24327 0 17269 0 338021 0 0 0 Neal Barkley Wife of Board Member 33137 Employee Compensation 0 Debbie Carter Son-in-law of Board Member 82461 Employee Compensation 0 X 1 44000 Fair market value 0 0 0 Form 990, Part VI, Section B, line 11b The 990 is made available for the Board of Directors review at their request. 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 15 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 2,926,097. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,926,097. Contract labor: Program service expenses 926,759. Management and general expenses 17,441. Fundraising expenses 0. Total expenses 944,200. Other fees for services: Program service expenses 2,368,258. Management and general expenses 1,252,246. Fundraising expenses 0. Total expenses 3,620,504. Form 990, Part XI, line 9: Decrease in beneficial interest in net assets of CRMC Foundation -9,019. 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 0 0 0 0 0 0 0 1 0 1 1 0 0 0 0