2016-11-04T10:55:29-05:00 2015-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2015-01-01 481178846 Coffeyville Regional Medical Center Inc COFF 6202511200 1400 W 4th Street Coffeyville KS 67337 Dean Ohmart CFO 6202511200 2016-10-25 1 Eric L Otting P00298454 7852334226 2016-10-21 2015 2017-02-10 21:41:12Z Dean Ohmart 1400 W 4th Street Coffeyville KS 67337 41248818 0 X http://crmcinc.org/ X 1996 KS Medical care and services by an acute care hospital. 8 8 470 70 1562 0 172732 662719 35900812 40023835 297126 348341 1615114 212728 37985784 41247623 11412 11760 0 0 19883208 20245201 0 0 36447 18588136 24410542 38482756 44667503 -496972 -3419880 45107094 39609755 10211061 8416669 34896033 31193086 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 39941203 11760 40040829 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. 39941203 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 76 0 1 470 1 1 1 0 0 0 0 0 0 0 0 0 X 8 8 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 1 0 X Dean Ohmart CFO 6202511200 1400 W 4th Coffeyville KS 67337 Mike Ewy Vice Chairman 2.00 X X 0 0 0 Barbara Kidwell 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 Debbie Carter Director 2.00 X 0 0 0 James Chromik Interim CEO 40.00 X 57600 0 0 William Page Interim CFO 40.00 X 51200 0 0 Mark Woodring CEO 40.00 X 168709 0 27915 Dean Ohmart CFO 40.00 X 111838 0 6231 Kalapurakkal Menon Physician 40.00 X 544560 0 44513 Baba Abudu Anesthesiologist 40.00 X 382970 0 44755 James Lin Physician 40.00 X 347727 0 39472 Shravan Gangula Physician 40.00 X 236326 0 42203 Mark Hill CRNA 40.00 X 197458 0 36661 2098388 0 241750 16 0 1 0 Gery Hsu MD Spinal Neurosurgical As 6921 E 109th St S Tulsa OK 74133 Physician 1693129 Alliance Recruiting PO Box 670416 Dallas TX 75267 Hospitalist services 1400137 Green Country Emergency Physicians 4500 S Garnett Rd Ste 300 Tulsa OK 74146 ER Coverage 740159 Netscript Inc 235 County Road 3520 Clarksville AR 72830 Transcription services 399217 Procare Healing Center 2100 E Britton Rd Oklahoma City OK 73131 Wound care 327400 18 58776 568967 34976 662719 Net patient service revenue 621990 39568059 39568059 Other patient related services 621990 375719 375719 Educ, lifeline, wellness and misc 900099 80057 80057 40023835 347271 347271 56552 0 56552 56552 56552 2265 1195 1070 1070 1070 Cafeteria and dietary income 722210 138690 138690 EHR incentive revenue 900099 14974 14974 Catering revenue 722320 1562 1562 950 950 156176 41247623 40040829 1562 542513 X 11760 11760 419161 419161 15400318 14140373 1235778 24167 1446419 1331725 112424 2270 1901284 1718785 179515 2984 1078019 989823 86504 1692 100035 100035 229035 229035 69914 69914 9028090 7675347 1352743 212253 207212 5041 127590 91152 36349 89 40508 36587 3852 69 945739 772290 171652 1797 142414 126939 15475 23452 19046 4406 158797 158797 3366817 2920855 442663 3299 373489 283217 90272 Medical supplies 5011912 5011912 Pharmacy drugs 3206303 3206303 Recruitment 361344 342361 18983 Repairs and maintenance 266267 266267 746583 630452 116051 80 44667503 39941203 4689853 36447 2284831 1261133 8727317 5476063 4412383 5456165 49937 14384 1305928 1324502 619547 783838 66493784 46623329 21819216 19870455 2807620 2583894 3080315 2839321 45107094 39609755 3703872 3516070 4887308 3669868 1539881 930731 80000 300000 10211061 8416669 X 32455955 28823947 2069410 1998471 370668 370668 34896033 31193086 45107094 39609755 X -3419880 -212128 -70939 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10984 0 0 0 10984 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. 370668 370668 370668 370668 370668 370668 370668 370668 0 1 1 76477 76477 26470222 15803163 10667059 20943201 16680257 4262944 19003884 14139909 4863975 19870455 Stock mutual funds 1987278 F Bond mutual funds 596616 F 2583894 Other receivables 187488 Beneficial interest in net assets of foundation 2369139 Deferred financing costs 52444 Sales tax receivable 230250 2839321 Liability for receivables sold with recourse 80000 Estimated third-party payor settlements 220000 300000 X 40976719 -212128 -212128 41188847 58776 58776 41247623 44667503 0 44667503 0 44667503 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 58,776. 1 1 1 X 1 X 1 1 0 1 0 745997 41390 704607 0.01580 6285618 4040909 2244709 0.05030 7031615 4082299 2949316 0.06610 295633 5624 290009 0.00650 8131013 5157811 2973202 0.06660 35867 35867 0.00080 8462513 5163435 3299078 0.07390 15494128 9245734 6248394 0.14000 1 1192842 165927 15246356 17446625 -2200269 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 13 1 0 0 1 X http://crmcinc.org X 1 13 1 http://crmcinc.org 0 0 1 X 100.000000000000 250.000000000000 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-policy/ 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: After several independent data analyses were completed, we put the information and summary conclusions before our local group of experts, who were asked to agree or disagree with the summary conclusions. Experts were free to augment potential conclusions with additional statements of need; however, new needs did not emerge from this exchange. Consultation with 19 local experts occurred via an internet based survey. The Local Experts participated in a structured communication technique called a Delphi method, originally developed as a systematic, interactive forecasting method which relies on a panel of experts who answer questionnaires in a series of rounds. After each round, we provided an anonymous summary of the experts' forecasts from the previous round, as well as the reasons provided for their judgments. The process encourages experts to revise their earlier answers in light of the replies of other members of their panel. Typically, this process decreases the range of answers and moves the expert opinions toward a consensus "correct" answer. The process stops when we identify the most pressing, highest priority community needs. In the process, each local expert allocated 100 points among all identified needs, having the opportunity to introduce needs previously unidentified and to challenge conclusions developed from the data analysis. A rank order of priorities emerged, with some needs receiving none or virtually no support and other needs receiving identical point allocations. Organizations and local groups consulted in conducting its most recent CHNA include: Montgomery County Health Department, Coffeyville Police Department, Four County Mental Health Center, Coffeyville Area Community Foundation, City of Coffeyville, Coffeyville Fire Deparatment, Coffeyville Community College, Coffeyville Recreation Center, Hall Levy Law Firm, John Deere Coffeyville Works Inc, Assisted Living at Windsor Place, Community Health Center of Southeast Kansas, and Coffeyville Doctors Clinic. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 11: To address cancer, the Medical Center expanded an annual event called "Pretty in Pink", which focuses on Breast Cancer Awareness and the importance of mammograms, to an additional location in Independence, Kansas. The Medical Center also offered pap smears for the first time at this event and also completed planning to expand its OB-GYN services. To address obesity, the Medical Center began labeling food to show serving size and nutritional content, increased the availability of water, and provided point-of-purchase prompts to highlight healthier alternatives in its cafeteria. It also initiated a wellness program and continued collaborative wellness efforts with the County Health Department and the Community Foundation.To address predisposing factors, the Medical Center continued coordinating efforts with local government health organizations to address these factors. It did not undertake any significant initiatives during the year because a local FQHC began addressing these needs in 2014.The Medical Center did not undertake any significant actions to meet the dental needs of the community because a local FQHC began meeting these needs.To address diabetes, Medical Center staff have conducted talks on diabetes. The Medical Center continued collaborating with local businesses to implement wellness programs in the workplace to prevent diabetes.To address compliance behavior, the Medical Center conducted collaborative efforts with the Wellness Coalition and participated in a variety of health and welfare events during the year. The Medical Center also focused its efforts on increasing patient safety and following up with patients post-discharge to ensure recovery.The Medical Center has many ongoing initiatives to recruit and employee physicians to address the primary physician shortage in the area.To address maternal and infant measures, the Medical Center analyzes the effectiveness of early elective delivery to determine when they are beneficial. It also employed a licensed child birth educator and lactation specialists. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 16i: The availability of the Medical Center's financial assistance policy is printed on each patient statement and posted on the Medical Center's website, and available and discussed at time of admission. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 22d: The maximum amounts charged by the Medical Center to FAP-eligible individuals for emergency or other medically necessary care can not exceed the amount calculated by multiplying gross charges for such care by the amounts generally billed percentage. This percentage is calculated as follows: Sum of all claims paid in full (including payments from beneficiaries and insureds) by Medicare fee-for-service and private payors during the prior fiscal year divided by the sum of gross charges for those claims. 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 a physician clinic. The subsidized cost associated with the physician clinic was $1,263,980. 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 for each type of payor.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 is 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 related 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 2015 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 encouraging patients to ask about the available payment options and how to apply for financial assistance. 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. Patients that are eligible for financial assistance under the Medical Center's policy were provided discounts ranging from 50% to 100% depending on the patient's medical indigency and family income. 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 2015 population of Montgomery County, Kansas to be 33,314. 18.6% of the population is 65 years of age or older, the median household income is $40,716, and 18.0% 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 151663 0 17046 0 0 0 17855 0 10060 0 196624 0 0 0 Kalapurakkal Menon Physician 544560 0 0 0 0 0 27268 0 17245 0 589073 0 0 0 Baba Abudu Anesthesiologist 382970 0 0 0 0 0 27509 0 17246 0 427725 0 0 0 James Lin Physician 347727 0 0 0 0 0 27375 0 12097 0 387199 0 0 0 Shravan Gangula Physician 236326 0 0 0 0 0 24958 0 17245 0 278529 0 0 0 Mark Hill CRNA 197458 0 0 0 0 0 20531 0 16130 0 234119 0 0 0 A Public Building Commission of the City of Coffeyville Kansas 830339430 19233MBB5 2012-05-15 8313639 Health Care Facilities Refunding Revenue Bonds, Series 2012 0 0 0 A 4919283 8313886 802500 134824 7376664 2012 0 1 1 1 A 0 0 0 0 0 0 0 A 0 0 0 0 0 0 0 0 0 A 0 Form 990, Schedule K, Part II, Line 3 The difference between the issue price from Schedule K, part I, column (e) and the total proceeds of issue from Schedule K, part II, line 3 is interest income earned on the bond funds held in the reserve account. Form 990, Part VI, Section B, line 11 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 Other fees for service: Program service expenses 7,675,347. Management and general expenses 1,352,743. Fundraising expenses 0. Total expenses 9,028,090. Form 990, Part XI, line 9: Decrease in beneficial interest in net assets of CRMC Foundation -70,939. 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 0 0 1 1 0 0 0 0