2016-01-28T09:01:14-06:00 2015-04-30 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2014-05-01 741394418 COLUMBUS COMMUNITY HOSPITAL COLU 9797322371 110 SHULT DRIVE COLUMBUS TX 78934 JAMES VANEK ADMINISTRATOR 9797322371 2016-01-28 1 GAYLE DE HAAS P01774581 8067911591 2014 2016-04-25 22:37:26Z JAMES VANEK 110 SHULT DRIVE COLUMBUS TX 78934 33168637 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 9 222 65 0 0 2254137 1926393 26945655 27583536 184658 380896 3708055 3261150 33092505 33151975 0 0 0 0 11002903 11102707 0 0 0 17638074 18864355 28640977 29967062 4451528 3184913 74476189 77227072 8972795 8550820 65503394 68676252 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 28419938 30821770 COLUMBUS COMMUNITY HOSPITAL IS A 40 BED ACUTE CARE FACILITY OFFERING COMPREHENSIVE HEALTH CARE. THE HOSPITAL HAD 4,048 ACUTE DAYS WITH TOTAL NURSERY DAYS OF 388. THERE WERE 7,466 ER VISITS WITH 2,445 SUGERIES. LAB PROCEDURES AVERAGED 9,651 PER MONTH AND RADIOLOGY PROCEDURES AVERAGING 1,978. 28419938 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 51 0 1 222 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 JERRY HALUSKA TRUSTEE (FORMER) 1.00 X 0 0 0 PAT GILLESPIE TRUSTEE (FORMER) 1.00 X 0 0 0 RON RHODES TRUSTEE 1.00 X 0 0 0 TRAVIS WEGENHOFT TRUSTEE (FORMER) 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 50.00 X 175682 0 0 REGINA WICKE CFO 50.00 X 119889 0 0 JENO HARGROVE DON 50.00 X 141874 0 0 RENE COOPER RN 56.00 X 146309 0 0 CYNTHIA SMITH RN 52.00 X 125403 0 0 JENNIFER HENDERSON RN 50.00 X 112986 0 0 PRISCA SOTO ASSISTANT DON 40.00 X 114869 0 0 YVONNE WAGNER NP 40.00 X 114195 0 0 1051207 0 0 8 0 1 0 CONCORD MEDICAL GROUP 3004 50TH STREET SUITE D LUBBOCK TX 79413 PHYSICIAN SERVICES 1191993 SDS PHYSICAL THERAPY PO BOX 335 COLUMBUS TX 78934 PHYSICAL THERAPY 1115847 TEXAS WOMEN'S CARE PO BOX 280 COLUMBUS TX 78934 PHYSICIAN SERVICES 408500 TROY MILLICAN 1158 ABEL RD NEW ULM TX 78950 PHYSICIAN 315820 DAVID NEISNER 120 CARDINAL LANE COLUMBUS TX 78934 PHYSICIAN 255747 17 55271 75904 1795218 12055 1926393 MEDICAL SERVICES 621990 27583536 27583536 27583536 365375 365375 41115 0 41115 41115 41115 15521 0 15521 15521 15521 55099 55271 16662 38437 38437 FOUNDATION CHANGE IN U 624100 1356320 1356320 INCENTIVE FUNDS 624100 1146563 1146563 UNCOMPENSATED CARE REV 624100 406935 406935 271780 271780 3181598 33151975 30821770 0 403812 X 263439 263439 8050908 7568996 481912 2788360 2538394 249966 28353 28353 16854 16854 7056369 7056369 53996 53996 490231 67125 423106 350180 350180 819045 819045 37227 26982 10245 266374 266374 1262230 1262230 120299 120299 MEDICAL SUPPLIES 5133420 5133420 BAD DEBT EXPENSE 2869013 2869013 INDIGENT CARE EXPENSE 340415 340415 TAXES 19253 19253 1096 1096 29967062 28419938 1547124 0 666576 504876 12362441 13347176 4353357 4901438 410400 205224 673076 730792 104233 89527 24662032 10262056 14518621 14399976 41387485 43048063 74476189 77227072 1712292 2130599 847945 350414 6199059 6069794 213499 13 8972795 8550820 X 65503394 68676252 65503394 68676252 74476189 77227072 X 3184913 -12055 X 0 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 947680 947680 13856150 3523514 10332636 386243 161433 224810 9471959 6577109 2894850 14399976 INTEREST IN NET ASSETS OF COLUMBUS COMMNITY HOSPITAL FOUNDATION 42486266 DUE FROM MEDICARE/MEDICAID 561797 43048063 PAYABLE TO MEDICARE 2011 13 13 X 30287569 0 30287569 2864406 2864406 33151975 27114711 0 27114711 2852351 2852351 29967062 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 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,869,013. VALUE OF DONATED ITEMS FOR FUNDRAISER AUCTION 12,055. FUNDRAISING EXPNESES -16,662. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 2,869,013. FUNDRAISING EXPENSES -16,662. AUCTION 110370 55271 55099 2055 14107 500 110370 55271 55099 2055 14107 500 16662 38437 1 1 X 1 X 1 X 500.000000000000 1 1 1 0 1 1 498775 90214 408561 0.01510 2067795 798956 1268839 0.04680 2566570 889170 1677400 0.06190 2566570 889170 1677400 0.06190 1 1394008 700627 9363147 8456530 906617 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 13 1 0 0 1 X 1 13 1 WWW.COLUMBUSCH.COM 1 0 1 X 200.000000000000 500.000000000000 X X X X X 1 1 1 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 FOUR OAKS MEDICAL CLINIC 109 SHULT DRIVE COLUMBUS TX 78934 OUTPATIENT CLINIC COLUMBUS MEDICAL CLINIC 2122 HWY 71 S COLUMBUS TX 78934 OUTPATIENT CLINIC PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 2,869,013. 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. X X 0 0 0 0 0 0 0 0 0 ROBERT F THOMAS CEO 175682 0 0 0 0 0 0 0 0 0 175682 0 0 0 PART I, LINE 3 ANNUAL PERFORMANCE-BASED MERIT INCREASE COUPLED WITH REVIEW OF SALARY SURVEY DATA FOR LIKE-SIZED HOSPITALS. 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 7,056,369. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 7,056,369. FORM 990, PART XI, LINE 9: VALUE OF ITEMS DONATED FOR FUNDRAISER AUCTION NOT RECORDED ON BOOKS IN ACCORDANCE WITH GAAP -12,055. 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 CASH