2015-09-30T11:02:02-05:00 2014-12-31 990 2014-01-01 273993262 COMANCHE COUNTY MEDICAL CENTER COMPANY COMA 2548794900 10201 STATE HIGHWAY 16 COMANCHE TX 764424462 DAVID FRESHOUR CFO 2548794900 2015-09-30 GAYLE DE HAAS P01774581 2014 2016-02-25 16:41:14Z DAVID FRESHOUR 10201 STATE HIGHWAY 16 COMANCHE TX 764424462 23174249 0 X WWW.COMANCHECMC.COM X 2010 TX TP PROVIDE COMPLETE AND QUALITY HEALTHCARE SERVICES TO THE CITIZENS OF COMANCHE COUNTY AND SURROUNDING AREAS. 5 4 174 22 0 0 60414 833747 19837565 21713654 228683 8580 435358 618268 20562020 23174249 0 0 0 0 7492162 7270039 0 0 0 13707225 13711434 21199387 20981473 -637367 2192776 5319236 5198736 6801652 4488376 -1482416 710360 COMANCHE COUNTY MEDICAL CENTER IS COMMITTED TO COMMUNITY TRUST. WE PLEDGE TO PROVIDE QUALITY HEALTHCARE THROUGH CARING, EFFICIENT, RESPONSIVE, AND COURTEOUS SERVICE EVERYDAY - WHILE ADDRESSING THE EVER-CHANGING HEALTHCARE NEEDS OF THE PEOPLE WE SERVE. 0 0 18895010 22333790 GENERAL AND ACUTE HOSPITAL 18895010 1 1 0 0 0 0 0 0 0 0 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 0 0 0 0 0 0 0 1 0 0 0 1 31 0 1 174 1 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X DAVID FRESHOUR 2548794900 10201 STATE HIGHWAY 16 COMANCHE TX 76442 JERRY MORGAN CHAIRMAN 0.50 X 0 0 0 MIKE HARE VICE CHAIRMAN 0.50 X 0 0 0 ROBERT PRATT SECRETARY 0.50 X 0 0 0 DWAYNE MILLER DIRECTOR 40.00 X 302308 0 0 PAUL MCKINZIE DIRECTOR 0.50 X 0 0 0 JIM CHRISTENSEN CEO 40.00 X 164879 0 0 DAVID FRESHOUR CFO 40.00 X 124057 0 0 DAN HANCOCK PHARMACIST 40.00 X 124267 0 0 RACHEL HILLIARD NURSE PRACTITIONER 40.00 X 120962 0 0 PATRICK LOWTHER DIRECTOR OF RADIOLOGY 40.00 X 104164 0 0 940637 0 0 6 0 1 0 XTEND HEALTHCARE 500 W MAIN STREET STE 14 GEBDERSIBVUKKE TN 37075 BUSINESS OFFICE 928991 COMANCHE PHYSICAL THERAPY PO BOX 130 DE LEON TX 76444 PHYSICAL THERAPY 413384 GUYLE DONHAM DO 437 TIMBER CREEK STEPHENVILLE TX 76401 PHYSICIAN SERVICES 354342 STEPHEN HOWARD DICKEY DO 200 CR 461 DE LEON TX 76444 PHYSICIAN SERVICES 315916 DAVIS GARRY TODD DO 501 APACHE TRAIL COMANCHE TX 76442 PHYSICIAN SERVICES 313581 11 43334 790413 833747 NET PATIENT SERVICE 621990 21713654 21713654 21713654 6712 6712 3558 0 3558 3558 3558 1868 0 1868 1868 1868 DSRIP 900099 358124 358124 PHARMACY 900099 122982 122982 MISCELLANEOUS 900099 92933 92933 40671 40671 614710 23174249 22333790 0 6712 X 638329 349393 288936 5642151 5203792 438359 87801 87801 454419 408233 46186 447339 403513 43826 776603 776603 62505 82 62423 138209 138209 3648445 3484224 164221 64273 46747 17526 181074 140768 40306 244776 244776 3570872 3557367 13505 16346 8706 7640 17614 14056 3558 71463 71463 233199 233199 235139 226669 8470 BAD DEBT 1971133 1971133 MEDICAL SUPPLIES 1668026 1667771 255 DUES & SUBSCRIPTIONS 686313 667032 19281 DIETARY 90730 90666 64 34714 17619 17095 20981473 18895010 2086463 0 1434522 590596 123152 1735692 1621978 603138 578032 139653 68180 4782490 3748029 916956 1034461 489275 1182337 5319236 5198736 4656062 2796708 2146110 1588835 -520 102833 6801652 4488376 X -1482416 710360 -1482416 710360 5319236 5198736 2192776 0 X 0 1 X 0 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 358581 56736 301845 4423909 3691293 732616 1034461 DUE FROM MEDICARE COST REPORT 523275 OTHER RECEIVABLES 592124 EMPLOYEE INSURANCE RECEIVABLE 66938 1182337 DUE TO B/AR -564 DUE TO MEDICAID COST REPORTS 103397 102833 X 21199558 0 21199558 1974691 1974691 23174249 19006782 0 19006782 1974691 1974691 20981473 PART X, LINE 2: PER AUDIT REPORT, "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 1,971,133. RENTAL INCOME 3,558. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1,971,133. RENTAL INCOME 3,558. 1 1 1 X 1 X 1 1 0 1 1 1025961 1812586 -786625 0.00000 1586158 1258549 327609 0.01720 0 0 2612119 3071135 -459016 0.01720 0 0 0 0 0 0 0 0 0 0 2612119 3071135 -459016 0.01720 1 975731 1521566 9293555 8640002 653553 X 1 1 1 1 COMANCHE COUNTY MEDICAL CENTER 10201 STATE HIGHWAY 16 COMANCHE TX 76442 WWW.COMANCHECMC.COM 100123 X X X X COMANCHE COUNTY MEDICAL CENTER 1 0 0 1 X X X X X X X X X 14 1 0 0 1 X WWW.COMANCHECMC.COM X 1 14 0 1 0 1 X 100.000000000000 200.000000000000 X X X X X 1 1 1 X X 1 X 0 X X X X 1 X 0 0 COMANCHE COUNTY MEDICAL CENTER PART V, SECTION B, LINE 5: THE CHNA COMPLETED INCLUDED INPUT FROM INDIVIDUALS IN THE COMMUNITY, INCLUDING MEDICAL STAFF (PHYSICIANS AND NURSING STAFF) AND BOARD MEMBERS OF CCMC, THROUGH FOCUS GROUPS, SURVEYS AND INTERVIEWS. COMANCHE COUNTY MEDICAL CENTER PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE PATIENTS IS A PERCENTAGE OF AMOUNTS GENERALLY BILLED BASED ON A "LOOK-BACK" METHOD THAT IS DERIVED FROM THE NET PATIENT SERVICE REVENUE DETERMINED BY THE ANNUAL AUDIT REPORT. THE FINANCIAL ASSISTANCE POLICY ILLUSTRATES THE AMOUNT OF THE PERCENTAGE DISCOUNT THAT APPLIES TO INDIVIDUALS BASED ON A SLIDING FEE SCALE. SCHEDULE H, PART V, SECTION B, LINE 2 WE ARE A MEMBER OF THE REGIONAL HEALTHCARE PARTNERSHIP 11 IN THE STATE WHO HAS CONDUCTED AN AREA COMMUNITY NEEDS SURVEY. SCHEDULE H, PART V, SECTION B, LINE 14 THE MEDICAL CENTER POSTS NOTICE OF ITS CHARITY CARE PROGRAM AND HOW A PATIENT MAY APPLY FOR CHARITY CARE. SCHEDULE H, PART V, SECTION B, LINE 1 THE MEDICAL CENTER SERVES THE COMANCHE COUNTY WHICH IS AN AREA OF 948 SQUARE MILES. THE ESTIMATED POPULATION IN 2014 WAS 13,974 WITH A MEDIAN HOUSEHOLD INCOME OF $35,883. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY COMANCHE COUNTY MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: WWW.COMANCHECMC.ORG 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 $ 1,971,133. PART III, LINE 4: BAD DEBTS ARE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL PROVIDES EMERGENCY AND MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF THE PATIENTS' ABILITY TO PAY.SEE PAGES 5-7 OF THE AUDIT REPORT. PART III, LINE 8: THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. PART III, LINE 9B: IT IS THE POLICY OF CCMC TO DISTINGUISH CHARITY CARE FROM BAD DEBT EXPENSE. TO BE ELIGIBLE FOR CHARITY CARE AS A FINANCIALLY INDIGENT PATIENT, A PERSONS INCOME SHALL BE AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES. THE HOSPITAL MAY CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ELIGIBILITY. TO BE ELIGIBLE FOR CHARITY CARE AS A MEDICALLY INDIGENT PATIENT, THE AMOUNT OWED BY THE PATIENT ON THE HOSPITAL BILL AFTER PAYMENT BY THIRD-PARTY PAYERS MUST EXCEED 40% OF THE PATIENTS ANNUAL GROSS INCOME AND THE PATIENT MUST BE UNABLE TO PAY THE REMAINING BILL. THE HOSPITAL WILL CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ABILITY TO PAY.THE HOSPITAL WILL POST NOTICE OF ITS CHARITY CARE PROGRAM AND HOW THE PATIENT MAY APPLY FOR CHARITY CARE. THE BUSINESS OFFICE WILL ATTEMPT TO IDENTIFY ALL CASES THAT WILL QUALIFY AS CHARITY AT THE TIME OF ADMISSION. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE A FINANCIAL ASSESSMENT FORM. THE BUSINESS OFFICE WILL TRANSFER THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM TO THE APPROPRIATE PROGRAM, SUCH AS MEDICAID. PATIENTS WHO ARE ELIGIBLE FOR MEDICAID AND OTHER INDIGENT HEALTH CARE PROGRAMS DO NOT QUALIFY AS FINANCIALLY INDIGENT, BUT THE UNREIMBURSED COSTS OF PROVIDING SERVICES TO RECIPIENTS OF THESE PROGRAMS SHALL BE REPORTED AS GOVERNMENT-SPONSORED INDIGENT HEALTH CARE, AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENTS FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENTAL ASSISTANCE, A DETERMINATION WILL BE MADE CONCERNING THE PATIENTS ELIGIBILITY FOR CHARITY CARE. NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATION IS MADE. SCHEDULE H, PART VI, LINE 1 THE ORGANIZATION HAS A BOARD MADE UP OF VOLUNTEERS THAT REPRESENT THE COMMUNITY. ANNUALLY DURING HOSPITAL WEEK, WE PROVIDE A HEALTH FAIR AND INVITE HEALTH CARE VENDORS FROM ALL OVER THE AREA FOR INDIVIDUALS WHO ATTEND IT. AT THE HEALTH FAIR, WE OFFER TO ALL THOSE INTERESTED FREE LIPID PROFILES AND THROUGH THE VENDOR PARTNERS, THERE IS MANY OTHER FREE TESTING OFFERED AT THE EVENT AS WELL.WE ALSO HAVE EMPLOYEES WHO SPEAK AT VARIOUS EVENTS (CIVIC CLUBS, ETC.) OUR SOCIAL WORKERS WORK WITH THE PATIENTS FOR THEIR NEEDS INCLUDING NURSING HOME PLACEMENT, HOME HEALTH SERVICES, ETC. WE ALSO PROVIDE PATIENT EDUCATION MATERIAL (THROUGH A VENDOR WE CONTRACT WITH AND PAY) CONDUCT CPR AND OTHER CLASSES THAT INDIVIDUALS CAN ATTEND. WE PROVIDE FLU SHOTS TO VOLUNTEERS, FOUNDATION MEMBERS, BOARD MEMBERS, PHYSICIANS, EMPLOYEES, AND DISTRICT EMPLOYEES WHO WORK IN OUR BUILDING FREQUENTLY. WE ALSO OFFER FLU CLINICS FOR A NOMINAL CHARGE THAT JUST COVERS THE COST OF THE SHOT. WE PROVIDE FLU CLINICS FOR BUSINESSES WHEN THEY REQUEST IT TOO. WE PARTICIPATE IN THE RELAY FOR LIFE EACH YEAR AND SPONSOR THEIR PROGRAM. 0 0 0 0 0 0 0 0 0 DWAYNE MILLER DIRECTOR 302308 0 0 0 0 0 0 0 0 0 302308 0 0 0 JIM CHRISTENSEN CEO 164879 0 0 0 0 0 0 0 0 0 164879 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY AN INDEPENDENT, THIRD-PARTY ACCOUNTANT. THE ORGANIZATION'S MANAGEMENT REVIEWS THE RETURN FOR ACCURACY, AND THE ORGANIZATION'S BOARD OF DIRECTORS APPROVES THE RETURN PRIOR TO IT BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND PHYSICIANS ARE REQUIRED TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST THROUGH THE SUBMISSION OF THE CCMC STATEMENT OF DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 IN 2013, CCMC BOARD OF DIRECTORS APPROVED CEO CONTRACT AND COMPENSATION THROUGH REVIEW AND APPROVAL, COMPARABILITY DATA, AND COMTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS ALSO INCLUDES APPROVAL BY THE HOSPITAL'S CEO, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. 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 DOUCMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONAL DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G HOSPITAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,484,224. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,484,224. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 164,221. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 164,221. COMANCHE COUNTY HEALTHCARE FOUNDATION PO BOX 634 COMANCHE TX 76442 202373650 SUPPORT ORGANIZATION TX 501(C)(3) 11C 0 COMANCHE COUNTY PHYSICIAN'S GROUP 10201 HIGHWAY 16 NORTH COMANCHE TX 76442 272634085 MEDICAL SERVICES TX 501(C)(4) 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMANCHE COUNTY HEALTHCARE FOUNDATION C ACV