2015-11-16T11:51:03-06:00 2014-12-31 481026809 Wendling Noe Nelson & Johnson LLC 534 S Kansas Ave Suite 1500 Topeka KS 666033491 990 2014-01-01 481178846 Coffeyville Regional Medical Center Inc COFF 6202511200 1400 W 4th Street Coffeyville KS 67337 Dean Ohmart CFO 6202511200 2015-11-11 1 Eric L Otting P00298454 7852334226 2015-11-11 2014 2016-04-25 22:37:26Z Dean Ohmart 1400 W 4th Street Coffeyville KS 67337 37986231 0 X crmcinc.com X 1996 KS Medical care and services by an acute care hospital. 8 8 450 76 1548 0 17957 172732 35016965 35900812 314457 297126 1856433 1615114 37205812 37985784 8196 11412 0 0 19886780 19883208 0 0 36002 17707711 18588136 37602687 38482756 -396875 -496972 47580026 45107094 12132643 10211061 35447383 34896033 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 33980512 11412 37333127 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. 33980512 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 47 0 1 450 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 Dr Raymond Hawley Chairman 2.00 X X 0 0 0 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 Director 2.00 X 0 0 0 Monte Coffman Director 2.00 X 0 0 0 Dr Paul Sandhu Director 2.00 X 0 0 0 Eli Stanton Director 2.00 X 0 0 0 John Smith CEO (thru Feb. 2014) 40.00 X 300917 0 1614 Cheryl Batchelor CFO (thru Aug. 2014) 40.00 X 103727 0 5684 James Chromik Interim CEO 40.00 X 123000 0 0 William Page Interim CFO 40.00 X 57600 0 0 Kathlene Elwess-Cahill CEO (Oct. 2014 only) 40.00 X 19474 0 0 Kalapurakkal Menon Physician 40.00 X 542140 0 16996 Baba Abudu Physician 40.00 X 370050 0 14116 Yogesh Kolwadkar Physician 40.00 X 352084 0 16996 Shravan Gangula Physician 40.00 X 220192 0 14817 Mark Hill CRNA 40.00 X 186652 0 10728 2275836 0 80951 17 0 1 0 Coffeyville Emergency Physicians LLC PO Box 564 Coffeyville KS 67337 ER physician fees 678795 Gery Hsu MD Spinal Neurosurgical As 6921 E 109th St S Tulsa OK 74133 Physician 511812 Medical Information Technology Meditech Circle Westwood MA 02090 Technology support services 247221 Netscript Inc 235 County Road 3520 Clarksville AR 72830 Transcription services 240506 Cancer and Blood Care PC 609 Virginia Ave Ponca City OK 74601 Oncology 205512 17 150609 6250 15873 172732 Net patient service revenue 621990 35516170 35516170 Educ, lifeline, wellness and misc 900099 309603 309603 Other patient related services 621990 75039 75039 35900812 297573 297573 40501 0 40501 40501 40501 447 -447 -447 -447 EHR incentive revenue 900099 871233 871233 Sales tax revenue 900099 561437 561437 Cafeteria and dietary income 722210 140303 140303 1640 92 1548 1574613 37985784 37333127 1548 478377 X 8412 8412 3000 3000 612015 612015 14524664 13390452 1111365 22847 1303427 1165891 135486 2050 2413498 2138855 270847 3796 1029604 949203 78781 1620 103867 103867 146598 146598 60597 60597 5561124 4556573 1004551 261221 199698 61523 128975 87482 41465 28 38355 34454 3836 65 913268 747145 164388 1735 129452 113638 15814 29832 25333 4499 211128 211128 3533750 3080776 449463 3511 303513 226827 76336 350 Medical Supplies 3471840 3471840 Pharmacy drugs 2567184 2567184 Medicaid provider asses 261308 261308 Dietary food 240694 219475 21219 625430 521838 103592 38482756 33980512 4466242 36002 2159376 2284831 8799692 8727317 4272816 4412383 78882 49937 1340361 1305928 635774 619547 65367787 43548571 24501244 21819216 2701142 2807620 3090739 3080315 47580026 45107094 3310324 3703872 7093520 4887308 935575 1539881 793224 80000 12132643 10211061 X 32983463 32455955 2093252 2069410 370668 370668 35447383 34896033 47580026 45107094 X -496972 -30537 -23841 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6077 0 0 0 6077 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 1.00000 0 1 1 76477 76477 26417869 15005179 11412690 20313037 15310339 5002698 18560404 13233053 5327351 21819216 Stock mutual funds 1992191 F Bond mutual funds 815429 F 2807620 Other receivables 262816 Beneficial interest in net assets of foundation 2440078 Deferred financing costs 72745 Sales tax receivable 232836 Estimated third party payor settlements 71840 3080315 Liability for receivables sold with recourse 80000 80000 X 37805085 -30537 -30537 37835622 150162 150162 37985784 38482756 0 38482756 0 38482756 Part V, Line 4: The Coffeyville Regional Medical Center Foundation's endowment consists of one 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 from Foundation 150,609. Loss on sale of equipment -447. 1 1 1 X 1 X 1 1 0 1 0 641632 74400 567232 0.01470 4113123 2655406 1457717 0.03790 4754755 2729806 2024949 0.05260 305590 5548 300042 0.00780 6371239 4156747 2214492 0.05750 33588 33588 0.00090 6710417 4162295 2548122 0.06620 11465172 6892101 4573071 0.11880 1 1454610 89520 14336422 17113787 -2777365 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 crmcinc.com X 1 13 1 crmcinc.com 0 0 1 X 100.000000000000 250.000000000000 X X X X X 1 1 X X X 1 X 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 Coffeyville Regional Medical Center 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 in 2014 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 during 2014.To address diabetes, one of the Medical Center's APRNs conducted a talk 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.During 2014, a large physician group left the community. Since that time, the Medical Center has begun initiatives to recruit and employee physicians to address this coverage gap.To address maternal and infant measures, the Medical Center began analyzing the effectiveness of early elective delivery to determine when they are beneficial. It also employed a licensed child birth educator and lactation specialists. For its efforts, the Medical Center was awarded for being one of the healthiest facilities for babies. 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. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 22d: The maximum amounts that can be charged by the Medical Center to FAP-eligible individuals for emergency or other medically necessary care is calculated by multiplying gross charges for such care by the amounts generally billed percentage. This percentage is calculated annually 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. Part V, Section B, Line 16 Financial Assistance Policy Website Availability Coffeyville Regional Medical Center, Inc Part V, Section B, line 16b website: http://www.crmcinc.com/guide_finassist.php 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, speech therapy, and a physician clinic. The cost associated with the physician clinic was $1,773,774. 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 determined using the charges written off to bad debt for patient accounts that had 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 the estimated $89,520 amount of bad debt attributed to patients elgible under our financial assistance policy should be included as community benefit. As a not-for-profit, patient care is provided to all, regardless of ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualifies bad debts as a community benefit. Part III, Line 8: The 2014 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: Every 3 years, CRMC hires 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. The latest survey conducted was completed in November 2012. 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. The Medical Center offered a sliding discount ranging from 10% to 25% for private pay patient bills over $200.00. Patients found 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 2014 population of Montgomery County, Kansas to be 34,065. 17.9% of the population is 65 years of age or older, the median household income is $39,669, and 19.4% 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 1 0 0 0 0 0 0 0 0 John Smith CEO (thru Feb. 2014) 295917 0 5000 0 0 0 1498 0 116 0 302531 0 0 0 Kalapurakkal Menon Physician 542140 0 0 0 0 0 15600 0 1396 0 559136 0 0 0 Baba Abudu Physician 370050 0 0 0 0 0 12720 0 1396 0 384166 0 0 0 Yogesh Kolwadkar Physician 352084 0 0 0 0 0 15600 0 1396 0 369080 0 0 0 Shravan Gangula Physician 220192 0 0 0 0 0 13421 0 1396 0 235009 0 0 0 Mark Hill CRNA 185902 0 750 0 0 0 9332 0 1396 0 197380 0 0 0 Part I, Line 4a John Smith, CEO (thru Feb. 2014), received a severance payment of $258,476.40. 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 3558639 8313886 802500 134824 7376562 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 No review was or will be conducted. Form 990, Part VI, Section B, line 12c The organization reviews concerns when identified. Members do not participate in 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 by the Board 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 4,556,573. Management and general expenses 1,004,551. Fundraising expenses 0. Total expenses 5,561,124. Form 990, Part XI, line 9: Decrease in beneficial interest in net assets of CRMC Foundation -23,841. 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 0 1 0 0 0 0