2013-12-10T10:00:44-06:00 2013-04-30 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2012-05-01 470542043 COLUMBUS COMMUNITY HOSPITAL INC % MIKE ADAMY COLU 4025623357 PO BOX 1800 Suite COLUMBUS NE 68602 MICHAEL T HANSEN 4025623357 2013-12-09 true Adam C Stark 4023481450 2012 2015-11-30 17:44:51Z J Joseph Barbaglia 4600 38th Street Columbus NE 68601 73984956 false X www.columbushosp.org X 1972 NE OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 11 10 649 333 17330 -39795 303177 117549 68343052 72520573 1233315 321804 664081 1025030 70543625 73984956 1334804 1469342 0 0 30379279 33905776 0 0 0 27885114 29781927 59599197 65157045 10944428 8827911 100607338 97892656 18331472 6956170 82275866 90936486 X OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 61819521 60383 73265127 General Hospital and Health Care: Columbus Community Hospital ("CCH") is a 47 bed acute care Hospital which currently employs over 600 people. It is a significant, positive economic force for Columbus and the area, returning dollars into the economy through local purchases by the organization, and salaries that return to the community. It is also a needed asset for the local communities where patients can obtain quality healthcare without the need to drive over 50 miles for care. In providing the care necessary for local communities, CCH has a variety of services. Following is a brief summary of some of the areas of service provided by CCH. -The main focus is acute care services For patients needing an extended recovery. the beds at CCH are also certified as swing beds. -To assist our non-English speaking patients, CCH uses competent, dedicated medical interpreters as a liaison between the care providers and the patient. Since this is the interpreters' full time job at the Hospital, they are available when needed, in house or on call 24/7. -To make the patient's stay successful and comfortable, CCH offers icu, medical surgical, OB, and an orthopedic service line along with a variety of complimentary ancillary services (wound care, diabetic education, cardiac rehab) and clinical pharmacy services provided. CCH uses barcoded medication administrated smart pumps and computerized physician order entry to enhance safety. -CCH offers rehabilitative services such as physical therapy, speech therapy, occupational therapy and drive rehab therapy, so patients don't have to travel so far to get adult therapy. Pediatric physical therapy, speech therapy, and occupational therapy are offered at our off-site location, Wiggles & Giggles Therapy (includes physicial, speech, and occupational therapies) for Kids. CCH has PTs, OTs and STs with specialized certification in cancer rehab. We launched our certified STAR Program at Columbus Community Hospital in November of 2012. We are one of only three hospitals in Nebraska to have achieved the STAR Program certification for cancer rehabilitation. STAR stands for Survivorship Training and Rehab. We have had at least 39 formal STAR Program referrals resulting in consultations for potential rehabilitation needs. Many of our STAR Program participants have needed physical therapy, speech therapy or occupational therapy and some have needed nutritional consults as well as psychosocial referrals. Some patients who have participated have had pulmonary concerns and cardiovascular factors. There also have been some STAR Program graduates that have transitioned to medical wellness here at CCH. STAR Program co-coordinators are Jill Jakub MOTR/L, CLT, and Michell Ruskamp MS, CCC-SLP. They are joined by 23 other clinicians including physicians, nurses, respiratory therapists, dieticians, social workers, and therapists who are STAR Program certified at CCH. The STAR Program Cancer Rehab Certification at CCH is funded by the Columbus Community Hospital Foundation. Our Certified Provider Team for the STAR Program is made up of 3 physicians, 6 physical therapists, 4 occupational therapists, 2 speech therapists, 4 nurses, 1 respiratory therapist, 3 social workers and 2 nutritionists. CCH HAS A specialized parkinsens treatment approach, which facilitates support groups for parkinsens, TBI and stroke patients. -Nurses in the Same Day Services Department prepare patients for surgery and if going home the same day, care for them after surgery. The department oversees several outpatient procedures, including seventy to ninety endoscopy procedures each month, also infusions and chemotherapy infusions. -CCH offers some of the most advanced imaging services including MRI, CT, Digital Mammography, Ultrasound, etc. Radiologists are on campus and/or available 24-7 to read the various scans. The dictation used by the radiologists is voice recognized and becomes part of the digital image. All images are digital, meaning there are no films. -CCH has an up to date Laboratory which performs over 12,000 tests on average per month, for both inpatients and outpatients. -CCH has highly trained, employed emergency physicians and nurses in their Emergency Department (ed) and offers 24-7 care. The Department includes support from qualified staff in respiratory care, social work, laboratory, medical interpreting, and diagnostic imaging. The ED was designated as a Level III Trauma Center in May, 2006. The Medical Staff and personnel in the Trauma Center have received specialized training to resuscitate and stabilize trauma patients. The trauma program provides systematic review of the trauma care and participates in injury prevention activities throughout the community. -CCH opened wound care services in August of 2008 with three patients. The identified service area includes a 45-mile radius around Columbus. By January, 2009 a second day was added to support the demand. This service has taken off far beyond what was expected. Previously, patients seeking this specialized treatment were required to travel on average 75 miles to see a wound clinic specialist. It was a much needed service for the local communities. Columbus commuinty hospital currently sees over 100 patients per month for wound care. -Centering on services outside the Hospital, the larger services are Home Health and Hospice services. Home Health is skilled health services for patients at their place of residence. The program is medically directed, therefore, it must be ordered by the attending physician. The program is Medicare and Medicaid certified and meets the requirements of the Joint Commission. Services provided within the program are: A) Supervision and administration of medications B) Intravenous therapy C) Teaching diabetic management D) Nutritional assessments E) Home Health Aides F) Personal Care services G) Occupational, Speech and Physical Therapies H) social work care management Hospice services are provided to persons who are no longer receiving curative treatment and whose life expectancy is six months or less. Care is provided by an interdisciplinary team which consists of the physician, nurse, social worker, therapist, home health aide, spiritual advisor, volunteer and other health professionals. -Our local Healthy Family Nebraska Program (HFN) targets young, primarily single, pregnant mothers and their families. Our voluntary HFN home visitation program targets the most vulnerable young women and their families by offering them, intense, in home education, support and resources. This home visiting program covers families in a four county area. The HFN requires each mother/family to actively participate in building an individualized family plan. This strength based approach promotes self-improvement, and enhances self-esteem and independence for our young parents that will help them make better decisions, and break out of destructive cycles. -CCH's Sleep Lab offers complete polysomnographic sleep testing for the purpose of diagnosing obstructive/central sleep apnea by trained and licensed sleep technicians. -Occupational Health Services (OHS) offers a menu of health care services designed to prevent and treat injuries in the workplace. Partnering with employers in more than 900 companies and with other health care professionals, OHS provides a comprehensive health and safety program specific to the needs of each business. A comprehensive testing procedure called the Physical Capacity Profile (pcp) matches employees to the job and is designed to accommodate individuals with handicaps. The PCP system was developed by an orthopedic physician. Through use of this testing, musculoskeletal imbalances are detected which helps employers place employees in the appropriate job to minimize the potential of injury. -Lifeline, an in home emergency response program, provides the vital safety net that many people need to continue living at home in familiar and comforting surroundings. The program is completely focused on ensuring the patient's independence, safety and well-being in their home. It operates with a bracelet worn by the patient with a button that can be pressed if help is needed. predetermined responders are summoned to their home or emergency transfer can be called if needed. This gives security to the patient and comfort to the patient's relatives. -Meals on Wheels are prepared by the Nutrition Services Department and are delivered by community volunteers. Seniors and physically handicapped adults qualify for the program. Special diets can also be accommodated. Financial assistance is available through the Nebraska Department of Social Services. -The Hospital participates in and has hosted county wide natural disasters and pandemic drills. CCH is a member of a larger preparedness team, RROMRS. This allows CCH to assist or receive assiStance from this regions medicare providers. CCH feels we are well prepared to handle a natural disaster or pandemic should one 1403561 1403561 Charity Care: CCH offers a Charity/Financial Aid Program to provide uncompensated services to people who are unable to pay. CCH Charity/Financial Aid Policy reflects the mission, vision and values of CCH. It is intended to assist low-income, underinsured, and uninsured individuals whose financial status, under the hospital's qualification criteria, makes it impractical or impossible to pay for necessary medical services. CCH has a fiduciary responsibility to seek payment for services from those who can pay, and every effort will be made to apply consistent, fair and equitable financial aid practices in a manner consistent with all applicable federal and state laws and regulations. CCH follows the Federal Poverty Guidelines (FPG) to determine both eligibility for free care, 100% of FPG, and discounted care, 200% FPG. CCH also offers catastrophic charity assistance. If the applicant qualifies for partial Charity/Financial Assistance and the total balance after all write-off's is $1,200 or greater, an additional write-off will be done as outlined below. Reduce to $1,200, adjustments will be done from oldest to newest. 63223082 true true false true false false false false false true true false false false false true false true false false false false false false false false true true true true true false false false false false false false false false false false false false true true true true false true 44 0 true 649 true true true false false false false false false false false false X 11 10 false false false false false false false true true false false true true true true true true true true false X MIKE ADAMY 4025623382 4600 38TH STREET COLUMBUS NE 68601 X JAMES PILLEN DVM 1.0 0.0 X X 0 0 0 ANTHONY RAIMONDO JR 1.0 0.0 X X 0 0 0 JEFFREY GOTSCHALL MD 1.0 0.0 X X 0 0 0 RONALD ERNST MD 1.0 0.0 X 0 0 0 JOHN C MCCLURE 1.0 0.0 X 0 0 0 REBECCA RAYmond 1.0 0.0 X 0 0 0 BONNIE MCPHILLIPS 1.0 0.0 X 0 0 0 BRIAN SCHMIDT 1.0 0.0 X 0 0 0 CLARK LEHR 1.0 0.0 X 0 0 0 BETH PRZYMUS 1.0 0.0 X 0 0 0 MARK HOWERTER MD 40.0 0.0 X 430238 0 17254 MICHAEL HANSEN 39.0 1.0 X 285748 0 15096 AMY BLASER 40.0 0.0 X 117753 0 12122 J JOSEPH BARBAGLIA 40.0 0.0 X 206436 0 18584 LINDA WALLINE 40.0 0.0 X 177977 0 16505 JAMES GOULET 40.0 0.0 X 174841 0 19653 ROBERT MILLER MD 40.0 0.0 X 232484 0 15626 MICHAEL MCGUIRE MD 40.0 0.0 X 417357 0 4997 RICHARD CIMPL MD 40.0 0.0 X 382843 0 6885 EDWARD FEHRINGER MD 40.0 0.0 X 340192 0 5108 ALEX KAZOS MD 40.0 0.0 X 229409 0 10082 2995278 0 141912 26 false true false INPATIENT PHYSICIAN ASSOC 3200 PINE LAKE RD STE A LINCOLN NE 68516 HOSPITALIST SVCS 819497 FOCUSONE SOLUTIONS LLC 13609 California St 300 OMAHA NE 68154 STAFFING AGENCY 201879 TSP CONSTRUCTION SERVICES INC 1112 N WEST AVE SIOUX FALLS SD 571041333 CONSTRUCTION SVCS 1743118 SUNQUEST INFORMATION SYSTEMS 250 South Williams Blvd TUCSON AZ 85711 IT SERVICES 151341 MCKESSON TECHNOLOGIES INC PO Box 98347 CHICAGO IL 60693 IT Consulting 1265326 9 117549 117549 NET PATIENT SVC REVENUE 621110 72313254 72313254 MEANINGFUL USE PAYMENT 900099 207319 207319 72520573 318431 318431 0 0 0 0 0 3373 3373 3373 3373 0 0 0 MEALS ON WHEELS 900099 50021 50021 CAFETERIA 722100 263146 263146 OTHER REVENUE 900099 711863 694533 17330 1025030 73984956 73265127 17330 584950 65781 65781 1403561 1403561 0 0 962755 962755 0 27012666 27012666 920503 920503 3101733 3101733 1908119 1908119 0 72106 72106 163123 163123 5786 5786 0 0 2713479 2713479 188284 188284 9060357 8811024 249333 1420413 1420413 0 1151503 1151503 192992 192992 0 99584 99584 216286 216286 0 5341079 5341079 259560 259560 PROVISION FOR BAD DEBTS 3963281 3963281 MINOR EQUIP. & FINANCING AGRMT 2027258 2027258 PURCHASED SERVICES 1290364 1290364 RECRUITING 282795 282795 1333677 1333677 65157045 63223082 1933963 0 5507494 1933467 0 0 0 0 8997202 9233671 0 0 0 0 0 0 1454475 1077673 1418337 1512950 86726440 49024725 37861816 37701715 45055102 46218318 0 0 0 0 0 0 312912 214862 100607338 97892656 6699617 6956170 0 0 0 0 11631855 0 0 0 0 0 0 0 0 0 0 0 18331472 6956170 X 82275866 90936486 0 0 0 0 82275866 90936486 100607338 97892656 X 8827911 -167291 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5786 5786 false OTHER ACTIVITIES SCHEDULE C, PART II-B, LINE 1I DUES PAID TO AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $3,126 DUES PAID TO NEBRASKA HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $2,660 1667736 74389 1742125 1573063 94673 1667736 1506660 66403 1573063 1426826 79844 -10 1506660 1299402 127424 1426826 0.00000 1.00000 0.00000 false true true 639544 639544 43742952 18261210 25481742 37107980 29053953 8054027 5235964 1709562 3526402 37701715 0 0 X FIN 48 FOOTNOTE SCHEDULE D, PART X The Hospital adopted Financial Accounting Standards Board (FASB) Interpretation No. 48, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109 (FIN 48). FIN 48 provides specific guidance on how to address uncertainty in accounting for income tax assets and liabilities, prescribing recognition thresholds and measurement attributes. The adoption of FIN 48 by Columbus Community Hospital did not have a material impact on the Hospital's financial position, results of operations, or cash flows. In Fiscal Years Ending 2013 and 2012, management determined that there are no income tax positions requiring recognition in the financial statements. SCHEDULE D PART V, LINE 4 ENDOWMENT FUNDS ARE HELD AND MAINTAINED BY COLUMBUS COMMUNITY HOSPITAL FOUNDATION. THE ENDOWMENT FUNDS EXIST IN SUPPORT OF IMPROVED HEALTH SERVICES BY COLUMBUS COMMUNITY HOSPITAL. true true X true X true X true true true false true true 693 745712 745712 0.01220 4065048 1387451 2677597 0.04380 693 4810760 1387451 3423309 0.05600 63565 492166 1955 490211 0.00800 811 1218981 17111 1201870 0.01960 1612 1612 601 11649 11649 0.00020 64977 1724408 19066 1705342 0.02780 65670 6535168 1406517 5128651 0.08380 1 1250 1250 1 650 2295 2295 1 2624 2624 2 3935 51909 6700 45209 0.00070 2 799 9157 600 8557 0.00010 7 5384 67235 7300 59935 0.00080 false 3963281 21114039 22457569 -1343530 X true true HEALTHPARK LLC PROPERTY MANAGEMENT 0.71000 ZARZ LLC PROPERTY MANAGEMENT 0.50000 1 1 Columbus Community Hospital INC

4600 38th Street Columbus NE 686011800

X X X 47 Bed acute care Hospital w/ 24 HR ER Services COLUMBUS COMMUNITY HOSPITAL INC true X X X X X X X X X 12 true true true X X X X X X X X X X false false true true 100 true 200. true X X X X true true X X X X X X X true false true X false false 9 PREMIER PHYSICAL THERAPY OF CCH

US 30 CTR BLDG 3100-23RD st ste 15 COLUMBUS NE 686013161

PHYSICAL & AQUATIC THERAPY, SPORTS TRAINING SERVICES WIGGLES & GIGGLES THERAPY FOR KIDS

2108-13TH STREET COLUMBUS NE 686015100

PEDIATRIC THERAPY SERVICES OCCUPATIONAL HEALTH SERVICES OF CCH

3005-19TH ST SUITE 300 COLUMBUS NE 686014252

EMP. HEALTH CARE SVCS TO PREVENT & TREAT WORK INJURIES WOUND HEALING CENTER

4600-38TH STREET SUITE 165 COLUMBUS NE 68601

WOUND TREATMENT CENTER HUMPHREY CLINIC OF CCH

3003 MAIN STREET HUMPHREY NE 686423155

CLINIC IN SMALL TOWN TO OFFER MEDICAL SVCS TO RESIDENTS HOSPICE OF COLUMBUS COMMUNITY HOSPITAL

3005-19TH STREET SUITE 600 COLUMBUS NE 686014248

HOSPICE SERVICES COLUMBUS COMMUNITY HOSPITAL SLEEP LAB

3020-19TH STREET SUITE 100 COLUMBUS NE 686014252

POLYSOMNOGRAPHIC SLEEP TESTING HOME HEALTH OF COLUMBUS COMMUNITY HOSP

3005-19TH STREET SUITE 600 COLUMBUS NE 686014248

HOME HEALTH SERVICES COLUMBUS ORTHOPEDIC & SPORTS MED CLINIC

4508 38TH STREET STE 133 COLUMBUS NE 686011668

FREE STANDING CLINIC PART I, LINE 3C N/A PART I, LINE 6A A Community Benefit report is included each year in the Hospital's quarterly newsletter "Housecall" with an electronic version of the newsletter housed on the Hospital's website. A separate landing page on the website was also created for the report to provide easy access to the report. PART I, LINE 7 To determine costs associated with Charity Care and Community Benefits costs, the Hospital has used the worksheets offered in the Schedule H instructions. The ratio of patient care costs to charges on Worksheet 2 was used to calculate THE amounts reported on Line 7 of the table. The denominator used to calculate column (F) is the total operating expenses in Part IX, less the bad debt amount of $3,963,281 to arrive to the denomination of $61,193,764. PART II COMMUNITY BUILDING ACTIVITIES -Hospital continues to collaborate with local Chamber of Commerce to recruit skilled professionals to fill job openings in the community. Provides support and staff time to assist in highlighting the health care community, providing specific department or hospital tours in order to recruit skilled professions to live and work here in the community. -Hospital sold land to the City to provide space for a twelve-acre urban lake and 20 acres of land for a future fire station on this property. The urban lake is equipped with a nice wooden dock that makes it very accessible for strollers, wheelchairs and other assistive devices to roll down the dock to fish or watch the waterfowl on the lake. Local assisted living and nursing care centers bring their wheel chair vans with residents to the lake as they can drive right up to the accessible dock. This urban lake, waterfowl area provides a community space within the city limits for the whole community, young and old alike. -Hospital continues to partner in several projects and community disease prevention initiatives with our local District Public Health Department and Community Health Center (CHC). The hospital provides financial support and much professional staff time as liaisons to these community partnerships throughout the year working on multiple chronic disease and accident prevention strategies. Some of these community initiatives include type II diabetes, hypertension and heart disease, pre and post natal newborn care, physical activity and exercise, colon cancer prevention and early detection as well as community preparedness to natural and manmade disasters. Several other initiatives are addressed throughout the year as community health issues arise. Thousands of community members are reached with these community initiative campaigns each year and these make a real difference in people's lives that are living with chronic health issues. WE PROVIDE FREE FLU SHOTS TO RESIDENTS OF HARBOR OF HOPE, A HOMELESS SHELTER. -Additionally CCH is in attendance in over a dozen Community Health Fairs/Community events each year, providing medical screenings and information for all community members. -CCH also partners with local day cares, schools and colleges to provide speakers and hands on learning events for students to encourage entry into the medical professions. PART III, LINE 4 Financial statements do not include any text for bad debt. The amount in Line 2 is the book bad debt amount. Charity care is kept separate from bad debt. PART III, LINE 8 In accordance with 42 CFR 413.24, Columbus Community Hospital uses the "Step-down Method" as its costing methodology. Departments within a provider are usually divided into two types: 1) Those that produce patient care revenue (e.g., routine services, radiology), and 2) Those that do not directly generate patient care revenue but are utilized as a service by other departments (e.g., laundry and linen, dietary). The two types of departments are commonly referred to as "revenue-producing cost centers" and "nonrevenue-producing cost centers," respectively. Although nonrevenue-producing cost centers do not directly produce patient care revenue, they contribute indirectly to patient care revenue generated by "serving" as a service to the revenue-producing centers and also to other nonrevenue-producing centers. Therefore, for the purpose of proper matching of revenue and expenses, the cost of the revenue-producing centers should include both its direct expenses and its proportionate share of the costs of each nonrevenue-producing center (indirect costs) based on the amount of services received. The process of allocating the cost of a particular nonrevenue-producing center to other nonrevenue-producing centers and revenue-producing centers is performed by utilizing a set of statistics (e.g., pounds of laundry for allocating "laundry and linen" costs, square feet for allocating "depreciation building" costs). Every nonrevenue-producing cost center has the potential of being allocated to every other nonrevenue-producing cost center in addition to the revenue-producing cost centers. This precludes a simple allocation of the direct expense of the nonrevenue-producing cost center because the indirect costs derived from allocation of other nonrevenue-producing cost centers must be computed in determining the "full cost" (direct and indirect costs) of the nonrevenue-producing cost center being allocated. The "Step-down Method" recognizes that services furnished by certain nonrevenue-producing departments are utilized by certain other nonrevenue-producing centers as well as by the revenue-producing centers. All costs of nonrevenue-producing centers are allocated to all centers that they serve, regardless of whether or not these centers produce revenue. The cost of the nonrevenue-producing center serving the greatest number of other centers, while receiving benefits from the least number of centers, is apportioned first. Following the apportionment of the cost of the nonrevenue-producing center, that center will be considered "closed" and no further costs are apportioned to that center. This applies even though it may have received some service from a center whose cost is apportioned later. Generally, if two centers furnish services to an equal number of centers while receiving benefits from an equal number, that center which has the greatest amount of expense should be allocated first. PART III, LINE 9B CHARITY (FINANCIAL AID) PROGRAM POLICY/PROCEDURE Columbus Community Hospital (CCH) offers a Charity/Financial Aid Program to provide uncompensated services to people who are unable to pay. CCH Charity/Financial Aid Policy reflects the mission, vision and values of CCH. It is intended to assist low-income, underinsured, and uninsured individuals whose financial status, under the hospital's qualification criteria, makes it impractical or impossible to pay for necessary medical services. CCH has a fiduciary responsibility to seek payment for services from those who can pay, and every effort will be made to apply consistent, fair and equitable financial aid practices in a manner consistent with all applicable federal and state laws and regulations. 1. Charity Policy a. Our Charity/Financial Aid Policy does not eliminate the personal responsibility and financial discounts are always secondary to other government-sponsored programs. However, CCH is committed to serve those without the means to pay and work with Good Neighbor Community Health Center and Medicaid services. 2. Health Insurance a. If a patient or guarantor has access to employer-based or government-sponsored health insurance, yet elected not to enroll or failed to maintain eligibility, they may be considered. They will be encouraged to obtain coverage at the next eligible period. b. If patient or guarantor has a Medical Savings Account, this needs to be expended before they are eligible for assistance. c. "Presumptive" financial assistance may be taken into consideration when a patient has expired and there is no estate. An incomplete financial assistance form may be on file because documentation was lacking that would support the provision of financial aid. In this case: i. A family member is contacted to insure no estate exits. ii. Family member may be asked to sign and date a statement to the effect that no estate exits. iii. The county in which the deceased patient resided is contacted to verify that no estate exits. d. CCH's Charity/Financial Aid is not a substitute for employer-sponsored, public or individually-purchased insurance, nor is CCH's financial aid policy a substitute for the responsibility of government and employers to expand access to health care coverage for all persons. 3. Accounts with a Balance a. Charity/Financial Aid may apply to balances due from insured patients for deductibles, co-payments, or co-insurance, or other types of patient payment responsibility. 4. Receiving an application a. CCH is diligent in its efforts to determine, at the earliest point in time, the patient's ability to pay. Information on Charity/Financial Assistance is available in key areas of the hospital on how to apply or obtain further information, as well as hospital website and patient statements. i. Hospital staff members who work closely with patients are educated on how to communicate financial aid availability and how to direct patients to staff responsible for the financial aid application process. ii. Staff members are trained to treat financial aid applicants with courtesy, confidentiality, and cultural sensitivity. iii. These principles and guidelines are for those patients who truly cannot afford health care services. b. Any person requesting financial aid information will be directed to the Patient Accounts or Social Services Departments. An application for the Charity/Financial Aid Program needs to be completed before an eligibility determination can be made. The application is also available in Spanish. Once the application is submitted with written proof of income, a determination will be made in a timely manner. One or more of the following are required as verification of income: i. A letter of rejection from the Department of Social Services (Medicaid) if applicable. ii. Signed copy of previous year's tax return. iii. Copy of most recent pay stub, with accumulative earnings. iv. Copy of recent three months of bank statements with an explanation of all deposits. v. Copy of any compensation received, i.e., unemployment, if applicable. vi. Social Security determination if applicable. c. A family is defined as anyone living together in a household; this will include college students, regardless of their residence, who are supported by their parents. 5. Review Process a. All completed applications are reviewed and approved by the Patient Financial Services Director and overseen by the Vice-President of Finance. b. Any applications that are in need of further assistance are taken to the Vice-President of Finance. c. All write-offs greater than $5,000 are reviewed by Vice President of Finance. d. Monthly the Vice-President of Finance oversees the Charity and Medicare Bad Debt statistical reports. e. If the applicant's income is above Poverty Guidelines, but is still in need of assistance, a sliding scale will be used. This scale is adjusted according to the current year's Poverty Guidelines. If the applicant qualifies for partial Charity/Financial Assistance, acceptable monthly payment arrangements must be agreed upon. f. If the applicant qualifies for partial Charity/Financial Assistance and the total balance after all write-off's is $1,200 or greater, an additional write-off will be done as outlined below. Reduce to $1,200, Adjustments will be done from oldest to newest. g. A letter will be sent to the Guarantor informing them of the determination for charity/financial assistance along with a Monthly Payment Agreement for those who qualified for partial approval or denied applicants. This Agreement needs to be signed and returned to the Patient Accounts Department within 10 days. 6. Documentation of Processed Accounts a. The Patient Financial Services Director will maintain a yearly log of all applicants. Documentation of approved accounts that have been written off or denied will be maintained. 7. Archived Applications a. All charity applications are scanned into HBF under Document Type 'Charity Applications' Part V, Section B, Line 3 Mobilizing for Action through Planning and Partnership (MAPP) process was developed by and is recommended for community assessment by the National Association of City and County Health Officials (NACCHO) and Center for Disease Control (CDC). MAPP was also a recommended community assessment by the Nebraska Rural Health Association in its "Community Health Assessment Collaborative Preliminary recommendations for Nebraska's community, nonprofit hospitals to comply with new requirements for tax exempt status enacted by the Patient Protection and Affordable Care Act" (September of 2011). MAPP was chosen in part because the process allows for input from parties who represent broad interests in the communities. Input from diverse sectors including medically underserved, low-income, minority populations and individuals from diverse age groups was obtained through surveys, targeted focus groups, open public meetings and target invitations to community leaders and agencies. The current MAPP assessment that CCH is involved with is the most thorough assessment to date with the most participation having over 100 individuals participate in the process to date from the district, this does not count the 1,000 individuals surveyed or the participants in focus groups. Part V, Section B, Line 4 -Alegent Health Memorial Hospital, Schuyler -Genoa Community Hospital -Boone County Health Center Part V, Section B, Line 5c THE DETAILED ASSESSMENT AND RELATED COMPONENTS ARE AVAILABLE VIA LINK ON http://www.columbushosp.org/news_events/community_health_needs_assessment_ chna.aspx; AVAILABLE ON REQUEST AND AVAILABLE FOR REVIEW AT Columbus Community Hospital. THE IMPLEMENTATION STRATEGY IS AVAILABLE VIA LINK ON http://www.columbushosp.org/news_events/chip_implementation_plan.aspx. Part V, Section B, Line 7 IDENTIFY THE PRIORITIES FOR AREAS THAT WE ARE NOT DIRECTLY ADDRESSING BUT THAT WE WILL MAINTAIN ACTIVE PARTNERSHIPS WITH AND REMAIN SUPPORTIVE OF THE LEAD ORGANIZATIONS FOCUSED ON THESE PRIORITIES. NEEDS ASSESSMENT In 2010, the Columbus community Hospital's five year strategic plan was implemented. The plan includes a thorough assessment of the organization's external environment in terms of opportunities and threats in order to determine its internal strengths and weaknesses. The plan also includes strategic issues, goals, and related strategies for future organizational effectiveness. Six Organizational Pillars were identified: quality, culture, people, service, facilities, and finance. 1) Quality - Quality efforts have been focused on evidence based processes and educating staff on the importance of use and integration into daily operations. Cch has implemented an electronic medical record to afford ease of information access and communication across the continuum of care. 2) Culture - In AN effort to achieve a high performance organization, cch is in the process of implementing a 4-part culture improvement initiative including teamstepps, just culture, studer, and lean/six sigma process improvement. A 3-year implementation time frame has been established. 3) People - CCH has continued to employ aggressive employee and physician recruitment efforts to attract and retain the workforce needed to support strategic growth initiatives across all service lines. 4) Services - cch performs annual, comprehensive program review of existing and new services and has ranked priority to begin service line development in areas such as hospital medicine, orthopedics, cardiology, cancer, and rehab services. 5) Facilities - CCH has developed a comprehensive master facilities plan that is able to adapt to current and future patient care needs. An emergency department expansion was completed in 2012. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE Here is a sample of what is available on our CCH Web Site with detailed links as well as hard copy information in a special wall unit located inside each patient room as well as outpatient areas in brochures. There is also a tutorial listed for each step of the way letting the patient know what they will need to bring along or have available to show for coping purposes. Monthly Payment Option If you are unable to pay your balance in full, please call Patient Accounts Department to set up an acceptable payment arrangement. Patient Charity/Financial Assistance Program If you feel your income is not sufficient to pay for your services at Columbus Community Hospital, please contact Patient Accounts Department AND/OR SOCIAL WORKERS for information regarding Charity/Financial Assistance. Further information about Medicare/Medicaid / Charity Care is provided in both English and Spanish. The state has their Medicaid applications available online. Our patient accounts and social services staff have financial/charity applications available in both English and Spanish to provide to our patients. Additionally, signage is posted directing patients to call as needed for financial help, and referrals are built into the Medical Admission software, so if patients voice concerns about the cost, or their lack of coverage a referral is generated to Social Services staff who will see patients individually and counsel on specific circumstances. Monthly statements have information on: 1)Payment plans 2)Charity/financial assistance program 3)24/7 online business office, which includes information on payment plans, charity/financial assistance, and downloadable financial/charity applications (available in English and Spanish). COMMUNITY INFORMATION The local economy- OUR HOSPITAL SERVICE AREA REMAINS IN A SMALL POCKET THAT HAS BEEN RELATIVELY PROTECTED FROM THE RECESSION. AS WE CURRENTLY HAVE OVER 300 SKILLED LEVEL POSITIONS AVAILABLE IN SEVERAL MANUFACTURING COMPANIES, INCLUDING PLASTICS, MEDICAL EQUIPMENT, ETHANOL AND THE LOCAL BEEF PACKING PLANT. COLUMBUS COMMUNITY HOSPITAL IS LOCATED IN COLUMBUS, NEBRASKA, WHICH IS THE LARGEST CITY IN PLATTE COUNTY. WITH A GROWING POPULATION OF 32,000, PLATTE COUNTY IS THE LARGEST OF THE SEVEN COUNTY SERVICE AREA. FROM JUNE 30, 2008 TO DECEMBER 31, 2009, UNEMPLOYMENT IN THE CITY OF COLUMBUS INCREASED SLIGHTLY FROM 3.0% OR 566 JOBLESS TO 3.7% OR 693 JOBLESS. DURING THIS SAME PERIOD OF TIME, THE NEBRASKA JOBLESS RATE WAS 4.6% AND THE NATIONAL AVERAGE WAS REPORTED AT 10%. SINCE NOVEMBER, 2008 JOB AVAILABILITY IN COLUMBUS HAS INCREASED BY 23%. THE UNEMPLOYMENT RATE REPORTED FOR COLUMBUS IN MAY, 2010 WAS 4.6%, WHILE THE STATE REPORTED 4.8% AND THE NATIONAL AVERAGE WAS 9.5%. AS REPORTED IN MONEY MAGAZINE, COLUMBUS IS LISTED AS THE THIRD BEST PLACE IN THE U.S. TO FIND EMPLOYMENT AND IN THE "TOP 100 BEST SMALL TOWNS TO LIVE". THREE COUNTIES IN NEBRASKA WERE LISTED IN THE TOP TEN COUNTIES IN THE U.S. TO LIVE AND WORK, INCLUDING PLATTE, MADISON (WHICH IS CONTIGUOUS TO PLATTE COUNTY) AND SARPY COUNTY NEAR LINCOLN, NEBRASKA. OUR LOCAL ECONOMY IS BASED ON AGRICULTURE AND MANUFACTURING, WITH MANY INDUSTRIAL COMPANIES ATTRACTED BY PLENTIFUL, LOW-PRICED HYDROELECTRIC POWER. AMONG THE MAJOR EMPLOYERS ARE ARCHER DANIELS MIDLAND (ADM), AN ETHANOL MANUFACTURING COMPANY; FLEX-CON; CENTRAL CONFINEMENT SERVICE; PILLEN FAMILY FARMS; VISHAY; BD MEDICAL PLANTS, A MEDICAL EQUIPMENT COMPANY; BEHLEN MANUFACTURING, WHICH MANUFACTURES STEEL BUILDINGS; AND NEBRASKA PUBLIC POWER, WITH HEADQUARTERS LOCATED IN COLUMBUS. DUE TO SUCCESSFUL ECONOMIC AND INDUSTRIAL DEVELOPMENT IN OUR AREA, THIS LARGE MANUFACTURING BASE REMAINS INTACT. A HARD-WORKING, WELL-EDUCATED WORKFORCE, LOW ENERGY COSTS AND A LOCAL ENVIRONMENT FRIENDLY TO BUSINESS, PROVIDE ENCOURAGEMENT FOR STRONG ECONOMIC AND INDUSTRIAL DEVELOPMENT WITHIN OUR SERVICE. ACCORDING TO THE NEBRASKA DEPARTMENT OF LABOR, COLUMBUS IS CONSIDERED A MAJOR HUB FOR THE MANUFACTURING INDUSTRY AND HAS A GREATER SHARE OF MANUFACTURING EMPLOYMENT THAN OTHER NEBRASKA METROPOLITAN AREAS. WE CONTINUE TO SEE AN INFLUX OF SINGLE AND YOUNG FAMILIES MOVING INTO OUR AREA SEEKING EMPLOYMENT. OUR COMMUNITY GROWTH CORRELATES TO OUR CONTINUING INCREASE IN HOSPITAL OUTPATIENT VISITS. OUTPATIENT VISITS REACHED 45,403 VISITS FOR THE FISCAL YEAR ENDING APRIL, 2013. THIS REPRESENTS A 0.6% INCREASE IN VISITS OVER THE SAME TWELVE MONTH PERIOD THE PRIOR YEAR. IN 2005, OUR OUTPATIENT VISITS OVER A TWELVE MONTH PERIOD TOTALED 38,129. THIS 19% INCREASE IN OUR OUTPATIENT VISITS OVER THE PAST SIX YEARS IS A REFLECTION OF THE SIGNIFICANT IMPACT THE DEMONSTRATION PROJECT HAS HAD ON OUR HOSPITAL. SERVICE CAPACITY: THE WOUND CENTER OPENED AUGUST OF 2008 WITH THREE PATIENTS. IT HAS GROWN TO 1,141 PATIENTS/VISITS AS OF APRIL 30, 2013. THE IDENTIFIED SERVICE AREA INCLUDES A 45-MILE RADIUS AROUND COLUMBUS. THE WOUND CENTER IS LOCATED IN THE VISITING PHYSICIAN OFFICE SUITE OF THE ATTACHED MEDICAL OFFICE BUILDING. THE CENTER OPERATES TWO DAYS PER WEEK. ADDITIONAL NURSE STAFF TIME IS SPENT EACH WEEK ASSISTING CLIENTS WITH WOUND APPLICATIONS, SCHEDULING APPOINTMENTS AND OTHER RESPONSIBILITIES SUCH AS ORDERING SUPPLIES AND MAINTAINING COMPLIANCE WITH NATIONAL STANDARDS. PREVIOUSLY, PATIENTS SEEKING THIS SPECIALIZED TREATMENT WERE REQUIRED TO TRAVEL ON AVERAGE 75 MILES TO SEE A WOUND CENTER SPECIALIST. THE VOLUME WE ARE SEEING AT THIS WOUND CENTER REINFORCES THE AMOUNT OF COMMUNITY NEED THAT EXIST FOR THIS SERVICE AND HAS GREATLY INCREASED THE LOCAL ACCESS TO SERVICE FOR SO MANY OF OUR HIGHER ACUITY PATIENTS AND THEIR FAMILIES. OUR NURSES ARE WCOM CERTIFIED, SO IN ADDITION TO WOUND CARE OUR PATIENTS WHO HAVE CHALLENGES WITH OSTOMY APPLIANCES AND SKIN CARE ARE TREATED. CCH INSTALLED A NEW CT SCANNER, NEW RADIOLOGIC/FLUSUSCOPY SYSTEM AND NUCLEAR MEDICINE CAMERA. THESE REPLACE EXISTING SYSTEMS WHICH ARE OUTDATED. WE RECENTLY OPENED A WOMEN'S IMAGING AREA WITHIN THE HOSPITAL WHICH IS SEPERATE FROM THE RADIOLOGY DEPARTMENT. A NEW REGISTRATION AREA RECENTLY OPENED WHICH PROVIDES PATIENT PRIVACY. WE REDUCED OUR MAMMOGRAPHY PROCEDURE PRICING 21% ON 2/8/12 AND SOUGHT AND RECEIVED A SUSAN G. KOMEN GRANT, WHICH THE HOSPITAL FOUNDATION MATCHED, TO PROMOTE MAMMOGRAPHY SCREENING FOR WOMEN IN THE COMMUNITY. BONE DENSITY, UPGRADED FROM CONTRACTING WITH A MOBILE SERVICE UNIT TO PURCHASING OUR OWN BONE DENSITY STATIONARY EQUIPMENT AND THE NECESSARY SUPPORT EQUIPMENT AND STAFF WHICH WAS ADDED IN EARLY 2010. THIS IS A GREAT ADDED BENEFIT TO THE COMMUNITY, INCREASING ACCESS FOR OUR PATIENTS AND PROVIDERS WHO NO LONGER HAVE TO AWAIT DIAGNOSIS WITH THE MOBILE UNITS' INTERMITTENT SERVICE. THIS IS ANOTHER NEW PROGRAM THAT INCREASES ACCESS AND ELIMINATES THE NEED TO TRAVEL TO OUT OF TOWN UNITS FOR PROMPT DIAGNOSIS THAT IS MADE POSSIBLE BY THE DEMONSTRATION PROJECT. THE DEMONSTRATION PROJECT HAS ALLOWED US TO PURCHASE ADDITIONAL EQUIPMENT, ELIMINATING THE WAIT FOR DIAGNOSIS DUE TO THE INTERMITTENT SERVICE OF MOBILE UNITS. THIS REDUCES THE NEED TO TRAVEL OUT OF TOWN FOR DIAGNOSIS AND IMPROVES ACCESS TO CARE FOR OUR COMMUNITY. COLUMBUS COMMUNITY HOSPITAL IS A 47 BED, ACUTE CARE HOSPITAL SERVING NEEDS OFFERING A VARIETY OF SURGICAL PROCEDURES AND SHORT TERM HOSPITALIZATIONS. ALL 47 BEDS ARE LICENSED FOR EITHER ACUTE CARE OR SWING BED PATIENTS. IN ADDITION, WE PROVIDE COMPREHENSIVE OUTPATIENT LABORATORY, RADIOLOGY, RESPIRATORY AND REHABILITATIVE SERVICES. WE ALSO PROVIDE FREE INTERPRETER SERVICES 24/7. OUR FACILITY OFFERS COMPREHENSIVE CARE, INCLUDING INTENSIVE CARE, MEDICAL-SURGICAL CARE, INPATIENT AND OUTPATIENT SURGICAL PROCEDURES (GENERAL, ENT, UROLOGY, PODIATRY, ORTHOPEDIC), AS WELL AS OTHER COMPLIMENTARY ANCILLARY SERVICES INCLUDING RESPIRATORY, WOUND CARE, DIABETES EDUCATION, ENDOSCOPIES AND CARDIOPULMONARY REHABILITATION. IN 2006, THE HOSPITAL'S EMERGENCY DEPARTMENT WAS DESIGNATED AS A LEVEL III TRAUMA CENTER WITH NURSES CERTIFIED IN TNCC, ACLS AND PALS. EIGHT OF THE EMERGENCY DEPARTMENT NURSES ARE ALSO CERTIFIED IN ENPC. A 30,000 SQUARE FOOT ADDITION TO THE HOSPITAL, PROVIDED THE EMERGENCY DEPARTMENT WITH EXPANDED SPACE. THE EMERGENCY DEPARTMENT ADDED TWO TRAUMA BAYS, A TWO-BAY AMBULANCE GARAGE, A DEDICATED DECONTAMINATION AREA, A DEDICATED FAMILY GRIEF AND COUNSELING ROOM, COVERED DRIVE-UP ACCESS AND A NEGATIVE AIR-PRESSURE ROOM, WHICH ALLOWS PATIENTS WITH COMMUNICABLE DISEASES TO BE TREATED WHILE PROTECTING OTHER PATIENTS AND STAFF. OUR HOME HEALTH/HOSPICE INTERDISCIPLINARY SERVICES ARE PROVIDED TO PATIENTS WITHIN A 30 MILE RADIUS OF COLUMBUS AND CAN PROVIDE IN HOME TELEHEALTH MONITORING. THE HOSPITAL'S SLEEP LAB PROVIDES POLYSOMNOGRAPHIC SLEEP TESTING. IN ADDITION, WE ARE EXPLORING THE POSSIBILITY OF MAKING AVAILABLE BOTH DAYTIME AND HOME SLEEP TESTS. IN JANUARY 2010, THE HOSPITAL HIRED A FULLTIME RN AS THE ORTHOPEDIC SERVICE LINE COORDINATOR. A MULTI-DISCIPLINARY TEAM WAS ORGANIZED TO REVIEW, STANDARDIZE AND IMPROVE THE PATIENT'S TOTAL JOINT PROCESS FROM DIAGNOSIS TO POST-SURGICAL RECOVERY AND IN NOVEMBER 2010 A NEW ORTHOPEDIC SERVICE LINE WAS IMPLEMENTED. IN MARCH, 2012 THE HOSPITAL ACQUIRED COLUMBUS ORTHOPEDIC AND SPORTS MEDICINE CLINIC, ENABLING THE HOSPITAL TO EXPAND THE SERVICE LINE AND ENSURE THE COMMUNITY'S AGING POPULATION ORTHOPEDIC SERVICES CLOSE TO HOME. THREE CARDIOLOGISTS HAVE RELOCATED TO COLUMBUS, PROVIDING FULL TIME CARDIOLOGY SERVICES TO THE AREA. SINCE 2010, 59 PHYSICIANS IN TOTAL HAVE BEEN RECRUITED TO SERVE THE NEEDS OF OUR PRIMARY AND SECONDARY SERVICE AREAS TO INCLUDE 54 MD'S AND 5 MIDLEVELS; 39 ARE FULL TIME PROVIDERS AND THE OTHER 28 ARE SERVING THE COMMUNITY IN A VISITING CAPACITY. THE HOSPITAL HAS COMPLETED CONSTRUCTION ON THREE ROAD PROJECTS ON AND AROUND THE CAMPUS TO INCREASE ACCESS TO THE FACILITY. TWO CLINIC BUILDINGS, ONE FOR A FAMILY PRACTICE GROUP AND ONE FOR A PHARMACY HAVE BEEN COMPLETED AS WELL. PROMOTION OF COMMUNITY HEALTH -The Hospital reinvests capital to improve patient care, attract the best qualified staff to provide quality care for our patients, provide medical education and prevention activities in the community. -Our Hospital is living our Mission and Vision within the community: *OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE *OUR VISION IS TO COMPASSIONATELY DELIVER THE STATE'S HIGHEST QUALITY PATIENT CARE -CORE VALUES CCH Core Values are: *INTEGRITY *COMPASSION (changed from "Commitment" as part of the communication of this strategic plan) *ACCOUNTABILITY *RESPECT *EXCELLENCE -The Hospital has prioritized our capital reinvestment by aligning it to the Strategic Plan. Our plan consists of SIX Organizational Pillars with goals and strategies associated with each. The SIX Pillars of Excellence consist of: *Quality *Culture *People *Services *Facilities *FINANCE Measurement of ongoing operational performance is organized around these Pillars of Excellence. These pillars were strategically identified as common measures around which operational performance is organized in many health care institutions and adapted for CCH. COLUMBUS COMMUNITY HOSPITAL HAS AN INDEPENDENT BOARD OF DIRECTORS MADE UP OF COMMUNITY LEADERS WITH DIVERSE BACKGROUNDS. COLUMBUS COMMUNITY HOSPITAL HAS AN OPEN EMERGENCY ROOM AVAILABLE TO ALL IN NEED NO MATTER OF RACE, CREED, AGE, OR ABILITY TO PAY. THE HOSPITAL ALSO HAS AN OPEN MEDICAL STAFF. AFFILIATED HEALTH CARE SYSTEM N/A STATE FILING OF COMMUNITY BENEFIT REPORT NONE PART V, LINE 14G INFORMATION BROCHURES ON FINANCIAL/CHARITY ASSISTANCE (F/C) ARE AVAILABLE IN KEY AREAS OF THE HOSPITAL. THE CCH WEBSITE HAS INFORMATION REGARDING F/C ASSISTANCE, AS WELL AS APPLICATIONS IN BOTH SPANISH AND ENGLISH. THE PATIENT STATEMENTS HAS INFORMATION REGARDING F/C ASSISTANCE. THE F/C APPLICATIONS ARE AVAILABLE TO ALL STAFF ON THE H DRIVE UNDER FORMS. THE EMERGENCY REGISTRATION, MAIN REGISTRATION, PATIENT ACCOUNTS AND SOCIAL SERVICES DEPARTMENTS HAVE THE F/C APPLICATIONS IN BOTH ENGLISH AND SPANISH AVAILABLE. true COLUMBUS COMMUNITY HOSPITAL FOUNDATION 4600 38TH STREET COLUMBUS NE 68601 470836747 501(C)(3) 60383 TO SUPPORT EXEMPT American Heart Association Inc 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 5398 To support exempt 2 0 CHARITY CARE TO PATIENTS 693 1403561 BOOK WRITE-OFF OF MED EXP GENERAL INFORMATION ON GRANTS AND ASSISTANCE Schedule I, Part I, Line 2 COLUMBUS COMMUNITY HOSPITAL does not typically give out donations, but occasionally a request is brought forward and the Board determines that it is in the best interest of the community to provide a particular grant. Prior to providing the grant, the Hospital determines that the organization it gives to is a 501(c)(3) organization or a government agency. The Hospital will also make grants to their related organizations as necessary to support their exempt purpose. X true true X X X X X X false false false false false false false false false MARK HOWERTER MD 430238 0 0 0 0 0 10000 0 12523 0 452761 0 0 0 MICHAEL HANSEN 268748 0 0 0 17000 0 10000 0 9661 0 305409 0 0 0 J JOSEPH BARBAGLIA 189440 0 0 0 16996 0 8730 0 12936 0 228102 0 0 0 LINDA WALLINE 161727 0 0 0 16250 0 6651 0 12476 0 197104 0 0 0 JAMES GOULET 156751 0 0 0 18090 0 7399 0 15113 0 197353 0 0 0 ROBERT MILLER MD 232484 0 0 0 0 0 9374 0 10226 0 252084 0 0 0 MICHAEL MCGUIRE MD 417357 0 0 0 0 0 0 0 8983 0 426340 0 0 0 RICHARD CIMPL MD 382843 0 0 0 0 0 0 0 10871 0 393714 0 0 0 EDWARD FEHRINGER MD 327452 0 0 0 12740 0 0 0 8354 0 348546 0 0 0 ALEX KAZOS MD 229409 0 0 0 0 0 5130 0 8926 0 243465 0 0 0 QUESTIONS REGARDING COMPENSATION PART I, LINE 1A THE ORGANIZATION PAID FOR SOCIAL AND HEALTH CLUB DUES AS PART OF THE CEO'S EMPLOYMENT AGREEMENT. These amounts were reflected on the CEO's W-2. GOVERNANCE, MANAGEMENT AND DISCLOSURE FORM 990, PART VI, LINE 15 The Hospital's Executive Compensation Committee, made up of independent Hospital Board members, reviews the CEO's compensation annually. The wage range is compared to information provided by third party consultants, from salary surveys. Decisions are documented. GOVERNANCE, MANAGEMENT AND DISCLOSURE Form 990, Part VI, Line 19 At Columbus Community Hospital, a 3-ring binder exists in the Executive Assistant's office labeled "For Public Disclosure" which includes the most current of the following: -Governing Documents which are the Hospital Bylaws -Conflict of Interest Policy -Audited Financial Statements -Forms 990 and 990-T GOVERNANCE, MANAGEMENT AND DISCLOSURE Form 990, Part VI, Line 12C Columbus Community Hospital does monitor any conflict of interests based on their conflict of interest policy. EMPLOYEES AND VOLUNTEERS are required to fully disclose any conflict of interest that may exist or appears to exist. Hospital reviews any of these conflicts and works with the Compliance Officer and the Vice President or CEO to determine if a conflict exists. If one does exist, the Hospital initiates actions to manage, reduce, or eliminate the conflict. GOVERNANCE, MANAGEMENT AND DISCLOSURE PART VI, LINE 11B The Form 990 will be available for all members of the finance committee to review. Upon committee review, the 990 will then be submitted to the Board for review and the Board will make any corrections if applicable. RECONCILIATION OF NET ASSETS PART XI, LINE 9 CHANGE IN INTEREST IN HEALTHPARK LLC & ZARZ LLC (167,291) COLUMBUS COMMUNITY HOSPITAL FOUNDATION 4600 38TH STREET COLUMBUS NE 68601 470836747 FUNDRAISING NE 501(c)(3) LINE 11, I CCH true HEALTHPARK TITLE CO 4600 38TH STREET COLUMBUS NE 68601 470830945 HOLDING CO. NE 501(c)(3) N/A CCH true ZARZ LLC PO BOX 1800 COLUMBUS NE 68602 273676428 PROPERTY MGMT NE HLTHPK TITLE CO related 0 0 false 0 false 0.50000 HEALTHPARK LLC PO BOX 1800 COLUMBUS NE 68602 470836733 PROPERTY MGMT NE HLTHPK TITLE CO related 0 0 false 0 false 0.29000 false true true false true false false false false true true false true true true false true false false COLUMBUS COMMUNITY HOSPITAL FOUNDATION b 60383 Cash COLUMBUS COMMUNITY HOSPITAL FOUNDATION c 117549 cash COLUMBUS COMMUNITY HOSPITAL FOUNDATION e 10387717 BOOK COLUMBUS COMMUNITY HOSPITAL FOUNDATION m 155955 book HEALTHPARK TITLE COMPANY k 285372 BOOK Part V, Line 2 (3) COLUMBUS COMMUNITY HOSPITAL FOUNDATION IS LISTED AS BACKING THE COLUMBUS COMMUNITY HOSPITAL, INC.'S TAX EXEMPT BOND. THIS IS COVERED WITH THE FOUNDATION'S NON-ENDOWED FUNDS. The bonds were paid off In January, 2013.