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COLUMBUS COMMUNITY HOSPITAL INC: Form 990, tax year 2010

View the entire original 990 at ProPublica ↗

Organization
COLUMBUS COMMUNITY HOSPITAL INC (EIN 47-0542043)
Tax period
2010-05-01 to 2011-04-30
Filed
2011-11-22
IRS object ID
201123269349300307
Schema version
2010v3.4
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-11-22T08:27:02-06:00Timestamp
Tax Period End Date2011-04-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1KPMG LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1Two Central Park Plaza Suite 1501AddressLine1
CityOmahaCity
StateNEState
ZIP Code681021626ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2010-05-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN470542043EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1COLUMBUS COMMUNITY HOSPITAL INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlCOLUNameControl
Phone4025623357Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 1800AddressLine1
CityCOLUMBUSCity
StateNEState
ZIP Code68602ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameJ JOSEPH BARBAGLIAName
TitleCHIEF FINANCIAL OFFICERTitle
Phone4025623357Phone
Date Signed2011-11-14DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone4023481450Phone
FieldValueIRS element (for citing)
Tax Year2010TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonJ Joseph BarbagliaNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line14600 38th StreetAddressLine1
CityColumbusCity
StateNEState
ZIP Code68601ZIPCode
FieldValueIRS element (for citing)
Gross Receipts66427883GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web Sitewww.columbushosp.orgWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1972YearFormation
State Legal DomicileNEStateLegalDomicile
Activity Or Mission DescriptionOUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE.ActivityOrMissionDescription
Nbr Voting Members Governing Body11NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees546TotalNbrEmployees
Total Nbr Volunteers287TotalNbrVolunteers
Total Gross UBI23868TotalGrossUBI
Net Unrelated Business Txbl Income-31951NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year126881ContributionsGrantsPriorYear
Contributions Grants Current Year140646ContributionsGrantsCurrentYear
Program Service Revenue Prior Year62997230ProgramServiceRevenuePriorYear
Program Service Revenue CY64569556ProgramServiceRevenueCY
Investment Income Prior Year1901096InvestmentIncomePriorYear
Investment Income Current Year-185651InvestmentIncomeCurrentYear
Other Revenue Prior Year495730OtherRevenuePriorYear
Other Revenue Current Year738418OtherRevenueCurrentYear
Total Revenue Prior Year65520937TotalRevenuePriorYear
Total Revenue Current Year65262969TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year10958670GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY1297521GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year27775081SalariesEtcPriorYear
Salaries Etc Current Year29018478SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year24951419OtherExpensePriorYear
Other Expenses Current Year26681899OtherExpensesCurrentYear
Total Expenses Prior Year63685170TotalExpensesPriorYear
Total Expenses Current Year56997898TotalExpensesCurrentYear
Revenues Less Expenses Prior Year1835767RevenuesLessExpensesPriorYear
Revenues Less Expenses CY8265071RevenuesLessExpensesCY
Total Assets BOY95225903TotalAssetsBOY
Total Assets EOY88904691TotalAssetsEOY
Total Liabilities BOY31164870TotalLiabilitiesBOY
Total Liabilities EOY16813490TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY64061033NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY72091201NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionOUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense54471927Expense
Grants222593Grants
Revenue65062192Revenue
DescriptionGeneral Hospital and Health Care: Columbus Community Hospital ("CCH") is a 47 bed acute care Hospital which currently employs over 500 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, cartiac rehab). -CCH offers rehabilitative services such as physical therapy, speech therapy, and occupational therapy for adults. 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. -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 11,700 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. -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 feels we are well prepared to handle a natural disaster or pandemic should one arise.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense1074928Expense
Grants1074928Grants
Revenue0Revenue
DescriptionCharity 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. $1,200 - $5,000 Reduce to $1,200 adjustments will be done from oldest to newest $5,001 - $10,000 Reduce to $1,400 >$10,001 Reduce to $1,800Description
FieldValueIRS element (for citing)
Total Program Service Expense55546855TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualstrueGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondstrueTaxExemptBonds
Invest Tax Exempt BondsfalseInvestTaxExemptBonds
Escrow AccountfalseEscrowAccount
On Behalf Of IssuerfalseOnBehalfOfIssuer
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgtrueTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109628NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees546NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members11NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
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Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonMIKE ADAMYNamePerson
Telephone Number4025623382TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line14600 38TH STREETAddressLine1
CityCOLUMBUSCity
StateNEState
ZIP Code68601ZIPCode
FieldValueIRS element (for citing)
Info In Schedule O Part VIIXInfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (21 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationKey EmployeeKeyEmployeeHighest Compensated EmployeeHighestCompensatedEmployee
JAMES PILLEN DVM
VICE CHAIR1.0XX000
RONALD ERNST MD
DIRECTOR1.0X000
JOHN C MCCLURE
DIRECTOR1.0X000
ANNE HALL
CHAIR PERSON1.0XX000
ANTHONY RAIMONDO JR
DIRECTOR1.0X000
REBECCA RAYMAN
DIRECTOR1.0X000
MARK HOWERTER MD
PHYSICIAN40.0X402966016430
JEFFREY GOTSCHALL MD
TREASURER1.0XX000
BONNIE MCPHILLIPS
DIRECTOR1.0X000
BRIAN SCHMIDT
DIRECTOR1.0X000
CLARK LEHR
DIRECTOR1.0X000
J JOSEPH BARBAGLIA
VP FINANCE40.0X160865017777
MICHAEL HANSEN
PRESIDENT/CEO40.0X18788506630
AMY BLASER
VP BUSINESS DEVELOPMENT40.0X101288015890
JAMES GOULET
VP OPERATIONS40.0161005015730X
LINDA WALLINE
VP NURSING40.0151960014933X
PHIL POWERS CRNA
CRNA40.0202534018812X
JOHN SAFRANEK MD
PHYSICIAN40.0175060012175X
ROBERT MILLER MD
PHYSICIAN40.0248270016545X
SARAH LANGAN
CRNA40.0185816011067X
MARK SWOPE
CRNA40.0186998018448X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2164647TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation164437TotalOtherCompensation
Number Individuals GT100 K22NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
INPATIENT PHYSICIAN ASSOC
3200 PINE LAKE RD STE ALINCOLNNE68516HOSPITALIST SVCS871849
MICHAEL MCGUIRE MD
604 N 38 STOMAHANE68131ORTHOPEDIC SURGERY153075
KPMG LLP
PO BOX 120001DALLASTX75312AUDITORS149734
BRYANLGH MEDICAL CENTER
PO BOX 82557LINCOLNNE68501STUDIES149734
STINSON MORRISON HECKER
PO BOX 419251KANSAS CITYMO64141ATTORNEYS117833
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Related Organizations140646RelatedOrganizations
Total Contributions140646TotalContributions

Program Service Revenue ProgramServiceRevenue

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DescriptionNET PATIENT SVC REVENUEDescription
Business Code621110BusinessCode
Total Revenue Column64569556TotalRevenueColumn
Related Or Exempt Function Income64569556RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue64569556TotalProgramServiceRevenue

Investment Income InvestmentIncome

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Total Revenue Column979263TotalRevenueColumn
Exclusion$979,263ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

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Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

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Total Revenue Column0TotalRevenueColumn

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

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Other1164914Other

Gain Or Loss GainOrLoss

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Other-1164914Other

Net Gain Or Loss Investments NetGainOrLossInvestments

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Total Revenue Column-1164914TotalRevenueColumn
Exclusion-$1,164,914ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

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Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

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Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

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Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (2 entries)

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OTHER REVENUE90009951650449263623868
CAFETERIA722100221914$221,914
FieldValueIRS element (for citing)
Total Other Revenue738418TotalOtherRevenue

Total Revenue TotalRevenue

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Total Revenue Column65262969TotalRevenueColumn
Related Or Exempt Function Income65062192RelatedOrExemptFunctionIncome
Unrelated Business Revenue23868UnrelatedBusinessRevenue
Exclusion$36,263ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

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Total222593Total
Program Services222593ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

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Total1074928Total
Program Services1074928ProgramServices

Foreign Grants ForeignGrants

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Total0Total

Benefits To Members BenefitsToMembers

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Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total643683Total
Management And General643683ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

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Total23018708Total
Program Services23018708ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total687532Total
Program Services687532ProgramServices

Other Employee Benefits OtherEmployeeBenefits

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Total3011401Total
Program Services3011401ProgramServices

Payroll Taxes PayrollTaxes

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Total1657154Total
Program Services1657154ProgramServices

Fees For Services Management FeesForServicesManagement

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Total0Total

Fees For Services Legal FeesForServicesLegal

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Total103557Total
Management And General103557ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

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Management And General169420ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

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Total5126Total
Management And General5126ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

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Total0Total

Fees For Services Other FeesForServicesOther

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Total2693387Total
Program Services2693387ProgramServices

Advertising Advertising

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Total141963Total
Management And General141963ManagementAndGeneral

Office Expenses OfficeExpenses

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Total7297154Total
Program Services7119454ProgramServices
Management And General177700ManagementAndGeneral

Information Technology InformationTechnology

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Total1001904Total
Program Services1001904ProgramServices

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total877710Total
Program Services877710ProgramServices

Travel Travel

FieldValueIRS element (for citing)
Total104771Total
Management And General104771ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total104823Total
Management And General104823ManagementAndGeneral

Interest Interest

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Total864707Total
Program Services864707ProgramServices

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total4457989Total
Program Services4457989ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total247837Total
Program Services247837ProgramServices

Other Expenses OtherExpenses (5 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServices
PROVISION FOR BAD DEBTS34712343471234
MINOR EQUIP. & FINANCING AGRMT19681601968160
MISC EXPENSES20539702053970
DEFERRED FINANCING COSTS10928851092885
BLDGS AND CLINICS2530225302

Total Functional Expenses TotalFunctionalExpenses

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Program Services55546855ProgramServices
Management And General1451043ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

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BOY2153622BOY
EOY1621171EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

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BOY3692157BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY7672436BOY
EOY9468918EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY210007BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

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BOY799428BOY
EOY1271025EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

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BOY1075539BOY
EOY802965EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis71361848LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec40456337LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY27429889BOY
EOY30905511EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

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BOY51156258BOY
EOY44723764EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY1036567BOY
EOY111337EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY95225903BOY
EOY88904691EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

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BOY5049890BOY
EOY3987593EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY26114980BOY
EOY12825897EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY31164870BOY
EOY16813490EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

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BOY64061033BOY
EOY72091201EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

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BOY64061033BOY
EOY72091201EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

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BOY95225903BOY
EOY88904691EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses8265071ReconcilationRevenueExpenses
Reconcilation Other Changes-234903ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiestrueOtherActivities
Other Activities$5,126OtherActivitiesAmount
Total Lobbying Expenditures IIB5126TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierOTHER ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1IReturnReference
ExplanationDUES PAID TO AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $3,160 DUES PAID TO NEBRASKA HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $1,966Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance1506660BeginningOfYearBalance
Contributions66403Contributions
End Of Year Balance1573063EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance1426826BeginningOfYearBalance
Contributions79844Contributions
Investment Earnings Or Losses-10InvestmentEarningsOrLosses
End Of Year Balance1506660EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1299402BeginningOfYearBalance
Contributions127424Contributions
End Of Year Balance1426826EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis581842OtherCostOrOtherBasis
Book Value581842BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis30401081OtherCostOrOtherBasis
Depreciation14743330Depreciation
Book Value15657751BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis33453212OtherCostOrOtherBasis
Depreciation24415962Depreciation
Book Value9037250BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis6925713OtherCostOrOtherBasis
Depreciation1297045Depreciation
Book Value5628668BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings30905511TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
FIN 48 FOOTNOTESCHEDULE D, PART XThe 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.
SCHEDULE DPART V, LINE 4ENDOWMENT FUNDS ARE HELD AND MAINTAINED BY COLUMBUS COMMUNITY HOSPITAL FOUNDATION. THE ENDOWMENT FUNDS EXIST IN SUPPORT OF IMPROVED HEALTH SERVICES BY COLUMBUS COMMUNITY HOSPITAL.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
Policy Applied To All HospitalsXPolicyAppliedToAllHospitals
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent100XPcent100
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent200 DXPcent200D
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Persons Served774PersonsServed
Total Community Benefit Expense617520TotalCommunityBenefitExpense
Net Community Benefit Expense617520NetCommunityBenefitExpense
Percent Of Total Expense0.01150PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Persons Served0PersonsServed
Total Community Benefit Expense3986733TotalCommunityBenefitExpense
Direct Offsetting Revenue2216541DirectOffsettingRevenue
Net Community Benefit Expense1770192NetCommunityBenefitExpense
Percent Of Total Expense0.03310PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Persons Served774PersonsServed
Total Community Benefit Expense4604253TotalCommunityBenefitExpense
Direct Offsetting Revenue2216541DirectOffsettingRevenue
Net Community Benefit Expense2387712NetCommunityBenefitExpense
Percent Of Total Expense0.04460PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs19NumberOfActivitiesOrPrograms
Persons Served3496PersonsServed
Total Community Benefit Expense388064TotalCommunityBenefitExpense
Direct Offsetting Revenue325DirectOffsettingRevenue
Net Community Benefit Expense387739NetCommunityBenefitExpense
Percent Of Total Expense0.00720PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served488PersonsServed
Total Community Benefit Expense44632TotalCommunityBenefitExpense
Direct Offsetting Revenue0DirectOffsettingRevenue
Net Community Benefit Expense44632NetCommunityBenefitExpense
Percent Of Total Expense0.00080PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served267PersonsServed
Total Community Benefit Expense17486TotalCommunityBenefitExpense
Net Community Benefit Expense17486NetCommunityBenefitExpense
Percent Of Total Expense0.00030PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs25NumberOfActivitiesOrPrograms
Persons Served4251PersonsServed
Total Community Benefit Expense450182TotalCommunityBenefitExpense
Direct Offsetting Revenue325DirectOffsettingRevenue
Net Community Benefit Expense449857NetCommunityBenefitExpense
Percent Of Total Expense0.00830PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs25NumberOfActivitiesOrPrograms
Persons Served5025PersonsServed
Total Community Benefit Expense5054435TotalCommunityBenefitExpense
Direct Offsetting Revenue2216866DirectOffsettingRevenue
Net Community Benefit Expense2837569NetCommunityBenefitExpense
Percent Of Total Expense0.05290PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense2500TotalCommunityBuildingExpense
Net Community Building Expense2500NetCommunityBuildingExpense

Economic Development EconomicDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense1500TotalCommunityBuildingExpense
Net Community Building Expense1500NetCommunityBuildingExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense6552TotalCommunityBuildingExpense
Net Community Building Expense6552NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Total Community Building Expense185000TotalCommunityBuildingExpense
Net Community Building Expense185000NetCommunityBuildingExpense
Percent Of Total Expense0.00350PercentOfTotalExpense

Leadership Development LeadershipDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served51PersonsServed
Total Community Building Expense235TotalCommunityBuildingExpense
Net Community Building Expense235NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served865PersonsServed
Total Community Building Expense3692TotalCommunityBuildingExpense
Net Community Building Expense3692NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served548PersonsServed
Total Community Building Expense3601TotalCommunityBuildingExpense
Net Community Building Expense3601NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served1464PersonsServed
Total Community Building Expense203080TotalCommunityBuildingExpense
Net Community Building Expense203080NetCommunityBuildingExpense
Percent Of Total Expense0.00380PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$2,002,902BadDebtExpenseAmount
Amount Attributable To0AmountAttributableTo
Amount Reimbursed By Medicare17858064AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare19115030CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-1256966MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
OtherXOther
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV (2 entries)

Description Ent Primary ActivityDescriptionEntPrimaryActivityOrganization Profit Or OwnershipOrganizationProfitOrOwnershipOfficers Etc Profit Or OwnershipOfficersEtcProfitOrOwnershipPhysicans Profit Or OwnershipPhysicansProfitOrOwnership
HEALTHPARK LLC
PROPERTY MANAGEMENT0.000000.000000.71000
ZARZ LLC
PROPERTY MANAGEMENT0.000000.000000.50000
FieldValueIRS element (for citing)
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Columbus Community Hospital IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line14600-38th StreetAddressLine1
CityColumbusCity
StateNEState
ZIP Code686011800ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours
Other47 BED ACUTE CARE HOSPITAL W/ 24 HOUR ER SERVICESOther

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Columbus Community Hospital IncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities8NumberOfOtherFacilities

Other Facilities OtherFacilities (8 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
PREMIER PHYSICAL THERAPY OF CCH
US 30 CTR BLDG 3100-23RD st ste 15COLUMBUSNE686013161PHYSICIAL & AQUATIC THERAPY, SPORTS TRAINING SERVICES
WIGGLES & GIGGLES THERAPY FOR KIDS
2108-13TH STREETCOLUMBUSNE686015100PEDIATRIC THERAPY SERVICES
OCCUPATIONAL HEALTH SERVICES OF CCH
3005-18TH ST SUITE 300COLUMBUSNE686014252EMP. HEALTH CARE SVCS TO PREVENT & TREAT WORK INJURIES
WOUND HEALING CENTER
4600-38TH STREET SUITE 165COLUMBUSNE68601WOUND TREATMENT CENTER
HUMPHREY CLINIC OF CCH
3003 MAIN STREETHUMPHREYNE686423155CLINIC IN SMALL TOWN TO OFFER MEDICAL SVCS TO RESIDENTS
HOSPICE OF COLUMBUS COMMUNITY HOSPITAL
3005-19TH STREET SUITE 600COLUMBUSNE686014248HOSPICE SERVICES
COLUMBUS COMMUNITY HOSPITAL SLEEP LAB
3020-18TH STREET SUITE 14COLUMBUSNE686014254POLYSOMNOGRAPHIC SLEEP TESTING
HOME HEALTH OF COLUMBUS COMMUNITY HOSP
3005-19TH STREET SUITE 600COLUMBUSNE686014248HOME HEALTH SERVICES

Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
PART I, LINE 3CN/A
PART I, LINE 6AThe Hospital prepares its own community benefit report. This report is printed in the local newspaper and is also listed on the Hospital's website for anyone to see.
PART I, LINE 7The Hospital used the series of worksheets offered in the instructions for Schedule H in determining the charity care and other community benefits cost. The ratio of patient care cost to charges on worksheet 2, Ratio of Patient Care Cost-to-Charges, was used to calculate the amounts on the table on line 7. $3,471,234 of Bad Debt included in functional expense Total Part IX, line 25, $56,997,898, is not included in the Total Operating Expenses used to calculate the Table 7 percentages.
PART II-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 continues to collaborate with 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. -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.COMMUNITY BUILDING ACTIVITIES
PART III, LINE 4Financial statements do not include any text for bad debt. The amount in Line 2 was based on the bad debt charges multiplied by the ratio of patient care cost to charge from worksheet 2, Line 11. Charity care is kept separate from bad debt.
PART III, LINE 8In 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 9BCHARITY (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 on a one-time basis. However, they will be expected to obtain coverage at the next eligible period or they may be excluded from financial assistance provided by CCH. 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. 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. $1,200 - $5,000 Reduce to $1,200 $5,001 - $10,000 Reduce to $1,400 >$10,001 Reduce to $1,800 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'
NEEDS ASSESSMENTIn 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 have been adopted to include: 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 is in the process of implementing an electronic medical record to afford ease of information access and communication across the continuum of care. 2) Culture - In 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 has performed 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 is slated for completion in early 2012.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCEHere 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, along with State Medicaid applications and CCH Charity Care applications that our Patient accounts & Social Work Staff have available in both languages to hand to patients as needed. 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 Work 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 charity applications (available in English and Spanish)
COMMUNITY INFORMATIONThe local economy- Currently our hospital service area remains in a small pocket that has been somewhat protected from the recession, as we continue to have over 300 skilled level positions open in wind generating manufacturing companies, plastics, medical equipment companies, ethanol plants and local beef packing. Our hospital is located in Platte County, the largest of the seven county service area, with a growing population of over 32,000 people. Columbus is the largest city in Platte County, Nebraska, 90 miles west by north of Omaha on the Loup River. The unemployment in the City of Columbus increased from a very low 3.0% (566 jobless) in June 30, 2008 to 3.7% (693 jobless) on December 31, 2008, surprisingly, unemployment only increased to 3.9% by December 31, 2009. This was at a time when Nebraska's state unemployment average was 4.6% with the national average still very high at 10%. Currently, as of May 2010 Columbus has an unemployment rate of 4.6%, compared to 4.8% statewide in Nebraska and 9.5% national average. Since November 2008, available jobs in Columbus NE have increased by 23%. Our area unemployment remains significantly lower than other State and National averages. In fact, Columbus is the third best place to find employment in the U.S. and in the "Top 100 Best Small Town to Live" according to Money Magazine. Of the top ten Counties in the U.S. to live and work, three of them were in Nebraska: Platte, Madison, (which is contiguous to our County of Platte) and Sarpy County near Lincoln Nebraska. Our local area features an economy based on agriculture and manufacturing, with many industrial companies attracted by cheap, plentiful hydroelectric power. Among the major employers are Archer Daniels Midland, (ADM) which runs a corn milling ethanol plant; Flex-Con; Central Confinement Service; Vishay; Becton Dickinson, a medical equipment company; Behlen Manufacturing, a maker of steel buildings; and the Nebraska Public Power District, which is headquartered in Columbus. This large manufacturing base still remains intact, due to successful economic and industrial development in our area. The perfect blend of a hardworking and well-educated work force, low energy costs and a local environment friendly to business has led to strong economic and industrial development within our service area. According to the Nebraska Department of Labor, the Columbus economy has a greater share of manufacturing employment than other Nebraska metropolitan areas, and Columbus is considered a major hub for the manufacturing industry. We continue to see an influx of young families and singles moving into our area to seek the open skilled positions. This community growth correlates with our continued increase in hospital outpatient visits which hit an all time high of 48,509 YTD visits for the last fiscal year ending April 2010. This represents a 2% increase in visits over the same twelve month period compared to the prior year. More significant is the increase in outpatient visits over the past five years since the demonstration project began. In 2005, our outpatient visits for the year totaled 38,129, representing a 27 % increase in the past five years. Service capacity: Our new Wound Clinic which was opened August of 2008 with three patients has grown to 296 patients as of July 31, 2010. The identified service area includes a 45-mile radius around Columbus. The wound clinic moved to there new permanent home in the visiting physician office suite of the attached Medical Office Building. By Dec. 2009 the clinic was operating two days per week and had added a Nurse Practitioner to support greater demand. Additional nurse staff time is spent each week assisting clients with wound appliance applications. Previously, patients seeking this specialized treatment were required to travel on average 75 miles to see a wound clinic specialist. The volume we are seeing at this Wound Clinic 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. 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. Orthopedic Service Line, hired a new F/T RN as the Orthopedic Services Coordinator in Jan. 2010. Since early this year have launched a multi disciplinary team to review, standardize and improve the patient's total joint process from diagnosis to post surgical recovery. Expect complete new Orthopedic Services Line rollout by November 2010. This process is challenged with probable decrease in volume due to relocation of one of two existing Orthopedic Surgeons from local practice office in August 2010. Aggressively recruiting two new Orthopedic Surgeons for replacement and expanded Ortho Service Line. In the interim, planning to contract with Locum Tenens Physicians to assist with local orthopedic practice coverage as well as handle surgical cases. Cardiologist - Two new Cardiologists have recently relocated to Columbus to live and work full time. This replaces the only F/T Cardiologist who lived and worked in the community for the past eleven years and relocated in 2009. Multiple Cardiologist groups from Omaha and Lincoln have worked to begin providing full time coverage in the Columbus area, following this opening. Outpatient Allergy Clinic - that has provided an intermittent service at a local Specialist office in our MOB, has stopped coming as of July 2010. In their office space an Oral Surgeon who is double boarded in oral surgery and plastics will begin providing outpatient clinic and surgical procedures beginning in August 2010. The hospital has completed three road projects on and around the campus which increases access to the facility. Two clinic buildings (one for a family practice group and one for a pharmacy) are almost completed. The hospital itself has a major addition in process. The emergency department will more than double its size and a women's imaging center will be separated from the normal radiology functions. Expansion of respiratory care and revision of the admissions area for more hippa compliance will also take place. The entire expansion will be completed in 2012.
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 SYSTEMN/A
STATE FILING OF COMMUNITY BENEFIT REPORTNONE

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEIN Of RecipientEINOfRecipientIRC SectionIRCSectionAmount Of Cash GrantAmountOfCashGrantPurpose Of GrantPurposeOfGrantAmount Of Non Cash AssistanceAmountOfNonCashAssistanceMethod Of ValuationMethodOfValuationDescription Of Non Cash AssistanceDescriptionOfNonCashAssistance
COLUMBUS COMMUNITY HOSPITAL FOUNDATION INC
4600 38TH STREETCOLUMBUSNE68601470836747501(C)(3)30000TO SUPPORT EXEMPT
CITY OF COLUMBUS NEBRASKA
2424 14 STREETCOLUMBUSNE68602GOVTROAD MAINTENANCE192593BOOKROAD
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants2TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations0TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

FieldValueIRS element (for citing)
Type Of GrantCHARITY CARE TO PATIENTSTypeOfGrant
Number Of Recipients774NumberOfRecipients
Amount Of Non Cash Assistance1074928AmountOfNonCashAssistance
Method Of ValuationBOOKMethodOfValuation
Description Of Non Cash AssistanceWRITE-OFF OF MED EXPDescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierGENERAL INFORMATION ON GRANTS AND ASSISTANCEIdentifier
Return ReferenceSchedule I, Part I, Line 2ReturnReference
ExplanationCOLUMBUS 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.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesXClubDuesOrFees
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Independent ConsultantXIndependentConsultant
Form990 Of Other OrganizationsXForm990OfOtherOrganizations
Written Employment ContractXWrittenEmploymentContract
Compensation SurveyXCompensationSurvey
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (10 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
J JOSEPH BARBAGLIA
14436500016500065970138390181301000
JAMES GOULET
1522050008800065000118890179394000
LINDA WALLINE
13546000016500059110112020169073000
PHIL POWERS CRNA
2004640002070082820151050225921000
MARK HOWERTER MD
4029660000098000117750424541000
JOHN SAFRANEK MD
1680580007002055350105480191143000
ROBERT MILLER MD
2482700000096550116820269607000
MICHAEL HANSEN
187885000000096970197582000
SARAH LANGAN
185816000007427064730199716000
MARK SWOPE
1792980007700068180154040209220000

Form990 Schedule J Part III Form990ScheduleJPartIII

FieldValueIRS element (for citing)
IdentifierQUESTIONS REGARDING COMPENSATIONIdentifier
Return ReferencePART I, LINE 1AReturnReference
ExplanationTHE 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.Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI

Issuer Name IssuerName

FieldValueIRS element (for citing)
Business Name Line1HOSPITAL AUTHO NO 1 OF PLATTE COUNTY NEBusinessNameLine1
FieldValueIRS element (for citing)
Issuer EIN470830844IssuerEIN
CUSIP Number000000000CUSIPNumber
Date Issued2010-05-04DateIssued
Issue Price23000000IssuePrice
Description Of PurposeREFUND PRIOR BONDS 4/27/00DescriptionOfPurpose
DefeasedfalseDefeased
On Behalf Of IssuerfalseOnBehalfOfIssuer
Pool FinancingfalsePoolFinancing

Form990 Schedule K Part II Form990ScheduleKPartII

FieldValueIRS element (for citing)
Amount Retired10165620AmountRetired
Total Proceeds23000000TotalProceeds
Other Spent Proceeds23000000OtherSpentProceeds
Year Of Subst Completion2002YearOfSubstCompletion
Current RefundingtrueCurrentRefunding
Advance RefundingfalseAdvanceRefunding
Final Allocation MadetrueFinalAllocationMade
Adequate Books And Recds MaintaindtrueAdequateBooksAndRecdsMaintaind

Form990 Schedule K Part III Form990ScheduleKPartIII

FieldValueIRS element (for citing)
Owning Bond Financed PropertyfalseOwningBondFinancedProperty
Any Lease ArrangementsfalseAnyLeaseArrangements
Mngment Cntrct Bond Financd PrprtytrueMngmentCntrctBondFinancdPrprty
Any Research AgreementsfalseAnyResearchAgreements
Bond Counsel Routinely EngagedtrueBondCounselRoutinelyEngaged
Prcntge Prvt Business Use By Others0.00000PrcntgePrvtBusinessUseByOthers
Percentage Of Prvt Business Re UBI0.00000PercentageOfPrvtBusinessReUBI
Total Private Business Use0.00000TotalPrivateBusinessUse
Post Issuance Compliance ProcdrstruePostIssuanceComplianceProcdrs

Form990 Schedule K Part IV Form990ScheduleKPartIV

FieldValueIRS element (for citing)
Form8038 T FiledfalseForm8038TFiled
Variable Rate IssuefalseVariableRateIssue
Hedge Identified In Books And RecdsfalseHedgeIdentifiedInBooksAndRecds
Gross Proceeds Invested In GICfalseGrossProceedsInvestedInGIC
Gross Proceeds InvestedfalseGrossProceedsInvested
Exception To RebatetrueExceptionToRebate

Form990 Schedule K Part V Form990ScheduleKPartV (3 entries)

IdentifierIdentifierExplanationExplanation
SCHEDULE K, PART III, LINE 3AColumbus Community Hospital has the following contracts, all of which have been reviewed by our attorneys and are 97-13 compliant: 1. Hospitalists services agreement for Hospital contracted with IPA Columbus, 2. Food service management agreement contracted with Aramark Healthcare Support Services, LLC, 3. Trauma surgery call for emergency agreement, required with Level III trauma status, with Ron Ernst, M.D., 4. Orthopedic emergency room call for patients requiring that specialty service with Michael McGuire, M.D., 5. Wound Care Healing Center Medical Director and Provider with Ron Ernst, M.D., 6. Professional services and medical director for Humphrey Clinic with Columbus Family Practice, PC, 7. Home Health/Hospice Associate Medical Director agreement with Drs. Ed Disco, M.D. and Dale Zaruba, M.D.
Schedule K, Part III, Line 5All unrelated business income is generated from property not financed by bonds reported on Schedule K.
Schedule K, Part III, Line 7Policies are in place, but are presently unwritten. Columbus Community Hospital is currently in the process of putting current policy in writing.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (6 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
GOVERNANCE, MANAGEMENT AND DISCLOSUREFORM 990, PART VI, LINE 15The 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 DISCLOSUREForm 990, Part VI, Line 19At 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 DISCLOSUREForm 990, Part VI, Line 12CColumbus 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.
COMPENSATION OF OFFICERSFORM 990,PART VIIMichael Hansen (President/CEO) DEVOTED ON AVERAGE 2 HOURS PER WEEK TO THE COLUMBUS COMMUNITY HOSPITAL FOUNDATION (RELATED ORGANIZATION) IN ADDITION TO HIS TIME SPENT AS CEO/PRESIDENT OF COLUMBUS COMMUNITY HOSPITAL. MR. HANSEN WAS PAID BY THE HOSPITAL FOR HIS SERVICES.
GOVERNANCE, MANAGEMENT AND DISCLOSUREPART VI, LINE 11AThe 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. If changes are made, a final copy of the 990 will be emailed to the Board members (via secure email) prior to filing with the IRS.
RECONCILIATION OF NET ASSETSPART XI, LINE 5CHANGE IN INVESTMENT IN HEALTHPARK TITLE CO. (234,903)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
4600 38TH STREETCOLUMBUSNE68601470836747FUNDRAISINGNE501(c)(3)LINE 11, ICCH
HEALTHPARK TITLE CO
4600 38TH STREETCOLUMBUSNE68601470830945HOLDING CO.NE501(c)(2)N/ACCH

Form990 Schedule R Part III Form990ScheduleRPartIII (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeTypeShare Of Total IncomeShareOfTotalIncomeShare Of EOY AssetsShareOfEOYAssetsDisproportionate AllocationsDisproportionateAllocationsCode VCodeVAmountGeneral Or Managing PartnerGeneralOrManagingPartnerPercentage OwnershipPercentageOwnership
ZARZ LLC
PO BOX 1800COLUMBUSNE68602273676428PROPERTY MGMTNEHLTHPK TITLE CORELATED00false$0false0.00000
HEALTHPARK LLC
PO BOX 1800COLUMBUSNE68602470836733PROPERTY MGMTNEHLTHPK TITLE CORELATED00false$0false0.00000
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgtrueLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgtrueSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgstruePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgtrueReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (4 entries)

Transaction TypeTransactionTypeAmount InvolvedAmountInvolved
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
C140646
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
L191960
COLUMBUS COMMUNITY HOSPITAL FOUNDATION
E12825897
HEALTHPARK TITLE COMPANY
B400000

Form990 Schedule R Part VII Form990ScheduleRPartVII

FieldValueIRS element (for citing)
IdentifierPART V, LINE 2Identifier
ExplanationCOLUMBUS 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.Explanation