2022-11-07T11:44:59-06:00 2021-12-31 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2021-01-01 481178846 Coffeyville Regional Medical Center Inc COFF 6202511200 1400 W 4th Street Coffeyville KS 67337 BRIAN LAWRENCE CEO 6202511200 2022-11-01 1 BRIAN LAWRENCE 999009999 Eric L Otting P00298454 7852334226 2022-11-01 3 AAL1 IAL1 2021 2022-09-23 18:48:47Z Brian Lawrence 1400 W 4th Street Coffeyville KS 67337 56839630 0 X http://crmcinc.org/ X 1996 KS Medical care and services by an acute care hospital. 7 6 456 62 0 0 8336538 10718546 42288064 44488393 109780 120482 159823 1512209 50894205 56839630 5591 6649 0 0 25937277 27880718 0 0 140013 22660004 24692920 48602872 52580287 2291333 4259343 38132182 34899870 16298761 8459469 21833421 26440401 To promote general health and well being through the development, promotion, improvement, and support of all forms of health care services in Coffeyville, Kansas and the surrounding area. 0 0 47954251 6649 44488393 Coffeyville Regional Medical Center operates an acute care hospital located in southeast Kansas. We provide inpatient, outpatient, urgent and emergent care, and physician services to all patients regardless of race, creed, sex, national origin, sexual preference, or ability to pay. 47954251 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 70 0 1 456 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 1 1 0 0 X Dale Guffey 6202511200 1400 W 4th Coffeyville KS 67337 Neal Barkley Director 2.00 X X 0 0 0 Monte Coffman Chairman 2.00 X X 0 0 0 Debbie Carter Secretary/Treasurer 2.00 X X 0 0 0 Mike Ewy Vice-Chairman 2.00 X 0 0 0 Craig Correll Director 2.00 X 0 0 0 Jeff Morris Director 2.00 X 0 0 0 Dr Garrick Rettele Director 2.00 X 0 0 0 Brian Lawrence CEO 40.00 X 328544 0 58194 Dale Guffey CFO 40.00 X 158056 0 31784 Michelle McGuirk Physician 40.00 X 422061 0 35334 Aaron Russell Physician 40.00 X 440407 0 60944 Shravan Gangula Physician 40.00 X 369324 0 58194 Baba Abudu Anesthesiologist 40.00 X 381314 0 44616 Perry Yung Ping Lin Physician 40.00 X 402802 0 57807 2502508 0 346873 29 0 1 0 Green Country Emergency Physician 1145 S Utica 365 Tulsa OK 74104 ER Coverage 965427 Regional Medical Laboratory 4142 South Mingo Road Tulsa OK 74146 Lab services 668999 Spinal Neurosurgical Associates 6921 E 109th St S Tulsa OK 74133 Physician services 526421 Nathan W Uy MD 7624 South Kingston Place Tulsa OK 74136 Physician services 302961 Varian Medical Systems Inc 3100 Hansen Way Palo Alto CA 94304 Treatment planning 272096 16 115740 10602806 10718546 Net patient service revenue 621110 43186979 43186979 340b Pharmacy 446110 927883 927883 Ambulance services 621910 224375 224375 Education, wellness, and miscella 900099 140523 140523 Other patient related services 621110 8633 8633 44488393 120482 120482 35712 0 35712 35712 35712 Insurance proceeds from asset los 900099 1348240 1348240 Cafeteria and dietary income 722310 128257 128257 1476497 56839630 44488393 0 1632691 X 6649 6649 652673 652673 21212433 20083921 1032069 96443 1799277 1705230 85935 8112 2789970 2616202 161420 12348 1426365 1319245 100844 6276 3000 3000 38725 38725 60728 60728 9147507 7874438 1267749 5320 114292 114292 158731 78160 77747 2824 133172 115687 16846 639 719703 579464 139038 1201 66309 61144 5157 8 10512 10382 130 88939 88939 3040257 2652304 383901 4052 443591 385348 56114 2129 Pharmacy drugs 5318282 5318282 Medical supplies 4196457 4196457 Medicaid provider asses 254808 254808 Dietary food 211910 202078 9832 685997 405513 279823 661 52580287 47954251 4486023 140013 2178095 3883727 9984806 6057162 5610610 4848419 1667097 1424827 270559 744280 59677429 44464540 15588166 15212889 2832849 2728566 38132182 34899870 5465175 5376141 9205451 1904882 1598135 985083 30000 193363 16298761 8459469 X 19497323 23756666 2336098 2683735 21833421 26440401 38132182 34899870 X 4259343 347637 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 2926 0 0 0 2926 0 Part II-B, Line 1: Coffeyville Regional Medical Center, Inc. is a member of the Kansas Hospital Association and American Hospital Association. These organizations engage in lobbying activities for hospital and general health care interests as part of the services provided to members. 400668 62314 62314 400668 370668 30000 17809 17809 400668 370668 22011 22011 370668 370668 28901 28901 370668 370668 33894 33894 370668 1.00000 0 1 1 76477 76477 24483122 17501823 6981299 23433041 16772079 6660962 11684789 10190638 1494151 15212889 Other receivables 209596 Beneficial interest in net assets of foundation 2295158 Sales tax receivable 212903 Estimated third-party payor settlements 10909 2728566 Liability for receivables sold with recourse 15000 Estimated third-party payor settlements 178363 193363 X 57187267 347637 347637 56839630 0 56839630 52580287 0 52580287 0 52580287 Part V, Line 4: The Coffeyville Regional Medical Center Foundation's endowment consists of a fund established for dietary scholarships. Part X, Line 2: The Medical Center is a not-for-profit corporation as described in Section 501(c)(3) of the Internal Revenue Code and is exempt from federal income taxes on related income pursuant to Section 501(a) of the Code. Part XI, Line 2d - Other Adjustments: Increase in beneficial interests in net assets of Foundation 347,637. 1 1 1 X 250.000000000000 1 X 1 1 0 1 0 1007725 120145 887580 0.01690 8128696 3632678 4496018 0.08550 9136421 3752823 5383598 0.10240 10574258 5662087 4912171 0.09340 10574258 5662087 4912171 0.09340 19710679 9414910 10295769 0.19580 1 1212992 155568 12339825 13012997 -673172 X 1 1 1 1 Coffeyville Regional Medical Center 1400 W 4th Street Coffeyville KS 67337 H063102 X X X Coffeyville Regional Medical Center Inc 1 0 0 1 X X X X X X X X X 19 1 0 1 1 X http://crmcinc.org/about/publications-reports/ X 1 19 0 1 0 1 X 250.000000000000 400.000000000000 X X X X X 1 1 X X X 1 X http://crmcinc.org/patients-visitors/billing-insurance/financial-assistance X http://crmcinc.org/patients-visitors/billing-insurance/financial-assistance X http://crmcinc.org/patients-visitors/billing-insurance/financial-assistance X X X X X 1 X 0 X X X X 1 X 0 0 Coffeyville Regional Medical Center, Inc Part V, Section B, Line 5: In August 2019, Coffeyville Regional Medical Center in conjunction with the Montgomery County Health Department began the process of updating the 2016 CHNA. The process included requesting various stakeholders in completing an on-line survey which was followed by a Town Hall Discussion in August 2019. The process included a wide variety of stake holders including business owners, civic leaders, consumers of health care, hospital personnel, and other local health care professionals. Coffeyville Regional Medical Center, Inc Part V, Section B, Line 6b: Montgomery County Health Department Coffeyville Regional Medical Center, Inc Part V, Section B, Line 11: Area of need: Economic development-CRMC continues to be very active in the Montgomery County Action Council (MCAC) to assist in the recruitment of new businesses and industries to our region. The Senior Director of Business Development attends the quarterly board meetings to support and advocate for growth. -CRMC continues to promote health and offer screenings to regional industries through our Business and Industry Health services. We provide support and education to locate industries to help them develop a healthier workforce. Area of need: Primary Care Providers-CRMC continues its recruitment efforts for primary care including Family Medicine, Pediatrics, and OB/GYN.-CRMC continues to provide health services at local schools through in-school nursing and/or scheduled screenings.Area of need: Chronic Disease Management-Chronic Disease Management classes did not occur due to COVID-19. Education and educational material were provided at patient appointments.-CRMC continued to provide community COVID-19 educaiton via press release, radio interviews, and social media.Area of need: Obesity, Nutrition, Fitness-CRMC produced "Health Hub" videos throughout 2021 to promote good nutrition. Videos and educational resources are located on the Medical Center's website.-No in-person health fairs were offered. 4 1 - CRMC Medical Group 1400 W 4th Street Coffeyville KS 67337 Surgery and Speciality Clinic 2 - CRMC Medical Group - Coffeyville 1400 W 4th Street Coffeyville KS 67337 Primary Care Physician Clinic 3 - CRMC Medical Group 1717 W 8th Street Coffeyville KS 67337 Women's Health, Obstetrics, and Gynocology 4 - CRMC Medical Group - Independence 122 W Myrtle St Independence KS 67301 Primary Care Physician Clinic Part I, Line 7: Amounts for financial assistance and certain other community benefit programs were obtained using known related charges and cost to charge ratios. The cost to charge ratios used include the overall cost to charge ratio derived from Worksheet 2 as well as individual department cost to charge ratios identified for the calculation of subsidized health services information. Part I, Line 7g: Subsidized health services are made up of services that the Medical Center provides despite a financial loss to the organization. These services include ambulance, home health, respiratory therapy, physical therapy, speech therapy, and physician clinics. Total costs for physician clinics amount to $6,360,067. Part III, Line 4: The Medical Center provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their estimated net realizable value. The Medical Center estimates this allowance based on the aging of its accounts receivable and its historical collection experience.Part III, Line 2Provisions for bad debts are related to accounts that have been deemed uncollectible during the year. The uncollectible amount is then written off pursuant with Hospital policy. The cost of the bad debts reported was determined based upon the cost to charge ratio multiplied by the total charges written off to bad debt expense.Part III, Line 3The estimate of bad debt expense attributable to patients who we believe would be eligible under the organization's financial assistance policy was estimated at 15%. The gross charge amount was then adjusted to cost using the overall cost to charge ratio obtained from worksheet 2. It is our belief that much more of the amount written off to bad debts relates to patients that would qualify for charity; however, do not take the time to complete the application process due to their individual circumstances. We believe that this amount should be considered a community benefit because we are legally required to provide medical services to patients regardless of the ability to pay. Part III, Line 8: The 2021 Medicare Cost Report was used to determine the Medicare revenue and related cost. The shortfall is a benefit to the Medical Center's community since it represents health care provided at less than cost to elderly and needy residents of the Medical Center's service area. Part III, Line 9b: Admission representatives review accounts during the admissions process to identify patients with possible financial need. To be considered for charity care, the financial policy states that financial advisors will determine if the patient is eligible to apply for Medicaid or other financial assistance programs. The advisors will then assist the patient through the process of applying for financial assistance programs within and outside of the Medical Center. Whenever possible, prior to admission, the Hospital will conduct a pre-admission interview with the patient, the guarantor, and or legal representative. Patients who may qualify for financial assistance from a governmental program will be referred to the appropriate program prior to being considered for charity care. Part VI, Line 2: The Medical Center periodically engages a consulting firm to assist with developing a strategic plan. Part of that process is to interview people in the community for their opinion on what the Medical Center can do to meet the community needs. Interviews include physicians, board members, auxiliary personnel, and business leaders in the community to help get a feel for what they see as most important for our community. Part VI, Line 3: The hospital has signs posted in each admission window and other locations in the hospital encouraging patients to ask about the available payment options and how to apply for financial assistance. The financial assitance policy and application form is also made available on the hospitals website. The patient may be referred to meet with one of the hospital's Financial Advisors, who will determine the patients' eligibility for benefits and help them through the process of applying for assistance. Part VI, Line 4: Coffeyville is located in the southeastern part of Montgomery County, located in Southeast Kansas. It is located 64 miles north of Tulsa, Oklahoma. The US Census Bureau estimates the 2021 population of Montgomery County, Kansas to be 31,156. 20.6% of the population is 65 years of age or older, the median household income is $45,288, and 17.8% of individuals are below poverty level. Part VI, Line 5: Health fairs, fundraising for relay for life, public education, and resources on Coffeyville Regional Medical Center's website are some examples of activities the Medical Center does to support health in the community. X X X 0 0 0 0 0 0 0 0 0 Aaron Russell Physician 409157 0 31250 0 0 0 25693 0 35251 0 501351 0 0 0 Perry Yung Ping Lin Physician 329744 0 73058 0 0 0 25693 0 32114 0 460609 0 0 0 Michelle McGuirk Physician 418311 0 3750 0 0 0 25693 0 9641 0 457395 0 0 0 Shravan Gangula Physician 277307 0 92017 0 0 0 25693 0 32501 0 427518 0 0 0 Baba Abudu Anesthesiologist 381314 0 0 0 0 0 25693 0 18923 0 425930 0 0 0 Brian Lawrence CEO 257344 0 71200 0 0 0 25693 0 32501 0 386738 0 0 0 Dale Guffey CFO 156856 0 1200 0 0 0 14175 0 17609 0 189840 0 0 0 Mark Slavin Son-in-law of Board Member 114598 Employee Compensation 0 Form 990, Part VI, Section B, line 11b A draft copy of the 990 is reviewed with the finance committee prior to filing. Form 990, Part VI, Section B, line 12c The organization reviews concerns when identified. Members are required to remove themselves from any discussion which may involve a conflict of interest. Form 990, Part VI, Section B, line 15a The salary for the CEO is determined by the Board of Directors and is based upon performance and comparative information obtained from the Kansas Hospital Association wage survey. Form 990, Part VI, Section C, line 19 The organization makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. Form 990, Part IX, line 11g Physician and specialist fees: Program service expenses 2,543,391. Management and general expenses 0. Fundraising expenses 0. Total expenses 2,543,391. Contract labor: Program service expenses 910,045. Management and general expenses 161,695. Fundraising expenses 185. Total expenses 1,071,925. Other fees for services: Program service expenses 4,421,002. Management and general expenses 1,106,054. Fundraising expenses 5,135. Total expenses 5,532,191. Form 990, Part XI, line 9: Increase in beneficial interest in net assets of CRMC Foundation 347,637. Form 990 Part XI, Line 2c: The Finance Committee reviews the audit prior to the presentation to the Board by the auditor. Coffeyville Regional Medical Center Foundation Inc 1400 W 4th Street Coffeyville KS 67337 480981990 To provide philanthropic assistance to Coffeyville Regional Medical Center KS 501(c)(3) Line 7 0 0 0 1 0 1 0 0 0 0 0 0 0 1 1 1 0 0 0 0