2017-02-07T16:07:51-06:00 2016-04-30 KPMG LLP 1212 North 96th Street Suite 300 Omaha NE 68114 990 2015-05-01 470542043 Columbus Community Hospital Inc % SHAUNA CZARNICK COLU 4025623357 PO Box 1800 Columbus NE 68602 MICHAEL T HANSEN CEO 2017-02-03 true Donald Neal Jr P00798244 4023481450 2015 2021-01-29 14:40:06Z Chad Van Cleave 4600 38th Street Columbus NE 68601 89993256 false X www.columbushosp.org X 1972 NE Our mission is to improve the health of the communities we serve. 10 10 710 246 20886 -43973 209336 562546 85845372 88053768 278753 349992 865945 1026950 87199406 89993256 1527434 1135910 0 0 38405724 40237051 0 0 0 32675999 35305130 72609157 76678091 14590249 13315165 100393386 114831604 6203038 7057792 94190348 107773812 X Our mission is to improve the health of the communities we serve. false false 73095628 300 88763274 Columbus Community Hospital (CCH) is a 47 bed acute care hospital which currently employs over 650 people. It is a significant, positive economic force for the Columbus area, returning dollars into the economy through local purchases by the organization and salaries that return to the community. It is an asset for the local communities where patients can obtain quality health care without the need to drive over 50 miles for care. CCH offers a variety of services that provide necessary care for area residents. Below is a brief summary of services offered by Columbus Community Hospital. - All 47 beds of the Hospital's acute care services are also certified as swing beds. - CCH provides certified, dedicated medical interpreters to assist non-English speaking patients. The interpreters are available in-house or on-call 24/7 and serve as a liaison between the care providers and the patient. - The Hospital provides ICU, medical surgical, OB and orthopedic services, along with a variety of complimentary ancillary services. These ancillary services include wound care, diabetic education and cardiac rehab and also include clinical pharmacy services. To enhance patient safety, CCH uses bar-coded medication administration, smart pumps and computerized physician order entry. - So that area residents can receive care close to home, CCH offers rehabilitative services that include physical therapy, speech therapy, occupational therapy as well as a driver's rehabilitation program. The Hospital's Wiggles and Giggles Therapy for Kids offers pediatric physical, occupational and speech for children ranging in age from babies to adolescents. In November 2012, the Hospital began offering the STAR cancer rehabilitation program, which includes physical, occupational and speech therapies. The STAR acronym stands for Survivorship, Training and Rehabilitation and CCH is one of only three hospitals in Nebraska to have achieved STAR program certification. The Hospital's program therapists are all certified through the STAR program. Over 74 STAR program referrals have been received through local providers, resulting in consultation for potential rehabilitation needs. In addition to physical, occupational and speech therapy, some of the participants have benefitted from nutritional consultations as well as psychosocial referrals. In addition, some of these patients have needed care for pulmonary issues and cardiovascular concerns. Several STAR participants have graduated from the program and transitioned into the Hospital's medical wellness program. - Nurses in the Hospital's Same Day Services (SDS) Department prepare patients for surgery and care for patients in both the inpatient and outpatient setting. The Department oversees several outpatient procedures, including 90 to 100 endoscopy procedures each month. SDS nurses also administer blood transfusions and chemotherapy infusions. - CCH offers some of the most advanced imaging services including MRI, CT, Digital Mammography and ultrasound. Radiologists are on campus and/or available 24/7. All images are digital, and the dictation used by radiologists is voice recognized and becomes part of the digital image. - The Hospital's laboratory performs an average of over 13,000 tests per month for both inpatients and outpatients. - The CCH Emergency Department (ED) employs highly trained emergency physicians and nurses, offering 24/7 care. Other Hospital departments providing support in the ED include Respiratory Care, Social Work, Laboratory, Medical Interpreters and Diagnostic Imaging. In May, 2006, the CCH Emergency Department was designated as a Level III Trauma Center. The Medical Staff and personnel in the Trauma Center have received specialized training to resuscitate and stabilize trauma patients. The Trauma Program provides systematic review of trauma care and participates in injury prevention activities throughout the community. - CCH opened wound care services in August, 2008, offering clinic hours one day per week. The identified service area includes a 45-mile radius around Columbus. By January 2009, a second day was added to support the demand. The program has exceeded the anticipated demand and provides a much needed service close to home. The clinic sees about 100 patients per month for wound care. - For services located in facilities off-site, the larger services are Home Health and Hospice. Home Health provides skilled health services for patients at their place of residence. The program is medically directed and must be ordered by the attending physician. Home Health is Medicare and Medicaid Certified and meets the requirements of the Joint Commission. Services provided within the program are: - Supervision and administration of medications - Intravenous therapy - Instructing patients in diabetic management - Nutritional assessments - Home Health aides - Personal care services - Occupational, speech and physical therapies - 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. - The CCH Sleep Lab offers complete polysomnographic sleep testing by trained and licensed sleep technicians for the purpose of diagnosing obstructive/central sleep apnea. Both daytime and night sleep studies are performed. - 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 800 companies and with other health care professions, OHS provides the Columbus and regional area businesses and industry with a comprehensive range of services designed to support and maintain a healthy, safe workforce while assisting them in meeting OSHA and DOT compliance regulations. Their full range of services include: - A comprehensive testing procedure called Physical Capacity Profile (PCP) that 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. - 24/7 drug and alcohol testing services - Pre-employment/post job offer physical assessments - On-site nursing services - Hearing/vision testing - Hearing conservation program management - Respiratory fit testing - Respiratory evaluation services - Flu shots and immunization programs - Wellness programs - 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. Pre-determined responders are summoned to their home or emergency transfer can be call if needed. - 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 also participates in and has hosted county-wide natural disaster and pandemic drills. As a member of a larger preparedness team, RROMRS, CCH can assist or receive assistance from this region's Medicare providers. Through these drills and exercises, the Hospital is well-prepared to handle a natural disaster or pandemic should one arise. 1135610 1135610 0 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 GREATER THAN $1,200, AN ADDITIONAL WRITE-OFF WILL BE DONE AS OUTLINED BELOW. REDUCE TO $1,200; ADJUSTMENTS WILL BE DONE FROM OLDEST TO NEWEST. 74231238 true true false true false false false false false true true false false false false true false true false false false false false false false false true true false true true false false false false false false false false false false false false false true true true true false true 50 0 true 710 true true true false false false false false false false false false X 10 10 false false false false false false false true true false false true true true true true true true true false X SHAUNA CZARNICK 4025623362 4600 38th Street Columbus NE 68601 X Brian Schmidt Chairman 1.0 0.0 X X 0 0 0 Clark Lehr Vice Chairman 1.0 0.0 X X 0 0 0 Brett Bonwell Treasurer 1.0 0.0 X X 0 0 0 Beth Przymus Director 1.0 0.0 X 0 0 0 Bonnie McPhillips Director 1.0 0.0 X 0 0 0 Christian VanKirk MD Director 1.0 0.0 X 0 0 0 Jeffrey Gotschall MD Director 1.0 0.0 X 0 0 0 Ronald Ernst MD Director 1.0 0.0 X 0 0 0 Stan Emerson Director 1.0 0.0 X 0 0 0 Tim Tooley Director 1.0 0.0 X 0 0 0 Amy Blaser VP Business Development 40.0 0.0 X 191220 0 37752 Chad Van Cleave VP Finance 40.0 0.0 X 119261 0 36900 J Joseph Barbaglia VP Finance - Retired 40.0 0.0 X 170375 0 19488 Scott Messersmith VP Operations 40.0 0.0 X 109343 0 26336 James Goulet VP Operations - Retired 40.0 0.0 X 213515 0 32333 Linda Walline VP Nursing 40.0 0.0 X 196070 0 29592 Michael Hansen President/CEO/Secretary 39.0 1.0 X 405910 0 70122 Dustin Volkmer MD Physician 40.0 0.0 X 463906 0 32622 Edward Fehringer MD Physician 40.0 0.0 X 659858 0 32622 Mark Howerter MD Physician 40.0 0.0 X 484087 0 32622 Michael McGuire MD Physician 40.0 0.0 X 524033 0 32622 Richard Cimpl Physician 40.0 0.0 X 619548 0 32622 4157126 0 415633 44 false true false TSP Construction Services Inc 1112 N West Ave Sioux Falls SD 571041333 Construction 4833755 McKesson Technologies Inc PO Box 98347 Chicago IL 60693 IT Consulting 924697 Inpatient Physician Associates 3200 Pine Lake Rd Suite A Lincoln NE 68516 Hospitalist Svcs 694106 Renovo Solutions LLC 1801 E Park Court Plaza Suite 206 Santa Ana CA 92701 Equipment Maint 167281 The Roberts Group Inc 730 N Grand Ave Waukesha WI 53186 Marketing Company 101852 5 539702 22844 562546 Net Patient Service Revenue 621110 87475747 87475747 Meaningful Use Payment 900099 578021 578021 88053768 266172 266172 0 0 0 0 0 83820 83820 83820 83820 0 0 0 Meals on Wheels 900099 58359 58359 Cafeteria 722514 296558 296558 Health Watch 900099 59077 59077 612956 592070 20886 1026950 89993256 88763274 20886 646550 300 300 1135610 1135610 0 0 1405694 1405694 0 30719704 30719704 1128234 1128234 4765516 4765516 2217903 2217903 0 67519 67519 151017 151017 6547 6547 0 0 3249349 3249349 213745 213745 10254390 9956282 298108 1756092 1756092 0 1675681 1675681 195511 195511 0 108712 108712 0 0 5750635 5750635 288911 288911 Provision for Bad Debts 5429402 5429402 Minor Equip & Financing AGR 2223518 2223518 Purchased Services 2038720 2038720 Recruiting 375552 375552 1519829 1519829 76678091 74231238 2446853 0 3994478 8653858 0 0 0 0 10097589 8358859 0 0 0 0 0 594349 1399607 1569487 1918503 1853872 115891454 63668176 48961389 52223278 33844577 41380166 0 0 0 0 0 0 177243 197735 100393386 114831604 6203038 7057792 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 6203038 7057792 X 94190348 107773812 0 0 0 0 94190348 107773812 100393386 114831604 X 13315165 268299 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 6547 6547 false Schedule C, Part II-B, Line 1i Dues paid to American Hospital Association allocated to lobbying $3,052 and dues paid to Nebraska Hospital Association allocated to lobbying $3,495. 1806283 25774 1832057 1798246 8037 1806283 1742125 56121 1798246 1667736 74389 1742125 1573063 94673 1667736 1.00000 false true true 1152275 1152275 63099138 24253050 38846088 44522290 36977299 7544991 7117751 2437827 4679924 52223278 0 0 X Schedule D, Part V, Line 4 Endowment funds are held and maintained by Columbus Community Hospital Foundation. The endowment funds exist in support of improved health services by Columbus Community Hospital. Schedule D, Part X, Line 2 The Hospital adopted Financial Accounting Standards Baord (FASB) Interpretation No. 48, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No, 109. FIN 48 provides specific guidance on how to address uncertainty in accounting for income tax assets and liabilities, prescribing recognition thresholds and measurement attributes. The adoption of FIN 48 by Columbus Community Hospital did not have a material impact on the Hospital's financial position, results of operations, or cash flows. In fiscal years ending 2016 and 2015, management determined that there are no income tax positions requiring recognition in the financial statements. true true X true X true X true true false true true 511365 0 511365 0.00720 4144286 958970 3185316 0.04470 0 0 0 4655651 958970 3696681 0.05190 64175 266012 4872 261140 0.00370 779233 7992 771241 0.01080 0 0 0 0 0 0 36437 0 36437 0.00050 64175 1081682 12864 1068818 0.01500 64175 5737333 971834 4765499 0.06690 415654 44422 371232 0.00520 690 5000 5000 0.00010 347 14759 24502 205 426 426 1242 435839 68924 376658 0.00530 false 5429402 21337861 25697467 -4359606 X true true HealthPark LLC Property management 0.2721 0.7279 ZARZ LLC Property management 0.4445 0.5555 1 1 Columbus Community Hospital Inc 4600 38th Street Columbus NE 686011800 www.colubushosp.org License #630001 X X X 47 Bed Acute Care Hospital w/ 24 hr ER Services Columbus Community Hospital Inc 1 false false true X X X X X X X X X 14 true true true true X See Section C X true 14 true See Section C false true X 100 200. X X true true X X X true X See Section C X See Section C X X X X X true X false X X X X true X false false Schedule H, Part V, Line 5 MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS WAS DEVELOPED BY AND IS RECOMMENDED FOR COMMUNITY ASSESSMENT BY THE NATIONAL ASSOCIATION OF CITY AND COUNTY HEALTH OFFICIALS (NACCHO) AND CENTER FOR DISEASE CONTROL (CDC). MAPP WAS ALSO A RECOMMENDED COMMUNITY ASSESSMENT BY THE NEBRASKA RURAL HEALTH ASSOCIATION IN ITS COMMUNITY HEALTH ASSESSMENT COLLABORATIVE PRELIMINARY RECOMMENDATIONS FOR NEBRASKA'S COMMUNITY, NONPROFIT HOSPITALS TO COMPLY WITH NEW REQUIREMENTS FOR TAX EXEMPT STATUS ENACTED BY THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (SEPTEMBER OF 2011). MAPP ALLOWS FOR INPUT FROM PARTIES WHO REPRESENT BROAD INTERESTS IN THE COMMUNITIES. INPUT FROM DIVERSE SECTORS INCLUDING MEDICALLY UNDERSERVED, LOW-INCOME, MINORITY POPULATIONS AND INDIVIDUALS FROM DIVERSE AGE GROUPS WAS OBTAINED THROUGH SURVEYS, TARGETED FOCUS GROUPS, OPEN PUBLIC MEETINGS AND TARGET INVITATIONS TO COMMUNITY LEADERS AND AGENCIES. THE HOSPITAL'S PARTICIPATION IN THE CURRENT MAPP ASSESSMENT IS THE MOST THOROUGH TO DATE WITH OVER 100 INDIVIDUALS IN THE DISTRICT PARTICIPATING IN THE PROCESS. THIS DOES NOT COUNT THE 1,000 INDIVIDUAL SURVEYS OR FOCUS GROUP PARTICIPANTS. Schedule H, Part V, Line 6a - Alegent Health Memorial Hospital, Schuyler - Genoa Community Hospital - Boone County Health Center Schedule H, Part V, Line 6b - Columbus Area United Way - East Central District Health Department Schedule H, Part V, Line 7a The detailed assessment and related components are available via link on https://www.columbushosp.org/news_events/community_health_needs_assessment _chna.aspx or available on request and available for review at Columbus Community Hospital. Schedule H, Part V, Line 10a THE IMPLEMENTATION STRATEGY IS AVAILABLE VIA LINK ON HTTPS://WWW.COLUMBUSHOSP.ORG/NEWS_EVENTS/CHIP_IMPLEMENTATION_PLAN.ASPX Schedule H, Part V, Line 11 CHNA Identified Health Care Needs The following "health priorities" were identified as recommended areas of intervention under the CHNA conducted in collaboration with the East Central District Health Department (contracting with Schmeekle Research, Inc.), covering the counties of Platte (where CCH is located), Boone, Colfax and Nance: - Access to health care - Obesity - Family support - Substance abuse - Mental health CCH will work hand-in-hand with the East Central District Health Department and other health and business-related agencies to address these needs. Specifically, CCH will take the lead in addressing the identified needs of access to health care and obesity by conducting the activities described below. It will support the identified needs of family support, substance abuse and mental health as requested by other participants of the CHNA that have agreed to take the lead in these areas. These participants already have programs in place and expertise in these areas. The allocation of duties in addressing these identified health care needs promotes program effectiveness and supports the efficient allocation of limited health care dollars. Implementation Strategy Access to health care: Improve access to comprehensive, quality health care services. CCH will take the lead exploring and/or implementing the following: - Objective: Reduce the death rate from cancer of the uterus/cervix. - Action Step: Explore ways to provide a free PAP screening event at CCH. Collaborate with the University of Nebraska Medical Center on cancer management. - Objective: Reduce the female breast cancer death rate. - Action Step: Research funding options to increase the number of uninsured/underinsured women's access to mammography. An application was submitted on December 13, 2012 to the Susan G. Komen Foundation for a grant in the amount of $9,000. - Objective: Reduce one of the barriers to care. Look at the feasibility of creating a volunteer transportation program for patients. - Action Step: Explore programs operated by volunteers. - Objective: Explore other disease health screening opportunities to increase access to health care and develop a plan to address early screening. - Action Step: CCH will take the lead for the Tune Up For Life Health Fair and explore options for more screenings. - Objective: To increase access to care, facilitate communication opportunities between providers and patients. - Action Step: Provide and support nurse triage line to area local providers for a small fee. - Objective: Implement a home monitoring program for patients receiving home health services. - Action Step: Ensure home health tele-monitoring systems are being utilized by patients. - Objective: Provide community screenings and an information day regarding diabetes. - Action Step: CCH will be the lead for Diabetes Awareness Day, scheduled year in October. - Objective: Explore forming a geriatric assessment team to complete patient testing and evaluation of best setting for patients. - Action Step: Collaboration with Pender Hospital and Columbus Family Practice. Family Support: To improve the stability, health and well-being of women, infants, children and families through the effective use of community resources. The child well-being work group will take the lead in exploring and/or implementing the objectives and action steps. Obesity: Promote healthy weight and reduce chronic disease risk. Columbus Community Hospital's dedication to helping create a healthier community is seen in the Hospital's commitment to building the Columbus Wellness Center. The Center not only provides increased access to exercise and fitness, but to registered dietitians as well. Through classes and individual consultation, the dietitians can help address lifestyle changes that decrease health issues associated with obesity and chronic disease. CCH is also taking the lead in exploring and/or implementing the following: - Objective: Reduce the number of adults who are considered obese. - Action Step: Include the Chamber of Commerce and meet with local HR representatives monthly to develop a worksite wellness plan that is user-friendly and can be packaged and ready for business use. - Objective: Grow the Platte County CHIP Obesity Prevention Coalition and gather resources for public distribution. - Action Step: Have coalition members invite other community agencies and individuals to join. Gather list of resources available for physical activity and nutrition and distribute to area businesses. Regularly publish articles in newspaper and on the website. Substance Abuse: Reduce substance abuse to protect the health, safety and quality of life for all, especially children in grades 6-12. The East Central District Health Department, Columbus Police Department and Platte County Sheriff's Department will take the lead in exploring and/or implementing the objectives and actions steps. CCH will provide advice and support as requested. Mental Health: Improve mental health through prevention and by ensuring access to appropriate, quality mental health services. The Platte County Mental Health CHIP group will take the lead in exploring and/or implementing the objectives and action steps. CCH will provide advice and support as requested. Schedule H, Part V, Line 16a https://www.columbushosp.org/for_patients_visitors/patients_financial_info rmation/discount_charity_care_programs.aspx Schedule H, Part V, Line 16b https://www.columbushosp.org/sites/www/Uploads/Charity-Financial%20Assista nce%20Application%20-%20English.pdf https://www.columbushosp.org/sites/www/Uploads/Charity-Financial%20Assista nce%20Applicaiton%20-%20Spanish.pdf Schedule H, Part V, Line 16i Information brochures on Financial/Charity Assistance (F/C) are available in key areas of the Hospital. The CCH website has information regarding F/C assistance as well as applications in both Spanish and English and the patient statements also contain information regarding F/C assistance. The F/C applications are available to all staff on the Hospital's internal "h" drive under the "forms" category. The Hospital's Emergency Department registration desk, main registration area, patient accounts desk and Social Services Department all have F/C applications readily available in both English and Spanish. 10 Premier Physical Therapy of CCH US 30 Center Bldg 3100-23rd St St Columbus NE 686013161 Outpatient Physical Therapy SPORTS TRAINING SERVICES Wiggles & Giggles Therapy for Kids 3912 38th Street Suite B Columbus NE 686015100 Pediatric Therapy Services Occupational Health Services of CCH 3005-19th St Suite 300 Columbus NE 686014252 Emp Health Care Svcs to Prevent & Treat Work Injuries Wound Healing Center 4600-38th St Suite 165 Columbus NE 68601 Wound Treatment Center Humphrey Clinic of CCH 3003 Main Street Humphrey NE 686423155 Clinic in small town to offer medical services to residents Hospice of Columbus Community Hospital 3005-19th St Suite 600 Columbus NE 686014248 Hospice Services Columbus Community Hospital Sleep Lab 3020-19th St Suite 100 Columbus NE 686014252 Polysomnographic Sleep Testing Home Health of Columbus Community Hosp 3005-16th St Suite 600 Columbus NE 686014248 Home Health Services Columbus Orthopedic & Sports Med Clinic 4508 38th St Suite 133 Columbus NE 686011668 Free Standing Clinic Rehabilitative Services 3912 38th Street Suite B Columbus NE 686015100 Outpatient Physical Therapy, Occupational Therapy and Speech Therapy Schedule H, Part I, Line 3c N/A Schedule H, Part I, Line 6a A COMMUNITY BENEFIT REPORT IS INCLUDED EACH YEAR IN THE HOSPITAL'S QUARTERLY NEWSLETTER HOUSECALL WITH AN ELECTRONIC VERSION OF THE NEWSLETTER HOUSED ON THE HOSPITAL'S WEBSITE. A SEPARATE LANDING PAGE ON THE WEBSITE WAS ALSO CREATED FOR THE REPORT TO PROVIDE EASY ACCESS TO THE REPORT. Schedule H, Part I, Line 7b THE REVENUE GENERATED BY MEDICAID PATIENTS IS MULTIPLIED BY THE COST TO CHARGE RATIO DEVELOPED IN WORKSHEET 2. THE REMAINING PRODUCT IS THE CALCULATED COST ASSOCIATED WITH THE CHARGES FROM MEDICAID PATIENTS. THESE COSTS ARE REDUCED BY THE REIMBURSEMENTS COLLECTED FOR THE MEDICAID CHARGES. THE REMAINING NUMBER IS THE NET COMMUNITY BENEFIT EXPENSE. Schedule H, PART I, LINE 7E EXPENSES REPRESENT WAGES ALONG WITH SERVICES AND SUPPLIES PURCHASED BY THE HOSPITAL. DIRECT OFFSETTING REVENUES REPRESENT CASH COLLECTED FOR THESE SERVICES. Schedule H, PART I, LINE 7I CASH DONATIONS REPRESENT THE MAJORITY OF THESE DONATIONS, THE LARGEST AMOUNT, $25,000, GOING TO THE EAST CENTRAL DISTRICT HEALTH DEPARTMENT TO SUPPORT COMMUNITY HEALTH PROGRAMS. OTHER CASH DONATIONS WERE MADE TO SMALLER ORGANIZATIONS FOR PROGRAMS OR EVENTS RELATING TO HEALTH. THE IN-KIND DONATIONS, $101, WERE MEALS ON WHEELS CARDS FOR THOSE WHO COULD NOT AFFORD THE MEALS. Schedule H, PART I, LINE 7, COLUMN (F) THE AMOUNT OF 71,248,689 USED AS THE DENOMINATOR TO COMPUTE COLUMN (F) IS CALCULATED BY TAKING TOTAL FUNCTIONAL EXPENSES OF 76,678,091 MINUS BAD DEBT EXPENSE OF 5,429,402. Schedule H, Part II Community Building Activities Columbus Community Hospital (CCH) continues to collaborate with the local Chamber of Commerce to recruit skilled professionals to fill job openings in the community. The Hospital also provides support and staff time to assist in highlighting the health care community, offering specific department or Hospital tours in order to recruit skilled professionals to live and work in Columbus. On Hospital-donated land, the City of Columbus created a twelve acre urban lake and, on the same property, an additional 20 acres designated as the future site of a fire station. A handicap/stroller-accessible dock on the urban lake allows access for fishing or to watch water fowl rest in the area as they migrate through Columbus. The urban lake provides a community space within the city limits for people of all ages. The Hospital continues to partner with our local public health department and community health center (CHC) on several projects and community disease prevention initiatives, providing financial support and professional staff time as liaisons to these community partnerships throughout the year. Working together with these agencies, some of the chronic disease and accident prevention strategies addressed include: Type II Diabetes, hypertension and heart disease, pre and postnatal newborn care, physical activity and exercise, colon cancer prevention and early detection, and community preparedness for natural and man-made disasters. These programs reach countless members of the community each year, making a difference in the lives of people living with chronic health issues. Other hospital-driven community health initiatives include: free flu shots for residents at the shelter for the homeless and participation in numerous community health fairs/events each year providing medical screenings and free health information/education. To encourage entry into the medical profession, Columbus Community Hospital partners with local day care facilities, area schools and colleges, offering its medical professionals as guest speakers or instructors at hands-on learning events. To help in recruitment of health care professionals and also to relieve the daycare shortage in Columbus, the Hospital Board has also approved the construction of an on-site daycare and pre-school for Hospital employees. Columbus Community Hospital has an independent Board of Directors, consisting of community leaders with diverse backgrounds. The CCH Board approved the construction of a $21 million, 85,723 square foot community wellness facility that opened on October 27, 2015. The Columbus Family YMCA leased, below fair market value, 62,397 square feet of the facility that is available for use by the entire community and includes: 2 gyms, 3 pools, and weight and exercise equipment. Classes for wellness and fitness are provided by health care professionals from the Hospital and YMCA staff. In separate areas, the facility also houses the Hospital's adult and pediatric therapies. Schedule H, Part III, Line 2 The methodology used to estimate bad debt expense is to take the private pay write-offs for the year and divide them by the total revenue generated from self-pay patients and multiply the product by the self-pay accounts receivable. This gives the amount of reserve necessary to cover the potential bad debt in current self-pay accounts receivable. Bad debt expense for the fiscal year is the amount of additional expense necessary to bring that reserve account to the calculated (estimated) balance. Schedule H, Part III, Line 3 N/A Schedule H, Part III, Line 4 Financial statements do not include any text for bad debt. The amount in Line 2 is the book bad debt amount. Charity care is kept separate from bad debt. Schedule H, Part III, Line 8 In accordance with 42 CFR 413.24, Columbus Community Hospital uses the step-down method as its costing methodology. Departments within a provider are usually divided into two types: 1) Those that produce patient care revenue (e.g., routing 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. 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 service 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 non-revenue-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. Schedule H, Part III, Line 9b The purpose of our Financial Assistance/Charity Program is to further the charitable mission of CCH by providing financially disadvantaged and other qualified patients with an avenue to apply for and receive free or discounted care consistent with the requirements of the Internal Revenue Code and implementing regulations under IRC Section 501(r). CCH's Financial Assistance Policy reflects the mission, vision and values of CCH. It is intended to assist low income, uninsured and underinsured individuals whose financial status, under the hospital's qualification criteria, makes it impractical or impossible to pay for medically necessary and emergency care. This Program provides a fair and comprehensive system of distributing free or discounted medical care to poor and financially disadvantaged patients within the available resources of CCH. This Policy addresses; Eligibility criteria for financial assistance; The extent to which financial assistance includes free and discounted care; The basis for calculating amounts charged to eligible patients; The method for applying for assistance; Actions that may be taken by CCH in the event of nonpayment; and Measures to widely publicize the Policy. CCH recognizes the individual's right to obtain quality health care regardless of age, sex, race, disability, national origin, marital status, sexual orientation, personal beliefs or their ability to pay. CCH has a fiduciary responsibility to seek payment for services from those who can pay. Needs Assessment In 2010, Columbus Community Hospital began implementing a five year strategic plan. The plan includes a thorough assessment of the organizations external environment in terms of opportunities and threats, as well as an assessment of the organizations internal strengths and weaknesses. The plan also includes strategic issues, goals and related strategies for future organizational effectiveness. Six organizational pillars were identified: Quality, Culture, People, Service, Facilities and Finance. 1) Quality: Quality efforts have been focused on Evidence-Based Processes (EBP) and educating staff on the importance of using and integrating these processes in daily operations. CCH has implemented an electronic medical record to afford ease of information access and communication across the continuum of care. The clinical leadership groups for nursing and respiratory therapy have initiated a review of how to integrate EBP into the clinical areas and will be starting classes to educate staff within and outside nursing. 2) Culture: In an effort to achieve a high performance organization, CCH is in the process of implementing a 4-part culture improvement initiative that includes: TeamSTEPPS, Just Culture, Student and Lean/Six Sigma Process Improvement. The Hospital continues to work with the Studer Group to hardwire appropriate tools, focusing on improving patient outcomes and create a culture/environment, making CCH and employer of choice, and where physicians want to bring their patients for care. 3) People: CCH has continued to be aggressive in its recruitment efforts to attract and retain the workforce needed to support strategic growth initiatives across all service lines. CCH is initiating a new on-boarding process for new employees. In addition, nursing has updated their orientation program and has trained preceptors and nurse mentors/coaches. 4) Services: CCH performs an annual comprehensive program review of existing and new services and has ranked priority service line development in the areas of hospital medicine, orthopedics, cardiology, cancer and rehab services. 5) Facilities: CCH has developed a comprehensive master facilities plan that can adapt to current and future patient care needs. An Emergency Department expansion was completed in 2012 with a new Medical Office Building recently completed to house visiting physicians and the Wound, Ostomy, and Continence Care (W.O.C.) Clinic. 6) Finance: CCH is working diligently to maintain financial stability. Our approach includes: work to extend the Demonstration Project with an alternate plan in place if the program is discontinued. The Hospital maintains a conservative successful investment strategy and continue growth in the CCH Foundation. Patient Education of Eligibility for Assistance Financial assistance information is available on the Hospitals website, including links to additional, in-depth information. Patient Charity/Financial Assistance Program: 1) If patients feel their income is not sufficient to pay for services at Columbus Community Hospital, they are encouraged to contact the Patient Accounts Department and/or Social Workers for information regarding charity/financial assistance. 2) Further information about Medicare/Medicaid/Charity Care is provided in both English and Spanish on our website. The State has Medicaid applications available online. Our Patient Accounts and Social Services staff can provide patients with financial/charity applications in either English or Spanish. 3) Additionally, signage is posted directing patients to call as needed for financial help. Referrals are built into to the medical admission software. If patients share concerns about the cost or their lack of coverage, a referral is generated to Social Services staff who will see patients, individually, and counsel on specific circumstances. 4) Monthly statements include the following information: a. Payment plans b. Charity/Financial Assistance Program c. 24/7 online Business Office access, which includes information on payment plans, charity/financial assistance and applications for financial/charity assistant available in both English and Spanish that can be downloaded from our website. A hard copy with information is also available in the Guide to Patient Services located in each patients room, as well as informative brochures located in outpatient areas. A step-by-step tutorial is also available, to help educate patients regarding what they need to bring when registering. Community Information The Local Economy Columbus Community Hospital is located in Columbus, Nebraska, which is the largest city in Platte County. With a growing population of 33,066, Platte County is the largest county of the seven counties in the CCH service area. From July, 31, 2013 to July 31, 2014, unemployment in the City of Columbus decreased slightly from 3.9% or 756 jobless to 3.3% or 610 jobless. During this same period of time, the Nebraska jobless rate was 3.6% and the National average was reported at 6.2%. As reported in Money Magazine, Columbus is listed as the third best place in the U.S. to find employment and in the top 100 best small towns to live. Three counties in Nebraska were listed in the Top Ten Counties in the U.S. to live and work, including Platte, Madison (which is contiguous to Platte County) and Sarpy County near Lincoln, Nebraska. Our local economy is based on agriculture and manufacturing, with many industrial companies attracted by plentiful, low-priced hydroelectric power. A hard-working, well-educated workforce, low energy costs and a local environment friendly to business provide encouragement for strong economic and industrial development within our area. Among the major employers are Archer Daniels Midland (ADM), an ethanol manufacturing company; FLEXCON; Central Confinement Services; Pillen Family Farms; Vishay; two BD Medical Plants, medical equipment companies; Behlen Manufacturing, which manufactures steel buildings; and Nebraska Public Power, with headquarters located in Columbus. According to the Nebraska Department of labor, Columbus is considered a major hub for the manufacturing industry and has a greater share of manufacturing employment than other Nebraska metropolitan areas. We continue to see an influx of single and young families moving into our area seeking employment. Our community growth correlates to our continuing increase in hospital outpatient visits. Outpatient visits reached 44,613 visits for the fiscal year ending April, 2014. In 2005, our outpatient visits over a twelve month period totaled 38,129. This 17% increase in our outpatient visits over the past nine years is a reflection of the significant impact the Demonstration Project has had on our Hospital. Service Capacity The W.O.C. Clinic opened in August of 2008. It has grown to 1,107 patients/visits as of April 30, 2014. The identified service area includes a 45-mile radius around Columbus. The W.O.C. Clinic is located in the visiting physician office suite in the attached Medical Office Building. The Clinic has scheduled visits two days per week with additional nurse staff time spent each week assisting outpatient clients with wound applications, as well as assisting in the application of wound vacs in surgery or on our medical floor. W.O.C. staff also schedules appointments and other responsibilities for the Clinic such as ordering supplies and maintaining compliance with national standards. Prior to the opening of the W.O.C. Clinic, patients seeking this specialized treatment were required to travel an average of 75 miles to see a wound center specialist. The volume we are seeing at this Clinic reinforces the amount of community need that existed for this service and has greatly increased local access for so many high acuity patients and their families. Our nurses are WCOM certified, so in addition to wound care, patients who have challenges with ostomy appliances and continence problems can be addressed through our Clinic. To replace older, existing systems, CCH recently installed a new CT scanner, new radiologic/fluoroscopy system and nuclear medicine camera. The Hospital recently opened a womens imaging area within the Hospital, which is separate from the rest of the Radiology Department. The registration area was recently renovated which provides additional privacy for patients. On February 8, 2012, we reduced our mammography procedure pricing by 21% as well as sought and received a Susan G. Komen grant. The grant provided uninsured and underinsured women in our community access to lifesaving mammograms. The Hospitals Foundation also provided matching funding for the grant. Because of the Hospitals participation in the Demonstration Project, CCH was able to purchase bone density equipment, support equipment and train staff in the use of this procedure. In the past, CCH had contracted for mobile density services, but the purchase of this equipment has increased access to care for our community and eliminated the need to wait for diagnosis from a mobile units intermittent service or travel out of town for the procedure. Columbus Community Hospital is a 47 bed, acute care hospital offering a variety of surgical procedures and short term hospitalizations. All 47 beds are licensed for either acute care or swing bed patients. In addition, CCH provides comprehensive outpatient laboratory, radiology, respiratory and rehabilitative services. We also provide free 24/7 interpreter services. Our facility offers comprehensive care, including intensive care, medical-surgical care, inpatient and outpatient general, ENT, urology, podiatry, orthopedic surgical procedures. Other ancillary services offered include: respiratory, wound care, diabetes education, endoscopy and cardiopulmonary rehabilitation. In 2006, the Hospitals Emergency Department was designated as a Level III Trauma Center, with nurses certified in TNCC, ACLS and PALS. Eight of the Emergency Department nurses are also certified in ENPC. A 30,000 square foot addition to the ED was completed in 2012. The expanded area allowed the ED to add two trauma bays, a two-bay ambulance garage, a dedicated decontamination area, a dedicated family grief and counseling room, covered drive-up access and a negative air-pressure room, which allows patients with communicable disease to be treated while protecting other patients and staff. CCH has an open emergency room available to all in need regardless of race, creed, age or ability to pay. The Hospital also has an open medical staff. The Hospitals Home Health/Hospice interdisciplinary services are available to patients within a 30 mile radius of Columbus, offering in-home telehealth monitoring. The CCH Sleep Lab provides polysomnographic sleep testing, available for both daytime and home sleep tests. In January 2010, the Hospital hired a fulltime RN as the Orthopedic Service Line Coordinator. In November of that same year, a multi-disciplinary team was organized to review, standardize and improve the patients total joint process from diagnosis to post-surgical recovery. In March 2012, the acquired Columbus Orthopedic and Sports Medicine Clinic, enabling the Hospital to expand the service line and ensure the communitys aging population orthopedic services close to home. In May, 2013, the Hospital expanded the RN Coordinators responsibility into case management in the Transitional Care Department. This expansion of duties enabled the Hospital to plan for continuity of care post-hospitalization. Three cardiologists have relocated to Columbus, providing full time cardiology services to the area. Since 2010, 63 physicians have been recruited to serve the needs of our primary and secondary service areas, including 55 MDs, 1 DPM and 7 mid-level providers. Thirty-four of these providers are full time, while the other 29 are serving in a visiting capacity. To increase access to CCH, the Hospital has completed construction on three road projects on and around the campus. Two clinic buildings, one for a family practice group and one for a pharmacy, have been completed as well. Promotion of Community Health In addition to construction of the Columbus Wellness Center, the Hospital reinvests capital to improve patient care, attract the best qualified staff, and provide medical education and prevention activities in our community. The Hospital is living its mission and vision within the community. Our Mission: To improve the health of the communities we serve. Our Vision: To compassionately deliver the States highest quality of patient care. Columbus Community Hospitals care values are: - Integrity - Compassion - 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 to each. The six Pillars of Excellence are: - Quality - Culture - People - Services - Facilities - Finance Measurement of ongoing operational performance is organized around these pillars. The pillars were strategically identified as common measures around which operational performance is organized in many health care institutions and adapted for CCH. Affiliated Health Care System N/A State Filing of Community Benefit Report None true CHARITY CARE TO PATIENTS 838 1135610 BOOK WRITE-OFF OF MED EXP Schedule I, Part I, Line 2 Columbus Community Hospital does not typically give out donations, but occasionally a request is brought forward and the Board determines that it is in the best interest of the community to provide a particular grant. Prior to providing the grant, the Hospital determines that the organization it gives to is a 501(C)(3) organization or a government agency. The Hospital will also make grants to these related organizations as necessary to support their exempt purpose. X true true X X X X X X false true false false false true false false false Amy Blaser VP Business Development 129347 0 11800 0 50073 0 15730 0 23844 0 230794 0 0 0 Chad Van Cleave VP Finance 119261 0 0 0 0 0 14878 0 23519 0 157658 0 0 0 J Joseph Barbaglia VP Finance - Retired 75068 0 32816 0 62491 0 8477 0 12299 0 191151 0 0 0 James Goulet VP Operations - Retired 165362 0 30153 0 18000 0 10311 0 24418 0 248244 0 0 0 Linda Walline VP Nursing 150409 0 27661 0 18000 0 7570 0 24221 0 227861 0 0 0 Michael Hansen President/CEO/Secretary 347285 0 40625 0 18000 0 48100 0 26405 0 480415 0 0 0 Dustin Volkmer MD Physician 463906 0 0 0 0 0 10600 0 26348 0 500854 0 0 0 Edward Fehringer MD Physician 531182 0 110676 0 18000 0 10600 0 26402 0 696860 0 0 0 Mark Howerter MD Physician 484087 0 0 0 0 0 10600 0 26215 0 520902 0 0 0 Michael McGuire MD Physician 494476 0 29557 0 0 0 10600 0 26179 0 560812 0 0 0 Richard Cimpl Physician 490012 0 111536 0 18000 0 10600 0 26348 0 656496 0 0 0 Schedule J, Part I, Line 1a The Organization paid for social and health club dues as part of the CEO's employment agreement. These amounts were reflected on the CEO's W-2. Schedule J, Part I, Line 4b The following reportable individuals participated in a supplemental nonqualified retirement plan during the 2015 calendar year. Amounts deferred from the plan were included in Column C of the Schedule J: Michael Hansen - $37,500 Amy Blaser - $10,080 Chad Van Cleave - $10,033 Schedule J, Part I, Line 3 The Hospital's Executive Compensation Committee, made up of independent Hospital Board members, reviews the CEO's compensation annually. The wage range is compared to information provided by third party consultants, from salary surveys, and then decisions are documented. Schedule J, Part I, Line 6a With the assistance of Towers-Watson, executive compensation consultants, the Board authorized paying an incentive to the executives for meeting specific Board-Established Directives. The Board authorized paying up to 25% of base compensation for Michael Hansen and up to 20% for the following VPs: - James Goulet - Linda Walline - Amy Blaser - Chad Van Cleave The incentive is based on goals established by the Board which are now reviewed annually. One of the goals is the Hospital's operating margin. The Board determines the associated metrics for each individual goal. Each of the goals is then assigned a weight based on the level of importance, as determined by the Board. The results are entered and the metric is tabulated. That number is multiplied by the corresponding weight. Once weighted, the figures are added in total to establish a score between 1 and 5. No incentive is paid if the Hospital's operating margin falls below 5.0%, regardless of the outcomes of the other measures. Bonuses paid to physicians are based on productivity. The incentives were paid in this fiscal year for work done in the previous fiscal year. The bonuses paid were: - Michael Hansen - $40,625 - Richard Cimpl, MD - $111,536 - Edward Fehringer, MD - $110,676 - Michael McGuire, MD - $29,557 - Joe Barbaglia - $32,816 - Amy Blaser - $11,800 - James Goulet - $30,153 - Linda Walline - $27,661 Form 990, Part VI, Line 11b The Form 990 will be available for all the Members of the Finance Committee to review. Upon Committee review, the 990 will then be submitted to the full Board for review and the Board will make any corrections if applicable. Form 990, Part VI, Line 12c Columbus Community Hospital monitors any conflict of interest 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 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. Form 990, Part VI, Line 15a The Hospital's Executive Compensation Committee, made up of independent Hospital Board Members, reviews the CEO's compensation annually. The wage range is compared to information provided by third party consultants. Decisions are documented. Form 990, Part VI, Line 15b The Hospital's CEO and Director of Human Resources, review the VP's and other highly compensated employee's compensation annually. The wage range is compared to information provided by third party consultants. Decisions are documented. Form 990, Part VI, Line 19 At Columbus Community Hospital, a 3-ring binder exists in the Executive Assistant's office labeled for public disclosure which includes the most current of the following: A) Governing Documents which are the Hospital's Bylaws B) Conflict of Interest Policy C) Audited Financial Statements D) Forms 990 and 990-T Form 990, Part XI, Line 9 Other changes Change in interest in Healthpark LLC & ZARZ LLC 268,299 Columbus Community Hospital Foundation 4600 38th Street Columbus NE 68601 470836747 Fundraising NE 501(C)(3) Line 11, I CCH true Healthpark Title Company 4600 38th Street Columbus NE 68601 470830945 Holding Co NE 501(C)(2) N/A CCH true ZARZ LLC PO Box 1800 Columbus NE 68602 273676428 Property Mgmt NE Hlthpk Title Co Related 0 0 false 0 true 0.44450 HealthPark LLC PO Box 1800 Columbus NE 68602 470836733 Property Mgmt NE Hlthpk Title Co Related 0 0 false 0 true 0.27210 false true true false true false false false false false true false true true true false true false true Columbus Community Hospital Foundation c 539702 Cash Healthpark Title Company k 77547 Book Healthpark Title Company s 482300 Cash