2016-10-04T10:42:02-05:00 2015-12-31 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2015-01-01 750711276 CROSBYTON CLINIC HOSPITAL CROS 8066752382 710 WEST MAIN STREET CROSBYTON TX 79322 DEBRA MILLER ADMINISTRATOR 8066752382 2016-10-04 GAYLE DE HAAS P01774581 8067911591 2016-09-27 2015 2017-02-10 21:41:12Z DEBRA MILLER 710 WEST MAIN STREET CROSBYTON TX 79322 6975637 0 X WWW.CROSBYTONCLINICHOSPITAL.COM X 1945 TX TO PROVIDE HEALTHCARE TO THE CITIZENS OF CROSBY COUNTY AND THE SURROUNDING AREAS. 7 7 107 0 0 0 550 20 5417867 5597071 4319 3577 1619853 1374969 7042589 6975637 0 0 0 0 3292017 3278991 0 0 0 3521001 3562615 6813018 6841606 229571 134031 4662770 4540143 568125 311467 4094645 4228676 SEE SCHEDULE O 0 0 6362947 6972040 OUR HOSPITAL PROVIDES GENERAL MEDICAL SERVICES TO THE CITIZENS OF CROSBYTON AND SURROUNDING AREAS. OUR LARGEST PROGRAMS ARE INPATIENT, SWING BED, AND OUTPATIENT SERVICES. WE OPERATE 25 ACUTE CARE BEDS. IN THE CURRENT YEAR, HOSPITAL PATIENT DAYS WERE 560 AND SWING BED DAYS WERE 297. WE PERFORMED 16,037 LAB PROCEDURES AND 3837 RADIOLOGY PROCEDURES AS WELL AS 1259 PHYSICAL THERAPY AND WOUND CARE VISITS. IN ADDITION, OUR RURAL HEALTH CLINIC LOGGED 7081 VISITS AND OUR EMERGENCY ROOM SAW 2560 PATIENTS. 6362947 1 0 0 0 0 0 0 0 0 0 1 0 0 1 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 53 0 1 107 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X DEBRA MILLER 8066758700 710 WEST MAIN STREET CROSBYTON TX 79322 DANNY BROOKS ELLISON CHAIRMAN 1.00 1.00 X X 0 0 0 KELLY WING VICE CHAIRMAN 1.00 1.00 X X 0 0 0 JOAN BURKE MURRAY SECRETARY 1.00 1.00 X X 0 0 0 BOBBY MAX HAM DIRECTOR 1.00 1.00 X 0 0 0 LESTER BOWNDS DIRECTOR 1.00 1.00 X 0 0 0 NATHAN BOARDMAN DIRECTOR 1.00 1.00 X 0 0 0 JACKY DEWBRE DIRECTOR 1.00 1.00 X 0 0 0 JAMES ALLEN ADAMS DIRECTOR (FORMER) 1.00 1.00 X 0 0 0 BELLE C PARKHILL CFO 40.00 X 25400 0 0 DEBRA MILLER ADMINISTRATOR 40.00 40.00 X 73265 0 0 RUTH E STALLARD REGISTERED NURSE 40.00 X 101540 0 0 200205 0 0 1 0 0 0 CONCORD MEDICAL GROUP PO BOX 489 MULESHOE TX 79347 ER MEDICAL 327513 STEVE ALLEY MD PA 536 S AYRSHIRE CROSBYTON TX 79322 PHYSICIAN SERVICES 276000 COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK TX 79410 PHYSICIAN SERVICES 225992 WAEL QUBTI MD 16002 CR 1865 LUBBOCK TX 79424 ER MEDICAL 101970 4 20 20 NET PATIENT REVENUE 623000 5597071 5597071 5597071 3577 3577 23014 0 23014 23014 23014 340B REVENUE 621990 658632 658632 UPL REVENUE 621990 642000 642000 MISCELLANEOUS 621990 51323 51323 1351955 6975637 6972040 0 3577 X 98665 98665 2526720 2435792 90928 6756 6268 488 435604 404147 31457 211246 204345 6901 65587 65587 2047 2047 1248100 1137399 110701 7141 5379 1762 95143 74397 20746 259202 234527 24675 6955 6955 299267 299267 83238 83238 BAD DEBT 774728 774728 PHARMACY 340 B MEDICINE 348964 348964 MEDICAL SUPPLIES 341055 341055 MISCELLANEOUS 19578 4516 15062 11610 1970 9640 6841606 6362947 478659 0 217834 75406 1778246 2393861 688196 652865 97290 95784 9071 9071 4725360 4155858 868768 569502 1003365 743654 4662770 4540143 311125 311467 257000 568125 311467 X 4094645 4228676 4094645 4228676 4662770 4540143 134031 0 X 1 X 1 X 1 0 X 25570 25570 1961907 1655700 306207 2737883 2500158 237725 569502 DUE FROM CROSBYTON HEALTH SERVICES 525030 THIRD PARTY RECIEVABLE 218624 743654 X 6450365 249456 249456 6200909 774728 774728 6975637 6325422 258544 258544 6066878 774728 774728 6841606 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT ORGANIZATION THAT IS EXEMPT FROM INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL EVALUATES AND ACCOUNTS FOR UNCERTAIN TAX POSITIONS IN ACCORDANCE WITH FINANCIAL ACCOUNTING STANDARDS BOARD (FASB) ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES (FORMERLY FASB INTERPRETATION 48 (FIN 48) ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES. THIS STANDARD REQUIRES CERTAIN DISCLOSURES ABOUT UNCERTAIN INCOME TAX POSITIONS. THE HOSPITAL EVALUATES ANY UNCERTAIN TAX POSITIONS USING THE PROVISIONS OF ASC 450, CONTINGENCIES. AS A RESULT, MANAGEMENT DOES NOT BELIEVE THAT ANY UNCERTAIN TAX POSITIONS CURRENTLY EXIST AND NO LOSS CONTINGENCY HAS BEEN RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL HAS FILED ALL APPLICABLE TAX RETURNS. PART XI, LINE 2D - OTHER ADJUSTMENTS: CROSBYTON HEALTH SERVICES CORPORATION REVENUE 249,456. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 774,728. PART XII, LINE 2D - OTHER ADJUSTMENTS: CROSBYTON HEALTH SERVICES CORPORATION EXPENSES 258,544. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 774,728. 1 1 X 1 X 1 X 1 1 0 0 243650 541184 -297534 0.00000 45389 163765 -118376 0.00000 289039 704949 -415910 289039 704949 -415910 1 558615 178536 1804268 2929384 -1125116 X 1 0 1 1 CROSBYTON CLINIC HOSPITAL 710 WEST MAIN STREET CROSBYTON TX 79322 000176 X X X X CROSBYTON CLINIC HOSPITAL 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X CROSBYTONCLINICHOSPITAL.COM/ X 1 13 1 CROSBYTONCLINICHOSPITAL.COM 0 0 1 X 200.000000000000 X X X X X 1 1 X X X X 1 X CROSBYTONCLINICHOSPITAL.COM X X X X X 1 X 0 X X X X 1 X 0 0 CROSBYTON CLINIC HOSPITAL PART V, SECTION B, LINE 5: THE CHNA WAS DESIGNED TO TAKE THE MISSION STATED BY THE HOSPITAL TO THE COMMUNITY AND DEVELOP IMPLEMENTABLE STRATEGIES TO ADDRESS THE NEEDS IDENTIFIED. BY LISTENING TO THE MEMBERS OF THE COMMUNITY, AND REVIEWING DEMOGRAPHIC AND STATISTICAL DATA, THE HOSPITAL CAN GAIN INFORMATION ON HEALTH STATUS, AND ON WHERE THE GAPS IN HEALTHCARE DELIVERY CURRENTLY EXIST. FURTHER, IT IDENTIFIED OPPORTUNITIES FOR GROWTH THAT MAY EXIST FOR THE HOSPITAL BY ASKING FOR DIRECT INPUT FROM COMMUNITY MEMBERS AND SOLIDIFIED THE HOSPITAL'S ROLE AS A PARTNER IN IMPROVING THE OVERALL HEALTH, EDUCATION, AND ECONOMIC DEVELOPMENT OF CROSBY COUNTY, TEXAS. THE CHNA INCLUDED SURVEYS, INTERVIEWS, AND FOCUS GROUPS WITH REPRESENTATIVES FROM THE FOLLOWING GROUPS:1. BUSINESS LEADERS2. HEALTHCARE PROFESSIONALS3. MINORITY COMMUNITY (HISPANIC AND AFRICAN AMERICAN)4. SENIOR CITIZENS5. SCHOOL DISTRICT6. CITY GOVERNMENT LEADERS7. LOW-INCOME PERSONS8. HOSPITAL ADMINISTRATION AND GOVERNANCE9. SUFFERERS OF CHRONIC DISEASES10. MEMBERS OF THE COMMUNITY UNDERSERVED BY THE HOSPITALADDITIONALLY, INTERVIEWS WERE HELD WITH CURRENT AND FORMER PATIENTS, THE HOSPITAL CEO, AND THE COUNTY JUDGE. THE SURVEY WAS DESIGNED TO IDENTIFY SELECT MEMBERS OF THE COMMUNITY WHO WERE REQUIRED BY THE ACA TO BE INCLUDED. THOSE WHO PARTICIPATED IN THE SURVEY AND VOLUNTEERED TO BE INCLUDED IN A FOCUS GROUP WERE THEN INTERVIEWED TO FURTHER DEVELOP THE RESULTS OF THIS CHNA. ALTHOUGH THE RESULTS WERE BROAD, COMMON NEEDS AND SOLUTIONS WERE IDENTIFIED THROUGH THE SURVEY, AND THE FOCUS GROUPS WERE TASKED WITH PRIORITIZING THE NEEDS AND SOLUTIONS PROPOSED. CROSBYTON CLINIC HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING LIST ARE NEEDS THAT WERE IDENTIFIED THROUGH THE CHNA COMPLETED IN OCTOBER 2013; ALL OF THESE NEEDS WERE NOT ADDRESSED BY THE IMPLEMENTATION STRATEGY DUE TO A LACK OF RESOURCES AVAILABLE TO THE HOSPITAL:1. INDIGENT POPULATION SERVICES - INADEQUATE ACCESS TO HEALTHCARE SERVICES FOR INDIVIDUALS WHO CANNOT AFFORD THEIR MEDICAL BILLS OR MEDICAL INSURANCE.2. EQUIPMENT UPGRADES - LACK OF UPDATED EQUIPMENT TO FULFILL NEEDS OF THE COMMUNITY.3. COORDINATION WITH OTHER LOCAL FACILITIES - INSUFFICIENT COMMUNICATION BETWEEN CCH AND OTHER MEDICAL FACILITIES IN THE COMMUNITY TO MEET PATIENT NEEDS.4. MAINTAINING EXISTING SERVICES - ENSURING THAT THE HOSPITAL, INCLUDING ER AND EMS SERVICES, DOES NOT REDUCE THE SERVICES THAT IT PROVIDES.5. DENTAL & VISION CARE - NO AVAILABILITY OF DENTAL AND VISION SERVICE FOR THE COMMUNITY. 1 1 - REEVES RHOADES TERRACE 640 SOUTH HARRISON CROSBYTON TX 79322 ASSISTED LIVING FACILITY PART III, LINE 4: PLEASE SEE PAGES 6-9 OF THE ATTACHED AUDIT REPORT. PART III, LINE 8: THE ORGANIZATION UTILIZES A COST TO CHARGE RATIO DETERMINED BY THEIR ANNUAL MEDICARE COST REPORT TO DETERMINE THE AMOUNT ON SCHEDULE H, PART III, SECTION B LINE 6. ALL OF THE SHORTFALL SHOULD BE TREATED AS A COMMUNITY BENEFIT. FORM 990, PART VI, SECTION B, LINE 11 THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. SENIOR MANAGEMENT CONSIDERS, COMPLETES, AND FINALIZES ALL DOCUMENTATION BEFORE FILING. FORM 990, PART VI, SECTION B, LINE 12C VERBAL AND WRITTEN DOCUMENTATION CONCERNING ANY CONFLICT OF INTEREST OCCUR DURING EMPLOYEE REVIEW AND DURING FISCAL YEAR END. FORM 990, PART VI, SECTION B, LINE 15 THE CEO, BOARD COMMITTEE, AND COMPLETE BOARD OF DIRECTORS RESEARCH AND REVIEW ALL DATA PROVIDED DURING THE SEARCH PROCESS. SEVERAL REDUCTION LAYERS ARE INVOLVED WHEN MORE THAN SEVERAL CANDIDATES ARE INVOLVED. MARKET DATA IS USED TO CONSIDER COMPENSATION LEVELS. FORM 990, PART VI, SECTION C, LINE 18 EXCEPT AS PROVIDED FOR IN THE ORGANIZATION'S FORM 1023 AND FORM 990S, THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONAL GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER PROGRAM SERVICE FEES: PROGRAM SERVICE EXPENSES 1,137,399. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,137,399. OTHER MANAGEMENT AND GENERAL FEES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 110,701. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 110,701. CROSBYTON HEALTH SERVICES 710 WEST MAIN STREET CROSBYTON TX 79322 752916531 ASSISTED LIVING TX 501(C)(3) LINE 11A, I CROSBYTON CLINIC HOSPITAL 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CROSBYTON HEALTH SERVICES D 525030 BOOK