2016-02-11T15:13:40-06:00 2015-06-30 580914992 DRAFFIN & TUCKER LLP PO BOX 71309 ALBANY GA 31708 990 2014-07-01 631058174 CULLMAN REGIONAL MEDICAL CENTER INC CULL 2567372598 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 NESHA DONALDSON CFO 2567372598 2016-02-16 true JACQUELINE G ATKINS P00861721 2298837878 2016-02-11 2014 2016-04-25 22:37:26Z JAMES CLEMENTS CEO 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 102978241 false X CRMCHOSPITAL.COM X 1939 AL CULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY. 14 13 1075 60 1477857 311076 970661 834973 91596673 95688771 2332099 1413843 5295109 5014551 100194542 102952138 76297 76800 0 46967312 44612842 0 0 49081377 51250610 96124986 95940252 4069556 7011886 104627424 112551392 85951042 94437206 18676382 18114186 X CULLMAN REGIONAL MEDICAL CENTER, LICENSED FOR 145 BEDS, OPERATES A 115-BED GENERAL ACUTE CARE HOSPITAL FOR THE COMMUNITY OF CULLMAN, ALABAMA AND SURROUNDING AREAS REGARDLESS OF A PATIENT'S ABILITY TO PAY. false false 82259081 76800 98362690 CRMC PROVIDES ACUTE CARE PATIENT SERVICES WHICH ARE RENDERED TO ALL MEMBERS OF THE COMMUNITY REGARDLESS OF THEIR ABILITY TO PAY. CRMC USES CHARITY APPLICATIONS BASED UPON FEDERAL POVERTY GUIDELINES AND FAMILY SIZE TO DETERMINE ELIGIBILITY FOLLOWING SERVICES PROVIDED. CRMC PROVIDES CARE 24 HOURS PER DAY, SEVEN DAYS A WEEK AND HAS PROVIDED 25,813 INPATIENT DAYS CARE, 7.27% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; 44,655 EMERGENCY ROOM VISITS, 20.44% WERE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN; AND 93,783 OUTPATIENT VISITS, 17.24% NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN. THE TOTAL UNREIMBUSED COST OF MEDICAL SERVICES PROVIDED TO THOSE NOT COVERED BY ANY GOVERNMENTAL OR PRIVATE INSURANCE PLAN IS REPORTED ON SCHEDULE H. CRMC ALSO PROVIDES COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY. 82259081 true true false false false false false false false false true false false false true true false true false false false false false false false false true true true false true true false false false false false false false false false false false false false false false true false false false true 213 0 1075 true true true false false false false false false false false false X 14 13 false false false false true true true true true false false true true true true true true true false true false X NESHA DONALDSON 2567372598 1912 ALABAMA HWY 157 CULLMAN AL 350580609 CHERYL BAILEY CNO/INTERIM 40.00 2.00 X X 152357 0 6431 DAVID MCKOY PAST CHAIRMA 2.00 X 0 0 0 TODD MCLEROY CHAIRMAN 2.00 2.00 X X 0 0 0 ALAN WOOD SECRETARY 2.00 X X 0 0 0 CLINT FREY MEMBER 2.00 X 0 0 0 DEL BROCK MEMBER 2.00 X 0 0 0 ROBIN HALL MD MEMBER 2.00 X 0 0 0 ROGER HUMPHREY MEMBER 2.00 X 0 0 0 GREG BARKSDALE MEMBER 2.00 X 0 0 0 JUDY BUTLER PATTERSON VICE CHAIRMA 2.00 X X 0 0 0 MARK BUSSMAN MEMBER 2.00 X 0 0 0 LIONEL POWELL TREASURER 2.00 X X 0 0 0 BETH ANDERSON MEMBER 2.00 X 0 0 0 BILL SMITH MD MEMBER 2.00 X 0 0 0 JAMES CLEMENTS CURRENT CEO 40.00 2.00 X X 0 0 0 NESHA DONALDSON CFO 40.00 1.00 X 122387 0 5181 JEFF STANLEY COO 40.00 X 0 0 0 EDWARD MAHAN MD CARDIOLOGIST 40.00 X 407991 0 19723 JOEL JOHNS MD HOSPITALIST 40.00 X 152345 0 4901 JOHN MORRIS MD HOSPITALIST 40.00 X 138759 0 5176 SUSAN COPELAND PAST VP-AMB. 40.00 X 133063 0 6132 STACEY HILL PAST PHARMAC 40.00 X 130576 0 8841 JIM WEIDNER FORMER CEO 40.00 2.00 X 329852 0 13262 1567330 69647 13 true true true CULLMAN ANESTHESIOLOGY & PAIN CONSUL PO BOX 1005 CULLMAN AL 350561005 CRNA SVCS 1765503 MEDASSETS PO BOX 405652 ATLANTA GA 303845652 BUS OFC SVCS 1569048 CROTHALL HEALTHCARE INC 13028 COLLECTION CENTER DRIVE CHICAGO IL 606930130 ENVIRONMENTAL S 852134 NEAREN CONSTRUCTION 116 2ND STREET SE CULLMAN AL 350553506 CONSTRUCTION 841131 DIVERSIFIED CLINICAL SERVICES PO BOX 636981 CINCINNATI OH 452636981 WOUND CARE SVC 603044 26 753324 75691 5958 834973 PATIENT SERVICE REVENUES 623000 94210914 94210914 OUTREACH LAB SERVICES 621500 716316 716316 CPAP MEDICAL EQUIPMENT 621990 687069 687069 CONFERENCE CENTER 532000 46829 46829 SPORTS FIRST 713940 27643 27643 95688771 1417725 1417725 234635 196422 234635 196422 431057 196422 234635 22221 26103 -3882 -3882 -3882 EMS MANAGEMENT FEES 621910 2691601 2691601 CAFETERIA/CATERING 722210 557044 557044 COMMUNITY SERVICE/EDUCATION 624110 480284 480284 854565 783469 71096 4583494 102952138 98362690 1477857 2276618 X 76800 76800 286356 286356 343114 343114 34607095 31675026 2932069 1312629 1193763 118866 5470274 4930512 539762 2593374 2332999 260375 4871593 3596943 1274650 748596 1769 746827 118117 118117 110128 110128 10170779 8063948 2106831 387279 935 386344 10346755 9021934 1324821 34059 34059 6486520 6139491 347029 453505 427292 26213 44142 21796 22346 9500 9500 4888230 4626710 261520 864788 864788 MEDICAL SUPPLIES 8918892 8918892 REPAIRS AND MAINT 2401925 355518 2046407 DUES AND SUBSCRIPTIONS 159734 159734 TAXES AND LICENSE 136430 136430 99638 9965 89673 95940252 82259081 13681171 0 8340308 14643704 10741334 9750933 385856 380416 1074826 867117 910117 806482 100505299 62631784 37845079 37873515 41913473 42558636 2580926 2806666 835505 2863923 104627424 112551392 11417640 13379600 33988 32877 65045756 62555427 385712 231013 9067946 18238289 85951042 94437206 X 18676382 18114186 18676382 18114186 104627424 112551392 X 7011886 -1102357 -6471725 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1875781 1875781 45500989 23416123 22084866 7050862 6428611 622251 44137972 32787050 11350922 1939695 1939695 37873515 MINIMUM PENSION LIABILITY 12257611 COST REPORT SETTLEMENTS 3098153 ACCRUED INTEREST 1734658 DEFERRED PENSION EXPENSE 1012714 INTERCOMPANY LIABILITY 135153 18238289 X SCHEDULE D, PAGE 3, PART X THE AUTHORITY IS A GOVERNMENTAL ENTITY AND IS EXEMPT FROM INCOME TAXES. ACCORDINGLY, NO PROVISION FOR INCOME TAXES HAS BEEN CONSIDERED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION THAT HAS BEEN RECOGNIZED AS TAX-EXEMPT PURSUANT TO SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL IS REQUIRED TO FILE A FORM 990 WITH THE INTERNAL REVENUE SERVICE. ANY INCOME EARNED FROM NON-RELATED BUSINESS SERVICES IS SUBJECT TO TAXATION. THE HOSPITAL APPLIES ACCOUNTING POLICIES THAT PRESCRIBE WHEN TO RECOGNIZE AND HOW TO MEASURE THE FINANCIAL STATEMENT EFFECTS OF INCOME TAX POSITIONS TAKEN OR EXPECTED TO BE TAKE ON ITS INCOME TAX RETURNS. THESE RULES REQUIRE MANAGEMENT TO EVALUATE THE LIKELIHOOD THAT, UPON EXAMINATION BY THE RELEVANT TAXING JURISDICTIONS, THOSE INCOME TAX POSITIONS WOULD BE SUSTAINED. BASED ON THAT EVALUATION, THE HOSPITAL ONLY RECOGNIZES THE MAXIMUM BENEFIT OF EACH INCOME TAX POSITION THAT IS MORE THAN 50% LIKELY OF BEING SUSTAINED. TO THE EXTENT THAT ALL OR A PORTION OF THE BENEFITS OF AN INCOME TAX POSITION ARE NOT RECOGNIZED, A LIABILITY WOULD BE RECOGNIZED FOR THE UNRECOGNIZED BENEFITS, ALONG WITH ANY INTEREST AND PENALTIES THAT WOULD RESULT FROM DISALLOWANCE OF THE POSITION. SHOULD ANY SUCH PENALTIES AND INTEREST BE INCURRED, THEY WOULD BE RECOGNIZED AS OPERATING EXPENSES. BASED ON THE RESULTS OF MANAGEMENT'S EVALUATION, NO LIABILITY IS RECOGNIZED IN THE ACCOMPANYING BALANCE SHEET FOR UNRECOGNIZED INCOME TAX POSITIONS. FURTHER, NO INTEREST OR PENALTIES HAVE BEEN ACCRUED OR CHARGED TO EXPENSE AS OF JUNE 30, 2015 AND 2014 OR FOR THE YEARS THEN ENDED. THE HOSPITAL'S TAX RETURNS ARE SUBJECT TO POSSIBLE EXAMINATION BY THE TAXING AUTHORITIES. FOR FEDERAL INCOME TAX PURPOSES, THE TAX RETURNS ESSENTIALLY REMAIN OPEN FOR POSSIBLE EXAMINATION FOR A PERIOD OF THREE YEARS AFTER THE RESPECTIVE FILING DEADLINES OF THOSE RETURNS. true true X true X true X true true false true true 1331 1477245 1477245 0.01540 17444 10080343 5061847 5018496 0.05230 18775 11557588 5061847 6495741 0.06770 21 2261 1579665 1540 1578125 0.01640 1 339 339 1 1800 1800 3 100 19680 19680 0.00020 26 2361 1601484 1540 1599944 0.01670 26 21136 13159072 5063387 8095685 0.08440 1 20 22 22 8 51762 22310 22310 0.00020 1 1227 1227 2 130 11384 4100 7284 0.00010 12 51912 34943 4100 30843 0.00030 true 23520081 42164544 34448280 7716264 X true true HERITAGE DIAGNOSTICS IMAGING SERVICES 0.21000 0.79000 1 1 CULLMAN REGIONAL MEDICAL CENTER 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 CRMCHOSPITAL.COM H2201 X X X HOSPICE, CLINICS & HOME HEALTH CULLMAN REGIONAL MEDICAL CENTER 1 false false true X X X X X X X X 13 true false false true X CRMCHOSPITAL.COM X true 13 false true false true X 200.000000000000 300.000000000000 X X X true true X X X X true X HTTPWWWCRMCHOSPITALCOM X HTTPWWWCRMCHOSPITALCOM X X X X true X true X X X X true X false false FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 5 THE CULLMAN COUNTY COMMUNITY HEALTH COALITION CREATED A TARGETED LIST OF AREAS OF EXPERTISE IN THE COMMUNITY THAT WOULD PROVIDE VALUABLE INPUT. EACH MEMBER OF THE COALITION WAS RESPONSIBLE FOR SUPPLYING AND COLLECTING SURVEYS TO THESE DIFFERENT AREAS IN THE COMMUNITY. THESE AREAS WOULD HELP GENERATE INPUT FROM A VARIETY OF SOURCES THAT WOULD HELP GENERATE AN OVERALL VIEW OF THE HEALTH OF THE COMMUNITY. THE GROUP ALSO CREATED BOTH A PRINTED SURVEY AND AN ONLINE ELECTRONIC SURVEY IN ORDER TO REACH MULTIPLE DEMOGRAPHICS THROUGHOUT THE COMMUNITY. AFTER BOTH THE SURVEY DATA AND SECONDARY DATA WERE COMPILED, DISCUSSION WAS CONDUCTED BY THE MEMBERS OF THE CULLMAN COUNTY COMMUNITY HEALTH COALITION IN ORDER TO COLLECT PRIMARY DATA ABOUT OUR COMMUNITY. THE COMMUNITY HEALTH COALITION MEMBERS REPRESENT BOTH THE HEALTHCARE COMMUNITY AND THE COMMUNITY AT LARGE; THEREFORE, THIS GROUP SERVED AS THE FOCUS GROUP PORTION OF THE NEEDS ASSESSMENT PROCESS. ONCE DATA COLLECTION WAS COMPLETE, A DISCUSSION MEETING WAS HELD WITH SEVERAL KEY COALITION AND COMMUNITY MEMBERS TO DISCUSS THE FINDINGS AND OBTAIN THEIR ASSISTANCE IN SETTING PRIORITIES TO RESPOND TO NEEDS IN THE COMMUNITY. FINALLY, A LEADERSHIP COMMITTEE WITHIN CULLMAN REGIONAL MEDICAL CENTER MET TO PRIORITIZE THESE NEEDS EVEN FURTHER AND DETERMINE HOW CULLMAN REGIONAL CAN BEST PARTICIPATE IN HELPING TO MEET THE NEEDS OF THE COMMUNITY. FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 11 PROGRESS TOWARDS THE 2013 CHNA IMPLEMENTATION PLAN 1) IMPROVE ACCESS TO HEALTH CARE BY: OADDRESS BARRIERS SUCH AS LACK OF HEALTH INSURANCE, LACK OF ABILITY TO PAY -CONTRACT WITH A MEDICAID ELIGIBILITY PROVIDER -APPROX 400-500 SCREENED PER MONTH -CHARITY CARE - PER POLICY -PROVIDE ENROLLMENT INFORMATION -ACA -ALL KIDS OGOOD SAMARITAN -PROVIDE NURSE PRACTITIONER FOR CLINIC - 76,400 -PROVIDE FREE SERVICES - 1,432 PATIENTS, 1,448,384 IN CHARGES ONURSE NAVIGATION -STEER PATIENTS TO AVAILABLE COMMUNITY RESOURCES OSTRENGTHEN RELATIONSHIPS WITH COMMUNITY CLINICS -PHYSICIAN LIAISON PROGRAM ESTABLISHED IN FY 2015 2) TREAT, EDUCATE AND PREVENT CHRONIC CONDITIONS SUCH AS OBESITY, HEART DISEASE, COPD, DIABETES, HYPERTENSION OCREATE EDUCATIONAL PROGRAMS FOR COMMUNITY MEMBERS -COMMUNITY EDUCATION SEMINARS -NEW PROGRAM - FREE PREVENTIVE HEALTH SCREENINGS -48 PEOPLE SCREENED IN FY 2015 3) PROMOTE WELLNESS FOR THE COMMUNITY OCRMC WELLNESS PROGRAM -TOBACCO CESSATION PROGRAM -PROVIDE FREE FITNESS FACILITIES -PROVIDE INCENTIVES THROUGH REDUCED HEALTH CARE COSTS -WEIGHT MANAGEMENT PROGRAMS OCOMMUNITY ACTIVITIES -EXERCISE OPTIONS FOR CERTAIN SEGMENTS OF THE COMMUNITY 4) STEER PATIENTS TO LOCAL RESOURCES FOR AN APPROPRIATE LEVEL OF CARE - CALLS RECEIVED BY CRMC NURSE NAVIGATION / CASE MANAGEMENT DEPARTMENT AND DIRECTED TO APPROPRIATE RESOURCE OGOOD SAMARITAN CLINIC -MAIL OR EMAIL APPLICATIONS TO POTENTIAL PATIENTS -INCLUDE CRMC BUSINESS CARD FOR ASSISTANCE TO COMPLETE APPLICATION -APPLICATIONS AVAILABLE THROUGH CRMC FINANCIAL COUNSELORS -FINANCIAL COUNSELORS ASSIST PATIENT TO COMPLETE APPLICATION OMEDICAID CLINIC 5) NURSE NAVIGATION PROVIDES SUPPORT AND DISTRIBUTION OF FOUNDATION FUNDS OF TWO SEPARATE FOUNDATIONS. NURSE NAV HELPS POTENTIAL PATIENTS COMPLETE APPLICATIONS AND OBTAINS FREE OR REDUCED COST MEDICATION AND TREATMENTS. THESE ARE CANCER-RELATED PROGRAMS, LOCAL COMMUNITY RESOURCES, LOCAL CHURCHES, AND LOCAL BUSINESSES THAT PROVIDE SUPPORT. OBOSOM BUDDIES - CANCER -15 PATIENTS ASSISTED OSCOTT LOCHRIDGE FOUNDATION - CANCER -10 PATIENTS OMEDICAL ALLIANCE OFIRST METHODIST, TEMPLE WOMEN'S GROUP, DESPERATION CHURCH, DAY STAR CHURCH, OPUBLIX - FREE MEDS OCULLMAN CARING FOR KIDS OTHE LINK OF CULLMAN COUNTY OCOMMISSION ON AGING ONORTHBROOK CARING CENTER OWAREHOUSE DISCOUNT OJET PEP OMURPHY'S USA 6) CRMC EMPLOYEE VOLUNTEERS FOR LOCAL ORGANIZATIONS: (HOSPITAL COMMUNITY SERVICE HOURS) OHOURS -COMMUNITY HEALTH EDUCATION 330 HOURS -COMMUNITY BASED CLINICAL SERVICE 1,696 HOURS -HEALTHCARE SUPPORT SERVICES 14,060 HOURS -SOCIAL & ENVIRONMENTAL IMPROVEMENT50 HOURS -OTHER HEALTH PROFESSIONAL EDUCATION5 HOURS -EMERGENCY & TRAUMA SERVICES90 HOURS -ECONOMIC DEVELOPMENT1 HOUR -COMMUNITY SUPPORT 672 HOURS -LEADERSHIP DEVELOPMENT48 HOURS -COMMUNITY HEALTH IMPROVEMENT ADVOCACY 108 HOURS OINCLUDES PARTICIPATION ON LOCAL BOARDS BY SENIOR LEADERSHIP, DEPARTMENT DIRECTORS, AND OTHER EMPLOYEES, SUCH AS GOOD SAMARITAN CLINIC AND THE LINK OF CULLMAN COUNTY. ALL OF THESE ORGANIZATIONS WERE CREATED TO IMPROVE THE QUALITY OF LIFE FOR THE CITIZENS OF CULLMAN COUNTY. OTRAUMA PREVENTION PROGRAM -EDUCATION ON THE RESPONSIBILITIES OF DRIVING SAFELY AND THE CONSEQUENCES THAT CAN OCCUR WHEN POOR JUDGMENT IS MADE WHILE DRIVING -PROVIDED BY CRMC EMPLOYEES, IN CONJUNCTION WITH THE CIRCUIT COURT -70 PARTICIPANTS DURING FY 2015 FACILITY 1, CULLMAN REGIONAL MEDICAL CENTER - PART V, LINE 13H THE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGH THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID. A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS. 1 HOSPICE OF CULLMAN COUNTY 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 HOSPICE PART I, LINE 3C - OTHER INCOME BASED CRITERIA FOR FREE OR DISCOUNTED CARE FEDERAL POVERTY GUIDELINES (200%) ARE USED TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. DISCOUNTED CARE WILL BE BASED ON MEDICARE REIMBURSEMENT. PART I, LINE 7 - COSTING METHODOLOGY EXPLANATION THE DATA REPORTED IN THIS AREA IS REPORTED AS INSTRUCTED BY CATHOLIC HEALTH ASSOCIATION'S "A GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFITS, 2008". THE HOSPITAL UTILIZES EPSI SOFTWARE FOR COST ACCOUNTING PURPOSES. SEE ALSO THE DESCRIPTION FOR PART III, LINE 2. PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGY AMOUNTS INCLUDED ON PART III LINE 2 REPRESENT THE AMOUNT OF CHARGES CONSIDERED UNCOLLECTIBLE AFTER REASONABLE ATTEMPTS TO COLLECT, AND WRITTEN OFF TO BAD DEBT EXPENSE. BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTS THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON THE EVALUATION OF THE OVERALL COLLECTIBILITY OF THE ACCOUNTS RECEIVABLE. AS ACCOUNTS ARE KNOWN TO BE UNCOLLECTIBLE, THE ACCOUNT IS CHARGED AGAINST THE ALLOWANCE. PART III, LINE 8 - MEDICARE EXPLANATION MEDICARE ALLOWABLE COSTS ARE COMPUTED IN ACCORDANCE WITH COST REPORTING METHODOLOGIES UTILIZED ON THE MEDICARE COST REPORT AND IN ACCORDANCE WITH RELATED REGULATIONS. INDIRECT COSTS ARE ALLOCATED TO DIRECT SERVICE AREAS USING THE MOST APPROPRIATE STATISTICAL BASIS. PART III, LINE 9B - COLLECTION PRACTICES EXPLANATION THE HOSPITAL PROVIDES CARE TO PATIENTS WHO MEET CERTAIN CRITERIA UNDER ITS FINANCIAL AID POLICY WITHOUT CHARGE OR AT AMOUNTS LESS THAN ITS ESTABLISHED RATES. BECAUSE THE HOSPITAL DOES NOT PURSUE COLLECTION OF AMOUNTS DETERMINED TO QUALIFY AS FINANCIAL AID, THEY ARE NOT REPORTED AS REVENUE. PART VI, LINE 2 - NEEDS ASSESSMENT THE HOSPITAL PARTICIPATES IN THE CULLMAN COUNTY HEALTH COALITION. THIS ORGANIZATION, COMPRISED OF VARIOUS HEALTH CARE PROVIDERS AND COMMUNITY LEADERS, ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY AND STRIVES TO PROVIDE RESOURCES THAT BEST MEET THOSE NEEDS. CRMC FILED A COMMUNITY HEALTH NEEDS ASSESSMENT AND IT IS AVAILIABLE ON THE HOSPITAL WEBSITE. THE 2013 COMMUNITY HEALTH NEEDS ASSESSMENT AND RELATED IMPLEMENTATION PLAN ARE WIDELY PUBLICIZED ON THE HOSPITAL'S WEBSITE WWW.CRMCHOSPITAL.COM. THE IMPLEMENTATION PLAN IS EMBEDDED IN THE CHNA ITSELF AND CAN BE FOUND ON PAGES 40-41. PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE HOSPITAL HAS CLEARLY WRITTEN FINANCIAL AID POLICIES THAT ARE AVAILABLE ON THE ORGANIZATION WEB SITE AND THROUGHOUT THE BUSINESS OFFICE. SIGNS ARE PROMINENTLY POSTED IN THE ER ABOUT THE AVAILABILITY OF FINANCIAL AID. A REPRESENTATIVE IS ALSO AVAILABLE TO DISCUSS ELIGIBILITY TO GOVERNMENT PROGRAMS. PART VI, LINE 4 - COMMUNITY INFORMATION THE HOSPITAL DRAWS PATIENTS PRINCIPALLY FROM CULLMAN COUNTY AND THE NEIGHBORING COUNTIES OF WALKER, WINSTON, MARSHALL, MORGAN, AND BLOUNT. CRMC IS THE ONLY HOSPITAL IN ITS PRIMARY SERVICE AREA. THE PRIMARY SERVICE AREA INCLUDES THE CITY OF CULLMAN, POPULATION 15,000, AND CULLMAN COUNTY, POPULATION 81,000. PER CAPITA INCOME FOR THIS AREA IS SLIGHTLY BELOW THE PER CAPITA INCOME FOR THE STATE OF ALABAMA. CULLMAN IS SERVED BY I-65, AND IS LOCATED BETWEEN HUNTSVILLE AND BIRMINGHAM. PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTH THE ORGANIZATION AND ITS VOLUNTEER BOARDS ARE COMPOSED OF COMMUNITY MEMBERS WITH DIVERSE PROFESSIONAL AND COMMUNITY SERVICE BACKGROUNDS, AS WELL AS PHYSICIAN MEMBERS. THE EMERGENCY DEPARTMENT IS OPEN 24 HOURS PER DAY, 7 DAYS PER WEEK, AND IS OPEN TO ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY. HOSPITAL EMPLOYEES, IN CONJUNCTION WITH OUR LOCAL JUDGES, HAVE DEVELOPED A TRAUMA PREVENTION PROGRAM. THIS PROGRAM IS PROVIDED BY CRMC EMPLOYEES ON A VOLUNTARY BASIS. OUR LOCAL JUDGES REFER TEENAGE DRIVING OFFENDERS TO THE PROGRAM TO TEACH THEM THE IMPORTANCE OF VEHICLE SAFETY. WHILE THEY ARE HERE, THEY ACTUALLY GET TO WITNESS THE VARIOUS STAGES OF A TRAUMA ACCIDENT, FROM THE TIME THEY ARRIVE AT THE ER, UNTIL THEY LEAVE THE HOSPITAL. COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE PROVIDING AMBULANCE SUPPORT FOR VARIOUS COMMUNITY ACTIVITIES AND PROVIDING COMMUNITY SUPPORT GROUPS. THESE SUPPORT GROUPS (ALZHEIMER'S, BREAST CANCER, ETC) PROMOTE THE PHYSICAL AND MENTAL HEALTH OF THE COMMUNITY THAT WE SERVE. CRMC PROVIDES WOMEN'S FIRST AND SENIOR CHOICE PROGRAMS. THE WOMEN'S FIRST PROGRAM OFFERS SEMINARS AND EDUCATION ON HEALTH AND LIFESTYLE ISSUES SUCH AS STRESS MANAGEMENT, PMS, MENOPAUSE, AND HEART DISEASE. IT ALSO GIVES DISCOUNT ADMISSION TO WORKSHOPS AND HEALTH SCREENINGS. SENIOR CHOICE PROVIDES SERVICES TO PROMOTE EMOTIONAL, SOCIAL, AND PHYSICAL WELL BEING FOR COMMUNITY MEMBERS WHO ARE 50 AND OVER. THESE PROGRAMS CURRENTLY HAVE 6,903 MEMBERS. CRMC ALSO PROVIDES A COMMUNITY EDUCATION CENTER WHICH OFFERS MEETING ROOMS AND CATERING SERVICES FOR LOCAL BUSINESSES, CHURCHES, CIVIC ORGANIZATIONS AND EDUCATIONAL GROUPS. ALL OF OUR AMBULANCES ARE EQUIPPED WITH 12 LEAD EKG TECHNOLOGY, WHICH TRANSMITS THE INFORMATION DIRECTLY TO THE EMERGENCY ROOM PHYSICIAN, ALLOWING THEM TO GET THE INFORMATION WHILE THE PATIENT IS IN TRANSIT. THIS PROGRAM HAS REDUCED THE TIME FROM DOOR TO ANGIOPLASTY, BY GETTING THE CARDIOLOGY TEAM IN PLACE BEFORE THE PATIENT ARRIVES. PART VI, LINE 7 - STATE FILING OF COMMUNITY BENEFIT REPORT ALABAMA true GOOD SAMARITAN CLINIC 401 ARNOLD ST NE CULLMAN AL 35055 200149215 3 76800 CURRENT OPERATIONS 1 SCHEDULE I, PAGE 1, PART I, LINE 2 THE HOSPITAL CONTINUOUSLY EVALUATES COMMUNITY ORGANIZATIONS (AS IDENTIFIED IN PART II ABOVE) PROVIDING HEALTHCARE NEEDS TO THE MEDICALLY UNDERSERVED WHO ALSO ARE MOST LIKELY UNABLE TO PAY. THE HOSPITAL EVALUATES THE NEEDS ON AN INDIVIDUAL BASIS BASED ON DOCUMENTED REQEUSTS FOR SERVICES PROVIDED. X true true X X X X X true false false false false false false false false CHERYL BAILEY CNO/INTERIM CEO 152219 138 6149 282 158788 JAMES CLEMENTS CURRENT CEO EDWARD MAHAN MD CARDIOLOGIST 406233 1758 9462 10261 427714 JOEL JOHNS MD HOSPITALIST 152242 103 234 4667 157246 JIM WEIDNER FORMER CEO 184385 145467 3266 9996 343114 SCHEDULE J, PAGE 1, PART I, LINE 1A THE ORGANIZATION PROVIDES A MEMBERSHIP TO THE LOCAL COUNTRY CLUB FOR THE CEO. ANY AMOUNTS CONSIDERED NONBUSINESS RELATED ARE INCLUDED IN THE RECIPIENT'S TAXABLE INCOME AND REPORTED ON THE FORM W-2. SCHEDULE J, PAGE 1, PART I, LINE 4 SUSAN COPELAND 17,997 0 0 STACEY HILL 30,760 0 0 JIM WEIDNER 144,740 0 0 SCHEDULE J, PART III CEO CONTRACT JAMES CLEMENTS IS A CONTRACTED EMPLOYEE OF BE SMITH INTERIM SERVICES AND SERVES AS THE ORGANIZATION'S CEO. THE ORGANIZATION PAID BE SMITH 203,348 FOR THE SERVICES PROVIDED BY THE CEO WHOSE DUTIES INCLUDE OPERATIONAL RESPONSIBILITY OVER THE HOSPITAL AND FOUNDATION. TOTAL AMOUNTS PAID TO BE SMITH DURING THE CALENDAR YEAR 2014 OF 372,813 ALSO INCLUDE THE SERVICES OF PHARMACY AND HUMAN RESOURCES DEPARTMENT DIRECTORS. A HEALTH CARE AUTHORITY OF CULLMAN CT 631149220 230186AMO 2009-12-03 68624416 DEFEASE 1993/2007 BONDS. false false false A 6020831 68624416 61819381 1352854 5452182 2009 true false true true A false false false false false true 0.01100 true false A false true false false false true MERRILL LYNCH 26.000000000000 false false false false false A false SCHEDULE K - ADDITIONAL INFORMATION HEALTH CARE AUTHORITY OF CULLMAN CTY THE ONLY BONDS ISSUED BY THE AUTHORITY FOR THE BENEFIT OF CRMC ARE THE BONDS, WHICH WERE ISSUED DECEMBER 3, 2009. A PORTION OF THE BONDS IS ALLOCABLE TO CAPITAL EQUIPMENT (THE "BOND- FINANCED EQUIPMENT") FINANCED BY CRMC AND THE AUTHORITY FOR USE AT A FREE- STANDING RADIATION ONCOLOGY CENTER OPERATED BY CRMC. THE BOND-FINANCED EQUIPMENT WAS SOLD ON DECEMBER 31, 2010 FOR CASH IN THE AMOUNT OF 800,000 TO A NONGOVERNMENTAL PERSON. THE SALE CONSTITUTES A DISPOSITON OF THE BOND-FINANCED EQUIPMENT FOR PURPOSES OF THE CHANGE IN USE RULES. WITHIN 2 YEARS OF THE SALE DATE, THE AUTHORITY USED THE DISPOSITION PROCEEDS FOR ALTERNATE USES COMPLYING WITH THE REQUIREMENTS OF TREAS. REG 1.141-12(E). FORM 990, PAGE 2, PART III, LINE 4A COMMUNITY EDUCATION AND WELLNESS ACTIVITIES TO THE COMMUNITY AND IS A MAJOR CONTRIBUTOR TO A LOCAL INDIGENT CLINIC SERVICING CULLMAN COUNTY. FORM 990, PAGE 6, PART VI, LINE 6 THE HEALTH CARE AUTHORITY OF CULLMAN COUNTY IS THE SOLE MEMBER OF CULLMAN REGIONAL MEDICAL CENTER INC. FORM 990, PAGE 6, PART VI, LINE 7A THE HEALTH CARE AUTHORITY OF CULLMAN COUNTY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS AS WELL. FORM 990, PAGE 6, PART VI, LINE 7B THE HEALTH CARE AUTHORITY OF CULLMAN COUNTY APPOINTS THE VOTING MAJORITY OF THE ORGANIZATION'S BOARD AND CONTROLS THE OPERATIONS OF THE ORGANIZATION. FORM 990, PAGE 6, PART VI, LINE 11B MANAGEMENT ASSISTS IN PREPARING SCHEDULES, REVIEWS THE ENTIRE DRAFT OF THE FORM 990 FOR CONTENT, AND RECOMMENDS CHANGES, IF ANY. PRIOR TO FILING, THE FINANCE COMMITTEE, CFO, AND ACCOUNTING DEPARTMENT REVIEW THE FORM. THE FINAL FORM, AS IT IS ULTIMATELY FILED WITH ALL SCHEDULES AND ATTACHMENTS, IS SENT TO EACH VOTING MEMBER, PRIOR TO FILING WITH THE IRS. FORM 990, PAGE 6, PART VI, LINE 12C ANNUALLY, BOARD MEMBERS, OFFICERS, AND DEPARTMENTAL DIRECTORS MUST IDENTIFY ANY CONFLICT, MANAGEMENT MONITORS AND MAY SUGGEST ANY AREAS OF CONFLICT. THE BOARD CHAIRMAN OR ADMINISTRATION REVIEWS ACTUAL AND PERCEIVED CONFLICTS OF INTEREST. IN THE EVENT OF A CONFLICT, THE MEMBER OR OFFICER WITH THE CONFLICT WILL DISMISS THEMSELVES FROM THE DISCUSSION AND ANY VOTES ON THE ISSUE. FORM 990, PAGE 6, PART VI, LINE 15A ANNUALLY THE BOARD (OR A COMMITTEE CHARGED WITH THE RESPONSIBILITY AND AUTHORITY TO DO SO ON BEHALF OF THE BOARD) REVIEWS THE COMPENSATION PACKAGE AND PROPOSED CONTRACT OF THE CEO. THE REVIEW IS CONDUCTED BY INDEPENDENT BOARD MEMBERS, IS BASED UPON REVIEW OF COMPARABILITY DATA PROVIDED BY OUTSIDE CONSULTANTS, AND IS DOCUMENTED IN THE RECORDS OF THE BOARD REFLECTING THE BASIS OF THE DETERMINATION BY THE THE BOARD (OR AUTHORIZED COMMITTEE). FORM 990, PAGE 6, PART VI, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS AVAILABLE TO ANY MEMBER OF THE PUBLIC WHO MAKES THEIR REQUEST AT THE ADMINISTRATIVE OFFICES OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G CONTRACT LABOR 700,366 24,081 0 MEDICAL PROFESSIONAL FEE 1,060,873 272,003 0 OUTSIDE SERVICE FEES 5,731,299 1,810,747 0 COLLECTION FEES 423,976 0 0 RECRUITING FEES 147,434 0 0 FORM 990, PART XI, LINE 9 CHANGE IN VALUE OF INTEREST RATE SWAP 1,121,890 CHANGE IN TEMP REST NET ASSETS OF AFFILIATE 239,258 CHANGE IN UNRESTRICTED ASSETS OF AFFILIATE -13,519 GASB 68 IMPLEMENTATION IMPACT -7,819,354 NET DECREASE IN NET ASSETS -6,471,725 CULLMAN REGIONAL MEDICAL CTR FNDN 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 630727880 FOUNDATION AL 501C3 7 NA false HEALTH CARE AUTHORITY OF CULLMAN CO 1912 ALABAMA HIGHWAY 157 CULLMAN AL 350580609 631149220 AUTHORITY AL 501C1 6 NA false false false true false false false false false false false false false true true true false false false false