2016-08-15T18:01:28-05:00 2015-09-30 BKD LLP 14241 DALLAS PARKWAY STE 1100 DALLAS TX 75254 990 2014-10-01 263091251 Dimmit Regional Hospital % ALMA MELENDEZ DIMM 8308762424 PO Box 1016 Carrizo Springs TX 78834 JIM BUCKNER CEO 9727028262 2016-08-15 true Jeanette Verrelli P00742631 9727028262 2014 2016-09-27 15:27:22Z JIM BUCKNER PO BOX 1016 CARRIZO SPRINGS TX 78834 21742108 false X WWW.DIMMITREGIONALHOSPITAL.COM X 2008 TX TO OPERATE AND MANAGE DIMMIT County MEMORIAL HOSPITAL; TO RAISE FUNDS ON BEHALF OF THE HOSPITAL; and to PROMOTE THE HEALTH OF RESIDENTS OF DIMMIT COUNTY. 7 7 270 13 0 0 0 9227 16971323 21596944 0 0 91451 135937 17062774 21742108 0 0 0 0 7685383 9276107 0 0 0 9955496 12442298 17640879 21718405 -578105 23703 7253274 6420853 2669513 1813389 4583761 4607464 X TO OPERATE AND MANAGE DIMMIT COUNTY MEMORIAL HOSPITAL; TO RAISE FUNDS ON BEHALF OF, AND CONTRIBUTE FINANCIAL SUPPORT TO, THE HOSPITAL; TO SUPPORT OTHER HEALTH-CARE DELIVERY ORGANIZATIONS THAT ARE CLOSELY RELATED TO THE HOSPITAL; AND TO PROMOTE THE HEALTH OF THE RESIDENTS OF DIMMIT COUNTY AND SURROUNDING COMMUNITIES. false false 17430456 21647480 PROVIDED MEDICAL CARE TO RESIDENTS IN THE DIMMIT COUNTY AREA, INCLUDING 572 OPERATIONS; 10,628 EMERGENCY ROOM VISITS; 819 OBSERVATIONS VISITS; 2,069 HOME HEALTH VISITS AND 3,403 TOTAL PATIENT DAYS. 17430456 true true false true false false false false false false true false false true false true true false false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true 36 0 true 270 true false false false false false false false false false false X 7 7 false false false false false false false true true false false false true true true false true true true false X ALMA MELENDEZ 8308762424 704 HOSPITAL DRIVE CARRIZO SPRINGS TX 78834 X BRUCE E LEONARD JR CHAIRMAN 0.25 0.0 X X 271 0 0 MIGUEL URIEGAS DIRECTOR 0.25 0.0 X 271 0 0 SAMMY ALLEN SECRETARY 0.25 0.0 X X 217 0 0 CLEO BUSTAMANTE JR VICE-CHAIRMAN 0.25 0.0 X X 244 0 0 AUGUST LINNARTZ JR DIRECTOR 0.25 0.0 X 135 0 0 ALFREDO CASTANEDA DIRECTOR 0.25 0.0 X 244 0 0 MARY ALICE VALDEZ DIRECTOR 0.25 0.0 X 298 0 0 CARMEN P ESQUIVEL CNO 40.0 0.0 X 105239 0 11782 ALMA MELENDEZ CFO 40.0 0.0 X 84081 0 6209 JIM BUCKNER INTERIM CEO 40.0 0.0 X 165646 0 10375 JOSE LUNA HOME HEALTH SUPERVISOR/DRG COD 40.0 0.0 X 112354 0 6052 469000 0 34418 3 false true false PHYSICAL THERAPY SYSTEMS 123 E MAIN ST UVALDE TX 78801 PHYSICAL THERAPY 314926 TAB ANESTHESIA 20 LOU STROP DR UVALDE TX 78801 24 HR ANESTHESIA 303000 EMCARE 13737 Noel Road Suite 1600 DALLAS TX 75240 24 HR E.R. COVERAGE 355009 HNI MEDICAL SERVICES 2950 50TH STREET LUBBOCK TX 79413 HOSPITALIST SERVICES 323671 TRUSTAFF TRAVEL NURSE PO BOX 63-8231 CINCINNATI OH 45263 E.R. & L.D. RN COVER 305638 9 9227 9227 Net Patient Revenue 621110 21460944 21460944 Clinic Rent 531390 136000 136000 21596944 0 0 0 0 0 0 0 0 0 0 Miscellaneous Revenue 900099 85401 85401 Dietary Meals 721210 33515 33515 Medical Transcripts 561000 17021 17021 135937 21742108 21647480 85401 X 0 0 0 0 385283 283682 101601 0 7027501 5166659 1860842 367218 275413 91805 953659 715244 238415 542446 396459 145987 0 -12198 -12198 155475 155475 0 0 0 3388287 2652170 736117 244878 1478 243400 284782 50510 234272 850 850 0 386453 203165 183288 148208 31518 116690 0 325 325 31859 914 30945 0 444551 444551 115436 101404 14032 Medical Supplies 1938979 1938979 Dues and Subscriptions 185806 39871 145935 Bad Debt Expense 5128439 5128439 . 168 168 21718405 17430456 4287949 0 386159 771995 530773 882255 0 0 1315145 1523700 0 0 0 0 0 0 49204 67822 2891 29636 3310614 1702241 1101840 1608373 0 0 0 0 0 0 0 0 3867262 1537072 7253274 6420853 982987 1187454 0 0 0 0 0 0 0 0 0 0 286639 625935 0 0 1399887 0 2669513 1813389 X 4583761 4607464 0 0 0 0 4583761 4607464 7253274 6420853 23703 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X true false false false false false false false false true 1421 1421 false SCHEDULE C, PART II-B, LINE 1I Other Activities: HOSPITAL PAID DUES TO ORGANIZATIONS, A PORTION OF WHICH IS DESIGNATED FOR LOBBYING EXPENSEs. 42425 36011 6414 3018004 1666230 1351774 250185 250185 1608373 Other Assets 70763 EST AMOUNTS FROM 3RD PARTY 1376216 DUE FROM DISTRICT 90093 1537072 0 . 0 0 X 16581810 -5160298 -5160298 21742108 21742108 16558107 16558107 5160298 5160298 21718405 SCHEDULE D, PART X, LINE 2 LIABILITY FOR UNCERTAIN TAX POSITIONS: As an essential government function, the District is generally exempt from federal and state income taxes under Section 115 of the Internal Revenue Code and a similar provision of state law. However, the District is subject to federal income tax on any unrelated business taxable income. The Hospital has been recognized as exempt from income taxes under Section 501 of the Internal Revenue Code and a similar provision of state law. However, the Hospital is subject to federal income tax on any unrelated business taxable income. The Hospital files tax returns in the U.S. federal jurisdiction. In 2012, the Hospital received notice from the IRS that its tax-exempt status had been automatically revoked, effective February 15, 2011. The Hospital believes the revocation to be an error and filed an application for retroactive reinstatement of its tax-exempt status with reasonable cause. The Hospital received a determination of exempt status effective November 5, 2012, the date of filing of the new application. The Hospital may be assessed penalties, interest and tax for the time period between February 15, 2011 and November 4, 2012 if the request for retroactive reinstatement with reasonable cause is not approved. However, the Hospital believes it is probable that the penalties, interest and tax will be abated with the retroactive reinstatement, which is currently under review by the Internal Revenue Service. Management currently estimates the amount of tax owed for the time period between February 15, 2011 and November 4, 2012 to be $95,000 to $237,000, however, the Hospital believes it is more-likely-than-not that its tax-exempt status will be retroactively reinstated and no provision is made in these financial statements. The Affordable Care Act requires hospitals to conduct Community Health Needs Assessments (CHNAs) every three years. The due date of initial CHNA under Affordable Care Act was September 30, 2013. The Hospitals CHNA was not completed and adopted by the board of directors until April 2014. Due to the untimely adoption of the Hospitals CHNA, the Hospital paid an excise tax penalty of $50,000, which is included in operating expenses on the statement of revenues, expenses and changes in net position. SCHEDULE D, PART XI, LINE 2D RECONCILIATION OF REVENUE PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT EXPENSE $(5,128,439) INTEREST EXPENSE (31,859) ------------------- TOTAL $(5,160,298) SCHEDULE D, PART XII, LINE 4b RECONCILIATION OF Expense PER AUDITED FINANCIAL STATEMENTS WITH RETURN: BAD DEBT EXPENSE $5,128,439 INTEREST EXPENSE 31,859 ----------------------- TOTAL $5,160,298 true true X true X true X true true true false true true 1578867 1578867 0.09520 1833296 4566803 3412163 4566803 1578867 0.09520 3412163 4566803 1578867 0.09520 false 5128439 2724499 2852219 -127720 X true true 1 1 DIMMIT REGIONAL HOSPITAL 704 HOSPITAL DRIVE CARRIZO SPRINGS TX 78834 www.dimmitregionalhospital.com 100175 X X X DIMMIT REGIONAL HOSPITAL 1 false false true X X X X X X X X 12 true false false true X See Part V, Section C X true 12 true SEE PART V, SECTION C false false true X 100 200. X true true X X true X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 INPUT FROM THE COMMUNITY: THE ORGANIZATION CONDUCTED INTERVIEWS AND FOCUS GROUPS WITH BUSINESS LEADERS, MEMBERS OF THE HISPANIC COMMUNITY, ELECTED OFFICIALS, SENIOR CITIZENS, THE HOSPITAL AUXILIARY, THE CHAMBER OF COMMERCE, AND MINISTERS. SCHEDULE H, PART V, SECTION B, LINE 7A AVAILABILITY OF CHNA: THE CHNA IS AVAILABLE UPON REQUEST OR AT THE FOLLOWING ADDRESS: http://www.dimmitregionalhospital.com/docs/Community-Health-Needs-Assessme nt.pdf?sub=Community+Health+Needs+Assessment SCHEDULE H, PART V, SECTION B, LINE 11 Identified Needs addressed and not addressed: THE IMPLEMENTATION STRATEGY ADDRESSED THE FOLLOWING NEEDS IDENTIFIED IN THE CHNA: 1. HOSPITAL OPERATION ISSUES - THERE IS A LACK OF CUSTOMER SERVICE TRAINING, AND THE LENGTH OF TIME TO FILE A PATIENT'S CLAIMS IS TOO LONG. THE HOSPITAL ALSO WANTS TO ENFORCE THE PERCEPTION THAT PERSONAL HEALTH INFORMATION IS NOT SHARED IN THE COMMUNITY. THE HOSPITAL PLANS TO ENFORCE HIPAA REQUIREMENTS AND FOLLOW THE PRINCIPLES SET FORTH IN "HARDWIRING EXCELLENCE: PURPOSE, WORTHWHILE WORK, MAKING A DIFFERENCE". THE HOSPITAL HAS ALSO INTENSIFIED STAFF TRAINING AROUND SERVICE EXCELLENCE. 2. COMMUNITY OUTREACH - THE HOSPITAL WANTS TO INCREASE VISIBILITY IN THE COMMUNITY AND INCREASE ACCESS TO SPECIALTY PHYSICIAN SERVICES. THE HOSPITAL HAS WORKED ON MEETING THIS NEED DURING THE 2015 FISCAL YEAR THROUGH THE FOLLOWING ACTIONS: - NEW ECHOCARDIOGRAPHY EQUIPMENT HAS BEEN PURCHASED TO HELP MANAGE PATIENTS IN HEART FAILURE. - THE HOSPITAL HAS A CAPITAL CAMPAIGN FOR MAMMOGRAPHY SERVICES IN PROGRESS. - THE FQHC IN CRYSTAL CITY AND THE HOSPITAL HAVE WORKED TOGETHER IN PRIMARY CARE RECRUITMENT. - STAFF TRAINED AS EDUCATORS IN BASIC LIFE SUPPORT AND ADVANCED CARDIAC LIFE SUPPORT AND ARE MAKING EDUCATION AVAILABLE TO THE CITY, COUNTY AND AREA EMPLOYERS AND THE COMMUNITY. - A NEW BREASTFEEDING CAMPAIGN IS UNDERWAY. - TWO NEW FAMILY PRACTICE PHYSICIANS STARTED IN 2015 BY RECRUITMENT EFFORT OF THE HOSPITAL. - A NEW CARDIOLOGIST NOW PRACTICES PART-TIME IN CARRIZO SPRINGS. THE ORGANIZATION'S CHNA IDENTIFIED SOME NEEDS THAT ARE BEYOND THEIR RESOURCES OR CAPABILITIES. SOME NEEDS ARE BEING ADDRESSED BY OTHER AGENCIES, PROVIDERS, OR ORGANIZATIONS. THESE NEEDS INCLUDE CHRONIC DISEASES (SUCH AS RENAL, CANCER, RESPIRATORY, MENTAL HEALTH AND SUBSTANCE ABUSE), TEEN PREGNANCY, INDUSTRIAL ACCIDENTS, HIGHWAY TRAUMA AND SPECIALTY PHYSICIAN ACCESS. SCHEDULE H, PART V, SECTION B, LINE 18, 19 & 20 BILLING AND COLLECTIONS: NEITHER DIMMIT REGIONAL HOSPITAL, NOR THIRD PARTIES AUTHORIZED BY DIMMIT REGIONAL HOSPITAL, TAKE ANY ACTIONS UPON NON-PAYMENT FROM A PATIENT BEFORE MAKING A REASONABLE EFFORT TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR THE FACILITY'S FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART V, SECTION B, LINE 10A AVAILABILITY OF IMPLEMENTATION STRATEGY: THE HOSPITAL'S IMPLEMENTATION STRATEGY IS AVAILABLE AT THE FOLLOWING WEB ADDRESS: http://www.dimmitregionalhospital.com/docs/Implementation_Plan.pdf?sub=Imp lementation+Plan 1 SURECARE CLINIC 404 SOUTH 8TH STREET CARRIZO SPRINGS TX 78834 family medicine SCHEDULE H, PART I, LINE 7, COLUMN F PERCENT OF TOTAL EXPENSE: THE AMOUNT OF BAD DEBT EXPENSES REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $5,128,439. SCHEDULE H, PART III, SECTION A, LINE 2 METHODOLOGY TO ESTIMATE BAD DEBT EXPENSE: THE AMOUNT ON LINE 2 IS BASED ON BAD DEBTS PER THE AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 3 BAD DEBT AS A COMMUNITY BENEFIT: THE ORGANIZATION IS UNABLE TO ESTIMATE THE AMOUNT FOR LINE 3 AND HAS ELECTED TO LEAVE IT BLANK. SCHEDULE H, PART III, SECTION A, LINE 4 BAD DEBT FOOTNOTE: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. SCHEDULE H, PART III, SECTION B, LINE 8 COSTING METHODOLOGY: THE MEDICAL CENTER USES COST REPORT METHODOLOGY, WHICH APPORTIONS ROUTINE COSTS BASED ON MEDICARE OR MEDICAID DAYS TO TOTAL DAYS AND APPORTIONS ANCILLARY COSTS BASED ON PROGRAM CHARGES TO TOTAL CHARGES. IN ADDITION, THE STATE OF TEXAS TREATS MEDICARE SHORTFALL AS COMMUNITY BENEFIT FOR MEETING STATUTORY REQUIREMENTS FOR CHARITY CARE AND COMMUNITY BENEFIT. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION PRACTICES: THE COLLECTION POLICY CURRENTLY DOES NOT CONTAIN EXPLICIT PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT: COMMUNITY ASSESSMENT IS CONDUCTED THROUGH TELEPHONE AND PERSONAL MEETINGS. COMMUNITY LEADERS, BUSINESS LEADERS AND COMMUNITY MEMBERS ARE INTERVIEWED CONCERNING THE NEEDS OF THE COMMUNITY. THE RESULTS ARE THEN PRESENTED TO THE BOARD OF MANAGERS AND A PLAN IS DEVELOPED TO ADDRESS THOSE NEEDS. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: CHARITY CARE APPLICATIONS ARE GIVEN TO E.R. PATIENTS THAT WILL BE SELF PAYING. A LETTER IS MAILED WITH A CHARITY CARE APPLICATION TO THESE PATIENTS. FOLLOW-UP CALLS ARE THEN MADE TO THE PATIENTS THAT WERE SENT APPLICATIONS TO EXPLAIN AND ASK IF THEY NEED HELP IN COMPLETING THESE FORMS. At Registration or Admission, Charity Care Applications are given to Inpatients and Outpatients that will be self paying. We also have available an Indigent Coordinator, Monday thru Friday, 8am to 5pm, that will talk to these patients and explain what assistance we have available. If an application is requested later, it is sent to patient. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION: DIMMIT COUNTY'S ESTIMATED POPULATION IS 10,980 WITH A TOTAL SERVICE AREA OF 24,100 PEOPLE. THE GENDER COMPOSITION IS 49% MALE AND 51% FEMALE. THE POVERTY RATE IS 25% AND THE median income per household is $38,140. SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH: A SPECIALTY CLINIC WAS STARTED AND CURRENTLY SERVICES PODIATRY, ONCOLOGY, DENTAL AND ENT SERVICES. DIMMIT REGIONAL HOSPITAL (DRH) IS CURRENTY RECRUITING FOR ORTHOPEDIC AND DERMATOLOGY. THIS WILL HELP ALLEVIATE FINANCIAL STRAIN FOR PATIENTS WHO NEED SPECIALTY CARE AND HAVE To TRAVEL TO OBTAIN IT. EDUCATION PROGRAMS ARE ALSO PROVIDED TO PROMOTE HEALTHCARE HABITS. ADDITIONALLY, TRAINING IS PROVIDED TO NEW PARENTS ON CAR SAFETY SEATS. SEATS ARE PROVIDED TO THOSE WHO CANNOT AFFORD THEM. HEALTH FAIRS ARE ALSO HELD AND SCHOLARSHIPS ARE AWARDED TO STUDENTS THAT ARE INTERESTED IN NURSING CAREERS. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM: N/A SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT: TEXAS Schedule H, Part I, Line 3c Factors other than FPG determining free or discounted care: THE HOSPITAL USES THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE: - Medical Indigency X X false false false false false false false false false JIM BUCKNER INTERIM CEO 155296 0 10350 0 0 0 6182 0 4193 0 176021 0 0 0 FORM 990, PART VI, SECTION B, LINE 11B PROCESS TO REVIEW FORM 990: THE FORM 990 WAS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM FOLLOWING THE COMPLETION OF AN AUDIT OF THE FINANCIAL STATEMENTS. AN OFFICER REVIEWS THE RETURN PRIOR TO FILING. FORM 990, PART VI, SECTION B, LINE 12C PROCESS FOR MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY: EACH DIRECTOR, PRINCIPAL OFFICER AND BOARD COMMITTEE MEMBER ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS THAT THEY AGREE TO COMPLY WITH THE CONFLICT OF INTEREST POLICY. WHEN A POSSIBLE CONFLICT OF INTEREST ARISES, THE DIRECTOR OR OFFICER MUST DISCLOSE THE INTEREST AND RELATED FACTS. THE PERSON MUST LEAVE THE MEETING AND THE REST OF THE BOARD MUST DECIDE IF A CONFLICT OF INTEREST EXISTS. IF IT IS DECIDED THAT A CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON IS NOT ALLOWED TO PARTICIPATE IN DISCUSSION OR VOTE ON THE TRANSACTION OR ARRANGEMENT INVOLVED. FORM 990, PART VI, SECTION B, LINE 15A REVIEW OF CEO OR TOP MGMT OFFICIAL COMPENSATION: THE COMPENSATION OF THE CEO INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DECISION. FORM 990, PART VI, SECTION B, LINE 15B REVIEW OF COMPENSATION OF OTHER OFFICERS: THE CEO COMPLETES AN EVALUATION FORM FOR ALL OTHER OFFICERS AND MEETS WITH EACH INDIVIDUAL TO DISCUSS. THE SCORE OR POINTS ON THE EVALUATION DETERMINES THE PERCENTAGE OF ANY COMPENSATION ADJUSTMENTS. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF DOCUMENTS: THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICIES AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SERVICES TOTAL FEES:2369529 FORM 990 PART IX LINE 11G DESCRIPTION:OUTSIDE SERVICES TOTAL FEES:793466 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES TOTAL FEES:34188 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER SERVICES TOTAL FEES:186541 FORM 990 PART IX LINE 11G DESCRIPTION:CONSULTANT SERVICES TOTAL FEES:4563 DIMMIT REGIONAL HOSPITAL DISTRICT PO BOX 1016 CARRIZO SPRINGS TX 78834 271613078 LEASING TX GOVT N/a NA false false false false false true false false false false false true false false false false false false false false