2014-11-08T13:29:55-06:00 2013-12-31 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2013-01-01 750711276 CROSBYTON CLINIC HOSPITAL CROS 8066752382 710 WEST MAIN STREET CROSBYTON TX 79322 DEBRA MILLER ADMINISTRATOR 8066752382 2014-11-08 JONATHAN PHILLIPS P01605460 8067911591 2014-10-07 2013 2015-11-30 17:44:51Z DEBRA MILLER 710 WEST MAIN STREET CROSBYTON TX 79322 7069245 0 X WWW.CROSBYTONCLINICHOSPITAL.COM X 1945 TX TO PROVIDE HEALTHCARE TO THE CITIZENS OF CROSBY COUNTY AND THE SURROUNDING AREAS. 6 6 103 0 0 0 1078 130420 5006428 5611571 2478 6033 842699 1266621 5852683 7014645 0 0 0 0 2995977 3197267 0 0 0 2895249 2927370 5891226 6124637 -38543 890008 7628153 4774740 4653087 909666 2975066 3865074 SEE SCHEDULE O 0 0 5660741 6879392 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. HOSPITAL PATIENT DAYS WERE 593 AND SWING BED DAYS WERE 685. IN 2013, THE HOSPITAL PERFORMED 60,449 LAB PROCEDURES, 4,097 RADIOLOGY PROCEDURES, AND 4,097 PHYSICAL THERAPY PROCEDURES. OUR RURAL HEALTH CLINIC LOGGED 6,908 VISITS AND OUR EMERGENCY ROOM SAW 2,525 PATIENTS. 5660741 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 0 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 65 0 103 1 0 0 0 0 0 0 0 0 0 0 0 0 X 6 6 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 TX X DEBRA MILLER 8066758700 710 WEST MAIN STREET CROSBYTON TX 79322 DANNY BROOKS ELLISON CHAIRMAN 1.00 X X 0 0 457 KELLY WING VICE CHAIRMAN 1.00 X X 0 0 457 JOAN BURKE MURRAY SECRETARY 1.00 X X 0 0 229 BOBBY MAX HAM DIRECTOR 1.00 X 0 0 457 LESTER BOWNDS DIRECTOR 1.00 X 0 0 377 JAMES ALLEN ADAMS DIRECTOR 1.00 X 0 0 297 DEBRA MILLER ADMINISTRATOR 40.00 X 67998 0 2900 RUTH E STALLARD NURSE PRACTITIONER 40.00 X 101908 0 0 169906 0 5174 1 0 0 0 CONCORD PO BOX 489 MULESHOE TX 79347 ER MEDICAL 299108 STEVE ALLEY MD PA 536 S AYRSHIRE CROSBYTON TX 79322 PHYSICIAN SERVICES 272880 WAEL QUBTI MD 16002 CR 1865 LUBBOCK TX 79424 ER MEDICAL 116390 3 50000 80420 130420 NET PATIENT REVENUE 623000 5611571 5611571 5611571 4833 4833 9661 0 9661 9661 9661 55800 54600 1200 1200 1200 UPL REVENUE 621990 642000 642000 340B REVENUE 621990 586564 586564 MISCELLANEOUS REVENUE 621400 27218 27218 1178 1178 1256960 7014645 6879392 0 4833 X 2581030 2369777 211253 6654 6654 402775 402775 206808 182234 24574 58558 58558 1030670 990016 40654 7021 7021 133427 90583 42844 171078 171078 16015 16015 587 587 283 283 279322 279322 77445 77445 MEDICAL SUPPLIES 374539 374539 BAD DEBT 354344 354344 340B PROGRAM EXPENSE 308901 308901 BUSINESS OFFICE COLLECT 71329 71329 43851 29167 14684 6124637 5660741 463896 0 279661 284846 1147574 1515547 778203 1153931 91367 97133 49113 49113 4587111 3622289 496145 964822 4786090 709348 7628153 4774740 644129 300666 15893 609000 3993065 0 4653087 909666 X 2975066 3865074 2975066 3865074 7628153 4774740 890008 0 X X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 25248 25248 1961907 1637067 324840 737887 279674 458213 1862069 1705548 156521 964822 DUE FROM CROSBYTON HEALTH SERVICES 695256 PATIENTS OVERPAYMENT REFUND ACCOUNT 10131 OTHER RECEIVABLES 3961 709348 X 6991938 331637 331637 6660301 354344 354344 7014645 6041464 271171 271171 5770293 354344 354344 6124637 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 331,637. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 354,344. PART XII, LINE 2D - OTHER ADJUSTMENTS: CROSBYTON HEALTH SERVICES CORPORATION EXPENSES 271,171. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 354,344. 1 1 X 1 X 0 1 1 0 1 1 259915 192415 67500 0.01100 607303 1110271 -502968 0.00000 867218 1302686 -435468 0.01100 867218 1302686 -435468 0.01100 1 231110 225827 1788632 3248867 -1460235 X 1 0 1 1 CROSBYTON CLINIC HOSPITAL 710 WEST MAIN STREET CROSBYTON TX 79322 X X X X CROSBYTON CLINIC HOSPITAL 1 1 X X X X X X X X X 13 1 0 1 X HTTP://WWW.CROSBYTONCLINICHOSPITAL.COM/ X X X X X X 0 0 1 1 200.000000000000 0 1 X X X X X X X 1 1 X X X 1 X 0 X X X X 1 X 0 0 CROSBYTON CLINIC HOSPITAL PART V, SECTION B, LINE 3: 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 7: 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 REEVES RHOADES TERRACE 640 SOUTH HARRISON CROSBYTON TX 79322 ASSISTED LIVING FACILITY 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 THE ORGANIZATION MAKES ITS FORM 1023 AND FORM 990 AVAILABLE TO THE PUBLIC UPON REQUEST. 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 EMS PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 94,439. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 94,439. HOSPITAL PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 895,577. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 895,577. HOME OFFICE PROFESSIONAL SERVICES: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 40,654. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 40,654. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT, REVIEW, AND COMPILATION OF ITS FINANCIAL STATEMENTS AND THE SELECTION OF AN INDEPENDENT ACCOUNTANT. THIS PROCESS IS NOT CHANGES FROM THE PRIOR YEAR. 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 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CROSBYTON HEALTH SERVICES D 1459986 ACV CROSBYTON HEALTH SERVICES E 764730 ACV