2014-11-17T16:12:58-06:00 2013-12-31 752570395 DURBIN & COMPANY LLP 2950 50TH STREET LUBBOCK TX 79413 990 2013-01-01 273993262 COMANCHE COUNTY MEDICAL CENTER COMPANY COMA 2548794900 10201 STATE HIGHWAY 16 COMANCHE TX 764424462 DAVID FRESHOUR CFO 2548794900 2014-11-17 JONATHAN PHILLIPS P01605460 8067911591 2014-11-17 2013 2015-11-30 17:44:51Z DAVID FRESHOUR 10201 STATE HIGHWAY 16 COMANCHE TX 764424462 20562020 0 X WWW.COMANCHECMC.COM X 2010 TX TP PROVIDE COMPLETE AND QUALITY HEALTHCARE SERVICES TO THE CITIZENS OF COMANCHE COUNTY AND SURROUNDING AREAS. 5 4 158 0 0 0 84929 60414 18779560 19837565 155 228683 111324 435358 18975968 20562020 0 0 0 0 7286896 7492162 0 0 0 11492414 13707225 18779310 21199387 196658 -637367 5846261 5319236 6691310 6801652 -845049 -1482416 COMANCHE COUNTY MEDICAL CENTER IS COMMITTED TO COMMUNITY TRUST. WE PLEDGE TO PROVIDE QUALITY HEALTHCARE THROUGH CARING, EFFICIENT, RESPONSIVE, AND COURTEOUS SERVICE EVERYDAY - WHILE ADDRESSING THE EVER-CHANGING HEALTHCARE NEEDS OF THE PEOPLE WE SERVE. 0 0 19328845 20098403 GENERAL AND ACUTE HOSPITAL 19328845 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 92 0 158 1 0 0 0 0 0 0 0 0 X 5 4 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 1 1 1 0 X DAVID FRESHOUR 2548794900 10201 STATE HIGHWAY 16 COMANCHE TX 76442 JERRY MORGAN CHAIRMAN 0.50 X 0 0 0 MIKE HARE VICE CHAIRMAN 0.50 X 0 0 0 ROBERT PRATT SECRETARY 0.50 X 0 0 0 DWAYNE MILLER DIRECTOR 40.00 X 306960 0 0 PAUL MCKINZIE DIRECTOR 0.50 X 0 0 0 JIM CHRISTENSEN CEO 40.00 X 27359 0 0 KEVIN STOREY CEO (FORMER) 40.00 X 87363 0 0 DAVID FRESHOUR CFO 40.00 X 74695 0 0 RAMONA SLOAN CNO 40.00 X 86075 0 0 DAN HANCOCK PHARMACIST 40.00 X 123519 0 0 RACHEL HILLIARD NURSE PRACTITIONER 40.00 X 116472 0 0 WESLEY MAYR PHYSICIAN ASSISTANT 40.00 X 103245 0 0 PATRICK LOWTHER DIRECTOR OF RADIOLOGY 40.00 X 108247 0 0 1033935 0 0 5 0 1 0 XTEND HEALTHCARE 500 W MAIN ST STE 14 HENDERSONVILLE TN 37075 BUSINESS OFFICE 864788 GUYLE DONHAM DO 437 TIMBER CREEK STEPHENVILLE TX 76401 PHYSICIAN SERVICES 362821 COMANCHE PHYSICAL THERAPY PO BOX 130 DE LEON TX 76444 PHYSICAL THERAPY 332522 STEPHEN HOWARD DICKEY DO 200 CR 461 DE LEON TX 76444 PHYSICIAN SERVICES 321824 DWAYNE MILLER MD 6610 HIGHWAY 2318 COMANCHE TX 76442 PHYSICIAN SERVICES 306960 11 7065 53349 60414 NET PATIENT SERVICE 621990 19837565 19837565 19837565 2111 2111 4000 0 4000 4000 4000 226572 0 226572 226572 226572 ELECTRONIC HEALTH RECO 900099 183190 183190 DSRIP 900099 110839 110839 CAFETERIA 900099 43529 43529 93800 30266 63534 431358 20562020 20098403 0 403203 X 582452 393035 189417 5958269 5608345 349924 95571 95571 398379 398058 321 457491 411847 45644 15569 15569 194268 194268 9463 9463 4040356 3134295 906061 118954 61853 57101 189721 150712 39009 326425 326425 3526535 3514071 12464 10984 7674 3310 21243 19670 1573 198191 198191 763441 763441 135290 113050 22240 BAD DEBT 2001246 2001246 MEDICAL SUPPLIES 1401118 1400984 134 DUES & SUBSCRIPTIONS 626811 602767 24044 DIETARY 112381 112381 0 15229 15229 21199387 19328845 1870542 0 379685 1434522 7144 0 1985167 1735692 601327 603138 251028 139653 4431786 3514830 1464146 916956 1157764 489275 5846261 5319236 3591358 4656062 3100429 2146110 -477 -520 6691310 6801652 X -845049 -1482416 -845049 -1482416 5846261 5319236 -637367 0 X X 1 X 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 343266 42552 300714 3942756 3472278 470478 145764 145764 916956 DUE TO HOSPITAL FROM 335594 DUE FROM MEDICARE COST REPORT 25196 DUE FROM MEDICAID COST REPORT -103397 DUE TO/FROM CCPG -2118 OTHER RECEIVABLES 234000 489275 DUE TO/FROM B/AR -520 -520 X 18560774 1534859 1534859 17025915 3536105 3536105 20562020 19198141 1534859 1534859 17663282 3536105 3536105 21199387 PART X, LINE 2: PER AUDIT REPORT, "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: SELF PAY DEDUCTION (INCLUDED AS BAD DEBT ON FS) PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE PART XII, LINE 2D - OTHER ADJUSTMENTS: SELF PAY DEDUCTION (INCLUDED AS BAD DEBT ON FS) PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT EXPENSE 1 1 1 X 1 X 1 1 1 0 0 469684 732273 -262589 0.00000 1661375 697311 964064 0.04550 2131059 1429584 701475 0.04550 2131059 1429584 701475 0.04550 0 1050877 1521566 9293555 8640002 653553 X 1 1 1 1 COMANCHE COUNTY MEDICAL CENTER 10201 STATE HIGHWAY 16 COMANCHE TX 76442 X X X COMANCHE COUNTY MEDICAL CENTER 1 1 X X X X X X X X X 13 1 0 1 X WWW.COMANCHECMC.COM X X X X X X X 1 0 1 1 100.000000000000 1 200.000000000000 1 X X X X X X 1 1 X X X X X X 1 0 X X X X 1 X 0 0 COMANCHE COUNTY MEDICAL CENTER PART V, SECTION B, LINE 3: THE CHNA COMPLETED INCLUDED INPUT FROM INDIVIDUALS (INCLUDING PHYSICIANS) ON THE HOSPITAL'S BOARD OF DIRECTORS. COMANCHE COUNTY MEDICAL CENTER PART V, SECTION B, LINE 20D: THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE PATIENTS IS A PERCENTAGE OF AMOUNTS GENERALLY BILLED BASED ON A "LOOK-BACK" METHOD THAT IS DERIVED FROM THE NET PATIENT SERVICE REVENUE DETERMINED BY THE ANNUAL AUDIT REPORT. THE FINANCIAL ASSISTANCE POLICY ILLUSTRATES THE AMOUNT OF THE PERCENTAGE DISCOUNT THAT APPLIES TO INDIVIDUALS BASED ON A SLIDING FEE SCALE. SCHEDULE H, PART V, SECTION B, LINE 2 WE ARE A MEMBER OF THE REGIONAL HEALTHCARE PARTNERSHIP 11 IN THE STATE WHO HAS CONDUCTED AN AREA COMMUNITY NEEDS SURVEY. SCHEDULE H, PART V, SECTION B, LINE 14 THE MEDICAL CENTER POSTS NOTICE OF ITS CHARITY CARE PROGRAM AND HOW A PATIENT MAY APPLY FOR CHARITY CARE. SCHEDULE H, PART V, SECTION B, LINE 1 THE MEDICAL CENTER SERVES THE COMANCHE COUNTY WHICH IS AN AREA OF 948 SQUARE MILES. THE ESTIMATED POPULATION IN 2011 WAS 13,891, WITH A MEDIAN HOUSEHOLD INCOME OF $34,878. PART III, LINE 4: BAD DEBTS ARE INCLUDED AS A COMMUNITY BENEFIT BECAUSE THE HOSPITAL PROVIDES EMERGENCY AND MEDICALLY NECESSARY CARE TO PATIENTS REGARDLESS OF THE PATIENTS' ABILITY TO PAY.PER THE AUDITED FINANCIAL STATEMENTS, "THE HOSPITAL RECOGNIZES PATIENT SERVICE REVENUE ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY PAYER COVERAGE ON THE BASIS OF CONTRACTUAL RATES FOR THE SERVICES RENDERED. FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE HOSPITAL RECOGNIZES REVENUE ON THE BASIS OF ITS STANDARD RATES FOR SERVICES PROVIDED. ON THE BASIS OF HISTORICAL EXPERIENCE, A SIGNIFICANT PORTION OF THE HOSPITAL'S UNINSURED PATIENTS WILL BE UNABLE OR UNWILLING TO PAY FOR THE SERVICES PROVIDED. THUS, THE HOSPITAL HAS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS RELATED TO UNINSURED PATIENTS IN THE PERIOD THE SERVICES ARE PROVIDED. THIS PROVISION FOR UNCOLLECTIBLE ACCOUNTS IS PRESENTED ON THE STATEMENT OF OPERATIONS AND CHANGE IN NET ASSETS (DEFICIT) AS A COMPONENT OF OPERATING EXPENSES. PART III, LINE 8: 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. PART III, LINE 9B: IT IS THE POLICY OF CCMC TO DISTINGUISH CHARITY CARE FROM BAD DEBT EXPENSE. TO BE ELIGIBLE FOR CHARITY CARE AS A FINANCIALLY INDIGENT PATIENT, A PERSONS INCOME SHALL BE AT OR BELOW 100% OF THE FEDERAL POVERTY GUIDELINES. THE HOSPITAL MAY CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ELIGIBILITY. TO BE ELIGIBLE FOR CHARITY CARE AS A MEDICALLY INDIGENT PATIENT, THE AMOUNT OWED BY THE PATIENT ON THE HOSPITAL BILL AFTER PAYMENT BY THIRD-PARTY PAYERS MUST EXCEED 40% OF THE PATIENTS ANNUAL GROSS INCOME AND THE PATIENT MUST BE UNABLE TO PAY THE REMAINING BILL. THE HOSPITAL WILL CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ABILITY TO PAY.THE HOSPITAL WILL POST NOTICE OF ITS CHARITY CARE PROGRAM AND HOW THE PATIENT MAY APPLY FOR CHARITY CARE. THE BUSINESS OFFICE WILL ATTEMPT TO IDENTIFY ALL CASES THAT WILL QUALIFY AS CHARITY AT THE TIME OF ADMISSION. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CASES WILL BE ASKED TO COMPLETE A FINANCIAL ASSESSMENT FORM. THE BUSINESS OFFICE WILL TRANSFER THOSE PATIENTS WHO MAY QUALIFY FOR FINANCIAL ASSISTANCE FROM A GOVERNMENTAL PROGRAM TO THE APPROPRIATE PROGRAM, SUCH AS MEDICAID. PATIENTS WHO ARE ELIGIBLE FOR MEDICAID AND OTHER INDIGENT HEALTH CARE PROGRAMS DO NOT QUALIFY AS FINANCIALLY INDIGENT, BUT THE UNREIMBURSED COSTS OF PROVIDING SERVICES TO RECIPIENTS OF THESE PROGRAMS SHALL BE REPORTED AS GOVERNMENT-SPONSORED INDIGENT HEALTH CARE, AS SOON AS SUFFICIENT INFORMATION IS AVAILABLE CONCERNING THE PATIENTS FINANCIAL RESOURCES AND ELIGIBILITY FOR GOVERNMENTAL ASSISTANCE, A DETERMINATION WILL BE MADE CONCERNING THE PATIENTS ELIGIBILITY FOR CHARITY CARE. NO COLLECTION EFFORTS WILL BE PURSUED ON A CHARITY ACCOUNT AFTER SUCH DETERMINATION IS MADE. SCHEDULE H, PART VI, LINE 1 THE ORGANIZATION HAS A BOARD MADE UP OF VOLUNTEERS THAT REPRESENT THE COMMUNITY. ANNUALLY DURING HOSPITAL WEEK, WE PROVIDE A HEALTH FAIR AND INVITE HEALTH CARE VENDORS FROM ALL OVER THE AREA FOR INDIVIDUALS WHO ATTEND IT. AT THE HEALTH FAIR, WE OFFER TO ALL THOSE INTERESTED FREE LIPID PROFILES AND THROUGH THE VENDOR PARTNERS, THERE IS MANY OTHER FREE TESTING OFFERED AT THE EVENT AS WELL.WE ALSO HAVE EMPLOYEES WHO SPEAK AT VARIOUS EVENTS (CIVIC CLUBS, ETC.) OUR SOCIAL WORKERS WORK WITH THE PATIENTS FOR THEIR NEEDS INCLUDING NURSING HOME PLACEMENT, HOME HEALTH SERVICES, ETC. WE ALSO PROVIDE PATIENT EDUCATION MATERIAL (THROUGH A VENDOR WE CONTRACT WITH AND PAY) CONDUCT CPR AND OTHER CLASSES THAT INDIVIDUALS CAN ATTEND. WE PROVIDE FLU SHOTS TO VOLUNTEERS, FOUNDATION MEMBERS, BOARD MEMBERS, PHYSICIANS, EMPLOYEES, AND DISTRICT EMPLOYEES WHO WORK IN OUR BUILDING FREQUENTLY. WE ALSO OFFER FLU CLINICS FOR A NOMINAL CHARGE THAT JUST COVERS THE COST OF THE SHOT. WE PROVIDE FLU CLINICS FOR BUSINESSES WHEN THEY REQUEST IT TOO. WE PARTICIPATE IN THE RELAY FOR LIFE EACH YEAR AND SPONSOR THEIR PROGRAM. 0 0 0 0 0 0 0 0 0 DWAYNE MILLER DIRECTOR 306960 0 0 0 0 0 0 0 0 0 306960 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 THE TAX RETURN IS PREPARED BY AN INDEPENDENT, THIRD-PARTY ACCOUNTANT. THE ORGANIZATION'S MANAGEMENT REVIEWS THE RETURN FOR ACCURACY, AND THE ORGANIZATION'S BOARD OF DIRECTORS APPROVES THE RETURN PRIOR TO IT BEING FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C BOARD MEMBERS AND PHYSICIANS ARE REQUIRED TO DISCLOSE ANY ACTUAL OR POTENTIAL CONFLICT OF INTEREST THROUGH THE SUBMISSION OF THE CCMC STATEMENT OF DISCLOSURE OF OUTSIDE INTERESTS AND ACTIVITIES AS THEY ARISE. FORM 990, PART VI, SECTION B, LINE 15 IN 2013, CCMC BOARD OF DIRECTORS APPROVED CEO CONTRACT AND COMPENSATION THROUGH REVIEW AND APPROVAL, COMPARABILITY DATA, AND COMTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE PROCESS FOR DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS ALSO INCLUDES APPROVAL BY THE HOSPITAL'S CEO, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. FORM 990, PART VI, SECTION C, LINE 18 THE ORGANIZATIONAL DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATIONAL DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE MADE AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART IX, LINE 11G HOSPITAL PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,134,295. MANAGEMENT AND GENERAL EXPENSES 906,061. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,040,356. FORM 990, PART XII, LINE 2C: THE BOARD OF DIRECTORS ASSUMES OVERSIGHT OF THE AUDIT AND RESPONSIBILITY FOR THE SELCTION OF AN INDEPENDENT, THIRD-PARTY ACCOUNTANT. THIS PROCESS IS UNCHANGED FROM THE PRIOR YEAR. COMANCHE COUNTY HEALTHCARE FOUNDATION PO BOX 634 COMANCHE TX 76442 202373650 SUPPORT ORGANIZATION TX 501(C)(3) 11C 0 COMANCHE COUNTY PHYSICIAN'S GROUP 10201 HIGHWAY 16 NORTH COMANCHE TX 76442 272634085 MEDICAL SERVICES TX 501(C)(4) 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 COMANCHE COUNTY HEALTHCARE FOUNDATION C 20987 ACV