Colusa Regional Medical Center: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- Colusa Regional Medical Center (EIN 31-1750849)
- Tax period
- 2012-04-01 to 2013-03-31
- Filed
- 2013-11-12
- IRS object ID
- 201313169349302856
- Schema version
- 2012v2.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-12T06:33:10-08:00 | Timestamp |
| Tax Period End Date | 2013-03-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TCA Partners LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1111 East Herndon Avenue Suite 211 | AddressLine1 |
| City | Fresno | City |
| State | CA | State |
| ZIP Code | 93720 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-04-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 311750849 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Colusa Regional Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COLU | NameControl |
| Phone | 5304585821 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 199 East Webster Street | AddressLine1 |
| City | Colusa | City |
| State | CA | State |
| ZIP Code | 95932 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Tish Miller | Name |
| Title | CFO | Title |
| Date Signed | 2013-11-12 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Inger Sullenger CPA | Name |
| PTIN | P01464277 | PTIN |
| Phone | 5595938767 | Phone |
| Self Employed | X | SelfEmployed |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Dale Kirby | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 199 East Webster Street | AddressLine1 |
| City | Colusa | City |
| State | CA | State |
| ZIP Code | 959322954 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 22791366 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| All Affiliates Included | false | AllAffiliatesIncluded |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.colusamedicalcenter.org | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2001 | YearFormation |
| State Legal Domicile | CA | StateLegalDomicile |
| Activity Or Mission Description | Not-for-profit General Acute Care Hospital, with outlying primary care Rural Health Clinics | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 220 | TotalNbrEmployees |
| Total Nbr Volunteers | 30 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 133830 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 104852 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 21107944 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 21343119 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 27672 | InvestmentIncomePriorYear |
| Investment Income Current Year | 42755 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 1033015 | OtherRevenuePriorYear |
| Other Revenue Current Year | 1300640 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 22302461 | TotalRevenuePriorYear |
| Total Revenue Current Year | 22791366 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 11458591 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 11682902 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 10405504 | OtherExpensePriorYear |
| Other Expenses Current Year | 8412751 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 21864095 | TotalExpensesPriorYear |
| Total Expenses Current Year | 20095653 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 438366 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2695713 | RevenuesLessExpensesCY |
| Total Assets BOY | 11086891 | TotalAssetsBOY |
| Total Assets EOY | 13647776 | TotalAssetsEOY |
| Total Liabilities BOY | 6147169 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 6012341 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 4939722 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7635435 | NetAssetsOrFundBalancesEOY |
| Mission Description | Not-for-profit General Acute Care Hospital, with outlying primary care Rural Health Clinics | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 16034475 | Expense |
| Revenue | 22369596 | Revenue |
| Description | The Hospital provides inpatient, outpatient, and emergency care services to patients in the surrounding community regardless of age, sex, religion, or ability to pay.The Hospital had 968 inpatient visits including skilled nursing, and 45,230 outpatient visits. | Description |
| Total Program Service Expense | 16034475 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | true | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | false | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBonds |
| Escrow Account | false | EscrowAccount |
| On Behalf Of Issuer | false | OnBehalfOfIssuer |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | true | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 39 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 220 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Form990-T Filed | false | Form990-TFiled |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Number Of8282 Filed | 0 | NumberOf8282Filed |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Form8899 Filed | false | Form8899Filed |
| Form1098 C Filed | false | Form1098CFiled |
| Excess Business Holdings | false | ExcessBusinessHoldings |
| Taxable Distributions | false | TaxableDistributions |
| Distribution To Donor | false | DistributionToDonor |
| Filed Lieu1041 | false | FiledLieu1041 |
| Licensed More Than One State | false | LicensedMoreThanOneState |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | false | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Tish Miller CFO | NamePerson |
| Telephone Number | 5304585821 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 199 East Webster Street | AddressLine1 |
| City | Colusa | City |
| State | CA | State |
| ZIP Code | 959322954 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (17 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|---|
| D'Ann Bressler | ||||||||
| Director/Found | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Michael Goodman MD | ||||||||
| Director/COS | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Marilyn Davison | ||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Jan Gomes | ||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Gary Teragawa | ||||||||
| Director | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Nancy Newlin | ||||||||
| Secretary | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Bob Kessinger | ||||||||
| Treasurer | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Ray Krause | ||||||||
| Vice President | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Brady Myers | ||||||||
| President | 2.00 | 0.00 | X | 0 | 0 | 0 | ||
| Terrence Deak | ||||||||
| CFO | 50.00 | 0.00 | 165043 | 0 | 24676 | X | ||
| Katherine Hughes | ||||||||
| CNO | 50.00 | 0.00 | 150485 | 0 | 12028 | X | ||
| Dale Kirby | ||||||||
| CEO | 50.00 | 0.00 | 228604 | 0 | 19212 | X | ||
| Deborah Santivanez | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | 150298 | 0 | 8505 | X | ||
| Paul O'Rourke-Babb | ||||||||
| Nurse Practitioner | 40.00 | 0.00 | 139736 | 0 | 14633 | X | ||
| Christine Gregory | ||||||||
| Registered Nurse | 40.00 | 0.00 | 129429 | 0 | 14735 | X | ||
| Shirley Barnett | ||||||||
| Registered Nurse | 40.00 | 0.00 | 126624 | 0 | 11392 | X | ||
| Addie McFadden | ||||||||
| Registered Nurse | 40.00 | 0.00 | 125888 | 0 | 7506 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1216107 | TotalReportableCompFromOrg |
| Total Other Compensation | 112687 | TotalOtherCompensation |
| Number Individuals GT100 K | 18 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Herbert Gladen MD | |||||
| 428 Sioc Street | Colusa | CA | 95932 | General Surgeon | 356000 |
| Sodexho | |||||
| Dept 43283 | Los Angeles | CA | 90088 | Dietary Svcs | 395381 |
| NPH Medical Services | |||||
| 2639 Forest Ave Ste 110 | Chico | CA | 95928 | Registry Services | 208234 |
| Burger Rehabilitation Services | |||||
| 1301 E Bidwell St | Folsom | CA | 95630 | Therapy Svcs | 605810 |
| Anesthesia IAG Services | |||||
| 1333 Cabana Way | Victorville | CA | 92392 | CRNA Anesthesia Svcs | 418051 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 11 | NumberOfContractorsGT100K |
| Government Grants | 45486 | GovernmentGrants |
| All Other Contributions | 59366 | AllOtherContributions |
| Total Contributions | 104852 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Net Patient Service Rev | Description |
| Total Revenue Column | 21343119 | TotalRevenueColumn |
| Related Or Exempt Function Income | 21343119 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 21343119 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 42755 | TotalRevenueColumn |
| Exclusion | $42,755 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 144265 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 144265 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 144265 | TotalRevenueColumn |
| Exclusion | $144,265 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount |
|---|---|---|---|
| Miscelleanous Operating | 17277 | 17277 | |
| EMR Incentive Payment | 1009200 | 1009200 | |
| Dietary,Pharm,Educ, Etc | 129898 | $129,898 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 1156375 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 22791366 | TotalRevenueColumn |
| Related Or Exempt Function Income | 22369596 | RelatedOrExemptFunctionIncome |
| Exclusion | $316,918 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | X | InfoInScheduleOPartIX |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 544132 | Total |
| Program Services | 434167 | ProgramServices |
| Management And General | 109965 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8521244 | Total |
| Program Services | 6799166 | ProgramServices |
| Management And General | 1722078 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 118660 | Total |
| Program Services | 94680 | ProgramServices |
| Management And General | 23980 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1762900 | Total |
| Program Services | 1406631 | ProgramServices |
| Management And General | 356269 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 735966 | Total |
| Program Services | 587233 | ProgramServices |
| Management And General | 148733 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 39577 | Total |
| Program Services | 31579 | ProgramServices |
| Management And General | 7998 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49908 | Total |
| Program Services | 39822 | ProgramServices |
| Management And General | 10086 | ManagementAndGeneral |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2289007 | Total |
| Program Services | 1826416 | ProgramServices |
| Management And General | 462591 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35182 | Total |
| Program Services | 28072 | ProgramServices |
| Management And General | 7110 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 82065 | Total |
| Program Services | 65480 | ProgramServices |
| Management And General | 16585 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 677088 | Total |
| Program Services | 540254 | ProgramServices |
| Management And General | 136834 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 10051 | Total |
| Program Services | 8020 | ProgramServices |
| Management And General | 2031 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14105 | Total |
| Program Services | 11254 | ProgramServices |
| Management And General | 2851 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 212512 | Total |
| Program Services | 169565 | ProgramServices |
| Management And General | 42947 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 632186 | Total |
| Program Services | 504426 | ProgramServices |
| Management And General | 127760 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 145295 | Total |
| Program Services | 115932 | ProgramServices |
| Management And General | 29363 | ManagementAndGeneral |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| Miscellaneous | 165424 | 131993 | 33431 |
| Equipment Rent & Maintenance | 285409 | 227730 | 57679 |
| Supplies | 1648626 | 1315451 | 333175 |
| Professional Fees | 1956477 | 1561088 | 395389 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 169839 | Total |
| Program Services | 135516 | ProgramServices |
| Management And General | 34323 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20095653 | Total |
| Program Services | 16034475 | ProgramServices |
| Management And General | 4061178 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1346787 | BOY |
| EOY | 3187940 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2135023 | BOY |
| EOY | 2402444 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2374673 | BOY |
| EOY | 2182246 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 357019 | BOY |
| EOY | 354052 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75219 | BOY |
| EOY | 85483 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 9940067 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4658544 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4798170 | BOY |
| EOY | 5281523 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 154088 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11086891 | BOY |
| EOY | 13647776 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1846598 | BOY |
| EOY | 1503426 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4300571 | BOY |
| EOY | 4508915 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6147169 | BOY |
| EOY | 6012341 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4939722 | BOY |
| EOY | 7635435 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4939722 | BOY |
| EOY | 7635435 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 11086891 | BOY |
| EOY | 13647776 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 2695713 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Separate | X | FinancialStatementSeparate |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5177745 | OtherCostOrOtherBasis |
| Depreciation | 1211115 | Depreciation |
| Book Value | 3966630 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4762322 | OtherCostOrOtherBasis |
| Depreciation | 3447429 | Depreciation |
| Book Value | 1314893 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 5281523 | TotalOfBookValueLandBuildings |
| Tot Revenue Etc Audited Fincl Stmt | 22791366 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 22791366 | RevenueSubtotal |
| Total Revenue Per Form990 | 22791366 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 20095653 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 20095653 | ExpensesSubtotal |
| Total Expenses Per Form990 | 20095653 | TotalExpensesPerForm990 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Unable To Provide Care | false | UnableToProvideCare |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
| Report Publically Available | false | ReportPublicallyAvailable |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2115215 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2115215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10530 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2115215 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2115215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10530 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2115215 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2115215 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10530 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 7500 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 7500 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4250 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4250 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 6400 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 6400 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 18150 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 18150 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00090 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $2,089,274 | BadDebtExpenseAmount |
| Amount Attributable To | 267525 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 7001210 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 7629528 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -628318 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Colusa Regional Medical Center | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 199 East Webster Street | AddressLine1 |
| City | Colusa | City |
| State | CA | State |
| ZIP Code | 959322954 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Colusa Regional Medical Center | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | true | CHNAConducted |
| Community Definition | X | CommunityDefinition |
| Community Demographics | X | CommunityDemographics |
| Existing Resources | X | ExistingResources |
| How Data Obtained | X | HowDataObtained |
| Community Health Needs | X | CommunityHealthNeeds |
| Other Health Issues | X | OtherHealthIssues |
| Identifying Process | X | IdentifyingProcess |
| Consulting Process | X | ConsultingProcess |
| Information Gaps | X | InformationGaps |
| Needs Assessment Conducted | 12 | NeedsAssessmentConducted |
| Take Into Account | true | TakeIntoAccount |
| Other Facilities | true | OtherFacilities |
| CHNA Widely Available | true | CHNAWidelyAvailable |
| Own Website | X | OwnWebsite |
| On Request | X | OnRequest |
| Adopt Implement Strategy | X | AdoptImplementStrategy |
| Execute Implement Strategy | X | ExecuteImplementStrategy |
| Include Operational Plans | X | IncludeOperationalPlans |
| Adopt Budget | X | AdoptBudget |
| Prioritize Health Needs | X | PrioritizeHealthNeeds |
| Prioritize Services | X | PrioritizeServices |
| All Needs Addressed | false | AllNeedsAddressed |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTax |
| File Form4720 Report Excise Tax | false | FileForm4720ReportExciseTax |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 125.0000 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 200.0000 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Asset Level | X | AssetLevel |
| Medical Indigency | X | MedicalIndigency |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Permit Report To Credit Agency | X | PermitReportToCreditAgency |
| Permit Lawsuit | X | PermitLawsuit |
| Permit Lien On Residence | X | PermitLienOnResidence |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Notify Upon Admission | X | NotifyUponAdmission |
| Notify Before Discharge | X | NotifyBeforeDischarge |
| Notified All Patients | X | NotifiedAllPatients |
| Documented Determination | X | DocumentedDetermination |
| Nondiscrim Emergency Care Policy | true | NondiscrimEmergencyCarePolicy |
| Medicare Rate | X | MedicareRate |
| Amounts Generally Billed | false | AmountsGenerallyBilled |
| Gross Charges | false | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 5 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (5 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| Colusa Specialty Clinic | ||||
| 2967 Davison Ct Ste A | Colusa | CA | 95932 | Outpatient Specialty & Indust Med Clinic |
| Williams Urgent Care & Med Ctr | ||||
| 501 E St Ste B | Williams | CA | 95987 | Rural Health Clinic |
| Stonyford Rural Health Clinic | ||||
| 5080 Stonyford-Lodoga Rd | Stonyford | CA | 95979 | Rural Health Clinic |
| Colusa Health Clinic | ||||
| 151 E Webster St | Colusa | CA | 95932 | Rural Health Clinic |
| Arbuckle Medical Office | ||||
| 900 King St | Arbuckle | CA | 95912 | Rural Health Clinic |
Form990 Schedule H Part VI Form990ScheduleHPartVI (13 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Part VI - Additional Information | N/A | |
| Part V - Explanation of Number of Facility Type | Besides the main hospital consisting of 42 beds, we also operate a 6 bed skilled nursing facility on our main campus; as well as 4 licensed rural health clinics; and a specialty and industrial medicine clinic, in surrounding communities throughout Colusa County. | |
| Part VI - Affilated Health Care System Roles and Promotion | N/A | |
| Part VI - Explanation Of How Organization Furthers Its Exempt Purpose | Our community board and management is committed to using surplus funds to improve access to care and improve or expand services offered throughout Colusa County. Our Community Board is open to all members of the public who wish to join. | |
| Part VI - Community Building Activities | Community building activities are generally provided to educate the community on health related issues, illness prevention, and free/discounted services to assess health and patient needs. | |
| Part VI - Community Information | Colusa Regional Medical Center serves the healthcare needs of the residents of Colusa County. We are largely a farming community, with about 30% of the population being Hispanic. A focus of the services we offer is to provide the medical services for this underserved population in our County. | |
| Part VI - Patient Education of Eligibility for Assistance | Patients are educated and informed about their eligibility for assistance through the prominent posting in each registration area, printing on the bill that is sent to patients, and other posted notices about the counseling available at the Hospital. | |
| Part VI - Needs Assessment | Mailed 800 stratified randomly sampled surveys, with 134 surveys returned for an 18% response rate. Conducted 4 focus groups: business/community leaders; health care providers; seniors; and, young parents. Also administered secondary data analysis and compared Colusa County to Glenn County and Lake County, California and the Nation on population rates, education and workforce rates, income rates, behavioral rist factors of adults and Hospital Compare.Other input is received on an ongoing basis through patient and physician surveys, and input from community leaders, our community Board members, and members of the community. | |
| Part V, Line 7 - Explanation of Needs Not Addressed and Reasons Why | Many of the needs have been and/or are being addressed in our strategic plan, goals and objectives for the current year. The needs were prioritized, and those with a high priority rose to the top to be addressed. Some needs are not currently being addressed due to: determined not to be a priority; lack of urgency; lack of hospital resources to sufficiently address; or financially unfeasible at this time. | Number of Hospital Faciltiy - 1 |
| Part V, Line 4 - List Other Hospital Facilities that Jointly Conducted Needs Assessment | N/A | Number of Hospital Faciltiy - 1 |
| Part V, Line 3 - Account Input from Person Who Represent the Community | Mailed 800 stratified randomly sampled surveys, with 134 surveys returned for an 18% response rate. Conducted 4 focus groups: business/community leaders; health care providers; seniors; and, young parents. Also administered secondary data analysis and compared Colusa County to Glenn County and Lake County, California and the Nation on population rates, education and workforce rates, income rates, behavioral rist factors of adults and Hospital Compare. | Number of Hospital Faciltiy - 1 |
| Part III, Line 9b - Provisions On Collection Practices For Qualified Patients | Policies state that collection efforts are to cease when a patient has qualified, or is in process of being qualified, for charity care. | |
| Part III, Line 8 - Explanation Of Shortfall As Community Benefit | Entire shortfall is attributable to community benefit, as the payments received from Medicare fell short of covering the actual cost of providing care. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | X | WrittenEmploymentContract |
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
| Rebuttable Presumption Procedure | false | RebuttablePresumptionProcedure |
Form990 Schedule J Part II Form990ScheduleJPartII (5 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg |
|---|---|---|---|---|---|
| Terrence Deak | |||||
| CFO | 150907 | 14136 | 4433 | 20243 | 189719 |
| Paul O'Rourke-Babb | |||||
| Nurse Practitioner | 139736 | 14633 | 154369 | ||
| Katherine Hughes | |||||
| CNO | 147485 | 3000 | 4229 | 7799 | 162513 |
| Deborah Santivanez | |||||
| Nurse Practitioner | 150298 | 650 | 7855 | 158803 | |
| Dale Kirby | |||||
| CEO | 198313 | 30291 | 5679 | 13533 | 247816 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | Sch J, Part III, Additional Information | Identifier |
| Return Reference | Part III, Additional Information | ReturnReference |
| Explanation | Bonus compensation was paid in accordance with employment agreements, based on benchmarks reached. Compensation surveys are reviewed to ensure that overall compensation levels are comparable with salaries paid in the healthcare industry. | Explanation |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | Brady Myers | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | Brd Mbr/Ins Broker | Relationship |
| Amount Of Transaction | 104377 | AmountOfTransaction |
| Description Of Transaction | Brokered Ins to Hospital | DescriptionOfTransaction |
| Sharing Of Revenues | false | SharingOfRevenues |
Form990 Schedule L Part V Form990ScheduleLPartV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Explanation | Brady Myers is a Board member of the Hospital, whom also brokers insurance to the Hospital. Although, he is paid nothing from the Hospital, he does receive a commission on the brokering of Hospital insurance via Insurance companies. The commission received from insurance companies related to the brokerage of insurance to the Hospital for 2012/2013 fiscal, was: $104,377. Therefore, Brady Myers was considered a non-independent voting member of the Board and listed as such on Form 990, part I. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (6 entries)
| Return ReferenceReturnReference | ExplanationExplanation | IdentifierIdentifier |
|---|---|---|
| Form 990, Part IX, Column (D), Fundraising Exps | The Hospital has both a Foundation and Auxiliary that generate some contribution revenue. They in turn donate their monies to Colusa Regional Medical Center (CRMC). Both the Foundation and Auxiliary are totally separate 501c3 entities from CRMC, and the Hospital does not pay any salaries or expenses for them. The Hospital has no staff or expenses currently, who are dedicated to supporting fundraising efforts or functions. Thus, there are no expenses that have been classified as "fundraising." | |
| Form 990, Part VI, Line 19: Other Organization Documents Publicly Available | Documents are all housed in Hospital Administration, and available upon request to the public. | Form 990, Part VI, Line 19 |
| Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees | The CEO reviews compensation surveys before adjusting salaries of officers of the organization. | Form 990, Part VI, Line 15b |
| Form 990, Part VI, Line 15a: Compensation Review & Approval Process - CEO, Top Management | Comparative Hospital compensation data is provided to the Board prior to determining adjustments to the CEO salary. | Form 990, Part VI, Line 15a |
| Form 990, Part VI, Line 11b: Form 990 Review Process | The 990 is reviewed and approved by management before filing, and a copy is available for the Board to review. | Form 990, Part VI, Line 11b |
| Form 990, Part VI, Line 2: Description of Business or Family Relationship of Officers, Directors, Et | Brady Myers is a Board member of the Hospital, whom also brokers insurance to the Hospital. Although, he is paid nothing from the Hospital, he does receive a commission on the brokering of Hospital insurance via Insurance companies. Therefore, he was considered a non-independent voting member of the Board and listed as such on Form 990, part I. | Form 990, Part VI, Line 2 |
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