2012-09-13T11:38:40-07:00 2012-03-31 TCA Partners LLP 1111 East Herndon Avenue Suite 211 Fresno CA 93720 990 2011-04-01 311750849 Colusa Regional Medical Center COLU 5304585821 199 East Webster Street Colusa CA 95932 Terrence Deak 2012-09-13 true Inger Sullenger CPA 5594317708 X 2011 2016-02-24 21:20:13Z Dale Kirby 199 East Webster Street Colusa CA 959322954 22302461 false false X www.colusamedicalcenter.org X 2001 CA Not-for-profit General Acute Care Hospital, with outlying primary care Rural Health Clinics 9 8 211 30 0 86014 133830 22521605 21107944 26833 27672 256237 1033015 22890689 22302461 0 0 11142191 11458591 0 0 10198796 10405504 21340987 21864095 1549702 438366 11217928 11086891 6716572 6147169 4501356 4939722 Not-for-profit General Acute Care Hospital, with outlying primary care Rural Health Clinics false false 15846201 21856790 The Hospital provides inpatient, outpatient, and emergency care services to patients in the surrounding community regardless of age, sex, religion, or ability to pay. 15846201 true true false false false false false false false false true false false false false false 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 false false false false false false false false true 47 0 true 211 true false false false false false false false false false false false 0 false false false false false false false false false false false X 9 8 true false false false false false false true true false false false true true true false true true true true false false X Terry Deak CFO 5304585821 199 East Webster Street Colusa CA 959322954 D'Ann Bressler 2.00 X 0 0 0 Sam Medrano MD 2.00 X 0 0 0 Marilyn Davison 2.00 X 0 0 0 Jan Gomes 2.00 X 0 0 0 Gary Teragawa 2.00 X 0 0 0 Nancy Newlin 2.00 X 0 0 0 Bob Kessinger 2.00 X 0 0 0 Ray Krause 2.00 X 0 0 0 Brady Myers 2.00 X 0 0 0 Terrence Deak 50.00 X 156339 0 23644 Katherine Hughes 50.00 X 145656 0 11665 Dale Kirby 50.00 X 234367 0 20242 Deborah Santivanez 40.00 X 149764 0 8686 Paul O'Rourke-Babb 40.00 X 144462 0 14134 Christine Gregory 40.00 X 135785 0 15607 Shirley Barnett 40.00 X 134185 0 11267 Karen Borm 40.00 X 120992 0 7238 1221550 112483 15 false true false Sodexho Dept 43283 Los Angeles CA 90088 Dietary Svcs 520431 North Valley Nephrology 1525 Plumas Court Ste B Yuba City CA 95991 Hospitalist Svcs 581400 Herbert Gladen MD 428 Sioc Street Colusa CA 95932 General Surgeon 275000 Burger Rehabilitation Services 1301 E Bidwell St Folsom CA 95630 Therapy Svcs 615015 Anesthesia IAG Services 1333 Cabana Way Victorville CA 92392 CRNA Anesthesia Svcs 373493 10 9567 124263 133830 Net Patient Service Rev 21107944 21107944 21107944 27672 27672 0 0 135320 135320 135320 135320 0 0 0 0 EMR Incentive Payment 748846 748846 Dietary,Pharm,Educ, Etc 148849 148849 897695 22302461 21856790 311841 0 0 0 0 536363 388733 147630 0 8432805 6111752 2321053 121648 88165 33483 1700828 1232691 468137 666947 483376 183571 0 9733 7054 2679 49946 36199 13747 0 0 0 1286375 932312 354063 54856 39757 15099 67780 49124 18656 0 0 644636 467206 177430 9550 6921 2629 0 10471 7589 2882 218552 158398 60154 0 616546 446847 169699 164070 118911 45159 Supplies 1640896 1189254 451642 Professional Fees 3059952 2217728 842224 Miscellaneous 103387 74931 28456 Equipment Rent & Maintenance 277219 200917 76302 Bad Debt 1962990 1422695 540295 228545 165641 62904 21864095 15846201 6017894 0 1713055 1346787 2031919 2135023 0 2148655 2374673 0 0 0 375861 357019 71089 75219 8824529 4026359 4875839 4798170 0 0 0 0 1510 0 11217928 11086891 2168388 1846598 4548184 4300571 6716572 6147169 X 4501356 4939722 4501356 4939722 11217928 11086891 438366 X false true true X false false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 4313064 1033046 3280018 4511465 2993313 1518152 4798170 22302461 21864095 438366 438366 22302461 22302461 22302461 21864095 21864095 21864095 true true X true X 125.000000000 true X true true false false false false 1994417 1994417 0.09120 1994417 1994417 0.09120 1994417 1994417 0.09120 7850 7850 0.00040 4450 4450 0.00020 11500 11500 0.00050 23800 23800 0.00110 true 1962990 318077 6640429 7641512 -1001083 X true true 1 0 Colusa Regional Medical Center

199 East Webster Street Colusa CA 959322954

X X X Colusa Regional Medical Center 1 false true true 125.0000 true 200.0000 true X X X X X X true true X X X true X X X true X X X X X X X true X true true 5 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 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 The Hospital's community board and management is committed to using surplus funds to improve access to care and improve or expand existing services offered throughout Colusa County. 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 The organization assesses health care needs of the communities it serves through patient and physician surveys, and input from community leaders, our community Board members, and other members of the community. Number of Hospital Faciltiy - 0 Part V, Line 21 - Charge Patients Amount Equal Gross Charge for Services Yes, patients are billed the gross charges if they do not qualify for discounted or charity care under our policies. Number of Hospital Faciltiy - 0 Part V, Line 20 - Explanation of Eligible Assistance Patients Billed More Than Insurance Rates Patients without insurance and under financial assistance were not charged more than those patients that did have insurance. 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 The entire shortfall should be considered as community benefit expenses as the the payments received from Medicare fell short of covering the actual cost of providing care. Part III, Line 4 - Bad Debt Expense The Hospital does not include a bad debt expense footnote in its financial statements, however there is a note describing charity care:Charity Care: The Hospital accepts all patients regardless of their ability to pay. A patient is classified as a charity patient by reference to certain established policies of the Hospital. Essentially, these policies define charity services as those services for which no payment is anticipated. Because the Hospital does not pursue collection of amounts determined to qualify as charity care, they are not reported as net patient service revenues. Services provided are recorded as gross patient service revenues and then written off entirely as an adjustment to net patient service revenues. X X X false false false false false false false false false false Terrence Deak 142642 13697 4196 19448 179983 175371 Paul O'Rourke-Babb 144462 14134 158596 149469 Katherine Hughes 145656 4185 7480 157321 154182 Deborah Santivanez 149764 650 8036 158450 144483 Dale Kirby 204813 29554 6021 14221 254609 253971 Christine Gregory 135785 1720 13887 151392 Sam Medrano MD Brd Mbr/ER Phys Contracted ER Physician false Brady Myers Brd Mbr/Ins Broker Brokered Ins to Hospital false 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. Sam Medrano, MD is a Board member of the Hospital, whom also serves as an ER physician of the Hospital. He is paid nothing directly from the Hospital, but the Hospital does pay a $15,000 monthly subsidy for ER coverage to his employer: Valley Emergency Physicians Medical Group. Likewise, he was considered a non-independent voting member of the Board until the Chief of Staff replacement arrived in January 1, 2012: Dr. Michael Goodman. As of the end of the year, Dr. Medrano was an independent voting board member and was listed as such on Form 990, part I. Form 990, Sch H, Part V, Section B, Lines 1-7 Please disregard the "No" response on line 1 of this section. The hospital chose not to answer the questions in this section (lines 1-7), as they are deemed optional for this year. However, the computer software automatically generates a "No" response to line 1, which should be disregarded. 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 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 15b 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 11 Form 990, Part VI, Line 11: 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 2 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. Sam Medrano, MD is a Board member of the Hospital, whom also serves as an ER physician of the Hospital. He is paid nothing directly from the Hospital, but the Hospital does pay a $15,000 monthly subsidy for ER coverage to his employer: Valley Emergency Physicians Medical Group. Likewise, he was considered a non-independent voting member of the Board until the Chief of Staff replacement arrived in January 1, 2012: Dr. Michael Goodman. As of the end of the year, Dr. Medrano was an independent voting board member and was listed as such on Form 990, part I.