CROSBYTON CLINIC HOSPITAL: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- CROSBYTON CLINIC HOSPITAL (EIN 75-0711276)
- Tax period
- 2011-01-01 to 2011-12-31
- Filed
- 2012-11-13
- IRS object ID
- 201243189349303364
- Schema version
- 2011v1.3
- 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 | 2012-11-13T14:16:28-06:00 | Timestamp |
| Tax Period End Date | 2011-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 7901 Woodway Drive Suite 100 | AddressLine1 |
| City | Waco | City |
| State | TX | State |
| ZIP Code | 76712 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 750711276 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Crosbyton Clinic Hospital | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % DEBRA MILLER | InCareOfName |
| Name Control | CROS | NameControl |
| Phone | 8066752382 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 West Main Street | AddressLine1 |
| City | Crosbyton | City |
| State | TX | State |
| ZIP Code | 79322 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DEBRA MILLER | Name |
| Title | ADMINISTRATOR | Title |
| Date Signed | 2012-11-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Carol S McIntosh | Name |
| Phone | 2547768244 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Debra Miller | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 West Main Street | AddressLine1 |
| City | Crosbyton | City |
| State | TX | State |
| ZIP Code | 79322 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 5854513 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.crosbytonclinichospital.com | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1945 | YearFormation |
| State Legal Domicile | TX | StateLegalDomicile |
| Activity Or Mission Description | To provide healthcare to the citizens of Crosbyton and the surrounding area. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 6 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 6 | NbrIndependentVotingMembers |
| Total Nbr Employees | 107 | TotalNbrEmployees |
| Total Nbr Volunteers | 6 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 517321 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1568 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 6059907 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 5821608 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 77170 | InvestmentIncomePriorYear |
| Investment Income Current Year | 3148 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 28189 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 6654398 | TotalRevenuePriorYear |
| Total Revenue Current Year | 5854513 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 3129561 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 3149328 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 2970675 | OtherExpensePriorYear |
| Other Expenses Current Year | 2822126 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 6100236 | TotalExpensesPriorYear |
| Total Expenses Current Year | 5971454 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 554162 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -116941 | RevenuesLessExpensesCY |
| Total Assets BOY | 4007698 | TotalAssetsBOY |
| Total Assets EOY | 7057641 | TotalAssetsEOY |
| Total Liabilities BOY | 877148 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 4044032 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 3130550 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 3013609 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | SEE SCHEDULE O. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 5084774 | Expense |
| Grants | 0 | Grants |
| Revenue | 5821608 | Revenue |
| Description | Provided healthcare services to the citizens of Crosbyton and surrounding areas. Operated a 25 acute care bed hospital providing services that included 772 inpatient days; 41,284 procedures such as EKG/EEG, respiratory, radiology, laboratory and IV therapies; 5,328 physical, occupational and speech therapy visits; 2,582 emergency visits and 82 blood bank units used. The hospital provided charity care in the amount of $186,816 and the Rural Health Clinic logged 7,128 visits during the year. | Description |
| Total Program Service Expense | 5084774 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | 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 | true | ReportOtherAssets |
| Report Other Liabilities | true | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 | false | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| 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 | false | 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 | true | RelatedEntity |
| Related Org Controlled Entity | true | 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 | 51 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 107 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| 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 |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 6 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 6 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | 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 | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | 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 | DEBRA MILLER | NamePerson |
| Telephone Number | 8066758700 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 WEST MAIN STREET | AddressLine1 |
| City | CROSBYTON | City |
| State | TX | State |
| ZIP Code | 79322 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (8 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation |
|---|---|---|---|---|---|---|
| Danny Brooks Ellison | ||||||
| Chairman | 1.0 | X | X | 0 | 0 | 457 |
| Kelly Wing | ||||||
| Vice Chairman | 1.0 | X | X | 0 | 0 | 457 |
| Joan Burke Murray | ||||||
| Secretary | 1.0 | X | X | 0 | 0 | 229 |
| Bobby Max Ham | ||||||
| Director | 1.0 | X | 0 | 0 | 457 | |
| Lester Bownds | ||||||
| Director | 1.0 | X | 0 | 0 | 457 | |
| James Allen Adams | ||||||
| Director | 1.0 | X | 0 | 0 | 297 | |
| Debra Miller | ||||||
| Administrator | 40.0 | X | 64602 | 0 | 2645 | |
| Carolyn Dewbre | ||||||
| CNO | 40.0 | X | 78462 | 0 | 3376 | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 143064 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 8375 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | false | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| Steve Alley MD PA | |||||
| 536 S Ayrshire | CROSBYTON | TX | 79322 | ER Medical Services | 274320 |
| Covenant Medical Group | |||||
| 3420 22nd Place | LUBBOCK | TX | 79410 | Physician Services | 209629 |
| Concord | |||||
| PO Box 489 | MULESHOE | TX | 79347 | ER Physician Service | 316980 |
| Wael Qubti MD | |||||
| 16002 CR 1865 | LUBBOCK | TX | 79424 | ER Physician Service | 103870 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| All Other Contributions | 1568 | AllOtherContributions |
| Total Contributions | 1568 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT REVENUE | 623000 | 5556007 | 5556007 |
| OTHER OPERATING REVENUE | 900099 | 255940 | 255940 |
| RENTAL INCOME | 531190 | 9661 | 9661 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 5821608 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 3148 | TotalRevenueColumn |
| Exclusion | $3,148 | 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 |
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 | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| MISCELLANEOUS REVENUE | 621400 | 15837 | $15,837 |
| VENDING MACHINE | 722210 | 10614 | $10,614 |
| MEDICAL RECORDS | 561000 | 1738 | $1,738 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 28189 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5854513 | TotalRevenueColumn |
| Related Or Exempt Function Income | 5821608 | RelatedOrExemptFunctionIncome |
| Exclusion | $31,337 | ExclusionAmount |
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 | 68260 | Total |
| Management And General | 68260 | 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 | 2593663 | Total |
| Program Services | 2335128 | ProgramServices |
| Management And General | 258535 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5781 | Total |
| Program Services | 4625 | ProgramServices |
| Management And General | 1156 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 293715 | Total |
| Program Services | 234972 | ProgramServices |
| Management And General | 58743 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 187909 | Total |
| Program Services | 151606 | ProgramServices |
| Management And General | 36303 | 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 | 57917 | Total |
| Management And General | 57917 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
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 | 1122114 | Total |
| Program Services | 1052687 | ProgramServices |
| Management And General | 69427 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5235 | Total |
| Management And General | 5235 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 153122 | Total |
| Program Services | 126470 | ProgramServices |
| Management And General | 26652 | 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 | 143267 | Total |
| Program Services | 62419 | ProgramServices |
| Management And General | 80848 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 30992 | Total |
| Program Services | 27866 | ProgramServices |
| Management And General | 3126 | 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 | 1027 | Total |
| Program Services | 1027 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2722 | Total |
| Management And General | 2722 | ManagementAndGeneral |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72704 | Total |
| Management And General | 72704 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 38314 | Total |
| Management And General | 38314 | ManagementAndGeneral |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| BAD DEBT EXPENSE | 722123 | 722123 | |
| MEDICAL SUPPLIES | 365851 | 365851 | |
| MISCELLANEOUS | 106738 | 106738 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5971454 | Total |
| Program Services | 5084774 | ProgramServices |
| Management And General | 886680 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 178999 | BOY |
| EOY | 75207 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 813960 | BOY |
| EOY | 784369 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 564193 | BOY |
| EOY | 674780 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 116319 | BOY |
| EOY | 95793 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 22289 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 3866710 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3358451 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 569245 | BOY |
| EOY | 508259 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1764982 | BOY |
| EOY | 4896944 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4007698 | BOY |
| EOY | 7057641 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 378690 | BOY |
| EOY | 391378 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 365250 | BOY |
| EOY | 423870 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 65443 | BOY |
| EOY | 37225 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 67765 | BOY |
| EOY | 3191559 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 877148 | BOY |
| EOY | 4044032 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3130550 | BOY |
| EOY | 3013609 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3130550 | BOY |
| EOY | 3013609 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 4007698 | BOY |
| EOY | 7057641 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -116941 | ReconcilationRevenueExpenses |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $250 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 250 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Form990 Schedule C Part IV Form990ScheduleCPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | GRANTS FOR LOBBYING PURPOSES | Identifier |
| Return Reference | SCHEDULE C, PART II-B, LINE 1F | ReturnReference |
| Explanation | THE HOSPITAL PAYS DUES TO TORCH, A PORTION OF WHICH IS UTILIZED FOR LOBBYING: TORCH DUES $2,500 X 10% = $250 | Explanation |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 25570 | OtherCostOrOtherBasis |
| Book Value | 25570 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1875897 | OtherCostOrOtherBasis |
| Depreciation | 1497840 | Depreciation |
| Book Value | 378057 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 93666 | OtherCostOrOtherBasis |
| Depreciation | 119104 | Depreciation |
| Book Value | -25438 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1871577 | OtherCostOrOtherBasis |
| Depreciation | 1741507 | Depreciation |
| Book Value | 130070 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Land Buildings | OtherLandBuildings | |
| Total Of Book Value Land Buildings | 508259 | TotalOfBookValueLandBuildings |
Other Assets OtherAssets (6 entries)
| DescriptionDescription | Book ValueBookValue |
|---|---|
| DUE FROM CROSBYTON HEALTH SVCS | 4051467 |
| PATIENTS-OVERPYMNT REFUND ACCT | 7796 |
| OTHER RECEIVABLES | 3259 |
| PROPERTY TAX RECEIVABLE | 565160 |
| DUE FROM MEDICARE/MEDICAID | 238598 |
| DEPOSITS | 30664 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | 4896944 | TotalBookValueOtherAssets |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | DUE FROM AFFILIATES | Description |
| Amount | $3,191,559 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 3191559 | TotalOfAmounts |
| Total Revenue | 5854513 | TotalRevenue |
| Total Expenses | 5971454 | TotalExpenses |
| Excess Or Deficit For Year | -116941 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -116941 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 5132390 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 5132390 | RevenueSubtotal |
| Other Revenues Not Included | 722123 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 722123 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 5854513 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 5249331 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 5249331 | ExpensesSubtotal |
| Other Expenses Not Included | 722123 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 722123 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 5971454 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FIN 48 FOOTNOTE | SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| RECONCILIATION OF REVENUE PER AUDITED FINANCIALS TO FORM 990 | SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $722,123 -------------------------------- TOTAL $722,123 |
| RECONCILIATION OF EXPENSES PER AUDITED FINANCIALS TO FORM 990 | SCHEDULE D, PART XIII, LINE 4B | BAD DEBT EXPENSE $722,123 -------------------------------- TOTAL $722,123 |
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 |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCare |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | true | AnnualCommunityBenefitReport |
| Report Publically Available | true | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 110843 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 110843 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02630 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 674982 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 790321 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -115339 | NetCommunityBenefitExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 785825 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 790321 | DirectOffsettingRevenue |
| Net Community Benefit Expense | -4496 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02630 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2137 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 2137 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00050 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 698434 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 698434 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16570 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 700571 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 700571 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.16620 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1486396 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 790321 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 696075 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.19250 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $722,123 | BadDebtExpenseAmount |
| Amount Reimbursed By Medicare | 2549196 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 1932801 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 616395 | 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 | false | 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 | CROSBYTON CLINIC HOSPITAL | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 W MAIN STREET | AddressLine1 |
| City | CROSBYTON | City |
| State | TX | State |
| ZIP Code | 79322 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| 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 | CROSBYTON CLINIC HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| CHNA Conducted | false | CHNAConducted |
| Eligibility Criteria Explained | true | EligibilityCriteriaExplained |
| Uses FPG Free | true | UsesFPGFree |
| FPG Free Percent | 200. | FPGFreePercent |
| Uses FPG Discounted | false | UsesFPGDiscounted |
| 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 |
| State Regulation | X | StateRegulation |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| 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 |
| Used Other Method | X | UsedOtherMethod |
| 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 | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REEVES RHOADES TERRACE | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 640 SOUTH HARRISON | AddressLine1 |
| City | CROSBYTON | City |
| State | TX | State |
| ZIP Code | 79322 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | ASSISTED LIVING FACILITY | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| CHARITY CARE ELIGIBILITY CRITERIA | SCHEDULE H, PART I, LINE 3C | MEDICALLY INDIGENT PATIENTS ARE CONSIDERED FOR CHARITY CARE ON A CASE-BY-CASE BASIS AND BASED ON A PERCENTAGE OF THEIR INCOME. AN ASSET TEST IS ALSO USED TO DETERMINE ELIGIBLITY FOR CHARITY CARE. THE HOSPITAL DOES NOT OFFER DISCOUNTED CARE, ONLY FREE CHARITY CARE. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES USED FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $722,123. | |
| BAD DEBT EXPENSE | SCHEDULE H, PART III, SECTION A, LINE 4 | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR UNCOLLECTIBLE ACCOUNTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYER HAS NOT YET PAID, OR FOR PAYERS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION THAT AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ORGANIZATION'S ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR SELF-PAY PATIENTS INCREASED FROM 35% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2010, TO 70% OF SELF-PAY ACCOUNTS RECEIVABLE AT DECEMBER 31, 2011. IN ADDITION, THE ORGANIZATION'S PROVISION FOR BAD DEBTS INCREASED APPROXIMATELY $210,000 FROM APPROXIMATELY $510,000 FOR THE YEAR ENDED DECEMBER 31, 2010, TO APPROXIMATELY $720,000 FOR THE YEAR ENDED DECEMBER 31, 2011. BOTH INCREASES WERE THE RESULT OF NEGATIVE TRENDS EXPERIENCED IN THE COLLECTION OF AMOUNTS FROM SELF-PAY PATIENTS IN FISCAL YEARS 2011 AND 2010. |
| PROVISIONS ON COLLECTION PRACTICES FOR QUALIFIED PATIENTS | SCHEDULE H, PART III, SECTION C, LINE 9B | THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITY THROUGH CITY AND COUNTY WIDE MEETING WITH COMMUNITY LEADERS. |
| CRITERIA FOR DETERMINING ELIGIBILITY FOR DISCOUNTED CARE | SCHEDULE H, PART V, LINE 10 | MEDICALLY INDIGENT PATIENTS ARE CONSIDERED FOR CHARITY CARE ON A CASE-BY-CASE BASIS AND BASED ON A PERCENTAGE OF THEIR INCOME. AN ASSET TEST IS ALSO USED TO DETERMINE ELIGIBLITY FOR CHARITY CARE. THE HOSPITAL DOES NOT OFFER DISCOUNTED CARE, ONLY FREE CHARITY CARE. |
| OTHER MEANS HOSPITAL FACILITY PUBLICIZED THE POLICY | SCHEDULE H, PART V, LINE 13G | POSTED ON BULLETIN BOARD IN HOSPITAL AND CLINIC. |
| OTHER BILLING DETERMINATION OF INDIVIDUALS WITHOUT INSURANCE | SCHEDULE H, PART V, LINE 19D | ALL UNFUNDED PATIENTS ARE GIVEN A 40% DISCOUNT PRIOR TO SENDING STATEMENTS. |
| CHARGE PATIENTS AMOUNT EQUAL GROSS CHARGE FOR SERVICES | SCHEDULE H, PART V, LINE 21 | ALL PATIENTS ARE CHARGED THE SAME AMOUNT WHICH IS THE GROSS CHARGE AMOUNT. HOWEVER, UNFUNDED PATIENTS ARE GIVEN A DISCOUNT AT BILLING TIME. |
| NEEDS ASSESSMENT | SCHEDULE H, PART VI, LINE 2 | THE HOSPITAL ASSESSES THE NEEDS OF THE COMMUNITY THROUGH CITY AND COUNTY WIDE MEETING WITH COMMUNITY LEADERS. |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | SCHEDULE H, PART VI, LINE 3 | SIGNS ARE POSTED TO INFORM PATIENTS WHERE TO APPLY FOR INDIGENT ASSISTANCE. |
| COMMUNITY INFORMATION | SCHEDULE H, PARTY VI, LINE 4 | THE HOSPITAL SERVES THE RURAL COMMUNITY OF CROSBY, DICKENS, AND MOTLEY COUNTIES ALONG WITH A PORTION OF SEVERAL OTHER SURROUNDING COUNTIES. |
| PROMOTION OF COMMUNITY HEALTH | SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL FURTHERS ITS EXEMPT PURPOSE IN THE COMMUNITY BY PARTICIPATING IN COMMUNITY HEALTH FAIRS AND INFLUENZA VACCINE CLINICS. |
| AFFILIATED HEALTH CARE SYSTEM | SCHEDULE H, PART VI, LINE 6 | N/A |
| STATE FILING OF COMMUNITY BENEFIT REPORT | SCHEDULE H, PART VI, LINE 7 | TEXAS |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| MISSION STATEMENT | FORM 990, PART III, LINE 1 | WE BELIEVE THAT LIFE IS A GIFT FROM GOD. EACH PERSON'S LIFE IS OF GREAT VALUE AND DESERVES RESPECT IN ALL STAGES, FROM CONCEPTION UNTIL DEATH. WE ARE COMMITTED TO RESPECTING EACH PERSON AS AN IRREPLACEABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. THE PURPOSE OF CROSBYTON CLINIC HOSPITAL IS TO PROVIDE QUALITY HEALTH CARE SERVICES WHICH CONTRIBUTE TO THE WELL-BEING OF THE HOSPITAL'S RURAL SERVICE AREA. ALL THOSE ASSOCIATED WITH THE HOSPITAL IN SERVICE ARE COMMITTED TO TREATING PATIENTS, THEIR FAMILIES, OTHER HOSPITAL GUESTS AND EACH OTHER WITH DIGNITY AND RESPECT. EACH PATIENT WHO ENTERS OUR HOSPITAL FACILITY IS SERVED BY COMPETENT, CARING AND HELPFUL HEALTHCARE PROFESSIONALS. CROSBYTON CLINIC HOSPITAL SYMBOLIZES QUALITY CARE IN A CARING ENVIRONMENT. |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED BY AN INDEPENDENT ACCOUNTING FIRM. SENIOR MANAGEMENT CONSIDERS, COMPLETES AND FINALIZES ALL DOCUMENTATION BEFORE FILING. |
| CONFLICT OF INTEREST | 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. |
| COMPENSATION REVIEW & APPROVAL PROCESS FOR OFFICERS & KEY EMPLOYEES | FORM 990, PART VI, SECTION B, LINE 15A & 15B | 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. |
| AVAILABILITY OF DOCUMENTS | 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. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROSBYTON HEALTH SERVICES | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 710 WEST MAIN STREET | AddressLine1 |
| City | CROSBYTON | City |
| State | TX | State |
| ZIP Code | 79322 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 752916531 | EIN |
| Primary Activities | ASST. LIVING | PrimaryActivities |
| Legal Domicile State | TX | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 11A | PublicCharityStatus |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CCH | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Org | true | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | true | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | false | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CROSBYTON HEALTH SERVICES | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | D | TransactionType |
| Amount Involved | 859909 | AmountInvolved |
| Method Of Amt Determination | BOOK VALUE | MethodOfAmtDetermination |
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