2012-11-13T14:16:28-06:00 2011-12-31 BKD LLP 7901 Woodway Drive Suite 100 Waco TX 76712 990 2011-01-01 750711276 Crosbyton Clinic Hospital % DEBRA MILLER CROS 8066752382 710 West Main Street Crosbyton TX 79322 DEBRA MILLER 2012-11-15 true Carol S McIntosh 2547768244 2011 2016-02-24 21:20:13Z Debra Miller 710 West Main Street Crosbyton TX 79322 5854513 false X www.crosbytonclinichospital.com X 1945 TX To provide healthcare to the citizens of Crosbyton and the surrounding area. 6 6 107 6 0 0 517321 1568 6059907 5821608 77170 3148 0 28189 6654398 5854513 0 0 0 0 3129561 3149328 0 0 0 2970675 2822126 6100236 5971454 554162 -116941 4007698 7057641 877148 4044032 3130550 3013609 X SEE SCHEDULE O. false false 5084774 0 5821608 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. 5084774 true false false true false false false false false false true false false true true false false true false false false false false false false false true true false false false false false false false false false false false false false false false false true true false false false true 51 0 true 107 true false false false false false false false false false false X 6 6 false false false false false false false true true false false false true true true true true true true false X DEBRA MILLER 8066758700 710 WEST MAIN STREET CROSBYTON TX 79322 Danny Brooks Ellison 1.0 X X 0 0 457 Kelly Wing 1.0 X X 0 0 457 Joan Burke Murray 1.0 X X 0 0 229 Bobby Max Ham 1.0 X 0 0 457 Lester Bownds 1.0 X 0 0 457 James Allen Adams 1.0 X 0 0 297 Debra Miller 40.0 X 64602 0 2645 Carolyn Dewbre 40.0 X 78462 0 3376 143064 0 8375 0 false false false 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 4 1568 1568 NET PATIENT REVENUE 623000 5556007 5556007 OTHER OPERATING REVENUE 900099 255940 255940 RENTAL INCOME 531190 9661 9661 5821608 3148 3148 0 0 0 0 0 0 MISCELLANEOUS REVENUE 621400 15837 15837 VENDING MACHINE 722210 10614 10614 MEDICAL RECORDS 561000 1738 1738 28189 5854513 5821608 31337 0 0 0 0 68260 68260 0 2593663 2335128 258535 5781 4625 1156 293715 234972 58743 187909 151606 36303 0 57917 57917 0 0 0 0 1122114 1052687 69427 5235 5235 153122 126470 26652 0 0 143267 62419 80848 30992 27866 3126 0 1027 1027 2722 2722 0 72704 72704 38314 38314 BAD DEBT EXPENSE 722123 722123 MEDICAL SUPPLIES 365851 365851 MISCELLANEOUS 106738 106738 5971454 5084774 886680 0 178999 75207 813960 784369 0 0 564193 674780 0 0 0 0 0 0 116319 95793 0 22289 3866710 3358451 569245 508259 0 0 0 0 0 0 0 0 1764982 4896944 4007698 7057641 378690 391378 0 0 365250 423870 0 0 0 0 0 0 65443 37225 0 0 67765 3191559 877148 4044032 X 3130550 3013609 0 0 0 0 3130550 3013609 4007698 7057641 -116941 X false true true X false X false false false false false true 250 false false false 250 false GRANTS FOR LOBBYING PURPOSES SCHEDULE C, PART II-B, LINE 1F THE HOSPITAL PAYS DUES TO TORCH, A PORTION OF WHICH IS UTILIZED FOR LOBBYING: TORCH DUES $2,500 X 10% = $250 25570 25570 1875897 1497840 378057 93666 119104 -25438 1871577 1741507 130070 508259 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 4896944 0 DUE FROM AFFILIATES 3191559 3191559 5854513 5971454 -116941 -116941 5132390 5132390 722123 722123 5854513 5249331 5249331 722123 722123 5971454 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 true true X true X false true true false true true 110843 110843 0.02630 674982 790321 -115339 785825 790321 -4496 0.02630 2137 2137 0.00050 698434 698434 0.16570 700571 700571 0.16620 1486396 790321 696075 0.19250 true 722123 2549196 1932801 616395 X true false 1 1 CROSBYTON CLINIC HOSPITAL

710 W MAIN STREET CROSBYTON TX 79322

X X X X CROSBYTON CLINIC HOSPITAL 1 false true true 200. false true X X X X X X X true true X X X true false X X X X true X false false 1 REEVES RHOADES TERRACE

640 SOUTH HARRISON CROSBYTON TX 79322

ASSISTED LIVING FACILITY 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 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. CROSBYTON HEALTH SERVICES 710 WEST MAIN STREET CROSBYTON TX 79322 752916531 ASST. LIVING TX 501(C)(3) 11A CCH true false false false true false false false false false false true false false false false false false false CROSBYTON HEALTH SERVICES D 859909 BOOK VALUE