2011-11-22T08:27:02-06:00 2011-04-30 KPMG LLP Two Central Park Plaza Suite 1501 Omaha NE 681021626 990 2010-05-01 470542043 COLUMBUS COMMUNITY HOSPITAL INC COLU 4025623357 PO BOX 1800 COLUMBUS NE 68602 J JOSEPH BARBAGLIA 4025623357 2011-11-14 true 4023481450 2010 2016-02-24 21:20:13Z J Joseph Barbaglia 4600 38th Street Columbus NE 68601 66427883 false X www.columbushosp.org X 1972 NE OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. 11 10 546 287 23868 -31951 126881 140646 62997230 64569556 1901096 -185651 495730 738418 65520937 65262969 10958670 1297521 0 0 27775081 29018478 0 0 0 24951419 26681899 63685170 56997898 1835767 8265071 95225903 88904691 31164870 16813490 64061033 72091201 X OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. false false 54471927 222593 65062192 General Hospital and Health Care: Columbus Community Hospital ("CCH") is a 47 bed acute care Hospital which currently employs over 500 people. It is a significant, positive economic force for Columbus and the area, returning dollars into the economy through local purchases by the organization, and salaries that return to the community. It is also a needed asset for the local communities where patients can obtain quality healthcare without the need to drive over 50 miles for care. In providing the care necessary for local communities, CCH has a variety of services. Following is a brief summary of some of the areas of service provided by CCH. -The main focus is acute care services For patients needing an extended recovery. the beds at CCH are also certified as swing beds. -To assist our non-English speaking patients, CCH uses competent, dedicated medical interpreters as a liaison between the care providers and the patient. Since this is the interpreters' full time job at the Hospital, they are available when needed, in house or on call 24/7. -To make the patient's stay successful and comfortable, CCH offers icu, medical surgical, OB, and an orthopedic service line along with a variety of complimentary ancillary services (wound care, diabetic education, cartiac rehab). -CCH offers rehabilitative services such as physical therapy, speech therapy, and occupational therapy for adults. Pediatric physical therapy, speech therapy, and occupational therapy are offered at our off-site location, Wiggles & Giggles Therapy (includes physicial, speech, and occupational therapies) for Kids. -Nurses in the Same Day Services Department prepare patients for surgery and if going home the same day, care for them after surgery. The department oversees several outpatient procedures, including seventy to ninety endoscopy procedures each month, also infusions and chemotherapy infusions. -CCH offers some of the most advanced imaging services including MRI, CT, Digital Mammography, Ultrasound, etc. Radiologists are on campus and/or available 24-7 to read the various scans. The dictation used by the radiologists is voice recognized and becomes part of the digital image. All images are digital, meaning there are no films. -CCH has an up to date Laboratory which performs over 11,700 tests on average per month, for both inpatients and outpatients. -CCH has highly trained, employed emergency physicians and nurses in their Emergency Department (ed) and offers 24-7 care. The Department includes support from qualified staff in respiratory care, social work, laboratory, medical interpreting, and diagnostic imaging. The ED was designated as a Level III Trauma Center in May, 2006. The Medical Staff and personnel in the Trauma Center have received specialized training to resuscitate and stabilize trauma patients. -CCH opened wound care services in August of 2008 with three patients. The identified service area includes a 45-mile radius around Columbus. By January, 2009 a second day was added to support the demand. This service has taken off far beyond what was expected. Previously, patients seeking this specialized treatment were required to travel on average 75 miles to see a wound clinic specialist. It was a much needed service for the local communities. Columbus commuinty hospital currently sees over 100 patients per month for wound care. -Centering on services outside the Hospital, the larger services are Home Health and Hospice services. Home Health is skilled health services for patients at their place of residence. The program is medically directed, therefore, it must be ordered by the attending physician. The program is Medicare and Medicaid certified and meets the requirements of the Joint Commission. Services provided within the program are: A) Supervision and administration of medications B) Intravenous therapy C) Teaching diabetic management D) Nutritional assessments E) Home Health Aides F) Personal Care services G) Occupational, Speech and Physical Therapies H) social work care management Hospice services are provided to persons who are no longer receiving curative treatment and whose life expectancy is six months or less. Care is provided by an interdisciplinary team which consists of the physician, nurse, social worker, therapist, home health aide, spiritual advisor, volunteer and other health professionals. -Our local Healthy Family Nebraska Program (HFN) targets young, primarily single, pregnant mothers and their families. Our voluntary HFN home visitation program targets the most vulnerable young women and their families by offering them, intense, in home education, support and resources. This home visiting program covers families in a four county area. The HFN requires each mother/family to actively participate in building an individualized family plan. This strength based approach promotes self-improvement, and enhances self-esteem and independence for our young parents that will help them make better decisions, and break out of destructive cycles. -CCH's Sleep Lab offers complete polysomnographic sleep testing for the purpose of diagnosing obstructive/central sleep apnea by trained and licensed sleep technicians. -Occupational Health Services (OHS) offers a menu of health care services designed to prevent and treat injuries in the workplace. Partnering with employers in more than 900 companies and with other health care professionals, OHS provides a comprehensive health and safety program specific to the needs of each business. A comprehensive testing procedure called the Physical Capacity Profile (pcp) matches employees to the job and is designed to accommodate individuals with handicaps. The PCP system was developed by an orthopedic physician. Through use of this testing, musculoskeletal imbalances are detected which helps employers place employees in the appropriate job to minimize the potential of injury. -Lifeline, an in home emergency response program, provides the vital safety net that many people need to continue living at home in familiar and comforting surroundings. The program is completely focused on ensuring the patient's independence, safety and well-being in their home. It operates with a bracelet worn by the patient with a button that can be pressed if help is needed. predetermined responders are summoned to their home or emergency transfer can be called if needed. This gives security to the patient and comfort to the patient's relatives. -Meals on Wheels are prepared by the Nutrition Services Department and are delivered by community volunteers. Seniors and physically handicapped adults qualify for the program. Special diets can also be accommodated. Financial assistance is available through the Nebraska Department of Social Services. -The Hospital participates in and has hosted county wide natural disasters and pandemic drills. CCH feels we are well prepared to handle a natural disaster or pandemic should one arise. 1074928 1074928 0 Charity Care: CCH offers a Charity/Financial Aid Program to provide uncompensated services to people who are unable to pay. CCH Charity/Financial Aid Policy reflects the mission, vision and values of CCH. It is intended to assist low-income, underinsured, and uninsured individuals whose financial status, under the hospital's qualification criteria, makes it impractical or impossible to pay for necessary medical services. CCH has a fiduciary responsibility to seek payment for services from those who can pay, and every effort will be made to apply consistent, fair and equitable financial aid practices in a manner consistent with all applicable federal and state laws and regulations. CCH follows the Federal Poverty Guidelines (FPG) to determine both eligibility for free care, 100% of FPG, and discounted care, 200% FPG. CCH also offers catastrophic charity assistance. If the applicant qualifies for partial Charity/Financial Assistance and the total balance after all write-off's is $1,200 or greater, an additional write-off will be done as outlined below. $1,200 - $5,000 Reduce to $1,200 adjustments will be done from oldest to newest $5,001 - $10,000 Reduce to $1,400 >$10,001 Reduce to $1,800 55546855 true true false true false false false false true true false false false false true false true false false false false false false false false true true true true true true false false false false false false false false false false false false false false false true true true true false true 28 0 true 546 true true true false false false false false false false false false X 11 10 false false false false false false false true true false false true true true true true true true true false X MIKE ADAMY 4025623382 4600 38TH STREET COLUMBUS NE 68601 X JAMES PILLEN DVM 1.0 X X 0 0 0 RONALD ERNST MD 1.0 X 0 0 0 JOHN C MCCLURE 1.0 X 0 0 0 ANNE HALL 1.0 X X 0 0 0 ANTHONY RAIMONDO JR 1.0 X 0 0 0 REBECCA RAYMAN 1.0 X 0 0 0 MARK HOWERTER MD 40.0 X 402966 0 16430 JEFFREY GOTSCHALL MD 1.0 X X 0 0 0 BONNIE MCPHILLIPS 1.0 X 0 0 0 BRIAN SCHMIDT 1.0 X 0 0 0 CLARK LEHR 1.0 X 0 0 0 J JOSEPH BARBAGLIA 40.0 X 160865 0 17777 MICHAEL HANSEN 40.0 X 187885 0 6630 AMY BLASER 40.0 X 101288 0 15890 JAMES GOULET 40.0 X 161005 0 15730 LINDA WALLINE 40.0 X 151960 0 14933 PHIL POWERS CRNA 40.0 X 202534 0 18812 JOHN SAFRANEK MD 40.0 X 175060 0 12175 ROBERT MILLER MD 40.0 X 248270 0 16545 SARAH LANGAN 40.0 X 185816 0 11067 MARK SWOPE 40.0 X 186998 0 18448 2164647 0 164437 22 false true false INPATIENT PHYSICIAN ASSOC 3200 PINE LAKE RD STE A LINCOLN NE 68516 HOSPITALIST SVCS 871849 MICHAEL MCGUIRE MD 604 N 38 ST OMAHA NE 68131 ORTHOPEDIC SURGERY 153075 KPMG LLP PO BOX 120001 DALLAS TX 75312 AUDITORS 149734 BRYANLGH MEDICAL CENTER PO BOX 82557 LINCOLN NE 68501 STUDIES 149734 STINSON MORRISON HECKER PO BOX 419251 KANSAS CITY MO 64141 ATTORNEYS 117833 6 140646 140646 NET PATIENT SVC REVENUE 621110 64569556 64569556 64569556 979263 979263 0 0 1164914 -1164914 -1164914 -1164914 0 0 0 OTHER REVENUE 900099 516504 492636 23868 CAFETERIA 722100 221914 221914 738418 65262969 65062192 23868 36263 222593 222593 1074928 1074928 0 0 643683 643683 0 23018708 23018708 687532 687532 3011401 3011401 1657154 1657154 0 103557 103557 169420 169420 5126 5126 0 0 2693387 2693387 141963 141963 7297154 7119454 177700 1001904 1001904 0 877710 877710 104771 104771 0 104823 104823 864707 864707 0 4457989 4457989 247837 247837 PROVISION FOR BAD DEBTS 3471234 3471234 MINOR EQUIP. & FINANCING AGRMT 1968160 1968160 MISC EXPENSES 2053970 2053970 DEFERRED FINANCING COSTS 1092885 1092885 BLDGS AND CLINICS 25302 25302 56997898 55546855 1451043 0 2153622 1621171 3692157 0 7672436 9468918 210007 0 799428 1271025 1075539 802965 71361848 40456337 27429889 30905511 51156258 44723764 1036567 111337 95225903 88904691 5049890 3987593 26114980 12825897 31164870 16813490 X 64061033 72091201 64061033 72091201 95225903 88904691 X 8265071 -234903 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5126 5126 false OTHER ACTIVITIES SCHEDULE C, PART II-B, LINE 1I DUES PAID TO AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $3,160 DUES PAID TO NEBRASKA HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING $1,966 1506660 66403 1573063 1426826 79844 -10 1506660 1299402 127424 1426826 1.00000 false true true 581842 581842 30401081 14743330 15657751 33453212 24415962 9037250 6925713 1297045 5628668 30905511 0 0 FIN 48 FOOTNOTE SCHEDULE D, PART X The Hospital adopted Financial Accounting Standards Board (FASB) Interpretation No. 48, Accounting for Uncertainty in Income Taxes - an Interpretation of FASB Statement No. 109 (FIN 48). FIN 48 provides specific guidance on how to address uncertainty in accounting for income tax assets and liabilities, prescribing recognition thresholds and measurement attributes. The adoption of FIN 48 by Columbus Community Hospital did not have a material impact on the Hospital's financial position, results of operations, or cash flows. SCHEDULE D PART V, LINE 4 ENDOWMENT FUNDS ARE HELD AND MAINTAINED BY COLUMBUS COMMUNITY HOSPITAL FOUNDATION. THE ENDOWMENT FUNDS EXIST IN SUPPORT OF IMPROVED HEALTH SERVICES BY COLUMBUS COMMUNITY HOSPITAL. true true X true X true X true true true false true true 774 617520 617520 0.01150 0 3986733 2216541 1770192 0.03310 774 4604253 2216541 2387712 0.04460 19 3496 388064 325 387739 0.00720 3 488 44632 0 44632 0.00080 3 267 17486 17486 0.00030 25 4251 450182 325 449857 0.00830 25 5025 5054435 2216866 2837569 0.05290 1 2500 2500 1 1500 1500 1 6552 6552 0.00010 1 185000 185000 0.00350 1 51 235 235 2 865 3692 3692 0.00010 1 548 3601 3601 0.00010 8 1464 203080 203080 0.00380 false 2002902 0 17858064 19115030 -1256966 X true true HEALTHPARK LLC PROPERTY MANAGEMENT 0.00000 0.00000 0.71000 ZARZ LLC PROPERTY MANAGEMENT 0.00000 0.00000 0.50000 1 1 Columbus Community Hospital Inc

4600-38th Street Columbus NE 686011800

X X X 47 BED ACUTE CARE HOSPITAL W/ 24 HOUR ER SERVICES Columbus Community Hospital Inc 1 8 PREMIER PHYSICAL THERAPY OF CCH

US 30 CTR BLDG 3100-23RD st ste 15 COLUMBUS NE 686013161

PHYSICIAL & AQUATIC THERAPY, SPORTS TRAINING SERVICES WIGGLES & GIGGLES THERAPY FOR KIDS

2108-13TH STREET COLUMBUS NE 686015100

PEDIATRIC THERAPY SERVICES OCCUPATIONAL HEALTH SERVICES OF CCH

3005-18TH ST SUITE 300 COLUMBUS NE 686014252

EMP. HEALTH CARE SVCS TO PREVENT & TREAT WORK INJURIES WOUND HEALING CENTER

4600-38TH STREET SUITE 165 COLUMBUS NE 68601

WOUND TREATMENT CENTER HUMPHREY CLINIC OF CCH

3003 MAIN STREET HUMPHREY NE 686423155

CLINIC IN SMALL TOWN TO OFFER MEDICAL SVCS TO RESIDENTS HOSPICE OF COLUMBUS COMMUNITY HOSPITAL

3005-19TH STREET SUITE 600 COLUMBUS NE 686014248

HOSPICE SERVICES COLUMBUS COMMUNITY HOSPITAL SLEEP LAB

3020-18TH STREET SUITE 14 COLUMBUS NE 686014254

POLYSOMNOGRAPHIC SLEEP TESTING HOME HEALTH OF COLUMBUS COMMUNITY HOSP

3005-19TH STREET SUITE 600 COLUMBUS NE 686014248

HOME HEALTH SERVICES PART I, LINE 3C N/A PART I, LINE 6A The Hospital prepares its own community benefit report. This report is printed in the local newspaper and is also listed on the Hospital's website for anyone to see. PART I, LINE 7 The Hospital used the series of worksheets offered in the instructions for Schedule H in determining the charity care and other community benefits cost. The ratio of patient care cost to charges on worksheet 2, Ratio of Patient Care Cost-to-Charges, was used to calculate the amounts on the table on line 7. $3,471,234 of Bad Debt included in functional expense Total Part IX, line 25, $56,997,898, is not included in the Total Operating Expenses used to calculate the Table 7 percentages. PART II COMMUNITY BUILDING ACTIVITIES -Hospital continues to collaborate with local Chamber of Commerce to recruit skilled professionals to fill job openings in the community. Provides support and staff time to assist in highlighting the health care community, providing specific department or hospital tours in order to recruit skilled professions to live and work here in the community. -Hospital continues to collaborate with the City to provide space for a twelve-acre urban lake and 20 acres of land for a future fire station on this property. The urban lake is equipped with a nice wooden dock that makes it very accessible for strollers, wheelchairs and other assistive devices to roll down the dock to fish or watch the waterfowl on the lake. Local assisted living and nursing care centers bring their wheel chair vans with residents to the lake as they can drive right up to the accessible dock. This urban lake, waterfowl area provides a community space within the city limits for the whole community, young and old alike. -Hospital continues to partner in several projects and community disease prevention initiatives with our local District Public Health Department and Community Health Center (CHC). The hospital provides financial support and much professional staff time as liaisons to these community partnerships throughout the year working on multiple chronic disease and accident prevention strategies. Some of these community initiatives include type II diabetes, hypertension and heart disease, pre- and post natal newborn care, physical activity and exercise, colon cancer prevention and early detection as well as community preparedness to natural and manmade disasters. Several other initiatives are addressed throughout the year as community health issues arise. Thousands of community members are reached with these community initiative campaigns each year and these make a real difference in people's lives that are living with chronic health issues. -Additionally CCH is in attendance in over a dozen Community Health Fairs/Community events each year, providing medical screenings and information for all community members. -CCH also partners with local day cares, schools and colleges to provide speakers and hands on learning events for students to encourage entry into the medical professions. PART III, LINE 4 Financial statements do not include any text for bad debt. The amount in Line 2 was based on the bad debt charges multiplied by the ratio of patient care cost to charge from worksheet 2, Line 11. Charity care is kept separate from bad debt. PART III, LINE 8 In accordance with 42 CFR 413.24, Columbus Community Hospital uses the "Step-down Method" as its costing methodology. Departments within a provider are usually divided into two types: 1) Those that produce patient care revenue (e.g., routine services, radiology), and 2) Those that do not directly generate patient care revenue but are utilized as a service by other departments (e.g., laundry and linen, dietary). The two types of departments are commonly referred to as "revenue-producing cost centers" and "nonrevenue-producing cost centers," respectively. Although nonrevenue-producing cost centers do not directly produce patient care revenue, they contribute indirectly to patient care revenue generated by "serving" as a service to the revenue-producing centers and also to other nonrevenue-producing centers. Therefore, for the purpose of proper matching of revenue and expenses, the cost of the revenue-producing centers should include both its direct expenses and its proportionate share of the costs of each nonrevenue-producing center (indirect costs) based on the amount of services received. The process of allocating the cost of a particular nonrevenue-producing center to other nonrevenue-producing centers and revenue-producing centers is performed by utilizing a set of statistics (e.g., pounds of laundry for allocating "laundry and linen" costs, square feet for allocating "depreciation building" costs). Every nonrevenue-producing cost center has the potential of being allocated to every other nonrevenue-producing cost center in addition to the revenue-producing cost centers. This precludes a simple allocation of the direct expense of the nonrevenue-producing cost center because the indirect costs derived from allocation of other nonrevenue-producing cost centers must be computed in determining the "full cost" (direct and indirect costs) of the nonrevenue-producing cost center being allocated. The "Step-down Method" recognizes that services furnished by certain nonrevenue-producing departments are utilized by certain other nonrevenue-producing centers as well as by the revenue-producing centers. All costs of nonrevenue-producing centers are allocated to all centers that they serve, regardless of whether or not these centers produce revenue. The cost of the nonrevenue-producing center serving the greatest number of other centers, while receiving benefits from the least number of centers, is apportioned first. Following the apportionment of the cost of the nonrevenue-producing center, that center will be considered "closed" and no further costs are apportioned to that center. This applies even though it may have received some service from a center whose cost is apportioned later. Generally, if two centers furnish services to an equal number of centers while receiving benefits from an equal number, that center which has the greatest amount of expense should be allocated first. PART III, LINE 9B CHARITY (FINANCIAL AID) PROGRAM POLICY/PROCEDURE Columbus Community Hospital (CCH) offers a Charity/Financial Aid Program to provide uncompensated services to people who are unable to pay. CCH Charity/Financial Aid Policy reflects the mission, vision and values of CCH. It is intended to assist low-income, underinsured, and uninsured individuals whose financial status, under the hospital's qualification criteria, makes it impractical or impossible to pay for necessary medical services. CCH has a fiduciary responsibility to seek payment for services from those who can pay, and every effort will be made to apply consistent, fair and equitable financial aid practices in a manner consistent with all applicable federal and state laws and regulations. 1. Charity Policy a. Our Charity/Financial Aid Policy does not eliminate the personal responsibility and financial discounts are always secondary to other government-sponsored programs. However, CCH is committed to serve those without the means to pay and work with Good Neighbor Community Health Center and Medicaid services. 2. Health Insurance a. If a patient or guarantor has access to employer-based or government-sponsored health insurance, yet elected not to enroll or failed to maintain eligibility, they may be considered on a one-time basis. However, they will be expected to obtain coverage at the next eligible period or they may be excluded from financial assistance provided by CCH. b. If patient or guarantor has a Medical Savings Account, this needs to be expended before they are eligible for assistance. c. "Presumptive" financial assistance may be taken into consideration when a patient has expired and there is no estate. An incomplete financial assistance form may be on file because documentation was lacking that would support the provision of financial aid. In this case: i. A family member is contacted to insure no estate exits. ii. Family member may be asked to sign and date a statement to the effect that no estate exits. iii. The county in which the deceased patient resided is contacted to verify that no estate exits. d. CCH's Charity/Financial Aid is not a substitute for employer-sponsored, public or individually-purchased insurance, nor is CCH's financial aid policy a substitute for the responsibility of government and employers to expand access to health care coverage for all persons. 3. Accounts with a Balance a. Charity/Financial Aid may apply to balances due from insured patients for deductibles, co-payments, or co-insurance, or other types of patient payment responsibility. 4. Receiving an application a. CCH is diligent in its efforts to determine, at the earliest point in time, the patient's ability to pay. Information on Charity/Financial Assistance is available in key areas of the hospital on how to apply or obtain further information. i. Hospital staff members who work closely with patients are educated on how to communicate financial aid availability and how to direct patients to staff responsible for the financial aid application process. ii. Staff members are trained to treat financial aid applicants with courtesy, confidentiality, and cultural sensitivity. iii. These principles and guidelines are for those patients who truly cannot afford health care services. b. Any person requesting financial aid information will be directed to the Patient Accounts or Social Services Departments. An application for the Charity/Financial Aid Program needs to be completed before an eligibility determination can be made. The application is also available in Spanish. Once the application is submitted with written proof of income, a determination will be made in a timely manner. One or more of the following are required as verification of income: i. A letter of rejection from the Department of Social Services (Medicaid) if applicable. ii. Signed copy of previous year's tax return. iii. Copy of most recent pay stub, with accumulative earnings. iv. Copy of recent three months of bank statements with an explanation of all deposits. v. Copy of any compensation received, i.e., unemployment, if applicable. vi. Social Security determination if applicable. c. A family is defined as anyone living together in a household; this will include college students, regardless of their residence, who are supported by their parents. 5. Review Process a. All completed applications are reviewed and approved by the Patient Financial Services Director and overseen by the Vice-President of Finance. b.Any applications that are in need of further assistance are taken to the Vice-President of Finance. c. All write-offs greater than $5,000 are reviewed by Vice President of Finance. d. Monthly the Vice-President of Finance oversees the Charity and Medicare Bad Debt statistical reports. e. If the applicant's income is above Poverty Guidelines, but is still in need of assistance, a sliding scale will be used. This scale is adjusted according to the current year's Poverty Guidelines. If the applicant qualifies for partial Charity/Financial Assistance, acceptable monthly payment arrangements must be agreed upon. f. If the applicant qualifies for partial Charity/Financial Assistance and the total balance after all write-off's is $1,200 or greater, an additional write-off will be done as outlined below. $1,200 - $5,000 Reduce to $1,200 $5,001 - $10,000 Reduce to $1,400 >$10,001 Reduce to $1,800 Adjustments will be done from oldest to newest. g. A letter will be sent to the Guarantor informing them of the determination for charity/financial assistance along with a Monthly Payment Agreement for those who qualified for partial approval or denied applicants. This Agreement needs to be signed and returned to the Patient Accounts Department within 10 days. 6. Documentation of Processed Accounts a. The Patient Financial Services Director will maintain a yearly log of all applicants. Documentation of approved accounts that have been written off or denied will be maintained. 7. Archived Applications a. All charity applications are scanned into HBF under Document Type 'Charity Applications' NEEDS ASSESSMENT In 2010, the Columbus community Hospital's five year strategic plan was implemented. The plan includes a thorough assessment of the organization's external environment in terms of opportunities and threats in order to determine its internal strengths and weaknesses. The plan also includes strategic issues, goals, and related strategies for future organizational effectiveness. Six Organizational Pillars have been adopted to include: quality, culture, people, service, facilities, and finance. 1) Quality - Quality efforts have been focused on evidence based processes and educating staff on the importance of use and integration into daily operations. Cch is in the process of implementing an electronic medical record to afford ease of information access and communication across the continuum of care. 2) Culture - In effort to achieve a high performance organization, cch is in the process of implementing a 4-part culture improvement initiative including teamstepps, just culture, studer, and lean/six sigma process improvement. A 3-year implementation time frame has been established. 3) People - CCH has continued to employ aggressive employee and physician recruitment efforts to attract and retain the workforce needed to support strategic growth initiatives across all service lines. 4) Services - cch has performed annual, comprehensive program review of existing and new services and has ranked priority to begin service line development in areas such as hospital medicine, orthopedics, cardiology, cancer, and rehab services. 5) Facilities - CCH has developed a comprehensive master facilities plan that is able to adapt to current and future patient care needs. An emergency department expansion is slated for completion in early 2012. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE Here is a sample of what is available on our CCH Web Site with detailed links as well as hard copy information in a special wall unit located inside each patient room as well as outpatient areas in brochures. There is also a tutorial listed for each step of the way letting the patient know what they will need to bring along or have available to show for coping purposes. Monthly Payment Option If you are unable to pay your balance in full, please call Patient Accounts Department to set up an acceptable payment arrangement. Patient Charity/Financial Assistance Program If you feel your income is not sufficient to pay for your services at Columbus Community Hospital, please contact Patient Accounts Department AND/OR SOCIAL WORKERS for information regarding Charity/Financial Assistance. Further information about Medicare/Medicaid / Charity Care is provided in both English and Spanish, along with State Medicaid applications and CCH Charity Care applications that our Patient accounts & Social Work Staff have available in both languages to hand to patients as needed. Additionally, signage is posted directing patients to call as needed for financial help, and referrals are built into the Medical Admission software, so if patients voice concerns about the cost, or their lack of coverage a referral is generated to Social Work staff who will see patients individually and counsel on specific circumstances. Monthly statements have information on: 1)Payment plans 2)Charity/financial assistance program 3)24/7 online business office, which includes information on payment plans, charity/financial assistance, and downloadable charity applications (available in English and Spanish) COMMUNITY INFORMATION The local economy- Currently our hospital service area remains in a small pocket that has been somewhat protected from the recession, as we continue to have over 300 skilled level positions open in wind generating manufacturing companies, plastics, medical equipment companies, ethanol plants and local beef packing. Our hospital is located in Platte County, the largest of the seven county service area, with a growing population of over 32,000 people. Columbus is the largest city in Platte County, Nebraska, 90 miles west by north of Omaha on the Loup River. The unemployment in the City of Columbus increased from a very low 3.0% (566 jobless) in June 30, 2008 to 3.7% (693 jobless) on December 31, 2008, surprisingly, unemployment only increased to 3.9% by December 31, 2009. This was at a time when Nebraska's state unemployment average was 4.6% with the national average still very high at 10%. Currently, as of May 2010 Columbus has an unemployment rate of 4.6%, compared to 4.8% statewide in Nebraska and 9.5% national average. Since November 2008, available jobs in Columbus NE have increased by 23%. Our area unemployment remains significantly lower than other State and National averages. In fact, Columbus is the third best place to find employment in the U.S. and in the "Top 100 Best Small Town to Live" according to Money Magazine. Of the top ten Counties in the U.S. to live and work, three of them were in Nebraska: Platte, Madison, (which is contiguous to our County of Platte) and Sarpy County near Lincoln Nebraska. Our local area features an economy based on agriculture and manufacturing, with many industrial companies attracted by cheap, plentiful hydroelectric power. Among the major employers are Archer Daniels Midland, (ADM) which runs a corn milling ethanol plant; Flex-Con; Central Confinement Service; Vishay; Becton Dickinson, a medical equipment company; Behlen Manufacturing, a maker of steel buildings; and the Nebraska Public Power District, which is headquartered in Columbus. This large manufacturing base still remains intact, due to successful economic and industrial development in our area. The perfect blend of a hardworking and well-educated work force, low energy costs and a local environment friendly to business has led to strong economic and industrial development within our service area. According to the Nebraska Department of Labor, the Columbus economy has a greater share of manufacturing employment than other Nebraska metropolitan areas, and Columbus is considered a major hub for the manufacturing industry. We continue to see an influx of young families and singles moving into our area to seek the open skilled positions. This community growth correlates with our continued increase in hospital outpatient visits which hit an all time high of 48,509 YTD visits for the last fiscal year ending April 2010. This represents a 2% increase in visits over the same twelve month period compared to the prior year. More significant is the increase in outpatient visits over the past five years since the demonstration project began. In 2005, our outpatient visits for the year totaled 38,129, representing a 27 % increase in the past five years. Service capacity: Our new Wound Clinic which was opened August of 2008 with three patients has grown to 296 patients as of July 31, 2010. The identified service area includes a 45-mile radius around Columbus. The wound clinic moved to there new permanent home in the visiting physician office suite of the attached Medical Office Building. By Dec. 2009 the clinic was operating two days per week and had added a Nurse Practitioner to support greater demand. Additional nurse staff time is spent each week assisting clients with wound appliance applications. Previously, patients seeking this specialized treatment were required to travel on average 75 miles to see a wound clinic specialist. The volume we are seeing at this Wound Clinic reinforces the amount of community need that exist for this service and has greatly increased the local access to service for so many of our higher acuity patients and their families. Bone Density, upgraded from contracting with a mobile service unit to purchasing our own Bone Density stationary equipment and the necessary support equipment and staff which was added in early 2010. This is a great added benefit to the community, increasing access for our patients and providers who no longer have to await diagnosis with the mobile units' intermittent service. This is another new program that increases access and eliminates the need to travel to out of town units for prompt diagnosis that is made possible by the Demonstration project. Orthopedic Service Line, hired a new F/T RN as the Orthopedic Services Coordinator in Jan. 2010. Since early this year have launched a multi disciplinary team to review, standardize and improve the patient's total joint process from diagnosis to post surgical recovery. Expect complete new Orthopedic Services Line rollout by November 2010. This process is challenged with probable decrease in volume due to relocation of one of two existing Orthopedic Surgeons from local practice office in August 2010. Aggressively recruiting two new Orthopedic Surgeons for replacement and expanded Ortho Service Line. In the interim, planning to contract with Locum Tenens Physicians to assist with local orthopedic practice coverage as well as handle surgical cases. Cardiologist - Two new Cardiologists have recently relocated to Columbus to live and work full time. This replaces the only F/T Cardiologist who lived and worked in the community for the past eleven years and relocated in 2009. Multiple Cardiologist groups from Omaha and Lincoln have worked to begin providing full time coverage in the Columbus area, following this opening. Outpatient Allergy Clinic - that has provided an intermittent service at a local Specialist office in our MOB, has stopped coming as of July 2010. In their office space an Oral Surgeon who is double boarded in oral surgery and plastics will begin providing outpatient clinic and surgical procedures beginning in August 2010. The hospital has completed three road projects on and around the campus which increases access to the facility. Two clinic buildings (one for a family practice group and one for a pharmacy) are almost completed. The hospital itself has a major addition in process. The emergency department will more than double its size and a women's imaging center will be separated from the normal radiology functions. Expansion of respiratory care and revision of the admissions area for more hippa compliance will also take place. The entire expansion will be completed in 2012. PROMOTION OF COMMUNITY HEALTH -The Hospital reinvests capital to improve patient care, attract the best qualified staff to provide quality care for our patients, provide medical education and prevention activities in the community. -Our Hospital is living our Mission and Vision within the community: *OUR MISSION IS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE *OUR VISION IS TO COMPASSIONATELY DELIVER THE STATE'S HIGHEST QUALITY PATIENT CARE -CORE VALUES CCH Core Values are: *INTEGRITY *COMPASSION (changed from "Commitment" as part of the communication of this strategic plan) *ACCOUNTABILITY *RESPECT *EXCELLENCE -The Hospital has prioritized our capital reinvestment by aligning it to the Strategic Plan. Our plan consists of SIX Organizational Pillars with goals and strategies associated with each. The SIX Pillars of Excellence consist of: *Quality *Culture *People *Services *Facilities *FINANCE Measurement of ongoing operational performance is organized around these Pillars of Excellence. These pillars were strategically identified as common measures around which operational performance is organized in many health care institutions and adapted for CCH. COLUMBUS COMMUNITY HOSPITAL HAS AN INDEPENDENT BOARD OF DIRECTORS MADE UP OF COMMUNITY LEADERS WITH DIVERSE BACKGROUNDS. COLUMBUS COMMUNITY HOSPITAL HAS AN OPEN EMERGENCY ROOM AVAILABLE TO ALL IN NEED NO MATTER OF RACE, CREED, AGE, OR ABILITY TO PAY. THE HOSPITAL ALSO HAS AN OPEN MEDICAL STAFF. AFFILIATED HEALTH CARE SYSTEM N/A STATE FILING OF COMMUNITY BENEFIT REPORT NONE true COLUMBUS COMMUNITY HOSPITAL FOUNDATION INC 4600 38TH STREET COLUMBUS NE 68601 470836747 501(C)(3) 30000 TO SUPPORT EXEMPT CITY OF COLUMBUS NEBRASKA 2424 14 STREET COLUMBUS NE 68602 GOVT 192593 BOOK ROAD ROAD MAINTENANCE 2 0 CHARITY CARE TO PATIENTS 774 1074928 BOOK WRITE-OFF OF MED EXP GENERAL INFORMATION ON GRANTS AND ASSISTANCE Schedule I, Part I, Line 2 COLUMBUS COMMUNITY HOSPITAL does not typically give out donations, but occasionally a request is brought forward and the Board determines that it is in the best interest of the community to provide a particular grant. Prior to providing the grant, the Hospital determines that the organization it gives to is a 501(c)(3) organization or a government agency. The Hospital will also make grants to their related organizations as necessary to support their exempt purpose. X true true X X X X X X false false false false false false false false false J JOSEPH BARBAGLIA 144365 0 0 0 16500 0 6597 0 13839 0 181301 0 0 0 JAMES GOULET 152205 0 0 0 8800 0 6500 0 11889 0 179394 0 0 0 LINDA WALLINE 135460 0 0 0 16500 0 5911 0 11202 0 169073 0 0 0 PHIL POWERS CRNA 200464 0 0 0 2070 0 8282 0 15105 0 225921 0 0 0 MARK HOWERTER MD 402966 0 0 0 0 0 9800 0 11775 0 424541 0 0 0 JOHN SAFRANEK MD 168058 0 0 0 7002 0 5535 0 10548 0 191143 0 0 0 ROBERT MILLER MD 248270 0 0 0 0 0 9655 0 11682 0 269607 0 0 0 MICHAEL HANSEN 187885 0 0 0 0 0 0 0 9697 0 197582 0 0 0 SARAH LANGAN 185816 0 0 0 0 0 7427 0 6473 0 199716 0 0 0 MARK SWOPE 179298 0 0 0 7700 0 6818 0 15404 0 209220 0 0 0 QUESTIONS REGARDING COMPENSATION PART I, LINE 1A THE ORGANIZATION PAID FOR SOCIAL AND HEALTH CLUB DUES AS PART OF THE CEO'S EMPLOYMENT AGREEMENT. These amounts were reflected on the CEO's W-2. HOSPITAL AUTHO NO 1 OF PLATTE COUNTY NE 470830844 000000000 2010-05-04 23000000 REFUND PRIOR BONDS 4/27/00 false false false 10165620 23000000 23000000 2002 true false true true false false true false true 0.00000 0.00000 0.00000 true false false false false false true SCHEDULE K, PART III, LINE 3A Columbus Community Hospital has the following contracts, all of which have been reviewed by our attorneys and are 97-13 compliant: 1. Hospitalists services agreement for Hospital contracted with IPA Columbus, 2. Food service management agreement contracted with Aramark Healthcare Support Services, LLC, 3. Trauma surgery call for emergency agreement, required with Level III trauma status, with Ron Ernst, M.D., 4. Orthopedic emergency room call for patients requiring that specialty service with Michael McGuire, M.D., 5. Wound Care Healing Center Medical Director and Provider with Ron Ernst, M.D., 6. Professional services and medical director for Humphrey Clinic with Columbus Family Practice, PC, 7. Home Health/Hospice Associate Medical Director agreement with Drs. Ed Disco, M.D. and Dale Zaruba, M.D. Schedule K, Part III, Line 5 All unrelated business income is generated from property not financed by bonds reported on Schedule K. Schedule K, Part III, Line 7 Policies are in place, but are presently unwritten. Columbus Community Hospital is currently in the process of putting current policy in writing. GOVERNANCE, MANAGEMENT AND DISCLOSURE FORM 990, PART VI, LINE 15 The Hospital's Executive Compensation Committee, made up of independent Hospital Board members, reviews the CEO's compensation annually. The wage range is compared to information provided by third party consultants, from salary surveys. Decisions are documented. GOVERNANCE, MANAGEMENT AND DISCLOSURE Form 990, Part VI, Line 19 At Columbus Community Hospital, a 3-ring binder exists in the Executive Assistant's office labeled "For Public Disclosure" which includes the most current of the following: -Governing Documents which are the Hospital Bylaws -Conflict of Interest Policy -Audited Financial Statements -Forms 990 and 990-T GOVERNANCE, MANAGEMENT AND DISCLOSURE Form 990, Part VI, Line 12C Columbus Community Hospital does monitor any conflict of interests based on their conflict of interest policy. EMPLOYEES AND VOLUNTEERS are required to fully disclose any conflict of interest that may exist or appears to exist. Hospital reviews any of these conflicts and works with the Compliance Officer and the Vice President or CEO to determine if a conflict exists. If one does exist, the Hospital initiates actions to manage, reduce, or eliminate the conflict. COMPENSATION OF OFFICERS FORM 990,PART VII Michael Hansen (President/CEO) DEVOTED ON AVERAGE 2 HOURS PER WEEK TO THE COLUMBUS COMMUNITY HOSPITAL FOUNDATION (RELATED ORGANIZATION) IN ADDITION TO HIS TIME SPENT AS CEO/PRESIDENT OF COLUMBUS COMMUNITY HOSPITAL. MR. HANSEN WAS PAID BY THE HOSPITAL FOR HIS SERVICES. GOVERNANCE, MANAGEMENT AND DISCLOSURE PART VI, LINE 11A The Form 990 will be available for all members of the finance committee to review. Upon committee review, the 990 will then be submitted to the Board for review and the Board will make any corrections if applicable. If changes are made, a final copy of the 990 will be emailed to the Board members (via secure email) prior to filing with the IRS. RECONCILIATION OF NET ASSETS PART XI, LINE 5 CHANGE IN INVESTMENT IN HEALTHPARK TITLE CO. (234,903) COLUMBUS COMMUNITY HOSPITAL FOUNDATION 4600 38TH STREET COLUMBUS NE 68601 470836747 FUNDRAISING NE 501(c)(3) LINE 11, I CCH HEALTHPARK TITLE CO 4600 38TH STREET COLUMBUS NE 68601 470830945 HOLDING CO. NE 501(c)(2) N/A CCH ZARZ LLC PO BOX 1800 COLUMBUS NE 68602 273676428 PROPERTY MGMT NE HLTHPK TITLE CO RELATED 0 0 false 0 false 0.00000 HEALTHPARK LLC PO BOX 1800 COLUMBUS NE 68602 470836733 PROPERTY MGMT NE HLTHPK TITLE CO RELATED 0 0 false 0 false 0.00000 false true true false true true false false false false false true true true false true false false COLUMBUS COMMUNITY HOSPITAL FOUNDATION C 140646 COLUMBUS COMMUNITY HOSPITAL FOUNDATION L 191960 COLUMBUS COMMUNITY HOSPITAL FOUNDATION E 12825897 HEALTHPARK TITLE COMPANY B 400000 PART V, LINE 2 COLUMBUS COMMUNITY HOSPITAL FOUNDATION IS LISTED AS BACKING THE COLUMBUS COMMUNITY HOSPITAL, INC.'S TAX EXEMPT BOND. THIS IS COVERED WITH THE FOUNDATION'S NON-ENDOWED FUNDS.