2023-04-14T11:14:11-05:00 2021-06-30 FORVIS LLP 1201 Walnut Suite 1700 KANSAS CITY MO 641062246 990 2020-07-01 440537826 COMMUNITY HOSPITAL ASSOCIATION INC % JON DAVIS COMM 6606862320 26136 US 59 FAIRFAX MO 64446 JULIE JONES CEO 6606862211 2023-05-15 true JULIE JONES 999009999 April Arnold CPA P01559426 8162216300 2023-03-31 2 2020 2023-04-26 12:10:37Z X JULIE L JONES 26136 US HWY 59 FAIRFAX MO 644460107 25572625 false X WWW.FAIRFAXMED.COM X 1976 MO TO PROVIDE QUALITY ACUTE CARE, EMERGENCY PRIMARY CARE AND OUTPATIENT SERVICES. 12 11 181 80 0 11397 3449243 20431195 21871850 246078 26619 88538 224913 20777208 25572625 0 0 0 0 10353487 9932563 0 0 52248 11887446 12946945 22240933 22879508 -1463725 2693117 23523575 20617643 21433246 15509700 2090329 5107943 X TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. false false 19559161 0 21871850 SEE SCHEDULE O 19559161 true false false true false false false false false false true false false false true false false true false false false false false false false false true true false false true false false false false false false true false false false false false false true true true false false true 7 0 true 181 true false false false false false false false false false false false false X 12 11 false false false false false true false true true false false true true true true true true true true false MO X JON DAVIS 6606862320 26136 US HIGHWAY 59 PO BOX 107 FAIRFAX MO 64446 RICHARD ARON BURKE MD DIRECTOR/CMO 40.0 0.0 X 584807 0 19822 DR DUSTIN CARPENTER MD DOCTOR 40.0 0.0 X 271851 0 10072 JULIE JONES CEO 40.0 1.0 X 205413 0 9894 KELLY OSBORN CRNA 40.0 0.0 X 189745 0 21737 RENEE KREIFELS CRNA 40.0 0.0 X 154157 0 18527 KATRINA LOCK ARNP 40.0 0.0 X 148712 0 4007 BRANDON LESEBERG PHARMACIST 40.0 0.0 X 123015 0 9478 JON DAVIS CFO 40.0 1.0 X 124719 0 7103 AMY RYAN DIRECTOR 1.0 0.0 X 0 0 0 COREY HERRON DIRECTOR 1.0 0.0 X 0 0 0 ROBERT JACKSON DIRECTOR/PRESIDENT/CHAIRMAN 1.0 1.0 X X 0 0 0 RICHARD OSWALD DIRECTOR/SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 GLENN SCOTT DIRECTOR 1.0 0.0 X 0 0 0 VIRGINIA LOW DIRECTOR/VICE-PRESIDENT 1.0 0.0 X X 0 0 0 SUSAN NOLAND DIRECTOR 1.0 0.0 X 0 0 0 TIM UMBARGER DIRECTOR 1.0 0.0 X 0 0 0 REBEKAH GEBHARDS DIRECTOR 1.0 0.0 X 0 0 0 GARRETT WOOD DIRECTOR 1.0 0.0 X 0 0 0 JIM ALLEN DIRECTOR 1.0 0.0 X 0 0 0 1802419 0 100640 11 false true false PSYCHIATRIC MEDIAL CARE LLC 9040 EXECUTIVE PARK DRIVE KNOXVILLE TN 37923 PSYCH SERVICES 561423 DOCS WHO CARE 800 W FRONTIER LANE OLATHE KS 66061 ER SERVICES 302804 THE NEBRASKA MEDICAL CENTER 987400 NEBRASKA MEDICAL CENTER OMAHA NE 68198 MANAGEMENT SUPPORT 351622 INSPIRE REHABILITATION LLC 2810 E 35TH ST 2 KEARNEY NE 68845 REHAB SERVICES 939930 NEBRASKA METHODIST HOSPITAL PO BO 2797 OMAHA NE 68103 IMAGING CONSULTING 136100 5 3364926 84317 3449243 Net Patient Service Revenue 621990 20995212 20995212 340B Revenue 621990 876638 876638 21871850 26619 26619 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA 900099 46096 46096 ALL OTHER MISC REVENUE 900099 178817 178817 178817 178817 224913 25572625 21871850 0 251532 0 0 0 0 1054555 856673 194625 3257 179218 179218 7050628 5693984 1334314 22330 73768 59926 13614 228 1025932 843063 179859 3010 548462 445546 101222 1694 0 0 0 0 19949 19949 126020 126020 0 0 0 2848309 2433192 408284 6833 36070 29302 6657 111 890043 723031 164263 2749 0 0 344599 279937 63598 1064 110659 89894 20423 342 0 0 443085 359943 81774 1368 0 1332796 1082704 245976 4116 200237 162664 36955 618 Repairs & Maint. 864225 702058 159498 2669 Medical Supplies 2041744 2041744 Bad Debt 2315352 2315352 Medicaid 772049 772049 601808 488881 111068 1859 22879508 19559161 3268099 52248 151169 5274 12290312 10845908 125251 197280 2477738 2274136 0 0 0 0 0 0 430814 470468 242178 191884 23722423 17957732 6828282 5764691 1445 0 0 0 0 0 0 0 976386 868002 23523575 20617643 1919720 1709981 0 0 0 0 0 0 0 0 0 0 9167479 8877153 1762700 0 8583347 4922566 21433246 15509700 X 2053937 4982741 36392 125202 2090329 5107943 23523575 20617643 X 2693117 324497 X false true X true false X false false false false false true 7776 false false false 7776 false SCHEDULE C, PART II-B THE LOBBYING EXPENSES RECORDED ARE A PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. 235304 235304 7952077 5730262 2221815 15535042 12227470 3307572 5764691 0 Due to Third Party 1504195 Refundable Advances 3418371 4922566 23525999 241339 241339 23284660 2287965 2287965 25572625 20605523 41367 41367 20564156 2315352 2315352 22879508 SCHEDULE D, PART XI, 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. SCHEDULE D, PART XI, LINES 2D & 4B LINE 2D RELATED ORGANIZATION'S REVENUE $ 241,339 LINE 4B BAD DEBT EXPENSE $ 2,315,352 CHANGE IN CONTRIBUTION FROM FOUNDATION $ (27,387) ------------- $ 2,287,965 SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D RELATED ORGANIZATION'S EXPENSES $ 41,367 LINE 4B BAD DEBT EXPENSE $ 2,315,352 true true X true X true X true true true false false 297696 297696 0.01450 2048857 1191038 857819 0.04170 19519 91693 0 2366072 1282731 1155515 0.05620 1202 285 917 51385 5786 45599 0.00220 1580 1015 565 1665 1665 0.00010 55832 7086 48746 0.00230 2421904 1289817 1204261 0.05850 true 2315352 179214 9274367 9193697 80670 X true true 1 1 COMMUNITY HOSPITAL-FAIRFAX 26136 US HWY 59 FAIRFAX MO 64446 WWW.FAIRFAXMED.COM/ 102-61 X X X X COMMUNITY HOSPITAL-FAIRFAX 1 false false true X X X X X X X X X 19 true false false true X WWW.FAIRFAXMED.COM/ABOUT/NEWS/CHNA/ X true 19 true WWW.FAIRFAXMED.COM/ABOUT/NEWS/CHNA/ false true X 200. 300. X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 CH-F INVITED AREA COMMUNITY EXPERTS TO GATHER IN 2 DIFFERENT FOCUS GROUPS. THOSE IN ATTENDANCE INCLUDED AREA COUNSELORS, CLERGY MEMBERS,LAW ENFORCEMENT, ECONOMIC DEVELOPMENT PERSONNEL, NURSING HOME REPRESENTATIVES, SCHOOL FACULTY, COMMUNITY SERVICES STAFF AND OTHER COMMUNITY EXPERTS. FOCUS GROUP ATTENDEES WERE ASKED A VARIETY OF QUESTIONS. DIALOGUE WAS CANDID AND FOCUS GROUP ATTENDEES USED THEIR KNOWLEDGE OF THE CONSTITUENCY THEY REPRESENT TO HONESTLY EVALUATE THE HEALTH OF THE COMMUNITY. RESULTS FROM THOSE MEETINGS ARE SUMMARIZED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. CH-F STAFF ALSO PARTICIPATED IN THE FOCUS GROUPS. COMMUNITY HOSPITAL-FAIRFAX RELEASED A CHNA SURVEY TO THE PUBLIC. THE QUESTIONS ON THE SURVEY WERE DETERMINED THROUGH GUIDANCE PROVIDED BY THE MISSOURI HOSPITAL ASSOCIATION AND INFORMATION GATHERED THROUGH THE FOCUS GROUPS AND SECONDARY RESEARCH. THE SURVEY WAS OFFERED ONLINE. PAPER COPIES WERE PROVIDED IN LOCATIONS WHERE POPULATIONS MIGHT HAVE DIFFICULTY ACCESSING IT ONLINE. THIS INCLUDES NURSING HOMES, SENIOR HOUSING AND NUTRITION CENTERS. CH-F PROMOTED THE SURVEY USING FACEBOOK, BLAST EMAILS, NEWSPAPER AND THE CABLE CHANNEL. 362 SURVEYS WERE RETURNED. COMMUNITY HOSPITAL-FAIRFAX ALSO COLLABORATED WITH COMMUNITY SERVICES INC. OF ATCHISON AND HOLT COUNTY TO DISTRIBUTE SURVEYS. COMMUNITY SERVICES INC. IS THE LOCAL AGENCY EMPOWERED TO HELP PEOPLE IN NEED IN THE ATCHISON AND HOLT COUNTY COMMUNITIES. SCHEDULE H, PART V, SECTION B, LINE 11 Implementation Plan Preventative Health Problem Statement: Atchison and Holt Counties are lagging the state average in colonoscopy rates, mammography rates and pneumonia vaccinations. The leading cause of death in Atchison and Holt counties is heart disease. Risk factors for heart disease are extremely prevalent in the community we serve. Why? Cancer is the second leading cause of death in both counties with colorectal cancer being second most prevalent type of cancer. Pneumonia is the leading cause of hospital admissions and COPD hospitalizations and death rates are much higher than the state average. Risk factors for heart disease, such as high cholesterol, blood pressure and diabetes are rampant in our community. Raising rates of preventative care and chronic care management in our communities will offer opportunities for early detection and better outcomes as well as education about healthy behaviors. Strategies: CH-F launched a Chronic Care Management program by December 1, 2019. Community Hospital-Fairfax hired a nurse to begin a chronic care management program. Patients with two or more chronic diseases will be welcomed into the program where they will receive a care plan, 24-hour access to a nurse, education and resources to better manage their diseases. In 2020, the Chronic Care Management Program or CCM grew substantially from less than 10 patients to over 60 patients participating in the program or 3% of our entire Medicare population. These patients receive one on one attention from a dedicated nurse that helps them to manage their chronic diseases. CH-F is pursuing a strategy to increase Annual Wellness visits by 50%. Annual Wellness Visits are a comprehensive look at a patient's whole health and represents an opportunity to review preventatives, discuss current medications and disease management and ensure that the patient has access to resources to promote the best possible health. Patients with annual wellness visits are significantly more compliant with recommended screenings. Annual Wellness Visits were a challenge in a pandemic year. Providing this needed service safely was a top priority for our wellness staff. Even with the constraints from the pandemic, the organization completed 478 Annual Wellness Visits or 36% of the attributed population. This is a significant increase over the year prior. To continue to increase annual wellness visits, the organization recently committed to a second wellness nurse to continue to grow this service. In the last year, despite the pandemic, CH-F launched a Step Up to Colorectal and Breast Cancer Screening campaign. We worked directly with our primary care providers to increase rates of breast cancer and colorectal cancer screenings in our population. We were able to increase rates of colorectal cancer screenings by 10% and breast cancer screenings by 12%. Cost of Care Problem Statement: CHNA respondents say that the cost of care is the biggest issue facing healthcare in their lives. Charity care applications and bad debt are rising at Community Hospital- Fairfax as fewer people have the resources to pay for care they need. 12% of Atchison and Holt County residents are uninsured. The median household income is below state and national averages. Community Hospital-Fairfax will develop a more aggressive pre-payment and charity care strategy to better serve uninsured and under-insured individuals to be implemented in January of 2020. Mental Health Problem Statement: The prevalence of mental health in Atchison and Holt Counties is significant. 40% of CHNA respondents say that depression is a minor or major problem in their household. Atchison and Holt County are in a mental healthcare provider shortage area. In 2020, Community Hospital-Fairfax continued to implement depression screenings across our primary care clinics. We also found increasing rates of adolescent depression and increased outreach to this population. To continue to reach our senior population, CH-F worked with Senior Life Solutions, an outpatient group therapy program, to provide telehealth services to continue to reach seniors with mental health needs in a safe manner. SCHEDULE H, PART V, LINE 16A, 16B & 16C http://www.fairfaxmed.com/contactus/payments/charity-care/ 6 MOUND CITY FAMILY MEDICINE 514 STATE STREET MOUND CITY MO 64470 PROVIDER BASED RURAL HEALTH CLINIC WEST NODAWAY FAMILY MEDICINE 226 W MAIN STREET BURLINGTON JUNCTION MO 64428 PROVIDER BASED RURAL HEALTH CLINIC SOUTH HOLT FAMILY MEDICINE 101 SOUTH WASHINGTON OREGON MO 64473 PROVIDER BASED RURAL HEALTH CLINIC TARKIO FAMILY MEDICINE 102 S 6TH STREET TARKIO MO 64491 PROVIDER BASED RURAL HEALTH CLINIC FAIRFAX FAMILY MEDICINE 309 E MAIN STREET FAIRFAX MO 64446 PROVIDER BASED RURAL HEALTH CLINIC ROCK PORT FAMILY MEDICINE 100 E CASS STREET ROCK PORT MO 64482 FEE FOR SERVICE CLINIC SCHEDULE H, PART I, LINE 3C ADDITIONAL FACTORS CONSIDERED IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE INCLUDE ASSET LEVELS, MEDICAL INDIGENCY, INSURANCE/UNDERINSURANCE STATUS AND RESIDENCY. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $2,315,352. SCHEDULE H, PART II COMMUNITY HOSPITAL-FAIRFAX PARTICIPATES IN YEAR-ROUND COMMUNITY BUILDING ACTIVITES. IN FEBRUARY, OVER 200 COMMUNITY MEMBERS WERE SERVED IN A FREE HEART HEALTH SCREENING. IN THE SPRING, AREA FIRST GRADERS ENJOY PEDIATRIC ORIENTATION, A FUN FILLED TIME TO VISIT THE HOSPITAL AND LEARN MORE ABOUT BEING A PATIENT OR A HEALTHCARE WORKER. THE SUMMERTIME KICKS OFF A REDUCED PRICE SPEED AND AGILITY CAMP FOR AREA ATHLETES WHERE THEY GET TO WORK OUT WITH PHYSICAL THERAPY STAFF AND LEARN HOW TO AVOID INJURY. THE ANNUAL BACK TO SCHOOL FAIRS ROUND OUT THE SUMMER WITH OVER 100 KIDS RECEIVING FREE SCHOOL SUPPLIES AND AN OPPORTUNITY TO SPEAK WITH A COUNSELOR ABOUT HEALTHY SCHOOL HABITS. IN THE FALL, BOTH MEN AND WOMEN PARTICIPATE IN HEALTHY EVENTS WITH AN ANNUAL PROSTATE SCREENING AND WOMEN'S EVENT WHERE FREE SCREENINGS AND HEALTH INFORMATION ARE OFFERED. THROUGHOUT THE YEAR, COMMUNITY MEMBERS HAVE AN OPPORTUNITY TO LEARN FROM HEALTHCARE PROFESSIONALS AT LUNCH AND LEARNS PROVIDED THROUGHOUT THE YEAR. STERLING CONNECTION, A FREE MEMBERSHIP SERVICE OFFERED TO THOSE 55 AND OLDER, ALSO PROVIDES CONNECTION POINTS TO THE HOSPITAL THROUGHOUT THE YEAR INCLUDING ICE CREAM SOCIALS, FREE SCREENINGS AND INFORMATIVE EVENTS. SIDELINE COVERAGE FOR LOCAL SPORTING EVENTS IS ALSO AN IMPORTANT PRIORITY AT COMMUNITY HOSPITAL-FAIRFAX. PHYSICIANS AND PHYSICAL THERAPISTS VOLUNTEER THEIR TIME EACH FALL TO AIDING STUDENT ATHLETES AT AREA FOOTBALL GAMES. SCHEDULE H, PART III, SECTION A, LINE 2 IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL 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. SCHEDULE H, PART III, SECTION A, LINE 3 THE AMOUNT OF ACCOUNT BALANCES WRITTEN OFF TO BAD DEBTS THAT POSSIBLY WOULD HAVE QUALIFIED FOR CHARITY HAD THEY BEEN WILLING TO PROVIDE THE NECESSARY INFORMATION, AND THE TOTAL OF BANKRUPTCIES THE HOSPITAL HAD TO WRITE OFF. SCHEDULE H, PART III, SECTION A, LINE 4 THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE IS IN NOTE 1 ON PAGE 9 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION A, LINE 8 THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 23% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. OUR CUSTOMER SERVICE SURVEYS RATE COMMUNITY HOSPITAL CONSISTENTLY OVER 90%, SHOWING THESE MEDICARE BENEFICIARIES APPRECIATE THE SERVICES COMMUNITY HOSPITAL PROVIDES AND HOW THE SERVICES ARE PROVIDED. THE COSTING SOURCE WAS THE FY2021 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION A, LINE 9B COLLECTION POLICY STATES ALL UNINSURED AND INSURED PATIENTS ARE INFORMED ON THEIR FIRST STATEMENT OF SERVICES THAT COMMUNITY HOSPITAL HAS A GRANT PROGRAM (FOR FINANCIAL ASSISTANCE) FOR THOSE WHO QUALIFY. THIS SAME TYPE OF 'ASSISTANCE AVAILABLE' INFORMATION IS ALSO IN THE PATIENT INFORMATION BROCHURES IN THE PATIENT ROOMS AND WAITING AREAS. PATIENTS MAY QUALIFY FOR A CHARITY DISCOUNT OR A MEDICALLY INDIGENT DISCOUNT, DEPENDING ON THEIR FINANCIAL SITUATION AND USING THE FEDERAL POVERTY GUIDELINES. SCHEDULE H, PART VI, LINE 2 IN THE MOST RECENT COMMUNITY NEEDS ASSESSMENT, COMMUNITY HOSPITAL FAIRFAX IDENTIFIED PRIMARY ACCESS TO HEALTHCARE AS CONTINUING TO BE THE MAIN DRIVER OF SIGNIFICANT HEALTH ISSUES IN OUR SERVICE AREA. RECENT SURVEYS SHOW THAT MANY HOUSEHOLDS DO NOT ACCESS HEALTHCARE AT A PRIMARY LEVEL EVEN WHEN A HEALTHCARE ISSUE REQUIRING PRIMARY CARE SERVICES IS NEEDED. INCREASED RISK FACTORS INCLUDE HEART DISEASE, CANCER, CHRONIC LOWER RESPIRATORY DISEASE, AND STROKE. I. ABILITY TO PAY FOR CARE - COMMUNITY HOSPITAL-FAIRFAX IDENTIFIED STRATEGIES TO ASSIST THOSE WITH NO INSURANCE OR HIGH DEDUCTIBLES TO ACCESS CARE THAT THEY NEED. TO ASSIST WITH THIS EFFORT, COMMUNITY HOSPITAL-FAIRFAX HAS SUCCESSFULLY IMPLEMENTED A STRATEGY TO NEGOTIATE PAYMENT STRUCTURES WHICH ARE FAVORABLE TO PATIENTS. IN ADDITION TO THIS STRATEGY, AN AGGRESSIVE FORGIVENESS PROGRAM FOR EXISTING DEBT WAS IMPLEMENTED IN FY2020 AND FY2021. II. PREVENTIVE CARE - COMMUNITY HOSPITAL-FAIRFAX ONBOARDED A CARE COORDINATOR/POPULATION HEALTH NURSE. THIS NURSE HAS BEEN VERY ACTIVE BUILDING AN ANNUAL WELLNESS VISIT AND CHRONIC CARE MANAGEMENT PROGRAM FOR PRIMARY CARE CLINIC PATIENTS. ANNUAL WELLNESS VISITS ARE A BENEFIT OFFERED TO MEDICARE PATIENTS AND ARE CRITICAL IN HELPING IDENTIFY HEALTH NEEDS AND OPPORTUNITIES IN THAT POPULATION. WITH LESS THAN A FULL YEAR OF ACTIVE ANNUAL WELLNESS VISIT PROGRAM, NEARLY 20% OF COMMUNITY HOSPITAL-FAIRFAX'S ATTRIBUTED MEDICARE POPULATION HAS RECEIVED AN ANNUAL WELLNESS VISIT WITH THE POPULATION HEALTH NURSE AND THEIR PROVIDER. CHRONIC CARE MANAGEMENT IS EQUALLY IMPORTANT TO PREVENTATIVE HEALTH AS ITS FOCUS IS TO PROVIDE EXTRA CARE FOR PATIENTS WITH MULTIPLE CHRONIC DISEASES. STRATEGIES ARE CURRENTLY IN DEVELOPMENT FOR THIS PROGRAM. SCHEDULE H, PART VI, LINE 3 COMMUNITY HOSPITAL BUSINESS OFFICE STAFF WILL DISCUSS WITH INPATIENTS AND OUTPATIENTS THE OPTIONS AVALIABLE TO HELP THE PATIENTS MEET THEIR FINANCIAL OBLIGATIONS TO COMMUNITY HOSPITAL. THEY DISCUSS THE FEDERAL/STATE GOVERNMENT PROGRAMS AVAILABLE AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEN INFORMATION IS INCLUDED IN THE STATEMENTS SENT TO PATIENTS (EXPLAINING THE AMOUNTS OWED BY THE PATIENT'S INSURANCE OR THE PATIENT), MUCH OF THE INFORMATION IS THE SAME AS THE INFORMATION DISCUSSED IN PERSON. SCHEDULE H, PART VI, LINE 4 COMMUNITY HOSPITAL-FAIRFAX SERVES THE ATCHISON, HOLT AND WESTERN NODAWAY COUNTIES, POPULATION APPROXIMATELY 10,700. THERE ARE FIVE MAIN TOWNS IN ATCHISON AND HOLT, ALL WITH POPULATIONS BELOW 2,000. THE POPULATION IS ALL RURAL AND THE ECONOMY IS LARGELY DRIVEN BY AGRICULTURE. THE POPULATION IS AGING WITH A MEDIAN HOUSEHOLD INCOME OF $43,000 and $46,000. SCHEDULE H, PART VI, LINE 5 TO EDUCATE AND PROVIDE SERVICES TO ITS COMMUNITY, COMMUNITY HOSPITAL RESPONDS BY PROVIDING THE FOLLOWING ACTIVITES: AN ANNUAL HEART HEALTH SCREENING OFFERED FREE OF CHARGE, AND FREE BLOOD PRESSURE CHECKS; DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR; FREE GLUCOSE SCREENING, BMI CHECKS AND BLOOD PRESSURE CHECKS AT ANNUAL WOMEN'S EVENT; AN ANNUAL BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN AND HEALTHY EATING CHOICES ARE DISCUSSED; AN ANNUAL PROSTATE SCREENING WHICH INCLUDES A FREE EXAM FOR LOCAL RESIDENTS. IN ADDITION, THE HOSPITAL INITIATED A WORKPLACE WELLNESS PROGRAM WHERE SCREENINGS ARE OFFERED AT A REDUCED PRICE FOR EMPLOYEES. X X false false false false false false false false false JULIE JONES CEO 204001 0 0 0 1412 0 6656 0 3238 0 215307 0 RICHARD ARON BURKE MD DIRECTOR/CMO 583885 0 0 0 922 0 9750 0 10072 0 604629 0 DR DUSTIN CARPENTER MD DOCTOR 271556 0 0 0 295 0 0 0 10072 0 281923 0 KELLY OSBORN CRNA 189552 0 0 0 193 0 9750 0 11987 0 211482 0 RENEE KREIFELS CRNA 153852 0 0 0 305 0 7500 0 11027 0 172684 0 KATRINA LOCK ARNP 148519 0 0 0 193 0 2230 0 1777 0 152719 0 0 0 SCHEDULE J, PART II THE COMPENSATION FOR JULIE JONES IS PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), AN UNRELATED 501(C)(3) HOSPITAL. SEE PART V SEE PART V SCHEDULE L , PART IV, LINE 1 A) JAMIE BURKE B) JAMIE BURKE IS THE DAUGHTER OF DR. RICHARD ARON BURKE, A DIRECTOR OF THE ORGANIZATION. C)$54,429 D) JAMIE IS COMPENSATED AS AN LPN FOR THE ORGANIZATION. E) NO A) JOANNA BURKE B) JOANNA BURKE IS THE WIFE OF DR. RICHARD ARON BURKE, A DIRECTOR OF THE ORGANIZATION. C)$124,789 D) JOANNA IS COMPENSATED AS A PEDIATRIC NURSE PRACTITIONER IN ONE OF OUR RELATED CLINICS. E) NO FORM 990, PAGE 1 HEADER - AMENDED RETURN THE AUDITED FINANCIAL STATEMENTS FOR THE JUNE 30, 2021 yearend WERE NOT finalized and issued by the TIME THE FORM 990 was originally required to be filed. THE form 990 IS being AMENDED TO reflect the changes in The finalized AUDITED FINANCIAL STATEMENTS that were issued after the Form 990 was filed. THIS AMENDED RETURN INCLUDES CHANGES TO PATIENT SERVICE REVENUE ON FORM 990, PART VIII; BAD DEBT EXPENSE ON FORM 990, PART IX AND SCHEDULE H, PART III; AND ACCOUNTS RECEIVABLE AND NET ASSETS ON FORM 990, PART X. THE SCHEDULE D RECONCILIATION TO THE AUDITED FINANCIALS STATEMENTS HAS BEEN UPDATED AND THE FINALIZED AUDIT REPORT HAS BEEN ATTACHED TO THE FORM 990. FORM 990, PART III, LINE 4A COMMUNITY HOSPITAL-FAIRFAX (CH-F) PRIDES ITSELF IN PROVIDING ACCESS TO HEALTHCARE TO A REGION WHERE HEALTH SERVICES ARE SPARSE, THE PHYSICIAN RATIO IS 5290:1 (NATIONAL BENCHMARK IS 1260:1) AND EMERGENCY SERVICES WOULD OTHERWISE BE 30 MILES OR MORE FROM THE POPULATION CENTERS. COMMUNITY HOSPITAL-FAIRFAX PROVIDES THE NORTHWEST MISSOURI AREA POPULATION OF 11,000 IN HOLT, ATCHISON AND WESTERN NODAWAY COUNTY WITH A 24 HOUR EMERGENCY ROOM, ACUTE CARE (INCLUDING OBSTETRICS) AND POST-ACUTE CARE SERVICES, PRIMARY CARE SERVICES, MANY OUTPATIENT SERVICES, SURGERY, ANCILLARY SERVICES, AND A FULL-SERVICE THERAPY DEPARTMENT. IN ADDITION TO SERVING THE HEALTH NEEDS OF A POPULATION THAT WOULD OTHERWISE NOT HAVE ACCESS TO CARE, COMMUNITY HOSPITAL-FAIRFAX CONTINUES TO INVEST IN A HEALTHY FUTURE FOR THE COMMUNITY. CH-F TRIES TO FOCUS ON THE GREATEST HEALTH NEEDS IN THE COMMUNITY WHICH TEND TO BE CHRONIC DISEASES SUCH AS HEART DISEASE, COPD AND ASTHMA, STROKE AND DIABETES. RISK FACTORS FOR THESE DISEASES ARE OBESITY, CIGARETTE SMOKING AND PHYSICAL INACTIVITY. NEARLY 30% OF THE CH-F SERVICE POPULATION IS OBESE, 69% REPORT PHYSICAL INACTIVITY AND 26% SMOKE. TO EDUCATE AND PROVIDE SERVICES TO A COMMUNITY WHERE THESE CHRONIC CONDITIONS PREVAIL, THE FOLLOWING ACTIVITIES ARE PART OF CH-F'S RESPONSE TO HEALTH NEEDS OF THE COMMUNITY: CH-F launched a Chronic Care Management program by December 1, 2019. Community Hospital-Fairfax hired a nurse to begin a chronic care management program. Patients with two or more chronic diseases will be welcomed into the program where they will receive a care plan, 24-hour access to a nurse, education and resources to better manage their diseases. In 2020, the Chronic Care Management Program or CCM grew substantially from less than 10 patients to over 60 patients participating in the program or 3% of our entire Medicare population. These patients receive one on one attention from a dedicated nurse that helps them to manage their chronic diseases. CH-F is pursuing a strategy to increase Annual Wellness visits by 50%. Annual Wellness Visits are a comprehensive look at a patient's whole health and represents an opportunity to review preventatives, discuss current medications and disease management and ensure that the patient has access to resources to promote the best possible health. Patients with annual wellness visits are significantly more compliant with recommended screenings. Annual Wellness Visits were a challenge in a pandemic year. Providing this needed service safely was a top priority for our wellness staff. Even with the constraints from the pandemic, the organization completed 478 Annual Wellness Visits or 36% of the attributed population. This is a significant increase over the year prior. To continue to increase annual wellness visits, the organization recently committed to a second wellness nurse to continue to grow this service. In the last year, despite the pandemic, CH-F launched a Step Up to Colorectal and Breast Cancer Screening campaign. We worked directly with our primary care providers to increase rates of breast cancer and colorectal cancer screenings in our population. We were able to increase rates of colorectal cancer screenings by 10% and breast cancer screenings by 12%. In the last fiscal year, CH-F needed to meet the needs of the community in a different way than traditional outreach activities. This year, CH-F worked to address the pressing concern of COVID-19 in the community. Here are the ways in which CH-F met these needs: 1. CH-F lead the Incident Command team for the community hosting a virtual meeting each day with partners from emergency management, public health and the local ambulance district. 2. CH-F lead the community testing effort by erecting a tent, securing PCR COVID-19 testing early on and responding to the needs of the community. 3. CH-F participated in mass testing events with the State of Missouri. 4. CH-F produced public health messages about the benefits of mask wearing and social distancing. 5. CH-F responded to and continues to respond to increased inpatient volume from COVID-19 admissions. 6. CHF developed a telehealth solution to continue offering primary care and mental health services to homebound individuals. 7. CH-F volunteered to administer rapid tests to school children free of charge to ensure a safe return to school. CH-F CONTINUES TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE TO A POPULATION THAT WOULD NOT OTHERWISE HAVE ACCESS. RECRUITING PHYSICIANS, NURSES, THERAPISTS AND OTHER HEALTHCARE PROVIDERS IS ONGOING. PURCHASING STATE OF THE ART EQUIPMENT WHEN POSSIBLE AND MAKING SURE THAT EACH MEMBER OF OUR COMMUNITY HAS THE CARE THEY DESERVE IS NOT AN EASY TASK, BUT ONE CH-F IS PROUD TO DO. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BY-LAWS STATE THAT THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST ELEVEN MEMBERS AND NO MORE THAN FIFTEEN MEMBERS. TWO OF THE DIRECTORS SHALL BE INDIVIDUALS NOMINATED BY THE NEBRASKA MEDICAL CENTER (NMC), SUBJECT TO A MAJORITY VOTE OF THE BOARD. IF AN NMC DIRECTOR IS NOT ELECTED BY THE BOARD, NMC SHALL CONTINUE TO NOMINATE OTHER CANDIDATES UNTIL A NOMINEE IS ELECTED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATION. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S ADMINISTRATION HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 WITH ALL COMPLETED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY OBTAINS WRITTEN AFFIRMATIONS FROM EACH OFFICER AND DIRECTOR AS TO THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A DISCLOSURE OCCURS, THE MATTER IS FORWARDED TO AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECORS TO REVIEW ALL CIRCUMSTANCES SURROUNDING THE CONFLICT OF INTEREST. THE DETERMINATION OF SUCH MATTERS IS DEEMED FINAL BY THE BOARD. THE CONFLICTED INDIVIDUAL MAY NOT VOTE OR PARTICIPATE IN DISCUSSIONS AND/OR DETERMINATIONS INVOLVING THE CONFLICT. IT IS NOTED IN THE BOARD MEETING MINUTES OF ANY INDIVIDUALS ABSTAINING FROM VOTING DUE TO ANY CONFLICT. FORM 990, PART VI, SECTION B, LINE 15A & 15B THE ORGANIZATION USES COMPARABILITY DATA TO DETERMINE THE COMPENSATION OF THE CEO AND OTHER OFFICERS. THE COMPENSATION OF THE CEO AND OTHER OFFICERS IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE LAST REVIEW WAS DONE IN 2021. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART XI, LINE 9 TRANSFER FROM RELATED ORGANIZATION $ 297,110 CHANGE IN CONTRIBUTION FROM FOUNDATION $ 27,387 --------- TOTAL $ 324,497 FORM 990 PART IX LINE 11G DESCRIPTION:EMERGENCY ROOM PHYSICIAN FEES TOTAL FEES:248026 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PHYSICIAN FEES TOTAL FEES:172917 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:215122 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - OTHER TOTAL FEES:218185 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:1994059 COMMUNITY HEALTHCARE FOUNDATION 26136 US HWY 59 FAIRFAX MO 64446 431757553 SUPPORT ORG MO 501(C)(3) 12A CHA true false false false false false false false false false false false false true true true false true false true COMMUNITY HEALTHCARE FOUNDATION S 297110 FMV