2023-03-24T11:18:08-05:00 2022-06-30 FORVIS LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2021-07-01 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 2023-05-15 2 2021 2023-04-26 12:10:37Z JULIE JONES 26136 US HWY 59 FAIRFAX MO 644460107 24227206 false X WWW.FAIRFAXMED.COM X 1976 MO TO PROVIDE QUALITY ACUTE CARE, EMERGENCY PRIMARY CARE AND OUTPATIENT SERVICES. 12 11 172 80 0 0 3449243 539063 21871850 23447707 26619 8897 224913 231539 25572625 24227206 0 0 0 0 9932563 10497269 0 0 58822 12946945 13707350 22879508 24204619 2693117 22587 20617643 16710906 15509700 11573407 5107943 5137499 X TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. false false 20490296 0 23447707 SEE SCHEDULE O 20490296 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 true false false false false false false true false false false false false false true true true false false true 7 0 true 172 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 X RICHARD ARON BURKE MD DIRECTOR/CHIEF MEDICAL OFFICER 40.0 0.0 X 709079 0 36360 DR DUSTIN CARPENTER MD PHYSICIAN 40.0 0.0 X 265263 0 17814 KELLY OSBORN CRNA 40.0 0.0 X 238340 0 34136 JULIE JONES CEO 40.0 1.0 X 238568 0 30241 KATRINA LOCK ARNP 40.0 0.0 X 143070 0 26517 JON DAVIS CFO 40.0 1.0 X 141576 0 16953 RENEE KREIFELS CRNA 40.0 0.0 X 124373 0 28950 REBECCA SCHLEUTER COO 40.0 0.0 X 115213 0 28953 AMY RYAN DIRECTOR/VICE-PRESIDENT 1.0 0.0 X X 0 0 0 COREY HERRON DIRECTOR 1.0 0.0 X 0 0 0 TERESA SMITH DIRECTOR 1.0 1.0 X 0 0 0 TOM BULLOCK DIRECTOR 1.0 1.0 X 0 0 0 GLENN SCOTT DIRECTOR 1.0 0.0 X 0 0 0 VIRGINIA LOW DIRECTOR/PRESIDENT/CHAIRMAN 1.0 1.0 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 SECRETARY/TREASURER 1.0 0.0 X 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 1975482 0 219924 10 false true false INSPIRE REHABILITATION LLC 8181 ARISTA PLACE SUITE 100 BROOMFIELD CO 80021 REHAB SERVICES 973121 PSYCHIATRIC MEDICAL CARE LLC PO BOX 734606 DALLAS TX 75373 SENIOR MENTAL HEALTH 603523 CPSI INC PO BOX 11407 BIRMINGHAM IL 35246 EHR SYSTEM 376345 THE NEBRASKA MEDICAL CENTER 988145 NEBRASKA MEDICAL CENT OMAHA NE 68198 PHARMACY SUPPORT 240195 DOCS WHO CARE 800 W FRONTIER LN OLATHE KS 66061 ER PHYSICIAN SERVICE 203590 9 480319 58744 539063 Net Patient Service Revenue 621990 22453182 22453182 340B Revenue 621990 994525 994525 23447707 8897 8897 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 CAFETERIA 900099 49410 49410 All Other Misc Revenue 900099 182129 182129 182129 182129 231539 24227206 23447707 0 240436 0 0 0 0 1219297 990502 225029 3766 153104 153104 7788709 6298469 1465712 24528 76719 62323 14159 237 696344 565678 128515 2151 563096 457434 103923 1739 0 30717 30717 109913 109913 6095 6095 0 0 2837171 2396797 433126 7248 33207 26977 6128 103 2109973 1718998 384439 6536 0 0 375672 305179 69333 1160 96020 78002 17721 297 0 0 419158 340505 77358 1295 0 1263574 1026072 233592 3910 271474 220533 50102 838 Repairs & Maint. 903946 734325 166829 2792 Medical Supplies 1895051 1895051 Bad Debt 1857503 1857503 Medicaid 778261 778261 719615 584583 132810 2222 24204619 20490296 3655501 58822 5274 4821 10845908 7065914 197280 0 2274136 2765675 0 0 0 0 0 0 470468 542930 191884 159087 24107810 19223433 5764691 4884377 0 0 0 0 0 0 0 0 868002 1288102 20617643 16710906 1709981 1886023 0 0 0 0 0 0 0 0 0 0 8877153 8370137 0 0 4922566 1317247 15509700 11573407 X 4982741 4999863 125202 137636 5107943 5137499 20617643 16710906 X 22587 6969 X false true X true true true X false false false false false true 6095 false false false 6095 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. 244304 244304 8003077 6164075 1839002 15555042 13059358 2495684 305387 305387 4884377 DUE FROM THIRD PARTY 1154000 Other Receivables 134102 1288102 0 REFUNDABLE ADVANCES 1177052 DUE TO THIRD PARTY 140195 1317247 22681124 274715 274715 22406409 1820797 1820797 24227206 22400199 53083 53083 22347116 1857503 1857503 24204619 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. SCHEDULE D, PART XI, LINES 2D & 4B LINE 2D RELATED ORGANIZATION'S REVENUE $ 274,715 LINE 4B BAD DEBT EXPENSE $ 1,857,503 CHANGE IN CONTRIBUTION FROM FOUNDATION $ (36,706) ------------- $ 1,820,797 SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D RELATED ORGANIZATION'S EXPENSES $ 53,083 LINE 4B BAD DEBT EXPENSE $ 1,857,503 true true X true X true X true true true false true true 126030 126030 0.00560 2226426 1407414 819012 0.03660 17905 83266 -65361 2370361 1490680 879681 0.04220 49266 49266 0.00220 1968 1968 0.00010 51234 51234 0.00230 2421595 1490680 930915 0.04450 true 1857503 190317 10278728 8557161 1721567 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 22 true false false true X SEE PART V, SECTION C X true 22 true SEE PART V, SECTION C 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 CHF USED FOCUS GROUPS FROM LOCAL FOOD ASSISTANCE PROGRAMS, CLERGY, SCHOOL ADMINISTRATION, OTHER AREA HEALTHCARE PROVIDERS AND PUBLIC ADMINISTRATORS AS PART OF THE CHNA STUDY. THIS WAS DONE THROUGH PAID OUTREACH THROUGH SOCIAL MEDIA, WEBSITE POP-UP, MASS MAILING TO SENIOR ADULTS, PUBLIC SPEAKING ENGAGEMENTS, AND EMAIL DISTRIBUTION. OF THOSE WHO RESPONDED, NEARLY HALF REPRESENTED HOUSEHOLDS OF MORE THAN ONE PERSON, PRIMARILY WOMEN AND IN ATCHISON COUNTY. HALF WERE OF INCOMES LESS THAN $75,000 PER YEAR. OF THE SURVEYS, 250 WERE MAILED TO A RANDOM LIST OF INDIVIDUALS OVER 65, WITH 84 OF THOSE RESPONDING. OF THE TOTAL SURVEYS, 306 WERE COLLECTED ELECTRONICALLY. SCHEDULE H, PART V, SECTION B, LINE 7A https://fairfaxmed.com/CHNA SCHEDULE H, PART V, SECTION B, LINE 10A https://fairfaxmed.com/CHNA SCHEDULE H, PART V, SECTION B, LINE 11 THE SURVEY WAS ADOPTED BY THE BOARD OF DIRECTORS IN THE MAY 2022 BOARD OF DIRECTORS MEETING. STRATEGIES FOR IMPLEMENATION THAT WERE SPECIFICALLY IDENTIFIED OF AREAS OF CONCERN BY THE COMMUNITEE WERE TELEHEALTH MENTAL HEALTH SERVICES AND THE NEED FOR ADDITIONAL PRIMARY CARE PHYSICIAN SERVICES. THIRD ON THE LIST WERE DEALING WITH UNHEALTHY BEHAVIORS AND CHRONIC CARE MANAGEMENT. FINALLY, ACCESS TO HEALTHCARE WAS MENTIONED AS A MAJOR CONCERN WITH THE INABILITY TO GET A CONVENIENT APPOINTMENT AND AFFORDABILITY AS THE MOST COMMON RESPONSE. EACH OF THESE AREAS WERE GIVEN THE GREEN LIGHT BY THE BOARD TO ADD TO THE HOSPITAL'S STRATEGIC PLAN, AS WELL AS ADOPTING A BUDGET FOR EACH. IN RESPONSE TO WHETHER WE PROVIDE THE DESIRED SERVICES, URGENT CARE, CHEMOTHERAPY, ENT, PODIATRY, DERMATOLOGY AND PULMONOLGY WERE LISTED AS THE KINDS OF SERVICES THE RESPONDENTS WOULD LIKE TO HAVE ACCESS TO LOCALLY. SCHEDULE H, PART V, SECTION B, LINE 16A, 16B & 16C https://fairfaxmed.com/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 PROVIDER BASED RURAL HEALTH 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 $1,857,503. SCHEDULE H, PART II Due to Covid-19 restrictions, Community Hospital-Fairfax curtailed much of its community building activities. However, the Back-to-School fair, annual prostate and women's health screenings continued under Covid-19 safety guidelines, such as masking and social distancing. Covid-19 testing was a priority during this time, with CHF testing for free all those without any qualifying insurance or inability to pay. 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 8 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, 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 FY2022 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION C, 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. SCHEDULE H, PART VI, LINE 7 MISSOURI X X false false false false false false false false false JON DAVIS CFO 141108 0 0 0 468 0 0 0 16953 0 158529 0 0 0 JULIE JONES CEO 237065 0 0 0 1503 0 23224 0 7017 0 268809 0 0 0 RICHARD ARON BURKE MD DIRECTOR/CHIEF MEDICAL OFFICER 707970 0 0 0 1109 0 19500 0 16860 0 745439 0 0 0 DR DUSTIN CARPENTER MD PHYSICIAN 264987 0 0 0 276 0 4050 0 13764 0 283077 0 0 0 KELLY OSBORN CRNA 238107 0 0 0 233 0 18641 0 15495 0 272476 0 0 0 KATRINA LOCK ARNP 142895 0 0 0 175 0 19500 0 7017 0 169587 0 0 0 RENEE KREIFELS CRNA 124159 0 0 0 214 0 12000 0 16950 0 153323 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, LINES 1 & 2 A) JAMIE BURKE B) JAMIE BURKE IS THE DAUGHTER OF DR. RICHARD ARON BURKE, A DIRECTOR OF THE ORGANIZATION. C) $49,531 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) $103,573 D) JOANNA IS COMPENSATED AS A PEDIATRIC NURSE PRACTITIONER IN ONE OF OUR RELATED CLINICS. E) NO 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 4,797:1 (NATIONAL BENCHMARK IS 1400:1) 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, 35% REPORT PHYSICAL INACTIVITY AND 22% 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. FOR ALL OTHER ACTIVITIES AND STRATEGIES RELATED TO THE CHNA, SEE THE REPORT AND IMPLENTATION STRATEGY AT WWW.FAIRFAXMED.COM/CHHA. 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 IN 2022. 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 TO RELATED ORGANIZATION $ ( 29,737) CHANGE IN CONTRIBUTION FROM FOUNDATION $ 36,706 --------- TOTAL $ 6,969 FORM 990 PART IX LINE 11G DESCRIPTION:EMERGENCY ROOM PHYSICIAN FEES TOTAL FEES:216442 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PHYSICIAN FEES TOTAL FEES:141127 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:132754 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - OTHER TOTAL FEES:211178 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:2135670 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 true false