FURP.ORG / PUBLIC DATA EXPLORER

CUMBERLAND VALLEY MANOR: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization
CUMBERLAND VALLEY MANOR (EIN 61-0913814)
Tax period
2020-10-01 to 2021-09-30
Filed
2022-08-09
IRS object ID
202232219349300928
Schema version
2020v4.2
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2022-08-09T11:16:35-05:00ReturnTs
Tax Period End2021-09-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN351178661PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BLUE & CO LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line12650 EASTPOINT PKWY SUITE 300AddressLine1Txt
CityLOUISVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP40223ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2020-10-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN610913814EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CUMBERLAND VALLEY MANORBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlCUMBBusinessNameControlTxt
Phone2708644315PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 438AddressLine1Txt
CityBURKESVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP42717ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonMARIBETH SHELTONPersonNm
Person TitleADMINISTRATORPersonTitleTxt
Phone2708644315PhoneNum
Signature2022-08-08SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

FieldValueIRS element (for citing)
Person FirstMARIBETHPersonFirstNm
Person LastSHELTONPersonLastNm
FieldValueIRS element (for citing)
SSN999009999SSN

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonNATHAN A RODGERS CPAPreparerPersonNm
PTINP01568275PTIN
Phone5029923500PhoneNum
Preparation2022-08-08PreparationDt

Additional Filer Information AdditionalFilerInformation

Trusted Customer TrustedCustomerGrp

FieldValueIRS element (for citing)
Trusted Customer2TrustedCustomerCd
Authentication Assurance LevelAAL1AuthenticationAssuranceLevelCd
Identity Assurance LevelIAL1IdentityAssuranceLevelCd
FieldValueIRS element (for citing)
Tax2020TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerROBERT FLOWERSPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 438AddressLine1Txt
CityBURKESVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP42717ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$7,323,694GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressN/AWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1975FormationYr
Legal Domicile StateKYLegalDomicileStateCd
Activity Or MissionPROVIDE PERSONAL AND INTERMEDIATE CARE TO RESIDENTS.ActivityOrMissionDesc
Voting Members Governing Body9VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee195TotalEmployeeCnt
Total Volunteers0TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$0PYContributionsGrantsAmt
CY Contributions Grants$3,245CYContributionsGrantsAmt
PY Program Service Revenue$7,539,771PYProgramServiceRevenueAmt
CY Program Service Revenue$7,307,348CYProgramServiceRevenueAmt
PY Investment Income$3,934PYInvestmentIncomeAmt
CY Investment Income$8,363CYInvestmentIncomeAmt
PY Other Revenue$5,957PYOtherRevenueAmt
CY Other Revenue$4,738CYOtherRevenueAmt
PY Total Revenue$7,549,662PYTotalRevenueAmt
CY Total Revenue$7,323,694CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$285CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$3,300,435PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$3,139,268CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$3,367,712PYOtherExpensesAmt
CY Other Expenses$3,577,880CYOtherExpensesAmt
PY Total Expenses$6,668,147PYTotalExpensesAmt
CY Total Expenses$6,717,433CYTotalExpensesAmt
PY Revenues Less Expenses$881,515PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$606,261CYRevenuesLessExpensesAmt
Total Assets BOY$3,616,098TotalAssetsBOYAmt
Total Assets EOY$3,705,716TotalAssetsEOYAmt
Total Liabilities BOY$995,923TotalLiabilitiesBOYAmt
Total Liabilities EOY$516,018TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$2,620,175NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$3,189,698NetAssetsOrFundBalancesEOYAmt
MissionTO PROVIDE PERSONAL, INTERMEDIATE, AND SKILLED CARE TO RESIDENTS.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$5,926,704ExpenseAmt
Grant$285GrantAmt
Revenue$7,312,086RevenueAmt
DescPATIENT RELATED SERVICES - PERSONAL, INTERMEDIATE, AND SKILLED CARE.Desc
Total Program Service Expenses$5,926,704TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B Required0ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying Activities0LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Donor Rstr Or Quasi Endowments0DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentYes (1)ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other Assets0ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt0IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate Hospital0OperateHospitalInd
Grants To Organizations0GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org MemYes (1)BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent0BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document26IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee195EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht Pymt0SubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst Inc0SubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members9GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or Stockholders0MembersOrStockholdersInd
Election Of Board Members0ElectionOfBoardMembersInd
Decisions Subject To Approva0DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn Body0Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower Policy0WhistleblowerPolicyInd
Document Retention Policy0DocumentRetentionPolicyInd
Compensation Process CEO0CompensationProcessCEOInd
Compensation Process Other0CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
States Where Copy Of Return Is FldKYStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1CUMBERLAND VALLEY MANOR MANAGEMENTBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone2708644315PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 438AddressLine1Txt
CityBURKSVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP42717ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
DR ROBERT FLOWERS SR
CHAIRMAN1.0040.00Yes (X)$13,000$647,350$16,074
JUDY FREDERICK
VICE CHAIRMAN1.000.00Yes (X)$0$0$0
MATTHEW HURT
TREASURER1.000.00Yes (X)$0$0$0
MARIE ROWE
SECRETARY1.000.00Yes (X)$0$0$0
RICHARD NEIKIRK
BOARD MEMBER1.0040.00Yes (X)$10,000$265,586$8,595
DR ROBERT FLOWERS JR
BOARD MEMBER1.0040.00Yes (X)$0$465,401$7,189
VICKIE DYER
BOARD MEMBER1.000.00Yes (X)$0$0$0
THOMAS BAKER
BOARD MEMBER1.000.00Yes (X)$0$0$0
MIKE MOSBY
BOARD MEMBER1.000.00Yes (X)$0$0$0
RICK CAPPS
CFO CCHA1.0040.00$0$203,663$13,634Yes (X)
MARIBETH SHELTON
ADMINISTRATION40.000.00$112,842$0$8,639Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$135,842TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,582,000TotReportableCompRltdOrgAmt
Total Other Compensation$54,131TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K1IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp

Contractor Name ContractorName

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1SELECT REHABILITATIONBusinessNameLine1Txt

Contractor Address ContractorAddress

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 71985AddressLine1Txt
CityCHICAGOCityNm
State AbbreviationILStateAbbreviationCd
ZIP606941985ZIPCd
FieldValueIRS element (for citing)
ServicesMEDICAL PAYMENTSServicesDesc
Compensation$558,442CompensationAmt
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K1CntrctRcvdGreaterThan100KCnt
All Other Contributions$3,245AllOtherContributionsAmt
Total Contributions$3,245TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp

FieldValueIRS element (for citing)
DescPROGRAM SERVICE REVENUDesc
Business900099BusinessCd
Total Revenue Column$7,307,348TotalRevenueColumnAmt
Related Or Exempt Func Income$7,307,348RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$7,307,348TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$8,363TotalRevenueColumnAmt
Exclusion$8,363ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescOTHER REVENUEDesc
Business900099BusinessCd
Total Revenue Column$4,738TotalRevenueColumnAmt
Related Or Exempt Func Income$4,738RelatedOrExemptFuncIncomeAmt
FieldValueIRS element (for citing)
Other Revenue Total$4,738OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$7,323,694TotalRevenueColumnAmt
Related Or Exempt Func Income$7,312,086RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$8,363ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$285TotalAmt
Program Services$285ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$23,000TotalAmt
Management And General$23,000ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$2,876,006TotalAmt
Program Services$2,502,125ProgramServicesAmt
Management And General$373,881ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$20,582TotalAmt
Program Services$17,906ProgramServicesAmt
Management And General$2,676ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$923TotalAmt
Program Services$803ProgramServicesAmt
Management And General$120ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$218,757TotalAmt
Program Services$190,319ProgramServicesAmt
Management And General$28,438ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$5,505TotalAmt
Program Services$5,505ProgramServicesAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$7,094TotalAmt
Management And General$7,094ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$634,018TotalAmt
Program Services$551,596ProgramServicesAmt
Management And General$82,422ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$8,968TotalAmt
Program Services$7,802ProgramServicesAmt
Management And General$1,166ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$27,240TotalAmt
Program Services$23,699ProgramServicesAmt
Management And General$3,541ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$12,889TotalAmt
Program Services$11,213ProgramServicesAmt
Management And General$1,676ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$16,904TotalAmt
Program Services$14,706ProgramServicesAmt
Management And General$2,198ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$12TotalAmt
Program Services$10ProgramServicesAmt
Management And General$2ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$128,833TotalAmt
Program Services$112,085ProgramServicesAmt
Management And General$16,748ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$789,705TotalAmt
Program Services$687,043ProgramServicesAmt
Management And General$102,662ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
DRUGS AND MEDICAL SUPPL$518,101$518,101
SUPPLIES$399,641$347,688$51,953
PROVIDER TAX$312,409$312,409
UTILITIES$172,213$149,825$22,388

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$544,348TotalAmt
Program Services$473,584ProgramServicesAmt
Management And General$70,764ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$6,717,433TotalAmt
Program Services$5,926,704ProgramServicesAmt
Management And General$790,729ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$1,248,689BOYAmt
EOY$1,505,335EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$814,098BOYAmt
EOY$856,100EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$52,700BOYAmt
EOY$52,908EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$197,598BOYAmt
EOY$177,813EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$1,545,794LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$432,234LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$1,156,975BOYAmt
EOY$1,113,560EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$146,038BOYAmt
EOY$0EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$3,616,098BOYAmt
EOY$3,705,716EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$479,047BOYAmt
EOY$353,579EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$502,555BOYAmt
EOY$117,087EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$14,321BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$45,352EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$995,923BOYAmt
EOY$516,018EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$2,620,175BOYAmt
EOY$3,189,698EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$2,620,175BOYAmt
EOY$3,189,698EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$3,616,098BOYAmt
EOY$3,705,716EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$606,261ReconcilationRevenueExpnssAmt
Prior Period Adjustments-$36,738PriorPeriodAdjustmentsAmt
Other Changes In Net Assets$0OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Publicly Supported Org509a2Yes (X)PubliclySupportedOrg509a2Ind

Gifts Grants Contris Rcvd509 GiftsGrantsContrisRcvd509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$120,831CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$92,167CurrentTaxYearMinus3YearsAmt
Current Tax Year$3,245CurrentTaxYearAmt
Total$216,243TotalAmt

Gross Receipts Admissions GrossReceiptsAdmissionsGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,483,513CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,224,606CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,582,679CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,539,771CurrentTaxYearMinus1YearAmt
Current Tax Year$7,307,348CurrentTaxYearAmt
Total$31,137,917TotalAmt

Total509 Total509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,604,344CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,316,773CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,582,679CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,539,771CurrentTaxYearMinus1YearAmt
Current Tax Year$7,310,593CurrentTaxYearAmt
Total$31,354,160TotalAmt

Amounts Rcvd Dsqlfy Person AmountsRcvdDsqlfyPersonGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Substantial Contributors Amt SubstantialContributorsAmtGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Subst And Dsqlfy Prsns Tot SubstAndDsqlfyPrsnsTotGrp

FieldValueIRS element (for citing)
Total$0TotalAmt
FieldValueIRS element (for citing)
Public Support Total509$31,354,160PublicSupportTotal509Amt

Gross Investment Income509 GrossInvestmentIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$818CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,934CurrentTaxYearMinus1YearAmt
Current Tax Year$8,363CurrentTaxYearAmt
Total$13,115TotalAmt

Investment Income And UBTI InvestmentIncomeAndUBTIGrp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$818CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$3,934CurrentTaxYearMinus1YearAmt
Current Tax Year$8,363CurrentTaxYearAmt
Total$13,115TotalAmt

Other Income509 OtherIncome509Grp

FieldValueIRS element (for citing)
Current Tax Year Minus2 Years$28,092CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$5,957CurrentTaxYearMinus1YearAmt
Current Tax Year$4,738CurrentTaxYearAmt
Total$38,787TotalAmt

Total Support Calendar Year TotalSupportCalendarYearGrp

FieldValueIRS element (for citing)
Current Tax Year Minus4 Years$5,604,344CurrentTaxYearMinus4YearsAmt
Current Tax Year Minus3 Years$5,316,773CurrentTaxYearMinus3YearsAmt
Current Tax Year Minus2 Years$5,611,589CurrentTaxYearMinus2YearsAmt
Current Tax Year Minus1 Year$7,549,662CurrentTaxYearMinus1YearAmt
Current Tax Year$7,323,694CurrentTaxYearAmt
Total$31,406,062TotalAmt
FieldValueIRS element (for citing)
Public Support CY5090.99830PublicSupportCY509Pct
Public Support PY5090.99870PublicSupportPY509Pct
Investment Income CY0.00040InvestmentIncomeCYPct
Investment Income PY0.00020InvestmentIncomePYPct
Thirty Thr Pct Suprt Tests CY509Yes (X)ThirtyThrPctSuprtTestsCY509Ind

Schedule D IRS990ScheduleD

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$53,542OtherCostOrOtherBasisAmt
Book Value$53,542BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,265,629OtherCostOrOtherBasisAmt
Depreciation$261,378DepreciationAmt
Book Value$1,004,251BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$226,623OtherCostOrOtherBasisAmt
Depreciation$170,856DepreciationAmt
Book Value$55,767BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$1,113,560TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

FieldValueIRS element (for citing)
DescDUE FROM MEDICAREDesc
Amt$45,352Amt
FieldValueIRS element (for citing)
Total Liability$45,352TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferencePART X, LINE 2:FormAndLineReferenceDesc
ExplanationACCOUNTING PRINCIPLES GENERALLY ACCEPTED IN THE UNITED STATES OF AMERICA REQUIRE MANAGEMENT TO EVALUATE TAX POSITIONS TAKEN BY THE HOSPITAL AND RECOGNIZE A TAX LIABILITY IF THE HOSPITAL HAS TAKEN AN UNCERTAIN TAX POSITION THAT MORE LIKELY THAN NOT WOULD NOT BE SUSTAINED UPON EXAMINATION BY VARIOUS FEDERAL AND STATE TAXING AUTHORITIES. MANAGEMENT HAS ANALYZED THE TAX POSITIONS TAKEN BY THE HOSPITAL, AND HAS CONCLUDED THAT AS OF JUNE 30, 2021 AND JUNE 30, 2020 THERE ARE NO UNCERTAIN POSITIONS TAKEN OR EXPECTED TO BE TAKEN THAT WOULD REQUIRE RECOGNITION OF A LIABILITY OR DISCLOSURE IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. THE HOSPITAL IS SUBJECT TO ROUTINE AUDITS BY TAXING JURISDICTIONS; HOWEVER, THERE ARE CURRENTLY NO AUDITS FOR ANY TAX PERIODS IN PROGRESS.ExplanationTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr Plan0SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org0CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs0CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
DR ROBERT FLOWERS SR
CHAIRMAN$0$310,866$0$0$13,000$336,484$0$8,550$0$7,524$13,000$663,424$0$0
RICHARD NEIKIRK
BOARD MEMBER$0$265,586$0$0$10,000$0$0$7,968$0$627$10,000$274,181$0$0
DR ROBERT FLOWERS JR
BOARD MEMBER$0$239,641$0$0$0$225,760$0$7,189$0$0$0$472,590$0$0
RICK CAPPS
CFO CCHA$0$203,663$0$0$0$0$0$6,110$0$7,524$0$217,297$0$0

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)

Relationship DescriptionRelationshipDescriptionTxtTransactionTransactionAmtTransactionTransactionDescSharing Of RevenuesSharingOfRevenuesInd
DR ROBERT FLOWERS DO PSC
BOARD MEMBER$13,000DR ROBERT FLOWERS IS A BOARD MEMBER OF CUMBERLAND VALLEY MANOR. HIS BUSINESS, DR ROBERT FLOWERS, DO PSC, WAS PAID 13,000 DURING THE YEAR FOR HIS POSITION AS MEDICAL DIRECTOR. ALL OTHER COMPENSATION REPORTED ON PAGE 7 AND SCH J IS FOR SERVICES HE PROVIDED AS A PHYSICIAN AT CUMBERLAND COUNTY HOSPITAL ASSOCIATION.0
RICK NEIKIRK
BOARD MEMBER$10,000RICK NEIKIRK IS A BOARD MEMBER OF CVM & IS PAID A MANAGEMENT FEE FOR CVM. HE IS THE CEO OF THE RELATED PARTY, CUMBERLAND COUNTY HOSPITAL ASSOCIATION.0

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART VI, SECTION B, LINE 11BA COPY OF THE FORM 990 IS REVIEWED BY ACCOUNTING PERSONNEL AND PRESENTED TO THE BOARD OF DIRECTORS PRIOR TO FILING.
FORM 990, PART VI, SECTION B, LINE 12CALL CONTRACTS AND OTHER AGREEMENTS ARE REVIEWED BY MANAGEMENT TO ENSURE THAT NO CONFLICTS EXIST OR HAVE THE ABILITY TO ARISE. THE BOARD OF DIRECTORS MUST VOTE ON THE POLICY IF A CONFLICTING EVENT ARISES AND A CONFLICTING BOARD MEMBER MUST ABSBTAIN FROM VOTING.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XII, LINE 2C:THE BOARD OF DIRECTORS ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT OF THE FINANCIAL STATEMENTS AND SELECTION OF THE INDEPENDENT ACCOUNTANT; AND NO PROCESSES HAVE CHANGED FROM PRIOR YEAR.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1CUMBERLAND COUNTY HOSPITAL ASSOCIATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 280AddressLine1Txt
CityBURKESVILLECityNm
State AbbreviationKYStateAbbreviationCd
ZIP42717ZIPCd
FieldValueIRS element (for citing)
EIN610624096EIN
Primary ActivitiesHOSPITALPrimaryActivitiesTxt
Legal Domicile StateKYLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity StatusLINE 3PublicCharityStatusTxt
Controlled Organization0ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsYes (1)ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org0GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org0LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org0PerformOfServicesForOthOrgInd
Perform Of Services By Other Org0PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees Sharing0PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org0ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd