2022-11-03T13:49:37-05:00 2021-12-31 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990EZ 2021-01-01 862448448 Country Care Hospice Inc COUN 3166615917 104 North Steen Street Mt Hope KS 67108 Teresa Achilles Executive Director 3166615917 2022-11-01 1 Teresa Achilles 999009999 Adam Crouch P01516101 7852334226 2022-10-26 0 AAL1 IAL1 2021 2022-09-23 18:48:47Z X X N/A X X 187777 X 180000 7768 9 187777 83517 4500 163848 251865 -64088 0 0 -64088 X 0 850 0 7768 0 8618 0 72706 0 -64088 X To provide hospice care services to seniors and their families. To provide hospice care services to seniors and their families. 0 242256 To provide grants to member hospice facilities for the care of specific individuals. 9608 0 242256 Teresa Achilles Executive Director 40.00 38749 17678 0 Holly Noble Secretary 1.00 0 0 0 Kayla Brown Treasurer 1.00 0 0 0 Gina Terry President 1.00 0 0 0 Amy Bennett Director 1.00 0 0 0 X 0 0 0 0 0 0 0 0 0 0 0 0 0 Teresa Achilles 104 North Steen Street Mt Hope KS 67108 3166615917 0 0 0 0 0 0 0 0 0 0 NONE NONE 1 X X 4 Attica Hospital District No 1 486088806 3 1 0 0 Cheney Golden Age Home Inc 486110967 10 1 0 0 Mt Hope Community Development Inc 480807269 10 1 0 0 Anthony Community Care Center Inc 481231930 10 1 0 0 4 0 0 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 Part I, Line 12g Anthony Community Care Center, Cheney Golden Age Home, and Mt Hope Community Development are IRC Section 501(c)(3) organizations while Attica Hospital District No. 1 is a hospital or a cooperative hospital service organization described in IRC Section 170(b)(1)(A)(iii). Country Care Hospice's Articles of Incorporation state that it will carry on exclusively for charitable purposes. The Hospice is supervised and controlled by the aforementioned entities through their appointment to the governing board of the Hospice. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED Form 990-EZ, Part I, Line 8 - Other Revenue Description: Interest. Amount: 9. Form 990-EZ, Part I, Line 16 - Other Expenses Description: DME Equipment Rental. Amount: 332. Description: Medical Supplies. Amount: 2,096. Description: Mileage Expense. Amount: 372. Description: Pharmacy Expense. Amount: 1,885. Description: Payroll Taxes. Amount: 7,380. Description: Wages and Benefits - Administration. Amount: 72,331. Description: Office Expenses. Amount: 18,247. Description: Dues and Subscriptions. Amount: 180. Description: Education Training Seminar. Amount: 5,720. Description: Insurance Expense. Amount: 2,180. Description: Professional Fees. Amount: 20,214. Description: Marketing and Advertising. Amount: 729. Description: Meals and Entertainment. Amount: 63. Description: Purchased Services. Amount: 18,283. Description: Small Equipment Purchase. Amount: 4,228. Description: Pro Bono Patient Expenses. Amount: 9,608. Total to Form 990-EZ, line 16: 163,848. Form 990-EZ, Part II, Line 24 - Other Assets Description: Medicare Accounts Receivable. Beg. of Year Amount: 0. End of Year Amount: 7,768. Form 990-EZ, Part II, Line 26 - Other Liabilities Description: Kansas Withholding Tax. Beg. of Year Amount: 0. End of Year Amount: 568. Description: Federal Unemployment Tax. Beg. of Year Amount: 0. End of Year Amount: 145. Description: Kansas Unemployment Tax. Beg. of Year Amount: 0. End of Year Amount: 180. Description: Loan - Anthony. Beg. of Year Amount: 0. End of Year Amount: 5,000. Description: Loan - Attica. Beg. of Year Amount: 0. End of Year Amount: 29,609. Description: Loan - Cheney. Beg. of Year Amount: 0. End of Year Amount: 12,068. Description: Loan - Mt Hope. Beg. of Year Amount: 0. End of Year Amount: 4,500. Description: Loan - Bridge Loan. Beg. of Year Amount: 0. End of Year Amount: 5,000. Description: Startup Cost to Reimburse. Beg. of Year Amount: 0. End of Year Amount: 15,636. The organization did not, during the year, receive any funds, directly,or indirectly, to pay premiums on a personal benefit contract.The organization, did not, during the year, pay any premiums, directly,or indirectly, on a personal benefit contract.