2025-09-24T14:49:20-05:00 2024-12-31 481026809 Wendling Noe Nelson & Johnson LLC 623 SW 10th Ave Suite 300 Topeka KS 66612 990 2024-01-01 862448448 Country Care Hospice Inc COUN 3166615917 710 W 14th Ave PO Box 306 Harper KS 67058 Teresa Achilles Executive Director 3166615917 2025-09-16 1 0 Adam Crouch P01516101 7852334226 2025-08-12 2024 2025-03-06 01:10:19Z Teresa Achilles 710 W 14th Ave Harper KS 67058 1087166 0 X N/A X 2021 KS To provide hospice care services to seniors and their families. 3 3 22 3 0 0 3881 3065 820733 1083908 101 193 0 0 824715 1087166 0 0 0 0 584717 739161 0 0 0 325658 397817 910375 1136978 -85660 -49812 137738 135449 253799 300173 -116061 -164724 To provide hospice care services to seniors and their families. 0 0 919404 1083908 Providing hospice care services to seniors and their families, including hospice care to residents of facilities owned and operated by member hospice facilities. Providing grants to member hospice facilities for the care of specific individuals. 919404 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 2 0 1 22 1 0 0 0 0 0 0 0 0 0 0 0 0 X 3 3 0 0 0 0 1 1 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Teresa Achilles 3166615917 710 W 14th Ave Harper KS 67058 Teresa Achilles Executive Director 40.00 X 53821 0 20831 Holly Noble President 1.00 X 0 0 0 Jessica Martin Secretary/Treasurer 1.00 X 0 0 0 53821 0 20831 0 0 0 0 0 3065 3065 Hospice Care Revenue 623000 1083908 1083908 1083908 193 193 1087166 1083908 0 193 74652 74652 564704 564704 51779 51779 48026 48026 9263 9263 57445 57445 7178 7178 11488 11488 13625 2540 11085 1659 1659 63410 54488 8922 617 617 1548 1548 23889 23889 Medicaid R & B 5% Fee 52668 52668 Pharmacy Expense 50933 50933 Vehicle Lease Expense 48257 48257 DME Equipment Rental 29584 29584 26253 16425 9828 1136978 919404 217574 0 3331 68001 133707 64567 2881 700 2881 137738 135449 192656 237487 61143 62686 253799 300173 X -116061 -164724 -116061 -164724 137738 135449 -49812 1149 0 X 0 0 0 X X 3 Attica Hospital District No 1 486088806 3 1 0 0 Cheney Golden Age Home Inc 486110967 10 1 0 0 Anthony Community Care Center Inc 481231930 10 1 0 0 3 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 amd Cheney Golden Age Home 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. 2881 2881 2881 Startup Cost to Reimburse 13408 Loan - Anthony 1884 Loan - Attica 25811 Loan - Cheney 15922 Loan - Bridge Loan 5661 62686 Form 990, Part VI, Section A, line 6 Country Care Hospice, Inc. is operated, supervised, and controlled by its members. These members are organizations which own and operate facilities that provide hospice care to the elderly and disabled. Form 990, Part VI, Section A, line 7a Member organizations have power to appoint directors to the governing body of Country Care Hospice, Inc. Form 990, Part VI, Section B, line 11b A copy of the 990 is provided to the board for final review and approval before filing. Form 990, Part VI, Section B, line 12c The policy is reviewed and signed yearly by the board and enforced through communication at board meetings. Form 990, Part VI, Section B, line 15 The board of directors reviews and approves the compensation for the Executive Director position. Form 990, Part VI, Section C, line 19 Items are available upon request from the administrative office. Cheney Golden Age Home Inc 724 N Main Street Cheney KS 67025 486110967 Nursing Facility KS 501(c)(3) 0 Anthony Community Care Center Inc 212 N 5th Avenue Anthony KS 67003 481231930 Nursing Facility KS 501(c)(3) 0 Attica Hospital District No 1 302 N Botkin Attica KS 67009 486088806 Nursing Facility KS 115 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0