2019-11-14T10:47:21-06:00 2018-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2018-01-01 480630224 COMMUNITY MEMORIAL HEALTHCARE INC % CURTIS R HAWKINSON COMM 7855622311 708 N 18TH STREET MARYSVILLE KS 66508 DAN FEHR CFO 7855622311 2019-11-15 true Gregory M Sullivan P01259107 8162216300 167.68.126.162 43372220193185000041 2019-11-14 P 6A5491EFFD9DEBA980EFEF504B2D78F34156ABFA 355CC2E4B6E27E32DAADC48E1CA8D97843AD7DA8 2018 2020-04-17 16:48:07Z CURTIS R HAWKINSON 708 N 18TH ST MARYSVILLE KS 66508 22901028 false X WWW.CMHCARE.ORG X 1955 KS CMH IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION THAT OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL FOR PATIENTS IN MARYSVILLE, KANSAS AND SURROUNDING AREAS. X 13 11 247 9 0 0 70400 75247 21599725 22709507 253009 346972 0 -230698 21923134 22901028 2000 2000 0 0 12480116 12323565 0 0 0 10626452 11160570 23108568 23486135 -1185434 -585107 23803032 12140213 16814676 2347683 6988356 9792530 X THE MISSION STATEMENT OF COMMUNITY MEMORIAL HEALTHCARE, INC. IS TO EXCEL AT CARING FOR YOU. THE VISION STATEMENT OF COMMUNITY MEMORIAL HEALTHCARE, INC. IS TO EXCEED EXPECTATIONS AS A TRUSTED AND VALUED HEALTH PROVIDER. false false 4551214 0 5223187 THREE RURAL HEALTH CLINICS WITH A TOTAL OF 22,025 OFFICE VISITS. 6727878 0 7721232 ACUTE ADULT, PEDIATRIC AND INFANT INPATIENT CARE, SWING BED, LABOR AND DELIVERY AND OBSERVATION CARE. 4,249 DAYS OF CARE PROVIDED. 1978788 0 2270951 24 HR EMERGENCY ROOM SERVICES - 3,509 VISITS, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES - 4,828 VISITS 6530001 2000 7494137 19787881 true true false true false false false false false true false false false false false false false true false false false false false false false false true true false false true false false false true false false true false false false false true false true true true false false true 39 0 true 247 true false false false false false false false false false false false false X 13 11 false false false false true true true true true false false true true true true true true true true false KS X CURTIS R HAWKINSON 7855622311 708 N 18TH ST MARYSVILLE KS 66508 X MARGE SCHLABACH DIRECTOR 1.0 0.0 X 0 0 0 ROBERT VOET DIRECTOR/CHAIRPERSON 2.0 1.0 X X 0 0 0 LUCY PAPES DIRECTOR 1.0 1.0 X 0 0 0 BRYCE PORTER DIRECTOR 1.0 0.0 X 0 0 0 DELORES STUMP DIRECTOR 1.0 0.0 X 0 0 0 GAIL GILKERSON DIRECTOR 1.0 0.0 X 0 0 0 KEN LAMOREAUX DIRECTOR 1.0 0.0 X 0 0 0 CANDACE WRIGHT DIRECTOR/VICE CHAIRPERSON 1.0 0.0 X X 0 0 0 DENNIS CASHIER DIRECTOR 1.0 0.0 X 0 0 0 JIM LADNER DIRECTOR 1.0 0.0 X 0 0 0 RAY SCULTZ DIRECTOR 1.0 0.0 X 0 0 0 DR JOHN HAEFELE DIRECTOR 40.0 0.0 X 313899 0 40140 NICK WOLFE DIRECTOR 1.0 1.0 X 0 0 0 EDWARD POPEJOY DIRECTOR 1.0 0.0 X 0 0 0 ERIN WRIGHT DIRECTOR 1.0 0.0 X 0 0 0 CURTIS R HAWKINSON CEO 40.0 1.0 X 156867 0 32420 DAN FEHR CFO 40.0 0.0 X 121789 0 27934 DR BEN BRUNA PHYSICIAN 40.0 0.0 X 415361 0 38140 DR SHANE THORESON PHYSICIAN 40.0 0.0 X 365314 0 38140 DR CHERYL RICE PHYSICIAN 40.0 0.0 X 304525 0 28680 DR KENNETH DUENSING PHYSICIAN 40.0 0.0 X 192995 0 34528 DR DANIELE WURTZ PHYSICIAN 40.0 0.0 X 249356 0 42456 2120106 0 282438 15 false true false CRIST AND PIESCHEL REHABILITATION 535 RIDGE RD WATERVILLE KS 66548 PT, OT, ST 1142211 MARYSVILLE ANESTHESIA 1017 BROADWAY STE 7 MARYSVILLE KS 66508 ANESTHESIOLOGIST 313402 CPSI 6600 WALL ST MOBILE AL 36695 COMPUTER SERVICES 284197 NEBRASKA HEART INSTITUTE 7500 S 91ST ST LINCOLN NE 68501 NUCLEAR MEDICINE 272495 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GRAVE WI 53527 MRI 147460 11 67115 8032 100 75247 Net Patient Service Revenue 621400 21321015 21321015 Dietary Income 624200 118444 118444 Other Operating Revenue 900099 1270048 1270048 22709507 166801 166801 0 0 0 0 0 180171 180171 180171 180171 0 0 0 0 0 0 0 0 0 LOSS ON EXTINGUISHMENT OF DEBT 900099 -230698 -230698 -230698 22901028 22709507 116274 0 2000 2000 0 0 711789 572012 139777 95495 74711 20784 9197543 7195762 2001781 294181 222113 72068 1367392 1288797 78595 657165 591325 65840 0 13376 13376 101999 101999 0 0 0 2932232 2790042 142190 0 34225 32662 1563 297232 188648 108584 66838 13 66825 0 987764 934445 53319 143943 143943 0 2430 2430 572439 2427 570012 0 1349498 1287378 62120 235121 139232 95889 BAD DEBT EXPENSE 1322466 1322466 MEDICAL SUPPLIES 2608022 2608022 EQUIP RENTAL & MAINTENANCE 305982 300817 5165 DUES & SUBSCRIPTIONS 152018 70230 81788 34985 20836 14149 23486135 19787881 3698254 0 21989 15884 481566 2431603 0 0 2702844 3219298 172247 129289 0 0 0 0 456140 478746 449869 534579 12103945 0 6648641 5024651 0 0 0 0 0 0 765791 306163 23803032 12140213 1884786 2308379 0 0 0 0 0 0 0 0 0 0 14929890 39304 0 0 0 0 16814676 2347683 X 6912562 9716736 0 0 75794 75794 6988356 9792530 23803032 12140213 X -585107 -535396 3924677 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 5853 false false false 5853 false SCHEDULE C, PART II-B, LINE 1F DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING. 1060979 50661 2000 48661 1060979 1060979 27670 2000 25670 1060979 1060979 27658 3000 24658 1060979 1072988 31992 2000 42001 1060979 1059062 178439 2000 162513 1072988 0.92860 0.07140 false false 21151930 -535396 108764 -426632 21578562 1322466 1322466 22901028 22282961 119292 119292 22163669 1322466 1322466 23486135 SCHEDULE D, PART V, LINE 4 BOARD-DESIGNATED ASSETS LIMITED TO USE OF $985,185 INCLUDE ASSETS SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS AND OPERATIONS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE THE ASSETS FOR OTHER PURPOSES. PERMANENTLY RESTRICTED ASSETS OF $75,794 HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY CMH IN PERPETUITY WITH THE INCOME TO BE USED FOR SCHOLARSHIPS. 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, LINE 2D RELATED ORGANIZATION REVENUES $ 108,764 SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSE $ 1,322,466 SCHEDULE D, PART XII, LINE 2D RELATED ORGANIZATION EXPENSES $ 119,292 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $ 1,322,466 true true X true X true X true true true false false 165094 165094 0.00700 1284250 1081193 203057 0.00900 1449344 1081193 368151 0.01600 78882 56585 22297 0.00100 78882 56585 22297 0.00100 1528226 1137778 390448 0.01700 false 1322466 264500 7582737 7799061 -216324 X true true 1 1 COMMUNITY MEMORIAL HOSPITAL 708 N 18TH ST MARYSVILLE KS 66508 WWW.CHMCARE.COM H058001 X X X X COMMUNITY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 16 true false false true X SEE PART V, SECTION C X true 16 true SEE PART V, SECTION C false true X 150. 400. X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, 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 INCLUDED MEMBERS OF THE LOCAL SCHOOL SYSTEM, RELIGIOUS ORGANIZATIONS, GOVERNMENTAL AGENCIES, NON-PROFITS, AND OTHER PUBLIC HEALTH AGENCIES AND REGIONAL MENTAL HEALTH PROVIDERS. SCHEDULE H, PART V, SECTION B, LINE 7A THE COMPLETE CHNA CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=CHNA&sub=About%20Us SCHEDULE H, PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=CHNA&sub=About%20Us SCHEDULE H, PART V, SECTION B, LINE 11 Our 2016 Health Needs Assessment was summarized and prioritized into 8 issues and those were further classified into groups which included mental health, obesity, aging population, and financial resources. To assist our aging community members we conduct monthly health topic luncheons geared towards our older population. We provide swing-bed, home health, and DME services to assist our population as they age but have introduced no new programs based on this CHNA. Financial constraints and insurance options are outside of our control but we do inform all patients of our financial assistance option that is granted to those demonstrating financial needs based upon our established criteria. Additionally, we have a resource within our pharmacy that works with insurance and pharmaceutical companies to assist low-income patients obtain free and reduced medications which is currently assisting 16 of our most vulnerable patients obtain medication worth over $25,000 per year. We conduct a health fair each year which provides (nearly 500 people) a comprehensive lab panel for a flat $30 fee cash price and annual sports physicals for $27.50 fee cash price to provide low cost options for annual diagnostic services. To assist with community obesity we provide daily, low-cost, prepared foods for the community meals on wheels program and the residents of local disability housing, provide some dietary education as part of several community farmer's markets, and co-coordinated some daily exercise groups in the public park. We do not provide structured mental health services locally, but partner with a regional provider to allow consultation via web-cam and referrals to their offices. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion SCHEDULE H, PART V, SECTION B, LINE 16C THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion 5 COMMUNITY PHYSICIANS CLINIC 1902 MAY ST MARYSVILLE KS 66508 RURAL HEALTH CLINIC BLUE RAPIDS MEDICAL CLINIC 607 LINCOLN BLUE RAPIDS KS 66411 RURAL HEALTH CLINIC COMMUNITY MEDICAL EQUIPMENT 805 BROADWAY MARYSVILLE KS 66508 DURABLE MEDICAL EQUIPMENT CMH HOME HEALTH 805 BROADWAY MARYSVILLE KS 66508 HOME HEALTH AGENCY COMMUNITY PHYSICIANS CLINIC - WYMORE 100 NORTH 7TH WYMORE NE 68466 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 3C ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS ARE FACTORS USED IN ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNTED CARE. SCHEDULE H, PART I, LINE 7 THE COST-TO-CHARGE RATIO WAS USED AS THE COSTING METHODOLOGY TO REPORT CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. SCHEDULE H, PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), SUBTRACTED FOR PURPOSES OF CALCULATING SHCEDULE H, PART I, LINE 7 IS $1,322,466. SCHEDULE H, PART III, SECTION A, LINE 2 A RESERVE FOR BAD DEBT IS CALCULATED ON OUTSTANDING ACCOUNTS RECEIVABLE BALANCES EACH MONTH BASED ON EXISTENCE OF INSURANCE COVERAGE AND AGE OF ACCOUNTS. AS ACCOUNTS ARE WRITTEN OFF, RETURNED FROM COLLECTIONS, OR COLLECTED ON, THOSE ARE APPLIED AGAINST THE RESERVE. THE NET CHANGE IN RESERVE IS REPORTED AS BAD DEBT EXPENSE EACH MONTH. SCHEDULE H, PART III, SECTION A, LINE 3 THERE IS NO WAY TO IDENTIFY PATIENTS THAT MIGHT HAVE QUALIFIED. SOME DO NOT RETURN DOCUMENTS OUT OF PRIDE, OTHERS ARE TRANSIENT AND LOCATING THEM IS EXCEEDINGLY DIFFICULT, OTHERS NO LONGER TRY TO MANAGE THEIR DEBTS. TO ESTIMATE THIS UNKNOWN WE APPLIED THE FOLLOWING LOGIC: HOSPITAL (EXCL RHC AND HHA) TURNED 1,500,000 TO COLLECTIONS IN 2018. 33% OF THIS AMOUNT WAS FOR UNINSURED PATIENTS. ASSUMING 60% OF THOSE PATIENTS WERE UNEMPLOYED OR IN LOW WAGE JOBS, WE APPLIED A 20% OVERALL ESTIMATE TO THE 1,322,466 BAD DEBT EXPENSE PREVIOUSLY REPORTED. SCHEDULE H, PART III, SECTION A, LINE 4 SEE NOTE 1 ON PAGE 9 AND 10 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 THE NUMBERS WERE DERIVED FROM THE MEDICARE COST REPORT. ALLOWABLE EXPENSES LESS THE BAD DEBT REDUCTION AND SEQUESTRATION REDUCTIONS. THESE COSTS ARE ALLOWABLE PER MEDICARE BUT WERE STATUTORILY REDUCED BY AN ARBITRARY PERCENTAGE REDUCTION TO ARRIVE AT FINAL REIMBURSEMENT. BY DEFINITION THE DIFFERENCE IS LEGIMITATE COSTS OF DOING BUSINESS THAT ARE NONETHELESS NOT PAID BY MEDICARE. SCHEDULE H, PART III, SECTION C, LINE 9B PATIENTS ARE INFORMED OF OUR FINANCIAL ASSISTANCE POLICY AT THE TIME OF SERVICES. IF REQUESTED, THEY ARE GIVEN THE APPLICATION AT TIME OF SERVICE OR PRIOR TO DISMISSAL. FINANCIAL ASSISTANCE IS OFFERED AT TIME LETTERS ARE SENT OUT REQUESTING PAYMENT AGREEMENTS AND AGAIN BEFORE ACCOUNTS ARE SENT TO COLLECTION. SCHEDULE H, PART VI, LINE 2 IN ADDITION TO CONDUCTING ITS OWN RESEARCH, CMH COLLABORATES THROUGH THE INTERAGENCY COOPERATIVE COUNCIL (A COLLECTION OF COUNTY WIDE NOT-FOR-PROFIT AGENCIES) TO ASSESS THE NEEDS OF MARSHALL COUNTY. SCHEDULE H, PART VI, LINE 3 THE INSURANCE OFFICE PERSONNEL EXPLAIN ELIGIBILITY TO PATIENTS AND WILL ASSIST WITH PAPERWORK. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED THROUGHOUT THE BUILDING (I.E. THE BUSINESS OFFICE, THE CLINICS, EMERGENCY DEPARTMENT). PATIENTS WHO ARE IDENTIFIED EITHER BEFORE SERVICES ARE RENDERED OR PRIOR TO DISCHARGE ARE CONTACTED BY THE BUSINESS OFFICE PERSONNEL TO ASSESS QUALIFICATION FOR MEDICAID OR FINANCIAL ASSISTANCE. BUSINESS OFFICE PERSONNEL ATTEMPT TO CONTACT PATIENTS VIA PHONE AND MAIL REGARDING THEIR BILL. PART OF THE CHARITY CARE PROGRAM IS TO ATTEMPT ENROLLMENT INTO THE MEDICAID PROGRAM. SCHEDULE H, PART VI, LINE 4 COMMUNITY MEMORIAL HEALTHCARE, INC. IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION THAT OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL. CMH PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY, CLINIC AND HOME HEALTH SERVICES TO MARYSVILLE, BLUE RAPIDS, BEATTIE, HANOVER, WATERVILLE, WASHINGTON, FRANKFORT, AXTELL AND HOME KANSAS. THESE AREAS ARE ALSO SERVED BY HANOVER HOSPITAL (HANOVER, KS), NEMAHA VALLEY COMMUNITY HOSPITAL (SENECA, KS), MERCY REGIONAL HEALTH CENTER (MANHATTAN, KS), BRYAN LGH HEALTH SYSTEM (LINCOLN, NE), SAINT ELIZABETH REGIONAL MEDICAL CENTER (LINCOLN, NE), SAINT FRANCIS HEALTH CENTER (TOPEKA, KS), STORMONT-VAIL HEALTHCARE (TOPEKA, KS). AS OF THE 2010 CENSUS, THE CITY OF MARYSVILLE HAD A TOTAL POPULATION OF 3,294, WHILE MARSHALL COUNTY POPULATION WAS 10,117. BELOW ARE ADDITIONAL MARSHALL COUNTY DEMOGRAPHICS: - 22% OF THE POPULATION IS OVER 65 YEARS OF AGE. - 29% OF THE POPULATION IS BETWEEN 45-64 YEARS OF AGE. - 27% OF THE POPULATION IS BETWEEN THE AGES OF 18-44. - MEDIAN HOUSEHOLD INCOME FOR MARSHALL COUNTY WAS $44,615 FOR 2014. - UNEMPLOYMENT IN MARSHALL COUNTY IS 5.2%. - 12.87% OF THE POPULATION ARE LIVING BELOW THE POVERTY LEVEL. - THE HOSPITAL IS THE THIRD LARGEST EMPLOYER IN THE COUNTY. SCHEDULE H, PART VI, LINE 5 COMMUNITY MEMORIAL HEALTHCARE SPONSORS AN ANNUAL HEALTH FAIR FOR THE GENERAL PUBLIC, DRAWING BLOOD AND RUNNING DIAGNOSTIC TESTS. THE HOSPITAL PUBLISHES A MONTHLY ARTICLE IN A LOCAL PAPER ADDRESSING CURRENT HEALTH TOPICS, AND HOSTS A MONTHLY LUNCHEON FOR THE OVER-55 POPULATION WITH SPEAKERS ON CURRENT HEALTH TOPICS. SCHEDULE H, PART VI, LINE 6 NOT APPLICABLE SCHEDULE H, PART VI, LINE 7 KANSAS X X X false false false false false false false false false CURTIS R HAWKINSON CEO 153122 0 0 0 3745 0 7507 0 24913 0 189287 0 DR JOHN HAEFELE DIRECTOR 295159 0 0 0 18740 0 14406 0 25734 0 354039 0 DR BEN BRUNA PHYSICIAN 388158 0 0 0 27203 0 14406 0 23734 0 453501 0 DR SHANE THORESON PHYSICIAN 355782 0 0 0 9532 0 14406 0 23734 0 403454 0 DR CHERYL RICE PHYSICIAN 304165 0 0 0 360 0 4946 0 23734 0 333205 0 DR KENNETH DUENSING PHYSICIAN 190619 0 0 0 2376 0 9994 0 24534 0 227523 0 DR DANIELE WURTZ PHYSICIAN 219343 0 0 0 30013 0 14222 0 28234 0 291812 0 DR DANIELE WURTZ PHYSICIAN MD - TUITION X 186000 129289 false true true 129289 SEE SCHEDULE L PART V WAGES SCHEDULE L, PART IV TRANSACTION 1 (A) CYNTHIA VOET (B) CYNTHIA VOET IS THE SPOUSE OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $50,598 (D) CYNTHIA VOET IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO TRANSACTION 2 (A) ALLISON MINGE (B) ALLISON MINGE IS THE DAUGHTER OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $44,897 (D) ALLISON MINGE IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO CAPITAL ASSETS 2018-12-19 10806694 BOOK VALUE 320297285 CMH FOUNDATION 708 NORTH 18TH STREET MARYSVILLE KS 66508 501(c)(3) true false false false SCHEDULE N, PART II, LINE 1 CMH FOUNDATION ISSUED NEW NOTES PAYABLE JOINTLY HELD BY USDA AND A PRIVATE BANK. CMH FOUNDATION USED THE PROCEEDS OF THIS NOTE TO PAY OFF THE HOSPITAL MORTGAGE AND ASSUME OWNERSHIP OF THE DEBT AND RELATED ASSETS. AS A RESULT OF THIS TRANSACTION THE CAPITAL ASSETS (LAND, BUILDING, AND EQUIPMENT) WERE TRANSFERRED TO CMH FOUNDATION. SCHEDULE N, PART II, LINE 2A ROBERT VOET, LUCEY PAPES, NICK WOLFE, & CURTIS HAWKINSON ARE DIRECTORS OR OFFICERS OF COMMUNITY MEMORIAL HOSPITAL, INC. AND CONTINUE TO BE DIRECTORS OF CMH FOUNDATION. FORM 990, PART III, LINE 4D INPATIENT AND OUTPATIENT SURGERIES AND SCOPES - 408 SERVICES RADIOLOGICAL SERVICES - 8,748 EXAMS LAB - 178,385 TESTS RT, PT, OT, ST SERVICES - 52,625 MODALITIES REFERRAL VISISTS - 4,484 CENTRAL SUPPLY, PHARMACY & DIETARY SERVICES FORM 990, PART VI, SECTION A, LINE 6 ANY PERSON, FIRM, ASSOCIATION, CORPORATION, OR BODY POLITIC OR SUBDIVISION THEREOF, MAY BECOME A MEMBER OF THE COMMUNITY MEMORIAL HEALTHCARE, INC. BY: (A) PAYING A MEMBERSHIP FEE OF $100.00; AND (B) AGREEING TO COMPLY WITH AND BE BOUND BY THE ARTICLES OF INCORPORATION AND BYLAWS AND ANY RULES AND REGULATIONS ADOPTED BY THE BOARD OF DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A A CERTIFICATE OF MEMBERSHIP SHALL ENTITLE THE LEGAL HOLDER TO ONE VOTE UPON MATTERS SUBMITTED TO A VOTE AT A MEETING OF THE MEMBERS WHERE THE LEGAL HOLDER OF THE CERTIFICATE IS A FIRM, ASSOCIATION, CORPORATION, OR A BODY POLITIC, OR A SUBDIVISION THEREOF, THE PRESIDENT, CHIEF EXECUTIVE OFFICER OR HIS DESIGNEE SHALL CAST THE VOTE. ALL QUESTIONS REQUIRING A VOTE OF THE MEMBERS SHALL BE DECIDED BY A VOTE OF A MAJORITY OF THE MEMBERS PRESENT EXCEPT AS OTHERWISE PROVIDED BY LAW, THE ARTICLES OF INCORPORATION OR THE BYLAWS. FORM 990, PART VI, SECTION A, LINE 7B 1. ANY SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF CORPORATE PROPERTY AND ASSETS OR ANY DISSOLUTION OF THE CORPORATION SHALL BE GOVERNED BY K.S.A. 17-6801 ET SEQ., REQUIRING A MAJORITY VOTE OF THE MEMBERS ENTITLED TO VOTE THEREON AT A DULY CALLED MEETING OF THE MEMBERS. 2. THE BYLAWS MAY NOT BE AMENDED, REVISED, OR REPEALED WITHOUT VOTE BY THE MEMBERSHIP. FORM 990, PART VI, SECTION B, LINE 11B THE CFO GATHERS INFORMATION TO PREPARE THE FORM 990 TAX RETURN. THIS INFORMATION IS THEN GIVEN TO AN INDEPENDENT ACCOUNTING FIRM WHO PREPARES AND REVIEWS THE FORM 990. THE INDEPENDENT ACCOUNTING FIRM THEN PROVIDES THE CFO AND FINANCE COMMITTEE A DRAFT OF THE FORM 990 FOR COMMENTS AND APPROVAL. ONCE THE CFO, FINANCE COMMITTEE, AND THE CPA FIRM APPROVE THE FORM 990, A COPY OF THE FORM 990 IS GIVEN TO THE GOVERNING BOARD MEMBERS ALONG WITH A RESPONSE TIME FOR QUESTIONS AND COMMENTS. ALL ISSUES ARE RESOLVED, A FINAL COPY OF THE FORM 990 IS SENT TO THE ENTIRE BOARD, AND THE 990 IS FILED. FORM 990, PART VI, SECTION B, LINE 12C BOARD OF DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS WILL COMPLETE A DISCLOSURE STATEMENT AT THE BEGINNING OF EACH CMH FISCAL YEAR AND PROVIDE SUCH STATEMENT TO THE CMH COMPLIANCE OFFICER. THE DISCLOSURE STATEMENT SHALL INCLUDE ANY INVESTMENT IN, OR ANY MANAGERIAL, CONSULTING, OR EMPLOYMENT RELATIONSHIP WITH, ANY OUTSIDE ENTITY THAT PROVIDES OR SEEKS TO PROVIDE GOODS OR SERVICES TO CMH, COMPETES WITH, OR INCLUDES CMH AS A JOINT VENTURE OR EQUITY INVESTOR. THE INTERESTED DIRECTOR SHOULD ABSTAIN FROM DISCUSSION AND VOTING ON THE MATTER BY TEMPORARILY LEAVING THE BOARD MEETING WHILE THE DISINTERESTED DIRECTORS DISCUSS AND VOTE. THE DISCLOSURE AND ABSTENTION SHALL BE RECORDED IN THE MINUTES OF THE BOARD MEETING. FORM 990, PART VI, SECTION B, LINE 15A & 15B THE COMPENSATION COMMITTEE CONSISTS OF FOUR MEMBERS OF THE BOARD AND MEETS AT LEAST SEMI-ANNUALLY OR MORE OR LESS FREQUENTLY AS NECESSARY. THE COMPENSATION COMMITTEE EXISTS TO DESIGN, IMPLEMENT, AND EVALUATE COMPENSATION FOR THE CEO, PHYSICIANS AND OTHER PERSONNEL. THE COMPENSATION COMMITTEE COMPLETES MEDICAL STAFF CONTRACT NEGOTIATIONS, EVALUATES AND COMPARES PERSONNEL WAGES TO INDUSTRY BENCHMARKS, AND PERFORMS THE CEO AND BOARD EVALUATIONS. THE COMPENSATION COMMITTEE APPROVED THE INITIAL CONTRACT FOR THE CEO AND THE CEO IS SUBJECT TO THE SAME PERCENTAGE ANNUAL INCREASE AS OTHER PERSONNEL. THE DELIBERATIONS AND DECISIONS REGARDING COMPENSATION ARRANGEMENTS ARE DOCUMENTED IN BOARD MINUTES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. Form 990, PART XI, LINE 9 ASSET TRANSFER FOR PREVIOUS LOAN PAYOFF $ 14,737,138 TRANSFER OF NET PP&E TO FOUNDATION $(10,806,694) ASSET TRANSFER TO AFFILIATE $( 5,817) ------------- 3,924,627 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-PHYSICAL THERAPY TOTAL FEES:859753 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-ANESTHESIOLOGY TOTAL FEES:396734 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-OCCP THERAPY TOTAL FEES:185744 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-NUCLEAR MEDICINE TOTAL FEES:195317 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICE TOTAL FEES:1294684 CMH FOUNDATION 708 N 18TH STREET MARYSVILLE KS 66508 320297285 SUPPORT KS 501(C)(3) 12A CMH true false false true false false false false false false false true false true true true false false true true CMH FOUNDATION C 67115 CASH CMH FOUNDATION R 10806694 BOOK VALUE CMH FOUNDATION S 14731371 FMV