2017-11-07T11:21:31-06:00 2016-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2016-01-01 480630224 COMMUNITY MEMORIAL HEALTHCARE INC % CURTIS R HAWKINSON COMM 7855622311 708 N 18TH STREET MARYSVILLE KS 66508 DAN FEHR CFO 7855622311 2017-11-15 true Kevin R Ensminger CPA P01310558 8162216300 167.68.126.162 43372220173115000000 2017-11-07 P 5755BA9FA13C18E98BD6463012DAF9F20348772C 4D02266371F55FDDA6DABD55B95E59043C5383CF 2016 2021-01-29 14:40:06Z CURTIS R HAWKINSON 708 N 18TH STREET MARYSVILLE KS 66508 21513830 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. 14 11 247 11 0 0 57750 68218 21628194 21286404 160652 157030 0 0 21846596 21511652 2000 3000 0 0 11454335 11949910 0 0 0 10125143 10406142 21581478 22359052 265118 -847400 26373461 24841721 17738750 16986105 8634711 7855616 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 5615465 0 6385921 THREE RURAL HEALTH CLINICS WITH A TOTAL OF 24,164 OFFICE VISITS. 2433368 0 2767233 ACUTE ADULT, PEDIATRIC AND INFANT INPATIENT CARE, SWING BED, LABOR AND DELIVERY AND OBSERVATION CARE. 3,744 DAYS OF CARE PROVIDED. 2246186 0 2554368 24 HR EMERGENCY ROOM SERVICES - 3,616 VISITS, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES - 5,942 VISITS 8423196 3000 9578882 18718215 true true false true false false false false false true true 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 false false true true true false false true 30 0 true 247 true false false false false false false false false false false X 14 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/VICE CHAIRPERSON 1.0 1.0 X X 0 0 0 TRENT MOSER DIR/CHAIRPERSON(UNTIL 05/16) 2.0 0.0 X X 0 0 0 LUCY PAPES DIRECTOR 1.0 1.0 X 0 0 0 BRYCE PORTER DIRECTOR/CHAIRPERSON 2.0 0.0 X 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 1.0 0.0 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 KENNETH DUENSING DIRECTOR 40.0 0.0 X 224633 0 29069 DR JOHN HAEFELE DIRECTOR 40.0 0.0 X 266215 0 31308 NICK WOLFE DIRECTOR 1.0 1.0 X 0 0 0 CURTIS R HAWKINSON CEO 40.0 1.0 X 160090 0 24030 BEVERLY FIFERLICK CFO (UNTIL 04/2016) 40.0 0.0 X 45718 0 5446 DAN FEHR CFO (STARTING 11/2016) 40.0 0.0 X 20535 0 2549 DR BEN BRUNA PHYSICIAN 40.0 0.0 X 376606 0 31308 DR SHANE THORESON PHYSICIAN 40.0 0.0 X 327324 0 31308 DR RANDALL BROWN PHYSICIAN 40.0 0.0 X 252831 0 31145 DR JOHN RYAN PHYSICIAN 40.0 0.0 X 229263 0 29246 DR FERNANDO UGARTE PHYSICIAN 40.0 0.0 X 200873 0 25836 2104088 0 241245 11 false true false CRIST AND PIESCHEL PT 1180 11th Rd MARYSVILLE KS 66508 PT, OT, ST 1093232 MARYSVILLE ANESTHESIA 1017 Broadway Ste 7 MARYSVILLE KS 66508 ANESTHESIOLOGIST 393891 CPSI 6600 Wall St MOBILE AL 36695 COMPUTER SERVICES 241400 NEBRASKA HEART INSTITUTE 7500 S 91st St LINCOLN NE 68501 NUC MED, ECHO TECH 241400 SHARED MEDICAL SRVICES 209 Limestone Pass COTTAGE GRAVE WI 53527 MRI 109620 5 53788 14080 350 68218 Net Patient Service Revenue 621400 20200085 20200085 Dietary Income 624200 130427 130427 Other Operating Revenue 900099 955892 955892 21286404 156008 156008 0 0 0 0 0 3200 1223 955 -1223 2245 1022 1022 0 0 0 0 0 0 0 0 0 0 21511652 21286404 157030 0 3000 3000 0 0 791408 630892 160516 154803 121749 33054 8707328 6848089 1859239 307584 225916 81668 1341926 1259630 82296 646861 586388 60473 0 16062 16062 71988 71988 0 0 0 2725547 2470673 254874 0 66697 64775 1922 314713 175748 138965 236 236 0 940742 884016 56726 167233 167233 0 8091 8091 611737 10934 600803 0 1541460 1502997 38463 218869 120186 98683 BAD DEBT EXPENSE 775913 775913 MEDICAL SUPPLIES 2418090 2418090 EQUIP RENTAL & MAINTENANCE 367730 354407 13323 DUES & SUBSCRIPTIONS 109073 68302 40771 51961 29041 22920 22359052 18718215 3640837 0 12387 10527 2721403 1429155 0 0 2541470 2276603 84333 46131 0 0 0 0 461563 453610 240643 266552 27418404 14003872 14657944 13414532 5491857 6144004 0 0 0 0 0 0 161861 800607 26373461 24841721 2012432 1628235 0 0 0 0 0 0 0 0 0 0 15726318 15357870 0 0 0 0 17738750 16986105 X 8558917 7779822 0 0 75794 75794 8634711 7855616 26373461 24841721 X -847400 107299 -38994 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 7270 false false false 7270 false SCHEDULE C, PART II-B, LINE 1F DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING. 1060979 27658 3000 24658 1060979 1072988 31992 2000 42001 1060979 1059062 178439 2000 162513 1072988 1134824 55511 2000 123306 5967 1059062 3126013 9249 68612 1000 2066944 1106 1134824 0.92860 0.07140 false false 81530 81530 19887436 7936889 11950547 7106686 5899800 1206886 342752 167183 175569 13414532 20901138 107299 58100 165399 20735739 775913 775913 21511652 21684796 101657 101657 21583139 775913 775913 22359052 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 $ 58,100 SCHEDULE D, PART XI, LINE 4B BAD DEBT EXPENSE $ 775,913 SCHEDULE D, PART XII, LINE 2D RELATED ORGANIZATION EXPENSES $ 101,657 SCHEDULE D, PART XII, LINE 4B BAD DEBT EXPENSE $ 775,913 true true X true X true X true true false true true 175147 175147 0.00810 1103792 914404 189388 0.00880 1278939 914404 364535 0.01690 122490 61250 61240 0.00280 122490 61250 61240 0.00280 1401429 975654 425775 0.01970 false 775913 75000 9704265 9894479 -190214 X true true 1 1 COMMUNITY MEMORIAL HEALTHCARE 708 N 18TH MARYSVILLE KS 66508 WWW.CMHCARE.ORG H058001 X X X X COMMUNITY MEMORIAL HEALTHCARE 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, LOCAL CITY AND COUNTY GOVERNMENT, LOCAL COMMUNITY NON-PROFIT ORGANIZATIONS, PUBLIC HEALTH AGENCIES AND MEDICAL AND MENTAL HEALTH PROVIDERS. SCHEDULE H, PART V, SECTION B, LINE 7A THE COMPLETE CHNA CAN BE FOUND AT: http://www.cmhcare.org/docs/CHNAOctober2016.pdf?child=2016+Community+Healt h+Needs+Assessment SCHEDULE H, PART V, SECTION B, LINE 10A THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: http://www.cmhcare.org/docs/ImplementationPlanMarshallCounty2017-2019.pdf? child=Implementation+Plan+for+Marshall+County+2017-2019 SCHEDULE H, PART V, SECTION B, LINE 11 Our Community Needs Assessment performed in 2016 was summarized/prioritized into 8 significant health needs. Several of these were grouped into the strategies for addressing obesity, and a couple of others were grouped into addressing access for Mental Health services. There were only two of the 8 needs which were not addressed in the implementation plan. Poverty and lack of financial resources obtaining primary care: WE cannot combat the financial resource needs of community members. We do provide financial assistance options with reduction or elimination of patient financial responsibility based on proven financial need. This has been in place for several years thus no new strategies were undertaken as a result of the most recent CHNA. Need for Health Services to respond to aging population: CMH provides nutrition assistance to home bound members of the community through our Meals on Wheels program. CMH provides Home Health and Swing-bed services in the community while other entities in the community provide longer term skilled nursing options. These services were initiated with the expectation of an aging population trend, and no new services were implemented as a result of the most recent CHNA. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient+Informatio n SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION CAN BE FOUND AT: http://www.cmhcare.org/docs//FinancialAssistanceApp2016.pdf 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+Informatio n 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 SCHEDULE H, PART I, LINE 7 IS $775,913. SCHEDULE H, PART III, SECTION A, LINE 2 WE SUMMARIZE ALL OUTSTANDING AR BY PAYER CATEGORY AND AGE. USING HISTORY, ECONOMIC OUTLOOK, AND MANAGEMENT EXPERIENCE; WE ESTIMATE EXPECTED COPAYS AND DEDUCTIBLES ON UPAID INSURANCE CLAIMS AND ADD THIS TO ALL BALANCES CURRENTLY BEING BILLED TO PATIENTS. USING A SLIDING SCALE BASED ON AGE OF ACCOUNTS WE APPLY A RESERVE PERCENTAGE TO THE EXPECTED FUTURE PATIENT RESPONSIBILITIES ABOVE. WHEN ACCOUNTS ARE WRITTEN OFF AS UNCOLLECTIBLE, PAYMENTS ARE MADE ON PREVIOUSLY WRITTEN OFF ACCOUNTS, OR CHARITY AND BANKRUPTCY DOCUMENTS ARE RECEIVED; THOSE AMOUNTS ARE APPLIED AGAINST THE RESERVE. EACH MONTH-END WE RECALCULATE THE RESERVE NEEDED ON CURRENT AR AS DESCRIBED ABOVE AND THE NET CHANGE IS RECOGNIZED AS BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 3 THERE IS NO KNOWN WAY TO IDENTIFY PATIENTS WHO WOULD HAVE QUALIFIED HAD THEY RESPONDED TO OUR REQUESTS FOR INFORMATION. THE 2015 CENSUS DATA SHOWS A 10.7% POVERTY RATE IN MARSHALL COUNTY KS. WE HAD 702,000 NET ACCOUNTS PLACED IN BAD DEBT DURING 2016 (EXCLUDING BANKRUPTCY, CHARITY, CROSSOVER, ETC.) WHICH WE APPLIED AGAINST THE POVERTY RATIO. WE VERIFIED 11,000 OF CURRENT YEAR BAD DEBT WHERE THE PATIENT QUALIFIED FOR CHARITY IN A PRIOR YEAR AND 8,000 OF BAD DEBT WHERE THE COLLECTION AGENCY RECEIVED CONFIRMATION OF NO COLLECTIBLE ASSETS. WE ASSUME THOSE NUMBERS WERE ALREADY CAPTURED IN THE GLOBAL PERCENTAGE CALCULATION AND DID NOT INCLUDE SEPARATELY FOR RISK OF DUPLICATION. SCHEDULE H, PART III, SECTION A, LINE 4 SEE NOTE 1 ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 THE NUMBERS WERE DERIVED FROM THE ORGANIZATION'S MEDICARE COST REPORT. THE MEDICARE SHORTFALL IS COMPRISED OF THE SEQUESTRATION AMOUNTS AND UNREIMBURSED BAD DEBT. THESE ARE LEGITIMATE REASONABLE COSTS WHICH ARE STATUTORILY EXCLUDED ON THE COST REPORT. THE COMMUNITY MEMBERS RECEIVED THE FULL VALUE OF THE SERVICES RENDERED WHILE THE HOSPITAL PROVIDED THESE SERVICES EXCLUSIVE OF REIMBURSEMENT. 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, PARTICIPATES IN THE COMMUNITY BABY BOOMER EXPO PROVIDING HEALTH EDUCATION, 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 146831 0 7433 0 5826 0 7774 0 16256 0 184120 0 0 0 DR KENNETH DUENSING DIRECTOR 222257 0 0 0 2376 0 12164 0 16905 0 253702 0 0 0 DR JOHN HAEFELE DIRECTOR 247855 0 0 0 18360 0 14403 0 16905 0 297523 0 0 0 DR BEN BRUNA PHYSICIAN 344008 0 0 0 32598 0 14403 0 16905 0 407914 0 0 0 DR SHANE THORESON PHYSICIAN 312014 0 0 0 15310 0 14403 0 16905 0 358632 0 0 0 DR RANDALL BROWN PHYSICIAN 232455 0 0 0 20376 0 14240 0 16905 0 283976 0 0 0 DR JOHN RYAN PHYSICIAN 226558 0 0 0 2705 0 12473 0 16773 0 258509 0 0 0 DR FERNANDO UGARTE PHYSICIAN 180294 0 0 0 20579 0 10630 0 15206 0 226709 0 0 0 DR BEN BRUNA PHYSICIAN MD - TUITION X 66000 22505 false true true DR SHANE THORESON PHYSICIAN MD - TUITION X 69284 23626 false true true 46131 SEE SCHEDULE L PART V SCHEDULE L, PART IV TRANSACTION 1 (A) KELLY MOSER (B) KELLY MOSER IS THE SPOUSE OF TRENT MOSER, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $21,912 (D) KELLY MOSER IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO TRANSACTION 2 (A) CYNTHIA VOET (B) CYNTHIA VOET IS THE SPOUSE OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $54,940 (D) CYNTHIA VOET IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO TRANSACTION 3 (A) SHANNON BRUNA (B) SHANNON BRUNA IS THE DAUGHTER OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $45,119 (D) SHANNON BRUNA IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO TRANSACTION 4 (A) ALISON VOET (B) ALISON VOET IS THE DAUGHTER OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $32,832 (D) ALLISON VOET IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO FORM 990, PART III, LINE 4D INPATIENT AND OUTPATIENT SURGERIES AND SCOPES - 1,145 SERVICES CARDIO PULMONARY - 3,027 SERVICES RADIOLOGICAL SERVICES - 12,004 EXAMS LAB - 260,822 TESTS RT, PT, OT, ST SERVICES - 46,787 MODALITIES REFERRAL VISITS - 4,628 VISITS 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 NET ASSET TRANSFER TO CMH FOUNDATION $ ( 38,994) FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-PHYSICAL THERAPY TOTAL FEES:862245 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-ANESTHESIOLOGY TOTAL FEES:442849 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-OCCP THERAPY TOTAL FEES:175454 FORM 990 PART IX LINE 11G DESCRIPTION:CONTRACT SVC-NUCLEAR MEDICINE TOTAL FEES:159571 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICE TOTAL FEES:1085428 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 false false true true true false false false false CMH FOUNDATION C 53788 CASH CMH FOUNDATION M 58100 CASH