CITIZENS MEDICAL CENTER INC EMPLOYEE BENEFIT TR: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- CITIZENS MEDICAL CENTER INC EMPLOYEE BENEFIT TR (EIN 48-0892178)
- Tax period
- 2015-01-01 to 2015-12-31
- Filed
- 2016-11-14
- IRS object ID
- 201643199349306024
- Schema version
- 2015v2.1
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2016-11-14T12:57:04-06:00 | ReturnTs |
| Tax Period End | 2015-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 481026809 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 534 S Kansas Ave Suite 1500 | AddressLine1Txt |
| City | Topeka | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 666033491 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480892178 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Citizens Medical Center Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | CITI | BusinessNameControlTxt |
| Phone | 7854627511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1Txt |
| City | Colby | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | Greg Unruh | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7854627511 | PhoneNum |
| Signature | 2016-10-17 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Heather R Eichem | PreparerPersonNm |
| PTIN | P01515553 | PTIN |
| Phone | 7852334226 | PhoneNum |
| Preparation | 2016-10-17 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2017-02-10 21:41:12Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | Greg Unruh | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1Txt |
| City | Colby | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $30,327,221 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.nwkshealthcare.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | Enhancing the lives of those we serve. | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 418 | TotalEmployeeCnt |
| Total Volunteers | 22 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $212,735 | PYContributionsGrantsAmt |
| CY Contributions Grants | $639,511 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $26,174,442 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,341,935 | CYProgramServiceRevenueAmt |
| PY Investment Income | $141,530 | PYInvestmentIncomeAmt |
| CY Investment Income | -$64,228 | CYInvestmentIncomeAmt |
| PY Other Revenue | $242,376 | PYOtherRevenueAmt |
| CY Other Revenue | $302,497 | CYOtherRevenueAmt |
| PY Total Revenue | $26,771,083 | PYTotalRevenueAmt |
| CY Total Revenue | $30,219,715 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $18,112 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $15,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $16,345,953 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $18,585,337 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $94,602 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,287,498 | PYOtherExpensesAmt |
| CY Other Expenses | $11,271,801 | CYOtherExpensesAmt |
| PY Total Expenses | $26,651,563 | PYTotalExpensesAmt |
| CY Total Expenses | $29,872,138 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $119,520 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $347,577 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,737,052 | TotalAssetsBOYAmt |
| Total Assets EOY | $21,439,309 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,094,041 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,396,265 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $11,643,011 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $12,043,044 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Enhancing the lives of those we serve. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $25,955,056 | ExpenseAmt |
| Grant | $15,000 | GrantAmt |
| Revenue | $29,496,417 | RevenueAmt |
| Desc | CMCI provided a wide range of healthcare services to residents of its service area. 3,660 patient days of inpatient care, 17,818 patient days of nursing facility care, 3,100 emergency room visits and 28,440 physician clinic visits were provided during the fiscal year. | Desc |
| Total Program Service Expenses | $25,955,056 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (1) | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 50 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 418 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Darcy Howard | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 7854627511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1Txt |
| City | Colby | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| Phillip Knox | |||||||
| Trustee | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Lon Frahm | |||||||
| Vice Chair | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Janet Saddler | |||||||
| Secretary | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| AJ Hurst | |||||||
| Treasurer | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Patricia Erickson | |||||||
| Trustee | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Michael Kersenbrock | |||||||
| Trustee | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Dorothy Kistler | |||||||
| Trustee | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Bob Standage | |||||||
| Chairperson | 4.00 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Lori Stanley | |||||||
| Trustee | 4.00 | Yes (X) | $0 | $0 | $0 | ||
| Gregory Unruh | |||||||
| CEO | 40.00 | $159,008 | $0 | $11,249 | Yes (X) | ||
| Patsy Evans | |||||||
| CFO | 40.00 | $122,198 | $0 | $9,612 | Yes (X) | ||
| Darren Matchell | |||||||
| Physician | 40.00 | $388,650 | $0 | $41,846 | Yes (X) | ||
| Kelly Gabel | |||||||
| Physician | 40.00 | $355,444 | $0 | $41,337 | Yes (X) | ||
| John Dygert | |||||||
| Physician | 40.00 | $319,410 | $0 | $40,367 | Yes (X) | ||
| Brewster Kellogg | |||||||
| Physician | 40.00 | $350,977 | $0 | $43,907 | Yes (X) | ||
| Brian Unruh | |||||||
| Physician Assistant | 40.00 | $204,648 | $0 | $21,007 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,900,335 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $209,325 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 18 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Colby Anesthesia Services Inc | |||||
| 2287 K 25 | Colby | KS | 67701 | CRNA Coverage | $519,956 |
| CPSI | |||||
| PO Box 850309 | Mobile | AL | 36685 | Computer support services | $180,324 |
| Wendling Noe Nelson & Johnson LLC | |||||
| 534 S Kansas Ave Suite 1500 | Topeka | KS | 66603 | Accounting and consulting services | $178,103 |
| Charles E Frankum MD LLC | |||||
| 1960 North Ogden RD STE 530 | Denver | CO | 80218 | Surgeon | $120,000 |
| Rural Sleep Solutions LLC | |||||
| PO Box 1134 | Nixa | MO | 65714 | Sleep studies | $115,650 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 5 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $556,429 | RelatedOrganizationsAmt |
| Government Grants | $65,060 | GovernmentGrantsAmt |
| All Other Contributions | $18,022 | AllOtherContributionsAmt |
| Total Contributions | $639,511 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient service revenue | 621990 | $28,610,823 | $28,610,823 |
| 340B Drug program | 621990 | $451,876 | $451,876 |
| Clinical outreach | 621400 | $281,200 | $281,200 |
| EHR incentive payment | 621990 | -$1,964 | -$1,964 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,341,935 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,878 | TotalRevenueColumnAmt |
| Exclusion | $16,878 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,796 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,796 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $28,796 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $28,796 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $26,400 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $107,506 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$81,106 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$81,106 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | -$81,106 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| Miscellaneous | 900099 | $144,049 | $144,049 | |
| Cafeteria & vending | 621990 | $66,909 | $66,909 | |
| Pharmacy sales | 446110 | $52,689 | $52,689 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,054 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,054 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $273,701 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $30,219,715 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,496,417 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $83,787 | ExclusionAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,000 | TotalAmt |
| Program Services | $15,000 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $315,810 | TotalAmt |
| Management And General | $315,810 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,576,540 | TotalAmt |
| Program Services | $13,032,292 | ProgramServicesAmt |
| Management And General | $1,474,696 | ManagementAndGeneralAmt |
| Fundraising | $69,552 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $674,564 | TotalAmt |
| Program Services | $597,766 | ProgramServicesAmt |
| Management And General | $73,608 | ManagementAndGeneralAmt |
| Fundraising | $3,190 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,034,950 | TotalAmt |
| Program Services | $1,795,759 | ProgramServicesAmt |
| Management And General | $229,607 | ManagementAndGeneralAmt |
| Fundraising | $9,584 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $983,473 | TotalAmt |
| Program Services | $861,889 | ProgramServicesAmt |
| Management And General | $116,983 | ManagementAndGeneralAmt |
| Fundraising | $4,601 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,797 | TotalAmt |
| Management And General | $5,797 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,148,174 | TotalAmt |
| Program Services | $1,554,623 | ProgramServicesAmt |
| Management And General | $592,606 | ManagementAndGeneralAmt |
| Fundraising | $945 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,522 | TotalAmt |
| Program Services | $11,098 | ProgramServicesAmt |
| Management And General | $18,424 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $409,793 | TotalAmt |
| Program Services | $285,525 | ProgramServicesAmt |
| Management And General | $123,474 | ManagementAndGeneralAmt |
| Fundraising | $794 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $470,294 | TotalAmt |
| Program Services | $425,447 | ProgramServicesAmt |
| Management And General | $44,090 | ManagementAndGeneralAmt |
| Fundraising | $757 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $83,776 | TotalAmt |
| Program Services | $50,532 | ProgramServicesAmt |
| Management And General | $32,658 | ManagementAndGeneralAmt |
| Fundraising | $586 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $294,871 | TotalAmt |
| Program Services | $294,871 | ProgramServicesAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,785,512 | TotalAmt |
| Program Services | $1,634,993 | ProgramServicesAmt |
| Management And General | $147,662 | ManagementAndGeneralAmt |
| Fundraising | $2,857 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $212,032 | TotalAmt |
| Program Services | $80,906 | ProgramServicesAmt |
| Management And General | $131,126 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Drugs | $2,830,693 | $2,830,693 | ||
| Medical supplies | $1,243,001 | $1,243,001 | ||
| Repairs and maintenance | $938,267 | $699,160 | $238,520 | $587 |
| Food expense | $318,298 | $318,298 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $501,771 | TotalAmt |
| Program Services | $223,203 | ProgramServicesAmt |
| Management And General | $277,419 | ManagementAndGeneralAmt |
| Fundraising | $1,149 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $29,872,138 | TotalAmt |
| Program Services | $25,955,056 | ProgramServicesAmt |
| Management And General | $3,822,480 | ManagementAndGeneralAmt |
| Fundraising | $94,602 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $27,464 | BOYAmt |
| EOY | $461,163 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,588,340 | BOYAmt |
| EOY | $512,977 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,461,859 | BOYAmt |
| EOY | $4,851,000 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $169,570 | BOYAmt |
| EOY | $186,131 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $922,148 | BOYAmt |
| EOY | $980,968 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $441,247 | BOYAmt |
| EOY | $560,549 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $36,380,601 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $25,023,011 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,753,339 | BOYAmt |
| EOY | $11,357,590 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $450,198 | BOYAmt |
| EOY | $436,791 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,922,887 | BOYAmt |
| EOY | $2,092,140 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,737,052 | BOYAmt |
| EOY | $21,439,309 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,140,190 | BOYAmt |
| EOY | $2,782,161 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,497,378 | BOYAmt |
| EOY | $6,547,295 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $456,473 | BOYAmt |
| EOY | $66,809 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,094,041 | BOYAmt |
| EOY | $9,396,265 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,999,988 | BOYAmt |
| EOY | $10,284,416 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,273,028 | BOYAmt |
| EOY | $1,388,633 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $369,995 | BOYAmt |
| EOY | $369,995 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,643,011 | BOYAmt |
| EOY | $12,043,044 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,737,052 | BOYAmt |
| EOY | $21,439,309 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $347,577 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$13,406 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $65,862 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $5,209 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $5,209 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Citizens Medical Center, Inc., is a member of the Kansas Hospital Association. This organization engages in lobbying activities for hospital and general health care interests as part of the services provided to members. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $235,982 | OtherCostOrOtherBasisAmt |
| Book Value | $235,982 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $17,930,880 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,629,685 | DepreciationAmt |
| Book Value | $6,301,195 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,355,319 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,557,339 | DepreciationAmt |
| Book Value | $3,797,980 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,858,420 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,835,987 | DepreciationAmt |
| Book Value | $1,022,433 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $11,357,590 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (4 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Interest receivable | $730 |
| Beneficial interest in net assets of foundations | $1,701,928 |
| Reinsurance proceeds recoverable | $197,000 |
| Other receivables | $192,482 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,092,140 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Estimated third-party payor settlements | Desc |
| Amt | $66,809 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $66,809 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $30,272,171 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$13,406 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $65,862 | OtherRevenueAmt |
| Revenue Not Reported | $52,456 | RevenueNotReportedAmt |
| Revenue Subtotal | $30,219,715 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $30,219,715 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $29,872,138 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $29,872,138 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $29,872,138 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part X, Line 2: | Management is not aware of any uncertainties in income tax positions. |
| Part XI, Line 2d - Other Adjustments: | Change in beneficial interest in net assets of foundations net of transfers 65,862. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $215,393 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,482 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $204,911 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00690 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,275,645 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,426,137 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $849,508 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02840 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,491,038 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $3,436,619 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,054,419 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03530 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,884 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $77 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $77 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,091,292 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,770,721 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,320,571 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04420 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,400 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,122,653 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $4,770,721 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,351,932 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04520 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,613,691 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $8,207,340 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,406,351 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08050 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $539,971 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $401,036 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,962,271 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,051,427 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$89,156 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Citizens Medical Center Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1Txt |
| City | Colby | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | Nursing facility and rural health clinic | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Citizens Medical Center | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 15 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | www.cmciks.com | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | www.cmciks.com | StrategyWebsiteURLTxt |
| Strategy Attached | 0 | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Citizens Medical Center | Part V, Section B, Line 5: Each community has a wealth of expertise to be tapped to conduct the CHNA. For this purpose, town hall meetings are the perfect forum to gather community insight. Town hall sessions were organized to provide an objective consensus-building method of reviewing and prioritizing county health issues. All town hall priority-setting and scoring processes involved the input of key stakeholders in attendance. During the meetings the topics of issue were addressed with round table discussions.The individuals and organizations comprising the town halls were critically important to the success of the CHNA. The following list outlines partners invited to each town hall meeting: local hospital, public health community, mental health community, community-based clinics, service providers, local residents, community leaders, opinion leaders, school leaders, business leaders, local government, faith-based organizations and person (or organizations serving them), people with chronic conditions, uninsured community members, low income residents, and minority groups. |
| Citizens Medical Center | Part V, Section B, Line 6b: Thomas County Health Department and Thomas County Commisoners/Representatives |
| Citizens Medical Center | Part V, Section B, Line 11: Dietary personnel worked in conjunction with Thomas County Coalition on programs to promote healthy eating and other desireable practices and on programs to promote active lifestyle. The Citizens Foundation purchased a facility for daycare to increase the availability for child daycare. A partnership was established with Norton County Hospital to expand clinic based mental health services. We plan to increase availability with continued partnership with High Plains Mental Health. We opened the Central Care Cancer Center inside CMCI to expand cancer services. Local dentists were notified of the need for more dentists that accept Medicaid or uninsured patients. Also educated local medical providers of dentists who accept Medicaid or uninsured patients. Offered quarterly diabetic classses with a Certified Diabetes Educator who is also a registered dietician. Participated in the Farmers Market and Senior Farmers Market to distribute nutrition education and affordable local produce. CMCI has expanded their clinic vaccination program, partnered with the Thomas County Coalition for a wellness fair, and promoted concussion screening for youth sport physicals, in an effort to expand preventative care. Identified local partners and attempted to establish multiple partnerships for medical transport. CMCI is recruiting more specialists. A Dermatologist, Urologist, Plastic Surgeon, and two Cardiologists were recruited in 2015. |
| Citizens Medical Center | Part V, Section B, Line 16i: The availability of financial assistance is published on the Medical Center's website. A plain language summary of the financial assistance policy is printed on each patient's statement. Information about financial assistance availability is given to patients each time they are spoken to by billing personnel. Information sheets summarizing the financial assistance policy and instructions on how to obtain more information is distributed to the Family Center for Health Care and the Thomas County Health Department. |
| Citizens Medical Center | Part V, Section B, Line 22d: Charges for medical care provided to uninsured patients will be limited to not more than the amounts generally billed to those individuals who have insurance. Amounts generally billed to individuals who have insurance are determined annually using the look-back method for Medicare and private health insurers. All payments received from Medicare and private health insurers in a 12-month period are dividued by the gross charges for these services to determine the percentage of charges that were paid by Medicare and private health insurers. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - Prairie Senior Living Complex | ||||
| 1625 S Franklin Ave | Colby | KS | 67701 | Long-term care facility |
| 2 - Family Center for Health Care | ||||
| 310 E College Dr | Colby | KS | 67701 | Rural health clinic |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 7: | Financial assistance at cost was determined by utilizing departmental cost-to-charge ratios for financial assistance provided in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of financial assistance provided for services not reported as subsidized health services.Unreimbursed Medicaid costs were also determined using a blend of cost-to-charge ratios for certain services and an overall cost-to-charge ratio derived from Worksheet 2 for all other services.The cost of providing subsidized health services was determined using a cost-to-charge ratio for each service.Actual costs and revenues were utilized for all other items reported on line 7. |
| Part I, Line 7g: | Subsidized health services are comprised of services that the Medical Center provides despite a financial loss to the organization. These services include the operation of a clinic with visiting physicians in various specialties and a rural health clinic. Costs attributable to physician clinics included on line 7(g), column (c), were $6,091,292 and unreimbursed costs attributable to physician clinics included on line 7(g), column (e), were $1,320,571. |
| Part II, Community Building Activities: | N/A |
| Part III, Line 4: | See note A2 (page 8) of the audited financial statements regarding the allowance for uncollectible accounts.Part III, Line 2Bad debts at cost were determined by utilizing departmental cost-to-charge ratios for bad debts in areas that are reported as subsidized health services. An overall cost-to-charge ratio derived from Worksheet 2 was used to determine the cost of bad debts in all other areas.Part III, Line 3Bad debt provisions attributable to patients eligible under the organization's financial assistance policy were determined using an estimated 74.3% of total bad debts. The Medical Center takes steps to assist individuals who are believed to qualify for financial assistance prior to writing accounts off as uncollectible. The Medical Center considers $401,036 of bad debt cost as community benefit. As a tax-exempt hospital, we must provide necessary services regardless of the patient's ability to pay for that care. Making quality patient care available to all in our community, regardless of their economic means, qualfies bad debts as a community benefit. |
| Part III, Line 8: | Medicare allowable costs were determined by using amounts from the Medical Center's Medicare cost report. The Medicare cost report apportions actual costs to the Medicare program using charges for ancillary services and patient days for nursing services. The Medical Center believes that all of the $89,156 Medicare shortfall should be considered as community benefit. The IRS Community Benefit Standard includes the provision of care to the elderly and Medicare patients. Medicare shortfalls must be absorbed by the Hospital in order to continue treating the elderly in our community. The Medical Center provides care regardless of this shortfall and thereby relieves the federal government of the burden of paying the full cost for Medicare beneficiaries. |
| Part III, Line 9b: | The financial assistance policy states that patients qualifying for charity care must complete a Financial Assistance Questionnaire and submit a copy of the patient's or relative's most recently-filed tax return. If charity care is considered appropriate by a committee, the patient's liability will be reduced by the approved amount. Any remaining balance on patient accounts is subject to the debt collection procedures articulated in the written policy. |
| Part VI, Line 2: | The Medical Center assesses the community health care needs primarily from responses from patients, community members, and health professionals. The Medical Center will take into account concerns or requests for services that are expressed by all patients and community members. Also, the Medical Center considers requests made by health professionals who include, but are not limited to, physicians, mid-level providers, social workers, nurses, and dieticians. |
| Part VI, Line 3: | All uninsured and under-insured patients are identified and screened upon admission by the Patient Financial Advisor. During this interview process, payment terms are discussed. If the patient appears to not have the ability to pay, they are asked to complete a financial questionnaire and provide a copy of their most recently filed tax return for determining their ability to pay under the Medical Center's financial assistance policy. If, during this interview process, it appears that a patient may qualify for assistance under state or federal assistance programs, they are referred to CMCI's Social Services Department for assistance in completing the applicable applications. |
| Part VI, Line 4: | The Medical Center is located in Colby, KS and serves the nine-county region of northwest Kansas, several of which are medically underserved. There are a total of eight small hospitals serving this nine-county region; however, CMCI provides many services that are unavailable in the smaller hospitals. The closest hospitals to the Medical Center are located in Oakley, Atwood, and Hoxie. These hospitals are approximately 23, 30, and 36 miles from Colby, respectively. The highest concentration of population for the service area is located in Colby, KS. Colby has a population of approximately 5,400 people. The median household income for the city is approximately $42,000. A major portion of the population that the Medical Center serves is Medicare-eligible citizens who live on a fixed income. |
| Part VI, Line 5: | The Medical Center is a grantee of the Kansas Department of Health & Environment, Kansas Quality of Care Project, and participates in programs identified by the state as needed to help improve the health of residents of our state and local area. Kansas Promoting Health Program is a chronic disease support group and is a program in which the Medical Center has trained facilitators and offers classes. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (1) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | Scholarships | GrantTypeTxt |
| Recipient | 13 | RecipientCnt |
| Cash Grant | $15,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | The Medical Center monitors the use of grant funds by sending nursing scholarship funds to the Kansas Board of Regents to ensure that the funds are used for the intended purpose and by requiring scholarship recipients to show proof of satisfactory course work. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Gregory Unruh | ||||||||||||||
| CEO | $159,008 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $11,249 | $0 | $170,257 | $0 | $0 | $0 |
| Darren Matchell | ||||||||||||||
| Physician | $388,650 | $0 | $0 | $0 | $0 | $0 | $18,428 | $0 | $23,418 | $0 | $430,496 | $0 | $0 | $0 |
| Kelly Gabel | ||||||||||||||
| Physician | $355,444 | $0 | $0 | $0 | $0 | $0 | $20,156 | $0 | $21,181 | $0 | $396,781 | $0 | $0 | $0 |
| John Dygert | ||||||||||||||
| Physician | $217,439 | $0 | $101,971 | $0 | $0 | $0 | $17,919 | $0 | $22,448 | $0 | $359,777 | $0 | $0 | $0 |
| Brewster Kellogg | ||||||||||||||
| Physician | $330,509 | $0 | $20,468 | $0 | $0 | $0 | $20,380 | $0 | $23,527 | $0 | $394,884 | $0 | $0 | $0 |
| Brian Unruh | ||||||||||||||
| Physician Assistant | $138,649 | $0 | $65,999 | $0 | $0 | $0 | $12,437 | $0 | $8,570 | $0 | $225,655 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part I, Line 6 | FormAndLineReferenceDesc |
| Explanation | The CEO and CFO have a bonus arrangement that is triggered if income from operations exceeds 2 percent of expenses. No bonuses were paid to the CEO or CFO in 2015. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The Medical Center is a not-for-profit corporation with 21 members at December 31, 2015. |
| Form 990, Part VI, Section A, line 7a | The Medical Center's corporate members elect the governing body. |
| Form 990, Part VI, Section B, line 11 | Form 990 is provided to the Chief Executive Officer who e-mails notices to members of the Board of Trustees that the Form 990 is available for review prior to filing the return. |
| Form 990, Part VI, Section B, line 12c | A conflict of interest disclosure form is provided with a copy of the current conflict of interest policy. This disclosure form is completed by each member of the Board of Trustees upon election and annually thereafter. |
| Form 990, Part VI, Section B, line 15 | The Board of Trustees reviews the compensation of the CEO and senior management. The Medical Center relies on a joint wage salary report published by the Kansas Hospital and Missouri Hospital Associations, as well as any and all available local data. |
| Form 990, Part VI, Section C, line 19 | The Medical Center makes its governing documents, conflict of interest policy, and financial statements available to the public upon written request. |
| Form 990, Part XI, line 9: | Change in beneficial interest in net assets of foundations net of transfers 65,862. |
Schedule R IRS990ScheduleR
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Med-Serv Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E College Drive | AddressLine1Txt |
| City | Colby | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480994564 | EIN |
| Primary Activities | Inactive | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Entity Type | C | EntityTypeTxt |
| Ownership | 1.00000 | OwnershipPct |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | 0 | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | 0 | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |