2016-05-04T13:00:04-05:00 2015-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2014-07-01 440537826 COMMUNITY HOSPITAL ASSOCIATION INC % JON DAVIS COMM 6606862211 PO BOX 107 FAIRFAX MO 644460107 JON DAVIS CFO 6606862211 2016-05-16 true Kevin Ensminger CPA P01310558 8162216300 2014 2016-08-17 19:52:53Z ROGER W STEINKRUGER 26136 US HWY 59 FAIRFAX MO 644460107 18402335 false X WWW.FAIRFAXMED.COM X 1976 MO TO PROVIDE QUALITY ACUTE CARE, EMERGENCY, AND OUTPATIENT SERVICES 11 10 124 80 0 0 217942 173630 11075612 12749928 218331 860326 388634 155763 11900519 13939647 1000 800 0 0 4798279 5571661 0 0 120355 8106688 9216006 12905967 14788467 -1005448 -848820 22658090 21732306 12243065 12952911 10415025 8779395 X TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. true false 12108111 800 12859871 SEE SCHEDULE O 12108111 true true false true false false false false false false true false false false true false false true false false false false false false true false true true false false true false false false false false false true false false false false false false true true true false false true 6 0 true 124 true false false false false false true true false false false false X 11 10 false true false false false true false true true false false true true true true true true true true false MO X JON DAVIS 6606862211 26136 US HWY 59 FAIRFAX MO 64446 AMY RYAN DIRECTOR 1.0 0.0 X 0 0 0 CHAD DERR DIRECTOR 1.0 0.0 X 0 0 0 COREY HERRON DIRECTOR 1.0 0.0 X 0 0 0 DEBORAH GLEASON DIRECTOR 1.0 0.0 X 0 0 0 JASON GARST DIRECTOR 1.0 0.0 X 0 0 0 KRISTI ATKINSON DIRECTOR 1.0 0.0 X 0 0 0 RICHARD OSWALD DIRECTOR/SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 ROBERT JACKSON DIRECTOR/PRESIDENT/CHAIRMAN 1.0 1.0 X X 0 0 0 SARAH WATKINS DIRECTOR 1.0 0.0 X 0 0 0 VIRGINIA LOW DIRECTOR/VICE PRESIDENT 1.0 0.0 X X 0 0 0 GLENN SCOTT DIRECTOR 1.0 0.0 X 0 0 0 RICHARD ARON BURKE MD DIRECTOR/CHIEF OF MED STAFF 11.0 1.0 X 116158 0 0 ROGER STEINKRUGER CEO 40.0 1.0 X 88480 0 0 NANCY S SOUTHARD CFO - RESIGNED SEPT 14 40.0 1.0 X 48301 0 6984 MYRA EVANS CEO - RESIGNED AUG 14 40.0 1.0 X 132996 0 21629 HAROLD LAWRENCE PHARMACIST 40.0 0.0 X 131547 0 32534 DUSTIN CARPENTER DOCTOR 40.0 0.0 X 123322 0 4580 RENEE KREIFELS CRNA 40.0 0.0 X 147908 0 3520 CONDRA ANDERSON FNP 40.0 0.0 X 110113 0 2743 898825 0 71990 6 false true false DR CARL LUEM PHYSICIAN SERVICES 135680 THE NEBRASKA MEDICAL CENTER MANAGEMENT SERVICES 549794 DOCS WHO CARE PHYSICIAN SERVICES 372418 INSPIRE REHABILIATION REHAB SERVICES 270332 CPSIEVIDENT COMPUTER SUPPORT SER 187120 6 79974 65535 28121 173630 NET PATIENT SERVICE REVENUE 621990 12749928 12749928 12749928 239531 239531 0 0 0 0 0 5005634 46687 4357714 73812 647920 -27125 620795 620795 7889 79974 31162 -23273 -23273 0 0 CAFETERIA 621990 51249 51249 340B DRUG REVENUE 900099 109943 109943 All Other Misc Revenue 900099 17844 17844 179036 13939647 12859871 906146 0 800 800 0 0 404485 337802 63652 3031 41402 41402 4157539 3211469 903067 43003 95315 74346 20016 953 526736 414216 107405 5115 346184 270024 72699 3462 291983 227747 61316 2920 33591 26201 7054 336 81868 63857 17192 819 0 0 32556 32556 1795903 1400804 377139 17960 65913 51412 13842 659 403454 314694 84725 4035 0 0 234490 182902 49243 2345 41996 32757 8819 420 0 0 561144 437692 117840 5611 0 1658808 1293870 348350 16588 111546 87006 23425 1115 REPAIRS & MAINT. 849839 662875 178466 8498 Medical Supplies 747633 747633 BAD DEBT 1327206 1327206 MEDICAID 629526 629526 348550 271870 73195 3485 14788467 12108111 2560001 120355 1778 142340 487564 578971 19044 16544 1282017 1663782 0 0 0 0 0 0 284969 314977 86451 107850 21784615 9453474 13668972 12331141 6805295 6576701 0 0 0 0 0 0 22000 0 22658090 21732306 694477 1737856 0 0 0 0 0 0 0 0 0 0 11540261 11209991 0 0 8327 5064 12243065 12952911 X 10415025 8779395 0 0 0 0 10415025 8779395 22658090 21732306 -848820 -786810 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 13908 false false false 13908 false SCHEDULE C, PART II-B THE LOBBYING EXPENSES RECORDED ARE A PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION. 235304 235304 7695411 2636016 5059395 13842748 6817458 7025290 11152 11152 12331141 0 DUE TO FOUNDATION 5064 5064 11956394 -786810 163319 -623491 12579885 32556 1327206 1359762 13939647 13568782 140077 140077 13428705 32556 1327206 1359762 14788467 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, LINES 2D & 4B LINE 2D RELATED ORGANIZATION'S REVENUE $ 107,031 COST OF GOODS SOLD 27,126 ELIMINATIONS < 2,000 > SPECIAL EVENT EXPENSES 31,162 -------- TOTAL $ 163,319 LINE 4B BAD DEBT EXPENSE $ 1,327,206 SCHEDULE D, PART XII, LINES 2D & 4B LINE 2D RELATED ORGANIZATION'S EXPENSES $ 83,789 COST OF GOODS SOLD 27,126 ELIMINATIONS < 2,000 > SPECIAL EVENT EXPENSES 31,162 -------- TOTAL $ 140,077 LINE 4B BAD DEBT EXPENSE $ 1,327,206 GOLF TOURNAMENT 60321 54784 5537 340 5908 760 2027 7861 CELEBRITY WAITE 27542 25190 2352 150 4891 9225 0 87863 79974 7889 340 5908 910 6918 17086 31162 -23273 true true true X false true true true false false 234754 234754 0.01950 1503927 665675 838252 0.06980 1738681 665675 1073006 0.08930 10433 2915 7518 0.00060 800 800 0.00010 213770 152988 60782 0.00640 1165 1165 0.00010 226168 155903 70265 0.00720 1964849 821578 1143271 0.09650 1762 1762 0.00010 373 373 0.00010 2135 2135 0.00020 false 1327206 81009 7360272 7114300 245972 X true true 1 1 COMMUNITY HOSPITAL-FAIRFAX 26136 US HWY 59 FAIRFAX MO 64446 http://www.fairfaxmed.com/ X X X X COMMUNITY HOSPITAL-FAIRFAX 1 false false true X X X X X X X X X 12 true false false true X WWW.FAIRFAXMED.COM/NEWS/CHNA/ X true 13 true WWW.FAIRFAXMED.COM/NEWS/CHNA/ false false true X 200. 0. X X X X true true X X X X true X SEE SECTION C X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 IN SEPTEMBER AND OCTOBER OF 2012, CH-F INVITED AREA COMMUNITY EXPERTS TO GATHER IN FOUR DIFFERENT FOCUS GROUPS. THOSE IN ATTENDANCE INCLUDED AREA COUNSELORS, CLERGY MEMBERS, LAW ENFORCEMENT, ECONOMIC DEVELOPMENT PERSONNEL, NURSING HOME REPRESENTATIVES, SCHOOL FACULTY, COMMUNITY SERVICES STAFF AND OTHER COMMUNITY EXPERTS. FOCUS GROUP ATTENDEES WERE ASKED A VARIETY OF QUESTIONS. DIALOGUE WAS CANDID AND FOCUS GROUP ATTENDEES USED THEIR KNOWLEDGE OF THE CONSTITUENCY THEY REPRESENT TO HONESTLY EVALUATE THE HEALTH OF THE COMMUNITY. RESULTS FROM THOSE MEETINGS ARE SUMMARIZED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. CH-F STAFF ALSO PARTICIPATED IN THE FOCUS GROUPS. NURSING STAFF WAS DIRECTLY INVOLVED AND SEVERAL SMALL GROUP MEETINGS DISCUSSED THE ABOVE QUESTIONS. FEEDBACK FROM NURSING WAS SIMILAR TO THAT OF THE FOCUS GROUPS. CH-F ALSO CONSULTED WITH LOCAL PUBLIC HEALTH OFFICIALS. MEETINGS WERE HELD ON TWO OCCASIONS WITH THE ATCHISON COUNTY HEALTH CENTER DIRECTOR, WHERE DATA THAT THEY HAD COLLECTED FROM YEARS PAST WAS SHARED AND A BETTER UNDERSTANDING OF THE NEEDS OF THE CLIENTELE THEY SERVE WAS GAINED. THE DIRECTOR OF THE HOLT COUNTY HEALTH CENTER PLAYED A KEY ROLE IN THE SMALL FOCUS GROUP HELD TO SORT THROUGH ALL THE NEEDS AND SET PRIORITIES. IN NOVEMBER OF 2012, COMMUNITY HOSPITAL-FAIRFAX RELEASED THE CH-F CHNA SURVEY TO THE PUBLIC. THE QUESTIONS ON THE SURVEY WERE DETERMINED THROUGH GUIDANCE PROVIDED BY THE MISSOURI HOSPITAL ASSOCIATION AND INFORMATION GATHERED THROUGH THE FOCUS GROUPS AND SECONDARY RESEARCH. FORTY-FOUR HUNDRED SURVEYS WERE MAILED TO ALL ATCHISON AND HOLT COUNTY ADDRESSES THE LAST WEEK IN NOVEMBER. THE SURVEY WAS ALSO OFFERED ONLINE, ON EACH MAILED SURVEY, THE WEB ADDRESS WAS PROVIDED FOR THE ONLINE SURVEY. CH-F PROMOTED THE SURVEY USING FACEBOOK, BLAST EMAILS, NEWSPAPER AND THE CABLE CHANNEL. COLLECTION BOXES WERE AVAILABLE AT THE MOUND CITY AND ROCK PORT SENIOR CENTERS AND THE TARKIO, ROCK PORT, AND MOUND CITY NEWSPAPERS FOR SURVEYS. 888 SURVEYS WERE RETURNED, REPRESENTING APPROXIMATELY 1800 INDIVIDUALS. COMMUNITY HOSPITAL-FAIRFAX ALSO COLLABORATED WITH COMMUNITY SERVICES INC. OF ATCHISON AND HOLT COUNTY TO DISTRIBUTE SURVEYS. COMMUNITY SERVICES INC. IS THE LOCAL AGENCY EMPOWERED TO HELP PEOPLE IN NEED IN THE ATCHISON AND HOLT COUNTY COMMUNITIES. ONE HUNDRED AND FIFTY SURVEYS WERE DISTRIBUTED TO COMMUNITY SERVICES WITH A SELF ADDRESSED, STAMPED ENVELOPE. 8.4% OF THE TOTAL SURVEYS RETURNED WERE FROM COMMUNITY SERVICES INC. SCHEDULE H, PART V, SECTION B, LINE 11 THE HOSPITAL IDENTIFIED 3 MAJOR PRIORITY AREAS IN OUR IMPLEMENTATION STRATEGY. 1. MENTAL HEALTH-TO RESPOND TO THESE NEEDS, WE IMPLEMENTED A TELE-PSYCH PROGRAM FOR 2 YEARS. TO FURTHER AND MORE COMPLETELY MEET THIS NEED, WE HAVE RECENTLY STARTED A PROGRAM FOR OUTPATIENT GROUP THERAPY FOR SENIOR CITIZENS IN OUR COMMUNITY. 2. ACCESS TO RESOURCES AMONG THE LOW INCOME-WE IMPLEMENTED A PROGRAM TO INCREASE ACCESS TO LIFE SAVING MEDICATION AMONG POPULATIONS WITHOUT INSURANCE COVERAGE, WE CERTIFIED STAFF TO ASSIST IN ACCESSING HEALTHCARE.GOV AND WORKED WITH LOCAL OFFICIALS TO LEARN MORE ABOUT MEDICAID. 3. HEALTHY LIFESTYLES-WE CONTINUED WITH EDUCATION IN HIGH SCHOOLS FOR TWO YEARS, DEVELOPED A WORKPLACE WELLNESS PROGRAM TO SERVE KEY BUSINESSES IN THE AREA AND OFFERED SEVERAL FREE HEART HEALTHY SCREENINGS AND FOLLOW UP EDUCATION. WE HAVE NOT SUCCESSFULLY ADDRESSED THE NEED FOR COPD OUTREACH AS STATED IN OUR IMPLEMENTATION PLAN DUE TO LACK OF ALLOCATED RESOURCES. SCHEDULE H, PART V, SECTION B, LINE 16B WWW.FAIRFAXMED.COM/CONTACTUS/PAYMENTS/CHARITY-CARE/ SCHEDULE H, PART V, SECTION B, LINE 22D THE MAXIMUM ALLOWABLE CHARGE IS BASED ON OUR AVERAGE COMMERCIAL INSURANCE RATES. 2 PRIMARY CARE CLINIC 26136 US HWY 59 FAIRFAX MO 64446 PRIMARY CARE FACILITY MOUND CITY FAMILY MEDICINE 514 STATE STREET MOUND CITY MO 64470 PRIMARY CARE FACILITY SCHEDULE H, PART I, LINE 3C APPLICANTS THAT DO NOT QUALIFY FOR CHARITY CARE DUE TO THE FEDERAL POVERTY GUIDELINES (FPG) SCALE CAN BE CONSIDERED FOR MEDICALLY INDIGENT ALLOWANCE. FOR THIS ALLOWANCE, EACH PATIENT'S FINANCIAL SITUATION WILL BE RESEARCHED ON AN INDIVIDUAL BASIS. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART I, LINE, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,327,206. SCHEDULE H, PART I, LINE 7G THE HOSPITAL INCLUDED $250,318 FROM PHYSICIAN CLINICS. SCHEDULE H, PART II COMMUNITY HOSPITAL-FAIRFAX PARTICIPATES IN YEAR ROUND COMMUNITY BUILDING ACTIVITES. IN FEBRUARY, COMMUNITY HOSPITAL HOSTED FREE HEART HEALTHY SCREENINGS FOR 80 PARTICIPANTS WHO WERE OFFERED FREE BLOOD PRESSURE, GLUCOSE, CHOLESTEROL, BODY COMPOSITION AND HEART HEALTH COUNSELING. IN ADDITION TO CELEBRATING HEART HEALTH AWARENESS MONTH, MONTHLY BLOOD PRESSURE CLINICS ARE OFFERED IN THREE LOCATIONS EVERY MONTH OF THE YEAR IN THE CH-F SERVICE AREA AS A SERVICE TO OUR COMMUNITY. PEDIATRIC ORIENTATION IS HELD IN THE SPRING OF EACH YEAR. 90 AREA FIRST GRADERS ARE INVITED INTO THE HOSPITAL TO ROLE PLAY WHAT IT MIGHT BE LIKE TO A PATIENT. FIRST GRADERS REALLY ENJOY RIDING IN THE WHEELCHAIR AND PUSHING BUTTONS ON THE HOSPITAL BED. IN THE LATE SUMMER, COMMUNITY HOSPITAL-FAIRFAX SPONSORS THE BACK TO SCHOOL FAIR. THIS IS A FAIR FOR LOW INCOME FAMILIES TO RECEIVE FREE SCHOOL SUPPLIES PRIOR TO THE SCHOOL YEAR STARTING. COMMUNITY HOSPITAL-FAIRFAX ORGANIZES THE COLLECTION OF FUNDS AND PURCHASES THE SUPPLIES. IN ADDITION, CHILDREN ARE TREATED TO TWO SESSIONS ON HEALTHY EATING AND GOOD HABITS FOR A HEALTHY SCHOOL YEAR WHERE THEY CAN LEARN. 100 CHILDREN WERE ABLE TO FILL BACKPACKS WITH NEEDED SUPPLIES LAST YEAR! IN THE FALL, COMMUNITY HOSPITAL-FAIRFAX INVITES MEN TO COME TO THE HOSPITAL FOR A FREE PROSTATE SCREENING CLINIC. THE PSA TEST IS OFFERED AT A REDUCED COST AND THE EXAM IS FREE. 60 TO 75 MEN PARTICIPATE IN THIS ACTIVITY ANNUALLY. THE FIRST WEEKEND OF NOVEMBER IS AN EXCITING TIME FOR THE COMMMUNITY'S WOMEN AS THE ANNUAL ME MARKET KICKS OFF. A GYM FULL OF SHOPPING OPPORTUNITIES ATTRACTS ABOUT 250 WOMEN ANNUALLY. ALONG WITH SHOPPING, WOMEN CAN RECEIVE FREE SCREENINGS AND HEALTH INFORMATION. CHOLESTEROL, GLUCOSE, BODY COMPOSITION, HEART HEALTH AND A FREE FALL RISK ASSESSMENT ARE ALL OFFERED FREE OF CHARGE OR AT A VERY REDUCED COST. SCHEDULE H, PART III, SECTION A, LINE 2 IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION A, LINE 3 LINE 3 IS THE AMOUNT OF ACCOUNT BALANCES WRITTEN OFF TO BAD DEBTS THAT POSSIBLY WOULD HAVE QUALIFIED FOR CHARITY HAD THEY BEEN WILLING TO PROVIDE THE NECESSARY INFORMATION, AND THE TOTAL OF BANKRUPTCIES THE HOSPITAL HAD TO WRITE OFF. SCHEDULE H, PART III, SECTION A, LINE 4 THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE IS IN NOTE 1 ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS. SCHEDULE H, PART III, SECTION B, LINE 8 THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 23% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. OUR CUSTOMER SERVICE SURVEYS RATE COMMUNITY HOSPITAL CONSISTENTLY OVER 90%, SHOWING THESE MEDICARE BENEFICIARIES APPRECIATE THE SERVICES COMMUNITY HOSPITAL PROVIDES AND HOW THE SERVICES ARE PROVIDED. THE COSTING SOURCE WAS THE FY15 MEDICARE COST REPORT. SCHEDULE H, PART III, SECTION C, LINE 9B COLLECTION POLICY STATES ALL UNINSURED AND INSURED PATIENTS ARE INFORMED ON THEIR FIRST STATEMENT OF SERVICES THAT COMMUNITY HOSPITAL HAS A GRANT PROGRAM (FOR FINANCIAL ASSISTANCE) FOR THOSE WHO QUALIFY. THIS SAME TYPE OF 'ASSISTANCE AVAILABLE' INFORMATION IS ALSO IN THE PATIENT INFORMATION BROCHURES IN THE PATIENT ROOMS AND WAITING AREAS. PATIENTS MAY QUALIFY FOR A CHARITY DISCOUNT OR A MEDICALLY INDIGENT DISCOUNT, DEPENDING ON THEIR FINANCIAL SITUATION AND USING THE FEDERAL POVERTY GUIDELINES. SCHEDULE H, PART VI, LINE 2 THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS COMPLETED AND IMPLEMENTATION BEGAN IN FY14. THREE AREAS OF NEED WERE IDENTIFIED: HEALTHY LIVING, ACCESS TO RESOURCES AMONG THE LOW INCOME AND MENTAL HEALTH. HEALTHY LIVING (CARDIAC): COMMUNITY HOSPITAL-FAIRFAX INITIATED ITS FIRST EVER FREE CARDIAC SCREENING IN FEBRUARY OF 2014. 80 PARTICIPATED RECEIVING FREE HEART EDUCATION IN ADDITION TO BLOOD PRESSURE, GLUCOSE, CHOLESTEROL AND BODY COMPOSITION SCREENINGS. EACH PARTICIPANT WAS INDIVIDUALLY COUNSELED WITH THEIR RESULTS. THIS WAS CONTINUED IN 2015 WITH ANOTHER 80 SCREENED. CH-F ALSO ROLLED OUT A WORKPLACE SCREENING PROGRAM SERVING 75 EMPLOYEES IN 3 LOCAL BUSINESSES WITH REDUCED PRICE SCREENINGS. MENTAL HEALTH: CH-F INITIATED A PSYCHIATRY TELEHEALTH CLINIC IN JANUARY OF 2014 BRINGING MENTAL HEALTH EXPERTISE TO THE REGION FOR THE FIRST TIME. IN 2015 A CONTRACT WAS SIGNED WITH SENIOR LIFE SOLUTIONS BRINGING ONSITE PSYCHIATRY AND GROUP COUNSELING TO THE MEDICARE AGED POPULATION. ACCESS TO RESOURCES: CH-F DEVELOPED AND APPROVED A PATIENT MEDICATION PROGRAM PROVIDING ASSISTANCE TO PATIENTS IN NEED OF LIFESAVING MEDICATION BY ASSISTING WITH MEDICATION ASSITANCE PROGRAMS THROUGH PHARMACEUTICAL COMPANIES. THE PROGRAM WAS IMPLEMENTED IN JULY OF 2014. SCHEDULE H, PART VI, LINE 3 COMMUNITY HOSPITAL BUSINESS OFFICE STAFF WILL DISCUSS WITH INPATIENTS AND OUTPATIENTS THE OPTIONS AVALIABLE TO HELP THE PATIENTS MEET THEIR FINANCIAL OBLIGATIONS TO COMMUNITY HOSPITAL. THEY DISCUSS THE FEDERAL/STATE GOVERNMENT PROGRAMS AVAILABLE AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEN INFORMATION IS INCLUDED IN THE STATEMENTS SENT TO PATIENTS (EXPLAINING THE AMOUNTS OWED BY THE PATIENT'S INSURANCE OR THE PATIENT), MUCH OF THE INFORMATION IS THE SAME AS THE INFORMATION DISCUSSED IN PERSON. SCHEDULE H, PART VI, LINE 4 COMMUNITY HOSPITAL-FAIRFAX SERVES THE ATCHISON, HOLT AND WESTERN NODAWAY COUNTIES, POPULATION APPROXIMATELY 10,700. THERE ARE FIVE MAIN TOWNS IN ATCHISON AND HOLT, ALL WITH POPULATIONS BELOW 2,000. THE POPULATION IS ALL RURAL AND THE ECONOMY IS LARGELY DRIVEN BY AGRICULTURE. THE POPULATION IS AGING WITH A MEDIAN HOUSEHOLD INCOME OF $45,129. SCHEDULE H, PART VI, LINE 5 TO EDUCATE AND PROVIDE SERVICES TO ITS COMMUNITY, COMMUNITY HOSPITAL RESPONDS BY PROVIDING THE FOLLOWING ACTIVITES: AN ANNUAL HEART HEALTH SCREENING OFFERED FREE OF CHARGE, AND FREE BLOOD PRESSURE CHECKS; DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR; FREE GLUCOSE SCREENING, BMI CHECKS AND BLOOD PRESSURE CHECKS AT ANNUAL WOMEN'S EVENT; AN ANNUAL BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN AND HEALTHY EATING CHOICES ARE DISCUSSED; AN ANNUAL PROSTATE SCREENING WHICH INCLUDES A FREE EXAM FOR LOCAL RESIDENTS. IN ADDITION, THE HOSPITAL INITIATED A WORKPLACE WELLNESS PROGRAM WHERE SCREENINGS ARE OFFERED AT A REDUCED PRICE FOR EMPLOYEES. X X false false false false false false false false false MYRA EVANS CEO - RESIGNED AUG 14 99318 0 0 0 33678 0 10721 0 10908 0 154625 0 0 0 HAROLD LAWRENCE PHARMACIST 122933 0 0 0 8614 0 7366 0 25168 0 164081 0 0 0 RENEE KREIFELS CRNA 147908 0 0 0 0 0 0 0 3520 0 151428 0 0 0 COMPENSATION FROM AN UNRELATED ORGANIZATION THE CEO COMPENSATION FOR MYRA EVANS AND ROGER STEINKRUGER, AND THE COMPENSATION FOR HAROLD LAWRENCE, ARE PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), AN UNRELATED 501(C)(3) HOSPITAL. SEE SUPPLEMENTAL INFORMATION SCHEDULE L , PART IV A) JAMIE BURKE B) JAMIE BURKE IS AN EMPLOYEE OF CHA AND THE SISTER OF DR. RICHARD ARON BURKE, WHO IS A DIRECTOR OF CHA C) $41,402 D) COMPENSATION E) NO FORM 990, PART III, LINE 2 THE HOSPITAL OPENED A PRIMARY CARE CLINIC IN MOUND CITY, MO. MOUND CITY FAMILY MEDICINE OPERATES WITH A FULL TIME PHYSICIAN AND A PART TIME FNP. FORM 990, PART III, LINE 4A COMMUNITY HOSPITAL-FAIRFAX (CH-F) PRIDES ITSELF IN PROVIDING ACCESS TO HEALTHCARE TO A REGION WHERE HEALTH SERVICES ARE SPARSE, THE PHYSICIAN RATIO IS 2750:1 (NATIONAL BENCHMARK IS 631:1) AND EMERGENCY SERVICES WOULD OTHERWISE BE 30 MILES OR MORE FROM THE POPULATION CENTERS. COMMUNITY HOSPITAL-FAIRFAX PROVIDES THE NORTHWEST MISSOURI AREA POPULATION OF 11,000 IN HOLT, ATCHISON AND WESTERN NODAWAY COUNTY WITH A 24 HOUR EMERGENCY ROOM, ACUTE CARE (INCLUDING OBSTETRICS) AND POST-ACUTE CARE SERVICES, MANY OUTPATIENT SERVICES, SURGERY, ANCILLARY SERVICES, AND A FULL-SERVICE THERAPY DEPARTMENT. IN ADDITION TO SERVING THE HEALTH NEEDS OF A POPULATION THAT WOULD OTHERWISE NOT HAVE ACCESS TO CARE, COMMUNITY HOSPITAL-FAIRFAX CONTINUES TO INVEST IN A HEALTHY FUTURE FOR THE COMMUNITY. CH-F TRIES TO FOCUS ON THE GREATEST HEALTH NEEDS IN THE COMMUNITY WHICH TEND TO BE CHRONIC DISEASES SUCH AS HEART DISEASE, COPD AND ASTHMA, STROKE AND DIABETES. RISK FACTORS FOR THESE DISEASES ARE OBESITY, CIGARETTE SMOKING AND PHYSICAL INACTIVITY. NEARLY 30% OF THE CH-F SERVICE POPULATION IS OBESE, 69% REPORT PHYSICAL INACTIVITY AND 26% SMOKE. TO EDUCATE AND PROVIDE SERVICES TO A COMMUNITY WHERE THESE CHRONIC CONDITIONS PREVAIL, THE FOLLOWING ACTIVITIES ARE PART OF CH-F'S RESPONSE TO HEALTH NEEDS OF THE COMMUNITY: 1. FEBRUARY HEART HEALTHY SCREENING EVENT WITH 80 PARTICIPANTS. PARTICIPANTS RECEIVED FREE BLOOD PRESSURE, CHOLESTEROL, GLUCOSE AND BODY COMPOSITION ALONG WITH CARDIAC COUNSELING. 2. DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR. 3. FREE GLUCOSE SCREENINGS, BMI CHECKS AND BLOOD PRESSURE CHECKS BIANNUALLY AT A WOMEN'S EVENT (ATTENDED BY 275 WOMEN). 4. ATTENDANCE AT AREA HEALTH FAIRS OFFERING FREE SCREENINGS. 5. CH-F IS STROKE READY AND HAS PROTOCOL IN PLACE TO RESPOND TO A STROKE WITHIN 60 MINUTES. 6. CH-F STAFF TEACHES HEALTHY EATING CHOICES AND GOOD HABITS FOR A HEALTHY SCHOOL YEAR AT THE AREA BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN. OVER 100 CHILDREN WERE REACHED THROUGH THIS ACTIVITY. 7. AN ANNUAL PROSTATE SCREENING IS HELD BY CH-F. A FREE EXAM WAS PROVIDED TO NEARLY 60 MEN THIS YEAR. IN ADDITION TO RESPONDING TO AREA HEALTH CONCERNS, CH-F ALSO WANTS TO ENSURE THAT THERE ARE HEALTHCARE PROVIDERS FOR FUTURE GENERATIONS IN NORTHWEST MISSOURI. SCHOLARSHIPS ARE AWARDED EACH YEAR TO STUDENTS ENROLLED IN A HEALTHCARE PROGRAM. A CAREER DAY WAS ALSO HOSTED FOR AREA 8TH GRADERS. 55 STUDENTS ATTENDED TO LEARN ABOUT HEALTH CAREERS THROUGH HANDS ON ACTIVITIES WITH PHYSICIANS, LABORATORY, RADIOLOGY, NURSING AND PHYSICAL THERAPY EMPLOYEES. AS THE SOLE HEALTHCARE FACILITY IN THE AREA, CH-F TAKES SERIOUS ITS OBLIGATION TO BE PREPARED IN AN EMERGENCY. OVER 55 HOURS WERE SPENT BY CH-F'S EMERGENCY PREPAREDNESS COORDINATOR LAST YEAR TRAINING TO BE READY IN CASE A DISASTER STRIKES. CH-F CONTINUES TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE TO A POPULATION THAT WOULD NOT OTHERWISE HAVE ACCESS. RECRUITING PHYSICIANS, NURSES, THERAPISTS AND OTHER HEALTHCARE PROVIDERS IS ONGOING. PURCHASING STATE OF THE ART EQUIPMENT WHEN POSSIBLE AND MAKING SURE THAT EACH MEMBER OF OUR COMMUNITY HAS THE CARE THEY DESERVE IS NOT AN EASY TASK, BUT ONE CH-F IS PROUD TO DO. FORM 990, PART VI, SECTION A, LINE 3 COMMUNITY HOSPITAL ASSOCIATION, INC. HOLDS A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC). NMC APPOINTS A CHIEF EXECUTIVE OFFICER TO MANAGE DAY-TO-DAY OPERATIONS. FORM 990, PART VI, SECTION A, LINE 7A THE ORGANIZATION'S BY-LAWS STATE THAT THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST ELEVEN MEMBERS AND NO MORE THAN FIFTEEN MEMBERS. ONE-HALF OF THE DIRECTORS SHALL BE INDIVIDUALS NOMINATED BY THE NEBRASKA MEDICAL CENTER (NMC), SUBJECT TO A MAJORITY VOTE OF THE BOARD. IF AN NMC DIRECTOR IS NOT ELECTED BY THE BOARD, NMC SHALL CONTINUE TO NOMINATE OTHER CANDIDATES UNTIL A NOMINEE IS ELECTED BY THE BOARD. FORM 990, PART VI, SECTION B, LINE 11B AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATION. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S ADMINISTRATION HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 WITH ALL COMPLETED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION ANNUALLY OBTAINS WRITTEN AFFIRMATIONS FROM EACH OFFICER AND DIRECTOR AS TO THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A DISCLOSURE OCCURS, THE MATTER IS VOTED ON BY THE BOARD OF DIRECTORS. IF A MAJORITY VOTE OCCURS THEN THE DISCLOSURE IS CONSIDERED A CONFLICT. THE CONFLICTED INDIVIDUAL MAY NOT VOTE OR PARTICIPATE IN THE MATTERS INVOLVING THE CONFLICT. IT IS NOTED IN THE BOARD MEETING MINUTES THAT THE INDIVIDUAL ABSTAINED FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15A & 15B THE ORGANIZATION USES COMPARABILITY DATA TO DETERMINE THE COMPENSATION OF THE CEO AND OTHER OFFICERS. THE COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE COMPENSATION OF THE OTHER OFFICERS IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE MOST RECENT COMPENSATION REVIEW WAS PERFORMED IN 2015 BY AMBER DURR, HR EXECUTIVE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VII, SECTION A, LINE 1A THE COMPENSATION FOR DR. ARON BURKE IS FOR SERVICES PERFORMED AS A PHYSICIAN, AND IS NOT COMPENSATION FOR BEING A DIRECTOR. FORM 990 PART IX LINE 11G DESCRIPTION:EMERGENCY ROOM PHYSICIAN FEES TOTAL FEES:442152 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER PHYSICIAN FEES TOTAL FEES:175696 FORM 990 PART IX LINE 11G DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:234464 FORM 990 PART IX LINE 11G DESCRIPTION:HOUSEKEEPING TOTAL FEES:134994 FORM 990 PART IX LINE 11G DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:808597 COMMUNITY HEALTHCARE FOUNDATION 26136 US HWY 59 FAIRFAX MO 64446 431757553 SUPPORT ORG MO 501(C)(3) 11A CHA true false false true false false false false false false false false true false true true false false false false COMMUNITY HEALTHCARE FOUNDATION C 65535 FMV