COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 44-0537826)
- Tax period
- 2013-07-01 to 2014-06-30
- Filed
- 2015-05-11
- IRS object ID
- 201541319349301039
- Schema version
- 2013v4.0
- 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 G
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2015-05-11T09:31:47-05:00 | ReturnTs |
| Tax Period End | 2014-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2013-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440537826 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % TABITHA WINTZ | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 6606862211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 107 | AddressLine1 |
| Address Line2 | Suite | AddressLine2 |
| City | Fairfax | City |
| State | MO | State |
| ZIP Code | 644460107 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | ROGER STEINKRUGER | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6606862211 | PhoneNum |
| Signature | 2015-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin Ensminger CPA | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 6606862211 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROGER STEINKRUGER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 644460107 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $15,468,888 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAIRFAXMED.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY ACUTE CARE, EMERGENCY, AND OUTPATIENT HOSPITAL SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 14 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 13 | VotingMembersIndependentCnt |
| Total Employee | 131 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $139,766 | PYContributionsGrantsAmt |
| CY Contributions Grants | $217,942 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $11,151,530 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $11,075,612 | CYProgramServiceRevenueAmt |
| PY Investment Income | $182,845 | PYInvestmentIncomeAmt |
| CY Investment Income | $218,331 | CYInvestmentIncomeAmt |
| PY Other Revenue | $326,575 | PYOtherRevenueAmt |
| CY Other Revenue | $388,634 | CYOtherRevenueAmt |
| PY Total Revenue | $11,800,716 | PYTotalRevenueAmt |
| CY Total Revenue | $11,900,519 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $43,860 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $5,219,557 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $4,798,279 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $106,067 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,322,824 | PYOtherExpensesAmt |
| CY Other Expenses | $8,106,688 | CYOtherExpensesAmt |
| PY Total Expenses | $12,586,241 | PYTotalExpensesAmt |
| CY Total Expenses | $12,905,967 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$785,525 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,005,448 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $23,503,036 | TotalAssetsBOYAmt |
| Total Assets EOY | $22,658,090 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $12,627,349 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,243,065 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,875,687 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,415,025 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,467,514 | ExpenseAmt |
| Grant | $1,000 | GrantAmt |
| Revenue | $11,407,151 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $10,467,514 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (true) | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 131 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | Yes (true) | QuidProQuoContributionsInd |
| Quid Pro Quo Contri Discl | Yes (true) | QuidProQuoContriDisclInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 14 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 13 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | Yes (true) | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MO | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TABITHA WINTZ | PersonNm |
| Phone | 6606862211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (24 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| ROBERT JACKSON | ||||||||
| DIRECTOR/PRESIDENT | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| RICHARD OSWALD | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| SANDRA FUHRMAN | ||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.0 | 1.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| CHAD DERR | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| SARAH WATKINS | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| AMY L RYAN | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| STEVE CUNNINGHAM | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| JASON GARST | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| KRISTI ATKINSON | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| BEVERLY JONES | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| COREY HERRON | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD ARON BURKE MD | ||||||||
| DIRECTOR/CHIEF OF MED STAFF | 11.0 | 1.0 | Yes (X) | $58,762 | $0 | $0 | ||
| DEBORAH GLEASON | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| VIRGINIA LOW | ||||||||
| DIRECTOR | 1.0 | Yes (X) | $0 | $0 | $0 | |||
| PAULA MILLER | ||||||||
| DIRECTOR/VICE PRESIDENT | 1.0 | Yes (X) | Yes (X) | |||||
| JACQUE GEBHARDS | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| MIKE FISHER | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| EDUARDO FERNANDEZ MD | ||||||||
| DIRECTOR | 1.0 | Yes (X) | ||||||
| MYRA EVANS | ||||||||
| CEO | 40.0 | 1.0 | Yes (X) | $178,644 | $0 | $19,484 | ||
| SUZANNE SOUTHARD | ||||||||
| CFO | 40.0 | 1.0 | Yes (X) | $62,010 | $0 | $6,057 | ||
| ERICA GILLETTE | ||||||||
| DOCTOR | 40.0 | $220,782 | $0 | $9,065 | Yes (X) | |||
| GARY MCINTYRE | ||||||||
| CRNA | 40.0 | $146,988 | $0 | $5,166 | Yes (X) | |||
| CONNIE ANDERSON | ||||||||
| FNP | 40.0 | $118,489 | $0 | $4,532 | Yes (X) | |||
| HAROLD LAWRENCE | ||||||||
| PHARMACIST | 40.0 | $124,389 | $0 | $29,458 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $910,064 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $73,762 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (3 entries)
| ServicesServicesDesc | CompensationCompensationAmt |
|---|---|
| DOCS WHO CARE | |
| PHYSICIAN SERVICES | $371,952 |
| CPSI | |
| COMPTR SUPPORT SVCS | $161,880 |
| DR CARL LUEM | |
| PHYSICIAN SERVICES | $142,920 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 3 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $74,421 | FundraisingAmt |
| Related Organizations | $14,108 | RelatedOrganizationsAmt |
| All Other Contributions | $129,413 | AllOtherContributionsAmt |
| Total Contributions | $217,942 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $11,075,612 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,075,612 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $11,075,612 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $157,277 | TotalRevenueColumnAmt |
| Exclusion | $157,277 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,597,903 | SecuritiesAmt |
| Other | $1,098 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $3,537,947 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $59,956 | SecuritiesAmt |
| Other | $1,098 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,054 | TotalRevenueColumnAmt |
| Exclusion | $61,054 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $16,515 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $74,421 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $30,422 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$13,907 | TotalRevenueColumnAmt |
| Exclusion | -$13,907 | ExclusionAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| INCENTIVE REVENUE | 900099 | $142,902 | $142,902 | |
| CAFETERIA | 621990 | $47,062 | $47,062 | |
| 340B DRUG REVENUE | 900099 | $188,637 | $188,637 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,940 | TotalRevenueColumnAmt |
| Exclusion | $23,940 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $402,541 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $11,900,519 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $11,407,151 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $275,426 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,000 | TotalAmt |
| Program Services | $1,000 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $174,250 | TotalAmt |
| Program Services | $158,561 | ProgramServicesAmt |
| Management And General | $14,976 | ManagementAndGeneralAmt |
| Fundraising | $713 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $43,458 | TotalAmt |
| Program Services | $43,458 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,938,061 | TotalAmt |
| Program Services | $3,039,480 | ProgramServicesAmt |
| Management And General | $857,736 | ManagementAndGeneralAmt |
| Fundraising | $40,845 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $100,278 | TotalAmt |
| Program Services | $78,217 | ProgramServicesAmt |
| Management And General | $21,058 | ManagementAndGeneralAmt |
| Fundraising | $1,003 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $223,707 | TotalAmt |
| Program Services | $176,898 | ProgramServicesAmt |
| Management And General | $44,681 | ManagementAndGeneralAmt |
| Fundraising | $2,128 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $318,525 | TotalAmt |
| Program Services | $248,450 | ProgramServicesAmt |
| Management And General | $66,890 | ManagementAndGeneralAmt |
| Fundraising | $3,185 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $244,000 | TotalAmt |
| Program Services | $190,320 | ProgramServicesAmt |
| Management And General | $51,240 | ManagementAndGeneralAmt |
| Fundraising | $2,440 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,198 | TotalAmt |
| Program Services | $16,534 | ProgramServicesAmt |
| Management And General | $4,452 | ManagementAndGeneralAmt |
| Fundraising | $212 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,415 | TotalAmt |
| Program Services | $84,564 | ProgramServicesAmt |
| Management And General | $22,767 | ManagementAndGeneralAmt |
| Fundraising | $1,084 | FundraisingAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,012 | TotalAmt |
| Management And General | $18,012 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,588,889 | TotalAmt |
| Program Services | $1,239,333 | ProgramServicesAmt |
| Management And General | $333,667 | ManagementAndGeneralAmt |
| Fundraising | $15,889 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,643 | TotalAmt |
| Program Services | $38,722 | ProgramServicesAmt |
| Management And General | $10,425 | ManagementAndGeneralAmt |
| Fundraising | $496 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $336,495 | TotalAmt |
| Program Services | $262,466 | ProgramServicesAmt |
| Management And General | $70,664 | ManagementAndGeneralAmt |
| Fundraising | $3,365 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $236,605 | TotalAmt |
| Program Services | $184,552 | ProgramServicesAmt |
| Management And General | $49,687 | ManagementAndGeneralAmt |
| Fundraising | $2,366 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $35,328 | TotalAmt |
| Program Services | $27,556 | ProgramServicesAmt |
| Management And General | $7,419 | ManagementAndGeneralAmt |
| Fundraising | $353 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $576,177 | TotalAmt |
| Program Services | $449,418 | ProgramServicesAmt |
| Management And General | $120,997 | ManagementAndGeneralAmt |
| Fundraising | $5,762 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,674,571 | TotalAmt |
| Program Services | $1,306,165 | ProgramServicesAmt |
| Management And General | $351,660 | ManagementAndGeneralAmt |
| Fundraising | $16,746 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $119,929 | TotalAmt |
| Program Services | $93,545 | ProgramServicesAmt |
| Management And General | $25,185 | ManagementAndGeneralAmt |
| Fundraising | $1,199 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| REPAIRS & MAINT. | $689,229 | $469,739 | $213,468 | $6,022 |
| Medical Supplies | $573,124 | $573,124 | ||
| BAD DEBT | $982,770 | $982,770 | ||
| MEDICAID | $624,142 | $624,142 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $228,161 | TotalAmt |
| Program Services | $178,500 | ProgramServicesAmt |
| Management And General | $47,402 | ManagementAndGeneralAmt |
| Fundraising | $2,259 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,905,967 | TotalAmt |
| Program Services | $10,467,514 | ProgramServicesAmt |
| Management And General | $2,332,386 | ManagementAndGeneralAmt |
| Fundraising | $106,067 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $116,181 | BOYAmt |
| EOY | $1,778 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $633,396 | BOYAmt |
| EOY | $487,564 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $31,221 | BOYAmt |
| EOY | $19,044 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,321,908 | BOYAmt |
| EOY | $1,282,017 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $308,528 | BOYAmt |
| EOY | $284,969 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $82,529 | BOYAmt |
| EOY | $86,451 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $21,463,638 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $7,794,666 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,270,776 | BOYAmt |
| EOY | $13,668,972 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,647,869 | BOYAmt |
| EOY | $6,805,295 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $90,628 | BOYAmt |
| EOY | $22,000 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,503,036 | BOYAmt |
| EOY | $22,658,090 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $717,605 | BOYAmt |
| EOY | $702,804 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,909,744 | BOYAmt |
| EOY | $11,540,261 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,627,349 | BOYAmt |
| EOY | $12,243,065 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,875,687 | BOYAmt |
| EOY | $10,415,025 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,875,687 | BOYAmt |
| EOY | $10,415,025 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $23,503,036 | BOYAmt |
| EOY | $22,658,090 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,005,448 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $544,786 | NetUnrlzdGainsLossesInvstAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | 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) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $7,372 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $7,372 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $309,117 | OtherCostOrOtherBasisAmt |
| Book Value | $309,117 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $5,569,332 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,530,921 | DepreciationAmt |
| Book Value | $4,038,411 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $13,470,890 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,705,089 | DepreciationAmt |
| Book Value | $7,765,801 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,114,299 | OtherCostOrOtherBasisAmt |
| Depreciation | $558,656 | DepreciationAmt |
| Book Value | $1,555,643 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $13,668,972 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $11,826,750 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $544,786 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $382,227 | OtherRevenueAmt |
| Revenue Not Reported | $927,013 | RevenueNotReportedAmt |
| Revenue Subtotal | $10,899,737 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $18,012 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $982,770 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,000,782 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $11,900,519 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $11,942,302 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $37,117 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $37,117 | ExpensesNotReportedAmt |
| Expenses Subtotal | $11,905,185 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $18,012 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $982,770 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,000,782 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,905,967 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 AND 4B | LINE 2D RELATED ORGANIZATION'S REVENUE $ 355,305 ELIMINATIONS < 3,500> SPECIAL EVENT EXPENSES 30,422 ------- TOTAL $ 382,227 LINE 4B BAD DEBT EXPENSE $ 982,770 |
| SCHEDULE D, PART XII, LINE 2D AND 4B | LINE 2D RELATED ORGANIZATION'S EXPENSES $ 10,195 ELIMINATIONS < 3,500> SPECIAL EVENT EXPENSES 30,422 ------- TOTAL $ 37,117 LINE 4B BAD DEBT EXPENSE $ 982,770 |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURN | NameOfEvent1Amt |
| Gross Receipts Event1 | $59,860 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $49,285 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $10,575 | GrossRevenueEvent1Amt |
| Cash Prizes Event1 | $1,440 | CashPrizesEvent1Amt |
| Non Cash Prizes Event1 | $4,399 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $4,972 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $8,346 | OtherDirectExpensesEvent1Amt |
| Name Of Event2 | CWD | NameOfEvent2Amt |
| Gross Receipts Event2 | $31,076 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $25,136 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $5,940 | GrossRevenueEvent2Amt |
| Rent Facility Costs Event2 | $150 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $4,445 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $6,670 | OtherDirectExpensesEvent2Amt |
| Other Events Total | 0 | OtherEventsTotalCnt |
| Gross Receipts Total | $90,936 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $74,421 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $16,515 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $1,440 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $4,399 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $150 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $9,417 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $15,016 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $30,422 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | -$13,907 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $253,307 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $253,307 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02130 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,566,472 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,026,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $539,737 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04530 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,819,779 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,026,735 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $793,044 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06660 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $26,438 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,530 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $23,908 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $19,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00160 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $388,335 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $337,150 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $51,185 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00430 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,220 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,220 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $434,993 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $339,680 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $95,313 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,254,772 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,366,415 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $888,357 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07460 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $923 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $923 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,746 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,746 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Workforce Development WorkforceDevelopmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $29,276 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $29,276 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00250 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $34,945 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $34,945 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00300 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $982,770 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $82,486 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $5,994,015 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,861,135 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $132,880 | 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 (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | 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 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.fairfaxmed.com/ | WebsiteAddressTxt |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| CHNA Conducted | Yes (true) | 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 | 12 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.fairfaxmed.com/news/chna/ | OwnWebsiteURLTxt |
| Rpt Available Upon Request | Yes (X) | RptAvailableUponRequestInd |
| Adopt Implementation Strategy | Yes (X) | AdoptImplementationStrategyInd |
| Exec Implementation Strategy | Yes (X) | ExecImplementationStrategyInd |
| Adopt Budget | Yes (X) | AdoptBudgetInd |
| Prioritize Health Needs | Yes (X) | PrioritizeHealthNeedsInd |
| Prioritize Services | Yes (X) | PrioritizeServicesInd |
| All Needs Addressed | Yes (true) | AllNeedsAddressedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Used Deter Elig Free Care | Yes (true) | FPGUsedDeterEligFreeCareInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Used Determ Elig Dscnt Care | Yes (true) | FPGUsedDetermEligDscntCareInd |
| FPG Family Incm Lmt Dscnt Care | 200. | FPGFamilyIncmLmtDscntCarePct |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| Income Level | Yes (X) | IncomeLevelInd |
| Asset Level | Yes (X) | AssetLevelInd |
| Medical Indigency | Yes (X) | MedicalIndigencyInd |
| Insurance Status | Yes (X) | InsuranceStatusInd |
| Uninsured Discount | Yes (X) | UninsuredDiscountInd |
| Medicaid Medicare | Yes (X) | MedicaidMedicareInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| Attached To Invoice | Yes (X) | AttachedToInvoiceInd |
| Posted In Emergency Room | Yes (X) | PostedInEmergencyRoomInd |
| Posted In Admission Office | Yes (X) | PostedInAdmissionOfficeInd |
| Provided On Admission | Yes (X) | ProvidedOnAdmissionInd |
| Available On Request | Yes (X) | AvailableOnRequestInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 3 | 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 ON 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 20D | THE HOSPITAL CHARGES ALL PATIENTS THE SAME RATE WHETHER THEY HAVE INSURANCE COVERAGE OR NOT. A 30% DISCOUNT OFF BILLED CHARGES IS OFFERED TO UNINSURED PATIENTS, AND THE BALANCE OF A 30% DISCOUNT (AFTER INSURANCE PAYS) TO APPLY TO DEDUCTIBLES AND CO-INSURANCE OWED TO THOSE THAT HAVE INSURANCE COVERAGE. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRIMARY CARE CLINIC | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | PRIMARY CARE PHYSICIAN CLINIC | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 6A | THE COMMUNITY BENEFIT REPORT IS COMPILED IN JANUARY OF EACH YEAR. |
| 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 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $982,770. |
| SCHEDULE H, PART I, LINE 7G | THE HOSPITAL INCLUDED $148,217 FROM A PHYSICIAN CLINIC. |
| SCHEDULE H, PART II | 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. A MAJOR FOCUS OF CH-F COMMUNITY ACTIVITIES WAS THE IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) IN FY13. SURVEYS, FOCUS GROUPS AND A GREAT DEAL OF BRAINSTORMING LEAD TO A FINISHED PRODUCT IN MAY OF 2013. AN IMPLEMENTATION PLAN IS IN PLACE TO ADDRESS THE MAJOR CONCERNS OF ACCESS TO HEALTHCARE AMONG THE LOW INCOME, CHRONIC DISEASE AND HEALTHY LIFESTYLES AND THE SHORTAGE OF MENTAL HEALTH PROFESSIONALS. IN ADDITION TO THE WORK ON THE CHNA, COMMUNITY HOSPITAL-FAIRFAX PARTICIPATES IN YEAR ROUND COMMUNITY BUILDING ACTIVITIES. IN FEBRUARY, COMMUNITY HOSPITAL-FAIRFAX SPONSORED OUR FIRST HEART HEALTH SCREENING FOR 80 PARTICIPANTS. THE GOAL IS TO CONTINUE TO GROW THIS IMPORTANT OPPORTUNITY TO EDUCATE OUR COMMUNITY. 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. ALSO, HELD EACH SPRING IS THE KID'S CAF. THIS IS AN EVENT WHERE CHILDREN GET TO "PLAY WITH THEIR FOOD" AND LEARN ABOUT HEALTHY EATING CHOICES. SEED SPITTING, CRACKER CRITTERS AND MAKING THEIR OWN SANDWICHES ARE JUST A FEW FUN ACTIVITIES. HOSPITAL EMPLOYEES ALSO SET UP A MOCK GROCERY STORY AND KIDS DO THEIR OWN SHOPPING. AFTER THEIR CARTS ARE FULL, VOLUNTEERS SHOW THEM WHAT ARE HEALTHY CHOICES AND WHERE THEY MIGHT MAKE OTHER CHOICES. AFTER THE KIDS CAF, THE HOSPITAL RENTS THE LOCAL SWIMMING POOL FOR KIDS TO ENJOY! 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. 110 CHILDREN WERE ABLE TO FILL BACKPACKS WITH NEEDED SUPPLIES LAST YEAR! IN AN EFFORT TO ADDRESS ONGOING HEART HEALTH ISSUES IN THE ADULT POPULATION, CH-F INITIATED A PROGRAM CALLED CHECK IT AT THE DOOR IN LOCAL HIGH SCHOOLS. ARMED WITH BLOOD PRESSURE CUFFS, A BODY COMPOSITION MACHINE, BLOOD SUGAR AND CHOLESTEROL CHECKS AND A LOT OF GREAT INFORMATION FOR YOUNG PEOPLE, THE TEAM OF A CH-F CARDIAC REHAB RN, DIETICIAN AND DEVELOPMENT STAFF OFFERED EDUCATION AND SCREENINGS TO 88 TEENS. 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 COMMUNITY'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. IN DECEMBER, 8TH GRADERS FROM AREA SCHOOLS STREAM INTO THE HOSPITAL FOR CAREER DAY. A MOCK CODE IS THEIR FAVORITE PART OF THE MORNING ALONG WITH FIRST HAND INTERACTION WITH NURSES AND PHYSICIANS ON STAFF. |
| SCHEDULE H, PART III, LINES 2, 3 and 4 | 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. 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. LINE 4 - PLEASE SEE THE SECTION ON PATIENT ACCOUNTS RECEIVABLE ON THE NOTE 1 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, LINE 8 | THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 23% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. 56% OF THE HOSPITAL'S REVENUE IS GENERATED BY THESE MEDICARE BENEFICIARIES. 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 FY12 MEDICARE COST REPORT. |
| SCHEDULE H, PART III, 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. IN ADDITION, CH-F STAFF INITIATED AN EDUCATION PROGRAM FOR FRESHMAN STUDENTS IN AREA HIGH SCHOOLS TEACHING HEART HEALTH. 5 HIGH SCHOOLS WERE VISITED WITH APPROXIMATELY 60 STUDENTS IN ATTENDANCE. MENTAL HEALTH: CH-F INITIATED A PSYCHIATRY TELEHEALTH CLINIC IN JANUARY OF 2014 BRINGING MENTAL HEALTH EXPERTISE TO THE REGION FOR THE FIRST TIME. 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 ASSISTANCE 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 AVAILABLE 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 THE SAME INFORMATION AS IS 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 $40,261. |
| SCHEDULE H, PART VI, LINE 5 | TO EDUCATE AND PROVIDE SERVICES TO ITS COMMUNITY, COMMUNITY HOSPITAL RESPONDS BY PROVIDING THE FOLLOWING ACTIVITIES: MONTHLY FREE BLOOD PRESSURE SCREENING AT AREA NUTRITION CENTERS; 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 KID'S CAFE WHICH INVOLVES CHILDREN LEARNING HEALTHY EATING CHOICES, AND A POOL PARTY FOR THE PARTICIPANTS WHICH PROMOTES PHYSICAL ACTIVITY; 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. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (4 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MYRA EVANS | ||||||||||||
| CEO | $178,644 | $0 | $0 | $0 | $0 | $0 | $5,849 | $0 | $13,635 | $0 | $198,128 | $0 |
| ERICA GILLETTE | ||||||||||||
| DOCTOR | $220,782 | $0 | $0 | $0 | $0 | $0 | $3,409 | $0 | $5,656 | $0 | $229,847 | $0 |
| GARY MCINTYRE | ||||||||||||
| CRNA | $146,988 | $0 | $0 | $0 | $0 | $0 | $2,205 | $0 | $2,961 | $0 | $152,154 | $0 |
| HAROLD LAWRENCE | ||||||||||||
| PHARMACIST | $124,389 | $0 | $0 | $0 | $0 | $0 | $6,556 | $0 | $22,902 | $0 | $153,847 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J, PART II | FormAndLineReferenceDesc |
| Explanation | THE CEO COMPENSATION FOR MYRA EVANS, AND THE COMPENSATION FOR HAROLD LAWRENCE, ARE PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), AN UNRELATED 501(C)(3) HOSPITAL. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE SUPPLEMENTAL INFORMATION | PersonNm |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | BUSINESS TRANSACTIONS | FormAndLineReferenceDesc |
| Explanation | a) JAMIE BURKE b) JAMIE BURKE IS AN EMPLOYEE CHA AND THE SISTER OF DR. RICHARD ARON BURKE, WHO IS A DIRECTOR OF CHA c) $43,458 d) COMPENSATION e) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | PROGRAM SERVICE ACCOMPLISHMENTS 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. MONTHLY FREE BLOOD PRESSURE CHECKS AT AREA NUTRITION CENTERS. 2. FEBRUARY HEART HEALTHY SCREENING EVENT WITH 80 PARTICIPANTS. PARTICIPANTS RECEIVED FREE BLOOD PRESSURE, CHOLESTEROL, GLUCOSE AND BODY COMPOSITION ALONG WITH CARDIAC COUNSELING. 3. DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR. 4. FREE GLUCOSE SCREENINGS, BMI CHECKS AND BLOOD PRESSURE CHECKS BIANNUALLY AT A WOMEN'S EVENT (ATTENDED BY 275 WOMEN). 5. ATTENDANCE AT AREA HEALTH FAIRS OFFERING FREE SCREENINGS. 6. CH-F IS STROKE READY AND HAS PROTOCOL IN PLACE TO RESPOND TO A STROKE WITHIN 60 MINUTES. 7. CH-F SPONSORS HEALTHY EATING ACTIVITIES FOR KIDS. THE KID'S CAF TEACHES KIDS ABOUT THE FOOD PLATE AND ENCOURAGES CHILDREN TO TRY NEW HEALTHY FOODS. OVER 100 CHILDREN WERE REACHED THROUGH THIS ACTIVITY IN FY2012 WITH 150 CHILDREN AND FAMILIES ATTENDING A POOL PARTY AFTER THE EVENT SPONSORED BY THE HOSPITAL. 8. 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. 10. 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 GENERATIONS IN NORTHWEST MISSOURI. $1,000 IN SCHOLARSHIPS IS 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 THERAPHY 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 4 | COMMUNITY HOSPITAL ASSOCIATION, INC., AMENDED THEIR BY-LAWS FROM FIFTEEN MEMBERS TO STATE, "THE BOARD SHALL CONSIST OF AT LEAST ELEVEN MEMBERS AND NO MORE THAN FIFTEEN." |
| 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 (NEMC), SUBJECT TO A MAJORITY VOTE OF THE BOARD. IF AN NEMC DIRECTOR IS NOT ELECTED BY THE BOARD, NEMC 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, LINES 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. |
| 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 XI, LINE 9 | Asset Transfer from Community Healthcare Foundation $ 4,908 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EMERGENCY ROOM PHYSICIAN FEES TOTAL FEES:479939 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PHYSICIAN FEES TOTAL FEES:221324 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:180000 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:HOUSEKEEPING TOTAL FEES:134821 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PROFESSIONAL FEES TOTAL FEES:572805 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION | BusinessNameLine1 |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431757553 | EIN |
| Primary Activities | SUPPORT ORG | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 11A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |