2015-05-11T09:31:47-05:00 2014-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2013-07-01 440537826 Community Hospital Association Inc % TABITHA WINTZ COMM 6606862211 PO Box 107 Suite Fairfax MO 644460107 ROGER STEINKRUGER CEO 6606862211 2015-05-15 true Kevin Ensminger CPA P01310558 6606862211 2013 2016-02-25 16:41:14Z ROGER STEINKRUGER 26136 US HWY 59 FAIRFAX MO 644460107 15468888 false X WWW.FAIRFAXMED.COM X 1976 MO TO PROVIDE QUALITY ACUTE CARE, EMERGENCY, AND OUTPATIENT HOSPITAL SERVICES. 14 13 131 80 0 0 139766 217942 11151530 11075612 182845 218331 326575 388634 11800716 11900519 43860 1000 0 0 5219557 4798279 0 0 106067 7322824 8106688 12586241 12905967 -785525 -1005448 23503036 22658090 12627349 12243065 10875687 10415025 X TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. false false 10467514 1000 11407151 SEE SCHEDULE O 10467514 true true false true false false false false false false true false false false false 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 7 0 true 131 true false false false false false true true false false false false X 14 13 false true true false false true false true true false false true true true true true true true true false MO X TABITHA WINTZ 6606862211 26136 US HWY 59 FAIRFAX MO 64446 X ROBERT JACKSON DIRECTOR/PRESIDENT 1.0 1.0 X X 0 0 0 RICHARD OSWALD DIRECTOR 1.0 1.0 X 0 0 0 SANDRA FUHRMAN DIRECTOR/SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 CHAD DERR DIRECTOR 1.0 X 0 0 0 SARAH WATKINS DIRECTOR 1.0 X 0 0 0 AMY L RYAN DIRECTOR 1.0 X 0 0 0 STEVE CUNNINGHAM DIRECTOR 1.0 1.0 X 0 0 0 JASON GARST DIRECTOR 1.0 X 0 0 0 KRISTI ATKINSON DIRECTOR 1.0 X 0 0 0 BEVERLY JONES DIRECTOR 1.0 1.0 X 0 0 0 COREY HERRON DIRECTOR 1.0 X 0 0 0 RICHARD ARON BURKE MD DIRECTOR/CHIEF OF MED STAFF 11.0 1.0 X 58762 0 0 DEBORAH GLEASON DIRECTOR 1.0 X 0 0 0 VIRGINIA LOW DIRECTOR 1.0 X 0 0 0 PAULA MILLER DIRECTOR/VICE PRESIDENT 1.0 X X JACQUE GEBHARDS DIRECTOR 1.0 X MIKE FISHER DIRECTOR 1.0 X EDUARDO FERNANDEZ MD DIRECTOR 1.0 X MYRA EVANS CEO 40.0 1.0 X 178644 0 19484 SUZANNE SOUTHARD CFO 40.0 1.0 X 62010 0 6057 ERICA GILLETTE DOCTOR 40.0 X 220782 0 9065 GARY MCINTYRE CRNA 40.0 X 146988 0 5166 CONNIE ANDERSON FNP 40.0 X 118489 0 4532 HAROLD LAWRENCE PHARMACIST 40.0 X 124389 0 29458 910064 0 73762 5 false true false DOCS WHO CARE PHYSICIAN SERVICES 371952 CPSI COMPTR SUPPORT SVCS 161880 DR CARL LUEM PHYSICIAN SERVICES 142920 3 74421 14108 129413 217942 NET PATIENT SERVICE REVENUE 621990 11075612 11075612 11075612 157277 157277 0 0 0 0 0 3597903 1098 3537947 59956 1098 61054 61054 16515 74421 30422 -13907 -13907 0 0 INCENTIVE REVENUE 900099 142902 142902 CAFETERIA 621990 47062 47062 340B DRUG REVENUE 900099 188637 188637 23940 23940 402541 11900519 11407151 275426 0 1000 1000 0 0 174250 158561 14976 713 43458 43458 3938061 3039480 857736 40845 100278 78217 21058 1003 223707 176898 44681 2128 318525 248450 66890 3185 244000 190320 51240 2440 21198 16534 4452 212 108415 84564 22767 1084 0 0 18012 18012 1588889 1239333 333667 15889 49643 38722 10425 496 336495 262466 70664 3365 0 0 236605 184552 49687 2366 35328 27556 7419 353 0 0 576177 449418 120997 5762 0 1674571 1306165 351660 16746 119929 93545 25185 1199 REPAIRS & MAINT. 689229 469739 213468 6022 Medical Supplies 573124 573124 BAD DEBT 982770 982770 MEDICAID 624142 624142 228161 178500 47402 2259 12905967 10467514 2332386 106067 116181 1778 633396 487564 31221 19044 1321908 1282017 0 0 0 0 0 0 308528 284969 82529 86451 21463638 7794666 15270776 13668972 5647869 6805295 0 0 0 0 0 0 90628 22000 23503036 22658090 717605 702804 0 0 0 0 0 0 0 0 0 0 11909744 11540261 0 0 0 0 12627349 12243065 X 10875687 10415025 0 0 0 0 10875687 10415025 23503036 22658090 -1005448 544786 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 7372 false false false 7372 false 309117 309117 5569332 1530921 4038411 13470890 5705089 7765801 2114299 558656 1555643 13668972 11826750 544786 382227 927013 10899737 18012 982770 1000782 11900519 11942302 37117 37117 11905185 18012 982770 1000782 12905967 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 GOLF TOURN 59860 49285 10575 1440 4399 4972 8346 CWD 31076 25136 5940 150 4445 6670 0 90936 74421 16515 1440 4399 150 9417 15016 30422 -13907 true true true X true X true true false true true 253307 253307 0.02130 1566472 1026735 539737 0.04530 1819779 1026735 793044 0.06660 26438 2530 23908 0.00200 19000 19000 0.00160 388335 337150 51185 0.00430 1220 1220 0.00010 434993 339680 95313 0.00800 2254772 1366415 888357 0.07460 923 923 0.00010 4746 4746 0.00040 29276 29276 0.00250 34945 34945 0.00300 false 982770 82486 5994015 5861135 132880 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 true X X X X X X X X X 12 true false true X http://www.fairfaxmed.com/news/chna/ X X X X X X true false true true 200. true 200. true X X X X X X true true X X X X X true false X X X X true X false false 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. 1 PRIMARY CARE CLINIC 26136 US HWY 59 FAIRFAX MO 64446 PRIMARY CARE PHYSICIAN CLINIC 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. X X false false false false false false false false false MYRA EVANS CEO 178644 0 0 0 0 0 5849 0 13635 0 198128 0 ERICA GILLETTE DOCTOR 220782 0 0 0 0 0 3409 0 5656 0 229847 0 GARY MCINTYRE CRNA 146988 0 0 0 0 0 2205 0 2961 0 152154 0 HAROLD LAWRENCE PHARMACIST 124389 0 0 0 0 0 6556 0 22902 0 153847 0 FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J, PART II 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. SEE SUPPLEMENTAL INFORMATION BUSINESS TRANSACTIONS 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 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 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