COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 44-0537826)
- Tax period
- 2010-07-01 to 2011-06-30
- Filed
- 2012-03-19
- IRS object ID
- 201210799349300641
- Schema version
- 2010v3.7
- 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 I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-19T16:08:27-04:00 | Timestamp |
| Tax Period End Date | 2011-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2010-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440537826 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 6606862211 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 107 | AddressLine1 |
| City | Fairfax | City |
| State | MO | State |
| ZIP Code | 644460107 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MYRA EVANS | Name |
| Title | CEO | Title |
| Date Signed | 2012-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MYRA EVANS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 66446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11626763 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FAIRFAXMED.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1976 | YearFormation |
| State Legal Domicile | MO | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE QUALITY ACUTE CARE, EMERGENCY, AND OUTPATIENT HOSPITAL SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 127 | TotalNbrEmployees |
| Total Nbr Volunteers | 100 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 2038618 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 1081477 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9691201 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 10395665 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 6014 | InvestmentIncomePriorYear |
| Investment Income Current Year | 23547 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 100866 | OtherRevenuePriorYear |
| Other Revenue Current Year | 96916 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11836699 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11597605 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 5475 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 819009 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4683566 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4615909 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 101606 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4613855 | OtherExpensePriorYear |
| Other Expenses Current Year | 6645621 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9302896 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12080539 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 2533803 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -482934 | RevenuesLessExpensesCY |
| Total Assets BOY | 17641477 | TotalAssetsBOY |
| Total Assets EOY | 20517337 | TotalAssetsEOY |
| Total Liabilities BOY | 10080447 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13439241 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7561030 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7078096 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 9079275 | Expense |
| Grants | 819009 | Grants |
| Revenue | 10395665 | Revenue |
| Description | SEE SCHEDULE O | Description |
| Total Program Service Expense | 9079275 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | true | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | true | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 8 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 127 | NumberOfEmployees |
| Employment Tax Returns Filed | true | EmploymentTaxReturnsFiled |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 12 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | MO | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SUZANNE SOUTHARD | NamePerson |
| Telephone Number | 6606862211 | TelephoneNumber |
Address US AddressUS
| 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 | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (18 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ROBERT JACKSON | |||||||
| DIRECTOR/VICE PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | |
| NANCY HURST | |||||||
| DIRECTOR/PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | |
| SANDRA FUHRMAN | |||||||
| DIRECTOR/SECRETARY/TREASURER | 1.0 | X | X | 0 | 0 | 0 | |
| RICHARD OSWALD | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BILL SMITH | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| JACQUE GEBHARDS | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| STEVE CUNNINGHAM | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| NANCY PETERS | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| DOUGLAS KLINE | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BEVERLY WHITE | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| PATRICIA FISHER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| R ARON BURKE MD | |||||||
| DIRECTOR | 1.0 | X | 45719 | 0 | 0 | ||
| WC BUD TICE | |||||||
| DIRECTOR | 1.0 | X | 0 | 160400 | 10570 | ||
| STEPHANIE DAUBERT | |||||||
| DIRECTOR | 1.0 | X | 0 | 171134 | 16800 | ||
| BILL SLAUGHTER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| MYRA EVANS | |||||||
| CEO | 40.0 | X | 168105 | 0 | 14124 | ||
| SUZANNE SOUTHARD | |||||||
| CFO | 40.0 | X | 57675 | 0 | 9160 | ||
| GARY MCINTYRE | |||||||
| CRNA | 40.0 | 141319 | 0 | 2120 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 412818 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 331534 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 52774 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| KIEWIT BUILDING GROUP | |
| GENERAL CONTRACTOR | 3388527 |
| DOCS WHO CARE | |
| PHYSICIAN SERVICES | 219606 |
| IRELAND CLINIC | |
| PHYSICIAN SERVICES | 162814 |
| CPSI | |
| COMPUTER SERVICES | 190663 |
| MORGAN ANESTHESIA SERVICES | |
| CRNA SERVICES | 149989 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 9 | NumberOfContractorsGT100K |
| Fundraising Events | 133970 | FundraisingEvents |
| Related Organizations | 47679 | RelatedOrganizations |
| All Other Contributions | 899828 | AllOtherContributions |
| Total Contributions | 1081477 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 10395665 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10395665 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 10395665 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 5074 | TotalRevenueColumn |
| Exclusion | $5,074 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 18473 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 0 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 18473 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18473 | TotalRevenueColumn |
| Exclusion | $18,473 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 57847 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 133970 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 29158 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 28689 | TotalRevenueColumn |
| Exclusion | $28,689 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (2 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| CAFETERIA | 722210 | 48666 | $48,666 |
| MISCELLANEOUS | 900099 | 19561 | $19,561 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 68227 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11597605 | TotalRevenueColumn |
| Related Or Exempt Function Income | 10395665 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $120,463 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 813999 | Total |
| Program Services | 813999 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5010 | Total |
| Program Services | 5010 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 312181 | Total |
| Management And General | 312181 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3604464 | Total |
| Program Services | 2621887 | ProgramServices |
| Management And General | 945451 | ManagementAndGeneral |
| Fundraising | 37126 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 111205 | Total |
| Program Services | 80891 | ProgramServices |
| Management And General | 29169 | ManagementAndGeneral |
| Fundraising | 1145 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 275597 | Total |
| Program Services | 202562 | ProgramServices |
| Management And General | 70275 | ManagementAndGeneral |
| Fundraising | 2760 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 312462 | Total |
| Program Services | 227285 | ProgramServices |
| Management And General | 81959 | ManagementAndGeneral |
| Fundraising | 3218 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 219181 | Total |
| Program Services | 159432 | ProgramServices |
| Management And General | 57491 | ManagementAndGeneral |
| Fundraising | 2258 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15301 | Total |
| Program Services | 11130 | ProgramServices |
| Management And General | 4013 | ManagementAndGeneral |
| Fundraising | 158 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 62678 | Total |
| Program Services | 45592 | ProgramServices |
| Management And General | 16440 | ManagementAndGeneral |
| Fundraising | 646 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1536858 | Total |
| Program Services | 1117910 | ProgramServices |
| Management And General | 403118 | ManagementAndGeneral |
| Fundraising | 15830 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 36396 | Total |
| Program Services | 26474 | ProgramServices |
| Management And General | 9547 | ManagementAndGeneral |
| Fundraising | 375 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1067471 | Total |
| Program Services | 776478 | ProgramServices |
| Management And General | 279998 | ManagementAndGeneral |
| Fundraising | 10995 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 212635 | Total |
| Program Services | 154671 | ProgramServices |
| Management And General | 55774 | ManagementAndGeneral |
| Fundraising | 2190 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 40958 | Total |
| Program Services | 29793 | ProgramServices |
| Management And General | 10743 | ManagementAndGeneral |
| Fundraising | 422 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 543699 | Total |
| Program Services | 395487 | ProgramServices |
| Management And General | 142612 | ManagementAndGeneral |
| Fundraising | 5600 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1250253 | Total |
| Program Services | 909434 | ProgramServices |
| Management And General | 327941 | ManagementAndGeneral |
| Fundraising | 12878 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 76630 | Total |
| Program Services | 55741 | ProgramServices |
| Management And General | 20100 | ManagementAndGeneral |
| Fundraising | 789 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| REPAIRS & MAINT. | 280828 | 204274 | 73661 | 2893 |
| DUES & SUBSCRIPTIONS | 44621 | 32457 | 11704 | 460 |
| BAD DEBT | 673427 | 673427 | ||
| MEDICAID | 403670 | 403670 | ||
| EMPLOYEE RECRUITMENT | 64396 | 46842 | 16891 | 663 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 116619 | Total |
| Program Services | 84829 | ProgramServices |
| Management And General | 30590 | ManagementAndGeneral |
| Fundraising | 1200 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12080539 | Total |
| Program Services | 9079275 | ProgramServices |
| Management And General | 2899658 | ManagementAndGeneral |
| Fundraising | 101606 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 15369 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 798218 | BOY |
| EOY | 333260 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 243307 | BOY |
| EOY | 168070 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1316635 | BOY |
| EOY | 1412026 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 226232 | BOY |
| EOY | 276067 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 97042 | BOY |
| EOY | 92834 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 20948790 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 3132706 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14944674 | BOY |
| EOY | 17816084 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 418996 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17641477 | BOY |
| EOY | 20517337 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1743088 | BOY |
| EOY | 575912 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 8337359 | BOY |
| EOY | 12863329 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10080447 | BOY |
| EOY | 13439241 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7561030 | BOY |
| EOY | 7078096 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7561030 | BOY |
| EOY | 7078096 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17641477 | BOY |
| EOY | 20517337 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -482934 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | true | FederalGrantAuditRequired |
| Federal Grant Audit Performed | true | FederalGrantAuditPerformed |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| Volunteers | false | Volunteers |
| Paid Staff Or Management | false | PaidStaffOrManagement |
| Media Advertisements | false | MediaAdvertisements |
| Mailings Members | false | MailingsMembers |
| Publications Or Broadcast | false | PublicationsOrBroadcast |
| Grants Other Organizations | true | GrantsOtherOrganizations |
| Grants Other Organizations | $3,330 | GrantsOtherOrganizationsAmount |
| Direct Contact Legislators | false | DirectContactLegislators |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 3330 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 309117 | OtherCostOrOtherBasis |
| Book Value | 309117 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5547392 | OtherCostOrOtherBasis |
| Depreciation | 335318 | Depreciation |
| Book Value | 5212074 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13006776 | OtherCostOrOtherBasis |
| Depreciation | 2685180 | Depreciation |
| Book Value | 10321596 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2085505 | OtherCostOrOtherBasis |
| Depreciation | 112208 | Depreciation |
| Book Value | 1973297 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 17816084 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Total Revenue | 11597605 | TotalRevenue |
| Total Expenses | 12080539 | TotalExpenses |
| Excess Or Deficit For Year | -482934 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -482934 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 12679644 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 1082039 | OtherRevenues |
| Revenue Not Rptd F990 | 1082039 | RevenueNotRptdF990 |
| Revenue Subtotal | 11597605 | RevenueSubtotal |
| Total Revenue Per Form990 | 11597605 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 11340892 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 74352 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 74352 | ExpensesNotRptdF990 |
| Expenses Subtotal | 11266540 | ExpensesSubtotal |
| Other Expenses Not Included | 813999 | OtherExpensesNotIncluded |
| Expenses Not Rptd On Fin Stmt | 813999 | ExpensesNotRptdOnFinStmt |
| Total Expenses Per Form990 | 12080539 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS DISCLOSURE | 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. |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XII, LINE 2D | RELATED ORGANIZATION'S REVENUE 1,052,881 SPECIAL EVENT EXPENSES 29,158 ----------- TOTAL $1,082,039 |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XIII, LINE 2D | RELATED ORGANIZATION EXPENSES 49,194 SPECIAL EVENT EXPENSES 29,158 ---------- TOTAL $74,352 |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XIII, LINE 4B | GRANT PAID TO RELATED ORGANIZATION $813,999 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 65700 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 41065 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 24635 | GrossRevenueEvent1 |
| Non Cash Prizes Event1 | 5763 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 500 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 3524 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 8092 | OtherDirectExpensesEvent1 |
| Name Of Event2 | ANNUAL APPEAL | NameOfEvent2 |
| Gross Receipts Event2 | 97814 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 75000 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 22814 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 312 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 28303 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 17905 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 10398 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 255 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 3412 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 957 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 6343 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 191817 | GrossReceiptsTotal |
| Charitable Contributions Total | 133970 | CharitableContributionsTotal |
| Gross Revenue Total Events | 57847 | GrossRevenueTotalEvents |
| Non Cash Prizes Total Events | 5763 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 755 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 6936 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 957 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 14747 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 29158 | DirectExpenseSummaryEvents |
| Net Income Summary | 28689 | NetIncomeSummary |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent200 D | X | Pcent200D |
| Free Disc Care Medically Indigent | true | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | true | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | false | ExpensesExceededBudget |
| Annual Community Benefit Report | false | AnnualCommunityBenefitReport |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 662893 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 662893 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05490 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1384300 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 759261 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 625039 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05170 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2047193 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 759261 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1287932 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.10660 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 9266 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1475 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 7791 | NetCommunityBenefitExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 47742 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5500 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 42242 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00350 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 306076 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 290199 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 15877 | NetCommunityBenefitExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1112 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1112 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 364196 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 297174 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 67022 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00360 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2411389 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1056435 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1354954 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.11020 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 3443 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 3443 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14013 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14013 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00120 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 9140 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 9140 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00080 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 26596 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 26596 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $673,427 | BadDebtExpenseAmount |
| Amount Attributable To | 36038 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 5408830 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 5376936 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 31894 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | X | CostToChargeRatio |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | true | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 107 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRIMARY CARE CLINIC | BusinessNameLine1 |
Address Address
| 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 Type | PRIMARY CARE PHYSICIAN CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (11 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| SCHEDULE H, PART I, LINE 7G | THE HOSPITAL INCLUDED $138,094 FROM A PHYSICIAN CLINIC. | |
| 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 $673,427. | |
| 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. | |
| COMMUNITY BUILDING ACTIVITIES | COMMUNITY HOSPITAL REACHES OUT TO OVER 200 WOMEN ON AN ANNUAL BASIS THROUGH A WOMEN'S HEALTH EVENT CALLED ME MARKET. HELD IN NOVEMBER EACH YEAR, THE ME MARKET FEATURES SHOPPING OPPORTUNITIES FOR WOMEN AS WELL AS HEALTH RELATED SPEAKERS AND FREE SCREENINGS. IN 2010, SPEAKERS ON TOPICS LIKE CARING FOR THE ELDERLY WERE OFFERED TO THE PUBLIC. FLU SHOTS, BLOOD PRESSURE CHECKS AND OTHER FREE SCREENINGS WERE ALSO OFFERED. IN FEBRUARY, COMMUNITY HOSPITAL OFFERS A FREE LUNCH TO THE COMMUNITY AND AN OPPORTUNITY FOR THEM TO ASK HEART HEALTH RELATED QUESTIONS TO ONE OF OUR CARDIOLOGISTS. FREE SCREENINGS AND DRAWINGS FOR MEMBERSHIPS TO GYMS ARE ALSO OFFERED TO THE PUBLIC. IN THE SPRING, COMMUNITY HOSPITAL FOCUSES ON CHILDREN'S HEALTH. OUR FIELD DAY OFFERS RACES AND ACTIVITIES FOR CHILDREN. HOSPITAL STAFF IS ON HAND TO TEACH CHILDREN ABOUT HEALTHY EATING HABITS, EXERCISE, AND THE DANGERS OF SMOKING. OVER SIXTY CHILDREN PARTICIPATED IN THIS 2010 EVENT. COMMUNITY HOSPITAL ALSO HOSTS PEDIATRIC ORIENTATION FOR AREA FIRST GRADERS. 90+ FIRST GRADERS JOIN HOSPITAL STAFF IN "ROLE PLAYING" A PATIENT AT THE HOSPITAL. STUDENTS LEARN WHAT GOES ON AT THEIR LOCAL HOSPITAL IN HOPES OF REDUCING THEIR FEAR UPON A VISIT LATER IN LIFE. IN SEPTEMBER OF EACH YEAR, COMMUNITY HOSPITAL HOSTS A FREE PROSTATE SCREENING (DIGITAL EXAM) AND A REDUCED PRICE PSA TEST TO MEN IN THE COMMUNITY. NEARLY 70 MEN PARTICIPATE IN THIS ANNUAL SCREENING. IN ADDITION TO THESE EVENTS, COMMUNITY HOSPITAL PUBLISHES A QUARTERLY NEWSLETTER WITH HEALTH RELATED INFORMATION THAT IS DISTRIBUTED TO AREA RESIDENTS. THE NEWSLETTER IS ACCOMPANIED BY REGULAR NEWSPAPER ARTICLES AND RADIO ADS. | SCHEDULE H, PART II |
| BAD DEBT EXPENSE | THE HOSPITAL USED THE ACTUAL ACCOUNT BALANCE AMOUNTS WRITTEN OFF AND SENT TO COLLECTION AGENCIES (NO HOME HEALTH OR FFPC) OR WRITTEN OFF DUE TO BANKRUPTCIES FOR THE TOTAL ON LINE 2. LINE 3 IS THE AMOUNT OF ACCOUNT BALANCES WRITTEN OFF DUE TO BANKRUPTCIES. THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. | SCHEDULE H, PART III, LINE 4 |
| MEDICARE SHORTFALL | 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 FY11 MEDICARE COST REPORT. | SCHEDULE H, PART III, LINE 8 |
| COLLECTION PRACTICES | 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 III, LINE 9B |
| NEEDS ASSESSMENT | No community needs assessment has been done to date. Community Hospital staff are scheduled for training in early 2012, which will help guide staff in the process and knowledge of who to involve in the gathering of the information. The plan is to have an assessment survey in the hands of local residents by November 2012. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | 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 3 |
| COMMUNITY INFORMATION | Community Hospital provides access to healthcare to a region where health services are sparse, the physician ratio is 3008:1, and emergency services would otherwise be 30 miles or more from the population centers. The greatest health needs in the community tend to be chronic diseases such as heart disease, COPD and Asthma, stroke and diabetes. Nearly 30% of the service population is obese, 69% report physical inactivity, and 26% smoke. | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | 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 healthy' event with a Q&A session with an onsite cardiologist, 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; Stroke Awareness event explaining the hospital's "stroke ready" response; 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 H, PART VI, LINE 5 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable
Recipient Name Business RecipientNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 107 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN Of Recipient | 431757553 | EINOfRecipient |
| IRC Section | 501(C)(3) | IRCSection |
| Amount Of Cash Grant | 813999 | AmountOfCashGrant |
| Purpose Of Grant | GENERAL SUPPORT | PurposeOfGrant |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 1 | TotalNbrOf501C3AndGovtGrants |
| Total Nbr Of Other Organizations | 0 | TotalNbrOfOtherOrganizations |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION AND BOOKS ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 15 | NumberOfRecipients |
| Amount Of Cash Grant | 5010 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MONITORING THE USE OF GRANT FUNDS IN THE U.S. | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | STUDENTS COMPLETE AND SUBMIT APPLICATIONS FOR SCHOLARSHIPS TWICE A YEAR. A COMMITTEE MEETS AND DETERMINES WHO IS AWARDED A SCHOLARSHIP. THE AMOUNT OF THE SCHOLARSHIPS AWARDED IS DEPENDENT ON THE ANNUAL BUDGET. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| WC BUD TICE | |||||||||||||
| 0 | 160400 | 0 | 0 | 0 | 0 | 0 | 7052 | 0 | 3518 | 0 | 170970 | 0 | 0 |
| STEPHANIE DAUBERT | |||||||||||||
| 0 | 171134 | 0 | 0 | 0 | 0 | 0 | 13123 | 0 | 3677 | 0 | 187934 | 0 | 0 |
| MYRA EVANS | |||||||||||||
| 168105 | 0 | 0 | 0 | 0 | 0 | 10515 | 0 | 3609 | 0 | 182229 | 0 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | COMPENSATION FROM RELATED ORGANIZATION | Identifier |
| Return Reference | FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J, PART II | ReturnReference |
| Explanation | THE CEO COMPENSATION IS PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), A RELATED ORGANIZATION. THE RELATED COMPENSATION PAID TO DIRECTORS IS FOR THEIR EMPLOYMENT WITH NMC, NOT FOR THEIR ROLE AS A DIRECTOR WITH THE HOSPITAL. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (17 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICE ACCOMPLISHMENTS | FORM 990, PART III, LINE 4A | Community Hospital-Fairfax (CH-F) prides itself in providing access to healthcare to a region where health services are sparse, the physician ratio is 3008:1 (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 event with an onsite cardiologist. Participants can attend and ask the cardiologist any question they desire about heart health. Fifty adults participated in this event in FY2011. 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 200 women) and the heart event. 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. Continuing education, including a stroke awareness event where 50 attended, contributes to public awareness about stroke response. 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 80 children were reached through this activity in FY2011. 8. CH-F staff teaches healthy eating choices at the area Back to School Fair where school supplies are distributed to needy children. Over 100 children were reached through this activity. 9. CH-F also sponsors an annual pool party to celebrate kids attendance at the Kid's Caf and promote physical 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 | Northwest Missouri. $6000 in scholarships is awarded each year to students enrolled in a healthcare program. Additionally, CH-F staff logged over 375 hours in FY11 with area high school students as they job shadowed. 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. |
| DELEGATION OF CONTROL OVER MANAGEMENT DUTIES | 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 REVIEW PROCESS | 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 AND CONCERNS THE ORGANIZATION'S ADMINISTRATION HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE 990 WITH ALL COMPLETED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| CONFLICT OF INTEREST POLICY | 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. |
| COMPENSATION REVIEW | 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. |
| AVAILABILITY OF DOCUMENTS | 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. |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ROBERT JACKSON TITLE:DIRECTOR/VICE PRESIDENT HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SANDRA FUHRMAN TITLE:DIRECTOR/SECRETARY/TREASURER HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BILL SMITH TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:NANCY PETERS TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:DOUGLAS KLINE TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BEVERLY WHITE TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:R. ARON BURKE, M.D. TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MYRA EVANS TITLE:CEO HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SUZANNE SOUTHARD TITLE:CFO HOURS:1 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 |
|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTCARE FOUNDATION | |||||||||
| PO BOX 107 | FAIRFAX | MO | 64446 | 431757553 | SUPPORT ORG | MO | 501(C)(3) | 11A | CHA |
| THE NEBRASKA MEDICAL CENTER | |||||||||
| 4350 DEWEY AVENUE | OMAHA | NE | 68198 | 911858433 | HOSPITAL | NE | 501(C)(3) | 3 | NA |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | true | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved |
|---|---|
| COMMUNITY HEALTHCARE FOUNDATION | |
| B | 813999 |
| COMMUNITY HEALTHCARE FOUNDATION | |
| E | 12734712 |