FURP.ORG / PUBLIC DATA EXPLORER

COMMUNITY MEMORIAL HEALTHCARE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEMORIAL HEALTHCARE INC (EIN 48-0630224)
Tax period
2011-01-01 to 2011-12-31
Filed
2012-11-15
IRS object ID
201213209349302666
Schema version
2011v1.3
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 ReturnHeader

FieldValueIRS element (for citing)
Timestamp2012-11-15T09:38:24-06:00Timestamp
Tax Period End Date2011-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1
CityKansas CityCity
StateMOState
ZIP Code641062246ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2011-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN480630224EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1Community Memorial Healthcare IncBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% WILLIAM H STORCKInCareOfName
Name ControlCOMMNameControl
Phone7855622311Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 N 18th StreetAddressLine1
CityMarysvilleCity
StateKSState
ZIP Code66508ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCURTIS R HAWKINSONName
TitleCHIEF EXECUTIVE OFFICERTitle
Date Signed2012-11-15DateSigned
Authorize Third PartytrueAuthorizeThirdParty

Preparer Preparer

FieldValueIRS element (for citing)
Phone8162216300Phone
FieldValueIRS element (for citing)
Tax Year2011TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCURTIS R HAWKINSONNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1708 N 18TH STREETAddressLine1
CityMARYSVILLECity
StateKSState
ZIP Code66508ZIPCode
FieldValueIRS element (for citing)
Gross Receipts19100626GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501c3XOrganization501c3
Web SiteWWW.CMHCARE.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1955YearFormation
State Legal DomicileKSStateLegalDomicile
Activity Or Mission DescriptionCOMMUNITY MEMORIAL HEALTHCARE, INC. IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION THAT OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL FOR PATIENTS IN MARYSVILLE, KANSAS AND SURROUNDING AREAS.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members10NbrIndependentVotingMembers
Total Nbr Employees280TotalNbrEmployees
Total Nbr Volunteers12TotalNbrVolunteers
Total Gross UBI0TotalGrossUBI
Net Unrelated Business Txbl Income0NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year507145ContributionsGrantsPriorYear
Contributions Grants Current Year283786ContributionsGrantsCurrentYear
Program Service Revenue Prior Year18217624ProgramServiceRevenuePriorYear
Program Service Revenue CY18724953ProgramServiceRevenueCY
Investment Income Prior Year59128InvestmentIncomePriorYear
Investment Income Current Year-2445InvestmentIncomeCurrentYear
Other Revenue Prior Year0OtherRevenuePriorYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year18783897TotalRevenuePriorYear
Total Revenue Current Year19006294TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year2000GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY2000GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year10573010SalariesEtcPriorYear
Salaries Etc Current Year10734212SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year7594119OtherExpensePriorYear
Other Expenses Current Year8969907OtherExpensesCurrentYear
Total Expenses Prior Year18169129TotalExpensesPriorYear
Total Expenses Current Year19706119TotalExpensesCurrentYear
Revenues Less Expenses Prior Year614768RevenuesLessExpensesPriorYear
Revenues Less Expenses CY-699825RevenuesLessExpensesCY
Total Assets BOY25538078TotalAssetsBOY
Total Assets EOY30249347TotalAssetsEOY
Total Liabilities BOY13489460TotalLiabilitiesBOY
Total Liabilities EOY18936375TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY12048618NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY11312972NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionTHE MISSION STATEMENT OF COMMUNITY MEMORIAL HEALTHCARE, INC. IS TO EXCEL AT CARING FOR YOU. THE VISION STATEMENT OF COMMUNITY MEMORIAL HEALTHCARE, INC. IS TO EXCEED EXPECTATIONS AS A TRUSTED AND VALUED HEALTH PROVIDER.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense3227814Expense
Grants0Grants
Revenue2415019Revenue
DescriptionEMERGENCY ROOM SERVICES, RESPIRATORY SERVICES, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense5545035Expense
Grants0Grants
Revenue2357982Revenue
DescriptionADULT AND PEDIATRIC INPATIENT ACUTE CARE SERVING 3,795 PATIENT DAYS.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense4204843Expense
Grants0Grants
Revenue9095389Revenue
DescriptionDIAGNOSTIC IMAGING INPATIENT AND OUTPATIENT PERFORMING 10,328 SCANS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp2967168TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt0TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev4856563TotalOfOtherProgramServiceRev
Total Program Service Expense15944860TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetsfalseReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotetrueReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MembertrueBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntityfalseTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109629NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees280NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members10NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonWILLIAM H STORCKNamePerson
Telephone Number7855622311TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1708 N 18TH STREETAddressLine1
CityMARYSVILLECity
StateKSState
ZIP Code66508ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (20 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
AMOS ALSTROM
DIRECTOR4.0X000
CAROL BLOCKER
DIRECTOR4.0X000
DON BRUNA
VICE-CHAIRPERSON/DIRECTOR4.0X000X
DAN CAFFREY
DIRECTOR4.0X000
KEN KICKHAFER
CHAIRPERSON/DIRECTOR4.0X000X
TRENT MOSER
DIRECTOR4.0X000
DAVID HAMEL
DIRECTOR4.0X000
GARY HOLLE
DIRECTOR4.0X000
WILLIAM OBORNY
DIRECTOR4.0X000
JOHN SCHWARTZ
DIRECTOR4.0X000
DELORES STUMP
DIRECTOR4.0X000
ED HENRY
DIRECTOR4.0X000
DR JOHN RYAN
CHIEF OF STAFF/DIRECTOR40.0X250091030254X
CURTIS R HAWKINSON
CEO40.0139784023637X
WILLIAM H STORCK
CFO40.090688018475X
DR MICHELLE STONE
DIRECTOR OF SWINGBED40.0376448030787X
DR JOHN HAEFELE
DIR OF RESPIRATORY THERAPY40.0217160030311X
DR RANDALL BROWN
DIRECTOR OF EMERGENCY SERVICES40.0282392031505X
DR KENNETH DUENSING
DIRECTOR OF PHYSICAL THERAPY40.0214858029952X
DR FERNANDO UGARTE
PHYSICIAN40.0252509030048X
FieldValueIRS element (for citing)
Total Reportable Comp From Org1823930TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation224969TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Description Of ServicesDescriptionOfServicesCompensationCompensation
CRIST PIESCHEL PT
PHYSICAL THERAPY723885
MARYSVILLE ANESTHESIA
ANESTHESIOLOGIST3582887
NEBRASKA HEART INST
CARDIO TESTS282375
SE NE MOBILE DIAG SERVS
ULTRASOUND & MAMO219254
CPSI
COMPUTER SERVICES193959
FieldValueIRS element (for citing)
Number Of Contractors GT100 K7NumberOfContractorsGT100K
All Other Contributions283786AllOtherContributions
Total Contributions283786TotalContributions

Program Service Revenue ProgramServiceRevenue (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncome
Net Patient Service Revenue6214001859019618590196
Dietary Income624200104802104802
Other Operating Revenue9000992995529955
FieldValueIRS element (for citing)
Total Program Service Revenue18724953TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column72325TotalRevenueColumn
Exclusion$72,325ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Gross Amount Sales Assets GrossAmountSalesAssets

FieldValueIRS element (for citing)
Other19562Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

FieldValueIRS element (for citing)
Other94332Other

Gain Or Loss GainOrLoss

FieldValueIRS element (for citing)
Other-74770Other

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column-74770TotalRevenueColumn
Exclusion-$74,770ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn
FieldValueIRS element (for citing)
Total Other Revenue0TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column19006294TotalRevenueColumn
Related Or Exempt Function Income18724953RelatedOrExemptFunctionIncome
Exclusion-$2,445ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total0Total

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total2000Total
Program Services2000ProgramServices

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total552929Total
Program Services425347ProgramServices
Management And General127582ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total138475Total
Program Services105537ProgramServices
Management And General32938ManagementAndGeneral

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total8462584Total
Program Services6449614ProgramServices
Management And General2012970ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total290856Total
Program Services219466ProgramServices
Management And General71390ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total674816Total
Program Services569869ProgramServices
Management And General104947ManagementAndGeneral

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total614552Total
Program Services565012ProgramServices
Management And General49540ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total0Total

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total5485Total
Management And General5485ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total108848Total
Management And General108848ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total0Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total2591704Total
Program Services2375875ProgramServices
Management And General215829ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total83837Total
Program Services82469ProgramServices
Management And General1368ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total234654Total
Program Services186143ProgramServices
Management And General48511ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total704430Total
Program Services664973ProgramServices
Management And General39457ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total149671Total
Program Services124106ProgramServices
Management And General25565ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total6889Total
Management And General6889ManagementAndGeneral

Interest Interest

FieldValueIRS element (for citing)
Total704575Total
Program Services14912ProgramServices
Management And General689663ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1307444Total
Program Services1245594ProgramServices
Management And General61850ManagementAndGeneral

Insurance Insurance

FieldValueIRS element (for citing)
Total243220Total
Program Services150705ProgramServices
Management And General92515ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBT EXPENSE623095623095
MEDICAL SUPPLIES17117451711745
EQUIP RENTAL & MAINTENANCE35687934304113838
DUES & SUBSCRIPTIONS799774305836919

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total57454Total
Program Services42299ProgramServices
Management And General15155ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total19706119Total
Program Services15944860ProgramServices
Management And General3761259ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY2437112BOY
EOY1055EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY1483920BOY
EOY2316453EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY485620BOY
EOY148422EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY3356291BOY
EOY3917219EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY23558BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY394975BOY
EOY493997EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY274962BOY
EOY256857EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis24709222LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec6353270LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY15335763BOY
EOY18355952EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY1662167BOY
EOY4142391EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY0BOY
EOY60279EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY83710BOY
EOY556722EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY25538078BOY
EOY30249347EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY2081473BOY
EOY1632154EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY11407987BOY
EOY17304221EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY13489460BOY
EOY18936375EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY10174718BOY
EOY10072144EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY1798106BOY
EOY1165034EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY75794BOY
EOY75794EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY12048618BOY
EOY11312972EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY25538078BOY
EOY30249347EOY
FieldValueIRS element (for citing)
Info In Schedule O Part XIXInfoInScheduleOPartXI
Reconcilation Revenue Expenses-699825ReconcilationRevenueExpenses
Reconcilation Other Changes-35821ReconcilationOtherChanges
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited
Audit CommitteetrueAuditCommittee
Financial Statement ConsolidatedXFinancialStatementConsolidated
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
Form4720 FiledfalseForm4720Filed
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationstrueGrantsOtherOrganizations
Grants Other Organizations$4,398GrantsOtherOrganizationsAmount
Direct Contact LegislatorsfalseDirectContactLegislators
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB4398TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierLOBBYING ACTIVITIESIdentifier
Return ReferenceSCHEDULE C, PART II-B, LINE 1(F)ReturnReference
ExplanationDUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance2859086BeginningOfYearBalance
Contributions266927Contributions
Investment Earnings Or Losses4502InvestmentEarningsOrLosses
Grants Or Scholarships2000GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses2502AdministrativeExpenses
End Of Year Balance3126013EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance2367441BeginningOfYearBalance
Contributions491645Contributions
Investment Earnings Or Losses2944InvestmentEarningsOrLosses
Grants Or Scholarships2000GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses944AdministrativeExpenses
End Of Year Balance2859086EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1716790BeginningOfYearBalance
Contributions650651Contributions
Investment Earnings Or Losses2121InvestmentEarningsOrLosses
Grants Or Scholarships2000GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses121AdministrativeExpenses
End Of Year Balance2367441EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance1060979BeginningOfYearBalance
Contributions655811Contributions
Investment Earnings Or Losses3613InvestmentEarningsOrLosses
Grants Or Scholarships2000GrantsOrScholarships
Other Expenditures0OtherExpenditures
Administrative Expenses1613AdministrativeExpenses
End Of Year Balance1716790EndOfYearBalance
FieldValueIRS element (for citing)
Board Designated EOY Balance0.31510BoardDesignatedEOYBalance
Permanent Endowment EOY Balance0.02420PermanentEndowmentEOYBalance
Term Endowment EOY Balance0.66070TermEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgsfalseEndowmentsHeldByRelatedOrgs

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis81530OtherCostOrOtherBasis
Book Value81530BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis18321102OtherCostOrOtherBasis
Depreciation2474347Depreciation
Book Value15846755BookValue
FieldValueIRS element (for citing)
Leasehold ImprovementsLeaseholdImprovements

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis5737302OtherCostOrOtherBasis
Depreciation3775360Depreciation
Book Value1961942BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis569288OtherCostOrOtherBasis
Depreciation103563Depreciation
Book Value465725BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings18355952TotalOfBookValueLandBuildings
Federal Income Tax Liability0FederalIncomeTaxLiability
Total Of Amounts0TotalOfAmounts
Total Revenue19006294TotalRevenue
Total Expenses19706119TotalExpenses
Excess Or Deficit For Year-699825ExcessOrDeficitForYear
Net Unrealized GL On Investments-35821NetUnrealizedGLOnInvestments
Other-$266,928OtherAmount
Total Adjustments-302749TotalAdjustments
Excess Or Deficit Per FS-1002574ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt18719045TotRevenueEtcAuditedFinclStmt
Net Unrealized Gains Investments-35821NetUnrealizedGainsInvestments
Other Revenues15500OtherRevenues
Revenue Not Rptd F990-20321RevenueNotRptdF990
Revenue Subtotal18739366RevenueSubtotal
Other Revenues Not Included266928OtherRevenuesNotIncluded
Revenue Not Rptd On Fin Stmt266928RevenueNotRptdOnFinStmt
Total Revenue Per Form99019006294TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt19706119TotExpensesEtcAuditedFinclStmt
Expenses Subtotal19706119ExpensesSubtotal
Total Expenses Per Form99019706119TotalExpensesPerForm990

Form990 Schedule D Part XIV Form990ScheduleDPartXIV (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ENDOWMENT FUNDSSCHEDULE D, PART V, LINE 4BOARD-DESIGNATED ASSETS LIMITED TO USE OF $985,007 INCLUDE ASSETS SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS AND OPERATIONS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE THE ASSETS FOR OTHER PURPOSES. TEMPORARY RESTRICTED NET ASSETS ARE THOSE WHOSE USE BY THE ORGANIZATION HAS BEEN LIMITED BY DONORS TO A SPECIFIC TIME OR PERIOD. TEMPORARY RESTRICTED ASSETS OF $2,065,356 ARE USED TO FUND CONSTRUCTION OF THE NEW UPCOMING BUILDING. PERMANENTLY RESTRICTED ASSETS OF $75,650 HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY CMH IN PERPETUITY WITH THE INCOME TO BE USED FOR SCHOLARSHIPS.
UNCERTAIN TAX POSITIONS DISCLOSURESCHEDULE D, PART X, LINE 2MANAGEMENT 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.
OTHER - RECONCILIATION OF REVENUE PER AUDITED F/S AND TAX RETURNSCHEDULE D, PART XI, LINE 8RESTRICTED ENDOWMENT CONTRIBUTIONS $(266,928)
OTHER - REVENUE INCLUDED ON LINE 1 BUT NOT ON FORM 990, PART VIII, LINE 12SCHEDULE D, PART XII, LINE 2DRELATED ORGANIZATION REVENUE $15,500
OTHER - REVENUE INCLUDED ON FORM 990, PART VIII, LINE 12 BUT NOT ON LINE 1SCHEDULE D, PART XII, LINE 4BRESTRICTED ENDOWMENT CONTRIBUTIONS $266,928

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent150XPcent150
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare

Discounted Other DiscountedOther

FieldValueIRS element (for citing)
OtherXOther
Discounted Other Percentage150.DiscountedOtherPercentage
FieldValueIRS element (for citing)
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgettrueExpensesExceededBudget
Unable To Provide CarefalseUnableToProvideCare
Annual Community Benefit ReportfalseAnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense388995TotalCommunityBenefitExpense
Direct Offsetting Revenue16412DirectOffsettingRevenue
Net Community Benefit Expense372583NetCommunityBenefitExpense
Percent Of Total Expense0.01890PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

FieldValueIRS element (for citing)
Total Community Benefit Expense388995TotalCommunityBenefitExpense
Direct Offsetting Revenue372682DirectOffsettingRevenue
Net Community Benefit Expense16313NetCommunityBenefitExpense
Percent Of Total Expense0.00100PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense777990TotalCommunityBenefitExpense
Direct Offsetting Revenue389094DirectOffsettingRevenue
Net Community Benefit Expense388896NetCommunityBenefitExpense
Percent Of Total Expense0.01990PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Total Community Benefit Expense777990TotalCommunityBenefitExpense
Direct Offsetting Revenue389094DirectOffsettingRevenue
Net Community Benefit Expense388896NetCommunityBenefitExpense
Percent Of Total Expense0.01990PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$1,635,457BadDebtExpenseAmount
Amount Attributable To326438AmountAttributableTo
Amount Reimbursed By Medicare3269337AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare3484462CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-215125MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1Community Memorial Healthcare IncBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1708 N 18th StreetAddressLine1
CityMarysvilleCity
StateKSState
ZIP Code66508ZIPCode
FieldValueIRS element (for citing)
Critical Access HospitalXCriticalAccessHospital
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Community Memorial Healthcare IncBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent150.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent150.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Medical IndigencyXMedicalIndigency
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Used Other MethodXUsedOtherMethod
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities5NumberOfOtherFacilities

Other Facilities OtherFacilities (5 entries)

Address Line1Address/AddressLine1CityAddress/CityStateAddress/StateZIP CodeAddress/ZIPCodeFacility TypeFacilityType
Community Physicians Clinic
1902 MAYMARYSVILLEKS66508RURAL HEALTH CLINIC
Marysville Clinic
808 N 19thMarysvilleKS66508RURAL HEALTH CLINIC
Blue Rapids Medical Clinic
607 lincolnBLUE RAPIDSKS66411RURAL HEALTH CLINIC
Community Medical Equipment
805 BroadwayMarysvilleKS66508Durable Medical Equipment
CMH Home Health
910 BroadwayMarysvilleKS66508Home Health Agency

Form990 Schedule H Part VI Form990ScheduleHPartVI (10 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
AMOUNT OF BAD DEBT REMOVED FROM PART I, LINE 7, CALCULATIONSCHEDULE H, PART I, LINE 7(F)THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), SUBTRACTED FOR PURPOSES OF CALCULATING SCHEDULE H, PART I, LINE 7(F) IS $623,095.
METHOD USED TO DETERMINE THE COST-TO-CHARGE RATIOSCHEDULE H, PART I, LINE 7(A)THE COST-TO-CHARGE RATIO WAS USED AS THE COSTING METHODOLOGY TO REPORT CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES.
METHOD USED TO DETERMINE BAD DEBT EXPENSESCHEDULE H, PART III, LINE 4CMH REPORTS PATIENT ACCOUNTS RECEIVABLES FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD PARTY PAYERS, PATIENTS, AND OTHERS. CMH PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVALBLES, HISTORICAL COLLETIVE INFORMATION AND EXISTING ECONOMIC CONDITIONS. THE AMOUNT ON LINE THREE WAS CALCULATED BY TAKING A RATIO OF CHARITY CARE TO NET PATIENT SERVICE REVENUE AND APPLYING THAT RATIO TO BAD DEBT. 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. The costing methodology used for lines 2 and 3 was the cost to charge ratio from the 2011 Medicare cost report. Line 3 was taken from the Medicare Bad debt schedule prepared for the 2011 cost report.
COSTING METHODOLOGY USED TO DETERMINE ALLOWABLE MEDICARE COSTSSCHEDULE H, PART III, LINE 8THERE WAS A SHORTFALL RELATING TO THE MEDICARE REVENUE RECEIVED AND RELATED ALLOWABLE MEDICARE COSTS. THE COSTING METHODOLOGY USED TO DETERMINE THESE AMOUNTS CAME FROM THE ORGANIZATIONS MEDICARE COST REPORT. THE SHORTFALL FROM LINE SEVEN REPRESENTS LEGITIMATE EXPENSES/COSTS INCURRED BY THE HOSPITAL TO SERVE MEDICARE PATIENTS. THESE ARE COSTS SIMILAR TO CHARITY CARE IN THAT THE HOSPITAL DID NOT COLLECT THESE FUNDS. AS SUCH THERE IS A DIRECT BENEFIT DERIVED FOR THE COMMUNITY IN THAT THE HOSPITAL WAS ABLE TO PROVIDE CARE FOR THESE PATIENTS. THEREFORE THE ENTIRE SHORTFALL SHOULD BE COUNTED AS A COMMUNITY BENEFIT.
COLLECTION PRACTICES FROM PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCESCHEDULE H, PART III, LINE 9BCMH RECOGNIZES THE FACT THAT SOME PATIENTS WILL NEED ASSISTANCE IN MEETING THEIR FINANCIAL OBLIGATIONS ON PATIENT ACCOUNTS. FOR THESE PATIENTS, THE FINANCIAL ASSISTANCE POLICY HAS BEEN ESTABLISHED. THIS POLICY MANDATES THAT NOTICE OF THE POLICY BE POSTED AT INPATIENT, OUTPATIENT, AND CLINIC ADMISSIONS AREAS. IT FURTHER MANDATES THAT "DURING THE COLLECTION PROCESS, CMH WILL AGAIN NOTIFY PATIENTS OF OUR PATIENT FINANCIAL ASSISTANCE POLICY".
SCHEDULE H, PART V, LINE 19DCommunity Memorial Healthcare provides discounts to all individuals eligible under the financial assistance policy. Community Memorial Healthcare is in the process of evaluating the appropriate discounts to eligible individuals under the financial assistance policy in connection with the proposed regulations issued by the IRS.
NEEDS ASSESSMENTSCHEDULE H, PART VI, LINE 2In addition to conducting it's own research CMH collaborates through the interagency cooperative council (a collection of county wide not-for-profit agencies) to assess the needs of Marshall County. CMH has partnered with Kansas State University and the Kansas Hospital Assoc. to conduct a community needs assessment in 2011.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCESCHEDULE H, PART VI, LINE 3The insurance office personnel explain eligibility to patients and will assist with paperwork. The availability of Financial asistance is posted through out the building(i.e. the business office, the clinics, Emergency department). Patients who are identified either before services are rendered or prior to discharged are contacted by the business office personnel to assess qualification for Medicaid or Financial assistance. Business office personnel attempt to contact patients via phone and mail regarding their bill. Part of the charity care program is to attempt enrollment into the medicaid program.
COMMUNITY INFORMATIONSCHEDULE H, PART VI, LINE 4Community Memorial Healthcare, Inc. is a not-for-profit membership corporation that owns and operates a general acute care hospital. CMH primarily earns revenues by providing inpatient, outpatient, emergency, clinic and home health services to Marysville, Blue Rapids, Beattie, Hanover, Waterville, Washington, Frankfort, Axtell and Home Kansas. These areas are also served by Hanover Hospital (Hanover, KS), Nemaha Valley Community Hospital(Seneca, KS), Mercy Regional Health Center(Manhattan, KS), Bryan LGH Health System( Lincoln, NE), Saint Elizabeth Regional Medical Center(Lincoln, NE), Saint Francis Health Center(Topeka KS), Stormont-Vail Healthcare(Topeka, KS). As of the 2000 census, the city of Marysville had a total population of 3,271, while Marshall County population was 10,965. BELOW ARE ADDITIONAL MARSHALL COUNTY DEMOGRAPHICS: 22% of the population is over 65 years of age. 28% of the population is between 45-64 years of age. 28% of the population is between the ages of 18-44. Median household income for Marshall county was $48,000 for 2008. Unemployment in Marshall county is 4.6%. 9.2% of the population are living below the poverty level. The hospital is the third largest employer in the county.
PROMOTION OF COMMUNITY HEALTHSCHEDULE H, PART VI, LINE 5Community Memorial Healthcare provides personnel and supplies to teach CPR classes for a nominal fee to the general public and local first responders. The hospital sponsors an annual healthfare for the general public drawing blood and runs diagnostic tests. The Hospital sponsors tours of local grocers with the intent of teaching community members how to read and understand nutrition labels and make healthy choices when purchasing groceries.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Idemnification Gross Up PaymentsXIdemnificationGrossUpPayments
Written Policy Re T And E ExpensestrueWrittenPolicyReTAndEExpenses
Substantiation RequiredtrueSubstantiationRequired
Compensation CommitteeXCompensationCommittee
Written Employment ContractXWrittenEmploymentContract
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgtrueCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Filing OrgBonusFilingOrgBonus Related OrgsBonusRelatedOrgsOther Compensation Filing OrgOtherCompensationFilingOrgOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Filing OrgDeferredCompFilingOrgDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Filing OrgTotalCompensationFilingOrgTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DR MICHELLE STONE
2694202792250702810134120173750407235000
CURTIS R HAWKINSON
1343290005455061700174670163421000
DR JOHN HAEFELE
370080174666054860116170186940247471000
DR RANDALL BROWN
3269102332010165000134120180930313897000
DR JOHN RYAN
449880202727023760134120168420280345000
DR KENNETH DUENSING
426060171065011870114550184970244810000
DR FERNANDO UGARTE
233304000192050134120166360282557000

Form990 Schedule J Part III Form990ScheduleJPartIII (2 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
TAX GROSS-UP PAYMENTSSCHEDULE J, PART I, LINE 1AA TAX GROSS-UP PAYMENT IN THE AMOUNT OF $18,464 WAS INCLUDED IN MICHELLE STONE'S W-2.
EXPLANATION OF COMPENSATION CONTINGENT OF REVENUESSCHEDULE J, PART I, LINE 5APHYSICIAN COMPENSATION IS BASED ON A PRODUCTION COMPONENT OF THEIR SERVICES. PHYSICIANS RECEIVE AS COMPENSATION, A PERCENTAGE OF CERTAIN QUALIFIED PROCEDURES IN WHICH THEY PERFORM.

Schedule L IRS990ScheduleL

FieldValueIRS element (for citing)
Total Balance Due0TotalBalanceDue

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

FieldValueIRS element (for citing)
Name PersonSEE SCHEDULE L PART VNamePerson

Form990 Schedule L Part V Form990ScheduleLPartV

FieldValueIRS element (for citing)
IdentifierBUSINESS TRANSACTIONS WITH INTERESTED PERSONSIdentifier
Return ReferenceSCHEDULE L, PART IVReturnReference
ExplanationBOARD MEMBER - GARY HOLLE (A) JOYCE HOLLE (B) SPOUSE (C) $65,361 (D) COMPENSATION (E) NO BOARD MEMBER- TRENT MOSER (A) KELLY MOSER (B) SPOUSE (C) $19,929 (D) COMPENSATION (E) NO BOARD MEMBER/OFFICER- JOHN RYAN (A) JILL RYAN (B) SPOUSE (C) $53,185 (D) COMPENSATION (E) NOExplanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (9 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
OTHER PROGRAM SERVICESFORM 990, PART III, LINE 4DLABORATORY SERVICES INPATIENT AND OUTPATIENT 264,676 TESTS AND 116 BLOOD TRANSFUSIONS.
MEMBERSFORM 990, PART VI, SECTION A, LINE 6ANY PERSON, FIRM, ASSOCIATION, CORPORATION, OR BODY POLITIC, OR SUBDIVISION THEREOF, MAY BECOME A MEMBER OF THE COMMUNITY MEMORIAL HEALTHCARE, INC. BY: (A) PAYING A MEMBERSHIP FEE OF $100.00; AND (B) AGREEING TO COMPLY WITH AND BE BOUND BY THE ARTICLES OF INCORPORATION AND BYLAWS AND ANY RULES AND REGULATIONS ADOPTED BY THE BOARD OF DIRECTORS OF THE CORPORATION.
MEMBERS MAY ELECT GOVERNING BODYFORM 990, PART VI, SECTION A, LINE 7AA CERTIFICATE OF MEMBERSHIP SHALL ENTITLE THE LEGAL HOLDER TO ONE VOTE UPON MATTERS SUBMITTED TO A VOTE AT A MEETING OF THE MEMBERS. WHERE THE LEGAL HOLDER OF THE CERTIFICATE IS A FIRM, ASSOCIATION, CORPORATION, OR A BODY POLITIC, OR A SUBDIVISION THEREOF, THE PRESIDENT, CHIEF EXECUTIVE OFFICER OR HIS DESIGNEE SHALL CAST THE VOTE. ALL QUESTIONS REQUIRING A VOTE OF THE MEMBERS SHALL BE DECIDED BY A VOTE OF A MAJORITY OF THE MEMBERS PRESENTING PERSON EXCEPT AS OTHERWISE PROVIDED BY LAW, THE ARTICLES OF INCORPORATION OR THE BYLAWS.
GOVERNING BODY DECISIONS SUBJECT TO APPROVAL OF MEMBERSFORM 990, PART VI, SECTION A, LINE 7B1. ANY SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF CORPORATE PROPERTY AND ASSETS OR ANY DISSOLUTION OF THE CORPORATION SHALL BE GOVERNED BY K.S.A. 17-6801 ET SEQ., REQUIRING A MAJORITY VOTE OF THE MEMBERS ENTITLED TO VOTE THEREON AT A DULY CALLED MEETING OF THE MEMBERS. 2. THE BYLAWS MAY NOT BE AMENDED, REVISED, OR REPEALED WITHOUT VOTE BY THE MEMBERSHIP.
FORM 990 REVIEW PROCESSFORM 990, PART VI, SECTION B, LINE 11BTHE CFO GATHERS INFORMATION TO PREPARE THE FORM 990 TAX RETURN. THIS INFORMATION IS THEN GIVEN TO AN INDEPENDENT ACCOUNTING FIRM WHO PREPARES AND REVIEWS THE FORM 990. THE INDEPENDENT ACCOUNTING FIRM THEN PROVIDES THE CFO AND FINANCE COMMITTEE A DRAFT OF THE FORM 990 FOR COMMENTS AND APPROVAL. ONCE THE CFO, FINANCE COMMITTEE, AND THE CPA FIRM APPROVE THE FORM 990, A COPY OF THE FORM 990 IS GIVEN TO THE GOVERNING BOARD MEMBERS ALONG WITH A RESPONSE TIME FOR QUESTIONS AND COMMENTS. ALL ISSUES ARE RESOLVED AND THE FORM 990 IS FILED.
CONFLICT OF INTEREST POLICYFORM 990, PART VI, SECTION B, LINE 12CBOARD OF DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS WILL COMPLETE A DISCLOSURE STATEMENT AT THE BEGINNING OF EACH CMH FISCAL YEAR AND PROVIDE SUCH STATEMENT TO THE CMH COMPLIANCE OFFICER. THE DISCLOSURE STATEMENT SHALL INCLUDE ANY INVESTMENT IN, OR ANY MANAGERIAL, CONSULTING, OR EMPLOYMENT RELATIONSHIP WITH, ANY OUTSIDE ENTITY THAT PROVIDES OR SEEKS TO PROVIDE GOODS OR SERVICES TO CMH, COMPETES WITH, OR INCLUDES CMH AS A JOINT VENTURE OR EQUITY INVESTOR. THE INTERESTED DIRECTOR SHOULD ABSTAIN FROM DISCUSSION AND VOTING ON THE MATTER BY TEMPORARILY LEAVING THE BOARD MEETING WHILE THE DISINTERESTED DIRECTORS DISCUSS AND VOTE. THE DISCLOSURE AND ABSTENTION SHALL BE RECORDED IN THE MINUTES OF THE BOARD MEETING.
COMPENSATION REVIEWFORM 990, PART VI, SECTION B, LINES 15A & BTHE COMPENSATION COMMITTEE EXISTS TO DESIGN, IMPLEMENT, AND EVALUATE BONUS CRITERIA FOR THE CEO'S COMPENSATION. FURTHERMORE, THE COMPENSATION COMMITTEE COMPLETES MEDICAL STAFF CONTRACT NEGOTIATIONS, EVALUATES AND COMPARES PERSONNEL WAGES TO INDUSTRY BENCHMARKS, AND PERFORMS THE CEO AND BOARD EVALUATIONS. THE COMPENSATION COMMITTEE CONSISTS OF FOUR MEMBERS OF THE BOARD AND THE COMMITTEE MEETS AT LEAST SEMI-ANNUALLY OR MORE FREQUENTLY AS NECESSARY. THE COMPENSATION REVIEW WAS LAST CONDUCTED IN 2010.
AVAILABILITY OF DOCUMENTS TO THE PUBLICFORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.
OTHER CHANGES IN NET ASSETSFORM 990, PART XI, LINE 5UNREALIZED LOSS ON INVESTMENTS $(35,821)

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1CMH FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1708 N 18TH STREETAddressLine1
CityMARYSVILLECity
StateKSState
ZIP Code66508ZIPCode
FieldValueIRS element (for citing)
EIN320297285EIN
Primary ActivitiesSUPPORTPrimaryActivities
Legal Domicile StateKSLegalDomicileState
Exempt Code SectionAPPLIED FORExemptCodeSection
Public Charity StatusAPPLIED FORPublicCharityStatus

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CMHBusinessNameLine1
FieldValueIRS element (for citing)
Controlled OrgtrueControlledOrg
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgtrueLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiestrueSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgtrueOtherTransferFromOtherOrg