COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2009
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 44-0537826)
- Tax period
- 2009-07-01 to 2010-06-30
- Filed
- 2011-02-15
- IRS object ID
- 201100469349300525
- Schema version
- 2009v1.7
- 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 D
- Schedule G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-02-15T08:57:37-06:00 | Timestamp |
| Tax Period End Date | 2010-06-30 | 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 | 2009-07-01 | 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 | 2011-02-15 | 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 | 2009 | 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 | 405 E MAIN | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 66446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 11869425 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c | X | Organization501c |
| Web Site | N/A | 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 HOSPITAL SERVICES | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 12 | NbrIndependentVotingMembers |
| Total Nbr Employees | 117 | TotalNbrEmployees |
| Total Nbr Volunteers | 205 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 793875 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 2038618 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 9941119 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9691201 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 4352 | InvestmentIncomePriorYear |
| Investment Income Current Year | 6014 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 90762 | OtherRevenuePriorYear |
| Other Revenue Current Year | 100866 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 10830108 | TotalRevenuePriorYear |
| Total Revenue Current Year | 11836699 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 33230 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 5475 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4834182 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4683566 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 60966 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 95539 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4627976 | OtherExpensePriorYear |
| Other Expenses Current Year | 4613855 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 9556354 | TotalExpensesPriorYear |
| Total Expenses Current Year | 9302896 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 1273754 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 2533803 | RevenuesLessExpensesCY |
| Total Assets BOY | 6773414 | TotalAssetsBOY |
| Total Assets EOY | 17641477 | TotalAssetsEOY |
| Total Liabilities BOY | 1746187 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 10080447 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 5027227 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 7561030 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO SERVE AND CARE FOR THE PHYSICAL, EMOTIONAL AND SOCIAL WELL-BEING OF THE SURROUNDING COMMUNITIES | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 6981650 | Expense |
| Grants | 28475 | Grants |
| Revenue | 9691201 | Revenue |
| Description | TO PROVIDE MEDICAL SERVICES, HEALTH EDUCATION, AND WELLNESS SERVICES INCLUDING, BUT NOT LIMITED TO DENTAL, OBSTETRICS, SURGERY, PEDIATRICS, AND INTERNAL MEDICINE | Description |
| Total Program Service Expense | 6981650 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | 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 |
| Balance Sheet Amounts Reported | true | BalanceSheetAmountsReported |
| 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 |
| Grants To Organizations | false | 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 |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 117 | 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 |
| 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 | 405 E MAIN | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
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 |
|---|---|---|---|---|---|---|---|
| BILL SLAUGHTER | |||||||
| DIRECTOR/PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | |
| NANCY HURST | |||||||
| DIRECTOR/VICE 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 | ||
| BOB JACKSON | |||||||
| 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 | 37353 | 0 | 0 | ||
| WC BUD TICE | |||||||
| DIRECTOR | 1.0 | X | 0 | 160101 | 14835 | ||
| STEPHANIE DAUBERT | |||||||
| DIRECTOR | 1.0 | X | 0 | 164645 | 17184 | ||
| MYRA EVANS | |||||||
| CEO | 40.0 | X | 161738 | 0 | 16332 | ||
| SUZANNE SOUTHARD | |||||||
| CFO | 40.0 | X | 52064 | 0 | 9092 | ||
| GARY MCINTYRE | |||||||
| CRNA | 40.0 | 130322 | 0 | 3604 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 381477 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 324746 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 61047 | 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 | 4783422 |
| LEO A DALY COMPANY | |
| ARCHITECT SERVICES | 594118 |
| IRELAND CLINIC | |
| PHYSICIAN SERVICES | 172360 |
| CPSI | |
| COMPUTER SERVICES | 123452 |
| SODEXO INC AFFILIATES | |
| ENVIRONMENT SERVICES | 121209 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 8 | NumberOfContractorsGT100K |
| Fundraising Events | 45831 | FundraisingEvents |
| Related Organizations | 1799665 | RelatedOrganizations |
| All Other Contributions | 193122 | AllOtherContributions |
| Total Contributions | 2038618 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 9691201 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9691201 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9691201 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 6014 | TotalRevenueColumn |
| Exclusion | $6,014 | 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 Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 900 | Real |
Less Rental Expenses LessRentalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 137 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 763 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 763 | TotalRevenueColumn |
| Exclusion | $763 | ExclusionAmount |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 65832 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 45831 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 32589 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 33243 | TotalRevenueColumn |
| Exclusion | $33,243 | 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 | 45967 | $45,967 |
| MISCELLANEOUS | 900099 | 20893 | $20,893 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 66860 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 11836699 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9691201 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $106,880 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 5475 | Total |
| Program Services | 5475 | 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 | 289748 | Total |
| Management And General | 289748 | 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 | 3758810 | Total |
| Program Services | 2910358 | ProgramServices |
| Management And General | 815499 | ManagementAndGeneral |
| Fundraising | 32953 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93290 | Total |
| Program Services | 77360 | ProgramServices |
| Management And General | 14835 | ManagementAndGeneral |
| Fundraising | 1095 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 222764 | Total |
| Program Services | 192344 | ProgramServices |
| Management And General | 28022 | ManagementAndGeneral |
| Fundraising | 2398 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 318954 | Total |
| Program Services | 241177 | ProgramServices |
| Management And General | 74362 | ManagementAndGeneral |
| Fundraising | 3415 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 213672 | Total |
| Program Services | 155425 | ProgramServices |
| Management And General | 56046 | ManagementAndGeneral |
| Fundraising | 2201 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 16619 | Total |
| Program Services | 12260 | ProgramServices |
| Management And General | 4359 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 59401 | Total |
| Management And General | 58789 | ManagementAndGeneral |
| Fundraising | 612 | 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 | 1227929 | Total |
| Program Services | 905843 | ProgramServices |
| Management And General | 322086 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35123 | Total |
| Program Services | 11608 | ProgramServices |
| Management And General | 9213 | ManagementAndGeneral |
| Fundraising | 14302 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1022871 | Total |
| Program Services | 721984 | ProgramServices |
| Management And General | 268299 | ManagementAndGeneral |
| Fundraising | 32588 | 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 | 146757 | Total |
| Program Services | 106751 | ProgramServices |
| Management And General | 38494 | ManagementAndGeneral |
| Fundraising | 1512 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 47153 | Total |
| Program Services | 31386 | ProgramServices |
| Management And General | 12368 | ManagementAndGeneral |
| Fundraising | 3399 | 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 | 9061 | Total |
| Program Services | 6591 | ProgramServices |
| Management And General | 2377 | ManagementAndGeneral |
| Fundraising | 93 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 329982 | Total |
| Program Services | 243392 | ProgramServices |
| Management And General | 86590 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 84039 | Total |
| Program Services | 61130 | ProgramServices |
| Management And General | 22043 | ManagementAndGeneral |
| Fundraising | 866 | Fundraising |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| REPAIRS & MAINT. | 294978 | 217605 | 77373 | |
| DUES & SUBSCRIPTIONS | 47871 | 35209 | 12557 | 105 |
| BAD DEBT | 669226 | 669226 | ||
| MEDICAID | 284990 | 284990 | ||
| EMPLOYEE RECRUITMENT | 42513 | 31362 | 11151 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 81671 | Total |
| Program Services | 60174 | ProgramServices |
| Management And General | 21496 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 9302896 | Total |
| Program Services | 6981650 | ProgramServices |
| Management And General | 2225707 | ManagementAndGeneral |
| Fundraising | 95539 | Fundraising |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 530516 | BOY |
| EOY | 813587 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 466332 | BOY |
| EOY | 243307 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1491833 | BOY |
| EOY | 1316635 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 238065 | BOY |
| EOY | 226232 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 98552 | BOY |
| EOY | 97042 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 22958889 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 8014215 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3948116 | BOY |
| EOY | 14944674 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6773414 | BOY |
| EOY | 17641477 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1657715 | BOY |
| EOY | 1743088 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 88472 | BOY |
| EOY | 8337359 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1746187 | BOY |
| EOY | 10080447 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5027227 | BOY |
| EOY | 7561030 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5027227 | BOY |
| EOY | 7561030 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 6773414 | BOY |
| EOY | 17641477 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 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 | 98813 | OtherCostOrOtherBasis |
| Book Value | 98813 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2545058 | OtherCostOrOtherBasis |
| Depreciation | 2265425 | Depreciation |
| Book Value | 279633 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 6167016 | OtherCostOrOtherBasis |
| Depreciation | 5748790 | Depreciation |
| Book Value | 418226 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 14148002 | OtherCostOrOtherBasis |
| Book Value | 14148002 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 14944674 | TotalOfBookValueLandBuildings |
| Total Revenue | 11836699 | TotalRevenue |
| Total Expenses | 9302896 | TotalExpenses |
| Excess Or Deficit For Year | 2533803 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 2533803 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 10669804 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 613063 | OtherRevenues |
| Revenue Not Rptd F990 | 613063 | RevenueNotRptdF990 |
| Revenue Subtotal | 10056741 | RevenueSubtotal |
| Other Revenues Not Included | 1779958 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 1779958 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 11836699 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 9352786 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 49890 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 49890 | ExpensesNotRptdF990 |
| Expenses Subtotal | 9302896 | ExpensesSubtotal |
| Total Expenses Per Form990 | 9302896 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FIN 48 | SCHEDULE D, PART X, LINE 2 | THE HOSPITAL ADOPTED PROVISIONS OF FINANCIAL ACCOUNTING STANDARDS BOARD INTERPRETATION NO. 48 (FIN 48), ACCOUNTING FOR UNCERTAINTY IN INCOME TAXES-AN INTERPRETATION OF FASB STATEMENT NO. 109, WHICH WAS SUBSEQUENTLY INCORPORATED INTO THE FASB ACCOUNTING CODIFICATION (ASC) TOPIC 740. THE IMPLEMENTATION OF THIS STANDARD HAD NO SIGNIFICANT IMPACT ON THE HOSPITAL'S FINANCIAL STATEMENTS. |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XII, LINE 2D & 4B | LINE 2D: -------- RELATED ORGANIZATION'S REVENUE $ 580,337 SPECIAL EVENT EXPENSES $ 32,589 RECLASS OF RENTAL EXPENSES $ 137 ----------- TOTAL $ 613,063 =========== LINE 4B: CONTRIBUTION $1,779,958 ----------- TOTAL $1,779,958 =========== |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XIII, LINE 2D | RELATED ORGANIZATION'S EXPENSES $ 17,164 SPECIAL EVENT EXPENSES $ 32,589 RECLASS OF RENTAL EXPENSES $ 137 ---------- TOTAL $ 49,890 ========== |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURN. | NameOfEvent1 |
| Gross Receipts Event1 | 61357 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 25729 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 35628 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 0 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 9708 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 6153 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 2741 | FoodAndBeverageEvent1 |
| Entertainment Event1 | 0 | EntertainmentEvent1 |
| Other Direct Expenses Event1 | 2595 | OtherDirectExpensesEvent1 |
| Name Of Event2 | CEL. DINNER | NameOfEvent2 |
| Gross Receipts Event2 | 33158 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 20102 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 13056 | GrossRevenueEvent2 |
| Cash Prizes Event2 | 1612 | CashPrizesEvent2 |
| Non Cash Prizes Event2 | 0 | NonCashPrizesEvent2 |
| Rent Facility Costs Event2 | 3507 | RentFacilityCostsEvent2 |
| Food And Beverage Event2 | 3399 | FoodAndBeverageEvent2 |
| Entertainment Event2 | 0 | EntertainmentEvent2 |
| Other Direct Expenses Event2 | 2141 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 17148 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 0 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 17148 | GrossRevenueOtherEvents |
| Cash Prizes Other Events | 0 | CashPrizesOtherEvents |
| Non Cash Prizes Other Events | 0 | NonCashPrizesOtherEvents |
| Rent Facility Costs Other Events | 0 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 0 | FoodAndBeverageOtherEvents |
| Entertainment Other Events | 0 | EntertainmentOtherEvents |
| Other Direct Expenses Other Events | 733 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 111663 | GrossReceiptsTotal |
| Charitable Contributions Total | 45831 | CharitableContributionsTotal |
| Gross Revenue Total Events | 65832 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1612 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 9708 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 9660 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 6140 | FoodAndBeverageTotalEvents |
| Entertainment Total Events | 0 | EntertainmentTotalEvents |
| Other Direct Expenses Total Events | 5469 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 32589 | DirectExpenseSummaryEvents |
| Net Income Summary | 33243 | 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 | 132231 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 132231 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01420 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1349332 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 924969 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 424363 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04560 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1481563 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 924969 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 556594 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05980 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 8304 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1735 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 6569 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 15095 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 4590 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10505 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 299014 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 301233 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1837 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1888 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 1888 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 324301 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 307558 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 20799 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00220 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1805864 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1232527 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 577393 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.06200 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1851 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1851 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Leadership Development LeadershipDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 4162 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 4162 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 14243 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 14243 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00150 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 1841 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 1841 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00020 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 22097 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 22097 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00230 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $683,671 | BadDebtExpenseAmount |
| Amount Attributable To | 19670 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 3673206 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4800734 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | -1127528 | 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 |
Form990 Schedule H Part V Form990ScheduleHPartV
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 | 405 E MAIN | 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 VI Form990ScheduleHPartVI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Costing Method Used | 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. | CostingMethodUsed |
| Subsidized Health Services Expln | THE HOSPITAL INCLUDED $242,861 FROM A PHYSICIAN CLINIC. | SubsidizedHealthServicesExpln |
| Percent Of Total Expense Expln | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FORM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $669,226. | PercentOfTotalExpenseExpln |
| Bad Debt Footnote | 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. | BadDebtFootnote |
| Shortfall As Community Benefit | THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 21% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. 57% OF THE HOSPITAL'S REVENUE IS GENERATED BY THESE MEDICARE BENEFICIARIES. OUR CUSTOMER SERVICE SURVEYS RATE COMMUNITY HOSPITAL-FAIRFAX CONSISTENTLY OVER 90%, SHOWING THESE MEDICARE BENEFICIARIES APPRECIATE THE SERVICES THE HOSPITAL PROVIDES AND HOW THE SERVICES ARE PROVIDED. THE COSTING SOURCE WAS THE FY10 MEDICARE COST REPORT. | ShortfallAsCommunityBenefit |
| Debt Collection Policy | 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. | DebtCollectionPolicy |
| Needs Assessment | THE HOSPITAL WILL BE DOING A COMMUNITY NEEDS ASSESEMENT IN THE NEAR FUTURE BUT HAS NOT DONE ONE YET. | NeedsAssessment |
| Patient Education Assistance | 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 EVERY INPATIENT PATIENT ROOM AND IN THE WAITING AREAS AT ADMISSIONS, EMERGENCY ROOMS, AND OTHER OUTPATIENT WAITING AREAS. UNINSURED INPATIENTS ARE VISITED BY COLLECTIONS STAFF WHO EXPLAIN THE OPTIONS AVAILABLE, SUCH AS CHARITY CARE AND MEDICALLY INDIGENT FINANCIAL ASSISTANCE, ASSISTANCE IN APPLYING FOR MEDICAID OR ANY OTHER FINANCIAL PROGRAM THE PATIENT NEEDS HELP APPLYING FOR. THIS SAME ASSISTANCE IS AVAILABLE FOR OUTPATIENTS. PATIENTS MAY QUALIFY FOR A CHARITY DISCOUNT OR A MEDICALLY INDIGENT DISCOUNT, DEPENDING ON THEIR FINANCIAL SITUATION AND USING THE FEDERAL POVERTY GUIDELINES. | PatientEducationAssistance |
| Community Information | THE COMMUNITY SERVED BY COMMUNITY HOSPITAL ASSOCIATION IS MAINLY AGRICULTURAL-RELATED BUSINESSES WITH A DECREASING POPULATION AND A DECLINE IN 'MAIN STREET' BUSINESSES. MANY CONSTITUENTS TRAVEL A 30-MILE RADIUS TO WORK IN FACTORIES. 2009 UNEMPLOYMENT RATES FOR THE AREAS: ATCHISON COUNTY 7.4 (4.7 IN 2008); HOLT COUNTY 7.2 (5.0 IN 2008). | CommunityInformation |
| 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. | CommunityBuildingActivities |
| Other Information | COMMUNITY HOSPITAL ASSOCIATION ALLOWS AREA ORGANIZATIONS TO HOLD WEEKLY/MONTHLY MEETINGS IN ITS CONFERENCE ROOM, SUCH AS WEIGHT WATCHERS, KIWANIS, QUILT GUILD, AMBULANCE DISTRICT. | OtherInformation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | false | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION AND BOOKS ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 9 | NumberOfRecipients |
| Amount Of Cash Grant | 5475 | AmountOfCashGrant |
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 | 160101 | 0 | 0 | 0 | 0 | 0 | 11563 | 0 | 3272 | 0 | 174936 | 0 | 0 |
| STEPHANIE DAUBERT | |||||||||||||
| 0 | 164645 | 0 | 0 | 0 | 0 | 0 | 13838 | 0 | 3346 | 0 | 181829 | 0 | 0 |
| MYRA EVANS | |||||||||||||
| 161738 | 0 | 0 | 0 | 0 | 0 | 12136 | 0 | 4196 | 0 | 178070 | 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 (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 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 11A | 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. |
| 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. |
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 | |||||||||
| 405 E MAIN | FAIRFAX | MO | 64446 | 431757553 | SUPPORT ORG | MO | 501(C)(3) | 11A | NA |
| 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 | false | 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
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 1799665 | AmountInvolved |