2011-02-15T08:57:37-06:00 2010-06-30 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2009-07-01 440537826 Community Hospital Association Inc COMM 6606862211 PO Box 107 Fairfax MO 644460107 MYRA EVANS 2011-02-15 true Michael J Engle 8162216300 2009 2016-02-24 21:20:13Z MYRA EVANS 405 E MAIN FAIRFAX MO 66446 11869425 false X N/A X 1976 MO TO PROVIDE QUALITY ACUTE CARE HOSPITAL SERVICES 15 12 117 205 0 0 793875 2038618 9941119 9691201 4352 6014 90762 100866 10830108 11836699 33230 5475 0 0 4834182 4683566 60966 0 95539 4627976 4613855 9556354 9302896 1273754 2533803 6773414 17641477 1746187 10080447 5027227 7561030 TO SERVE AND CARE FOR THE PHYSICAL, EMOTIONAL AND SOCIAL WELL-BEING OF THE SURROUNDING COMMUNITIES false false 6981650 28475 9691201 TO PROVIDE MEDICAL SERVICES, HEALTH EDUCATION, AND WELLNESS SERVICES INCLUDING, BUT NOT LIMITED TO DENTAL, OBSTETRICS, SURGERY, PEDIATRICS, AND INTERNAL MEDICINE 6981650 true true false false false false false false false true false true false false false false false false true false true false true true false false false false false false false false false false false false false true true false false true 11 0 true 117 true false false false false false true true false false false 15 12 false true false false false false false true true false false true true true true true true true true false MO X SUZANNE SOUTHARD 6606862211 405 E MAIN FAIRFAX MO 64446 BILL SLAUGHTER 1.0 X X 0 0 0 NANCY HURST 1.0 X X 0 0 0 SANDRA FUHRMAN 1.0 X X 0 0 0 RICHARD OSWALD 1.0 X 0 0 0 BILL SMITH 1.0 X 0 0 0 JACQUE GEBHARDS 1.0 X 0 0 0 STEVE CUNNINGHAM 1.0 X 0 0 0 NANCY PETERS 1.0 X 0 0 0 BOB JACKSON 1.0 X 0 0 0 DOUGLAS KLINE 1.0 X 0 0 0 BEVERLY WHITE 1.0 X 0 0 0 PATRICIA FISHER 1.0 X 0 0 0 R ARON BURKE MD 1.0 X 37353 0 0 WC BUD TICE 1.0 X 0 160101 14835 STEPHANIE DAUBERT 1.0 X 0 164645 17184 MYRA EVANS 40.0 X 161738 0 16332 SUZANNE SOUTHARD 40.0 X 52064 0 9092 GARY MCINTYRE 40.0 X 130322 0 3604 381477 324746 61047 2 false true false 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 8 45831 1799665 193122 2038618 NET PATIENT SERVICE REVENUE 621990 9691201 9691201 9691201 6014 6014 0 0 900 137 763 763 763 0 65832 45831 32589 33243 33243 0 0 CAFETERIA 722210 45967 45967 MISCELLANEOUS 900099 20893 20893 66860 11836699 9691201 0 106880 0 5475 5475 0 0 289748 289748 0 3758810 2910358 815499 32953 93290 77360 14835 1095 222764 192344 28022 2398 318954 241177 74362 3415 213672 155425 56046 2201 16619 12260 4359 59401 58789 612 0 0 0 1227929 905843 322086 35123 11608 9213 14302 1022871 721984 268299 32588 0 0 146757 106751 38494 1512 47153 31386 12368 3399 0 0 9061 6591 2377 93 0 329982 243392 86590 84039 61130 22043 866 REPAIRS & MAINT. 294978 217605 77373 DUES & SUBSCRIPTIONS 47871 35209 12557 105 BAD DEBT 669226 669226 MEDICAID 284990 284990 EMPLOYEE RECRUITMENT 42513 31362 11151 81671 60174 21496 9302896 6981650 2225707 95539 530516 813587 466332 243307 1491833 1316635 238065 226232 98552 97042 22958889 8014215 3948116 14944674 6773414 17641477 1657715 1743088 88472 8337359 1746187 10080447 X 5027227 7561030 5027227 7561030 6773414 17641477 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 98813 98813 2545058 2265425 279633 6167016 5748790 418226 14148002 14148002 14944674 11836699 9302896 2533803 2533803 10669804 613063 613063 10056741 1779958 1779958 11836699 9352786 49890 49890 9302896 9302896 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 ========== GOLF TOURN. 61357 25729 35628 0 9708 6153 2741 0 2595 CEL. DINNER 33158 20102 13056 1612 0 3507 3399 0 2141 1 17148 0 17148 0 0 0 0 0 733 111663 45831 65832 1612 9708 9660 6140 0 5469 32589 33243 true true true X true X true true false false 132231 132231 0.01420 1349332 924969 424363 0.04560 1481563 924969 556594 0.05980 8304 1735 6569 0.00070 15095 4590 10505 0.00110 299014 301233 1837 0.00020 1888 1888 0.00020 324301 307558 20799 0.00220 1805864 1232527 577393 0.06200 1851 1851 0.00020 4162 4162 0.00040 14243 14243 0.00150 1841 1841 0.00020 22097 22097 0.00230 false 683671 19670 3673206 4800734 -1127528 X true true COMMUNITY HOSPITAL-FAIRFAX

405 E MAIN FAIRFAX MO 64446

X X X X 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. THE HOSPITAL INCLUDED $242,861 FROM A PHYSICIAN CLINIC. THE AMOUNT OF BAD DEBT EXPENSE REMOVED FORM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $669,226. 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. 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. 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. THE HOSPITAL WILL BE DOING A COMMUNITY NEEDS ASSESEMENT IN THE NEAR FUTURE BUT HAS NOT DONE ONE YET. 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. 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). 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. COMMUNITY HOSPITAL ASSOCIATION ALLOWS AREA ORGANIZATIONS TO HOLD WEEKLY/MONTHLY MEETINGS IN ITS CONFERENCE ROOM, SUCH AS WEIGHT WATCHERS, KIWANIS, QUILT GUILD, AMBULANCE DISTRICT. false TUITION AND BOOKS ASSISTANCE 9 5475 X X false false false false false false false false false 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 COMPENSATION FROM RELATED ORGANIZATION FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J, PART II 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. 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. 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 false false true false true false false false false false true false true true false true false false COMMUNITY HEALTHCARE FOUNDATION C 1799665