SUMNER COMMUNITY CLUB: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- SUMNER COMMUNITY CLUB (EIN 42-0670596)
- Tax period
- 2010-01-01 to 2010-12-31
- Filed
- 2011-11-11
- IRS object ID
- 201113159349303561
- Schema version
- 2010v3.2
- 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 H
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2011-11-11T15:21:23-06:00 | Timestamp |
| Tax Period End Date | 2010-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SEIM JOHNSON LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT STREET SUITE 200 | AddressLine1 |
| City | OMAHA | City |
| State | NE | State |
| ZIP Code | 680224722 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 420670596 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUMNER COMMUNITY CLUB | BusinessNameLine1 |
| Business Name Line2 | D/B/A COMMUNITY MEMORIAL HOSPITAL | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | SUMN | NameControl |
| Phone | 5635783275 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 W 1ST STREET PO BOX 148 | AddressLine1 |
| City | SUMNER | City |
| State | IA | State |
| ZIP Code | 506740148 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MARY S WELLS | Name |
| Title | CEO | Title |
| Phone | 5635783275 | Phone |
| Date Signed | 2011-11-06 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | BARBARA J FAJEN | Name |
| Phone | 4023302660 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MARY S WELLS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 W 1ST STREET PO BOX 148 | AddressLine1 |
| City | SUMNER | City |
| State | IA | State |
| ZIP Code | 506740148 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 9843906 | GrossReceipts |
| Group Return For Affiliates | 0 | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.CMHSUMNER.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1950 | YearFormation |
| State Legal Domicile | IA | StateLegalDomicile |
| Activity Or Mission Description | COMMUNITY MEMORIAL HOSPITAL SERVES THE AREA THROUGH ITS HEALTHCARE AND EDUCATIONAL SERVICES. WE EMPHASIZE CONCERN FOR THE QUALITY OF A PERSON' S LIFE, THROUGH EVERY MEASURE INTENDED TO PRESERVE LIFE WITH DIGNITY AND RESPECT. WE ARE DEDICATED TO CREATING AND MAINTAINING AN ENVIRONMENT SUPPORTING EXCELLENCE IN HEALTHCARE. WE PROVIDE QUALIFIED AND PROPERLY TRAINED PERSONNEL AND MEDICAL STAFF IN AN ATMOSPHERE WHICH INSPIRES A CREATIVE APPROACH TO THE COMPLEX HEALTHCARE CHALLENGES OF TODAY AND TOMORROW. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 13 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 0 | TotalNbrVolunteers |
| Total Gross UBI | 1781 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | -372 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 108655 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 591026 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 8791882 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 9081554 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 31147 | InvestmentIncomePriorYear |
| Investment Income Current Year | 16459 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 96377 | OtherRevenuePriorYear |
| Other Revenue Current Year | 146051 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 9028061 | TotalRevenuePriorYear |
| Total Revenue Current Year | 9835090 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4491299 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 4714193 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 4019238 | OtherExpensePriorYear |
| Other Expenses Current Year | 4146237 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 8510537 | TotalExpensesPriorYear |
| Total Expenses Current Year | 8860430 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 517524 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 974660 | RevenuesLessExpensesCY |
| Total Assets BOY | 10461465 | TotalAssetsBOY |
| Total Assets EOY | 11272413 | TotalAssetsEOY |
| Total Liabilities BOY | 2663642 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 2454855 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7797823 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 8817558 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF SUMNER AND SURROUNDING AREAS, WHILE COORDINATING OTHER NEEDED SERVICES. | MissionDescription |
| Significant New Program Services | 0 | SignificantNewProgramServices |
| Significant Change | 0 | SignificantChange |
| Expense | 809407 | Expense |
| Revenue | 1559325 | Revenue |
| Description | DURING THE YEAR OF 2010, CMH MEDICAL CLINIC WAS STAFFED WITH 3 PROVIDERS WHICH CONSISTED OF 2 PHYSICIANS AND 1 NURSE PRACTITIONER. THE PROVIDERS OFFERED CARE TO ALL AGE RANGES, NEWBORN TO GERIATRIC, INCLUDING WELL CHILD VISITS, IMMUNIZATIONS, ROUTINE PEDIATRIC CARE, SHARED MATERNITY CARE, AND WOUND CARE. FOR THE YEAR 2010, 7425 PATIENTS WERE SERVED FROM AN APPROXIMATE 50 MILE RADIUS. PROVIDERS ALSO ROUNDED MONTHLY ON NURSING HOME PATIENTS AT HILLCREST HOME IN SUMNER AND TRIPOLI NURSING HOME IN TRIPOLI. IN ADDITION, PROVIDERS ALSO DID PHYSICALS FOR AREA FIREFIGHTER AND EMS AGENCIES AND POST-JOB OFFER PHYSICALS FOR TWO LOCAL BUSINESSES. THE PROVIDERS ALSO TOOK CALL FOR THE EMERGENCY DEPARTMENT ON A REGULAR SCHEDULED BASIS THROUGHOUT EACH MONTH. THE PROVIDERS ALSO PRECEPTED A NUMBER OF STUDENTS FROM VARIOUS PROGRAMS FROM ALLEN COLLEGE IN WATERLOO AND UPPER IOWA UNIVERSITY IN FAYETTE. CLINIC STAFF WENT TO AN AREA BANK THE FIRST TUESDAY OF EACH MONTH AND OFFERED FREE BLOOD PRESSURE CHECKS. CLINIC HOURS ARE MONDAY THROUGH FRIDAY STARTING AT 7 AM AND ENDING AT 5 PM. | Description |
Activity2 Activity2
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 827442 | Expense |
| Revenue | 413785 | Revenue |
| Description | IN 2010 CMH HAD 174 PATIENT ACUTE ADMISSIONS WHICH IS HIGHER THAN THE PRIOR YEAR. THE NURSING MEDICAL SUPPLIES AND RESOURCES USED ARE GREATER THAN 2009 AS WELL. CMH UTILIZED A RESOURCE CALLED EXECUTIVE HEALTH RESOURCES (EHR) TO ASSIST WITH SECONDARY ACUTE ADMISSION AND CONTINUED STAY REVIEWS FOR MEETING GUIDELINES FOR ADMISSION CRITERIA. THIS ENSURES COMPLIANCE AS TO THE APPROPRIATE LEVEL OF CARE THAT THE PATIENT IS ADMITTED TO. | Description |
Activity3 Activity3
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 702457 | Expense |
| Revenue | 969279 | Revenue |
| Description | THE CMH EMERGENCY DEPARTMENT SERVED A TOTAL OF 1202 PATIENTS IN 2010. THIS IS A DECLINE OF 114 VISITS COMPARED TO 1316 IN 2009. HOWEVER, THE NUMBER OF PHYSICIAN HOURS SPENT IN THE ED INCREASED FROM 1832 IN 2009 TO 2210 IN 2010. IN 2010 THE ED IMPLEMENTED CQI PROJECTS THAT MONITORED PHYSICIAN ARRIVAL TO THE ED WITHIN 30 MINUTES, RETURN VISITS BY PATIENTS WITH THE SAME DIAGNOSIS, COMPLETENESS OF EMERGENCY TRANSFER FORMS, CHEST PAIN PROTOCOLS, AND PAIN RESOLUTION. THE EDUCATIONAL FOCUS FOR 2010 CENTERED ON TRAUMA DOCUMENTATION AND EMTALA TRAINING. OTHER AREAS OF EDUCATION THAT WERE HIGHLIGHTED INCLUDE INSERTION OF CENTRAL LINES, CHEST PAIN PROTOCOLS, COMPUTERIZED CHARTING, AND OB DELIVERIES. | Description |
Activity Other ActivityOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | 5036394 | Expense |
| Revenue | 6212395 | Revenue |
| Description | VARIOUS INPATIENT AND OTHER HEALTH CARE SERVICES. | Description |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Other Program Service Exp | 5036394 | TotalOfOtherProgramServiceExp |
| Total Of Other Program Service Rev | 6212395 | TotalOfOtherProgramServiceRev |
| Total Program Service Expense | 7375700 | TotalProgramServiceExpense |
| Described In501 C3 | 1 | DescribedIn501C3 |
| Schedule B Required | 1 | ScheduleBRequired |
| Political Activities | 0 | PoliticalActivities |
| Lobbying Activities | 0 | LobbyingActivities |
| Donor Advised Funds | 0 | DonorAdvisedFunds |
| Conservation Easements | 0 | ConservationEasements |
| Collections Of Art | 0 | CollectionsOfArt |
| Credit Counseling | 0 | CreditCounseling |
| Term Or Permanent Endowments | 1 | TermOrPermanentEndowments |
| Report Land Bldg Equip | 1 | ReportLandBldgEquip |
| Report Invest Oth Securities | 1 | ReportInvestOthSecurities |
| Report Prog Rel Invest | 0 | ReportProgRelInvest |
| Report Other Assets | 0 | ReportOtherAssets |
| Report Other Liabilities | 0 | ReportOtherLiabilities |
| Report Fin48 Footnote | 1 | ReportFin48Footnote |
| Independent Audit Financial Stmt | 0 | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | 1 | ConsolidatedAuditFinancialStmt |
| School | 0 | School |
| Foreign Office | 0 | ForeignOffice |
| Foreign Activities | 0 | ForeignActivities |
| More Than5000 K To Organizations | 0 | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividuals |
| Professional Fundraising | 0 | ProfessionalFundraising |
| Fundraising Activities | 0 | FundraisingActivities |
| Gaming | 0 | Gaming |
| Hospital | 1 | Hospital |
| Financial Stmt Attached | 0 | FinancialStmtAttached |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Schedule J Required | 1 | ScheduleJRequired |
| Tax Exempt Bonds | 1 | TaxExemptBonds |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBonds |
| Escrow Account | 0 | EscrowAccount |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Excess Benefit Transaction | 0 | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | 0 | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | 0 | LoanToOfficerOrDQP |
| Grant To Related Person | 0 | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | 0 | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | 1 | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | 1 | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | 0 | DeductibleNonCashContributions |
| Deductible Contributions Of Art | 0 | DeductibleContributionsOfArt |
| Terminated | 0 | Terminated |
| Partial Liquidation | 0 | PartialLiquidation |
| Disregarded Entity | 0 | DisregardedEntity |
| Related Entity | 1 | RelatedEntity |
| Related Org Controlled Entity | 1 | RelatedOrgControlledEntity |
| Transaction Related Entity | 0 | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | 0 | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | 0 | ActivitiesConductedPartnership |
| Schedule O Required | 1 | ScheduleORequired |
| Number Forms Transmitted With1096 | 11 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | 1 | ComplianceWithBackupWitholding |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | 1 | UnrelatedBusinessIncome |
| Form990-T Filed | 1 | Form990-TFiled |
| Foreign Financial Account | 0 | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTrans |
| Taxable Party Notification | 0 | TaxablePartyNotification |
| Non Deductible Contributions | 0 | NonDeductibleContributions |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributions |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | 0 | FundsToPayPremiums |
| Premiums Paid | 0 | PremiumsPaid |
| Indoor Tanning Services | 0 | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 13 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | 0 | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | 1 | DelegationOfManagementDuties |
| Changes To Organizing Docs | 0 | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuse |
| Members Or Stockholders | 1 | MembersOrStockholders |
| Election Of Board Members | 1 | ElectionOfBoardMembers |
| Decisions Subject To Approval | 1 | DecisionsSubjectToApproval |
| Minutes Of Governing Body | 1 | MinutesOfGoverningBody |
| Minutes Of Committees | 1 | MinutesOfCommittees |
| Officer Mailing Address | 0 | OfficerMailingAddress |
| Local Chapters | 0 | LocalChapters |
| Form990 Provided To Governing Body | 1 | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | 1 | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | 1 | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | 1 | RegularMonitoringEnforcement |
| Whistleblower Policy | 1 | WhistleblowerPolicy |
| Document Retention Policy | 1 | DocumentRetentionPolicy |
| Compensation Process CEO | 0 | CompensationProcessCEO |
| Compensation Process Other | 0 | CompensationProcessOther |
| Investment In Joint Venture | 0 | InvestmentInJointVenture |
| States Where Copy Of Return Is Filed | IA | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
Name Business NameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SARA TRAINOR | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Telephone Number | 5635783275 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 WEST 1ST STREET PO BOX 148 | AddressLine1 |
| City | SUMNER | City |
| State | IA | State |
| ZIP Code | 50674 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (19 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | OfficerOfficer | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| PAUL BAHE | |||||||
| BOARD MEMBER - CHAIR | 1.30 | X | 0 | 0 | 0 | ||
| MIKE MEYER | |||||||
| BOARD MEMBER - VICE CHAIR | 1.30 | X | 0 | 0 | 0 | ||
| DEB TOENGES | |||||||
| BOARD MEMBER - SEC/TREAS | 1.30 | X | 0 | 0 | 0 | ||
| DEB BECKNER | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| LUARA NECKER | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| DAVE VOSS | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| JAMES LAHMANN | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| CONNIE LEICHER | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| MIKE SCHAFFNER | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| RICK PEDERSON | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| JENNIFER YEAROUS | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| BILL SCHWAKE | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| DIANE PAGEL | |||||||
| BOARD MEMBER | 0.80 | X | 0 | 0 | 0 | ||
| MARY WELLS | |||||||
| CEO | 40.00 | 135278 | 0 | 19195 | X | ||
| SARA TRAINOR | |||||||
| CFO | 40.00 | 97621 | 0 | 29576 | X | ||
| LYNNE NIEMANN | |||||||
| DIRECTOR OF NURSING & PATIENT CARE | 40.00 | 80806 | 0 | 16387 | X | ||
| TROY BUCHHOLZ | |||||||
| PHYSICIAN | 40.00 | 291479 | 0 | 31050 | X | ||
| TED SAI SCHWARM | |||||||
| PHYSICIAN | 40.00 | 259207 | 0 | 28833 | X | ||
| ROBERTA MITTELSTED | |||||||
| ARNP | 40.00 | 93018 | 0 | 18526 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 864391 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 0 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 125041 | TotalOtherCompensation |
| Number Individuals GT100 K | 3 | NumberIndividualsGT100K |
| Formers Listed | 0 | FormersListed |
| Total Comp GT150 K | 1 | TotalCompGT150K |
| Compensation From Other Sources | 0 | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PERFORMANCE REHAB LLC | |||||
| 909 W 1ST ST | SUMNER | IA | 50674 | REHAB SERVICES | 351950 |
| CPSI | |||||
| 6600 WALL STREET | MOBILE | AL | 36695 | COMPUTER SERVICES | 189095 |
| EMERGENCY PRACTICE ASSOCIATES INC | |||||
| PO BOX 1260 | WATERLOO | IA | 50704 | ED COVERAGE | 154650 |
| ALLEN MEMORIAL HOSPITAL - DES MOINES | |||||
| 1200 PLEASANT ST | DES MOINES | IA | 50309 | LAB SERVICES | 151397 |
| HEALTH ENTERPRISES OF IOWA | |||||
| 4250 GLASS ROAD NE | CEDAR RAPIDS | IA | 52403 | CRNA AND RADIOLOGY | 140845 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 5 | NumberOfContractorsGT100K |
| Related Organizations | 1082 | RelatedOrganizations |
| Government Grants | 37444 | GovernmentGrants |
| All Other Contributions | 552500 | AllOtherContributions |
| Total Contributions | 591026 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| MEDICARE/MEDICAID PAYM | 621400 | 5812974 | 5812974 |
| PATIENT REVENUE - PRIV | 621400 | 3250275 | 3250275 |
| COMMUNITY WELLNESS | 621990 | 18305 | 18305 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 9081554 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 24444 | TotalRevenueColumn |
| Exclusion | $24,444 | ExclusionAmount |
Gross Rents GrossRents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 47735 | Real |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 47735 | Real |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 47735 | TotalRevenueColumn |
| Exclusion | $47,735 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 831 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 8587 | Securities |
| Other | 229 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | -8587 | Securities |
| Other | 602 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -7985 | TotalRevenueColumn |
| Exclusion | -$7,985 | ExclusionAmount |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome | ExclusionExclusionAmount | Unrelated Business RevenueUnrelatedBusinessRevenue |
|---|---|---|---|---|---|
| MISCELLANEOUS INCOME | 900099 | 73230 | 73230 | ||
| CAFETERIA EMPLOYEES | 900099 | 23305 | $23,305 | ||
| CATERING | 722320 | 1781 | 1781 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 98316 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9835090 | TotalRevenueColumn |
| Related Or Exempt Function Income | 9154784 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 1781 | UnrelatedBusinessRevenue |
| Exclusion | $87,499 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 989432 | Total |
| Program Services | 707762 | ProgramServices |
| Management And General | 281670 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 42415 | Total |
| Program Services | 42415 | ProgramServices |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2680688 | Total |
| Program Services | 2196381 | ProgramServices |
| Management And General | 484307 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 741677 | Total |
| Program Services | 617175 | ProgramServices |
| Management And General | 124502 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259981 | Total |
| Program Services | 209447 | ProgramServices |
| Management And General | 50534 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 192945 | Total |
| Management And General | 192945 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58288 | Total |
| Management And General | 58288 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1660342 | Total |
| Program Services | 1438788 | ProgramServices |
| Management And General | 221554 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17868 | Total |
| Program Services | 17868 | ProgramServices |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 960859 | Total |
| Program Services | 900100 | ProgramServices |
| Management And General | 60759 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 120087 | Total |
| Program Services | 120087 | ProgramServices |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 35370 | Total |
| Program Services | 25199 | ProgramServices |
| Management And General | 10171 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 97356 | Total |
| Program Services | 97356 | ProgramServices |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 514742 | Total |
| Program Services | 514742 | ProgramServices |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72433 | Total |
| Program Services | 72433 | ProgramServices |
Other Expenses OtherExpenses (3 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices |
|---|---|---|
| PROVISION FOR BAD DEBT | 286264 | 286264 |
| DUES AND SUBSCRIPTIONS | 97415 | 97415 |
| MISC. EXPENSES | 32268 | 32268 |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8860430 | Total |
| Program Services | 7375700 | ProgramServices |
| Management And General | 1484730 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 100 | BOY |
| EOY | 100 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3163035 | BOY |
| EOY | 3052573 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | 527182 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 946011 | BOY |
| EOY | 1397780 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 101196 | BOY |
| EOY | 101814 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 89299 | BOY |
| EOY | 88005 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 7746248 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4782702 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 3102239 | BOY |
| EOY | 2963546 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 284775 | BOY |
| EOY | 279574 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2638298 | BOY |
| EOY | 2684825 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 136512 | BOY |
| EOY | 177014 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10461465 | BOY |
| EOY | 11272413 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 980472 | BOY |
| EOY | 1063355 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1205000 | BOY |
| EOY | 1055000 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 478170 | BOY |
| EOY | 336500 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2663642 | BOY |
| EOY | 2454855 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5084129 | BOY |
| EOY | 5808829 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 75396 | BOY |
| EOY | 387171 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2638298 | BOY |
| EOY | 2621558 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7797823 | BOY |
| EOY | 8817558 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 10461465 | BOY |
| EOY | 11272413 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | 974660 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 45075 | ReconcilationOtherChanges |
| Info In Schedule O Part XII | X | InfoInScheduleOPartXII |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | 0 | AccountantCompileOrReview |
| FS Audited | 1 | FSAudited |
| Audit Committee | 1 | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequired |
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
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2638298 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 110582 | InvestmentEarningsOrLosses |
| Other Expenditures | 64055 | OtherExpenditures |
| End Of Year Balance | 2684825 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2634633 | BeginningOfYearBalance |
| Investment Earnings Or Losses | 58750 | InvestmentEarningsOrLosses |
| Other Expenditures | 55085 | OtherExpenditures |
| End Of Year Balance | 2638298 | EndOfYearBalance |
Current Year Minus2 Years CurrentYearMinus2Years
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 2889909 | BeginningOfYearBalance |
| Investment Earnings Or Losses | -246778 | InvestmentEarningsOrLosses |
| Other Expenditures | 8498 | OtherExpenditures |
| End Of Year Balance | 2634633 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Permanent Endowment EOY Balance | 1.00000 | PermanentEndowmentEOYBalance |
| Endowments Held By Unrelated Orgs | 1 | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | 0 | EndowmentsHeldByRelatedOrgs |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 49781 | OtherCostOrOtherBasis |
| Book Value | 49781 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4412561 | OtherCostOrOtherBasis |
| Depreciation | 2505350 | Depreciation |
| Book Value | 1907211 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 3017989 | OtherCostOrOtherBasis |
| Depreciation | 2116808 | Depreciation |
| Book Value | 901181 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 265917 | OtherCostOrOtherBasis |
| Depreciation | 160544 | Depreciation |
| Book Value | 105373 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 2963546 | TotalOfBookValueLandBuildings |
Other Securities OtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PERPETUAL TRUST | Description |
| Book Value | 2684825 | BookValue |
| Method Of Valuation | F | MethodOfValuation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Securities | 2684825 | TotalOfBookValueSecurities |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: | PART V, LINE 4: | THE HOSPITAL IS BENEFICIARY OF A DONOR CREATED PERPETUAL TRUST. THESE ASSETS ARE HELD IN PERPETUITY WITH ONLY THE INCOME BEING USED TO SUPPORT THE HOSPITAL'S OPERATIONS. |
| DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: | PART X: | THE HOSPITAL AND FOUNDATION ARE NOT-FOR-PROFIT CORPORATIONS AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE SERVICE AND ARE EXEMPT FROM FEDERAL INCOME TAXES IN RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2010 AND 2009, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | 1 | CharityCarePolicy |
| Written Policy | 1 | WrittenPolicy |
| FPG Reference Free Care | 1 | FPGReferenceFreeCare |
Other Percentage OtherPercentage
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Free Other Percentage | 125.000000000000 | FreeOtherPercentage |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | 1 | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | 1 | FreeDiscCareMedicallyIndigent |
| Amounts Budgeted For Charity Care | 1 | AmountsBudgetedForCharityCare |
| Expenses Exceeded Budget | 1 | ExpensesExceededBudget |
| Unable To Provide Care | 0 | UnableToProvideCare |
| Annual Community Benefit Report | 1 | AnnualCommunityBenefitReport |
| Report Publically Available | 0 | ReportPublicallyAvailable |
Charity Care At Cost CharityCareAtCost
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 55415 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 55415 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00650 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 55415 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 55415 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00650 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 25187 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 2790 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22397 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00260 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 45045 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 45045 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00530 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 295611 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 28639 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 266972 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.03110 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 28135 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 5324 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 22811 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00270 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 393978 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 36753 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 357225 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04170 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 449393 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 36753 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 412640 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04820 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 1 | BadDebtExpenseReported |
| Bad Debt Expense | $228,108 | BadDebtExpenseAmount |
| Amount Attributable To | 55415 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 4514224 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 4469529 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 44695 | 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 | 1 | WrittenDebtCollectionPolicy |
| Provision For Charity Care | 1 | ProvisionForCharityCare |
| Number Of Hospital Facilities | 1 | NumberOfHospitalFacilities |
Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Number | 1 | FacilityNumber |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SUMNER COMMUNITY CLUB DBA COMMUNITY | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | MEMORIAL HOSP 909 W 1ST ST PO BOX | AddressLine1 |
| Address Line2 | 148 | AddressLine2 |
| City | SUMNER | City |
| State | IA | State |
| ZIP Code | 50674 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
| Other | PROVIDER-BASED MEDICAL CLINIC | Other |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
Form990 Schedule H Part VI Form990ScheduleHPartVI (15 entries)
| ExplanationExplanation |
|---|
| PART I, LINE 3C: NOT APPLICABLE |
| PART I, LINE 6A: NOT APPLICABLE |
| PART I, LINE 7: THE COST TO CHARGE RATIO PER THE COST REPORT WAS USED TO CALCULATE THE AMOUNTS IN THE UPPER PORTION OF THE TABLE. COSTING OF THE "OTHER BENEFITS" PORTION OF THE TABLE WAS CALCULATED PER GUIDANCE PROVIDED BY THE IOWA HOSPITAL ASSOCIATION IN TERMS OF PROPER REPORTING OF COMMUNITY BENEFITS. |
| PART I, LINE 7G: NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED. |
| PART I, L7 COL(F): BAD DEBT EXPENSE OF $286,264 WAS DEDUCTED FROM TOTAL EXPENSES (PART IX, LINE 25) OF $8,860,430. THE RESULT, $8,574,166, WAS USED AS THE DENOMINATOR IN COMPUTING SCHEDULE H, PART I, LINE 7A THROUGH K, COLUMN (F).PERCENTAGES BASED ON COLUMN (C), TOTAL COMMUNITY BENEFIT EXPENSE, ARE AS FOLLOWS:CHARITY CARE AT COST - .65%COMMUNITY HEALTH IMPROVEMENT SERVICES - .29%HEALTH PROFESSIONALS EDUCATION - .53%SUBSIDIZED HEALTH SERVICES - 3.45%CASH & IN-KIND CONTRIBUTIONS - .33%TOTAL OTHER BENEFITS - 4.59%TOTAL - 5.24% |
| PART II: NOT APPLICABLE |
| PART III, LINE 4: PAYMENT FOR SERVICES IS EXPECTED WITHIN THIRTY DAYS OF RECEIPT OF THE BILLING. ACCOUNTS CONSIDERED PAST DUE ARE SENT TO COLLECTION AGENCIES WHEN INTERNAL COLLECTION EFFORTS HAVE BEEN UNSUCCESSFUL. ANY AMOUNTS DEEMED UNCOLLECTIBLE ARE WRITTEN OFF ON A MONTHLY BASIS. THE HOSPITAL DOES NOT CHARGE INTEREST ON OUTSTANDING BALANCES OWED. BAD DEBT EXPENSE IS NOT INCLUDED WITH COMMUNITY BENEFITS.LINE 2 WAS CALCULATED AS FOLLOWS: (TOTAL OPERATING EXPENSES LESS BAD DEBT EXPENSE) / GROSS PATIENT REVENUE X BAD DEBT EXPENSE AND LINE 3 WAS CALCULATED AS FOLLOWS: (TOTAL OPERATING EXPENSES LESS BAD DEBT EXPENSE) / GROSS PATIENT REVENUE X CHARITY CARE EXPENSEALL AMOUNTS ARE PER THE AUDITED FINANCIAL STATEMENTS. BAD DEBT EXPENSE IS NOT INCLUDED WITH COMMUNITY BENEFITS. |
| PART III, LINE 8: THIS IS NOT APPLICABLE, AS THERE WAS AN OVERAGE RATHER THAN A SHORTFALL. THE COSTING METHODOLOGY IS BASED ON A COST TO CHARGE RATIO AS WE ARE A CRITICAL ACCESS HOSPITAL. MEDICARE COST REPORT FIGURES WERE USED TO DETERMINE THE AMOUNTS REPORTED AS MEDICARE ALLOWABLE COSTS. |
| PART III, LINE 9B: COMMUNITY MEMORIAL HOSPITAL'S COLLECTIONS POLICY STATES "ALL COLLECTION EFFORTS WILL CEASE IF A COMPLETE CHARITY CARE APPLICATION HAS BEEN RECEIVED OR IF IT IS KNOWN THAT THE PATIENT QUALIFIES FOR PRESUMED CHARITY CARE. THE CFO WILL NOTIFY THE BUSINESS OFFICE MANAGER IN EACH OF THESE CASES. ONCE A DECISION HAS BEEN MADE ON THE CHARITY CARE APPLICATION, COLLECTION EFFORTS WILL STOP IF IT WAS APPROVED, OR CONTINUE WHERE THEY LEFT OFF IF THE APPLICATION WAS DENIED." |
| PART VI, LINE 7: THE COMMUNITY BENEFIT REPORT IS FILED WITH THE IOWA HOSPITAL ASSOCIATION. IT IS NOT FILED WITH THE STATE OF IOWA OR WITH ANY STATE AGENCY. |
| PART VI, LINE 2: THIS PAST YEAR A GROUP OF COMMUNITY MEMBERS WORKED ON A COMMITTEE TO HELP DIRECT THE SERVICES AND BUILDING OF A REPLACEMENT HOSPITAL. THIS GROUP OF PEOPLE AGREED TO MEET WITH OTHER MEMBERS OF THE COMMUNITY AND CAME BACK TO THE COMMITTEE WITH IDEAS. ALL WERE GIVEN AN OPPORTUNITY TO SHARE INPUT AND WHEN IDEAS WERE GIVEN THEY WERE INVESTIGATED. AN EXAMPLE OF THIS WAS TO OFFER A DIALYSIS OUTPATIENT CENTER. THIS WAS INVESTIGATED AND IT WAS FOUND THAT THE SURROUNDING AREAS WERE ALREADY SATURATED WITH THIS SERVICE AND THEY WOULD NOT SUPPORT IT AT SUMNER. CMH HAS LAY PERSONS FROM THE COMMUNITY WHO SERVE ON OUR BOARD OF DIRECTORS AND CMH FOUNDATION BOARD. THESE MEMBERS SHARE WITH CMH ANY IDEAS THEY HAVE HEARD FROM THE COMMUNITY. THE CMH AUXILIARY IS SUPPORTED FROM MEMBERS OF THE COMMUNITY. THEY ARE CONSTANTLY RESEARCHING THE NEEDS OF THE COMMUNITY AND LOOKING FOR WAYS TO SUPPORT CMH. THE CLERGY OF THE COMMUNITY ARE ALSO VERY ACTIVE AND HAVE OPEN COMMUNICATIONS WITH ADMINISTRATION ABOUT IDEAS THEY HAVE HEARD. ANOTHER WAY CMH REACHES OUT IS THROUGH THE PRESS GANEY PATIENT SATISFACTION SURVEY. CMH CURRENTLY HAS THREE (3) SURVEYS THAT GO OUT TO PATIENTS FOR IDEAS AND COMMENTS. |
| PART VI, LINE 3: CMH HAS A PAYMENT BROCHURE THAT IS LOCATED AT THE REGISTRATION DESK FOR ALL PATIENTS TO TAKE WITH THEM EXPLAINING OUR PAYMENT TERMS AND THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE IS ALSO AN AREA ON THE STATEMENTS SENT TO PATIENTS THAT ALLOWS FOR MESSAGES TO BE PRINTED. THE MESSAGE ROTATES, BUT AT TIMES INDICATES THE AVAILABILITY FOR ASSISTANCE FOR THOSE WHO QUALIFY. |
| PART VI, LINE 4: CMH'S PRIMARY SERVICE AREA CONSISTS OF FIVE ZIP CODES, WHICH INCLUDE SUMNER (50674), TRIPOLI (50676) WESTGATE (50681), FREDERICKSBURG (50630) AND HAWKEYE (52147). |
| PART VI, LINE 6: NOT APPLICABLE |
| PART VI, LINE 7: NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Severance Payment | 0 | SeverancePayment |
| Supplemental Nonqual Retire Plan | 0 | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | 0 | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | 0 | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | 0 | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | 0 | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | 0 | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | 0 | AnyNonFixedPayments |
| Initial Contract Exception | 0 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MARY WELLS | |||||||||||||
| 117022 | 0 | 18231 | 0 | 25 | 0 | 5614 | 0 | 13581 | 0 | 154473 | 0 | 0 | 0 |
| TROY BUCHHOLZ | |||||||||||||
| 172655 | 0 | 12000 | 0 | 106824 | 0 | 9988 | 0 | 21062 | 0 | 322529 | 0 | 0 | 0 |
| TED SAI SCHWARM | |||||||||||||
| 144805 | 0 | 0 | 0 | 114402 | 0 | 9989 | 0 | 18844 | 0 | 288040 | 0 | 0 | 0 |
Schedule K IRS990ScheduleK
Form990 Schedule K Part I Form990ScheduleKPartI
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF SUMNER IOWA | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Issuer EIN | 426005269 | IssuerEIN |
| CUSIP Number | 866451AS6 | CUSIPNumber |
| Date Issued | 2003-12-15 | DateIssued |
| Issue Price | 450000 | IssuePrice |
| Description Of Purpose | CONSTRUCTION AND IMPROVEMENTS TO FACILITIES | DescriptionOfPurpose |
| Defeased | 0 | Defeased |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuer |
| Pool Financing | 0 | PoolFinancing |
Form990 Schedule K Part II Form990ScheduleKPartII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Amount Retired | 235000 | AmountRetired |
| Total Proceeds | 450125 | TotalProceeds |
| Amount In Reserve Fund | 45300 | AmountInReserveFund |
| Capital Expenditures | 450125 | CapitalExpenditures |
| Year Of Subst Completion | 2004 | YearOfSubstCompletion |
| Current Refunding | 0 | CurrentRefunding |
| Advance Refunding | 0 | AdvanceRefunding |
| Final Allocation Made | 1 | FinalAllocationMade |
| Adequate Books And Recds Maintaind | 1 | AdequateBooksAndRecdsMaintaind |
Form990 Schedule K Part III Form990ScheduleKPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Owning Bond Financed Property | 0 | OwningBondFinancedProperty |
| Any Lease Arrangements | 0 | AnyLeaseArrangements |
| Mngment Cntrct Bond Financd Prprty | 1 | MngmentCntrctBondFinancdPrprty |
| Any Research Agreements | 0 | AnyResearchAgreements |
| Bond Counsel Routinely Engaged | 1 | BondCounselRoutinelyEngaged |
| Prcntge Prvt Business Use By Others | 0.00000 | PrcntgePrvtBusinessUseByOthers |
| Percentage Of Prvt Business Re UBI | 0.00000 | PercentageOfPrvtBusinessReUBI |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUse |
| Post Issuance Compliance Procdrs | 1 | PostIssuanceComplianceProcdrs |
Form990 Schedule K Part IV Form990ScheduleKPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8038 T Filed | 0 | Form8038TFiled |
| Variable Rate Issue | 0 | VariableRateIssue |
| Hedge Identified In Books And Recds | 0 | HedgeIdentifiedInBooksAndRecds |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGIC |
| Gross Proceeds Invested | 0 | GrossProceedsInvested |
| Exception To Rebate | 1 | ExceptionToRebate |
Form990 Schedule K Part V Form990ScheduleKPartV (2 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FORM 990, SCHEDULE K, PART III, LINE 3(A) | MANAGEMENT OR SERVICE CONTRACTS | THE ORGANIZATION HAS DETERMINED THAT THE SERVICE CONTRACTS ARE QUALIFIED CONTRACTS MEETING THE SAFE HARBOR AVAILABLE UNDER REVENUE PROCEDURE 97-13 AND DO NOT RESULT IN PRIVATE USE. |
| FORM 990, SCHEDULE K, PART III, LINE 3(C) | BOND COUNSEL TO REVIEW MANAGEMENT AND SERVICE CONTRACTS | THE ORGANIZATION REVIEWS SERVICE CONTRACTS ON AN AS NEEDED BASIS TO ENSURE COMPLIANCE WITH REVENUE PROCEDURE 97-13. |
Schedule L IRS990ScheduleL
Form990 Schedule L Part IV Form990ScheduleLPartIV
Name Of Interested Person NameOfInterestedPerson
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | JUSTIN TRAINOR | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship | SPOUSE OF CFO | Relationship |
| Amount Of Transaction | 351950 | AmountOfTransaction |
| Description Of Transaction | PERFORMANCE REHAB IS 40% OWNED BY JUSTIN TRAINOR, THE SPOUSE OF SARA TRAINOR, CFO. THE ENTITY PROVIDES PHYSICAL AND OCCUPATIONAL THERAPIES AT CMH. PERFORMANCE REHAB'S COMPENSATION FROM CMH IS CALCULATED AS A PERCENTAGE OF CMH'S NET REIMBURSEMENT FOR THERAPY SERVICES. | DescriptionOfTransaction |
| Sharing Of Revenues | 1 | SharingOfRevenues |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| FORM 990, PART VI, SECTION A, LINE 3 | THE ORGANIZATION HAS A MANAGEMENT CONTRACT WITH ALLEN HEALTH SYSTEMS. | |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION'S ARTICLES OF INCORPORATION PROVIDE THAT THE CORPORATION "HAS NO CAPITAL STOCK AND THE CAPITAL OF THIS ASSOCIATION SHALL BE THE MEMBERSHIP FEES . . . FIXED BY THE BOARD OF DIRECTORS". ANYONE IN THE COMMUNITY MAY BE A MEMBER OF THE CORPORATION UPON PAYMENT OF THE $1 MEMBERSHIP FEE, AS FIXED BY THE BOARD OF DIRECTORS IN THE BYLAWS. THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION A, LINE 7A | EACH BOARD OF DIRECTOR SHALL BE ELECTED BY THE LARGEST VOTE CAST BY THE MEMBERS PRESENT AT THE ANNUAL MEETING. ABSENTEE BALLOTS WILL BE ALLOWED FOR EMPLOYEES WORKING AT COMMUNITY MEMORIAL HOSPITAL DURING THE ACTUAL HOURS OF THE ANNUAL MEETING. | |
| FORM 990, PART VI, SECTION A, LINE 7B | IN 2003, COMMUNITY MEMORIAL HOSPITAL (CMH) ENTERED INTO AN OPERATING AGREEMENT WITH ALLEN HEALTH SYSTEM (AHS). UNDER THE TERMS OF THAT AGREEMENT, A JOINT GOVERNANCE STRUCTURE WAS ESTABLISHED, WHEREBY AHS AND THE BOARD OF DIRECTORS OF CMH EXERCISE JOINT AUTHORITY FOR THE OPERATION OF THE HOSPITAL. WHILE AHS HAS DAY-TO-DAY OPERATIONAL CONTROL, CERTAIN GOVERNANCE AUTHORITY ACTIONS REQUIRE THE PARTICIPATION OF BOTH AHS AND CMH'S BOARD OF DIRECTORS. | |
| FORM 990, PART VI, SECTION B, LINE 11 | THE IRS FORM 990 WILL BE PRESENTED TO THE CMH BOARD OF DIRECTORS AT A REGULARLY SCHEDULED MONTHLY MEETING FOR REVIEW. IT WILL BE NOTED AS AN AGENDA ITEM UNDER "NEW BUSINESS" AND REQUIRES THE PROPER APPROVAL FROM THE BOARD PRIOR TO BEING SUBMITTED. | |
| THE BOARD OF DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE/QUESTIONNAIRE. THESE ARE REVIEWED BY THE CEO AND BOARD CHAIR. EACH MONTH THERE IS AN AGENDA ITEM AT THE BOARD MEETING FOR ANY CONFLICTS RELATED TO THE REST OF THE AGENDA TO BE DISCLOSED. IF NONE ARE NOTED, BUT THE BOARD CHAIR FEELS ONE EXISTS, IT IS THE CHAIR'S RESPONSIBILITY TO INQUIRE ABOUT IT BEFORE PROCEEDING. WHEN THERE IS A CONFLICT OF INTEREST, THE PERSON WITH THE CONFLICT ABSTAINS FROM VOTING. | FORM 990, PART VI, SECTION B, LINE 12C | |
| THE ORGANIZATION IS JOINTLY OPERATED WITH ALLEN HEALTH SYSTEM. A VICE PRESIDENT OF ALLEN HEALTH SYSTEM IS RESPONSIBLE FOR SETTING THE SALARY FOR MARY WELLS, CEO. THE VP USES SALARY SURVEY INFORMATION FROM THE IOWA HOSPITAL ASSOCIATION TO DETERMINE A REASONABLE RANGE FOR THE CEO'S COMPENSATION. THE CEO IS RESPONSIBLE FOR SETTING THE SALARIES OF SARA TRAINOR, CFO AND LYNNE NIEMANN, DIRECTOR OF NURSING (BOTH ARE OFFICERS). COMPARABILITY DATA IS ALSO USED IN SETTING THE OFFICERS' COMPENSATION. | ||
| THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. HOWEVER, FINANCIAL STATEMENTS ARE MADE AVAILABLE AT THE SUMNER COMMUNITY CLUB MEETING AND A PERSON MAY BECOME A MEMBER OF THE SUMNER COMMUNITY CLUB BY PAYING THE $1.00 MEMBERSHIP FEE. | FORM 990, PART VI, SECTION C, LINE 19 | |
| AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATION | PAUL BAHE, BOARD CHAIR, DEVOTES AN AVERAGE OF .8 HOURS PER WEEK TO FRIENDS OF COMMUNITY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. JAMES LAHMANN, BOARD MEMBER, DEVOTES AN AVERAGE OF .8 HOURS PER WEEK TO FRIENDS OF COMMUNITY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. BILL SCHWAKE, BOARD MEMBER, DEVOTES AN AVERAGE OF .8 HOURS PER WEEK TO FRIENDS OF COMMUNITY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. MARY WELLS, CEO, DEVOTES AN AVERAGE OF 2.0 HOURS PER WEEK TO FRIENDS OF COMMUNITY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. SARA TRAINOR, CFO, DEVOTES AN AVERAGE OF .5 HOURS PER WEEK TO FRIENDS OF COMMUNITY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. LYNNE NIEMANN, DIRECTOR OF NURSING AND PATIENT CARE, DEVOTES AN AVERAGE OF .3 HOURS PER WEEK TO FRIENDS OF COMMUNITY MEMORIAL HOSPITAL, A RELATED ORGANIZATION. | FORM 990, PAGE 7, PART VII, SECTION A, LINE 1A |
| CHANGES IN NET ASSETS OR FUND BALANCES: | NET UNREALIZED GAINS ON INVESTMENTS: 45,075. | FORM 990, PART XI, LINE 5: |
| COMMITTEE WITH OVERSIGHT OF THE AUDIT | THERE HAVE BEEN NO CHANGES FROM THE PRIOR YEAR. THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY OF SELECTING THE INDEPENDENT ACCOUNTANT. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE BOARD OF DIRECTORS. | FORM 990, PAGE 12, PART XI, LINE 2C |
| PROCESS FOR DETERMINING COMPENSATION | THE ORGANIZATION IS JOINTLY OPERATED WITH ALLEN HEALTH SYSTEM. A VICE PRESIDENT OF ALLEN HEALTH SYSTEM IS RESPONSIBLE FOR SETTING THE SALARY FOR MARY WELLS, CEO. THE VP USES SALARY SURVEY INFORMATION FROM THE IOWA HOSPITAL ASSOCIATION TO DETERMINE A REASONABLE RANGE FOR THE CEO'S COMPENSATION. THE CEO IS RESPONSIBLE FOR SETTING THE SALARIES OF SARA TRAINOR, CFO AND LYNNE NIEMANN, DIRECTOR OF NURSING (BOTH ARE OFFICERS). COMPARABILITY DATA IS ALSO USED IN SETTING THE OFFICERS' COMPENSATION. | FORM 990, PAGE 6, PART VI, SECTION B, LINE 15 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII
Name Of Disregarded Entity NameOfDisregardedEntity
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FRIENDS OF CMH SUMNER COMMUNITY MEMORIAL HOSPITAL FOUNDATION | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 909 W 1ST STREET | AddressLine1 |
| City | SUMNER | City |
| State | IA | State |
| ZIP Code | 50674 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 421408693 | EIN |
| Primary Activities | SUPPORT SUMNER COMMUNITY CLUB | PrimaryActivities |
| Legal Domicile State | IA | LegalDomicileState |
| Exempt Code Section | 501(C)(3) | ExemptCodeSection |
| Public Charity Status | 7 | PublicCharityStatus |
| Direct Controlling Entity NA | N/A | DirectControllingEntityNA |
| Controlled Org | 1 | ControlledOrg |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | 0 | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | 0 | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | 1 | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | 0 | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | 0 | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | 0 | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | 0 | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | 0 | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | 0 | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | 0 | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | 1 | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | 1 | SharingOfFacilities |
| Sharing Of Paid Employees | 1 | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | 1 | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | 0 | OtherTransferToOtherOrg |
| Other Transfer From Other Org | 0 | OtherTransferFromOtherOrg |