2011-11-11T15:21:23-06:00 2010-12-31 SEIM JOHNSON LLP 18081 BURT STREET SUITE 200 OMAHA NE 680224722 990 2010-01-01 420670596 SUMNER COMMUNITY CLUB D/B/A COMMUNITY MEMORIAL HOSPITAL SUMN 5635783275 909 W 1ST STREET PO BOX 148 SUMNER IA 506740148 MARY S WELLS 5635783275 2011-11-06 1 BARBARA J FAJEN 4023302660 2010 2016-02-24 21:20:13Z MARY S WELLS 909 W 1ST STREET PO BOX 148 SUMNER IA 506740148 9843906 0 X WWW.CMHSUMNER.ORG X 1950 IA 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. 13 13 0 0 1781 -372 108655 591026 8791882 9081554 31147 16459 96377 146051 9028061 9835090 0 0 0 0 4491299 4714193 0 0 0 4019238 4146237 8510537 8860430 517524 974660 10461465 11272413 2663642 2454855 7797823 8817558 X TO PROVIDE QUALITY HEALTH CARE TO THE PEOPLE OF SUMNER AND SURROUNDING AREAS, WHILE COORDINATING OTHER NEEDED SERVICES. 0 0 809407 1559325 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. 827442 413785 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. 702457 969279 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. 5036394 6212395 VARIOUS INPATIENT AND OTHER HEALTH CARE SERVICES. 5036394 6212395 7375700 1 1 0 0 0 0 0 0 1 1 1 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 0 1 11 0 1 0 1 1 0 0 0 0 0 0 0 0 0 X 13 13 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IA X SARA TRAINOR 5635783275 909 WEST 1ST STREET PO BOX 148 SUMNER IA 50674 X PAUL BAHE 1.30 X 0 0 0 MIKE MEYER 1.30 X 0 0 0 DEB TOENGES 1.30 X 0 0 0 DEB BECKNER 0.80 X 0 0 0 LUARA NECKER 0.80 X 0 0 0 DAVE VOSS 0.80 X 0 0 0 JAMES LAHMANN 0.80 X 0 0 0 CONNIE LEICHER 0.80 X 0 0 0 MIKE SCHAFFNER 0.80 X 0 0 0 RICK PEDERSON 0.80 X 0 0 0 JENNIFER YEAROUS 0.80 X 0 0 0 BILL SCHWAKE 0.80 X 0 0 0 DIANE PAGEL 0.80 X 0 0 0 MARY WELLS 40.00 X 135278 0 19195 SARA TRAINOR 40.00 X 97621 0 29576 LYNNE NIEMANN 40.00 X 80806 0 16387 TROY BUCHHOLZ 40.00 X 291479 0 31050 TED SAI SCHWARM 40.00 X 259207 0 28833 ROBERTA MITTELSTED 40.00 X 93018 0 18526 864391 0 125041 3 0 1 0 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 5 1082 37444 552500 591026 MEDICARE/MEDICAID PAYM 621400 5812974 5812974 PATIENT REVENUE - PRIV 621400 3250275 3250275 COMMUNITY WELLNESS 621990 18305 18305 9081554 24444 24444 47735 47735 47735 47735 831 8587 229 -8587 602 -7985 -7985 MISCELLANEOUS INCOME 900099 73230 73230 CAFETERIA EMPLOYEES 900099 23305 23305 CATERING 722320 1781 1781 98316 9835090 9154784 1781 87499 989432 707762 281670 42415 42415 2680688 2196381 484307 741677 617175 124502 259981 209447 50534 192945 192945 58288 58288 1660342 1438788 221554 17868 17868 960859 900100 60759 120087 120087 35370 25199 10171 97356 97356 514742 514742 72433 72433 PROVISION FOR BAD DEBT 286264 286264 DUES AND SUBSCRIPTIONS 97415 97415 MISC. EXPENSES 32268 32268 8860430 7375700 1484730 0 100 100 3163035 3052573 527182 946011 1397780 101196 101814 89299 88005 7746248 4782702 3102239 2963546 284775 279574 2638298 2684825 136512 177014 10461465 11272413 980472 1063355 1205000 1055000 478170 336500 2663642 2454855 X 5084129 5808829 75396 387171 2638298 2621558 7797823 8817558 10461465 11272413 X 974660 45075 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2638298 110582 64055 2684825 2634633 58750 55085 2638298 2889909 -246778 8498 2634633 1.00000 1 0 49781 49781 4412561 2505350 1907211 3017989 2116808 901181 265917 160544 105373 2963546 PERPETUAL TRUST 2684825 F 2684825 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. 1 1 1 X 125.000000000000 1 X 1 1 1 0 1 0 55415 55415 0.00650 55415 55415 0.00650 25187 2790 22397 0.00260 45045 45045 0.00530 295611 28639 266972 0.03110 28135 5324 22811 0.00270 393978 36753 357225 0.04170 449393 36753 412640 0.04820 1 228108 55415 4514224 4469529 44695 X 1 1 1 1 SUMNER COMMUNITY CLUB DBA COMMUNITY

MEMORIAL HOSP 909 W 1ST ST PO BOX 148 SUMNER IA 50674

X X X PROVIDER-BASED MEDICAL CLINIC COMMUNITY MEMORIAL HOSPITAL 1 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 X 0 0 0 0 0 0 0 0 0 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 CITY OF SUMNER IOWA 426005269 866451AS6 2003-12-15 450000 CONSTRUCTION AND IMPROVEMENTS TO FACILITIES 0 0 0 235000 450125 45300 450125 2004 0 0 1 1 0 0 1 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 0 1 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. JUSTIN TRAINOR SPOUSE OF CFO 351950 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. 1 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. FORM 990, PART VI, SECTION B, LINE 12C 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. 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, PART VI, SECTION C, LINE 19 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. AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATION FORM 990, PAGE 7, PART VII, SECTION A, LINE 1A 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. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 45,075. COMMITTEE WITH OVERSIGHT OF THE AUDIT FORM 990, PAGE 12, PART XI, LINE 2C 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. PROCESS FOR DETERMINING COMPENSATION FORM 990, PAGE 6, PART VI, SECTION B, LINE 15 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. FRIENDS OF CMH SUMNER COMMUNITY MEMORIAL HOSPITAL FOUNDATION 909 W 1ST STREET SUMNER IA 50674 421408693 SUPPORT SUMNER COMMUNITY CLUB IA 501(C)(3) 7 N/A 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0