COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 44-0537826)
- Tax period
- 2021-07-01 to 2022-06-30
- Filed
- 2023-03-24
- IRS object ID
- 202340839349301109
- Schema version
- 2021v4.2
- 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 C
- Schedule D
- Schedule H
- Schedule J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-03-24T11:18:08-05:00 | ReturnTs |
| Tax Period End | 2022-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1Txt |
| City | Kansas City | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 641062246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440537826 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JON DAVIS | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 6606862320 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JULIE JONES | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6606862211 | PhoneNum |
| Signature | 2023-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JULIE | PersonFirstNm |
| Person Last | JONES | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | April Arnold CPA | PreparerPersonNm |
| PTIN | P01559426 | PTIN |
| Phone | 8162216300 | PhoneNum |
| Preparation | 2023-05-15 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JULIE JONES | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 644460107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $24,227,206 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAIRFAXMED.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY ACUTE CARE, EMERGENCY PRIMARY CARE AND OUTPATIENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 172 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,449,243 | PYContributionsGrantsAmt |
| CY Contributions Grants | $539,063 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $21,871,850 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $23,447,707 | CYProgramServiceRevenueAmt |
| PY Investment Income | $26,619 | PYInvestmentIncomeAmt |
| CY Investment Income | $8,897 | CYInvestmentIncomeAmt |
| PY Other Revenue | $224,913 | PYOtherRevenueAmt |
| CY Other Revenue | $231,539 | CYOtherRevenueAmt |
| PY Total Revenue | $25,572,625 | PYTotalRevenueAmt |
| CY Total Revenue | $24,227,206 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,932,563 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,497,269 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $58,822 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $12,946,945 | PYOtherExpensesAmt |
| CY Other Expenses | $13,707,350 | CYOtherExpensesAmt |
| PY Total Expenses | $22,879,508 | PYTotalExpensesAmt |
| CY Total Expenses | $24,204,619 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,693,117 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $22,587 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $20,617,643 | TotalAssetsBOYAmt |
| Total Assets EOY | $16,710,906 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $15,509,700 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,573,407 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,107,943 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,137,499 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $20,490,296 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $23,447,707 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $20,490,296 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 7 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 172 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | MO | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JON DAVIS | PersonNm |
| Phone | 6606862320 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HIGHWAY 59 PO BOX 107 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| RICHARD ARON BURKE MD | ||||||||
| DIRECTOR/CHIEF MEDICAL OFFICER | 40.0 | 0.0 | Yes (X) | $709,079 | $0 | $36,360 | ||
| DR DUSTIN CARPENTER MD | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $265,263 | $0 | $17,814 | Yes (X) | ||
| KELLY OSBORN | ||||||||
| CRNA | 40.0 | 0.0 | $238,340 | $0 | $34,136 | Yes (X) | ||
| JULIE JONES | ||||||||
| CEO | 40.0 | 1.0 | $238,568 | $0 | $30,241 | Yes (X) | ||
| KATRINA LOCK | ||||||||
| ARNP | 40.0 | 0.0 | $143,070 | $0 | $26,517 | Yes (X) | ||
| JON DAVIS | ||||||||
| CFO | 40.0 | 1.0 | $141,576 | $0 | $16,953 | Yes (X) | ||
| RENEE KREIFELS | ||||||||
| CRNA | 40.0 | 0.0 | $124,373 | $0 | $28,950 | Yes (X) | ||
| REBECCA SCHLEUTER | ||||||||
| COO | 40.0 | 0.0 | $115,213 | $0 | $28,953 | Yes (X) | ||
| AMY RYAN | ||||||||
| DIRECTOR/VICE-PRESIDENT | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| COREY HERRON | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| TERESA SMITH | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| TOM BULLOCK | ||||||||
| DIRECTOR | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | ||
| GLENN SCOTT | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| VIRGINIA LOW | ||||||||
| DIRECTOR/PRESIDENT/CHAIRMAN | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| SUSAN NOLAND | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| TIM UMBARGER | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| REBEKAH GEBHARDS | ||||||||
| SECRETARY/TREASURER | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| GARRETT WOOD | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| JIM ALLEN | ||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,975,482 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $219,924 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 10 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| INSPIRE REHABILITATION LLC | |||||
| 8181 ARISTA PLACE SUITE 100 | BROOMFIELD | CO | 80021 | REHAB SERVICES | $973,121 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 734606 | DALLAS | TX | 75373 | SENIOR MENTAL HEALTH | $603,523 |
| CPSI INC | |||||
| PO BOX 11407 | BIRMINGHAM | IL | 35246 | EHR SYSTEM | $376,345 |
| THE NEBRASKA MEDICAL CENTER | |||||
| 988145 NEBRASKA MEDICAL CENT | OMAHA | NE | 68198 | PHARMACY SUPPORT | $240,195 |
| DOCS WHO CARE | |||||
| 800 W FRONTIER LN | OLATHE | KS | 66061 | ER PHYSICIAN SERVICE | $203,590 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $480,319 | GovernmentGrantsAmt |
| All Other Contributions | $58,744 | AllOtherContributionsAmt |
| Total Contributions | $539,063 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 621990 | $22,453,182 | $22,453,182 |
| 340B Revenue | 621990 | $994,525 | $994,525 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $23,447,707 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $8,897 | TotalRevenueColumnAmt |
| Exclusion | $8,897 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA | 900099 | $49,410 | $49,410 |
| All Other Misc Revenue | 900099 | $182,129 | $182,129 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $182,129 | TotalRevenueColumnAmt |
| Exclusion | $182,129 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $231,539 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $24,227,206 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $23,447,707 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $240,436 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,219,297 | TotalAmt |
| Program Services | $990,502 | ProgramServicesAmt |
| Management And General | $225,029 | ManagementAndGeneralAmt |
| Fundraising | $3,766 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $153,104 | TotalAmt |
| Program Services | $153,104 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,788,709 | TotalAmt |
| Program Services | $6,298,469 | ProgramServicesAmt |
| Management And General | $1,465,712 | ManagementAndGeneralAmt |
| Fundraising | $24,528 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $76,719 | TotalAmt |
| Program Services | $62,323 | ProgramServicesAmt |
| Management And General | $14,159 | ManagementAndGeneralAmt |
| Fundraising | $237 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $696,344 | TotalAmt |
| Program Services | $565,678 | ProgramServicesAmt |
| Management And General | $128,515 | ManagementAndGeneralAmt |
| Fundraising | $2,151 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $563,096 | TotalAmt |
| Program Services | $457,434 | ProgramServicesAmt |
| Management And General | $103,923 | ManagementAndGeneralAmt |
| Fundraising | $1,739 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $30,717 | TotalAmt |
| Management And General | $30,717 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $109,913 | TotalAmt |
| Management And General | $109,913 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,095 | TotalAmt |
| Management And General | $6,095 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,837,171 | TotalAmt |
| Program Services | $2,396,797 | ProgramServicesAmt |
| Management And General | $433,126 | ManagementAndGeneralAmt |
| Fundraising | $7,248 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $33,207 | TotalAmt |
| Program Services | $26,977 | ProgramServicesAmt |
| Management And General | $6,128 | ManagementAndGeneralAmt |
| Fundraising | $103 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,109,973 | TotalAmt |
| Program Services | $1,718,998 | ProgramServicesAmt |
| Management And General | $384,439 | ManagementAndGeneralAmt |
| Fundraising | $6,536 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $375,672 | TotalAmt |
| Program Services | $305,179 | ProgramServicesAmt |
| Management And General | $69,333 | ManagementAndGeneralAmt |
| Fundraising | $1,160 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $96,020 | TotalAmt |
| Program Services | $78,002 | ProgramServicesAmt |
| Management And General | $17,721 | ManagementAndGeneralAmt |
| Fundraising | $297 | FundraisingAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $419,158 | TotalAmt |
| Program Services | $340,505 | ProgramServicesAmt |
| Management And General | $77,358 | ManagementAndGeneralAmt |
| Fundraising | $1,295 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,263,574 | TotalAmt |
| Program Services | $1,026,072 | ProgramServicesAmt |
| Management And General | $233,592 | ManagementAndGeneralAmt |
| Fundraising | $3,910 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $271,474 | TotalAmt |
| Program Services | $220,533 | ProgramServicesAmt |
| Management And General | $50,102 | ManagementAndGeneralAmt |
| Fundraising | $838 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Repairs & Maint. | $903,946 | $734,325 | $166,829 | $2,792 |
| Medical Supplies | $1,895,051 | $1,895,051 | ||
| Bad Debt | $1,857,503 | $1,857,503 | ||
| Medicaid | $778,261 | $778,261 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $719,615 | TotalAmt |
| Program Services | $584,583 | ProgramServicesAmt |
| Management And General | $132,810 | ManagementAndGeneralAmt |
| Fundraising | $2,222 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,204,619 | TotalAmt |
| Program Services | $20,490,296 | ProgramServicesAmt |
| Management And General | $3,655,501 | ManagementAndGeneralAmt |
| Fundraising | $58,822 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,274 | BOYAmt |
| EOY | $4,821 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,845,908 | BOYAmt |
| EOY | $7,065,914 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $197,280 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,274,136 | BOYAmt |
| EOY | $2,765,675 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $470,468 | BOYAmt |
| EOY | $542,930 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $191,884 | BOYAmt |
| EOY | $159,087 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $24,107,810 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $19,223,433 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,764,691 | BOYAmt |
| EOY | $4,884,377 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $868,002 | BOYAmt |
| EOY | $1,288,102 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,617,643 | BOYAmt |
| EOY | $16,710,906 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,709,981 | BOYAmt |
| EOY | $1,886,023 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,877,153 | BOYAmt |
| EOY | $8,370,137 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,922,566 | BOYAmt |
| EOY | $1,317,247 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,509,700 | BOYAmt |
| EOY | $11,573,407 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,982,741 | BOYAmt |
| EOY | $4,999,863 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $125,202 | BOYAmt |
| EOY | $137,636 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,107,943 | BOYAmt |
| EOY | $5,137,499 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $20,617,643 | BOYAmt |
| EOY | $16,710,906 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $22,587 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $6,969 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $6,095 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $6,095 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B | FormAndLineReferenceDesc |
| Explanation | THE LOBBYING EXPENSES RECORDED ARE A PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $244,304 | OtherCostOrOtherBasisAmt |
| Book Value | $244,304 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,003,077 | OtherCostOrOtherBasisAmt |
| Depreciation | $6,164,075 | DepreciationAmt |
| Book Value | $1,839,002 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $15,555,042 | OtherCostOrOtherBasisAmt |
| Depreciation | $13,059,358 | DepreciationAmt |
| Book Value | $2,495,684 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $305,387 | OtherCostOrOtherBasisAmt |
| Book Value | $305,387 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $4,884,377 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM THIRD PARTY | $1,154,000 |
| Other Receivables | $134,102 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,288,102 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (2 entries)
| DescDesc | AmtAmt |
|---|---|
| REFUNDABLE ADVANCES | $1,177,052 |
| DUE TO THIRD PARTY | $140,195 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,317,247 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $22,681,124 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $274,715 | OtherRevenueAmt |
| Revenue Not Reported | $274,715 | RevenueNotReportedAmt |
| Revenue Subtotal | $22,406,409 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,820,797 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,820,797 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $24,227,206 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,400,199 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $53,083 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $53,083 | ExpensesNotReportedAmt |
| Expenses Subtotal | $22,347,116 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,857,503 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,857,503 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $24,204,619 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINES 2D & 4B | LINE 2D RELATED ORGANIZATION'S REVENUE $ 274,715 LINE 4B BAD DEBT EXPENSE $ 1,857,503 CHANGE IN CONTRIBUTION FROM FOUNDATION $ (36,706) ------------- $ 1,820,797 |
| SCHEDULE D, PART XII, LINES 2D & 4B | LINE 2D RELATED ORGANIZATION'S EXPENSES $ 53,083 LINE 4B BAD DEBT EXPENSE $ 1,857,503 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $126,030 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $126,030 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00560 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,226,426 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,407,414 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $819,012 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03660 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $17,905 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $83,266 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | -$65,361 | NetCommunityBenefitExpnsAmt |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,370,361 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,490,680 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $879,681 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04220 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $49,266 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $49,266 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00220 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,968 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,968 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $51,234 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $51,234 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00230 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,421,595 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,490,680 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $930,915 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04450 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,857,503 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $190,317 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $10,278,728 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,557,161 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $1,721,567 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.FAIRFAXMED.COM/ | WebsiteAddressTxt |
| State License | 102-61 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 22 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 22 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | FPGFamilyIncmLmtDscntCarePct |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | CHF USED FOCUS GROUPS FROM LOCAL FOOD ASSISTANCE PROGRAMS, CLERGY, SCHOOL ADMINISTRATION, OTHER AREA HEALTHCARE PROVIDERS AND PUBLIC ADMINISTRATORS AS PART OF THE CHNA STUDY. THIS WAS DONE THROUGH PAID OUTREACH THROUGH SOCIAL MEDIA, WEBSITE POP-UP, MASS MAILING TO SENIOR ADULTS, PUBLIC SPEAKING ENGAGEMENTS, AND EMAIL DISTRIBUTION. OF THOSE WHO RESPONDED, NEARLY HALF REPRESENTED HOUSEHOLDS OF MORE THAN ONE PERSON, PRIMARILY WOMEN AND IN ATCHISON COUNTY. HALF WERE OF INCOMES LESS THAN $75,000 PER YEAR. OF THE SURVEYS, 250 WERE MAILED TO A RANDOM LIST OF INDIVIDUALS OVER 65, WITH 84 OF THOSE RESPONDING. OF THE TOTAL SURVEYS, 306 WERE COLLECTED ELECTRONICALLY. |
| SCHEDULE H, PART V, SECTION B, LINE 7A | https://fairfaxmed.com/CHNA |
| SCHEDULE H, PART V, SECTION B, LINE 10A | https://fairfaxmed.com/CHNA |
| SCHEDULE H, PART V, SECTION B, LINE 11 | THE SURVEY WAS ADOPTED BY THE BOARD OF DIRECTORS IN THE MAY 2022 BOARD OF DIRECTORS MEETING. STRATEGIES FOR IMPLEMENATION THAT WERE SPECIFICALLY IDENTIFIED OF AREAS OF CONCERN BY THE COMMUNITEE WERE TELEHEALTH MENTAL HEALTH SERVICES AND THE NEED FOR ADDITIONAL PRIMARY CARE PHYSICIAN SERVICES. THIRD ON THE LIST WERE DEALING WITH UNHEALTHY BEHAVIORS AND CHRONIC CARE MANAGEMENT. FINALLY, ACCESS TO HEALTHCARE WAS MENTIONED AS A MAJOR CONCERN WITH THE INABILITY TO GET A CONVENIENT APPOINTMENT AND AFFORDABILITY AS THE MOST COMMON RESPONSE. EACH OF THESE AREAS WERE GIVEN THE GREEN LIGHT BY THE BOARD TO ADD TO THE HOSPITAL'S STRATEGIC PLAN, AS WELL AS ADOPTING A BUDGET FOR EACH. IN RESPONSE TO WHETHER WE PROVIDE THE DESIRED SERVICES, URGENT CARE, CHEMOTHERAPY, ENT, PODIATRY, DERMATOLOGY AND PULMONOLGY WERE LISTED AS THE KINDS OF SERVICES THE RESPONDENTS WOULD LIKE TO HAVE ACCESS TO LOCALLY. |
| SCHEDULE H, PART V, SECTION B, LINE 16A, 16B & 16C | https://fairfaxmed.com/charity-care/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 6 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (6 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| MOUND CITY FAMILY MEDICINE | ||||
| 514 STATE STREET | MOUND CITY | MO | 64470 | PROVIDER BASED RURAL HEALTH CLINIC |
| WEST NODAWAY FAMILY MEDICINE | ||||
| 226 W MAIN STREET | BURLINGTON JUNCTION | MO | 64428 | PROVIDER BASED RURAL HEALTH CLINIC |
| SOUTH HOLT FAMILY MEDICINE | ||||
| 101 SOUTH WASHINGTON | OREGON | MO | 64473 | PROVIDER BASED RURAL HEALTH CLINIC |
| TARKIO FAMILY MEDICINE | ||||
| 102 S 6TH STREET | TARKIO | MO | 64491 | PROVIDER BASED RURAL HEALTH CLINIC |
| FAIRFAX FAMILY MEDICINE | ||||
| 309 E MAIN STREET | FAIRFAX | MO | 64446 | PROVIDER BASED RURAL HEALTH CLINIC |
| ROCK PORT FAMILY MEDICINE | ||||
| 100 E CASS STREET | ROCK PORT | MO | 64482 | PROVIDER BASED RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | ADDITIONAL FACTORS CONSIDERED IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE INCLUDE ASSET LEVELS, MEDICAL INDIGENCY, INSURANCE/UNDERINSURANCE STATUS AND RESIDENCY. |
| SCHEDULE H, PART I, LINE 7 | 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. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,857,503. |
| SCHEDULE H, PART II | Due to Covid-19 restrictions, Community Hospital-Fairfax curtailed much of its community building activities. However, the Back-to-School fair, annual prostate and women's health screenings continued under Covid-19 safety guidelines, such as masking and social distancing. Covid-19 testing was a priority during this time, with CHF testing for free all those without any qualifying insurance or inability to pay. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | THE AMOUNT OF ACCOUNT BALANCES WRITTEN OFF TO BAD DEBTS THAT POSSIBLY WOULD HAVE QUALIFIED FOR CHARITY HAD THEY BEEN WILLING TO PROVIDE THE NECESSARY INFORMATION, AND THE TOTAL OF BANKRUPTCIES THE HOSPITAL HAD TO WRITE OFF. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE IS IN NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 23% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. OUR CUSTOMER SERVICE SURVEYS RATE COMMUNITY HOSPITAL CONSISTENTLY OVER 90%, SHOWING THESE MEDICARE BENEFICIARIES APPRECIATE THE SERVICES COMMUNITY HOSPITAL PROVIDES AND HOW THE SERVICES ARE PROVIDED. THE COSTING SOURCE WAS THE FY2022 MEDICARE COST REPORT. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | 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. |
| SCHEDULE H, PART VI, LINE 2 | IN THE MOST RECENT COMMUNITY NEEDS ASSESSMENT, COMMUNITY HOSPITAL FAIRFAX IDENTIFIED PRIMARY ACCESS TO HEALTHCARE AS CONTINUING TO BE THE MAIN DRIVER OF SIGNIFICANT HEALTH ISSUES IN OUR SERVICE AREA. RECENT SURVEYS SHOW THAT MANY HOUSEHOLDS DO NOT ACCESS HEALTHCARE AT A PRIMARY LEVEL EVEN WHEN A HEALTHCARE ISSUE REQUIRING PRIMARY CARE SERVICES IS NEEDED. INCREASED RISK FACTORS INCLUDE HEART DISEASE, CANCER, CHRONIC LOWER RESPIRATORY DISEASE, AND STROKE. I. ABILITY TO PAY FOR CARE - COMMUNITY HOSPITAL-FAIRFAX IDENTIFIED STRATEGIES TO ASSIST THOSE WITH NO INSURANCE OR HIGH DEDUCTIBLES TO ACCESS CARE THAT THEY NEED. TO ASSIST WITH THIS EFFORT, COMMUNITY HOSPITAL-FAIRFAX HAS SUCCESSFULLY IMPLEMENTED A STRATEGY TO NEGOTIATE PAYMENT STRUCTURES WHICH ARE FAVORABLE TO PATIENTS. IN ADDITION TO THIS STRATEGY, AN AGGRESSIVE FORGIVENESS PROGRAM FOR EXISTING DEBT WAS IMPLEMENTED IN FY2020 AND FY2021. II. PREVENTIVE CARE - COMMUNITY HOSPITAL-FAIRFAX ONBOARDED A CARE COORDINATOR/POPULATION HEALTH NURSE. THIS NURSE HAS BEEN VERY ACTIVE BUILDING AN ANNUAL WELLNESS VISIT AND CHRONIC CARE MANAGEMENT PROGRAM FOR PRIMARY CARE CLINIC PATIENTS. ANNUAL WELLNESS VISITS ARE A BENEFIT OFFERED TO MEDICARE PATIENTS AND ARE CRITICAL IN HELPING IDENTIFY HEALTH NEEDS AND OPPORTUNITIES IN THAT POPULATION. WITH LESS THAN A FULL YEAR OF ACTIVE ANNUAL WELLNESS VISIT PROGRAM, NEARLY 20% OF COMMUNITY HOSPITAL-FAIRFAX'S ATTRIBUTED MEDICARE POPULATION HAS RECEIVED AN ANNUAL WELLNESS VISIT WITH THE POPULATION HEALTH NURSE AND THEIR PROVIDER. CHRONIC CARE MANAGEMENT IS EQUALLY IMPORTANT TO PREVENTATIVE HEALTH AS ITS FOCUS IS TO PROVIDE EXTRA CARE FOR PATIENTS WITH MULTIPLE CHRONIC DISEASES. STRATEGIES ARE CURRENTLY IN DEVELOPMENT FOR THIS PROGRAM. |
| SCHEDULE H, PART VI, LINE 3 | COMMUNITY HOSPITAL BUSINESS OFFICE STAFF WILL DISCUSS WITH INPATIENTS AND OUTPATIENTS THE OPTIONS AVALIABLE TO HELP THE PATIENTS MEET THEIR FINANCIAL OBLIGATIONS TO COMMUNITY HOSPITAL. THEY DISCUSS THE FEDERAL/STATE GOVERNMENT PROGRAMS AVAILABLE AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEN INFORMATION IS INCLUDED IN THE STATEMENTS SENT TO PATIENTS (EXPLAINING THE AMOUNTS OWED BY THE PATIENT'S INSURANCE OR THE PATIENT), MUCH OF THE INFORMATION IS THE SAME AS THE INFORMATION DISCUSSED IN PERSON. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY HOSPITAL-FAIRFAX SERVES THE ATCHISON, HOLT AND WESTERN NODAWAY COUNTIES, POPULATION APPROXIMATELY 10,700. THERE ARE FIVE MAIN TOWNS IN ATCHISON AND HOLT, ALL WITH POPULATIONS BELOW 2,000. THE POPULATION IS ALL RURAL AND THE ECONOMY IS LARGELY DRIVEN BY AGRICULTURE. THE POPULATION IS AGING WITH A MEDIAN HOUSEHOLD INCOME OF $43,000 and $46,000. |
| SCHEDULE H, PART VI, LINE 5 | TO EDUCATE AND PROVIDE SERVICES TO ITS COMMUNITY, COMMUNITY HOSPITAL RESPONDS BY PROVIDING THE FOLLOWING ACTIVITES: AN ANNUAL HEART HEALTH SCREENING OFFERED FREE OF CHARGE, AND FREE BLOOD PRESSURE CHECKS; DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR; FREE GLUCOSE SCREENING, BMI CHECKS AND BLOOD PRESSURE CHECKS AT ANNUAL WOMEN'S EVENT; AN ANNUAL BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN AND HEALTHY EATING CHOICES ARE DISCUSSED; AN ANNUAL PROSTATE SCREENING WHICH INCLUDES A FREE EXAM FOR LOCAL RESIDENTS. IN ADDITION, THE HOSPITAL INITIATED A WORKPLACE WELLNESS PROGRAM WHERE SCREENINGS ARE OFFERED AT A REDUCED PRICE FOR EMPLOYEES. |
| SCHEDULE H, PART VI, LINE 7 | MISSOURI |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JON DAVIS | ||||||||||||||
| CFO | $141,108 | $0 | $0 | $0 | $468 | $0 | $0 | $0 | $16,953 | $0 | $158,529 | $0 | $0 | $0 |
| JULIE JONES | ||||||||||||||
| CEO | $237,065 | $0 | $0 | $0 | $1,503 | $0 | $23,224 | $0 | $7,017 | $0 | $268,809 | $0 | $0 | $0 |
| RICHARD ARON BURKE MD | ||||||||||||||
| DIRECTOR/CHIEF MEDICAL OFFICER | $707,970 | $0 | $0 | $0 | $1,109 | $0 | $19,500 | $0 | $16,860 | $0 | $745,439 | $0 | $0 | $0 |
| DR DUSTIN CARPENTER MD | ||||||||||||||
| PHYSICIAN | $264,987 | $0 | $0 | $0 | $276 | $0 | $4,050 | $0 | $13,764 | $0 | $283,077 | $0 | $0 | $0 |
| KELLY OSBORN | ||||||||||||||
| CRNA | $238,107 | $0 | $0 | $0 | $233 | $0 | $18,641 | $0 | $15,495 | $0 | $272,476 | $0 | $0 | $0 |
| KATRINA LOCK | ||||||||||||||
| ARNP | $142,895 | $0 | $0 | $0 | $175 | $0 | $19,500 | $0 | $7,017 | $0 | $169,587 | $0 | $0 | $0 |
| RENEE KREIFELS | ||||||||||||||
| CRNA | $124,159 | $0 | $0 | $0 | $214 | $0 | $12,000 | $0 | $16,950 | $0 | $153,323 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE J, PART II | FormAndLineReferenceDesc |
| Explanation | THE COMPENSATION FOR JULIE JONES IS PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), AN UNRELATED 501(C)(3) HOSPITAL. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (2 entries)
| SEE PART V |
| SEE PART V |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L , PART IV, LINES 1 & 2 | FormAndLineReferenceDesc |
| Explanation | A) JAMIE BURKE B) JAMIE BURKE IS THE DAUGHTER OF DR. RICHARD ARON BURKE, A DIRECTOR OF THE ORGANIZATION. C) $49,531 D) JAMIE IS COMPENSATED AS AN LPN FOR THE ORGANIZATION. E) NO A) JOANNA BURKE B) JOANNA BURKE IS THE WIFE OF DR. RICHARD ARON BURKE, A DIRECTOR OF THE ORGANIZATION. C) $103,573 D) JOANNA IS COMPENSATED AS A PEDIATRIC NURSE PRACTITIONER IN ONE OF OUR RELATED CLINICS. E) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | COMMUNITY HOSPITAL-FAIRFAX (CH-F) PRIDES ITSELF IN PROVIDING ACCESS TO HEALTHCARE TO A REGION WHERE HEALTH SERVICES ARE SPARSE. THE PHYSICIAN RATIO IS 4,797:1 (NATIONAL BENCHMARK IS 1400:1) AND EMERGENCY SERVICES WOULD OTHERWISE BE 30 MILES OR MORE FROM THE POPULATION CENTERS. COMMUNITY HOSPITAL-FAIRFAX PROVIDES THE NORTHWEST MISSOURI AREA POPULATION OF 11,000 IN HOLT, ATCHISON AND WESTERN NODAWAY COUNTY WITH A 24-HOUR EMERGENCY ROOM, ACUTE CARE (INCLUDING OBSTETRICS) AND POST-ACUTE CARE SERVICES, PRIMARY CARE SERVICES, MANY OUTPATIENT SERVICES, SURGERY, ANCILLARY SERVICES, AND A FULL-SERVICE THERAPY DEPARTMENT. IN ADDITION TO SERVING THE HEALTH NEEDS OF A POPULATION THAT WOULD OTHERWISE NOT HAVE ACCESS TO CARE, COMMUNITY HOSPITAL-FAIRFAX CONTINUES TO INVEST IN A HEALTHY FUTURE FOR THE COMMUNITY. CH-F TRIES TO FOCUS ON THE GREATEST HEALTH NEEDS IN THE COMMUNITY WHICH TEND TO BE CHRONIC DISEASES SUCH AS HEART DISEASE, COPD AND ASTHMA, STROKE AND DIABETES. RISK FACTORS FOR THESE DISEASES ARE OBESITY, CIGARETTE SMOKING AND PHYSICAL INACTIVITY. NEARLY 30% OF THE CH-F SERVICE POPULATION IS OBESE, 35% REPORT PHYSICAL INACTIVITY AND 22% SMOKE. TO EDUCATE AND PROVIDE SERVICES TO A COMMUNITY WHERE THESE CHRONIC CONDITIONS PREVAIL, THE FOLLOWING ACTIVITIES ARE PART OF CH-F'S RESPONSE TO HEALTH NEEDS OF THE COMMUNITY: CH-F LAUNCHED A CHRONIC CARE MANAGEMENT PROGRAM BY DECEMBER 1, 2019. COMMUNITY HOSPITAL-FAIRFAX HIRED A NURSE TO BEGIN A CHRONIC CARE. FOR ALL OTHER ACTIVITIES AND STRATEGIES RELATED TO THE CHNA, SEE THE REPORT AND IMPLENTATION STRATEGY AT WWW.FAIRFAXMED.COM/CHHA. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION'S BY-LAWS STATE THAT THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST ELEVEN MEMBERS AND NO MORE THAN FIFTEEN MEMBERS. TWO OF THE DIRECTORS SHALL BE INDIVIDUALS NOMINATED BY THE NEBRASKA MEDICAL CENTER (NMC), SUBJECT TO A MAJORITY VOTE OF THE BOARD. IF AN NMC DIRECTOR IS NOT ELECTED BY THE BOARD, NMC SHALL CONTINUE TO NOMINATE OTHER CANDIDATES UNTIL A NOMINEE IS ELECTED BY THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATION. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S ADMINISTRATION HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 WITH ALL COMPLETED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| 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 FORWARDED TO AN EXECUTIVE COMMITTEE OF THE BOARD OF DIRECORS TO REVIEW ALL CIRCUMSTANCES SURROUNDING THE CONFLICT OF INTEREST. THE DETERMINATION OF SUCH MATTERS IS DEEMED FINAL BY THE BOARD. THE CONFLICTED INDIVIDUAL MAY NOT VOTE OR PARTICIPATE IN DISCUSSIONS AND/OR DETERMINATIONS INVOLVING THE CONFLICT. IT IS NOTED IN THE BOARD MEETING MINUTES OF ANY INDIVIDUALS ABSTAINING FROM VOTING DUE TO ANY CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | THE ORGANIZATION USES COMPARABILITY DATA TO DETERMINE THE COMPENSATION OF THE CEO AND OTHER OFFICERS. THE COMPENSATION OF THE CEO AND OTHER OFFICERS IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE LAST REVIEW WAS IN 2022. |
| 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. |
| FORM 990, PART XI, LINE 9 | TRANSFER TO RELATED ORGANIZATION $ ( 29,737) CHANGE IN CONTRIBUTION FROM FOUNDATION $ 36,706 --------- TOTAL $ 6,969 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EMERGENCY ROOM PHYSICIAN FEES TOTAL FEES:216442 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PHYSICIAN FEES TOTAL FEES:141127 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:132754 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - OTHER TOTAL FEES:211178 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:2135670 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431757553 | EIN |
| Primary Activities | SUPPORT ORG | PrimaryActivitiesTxt |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 12A | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |