CITIZENS MEDICAL CENTER INC EMPLOYEE BENEFIT TR: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- CITIZENS MEDICAL CENTER INC EMPLOYEE BENEFIT TR (EIN 48-0892178)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-08
- IRS object ID
- 202233129349300243
- 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 B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-08T07:34:12-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | 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 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 672066601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480892178 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITIZENS MEDICAL CENTER INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % RYAN STOVER | InCareOfNm |
| Business Name Control | CITI | BusinessNameControlTxt |
| Phone | 7854627511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E COLLEGE DRIVE | AddressLine1Txt |
| City | COLBY | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RYAN STOVER | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 7854627511 | PhoneNum |
| Signature | 2022-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | Ryan | PersonFirstNm |
| Person Last | Stover | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNELL LINOT | PreparerPersonNm |
| PTIN | P01663908 | PTIN |
| Phone | 3162652811 | PhoneNum |
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 | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | GREG UNRUH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E COLLEGE DRIVE | AddressLine1Txt |
| City | COLBY | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $59,338,711 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CMCIKS.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1979 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | ENHANCING THE LIVES OF THOSE WE SERVE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 506 | TotalEmployeeCnt |
| Total Volunteers | 25 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $3,536,838 | PYContributionsGrantsAmt |
| CY Contributions Grants | $8,204,636 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $46,020,177 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $50,428,218 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$398 | PYInvestmentIncomeAmt |
| CY Investment Income | $3,715 | CYInvestmentIncomeAmt |
| PY Other Revenue | $607,220 | PYOtherRevenueAmt |
| CY Other Revenue | $702,142 | CYOtherRevenueAmt |
| PY Total Revenue | $50,163,837 | PYTotalRevenueAmt |
| CY Total Revenue | $59,338,711 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $10,392 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $17,156 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $12,943 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $27,292,567 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $28,909,381 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $72,615 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $20,752,618 | PYOtherExpensesAmt |
| CY Other Expenses | $21,121,073 | CYOtherExpensesAmt |
| PY Total Expenses | $48,068,520 | PYTotalExpensesAmt |
| CY Total Expenses | $50,047,610 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,095,317 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $9,291,101 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $37,793,377 | TotalAssetsBOYAmt |
| Total Assets EOY | $38,946,719 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $21,174,630 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $12,470,671 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $16,618,747 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $26,476,048 | NetAssetsOrFundBalancesEOYAmt |
| Mission | ENHANCING THE LIVES OF THOSE WE SERVE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $41,422,572 | ExpenseAmt |
| Grant | $17,156 | GrantAmt |
| Revenue | $50,442,962 | RevenueAmt |
| Desc | CMCI PROVIDED A WIDE RANGE OF HEALTHCARE SERVICES TO RESIDENTS OF ITS SERVICE AREA. 3,913 PATIENT DAYS OF INPATIENT CARE, 17,313 PATIENT DAYS OF NURSING FACILITY CARE, 3,345 EMERGENCY ROOM VISITS, AND 33,092 PHYSICIAN CLINIC VISITS WERE PROVIDED DURING THE FISCAL YEAR. | Desc |
| Total Program Service Expenses | $41,422,572 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | 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 | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | 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 | Yes (true) | 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 | false | 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 | Yes (true) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 52 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 506 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | Yes (true) | UnrelatedBusIncmOverLimitInd |
| Form990 T Filed | Yes (true) | Form990TFiledInd |
| 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 | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | 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 | Yes (true) | 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 |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | RYAN STOVER | PersonNm |
| Phone | 7854627511 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E COLLEGE DRIVE | AddressLine1Txt |
| City | COLBY | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|
| KELLY GABEL | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $414,217 | $0 | $47,927 | ||
| BRENDA KOPRIVA | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $405,417 | $0 | $31,994 | ||
| DARREN MATCHELL | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $384,190 | $0 | $37,199 | ||
| DERECK TOTTEN | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $363,749 | $0 | $41,835 | ||
| GREG UNRUH | ||||||||
| CHIEF EXECUTIVE OFFICER | 40.0 | 1.0 | $283,433 | $0 | $27,510 | Yes (X) | ||
| PAUL SCHIFERL | ||||||||
| PHARMACIST | 40.0 | 0.0 | Yes (X) | $272,175 | $0 | $26,584 | ||
| RYAN STOVER | ||||||||
| CHIEF FINANCIAL OFFICER | 40.0 | 1.0 | $184,644 | $0 | $20,496 | Yes (X) | ||
| BOB STANDAGE | ||||||||
| CHAIR | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LON FRAHM | ||||||||
| VICE CHAIR | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JANET SADDLER | ||||||||
| SECRETARY | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| MICHAEL HAMILTON | ||||||||
| TREASURER | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JEANENE BROWN | ||||||||
| TRUSTEE | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| EILEEN LOVENSTEIN | ||||||||
| TRUSTEE | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| JENNIFER SCHOENFELD | ||||||||
| TRUSTEE | 4.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,307,825 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $233,545 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 42 | 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 |
|---|---|---|---|---|---|
| AMERISOURCE | |||||
| PO BOX 27550 | CHICAGO | IL | 606731275 | MEDICAL | $3,522,624 |
| MEDICAL RECOVERY SERVICES ASSOCIATE | |||||
| 901 W MAIN ST STE 100 | BLUE SPRINGS | MO | 640153787 | BILLING SERVICES | $590,326 |
| MEDLINE INDUSTRIES | |||||
| DEPT 1080 PO BOX 121080 | DALLAS | TX | 753121080 | MEDICAL SUPPLIER | $1,002,542 |
| HFG ARCHITECTURE | |||||
| 330 N MEAD ST | WICHITA | KS | 67202 | ARCHITECTURE SVCS | $1,592,652 |
| CARDINAL HEALTH | |||||
| 7920 ELMBROOK STE 100 | DALLAS | TX | 75247 | MEDICAL SUPPLIER | $436,265 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 48 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $46,051 | RelatedOrganizationsAmt |
| Government Grants | $7,785,457 | GovernmentGrantsAmt |
| All Other Contributions | $373,128 | AllOtherContributionsAmt |
| Noncash Contributions | $4,999 | NoncashContributionsAmt |
| Total Contributions | $8,204,636 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 621990 | $47,007,895 | $47,007,895 |
| 340B Drug Program | 621990 | $3,420,323 | $3,420,323 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $50,428,218 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,665 | TotalRevenueColumnAmt |
| Exclusion | $3,665 | 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 |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,126 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $10,126 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,126 | TotalRevenueColumnAmt |
| Exclusion | $10,126 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $50 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $50 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $50 | TotalRevenueColumnAmt |
| Exclusion | $50 | ExclusionAmt |
| 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 (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Childcare | 621990 | $211,232 | $211,232 | |
| Pharmacy Sales | 624410 | $14,744 | $14,744 | |
| Cafeteria & Vending | 446110 | $132,161 | $132,161 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $333,879 | TotalRevenueColumnAmt |
| Exclusion | $333,879 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $692,016 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $59,338,711 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $50,442,962 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $691,113 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,840 | TotalAmt |
| Program Services | $3,840 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,316 | TotalAmt |
| Program Services | $13,316 | ProgramServicesAmt |
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 | $516,082 | TotalAmt |
| Management And General | $516,082 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,703,840 | TotalAmt |
| Program Services | $21,430,605 | ProgramServicesAmt |
| Management And General | $2,246,504 | ManagementAndGeneralAmt |
| Fundraising | $26,731 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $925,073 | TotalAmt |
| Program Services | $859,209 | ProgramServicesAmt |
| Management And General | $65,751 | ManagementAndGeneralAmt |
| Fundraising | $113 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,506,386 | TotalAmt |
| Program Services | $2,105,527 | ProgramServicesAmt |
| Management And General | $395,684 | ManagementAndGeneralAmt |
| Fundraising | $5,175 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,258,000 | TotalAmt |
| Program Services | $1,116,777 | ProgramServicesAmt |
| Management And General | $139,916 | ManagementAndGeneralAmt |
| Fundraising | $1,307 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $132,463 | TotalAmt |
| Management And General | $132,463 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $25,173 | TotalAmt |
| Management And General | $25,173 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $311,595 | TotalAmt |
| Management And General | $311,595 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,208 | TotalAmt |
| Management And General | $6,208 | 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 | $4,950 | TotalAmt |
| Management And General | $4,950 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,510,234 | TotalAmt |
| Program Services | $2,942,054 | ProgramServicesAmt |
| Management And General | $1,568,180 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $45,279 | TotalAmt |
| Program Services | $3,273 | ProgramServicesAmt |
| Management And General | $42,006 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $978,511 | TotalAmt |
| Program Services | $433,288 | ProgramServicesAmt |
| Management And General | $544,144 | ManagementAndGeneralAmt |
| Fundraising | $1,079 | 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 | $485,591 | TotalAmt |
| Program Services | $250,035 | ProgramServicesAmt |
| Management And General | $231,332 | ManagementAndGeneralAmt |
| Fundraising | $4,224 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $98,644 | TotalAmt |
| Program Services | $58,477 | ProgramServicesAmt |
| Management And General | $40,080 | ManagementAndGeneralAmt |
| Fundraising | $87 | 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 | $79,565 | TotalAmt |
| Program Services | $76,233 | ProgramServicesAmt |
| Management And General | $3,330 | ManagementAndGeneralAmt |
| Fundraising | $2 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $300,675 | TotalAmt |
| Program Services | $148,834 | ProgramServicesAmt |
| Management And General | $148,834 | ManagementAndGeneralAmt |
| Fundraising | $3,007 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,234,065 | TotalAmt |
| Program Services | $1,105,862 | ProgramServicesAmt |
| Management And General | $1,105,862 | ManagementAndGeneralAmt |
| Fundraising | $22,341 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $493,179 | TotalAmt |
| Program Services | $197,326 | ProgramServicesAmt |
| Management And General | $295,853 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| Drugs | $5,164,015 | $5,164,015 | ||
| Medical Supplies | $3,251,914 | $3,251,914 | ||
| Repairs and Maintenance | $1,314,819 | $1,013,869 | $295,930 | $5,020 |
| Food Expense | $457,184 | $457,184 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,227,009 | TotalAmt |
| Program Services | $790,934 | ProgramServicesAmt |
| Management And General | $432,546 | ManagementAndGeneralAmt |
| Fundraising | $3,529 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $50,047,610 | TotalAmt |
| Program Services | $41,422,572 | ProgramServicesAmt |
| Management And General | $8,552,423 | ManagementAndGeneralAmt |
| Fundraising | $72,615 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,538,237 | BOYAmt |
| EOY | $7,400,213 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,088,307 | BOYAmt |
| EOY | $7,468,200 | 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 | $141,951 | BOYAmt |
| EOY | $326,952 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,419,027 | BOYAmt |
| EOY | $1,629,735 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $784,484 | BOYAmt |
| EOY | $648,372 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $47,846,096 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $32,877,602 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,773,251 | BOYAmt |
| EOY | $14,968,494 | 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 | $7,048,120 | BOYAmt |
| EOY | $6,504,753 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,793,377 | BOYAmt |
| EOY | $38,946,719 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,518,166 | BOYAmt |
| EOY | $4,454,736 | 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 | $3,620,847 | BOYAmt |
| EOY | $4,186,113 | 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 | $9,035,617 | BOYAmt |
| EOY | $3,829,822 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,174,630 | BOYAmt |
| EOY | $12,470,671 | 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 | $14,258,864 | BOYAmt |
| EOY | $23,578,579 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,359,883 | BOYAmt |
| EOY | $2,897,469 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,618,747 | BOYAmt |
| EOY | $26,476,048 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,793,377 | BOYAmt |
| EOY | $38,946,719 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $9,291,101 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $1,858 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $564,342 | 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) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| 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 B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
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 | $6,208 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $6,208 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
| Form4720 Filed4912 Tax | false | Form4720Filed4912TaxInd |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1f | FormAndLineReferenceDesc |
| Explanation | CITIZENS MEDICAL CENTER, INC., IS A MEMBER OF THE KANSAS HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. THESE ORGANIZATIONS ENGAGE IN LOBBYING ACTIVITIES FOR HOSPITAL AND GENERAL HEALTH CARE INTERESTS AS PART OF THE SERVICES PROVIDED TO MEMBERS. 7.5% OF KHA DUES AND 25.56% OF AHA DUES PAID WERE FOR LOBBYING ACTIVITIES. | 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 | $235,982 | OtherCostOrOtherBasisAmt |
| Book Value | $235,982 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $21,743,014 | OtherCostOrOtherBasisAmt |
| Depreciation | $16,402,470 | DepreciationAmt |
| Book Value | $5,340,544 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,224,002 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,795,821 | DepreciationAmt |
| Book Value | $428,181 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $20,298,991 | OtherCostOrOtherBasisAmt |
| Depreciation | $14,679,311 | DepreciationAmt |
| Book Value | $5,619,680 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,344,107 | OtherCostOrOtherBasisAmt |
| Book Value | $3,344,107 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $14,968,494 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (5 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Interest Receivable | -$1,525 |
| Beneficial Interest in Net Ass | $2,897,469 |
| Reinsurance Proceeds Recoverab | $124,703 |
| Other Receivables | $557,637 |
| Assets Limited As to Use | $2,926,469 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $6,504,753 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $59,899,961 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $1,858 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $564,342 | OtherRevenueAmt |
| Revenue Not Reported | $566,200 | RevenueNotReportedAmt |
| Revenue Subtotal | $59,333,761 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $4,950 | InvestmentExpensesNotIncldAmt |
| Revenue Not Reported Fincl Stmt | $4,950 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $59,338,711 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $50,042,660 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $50,042,660 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $4,950 | InvestmentExpensesNotIncld2Amt |
| Expenses Not Rpt Fincl Stmt | $4,950 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $50,047,610 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (2 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, LINE 2D | CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATIONS NET OF TRANSFERS 564,342 |
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 |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 130. | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,088,280 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,088,280 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02170 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,988,497 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,061,166 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $927,331 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01850 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,076,777 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,061,166 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,015,611 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04020 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 20 | ActivitiesOrProgramsCnt |
| Persons Served | 327 | PersonsServedCnt |
| Total Community Benefit Expns | $68,645 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $68,645 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00140 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 2121 | PersonsServedCnt |
| Total Community Benefit Expns | $13,970 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,010 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,960 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Research ResearchGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Persons Served | 0 | PersonsServedCnt |
| Total Community Benefit Expns | $0 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $0 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 25 | PersonsServedCnt |
| Total Community Benefit Expns | $1,579 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $0 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,579 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 28 | ActivitiesOrProgramsCnt |
| Persons Served | 2473 | PersonsServedCnt |
| Total Community Benefit Expns | $84,194 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,010 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $74,184 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00150 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 28 | ActivitiesOrProgramsCnt |
| Persons Served | 2473 | PersonsServedCnt |
| Total Community Benefit Expns | $4,160,971 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,071,176 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,089,795 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04170 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $2,112,729 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $39,908,588 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $39,908,588 | CostOfCareReimbursedByMedcrAmt |
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 | CITIZENS MEDICAL CENTER | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E COLLEGE DRIVE | AddressLine1Txt |
| City | COLBY | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| State License | H097001 | 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 |
| Other | NURSING FACILITY AND RURAL HEALTH CLINIC. | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITIZENS MEDICAL CENTER | 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 | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SCH H, PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SCH H, 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 | 130. | 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 |
| 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 |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SCH H, PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SCH H, PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SCH H, PART V, 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | EACH COMMUNITY HAS A WEALTH OF EXPERTISE TO BE TAPPED TO CONDUCT THE CHNA. FOR THIS PURPOSE, TOWN HALL MEETINGS ARE THE PERFECT FORUM TO GATHER COMMUNITY INSIGHT. TOWN HALL SESSIONS WERE ORGANIZED TO PROVIDE AN OBJECTIVE CONSENSUS-BUILDING METHOD OF REVIEWING AND PRIORITIZING COUNTY HEALTH ISSUES. DURING THE MEETINGS, THE TOPICS OF ISSUE WERE ADDRESSED WITH ROUND TABLE DISCUSSIONS. THE INDIVIDUALS AND ORGANIZATIONS COMPRISING THE TOWN HALLS WERE CRITICALLY IMPORTANT TO THE SUCCESS OF THE CHNA. THE FOLLOWING LIST OUTLINES PARTNERS INVITED TO EACH TOWN HALL MEETING: LOCAL HOSPITAL, PUBLIC HEALTH COMMUNITY, MENTAL HEALTH COMMUNITY, COMMUNITY-BASED CLINICS, SERVICE PROVIDERS, LOCAL RESIDENTS,COMMUNITY LEADERS, OPINION LEADERS, SCHOOL LEADERS, BUSINESS LEADERS,LOCAL GOVERNMENT, FAITH-BASED ORGANIZATIONS AND PERSONS (OR ORGANIZATIONS) SERVING THEM, PEOPLE WITH CHRONIC CONDITIONS, UNINSURED COMMUNITY MEMBERS, LOW-INCOME RESIDENTS, AND MINORITY GROUPS. |
| SCHEDULE H, PART V, SECTION B, LINE 6B | THOMAS COUNTY HEALTH DEPARTMENT AND THOMAS COUNTY COMMISSIONERS/REPRESENTATIVES. |
| SCHEDULE H, PART V, SECTION B, LINE 7A | HTTPS://CMCIKS.COM/PATIENTS-VISITORS/COMMUNITY-HEALTH-ASSESSMENT/ |
| SCHEDULE H, PART V, SECTION B, LINE 10A | HTTPS://CMCIKS.COM/PATIENTS-VISITORS/COMMUNITY-HEALTH-ASSESSMENT/ |
| SCHEDULE H, PART V, SECTION B, LINE 11 | The top areas of need found in the 2021 CHNA process were as follows: 1. Mental Health 2. Housing 3. Child Care Options 4. Lake of Qualified Available Workforce 5. Drug & Alcohol Abuse 6. Nutrition/Healthy Food Options These needs are being addressed on an ongoing basis according to the Implementation Plan. Although there were other needs identified during the CHNA process, not all needs are being addressed by CMCI due to both time and financial resources. |
| SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, AND 16C | HTTPS://CMCIKS.COM/CITIZENS-MEDICAL-CENTER/PATIENT-FINANCIAL-SERVICES/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| PRAIRIE SENIOR LIVING COMPLEX | ||||
| 1625 S FRANKLIN AVE | COLBY | KS | 67701 | LONG-TERM CARE FACILITY |
| FAMILY CENTER FOR HEALTH CARE | ||||
| 310 E COLLEGE DRIVE | COLBY | KS | 67701 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (10 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | FINANCIAL ASSISTANCE AT COST WAS DETERMINED BY UTILIZING DEPARTMENTAL COST-TO-CHARGE RATIOS FOR FINANCIAL ASSISTANCE PROVIDED IN AREAS THAT ARE REPORTED AS SUBSIDIZED HEALTH SERVICES. AN OVERALL COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE THE COST OF FINANCIAL ASSISTANCE PROVIED FOR SERVICES NOT REPORTED AS SUBSIDIZED HEALTH SERVICES. UNREIMBURSED MEDICAL COSTS WERE ALSO DETERMINED USING A BLEND OF COST-TO-CHARGE RATIOS FOR CERTAIN SERVICES AND AN OVERALL COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 FOR ALL OTHER SERVICES. THE COST OF PROVIDING SUBSIDIZED HEALTH SERVICES WAS DETERMINED USING A COST-TO-CHARGE RATIO FOR EACH SERVICE. ACTUAL COSTS AND REVENUES WERE UTILIZED FOR ALL OTHER ITEMS REPORTED ON LINE 7. |
| SCHEDULE H, PART III, LINE 2 | BAD DEBTS AT COST WERE DETERMINED BY UTILIZING DEPARTMENTAL COST-TO-CHARGE RATIOS FOR BAD DEBTS IN AREAS THAT ARE REPORTED AS SUBSIDIZED HEALTH SERVICES. AN OVERALL COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE THE COST OF BAD DEBTS IN ALL OTHER AREAS. |
| SCHEDULE H, PART III, LINE 3 | THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASONABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. |
| SCHEDULE H, PART III, LINE 4 | SEE PAGE 16 OF THE AUDITED FINANCIAL STATEMENTS REGARDING THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. |
| SCHEDULE H, PART III, LINE 8 | MEDICARE ALLOWABLE COSTS WERE DETERMINED USING AMOUNTS FROM THE MEDICAL CENTER'S MEDICARE COST REPORT. THE MEDICARE COST REPORT APPORTIONS ACTUAL COSTS TO THE MEDICARE PROGRAM USING CHARGES FOR ANCILLARY SERVICES AND PATIENT DAYS FOR NURSING SERVICES. THE MEDICAL CENTER BELIEVES THAT ALL OF THE MEDICARE SHORTFALL SHOULD BE CONSIDERED A COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. THE MEDICAL CENTER PROVIDES CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVES THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. |
| SCHEDULE H, PART III, LINE 9B | THE FINANCIAL ASSISTANCE POLICY STATES THAT PATIENTS QUALIFYING FOR CHARITY CARE MUST COMPLETE A FINANCIAL ASSISTANCE QUESTIONNAIRE AND SUBMIT A COPY OF THE PATIENT'S OR RELATIVE'S MOST RECENTLY-FILED TAX RETURN. IF CHARITY CARE IS CONSIDERED APPROPRIATE BY A COMMITTEE, THE PATIENT'S LIABILITY WILL BE REDUCED BY THE APPROVED AMOUNT. ANY REMAINING BALANCE ON PATIENT ACCOUNTS IS SUBJECT TO THE DEBT COLLECTION PROCEDURES ARTICULATED IN THE WRITTEN POLICY. |
| SCHEDULE H, PART VI, LINE 2 | THE MEDICAL CENTER ASSESSES THE COMMUNITY HEALTH CARE NEEDS PRIMARILY FROM RESPONSES FROM PATIENTS, COMMUNITY MEMBERS, AND HEALTH PROFESSIONALS. THE MEDICAL CENTER WILL TAKE INTO ACCOUNT CONCERNS OR REQUESTS FOR SERVICES THAT ARE EXPRESSED BY ALL PATIENTS AND COMMUNITY MEMBERS. ALSO, THE MEDICAL CENTER CONSIDERS REQUESTS MADE BY HEALTH PROFESSIONALS WHO INCLUDE, BUT ARE NOT LIMIT TO, PHYSICIANS, MID-LEVEL PROVIDERS, SOCIAL WORKERS, NURSES, AND DIETICIANS. |
| SCHEDULE H, PART VI, LINE 3 | ALL UNINSURED AND UNDER-INSURED PATIENTS ARE IDENTIFIED AND SCREENED UPON ADMISSION BY THE PATIENT FINANCIAL ADVISOR. DURING THIS INTERVIEW PROCESS, PAYMENT TERMS ARE DISCUSSED. IF THE PATIENT APPEARS TO NOT HAVE THE ABILITY TO PAY, THEY ARE ASKED TO COMPLETE A FINANCIAL QUESTIONNAIRE AND PROVIDE A COPY OF THEIR MOST RECENTLY FILED TAX RETURN FOR DETERMINING THEIR ABILITY TO PAY UNDER THE MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY. IF DURING THIS INTERVIEW PROCESS, IT APPEARS THAT A PATIENT MAY QUALIFY FOR ASSISTANCE UNDER STATE OR FEDERAL ASSISTANCE PROGRAMS, THEY ARE REFERRED TO CMCI'S SOCIAL SERVICES DEPARTMENT FOR ASSISTANCE IN COMPLETING THE APPLICABLE APPLICATIONS. |
| SCHEDULE H, PART VI, LINE 4 | THE MEDICAL CENTER IS LOCATED IN COLBY, KS AND SERVES THE NINE-COUNTY REGION OF NORTHWEST KANSAS, SEVERAL OF WHICH ARE MEDICALLY UNDERSERVED. THERE ARE A TOTAL OF EIGHT SMALL HOSPITALS SERVING THIS NINE-COUNTY REGION, HOWEVER, CMCI PROVIDES MANY SERVCES THAT ARE UNAVAILABLE IN SMALLER HOSPITALS. THE CLOSEST HOSPITALS TO THE MEDICAL CENTER ARE LOCATED IN OAKLEY, ATWOOD, AND HOXIE. THESE HOSPITALS ARE APPROXIMATELY 23,30, AND 36 MILES FROM COLBY, RESPECTIVELY. THE HIGHEST CONCENTRATION OF POPULATION FOR THE SERVICE AREA IS LOCATED IN COLBY, KS. COLBY HAS A POPULATION OF APPROXIMATELY 5,400 PEOPLE. THE MEDIAN HOUSEHOLD INCOME FOR THE CITY IS APPROXIMATELY $48,600. A MAJOR PORTION OF THE POPULATION THAT THE MEDICAL CENTER SERVES IS MEDICARE-ELIGIBLE CITIZENS WHO LIVE ON A FIXED INCOME. |
| SCHEDULE H, PART VI, LINE 5 | THE MEDICAL CENTER IS A GRANTEE OF THE KANSAS DEPARTMENT OF HEALTH & ENVIRONMENT, KANSAS QUALITY OF CARE PROJECT, AND PARTICIPATES IN PROGRAMS IDENTIFIED BY THE STATE AS NEEDED TO HELP IMPROVE THE HEALTH OF RESIDENTS OF OUR STATE AND LOCAL AREA. KANSAS PROMOTING HEALTH PROGRAM IS A CHONIC DISEASE SUPPORT GROUP AND IS A PROGRAM IN WHICH THE MEDICAL CENTER HAS TRAINED FACILITATORS AND OFFERS CLASSES. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | SCHOLARSHIPS | GrantTypeTxt |
| Recipient | 13 | RecipientCnt |
| Cash Grant | $13,316 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | CITIZENS MEDICAL CENTER AWARDS SCHOLARSHIPS ANNUALLY TO INDIVIDUALS WHO ARE STUDYING IN HEALTHCARE FIELDS INCLUDING, BUT NOT LIMITED TO: NURSING, LAB, RADIOLOGY, THERAPY, DIETETICS, MEDICAL RECORDS, TRANSCRIPTION, GERIATRICS, MD, DO, ARNP, PA, PHARMACY, SOCIAL SERVICES, OR HEALTHCARE ADMINISTRATION. CANDIDATES MUST COMPLETE AN APPLICATION AND ARE INTERVIEWED BY THE FOUNDATION EXECUTIVE DIRECTOR AND EDUCATION MANAGER. THE CITIZENS FOUNDATION BOARD AND CEO APPROVE THE FINAL SCHOLARSHIP RECIPIENTS. THE SCHOLARSHIP RECIPIENTS ARE RESPONSIBLE FOR TRACKING THE FUNDS AFTER AWARDS ARE MADE. | ExplanationTxt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| 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 | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (true) | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| RYAN STOVER | ||||||||||||||
| CHIEF FINANCIAL OFFICER | $164,371 | $0 | $19,823 | $0 | $450 | $0 | $9,869 | $0 | $10,627 | $0 | $205,140 | $0 | $0 | $0 |
| GREG UNRUH | ||||||||||||||
| CHIEF EXECUTIVE OFFICER | $229,257 | $0 | $50,366 | $0 | $3,810 | $0 | $14,772 | $0 | $12,738 | $0 | $310,943 | $0 | $0 | $0 |
| KELLY GABEL | ||||||||||||||
| PHYSICIAN | $413,051 | $0 | $866 | $0 | $300 | $0 | $21,472 | $0 | $26,455 | $0 | $462,144 | $0 | $0 | $0 |
| PAUL SCHIFERL | ||||||||||||||
| PHARMACIST | $248,539 | $0 | $23,366 | $0 | $270 | $0 | $14,502 | $0 | $12,082 | $0 | $298,759 | $0 | $0 | $0 |
| BRENDA KOPRIVA | ||||||||||||||
| PHYSICIAN | $404,251 | $0 | $866 | $0 | $300 | $0 | $8,312 | $0 | $23,682 | $0 | $437,411 | $0 | $0 | $0 |
| DARREN MATCHELL | ||||||||||||||
| PHYSICIAN | $383,324 | $0 | $866 | $0 | $0 | $0 | $19,118 | $0 | $18,081 | $0 | $421,389 | $0 | $0 | $0 |
| DERECK TOTTEN | ||||||||||||||
| PHYSICIAN | $362,613 | $0 | $866 | $0 | $270 | $0 | $16,059 | $0 | $25,776 | $0 | $405,584 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 5A | KELLY GABEL, PAUL SCHIFERL, BRENDA KOPRIVA, DARREN MATCHELL, AND DERECK TOTTEN RECEIVED A BONUS IN 2021 BASED ON THE REVENUES OF THE ORGANIZATION. |
| SCHEDULE J, PART I, LINE 6A | GREG UNRUH AND RYAN STOVER ARE COMPENSATED BY CITIZENS MEDICAL CENTER, INC., AND HAVE A BONUS ARRANGEMENT THAT IS BASED ON FOUR AREAS: PATIENT SATISFACTION, NET MARGIN, AR DAYS BELOW 60, AND DOCTOR TO DOOR AVERAGE TIME. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 6 | THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION WITH 21 MEMBERS AT DECEMBER 31, 2021. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE MEDICAL CENTER'S CORPORATE MEMBERS ELECT THE GOVERNING BODY. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE RETURN IS THEN REVIEWED BY THE ORGANIZATION'S CEO AND BOARD OF TRUSTEES. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL BOARD MEMBERS PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | A CONFLICT OF INTEREST DISCLOSURE FORM IS PROVIDED WITH A COPY TO THE CURRENT CONFLICT OF INTEREST POLICY. THIS DISCLOSURE IS COMPLETED BY EACH MEMBER OF THE BOARD OF TRUSTEES UPON ELECTION AND ANNUALLY THEREAFTER. IF A CONFLICT OF INTEREST IS DISCOVERED, THE MEMBER CONCERNED IS NOT ALLOWED TO VOTE ON THE RELATED MATTER. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | THE BOARD OF TRUSTEES REVIEWS THE COMPENSATION OF THE CEO AND SENIOR MANAGEMENT. THE MEDICAL CENTER RELIES ON A JOINT WAGE SALARY REPORT PUBLISHED BY THE KANSAS HOSPITAL AND MISSOURI HOSPITAL ASSOCIATIONS, AS WELL AS ANY AND ALL AVAILABLE LOCAL DATA. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE MEDICAL CENTER MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST. |
| FORM 990, PART XI, LINE 9 | THE CHANGE IN BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATIONS NET OF TRANSFERS IS 564,342. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITIZENS MEDICAL CENTER EMPLOYEE BENEFIT | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E COLLEGE DRIVE | AddressLine1Txt |
| City | COLBY | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481158262 | EIN |
| Primary Activities | BENEFITS | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(9) | ExemptCodeSectionTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMCI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MED-SERV INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 E COLLEGE DRIVE | AddressLine1Txt |
| City | COLBY | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67701 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480994564 | EIN |
| Primary Activities | INACTIVE | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMCI | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | C | EntityTypeTxt |
| Share Of Total Income | $0 | ShareOfTotalIncomeAmt |
| Share Of EOY Assets | $0 | ShareOfEOYAssetsAmt |
| Ownership | 1.00000 | OwnershipPct |
| 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 | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITIZENS MEDICAL CENTER EMPLOYEE BENEFIT PLAN | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | M | TransactionTypeTxt |
| Involved | $1,493,073 | InvolvedAmt |
| Method Of Amount Determination | COST | MethodOfAmountDeterminationTxt |