2021-03-28T11:33:37-05:00 2020-09-30 470698853 BLAND & ASSOCIATES PC 450 REGENCY PARKWAY STE 340 OMAHA NE 68114 990 2019-10-01 480608913 SALEM HOSPITAL INC SALE 6209471450 704 S ASH STREET HILLSBORO KS 67063 PETER MUNGAI CEO/ADMINISTRATOR 6209472272 2021-03-28 1 NICOLE SNOW P01392174 4023978822 2021-03-23 2019 2022-09-23 18:48:47Z SALEM HOME PETER MUNGAI 704 S ASH STREET HILLBORO KS 67063 3495608 0 X WWW.SALEMHOMEKS.ORG X 1953 KS SALEM HOME WILL MASTER PERSON-CENTERED CARE TO BENEFIT RESIDENTS, FAMILIES, STAFF, AND THE COMMUNITY. 7 7 94 10 4951 -9753 77500 458613 2895553 2963976 27423 2775 86883 70244 3087359 3495608 0 0 0 0 1886570 1851800 0 0 0 1182896 1263331 3069466 3115131 17893 380477 833102 1593534 183319 563274 649783 1030260 SALEM HOME WILL MASTER PERSON-CENTERED CARE TO BENEFIT RESIDENTS, FAMILIES, STAFF, AND THE COMMUNITY. 0 0 2723281 2963976 PROVIDED LONG-TERM CARE VIA A SKILLED NURSING FACILITY AND INDEPENDENT LIVING APARTMENTS. CARE WAS PROVIDED FOR A TOTAL OF 61 NURSING FACILITY RESIDENTS AND 12 APARTMENT RESIDENTS. THERE WERE A TOTAL OF 12,484 CENSUS DAYS FOR NURSING FACILITY RESIDENTS. 2723281 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 4 0 1 94 1 1 1 0 0 0 0 0 0 0 0 0 X 7 7 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 0 0 KS X HEATHER CROCKER 6209471459 704 S ASH ST HILLSBORO KS 67063 WENDELL DIRKS CHAIR/DIRECTOR 1.00 X X 0 0 0 JOANN KNAK SECRETARY/DIRECTOR 1.00 X X 0 0 0 TOM KOSLOWSKY DIRECTOR 1.00 X 0 0 0 JOYCE KYLE DIRECTOR 1.00 X 0 0 0 EILEEN UNRUH DIRECTOR 1.00 X 0 0 0 HANK WIEBE DIRECTOR 1.00 X 0 0 0 DELAYNE HERBEL DIRECTOR 1.00 X 0 0 0 PETER MUNGAI CEO/ADMINISTRATOR 40.00 X 97700 0 1941 HEATHER CROCKER DIRECTOR OF FINANCE 40.00 X 56010 0 3338 153710 0 5279 0 0 0 0 0 378681 79932 77500 458613 NET RESIDENT SERVICE R 623000 2963976 2963976 2963976 2775 2775 53651 0 53651 53651 53651 OTHER REVENUE 722513 10440 10440 MEALS 900099 3623 3623 VENDING MACHINES 900099 1328 1328 1202 1202 16593 3495608 2963976 4951 68068 X 153710 140080 13630 1490040 1357915 132125 91572 86664 4908 116478 110236 6242 150 150 24000 24000 443096 434645 8451 140286 140286 8039 7225 814 3 3 61708 61708 35800 35800 FOOD 121378 92370 29008 MEDICAL SUPPLIES 112782 112782 UTILITIES 90627 90627 IN KIND EXPENSE 77500 77500 147962 72798 75164 3115131 2723281 391850 0 25934 148007 120502 767924 265965 257576 620 23261 25864 938179 544636 397440 393543 833102 1593534 162224 179715 10115 6238 377321 10980 183319 563274 X 649783 1030260 649783 1030260 833102 1593534 380477 0 X 0 1 X 1 0 X 0 0 0 0 0 1 369 0 0 0 369 0 PART II-B, LINE 1: A PORTION OF THE LEADING AGE KANSAS ANNUAL DUES ARE FOR LOBBYING ACTIVITIES. 938179 544636 393543 393543 3495608 0 3495608 0 3495608 3115131 0 3115131 0 3115131 X RENTAL EXPENSE 1 77500 FMV 0 0 0 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 CHIEF EXECUTIVE OFFICER. ANY QUESTIONS OR CONCERNS THE CHIEF EXECUTIVE OFFICER HAS ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. FORM 990, PART VI, SECTION B, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, AND ALLEMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF SALEM HOME. THESE INDIVIDUALSARE REQUIRED TO ANNUALLY SIGN A STATEMENT CONFIRMING THAT THEY RECEIVED ACOPY OF THE CONFLICT OF INTEREST POLICY, HAVE READ AND UNDERSTAND THEPOLICY, AND HAVE AGREED TO COMPLY WITH THE POLICY. ANY POTENTIAL CONFLICTSOF INTEREST MUST BE DISCLOSED TO THE CHIEF EXECUTIVE OFFICER (OR TO THEBOARD CHAIR IF IT IS THE CEO WHO HAS THE POTENTIAL CONFLICT). THE POTENTIALCONFLICT WILL THEN BE BROUGHT TO THE BOARD OF DIRECTORS WHO SHALL DETERMINEIF AN ACTUAL CONFLICT EXISTS. IF AN ACTUAL CONFLICT EXISTS, THE INDIVIDUALWITH THE CONFLICT MUST RECUSE THEMSELF FROM THE BOARD MEETING UNTIL THEDISCUSSION AND APPROVAL OF THE TRANSACTION IS COMPLETED. FORM 990, PART VI, SECTION B, LINE 15A IN 2016, THE INTERIM CEO REVIEWED COMPARABLE POSITIONS AND PROVIDED THEBOARD OF DIRECTORS WITH SUGGESTED COMPENSATION FOR THE NEW CEO POSITION.THE BOARD OF DIRECTORS AGREEN UPON COMPENSATION, WHICH WAS DOCUMENTED IN ANOFFER LETTER TO THE NEW CEO. THIS OFFER LETTER WAS SIGNED BY THE NEW CEO, INTERIM CEO, AND BOARD OF DIRECTORS CHAIRMAN. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G OTHER FEES: PROGRAM SERVICE EXPENSES 434,645. MANAGEMENT AND GENERAL EXPENSES 8,451. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 443,096.