2020-05-15T13:49:18-05:00 2019-09-30 470698853 BLAND & ASSOCIATES PC 450 REGENCY PKWY STE 340 OMAHA NE 68114 990 2018-10-01 480608913 SALEM HOSPITAL INC SALE 6209472272 704 S ASH STREET HILLSBORO KS 67063 PETER MUNGAI CEO/ADMINISTRATOR 6209471450 2020-03-17 true NICOLE SNOW P01392174 4023978822 2020-05-15 66.37.249.14 2020-05-15 13:49:18 CD P EB1CF38BD7499AE37A8AFBE6A04FF9DAFFA54D41 EB1CF38BD7499AE37A8AFBE6A04FF9DAFFA54D41 2018 2020-09-23 17:36:50Z SALEM HOME PETER MUNGAI 704 S ASH STREET HILLSBORO KS 67063 3126450 false X WWW.SALEMHOMEKS.ORG X 1953 KS SALEM HOME WILL MASTER PERSON-CENTERED CARE TO BENEFIT RESIDENTS, FAMILIES, STAFF, AND THE COMMUNITY. 7 7 93 20 12761 77500 77500 2598754 2895553 59 27423 86177 86883 2762490 3087359 0 0 1749130 1886570 0 0 947234 1182896 2696364 3069466 66126 17893 856670 833102 224780 183319 631890 649783 SALEM HOME WILL MASTER PERSON-CENTERED CARE TO BENEFIT RESIDENTS, FAMILIES, STAFF, AND THE COMMUNITY. false false 2712267 2895553 PROVIDED LONG-TERM CARE VIA A SKILLED NURSING FACILITY AND INDEPENDENT LIVING APARTMENTS. CARE WAS PROVIDED FOR A TOTAL OF 72 NURSING FACILITY RESIDENTS AND 11 APARTMENT RESIDENTS. THERE WERE A TOTAL OF 12,880 CENSUS DAYS FOR NURSING FACILITY RESIDENTS. 2712267 true false false true false false false false false false true false false false true false true false false false false false false false false false false false false false false false false false false false false false true false false false false false false false false true 4 0 true 93 true true true false false false false false false false X 7 7 false false false false false false false true true false false true true true true true true true false false KS X HEATHER CROCKER 6209471459 704 S ASH ST HILLSBORO KS 67063 WENDELL DIRKS CHAIR/DIRECT 1.00 X X 0 0 0 JOANN KNAK SECRETARY/DI 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/ADMINIST 40.00 X 92003 0 991 HEATHER CROCKER DIRECTOR OF 40.00 X 52000 0 3125 144003 4116 false false false 77500 77500 77500 NET RESIDENT SERVICE REVENUE 623000 2895553 2895553 2895553 1633 1633 67812 2373 65439 65439 65439 62508 36718 25790 25790 25790 MEALS 900099 10934 10934 OTHER REVENUE 722513 6424 6424 SHARED SERVICES REVENUE 900099 2259 2259 1827 1827 21444 3087359 2921343 12761 75755 X 144003 144003 1512746 1378345 134401 4327 4133 194 105271 100561 4710 120223 114845 5378 1102 833 269 25013 25013 381522 381522 106029 77333 28696 9168 7742 1426 284 284 54082 54082 30754 30754 FOOD 131642 131642 MEDICAL SUPPLIES 95901 95901 UTILITIES 89697 89697 IN-KIND EXPENSE 77500 77500 180202 107926 72276 3069466 2712267 357199 0 39505 25934 143455 120502 257467 265965 24326 23261 880369 482929 391917 397440 856670 833102 214485 162224 10295 10115 10980 224780 183319 X 631890 649783 631890 649783 856670 833102 X 17893 X false true X true false X false false false false false true 319 false false false 319 false SCHEDULE C, PART IV A PORTION OF THE LEADINGAGE KANSAS ANNUAL DUES WERE FOR LOBBYING ACTIVITIES. 880369 482929 397440 397440 CAPITAL LEASE 10980 10980 3089732 2373 2373 3087359 3087359 3071839 2373 2373 3069466 3069466 SCHEDULE D, PAGE 4, PART XI, LINE 2D RENTAL EXPENSES 2,373 SCHEDULE D, PAGE 4, PART XII, LINE 2D RENTAL EXPENSES 2,373 SCHEDULE D, PAGE 4, PART XII, LINE 4B -2,373 BOOK / TAX DEPRECIATION DIFFERENCE 2,373 X 1 77500 false false false FORM 990, PAGE 6, PART VI, 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, PAGE 6, PART VI, LINE 12C THE CONFLICT OF INTEREST POLICY COVERS DIRECTORS, OFFICERS, AND ALL EMPLOYEES WHO CAN INFLUENCE THE ACTIONS OF SALEM HOME. THESE INDIVIDUALS ARE REQUIRED TO ANNUALLY SIGN A STATEMENT CONFIRMING THAT THEY RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAVE READ AND UNDERSTAND THE POLICY, AND HAVE AGREED TO COMPLY WITH THE POLICY. ANY POTENTIAL CONFLICTS OF INTEREST MUST BE DISCLOSED TO THE CHIEF EXECUTIVE OFFICER (OR TO THE BOARD CHAIR IF IT IS THE CEO WHO HAS THE POTENTIAL CONFLICT). THE POTENTIAL CONFLICT WILL THEN BE BROUGHT TO THE BOARD OF DIRECTORS WHO SHALL DETERMINE IF AN ACTUAL CONFLICT EXISTS. IF AN ACTUAL CONFLICT EXISTS, THE INDIVIDUAL WITH THE CONFLICT MUST RECUSE THEMSELF FROM THE BOARD MEETING UNTIL THE DISCUSSION AND APPROVAL OF THE TRANSACTION IS COMPLETED. FORM 990, PAGE 6, PART VI, LINE 15A IN 2016, THE INTERIM CEO REVIEWED COMPARABLE POSITIONS AND PROVIDED THE BOARD OF DIRECTORS WITH SUGGESTED COMPENSATION FOR THE NEW CEO POSITION. THE BOARD OF DIRECTORS AGREEN UPON COMPENSATION, WHICH WAS DOCUMENTED IN AN OFFER LETTER TO THE NEW CEO. THIS OFFER LETTER WAS SIGNED BY THE NEW CEO, INTERIM CEO, AND BOARD OF DIRECTORS CHAIRMAN. FORM 990, PAGE 6, PART VI, 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 381,522 0 0