COMMUNITY MEMORIAL HEALTHCARE INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEMORIAL HEALTHCARE INC (EIN 48-0630224)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-11-11
- IRS object ID
- 202023169349301532
- Schema version
- 2019v5.1
- 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 J
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-11-11T08:42:30-06:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD 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 | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480630224 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HEALTHCARE INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % CURTIS R HAWKINSON | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 7855622311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 N 18TH STREET | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66508 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CURTIS W HAWKINSON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7855622311 | PhoneNum |
| Signature | 2020-11-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Gregory M Sullivan | PreparerPersonNm |
| PTIN | P01259107 | PTIN |
| Phone | 8162216300 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.126.162 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 43372220203165000001 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2020-11-11 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 4FFCF17FAA7DF0DADDA289A43AEF3406AF7B162A | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 355CC2E4B6E27E32DAADC48E1CA8D97843AD7DA8 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | CURTIS R HAWKINSON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 N 18TH ST | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66508 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,254,907 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CMHCARE.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1955 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | CMH IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION THAT OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL FOR PATIENTS IN MARYSVILLE, KANSAS AND SURROUNDING AREAS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 13 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 249 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $75,247 | PYContributionsGrantsAmt |
| CY Contributions Grants | $194,897 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $22,709,507 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $22,846,239 | CYProgramServiceRevenueAmt |
| PY Investment Income | $346,972 | PYInvestmentIncomeAmt |
| CY Investment Income | $213,771 | CYInvestmentIncomeAmt |
| PY Other Revenue | -$230,698 | PYOtherRevenueAmt |
| CY Other Revenue | $0 | CYOtherRevenueAmt |
| PY Total Revenue | $22,901,028 | PYTotalRevenueAmt |
| CY Total Revenue | $23,254,907 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,000 | 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 | $12,323,565 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $12,267,099 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,160,570 | PYOtherExpensesAmt |
| CY Other Expenses | $10,365,928 | CYOtherExpensesAmt |
| PY Total Expenses | $23,486,135 | PYTotalExpensesAmt |
| CY Total Expenses | $22,633,027 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$585,107 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $621,880 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $12,140,213 | TotalAssetsBOYAmt |
| Total Assets EOY | $12,946,981 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $2,347,683 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,990,201 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,792,530 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $10,956,780 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION STATEMENT OF COMMUNITY MEMORIAL HEALTHCARE, INC. IS TO EXCEL AT CARING FOR YOU. THE VISION STATEMENT OF COMMUNITY MEMORIAL HEALTHCARE, INC. IS TO EXCEED EXPECTATIONS AS A TRUSTED AND VALUED HEALTH PROVIDER. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,483,706 | ExpenseAmt |
| Revenue | $5,254,635 | RevenueAmt |
| Desc | THREE RURAL HEALTH CLINICS WITH A TOTAL OF 21,331 OFFICE VISITS. | Desc |
Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $6,628,088 | ExpenseAmt |
| Revenue | $7,767,721 | RevenueAmt |
| Desc | ACUTE ADULT, PEDIATRIC AND INFANT INPATIENT CARE, SWING BED, LABOR AND DELIVERY AND OBSERVATION CARE. 3,978 DAYS OF CARE PROVIDED. | Desc |
Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expense | $1,949,438 | ExpenseAmt |
| Revenue | $2,284,624 | RevenueAmt |
| Desc | 24 HR EMERGENCY ROOM SERVICES - 3,368 VISITS, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES - 4,436 VISITS | Desc |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Prog Srvc Expense | $6,433,144 | TotalOtherProgSrvcExpenseAmt |
| Total Other Prog Srvc Revenue | $7,539,259 | TotalOtherProgSrvcRevenueAmt |
| Total Program Service Expenses | $19,494,376 | 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 | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | 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 | 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 | Yes (true) | 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 | 37 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 249 | 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 | 13 | 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 | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | 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 | KS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | CURTIS R HAWKINSON | PersonNm |
| Phone | 7855622311 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 N 18TH ST | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66508 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (23 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 | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| DR BEN BRUNA | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $393,065 | $0 | $19,122 | ||
| SHANE THORESON | ||||||||
| DIRECTOR | 40.0 | 0.0 | $348,590 | $0 | $19,610 | Yes (X) | ||
| DR JOHN HAEFELE | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $319,201 | $0 | $20,898 | ||
| DR DANIELE WURTZ | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $307,867 | $0 | $25,810 | ||
| DR CHERYL RICE | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $306,323 | $0 | $25,810 | ||
| DR KENNETH DUENSING | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $203,892 | $0 | $19,725 | ||
| CURTIS R HAWKINSON | ||||||||
| CEO | 40.0 | 1.0 | $163,497 | $0 | $20,137 | Yes (X) | ||
| DAN FEHR | ||||||||
| CFO | 40.0 | 0.0 | $123,844 | $0 | $17,962 | Yes (X) | ||
| MARGE SCHLABACH | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| ROBERT VOET | ||||||||
| DIRECTOR/CHAIRPERSON | 2.0 | 1.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| LUCY PAPES | ||||||||
| DIRECTOR | 1.0 | 0.5 | $0 | $0 | $0 | Yes (X) | ||
| BRYCE PORTER | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| GAIL GILKERSON | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| KEN LAMOREAUX | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| CANDACE WRIGHT | ||||||||
| DIRECTOR/VICE CHAIRPERSON | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| DENNIS CASHIER | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| NICK WOLFE | ||||||||
| DIRECTOR | 1.0 | 0.5 | $0 | $0 | $0 | Yes (X) | ||
| EDWARD POPEJOY | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| ERIN WRIGHT | ||||||||
| DIRECTOR | 1.0 | 0.5 | $0 | $0 | $0 | Yes (X) | ||
| MARY CAFFREY | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| JEFF CRIST | ||||||||
| DIRECTOR | 1.0 | 0.5 | $0 | $0 | $0 | Yes (X) | ||
| GARY HOLLE | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| GAGE ZIERLEIN | ||||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,166,279 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $169,074 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | 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 |
|---|---|---|---|---|---|
| CRIST AND PIESCHEL REHABILITATION | |||||
| 535 RIDGE RD | WATERVILLE | KS | 66548 | PT, OT, ST | $1,040,043 |
| MARYSVILLE ANESTHESIA | |||||
| 1017 BROADWAY STE 7 | MARYSVILLE | KS | 66508 | ANESTHESIOLOGIST | $357,825 |
| CPSI | |||||
| 6600 WALL ST | MOBILE | AL | 36695 | COMPUTER SERVICES | $291,223 |
| NEBRASKA HEART INSTITUTE | |||||
| 7500 S 91ST ST | LINCOLN | NE | 68501 | NUCLEAR MEDICINE | $213,049 |
| SHARED MEDICAL SERVICES | |||||
| 209 LIMESTONE PASS | COTTAGE GRAVE | WI | 53527 | MRI | $124,083 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 11 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $184,816 | RelatedOrganizationsAmt |
| Government Grants | $6,000 | GovernmentGrantsAmt |
| All Other Contributions | $4,081 | AllOtherContributionsAmt |
| Total Contributions | $194,897 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net Patient Service Revenue | 621400 | $21,566,432 | $21,566,432 |
| Dietary Income | 624200 | $68,126 | $68,126 |
| Other Operating Revenue | 900099 | $1,211,681 | $1,211,681 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $22,846,239 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $195,370 | TotalRevenueColumnAmt |
| Exclusion | $195,370 | 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 |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $18,401 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $18,401 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,401 | 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $0 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,254,907 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $22,846,239 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $195,370 | 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 | $693,640 | TotalAmt |
| Program Services | $555,576 | ProgramServicesAmt |
| Management And General | $138,064 | 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 | $9,369,264 | TotalAmt |
| Program Services | $7,406,264 | ProgramServicesAmt |
| Management And General | $1,963,000 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $288,452 | TotalAmt |
| Program Services | $223,483 | ProgramServicesAmt |
| Management And General | $64,969 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,239,531 | TotalAmt |
| Program Services | $1,176,698 | ProgramServicesAmt |
| Management And General | $62,833 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $676,212 | TotalAmt |
| Program Services | $610,389 | ProgramServicesAmt |
| Management And General | $65,823 | ManagementAndGeneralAmt |
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 | $19,898 | TotalAmt |
| Management And General | $19,898 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $120,703 | TotalAmt |
| Management And General | $120,703 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
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 | $3,162,332 | TotalAmt |
| Program Services | $3,033,232 | ProgramServicesAmt |
| Management And General | $129,100 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,535 | TotalAmt |
| Program Services | $43,791 | ProgramServicesAmt |
| Management And General | $744 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $295,453 | TotalAmt |
| Program Services | $163,695 | ProgramServicesAmt |
| Management And General | $131,758 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,507 | TotalAmt |
| Program Services | $5,350 | ProgramServicesAmt |
| Management And General | $70,157 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $934,496 | TotalAmt |
| Program Services | $881,014 | ProgramServicesAmt |
| Management And General | $53,482 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,783 | TotalAmt |
| Program Services | $150,783 | ProgramServicesAmt |
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 | $2,041 | TotalAmt |
| Management And General | $2,041 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,350,926 | TotalAmt |
| Program Services | $1,257,295 | ProgramServicesAmt |
| Management And General | $93,631 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $227,226 | TotalAmt |
| Program Services | $128,193 | ProgramServicesAmt |
| Management And General | $99,033 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $864,266 | $864,266 | |
| MEDICAL SUPPLIES | $2,584,436 | $2,584,436 | |
| EQUIP RENTAL & MAINTENANCE | $315,065 | $307,642 | $7,423 |
| DUES & SUBSCRIPTIONS | $171,226 | $71,937 | $99,289 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,035 | TotalAmt |
| Program Services | $30,332 | ProgramServicesAmt |
| Management And General | $16,703 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $22,633,027 | TotalAmt |
| Program Services | $19,494,376 | ProgramServicesAmt |
| Management And General | $3,138,651 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,884 | BOYAmt |
| EOY | $14,813 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,431,603 | BOYAmt |
| EOY | $1,074,269 | 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 | $3,219,298 | BOYAmt |
| EOY | $3,491,321 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $129,289 | BOYAmt |
| EOY | $103,363 | 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 | $478,746 | BOYAmt |
| EOY | $491,769 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $534,579 | BOYAmt |
| EOY | $463,301 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,024,651 | BOYAmt |
| EOY | $6,167,154 | 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 | $306,163 | BOYAmt |
| EOY | $1,140,991 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,140,213 | BOYAmt |
| EOY | $12,946,981 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,308,379 | BOYAmt |
| EOY | $1,963,827 | 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 | $39,304 | BOYAmt |
| EOY | $26,374 | 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 | $2,347,683 | BOYAmt |
| EOY | $1,990,201 | 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 | $9,716,736 | BOYAmt |
| EOY | $10,880,986 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $75,794 | BOYAmt |
| EOY | $75,794 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,792,530 | BOYAmt |
| EOY | $10,956,780 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,140,213 | BOYAmt |
| EOY | $12,946,981 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $621,880 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $542,370 | NetUnrlzdGainsLossesInvstAmt |
| 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 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 | |
| Form4720 Filed | false | Form4720FiledInd |
| Volunteers | Yes (true) | VolunteersInd |
| Paid Staff Or Management | Yes (true) | PaidStaffOrManagementInd |
| Media Advertisements | Yes (true) | MediaAdvertisementsInd |
| Media Advertisements | $1,390 | MediaAdvertisementsAmt |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $5,606 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $6,996 | 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, LINE 1F | FormAndLineReferenceDesc |
| Explanation | DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,060,979 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $50,831 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $1,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $48,115 | OtherExpendituresAmt |
| Administrative Expenses | $1,716 | AdministrativeExpensesAmt |
| End Year Balance | $1,060,979 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,060,979 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $50,661 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $2,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $48,661 | OtherExpendituresAmt |
| End Year Balance | $1,060,979 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,060,979 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $27,670 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $2,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $25,670 | OtherExpendituresAmt |
| End Year Balance | $1,060,979 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,060,979 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $27,658 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $3,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $24,658 | OtherExpendituresAmt |
| End Year Balance | $1,060,979 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,072,988 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $31,992 | InvestmentEarningsOrLossesAmt |
| Grants Or Scholarships | $2,000 | GrantsOrScholarshipsAmt |
| Other Expenditures | $42,001 | OtherExpendituresAmt |
| End Year Balance | $1,060,979 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.92860 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.07140 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM FOUNDATION | $467,368 |
| DUE FROM THIRD PARTY | $673,623 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,140,991 | TotalBookValueOtherAssetsAmt |
| Total Rev Etc Audited Fincl Stmt | $23,113,229 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $542,370 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $180,218 | OtherRevenueAmt |
| Revenue Not Reported | $722,588 | RevenueNotReportedAmt |
| Revenue Subtotal | $22,390,641 | RevenueSubtotalAmt |
| Other Revenues Not Included | $864,266 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $864,266 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $23,254,907 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $22,690,584 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $921,823 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $921,823 | ExpensesNotReportedAmt |
| Expenses Subtotal | $21,768,761 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $864,266 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $864,266 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $22,633,027 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART V, LINE 4 | BOARD-DESIGNATED ASSETS LIMITED TO USE OF $985,185 INCLUDE ASSETS SET ASIDE BY THE BOARD OF DIRECTORS FOR FUTURE CAPITAL IMPROVEMENTS AND OPERATIONS OVER WHICH THE BOARD RETAINS CONTROL AND MAY, AT ITS DISCRETION, SUBSEQUENTLY USE THE ASSETS FOR OTHER PURPOSES. PERMANENTLY RESTRICTED ASSETS OF $75,794 HAVE BEEN RESTRICTED BY DONORS TO BE MAINTAINED BY CMH IN PERPETUITY WITH THE INCOME TO BE USED FOR SCHOLARSHIPS. |
| 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 | RELATED ORGANIZATION REVENUES $ 180,218 |
| SCHEDULE D, PART XI, LINE 4B | BAD DEBT EXPENSE $ 864,266 |
| SCHEDULE D, PART XII, LINE 2D | RELATED ORGANIZATION EXPENSES $ 921,823 |
| SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $ 864,266 |
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 |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| 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 | $167,984 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $167,984 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,230,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $790,381 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $439,635 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,398,000 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $790,381 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $607,619 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02800 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,623 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $34,896 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,727 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $50,623 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $34,896 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $15,727 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00100 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,448,623 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $825,277 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $623,346 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02900 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $948,469 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $237,117 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $7,965,334 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,207,012 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$241,678 | 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 MEMORIAL HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 N 18TH ST | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66508 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CHMCARE.COM | WebsiteAddressTxt |
| State License | H058001 | 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 MEMORIAL HOSPITAL | 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 | 19 | 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 |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | 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 | 150. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| 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 |
| 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 PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE 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 Medicaid Medcr Prvt | Yes (X) | LookBackMedicaidMedcrPrvtInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | A TARGETED SURVEY WAS SENT TO MEMBERS OF THE LOCAL SCHOOL SYSTEM, RELIGIOUS ORGANIZATIONS, GOVERNMENTAL AGENCIES, NON-PROFITS, AND OTHER PUBLIC HEALTH AGENCIES, REGIONAL MENTAL HEALTH PROVIDERS, AND BUSINESS LEADERS. |
| SCHEDULE H, PART V, SECTION B, LINE 7A | THE COMPLETE CHNA CAN BE FOUND AT: http://www.cmhcare.org/docs/Final_CHNA_Report%2C_2019.pdf?sub=Patient%20In formation |
| SCHEDULE H, PART V, SECTION B, LINE 10A | THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: http://www.cmhcare.org/docs/Implementation_Strategy_2020-2022_Final.pdf?su b=Patient%20Information |
| SCHEDULE H, PART V, SECTION B, LINE 11 | OUR 2019 HEALTH NEEDS ASSESSMENT WAS SUMMARIZED AND PRIORITIZED INTO 6 ISSUES WHICH DID NOT VARY SIGNIFICANTLY FROM OUR PREVIOUS CHNA. ISSUES INCLUDE MENTAL HEALTH, OBESITY, AGING POPULATION, POVERTY, AND ACCESS TO CARE. TO ASSIST OUR AGING COMMUNITY MEMBERS WE CONDUCT MONTHLY HEALTH TOPIC LUNCHEONS GEARED TOWARDS OUR OLDER POPULATION. WE PROVIDE SWING-BED, HOME HEALTH, AND DME SERVICES TO ASSIST OUR POPULATION AS THEY AGE BUT HAVE INTRODUCED NO NEW PROGRAMS BASED ON THIS CHNA. FINANCIAL CONSTRAINTS AND INSURANCE OPTIONS ARE OUTSIDE OF OUR CONTROL BUT WE DO INFORM ALL PATIENTS OF OUR FINANCIAL ASSISTANCE OPTION THAT IS GRANTED TO THOSE DEMONSTRATING FINANCIAL NEEDS BASED UPON OUR ESTABLISHED CRITERIA. ADDITIONALLY, WE HAVE A RESOURCE WITHIN OUR PHARMACY THAT WORKS WITH INSURANCE AND PHARMACEUTICAL COMPANIES TO ASSIST LOW-INCOME PATIENTS OBTAIN FREE AND REDUCED MEDICATIONS WHICH IS CURRENTLY ASSISTING 7 OF OUR MOST VULNERABLE PATIENTS OBTAIN MEDICATION WORTH NEARLY $12,000 PER YEAR. WE CONDUCT A HEALTH FAIR EACH YEAR WHICH PROVIDES (NEARLY 500 PEOPLE) A COMPREHENSIVE LAB PANEL FOR A FLAT $30 FEE CASH PRICE AND ANNUAL SPORTS PHYSICALS FOR $27.50 FEE CASH PRICE TO PROVIDE LOW COST OPTIONS FOR ANNUAL DIAGNOSTIC SERVICES. TO ASSIST WITH COMMUNITY OBESITY WE PROVIDE DAILY, LOW-COST, PREPARED FOODS FOR THE RESIDENTS OF LOCAL DISABILITY HOUSING. WE DO NOT PROVIDE STRUCTURED MENTAL HEALTH SERVICES LOCALLY, BUT PARTNER WITH A REGIONAL PROVIDER TO ALLOW CONSULTATION VIA WEB-CAM AND REFERRALS TO THEIR OFFICES. WE CONTINUE TO HAVE A WIDE VARIETY OF SPECIALIST SERVICES PROVIDED ON-SITE WITH PHYSICIANS WHO DRIVE FROM MORE THAN 70 MILES AWAY TO CONDUCT WEEKLY OR MONTHLY CLINIC SCHEDULES. WE PROVIDE SPACE TO A DIALYSIS PROVIDER TO CONDUCT TREATMENTS ON-SITE RATHER THAN REQUIRING PATIENT AND CAREGIVERS TO TRAVEL 70 MILES EACH WAY SEVERAL TIMES EACH WEEK FOR TREATMENTS. |
| SCHEDULE H, PART V, SECTION B, LINE 16A | THE FAP CAN BE FOUND AT: http://www.cmhcare.org/docs/2018_Financial_Assistance_Policy.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16B | THE FAP APPLICATION CAN BE FOUND AT: http://www.cmhcare.org/docs//FinancialAssistanceApp2016.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16C | THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| COMMUNITY PHYSICIANS CLINIC | ||||
| 1902 MAY ST | MARYSVILLE | KS | 66508 | RURAL HEALTH CLINIC |
| BLUE RAPIDS MEDICAL CLINIC | ||||
| 607 LINCOLN | BLUE RAPIDS | KS | 66411 | RURAL HEALTH CLINIC |
| COMMUNITY MEDICAL EQUIPMENT | ||||
| 805 BROADWAY | MARYSVILLE | KS | 66508 | DURABLE MEDICAL EQUIPMENT |
| CMH HOME HEALTH | ||||
| 805 BROADWAY | MARYSVILLE | KS | 66508 | HOME HEALTH AGENCY |
| COMMUNITY PHYSICIANS CLINIC - WYMORE | ||||
| 100 NORTH 7TH | WYMORE | NE | 68466 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | FAP PROVIDES DISCOUNTS FOR INCOME LEVELS ABOVE 150% OF FPG. 50% OF INCOME ABOVE FPG APPLIED TO OUTSTANDING BALANCE AND DIFFERENCE IS ELIGIBLE FOR DISCOUNT IF NO OTHER ASSETS ARE IDENTIFIED. THIS ALLOWS DISCOUNTS TO APPLY IN CATASTROPHIC SITUATIONS EVEN WHEN THE PATIENT WOULD NOT OTHERWISE HAVE QUALIFIED FOR CHARITY CONSIDERATION. |
| SCHEDULE H, PART I, LINE 7 | THE COST-TO-CHARGE RATIO WAS USED AS THE COSTING METHODOLOGY TO REPORT CHARITY CARE AND OTHER COMMUNITY BENEFITS AT COST. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), SUBTRACTED FOR PURPOSES OF CALCULATING SHCEDULE H, PART I, LINE 7 IS $864,276 |
| SCHEDULE H, PART III, SECTION A, LINE 2 | A PAYER SPECIFIC RESERVE IS CALCULATED EACH MONTH BASED ON TOTAL RECEIPTS AS A PERCENTAGE OF HISTORICAL GROSS AR. THIS IS SEPARATED INTO CONTRACT ADJUSTMENTS AND UNCOLLECTED BALANCES. AS ACCOUNTS ARE DEEMED NONCOLLECTABLE, AND IF ANY AMOUNTS ARE LATER RECEIVED, THESE ARE APPLIED TO THE RESERVE AND THE DIFFERENCE IS REPORTED AS MONTHLY BAD DEBT EXPENSE. UNDER GAAP STANDARDS IN 2019 GROSS AR, CONTRACT ADJ, AND UNCOLLECTED AMOUNTS ARE COMBINED INTO A SINGLE NET REVENUE LINE ON THE AUDIT FINANCIALS. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | MARSHALL COUNTY KS HAS APPROXIMATELY 10% OF THE POPULATION BELOW THE POVERTY LINE, WHILE WE USE 150% OF THE FPG AS OUR CHARITY ELIGIBILITY. PATIENTS WITH NO INSURANCE OR HIGH DEDUCTIBLE PLANS COMPOSE A DISPROPORTIONATE AMOUNT OF OUR BAD DEBT. THE CULTURE IN OUR COMMUNITY DISCOURAGES ASKING FOR CHARITY AND MANY WHO WE ARE CONFIDENT WOULD QUALIFY WILL NOT APPLY, EVEN WHEN SUGGESTED TO THEM. BASED ON THESE FACTORS WE ESTIMATE AT LEAST 25% OF OUR BAD DEBT WOULD BE CHARITY ELIGIBLE IF THEY WOULD APPLY. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | SEE NOTE 3 ON PAGE 23 OF THE ATTACHED FINANCIAL STATEMENTS |
| SCHEDULE H, PART III, SECTION B, LINE 8 | THE NUMBERS WERE DERIVED FROM THE MEDICARE COST REPORT. ALLOWABLE EXPENSES LESS THE BAD DEBT REDUCTION AND SEQUESTRATION REDUCTIONS. THESE COSTS ARE ALLOWABLE PER MEDICARE BUT WERE STATUTORILY REDUCED BY AN ARBITRARY PERCENTAGE REDUCTION TO ARRIVE AT FINAL REIMBURSEMENT. BY DEFINITION THE DIFFERENCE IS LEGITIMATE COSTS OF DOING BUSINESS THAT ARE NONETHELESS NOT PAID BY MEDICARE. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | PATIENTS ARE INFORMED OF OUR FINANCIAL ASSISTANCE POLICY AT THE TIME OF SERVICES. IF REQUESTED, THEY ARE GIVEN THE APPLICATION AT TIME OF SERVICE OR PRIOR TO DISMISSAL. FINANCIAL ASSISTANCE IS OFFERED AT TIME LETTERS ARE SENT OUT REQUESTING PAYMENT AGREEMENTS AND AGAIN BEFORE ACCOUNTS ARE SENT TO COLLECTION. |
| SCHEDULE H, PART VI, LINE 2 | COMMUNITY MEMORIAL HEALTHCARE REVIEWED OUR PRIOR CHNA AND THOSE OF SURROUNDING COMMUNITIES, REVIEWED DEMOGRAPHIC INFORMATION OF HISTORICAL PATIENT ENCOUNTERS, AND UTILIZED PUBLICLY AVAILABLE CDC AND HEALTH RANKING DATA ON HEALTH FACTORS, OUTCOMES, AND MARKETSHARE; COMPARING LOCAL AND NATIONAL RESULTS. WE THEN SURVEYED KEY STAKEHOLDERS IN OUR COMMUNITY TO DETERMINE ANY NEW OR CONTINUING AREAS OF CONCERN IN OUR SPECIFIC COMMUNITY. THIS INFORMATION WAS AGGREGATED AND COMPARED TO CAPABILITIES OF CMH AND OF OTHER COMMUNITY RESOURCES AVAILABLE IN OUR AREA. |
| SCHEDULE H, PART VI, LINE 3 | THE INSURANCE OFFICE PERSONNEL EXPLAIN ELIGIBILITY TO PATIENTS AND WILL ASSIST WITH PAPERWORK. THE AVAILABILITY OF FINANCIAL ASSISTANCE IS POSTED THROUGHOUT THE BUILDING (I.E. THE BUSINESS OFFICE, THE CLINICS, EMERGENCY DEPARTMENT) AND ON OUR WEBSITE. PATIENTS WHO ARE IDENTIFIED EITHER BEFORE SERVICES ARE RENDERED OR PRIOR TO DISCHARGE ARE CONTACTED BY THE BUSINESS OFFICE PERSONNEL TO ASSESS QUALIFICATION FOR MEDICAID OR FINANCIAL ASSISTANCE. BUSINESS OFFICE PERSONNEL ATTEMPT TO CONTACT PATIENTS VIA PHONE AND MAIL REGARDING THEIR BILL. PART OF THE CHARITY CARE PROGRAM IS TO ATTEMPT ENROLLMENT INTO THE MEDICAID PROGRAM. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY MEMORIAL HEALTHCARE, INC. IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION WHICH OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL, THREE RURAL HEALTH CLINICS, AND A HOME HEALTH AGENCY. 80% OF THE POPULATION WE SERVE ARE RESIDENTS OF MARSHALL COUNTY KS, 13% LIVE IN NEIGHBORING WASHINGTON COUNTY, 4% LIVE IN GAGE COUNTY NE, AND 3% LIVE ELSEWHERE DUE TO OUR PROXIMITY TO A MULTI-STATE EAST/WEST HIGHWAY. MARSHALL COUNTY HAS AN ESTIMATED POPULATION OF JUST UNDER 10,000. 50% OF OUR RESIDENTS ARE 45 YEARS OR OLDER AND 71% LIVE OUTSIDE OF CITY BOUNDARIES. HOUSEHOLD INCOME IS 20% LOWER THAN THE NATIONAL AVERAGE AND OUR POVERTY LEVEL IS 9%. THE CLOSEST TERTIARY HOSPITALS ARE MORE THAN 80 MILES IN ANY DIRECTION. WITHIN THAT GEOGRAPHIC CIRCLE ARE A HANDFUL OF ACUTE PRIMARY HOSPITALS OF SIMILAR SIZE AND CAPABILITIES TO CMH. |
| SCHEDULE H, PART VI, LINE 5 | CMH SPONSORS AN ANNUAL HEALTH FAIR WITH REDUCED COST BLOOD SCREENINGS, SERVING ABOUT 500 PEOPLE EACH YEAR. CMH ALSO PARTNERED WITH THE LOCAL PARENTS AS TEACHERS PROGRAM TO ADD A CHILDRENS HEALTH & SAFETY FAIR TO THE EVENT CMH HOSTS A MONTHLY EDUCATIONAL PROGRAM FOR SENIORS FEATURING INFORMATION PROVIDED BY CMH CLINICAL STAFF ON HEALTH CONCERNS RELATED TO AGING, AND COMMUNITY ENGAGEMENT OPPORTUNITIES. BREAST CANCER AWARENESS ACTIVITIES ARE HELD EACH OCTOBER FOR THE STAFF AND PUBLIC, INCLUDING AN AFTER-HOURS CONVENIENCE MAMMOGRAM CLINIC, AN IN-MEMORIAM PINK BALLOON LAUNCH, AND EDUCATIONAL SPEAKERS. CMH IS THE LEAD SPONSOR OF THE PONY EXPRESS HALF MARATHON & 5K AND ALSO SUPPORTS THE PONY EXPRESS GRAVEL DASH BICYCLE RACE BY DONATING BOTTLED WATER AND REFRESHMENTS TO PARTICIPANTS, AND STAFFING A FIRST AID TENT CMH ALSO PROVIDES A FIRST AID TENT AND MEDICAL STAFF AT OTHER COMMUNITY EVENTS, INCLUDING BIG BLUE RIVER DAYS AND THE MARSHALL COUNTY ART COOPERATIVES OUTDOOR MUSIC FESTIVALS FEATURING KANSAS AND THE BEACH BOYS. THE CMH CONFERENCE ROOM IS SHARED WITH THE OUTSIDE COMMUNITY AND NON-PROFITS FOR EDUCATIONAL PURPOSES AND SEVERAL SUPPORT GROUPS USE THE CONFERENCE SPACE FOR MONTHLY MEETINGS, INCLUDING TWO GRIEF SUPPORT GROUPS, BREASTFEEDING SUPPORT, SUPPORT FOR PARKINSONS DISEASE PATIENTS AND THEIR CARETAKERS, AND ALZHEIMERS PATIENTS AND THEIR CARETAKERS. CMH PROVIDES DAILY MEALS AT COST TO THE LOCAL RESIDENTIAL CARE FACILITY POPULATION THE CMH MEDICAL STAFF PARTICIPATE ON SEVERAL COMMUNITY BOARDS, SERVE AS MEDICAL DIRECTORS FOR LOCAL NURSING HOME AND HOSPICE ORGANIZATIONS, FUNCTION AS THE COUNTY PUBLIC HEALTH OFFICER, AND ALL PHYSICIAN STAFF FUNCTION AS DEPUTY COUNTY CORONERS AND SEVERAL PROVIDE MEDICAL SUPPORT AT SCHOOL ATHLETIC EVENTS. CMH STAFF MEMBERS PARTICIPATE IN VARIOUS FUNDRAISERS FOR THE COMMUNITY INCLUDING ADOPT-A-FAMILY, TOYS FOR TOTS BAKE SALES, CASUAL FOR A CAUSE JEANS DAYS, AND MORE. CMH CLINICAL AND MEDICAL STAFF OFFER A JOB SHADOWING PROGRAM PROVIDING INTERNSHIP OPPORTUNITIES FOR TEENS, UNDERGRADUATE COLLEGE STUDENTS, AND MEDICAL STUDENTS. THE HOSPITAL WORKS WITH COLLEGES AND UNIVERSITIES TO SERVE AS A TRAINING SITE FOR NURSING AND OTHER HEALTHCARE-RELATED JOBS. CMH ENTITIES ACCEPT ALL PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY. CMH STAFF HOSTS A SAFE BABYSITTING CLASS FOR 5TH & 6TH GRADE STUDENTS TO LEARN CPR/INFANT CPR, GENERIC FIRST AID, DIAPER CHANGING, BOTTLE MAKING, AND OTHER BASICS. CMH HOSTS KINDERGARTNERS FROM AREA SCHOOLS TO BECOME FAMILIAR WITH THE HOSPITAL, MEET EMERGENCY ROOM AND OTHER MEDICAL STAFF, LEARN ABOUT COMMON CHILDHOOD HEALTH CONCERNS SUCH AS A BROKEN BONE, AND LEARN ABOUT CAREERS IN HEALTHCARE. CMH STAFF MEMBERS DONATE CASES OF FACIAL TISSUES TO AREA SCHOOLS TO PREVENT THE SPREAD OF GERMS THROUGHOUT THE SCHOOL YEAR. |
| SCHEDULE H, PART VI, LINE 6 | NOT APPLICABLE |
| SCHEDULE H, PART VI, LINE 7 | NOT APPLICABLE |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Committee | Yes (X) | CompensationCommitteeInd |
| 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 | 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CURTIS R HAWKINSON | ||||||||||||||
| CEO | $156,065 | $0 | $0 | $0 | $7,432 | $0 | $0 | $0 | $20,137 | $0 | $183,634 | $0 | ||
| SHANE THORESON | ||||||||||||||
| DIRECTOR | $348,104 | $0 | $0 | $0 | $486 | $0 | $0 | $0 | $19,610 | $0 | $368,200 | $0 | ||
| DR BEN BRUNA | ||||||||||||||
| PHYSICIAN | $392,536 | $0 | $0 | $0 | $529 | $0 | $0 | $0 | $19,122 | $0 | $412,187 | $0 | $0 | $0 |
| DR CHERYL RICE | ||||||||||||||
| PHYSICIAN | $305,783 | $0 | $0 | $0 | $540 | $0 | $0 | $0 | $25,810 | $0 | $332,133 | $0 | $0 | $0 |
| DR DANIELE WURTZ | ||||||||||||||
| PHYSICIAN | $277,710 | $0 | $0 | $0 | $30,157 | $0 | $0 | $0 | $25,810 | $0 | $333,677 | $0 | $0 | $0 |
| DR JOHN HAEFELE | ||||||||||||||
| PHYSICIAN | $300,344 | $0 | $0 | $0 | $18,857 | $0 | $0 | $0 | $20,898 | $0 | $340,099 | $0 | $0 | $0 |
| DR KENNETH DUENSING | ||||||||||||||
| PHYSICIAN | $199,305 | $0 | $0 | $0 | $4,587 | $0 | $0 | $0 | $19,725 | $0 | $223,617 | $0 | $0 | $0 |
Schedule L IRS990ScheduleL
Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DR DANIELE WURTZ | PersonNm |
| Relationship With Org | PHYSICIAN | RelationshipWithOrgTxt |
| Loan Purpose | MD - TUITION | LoanPurposeTxt |
| Loan From Organization | Yes (X) | LoanFromOrganizationInd |
| Original Principal | $186,000 | OriginalPrincipalAmt |
| Balance Due | $103,363 | BalanceDueAmt |
| Default | false | DefaultInd |
| Board Or Committee Approval | Yes (true) | BoardOrCommitteeApprovalInd |
| Written Agreement | Yes (true) | WrittenAgreementInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Balance Due | $103,363 | TotalBalanceDueAmt |
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE SCHEDULE L PART V | PersonNm |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART IV | FormAndLineReferenceDesc |
| Explanation | TRANSACTION 1 (A) CYNTHIA VOET (B) CYNTHIA VOET IS THE SPOUSE OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $50,598 (D) CYNTHIA VOET IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO TRANSACTION 2 (A) ALLISON MINGE (B) ALLISON MINGE IS THE DAUGHTER OF ROBERT VOET, A DIRECTOR AND OFFICER OF COMMUNITY MEMORIAL HEALTHCARE, INC. (C) $44,897 (D) ALLISON MINGE IS AN EMPLOYEE OF COMMUNITY MEMORIAL HEALTHCARE, INC. (E) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4D | INPATIENT AND OUTPATIENT SURGERIES AND SCOPES - 746 SERVICES RADIOLOGICAL SERVICES - 9,078 EXAMS LAB - 180,864 TESTS RT, PT, OT, ST SERVICES - 50,656 MODALITIES REFERRAL VISITS -5,278 CENTRAL SUPPLY, PHARMA & DIETARY SERVICES |
| FORM 990, PART VI, SECTION A, LINE 6 | ANY PERSON, FIRM, ASSOCIATION, CORPORATION, OR BODY POLITIC OR SUBDIVISION THEREOF, MAY BECOME A MEMBER OF THE COMMUNITY MEMORIAL HEALTHCARE, INC. BY: (A) PAYING A MEMBERSHIP FEE OF $100.00; AND (B) AGREEING TO COMPLY WITH AND BE BOUND BY THE ARTICLES OF INCORPORATION AND BYLAWS AND ANY RULES AND REGULATIONS ADOPTED BY THE BOARD OF DIRECTORS OF THE CORPORATION. |
| FORM 990, PART VI, SECTION A, LINE 7A | A CERTIFICATE OF MEMBERSHIP SHALL ENTITLE THE LEGAL HOLDER TO ONE VOTE UPON MATTERS SUBMITTED TO A VOTE AT A MEETING OF THE MEMBERS WHERE THE LEGAL HOLDER OF THE CERTIFICATE IS A FIRM, ASSOCIATION, CORPORATION, OR A BODY POLITIC, OR A SUBDIVISION THEREOF, THE PRESIDENT, CHIEF EXECUTIVE OFFICER OR HIS DESIGNEE SHALL CAST THE VOTE. ALL QUESTIONS REQUIRING A VOTE OF THE MEMBERS SHALL BE DECIDED BY A VOTE OF A MAJORITY OF THE MEMBERS PRESENT EXCEPT AS OTHERWISE PROVIDED BY LAW, THE ARTICLES OF INCORPORATION OR THE BYLAWS. |
| FORM 990, PART VI, SECTION A, LINE 7B | 1. ANY SALE, LEASE, OR EXCHANGE OF ALL OR SUBSTANTIALLY ALL OF CORPORATE PROPERTY AND ASSETS OR ANY DISSOLUTION OF THE CORPORATION SHALL BE GOVERNED BY K.S.A. 17-6801 ET SEQ., REQUIRING A MAJORITY VOTE OF THE MEMBERS ENTITLED TO VOTE THEREON AT A DULY CALLED MEETING OF THE MEMBERS. 2. THE BYLAWS MAY NOT BE AMENDED, REVISED, OR REPEALED WITHOUT VOTE BY THE MEMBERSHIP. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CFO GATHERS INFORMATION TO PREPARE THE FORM 990 TAX RETURN. THIS INFORMATION IS THEN GIVEN TO AN INDEPENDENT ACCOUNTING FIRM WHO PREPARES AND REVIEWS THE FORM 990. THE INDEPENDENT ACCOUNTING FIRM THEN PROVIDES THE CFO AND FINANCE COMMITTEE A DRAFT OF THE FORM 990 FOR COMMENTS AND APPROVAL. ONCE THE CFO, FINANCE COMMITTEE, AND THE CPA FIRM APPROVE THE FORM 990, A COPY OF THE FORM 990 IS GIVEN TO THE GOVERNING BOARD MEMBERS ALONG WITH A RESPONSE TIME FOR QUESTIONS AND COMMENTS. ALL ISSUES ARE RESOLVED, A FINAL COPY OF THE FORM 990 IS SENT TO THE ENTIRE BOARD, AND THE 990 IS FILED. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD OF DIRECTORS, OFFICERS, AND COMMITTEE MEMBERS WILL COMPLETE A DISCLOSURE STATEMENT AT THE BEGINNING OF EACH CMH FISCAL YEAR AND PROVIDE SUCH STATEMENT TO THE CMH COMPLIANCE OFFICER. THE DISCLOSURE STATEMENT SHALL INCLUDE ANY INVESTMENT IN, OR ANY MANAGERIAL, CONSULTING, OR EMPLOYMENT RELATIONSHIP WITH, ANY OUTSIDE ENTITY THAT PROVIDES OR SEEKS TO PROVIDE GOODS OR SERVICES TO CMH, COMPETES WITH, OR INCLUDES CMH AS A JOINT VENTURE OR EQUITY INVESTOR. THE INTERESTED DIRECTOR SHOULD ABSTAIN FROM DISCUSSION AND VOTING ON THE MATTER BY TEMPORARILY LEAVING THE BOARD MEETING WHILE THE DISINTERESTED DIRECTORS DISCUSS AND VOTE. THE DISCLOSURE AND ABSTENTION SHALL BE RECORDED IN THE MINUTES OF THE BOARD MEETING. |
| a | THE COMPENSATION COMMITTEE CONSISTS OF FOUR MEMBERS OF THE BOARD AND MEETS AT LEAST SEMI-ANNUALLY OR MORE OR LESS FREQUENTLY AS NECESSARY. THE COMPENSATION COMMITTEE EXISTS TO DESIGN, IMPLEMENT, AND EVALUATE COMPENSATION FOR THE CEO, PHYSICIANS AND OTHER PERSONNEL. THE COMPENSATION COMMITTEE COMPLETES MEDICAL STAFF CONTRACT NEGOTIATIONS, EVALUATES AND COMPARES PERSONNEL WAGES TO INDUSTRY BENCHMARKS, AND PERFORMS THE CEO AND BOARD EVALUATIONS. THE COMPENSATION COMMITTEE APPROVED THE INITIAL CONTRACT FOR THE CEO AND THE CEO IS SUBJECT TO THE SAME PERCENTAGE ANNUAL INCREASE AS OTHER PERSONNEL. THE DELIBERATIONS AND DECISIONS REGARDING COMPENSATION ARRANGEMENTS ARE DOCUMENTED IN BOARD MINUTES. LAST MET APRIL 2018 |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SVC-PHYSICAL THERAPY TOTAL FEES:779273 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SVC-ANESTHESIOLOGY TOTAL FEES:438215 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SVC-OCCP THERAPY TOTAL FEES:168236 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT SVC- NUCLEAR MEDICINE TOTAL FEES:204357 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER FEES FOR SERVICE TOTAL FEES:1572251 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CMH FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 708 N 18TH STREET | AddressLine1Txt |
| City | MARYSVILLE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66508 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320297285 | EIN |
| Primary Activities | SUPPORT | PrimaryActivitiesTxt |
| Legal Domicile State | KS | 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 | CMH | 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 | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | Yes (true) | 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 | Yes (true) | 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 | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | Yes (true) | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (2 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| CMH FOUNDATION | ||
| C | $184,816 | FMV |
| CMH FOUNDATION | ||
| D | $15,731,476 | FMV |