2020-11-11T08:42:30-06:00 2019-12-31 BKD LLP 1201 Walnut Suite 1700 Kansas City MO 641062246 990 2019-01-01 480630224 COMMUNITY MEMORIAL HEALTHCARE INC % CURTIS R HAWKINSON COMM 7855622311 708 N 18TH STREET MARYSVILLE KS 66508 CURTIS W HAWKINSON CEO 7855622311 2020-11-16 true Gregory M Sullivan P01259107 8162216300 167.68.126.162 43372220203165000001 2020-11-11 P 4FFCF17FAA7DF0DADDA289A43AEF3406AF7B162A 355CC2E4B6E27E32DAADC48E1CA8D97843AD7DA8 2019 2021-01-29 14:40:06Z CURTIS R HAWKINSON 708 N 18TH ST MARYSVILLE KS 66508 23254907 false X WWW.CMHCARE.ORG X 1955 KS 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. 13 11 249 9 0 75247 194897 22709507 22846239 346972 213771 -230698 0 22901028 23254907 2000 0 0 0 12323565 12267099 0 0 0 11160570 10365928 23486135 22633027 -585107 621880 12140213 12946981 2347683 1990201 9792530 10956780 X 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. false false 4483706 5254635 THREE RURAL HEALTH CLINICS WITH A TOTAL OF 21,331 OFFICE VISITS. 6628088 7767721 ACUTE ADULT, PEDIATRIC AND INFANT INPATIENT CARE, SWING BED, LABOR AND DELIVERY AND OBSERVATION CARE. 3,978 DAYS OF CARE PROVIDED. 1949438 2284624 24 HR EMERGENCY ROOM SERVICES - 3,368 VISITS, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES - 4,436 VISITS 6433144 7539259 19494376 true true false true false false false false false true false false false true false false false true false false false false false false false false true true false false true false false false true false false true false false false false false false true true true false false true 37 0 true 249 true false false false false false false false false false false false false X 13 11 false false false false true true true true true false false true true true true true true true true false KS X CURTIS R HAWKINSON 7855622311 708 N 18TH ST MARYSVILLE KS 66508 X DR BEN BRUNA PHYSICIAN 40.0 0.0 X 393065 0 19122 SHANE THORESON DIRECTOR 40.0 0.0 X 348590 0 19610 DR JOHN HAEFELE PHYSICIAN 40.0 0.0 X 319201 0 20898 DR DANIELE WURTZ PHYSICIAN 40.0 0.0 X 307867 0 25810 DR CHERYL RICE PHYSICIAN 40.0 0.0 X 306323 0 25810 DR KENNETH DUENSING PHYSICIAN 40.0 0.0 X 203892 0 19725 CURTIS R HAWKINSON CEO 40.0 1.0 X 163497 0 20137 DAN FEHR CFO 40.0 0.0 X 123844 0 17962 MARGE SCHLABACH DIRECTOR 1.0 0.0 X 0 0 0 ROBERT VOET DIRECTOR/CHAIRPERSON 2.0 1.0 X X 0 0 0 LUCY PAPES DIRECTOR 1.0 0.5 X 0 0 0 BRYCE PORTER DIRECTOR 1.0 0.0 X 0 0 0 GAIL GILKERSON DIRECTOR 1.0 0.0 X 0 0 0 KEN LAMOREAUX DIRECTOR 1.0 0.0 X 0 0 0 CANDACE WRIGHT DIRECTOR/VICE CHAIRPERSON 1.0 0.0 X X 0 0 0 DENNIS CASHIER DIRECTOR 1.0 0.0 X 0 0 0 NICK WOLFE DIRECTOR 1.0 0.5 X 0 0 0 EDWARD POPEJOY DIRECTOR 1.0 0.0 X 0 0 0 ERIN WRIGHT DIRECTOR 1.0 0.5 X 0 0 0 MARY CAFFREY DIRECTOR 1.0 0.0 X 0 0 0 JEFF CRIST DIRECTOR 1.0 0.5 X 0 0 0 GARY HOLLE DIRECTOR 1.0 0.0 X 0 0 0 GAGE ZIERLEIN DIRECTOR 1.0 0.0 X 0 0 0 2166279 0 169074 15 false true false CRIST AND PIESCHEL REHABILITATION 535 RIDGE RD WATERVILLE KS 66548 PT, OT, ST 1040043 MARYSVILLE ANESTHESIA 1017 BROADWAY STE 7 MARYSVILLE KS 66508 ANESTHESIOLOGIST 357825 CPSI 6600 WALL ST MOBILE AL 36695 COMPUTER SERVICES 291223 NEBRASKA HEART INSTITUTE 7500 S 91ST ST LINCOLN NE 68501 NUCLEAR MEDICINE 213049 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GRAVE WI 53527 MRI 124083 11 184816 6000 4081 194897 Net Patient Service Revenue 621400 21566432 21566432 Dietary Income 624200 68126 68126 Other Operating Revenue 900099 1211681 1211681 22846239 195370 195370 0 0 0 0 0 18401 18401 18401 0 0 0 0 0 0 0 0 0 0 23254907 22846239 195370 0 0 0 0 693640 555576 138064 0 9369264 7406264 1963000 288452 223483 64969 1239531 1176698 62833 676212 610389 65823 0 19898 19898 120703 120703 0 0 0 3162332 3033232 129100 0 44535 43791 744 295453 163695 131758 75507 5350 70157 0 934496 881014 53482 150783 150783 0 2041 2041 0 0 1350926 1257295 93631 227226 128193 99033 BAD DEBT EXPENSE 864266 864266 MEDICAL SUPPLIES 2584436 2584436 EQUIP RENTAL & MAINTENANCE 315065 307642 7423 DUES & SUBSCRIPTIONS 171226 71937 99289 47035 30332 16703 22633027 19494376 3138651 0 15884 14813 2431603 1074269 0 0 3219298 3491321 129289 103363 0 0 0 0 478746 491769 534579 463301 0 0 5024651 6167154 0 0 0 0 0 0 306163 1140991 12140213 12946981 2308379 1963827 0 0 0 0 0 0 0 0 0 0 39304 26374 0 0 0 0 2347683 1990201 X 9716736 10880986 75794 75794 9792530 10956780 12140213 12946981 621880 542370 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false true true true 1390 false false true 5606 false false false 6996 false SCHEDULE C, PART II-B, LINE 1F DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING. 1060979 50831 1000 48115 1716 1060979 1060979 50661 2000 48661 1060979 1060979 27670 2000 25670 1060979 1060979 27658 3000 24658 1060979 1072988 31992 2000 42001 1060979 0.92860 0.07140 false false DUE FROM FOUNDATION 467368 DUE FROM THIRD PARTY 673623 1140991 23113229 542370 180218 722588 22390641 864266 864266 23254907 22690584 921823 921823 21768761 864266 864266 22633027 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 true true X true X true X true true true false true true 167984 167984 0.00800 1230016 790381 439635 0.02000 1398000 790381 607619 0.02800 50623 34896 15727 0.00100 50623 34896 15727 0.00100 1448623 825277 623346 0.02900 false 948469 237117 7965334 8207012 -241678 X true true 1 1 COMMUNITY MEMORIAL HOSPITAL 708 N 18TH ST MARYSVILLE KS 66508 WWW.CHMCARE.COM H058001 X X X X COMMUNITY MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 19 true false false true X SEE PART V, SECTION C true 20 true SEE PART V, SECTION C false true X 150. 400. X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X true X false X X X X true X false false 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 5 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 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 X X X false false false false false false false false false CURTIS R HAWKINSON CEO 156065 0 0 0 7432 0 0 0 20137 0 183634 0 SHANE THORESON DIRECTOR 348104 0 0 0 486 0 0 0 19610 0 368200 0 DR BEN BRUNA PHYSICIAN 392536 0 0 0 529 0 0 0 19122 0 412187 0 0 0 DR CHERYL RICE PHYSICIAN 305783 0 0 0 540 0 0 0 25810 0 332133 0 0 0 DR DANIELE WURTZ PHYSICIAN 277710 0 0 0 30157 0 0 0 25810 0 333677 0 0 0 DR JOHN HAEFELE PHYSICIAN 300344 0 0 0 18857 0 0 0 20898 0 340099 0 0 0 DR KENNETH DUENSING PHYSICIAN 199305 0 0 0 4587 0 0 0 19725 0 223617 0 0 0 DR DANIELE WURTZ PHYSICIAN MD - TUITION X 186000 103363 false true true 103363 SEE SCHEDULE L PART V SCHEDULE L, PART IV 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 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 CMH FOUNDATION 708 N 18TH STREET MARYSVILLE KS 66508 320297285 SUPPORT KS 501(C)(3) 12A CMH true false false true true false false false false false false true false true true true false false true true CMH FOUNDATION C 184816 FMV CMH FOUNDATION D 15731476 FMV