STRATEGY STUDIO / NONPROFIT PEOPLE SEARCH

COMMUNITY MEMORIAL HEALTHCARE INC: Form 990, tax year 2018

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEMORIAL HEALTHCARE INC (EIN 48-0630224)
Tax period
2018-01-01 to 2018-12-31
Filed
2019-11-14
IRS object ID
201923189349303332
Schema version
2018v3.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2019-11-14T10:47:21-06:00ReturnTs
Tax Period End2018-12-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1Txt
CityKansas CityCityNm
State AbbreviationMOStateAbbreviationCd
ZIP641062246ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2018-01-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN480630224EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HEALTHCARE INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% CURTIS R HAWKINSONInCareOfNm
Business Name ControlCOMMBusinessNameControlTxt
Phone7855622311PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 N 18TH STREETAddressLine1Txt
CityMARYSVILLECityNm
State AbbreviationKSStateAbbreviationCd
ZIP66508ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonDAN FEHRPersonNm
Person TitleCFOPersonTitleTxt
Phone7855622311PhoneNum
Signature2019-11-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonGregory M SullivanPreparerPersonNm
PTINP01259107PTIN
Phone8162216300PhoneNum

Filing Security Information FilingSecurityInformation

IP Address IPAddress

FieldValueIRS element (for citing)
I Pv4 Address167.68.126.162IPv4AddressTxt
FieldValueIRS element (for citing)
Federal Original Submission Id43372220193185000041FederalOriginalSubmissionId
Federal Original Submission Id2019-11-14FederalOriginalSubmissionIdDt
Filing License TypePFilingLicenseTypeCd
At Submission Creation Device Id6A5491EFFD9DEBA980EFEF504B2D78F34156ABFAAtSubmissionCreationDeviceId
At Submission Filing Device Id355CC2E4B6E27E32DAADC48E1CA8D97843AD7DA8AtSubmissionFilingDeviceId
FieldValueIRS element (for citing)
Tax2018TaxYr
Build TS2020-04-17 16:48:07ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerCURTIS R HAWKINSONPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 N 18TH STAddressLine1Txt
CityMARYSVILLECityNm
State AbbreviationKSStateAbbreviationCd
ZIP66508ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$22,901,028GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.CMHCARE.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1955FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionCMH 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
Contract TerminationYes (X)ContractTerminationInd
Voting Members Governing Body13VotingMembersGoverningBodyCnt
Voting Members Independent11VotingMembersIndependentCnt
Total Employee247TotalEmployeeCnt
Total Volunteers9TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$70,400PYContributionsGrantsAmt
CY Contributions Grants$75,247CYContributionsGrantsAmt
PY Program Service Revenue$21,599,725PYProgramServiceRevenueAmt
CY Program Service Revenue$22,709,507CYProgramServiceRevenueAmt
PY Investment Income$253,009PYInvestmentIncomeAmt
CY Investment Income$346,972CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue-$230,698CYOtherRevenueAmt
PY Total Revenue$21,923,134PYTotalRevenueAmt
CY Total Revenue$22,901,028CYTotalRevenueAmt
PY Grants And Similar Paid$2,000PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$2,000CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$12,480,116PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$12,323,565CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$10,626,452PYOtherExpensesAmt
CY Other Expenses$11,160,570CYOtherExpensesAmt
PY Total Expenses$23,108,568PYTotalExpensesAmt
CY Total Expenses$23,486,135CYTotalExpensesAmt
PY Revenues Less Expenses-$1,185,434PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$585,107CYRevenuesLessExpensesAmt
Total Assets BOY$23,803,032TotalAssetsBOYAmt
Total Assets EOY$12,140,213TotalAssetsEOYAmt
Total Liabilities BOY$16,814,676TotalLiabilitiesBOYAmt
Total Liabilities EOY$2,347,683TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$6,988,356NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$9,792,530NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionTHE 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 SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$4,551,214ExpenseAmt
Grant$0GrantAmt
Revenue$5,223,187RevenueAmt
DescTHREE RURAL HEALTH CLINICS WITH A TOTAL OF 22,025 OFFICE VISITS.Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

FieldValueIRS element (for citing)
Expense$6,727,878ExpenseAmt
Grant$0GrantAmt
Revenue$7,721,232RevenueAmt
DescACUTE ADULT, PEDIATRIC AND INFANT INPATIENT CARE, SWING BED, LABOR AND DELIVERY AND OBSERVATION CARE. 4,249 DAYS OF CARE PROVIDED.Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

FieldValueIRS element (for citing)
Expense$1,978,788ExpenseAmt
Grant$0GrantAmt
Revenue$2,270,951RevenueAmt
Desc24 HR EMERGENCY ROOM SERVICES - 3,509 VISITS, DURABLE MEDICAL EQUIPMENT SALES, AND HOME HEALTH SERVICES - 4,828 VISITSDesc
FieldValueIRS element (for citing)
Total Other Prog Srvc Expense$6,530,001TotalOtherProgSrvcExpenseAmt
Total Other Prog Srvc Grant$2,000TotalOtherProgSrvcGrantAmt
Total Other Prog Srvc Revenue$7,494,137TotalOtherProgSrvcRevenueAmt
Total Program Service Expenses$19,787,881TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesfalseReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemYes (true)BusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationYes (true)PartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document39IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee247EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members13GoverningBodyVotingMembersCnt
Independent Voting Member11IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
States Where Copy Of Return Is FldKSStatesWhereCopyOfReturnIsFldCd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonCURTIS R HAWKINSONPersonNm
Phone7855622311PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 N 18TH STAddressLine1Txt
CityMARYSVILLECityNm
State AbbreviationKSStateAbbreviationCd
ZIP66508ZIPCd
FieldValueIRS element (for citing)
Info In Schedule O Part VIIYes (X)InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
MARGE SCHLABACH
DIRECTOR1.00.0Yes (X)$0$0$0
ROBERT VOET
DIRECTOR/CHAIRPERSON2.01.0Yes (X)$0$0$0Yes (X)
LUCY PAPES
DIRECTOR1.01.0Yes (X)$0$0$0
BRYCE PORTER
DIRECTOR1.00.0Yes (X)$0$0$0
DELORES STUMP
DIRECTOR1.00.0Yes (X)$0$0$0
GAIL GILKERSON
DIRECTOR1.00.0Yes (X)$0$0$0
KEN LAMOREAUX
DIRECTOR1.00.0Yes (X)$0$0$0
CANDACE WRIGHT
DIRECTOR/VICE CHAIRPERSON1.00.0Yes (X)$0$0$0Yes (X)
DENNIS CASHIER
DIRECTOR1.00.0Yes (X)$0$0$0
JIM LADNER
DIRECTOR1.00.0Yes (X)$0$0$0
RAY SCULTZ
DIRECTOR1.00.0Yes (X)$0$0$0
DR JOHN HAEFELE
DIRECTOR40.00.0Yes (X)$313,899$0$40,140
NICK WOLFE
DIRECTOR1.01.0Yes (X)$0$0$0
EDWARD POPEJOY
DIRECTOR1.00.0Yes (X)$0$0$0
ERIN WRIGHT
DIRECTOR1.00.0Yes (X)$0$0$0
CURTIS R HAWKINSON
CEO40.01.0$156,867$0$32,420Yes (X)
DAN FEHR
CFO40.00.0$121,789$0$27,934Yes (X)
DR BEN BRUNA
PHYSICIAN40.00.0$415,361$0$38,140Yes (X)
DR SHANE THORESON
PHYSICIAN40.00.0$365,314$0$38,140Yes (X)
DR CHERYL RICE
PHYSICIAN40.00.0$304,525$0$28,680Yes (X)
DR KENNETH DUENSING
PHYSICIAN40.00.0$192,995$0$34,528Yes (X)
DR DANIELE WURTZ
PHYSICIAN40.00.0$249,356$0$42,456Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$2,120,106TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$0TotReportableCompRltdOrgAmt
Total Other Compensation$282,438TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K15IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
CRIST AND PIESCHEL REHABILITATION
535 RIDGE RDWATERVILLEKS66548PT, OT, ST$1,142,211
MARYSVILLE ANESTHESIA
1017 BROADWAY STE 7MARYSVILLEKS66508ANESTHESIOLOGIST$313,402
CPSI
6600 WALL STMOBILEAL36695COMPUTER SERVICES$284,197
NEBRASKA HEART INSTITUTE
7500 S 91ST STLINCOLNNE68501NUCLEAR MEDICINE$272,495
SHARED MEDICAL SERVICES
209 LIMESTONE PASSCOTTAGE GRAVEWI53527MRI$147,460
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K11CntrctRcvdGreaterThan100KCnt
Related Organizations$67,115RelatedOrganizationsAmt
Government Grants$8,032GovernmentGrantsAmt
All Other Contributions$100AllOtherContributionsAmt
Total Contributions$75,247TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net Patient Service Revenue621400$21,321,015$21,321,015
Dietary Income624200$118,444$118,444
Other Operating Revenue900099$1,270,048$1,270,048
FieldValueIRS element (for citing)
Total Program Service Revenue$22,709,507TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$166,801TotalRevenueColumnAmt
Exclusion$166,801ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$180,171SecuritiesAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$180,171SecuritiesAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$180,171TotalRevenueColumnAmt
Exclusion$180,171ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp

FieldValueIRS element (for citing)
DescLOSS ON EXTINGUISHMENT OF DEBTDesc
Business900099BusinessCd
Total Revenue Column-$230,698TotalRevenueColumnAmt
Exclusion-$230,698ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total-$230,698OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$22,901,028TotalRevenueColumnAmt
Related Or Exempt Func Income$22,709,507RelatedOrExemptFuncIncomeAmt
Exclusion$116,274ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$2,000TotalAmt
Program Services$2,000ProgramServicesAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$711,789TotalAmt
Program Services$572,012ProgramServicesAmt
Management And General$139,777ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$95,495TotalAmt
Program Services$74,711ProgramServicesAmt
Management And General$20,784ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$9,197,543TotalAmt
Program Services$7,195,762ProgramServicesAmt
Management And General$2,001,781ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$294,181TotalAmt
Program Services$222,113ProgramServicesAmt
Management And General$72,068ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,367,392TotalAmt
Program Services$1,288,797ProgramServicesAmt
Management And General$78,595ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$657,165TotalAmt
Program Services$591,325ProgramServicesAmt
Management And General$65,840ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$13,376TotalAmt
Management And General$13,376ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$101,999TotalAmt
Management And General$101,999ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,932,232TotalAmt
Program Services$2,790,042ProgramServicesAmt
Management And General$142,190ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$34,225TotalAmt
Program Services$32,662ProgramServicesAmt
Management And General$1,563ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$297,232TotalAmt
Program Services$188,648ProgramServicesAmt
Management And General$108,584ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$66,838TotalAmt
Program Services$13ProgramServicesAmt
Management And General$66,825ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$987,764TotalAmt
Program Services$934,445ProgramServicesAmt
Management And General$53,319ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$143,943TotalAmt
Program Services$143,943ProgramServicesAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$2,430TotalAmt
Management And General$2,430ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$572,439TotalAmt
Program Services$2,427ProgramServicesAmt
Management And General$570,012ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$1,349,498TotalAmt
Program Services$1,287,378ProgramServicesAmt
Management And General$62,120ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$235,121TotalAmt
Program Services$139,232ProgramServicesAmt
Management And General$95,889ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
BAD DEBT EXPENSE$1,322,466$1,322,466
MEDICAL SUPPLIES$2,608,022$2,608,022
EQUIP RENTAL & MAINTENANCE$305,982$300,817$5,165
DUES & SUBSCRIPTIONS$152,018$70,230$81,788

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$34,985TotalAmt
Program Services$20,836ProgramServicesAmt
Management And General$14,149ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$23,486,135TotalAmt
Program Services$19,787,881ProgramServicesAmt
Management And General$3,698,254ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$21,989BOYAmt
EOY$15,884EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$481,566BOYAmt
EOY$2,431,603EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,702,844BOYAmt
EOY$3,219,298EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$172,247BOYAmt
EOY$129,289EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$456,140BOYAmt
EOY$478,746EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$449,869BOYAmt
EOY$534,579EOYAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$12,103,945BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$6,648,641BOYAmt
EOY$5,024,651EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$765,791BOYAmt
EOY$306,163EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$23,803,032BOYAmt
EOY$12,140,213EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,884,786BOYAmt
EOY$2,308,379EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$14,929,890BOYAmt
EOY$39,304EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$16,814,676BOYAmt
EOY$2,347,683EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$6,912,562BOYAmt
EOY$9,716,736EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$75,794BOYAmt
EOY$75,794EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$6,988,356BOYAmt
EOY$9,792,530EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$23,803,032BOYAmt
EOY$12,140,213EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$585,107ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$535,396NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$3,924,677OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
Form4720 FiledfalseForm4720FiledInd
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$5,853GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$5,853TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE C, PART II-B, LINE 1FFormAndLineReferenceDesc
ExplanationDUES PAID TO THE KANSAS HOSPITAL ASSOCIATION AND AMERICAN HOSPITAL ASSOCIATION ALLOCATED TO LOBBYING.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,060,979BeginningYearBalanceAmt
Investment Earnings Or Losses$50,661InvestmentEarningsOrLossesAmt
Grants Or Scholarships$2,000GrantsOrScholarshipsAmt
Other Expenditures$48,661OtherExpendituresAmt
End Year Balance$1,060,979EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,060,979BeginningYearBalanceAmt
Investment Earnings Or Losses$27,670InvestmentEarningsOrLossesAmt
Grants Or Scholarships$2,000GrantsOrScholarshipsAmt
Other Expenditures$25,670OtherExpendituresAmt
End Year Balance$1,060,979EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,060,979BeginningYearBalanceAmt
Investment Earnings Or Losses$27,658InvestmentEarningsOrLossesAmt
Grants Or Scholarships$3,000GrantsOrScholarshipsAmt
Other Expenditures$24,658OtherExpendituresAmt
End Year Balance$1,060,979EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,072,988BeginningYearBalanceAmt
Investment Earnings Or Losses$31,992InvestmentEarningsOrLossesAmt
Grants Or Scholarships$2,000GrantsOrScholarshipsAmt
Other Expenditures$42,001OtherExpendituresAmt
End Year Balance$1,060,979EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,059,062BeginningYearBalanceAmt
Investment Earnings Or Losses$178,439InvestmentEarningsOrLossesAmt
Grants Or Scholarships$2,000GrantsOrScholarshipsAmt
Other Expenditures$162,513OtherExpendituresAmt
End Year Balance$1,072,988EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.92860BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.07140PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd
LandLandGrp
BuildingsBuildingsGrp
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp
Total Rev Etc Audited Fincl Stmt$21,151,930TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$535,396NetUnrealizedGainsInvstAmt
Other Revenue$108,764OtherRevenueAmt
Revenue Not Reported-$426,632RevenueNotReportedAmt
Revenue Subtotal$21,578,562RevenueSubtotalAmt
Other Revenues Not Included$1,322,466OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt$1,322,466RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$22,901,028TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$22,282,961TotExpnsEtcAuditedFinclStmtAmt
Other Expenses Included$119,292OtherExpensesIncludedAmt
Expenses Not Reported$119,292ExpensesNotReportedAmt
Expenses Subtotal$22,163,669ExpensesSubtotalAmt
Other Expenses Not Included$1,322,466OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$1,322,466ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$23,486,135TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4BOARD-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 2MANAGEMENT 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 2DRELATED ORGANIZATION REVENUES $ 108,764
SCHEDULE D, PART XI, LINE 4BBAD DEBT EXPENSE $ 1,322,466
SCHEDULE D, PART XII, LINE 2DRELATED ORGANIZATION EXPENSES $ 119,292
SCHEDULE D, PART XII, LINE 4BBAD DEBT EXPENSE $ 1,322,466

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd
Percent150Yes (X)Percent150Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$165,094TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$165,094NetCommunityBenefitExpnsAmt
Total Expense0.00700TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,284,250TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,081,193DirectOffsettingRevenueAmt
Net Community Benefit Expns$203,057NetCommunityBenefitExpnsAmt
Total Expense0.00900TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,449,344TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,081,193DirectOffsettingRevenueAmt
Net Community Benefit Expns$368,151NetCommunityBenefitExpnsAmt
Total Expense0.01600TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$78,882TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$56,585DirectOffsettingRevenueAmt
Net Community Benefit Expns$22,297NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$78,882TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$56,585DirectOffsettingRevenueAmt
Net Community Benefit Expns$22,297NetCommunityBenefitExpnsAmt
Total Expense0.00100TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,528,226TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,137,778DirectOffsettingRevenueAmt
Net Community Benefit Expns$390,448NetCommunityBenefitExpnsAmt
Total Expense0.01700TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReportedInd
Bad Debt Expense$1,322,466BadDebtExpenseAmt
Bad Debt Expense Attributable$264,500BadDebtExpenseAttributableAmt
Reimbursed By Medicare$7,582,737ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$7,799,061CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$216,324MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOSPITALBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 N 18TH STAddressLine1Txt
CityMARYSVILLECityNm
State AbbreviationKSStateAbbreviationCd
ZIP66508ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.CHMCARE.COMWebsiteAddressTxt
State LicenseH058001StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEMORIAL HOSPITALBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted16CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsfalseCHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care150.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.FPGFamilyIncmLmtDscntCarePct
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Provided Nonprofit ContactYes (X)ProvidedNonprofitContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLSEE PART V, SECTION CFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLSEE PART V, SECTION CFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLSEE PART V, SECTION CFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicaid Medcr PrvtYes (X)LookBackMedicaidMedcrPrvtInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (7 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5INCLUDED MEMBERS OF THE LOCAL SCHOOL SYSTEM, RELIGIOUS ORGANIZATIONS, GOVERNMENTAL AGENCIES, NON-PROFITS, AND OTHER PUBLIC HEALTH AGENCIES AND REGIONAL MENTAL HEALTH PROVIDERS.
SCHEDULE H, PART V, SECTION B, LINE 7ATHE COMPLETE CHNA CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=CHNA&sub=About%20Us
SCHEDULE H, PART V, SECTION B, LINE 10ATHE IMPLEMENTATION STRATEGY CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=CHNA&sub=About%20Us
SCHEDULE H, PART V, SECTION B, LINE 11Our 2016 Health Needs Assessment was summarized and prioritized into 8 issues and those were further classified into groups which included mental health, obesity, aging population, and financial resources. 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 16 of our most vulnerable patients obtain medication worth over $25,000 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 community meals on wheels program and the residents of local disability housing, provide some dietary education as part of several community farmer's markets, and co-coordinated some daily exercise groups in the public park. 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.
SCHEDULE H, PART V, SECTION B, LINE 16ATHE FAP CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion
SCHEDULE H, PART V, SECTION B, LINE 16BTHE FAP APPLICATION CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion
SCHEDULE H, PART V, SECTION B, LINE 16CTHE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: http://www.cmhcare.org/getpage.php?name=charitycare&sub=Patient%20Informat ion
FieldValueIRS element (for citing)
Facility5FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdFacilityFacilityTxt
COMMUNITY PHYSICIANS CLINIC
1902 MAY STMARYSVILLEKS66508RURAL HEALTH CLINIC
BLUE RAPIDS MEDICAL CLINIC
607 LINCOLNBLUE RAPIDSKS66411RURAL HEALTH CLINIC
COMMUNITY MEDICAL EQUIPMENT
805 BROADWAYMARYSVILLEKS66508DURABLE MEDICAL EQUIPMENT
CMH HOME HEALTH
805 BROADWAYMARYSVILLEKS66508HOME HEALTH AGENCY
COMMUNITY PHYSICIANS CLINIC - WYMORE
100 NORTH 7THWYMORENE68466RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3CASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS ARE FACTORS USED IN ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNTED CARE.
SCHEDULE H, PART I, LINE 7THE 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 FTHE 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 $1,322,466.
SCHEDULE H, PART III, SECTION A, LINE 2A RESERVE FOR BAD DEBT IS CALCULATED ON OUTSTANDING ACCOUNTS RECEIVABLE BALANCES EACH MONTH BASED ON EXISTENCE OF INSURANCE COVERAGE AND AGE OF ACCOUNTS. AS ACCOUNTS ARE WRITTEN OFF, RETURNED FROM COLLECTIONS, OR COLLECTED ON, THOSE ARE APPLIED AGAINST THE RESERVE. THE NET CHANGE IN RESERVE IS REPORTED AS BAD DEBT EXPENSE EACH MONTH.
SCHEDULE H, PART III, SECTION A, LINE 3THERE IS NO WAY TO IDENTIFY PATIENTS THAT MIGHT HAVE QUALIFIED. SOME DO NOT RETURN DOCUMENTS OUT OF PRIDE, OTHERS ARE TRANSIENT AND LOCATING THEM IS EXCEEDINGLY DIFFICULT, OTHERS NO LONGER TRY TO MANAGE THEIR DEBTS. TO ESTIMATE THIS UNKNOWN WE APPLIED THE FOLLOWING LOGIC: HOSPITAL (EXCL RHC AND HHA) TURNED 1,500,000 TO COLLECTIONS IN 2018. 33% OF THIS AMOUNT WAS FOR UNINSURED PATIENTS. ASSUMING 60% OF THOSE PATIENTS WERE UNEMPLOYED OR IN LOW WAGE JOBS, WE APPLIED A 20% OVERALL ESTIMATE TO THE 1,322,466 BAD DEBT EXPENSE PREVIOUSLY REPORTED.
SCHEDULE H, PART III, SECTION A, LINE 4SEE NOTE 1 ON PAGE 9 AND 10 OF THE ATTACHED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION B, LINE 8THE 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 LEGIMITATE COSTS OF DOING BUSINESS THAT ARE NONETHELESS NOT PAID BY MEDICARE.
SCHEDULE H, PART III, SECTION C, LINE 9BPATIENTS 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 2IN ADDITION TO CONDUCTING ITS OWN RESEARCH, CMH COLLABORATES THROUGH THE INTERAGENCY COOPERATIVE COUNCIL (A COLLECTION OF COUNTY WIDE NOT-FOR-PROFIT AGENCIES) TO ASSESS THE NEEDS OF MARSHALL COUNTY.
SCHEDULE H, PART VI, LINE 3THE 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). 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 4COMMUNITY MEMORIAL HEALTHCARE, INC. IS A NOT-FOR-PROFIT MEMBERSHIP CORPORATION THAT OWNS AND OPERATES A GENERAL ACUTE CARE HOSPITAL. CMH PRIMARILY EARNS REVENUES BY PROVIDING INPATIENT, OUTPATIENT, EMERGENCY, CLINIC AND HOME HEALTH SERVICES TO MARYSVILLE, BLUE RAPIDS, BEATTIE, HANOVER, WATERVILLE, WASHINGTON, FRANKFORT, AXTELL AND HOME KANSAS. THESE AREAS ARE ALSO SERVED BY HANOVER HOSPITAL (HANOVER, KS), NEMAHA VALLEY COMMUNITY HOSPITAL (SENECA, KS), MERCY REGIONAL HEALTH CENTER (MANHATTAN, KS), BRYAN LGH HEALTH SYSTEM (LINCOLN, NE), SAINT ELIZABETH REGIONAL MEDICAL CENTER (LINCOLN, NE), SAINT FRANCIS HEALTH CENTER (TOPEKA, KS), STORMONT-VAIL HEALTHCARE (TOPEKA, KS). AS OF THE 2010 CENSUS, THE CITY OF MARYSVILLE HAD A TOTAL POPULATION OF 3,294, WHILE MARSHALL COUNTY POPULATION WAS 10,117. BELOW ARE ADDITIONAL MARSHALL COUNTY DEMOGRAPHICS: - 22% OF THE POPULATION IS OVER 65 YEARS OF AGE. - 29% OF THE POPULATION IS BETWEEN 45-64 YEARS OF AGE. - 27% OF THE POPULATION IS BETWEEN THE AGES OF 18-44. - MEDIAN HOUSEHOLD INCOME FOR MARSHALL COUNTY WAS $44,615 FOR 2014. - UNEMPLOYMENT IN MARSHALL COUNTY IS 5.2%. - 12.87% OF THE POPULATION ARE LIVING BELOW THE POVERTY LEVEL. - THE HOSPITAL IS THE THIRD LARGEST EMPLOYER IN THE COUNTY.
SCHEDULE H, PART VI, LINE 5COMMUNITY MEMORIAL HEALTHCARE SPONSORS AN ANNUAL HEALTH FAIR FOR THE GENERAL PUBLIC, DRAWING BLOOD AND RUNNING DIAGNOSTIC TESTS. THE HOSPITAL PUBLISHES A MONTHLY ARTICLE IN A LOCAL PAPER ADDRESSING CURRENT HEALTH TOPICS, AND HOSTS A MONTHLY LUNCHEON FOR THE OVER-55 POPULATION WITH SPEAKERS ON CURRENT HEALTH TOPICS.
SCHEDULE H, PART VI, LINE 6NOT APPLICABLE
SCHEDULE H, PART VI, LINE 7KANSAS

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Compensation CommitteeYes (X)CompensationCommitteeInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmt
CURTIS R HAWKINSON
CEO$153,122$0$0$0$3,745$0$7,507$0$24,913$0$189,287$0
DR JOHN HAEFELE
DIRECTOR$295,159$0$0$0$18,740$0$14,406$0$25,734$0$354,039$0
DR BEN BRUNA
PHYSICIAN$388,158$0$0$0$27,203$0$14,406$0$23,734$0$453,501$0
DR SHANE THORESON
PHYSICIAN$355,782$0$0$0$9,532$0$14,406$0$23,734$0$403,454$0
DR CHERYL RICE
PHYSICIAN$304,165$0$0$0$360$0$4,946$0$23,734$0$333,205$0
DR KENNETH DUENSING
PHYSICIAN$190,619$0$0$0$2,376$0$9,994$0$24,534$0$227,523$0
DR DANIELE WURTZ
PHYSICIAN$219,343$0$0$0$30,013$0$14,222$0$28,234$0$291,812$0

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

FieldValueIRS element (for citing)
PersonDR DANIELE WURTZPersonNm
Relationship With OrgPHYSICIANRelationshipWithOrgTxt
Loan PurposeMD - TUITIONLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$186,000OriginalPrincipalAmt
Balance Due$129,289BalanceDueAmt
DefaultfalseDefaultInd
Board Or Committee ApprovalYes (true)BoardOrCommitteeApprovalInd
Written AgreementYes (true)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$129,289TotalBalanceDueAmt

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

FieldValueIRS element (for citing)
PersonSEE SCHEDULE L PART VPersonNm
FieldValueIRS element (for citing)
TransactionWAGESTransactionDesc

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE L, PART IVFormAndLineReferenceDesc
ExplanationTRANSACTION 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) NOExplanationTxt

Schedule N IRS990ScheduleN

FieldValueIRS element (for citing)
Liquidation Of Assets TableLiquidationOfAssetsTableGrp

Disposition Of Assets Detail DispositionOfAssetsDetail

FieldValueIRS element (for citing)
Assets Distri Or Expnss PaidCAPITAL ASSETSAssetsDistriOrExpnssPaidDesc
Distribution2018-12-19DistributionDt
Fair Market Value Of Asset$10,806,694FairMarketValueOfAssetAmt
Method Of FMV DeterminationBOOK VALUEMethodOfFMVDeterminationTxt
EIN320297285EIN
PersonCMH FOUNDATIONPersonNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 NORTH 18TH STREETAddressLine1Txt
CityMARYSVILLECityNm
State AbbreviationKSStateAbbreviationCd
ZIP66508ZIPCd
FieldValueIRS element (for citing)
IRC Section501(c)(3)IRCSectionTxt
FieldValueIRS element (for citing)
Director Of Successor2Yes (true)DirectorOfSuccessor2Ind
Employee Of Successor2falseEmployeeOfSuccessor2Ind
Owner Of Successor2falseOwnerOfSuccessor2Ind
Receive Compensation2falseReceiveCompensation2Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE N, PART II, LINE 1CMH FOUNDATION ISSUED NEW NOTES PAYABLE JOINTLY HELD BY USDA AND A PRIVATE BANK. CMH FOUNDATION USED THE PROCEEDS OF THIS NOTE TO PAY OFF THE HOSPITAL MORTGAGE AND ASSUME OWNERSHIP OF THE DEBT AND RELATED ASSETS. AS A RESULT OF THIS TRANSACTION THE CAPITAL ASSETS (LAND, BUILDING, AND EQUIPMENT) WERE TRANSFERRED TO CMH FOUNDATION.
SCHEDULE N, PART II, LINE 2AROBERT VOET, LUCEY PAPES, NICK WOLFE, & CURTIS HAWKINSON ARE DIRECTORS OR OFFICERS OF COMMUNITY MEMORIAL HOSPITAL, INC. AND CONTINUE TO BE DIRECTORS OF CMH FOUNDATION.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART III, LINE 4DINPATIENT AND OUTPATIENT SURGERIES AND SCOPES - 408 SERVICES RADIOLOGICAL SERVICES - 8,748 EXAMS LAB - 178,385 TESTS RT, PT, OT, ST SERVICES - 52,625 MODALITIES REFERRAL VISISTS - 4,484 CENTRAL SUPPLY, PHARMACY & DIETARY SERVICES
FORM 990, PART VI, SECTION A, LINE 6ANY 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 7AA 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 7B1. 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 11BTHE 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 12CBOARD 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.
FORM 990, PART VI, SECTION B, LINE 15A & 15BTHE 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.
FORM 990, PART VI, SECTION C, LINE 19THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC.
Form 990, PART XI, LINE 9ASSET TRANSFER FOR PREVIOUS LOAN PAYOFF $ 14,737,138 TRANSFER OF NET PP&E TO FOUNDATION $(10,806,694) ASSET TRANSFER TO AFFILIATE $( 5,817) ------------- 3,924,627
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACT SVC-PHYSICAL THERAPY TOTAL FEES:859753
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACT SVC-ANESTHESIOLOGY TOTAL FEES:396734
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACT SVC-OCCP THERAPY TOTAL FEES:185744
FORM 990 PART IX LINE 11GDESCRIPTION:CONTRACT SVC-NUCLEAR MEDICINE TOTAL FEES:195317
FORM 990 PART IX LINE 11GDESCRIPTION:OTHER FEES FOR SERVICE TOTAL FEES:1294684

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp

Disregarded Entity Name DisregardedEntityName

FieldValueIRS element (for citing)
Business Name Line1CMH FOUNDATIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1708 N 18TH STREETAddressLine1Txt
CityMARYSVILLECityNm
State AbbreviationKSStateAbbreviationCd
ZIP66508ZIPCd
FieldValueIRS element (for citing)
EIN320297285EIN
Primary ActivitiesSUPPORTPrimaryActivitiesTxt
Legal Domicile StateKSLegalDomicileStateCd
Exempt Code Section501(C)(3)ExemptCodeSectionTxt
Public Charity Status12APublicCharityStatusTxt

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CMHBusinessNameLine1Txt
FieldValueIRS element (for citing)
Controlled OrganizationYes (true)ControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgfalseLoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesYes (true)SharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgYes (true)TransferToOtherOrgInd
Transfer From Other OrgYes (true)TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (3 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
CMH FOUNDATION
C$67,115CASH
CMH FOUNDATION
R$10,806,694BOOK VALUE
CMH FOUNDATION
S$14,731,371FMV