COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2016
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 44-0537826)
- Tax period
- 2016-07-01 to 2017-06-30
- Filed
- 2018-04-30
- IRS object ID
- 201831209349300533
- Schema version
- 2016v3.1
- 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 | 2018-04-30T09:51:38-05:00 | ReturnTs |
| Tax Period End | 2017-06-30 | 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 | 2016-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440537826 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JON DAVIS | InCareOfNm |
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 6606862211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 107 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 644460107 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JON DAVIS | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 6606862211 | PhoneNum |
| Signature | 2018-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin R Ensminger CPA | PreparerPersonNm |
| PTIN | P01310558 | 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 | 43372220181205000003 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-04-30 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | DEF7F836EB13EF5586E4DEF561E07D6CC4802C25 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | DB1F27599D63D016C4D6F8B7B8119982672D8AA1 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2016 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | ROGER W STEINKRUGER | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 644460107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $19,423,593 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.FAIRFAXMED.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1976 | FormationYr |
| Legal Domicile State | MO | LegalDomicileStateCd |
| Activity Or Mission | TO PROVIDE QUALITY ACUTE CARE, EMERGENCY, PRIMARY CARE AND OUTPATIENT SERVICES. | ActivityOrMissionDesc |
| Voting Members Governing Body | 11 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 10 | VotingMembersIndependentCnt |
| Total Employee | 139 | TotalEmployeeCnt |
| Total Volunteers | 80 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $105,562 | PYContributionsGrantsAmt |
| CY Contributions Grants | $75,428 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,273,995 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,426,650 | CYProgramServiceRevenueAmt |
| PY Investment Income | $87,742 | PYInvestmentIncomeAmt |
| CY Investment Income | $277,595 | CYInvestmentIncomeAmt |
| PY Other Revenue | $274,887 | PYOtherRevenueAmt |
| CY Other Revenue | $615,336 | CYOtherRevenueAmt |
| PY Total Revenue | $14,742,186 | PYTotalRevenueAmt |
| CY Total Revenue | $15,395,009 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | 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 | $6,366,370 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $7,088,426 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $99,719 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $9,291,722 | PYOtherExpensesAmt |
| CY Other Expenses | $9,683,356 | CYOtherExpensesAmt |
| PY Total Expenses | $15,658,092 | PYTotalExpensesAmt |
| CY Total Expenses | $16,771,782 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$915,906 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$1,376,773 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,617,975 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,471,387 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $11,807,396 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $11,792,431 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $7,810,579 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $6,678,956 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $13,691,618 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $14,911,563 | RevenueAmt |
| Desc | SEE SCHEDULE O | Desc |
| Total Program Service Expenses | $13,691,618 | 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 |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | 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 | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 | 12 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 139 | 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 |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 11 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 10 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | 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 | MO | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JON DAVIS | PersonNm |
| Phone | 6606862211 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (19 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| AMY RYAN | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| CHAD DERR | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| COREY HERRON | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| TOM FRETTE | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| ROBERT JACKSON | |||||||||
| DIRECTOR/PRESIDENT/CHAIRMAN | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| JASON GARST | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD OSWALD | |||||||||
| DIRECTOR/SECRETARY/TREASURER | 1.0 | 1.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| GLENN SCOTT | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| SARAH WATKINS | |||||||||
| DIRECTOR | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| RICHARD ARON BURKE MD | |||||||||
| DIRECTOR/CHIEF OF STAFF | 11.0 | 0.0 | Yes (X) | $108,520 | $0 | $0 | |||
| VIRGINIA LOW | |||||||||
| DIRECTOR/VICE-PRESIDENT | 1.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | ||
| ROGER STEINKRUGER | |||||||||
| CEO | 40.0 | 1.0 | $249,504 | $0 | $28,257 | Yes (X) | |||
| JON DAVIS | |||||||||
| CFO | 40.0 | 1.0 | $131,708 | $0 | $8,256 | Yes (X) | |||
| JULIE JONES | |||||||||
| CNO | 40.0 | 0.0 | $173,459 | $0 | $5,614 | Yes (X) | |||
| DR DUSTIN CARPENTER MD | |||||||||
| DOCTOR | 40.0 | 0.0 | $242,661 | $0 | $6,976 | Yes (X) | |||
| RENEE KREIFELS | |||||||||
| CRNA | 40.0 | 0.0 | $156,602 | $0 | $6,157 | Yes (X) | |||
| KELLY OSBORN | |||||||||
| CRNA | 40.0 | 0.0 | $155,540 | $0 | $1,863 | Yes (X) | |||
| HAROLD LAWRENCE | |||||||||
| PHARMACIST | 40.0 | 0.0 | $144,418 | $0 | $40,412 | Yes (X) | |||
| CONDRA ANDERSON | |||||||||
| FNP | 40.0 | 0.0 | $115,047 | $0 | $1,199 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,477,459 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $98,734 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | 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 |
|---|---|---|---|---|---|
| PSYCHIATRIC MEDIAL CARE LLC | |||||
| 9040 EXECUTIVE PARK DRIVE | KNOXVILLE | TN | 37923 | PSYCH SERVICES | $351,973 |
| DOCS WHO CARE | |||||
| 800 W FRONTIER LANE | OLATHE | KS | 66061 | ER SERVICES | $412,533 |
| THE NEBRASKA MEDICAL CENTER | |||||
| 987400 NEBRASKA MEDICAL CENTER | OMAHA | NE | 68198 | MANAGEMENT SUPPORT | $564,908 |
| INSPIRE REHABILITATION LLC | |||||
| 2810 E 35TH ST 2 | KEARNEY | NE | 68845 | REHAB SERVICES | $685,543 |
| FOCUSONE SOLUTIONS LLC | |||||
| PO BOX 3037 | OMAHA | NE | 68103 | TRAVELER SERVICES | $216,306 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $73,028 | RelatedOrganizationsAmt |
| All Other Contributions | $2,400 | AllOtherContributionsAmt |
| Total Contributions | $75,428 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621990 | BusinessCd |
| Total Revenue Column | $14,426,650 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,426,650 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,426,650 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $97,345 | TotalRevenueColumnAmt |
| Exclusion | $97,345 | 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 | $4,208,834 | SecuritiesAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $4,028,584 | SecuritiesAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | $180,250 | SecuritiesAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $180,250 | TotalRevenueColumnAmt |
| Exclusion | $180,250 | ExclusionAmt |
| 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 |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt | ExclusionExclusionAmt |
|---|---|---|---|---|
| 340B DRUG REVENUE | 900099 | $484,913 | $484,913 | |
| CAFETERIA | 900099 | $53,654 | $53,654 | |
| All Other Misc Revenue | $76,769 | $76,769 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $76,769 | TotalRevenueColumnAmt |
| Exclusion | $76,769 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $615,336 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,395,009 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,911,563 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $408,018 | 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 | $527,672 | TotalAmt |
| Program Services | $444,457 | ProgramServicesAmt |
| Management And General | $80,500 | ManagementAndGeneralAmt |
| Fundraising | $2,715 | FundraisingAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $46,705 | TotalAmt |
| Program Services | $46,705 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,417,870 | TotalAmt |
| Program Services | $4,336,552 | ProgramServicesAmt |
| Management And General | $1,046,042 | ManagementAndGeneralAmt |
| Fundraising | $35,276 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $634,658 | TotalAmt |
| Program Services | $534,311 | ProgramServicesAmt |
| Management And General | $97,073 | ManagementAndGeneralAmt |
| Fundraising | $3,274 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $461,521 | TotalAmt |
| Program Services | $371,829 | ProgramServicesAmt |
| Management And General | $86,766 | ManagementAndGeneralAmt |
| Fundraising | $2,926 | FundraisingAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $286,122 | TotalAmt |
| Program Services | $230,517 | ProgramServicesAmt |
| Management And General | $53,791 | ManagementAndGeneralAmt |
| Fundraising | $1,814 | FundraisingAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $52,461 | TotalAmt |
| Program Services | $42,266 | ProgramServicesAmt |
| Management And General | $9,863 | ManagementAndGeneralAmt |
| Fundraising | $333 | FundraisingAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,410 | TotalAmt |
| Program Services | $80,091 | ProgramServicesAmt |
| Management And General | $18,689 | ManagementAndGeneralAmt |
| Fundraising | $630 | FundraisingAmt |
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 | $27,483 | TotalAmt |
| Management And General | $27,483 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,499,910 | TotalAmt |
| Program Services | $1,683,105 | ProgramServicesAmt |
| Management And General | $790,028 | ManagementAndGeneralAmt |
| Fundraising | $26,777 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $115,320 | TotalAmt |
| Program Services | $92,909 | ProgramServicesAmt |
| Management And General | $21,680 | ManagementAndGeneralAmt |
| Fundraising | $731 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $585,203 | TotalAmt |
| Program Services | $471,475 | ProgramServicesAmt |
| Management And General | $110,018 | ManagementAndGeneralAmt |
| Fundraising | $3,710 | FundraisingAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $245,589 | TotalAmt |
| Program Services | $197,861 | ProgramServicesAmt |
| Management And General | $46,171 | ManagementAndGeneralAmt |
| Fundraising | $1,557 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $138,389 | TotalAmt |
| Program Services | $111,494 | ProgramServicesAmt |
| Management And General | $26,017 | ManagementAndGeneralAmt |
| Fundraising | $877 | FundraisingAmt |
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 | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $520,891 | TotalAmt |
| Program Services | $419,661 | ProgramServicesAmt |
| Management And General | $97,928 | ManagementAndGeneralAmt |
| Fundraising | $3,302 | FundraisingAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,422,313 | TotalAmt |
| Program Services | $1,145,901 | ProgramServicesAmt |
| Management And General | $267,395 | ManagementAndGeneralAmt |
| Fundraising | $9,017 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,324 | TotalAmt |
| Program Services | $87,272 | ProgramServicesAmt |
| Management And General | $20,365 | ManagementAndGeneralAmt |
| Fundraising | $687 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| REPAIRS & MAINT. | $589,018 | $474,548 | $110,735 | $3,734 |
| Medical Supplies | $998,111 | $998,111 | ||
| BAD DEBT | $1,028,992 | $1,028,992 | ||
| MEDICAID | $593,997 | $593,997 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $371,823 | TotalAmt |
| Program Services | $299,564 | ProgramServicesAmt |
| Management And General | $69,901 | ManagementAndGeneralAmt |
| Fundraising | $2,359 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,771,782 | TotalAmt |
| Program Services | $13,691,618 | ProgramServicesAmt |
| Management And General | $2,980,445 | ManagementAndGeneralAmt |
| Fundraising | $99,719 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $849 | BOYAmt |
| EOY | $6,859 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $249,780 | BOYAmt |
| EOY | $576,498 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,364 | BOYAmt |
| EOY | $89,392 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,623,950 | BOYAmt |
| EOY | $1,858,104 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | 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 | $344,031 | BOYAmt |
| EOY | $363,641 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $106,511 | BOYAmt |
| EOY | $129,634 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $22,199,435 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,414,612 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,990,605 | BOYAmt |
| EOY | $9,784,823 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,685,885 | BOYAmt |
| EOY | $5,205,792 | 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 | $600,000 | BOYAmt |
| EOY | $456,644 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,617,975 | BOYAmt |
| EOY | $18,471,387 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $975,648 | BOYAmt |
| EOY | $1,130,221 | 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 | $10,806,748 | BOYAmt |
| EOY | $10,416,419 | 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 | $25,000 | BOYAmt |
| EOY | $245,791 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,807,396 | BOYAmt |
| EOY | $11,792,431 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,810,579 | BOYAmt |
| EOY | $6,634,206 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $44,750 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,810,579 | BOYAmt |
| EOY | $6,678,956 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,617,975 | BOYAmt |
| EOY | $18,471,387 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$1,376,773 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $245,150 | 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 | false | FederalGrantAuditRequiredInd |
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 | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $15,462 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $15,462 | 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 | FormAndLineReferenceDesc |
| Explanation | THE LOBBYING EXPENSES RECORDED ARE A PORTION OF DUES PAID TO THE MISSOURI HOSPITAL ASSOCIATION. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $235,304 | OtherCostOrOtherBasisAmt |
| Book Value | $235,304 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $7,723,776 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,661,457 | DepreciationAmt |
| Book Value | $4,062,319 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $14,209,342 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,753,155 | DepreciationAmt |
| Book Value | $5,456,187 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $31,013 | OtherCostOrOtherBasisAmt |
| Book Value | $31,013 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $9,784,823 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO FOUNDATION | Desc |
| Amt | $245,791 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $245,791 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $14,989,877 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $245,150 | NetUnrealizedGainsInvstAmt |
| Other Revenue | $406,193 | OtherRevenueAmt |
| Revenue Not Reported | $651,343 | RevenueNotReportedAmt |
| Revenue Subtotal | $14,338,534 | RevenueSubtotalAmt |
| Investment Expenses Not Incld | $27,483 | InvestmentExpensesNotIncldAmt |
| Other Revenues Not Included | $1,028,992 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,056,475 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $15,395,009 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,785,913 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $70,606 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $70,606 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,715,307 | ExpensesSubtotalAmt |
| Investment Expenses Not Incld2 | $27,483 | InvestmentExpensesNotIncld2Amt |
| Other Expenses Not Included | $1,028,992 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,056,475 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $16,771,782 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART XI, 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, LINES 2D & 4B | LINE 2D RELATED ORGANIZATION'S REVENUE $ 479,221 ELIMINATIONS ( 73,028) ----------- TOTAL $ 406,193 LINE 4B BAD DEBT EXPENSE $ 1,028,992 |
| SCHEDULE D, PART XII, LINES 2D & 4B | LINE 2D RELATED ORGANIZATION'S EXPENSES $ 70,606 LINE 4B BAD DEBT EXPENSE $ 1,028,992 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $649,063 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $38,524 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $610,539 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03900 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,439,741 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $749,601 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $690,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04400 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,088,804 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $788,125 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,300,679 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08300 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $25,523 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,021 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $24,502 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00200 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $552,016 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $461,876 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $90,140 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00600 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $577,539 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $462,897 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $114,642 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00800 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,666,343 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,251,022 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,415,321 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09100 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,291 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,291 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00020 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,972 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,972 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $10,263 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $10,263 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00060 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,028,992 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $82,665 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $9,180,417 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $6,061,462 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $3,118,955 | 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 HOSPITAL-FAIRFAX | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | http://www.fairfaxmed.com/ | WebsiteAddressTxt |
| 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 HOSPITAL-FAIRFAX | 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 | 15 | 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 | WWW.FAIRFAXMED.COM/ABOUT/NEWS/CHNA1/ | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 15 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | WWW.FAIRFAXMED.COM/ABOUT/NEWS/CHNA1/ | 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 | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300. | 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 |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE 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 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 Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | CH-F INVITED AREA COMMUNITY EXPERTS TO GATHER IN 3 DIFFERENT FOCUS GROUPS. THOSE IN ATTENDANCE INCLUDED AREA COUNSELORS, CLERGY MEMBERS, LAW ENFORCEMENT, ECONOMIC DEVELOPMENT PERSONNEL, NURSING HOME REPRESENTATIVES, SCHOOL FACULTY, COMMUNITY SERVICES STAFF AND OTHER COMMUNITY EXPERTS. FOCUS GROUP ATTENDEES WERE ASKED A VARIETY OF QUESTIONS. DIALOGUE WAS CANDID AND FOCUS GROUP ATTENDEES USED THEIR KNOWLEDGE OF THE CONSTITUENCY THEY REPRESENT TO HONESTLY EVALUATE THE HEALTH OF THE COMMUNITY. RESULTS FROM THOSE MEETINGS ARE SUMMARIZED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT REPORT. CH-F STAFF ALSO PARTICIPATED IN THE FOCUS GROUPS. COMMUNITY HOSPITAL-FAIRFAX RELEASED A CHNA SURVEY TO THE PUBLIC. THE QUESTIONS ON THE SURVEY WERE DETERMINED THROUGH GUIDANCE PROVIDED BY THE MISSOURI HOSPITAL ASSOCIATION AND INFORMATION GATHERED THROUGH THE FOCUS GROUPS AND SECONDARY RESEARCH. THE SURVEY WAS OFFERED ONLINE. PAPER COPIES WERE PROVIDED IN LOCATIONS WHERE POPULATIONS MIGHT HAVE DIFFICULTY ACCESSING IT ONLINE. THIS INCLUDES NURSING HOMES, SENIOR HOUSING AND NUTRITION CENTERS. CH-F PROMOTED THE SURVEY USING FACEBOOK, BLAST EMAILS, NEWSPAPER AND THE CABLE CHANNEL. 556 SURVEYS WERE RETURNED. COMMUNITY HOSPITAL-FAIRFAX ALSO COLLABORATED WITH COMMUNITY SERVICES INC. OF ATCHISON AND HOLT COUNTY TO DISTRIBUTE SURVEYS. COMMUNITY SERVICES INC. IS THE LOCAL AGENCY EMPOWERED TO HELP PEOPLE IN NEED IN THE ATCHISON AND HOLT COUNTY COMMUNITIES. |
| SCHEDULE H, PART V, SECTION B, LINE 11 | IDENTIFIED NEEDS AND AREAS OF PRIORITY PRIMARY CARE ACCESS PROBLEM STATEMENT: PRIMARY CARE ACCESS WAS IDENTIFIED IN BOTH THE CHNA SURVEY AND THE FOCUS GROUPS AS A SIGNIFICANT ISSUE. ATCHISON AND HOLT COUNTIES ARE LOCATED IN A HPSA. BOTH ATCHISON AND HOLT COUNTIES ARE RANKED LOW FOR RATIOS OF POPULATION TO PRIMARY CARE PROVIDERS. THIS IS BECAUSE PRIMARY CARE PHYSICIANS ARE SCARCE AND DIFFICULT TO RECRUIT TO RURAL AREAS. COMMUNITY HOSPITAL-FAIRFAX STRATEGIES: COMMUNITY HOSPITAL-FAIRFAX HAS RECRUITED A THIRD PHYSICIAN TO THE AREA IN OCTOBER OF 2016. CH-F INTENDS TO OPEN A THIRD PRIMARY CARE CLINIC IN THE SERVICE AREA IN 2016. TWO PREVIOUS CLINICS WERE OPENED IN 2014 IN MOUND CITY AND IN 2016 IN OREGON. TIMELINE: OCTOBER 2016 ANTICIPATED IMPACT: CH-F BELIEVES THAT A NEW PRIMARY CARE PHYSICIAN WILL LESSEN THE BURDEN ON EXISTING PROVIDERS AND ALLOW FOR PATIENTS TO RECEIVE MORE CONVENIENT APPOINTMENTS. IT SHOULD ALSO ALLOW CLINICS MORE TIME TO SEE PATIENTS AND FURTHER DEVELOP THE WELLNESS INITIATIVE HIGHLIGHTED LATER IN THIS PLAN. MENTAL HEALTH PROBLEM STATEMENT: MENTAL HEALTH WAS IDENTIFIED AS A MAJOR PRIORITY AMONG NEEDS IDENTIFIED IN THE CHNA SURVEY AND IN FOCUS GROUPS. ATCHISON AND HOLT COUNTIES ARE BOTH IN A MENTAL HEALTH HPSA. ER UTILIZATION FOR AFFECTIVE DISORDERS IS INCREASING IN RURAL MISSOURI. LIKE PRIMARY CARE, MENTAL HEALTH PROVIDERS ARE EXTREMELY SCARCE AND DIFFICULT TO RECRUIT TO RURAL AREAS. COMMUNITY HOSPITAL-FAIRFAX STRATEGIES: - MAINTAIN SENIOR LIFE SOLUTIONS PROGRAM AND GROW TO A SECOND TRACK AS NEEDS SUGGEST. - RECRUIT AND RETAIN TELE-PSYCHIATRY AS AN ONGOING SPECIALIST CLINIC. - DEVELOP SUPPORT GROUPS FOR VARIOUS NEEDS SUCH AS GRIEF, DIVORCE AND SUBSTANCE ABUSE. - PARTNER WITH EXISTING RESOURCES TO BRING ADDITIONAL COUNSELING SERVICES TO THE COMMUNITY. TIMELINE: SENIOR LIFE SOLUTIONS SECOND TRACK BY JUNE OF 2018. TELE-PSYCHIATRY SPECIALTY CLINIC BY JUNE OF 2018. SUPPORT GROUP PROGRAM DEVELOPMENT BY JUNE OF 2017. ADDITIONAL COUNSELING RESOURCES TO THE COMMUNITY BY JUNE OF 2017. ANTICIPATED IMPACT: SLS WILL ACCOMMODATE TWICE AS MANY PATIENTS THAN ARE BEING CURRENTLY SERVED. TELE-PSYCHIATRY AND ADDITIONAL COUNSELING RESOURCES SHOULD EASE REFERRAL CHALLENGES FOR PRIMARY CARE PHYSICIANS AN INCREASE ACCESS FOR PATIENTS. SUPPORT GROUPS WILL GIVE UNMET NEEDS AN OUTLET FOR DEALING WITH SOME OF THESE CHALLENGES. ABILITY TO PAY FOR CARE PROBLEM STATEMENT: UNINSURED RATES CONTINUE TO STAGNATE INSTEAD OF IMPROVE. PER CAPITA INCOME REMAINS BELOW THE STATE AND NATIONAL AVERAGE. BAD DEBT AND CHARITY CARE ARE BECOMING A LARGER PERCENTAGE OF REVENUE EACH YEAR AT CH-F. COST OF CARE CONTINUES TO INCREASE MAKING HEALTHCARE LESS AND LESS AFFORDABLE. MISSOURI DID NOT EXPAND MEDICAID AND DESPITE ADDITIONAL INSURANCE OPTIONS BEING AVAILABLE, THEY ARE STILL LARGELY FINANCIALLY UNREACHABLE FOR MANY IN THE LOWER INCOME BRACKETS. COMMUNITY HOSPITAL-FAIRFAX STRATEGIES: COMMUNITY HOSPITAL-FAIRFAX IS COMMITTED TO EXPLORING A VARIETY OF STRATEGIES TO ASSIST THOSE WITH NO INSURANCE OR HIGH DEDUCTIBLES IN ACCESSING THE CARE THAT THEY NEED WITH OPTIONS TO MAKE IT AFFORDABLE. THESE STRATEGIES MAY INCLUDE TRAINING STAFF TO PROVIDE COUNSELING FOR PAYMENT OPTIONS, DEVELOPING DISCOUNTS FOR PRIVATE PAY PATIENTS, PROVIDING BETTER ESTIMATES FOR PRE-PAYMENT AND COPAYMENT, CREATING PROGRAMS FOR FORGIVENESS FOR OLD ACCOUNTS AND PROVIDING PAYMENT OPTIONS TO AVOID COLLECTIONS WHENEVER POSSIBLE. TIMELINE: PLANNING WILL OCCUR IN THE REMAINDER OF 2016 WITH DEPLOYMENT OF MOST STRATEGIES IN 2017. ANTICIPATED IMPACT: WE BELIEVE THAT THESE STRATEGIES WILL RELIEVE THOSE FACING DIFFICULT DECISIONS BETWEEN HEALTHCARE AND OTHER COMPETING FINANCIAL NEEDS. WE BELIEVE THAT WE WILL ALSO BE ABLE TO PROTECT A VULNERABLE POPULATION FROM ADDITIONAL FINANCIAL STRESS FROM THE COST OF CARE. PREVENTIVE CARE PROBLEM STATEMENT: NORTHWEST MISSOURIANS, INCLUDING ATCHISON AND HOLT RESIDENTS, HAVE OPPORTUNITIES FOR INCREASING ACCESS TO PREVENTIVE CARE. AREAS BELOW THE STATE AS A WHOLE INCLUDE ADULT IMMUNIZATIONS, ROUTINE CHECKUPS, COLONOSCOPIES, CLINICAL BREAST EXAMS, MAMMOGRAMS AND HEART DISEASE SCREENINGS. WITH HIGHER THAN STATE AVERAGE IN AVOIDABLE HOSPITALIZATIONS, PREVENTIVE CARE COULD PLAY AN IMPORTANT ROLE IN MAKING THE COMMUNITY HEALTHIER. THERE ARE A VARIETY OF FACTORS THAT CONTRIBUTE TO LACK OF PREVENTIVE CARE. OTHER DATA SUGGESTS THAT THE PRIMARY REASON IS COST. WITH CHANGES TO INSURANCE PLANS, ADDITIONAL WELLNESS VISITS ARE NOW COVERED WHICH SHOULD INCREASE UTILIZATION. COMMUNITY HOSPITAL-FAIRFAX STRATEGIES: COMMUNITY HOSPITAL-FAIRFAX WILL HAVE OPENED THREE PRIMARY CARE CLINICS SINCE AUGUST OF 2014. A NEW PROJECT WILL BE INITIATED TO INCREASE PREVENTIVE CARE VISITS IN THE POPULATION CARED FOR BY THESE CLINICS. THESE VISITS WILL INCLUDE TRADITIONAL SCREENINGS ALONG WITH DEPRESSION AND COUNSELING REGARDING ADVANCED DIRECTIVES. TIMELINE: JANUARY 2017 ANTICIPATED IMPACT: WE BELIEVE THAT INCREASING WELLNESS VISITS IN THIS POPULATION WILL INCREASE RATES OF IMMUNIZATIONS AND PREVENTIVE SCREENINGS. UNMET NEEDS CH-F RECOGNIZES THAT WE ARE UNABLE TO MEET EVERY NEED DISCOVERED IN THE CH-F CHNA. SOMETIMES RESOURCES ARE NOT AVAILABLE TO MEET THESE NEEDS OR THE HOSPITAL IS NOT THE BEST ORGANIZATION TO TAKE A LEADERSHIP ROLE. ADDITIONALLY, SOME ORGANIZATIONS ARE ALREADY WORKING ON SOLUTIONS FOR SOME OF THESE ISSUES. THE FOLLOWING DESCRIBES HOW WE INTEND TO MEET THE NEEDS WE IDENTIFIED AND, IF WE CHOSE NOT TO ADDRESS CERTAIN PROBLEMS, WHY. AREA OF CONCERN POPULATION LOSS - NO ATCHISON AND HOLT COUNTIES HAVE EXISTING ORGANIZATIONS TO MEET THESE NEEDS. AGING POPULATION - YES THIS CANNOT BE ADDRESSED; THE NEEDS CAN ONLY BE ANTICIPATED. THE WORK THAT CH-F IS DOING IN CARE TRANSITIONS, WELLNESS AND HOMECARE WILL PREPARE THE HOSPITAL TO MEET THE HEALTH NEEDS OF AN AGING POPULATION. ADDITIONAL PRIMARY CARE RESOURCES WILL ALSO MEET THIS NEED. CHILDREN IN POVERTY - NO CH-F IS NOT DIRECTLY ADDRESSING THIS NEED IN THIS CHNA IMPLEMENTATION PHASE. HOWEVER, THE HOSPITAL HAS ADDED SLIDING FEE SCALE CLINICS IN THE LAST 18 MONTHS WHICH HAVE SERVED THIS NEED. CH-F IS ALSO IN THE SIXTH YEAR OF PROVIDING THE BACK TO SCHOOL FAIRS WHICH INCLUDE FREE SCHOOL SUPPLIES AND SOME HEALTH SERVICES FOR UNDERPRIVILEGED CHILDREN. INADEQUATE SLEEP - NO CH-F DOES NOT HAVE THE RESOURCES TO MEET THIS NEED. HOWEVER, WELLNESS ISSUES ADDRESSING OVERALL HEALTH MAY ASSIST THIS ISSUE. ACCESS TO PRIMARY CARE - YES CH-F PLANS TO OPEN A 3RD CLINIC AND RECRUIT AN ADDITIONAL CLINIC IN THE FALL OF 2016. ACCESS TO SPECIFIC SPECIALISTS - YES CH-F INTENDS TO RECRUIT ADDITIONAL SPECIALISTS IDENTIFIED IN THE SURVEY. ACCESS TO MENTAL HEALTH PROVIDERS - YES CH-F INTENDS TO MAINTAIN AND EXPAND SENIOR LIFE SOLUTIONS. ADDITIONALLY, CH-F INTENDS TO BRING ADDITIONAL COUNSELING SERVICES TO THE AREA. STAGNANT AND BELOW NATIONAL AVERAGE INSURANCE COVERAGE - YES CH-F HAS IDENTIFIED THIS AS A MAJOR ISSUE IN THE COMMUNITY AND WILL BE DEVELOPING STRATEGIES TO ASSIST THE UNINSURED OR UNDERINSURED IN ACCESSING CARE. INABILITY TO PAY FOR CARE - YES SEE ABOVE. PHYSICAL INACTIVITY - YES CH-F IS EXPLORING OPPORTUNITIES TO INCORPORATE PHYSICAL ACTIVITY COACHING AND EDUCATION INTO THE WELLNESS INITIATIVE. PREVENTATIVE HEALTH - YES CH-F IS EXPLORING OPPORTUNITIES TO BUILD WELLNESS CARE THROUGH PRIMARY CARE CLINICS WHICH WILL INCLUDE IDENTIFICATION OF PREVENTIVE HEALTH OPPORTUNITIES. CHRONIC DISEASE - YES CH-F PLANS TO ADDRESS CHRONIC DISEASE CARE THROUGH THE WELLNESS INITIATIVE IN ADDITION TO THE CARE TRANSITIONS PROJECT. CANCER - NO CH-F DOES NOT HAVE THE RESOURCES TO ADDRESS THIS HEALTH ISSUE. CH-F WILL MAINTAIN ALL NECESSARY SERVICES. |
| SCHEDULE H, PART V, SECTION B, LINE 16A, 16B & 16C | WWW.FAIRFAXMED.COM/CONTACTUS/PAYMENTS/CHARITY-CARE/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| MOUND CITY FAMILY MEDICINE | ||||
| 514 STATE STREET | MOUND CITY | MO | 64470 | PRIMARY CARE FACILITY |
| WEST NODAWAY FAMILY MEDICINE | ||||
| 226 W MAIN STREET | BURLINGTON JUNCTION | MO | 64428 | PRIMARY CARE FACILITY |
| SOUTH HOLT FAMILY MEDICINE | ||||
| 101 SOUTH WASHINGTON | OREGON | MO | 64473 | PRIMARY CARE FACILITY |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | ADDITIONAL FACTORS CONSIDERED IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE INCLUDE ASSET LEVELS, MEDICAL INDIGENCY, INSURANCE/UNDERINSURANCE STATUS AND RESIDENCY. |
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,028,992. |
| SCHEDULE H, PART II | COMMUNITY HOSPITAL-FAIRFAX PARTICIPATES IN YEAR-ROUND COMMUNITY BUILDING ACTIVITES. IN FEBRUARY, OVER 200 COMMUNITY MEMBERS WERE SERVED IN A FREE HEART HEALTH SCREENING. IN THE SPRING, AREA FIRST GRADERS ENJOY PEDIATRIC ORIENTATION, A FUN FILLED TIME TO VISIT THE HOSPITAL AND LEARN MORE ABOUT BEING A PATIENT OR A HEALTHCARE WORKER. THE SUMMERTIME KICKS OFF A REDUCED PRICE SPEEED AND AGILITY CAMP FOR AREA ATHLETES WHERE THEY GET TO WORK OUT WITH PHYSICAL THERAPY STAFF AND LEARN HOW TO AVOID INJURY. THE ANNUAL BACK TO SCHOOL FAIRS ROUND OUT THE SUMMER WITH OVER 100 KIDS RECEIVING FREE SCHOOL SUPPLIES AND AN OPPORTUNITY TO SPEAK WITH A COUNSELOR ABOUT HEALTHY SCHOOL HABITS. IN THE FALL, BOTH MEN AND WOMEN PARTICIPATE IN HEALTHY EVENTS WITH AN ANNUAL PROSTATE SCREENING AND WOMENS EVENT WHERE FREE SCREENINGS AND HEALTH INFORMATION ARE OFFERED. THROUGHOUT THE YEAR, COMMUNITY MEMBERS HAVE AN OPPORTUNITY TO LEARN FROM HEALTHCARE PROFESSIONALS AT LUNCH AND LEARNS PROVIDED THROUGHOUT THE YEAR. STERLING CONNECTION, A FREE MEMBERSHIP SERVICE OFFERED TO THOSE 55 AND OLDER, ALSO PROVIDES CONNECTION POINTS TO THE HOSPITAL THROUGHOUT THE YEAR INCLUDING ICE CREAM SOCIALS, FREE SCREENINGS AND INFORMATIVE EVENTS. SIDELINE COVERAGE FOR LOCAL SPORTING EVENTS IS ALSO AN IMPORTANT PRIORITY AT COMMUNITY HOSPITAL-FAIRFAX. PHYSICIANS AND PHYSICAL THERAPISTS VOLUNTEER THEIR TIME EACH FALL TO AIDING STUDENT ATHLETES AT AREA FOOTBALL GAMES. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYER SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | THE AMOUNT OF ACCOUNT BALANCES WRITTEN OFF TO BAD DEBTS THAT POSSIBLY WOULD HAVE QUALIFIED FOR CHARITY HAD THEY BEEN WILLING TO PROVIDE THE NECESSARY INFORMATION, AND THE TOTAL OF BANKRUPTCIES THE HOSPITAL HAD TO WRITE OFF. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | THE AUDIT FOOTNOTE ADDRESSING BAD DEBT EXPENSE IS IN NOTE 1 ON PAGE 8 OF THE ATTACHED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, SECTION A, LINE 8 | THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 23% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. OUR CUSTOMER SERVICE SURVEYS RATE COMMUNITY HOSPITAL CONSISTENTLY OVER 90%, SHOWING THESE MEDICARE BENEFICIARIES APPRECIATE THE SERVICES COMMUNITY HOSPITAL PROVIDES AND HOW THE SERVICES ARE PROVIDED. THE COSTING SOURCE WAS THE FY16 MEDICARE COST REPORT. |
| SCHEDULE H, PART III, SECTION A, LINE 9B | COLLECTION POLICY STATES ALL UNINSURED AND INSURED PATIENTS ARE INFORMED ON THEIR FIRST STATEMENT OF SERVICES THAT COMMUNITY HOSPITAL HAS A GRANT PROGRAM (FOR FINANCIAL ASSISTANCE) FOR THOSE WHO QUALIFY. THIS SAME TYPE OF 'ASSISTANCE AVAILABLE' INFORMATION IS ALSO IN THE PATIENT INFORMATION BROCHURES IN THE PATIENT ROOMS AND WAITING AREAS. PATIENTS MAY QUALIFY FOR A CHARITY DISCOUNT OR A MEDICALLY INDIGENT DISCOUNT, DEPENDING ON THEIR FINANCIAL SITUATION AND USING THE FEDERAL POVERTY GUIDELINES. |
| SCHEDULE H, PART VI, LINE 2 | A. COMMUNITY HOSPITAL-FAIRFAX IDENTIFIED THREE AREAS OF PRIORITY IN THE COMMUNITY NEEDS ASSESSMENT. I. PRIMARY CARE ACCESS PRIMARY CARE ACCESS WAS IDENTIFIED AS A SIGNIFICANT ISSUE. PRIMARY CARE PHYSICIANS ARE SCARCE AND DIFFICULT TO RECRUIT TO RURAL AREAS AND ACCESS TO APPOINTMENTS CAN BE LIMITED. AS A RESPONSE TO THIS IDENTIFIED NEED, COMMUNITY HOSPITAL-FAIRFAX RECRUITED A NEW PRIMARY CARE PHYSICIAN IN THE FALL OF 2016 AND ADDED AN ADDITIONAL NURSE PRACTITIONER IN THE SUMMER OF 2017. COMMUNITY HOSPITAL-FAIRFAX ALSO OPENED A NEW CLINIC SITE IN BURLINGTON JUNCTION IN THE FALL OF 2016 AND ANOTHER SITE IN FAIRFAX IN THE WINTER OF 2018. FINALLY, COMMUNITY HOSPITAL-FAIRFAX MERGED WITH TWO PRIVATELY RUN PHYSICIAN CLINICS IN JULY OF 2017. IN FY2016, 4,861 VISITS WERE MADE TO COMMUNITY HOSPITAL-FAIRFAX PRIMARY CARE CLINICS. IN FY2017, CLINIC VISITS WERE INCREASED TO 6,986. THIS INDICATES CH-F STRATEGIES TO INCREASE PRIMARY CARE ACCESS HAVE RESULTED IN MORE LOCAL APPOINTMENTS AVAILABLE FOR OUR POPULATION. II. MENTAL HEALTH ACCESS. COMMUNITY HOSPITAL-FAIRFAX IDENTIFIED STRATEGIES INCLUDED INCREASING OUR EXISTING SENIOR LIFE SOLUTIONS (GROUP THERAPY PROGRAM), RECRUITING A PSYCHIATRY PRESENCE, DEVELOPING SUPPORT GROUPS AND PARTNERING WITH EXISTING RESOURCES TO BRING COUNSELING TO THE COMMUNITY. IN FY2017, COMMUNITY HOSPITAL-FAIRFAX MOVED A MODULAR BUILDING ONTO THE CAMPUS TO FACILITATE EXPANDING SENIOR LIFE SOLUTIONS AND DOUBLING THE NUMBER OF PARTICIPANTS THAT COULD BE SERVED IN THIS GROUP THERAPY PROGRAM. ALSO, IN FY2017, COMMUNITY HOSPITAL-FAIRFAX ADDED A MONTHLY PSYCHIATRY SPECIALTY CLINIC WITH A PSYCHIATRIST ONSITE THAT TREATS ALL TYPES OF PATIENTS. WORK CONTINUES TO BOLSTER SUPPORT GROUPS AND TO RECRUIT COUNSELING RESOURCES (WHICH REMAIN SCARCE) TO THE AREA. III. ABILITY TO PAY FOR CARE COMMUNITY HOSPITAL-FAIRFAX IDENTIFIED STRATEGIES TO ASSIST THOSE WITH NO INSURANCE OR HIGH DEDUCTIBLES TO ACCESS CARE THAT THEY NEED. TO ASSIST WITH THIS EFFORT, COMMUNITY HOSPITAL-FAIRFAX HAS SUCCESSFULLY IMPLEMENTED A STRATEGY TO NEGOTIATE PAYMENT STRUCTURES WHICH ARE FAVORABLE TO PATIENTS. IN ADDITION TO THIS STRATEGY, AN AGGRESSIVE FORGIVENESS PROGRAM FOR EXISTING DEBT WAS IMPLEMENTED IN FY16 AND FY17. THIS WORK HAS RESULTED IN LOWERING COMMUNITY HOSPITAL-FAIRFAX BAD DEBT FROM 9% APPROXIMATELY TO LESS THAN 6%. IV. PREVENTIVE CARE COMMUNITY HOSPITAL-FAIRFAX IDENTIFIED A NEED FOR ADDITIONAL PREVENTIVE CARE IN OUR COMMUNITIES. OUR STRATEGY FIRST INCLUDED EXPANDING ACCESS TO PRIMARY CARE WHERE THESE OPPORTUNITIES COULD BE IDENTIFIED. NOW THAT WE HAVE SUCCEEDED IN INCREASING ACCESS TO PRIMARY CARE, WE HAVE LAUNCHED AN ACO STRATEGY IN OUR CLINICS TO ADOPT ADDITIONAL MEASURES FOR PREVENTATIVE CARE. A CARE COORDINATOR HAS BEEN HIRED AND AN AGGRESSIVE EFFORT TO SCHEDULE OUR MEDICARE PATIENTS FOR THEIR ANNUAL WELLNESS VISIT HAS RECENTLY BEEN INITIATED. |
| SCHEDULE H, PART VI, LINE 3 | COMMUNITY HOSPITAL BUSINESS OFFICE STAFF WILL DISCUSS WITH INPATIENTS AND OUTPATIENTS THE OPTIONS AVALIABLE TO HELP THE PATIENTS MEET THEIR FINANCIAL OBLIGATIONS TO COMMUNITY HOSPITAL. THEY DISCUSS THE FEDERAL/STATE GOVERNMENT PROGRAMS AVAILABLE AND THE HOSPITAL'S FINANCIAL ASSISTANCE PROGRAM. THEN INFORMATION IS INCLUDED IN THE STATEMENTS SENT TO PATIENTS (EXPLAINING THE AMOUNTS OWED BY THE PATIENT'S INSURANCE OR THE PATIENT), MUCH OF THE INFORMATION IS THE SAME AS THE INFORMATION DISCUSSED IN PERSON. |
| SCHEDULE H, PART VI, LINE 4 | COMMUNITY HOSPITAL-FAIRFAX SERVES THE ATCHISON, HOLT AND WESTERN NODAWAY COUNTIES, POPULATION APPROXIMATELY 10,700. THERE ARE FIVE MAIN TOWNS IN ATCHISON AND HOLT, ALL WITH POPULATIONS BELOW 2,000. THE POPULATION IS ALL RURAL AND THE ECONOMY IS LARGELY DRIVEN BY AGRICULTURE. THE POPULATION IS AGING WITH A MEDIAN HOUSEHOLD INCOME OF $45,129. |
| SCHEDULE H, PART VI, LINE 5 | TO EDUCATE AND PROVIDE SERVICES TO ITS COMMUNITY, COMMUNITY HOSPITAL RESPONDS BY PROVIDING THE FOLLOWING ACTIVITES: AN ANNUAL HEART HEALTH SCREENING OFFERED FREE OF CHARGE, AND FREE BLOOD PRESSURE CHECKS; DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR; FREE GLUCOSE SCREENING, BMI CHECKS AND BLOOD PRESSURE CHECKS AT ANNUAL WOMEN'S EVENT; AN ANNUAL BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN AND HEALTHY EATING CHOICES ARE DISCUSSED; AN ANNUAL PROSTATE SCREENING WHICH INCLUDES A FREE EXAM FOR LOCAL RESIDENTS. IN ADDITION, THE HOSPITAL INITIATED A WORKPLACE WELLNESS PROGRAM WHERE SCREENINGS ARE OFFERED AT A REDUCED PRICE FOR EMPLOYEES. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| 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 | Yes (true) | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| ROGER STEINKRUGER | ||||||||||||
| CEO | $203,201 | $0 | $43,260 | $0 | $3,043 | $0 | $7,955 | $0 | $20,302 | $0 | $277,761 | $0 |
| DR DUSTIN CARPENTER MD | ||||||||||||
| DOCTOR | $241,756 | $0 | $0 | $0 | $905 | $0 | $0 | $0 | $6,976 | $0 | $249,637 | $0 |
| RENEE KREIFELS | ||||||||||||
| CRNA | $154,772 | $0 | $0 | $0 | $1,830 | $0 | $0 | $0 | $6,157 | $0 | $162,759 | $0 |
| KELLY OSBORN | ||||||||||||
| CRNA | $155,420 | $0 | $0 | $0 | $120 | $0 | $0 | $0 | $1,863 | $0 | $157,403 | $0 |
| HAROLD LAWRENCE | ||||||||||||
| PHARMACIST | $133,429 | $0 | $10,025 | $0 | $964 | $0 | $9,566 | $0 | $30,846 | $0 | $184,830 | $0 |
| JULIE JONES | ||||||||||||
| CNO | $161,010 | $0 | $10,000 | $0 | $2,449 | $0 | $0 | $0 | $5,614 | $0 | $179,073 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 7 | BONUSES WERE PAID BASED ON A NUMBER OF PROFESSIONAL AND PERSONAL PERFORMANCE-RELATED CRITERIA. |
| SCHEDULE J, PART II | THE COMPENSATION FOR ROGER STEINKRUGER AND HAROLD LAWRENCE ARE PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), AN UNRELATED 501(C)(3) HOSPITAL. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE SUPPLEMENTAL INFORMATION | PersonNm |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L , PART IV | FormAndLineReferenceDesc |
| Explanation | A) JAMIE BURKE B) JAMIE BURKE IS AN EMPLOYEE OF CH-F AND THE SISTER OF DR. RICHARD ARON BURKE, WHO IS A DIRECTOR OF CH-F. C) $46,705 D) COMPENSATION E) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | COMMUNITY HOSPITAL-FAIRFAX (CH-F) PRIDES ITSELF IN PROVIDING ACCESS TO HEALTHCARE TO A REGION WHERE HEALTH SERVICES ARE SPARSE, THE PHYSICIAN RATIO IS 2750:1 (NATIONAL BENCHMARK IS 631:1) AND EMERGENCY SERVICES WOULD OTHERWISE BE 30 MILES OR MORE FROM THE POPULATION CENTERS. COMMUNITY HOSPITAL-FAIRFAX PROVIDES THE NORTHWEST MISSOURI AREA POPULATION OF 11,000 IN HOLT, ATCHISON AND WESTERN NODAWAY COUNTY WITH A 24 HOUR EMERGENCY ROOM, ACUTE CARE (INCLUDING OBSTETRICS) AND POST-ACUTE CARE SERVICES, MANY OUTPATIENT SERVICES, SURGERY, ANCILLARY SERVICES, AND A FULL-SERVICE THERAPY DEPARTMENT. IN ADDITION TO SERVING THE HEALTH NEEDS OF A POPULATION THAT WOULD OTHERWISE NOT HAVE ACCESS TO CARE, COMMUNITY HOSPITAL-FAIRFAX CONTINUES TO INVEST IN A HEALTHY FUTURE FOR THE COMMUNITY. CH-F TRIES TO FOCUS ON THE GREATEST HEALTH NEEDS IN THE COMMUNITY WHICH TEND TO BE CHRONIC DISEASES SUCH AS HEART DISEASE, COPD AND ASTHMA, STROKE AND DIABETES. RISK FACTORS FOR THESE DISEASES ARE OBESITY, CIGARETTE SMOKING AND PHYSICAL INACTIVITY. NEARLY 30% OF THE CH-F SERVICE POPULATION IS OBESE, 69% REPORT PHYSICAL INACTIVITY AND 26% SMOKE. TO EDUCATE AND PROVIDE SERVICES TO A COMMUNITY WHERE THESE CHRONIC CONDITIONS PREVAIL, THE FOLLOWING ACTIVITIES ARE PART OF CH-F'S RESPONSE TO HEALTH NEEDS OF THE COMMUNITY: 1. FEBRUARY HEART HEALTHY SCREENING EVENT WITH 200 PLUS PARTICIPANTS. PARTICIPANTS RECEIVED FREE BLOOD PRESSURE, CHOLESTEROL, GLUCOSE AND BODY COMPOSITION ALONG WITH CARDIAC COUNSELING. HEART SCREENINGS ARE HELD IN CLINIC LOCATIONS IN ADDITION TO ONSITE AT THE HOSPITAL. 2. FREE GLUCOSE SCREENINGS, BMI CHECKS AND BLOOD PRESSURE CHECKS BIANNUALLY AT A WOMEN'S EVENT (ATTENDED BY 225 WOMEN). 3. ATTENDANCE AT AREA HEALTH FAIRS OFFERING FREE SCREENINGS. 4. CH-F IS STROKE READY AND HAS PROTOCOL IN PLACE TO RESPOND TO A STROKE WITHIN 60 MINUTES. 5. CH-F STAFF TEACHES HEALTHY EATING CHOICES AND GOOD HABITS FOR A HEALTHY SCHOOL YEAR AT THE AREA BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN. OVER 100 CHILDREN WERE REACHED THROUGH THIS ACTIVITY. 6. AN ANNUAL PROSTATE SCREENING IS HELD BY CH-F. A FREE EXAM WAS PROVIDED TO NEARLY 45 MEN THIS YEAR. IN ADDITION TO RESPONDING TO AREA HEALTH CONCERNS, CH-F ALSO WANTS TO ENSURE THAT THERE ARE HEALTHCARE PROVIDERS FOR FUTURE GENERATIONS IN NORTHWEST MISSOURI. SCHOLARSHIPS ARE AWARDED EACH YEAR TO STUDENTS ENROLLED IN A HEALTHCARE PROGRAM. A CAREER DAY WAS ALSO HOSTED FOR AREA 8TH GRADERS. 55 STUDENTS ATTENDED TO LEARN ABOUT HEALTH CAREERS THROUGH HANDS ON ACTIVITIES WITH PHYSICIANS, LABORATORY, RADIOLOGY, NURSING AND PHYSICAL THERAPY EMPLOYEES. CH-F ALSO HOSTS JUNIORS FOR A CAREER DAY AND OFFERS JOB SHADOWING FOR ALL STUDENTS 16 AND OLDER. CH-F CONTINUES TO SERVE THE COMMUNITY BY PROVIDING HEALTHCARE TO A POPULATION THAT WOULD NOT OTHERWISE HAVE ACCESS. RECRUITING PHYSICIANS, NURSES, THERAPISTS AND OTHER HEALTHCARE PROVIDERS IS ONGOING. PURCHASING STATE OF THE ART EQUIPMENT WHEN POSSIBLE AND MAKING SURE THAT EACH MEMBER OF OUR COMMUNITY HAS THE CARE THEY DESERVE IS NOT AN EASY TASK, BUT ONE CH-F IS PROUD TO DO. |
| FORM 990, PART VI, SECTION A, LINE 3 | COMMUNITY HOSPITAL ASSOCIATION, INC. HOLDS A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC). NMC APPOINTS A CHIEF EXECUTIVE OFFICER TO MANAGE DAY-TO-DAY OPERATIONS. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE ORGANIZATION'S BY-LAWS STATE THAT THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST ELEVEN MEMBERS AND NO MORE THAN FIFTEEN MEMBERS. ONE-HALF OF THE DIRECTORS SHALL BE INDIVIDUALS NOMINATED BY THE NEBRASKA MEDICAL CENTER (NMC), SUBJECT TO A MAJORITY VOTE OF THE BOARD. IF AN NMC DIRECTOR IS NOT ELECTED BY THE BOARD, NMC SHALL CONTINUE TO NOMINATE OTHER CANDIDATES UNTIL A NOMINEE IS ELECTED BY THE BOARD. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATION. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S ADMINISTRATION HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE 990 WITH ALL COMPLETED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION ANNUALLY OBTAINS WRITTEN AFFIRMATIONS FROM EACH OFFICER AND DIRECTOR AS TO THEIR COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY. IF A DISCLOSURE OCCURS, THE MATTER IS VOTED ON BY THE BOARD OF DIRECTORS. IF A MAJORITY VOTE OCCURS THEN THE DISCLOSURE IS CONSIDERED A CONFLICT. THE CONFLICTED INDIVIDUAL MAY NOT VOTE OR PARTICIPATE IN THE MATTERS INVOLVING THE CONFLICT. IT IS NOTED IN THE BOARD MEETING MINUTES THAT THE INDIVIDUAL ABSTAINED FROM VOTING. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE ORGANIZATION USES COMPARABILITY DATA TO DETERMINE THE COMPENSATION OF THE CEO AND OTHER OFFICERS. THE COMPENSATION OF THE CEO IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE COMPENSATION OF THE OTHER OFFICERS IS REVIEWED AND APPROVED BY THE BOARD OF DIRECTORS. THE MOST RECENT COMPENSATION REVIEW WAS PERFORMED IN 2017 BY SHARON GARDNER, INTERIM HR EXECUTIVE. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND AUDITED FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART VII, SECTION A, LINE 1A | THE COMPENSATION FOR DR. ARON BURKE IS FOR SERVICES PERFORMED AS A PHYSICIAN, AND IS NOT COMPENSATION FOR BEING A DIRECTOR. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EMERGENCY ROOM PHYSICIAN FEES TOTAL FEES:451329 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - PHARMACY TOTAL FEES:260881 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PROFESSIONAL FEES - OTHER TOTAL FEES:299064 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:HOUSEKEEPING TOTAL FEES:193350 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER PHYSICIAN FEES TOTAL FEES:93745 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:1201541 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1Txt |
| City | FAIRFAX | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 64446 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 431757553 | EIN |
| Primary Activities | SUPPORT ORG | PrimaryActivitiesTxt |
| Legal Domicile State | MO | 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 | CHA | 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 | false | 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 | false | 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 | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE FOUNDATION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionTypeTxt |
| Involved | $73,028 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |