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COMMUNITY MEDICAL CENTER INC: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization
COMMUNITY MEDICAL CENTER INC (EIN 47-0421272)
Tax period
2013-08-01 to 2014-07-31
Filed
2015-01-20
IRS object ID
201500209349301060
Schema version
2013v4.0
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)
Return2015-01-20T16:24:48-06:00ReturnTs
Tax Period End2014-07-31TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN470585450PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1DOHMAN AKERLUND & EDDY LLCBusinessNameLine1

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1PO BOX 470AddressLine1
CityAURORACity
StateNEState
ZIP Code688180470ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2013-08-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN470421272EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEDICAL CENTER INCBusinessNameLine1
FieldValueIRS element (for citing)
Business Name ControlCOMMBusinessNameControlTxt
Phone4022456500PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13307 BARADA STREETAddressLine1
CityFALLS CITYCity
StateNEState
ZIP Code68355ZIPCode

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSCOTT L SAWYERPersonNm
Person TitleCHIEF FINANCIAL OFFICERPersonTitleTxt
Phone4022456500PhoneNum
Signature2015-01-20SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonTIMOTHY J COUFALPreparerPersonNm
PTINP00964304PTIN
Phone4026946404PhoneNum
Preparation2015-01-20PreparationDt
FieldValueIRS element (for citing)
Tax2013TaxYr
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerRYAN LARSENPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1SAME AS ABOVEAddressLine1
CityFALLS CITYCity
StateNEState
ZIP Code68355ZIPCode
FieldValueIRS element (for citing)
Gross Receipts$23,947,398GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressHTTP://CMCFC.ORGWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation1995FormationYr
Legal Domicile StateNELegalDomicileStateCd
Activity Or MissionTO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, REGLIGIOUS BELIEFS OR FINANCIAL STANDING.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent8VotingMembersIndependentCnt
Total Employee209TotalEmployeeCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$322,375PYContributionsGrantsAmt
CY Contributions Grants$369,340CYContributionsGrantsAmt
PY Program Service Revenue$21,918,647PYProgramServiceRevenueAmt
CY Program Service Revenue$23,561,032CYProgramServiceRevenueAmt
PY Investment Income-$164,667PYInvestmentIncomeAmt
CY Investment Income$17,026CYInvestmentIncomeAmt
CY Other Revenue$0CYOtherRevenueAmt
PY Total Revenue$22,076,355PYTotalRevenueAmt
CY Total Revenue$23,947,398CYTotalRevenueAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$9,299,760PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$9,531,424CYSalariesCompEmpBnftPaidAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$11,340,134PYOtherExpensesAmt
CY Other Expenses$12,357,518CYOtherExpensesAmt
PY Total Expenses$20,639,894PYTotalExpensesAmt
CY Total Expenses$21,888,942CYTotalExpensesAmt
PY Revenues Less Expenses$1,436,461PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,058,456CYRevenuesLessExpensesAmt
Total Assets BOY$36,545,625TotalAssetsBOYAmt
Total Assets EOY$39,380,003TotalAssetsEOYAmt
Total Liabilities BOY$20,620,643TotalLiabilitiesBOYAmt
Total Liabilities EOY$21,397,759TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$15,924,982NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$17,982,244NetAssetsOrFundBalancesEOYAmt
MissionTO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, REGLIGIOUS BELIEFS OR FINANCIAL STANDING.MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$18,648,413ExpenseAmt
DescCOMMUNITY MEDICAL CENTER PROVIDES MEDICAL SERVICES TO MEET THE NEEDS OF THE PEOPLE OF RICHARDSON COUNTY AND THE SURROUNDING COMMUNITIES. COMMUNITY MEDICAL CENTER PROVIDED 1,963 INPATIENT DAYS, 1,336 SWING-BED DAYS, 125 NURSERY DAYS, 11,555 CLINIC VISITS AND NUMEREOUS OUTPATIENT SERVICES DURING THE YEAR. COMMUNITY BENEFITS INCLUDE 456,813 OF SUBSIDIZED HEALTH SERVICES, 394,342 OF TRADITIONAL CHARITY CARE,321,465 OF BAD DEBT, 19,875 OF COMMUNITY ACTIVITIES, 9,945 OF COMMUNITY SERVICES, AND 12,000 OF HEALTH EDUCATION.Desc
Total Program Service Expenses$18,648,413TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesfalseLobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsfalseReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (true)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtfalseConsolidatedAuditFinclStmtInd
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 OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document45IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (true)BackupWthldComplianceInd
Employee209EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member8IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersfalseMembersOrStockholdersInd
Election Of Board MembersfalseElectionOfBoardMembersInd
Decisions Subject To ApprovafalseDecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyfalseForm990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyfalseWhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonSCOTT L SAWYERPersonNm
Phone4022456501PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line13307 BARADA STREETAddressLine1
CityFALLS CITYCity
StateNEState
ZIP Code68355ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
KENT BIEKER
CHAIRPERSON1.00Yes (X)$0$0$0
NICK HARLING
VICE-CHAIR1.00Yes (X)$0$0$0
TONY BRUNETTE
TREASURER1.00Yes (X)$0$0$0
MARGARET MCINTEER
SECRETARY1.00Yes (X)$0$0$0
JOHN C HUNZEKER
DIRECTOR1.00Yes (X)$0$0$0
LAURIE KIMBROUGH
DIRECTOR1.00Yes (X)$0$0$0
CR JAMES DDS
DIRECTOR1.00Yes (X)$0$0$0
JOHN WILSON
DIRECTOR1.00Yes (X)$0$0$0
STEVE SEVERIN
DIRECTOR1.00Yes (X)$0$0$0
RENIE GERWECK
DIRECTOR1.00Yes (X)$0$0$0
RYAN LARSEN
CEO40.00$161,256$0$38,285Yes (X)
SCOTT SAWYER
CFO40.00$142,653$0$24,040Yes (X)
BARBARA HOWARD
CHIEF CLINIC40.00$101,958$0$15,927Yes (X)
DAVID BORG
PHYSICIAN40.00$360,295$0$52,606Yes (X)
SANDRA CATLIN
APRN40.00$185,562$0$24,680Yes (X)
GAYLE KELLER
APRN40.00$116,460$0$26,290Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,068,184TotalReportableCompFromOrgAmt
Total Other Compensation$181,828TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K6IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1CityContractorAddress/USAddress/CityStateContractorAddress/USAddress/StateZIP CodeContractorAddress/USAddress/ZIPCodeServicesServicesDescCompensationCompensationAmt
PRTS-NACHTIGAL LLC
700 OREGON STREETHIAWATHAKS66434PT/OT SERVICES$659,122
SHADOW ANESTHESIA SERVICES
65675 711 ROADFALLS CITYNE68355ANESTHESIA SVCS$370,025
CARDINAL HEALTH
21337 NETWORK PLACECHICAGOIL60673PHARMACY SVCS$351,873
NHI OUTREACH CLINICAL SERVICES
7440 S 91ST STREETLINCOLNNE68501NM & ECHO SERV$179,272
NAVIN HAFFTY & ASSOCIATES LLC
1900 WEST PARK DRIVEWESTBOROUGHMA01581CONSULTING SERV$153,428
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt
Government Grants$290,043GovernmentGrantsAmt
All Other Contributions$79,297AllOtherContributionsAmt
Total Contributions$369,340TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE622110$23,331,279$23,331,279
MISCELLANEOUS HOPSITAL REV622110$124,513$124,513
CAFETERIA722310$74,752$74,752
LIFELINE900099$30,488$30,488
FieldValueIRS element (for citing)
Total Program Service Revenue$23,561,032TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$14,986TotalRevenueColumnAmt
Exclusion$14,986ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$2,040OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$2,040OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$2,040TotalRevenueColumnAmt
Related Or Exempt Func Income$2,040RelatedOrExemptFuncIncomeAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$23,947,398TotalRevenueColumnAmt
Related Or Exempt Func Income$23,563,072RelatedOrExemptFuncIncomeAmt
Exclusion$14,986ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$405,867TotalAmt
Program Services$101,958ProgramServicesAmt
Management And General$303,909ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,978,340TotalAmt
Program Services$5,912,676ProgramServicesAmt
Management And General$1,065,664ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$292,738TotalAmt
Program Services$226,100ProgramServicesAmt
Management And General$66,638ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$1,353,907TotalAmt
Program Services$1,117,142ProgramServicesAmt
Management And General$236,765ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$500,572TotalAmt
Program Services$406,646ProgramServicesAmt
Management And General$93,926ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$9,714TotalAmt
Management And General$9,714ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$26,810TotalAmt
Management And General$26,810ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$3,249,233TotalAmt
Program Services$2,980,964ProgramServicesAmt
Management And General$268,269ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$36,939TotalAmt
Program Services$7,407ProgramServicesAmt
Management And General$29,532ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$139,669TotalAmt
Program Services$56,672ProgramServicesAmt
Management And General$82,997ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$304,299TotalAmt
Program Services$302,991ProgramServicesAmt
Management And General$1,308ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$36,896TotalAmt
Program Services$20,269ProgramServicesAmt
Management And General$16,627ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$40,893TotalAmt
Program Services$24,572ProgramServicesAmt
Management And General$16,321ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$901,213TotalAmt
Program Services$767,794ProgramServicesAmt
Management And General$133,419ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$2,008,020TotalAmt
Program Services$1,710,744ProgramServicesAmt
Management And General$297,276ManagementAndGeneralAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$67,707TotalAmt
Program Services$2,609ProgramServicesAmt
Management And General$65,098ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
CENTRAL SUPPLY$2,049,739$2,049,739
PHARMACY$1,424,363$1,424,363
REPAIR AND MAINTENANCE$530,709$310,524$220,185
ADMIN OFFICE$290,473$4,778$285,695

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$1,240,841TotalAmt
Program Services$1,220,465ProgramServicesAmt
Management And General$20,376ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$21,888,942TotalAmt
Program Services$18,648,413ProgramServicesAmt
Management And General$3,240,529ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$6,381,512BOYAmt
EOY$12,416,827EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$3,601,651BOYAmt
EOY$4,185,858EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$12,809BOYAmt
EOY$500EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$4,623,371BOYAmt
EOY$3,234,046EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$4,688BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$57,816BOYAmt
EOY$107,721EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$242,702BOYAmt
EOY$275,454EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$27,816,426LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$9,685,594LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$19,845,235BOYAmt
EOY$18,130,832EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$5,983BOYAmt
EOY$135,799EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$408,063BOYAmt
EOY$382,966EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,361,795BOYAmt
EOY$510,000EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$36,545,625BOYAmt
EOY$39,380,003EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,394,348BOYAmt
EOY$1,658,932EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
EOY$369,445EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$17,083,068BOYAmt
EOY$16,765,855EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$2,143,227BOYAmt
EOY$2,603,527EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$20,620,643BOYAmt
EOY$21,397,759EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$15,924,982BOYAmt
EOY$17,982,244EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,924,982BOYAmt
EOY$17,982,244EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$36,545,625BOYAmt
EOY$39,380,003EOYAmt
FieldValueIRS element (for citing)
Reconcilation Revenue Expnss$2,058,456ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$1,194NetUnrlzdGainsLossesInvstAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Separate Basis Fincl StmtYes (X)SeparateBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

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 D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$2,528,700BeginningYearBalanceAmt
Contributions$579,415ContributionsAmt
Investment Earnings Or Losses$4,686InvestmentEarningsOrLossesAmt
End Year Balance$3,112,800EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,755,831BeginningYearBalanceAmt
Contributions$768,898ContributionsAmt
Investment Earnings Or Losses$3,982InvestmentEarningsOrLossesAmt
Administrative Expenses$11AdministrativeExpensesAmt
End Year Balance$2,528,700EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$993,457BeginningYearBalanceAmt
Contributions$837,845ContributionsAmt
Investment Earnings Or Losses$3,438InvestmentEarningsOrLossesAmt
Other Expenditures$78,887OtherExpendituresAmt
Administrative Expenses$22AdministrativeExpensesAmt
End Year Balance$1,755,831EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$979,328BeginningYearBalanceAmt
Contributions$791,569ContributionsAmt
Investment Earnings Or Losses$1,275InvestmentEarningsOrLossesAmt
Other Expenditures$778,715OtherExpendituresAmt
End Year Balance$993,457EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$561,962BeginningYearBalanceAmt
Contributions$11,553,894ContributionsAmt
Investment Earnings Or Losses$3,723InvestmentEarningsOrLossesAmt
Other Expenditures$11,140,251OtherExpendituresAmt
End Year Balance$979,328EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY1.00000BoardDesignatedBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,184,880OtherCostOrOtherBasisAmt
Book Value$1,184,880BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$17,345,085OtherCostOrOtherBasisAmt
Depreciation$4,522,342DepreciationAmt
Book Value$12,822,743BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,637,624OtherCostOrOtherBasisAmt
Depreciation$473,011DepreciationAmt
Book Value$1,164,613BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$7,437,013OtherCostOrOtherBasisAmt
Depreciation$4,690,241DepreciationAmt
Book Value$2,746,772BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$211,824OtherCostOrOtherBasisAmt
Book Value$211,824BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$18,130,832TotalBookValueLandBuildingsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
CONDITIONAL CONTRIBUTION$1,950,000
EST THIRD-PARTY PAYOR SETTLEMENTS$530,000
DEFERRED COMPENSATION$123,527
FieldValueIRS element (for citing)
Total Liability$2,603,527TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$23,946,204TotalRevEtcAuditedFinclStmtAmt
Net Unrealized Gains Invst-$1,194NetUnrealizedGainsInvstAmt
Revenue Not Reported-$1,194RevenueNotReportedAmt
Revenue Subtotal$23,947,398RevenueSubtotalAmt
Total Revenue Per Form990$23,947,398TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$21,888,942TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal$21,888,942ExpensesSubtotalAmt
Total Expenses Per Form990$21,888,942TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE D, PAGE 2, PART V, LINE 4THE FUNDS INCLUDE 6,235 DESIGNATED BY THE BOARD FOR CAPITAL IMPROVEMENTS, 211,244 DESIGNATED BY THE BOARD FOR DEFERRED COMPENSATION, 333,720 DESIGNATED BY A LONG-TERM DEBT COVENANT ON THE USDA LOAN, 599,713 DESIGNATED BY BANK SNB TO BE USED FOR EQUIPMENT AND 1,961,888 DESIGNATED AS A DEBT SINKING FUND.
SCHEDULE D, PAGE 3, PART XTHE MEDICAL CENTER IS EXEMPT FROM PAYMENT OF FEDERAL AND STATE INCOME TAXES UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE, BUT IS SUBJECT TO FEDERAL INCOME TAX ON ANY UNRELATED BUSINESS TAXABLE INCOME. THE MEDICAL CENTER FOLLOWS FINANCIAL ACCOUNTING STANDARDS BOARD APPLICABLE ACCOUNTING STANDARDS FOR UNCERTAINTIES IN INCOME TAXES AND REQUIRED DISCLOSURES THEREON. AS OF JULY 31, 2014 AND 2013, THERE IS NO RESERVE FOR UNCERTAIN TAX POSITIONS. THE MEDICAL CENTER HAS NOT RECOGNIZED ANY INTEREST OR PENALTIES IN RELATION TO INCOME TAX FILINGS AS OF OR FOR THE YEARS ENDED JULY 31, 2014 OR 2013. ADDITIONALLY, TAX YEARS ENDED JULY 31, 2012, 2013 AND 2014 ALL REMAIN OPEN AND ARE SUBJECT TO POTENTIAL EXAMINATION BY TAXING JURISDICTIONS.

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
Percent200Yes (X)Percent200Ind
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$394,342TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$394,342NetCommunityBenefitExpnsAmt
Total Expense0.01800TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$394,342TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$394,342NetCommunityBenefitExpnsAmt
Total Expense0.01800TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$9,945TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$9,945NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$12,000NetCommunityBenefitExpnsAmt
Total Expense0.00050TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$456,813TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$456,813NetCommunityBenefitExpnsAmt
Total Expense0.02090TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$478,758TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$478,758NetCommunityBenefitExpnsAmt
Total Expense0.02190TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$873,100TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$873,100NetCommunityBenefitExpnsAmt
Total Expense0.03990TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$12,500TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$12,500NetCommunityBenefitExpnsAmt
Total Expense0.00060TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$5,000TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$5,000NetCommunityBenefitExpnsAmt
Total Expense0.00020TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,375TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$2,375NetCommunityBenefitExpnsAmt
Total Expense0.00010TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$19,875TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$19,875NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$321,465BadDebtExpenseAmt
Bad Debt Expense Attributable$32,147BadDebtExpenseAttributableAmt
Reimbursed By Medicare$11,932,367ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,623,238CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall$309,129MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnfalseFinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEDICAL CENTERBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line13307 BARADA STREETAddressLine1
CityFALLS CITYCity
StateNEState
ZIP Code68355ZIPCode
FieldValueIRS element (for citing)
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 MEDICAL CENTERBusinessNameLine1
FieldValueIRS element (for citing)
Facility1FacilityNum
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
Information GapsYes (X)InformationGapsInd
OtherYes (X)OtherInd
CHNA Conducted13CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLHTTP://CMCFC.ORGOwnWebsiteURLTxt
Rpt Available Upon RequestYes (X)RptAvailableUponRequestInd
Adopt Implementation StrategyYes (X)AdoptImplementationStrategyInd
Exec Implementation StrategyYes (X)ExecImplementationStrategyInd
Develop Community Wide PlanYes (X)DevelopCommunityWidePlanInd
Exec Community Wide PlanYes (X)ExecCommunityWidePlanInd
Prioritize Health NeedsYes (X)PrioritizeHealthNeedsInd
All Needs AddressedYes (true)AllNeedsAddressedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Used Deter Elig Free CareYes (true)FPGUsedDeterEligFreeCareInd
FPG Family Incm Lmt Free Care200.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Used Determ Elig Dscnt CareYes (true)FPGUsedDetermEligDscntCareInd
FPG Family Incm Lmt Dscnt Care300.000000000000FPGFamilyIncmLmtDscntCarePct
Explained BasisYes (true)ExplainedBasisInd
Income LevelYes (X)IncomeLevelInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
Posted On WebsiteYes (X)PostedOnWebsiteInd
Available On RequestYes (X)AvailableOnRequestInd
Other PublicityYes (X)OtherPublicityInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Collection ActivitiesfalseCollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 3FOCUS GROUP MEETINGS WERE HELD AS PART OF THE MAPP (MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIPS) STRATGIC PLANNING PROCESS. REPRESENTATIVES FROM BOTH FALLS CITY AND HUMBOLDT INCLUDED THE THREE SCHOOL DISTRICTS, MINISTERIAL ASSOCIATION, HOME HEALTH CARE, LONG TERM CARE, LAW ENFORCEMENT, AMBULANCE SERVICES (FOR PROFIT AND VOLUNTEER), MEDICAL COMMUNITY, COUNTY GOVERNMENT, EMERGENCY MANAGEMENT, SCHOOL NURSING, THE HOSPITAL, AND THE HEALTH DEPARTMENT.
FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 14GAT ADMISSION OR AT LEAST PRIOR TO DISCHARGE REGISTRATION PERSONNEL REFER UNINSURED AND/OR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE POLICY.
FACILITY 1, COMMUNITY MEDICAL CENTER - PART V, LINE 20DTHE HOSPITAL FACILITY CHARGES PATIENTS WITHOUT INSURANCE THE SAME RATES AS PATIENTS WHO HAVE INSURANCE FOR THOSE SERVICES AT THE HOSPITAL FACILITY. PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE ARE GIVEN A MINIMUM OF 25% DISCOUNT ON SERVICES. THE 25% REDUCTION IS BETTER THAN THE AVERAGE OF ITS THREE LOWEST NEGOTIATED COMMERICAL INSURANCE RATES.
FieldValueIRS element (for citing)
Facility2FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)

Address Line1USAddress/AddressLine1CityUSAddress/CityStateUSAddress/StateZIP CodeUSAddress/ZIPCodeFacilityFacilityTxt
FAMILY MEDICINE
3307 BARADA STREETFALLS CITYNE68355RURAL HEALTH CLINIC
HUMBOLDT FAMILY MEDICINE
1120 GRAND AVENUEHUMBOLDTNE68376RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
PART I, LINE 7, COLUMN (F) - EXCLUSIONS FROM PERCENT OF TOTAL EXPENSENO BAD DEBT EXPENSE IS INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A) AS BAD DEBT EXPENSE OF 492,327 IS REPORTED WITH NET PATIENT SERVICE REVENUE ON FORM 990, PART VIII, LINE 2.A., CONSISTENT WITH FINANCIAL STATEMENTS.
PART I, LINE 7 - COSTING METHODOLOGY EXPLANATIONTHE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST TO CHARGE RATIO.
PART II - COMMUNITY BUILDING ACTIVITIESCOMMUNITY-BUILDING ACTIVITIES INCLUDE PROGRAMS THAT ADDRESS THE ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOMELESSNESS, AND ENVIRONMENTAL PROBLEMS. THE ORGANIZATION PROVIDED 5,000 TO FALLS CITY ECONMIC DEVELOPMENT AND GROWTH ENTERPRISE (EDGE) TO SUPPORT ECONOMIC DEVELOPMENT IN FALLS CITY AND RICHARDSON COUNTY. THE ORGANIZATION FUNDED 5,000 TO THE BALL FIELD PROJECT AND 2,500 TO THE MAIN STREET PROJECT IN SUPPORT OF TWO COMMUNITY IMPROVEMENT AND REVITALIZATION PROJECTS. THE ORGANIZATION ALSO CONTRIBUTED 5,000 TO SACRED HEART - PROJECT RENEW 125. THE ORGANIZATION ALSO CONTRIBUTED 2,375 TO VARIOUS HEALTH-ORIENTED ACTIVITIES AND SCHOOL PROJECTS DURING THE YEAR.
PART III, LINE 2 - BAD DEBT EXPENSE METHODOLOGYOVERALL COST TO CHARGE RATIO WAS USED TO DETERMINE AMOUNTS REPORTED ON SCHEDULE H, PART III, LINE 2. BAD DEBT EXPENSE REPORTED ON FORM 990, PART VIII, LINE 2A WAS 492,327.
PART III, LINE 3 BAD DEBT EXPENSE, PATIENTS ELIGIBLE FOR ASSISTANCEAFTER REVIEW OF BAD DEBTS WRITTEN OFF IT WAS DETERMINED APPROXIMATELY 10% OF BAD DEBT ACCOUNTS WRITTEN OFF WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE INDIVIDUALS WOULD HAVE COMPLETED THE APPLICATION PROCESS. RATIONALE FOR INCLUDED BAD DEBT AS A COMMUNITY BENEFIT - BY LAW, THE ORGANIZATION CANNOT REFUSE CERTAIN SERVICES TO PATIENTS, REGARDLESS OF THEIR ABILITY TO PAY, THUS BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT.
BAD DEBT EXPENSE FOOTNOTE TO FINANCIAL STATEMENTSACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH UNINSURED/SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. AS A RESULT, THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOR UNINSURED/SELF-PAY PATIENTS INCREASED FROM 556,000 AT JULY 31, 2013 TO 750,000 AT JULY 31, 2014 AS UNINSURED/SELF-PAY ACCOUNTS OVER 181 DAYS OUTSTANDING INCREASED OVER 56%.
PART III, LINE 8 - MEDICARE EXPLANATIONTHE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 6.
PART VI, LINE 2 - NEEDS ASSESSMENTTHE ORGANIZATION USES ITS CHNA TO ASSESS THE NEEDS OF THE COMMUNITY IT SERVICES.
PART VI, LINE 3 - PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCETHE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE ORGANIZATION'S HELPFUL OPTIONS FOR PATIENT EXPENSES (HOPE) PROGRAM OR FINANCIAL ASSISTANCE POLICY BY HAVING THE INFORMATION AVAILABLE ON THEIR WEBSITE, PROVIDING THE INFORMATION TO ALL WHO INQUIRE ABOUT OBTAINING FINANCIAL ASSISTANCE, AND BY REFERRING THOSE KNOWN TO BE UNINSURED AND/OR TO HAVE LOW INCOME TO FINANCIAL COUNSELORS WHO WILL DISCUSS THE POLICY.
PART VI, LINE 4 - COMMUNITY INFORMATIONRICHARDSON COUNTY, NEBRASKA IS PRIMARILY RURAL AND INCLUDES THE CITIES OF BARADA, DAWSON, FALLS CITY, HUMBOLDT, PRESTON, RULO, SALEM SHUBERT, STELLA, AND VERDON. IT IS LOCATED IN THE SOUTHEAST CORNER OF NEBRASKA. POPULATION ACCORDING TO THE 2010 CENSUS IS 8,363, DECLINING 12.3% FROM 2000. PERSONS 65 YEARS AND OLDER IS 23.2% WHILE PERSONS 18 AND YOUNGER IS 21.0%. ETHNIC BACKGROUDS BY PERCENT INCLUDE WHITE - 94.2%, AMERICAN INDIAN AND ALASKA NATIVE PERSONS - 3.3%, WITH ALL OTHERS REPORTING LESS THAN 2%. THERE ARE 3,782 HOUSEHOLDS WITH AN AVERAGE OF 2.15 PERSONS PER HOUSEHOLD. MEDIAN HOUSEHOLD INCOME IS 38,977 WITH 15.9% OF PERSONS BELOW THE POVERTY LEVEL. THERE ARE 551.84 TOTAL SQUARE MILES AND 15.2 PERSON PER SQUARE MILE.
PART VI, LINE 5 - PROMOTION OF COMMUNITY HEALTHTHE ORGANIZATION'S BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVALEDGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. IN ADDITION, THE ORGANIZATION CONTINUALLY APPLIES SURPLUS FUNDS TOWARD THE IMPROVEMENT OF PATIENT CARE, SUCH AS NEW FACILITIES AND THE PURCHASE OF NEW/UPDATED MEDICAL EQUIPMENT.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Club Dues Or FeesYes (X)ClubDuesOrFeesInd
Written Policy Ref T And E ExpnssYes (true)WrittenPolicyRefTAndEExpnssInd
Substantiation RequiredYes (true)SubstantiationRequiredInd
Written Employment ContractYes (X)WrittenEmploymentContractInd
Compensation SurveyYes (X)CompensationSurveyInd
Board Or Committee ApprovalYes (X)BoardOrCommitteeApprovalInd
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanfalseSupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgYes (true)CompBasedOnRevenueOfFlngOrgInd
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 (4 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtBonus Filing OrganizationBonusFilingOrganizationAmountDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmt
RYAN LARSEN
CEO$154,256$7,000$18,167$20,118$199,541
SCOTT SAWYER
CFO$102,153$40,500$14,141$9,899$166,693
DAVID BORG
PHYSICIAN$139,327$189,048$32,452$20,154$412,901$31,920
SANDRA CATLIN
APRN$58,035$124,509$9,327$15,353$210,242$3,018

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE J, PAGE 1, PART I, LINE 1ARYAN LARSEN, CEO - ACHE DUES 325
SCHEDULE J, PAGE 1, PART I, LINE 5APROVIDER PRODUCTIVITY BONUSES ARE CALCULATED BASED ON RURAL HEALTH CLINIC REVENUES.
SCHEDULE J, PART IIIPRODUCTIVITY BONUSES BASED ON REVENUES: DAVID BORG 189,048 SANDRA CATLIN 124,409

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (5 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PAGE 6, PART VI, LINE 11BTHE FORM 990 IS REVIEWED BY THE CFO AND IS PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN.
FORM 990, PAGE 6, PART VI, LINE 12CMANAGEMENT CONTINUALLY REVIEWS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ANNUAL DISCLOSURES AND RELATIONSHIPS WITH COMMUNITY MEDICAL CENTER TO IDENTIFY POSSIBLE CONFLICTS OF INTEREST. ONCE A CONFLICT OF INTEREST IS IDENTIFIED, THE CONFLICT WOULD BE DOCUMENTED AND MONITORED TO ENSURE APPROPRIATE ACTION IS TAKEN BASED ON THE SITUATION.
FORM 990, PAGE 6, PART VI, LINE 15ACOMPENSATION FOR THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS UTILIZE INDEPENDENT PARTIES OR STUDIES OCCASIONALLY.
FORM 990, PAGE 6, PART VI, LINE 19GOVERNING DOCUMENTS, CONFLICTS OF INTEREST STATEMENTS, AND FINANCIAL STATEMETNS ARE NOT MADE AVAILABLE TO THE PUBLIC WITHOUT APPROVAL BY THE BOARD OF DIRECTORS.
FORM 990, PART IX, LINE 11GPHYSICAL THERAPY CONTRACT SVC 475,380 0 0 CRNA CONTRACT SVC 399,817 0 0 PHARMACY PURCHASED SVC 306,756 0 0 INFORMATION SYSTEMS PURCHASED 0 49,453 0 ER DOCTORS CONTRACT SVC 61,295 0 0 INFORMATION SYSTEMS CONSULTIN 0 5,900 0 BLOOD PROC/STRNG/ADM PURCHASE 57,993 0 0 MRI PURCHASED SVC 118,000 0 0 OCCUPATIONAL THERAPY CONTRACT 171,033 0 0 ER CONTRACT LABOR 67,635 0 0 LABORATORY CONTRACT SERVICE 89,096 0 0 ECHOCARDIOGRAPHY PURCHASED SV 86,636 0 0 NUCLEAR MED PURCHASED SVC 66,494 0 0 VASCULAR STUDIES PURCHASED SV 70,581 0 0 PHARMACY RX CONTRACT SVC 70,499 0 0 QUALITY ASSURANCE PURCHASED S 33,657 0 0 LAUNDRY PURCHASED SVC 29,333 0 0 ADMINISTRATION PURCHASED SVC 0 42,631 0 SPEECH THERAPY PURCHASED SVC 36,457 0 0 SLEEP STUDY PURCHASED SVC 50,250 0 0 HUMBOLDT CLINIC PHYSICIAN CON 31,438 0 0 HLTH INFO MGMT PURCHASED SVC 0 25,349 0 HUMAN RESOURCES PURCHASED SVC 0 20,287 0 ALL OTHER 155,848 0 0 OPERATING ROOM PURCHASED SERV 25,218 0 0 PHYSICIAN CONTRACT SERVICES 535,548 37,838 0 PT ACCTG BILLING FEES 0 27,581 0 PT ACCTG PURCHASED SERV 0 32,842 0 MIS COMPUTER MAINTENANCE 0 26,388 0 NURSING ADMIN CONTRACT LABOR 42,000 0 0

Schedule R IRS990ScheduleR

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1FALLS CITY HOMEFRONT DEVELOPMENTBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line1111 E 17TH STREETAddressLine1
CityFALLS CITYCity
StateNEState
ZIP Code68355ZIPCode
FieldValueIRS element (for citing)
EIN463845964EIN
Primary ActivitiesDEVELOPERPrimaryActivitiesTxt
Legal Domicile StateNELegalDomicileStateCd
Direct Controlling NAN/ADirectControllingNACd
Predominant Income TypeUNRELATEDPredominantIncomeTypeTxt
Share Of Total Income-$1,194ShareOfTotalIncomeAmt
Share Of EOY Assets$196,306ShareOfEOYAssetsAmt
Disproportionate AllocationsfalseDisproportionateAllocationsInd
General Or Managing PartnerfalseGeneralOrManagingPartnerInd
Ownership0.50000OwnershipPct

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp

Related Organization Name RelatedOrganizationName

FieldValueIRS element (for citing)
Business Name Line1COMMUNITY MEDICAL CENTER FOUNDATIONBusinessNameLine1

US Address USAddress

FieldValueIRS element (for citing)
Address Line13307 BARADA STREETAddressLine1
CityFALLS CITYCity
StateNEState
ZIP Code68355ZIPCode
FieldValueIRS element (for citing)
EIN463491851EIN
Primary ActivitiesSUPPORTPrimaryActivitiesTxt
Legal Domicile StateNELegalDomicileStateCd

Direct Controlling Entity Name DirectControllingEntityName

FieldValueIRS element (for citing)
Business Name Line1CMCBusinessNameLine1
Business Name Line2COMMUNITY MEDICAL CENTER FOUNDATIONBusinessNameLine2
FieldValueIRS element (for citing)
Entity TypeC CORPEntityTypeTxt
Controlled OrganizationfalseControlledOrganizationInd
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
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 OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingfalsePaidEmployeesSharingInd
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE RFormAndLineReferenceDesc
ExplanationPART VI, RELATED ORGANIZATION (1) - COMMUNITY MEDICAL CENTER IS THE SOLE MEMBER OF COMMUNITY MEDICAL CENTER FOUNDATION, A NONPROFIT CORPORATION, THAT IS AWAITING APPROVAL OF TAX-EXEMPT STATUS FROM THE IRS.ExplanationTxt