COMMUNITY HEALTHCARE SYSTEM INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: COMMUNITY HEALTHCARE SYSTEM INC (EIN 48-1020227)
Tax period: 2011-04-01 to 2012-03-31
Filed: 2013-02-25
IRS object ID: 201300569349300505
Schema version: 2011v1.2
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 C
Schedule D
Schedule H
Schedule J
Schedule K
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-02-25T07:12:27-08:00	Timestamp
Tax Period End Date	2012-03-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GEORGE BOWERMAN & NOEL PA	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	301 N MAIN SUITE 1350	AddressLine1
City	WICHITA	City
State	KS	State
ZIP Code	67202	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-04-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	481020227	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HEALTHCARE SYSTEM INC	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	COMM	NameControl
Phone	7858894657	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	120 WEST 8TH STREET	AddressLine1
City	ONAGA	City
State	KS	State
ZIP Code	66521	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	MONICA HOLTHAUS	Name
Title	CFO	Title
Phone	7858894657	Phone
Date Signed	2013-02-11	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	ERIC MEYER	Name
Phone	3162626277	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	MONICA HOLTHAUS	NameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	120 WEST 8TH ST	AddressLine1
City	ONAGA	City
State	KS	State
ZIP Code	66521	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	26394770	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	N/A	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1986	YearFormation
State Legal Domicile	KS	StateLegalDomicile
Activity Or Mission Description	Community HealthCare System,in partnership with our medical staff, has a long standing tradition in providing quality and compassionate health care to rural commmunities of NE Kansas and all our patients. Ourmission is to enrich the health and lives of the people we serve.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	9	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	511	TotalNbrEmployees
Total Nbr Volunteers	0	TotalNbrVolunteers
Total Gross UBI	0	TotalGrossUBI
Contributions Grants Prior Year	65124	ContributionsGrantsPriorYear
Contributions Grants Current Year	58588	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	24803620	ProgramServiceRevenuePriorYear
Program Service Revenue CY	26144381	ProgramServiceRevenueCY
Investment Income Prior Year	24925	InvestmentIncomePriorYear
Investment Income Current Year	26118	InvestmentIncomeCurrentYear
Other Revenue Prior Year	175568	OtherRevenuePriorYear
Other Revenue Current Year	165683	OtherRevenueCurrentYear
Total Revenue Prior Year	25069237	TotalRevenuePriorYear
Total Revenue Current Year	26394770	TotalRevenueCurrentYear
Grants And Similar Amnts CY	0	GrantsAndSimilarAmntsCY
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	16495481	SalariesEtcPriorYear
Salaries Etc Current Year	17613372	SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	7549356	OtherExpensePriorYear
Other Expenses Current Year	7824574	OtherExpensesCurrentYear
Total Expenses Prior Year	24044837	TotalExpensesPriorYear
Total Expenses Current Year	25437946	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	1024400	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	956824	RevenuesLessExpensesCY
Total Assets BOY	9477269	TotalAssetsBOY
Total Assets EOY	10116983	TotalAssetsEOY
Total Liabilities BOY	5985906	TotalLiabilitiesBOY
Total Liabilities EOY	5668796	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	3491363	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	4448187	NetAssetsOrFundBalancesEOY
Mission Description	Community HealthCare System, in partnership with our medical staff, has a	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	19749665	Expense
Revenue	26144381	Revenue
Description	RURAL HOSPITAL PROVIDING MEDICAL CARE ON BOTH AN INPATIENT AND OUTPATIENT BASIS TO AREA RESIDENTS. SERVICES PROVIDED INCLUDE EMERGENCY, OBSTETRICS, SURGICAL, RADIOLOGY, REHABILITATION, RURAL HEALTH CLINIC AND LONG TERM CARE	Description
Total Program Service Expense	19749665	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	false	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	true	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	true	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	false	ReportFin48Footnote
Independent Audit Financial Stmt	true	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	false	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	false	GrantsToOrganizations
Grants To Individuals	false	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	true	TaxExemptBonds
Invest Tax Exempt Bonds	false	InvestTaxExemptBonds
Escrow Account	false	EscrowAccount
On Behalf Of Issuer	false	OnBehalfOfIssuer
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	false	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	false	RelatedOrgControlledEntity
Transaction Related Entity	false	TransactionRelatedEntity
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	540	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	511	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	false	UnrelatedBusinessIncome
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Form8899 Filed	true	Form8899Filed
Form1098 C Filed	true	Form1098CFiled
Excess Business Holdings	false	ExcessBusinessHoldings
Taxable Distributions	false	TaxableDistributions
Distribution To Donor	false	DistributionToDonor
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	9	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	true	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	false	MembersOrStockholders
Election Of Board Members	false	ElectionOfBoardMembers
Decisions Subject To Approval	false	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	true	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	false	InvestmentInJointVenture
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	MONICA HOLTHAUS	NamePerson
Telephone Number	7858894657	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	120 W 8TH STREET	AddressLine1
City	ONAGA	City
State	KS	State
ZIP Code	66521	ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (18 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	OfficerOfficer	Highest Compensated EmployeeHighestCompensatedEmployee
JUSTIN BOSWELL
CHAIRMAN	2.00	X	2369	0	0
VIRGINIA REZAC
VICE CHAIRMAN	2.00	X	1837	0	0
ALAN FISCHER
SECRETARY	2.00	X	1874	0	0
MELVIN HANDLEY
DIRECTOR	2.00	X	1369	0	0
OWEN DUER
DIRECTOR	2.00	X	463	0	0
PHIL SPRINGER
DIRECTOR	2.00	X	1194	0	0
MARK BOUTON
DIRECTOR	2.00	X	2001	0	0
KAREN HARDER
DIRECTOR	2.00	X	1630	0	0
ROBERT LADNER
DIRECTOR	2.00	X	94	0	0
GREG UNRUH
CEO	40.00		180235	0	20447	X
MARCIA WALSH
COO	40.00		146768	0	12127	X
MONICA HOLTHAUS
CFO	40.00		96820	0	1321	X
ROSALIND LEWIS
CNO	40.00		107494	0	1464	X
DR DAVID
ALLEN	40.00		378206	0	10475		X
DR THOMAS WALSH
PHYSICIAN	40		308678		7577		X
DR DAGOBERTO HEREDIA
PHYSICIAN	40		288495		2028		X
DR NANCY ZIDEK
PHYSICIAN	40		222336		5084		X
DR MELISSA GOULART
PHYSICIAN	40		221505		6616		X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	1963368	TotalReportableCompFromOrg
Total Other Compensation	67139	TotalOtherCompensation
Number Individuals GT100 K	8	NumberIndividualsGT100K
Formers Listed	false	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
ANESTHESIA PROFESSIONALS
2017 W HARBORLIGHT C	WICHITA	KS	67204	ANESTHESIA SERVICES	384000
STORMONT-VAIL HLTH CARE
1500 SW 10TH STREET	TOPEKA	KS	66604	MEDICAL SERVICES	230605
BENEFIT MANAGEMENT INC
2015 16TH STREET	GREAT BEND	KS	67530	THIRD PARTY ADMINISTRATOR FOR HEALTH INSURANCE	164433
HEALTHLAND
625 S LAKESHORE DR	GLEENWOOD	MN	56334	COMPUTER SYSTEM MAINTENANCE	213567
SHARED MEDICAL SERVICES INC
209 LIMESTONE PASS	COTTAGE GROVE	WI	53527	MRI SERVICES	126800

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	8	NumberOfContractorsGT100K
Government Grants	27161	GovernmentGrants
All Other Contributions	31427	AllOtherContributions
Total Contributions	58588	TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn
NET PATIENT SERVICE REVENUE	622110	25123538
TAX SUBSIDY	622110	1020843

Field	Value	IRS element (for citing)
Total Program Service Revenue	26144381	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	26118	TotalRevenueColumn
Exclusion	$26,118	ExclusionAmount

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	17927	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	17927	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	17927	TotalRevenueColumn
Exclusion	$17,927	ExclusionAmount

Other Revenue Misc OtherRevenueMisc

Field	Value	IRS element (for citing)
Description	Other	Description
Business Code	900099	BusinessCode
Total Revenue Column	147756	TotalRevenueColumn
Exclusion	$147,756	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	147756	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	26394770	TotalRevenueColumn
Related Or Exempt Function Income	26144381	RelatedOrExemptFunctionIncome
Exclusion	$191,801	ExclusionAmount

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	544148	Total
Program Services	413061	ProgramServices
Management And General	131087	ManagementAndGeneral
Fundraising	0	Fundraising

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	14696925	Total
Program Services	11687027	ProgramServices
Management And General	3009898	ManagementAndGeneral
Fundraising	0	Fundraising

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	93974	Total
Program Services	69030	ProgramServices
Management And General	24944	ManagementAndGeneral
Fundraising	0	Fundraising

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	1227019	Total
Program Services	873954	ProgramServices
Management And General	353065	ManagementAndGeneral
Fundraising	0	Fundraising

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	1051306	Total
Program Services	832074	ProgramServices
Management And General	219232	ManagementAndGeneral
Fundraising	0	Fundraising

Advertising Advertising

Field	Value	IRS element (for citing)
Total	100794	Total
Program Services	85946	ProgramServices
Management And General	14848	ManagementAndGeneral
Fundraising	0	Fundraising

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	114034	Total
Program Services	74766	ProgramServices
Management And General	39268	ManagementAndGeneral
Fundraising	0	Fundraising

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	1177274	Total
Program Services	746763	ProgramServices
Management And General	430511	ManagementAndGeneral
Fundraising	0	Fundraising

Travel Travel

Field	Value	IRS element (for citing)
Total	133970	Total
Program Services	98836	ProgramServices
Management And General	35134	ManagementAndGeneral
Fundraising	0	Fundraising

Interest Interest

Field	Value	IRS element (for citing)
Total	169586	Total
Program Services	169586	ProgramServices
Management And General	0	ManagementAndGeneral
Fundraising	0	Fundraising

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	658997	Total
Program Services	487657	ProgramServices
Management And General	171340	ManagementAndGeneral
Fundraising	0	Fundraising

Insurance Insurance

Field	Value	IRS element (for citing)
Total	253972	Total
Program Services	146066	ProgramServices
Management And General	107906	ManagementAndGeneral
Fundraising	0	Fundraising

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
LEASED EQUIPMENT	128403	107809	20594
MISCELLANEOUS	134973	25052	109921
DUES AND SUBSCRIPTIONS	151246	72616	78630
EDUCATION	86641	59550	27091

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4714684	Total
Program Services	3799872	ProgramServices
Management And General	914812	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	25437946	Total
Program Services	19749665	ProgramServices
Management And General	5688281	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	1093221	BOY
EOY	1739334	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	2858730	BOY
EOY	3004715	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	802088	BOY
EOY	880269	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	190833	BOY
EOY	194423	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	12483291	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	8741794	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	3596495	BOY
EOY	3741497	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	245348	BOY
EOY	182184	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	108965	BOY
EOY	74555	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	581589	BOY
EOY	300006	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	9477269	BOY
EOY	10116983	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	2799722	BOY
EOY	2782348	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	2365000	BOY
EOY	2105000	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	727542	BOY
EOY	687806	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	93642	BOY
EOY	93642	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	5985906	BOY
EOY	5668796	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	3300099	BOY
EOY	4317661	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	191264	BOY
EOY	130526	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	3491363	BOY
EOY	4448187	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	9477269	BOY
EOY	10116983	EOY

Field	Value	IRS element (for citing)
Reconcilation Revenue Expenses	956824	ReconcilationRevenueExpenses
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	false	AuditCommittee
Financial Statement Separate	X	FinancialStatementSeparate
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii
Public Support Total170	0	PublicSupportTotal170

Gross Investment Income170 GrossInvestmentIncome170

Field	Value	IRS element (for citing)
Total	0	Total

Field	Value	IRS element (for citing)
Public Support Pertcentage170	0	PublicSupportPertcentage170
Public Support Total509	0	PublicSupportTotal509
Public Support Percentage509	0	PublicSupportPercentage509
Investment Income Percentage	0	InvestmentIncomePercentage

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$4,711	OtherActivitiesAmount
Total Lobbying Expenditures IIB	4711	TotalLobbyingExpendituresIIB

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Pt II-B Line 1i	Identifier
Explanation	LOBBYING PORTION OF KANSAS HOSPITAL ASSOCIATION DUES	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	370866	OtherCostOrOtherBasis
Book Value	370866	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	6009629	OtherCostOrOtherBasis
Depreciation	3803906	Depreciation
Book Value	2205723	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	6051392	OtherCostOrOtherBasis
Depreciation	4937888	Depreciation
Book Value	1113504	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	51404	OtherCostOrOtherBasis
Book Value	51404	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	3741497	TotalOfBookValueLandBuildings

Other Securities OtherSecurities (2 entries)

DescriptionDescription	Book ValueBookValue	Method Of ValuationMethodOfValuation
FUNDS HELD BY TRUSTEE UNDER INDENTURE AGREEMENT	142143	F
ASSETS WHOSE USE IS LIMITED-CD	40041	C

Field	Value	IRS element (for citing)
Total Of Book Value Securities	182184	TotalOfBookValueSecurities

Other Assets OtherAssets (3 entries)

DescriptionDescription	Book ValueBookValue
DUE FROM THIRD PARTY PAYER	159572
DEFERRED FINANCING COSTS	97755
OTHER	42679

Field	Value	IRS element (for citing)
Total Book Value Other Assets	300006	TotalBookValueOtherAssets

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
Description	DUE TO COMMUNITY HOSPITAL DISTRICT	Description
Amount	$93,642	Amount

Field	Value	IRS element (for citing)
Total Of Amounts	93642	TotalOfAmounts
Total Revenue	26394770	TotalRevenue
Total Expenses	25437946	TotalExpenses
Excess Or Deficit For Year	956824	ExcessOrDeficitForYear
Excess Or Deficit Per FS	956824	ExcessOrDeficitPerFS
Tot Revenue Etc Audited Fincl Stmt	26394770	TotRevenueEtcAuditedFinclStmt
Revenue Subtotal	26394770	RevenueSubtotal
Total Revenue Per Form990	26394770	TotalRevenuePerForm990
Tot Expenses Etc Audited Fincl Stmt	25437946	TotExpensesEtcAuditedFinclStmt
Expenses Subtotal	25437946	ExpensesSubtotal
Total Expenses Per Form990	25437946	TotalExpensesPerForm990

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent200 D	X	Pcent200D
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	false	ExpensesExceededBudget
Annual Community Benefit Report	false	AnnualCommunityBenefitReport

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Total Community Benefit Expense	156118	TotalCommunityBenefitExpense
Net Community Benefit Expense	156118	NetCommunityBenefitExpense
Percent Of Total Expense	0.00610	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1341924	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1014531	DirectOffsettingRevenue
Net Community Benefit Expense	327393	NetCommunityBenefitExpense
Percent Of Total Expense	0.01290	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Total Community Benefit Expense	1498042	TotalCommunityBenefitExpense
Direct Offsetting Revenue	1014531	DirectOffsettingRevenue
Net Community Benefit Expense	483511	NetCommunityBenefitExpense
Percent Of Total Expense	0.01900	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	330646	TotalCommunityBenefitExpense
Direct Offsetting Revenue	185880	DirectOffsettingRevenue
Net Community Benefit Expense	144766	NetCommunityBenefitExpense
Percent Of Total Expense	0.00570	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10160081	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8595050	DirectOffsettingRevenue
Net Community Benefit Expense	1565031	NetCommunityBenefitExpense
Percent Of Total Expense	0.06150	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	10490727	TotalCommunityBenefitExpense
Direct Offsetting Revenue	8780930	DirectOffsettingRevenue
Net Community Benefit Expense	1709797	NetCommunityBenefitExpense
Percent Of Total Expense	0.06720	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Total Community Benefit Expense	11988769	TotalCommunityBenefitExpense
Direct Offsetting Revenue	9795461	DirectOffsettingRevenue
Net Community Benefit Expense	2193308	NetCommunityBenefitExpense
Percent Of Total Expense	0.08620	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense	$535,659	BadDebtExpenseAmount
Amount Attributable To	40144	AmountAttributableTo
Amount Reimbursed By Medicare	4879443	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	4880319	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-876	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare
Number Of Hospital Facilities	1	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

Field	Value	IRS element (for citing)
Facility Number	1	FacilityNumber

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL ONAGA	BusinessNameLine1

Address Address

Field	Value	IRS element (for citing)
Address Line1	120 WEST 8TH	AddressLine1
City	ONAGA	City
State	KS	State
ZIP Code	66521	ZIPCode

Field	Value	IRS element (for citing)
Critical Access Hospital	X	CriticalAccessHospital

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL ONAGA	BusinessNameLine1

Field	Value	IRS element (for citing)
Hospital Facility Number	1	HospitalFacilityNumber
CHNA Conducted	false	CHNAConducted
Eligibility Criteria Explained	true	EligibilityCriteriaExplained
Uses FPG Free	true	UsesFPGFree
FPG Free Percent	200	FPGFreePercent
Uses FPG Discounted	true	UsesFPGDiscounted
FPG Discount Percent	200	FPGDiscountPercent
Explains Basis	true	ExplainsBasis
Income Level	X	IncomeLevel
Asset Level	X	AssetLevel
Medical Indigency	X	MedicalIndigency
Uninsured Discount	X	UninsuredDiscount
Explains Application Method	true	ExplainsApplicationMethod
Includes Publicity Measures	true	IncludesPublicityMeasures
Available On Request	X	AvailableOnRequest
Actions On Nonpayment	true	ActionsOnNonpayment
Permit Other Actions	X	PermitOtherActions
Collection Activities	false	CollectionActivities
Notify Upon Admission	X	NotifyUponAdmission
Notify Before Discharge	X	NotifyBeforeDischarge
Notified All Patients	X	NotifiedAllPatients
Documented Determination	X	DocumentedDetermination
Nondiscrim Emergency Care Policy	true	NondiscrimEmergencyCarePolicy
Used Other Method	X	UsedOtherMethod
Amounts Generally Billed	false	AmountsGenerallyBilled
Gross Charges	false	GrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	4	NumberOfOtherFacilities

Other Facilities OtherFacilities (4 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
EASTRIDGE NURSING FACILITY
600 1ST STREET	CENTRALIA	KS	66415	LONG TERM CARE
DOWNTOWN MEDICAL CLINIC
112 EAST 2ND STREET	FRANKFORT	KS	66427	RURAL HEALTH CLINIC
HOLTON FAMILY HEALTH CLINIC
1603 WEST 4TH STREET	HOLTON	KS	66536	RURAL HEALTH CLINIC
WETMORELAND MEDICAL CLINIC
208 NORTH 1ST STREET	WESTMORELAND	KS	66549	CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (90 entries)

IdentifierIdentifier	ExplanationExplanation
Pt I Line 7	The total cost to charge ratio derived from the
	Medicare cost report was applied to gross charges to compute
	the community benefit expense for charity care and
	unreimbursed Medicaid. The community benefit expense
Pt VI Line 3	for community health improvement services and
	subsidized health services was obtained from the total
	costs per Worksheet B on the Medicare cost report
	with adjustments made to exclude amounts otherwise
	included as charity care, bad debts or unreimbursed
	Medicaid.
Pt I Line 7g	Subsidized heath services include the cost attributable
	to physician clinics operated in rural communities
	and designated as Rural Health Clinics - $1,286,866
Pt III Line 4	The total cost to charge ratio derived from the
	Medicare cost report was applied to the gross charges
	written off (net of collections) to compute the
	community benefit expense for bad debts. The cost of
	providing services to those with the inability to pay
	or where collection efforts are not successful are
	included as community benefit expense to represent
	the full costs of providing services to the community.
	Financial statement footnote-If the patient is
	unable to pay the full amount at the time the patient is billed,
	the System negotiates a payment plan whereby monthly
	payments are made by the patient on the account. Accounts
	are considered delinquent and subsequently written off as bad debts
	based on individual credit evaluation and specific circumstances
	of the account. If future actual default rates on accounts receivable
	differ from those currently anticipated, the System may have to adjust its
	allowance for doubtful accounts, which would affect earnings
	in the period the adjustments are made.
Pt III Line 8	Medicare allowable cost per the Medicare cost report.
	Costs are apportioned to the Medicare program based on
	departmental cost to charge ratios for ancillary services
	and patient days for inpatient and swing bed services.
Pt III Line 9b	If collection efforts determine that a patient may
	qualify for finacial assistance, the financial assistance
	process is initiated including attempts to obtain the
	documentation required under the policy. Collection
	and financial assistance policies are consistently applied to all
	patients. Indigent patients balances adjusted according to Medicare bad debt policies
Pt V	One skilled nursing facility
Pt VI Line 2	Informal needs assessment performed on an ongoing basis.
	Hospital personnel identify needs based on admissions
	and discharge data. Needs are also identified by
	requests from surrounding rural communities. Formal
	needs assessment is in process.
Pt VI Line 3	The availability of financial assistance is stated in
	collection letters sent to patients. Collections staff
	also inform uninsured patients of financial assistance
	available and policies are addressed verbally at admission with
	clinic patients.
Pt VI Line 5	All of the organization's governing body is comprised
	of individuals who reside in the organizaton's primary
	service area.
	Community HealthCare System, Inc. (the System) is a
	non-profit organization created by the Board of
	Directors of, and is considered a component unit of
	Community Hospital District No. 1 of
	Pottawatomie, Jackson and Nemaha Counties, Kansas
	to operate, control, and manage all matters concerning
	healthcare services in its service area pursuant to a lease agreement
	between the Hospital District and the System.
	The Hospital District Board appoints the members of the Board of Directors
	of the System. The Hospital District board is elected.
	The System's responsiveness to the community is demonstrated
	by the operation of Rural Health/Physician clinics in
	surrounding rural communities to provide access to care
	at the request from the surrounding communities or as a
	result of identified needs. The system participates
	in all government sponsored health care programs (Medicare,
	Medicaid, CHAMPUS, Tricare)and serves all persons
	regardless of ability to pay. The System operates
	LifeCare fitness centers in an effort to enhance
	community health thereby reducing total health care
	cost. The System extends medical staff privileges to
	qualified physicians in the community.
Pt VI Line 4	Critical Access Hospital serving primarly as sole provider
	to rural areas in Pottawatomie, Jackson and Nemaha Counties.
Pt V Sec B 19d	The Hospital assists those patients who are uninsured
	or have non-covered services by providing a 20% discount
	for hospital, emergency room, anesthesia, clinic home
	health and for medically needed DME. Further discounts
	are also available under the Hospital's financial
	assistance policy.
Pt V Sec B 15e	If the patient is able to pay a portion of their bill as
	determined by the financial assistance policy, a payment
	arrangement is made with the patient. Normal collection
	procedures (statements & letters) followed for remaining
	patient balance, if any.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Severance Payment	false	SeverancePayment
Supplemental Nonqual Retire Plan	false	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	true	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Deferred Comp Filing OrgDeferredCompFilingOrg	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Total Compensation Filing OrgTotalCompensationFilingOrg	Bonus Filing OrgBonusFilingOrg
GREG UNRUH
180235	15280	5167	200682
MARCIA WALSH
146768	7200	4927	158895
DR DAVID
55200	3782	6693	388681	323006
DR THOMAS WALSH
59168	2504	5073	316255	249510
DR DAGOBERTO HEREDIA
288495	1443	585	290523
DR NANCY ZIDEK
19548		5084	227420	202788
DR MELISSA GOULART
221505		6616	228121

Form990 Schedule J Part III Form990ScheduleJPartIII

Field	Value	IRS element (for citing)
Identifier	Pt I Line 5a	Identifier
Explanation	PHYSICIAN COMPENSATION BASED, IN PART, ON PATIENT CLINIC CHARGES	Explanation

Schedule K IRS990ScheduleK

Form990 Schedule K Part I Form990ScheduleKPartI (2 entries)

Issuer EINIssuerEIN	CUSIP NumberCUSIPNumber	Date IssuedDateIssued	Issue PriceIssuePrice	Description Of PurposeDescriptionOfPurpose	DefeasedDefeased	On Behalf Of IssuerOnBehalfOfIssuer	Pool FinancingPoolFinancing
CITY OF HOLTON KANSAS
486030368	436578BE7	2003-03-31	1325000	HEALTHCARE FACILITIES	false	false	false
CITY OF ST MARYS
486024500	792607AK9	2003-07-15	2000000	HEALTHCARE FACILITIES	false	false	false

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifier	ExplanationExplanation
Pt VI, Line 11a	Reviewed by the Chairman of the Board prior to filing
	and available to other Board members upon request.
Pt VI, Line 12c	Required to disclose conflict of interest upon hire/appointment
	to board and also update and report changes thereafter
Pt VI, Line 15	CEO compensation is reviewed annually by the board of
	directors: officer and key employee compensation is
	reviewed by CEO utilizing information obtained from
	sources such as the Kansas Hospital Association,
	Bureau of Labor and Kansas Department of Labor
Pt VI, Line 2	Dr. Tom Walsh/Marcia Walsh, COO - Spouse
Pt VI, Line 19	Reference documents not available to the public
Form 990, Part IX, Line 24f	CONTRACT LABOR 1352811. 1238707. 114104. 0. PROFESSIONAL FEES 222466. 0. 222466. 0. SUPPLIES 2366759. 2136670. 230089. 0. REPAIR AND MAINTENANCE 628091. 318749. 309342. 0. MINOR EQUIPMENT 144557. 105746. 38811. 0.

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL DISTRICT NO 1 OF POTTAWATOMIE JACKSON AND NEMAHA COUNTIE	BusinessNameLine1

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	120 WEST 8TH STREET	AddressLine1
City	ONAGA	City
State	KS	State
ZIP Code	66521	ZIPCode

Field	Value	IRS element (for citing)
EIN	486089515	EIN
Primary Activities	HOSPITAL DISTIRCT	PrimaryActivities
Legal Domicile State	KS	LegalDomicileState

Direct Controlling Entity Name DirectControllingEntityName

Field	Value	IRS element (for citing)
Business Name Line1	NA	BusinessNameLine1

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	false	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	false	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	false	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	false	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	true	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	false	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

Field	Value	IRS element (for citing)
Business Name Line1	COMMUNITY HOSPITAL DISTRICT NO 1 OF POTTAWATOMIE JACKSON AND NEMAHA COUNTIE	BusinessNameLine1

Field	Value	IRS element (for citing)
Transaction Type	j	TransactionType
Amount Involved	585400	AmountInvolved
Method Of Amt Determination	ACTUAL	MethodOfAmtDetermination