COMMUNITY HOSPITAL ASSOCIATION: Form 990, tax year 2011
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HOSPITAL ASSOCIATION (EIN 44-0537826)
- Tax period
- 2011-07-01 to 2012-06-30
- Filed
- 2013-03-28
- IRS object ID
- 201340879349300419
- Schema version
- 2011v1.5
- 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 G
- Schedule H
- Schedule I
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-03-28T14:21:53-05:00 | Timestamp |
| Tax Period End Date | 2012-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2011-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 440537826 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Community Hospital Association Inc | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % SUZANNE SOUTHARD | InCareOfName |
| Name Control | COMM | NameControl |
| Phone | 6606862211 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO Box 107 | AddressLine1 |
| City | Fairfax | City |
| State | MO | State |
| ZIP Code | 644460107 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MYRA EVANS | Name |
| Title | CEO | Title |
| Date Signed | 2013-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2011 | TaxYear |
| Build TS | 2016-02-25 16:41:14Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | MYRA EVANS | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 12165256 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.FAIRFAXMED.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1976 | YearFormation |
| State Legal Domicile | MO | StateLegalDomicile |
| Activity Or Mission Description | TO PROVIDE QUALITY ACUTE CARE, EMERGENCY, AND OUTPATIENT HOSPITAL SERVICES. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 15 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 13 | NbrIndependentVotingMembers |
| Total Nbr Employees | 104 | TotalNbrEmployees |
| Total Nbr Volunteers | 90 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 1081477 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 607905 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 10395665 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 11227439 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 23547 | InvestmentIncomePriorYear |
| Investment Income Current Year | 5735 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 96916 | OtherRevenuePriorYear |
| Other Revenue Current Year | 295827 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 11597605 | TotalRevenuePriorYear |
| Total Revenue Current Year | 12136906 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 819009 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 52981 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 4615909 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 5110727 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 109177 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 6645621 | OtherExpensePriorYear |
| Other Expenses Current Year | 7559846 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 12080539 | TotalExpensesPriorYear |
| Total Expenses Current Year | 12723554 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -482934 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -586648 | RevenuesLessExpensesCY |
| Total Assets BOY | 20517337 | TotalAssetsBOY |
| Total Assets EOY | 19529044 | TotalAssetsEOY |
| Total Liabilities BOY | 13439241 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 13037596 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 7078096 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 6491448 | NetAssetsOrFundBalancesEOY |
| Info In Schedule O Part III | X | InfoInScheduleOPartIII |
| Mission Description | TO BE THE HEALTHCARE PROVIDER OF CHOICE FOR THE COMMUNITIES WE SERVE. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 10022668 | Expense |
| Grants | 5775 | Grants |
| Revenue | 11227439 | Revenue |
| Description | SEE SCHEDULE O | Description |
| Total Program Service Expense | 10022668 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | 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 | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | 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 | true | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | true | Hospital |
| Financial Stmt Attached | true | FinancialStmtAttached |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | true | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| 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 | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 8 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 104 | 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 | true | QuidProQuoContributions |
| Quid Pro Quo Disclosure | true | QuidProQuoDisclosure |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 15 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 13 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | true | 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 |
| States Where Copy Of Return Is Filed | MO | StatesWhereCopyOfReturnIsFiled |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | SUZANNE SOUTHARD | NamePerson |
| Telephone Number | 6606862211 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | X | InfoInScheduleOPartVII |
Form990 Part VII Section A Form990PartVIISectionA (20 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Highest Compensated EmployeeHighestCompensatedEmployee |
|---|---|---|---|---|---|---|---|
| ROBERT JACKSON | |||||||
| DIRECTOR/VICE PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | |
| NANCY HURST | |||||||
| DIRECTOR/PRESIDENT | 1.0 | X | X | 0 | 0 | 0 | |
| SANDRA FUHRMAN | |||||||
| DIRECTOR/SECRETARY/TREASURER | 1.0 | X | X | 0 | 0 | 0 | |
| RICHARD OSWALD | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BILL SMITH | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| JACQUE GEBHARDS | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| STEVE CUNNINGHAM | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| JASON GARST | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| CHAD DERR | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| BEVERLY WHITE | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| PATRICIA FISHER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| EDUARDO FERNANDEZ MD | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| DEBBIE GLEASON | |||||||
| DIRECTOR | 1.0 | X | 0 | 105947 | 17669 | ||
| KRISTI ATKINSON | |||||||
| DIRECTOR | 1.0 | X | 0 | 86434 | 13343 | ||
| PAULA MILLER | |||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | ||
| WC BUD TICE | |||||||
| DIRECTOR | 1.0 | X | 0 | 143172 | 10396 | ||
| STEPHANIE DAUBERT | |||||||
| DIRECTOR | 1.0 | X | 0 | 179536 | 17143 | ||
| MYRA EVANS | |||||||
| CEO | 40.0 | X | 174244 | 0 | 23145 | ||
| SUZANNE SOUTHARD | |||||||
| CFO | 40.0 | X | 54131 | 0 | 11961 | ||
| GARY MCINTYRE | |||||||
| CRNA | 40.0 | 138704 | 0 | 2081 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 367079 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 515089 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 95738 | TotalOtherCompensation |
| Number Individuals GT100 K | 2 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (5 entries)
| Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|
| DOCS WHO CARE | |
| PHYSICIAN SERVICES | 303137 |
| CPSI | |
| COMPTR SUPPORT SVCS | 288860 |
| FOCUSONE SOLUTIONS LLC | |
| TEMPORARY STAFFING | 282033 |
| MORGAN ANESTHESIA SERVICES | |
| CRNA SERVICES | 149989 |
| SODEXHO INC AFFILIATES | |
| ENVIRONMENT SERVICES | 126037 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 7 | NumberOfContractorsGT100K |
| Fundraising Events | 162860 | FundraisingEvents |
| Related Organizations | 381784 | RelatedOrganizations |
| All Other Contributions | 63261 | AllOtherContributions |
| Total Contributions | 607905 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | NET PATIENT SERVICE REVENUE | Description |
| Business Code | 621990 | BusinessCode |
| Total Revenue Column | 11227439 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11227439 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 11227439 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 4735 | TotalRevenueColumn |
| Exclusion | $4,735 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1000 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 1000 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 1000 | TotalRevenueColumn |
| Exclusion | $1,000 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Income Fundraising Events | 57718 | GrossIncomeFundraisingEvents |
| Cntrbtns Rprtd Fundraising Events | 162860 | CntrbtnsRprtdFundraisingEvents |
| Fundraising Direct Expenses | 28350 | FundraisingDirectExpenses |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 29368 | TotalRevenueColumn |
| Exclusion | $29,368 | ExclusionAmount |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Other Revenue Misc OtherRevenueMisc (3 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | ExclusionExclusionAmount |
|---|---|---|---|
| EHR INCENTIVE REVENUE | 900099 | 201250 | $201,250 |
| CAFETERIA | 621990 | 54380 | $54,380 |
| All Other Misc Revenue | 900099 | 10829 | $10,829 |
Miscellaneous Revenue MiscellaneousRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 10829 | TotalRevenueColumn |
| Exclusion | $10,829 | ExclusionAmount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 266459 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 12136906 | TotalRevenueColumn |
| Related Or Exempt Function Income | 11227439 | RelatedOrExemptFunctionIncome |
| Unrelated Business Revenue | 0 | UnrelatedBusinessRevenue |
| Exclusion | $301,562 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 52981 | Total |
| Program Services | 52981 | ProgramServices |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 259773 | Total |
| Management And General | 259773 | ManagementAndGeneral |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3904574 | Total |
| Program Services | 3005620 | ProgramServices |
| Management And General | 858749 | ManagementAndGeneral |
| Fundraising | 40205 | Fundraising |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 99937 | Total |
| Program Services | 76928 | ProgramServices |
| Management And General | 21980 | ManagementAndGeneral |
| Fundraising | 1029 | Fundraising |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 533501 | Total |
| Program Services | 412385 | ProgramServices |
| Management And General | 115699 | ManagementAndGeneral |
| Fundraising | 5417 | Fundraising |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 312942 | Total |
| Program Services | 240893 | ProgramServices |
| Management And General | 68827 | ManagementAndGeneral |
| Fundraising | 3222 | Fundraising |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 225698 | Total |
| Program Services | 173735 | ProgramServices |
| Management And General | 49639 | ManagementAndGeneral |
| Fundraising | 2324 | Fundraising |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13262 | Total |
| Program Services | 10208 | ProgramServices |
| Management And General | 2917 | ManagementAndGeneral |
| Fundraising | 137 | Fundraising |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 65943 | Total |
| Program Services | 50761 | ProgramServices |
| Management And General | 14503 | ManagementAndGeneral |
| Fundraising | 679 | Fundraising |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1706867 | Total |
| Program Services | 1313894 | ProgramServices |
| Management And General | 375398 | ManagementAndGeneral |
| Fundraising | 17575 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 41035 | Total |
| Program Services | 31587 | ProgramServices |
| Management And General | 9025 | ManagementAndGeneral |
| Fundraising | 423 | Fundraising |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 388959 | Total |
| Program Services | 299409 | ProgramServices |
| Management And General | 85545 | ManagementAndGeneral |
| Fundraising | 4005 | Fundraising |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 230301 | Total |
| Program Services | 177279 | ProgramServices |
| Management And General | 50651 | ManagementAndGeneral |
| Fundraising | 2371 | Fundraising |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 49061 | Total |
| Program Services | 37766 | ProgramServices |
| Management And General | 10790 | ManagementAndGeneral |
| Fundraising | 505 | Fundraising |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 620204 | Total |
| Program Services | 477414 | ProgramServices |
| Management And General | 136404 | ManagementAndGeneral |
| Fundraising | 6386 | Fundraising |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1669891 | Total |
| Program Services | 1285430 | ProgramServices |
| Management And General | 367266 | ManagementAndGeneral |
| Fundraising | 17195 | Fundraising |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 93559 | Total |
| Program Services | 72019 | ProgramServices |
| Management And General | 20577 | ManagementAndGeneral |
| Fundraising | 963 | Fundraising |
Other Expenses OtherExpenses (4 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral | FundraisingFundraising |
|---|---|---|---|---|
| REPAIRS & MAINT. | 383920 | 295529 | 84437 | 3954 |
| Medical Supplies | 728967 | 728967 | ||
| BAD DEBT | 945706 | 945706 | ||
| MEDICAID | 173013 | 173013 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 223460 | Total |
| Program Services | 161144 | ProgramServices |
| Management And General | 59529 | ManagementAndGeneral |
| Fundraising | 2787 | Fundraising |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12723554 | Total |
| Program Services | 10022668 | ProgramServices |
| Management And General | 2591709 | ManagementAndGeneral |
| Fundraising | 109177 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 27870 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 333260 | BOY |
| EOY | 330049 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 168070 | BOY |
| EOY | 97335 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1412026 | BOY |
| EOY | 1344633 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 276067 | BOY |
| EOY | 332474 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 92834 | BOY |
| EOY | 69003 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 21356804 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4430124 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 17816084 | BOY |
| EOY | 16926680 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 418996 | BOY |
| EOY | 401000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20517337 | BOY |
| EOY | 19529044 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 575912 | BOY |
| EOY | 753133 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12863329 | BOY |
| EOY | 12284463 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13439241 | BOY |
| EOY | 13037596 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7078096 | BOY |
| EOY | 6491448 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 7078096 | BOY |
| EOY | 6491448 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 20517337 | BOY |
| EOY | 19529044 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | -586648 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 0 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
| Audit Committee | true | AuditCommittee |
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital170b1 Aiii | X | Hospital170b1Aiii |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbying | |
| Total Direct Lobbying | TotalDirectLobbying | |
| Total Lobbying Expenditures | TotalLobbyingExpenditures | |
| Other Exempt Purpose Expenditures | OtherExemptPurposeExpenditures | |
| Total Exempt Purpose Expenditures | TotalExemptPurposeExpenditures | |
| Lobbying Nontaxable | LobbyingNontaxableAmount | |
| Grassroots Nontaxable | GrassrootsNontaxableAmount | |
| Tot Lobbying Grassroot Minus Non Tx | TotLobbyingGrassrootMinusNonTx | |
| Tot Lobby Expend Mns Lobbying Nontx | TotLobbyExpendMnsLobbyingNontx | |
| 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 | true | DirectContactLegislators |
| Direct Contact Legislators | $2,062 | DirectContactLegislatorsAmount |
| Rallies Demonstrations | false | RalliesDemonstrations |
| Other Activities | false | OtherActivities |
| Total Lobbying Expenditures IIB | 2062 | TotalLobbyingExpendituresIIB |
| Not Described In501c3 | false | NotDescribedIn501c3 |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 309117 | OtherCostOrOtherBasis |
| Book Value | 309117 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 5569332 | OtherCostOrOtherBasis |
| Depreciation | 733571 | Depreciation |
| Book Value | 4835761 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovements |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 13373477 | OtherCostOrOtherBasis |
| Depreciation | 3434089 | Depreciation |
| Book Value | 9939388 | BookValue |
Other Land Buildings OtherLandBuildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 2104878 | OtherCostOrOtherBasis |
| Depreciation | 262464 | Depreciation |
| Book Value | 1842414 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 16926680 | TotalOfBookValueLandBuildings |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
| Total Revenue | 12136906 | TotalRevenue |
| Total Expenses | 12723554 | TotalExpenses |
| Excess Or Deficit For Year | -586648 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | -586648 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 11835325 | TotRevenueEtcAuditedFinclStmt |
| Other Revenues | 50418 | OtherRevenues |
| Revenue Not Rptd F990 | 50418 | RevenueNotRptdF990 |
| Revenue Subtotal | 11784907 | RevenueSubtotal |
| Other Revenues Not Included | 351999 | OtherRevenuesNotIncluded |
| Revenue Not Rptd On Fin Stmt | 351999 | RevenueNotRptdOnFinStmt |
| Total Revenue Per Form990 | 12136906 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 12764101 | TotExpensesEtcAuditedFinclStmt |
| Other Expenses Included | 40547 | OtherExpensesIncluded |
| Expenses Not Rptd F990 | 40547 | ExpensesNotRptdF990 |
| Expenses Subtotal | 12723554 | ExpensesSubtotal |
| Total Expenses Per Form990 | 12723554 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| UNCERTAIN TAX POSITIONS DISCLOSURE | SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XII, LINE 2D | RELATED ORGANIZATION'S REVENUE 22,068 SPECIAL EVENT EXPENSES 28,350 ------- TOTAL $50,418 |
| RECONCILIATION OF REVENUE | SCHEDULE D, PART XII, LINE 4B | CONTRIBUTION FROM RELATED ENTITY $351,999 |
| RECONCILIATION OF EXPENSES | SCHEDULE D, PART XIII, LINE 2D | RELATED ORGANIZATION'S EXPENSES 12,197 SPECIAL EVENT EXPENSES 28,350 ------- TOTAL $40,547 |
Schedule G IRS990ScheduleG
Events Information EventsInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Event1 | GOLF TOURNAMENT | NameOfEvent1 |
| Gross Receipts Event1 | 66550 | GrossReceiptsEvent1 |
| Charitable Contributions Event1 | 40885 | CharitableContributionsEvent1 |
| Gross Revenue Event1 | 25665 | GrossRevenueEvent1 |
| Cash Prizes Event1 | 1680 | CashPrizesEvent1 |
| Non Cash Prizes Event1 | 6526 | NonCashPrizesEvent1 |
| Rent Facility Costs Event1 | 40 | RentFacilityCostsEvent1 |
| Food And Beverage Event1 | 3412 | FoodAndBeverageEvent1 |
| Other Direct Expenses Event1 | 6428 | OtherDirectExpensesEvent1 |
| Name Of Event2 | ANNUAL APPEAL | NameOfEvent2 |
| Gross Receipts Event2 | 123431 | GrossReceiptsEvent2 |
| Charitable Contributions Event2 | 100000 | CharitableContributionsEvent2 |
| Gross Revenue Event2 | 23431 | GrossRevenueEvent2 |
| Other Direct Expenses Event2 | 817 | OtherDirectExpensesEvent2 |
| Total Number Of Other Events | 1 | TotalNumberOfOtherEvents |
| Gross Receipts Other Events | 30597 | GrossReceiptsOtherEvents |
| Charitable Contrib Other Events | 21975 | CharitableContribOtherEvents |
| Gross Revenue Other Events | 8622 | GrossRevenueOtherEvents |
| Rent Facility Costs Other Events | 180 | RentFacilityCostsOtherEvents |
| Food And Beverage Other Events | 3735 | FoodAndBeverageOtherEvents |
| Other Direct Expenses Other Events | 5532 | OtherDirectExpensesOtherEvents |
| Gross Receipts Total | 220578 | GrossReceiptsTotal |
| Charitable Contributions Total | 162860 | CharitableContributionsTotal |
| Gross Revenue Total Events | 57718 | GrossRevenueTotalEvents |
| Cash Prizes Total Events | 1680 | CashPrizesTotalEvents |
| Non Cash Prizes Total Events | 6526 | NonCashPrizesTotalEvents |
| Rent Facility Costs Total Events | 220 | RentFacilityCostsTotalEvents |
| Food And Beverage Total Events | 7147 | FoodAndBeverageTotalEvents |
| Other Direct Expenses Total Events | 12777 | OtherDirectExpensesTotalEvents |
| Direct Expense Summary Events | 28350 | DirectExpenseSummaryEvents |
| Net Income Summary | 29368 | NetIncomeSummary |
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 | 153281 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 153281 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01200 | PercentOfTotalExpense |
Unreimbursed Medicaid UnreimbursedMedicaid
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1674985 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 919216 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 755769 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.05940 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 1828266 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 919216 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 909050 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07140 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 12011 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1305 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 10706 | NetCommunityBenefitExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 13775 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 13775 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00110 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 304958 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 234437 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 70522 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00440 | PercentOfTotalExpense |
Cash And In Kind Contributions CashAndInKindContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 765 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 765 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00010 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 331509 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 235742 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 95768 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00560 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 2159775 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 1154958 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 1004818 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.07700 | PercentOfTotalExpense |
Community Support CommunitySupport
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 465 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 465 | NetCommunityBuildingExpense |
Health Improvement Advocacy HealthImprovementAdvocacy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 9383 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 9383 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00070 | PercentOfTotalExpense |
Workforce Development WorkforceDevelopment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 31086 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 31086 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00240 | PercentOfTotalExpense |
Total Total
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Building Expense | 40934 | TotalCommunityBuildingExpense |
| Net Community Building Expense | 40934 | NetCommunityBuildingExpense |
| Percent Of Total Expense | 0.00310 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReported |
| Bad Debt Expense | $945,706 | BadDebtExpenseAmount |
| Amount Attributable To | 149872 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 6117965 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 6096363 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 21602 | 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-FAIRFAX | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Licensed Hospital | X | LicensedHospital |
| General Medical And Surgical | X | GeneralMedicalAndSurgical |
| Critical Access Hospital | X | CriticalAccessHospital |
| Er24 Hours | X | Er24Hours |
Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL-FAIRFAX | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital Facility Number | 1 | HospitalFacilityNumber |
| 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 |
| Insurance Status | X | InsuranceStatus |
| Uninsured Discount | X | UninsuredDiscount |
| Medicaid Medicare | X | MedicaidMedicare |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Attached To Invoices | X | AttachedToInvoices |
| Posted In Emergency Room | X | PostedInEmergencyRoom |
| Posted In Admission Office | X | PostedInAdmissionOffice |
| Provided On Admission | X | ProvidedOnAdmission |
| Available On Request | X | AvailableOnRequest |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | false | CollectionActivities |
| 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 | 1 | NumberOfOtherFacilities |
Other Facilities OtherFacilities
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PRIMARY CARE CLINIC | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 26136 US HWY 59 | AddressLine1 |
| City | FAIRFAX | City |
| State | MO | State |
| ZIP Code | 64446 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility Type | PRIMARY CARE PHYSICIAN CLINIC | FacilityType |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | ExplanationExplanation | Return ReferenceReturnReference |
|---|---|---|
| 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 $945,706. | |
| SCHEDULE H, PART I, LINE 7G | THE HOSPITAL INCLUDED $60,415 FROM A PHYSICIAN CLINIC. | |
| COMMUNITY BUILDING ACTIVITIES | Community Hospital-Fairfax participates in year round community building activities. In February, Community Hospital-Fairfax sponsors a Wear Red Challenge. Businesses, organizations and schools are challenged to wear red for heart health. In return, heart healthy information is mailed to each participant for their employees. Hundreds participate each year. In addition to celebrating heart health awareness month, monthly blood pressure clinics are offered in three locations every month of the year in the CH-F service area as a service to our community. Pediatric Orientation is held in the spring of each year. 90 area first graders are invited into the hospital to role play what it might be like to a patient. First graders really enjoy riding in the wheelchair and pushing buttons on the hospital bed. Also, held each spring is the Kid's Caf. This is an event where children get to "play with their food" and learn about healthy eating choices. Seed spitting, cracker critters and making their own sandwiches are just a few fun activities. Hospital employees also set up a mock grocery story and kids do their own shopping. After their carts are full, volunteers show them what are healthy choices and where they might make other choices. After the Kids Caf, the hospital rents the local swimming pool for kids to enjoy! In the late summer, Community Hospital-Fairfax sponsors the Back to School Fair. This is a fair for low income families to receive free school supplies prior to the school year starting. Community Hospital-Fairfax organizes the collection of funds and purchases the supplies. 150 children were able to fill backpacks with needed supplies last year! In the fall, Community Hospital-Fairfax invites men to come to the hospital for a free prostate screening clinic. The PSA test is offered at a reduced cost and the exam is free. 60 to 75 men participate in this activity annually. During Physical Therapy month, therapists travel the hospital service area and offer free fall risk assessments and assistive device assessments at area nutrition centers. Up to 50 receive this helpful screening each year in an effort to reduce their potential for falls. October brings with it Breast Cancer Month. Community Hospital-Fairfax delivers bags of mints and mammogram reminders to area businesses in an effort to raise awareness for women receiving this important screening. The first weekend of November is an exciting time for the community's women as the annual Me Market kicks off. A gym full of shopping opportunities attracts about 250 women annually. Along with shopping, women can receive free screenings and health information. Cholesterol, glucose, body composition, heart health and a free fall risk assessment are all offered free of charge or at a very reduced cost. | SCHEDULE H, PART II |
| BAD DEBT EXPENSE | THE HOSPITAL USED THE ACTUAL ACCOUNT BALANCE AMOUNTS WRITTEN OFF AND SENT TO COLLECTION AGENCIES (NO HOME HEALTH OR PCC) FOR THE TOTAL ON LINE 2. LINE 3 IS 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. THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN FULL WHEN BILLED. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. | SCHEDULE H, PART III, LINE 4 |
| MEDICARE SHORTFALL | THE HOSPITAL'S SERVICE AREA IS APPROXIMATELY 23% MEDICARE BENEFICIARIES WHO PREFER TO GET THEIR MEDICAL CARE LOCALLY. 56% OF THE HOSPITAL'S REVENUE IS GENERATED BY THESE MEDICARE BENEFICIARIES. 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 FY12 MEDICARE COST REPORT. | SCHEDULE H, PART III, LINE 8 |
| COLLECTION PRACTICES | 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 III, LINE 9B |
| BILLING TO INDIVIDUALS WITHOUT INSURANCE COVERING EMERGENCY | The hospital charges all patients the same rate whether they have insurance coverage or not. A 30% discount off billed charges is offered to uninsured patients, and the balance of a 30% discount (after insurance pays) to apply to deductibles and co-insurance owed to those that have insurance coverage. | SCHEDULE H, PART V, SECTION B, LINE 19D |
| NEEDS ASSESSMENT | The Community Health Needs Assessment is underway at Community Hospital-Fairfax. The secondary research was completed in June-July of 2012. Four focus groups with 50 experts that represent children, elderly, law enforcement and the underpriveledged were held between Sept. and Oct. and the findings written into a report that will be used in conjunction with the whole community survey that is currently being conducted. The survey process kicked off in November of 2012. The survey was emailed to 4400 homes and offered online. Newspaper and social media were also used. Drop boxes were also placed at local senior centers and newspaper offices. Community Hospital-Fairfax also partnered with Community Services Inc., the agency that serves the underpriveledged in our area, to distribute surveys to their clients. Nearly 60 surveys were collected through that partnership. To date, the return rate has been about 15% with more surveys still coming in. This data will be analyzed and a team put together to determine a solution in the FQ2013 with the full report available for wide distribution by May of 2013. | SCHEDULE H, PART VI, LINE 2 |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | Community Hospital Business Office staff will discuss with inpatients and outpatients the options available 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 the same information as is discussed in person. | SCHEDULE H, PART VI, LINE 3 |
| COMMUNITY INFORMATION | 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 $40,261. | SCHEDULE H, PART VI, LINE 4 |
| PROMOTION OF COMMUNITY HEALTH | TO EDUCATE AND PROVIDE SERVICES TO ITS COMMUNITY, COMMUNITY HOSPITAL RESPONDS BY PROVIDING THE FOLLOWING ACTIVITIES: MONTHLY FREE BLOOD PRESSURE SCREENING AT AREA NUTRITION CENTERS; AN ANNUAL 'HEART HEALTHY' EVENT WITH A Q&A SESSION WITH AN ONSITE CARDIOLOGIST, 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 KID'S CAFE WHICH INVOLVES CHILDREN LEARNING HEALTHY EATING CHOICES, AND A POOL PARTY FOR THE PARTICIPANTS WHICH PROMOTES PHYSICAL ACTIVITY; 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. | SCHEDULE H, PART VI, LINE 5 |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Form990 Schedule I Part III Form990ScheduleIPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Type Of Grant | TUITION AND BOOKS ASSISTANCE | TypeOfGrant |
| Number Of Recipients | 9 | NumberOfRecipients |
| Amount Of Cash Grant | 52981 | AmountOfCashGrant |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | MONITORING THE USE OF GRANT FUNDS IN THE U.S. | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | STUDENTS COMPLETE AND SUBMIT APPLICATIONS FOR SCHOLARSHIPS TWICE A YEAR. A COMMITTEE MEETS AND DETERMINES WHO IS AWARDED A SCHOLARSHIP. THE AMOUNT OF THE SCHOLARSHIPS AWARDED IS DEPENDENT ON THE ANNUAL BUDGET. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Compensation Survey | X | CompensationSurvey |
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | false | SeverancePayment |
| Supplemental Nonqual Retire Plan | false | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | 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 (3 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| MYRA EVANS | |||||||||||||
| 174244 | 0 | 0 | 0 | 0 | 0 | 18396 | 0 | 4749 | 0 | 197389 | 0 | 0 | 0 |
| WC BUD TICE | |||||||||||||
| 0 | 143172 | 0 | 0 | 0 | 0 | 0 | 6946 | 0 | 3450 | 0 | 153568 | 0 | 0 |
| STEPHANIE DAUBERT | |||||||||||||
| 0 | 179536 | 0 | 0 | 0 | 0 | 0 | 13436 | 0 | 3707 | 0 | 196679 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | COMPENSATION FROM RELATED ORGANIZATION | Identifier |
| Return Reference | FORM 990, PART VII, SECTION A, LINE 1A AND SCHEDULE J, PART II | ReturnReference |
| Explanation | THE CEO COMPENSATION IS PAID THROUGH A MANAGEMENT CONTRACT WITH THE NEBRASKA MEDICAL CENTER (NMC), A RELATED ORGANIZATION. THE RELATED COMPENSATION PAID TO DIRECTORS IS FOR THEIR EMPLOYMENT WITH NMC, NOT FOR THEIR ROLE AS A DIRECTOR WITH THE HOSPITAL. | Explanation |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (16 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| PROGRAM SERVICE ACCOMPLISHMENTS | 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. MONTHLY FREE BLOOD PRESSURE CHECKS AT AREA NUTRITION CENTERS. 2. FEBRUARY HEART HEALTHY AWARENESS EVENT WITH 40 BUSINESSES AND 5 SCHOOLS PARTICIPATING. 3. DIABETES COUNSELING CLASSES WITH A REGISTERED DIETICIAN AND CERTIFIED DIABETES EDUCATOR. 4. FREE GLUCOSE SCREENINGS, BMI CHECKS AND BLOOD PRESSURE CHECKS BIANNUALLY AT A WOMEN'S EVENT (ATTENDED BY 275 WOMEN). 5. ATTENDANCE AT AREA HEALTH FAIRS OFFERING FREE SCREENINGS. 6. CH-F IS STROKE READY AND HAS PROTOCOL IN PLACE TO RESPOND TO A STROKE WITHIN 60 MINUTES. 7. CH-F SPONSORS HEALTHY EATING ACTIVITIES FOR KIDS. THE KID'S CAF TEACHES KIDS ABOUT THE FOOD PLATE AND ENCOURAGES CHILDREN TO TRY NEW HEALTHY FOODS. OVER 100 CHILDREN WERE REACHED THROUGH THIS ACTIVITY IN FY2012 WITH 150 CHILDREN AND FAMILIES ATTENDING A POOL PARTY AFTER THE EVENT SPONSORED BY THE HOSPITAL. 8. CH-F STAFF TEACHES HEALTHY EATING CHOICES AT THE AREA BACK TO SCHOOL FAIR WHERE SCHOOL SUPPLIES ARE DISTRIBUTED TO NEEDY CHILDREN. OVER 100 CHILDREN WERE REACHED THROUGH THIS ACTIVITY. 9. CH-F ALSO SPONSORS AN ANNUAL POOL PARTY TO CELEBRATE KIDS ATTENDANCE AT THE KID'S CAF AND PROMOTE PHYSICAL ACTIVITY. 10. AN ANNUAL PROSTATE SCREENING IS HELD BY CH-F. A FREE EXAM WAS PROVIDED TO NEARLY 60 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 | GENERATIONS IN NORTHWEST MISSOURI. $6,000 IN SCHOLARSHIPS IS AWARDED EACH YEAR TO STUDENTS ENROLLED IN A HEALTHCARE PROGRAM. ADDITIONALLY, CH-F STAFF LOGGED OVER 375 HOURS IN FY2012 WITH AREA HIGH SCHOOL STUDENTS AS THEY JOB SHADOWED. A CAREER DAY WAS ALSO HOSTED FOR AREA 8TH GRADERS. 52 STUDENTS ATTENDED TO LEARN ABOUT HEALTHCAREERS THROUGH HANDS ON ACTIVITIES WITH PHYSICIANS, LABORATORY, RADIOLOGY, NURSING AND PHYSICAL THERAPHY EMPLOYEES. AS THE SOLE HEALTHCARE FACILITY IN THE AREA, CH-F TAKES SERIOUS ITS OBLIGATION TO BE PREPARED IN AN EMERGENCY. OVER 55 HOURS WERE SPENT BY CH-F'S EMERGENCY PREPAREDNESS COORDINATOR LAST YEAR TRAINING TO BE READY IN CASE A DISASTER STRIKES. 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. |
| DELEGATION OF CONTROL OVER MANAGEMENT DUTIES | 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 REVIEW PROCESS | 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. |
| CONFLICT OF INTEREST POLICY | 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. |
| COMPENSATION REVIEW | 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. |
| AVAILABILITY OF DOCUMENTS | 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. |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:ROBERT JACKSON TITLE:DIRECTOR/VICE PRESIDENT HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SANDRA FUHRMAN TITLE:DIRECTOR/SECRETARY/TREASURER HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BILL SMITH TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:STEVE CUNNINGHAM TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:BEVERLY WHITE TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:EDUARDO FERNANDEZ, M.D. TITLE:DIRECTOR HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:MYRA EVANS TITLE:CEO HOURS:1 |
| HOURS DEVOTED FOR RELATED ORGANIZATION | FORM 990 PART VII | NAME:SUZANNE SOUTHARD TITLE:CFO HOURS:1 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| COMMUNITY HEALTCARE FOUNDATION | ||||||||||
| 26136 US HWY 59 | FAIRFAX | MO | 64446 | 431757553 | SUPPORT ORG | MO | 501(C)(3) | 11A | CHA | true |
| THE NEBRASKA MEDICAL CENTER | ||||||||||
| 4350 DEWEY AVENUE | OMAHA | NE | 68198 | 911858433 | HOSPITAL | NE | 501(C)(3) | 3 | NA | false |
| CLARKSON COLLEGE | ||||||||||
| 101 SOUTH 42ND STREET | OMAHA | NE | 68131 | 363649217 | COLLEGE | NE | 501(C)(3) | 2 | NMC | false |
Form990 Schedule R Part III Form990ScheduleRPartIII
Name Of Related Org NameOfRelatedOrg
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BELLEVUE MED CTR | BusinessNameLine1 |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2500 BMC DRIVE | AddressLine1 |
| City | BELLEVUE | City |
| State | NE | State |
| ZIP Code | 68123 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 204305186 | EIN |
| Primary Activity | ACUTE CARE | PrimaryActivity |
| Legal Domicile State | NE | LegalDomicileState |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NMC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Predominant Income Type | RELATED | PredominantIncomeType |
| Share Of Total Income | 0 | ShareOfTotalIncome |
| Share Of EOY Assets | 0 | ShareOfEOYAssets |
| Disproportionate Allocations | false | DisproportionateAllocations |
| Code V | $0 | CodeVAmount |
| General Or Managing Partner | false | GeneralOrManagingPartner |
| Percentage Ownership | 0.00000 | PercentageOwnership |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Percentage OwnershipPercentageOwnership |
|---|---|---|---|---|---|---|---|---|---|---|---|
| NHS ORTHOPAEDIC SERVICES INC | |||||||||||
| 988145 NEBRASKA MEDICAL CENTER | OMAHA | NE | 68198 | 470845238 | INVESTMTN SVCS | NE | NMC | C CORP | 0 | 0 | 0.00000 |
| NEBRASKA HEALTH PARTNERS INC | |||||||||||
| 987400 NEBRASKA MEDICAL CENTER | OMAHA | NE | 68198 | 470816463 | MANAGEMENT | NE | NMC | C CORP | 0 | 0 | 0.00000 |
| 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 | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | 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 | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | true | SharingOfFacilities |
| Sharing Of Paid Employees | true | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | true | 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 HEALTHCARE FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | C | TransactionType |
| Amount Involved | 381784 | AmountInvolved |
| Method Of Amt Determination | FMV | MethodOfAmtDetermination |