COMMUNITY MEDICAL CENTER INC: Form 990, tax year 2010
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEDICAL CENTER INC (EIN 47-0421272)
- Tax period
- 2010-08-01 to 2011-07-31
- Filed
- 2012-03-15
- IRS object ID
- 201240759349300344
- Schema version
- 2010v3.7
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2012-03-15T16:42:01-05:00 | Timestamp |
| Tax Period End Date | 2011-07-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | DOHMAN AKERLUND & EDDY LLC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 470 | AddressLine1 |
| City | AURORA | City |
| State | NE | State |
| ZIP Code | 688180470 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2010-08-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 470421272 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEDICAL CENTER INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | COMM | NameControl |
| Phone | 4022456501 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1 |
| City | FALLS CITY | City |
| State | NE | State |
| ZIP Code | 68355 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | SCOTT L SAWYER | Name |
| Title | CHIEF FINANCIAL OFFICER | Title |
| Phone | 4022456501 | Phone |
| Date Signed | 2012-03-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | TIMOTHY J COUFAL | Name |
| Phone | 4026946404 | Phone |
| Date Prepared | 2012-03-15 | DatePrepared |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2010 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | RYAN LARSEN | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | SAME AS ABOVE | AddressLine1 |
| City | FALLS CITY | City |
| State | NE | State |
| ZIP Code | 68355 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 18258516 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | HTTP://CMCFC.ORG | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 1995 | YearFormation |
| State Legal Domicile | NE | StateLegalDomicile |
| Activity Or Mission Description | TO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, RELIGIOUS BELIEFS OR FINANCIAL STANDING. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 8 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 8 | NbrIndependentVotingMembers |
| Total Nbr Employees | 208 | TotalNbrEmployees |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 128051 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 219218 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 16957330 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 18026525 | ProgramServiceRevenueCY |
| Investment Income Prior Year | -2282000 | InvestmentIncomePriorYear |
| Investment Income Current Year | -58647 | InvestmentIncomeCurrentYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 14803381 | TotalRevenuePriorYear |
| Total Revenue Current Year | 18187096 | TotalRevenueCurrentYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 8547567 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 8265693 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 8357305 | OtherExpensePriorYear |
| Other Expenses Current Year | 9143655 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 16904872 | TotalExpensesPriorYear |
| Total Expenses Current Year | 17409348 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -2101491 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 777748 | RevenuesLessExpensesCY |
| Total Assets BOY | 33807196 | TotalAssetsBOY |
| Total Assets EOY | 33958439 | TotalAssetsEOY |
| Total Liabilities BOY | 21676433 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 21049928 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 12130763 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 12908511 | NetAssetsOrFundBalancesEOY |
| Mission Description | TO OFFER GENERAL HEALTHCARE SERVICES WITHIN THE SCOPE OF ITS LICENSE AND CAPABILITIES; TO RENDER HEALTHCARE TO ALL PERSONS WITHOUT RESPECT TO RACE, RELIGIOUS BELIEFS OR FINANCIAL STANDING. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 13928928 | Expense |
| Description | COMMUNITY MEDICAL CENTER PROVIDES MEDICAL SERVICES TO MEET THE NEEDS OF THE PEOPLE OF RICHARDSON COUNTY AND THE SURROUNDING COMMUNITIES. COMMUNITY MEDICAL CENTER PROVIDED 2,226 INPATIENT DAYS, 2,128 SWING-BED DAYS, 116 NURSERY DAYS, 12,013 CLINIC VISITS AND NUMEREOUS OUTPATIENT SERVICES DURING THE YEAR. COMMUNITY BENEFITS INCLUDE 427,903 OF SUBSIDIZED HEALTH SERVICES, 294,909 OF TRADITIONAL CHARITY CARE, 218,055 OF BAD DEBT AND 5,000 OF HEALTH EDUCATION. | Description |
| Total Program Service Expense | 13928928 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | 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 | true | 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 | 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 | 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 | false | RelatedEntity |
| Related Org Controlled Entity | false | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 48 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Compliance With Backup Witholding | true | ComplianceWithBackupWitholding |
| Number Of Employees | 208 | 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 |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 8 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 8 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | 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 | false | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | false | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | false | 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 | SCOTT L SAWYER | NamePerson |
| Telephone Number | 4022456501 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1 |
| City | FALLS CITY | City |
| State | NE | State |
| ZIP Code | 68355 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (15 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 |
|---|---|---|---|---|---|---|---|
| RODGER MERZ | |||||||
| CHAIRPERSON | 1.00 | X | 0 | 0 | 0 | ||
| RENIE GERWECK | |||||||
| VICE-CHAIR | 1.00 | X | 0 | 0 | 0 | ||
| STEVE SEVERIN | |||||||
| SECRETARY | 1.00 | X | 0 | 0 | 0 | ||
| DANA RATHJE | |||||||
| TREASURER | 1.00 | X | 0 | 0 | 0 | ||
| LAURIE KIMBROUGH | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| CHUCK HUNZEKER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| KENT BIEKER | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| DIRCK CLARK | |||||||
| DIRECTOR | 1.00 | X | 0 | 0 | 0 | ||
| RYAN LARSEN | |||||||
| CEO | 40.00 | 196240 | 0 | 35571 | X | ||
| SCOTT SAWYER | |||||||
| CFO | 40.00 | 104075 | 0 | 21971 | X | ||
| BARBARA HOWARD | |||||||
| DON | 40.00 | 88217 | 0 | 12516 | X | ||
| DAVID BORG | |||||||
| PHYSICIAN | 40.00 | 405773 | 0 | 58590 | X | ||
| HONG CUI | |||||||
| PHYSICIAN | 40.00 | 200558 | 0 | 14671 | X | ||
| SANDRA CATLIN | |||||||
| ARNP | 40.00 | 157798 | 0 | 23655 | X | ||
| CHARLES HAGEDORN | |||||||
| CRNA | 40.00 | 157516 | 0 | 6498 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 1310177 | TotalReportableCompFromOrg |
| Total Other Compensation | 173472 | TotalOtherCompensation |
| Number Individuals GT100 K | 6 | NumberIndividualsGT100K |
| Formers Listed | false | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation (4 entries)
| Address Line1AddressOfContractor/AddressUS/AddressLine1 | CityAddressOfContractor/AddressUS/City | StateAddressOfContractor/AddressUS/State | ZIP CodeAddressOfContractor/AddressUS/ZIPCode | Description Of ServicesDescriptionOfServices | CompensationCompensation |
|---|---|---|---|---|---|
| PTRS-NACHTIGAL LLC | |||||
| 700 OREGON STREET | HIAWATHA | KS | 66434 | PT/OT SERVICES | 544113 |
| CARDINAL HEALTH | |||||
| 21337 NETWORK PLACE | CHICAGO | IL | 60673 | PHARMACY SVCS | 268536 |
| NHI OUTREACH CLINICAL SERVICES | |||||
| 7440 S 91ST STREET | LINCOLN | NE | 68501 | NM & ECHO SERV | 110189 |
| SHARED MEDICAL SERVICES | |||||
| PO BOX 330 | COTTAGE GROVE | WI | 53527 | MRI SERVICES | 103810 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 4 | NumberOfContractorsGT100K |
| Government Grants | 165666 | GovernmentGrants |
| All Other Contributions | 53552 | AllOtherContributions |
| Noncash Contributions | 6762 | NoncashContributions |
| Total Contributions | 219218 | TotalContributions |
Program Service Revenue ProgramServiceRevenue (5 entries)
| DescriptionDescription | Business CodeBusinessCode | Total Revenue ColumnTotalRevenueColumn | Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 622110 | 17779847 | 17779847 |
| MISCELLANEOUS HOPSITAL REV | 622110 | 86261 | 86261 |
| CAFETERIA | 722310 | 64737 | 64737 |
| PHARMACY | 900099 | 60780 | 60780 |
| LIFELINE | 900099 | 34900 | 34900 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 18026525 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 9923 | TotalRevenueColumn |
| Exclusion | $9,923 | ExclusionAmount |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 2850 | Other |
Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | 71420 | Other |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -68570 | Other |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -68570 | TotalRevenueColumn |
| Related Or Exempt Function Income | -68570 | RelatedOrExemptFunctionIncome |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 18187096 | TotalRevenueColumn |
| Related Or Exempt Function Income | 17957955 | RelatedOrExemptFunctionIncome |
| Exclusion | $9,923 | ExclusionAmount |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 388532 | Total |
| Program Services | 88217 | ProgramServices |
| Management And General | 300315 | ManagementAndGeneral |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 6106860 | Total |
| Program Services | 5187457 | ProgramServices |
| Management And General | 919403 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 253688 | Total |
| Program Services | 193441 | ProgramServices |
| Management And General | 60247 | ManagementAndGeneral |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1078206 | Total |
| Program Services | 890300 | ProgramServices |
| Management And General | 187906 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 438407 | Total |
| Program Services | 353648 | ProgramServices |
| Management And General | 84759 | ManagementAndGeneral |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 44710 | Total |
| Management And General | 44710 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 33000 | Total |
| Management And General | 33000 | ManagementAndGeneral |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 2595482 | Total |
| Program Services | 2395531 | ProgramServices |
| Management And General | 199951 | ManagementAndGeneral |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 20800 | Total |
| Program Services | 4458 | ProgramServices |
| Management And General | 16342 | ManagementAndGeneral |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 140151 | Total |
| Program Services | 77974 | ProgramServices |
| Management And General | 62177 | ManagementAndGeneral |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 367400 | Total |
| Program Services | 5335 | ProgramServices |
| Management And General | 362065 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25685 | Total |
| Program Services | 15899 | ProgramServices |
| Management And General | 9786 | ManagementAndGeneral |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 27600 | Total |
| Program Services | 19292 | ProgramServices |
| Management And General | 8308 | ManagementAndGeneral |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 945800 | Total |
| Program Services | 677354 | ProgramServices |
| Management And General | 268446 | ManagementAndGeneral |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1560302 | Total |
| Program Services | 1117488 | ProgramServices |
| Management And General | 442814 | ManagementAndGeneral |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 72309 | Total |
| Program Services | 12386 | ProgramServices |
| Management And General | 59923 | ManagementAndGeneral |
Other Expenses OtherExpenses (5 entries)
| DescriptionDescription | TotalTotal | Program ServicesProgramServices | Management And GeneralManagementAndGeneral |
|---|---|---|---|
| PHARMACY | 984127 | 984127 | |
| CENTRAL SUPPLY | 385150 | 385150 | |
| REPAIR AND MAINTENANCE | 358385 | 253914 | 104471 |
| PROVISION FOR BAD DEBTS | 296136 | 296136 | |
| EQUIPMENT RENTAL | 268574 | 248913 | 19661 |
All Other Expenses AllOtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 1018044 | Total |
| Program Services | 1018044 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 17409348 | Total |
| Program Services | 13928928 | ProgramServices |
| Management And General | 3480420 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 5118584 | BOY |
| EOY | 6320809 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2057340 | BOY |
| EOY | 2066194 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 424759 | BOY |
| EOY | 254822 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2325439 | BOY |
| EOY | 3109352 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 194203 | BOY |
| EOY | 82502 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 53186 | BOY |
| EOY | 48650 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 417251 | BOY |
| EOY | 280321 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Buildings Equipment Basis | 25537066 | LandBuildingsEquipmentBasis |
| Land Bldg Equipment Accum Deprec | 4695193 | LandBldgEquipmentAccumDeprec |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 22026745 | BOY |
| EOY | 20841873 | EOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13772 | BOY |
| EOY | 14355 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 485917 | BOY |
| EOY | 459561 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 690000 | BOY |
| EOY | 480000 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33807196 | BOY |
| EOY | 33958439 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1460180 | BOY |
| EOY | 1206342 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 18047208 | BOY |
| EOY | 17737886 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 2169045 | BOY |
| EOY | 2105700 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 21676433 | BOY |
| EOY | 21049928 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12130763 | BOY |
| EOY | 12908511 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 12130763 | BOY |
| EOY | 12908511 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 33807196 | BOY |
| EOY | 33958439 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 777748 | ReconcilationRevenueExpenses |
| 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 D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Disclosed Orgs Legal Control | false | DisclosedOrgsLegalControl |
| Disclosed For Charitable Purposes | false | DisclosedForCharitablePurposes |
| Written Policy Monitoring | false | WrittenPolicyMonitoring |
| Sect170h Requirements Satisfied | false | Sect170hRequirementsSatisfied |
| Solicited Assets For Sale | false | SolicitedAssetsForSale |
| Agent Trustee Etc | false | AgentTrusteeEtc |
| Included On FS | false | IncludedOnFS |
Current Year CurrentYear
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 979328 | BeginningOfYearBalance |
| Contributions | 791570 | Contributions |
| Investment Earnings Or Losses | 1275 | InvestmentEarningsOrLosses |
| Other Expenditures | 778715 | OtherExpenditures |
| End Of Year Balance | 993457 | EndOfYearBalance |
Current Year Minus1 Year CurrentYearMinus1Year
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Of Year Balance | 561962 | BeginningOfYearBalance |
| Contributions | 11553894 | Contributions |
| Investment Earnings Or Losses | 3723 | InvestmentEarningsOrLosses |
| Other Expenditures | 11140251 | OtherExpenditures |
| End Of Year Balance | 979328 | EndOfYearBalance |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated EOY Balance | 1.00000 | BoardDesignatedEOYBalance |
| Endowments Held By Unrelated Orgs | false | EndowmentsHeldByUnrelatedOrgs |
| Endowments Held By Related Orgs | false | EndowmentsHeldByRelatedOrgs |
| Are Related Orgs Listed Schedule R | false | AreRelatedOrgsListedScheduleR |
Land Land
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1352420 | OtherCostOrOtherBasis |
| Book Value | 1352420 | BookValue |
Buildings Buildings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 17513170 | OtherCostOrOtherBasis |
| Depreciation | 1613358 | Depreciation |
| Book Value | 15899812 | BookValue |
Leasehold Improvements LeaseholdImprovements
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 1680612 | OtherCostOrOtherBasis |
| Depreciation | 167627 | Depreciation |
| Book Value | 1512985 | BookValue |
Equipment Equipment
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | 4990864 | OtherCostOrOtherBasis |
| Depreciation | 2914208 | Depreciation |
| Book Value | 2076656 | BookValue |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Book Value Land Buildings | 20841873 | TotalOfBookValueLandBuildings |
Other Liabilities OtherLiabilities (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| CONDITIONAL CONTRIBUTION | $2,000,000 |
| EST THIRD-PARTY PAYOR SETTLEMENTS | $60,000 |
| DEFERRED COMPENSATION | $45,700 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Of Amounts | 2105700 | TotalOfAmounts |
| Total Revenue | 18187096 | TotalRevenue |
| Total Expenses | 17409348 | TotalExpenses |
| Excess Or Deficit For Year | 777748 | ExcessOrDeficitForYear |
| Excess Or Deficit Per FS | 777748 | ExcessOrDeficitPerFS |
| Tot Revenue Etc Audited Fincl Stmt | 18187096 | TotRevenueEtcAuditedFinclStmt |
| Revenue Subtotal | 18187096 | RevenueSubtotal |
| Total Revenue Per Form990 | 18187096 | TotalRevenuePerForm990 |
| Tot Expenses Etc Audited Fincl Stmt | 17409348 | TotExpensesEtcAuditedFinclStmt |
| Expenses Subtotal | 17409348 | ExpensesSubtotal |
| Total Expenses Per Form990 | 17409348 | TotalExpensesPerForm990 |
Form990 Schedule D Part XIV Form990ScheduleDPartXIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | INTENDED USES FOR ENDOWMENT FUNDS | Identifier |
| Return Reference | SCHEDULE D, PAGE 2, PART V, LINE 4 | ReturnReference |
| Explanation | THE FUNDS INCLUDE 5,490 DESIGNATED BY THE BOARD FOR CAPITAL IMPROVEMENTS, 109,919 DESIGNATED BY BOARD FOR DEFERRED COMPENSATION, 166,860 DESIGNATED BY A LONG-TERM DEBT COVENANT ON THE USDA LOAN, 230,253 DESIGNATED LOAN PROCEEDS TO BE USED FOR EQUIPMENT, AND 480,935 DESIGNATED AS A DEBT SINKING FUND. | Explanation |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Charity Care Policy | true | CharityCarePolicy |
| Written Policy | true | WrittenPolicy |
| Policy Applied To All Hospitals | X | PolicyAppliedToAllHospitals |
| FPG Reference Free Care | true | FPGReferenceFreeCare |
| Pcent200 | X | Pcent200 |
| FPG Reference Discounted Care | true | FPGReferenceDiscountedCare |
| Pcent300 | X | Pcent300 |
| Free Disc Care Medically Indigent | false | 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 | 294909 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 294909 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01720 | PercentOfTotalExpense |
Total Charity Care TotalCharityCare
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 294909 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 294909 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.01720 | PercentOfTotalExpense |
Community Health Services CommunityHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 6851 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 6851 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00040 | PercentOfTotalExpense |
Health Professions Education HealthProfessionsEducation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 5000 | TotalCommunityBenefitExpense |
| Net Community Benefit Expense | 5000 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.00030 | PercentOfTotalExpense |
Subsidized Health Services SubsidizedHealthServices
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 449617 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21713 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 427904 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02500 | PercentOfTotalExpense |
Total Other Benefits TotalOtherBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 461468 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21713 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 439755 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.02570 | PercentOfTotalExpense |
Total Community Benefits TotalCommunityBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expense | 756377 | TotalCommunityBenefitExpense |
| Direct Offsetting Revenue | 21713 | DirectOffsettingRevenue |
| Net Community Benefit Expense | 734664 | NetCommunityBenefitExpense |
| Percent Of Total Expense | 0.04290 | PercentOfTotalExpense |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | true | BadDebtExpenseReported |
| Bad Debt Expense | $218,055 | BadDebtExpenseAmount |
| Amount Attributable To | 21806 | AmountAttributableTo |
| Amount Reimbursed By Medicare | 9897810 | AmountReimbursedByMedicare |
| Cost Of Care Reimbursed By Medicare | 9782571 | CostOfCareReimbursedByMedicare |
| Medicare Surplus Or Shortfall | 115239 | MedicareSurplusOrShortfall |
Costing Methodology Used CostingMethodologyUsed
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | X | Other |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | true | WrittenDebtCollectionPolicy |
| Provision For Charity Care | false | 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 MEDICAL CENTER | BusinessNameLine1 |
Address Address
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 3307 BARADA STREET | AddressLine1 |
| City | FALLS CITY | City |
| State | NE | State |
| ZIP Code | 68355 | 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 MEDICAL CENTER | 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 | 200.0 | FPGFreePercent |
| Uses FPG Discounted | true | UsesFPGDiscounted |
| FPG Discount Percent | 300.0 | FPGDiscountPercent |
| Explains Basis | true | ExplainsBasis |
| Income Level | X | IncomeLevel |
| Explains Application Method | true | ExplainsApplicationMethod |
| Includes Publicity Measures | true | IncludesPublicityMeasures |
| Posted On Website | X | PostedOnWebsite |
| Available On Request | X | AvailableOnRequest |
| Other Publicity | X | OtherPublicity |
| Actions On Nonpayment | true | ActionsOnNonpayment |
| Collection Activities | true | CollectionActivities |
| Report To Credit Agency | X | ReportToCreditAgency |
| Lawsuit | X | Lawsuit |
| Lien On Residence | X | LienOnResidence |
| 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 | true | GrossCharges |
Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Other Facilities | 2 | NumberOfOtherFacilities |
Other Facilities OtherFacilities (2 entries)
| Address Line1Address/AddressLine1 | CityAddress/City | StateAddress/State | ZIP CodeAddress/ZIPCode | Facility TypeFacilityType |
|---|---|---|---|---|
| FAMILY MEDICINE | ||||
| 3307 BARADA STREET | FALLS CITY | NE | 68355 | RURAL HEALTH CLINIC |
| HUMBOLDT FAMILY MEDICINE | ||||
| 1120 GRAND AVENUE | HUMBOLDT | NE | 68376 | RURAL HEALTH CLINIC |
Form990 Schedule H Part VI Form990ScheduleHPartVI (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| EXCLUSIONS FROM PERCENT OF TOTAL EXPENSE | PART I LINE 7 COLUMN F | 296136 |
| COSTING METHODOLOGY EXPLANATION | PART I LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE WAS A COST TO CHARGE RATIO |
| COMMUNITY BUILDING ACTIVITIES | PART II | ALTHOUGH NO COMMUNITY BUILDING ACTIVITIES WERE REPORTED IN PART II THE ORGANIZATION WORKS CLOSELY WITH OTHERS IN THE COMMUNITY TO IMPROVE THE HEALTH AND WELFARE OF COMMUNITY MEMBERS THE ORGANIZATION HAS RECENTLY MOVED INTO A NEW HOSPITAL FACILITY TO PROVIDE THE BEST POSSIBLE CARE TO PATIENTS IT SERVES ALSO AS THE LARGEST EMPLOYER IN FALLS CITY THE NEW FACILITY PROVIDES A BETTER WORK ENVIRONMENT FOR THE ORGANIZATIONS WORKFORCE |
| BAD DEBT EXPENSE EXPLANATION | PART III LINE 4 | FINANCIAL STATEMENT FOOTNOTE EXPENSES INCLUDE A PROVISION FOR DOUBTFUL ACCOUNTS TO ALLOW FOR ESTIMATED UNCOLLECTIBLE ACCOUNTS THIS PROVISION IS BASED ON PAST EXPERIENCE AND ON ANALYSIS OF CURRENT ACCOUNTS RECEIVABLE COLLECTIBILITY ACCOUNTS ARE CONSIDERED DELINQUENT BASED ON PASSAGE OF A SPECIFIED PERIOD OF TIME AND CONSIDERATION OF PAYMENT HISTORY ACCOUNTS DEEMED UNCOLLECTIBLE ARE CHARGED TO THE ALLOWANCE IN THE YEAR THEY ARE DEEMED UNCOLLECTIBLE AS A RESULT THERE IS AT LEAST A REASONABLE POSSIBILITY THAT RECORDED ESTIMATES WILL CHANGE BY A MATERIAL AMOUNT IN THE NEAR TERM THE ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS 434000 AND 465000 AT JULY 31 2011 AND 2010 RESPECTIVELY COSTING METHODOLOGY FOR LINE 2 OVERALL COST TO CHARGE RATIO WAS USED TO DETERMINE AMOUNTS REPORTED ON SCHEDULE H PART III LINE 2 BAD DEBT EXPENSE REPORTED ON FORM 990 PART IX LINE 25 WAS 296136 COSTING METHODOLOGY FOR LINE 3 AFTER REVIEW OF BAD DEBTS WRITTEN OFF IT WAS DETERMINED APPROXIMATELY 10 OF BAD DEBT ACCOUNTS WRITTEN OFF WOULD HAVE QUALIFIED FOR CHARITY CARE IF THE INDIVIDUALS WOULD HAVE COMPLETED THE APPLICATION PROCESS RATIONALE FOR INCLUDED BAD DEBT AS A COMMUNITY BENEFIT BY LAW THE ORGANIZATION CANNOT REFUSE CERTAIN SERVICES TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY THUS BAD DEBT SHOULD BE INCLUDED AS A COMMUNITY BENEFIT |
| MEDICARE EXPLANATION | PART III LINE 8 | THE MEDICARE COST REPORT WAS USED TO DETERMINE THE AMOUNTS REPORTED ON LINE 6 |
| NEEDS ASSESSMENT | PART VI | THE ORGANIZATION ASSESSES THE NEEDS OF THE COMMUNITIES IS SERVICES BY MONITORING THE UTILIZATION OF SERVICES OFFERED AND EVALUATING NEW SERVICES WHICH COULD BE OFFERED TO IMPROVE THE HEALTH AND WELFARE OF THE CITIZENS IN THE COMMUNITIES IT SERVES STARTING IN 2012 THE ORGANIZATION WILL CONDUCT A COMMUNITY NEEDS ASSESSMENT EVERY 3 YEARS AND EXECUTE AGAINST IT |
| PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE | PART VI | THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER THE ORGANIZATIONS HELPFUL OPTIONS FOR PATIENT EXPENSES HOPE PROGRAM OR FINANCIAL ASSISTANCE POLICY BY HAVING THE INFORMATION AVAILABLE ON THEIR WEBSITE PROVIDING THE INFORMATION TO ALL WHO INQUIRE ABOUT OBTAINING FINANCIAL ASSISTANCE AND BY REFERRING THOSE KNOWN TO BE UNINSURED ANDOR TO HAVE LOW INCOME TO FINANCIAL COUNSELORS WHO WILL DISCUSS THE POLICY |
| COMMUNITY INFORMATION | PART VI | RICHARDSON COUNTY NEBRASKA IS PRIMARILY RURAL AND INCLUDES THE CITIES OF BARADA DAWSON FALLS CITY HUMBOLDT PRESTON RULO SALEM SHUBERT STELLA AND VERDON IT IS LOCATED IN THE SOUTHEAST CORNER OF NEBRASKA POPULATION ACCORDING TO THE 2010 CENSUS IS 8363 DECLINING 123 FROM 2000 PERSONS 65 YEARS AND OLDER IS 229 WHILE PERSONS 18 AND YOUNGER IS 215 ETHNIC BACKGROUDS BY PERCENT INCLUDE WHITE 943 AMERICAN INDIAN AND ALASKA NATIVE PERSONS 30 WITH ALL OTHERS REPORTING LESS THAN 2 THERE ARE 3862 HOUSEHOLDS WITH AN AVERAGE OF 219 PERSONS PER HOUSEHOLD MEDIAN HOUSEHOLD INCOME IS 35165 WITH 142 OF PERSONS BELOW THE POVERTY LEVEL THERE ARE 55184 TOTAL SQUARE MILES AND 152 PERSON PER SQUARE MILE |
| HEALTH OF COMMUNITY IN RELATION TO EXEMPT PURPOSE | PART VI | THE ORGANIZATIONS BOARD OF DIRECTORS IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATIONS PRIMARY SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION NOR FAMILY MEMBERS THEREOF THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVALEDGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY IN ADDITION THE ORGANIZATION CONTINUALLY APPLIES SURPLUS FUNDS TOWARD THE IMPROVEMENT OF PATIENT CARE SUCH AS NEW FACILITIES AND THE PURCHASE OF NEWUPDATED MEDICAL EQUIPMENT |
| COMMUNITY MEDICAL CENTER LINE NUMBER 1 PART V LINE 13G | PART V LINE 13G | REGISTRATION PERSONNEL REFERRED UNINSURED ANDOR LOW INCOME PATIENTS TO FINANCIAL COUNSELORS TO DISCUSS THE POLICY |
| COMMUNITY MEDICAL CENTER LINE NUMBER 1 PART V LINE 19D | PART V LINE 19D | THE HOSPITAL FACILITY CHARGES PATIENTS WITHOUT INSURANCE THE SAME RATES AS PATIENTS WHO HAVE INSURANCE FOR THOSE SERVICES AT THE HOSPITAL FACILITY PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE ARE GIVEN A MINIMUM OF 25 DISCOUNT ON SERVICES |
| COMMUNITY MEDICAL CENTER LINE NUMBER 1 PART V LINE 21 | PART V LINE 21 | THE HOSPITAL FACILITY CHARGES PATIENTS WITHOUT INSURANCE THE SAME RATES AS PATIENTS WHO HAVE INSURANCE FOR THOSE SERVICES AT THE HOSPITAL FACILITY PATIENTS THAT QUALIFY FOR FINANCIAL ASSISTANCE ARE GIVEN A MINIMUM OF 25 DISCOUNT ON SERVICES |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Club Dues Or Fees | X | ClubDuesOrFees |
| Written Policy Re T And E Expenses | true | WrittenPolicyReTAndEExpenses |
| Substantiation Required | true | SubstantiationRequired |
| Written Employment Contract | X | WrittenEmploymentContract |
| 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 | 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 (5 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrg | Bonus Filing OrgBonusFilingOrg | Deferred Comp Filing OrgDeferredCompFilingOrg | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Total Compensation Filing OrgTotalCompensationFilingOrg | Other Compensation Filing OrgOtherCompensationFilingOrg |
|---|---|---|---|---|---|
| RYAN LARSEN | |||||
| 136240 | 60000 | 19912 | 15659 | 231811 | |
| DAVID BORG | |||||
| 155002 | 221588 | 42884 | 15706 | 464363 | 29183 |
| HONG CUI | |||||
| 156917 | 10000 | 1578 | 13093 | 215229 | 33641 |
| SANDRA CATLIN | |||||
| 57826 | 82894 | 7949 | 15706 | 181453 | 17078 |
| CHARLES HAGEDORN | |||||
| 150016 | 7500 | 6498 | 164014 | ||
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| FRINGE OR EXPENSE EXPLANATION | SCHEDULE J, PAGE 1, PART I, LINE 1A | RYAN LARSEN, CEO - LIONS CLUB DUES 146.50, FALL CITY ROTARY CLUB 100.00 |
| COMPENSATION CONTINGENT UPON REVENUES OF ORGANIZATION | SCHEDULE J, PAGE 1, PART I, LINE 5A | PROVIDER PRODUCTIVITY BONUSES ARE CALCULATED BASED ON RURAL HEALTH CLINIC REVENUES. |
| OTHER ADDITIONAL INFORMATION | SCHEDULE J, PART III | PRODUCTIVITY BONUSES BASED ON REVENUES: DAVID BORG 107,380 SANDRA CATLIN 81,057 |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| ORGANIZATION'S PROCESS USED TO REVIEW FORM 990 | FORM 990, PAGE 6, PART VI, LINE 11B | THE FORM 990 IS REVIEWED BY THE CFO AND IS PRESENTED TO THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS FOR APPROVAL PRIOR TO FILING THE RETURN. |
| ENFORCEMENT OF CONFLICTS POLICY | FORM 990, PAGE 6, PART VI, LINE 12C | MANAGEMENT CONTINUALLY REVIEWS OFFICERS, DIRECTORS, TRUSTEES AND KEY EMPLOYEES ANNUAL DISCLOSURES AND RELATIONSHIPS WITH COMMUNITY MEDICAL CENTER TO IDENTIFY POSSIBLE CONFLICTS OF INTEREST. ONCE A CONFLICT OF INTEREST IS IDENTIFIED, THE CONFLICT WOULD BE DOCUMENTED AND MONITORED TO ENSURE APPROPRIATE ACTION IS TAKEN BASED ON THE SITUATION. |
| COMPENSATION PROCESS FOR TOP OFFICIAL | FORM 990, PAGE 6, PART VI, LINE 15A | COMPENSATION FOR THE CEO IS DETERMINED BY THE BOARD OF DIRECTORS. THE BOARD OF DIRECTORS UTILIZE INDEPENDENT PARTIES OR STUDIES OCCASIONALLY. |
| GOVERNING DOCUMENTS DISCLOSURE EXPLANATION | FORM 990, PAGE 6, PART VI, LINE 19 | GOVERNING DOCUMENTS, CONFLICTS OF INTEREST STATEMENTS, AND FINANCIAL STATEMETNS ARE NOT MADE AVAILABLE TO THE PUBLIC WITHOUT APPROVAL BY THE BOARD OF DIRECTORS. |