2025-10-27T15:04:59-05:00 2024-12-31 450250958 EIDE BAILLY LLP 18081 BURT ST STE 200 OMAHA NE 680224722 990 2024-01-01 420670596 SUMNER COMMUNITY CLUB SUMN 5635783275 PO BOX 148 SUMNER IA 506740148 DAWN EVERDING CHA/CFO 5635783275 2025-10-24 1 1 MEGAN L KOZIOL CPA P01544037 4023302660 2025-10-24 2024 2025-03-06 01:10:19Z COMMUNITY MEMORIAL HOSPITAL DAWN EVERDING PO BOX 148 SUMNER IA 506740148 19330138 0 X CMHSUMNER.ORG X 1950 IA SERVING THE AREA THROUGH HEALTHCARE AND EDUCATIONAL SERVICES. 12 12 0 30 8956 0 261295 213891 16624951 18535781 406405 385289 132019 126727 17424670 19261688 0 0 0 0 8045177 8596909 0 0 0 9759640 10840861 17804817 19437770 -380147 -176082 29463331 29666368 16579021 16655639 12884310 13010729 X THE BEST CARE WHERE AND WHEN YOU NEED IT. 0 0 12758206 11157747 REVENUE AND EXPENSES RELATING TO DEPARTMENTS THAT OPERATE WITHIN COMMUNITY MEMORIAL HOSPITAL. THESE DEPARTMENTS INCLUDE, BUT ARE NOT LIMITED TO, LABORATORY, RADIOLOGY, OPERATING AND RECOVERY ROOM, AND PHYSICAL, OCCUPATIONAL AND SPEECH THERAPY SERVICES. EACH OF THESE DEPARTMENTS PROVIDES STATISTICAL INFORMATION BASED ON VOLUME RELATED TO THE SPECIFIC SERVICE AREA AND WORKS IN CONJUNCTION WITH SERVICES PROVIDED IN THE CMH MEDICAL CLINIC, EMERGENCY DEPARTMENT AND ACUTE NURSING SERVICES. 2020566 4327640 COMMUNITY MEMORIAL HOSPITAL (CMH) MEDICAL CLINIC CONTINUED TO SERVE SUMNER, IA AND THE SURROUNDING AREA IN THE YEAR 2024. ON JANUARY 1, 2022, CMH COMPLETED THE ACQUISITION OF THE FREDERICKSBURG MEDICAL CLINIC, FORMERLY KNOWN AS FREDERICKSBURG FAMILY HEALTH CLINIC, LLC,. THIS WAS PREVIOUSLY AN INDEPENDENT PRIVATE PRACTICE WITH ONE PHYSICIAN IN THE CLINIC. CLINIC VOLUMES FOR 2024 INCLUDE VISITS FROM THIS CLINIC AS WELL. CMH CLINIC WAS STAFFED WITH 6 PROVIDERS. THE CMH CLINIC HAS TWO NURSE PRACTITIONERS AND FOUR PHYSICIANS. PATIENTS WERE SERVED IN MANY CAPACITIES INCLUDING, BUT NOT LIMITED TO, WELL CHILD VISITS, ANNUAL WELLNESS VISITS, IMMUNIZATIONS, ROUTINE PEDIATRIC CARE, SHARED MATERNITY CARE, WOUND CARE, THERAPEUTIC INJECTIONS AND MANIPULATION TREATMENTS. PATIENTS RANGED FROM NEWBORN TO GERIATRIC. A 50-MILE RADIUS OF SUMNER WAS SERVED WITH A TOTAL PATIENT VOLUME OF 18,231 FOR 2024. IN ADDITION TO CLINIC VISITS, OUR PROVIDERS CONTINUE THEIR SERVICE TO SURROUNDING NURSING HOMES AND ASSISTED LIVING FACILITIES WITH PATIENTS SEEN MONTHLY AT HILLCREST HOME IN SUMNER, MAPLECREST MANOR IN FAYETTE, TRIPOLI NURSING & REHAB IN TRIPOLI, AND COBBLESTONE ASSISTED LIVING IN SUMNER. OTHER SERVICES TO THE COMMUNITY WERE PHYSICALS FOR AREA FIREFIGHTERS AND EMS AGENCIES AND POST-JOB OFFER PHYSICALS FOR SEVEN LOCAL BUSINESSES. PROVIDERS CONTINUE TO COVER THE NEEDS OF THE EMERGENCY DEPARTMENT ON A REGULAR SCHEDULED BASIS THROUGH THE EVENING AND ON WEEKENDS EACH MONTH. INDIVIDUALS FROM THE COMMUNITY ARE ALLOWED TO WALK INTO THE CLINIC FOR FREE BLOOD PRESSURE CHECKS WHENEVER NEEDED. PROVIDERS AVIDLY PRECEPT FOR STUDENT'S VARIOUS PROGRAMS WITH CHAMBERLAIN UNIVERSITY, CHICAGO IL, AND THE UNIVERSITY OF IOWA HOSPITALS & CLINICS, IOWA CITY, IA, TAKING ADVANTAGE OF THIS IN 2024. THE CLINIC HOURS ARE MONDAY THROUGH FRIDAY 7 AM TO 5 PM. 1531573 1644944 THE CMH EMERGENCY DEPARTMENT SERVED 1,789 PATIENTS IN 2024. THIS IS A DECREASE OF 34 PATIENT VISITS FROM 1,823 VISITS IN 2023. THE NUMBER OF PHYSICIAN HOURS SPENT IN THE EMERGENCY DEPARTMENT INCREASED FROM 4,720 IN 2023 TO 4,924 IN 2024.THE EDUCATIONAL FOCUS FOR 2024 CENTERED AROUND MOCK CODES/SCENARIOS, EDUCATION AT NURSING MEETINGS, AND PRESENTATION BOARDS. THE MOCK CODES/SCENARIOS WERE COMPLETED IN PARTNERSHIP WITH THE ED PA AND NURSING LEADERSHIP. THE SUBJECTS EDUCATED ON WITH MOCK CODES THROUGHOUT 2024 WERE RESPIRATORY FAILURE, AIRWAY MANAGEMENT, FARM ACCIDENT/TRAUMA, PNEUMOTHORAX AND CHEST TUBES, CARDIAC ARREST, DROWNING, AND DECONTAMINATION. WE ALSO PARTICIPATED IN THE RURAL TRAUMA TEAM DEVELOPMENT COURSE TO WORK ON OUR TRAUMA ASSESSMENT SKILLS AND INTERVENTIONS/STABILIZATION. 2024 C.Q.I - CONTINUOUS IMPROVEMENT PROGRAM PROJECTS IN THE EMERGENCY DEPARTMENT WERE HAVING ALL DOCUMENTING TETANUS REVIEW AND STATUS, ASSESSING AND DOCUMENTING VITAL SIGNS WITHIN 15 MINUTES OF ARRIVAL, AND COMPLETING CALLBACKS TO PATIENTS WITHIN 72 HOURS. CQI PROJECTS ON THE INPATIENT FLOOR WERE COMPLETING DUAL SKIN ASSESSMENTS AND COMPLETING INPATIENT CALLBACKS WITHIN 72 HOURS.THE CQI PROJECTS IN THE SURGERY DEPARTMENT WERE COMPLETING THE GAD-7 SCREENING IF A PAIN CLINIC PATIENT HAD A POSITIVE PHQ-2 SCREENING, COMPLETING A TIME OUT PRIOR TO THE START OF A PAIN PROCEDURE, AND MAKING SURE THE ANESTHESIA PROVIDER HAD VISITED AND DOCUMENTED THEIR ASSESSMENT/NOTES PRIOR TO THE PATIENT GOING BACK TO THE OR. THE CQI GOAL FOR THE INFUSION DEPARTMENT WAS ASSESSING AND DOCUMENTING A FULL SET OF VITALS ON EACH INFUSION ENCOUNTER/PATIENT. NURSING INITIAL OR RECERTIFICATIONS INCLUDED: BLS, MOAB, HAZMAT, ACLS, PALS, TNCC, AND NRP. EDUCATION PRESENTED AT THE INPATIENT NURSES' MEETINGS IN IN 2024 INCLUDED EMTALA, CODE DOCUMENTATION/FLOWSHEET, IV EXTRAVASATION, TRAUMA ALERTS, GLIDESCOPES AND STYLETS, COLLECTING URINE FROM AN INDWELLING CATHETER, SEPSIS, SUICIDE PREVENTION, HOSPICE PATIENTS AND SERVICES, FROST BITE, AND DKA/HHS. THE SURGERY TEAM HAS WORKED ON THEIR OWN EDUCATION STRUCTURE WHICH CONSISTS OF AT LEAST 2 FULL DAYS OF EDUCATION TO HELP DEVELOP THE YOUNGER SURGERY NURSES. EDUCATION CONSISTED OF GI SCOPE PROCESSING, INSTRUMENTS, STERILE PROCESSING, PATIENT POSITIONING, AND DRAPING. COMMUNITY MEMORIAL HOSPITAL SPENT A WEEK IN MARCH WHERE THERE ARE MANY EDUCATION TOPICS PRESENTED, KNOWN TO THE STAFF AS MARCH MADNESS.IN 2024 THE TOPICS WERE BIPAP, VAPOTHERM, GLIDESCOPE/BRONCHOSCOPE, NEEDLE DECOMPRESSION, CHEST TUBES AND DRAINAGE SYSTEM, AND INTEROSSEOUS ACCESS. 1219951 1478653 ACUTE NURSING HAD 78 ADMISSIONS IN 2024. CMH UTILIZES A COMPANY CALLED MCKESSON'S CHANGE HEALTHCARE FOR QUALIFYING PATIENTS TO DETERMINE IF THEY MEET INPATIENT ADMISSION CRITERIA. THE AVERAGE LENGTH OF STAY FOR ACUTE WAS 65.20 HOURS. THIS IS WELL BELOW THE 96 HOURS THRESHOLD FOR CRITICAL ACCESS. THERE WAS A TOTAL OF 209 ACUTE PATIENT DAYS AND 368 SWING BED DAYS IN 2024. 1219951 1478653 17530296 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 8 0 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 X 12 12 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 IA X DAWN EVERDING 5635783275 909 WEST 1ST STREET PO BOX 148 SUMNER IA 50674 LONNY MILLER PHYSICIAN 40.00 0.00 X 468886 26072 57244 LUCAS BRINKMAN PHYSICIAN 40.00 0.00 X 499577 0 42909 DANIEL SCHNADT PHYSICIAN 40.00 0.00 X 450243 0 32552 SUNBIR GILL PHYSICIAN 40.00 0.00 X 384169 0 28970 DAWN EVERDING CHA/CFO 39.00 1.00 X 214398 0 33982 ANN REID PHYSICIAN'S ASSISTANT 40.00 0.00 X 144597 0 31112 DUANE HILDEBRANDT CHAIR 0.80 0.80 X X 0 0 0 PAUL BAHE VICE CHAIR 0.80 0.00 X X 0 0 0 ELAINE DAVIS SECRETARY/TREASURER 0.80 0.00 X X 0 0 0 BRENDA WINZENBURG BOARD MEMBER 0.80 0.00 X 0 0 0 DREW BAKER BOARD MEMBER 0.80 0.00 X 0 0 0 ANGELA LEETE BOARD MEMBER 0.80 0.00 X 0 0 0 DONNA MOHLIS BOARD MEMBER 0.80 0.80 X 0 0 0 DAVID SCOTT BOARD MEMBER 0.80 0.00 X 0 0 0 JERRY RENO BOARD MEMBER 0.80 0.00 X 0 0 0 KEVIN HOLTZ BOARD MEMBER 0.80 0.00 X 0 0 0 MICHELE ANDERSON BOARD MEMBER 0.80 0.80 X 0 0 0 MARIAH SCHMITZ BOARD MEMBER 0.80 0.00 X 0 0 0 PAM FRISCH BOARD MEMBER (THRU 03/24) 0.80 0.00 X 0 0 0 2161870 26072 226769 10 0 1 0 UNITYPOINT HEALTH - ALLEN MEMORIAL HOSPI PO BOX 83381 CHICAGO IL 60691 MEDICAL SERVICES 1964059 PERFORMANCE REHAB LLC 909 W 1ST ST SUMNER IA 50674 REHAB SERVICES 919303 UNITYPOINT HEALTH PO BOX 83381 CHICAGO IL 60691 IT SUPPORT/REFERENCE LAB 675195 PSYCHIATRIC MEDICAL CARE PO BOX 734606 DALLAS TX 753734606 SENIOR LIFE SOLUTIONS SERVICES 529351 IOWA ANESTHESIA PO BOX 1665 CEDAR RAPIDS IA 52406 ANESTHESIA SERVICES 336222 12 197491 16400 213891 PATIENT SERVICE REVENUE 621400 17939284 17939284 340B INCOME 621990 578245 578245 COMMUNITY WELLNESS 621990 1970 1970 16282 16282 18535781 453739 453739 73203 0 73203 73203 73203 68450 -68450 -68450 -68450 CAFETERIA EMPLOYEES 900099 44568 44568 CATERING 722320 8956 8956 53524 19261688 18608984 8956 429857 X 248677 248677 6321661 5846385 475276 1539772 1389147 150625 486799 435301 51498 100000 100000 19000 19000 75959 75959 5188688 5033048 155640 30399 30399 618961 561997 56964 267412 229623 37789 48103 35374 12729 607444 601172 6272 1220691 1208086 12605 128917 127586 1331 MEDICAL SUPPLIES 1850632 1850133 499 DUES AND SUBSCRIPTIONS 560509 101441 459068 FOOD 68581 68581 FRIENDS EXPENSES 47328 42104 5224 8237 318 7919 19437770 17530296 1907474 0 200 200 13126734 14411388 1632347 1588501 263568 265599 343940 235747 23985452 17360473 7603986 6624979 4733169 5035670 1759387 1504284 29463331 29666368 1121448 1674682 15037155 14709028 420418 271929 16579021 16655639 X 8151141 7975059 4733169 5035670 12884310 13010729 29463331 29666368 -176082 302501 0 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1958 1958 0 PART II-B, LINE 1: THE HOSPITAL PAID DUES TO THE IOWA HOSPITAL ASSOCIATION AND THE AMERICAN HOSPITAL ASSOCIATION. A PORTION OF THE DUES WERE USED FOR LOBBYING ACTIVITIES. 4733169 302501 5035670 4561169 172000 4733169 4884647 -323478 4561169 4002704 881943 4884647 3939855 62849 4002704 0.00000 1.00000 0.00000 0 1 1 100421 100421 14263904 9453763 4810141 7498463 6239186 1259277 2122664 1667524 455140 6624979 PENNINGTON TRST ASST-LT 5035670 C 5035670 OTHER RECEIVABLES 1019103 RIGHT OF USE ASSETS 271903 ESTIMATED THIRD-PARTY PAYOR SETTLEM 213278 1504284 CAPITAL LEASE OBLIGATIONS 271929 271929 X PART V, LINE 4: THE HOSPITAL IS BENEFICIARY OF A DONOR CREATED PERPETUAL TRUST. ASSETS HELD BY THE TRUST INCLUDE CASH AND CASH EQUIVALENTS, CDS, EQUITIES, AND FARMLAND. A PROVISION OF THE TRUST REQUIRES THAT INCOME EARNED BE DISTRIBUTED AT LEAST ANNUALLY TO THE HOSPITAL. INCOME DISTRIBUTIONS FROM THE TRUST ARE UNRESTRICTED AND CAN BE USED FOR ANY PURPOSE DEEMED BENEFICIAL. IN 2015, THE GRAIN, LIVESTOCK AND EQUIPMENT THAT WERE PREVIOUSLY HELD BY THE TRUST WERE LIQUIDATED IN FULL AND THE FARMLAND IS BEING OPERATED ON A CASH BASIS RENTAL AGREEMENT. PART X, LINE 2: THE HOSPITAL AND FOUNDATION ACCOUNT FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC TOPIC 740, INCOME TAXES. THE HOSPITAL AND FOUNDATION RECOGNIZE THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2024 AND 2023, THE HOSPITAL AND FOUNDATION HAD NO UNCERTAIN TAX POSITIONS ACCRUED. 1 1 X 1 X 1 X 600.000000000000 1 1 0 1 1 14900 14900 0.00080 2016675 2016675 76697 61911 14786 0.00080 2108272 2078586 29686 0.00160 55590 31019 24571 0.00130 103572 103572 0.00530 186105 53705 132400 0.00680 27300 4000 23300 0.00120 372567 88724 283843 0.01460 2480839 2167310 313529 0.01620 1 226638 27650 6355986 6452533 -96547 X 1 1 1 1 SUMNER COMMUNITY CLUB DBA COMMUNITY MEMORIAL HOSP 909 W 1ST ST PO BOX 148 SUMNER IA 50674 CMHSUMNER.ORG 090086H X X X PROVIDER-BASED MEDICAL CLINIC COMMUNITY MEMORIAL HOSPITAL 1 0 0 1 X X X X X X X X X 22 1 1 1 1 X HTTPS://WWW.CMHSUMNER.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS X 1 22 1 HTTPS://WWW.CMHSUMNER.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS 0 1 X 200.000000000000 600.000000000000 X 1 1 X X X X 1 X HTTPS://WWW.CMHSUMNER.ORG/PATIENTS/FINANCIAL-ASSISTANCE X HTTPS://WWW.CMHSUMNER.ORG/PATIENTS/FINANCIAL-ASSISTANCE X HTTPS://WWW.CMHSUMNER.ORG/PATIENTS/FINANCIAL-ASSISTANCE X X X X X 1 X 0 X X X X 1 X 0 0 COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: THE 27-QUESTION SURVEY OPPORTUNITY WAS PUBLICIZED IN AREA NEWSPAPERS AND ONLINE. THE MEDIA RELEASE WAS SENT OUT TO PRINT, RADIO, CABLE AND TELEVISION CONTACTS. IN ADDITION, EMAILS WERE SENT WITH A LINK TO THE SURVEY (OR HARD COPY WAS MADE AVAILABLE) TO AREA CHURCHES, AREA SCHOOL CONTACTS, AND ORGANIZATIONS. THERE WERE 145 INDIVIDUALS THAT RESPONDED TO THE NEEDS ASSESSMENT SURVEY THAT WAS CONDUCTED. THIS SURVEY SAMPLE REPRESENTED A SMALL CROSS-SECTION OF THE POPULATION AREAS IN THE COMMUNITIES INCLUDED IN THE ASSESSMENT. THE SERVICE AREA THAT WAS SURVEYED INCLUDED 3 COUNTIES THAT ARE ALL SERVED BY THE HOSPITALS AND AGENCIES THAT COLLABORATED IN THE NEEDS ASSESSMENT PROCESS. COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6A: WAVERLY HEALTH CENTER, WAVERLY, IA COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: BREMER COUNTY PUBLIC HEALTH AND WAVERLY-SHELL ROCK AREA UNITED WAY COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE BOARD OF DIRECTORS REVIEWED THE LIST OF NEEDS IDENTIFIED AND THE NUMBER OF RESPONSES RECEIVED FOR EACH INDIVIDUAL NEED. THROUGH THIS REVIEW PROCESS, THE BOARD OF DIRECTORS IDENTIFIED FOUR NEEDS TO FOCUS ON AND CREATED AN IMPLEMENTATION PLAN TO ADDRESS THE NEEDS. THE NEEDS THAT HAVE BEEN CHOSEN TO ADDRESS INCLUDE: ACCESS TO HEALTHCARE, CHRONIC DISEASE MANAGEMENT, WELLNESS INITIATIVES, AND ACCESS TO MENTAL HEALTH SERVICES. THE BOARD OF DIRECTORS HAS ACKNOWLEDGED THAT THESE NEEDS FALL WITHIN THE SCOPE OF THE MISSION AND EACH COVERS A BROAD SPECTRUM AND OFFERS ONGOING OPPORTUNITIES FOR IMPROVEMENT. THE BOARD OF DIRECTORS IS COMMITTED TO THE SUCCESS AND SUSTAINABILITY OF QUALITY LOCAL HEALTHCARE AND PLACING A FOCUS ON THESE NEEDS HELPS ACHIEVE THIS. COMMUNITY MEMORIAL HOSPITAL HAS INCLUDED FUNDS IN THE OPERATING BUDGET TO CONTINUE TO SUPPORT THE NEEDS ASSESSMENT MOVING FORWARD.IN THE CURRENT YEAR, THE FACILITY HAS TAKEN THE FOLLOWING ACTIONS TO ADDRESS THE NEEDS AS:1. ACCESS TO HEALTHCARE A. SPECIALTY SERVICES FOR GASTROENTEROLOGY WERE RESTARTED IN 2024. DUE TO PROVIDER UNAVAILABILITY IN THE CONTRACT PROVIDER GROUP, THIS SPECIALTY WAS NOT AVAILABLE IN OUR FACILITY IN 2023. B. FINAL ONBOARDING OF 3 NEW PHYSICIANS IN CMH MEDICAL CLINIC AFTER THE DEPARTURE OF ONE OF THE PRIMARY PHYSICIANS IN SEPTEMBER 2022. THIS DEPARTURE RESULTED IN MORE CONCERNS SHOWING UP WITH PATIENT ACCESS IN THE CLINIC.2. CHRONIC DISEASE MANAGEMENT A. WELLNESS LAB TESTING CONTINUES TO BE ACCESSIBLE TO THE COMMUNITY TO RECEIVE EXAMS TO BE DONE AND NOT REQUIRING A PHYSICIAN ORDER. THE RESULTS ARE PROVIDED TO THE PATIENT AND PRIMARY CARE PROVIDERS AS REQUESTED. B. CONTINUATION OF DIABETIC EDUCATION WAS OFFERED THROUGH THE CMH MEDICAL CLINIC. WE WERE ABLE TO ACCESS REGISTERED DIETICIAN CONSULTATION SERVICES THROUGH TELEHEALTH OPPORTUNITIES WITH UNITYPOINT HEALTH WATERLOO/MARSHALLTOWN. THIS PROVIDED LOCAL COVERAGE TO PATIENTS WITH CHRONIC DIABETIC DISEASE MANAGEMENT AND AFFORDED THE OPPORTUNITY FOR PATIENTS WITH A NEW DIAGNOSIS IN THE SAME AREA. 3. WELLNESS INITIATIVES A. WELLNESS LAB 'CLINICS' WERE EXTENDED TO OUTSIDE COMMUNITIES. THE SAME WELLNESS LAB OPTIONS ARE AVAILABLE WITHIN THE HOSPITAL PROPER AND THESE ADDITIONAL SITES ALLOWED MORE PARTICIPATION FROM THOSE COMMUNITIES. THIS INCLUDED DRAWS IN TRIPOLI AND HILLCREST HOME (LONG-TERM CARE FACILITY) IN SUMNER. B. DIETICIAN LEAD TELEHEALTH MEDICAL NUTRITION THERAPY (MNT) WAS OFFERED AS AN ADDITIONAL OPTION FOR PATIENTS TO PROVIDE NUTRITIONAL ASSESSMENTS, GOAL SETTING, TAILORED NUTRITION PLAN AND FOLLOW-UP VISITS TO MONITOR PROGRESS. THIS SERVICE WAS OFFERED TO PATIENTS MEETING CERTAIN CRITERIA TO BECOME HEALTHIER AND MANAGE MEDICAL CONDITIONS.4. ACCESS TO MENTAL HEALTH SERVICES A. LICENSED MENTAL HEALTH COUNSELOR (THERAPIST) WAS ONBOARDED AS PART OF THE CMH MEDICAL CLINIC TEAM IN SEPTEMBER. IN ADDITION, AN ARNP FROM THE CMH MEDICAL CLINIC WAS IN HER FINAL CLINICAL ROTATIONS FOR A POST MASTER'S CERTIFICATION IN BEHAVIORAL HEALTH. THE THERAPIST IS FULLY DEDICATED TO OFFERING MENTAL HEALTH COUNSELING AND THE ARNP HAS A DESIGNATED DAY WITHIN HER FAMILY PRACTICE PATIENTS TO SEE MENTAL HEALTH PATIENTS. THESE SERVICES WERE IMPLEMENTED FULLY BY OCTOBER 2024. THE MOST RECENT CHNA INDICATED THE NEED FOR HOME HEALTH SERVICES IN THE COMMUNITY THE ORGANIZATION WILL NOT ADDRESS THIS SPECIFIC NEED DUE TO BUDGET CONSTRAINTS AND COVERAGE BEING OFFERED BY MULTIPLE OTHER ORGANIZATIONS IN THE SURROUNDING COMMUNITIES. OUR FACILITY IS NOT EQUIPPED TO MANAGE THIS SERVICE LINE IN ADDITION TO MAINTAINING THE CURRENT STRUCTURE AND SERVICES THAT ARE ALREADY PROVIDED. COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 15E: COMMUNITY MEMORIAL HOSPITAL PATIENT STATEMENTS INCLUDE INFORMATION ON HOW TO MAKE APPLICATION FOR FINANCIAL ASSISTANCE. IN ADDITION TO THE STANDARD INFORMATION, COMMUNITY MEMORIAL HOSPITAL ALSO HAS A DESIGNATED STAFF MEMBER THAT MONITORS PATIENT ACCOUNTS THAT ARE RECEIVING A SECOND OR THIRD STATEMENT. THIS STAFF MEMBER MAKES CONTACT WITH THE INDIVIDUAL PATIENTS TO DETERMINE IF A FINANCIAL ASSISTANCE APPLICATION SHOULD BE MAILED OUT FOR COMPLETION. THE FINANCIAL ASSISTANCE APPLICATION PROVIDES A LISTING OF THE INFORMATION THAT WILL BE NEEDED IN ORDER TO PROCEED WITH ITS REVIEW. 2 1 - CMH MEDICAL CLINIC 909 WEST 1ST STREET PO BOX 148 SUMNER IA 50674 MEDICAL CLINIC 2 - FREDERICKSBURG MEDICAL CLINIC 115 SCHULT RIDGE RD FREDERICKSBURG IA 50630 MEDICAL CLINIC PART I, LINE 3C: IN ADDITION TO FEDERAL POVERTY GUIDELINES, THE ORGANIZATION USES ASSET LEVEL TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. PART I, LINE 6A: THE REPORT IS PREPARED BY THE STAFF OF COMMUNITY MEMORIAL HOSPITAL. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. UNREIMBURSED MEDICAID ON LINE 7B, WAS CALCULATED USING THE COSTING METHODS TO PREPARE THE COST REPORTS. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION, LINE 7F, SUBSIDIZED HEALTH SERVICES, LINE 7G, AND CASH AND IN-KIND CONTRIBUTIONS FOR COMMUNITY BENEFIT, LINE 7I, ARE REPORTED BASED ON ACTUAL EXPENSES REPORTED IN THE GENERAL LEDGER. PART I, LINE 7G: NO COSTS ASSOCIATED WITH PHYSICIAN CLINICS WERE INCLUDED. PART II, COMMUNITY BUILDING ACTIVITIES: COMMUNITY MEMORIAL HOSPITAL DID NOT REPORT ANY COMMUNITY BUILDING ACTIVITIES IN PART II OF SCHEDULE H. PART III, LINE 2: THE AMOUNT ON LINE 2 REPRESENTS IMPLICIT PRICE CONCESSIONS. THE CONCESSIONS REFLECT MANAGEMENT'S ESTIMATE OF AMOUNTS THAT WILL NOT BE COLLECTED IN THE FUTURE AND ARE BASED ON REVIEWS OF PATIENT BALANCES BY PAYER CLASSES. PERCENTAGES ARE APPLIED TO EACH PAYER CLASS BASED ON CONTRACTUAL AGREEMENTS AND HISTORICAL COLLECTION AND RECOVERY INFORMATION TO DETERMINE THAT NET REALIZABLE VALUE OF THE PATIENT RECEIVABLES. PART III, LINE 3: THE ESTIMATED AMOUNT OF THE ORGANIZATION'S IMPLICIT PRICE CONCESSIONS ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN APPROXIMATE 12.2% OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL IN THE SERVICE AREA. PART III, LINE 4: THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES IMPLICIT PRICE CONCESSIONS IS LOCATED IN FOOTNOTE 1 ON PAGES 12 AND 13 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: THE ENTIRE MEDICARE SHORTFALL IS CONSIDERED A COMMUNITY BENEFIT. SERVICES ARE PROVIDED TO PATIENTS UNDER THE MEDICARE PROGRAM EVEN THOUGH THE HOSPITAL KNOWS THEY WILL NOT RECOVER ALL OF THE COSTS FROM PROVIDING THE SERVICES. THIS PROGRAM IS CONSIDERED SUBSIDIZED BY THE HOSPITAL AND OTHER PAYORS. PATIENTS RELY ON THESE SERVICES FOR THEIR HEALTH AND WELL-BEING AND ARE ESSENTIAL FOR THEIR ACCESS TO HEALTHCARE. TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. THE MEDICARE COST REPORT IS COMPLETED BASED ON THE RULES AND REGULATIONS SET FORTH BY CENTERS FOR MEDICARE AND MEDICAID SERVICES. PART III, LINE 9B: COMMUNITY MEMORIAL HOSPITAL'S COLLECTIONS POLICY STATES THAT THE HOSPITAL WILL "REFRAIN FROM INITIATING EXTRAORDINARY COLLECTION ACTIONS FOR 120 DAYS FROM THE DATE OF THE PATIENT'S FIRST POST DISCHARGE BILLING STATEMENT" IF ELIGIBILITY FOR FINANCIAL ASSISTANCE IS UNDETERMINED. IN ADDITION, "IF THE PATIENT SUBMITS A COMPLETE FINANCIAL ASSISTANCE APPLICATION AT ANY TIME WITHIN THE APPLICATION PERIOD, THE HOSPITAL MUST SUSPEND ANY EXTRAORDINARY COLLECTION ACTIONS, DETERMINE THE ELIGIBILITY, AND NOTIFY THE PATIENT". ONCE A DECISION IS MADE ON THE FINANCIAL ASSISTANCE APPLICATION, COLLECTION EFFORTS WILL STOP IF IT IS APPROVED OR CONTINUE WHERE THE EFFORTS LEFT OFF IF THE APPLICATION IS DECLINED. PART VI, LINE 2: COMMUNITY MEMORIAL HOSPITAL COMPLETED THE CHNA PROCESS IN 2022. THE CHNA IS CURRENTLY POSTED ON THE HOSPITAL WEBSITE (CMHSUMNER.ORG/ABOUT/COMMUNITY-HEALTH-NEEDS-ASSESSMENTS). THE FOUR AREAS OF FOCUS CHOSEN BY COMMUNITY MEMORIAL HOSPITAL FROM THE CHNA INCLUDE: ACCESS TO HEALTHCARE, CHRONIC DISEASE MANAGEMENT, WELLNESS INITIATIVES, AND ACCESS TO MENTAL HEALTH SERVICES. MANY OF THE BOARD OF DIRECTORS ARE INVOLVED IN VARIOUS GROUPS AND BUSINESSES IN THE COMMUNITY AND RECEIVE INPUT FROM COMMUNITY MEMBERS. THIS COMMUNITY INVOLVEMENT IS INCREASED WITH ANOTHER GROUP OF INDIVIDUALS WHO ARE INVOLVED IN THE HOSPITAL AUXILIARY AND FOUNDATION. IN A SMALLER TOWN, PEOPLE ARE AWARE OF WHO SERVES ON THE HOSPITAL BOARD AND FOUNDATION BOARDS, IN THE AUXILIARY AND HOSPITAL ADMINISTRATION. COMMUNITY MEMBERS FEEL COMFORTABLE APPROACHING THEM WITH THE NEEDS THAT THEY SEE AS A BENEFIT TO THE COMMUNITY, SUCH AS, IMPROVING ACCESS TO SPECIALIST SERVICES WITH INCREASED OFFERINGS OF OUTPATIENT CLINICS WITHIN THE HOSPITAL.THE HOSPITAL SEES ITS ROLE AS CARE OF ILLNESS BUT ALSO IMPROVEMENT OF HEALTH AND WELLNESS. IN REGARD TO THESE GOALS, ALMOST MONTHLY THERE ARE OPPORTUNITIES FOR EDUCATION ON VARIOUS HEALTH TOPICS OFFERED IN THE COMMUNITY. THE HOSPITAL ADDITIONALLY SPONSORS LOCAL INDUSTRY-HOSTED HEALTH FAIRS AND COMMUNITY WELLNESS TESTING. THE WELLNESS TESTING OFFERINGS HAVE SEEN INCREASING PARTICIPATION BY COMMUNITY MEMBERS AND PRESENT THE OPPORTUNITY FOR ADDITIONAL COMMUNITY INPUT.AS THE HOSPITAL PLANNED FOR THE NEW REPLACEMENT FACILITY, A GREAT DEAL OF PREPARATION WORK WAS DONE TO BE SURE TO BUILD FOR THE PRESENT NEEDS AS TO HEALTH SERVICES BUT TO ALSO MAKE SURE THAT WE CAN ADDRESS FUTURE NEEDS. WE KNEW THAT DIAGNOSTIC SERVICES WOULD BE AN INCREASING FOCUS AS TO STANDARDS OF CARE. PART VI, LINE 3: CMH HAS A PAYMENT BROCHURE THAT IS LOCATED AT THE REGISTRATION DESK FOR ALL PATIENTS TO TAKE WITH THEM EXPLAINING OUR PAYMENT TERMS AND THE AVAILABILITY OF FINANCIAL ASSISTANCE. THERE IS ALSO AN AREA ON THE STATEMENTS SENT TO PATIENTS THAT ALLOWS FOR MESSAGES TO BE PRINTED. THE MESSAGE INDICATES THE AVAILABILITY FOR ASSISTANCE FOR THOSE WHO QUALIFY. IN ADDITION, A DESIGNATED STAFF MEMBER WORKS DIRECTLY WITH PATIENTS WITH OPEN ACCOUNT BALANCES TO PROVIDE PAYMENT PLANS, FINANCIAL ASSISTANCE APPLICATIONS OR ADDITIONAL INSURANCE COVERAGE POSSIBILITIES. PART VI, LINE 4: CMH'S PRIMARY SERVICE AREA CONSISTS OF CITIES FROM THE FOLLOWING SEVEN ZIP CODES, WHICH INCLUDE SUMNER (50674), FREDERICKSBURG (50630), NEW HAMPTON (50659), TRIPOLI (50676), HAWKEYE (52147), WESTGATE (50681) AND LAWLER (52154). THE COMMUNITIES THAT ARE INCLUDED IN THE CMH SERVICE AREA PRIMARILY CONSIST OF FARMING BACKGROUNDS AND RURAL AREAS. THE PRIMARY POPULATION IS LOCATED IN A RURAL SETTING WITH SUMNER BEING THE LARGEST CITY WITH A POPULATION OF APPROXIMATELY 2,000. PART VI, LINE 5: COMMUNITY MEMORIAL HOSPITAL (CMH) IS A PILLAR IN THE COMMUNITY AND STRIVES TO BE A STRONG COMMUNITY PARTNER. CMH CONTINUES TO REACH OUT AND PARTNER WITH THE COMMUNITY IN MANY AREAS. CMH HELPS TO PROMOTE HEALTH AND WELLNESS BY SUPPORTING COMMUNITY GROUPS AND INITIATIVES AND CONSISTENTLY OFFERS "HEALTH HIGHLIGHTS," WHICH PROVIDE FREE EDUCATION ON VARIOUS HEALTH-RELATED TOPICS. CMH CONTINUES TO HELP COORDINATE AND PLAN PREPAREDNESS TRAINING AND DRILLS FOR THE COMMUNITY, WORKING WITH SEVERAL LOCAL AND COUNTY AGENCIES. THE RELATIONSHIPS AND COLLABORATION CREATED IS BENEFICIAL FOR ALL INVOLVED AND THE RESIDENTS WE SERVE. IN ADDITION, HOSPITAL PREPAREDNESS STAFF HAVE PARTNERED WITH COUNTY RESOURCES TO INTRODUCE ALICE TRAINING TO AREA BUSINESSES. LASTLY, CRITICAL INCIDENT STRESS DEBRIEFING (CISD) TRAINED STAFF HAVE BEEN UTILIZED ON MULTIPLE OCCASIONS TO LEAD DEBRIEFINGS FOR AREA EMERGENCY RESPONSE AGENCIES FOLLOWING FIRES, DEATHS, ETC. PART VI, LINE 6: COMMUNITY MEMORIAL HOSPITAL IS NOT PART OF AN AFFILIATED HEALTH CARE SYSTEM. PART VI, LINE 7, REPORTS FILED WITH STATES IA X 0 1 0 0 0 0 0 0 0 LONNY MILLER PHYSICIAN 468886 26072 0 0 0 0 21660 840 34462 2064 525008 28976 0 0 LUCAS BRINKMAN PHYSICIAN 427249 0 72328 0 0 0 22500 0 22173 0 544250 0 0 0 DANIEL SCHNADT PHYSICIAN 450243 0 0 0 0 0 22500 0 11414 0 484157 0 0 0 SUNBIR GILL PHYSICIAN 384169 0 0 0 0 0 22403 0 7918 0 414490 0 0 0 DAWN EVERDING CHA/CFO 205433 0 8965 0 0 0 11283 0 22996 0 248677 0 0 0 ANN REID PHYSICIAN'S ASSISTANT 144597 0 0 0 0 0 7488 0 24239 0 176324 0 0 0 PART I, LINE 3 THE ORGANIZATION IS JOINTLY OPERATED WITH UNITYPOINT HEALTH - WATERLOO, ALLEN HEALTH SYSTEM. THE CEO OF UNITYPOINT HEALTH IS RESPONSIBLE FOR SETTING THE SALARY FOR THE CHIEF HOSPITAL ADMINISTRATOR/CFO OF CMH. THE CEO OF UNITYPOINT HEALTH-WATERLOO, ALLEN HEALTH SYSTEM USES SALARY SURVEY INFORMATION FROM THE IOWA HOSPITAL ASSOCIATION TO DETERMINE A REASONABLE RANGE FOR THE CHIEF HOSPITAL ADMINISTRATOR/CFO'S COMPENSATION. PART I, LINE 4B DAWN EVERDING, CHIEF HOSPITAL ADMINISTRATOR/CFO, DEFERRED $23,000 TO A NONQUALIFIED 457(B) PLAN DURING THE YEAR. FORM 990, PART V, LINE 2A: ALL CMH EMPLOYEES ARE EMPLOYEES OF UNITYPOINT HEALTH - WATERLOO (FORMERLY ALLEN HEALTH SYSTEMS). UNITYPOINT HEALTH - WATERLOO COMPLETES ALL PAYROLL FUNCTIONS AND CMH REIMBURSES UNITYPOINT HEALTH - WATERLOO FOR ALL WAGE AND BENEFIT EXPENSES INCURRED. FORM 990, PART VI, SECTION A, LINE 1A THE EXECUTIVE COMMITTEE, CONSISTING OF THE BOARD CHAIRMAN, VICE-CHAIRMAN, AND THE SECRETARY-TREASURER, HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION A, LINE 3 THE ORGANIZATION HAS AN EXTENDED MANAGEMENT CONTRACT WITH UNITYPOINT HEALTH - WATERLOO, FORMALLY KNOWN AS ALLEN HEALTH SYSTEMS. FORM 990, PART VI, SECTION A, LINE 6 THE ORGANIZATION'S ARTICLES OF INCORPORATION PROVIDE THAT THE CORPORATION "HAS NO CAPITAL STOCK AND THE CAPITAL OF THIS ASSOCIATION SHALL BE THE MEMBERSHIP FEES. . . FIXED BY THE BOARD OF DIRECTORS". ANYONE IN THE COMMUNITY MAY BE A MEMBER OF THE CORPORATION UPON PAYMENT OF THE $1 MEMBERSHIP FEE, AS FIXED BY THE BOARD OF DIRECTORS ACCORDING TO THE BYLAWS. THE ORGANIZATION'S MEMBERS ELECT THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7A EACH BOARD OF DIRECTOR SHALL BE ELECTED BY THE LARGEST VOTE CAST BY THE MEMBERS PRESENT AT THE ANNUAL MEETING. ABSENTEE BALLOTS WILL BE ALLOWED FOR EMPLOYEES WORKING AT COMMUNITY MEMORIAL HOSPITAL DURING THE ACTUAL HOURS OF THE ANNUAL MEETING. FORM 990, PART VI, SECTION A, LINE 7B IN 2003, COMMUNITY MEMORIAL HOSPITAL (CMH) ENTERED INTO AN OPERATING AGREEMENT WITH ALLEN HEALTH SYSTEM (AHS), NOW REFERRED TO AS UNITYPOINT HEALTH - WATERLOO. UNDER THE TERMS OF THAT AGREEMENT, A JOINT GOVERNANCE STRUCTURE WAS ESTABLISHED, WHEREBY UNITYPOINT HEALTH AND THE BOARD OF DIRECTORS OF CMH EXERCISE JOINT AUTHORITY FOR THE OPERATION OF THE HOSPITAL. WHILE UNITYPOINT HEALTH HAS DAY-TO-DAY OPERATIONAL CONTROL, CERTAIN GOVERNANCE AUTHORITY ACTIONS REQUIRE THE PARTICIPATION OF BOTH UNITYPOINT'S AND CMH'S BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 11B THE IRS FORM 990 IS PRESENTED TO THE CMH BOARD OF DIRECTORS AT A REGULARLY SCHEDULED MONTHLY MEETING FOR REVIEW. IT WILL BE NOTED AS AN AGENDA ITEM UNDER "INFORMATIONAL/ACTION AND REQUIRES THE PROPER APPROVAL FROM THE BOARD PRIOR TO BEING SUBMITTED TO THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE BOARD OF DIRECTORS AND KEY EMPLOYEES ARE REQUIRED TO ANNUALLY COMPLETE A CONFLICT OF INTEREST DISCLOSURE/QUESTIONNAIRE. THESE ARE REVIEWED BY THE CEO AND BOARD CHAIR. EACH MONTH THERE IS AN AGENDA ITEM AT THE BOARD MEETING FOR ANY CONFLICTS RELATED TO THE REST OF THE AGENDA TO BE DISCLOSED. IF NONE ARE NOTED, BUT THE BOARD CHAIR FEELS ONE EXISTS, IT IS THE CHAIR'S RESPONSIBILITY TO INQUIRE ABOUT IT BEFORE PROCEEDING. WHEN THERE IS A CONFLICT OF INTEREST, THE PERSON WITH THE CONFLICT ABSTAINS FROM VOTING. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION IS JOINTLY OPERATED WITH UNITYPOINT HEALTH WATERLOO, FORMERLY KNOWN AS ALLEN HEALTH SYSTEM. THE CEO OF UNITYPOINT HEALTH IS RESPONSIBLE FOR SETTING THE SALARY FOR THE CHIEF HOSPITAL ADMINISTRATOR/CHIEF FINANCIAL OFFICER OF CMH. THE CEO OF ALLEN HEALTH SYSTEMS USES SALARY SURVEY INFORMATION FROM THE IOWA HOSPITAL ASSOCIATION TO DETERMINE A REASONABLE RANGE FOR THE CHIEF HOSPITAL ADMINISTRATOR/CFO'S COMPENSATION. THE CMH CHIEF HOSPITAL ADMINISTRATOR/CFO IS RESPONSIBLE FOR SETTING THE SALARIES OF MADISON SCHWEER, MANAGER OF NURSING SERVICES, SHEILA UHLENHAKE, DIRECTOR OF OPERATIONS AND BETH HAUSER, DIRECTOR OF CLINICAL SERVICES. COMPARABILITY DATA IS ALSO USED IN SETTING THE OFFICERS AND KEY EMPLOYEES' COMPENSATION . FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. HOWEVER, FINANCIAL STATEMENTS ARE MADE AVAILABLE AT THE SUMNER COMMUNITY CLUB MEETING AND A PERSON MAY BECOME A MEMBER OF THE SUMNER COMMUNITY CLUB BY PAYING THE $1 ANNUAL MEMBERSHIP FEE. FORM 990, PART IX, LINE 11G OUTSIDE SERVICES: PROGRAM SERVICE EXPENSES 2,720,194. MANAGEMENT AND GENERAL EXPENSES 155,640. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,875,834. EMERGENCY ROOM SPECIALIST FEES: PROGRAM SERVICE EXPENSES 1,165,255. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,165,255. PHYSICAL THERAPY FEES: PROGRAM SERVICE EXPENSES 725,495. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 725,495. ANESTHESIOLOGIST FEES: PROGRAM SERVICE EXPENSES 348,101. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 348,101. LAB FEES: PROGRAM SERVICE EXPENSES 74,003. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 74,003. FORM 990, PAGE 12, PART XII, LINE 2C: THERE HAVE BEEN NO CHANGES FROM THE PRIOR YEAR. THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY OF SELECTING THE INDEPENDENT ACCOUNTANT TO COMPLETE THE AUDIT WORK. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE BOARD OF DIRECTORS. FRIENDS OF CMH SUMNER COMMUNITY MEMORIAL HOSPITAL FOUNDATION 909 W 1ST STREET SUMNER IA 50674 421408693 HOSPITAL FOUNDATION IA 501(C)(3) LINE 7 SUMNER COMMUNITY CLUB 1 CHARITABLE TRUST TRUST IA SUMNER COMMUNITY CLUB 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 CHARITABLE TRUST C 137526 CASH TRANSFERRED EQUALS FMV FRIENDS OF CMH SUMNER COMMUNITY MEMORIAL HOSPITAL FOUNDATION C 59965 CASH TRANSFERRED EQUALS FMV