MERCY HOSPITAL INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- MERCY HOSPITAL INC (EIN 48-0663711)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-07-07
- IRS object ID
- 202331889349301008
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-07-07T11:04:43-05:00 | ReturnTs |
| Tax Period End | 2022-09-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | FORVIS LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 672066601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-10-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480663711 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % AARON HERBEL | InCareOfNm |
| Business Name Control | MERC | BusinessNameControlTxt |
| Phone | 6203456391 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 180 | AddressLine1Txt |
| City | MOUNDRIDGE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67107 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AARON J HERBEL | PersonNm |
| Person Title | ADMINISTRATOR | PersonTitleTxt |
| Phone | 6203456391 | PhoneNum |
| Signature | 2023-08-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | AARON J | PersonFirstNm |
| Person Last | HERBEL | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNELL LINOT | PreparerPersonNm |
| PTIN | P01663908 | PTIN |
| Phone | 3162652811 | PhoneNum |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 2 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | TaxYr |
| Build TS | 2023-04-26 12:10:37Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | AARON HERBEL | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 218 E PACK ST | AddressLine1Txt |
| City | MOUNDRIDGE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $4,389,409 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Group Exemption | 1971 | GroupExemptionNum |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.MERCYH.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | TO MEET THE HEALTHCARE NEEDS OF THOSE LIVING IN MOUNDRIDGE, KANSAS AND SURROUNDING RURAL AREAS REGARDLESS OF AGE, RACE, ETHNICITY, OR ECONOMIC STATUS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 12 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 11 | VotingMembersIndependentCnt |
| Total Employee | 70 | TotalEmployeeCnt |
| Total Volunteers | 18 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $2,678,767 | PYContributionsGrantsAmt |
| CY Contributions Grants | $1,391,110 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $3,353,222 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $2,976,696 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$4,738 | PYInvestmentIncomeAmt |
| CY Investment Income | $1,000 | CYInvestmentIncomeAmt |
| PY Other Revenue | $12,706 | PYOtherRevenueAmt |
| CY Other Revenue | $16,503 | CYOtherRevenueAmt |
| PY Total Revenue | $6,039,957 | PYTotalRevenueAmt |
| CY Total Revenue | $4,385,309 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,000 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,213,586 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,780,700 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $2,302,220 | PYOtherExpensesAmt |
| CY Other Expenses | $2,432,866 | CYOtherExpensesAmt |
| PY Total Expenses | $4,515,806 | PYTotalExpensesAmt |
| CY Total Expenses | $5,223,566 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,524,151 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$838,257 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $3,427,687 | TotalAssetsBOYAmt |
| Total Assets EOY | $4,051,682 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $158,081 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,620,333 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,269,606 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,431,349 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO PROVIDE HEALTH CARE SERVICES TO PERSONS IN MOUNDRIDGE, KANSAS AND THE SURROUNDING RURAL AREAS. WE, THE STAFF AT MERCY BELIEVE THAT PAUL'S INJUNCTION: BY LOVE SERVE ONE ANOTHER, SHOULD BE THE BASIS OF OUR SERVICE HERE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $4,217,832 | ExpenseAmt |
| Grant | $10,000 | GrantAmt |
| Revenue | $3,125,377 | RevenueAmt |
| Desc | MERCY HOSPITAL, INC., HAS CONTINUED TO SERVE THE MOUNDRIDGE COMMUNITY SINCE 1944, WITH ACUTE CARE, SWING BED AND RESPITE SERVICES, LAB, RADIOLOGY, AND SURGERY, INPATIENT AND OUTPATIENT PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPY, AND 24-HOUR EMERGENCY ROOM. OUR MEDICAL STAFF CONSISTS OF SIX FAMILY-PRACTICE PHYSICIANS AND FOUR PHYSICIAN ASSISTANTS. SCHEDULE O FOR CONTINUATION. | Desc |
| Total Program Service Expenses | $4,217,832 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | Yes (true) | GrantsToIndividualsInd |
| Schedule J Required | false | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 6 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 70 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 12 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 11 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | false | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | AARON HERBEL | PersonNm |
| Phone | 6203456391 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 218 E PACK ST | AddressLine1Txt |
| City | MOUNDRIDGE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|
| AARON HERBEL | |||||||
| ADMINISTRATOR AND CFO | 40.0 | 0.0 | Yes (X) | $76,295 | $0 | $5,386 | |
| ARLIS RATZLAFF | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| LAVERN NIKKEL | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| KENDEL KOEHN | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| WAYLAN WIGGERS | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| LONNIE UNRUH | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| VINCE KOEHN | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| MICHAEL UNRUH | |||||||
| CHAIRMAN/DIRECTOR | 2.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DAVID LITWILLER | |||||||
| ASSISTANT CHAIRMAN/DIRECTOR | 2.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DOYLE WIEBE | |||||||
| SECRETARY/TREASURER/DIRECTOR | 2.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) |
| DONAVON LEE KOEHN | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| DAVID BECKER | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| CLIFFORD KOEHN | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| MERLE ENSZ | |||||||
| DIRECTOR | 1.0 | 0.0 | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $76,295 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $5,386 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 0 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | false | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| FUQUA CONSTRUCTION INC | |||||
| PO BOX 335 | INMAN | KS | 67546 | GENERAL CONTRACTOR | $651,030 |
| REHABVISIONS | |||||
| 11623 ARBOR STREET | OMAHA | NE | 681442991 | THERAPY | $303,672 |
| GREAT PLAINS HEALTH ALLIANCE | |||||
| 250 NORTH ROCK ROAD | WICHITA | KS | 67206 | MEDICAL RECORDS | $264,492 |
| BCBS EMPLOYEE HEALTH INS | |||||
| PO BOX 1402 | TOPEKA | KS | 666010412 | HEALTH INSURANCE | $173,680 |
| CASCADE HEALTH SERVICES | |||||
| 1001 NW BARRY ROAD | KANSAS CITY | MO | 64155 | CONTRACTED NURSING | $165,318 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 7 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $632,383 | GovernmentGrantsAmt |
| All Other Contributions | $758,727 | AllOtherContributionsAmt |
| Total Contributions | $1,391,110 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $2,976,696 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,976,696 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $2,976,696 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,142 | TotalRevenueColumnAmt |
| Exclusion | $1,142 | ExclusionAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $5,100 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $4,100 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,000 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $1,000 | TotalRevenueColumnAmt |
| Exclusion | $1,000 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| EMPLOYEE/GUEST MEALS | 722514 | $13,685 | $13,685 | |
| MEDICAL RECORD FEES | 621300 | $1,371 | $1,371 | |
| All Other Misc Revenue | 900099 | $305 | $293 | $12 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $305 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $12 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $293 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $15,361 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $4,385,309 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,978,079 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $16,120 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,000 | TotalAmt |
| Program Services | $10,000 | ProgramServicesAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $86,448 | TotalAmt |
| Management And General | $86,448 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,307 | TotalAmt |
| Management And General | $10,307 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,320,149 | TotalAmt |
| Program Services | $2,056,932 | ProgramServicesAmt |
| Management And General | $263,217 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,792 | TotalAmt |
| Program Services | $2,792 | ProgramServicesAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $176,000 | TotalAmt |
| Program Services | $156,033 | ProgramServicesAmt |
| Management And General | $19,967 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $185,004 | TotalAmt |
| Program Services | $164,016 | ProgramServicesAmt |
| Management And General | $20,988 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $55,605 | TotalAmt |
| Management And General | $55,605 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $483 | TotalAmt |
| Management And General | $483 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $914,214 | TotalAmt |
| Program Services | $910,916 | ProgramServicesAmt |
| Management And General | $3,298 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,501 | TotalAmt |
| Management And General | $9,501 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $520,995 | TotalAmt |
| Program Services | $61,804 | ProgramServicesAmt |
| Management And General | $459,191 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $75,614 | TotalAmt |
| Program Services | $60,589 | ProgramServicesAmt |
| Management And General | $15,025 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $11,415 | TotalAmt |
| Program Services | $3,232 | ProgramServicesAmt |
| Management And General | $8,183 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,646 | TotalAmt |
| Program Services | $6,646 | ProgramServicesAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $21,069 | TotalAmt |
| Program Services | $19,297 | ProgramServicesAmt |
| Management And General | $1,772 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $269,216 | TotalAmt |
| Program Services | $246,570 | ProgramServicesAmt |
| Management And General | $22,646 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $42,755 | TotalAmt |
| Program Services | $39,158 | ProgramServicesAmt |
| Management And General | $3,597 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $362,706 | $362,706 | |
| EQUIPMENT RENTAL/MAINTENANCE | $60,175 | $59,286 | $889 |
| FOOD/DIETARY SUPPLIES | $57,716 | $57,716 | |
| _ | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $24,756 | TotalAmt |
| Program Services | $139 | ProgramServicesAmt |
| Management And General | $24,617 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,223,566 | TotalAmt |
| Program Services | $4,217,832 | ProgramServicesAmt |
| Management And General | $1,005,734 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $556,084 | BOYAmt |
| EOY | $183,437 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $540,204 | BOYAmt |
| EOY | $467,231 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $200,919 | BOYAmt |
| EOY | $219,980 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $36,168 | BOYAmt |
| EOY | $34,243 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,814,651 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $3,675,803 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,079,330 | BOYAmt |
| EOY | $3,138,848 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,982 | BOYAmt |
| EOY | $7,943 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,427,687 | BOYAmt |
| EOY | $4,051,682 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,581 | BOYAmt |
| EOY | $464,833 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $25,500 | BOYAmt |
| EOY | $1,155,500 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $158,081 | BOYAmt |
| EOY | $1,620,333 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,964,137 | BOYAmt |
| EOY | $2,322,770 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $305,469 | BOYAmt |
| EOY | $108,579 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,269,606 | BOYAmt |
| EOY | $2,431,349 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,427,687 | BOYAmt |
| EOY | $4,051,682 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$838,257 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | Yes (true) | AccountantCompileOrReviewInd |
Acct Compile Or Review Basis AcctCompileOrReviewBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FS Audited | false | FSAuditedInd |
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| 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) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $483 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | Yes (true) | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $483 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE C, PART II-B, LINE 1F | A PORTION OF THE DUES PAID TO KHA ARE DEDICATED TO LOBBYING. |
| SCHEDULE C, PART II-B, LINE 1G | DIRECT CONTACT WITH LEGISLATORS WAS DUE TO PRESENCE AT THE KHA-SPONSORED EVENTS. NO FUNDS WERE EXPENDED EXPRESSLY FOR THE PURPOSE OF INTERACTING WITH LEGISLATORS. |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $69,011 | InvestmentCostOrOtherBasisAmt |
| Book Value | $69,011 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $3,677,114 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $2,066,087 | DepreciationAmt |
| Book Value | $1,611,027 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $2,503,503 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $1,575,832 | DepreciationAmt |
| Book Value | $927,771 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $564,923 | InvestmentCostOrOtherBasisAmt |
| Depreciation | $33,884 | DepreciationAmt |
| Book Value | $531,039 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $3,138,848 | TotalBookValueLandBuildingsAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART X, LINE 2 | FormAndLineReferenceDesc |
| Explanation | 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. | ExplanationTxt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 32 | PersonsServedCnt |
| Total Community Benefit Expns | $84,670 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $84,670 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01620 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 336 | PersonsServedCnt |
| Total Community Benefit Expns | $304,314 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $87,991 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $216,323 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04140 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 368 | PersonsServedCnt |
| Total Community Benefit Expns | $388,984 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $87,991 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $300,993 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05760 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 2278 | PersonsServedCnt |
| Total Community Benefit Expns | $4,719 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,719 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 2 | ActivitiesOrProgramsCnt |
| Persons Served | 1108 | PersonsServedCnt |
| Total Community Benefit Expns | $1,322,275 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $638,362 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $683,913 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13100 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 1 | ActivitiesOrProgramsCnt |
| Persons Served | 15 | PersonsServedCnt |
| Total Community Benefit Expns | $329 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $329 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 5 | ActivitiesOrProgramsCnt |
| Persons Served | 3401 | PersonsServedCnt |
| Total Community Benefit Expns | $1,327,323 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $638,362 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $688,961 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.13200 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Activities Or Programs | 7 | ActivitiesOrProgramsCnt |
| Persons Served | 3769 | PersonsServedCnt |
| Total Community Benefit Expns | $1,716,307 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $726,353 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $989,954 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18960 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $147,298 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $65,874 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $992,972 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,147,643 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$1,154,671 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 218 E PACK STREET | AddressLine1Txt |
| City | MOUNDRIDGE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.MERCYH.ORG | WebsiteAddressTxt |
| State License | H059003 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | MERCY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 21 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | Yes (true) | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SCHEDULE H, PART V, SECTION C | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | WWW.MCPHERSONHOSPITAL.ORG | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 21 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SCHEDULE H, PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 150. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SCHEDULE H, PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SCHEDULE H, PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SCH H, PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | SURVEY FORMS WERE DISTRIBUTED TO THE GENERAL PUBLIC THROUGH AN ONLINE SURVEY PLATFORM, AND ALSO MADE AVAILABLE IN PAPER FORM AT PUBLIC LOCATIONS SUCH AS THE SENIOR CENTER, THE HOSPITAL, AND THE LOCAL CLINICS. SURVEYS WERE LINKED ON THE HOSPITAL WEBSITE FOR ANY MEMBER OF THE COMMUNITY TO ACCESS. FOLLOWING THE INITIAL COMMUNITY SURVEY, A FOLLOW-UP WORKGROUP WAS HELD, HOSTED BY THE MCPHERSON COUNTY HEALTH DEPARTMENT AND MCPHERSON HOSPITAL. PHYSICIANS FROM THE CONTRIBUTING HOSPITALS, AS WELL AS THE COUNTY HEALTH DIRECTOR WERE IN ATTENDENCE, AND PROVIDED THEIR INSIGHT AND EXPERTISE. MEMBERS OF THE COMMUNITY, INCLUDING REPRESENTATIVES FROM COUNTY EMERGENCY SERVICES, DIASABILITY SUPPORT AND SOCIAL PROGRAMS (INCLUDING THE COUNTY FOODBANK) AS WELL AS OTHER INDIVIDUALS WERE ALSO IN ATTENDENCE AND CONTRIBUTED THEIR INPUT. FOLLOWING THE COUNTY-WIDE MEETING, MERCY HOSPITAL HOSTED A MOUNDRIDGE-SPECIFIC TOWN-HALL MEEITNG WITH MEMBERS OF OUR COMMUNITY TO DRILL INTO COMMUNITY-SPECIFIC DATA AND NEEDS. THE RESULTS OF BOTH OF THESE EFFORTS WERE USED TO COMPILE THE CHNA REPORT. THOSE IN ATTENDANCE AT THE TOWN-HALL INCLUDED CITY LEADERSHIP, SCHOOL DISTRICT LEADERSHIP, CITY EMS, LOCAL LTC LEADERS, COMMUNITY MEMBERS AT LARGE, HOSPITAL BOARD MEMBERS, HOSPITAL EXECUTIVES, COMMUNITY FOUNDATION BOARD MEMBERS, MOUNDRIDGE POLICE CHIEF, REPRESENTATIVES FROM THE FAITH-BASED COMMUNITY AND LOCAL COMMUNITY MENTAL HEALTH CENTER REPRESENTATIVES. |
| SCHEDULE H, PART V, SECTION B, LINE 6A | MCPHERSON HOSPITAL, LINDSBORG COMMUNITY HOSPITAL |
| SCHEDULE H, PART V, SECTION B, LINE 6B | MCPHERSON COUNTY HEALTH DEPARTMENT |
| SCHEDULE H, PART V, SECTION B, LINE 7A | WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| SCHEDULE H, PART V, SECTION B, LINE 10A | WWW.MERCYH.ORG/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| SCHEDULE H, PART V, SECTION B, LINE 11 | MERCY HOSPITAL IS PARTNERING WITH PIFC AND OTHER COMMUNITY ORGANIZATIONS TO INCREASE ACCESS TO HEALTHCARE SPECIALTY SERVICES. THIS WAS IDENTIFIED AS A NEED DURING THE CHNA. MERCY IS ACTIVELY DEVELOPING A WALK-IN CLINIC TO OPEN LATER IN 2023. ACCESS TO URGENT CARE SERVICES WAS A NEED IDNETIFIED DURING THE CHNA. HEALTH INSURANCE EDUCATION, AN IDENTIFIED NEED, WILL BE ADDRESSED AT A FREE INSURANCE WORKSHOP MERCY IS HOSTING IN OCTOBER 2023 WITH A LOCAL MEDICARE EXPERT. ALL COMMUNITY MEMBERS WILL BE INVITED. THE HOSPITAL CONTINUES TO GROW DISTIBUTION OF OUR FREE NEWSLETTER TO OUR COMMUNITY. THIS IS PUBLISHED QUARTERLY AND DISTRUBUTED BY MAIL AND DIRECT DELIVERY TO OVER 2,100 HOUSEHOLDS WITHIN OUR SERVICE AREA. THIS PUBLICATION OFFERS HEALTHY LIFESTYLE INFORMATION ON A RANGE OF ISSUES IDENTIFIED IN THE LAST CHNA INCLUDING OBESITY, MENTAL HEALTH AND SUBSTANCE ABUSE. WE ARE CONNECTING PATIENTS TO RESOURCES THAT WILL HELP THEM LIVE MORE WHOLESOME LIVES. MERCY CONTINUES PROVIDING FREE BLOOD PRESSURE CHECKS MONTHLY AT THE LOCAL SENIOR CENTER. MERCY IS WORKING ALONGSIDE PRAIRIE VIEW MENTAL HEALTH TO PROVIDE OPTIMAL EMERGENT MENTAL HEALTH SCREENINGS AND CRISIS INTERVENTION TREATMENT WHERE NEEDED. OBESITY TREATMENT AND HEALTHY LIVING TOPICS ARE ADDRESSED IN THE NEWSLETTER, BUT ARE NOT PART OF MERCY'S CORE TREATMENT SERVICES. WE PARTNER WITH LOCAL HEALTHCARE PROVIDERS TO CONNECT PATIENTS TO THESE SERVICES. MERCY HOSPITAL IS COMMITTED TO FOCUSING OUR RESOURCES AND EFFORTS ON ADDRESSING THESE PRIORITIES THOUGH 2023 AND BEYOND, TO MEET THE COMMUNITY'S HEALTH NEEDS. |
| SCHEDULE H, PART V, SECTION B, LINES 16A, 16B, AND 16C | WWW.MERCYH.ORG/FINANCIAL-ASSISTANCE/ |
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | IN ADDITION TO FPG CONSIDERATIONS, THE HOSPITAL ALSO USES ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS TO DETERMINE WHETHER INDIVIDUALS ARE FAP ELIGIBLE. HOSPITAL ONLY PROVIDES 100% CHARITY CARE TO ELIGIBLE INDIVIDUALS. NO SLIDING SCALE IS USED TO DETERMINE DISCOUNTED CARE. ALL FAP ELIGIBLE INDIVIDUALS RECEIVE 100% FREE CARE. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H IS THE COST TO CHARGE RATIO FROM THE ORGANIZATION'S 9/30/2022 MEDICARE COST REPORT. SCHEDULE H, PART I, LINE 7, COLUMN F NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE HOSPITAL ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYER SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND CO-PAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE HOSPITAL RECORDS A SIGNIFICANT PROVISION FOR UNCOLLECTIBLE ACCOUNTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED OR PROVIDED BY POLICY) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED, IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AMOUNT REPORTED IS THE INCREASE OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS, BASED ON THE EXPENSES INCURRED IN TAX YEAR 2022. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | THE HOSPITAL'S BAD DEBT EXPENSE WAS MUCH HIGHER IN THIS TAX YEAR. THIS WAS DUE TO HIGH SELF-PAY ACCOUNTS-RECIEVABLE CARRYOVER FROM THE PREVIOUS YEAR. THERE WAS SOME CLEAN-UP OF OLD ACCOUNTS FROM THE PREVIOUS YEAR, WHICH RESULTED IN A HIGHER VOLUME. THERE IS A CERTAIN PERCENTAGE OF INDIVIDUALS EVERY YEAR WHO, DUE TO BEING IN THE HOSPITAL A SHORT TIME, ONLY INTERACTING WITH HOSPITAL STAFF IN THE ER SETTING (I.E. ONLY FOR SHORT PERIODS OF TIME WITH NO OPPORTUNITY TO COLLECT THE NECESSARY INFORMATION), OR DUE TO INSTABILITY IN THEIR LIVING ARRANGEMENTS, ARE UNABLE TO PROVIDE THE REQUIRED INFORMATION FOR A CHARITY CARE APPLICATION TO BE PROCESSED. WE SAW A DECREASE IN PATIENT PAYMENTS ON ACCOUNTS WHICH IS BELIEVED TO BE DUE TO LOWER PATIENT CASH-IN-HAND AND MEDICAL DEBTS NOT BEING FIRST PRIORITY. WE WERE SERVED SEVERAL BANKRUPTCY PAPERS DURING FY 2022 WHICH LED TO THOSE ACCOUNTS BEING DISCHARGED AS BAD DEBT. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | WE PROVIDE OUTPATIENT SERVICES AS A BENEFIT TO OUR COMMUNITY, ALLOWING OUR LOCAL CITIZENS TO RECEIVE CARE CLOSE TO HOME AND WITHIN TIMEFRAMES WHEN THEIR CONDITION CAN BE TREATED. STATISTICS SHOW THAT WHEN AN EMERGENCY ROOM CLOSES IN A COMMUNITY, THE MORTALITY RATE INCREASES BY 6 PERCENTAGE POINTS DUE TO REDUCTION IN ACCESS TO CARE. THE OUTPATIENT CARE WE PROVIDE IS REIMBURSED AT WELL BELOW COST FROM BOTH MEDICARE AND MEDICAID. THE COST TO CHARGE RATIO FROM THE MOST-RECENTLY FILED MEDICARE COST REPORT WAS USED TO DETERMINE MEDICARE-ALLOWABLE COSTS FOR THE ASSOCIATED PAYMENTS, LESS AMOUNTS REPORTED AS COMMUNITY BENEFIT UNDER PART I SECTION 7. EXPENSES WERE UP SIGNIFICANTLY FOR MERCY HOSPITAL IN 2022 AND DUE TO LOWER PATIENT VOLUMES, THE CORRESPONDING REVENUE WAS NOT THERE TO OFSET THE COST INCREASES. |
| SCHEDULE H, PART III, SECTION C, LINE 9B | ANY SELF-PAY ACCOUNT THAT HAS BEEN SELF-PAY FOR 90 DAYS WITH NO ACTION SHALL BE CONSIDERED DELINQUENT. THESE ACCOUNTS WITH BALANCES OVER $50.00 ARE PASSED ON TO OUR INTERNAL COLLECTIONS DEPARTMENT, TO ATTEMPT CONTACT WITH THE GUARANTOR TO ESTABLISH A PAYMENT PLAN. THIS METHOD INCLUDES MAILINGS AND PHONE CALLS. BANKRUPTCIES WILL HAVE ALL COLLECTIONS EFFORTS STOPPED UPON RECEIPT OF BANKRUPTCY NOTICE. ALL ACCOUNTS BEING WORKED BY OUR INTERNAL COLLECTIONS DEPARTMENT ARE OFFERED THE HOSPITAL'S ESTABLISHED FINANCIAL ASSISTANCE POLICY AND APPLICATION. ANY PATIENT ACCOUNTS WHICH QUALIFY ARE HANDLED ACCORDING TO THAT POLICY. FUTURE ACCOUNTS FOR A GUARANTOR WHO IS KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE MAY BE AWARDED CHARITY CARE BASED ON ADMINISTRATIVE DECISION. ALL FINANCIAL ASSISTANCE APPLICATIONS ARE SUBJECT TO PERIODIC AND ANNUAL REVIEW TO ENSURE THE GUARANTOR'S CURRENT FINANCIAL SITUATION IS TAKEN INTO CONSIDERATION. |
| SCHEDULE H, PART VI, LINE 2 | IN 2022, A JOINT COMMUNITY HEALTH NEEDS ASSESSMENT WAS PERFORMED WITH TWO OTHER AREA HOSPITALS, IN CONJUNCTION WITH THE COUNTY HEALTH DEPARTMENT. RESIDENTS WERE ASKED TO COMPLETE ONLINE OR PAPER SURVEYS REGARDING HEALTH CONCERNS AND OPPORTUNITIES. AFTER INITIAL HEALTH ISSUES WERE IDENTIFIED, A WORKGROUP WAS FORMED REPRESENTING A CROSS SECTION OF SURVEY RESPONDENTS ALONG WITH COMMUNITY HEALTH EXPERTS AND RESOURCES. THIS WORKGROUP PRIORITIZED THE ISSUES AFFECTING THE COMMUNITY USING PUBLIC HEALTH DATA TO CONFIRM ADDITIONAL FACTORS. MERCY HOSPITAL HOSTED A TOWN-HALL MEETING WITH COMMUNITY RESIDENTS AND TOWN LEADERS TO FURTHER DRILL DOWN INTO NEEDS AND SURVEY THE POPULATION. ALL THIS INFORMATION WAS COMPILED INTO A REPORT WHICH HAS BEEN PUBLISHED ON OUR WEBSITE. MERCY HOSPITAL IDENTIFIED SOLUTIONS TO THESE IDENTIFIED HEALTH CONCERNS AND RELEASED A FACILITY-SPECIFIC IMPLEMENTATION PLAN, WHICH IS BEING CARRIED OUT STARTING IN 2023 THROUGH THE END OF 2025. ALL THESE DOCUMENTS ARE REVIEWED AND DISCUSSED WITH THE HOSPITAL'S PATIENT AND FAMILY ENGAGEMENT COMMITTEE CHOSEN FROM THE PATIENT POPULATION IN THE COMMUNITY. THESE INDIVIDUALS HELP TO DETERMINE THE WORTHINESS AND EFFICACY OF THE HOSPITAL'S EFFORTS. |
| SCHEDULE H, PART VI, LINE 3 | COMMUNICATION OF THE FINANCIAL ASSISTANCE AVAILABLE FROM MERCY HOSPITAL, INC. SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT ARE NOT LIMITED TO, THE PUBLICATION OF NOTICES IN PATIENT BILLS AND BY POSTING NOTICES IN EMERGENCY ROOMS, REGISTRATION, PATIENT FINANCIAL SERVICES AND AT OTHER PUBLIC PLACES AS MERCY HOSPITAL, INC. MAY ELECT. INFORMATION SHALL ALSO BE INCLUDED ON THE FACILITY WEBSITE AND IN THE CONDITIONS OF ADMISSION FORM. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE MERCY HOSPITAL, INC. STAFF OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL SERVICES STAFF, SOCIAL WORKER AND CASE MANAGER. A REQUEST FOR FINANCIAL ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. |
| SCHEDULE H, PART VI, LINE 4 | MERCY HOSPITAL IS LOCATED IN MOUNDRIDGE, KS AND SERVES AN DENSELY-SETTLED RURAL AREA THAT ALSO INCLUDES INDIVIDUALS FROM FOUR SURROUNDING COMMUNITIES. MOUNDRIDGE AND THE SURROUNDING RURAL SPACE HAS A POPULATION OF APPROXIMATELY 6,500 PEOPLE. BENEFICIARIES ARE FROM FARMING AND SOME MANUFACTURING ORGANIZATIONS IN THE APPROXIMATE 30-MILE RADIUS OF THE HOSPITAL. THERE ARE TWO OTHER HOSPITALS WITHIN A 20-MILE RADIUS ALSO SERVING THE AREA. |
| SCHEDULE H, PART VI, LINE 5 | THE HOSPITAL HAS AN ACTIVE PATIENT AND FAMILY ENGAGEMENT COMMITTEE THAT MEETS AT LEAST QUARTERLY. THIS GROUP IS COMPRISED OF VOLUNTEER COMMUNITY MEMBERS WHO HAVE BEEN PATIENTS IN THE HOSPITAL. THESE INDIVIDUALS SERVE AS ADVISORS FOR THE BOARD AND MEDICAL STAFF TO PROVIDE INSIGHT FROM THE COMMUNITY TO INFLUENCE HOSPITAL POLICY AND DECISIONS. MEDICAL STAFF IS COMPOSED OF COURTESY AND CONSULTING PHYSICIANS WHO MEET QUARTERLY. TOPICS RELATING TO COMMUNITY HEALTH MAY BE DISCUSSED IN MEDICAL STAFF MEETINGS. THE HOSPITAL'S BOARD IS COMPRISED OF 12 VOLUNTEER MEMBERS FROM VARIOUS REGIONS OF THE SERVICE AREA. |
| SCHEDULE H, PART VI, LINE 6 | N/A |
| SCHEDULE H, PART VI, LINE 7 | N/A |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | Yes (true) | GrantRecordsMaintainedInd |
Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Type | PHYSICIAN LOAN REPAYMENT ASSISTANCE | GrantTypeTxt |
| Recipient | 1 | RecipientCnt |
| Cash Grant | $10,000 | CashGrantAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE I, PART I, LINE 2 | FormAndLineReferenceDesc |
| Explanation | MERCY HOSPITAL IS NOT A FOUNDATION, AND THE GRANTS WE WOULD AWARD ARE ONLY TO INDIVIDUALS WHO MEET VERY SPECIFIC CRITERIA, SUCH AS A NEW PHYSICIAN PROVIDER WHO IS COMING TO TOWN. ALL GRANT TERMS MUST BE MET IN ADVANCE BEFORE THE FUNDS ARE DISBURSED. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | BRENDA KOEHN | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | SPOUSE OF BOARD MEMBER | RelationshipDescriptionTxt |
| Transaction | $10,307 | TransactionAmt |
| Transaction | SALARIES | TransactionDesc |
| Sharing Of Revenues | false | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | THE FOLLOWING STATISTICS ARE OFFERED FOR THE FISCAL YEAR ENDING 9-30-2022: 194 MEDICARE, MEDICAID, AND MEDICARE ADVANTAGE ADMISSIONS AND 194 DISMISSALS; AGED PATIENTS SERVICES - 569 DAYS; PEDIATRICS SERVICES - 0 DAYS; SWING BED DAYS - 449; EKGS PERFORMED - 326; OUTPATIENT THERAPY - 4,211 INSTANCES OF SERVICE; ER VISITS - 1,074. |
| FORM 990, PART VI, LINE 1A | ALL MEMBERS OF THE BOARD OF DIRECTORS HAVE THE SAME VOTING PRIVILAGES. THE EXECUTIVE COMMITTEE DOES HAVE AUTHORITY TO ACT ON ANY MATTERS WHICH MAY ARISE BETWEEN REGULAR MEETINGS, SUJECT TO APPROVAL BY THE FULL BOARD AT THIER NEXT REGULAR MEETING. |
| FORM 990, PART VI, SECTION A, LINE 6 | MEMBERSHIP IN MERCY HOSPITAL, INC. IS LIMITED TO THE CONGREGATIONS OF THE VARIOUS CHURCHES OF THE CHURCH OF GOD IN CHRIST MENNONITE WITHIN THE AREA SERVED BY THE HOSPITAL. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO ELECT, ADD, OR REMOVE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | THE VARIOUS CONGREGATIONS, BEING THE MEMBERS OF MERCY HOSPITAL, INC., HAVE THE RIGHT TO APPROVE THE BYLAWS, ARTICLES OF INCORPORATION, AND APPROVE OR REMOVE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES THE FORM 990. THE FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN REVIEWED BY THE ORGANIZATION'S ADMINISTRATOR AND CFO. ANY QUESTIONS OR CONCERNS ARE ADDRESSED AND ANY NECESSARY CHANGES ARE MADE. THE FINAL FORM 990, WITH ALL REQUIRED SCHEDULES, IS PROVIDED TO ALL VOTING MEMBERS OF THE BOARD FOR THEIR REVIEW PRIOR TO FILING THE 990. |
| FORM 990, PART VI, SECTION B, LINE 12C | BOARD MEMBERS AND THE ADMINISTRATOR REVIEW THE CONFLICT OF INTEREST POLICY ANNUALLY. EACH INDIVIDUAL IS RESPONSIBLE FOR DISCLOSING ANY POTENTIAL CONFLICTS. AN ADMINISTRATIVE BOARD DETERMINES WHETHER A CONFLICT IS PRESENT. IF A CONFLICT OF INTEREST IS PRESENT THE INTERESTED BOARD MEMBER IS EXCUSED FROM THE BOARDROOM DURING THE VOTE. THE ADMINISTRATIVE BOARD IS COMPOSED OF THREE INDIVIDUALS: AARON HERBEL, ADMINISTRATOR AND ACTING CFO; LORIE FRIESEN DON, AND VERLA FRIESEN, CORPORATE COMPLIANCE OFFICER. |
| FORM 990, PART VI, SECTION B, LINES 15A & 15B | AT THE TIME OF HIRE AND ANNUALLY THEREAFTER, THE KHA'S PUBLISHED WAGE SCALE AND AN INFORMAL SURVEY OF AREA COMPENSATION COMPARABLES ARE USED TO ESTABLISH REASONABLE COMPENSATION LEVELS. IN ADDITION, AN ANNUAL PERFORMANCE EVALUATION IS PERFORMED BY THE EXECUTIVE COMMITTEE OF THE HOSPITAL BOARD OF DIRECTORS. THE EVALUATIONS COMPLETED BY THE EXECUTIVE COMMITTEE ARE THEN PRESENTED TO THE BOARD OF DIRECTORS FOR APPROVAL. DOCUMENTATION OF THE APPROVED EVALUATIONS FOR COMPENSATION IS INCLUDED IN THE BOARD MINUTES. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICTS OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON WRITTEN REQUEST TO THE HOSPITAL ADMINISTRATOR. |
| FORM 990, PART XII, LINE 2C | A BOARD MEMBER NOW OVERSEES OR REVIEWS THE FINANCIAL DOCUMENTS PREPARED BY THE CFO. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:874953 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED PLANT MAINT SERVICES TOTAL FEES:39201 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED DIETARY SERVICES TOTAL FEES:60 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHURCH OF GOD IN CHRIST MENNONITE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 100 AVE C | AddressLine1Txt |
| City | MOUNDRIDGE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67107 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 237022612 | EIN |
| Primary Activities | CHURCH | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 1 | PublicCharityStatusTxt |
| Controlled Organization | false | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (true) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (true) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |