GREAT PLAINS OF REPUBLIC CO INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- GREAT PLAINS OF REPUBLIC CO INC (EIN 48-1226977)
- Tax period
- 2021-10-01 to 2022-09-30
- Filed
- 2023-08-08
- IRS object ID
- 202302209349300720
- 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 J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2023-08-08T09:16:27-05:00 | 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 | 481226977 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT PLAINS OF REPUBLIC CO INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % JASON BARB | InCareOfNm |
| Business Name Control | GREA | BusinessNameControlTxt |
| Phone | 3166851523 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD SUITE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JASON BARB | PersonNm |
| Person Title | CFO | PersonTitleTxt |
| Phone | 3166851523 | PhoneNum |
| Signature | 2023-06-01 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JASON | PersonFirstNm |
| Person Last | BARB | 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 | JASON BARB | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD SUITE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $22,553,418 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.RPHOSPITAL.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | TO OPERATE AN ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN BELLEVILLE, KANSAS AND THE SURROUNDING RURAL COMMUNITIES IN REPUBLIC COUNTY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 200 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $6,913,771 | PYContributionsGrantsAmt |
| CY Contributions Grants | $4,927,358 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $16,520,477 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,405,333 | CYProgramServiceRevenueAmt |
| PY Investment Income | $19,092 | PYInvestmentIncomeAmt |
| CY Investment Income | -$12,231 | CYInvestmentIncomeAmt |
| PY Other Revenue | $160,952 | PYOtherRevenueAmt |
| CY Other Revenue | $200,657 | CYOtherRevenueAmt |
| PY Total Revenue | $23,614,292 | PYTotalRevenueAmt |
| CY Total Revenue | $22,521,117 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $9,534,382 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $10,802,949 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $8,436,715 | PYOtherExpensesAmt |
| CY Other Expenses | $8,068,018 | CYOtherExpensesAmt |
| PY Total Expenses | $17,971,097 | PYTotalExpensesAmt |
| CY Total Expenses | $18,870,967 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $5,643,195 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,650,150 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $16,186,685 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,168,964 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $5,558,894 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $3,891,023 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,627,791 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $14,277,941 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $15,828,671 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $17,413,913 | RevenueAmt |
| Desc | REPUBLIC COUNTY HOSPITAL'S (RCH) PRIMARY PROGRAM IS THE DELIVERY OF HEALTHCARE AND RELATED SERVICES TO PATIENTS FROM REPUBLIC COUNTY AND CONTIGUOUS COUNTIES IN KANSAS OF CLOUD, JEWELL AND WASHINGTON. SERVICES INCLUDE INPATIENT ACUTE, SURGERY, OUTPATIENT, OBSTETRIC, EMERGENCY ROOM, INTERMEDIATE SWING BED (ISB) AND SKILLED NURSING CARE (SNF). REPUBLIC COUNTY HOSPITAL PROVIDES NEEDED HEALTH CARE SERVICES TO PATIENTS WHO COME TO OUR HOSPITAL FOR CARE, REGARDLESS OF THE PATIENT'S ABILITY TO PAY AND HAS A FINANCIAL ASSISTANCE PROGRAM FOR THOSE PATIENTS WITH LIMITED RESOURCES. SEE SCHEDULE O FOR CONTINUATION. | Desc |
| Total Program Service Expenses | $15,828,671 | 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 | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | 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 | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | 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 | false | 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 | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | Yes (true) | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (true) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 33 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 200 | 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 | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | 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 | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | 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 | JASON BARB | PersonNm |
| Phone | 3166851523 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| DAVE DELLASEGA | ||||||||
| PRESIDENT/SECRETARY/DIRECTOR | 2.0 | 40.0 | Yes (X) | Yes (X) | $0 | $209,142 | $59,769 | |
| BRENT MARTIN | ||||||||
| COO | 40.0 | 0.0 | $164,280 | $0 | $50,656 | Yes (X) | ||
| DANIEL KELLY | ||||||||
| ADMINISTRATOR | 40.0 | 0.0 | Yes (X) | $185,950 | $0 | $13,631 | ||
| DURREL KELLEY | ||||||||
| SENIOR VP OF OPERATIONS | 2.0 | 40.0 | Yes (X) | $0 | $127,901 | $30,947 | ||
| REBECCA BROWN | ||||||||
| DON | 40.0 | 0.0 | $122,705 | $0 | $27,806 | Yes (X) | ||
| BARRY BOTTGER | ||||||||
| CFO | 40.0 | 0.0 | Yes (X) | $122,089 | $0 | $28,367 | ||
| TRISHA CHAMPLIN | ||||||||
| RN | 40.0 | 0.0 | $112,587 | $0 | $34,895 | Yes (X) | ||
| KELSEY MUGLER | ||||||||
| LAB TECH | 40.0 | 0.0 | $99,262 | $0 | $35,566 | Yes (X) | ||
| JASON BARB | ||||||||
| CFO | 0.25 | 40.0 | Yes (X) | $0 | $46,160 | $5,528 | ||
| DAVE RANKIN | ||||||||
| CHAIRMAN/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN TERRILL | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEVE CARLSON | ||||||||
| TREASURER/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR BARBARA BROWN APPLEGATE | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| ARTHUR HENDRICKSON | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| CHARLES WESTIN | ||||||||
| DIRECTOR/CHAIRMAN | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROGER JOHN | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $806,873 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $383,203 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $287,165 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 5 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | 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 |
|---|---|---|---|---|---|
| GPHA | |||||
| 250 N ROCK RD STE 160 | WICHITA | KS | 67206 | MANAGEMENT AND SERV | $856,120 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 734606 | DALLAS | TX | 753734606 | CONTRACT SERVICES | $451,165 |
| LARRY TROSHYNSKI | |||||
| 630 W 101ST PLACE | OVERLAND PARK | KS | 66212 | CONTRACT SERVICES | $169,500 |
| QUALIVIS | |||||
| PO BOX 1180 | COLUMBIA | SC | 29201 | CONTRACT NURSING | $340,982 |
| GLMV ARCHITECTURE | |||||
| 1525 E DOUGLAS AVE | WICHITA | KS | 67211 | ARCHITECT SERVICES | $391,155 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 13 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $1,559,397 | GovernmentGrantsAmt |
| All Other Contributions | $3,367,961 | AllOtherContributionsAmt |
| Total Contributions | $4,927,358 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | NET PATIENT SERVICE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $17,405,333 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,405,333 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,405,333 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $10,380 | TotalRevenueColumnAmt |
| Exclusion | $10,380 | ExclusionAmt |
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 | $0 | TotalRevenueColumnAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,338 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $9,338 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,338 | TotalRevenueColumnAmt |
| Exclusion | $9,338 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $9,690 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $32,301 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$22,611 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$22,611 | TotalRevenueColumnAmt |
| Exclusion | -$22,611 | 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 | 722513 | $60,525 | $60,525 | |
| OUTSIDE SERVICES | 621300 | $8,580 | $8,580 | |
| VENDING INCOME/REBATES | 900099 | $56,674 | $56,674 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $65,540 | TotalRevenueColumnAmt |
| Exclusion | $65,540 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $191,319 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $22,521,117 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,413,913 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $179,846 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
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 | $0 | TotalAmt |
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 | $373,568 | TotalAmt |
| Management And General | $373,568 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,187,181 | TotalAmt |
| Program Services | $7,255,980 | ProgramServicesAmt |
| Management And General | $931,201 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $544,979 | TotalAmt |
| Program Services | $467,489 | ProgramServicesAmt |
| Management And General | $77,490 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,102,933 | TotalAmt |
| Program Services | $853,647 | ProgramServicesAmt |
| Management And General | $249,286 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $594,288 | TotalAmt |
| Program Services | $506,709 | ProgramServicesAmt |
| Management And General | $87,579 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $173,287 | TotalAmt |
| Management And General | $173,287 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,859 | TotalAmt |
| Management And General | $26,859 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,925 | TotalAmt |
| Management And General | $49,925 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,093 | TotalAmt |
| Management And General | $3,093 | 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 | $2,943,656 | TotalAmt |
| Program Services | $2,327,284 | ProgramServicesAmt |
| Management And General | $616,372 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $49,282 | TotalAmt |
| Program Services | $7,798 | ProgramServicesAmt |
| Management And General | $41,484 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,296,736 | TotalAmt |
| Program Services | $1,191,980 | ProgramServicesAmt |
| Management And General | $104,756 | 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 | $432,956 | TotalAmt |
| Program Services | $383,674 | ProgramServicesAmt |
| Management And General | $49,282 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,189 | TotalAmt |
| Program Services | $7,078 | ProgramServicesAmt |
| Management And General | $111 | 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 | $46,711 | TotalAmt |
| Program Services | $36,618 | ProgramServicesAmt |
| Management And General | $10,093 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,959 | TotalAmt |
| Program Services | $18,323 | ProgramServicesAmt |
| Management And General | $636 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $783,321 | TotalAmt |
| Program Services | $715,786 | ProgramServicesAmt |
| Management And General | $67,535 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,354 | TotalAmt |
| Program Services | $120,789 | ProgramServicesAmt |
| Management And General | $15,565 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $1,739,801 | $1,739,801 | $0 |
| EQUIPMENT RENTAL & REPAIRS | $195,820 | $179,878 | $15,942 |
| DUES & SUBSCRIPTIONS | $36,606 | $3,030 | $33,576 |
| LICENSES/TAXES | $4,368 | $4,368 | $0 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $123,095 | TotalAmt |
| Program Services | $8,439 | ProgramServicesAmt |
| Management And General | $114,656 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,870,967 | TotalAmt |
| Program Services | $15,828,671 | ProgramServicesAmt |
| Management And General | $3,042,296 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,697,820 | BOYAmt |
| EOY | $4,572,154 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $371,798 | BOYAmt |
| EOY | $570,458 | 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 | $3,168,339 | BOYAmt |
| EOY | $3,335,610 | 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 | $3,086 | BOYAmt |
| EOY | $3,687 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $211,983 | BOYAmt |
| EOY | $231,808 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $132,614 | BOYAmt |
| EOY | $592,026 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $21,134,052 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,824,193 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,583,022 | BOYAmt |
| EOY | $8,309,859 | 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 | $0 | BOYAmt |
| EOY | $0 | 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 | $18,023 | BOYAmt |
| EOY | $553,362 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,186,685 | BOYAmt |
| EOY | $18,168,964 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,501,884 | BOYAmt |
| EOY | $3,409,597 | 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 | $49,614 | 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 | $57,010 | BOYAmt |
| EOY | $431,812 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | 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 | $5,558,894 | BOYAmt |
| EOY | $3,891,023 | 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 | $10,439,754 | BOYAmt |
| EOY | $14,277,941 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $188,037 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,627,791 | BOYAmt |
| EOY | $14,277,941 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $16,186,685 | BOYAmt |
| EOY | $18,168,964 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $3,650,150 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
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 | $3,093 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,093 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1F | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. | ExplanationTxt |
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) |
|---|---|---|
| Other Cost Or Other Basis | $14,107 | OtherCostOrOtherBasisAmt |
| Book Value | $14,107 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $8,166,655 | OtherCostOrOtherBasisAmt |
| Depreciation | $7,250,499 | DepreciationAmt |
| Book Value | $916,156 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,808,039 | OtherCostOrOtherBasisAmt |
| Depreciation | $5,111,008 | DepreciationAmt |
| Book Value | $4,697,031 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,145,251 | OtherCostOrOtherBasisAmt |
| Depreciation | $462,686 | DepreciationAmt |
| Book Value | $2,682,565 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $8,309,859 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $22,521,117 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $22,521,117 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $22,521,117 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $18,870,967 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $18,870,967 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $18,870,967 | TotalExpensesPerForm990Amt |
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 |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| 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) |
|---|---|---|
| Total Community Benefit Expns | $143,179 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $143,179 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00760 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,222,559 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $454,366 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $768,193 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04070 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,365,738 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $454,366 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $911,372 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04830 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,781 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,781 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $140 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $140 | NetCommunityBenefitExpnsAmt |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,921 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,921 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00050 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,374,659 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $454,366 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $920,293 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04880 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $319,801 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $9,822,498 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $9,822,498 | CostOfCareReimbursedByMedcrAmt |
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 | REPULIC COUNTY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2420 G STREET | AddressLine1Txt |
| City | BELLEVILLE | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66935 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.RPHOSPITAL.ORG | WebsiteAddressTxt |
| State License | H079001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Facility Reporting Group | 1 | FacilityReportingGroupCd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | REPULIC COUNTY HOSPITAL | 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 | false | 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 |
| 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 | 200. | 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 (6 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | THE ASSESSMENT PROCESS WAS INITIATED AND CHAIRED JOINTLY BY REPUBLIC COUNTY HOSPITAL AND THE REPUBLIC COUNTY HEALTH DEPARTMENT. ALL OF THE EDUCATIONAL, GOVERNMENTAL, CIVIC AND HEALTH RELATED ORGANIZATIONS WITHIN THE COMMUNITY WERE INVITED TO PARTICIPATE. |
| SCHEDULE H, PART V, LINE 6B | REPUBLIC COUNTY HEALTH DEPARTMENT |
| SCHEDULE H, PART V, SECTION B, LINE 7A | https://www.rphospital.org/getpage.php?name=Community_Health_Needs_Assessm ent |
| SCHEDULE H, PART V, SECTION B, LINE 10A | https://www.rphospital.org/getpage.php?name=Community_Health_Needs_Assessm ent |
| SCHEDULE H, PART V, SECTION B, LINE 11 | THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED NINE (9) SPECIFIC COMMUNITY HEALTH NEEDS. TWO OF THOSE NINE NEEDS (HOUSING AND CHILDCARE) WERE NOT ADDRESSED DUE TO A LACK OF FINANCIAL RESOURCES AND/OR DEEMED OUTSIDE THE SCOPE OF HOSPITAL MISSION OF CRITICAL OPPERATIONS. REPUBLIC COUNTY HOSPITAL (RCH) IS PROMOTING PHYSICAL AND MENTAL HEALTH, WELLNESS, AND CHRONIC DISEASE PREVENTION. RCH IS COLLABORATING WITH OTHER PROVIDERS IN THE COUNTY TO PROVIDE EDUCATION RESOURCES AND SUPPORTING THE REPUBLIC COUNTY HEALTH DEPARTMENT, REPUBLIC COUNTY RESOURCE COUNCIL AND SCHOOL DISTRICTS USD 109 AND 426 IN REPUBLIC COUNTY. RCH IS IMPROVING ACCESS TO INFORMATION AND ASSISTANCE ACROSS MULTIPLE NEEDS AND POPULATIONS. THE HOSPITAL IS SUPPORTING THE REPUBLIC COUNTY RESOURCE COUNCIL IN KEEPING THE HEALTH SERVICES DIRECTORY CURRENT AND AVAILABLE TO THE PUBLIC. ADDITIONALLY, RCH IS WORKING WITH OTHER PROVIDERS TO ENHANCE AWARENESS FOR EXISTING PROGRAMS AND SERVICES WHILE ALSO WORKING TO ESTABLISH SUSTAINABLE ATTENTION IN PROMOTING HEALTHY LIVING THROUGH PROGRAMMING SPECIFIC TO PATIENT POPULATIONS AND NEEDS AS OUTLINE IN THE RCH CHNA IMPLEMENTATION PLAN. |
| SCHEDULE H, PART V, SECTION B, LINE 16A, B & C | HTTPS://WWW.RPHOSPITAL.ORG/GETPAGE.PHP?NAME=FINANCIAL_ASSISTANCE&SUB=PATIE NTS%20%26%20VISITORS |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| BELLEVILLE MEDICAL CLINIC PA | ||||
| 2337 G STREET | BELLEVILLE | KS | 66935 | MEDICAL CLINIC |
| REPUBLIC COUNTY MEDICAL FAMILY PHYSICIAN | ||||
| 2337 G STREET | BELLEVILLE | KS | 66935 | MEDICAL CLINIC |
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | THE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. |
| SCHEDULE H, PART I, LINE 7 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART III, LINE 2 | HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. |
| SCHEDULE H, PART III, LINE 3 | THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASONABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. |
| SCHEDULE H, PART III, LINE 4 | NOT APPLICABLE DUE TO ADOPTION OF ASC 606 REVENUE CONTRACTS WITH CUSTOMERS. |
| SCHEDULE H, PART III, LINE 8 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART III, LINE 9B | ALL CHARITY CARE CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPT FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. |
| SCHEDULE H, PART VI, LINE 2 | The Republic County Hospital (RCH) assesses the health care needs of the community it serves in an ongoing fashion. RCH strives to provide services that meet patient needs, and that the needs of the population served guide decisions about which services will be provided directly or through referral, consultation, contractual arrangements, or other agreements. We determine these needs in a variety of ways. In 2022, a Community Health Needs Assessment (CHNA) was conducted by VVV Consultants LLC. This assessment involved an extensive on-line survey and a town-hall meeting with community stakeholders (plus other extensive data collection) that addressed access to primary care health services, health insurance, travel distance for services, hospital services, county health department services and other county health related services. The survey identified the top nine community concerns, in which seven of the nine were identified as the top health concerns in our County. The results of this survey were shared with the public, community stakeholders and providers, and were used to address the perceived health related need in the identified areas. A copy of the results the CHNA and Implementation Strategy Plan are available upon request and posted to our website, www.rphospital.org.) Using the Community Health Needs Assessment that was conducted by VVV Consultants LLC for FY ending September 30th, 2022, community and stakeholder input a Community Health Implementation Strategy for 2022-2023 was developed, approved by the Board of Trustees, and is posted on the Republic County Hospital website as noted. The 2022 Implementation Strategy Plan- Year 1 of 3 (starting 10/1/22-9/30/23) was reviewed and approved by the Governing Board September 26th, 2022, as required by Law, and is posted on the website as well. An important component of the Hospital Mission and Vision is that of being a health resource to the community by advocating healthy behaviors, working in concert with other health care providers, promoting health services through education, and by recruiting and retaining qualified health professionals. Services are also assessed through HCAHPS patient satisfaction survey processes. Board Meetings are open to the public and we have open communication with our patients and their physicians about the types and quality of services provided. Needs are also identified through community involvement and are brought to the hospital through the Patient and Family Advisory Council, which meets regularly. |
| SCHEDULE H, PART VI, LINE 3 | The Republic County Hospital has a written financial assistance/charity care policy and a credit policy that is included in the patient information brochure received by all inpatients and outpatient surgery patients. The credit policy is also posted on the Hospital's website, www.rphospital.org. In addition to other payment options the patient brochure, website and each billing statement sent to patients includes the statement "Republic County Hospital also offers a healthcare assistance program that provides medical care free, or at reduced rates, for patients who qualify based on income guidelines". The Hospital's Financial Counselor visits with private pay patients and patients with high deductibles to determine if they qualify for the Hospital charity care/financial assistance program. The hospital also employs a Social Services worker who consults and assists private pay or uninsured patients to determine if they qualify for assistance through the State Medicaid Program or other government programs. This employee is a member of the County Resource Council. The Social Services worker will assist in completing the applications for medical assistance and act as a resource for other health related services. |
| SCHEDULE H, PART VI, LINE 4 | Republic County Hospital is located in Belleville, Kansas and serves the residents of Republic County and surrounding area. The est. population of Republic County, by 2019 census, is 4,636 which is down 6.9% since 2010. The service area for the Hospital is Republic County and contiguous counties in Northcentral Kansas and Southcentral Nebraska. These Counties in Kansas are exclusively rural. Republic County has a population density of less than 8 people per square mile and 27.8% of the population is over the age of 65 years. The racial makeup of the county by 2019 census was 96.6% White, 2.6% Hispanic or Latin American and .8% Black or African American. 5.9% of the population was under 5 years of age and the per capita income in the past 12 months (in 2029 dollars) is $24,647. Specifically, 12.2% of Republic County households are living in poverty with 8.7% of the population experiencing severe housing problems. Approximately 60% of hospital services are delivered to patients 65 years of age or older. Complete demographics and other information are available on the Hospital Website in the CHNA section. |
| SCHEDULE H, PART VI, LINE 5 | Republic County Hospital participates in community building activities. The hospital is very active in community education on the benefits of immunizations for the prevention of influenza and pneumonia. We work with the County Health Department, Nursing Homes in the community and with local physicians and pharmacies to improve immunization rates. The hospital is very active in and is an integral part of our County Emergency Preparedness activities. The Hospital is an education provider for continuing education and in addition to other classes presents classes for CPR, ACLS, NRP and TNCC certifications. We work closely with the County EMS in the delivery of emergency services. The hospital is an educational site for nursing students from the Cloud County Community College and we frequently have Medical Students in our facility for clinical clerkships and Family Practice Residents here for month long rural residencies. We are also a clinical practice site for Medical Laboratory Technicians, Physician Assistant Students, various Allied Health Students and Advanced Practice Registered Nurse Students. We provide scholarships for students enrolled in health-related professional studies. Republic County Hospital also collaborate with and assists with leadership to the local North Central Kansas Health Care Foundation to support activities related to physician recruitment and supporting the healthcare infrastructure in Republic County. The Chief Executive Officer participates as a Board Member of the Republic County Economic Development Corporation. The hospital sponsors and holds an annual community health fair to educate the community on current and ongoing health issues. We have fully implemented an electronic health record that can be shared with other providers to improve care and reduce health care costs. The hospital also takes seriously its efforts at promoting the mental health for seniors in its community in partnership with the Senior Life Solutions program in Republic County. Republic County Hospital is a 25 bed Critical Access Hospital and Level 4 Trauma rated facility. The Hospital provides 24-hour Emergency Room Care and financially subsidizes this service. The Hospital contracts with the local physicians and since the cost of the coverage far exceeds the income generated through the ER, we consider this to be a heavily subsidized service. The hospital participates in all government health care plans and is the only hospital in Republic County. We have an open medical staff and have several specialist physicians holding outpatient clinics in our community preventing the need for persons in our community to travel long distances for these specialty medical services. We promote community health through health fairs, public service announcements, classes through collaboration and support of various health education opportunities across the community we serve. The hospital works closely with a regional hospice provider in the provision Hospice services. The hospital provides Childbirth Education Classes and Breastfeeding support to our patients and community. |
| SCHEDULE H, PART VI, LINE 6 | Organization is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501(c)(3) organization which provides management services and operational, finance and accounting support to the Hospital. GPHA does not provide services directly to patients, but it does provide access to professionals that may not be affordable to the normal critical access hospital. GPHA provides education and assistance in areas such as HIPAA, Medicare reimbursement, meaningful use requirements for computer system, etc. GPHA is an affiliation of Critical Access Hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospitals, communities and other health care organizations. GPHA provides policies and guidance to its Critical Access facilities regarding financial assistance, conflicts of interest, corporate compliance and many other areas. GPHA also provides educational sessions for board Members, Business Office Managers, Billers, Medical Records personnel and Administrators. GPHA is a vital link in allowing CAH hospitals to operate at a high quality within the cash constraints imposed by the Critical Access program. |
| SCHEDULE H, PART VI, LINE 7 | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVE DELLASEGA | ||||||||||||||
| PRESIDENT/SECRETARY/DIRECTOR | $0 | $206,439 | $0 | $0 | $0 | $2,703 | $0 | $20,695 | $0 | $39,074 | $0 | $268,911 | $0 | $0 |
| DURREL KELLEY | ||||||||||||||
| SENIOR VP OF OPERATIONS | $0 | $126,271 | $0 | $0 | $0 | $1,630 | $0 | $12,293 | $0 | $18,654 | $0 | $158,848 | $0 | $0 |
| DANIEL KELLY | ||||||||||||||
| ADMINISTRATOR | $183,787 | $0 | $0 | $0 | $2,163 | $0 | $773 | $0 | $12,858 | $0 | $199,581 | $0 | $0 | $0 |
| BRENT MARTIN | ||||||||||||||
| COO | $162,433 | $0 | $0 | $0 | $1,847 | $0 | $15,628 | $0 | $35,028 | $0 | $214,936 | $0 | $0 | $0 |
| REBECCA BROWN | ||||||||||||||
| DON | $121,263 | $0 | $0 | $0 | $1,442 | $0 | $11,470 | $0 | $16,336 | $0 | $150,511 | $0 | $0 | $0 |
| BARRY BOTTGER | ||||||||||||||
| CFO | $120,653 | $0 | $0 | $0 | $1,436 | $0 | $11,409 | $0 | $16,958 | $0 | $150,456 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | COMPENSATION FOR DURREL KELLEY, DAVE DELLASEGA, AND JASON BARB IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. KELLEY, MR. DELLASEGA, AND MR. BARB. THE AMERICAN COLLEGE HEALTHCARE EXECUTIVES AND THE KANSAS HOSPITAL ASSOCIATION ALSO HAVE COMPARABLE COMPENSATION DATA THAT CAN BE USED BY THE BOARD. A COMPENSATION REVIEW WAS DONE WHEN DAVE DELLASEGA TOOK OVER AS CEO AND WAS CONDUCTED BY THE BOARD, BUT SINCE THAT TIME THERE HAS BEEN NO FORMAL COMPENSATION REVIEW. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | Republic County Hospital's (RCH) primary program is the delivery of healthcare and related services to patients from Republic County and contiguous counties in Northcentral Kansas and Southcentral Nebraska. Services include inpatient acute, surgery, outpatient, obstetric, emergency room and Intermediate Swing Bed (ISB). Republic County Hospital provides needed health care services to patients who come to our hospital for care, regardless of the patient's ability to pay and has a financial assistance program for those patients with limited resources. Major accomplishments in FY 2022 include the following: 1) RCH has and continues to support the citizens of Republic County through the federal Public Health Emergency for COVID- 19 (PHE) set to expire May 11th, 2023. Our involvement has been multifaceted from organizing and assisting with community planning to mitigation, testing, with administering the vaccine and other approved treatments. 2) The hospital attested to Meaningful Use Stage 3. 3) Hospital staff provides education to the community including smoking cessation and works closely with area schools on prevention of head injuries occurring during sports. 4) The hospital maintains the outpatient seniors group therapy program Senior Life Solutions. 5) Retained and recertified for our Level 4 Trauma certification. 6) Continues to update our website meeting the price transparency requirements for CMS and No Surprises Act requirements. 7) Continue Case Management services for our patients. 8) Hospital participates in open forum coffee for local chamber of commerce on a weekly basis. 9) Hospital also regularly serves as a clinical site for nursing students and Certified Nursing Assistant (CNA) students from a neighboring community college. 10) Continues to offer regular exercise programming for our community. 11) Continue to provide patient assistance with a certified diabetic educator. 12) RCH continues to provide a breastfeeding program for the community and provides education and patient support to breast feeding mothers in the community with an international board-certified lactation consultant. The hospital also provides Childbirth Education Classes. 13) Collaborates with the North Central Kansas Healthcare foundations through providing community education on the services we provide and offering a community health fair in conjunction with their annual radiothon fundraiser. 14) Supply appropriate patients discharging from our ED with flu kits. 15) The RCH BOT reviewed and approved our 2022 Community Health Needs Assessment and Implementation Strategy -for FY ending Sept. 2023. The CHNA and Implementation Strategy can be found on our hospital website. 16) Below please find the: A Year in Review - RCH 2022 that list changes in roles, major accomplishments with surveys, accreditations and equipment upgrades and additional services. |
| FORM 990, PART VI, SECTION A, LINE 2 | DAVE DELLASEGA, DURREL KELLEY, AND JASON BARB HAVE A BUSINESS RELATIONSHIP. THEY ARE BOTH EMPLOYED BY, AND ALSO OFFICERS OF, A RELATED 501(C)(3) ORGANIZATION, GREAT PLAINS HEALTH ALLIANCE. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT PLAINS HEALTH ALLIANCE, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF GREAT PLAINS OF REPUBLIC CO., INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING THE 990 WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS, AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. |
| FORM 990, PART VI, SECTION B, LINES 15A & B | THE CEO AND COO ARE COMPENSATED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GPHA'S BOARD USES COMPARABILITY DATA IN SETTING THEIR SALARIES, AND DOCUMENTATION IS RETAINED OF THE BOARD'S DELIBERATIONS AND DECISIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1837327 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:150151 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB SERVICES TOTAL FEES:226803 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARMACY SERVICES TOTAL FEES:186293 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:456474 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:21347 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PLANT OPERATIONS TOTAL FEES:64042 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:DIETARY SERVICES TOTAL FEES:1219 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| GREAT PLAINS HEALTH ALLIANCE | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480617739 | MANAGEMENT | KS | 501(C)(3) | 3 | NA | false |
| GREAT PLAINS HEALTH CARE FOUNDATION INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480955870 | SUPPORT | KS | 501(C)(3) | 10 | GPHA INC | Yes (true) |
| GREAT PLAINS OF SABETHA COUNTY INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481236156 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF OTTAWA COUNTY INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226856 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF SMITH COUNTY INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226830 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF CHEYENNE COUNTY | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226831 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF ELLINWOOD INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226976 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GPHA EMPLOYEE BENEFITS TRUST | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 476918582 | HEALTH PLAN | KS | 501(C)(9) | GPHA INC | Yes (true) | |
| 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 | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | 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 | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GPHA EMPLOYEE BENEFITS TRUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionTypeTxt |
| Involved | $985,781 | InvolvedAmt |
| Method Of Amount Determination | FMV | MethodOfAmountDeterminationTxt |