PAWNEE VALLEY COMMUNITY HOSPITAL INC: Form 990, tax year 2020
View the entire original 990 at ProPublica ↗
- Organization
- PAWNEE VALLEY COMMUNITY HOSPITAL INC (EIN 48-1253246)
- Tax period
- 2020-07-01 to 2021-06-30
- Filed
- 2022-05-16
- IRS object ID
- 202221369349306272
- Schema version
- 2020v4.1
- 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 | 2022-05-16T10:54:15-05:00 | ReturnTs |
| Tax Period End | 2021-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1Txt |
| City | KANSAS CITY | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 641062246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2020-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481253246 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAWNEE VALLEY COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % GEORGE HARMS TREASURER | InCareOfNm |
| Business Name Control | PAWN | BusinessNameControlTxt |
| Phone | 6202853161 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 923 CARROLL AVE | AddressLine1Txt |
| City | LARNED | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHAE VEACH | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 6202853161 | PhoneNum |
| Signature | 2022-05-16 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | SHAE | PersonFirstNm |
| Person Last | VEACH | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | XXX-XX-XXXX | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | April Arnold CPA | PreparerPersonNm |
| PTIN | P01559426 | PTIN |
| Phone | 8162216300 | PhoneNum |
| Preparation | 2022-05-16 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 3 | TrustedCustomerCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2020 | TaxYr |
| Build TS | 2022-09-23 18:48:47Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | SHAE VEACH | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 923 CARROLL AVE | AddressLine1Txt |
| City | LARNED | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $23,026,242 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.PAWNEEVALLEYHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | PAWNEE VALLEY COMMUNITY HOSPITAL, INC. IS A TAX-EXEMPT CHARITABLE ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS LICENSED (SEE SCHEDULE O) | ActivityOrMissionDesc |
| Voting Members Governing Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 161 | TotalEmployeeCnt |
| Total Volunteers | 100 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,024,860 | PYContributionsGrantsAmt |
| CY Contributions Grants | $3,731,068 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,126,170 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $19,063,912 | CYProgramServiceRevenueAmt |
| PY Investment Income | $64,318 | PYInvestmentIncomeAmt |
| CY Investment Income | $9,661 | CYInvestmentIncomeAmt |
| PY Other Revenue | $176,866 | PYOtherRevenueAmt |
| CY Other Revenue | $221,601 | CYOtherRevenueAmt |
| PY Total Revenue | $18,392,214 | PYTotalRevenueAmt |
| CY Total Revenue | $23,026,242 | 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 | $8,795,041 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,974,847 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,223,802 | PYOtherExpensesAmt |
| CY Other Expenses | $8,019,770 | CYOtherExpensesAmt |
| PY Total Expenses | $16,018,843 | PYTotalExpensesAmt |
| CY Total Expenses | $16,994,617 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,373,371 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $6,031,625 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $21,161,892 | TotalAssetsBOYAmt |
| Total Assets EOY | $24,523,928 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,201,379 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $22,505,889 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,960,513 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,018,039 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | PAWNEE VALLEY COMMUNITY HOSPITAL, INC. IS A TAX-EXEMPT CHARITABLE ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS LICENSED BY THE STATE OF KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT. THE PURPOSE OF THE ORGANIZATION IS (SEE SCHEDULE O) | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $13,295,557 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $16,773,912 | RevenueAmt |
| Desc | PATIENT CARE: PROGRAM SERVICES CONSIST OF ROUTINE AND ANCILLARY DEPARTMENT HEALTHCARE SERVICES PROVIDED BY A HEALTHCARE ORGANIZATION AS DESCRIBED IN 501(C)(3) OF THE IRS CODE. | Desc |
| Total Program Service Expenses | $13,295,557 | 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 | Yes (true) | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | false | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | false | 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 | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Employee | 161 | 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 | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | 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 | Yes (true) | 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 | GEORGE HARMS TREASURER | PersonNm |
| Phone | 7856235000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 CANTERBURY | AddressLine1Txt |
| City | HAYS | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| EDWARD HERRMAN | ||||||||
| DIRECTOR | 4.0 | 40.0 | Yes (X) | $0 | $566,211 | $134,845 | ||
| CHRISTIAN WHITTINGTON MD | ||||||||
| DIRECTOR/PHYSICIAN-NONVOTING | 40.0 | 0.0 | Yes (X) | $361,989 | $0 | $46,768 | ||
| GEORGE HARMS | ||||||||
| TREASURER | 4.0 | 40.0 | Yes (X) | $0 | $284,071 | $82,716 | Yes (X) | |
| MC HILL | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $273,360 | $0 | $43,237 | Yes (X) | ||
| SHAE VEACH | ||||||||
| PRESIDENT | 4.0 | 40.0 | Yes (X) | $0 | $225,143 | $75,272 | Yes (X) | |
| TERRY SIEK | ||||||||
| DIRECTOR | 4.0 | 40.0 | Yes (X) | $0 | $226,935 | $58,598 | ||
| DUSTY ATTERBURY | ||||||||
| APRN | 40.0 | 0.0 | $206,226 | $0 | $38,607 | Yes (X) | ||
| MELANIE URBAN | ||||||||
| ADMINISTRATOR | 1.0 | 40.0 | $0 | $137,947 | $33,131 | Yes (X) | ||
| DAVID SHERRADEN | ||||||||
| PHYSICIAN ASSISTANT | 40.0 | 0.0 | $148,270 | $0 | $9,965 | Yes (X) | ||
| CALVIN KRUGER | ||||||||
| PHYSICIAN ASSISTANT | 40.0 | 0.0 | $148,476 | $0 | $9,754 | Yes (X) | ||
| STACY TROUT | ||||||||
| PHYSICIAN ASSISTANT | 40.0 | 0.0 | $141,632 | $0 | $9,710 | Yes (X) | ||
| JOHN HAAS | ||||||||
| VICE PRESIDENT | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| LYNN BARGER | ||||||||
| SECRETARY | 4.0 | 0.0 | Yes (X) | $0 | $0 | $0 | Yes (X) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,279,953 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $1,440,307 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $542,603 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 7 | 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 |
|---|---|---|---|---|---|
| HAYS MEDICAL CENTER | |||||
| 2220 CANTERBURY DR | HAYS | KS | 67601 | MEDICAL SERVICES | $2,946,663 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 772976 | CHICAGO | IL | 60677 | LABORATORY SERVICES | $225,039 |
| GE HEALTHCARE | |||||
| PO BOX 96483 | CHICAGO | IL | 60693 | EQUIP. MAINTENANCE | $173,826 |
| ANESTHESIOLOGIST ASSOCIATES OF HAYS | |||||
| PO BOX 821 | HAYS | KS | 67601 | ANESTHESIA SERVICES | $118,054 |
| UNIVERSITY OF KANSAS HOSPITAL AUTHO | |||||
| PO BOX 955772 | ST LOUIS | MO | 631955772 | FINANCIAL SERVICES | $227,563 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $305,685 | RelatedOrganizationsAmt |
| Government Grants | $3,425,383 | GovernmentGrantsAmt |
| Total Contributions | $3,731,068 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (4 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient service revenue | 622000 | $18,286,137 | $18,286,137 |
| 340b drug program | 900099 | $752,318 | $752,318 |
| Outreach therapy services | 900099 | $3,499 | $3,499 |
| Lab fairs | 900099 | $21,958 | $21,958 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $19,063,912 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $9,661 | TotalRevenueColumnAmt |
| Exclusion | $9,661 | 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 |
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 |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| 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 |
|---|---|---|---|---|
| Meals sold to employees and guest | 722210 | $92,828 | $92,828 | |
| _ | $0 | $0 | ||
| _ | $0 | $0 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $128,773 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $0 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $128,773 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $221,601 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $23,026,242 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $19,063,912 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $231,262 | 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 | $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 | $594,789 | TotalAmt |
| Program Services | $389,194 | ProgramServicesAmt |
| Management And General | $205,595 | 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 | $6,622,213 | TotalAmt |
| Program Services | $6,056,844 | ProgramServicesAmt |
| Management And General | $565,369 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $329,195 | TotalAmt |
| Program Services | $293,630 | ProgramServicesAmt |
| Management And General | $35,565 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $938,240 | TotalAmt |
| Program Services | $836,876 | ProgramServicesAmt |
| Management And General | $101,364 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $490,410 | TotalAmt |
| Program Services | $437,428 | ProgramServicesAmt |
| Management And General | $52,982 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,290,000 | TotalAmt |
| Management And General | $2,290,000 | ManagementAndGeneralAmt |
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 | $99,254 | TotalAmt |
| Management And General | $99,254 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,614 | TotalAmt |
| Management And General | $3,614 | 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 | $1,946,075 | TotalAmt |
| Program Services | $1,946,075 | ProgramServicesAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $92,291 | TotalAmt |
| Program Services | $92,291 | ProgramServicesAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,306 | TotalAmt |
| Program Services | $122,334 | ProgramServicesAmt |
| Management And General | $6,972 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $124,051 | TotalAmt |
| Program Services | $74,431 | ProgramServicesAmt |
| Management And General | $49,620 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $489,436 | TotalAmt |
| Program Services | $489,436 | ProgramServicesAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $18,989 | TotalAmt |
| Program Services | $11,225 | ProgramServicesAmt |
| Management And General | $7,764 | 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 | $0 | TotalAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,300 | TotalAmt |
| Management And General | $3,300 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $80,328 | TotalAmt |
| Program Services | $48,197 | ProgramServicesAmt |
| Management And General | $32,131 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Pharmaceuticals | $1,265,797 | $1,265,797 | |
| Medical Supplies | $1,003,807 | $1,003,807 | |
| Dietary | $149,669 | $149,669 | |
| DUES & SUBSCRIPTIONS | $153,907 | $153,907 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $169,946 | TotalAmt |
| Program Services | $78,323 | ProgramServicesAmt |
| Management And General | $91,623 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,994,617 | TotalAmt |
| Program Services | $13,295,557 | ProgramServicesAmt |
| Management And General | $3,699,060 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,115,290 | BOYAmt |
| EOY | $879 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,496,311 | BOYAmt |
| EOY | $19,450,938 | 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 | $1,960,510 | BOYAmt |
| EOY | $2,361,253 | 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 | $353,021 | BOYAmt |
| EOY | $399,121 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $77,523 | BOYAmt |
| EOY | $153,187 | EOYAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $78,725 | BOYAmt |
| EOY | $140,511 | 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 | $3,080,512 | BOYAmt |
| EOY | $2,018,039 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,161,892 | BOYAmt |
| EOY | $24,523,928 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,252,322 | BOYAmt |
| EOY | $2,001,245 | 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 | $3,328,469 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $14,620,588 | BOYAmt |
| EOY | $20,504,644 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,201,379 | BOYAmt |
| EOY | $22,505,889 | 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 | $811,559 | BOYAmt |
| EOY | $979,302 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,148,954 | BOYAmt |
| EOY | $1,038,737 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,960,513 | BOYAmt |
| EOY | $2,018,039 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $21,161,892 | BOYAmt |
| EOY | $24,523,928 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $6,031,625 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$5,974,099 | OtherChangesInNetAssetsAmt |
| 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) |
|---|---|---|
| Consolidated Basis Fincl Stmt | Yes (X) | ConsolidatedBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | $3,614 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,614 | 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 | Pawnee Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospitals and health care as part of the services provided to members. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp |
CY Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,450,099 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $174,437 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,624,536 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,437,709 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $12,390 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,450,099 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,193,650 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $244,059 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,437,709 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,266,232 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | -$72,582 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,193,650 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $1,169,777 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $96,455 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,266,232 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Prmnnt Endowment Balance EOY | 1.00000 | PrmnntEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | false | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (true) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (true) | RelatedOrgListSchRInd |
| Land | LandGrp | |
| Buildings | BuildingsGrp | |
| Leasehold Improvements | LeaseholdImprovementsGrp | |
| Equipment | EquipmentGrp | |
| Other Land Buildings | OtherLandBuildingsGrp |
Other Assets Org OtherAssetsOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Beneficial interest foundation | Desc |
| Book Value | $2,018,039 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $2,018,039 | TotalBookValueOtherAssetsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)
| DescDesc | AmtAmt |
|---|---|
| Pension Liability | $140,511 |
| Due to Pawnee County | $15,409,580 |
| Due to Hays Medical Center | $968,257 |
| EST. AMOUNTS DUE TO THIRD-PARTY | $3,986,296 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $20,504,644 | TotalLiabilityAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE D, PART V, LINE 4 | FormAndLineReferenceDesc |
| Explanation | DONATIONS ARE REQUESTED FOR SPECIFIC ITEMS OR IMPROVEMENTS TO THE HOSPITAL. WHEN A DONATION IS RECEIVED FOR THAT SPECIFIC ITEM, IT IS RESTRICTED FOR THAT USE BY THE BOARD UNTIL THE SPECIFIC ITEM OR IMPROVEMENT IS PURCHASED. AT ANY ONE TIME, ONE OR MORE SUCH PROJECTS CAN BE IN PROGRESS. | 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 | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| 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 | $92,541 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $92,541 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00580 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,129,104 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $490,843 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $638,261 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03980 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,221,645 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $490,843 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $730,802 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04560 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,750 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,750 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,500,094 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $953,875 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,546,219 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09650 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,501,844 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $953,875 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,547,969 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.09660 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,723,489 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,444,718 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,278,771 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14220 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (true) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $700,074 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $11,374,957 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,543,082 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$168,125 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| 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 | PAWNEE VALLEY COMMUNITY HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 923 CARROLL AVE | AddressLine1Txt |
| City | LARNED | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.PAWNEEVALLEYHOSPITAL.COM | WebsiteAddressTxt |
| State License | H-073-002 | 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 |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAWNEE VALLEY COMMUNITY 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 | 20 | 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 PART V, SECTION C | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 20 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE 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 | 300. | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| 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 part v, section c | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | see part v, section c | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | see 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 |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE PAWNEE COUNTY HEALTH DEPARTMENT. A TOWN HALL MEETING WAS ORGANIZED TO PROVIDE AN OBJECTIVE CONSENSUS BUILDING METHOD OF REVIEWING AND PRIORITIZING COUNTY HEALTH ISSUES. DURING THE TOWN HALL MEETING, THE GROUP REFLECTED ON THE SIZE AND SERIOUSNESS OF ANY HEALTH CONCERNS CITED AND DISCUSSED CURRENT COMMUNITY HEALTH STRENGTHS. THE GROUP IDENTIFIED AND RANKED TOP COMMUNITY HEALTH CONCERNS, AND ALL TOWN HALL ATTENDEES WERE ENCOURAGED TO CONTINUE TO CONTRIBUTE IDEAS BY GOING ONLINE AND TAKING A FEEDBACK SURVEY THAT ADDRESSES ANY ADDITIONAL THOUGHTS RELATED TO THE CHNA. ALL TOWN HALL PRIORITY-SETTING AND SCORE PROCESSES INVOLVED THE INPUT OF A DIVERSE GROUP WITH KNOWLEDGE AND/OR EXPERTISE IN PUBLIC HEALTH AS WELL AS PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. KEY STAKEHOLDERS IN ATTENDANCE INCLUDED REPRESENTATIVES FROM AIR MED CARE/EAGLE MED, CITY OF LARNED, COUNTRY LIVING OF LARNED, USD 495 FORT LARNED, FRICK VET, FUSION BANK, HEART OF KANSAS FAMILY HEALTH CENTER, LARNED AREA CHAMBER OF COMMERCE, LARNED STATE HOSPITAL, PAWNEE COUNTY HEALTH DEPARTMENT, PAWNEE COUNTY SHERIFF'S DEPARTMENT, AND REPRESENTATIVES OF PAWNEE VALLEY COMMUNITY HOSPITAL. THE CHNA WAS COORDINATED AND PRODUCED BY VVV CONSULTANTS, LLC FROM OLATHE, KANSAS. |
| SCHEDULE H, PART V, SECTION B, LINE 6B | PAWNEE COUNTY, KS |
| SCHEDULE H, PART V, SECTION B, LINE 7A | https://www.pawneevalleyhospital.com/wp-content/uploads/2021/07/June-29-CH NA_2021_PawneeCoKS_Report_Final_052021_Updated-003.pdf |
| Schedule H, Part V, Section B, Line 10A | https://www.pawneevalleyhospital.com/wp-content/uploads/2022/01/CHNA2021_I mpDetailPlan_PawneeCoKS_Release1-002.pdf |
| Schedule H, Part V, Section B, Line 11 | Pawnee Valley Community Hospital, Inc. conducted its fourth Community Health Needs Assessment along with the Pawnee County Health Department in 2021. The Hospital and County Health Department will work with others in the community to address the needs that were identified in the survey. The needs that received the most votes are listed below. - Mental Health (Diagnosis, Placement, Aftercare) - 16.5% - Drug (Opioids) & Alcohol Abuse - 14.8% - Access to Care After Hours - 8.7% - Affordable Care - 7.8% - Awareness of Health Services - 7.8% - Teen Tobacco/Vaping - 7.8% - Awareness of Exercise/Fitness Activities - 6.1% - Insurance Coverage - 6.1% - Women's Health (Maternal & Fetal, Breastfeeding, etc.) - 6.1% The Town Hall meeting also noted the Community's Health Strengths, which are listed below. - Nutrition - Health Food Options - Nursing Home/Senior Care - Access to Services - Growth Opportunity - Charity Care - Care Coordination/Leadership - Recreational Activities - Stable Health Services - Health Department - Communication/Collaboration - Ratio of Providers Since the Community Health Needs Assessment was conducted toward the end of the fiscal year, most of the work in implementing the plan to address the needs will occur during the next few years. However, on the 2021 CHNA Implementation Plan, it is noted that several areas are not part of hospital mission critical operations and that the Hospital will be a partner with others to address these needs. These needs and the lead partner are listed below. - Mental Health (Diagnosis, Placement, Aftercare) - Mental Health Agency/Pawnee County Health Department - Drug (Opioids) & Alcohol Abuse - Mental Health Agency/Pawnee County Health Department - Teen Tobacco/Vaping - Pawnee County Health Department - Awareness of Exercise/Fitness Activities - Pawnee County Health Department - Insurance Coverage - No lead partner identified at this time The remaining CHNA Health Areas of Need will be addressed with Pawnee Valley Community Hospital as the lead partner in fiscal years 2022 and 2023. |
| Schedule H, Part V, Section B, Line 13B | FINANCIAL ASSISTANCE MAY BE GIVEN FOR CATASTROPHIC MEDICAL EXPENSES, EVEN IF PATIENT'S INCOME EXCEEDS THE FEDERAL POVERTY GUIDELINES. |
| Schedule H, Part V, Section B, Line 16A | https://www.pawneevalleyhospital.com/wp-content/uploads/2022/01/Financial- Assistance-Policy-PVCH.pdf |
| Schedule H, Part V, Section B, Line 16B | https://www.pawneevalleyhospital.com/wp-content/uploads/2021/12/BUS116a-1. pdf |
| SCHEDULE H, PART V, SECTION B, LINE 16C | https://www.pawneevalleyhospital.com/billing/financial-assistance-policy-s ummary/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | PAWNEE VALLEY MEDICAL PAVILION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 713 W 11TH ST | AddressLine1Txt |
| City | LARNED | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | FAMILY MEDICINE | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 7 | A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE FINANCIAL ASSISTANCE AT COST AND THE COST OF SUBSIDIZED HEALTH SERVICES. A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE THE COSTS OF SERVING MEDICAID BENEFICIARIES. |
| SCHEDULE H, PART I, LINE 7G | SUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT EXPENSES INCLUDE $892,409 OF EXPENSES ATTRIBUTABLE TO PHYSICIAN CLINICS THAT HAVE NET OPERATING LOSSES. |
| SCHEDULE H, PART III, LINE 2 | COSTING METHODOLOGY: A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE BAD DEBT EXPENSE AT COST. |
| SCHEDULE H, PART III, LINE 4 | THE FOOTNOTE FROM THE HOSPITAL'S FINANCIAL STATEMENTS FOLLOWS: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. |
| Schedule H, Part III, Line 8 | THE MEDICARE COST REPORT WAS THE COSTING METHODOLOGY USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS PERTAINING TO MEDICARE NET REVENUE. ALLOWABLE COSTS OF CARE REPORTED ON LINE 6 WERE DETERMINED USING AMOUNTS FROM WORKSHEET D, PART V AND WORKSHEET D-1 IN THE PAWNEE VALLEY COMMUNITY HOSPITAL, INC., MEDICARE COST REPORT FOR FISCAL YEAR ENDED JUNE 30, 2021. |
| Schedule H, Part III, LINE 9B | Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient. |
| Schedule H, Part VI, Line 2 | AN EFFORT TO UNDERSTAND AND CREATE A HEALTHIER COMMUNITY REQUIRES COLLABORATION AND INPUT FROM MANY COMMUNITY STAKEHOLDERS. THROUGH DATA RESEARCH AND KEY CONVERSATIONS IN THE PAWNEE COUNTY AREA, THIS CHNA PULLS TOGETHER COMMUNITY FINDINGS AND ADDRESSES TOP HEALTH PRIORITIES TO HELP IMPROVE COMMUNITY HEALTH OVER THE NEXT THREE YEARS. THE HOSPITAL ALSO ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, AND ANNUAL STRATEGIC PLANNING PROCESS HEADED BY THE HEALTH SYSTEM. THE HOSPITAL OBTAINS MARKET DATA THROUGH ITS ANNUAL STRATEGIC PLANNING PROCESS. WITH THIS DATA, THE HOSPITAL IDENTIFIES SERVICES RECEIVED BY THE RESIDENTS OF OUR COMMUNITY (DEFINED BY OUR PRIMARY AND SECONDARY SERVICE AREAS). ANY PREDOMINANT SERVICES NOT CURRENTLY OFFERED BY THE HOSPITAL ARE CONSIDERED DURING STRATEGIC PLANNING. THE HOSPITAL ALSO WORKS CLOSELY WITH THE PUBLIC HEALTH COMMISSION AND THE SCHOOL DISTRICT WHEN ASSESSING THESE NEEDS. ANOTHER ELEMENT OF THE COMMUNITY NEEDS ASSESSMENT INVOLVES ANNUALLY UPDATING THE HOSPITAL'S PROVISION OF CARE PLAN AND ITS CRITICAL ACCESS HOSPITAL ANNUAL REPORT. FINALLY, THE HOSPITAL AND RELATED HEALTH SYSTEM ARE ACTIVELY ENGAGED IN A VARIETY OF FORMAL HEALTH PROFESSIONALS EDUCATION PROGRAMS. |
| Schedule H, Part VI, Line 3 | Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. A financial assistance policy summary is included with every statement that is sent to an uninsured patient. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well. |
| Schedule H, Part VI, Line 4 | Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $43,250. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.2% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned. |
| Schedule H, Part VI, Line 5 | Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians. |
| SCHEDULE H, PART VI, LINE 6 | Pawnee Valley Community Hospital, Inc. is a component unit of Hays Medical Center, Inc. As of January 1, 2017, Hays Medical Center, Inc. became a component unit of the University of Kansas Hospital Authority. |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (true) | 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 (11 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| SHAE VEACH | ||||||||||||||
| PRESIDENT | $0 | $213,835 | $0 | $0 | $0 | $11,308 | $0 | $46,860 | $0 | $28,412 | $0 | $300,415 | $0 | $0 |
| GEORGE HARMS | ||||||||||||||
| TREASURER | $0 | $280,931 | $0 | $116 | $0 | $3,024 | $0 | $60,600 | $0 | $22,116 | $0 | $366,787 | $0 | $0 |
| EDWARD HERRMAN | ||||||||||||||
| DIRECTOR | $0 | $560,388 | $0 | $0 | $0 | $5,823 | $0 | $102,600 | $0 | $32,245 | $0 | $701,056 | $0 | $0 |
| CHRISTIAN WHITTINGTON MD | ||||||||||||||
| DIRECTOR/PHYSICIAN-NONVOTING | $272,748 | $0 | $20,000 | $0 | $69,241 | $0 | $17,100 | $0 | $29,668 | $0 | $408,757 | $0 | $0 | $0 |
| MELANIE URBAN | ||||||||||||||
| ADMINISTRATOR | $0 | $136,985 | $0 | $800 | $0 | $162 | $0 | $8,448 | $0 | $24,683 | $0 | $171,078 | $0 | $0 |
| TERRY SIEK | ||||||||||||||
| DIRECTOR | $0 | $226,444 | $0 | $0 | $0 | $491 | $0 | $47,853 | $0 | $10,745 | $0 | $285,533 | $0 | $0 |
| MC HILL | ||||||||||||||
| PHYSICIAN | $245,000 | $0 | $20,000 | $0 | $8,360 | $0 | $15,900 | $0 | $27,337 | $0 | $316,597 | $0 | $0 | $0 |
| DUSTY ATTERBURY | ||||||||||||||
| APRN | $122,299 | $0 | $1,078 | $0 | $82,849 | $0 | $12,784 | $0 | $25,823 | $0 | $244,833 | $0 | $0 | $0 |
| CALVIN KRUGER | ||||||||||||||
| PHYSICIAN ASSISTANT | $139,123 | $0 | $1,078 | $0 | $8,275 | $0 | $8,893 | $0 | $861 | $0 | $158,230 | $0 | $0 | $0 |
| DAVID SHERRADEN | ||||||||||||||
| PHYSICIAN ASSISTANT | $138,956 | $0 | $893 | $0 | $8,421 | $0 | $5,304 | $0 | $4,661 | $0 | $158,235 | $0 | $0 | $0 |
| STACY TROUT | ||||||||||||||
| PHYSICIAN ASSISTANT | $140,549 | $0 | $985 | $0 | $98 | $0 | $8,492 | $0 | $1,218 | $0 | $151,342 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Schedule J, Part I, Line 3 | A RELATED ORGANIZATION USES A COMPENSATION COMMITTEE, INDEPENDENT COMPENSATION CONSULTANT, WRITTEN EMPLOYMENT CONTRACT, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF THE HOSPITAL'S ADMINISTRATOR. |
| Form 990, Schedule J, Part I, Line 4b | CONTRIBUTIONS TO THE PLAN: TERRY SIEK $34,181 GEORGE HARMS $43,500 SHAE VEACH $33,000 EDWARD HERRMAN $85,500 |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part I, Line 1 | BY THE STATE OF KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT. THE PURPOSE OF THE ORGANIZATION IS TO IMPROVE THE QUALITY OF LIFE FOR THE COMMUNITIES WE SERVICE THROUGH EXCEPTIONAL HEALTHCARE AND SERVICE EXCELLENCE. THE ORGANIZATION IS STRIVING TO BE THE BEST CRITICAL ACCESS HOSPITAL IN RURAL AMERICA. |
| Form 990, Part III, Line 1 | TO PROVIDE HEALTHCARE FACILITIES AND SERVICES FOR THE CARE AND TREATMENT OF INPATIENTS AND OUTPATIENTS WHO ARE ACUTELY ILL OR WHO OTHERWISE REQUIRE MEDICAL CARE AND RELATED SERVICES. THE CORE PURPOSE OF THE CORPORATION IS TO IMPROVE THE QUALITY OF LIFE FOR THE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL HEALTHCARE AND SERVICE EXCELLENCE. |
| FORM 990, PART IV, LINE 20B | THE AUDITED FINANCIAL STATEMENTS FOR THE CURRENT YEAR WERE NOT COMPLETE AT THE TIME OF FILING. THE HOSPITAL HAS ATTACHED THE PRIOR YEAR AUDIT REPORT TO THE RETURN. ONCE THE CURRENT YEAR AUDIT REPORT IS COMPLETE, THE HOSPITAL WILL AMEND THE RETURN. |
| FORM 990, PART VI, SECTION A, LINE 6 | THE ORGANIZATION HAS ONE MEMBER, HAYSMED PARTNERS, INC., WHICH BECAME THE SOLE MEMBER AS OF MARCH 1, 2010. HAYSMED PARTNERS, INC., IS A WHOLLY-OWNED SUBSIDIARY OF HAYS MEDICAL CENTER, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | THE BOARD MEMBERS OF HAYSMED PARTNERS, INC., THE SOLE MEMBER OF PAWNEE VALLEY COMMUNITY HOSPITAL, APPOINT THE BOARD MEMBERS OF PAWNEE VALLEY COMMUNITY HOSPITAL, INC. |
| FORM 990, PART VI, SECTION A, LINE 7B | HAYSMED PARTNERS, INC., THE SOLE MEMBER OF PAWNEE VALLEY COMMUNITY HOSPITAL, ELECTS THE BOARD MEMBERS OF PAWNEE VALLEY COMMUNITY HOSPITAL. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. IT IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THEY HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FINAL FORM 990 IS THEN PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | OFFICERS, DIRECTORS AND KEY EMPLOYEES, ALONG WITH ALL ASSOCIATES, ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENTS ARE REVIEWED BY THE BOARD, THE COMPLIANCE OFFICER, AND GOVERNANCE DIRECTOR, AS WELL. WHEN CONFLICT OF INTEREST ISSUES ARISE DURING A BOARD MEETING, THE BOARD MEMBERS WITH THE CONFLICT ARE ASKED TO REMOVE THEMSELVES FROM DISCUSSION OR FROM THE ROOM ENTIRELY. THEY ARE NOT ALLOWED TO VOTE ON THAT PARTICULAR ISSUE. |
| FORM 990, PART VI, SECTION B, LINE 15A & 15B | THE HOSPITAL ADMINISTRATOR AND OFFICERS' SALARIES ARE REVIEWED ANNUALLY BY AN INDEPENDENT CONSULTING GROUP AND THE BOARD MEMBERS. THEY BASE THE REVIEW ON SALARY COMPARISONS OBTAINED BY THE CONSULTING GROUP FROM PEER HOSPITALS IN SIMILAR GEOGRAPHIC REGIONS. THE LAST REVIEW WAS CONDUCTED IN APRIL 2020. |
| FORM 990, PART VI, SECTION C, LINE 19 | THESE DOCUMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC. |
| Form 990, Part XI, Line 9 | Transfers to Pawnee County ($ 6,031,624) Change in assets held by foundation $ 57,525 ------------ Total ($ 5,974,099) |
| Form 990, Part XII, Line 2c | THE PAWNEE VALLEY COMMUNITY HOSPITAL, INC. BOARD AND THE HEALTH SYSTEM AUDIT COMMITTEE ARE RESPONSIBLE FOR THE OVERSIGHT OF PAWNEE VALLEY COMMUNITY HOSPITAL INC.'S, FINANCIAL STATEMENT AUDIT AND THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 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 | Direct Controlling NADirectControllingNACd |
|---|---|---|---|---|---|---|---|---|---|---|---|
| HAYSMED PARTNERS INC | |||||||||||
| 2220 CANTERBURY DR | HAYS | KS | 67601 | 270877152 | MANAGEMENT | KS | 501(C)(3) | 3 | HMC | Yes (true) | |
| HAYS MEDICAL CENTER INC | |||||||||||
| 2220 CANTERBURY DR | HAYS | KS | 67601 | 480559088 | HOSPITAL | KS | 501(C)(3) | 3 | UKHA | Yes (true) | |
| PAWNEE VALLEY COMMUNITY HOSPITAL FDN | |||||||||||
| 923 CARROLL AVE | LARNED | KS | 67550 | 455333776 | SUPPORT | KS | 501(C)(3) | 12A | PVCH | Yes (true) | |
| UNIVERSITY OF KANSAS HOSPITAL AUTHORITY | |||||||||||
| 3901 RAINBOW BLVD | KANSAS CITY | KS | 66160 | 481202402 | HOSPITAL | KS | false | N/A | |||
| ST ROSE HEALTH CENTER | |||||||||||
| 3515 Broadway | Great Bend | KS | 67530 | 472117443 | HEALTH CENTER | KS | 501(C)(3) | 3 | UKHA | Yes (true) | |
| TURNING POINT THE CENTER FOR HOPE | |||||||||||
| 8900 STATE LINE ROAD STE 240 | LEAWOOD | KS | 66206 | 431900039 | HEALTHCARE | KS | 501(C)(3) | 7 | UKHA | Yes (true) | |
| KANSAS UNIVERSITY PHYSICIANS INC | |||||||||||
| 3901 RAINBOW BLVD 4070 DELP | KANSAS CITY | MO | 66160 | 481163756 | HEALTHCARE | KS | 501(C)(3) | 10 | UKP | Yes (true) | |
Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | General Or Managing PartnerGeneralOrManagingPartnerInd |
|---|---|---|---|---|---|---|---|---|
| KU MEDWEST AMBULATORY SURGERY | ||||||||
| 7405 RENNER ROAD | SHAWNEE | KS | 66217 | 020664568 | HEALTHCARE | KS | UKHA | false |
| UKH SPORTS MED LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY STE 200 | WESTWOOD | KS | 66205 | 463123647 | HEALTHCARE | KS | UKHA | false |
| KH ALLIANCE LLC | ||||||||
| 4000 CAMBRIDGE STREET | KANSAS CITY | KS | 66160 | 472838147 | HEALTHCARE | KS | UKHA | false |
| KANSAS CLINICAL IMPROVEMENT COLLABORATIV | ||||||||
| 112 SW 7TH STREET SUITE 3C | TOPEKA | KS | 66603 | 812776361 | HEALTHCARE | KS | UKHA | false |
| KANSAS PRIMARY CARE ALLIANCE LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY SUITE 200 | WESTWOOD | KS | 66205 | 463164140 | HEALTHCARE | KS | UKHA | false |
| UKHS GREAT BEND LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY STE 312 | WESTWOOD | KS | 66205 | 830516935 | HEALTHCARE | KS | UKHA | false |
| UKHS SPORTS PERFORMANCE CENTER LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY STE 312 | WESTWOOD | KS | 66205 | 830888634 | HEALTHCARE | KS | UKHA | false |
| UKHS GREAT BEND PHYSICIANS LLC | ||||||||
| 2330 SHAWNEE MISSION PKWY STE 312 | WESTWOOD | KS | 66205 | 831255734 | HEALTHCARE | KS | UKHS GREAT BEND | false |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Entity TypeEntityTypeTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| JAYHAWK PRIMARY CARE INC | |||||||||
| 2300 SHAWNEE MISSION PARKWAY STE 3 | WESTWOOD | KS | 66205 | 481159444 | HEALTHCARE | KS | UKHA | C-CORP | Yes (true) |
| MID-AMERICA CARDIOLOGY ASSOCIATES INC | |||||||||
| 4000 CAMBRIDGE STREET STE G600 | KANSAS CITY | KS | 66160 | 480980010 | HEALTHCARE | MO | UKHA | C-CORP | Yes (true) |
| UNIVERSITY OF KANSAS PHYSICIANS INC | |||||||||
| 2330 SHAWNEE MISSION PKWY STE 200 | WESTWOOD | KS | 66205 | 471214865 | HEALTHCARE | KS | UKHA | C-CORP | Yes (true) |
| UKHA PROGRAM SUPPORT INC | |||||||||
| 2330 SHAWNEE MISSION PKWY STE 200 | WESTWOOD | KS | 66205 | 455571151 | REAL ESTATE | KS | UKHA | C-CORP | 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 | 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 | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (true) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (true) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (true) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp (7 entries)
| Transaction TypeTransactionTypeTxt | InvolvedInvolvedAmt | Method Of Amount DeterminationMethodOfAmountDeterminationTxt |
|---|---|---|
| PVCH Foundation | ||
| C | $305,685 | FMV |
| HAYS MEDICAL CENTER INC | ||
| E | $126,287 | FMV |
| University of Kansas Health System | ||
| E | $807,862 | FMV |
| HAYS MEDICAL CENTER INC | ||
| M | $480,170 | FMV |
| Hays Medical Center Inc | ||
| O | $300,578 | FMV |
| PVCH Foundation | ||
| O | $79,724 | FMV |
| Hays Medical Center Inc | ||
| P | $2,290,000 | FMV |