RURAL HEALTH RESOURCES OF JACKSON CO INC: Form 990, tax year 2020

View the entire original 990 at ProPublica ↗

Organization: RURAL HEALTH RESOURCES OF JACKSON CO INC (EIN 74-2826278)
Tax period: 2020-04-01 to 2021-03-31
Filed: 2022-02-10
IRS object ID: 202230419349300823
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 K
Schedule L
Schedule O

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2022-02-10T10:47:41-06:00	ReturnTs
Tax Period End	2021-03-31	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	2020-04-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	742826278	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RURAL HEALTH RESOURCES OF JACKSON CO INC	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
In Care Of	% BART KENTON	InCareOfNm
Business Name Control	RURA	BusinessNameControlTxt
Phone	7853642116	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1110 COLUMBINE DRIVE	AddressLine1Txt
City	HOLTON	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	66436	ZIPCd

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	CARRIE SAIA	PersonNm
Person Title	CEO	PersonTitleTxt
Phone	7853649636	PhoneNum
Signature	2022-02-15	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Signing Officer SigningOfficerGrp

Person Full Name PersonFullName

Field	Value	IRS element (for citing)
Person First	CARRIE	PersonFirstNm
Person Last	SAIA	PersonLastNm

Field	Value	IRS element (for citing)
SSN	XXX-XX-XXXX	SSN

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	Michael J Engle	PreparerPersonNm
PTIN	P00482834	PTIN
Phone	8162216300	PhoneNum
Preparation	2022-02-15	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

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	HOLTON COMMUNITY HOSPITAL	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Principal Officer	CARRIE SAIA	PrincipalOfficerNm

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1110 COLUMBINE DRIVE	AddressLine1Txt
City	HOLTON	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	66436	ZIPCd

Field	Value	IRS element (for citing)
Gross Receipts	$22,685,930	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.HOLTONHOSPITAL.COM	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1997	FormationYr
Legal Domicile State	KS	LegalDomicileStateCd
Activity Or Mission	TO PROVIDE HIGH QUALITY HEALTHCARE SERVICES TO ALL OF JACKSON COUNTY AND SURROUNDING COMMUNITIES WHILE CONSISTENTLY DEMONSTRATING PROFESSIONALISM WITH THE HOMETOWN TOUCH.	ActivityOrMissionDesc
Voting Members Governing Body	8	VotingMembersGoverningBodyCnt
Voting Members Independent	6	VotingMembersIndependentCnt
Total Employee	222	TotalEmployeeCnt
Total Volunteers	35	TotalVolunteersCnt
Total Gross UBI	$0	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$0	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$1,478,348	PYContributionsGrantsAmt
CY Contributions Grants	$3,288,858	CYContributionsGrantsAmt
PY Program Service Revenue	$19,089,021	PYProgramServiceRevenueAmt
CY Program Service Revenue	$19,159,081	CYProgramServiceRevenueAmt
PY Investment Income	$81,404	PYInvestmentIncomeAmt
CY Investment Income	$71,584	CYInvestmentIncomeAmt
PY Other Revenue	$162,414	PYOtherRevenueAmt
CY Other Revenue	$166,407	CYOtherRevenueAmt
PY Total Revenue	$20,811,187	PYTotalRevenueAmt
CY Total Revenue	$22,685,930	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	$10,605,816	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$12,193,533	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$8,994,352	PYOtherExpensesAmt
CY Other Expenses	$10,278,758	CYOtherExpensesAmt
PY Total Expenses	$19,600,168	PYTotalExpensesAmt
CY Total Expenses	$22,472,291	CYTotalExpensesAmt
PY Revenues Less Expenses	$1,211,019	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$213,639	CYRevenuesLessExpensesAmt
Total Assets BOY	$25,346,668	TotalAssetsBOYAmt
Total Assets EOY	$32,015,245	TotalAssetsEOYAmt
Total Liabilities BOY	$19,050,916	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$25,183,987	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$6,295,752	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$6,831,258	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	TO PROVIDE PROFESSIONALISM, COMPASSION AND EXCELLENCE IN HEALTHCARE FOR A HEALTHIER COMMUNITY.	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$13,931,414	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$14,832,530	RevenueAmt
Desc	SEE SCHEDULE O.	Desc

Prog Srvc Accom Acty2 ProgSrvcAccomActy2Grp

Field	Value	IRS element (for citing)
Expense	$2,021,018	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$3,410,643	RevenueAmt
Desc	THERE ARE 3 RURAL HEALTH CLINICS: 1 RURAL HEALTH CLINIC WITHIN THE SAME COMMUNITY WHERE THE HOSPITAL RESIDES, AND 2 RURAL HEALTH CLINICS LOCATED IN 2 SMALLER NEARBY COMMUNITIES. THE RURAL HEALTH CLINICS REPORTED 11,701 VISITS FROM 4/1/20 THROUGH 3/31/21. PROVIDERS FOR THE RURAL HEALTH CLINICS LIVE AND WORK IN THE SAME COMMUNITY AND ARE ACTIVELY INVOLVED IN COMMUNITY ACTIVITIES; OFFERING A LARGE VARIETY OF EDUCATIONAL SERVICES AS WELL AS CLINICAL SERVICES SUCH AS PROVIDING 2 LOCAL HIGH SCHOOLS SPORTS PHYSICALS AT LITTLE TO NO CHARGE.	Desc

Prog Srvc Accom Acty3 ProgSrvcAccomActy3Grp

Field	Value	IRS element (for citing)
Expense	$1,268,180	ExpenseAmt
Grant	$0	GrantAmt
Revenue	$915,908	RevenueAmt
Desc	A HOSPITAL BASED HOME HEALTH & HOSPICE AGENCY PROVIDES IN-HOME NURSING AND REHABILITATION CARE TO JACKSON COUNTY AND SURROUNDING COUNTY RESIDENTS. THE VISITS TOTALED 3,379 VISITS FROM 4/1/2020 TO 3/31/2021, HOSPICE SERVICES TOTAL 2,607 HOSPICE PATIENT DAYS FOR THE SAME PERIOD.	Desc

Field	Value	IRS element (for citing)
Total Program Service Expenses	$17,220,612	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	Yes (true)	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	Yes (true)	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	false	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	false	GrantsToOrganizationsInd
Grants To Individuals	false	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	Yes (true)	TaxExemptBondsInd
Invest Tax Exempt Bonds	false	InvestTaxExemptBondsInd
Escrow Account	false	EscrowAccountInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	Yes (true)	BusinessRlnWithFamMemInd
Business Rln With35 Ctrl Ent	false	BusinessRlnWith35CtrlEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	false	RelatedEntityInd
Related Organization Ctrl Ent	false	RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	32	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	222	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	6	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	false	MembersOrStockholdersInd
Election Of Board Members	false	ElectionOfBoardMembersInd
Decisions Subject To Approva	false	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	false	CompensationProcessOtherInd
Investment In Joint Venture	false	InvestmentInJointVentureInd
States Where Copy Of Return Is Fld	KS	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Field	Value	IRS element (for citing)
Person	BART KENTON	PersonNm
Phone	7853649636	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1110 COLUMBINE DRIVE	AddressLine1Txt
City	HOLTON	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	66436	ZIPCd

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	Yes (X)	InfoInScheduleOPartVIIInd

Form990 Part VII Section A Form990PartVIISectionAGrp (17 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	Highest Compensated EmployeeHighestCompensatedEmployeeInd	OfficerOfficerInd
CLINT COLBERG
DIRECTOR/CHIEF OF MED STAFF	40.0	0.0	Yes (X)	$305,487	$0	$38,806
MALIA WARNEREND 720
DIRECTOR/CHIEF OF MED STAFF	40.0	0.0	Yes (X)	$281,809	$0	$40,160
LADONA SCHMIDT
PHYSICIAN	40.0	0.0		$206,183	$0	$30,731	Yes (X)
ERIN LOCKE
PHYSICIAN	40.0	0.0		$220,325	$0	$15,921	Yes (X)
JOEL HUTCHINS
PHYSICIAN	40.0	0.0		$186,639	$0	$13,180	Yes (X)
CARRIE SAIA
CHIEF EXECUTIVE OFFICER	40.0	0.0		$173,838	$0	$25,149		Yes (X)
JOSHUA C MOULIN
PHYSICIAN'S ASSISTANT	40.0	0.0		$156,823	$0	$34,374	Yes (X)
KAYLIE ZIMMERMAN
APRN	40.0	0.0		$135,092	$0	$19,581	Yes (X)
BART KENTON
CHIEF FINANCIAL OFFICER	40.0	0.0		$113,061	$0	$30,033		Yes (X)
BOBBI MCGRATH
DIRECTOR/BOARD CHAIR	1.0	0.0	Yes (X)	$0	$0	$0		Yes (X)
DAN BRENNER
DIRECTOR/VICE CHAIR	1.0	0.0	Yes (X)	$0	$0	$0		Yes (X)
MICHAEL MOSIER
DIRECTOR/SECRETARY	1.0	0.0	Yes (X)	$0	$0	$0		Yes (X)
CHAD BONTRAGER
DIRECTOR/BOARD TREASURER	1.0	0.0	Yes (X)	$0	$0	$0		Yes (X)
MARK AESCHLIMAN
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
HEATHER SCHRICK
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
GLORIA STAVROPOULOS
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0
MARILYN WATKINS
DIRECTOR	1.0	0.0	Yes (X)	$0	$0	$0

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$1,779,257	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$0	TotReportableCompRltdOrgAmt
Total Other Compensation	$247,935	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	22	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
PSYCHIATRIC MEDICAL CARE LLC
8 CADILLAC DRIVE 230	NASHVILLE	TN	66606	PHYSICIAN CONSULTING	$447,807
MOSS ANETHESIA LLC
8401 NW US HWY 75	TOPEKA	KS	66618	ANESTHESIA SERVICES	$350,200
ATHENAHEALTH
311 ARSENAL STREET	WATERTOWN	MA	02472	SUPPORT/SOFTWARE	$578,454
PREMIER SPECIALTY NETWORK
1835 E REPUBLIC RD	SPRINGFIELD	MO	65804	SPECIALTY PHYSICIAN	$453,933
RURAL PARTNERS IN MEDICINE LLC
8181 ARISTA PLACE	BROOMFIELD	CO	80021	SPECIALTY PHYSICIAN	$497,250

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	9	CntrctRcvdGreaterThan100KCnt
Government Grants	$2,789,522	GovernmentGrantsAmt
All Other Contributions	$499,336	AllOtherContributionsAmt
Total Contributions	$3,288,858	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (2 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
NET PATIENT SERVICE REVENUE	622110	$17,856,768	$17,856,768
340B REVENUE	623000	$1,302,313	$1,302,313

Field	Value	IRS element (for citing)
Total Program Service Revenue	$19,159,081	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$69,384	TotalRevenueColumnAmt
Exclusion	$69,384	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

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Other	$2,200	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Other	$2,200	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$2,200	TotalRevenueColumnAmt
Exclusion	$2,200	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
REBATE INCOME	623000	$104,242	$104,242
CAFETERIA	623000	$19,523	$19,523
ALL OTHER MISC REVENUE	623000	$42,642	$42,642

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$42,642	TotalRevenueColumnAmt
Exclusion	$42,642	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$166,407	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$22,685,930	TotalRevenueColumnAmt
Related Or Exempt Func Income	$19,159,081	RelatedOrExemptFuncIncomeAmt
Exclusion	$237,991	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	$1,030,160	TotalAmt
Program Services	$854,601	ProgramServicesAmt
Management And General	$175,559	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$46,880	TotalAmt
Program Services	$46,880	ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$8,758,598	TotalAmt
Program Services	$6,313,240	ProgramServicesAmt
Management And General	$2,445,358	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$288,527	TotalAmt
Program Services	$234,458	ProgramServicesAmt
Management And General	$54,069	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$1,340,300	TotalAmt
Program Services	$999,286	ProgramServicesAmt
Management And General	$341,014	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$729,068	TotalAmt
Program Services	$557,276	ProgramServicesAmt
Management And General	$171,792	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$26,081	TotalAmt
Program Services	$21,125	ProgramServicesAmt
Management And General	$4,956	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$85,003	TotalAmt
Management And General	$85,003	ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

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	$4,083,334	TotalAmt
Program Services	$3,652,563	ProgramServicesAmt
Management And General	$430,771	ManagementAndGeneralAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$74,188	TotalAmt
Program Services	$1,304	ProgramServicesAmt
Management And General	$72,884	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$744,923	TotalAmt
Program Services	$577,546	ProgramServicesAmt
Management And General	$167,377	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$755,357	TotalAmt
Program Services	$8,699	ProgramServicesAmt
Management And General	$746,658	ManagementAndGeneralAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$338,378	TotalAmt
Program Services	$247,138	ProgramServicesAmt
Management And General	$91,240	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$170,110	TotalAmt
Program Services	$165,897	ProgramServicesAmt
Management And General	$4,213	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	$117,269	TotalAmt
Program Services	$85,649	ProgramServicesAmt
Management And General	$31,620	ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$638,744	TotalAmt
Program Services	$466,514	ProgramServicesAmt
Management And General	$172,230	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$138,959	TotalAmt
Program Services	$118,102	ProgramServicesAmt
Management And General	$20,857	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPPLIES	$1,989,427	$1,989,427
BAD DEBT EXPENSE	$582,954	$582,954
REPAIRS AND MANTENANCE	$299,240	$252,046	$47,194
DUES AND SUBSCRIPTIONS	$57,189	$15,813	$41,376

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$177,602	TotalAmt
Program Services	$30,094	ProgramServicesAmt
Management And General	$147,508	ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$22,472,291	TotalAmt
Program Services	$17,220,612	ProgramServicesAmt
Management And General	$5,251,679	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$12,216,048	BOYAmt
EOY	$5,320,106	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$1,980,663	BOYAmt
EOY	$3,839,139	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	$2,595,590	BOYAmt
EOY	$3,083,320	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	$197,557	BOYAmt
EOY	$151,891	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$148,222	BOYAmt
EOY	$165,849	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$24,082,033	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$6,313,603	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$7,945,992	BOYAmt
EOY	$17,768,430	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	$262,596	BOYAmt
EOY	$1,686,510	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$25,346,668	BOYAmt
EOY	$32,015,245	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$2,451,755	BOYAmt
EOY	$2,105,921	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	$5,694	BOYAmt
EOY	$1,712,327	EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$14,615,000	BOYAmt
EOY	$14,615,000	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	$1,836,525	BOYAmt
EOY	$1,777,519	EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$2,022,937	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$141,942	BOYAmt
EOY	$2,950,283	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$19,050,916	BOYAmt
EOY	$25,183,987	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	$6,223,536	BOYAmt
EOY	$6,437,175	EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$72,216	BOYAmt
EOY	$394,083	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$6,295,752	BOYAmt
EOY	$6,831,258	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$25,346,668	BOYAmt
EOY	$32,015,245	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$213,639	ReconcilationRevenueExpnssAmt
Other Changes In Net Assets	$321,867	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)
Separate Basis Fincl Stmt	Yes (X)	SeparateBasisFinclStmtInd

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	Yes (true)	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (true)	GrantsOtherOrganizationsInd
Grants Other Organizations	$3,132	GrantsOtherOrganizationsAmt
Direct Contact Legislators	Yes (true)	DirectContactLegislatorsInd
Direct Contact Legislators	$1,423	DirectContactLegislatorsAmt
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	false	OtherActivitiesInd
Total Lobbying Expenditures	$4,555	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE C, PART II-B, LINE 1F	THIS AMOUNT REPRESENTS THE PORTION OF THE DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION AND THE KANSAS HOSPITAL ASSOCIATION THAT ARE FOR LOBBYING.
SCHEDULE C, PART II-B, LINE 1G	CARRIE SAIA, CHIEF EXECUTIVE OFFICER, IS A REPRESENTATIVE FOR THE KANSAS HOSPITAL ASSOCIATION TO THE AMERICAN HOSPITAL ASSOCIATION AND HAS MEETINGS WITH LEGISLATORS IN TOPEKA, KANSAS AND WASHINGTON, D.C.

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	$46,266	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,038	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,038	OtherExpendituresAmt
End Year Balance	$46,266	EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$46,266	BeginningYearBalanceAmt
Investment Earnings Or Losses	$1,051	InvestmentEarningsOrLossesAmt
Other Expenditures	$1,051	OtherExpendituresAmt
End Year Balance	$46,266	EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$46,266	BeginningYearBalanceAmt
Investment Earnings Or Losses	$318	InvestmentEarningsOrLossesAmt
Other Expenditures	$318	OtherExpendituresAmt
End Year Balance	$46,266	EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$46,266	BeginningYearBalanceAmt
Investment Earnings Or Losses	$318	InvestmentEarningsOrLossesAmt
Other Expenditures	$318	OtherExpendituresAmt
End Year Balance	$46,266	EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

Field	Value	IRS element (for citing)
Beginning Year Balance	$46,266	BeginningYearBalanceAmt
Investment Earnings Or Losses	$374	InvestmentEarningsOrLossesAmt
Other Expenditures	$374	OtherExpendituresAmt
End Year Balance	$46,266	EndYearBalanceAmt

Field	Value	IRS element (for citing)
Prmnnt Endowment Balance EOY	1.00000	PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org	false	EndowmentsHeldUnrelatedOrgInd
Endowments Held Related Org	false	EndowmentsHeldRelatedOrgInd

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$9,983	OtherCostOrOtherBasisAmt
Book Value	$9,983	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$13,264,868	OtherCostOrOtherBasisAmt
Depreciation	$2,636,683	DepreciationAmt
Book Value	$10,628,185	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$855,694	OtherCostOrOtherBasisAmt
Depreciation	$477,002	DepreciationAmt
Book Value	$378,692	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$4,855,398	OtherCostOrOtherBasisAmt
Depreciation	$2,736,973	DepreciationAmt
Book Value	$2,118,425	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$5,096,090	OtherCostOrOtherBasisAmt
Depreciation	$462,945	DepreciationAmt
Book Value	$4,633,145	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$17,768,430	TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (3 entries)

DescDesc	Book ValueBookValueAmt
DEFERRED FINANCING COSTS	$75,823
DUE FROM THIRD PARTY	$1,540,000
OTHER ASSETS	$70,687

Field	Value	IRS element (for citing)
Total Book Value Other Assets	$1,686,510	TotalBookValueOtherAssetsAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp

Field	Value	IRS element (for citing)
Desc	DUE TO THIRD PARTY	Desc
Amt	$2,950,283	Amt

Field	Value	IRS element (for citing)
Total Liability	$2,950,283	TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt	$22,102,976	TotalRevEtcAuditedFinclStmtAmt
Revenue Subtotal	$22,102,976	RevenueSubtotalAmt
Other Revenues Not Included	$582,954	OtherRevenuesNotIncludedAmt
Revenue Not Reported Fincl Stmt	$582,954	RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990	$22,685,930	TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt	$21,889,337	TotExpnsEtcAuditedFinclStmtAmt
Expenses Subtotal	$21,889,337	ExpensesSubtotalAmt
Other Expenses Not Included	$582,954	OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt	$582,954	ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990	$22,472,291	TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE D, PART V, LINE 4	THE PERMANENTLY DONOR RESTRICTED ENDOWMENT ONLY ALLOWS THE ORGANIZATION TO USE INTEREST INCOME FOR OPERATIONS.
SCHEDULE D, PART X, LINE 2	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.
SCHEDULE D, PART XI AND PART XII, LINE 4B	PROVISION FOR UNCOLLECTIBLE ACCOUNTS $ 582,954

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
Percent100	Yes (X)	Percent100Ind
FPG Reference Discounted Care	Yes (true)	FPGReferenceDiscountedCareInd
Percent200 D	Yes (X)	Percent200DInd
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	$36,002	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$36,002	NetCommunityBenefitExpnsAmt
Total Expense	0.00160	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,491,844	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$561,572	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$930,272	NetCommunityBenefitExpnsAmt
Total Expense	0.04250	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,527,846	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$561,572	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$966,274	NetCommunityBenefitExpnsAmt
Total Expense	0.04410	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Persons Served	816	PersonsServedCnt
Total Community Benefit Expns	$6,955	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$6,955	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Persons Served	10	PersonsServedCnt
Total Community Benefit Expns	$55,845	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$55,845	NetCommunityBenefitExpnsAmt
Total Expense	0.00260	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$1,268,180	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$915,981	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$352,199	NetCommunityBenefitExpnsAmt
Total Expense	0.01610	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$7,016	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$7,016	NetCommunityBenefitExpnsAmt
Total Expense	0.00030	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	826	PersonsServedCnt
Total Community Benefit Expns	$1,337,996	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$915,981	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$422,015	NetCommunityBenefitExpnsAmt
Total Expense	0.01930	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Persons Served	826	PersonsServedCnt
Total Community Benefit Expns	$2,865,842	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$1,477,553	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$1,388,289	NetCommunityBenefitExpnsAmt
Total Expense	0.06340	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReportedInd
Bad Debt Expense	$582,954	BadDebtExpenseAmt
Bad Debt Expense Attributable	$6,878	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$6,820,952	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$11,004,981	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$4,184,029	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd
Hospital Facilities	1	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

Field	Value	IRS element (for citing)
Facility	1	FacilityNum

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	HOLTON COMMUNITY HOSPITAL	BusinessNameLine1Txt

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	1110 COLUMBINE DRIVE	AddressLine1Txt
City	HOLTON	CityNm
State Abbreviation	KS	StateAbbreviationCd
ZIP	66436	ZIPCd

Field	Value	IRS element (for citing)
Website Address	WWW.HOLTONHOSPITAL.COM	WebsiteAddressTxt
State License	H043001	StateLicenseNum
Licensed Hospital	Yes (X)	LicensedHospitalInd
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	HOLTON COMMUNITY 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	18	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
Paper Copy Public Inspection	Yes (X)	PaperCopyPublicInspectionInd
Rpt Available Thru Other Method	Yes (X)	RptAvailableThruOtherMethodInd
Implementation Strategy Adopt	Yes (true)	ImplementationStrategyAdoptInd
Implementation Strategy Adpt	18	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	100	FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care	200.	FPGFamilyIncmLmtDscntCarePct
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
Provided Nonprofit Contact	Yes (X)	ProvidedNonprofitContactInd
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	HOLTON COMMUNITY HOSPITAL LEADERSHIP ALONG WITH JACKSON COUNTY HEALTH DEPARTMENT STARTED OFF BY ESTABLISHING A TIMELINE AND ROLES FOR THE CHNA. A CONSULTANT WAS HIRED TO ASSIST IN THE PROCESS. THIS GROUP THEN DEVELOPED A LIST OF INDIVIDUALS AND ENTITIES WITHIN JACKSON COUNTY THAT WOULD CONNECT WITH THE MAJORITY OF THE POPULATION OF JACKSON COUNTY. THE LIST INCLUDED PHYSICIANS, PUBLIC HEALTH OFFICIALS, OTHER HEALTHCARE PROVIDERS, CLERGY, COMMUNITY AND CIVIC LEADERS, EDUCATION STAFF, FAMILY CARE-GIVERS, AND MEMBERS OF AT-RISK POPULATIONS. A SURVEY WAS THEN CREATED CONSISTING OF 18 QUESTIONS TO ASSESS AREAS OF NEED WITHIN JACKSON COUNTY AND EMAILED TO THE LIST. PRESS RELEASES AND EMAIL REMINDERS WERE SENT TO HELP ENCOURAGE PARTICIPATION IN THE SURVEY PROCESS. A TOWN HALL MEETING WAS SET UP TO GET ADDITIONAL INPUT FROM THE COMMUNITY. THE DATE AND TIME WAS POSTED IN THE LOCAL NEWSPAPER AND FLYERS WERE PUT IN LOCAL BUSINESSES. SURVEY DATA WAS PRESENTED AT THE TOWN HALL MEETING WHICH WAS ATTENDED BY 36 INDIVIDUALS. IN ADDITION TO THE HOSPITAL AREAS OF HEALTHCARE REPRESENTED AT THE TOWN HALL MEETING WERE PROFESSIONALS IN THE AREAS OF FAMILY MEDICINE, VISION, MENTAL HEALTH, COMMUNITY HEALTH, AND LONG-TERM CARE. OTHERS ATTENDING WERE REPRESENTATIVES FROM THE LOCAL SCHOOLS, NEWSPAPER, BANKS, SEVERAL CIVIC ORGANIZATIONS AS WELL AS COMMUNITY MEMBERS. THROUGH INPUT FROM THE ATTENDEES INCLUDING A VOTING PROCESS BY EACH INDIVIDUAL, THE LIST OF NEEDS WAS NARROWED DOWN TO 8 ITEMS.
SCHEDULE H, PART V, SECTION B, LINE 6B	JACKSON COUNTY PUBLIC HEALTH DEPARTMENT KANZA MENTA HEALTH SERVICES NEKCAP-NORTHEAST KANSAS COMMUNITY ACTION PROGRAM KSU RESEARCH AND EXTENSION
SCHEDULE H, PART V, SECTION B, LINE 7A	THE COMPLETE CHNA CAN BE FOUND AT HTTPS://HOLTONHOSPITAL.COM/WP-CONTENT/UPLOADS/2021/02/JACKSON_COUNTY_CHA_2 019.PDF
SCHEDULE H, PART V, SECTION B, LINE 7D	COPIES ARE ALSO AVAILABLE AT ALL OTHER HEALTHCARE PROVIDERS IN THE COUNTY.
SCHEDULE H, PART V, SECTION B, LINE 10A	THE IMPLEMENTATION STRATEGY CAN BE FOUND AT: HTTPS:HOLTONHOSPITAL.COM/WP-CONTENT/UPLOADS/2021/02/CHNA_IMPLAN_JACKSONCOK S_2018.PDF
SCHEDULE H, PART V, SECTION B, LINE 11	DURING THE COMMUNITY HEALTH NEEDS ASSESSMENT OF 2019 THE FOLLOWING WERE IDENTIFIED AS THE TOP CHALLENGES TO RESIDENTS OF JACKSON COUNTY. 1) MENTAL HEALTH (DIAGNOSIS, PLACEMENT, AFTERCARE) 2) PUBLIC TRANSPORTATION 3) FOOD INSECURITY 4) AWARENESS OF HEALTHCARE SERVICES 5) POVERTY/EMPLOYMENT READINESS 6) LANGUAGE TRANSLATORS (GUATEMALAN, OTHERS) 7) SUBSTANCE ABUSE (METH, MARIJUANA, OPIOIDS) 8) OBESITY (NUTRITION/EXERCISE) A FOLLOW-UP MEETING WAS CONDUCTED TO FINALIZE AN IMPLEMENTATION STRATEGY TO ADDRESS THE IDENTIFIED NEEDS. ATTENDING WERE REPRESENTATIVES FROM THE JACKSON COUNTY PUBLIC HEALTH DEPARTMENT, KANZA MENTAL HEALTH SERVICES, NEKCAP- NORTHEAST KANSAS COMMUNITY ACTION PROGRAM, KSU RESEARCH AND EXTENSION, JACKSON COUNTY COMMISSION, AND THRIVE OF JACKSON COUNTY. DURING THE PROCESS, IT WAS FIRST DETERMINED WHETHER THE NEED WAS PART OF HOLTON COMMUNITY HOSPITALS MISSION OF CRITICAL OPERATIONS. AFTER THAT IT WAS THEN DETERMINED IF THE SPECIFIC ACTIONS IDENTIFIED TO ADDRESS EACH NEED WOULD BE PERFORMED BY HOLTON COMMUNITY HOSPITAL AND IF THE HOSPITAL WOULD ALLOCATE FUNDS TO THE ACTION. IN ADDITION TO THE ITEMS LISTED BELOW, THERE ARE SEVERAL COMMUNITY RELATED SPECIFIC ACTIONS THAT ARE LISTED ON OUR CHNA STRATEGIC PLAN. THE FOLLOWING ITEMS ARE DIRECTLY RELATED TO ACTIONS THAT THE HOSPITAL WILL ADDRESS AND DOLLAR AMOUNTS ALLOCATED TO THE SPECIFIC ACTIONS. 1) MENTAL HEALTH (DIAGNOSIS, PLACEMENT, AFTERCARE) A. Launch community education. Collaborate with community, elementary, middle, and high schools to educate students on mental health (destigmatize mental health conditions, suicide prevention and social media bullying). $450 B. Increase depression screenings by primary care physicians. Add trauma assessment for pediatrics and other mental health issues. $750 C. Explore development of senior life solutions program. $5,000 D. Explore / Expand USDA 2nd track Senior Life Solutions. $21,000 2) PUBLIC TRANSPORTATION - THIS IS NOT A PART OF HOLTON COMMUNITY HOSPITALS MISSION OF CRITICAL OPERATIONS. A. Develop a county transportation master plan. Work with local organizations to brainstorm ideas for transportation alternatives. B. Promote telemedicine and telehealth services when possible as an alternative to patient's traveling for care delivery. $1,000 C. Educate schedulers to consolidate appointments with different specialties on same day in order to minimize travel needed. 3) FOOD INSECURITY - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Continue community backpack program, school food improvement initiatives and THRIVE donations. $1,000 B. Establish formal "Jackson Co Healthy Eating" program. Seek KS grant(s) to provide healthy eating bulletin to all local households and create a county event twice a year with speaker and panel. $500 C. Work with local employers to provide healthy lunch options for their staff. $972 D. Offer and promote nutrition and label reading education, gardening strategies and a community garden growth opportunities. Explore possible snap approval of local venders at farmer's markets. E. Encourage the utilization of dietician in primary care and specialty care settings. Recruit a dietician. $750 F. Offer free cooking classes, using produce from community gardens, and provide recipes for healthy dinners. $750 G. Establish relationship with schools to provide education to students and families about healthy eating strategies. Encourage healthy after school snacking. 4) AWARENESS OF HEALTHCARE SERVICES A. Continue HCH marketing activities. Promote existing healthcare services, facilities and specialists. Increase marketing activities to generate community interest and awareness. $5,400 B. Educate community about existing HC services using digital tool (Facebook / Website). Advertise on the radio and in the newspapers. Create fliers of different services and programs and hang in schools, churches, and other community gathering places. $500 C. Create comprehensive Jackson County Resource Guide on dedicated community website. Create options to set appointments /see openings. $250 D. Send hospital leadership and staff to local events, activities, and programs to promote and publicize facilities and services. Organize who goes where and when. $960 E. Start up and host lunch and learn where healthcare staff are able to describe their services to a different demographic of individuals than those that would be able to attend an evening dinner (consider breakfast options as well). $500 F. Promote and support free sports physicals. $900 5) POVERTY/EMPLOYMENT READINESS - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Promote and advertise surrounding area college job fairs to high school students and the unemployed such as the Washburn Tech Program. $1 B. Continue to partner with churches and other community programs to develop soup kitchen/food pantry for those in need. 6) LANGUAGE TRANSLATORS (GUATEMALAN, OTHERS) - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Launch HCH Translator service. B. Explore resources needed to clarify an employee translator. C. Research and evaluate different translation services that allow access to remote translation services (i.e. you call in and translation is done via the telephone) $720 D. Dedicate a resource in the area to act as a translator for the healthcare organizations (i.e. a community member who speaks both Guatemalan and English) $1 E. Provide the resources needed and dedicate 2-5 hospital staff members to learn the necessary translation languages 7) SUBSTANCE ABUSE (METH, MARIJUANA, OPIOIDS) - This is not part of Holton Community Hospitals Mission of Critical Operations. A. Continue to monitor prescription drug abuse. Support area physicians in discouraging prescription drug abuse. Create alert system between physicians and pharmacies for drug abuse. B. Continue training substance abuse - law enforcements. Administer ER Nar Policy / Promote Nar Can Community Education series. C. Continue / promote Discarding Old Prescriptions service at local police departments, focus on opioids. Expand take back day (yearly) to quarterly. $30 D. Expand school educational program (DARE) to educate on drug abuse and its consequences. E. Partner with local police authorities to develop a plan for helping those using drugs illegally. Include treatment of addiction in these plans. F. Support substance abuse counseling for community members. Educate the schools and local community organizations on signs of drug abuse. Establish resource list available for addiction treatment. G. Expand screening brief intervention referral and treatment (SBIRT). Expand outpatient programs for substance abuse. 8) OBESITY (NUTRITION/EXERCISE). A. Sponsor community activities that promote physical fitness/exercise for the entire family such as: Walk Holton JACO. Sponsor a community-wide "fitness challenge" all ages. $500 B. Create community educational series focusing on cooking demos, food labels, grocery store tours, restaurants healthy meals portions options, health fairs, classes, speakers etc. C. Launch diabetic educational services. Partner with providers and Jackson County Health Dept. to launch. $450 allocated D. Educate local businesses and industries on the benefits of offering wellness programs for their employees. E. Work with economic development groups to provide education and fitness activities for community members. F. Start "Awareness Program" to educate elementary/middle school children and their families about obesity. G. Continue to provide education to employers through worksite health fairs and educational programs, including various screenings.
SCHEDULE H, PART V, SECTION B, LINE 16A	THE FAP CAN BE FOUND AT: HTTPS://HOLTONHOSPITAL.COM/WP-CONTENT/UPLOADS/2022/01/FINANCIAL-ASSISTANCE -POLICY-FINAL-REVISED-1.26.2022.PDF
SCHEDULE H, PART V, SECTION B, LINE 16B	THE FAP APPLICATION CAN BE FOUND AT: HTTPS://HOLTONHOSPITAL.COM/WP-CONTENT/UPLOADS/2022/01/FINANCIAL-ASSISTANCE -APP.DOC
SCHEDULE H, PART V, SECTION B, LINE 16C	THE PLAIN LANGUAGE SUMMARY CAN BE FOUND AT: HTTPS://HOLTONHOSPITAL.COM/HOSPITAL-CARE/PATIENT-INFORMATION/

Field	Value	IRS element (for citing)
Facility	3	FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)

Address Line1USAddress/AddressLine1Txt	CityUSAddress/CityNm	State AbbreviationUSAddress/StateAbbreviationCd	ZIPUSAddress/ZIPCd	FacilityFacilityTxt
FAMILY PRACTICE ASSOCIATES - HOLTON
1100 COLUMBINE DRIVE	HOLTON	KS	66436	RURAL HEALTH CLINIC
FAMILY PRACTICE ASSOCIATES - HOYT
117 W 3RD	HOYT	KS	66440	RURAL HEALTH CLINIC
FAMILY PRACTICE ASSOCIATES - WETMORE
323 SECOND STREET	WETMORE	KS	66550	RURAL HEALTH CLINIC

Supplemental Information Detail SupplementalInformationDetail (12 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
SCHEDULE H, PART I, LINE 3C	INSURANCE STATUS AND UNDERINSURANCE STATUS ARE OTHER FACTORS USED IN THE ELIGIBILITY CRITERIA EXPLAINED IN THE FAP FOR PROVIDING FREE AND DISCOUNTED CARE.
SCHEDULE H, PART I, LINE 7	THE COSTING METHODOLOGY USED TO CALCUATE THE AMOUNT CONTAINED IN THE TABLE OF SCHEDULE H, PART I, LINE 7 IS THE COST-TO-CHARGE RATIO.
SCHEDULE H, PART I, LINE 7, COLUMN F	THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCUATING THE NET COMMUNITY BENEFITS EXPENSE PERCENTAGE WAS $582,954.
SCHEDULE H, PART III, SECTION A, LINE 2	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 DOUBTFUL ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS. AS A SERVICE TO THE PATIENT, THE HOSPITAL BILLS THIRD-PARTY PAYERS DIRECTLY AND BILLS THE PATIENT WHEN THE PATIENT'S LIABILITY IS DETERMINED. PATIENT ACCOUNTS RECEIVABLE ARE DUE IN ACCORDANCE WITH A PREDETERMINED PAYMENT PLAN BASED ON THE VALUE OF THE PATIENT'S BALANCE. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBT BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT.
SCHEDULE H, PART III, SECTION A, LINE 3	BAD DEBT EXPENSE (AT COST) IDENTIFIED THE PROVISION FOR UNCOLLECTIBLES FROM 3/31/21 AUDITED STATEMENT OF OPERATIONS. MULTIPLIED THAT AMOUNT BY THE COST TO CHARGE RATIO. CHARITY CARE (AT COST): LOGS MAINTAINED BY CASH COLLECTOR. LOG CONTAINS DATA OF THE DOLLAR AMOUNT TURNED TO BAD DEBT WHERE A CHARITY CARE APPLICATION WAS SENT BUT NOT RETURNED AND WHEN CHARITY CARE APPLICATION WAS RETURNED BUT PATIENT DID NOT FULFILL FINANCIAL OBLIGATION. SUBSEQUENTLY, MULTIPLIED THAT AMOUNT BY THE COST-TO-CHARGE RATIO IDENTIFIED IN SCHEDULE H, PART I.
SCHEDULE H, PART III, SECTION A, LINE 4	SEE PAGE 9 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS.
SCHEDULE H, PART III, SECTION B, LINE 8	SERVING PATIENTS WITH GOVERNMENT HEATH BENEFITS, SUCH AS MEDICARE, IS A COMPONENT OF THE COMMUNITY BENEFIT STANDARD TAHT TAX-EXEMPT HOSPITALS ARE HELD TO. THIS IMPLIES THAT SERVING MEDICARE PATIENTS IS A COMMUNITY BENEFIT AND THAT THE HOSPITAL OPERATES TO PROMOTE THE HEALTH OF THE COMMUNITY.
SCHEDULE H, PART III, SECTION C, LINE 9B	FOR INDIVIDUALS WHO HAVE FINANCIAL DIFFICULTIES, THE HOSPITAL USES REASONABLE EFFORTS TO DETERMINE FINANCIAL ASSISTANCE ELIGIBILITY. THESE EFFORTS INCLUDE PROVIDING THE INDIVIDUAL WITH A PLAIN LANGUAGE SUMMARY (BROCHURE) OF THE FINANCIAL ASSISTANCE PROGRAM, A NOTICE ON ALL PATIENT BILLING STATEMENTS AND OTHER WRITTEN COMMUNICATIONS REGARDING BILLINGS, ORAL COMMUNICATIONS REGARDING AMOUNT DUE, AND OTHER MEANS AVAILABLE TO THE HOSPITAL TO IDENTIFY INDIVIDUALS WHO MAY BE ELIGIBLE FOR INSURANCE COVERAGE OR FINANCIAL ASSISTANCE. THE HOSPITAL WILL NOT ENGAGE IN EXTRAORDINARY COLLECTIONS ACTIONS (ECA) AGAINST AN INDIVIDUAL UNTIL IT IS DETERMINED THAT THE INDIVIDUAL HAS THE INCOME TO PAY OR THE INDIVIDUAL HAS NOT COOPERATED IN AN EFFORT TO ESTABLISH FINANCIAL ASSISTANCE ELIGIBILITY. IF A FINANCIAL ASSISTANCE APPLICATION HAS NOT BEEN SUBMITTED BY THE 120TH DAY AFTER THE HOSPITAL PROVIDED THE INDIVIDUAL WITH THE FIRST PATIENT BILLING STATEMENT, THE HOSPITAL MAY ENGAGE IN EXTRAORDINARY COLLECTIONS ACTIONS (ECA). IF AN APPLICATION IS SUBMITTED WITHIN THE 240TH DAY AFTER THE FIRST PATIENT BILLING STATEMENT, THE HOSPITAL WILL DISCONTINUE ECA UNTIL IT IS DETERMINED IF THE INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE.
SCHEDULE H, PART VI, LINE 2	OUR CURRENT 12-BED HOSPITAL IS LOCATED WITHIN THE OUTER REGION OF THE HOLTON CITY LIMITS. OUR EXPANDED FACILITIES ALLOW US TO PROVIDE A BROAD RANGE OF HEALTHCARE SERVICES TO ALL MEMBERS OF OUR COMMUNITY WITHOUT REGARD TO AGE, RACE, SEX OR FINANCIAL CONSTRAINTS. WE REGULARLY EVALUATE THE SERVICES WE PROVIDE TO SEE IF THEY ARE BEING UTILIZED AND TO SEE WHAT ADDITIONAL SERVICES CAN BE PROVIDED. WE UTILIZE OUR COMMUNITY HEALTH NEEDS ASSESSMENT AND PATIENT FAMILY ADVISORY COMMITTEE INPUT TO DETERMINE IF ADDITIONAL SERVICES NEED TO BE PROVIDED. WE ARE COMMITTED TO PROVIDING QUALITY HEALTHCARE TO ALL MEMBERS OF OUR COMMUNITY. BECAUSE WE ARE A SMALL TOWN HOSPITAL, A MAJORITY OF OUR PATIENTS HAVE A STRONG BOND WITH OUR STAFF. THIS ALLOWS US TO PROVIDE CARE THAT EXTENDS BEYOND JUST MEDICAL NEEDS. THE COST AND DIFFICULTY IN SEEKING CARE IN OTHER AREAS FOR OUR ELDERLY AND POOR POPULATION REINFORCES THE NEED FOR A STRONG COMMUNITY HOSPITAL. WE STRIVE TO MEET THIS NEED BY PROVIDING ALL SERVICES POSSIBLE. WE HAVE BEEN DISTRIBUTING PATIENT SATISFACTION SURVEYS THROUGHOUT OUR SURGICAL, INPATIENT, OUTPATIENT, RURAL HEALTH CLINIC, EMERGENCY ROOM AND REHABILITATION SERVICES FOR APPROXIMATELY 6 YEARS. THE RESULTS OF THESE SURVEYS ARE COMPILED MONTHLY AND ARE USED TO BETTER OUR PATIENT SERVICES. WE HAVE ALSO ESTABLISHED A SURGICAL OVERSIGHT COMMITTEE THAT MEETS MONTHLY ON HOW TO IMPROVE SERVICES AND PROCESSES IN THE SURGERY DEPARTMENT. LISTED BELOW ARE SOME OF THE SERVICES PROVIDED BY HOLTON COMMUNITY HOSPITAL. HOLTON COMMUNITY HOSPITAL IS PROUD TO BE A CERTIFIED 'STROKE READY' FACILITY. OUR REHABILITATION SERVICES DEPARTMENT PROVIDES A FULL-COMPLIMENT OF OCCUPATIONAL AND PHYSICAL THERAPIES, INCLUDING A LYMPHEDEMA MANAGEMENT PROGRAM AND SPEECH THERAPY. OUR CARDIOVASCULAR SERVICES DEPARTMENT PROVIDES CARDIAC REHAB, AS WELL AS PERFORMS PULMONARY FUNCTION PROCEDURES AND STRESS TESTS, AND PROVIDES ONE-ON-ONE CERTIFIED DIABETES EDUCATION AND TOBACCO CESSATION COUNSELING. THE SURGERY DEPARTMENT PROVIDES 24/7 SURGICAL SERVICES. WE HAVE A LARGE VARIETY OF SPECIALTY PHYSICIANS WHO TREAT PATIENTS IN THE FACILITY AS WELL AS PERFORM NUMEROUS SURGICAL PROCEDURES. THE RADIOLOGY DEPARTMENT, IN COLLABORATION WITH ST. FRANCIS HOSPITAL, PROVIDES MOBILE NUCLEAR MEDICINE TESTING ON SITE. THE FACILITY ALSO CONTRACTS WITH SHARED MEDICAL SERVICES, INC. TO PROVIDE ON-SITE MOBILE MRI TESTING. THE RADIOLOGY DEPARTMENT IS ALSO VERY PROUD TO HAVE A 32-SLICE CT SCANNER WHICH PROVIDES HIGH RESOLUTION IMAGES. A CT SCANNER WITH THIS CAPABILITY IS A RARITY IN A HOSPITAL OF OUR SIZE. OUR HOSPITAL OFFERS A FULL-SERVICE, 24-7 EMERGENCY DEPARTMENT WITH A PHYSICIAN AVAILABLE AT ALL TIMES. WE HAVE TRANSFER AGREEMENTS WITH SURROUNDING HOSPITALS FOR THOSE PATIENTS WHO PRESENT TO THE HOSPITAL EMERGENCY DEPARTMENT AND REQUIRE CARE BEYOND OUR CAPABILITIES. OUR 12-BED IN-PATIENT UNIT PROVIDES CARE TO MEDICAL-SURGICAL PATIENTS, SUB-ACUTE PATIENTS, PEDIATRICS AND GERIATRICS. WE PROVIDE OBSTETRICAL AND NEWBORN CARE PATIENT SERVICES WHICH IS BECOMING INCREASINGLY RARE AMONG RURAL HOSPITALS. WE ARE ALSO LICENSED TO PROVIDE SWINGBED SERVICES. THIS ALLOWS PATIENTS TO RECEIVE TRANSITIONAL INPATIENT REHABILIATION AND RECOVERY SERVICES. HOLTON COMMUNITY HOSPITAL HAS A FULL-SERVICE HOME HEALTH AND HOSPICE PROGRAM. OUR AWARD-WINNING HOSPICE DELIVERS END OF LIFE CARE TO PATIENTS OF PROVIDERS THROUGHOUT NORTHEAST KANSAS. OUR RURAL HEALTH CLINIC (FAMILY PRACTICE ASSOCIATES) HAS THREE LOCATIONS IN HOLTON, HOYT AND WETMORE, KANSAS. OUR MIX OF THREE PHYSICIANS, TWO PHYSICIAN ASSISTANTS AND THREE ADVANCED REGISTERED NURSE PRACTITIONERS ALLOWS OUR COMMUNITY MEMBERS TO FIND A PROVIDER THAT BEST SERVES THEIR HEALTH CARE NEEDS. SEEING A NEED FOR SPORTS MEDICINE SERVICES WITHIN OUR LOCAL COMMUNITY, A CONTRACTUAL AGREEMENT WAS REACHED WITH A LOCAL SCHOOL SYSTEM. OUR PHYSICIAN'S ASSISTANT, ALSO A REGISTERED PHYSICAL THERAPIST, OFFERS SPORTS MEDICINE SERVICES 2 AFTERNOONS PER WEEK AT HOLTON HIGH SCHOOL. HE ALSO ATTENDS ALL HOME GAMES, AND AWAY GAMES AS NEEDED, TO ASSIST WITH POSSIBLE INJURIES THAT MIGHT OCCUR.
SCHEDULE H, PART VI, LINE 3	HOLTON COMMUNITY HOSPITAL POSTS SIGNS AT ITS REGISTRATION LOCATIONS REGARDING THE AVAILABILITY OF OUR FINANCIAL ASSISTANCE PROGRAM. THE FAP POLICY IS ALSO AVAILABLE AT SEVERAL LOCATIONS IN THE COMMUNITY. THE AVAILABILITY OF A FINANCIAL ASSISTANCE PROGRAM IS ALSO IDENTIFIED ON ALL HOSPITAL PATIENT SERVICE RELATED LETTERS AND GUARANTOR STATEMENTS. ONCE A PATIENT CALLS TO INQUIRE ABOUT THE FINANCIAL ASSISTANCE PROGRAM THE PATIENT FINANCIAL COUNSELOR WORKS ONE-ON-ONE WITH THE PATIENTS OUTLINING THE REQUIREMENTS, DOCUMENTS NEEDED AND EXPLAINS OUR FINANCIAL ASSISTANCE PROGRAM IN DETAIL.
SCHEDULE H, PART VI, LINE 4	JACKSON COUNTY IS LOCATED IN THE NORTHEASTERN PART OF KANSAS LOCATED ON US HIGHWAY 75. HOLTON COMMUNITY HOSPITAL AND FAMILY PRACTICE ASSOCIATES PHYSICIAN'S CLINIC ARE THE PREMIERE HEALTHCARE PROVIDERS IN OUR COUNTY. LIKE OTHER RURAL HOSPITALS, HCH SERVES A HIGHER PERCENTAGE OF ELDERLY AND CHILDREN LIVING IN POVERTY WHILE THE COUNTY EXPERIENCES HIGHER LEVELS OF UNEMPLOYMENT AND LOWER INCOMES. ACCORDING TO A REPORT GENERATED BY THE KANSAS RURAL HEALTH OPTIONS PROJECT, RURAL INDIVIDUALS REPORT POORER OVERALL HEALTH AND MORE CHRONIC HEALTH CONDITIONS. ADDITIONALLY, RURAL COUNTIES SEE A HIGHER RATE OF UNINSURED INDIVIDUALS AND HAVE FEWER HEALTH CARE SERVICES AVAILABLE TO THEM. FINALLY, PEOPLE IN RURAL COMMUNITIES ARE MORE LIKELY TO DERIVE PART OF THEIR INCOME FROM THE HEALTHCARE INDUSTRY (EITHER DIRECTLY OR INDIRECTLY). COUNTY HEALTH RANKINGS WEBSITE STATE THAT THE POPULATION OF JACKSON COUNTY WAS ESTIMATED TO BE 13,280 IN 2020 AND DENSITY OF 21 PERSONS PER SQUARE MILE. JACKSON COUNTY POPULATION CONSISTS OF 24.9% UNDER 18 YEARS OF AGE AND 19.1% OF PERSONS 65 YEARS OF AGE AND ABOVE. JACKSON COUNTY HOLDS THE DESIGNATION OF BEING A HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). THIS DESIGNATION COMES FROM THE KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT (KDHE) AND IDENTIFIES AREAS OF THE STATE THAT ARE MEDICALLY UNDERSERVED. AS PUBLISHED IN COUNTY HEALTH RANKINGS 2020 THERE IS ONLY 1 PRIMARY CARE PROVIDER PER 1,480 RESIDENTS IN THE COUNTY, BELOW THE STATE'S AVERAGE OF 1 PER 1,290 RESIDENTS. ADDITIONALLY, THIS SAME WEBSITE NOTED THAT IN 2020 MORE THAN 12% OF ADULTS IN OUR COUNTY HAS NO HEALTH INSURANCE. THE SAME WEBSITE REPORTS THAT 15% OF JACKSON COUNTY, KANSAS CHILDREN UNDER THE AGE OF 18 WERE LIVING AT OR BELOW THE POVERTY LINE. ALSO, REPORTED FOR THE SAME PERIOD 30% OF JACKSON COUNTY CHILDREN LIVED IN SINGLE PARENT HOUSEHOLDS. ALSO, THE MEDIAN HOUSEHOLD INCOME OF JACKSON COUNTY RESIDENTS WAS APPROXIMATELY $56,300, COMPARED TO THE STATE'S MEDIAN INCOME OF $58,200. ALSO 8.5% OF JACKSON COUNTY RESIDENTS ARE AMERICAN INDIAN AS COMPARED TO A KANSAS AVERAGE OF 1.2%. ADDITIONALLY, IN A RECENT SURVEY (2019) COMPLETED BY THE UNIVERSITY OF WISCONSIN POPULATION HEALTH INSTITUTE AND THE ROBERT WOOD JOHNSON FOUNDATION, JACKSON COUNTY RANKED 52ND IN THE STATE ON THE HEALTH OF OUR COUNTY. JACKSON COUNTY SCORES BELOW STATE BENCHMARKS IN HEALTH CARE, LENGTH OF LIFE, HEALTHY BEHAVIORS, AND PHYSICAL ENVIRONMENT FACTORS.
SCHEDULE H, PART VI, LINE 5	HOSPITAL EMPLOYEES ARE ENCOURAGED TO PARTICIPATE IN LOCAL COMMUNITY ACTIVITIES. EMPLOYEES ARE MEMBERS OF THE LOCAL CHAMBER OF COMMERCE, SERVE AS BOARD MEMBERS WITH SEVERAL LOCAL ORGANIZATIONS, AND ARE BOARD MEMBERS OF A STATE ORGANIZATION PROMOTING THE PATIENT FINANCIAL SERVICES SEGMENT OF HEALTHCARE. EMPLOYEES ARE INVOLVED ON SEVERAL LEVELS WITH YOUTH PROGRAMS. EMPLOYEES PROVIDE INSERVICE TRAINING TO VARIOUS LOCAL AGENCIES ON HEALTH ORIENTED SUBJECTS SUCH AS MEDICAL ADMINISTRATION.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Compensation Committee	Yes (X)	CompensationCommitteeInd
Written Employment Contract	Yes (X)	WrittenEmploymentContractInd
Compensation Survey	Yes (X)	CompensationSurveyInd
Board Or Committee Approval	Yes (X)	BoardOrCommitteeApprovalInd
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
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 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
MALIA WARNEREND 720
DIRECTOR/CHIEF OF MED STAFF	$281,809	$0	$0	$0	$0	$0	$11,400	$0	$28,760	$0	$321,969	$0	$0	$0
CARRIE SAIA
CHIEF EXECUTIVE OFFICER	$173,838	$0	$0	$0	$0	$0	$7,321	$0	$17,828	$0	$198,987	$0	$0	$0
CLINT COLBERG
DIRECTOR/CHIEF OF MED STAFF	$305,487	$0	$0	$0	$0	$0	$11,400	$0	$27,406	$0	$344,293	$0	$0	$0
JOEL HUTCHINS
PHYSICIAN	$186,639	$0	$0	$0	$0	$0	$7,521	$0	$5,659	$0	$199,819	$0	$0	$0
JOSHUA C MOULIN
PHYSICIAN'S ASSISTANT	$156,823	$0	$0	$0	$0	$0	$6,814	$0	$27,560	$0	$191,197	$0	$0	$0
ERIN LOCKE
PHYSICIAN	$220,325	$0	$0	$0	$0	$0	$8,941	$0	$6,980	$0	$236,246	$0	$0	$0
LADONA SCHMIDT
PHYSICIAN	$206,183	$0	$0	$0	$0	$0	$8,471	$0	$22,260	$0	$236,914	$0	$0	$0
KAYLIE ZIMMERMAN
APRN	$135,092	$0	$0	$0	$0	$0	$5,790	$0	$13,791	$0	$154,673	$0	$0	$0

Schedule K IRS990ScheduleK

Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd

Issuer Name IssuerName

Field	Value	IRS element (for citing)
Business Name Line1	CITY OF HOLTON KS	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Bond Issuer EIN	486030368	BondIssuerEIN
CUSIP	436580AA2	CUSIPNum
Bond Issued	2019-10-10	BondIssuedDt
Issue Price	$14,615,000	IssuePriceAmt
Purpose	SEE PART VI	PurposeDesc
Defeased	false	DefeasedInd
On Behalf Of Issuer	false	OnBehalfOfIssuerInd
Pool Financing	false	PoolFinancingInd

Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Retired	$0	RetiredAmt
Bond Defeased	$0	BondDefeasedAmt
Total Proceeds	$14,615,000	TotalProceedsAmt
In Reserve Fund	$0	InReserveFundAmt
Capitalized Interest	$447,584	CapitalizedInterestAmt
Refunding Escrow	$0	RefundingEscrowAmt
Issuance Costs From Proceeds	$195,178	IssuanceCostsFromProceedsAmt
Credit Enhancement	$0	CreditEnhancementAmt
Working Capital Expenditures	$0	WorkingCapitalExpendituresAmt
Capital Expenditures	$12,300,043	CapitalExpendituresAmt
Other Spent Proceeds	$0	OtherSpentProceedsAmt
Unspent	$1,672,195	UnspentAmt
Refunding Tax Exempt Bonds	Yes (true)	RefundingTaxExemptBondsInd
Refunding Taxable Bonds	false	RefundingTaxableBondsInd
Final Allocation Made	false	FinalAllocationMadeInd
Adequate Books And Rec Maint	Yes (true)	AdequateBooksAndRecMaintInd

Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Owning Bond Financed Property	false	OwningBondFinancedPropertyInd
Any Lease Arrangements	false	AnyLeaseArrangementsInd
Mgmt Contract Bond Fincd Prop	Yes (true)	MgmtContractBondFincdPropInd
Engage Bond Counsel Contracts	Yes (true)	EngageBondCounselContractsInd
Any Research Agreements	false	AnyResearchAgreementsInd
Private Bus Use By Others	0	PrivateBusUseByOthersPct
Bond Iss Meet Prvt Sec Pymt Test	false	BondIssMeetPrvtSecPymtTestInd
Change In Use Bond Financed Prop	false	ChangeInUseBondFinancedPropInd
Remedial Action Taken	false	RemedialActionTakenInd
Procs Nonqualified Bond Remdtd	Yes (true)	ProcsNonqualifiedBondRemdtdInd

Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Form8038 T Filed	false	Form8038TFiledInd
Exception To Rebate	Yes (true)	ExceptionToRebateInd
Variable Rate Issue	false	VariableRateIssueInd
Hedge Identified In Bks And Rec	false	HedgeIdentifiedInBksAndRecInd

Hedge Provider Name HedgeProviderName

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Gross Proceeds Invested In GIC	false	GrossProceedsInvestedInGICInd

GIC Provider Name GICProviderName

Field	Value	IRS element (for citing)
Business Name Line1	0	BusinessNameLine1Txt

Field	Value	IRS element (for citing)
Gross Proceeds Invested	false	GrossProceedsInvestedInd
Written Proc To Monitor Reqs	Yes (true)	WrittenProcToMonitorReqsInd

Procedures Corrective Action ProceduresCorrectiveActionGrp

Field	Value	IRS element (for citing)
Bond Reference	A	BondReferenceCd
Procedures Corrective Action	Yes (true)	ProceduresCorrectiveActionInd

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
PART I, ROW A, COLUMN F	INTERIM FINANCING TO CONSTRUCT, FURNISH AND EQUIP ADDITIONS TO THE HOSPITAL FACILITY AND A RURAL HEALTH CLINIC.
PART II, COLUMN A , LINE 3	ANY INVESTMENT EARNINGS EARNED DURING THE PROJECT PERIOD WERE USED TO PAY CASH MANAGEMENT FEES AND AS A RESULT HAVE NOT BEEN REPORTED.
PART III	PART III WAS NOT COMPLETED FOR THE REFUNDING PORTION WHICH FINANCED PROJECTS PRIOR TO JANUARY 1, 2003.

Schedule L IRS990ScheduleL

Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp

Name Of Interested NameOfInterested

Field	Value	IRS element (for citing)
Person	SEE SCHEDULE L PART V	PersonNm

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	FORM 990, SCHEDULE L, PART IV	FormAndLineReferenceDesc
Explanation	TRANSACTION (1) (A) BARBARA WHEELER (B) BARBARA WHEELER IS THE MOTHER OF BOARD MEMBER HEATHER SCHRICK. (C) $46,880 (D) BARBARA WHEELER IS AN EMPLOYEE OF RURAL HEALTH RESOURCES OF JACKSON COUNTY. (E) NO	ExplanationTxt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (13 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 4A	RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC) IS A 12-BED CRITICAL ACCESS HOSPITAL IN A SMALL RURAL COMMUNITY. RHRJC OFFERS A WIDE RANGE OF SERVICES INCLUDING PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, REGISTERED DIETICIAN SERVICES, MRI, MRA, NUCLEAR MEDICINE, CT SCAN ALONG WOTHER RADIOLOGY SERVICES, SURGERY, LABORATORY, A CERTIFIED DIABETIC EDUCATION PROGRAM, CARDIOVASCULAR SERVICES, CERTIFIED LYMPHEDEMA PROGRAM, OUTPATIENT GERIATRIC PSYCHOLOGY, AND ROUND CARE SERVIES AS WELL AVARIETY OF SPECIALTY PROVIDER SERVICES. THE HOSPITAL STAFF IS A CERTIFIED 'STROKE READY' FACILITY AND TRAINED TO TEACH OUTREACH SERVICES UNDER THE NATIONAL ARTHRITIS FOUNDATION EXERCISE PROGRAM. THE HOSPITAL ALSO OFFERS HOME HEALTH AND HOSPICE SERVICES. THE HOSPITAL PROVIDED 24/7 EMERGENCY ROOM SERVICES WITH 2,528 EMERGENCY ROOM VISITS RECORDED FROM 4/1/20 THROUGH 3/31/21. EMERGECNY ROOM SERVICES ARE SUPPORTED BY STAFF TRAINED IN ADVANCED CARDIACLIFE SUPPORT, CPR, EMERGENCY NURSING PEDIATRICS, TRAUMA NURSING CORE CURRICULUM, AND PEDIATRIC ADVANCED LIFE SUPPORT. THE HOSPITAL IDENTIFIED 12,157 INPATIENT HOURS AND 3,364 OBSERVATION HOURS FROM 4/1/20 THROUGH 3/31/21.
FORM 990, PART VI, SECTION A, LINE 1A	THE CLASS C DIRECTOR SHALL BE THE CHIEF OF MEDICAL STAFF AND SERVE (1) YEAR TERM. THE CLASS C DIRECTOR SHALL BE ENTITLED TO PARTICIPATE AND VOTE ON ALL MATTERS EXCEPT FOR: (A) EMPLOYEE COMPENSATION AND (B) EMPLOYEE PERSONNEL MATTERS.
FORM 990, PART VI, SECTION B, LINE 11B	AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE FORM 990. THE 990 IS THEN REVIEWED BY THE CEO AND CFO OF RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC). ANY QUESTIONS OR CONCERNS THAT ARISE ARE ADDRESSED WITH THE ACCOUNTING FIRM AND CORRECTIONS, CLARIFICATIONS OR REVISIONS ARE MADE AS NECESSARY. THE FINAL 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD OF RHRJC PRIOR TO THE FILING OF THE 990.
FORM 990, PART VI, SECTION B, LINE 12C	UPON HIRE (OR IN THE CASE OF ELECTION OF BOARD MEMBERS) AND ANNUALLY THEREAFTER, THE CEO OR DESIGNEE(S) SHALL PROVIDE TO THE BOARD, STAFF AND EMPLOYED PROVIDERS OF RURAL HEALTH RESOURCES OF JACKSON COUNTY (RHRJC) A COPY OF THE CONFLICT OF INTEREST POLICY AND THE APPLICABLE CONFLICT OF INTEREST DISCLOSURE FORM. THESE DOCUMENTS WILL BE COMPLETED TO IDENTIFY ANY RELATIONSHIPS, POSITIONS, OR CIRCUMSTANCES IN WHICH IT IS BELIEVED A CONFLICT MAY ARISE. THE ANNUAL MONITORING AND REVIEW PROCESS WILL BE PART OF RHRJC'S CORPORATE COMPLIANCE PLAN. ANY POTENTIAL CONFLICT OF INTEREST CONCERNS THAT ARISE SHALL BE REPORTED BY THE CEO TO THE BOARD CHAIR. SHOULD THE CONCERN INVOLVE THE BOARD CHAIR, THE BOARD VICE-CHAIR WILL BE INFORMED INSTEAD. EACH BOARD MEMBER, STAFF MEMBER OR EMPLOYED PROVIDER SHALL FULLY DISCLOSE ANY AND ALL ACTUAL OR POTENTIAL CONFLICTS, DUALITY OF INTEREST OR RESPONSIBILITY INVOLVING INDIVIDUAL, PERSONAL, OR BUSINESS ISSUES WHICH MAY EXIST. IF THERE IS A CONFLICT, THE CONFLICTED INDIVIDUALS ABSTAIN FROM VOTING.
FORM 990, PART VI, SECTION B, LINE 15A	ANNUALLY AT THE EMPLOYEE REVIEW PERIOD (USUALLY DURING AUGUST AND SEPTEMBER) THE BOARD OF DIRECTORS IS SUPPLIED WITH A SALARY SURVEY FROM THE KANSAS HOSPITAL ASSOCIATION FOR THE CURRENT YEAR. THE BOARD THEN EVALUATES THE CEO SALARY SURVEY TO DETERMINE IF THE CEO'S SALARY IS APPROPRIATE AND WHAT ANNUAL PAY ADJUSTMENT IS APPROPRIATE FOR THE CURRENT YEAR.
FORM 990, PART VI, SECTION C, LINE 19	THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE UPON REQUEST.
FORM 990, PART XI, LINE 9	CHANGE IN NET ASSETS WITH DONOR RESTRICTIONS $321,867
FORM 990 PART IX LINE 11G	DESCRIPTION:NURSING TOTAL FEES:350004
FORM 990 PART IX LINE 11G	DESCRIPTION:MRI TOTAL FEES:121113
FORM 990 PART IX LINE 11G	DESCRIPTION:ER PROVIDERS ON CALL FEES TOTAL FEES:398992
FORM 990 PART IX LINE 11G	DESCRIPTION:COLLECTION COMPANY FEES TOTAL FEES:26606
FORM 990 PART IX LINE 11G	DESCRIPTION:MISC MANAGEMENT SERVICES TOTAL FEES:306688
FORM 990 PART IX LINE 11G	DESCRIPTION:MISC MEDICAL SERVICES TOTAL FEES:2879931