HIAWATHA HOSPITAL ASSOCIATION INC: Form 990, tax year 2021
View the entire original 990 at ProPublica ↗
- Organization
- HIAWATHA HOSPITAL ASSOCIATION INC (EIN 48-0577658)
- Tax period
- 2021-01-01 to 2021-12-31
- Filed
- 2022-11-11
- IRS object ID
- 202223159349301972
- Schema version
- 2021v4.2
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule K
- Schedule L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2022-11-11T09:00:53-06:00 | ReturnTs |
| Tax Period End | 2021-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 18081 BURT ST STE 200 | AddressLine1Txt |
| City | OMAHA | CityNm |
| State Abbreviation | NE | StateAbbreviationCd |
| ZIP | 680224722 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2021-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480577658 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | HIAW | BusinessNameControlTxt |
| Phone | 9133605584 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFF PERRY | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 9133605584 | PhoneNum |
| Signature | 2022-11-08 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Signing Officer SigningOfficerGrp
Person Full Name PersonFullName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person First | JEFF | PersonFirstNm |
| Person Last | PERRY | PersonLastNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| SSN | 999009999 | SSN |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | WENDY R COOLEY CPA | PreparerPersonNm |
| PTIN | P01523804 | PTIN |
| Phone | 4023302660 | PhoneNum |
| Preparation | 2022-11-08 | PreparationDt |
Additional Filer Information AdditionalFilerInformation
Trusted Customer TrustedCustomerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trusted Customer | 0 | TrustedCustomerCd |
| Authentication Assurance Level | AAL1 | AuthenticationAssuranceLevelCd |
| Identity Assurance Level | IAL1 | IdentityAssuranceLevelCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2021 | 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 | AMBERWELL HIAWATHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF PERRY | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $36,634,529 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | HTTPS://WWW.HCH-KS.ORG/ | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | AS A RURAL COMMUNITY HOSPITAL, HIAWATHA HOSPITAL'S PRIMARY GOAL IS TO PROVIDE MODERN, RELIABLE, AFFORDABLE HEALTH CARE THAT BEST MEETS THE NEEDS OF OUR COMMUNITY. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 6 | VotingMembersIndependentCnt |
| Total Employee | 291 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $1,248,724 | PYContributionsGrantsAmt |
| CY Contributions Grants | $6,575,295 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,324,725 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $29,968,646 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$99,265 | PYInvestmentIncomeAmt |
| CY Investment Income | $12,695 | CYInvestmentIncomeAmt |
| PY Other Revenue | $112,670 | PYOtherRevenueAmt |
| CY Other Revenue | $77,893 | CYOtherRevenueAmt |
| PY Total Revenue | $29,586,854 | PYTotalRevenueAmt |
| CY Total Revenue | $36,634,529 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $3,708 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $10,102 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,819,362 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,845,235 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $13,876,089 | PYOtherExpensesAmt |
| CY Other Expenses | $15,264,673 | CYOtherExpensesAmt |
| PY Total Expenses | $28,699,159 | PYTotalExpensesAmt |
| CY Total Expenses | $31,120,010 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $887,695 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $5,514,519 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $29,553,059 | TotalAssetsBOYAmt |
| Total Assets EOY | $31,506,410 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $19,332,005 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $15,126,815 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $10,221,054 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $16,379,595 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | THE MISSION AND RESPONSIBILITY OF HIAWATHA HOSPITAL ASSOCIATION, INC. ("HOSPITAL") IS TO PROVIDE QUALITY HEALTH CARE TO OUR PATIENTS THROUGHOUT NORTHEAST KANSAS, IN ACCORDANCE WITH THE CHARTER DOCUMENTS ("ARTICLES OF INCORPORATION") OF THE HOSPITAL AND IN COMPLIANCE WITH APPLICABLE FEDERAL, STATE AND LOCAL LAWS. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $27,336,865 | ExpenseAmt |
| Grant | $10,102 | GrantAmt |
| Revenue | $29,968,646 | RevenueAmt |
| Desc | HIAWATHA COMMUNITY HOSPITAL'S PRIMARY GOAL IS TO PROVIDE QUALITY, MODERN, AFFORDABLE HEALTHCARE TO OUR COMMUNITY. IN 2021, WE PROVIDED SERVICE FOR 2,784 INPATIENT DAYS, 98 INPATIENT SURGERIES AND 792 OUTPATIENT SURGERIES. WE DELIVERED 68 BABIES AND PROVIDED OUTPATIENT SERVICES TO 45,472 PATIENTS. BY PROVIDING SERVICES LIKE OBSTETRICS AND 24 HOUR EMERGENCY SERVICES THAT NOT ALL SMALL RURAL HOSPITALS PROVIDE, EVEN THOUGH THE PROGRAMS ARE NOT ALWAYS PROFITABLE FOR THE HOSPITAL, WE STRONGLY FEEL THAT THESE SERVICES PROVIDE NECESSARY CARE TO ADDRESS OUR COMMUNITY'S OVERALL HEALTH WHILE PROMOTING OUR MISSION AS A CHARITABLE ORGANIZATION. | Desc |
| Total Program Service Expenses | $27,336,865 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | 0 | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | 0 | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (1) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | 0 | InvestTaxExemptBondsInd |
| Escrow Account | 0 | EscrowAccountInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | Yes (1) | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | 0 | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (1) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | 0 | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 45 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 291 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | 0 | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | 0 | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 6 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | 0 | MembersOrStockholdersInd |
| Election Of Board Members | 0 | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | 0 | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | 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 | SHARESE MOSER | PersonNm |
| Phone | 7857426431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (22 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Key EmployeeKeyEmployeeInd | OfficerOfficerInd | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd |
|---|---|---|---|---|---|---|---|---|---|
| DR CROSBY GERNON | |||||||||
| RADIOLOGIST | 40.00 | 0.00 | Yes (X) | $400,505 | $0 | $42,787 | |||
| DR PETER ROSA | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $383,997 | $0 | $43,187 | Yes (X) | |||
| DR JESSICA JARVIS | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $329,925 | $0 | $31,915 | Yes (X) | |||
| DR BRYON BIGHAM | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $313,371 | $0 | $43,135 | Yes (X) | |||
| DUSTIN WILLIAMS | |||||||||
| APRN | 40.00 | 0.00 | $250,216 | $0 | $32,990 | Yes (X) | |||
| JOHN BROBERG | |||||||||
| CEO THRU 11/21 | 40.00 | 0.00 | $234,942 | $0 | $0 | Yes (X) | |||
| DANIELLE JAGELS | |||||||||
| APRN | 40.00 | 0.00 | $173,741 | $0 | $38,937 | Yes (X) | |||
| DR LOWELL SEARIGHT | |||||||||
| PHYSICIAN | 40.00 | 0.00 | $178,642 | $0 | $16,392 | Yes (X) | |||
| BRETT GLIEM | |||||||||
| PHYSICIAN ASSISTANT | 40.00 | 0.00 | Yes (X) | $144,873 | $0 | $30,700 | |||
| JODI TWOMBLY | |||||||||
| PHYSICIAN ASSISTANT | 40.00 | 0.00 | Yes (X) | $138,799 | $0 | $36,538 | |||
| JEAN ABEITA | |||||||||
| PHARMACIST | 40.00 | 0.00 | Yes (X) | $144,384 | $0 | $23,769 | |||
| ZANE HOFFMAN | |||||||||
| PHARMACIST | 40.00 | 0.00 | Yes (X) | $118,464 | $0 | $39,426 | |||
| SHARESE MOSER | |||||||||
| DIRECTOR OF FINANCE | 40.00 | 0.00 | $85,500 | $0 | $21,631 | Yes (X) | |||
| JEFF PERRY | |||||||||
| CEO | 20.00 | 0.00 | $31,150 | $0 | $0 | Yes (X) | |||
| GREG RODVELT | |||||||||
| PRESIDENT | 0.50 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| DEL ELFFNER | |||||||||
| VICE PRESIDENT | 0.30 | 1.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| JOHN MOORE | |||||||||
| SECRETARY/TREASURER | 0.30 | 0.00 | $0 | $0 | $0 | Yes (X) | Yes (X) | ||
| ANDREA COLLINS-KELLER | |||||||||
| TRUSTEE | 0.30 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| MANDY GRAHAM | |||||||||
| TRUSTEE | 0.30 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| WILLIE GEISENDORF | |||||||||
| TRUSTEE | 0.30 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| HOWARD ELLIOTT | |||||||||
| TRUSTEE | 0.30 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| JAKE WISDOM | |||||||||
| TRUSTEE THRU 02/21 | 0.30 | 0.00 | $0 | $0 | $0 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,928,509 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $401,407 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 15 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| STARS INC | |||||
| 201 S 4TH STREET | HIAWATHA | KS | 66434 | PT/OT/RT THERAPY SERVICES | $652,004 |
| STEVEN H GUNNELLS ANESTHESIA | |||||
| 2561 LINDEN AVE | HIAWATHA | KS | 66434 | CRNA SERVICES | $257,469 |
| MIDWEST DATA CENTER | |||||
| PO BOX 39 | ROCK PORT | MO | 64482 | IT SERVICES | $236,817 |
| ANESTHESIA ETC INC | |||||
| PO BOX 95 | SENECA | KS | 66538 | CRNA SERVICES | $223,500 |
| NORTHEASTERN ANESTHESIA SERVICES PA | |||||
| 1706 GRACELAND DR | SABETHA | KS | 66534 | CRNA SERVICES | $174,001 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 9 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $146,169 | RelatedOrganizationsAmt |
| Government Grants | $6,181,154 | GovernmentGrantsAmt |
| All Other Contributions | $247,972 | AllOtherContributionsAmt |
| Total Contributions | $6,575,295 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| MEDICARE/MEDICAID PAYMENTS | 621400 | $15,862,779 | $15,862,779 |
| PATIENT REVENUE - PRIVATE PAY | 621400 | $11,597,805 | $11,597,805 |
| 340B INCOME | 621990 | $2,489,568 | $2,489,568 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,494 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $18,494 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $29,968,646 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,695 | TotalRevenueColumnAmt |
| Exclusion | $12,695 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,802 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $7,802 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,802 | TotalRevenueColumnAmt |
| Exclusion | $7,802 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | CAFETERIA | Desc |
| Business | 900099 | BusinessCd |
| Total Revenue Column | $70,091 | TotalRevenueColumnAmt |
| Exclusion | $70,091 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $70,091 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $36,634,529 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $29,968,646 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $90,588 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,102 | TotalAmt |
| Program Services | $10,102 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,209,671 | TotalAmt |
| Program Services | $1,836,448 | ProgramServicesAmt |
| Management And General | $373,223 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,755,574 | TotalAmt |
| Program Services | $10,291,026 | ProgramServicesAmt |
| Management And General | $464,548 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $373,104 | TotalAmt |
| Program Services | $355,191 | ProgramServicesAmt |
| Management And General | $17,913 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,666,817 | TotalAmt |
| Program Services | $1,497,964 | ProgramServicesAmt |
| Management And General | $168,853 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $840,069 | TotalAmt |
| Program Services | $800,482 | ProgramServicesAmt |
| Management And General | $39,587 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $65,726 | TotalAmt |
| Program Services | $484 | ProgramServicesAmt |
| Management And General | $65,242 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $133,232 | TotalAmt |
| Management And General | $133,232 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,458,539 | TotalAmt |
| Program Services | $4,303,291 | ProgramServicesAmt |
| Management And General | $155,248 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,013 | TotalAmt |
| Program Services | $56,475 | ProgramServicesAmt |
| Management And General | $5,538 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $222,377 | TotalAmt |
| Program Services | $171,631 | ProgramServicesAmt |
| Management And General | $50,746 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $155,500 | TotalAmt |
| Program Services | $109,158 | ProgramServicesAmt |
| Management And General | $46,342 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,102,783 | TotalAmt |
| Program Services | $810,643 | ProgramServicesAmt |
| Management And General | $292,140 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $77,313 | TotalAmt |
| Program Services | $46,340 | ProgramServicesAmt |
| Management And General | $30,973 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $232,155 | TotalAmt |
| Program Services | $20,354 | ProgramServicesAmt |
| Management And General | $211,801 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,129,935 | TotalAmt |
| Program Services | $11,071 | ProgramServicesAmt |
| Management And General | $1,118,864 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $653,763 | TotalAmt |
| Program Services | $156,431 | ProgramServicesAmt |
| Management And General | $497,332 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $4,801,425 | $4,795,845 | $5,580 |
| BAD DEBT | $1,651,326 | $1,651,326 | |
| DUES & SUBSCRIPTIONS | $369,975 | $317,102 | $52,873 |
| MISC EXPENSE | $148,611 | $95,501 | $53,110 |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,120,010 | TotalAmt |
| Program Services | $27,336,865 | ProgramServicesAmt |
| Management And General | $3,783,145 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $286 | BOYAmt |
| EOY | $366 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $15,892,152 | BOYAmt |
| EOY | $13,540,608 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,297,690 | BOYAmt |
| EOY | $4,737,443 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $656,243 | BOYAmt |
| EOY | $813,797 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $221,283 | BOYAmt |
| EOY | $182,630 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $33,245,119 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $22,755,470 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,485,405 | BOYAmt |
| EOY | $10,489,649 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $644,022 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $1,097,895 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,553,059 | BOYAmt |
| EOY | $31,506,410 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,391,051 | BOYAmt |
| EOY | $2,611,680 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,576,665 | BOYAmt |
| EOY | $4,428,615 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,089,841 | BOYAmt |
| EOY | $5,955,000 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $420,072 | BOYAmt |
| EOY | $124,709 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,570,000 | BOYAmt |
| EOY | $1,850,582 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,284,376 | BOYAmt |
| EOY | $156,229 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,332,005 | BOYAmt |
| EOY | $15,126,815 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows FASB117 | Yes (X) | OrganizationFollowsFASB117Ind |
No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,221,054 | BOYAmt |
| EOY | $15,735,573 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $644,022 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,221,054 | BOYAmt |
| EOY | $16,379,595 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $29,553,059 | BOYAmt |
| EOY | $31,506,410 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $5,514,519 | ReconcilationRevenueExpnssAmt |
| Prior Period Adjustments | $618,381 | PriorPeriodAdjustmentsAmt |
| Other Changes In Net Assets | $25,641 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | 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 (1) | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (1) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (1) | 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) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | 0 | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | Yes (1) | OtherActivitiesInd |
| Other Activities | $5,335 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $5,335 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART II-B, LINE 1: | FormAndLineReferenceDesc |
| Explanation | DUES PAID TO KHA & AHA CONTAIN A PORTION FOR LOBBYING EXPENSES. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $784,309 | OtherCostOrOtherBasisAmt |
| Book Value | $784,309 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,237,118 | OtherCostOrOtherBasisAmt |
| Depreciation | $11,525,925 | DepreciationAmt |
| Book Value | $6,711,193 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,698,144 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,169,776 | DepreciationAmt |
| Book Value | $1,528,368 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,525,548 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,059,769 | DepreciationAmt |
| Book Value | $1,465,779 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,489,649 | TotalBookValueLandBuildingsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | LEASE LIABILITY | Desc |
| Amt | $156,229 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $156,229 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $34,983,203 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Not Reported | $0 | RevenueNotReportedAmt |
| Revenue Subtotal | $34,983,203 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,651,326 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,651,326 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $36,634,529 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $29,468,684 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $29,468,684 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,651,326 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,651,326 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $31,120,010 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. THE HOSPITAL HAS RECEIVED A DETERMINATION LETTER INDICATING THAT THEY ARE EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE INTERNAL REVENUE CODE. THE INTERNAL REVENUE SERVICE HAS ESTABLISHED STANDARDS TO BE MET TO MAINTAIN TAX EXEMPT STATUS. THE HOSPITAL ACCOUNTS FOR UNCERTAINTIES IN ACCOUNTING FOR INCOME TAX ASSETS AND LIABILITIES USING GUIDANCE INCLUDED IN FASB ASC 740, INCOME TAXES. THE HOSPITAL RECOGNIZES THE EFFECT OF INCOME TAX POSITIONS ONLY IF THOSE POSITIONS ARE MORE LIKELY THAN NOT OF BEING SUSTAINED. AT DECEMBER 31, 2021 AND 2020, THE HOSPITAL HAD NO UNCERTAIN TAX POSITIONS ACCRUED. |
| PART XI, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 1,651,326. |
| PART XII, LINE 4B - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE 1,651,326. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent300 | Yes (X) | Percent300Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | 0 | FinancialAssistanceBudgetInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $855,478 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $855,478 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02900 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,021,898 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,858,864 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,163,034 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03950 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,877,376 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,858,864 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,018,512 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06850 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $8,047 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $8,047 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $119,866 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $119,866 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00410 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $152,391 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $141,904 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $10,487 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $280,304 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $141,904 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $138,400 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00480 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,157,680 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,000,768 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,156,912 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07330 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,842 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,842 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,842 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,842 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,651,326 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $297,238 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $11,749,097 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,288,097 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | $461,000 | 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 (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | HIAWATHA HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HCH-KS.ORG | WebsiteAddressTxt |
| State License | H007001 | 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 | HIAWATHA HOSPITAL ASSOCIATION INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 | 19 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | HTTPS://WWW.HCH-KS.ORG/GETPAGE.PHP?NAME=COMMUNITY_BENEFITS | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 19 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | HTTPS://WWW.HCH-KS.ORG/GETPAGE.PHP?NAME=COMMUNITY_BENEFITS | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 300.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | 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 (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | HTTPS://WWW.HCH-KS.ORG/GETPAGE.PHP?NAME=FAP | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | HTTPS://WWW.HCH-KS.ORG/GETPAGE.PHP?NAME=FAP | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | HTTPS://WWW.HCH-KS.ORG/GETPAGE.PHP?NAME=FAP | 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 (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | 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 (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| HIAWATHA HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 5: WE CHOSE INDIVIDUALS WHO WOULD HAVE UNIQUE UNDERSTANDING OF THE DIFFERENT POPULATIONS IN OUR COMMUNITY TO BE ON THE COMMITTEE. THE COMMITTEE HELPED FORMULATE THE SURVEY TO TAKE TO OUR COMMUNITY AND GAVE SIGNIFICANT FEEDBACK AND DIRECTION ABOUT WHAT SPECIFIC POPULATION NEEDS WERE.INCLUDED ON THE COMMITTEE:- THE NURSING DIRECTOR FOR BROWN COUNTY HEALTH DEPARTMENT- SUPERINTENDENT OF HIAWATHA USD 415- LOCAL LAW ENFORCEMENT- LOCAL GOVERNMENT- AREA AGENCY ON AGING- KNZA MENTAL HEALTH |
| HIAWATHA HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 6B: BROWN COUNTY HEALTH DEPARTMENT |
| HIAWATHA HOSPITAL ASSOCIATION, INC. | PART V, SECTION B, LINE 11: THE HOSPITAL IS ADDRESSING MOST OF THE SIGNIFICANT NEEDS IDENTIFIED IN ITS MOST RECENTLY CONDUCTED CHNA:TO ADDRESS THE SIGNIFICANT NEED OF ADDITIONAL PROVIDERS, THE HOSPITAL WILL CONTINUE TO RECRUIT HCH PROVIDERS TO THE AREA USING NATIONAL RECRUITERS TO FIND QUALITY PROVIDERS. THE HOSPITAL WILL EXPLORE RELATIONSHIPS WITH TERTIARY HOSPITALS TO HAVE VISITING SPECIALIST HOURS AND CREATE AN HCH ON-BOARDING PROGRAM. THE HOSPITAL WILL OFFER COMMUNITY HEALTH FAIRS TO EXPOSE RESIDENTS TO HEALTH CARE PROVIDERS AVAILABLE WITHIN THE AREA. THE HOSPITAL WILL EXPLORE TELEMEDICINE AND TELEHEALTH SERVICES FOR ADDITIONAL PROVIDER SPECIALTY SUPPORT. THE HOSPITAL WILL COMPLETE A DR MANPOWER WORKFORCE NEEDS STUDY IN CONJUNCTION WITH PSA PROVIDERS. IN ADDITION, THE HOSPITAL WILL CREATE A PSA LOCAL COMMUNITY HEALTHCARE RECRUITMENT COMMITTEE WITH A STRATEGY TO GROW PHYSICIAN WORKFORCE AND WILL HOLD UPDATE MEETINGS EVERY QUARTER.TO ADDRESS THE SIGNIFICANT NEED OF THE FINANCIAL HEALTH OF THE LOCAL HOSPITAL, THE HOSPITAL WILL CONTINUE TO EXPLORE THE FUNDING RESOURCES AVAILABLE FROM THE FEDERAL GOVERNMENT / STATE OF KANSAS AND BROWN COUNTY FOR HEALTHCARE SERVICES. THE HOSPITAL WILL CONTINUE TO ADVANCE BROWN COUNTY SALES TAX 2.0 CAMPAIGN AND WILL CONTINUE WITH TAX SUPPORT FUNDING INITIATIVES. THE HOSPITAL WILL CONTINUE TO USE DATA REVIEW, MANAGER INPUT, AND NATIONAL BENCHMARKS TO SET A STANDARD STAFFING RATIO FOR THE HOSPITAL OVERALL AND FOR EACH DEPARTMENT. THE HOSPITAL WILL RE-EVALUATE THESE STANDARDS ON A ROUTINE BASIS. THE HOSPITAL WILL CONTINUE WORK-PROCESS REDESIGN TO ENSURE FINANCIAL RESPONSIBILITY. HOSPITAL ADMINISTRATION WILL MANAGE STAFFING LEVELS FROM SHIFT TO SHIFT AND CROSS-TRAIN PERSONNEL ACROSS DEPARTMENTS. THE HOSPITAL WILL CONTINUE TO ANALYZE COMPENSATION PRACTICES ACROSS THE ORGANIZATION FOR STANDARDIZATION AND CONSISTENCY. THE HOSPITAL WILL INVESTIGATE & FIND GRANTS TO SUPPORT NON PROFITABLE SERVICES AND APPLY FOR GRANT FUNDING ASSISTANCE. THE HOSPITAL WILL CONTINUE TO SUPPORT MEDICAID EXPANSION, UTILIZE KHA SPEAKERS TO COME TO HCH AT LEAST TWO TIMES PER YEAR.TO ADDRESS THE SIGNIFICANT NEED OF THE COMMUNITY COLLABORATION BETWEEN AGENCIES THE HOSPITAL WILL DEVELOP PARTNER RELATIONSHIPS WITH KEY COMMUNITY MENTAL HEALTH PARTNERS FOR COLLECTIVE IMPACT. THE HOSPITAL WILL CREATE A COLLABORATION AMONG THE FITNESS CENTERS, PARENTS AS TEACHERS, SCHOOLS, SURROUNDING HEALTH DEPARTMENTS, AND FIRE DEPARTMENTS TO ENHANCE PARENTS' HEALTH LITERACY AND PROMOTE CHILDREN'S HEALTHY DEVELOPMENT. THE HOSPITAL WILL CREATE A COMMUNITY / BROWN CO FACEBOOK PAGE (FROM CHAMBER AND HEALTH DEPT PAGES). PROVIDE WEB LINKS TO AREA PROVIDERS, SCHOOLS & CHURCHES TO LIST SERVICES & PROGRAMS. THE HOSPITAL WILL EXPLORE & RELAUNCH HEALTHCARE COMMUNITY COALITION. MEET QUARTERLY TO REVAMP IDEAS AND REVIEW TOP NEEDS FOR BROWN COUNTY SCHOOLS TO HOST THE MEETINGS. THE HOSPITAL WILL EXPAND RELATIONSHIPS WITH CHURCH AND COMMUNITY ORGANIZATIONS THAT OFFER TEEN LIFESTYLE SKILLS TRAINING AND GED PREPARATION TO IDENTIFY SERVICE GAPS AND WAYS TO ENHANCE PARTNERSHIPS (I.E., YOUNG LIFE, 4-H, 5TH QUARTER). CONTINUE TO PROVIDE GED ONLINE CLASSES. THE HOSPITAL WILL HOST COMMUNITY EDUCATION EVENTS IN ORDER TO PROMOTE LOCAL HEALTHCARE / SOCIAL SERVICE PROGRAMS. FOCUS ON COUNTY FAIR, SCHOOL ATHLETES AND WELCOME WAGON. UTILIZE THIS EFFORT WITH AAA. CONTINUE WITH COMMUNITY BABY SHOWERS AT LEAST TWICE PER YEAR THROUGH HD. THE HOSPITAL WILL COLLABORATE WITH KICKAPOO FOR THEIR HEALTH FAIR EFFORTS. THE HOSPITAL WILL COLLABORATE AND HOST LUNCH & LEARNS (MONTHLY) TO EDUCATE COMMUNITY ON HEALTH & WELLNESS PRACTICES / SOCIAL SERVICE PROGRAMS.TO ADDRESS THE SIGNIFICANT NEED OF THE AWARENESS OF SERVICES AMONG THE COMMUNITY THE HOSPITAL WILL CREATE A COLLABORATION AMONGST ALL STAKEHOLDERS IN BROWN COUNTY. HAVE MEETINGS QUARTERLY TO DISCUSS SERVICE OFFERINGS TO THE COMMUNITY. THE HOSPITAL WILL INVESTIGATE OPPORTUNITIES TO CREATE A COMMUNITY FACEBOOK PAGE. PROVIDE WEB LINKS TO AREA PROVIDERS, SCHOOLS & CHURCHES TO LIST SERVICES & PROGRAMS. THE HOSPITAL WILL DEVELOP PARTNER RELATIONSHIPS WITH KEY COMMUNITY PROVIDERS FOR COLLECTIVE IMPACT. UTILIZE NEK MULTI-COUNTY HEALTH DEPARTMENT CONTACTS SUCH AS: DONIPHAN CO HD, AND OTHERS. THE HOSPITALS WILL HOST LUNCH & LEARNS (AT LEAST QUARTERLY) TO EDUCATE COMMUNITY ON HEALTH & WELLNESS PRACTICES / SOCIAL SERVICE PROGRAMS. THE HOSPITAL WILL MAINTAIN A COMMUNITY INVENTORY OF HEALTHCARE SERVICES IN THE AREA, INCLUDING HOURS OF SERVICE. MAKE INVENTORY AVAILABLE TO THE PUBLIC, AS NEEDED. THE HOSPITAL WILL CONTINUE TO OFFER COMMUNITY HEALTH FAIRS TO EXPOSE RESIDENTS TO HEALTH CARE AVAILABILITY. ASK THREE PSA SCHOOLS TO ASSIST AND HOST AT LEAST TWICE PER YEAR. THE HOSPITAL WILL PROVIDE PSA CONSUMER REPORTS TO COMMUNITY. THE HOSPITAL WILL CONTINUE SHARING THE HCH CALENDAR OF EVENTS WITH THE COMMUNITY. CREATE A HEALTH DEPT EVENT CALENDAR AND MAKE IT AVAILABLE TO THE COMMUNITY. THE HOSPITAL WILL UTILIZE BROWN CO FB PAGE TO POST.THE FOLLOWING STRATEGIES WERE PUT ON HOLD DUE TO THE PANDEMIC AND THE AMOUNT OF TIME THE HOSPITAL WAS FOCUSING ON HOW TO RESPOND AND CONTINUE TO PROVIDE CARE TO OUR PATIENTS AND COMMUNITY. WE PROVIDE MEDICALLY-RELATED TRANSPORTATION AT NO COST TO THE PUBLIC, PROVIDE MENTAL HEALTH SCREENINGS AND PROMOTE THE LOCAL PARKS AND REC AND WALKING TRAILS. WE WORK ON OBTAINING COMMUNITY-WIDE GRANTS TO IMPROVE LOCAL HABITS THAT RESULT IN HEALTHY OUTCOMES. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 2 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (2 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| 1 - HIAWATHA COMM HOSP FAM PRACTICE CLINIC | ||||
| 300 OREGON STREET 2ND FLOOR | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
| 2 - HIAWATHA COMM HOSPITAL HIGHLAND CLINIC | ||||
| 415 S MAIN STREET | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (16 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | IN ADDITION TO FPG, THE ORGANIZATION USES ASSET LEVEL, INSURANCE STATUS, RESIDENCY, MEDICAL INDIGENCY, AND UNDERINSURANCE STATUS AS FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| PART I, LINE 6A: | THE COMMUNITY BENEFIT REPORT IS PREPARED BY VVV CONSULTING AND IS POSTED ON THE HOSPITAL'S WEBSITE. |
| PART I, LINE 7: | THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,651,326. |
| PART II, COMMUNITY BUILDING ACTIVITIES: | LITTLE HANDS DAYCARE IS A NOT FOR PROFIT DAYCARE THAT PROVIDES LICENSED, RELIABLE, QUALITY DAYCARE AND EDUCATION TO CHILDREN IN THE COMMUNITY. ONE OF THE ISSUES CITED BY LOCAL EMPLOYERS WHEN RECRUITING WORK WAS A LACK OF OPENINGS WITH LOCAL DAYCARE PROVIDERS. LITTLE HANDS WAS STARTED TO ADDRESS THAT NEED. HIAWATHA HOSPITAL'S CONTRIBUTIONS IN TIME AND SUPPLIES HAS HELPED THEM TO BE ABLE TO PROVIDE QUALITY SERVICES WHILE OPERATING ON MINIMAL MARGINS. |
| PART III, LINE 2: | GENERALLY, PATIENTS WHO ARE COVERED BY THIRD-PARTY PAYORS ARE RESPONSIBLE FOR RELATED DEDUCTIBLES AND COINSURANCE, WHICH VARY IN AMOUNT. THE HOSPITAL PROVIDES SERVICES TO UNINSURED PATIENTS, AND OFFERS THOSE UNINSURED PATIENTS A DISCOUNT, EITHER BY POLICY OR LAW, FROM STANDARD CHARGES. THE HOSPITAL ESTIMATES THE TRANSACTION PRICE FOR PATIENTS WITH DEDUCTIBLES AND COINSURANCE AND FROM THOSE WHO ARE UNINSURED BASED ON HISTORICAL EXPERIENCE AND CURRENT MARKET CONDITIONS. THE INITIAL ESTIMATE OF THE TRANSACTION PRICE IS DETERMINED BY REDUCING THE STANDARD CHARGE BY ANY CONTRACTUAL ADJUSTMENTS, DISCOUNTS AND IMPLICIT PRICE CONCESSIONS. SUBSEQUENT CHANGES TO THE ESTIMATE OF THE TRANSACTION PRICE ARE RECORDED AS ADJUSTMENTS TO PATIENT SERVICE REVENUE IN THE PERIOD OF CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN THE PATIENT'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE. |
| PART III, LINE 3: | BEFORE MAKING ACCOUNTS ELIGIBLE FOR BAD DEBT, WE RUN ALL ACCOUNTS THROUGH A COMPANY TO CHECK TO SEE IF THEY WOULD LIKELY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THOSE WHO COME BACK AS PROBABLE ARE CONTACTED AND ASKED AGAIN TO COMPLETE A FAP APPLICATION. MANY INDIVIDUALS ARE NOT WILLING TO COMPLETE THE APPLICATION. AT THAT POINT THEY ARE GRANTED PRESUMPTIVE FINANCIAL ASSISTANCE STATUS AND THEIR BALANCES ARE WRITTEN OFF TO CHARITY CARE INSTEAD OF BAD DEBT. WHILE WE FEEL THAT WE WORK VERY DILIGENTLY TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY, WE CANNOT GUARANTEE A PERFECT SYSTEM. SO THE ABOVE FIGURE IS AN ESTIMATION OF THE BALANCES THAT MAY HAVE NOT BEEN CAUGHT BY OUR SYSTEM. |
| PART III, LINE 4: | THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN A SPECIFIC FOOTNOTE DESCRIBING BAD DEBT. HOWEVER, PAGES 8, 10 AND 11 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS INCLUDE FOOTNOTES TITLED "PATIENT ACCOUNTS RECEIVABLE" "PATIENT SERVICE REVENUE", AND "PATIENT FINANCIAL ASSISTANCE". |
| PART III, LINE 8: | THERE IS NO SHORTFALL REPORTED IN THE CURRENT YEAR. |
| PART III, LINE 9B: | CHARITY CARE APPLICATIONS ARE MADE AVAILABLE TO ALL PATIENTS AT THE TIME OF REGISTRATION, ON STATEMENTS, AND ON THE WEBSITE. 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT IS MADE ON AN ACCOUNT, IF PAYMENT ISN'T MADE AND A CHARITY CARE APPLICATION ISN'T COMPLETED THE PATIENT'S NAME IS RUN THROUGH A COMPANY TO CHECK FOR PRESUMPTIVE CHARITY CARE. IF THEY QUALIFY, THEY ARE OFFERED AN APPLICATION AGAIN. IF THEY FAIL TO COMPLETE THE APPLICATION, THEY ARE WRITTEN OFF TO CHARITY CARE UNDER OUR PRESUMPTIVE CHARITY CARE PROGRAM. IF THEY DO NOT QUALIFY FOR CHARITY CARE, AND HAVE NOT RESPONDED TO OUR REQUESTS FOR PAYMENTS FOR 120 DAYS, THEN THE ACCOUNT IS GRANTED APPROVAL BY THE BOARD OF TRUSTEES. ONCE AN ACCOUNT IS GRANTED APPROVAL BY THE BOARD, IT IS SENT TO THE COLLECTION AGENCY. WE GIVE THE COLLECTION AGENCY SEVERAL MONTHS TO COLLECT THE DEBT. IF THEY ARE UNSUCCESSFUL, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND WRITTEN OFF. |
| PART VI, LINE 2: | NOT ONLY DID WE SEEK FEEDBACK FROM COMMITTEE MEMBERS REPRESENTING LESSER-HEARD VOICES FROM OUR COMMUNITY, BUT WE MADE AN ONLINE SURVEY AVAILABLE, WE PUT HARD COPIES OF THE SURVEY IN MULTIPLE PLACES INCLUDING ALL OF THE TOWNS IN OUR SERVICE AREA. WE COMBINED THAT FEEDBACK WITH STATISTICAL INFORMATION FROM RELIABLE SOURCES TO IDENTIFY PRIORITIES. |
| PART VI, LINE 3: | WE POST INFORMATION ABOUT OUR FAPS EXISTENCE IN PROMINENT LOCATIONS. WE MAKE COPIES OF THE FAP AVAILABLE DURING REGISTRATION, IN INPATIENT ROOMS, ONLINE, AND ON OUR BILLING CORRESPONDENCE. |
| PART VI, LINE 4: | THE HOSPITAL SERVES A GEOGRAPHIC AREA THAT ENCOMPASSES ATCHISON, BROWN, DONIPHAN, JACKSON AND NEMAHA COUNTIES IN KANSAS, AND RICHARDSON COUNTY IN NEBRASKA. OF THOSE PATIENTS, 85% ARE FROM BROWN AND DONIPHAN COUNTIES. THESE ARE MOSTLY RURAL COMMUNITIES. 88% OF THE POPULATION OF THE BROWN AND DONIPHAN COUNTIES THAT IS 25 YEARS OR OLDER HAS A MINIMUM OF A HIGH SCHOOL DIPLOMA, 16% HAS A BACHELORS DEGREE OR HIGHER. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS $41,300 COMPARED TO THE STATE WIDE MEDIAN HOUSEHOLD INCOME OF $50,594. 16% OF THE POPULATION LIVES IN POVERTY; 19% FOR BROWN COUNTY ALONE. 16% OF THE POPULATION IN BROWN AND DONIPHAN COUNTIES DOES NOT HAVE HEALTH INSURANCE. |
| PART VI, LINE 5: | WE SUPPORT A WIDE ARRAY OF PROGRAMS AND PROJECTS IN OUR COMMUNITY. MANY OF OUR KEY EMPLOYEES SERVE ON MULTIPLE BOARDS THAT HAVE A POSITIVE IMPACT ON VARIOUS ASPECTS OF THE COMMUNITY. WE PROVIDE DONATIONS OF BOTH TIME AND MONEY TO VARIOUS SERVICE ORGANIZATIONS. |
| PART VI, LINE 6: | THE HOSPITAL IS PART OF AN AFFILIATED HEALTH CARE SYSTEM WITH AMBERWELL ATCHISON ASSOCIATION. |
| PART VI, LINE 7, REPORTS FILED WITH STATES | KS |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TOWN AND COUNTRY EMS LLC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 296 708 N 1ST | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 454148768 | RecipientEIN |
| Cash Grant | $6,205 | CashGrantAmt |
| Non Cash Assistance | $0 | NonCashAssistanceAmt |
| Purpose Of Grant | SUPPORT AMBULANCE SERVICES | PurposeOfGrantTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 0 | Total501c3OrgCnt |
| Total Other Org | 1 | TotalOtherOrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (1) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (1) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | 0 | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (1) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | 0 | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | 0 | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR CROSBY GERNON | ||||||||||||||
| RADIOLOGIST | $399,954 | $0 | $500 | $0 | $51 | $0 | $9,000 | $0 | $33,787 | $0 | $443,292 | $0 | $0 | $0 |
| DR PETER ROSA | ||||||||||||||
| PHYSICIAN | $297,998 | $0 | $85,948 | $0 | $51 | $0 | $6,706 | $0 | $36,481 | $0 | $427,184 | $0 | $0 | $0 |
| DR JESSICA JARVIS | ||||||||||||||
| PHYSICIAN | $295,678 | $0 | $34,196 | $0 | $51 | $0 | $0 | $0 | $31,915 | $0 | $361,840 | $0 | $0 | $0 |
| DR BRYON BIGHAM | ||||||||||||||
| PHYSICIAN | $300,125 | $0 | $13,195 | $0 | $51 | $0 | $6,812 | $0 | $36,323 | $0 | $356,506 | $0 | $0 | $0 |
| DUSTIN WILLIAMS | ||||||||||||||
| APRN | $233,625 | $0 | $16,540 | $0 | $51 | $0 | $0 | $0 | $32,990 | $0 | $283,206 | $0 | $0 | $0 |
| JOHN BROBERG | ||||||||||||||
| CEO THRU 11/21 | $234,942 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $234,942 | $0 | $0 | $0 |
| DANIELLE JAGELS | ||||||||||||||
| APRN | $135,279 | $0 | $38,411 | $0 | $51 | $0 | $6,683 | $0 | $32,254 | $0 | $212,678 | $0 | $0 | $0 |
| DR LOWELL SEARIGHT | ||||||||||||||
| PHYSICIAN | $169,091 | $0 | $9,500 | $0 | $51 | $0 | $3,806 | $0 | $12,586 | $0 | $195,034 | $0 | $0 | $0 |
| BRETT GLIEM | ||||||||||||||
| PHYSICIAN ASSISTANT | $112,589 | $0 | $32,233 | $0 | $51 | $0 | $2,534 | $0 | $28,166 | $0 | $175,573 | $0 | $0 | $0 |
| JODI TWOMBLY | ||||||||||||||
| PHYSICIAN ASSISTANT | $122,208 | $0 | $16,540 | $0 | $51 | $0 | $2,751 | $0 | $33,787 | $0 | $175,337 | $0 | $0 | $0 |
| JEAN ABEITA | ||||||||||||||
| PHARMACIST | $143,833 | $0 | $500 | $0 | $51 | $0 | $3,223 | $0 | $20,546 | $0 | $168,153 | $0 | $0 | $0 |
| ZANE HOFFMAN | ||||||||||||||
| PHARMACIST | $117,913 | $0 | $500 | $0 | $51 | $0 | $2,639 | $0 | $36,787 | $0 | $157,890 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 1A | JOHN BROBERG, CEO THRU NOVEMBER OF 2021, RECEIVED COMPENSATION FOR HOUSING THE AMOUNT OF $4,600 AS A TAXABLE BENEFIT. THE AMOUNT WAS INCLUDED ON THE 1099. |
| PART I, LINE 5 | THE PROVIDERS ARE PAID A PERFORMANCE BONUS BASED ON PRODUCTIVITY AND CONSIDERATION OF REVENUES. |
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 HIAWATHA KANSAS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 486025665 | BondIssuerEIN |
| CUSIP | 428545CY1 | CUSIPNum |
| Bond Issued | 2020-03-31 | BondIssuedDt |
| Issue Price | $6,295,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | 0 | DefeasedInd |
| On Behalf Of Issuer | 0 | OnBehalfOfIssuerInd |
| Pool Financing | 0 | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $340,000 | RetiredAmt |
| Total Proceeds | $6,295,000 | TotalProceedsAmt |
| In Reserve Fund | $300,000 | InReserveFundAmt |
| Issuance Costs From Proceeds | $125,900 | IssuanceCostsFromProceedsAmt |
| Working Capital Expenditures | $1,899,946 | WorkingCapitalExpendituresAmt |
| Other Spent Proceeds | $4,169,100 | OtherSpentProceedsAmt |
| Unspent | $100,054 | UnspentAmt |
| Refunding Tax Exempt Bonds | Yes (1) | RefundingTaxExemptBondsInd |
| Refunding Taxable Bonds | 0 | RefundingTaxableBondsInd |
| Final Allocation Made | 0 | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (1) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | 0 | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | 0 | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (1) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (1) | EngageBondCounselContractsInd |
| Any Research Agreements | 0 | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | 0 | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | 0 | ChangeInUseBondFinancedPropInd |
| Procs Nonqualified Bond Remdtd | Yes (1) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | 0 | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (1) | RebateNotDueYetInd |
| Exception To Rebate | 0 | ExceptionToRebateInd |
| No Rebate Due | 0 | NoRebateDueInd |
| Variable Rate Issue | 0 | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | 0 | HedgeIdentifiedInBksAndRecInd |
| Gross Proceeds Invested In GIC | 0 | GrossProceedsInvestedInGICInd |
| Gross Proceeds Invested | 0 | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (1) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (1) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE A, COLUMN F | THE BONDS WERE ISSUED TO (1) REFUND THE SERIES 2014 BONDS (ISSUED 9/29/2014) AND (2) MAKE CAPITAL IMPROVEMENTS INCLUDING STRUCTURAL IMPROVEMENTS AND THE ACQUISITION OF CAPITAL ASSETS TO IMPROVE HOSPITAL SERVICES. |
| PART II, LINE 13, COLUMN A | THE PROJECT IS STILL IN PROGRESS |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MANDY GRAHAM | PersonNm |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Relationship Description | MANDY GRAHAM, TRUSTEE, AND A GREATER THAN 35% OWNER OF RESTORE. | RelationshipDescriptionTxt |
| Transaction | $161,000 | TransactionAmt |
| Transaction | THE HOSPITAL PAID RESTORE $161,000 FOR SPEECH THERAPY. | TransactionDesc |
| Sharing Of Revenues | 0 | SharingOfRevenuesInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL EMPLOYEES AND DECISION MAKERS FOR THE HOSPITAL ARE COVERED UNDER THIS POLICY. CONFLICTS ARE EITHER REVIEWED BY THE CORPORATE COMPLIANCE OFFICER OR THE BOARD PRESIDENT. AT BOARD MEETINGS, THE BOARD CHAIR IS APPRAISED OF ALL CONFLICTS OF INTEREST AND THEN ASKS THE MEMBER TO ABSTAIN FROM DISCUSSING AND VOTING ON TOPICS OF CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15 | HUMAN RESOURCES PERIODICALLY PROVIDES THE PRESIDENT OF THE BOARD OF DIRECTORS WITH A COMPENSATION SURVEY COMPILED BY THE KANSAS HOSPITAL ASSOCIATION. THE SURVEY DELINEATES COMPENSATION PACKAGES FOR ADMINISTRATORS AT HOSPITALS THAT ARE SIMILAR TO HIAWATHA. BASED ON THAT SURVEY, THE ADMINISTRATOR'S PERFORMANCE, AND THE PERFORMANCE OF THE HOSPITAL, THE BOARD SETS THE ADMINISTRATOR'S SALARY. THE LAST EVALUATION WAS GIVEN IN 2021 WHILE HIRING OUR CURRENT CEO. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART IX, LINE 11G | OTHER SERVICE FEES: PROGRAM SERVICE EXPENSES 4,303,291. MANAGEMENT AND GENERAL EXPENSES 155,248. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,458,539. |
| FORM 990, PART XI, LINE 9: | CHANGE IN INTEREST IN FOUNDATION 25,641. |
| FORM 990, PAGE 12, PART XII, LINE 2C: | THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY OF SELECTING THE INDEPENDENT ACCOUNTANT TO COMPLETE THE AUDIT WORK. THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS HAS THE RESPONSIBILITY FOR THE OVERSIGHT OF THE AUDIT. UPON CONCLUSION OF THE AUDIT, THE AUDITING FIRM PRESENTS THE RESULTS AND FINDINGS TO THE BOARD OF DIRECTORS. THIS PROCESS HAS NOT CHANGED FROM THE PRIOR YEAR. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA COMMUNITY HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481223766 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | LINE 12D, III-O | PublicCharityStatusTxt |
| Controlled Organization | 0 | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARITABLE REMAINDER TRUST (1) | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | TRUST | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Entity Type | T | EntityTypeTxt |
| Controlled Organization | Yes (1) | ControlledOrganizationInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | 0 | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | 0 | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | 0 | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | 0 | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (1) | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | 0 | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | 0 | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |