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PAWNEE VALLEY COMMUNITY HOSPITAL INC: Form 990, tax year 2019

View the entire original 990 at ProPublica ↗

Organization
PAWNEE VALLEY COMMUNITY HOSPITAL INC (EIN 48-1253246)
Tax period
2019-07-01 to 2020-06-30
Filed
2021-05-17
IRS object ID
202111379349306026
Schema version
2019v5.1
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 ReturnHeader

FieldValueIRS element (for citing)
Return2021-05-17T13:40:58-05:00ReturnTs
Tax Period End2020-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1BKD LLPBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line11201 Walnut Suite 1700AddressLine1Txt
CityKANSAS CITYCityNm
State AbbreviationMOStateAbbreviationCd
ZIP641062246ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2019-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN481253246EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PAWNEE VALLEY COMMUNITY HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
In Care Of% GEORGE HARMS TREASURERInCareOfNm
Business Name ControlPAWNBusinessNameControlTxt
Phone6202853161PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 CARROLL AVEAddressLine1Txt
CityLARNEDCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonSHAE VEACHPersonNm
Person TitlePRESIDENTPersonTitleTxt
Phone6202853161PhoneNum
Signature2021-05-15SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonMichael J EnglePreparerPersonNm
PTINP00482834PTIN
Phone8162216300PhoneNum
Preparation2021-05-15PreparationDt
FieldValueIRS element (for citing)
Tax2019TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerSHAE VEACHPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 CARROLL AVEAddressLine1Txt
CityLARNEDCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$18,392,214GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website AddressWWW.PAWNEEVALLEYHOSPITAL.COMWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionPAWNEE VALLEY COMMUNITY HOSPITAL, INC. IS A TAX-EXEMPT CHARITABLE ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS LICENSED (SEE SCHEDULE O)ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee146TotalEmployeeCnt
Total Volunteers100TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
PY Contributions Grants$65,083PYContributionsGrantsAmt
CY Contributions Grants$1,024,860CYContributionsGrantsAmt
PY Program Service Revenue$18,127,681PYProgramServiceRevenueAmt
CY Program Service Revenue$17,126,170CYProgramServiceRevenueAmt
PY Investment Income$97,575PYInvestmentIncomeAmt
CY Investment Income$64,318CYInvestmentIncomeAmt
PY Other Revenue$211,716PYOtherRevenueAmt
CY Other Revenue$176,866CYOtherRevenueAmt
PY Total Revenue$18,502,055PYTotalRevenueAmt
CY Total Revenue$18,392,214CYTotalRevenueAmt
PY Grants And Similar Paid$0PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$0CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,855,968PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,795,041CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,701,222PYOtherExpensesAmt
CY Other Expenses$7,223,802CYOtherExpensesAmt
PY Total Expenses$15,557,190PYTotalExpensesAmt
CY Total Expenses$16,018,843CYTotalExpensesAmt
PY Revenues Less Expenses$2,944,865PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,373,371CYRevenuesLessExpensesAmt
Total Assets BOY$15,859,560TotalAssetsBOYAmt
Total Assets EOY$21,161,892TotalAssetsEOYAmt
Total Liabilities BOY$14,154,358TotalLiabilitiesBOYAmt
Total Liabilities EOY$19,201,379TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,705,202NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,960,513NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPAWNEE VALLEY COMMUNITY HOSPITAL, INC. IS A TAX-EXEMPT CHARITABLE ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS LICENSED BY THE STATE OF KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT. THE PURPOSE OF THE ORGANIZATION IS (SEE SCHEDULE O)MissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$11,914,906ExpenseAmt
Grant$0GrantAmt
Revenue$17,126,170RevenueAmt
DescPATIENT CARE: PROGRAM SERVICES CONSIST OF ROUTINE AND ANCILLARY DEPARTMENT HEALTHCARE SERVICES PROVIDED BY A HEALTHCARE ORGANIZATION AS DESCRIBED IN 501(C)(3) OF THE IRS CODE.Desc
Total Program Service Expenses$11,914,906TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Donor Rstr Or Quasi EndowmentsYes (true)DonorRstrOrQuasiEndowmentsInd
Report Land Building EquipmentfalseReportLandBuildingEquipmentInd
Report Investments Other SecfalseReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnotefalseIncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesfalseFundraisingActivitiesInd
Gaming ActivitiesfalseGamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsfalseGrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingfalseLoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With35 Ctrl EntfalseBusinessRlnWith35CtrlEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntYes (true)RelatedOrganizationCtrlEntInd
Transaction With Control EntYes (true)TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee146EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Subj To Tax Rmnrtn Ex Prcht PymtfalseSubjToTaxRmnrtnExPrchtPymtInd
Subject To Excs Tax Net Invst IncfalseSubjectToExcsTaxNetInvstIncInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyYes (true)DocumentRetentionPolicyInd
Compensation Process CEOYes (true)CompensationProcessCEOInd
Compensation Process OtherYes (true)CompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGEORGE HARMS TREASURERPersonNm
Phone7856235000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12220 CANTERBURYAddressLine1Txt
CityHAYSCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67601ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtOfficerOfficerIndHighest Compensated EmployeeHighestCompensatedEmployeeInd
EDWARD HERRMAN
DIRECTOR4.040.0Yes (X)$0$634,084$119,981
BRYCE YOUNG
PRESIDENT4.040.0Yes (X)$0$334,138$87,232Yes (X)
GEORGE HARMS
TREASURER4.040.0Yes (X)$0$342,174$73,069Yes (X)
CHRISTIAN WHITTINGTON MD
DIRECTOR/PHYSICIAN-NONVOTING40.00.0Yes (X)$355,560$0$45,837
MC HILL
PHYSICIAN40.00.0$276,565$0$42,225Yes (X)
DAVID SANGER
PHYSICIAN40.00.0$263,226$0$44,875Yes (X)
SHAE VEACH
PRESIDENT4.040.0Yes (X)$0$235,809$70,847Yes (X)
DEBBIE TOMLINSON
APRN40.00.0$190,238$0$15,004Yes (X)
CALVIN KRUGER
PHYSICIAN ASSISTANT40.00.0$150,746$0$10,744Yes (X)
STACY TROUT
PHYSICIAN ASSISTANT40.00.0$144,461$0$10,388Yes (X)
KENDRA BARKER
ADMINISTRATOR0.040.0$0$95,985$16,875Yes (X)
MELANIE URBAN
ADMINISTRATOR0.040.0$0$62,102$11,681Yes (X)
JOHN HAAS
VICE PRESIDENT4.00.0Yes (X)$0$0$0Yes (X)
LYNN BARGER
SECRETARY4.00.0Yes (X)$0$0$0Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,380,796TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,704,292TotReportableCompRltdOrgAmt
Total Other Compensation$548,758TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K9IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedfalseFormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
HAYS MEDICAL CENTER
2220 CANTERBURY DRHAYSKS67601MEDICAL SERVICES$2,846,815
QUEST DIAGNOSTICS
PO BOX 772976CHICAGOIL60677LABORATORY SERVICES$147,279
GE HEALTHCARE
PO BOX 96483CHICAGOIL60693EQUIP. MAINTENANCE$173,070
University of Kansas Hospital Autho
PO BOX 955772ST LOUISMO631955772FINANCIAL SERVICES$684,000
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Related Organizations$72,796RelatedOrganizationsAmt
Government Grants$951,385GovernmentGrantsAmt
All Other Contributions$679AllOtherContributionsAmt
Total Contributions$1,024,860TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (4 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net patient service revenue622000$16,018,610$16,018,610
340b drug program900099$1,083,150$1,083,150
Outreach therapy services900099$3,047$3,047
Lab fairs900099$21,363$21,363
FieldValueIRS element (for citing)
Total Program Service Revenue$17,126,170TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$64,143TotalRevenueColumnAmt
Exclusion$64,143ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$900RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$900RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$900TotalRevenueColumnAmt
Exclusion$900ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Other$175OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Other$175OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$175TotalRevenueColumnAmt
Exclusion$175ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$0FundraisingGrossIncomeAmt
Fundraising Direct Expenses$0FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gaming Gross Income$0GamingGrossIncomeAmt
Gaming Direct Expenses$0GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmt
Meals sold to employees and guest722210$125,290$125,290
_$0
_$0

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$50,676TotalRevenueColumnAmt
Exclusion$50,676ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$175,966OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,392,214TotalRevenueColumnAmt
Related Or Exempt Func Income$17,126,170RelatedOrExemptFuncIncomeAmt
Exclusion$241,184ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Foreign Grants ForeignGrantsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Benefits To Members BenefitsToMembersGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$581,362TotalAmt
Program Services$392,932ProgramServicesAmt
Management And General$188,430ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,537,949TotalAmt
Program Services$5,942,060ProgramServicesAmt
Management And General$595,889ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$321,366TotalAmt
Program Services$286,647ProgramServicesAmt
Management And General$34,719ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$855,350TotalAmt
Program Services$762,941ProgramServicesAmt
Management And General$92,409ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$499,014TotalAmt
Program Services$445,102ProgramServicesAmt
Management And General$53,912ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$2,346,316TotalAmt
Management And General$2,346,316ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$4,171TotalAmt
Management And General$4,171ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

FieldValueIRS element (for citing)
Total$58,172TotalAmt
Management And General$58,172ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$3,469TotalAmt
Management And General$3,469ManagementAndGeneralAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,740,685TotalAmt
Program Services$1,476,208ProgramServicesAmt
Management And General$264,477ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$40,145TotalAmt
Program Services$1,238ProgramServicesAmt
Management And General$38,907ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$151,154TotalAmt
Program Services$100,804ProgramServicesAmt
Management And General$50,350ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$115,404TotalAmt
Program Services$69,242ProgramServicesAmt
Management And General$46,162ManagementAndGeneralAmt

Royalties RoyaltiesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$534,072TotalAmt
Program Services$413,733ProgramServicesAmt
Management And General$120,339ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$56,831TotalAmt
Program Services$32,882ProgramServicesAmt
Management And General$23,949ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$2,759TotalAmt
Management And General$2,759ManagementAndGeneralAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$0TotalAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$100,469TotalAmt
Program Services$60,281ProgramServicesAmt
Management And General$40,188ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Pharmaceuticals$1,128,380$1,128,380
Medical Supplies$507,480$507,480
Dietary$164,042$164,042
DUES AND SUBSCRIPTIONS$160,141$103,617$56,524

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$110,112TotalAmt
Program Services$27,317ProgramServicesAmt
Management And General$82,795ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$16,018,843TotalAmt
Program Services$11,914,906ProgramServicesAmt
Management And General$4,103,937ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$953,811BOYAmt
EOY$1,115,290EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$9,895,444BOYAmt
EOY$14,496,311EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,633,556BOYAmt
EOY$1,960,510EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$361,167BOYAmt
EOY$353,021EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$137,416BOYAmt
EOY$77,523EOYAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$172,964BOYAmt
EOY$78,725EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,705,202BOYAmt
EOY$3,080,512EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$15,859,560BOYAmt
EOY$21,161,892EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,187,172BOYAmt
EOY$1,252,322EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$3,328,469EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$12,967,186BOYAmt
EOY$14,620,588EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$14,154,358BOYAmt
EOY$19,201,379EOYAmt
FieldValueIRS element (for citing)
Organization Follows FASB117Yes (X)OrganizationFollowsFASB117Ind

No Donor Restriction Net Assets NoDonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$644,756BOYAmt
EOY$811,559EOYAmt

Donor Restriction Net Assets DonorRestrictionNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,060,446BOYAmt
EOY$1,148,954EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,705,202BOYAmt
EOY$1,960,513EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$15,859,560BOYAmt
EOY$21,161,892EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$2,373,371ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$2,118,060OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredfalseFederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbyingGrp
Total Direct LobbyingTotalDirectLobbyingGrp
Total Lobbying ExpendTotalLobbyingExpendGrp
Other Exempt Purpose ExpendOtherExemptPurposeExpendGrp
Total Exempt Purpose ExpendTotalExemptPurposeExpendGrp
Lobbying Nontaxable AmountLobbyingNontaxableAmountGrp
Grassroots NontaxableGrassrootsNontaxableGrp
Tot Lbbyng Grassroot Mns Non TxTotLbbyngGrassrootMnsNonTxGrp
Tot Lbby Expend Mns Lbbyng Non TxTotLbbyExpendMnsLbbyngNonTxGrp
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$3,469GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$3,469TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule C, Part II-B, Line 1fFormAndLineReferenceDesc
ExplanationPawnee Valley Community Hospital is a member of the Kansas Hospital Association and the American Hospital Association. Both of these organizations engage in lobbying activities for hospitals and health care as part of the services provided to members.ExplanationTxt

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmountsArtPublicExhibitionAmountsGrp
Held Works ArtHeldWorksArtGrp

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,437,709BeginningYearBalanceAmt
Investment Earnings Or Losses$12,390InvestmentEarningsOrLossesAmt
End Year Balance$1,450,099EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,193,650BeginningYearBalanceAmt
Investment Earnings Or Losses$244,059InvestmentEarningsOrLossesAmt
End Year Balance$1,437,709EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,266,232BeginningYearBalanceAmt
Investment Earnings Or Losses-$72,582InvestmentEarningsOrLossesAmt
End Year Balance$1,193,650EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$1,169,777BeginningYearBalanceAmt
Investment Earnings Or Losses$96,455InvestmentEarningsOrLossesAmt
End Year Balance$1,266,232EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$934,796BeginningYearBalanceAmt
Investment Earnings Or Losses$234,981InvestmentEarningsOrLossesAmt
End Year Balance$1,169,777EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (true)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (true)RelatedOrgListSchRInd
LandLandGrp
BuildingsBuildingsGrp
Leasehold ImprovementsLeaseholdImprovementsGrp
EquipmentEquipmentGrp
Other Land BuildingsOtherLandBuildingsGrp

Other Assets Org OtherAssetsOrgGrp (2 entries)

DescDescBook ValueBookValueAmt
Beneficial interest foundation$1,960,512
AMOUNTS DUE FROM THIRD-PARTY$1,120,000
FieldValueIRS element (for citing)
Total Book Value Other Assets$3,080,512TotalBookValueOtherAssetsAmt
Federal Income Tax Liability$0FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (5 entries)

DescDescAmtAmt
Pension Liability$78,725
DUE TO UNIV. OF KS HOSPITAL$839,000
Due to Pawnee County$11,221,644
Due to Hays Medical Center$280,547
EST. AMOUNTS DUE TO THIRD-PARTY$2,200,672
FieldValueIRS element (for citing)
Total Liability$14,620,588TotalLiabilityAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSCHEDULE D, PART V, LINE 4FormAndLineReferenceDesc
ExplanationDONATIONS ARE REQUESTED FOR SPECIFIC ITEMS OR IMPROVEMENTS TO THE HOSPITAL. WHEN A DONATION IS RECEIVED FOR THAT SPECIFIC ITEM, IT IS RESTRICTED FOR THAT USE BY THE BOARD UNTIL THE SPECIFIC ITEM OR IMPROVEMENT IS PURCHASED. AT ANY ONE TIME, ONE OR MORE SUCH PROJECTS CAN BE IN PROGRESS.ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CareYes (true)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other130.FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (true)FPGReferenceDiscountedCareInd
Percent300Yes (X)Percent300Ind
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportfalseAnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$163,736TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$163,736NetCommunityBenefitExpnsAmt
Total Expense0.01020TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,213,171TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$507,114DirectOffsettingRevenueAmt
Net Community Benefit Expns$706,056NetCommunityBenefitExpnsAmt
Total Expense0.04410TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,376,907TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$507,114DirectOffsettingRevenueAmt
Net Community Benefit Expns$869,792NetCommunityBenefitExpnsAmt
Total Expense0.05430TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,372TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$4,372NetCommunityBenefitExpnsAmt
Total Expense0.00030TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,626,586TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,199,742DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,426,844NetCommunityBenefitExpnsAmt
Total Expense0.08910TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,630,958TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,199,742DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,431,216NetCommunityBenefitExpnsAmt
Total Expense0.08940TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,007,865TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,706,856DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,301,008NetCommunityBenefitExpnsAmt
Total Expense0.14370TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$1,324,928BadDebtExpenseAmt
Reimbursed By Medicare$11,484,960ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$11,753,572CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$268,612MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PAWNEE VALLEY COMMUNITY HOSPITAL INCBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 CARROLL AVEAddressLine1Txt
CityLARNEDCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67601ZIPCd
FieldValueIRS element (for citing)
Website AddressWWW.PAWNEEVALLEYHOSPITAL.COMWebsiteAddressTxt
State LicenseH-073-002StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1PAWNEE VALLEY COMMUNITY HOSPITAL INCBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted17CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLSEE PART V, SECTION COwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt17ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLSEE PART V, SECTION CStrategyWebsiteURLTxt
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care130.FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care300.FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLsee part v, section cFAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLsee part v, section cFAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLsee part v, section cFAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP TranslatedYes (X)FAPTranslatedInd
FAP Actions On NonpaymentYes (true)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection ActivitiesfalseCollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (true)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally BilledfalseAmountsGenerallyBilledInd
Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART V, SECTION B, LINE 5THE CHNA WAS CONDUCTED IN COLLABORATION WITH THE PAWNEE COUNTY HEALTH DEPARTMENT. A TOWN HALL MEETING WAS ORGANIZED TO PROVIDE AN OBJECTIVE CONSENSUS BUILDING METHOD OF REVIEWING AND PRIORITIZING COUNTY HEALTH ISSUES. DURING THE TOWN HALL MEETING, THE GROUP REFLECTED ON THE SIZE AND SERIOUSNESS OF ANY HEALTH CONCERNS CITED AND DISCUSSED CURRENT COMMUNITY HEALTH STRENGTHS. THE GROUP IDENTIFIED AND RANKED TOP COMMUNITY HEALTH CONCERNS, AND ALL TOWN HALL ATTENDEES WERE ENCOURAGED TO CONTINUE TO CONTRIBUTE IDEAS BY GOING ONLINE AND TAKING A FEEDBACK SURVEY THAT ADDRESSES ANY ADDITIONAL THOUGHTS RELATED TO THE CHNA. ALL TOWN HALL PRIORITY-SETTING AND SCORE PROCESSES INVOLVED THE INPUT OF A DIVERSE GROUP WITH KNOWLEDGE AND/OR EXPERTISE IN PUBLIC HEALTH AS WELL AS PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL. KEY STAKEHOLDERS IN ATTENDANCE INCLUDED REPRESENTATIVES FROM: UNITED WAY, WELCOME INN SENIOR CENTER, CENTER FOR COUNSELING, ANGELS CARE HOME HEALTH, GOLDEN BELT FOUNDATION, LARNED CITY COUNCIL, BURDETT CITY COUNCIL AND GARFIELD CITY COUNCIL AND ROZEL COMMUNITY, PAWNEE COUNTY SHERRIFF'S OFFICE, LARNED POLICE DEPARTMENT, PAWNEE COUNTY HEALTH DEPARTMENT, COUNTY COMMISSIONERS, MEMBERS OF THE CHAMBER OF COMMERCE, MEMBERS OF THE USD 495 SCHOOL BOARD, SCHOOL NURSES OF USD 495, LOCAL MEMBERS OF THE MEDIA, LOCAL RELIGIOUS ORGANIZATIONS AND REPRESENTATIVE OF PAWNEE VALLEY COMMUNITY HOSPITAL. THE CHNA WAS COORDINATED AND PRODUCED BY VVV RESEARCH AND DEVELOPMENT, INC. FROM OLATHE, KANSAS.
SCHEDULE H, PART V, SECTION B, LINE 6BPAWNEE COUNTY, KS
SCHEDULE H, PART V, SECTION B, LINE 7AHTTP://WWW.PAWNEEVALLEYHOSPITAL.COM/WP-CONTENT/UPLOADS/2018/09/CHNA-IMPROV EMENTPLAN-PAWNEE-2018.PDF
Schedule H, Part V, Section B, Line 10AHTTPS://PAWNEEVALLEYHOSPITAL.COM/WPCONTENT/UPLOADS/2018/09/CHNA-IMPROVEMEn TPLAN-PAWNEE-2018.PDF
Schedule H, Part V, Section B, Line 11ANNUAL DESCRIPTION OF THE ACTIONS TAKEN BY THE HOSPITAL DURING THE FISCAL YEAR TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGHOUT THE MOST RECENTLY CONDUCTED CHNA: 1-MENTAL HEALTH: THE HEART OF KANSAS CLINIC OFFERS BEHAVIORAL HEALTH CARE IN LARNED TWO DAYS A WEEK. PAWNEE COUNTY HEALTH DEPARTMENT PROVIDED EDUCATION ON MENTAL HEALTH AT THE 2019 FALL HEALTH FAIRS AND THE 2019 4-H FAIR. THE CENTER FOR COUNSELING AND CONSULTATION HAS COUNSELORS AVAILABLE IN LARNED TWO DAYS A WEEK (WEDNESDAY AND THURSDAY) FOR MENTAL HEALTH ISSUES. IN ADDITION THE CENTER FOR COUNSELING AND CONSULTATION ALSO OFFERS SUBSTANCE ABUSE COUNSELING IN LARNED ON FRIDAYS. PAWNEE VALLEY COMMUNITY HOSPITAL FOUNDATION HOSTED A MENTAL HEALTH EVENT,"THE MANY FACES OF MENTAL HEALTH" ON MARCH 19, 2019. EVENT FOCUSED ON TEENS AND MENTAL HEALTH. JEFF YALDEN CAME AND SPOKE AT THE EVENT. DURING THE DAY THE STUDENTS OF LARNED MIDDLE SCHOOL, LARNED HIGH SCHOOL, AND PAWNEE HEIGHTS ATTENDED THE EVENT. DURING THE EVENING THE EVENT WAS OPEN TO THE COMMUNITY, WITH OVER 300 ATTENDEES. CENTER FOR COUNSELING HAS HOSTED MENTAL FIRST AID COURSES WITHIN PAWNEE COUNTY. WITH COVID-19 PRECAUTIONS, NO NEW EVENTS WERE HELD DURING FY 2020 TO FOCUS ON MENTAL HEALTH. 2-AWARENESS OF LOCAL HC SERVICES: PAWNEE VALLEY COMMUNITY HOSPITAL HAS HIRED FOR A PART-TIME POSITION. THE DUTIES OF THIS POSITION INCLUDE MARKETING THE HOSPITAL SERVICES THROUGH MANY MARKETING AVENUES. THE PAWNEE COUNTY HEALTH DEPARTMENT GIVES ALL WIC CLIENTS A PAWNEE COUNTY RESOURCE LIST. SERVICES AVAILABLE VIA PAWNEE COUNTY HEALTH DEPARTMENT ARE LISTED ON THE COUNTY WEBSITE. 3-OPIOIDS CRISIS: PAWNEE VALLEY COMMUNITY HOSPITAL OFFERS A PAIN CLINIC AND HAS DEVELOPED POLICIES PERTAINING TO PRESCRIBING OPIOIDS. THIS PAIN CLINIC DOES NOT OFFER OPIOIDS, BUT RATHER, PROVIDES EPIDURAL STEROID INJECTIONS. PAWNEE COUNTY HEALTH DEPARTMENT PROVIDED EDUCATION ON OPIOID USAGE AT THE 2019 SPRING AND FALL HEALTH FAIRS AND THE 2019 4-H FAIR. THE CENTER FOR COUNSELING AND CONSULTATION AS MENTIONED ABOVE HAS COUNSELING SERVICES AVAILABLE ON FRIDAYS IN LARNED FOR SUBSTANCE ABUSE. 4-WOMEN'S HEALTH: IN 2018, PAWNEE VALLEY COMMUNITY HOSPITAL ESTABLISHED MAMMOGRAPHY WITHIN THE FACILITY. THE OPTION OF HAVING SPECIALTY OUT-REACH CLINIC CONTINUES TO BE ASSESSED BUT WAS DELAYED DUE TO COVID-19. PAWNEE COUNTY HEALTH DEPARTMENT CONTINUES TO OFFER THE FAMILY PLANNING SERVICE. 5-POVERTY/EMPLOYMENT READINESS, SCHOOL LUNCHES: CITY OF LARNED HAS ESTABLISHED THE "CIRCLES" PROGRAM. NOON LIONS CLUB HAS DONATED FUNDS TO ASSIST WITH THIS PROGRAM. THROUGH VIDEO, PAWNEE COUNTY IS ACTIVELY WORKING ON PROMOTING JOB OPPORTUNITIES AT LSH AND PAWNEE COUNTY. JOB OPENINGS CAN BE POSTED ON THE PAWNEE COUNTY CHAMBER WEBSITE. 6-HC SUPPORT GROUPS (CHRONIC DISEASE, WELLNESS, ETC.): PAWNEE VALLEY COMMUNITY HOSPITAL HAS A PART-TIME HEALTH COACH POSITION AND HOSTS A QUARTERLY DIABETIC EDUCATION COURSE. PAWNEE COUNTY HEALTH DEPARTMENT OFFERS A BREASTFEEDING SUPPORT/PEER COUNSELING GROUP, FACILITATES A DIABETIC SUPPORT GROUP WITH THE LOCAL WELCOME INN, OFFERS METABOLIC SCREENING, AND HEALTH COACHING. 7-PEDIATRIC CARE: PAWNEE VALLEY COMMUNITY HOSPITAL AND PAWNEE COUNTY HEALTH DEPARTMENT WORK TOGETHER TO SCREEN CHILDREN FOR LEAD. IF A CHILD IS SEEN AT PAWNEE VALLEY MEDICAL ASSOCIATES AND IS IN NEED OF LEAD SCREENING, THEY ARE REFERRED TO THE HEALTH DEPARTMENT FOR TESTING. PAWNEE VALLEY COMMUNITY HOSPITAL CONTINUES TO EVALUATE THE NEED AND OPTIONS FOR A PEDIATRICIAN WEEKLY OR BIWEEKLY.
Schedule H, Part V, Section B, Line 13BFINANCIAL ASSISTANCE MAY BE GIVEN FOR CATASTROPHIC MEDICAL EXPENSES, EVEN IF PATIENT'S INCOME EXCEEDS THE FEDERAL POVERTY GUIDELINES.
Schedule H, Part V, Section B, Line 16AHTTPS://WWW.PAWNEEVALLEYHOSPITAL.COM/WP-CONTENT/UPLOADS/2018/12/FINANCI AL-ASSISTANCE-POLICY-PVCH11-2018.PDF
Schedule H, Part V, Section B, Line 16Bhttps://www.pawneevalleyhospital.com/wp-content/uploads/2019/02/BUS136.pdf AND https://www.pawneevalleyhospital.com/wp-content/uploads/2019/02/BUS116a.pd f
SCHEDULE H, PART V, SECTION B, LINE 16Chttps://www.pawneevalleyhospital.com/billing/financial-assistance-policy-s ummary/
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1PAWNEE VALLEY MEDICAL PAVILIONBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1713 W 11TH STAddressLine1Txt
CityLARNEDCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
FacilityFAMILY MEDICINEFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
SCHEDULE H, PART I, LINE 7A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE FINANCIAL ASSISTANCE AT COST AND THE COST OF SUBSIDIZED HEALTH SERVICES. A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO DETERMINE THE COSTS OF SERVING MEDICAID BENEFICIARIES.
SCHEDULE H, PART I, LINE 7GSUBSIDIZED HEALTH SERVICES COMMUNITY BENEFIT EXPENSES INCLUDE $848,766 OF EXPENSES ATTRIBUTABLE TO PHYSICIAN CLINICS THAT HAVE NET OPERATING LOSSES.
SCHEDULE H, PART III, LINE 2COSTING METHODOLOGY: A COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2 WAS USED TO CALCULATE BAD DEBT EXPENSE AT COST.
SCHEDULE H, PART III, LINE 4THE FOOTNOTE FROM THE HOSPITAL'S FINANCIAL STATEMENTS FOLLOWS: THE HOSPITAL REPORTS PATIENT ACCOUNTS RECEIVABLE FOR SERVICES RENDERED AT NET REALIZABLE AMOUNTS FROM THIRD-PARTY PAYERS, PATIENTS AND OTHERS. THE HOSPITAL PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS BASED UPON A REVIEW OF OUTSTANDING RECEIVABLES, HISTORICAL COLLECTION INFORMATION AND EXISTING ECONOMIC CONDITIONS.
Schedule H, Part III, Line 8THE MEDICARE COST REPORT WAS THE COSTING METHODOLOGY USED TO DETERMINE THE ALLOWABLE MEDICARE COSTS PERTAINING TO MEDICARE NET REVENUE. ALLOWABLE COSTS OF CARE REPORTED ON LINE 6 WERE DETERMINED USING AMOUNTS FROM WORKSHEET D, PART V AND WORKSHEET D-1 IN THE PAWNEE VALLEY COMMUNITY HOSPITAL, INC., MEDICARE COST REPORT FOR FISCAL YEAR ENDED JUNE 30, 2020.
Schedule H, Part III, LINE 9BWhenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient.
Schedule H, Part VI, Line 2AN EFFORT TO UNDERSTAND AND CREATE A HEALTHIER COMMUNITY REQUIRES COLLABORATION AND INPUT FROM MANY COMMUNITY STAKEHOLDERS. THROUGH DATA RESEARCH AND KEY CONVERSATIONS IN THE PAWNEE COUNTY AREA, THIS CHNA PULLS TOGETHER COMMUNITY FINDINGS AND ADDRESSES TOP HEALTH PRIORITIES TO HELP IMPROVE COMMUNITY HEALTH OVER THE NEXT THREE YEARS. THE HOSPITAL ALSO ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, AND ANNUAL STRATEGIC PLANNING PROCESS HEADED BY THE HEALTH SYSTEM. THE HOSPITAL OBTAINS MARKET DATA THROUGH ITS ANNUAL STRATEGIC PLANNING PROCESS. WITH THIS DATA, THE HOSPITAL IDENTIFIES SERVICES RECEIVED BY THE RESIDENTS OF OUR COMMUNITY (DEFINED BY OUR PRIMARY AND SECONDARY SERVICE AREAS). ANY PREDOMINANT SERVICES NOT CURRENTLY OFFERED BY THE HOSPITAL ARE CONSIDERED DURING STRATEGIC PLANNING. THE HOSPITAL ALSO WORKS CLOSELY WITH THE PUBLIC HEALTH COMMISSION AND THE SCHOOL DISTRICT WHEN ASSESSING THESE NEEDS. ANOTHER ELEMENT OF THE COMMUNITY NEEDS ASSESSMENT INVOLVES ANNUALLY UPDATING THE HOSPITAL'S PROVISION OF CARE PLAN AND ITS CRITICAL ACCESS HOSPITAL ANNUAL REPORT. FINALLY, THE HOSPITAL AND RELATED HEALTH SYSTEM ARE ACTIVELY ENGAGED IN A VARIETY OF FORMAL HEALTH PROFESSIONALS EDUCATION PROGRAMS.
Schedule H, Part VI, Line 3Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. A financial assistance policy summary is included with every statement that is sent to an uninsured patient. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well.
Schedule H, Part VI, Line 4Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $43,250. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.6% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned.
Schedule H, Part VI, Line 5Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians.
SCHEDULE H, PART VI, LINE 6Pawnee Valley Community Hospital, Inc. is a component unit of Hays Medical Center, Inc. As of January 1, 2017, Hays Medical Center, Inc. became a component unit of the University of Kansas Hospital Authority.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (10 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
BRYCE YOUNG
PRESIDENT$0$284,565$0$45,362$0$4,211$0$60,468$0$26,764$0$421,370$0$0
SHAE VEACH
PRESIDENT$0$201,497$0$23,489$0$10,823$0$45,498$0$25,349$0$306,656$0$0
GEORGE HARMS
TREASURER$0$278,936$0$43,592$0$19,646$0$58,882$0$14,187$0$415,243$0$0
EDWARD HERRMAN
DIRECTOR$0$529,369$0$100,000$0$4,715$0$96,646$0$23,335$0$754,065$0$0
CHRISTIAN WHITTINGTON MD
DIRECTOR/PHYSICIAN-NONVOTING$267,061$0$20,058$0$68,441$0$16,800$0$29,037$0$401,397$0$0$0
MC HILL
PHYSICIAN$252,415$0$20,000$0$4,150$0$15,900$0$26,325$0$318,790$0$0$0
DEBBIE TOMLINSON
APRN$175,158$0$0$0$15,080$0$11,478$0$3,526$0$205,242$0$0$0
CALVIN KRUGER
PHYSICIAN ASSISTANT$138,569$0$0$0$12,177$0$9,035$0$1,709$0$161,490$0$0$0
STACY TROUT
PHYSICIAN ASSISTANT$139,065$0$0$0$5,396$0$8,662$0$1,726$0$154,849$0$0$0
DAVID SANGER
PHYSICIAN$242,350$0$20,000$0$876$0$15,900$0$28,975$0$308,101$0$0$0

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Schedule J, Part I, Line 3A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator.
Form 990, Schedule J, Part I, Line 4bContributions to the plan: Bryce Young $43,668 George Harms $42,082 Shae Veach $31,040 Edward Herrman $79,846

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (11 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
FORM 990, PART I, LINE 1BY THE STATE OF KANSAS DEPARTMENT OF HEALTH AND ENVIRONMENT. THE PURPOSE OF THE ORGANIZATION IS TO IMPROVE THE QUALITY OF LIFE FOR THE COMMUNITIES WE SERVICE THROUGH EXCEPTIONAL HEALTHCARE AND SERVICE EXCELLENCE. THE ORGANIZATION IS STRIVING TO BE THE BEST CRITICAL ACCESS HOSPITAL IN RURAL AMERICA.
FORM 990, PART III, LINE 1TO PROVIDE HEALTHCARE FACILITIES AND SERVICES FOR THE CARE AND TREATMENT OF INPATIENTS AND OUTPATIENTS WHO ARE ACUTELY ILL OR WHO OTHERWISE REQUIRE MEDICAL CARE AND RELATED SERVICES. THE CORE PURPOSE OF THE CORPORATION IS TO IMPROVE THE QUALITY OF LIFE FOR THE COMMUNITIES WE SERVE THROUGH EXCEPTIONAL HEALTHCARE AND SERVICE EXCELLENCE.
FORM 990, PART VI, SECTION A, LINE 6THE ORGANIZATION HAS ONE MEMBER, HAYSMED PARTNERS, INC., WHICH BECAME THE SOLE MEMBER AS OF MARCH 1, 2010. HAYSMED PARTNERS, INC., IS A WHOLLY-OWNED SUBSIDIARY OF HAYS MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION A, LINE 7ATHE BOARD MEMBERS OF HAYSMED PARTNERS, INC., THE SOLE MEMBER OF PAWNEE VALLEY COMMUNITY HOSPITAL, APPOINT THE BOARD MEMBERS OF PAWNEE VALLEY COMMUNITY HOSPITAL, INC.
FORM 990, PART VI, SECTION A, LINE 7BHAYSMED PARTNERS, INC., THE SOLE MEMBER OF PAWNEE VALLEY COMMUNITY HOSPITAL, ELECTS THE BOARD MEMBERS OF PAWNEE VALLEY COMMUNITY HOSPITAL.
Form 990, Part VI, Section B, LINE 11BTHE FORM 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. IT IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS AND CONCERNS THEY HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS ARE MADE. THE FINAL FORM 990 IS THEN PROVIDED TO THE BOARD FOR REVIEW PRIOR TO FILING.
Form 990, Part VI, Section B, Line 12COFFICERS, DIRECTORS & KEY EMPLOYEES, ALONG WITH ALL ASSOCIATES, ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT ANNUALLY. THE STATEMENTS ARE REVIEWED BY THE BOARD, THE COMPLIANCE OFFICER, AND GOVERNANCE DIRECTOR, AS WELL. WHEN CONFLICT OF INTEREST ISSUES ARISE DURING A BOARD MEETING, THE BOARD MEMBERS WITH THE CONFLICT ARE ASKED TO REMOVE THEMSELVES FROM DISCUSSION OR FROM THE ROOM ENTIRELY. THEY ARE NOT ALLOWED TO VOTE ON THAT PARTICULAR ISSUE.
Form 990, PART VI, SECTION B, LINES 15A & 15BTHE HOSPITAL ADMINISTRATOR AND OFFICERS' SALARIES ARE REVIEWED ANNUALLY BY AN INDEPENDENT CONSULTING GROUP AND THE BOARD MEMBERS. THEY BASE THE REVIEW ON SALARY COMPARISONS OBTAINED BY THE CONSULTING GROUP FROM PEER HOSPITALS IN SIMILAR GEOGRAPHIC REGIONS.
Form 990, Part VI, Section C, Line 19These documents are not made available to the public.
Form 990, Part XI, Line 9Transfers to Pawnee County ($ 2,373,368) Change in assets held by foundation $ 255,308 ------------ Total ($ 2,118,060)
Form 990, Part XII, Line 2cTHE PAWNEE VALLEY COMMUNITY HOSPITAL, INC. BOARD AND THE HEALTH SYSTEM AUDIT COMMITTEE ARE RESPONSIBLE FOR THE OVERSIGHT OF PAWNEE VALLEY COMMUNITY HOSPITAL INC.'S, FINANCIAL STATEMENT AUDIT AND THE SELECTION PROCESS OF AN INDEPENDENT ACCOUNTANT.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (7 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationIndDirect Controlling NADirectControllingNACd
HAYSMED PARTNERS INC
2220 CANTERBURY DRHAYSKS67601270877152MANAGEMENTKS501(C)(3)3HMCYes (true)
HAYS MEDICAL CENTER INC
2220 CANTERBURY DRHAYSKS67601480559088HOSPITALKS501(C)(3)3UKHAYes (true)
PAWNEE VALLEY COMMUNITY HOSPITAL FDN
923 CARROLL AVELARNEDKS67550455333776SUPPORTKS501(C)(3)12APVCHYes (true)
UNIVERSITY OF KANSAS HOSPITAL AUTHORITY
3901 RAINBOW BLVDKANSAS CITYKS66160481202402HOSPITALKSfalseN/A
ST ROSE HEALTH CENTER
2220 CANTERBURY DRHAYSKS67601472117443HEALTH CENTERKS501(C)(3)3UKHAYes (true)
TURNING POINT THE CENTER FOR HOPE
8900 STATE LINE ROAD STE 240LEAWOODKS66206431900039HEALTHCAREKS501(C)(3)7UKHAYes (true)
KANSAS UNIVERSITY PHYSICIANS INC
3901 RAINBOW BLVD 4070 DELPKANSAS CITYMO66160481163756HEALTHCAREKS501(C)(3)10UKPYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (8 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtGeneral Or Managing PartnerGeneralOrManagingPartnerInd
KU MEDWEST AMBULATORY SURGERY
7405 RENNER ROADSHAWNEEKS66217020664568HEALTHCAREKSUKHAfalse
UKH SPORTS MED LLC
2330 SHAWNEE MISSION PKWY STE 200WESTWOODKS66205463123647HEALTHCAREKSUKHAfalse
KH ALLIANCE LLC
4000 CAMBRIDGE STREETKANSAS CITYKS66160472838147HEALTHCAREKSUKHAfalse
KANSAS CLINICAL IMPROVEMENT COLLABORATIV
112 SW 7TH STREET SUITE 3CTOPEKAKS66603812776361HEALTHCAREKSUKHAfalse
KANSAS PRIMARY CARE ALLIANCE LLC
2330 SHAWNEE MISSION PKWY SUITE 200WESTWOODKS66205463164140HEALTHCAREKSUKHAfalse
UKHS GREAT BEND LLC
2330 SHAWNEE MISSION PKWY STE 312WESTWOODKS66205830516935HEALTHCAREKSUKHAfalse
UKHS SPORTS PERFORMANCE CENTER LLC
2330 SHAWNEE MISSION PKWY STE 312WESTWOODKS66205830888634HEALTHCAREKSUKHAfalse
UKHS GREAT BEND PHYSICIANS LLC
2330 SHAWNEE MISSION PKWY STE 312WESTWOODKS66205831255734HEALTHCAREKSUKHS GREAT BENDfalse

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (4 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtControlled OrganizationControlledOrganizationInd
JAYHAWK PRIMARY CARE INC
2300 SHAWNEE MISSION PARKWAY STE 3WESTWOODKS66205481159444HEALTHCAREKSUKHAC-CORPYes (true)
MID-AMERICA CARDIOLOGY ASSOCIATES INC
4000 CAMBRIDGE STREET STE G600KANSAS CITYKS66160480980010HEALTHCAREMOUKHAC-CORPYes (true)
UNIVERSITY OF KANSAS PHYSICIANS INC
2330 SHAWNEE MISSION PKWY STE 200WESTWOODKS66205471214865HEALTHCAREKSUKHAC-CORPYes (true)
UKHA PROGRAM SUPPORT INC
2330 SHAWNEE MISSION PKWY STE 200WESTWOODKS66205455571151REAL ESTATEKSUKHAC-CORPYes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (true)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (true)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (true)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (true)PerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (true)ReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (7 entries)

Transaction TypeTransactionTypeTxtInvolvedInvolvedAmtMethod Of Amount DeterminationMethodOfAmountDeterminationTxt
HAYS MEDICAL CENTER INC
E$193,767FMV
HAYS MEDICAL CENTER INC
M$493,313FMV
HAYS MEDICAL CENTER INC
O$386,742FMV
PVCH FOUNDATION
O$75,575FMV
UKHS GREAT BEND LLC
O$63,092FMV
HAYS MEDICAL CENTER INC
P$2,300,000FMV
UKHA
P$155,000FMV