GREAT PLAINS OF CHEYENNE CO INC: Form 990, tax year 2019
View the entire original 990 at ProPublica ↗
- Organization
- GREAT PLAINS OF CHEYENNE CO INC (EIN 48-1226831)
- Tax period
- 2019-01-01 to 2019-12-31
- Filed
- 2020-10-27
- IRS object ID
- 202033019349301723
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2020-10-27T14:34:02-05:00 | ReturnTs |
| Tax Period End | 2019-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1551 N WATERFRONT PKWY STE 300 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 672066601 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2019-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481226831 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT PLAINS OF CHEYENNE COUNTY INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % DAVE DELLASEGA | InCareOfNm |
| Business Name Control | GREA | BusinessNameControlTxt |
| Phone | 3166851523 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVE DELLASEGA | PersonNm |
| Person Title | CEO AND PRESIDENT | PersonTitleTxt |
| Phone | 3166851523 | PhoneNum |
| Signature | 2020-05-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | SHAWNELL LINOT | PreparerPersonNm |
| PTIN | P01663908 | PTIN |
| Phone | 3162652811 | PhoneNum |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 167.68.126.162 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Federal Original Submission Id | 48010220203015000031 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2020-10-27 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | 066B6432F8DC24BA6735E6E2B8FCFDB371380179 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | BA21A7A7DF03597CAA95FF5B57CCAA395E7C7A92 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2019 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | DAVE DELLASEGA | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $12,255,842 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.CHEYENNECOUNTYHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | TO OPERATE AN ACUTE CARE HOSPITAL THAT PROVIDES MEDICAL CARE TO THE GENERAL PUBLIC IN ST. FRANCIS, KANSAS AND SURROUNDING RURAL COMMUNITIES IN CHEYENNE COUNTY, KANSAS. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 117 | TotalEmployeeCnt |
| Total Volunteers | 7 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,262,721 | PYContributionsGrantsAmt |
| CY Contributions Grants | $805,365 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $9,324,129 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $10,085,434 | CYProgramServiceRevenueAmt |
| PY Investment Income | $7,344 | PYInvestmentIncomeAmt |
| CY Investment Income | -$11,334 | CYInvestmentIncomeAmt |
| PY Other Revenue | $894,580 | PYOtherRevenueAmt |
| CY Other Revenue | $1,333,611 | CYOtherRevenueAmt |
| PY Total Revenue | $11,488,774 | PYTotalRevenueAmt |
| CY Total Revenue | $12,213,076 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $6,071,574 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $6,827,883 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $5,789,354 | PYOtherExpensesAmt |
| CY Other Expenses | $6,078,359 | CYOtherExpensesAmt |
| PY Total Expenses | $11,860,928 | PYTotalExpensesAmt |
| CY Total Expenses | $12,906,242 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$372,154 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$693,166 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $4,533,506 | TotalAssetsBOYAmt |
| Total Assets EOY | $5,290,550 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $1,315,750 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $2,765,960 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $3,217,756 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $2,524,590 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | TO OPERATE HOSPITAL FACILITIES FOR THE DELIVERY OF HOSPITAL AND RELATED HEALTH CARE SERVICES, HEALTH RELATED EDUCATION, AS WELL AS THE PROMOTION OF HEALTH AND WELLNESS, WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $10,745,921 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $10,085,434 | RevenueAmt |
| Desc | Cheyenne County Hospital (CCH) is a Critical Care Access, Level IV Trauma 16 bed hospital providing emergency, acute and swing bed care to Cheyenne County and surrounding areas; it employs one full time physician, two physician assistants (PA-C), 19 registered nurses (RN/PRN), one certified registered nurse anesthetists (CRNA), and other allied health professionals. SEE SCHEDULE O FOR CONTINUATION. | Desc |
| Total Program Service Expenses | $10,745,921 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (true) | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Donor Rstr Or Quasi Endowments | false | DonorRstrOrQuasiEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | false | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | false | ReportOtherAssetsInd |
| Report Other Liabilities | false | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (true) | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With35 Ctrl Ent | false | BusinessRlnWith35CtrlEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | Yes (true) | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | Yes (true) | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 47 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 117 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Subj To Tax Rmnrtn Ex Prcht Pymt | false | SubjToTaxRmnrtnExPrchtPymtInd |
| Subject To Excs Tax Net Invst Inc | false | SubjectToExcsTaxNetInvstIncInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 8 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (true) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | false | CompensationProcessCEOInd |
| Compensation Process Other | false | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | DAVE DELLASEGA | PersonNm |
| Phone | 3166851523 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 250 NORTH ROCK ROAD STE 160 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67206 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (16 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Highest Compensated EmployeeHighestCompensatedEmployeeInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd |
|---|---|---|---|---|---|---|---|---|
| DANA JEWELL-BROUGHMAN | ||||||||
| PHYSICIAN ASSISTANT | 40.0 | 0.0 | Yes (X) | $267,892 | $0 | $48,627 | ||
| KIM ZWEYGARDT | ||||||||
| CRNA | 40.0 | 0.0 | Yes (X) | $222,270 | $0 | $37,712 | ||
| DAVE DELLASEGA | ||||||||
| PRESIDENT/CEO/DIRECTOR | 2.0 | 40.0 | $0 | $208,624 | $33,481 | Yes (X) | Yes (X) | |
| HEATHER LICKE | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $218,340 | $0 | $7,029 | ||
| KELLY POTTORFF | ||||||||
| ADMINISTRATOR | 40.0 | 0.0 | $163,499 | $0 | $30,232 | Yes (X) | ||
| DURREL KELLEY | ||||||||
| SENIOR VP OF OPERATIONS | 2.25 | 40.0 | $0 | $160,492 | $32,685 | Yes (X) | ||
| GLENN VOLGELSONG | ||||||||
| PHYSICIAN | 40.0 | 0.0 | Yes (X) | $172,922 | $0 | $10,861 | ||
| KRISTIE RAILE | ||||||||
| PHYSICIAN ASSISTANT | 40.0 | 0.0 | Yes (X) | $140,545 | $0 | $14,090 | ||
| HEIDI TICE | ||||||||
| CFO | 40.0 | 0.0 | $103,845 | $0 | $12,842 | Yes (X) | ||
| DAVE RANKIN | ||||||||
| CHAIRMAN/DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| CHARLES WESTIN | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| ROBERT HAMILTON | ||||||||
| SECRETARY/DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| JOHN TERRILL | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| STEVE CARLSON | ||||||||
| TREASURER/DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | Yes (X) | |
| DR BARBARA BROWN APPL | ||||||||
| DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | ||
| ART HENRICKSON | ||||||||
| DIRECTOR | 0.25 | 2.25 | $0 | $0 | $0 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,289,313 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $369,116 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $227,559 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| GPHA | |||||
| 250 N ROCK ROAD | WICHITA | KS | 67206 | MANAGEMENT, CBO, IT | $693,294 |
| PSYCHIATRIC MEDICAL CARE LLC | |||||
| PO BOX 734606 | DALLAS | TX | 753734606 | SENIOR LIFE PROVIDER | $477,900 |
| PIONEER HEALTH | |||||
| 9790 E 298TH STREET S | PORUM | OK | 74455 | CONTRACTED PROVIDER | $316,923 |
| REACH SOLUTIONS | |||||
| 1981 14TH AVE | MCPHERSON | KS | 67460 | COMPUTER SUPPORT | $129,974 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $700,212 | GovernmentGrantsAmt |
| All Other Contributions | $105,153 | AllOtherContributionsAmt |
| Total Contributions | $805,365 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | PATIENT SERVICE REVENUE | Desc |
| Business | 621300 | BusinessCd |
| Total Revenue Column | $10,085,434 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,085,434 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $10,085,434 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $29,757 | TotalRevenueColumnAmt |
| Exclusion | $29,757 | ExclusionAmt |
Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Royalties Revenue RoyaltiesRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $1,675 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $42,766 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$41,091 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$41,091 | TotalRevenueColumnAmt |
| Exclusion | -$41,091 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $0 | FundraisingGrossIncomeAmt |
| Fundraising Direct Expenses | $0 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gaming Gross Income | $0 | GamingGrossIncomeAmt |
| Gaming Direct Expenses | $0 | GamingDirectExpensesAmt |
Net Income From Gaming NetIncomeFromGamingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Sales Of Inventory | $0 | GrossSalesOfInventoryAmt |
| Cost Of Goods Sold | $0 | CostOfGoodsSoldAmt |
Net Income Or Loss NetIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $0 | TotalRevenueColumnAmt |
Other Revenue Misc OtherRevenueMiscGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| EMPLOYEE/GUEST MEALS | 722513 | $29,588 | $29,588 |
| HEALTH FAIR | 900099 | $24,945 | $24,945 |
| LOCAL PHARMACY INCOME | 446110 | $1,176,667 | $1,176,667 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $102,411 | TotalRevenueColumnAmt |
| Exclusion | $102,411 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $1,333,611 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $12,213,076 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $10,085,434 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $1,322,277 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Foreign Grants ForeignGrantsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Benefits To Members BenefitsToMembersGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $310,419 | TotalAmt |
| Management And General | $310,419 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,176,732 | TotalAmt |
| Program Services | $4,570,971 | ProgramServicesAmt |
| Management And General | $605,761 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $354,794 | TotalAmt |
| Program Services | $311,734 | ProgramServicesAmt |
| Management And General | $43,060 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $616,538 | TotalAmt |
| Program Services | $484,959 | ProgramServicesAmt |
| Management And General | $131,579 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $369,400 | TotalAmt |
| Program Services | $307,698 | ProgramServicesAmt |
| Management And General | $61,702 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $87,740 | TotalAmt |
| Management And General | $87,740 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,978 | TotalAmt |
| Management And General | $3,978 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $63,450 | TotalAmt |
| Management And General | $63,450 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,518 | TotalAmt |
| Management And General | $2,518 | ManagementAndGeneralAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,388,133 | TotalAmt |
| Program Services | $1,780,945 | ProgramServicesAmt |
| Management And General | $607,188 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $37,404 | TotalAmt |
| Program Services | $144 | ProgramServicesAmt |
| Management And General | $37,260 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $433,607 | TotalAmt |
| Program Services | $397,761 | ProgramServicesAmt |
| Management And General | $35,846 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $333 | TotalAmt |
| Program Services | $333 | ProgramServicesAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $235,959 | TotalAmt |
| Program Services | $175,439 | ProgramServicesAmt |
| Management And General | $60,520 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,242 | TotalAmt |
| Program Services | $9,622 | ProgramServicesAmt |
| Management And General | $620 | ManagementAndGeneralAmt |
Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,706 | TotalAmt |
| Program Services | $52,632 | ProgramServicesAmt |
| Management And General | $16,074 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,267 | TotalAmt |
| Program Services | $7,861 | ProgramServicesAmt |
| Management And General | $1,406 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $258,923 | TotalAmt |
| Program Services | $239,472 | ProgramServicesAmt |
| Management And General | $19,451 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $62,000 | TotalAmt |
| Program Services | $54,715 | ProgramServicesAmt |
| Management And General | $7,285 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES & DRUGS | $1,564,810 | $1,564,810 | |
| EQUIPMENT RENTAL & MAINTENANCE | $285,552 | $280,951 | $4,601 |
| BAD DEBT EXPENSE | $411,776 | $411,776 | |
| DUES & SUBSCRIPTIONS | $48,167 | $8,304 | $39,863 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $105,794 | TotalAmt |
| Program Services | $85,794 | ProgramServicesAmt |
| Management And General | $20,000 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $12,906,242 | TotalAmt |
| Program Services | $10,745,921 | ProgramServicesAmt |
| Management And General | $2,160,321 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,175 | BOYAmt |
| EOY | $4,175 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,086,615 | BOYAmt |
| EOY | $1,896,287 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,504,477 | BOYAmt |
| EOY | $1,995,090 | EOYAmt |
Receivables From Officers Etc ReceivablesFromOfficersEtcGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $157,893 | BOYAmt |
| EOY | $175,282 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $37,564 | BOYAmt |
| EOY | $22,691 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $6,976,831 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $5,816,682 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,302,346 | BOYAmt |
| EOY | $1,160,149 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,253 | BOYAmt |
| EOY | $10,287 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $431,183 | BOYAmt |
| EOY | $26,589 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,533,506 | BOYAmt |
| EOY | $5,290,550 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,252,880 | BOYAmt |
| EOY | $2,639,100 | EOYAmt |
Grants Payable GrantsPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $62,870 | BOYAmt |
| EOY | $126,860 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,315,750 | BOYAmt |
| EOY | $2,765,960 | 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 | $3,079,392 | BOYAmt |
| EOY | $2,451,452 | EOYAmt |
Donor Restriction Net Assets DonorRestrictionNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $138,364 | BOYAmt |
| EOY | $73,138 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,217,756 | BOYAmt |
| EOY | $2,524,590 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,533,506 | BOYAmt |
| EOY | $5,290,550 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$693,166 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $2,518 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $2,518 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | false | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE C, PART II-B, LINE 1F | FormAndLineReferenceDesc |
| Explanation | A PORTION OF THE ANNUAL DUES PAID TO KHA AND AHA ARE USED FOR LOBBYING. | ExplanationTxt |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amounts | ArtPublicExhibitionAmountsGrp | |
| Held Works Art | HeldWorksArtGrp | |
| CY Minus3 Yr Endwmt Fund | CYMinus3YrEndwmtFundGrp | |
| CY Minus4 Yr Endwmt Fund | CYMinus4YrEndwmtFundGrp |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $9,040 | OtherCostOrOtherBasisAmt |
| Book Value | $9,040 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,141,032 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,569,004 | DepreciationAmt |
| Book Value | $572,028 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $3,632,346 | OtherCostOrOtherBasisAmt |
| Depreciation | $3,104,852 | DepreciationAmt |
| Book Value | $527,494 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $194,413 | OtherCostOrOtherBasisAmt |
| Depreciation | $142,826 | DepreciationAmt |
| Book Value | $51,587 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $1,160,149 | TotalBookValueLandBuildingsAmt |
| Total Rev Etc Audited Fincl Stmt | $11,801,300 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | -$411,776 | OtherRevenueAmt |
| Revenue Not Reported | -$411,776 | RevenueNotReportedAmt |
| Revenue Subtotal | $12,213,076 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $12,213,076 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $12,494,466 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $12,494,466 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $411,776 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $411,776 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $12,906,242 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART X, LINE 2 | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. |
| SCHEDULE D, PART XI, LINE 2D | PROVISION FOR UNCOLLECTIBLE ACCOUNTS (411,776) |
| SCHEDULE D, PART XII, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 411,776 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | false | FPGReferenceDiscountedCareInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | false | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | Yes (true) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (true) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $145,828 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $145,828 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01170 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $497,284 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $220,613 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $276,761 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02210 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $643,112 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $220,613 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $422,589 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.03380 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $261,655 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $171,759 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $89,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $261,655 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $171,759 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $89,896 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00720 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $904,767 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $392,372 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $512,485 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04100 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $411,776 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $5,450,676 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $5,450,676 | CostOfCareReimbursedByMedcrAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT PLAINS OF CHEYENNE COUNTY INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 210 W FIRST STREET | AddressLine1Txt |
| City | ST FRANCIS | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67756 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.CHEYENNECOUNTYHOSPITAL.COM | WebsiteAddressTxt |
| State License | H012001 | 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 | GREAT PLAINS OF CHEYENNE COUNTY INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 17 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | SEE SCHEDULE H, PART V, SECTION C | OwnWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Rpt Available Thru Other Method | Yes (X) | RptAvailableThruOtherMethodInd |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 17 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE SCHEDULE H, PART V, SECTION C | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 200. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 0. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE SCHEDULE H, PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE SCHEDULE H, PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE SCH H, PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Prospective Medicare Medicaid | Yes (X) | ProspectiveMedicareMedicaidInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (7 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | A PRIORITY OF THE PROGRAM IS TO SOLICIT INPUT FROM A BROAD CROSS SECTION OF THE COMMUNITY, NOT SIMPLY MEMBERS OF THE LOCAL HEALTHCARE SECTOR. THE MEETING PARTICIPANTS INCLUDED COMMUNITY RESIDENTS AND GOVERNMENTAL AND BUSINESS LEADERS WITHIN THE COMMUNITY. SCHEDULE H, PART V, SECTION B, LINE 6B THE ASSESSMENT PROCESS WAS INITIATED BY BOTH CHEYENNE COUNTY HOSPITAL AND CHEYENNE COUNTY HEALTH DEPARTMENT WITH THE CONSULTANT VVV RESEARCH AND DEVELOPMENT, LLC. SCHEDULE H, PART V, LINE 7A WWW.CHEYENNECOUNTYHOSPITAL.COM/ABOUT_US/2017_COMMUNITY_HEALTH_NEED S_ASSESSMENT.ASPX |
| SCHEDULE H, PART V, LINE 7D | THE CHNA RESULTS WERE SHARED AT A TOWN HALL MEETING. |
| SCHEDULE H, PART V, LINE 10A | https://www.cheyennecountyhospital.com/about_us/2017_community_health_need s_assessment.aspx |
| SCHEDULE H, PART V, LINE 11 | OVER HALF OF THOSE SURVEYED BY THE CHNA FELT THAT MENTAL HEALTH SERVICES SHOULD BE AVAILABLE WITHIN 30 MINUTES OF THEIR HOME. TO MEET THIS NEED, CHEYENNE COUNTY HOSPITAL ESTABLISHED MENTAL HEALTH SERVICES LOCALLY ONE TIME PER WEEK. A CLINIC RENOVATION PROVIDED, AMONG OTHER THINGS, AN OFFICE FOR MENTAL HEALTH. OTHER SPECIALTIES WERE ALSO IDENTIFIED AND THE HOSPITAL INTENDS TO OFFER MONTHLY ACCESS TO THE SERVICES WHEN FEASIBLE. THE CHNA ALSO REINFORCED THE FACT THAT THE SURROUNDING POPULATION IS AGING, AND THE HOSPITAL WILL CONTINUE TO MAKE ELDERLY CARE A TOP PRIORITY. THE HOSPITAL HAS APPLIED FOR NUMEROUS GRANTS AIMED AT PARTNERING WITH LOCAL EMS ENTITIES TO REDUCE THE NUMBER OF UNCECESSARY ELDERLY ADMISSIONS, AND ESTABLISHING A MODEL BY WHICH IN-HOME CARE IS PROVIDED. ADDITIONALLY, THE HOSPITAL IS PURSUING A LEVEL III PCMH ACCREDITATION TO ENHANCE THE CONTINUITY OF CARE FOR ELDERLY PATIENTS AS WELL AS THE OVERALL QUALITY OF CARE EXTENDED TO ALL PATRONS. WHILE SOME OF THE NEEDS WERE COMBINED IN IDENTIFYING THESE PRIORITIES, OTHER NEEDS WERE NOT ADDRESSED DUE TO A LACK OF FINANCIAL AND OTHER RESOURCES. |
| SCHEDULE H, PART V, LINE 16A | HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/PATIENTS_VISITORS/FINANCIAL_ASSISTA NCE.ASPX |
| SCHEDULE H, PART V, LINE 16B | HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/PATIENTS_VISITORS/FINANCIAL_ASSISTA NCE.ASPX |
| SCHEDULE H, PART V, LINE 16C | HTTPS://WWW.CHEYENNECOUNTYHOSPITAL.COM/PATIENTS_VISITORS/FINANCIAL_ASSISTA NCE.ASPX |
| 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 |
|---|---|---|---|---|
| CHEYENNE COUNTY CLINIC - ST FRANCIS | ||||
| 221 W 1ST STREET | ST FRANCIS | KS | 67756 | OUTPATIENT CLINIC |
| CHEYENNE COUNTY CLINIC - BIRD CITY | ||||
| 233 W 4TH STREET | BIRD CITY | KS | 67731 | OUTPATIENT CLINIC |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | THE ORGANIZATION USED THE FOLLOWING CRITERIA TO DETERMINE ELIGIBILITY FOR FINANCIAL ASSISTANCE: ASSET LEVEL, MEDICAL INDIGENCY, INSURANCE STATUS, AND UNDERINSURANCE STATUS. SCHEDULE H, PART I, LINE 7 THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS CONTAINED IN THE TABLE OF PART I, LINE 7, OF SCHEDULE H, IS A COST TO CHARGE RATIO. SCHEDULE H, PART I, LINE 7, COLUMN F THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $411,776. SCHEDULE H, PART III, LINE 2 HOSPITAL CHARGES THAT ARE NOT COLLECTED AND ARE NOT APPROVED FOR FINANCIAL ASSISTANCE ARE CLASSIFIED AS BAD DEBTS FROM PATIENTS WHO WILL NOT PAY. |
| SCHEDULE H, PART III, LINE 3 | THE COSTING METHODOLOGY IS BASED ON THE ORGANIZATION'S MEDICARE COST-TO-CHARGE RATIO. WHILE WE RECOGNIZE THAT THERE WOULD BE SOME BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY, WE HAVE NO REASONABLE BASIS FOR ESTIMATING THIS FIGURE. IF ELIGIBILITY IS KNOWN, THE AMOUNT WOULD FALL UNDER CHARITY CARE AND NOT BAD DEBT. |
| SCHEDULE H, PART III, LINE 4 | SEE PAGE 7 OF THE AUDITED FINANCIALS UNDER NOTE 1. |
| SCHEDULE H, PART III, LINE 8 | THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNT ON LINE 6 IS A COST TO CHARGE RATIO. |
| SCHEDULE H, PART III, LINE 9B | ALL CHARITY CARE CHARGES AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPT FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. |
| SCHEDULE H, PART VI, LINE 2 | Cheyenne County will continue to offer community health fairs to expose residents to health care careers. In addition, the hospital will partner with the schools in the county and nearby colleges to spread awareness on jobs that are available in healthcare on the local level. Cheyenne County is determined to grow our own providers and health care workers by spending time on open houses, job shadowing, and increasing our relationship with the schools and close by local hospitals. The mental health needs for all age groups in the country have definitely made their mark on what we need to look at and accomplish in the next few years. Cheyenne County Hospital has successfully initiated a Geriatric Psych program that addresses personal loss, change that all people of later years go through, depression, and other age change illnesses. We are taking on the role of spearhead as we are working on the local level with the county government, law enforcement, schools, clergy to establish a long lasting task force that will address the ongoing concerns of mental health issues of today and into the far reaching future. We will take great care to look at educating all staff on the delivery of mental health services. |
| SCHEDULE H, PART VI, LINE 3 | Cheyenne County Hospital's Financial Assistance Program includes both a charity care program and a discount that takes into consideration a patient's household income and qualifying assets. A Cheyenne County Hospital financial counselor consults with private pay patients to see if they qualify for financial assistance. CCH has posted information regarding the availability of financial assistance throughout its facilities and on their website. If discovered during the accounts receivable collection process that a patient is having trouble paying bills, both the hospital, clinic and the centralized billing office will inform the patient that financial assistance is available. As part of the financial assistance program all applicants must apply for assistance with The Midland Group. The Midland Group focuses on helping patients find assistance through Medicaid or any other funding available to help meet patient needs. If after the initial interview there is consensus that the patient may qualify for financial assistance, the financial counselor provides to the patient the necessary forms in addition to soliciting supporting documentation for the request (patient bank statements, tax returns, etc.). Computations based on current Federal Poverty Level Guidelines are completed to see if qualifications are appropriate and the percentage of charges to be written off is determined based on family size and household income. Additionally, with the implementation of the Affordable Care Act health insurance information is made available for patients and their families regarding the Insurance Marketplace as well as instruction on how to contact a navigator for assistance. All instances of charity care are approved by the Administrator or designated representative of the Hospital. The sliding fee scale is limited to the clinic where the care was obtained. The clinic also has a prescription assistance program which leverages indigent drug programs offered by pharmaceutical companies. Additionally, the hospital has posted its' charge master on its website (www.cheyennecountyhospital.com) to ensure health consumers have a reasonable expectation of charges. |
| SCHEDULE H, PART VI, LINE 4 | Cheyenne County Hospital serves patients chiefly from the geographical boundaries of Cheyenne County, Kansas; this includes the primary population centers of St. Francis and Bird City. Additionally patients from surrounding communities including McDonald, Atwood, Goodland, and Kanorado, Kansas, as well as Burlington, Idalia, and Wray, Colorado, and Haigler and Benkelman, Nebraska patron our facility. Cheyenne County is the remote northwestern most county of Kansas and is bordered by Dundy County, Nebraska to the north; Yuma and Kit Carson Counties in Colorado to the West; Sherman County, Kansas to the south; and Rawlins County, Kansas to the east. We are equidistant between Denver, Colorado and Hays, Kansas; each being 180 miles away. Cheyenne County Hospital (CCH) is the last hospital westbound on US Highway 36 until reaching the Denver Metro Area. Cheyenne County has a population of 2,661 residents as of July 1, 2016, lower than the Kansas Rural Norm of 9,240. The percent change in population in Cheyenne County from April 1, 2010 to July 1, 2016 is -2.4%, higher than the Kansas Rural Norm of -2.0%. The percent of persons 65 years and over in Cheyenne County is 26.2%, higher than the Kansas Rural Norm of 20.9%. The percent of white alone persons in Cheyenne County is 96.9%, higher than the Kansas Rural Norm of 94.6%. The percent of Hispanic or Latino persons in Cheyenne County is 6.8%, higher than the Kansas Rural Norm of 4.6%. The percent of languages other than English spoken at home by persons age 5 years+ is 5.5%, higher than the Kansas Rural Norm of 3.9%. The percent of persons age 1 year+ living in the same house as one year ago in Cheyenne County is 90.8%, higher than the Kansas Rural Norm of 87.0%. The total veterans in Cheyenne County is 264, lower than the Kansas Rural Norm of 697. The population per square mile in Cheyenne County is 2.7, lower than the Kansas Rural Norm of 11.8. The percent of child in single-parent households in Cheyenne County is 22.0%, lower than the Kansas Rural Norm of 25.2%. The percent of limited access to healthy foods in Cheyenne County is 37.0%, higher than the Kansas Rural Norm of 14.1%. |
| SCHEDULE H, PART VI, LINE 5 | The hospital provides for and promotes the health of the citizens of Cheyenne County by offering the following services: diabetes education/counseling, smoking prevention and control, health education for students, prenatal classes and numerous other tailored programs. Health fairs are offered both in the fall and spring each year through the County Health Department; in 2019, 370 patient encounters were achieved through the two health fairs. Our professional staff, including one MD, Physical Assistants, RN's, LPN's and physical and respiratory therapy staff, provide community education on a variety of health issues in a variety of venues. During the flu season we offer numerous immunization clinics to provide much needed flu vaccinations to our populace. Prior to the start of the school year we also offer free annual sports physicals to area athletes. We promote cancer awareness by supporting the annual Relay for Life activities in Cheyenne County. In conjunction with the community ambulance service the hospital sponsors CPR and NRP training for professionals in Cheyenne County. The CCH physical therapist conducts in-home safety assessments for county residents to prevent trips and falls as well as assessments to decide if patients can return to their homes. The Hospital maintains biohazard equipment that can be used in the event of toxic spills or biohazard emergencies in the County to include isolation rooms and showers. Equipment for airborne pathogens is also available. The Hospital annually participates in Emergency Preparedness Trainings with local police and firefighting units within the county and region. The Decontamination Team, which is comprised of hospital healthcare professionals, practices various drills and rehearsals to ensure preparedness. Cheyenne County started an outpatient geriatric psych service in the latter part of 2017. The service is called Senior Life Solutions which is an intensive outpatient psychiatric program designed to meet the needs of adults over the age of 65 in our community. The program addresses issues such as depression or anxiety that can often be related to aging. The patient is offered services by an interdisciplinary team of caring, experienced, behavioral health professionals, which includes a psychiatrist, licensed therapist, and a registered nurse. Cheyenne County Hospital also participates in a variety of community building activities. The hospital makes its fitness equipment available to Cheyenne County citizens for a minimal monthly cost. The hospital is very active in community education on the benefits of immunizations for the prevention of influenza and pneumonia. We work through the Cheyenne County Health Department, nursing home, rural health clinics and the local pharmacy to improve immunization rates. CCH additionally partners closely with the County EMS in the delivery of emergency services; approximately 50% of ambulatory services/transfers have a Cheyenne County Hospital employee on board. Additionally, with the assistance of federal and private grants, CCH helped launch a revolutionary program whereby patients with two or more chronic conditions and/or qualifying cardiac problems receive periodic assessments in their home by a local healthcare professional. CCH additionally serves as a rural rotation site for medical students and residents from various Kansas educational programs and has functioned as a didactic and clinical practice site for vocational institutions throughout the area. Furthermore, CCH continues to provide an annual scholarship program for graduating Cheyenne County students intending to pursue a vocation in healthcare. The Hospital participates in all government healthcare programs/plans which include the following: Medicare, KanCare (United, Sunflower and Amerigroup) and TriCare. The Hospital has received designation from the Medicare Program as a Critical Access Program and is the only Hospital in Cheyenne County. Supported by our own medical staff, the Hospital provides 24 hour Emergency Room Care and is a designated Level IV Trauma center. Additionally, multiple specialty physicians provide outpatient care in our facility which greatly mitigates the need for persons in our community to travel long distances for their unique medical needs. To compliment these outpatient services, as mentioned, CCH developed a growing telemedicine program in 2016 which has further enabled local access to expanded scopes of practice. Education promoted by the Hospital throughout the county also provides residents with vital information on how to minimize their afflictions and maximize their quality of life through proactive preventative care. |
| SCHEDULE H, PART VI, LINE 6 | The organization is affiliated with Great Plains Health Alliance, Inc. (GPHA), a non-profit 501(c)(3) organization, which provides management services and operational, financial and accounting support to the Hospital. GPHA is an affiliation of Critical Access hospitals in Kansas and Nebraska that provides networking opportunities with other rural hospitals, communities and leaders. Although GPHA does not provide services directly to patients, it does provide access to healthcare professionals that may otherwise be cost prohibitive. GPHA provides education and assistance in areas such as Corporate Compliance, HIPAA, Medicare reimbursement, Meaningful Use, hospital finance and many other areas. Additional education/training opportunities are extended through GPHA to Board Members, Business Office Managers, Billers, Medical Records personnel, Directors of Nursing, Administrators, etc. GPHA serves as a vital link to allowing critical access hospitals the ability to offer high quality medicine in frontier population areas. |
| SCHEDULE H, PART VI, LINE 7 | N/A |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | false | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DAVE DELLASEGA | ||||||||||||||
| PRESIDENT/CEO/DIRECTOR | $0 | $208,541 | $0 | $0 | $0 | $83 | $0 | $20,484 | $0 | $12,997 | $0 | $242,105 | $0 | $0 |
| KELLY POTTORFF | ||||||||||||||
| ADMINISTRATOR | $161,700 | $0 | $0 | $0 | $1,799 | $0 | $16,393 | $0 | $13,839 | $0 | $193,731 | $0 | $0 | $0 |
| DURREL KELLEY | ||||||||||||||
| SENIOR VP OF OPERATIONS | $0 | $160,275 | $0 | $0 | $0 | $217 | $0 | $15,277 | $0 | $17,408 | $0 | $193,177 | $0 | $0 |
| DANA JEWELL-BROUGHMAN | ||||||||||||||
| PHYSICIAN ASSISTANT | $265,576 | $0 | $0 | $0 | $2,316 | $0 | $26,961 | $0 | $21,666 | $0 | $316,519 | $0 | $0 | $0 |
| KIM ZWEYGARDT | ||||||||||||||
| CRNA | $220,154 | $0 | $0 | $0 | $2,116 | $0 | $22,416 | $0 | $15,296 | $0 | $259,982 | $0 | $0 | $0 |
| HEATHER LICKE | ||||||||||||||
| PHYSICIAN | $218,340 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $7,029 | $0 | $225,369 | $0 | $0 | $0 |
| KRISTIE RAILE | ||||||||||||||
| PHYSICIAN ASSISTANT | $139,789 | $0 | $0 | $0 | $756 | $0 | $13,274 | $0 | $816 | $0 | $154,635 | $0 | $0 | $0 |
| GLENN VOLGELSONG | ||||||||||||||
| PHYSICIAN | $172,922 | $0 | $0 | $0 | $0 | $0 | $0 | $0 | $10,861 | $0 | $183,783 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | FORM 990, PART VII; SCHEDULE J, PART I, LINE 3 | FormAndLineReferenceDesc |
| Explanation | COMPENSATION FOR DURREL KELLEY AND DAVE DELLASEGA IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. KELLEY AND MR. DELLASEGA. THE AMERICAN COLLEGE HEALTHCARE EXECUTIVES AND THE KANSAS HOSPITAL ASSOCIATION ALSO HAVE COMPARABLE COMPENSATION DATA THAT CAN BE USED BY THE BOARD. A COMPENSATION REVIEW WAS DONE WHEN DAVE DELLASEGA TOOK OVER AS CEO AND WAS CONDUCTED BY THE BOARD, BUT SINCE THAT TIME THERE HAS BEEN NO FORMAL COMPENSATION REVIEW. | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | Cheyenne County Hospital's aim is to provide safe, high quality, team based healthcare to Cheyenne County, Kansas and surrounding areas. CCH is a critical access hospital serving a frontier area population (population density of 2.70) and has been designated as a Medically Underserved Area since 2005. We provide a variety of care including primary care in two rural health clinics, inpatient care (including acute care), observation, swing bed, intermediate swing bed services and obstetrics. In addition we provide a variety of outpatient and diagnostic procedures and have general surgery performed onsite. We provide 24/7 coverage of an Emergency Room that is staffed with our own providers. Cheyenne County Hospital's most expensive entities in 2019 included our rural health clinic, nursing and pharmacy. Our success by way of these capacities is reflected in the number of patients served, as highlighted below, and the innovative ways with which we continue to find new ways to meet the evolving needs of our patients. Rural Health Clinic: Our Rural Health Clinic (RHC) is designated as a Safety Net Clinic by the State of Kansas. The clinic served 7910 patients visits in 2019, focusing on activities concerned with prevention and treatment of common medical problems in an outpatient setting. Care is delivered by primary care practitioners to individuals who present for service regardless of their ability to pay. Expense is often a barrier to care in our community and for that reason the rural health clinic remains responsive to a population often with fixed incomes. In 2019, the RHC was awarded a Primary Care Clinic grant of $127,450.00 which included $6,450 for prescription drug assistance. This critical funding assisted the clinic in providing access to quality, community-based health-care, reducing health disparities for our county's underserved populations, and providing access to prescription drugs for patients that could not otherwise afford medication. As evidence of our commitment to provide quality healthcare to our patient base, in June of 2015 the CCH Rural Health Clinic achieved a Level III certification as a Patient Centered Medical Home (PCMH) from the National Committee for Quality Assurance. Unquestionably, this national accreditation speaks to the commitment of our providers and staff to deliver outstanding medical attention to our patients and the significant process improvements induced by the endeavor is evidence of the clinic's commitment to overcoming traditional rural healthcare barriers. Nursing: The second largest expense by department for 2019 was nursing. Not only in service to the more than 182 acute inpatients, 103 swing bed admissions, and 12 obstetric admissions in 2019, nursing was instrumental in overseeing key facility services such as Hospital Pharmacy (which included the implementation of the cost saving 340B program), Infection Control, Case Management, Education and other outpatient services. Nursing was a key voice on the county's Rural Healthcare Task Force whose major achievement was leveraging federal and private grant dollars to establish a program by which routine and affordable in-home visits can be extended to Cheyenne County's most vulnerable chronically ill patients. Additionally, the nursing department staffed CCH's 24 hour emergency room, providing compassionate care to the more than 877 patients presenting to the ER in 2019 regardless of their ability to pay. In sum, as the primary front line staff for the facility, the nursing department was essential to CCH's ability to extend quality care to the greater than 2,600 residents of Cheyenne County. Pharmacy Pharmacy was the third largest expense for 2019 with a total expense of $1,361,445. The expense for the 340B program was $880,403 of the total above. FORM 990, PART VI, SECTION A, LINE 2 DAVE DELLASEGA AND DURREL KELLEY HAVE A BUSINESS RELATIONSHIP. THEY ARE BOTH EMPLOYED BY, AND ALSO OFFICERS OF, A RELATED 501(C)(3) ORGANIZATION, GREAT PLAINS HEALTH ALLIANCE. |
| FORM 990, PART VI, SECTION A, LINE 6 | GREAT PLAINS HEALTH ALLIANCE, INC., A NOT-FOR-PROFIT, 501(C)(3) ORGANIZATION, IS THE SOLE MEMBER OF GREAT PLAINS OF CHEYENNE COUNTY, INC. |
| FORM 990, PART VI, SECTION A, LINE 7A | GREAT PLAINS HEALTH ALLIANCE, INC., BEING THE SOLE MEMBER, HAS THE RIGHT TO ELECT AND APPROVE ALL THE BOARD MEMBERS. |
| FORM 990, PART VI, SECTION A, LINE 7B | GREAT PLAINS HEALTH ALLIANCE, INC. (GPHA) IS THE SOLE MEMBER AND HAS THE AUTHORITY TO APPROVE THE ARTICLES OF INCORPORATION, BYLAWS, ELECTION TO OR REMOVAL FROM THE BOARD OF DIRECTORS, THE ANNUAL OPERATING AND CAPITAL BUDGETS, AND THE LONG RANGE OR STRATEGIC PLANS. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE 990 IS PREPARED AND REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. THE 990 IS THEN PROVIDED TO THE CHIEF EXECUTIVE OFFICER FOR REVIEW AND APPROVAL. AN ELECTRONIC DRAFT OF THE 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO THE FULL BOARD FOR REVIEW PRIOR TO FILING THE 990 WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE ORGANIZATION IS REQUIRED TO ADOPT GPHA'S CONFLICT OF INTEREST POLICY. ALL BOARD MEMBERS, OFFICERS AND EMPLOYEES ARE SUBJECT TO THE CONFLICT OF INTEREST POLICY AND SIGN AN ANNUAL ACKNOWLEDGEMENT THAT THEY HAVE READ, UNDERSTAND AND COMPLIED WITH THE GPHA CONFLICT OF INTEREST POLICY. UNDER THE POLICY, ANY MEMBER WHO HAS A DIRECT OR INDIRECT (VIA FAMILY) FINANCIAL INTEREST IS CHARACTERIZED AS AN INTERESTED PERSON. INTERESTED PERSONS ARE REQUIRED TO DISCLOSE FINANCIAL INTERESTS WITH COMPANIES DOING BUSINESS WITH GPHA. THE INTERESTED PERSON MUST RECUSE THEMSELVES FROM FURTHER DISCUSSIONS OF THE TRANSACTION AND LEAVE THE ROOM. THE REMAINING NON-INTERESTED MEMBERS DECIDE IF A CONFLICT OF INTEREST EXISTS. THE BOARD CHAIR MAY APPOINT ANOTHER DISINTERESTED PARTY TO DISCUSS THE TRANSACTION OR THE REMAINING BOARD MEMBERS MAY VOTE TO ENTER INTO OR ABSTAIN FROM THE SUSPECT TRANSACTION. FAILURE TO DISCLOSE FINANCIAL INTERESTS BY INTERESTED BOARD MEMBERS WILL RESULT IN DISCIPLINARY ACTION, INCLUDING SANCTIONING BY BOARD. ALL CONFLICTS OF INTEREST AND THEIR ULTIMATE RESOLUTION ARE DOCUMENTED IN THE BOARD MINUTES. THE BOARD CONDUCTS PERIODIC REVIEWS TO DETERMINE THAT CONFLICTS ARE BEING IDENTIFIED AND RESOLVED ACCORDING TO POLICY DOCUMENTATION. REVIEWS BY OUTSIDE EXPERTS ARE PERMITTED, BUT NOT REQUIRED. FORM 990, PART VI, SECTION B, LINES 15A & B THE CEO AND COO ARE COMPENSATED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GPHA'S BOARD USES COMPARABILITY DATA IN SETTING THEIR SALARIES, AND DOCUMENTATION IS RETAINED OF THE BOARD'S DELIBERATIONS AND DECISIONS. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE COMPANY'S KANSAS ANNUAL REPORT IS ALSO AVAILABLE UPON REQUEST FROM THE KANSAS SECRETARY OF STATE. |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACTED MEDICAL STAFF TOTAL FEES:1597280 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:293814 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB SERVICES TOTAL FEES:65394 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARMACY SERVICES TOTAL FEES:114007 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:94573 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PLANT OPERATIONS TOTAL FEES:218801 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:DIETARY SERVICES TOTAL FEES:4264 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (9 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Business Name Line1DirectControllingEntityName/BusinessNameLine1Txt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|---|
| GREAT PLAINS HEALTH CARE FOUNDATION INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480955870 | SUPPORT | KS | 501(C)(3) | 10 | GPHA INC | Yes (true) |
| GREAT PLAINS OF KIOWA COUNTY INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226833 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF OTTAWA COUNTY INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226856 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF REPUBLIC COUNTY INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226977 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF SABETHA COUNTY INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481236156 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF SMITH COUNTY INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226820 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF ELLINWOOD INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226976 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS HEALTH ALLIANCE INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480617739 | MANAGEMENT | KS | 501(C)(3) | 3 | NA | false |
| GREAT PLAINS EMPLOYEE BENEFITS TRUST | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 476918582 | HEALTH PLAN | KS | 501(C)(9) | GPHA INC | Yes (true) | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | false | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (true) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (true) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | Yes (true) | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GPHA EMPLOYEE BENEFITS TRUST | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | R | TransactionTypeTxt |
| Involved | $545,628 | InvolvedAmt |
| Method Of Amount Determination | ACTUAL | MethodOfAmountDeterminationTxt |