GREAT PLAINS OF SMITH CO INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- GREAT PLAINS OF SMITH CO INC (EIN 48-1226830)
- Tax period
- 2017-04-01 to 2018-03-31
- Filed
- 2019-02-14
- IRS object ID
- 201930459349300048
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule J
- Schedule K
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2019-02-14T11:38:25-06:00 | ReturnTs |
| Tax Period End | 2018-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 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 | 2017-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481226830 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT PLAINS OF SMITH CO 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 | PersonTitleTxt |
| Phone | 3166851523 | PhoneNum |
| Signature | 2019-01-15 | 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 | 48010220190455000005 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2019-02-14 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | B98F5FB64AC52D24D812995DABA8F8EA82147269 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 1E18B200E692A862BC78DEF5BEBFB82C16DD5F39 | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2019-02-21 02:37:17Z | BuildTS |
Form 990 IRS990
Doing Business As Name DoingBusinessAsName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SMITH COUNTY MEMORIAL HOSPITAL | BusinessNameLine1Txt |
| 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 | $15,633,606 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.SMITHCOHOSP.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1999 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | THE OPERATION OF HOSPITAL FACILITIES FOR THE DELIVERY OF HEALTH CARE SERVICES, EDUCATION, AND WELLNESS WITHOUT REGARD TO RACE, CREED, COLOR, SEX OR FINANCIAL CIRCUMSTANCE. | ActivityOrMissionDesc |
| Voting Members Governing Body | 8 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 191 | TotalEmployeeCnt |
| Total Volunteers | 8 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $1,652,845 | PYContributionsGrantsAmt |
| CY Contributions Grants | $528,951 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $14,606,058 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $14,765,182 | CYProgramServiceRevenueAmt |
| PY Investment Income | $14,079 | PYInvestmentIncomeAmt |
| CY Investment Income | $29,187 | CYInvestmentIncomeAmt |
| PY Other Revenue | $91,704 | PYOtherRevenueAmt |
| CY Other Revenue | $301,869 | CYOtherRevenueAmt |
| PY Total Revenue | $16,364,686 | PYTotalRevenueAmt |
| CY Total Revenue | $15,625,189 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $0 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $8,093,937 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,217,183 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $7,224,548 | PYOtherExpensesAmt |
| CY Other Expenses | $7,594,935 | CYOtherExpensesAmt |
| PY Total Expenses | $15,318,485 | PYTotalExpensesAmt |
| CY Total Expenses | $15,812,118 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,046,201 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$186,929 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $8,738,752 | TotalAssetsBOYAmt |
| Total Assets EOY | $29,138,369 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $3,639,872 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $24,267,071 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,098,880 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $4,871,298 | NetAssetsOrFundBalancesEOYAmt |
| 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 | $13,411,843 | ExpenseAmt |
| Grant | $0 | GrantAmt |
| Revenue | $14,765,182 | RevenueAmt |
| Desc | GREAT PLAINS OF SMITH COUNTY, INC., DBA SMITH COUNTY MEMORIAL HOSPITAL DELIVERS PRIMARY HEALTHCARE SERVICES TO A SERVICE AREA THAT INCULDES SMITH COUNTY, KANSAS. THE SERVICE AREA ALSO INCLUDES, TO A LESSER DEGREE, PHILLIPS, JEWELL, AND OSBORNE COUNTIES IN KANSAS, AS WELL AS FRANKLIN AND WEBSTER COUNTIES IN NEBRASKA. THE PRIMARY HEALTHCARE SERVICES ARE DELIVERED THROUGH A RURAL HEALTH CLINIC AND A CRITICAL ACCESS HOSPITAL, INCLUDING INPATIENT, OUTPATIENT, AND SKILLED NURSING (SWING BED) SERVICES. SEE SCHEDULE O FOR CONTINUATION. | Desc |
| Total Program Service Expenses | $13,411,843 | 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 |
| Temp Or Permanent Endowments | Yes (true) | TempOrPermanentEndowmentsInd |
| 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 | Yes (true) | 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 | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| 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 | false | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 57 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 191 | 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 |
| 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 | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (true) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (true) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (true) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | 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 | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| TOM KELLER DVM | ||||||||
| CHAIRMAN/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVE DELLASEGA | ||||||||
| PRESIDENT/CEO/DIRECTOR | 2.0 | 40.0 | Yes (X) | Yes (X) | $0 | $211,212 | $30,675 | |
| BILL NAVIS | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JOHN TERRILL | ||||||||
| VICE PRESIDENT/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| ROBERT HAMILTON | ||||||||
| SECRETARY/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| STEVE CARLSON | ||||||||
| TREASURER/DIRECTOR | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DAVE RANKIN | ||||||||
| DIRECTOR/CHAIRMAN | 0.25 | 2.25 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| DR BARBARA BROWN APPLEGATE | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| ARTHUR HENRICKSON | ||||||||
| DIRECTOR | 0.25 | 2.25 | Yes (X) | $0 | $0 | $0 | ||
| DURREL KELLEY | ||||||||
| COO | 2.0 | 40.0 | Yes (X) | $0 | $166,790 | $34,566 | ||
| ALLEN VANDRIEL | ||||||||
| ADMINISTRATOR | 40.0 | 0.0 | Yes (X) | $148,720 | $0 | $33,863 | ||
| JUSTIN OVERMILLER | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $288,865 | $0 | $50,740 | Yes (X) | ||
| FERRILL CONANT | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $290,848 | $0 | $42,823 | Yes (X) | ||
| TAMARA WINDSCHEFFEL | ||||||||
| ARNP | 40.0 | 0.0 | $167,425 | $0 | $34,967 | Yes (X) | ||
| STACEY DIMITT | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $267,161 | $0 | $50,951 | Yes (X) | ||
| HANNAH HAACK | ||||||||
| PHYSICIAN | 40.0 | 0.0 | $274,444 | $0 | $53,840 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,437,463 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $378,002 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $332,425 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 8 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| MHS DATA CENTER | |||||
| 103 E 27TH SUITE A | HAYS | KS | 67601 | COMPUTER SERVICE | $475,165 |
| QUEST DIAGNOSTICS | |||||
| PO BOX 719 | HAYS | KS | 67601 | REFERENCE LAB | $145,912 |
| CRP HOLDINGS LLC | |||||
| 3445 N CAISEWAU BLVD | CHICAGO | IL | 606941849 | WOUND CARE | $145,500 |
| GREAT PLAINS HEALTH ALLIANCE | |||||
| 250 N ROCK RD SUITE 160 | WICHITA | KS | 67206 | BILLING SERVICE | $137,436 |
| GREAT PLAINS HEALTH ALLIANCE | |||||
| PO BOX 366 | PHILLIPSBURG | KS | 67661 | MANAGEMENT FEES | $144,128 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Government Grants | $454,479 | GovernmentGrantsAmt |
| All Other Contributions | $74,472 | AllOtherContributionsAmt |
| Total Contributions | $528,951 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| NET PATIENT SERVICE REVENUE | 621300 | $12,633,526 | $12,633,526 |
| 340B PRESCRIPTION DRUG REVENUE | 621300 | $2,131,656 | $2,131,656 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $14,765,182 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $37,604 | TotalRevenueColumnAmt |
| Exclusion | $37,604 | 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 |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $8,417 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$8,417 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$8,417 | TotalRevenueColumnAmt |
| Exclusion | -$8,417 | 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 | $56,057 | $56,057 |
| WELLNESS CENTER | 713940 | $16,208 | $16,208 |
| VENDOR REBATES | 900099 | $78,277 | $78,277 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $151,327 | TotalRevenueColumnAmt |
| Exclusion | $151,327 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $301,869 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $15,625,189 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $14,765,182 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $331,056 | 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 | $184,769 | TotalAmt |
| Management And General | $184,769 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,152,075 | TotalAmt |
| Program Services | $5,471,731 | ProgramServicesAmt |
| Management And General | $680,344 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $423,955 | TotalAmt |
| Program Services | $381,690 | ProgramServicesAmt |
| Management And General | $42,265 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,042,878 | TotalAmt |
| Program Services | $869,712 | ProgramServicesAmt |
| Management And General | $173,166 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $413,506 | TotalAmt |
| Program Services | $354,318 | ProgramServicesAmt |
| Management And General | $59,188 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,626 | TotalAmt |
| Management And General | $126,626 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,676 | TotalAmt |
| Management And General | $14,676 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $72,312 | TotalAmt |
| Management And General | $72,312 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,321,126 | TotalAmt |
| Program Services | $1,656,401 | ProgramServicesAmt |
| Management And General | $664,725 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $14,455 | TotalAmt |
| Program Services | $6,202 | ProgramServicesAmt |
| Management And General | $8,253 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,922 | TotalAmt |
| Program Services | $317,325 | ProgramServicesAmt |
| Management And General | $43,597 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,052 | TotalAmt |
| Program Services | $1,766 | ProgramServicesAmt |
| Management And General | $2,286 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $224,020 | TotalAmt |
| Program Services | $167,044 | ProgramServicesAmt |
| Management And General | $56,976 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,726 | TotalAmt |
| Program Services | $3,290 | ProgramServicesAmt |
| Management And General | $436 | 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 | $76,434 | TotalAmt |
| Program Services | $61,669 | ProgramServicesAmt |
| Management And General | $14,765 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $7,586 | TotalAmt |
| Program Services | $5,421 | ProgramServicesAmt |
| Management And General | $2,165 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $414,295 | TotalAmt |
| Program Services | $296,046 | ProgramServicesAmt |
| Management And General | $118,249 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $126,435 | TotalAmt |
| Program Services | $90,348 | ProgramServicesAmt |
| Management And General | $36,087 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $2,703,567 | $2,703,567 | |
| PROVISION FOR BAD DEBTS | $771,991 | $771,991 | |
| EQUIPMENT RENTAL/MAINTENANCE | $271,753 | $238,175 | $33,578 |
| DUES & SUBSCRIPTIONS | $41,061 | $15,147 | $25,914 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $39,898 | TotalAmt |
| Management And General | $39,898 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,812,118 | TotalAmt |
| Program Services | $13,411,843 | ProgramServicesAmt |
| Management And General | $2,400,275 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $74,535 | BOYAmt |
| EOY | $528,429 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,640,487 | BOYAmt |
| EOY | $1,718,994 | 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 | $1,479,100 | BOYAmt |
| EOY | $1,706,231 | 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 | $223,019 | BOYAmt |
| EOY | $254,260 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $239,896 | BOYAmt |
| EOY | $101,519 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $31,170,470 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $6,678,948 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,561,527 | BOYAmt |
| EOY | $24,491,522 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Investments Program Related InvestmentsProgramRelatedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Intangible Assets IntangibleAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $520,188 | BOYAmt |
| EOY | $337,414 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,738,752 | BOYAmt |
| EOY | $29,138,369 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,127,160 | BOYAmt |
| EOY | $3,383,917 | 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 | $1,512,712 | BOYAmt |
| EOY | $20,144,154 | EOYAmt |
Escrow Account Liability EscrowAccountLiabilityGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Loans From Officers Directors LoansFromOfficersDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $739,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,639,872 | BOYAmt |
| EOY | $24,267,071 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,116,470 | BOYAmt |
| EOY | $3,960,395 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $49,216 | BOYAmt |
| EOY | $18,362 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $933,194 | BOYAmt |
| EOY | $892,541 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,098,880 | BOYAmt |
| EOY | $4,871,298 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $8,738,752 | BOYAmt |
| EOY | $29,138,369 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | -$186,929 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | -$40,653 | NetUnrlzdGainsLossesInvstAmt |
| 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
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grassroots Lobbying | TotalGrassrootsLobbyingGrp | |
| Total Direct Lobbying | TotalDirectLobbyingGrp | |
| Total Lobbying Expend | TotalLobbyingExpendGrp | |
| Other Exempt Purpose Expend | OtherExemptPurposeExpendGrp | |
| Total Exempt Purpose Expend | TotalExemptPurposeExpendGrp | |
| Lobbying Nontaxable Amount | LobbyingNontaxableAmountGrp | |
| Grassroots Nontaxable | GrassrootsNontaxableGrp | |
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp | |
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (true) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $3,046 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | false | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,046 | 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 Endwmt Fund CYEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $982,411 | BeginningYearBalanceAmt |
| Contributions | $17,349 | ContributionsAmt |
| Investment Earnings Or Losses | -$27,421 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $61,436 | OtherExpendituresAmt |
| End Year Balance | $910,903 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $931,434 | BeginningYearBalanceAmt |
| Contributions | $49,072 | ContributionsAmt |
| Investment Earnings Or Losses | $67,637 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $65,732 | OtherExpendituresAmt |
| End Year Balance | $982,411 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $904,033 | BeginningYearBalanceAmt |
| Contributions | $45,770 | ContributionsAmt |
| Investment Earnings Or Losses | $14,884 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $33,253 | OtherExpendituresAmt |
| End Year Balance | $931,434 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $835,575 | BeginningYearBalanceAmt |
| Contributions | $9,959 | ContributionsAmt |
| Investment Earnings Or Losses | $75,163 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $16,664 | OtherExpendituresAmt |
| End Year Balance | $904,033 | EndYearBalanceAmt |
CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $790,370 | BeginningYearBalanceAmt |
| Contributions | $7,624 | ContributionsAmt |
| Investment Earnings Or Losses | $75,716 | InvestmentEarningsOrLossesAmt |
| Other Expenditures | $38,135 | OtherExpendituresAmt |
| End Year Balance | $835,575 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Designated Balance EOY | 0.00000 | BoardDesignatedBalanceEOYPct |
| Prmnnt Endowment Balance EOY | 0.97980 | PrmnntEndowmentBalanceEOYPct |
| Term Endowment Balance EOY | 0.02020 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | Yes (true) | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | false | EndowmentsHeldRelatedOrgInd |
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $399,451 | OtherCostOrOtherBasisAmt |
| Book Value | $399,451 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $3,598,761 | OtherCostOrOtherBasisAmt |
| Depreciation | $2,316,848 | DepreciationAmt |
| Book Value | $1,281,913 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $5,449,045 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,253,221 | DepreciationAmt |
| Book Value | $1,195,824 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Cost Or Other Basis | $0 | InvestmentCostOrOtherBasisAmt |
| Other Cost Or Other Basis | $21,723,213 | OtherCostOrOtherBasisAmt |
| Depreciation | $108,879 | DepreciationAmt |
| Book Value | $21,614,334 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $24,491,522 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to Third Party | Desc |
| Amt | $739,000 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $739,000 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $14,812,545 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | -$40,653 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$771,991 | OtherRevenueAmt |
| Revenue Not Reported | -$812,644 | RevenueNotReportedAmt |
| Revenue Subtotal | $15,625,189 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $15,625,189 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,040,127 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $15,040,127 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $771,991 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $771,991 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,812,118 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE D, PART V, LINE 4 | THE INTENDED USE OF THE ENDOWMENT FUNDS IS TO SUPPORT THE CONTINUING OPERATIONS OF THE REPORTING ORGANIZATION. |
| 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 (771,991) |
| SCHEDULE D, PART XII, LINE 4B | PROVISION FOR UNCOLLECTIBLE ACCOUNTS 771,991 |
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 | $152,839 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $152,839 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01020 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $607,208 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $370,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $236,264 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01570 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $760,047 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $370,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $389,103 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02590 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,904 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $52,904 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $52,904 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00350 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $812,951 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $370,944 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $442,007 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02940 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $771,991 | BadDebtExpenseAmt |
| Reimbursed By Medicare | $3,596,688 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $3,596,688 | 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 SMITH CO INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 614 SOUTH MAIN STREET | AddressLine1Txt |
| City | SMITH CENTER | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66967 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.SMITHCOHOSP.ORG | WebsiteAddressTxt |
| State License | H092001 | 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 |
| Other | RURAL HEALTH CLINIC LONG-TERM CARE UNIT | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GREAT PLAINS OF SMITH CO 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 | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | false | 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 |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | 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 |
| 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, 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 BUSINESS LEADERS WITHIN THE COMMUNITY. THIS INFORMATION CAN BE FOUND IN THE SMITH COUNTY, KS TOWN HALL ROSTER AS PART OF THE TOWN HALL ATTENDEES NOTES & FEEDBACK LOCATED IN THE DETAILED EXHIBITS OF THE CHNA. |
| SCHEDULE H, PART V, LINE 7A | HTTPS://WWW.SCMHKS.ORG/ABOUT-US/COMMUNITY-HEALTH-NEEDS-ASSESSMENT/ |
| SCHEDULE H, PART V, LINE 10 | HTTP://SCMH.BITBRILLIANT.COM/FILES/2018/08/IMPLEMENTATION-STRATEGY.PDF |
| SCHEDULE H, PART V, LINE 11 | THE CHNA CONDUCTED HIGHLIGHTED TWO PRIORITIES IN SMITH COUNTY; FIRST, UPDATING EXISTING FACILITIES TO CREATE A NEW HEALTH CARE CENTER WITH AN EXPANDED ARRAY OF PROGRAMS AND SERVICES. THE HOSPITAL IS BUILDING A COUNTY COALITION TO FOCUS ON THE FUTURE OF HEALTH CARE IN THE COUNTY. THE HOSPITAL PUT UP A WEBSITE TO REACH MORE PEOPLE, HIRED A FUNDRAISER TO RAISE CAPITAL FOR A NEW HEALTH CARE CENTER, AND HELD A HEALTH CARE EVENT FAIR. THE SECOND PRIORITY IS A FOCUS ON COMMUNITY HEALTH AND WELLNESS. TO MEET THIS NEED, SMITH COUNTY HOSPITAL IS PUTTING TOGETHER A COMMUNITY GARDEN AND REVITALIZING RECREATION IN SMITH COUNTY THROUGH LEADERSHIP BOARD MEETINGS, REGULAR MONTHLY MEETINGS, AND PUBLIC EVENTS AND FORUMS. |
| SCHEDULE H, PART V, LINE 16A | https://www.scmhks.org/services/financial-assistance/ |
| SCHEDULE H, PART V, LINE 16B | https://www.scmhks.org/services/financial-assistance/ |
| SCHEDULE H, PART V, LINE 16C | HTTPS://WWW.SCMHKS.ORG/SERVICES/FINANCIAL-ASSISTANCE-RESOURCES/ |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SMITH COUNTY FAMILY PRACTICE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 119 E PARLIAMENT STREET | AddressLine1Txt |
| City | SMITH CENTER | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66967 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | FAMILY PRACTICE | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (14 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 $771,991. |
| 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 PAGES 7 AND 8 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 AND CHARGES NOT TO BE COLLECTED DUE TO FINANCIAL ASSISTANCE COMPUTATIONS ARE EXEMPTED FROM COLLECTION POLICIES AND PRACTICES. THESE ACCOUNTS ARE REMOVED FROM THE COLLECTION CYCLE. |
| SCHEDULE H, PART VI, LINE 2 | GREAT PLAINS OF SMITH COUNTY, INC. USES BOTH FORMAL AND INFORMAL METHODS TO DETERMINE THE NEEDS OF THE COMMUNITIES IT SERVES. FORMAL MECHANISMS PRIMARILY CENTER ON COMMUNITY HEALTH NEEDS ASSESSMENTS. THE THIRD ROUND OF CHNA WAS COMPLETED AND THE REPORT WAS ISSUED IN JUNE 2018. AN IMPLEMENTATION PLAN WAS DEVELOPED BASED ON THAT NEEDS ASSESSMENT. INFORMALLY, GPSC HAS USED PUBLIC FORUMS, PARTICULARLY ASSOCIATED WITH OUR CONSTRUCTION PROJECT FOR A REPLACEMENT FACILITY TO SEEK INPUT FROM ALL OF THE COMMUNITIES IN SMITH COUNTY. THE FEEDBACK RECEIVED FROM BOTH THE CHNA AND THE PUBLIC FORUMS HAS BEEN INCORPORATED INTO OUR PLANS FOR THE NEW FACILITY, WHICH WAS COMPLETED IN 2018. IN ADDITION, THE BOARD OF TRUSTEES OF SMITH COUNTY MEMORIAL HOSPITAL (OPERATED BY GPSC) SERVES AS A CONDUIT FOR INPUT FROM THE COMMUNITY ON A WIDE RANGE OF ISSUES. IN ADDITION TO INDIVIDUAL INTERACTIONS WITH CITIZENS THAT EACH OF THE TRUSTEES UNDERTAKES, THERE IS ALSO FREQUENT AND TRANSPARENT INTERACTION WITH THE SMITH COUNTY COMMISSIONERS, WHO APPOINT THE TRUSTEES. FAVORED PROCEEDING WITH THE CONSTRUCTION PROJECT. THE BOARD OF TRUSTEES AND PBC BOARD, HEEDING THIS STRONG VOTE OF SUPPORT, HAVE MOVED FORWARD WITH THE FINANCING AND DEVELOPMENT OF PLANS FOR THE NEW FACILITY. |
| SCHEDULE H, PART VI, LINE 3 | OUR FINANCIAL ASSISTANCE POLICY IS ROUTINELY UTILIZED IN COMMUNICATING WITH PATIENTS REGARDING THEIR FINANCIAL OBLIGATIONS TO US. EVERY BILLING STATEMENT SENT TO PATIENTS INCLUDES INFORMATION REGARDING THE FAP AND WHO TO CONTACT WITH QUESTIONS. EVERY TELEPHONE CONTACT WITH OUR PATIENT ACCOUNTS STAFF INCLUDES QUESTIONING OF PATIENTS REGARDING THE NEED FOR ASSISTANCE WITH APPLICATION FOR FINANCIAL ASSISTANCE. OUR FINANCIAL ASSISTANCE POLICY IS POSTED ON OUR PUBLIC WEBSITE, ALSO INCLUDING CONTACT INFORMATION. |
| SCHEDULE H, PART VI, LINE 4 | THE 2010 CENSUS SHOWED A POPULATION OF 3,853 INDIVIDUALS IN SMITH COUNTY, KANSAS. KANSAS VITAL STATISTICS ESTIMATES A POPULATION OF 3668 IN 2017. THE DEMOGRAPHIC BREAKDOWN OF THAT POPULATION SHOWS 27% OF THE TOTAL AGED 65 OR ABOVE. THIS COMPARES TO A STATEWIDE POPULATION OF 14% ABOVE THE AGE OF 65. THE POPULATION DENSITY OF SMITH COUNTY IS LESS THAN 6 PERSONS PER SQUARE MILE, CLASSIFYING THE COUNTY A FRONTIER. APPROXIMATELY 96% OF THE POPULATION ARE CLASSIFIED AS CAUCASIAN, APPROXIMATELY 2% HISPANIC, AND LESS THAN 1% BLACK. THE POPULATION IS 51% FEMALE, 49% MALE. THE AVERAGE HOUSEHOLD INCOME FOR THE COUNTY IS $53,074. |
| SCHEDULE H, PART VI, LINE 5 | SMITH COUNTY MEMORIAL HOSPITAL HAS A FIVE MEMBER BOARD OF TRUSTEES APPOINTED BY THE COUNTY BOARD OF COMMISSIONERS. THIS BOARD MAINTAINS RESPONSIBILITY FOR THE MAINTENANCE AND UPKEEP OF THE FACILITIES UTILIZED BY SMITH COUNTY MEMORIAL HOSPITAL AND SMITH COUNTY FAMILY PRACTICE. SMITH COUNTY MEMORIAL HOSPITAL, OPERATED BY GREAT PLAINS OF SMITH COUNTY, OPERATES A MEALS ON WHEELS PROGRAM IN SMITH CENTER. THIS PROGRAM PROVIDES ONE MEAL PER DAY CONSISTING OF A BALANCED DIET, PROVIDED AT REDUCED RATES TO MEMBERS OF THE COMMUNITY UNABLE TO COOK FOR THEMSELVES. CLIENTS OF THIS PROGRAM INCLUDE INDIVIDUALS LIVING IN THEIR OWN HOMES, AS WELL AS IN SEVERAL INCOME-SUBSIDIZED HOUSING FACILITIES OPERATED PRIVATELY OR BY THE PUBLIC HOUSING AUTHORITY IN SMITH CENTER. THE MEALS ARE PREPARED AND PACKAGED IN THE SCMH KITCHEN. THEY ARE DELIVERED BY COMMUNITY VOLUNTEERS. THE PRICE FOR THE MEALS IS DEEPLY DISCOUNTED, RESULTING IN PROVISION OF MEALS AT FAR LESS THAN THE COST OF THEIR PRODUCTION. SMITH COUNTY FAMILY PRACTICE, OPERATED AS A DEPARTMENT OF SMITH COUNTY MEMORIAL HOSPITAL, OFFERS SPORTS PHYSICALS ANNUALLY TO STUDENTS AT TWO SCHOOL DISTRICTS IN THE COUNTY. THE PHYSICALS ARE PROVIDES AT A DEEPLY DISCOUNTED FEE, WITH THE PROCEEDS FROM THEM DONATED BACK TO THE SCHOOLS. THE HOSPITAL ALSO PROVIDES AN EDUCATIONAL PROGRAM FOR KINDERGARTEN STUDENTS IN ONE LOCAL SCHOOL DISTRICT EACH YEAR TO FAMILIARIZE THEM WITH DIFFERENT SERVICE AREAS OF THE HOSPITAL TO HELP ALLEVIATE ANXIETY IN THE EVENT THEY NEED TO USE OUR SERVICES. SMITH COUNTY MEMORIAL HOSPITAL WORKS CLOSELY WITH SMITH COUNTY EMS TO FACILITATE THE DELIVERY OF EMERGENCY MEDICAL SERVICES THROUGHOUT THE COUNTY. THIS INCLUDES PROVISION ON MEDICAL DIRECTION TO THE EMS AGENCY BY ONE OF OUR EMPLOYED PHYSICIANS. IN ADDITION, SMITH COUNTY MEMORIAL HOSPITAL MAINTAINS A TRAILER-BASED BIOHAZARD RESPONSE UNIT, WHICH CAN BE UTILIZED ANYWHERE IN THE COUNTY IT IS NEEDED. THE HOSPITAL ALSO PARTICIPATES ANNUALLY IN EMERGENCY PREPAREDNESS TRAINING IN CONJUNCTION WITH LAW ENFORCEMENT, FIRE, AND EMS PERSONNEL. AS A CRITICAL ACCESS HOSPITAL, SMITH COUNTY MEMORIAL HOSPITAL PROVIDES 24-HOUR EMERGENCY MEDICAL CARE, IN ADDITION TO INPATIENT AND OUTPATIENT SERVICES. SMITH COUNTY MEMORIAL HOSPITAL IS THE ONLY HOSPITAL LOCATED IN SMITH COUNTY. WE HAVE AN OPEN MEDICAL STAFF, ACCEPTING MEMBERSHIP FROM A WIDE VARIETY OF LOCAL AND VISITING PROVIDERS. SCMH PROVIDES SPACE FOR THE REGIONAL COMMUNITY MENTAL HEALTH CENTER TO PROVIDE COUNSELING SERVICES TO RESIDENTS OF THE AREA ON A WEEKLY BASIS. TELEHEALTH SERVICES ARE USED FOR THE DELIVERY OF SPECIALTY MEDICAL SERVICES NOT AVAILABLE IN THE COMMUNITY, AND ARE PROVIDED FOR PUBLIC SERVICE EVENTS, SUCH AS MENTAL HEALTH HEARINGS, COURT ORDERED COUNSELING SESSIONS, ETC. SMITH COUNTY MEMORIAL HOSPITAL ALSO WORKS CLOSELY WITH HOSPICE SERVICES, INC., THE REGIONAL PROVIDER OF HOSPICE SERVICES. |
| SCHEDULE H, PART VI, LINE 6 | SMITH COUNTY MEMORIAL HOSPITAL IS OPERATED BY GREAT PLAINS OF SMITH CO., INC., A SUBSIDIARY OF GREAT PLAINS HEALTH ALLIANCE. GPHA IS A 501(C)(3) NOT FOR PROFIT ORGANIZATION WHICH PROVIDES MANAGEMENT, FINANCE, BILLING, INFORMATION SYSTEMS, AND PHARMACY SUPPORT SERVICES TO ITS AFFILIATED ORGANIZATIONS. GPHA DOES NOT PROVIDE SERVICES DIRECTLY TO PATIENTS, BUT PROVIDES ACCESS TO PROFESSIONALS AND SYSTEMS WHICH MIGHT NOT OTHERWISE BE AVAILABLE OR AFFORDABLE TO SMALL RURAL HOSPITALS. GPHA PROVIDES EDUCATION AND ASSISTANCE IN AREAS SUCH AS HIPAA PRIVACY AND SECURITY, MEDICARE AND MEDICAID REIMBURSEMENT RULES AND REGULATIONS, MEANINGFUL USE REQUIREMENTS FOR ELECTRONIC HEALTH RECORDS, ETC. GREAT PLAINS HEALTH ALLIANCE BRINGS TOGETHER ITS NETWORKED CRITICAL ACCESS HOSPITALS IN KANSAS AND NEBRASKA TO LEARN FROM EACH OTHER AND DEVELOP BEST PRACTICES IN CARE PROVISION, MANAGEMENT, AND GOVERNANCE. AFFILIATED HOSPITALS RECEIVE POLICY GUIDANCE REGARDING FINANCIAL ASSISTANCE TO PATIENTS, CORPORATE COMPLIANCE, CONFLICTS OF INTEREST, AND MANY OTHER AREAS. GUIDANCE IS ALSO PROVIDED TO THE GOVERNING BOARDS OF AFFILIATED HOSPITALS TO ASSIST THEM IN FULFILLING THEIR FIDUCIARY RESPONSIBILITIES. |
| 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 | $211,212 | $0 | $0 | $0 | $0 | $0 | $20,484 | $0 | $10,191 | $0 | $241,887 | $0 | $0 |
| DURREL KELLEY | ||||||||||||||
| COO | $0 | $166,790 | $0 | $0 | $0 | $0 | $0 | $16,059 | $0 | $18,507 | $0 | $201,356 | $0 | $0 |
| ALLEN VANDRIEL | ||||||||||||||
| ADMINISTRATOR | $148,720 | $0 | $0 | $0 | $0 | $0 | $14,360 | $0 | $19,503 | $0 | $182,583 | $0 | $0 | $0 |
| JUSTIN OVERMILLER | ||||||||||||||
| PHYSICIAN | $288,865 | $0 | $0 | $0 | $0 | $0 | $26,200 | $0 | $24,540 | $0 | $339,605 | $0 | $0 | $0 |
| FERRILL CONANT | ||||||||||||||
| PHYSICIAN | $290,848 | $0 | $0 | $0 | $0 | $0 | $26,200 | $0 | $16,623 | $0 | $333,671 | $0 | $0 | $0 |
| TAMARA WINDSCHEFFEL | ||||||||||||||
| ARNP | $167,425 | $0 | $0 | $0 | $0 | $0 | $16,161 | $0 | $18,806 | $0 | $202,392 | $0 | $0 | $0 |
| STACEY DIMITT | ||||||||||||||
| PHYSICIAN | $267,161 | $0 | $0 | $0 | $0 | $0 | $25,961 | $0 | $24,990 | $0 | $318,112 | $0 | $0 | $0 |
| HANNAH HAACK | ||||||||||||||
| PHYSICIAN | $274,444 | $0 | $0 | $0 | $0 | $0 | $26,200 | $0 | $27,640 | $0 | $328,284 | $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 DAVE DELLASEGA AND DURRELL KELLEY IS PROVIDED BY GREAT PLAINS HEALTH ALLIANCE, A RELATED ORGANIZATION. GREAT PLAINS HEALTH ALLIANCE'S BOARD OF DIRECTORS ANNUALLY APPROVE THE COMPENSATION FOR MR. DELLASEGA AND MR. KELLEY. 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 K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SMITH COUNTY KANSAS PUBLIC BUILDING COMMISSION | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 271520447 | BondIssuerEIN |
| CUSIP | 000000000 | CUSIPNum |
| Bond Issued | 2016-06-29 | BondIssuedDt |
| Issue Price | $27,250,403 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $0 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $27,251,280 | TotalProceedsAmt |
| In Reserve Fund | $0 | InReserveFundAmt |
| Capitalized Interest | $569,130 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $466,875 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $26,214,624 | CapitalExpendituresAmt |
| Other Spent Proceeds | $0 | OtherSpentProceedsAmt |
| Unspent | $652 | UnspentAmt |
| Substantial Completion | 2018 | SubstantialCompletionYr |
| Current Refunding | false | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | false | FinalAllocationMadeInd |
| Adequate Books And Rec Maint | Yes (true) | AdequateBooksAndRecMaintInd |
Tax Exempt Bonds Private Bus Use TaxExemptBondsPrivateBusUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Owning Bond Financed Property | false | OwningBondFinancedPropertyInd |
| Any Lease Arrangements | false | AnyLeaseArrangementsInd |
| Mgmt Contract Bond Fincd Prop | Yes (true) | MgmtContractBondFincdPropInd |
| Engage Bond Counsel Contracts | Yes (true) | EngageBondCounselContractsInd |
| Any Research Agreements | false | AnyResearchAgreementsInd |
| Private Bus Use By Others | 0.00000 | PrivateBusUseByOthersPct |
| Private Bus Concerning UBI | 0.00000 | PrivateBusConcerningUBIPct |
| Total Private Business Use | 0.00000 | TotalPrivateBusinessUsePct |
| Bond Iss Meet Prvt Sec Pymt Test | false | BondIssMeetPrvtSecPymtTestInd |
| Change In Use Bond Financed Prop | false | ChangeInUseBondFinancedPropInd |
| Remedial Action Taken | false | RemedialActionTakenInd |
| Procs Nonqualified Bond Remdtd | Yes (true) | ProcsNonqualifiedBondRemdtdInd |
Tax Exempt Bonds Arbitrage TaxExemptBondsArbitrageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Form8038 T Filed | false | Form8038TFiledInd |
| Rebate Not Due Yet | Yes (true) | RebateNotDueYetInd |
| Variable Rate Issue | false | VariableRateIssueInd |
| Hedge Identified In Bks And Rec | false | HedgeIdentifiedInBksAndRecInd |
Hedge Provider Name HedgeProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested In GIC | false | GrossProceedsInvestedInGICInd |
GIC Provider Name GICProviderName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 0 | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Proceeds Invested | false | GrossProceedsInvestedInd |
| Written Proc To Monitor Reqs | Yes (true) | WrittenProcToMonitorReqsInd |
Procedures Corrective Action ProceduresCorrectiveActionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Procedures Corrective Action | Yes (true) | ProceduresCorrectiveActionInd |
Supplemental Information Detail SupplementalInformationDetail (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE K, PART I, LINE A, COLUMN (E) | THE BONDS WERE ISSUED AS A DRAW-DOWN LOAN PURSUANT TO REGULATIONS 1.150-1(C)(4)(I). THE ISSUE PRICE REPORTED REPRESENTS THE AMOUNT OF BOND PROCEEDS DRAWN AS OF 12/31/2018. |
| SCHEDULE K, PART I, LINE A, COLUMN (F) | ACQUIRE, CONSTRUCT, EQUIP, AND FURNISH REPLACEMENT HOSPITAL. |
| SCHEDULE K, PART II, COLUMN A, LINE 3 | THE BONDS WERE ISSUED AS A DRAW-DOWN LOAN PURSUANT TO REGULATIONS 1.150-1(C)(4)(I). THIS AMOUNT DOES NOT EQUAL PART I, LINE A, COLUMN (E) DUE TO INVESTMENT EARNINGS THROUGH 12/31/2018. |
| SCHEDULE K, PART II, COLUMN A, LINE 10 | THIS AMOUNT REPRESENTS THE TOTAL BOND PROCEEDS USED FOR CAPITAL EXPENDITURES AS OF 12/31/2018. |
| SCHEDULE K, PART II, COLUMN A, LINE 12 | THIS AMOUNT REPRESENTS THE BOND PROCEEDS REMAINING IN THE PROJECT FUND AS OF 12/31/2018. |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (17 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 4A | SMITH COUNTY MEMORIAL HOSPITAL PROVIDES INPATIENT AND OUTPATIENT MEDICAL CARE IN A CRITICAL ACCESS HOSPITAL. THE SERVICES PROVIDED TO RESIDENTS OF THE SERVICE AREA INCLUDE THE FOLLOWING: a. INPATIENT HOSPITAL CARE ENCOMPASSING ACUTE CARE FOR MEDICAL AND SOME SURGICAL PATIENTS. b. SKILLED AND PRIVATE PAY NURSING AND REHABILITATIVE CARE TO INPATIENTS DELIVERED THROUGH OUR SWING BED PROGRAM. c. OBSTETRICAL CARE, INCLUDING PRENATAL EDUCATION OF EXPECTANT MOTHERS, MONITORING OF THE PRENATAL COURSE, DELIVERY AND POSTPARTUM CARE OF MOTHERS AND BABIES, WHETHER DELIVERED VAGINALLY OR BY CAESAREAN SECTION, AND POSTPARTUM ASSISTANCE AND EDUCATION TO MOTHERS. d. EMERGENCY CARE AVAILABLE 24 HOURS PER DAY BY A STAFF OF REGISTERED NURSES, ADVANCED PRACTICE REGISTERED NURSES, AND PHYSICIANS. ALL EMERGENCY DEPARTMENT STAFF ARE CERTIFIED IN VARIOUS TYPES OF ADVANCED LIFE SUPPORT TECHNIQUES, INCLUDING ADVANCED CARDIOVASCULAR LIFE SUPPORT, PEDIATRIC ADVANCED LIFE SUPPORT, AND ADVANCED TRAUMA CARE COURSES. THE FACILITY IS DESIGNATED AS A LEVEL IV TRAUMA CENTER AND IS A PARTICIPANT IN THE KANSAS CLINICAL IMPROVEMENT COLLABORATIVE. e. INPATIENT AND OUTPATIENT SURGICAL SERVICES. SURGICAL PROCEDURES WITH THE EXCEPTION OF CAESAREAN SECTIONS, ARE PRIMARILY SCHEDULED SERVICES. SURGICAL AND ANESTHESIA STAFF ARE AVAILABLE 24 HOURS PER DAY, HOWEVER, IN THE EVENT THAT AN EMERGENT CAESAREAN SECTION OR OTHER SURGICAL PROCEDURE IS REQUIRED. f. ANCILLARY DIAGNOSTIC AND THERAPEUTIC SERVICES INCLUDING A FULL SERVICE LABORATORY, DIAGNOSTIC IMAGING, PHYSICAL, OCCUPATIONAL, AND SPEECH THERAPIES, CARDIAC AND PULMONARY REHABILITATION, AND SLEEP DIAGNOSTICS. LABORATORY AND IMAGING SERVICES ARE AVAILABLE 24 HOURS PER DAY FOR EMERGENT CASES. g. DIETARY SERVICES TO INPATIENTS AND OUTPATIENTS. THIS DEPARTMENT IS ALSO THE PROVIDER OF ALL MEALS FOR THE MEALS ON WHEELS PROGRAM IN THE COMMUNITY. SMITH COUNTY FAMILY PRACTICE PROVIDES PRIMARY CARE SERVICES USING THE SERVICES OF BOARD CERTIFIED FAMILY PRACTICE PHYSICIANS AND ADVANCED PRACTICE REGISTERED NURSES. SERVICES ARE PROVIDED TO PRENATAL, POSTPARTUM, PEDIATRIC, ADULT, AND GERIATRIC PATIENTS. FOUR BOARD CERTIFIED FAMILY MEDICINE PHYSICIANS AND THREE ADVANCED PRACTICE REGISTERED NURSES (NURSE PRACTITIONERS) PROVIDE THESE SERVICES. IN ADDITION TO SERVICES IN THE RURAL HEALTH CLINIC, THE PROVIDERS ALSO SERVE PATIENTS IN THE CRITICAL ACCESS HOSPITAL (INCLUDING THE EMERGENCY DEPARTMENT), THE OUTPATIENT TREATMENT AREAS, AND IN SKILLED NURSING AND ICF LONG TERM CARE FACILITIES IN SMITH COUNTY AND SURROUNDING AREAS. |
| 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 MEMEBER OF GREAT PLAINS OF SMITH CO., 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:1168774 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:BILLING/COLLECTIONS TOTAL FEES:551671 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB SERVICES TOTAL FEES:232538 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHARMACY SERVICES TOTAL FEES:149222 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ADMINISTRATION/HUMAN RESOURCES TOTAL FEES:107878 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:MAINTENANCE/HOUSEKEEPING TOTAL FEES:76508 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:DIETARY SERVICES TOTAL FEES:16400 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PLANT OPERATIONS TOTAL FEES:18135 |
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 ALLIANCE INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 480617739 | MANAGEMENT | KS | 501(C)(3) | 3 | NA | false |
| 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 ELLINWOOD INC | ||||||||||
| 250 NORTH ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226976 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF KIOWA COUNTY INC | ||||||||||
| 250 N 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 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226856 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF SABETHA COUNTY INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481236156 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF REPUBLIC COUNTY INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226977 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| GREAT PLAINS OF CHEYENNE COUNTY INC | ||||||||||
| 250 N ROCK ROAD STE 160 | WICHITA | KS | 67206 | 481226831 | HOSPITAL | KS | 501(C)(3) | 3 | GPHA INC | Yes (true) |
| SCMH QALICB INC | ||||||||||
| 921 EAST HIGHWAY 36 | SMITH CENTER | KS | 66967 | 823936808 | FINANCING | KS | 501(C)(3) | 3 | 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 | Yes (true) | 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 | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |