HIAWATHA HOSPITAL ASSOCIATION INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- HIAWATHA HOSPITAL ASSOCIATION INC (EIN 48-0577658)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-11-14
- IRS object ID
- 201833189349309653
- 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 L
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-11-14T15:13:22-06:00 | ReturnTs |
| Tax Period End | 2017-12-31 | 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 | 1201 Walnut Suite 1700 | AddressLine1Txt |
| City | Kansas City | CityNm |
| State Abbreviation | MO | StateAbbreviationCd |
| ZIP | 641062246 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 480577658 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Hiawatha Hospital Association Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of | % SHARESE MOSER | InCareOfNm |
| Business Name Control | HIAW | BusinessNameControlTxt |
| Phone | 7857422131 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 Utah Street | AddressLine1Txt |
| City | Hiawatha | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JEFFREY SHELTON | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 7857426210 | PhoneNum |
| Signature | 2018-11-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Kevin R Ensminger CPA | PreparerPersonNm |
| PTIN | P01310558 | PTIN |
| Phone | 8162216300 | 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 | 43372220183185000011 | FederalOriginalSubmissionId |
| Federal Original Submission Id | 2018-11-14 | FederalOriginalSubmissionIdDt |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | F6BF5B16C48C6AE82FDB67C146FA93A60BCDDE86 | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | 876A1D03DE60EC9B40C6AE3A7A8021F568D68EEB | 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 | Hiawatha Community Hospital | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | JEFF SHELTON | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $26,629,894 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.HCH-KS.ORG | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | AS A RURAL COMMUNITY HOSPITAL, HIAWATHA HOSPITAL'S PRIMARY GOAL IS TO PROVIDE MODERN, RELIABLE, AFFORDABLE HEALTH SERVICES THAT BEST MEET THE NEEDS OF OUR COMMUNITY RESIDENTS | ActivityOrMissionDesc |
| Voting Members Governing Body | 10 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 9 | VotingMembersIndependentCnt |
| Total Employee | 301 | TotalEmployeeCnt |
| Total Volunteers | 9 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $150,992 | PYContributionsGrantsAmt |
| CY Contributions Grants | $48,615 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $24,599,800 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $26,424,535 | CYProgramServiceRevenueAmt |
| PY Investment Income | -$28,168 | PYInvestmentIncomeAmt |
| CY Investment Income | -$32,888 | CYInvestmentIncomeAmt |
| PY Other Revenue | $122,566 | PYOtherRevenueAmt |
| CY Other Revenue | $120,281 | CYOtherRevenueAmt |
| PY Total Revenue | $24,845,190 | PYTotalRevenueAmt |
| CY Total Revenue | $26,560,543 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $12,350 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $7,834 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $14,975,832 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $15,294,127 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $1,756 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $11,359,795 | PYOtherExpensesAmt |
| CY Other Expenses | $12,074,735 | CYOtherExpensesAmt |
| PY Total Expenses | $26,347,977 | PYTotalExpensesAmt |
| CY Total Expenses | $27,376,696 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,502,787 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | -$816,153 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $19,183,400 | TotalAssetsBOYAmt |
| Total Assets EOY | $18,759,941 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $9,529,587 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,917,785 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $9,653,813 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $8,842,156 | NetAssetsOrFundBalancesEOYAmt |
| Mission | TO DELIVER EXCEPTIONAL PATIENT CARE WITH AN EMPHASIS ON PATIENT SAFETY, CONSUMER SATISFACTION, AND QUALITY OUTCOMES. | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $23,051,894 | ExpenseAmt |
| Grant | $7,834 | GrantAmt |
| Revenue | $26,442,003 | RevenueAmt |
| Desc | HIAWATHA COMMUNITY HOSPITAL'S PRIMARY GOAL IS TO PROVIDE QUALITY, MODERN, AFFORDABLE HEALTHCARE TO OUR COMMUNITY. IN 2017, WE PROVIDED SERVICE FOR 3,908 INPATIENT DAYS, 107 INPATIENT SURGERIES AND 1,184 OUTPATIENT SURGERIES. WE DELIVERED 81 BABIES AND PROVIDED OUTPATIENT SERVICES TO 28,733 PATIENTS. BY PROVIDING SERVICES LIKE OBSTETRICS AND 24 HOUR EMERGENCY SERVICES THAT NOT ALL SMALL RURAL HOSPITALS PROVIDE, EVEN THOUGH THE PROGRAMS ARE NOT ALWAYS PROFITABLE FOR THE HOSPITAL, WE STRONGLY FEEL THAT THESE SERVICES PROVIDE NECESSARY CARE TO ADDRESS OUR COMMUNITY'S OVERALL HEALTH WHILE PROMOTING OUR MISSION AS A CHARITABLE ORGANIZATION. | Desc |
| Total Program Service Expenses | $23,051,894 | 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 | false | 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 | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | Yes (true) | TaxExemptBondsInd |
| Invest Tax Exempt Bonds | false | InvestTaxExemptBondsInd |
| Escrow Account | false | EscrowAccountInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (true) | BusinessRlnWithFamMemInd |
| Business Rln 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 | 31 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 301 | 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 | 10 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 9 | IndependentVotingMemberCnt |
| Family Or Business Rln | false | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (true) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| States Where Copy Of Return Is Fld | KS | StatesWhereCopyOfReturnIsFldCd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SHARESE MOSER | PersonNm |
| Phone | 7857426431 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (20 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 | Key EmployeeKeyEmployeeInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|---|
| DR BRYON BIGHAM | |||||||||
| PHYSICIAN/CHIEF OF STAFF | 40.0 | 0.0 | Yes (X) | Yes (X) | $345,750 | $0 | $42,411 | ||
| CHERYL RASMUSSEN | |||||||||
| TRUSTEE | 0.25 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| ERIK MADESEN | |||||||||
| SEC/TREASURER/TRUSTEE | 0.3 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| GALEN MEYER | |||||||||
| TRUSTEE | 0.25 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| NICK HRENCHER | |||||||||
| PRESIDENT/TRUSTEE | 0.5 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| ANDY DELANEY | |||||||||
| VICE PRESIDENT/TRUSTEE | 0.3 | 0.0 | Yes (X) | Yes (X) | $0 | $0 | $0 | ||
| CHAD BACHMAN | |||||||||
| TRUSTEE | 0.25 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| BRIAN LILLIE | |||||||||
| TRUSTEE | 0.25 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| MANDY GRAHAM | |||||||||
| TRUSTEE | 0.25 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| GREG RODVELT | |||||||||
| TRUSTEE | 0.25 | 0.0 | Yes (X) | $0 | $0 | $0 | |||
| JOHN BROBERG | |||||||||
| INTERIM CEO TO 7/28/2017 | 40.0 | 0.0 | Yes (X) | $141,532 | $0 | $0 | |||
| JEFFREY SHELTON | |||||||||
| CEO FROM 7/31/2017 | 40.0 | 0.0 | Yes (X) | $73,666 | $0 | $13,221 | |||
| DR PETE ROSA | |||||||||
| PHYSICIAN | 40.0 | 0.0 | $355,941 | $0 | $41,272 | Yes (X) | |||
| DR CROSBY GERNON | |||||||||
| RADIOLOGIST | 40.0 | 0.0 | $434,344 | $0 | $45,754 | Yes (X) | |||
| DR STEFFEN SHAMBURG | |||||||||
| PHYSICIAN | 40.0 | 0.0 | $483,004 | $0 | $36,445 | Yes (X) | |||
| JEAN ABEITA | |||||||||
| PHARMACIST | 40.0 | 0.0 | $139,434 | $0 | $35,570 | Yes (X) | |||
| DUSTIN WILLIAMS | |||||||||
| APRN | 40.0 | 0.0 | $181,122 | $0 | $37,055 | Yes (X) | |||
| DR JULIE ROSA | |||||||||
| PHYSICIAN | 20.0 | 0.0 | $159,709 | $0 | $4,966 | Yes (X) | |||
| DR JESSICA JARVIS | |||||||||
| PHYSICIAN | 40.0 | 0.0 | $204,657 | $0 | $22,537 | Yes (X) | |||
| JODI TWOMBLY | |||||||||
| PA | 40.0 | 0.0 | $120,644 | $0 | $33,829 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,639,803 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $313,060 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 11 | 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 |
|---|---|---|---|---|---|
| STEVEN H GUNNELLS ANESTHESIA | |||||
| 2561 LINDEN AVENUE | HIAWATHA | KS | 66434 | CRNA | $673,480 |
| STARS INC | |||||
| 509 N 2ND | HIAWATHA | KS | 66434 | THERAPY SERVICES | $647,054 |
| ROCK PORT TELEPHONE COMPANY | |||||
| PO BOX 147 | ROCK PORT | MO | 64482 | IT CONTRACT SERVICES | $333,857 |
| ICE TECHNOLOGIES INC | |||||
| 411 SE 9TH STREET | PELLA | IA | 50219 | EMR SUPPORT HOSTING | $265,130 |
| BKD LLP | |||||
| 1201 WALNUT STREET | KANSAS CITY | MO | 64106 | ACCOUNTING | $110,022 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $48,615 | AllOtherContributionsAmt |
| Total Contributions | $48,615 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENUE | 621110 | $24,526,174 | $24,526,174 |
| OTHER PATIENT REVENUE | 621110 | $122,256 | $122,256 |
| 340B PHARMACY | 446110 | $1,776,105 | $1,776,105 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $26,424,535 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,473 | TotalRevenueColumnAmt |
| Exclusion | $7,473 | 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 |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $45,518 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $28,653 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $16,865 | RealAmt |
| Personal | $0 | PersonalAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $16,865 | TotalRevenueColumnAmt |
| Exclusion | $16,865 | ExclusionAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $607 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $40,698 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | -$40,091 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | -$40,361 | TotalRevenueColumnAmt |
| Exclusion | -$40,361 | 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 (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt |
|---|---|---|---|
| CAFETERIA INCOME | 722514 | $102,487 | $102,487 |
| MISC INCOME | 621110 | $929 | $929 |
Miscellaneous Revenue MiscellaneousRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $929 | TotalRevenueColumnAmt |
| Exclusion | $929 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $103,416 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $26,560,543 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $26,424,535 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $87,393 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,138 | TotalAmt |
| Program Services | $4,138 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $3,696 | TotalAmt |
| Program Services | $3,696 | ProgramServicesAmt |
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 | $2,013,340 | TotalAmt |
| Program Services | $1,801,908 | ProgramServicesAmt |
| Management And General | $211,432 | ManagementAndGeneralAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $164,675 | TotalAmt |
| Program Services | $164,675 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $9,727,191 | TotalAmt |
| Program Services | $8,546,104 | ProgramServicesAmt |
| Management And General | $1,181,087 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $386,556 | TotalAmt |
| Program Services | $337,434 | ProgramServicesAmt |
| Management And General | $49,122 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,242,812 | TotalAmt |
| Program Services | $1,805,586 | ProgramServicesAmt |
| Management And General | $437,226 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $759,553 | TotalAmt |
| Program Services | $675,645 | ProgramServicesAmt |
| Management And General | $83,908 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $23,899 | TotalAmt |
| Program Services | $2,815 | ProgramServicesAmt |
| Management And General | $21,084 | ManagementAndGeneralAmt |
Fees For Services Accounting FeesForServicesAccountingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $106,351 | TotalAmt |
| Management And General | $106,351 | ManagementAndGeneralAmt |
Fees For Services Lobbying FeesForServicesLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,760 | TotalAmt |
| Management And General | $4,760 | 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 | $2,899,935 | TotalAmt |
| Program Services | $2,220,720 | ProgramServicesAmt |
| Management And General | $677,459 | ManagementAndGeneralAmt |
| Fundraising | $1,756 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $71,648 | TotalAmt |
| Program Services | $52,066 | ProgramServicesAmt |
| Management And General | $19,582 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $533,827 | TotalAmt |
| Program Services | $322,727 | ProgramServicesAmt |
| Management And General | $211,100 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $108,099 | TotalAmt |
| Program Services | $8,072 | ProgramServicesAmt |
| Management And General | $100,027 | ManagementAndGeneralAmt |
Royalties RoyaltiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $549,408 | TotalAmt |
| Program Services | $429,385 | ProgramServicesAmt |
| Management And General | $120,023 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $47,705 | TotalAmt |
| Program Services | $35,855 | ProgramServicesAmt |
| Management And General | $11,850 | 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 | $289 | TotalAmt |
| Management And General | $289 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $209,312 | TotalAmt |
| Program Services | $31,993 | ProgramServicesAmt |
| Management And General | $177,319 | ManagementAndGeneralAmt |
Payments To Affiliates PaymentsToAffiliatesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,775,238 | TotalAmt |
| Program Services | $1,167,854 | ProgramServicesAmt |
| Management And General | $607,384 | ManagementAndGeneralAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $179,570 | TotalAmt |
| Program Services | $106,605 | ProgramServicesAmt |
| Management And General | $72,965 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| BAD DEBT EXPENSE | $1,421,076 | $1,421,076 | |
| REPAIRS & MAINTENANCE | $732,437 | $693,045 | $39,392 |
| DUES & SUBSCRIPTIONS | $313,008 | $233,151 | $79,857 |
| MEDICAL SUPPLIES | $2,961,662 | $2,932,858 | $28,804 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $136,511 | TotalAmt |
| Program Services | $54,486 | ProgramServicesAmt |
| Management And General | $82,025 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $27,376,696 | TotalAmt |
| Program Services | $23,051,894 | ProgramServicesAmt |
| Management And General | $4,323,046 | ManagementAndGeneralAmt |
| Fundraising | $1,756 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,163 | BOYAmt |
| EOY | $1,163 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,565,942 | BOYAmt |
| EOY | $2,229,434 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $51,802 | BOYAmt |
| EOY | $56,775 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,406,164 | BOYAmt |
| EOY | $4,888,407 | 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 | $445,955 | BOYAmt |
| EOY | $434,940 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $270,492 | BOYAmt |
| EOY | $263,102 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $32,970,963 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $22,084,843 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $12,441,882 | BOYAmt |
| EOY | $10,886,120 | 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 | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,183,400 | BOYAmt |
| EOY | $18,759,941 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,805,240 | BOYAmt |
| EOY | $2,313,639 | 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 | $5,605,000 | BOYAmt |
| EOY | $5,051,952 | 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 | $675,347 | BOYAmt |
| EOY | $574,194 | 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 | $444,000 | BOYAmt |
| EOY | $1,978,000 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,529,587 | BOYAmt |
| EOY | $9,917,785 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,594,281 | BOYAmt |
| EOY | $8,778,128 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $59,532 | BOYAmt |
| EOY | $64,028 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,653,813 | BOYAmt |
| EOY | $8,842,156 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $19,183,400 | BOYAmt |
| EOY | $18,759,941 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | -$816,153 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | $4,496 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (true) | AuditCommitteeInd |
| Federal Grant Audit Required | false | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule C IRS990ScheduleC
Total Grassroots Lobbying TotalGrassrootsLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $4,760 | FilingOrganizationsTotalAmt |
Total Direct Lobbying TotalDirectLobbyingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $0 | FilingOrganizationsTotalAmt |
Total Lobbying Expend TotalLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $4,760 | FilingOrganizationsTotalAmt |
Other Exempt Purpose Expend OtherExemptPurposeExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $27,391,936 | FilingOrganizationsTotalAmt |
Total Exempt Purpose Expend TotalExemptPurposeExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $27,396,696 | FilingOrganizationsTotalAmt |
Lobbying Nontaxable Amount LobbyingNontaxableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $1,000,000 | FilingOrganizationsTotalAmt |
Grassroots Nontaxable GrassrootsNontaxableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Filing Organizations Total | $250,000 | FilingOrganizationsTotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Lbbyng Grassroot Mns Non Tx | TotLbbyngGrassrootMnsNonTxGrp | |
| Tot Lbby Expend Mns Lbbyng Non Tx | TotLbbyExpendMnsLbbyngNonTxGrp |
Avg Lobbying Nontaxable Amount AvgLobbyingNontaxableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $1,000,000 | CurrentYearMinus3Amt |
| Current Year Minus2 | $1,000,000 | CurrentYearMinus2Amt |
| Current Year Minus1 | $1,000,000 | CurrentYearMinus1Amt |
| Current Year | $1,000,000 | CurrentYearAmt |
| Total | $4,000,000 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Lobbying Ceiling | $6,000,000 | LobbyingCeilingAmt |
Avg Total Lobbying Expend AvgTotalLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $6,184 | CurrentYearMinus3Amt |
| Current Year Minus2 | $6,763 | CurrentYearMinus2Amt |
| Current Year Minus1 | $7,865 | CurrentYearMinus1Amt |
| Current Year | $4,760 | CurrentYearAmt |
| Total | $25,572 | TotalAmt |
Avg Grassroots Nontaxable AvgGrassrootsNontaxableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $250,000 | CurrentYearMinus3Amt |
| Current Year Minus2 | $250,000 | CurrentYearMinus2Amt |
| Current Year Minus1 | $250,000 | CurrentYearMinus1Amt |
| Current Year | $250,000 | CurrentYearAmt |
| Total | $1,000,000 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grassroots Ceiling | $1,500,000 | GrassrootsCeilingAmt |
Avg Grassroots Lobbying Expend AvgGrassrootsLobbyingExpendGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Year Minus3 | $6,184 | CurrentYearMinus3Amt |
| Current Year Minus2 | $6,763 | CurrentYearMinus2Amt |
| Current Year Minus1 | $7,865 | CurrentYearMinus1Amt |
| Current Year | $4,760 | CurrentYearAmt |
| Total | $25,572 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grants Other Organizations | $4,760 | GrantsOtherOrganizationsAmt |
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 | $784,309 | OtherCostOrOtherBasisAmt |
| Book Value | $784,309 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $18,006,094 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,271,298 | DepreciationAmt |
| Book Value | $7,734,796 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Leasehold Improvements | LeaseholdImprovementsGrp |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $12,842,123 | OtherCostOrOtherBasisAmt |
| Depreciation | $10,868,292 | DepreciationAmt |
| Book Value | $1,973,831 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,338,437 | OtherCostOrOtherBasisAmt |
| Depreciation | $945,253 | DepreciationAmt |
| Book Value | $393,184 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $10,886,120 | TotalBookValueLandBuildingsAmt |
| Federal Income Tax Liability | $0 | FederalIncomeTaxLiabilityAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | Due to 3rd party payers | Desc |
| Amt | $1,977,233 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $1,978,000 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $25,246,590 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $107,123 | OtherRevenueAmt |
| Revenue Not Reported | $107,123 | RevenueNotReportedAmt |
| Revenue Subtotal | $25,139,467 | RevenueSubtotalAmt |
| Other Revenues Not Included | $1,421,076 | OtherRevenuesNotIncludedAmt |
| Revenue Not Reported Fincl Stmt | $1,421,076 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $26,560,543 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $25,984,273 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | $28,653 | OtherExpensesIncludedAmt |
| Expenses Not Reported | $28,653 | ExpensesNotReportedAmt |
| Expenses Subtotal | $25,955,620 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $1,421,076 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $1,421,076 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $27,376,696 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (5 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 | CHANGE IN FOUNDATION NET ASSETS $ 73,974 CHANGE IN ESTATE RECEIVABLE 4,973 CHANGE IN TRUST RECEIVABLE ( 477) RENTAL EXPENSES 28,653 ------------ TOTAL $ 107,123 |
| SCHEDULE D, PART XI, LINE 4B | BAD DEBT EXPENSE $ 1,421,076 |
| SCHEDULE D, PART XII, LINE 2D | RENTAL EXPENSES $ 28,653 |
| SCHEDULE D, PART XII, LINE 4B | BAD DEBT EXPENSE $ 1,421,076 |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent150 | Yes (X) | Percent150Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent250 | Yes (X) | Percent250Ind |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | false | FinancialAssistanceBudgetInd |
| 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 | $684,196 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $684,196 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.02640 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,440,684 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,740,371 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $3,700,313 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.14260 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $589,300 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $296,281 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $293,019 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01130 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,714,180 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,036,652 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,677,528 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18030 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,219 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,219 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00120 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $159,241 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $159,241 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00610 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $526 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $526 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $189,986 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $189,986 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00730 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $6,904,166 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,036,652 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $4,867,514 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.18760 | TotalExpensePct |
Community Support CommunitySupportGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $4,007 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $4,007 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Health Improvement Advocacy HealthImprovementAdvocacyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,598 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $2,598 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00010 | TotalExpensePct |
Other Communtity Building Acty OtherCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $23,614 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $23,614 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00090 | TotalExpensePct |
Total Communtity Building Acty TotalCommuntityBuildingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $30,219 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $30,219 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00110 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | false | BadDebtExpenseReportedInd |
| Bad Debt Expense | $1,421,076 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $71,054 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,790,677 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $11,414,193 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$2,623,516 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | HCH-KS.ORG | WebsiteAddressTxt |
| State License | H007001 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| General Medical And Surgical | Yes (X) | GeneralMedicalAndSurgicalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA COMMUNITY HOSPITAL | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 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 | www.hch-ks.org/docs/CHNA_Impl_Plan_HCH | 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 | 150. | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 250. | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Residency Criteria | Yes (X) | ResidencyCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, SECTION C | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, SECTION C | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, SECTION C | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Translated | Yes (X) | FAPTranslatedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | false | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (true) | NondisEmergencyCarePolicyInd |
| Look Back Medicare | Yes (X) | LookBackMedicareInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART V, SECTION B, LINE 5 | WE CHOSE INDIVIDUALS WHO WOULD HAVE UNIQUE UNDERSTANDING OF THE DIFFERENT POPULATIONS IN OUR COMMUNITY TO BE ON THE COMMITTEE. THE COMMITTEE HELPED FORMULATE THE SURVEY TO TAKE TO OUR COMMUNITY AND GAVE SIGNIFICANT FEEDBACK AND DIRECTION ABOUT WHAT SPECIFIC POPULATION NEEDS WERE. INCLUDED ON THE COMMITTEE: - THE NURSING DIRECTOR FOR BROWN COUNTY HEALTH DEPARTMENT - DR. PETE ROSA WAS NOT ONLY THE DIRECTOR OF THE MEDICAL STAFF WHEN WE DID THE SURVEY, BUT ALSO SERVED ON THE LOCAL SCHOOL BOARD - LOCAL LAW ENFORCEMENT - LOCAL GOVERNMENT - AREA AGENCY ON AGING - LYNN DIERKING, RN, IS THE DIRECTOR OF OUR HOME HEALTH AGENCY |
| SCHEDULE H, PART V, SECTION B, LINE 7A | www.hch-ks.org/docs/Hiawatha_CHNARound2_2016_FINAL.pdf |
| SCHEDULE H, PART V, SECTION B, LINE 11 | WE PROVIDE MEDICALLY-RELATED TRANSPORTATION AT NO COST TO THE PUBLIC, PROVIDE MENTAL HEALTH SCREENINGS AND PROMOTE THE LOCAL PARKS AND REC AND WALKING TRAILS. WE WORK ON OBTAINING COMMUNITY-WIDE GRANTS TO IMPROVE LOCAL HABITS THAT RESULT IN HEALTHY OUTCOMES. |
| SCHEDULE H, PART V, SECTION B, LINES 16A, B & C | www.hch-ks.org/getpage.php?name=FAP |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 3 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| HIAWATHA COMMUNITY HOSPITAL HOME HEALTH | ||||
| 300 UTAH STREET | HIAWATHA | KS | 66434 | HOME HEALTH |
| HIAWATHA COMM HOSP FAM PRACTICE CLINIC | ||||
| 300 OREGON STREET 2ND FLOOR | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
| HIAWATHA COMM HOSPITAL HIGHLAND CLINIC | ||||
| 415 S MAIN STREET | HIAWATHA | KS | 66434 | RURAL HEALTH CLINIC |
Supplemental Information Detail SupplementalInformationDetail (15 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE H, PART I, LINE 3C | IN ADDITION TO FPG, THE ORGANIZATION USES ASSET LEVEL, INSURANCE STATUS, RESIDENCY, MEDICAL INDIGENCY, AND UNDERINSURANCE STATUS AS FACTORS IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE. |
| SCHEDULE H, PART I, LINE 7 | THE HOSPITAL USES THE COST-TO-CHARGE RATIO. THIS METHOD WAS USED TO CALCULATE THE FIGURES IN THE TABLE AND WAS DETERMINED BY COMPARING PATIENT CARE COST TO PATIENT CARE CHARGES. |
| SCHEDULE H, PART I, LINE 7, COLUMN F | THE AMOUNT OF BAD DEBT EXPENSE REMOVED FROM TOTAL EXPENSES FOR CALCULATING THE NET COMMUNITY BENEFIT EXPENSE PERCENTAGE WAS $1,421,076. |
| SCHEDULE H, PART II, LINES 1 - 10 | LITTLE HANDS DAYCARE IS A NOT FOR PROFIT DAYCARE THAT PROVIDES LICENSED, RELIABLE, QUALITY DAYCARE AND EDUCATION TO CHILDREN IN THE COMMUNITY. ONE OF THE ISSUES CITED BY LOCAL EMPLOYERS WHEN RECRUITING WORK WAS A LACK OF OPENINGS WITH LOCAL DAYCARE PROVIDERS. LITTLE HANDS WAS STARTED TO ADDRESS THAT NEED. HIAWATHA HOSPITAL'S CONTRIBUTIONS IN TIME AND SUPPLIES HAS HELPED THEM TO BE ABLE TO PROVIDE QUALITY SERVICES WHILE OPERATING ON MINIMAL MARGINS. HIAWATHA COMMUNITY HOSPITAL LEARNED THROUGH OUR COMMUNITY BENEFIT STUDY THAT TRANSPORTATION IS A BARRIER FOR MANY CITIZENS TO OBTAINING HEALTHCARE. SO WE BEGAN OPERATING A FREE MEDICAL TRANSPORT VAN THAT CAN BE USED WITHOUT COST TO GET PEOPLE TO MEDICAL APPOINTMENTS OR BACK FROM STAYS AT HOSPITALS IN LARGER COMMUNITIES. |
| SCHEDULE H, PART III, SECTION A, LINE 2 | ALL APPLICABLE INSURANCE CONTRACT DISCOUNTS, SELF-PAY CONTRACT DISCOUNTS, AND CHARITY CARE SLIDING SCALE DISCOUNTS ARE APPLIED PRIOR TO BALANCE BEING ELIGIBLE TO BE WRITTEN OFF AS BAD DEBT. ONCE THE ACCOUNT IS ELIGIBLE, THE ACCOUNT IS FORWARDED TO THE BOARD OF TRUSTEES FOR CONSIDERATION. ONLY AFTER BOARD APPROVAL IS GRANTED IS THE ACCOUNT WRITTEN OFF TO BAD DEBT. |
| SCHEDULE H, PART III, SECTION A, LINE 3 | BEFORE MAKING ACCOUNTS ELIGIBLE FOR BAD DEBT, WE RUN ALL ACCOUNTS THROUGH A COMPANY TO CHECK TO SEE IF THEY WOULD LIKELY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. THOSE WHO COME BACK AS PROBABLE ARE CONTACTED AND ASKED AGAIN TO COMPLETE A FAP APPLICATION. MANY INDIVIDUALS ARE NOT WILLING TO COMPLETE THE APPLICATION. AT THAT POINT THEY ARE GRANTED PRESUMPTIVE FINANCIAL ASSISTANCE STATUS AND THEIR BALANCES ARE WRITTEN OFF TO CHARITY CARE INSTEAD OF BAD DEBT. WHILE WE FEEL THAT WE WORK VERY DILIGENTLY TO PROVIDE FINANCIAL ASSISTANCE TO THOSE WHO QUALIFY, WE CANNOT GUARANTEE A PERFECT SYSTEM. SO THE ABOVE FIGURE IS AN ESTIMATION OF THE BALANCES THAT MAY HAVE NOT BEEN CAUGHT BY OUR SYSTEM. |
| SCHEDULE H, PART III, SECTION A, LINE 4 | THE FOOTNOTE IS FOUND ON PAGE 8 OF THE ATTACHED AUDITED FINANCIAL STATEMENTS. |
| SCHEDULE H, PART III, SECTION B, LINE 8 | MEDICARE WITHHELD 2% FROM OUR SETTLEMENT THAT REPRESENTS THE SEQUESTRATION AMOUNT. THIS YEAR THAT AMOUNT IS $178,302. THAT 2% REDUCES OUR REIMBURSEMENT TO LESS THAN COSTS. HCH CONSIDERS THIS FULL AMOUNT AS COMMUNITY BENEFIT AS THE HOSPITAL IS PROVIDING SERVICES NOT JUST BELOW THE AGREED UPON RATE WITH MEDICARE, BUT AT A LOSS. |
| SCHEDULE H, PART III, SECTION B, LINE 9B | CHARITY CARE APPLICATIONS ARE MADE AVAILABLE TO ALL PATIENTS AT THE TIME OF REGISTRATION, ON STATEMENTS, AND ON THE WEBSITE. 120 DAYS AFTER THE FIRST POST DISCHARGE STATEMENT IS MADE ON AN ACCOUNT, IF PAYMENT ISN'T MADE AND A CHARITY CARE APPLICATION ISN'T COMPLETED THE PATIENT'S NAME IS RUN THROUGH A COMPANY TO CHECK FOR PRESUMPTIVE CHARITY CARE. IF THEY QUALIFY, THEY ARE OFFERED AN APPLICATION AGAIN. IF THEY FAIL TO COMPLETE THE APPLICATION, THEY ARE WRITTEN OFF TO CHARITY CARE UNDER OUR PRESUMPTIVE CHARITY CARE PROGRAM. IF THEY DO NOT QUALIFY FOR CHARITY CARE, AND HAVE NOT RESPONDED TO OUR REQUESTS FOR PAYMENTS FOR 120 DAYS, THEN THE ACCOUNT IS PUT ON A LIST FOR APPROVAL BY THE BOARD OF TRUSTEES. ONCE AN ACCOUNT IS GRANTED APPROVAL BY THE BOARD, IT IS SENT TO THE COLLECTION AGENCY. WE GIVE THE COLLECTION AGENCY SEVERAL MONTHS TO COLLECT THE DEBT. IF THEY ARE UNSUCCESSFUL, THE ACCOUNT IS RETURNED TO THE HOSPITAL AND WRITTEN OFF. |
| SCHEDULE H, PART VI, LINE 2 | NOT ONLY DID WE SEEK FEEDBACK FROM COMMITTEE MEMBERS REPRESENTING LESSER-HEARD VOICES FROM OUR COMMUNITY, BUT WE MADE AN ONLINE SURVEY AVAILABLE, WE PUT HARD COPIES OF THE SURVEY IN MULTIPLE PLACES INCLUDING ALL OF THE TOWNS IN OUR SERVICE AREA. WE COMBINED THAT FEEDBACK WITH STATISTICAL INFORMATION FROM RELIABLE SOURCES TO IDENTIFY PRIORITIES. |
| SCHEDULE H, PART VI, LINE 3 | WE POST INFORMATION ABOUT OUR FAPS EXISTENCE IN PROMINENT LOCATIONS. WE MAKE COPIES OF THE FAP AVAILABLE DURING REGISTRATION, IN INPATIENT ROOMS, ONLINE, AND ON OUR BILLING CORRESPONDENCE. |
| SCHEDULE H, PART VI, LINE 4 | THE HOSPITAL SERVES A GEOGRAPHIC AREA THAT ENCOMPASSES ATCHISON, BROWN, DONIPHAN, JACKSON AND NEMAHA COUNTIES IN KANSAS, AND RICHARDSON COUNTY IN NEBRASKA. OF THOSE PATIENTS, 85% ARE FROM BROWN AND DONIPHAN COUNTIES. THESE ARE MOSTLY RURAL COMMUNITIES. 88% OF THE POPULATION OF THE BROWN AND DONIPHAN COUNTIES THAT IS 25 YEARS OR OLDER HAS A MINIMUM OF A HIGH SCHOOL DIPLOMA, 16% HAS A BACHELORS DEGREE OR HIGHER. THE AVERAGE MEDIAN HOUSEHOLD INCOME IS $41,300 COMPARED TO THE STATE WIDE MEDIAN HOUSEHOLD INCOME OF $50,594. 16% OF THE POPULATION LIVES IN POVERTY; 19% FOR BROWN COUNTY ALONE. 16% OF THE POPULATION IN BROWN AND DONIPHAN COUNTIES DOES NOT HAVE HEALTH INSURANCE. |
| SCHEDULE H, PART VI, LINE 5 | WE SUPPORT A WIDE ARRAY OF PROGRAMS AND PROJECTS IN OUR COMMUNITY. MANY OF OUR KEY EMPLOYEES SERVE ON MULTIPLE BOARDS THAT HAVE A POSITIVE IMPACT ON VARIOUS ASPECTS OF THE COMMUNITY. WE PROVIDE DONATIONS OF BOTH TIME AND MONEY TO VARIOUS SERVICE ORGANIZATIONS. |
| SCHEDULE H, PART VI, LINE 6 | N/A |
| SCHEDULE H, PART VI, LINE 7 | KANSAS |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Housing Allowance Or Residence | Yes (X) | HousingAllowanceOrResidenceInd |
| Written Policy Ref T And E Expnss | Yes (true) | WrittenPolicyRefTAndEExpnssInd |
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Compensation Survey | Yes (X) | CompensationSurveyInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (true) | 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 (9 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 |
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| DR BRYON BIGHAM | ||||||||||||
| PHYSICIAN/CHIEF OF STAFF | $249,664 | $0 | $96,086 | $0 | $0 | $0 | $10,314 | $0 | $32,097 | $0 | $388,161 | $0 |
| JEAN ABEITA | ||||||||||||
| PHARMACIST | $137,303 | $0 | $0 | $0 | $2,131 | $0 | $5,973 | $0 | $29,597 | $0 | $175,004 | $0 |
| DUSTIN WILLIAMS | ||||||||||||
| APRN | $170,122 | $0 | $11,000 | $0 | $0 | $0 | $7,243 | $0 | $29,812 | $0 | $218,177 | $0 |
| DR JULIE ROSA | ||||||||||||
| PHYSICIAN | $117,297 | $0 | $42,412 | $0 | $0 | $0 | $4,966 | $0 | $0 | $0 | $164,675 | $0 |
| DR JESSICA JARVIS | ||||||||||||
| PHYSICIAN | $204,657 | $0 | $0 | $0 | $0 | $0 | $2,274 | $0 | $20,263 | $0 | $227,194 | $0 |
| JODI TWOMBLY | ||||||||||||
| PA | $105,644 | $0 | $15,000 | $0 | $0 | $0 | $4,489 | $0 | $29,340 | $0 | $154,473 | $0 |
| DR PETE ROSA | ||||||||||||
| PHYSICIAN | $244,702 | $0 | $111,239 | $0 | $0 | $0 | $10,460 | $0 | $30,812 | $0 | $397,213 | $0 |
| DR CROSBY GERNON | ||||||||||||
| RADIOLOGIST | $381,569 | $0 | $34,775 | $0 | $18,000 | $0 | $15,962 | $0 | $29,792 | $0 | $480,098 | $0 |
| DR STEFFEN SHAMBURG | ||||||||||||
| PHYSICIAN | $355,350 | $0 | $127,654 | $0 | $0 | $0 | $13,064 | $0 | $23,381 | $0 | $519,449 | $0 |
Supplemental Information Detail SupplementalInformationDetail (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| SCHEDULE J, PART I, LINE 1A | JEFFREY SHELTON, CEO, RECEIVED EMPLOYER PROVIDED HOUSING IN THE AMOUNT OF $3875 AS A TAXABLE BENEFIT. THE AMOUNT WAS INCLUDED IN HIS W-2. |
| SCHEDULE J, PART I, LINE 5A | THE DOCTORS ARE PAID A PERFORMANCE BONUS BASED ON PRODUCTIVITY AND CONSIDERATION OF REVENUES AND EXPENSES. |
Schedule K IRS990ScheduleK
Tax Exempt Bonds Issues TaxExemptBondsIssuesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
Issuer Name IssuerName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CITY OF HIAWATHA KANSAS | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Issuer EIN | 486025665 | BondIssuerEIN |
| CUSIP | 428545CN5 | CUSIPNum |
| Bond Issued | 2014-09-29 | BondIssuedDt |
| Issue Price | $6,440,000 | IssuePriceAmt |
| Purpose | SEE PART VI | PurposeDesc |
| Defeased | false | DefeasedInd |
| On Behalf Of Issuer | false | OnBehalfOfIssuerInd |
| Pool Financing | false | PoolFinancingInd |
Tax Exempt Bonds Proceeds TaxExemptBondsProceedsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bond Reference | A | BondReferenceCd |
| Retired | $1,260,000 | RetiredAmt |
| Bond Defeased | $0 | BondDefeasedAmt |
| Total Proceeds | $6,440,000 | TotalProceedsAmt |
| In Reserve Fund | $300,662 | InReserveFundAmt |
| Capitalized Interest | $0 | CapitalizedInterestAmt |
| Refunding Escrow | $0 | RefundingEscrowAmt |
| Issuance Costs From Proceeds | $115,920 | IssuanceCostsFromProceedsAmt |
| Credit Enhancement | $0 | CreditEnhancementAmt |
| Working Capital Expenditures | $0 | WorkingCapitalExpendituresAmt |
| Capital Expenditures | $0 | CapitalExpendituresAmt |
| Other Spent Proceeds | $6,324,080 | OtherSpentProceedsAmt |
| Unspent | $0 | UnspentAmt |
| Substantial Completion | 2011 | SubstantialCompletionYr |
| Current Refunding | Yes (true) | CurrentRefundingInd |
| Advance Refunding | false | AdvanceRefundingInd |
| Final Allocation Made | Yes (true) | 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 | Yes (true) | 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 |
| Change In Use Bond Financed Prop | 0.00000 | ChangeInUseBondFinancedPropPct |
| 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 |
| Exception To Rebate | false | ExceptionToRebateInd |
| No Rebate Due | false | NoRebateDueInd |
| 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | PART I, LINE A, COLUMN F | FormAndLineReferenceDesc |
| Explanation | THE BONDS WERE ISSUED TO REFUND THE SERIES 2007 BONDS (ISSUED 03/29/2007) AND REFUND THE TAXABLE BANK LOANS. | ExplanationTxt |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp
Name Of Interested NameOfInterested
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | SEE PART V | PersonNm |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | SCHEDULE L, PART V | FormAndLineReferenceDesc |
| Explanation | A) DR. JULIE ROSA B) DR. JULIE ROSA, A PHYSICIAN AT HIAWATHA COMMUNITY HOSPITAL, IS THE SPOUSE OF DR. PETER ROSA, A KEY EMPLOYEE OF THE HOSPITAL C) $ 164,675 D) COMPENSATION E) NO | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (14 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART III, LINE 1 | HIAWATHA COMMUNITY HOSPITAL'S HIGHEST PRIORITY IS THE PROVISION OF QUALITY HEALTH CARE TO OUR PATIENTS THROUGHOUT NORTHEAST KANSAS. COMPREHENSIVE SERVICES INCLUDE PRIMARY, SECONDARY, AND LONG-TERM CARE. TO CARRY OUT THIS MISSION, HEALTH PROFESSIONALS WITHIN THE HOSPITAL CONTINUALLY WORK TOGETHER TO IMPROVE PATIENT CARE AND EDUCATION. THIS TEAM APPROACH ASSURES THAT OUR PATIENTS WILL BENEFIT FROM THE MOST UP-TO-DATE MEDICAL PRACTICES AVAILABLE. THE HOSPITAL CAN ONLY CONTINUE TO EXIST TO SERVE ITS MISSION THROUGH SOUND FINANCIAL MANAGEMENT AND STRATEGIC PLANNING. THEREFORE, THE PRINCIPLES OF COST EFFECTIVENESS AND EFFICIENCY GOVERN THE DEVELOPMENT OF HEALTH CARE POLICY FOR THE HOSPITAL. EXTERNAL AND INTERNAL ASSESSMENTS ARE DONE TO DETERMINE EVOLUTIONARY NEEDS AND TO RESPOND TO THE DEMANDS OF EVER-CHANGING TECHNOLOGY. HIAWATHA COMMUNITY HOSPITAL FEELS A STRONG COMMITMENT TO ITS EMPLOYEES AND STRIVES ALWAYS TO TREAT THEM FAIRLY, RESPONSIBLY, AND WITH A SENSE OF CONCERN FOR THEIR WELL-BEING. THE PROVISION OF COMPREHENSIVE CONTINUING EDUCATION IS ESSENTIAL TO MAINTAIN ADEQUATE SKILL LEVELS AND FOSTER A SENSE OF PRIDE AND PROFESSIONALISM. AS A COMMUNITY HOSPITAL, HIAWATHA COMMUNITY HOSPITAL RECOGNIZES ITS RESPONSIBILITY TO PROVIDE PUBLIC HEALTH EDUCATION AND, AS SUCH, STRIVES TO SERVE AS A REGIONAL HEALTH RESOURCE CENTER. MEDICAL AND PROFESSIONAL STAFF ARE ENCOURAGED TO PARTICIPATE IN COMMUNITY ACTIVITIES AND EDUCATION. |
| FORM 990, PART VI, SECTION B, LINE 11B | AN INDEPENDENT ACCOUNTING FIRM PREPARES AND REVIEWS THE 990. THE 990 IS THEN REVIEWED BY THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL. ANY QUESTIONS OR CONCERNS THE ORGANIZATION'S OFFICERS AND ACCOUNTING PERSONNEL HAVE ARE ADDRESSED AND ANY CORRECTIONS OR CLARIFICATIONS THAT NEED TO BE MADE ARE MADE. THE FINAL FORM 990 WITH ALL REQUIRED SCHEDULES IS THEN PROVIDED TO ALL VOTING MEMBERS OF THE BOARD PRIOR TO FILING. |
| FORM 990, PART VI, SECTION B, LINE 12C | ALL EMPLOYEES AND DECISION MAKERS FOR THE HOSPITAL ARE COVERED UNDER THIS POLICY. CONFLICTS ARE EITHER REVIEWED BY THE CORPORATE COMPLIANCE OFFICER OR THE BOARD PRESIDENT. AT BOARD MEETINGS, THE BOARD CHAIR IS APPRAISED OF ALL CONFLICTS OF INTEREST AND THEN ASKS THE MEMBER TO ABSTAIN FROM DISCUSSING AND VOTING ON TOPICS OF CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | THE DIRECTOR OF HUMAN RESOURCES PERIODICALLY PROVIDES THE PRESIDENT OF THE BOARD OF DIRECTORS WITH A COMPENSATION SURVEY COMPILED BY THE KANSAS HOSPITAL ASSOCIATION. THE SURVEY DELINEATES COMPENSATION PACKAGES FOR ADMINISTRATORS AT HOSPITALS THAT ARE SIMILAR TO HIAWATHA. BASED ON THAT SURVEY, THE ADMINISTRATOR'S PERFORMANCE, AND THE PERFORMANCE OF THE HOSPITAL, THE BOARD SETS THE ADMINISTRATOR'S SALARY. THE LAST EVALUATION WAS GIVEN IN 2017 WHILE WE WERE TRYING TO HIRE A NEW CEO. |
| FORM 990, PART VI, SECTION B, LINE 15B | AN ATTORNEY'S OFFICE THAT SPECIALIZES IN HEALTHCARE REVIEWED AND HELPED TO REVISE THE DOCTOR'S CONTRACTS STARTING IN DECEMBER OF 2016. |
| FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. |
| FORM 990, PART XI, LINE 9 | CHANGE IN ESTATE RECEIVABLE $ 4,973 CHANGE IN TRUST RECEIVABLE ( 477) --------- $ 4,496 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:ANESTHESIOLOGY TOTAL FEES:675080 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:PHYICAL THERAPY TOTAL FEES:431372 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:EMR SERVICES TOTAL FEES:267784 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:RESPRATORY THERAPY TOTAL FEES:161143 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:LAB SERVICES TOTAL FEES:121405 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:CONTRACT IT SERVICES TOTAL FEES:280873 |
| FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:962278 |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HIAWATHA HOSPITAL FOUNDATION | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 300 UTAH STREET | AddressLine1Txt |
| City | HIAWATHA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66434 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481223766 | EIN |
| Primary Activities | FUNDRAISING | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Exempt Code Section | 501(C)(3) | ExemptCodeSectionTxt |
| Public Charity Status | 12D | PublicCharityStatusTxt |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | false | ControlledOrganizationInd |
Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp
Related Organization Name RelatedOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | CHARITABLE REMAINDER TRUST (1) | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Primary Activities | TRUST | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | HHA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Controlled Organization | Yes (true) | ControlledOrganizationInd |
| 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 | Yes (true) | 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 | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | Yes (true) | 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 |