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PAWNEE VALLEY COMMUNITY HOSPITAL INC: Form 990, tax year 2016

View the entire original 990 at ProPublica ↗

Organization
PAWNEE VALLEY COMMUNITY HOSPITAL INC (EIN 48-1253246)
Tax period
2016-07-01 to 2017-06-30
Filed
2018-05-09
IRS object ID
201831299349301718
Schema version
2016v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2018-05-09T12:56:40-05:00ReturnTs
Tax Period End2017-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN481026809PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Wendling Noe Nelson & Johnson LLCBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1534 S Kansas Ave Suite 1500AddressLine1Txt
CityTopekaCityNm
State AbbreviationKSStateAbbreviationCd
ZIP666033491ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2016-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN481253246EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pawnee Valley Community Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlPAWNBusinessNameControlTxt
Phone6202853161PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 Carroll AveAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGeorge HarmsPersonNm
Person TitleSecretary/TreasurerPersonTitleTxt
Phone7856235000PhoneNum
Signature2018-04-25SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonHeather R EichemPreparerPersonNm
PTINP01515553PTIN
Phone7852334226PhoneNum
Preparation2018-04-25PreparationDt
FieldValueIRS element (for citing)
Tax2016TaxYr
Build TS2022-09-23 18:48:47ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGeorge HarmsPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 Carroll AveAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$17,945,770GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.pawneevalleyhospital.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionPawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. The Organization is striving to be the best Critical Access Hospital in rural America.ActivityOrMissionDesc
Voting Members Governing Body6VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee154TotalEmployeeCnt
Total Volunteers92TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$340,563PYContributionsGrantsAmt
CY Contributions Grants$152,936CYContributionsGrantsAmt
PY Program Service Revenue$17,935,656PYProgramServiceRevenueAmt
CY Program Service Revenue$17,590,974CYProgramServiceRevenueAmt
PY Investment Income$7,026PYInvestmentIncomeAmt
CY Investment Income$20,752CYInvestmentIncomeAmt
PY Other Revenue$186,699PYOtherRevenueAmt
CY Other Revenue$181,108CYOtherRevenueAmt
PY Total Revenue$18,469,944PYTotalRevenueAmt
CY Total Revenue$17,945,770CYTotalRevenueAmt
PY Grants And Similar Paid$283,287PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$28,716CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$8,235,368PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$8,409,323CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,808,332PYOtherExpensesAmt
CY Other Expenses$9,536,447CYOtherExpensesAmt
PY Total Expenses$15,326,987PYTotalExpensesAmt
CY Total Expenses$17,974,486CYTotalExpensesAmt
PY Revenues Less Expenses$3,142,957PYRevenuesLessExpensesAmt
CY Revenues Less Expenses-$28,716CYRevenuesLessExpensesAmt
Total Assets BOY$9,241,754TotalAssetsBOYAmt
Total Assets EOY$10,623,043TotalAssetsEOYAmt
Total Liabilities BOY$8,018,579TotalLiabilitiesBOYAmt
Total Liabilities EOY$9,269,859TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$1,223,175NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,353,184NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facitities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Corporation is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$13,623,973ExpenseAmt
Grant$28,716GrantAmt
Revenue$17,616,548RevenueAmt
DescPatient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code.Desc
Total Program Service Expenses$13,623,973TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 Footnote0IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee154EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members6GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGeorge Harms TreasurerPersonNm
Phone7856235000PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line12220 CanterburyAddressLine1Txt
CityHaysCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67601ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Bryce Young
President4.0040.00Yes (X)Yes (X)$0$332,241$95,883
Shae Veach
Vice President4.0040.00Yes (X)Yes (X)$0$240,646$73,640
George Harms
Secretary/Treasurer4.0040.00Yes (X)Yes (X)$0$311,382$78,461
John Jeter MD
Director4.0040.00Yes (X)$0$750,080$148,373
David Sanger MD
Director/Physician40.00Yes (X)$230,407$0$41,392
Lynn Barger
Director4.00Yes (X)$0$0$0
John Haas
Director4.00Yes (X)$0$0$0
Eric Lybarger
Administrator40.00Yes (X)$37,723$0$4,871
Amanda Bickle
APRN40.00$124,469$0$28,433Yes (X)
Debbie Tomlinson
APRN40.00$140,766$0$11,116Yes (X)
Cynthia Carter
Registered Nurse40.00$103,472$0$16,116Yes (X)
Christian Whittington
Physician40.00$273,661$0$43,017Yes (X)
Dusty Atterbury
Physician Assistant40.00$101,983$0$31,398Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$1,012,481TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,634,349TotReportableCompRltdOrgAmt
Total Other Compensation$572,700TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K12IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Hays Medical Center
2220 Canterbury DriveHaysKS67601Contract Services$2,957,606
GE Healthcare
9900 W Innovation DriveWauwatosaWI53226Repairs and Maintenance$160,038
Quest Diagnostics
PO Box 14730St LouisMO63150Lab Services$158,643
Anesthesiologist Associates of Hays
PO Box 821HaysKS67601Anethesia Services$150,530
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Government Grants$124,220GovernmentGrantsAmt
All Other Contributions$28,716AllOtherContributionsAmt
Noncash Contributions$6,097NoncashContributionsAmt
Total Contributions$152,936TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net patient service revenue622000$16,665,325$16,665,325
340b drug program900099$859,235$859,235
Outreach therapy services900099$39,197$39,197
Lab fairs900099$27,216$27,216
EHR incentive payments900099$1$1
FieldValueIRS element (for citing)
Total Program Service Revenue$17,590,974TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$20,752TotalRevenueColumnAmt
Exclusion$20,752ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,800RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$1,800RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,800TotalRevenueColumnAmt
Related Or Exempt Func Income$1,800RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Meals sold to employees and guest722210$155,534$155,534
Other miscellaneous revenue900099$23,774$23,774
FieldValueIRS element (for citing)
Other Revenue Total$179,308OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$17,945,770TotalRevenueColumnAmt
Related Or Exempt Func Income$17,616,548RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$176,286ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$28,716TotalAmt
Program Services$28,716ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$455,997TotalAmt
Program Services$305,898ProgramServicesAmt
Management And General$150,099ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,406,719TotalAmt
Program Services$5,880,175ProgramServicesAmt
Management And General$526,544ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$280,472TotalAmt
Program Services$253,350ProgramServicesAmt
Management And General$27,122ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$800,848TotalAmt
Program Services$736,852ProgramServicesAmt
Management And General$63,996ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$465,287TotalAmt
Program Services$420,319ProgramServicesAmt
Management And General$44,968ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$2,425,400TotalAmt
Management And General$2,425,400ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$12,509TotalAmt
Management And General$12,509ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$44,761TotalAmt
Management And General$44,761ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,566,374TotalAmt
Program Services$1,293,464ProgramServicesAmt
Management And General$272,910ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$59,214TotalAmt
Program Services$1,327ProgramServicesAmt
Management And General$57,887ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$57,838TotalAmt
Program Services$27,793ProgramServicesAmt
Management And General$30,045ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$88,844TotalAmt
Program Services$53,306ProgramServicesAmt
Management And General$35,538ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$2,788,256TotalAmt
Program Services$2,337,952ProgramServicesAmt
Management And General$450,304ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$9,472TotalAmt
Program Services$9,312ProgramServicesAmt
Management And General$160ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,091TotalAmt
Program Services$3,091ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$91,278TotalAmt
Program Services$54,767ProgramServicesAmt
Management And General$36,511ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Pharmaceuticals$986,834$986,834
Medical supplies$359,773$359,773
Service contracts$299,109$289,216$9,893
Dietary$174,702$174,702$0

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$568,992TotalAmt
Program Services$407,126ProgramServicesAmt
Management And General$161,866ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$17,974,486TotalAmt
Program Services$13,623,973ProgramServicesAmt
Management And General$4,350,513ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$518,161BOYAmt
EOY$925,211EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,775,255BOYAmt
EOY$5,256,421EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$1,720,178BOYAmt
EOY$2,066,682EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$260,760BOYAmt
EOY$284,579EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$160,630BOYAmt
EOY$151,199EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$1,806,770BOYAmt
EOY$1,938,951EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$9,241,754BOYAmt
EOY$10,623,043EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$1,024,291BOYAmt
EOY$992,734EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,994,288BOYAmt
EOY$8,277,125EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$8,018,579BOYAmt
EOY$9,269,859EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$217,338BOYAmt
EOY$347,347EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$1,005,837BOYAmt
EOY$1,005,837EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$1,223,175BOYAmt
EOY$1,353,184EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,241,754BOYAmt
EOY$10,623,043EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss-$28,716ReconcilationRevenueExpnssAmt
Other Changes In Net Assets$158,725OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consol And Sep Basis Fincl StmtYes (X)ConsolAndSepBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (1)AuditCommitteeInd
Federal Grant Audit Required0FederalGrantAuditRequiredInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other OrganizationsYes (1)GrantsOtherOrganizationsInd
Grants Other Organizations$4,855GrantsOtherOrganizationsAmt
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other Activities0OtherActivitiesInd
Total Lobbying Expenditures$4,855TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

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

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$934,796BeginningYearBalanceAmt
Investment Earnings Or Losses$234,981InvestmentEarningsOrLossesAmt
End Year Balance$1,169,777EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$372,016BeginningYearBalanceAmt
Contributions$1,515,575ContributionsAmt
Other Expenditures$952,795OtherExpendituresAmt
End Year Balance$934,796EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$142,777BeginningYearBalanceAmt
Contributions$408,437ContributionsAmt
Other Expenditures$179,198OtherExpendituresAmt
End Year Balance$372,016EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$1,026,228ContributionsAmt
Other Expenditures$883,451OtherExpendituresAmt
End Year Balance$142,777EndYearBalanceAmt
FieldValueIRS element (for citing)
Prmnnt Endowment Balance EOY1.00000PrmnntEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
Estimated third-party payor settlements$462,000
Other receivables$120,560
Beneficial interest in net assets of foundation$1,353,184
Receivable from related party$3,207
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,938,951TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Due to Pawnee County$7,615,449
Due to Hays Medical Center, Inc.$639,747
Estimated third-party payor settlements$21,929
FieldValueIRS element (for citing)
Total Liability$8,277,125TotalLiabilityAmt
Total Rev Etc Audited Fincl Stmt$18,075,779TotalRevEtcAuditedFinclStmtAmt
Other Revenue$130,009OtherRevenueAmt
Revenue Not Reported$130,009RevenueNotReportedAmt
Revenue Subtotal$17,945,770RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$17,945,770TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$17,945,770TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$17,945,770ExpensesSubtotalAmt
Other Expenses Not Included$28,716OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$28,716ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$17,974,486TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part V, Line 4:Donations are requested for specific items or improvements to the Hospital. When a donation is received for that specific item, it is restricted for that use by the Board until the specific item or improvement is purchased. At any one time, one or more such projects can be in progress.
Part XI, Line 2d - Other Adjustments:Change in beneficial interest in net assets of Foundation 130,009.
Part XII, Line 4b - Other Adjustments:Transfer of equipment to Pawnee County 28,716.

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (1)FinancialAssistancePolicyInd
Written PolicyYes (1)WrittenPolicyInd
FPG Reference Free CareYes (1)FPGReferenceFreeCareInd

Free Care Oth Percentage FreeCareOthPercentageGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
Free Care Other130.000000000000FreeCareOtherPct
FieldValueIRS element (for citing)
FPG Reference Discounted CareYes (1)FPGReferenceDiscountedCareInd
Percent400Yes (X)Percent400Ind
Free Care Medically IndigentYes (1)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (1)FinancialAssistanceBudgetInd
Expenses Exceed Budget0ExpensesExceedBudgetInd
Annual Community Bnft Report0AnnualCommunityBnftReportInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$181,652TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$181,652NetCommunityBenefitExpnsAmt
Total Expense0.01010TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$971,096TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$206,143DirectOffsettingRevenueAmt
Net Community Benefit Expns$764,953NetCommunityBenefitExpnsAmt
Total Expense0.04260TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,152,748TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$206,143DirectOffsettingRevenueAmt
Net Community Benefit Expns$946,605NetCommunityBenefitExpnsAmt
Total Expense0.05270TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,071,809TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,474,459DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,597,350NetCommunityBenefitExpnsAmt
Total Expense0.08890TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$3,071,809TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,474,459DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,597,350NetCommunityBenefitExpnsAmt
Total Expense0.08890TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,224,557TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,680,602DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,543,955NetCommunityBenefitExpnsAmt
Total Expense0.14160TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$575,082BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$9,017,268ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$9,235,329CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$218,061MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
OtherYes (X)OtherInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (1)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (1)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pawnee Valley Community Hospital IncBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 Carroll AvenueAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Pawnee Valley Community Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Prior CHNA ImpactYes (X)PriorCHNAImpactInd
CHNA Conducted14CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://www.pawneevalleyhospital.com/OwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLhttp://www.pawneecountykansas.com/OtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt14ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care130.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttp://www.pawneevalleyhospital.com/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttp://www.pawneevalleyhospital.com/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttp://www.pawneevalleyhospital.com/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
Notified FAP Copy Bill DisplayYes (X)NotifiedFAPCopyBillDisplayInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
Provided Written NoticeYes (X)ProvidedWrittenNoticeInd
Made Effort Orally NotifyYes (X)MadeEffortOrallyNotifyInd
Processed FAP ApplicationYes (X)ProcessedFAPApplicationInd
Made Presumptive Elig DetermYes (X)MadePresumptiveEligDetermInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Look Back Medicare PrivateYes (X)LookBackMedicarePrivateInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meeting, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and score processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interests of the community served by the hospital. Key stakeholders in attendance included representatives from: United Way, Welcome Inn Senior Center, Center for Counseling, Angels Care Home Health, Golden Belt Foundation, Larned City Council, Burdett City Council and Garfield City Council and Rozel Community, Pawnee County Sherriff's office, Larned Police Department, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, school nurses of USD 495, local members of the media, local religious organizations and representative of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas.
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 6b: Pawnee County, KS
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 11: Annual description of the actions taken by the Hospital during the fiscal year to address the significant health needs identified throught the most recently conducted CHNA:1.) Build and/or Develop Exercise Facilities - 37 votes, 22.8%Construction on the Fort Larned USD #495 community fitness center is complete and is expected to be open to the public August 2017. Any Pawnee County taxpayer can get a membership to the fitness center for $25 a year.PVCH is planning their annual fun run for August 2017. The money raised will be used to help purchase physical education equipment and playground equipment for the new elementary school. The community continues to support other local exercise entities such as spin class, taekwondo, Yoga and an independently owned exercise gym.2.) Expand Oncology Services - 25 votes, 15.4%We have explored the feasibility of offering oncology services and providers in Pawnee County and it was determined not to be feasible at this time. The services that PVCH provides to Oncology patients through our special nursing services department are Central Line Maintenance, Transfusions, Injections, non-chemo infusions, and removal of chemotherapy pumps.3.) Improve Air Quality (Feed Lots) - 20 votes, 12.3%.We plan to continue to look into improving air quality in Pawnee County. More research needs to be done to determine if it is feasible for PVCH to implement a plan to address air quality issues.4.) Reduce Drug/Alcohol Abuse - 20 votes, 12.3%.PVCH currently does education and discharge instructions in our Emergency Department for any patients that come in under the influence of drugs and/or alcohol.The Pawnee County Health Department and Pawnee Valley Community Hospital continues to partner with The Center for Counseling through an "Improving Health in Rural Counties" grant. The grant project focuses on public mental health awareness and utilization campaign focusing on (1) recognition and understanding of the importance of mental health and substance abuse issues; (2) public recognition of local behavior health resources/services (including substance use); and (3) increased utilization of those services.- Print and radio advertisements are ongoing to increase behavioral health awareness and assist with increasing understanding of available community resources.- A community behavioral health resource has been created to assist linking people to appropriate treatment.- Crisis mental health Screenings are being performed by telemedicine to help make the screenings more accessible and get people to assistance more rapidly.- Mental health kiosks "Get a Checkup from the Neck Up" are available at the health department for people to take an anonymous screening (eight different categories) and results are given to the person and they are directed by information on the screen to access assistance.- Information is provided at community health fairs on mental health and substance use issues.The Pawnee County Commissioners signed a resolution on April 3rd, 2017 for the "Stepping Up Initiative". This initiative is to help reduce the number of people with mental illnesses in jails, including those with substance abuse, as three quarters of those with mental health illness in jails also have substance abuse issues. The first community partner meeting for this initiative will be April 19th and includes the following: 1. Larned State Hospital 2. Law Enforcement 3. EMS 4. Pawnee Valley Community Hospital 5. The Center for Counseling 6. Pawnee County Ministerial Alliance 7. Community Corrections 8. Family Crisis Center 9. County Attorney 10. Public Health 11. Medical ProviderThe health department, as part of our comprehensive data collection, screens individuals accessing the health department for alcohol and substance abuse and then refers if help is needed.5.) Provide Health Food Options - 14 votes, 8.6%.Pawnee Valley Community Hospital is promoting healthy eating lifestyles focusing on food labels, healthy meal options, nutrition, and portion control. In 2016 PVCH signed the healthy Kansas hospital initiative. We are in the process of forming an internal committee and developing a policy. The plan is to then extend the committee to include community members and focus on what changes we can make in the community such as grocery store options and healthy meal options at local restaurants. We continue to offer diabetic education classes which is a two day session 6 times a year. Participants eat at the facility and go through the cafeteria line and are encouraged to make healthier food choices.PVCH continues to educate children at their annual sixth grade health fair and includes education on portion control, label reading, and exercise.The health department promotes the diabetes support group and sends out their meeting reminders each month. The diabetes support group discusses nutrition with people in attendance.6.) Increase Access to Home Health/Hospice - 11 votes, 6.8%.PVCH continues to be a partner with the Kansas Heart and Stroke Collaborative and we have a part time staff member that goes into the home and checks on the patient and makes sure they are following the guidelines provided by their physician, pertaining to heart and stroke.PVCH has obtained an agreement with Golden Belt Home Health and Hospice for respite care.7.) Offer Nursing Home Dementia Services - 11 votes, 6.8%.Country Living Assisted Living facility in Pawnee County will be opening another building for "Memory Care" in November 2017. Number of beds dedicated to memory care is based on availability and need of care level of the patient. Staff is trained with dementia and Alzheimer's training. Country Living is a member of the Alzheimer's association.
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 13b: Financial assistance may be given for catastrophic medical expenses, even if patient's income exceeds the Federal poverty guidelines.
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line11 - Pawnee Valley Medical AssociatesBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1713 W 11th StAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
FacilityFamily MedicineFacilityTxt

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 7:A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries.
Part I, Line 7g:Subsidized health services community benefit expenses include $486,330 of expenses attributable to physician clinics that have net operating losses.
Part III, Line 4:The footnote from the hospital's financial statements follows:The Hospital provides for accounts receivable that could become uncollectible in the future by establishing an allowance to reduce the carrying value of such receivables to their net realizable value. The Hospital estimates this allowance based on the aging of its accounts receivable and its historical collection experience for each type of payor.Part III Line 2:Costing methodology: A cost-to-charge ratio derived from Worksheet 2 was used to calculate bad debt expense at cost.
Part III, Line 8:The Medicare cost report was the costing methodology used to determine the allowable Medicare costs pertaining to Medicare net revenue. Allowable costs of care reported on line 6 were determined using amounts from Worksheet D, Part V and Worksheet D-1 in the Pawnee Valley Community Hospital, Inc., Medicare cost report for fiscal year ended June 30, 2017.
Part III, Line 9b:Whenever possible, the customer service representatives (CSR's) of Pawnee Valley Community Hospital try to determine the estimated self-pay balance prior to the patient receiving services. Charity care eligibility is first considered at this point in time. In addition, if full payment is not received or payment is not made with 30 days, the CSR contacts the patient. If it is determined that at least a two-year payment plan cannot be established with the patient, the CSR will screen for charity care and request that the charity care application be completed by the patient.
Part VI, Line 3:Information regarding the Pawnee Valley Community Hospital, Inc. charity care program is located on the Pawnee Valley Community Hospital and Hays Medical Center, Inc. website for patients and community members to view, and the financial assistance application is also on the HMC website to print off and complete. A financial assistance policy summary is included with every statement that is sent to an uninsured patient. In addition, if a customer service representative contacts a patient about a bill and in visiting with them they determine that patient could possibly qualify for the hospital's charity care policy, the CSR will send the application to the patient as well.
Part VI, Line 4:Pawnee Valley Community Hospital, Inc. is located in Larned, Kansas, which has a population of approximately 4,050 people, as of the 2010 census. The median household income of Larned was $43,250. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 8.1% of the hospital's revenue is from services provided to patients eligible for Medicaid. Pawnee Valley Community Hospital, Inc. is the only hospital in Larned, Kansas. It mainly serves the community of Larned.
Part VI, Line 5:Pawnee Valley Community Hospital, Inc. promotes the health of the community by extending medical privileges to most qualified, local physicians.
Part VI, Line 6:Pawnee Valley Community Hospital, Inc. is a component unit of Hays Medical Center, Inc. As of January 1, 2017, Hays Medical Center, Inc. became a component unit of the University of Kansas Hospital Authority.

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Pawnee CountyBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1715 BroadwayAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
Recipient EIN486007542RecipientEIN
Non Cash Assistance$28,716NonCashAssistanceAmt
Valuation Method UsedCash paidValuationMethodUsedDesc
Non Cash AssistanceTransfer of equipment and landhold improvementsNonCashAssistanceDesc
Purpose Of GrantPawnee County owns all fixed assets (land, building, equipment) used by the Hospital. To expedite the purchase of equipment and obtain favorable purchasing terms, the Hospital purchased equipment on behalf of the County. The Pawnee Valley Community Hospital Foundation reimbursed the Hospital for the purchase. The Hospital then transferred ownership of the equipment to Pawnee County. The Foundation also paid for a landhold improvement. This improvement was given to the Hospital who then transferred ownership to Pawnee County.PurposeOfGrantTxt

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance Payment0SeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (1)SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm0EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org0CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs0CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgYes (1)CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsYes (1)CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments0AnyNonFixedPaymentsInd
Initial Contract Exception0InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (8 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Bryce Young
President$0$265,759$0$66,482$0$0$0$67,126$0$28,757$0$428,124$0$0
Shae Veach
Vice President$0$186,000$0$33,877$0$20,769$0$47,575$0$26,065$0$314,286$0$0
George Harms
Secretary/Treasurer$0$251,161$0$60,221$0$0$0$62,901$0$15,560$0$389,843$0$0
John Jeter MD
Director$0$542,748$0$185,472$0$21,860$0$125,434$0$22,939$0$898,453$0$0
David Sanger MD
Director/Physician$216,073$0$0$0$14,334$0$13,745$0$27,647$0$271,799$0$0$0
Amanda Bickle
APRN$122,193$0$276$0$2,000$0$3,917$0$24,516$0$152,902$0$0$0
Debbie Tomlinson
APRN$137,890$0$276$0$2,600$0$8,514$0$2,602$0$151,882$0$0$0
Christian Whittington
Physician$211,811$0$0$0$61,850$0$15,900$0$27,117$0$316,678$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator.
Part I, Line 4bContributions to the plan: John Jeter, M.D. - $109,534 Bryce Young - $51,226 George Harms - $47,001 Shae Veach - $34,067
Part I, Line 6A portion of the Administrator's incentive compensation is determined by net earnings exceeding budget for the fiscal year. A portion of incentive compensation for officers and key employees of Hays Medical Center, Inc., a related organization, is determined by net earnings exceeding budget for the fiscal year.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc.
Form 990, Part VI, Section A, line 7aThe Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc.
Form 990, Part VI, Section A, line 7bHaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital.
Form 990, Part VI, Section B, line 11bForm 990 was reviewed with the Board members prior to filing.
Form 990, Part VI, Section B, line 12cOfficers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are used to monitor and enforce compliance with the policy.
Form 990, Part VI, Section B, line 15The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members.
Form 990, Part VI, Section C, line 19These documents are not made available to the public.
Form 990, Part XI, line 9:Change in beneficial interest in net assets of foundation 130,009. Transfers to Pawnee County 28,716.
Form 990. Part XII, Line 2cHays Medical Center, Inc., has an audit committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc's., financial statement audit and the selection process of an independent accountant.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (5 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationInd
HaysMed Partners Inc (HMed)
2220 Canterbury DrHaysKS67601270877152Owns management contract for Pawnee Valley Community HospitalKS501(c)(3)Line 30
Hays Medical Center Inc
2220 Canterbury DrHaysKS67601480559088HospitalKS501(c)(3)Line 30
Pawnee Valley Community Hospital Foundation
923 Carroll AveLarnedKS67550455333776Support the activities and mission of the HospitalKS501(c)(3)Line 12a0
University of Kansas Hospital Authority
3901 Rainbow BoulevardKansas CityKS66160481202402HospitalKS0
St Rose Health Center
2220 Canterbury DrHaysKS67601472117443Outpatient health centerKS501(c)(3)Line 30
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org0LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth Org0RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgYes (1)RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd