PAWNEE VALLEY COMMUNITY HOSPITAL INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- PAWNEE VALLEY COMMUNITY HOSPITAL INC (EIN 48-1253246)
- Tax period
- 2015-07-01 to 2016-06-30
- Filed
- 2017-05-11
- IRS object ID
- 201721319349304202
- Schema version
- 2015v3.0
- 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
- Form 990
- Schedule A
- Schedule B
- Schedule C
- Schedule D
- Schedule H
- Schedule I
- Schedule J
- Schedule M
- Schedule O
- Schedule R
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-05-11T14:29:22-05:00 | ReturnTs |
| Tax Period End | 2016-06-30 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 481026809 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Wendling Noe Nelson & Johnson LLC | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 534 S Kansas Ave Suite 1500 | AddressLine1Txt |
| City | Topeka | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 666033491 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-07-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481253246 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawnee Valley Community Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | PAWN | BusinessNameControlTxt |
| Phone | 6202853161 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 923 Carroll Ave | AddressLine1Txt |
| City | Larned | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | George Harms | PersonNm |
| Person Title | Secretary/Treasurer | PersonTitleTxt |
| Phone | 7856235000 | PhoneNum |
| Signature | 2017-05-10 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | Heather R Eichem | PreparerPersonNm |
| PTIN | P01515553 | PTIN |
| Phone | 7852334226 | PhoneNum |
| Preparation | 2017-05-10 | PreparationDt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2015 | TaxYr |
| Build TS | 2021-01-29 14:40:06Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | George Harms | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 923 Carroll Ave | AddressLine1Txt |
| City | Larned | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $18,469,944 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | www.pawneevalleyhospital.com | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 2001 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | Pawnee 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 Body | 6 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 2 | VotingMembersIndependentCnt |
| Total Employee | 158 | TotalEmployeeCnt |
| Total Volunteers | 99 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $907,604 | PYContributionsGrantsAmt |
| CY Contributions Grants | $340,563 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $17,240,485 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $17,935,656 | CYProgramServiceRevenueAmt |
| PY Investment Income | $4,292 | PYInvestmentIncomeAmt |
| CY Investment Income | $7,026 | CYInvestmentIncomeAmt |
| PY Other Revenue | $169,424 | PYOtherRevenueAmt |
| CY Other Revenue | $186,699 | CYOtherRevenueAmt |
| PY Total Revenue | $18,321,805 | PYTotalRevenueAmt |
| CY Total Revenue | $18,469,944 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $901,744 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $283,287 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $7,917,015 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $8,235,368 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $6,688,940 | PYOtherExpensesAmt |
| CY Other Expenses | $6,808,332 | CYOtherExpensesAmt |
| PY Total Expenses | $15,507,699 | PYTotalExpensesAmt |
| CY Total Expenses | $15,326,987 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $2,814,106 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $3,142,957 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $7,788,872 | TotalAssetsBOYAmt |
| Total Assets EOY | $9,241,754 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $6,709,764 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $8,018,579 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,079,108 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,223,175 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | Pawnee 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 Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $11,439,829 | ExpenseAmt |
| Grant | $283,287 | GrantAmt |
| Revenue | $17,958,979 | RevenueAmt |
| Desc | Patient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code. | Desc |
| Total Program Service Expenses | $11,439,829 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (1) | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | Yes (1) | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | 0 | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (1) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | Yes (1) | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | 0 | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | Yes (1) | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | Yes (1) | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | 0 | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | Yes (1) | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 0 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 158 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 6 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 2 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | 0 | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (1) | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (1) | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | George Harms Treasurer | PersonNm |
| Phone | 7856235000 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2220 Canterbury | AddressLine1Txt |
| City | Hays | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67601 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (14 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|---|
| Bryce Young | ||||||||
| President | 4.00 | 36.00 | Yes (X) | Yes (X) | $0 | $347,293 | $98,146 | |
| Shae Veach | ||||||||
| Vice President | 4.00 | 36.00 | Yes (X) | Yes (X) | $0 | $230,678 | $72,677 | |
| George Harms | ||||||||
| Secretary/Treasurer | 4.00 | 36.00 | Yes (X) | Yes (X) | $0 | $319,973 | $89,947 | |
| John Jeter MD | ||||||||
| Director | 4.00 | 36.00 | Yes (X) | $0 | $784,745 | $156,635 | ||
| Larry Watts | ||||||||
| Director | 4.00 | 36.00 | Yes (X) | $0 | $303,068 | $57,360 | ||
| David Sanger MD | ||||||||
| Director/Physician | 40.00 | Yes (X) | $234,407 | $0 | $42,722 | |||
| John Settle | ||||||||
| Director | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| John Haas | ||||||||
| Director | 4.00 | Yes (X) | $0 | $0 | $0 | |||
| John Hughes | ||||||||
| Administrator | 40.00 | Yes (X) | $0 | $129,998 | $21,301 | |||
| Amanda Bickle | ||||||||
| APRN | 40.00 | $162,681 | $0 | $29,345 | Yes (X) | |||
| Debbie Tomlinson | ||||||||
| APRN | 40.00 | $167,431 | $0 | $12,744 | Yes (X) | |||
| Cristine Goodwin | ||||||||
| Physician | 30.00 | $150,135 | $0 | $29,681 | Yes (X) | |||
| Christian Whittington | ||||||||
| Physician | 40.00 | $251,504 | $0 | $44,075 | Yes (X) | |||
| Dusty Atterbury | ||||||||
| Physician Assistant | 40.00 | $119,267 | $0 | $33,312 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $1,085,425 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $2,115,755 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $687,945 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 9 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (1) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (4 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| Hays Medical Center | |||||
| 2220 Canterbury Drive | Hays | KS | 67601 | Contract Services | $2,957,606 |
| Quest Diagnostics | |||||
| PO Box 14730 | St Louis | MO | 63150 | Lab Services | $192,267 |
| Anesthesiologist Associates of Hays | |||||
| PO Box 821 | Hays | KS | 67601 | Anethesia Services | $154,824 |
| Docs Who Care | |||||
| 1337 S Foundatin Drive | Olathe | KS | 66061 | Emergency Room Physician Services | $108,554 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 4 | CntrctRcvdGreaterThan100KCnt |
| Related Organizations | $283,287 | RelatedOrganizationsAmt |
| Government Grants | $57,276 | GovernmentGrantsAmt |
| Noncash Contributions | $86,726 | NoncashContributionsAmt |
| Total Contributions | $340,563 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (5 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| Net patient service revenue | 622000 | $17,214,947 | $17,214,947 |
| 340b drug program | 900099 | $535,237 | $535,237 |
| Outreach therapy services | 900099 | $79,657 | $79,657 |
| EHR incentive payments | 900099 | $75,517 | $75,517 |
| Lab fairs | 900099 | $30,298 | $30,298 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $17,935,656 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $7,026 | TotalRevenueColumnAmt |
| Exclusion | $7,026 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,100 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $2,100 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $2,100 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $2,100 | RelatedOrExemptFuncIncomeAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Meals sold to employees and guest | 722210 | $163,376 | $163,376 | |
| Other miscellaneous revenue | 900099 | $21,223 | $21,223 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $184,599 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $18,469,944 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $17,958,979 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $170,402 | ExclusionAmt |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $283,287 | TotalAmt |
| Program Services | $283,287 | ProgramServicesAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $425,375 | TotalAmt |
| Program Services | $260,720 | ProgramServicesAmt |
| Management And General | $164,655 | ManagementAndGeneralAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,260,737 | TotalAmt |
| Program Services | $5,678,856 | ProgramServicesAmt |
| Management And General | $581,881 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $272,400 | TotalAmt |
| Program Services | $247,413 | ProgramServicesAmt |
| Management And General | $24,987 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $822,896 | TotalAmt |
| Program Services | $754,627 | ProgramServicesAmt |
| Management And General | $68,269 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $453,960 | TotalAmt |
| Program Services | $404,968 | ProgramServicesAmt |
| Management And General | $48,992 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,297,752 | TotalAmt |
| Management And General | $2,297,752 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $16,509 | TotalAmt |
| Management And General | $16,509 | ManagementAndGeneralAmt |
Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $44,186 | TotalAmt |
| Management And General | $44,186 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,488,550 | TotalAmt |
| Program Services | $1,242,402 | ProgramServicesAmt |
| Management And General | $246,148 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $68,343 | TotalAmt |
| Program Services | $3,067 | ProgramServicesAmt |
| Management And General | $65,276 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $58,538 | TotalAmt |
| Program Services | $28,198 | ProgramServicesAmt |
| Management And General | $30,340 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $88,947 | TotalAmt |
| Program Services | $53,376 | ProgramServicesAmt |
| Management And General | $35,571 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $360,181 | TotalAmt |
| Program Services | $300,427 | ProgramServicesAmt |
| Management And General | $59,754 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,930 | TotalAmt |
| Program Services | $11,148 | ProgramServicesAmt |
| Management And General | $4,782 | ManagementAndGeneralAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,072 | TotalAmt |
| Program Services | $6,072 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $91,277 | TotalAmt |
| Program Services | $54,766 | ProgramServicesAmt |
| Management And General | $36,511 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| Pharmaceuticals | $879,744 | $879,744 | |
| Medical supplies | $407,657 | $407,657 | |
| Service contracts | $243,820 | $231,297 | $12,523 |
| Dietary | $169,894 | $169,894 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $570,932 | TotalAmt |
| Program Services | $421,910 | ProgramServicesAmt |
| Management And General | $149,022 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $15,326,987 | TotalAmt |
| Program Services | $11,439,829 | ProgramServicesAmt |
| Management And General | $3,887,158 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $432,300 | BOYAmt |
| EOY | $518,161 | EOYAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,592,523 | BOYAmt |
| EOY | $4,775,255 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,745,586 | BOYAmt |
| EOY | $1,720,178 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $280,864 | BOYAmt |
| EOY | $260,760 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $136,365 | BOYAmt |
| EOY | $160,630 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,601,234 | BOYAmt |
| EOY | $1,806,770 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,788,872 | BOYAmt |
| EOY | $9,241,754 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,054,368 | BOYAmt |
| EOY | $1,024,291 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,655,396 | BOYAmt |
| EOY | $6,994,288 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $6,709,764 | BOYAmt |
| EOY | $8,018,579 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,079,108 | BOYAmt |
| EOY | $217,338 | EOYAmt |
Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| EOY | $1,005,837 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,079,108 | BOYAmt |
| EOY | $1,223,175 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $7,788,872 | BOYAmt |
| EOY | $9,241,754 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | Yes (X) | InfoInScheduleOPartXIInd |
| Reconcilation Revenue Expnss | $3,142,957 | ReconcilationRevenueExpnssAmt |
| Other Changes In Net Assets | -$2,998,890 | OtherChangesInNetAssetsAmt |
| Info In Schedule O Part XII | Yes (X) | InfoInScheduleOPartXIIInd |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Consol And Sep Basis Fincl Stmt | Yes (X) | ConsolAndSepBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Contributor Information ContributorInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor | RESTRICTED | ContributorNum |
Contributor Business Name ContributorBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor US Address ContributorUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Contributions | RESTRICTED | TotalContributionsAmt |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | 0 | VolunteersInd |
| Paid Staff Or Management | 0 | PaidStaffOrManagementInd |
| Media Advertisements | 0 | MediaAdvertisementsInd |
| Mailings Members | 0 | MailingsMembersInd |
| Publications Or Broadcast | 0 | PublicationsOrBroadcastInd |
| Grants Other Organizations | Yes (1) | GrantsOtherOrganizationsInd |
| Grants Other Organizations | $3,030 | GrantsOtherOrganizationsAmt |
| Direct Contact Legislators | 0 | DirectContactLegislatorsInd |
| Rallies Demonstrations | 0 | RalliesDemonstrationsInd |
| Other Activities | 0 | OtherActivitiesInd |
| Total Lobbying Expenditures | $3,030 | TotalLobbyingExpendituresAmt |
| Not Described Section501c3 | 0 | NotDescribedSection501c3Ind |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Part II-B, Line 1: | FormAndLineReferenceDesc |
| Explanation | Pawnee 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
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $934,796 | BeginningYearBalanceAmt |
| Investment Earnings Or Losses | $234,981 | InvestmentEarningsOrLossesAmt |
| End Year Balance | $1,169,777 | EndYearBalanceAmt |
CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $372,016 | BeginningYearBalanceAmt |
| Contributions | $1,515,575 | ContributionsAmt |
| Other Expenditures | $952,795 | OtherExpendituresAmt |
| End Year Balance | $934,796 | EndYearBalanceAmt |
CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Beginning Year Balance | $142,777 | BeginningYearBalanceAmt |
| Contributions | $408,437 | ContributionsAmt |
| Other Expenditures | $179,198 | OtherExpendituresAmt |
| End Year Balance | $372,016 | EndYearBalanceAmt |
CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributions | $1,026,228 | ContributionsAmt |
| Other Expenditures | $883,451 | OtherExpendituresAmt |
| End Year Balance | $142,777 | EndYearBalanceAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Term Endowment Balance EOY | 1.00000 | TermEndowmentBalanceEOYPct |
| Endowments Held Unrelated Org | 0 | EndowmentsHeldUnrelatedOrgInd |
| Endowments Held Related Org | Yes (1) | EndowmentsHeldRelatedOrgInd |
| Related Org List Sch R | Yes (1) | RelatedOrgListSchRInd |
| Total Book Value Land Buildings | $0 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (3 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| Estimated third-party payor settlements | $426,000 |
| Other receivables | $157,595 |
| Beneficial interest in net assets of foundation | $1,223,175 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $1,806,770 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)
| DescDesc | AmtAmt |
|---|---|
| Due to Pawnee County | $6,702,379 |
| Due to Hays Medical Center, Inc. | $211,909 |
| Estimated third-party payor settlements | $80,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $6,994,288 | TotalLiabilityAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $18,614,010 | TotalRevEtcAuditedFinclStmtAmt |
| Other Revenue | $144,066 | OtherRevenueAmt |
| Revenue Not Reported | $144,066 | RevenueNotReportedAmt |
| Revenue Subtotal | $18,469,944 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $18,469,944 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $15,043,700 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Not Reported | $0 | ExpensesNotReportedAmt |
| Expenses Subtotal | $15,043,700 | ExpensesSubtotalAmt |
| Other Expenses Not Included | $283,287 | OtherExpensesNotIncludedAmt |
| Expenses Not Rpt Fincl Stmt | $283,287 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $15,326,987 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (4 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 X, Line 2: | Management is not aware of any uncertainties in income tax positions. |
| Part XI, Line 2d - Other Adjustments: | Change in beneficial interest in net assets of Foundation 144,066. |
| Part XII, Line 4b - Other Adjustments: | Transfer of equipment to Pawnee County 283,287. |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
Free Care Oth Percentage FreeCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Free Care Other | 130.000000000000 | FreeCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
| Percent400 | Yes (X) | Percent400Ind |
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | 0 | ExpensesExceedBudgetInd |
| Annual Community Bnft Report | 0 | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $168,964 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $168,964 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01100 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $948,092 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $334,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $613,553 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.04000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,117,056 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $334,539 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $782,517 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05100 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,821,509 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,742,924 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,078,585 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07040 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $5,420 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $5,420 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00040 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $2,826,929 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,742,924 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,084,005 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07080 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $3,943,985 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $2,077,463 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $1,866,522 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.12180 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | Yes (1) | BadDebtExpenseReportedInd |
| Bad Debt Expense | $606,288 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $42,440 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $8,536,326 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $8,728,901 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$192,575 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | 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 | Pawnee Valley Community Hospital Inc | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 923 Carroll Avenue | AddressLine1Txt |
| City | Larned | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| 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 | Pawnee Valley Community Hospital Inc | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | 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 |
| Information Gaps | Yes (X) | InformationGapsInd |
| CHNA Conducted | 14 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (1) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.pawneevalleyhospital.com/ | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | http://www.pawneecountykansas.com/ | OtherWebsiteURLTxt |
| Paper Copy Public Inspection | Yes (X) | PaperCopyPublicInspectionInd |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 14 | ImplementationStrategyAdptYr |
| Strategy Posted Website | 0 | StrategyPostedWebsiteInd |
| Strategy Attached | Yes (1) | StrategyAttachedInd |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 130.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 400.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| 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 (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://http://www.pawneevalleyhospital.com/ | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | http://http://www.pawneevalleyhospital.com/ | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | http://http://www.pawneevalleyhospital.com/ | 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 |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| FAP Notified Upon Admission | Yes (X) | FAPNotifiedUponAdmissionInd |
| FAP Notified Before Discharge | Yes (X) | FAPNotifiedBeforeDischargeInd |
| FAP Notified All Patients | Yes (X) | FAPNotifiedAllPatientsInd |
| Documented Elig Determination | Yes (X) | DocumentedEligDeterminationInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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:Build and/or develop Exercise Facilities was #1 on the health needs Priorities- with 37 votes, 22.8%. Pawnee Valley Community Hospital supported USD #495 in 2015 to pass a bond for a new elementary school and renovations to the high school. Because of the CHNA and the school districts involvement and listening to the needs of Pawnee County, they have incorporated an exercise facility, in the renovations to the high school, which will be open to the public. The wellness center is expected to be open to the public August 2017.PVCH once again had their annual fun run in June 2016. The money raised was used to help purchase equipment for high school athletes. The 2017 fun run will be geared towards younger children. The plan is to have an obstacle course along with a walk and run. The proceeds from the event will go towards purchasing gym/PE equipment for the new elementary school. LA Psycle, opened its doors in 2015 for the community to sign up for spin classes. This program continues to grow. Pride Committee added a second walking trail to the community in 2015. This walking trail goes around Camp Pawnee. PVCH staff has done community presentations for heart disease awareness. In February 2016 at half time of a local basketball game, hospital staff with the help of Larned high school students did a "Flash Mob" to promote CPR. Expand Oncology Treatment was #2 on the health needs priorities - with 25 votes, 15.4%. In order to implement an effective oncology service line, many factors must come together. 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. We have had the great fortune of being able to partner with the Dreiling/Schmidt Cancer Institute at HaysMed. It is vitally important to maintain the relationship with both primary care medical staff as well as specialists. This will ensure consistent continuity for our patients as they move through the continuum of their cancer treatment course. 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.Improve Quality Air Flow was #3 on health needs priorities - with 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.Reducing Drug/Alcohol Abuse was #4 on health needs priorities - with 20 votes, 12.3%. The Pawnee County Health Department and Pawnee Valley Community Hospital continue 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 Hospital2. Law Enforcement3. EMS4. Pawnee Valley Community Hospital5. The Center for Counseling6. Pawnee County Ministerial Alliance7. Community Corrections8. Family Crisis Center9. County Attorney10. Public Health11. 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. Provide Healthy Food Options was #5 on health needs priorities - with 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. In 2016 a healthy snack and drink vending machine was added to the ER waiting room. Candy bars and sweet snacks have been eliminated from the grab and go section of the cafeteria. We continue to offer diabetic education classes and have increased the class to a two day session. 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 provides educational booths on healthy food at the Pawnee County fair each summer. We provide clients with appropriate educational materials on healthy eating and refer to food and nutrition education programs such as WIC. We also refer to the local food bank and participate in the Bob Box program through the Kansas Food Bank and refer children and families to the summer lunch program and the backpack buddies program. Schools are doing a good job with providing healthy food options at concession stands as well as local convenience stores readily have healthy foods in accessible locations in the stores to encourage fresh fruits and healthy foods.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. Increase Access to Home Health/Hospice was #6 on health needs priorities with 11 votes, 6.8%. Continuing to look at the feasibility and what we can do to increase access to home health/hospice. We will continue to promote existing agencies and educate patients of services available. PVCH has partnered with the Kansas Heart and Stroke Collaborative and 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. In August 2016 a contract from Gentiva Hospice was reviewed by the Utilization Review Committee. It was determined that it is not financially feasible at this time but will be re-evaluated in the future.Offer Nursing Home - Dementia Services was #7 on health needs priorities with 11 votes, 6.8%. Country Living Assisted Living facility in Pawnee County recently opened an addition to their memory care unit adding 4 additional beds for a total of 12 beds dedicated to dementia patients. We will continue to work on identifying nursing home dementia services in Pawnee County and educate entities and individuals who may be in need of these services. |
| 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. |
| Pawnee Valley Community Hospital, Inc. | Part V, Section B, Line 22d: The hospital used the look-back method based on actual paid claims by Medicare and all other private health insurers paying claims to the hospital. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | 1 - Pawnee Valley Medical Associates | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 713 W 11th St | AddressLine1Txt |
| City | Larned | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | Family Medicine | FacilityTxt |
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| 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 $1,949,466 of expenses attributable to physician clinics that have net operating losses. |
| Part III, Line 4: | The footnote from the hospital's financial statements follows:Accounts receivable are reduced by an allowance for uncollectible accounts. In evaluating the collectability of accounts receivable, the Hospital analyzes its past history and identifies trends for each of its major payor sources of revenue to estimate the appropriate allowance for uncollectible accounts and provision for bad debts. Management regularly reviews data about these major payor sources of revenue in evaluating the sufficiency of the allowance for uncollectible accounts. For receivables associated with services provided to patients who have third-party coverage, the Hospital analyzes contractually due amounts and provides an allowance for uncollectible accounts and a provision for bad debts, if necessary (for example, for expected uncollectible deductibles and copayments on accounts for which the third-party payor has not yet paid, or for payors who are known to be having financial difficulties that make the realization of amounts due unlikely). For receivables associated with self-pay patients (which includes both patients without insurance and patients with deductible and copayment balances due for which third-party coverage exists for part of the bill), the Hospital records a significant provision for bad debts in the period of service on the basis of its past experience, which indicates that many patients are unable or unwilling to pay the portion of their bill for which they are financially responsible. The difference between the standard rates (or the discounted rates if negotiated) and the amounts actually collected after all reasonable collection efforts have been exhausted is charged off against the allowance for uncollectible accounts.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 3:Methodology for bad debt cost for financial assistance eligible: The estimate for the amount of bad debt expense attributable to patients eligible under the FAP is based upon the experience of a related organization. |
| 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, 2016. |
| 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 not a part of an affiliated health care system. |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Grant Records Maintained | 0 | GrantRecordsMaintainedInd |
Recipient Table RecipientTable
Recipient Business Name RecipientBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Pawnee County | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 715 Broadway | AddressLine1Txt |
| City | Larned | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67550 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient EIN | 486007542 | RecipientEIN |
| Non Cash Assistance | $283,287 | NonCashAssistanceAmt |
| Valuation Method Used | Cash paid | ValuationMethodUsedDesc |
| Non Cash Assistance | Transfer of equipment and landhold improvements | NonCashAssistanceDesc |
| Purpose Of Grant | Pawnee 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 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total501c3 Org | 1 | Total501c3OrgCnt |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | 0 | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | Yes (1) | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | 0 | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | 0 | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | 0 | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | Yes (1) | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | Yes (1) | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | 0 | AnyNonFixedPaymentsInd |
| Initial Contract Exception | 0 | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (12 entries)
| TitleTitleTxt | Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt | Bonus Filing OrganizationBonusFilingOrganizationAmount | Bonus Related OrganizationsBonusRelatedOrganizationsAmt | Other Compensation Filing OrgOtherCompensationFilingOrgAmt | Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt | Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt | Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Bryce Young | ||||||||||||||
| President | $0 | $273,065 | $0 | $74,228 | $0 | $0 | $0 | $68,431 | $0 | $29,715 | $0 | $445,439 | $0 | $0 |
| Shae Veach | ||||||||||||||
| Vice President | $0 | $189,274 | $0 | $37,943 | $0 | $3,461 | $0 | $45,732 | $0 | $26,945 | $0 | $303,355 | $0 | $0 |
| George Harms | ||||||||||||||
| Secretary/Treasurer | $0 | $252,293 | $0 | $67,680 | $0 | $0 | $0 | $63,797 | $0 | $26,150 | $0 | $409,920 | $0 | $0 |
| John Jeter MD | ||||||||||||||
| Director | $0 | $554,238 | $0 | $208,446 | $0 | $22,061 | $0 | $130,202 | $0 | $26,433 | $0 | $941,380 | $0 | $0 |
| Larry Watts | ||||||||||||||
| Director | $0 | $215,637 | $0 | $87,431 | $0 | $0 | $0 | $42,730 | $0 | $14,630 | $0 | $360,428 | $0 | $0 |
| David Sanger MD | ||||||||||||||
| Director/Physician | $216,074 | $0 | $0 | $0 | $18,333 | $0 | $14,185 | $0 | $28,537 | $0 | $277,129 | $0 | $0 | $0 |
| John Hughes | ||||||||||||||
| Administrator | $0 | $121,346 | $0 | $8,652 | $0 | $0 | $0 | $2,628 | $0 | $18,673 | $0 | $151,299 | $0 | $0 |
| Amanda Bickle | ||||||||||||||
| APRN | $123,234 | $0 | $167 | $0 | $39,280 | $0 | $3,926 | $0 | $25,419 | $0 | $192,026 | $0 | $0 | $0 |
| Debbie Tomlinson | ||||||||||||||
| APRN | $145,839 | $0 | $251 | $0 | $21,341 | $0 | $10,133 | $0 | $2,611 | $0 | $180,175 | $0 | $0 | $0 |
| Cristine Goodwin | ||||||||||||||
| Physician | $148,148 | $0 | $0 | $0 | $1,987 | $0 | $1,479 | $0 | $28,202 | $0 | $179,816 | $0 | $0 | $0 |
| Christian Whittington | ||||||||||||||
| Physician | $205,235 | $0 | $0 | $0 | $46,269 | $0 | $15,192 | $0 | $28,883 | $0 | $295,579 | $0 | $0 | $0 |
| Dusty Atterbury | ||||||||||||||
| Physician Assistant | $89,767 | $0 | $167 | $0 | $29,333 | $0 | $7,564 | $0 | $25,748 | $0 | $152,579 | $0 | $0 | $0 |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Part I, Line 3 | A 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 4b | Contributions to the plan: John Jeter, M.D. - $114,302 Bryce Young - $52,531 George Harms - $47,897 Shae Veach - $33,292 Larry Watts - $26,830 |
| Part I, Line 6 | A 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 M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | Healing garden | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $86,726 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | Cash paid | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (9 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Form 990, Part VI, Section A, line 6 | The 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 7a | The 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 7b | HaysMed 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 11 | Form 990 was reviewed with the Board members prior to filing. |
| Form 990, Part VI, Section B, line 12c | Officers, 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 15 | The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members. |
| Form 990, Part VI, Section C, line 19 | These documents are not made available to the public. |
| Form 990, Part XI, line 9: | Increase in amount due to Pawnee County -1,355,277. Transfers to Pawnee County -1,787,679. Change in beneficial interest in net assets of foundation 144,066. |
| Form 990. Part XII, Line 2c | Hays 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 (3 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | EINEIN | Primary ActivitiesPrimaryActivitiesTxt | Legal Domicile StateLegalDomicileStateCd | Exempt Code SectionExemptCodeSectionTxt | Public Charity StatusPublicCharityStatusTxt | Controlled OrganizationControlledOrganizationInd |
|---|---|---|---|---|---|---|---|---|---|
| HaysMed Partners Inc | |||||||||
| 2220 Canterbury Dr | Hays | KS | 67601 | 270877152 | Owns management contract for Pawnee Valley Community Hospital | KS | 501(c)(3) | 170(b)(1)(A)(iii) | 0 |
| Hays Medical Center Inc | |||||||||
| 2220 Canterbury Dr | Hays | KS | 67601 | 480559088 | Hospital | KS | 501(c)(3) | 170(b)(1)(A)(iii) | 0 |
| Pawnee Valley Community Hospital Foundation | |||||||||
| 923 Carroll Ave | Larned | KS | 67550 | 455333776 | Support the activities and mission of the Hospital | KS | 501(c)(3) | 509(A)(3), Type I | 0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | 0 | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | 0 | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | Yes (1) | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | 0 | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | Yes (1) | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | 0 | DivRelatedOrganizationInd |
| Asset Sale To Other Org | 0 | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | 0 | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | 0 | AssetExchangeInd |
| Rental Of Facilities To Oth Org | 0 | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (1) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | Yes (1) | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | Yes (1) | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | 0 | SharingOfFacilitiesInd |
| Paid Employees Sharing | Yes (1) | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | Yes (1) | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | Yes (1) | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | 0 | TransferToOtherOrgInd |
| Transfer From Other Org | 0 | TransferFromOtherOrgInd |