COMMUNITY HEALTHCARE SYSTEM INC: Form 990, tax year 2015
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY HEALTHCARE SYSTEM INC (EIN 48-1020227)
- Tax period
- 2015-04-01 to 2016-03-31
- Filed
- 2017-02-15
- IRS object ID
- 201730469349303153
- 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 ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2017-02-15T13:28:39-08:00 | ReturnTs |
| Tax Period End | 2016-03-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | GEORGE BOWERMAN & NOEL PA | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 301 N MAIN SUITE 1350 | AddressLine1Txt |
| City | WICHITA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 67202 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2015-04-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 481020227 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HEALTHCARE SYSTEM INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 7858895036 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 WEST 8TH STREET | AddressLine1Txt |
| City | ONAGA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66521 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | TODD WILLERT | PersonNm |
| Person Title | CHIEF EXECUTIVE OFFICER | PersonTitleTxt |
| Phone | 7858895036 | PhoneNum |
| Signature | 2017-02-15 | SignatureDt |
| Discuss With Paid Preparer | Yes (true) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | PAUL R BOWERMAN | PreparerPersonNm |
| Phone | 3162626277 | PhoneNum |
| Preparation | 2017-02-15 | 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 | TODD WILLERT | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 WEST 8TH ST | AddressLine1Txt |
| City | ONAGA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66521 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $31,708,240 | GrossReceiptsAmt |
| Group Return For Affiliates | false | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | http://www.chcsks.org | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1986 | FormationYr |
| Legal Domicile State | KS | LegalDomicileStateCd |
| Activity Or Mission | Community HealthCare System,in partnership with our medical staff, has a long standing tradition in providing quality and compassionate health care to rural commmunities of NE Kansas and all our patients. Our mission is to enrich the health and lives of the people we serve. | ActivityOrMissionDesc |
| Voting Members Governing Body | 7 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 7 | VotingMembersIndependentCnt |
| Total Employee | 570 | TotalEmployeeCnt |
| Total Volunteers | 0 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| PY Contributions Grants | $79,341 | PYContributionsGrantsAmt |
| CY Contributions Grants | $48,236 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $28,593,522 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $30,906,650 | CYProgramServiceRevenueAmt |
| PY Investment Income | $35,354 | PYInvestmentIncomeAmt |
| CY Investment Income | $35,195 | CYInvestmentIncomeAmt |
| PY Other Revenue | $668,666 | PYOtherRevenueAmt |
| CY Other Revenue | $718,159 | CYOtherRevenueAmt |
| PY Total Revenue | $29,376,883 | PYTotalRevenueAmt |
| CY Total Revenue | $31,708,240 | CYTotalRevenueAmt |
| CY Grants And Similar Paid | $0 | CYGrantsAndSimilarPaidAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $20,811,560 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $20,917,581 | CYSalariesCompEmpBnftPaidAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $5,867 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $10,039,381 | PYOtherExpensesAmt |
| CY Other Expenses | $10,582,886 | CYOtherExpensesAmt |
| PY Total Expenses | $30,850,941 | PYTotalExpensesAmt |
| CY Total Expenses | $31,500,467 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | -$1,474,058 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $207,773 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $11,948,788 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,897,657 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $10,198,671 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $9,939,767 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $1,750,117 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $1,957,890 | NetAssetsOrFundBalancesEOYAmt |
| Mission | Community HealthCare System,in partnership | MissionDesc |
| Significant New Program Srvc | false | SignificantNewProgramSrvcInd |
| Significant Change | false | SignificantChangeInd |
| Expense | $22,930,959 | ExpenseAmt |
| Revenue | $31,431,224 | RevenueAmt |
| Desc | RURAL HOSPITAL PROVIDING MEDICAL CARE ON BOTH AN INPATIENT AND OUTPATIENT BASIS TO AREA RESIDENTS. SERVICES PROVIDED INCLUDE EMERGENCY, OBSTETRICS, SURGICAL, RADIOLOGY, REHABILITATION, RURAL HEALTH CLINIC, HOME HEALTH CARE, AND LONG TERM CARE | Desc |
| Total Program Service Expenses | $22,930,959 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (true) | DescribedInSection501c3Ind |
| Schedule B Required | false | ScheduleBRequiredInd |
| Political Campaign Acty | false | PoliticalCampaignActyInd |
| Lobbying Activities | Yes (true) | LobbyingActivitiesInd |
| Subject To Proxy Tax | false | SubjectToProxyTaxInd |
| Donor Advised Fund | false | DonorAdvisedFundInd |
| Conservation Easements | false | ConservationEasementsInd |
| Collections Of Art | false | CollectionsOfArtInd |
| Credit Counseling | false | CreditCounselingInd |
| Temp Or Permanent Endowments | false | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (true) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | Yes (true) | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | false | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (true) | ReportOtherAssetsInd |
| Report Other Liabilities | Yes (true) | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | false | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (true) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | false | ConsolidatedAuditFinclStmtInd |
| School Operating | false | SchoolOperatingInd |
| Foreign Office | false | ForeignOfficeInd |
| Foreign Activities | false | ForeignActivitiesInd |
| More Than5000 K To Org | false | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividualsInd |
| Professional Fundraising | false | ProfessionalFundraisingInd |
| Fundraising Activities | false | FundraisingActivitiesInd |
| Gaming Activities | false | GamingActivitiesInd |
| Operate Hospital | Yes (true) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (true) | AuditedFinancialStmtAttInd |
| Grants To Organizations | false | GrantsToOrganizationsInd |
| Grants To Individuals | false | GrantsToIndividualsInd |
| Schedule J Required | Yes (true) | ScheduleJRequiredInd |
| Tax Exempt Bonds | false | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | false | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | false | PYExcessBenefitTransInd |
| Loan Outstanding | false | LoanOutstandingInd |
| Grant To Related Person | false | GrantToRelatedPersonInd |
| Business Rln With Org Mem | false | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | false | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | false | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | false | DeductibleNonCashContriInd |
| Deductible Art Contribution | false | DeductibleArtContributionInd |
| Terminate Operations | false | TerminateOperationsInd |
| Partial Liquidation | false | PartialLiquidationInd |
| Disregarded Entity | false | DisregardedEntityInd |
| Related Entity | Yes (true) | RelatedEntityInd |
| Related Organization Ctrl Ent | false | RelatedOrganizationCtrlEntInd |
| Transaction With Control Ent | false | TransactionWithControlEntInd |
| Activities Conducted Prtshp | false | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (true) | ScheduleORequiredInd |
| IRP Document | 58 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (true) | BackupWthldComplianceInd |
| Employee | 570 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (true) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | false | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | false | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | false | TaxablePartyNotificationInd |
| Nondeductible Contributions | false | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | false | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | false | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | false | PayPremiumsPrsnlBnftCntrctInd |
| DAF Excess Business Holdings | false | DAFExcessBusinessHoldingsInd |
| Taxable Distributions | false | TaxableDistributionsInd |
| Distribution To Donor | false | DistributionToDonorInd |
| Indoor Tanning Services | false | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 7 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 7 | IndependentVotingMemberCnt |
| Family Or Business Rln | Yes (true) | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | false | DelegationOfMgmtDutiesInd |
| Change To Org Documents | false | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | false | MembersOrStockholdersInd |
| Election Of Board Members | false | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | false | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (true) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | Yes (true) | MinutesOfCommitteesInd |
| Officer Mailing Address | false | OfficerMailingAddressInd |
| Local Chapters | false | LocalChaptersInd |
| Form990 Provided To Gvrn Body | false | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (true) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (true) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (true) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (true) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (true) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (true) | CompensationProcessCEOInd |
| Compensation Process Other | Yes (true) | CompensationProcessOtherInd |
| Investment In Joint Venture | false | InvestmentInJointVentureInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MONICA HOLTHAUS | PersonNm |
| Phone | 7858895036 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 W 8TH STREET | AddressLine1Txt |
| City | ONAGA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66521 | ZIPCd |
Form990 Part VII Section A Form990PartVIISectionAGrp (17 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | OfficerOfficerInd | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| JUSTIN BOSWELL | |||||||
| CHAIRMAN | 2.00 | Yes (X) | $5,133 | $0 | $0 | ||
| ALAN FISCHER | |||||||
| SECRETARY | 2.00 | Yes (X) | $1,198 | $0 | $0 | ||
| MARK BOUTON | |||||||
| DIRECTOR | 2.00 | Yes (X) | $1,745 | $0 | $0 | ||
| KAREN HARDER | |||||||
| VICE CHAIRMAN | 2.00 | Yes (X) | $2,263 | $0 | $0 | ||
| ROBERT LADNER | |||||||
| DIRECTOR | 2.00 | Yes (X) | $2,150 | $0 | $0 | ||
| JEREMY HEIT | |||||||
| DIRECTOR | 2.00 | Yes (X) | $1,238 | $0 | $0 | ||
| TIM KITE | |||||||
| DIRECTOR | 2.00 | Yes (X) | $630 | $0 | $0 | ||
| TODD WILLERT | |||||||
| CEO | 40.00 | $143,062 | $0 | $15,003 | Yes (X) | ||
| MARCIA WALSH | |||||||
| COO | 40.00 | $159,814 | $0 | $17,553 | Yes (X) | ||
| MONICA HOLTHAUS | |||||||
| CFO | 40.00 | $123,400 | $0 | $11,351 | Yes (X) | ||
| ROSALIND LEWIS | |||||||
| CNO | 40.00 | $123,264 | $0 | $11,817 | Yes (X) | ||
| RODNEY EVANS | |||||||
| CIO | 40.00 | $127,851 | $0 | $15,985 | Yes (X) | ||
| DR DAVID ALLEN | |||||||
| PHYSICIAN | 40.00 | $347,539 | $0 | $24,617 | Yes (X) | ||
| DR THOMAS WALSH | |||||||
| PHYSICIAN | 40.00 | $349,526 | $0 | $23,420 | Yes (X) | ||
| DR DAGOBERTO HEREDIA | |||||||
| PHYSICIAN | 40 | $313,418 | $16,336 | Yes (X) | |||
| DR MARCUS WEISER | |||||||
| PHYSICIAN | 40 | $360,173 | $24,505 | Yes (X) | |||
| DR JOHN KELLEY | |||||||
| PHYSICIAN | 40 | $238,601 | $20,497 | Yes (X) | |||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $2,301,005 | TotalReportableCompFromOrgAmt |
| Total Other Compensation | $181,084 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 23 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | false | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | Yes (true) | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | false | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| ANESTHESIA PROFESSIONALS | |||||
| 2017 W HARBORLIGHT C | WICHITA | KS | 67204 | ANESTHESIA SERVICES | $384,000 |
| STORMONT-VAIL HLTH CARE | |||||
| 1500 SW 10TH STREET | TOPEKA | KS | 66604 | MEDICAL SERVICES | $267,243 |
| BENEFIT MANAGEMENT INC | |||||
| 2015 16TH STREET | GREAT BEND | KS | 67530 | THIRD PARTY ADMINISTRATOR FOR HEALTH INSURANCE | $219,188 |
| ELECTRONIC CONTRACTING CO | |||||
| PO BOX 29195 | LINCOLN | NE | 68529 | ISTALLATION OF NURSE CALL SYSTEMS | $187,026 |
| Quality Systems Inc | |||||
| PO Box 511449 | Los Angeles | CA | 90051 | EHR Computer System Maintenance | $219,035 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 10 | CntrctRcvdGreaterThan100KCnt |
| All Other Contributions | $48,236 | AllOtherContributionsAmt |
| Total Contributions | $48,236 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt |
|---|---|---|
| NET PATIENT SERVICE REVENUE | 621990 | $29,646,226 |
| TAX SUBSIDY | 621990 | $1,260,424 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $30,906,650 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $35,195 | TotalRevenueColumnAmt |
| Exclusion | $35,195 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,300 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $3,300 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $3,300 | TotalRevenueColumnAmt |
| Exclusion | $3,300 | ExclusionAmt |
Other Revenue Misc OtherRevenueMiscGrp (2 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | ExclusionExclusionAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|---|
| Other | 900099 | $190,285 | $190,285 | |
| EHR Meaningful use | 621990 | $524,574 | $524,574 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Revenue Total | $714,859 | OtherRevenueTotalAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $31,708,240 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $31,431,224 | RelatedOrExemptFuncIncomeAmt |
| Exclusion | $228,780 | ExclusionAmt |
Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $691,746 | TotalAmt |
| Program Services | $525,102 | ProgramServicesAmt |
| Management And General | $166,644 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $17,662,732 | TotalAmt |
| Program Services | $13,997,574 | ProgramServicesAmt |
| Management And General | $3,665,158 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $99,923 | TotalAmt |
| Program Services | $79,296 | ProgramServicesAmt |
| Management And General | $20,627 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,213,074 | TotalAmt |
| Program Services | $808,829 | ProgramServicesAmt |
| Management And General | $404,245 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,250,106 | TotalAmt |
| Program Services | $978,882 | ProgramServicesAmt |
| Management And General | $271,224 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $142,747 | TotalAmt |
| Program Services | $73,102 | ProgramServicesAmt |
| Management And General | $69,413 | ManagementAndGeneralAmt |
| Fundraising | $232 | FundraisingAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $125,120 | TotalAmt |
| Program Services | $93,952 | ProgramServicesAmt |
| Management And General | $30,951 | ManagementAndGeneralAmt |
| Fundraising | $217 | FundraisingAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $2,049,360 | TotalAmt |
| Program Services | $323,093 | ProgramServicesAmt |
| Management And General | $1,726,267 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $129,989 | TotalAmt |
| Program Services | $98,272 | ProgramServicesAmt |
| Management And General | $31,717 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Interest InterestGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $187,214 | TotalAmt |
| Program Services | $11,381 | ProgramServicesAmt |
| Management And General | $175,833 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,348,030 | TotalAmt |
| Program Services | $997,541 | ProgramServicesAmt |
| Management And General | $350,489 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $261,682 | TotalAmt |
| Program Services | $150,501 | ProgramServicesAmt |
| Management And General | $111,181 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt | FundraisingFundraisingAmt |
|---|---|---|---|---|
| LEASED EQUIPMENT | $158,253 | $113,448 | $44,805 | $0 |
| MISCELLANEOUS | $155,331 | $18,655 | $134,288 | $2,388 |
| DUES AND SUBSCRIPTIONS | $419,334 | $237,159 | $181,677 | $498 |
| EDUCATION | $127,031 | $90,980 | $35,817 | $234 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $5,478,795 | TotalAmt |
| Program Services | $4,333,192 | ProgramServicesAmt |
| Management And General | $1,143,305 | ManagementAndGeneralAmt |
| Fundraising | $2,298 | FundraisingAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $31,500,467 | TotalAmt |
| Program Services | $22,930,959 | ProgramServicesAmt |
| Management And General | $8,563,641 | ManagementAndGeneralAmt |
| Fundraising | $5,867 | FundraisingAmt |
Cash Non Interest Bearing CashNonInterestBearingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $465,557 | BOYAmt |
| EOY | $636,047 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,300,634 | BOYAmt |
| EOY | $3,724,504 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $756,296 | BOYAmt |
| EOY | $861,267 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $114,972 | BOYAmt |
| EOY | $370,155 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $18,477,864 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $12,752,311 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,772,248 | BOYAmt |
| EOY | $5,725,553 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $40,319 | BOYAmt |
| EOY | $40,319 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $498,762 | BOYAmt |
| EOY | $539,812 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,948,788 | BOYAmt |
| EOY | $11,897,657 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $3,448,085 | BOYAmt |
| EOY | $3,503,745 | EOYAmt |
Deferred Revenue DeferredRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,234,720 | BOYAmt |
| EOY | $733,135 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,422,224 | BOYAmt |
| EOY | $5,609,245 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $93,642 | BOYAmt |
| EOY | $93,642 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,198,671 | BOYAmt |
| EOY | $9,939,767 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,740,072 | BOYAmt |
| EOY | $1,947,845 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $10,045 | BOYAmt |
| EOY | $10,045 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $1,750,117 | BOYAmt |
| EOY | $1,957,890 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $11,948,788 | BOYAmt |
| EOY | $11,897,657 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $207,773 | ReconcilationRevenueExpnssAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | false | AccountantCompileOrReviewInd |
| FS Audited | Yes (true) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | false | AuditCommitteeInd |
| Federal Grant Audit Required | Yes (true) | FederalGrantAuditRequiredInd |
| Federal Grant Audit Performed | Yes (true) | FederalGrantAuditPerformedInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
| Public Support Total170 | $0 | PublicSupportTotal170Amt |
Gross Investment Income170 GrossInvestmentIncome170Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support CY170 | 0 | PublicSupportCY170Pct |
| Public Support Total509 | $0 | PublicSupportTotal509Amt |
| Public Support CY509 | 0 | PublicSupportCY509Pct |
| Investment Income CY | 0 | InvestmentIncomeCYPct |
Schedule C IRS990ScheduleC
| Field | Value | IRS element (for citing) |
|---|---|---|
| Volunteers | false | VolunteersInd |
| Paid Staff Or Management | false | PaidStaffOrManagementInd |
| Media Advertisements | false | MediaAdvertisementsInd |
| Mailings Members | false | MailingsMembersInd |
| Publications Or Broadcast | false | PublicationsOrBroadcastInd |
| Grants Other Organizations | false | GrantsOtherOrganizationsInd |
| Direct Contact Legislators | false | DirectContactLegislatorsInd |
| Rallies Demonstrations | false | RalliesDemonstrationsInd |
| Other Activities | Yes (true) | OtherActivitiesInd |
| Other Activities | $7,170 | OtherActivitiesAmt |
| Total Lobbying Expenditures | $7,170 | TotalLobbyingExpendituresAmt |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt II-B Line 1 | FormAndLineReferenceDesc |
| Explanation | Lobbying portion of Kansas Hospital Association dues. | ExplanationTxt |
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $379,620 | OtherCostOrOtherBasisAmt |
| Book Value | $379,620 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $6,265,458 | OtherCostOrOtherBasisAmt |
| Depreciation | $4,695,114 | DepreciationAmt |
| Book Value | $1,570,344 | BookValueAmt |
Leasehold Improvements LeaseholdImprovementsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $11,832,786 | OtherCostOrOtherBasisAmt |
| Depreciation | $8,057,197 | DepreciationAmt |
| Book Value | $3,775,589 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $5,725,553 | TotalBookValueLandBuildingsAmt |
Other Securities OtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | ASSETS WHOSE USE IS LIMITED-CD | Desc |
| Book Value | $40,319 | BookValueAmt |
| Method Valuation | C | MethodValuationCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Securities | $40,319 | TotalBookValueSecuritiesAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| DUE FROM THIRD PARTY PAYER | $361,097 |
| DEFERRED FINANCING COSTS | $178,715 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $539,812 | TotalBookValueOtherAssetsAmt |
Other Liabilities Org OtherLiabilitiesOrgGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Desc | DUE TO COMMUNITY HOSPITAL DISTRICT | Desc |
| Amt | $93,642 | Amt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Liability | $93,642 | TotalLiabilityAmt |
| Total Rev Etc Audited Fincl Stmt | $31,708,240 | TotalRevEtcAuditedFinclStmtAmt |
| Revenue Subtotal | $31,708,240 | RevenueSubtotalAmt |
| Total Revenue Per Form990 | $31,708,240 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $31,500,467 | TotExpnsEtcAuditedFinclStmtAmt |
| Expenses Subtotal | $31,500,467 | ExpensesSubtotalAmt |
| Total Expenses Per Form990 | $31,500,467 | TotalExpensesPerForm990Amt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (true) | FinancialAssistancePolicyInd |
| Written Policy | Yes (true) | WrittenPolicyInd |
| FPG Reference Free Care | Yes (true) | FPGReferenceFreeCareInd |
| Percent200 | Yes (X) | Percent200Ind |
| FPG Reference Discounted Care | Yes (true) | FPGReferenceDiscountedCareInd |
| Percent200 D | Yes (X) | Percent200DInd |
| Free Care Medically Indigent | Yes (true) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (true) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (true) | ExpensesExceedBudgetInd |
| Unable To Provide Care | false | UnableToProvideCareInd |
| Annual Community Bnft Report | false | AnnualCommunityBnftReportInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $162,745 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $162,745 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00520 | TotalExpensePct |
Unreimbursed Medicaid UnreimbursedMedicaidGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,509,761 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,171,408 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $338,353 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01070 | TotalExpensePct |
Unreimbursed Costs UnreimbursedCostsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Expense | 0.00000 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,672,506 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,171,408 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $501,098 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.01590 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $292,487 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $216,250 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $76,237 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00240 | TotalExpensePct |
Health Professions Education HealthProfessionsEducationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Expense | 0.00000 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $12,885,499 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,705,196 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,180,303 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06920 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Expense | 0.00000 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,177,986 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $10,921,446 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,256,540 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.07160 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $14,850,492 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $12,092,854 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $2,757,638 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.08750 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense | $563,382 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $422,537 | BadDebtExpenseAttributableAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cost To Charge Ratio | Yes (X) | CostToChargeRatioInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (true) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (true) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ONAGA | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 WEST 8TH | AddressLine1Txt |
| City | ONAGA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66521 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL ONAGA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | false | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | false | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (true) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (true) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | false | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | Yes (true) | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (true) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | http://www.chcsks.org | OwnWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (true) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (true) | StrategyPostedWebsiteInd |
| Strategy Website URL | http://www.chcsks.org/about-community-needs.html | StrategyWebsiteURLTxt |
| Strategy Attached | false | StrategyAttachedInd |
| Organization Incur Excise Tax | false | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (true) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 2.00000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 2.00000000 | FPGFamilyIncmLmtDscntCarePct |
| Income Level Criteria | Yes (X) | IncomeLevelCriteriaInd |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Explained Basis | Yes (true) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (true) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Includes Publicity Measures | Yes (true) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | http://www.chcsks.org/patients-financial.html | FAPAvailableOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP Notice Displayed | Yes (X) | FAPNoticeDisplayedInd |
| FAP Actions On Nonpayment | Yes (true) | FAPActionsOnNonpaymentInd |
| Permit Other Actions | Yes (X) | PermitOtherActionsInd |
| Collection Activities | false | 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 (true) | NondisEmergencyCarePolicyInd |
| Other Method Used | Yes (X) | OtherMethodUsedInd |
| Amounts Generally Billed | false | AmountsGenerallyBilledInd |
| Gross Charges | false | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (2 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COMMUNITY HOSPITAL, ONAGA Pt V Line 6b | Pottawatomie County Health Department |
| COMMUNITY HOSPITAL, ONAGA Pt V Line 19d | The System assists those patients who are uninsured or have non-covered services by providing a 20% discount for the hospital, emergency room, anesthesia, clinic, home health and for medically needed durable medical equipment. Further, discounts are also available under the System's financial assistance policy. |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 5 | FacilityNum |
Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp
Oth Hlth Care Fclts OthHlthCareFcltsGrp (5 entries)
| Address Line1USAddress/AddressLine1Txt | CityUSAddress/CityNm | State AbbreviationUSAddress/StateAbbreviationCd | ZIPUSAddress/ZIPCd | FacilityFacilityTxt |
|---|---|---|---|---|
| Eastridge Nursing Facility | ||||
| 600 1st Street | Centralia | KS | 66415 | Long-term Care |
| Downtown Medical Clinic | ||||
| 112 East 2nd Street | Frankfort | KS | 66427 | Rural Health Clinic |
| Holton Family Health Clinic | ||||
| 1603 West 4th Street | Holton | KS | 66536 | Rural Health Clinic |
| Westmoreland Medical Clinic | ||||
| 208 North 1st Street | Westmoreland | KS | 66549 | Medical Clinic |
| Family Practice Medical Clinic | ||||
| 6221 5th Street | Corning | KS | 66417 | Medical Clinic |
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt I Line 7 | The total cost to charge ratio derived from the Medicare cost report was applied to gross charges to compute the community benefit expense for charity care and unreimbursed Medicaid. The community benefit expense for community health improvement services and subsidized health services was obtained from the total costs per Worksheet B on the Medicare cost report with adjustments made to exclude amounts otherwise included as charity care, bad debts or unreimbursed Medicaid. |
| Pt I Line 7g | Subsidized health services include the cost attibutable to physician clinics operated in rural communities and designated as Rural Health Clinics. |
| Pt III Line 2 | The total cost to charge ratio derived from the Medicare cost report was applied to the gross charges written off (net of collections) to compute the community benefit expense for bad debts. |
| Pt III Line 3 | The cost of providing services to those with the inability to pay or where collection efforts are not successful are included as community benefit expense to represent the full costs of providing services to the community. |
| Pt III Line 4 | FROM FINANCIAL STATEMENT FOOTNOTE-IF THE PATIENT IS UNABLE TO PAY THE FULL AMOUNT AT THE TIME THE PATIENT IS BILLED, THE SYSTEM NEGOTIATES A PAYMENT PLAN WHEREBY MONTHLY PAYMENTS ARE MADE BY THE PATIENT ON THE ACCOUNT. ACCOUNTS ARE CONSIDERED DELINQUENT AND SUBSEQUENTLY WRITTEN OFF AS BAD DEBTS BASED ON INDIVIDUAL CREDIT EVALUATION AND SPECIFIC CIRCUMSTANCES OF THE ACCOUNT. IF FUTURE DEFAULT RATES ON ACCOUNTS RECEIVABLE DIFFER FROM THOSE CURRENTLY ANTICIPATED, THE SYSTEM MAY HAVE TO ADJUST ITS A |
| Pt III Line 8 | Medicare allowable cost per the Medicare cost report. Costs are apportioned to the Medicare program based on departmental cost to charge ratios for ancillary services and patient days for inpatient and swing bed services. |
| Pt III Line 9b | If collection efforts determine that a patient may qualify for financial assistance, the financial assistance process is initiated including attempts to obtain the documentation required under the policy. Collection and financial assistance policies are consistently applied to all patients. Indigent patient's balances adjusted according to Medicare bad debt policies. |
| Pt VI Line 2 | Informal needs assessment performed on an ongoing basis. Hospital personnel identify needs based on admissions and discharge data. Needs are also identified by requests from surrounding rural communities. Formal needs assessment is in process. |
| Pt VI Line 3 | The availability of financial assistance is stated in collection letters sent to patients. Collections staff also inform uninsured patients of financial assistance available and policies are addressed verbally at admission with clinic patients. |
| Pt VI Line 4 | The System provides inpatient, outpatient, swing bed, physician clinic, home health, and long-term nursing care to patients primarily as sole provider to rural areas in the Pottawatomie, Jackson and Nemaha counties area. |
| Pt VI Line 5 | ALL OF THE ORGANIZATION'S GOVERNING BODY IS COMPRISED OF INDIVIDUALS WHO RESIDE IN THE ORGANIZATION'S PRIMARY SERVICES AREA. THE SYSTEM IS A NON-PROFIT ORGANIZATION CREATED BY THE BOARD OF DIRECTORS OF, AND IS CONSIDERED A COMPONENT UNIT OF COMMUNITY HOSPITA DISTRICT NO. 1 OF POTTAWATOMIE, JACKSON, AND NEMAHA COUNTIES, KANSAS TO OPERATE, CONTROL, AND MANAGE ALL MATTERS CONCERNING HEALTHCARE SERVICES IN ITS SERVICE AREA PURSUANT TO A LEASE AGREEMENT BETWEEN THE HOSPITAL DISTRICT AND THE SYSTEM. T |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Substantiation Required | Yes (true) | SubstantiationRequiredInd |
| Written Employment Contract | Yes (X) | WrittenEmploymentContractInd |
| Board Or Committee Approval | Yes (X) | BoardOrCommitteeApprovalInd |
| Severance Payment | false | SeverancePaymentInd |
| Supplemental Nonqual Rtr Plan | false | SupplementalNonqualRtrPlanInd |
| Equity Based Comp Arrngm | false | EquityBasedCompArrngmInd |
| Comp Based On Revenue Of Flng Org | Yes (true) | CompBasedOnRevenueOfFlngOrgInd |
| Comp Bsd On Rev Related Orgs | false | CompBsdOnRevRelatedOrgsInd |
| Comp Bsd Net Earns Flng Org | false | CompBsdNetEarnsFlngOrgInd |
| Comp Bsd Net Earns Rltd Orgs | false | CompBsdNetEarnsRltdOrgsInd |
| Any Non Fixed Payments | false | AnyNonFixedPaymentsInd |
| Initial Contract Exception | false | InitialContractExceptionInd |
Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (7 entries)
| Base Compensation Filing OrgBaseCompensationFilingOrgAmt | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt | Total Compensation Filing OrgTotalCompensationFilingOrgAmt | Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt |
|---|---|---|---|
| TODD WILLERT | |||
| $143,062 | $5,582 | $148,644 | |
| MARCIA WALSH | |||
| $159,814 | $6,437 | $167,703 | $1,452 |
| DR DAVID ALLEN | |||
| $347,539 | $8,652 | $359,770 | $3,579 |
| DR THOMAS WALSH | |||
| $349,526 | $8,147 | $360,531 | $2,858 |
| DR DAGOBERTO HEREDIA | |||
| $313,418 | $2,880 | $317,862 | $1,564 |
| DR MARCUS WEISER | |||
| $360,173 | $8,292 | $372,109 | $3,644 |
| DR JOHN KELLEY | |||
| $238,601 | $8,223 | $248,292 | $1,468 |
Supplemental Information Detail SupplementalInformationDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form And Line Reference | Pt I Line 5a | FormAndLineReferenceDesc |
| Explanation | Physician compensation based, in part, on patient clinic charges | ExplanationTxt |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (11 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| Pt VI, Line 2 | Dr. Tom Walsh/Marcia Walsh, COO - Spouse |
| Pt VI, Line 11b | Reviewed by the Chairman of the Board prior to filing and available to other Board members upon request. |
| Pt VI, Line 12c | Required to disclose conflict of interest upon hire/appointment to Board and also update and report changes thereafter. |
| Pt VI, Line 15a | CEO compensation is reviewed annually by the Board of Directors. |
| Pt VI, Line 15b | Other officer and key employee compensation is reviewed by CEO utilizing information obtained from sources such as the Kansas Hospital Association, Bureau of Labor and Kansas Department of Labor. |
| Form 990, Part IX, Line 24e | CONTRACT LABOR 1523580. 1207925. 313370. 2285. |
| Form 990, Part IX, Line 24e | PROFESSIONAL FEES 261139. 0. 261139. 0. |
| Form 990, Part IX, Line 24e | SUPPLIES 2526966. 2315066. 211887. 13. |
| Form 990, Part IX, Line 24e | REPAIR AND MAINTENANCE 891985. 593135. 298850. 0. |
| Form 990, Part IX, Line 24e | MINOR EQUIPMENT 246521. 190660. 55861. 0. |
| Form 990, Part IX, Line 24e | Property taxes 28604. 26406. 2198. 0. |
Schedule R IRS990ScheduleR
Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp
Disregarded Entity Name DisregardedEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL DISTRICT NO 1 OF POTTAWATOMIE JACKSON AND NEMAHA COUNTIE | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 120 WEST 8TH STREET | AddressLine1Txt |
| City | ONAGA | CityNm |
| State Abbreviation | KS | StateAbbreviationCd |
| ZIP | 66521 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 486089515 | EIN |
| Primary Activities | HOSPITAL DISTIRCT | PrimaryActivitiesTxt |
| Legal Domicile State | KS | LegalDomicileStateCd |
Direct Controlling Entity Name DirectControllingEntityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | NA | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Annts Rnts Rylts | false | ReceiptOfIntAnntsRntsRyltsInd |
| Gift Grnt Or Cap Contri To Oth Org | false | GiftGrntOrCapContriToOthOrgInd |
| Gift Grnt Cap Contri From Oth Org | false | GiftGrntCapContriFromOthOrgInd |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrgInd |
| Loans Or Guarantees From Oth Org | false | LoansOrGuaranteesFromOthOrgInd |
| Div Related Organization | false | DivRelatedOrganizationInd |
| Asset Sale To Other Org | false | AssetSaleToOtherOrgInd |
| Asset Purchase From Other Org | false | AssetPurchaseFromOtherOrgInd |
| Asset Exchange | false | AssetExchangeInd |
| Rental Of Facilities To Oth Org | false | RentalOfFacilitiesToOthOrgInd |
| Rental Of Fclts From Oth Org | Yes (true) | RentalOfFcltsFromOthOrgInd |
| Perform Of Services For Oth Org | false | PerformOfServicesForOthOrgInd |
| Perform Of Services By Other Org | false | PerformOfServicesByOtherOrgInd |
| Sharing Of Facilities | false | SharingOfFacilitiesInd |
| Paid Employees Sharing | false | PaidEmployeesSharingInd |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrgInd |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrgInd |
| Transfer To Other Org | false | TransferToOtherOrgInd |
| Transfer From Other Org | false | TransferFromOtherOrgInd |
Transactions Related Org TransactionsRelatedOrgGrp
Other Organization Name OtherOrganizationName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY HOSPITAL DISTRICT NO 1 OF POTTAWATOMIE JACKSON AND NEMAHA COUNTIE | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Transaction Type | k | TransactionTypeTxt |
| Method Of Amount Determination | ACTUAL | MethodOfAmountDeterminationTxt |