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PAWNEE VALLEY COMMUNITY HOSPITAL INC: Form 990, tax year 2014

View the entire original 990 at ProPublica ↗

Organization
PAWNEE VALLEY COMMUNITY HOSPITAL INC (EIN 48-1253246)
Tax period
2014-07-01 to 2015-06-30
Filed
2016-05-11
IRS object ID
201621329349303727
Schema version
2014v6.0
Source
Download XML · Original 990 at ProPublica

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

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2016-05-11T16:13:01-05:00ReturnTs
Tax Period End2015-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN481026809PreparerFirmEIN

Preparer Firm Name PreparerFirmName

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

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1534 S Kansas Ave Suite 1500AddressLine1Txt
CityTopekaCityNm
State AbbreviationKSStateAbbreviationCd
ZIP666033491ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2014-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN481253246EIN

Business Name BusinessName

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

US Address USAddress

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

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonGeorge HarmsPersonNm
Person TitleSecretary/TreasurerPersonTitleTxt
Phone7856235000PhoneNum
Signature2016-05-04SignatureDt
Discuss With Paid PreparerYes (1)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonHeather R EichemPreparerPersonNm
PTINP01515553PTIN
Phone7852334226PhoneNum
Preparation2016-05-04PreparationDt
FieldValueIRS element (for citing)
Tax2014TaxYr
Build TS2016-08-17 19:52:53ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Principal OfficerGeorge HarmsPrincipalOfficerNm

US Address USAddress

FieldValueIRS element (for citing)
Address Line1923 Carroll AveAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$18,321,805GrossReceiptsAmt
Group Return For Affiliates0GroupReturnForAffiliatesInd
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.pawneevalleyhospital.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2001FormationYr
Legal Domicile StateKSLegalDomicileStateCd
Activity Or MissionPawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence. The Organization is striving to be the best Critical Access Hospital in rural America.ActivityOrMissionDesc
Voting Members Governing Body7VotingMembersGoverningBodyCnt
Voting Members Independent2VotingMembersIndependentCnt
Total Employee163TotalEmployeeCnt
Total Volunteers99TotalVolunteersCnt
Total Gross UBI$0TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$190,261PYContributionsGrantsAmt
CY Contributions Grants$907,604CYContributionsGrantsAmt
PY Program Service Revenue$15,182,064PYProgramServiceRevenueAmt
CY Program Service Revenue$17,240,485CYProgramServiceRevenueAmt
PY Investment Income$7,294PYInvestmentIncomeAmt
CY Investment Income$4,292CYInvestmentIncomeAmt
PY Other Revenue$0PYOtherRevenueAmt
CY Other Revenue$169,424CYOtherRevenueAmt
PY Total Revenue$15,379,619PYTotalRevenueAmt
CY Total Revenue$18,321,805CYTotalRevenueAmt
PY Grants And Similar Paid$179,198PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$901,744CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$5,961,003PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$7,917,015CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$6,339,813PYOtherExpensesAmt
CY Other Expenses$6,688,940CYOtherExpensesAmt
PY Total Expenses$12,480,014PYTotalExpensesAmt
CY Total Expenses$15,507,699CYTotalExpensesAmt
PY Revenues Less Expenses$2,899,605PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$2,814,106CYRevenuesLessExpensesAmt
Total Assets BOY$8,019,575TotalAssetsBOYAmt
Total Assets EOY$7,788,872TotalAssetsEOYAmt
Total Liabilities BOY$7,610,192TotalLiabilitiesBOYAmt
Total Liabilities EOY$6,709,764TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$409,383NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$1,079,108NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part IIIYes (X)InfoInScheduleOPartIIIInd
MissionPawnee Valley Community Hospital, Inc. is a tax-exempt charitable organization under Section 501(c)(3) of the Internal Revenue Code and is licensed by the State of Kansas Department of Health and Environment. The purpose of the Organization is to provide healthcare facitities and services for the care and treatment of inpatients and outpatients who are acutely ill or who otherwise require medical care and related services. The core purpose of the Corporation is to improve the quality of life for the communities we serve through exceptional healthcare and service excellence.MissionDesc
Significant New Program Srvc0SignificantNewProgramSrvcInd
Significant Change0SignificantChangeInd
Expense$11,647,456ExpenseAmt
Grant$901,744GrantAmt
Revenue$17,262,899RevenueAmt
DescPatient care: Program services consist of routine and ancillary department healthcare services provided by a healthcare organization as described in 501(c)(3) of the IRS code.Desc
Total Program Service Expenses$11,647,456TotalProgramServiceExpensesAmt
Described In Section501c3Yes (1)DescribedInSection501c3Ind
Schedule B RequiredYes (1)ScheduleBRequiredInd
Political Campaign Acty0PoliticalCampaignActyInd
Lobbying ActivitiesYes (1)LobbyingActivitiesInd
Subject To Proxy Tax0SubjectToProxyTaxInd
Donor Advised Fund0DonorAdvisedFundInd
Conservation Easements0ConservationEasementsInd
Collections Of Art0CollectionsOfArtInd
Credit Counseling0CreditCounselingInd
Temp Or Permanent EndowmentsYes (1)TempOrPermanentEndowmentsInd
Report Land Building Equipment0ReportLandBuildingEquipmentInd
Report Investments Other Sec0ReportInvestmentsOtherSecInd
Report Program Related Invst0ReportProgramRelatedInvstInd
Report Other AssetsYes (1)ReportOtherAssetsInd
Report Other LiabilitiesYes (1)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (1)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtYes (1)IndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (1)ConsolidatedAuditFinclStmtInd
School Operating0SchoolOperatingInd
Foreign Office0ForeignOfficeInd
Foreign Activities0ForeignActivitiesInd
More Than5000 K To Org0MoreThan5000KToOrgInd
More Than5000 K To Individuals0MoreThan5000KToIndividualsInd
Professional Fundraising0ProfessionalFundraisingInd
Fundraising Activities0FundraisingActivitiesInd
Gaming Activities0GamingActivitiesInd
Operate HospitalYes (1)OperateHospitalInd
Audited Financial Stmt AttYes (1)AuditedFinancialStmtAttInd
Grants To OrganizationsYes (1)GrantsToOrganizationsInd
Grants To Individuals0GrantsToIndividualsInd
Schedule J RequiredYes (1)ScheduleJRequiredInd
Tax Exempt Bonds0TaxExemptBondsInd
Engaged In Excess Benefit Trans0EngagedInExcessBenefitTransInd
PY Excess Benefit Trans0PYExcessBenefitTransInd
Loan Outstanding0LoanOutstandingInd
Grant To Related Person0GrantToRelatedPersonInd
Business Rln With Org Mem0BusinessRlnWithOrgMemInd
Business Rln With Fam Mem0BusinessRlnWithFamMemInd
Business Rln With Officer Ent0BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri0DeductibleNonCashContriInd
Deductible Art Contribution0DeductibleArtContributionInd
Terminate Operations0TerminateOperationsInd
Partial Liquidation0PartialLiquidationInd
Disregarded Entity0DisregardedEntityInd
Related EntityYes (1)RelatedEntityInd
Related Organization Ctrl Ent0RelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org0TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp0ActivitiesConductedPrtshpInd
Schedule O RequiredYes (1)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Backup Wthld ComplianceYes (1)BackupWthldComplianceInd
Employee163EmployeeCnt
Employment Tax Returns FiledYes (1)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit0UnrelatedBusIncmOverLimitInd
Foreign Financial Account0ForeignFinancialAccountInd
Prohibited Tax Shelter Trans0ProhibitedTaxShelterTransInd
Taxable Party Notification0TaxablePartyNotificationInd
Nondeductible Contributions0NondeductibleContributionsInd
Quid Pro Quo Contributions0QuidProQuoContributionsInd
Form8282 Property Disposed Of0Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct0RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct0PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services0IndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members7GoverningBodyVotingMembersCnt
Independent Voting Member2IndependentVotingMemberCnt
Family Or Business Rln0FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties0DelegationOfMgmtDutiesInd
Change To Org Documents0ChangeToOrgDocumentsInd
Material Diversion Or Misuse0MaterialDiversionOrMisuseInd
Members Or StockholdersYes (1)MembersOrStockholdersInd
Election Of Board MembersYes (1)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (1)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (1)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (1)MinutesOfCommitteesInd
Officer Mailing Address0OfficerMailingAddressInd
Local Chapters0LocalChaptersInd
Form990 Provided To Gvrn BodyYes (1)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (1)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (1)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (1)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (1)WhistleblowerPolicyInd
Document Retention PolicyYes (1)DocumentRetentionPolicyInd
Compensation Process CEOYes (1)CompensationProcessCEOInd
Compensation Process OtherYes (1)CompensationProcessOtherInd
Investment In Joint Venture0InvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

FieldValueIRS element (for citing)
PersonGeorge Harms TreasurerPersonNm
Phone7856235000PhoneNum

US Address USAddress

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

Form990 Part VII Section A Form990PartVIISectionAGrp (13 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeInd
Bryce Young
President4.0036.00Yes (X)Yes (X)$0$260,247$80,480
Shae Veach
Vice President4.0036.00Yes (X)Yes (X)$0$200,871$60,537
George Harms
Secretary/Treasurer4.0036.00Yes (X)Yes (X)$0$156,923$40,863
John Jeter MD
Director4.0036.00Yes (X)$0$521,550$134,596
Larry Watts
Director4.0036.00Yes (X)$0$306,053$77,354
David Sanger MD
Director/Physician40.00Yes (X)$94,338$120,898$37,203
John Settle
Director4.00Yes (X)$0$0$0
John Haas
Director4.00Yes (X)$0$0$0
John Hughes
Administrator40.00Yes (X)$0$0$0
Amanda Bickle
APRN40.00$131,292$0$26,185Yes (X)
Cynthia Carter
RN40.00$108,301$0$15,775Yes (X)
Cristine Goodwin
Physician34.00$70,385$82,115$24,669Yes (X)
Christian Whittington
Physician40.00$91,269$106,346$30,212Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$495,585TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,755,003TotReportableCompRltdOrgAmt
Total Other Compensation$527,874TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K2IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed0FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (1)TotalCompGreaterThan150KInd
Compensation From Other Srcs0CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (4 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
Hays Medical Center
2220 Canterbury DriveHaysKS67601Contract Services$3,399,671
Quest Diagnostics
PO Box 14730St LouisMO63150Lab Services$170,009
Shared Medical Services Inc
209 Limestone PassCottage GroveWI53527MRI services$143,380
Docs Who Care
1337 S Foundatin DriveOlatheKS66061Emergency Room Physician Services$104,333
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K4CntrctRcvdGreaterThan100KCnt
Related Organizations$901,744RelatedOrganizationsAmt
Government Grants$5,860GovernmentGrantsAmt
Total Contributions$907,604TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Net patient service revenue622000$17,143,934$17,143,934
Outreach therapy services900099$68,272$68,272
Lab fairs900099$28,279$28,279
FieldValueIRS element (for citing)
Total Program Service Revenue$17,240,485TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$4,292TotalRevenueColumnAmt
Exclusion$4,292ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$1,300RealAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$1,300RealAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,300TotalRevenueColumnAmt
Related Or Exempt Func Income$1,300RelatedOrExemptFuncIncomeAmt

Other Revenue Misc OtherRevenueMiscGrp (2 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtExclusionExclusionAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt
Meals sold to employees and guest722210$147,010$147,010
Other miscellaneous revenue900099$21,114$21,114
FieldValueIRS element (for citing)
Other Revenue Total$168,124OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$18,321,805TotalRevenueColumnAmt
Related Or Exempt Func Income$17,262,899RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$151,302ExclusionAmt

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$901,744TotalAmt
Program Services$901,744ProgramServicesAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

FieldValueIRS element (for citing)
Total$321,226TotalAmt
Program Services$256,012ProgramServicesAmt
Management And General$65,214ManagementAndGeneralAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$6,152,504TotalAmt
Program Services$5,556,770ProgramServicesAmt
Management And General$595,734ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$223,602TotalAmt
Program Services$199,483ProgramServicesAmt
Management And General$24,119ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$754,056TotalAmt
Program Services$680,167ProgramServicesAmt
Management And General$73,889ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$465,627TotalAmt
Program Services$418,200ProgramServicesAmt
Management And General$47,427ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

FieldValueIRS element (for citing)
Total$2,348,032TotalAmt
Management And General$2,348,032ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$26,433TotalAmt
Management And General$26,433ManagementAndGeneralAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

FieldValueIRS element (for citing)
Total$23,559TotalAmt
Management And General$23,559ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$1,541,452TotalAmt
Program Services$1,329,840ProgramServicesAmt
Management And General$211,612ManagementAndGeneralAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$77,690TotalAmt
Program Services$5,115ProgramServicesAmt
Management And General$72,575ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$41,504TotalAmt
Program Services$27,976ProgramServicesAmt
Management And General$13,528ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$105,235TotalAmt
Program Services$63,641ProgramServicesAmt
Management And General$41,594ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$340,935TotalAmt
Program Services$282,396ProgramServicesAmt
Management And General$58,539ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$13,703TotalAmt
Program Services$12,044ProgramServicesAmt
Management And General$1,659ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$3,408TotalAmt
Program Services$3,408ProgramServicesAmt

Insurance InsuranceGrp

FieldValueIRS element (for citing)
Total$108,180TotalAmt
Program Services$64,908ProgramServicesAmt
Management And General$43,272ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Pharmaceuticals$655,073$655,073
Medical supplies$453,555$453,232$323
Dietary$164,924$156,275$8,649
Service contracts$143,496$130,464$13,032

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$641,761TotalAmt
Program Services$450,708ProgramServicesAmt
Management And General$191,053ManagementAndGeneralAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$15,507,699TotalAmt
Program Services$11,647,456ProgramServicesAmt
Management And General$3,860,243ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$246,579BOYAmt
EOY$432,300EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$4,529,204BOYAmt
EOY$2,592,523EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,330,522BOYAmt
EOY$1,745,586EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$265,762BOYAmt
EOY$280,864EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$113,774BOYAmt
EOY$136,365EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$533,734BOYAmt
EOY$2,601,234EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$8,019,575BOYAmt
EOY$7,788,872EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$908,936BOYAmt
EOY$1,054,368EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$6,701,256BOYAmt
EOY$5,655,396EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$7,610,192BOYAmt
EOY$6,709,764EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$409,383BOYAmt
EOY$1,079,108EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$409,383BOYAmt
EOY$1,079,108EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$8,019,575BOYAmt
EOY$7,788,872EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$2,814,106ReconcilationRevenueExpnssAmt
Other Changes In Net Assets-$2,144,381OtherChangesInNetAssetsAmt
Info In Schedule O Part XIIYes (X)InfoInScheduleOPartXIIInd
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or Review0AccountantCompileOrReviewInd
FS AuditedYes (1)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

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

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

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

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Volunteers0VolunteersInd
Paid Staff Or Management0PaidStaffOrManagementInd
Media Advertisements0MediaAdvertisementsInd
Mailings Members0MailingsMembersInd
Publications Or Broadcast0PublicationsOrBroadcastInd
Grants Other OrganizationsYes (1)GrantsOtherOrganizationsInd
Grants Other Organizations$2,827GrantsOtherOrganizationsAmt
Direct Contact Legislators0DirectContactLegislatorsInd
Rallies Demonstrations0RalliesDemonstrationsInd
Other Activities0OtherActivitiesInd
Total Lobbying Expenditures$2,827TotalLobbyingExpendituresAmt
Not Described Section501c30NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

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

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

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

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

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

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Contributions$1,026,228ContributionsAmt
Other Expenditures$883,451OtherExpendituresAmt
End Year Balance$142,777EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.00000BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY0.00000PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY1.00000TermEndowmentBalanceEOYPct
Endowments Held Unrelated Org0EndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgYes (1)EndowmentsHeldRelatedOrgInd
Related Org List Sch RYes (1)RelatedOrgListSchRInd
Total Book Value Land Buildings$0TotalBookValueLandBuildingsAmt

Other Assets Org OtherAssetsOrgGrp (4 entries)

DescDescBook ValueBookValueAmt
Estimated third-party payor settlements$1,501,813
Other receivables$8,260
Receivables from related parties$12,053
Beneficial interest in net assets of foundation$1,079,108
FieldValueIRS element (for citing)
Total Book Value Other Assets$2,601,234TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDescAmtAmt
Due to Pawnee County$5,063,815
Due to Hays Medical Center, Inc.$531,581
Estimated third-party payor settlements$60,000
FieldValueIRS element (for citing)
Total Liability$5,655,396TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd
Total Rev Etc Audited Fincl Stmt$18,991,530TotalRevEtcAuditedFinclStmtAmt
Other Revenue$669,725OtherRevenueAmt
Revenue Not Reported$669,725RevenueNotReportedAmt
Revenue Subtotal$18,321,805RevenueSubtotalAmt
Revenue Not Reported Fincl Stmt$0RevenueNotReportedFinclStmtAmt
Total Revenue Per Form990$18,321,805TotalRevenuePerForm990Amt
Tot Expns Etc Audited Fincl Stmt$14,605,955TotExpnsEtcAuditedFinclStmtAmt
Expenses Not Reported$0ExpensesNotReportedAmt
Expenses Subtotal$14,605,955ExpensesSubtotalAmt
Other Expenses Not Included$901,744OtherExpensesNotIncludedAmt
Expenses Not Rpt Fincl Stmt$901,744ExpensesNotRptFinclStmtAmt
Total Expenses Per Form990$15,507,699TotalExpensesPerForm990Amt

Supplemental Information Detail SupplementalInformationDetail (4 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part V, Line 4:Donations are requested for specific items or improvements to the Hospital. When a donation is received for that specific item, it is restricted for that use by the Board until the specific item or improvement is purchased. At any one time, one or more such projects can be in progress.
Part 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 669,725.
Part XII, Line 4b - Other Adjustments:Transfer of equipment to Pawnee County 901,744.

Schedule H IRS990ScheduleH

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

Free Care Oth Percentage FreeCareOthPercentageGrp

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

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$107,209TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$107,209NetCommunityBenefitExpnsAmt
Total Expense0.00690TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,167,382TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$389,127DirectOffsettingRevenueAmt
Net Community Benefit Expns$778,255NetCommunityBenefitExpnsAmt
Total Expense0.05020TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Total Community Benefit Expns$1,274,591TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$389,127DirectOffsettingRevenueAmt
Net Community Benefit Expns$885,464NetCommunityBenefitExpnsAmt
Total Expense0.05710TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,862,393TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,925,591DirectOffsettingRevenueAmt
Net Community Benefit Expns$936,802NetCommunityBenefitExpnsAmt
Total Expense0.06040TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$13,679TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns$13,679NetCommunityBenefitExpnsAmt
Total Expense0.00090TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$2,876,072TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$1,925,591DirectOffsettingRevenueAmt
Net Community Benefit Expns$950,481NetCommunityBenefitExpnsAmt
Total Expense0.06130TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Total Community Benefit Expns$4,150,663TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$2,314,718DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,835,945NetCommunityBenefitExpnsAmt
Total Expense0.11840TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (1)BadDebtExpenseReportedInd
Bad Debt Expense$797,186BadDebtExpenseAmt
Bad Debt Expense Attributable$55,803BadDebtExpenseAttributableAmt
Reimbursed By Medicare$8,174,315ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$8,359,350CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$185,035MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

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

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

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

US Address USAddress

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

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Pawnee Valley Community Hospital IncBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PY0FirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PY0TaxExemptHospitalCYOrPYInd
CHNA ConductedYes (1)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted14CHNAConductedYr
Take Into Account Others InputYes (1)TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts0CHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (1)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (1)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://www.pawneevalleyhospital.com/OwnWebsiteURLTxt
Other WebsiteYes (X)OtherWebsiteInd
Other Website URLhttp://www.pawneecountykansas.com/OtherWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (1)ImplementationStrategyAdoptInd
Implementation Strategy Adpt14ImplementationStrategyAdptYr
Strategy Posted Website0StrategyPostedWebsiteInd
Strategy AttachedYes (1)StrategyAttachedInd
Organization Incur Excise Tax0OrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (1)EligCriteriaExplainedInd
FPG Family Incm Lmt Free DscntYes (X)FPGFamilyIncmLmtFreeDscntInd
FPG Family Incm Lmt Free Care130.000000000000FPGFamilyIncmLmtFreeCarePct
FPG Family Incm Lmt Dscnt Care400.000000000000FPGFamilyIncmLmtDscntCarePct
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Residency CriteriaYes (X)ResidencyCriteriaInd
Explained BasisYes (1)ExplainedBasisInd
App Financial Asst ExplnYes (1)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (1)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
FAP Available On Website URLhttp://http://www.pawneevalleyhospital.com/FAPAvailableOnWebsiteURLTxt
FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
FAP App Available On Website URLhttp://http://www.pawneevalleyhospital.com/FAPAppAvailableOnWebsiteURLTxt
FAP Summary On WebsiteYes (X)FAPSummaryOnWebsiteInd
FAP Summary On Website URLhttp://http://www.pawneevalleyhospital.com/FAPSummaryOnWebsiteURLTxt
FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
FAP Sum Avlbl On Request No ChrgYes (X)FAPSumAvlblOnRequestNoChrgInd
FAP Notice DisplayedYes (X)FAPNoticeDisplayedInd
Communtity Notified FAPYes (X)CommuntityNotifiedFAPInd
FAP Actions On NonpaymentYes (1)FAPActionsOnNonpaymentInd
Permit No ActionsYes (X)PermitNoActionsInd
Collection Activities0CollectionActivitiesInd
FAP Notified Upon AdmissionYes (X)FAPNotifiedUponAdmissionInd
FAP Notified Before DischargeYes (X)FAPNotifiedBeforeDischargeInd
FAP Notified All PatientsYes (X)FAPNotifiedAllPatientsInd
Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
Nondis Emergency Care PolicyYes (1)NondisEmergencyCarePolicyInd
Other Method UsedYes (X)OtherMethodUsedInd
Amounts Generally Billed0AmountsGenerallyBilledInd
Gross Charges0GrossChargesInd

Supplemental Information SupplementalInformationGrp (8 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 5: The CHNA was conducted in collaboration with the Pawnee County Health Department. A Town Hall meeting was organized to provide an objective consensus building method of reviewing and prioritizing county health issues. During the Town Hall meeting, the group reflected on the size and seriousness of any health concerns cited and discussed current community health strengths. The group identified and ranked top community health concerns, and all Town Hall attendees were encouraged to continue to contribute ideas by going online and taking a feedback survey that addresses any additional thoughts related to the CHNA. All Town Hall priority-setting and score processes involved the input of a diverse group with knowledge and/or expertise in public health as well as persons who represent the broad interests of the community served by the hospital. Key stakeholders in attendance included representatives from: United Way, Welcome Inn Senior Center, Center for Counseling, Angels Care Home Health, Golden Belt Foundation, Larned City Council, Burdett City Council and Garfield City Council and Rozel Community, Pawnee County Sherriff's office, Larned Police Department, Pawnee County Health Department, County Commissioners, members of the Chamber of Commerce, members of the USD 495 School Board, school nurses of USD 495, local members of the media, local religious organizations and representative of Pawnee Valley Community Hospital. The CHNA was coordinated and produced by VVV Research & Development, Inc. from Olathe, Kansas.
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 6b: Pawnee County, KS
Pawnee Valley Community Hospital, Inc.Part V, Section B, Line 11: Annual description of the actions taken by the Hospital during the fiscal year to address the significant health needs identified throught the most recently conducted CHNA: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. PVCH once again had their annual fun run in June 2015. LA Psycle, opened its doors in 2015 for the community to sign up for spin classes. Pride Committee also added a second walking trail to the community. This walking trail goes around Camp Pawnee. PVCH staff have done community presentations for heart disease awareness. 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. In lieu of this partnership, we hope to continue to be an outreach clinic for Dreiling/Schmidt Cancer Institute. 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. 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 in coordination with the Center For Counseling & Consultation has received a grant for improving health in rural communities from the Centene Foundation. As part of this grant opportunity, we are working with Wichita State University's Community Engagement Institute to administer a behavioral health survey to identified community partners/stakeholders in Pawnee, Barton, Rice and Stafford Counties. The survey is designed to bring a better understanding of current awareness and support for community based mental health and substance abuse services. While the survey's primary purpose is to identify demand for specific behavioral health services, areas for improvement, and past utilization/referrals, the survey will also serve a primary role in starting conversations for change and greater community involvement in each of these counties. We hope to increase the recognition and understanding of the importance of mental health and substance abuse issues in our county. 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. There are no vending machines in our hospital and 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. PVCH and Pawnee County Health Department have both had educational booths at the county fair and twice a year at the community health fair. The health department has increased their educational items pertaining to healthy food options for the public to obtain. 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. 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 a building specifically for 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 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.
Part V, Section B, Line 16Financial Assistance Policy Website Availability
Pawnee Valley Community Hospital, Inc. Part V, Section B, line 16a website:http://http://www.pawneevalleyhospital.com/
Pawnee Valley Community Hospital, Inc. Part V, Section B, line 16b website:http://http://www.pawneevalleyhospital.com/
Pawnee Valley Community Hospital, Inc. Part V, Section B, line 16c website:http://http://www.pawneevalleyhospital.com/
FieldValueIRS element (for citing)
Facility1FacilityNum

Oth Hlth Care Fclts Not Hospital OthHlthCareFcltsNotHospitalGrp

Oth Hlth Care Fclts OthHlthCareFcltsGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Pawnee Valley Medical AssociatesBusinessNameLine1Txt

US Address USAddress

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

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 7:A cost-to-charge ratio derived from Worksheet 2 was used to determine financial assistance at cost and the cost of subsidized health services. A cost-to-charge ratio derived from Worksheet 2 was used to determine the costs of serving Medicaid beneficiaries.
Part I, Line 7g:Subsidized health services community benefit expenses include $2,039,012 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, 2015.
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. 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 $46,464. Approximately 5.9% of families were below the poverty line, and 7.4% of the total population was below the poverty line. Approximately 9.2% 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

FieldValueIRS element (for citing)
Grant Records Maintained0GrantRecordsMaintainedInd

Recipient Table RecipientTable

Recipient Business Name RecipientBusinessName

FieldValueIRS element (for citing)
Business Name Line1Pawnee CountyBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1715 BroadwayAddressLine1Txt
CityLarnedCityNm
State AbbreviationKSStateAbbreviationCd
ZIP67550ZIPCd
FieldValueIRS element (for citing)
Recipient EIN486007542RecipientEIN
Non Cash Assistance$901,744NonCashAssistanceAmt
Valuation Method UsedCash paidValuationMethodUsedDesc
Non Cash AssistanceTransfer of equipmentNonCashAssistanceDesc
Purpose Of GrantPawnee County owns all fixed assets (land, building, equipment) used by the Hospital. To expedite the purchase of equipment and obtain favorable purchasing terms, the Hospital purchased equipment on behalf of the County. The Pawnee Valley Community Hospital Foundation reimbursed the Hospital for the purchase. The Hospital then transferred ownership of the equipment to Pawnee County.PurposeOfGrantTxt
FieldValueIRS element (for citing)
Total501c3 Org1Total501c3OrgCnt
Total Other Org0TotalOtherOrgCnt

Schedule J IRS990ScheduleJ

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

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (9 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
Bryce Young
President$0$257,922$0$0$0$2,325$0$54,663$0$25,817$0$340,727$0$0
Shae Veach
Vice President$0$163,194$0$0$0$37,677$0$36,741$0$23,796$0$261,408$0$0
George Harms
Secretary/Treasurer$0$156,923$0$0$0$0$0$23,538$0$17,325$0$197,786$0$0
John Jeter MD
Director$0$519,639$0$0$0$1,911$0$111,046$0$23,550$0$656,146$0$0
Larry Watts
Director$0$299,172$0$0$0$6,881$0$60,476$0$16,878$0$383,407$0$0
David Sanger MD
Director/Physician$94,338$111,731$0$0$0$9,167$5,719$6,785$10,484$14,215$110,541$141,898$0$0
Amanda Bickle
APRN$131,081$0$211$0$0$0$2,744$0$23,441$0$157,477$0$0$0
Cristine Goodwin
Physician$70,385$82,115$0$0$0$0$4,292$5,008$1,154$14,215$75,831$101,338$0$0
Christian Whittington
Physician$91,269$106,346$0$0$0$0$5,538$0$10,459$14,215$107,266$120,561$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Part I, Line 3A related organization uses a compensation committee, independent compensation consultant, written employment contract, and approval by the board or compensation committee to establish the compensation of the Hospital's Administrator.
Part I, Line 4bContributions to the plan: John Jeter, M.D. - $77,946 Bryce Young - $39,063 George Harms - $23,538 Shae Veach - $24,629 Larry Watts - $44,876
Part I, Line 6A portion of the Administrator's incentive compensation is determined by net earnings exceeding budget for the fiscal year. A portion of incentive compensation for officers and key employees of Hays Medical Center, Inc., a related organization, is determined by net earnings exceeding budget for the fiscal year.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (9 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part VI, Section A, line 6The organization has one member, HaysMed Partners, Inc., which became the sole member as of March 1, 2010. HaysMed Partners, Inc., is a wholly-owned subsidiary of Hays Medical Center, Inc.
Form 990, Part VI, Section A, line 7aThe Board members of HaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, appoint the Board members of Pawnee Valley Community Hospital, Inc.
Form 990, Part VI, Section A, line 7bHaysMed Partners, Inc., the sole member of Pawnee Valley Community Hospital, elects the Board members of Pawnee Valley Community Hospital.
Form 990, Part VI, Section B, line 11Form 990 was reviewed with the Board members prior to filing.
Form 990, Part VI, Section B, line 12cOfficers, directors & key employees, along with all associates, are required to complete a conflict of interest statement annually. The statements are used to monitor and enforce compliance with the policy.
Form 990, Part VI, Section B, line 15The hospital administrator and officers' salaries are reviewed annually by an independent consulting group and the Board members.
Form 990, Part VI, Section C, line 19These documents are not made available to the public.
Form 990, Part XI, line 9:Increase in amount due to Pawnee County -1,946,187. Transfers to Pawnee County -867,919. Change in beneficial interest in net assets of foundation 669,725.
Form 990. Part XII, Line 2cHays Medical Center, Inc., has an audit committee that is responsible for the oversight of Pawnee Valley Community Hospital, Inc's., financial statement audit and the selection process of an independent accountant.

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (3 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtControlled OrganizationControlledOrganizationInd
HaysMed Partners Inc
2220 Canterbury DrHaysKS67601270877152Owns management contract for Pawnee Valley Community HospitalKS501(c)(3)170(b)(1)(A)(iii)0
Hays Medical Center Inc
2220 Canterbury DrHaysKS67601480559088HospitalKS501(c)(3)170(b)(1)(A)(iii)0
Pawnee Valley Community Hospital Foundation
923 Carroll AveLarnedKS67550455333776Support the activities and mission of the HospitalKS501(c)(3)509(A)(3), Type I0
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts Rylts0ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org0GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgYes (1)GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgYes (1)LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (1)LoansOrGuaranteesFromOthOrgInd
Div Related Organization0DivRelatedOrganizationInd
Asset Sale To Other Org0AssetSaleToOtherOrgInd
Asset Purchase From Other Org0AssetPurchaseFromOtherOrgInd
Asset Exchange0AssetExchangeInd
Rental Of Facilities To Oth OrgYes (1)RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org0RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgYes (1)PerformOfServicesForOthOrgInd
Perform Of Services By Other OrgYes (1)PerformOfServicesByOtherOrgInd
Sharing Of Facilities0SharingOfFacilitiesInd
Paid Employees SharingYes (1)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (1)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgYes (1)ReimbursementPaidByOtherOrgInd
Transfer To Other Org0TransferToOtherOrgInd
Transfer From Other Org0TransferFromOtherOrgInd