LEWIS AND CLARK INFORMATION EXCHANGE: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LEWIS AND CLARK INFORMATION EXCHANGE (EIN 32-0290671)
- Tax period
- 2012-07-01 to 2013-06-30
- Filed
- 2014-05-13
- IRS object ID
- 201401339349301535
- Schema version
- 2012v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2014-05-13T10:47:34-05:00 | Timestamp |
| Tax Period End Date | 2013-06-30 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | BKD LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1201 Walnut Suite 1700 | AddressLine1 |
| City | Kansas City | City |
| State | MO | State |
| ZIP Code | 641062246 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-07-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 320290671 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | LEWIS AND CLARK INFORMATION EXCHANGE | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % MICHAEL DITTEMORE | InCareOfName |
| Name Control | LEWI | NameControl |
| Phone | 8162146894 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12200 NW AMBASSADOR DRIVE | AddressLine1 |
| Address Line2 | Suite 232 | AddressLine2 |
| City | KANSAS CITY | City |
| State | MO | State |
| ZIP Code | 64143 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | MICHAEL DITTEMORE | Name |
| Title | EXECUTIVE DIRECTOR | Title |
| Phone | 8162146894 | Phone |
| Date Signed | 2014-05-15 | DateSigned |
| Authorize Third Party | true | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | Michael J Engle | Name |
| Phone | 8162216300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-03-07 17:11:31Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Change | X | AddressChange |
| Name Of Principal Officer Person | MICHAEL DITTEMORE | NameOfPrincipalOfficerPerson |
Address Principal Officer US AddressPrincipalOfficerUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12200 NW AMBASSADOR DRIVE | AddressLine1 |
| City | KANSAS CITY | City |
| State | MO | State |
| ZIP Code | 64143 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | 538557 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | WWW.LACIE-HIE.COM | WebSite |
| Type Of Organization Corporation | X | TypeOfOrganizationCorporation |
| Year Formation | 2009 | YearFormation |
| State Legal Domicile | MO | StateLegalDomicile |
| Activity Or Mission Description | COORDINATION OF HEALTH INFORMATION SHARING FOR BETTER UNDERSTANDING OF THE PATIENT'S MEDICAL HISTORY. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 11 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 11 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 11 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Net Unrelated Business Txbl Income | 0 | NetUnrelatedBusinessTxblIncome |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 239409 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 196352 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 299148 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 0 | InvestmentIncomePriorYear |
| Investment Income Current Year | 0 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 196352 | TotalRevenuePriorYear |
| Total Revenue Current Year | 538557 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 112000 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 537347 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 385725 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 302082 | OtherExpensePriorYear |
| Other Expenses Current Year | 316369 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 839429 | TotalExpensesPriorYear |
| Total Expenses Current Year | 814094 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | -643077 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | -275537 | RevenuesLessExpensesCY |
| Total Assets BOY | 1717 | TotalAssetsBOY |
| Total Assets EOY | 1180013 | TotalAssetsEOY |
| Total Liabilities BOY | 963651 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 1093111 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | -961934 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 86902 | NetAssetsOrFundBalancesEOY |
| Mission Description | COORDINATION OF HEALTH INFORMATION SHARING FOR BETTER UNDERSTANDING OF THE PATIENT'S MEDICAL HISTORY. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 755364 | Expense |
| Grants | 112000 | Grants |
| Revenue | 299148 | Revenue |
| Description | COORDINATION OF HEALTH INFORMATION SHARING FOR BETTER UNDERSTANDING OF THE PATIENT'S MEDICAL HISTORY. | Description |
| Total Program Service Expense | 755364 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | true | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | true | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | true | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | true | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 11 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 11 | NumberIndependentVotingMembers |
| Family Or Business Relationship | true | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | true | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | true | MembersOrStockholders |
| Election Of Board Members | true | ElectionOfBoardMembers |
| Decisions Subject To Approval | true | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | true | CompensationProcessCEO |
| Compensation Process Other | true | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | MICHAEL DITTEMORE | NamePerson |
| Telephone Number | 8162146894 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 12200 NW AMBASSADOR DRIVE STE 232 | AddressLine1 |
| City | KANSAS CITY | City |
| State | MO | State |
| ZIP Code | 64143 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (23 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Individual Trustee Or DirectorIndividualTrusteeOrDirector | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | Average Hours Per Week RelatedAverageHoursPerWeekRelated | OfficerOfficer | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| GREG ATOR MD | ||||||||
| DIRECTOR\CHAIR | 1.0 | X | 0 | 0 | 0 | |||
| LAURA FITZMAURICE MD | ||||||||
| DIRECTOR\VICE CHAIR | 1.0 | X | 0 | 0 | 0 | |||
| JACK WAGNER | ||||||||
| DIRECTOR\TREASURER | 1.0 | X | 0 | 0 | 0 | |||
| JOE BOYCE MD | ||||||||
| DIRECTOR\SECRETARY | 1.0 | X | 0 | 405396 | 77761 | 59.0 | X | |
| MITZI CARDENAS | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| DAVID NILL MD | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JILL WATSON | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| BEN ERNST | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| HAROLD JOHNSON | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| AL SINISI | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JENNIFER KOZINN | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| DIRCK CLARK | ||||||||
| DIRECTOR\OFFICER | 1.0 | X | 0 | 354135 | 63789 | 59.0 | X | |
| LINDA BAHRKE | ||||||||
| DIRECTOR | 1.0 | X | 0 | 292596 | 69619 | 59.0 | ||
| BRIAN BRADLEY | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| JON DOOLITTLE | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| DEBBIE GASH | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| CLAY PATTERSON | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| SAM TURNER | ||||||||
| DIRECTOR | 1.0 | X | 0 | 0 | 0 | |||
| MICHAEL DITTEMORE | ||||||||
| EXECUTIVE DIRECTOR | 50.0 | 88016 | 0 | 10114 | X | |||
| JEFFREY BLOEMKER | ||||||||
| EXECUTIVE DIRECTOR | 60.0 | 141356 | 0 | 27519 | X | |||
| DOUGLAS BRANDT | ||||||||
| ASSISTANT TREASURER | 1.0 | 0 | 264270 | 77509 | 59.0 | X | ||
| JOHN P WILSON | ||||||||
| SECRETARY/TREASURER | 1.0 | 0 | 667480 | 88988 | 59.0 | X | ||
| HELEN THOMPSON | ||||||||
| FORMER DIRECTOR | 0 | 218945 | 10528 | X | ||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 229372 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 2202822 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 425827 | TotalOtherCompensation |
| Number Individuals GT100 K | 1 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
Contractor Compensation ContractorCompensation
Name Of Contractor NameOfContractor
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | CERNER CORPORATION | NamePerson |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Of Contractor | AddressOfContractor | |
| Description Of Services | SOFTWARE SYSTEMS | DescriptionOfServices |
| Compensation | 105000 | Compensation |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Number Of Contractors GT100 K | 1 | NumberOfContractorsGT100K |
| Government Grants | 239409 | GovernmentGrants |
| Total Contributions | 239409 | TotalContributions |
Program Service Revenue ProgramServiceRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PROGRAM SERVICE REVENUE | Description |
| Business Code | 518210 | BusinessCode |
| Total Revenue Column | 299148 | TotalRevenueColumn |
| Related Or Exempt Function Income | 299148 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | 299148 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 538557 | TotalRevenueColumn |
| Related Or Exempt Function Income | 299148 | RelatedOrExemptFunctionIncome |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 112000 | Total |
| Program Services | 112000 | ProgramServices |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 142030 | Total |
| Program Services | 142030 | ProgramServices |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 189542 | Total |
| Program Services | 156764 | ProgramServices |
| Management And General | 32778 | ManagementAndGeneral |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 13189 | Total |
| Program Services | 13189 | ProgramServices |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 15962 | Total |
| Program Services | 10402 | ProgramServices |
| Management And General | 5560 | ManagementAndGeneral |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 25002 | Total |
| Program Services | 23527 | ProgramServices |
| Management And General | 1475 | ManagementAndGeneral |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 103510 | Total |
| Program Services | 101254 | ProgramServices |
| Management And General | 2256 | ManagementAndGeneral |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 167995 | Total |
| Program Services | 158132 | ProgramServices |
| Management And General | 9863 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 12917 | Total |
| Program Services | 11587 | ProgramServices |
| Management And General | 1330 | ManagementAndGeneral |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 14775 | Total |
| Program Services | 11820 | ProgramServices |
| Management And General | 2955 | ManagementAndGeneral |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 8451 | Total |
| Program Services | 6761 | ProgramServices |
| Management And General | 1690 | ManagementAndGeneral |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 3639 | Total |
| Program Services | 3639 | ProgramServices |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 4836 | Total |
| Program Services | 4063 | ProgramServices |
| Management And General | 773 | ManagementAndGeneral |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | Miscellaneous expenses | Description |
| Total | 246 | Total |
| Program Services | 196 | ProgramServices |
| Management And General | 50 | ManagementAndGeneral |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 814094 | Total |
| Program Services | 755364 | ProgramServices |
| Management And General | 58730 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1717 | BOY |
| EOY | 1148515 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 14281 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 14748 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 2469 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1717 | BOY |
| EOY | 1180013 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 49972 | BOY |
| EOY | 73373 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1019738 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 913679 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 963651 | BOY |
| EOY | 1093111 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -961934 | BOY |
| EOY | 86902 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | -961934 | BOY |
| EOY | 86902 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 1717 | BOY |
| EOY | 1180013 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part XI | X | InfoInScheduleOPartXI |
| Reconcilation Revenue Expenses | -275537 | ReconcilationRevenueExpenses |
| Reconcilation Other Changes | 1324373 | ReconcilationOtherChanges |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Publicly Supported Org509a2 | X | PubliclySupportedOrg509a2 |
Gifts Grants Contrib Received509 GiftsGrantsContribReceived509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 0 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 0 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 0 | CurrentTaxYearMinus1Year |
| Current Tax Year | 239409 | CurrentTaxYear |
| Total | 239409 | Total |
Gross Receipts From Admissions GrossReceiptsFromAdmissions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 327213 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 359949 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 196352 | CurrentTaxYearMinus1Year |
| Current Tax Year | 299148 | CurrentTaxYear |
| Total | 1182662 | Total |
Gross Receipts From Non UBI GrossReceiptsFromNonUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Tax Rev Levied For Org Benefit509 TaxRevLeviedForOrgBenefit509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Value Of Svcs Fclts Furnishd By Govt ValueOfSvcsFcltsFurnishdByGovt
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total509 Total509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 327213 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 359949 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 196352 | CurrentTaxYearMinus1Year |
| Current Tax Year | 538557 | CurrentTaxYear |
| Total | 1422071 | Total |
Amts Recd From Disqual Persons AmtsRecdFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Amts From Subst Contributors AmtsFromSubstContributors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 317213 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 337239 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 170452 | CurrentTaxYearMinus1Year |
| Current Tax Year | 244446 | CurrentTaxYear |
| Total | 1069350 | Total |
Support From DQ Ps Etc SupportFromDQPsEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus3 Years | 317213 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 337239 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 170452 | CurrentTaxYearMinus1Year |
| Current Tax Year | 244446 | CurrentTaxYear |
| Total | 1069350 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Public Support Total509 | 352721 | PublicSupportTotal509 |
Gross Investment Income509 GrossInvestmentIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Post1975 UBTI Post1975UBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Investment Income And UBTI InvestmentIncomeAndUBTI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Net Income From Other UBI NetIncomeFromOtherUBI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Income509 OtherIncome509
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Total Support Total TotalSupportTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Current Tax Year Minus4 Years | 0 | CurrentTaxYearMinus4Years |
| Current Tax Year Minus3 Years | 327213 | CurrentTaxYearMinus3Years |
| Current Tax Year Minus2 Years | 359949 | CurrentTaxYearMinus2Years |
| Current Tax Year Minus1 Year | 196352 | CurrentTaxYearMinus1Year |
| Current Tax Year | 538557 | CurrentTaxYear |
| Total | 1422071 | Total |
| Field | Value | IRS element (for citing) |
|---|---|---|
| First5 Years509 | X | First5Years509 |
| Public Support Percentage509 | 0.00000 | PublicSupportPercentage509 |
Schedule B IRS990ScheduleB
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | RESTRICTED | ContributorNumber |
Contributor Name Business ContributorNameBusiness
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | RESTRICTED | BusinessNameLine1 |
Contributor Address US ContributorAddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | RESTRICTED | AddressLine1 |
| Address Line2 | RESTRICTED | AddressLine2 |
| City | RESTRICTED | City |
| State | RESTRICTED | State |
| ZIP Code | RESTRICTED | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Aggregate Contributions | RESTRICTED | AggregateContributions |
Schedule D IRS990ScheduleD
| Field | Value | IRS element (for citing) |
|---|---|---|
| Art Public Exhibition Amts | ArtPublicExhibitionAmts | |
| Held Works Of Art Amts | HeldWorksOfArtAmts | |
| Current Year Minus3 Years | CurrentYearMinus3Years | |
| Current Year Minus4 Years | CurrentYearMinus4Years | |
| Land | Land | |
| Buildings | Buildings | |
| Leasehold Improvements | LeaseholdImprovements | |
| Equipment | Equipment | |
| Other Land Buildings | OtherLandBuildings | |
| Federal Income Tax Liability | 0 | FederalIncomeTaxLiability |
| Total Of Amounts | 0 | TotalOfAmounts |
Form990 Schedule D Part XIII Form990ScheduleDPartXIII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | UNCERTAIN TAX POSITIONS DISCLOSURE | Identifier |
| Return Reference | SCHEDULE D, PART X, LINE 2 | ReturnReference |
| Explanation | MANAGEMENT HAS EVALUATED THEIR INCOME TAX POSITIONS UNDER THE GUIDANCE INCLUDED IN ASC 740. BASED ON THEIR REVIEW, MANAGEMENT HAS NOT IDENTIFIED ANY MATERIAL UNCERTAIN TAX POSITIONS TO BE RECORDED OR DISCLOSED IN THE FINANCIAL STATEMENTS. | Explanation |
Schedule I IRS990ScheduleI
| Field | Value | IRS element (for citing) |
|---|---|---|
| Records Maintained | true | RecordsMaintained |
Recipient Table RecipientTable (3 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EIN Of RecipientEINOfRecipient | IRC SectionIRCSection | Amount Of Cash GrantAmountOfCashGrant | Purpose Of GrantPurposeOfGrant | Amount Of Non Cash AssistanceAmountOfNonCashAssistance | Method Of ValuationMethodOfValuation | Description Of Non Cash AssistanceDescriptionOfNonCashAssistance |
|---|---|---|---|---|---|---|---|---|---|---|
| HIAWATHA COMMUNITY HOSPITAL | ||||||||||
| 300 UTAH STREET | HIAWATHA | KS | 66434 | 480577658 | 501(C)(3) | 9000 | SET-UP COSTS | |||
| ANTHONY MEDICAL CENTER | ||||||||||
| 1101 E SPRING STREET | ANTHONY | KS | 67003 | 480993940 | 501(C)(3) | 60000 | SET-UP COSTS | |||
| UNIVERSITY OF KANSAS MEDICAL CENTER | ||||||||||
| 3901 RAINBOW BLVD | KANSAS CITY | KS | 66160 | 481202402 | GOVERNMENT | MEMBER SERVICE FEES | 43000 | FMV | MONTHLY SVC FEES | |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Nbr Of501 C3 And Govt Grants | 3 | TotalNbrOf501C3AndGovtGrants |
Form990 Schedule I Part IV Form990ScheduleIPartIV
| Field | Value | IRS element (for citing) |
|---|---|---|
| Identifier | PROCESS FOR MONITORING THE USE OF GRANTS IN THE U.S. | Identifier |
| Return Reference | SCHEDULE I, PART I, LINE 2 | ReturnReference |
| Explanation | CASH GRANTS FOR EXPENSE REIMBURSEMENTS REQUIRE THE SUBMISSION OF DETAILED INVOICES/RECEIPTS WITH PAID CHECK COPIES. THESE ARE COMPARED TO ALLOWABLE COSTS, AND REIMBURSEMENT IS MADE FOR THOSE ALLOWABLE EXPENDITURES. NON-CASH GRANTS ARE FOR MEMBER SERVICE FEES. NO MONITORING IS NECESSARY. | Explanation |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Board Or Committee Approval | X | BoardOrCommitteeApproval |
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | false | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| JOE BOYCE MD | ||||||||||||||
| DIRECTOR\SECRETARY | 0 | 314774 | 0 | 85833 | 0 | 4789 | 0 | 58930 | 0 | 18831 | 0 | 483157 | 0 | 0 |
| DIRCK CLARK | ||||||||||||||
| DIRECTOR\OFFICER | 0 | 234845 | 0 | 56880 | 0 | 62410 | 0 | 45409 | 0 | 18380 | 0 | 417924 | 0 | 0 |
| LINDA BAHRKE | ||||||||||||||
| DIRECTOR | 0 | 215432 | 0 | 30394 | 0 | 46770 | 0 | 47197 | 0 | 22422 | 0 | 362215 | 0 | 0 |
| JEFFREY BLOEMKER | ||||||||||||||
| EXECUTIVE DIRECTOR | 123828 | 0 | 14017 | 0 | 3511 | 0 | 5753 | 0 | 21766 | 0 | 168875 | 0 | 0 | 0 |
| DOUGLAS BRANDT | ||||||||||||||
| ASSISTANT TREASURER | 0 | 222791 | 0 | 35197 | 0 | 6283 | 0 | 58315 | 0 | 19194 | 0 | 341779 | 0 | 0 |
| JOHN P WILSON | ||||||||||||||
| SECRETARY/TREASURER | 0 | 403494 | 0 | 124620 | 0 | 139366 | 0 | 88988 | 0 | 0 | 0 | 756468 | 0 | 0 |
| HELEN THOMPSON | ||||||||||||||
| FORMER DIRECTOR | 0 | 59293 | 0 | 0 | 0 | 159652 | 0 | 4055 | 0 | 6473 | 0 | 229473 | 0 | 0 |
Form990 Schedule J Part III Form990ScheduleJPartIII (3 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| SEVERENCE PAYMENT OR CHANGE-OF-CONTROL PAYMENT | SCHEDULE J, PART I, LINE 4A | HELEN THOMPSON $129,880 |
| SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN | SCHEDULE J, PART I, LINE 4B | JOHN WILSON 78,988 DOUGLAS BRANDT 48,459 DIRCK CLARK 34,090 JOE BOYCE, MD 48,487 LINDA BAHRKE 36,357 FOR JOE BOYCE,MD, JOHN P. WILSON, DIRCK CLARK, DOUGLAS BRANDT, AND LINDA BAHRKE THE COMPENSATION WAS PROVIDED BY HEARTLAND REGIONAL MEDICAL CENTER. INCLUDED IN THE DEFERRED COMPENSATION ARE EMPLOYER CONTRIBUTIONS INTO QUALIFIED PLANS AND NON-QUALIFIED DEFERRED COMPENSATION PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE AND SEVERANCE THAT IS PROVIDED WITHIN THE EXECUTIVE'S EMPLOYMENT AGREEMENT. THEREFORE, AMOUNTS MAY NEVER BE PAID. HELEN THOMPSON RECEIVED A SEVERANCE PAYMENT AFTER SEPARATING FROM HEARTLAND REGIONAL MEDICAL CENTER PER HER EMPLOYMENT CONTRACT. |
| COMPENSATION OF CHIEF OPERATING OFFICER | FORM 990, PART VII & SCHEDULE J, PART II | Helen Thompson was employed as CIO for Heartland Regional Medical Center and terminated in January 2011. Her severance package included compensation through June 2012. As a part of her duties as CIO, she also served as Director and CEO of LACIE; no additional compensation was earned. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (12 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| BUSINESS/FAMILY RELATIONSHIPS | FORM 990, PART VI, SECTION A, LINE 2 | JOHN P. WILSON, DOUG BRANDT, DIRCK CLARK, KAREN DITTEMORE, JOE BOYCE, MD AND LINDA BAHRKE ARE ALL EMPLOYEES OF A PAST AFFILIATE, HEARTLAND REGIONAL MEDICAL CENTER. |
| SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS | FORM 990, PART VI, SECTION A, LINE 4 | EFFECTIVE APRIL 1, 2013, HEARTLAND HEALTH WITHDREW FROM ITS POSITION AS SOLE MEMBER OF LACIE, AND LACIE IS NOW GOVERNED BY A SELF-PERPETUATING BOARD. |
| MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, SECTION A, LINE 6 | HEARTLAND HEALTH, A MISSOURI NONPROFIT CORPORATION, WAS THE SOLE MEMBER OF LEWIS AND CLARK INFORMATION EXCHANGE FOR NINE MONTHS ENDING MARCH 31, 2013. HEARTLAND HEALTH HAD THE RIGHT TO ELECT THE BOARD OF DIRECTORS OF LEWIS AND CLARK INFORMATION EXCHANGE. HEARTLAND HEALTH WAS NOT ENTITLED TO RECEIVE A SHARE OF LEWIS AND CLARK INFORMATION EXCHANGE'S PROFITS, EXCESS DUES, OR ASSETS UPON DISSOLUTION. AS OF APRIL 1, 2013 LEWIS AND CLARK INFORMATION EXCHANGE HAS NO MEMBERS OR STOCKHOLDERS. |
| MEMBERS OR STOCKHOLDERS MAY ELECT GOVERNING BODY | FORM 990, PART VI, SECTION A, LINE 7A | HEARTLAND HEALTH WAS THE SOLE MEMBER OF LEWIS AND CLARK INFORMATION EXCHANGE UNTIL MARCH 31, 2013 AND HAD THE RIGHT TO ELECT ALL THE BOARD OF DIRECTORS. AS OF APRIL 1, 2013, HEARTLAND HEALTH HAS THE RIGHT TO NOMINATE AND ELECT 10% OF THE TOTAL NUMBER OF DIRECTORS UNTIL SUCH TIME SPECIFIED IN THE SEPARATION AGREEMENT. |
| GOVERNING BOARD DECISIONS SUBJECT TO APPROVAL OF MEMBERS OR STOCKHOLDERS | FORM 990, PART VI, SECTION A, LINE 7B | FOR JULY, 2012 THROUGH MARCH, 2013, THE CORPORATE BYLAWS OF LEWIS AND CLARK INFORMATION EXCHANGE IDENTIFIED CERTAIN RIGHTS AND POWERS WHICH WERE RESERVED TO HEARTLAND HEALTH, THE SOLE MEMBER. IN EACH INSTANCE, THE RIGHTS AND POWERS RESERVED TO THE SOLE MEMBER MAY BE SUMMARIZED AS FOLLOWS: A. OVERALL STRATEGIC DIRECTION B. ELECTION OF BOARD MEMBERS C. APPOINTMENT OF THE PRESIDENT, OTHER SENIOR OFFICERS, AUDITORS, AND LEGAL COUNSEL D. ESTABLISHMENT OF BANKING RELATIONSHIPS E. MANAGEMENT OF CASH AND OTHER ASSETS F. APPROVAL OF CHANGES TO THE ARTICLES OF INCORPORATION AND BYLAWS G. LONG-RANGE PLANNING H. ADOPTION OF ANNUAL OPERATING BUDGETS |
| FORM 990 REVIEW PROCESS | FORM 990, PART VI, SECTION A, LINE 11B | RETURNS ARE PREPARED BY AN INDEPENDENT ACCOUNTING FIRM, REVIEWED BY THE TREASURER AND ASSISTANT TREASURER AND THEN POSTED TO A WEBSITE FOR REVIEW BY DIRECTORS PRIOR TO FILING. |
| MONITORING OF CONFLICT OF INTEREST POLICY | FORM 990, PART VI, SECTION B, LINE 12C | UPON AGREEING TO FILL A BOARD POSITION, THE PROSPECTIVE MEMBER IS REQUIRED TO SIGN A CONFLICT OF INTEREST DOCUMENT WHICH DISCLOSES FAMILY AND BUSINESS RELATIONSHIPS THAT COULD BE CONSIDERED IN CONFLICT WITH THEIR POSITION ON THE BOARD. IN THIS DOCUMENT, THEY AGREE THAT THEY WILL DISCLOSE ANY ACTIVITIES IN WHICH THEY MAY NOT BE INDEPENDENT IN REGARDS TO A TRANSACTION. THIS DOCUMENT IS DISTRIBUTED AND HELD BY LEGAL COUNSEL. ANNUALLY, THE CORPORATE COMPLIANCE OFFICER DISTRIBUTES A SURVEY TO EACH BOARD MEMBER TO FACILITATE DISCLOSURE OF ANY REPORTABLE ACTIVITIES. DURING THE COURSE OF BOARD MEETINGS, BOARD MEMBERS WILL DISMISS THEMSELVES FROM MEETINGS AND/OR ABSTAIN FROM VOTING DURING DISCUSSIONS OF ISSUES THAT RELATE TO THOSE SPECIFIC MEMBERS OR THE COMPANIES THAT THEY REPRESENT. ALL DISMISSALS AND ABSTENTIONS ARE RECORDED IN THE MINUTES OF THE BOARD MEETING. ANNUALLY, THE OFFICERS AND KEY EMPLOYEES ARE REQUIRED TO SIGN A CODE OF CONDUCT DOCUMENT IN WHICH THEY AGREE TO ETHICAL BEHAVIOR AND ADHERING TO CONFIDENTIALITY POLICIES. THEY ALSO RECIEVE A QUESTIONNAIRE WHICH FACILITATES THE DISCLOSURE OF ANY REPORTABLE ACTIVITIES TO THE CORPORATE COMPLIANCE OFFICER. |
| COMPENSATION REVIEW | FORM 990, PART VI, SECTION B, LINES 15A & 15B | THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE COMPENSATION ANNUALLY DURING THE BUDGET PROCESS. THE FINANCE COMMITTEE CONSIDERS EXTERNAL FACTORS SUCH AS COMPENSATION FOR LIKE POSITIONS IN THE MARKET AREA OBTAINED FROM COBALT ASTRA, A HUMAN RESOURCES CONSULTING FIRM. THEY ALSO REVIEW INFLATION AND COST OF LIVING CHANGES. THE FINANCE COMMITTEE MAKES RECOMMENDATIONS TO THE BOARD OF DIRECTORS REGARDING COMPENSATION MATTERS. |
| AVAILABILITY OF DOCUMENTS | FORM 990, PART VI, SECTION C, LINE 19 | THE ORGANIZATION DOES NOT MAKE ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY OR FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC. |
| RECONCILIATION OF NET ASSETS | FORM 990, PART XII, LINE 9 | DECONSOLIDATION FROM HEARTLAND HEALTH $ 1,324,373 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:PURCHASED SERVICES TOTAL FEES:158537 |
| OTHER FEES FOR SERVICES FOR NON-EMPLOYEES | FORM 990 PART IX LINE 11G | DESCRIPTION:OTHER FEES FOR SERVICES TOTAL FEES:9458 |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (6 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| HEARTLAND HEALTH | ||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 431283316 | HEALTH CARE | MO | 501(C)(3) | 11a | NA | false |
| HEARTLAND FOUNDATION | ||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 431262768 | SUPPORT | MO | 501(C)(3) | 9 | HH | true |
| HEARTLAND LONG TERM ACUTE CARE HOSPITAL | ||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 261972987 | HEALTH CARE | MO | 501(C)(3) | 3 | HH | true |
| HEARTLAND REGIONAL MEDICAL CENTER | ||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 440545289 | HEALTH CARE | MO | 501(C)(3) | 3 | HH | true |
| REGIONAL EMERGENCY MEDICAL SERVICE | ||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 273923442 | AMBULANCE SVC | MO | 501(C)(3) | 9 | HH | true |
| HEARTLAND HEALTH CARE PLAN TRUST FUND | ||||||||||
| 5325 FAROAN | ST JOSEPH | MO | 64506 | 431286484 | EMP BENEFITS | MO | 501(C)(9) | HH | true | |
Form990 Schedule R Part IV Form990ScheduleRPartIV (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Type Of EntityTypeOfEntity | Share Of Total IncomeShareOfTotalIncome | Share Of EOY AssetsShareOfEOYAssets | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|---|
| MIDWESTERN HEALTH MANAGEMENT INC | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 431264358 | HEALTH CARE | MO | HH | C - CORPORATION | 0 | 0 | true |
| COMMUNITY HEALTH PLAN | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 431690582 | INSURANCE | MO | HH | C - CORPORATION | 0 | 0 | true |
| COMMUNITY HEALTH PLAN INSURANCE COMPANY | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 431210152 | INSURANCE | MO | HH | C - CORPORATION | 0 | 0 | true |
| HHS PROPERTIES INC | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 431593799 | DEVELOPMENT | MO | HH | C - CORPORATION | 0 | 0 | true |
| UPTOWN HOUSING INC | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 261416252 | DEVELOPMENT | MO | HH | C - CORPORATION | 0 | 0 | true |
| UPTOWN ST JOSEPH REDEVELOPMENT | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 201742813 | DEVELOPMENT | MO | HH | C - CORPORATION | 0 | 0 | true |
| SHOAL CREEK FAMILY MEDICINE AND ALLERGY | |||||||||||
| 5325 FARAON | ST JOSEPH | MO | 64506 | 010754265 | HEALTH SVC.S | MO | HH | C - CORPORATION | 0 | 0 | true |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | true | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Dividends Related Organization | false | DividendsRelatedOrganization |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | true | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | true | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | true | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | true | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | false | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable (3 entries)
| Transaction TypeTransactionType | Amount InvolvedAmountInvolved | Method Of Amt DeterminationMethodOfAmtDetermination |
|---|---|---|
| HEARTLAND REGIONAL MEDICAL CENTER | ||
| C | 395170 | FMV |
| HEARTLAND REGIONAL MEDICAL CENTER | ||
| M | 52434 | FMV |
| HEARTLAND REGIONAL MEDICAL CENTER | ||
| P | 505742 | FMV |